MST-Department of Community Health

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Access and utilization of immunization services among refugees in Eastleigh North section of Nairobi, Kenya
(2013-02-01) Wagacha, Burton John
Immunization has been shown to be one of the most cost effective health prevention and intervention against childhood morbidity and mortality. Over 30 million children especially from Sub-Sahara Africa are not reached each year with routine immunization. As a result, 1.5 million children under five years die each year from vaccine preventable diseases. Recent outbreak of Polio, Measles and pertusis in Kenya with index cases among refugees from neighbouring countries raises the possibility that their immunization coverage may be way below WHO standards of 90%. Additionally, refugees who live diffusely among urban population lack specific programmes targeting them with primary health interventions. For instance, in 2007 Immunization coverage in Kenya was 76% and in Nairobi it was 65%. However, Eastleigh area which hosts thousands of refugees recorded only coverage of 51 %. The purpose of this study, therefore, was to establish levels of access and utilization of immunization services among refugees in Eastleigh North. A descriptive crosssectional study design was used. A sample of 432 children of refugees living in Eastleigh North was selected. Informed consent was obtained from the guardian after explanation and clarification of study objectives. The data was collected using semistructured questionnaires, key informant interviews and visits to health facilities. The data was analyzed using Statistical Package for Social Scientist (SPSS version 16) and presented in frequency tables, bar graphs and pie charts. All the respondents were women either mothers or guardians to the children below 5 years. Of all the respondents interviewed, 39.6% had no formal education and overwhelming majority (97.2%) were once married. However, 46.8% of the respondents were in polygamous marriage. A high proportion, 95.4% of the respondents were of Somalia origin, 4.2% from Ethiopia while 0.5% was of Eritrean origin. About 60% of the respondents relied on remittances from relatives and friends abroad while 6.37% were doing business in Kenya. Among the 432 children studied, 53.5% were males and 46.5% were female below 60months old with a mean age of 30.1 months. The study established that there was significant statistical association between level of income (P=0.043), availability of services (P=0.004), cultural beliefs (P=0.002), communication barrier (P=0.020) and police harassment (P=0.04) and access and utilization of immunization services. The study also established that there was no significant statistical association between level of education (P=0.827), Knowledge on importance of immunization (P=0.472) and utilization of immunization services. The study concluded that complete immunization coverage for the children was 39%, which was way below WHO target of 90% and socio-cultural and economic and healthcare institutional and providers' factors hindered refugees' access and utilization of immunization services. The study recommended that Medical Officer of Health (MOH) at the Nairobi City Council to conduct catch-up immunization campaign in Eastleigh North. In addition, UN Refugee Agency and Department of Refugees Affairs to identify and issue identification documents to the unregistered refugees to curb police arrests and also enable refugees move freely, work and do business in Nairobi. The study also recommended that the MOH to establish program to sensitize refugees about the negative effect of the cultural beliefs and to increase staffing level in the facilities while ensuring that significant number of them speak Somali or hire Somali interpreters, because Somali language was the commonest mode of communication by refugees in the area. The study recommended further research to compare refugees and host community living in similar settings.
Access to Sexual and Reproductive Health Care Services by Adolescent Girls Aged 15-19 Years among Pastoral Communities In Narok County, Kenya
(Kenyatta University, 2015-11) Njoki, Mbugua Leah
The subject of adolescent sexual and reproductive health has acquired prominence more than ever before in recent years, dominating local and international forums deliberating on adolescent sexual and reproductive health. Most of the discussions, targeted interventions and researches undertaken on Adolescent Sexual and Reproductive Health (ASRH) have looked at the issue from infrastructural and resource capital allocation culminating into school-based reproductive health programs. Pastoral communities are characterized by a life of moving from place to place which complicates their access to basic facilities including static healthcare services. This study sought to establish access to sexual and reproductive healthcare services by adolescent girls among pastoral communities. The study was a cross-sectional descriptive study and was confined to the adolescent girls among pastoral communities in Narok South Sub-County which was purposively sampled to represent pastoral communities in Kenya. Simple random selection of households and individual respondents was done. Interviewer administered structured questionnaires, key informant interviews guides and focus group discussions guides were used to garner quantitative and qualitative data. Data analysis was performed using SPSS version 21 for quantitative data and content analysis was done for qualitative data. The study found out that there were no specific youth sexual and reproductive healthcare services. The factors that influenced access to SRH services by the adolescent girls included socio-cultural factors: cultural beliefs(27%) and restriction by family members(73%); individual barriers: shyness (14%) and fear (86%); unfriendly service providers (19.6%); economic factors: financial constraints (39%), long distances (32%) and lack of transport (29%); information barriers: ignorance and illiteracy (58%) and no knowledge of where services are offered (42%). There was significant association between access of SRH services and their use: SRH information (χ2 =15.064, df=1, p<0.001), condoms (χ2 =19.167, df=1, p<0.001), injections (χ2 =7.851, df=1, p=0.005),and prenatal care(χ2 =5.738, df=1, p=0.017). The study recommends that the government and other stakeholders set up of centres that offer adolescent-friendly SRH services and setting up of mobile clinics to serve adolescents in the interior marginalized areas who are unable to access static facilities due to financial constraints, distance and lack of transport.
Accessibility to Integrated Community Case Management Services For Childhood Pneumonia among Caregivers in Kisii County, Kenya
(Kenyatta University, 2023-11) Mwambi, Dennis Oroo; Isaac Mwanzo
Pneumonia contributes to the increased childhood deaths worldwide. Prompt diagnosis and treatment with antibiotics has resulted in the reduction of pneumonia deaths. In 2014, Kisii County had a pneumonia prevalence of 10% among children under the age of five years, which surpassed the 9% national average. Even though most caregivers (71%) in Kisii sought advice from health facilities or provider, this did not translate to treatment of the pneumonia cases, as only 41% of the cases were eventually provided with antibiotics. Although Kisii County implemented iCCM for childhood illnesses, including pneumonia, there are information gaps regarding accessibility, knowledge and factors that could influence access to iCCM for childhood pneumonia. Therefore, the main goal of this study was to ascertain whether caregivers in Kisii County had access to iCCM services related to childhood pneumonia. A descriptive cross-sectional research approach was used for this study. The research participants included 332 randomly sampled caregivers of children below 5 years in Bomachoge Borabu and Bomachoge Chache sub-counties and 10 key informants from both the county and subcounty levels. Data were collected using both structured and key informant interviews (KIIs). The variables of interest were analysed using frequency-based descriptive analysis, which was utilised to study quantitative data. Qualitative data were organised and analysed thematically. Findings revealed that only 111 (34%) of the respondents had access to iCCM for childhood pneumonia. Notably, the likelihood of access to iCCM for childhood pneumonia reduced with caregiver age, with caregivers under 20 years being 1.5 times more likely to access iCCM. Separated or single caregivers were six times as likely to access iCCM, while those ascribing to the Catholic faith increased the likelihood of access by 1.7 times. Respondents engaged in business as their main source of income increased the likelihood by 2.97 times, while employed caregivers had a 1.4 times higher likelihood to access iCCM for childhood pneumonia. This study showed a high knowledge of childhood pneumonia among the caregivers. Most respondents, 232 (70.3%), mentioned at least one pneumonia symptom and nearly all respondents, 326 (98.8%), identified at least one severe pneumonia symptom. Additionally, 26 (7.9%) mentioned at least one of the three main causes of pneumonia and 287 (87%) mentioned at least one approach to prevent pneumonia. Knowledge of pneumonia symptoms (p 0.315, df 2), severe pneumonia symptoms (p 0.125, df 3), cause of pneumonia (p 0.885, df 3) and pneumonia prevention approaches (p 0.575, df 2) were not significant predictors of access to iCCM for childhood pneumonia. Many respondents, 160 (48.5%), sought help a CHV as their first point of contact when their children started showing signs of pneumonia, with very few, 48 (15%), visiting government health facilities, 3 (1%) visiting private clinics and 3 (1%) went to chemists, while a small fraction, 4 (1.2%), visited traditional herbalists. Only 98 (29.7%) of sick children are taken through the MoH protocol for pneumonia diagnosis and treatment at the community level, posing a potential risk of mismanagement of children with pneumonia. The likelihood of access to iCCM for childhood pneumonia increased by 3.03 times for caregivers who perceived pneumonia as a serious disease, while it increased by 0.1 times for respondents who did not think pandemics affected access to iCCM. The study recommends continuous access to timely diagnosis and treatment for pneumonia among children under 5 years, investment in pneumonia awareness creation programmes targeting caregivers of children under 5 years, provision of routine support supervision to the CHVs and as such ensure compliance with the MoH protocol on pneumonia case identification and management, mechanisms for households to continue accessing health services.
Adherence to Anti retrovlral Therapy Protocol among Teachers in Homa bay District of Homa bay County Nyanza Province - Kenya
(2014-03-10) Nyangor, George Obondo; Otieno, Micheal Frederick; Ochieng, James
Anti-retroviral therapy (ART) is a lifesaving treatment for HIV positive people. Adherence to treatment protocol is extremely important to ensuring that drug efficacy does not fail with time. Research findings by other researchers in developed countries indicate that adherence to ART treatment protocol is a problem.. It implies that in developing countries like Kenya which have poor health infrastructure the problem is much bigger. The research was conducted in Homa-Bay District which is a typical rural district in Kenya where poverty is rampant among the rural population, the standard of education is not only low but 3}~ in the decline. The district ~l!'
An assesment of infant feeding options among hiv positive women attending comprehensive care clinic at Kiambu District hospital Kenya.
(2013-07-22) Mwangi, Catherine Wanjiku
In Kenya, limited studies have been conducted to investigate infant feeding choices of HIV positive mothers attending Comprehensive Care Clinic. This study therefore determined infant feeding options of HIV positive mothers attending Comprehensive Care Clinic at Kiambu district hospital. A cross-sectional survey was conducted with a desired sample size of four hundred (400) HIV positive mothers for a period of 12 weeks. Systematic random sampling was used to select respondents for the study. Data was collected using a structured interview schedule and Focus Group Discussion (FGD) and was entered, analyzed using statistical package for social sciences (SPSS) version 12.0. Pearson‟s Chi-square test was used to test the significance of association between variables. Multiple Logistic Regression was performed to determine the factors independently associated with inappropriate infant feeding option. At the end of the study a total of 390 respondents were interviewed. The factors associated with inappropriate infant feeding option in the multivariate analysis were HIV disclosure (OR=4.91; CI: =1.2-11.3; p=0.0040), Participation in PMTCT program (OR=4.34; CI: =1.4-11.6; p=0.0051), Stigma (OR=2.46; CI: 1.9-12.2; p=0.0178), Counseling on stigma associated with infant feeding (OR=4.73 CI: 1.1-11.2; p=0.0032). The infant feeding experiences of HIV- positive mothers thus have serious implications for the operational effectiveness of programmes that aim to prevent HIV transmission from mother to child and therefore the findings of this study underscore the need by the ministry of health to come up with strategies to increase uptake of PMTCT services in order to increase rates of HIV disclosure, reduce stigma and acquire accurate information on HIV transmission through breastfeeding. There is also need for the ministry of health to launch educational programmes that aim to increase knowledge and create awareness on HIV transmission from an infected mother to her child as well as investigate adequacy of counseling offered at the comprehensive care clinics.
Assessement of Diarrhoeal Disease Attributable to Water, Sanitation and Hygiene among under Five in Kasarani, Nairobi County
(2014-03-05) Kimani, Humprey Mbuti; Akunga, Daniel; Anyango, S. O.
Cause of diarrhea is known to have many risk factors. They include unsafe water, lack of water leading to low personal and domestic hygiene, poor water infrastructural and management systems. Contamination of drinking water is known to be a problem in many developing countries. This is even of more concern in high residential low income areas. Nairobi City is not an exception hence this study was conducted in Kasarani to assess diarrhea disease attributed to water, sanitation and hygiene (WASH) among under-fives. The study aimed at determining the quality of water the households were consuming. The main objective of this study was to establish the association between diarrhea among the under-five and water, sanitation and hygiene. To achieve this goal, the study area was categorized in four study environs namely low density high income (LDHI), medium density middle income (MDMI), high density low income (HDLI and informal settlement low income (ISLI). The study adopted a crosssectional study design. The study used both structured questionnaire and hygiene observational checklist as data collection instruments. To ascertain disease trends among the under fives, the study reviewed disease records from licensed health facilities. Derived values of tables, percentages, graphs and ratios were adopted for data presentation. To determine association and significant differences between variables, data were subjected to inferential statistics and Chi-square tests respectively. For comparisons of quantitative variables, ANOVA test was used. The findings of this study indicated that Nairobi water and sewerage company ( NWSCO) was the main source of water supply in the study environs (100%). Under five children from household consuming less than 60.75litres a day and who were predominantly from (ISLI) were at a higher risk of diarrhoea compared to those who consumed more than 60.75 litres a day (p<0.001). Households experiencing water shortages in frequencies of less than three days were found to carry a higher risk for childhood diarrhoea (p< 0.001). This study determined that water consumed in Kasarani was a risk for childhood diarrhoea (p=0.019) with tap water showing a significantly higher contamination 13.7% than household water container 7.2% for T. Coli bacteria. The microbial results observed attributed contamination to the distribution network or household and personal hygiene among the MDMI, HDLI and ISLI residential environs. Overall, the results indicated that the amount of water a household consumed per day was an important risk factor for childhood diarrhea in the study environs (p= 0.00 1). The study observed that Age of a child (p=0.046), Water treatment method (p=0.002), method of storage of solid waste p
Assessing the national school health policy on the status of water, hygiene and sanitation in primary schools of Sabatia, Vihiga County, Kenya
(Kenyatta University, 2016-03) Kishasha, Meshack Kijungu
School Health began in Kenya in 1960‟s as an initiative of UNESCO and FAO as an intervention tool to encourage attendance and reduce malnutrition in school-going children. The introduction of free, Universal Primary Education (UPE) in 2003 increased pupil enrolment from 5.9 to over 7.8 million thus overstretching water, hygiene and sanitation facilities hence necessitating for a policy. In 2009, the Kenya Government developed the National School-based health program with its policy in eight health thematic areas whose goal was to enhance the quality of health in school communities by creating a healthy and friendly environment for teaching and learning. One of the key areas addressed by the program was water, hygiene and sanitation in primary schools. The purpose of this study was therefore to assess the current health status on water, hygiene and sanitation in primary schools of Sabatia District based on this policy and its guidelines. The target population consisted of all the 102 primary schools in Sabatia district. Thirty one (31) schools were clusterly and randomly selected for study. The objectives of the study were to describe the current health status of the schools by determining the risk factors for disease transmission and identifying the measures that are in place for prevention and control of the diseases related to water, hygiene and sanitation in the schools. The study employed a cross-sectional research design that utilized both quantitative and qualitative paradigms. Probability sampling design was used which employed both cluster and simple random sampling techniques in the selection of the schools and the study participants respectively. The study captured a randomly selected sample size of 31out of 102 schools in the district for study. Structured, non-structured questionnaires, focus group discussions (FGDs), key informant interviews (KII) and observational checklist were employed to collect data. All the 31 schools were assessed on the compliance to national school health policy and guidelines; 31 FGDs and 3 KII were undertaken to identify barriers to implementing good hygiene, sanitation and provision of safe water for use in schools. The study identified gaps with regards to the status of water, hygiene and sanitation. There was insufficient (3%) quality surveillance and monitoring for water safety in schools. The pupil-toilet ratio was grossly inadequate at 50:1 against the recommended 30:1 for schools. Forty percent of the toilets were found to be dirty. There was significant statistical association between sources of water and diarrhea diseases among pupils in schools (p<0.0019). However, the following were identified in FGDs and KII; insufficient supervision by health and water authorities, lack of partnerships with local businessmen, local community and politicians to help build enabling structures for school health. The research concluded that there were potential risks for disease transmission in schools given the current status of water, hygiene and sanitation. The study therefore rejected the null hypothesis and that there was no existence of the policy document in all schools. The study recommended that there was dire need for schools to liaise with the national and county governments to develop and form an effective implementation Board that would oversee and enforce the national school health policy and programs. The key contribution of this study was to provide baseline data on school health for future planning, interventions and facilitate sound policy implementation of the National Comprehensive School Health Program.
Assessment of factors influencing infant feeding practices among HIV positive mothers in Rongo District, Western Kenya
(2013-08-14) Wapang’ana, Godfrey Nyongesa
Infant feeding is critical and a key determinant of good nutrition and health status, survival and development. Breast feeding is universal and socio-culturally acceptable method of child feeding. Breast milk is nutritionally balanced and provides immunity against diseases. However, breast milk can transmit HIV from mother to child. This has posed public health dilemma. A lot of work has been done on HIV including MTCT but there remains a dearth of information related to appropriate feeding for infants of mothers infected with HIV. Some suggested infant feeding in theory have lots of merit but not much has been done to determine their practical feasibility especially in the African rural setting. The study was designed to assess infant feeding practices and viable breast milk alternatives for infants born to HIV positive mothers and the socio-cultural and economic conditions surrounding the choice of such practices in a rural community in Western Kenya. The study carried out in Rongo district between June and July 2011 had three objectives namely: to 1) determine maternal knowledge on mother-to-child transmission of HIV, 2) investigate the alternatives infant feeding practices used in the community and 3) determine factors influencing mothers’ decision on the choice of infant feeding alternatives. Descriptive cross-sectional study design employing both quantitative and qualitative methodologies was used. Multistage sampling technique was used. Stratified sampling was used to sample 5 health facilities out of 18 to be included in the study. Health facilities were divided into three strata based on government classifications, that is, L2, L3 and L4. Health facilities in each stratum were assigned a numbers. This was written on a piece of paper and folded. 2 health facilities in each stratum were sampled using simple random sampling. 111 HIV positive mothers with children aged 0-12 months attending services in the sampled health facilities were randomly assigned numbers and systematically sampled to participate in the study. Data collection involved administration of semi-structured questionnaire to one hundred and eleven HIV positive mothers with infants. In addition, focus group discussion (FGD) guide was used to collect information from elderly women, women in age bracket 15-49 years and men whose spouses were within 15-49 years age bracket. Key informant guide (KII) was used to collect data from health facility in-charges. Data was analyzed using SPSS version 16.0. Maternal knowledge on MTCT of HIV was high (66.7%) in the study area. However, this had no association with maternal choice of infant feeding practice (P=0.09). On the other hand, maternal knowledge indicated some association with level of formal education attained (P=0.07) and exposure to other information received through health talks and or counseling from health workers or media (P=0.06). Despite high level of maternal knowledge, majority of respondents practiced mixed infant feeding before 6 months, which increases MTCT of HIV. The choice of alternative infant feeding practice was influenced by a number of factors among them; cultural attitudes, level of income and availability and affordability of food. Strong association was noted; income (P=0.05), cultural attitudes (P=0.045), pressure from family members (P=0.045), stigma and discrimination, belief about HIV transmission from mother to child (P=0.05) and HIV has no cure (P=0.03) and household food availability (P=0.014). Cow’s milk is the most preferred infant feeding option (99.1%) followed by commercial infant formula (96.4%). Wet nursing is the least preferred option. In conclusion, the choice of infant feeding practice is not associated with level of maternal knowledge of MTCT of HIV. Commonly used infant feeding options include cow milk, porridge and commercial formula. World Health Organization guidelines on infant feeding in HIV recommends exclusive breast feeding to infants for six months.
Assessment of hiv/aids workplace policy adoption in factories in Machakos County, Kenya
(Kenyatta University, 2018-07) Kaliti, Jacinta Mutheu
ABSTRACT HIV/AIDs pandemic poses a significant obstacle to the attainment of decent work and sustainable development. Its effects are concentrated among the most productive age groups imposing huge costs on enterprises through falling productivity, increased labour costs and the loss of skills and experience. Despite ILO recognizing adoption of HIV/AIDs workplace policy as the initial practical step towards addressing HIV/AIDs pandemic and its effect at the work place, many companies are yet to adopt the HIV/AIDs workplace policy as a guiding document in recognizing and addressing HIV/AIDs as a workplace issue. Therefore, the broad objective of the study was to assess adoption of HIV/AIDs workplace policy among factories in Machakos County, Kenya. The study adopted a cross-sectional study design incorporating use of pre-tested questionnaires, key informant guides, focus group discussion guide and observation checklist for collecting data. A stratified sampling technique was used to sample a total of 386 respondents while purposive sampling was used to select 22 key informants who participated in the study. Descriptive statistics and Chi-square test were used to analyze quantitative data with the aid of Statistical Package for Social Sciences. Qualitative data was thematically analyzed using Nvivo software. Findings of the study indicated that only 39% of the factories had adopted HIV/AIDs workplace policy. On policy awareness, 70% of the respondents were aware of the policy. Out of these, 53% of the respondents had a moderate policy content awareness level and above. In regards to work-related factors, stigmatization (p=0.001) staff involvement (p=0.021), employer commitment (p=0.012), workers union activism (P=0.002) and government support (0.037) influenced adoption of the HIV/AIDs workplace policy in the factories. The main challenges facing adoption of the policy were poor enforcement of policies, lack of employer commitment, government support and employee involvement. In conclusion, there is low level of HIV/AIDs adoption in the factories due to poor enforcement of policies, low awareness of employees on the ILO recommendation in regards to HIV/AIDs workplace policy and lack of sufficient stakeholder support and commitment in developing, implementing and sustaining gains of the policy at the workplace. The study recommends enforcement of adoption of HIV/AIDs workplace policies by the factory management. The study identifies need for close supervision by government agencies, provision of regular sensitization/awareness seminars, trainings and sharing of relevant information on the policy and adequate staff involvement in adoption and implementation of the policy.
Assessment of Mothers’ Compliance with National Infant and Young Child Feeding Recommendations amongst Children Aged 0-24 Months in Nakuru Municipality, Kenya
(2014-02-24) Kamau, Anne Njeri; Kabiru, Ephantus W.; Mwaniki, Joyce
Optimal infant and young child feeding (IYCF) is the World Health Organization (WHO) recommended way of feeding children. There is a lot that has been done on IYCF but there still remains a dearth of information in areas related to the application of IYCF recommendations in various regions. In the nations all around the globe, national IYCF recommendations and programs are in place. However, various studies reveal low incidences of exclusive breastfeeding (EBF); a major indicator of IYCF. It implies non- compliance to the national guidelines on IYCF amongst the mothers. This study was designed to assess the mothers „compliance with IYCF recommendations amongst mothers with infants aged 0-24 months in Nakuru Municipality. The study was carried out in five health facilities. The objectives were to establish the demographic and socio-economic characteristics of mothers, to establish the mothers‟ level of knowledge on IYCF recommendations, to establish the mothers‟ prior plan, sources of information, popular culture, prior teenage exposure to breastfeeding mother and support for IYCF, to establish the mothers‟ IYCF practices and to establish the mothers‟ level of compliance with IYCF recommendations. The study involved the administration of interview questionnaire adopted from the WHO questionnaire on the 24 hour recall food diversity. Nine research assistants were trained prior the exercise to collect data from 377 mothers with children aged 0-24 months. The findings indicated that 37.9% of the mothers were 25-29 years, 86% were married, 37% had attained secondary education and 40.6% were housewives. Over half (57%) of the children in the mother-child pair were aged 7-24 months while 62.1% were subsequent birth (second to seventh) with only 37.9% being firstborn. Mothers‟ knowledge on IYCF recommendation was good (66%) and indicated areas requiring strengthening as the insufficient breast milk management and the frequency of complementary meals during the transition period from breast milk to solids, semi-solid and soft food. Mothers‟ IYCF practice was predominantly early introduction of solids, semi-solid and soft food as early as 2 months. Almost half (49.6%) of mothers‟ had prior plan for exclusive breastfeeding for six months, however only 14.2% carried through their plan. The main sources of IYCF information was the media (radio and television) by 39.3%, a large majority (95.5%) of the mothers had prior teenage breastfeeding exposure to witnessing a mother frequently breastfeed. The popular culture of IYCF was early (0-3 months) introduction of solids, semi-solids and soft foods (39%). The main sources of reassurance (support) on mothers‟ IYCF practice was by the community health nurse (46.4%). The mothers‟ level of compliance with IYCF recommendation was 55%. The study recommends that; IYCF information should be targeted to all mothers irrespective of neither demographic nor socioeconomic variables at HF by the CHN. Dissemination of information by health workers should emphasize on IYCF aspect of complementary feeding and continued breastfeeding up to two years and beyond when giving IYCF information to mothers. The policy makers should come up with strategies of building capacity to increase the community health nurse efforts of supporting IYCF. The policy makers need to come up with IYCF policies that would reach the mothers in the community with practical IYCF intervention. County Health System to ensure the CHEW monitor and evaluate of IYCF compliance at family level.
Assessment of Nutrition Status and Dietary Diversity among Children 6-59 Months in Mathare Valley, Nairobi County, Kenya
(2014-02-19) Mutakaa, Lisbeth Kageni; Akunga, Daniel; Njogu, Eunice
Under nutrition is the underlying cause of more than half of all deaths in children aged less than five years worldwide. There are 143 million children under five who are underweight in the developing world. In Kenya, severe acute malnutrition is responsible for 82,000 deaths annually with a significant percentage being from urban slums. The purpose of this study was to assess nutritional status children aged 6-59 months in Mathare valley, a low income settlement in Nairobi. A cross-sectional study design was used. Data was collected using structured and non structured questionnaires. A total of 246 children aged 6-59 months were taken the anthropometric measurements to determine their nutritional status and their caregivers interviewed. Two focus group discussions and 6 Key informant interviews were conducted. The dependent variable was nutritional status of children below five years and independent variables included socioeconomic attributes, dietary intake, and dietary diversity. Descriptive analysis was done using IBM SPSS software version 19 and anthropometry analysis by ENA for SMART. Severe malnutrition measured by MUAC was observed in 6.5% of the children. Severe stunting, wasting and underweight measured using HAZ, WHZ and WAZ.was observed in 5.7%, 4.1% and 4.5% respectively. Among the 246 children, 39.0 had fallen ill within the previous two weeks and several had fallen ill more than once within the same period. The major symptoms included diarrhea, cough and vomiting by 50%, 47.9% and 40.6% respectively. Dietary score for 104(42.1%) households was low. There is need to regularly monitor nutrition status of children below five years and to have up to date data for informed decision making.
Assessment of prevention behavioural practices among adult tuberculosis patients in Eastleigh division, Nairobi County,Kenya
(2014) Mohamud, Farhia
Tuberculosis is a common and often deadly airborne bacterial infectious disease which usually targets the lungs (pulmonary TB) and affects any organ outside pulmonary parenchyma (Extra-pulmonary TB), and is a major cause of illness and death worldwide. It causes ill-health among millions of people each year and ranks as the second leading cause of death from an infectious disease worldwide, after the human immunodeficiency virus (HIV). About one third of the world’s population is infected with TB; two-thirds of these cases estimated to occur among people aged 15–59 years, which, unfortunately, is the most productive age group. This has a negative effect on the economy because this group contributes greatly to the workforce. Approximately 9 million new cases in 2011 and 1.4 million TB deaths (990,000 were HIV negative people and 430, 000 were HIV-associated TB deaths) were reported. TB cases notified in Kenya were 99,159 TB cases in 2012 with more than 4000 deaths, thus making Kenya to be one of the 22 high TB burden countries in the world and the fifth highest burden in Africa. Kenya continues to treat an increased number of TB patients each year; however, widespread co-infection with HIV (close to 38 percent of new TB patients) makes TB treatment difficult. The aim of this study was to determine the level of knowledge, attitude and practice of preventive behavior towards tuberculosis among adult tuberculosis patients in Eastleigh Division, Nairobi County. The study population was TB patients attending TB health facilities in Eastleigh Division. The study design was descriptive cross-sectional study. Quantitative approaches through semi-structured questionnaires were used to collect data on demographic, awareness, knowledge, attitude and practice of preventive behavior among adults, where a systematic random sampling (n=384) of respondents was used for the study. Descriptive statistical method was used to summarize and analyze the data using the Statistical Package for Social Science (SPSS) version 20. Associations between knowledge, attitude and practice levels were analyzed using Chi-Square. A total of 78.8% were aware of pulmonary tuberculosis, few were aware of extra-pulmonary TB. A total of 51.6% of the respondents had high knowledge level on TB, while 48.4% had low knowledge level on tuberculosis. On attitude level 54.4% of the respondents had negative attitude while 45.6% had positive attitude. A total of 67.2% of the respondents had high practice of prevention behaviour towards TB. Educational status was significantly associated with TB knowledge (P=0.001), occupation (P=0.006), and religion (P=0.001) while nationality of the respondents was associated with TB knowledge (P=0.001). Gender was associated with practice of prevention behavior towards TB (P=0.062) and education level was associated with practice of preventive behavior towards TB (P=0.001). The study also established that Muslim religion was associated with attitude towards TB (P=0.041) while knowledge was associated with attitude towards TB (P=0.045). The result also indicate that attitude was associated with practice of prevention behavior towards TB (P=0.029). Generally over all knowledge and attitude of TB patients about TB were low. So implementation of health education and awareness creation by using different mechanisms and further research are recommended. The findings of this study is valuable in informing prevention policy of tuberculosis programs at tuberculosis health facilities in Eastleigh Division, Nairobi County as well as enhance health education related to TB knowledge on causative agents and mode of transmission with the aim of reducing new tuberculosis cases.
Assessment of Referral Practices and Facilitation Activities of HIV Testing and Counseling Sites in Nairobi City County, Kenya
(Kenyatta University, 2020-02) Malaba, Joy Serah
Knowledge of one’s HIV status through HIV Testing and Counselling remains the first step towards HIV prevention, appropriate care, support and treatment services. The knowledge needs to be coupled with means ofaccessing and obtaining essential post test services including appropriate care and treatment for all individuals who test HIV positive. Through linkages with care, treatment and support programs, HTC is expected to contribute to lessening the impact of the HIV epidemic on children, adults, families and communities only if all clients who test HIV positive are offered and/or linkedto all the requisite prevention, care and treatment services. Therefore the aim of the study was toidentify frequency of referrals, referral practices and facilitation activities of HTC providers in Nairobi County for individuals who test HIV positive.The objectives of the study were to determine the frequency of referrals for HIV positive clients by type of HTC site, identify the referral practices by HTC type and establish referral facilitation activities for clients to test HIV positive by type of HTC type in Nairobi County. A cross-sectional comparative study design was employed. The study took a census approach and a total of 92 sites participated in the study.A structured questionnaire was administered to 92 authorized personnel at the HTC sites. The Statistical Package for Social Sciences version 22.0 was used for quantitative data analysis. Key variables of the study were cross tabulated with the main institutional variables and aggregates computed. The relationship between the HTC site type and thevaried referral practices and facilitation activities was assessed using the chi square test of association. The results were presented in form of tables, bar charts, and pie charts.Findings showed that 94% the sites referred all the clients who tested HIV positive. However, there was no association between type of HTC site and referrals (X2 = 0.0039, P =0.95). Majority of the sites had a documented referral system. Nevertheless, there was no relationship between the type of HTC site and a documented referral system (X2 = 0.432, P =1). Only 44% of the sites had conducted referrals for HIV positive clients considered to be emergency cases, with 45% reporting accompanying clients. None of the referral facilitation activities studied had an association with the type of HTC site. The study concluded that there are gaps in the frequency of referrals, referral practices and facilitation activities of HTC providers for clients who test HIV positive in Nairobi County. The study recommends actions for both policy and practice modifications. Inorder to increase frequency of referrals, NASCOP should institute compliance measures to ensure HTC providers adhere to policy requirements for referral and linkage of all individuals who test HIV positive. The HTC sites should institute review of frequency of referrals and institute corrective measures to ensure linkage of all individuals who test HIV positive. Inorder to enhance referral practices, the National AIDS and STIs Control Program should refine and disseminate standardized guidance on referral practices for HTC sites. HTC sites should adhere to standard documentation for referrals, institute formal collaborative relationships with referral network partners and designate staff to manage referrals and folow ups. Inorder to improve referral facilitation activities, NASCOP should refine and disseminate standard guidance on referral facilitation activities related to accompaniment, transportation and follow up for clients who test HIV positive. On the other hand HTC sites should establish site specific activities that will ensure accompaniment, provision of transport and/or bus fare and follow up to intensify linkage of individuals who test HIV positive and are regarded as emergency cases, into requisite HIV care and treatment services.
Assessment of the healthcare providers knowledge and capacity to detect rift valley fever infections in Maragua Sub-County of Murang’a County of Kenya
(Kenyatta University, 2016-04) Gacheru, Stephen G.
Rift valley fever (RVF) is a zoonotic mosquito-borne viral disease found in Africa and other continents and is documented in Kenya since 1910. Mosquito and other insect bites, contact with body fluids during slaughter, milking, treatment and examination and consumption of under-cooked contaminated animal products transmit the disease. In epizootic areas, RVF causes abortion in majority of pregnant ewes and cows while high mortality occurs among newborn lambs making diagnosis easy. In humans the disease causes hemorrhagic fever, encephalitis, retinal vasculitis and death. Laboratory confirmation is necessary especially when RVF extends to new regions. The lack of capacity and ability to detect RVF infections early has resulted in massive economic losses in herds of sheep and cattle, and human fatalities. Outbreaks are associated with high population of vector insects as occurs following unusually high level rainfall with prolonged flooding. With the increasing trends of flooding in Kenya, it is apparent that there is need for more attention on the disease. Outbreaks in Kenya are in 5-15 years’ cycle, the most recent being December 2006 to June 2007. Since the first outbreak, Murang’a County has always been one of the high risk areas. The capacity of healthcare providers and healthcare facilities in Murang’a County to handle and diagnose RVF is not known. This study assessed the capacity of healthcare providers’ and healthcare facilities to diagnose Rift Valley Virus infections. Sixty-six (66) healthcare facilities, Government, Private and Faith-based were censured, data obtained and relevant data on Rift Valley Virus infections extracted for analysis. Data was collected by administering structured questionnaires to eighty-four purposely and conveniently selected healthcare providers in the healthcare facilities while the capacity of the healthcare facilities was determined by a checklist as per World Health Organization (WHO) standards for RVF diagnosis. The data was processed using Statistical Package for Social Sciences. This study found that the healthcare providers lacked the capacity to detect RVF while most facilities lacked equipment to detect and handle RVF. There was no significant difference in education and training levels of the health care providers in the health care facilities (P= 0.5132) and (P = 0.8124), respectfully. The tools, equipment and facilities available in the healthcare institutions were found to be below the WHO expectations. The study recommends carrying out of similar studies in other high-risk counties for better understanding and preparedness in case of an outbreak. The study also informs the Kenya Government on the priority areas of training, re-training and requirements of healthcare providers especially in high-risk locations.
Bacterial Causative Agents of Food Poisoning and Associated Risk Factors among Patients Attending Thika Level 5 Hospital in Kiambu County, Kenya
(kenyatta university, 2023) Karanja, Esther Nduta; Nelson Menza; Ephantus W. Kabiru
Food poisoning results from ingestion of contaminated food or water that contains microbial agents that cause illness or release their toxins onto the food. Examples of bacteria are Campylobacter, Vibrio cholerae, Salmonella typhi, Escherichia coli. The study was conducted in Thika level 5 to determine bacterial food poisoning and associated risk factors among patients. A cross-sectional study design and purposive sampling technique was adopted. Structured questionnaires and observation checklist were used as data collection tools. Microscopy, stool culture and biochemical tests were used to identify bacterial causative agents. Statistical package for social sciences was used to manage data. Frequencies and percentages were used to analyze bacteria, clinical signs and symptoms. Chi-square using a Confidence Interval (CI) of 0.05 determined association between socio-economic, socio-demographics, environmental, hand washing practices and kitchen hygiene risk factors to bacterial food poisoning. Multinomial logistic regression confirmed significant predictors of food poisoning. Ethical approval was sought from Kenyatta University Ethical Review Committee; permit to collect data was sought from National commission for science and Technology. Statistical analysis established significant association between gender and food poisoning (χ2=13.165, df=4, p=0.010); education level and food poisoning (χ2=22.032, df =12, p=0.037). Vibrio cholerae 45(42.1%) was the most isolated bacteria while the least was Shigella 6(5.6%). Majority 91(85%) respondents reported diarrhoea lasting three days. Results indicate hygiene practices were low which is highly linked to food poisoning. There was a significant association between not washing hands after visiting the toilet and food poisoning (χ2=15.937, df=8, p=0.043).Lastly open defecation was a significant contributing factor to food poisoning (χ2=10.529, df=4, p=0.032). Significant predictors to food poisoning were, not washing hands after using the latrine due to lack of access to a hand washing point as well as having dirty hands. Not boiling water before drinking, not washing hands before mealtime, and lastly openly defecating. Increasing the awareness on causative agents, sources of contamination and improving hygiene practices at household level through encouraging the male population to practice hygiene will influence positively towards efficient, targeted public health interventions to prevent unnecessary illness.
Barriers to Mental Health Services Utilization among Caregivers of Mental Health Outpatients at Mathari National Teaching and Referral Hospital, Nairobi City, Kenya
(Kenyatta University, 2023-08) Chelelgo, Victor Kibichii; Gilbert M. Munyoki; Meshack Onyambu Ondora
World Health Organization (WHO) defines mental health as a state of well-being where people realize and recognize their capacities, cope with life stressors, and contribute positively to society. Cases of mental illness in Kenya have been on the rise with an estimated prevalence of 10.7%. There is a gap between the need or demand for mental health services (MHS) and their utilization despite the government’s effort to devolve mental health care services to level 4 hospitals. There are about 284 level 4 hospitals in the country and only 29 of them offer mental health services. Psychiatric services are available in 26 out of 47 counties in Kenya. This leaves people in the remaining 21 counties to seek mental health services from other counties or MNTRH located in Nairobi. Therefore, there is need to address the barriers that limit the provision and use of mental health services if there is hope to lower the burden resulting from mental illnesses in Kenya. The main objective of the study was to investigate barriers to the utilization of mental health services at the MNTRH outpatient clinic. The study was a cross-sectional descriptive study that employed mixed (qualitative and quantitative) methods. Questionnaires were used to collect data coupled with structured interviews of key informants. 216 caregivers completed the questionnaires, and 5 key informants (healthcare workers) were interviewed. The study findings revealed that the cost of seeking mental health services is a critical barrier to accessing these services at the MNTRH outpatient clinic. More than half of the participants missed their clinics due to the cost of medication, 56% (n=120), consultation costs 55% (n=118), and transport= 54% (n=116). Pearson’s Chi-square showed statistically significant associations between the cost of transport, consultation, and medication and missing appointments among mentally ill patients at MNTRH (p < 0.01). Similarly, stigma from the community was associated with patients’ intentions to cease their attendance at clinics at MNTRH (p < 0.01). Caregivers sought other types of mental health services such as spiritual healing before taking their mentally ill relative for formal care. People with mental illness experienced social stigma 59.3% (n=128). It was concluded that the cost of mental health services was a barrier to access and utilization of mental health services. The study also concluded that stigmatizing mentally ill patients, families, and healthcare workers discourages them from seeking or offering mental health services. The study also found that there are healthcare workers’ and facility-related barriers to utilization of mental health services. The study recommended the Ministry of Health and MNTRH develop a strategic or sponsored payment plan besides NHIF for people with mental health tailored to patients' or caregivers’ level of income to reduce barriers to mental health services due to cost, particularly of medication. Future studies should use comprehensive theoretical models such as Social Ecological Model to conceptualize multiple factors that may influence the utilization of mental health services not only at MNTRH but also in Kenya.
Behavioural, Environmental, Socioeconomic and Demographic Determinants of Diarrhoea Morbidity among Children Under 5 Years in Migori County, Kenya
(Kenyatta University, 2017-10) Omondi, Odero Collince
Globally, there are 2.5 billion cases of diarrhoea among under fives every year. In 2015, diarrhoea caused 9% of deaths among under fives worldwide. In Africa, there are 696 million cases of diarrhoea among under fives every year. About 46%deaths among under fives in Africa are attributed to diarrhoea. In Kenya, diarrhoea accounted for 20% of deaths among under fives in 2011 causing 38,802 deaths. In Migori County, diarrhoea is a major cause of morbidity and mortality, yet the interaction with predisposing factors is still high. This study focused on assessing the behavioural, environmental, socioeconomic and demographic determinants of diarrhoea morbidity among children under 5 years in Migori County, Kenya. xiv A cross-sectional study design was used. A total of 216 under fives were sampled using multistage sampling technique. A questionnaire was used as the research instrument for data collection. SPSS was used for data analysis. Descriptive statistics, Chi-square test of independence and Fisher’s exact tests were computed. According to study findings, 18% of under-fives in Migori County had diarrhoea two weeks before the study. Socioeconomic and demographic factors associated with diarrhoea among under fives was the number of rooms in a household ( = 0.002). Behavioural factors included hand washing with soap ( <0.001; food storage method ( <0.001); and heating stored food before feeding ( <0.001). Environmental factors included method of refuse disposal ( <0.001); latrine availability ( = 0.001); latrine type ( = 0.037);latrine sharing ( <0.001); source of drinking water ( = 0.009); water storage ( = 0.002); method of drawing water ( = 0.005); scooper cleaning ( <0.001); cleaning water container before refilling ( = 0.034); and drinking water treatment ( = 0.010). Conclusion of the study was that determinants of diarrhoea morbidity identified should be addressed to prevent occurrence of diarrhoea disease among under fives. The null hypothesis that diarrhoea among under fives has no association with behavioural, environmental, socioeconomic and demographic factors was rejected. Among the three categories of determinants, environmental factors had more significant associations. Recommendation is that the community in the study area could possibly benefit is concerted efforts are made to increase the number of latrines. Efforts should be made to protect water sources in the study community. In addition, the study emphasizes that hygiene practices should be encouraged, and intervention programmes should be implemented on refuse disposal to create awareness on proper refuse and wastewater disposal.
Birth preparedness among women in Tharaka Nithi County, Kenya
(2014) Makunyi, Eliphas Gitonga
It is estimated that in 2008, 358,000 maternal deaths occurred in the world. It is also estimated that in Kenya, 7,700 women die annually due to pregnancy related complications. This translates to approximately 21 women each day or approximately one Kenyan woman every hour. Out of every 10 women, 9 of them receive skilled ante-natal care but only 4 receive skilled birth attendance. The objective of the study was to assess the determinants of birth preparedness among women attending maternal and child health in Tharaka sub-county. The specific objectives were to assess the proportion of women with birth preparedness plans, to assess the socio-demographic, maternal and institutional determinants of birth preparedness. The area of study was Tharaka sub-county and the target population were women who had delivered within two years prior to the study attending maternal and child health clinics. A descriptive cross sectional study was carried out. Data collection was done using interviewer administered questionnaires, focus group discussion guide and key informant interview guide. Tharaka sub-county was purposively selected. Stratified sampling was used to select the facilities while systematic sampling was used to select the respondents. Every 14th client attending maternal and child health clinic was interviewed. The sample size was 345. STATA version 11 was used to analyse the data. Descriptive statistics was used to generate proportions and frequencies while chi square, Fisher’s exact test and logistic regression were used to draw inferences. This study found out that the proportion of women that was prepared for birth was low (20.3%). The aspect of birth preparedness that was identified and planned for by the highest number of women was finances for delivery expenses (74%) followed by place of delivery (68%) while the least was the mode of transport to the facility (35%). The socio-demographic determinants were maternal education (OR=1.5), occupation (OR=3.5), average income (OR=1.6) and marital status (OR=2.2). The maternal determinants were history of still birth (OR=0.2) and attendance of 4 or more ante natal visits (OR=2.2). There were no institutional determinants of birth preparedness with this study. In conclusion, the level of birth preparedness is low. The research recommends to ministry of health to sensitize women of reproductive age on birth preparedness. Birth preparedness should also be improved through quality ANC. The government through relevant agencies should encourage the education of the girl child and put in place strategies to increase the average income of women.
Caregiver feeding practices and socio-economic factors that influence the nutritional status of children under-five years in Mlolongo, Kenya.
(2015-05) Ndambuki, Seth K.
The co-existence of under nutrition and over nutrition in the same country (double burden) is a global public health challenge that is becoming a problem in Sub-Saharan Africa. However, little information is available on this trend in Kenya and more so in the urban poor. The purpose of the study was to assess the nutritional status of children under-five years of age living in Mlolongo informal settlement and the caregiver feeding practices and Socio-economic factors that influence this nutritional status. A sample of 165 households with caregiver-child pairs were selected for the study. Data was collected using semi-structured interviews, observation check list, Focus group discussions and anthropometric measurements. Data analysis was carried out using WHO anthro version 2 and SPSS version 19. Research findings revealed 33.5% of the children were stunted, 11.4% were wasted and 13.3% were underweight. Severe stunting was found in 16.8% of the children, 3.2% were severely wasted and 2.4% were severely underweight. Overweight was found in 11.4% of the children and the obese were 5.1%. Boys were more undernourished than girls, and girls were more over nourished than boys. Children aged 12-23 months had the highest prevalence of stunting (60%) and wasting (17.9%) and children aged 0-5 months had the highest prevalence of underweight (24.4%) and overweight (23.1%). The demographic factors found to be significant predictors (P<0.05) of child nutritional status were caregiver‟s age (<24 years) and the number of siblings to the surveyed child. Socio-economic factors found to be significantly associated with child nutritional status were caregiver‟s level of education and income. Initiation to breastfeeding and caregiver-child interactions during child feeding was significantly associated with child nutritional status. Sanitation practices such as dumping of refuse coupled with presence of excreta/effluent within the compound was a significant predictor of child wasting. Also diarrhea within the last two weeks preceding the survey was significantly associated with wasting. The study reveals that chronic malnutrition is pronounced in the area and the most undernourished group (12-23 months olds) falls in the 1000-day window and if not addressed may increase the child‟s risk of developing chronic illnesses later in life. The high prevalence of overweight children implies that even the urban poor are undergoing nutrition transition. The findings of the study imply a “double burden” of malnutrition in children under five years with under nutrition more pronounced in the area. This state could be linked to socio-economic factors, caregiver feeding practices, child morbidity and sanitation practices.
Caregiver Home Based Practices for Managing Children Aged (0-59 Months) With Diarrheal Disease in Busia County, Kenya
(Kenyatta University, 2020) Mwaro, Dickson Otiangala
Globally, diarrhea remains the second leading cause of reported mortalities among children (0-59 months) and a cause of significant morbidity, especially in developing countries. In Kenya, diarrhea accounts for 16% of deaths among children (0-59 months). It’s a major cause of mortality in children below five years after malaria and pneumonia in Busia County. Many of the children die due to poor home-based management of diarrhea. The main aim of the study was to explore the different interventions care givers use to manage diarrhea among children (0-59 months) in Busia County and factors associated with home-based management of diarrhea. This was a facility-based descriptive cross-sectional study done in Busia County. Multistage sampling was used to obtain the study sample and a sample size of 389 was used. Both inferential and descriptive statistics were used for quantitative data. Chi-square was used to test relationships between dependent and independent variables at 95% confidence interval. Logistic regression was used to examine the associations between socio-demographic and economic factors, level of knowledge and practices adopted for home-based care. A p-value of less than 0.05 was considered significant. The general knowledge of caregivers on home-based care was unsatisfactory. Out of the 389 caregivers interviewed, only 114(29.3%) had good knowledge level of knowledge on home-based management of diarrhea. Specifically, only 62(20.6%) could mention more than 1 acceptable cause of diarrhea while less than half of the caregivers (48%) thought diarrhea could be prevented. Knowledge of diarrhea management was also not sufficient. Despite all (389 caregivers) having practiced home-based management of diarrhea in the in the last 2 weeks, the study revealed that the overall home-based care practices were inappropriate 280(72%). Socio-demographic and economic factors like education, occupation, distance to the health facility, source of information and number of household members were significantly associated with appropriate home-based management of diarrhea at <0.001*, <0.001*, 0.044*, 0.003 and 0.001 respectively. Good level of caregivers knowledge was also significant to appropriate home-based management of diarrhea (<0.001*). When other factors had been adjusted, caregivers education p=0111 and care givers level of knowledge p= 0.0021 were found to be significantly associated with appropriate home-based care of diarrhea in children (0-59 months). The general conclusion of the study was that the caregivers’ level of knowledge about diarrhea was unsatisfactory and measures adopted by caregivers for home-based management of diarrhea were inappropriate. There is, therefore, need for extensive educational interventions such as health education and promotion activities on diarrheal diseases in the study area, together with emphasize on teaching caregivers about the “germ theory” of disease causation, effects, dangers as well as appropriate home management practices and prevention of diarrheal diseases.

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