PHD-School of Public Health

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    Acrylamide determination in selected plant-based foods and associated health risk among consumers in Kibera informal settlement in Nairobi City County, Kenya
    (Kenyatta University, 2023) Towett, Anne Chepngeno
    Acrylamide is a chemical substance classified as a genotoxin, neurotoxin and a Group 2A carcinogen. It can contribute largely to the disease burden in the world. Acrylamide has been used over time in various ways. It was demonstrated to be present in food as a food processing contaminant in the year 2002. It was found to be in significant amounts in commonly consumed foods. Dietary acrylamide is a key contributor to the exposure of acrylamide in human beings. The leading sources of dietary acrylamide include potato products, cereal products and roasted coffee. The study aimed at determining acrylamide in selected plant-based foods and associated health risk among consumers in Kibera informal settlement in Nairobi City County which was selected purposively. An analytical cross-sectional research design was used to carry out the study. The sample sizes for vendors and consumers were determined using Kothari’s and Fisher’s formulae, respectively. Study participants included 248 vendors and 384 consumers of selected foods who were recruited using convenience sampling technique. Research instruments included researcher- administered closed-ended questionnaire for food vendors and food frequency questionnaire for consumers. Step-on body weight scale was used to take consumers’ weights. A laboratory 4-digit weighing scale was used to weigh the food portion sizes. A total of 162 food samples were collected. A fine blade blender was used to grind and homogenize collected food samples while high performance liquid chromatographyultraviolet (HPLC-UV) machine was used to quantify acrylamide in food samples. Acrylamide was detected in all the samples analyzed. The highest acrylamide concentration was found in crisps (246.9µg/kg) and the least was found in mandazi (44.1µg/kg). All wheat-based samples exceeded the acrylamide Benchmark level (50µg/kg). The average acrylamide knowledge of vendors was 25.8% (poor) and that of consumers was 27.2% (poor). There was a statistically significant difference (p = 0.000) between acrylamide means of food groups analyzed. Acrylamide content was statistically significantly higher in coffee (p<0.05) than in all other food samples. Chapatti contributed most of dietary acrylamide intake at 38.19% with a mean exposure of 0.097 µg/kg bw/day. The average dietary acrylamide intake from the selected foods was 17.008µg/day. All the MOEs computed for consumption of all the selected foods were below 10,000 implying possibility of public health risk for neoplastic effects. All MOEs computed for peripheral neuropathy were of no public health concern. The research concluded that based on the BMDL10 for neoplastic effects, there is a possibility of public health risk for the MOEs below 10,000. The research recommends a diversification of diet by consumers so as to minimize consumption of acrylamide loaded foods. The results are beneficial to food safety teams in Kenya and beyond and also the community where the study was conducted since the results will be an eye opener on acrylamide health related issues surrounding the communities.
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    Adherence and Treatment Outcomes among Patients with Comorbidity of Depression and Other Mental Disorders attending Psychiatric Hospitals in Rwanda
    (2014-08-18) Mutabazi, Michel
    Mental disorders constitute a serious public health problem. Besides, the co-morbidities of mental disorders pose a major problem with regard to adherence and treatment outcomes. This pseudo-longitudinal study aimed to investigate adherence and treatment outcomes among patients with comorbidity of depression and other mental disorders attending psychiatric hospitals in Rwanda. A sample of 382 patients was selected using systematic random sampling from three neuropsychiatric sites. The first and second assessments of patients took place after two and four months from each date of recruitment respectively. Data was collected during interviews using validated semi- structured tools and scales and from medical records of patients and analyzed using SPSS. It was found that the point prevalence of comorbidity of depression and other mental or neurological disorders was 31.4%. Among these patients, 18.1% had comorbidity of depression and other mental disorders but without any neurological disorder and 12.3% had depression and other neurological disorders but without any other mental disorders and 1% had depression, other mental and neurological disorders. The mean perceived social support (31.4%) was low and some patients lacked the support they needed. The mean perceived social stress (11.5%) was also low but could have effects on specific patients who experienced it. The overall level of functioning among patients was 57±13.8 falling in the GAF interval of [51-60]. This means that on average patients had moderate symptoms or moderate impairments in functioning. The overall level of adherence to treatment was found to be 65.8%. This indicates that the patients did not adhere optimally to their treatment: only 32.5% of patients achieved optimal adherence (score ≥ 80%). This is a lower rate compared to developed countries. The t-tests and chi-square tests were undertaken. The significant factors (p<0.05) influencing (hindering or promoting) adherence to treatment were medication side effects, affordability of treatment regimen, poor fit between treatment requirements and patient’s lifestyles or daily routine, poor communication, attitudes of service providers, availability of appointment staff, comorbidity of depression and other disorders, being busy, forgetfulness, travelling, social support, problems in social environment, having relatives who were stressful to patients, having economic barriers to access healthcare services and stigmatization. A weak significant relationship between adherence to treatment and treatment o number of patients who adhere optimally to treatment in order to have better treatment outcomes.
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    Advancing Breast Cancer Screening Uptake, Knowledge and Attitude through Mobile Phone Text Messaging among Women in Homa Bay County, Kenya
    (Kenyatta University, 2024-02) Odhiambo, Felix Blair
    Breast cancer is responsible for many deaths globally, especially in poor countries like Kenya. This is attributed to inadequate screening services, low knowledge on breast cancer among women besides poor access to advanced and early treatment. The problem worsens in rural areas where most people dwell. Mobile health (m-health) can improve screening and has revolutionized health sector by increasing drug adherence and clinical patient management. The purpose of this research was to investigate the possibility of improving breast cancer knowledge, attitude and screening among women in Homa Bay County, Kenya through education given using mobile phone-based text messaging service. This was a quasi-experimental design using a sample size of 340 women with intervention arm and control arm each having 170 participants. Questionnaires were used to collect both baseline and end line data among women. Ten key informant interviews were also done. Descriptive and inferential statistics were used to analyze quantitative data. Qualitative data were categorized and analyzed thematically. Test difference between baseline and end line was done using independent t test. Chi square test was applied in testing association for categorical variables. Statistical significance was set at p value less < 0.05. Predictors of breast cancer was estblished using logistic regression analysis. The result was presented in tables and charts. The results revealed low breast cancer screening amongst women in Homa Bay County with 9.7% and 9.6 % of women having gone for BC screening in the intervention and control control respectively. At end line, the screening levels were 32.3% and 19.9 % in the intervention and control respectively. There was an increase in knowledge on breast cancer and breast cancer screening after the intervention with an attributable percentage of 12.4 %. The knowledge levels tested insignificant indicating that knowledge levels were not adequate at both baseline and end line (t=0.5925 df = 8, p value= 0.5699 and (t = 0.2849, df = 8, p value= 0.7829). Significant barriers to breast cancer screening were knowledge (t=5.503, df 571, p =0.000), distance to screening facilities (t=1.908, df 564, p=0.047), and screening cost (t=0.035 df 565, p=0.050). Furthermore, there was a significant change in knowledge towards breast cancer and breast cancer screening (M = 44.4, SD = 16.1) and after (M = 50.1, SD = 15), t (17) = 6, p < 0.001). there was no significance influence on mobile based education on the altitude of women towards breast cancer screening. Sociodemographic factors related to breast cancer screening at the baseline was religious affiliation (2 =9.651, p =0.048). A multiple logistic regression revealed those who take alcohol were more likely to go for screening of breast cancer (OR =2.909, P value =0.016, β=1.068) and having a family member ever diagnosed with cancer (OR =1.950, P value =0.017). The results of this study can inform public health practitioners on the possibility of using mobile health text messaging service as an education tool on breast cancer for increased knowledge and screening. This can be adopted by policy makers in cancer education, control and management.
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    Assessment of Heavy Metal Concentration in the Environment and Perceived Health Risks by the Community around Kadhodeki Dumpsite, Nairobi county
    (2014-02-22) Njagi, Joan Murugi; Njagi, E.N.M.; Akungah, Daniel Nyagetiria; Afullo, A. T. O
    Solid wastes constitute a disaster for human health and environmental degradation. Dumpsites in Kenyan urban settlements are used as sources of nutrient rich soils for cultivating crops without regard to the risks of perceived toxic heavy metal pollution from the wastes. Water sources near the dumpsites are used as domestic water source for the people living near such sites. This water is often contaminated by toxic heavy metals leaching from the dumpsite. Heavy metals are known to accumulate in the plants then passed to the humans through the food chain. Prolonged consumption of unsafe concentrations of heavy metals through foodstuffs may lead to the accumulation of heavy metals in the humans causing disruption of numerous biochemical processes. The aim of this study was to determine the level of heavy metals in the vegetables, soil and water samples collected around Kadhodeki dumpsite. The study also sought to assess the knowledge, attitude and perceptions of the health risks posed by the site to the residents of the village. Heavy metal determination samples collected was carried out using X- ray fluorescence (XRF) analytical method. A descriptive cross sectional survey was carried out to assess the knowledge, attitudes and perceptions of people living around the study area. The analytical data was subjected to statistical tests of significance using ANOVA and post hoc analysis by Tukeys test (P<0.05) to determine whether there was any significant difference between the study sites. Chi square was used to determine if there were associations between the study variables in the survey. The research found that the vegetables under study had low levels of essential metals Fe, Mn, Zn and Cu while they had higher levels of Ni, Co, V, and more than maximum allowable levels (MAL) of Hg and Pb. V, Mn, Cu, Ni, Hg concentrations in the soil were higher than MAL for agricultural soils while Fe, Zn were within the limits. The water was contaminated by high than allowed levels of Mn (366-856 μg/l) and Fe (5132-12402 μg/l) in drinking water while Zn (40-336 μg/l) was below the WHO limits. The people living in Kadhodeki village had inadequate knowledge about the health risks which was significantly associated with the level of education (χ2 = 20.86 df=1 P<0.01). A significant association between level of education and perception was also revealed (χ2=13.57, df=1, p<0.01). Insignificant associations between age and the number of years the participants had lived in the village were found for the variables of knowledge, attitude and perception. Health education to the people living in Kadhodeki village on the dangers posed by the vegetables grown around the dumpsite should be done to prevent further consumption of contaminated crops. Farmers growing edible crops around the site should be advised to stop doing so and instead encouraged to grow other crops which can provide some earning and at the same time reclaim the land.
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    Association of functionality and nutritional status of elderly persons: a comparison between institutionalized and non – institutionalized elderly in Nairobi County, in Kenya
    (Kenyatta University, 2015-10) Mugo, Wairimu Judy
    Malnutrition has been recognized as a common problem among the elderly persons and is associated with certain diseases and impaired functioning, but less is known about its relationship with nutrition intake and nutritional care among the elderly residents. This study determined the association of functionality and nutritional status of the Institutionalized elderly and compared with that of the elderly living with their family or community members. It also compared the functionality of the two categories of elderly men and women, and determined the extent to which functional independence impacts on the nutritional status of the elderly in the Nairobi County, Kenya. The Mini Nutritional Assessment questionnaire and the Modified Barthel Index were used to measure the nutritional status and functionality of the elderly. One Questionnaire was administered to the social welfare officer in each of the sampled institutions and a similar questionnaire administered to the care-giver of the elderly in the community to collect information on Institutions and Non- Institutional characteristics that relate to nutritional status and functionality of the elderly. Two hundred and seventy elderly men and women who met the inclusion criteria were sampled, 135 from 4 Institutions and 135 from Gumba, Kariobangi, Huruma and Kawangware divisions. Data were coded and entered using EPI Info version 9 and were analyzed using SPSS version 17. The participants were randomly selected and the response rate was 98.5% for the Non-Institutionalized elderly and 96.5% for the elderly living in the Institutions of the elderly. There was a significant relationship between gender and MUAC (2 = 12.745, df = 2, p = 0.002) with the mean MUAC measure among women (0.77  4.13) being higher than that of men (0.75  0.388), t = 4.446, df = 268, p = 0.714. There were more overweight non-institutionalized elderly (20.5%) compared to those in the institutions of the elderly (14.7%). There was a significant relationship between MUAC measure and CC (2 = 68.563, df = 2, p = 0.001), with the mean MUAC measure being higher (0.76  0.401) and mean measure of CC being 0.72  0.448, f = 45.28, df = 1, p = < 0.001. Eighty eight percent of the Institutionalized elderly consume 3 or more meals per day compared to 54.8% of the non-institutionalized elderly. There were more totally dependent elderly at Institutions (13.6%), compared to 3% who were Non-institutionalized. Functionality level was found to correlate positively with self-view of health status (r = + 0.133, p = 0.046) and the intake of 3 or more prescription drugs per day (r = + 0.139, p = 0.034). Body mass index of the elderly was found to correlate negatively to Calf Circumference (r = - 0.156, p = 0.027) and Stair Climbing (r = - 0.148, p = 0.025). Protein intake was found to correlate positively to the consumption of fruits and vegetables (r = +0.139, p = 0.029). Nutritional status of the elderly was found to correlate with functional ability. National and County governments should make and implement policies that would promote the nutritional status and functionality of the institutionalized and Non-institutionalized elderly.
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    Bioaccessibility of Iron and Zinc from Micronutrient Powder Added in Germinated Porridges among Children Aged 6-23 Months in Homabay County, Kenya
    (Kenyatta University, 2021) Moraa, Momanyi Susan; Judith Kimiywe; Hudson Nyambaka
    Iron and zinc deficiency remains a burden among Kenyan children. Point-of-use fortification of complementary foods using micronutrient powder [MNP] containing vitamins and minerals has been recommended to improve the health and nutrition of children aged 6-23 months. Evidence-based information on different food vehicles for optimum bioavailability of micronutrients from the MNP is lacking. The main objective of this study was to determine the bioaccessibility of iron and zinc from micronutrient powder added in germinated porridges in children aged 6-23 months in West Kwabwai location, Homabay County, Kenya. Phase 1 of the study was the in vitro bioaccessibility of iron and zinc from germinated and non-germinated maize, millet and sorghum porridges with MNP. Non-germinated or germinated cereals were milled to flour. Porridge was cooked following the local known procedures. One-gram sachet of MNP [10mg iron as NaFeEDTA and 4.1mg zinc] was added to a 250ml cup of cooked porridge. Iron and zinc bio-accessibilities [%] were measured using in vitro dialysability methods. Factorial ANOVA was used to determine the effect of germination and cereal type on iron and zinc bioaccessibility. Phase 2 was conducted to establish the acceptability of different germinated porridges with MNP among children. The trial was single blind cluster randomized parallel study for 8 weeks with four sub-locations being randomized. A total of 200 children were selected by simple random sampling. A questionnaire and a morbidity data sheet were used to collect data on the amount of porridge consumed and health status of children, respectively. The acceptability trial data was analyzed using ANOVA. Phase 3 determined the anthropometric, iron and zinc nutritional status, and dietary intake of children. A descriptive cross sectional survey was done in the location. Using a population weighted simple stratified sampling method, 314 children were selected in the three sub-locations. Structured questionnaires were used to collect data on sociodemographic status, and anthropometric measurements of children. Food frequency questionnaire and a 24-hour dietary recall questionnaire were used to identify the complementary foods and to assess the dietary adequacy, respectively. ENA for SMART software was used for analysis of anthropometric data while Nutri-survey was used for analysis of nutrient intake. Serum content of iron and zinc were determined by spectrophotometric method. Binary logistic regression models were computed to identify the association of food and nutrient patterns as independent variables with wasting, stunting, underweight, anemia, iron deficiency, iron deficiency anemia and zinc deficiency as the dependent variables. The association was considered statistically significant when the p-value obtained was less than 0.05. Both, germination and cereal type significantly affected iron and zinc bioaccessibility. Germination significantly increased bioaccessibility of added iron in maize [1.3 to 2.7%] and millet [1.8 to 5.5%] porridges, but not in sorghum [5.3 to 4.5%; p=0.192]. Germination significantly increased bioaccessibility of added zinc in all three cereal porridges [maize: 12.6 to 30.7%; millet: 10.6 to 33.7%; sorghum: 15.5 to 38.8%]. The mean amount of germinated porridges [millet 241.46ml, maize 238.69ml, sorghum 230.29ml] consumed during the trial was more than the non-germinated porridges. The survey revealed that, at <-2SD, 17.5% of children were stunted, 13.4%; underweight, 6.4%; wasted. The prevalence of anemia, iron and zinc deficiency is 50.6%, 39.5% and 43.6%, respectively. These results indicate that germination of cereal-based porridge can significantly improve the bioaccessibility of added iron and zinc from MNP.
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    Burden of Diabetes Mellitus among Patients in Thika Level Five Hospital, Kiambu County, Kenya
    (Kenyatta University, 2019-05) Kipkalom, Rosebella J.
    The burden of diabetes is reflected not only in the increasing numbers of people with diabetes, but also in the growing numbers of premature deaths due to diabetes. One measure of burden of disease is disability-adjusted life years (DALYs), which combines estimates of years of life lost due to premature death (YLL) and years lived with disability (YLD) to count the total years of healthy life lost from disease and injury. In Kenya, Non-Communicable Diseases (NCDs) accounts for more than 50% of total hospital admissions and over 55% of hospital deaths. The major NCDs are cardiovascular conditions, cancers, diabetes, and chronic obstructive pulmonary diseases. In Kenya there were 1,976,337 NCDs cases in 2012. Nairobi and Kiambu led all other counties in NCDs with 155,899 and 126,754 cases respectively. The Kenyan health sector is predominantly financed by private sector sources (including out-of-pocket Expenses (OoPE) borne by patients, family members and relatives). However, there are only sparse data available from developing countries on the expenditure on diabetes care. Knowing the medical cost of diabetes is critical to understanding the long-term economic consequences of diabetes prevention. The broad objective of the study was to quantify the burden of Diabetes Mellitus among patients attending Thika level 5 Hospital, Kiambu County, Kenya. The study employed prospective prognostic study design and was carried out in Thika level 5 Hospital, Kiambu County. The study population comprised of diabetic patients attending outpatient diabetic clinic. The respondents were recruited into the study till saturation of 594 respondents. Data was collected for YLL, YLD, Direct costs and Indirect costs. EQ-5D-5L tool was used to measure HRQoL. Data analysis was done using SPSS, Microsoft Excel Worksheet and DISMOD II. The results showed that diabetic patient incurs a mean of KSHs 28,433 within six months (translating to approximately KSHs 56,866 per annum). According to the results from this study,43% was attributed to direct costs while 57% for indirect costs spent by a diabetes patient. A total of 805/1000 DALYs was lost as a result of premature mortality and disability associated with diabetes. Most of the diabetes patients in the study had a reduced Health Related Quality of Life(HRQoL) as per the EQ-5D-5L tool with a mean VAS of 0.55. Knowledge on burden of diabetes especially medical cost of diabetes is critical to understanding the long-term economic consequences of diabetes prevention. Thus, assuming prevention costs can be kept sufficiently low, effective diabetes prevention efforts would likely lead to a reduction in long-term medical costs. The results of this study informs policy makers in Kiambu County and Ministry of Health on need to work towards comprehensive and sustainable solutions in regard to diabetes. Based on the study findings, it is recommended that the National government and Kiambu County government of Kiambu to give priority to diabetes disease by providing free insulin and oral glycemic drugs to diabetes patients. It also recommends that the National government and Kiambu County government to prioritize diabetes care by ensuring all patients subscribe to NHIF and to cover management costs of diabetes, both for outpatient and in-patient services through NHIF, thereby reducing the economic burden of a diabetic patient and also improve HRQoL and reduce DALYs.
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    Caregivers Performance in Care and Support of HIV & AIDS Orphans and Vulnerable Children in Homa-Bay County, Kenya.
    (Kenyatta University, 2023-09) Misore, Juliana Achieng; Alloys Orago; Wilson Otenga
    Caregiver practices, which are forms of support and resources made available at the household level within the community, may be of benefit to orphans and vulnerable children (OVC). Such a desire is essential in order to give orphans and vulnerable children access to the social determinants of health, which include health care, clean & safe water, a healthy environment, food, good housing, education, and income. The availability of all and or appropriate social determinants of health for orphans and vulnerable children is decreasing due to a number of factors. Such as high poverty, weak health, social, and community systems, and inadequate caregiver support programme. There are still no proven qualitative and quantitative methods, for measuring or quantifying caregivers‟ activities, which are critical in addressing inequities among orphans and vulnerable children. This study investigated care and support practice of caregivers toward orphans and vulnerable children in North and South Suba Sub-counties in Homa-Bay County. An analytical cross sectional survey design with mixed method was used to collect both quantitative and qualitative data. Quantitative data were collected using semi-structured questionnaires and observation checklist administered to 647 caregivers. Qualitative data were collected using focus group discussion, in depth and key Informant Interviews. Descriptive and inferential statistics were used to analyse quantitative data whereas qualitative data were thematically analyzed to complement quantitative date. Findings were presented using tables pie charts and bar graphs. A sizeable majority of caregivers, 47%, were unaware of the existence of organizations offering care and support services, demonstrating a weak organizational structure. The Cramers V test was used to determine the correlation coefficient of 0.162, which measured the “caregiver‟s inability‟‟ to provide for OVC adequately. Using chi-square P=0.008, the study found that caregiver participation in OVC initiatives was at a low level. The availability of clean, safe water and the prevalence of diarrheal morbidity were shown to be strongly negatively correlated, as indicated by the tetrachoric correlation coefficient value negative. According to the study's findings, 58% of OVC caregivers in Suba North and South Sub Counties of Homa- Bay had poor performance and make less than $1 per day. The study's findings' implications for academic researchers and MOH policy makers were also discussed. The study suggested the following for policy, practice, and additional research, in that order: Making policies that support the expansion of the Community Health Strategy accessible to caregivers and their families, improving caregivers' skills in providing personalized care for OVC, participating more in OVC programs and planning, monitoring, and assessing caregivers' activities to improve caregivers‟ performance in Suba Sub counties.
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    Citizen Participation in Management of Devolved Healthcare Funds in Embu County, Kenya
    (Kenyatta University, 2021) Watetu, Kabeu Emma; Andrew Yitambe; George Otieno
    Devolution of healthcare in Africa has been advocated as a response to most healthcare ills, and to facilitate greater citizen participation. Kenya, driven by the need to bring services closer to people has now joined countries like United Kingdom, Italy and Spain in having devolved health care system, hopefully to be like South Africa and Rwanda which have successful devolved healthcare in Africa. The main objective of this study was to investigate citizen participation in management of devolved healthcare funds in Embu County. This study used cross sectional descriptive design and mixed research design. The sample comprised of 20 Members of County Assemblies, 39 chiefs, 109 sub chiefs and 1,537 voters drawn from a population of 309,468 community members aged 18 years and above. Data analysis was done using descriptive statistics, correlation and regression analysis. The study drew a response rate of 91.3%. The average age of the respondents was 41.44 (SD ± 15.83) and having lived in Embu county an average of 40.22 years. On gender, males were 53.1% and females 46.9%. Manyatta constituency had 32.0% respondents, Runyenjes 28.1% Mbeere North 23.4% while Mbeere South had 16.5%. Majority were married (54.7%) with the least being divorced (5.8%). Respondents were almost evenly distributed among casual laborers, self-employed/business and farming (24.9%, 24.1%, 23.3%). The unemployed were 12.8%. Over 70% had attained secondary education and above while 5.1% lacked formal education. Level of citizen participation was low (27.2%) with voting being the activity that showed greatest extent of participation/involvement (44.7%). Groups and organizations which influenced participation were non-governmental organizations (p = 0.012; OR=0.609) and political leaders (p=0.006; OR=0.706). Individual characteristics that significantly influenced participation in management of devolved health care funds were constituency of residence (p = 0.004; OR=1.186), occupation (p = 0.005; OR=0.866) and highest level of education (p = 0.001; OR=0.788). Budgeting and planning was the only positively significant area of citizen participation (p = 0.000; OR = 0.28). Community‘s level of awareness on legal, policy and institutional frameworks was less than 30% across all 15 frameworks examined, where five were statistically significant. The strongest was Constitution of Kenya, 2010 Article 232(1)(d) with (p=0.000; OR=3.832) others were Constitution of Kenya, 2010 Article 27 (p=0.000; OR 0.203), Constitution of Kenya, 2010 Article 33(p=0.033; OR=3.315), County Governments Act section 91(p=0.038; OR=2.104) and Public Procurement and Disposal Act 2015 Section 68(3), 125(5), 138, and 179(p=0.004; OR=0.428). M&E was the only statistically significant institutional frameworks (p<0.01; OR=0.384). On Community perception and experiences, process legitimacy and adequate access to information aspects were statistically significant with p<0.01; OR of 0.354 and p<0.05; OR of 1.298 respectively. The study concluded that Constituency of residence, awareness of the constitution of Kenya and adequate access to information were factors that greatly influence citizen participation with an OR of 1.186, 3.832 and 1.298 respectively. The study recommends that public participation needs to be facilitated and enhanced to improve service delivery in county governments in Kenya. Findings will be useful to County and National Governments policy designers as they formulate Legal and Institutional frameworks enabling Citizen Participation.
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    Constructive Men’s Engagement (CME) in Enhancing Reproductive Health in Makindu and Mutitu Sub-Counties of Kenya.
    (2014-09-01) Kimathi, George
    Reproductive health problems are the leading cause of women's ill health and death worldwide. Approximately 99% of all maternal deaths occur in developing countries, with Sub-Saharan Africa registering a maternal mortality ratio of 1,000/100,000 live births. Maternal mortality in Kenya has continued to rise since 2003, from a ratio of 414 deaths per 100,000 live births to 488 deaths per 100,000 live births in 2009. Over 56% of deliveries in Kenya are attended by unskilled people and outside health facilities. Only 28% of women receive skilled care within the first 4 critical hours following delivery. Men play cardinal and dominant roles in reproductive health. However, increasing their participation has not always been achieved. The main objective of this study was to establish individual, programmatic and healthcare provider related determinants of Constructive Men’s Engagement (CME) in reproductive health, and explore their potential for improving women’s health. An interventional quasi-experimental design was applied with interventions to promote CME-RH being implemented in Makindu Sub-county for 12 months following baseline while Mutitu Sub-county served as a control site. A total of 968 men and 32 nurses participated with 484 men respondents being interviewed at baseline and end-term in both sites. Furthermore, 8 men and 10 women FGDs, in addition to 18 KII were undertaken. A GEM Scale for CME- RH was adapted and applied to establish CME-RH levels among respondents. Similarly, a Trainer of Trainers’ manual on CME-RH was also developed and used to facilitate fortnightly CME-RH sessions with groups of men in Makindu. SPSS Ver 19.1 was used for data management with Chi-square tests, correlation and regression statistics applied for analysis. At baseline, Makindu and Mutitu had 43.4% and 44.6% of men who had CME-RH respectively. However Makindu recorded 60.3%, while Mutitu had only 47.1% of men who were CME-RH compliant at post-test. On individual characteristics, education level OR= 2.095 (0.902- 4.839) p=0.004, age of respondent OR= 1.716 (1.328 -2.438) p<0.010, knowledge on the number of times a pregnant woman should attend ante-natal clinic OR =1.738 (1.239 - 2.925) p=0.008 and knowledge of conventional family planning methods OR= 0.733 (0.579 - 0.968) p=0.043 were identified as independent predictors of CME-RH. Spousal approval for use of family planning OR= 1.316 (0.06 - 2.296) p=0.002 as well as approval for access to FP services by young unmarried couples OR= 2.881 (1.783 - 5.271) p<0.001 were also significant. Programmatic independent predictors of CME-RH were identified as having male only RH meetings/trainings OR= 1.094 (0.766 - 1.703) p=0.015, lack of confidentiality among ANC/MCH staff OR=1.297 (0.793 - 2.237) p=0.016 and the perception that RH programs have done little to involve men OR=1.963 (1.289 - 2.19) p=0.003. The capacity of health care providers including their skills, competencies and attitude also greatly influenced CME-RH. This study recommends promotion of CME-RH to be prioritized while reproductive health programs should adopt a multi-sectoral approach in design and implementation. Trainings and health promotion meetings targeting men on RH matters should always be organized for men only. Ways must also be devised to ensure staff at ANC/MCH clinics observe confidentiality with regard to client information, while RH programs must engender men to play seminal roles as prevalent at household and community level. Research would be valuable to unravel cultural values and practices that could be harnessed to promote CME-RH in Kitui and Makueni Counties.
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    Contraceptive Uptake and Adherence amongst Post Abortion Women Following Contraceptive Counselling By Physicians and Midwives in Kisumu County, Kenya
    (Kenyatta University, 2020-12) Odero, Theresa Mary Awuor
    Complications of unsafe abortion and those of incomplete abortion, led to 120,000 Kenyan women receiving Post Abortion Care (PAC) in 2012, and of these women, 70% had not used contraception before pregnancy and repeat abortion is common. The aim of the research was to explore contraceptive uptake, adherence to contraceptive use, associated factors and satisfaction with care among women seeking post abortion-care (PAC) in Kisumu, Kenya and to determine the technical competence of midwives as compared to physicians in terms of contraceptive counselling. The study (included 128 women in the quantitative study and 20 in the qualitative study) nested in a larger randomized controlled trial, where women sought PAC at two public hospitals in Kisumu, in October 2015–September 2017. The 128 women randomly assigned to a midwife or a physician for PAC, including contraceptive counselling, and followed-up after 7–10 days and three months. Associated factors for contraceptive uptake analyzed with binary logistic regression, and contraceptive method choice, adherence and satisfaction level examined by descriptive statistics, using IBM SPSS Statistics for Windows, Version 22.0 while framework analysis was used to analyze qualitative data. The results showed that of the 128 randomly selected PAC-seeking women, 95.3% accepted the use of contraception. The women were between the age of 15 and 40 years. Methods chosen after contraceptive counselling were hormonal injections (39%); contraceptive pills (33.3%) condoms (22.8%), hormonal implant (4.1%) and fertility (0.8%). None chose intrauterine device (IUD) or a permanent contraceptive method. After 3-months, follow-up 79.7% retained the chosen contraceptive method while 20.3% had changed the chosen type of contraception to another method. Women (96.1%) still used contraception, and were satisfied with the chosen contraceptive method (x2= 1.0112, df = 3, p =0.799). The twenty (20) women in the qualitative study selected from the 128 who had participated in the quantitative study, to determine their experiences of contraceptive counselling that was provided during counselling and provision of contraceptive methods. Women generally had positive experiences with contraceptive counselling from service providers and it helped them in making informed choice of contraceptives and were able to discuss the contraceptives in general and more in detail on the method of choice. Follow up visits well planned and women could visit facilities anytime they had a problem following post abortion care, before planned visits women were given a call a day before to remind them of visits. The counselling they received was effective in supporting contraceptive uptake and adherence. In conclusion, the study shows that there were no statistical difference in contraceptive uptake and adherence provided by midwives (98.5%) as compared to physicians (93.5%) in providing contraceptive methods to post abortion women effectively. Women have good experiences during interaction with midwives and physicians during counselling. Since the post abortion women were satisfied with the contraceptives counselling provided and services dispensed, meaning both physicians and midwives can provide services effectively therefore recommend the midwives to counsel and provide contraceptives to post abortion women.
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    Determinants of health inequalities among adults in Korogocho informal settlement, Nairobi, Kenya
    (2014-09-12) Eboreime-oikeh, Imesidayo Omua
    Dearth of actionable evidence of the magnitude, determinants, and mediators of health inequalities in deprived communities has hampered efforts to eliminate invidious health inequalities. The objectives of this study, which set out to bridge the knowledge gap, were to assess the magnitude of health inequalities, identify the determinants of health inequalities, and determine which material, psychosocial, and behavioral factors mediate health inequalities in Korogocho, an informal settlement in Nairobi, capital city of Kenya. Eligible, consenting adults were selected from each of Korogocho informal settlement's nine villages, for this cross-sectional, field-based study, through multi-stage mixed cluster sampling. The independent variables comprised demographic, socioeconomic, and environmental determinants while the mediating variables were material, psychosocial, and behavioral factors. Differences in the prevalence of the dependent variables: self-rated health status and self-reported chronic health conditions, were the indicators of health inequalities. Health inequalities were measured in three dimensions: health disadvantage, health gap, and social health gradient using prevalence difference, odds ratio, and concentration curves respectively. Complementary qualitative data were collected from six focus group discussions and key informant interviews. The study population comprised 719 adults aged 25 to 59 years, mean age 34.20 ± 8.68 years with 188 (26.1%) males. Ngomongo village respondents had the highest prevalence of poor self-rated health status (44.3%) while Grogan B village respondents had the highest prevalence (29.7%) of self-reported chronic health conditions. Compared to Korogocho informal settlement, Ngomongo village (Odds ratio [OR], 2.22; 95% CI, 1.44 to 3.44; P = 0.0003) and Kisumu Ndogo village (OR, 1.76; 95% CI, 1.06 to 2.93; P = 0.029) respondents suffered significant health disadvantage. Varying magnitudes of health gaps and gradients were detected in the villages except in Highridge village where the magnitude of health inequalities was not statistically significant. Social health gradients were most marked within Gitathuru and Kisumu Ndogo villages but not across Korogocho informal settlement. From binary logistic regression, older age (45 to 59 years), female gender, lack of access to health care, and village of residence were the significant determinants of health inequalities. Significant mediators of health inequalities were alcohol intake, lack of voluntary physical exercise, having multiple, concurrent sexual partners, and unprotected sex. Mediators contributed between 10.5% and 14% in females and between 30.3% and 40.4% in males, to health inequalities. The qualitative interviewees attributed ill-health mainly, to environmental pollution, poor sanitation, and poverty. To conclude, despite mass deprivations and concentrated poverty, disaggregated data showed significant magnitudes of health inequalities within and across some villages of Korogocho informal settlement. Most of the identified determinants and mediators of health inequalities were socially constructed and therefore remediable. This study provides needed policy-relevant evidence, which is based on local priorities and should help stakeholders to target policies and design interventions such as social protection, gender mainstreaming, environmental regeneration, and health promotion to eliminate health inequalities and hence leverage aggregate population health. Future large scale, longitudinal studies that incorporate life-courses perspectives are recommended to further validate the findings of this study in other deprived communities in Africa and globally.
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    Determinants of Psychosocial Well-Being of Children (10-17 Years) Affected by Hiv and Aids in Kiambu County, Kenya
    (Kenyatta University, 2019-09) Ashioya, Damaris Shihundu
    Children affected by HIV and AIDS (CAHA) are faced with psychological, social and economic challenges among others. HIV and AIDS has compounded the situation posing more suffering to children whose parents have died of the same. Children affected by HIV and AIDS have been supported in various ways by their extended families and many other organizations. While there are a number of programmes that address the material needs of CAHA, there is less emphasis in assisting these children cope with the distress associated with nursing or living with sick members of the family, witnessing deaths of their parents and suffering the consequences thereafter. The psychosocial well-being of CAHA may be affected as a result of illness and death of their parents, exploitation, stigma and separation from siblings as well as lack of adult support. The purpose of this study was to examine the determinants of psychosocial well-being of children affected by HIV and AIDS. This was a cross-sectional survey targeting 3780 children between 10-17 years affected by HIV and AIDS living in foster families from registered CBOs in Kiambu County. Multi-stage cluster sampling was used to select 345 children aged 10-17 years. First, Thika Sub County was purposively selected, in the second stage systematic random sampling was done for supporting families with CAHA and the third stage simple random sampling was carried out in foster families with more than one CAHA to select the participant for the study. Key informant interview guides, questionnaires, observation checklist and child drawings were used to collect data. Both quantitative and qualitative data were organized and categorized for analysis. Using Statistical Package for Social Sciences (SPSS) Version 20, quantitative data was analyzed using descriptive statistics; frequencies, means and percentages. Chi-square and factor analysis were used to test the formulated hypotheses. Qualitative data was transcribed, coded and categorized into themes and words to allow for analysis and presentation. Results of the study established that there was a significant relationship between care provided by foster families and psychosocial well-being of CAHA based on results of factor analysis at 61.4% and chi-square results (χ2= 4.6607; df= 4; p=0.001). This study showed that there existed a significant relationship between the types of support available in the community and psychosocial well-being of children affected by HIV and AIDS (χ2=7.8207; df =6; p=0.012). In addition, this study identified a significant relationship between coping strategies adopted by children affected by HIV and AIDS and their psychosocial well-being (χ2 = 6.4420; df= 6; p=0.003). This study concluded that there were established relationships between care provided by foster families, type of support available by the community and coping strategies adopted by children affected by HIV and AIDS and their psychosocial well-being. The study recommended that the Kenya government should commit resources to promote the psychosocial well-being of CAHA at various levels through government mandated departments. Parents can be guided to develop permanency plans for their children and finally stakeholders; County governments, schools and non-governmental organizations can work together to ensure sustainability of families and communities so that children are retained in responsive environments.
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    Determinants of Utilization of Hospital Delivery among Post-Natal Mothers in Thika and Kangundo Hospitals, Kenya
    (Kenyatta University, 2015-01-22) Kabue, Priscillah Njeri
    Maternal mortality rate due to pregnancy-related complications remains high at 488 per 100,000 live births in Kenya. If mothers are treated appropriately and in a timely manner, in a hospital almost all women who develop pregnancy-related complications can be saved from death and disability. The purpose of study was to assess why hospital deliveries in Kenya have remained low despite government strategies on improving health system and human resources. The objective of the study was to assess the determinants of utilization of hospital delivery and the rating of the health care services among postnatal mothers in Thika and Kangundo District Hospitals which are in Kiambu and Machakos Counties respectively. In view of this a cross- sectional study was conducted with an aim of establishing the factors that determine utilization of hospital during delivery. The study population was composed of eight hundred post natal mothers from Thika and Kangundo Districts attending Maternal Child Health Clinics who had delivered less than one year ago. Structured questionnaires and interviews were used to collect the data. In addition, Focus Group Discussions were conducted in each District and Key informants interviewed. Quantitative data was analyzed using SPSS for windows version 16 and data presented in form of tables and bar charts. The qualitative data from the focus group and Key informants was transcribed and a summary written. From the study Client oriented factors that were found to be associated with hospital delivery in both Kangundo and Thika included occupation (p = 0.028, p = 0.007), having money to go to the hospital (p = 0.000, p = 0.00), short distance from the health facility (p = 0.001, p = 0.029), and client having delivered in the hospital before (p = 0.000, p = 0.000) respectively among others. On binary regression Client oriented factors that predicted place of delivery in Kangundo were education level, previous delivery in a hospital and number of antenatal clinic attendance while in Thika they included client view of health worker, previous delivery in a hospital and economic factors. Health facility oriented factors that were associated with hospital delivery in Kangundo were lack of privacy (p = 0.000) while in Thika the manner in which the mother was handled by the health care worker (p = 0.001) and whether the mother received expected care (p =0.017). Rating of the health care services in terms of acceptability was average with only half of respondents feeling that the services were acceptable in both hospitals. In terms of accessibility 74% could access the hospital through matatus. In terms of availability time taken to be attended was rated above average while availability of health facilities and services required was below average in both districts. Quality of care during delivery was rated high in both districts with 72% of the respondents being assisted during head delivery but in terms of infection control this was above average. The research concludes that mothers do not utilize the health facility for delivery in both areas because of cost of the services, distance from the hospital, negative attitude of the health workers, lack of privacy and poor quality of care. Information generated by this study will be recommended to the policy makers in the Ministries of Health for use in addressing the challenges facing hospital delivery therefore promoting it leading to reduction in maternal morbidity and mortality.
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    Drivers, decision making processes and outcomes of unsafe abortion in four districts of Siaya County, Kenya .
    (2013-03-18) Osur, Joakim
    Unsafe abortion is a major public health problem causing 13% and 30% of maternal deaths globally and in Kenya respectively. Despite this, the drivers of the practice in Kenyan communities are scarcely documented. Further, little is documented about the decision making process for women who chose unsafe abortion and whether social networks have a role on this. In addition, not much is known about the methods unsafe abortion providers use and the outcomes of the methods. The objectives of this study were, therefore, to determine the drivers of the practice; find out how social networks influence women's decisions to procure abortion; and determine outcomes of methods used in Siaya County. The study employed a mixture of quantitative and qualitative techniques including cross-sectional survey of 320 patients presenting to health facilities after attempted unsafe abortion; case studies of 8 women who had undergone unsafe abortions; one enquiry into unsafe abortion related death using Rashomon technique and in-depth interviews with 12 unsafe abortion providers and 21 key informants. The findings indicated that women procuring unsafe abortions were mostly below the age of 24 years (76%), in their first trimester of pregnancy (85%) and presenting to health facilities with incomplete abortion (87%). The most commonly reported drivers of unsafe abortion included inadequate infrastructure and equipment in health facilities with all facilities studied not having a full complement of recommended conditions. Only 5.5% of eligible health workers were competent and willing to provide termination of pregnancy services. At community level, unsafe abortions were associated with desire for a good life, pressure from social contacts, and the determination of unsafe abortion providers to give the service. Social networks were found to play a role in the woman's decision making process with 95% of the women consulting with their social networks before making a decision. These consultations led to 63% of women owning a decision to abort while the rest were either not sure or even felt compelled to abort. Logistic regression predictions showed that the man causing the pregnancy and the woman's mother were the most influential persons in cases of unsafe abortion. A case fatality rate of 0.3 per 1000 women aged 15 - 44 was recorded. Other severe complications included hemorrhage requiring blood transfusion and pelvic infection. A Chi square test revealed significant difference in the outcomes of unsafe abortion based on the methods used (X2 = 193, df = 30, p 0.05). Logistic regression predictions confirmed that the outcomes depended on methods used, genital tract injury, for example, being 30%, 120% and 370% more likely to occur with use of self -inserted gadgets, self- inserted medicine and gadget inserted by someone else respectively as compared to hemorrhage not requiring transfusion. It is recommended that the Ministries in charge of Health and NGOs running programs to reduce unsafe abortion prioritizes community involvement as a way of reducing unsafe abortion; give unsafe abortion providers capacity to counsel and refer patients to health facilities; and that the identified drivers of unsafe abortion are addressed comprehensively.
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    Effect of Health Education Intervention in the Management of Type-II Diabetes Mellitus among Adults Attending Garissa County Referral Hospital, Kenya
    (Kenyatta University, 2022) Abdalla, Abdirahman; Ephantus W. Kabiru; Tom Were
    Diabetes mellitus (DM) is a metabolic disorder that is characterized by hyperglycaemia due to defective insulin action and/or secretion. Diabetes mellitus type-2 (DM2) is the most common and a major public health burden in Kenya. It is projected to reach a prevalence of 4.5% by the year 2025. Effective interventions for DM2 comprise improving diabetes knowledge, individualized health education, lifestyle and behavioural change, monitoring body mass index (BMI) and diabetes control markers, as well as pharmacological interventions. Despite studies showing that health education and improved knowledge of diabetes predict improved plasma levels of diabetes control markers in the DM2 patients, these markers have not been used in the management and control of the disease in Garissa County. The main objective of this study was to establish effect of group health education in the control and management of DM2 at Garissa County Referral Hospital. This study utilized an unequal proportion prospective quasi-experimental study among a total of 152 adults stratified into intervention (cases, n=83) and control (n=69) groups. The cases were individuals with DM2 from among those (n=500) who were screened following fasting. The controls comprised DM2 patients on standard care. The study participants were purposively selected into each arm of the study. Structured questionnaires were used for collecting socio-demographic, socio-economic, and lifestyle data. The intervention group was offered group based standard health education program. Baseline and post-test measurements of the diabetes control markers were analysed in both the cases and the control group. Data analysis was done using IBM/SPSS version 27.0. Socio-demographic and socio-economic assessment indicated that the distribution of age, gender, education levels, marital status, monthly house-hold income, house-hold size, and familial history of diabetes was similar between the cases and controls. The prevalence of type-2 diabetes was 16.6%. Lifestyle evaluation indicated higher rates of smoking a pack of cigarettes daily (71.1% vs. 24.6%) or more than a pack of cigarettes daily (9.6% vs. 17.4%; χ2=33.289; df=2; P<0.0001) in the cases and controls, respectively. Overall levels of good knowledge in the cases and controls at baseline (57.8% vs. 72.5%; χ2=3.816; df=1; P=0.051); and after intervention (88.0% vs. 66.7%; χ2=11.058; df=1; P=0.001), respectively. Diabetic control marker analysis indicated that only HbA1c levels were significantly lower in the cases compared to controls at baseline (P=0.002). After intervention, BMI (P=0.005), HbA1c (P<0.0001) and fasting glucose (P<0.0001) were significantly lower in the cases relative to the controls. In addition, among the intervention group, the BMI, HbA1c, LDL-cholesterol, HDL-cholesterol, triglycerides and fasting glucose were significantly lower after intervention compared to baseline levels (P<0.01 for all). Altogether, these results indicate that group health education intervention had an effect in improving the levels of knowledge on diabetes as well as improving the levels of diabetes control markers. Thus, it is recommended that promotion of group-based health educational programs improves management of DM2.
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    Effect of Mhealth Technology in Enhancing Postnatal Visits amongst Mothers Attending Mch/Fp Clinics in Selected Hospitals in Kakamega County, Kenya.
    (Kenyatta University, 2022) Ngigi, Charles Kiragu; Justus O. S. Osero; Anthony Wanyoro
    Postnatal care is the provision of health services to the mother and newborn after delivery. It offers the opportunity to assess the mother for any medical, mental, emotional and social issues, and early assessment of risk factors and physical problems with the baby. Postnatal care services are offered by skilled health care workers during the postnatal visits. In Kenya mothers are expected to attend a minimum of four postnatal visits spread across the postnatal period though only a few do that. Globally, very few postnatal mothers seek postnatal services within two days. High maternal and neonatal mortality rate is observed during the first forty two days after child birth. This trend continues throughout the first year of the neonate. The main goal of the study was to determine the effect of mobile health technology in enhancing postnatal visits among postnatal mothers in Maternal Child Health and Family Planning (MCH/FP) clinics in designated health facilities in Kakamega County, Kenya. The study was designed as a cluster Randomized Controlled Trial (RCT) that involved four arms. In control arm the participants received only the routine written and verbal communication whereas in intervention arm 1, participants received routine verbal and written communication and mobile SMS, in arm 2 they received written and verbal communication and a voice call whereas in arm 3, the participants received written/verbal communication and combination of voice call plus Short Text Messages sent to remind them to visit the postnatal clinic. The reminders were packaged together with postnatal (PN) educational health messages. The research involved a study population of 320 postnatal mothers attending MCH/FP clinics. The study sites were purposively selected from four Sub Counties in Kakamega County. Study subjects were selected using a systematic sampling technique until the target was achieved. Quantitative and qualitative data was collected using interview, FGD and KII guides. Data was entered into Microsoft Access data base and analysed using SPSS version 24. At the baseline it was observed that 27% of the participants adhered to 2nd and 3rd postnatal clinic visits. After the intervention there was significant difference (χ²=28, df=3, p=0.001) between control and intervention arm. Majority of participants (82%) had no/low knowledge on postnatal care before the intervention, however there was significant difference in knowledge between control and study arms (χ²=113, df=9, p=0.000) after sending health messages. This study concluded that postnatal mothers in Kakamega County have low or no knowledge on postnatal care and only a few attend postnatal clinic within two weeks. This is likely to affect the uptake of postnatal services. Postnatal mothers had a positive attitude on use of mobile health technology in health care. There is a significant relationship between mobile phone reminders and adherence to 2nd and 3rd postnatal visit. Kakamega County government should integrate use of mobile telephone services packaged together with postnatal educational health messages in the provision of health services.
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    The effect of selenium intake in progression of asymptomatic hiv type 1 infected children in Nyamasaria sub county Kisumu County Kenya
    (2015) Otieno, Samwel Boaz
    The prevalence of the Human-Immuno-deficiency Virus has been observed to be inversely related to selenium levels in foods. More recent Demographic Health Surveys have shown that despite the prevalence of HIV reducing by half in Kenya the prevalence in Kisumu County still remains twice the National prevalence, which suggests that there could be other factors involved in HIV epidemiology in the County. The hypothesis of this study was that selenium intake does not cause rapid progression of to AIDS from HIV infected children in Kisumu County. The main objective was to determine the effect the intake of yeast selenium on CD4 T cells and Weight for Age Z Score in HIV positive children (3-16 years). In this study a total of 68 HIV positive children were registered in the study to asses the efficacy of selenium. Yeast selenium (50μgm) was given to 34 children while the remaining 34 were put on a placebo.Blood samples and weight of the both groups were taken at 3 months intervals from 0, 3months and 6 months. The blood samples were analyzed by Enzyme Linked Immunosorbent Assay for CD4T cells while Weight for Age Z score was analyzed by Epi.Info version 3.4 and SPSS version16 for significance.In the study it was shown that children on selenium had progressive improvement of WAZ and which was significantly different at six months between children on selenium and the controls {F (5,12) = 5.758, P=0.006}.By using -2 standard deviations Z scores as a measure of cut-off, 15% boys and no girl on selenium was wasted at six months. Among the controls 64% of boys and 38% of girls were wasted at six months. The children on selenium had weight gain of up to 2.5 kilograms in six months. There was a significant mean increase CD4 T cell count at six months among the children on selenium,{ t( 1, N=30) = -2.943, p=0.006} compared to the matched controls {t =(1,N=30) =1.258 p= 0.0.0218}. CD4 T cell count increased among all age groups on test,3-5years (+ 267.1),5-8 years (+200.3) 9-15 years (+71.2) cells/mm3 . In matched controls a decrease was observed in all age categories, 3-5 years (-71),5-8 years (-125) and 9-13years (-10.1) cells/mm3 . There was no significant difference in CD4 T cell count between boys {F (2, 32) = 1.531 p= 0.232} and between girls {F (2, 49) = 1.040, p= 0.361} and between boys and girls {F (5, 81) = 1.379, p= 0.241} among the children on test. Similarly no significant difference was observed between boys and girls {F (5, 86) = 1.168, p= 0.332} in matched controls. In the test group there was a significant positive correlation between weight for age (WAZ), and CD4 T Cell Count p=0.007, R2= 0.252, F<0.05, β =252.23.There was a significant correlation observed between Weight for Z score and CD4 T cell count{ t( 2, N=27) = 2.94 p=0.007} with β = +252.23 and adjusted R² of 0.2016..In matched controls no significant correlation between weight for age Z-Score and CD4 T cell count change was observed at six months{ t (2, N=26) =0.08 p = 0.934} with β coefficient of +3.366 and adjusted R² =0.0337 .No positive correlation was observed among the children on selenium between CD4 T Cell count, and gender {t (2,27) = -0.69 p=0.0.495} with β coefficient of -138.23. Similarly in a matched control there was no significant correlation between CD4 T cell count and gender {t (2, N=26) = -0.90 p= -0.380} with β coefficient of -135.50.Majority (96.78%) of children on test either remained or progressed to WHO immunological stage I. It can be concluded that selenium intake slowed the rate of progression to AIDS from HIV positive patients as shown by increase in CD4 T cell count and further that there was no significant response between girls and boys. It is recommended that selenium be given as supplement to the HIV positive children on WHO clinical stage I to III as away of delaying progression to WHO stage IV.
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    Effect of Training Mothers and Motorcycle (Boda-Boda) Riders in Community-Based Referrals on Maternal Outcome in East – Central, Uganda
    (Kenyatta University, 2021) Mwebaza, Muluya Kharim; Rucha Kenneth Kibaara; Peter Kithuka; John Francis Mugisha
    Uganda has a reproductive health situation characterized by delayed community maternal referrals; and yet timely referral to skilled care is essential for pregnant mothers who are at high-risk, to have immediate access to appropriate health care. This has led to few safe deliveries at health centres (52 percent in east – central region compared to 74 percent nationally). Maternal mortality ratio (MMR) at 346 per 100,000 live births and neonatal mortality rate (NMR) at 27 per 1,000 live births respectively in east – central Uganda is high compared to 211 per 100,000 live births and 20 per 1,000 live births respectively globally. This study aimed at training expectant mothers and boda-boda riders on innovation, communication and technology, fleet management, the roles of the different stakeholders and the prevention and management of emergencies. This enabled the establishment of the effect of training of boda-boda riders and expectant mothers in community-based referrals on maternal outcome. This study used a non randomized control trial study design of community intervention. Four sub-counties were selected in the intervention and 4 in the control arms respectively. The study population consisted of 503 pregnant mothers in their third trimester and 192 boda-boda riders randomly and conveniently sampled respectively. Self administered questionnaires, in-depth and key informant interviews, focus group discussions, and secondary records were used to collect both quantitative and qualitative data. Descriptive and inferential data analysis methods using STATA version 14 was conducted for quantitative data. Thematic analysis was done using Ti 7 software atlas. Findings revealed that 70.5% of mothers used boda-boda transport to health centres to deliver, of whom 69.4% were trained boda-boda riders in the intervention arm. Only 51.2% of mothers used boda-boda transport in the control arm. Socio-demographic characteristics of mothers; age (25 – 34 years OR=17.581, p=0.001 and 35 – 44 years OR=247.660, p=0.000), religion (Protestants OR=0.122, p=0.013 and Moslems OR=0.197, p=0.050) and means of transport used by mothers (Motorcycle OR=5.132, p=0.001 and Walking OR=35.732, p=0.000) influenced the maternal outcome. Only age and ownership of motorcycles for the boda-boda riders influenced maternal outcome (25 – 34 years OR=11.351, p=0.000; Personal ownership OR=3.549, p=0.002 respectively). Also, attitude of mothers on comfort of boda-boda transport influenced the maternal outcome (OR=8.352, p=0.011). Communication systems, that is, possession of phones by mothers (OR=4.200, p=0.000) and time interval boda-boda rider took to respond when contacted (21 – 30 minutes OR=0.124, p=0.002 and 31 – 60 minutes OR= 0.003, p=0.000) had effect on the maternal outcome. Lastly, knowledge attained during training by boda-boda riders on fleet management and referral systems had effect on maternal outcome (OR=1.202, p=0.022). For mothers, knowledge attained on the roles of stakeholders and fleet management and referral systems had effect on maternal outcome (OR=2.290, p=0.011 and OR=0.117, p=0.009 respectively). In conclusion, increase in knowledge of mothers and boda-boda riders, system of communication, attitude of mothers and socio-demographic characteristics increased supervised deliveries and have demonstrated its potential in addressing the challenges associated with community referral needs in rural settings. This adds credence to the need for rolling out of training of mothers and boda-boda riders to a greater geographical area. It will also be useful to policy makers whose efforts are geared towards increasing health facility-based deliveries to reduce MMR and NMR.
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    Effectiveness of a Mobile Phone Based Intervention in Improving Medication Adherence among Hypertensive Patients in Nyeri County, Kenya
    (Kenyatta University, 2023-12) Mutua, Ernest Muthami
    Globally, non-adherence to prescribed medications is identified as a major barrier to blood pressure control among persons living with hypertension. Uncontrolled hyperten sion is a leading risk factor for heart disease, kidney disease, stroke and general poor health. In Kenya, over a quarter of the adult population is estimated to be living with hypertension, with only 12.5% of them having their blood pressure under control. This study sought to evaluate the effectiveness of a mobile phone based intervention in im proving medication adherence among hypertensive patients on follow-up in Nyeri County. The study adopted an interventional design conducted in two phases. In phase I, a total of 339 hypertensive patients attending two tertiary care hospitals (Consolata Mathari Mission Hospital and Nyeri County Referral Hospital) were enrolled in a base line cross sectional survey to assess the extent to which they were adhering to their pre scribed medicines, and also to explore the factors associated with their medication tak ing behavior. In phase II, a two arm parallel randomized controlled trial comprising of 120 patients who had been found to be non-adherent to their prescribed medicines in phase I was undertaken to evaluate the effectiveness of a mobile phone based interven tion in supporting medication adherence. Participants in the experimental arm received the study‘s mobile phone based intervention on top of the usual care offered in the out patient clinic, while those in the control group were continued on the regular care only. The mobile phone intervention comprised of text messages and voice calls to deliver hypertension related health education to patients allocated to the experimental arm. The primary outcome variable of the study was medication adherence, which was assessed using a validated medication adherence questionnaire and calculation of the proportion of days a patient was covered with medication (PDC) during the follow-up duration. Nearly half (46.6%) of the 339 patients who participated in the baseline survey were non-adherent to their prescribed medications. After fitting a multivariate logistic regres sion model, the factors that were significantly associated with antihypertensive medica tion non-adherence included: having poor hypertension knowledge (adjusted odds ratio (AOR), 5.6, 95% CI, 3.3, 9.4); being on multiple medications (AOR, 2.8, 95% CI, 1.7, 4.7) and receiving two or more daily doses of medications (AOR, 2.3, 95% CI 1.3, 4.0). In the randomized controlled trial, it was established that the study's mobile phone based intervention led to a statistically significant medication adherence improvement effect over a 6 month period of follow up; patients who had received the mobile phone based intervention were 6.1 times more likely to be adherent than those who had been on usual care only (95% CI 2.6, 14.3). The intervention also resulted to a significant improvement in blood pressure control; at the end of follow up, patients who were in the experimental arm were 4.6 times more likely to have achieved the target blood pres sure level compared to their counterparts in the usual care group (95% CI, 2.0, 10.3). The intervention also led to an improvement in patients‘ knowledge and perceptions about hypertension and the need for persistence with medication use. Overall, this study found that use of an educational mobile phone based intervention was effective in en hancing medication adherence among patients on hypertension treatment. Given the central role of medication adherence in hypertension management, the intervention may be considered as an additional component in the comprehensive care given to patients living with hypertension.