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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!'
Adherence to Data Protection Guidelines among Health Researchers at Kenya Medical Research Institute
(Kenyatta University, 2021) Kipchirchir, Kebenei Enock; George O. Otieno; Kenneth Rucha
Researchers are expected to keep participants’ data in a highly confidential and private manner. A study conducted in Kenya in 2014 revealed that the research stakeholders face different challenges relating to the sharing of public health data. The exposure of data occurs through stigmatization, invasion of privacy, disrespecting autonomy and unfair competition either intentionally or unintentional 'misuse' of data. The general research objective of this study was to examine the adherence to the data protection guidelines in health research in KEMRI, Kenya. Cross-sectional study design was used and it employed quantitative methods of data collection and analysis. The sample size for this study was 128 research participants, however an extra 10% was added to cover for non-respondence. The study targeted the KEMRI’s scientists who have participated in any research project. Stratified sampling method and the “Probability Proportional to Size” (PPS) was used to get the desired sample in each of the KEMRI center. The data analysis was done using SPSS Version 23. Descriptive statistics and chi-square test were done to determine significant association and results presented in tables, graphs and charts. A total of nine questions were asked to determine the adherence to the national guidelines. A respondent is considered to have adhered if he/she has agreed to all the 9 items. The neutral respondents were considered as non-adherence. The findings reveal that 18 (12.6%) of the respondents adhered to data protection guidelines in health research while the majority did not adhere 121 (87.4%). P-values <0.05 were considered significant. Results further showed that guidelines or policies on data protection within the institute are the organizational factor which highly influences adherence to data protection (p-value of 0.01). Restricting access to the authorized persons and use of codes to conceal participant’s identity (p-value of 0.04) are the best ways of protecting health research data. In conclusion, most researchers do not comply with all aspects of national guidelines on data protection which may lead to the exposure and leakage of participant’s data. In view of the findings, the researcher recommends the creation of awareness through workshops and trainings as well as the development of institutional guidelines as the best ways of adhering to data protection guidelines.
Adherence to Pulmonary Tuberculosis Treatment in Murang’a County, Kenya
(Kenyatta University, 2020-03) Gitonga, Charles Muthui
Non-adherence to Tuberculosis treatment is a major barrier for TB control programs because incomplete treatment may result in prolonged infectiousness, drug resistance, relapse and death. Successful treatment of TB involves taking anti TB drugs for at least six months as per the doctors advise. Currently, Tuberculosis has become a resurgent public Health problem in developing countries and is the leading cause of death from any single infectious agent. The purpose of the study was to identify factors contributing to non-adherence to TB treatment amongst pulmonary TB patients in Maragua Sub-County of Murang’a County. The objectives included were to determine the social-economic related, healthcare-related, patient-related and disease and medicine related factors associated with non-adherence of TB treatment amongst patients in Murang’a County. The study was guided by the Health Belief model as the theoretical framework. A cross-sectional survey study design was used. Census method was used and all 270 people were considered. Data was collected using a mixed method approach of interview guides, questionnaires and Focus Group Discussions. A total of 270 adult Pulmonary TB patients, amongst whom 59 (47%) were adherents and 67(53%) non adherents with TB treatment, who received treatment in 2017 and had completed treatment, Community Health workers, and Health Personnel in the TB clinic participated in the study. Data was entered to EPI INFO version 3.5.3 and analysed using Statistical Package for Social Sciences (SPSS) version 22. Multiple logistic regressions was used to identify associations and to control potential confounding variables. Chi Square was used to test independence of categorical variables with p value of less than 0.05 at 95% confidence interval being considered significant. Data presentation was done using figures and tables. From the results of the study only the distance taken to collect drugs in the health facility was found to be associated with non-adherence to TB treatment (n=9 ,13%). The study recommends that measures should be undertaken so as to reduce the non-adherence level to TB treatment by ensuring anti-Tb treatment is accessible to patients at the nearest Health facility from their residence. Additionally, the study proposes that the patients should be sensitized on the importance of adherence to TB drug mediction. Interventions with Health promotion initiatives emphasizing the benefits of treatment adherence should be enhanced in the communities by further large scale multicentred studies and that an enabling environment which is conducive for good patient interactions should be created. The study concludes that there are challenges facing adherence of TB treatment which ought to be addressed. The study, suggests that measures to improve drug adherence such as improving health conditions, increasing the availability of drugs and conducting health educations to the patients is essential in minimizing the drug non-adherence to TB drugs.
Administration of Informed Consent for Medical Imaging Services among Patients in Government Hospitals in Nairobi City County, Kenya
(Kenyatta University, 2021) Koi, Victoria Otysula; Andrea Yitambe; Peterson Warutere
Informed consent is a requirement by law to allow patients to make decisions with respect to their health and well-being. It is an ethical and legal requirement that patients seeking medical imaging services should give an informed consent prior to seeking treatment with respect from healthcare providers. However, the extent of usage of the informed consent process varies across medical procedures. The study therefore sought to assess informed consent process in medical imaging procedures for patients in government hospitals in Nairobi City County, Kenya. The study adopted a descriptive cross-sectional study design. The study specifically focused on administration of informed consent, contents of the patients Informed Consent Forms and modes of informed consent used among patients for medical imaging services. Imaging departments in Kenyatta National hospital, Mbagathi, Mama Lucy, National spinal injury and National Mathare Hospitals in Nairobi City County were chosen as the area of study. The patients in the imaging departments of the selected hospitals were recruited for the study. The sample size selected was 307 respondents. The respondents were selected using systematic random sampling at a predetermined interval of 3. Collected data was coded for analysis by use of Statistical Package for Social Sciences. Analysis was conducted on descriptive and inferential statistics. Frequency tables, pie-charts and graphs were used to present the quantitative data. Inferential statistics were done using Chi Square tests to determine the association between study variables at 95% confidence interval (p<0.05). The ethical considerations were strictly followed during data collection. The study results revealed that majority 222(75.0%) of respondents were administered with informed consent with 79(75.2%) of respondents in Kenyatta National Hospital reporting to have adequately administered with informed consent before a medical imaging procedure. It was established that most 181(61.1%) patients sought for X-ray services compared to other imaging procedures for treatment. Verbal informed consent was the most used mode of informed consent with 123(55.0%) respondents having administered to it. It was further revealed that age (χ2=3.782; df= 4; p=0.016;), level of education (χ2=3.89; df= 4; p=0.030), revelation of reason for referral (χ2=26.081; df=1; p=0.001), provision of right to refuse or defer imaging (χ2=33.468; df= 1; p=0.001), giving consent for treatment (χ2=70.733; df=1; p=0.001), decision making for wellbeing (χ2=12.056; df=1; p=0.001), pre-operative counseling (χ2=9.533; df=1; p=0.002), cases of negligence from clinicians (χ2=22.414; df=1; p=0.001), understanding information provided by clinicians (χ2=4.394; df=1; p=0.036), adaptation of informed consent doctrine meeting physicians and patients (χ2=7.648; df=1; p=0.006), performance of diagnosis from patients’ past medical history (χ2=9.788; df=1; p=0.002), advice on alternative treatment options available (χ2=8.065; df=1; p=0.005), disclosure of information by practitioners (χ2=19.406; df=1; p=0.001) and physical examination done before medication (χ2=9.006; df=1; p=0.003) were significantly associated with informed consent administration among respondents. The study concludes that informed consent was administered to majority of respondents in Public Hospitals in Nairobi City County. Most of the domains of the contents of informed consent were adhered to. The study further concludes that verbal informed consent was the most prevalent mode administered with most of the respondents utilizing X-ray medical imaging services. These research findings provide a great insights and information to leaders, managers, law makers, governing and oversight authorities in decision making, policy formulation, strategic planning and regulation in a context specific to provide a conducive environment for practicing medical imaging procedures in an ethical and legal manner.
Adolescent Friendly Health Services in Level Two Facilities among Public Secondary School Students in Mombasa County, Kenya
(Kenyatta University, 2020) Amuko, Selpha Ongaya
Adolescents’ health is a great determinant of a country’s development since adolescents contribute a large proportion of the population. Sexual and reproductive health problems have been identified in several studies to be a major cause of ill health and even death among young people. These problems demand specialized attention which can be achieved through unlocking access to sexual and reproductive health services to young people through adolescent friendly health services. Despite the adoption of the adolescent friendly health services in all government health facilities, there is still high incidences of teenage pregnancies and HIV infections among young persons aged 15-19 years. The main objective of this study was to assess the adolescent friendly health services in public primary care facilities to adolescents aged 13-17 years attending secondary schools in Kisauni Sub-County, Mombasa, Kenya. The study was conducted to assess the views of secondary school students on adolescent friendly health services in level 2 facilities in Kisauni SubCounty, Mombasa County, Kenya. The study looked at staff characteristics, facility characteristics, interpersonal relationships and their association with students’ perceptions on friendliness of services. A survey was conducted with 313 secondary school going students from two public schools in Kisauni Sub-County, Mombasa County Kenya. Students were selected using a simple random selection process and structured questionnaires used to collect data. Additionally, researchers assessed four public primary care facilities using an observational checklist and Key informant interviews conducted on facility in charges. Relationships between variables were assessed using Chi-Square at 95% confidence interval. Finite correction formula was used to determine the sample size for the study. Kisauni Sub-County was selected purposively. Four public primary health care facilities in the Sub-County were included. Stratified random sampling and simple random sampling methods was used to select participants. Statistical package for social sciences (SPSS) version 23 was used for the analysis of quantitative data. For qualitative data, content analysis was done for open- ended questions responses. Chi-square was used to test the association between the independent and dependent variables of the study. Bar graphs and pie charts were used to present information obtained. The association was deemed statistically significant when the p-value was less than 0.05 at 95% level of confidence. Of all the respondents (n=313), 42% reported the services to be friendly. More than half 65.5% (n 205) of all the respondents thought facilities had appropriate staff to provide adolescent and friendly health services (AFHS) whereas majority 98% of all the respondents reported to prefer staff of same sex and age to offer services to them since they could understand them easily. Media (radio, newspapers) and static advertisements significantly influenced AFHS p - values 0.017 and 0.004 respectively. Less than a half of those who reported friendly services mentioned being aware of services offered in other settings (43.2%(n=32) drop-in centers, 43.7%(n=44) community outreach and 39.2% (n=65) school health programs. Accessing facility by use of vehicle and walking on foot had significant influence on AFHS, p- values of 0.001 and 0.003 respectively. Involvement of other agencies in service review had a significant influence on the friendliness of services, p- value 0.003. The adolescent health services in Mombasa were concluded not friendly. More studies to be carried out on barriers to access. Policy makers and implementers in the health sector found these study findings useful in quality improvement of adolescent friendly health services.
Adoption Level of a Proactive Safety Program Within the Construction Phase of Olkaria’s Geothermal Power Stations of Nakuru County, Kenya
(Kenyatta University, 2020-02) Nzioka, Luka Musembi
Kenya is among the leading countries globally with significant geothermal resources. Geothermal energy provides reliable, cost-competitive, base load power with a small carbon footprint, and reduces vulnerability to changes in climate by diversifying power supply away from hydropower. Kenya has set out ambitious targets for geothermal power plants to meet an increasing power demand with significant impact to the safety and health of the workforce. This study focused mainly on this sector with a great emphasis to Olkaria’s geothermal power stations of Nakuru County that are under development. Olkaria domes has over 71% of Kenya’s potential to geothermal power capability. The overall objective of this study was to determine level of adoption of proactive safety program measures within construction phase of Olkaria’ s geothermal power stations of Nakuru County. Additionally, the study sought to identify the level of importance attached to each proactive safety measure, determines the strategies employed in ensuring that proactive safety program measures are adopted at construction phase and to establish the barriers and success factors to the adoption of this proactive safety program measures. Safety performance metrics and leading indicators from Institute for Work and Health Organisational performance metrics provided measure for the safety performance. Known safety performance indicators of this study were quantitative and qualitative. A descriptive cross-sectional and evaluative study design which uses both quantitative and qualitative methods in data collection has been applied in this study, with a study population being the workers working at the two Geothermal power plants that are currently under construction, a sample was drawn from all the Departments, data was collected using a self-administered questionnaires, observations through a structured checklist, document review and key informant interviews. The data collected was computer managed and analyzed by using the Statistical Package for the Social Sciences software version 20.0. Analysis was achieved by use of descriptive statistics which includes frequencies, percentages, and the mean. The overall result shows that there is partial adoption of the proactive safety measures with dismal performance in process safety measures and thus need for contractors to have policy statement by the top management in commitment to support proactive safety program adoption and implementation. The research pointed out that, employee competency assessment is of great importance to this challenging area, and management should consider their competencies before being hired. Barriers to the adoption of this program has been noted, the management has not provided adequate budget allocation to the provision of personal protective equipment and thus workers are vulnerable to injuries as a result, there is need for management to incorporate safety budget in their core project budget. The findings of this study when adopted, will provide a body of knowledge to all players within the construction phase to enforce a positive safety culture, help to prevent accidents from occurring, and improve health and safety of workers. By incorporating these proactive safety measures as a zero-harm strategy, management shall understand that accidents are preventable and zero accident is a realizable goal.
Adoption of Biomass Briquettes as Alternative Source of Energy in Maasai-Mau Region, Narok County, Kenya
(Kenyatta University, 2020-11) Mokaya, Dennis Chweya
Climate change phenomenal is a trend that impacts the local communities by affecting their way of life. High demand for wood products to meet the demand of energy supply in Maasai-Mau region has seen the depletion of the forest cover thus increasing carbon dioxide emission and other greenhouse gases into the atmosphere. However, there is no extensive research on the benefits of alternative sources of energy like solar, biogas and biomass briquette in mitigating these impacts. The study investigated the adoption of biomass briquettes as an alternative source of energy in Maasai-Mau, Narok County, Kenya. The study was guided with three objectives (i) to determine the level of adoption of biomass briquette in Maasai-Mau region, (ii) to evaluate the challenges and hindrances Maasai-Mau residents face in the adoption of biomass briquettes in Maasai-Mau region and (iii) to investigate the availability of biomass briquette making materials in Maasai-Mau region. The study used two sampling techniques; systematic and purposive sampling to get information from the key informants and households in the study area with a target sample of 100 respondents. The findings obtained were analysed through Excel and Statistical Package of Social Sciences. Data results were presented in graphs, pie-charts, and tables. From the results, the hypothesis was analysed by Chi-square (2). The study failed to reject the null hypothesis of a relatively low level of education hinders the adoption of biomass briquette, where (2=9.866, DF=6, P=0.13). The study concluded that the level of biomass adoption in Maasai-Mau region was relatively low with only 28% of the households using briquettes daily as compared to other sources of energy. The other conclusion from the study was that biomass briquette making materials were readily available with saw dust chippings and charcoal dusts ranking 84.61% and 79.49% respectively. Finally, the study found out that lack of funds and lack of briquette making skills were the highest challenge to adoption of briquette making technology in the region, being ranked as 88% and 77.6% respectively. The primary recommendations were that the Massai-Mau region residents be educated on biomass briquette making skills, and ensuring that their biomass briquette initiatives are funded to solve the challenges they face while adopting this clean energy mechanism as an alternative source of energy.
Adoption of Community Hygiene Strategies for Safe Water and Sanitation among Mothers of Underfives in Kitui County, Kenya
(Kenyatta University, 2019-04) Mutie, Lydia Mbeti
Inadequate access to safe drinking water, sanitation and hygiene constitutes a serious global threat to health accounting for approximately 4 billion cases of illness annually. Children under five years in the developing world are most affected, where nearly 1.6 million deaths are recorded annually due to diarrhea alone. This accounts for 15% of all deaths among under fives. Poor sanitation and hygiene practices are among the main factors associated with sanitary diseases. The purpose of this study was to analyze the adoption of community hygiene strategies to safe water and sanitation among mothers of under five year olds in Migwani Division, Kitui County, Kenya. Objectives guiding the study were: to determine adoption of community hygiene facilities for safe water and sanitation among mothers of under five year olds, to examine the prevalence of common sanitary diseases among children under five years old and to assess the influence of community hygiene practices on safe water and sanitation among mothers of under five year olds within Migwani Division, Kitui County. The study adopted a descriptive survey research design. A sample of 94 mothers of children under 5years old, 3 public health officers and 57 community health workers was used for the study. The total number of respondents was 154 and the response rate obtained was 89%. Data was collected using interview schedules, questionnaires and observation checklists. Quantitative data was coded to develop code sheet quantitative data. Qualitative data was thematically categorized and analyzed using Statistical Package for Social Science Version 20. Statistical analysis involved determination of percentages, means, standard deviation and logistic regression. The results of the study show that only 50.6% of the mothers had access to treated piped water with the rest using pond water, stream water or harvested rain water. More than 40% of the mothers used untreated water sourced from open wells, which increased water borne diseases among children. Toilets were observed in 89.9% of the homesteads with 10.1% practicing open defecation. Common sanitation and water borne diseases reported were worms, amoeba, diarrhea, and dysentery. Mothers who used both open well water and stream water were more likely to have children suffer from diarrhea compared to those who used piped water (9. 37 for stream water, 9.42 open wells and 5.42 for piped water-p<0.05). Amoeba prevalence was 82.6% among children whose mothers were using untreated water. Majority of mothers (76.4%) lived more than 10km from water sources therefore forced to use unsafe water. Hand washing at critical times was at 94.4% meaning hygiene awareness was high, evidenced by 61.8% of homesteads with hand washing facilities outside toilets. High level of adoption of safe water and sanitation practices were: Availability and use of toilets, hand washing facilities, hand washing and treating drinking water. Medium level was access to safe water and participation in health programmes. Low adoption was evidenced by prevalence of sanitary diseases and long distances to water sources. Therefore, Community hygiene strategies and practices have great influence on levels of adoption of safe water and sanitation practices among mothers of children under five years old. Recommendations of the study are: community involvement in assessing their health, training of community health workers on concepts of health care and development, change in human behavior in community response towards disease outbreaks and emergencies and poverty alleviation in order to improve adoption of community hygiene strategies for safe water and sanitation.
Anthropogenic Impacts on Land Use and Land Cover Change in Ombeyi Wetland, Kisumu County, Kenya
(Kenyatta University, 2020-11) Odhiambo, Nicodemus Osoro
Land use and land cover change dynamics and associated human-induced transitions studies are very critical in the formulation of sustainable land management strategies, land use systems and policies. The study aimed at generating a characterized area estimate of Ombeyi wetland’s land use and land cover change schema for the period between 1990 and 2017, examining the spatial and temporal characteristics of anthropogenic impacts and their relationship with land use and land cover change in Ombeyi wetland, and to evaluate the impact of existing plan/program used for sustainable management of Ombeyi wetland. The study adopted a mixed-method design consisting of remote sensing and GIS-based analysis, key informants interview, and a household survey of 384 households. Remote sensing analysis revealed that between 1990 and 2017, the area covered by papyrus vegetation has decreased from 1017.01 Ha to 4.04 Ha while agricultural land and built-up area increased from 2966.5 Ha to 3450.8 Ha and 52.46 Ha to 581.2 Ha, respectively. Key informants attributed the changes to population increase (29.2%) and their associated demand for land and natural resources. Analysis of household-survey results validated the observed patterns during the remotely sensed data analysis phase, as majority of the respondents (90.1%) own land within the wetland through inheritance. The respondents reported farming (92.2%) as their main occupation with 72.4% of the same respondents attaining primary level education and below. Most of the respondents (24.7%) are aged between 21 and 30 years with 88.3 %, earning Kshs >2,500 or more monthly from wetland utilization. Wetland conservation was not popular as 70.1% of the respondents were against conservation while 98.1% have never participated in any conservation efforts. Results from the evaluation of the integrated management plan 2014-2018 objectives were, afforestation and re-afforestation in catchment areas (50%), improve environmental education and awareness (50%), halt pollution and improve water quality (45.45%), improved food security and household income (41.67%), and enhancement of participatory monitoring and evaluation (50%). Hypothesis testing for; there is significant spatial and temporal change in Ombeyi wetlands’ land cover types using T-test resulted in a p-value of 0.999, while correlational test for hypothesis; anthropogenic impacts significantly correlate with changes in land use and land cover resulted in a r-value of 0.892. Both hypotheses were accepted. The respondents proposed land use zoning (30.2%) as the most suitable conservation measure. The current state of land cover and its dynamics have had negative impacts on the livelihoods of residents and resources management.
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 Level of Readiness for Computerized Health Management Information System Among Nurses in Kenyatta National Hospital, Nairobi, Kenya
(2014-08-18) Mucheneh, Olive Mirai
Healthcare Organizations are now in the process of implementing computerized health management health information system (CHMIS) with a hope that they will improve on safety, efficiency and effectiveness of patient healthcare (Ammenwerth, 2004). More specifically, due to advances of technologies, the adoption of CHMIS is growing rapidly. CHMIS are believed to offer significant benefits in improving patient health care delivery (Thompson, 2005). Health care Organizations implement CHMIS, without knowing whether, nurses will be willing to adopt such systems. If nurses reject the new technologies, CHMIS implementation will not succeed, resulting to poor health care and wastage of resources. The main objective of this study was to assess the level of readiness for CHMIS among nurses in Kenyatta National Hospital (KNH). The specific objectives were to assess the level of readiness for CHMIS, to determine the influence of demographic characteristics influencing readiness for CHMIS, to determine the institutional characteristics influencing readiness for CHMIS, determine the influence of information technology (IT) skills on readiness for CHMIS. The research problem was studied with cross sectional descriptive design using both quantitative and qualitative techniques. The study was conducted at KNH with a sample of 313. The study used a self-administered questionnaire for the respondents, focus group and key informant interview guides for focus group discussion and key informant interviews. Standard package for social sciences (SPSS) version 19.0 was used for analysis. Descriptive and inferential statistics were computed. Results were presented in tables and in narration. The mean for level of readiness was 3.5 which was low. The study found that 110 (35%) were ready for CHMIS, while 203(65%) were not ready. The study showed a significant relationship between designation and readiness for CHMIS among nurses in KNH x2 (1) = 12.26, p = 0.000). However, there was no significant relationship between gender x 2 (1) = 0.01, p = 0.91; age x2 (2) = 3.87, p = 0.14; level of education x 2(1) =0.15, p =0.70; highest qualification x2 (1) = 3.34, p = 0.07; work experience x 2 (1) = 3.67, p = 0.05 and readiness for CHMIS among nurses. The study further showed a significant relationship between overall institutional characteristics x2 (1) = 41.69, p= 0.000 and readiness for CHMIS among nurses. The study showed a significant relationship between IT skills and readiness for CHMIS x2 (1) = 7.613, p = 0.006. Results from focus group discussion and key informant interviews indicated that the hospital has not trained nurses in IT, the top management has not communicated the IT strategy to nurses, and awareness and participation among nurses was lacking. System champions were also lacking among nurses as well as technical support. Further, KNH lacked sufficient infrastructure for CHMIS and the hospital has not carried any technology assessment to find out whether nurses were ready for CHMIS or not. The hospital information communication technology (ICT) master plan was still on draft. Based on these findings, the study recommends that; the top hospital management should fully assess nurses level of readiness and other requirements prior to implementing CHMIS, provide IT training to nurses, identify system champions among nurses, provide sufficient infrastructure for CHMIS implementation, and finalize the ICT master plan for possible implementation. The study recommended that future research could investigate which new constructs such as high innovativeness, low insecurity and discomfort could add to the explained levels of technology readiness (TR).
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 Adherence to Antiretroviral Therapy among Children below 5 Years of Age in North Kinangop Sub-County, Nyandarua County, Kenya
(Kenyatta University, 2020-01) Musovya, James
Despite the concerted efforts at achieving a 50% reduction in deaths resulting from HIV, a high number of children below the age of 5 years continue to get resistance to first line ART medicines and are second line ARV medication. Efforts to deal with this issue seems not to have taken root in many developing countries, including Kenya. HIV suppression still remains a big challenge in this age bracket with at least one in every six patients failing to achieve the required adherence levels of more than 95% for successful HIV treatment. The net effect is the increase in the AIDS related deaths among the under 5s preventing the country from attaining its SDGs commitment of lowering these deaths by 50% by 2015.The main objective of this study was to assess the adherence to ART among the under 5s in Kinangop Sub-county, Nyandarua County, Kenya. Community based cross sectional study design was used in this study. The study utilized purposive sampling in selecting the hospitals to develop sample frames and Simple random sampling technique to get a sample size of 195 subjects. Researcher-administered questionnaires with open and closed ended questions and Focused Group Discussions (FGDs) were used as the main data collection methods. Collected Qualitative data from FGD interview was translated into a common language and was thereafter typed into MS Word. It was then analyzed manually to fit into the study themes. On the other side, collected Quantitative data gotten from questionnaires used to be checked daily for completeness and was then coded for before it was entered into computer. Similar responses were collected together to form different categories before entering them into computer programme Epi- info version 6 and was then analyzed by version 20 SPSS. This research used univariate, bivariate and multivariate analysis. As for univariate analysis, population distribution by background characteristics was shown. While in bivariate analysis, the association between the dependent and independent variables was showed by cross tabulations then t-test values tested whether or not, the dependent and independent variables association was significant. For multivariate analysis, the study used logistic regression to analyze and determine the effect of explanatory variables has on the dependent variables. ART regimen characteristics had significant association with adherence in this study (t-test=8.7:1df: p=0.000) and were similar to findings by Van Dyke RB, et al., 2009.Duration of medication” and “whether the child was on other medication” were significance as far as adherence is concerned in this study (t-test=4.411:1df: p<0.005) .The higher the level of education, the better the adherence (t-test=7.935:1df: p<.005), however there was no significance in the association between the caregivers’ ability to explain the medication regimen by the names of the drugs it contains and adherence. The study also found that Children who knew why they take ARVS drug had better adherence as opposed to those who did not know disclosure had significant association with adherence/non-adherence outcomes (t-test=10.757:1df: p=0.005). The findings of this study have being shared with the health care facilities involved and a manuscript submitted for publication to a pediatric ART adherence counseling journal for use in hospital and community settings.
Assessment of Anti-Female Genital Mutilation Program in Garissa County, Kenya
(Kenyatta University, 2021) Derow, Yasmin Hassan; Eliphas Gitonga
Female genital mutilation (FGM), is a social traditional practice performed by cutting parts of the external female genitalia. Globally, over three million women take part in the practice each year. The practise of this rite was made illegal in Kenya in 2011 and a board established to spearhead its abandonment in a program referred to as AntiFGM campaign. Garissa County in north eastern Kenya has the highest practise of FGM with a prevalence of 94%. This study aimed to investigate the success of the antiFGM programs in Garissa County with specific objectives being to determining the level of knowledge of adolescents/youth of Garissa County towards the anti FGM law, to determine the attitude of area residents towards the anti FGM law and to determine factors that influenced the implementation of the antiFGM law in Garissa County. Mixed methods study design was used in this study. A cross-sectional design using interviewer guided questionnaires to collect data was conducted among 108 randomly selected participants and results used to answer objectives one to three. Desktop review of previous studies was use to answer objective four. Data was analyzed using SPSS version 25. Chi-square and Fishers exact were used to compare participants characteristics against study outcome variable. Of the 108 participants, 53.7% were female. The median age of participants was 23 years (Interquartile range [IQR] 15-40). The prevalence of FGM was 62% with the mean age of circumcision being 8.3 years (SD 2.7 years). There was a statistically significant association between practicing Islam and FGM (p=0.001). There was an improvement on the level of awareness of the antiFGM law among youth in Garissa at 84%. Two thirds of participants did not support FGM. Mothers were the main influencers and decision makers on having FGM practiced. Excision was the main type of FGM practiced with traditional circumcizers being the preferred circumcizers followed by trained nurses and midwives. Introduction of the antiFGM law and advocacy by NGOs focused on combating FGM has led to a reduction in the prevalence of FGM and a reduction in the support of the act. There is an increase in the medicalization of FGM in Garissa with evidence of the practice going underground. This study recommends NGOs to have a clearer focus on the method chosen in advocating for abandonment of FGM.
Assessment of Awareness of Available Gender Based Violence Interventions among Women of Reproductive Age in Kibera Slums Nairobi
(Kenyatta University, 2021) Wairimu, Wanjohi Bancy; Margaret Keraka; Michel Mutabazi
Dealing with violence against women is key for achieving sustainable development goals (SDG) for equality of gender and empowering women and SDGs 3, 4 and 5. Globally, GBV prevalence accounts for 10-35%. In the year 2014, 45% of Kenyan women aged 14-49 years have reported some form of gender-based violence in their lifetime. About 29% of the women reported to have had experienced it in the previous year. About 16% of these women, reported sexual abuse and 13%, of them had it happen in the previous year. The study assessed awareness on available GBV interventions to women of reproductive age in Kibera. It also identified the types of interventions which were offered to survivors. Descriptive cross sectional study was used (which involved collecting and analyzing both qualitative and quantitative data) and this was conducted in Kibera slums. A sample size of 390 women of the reproductive age was conveniently selected from Kibera which has 13 villages hence 30 women from each village. The respondents were interviewed to obtain the required information using structured questionnaires which had both closed and open ended questions. SPSS version 20 was used for statistical analysis. Chi square tests was carried out to assess awareness of availabile GBV interventions. Descriptive analysis was used. This study confirms that there is a gap between the variable age where the p value is 0.001 which is less than the level of significance of 0.05 where the younger an individual is, the lower the level of awareness on available GBV interventions. The higher the education level, the lower the level of GBV as per the findings where the variable education had a p value of 0.001. The study found challenges in accessing health care for victims of GBV where survivors felt they could not report the perpetrators most of who were the breadwinners hence legal measures was the least taken form of intervention accounting for only 4.3% of the study participants had sought legal redress.Verbal abuse was the most rampant form of abuse accounting for 24.4%. A 49.1% of the interviewees did not seek any help for the abuse faced. About 10% of the interviewees had faced more than two forms of abuse. Sexual abuse accounted for 18.7% which is higher than what had been reported by KDHS in Kenya in the year 2014 which was at 16%. The rape cases were at 3.3% which is a higher number considering this was just done in one slum area in Kenya which when compared to South Africa that reported a prevalence of 11% of rape cases. Affordability of interventions, accessibility, acceptability of legal measures and cultural factors all have a p value of less than 0.05 meaning that these factors affect awareness of the available GBV interventions. Out of the clients interviewed, 28.7% were not aware about any type of interventions offered. The study also found that majority of the cases occurred from their partners or people within the household. Sexual harassment rate was high as well as verbal abuse accounting for 15.4% and 24.4% respectively. The findings of this study if applied will assist in raising awareness on the available GBV interventions in Kibera Slums.
Assessment of Awareness on Vesico-Vaginal Fistula among Women of Reproductive Age in Kawangware Slums, Nairobi City County, Kenya
(Kenyatta University, 2019) Maeri, Jacquelyne Aluoch
Obstetric Vesico-Vaginal Fistula is a reproductive health problem mainly caused by prolonged obstructed labour and delay in seeking emergency obstetric care after delivery. In developing countries such as those in sub-Saharan Africa, obstetric Vesico-Vaginal Fistula continues to cause suffering to a number of women and their families. Women with obstetric fistula not only have to endure the negative physical and emotional impacts of the disease but also social and economic impacts which are also negative. Considering the suffering of families associated with this disease, we set out to investigate community awareness of obstetric fistula especially in areas with poor access to social amenities such as informal settlements. The main aim of this study was to assess the level of community awareness among women of reproductive age in Kawangware Slums of Nairobi City County, Kenya. The study mainly focused on community awareness, knowledge levels, risk factors and attitudes towards Vesico-Vaginal Fistula. The study used descriptive cross-sectional study design. Both quantitative and qualitative data were collected. Quantitative data was collected using questionnaires administered to women of reproductive age while qualitative data was collected using focused group discussion guides. The study targeted 422 adult women aged 18 years and above in Kawangware slums. Systematic random sampling was used to select respondents using a predetermined interval. Every fifth woman who met the inclusion criteria was included in the study. The researcher obtained ethical clearance from the Kenyatta University Ethical Review Committee prior to data collection and a research permit from National Commission for Science, Technology and Innovation. Informed consent was also sought from study respondents. Data was then cleaned and entered into a Microsoft excel datasheet for processing. This was later exported to SPSS version 22.0 for analysis. Descriptive data were presented using frequency tables, graphs and pie-charts. Inferential statistics were done to establish the relationship between variables using Chi-square tests done at 95% confidence interval and p-values of <0.005 considered statistically significant. Qualitative data from focused grouped discussions were triangulated with quantitative data as direct quotes or narrations from respondents. The results revealed that 56% of respondents had low awareness with scores of less than 5. 57% of respondents had low knowledge on occurrence of VVF. Knowledge levels were significantly associated with community awareness (p=0.004). Majority of risk factors were significantly associated with community awareness such as early pregnancy (p=0.001), delayed access to obstetric care (p=0.006) and prolonged labour. 67% of respondents had negative attitude towards Vesico-vaginal Fistula based on Likert scale scores. There were significant statistical association between attitude and community awareness (p=0.010). The study concludes that the respondents from Kawangware had low awareness levels, low knowledge levels and negative attitude towards Vesico-Vaginal Fistula. The findings will be availed to governmental and non-governmental organizations for structuring programs and strategizing on interventions targeting creation of community awareness as well as its prevention and management. These results would also be of use to the Ministry of Health for purposes of health education, policy formulation and implementation with regards to workable short and long-term Vesico-Vaginal Fistula interventions.

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