MST-Department of Health Management & Informatics

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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.
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.
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).
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 HIV-positive postnatal clients’ satisfaction with prevention of mother-to-child transmission services at Kenyatta National Hospital, Nairobi, Kenya
(Kenyatta University, 2016-07) Gikonyo, Jackson Mwaniki
In the era of HIV and AIDS global pandemic, clients‟ satisfaction is one of the outcome measures for the free PMTCT services and HIV/AIDS care.Despite increasing availability and accessibility to free PMTCT services in Kenya, there is inadequate information on clients‟ satisfaction with PMTCT services.This study aimed at establishing the levels of HIV- positive postnatal clients‟ satisfaction with PMTCT services offered in post pregnancy clinic atKenyatta National Hospital, possible influencing factors and improvement strategies to enhance achievement of desired clients‟ satisfaction. A descriptive cross sectional study was conducted for HIV-positive postnatal clients. A simple random sampling was used to obtain 139 participants at service exit after consideringformulated eligibility criteria (exclusion and inclusion).Quantitative data was collected by use of in-depth exit interviews and focus group discussions. Data was processed using SPSS software version.22 to test hypothesis and explain relationships.Results were considered significant when p-value was equal or less than 0.05.The results revealed that integrated PMTCT services were offered in every clinic appointment.Results from Chi-square test were further confirmed by use of logistic regression analysis that showed that; waiting time (p<0.01), resources and infrastructure (p<0.01), clients‟ level of knowledge of HIV (p<0.01), health providers‟ attitudes (p<0.01), provider-client communication (p<0.01), psychosocial support and stigma (p<0.01) were found to have influenced clients‟ satisfaction with the PMTCT services.The study findings enabled the rejection of null hypothesis and adoption of alternative hypothesis. Overall, the study results revealed that majority (86/139) of the respondents were satisfied with PMTCT services offered while more than one third of the respondents (53/139) were dissatisfied. Clients‟ satisfaction was associated with staff understanding of clients‟ needs, desires, expectations and concerns, quality of services or care received,adequate counseling,strong psychosocial support servicesand quality laboratory services. The clients‟ dissatisfaction was associated with long waiting time, delayed laboratory investigations, pharmacy being located far from the clinic, high cost incurred when travelling to seek for PMTCT services from their residential zones, inadequate privacy and confidentiality etc.The study yielded a range of new insights on strategies for achieving desired satisfaction with PMTCT services such as reduction of waiting time, performance and quality improvement, improved infrastructure and supply of relevant resources, improved integration and organization of relevant services such as partner involvement, child healthcare, HIV testing services etc. The improvement strategies will enhance efficiency and effectiveness in provision of PMTCT services as indicated in the national guidelines.The study recommends that stakeholders of PMTCT program embrace and implement the proposed improvement strategies, facilitate similar studies in future throughout the country to identify experiences, service quality gaps and model best practices for sharing among stakeholders to strengthen PMTCT program in the country.
Barriers to early diagnosis of invasive cervical cancer among patients receiving treatment at Kenyatta National Hospital, Nairobi Kenya
(2014) Korir, Anne Rugutt
Although cancer still remains a major health problem, early diagnosis and improved therapeutic interventions of cervical cancer in developed countries are quite different from what is observed in the developing countries; Kenya included. In resource constrained environments, limited access to oncology facilities, coupled with the stigma associated with cancer has much influence on the disease reporting and management. While the biological factors associated with early diagnosis and proper management have been documented, there is need to clearly define the role of individual, social, cultural and economic factors as determinants of early diagnosis of cervical cancer. The main objective of the study was to determine the barriers to early diagnosis among cervical cancer patients. Kenyatta National Hospital was chosen because it is the only national referral hospital in Kenya with radiotherapy machine used in treatment of cancer patients. Given that the cost of treatment is lower than the private hospitals, it attracts a large number of patients as referrals from the forty seven counties in the country. This was a descriptive survey using researcher-administered structured questionnaires to obtain data from a sample of 320 cervical cancer patients in Kenyatta National Hospital‟s radiotherapy clinic and among in-patients. To corroborate the findings from the patients, key informant schedule was administered to 30 healthcare personnel who interact closely with these patients to seek their views on reasons for late diagnosis. The data was analyzed using SPSS version 16.1 and presented in frequencies, graphs and tables. Chi square was used to test association among variables and significance level was set at 0.05. Individual patient‟s attitudes of the disease and health seeking behaviour were analyzed and correlated with the measurable outcomes which include; time lapse to disease diagnosis, age, socio-economic status, cultural factors, health facility-related factors and reaction time by health personnel. The findings have been correlated with time of onset of disease to diagnosis and treatment. The findings of this study established that general lack of knowledge on cervical cancer (75.3%) was significantly associated with late diagnosis (Chi-square=9.27 (1, N= 320; p=0.0023). A preponderance 266 (83.1%) had no knowledge on screening tests prior to diagnosis while only 54 (16.9%) were aware of Pap smear test. Similarly education level (² = 20.62 (3, N=316, P<.0001) was significantly association with late diagnosis of cervical cancer. Logistic regression analyses showed that higher education attainment was associated with 0.58 lower odds of late diagnosis of cervical cancer. Other social factors like age at diagnosis, locality, marital status and religion did not show any significant association with either early or late diagnosis.This study recommends that well organized cancer awareness and screening programmes be established while considering aspects of accessibility and affordability. Strengthening healthcare and referral systems, as well as continuing education of existing healthcare providers is recommended.
Clinician Workload Determinants at Paediatric Wards of Selected Private and Public Hospitals in Nairobi City County, Kenya
(Kenyatta University, 2020) Kiura, Daniel Munyi; Andrew Yitambe; Goretti Ofafa
Human Resources for Health is a key pillar of healthcare provision necessitating prudent staffing norms to meet workload demands of health facilities. Uniform staffing norms across health systems based solely on policy guidelines can no longer be used at facility level without adjusting for facility specific trends of workload determinants such as occupancy the omission of which results in poor outcomes or wasted resources due to inadequate staffing mix. The study utilized a cross sectional design & sought to confirm or disapprove the correlation between bed occupancy and patient care activity time with clinician workload at paediatric wards of selected public & private hospitals in Nairobi County, Kenya and drive for determinant informed application of staffing norms in the different settings of the health sector. A validated staffing standardization model was used to estimate Clinician Workload. The different types of activities that clinicians carry out in their daily work were determined through key informant interviews. Results of the interviews helped design a work sampling data collection tool through which observations were made on the frequency of patient care activities carried out by the clinicians and thus established activity times. Activity time data collected from the survey was analyzed using Statistical Package for Social Sciences (SPSS) version 22 and factored into the validated model so as to derive workload and the corresponding clinician staffing level. Multivariate linear regression analysis was used to correlate the various independent variables and clinician workload followed by test of significance for each variable. A sample of 6188 observations were made among 115 clinicians with a distribution of 4,890 (79.0 %) observations for direct patient care activities, 771(12.5 %) observations for indirect patient care activities and 527(8.5%) observations on allowance activities. Differences were observed between public & private facilities in average bed occupancy (2= -0.505, df= 53, p = 0.000) and proportion of time spent by clinicians in direct patient care activities (2= -10.995, df=53 p = < 0.05) but no significant difference in workload required (t=- 1.415, df=53, p= 0.163). There was varied but significant correlation between various variables and workload including direct patient activities (r=.743, P< .000), indirect patient activities (r=-.311, P< .021) and bed occupancy (r=.314, P< .020). The study concluded that workload increases by one unit with every 8.8% change in direct patient care activities volume, every 5% change in indirect patient care activities and 14.3% change in bed occupancy with the three factors accounting for 54.4%, 9.7%, and 9.8% of the determinants of workload respectively. Multivariate regression of the combined factors of patient care activities, allowance activity, ward occupancy and facility owner found these factors to account for 85.9% of the variation in clinician workload (p-value <0.001). The study recommends that the magnitude of direct patient care activities should be considered when determining clinician workload, that strategies of reducing the effect of indirect patient care activities on clinician workload should be devised and that bed occupancy trends should be studied and factored into workload determination derivation of staffing norms.
Clinicians User Satisfaction with Paper-Based Patient Information System in Kenyatta National Hospital and Mbagathi County Hospital, Nairobi, Kenya
(Kenyatta University, 2016) Kimani, Alice Wanjiku
User satisfaction with paper-based information system is a subjective evaluation of the various individual, organizational, and societal consequences of information systems use. Despite the widespread use, the need to identify the extent to which clinicians are satisfied with the patient information systems in health institutions is still necessary. The purpose of this study was therefore to investigate the clinicians' (doctors, dentists and clinical officers) user satisfaction with paper-based patient information systems in Kenyatta National Hospital (KNH) and Mbagathi County Hospital (MCH).The specific objectives were: To determine the proportion of clinicians who were satisfied, to determine the influence of user characteristics, to determine the organizational characteristics that influenced satisfaction and to determine the influence of information quality to clinician’s satisfaction. This was a cross sectional descriptive study. The two hospitals were purposively selected. The study employed stratified random sampling. Probability proportionate to size sampling of the clinicians was done and simple random sampling was done to identify the respondents. Data collection tools employing both quantitative and qualitative parameters were used in this study. Questionnaire was pretested in Mathari Hospital and thereafter refined accordingly. Data was obtained from 190 clinicians using self-administered questionnaires, FODs and KT interviews to provide in-depth information. Data was analyzed by SPSS Version 16.0 and the results of the findings presented in form of figures and tables while association between variables was assessed using chi square statistics. The findings showed that clinician's satisfaction was at 15.3%. Age (x2=42.079, df=3, p=.OOO), years worked (X2=41.973, df=4, p=.OOO), education (X2=4.518, df=I, p=0.034), designation (X2=23.385, df=3, p=.OOO) was statistically significant to clinicians user satisfaction. Overall organizational characteristics (X2=6.409, df=l, p=.Oll) and information quality dimensions (p< .01) was statistically- significant in relation to clinician's user satisfaction. The study therefore showed need to address factors that contribute to very low clinicians' satisfaction level with paper based patient information systems. Findings of this study will be used by policy makers to develop policy on information systems to ensure that clinicians' requirements are met.
Compliance with the Medical Records Documentation Standard Operating Procedure among Health Workers in Bungoma Hospital County, Kenya
(Kenyatta University, 2021) Omoit, David Franklin Opudi; George O. Otieno; Kenneth Kibaara Rucha
Improving medical records documentation among the health workers remains a major challenge to achieving compliance to medical records documentation SOP in many developing countries. Compliance to medical records documentation SOP can be used to improve health care and protect people against catastrophic health care risks and expenses. Most developing countries have low compliance to medical records documentation SOP and rely on manual systems for documentation. Despite having automated systems in some private and public health facilities, compliance to medical records documentation is still below the acceptable standards. The main objective of this study was to establish compliance with medical records documentation SOP among health workers in Bungoma level 4 hospital, Kenya, with specific objective of determining association between socio-demographic characteristics and compliance with medical records documentation SOP, influence of institutional characteristics and, influence of health workers' IT Proficiency on compliance with medical records documentation SOP among health workers in Bungoma level 4 hospital. The current study adopted an analytical cross-sectional design and quantitative data was collected using self-administered questionnaires, stratified proportionate and simple random sampling techniques were both employed to select 197 health workers sampled from a target population of 400 in Bungoma level 4 hospital. Chi-square, fishers exact, and Binary logistic regression analyses were used to test the association and the relationships between dependent (compliance with medical records documentation SOP) and independent variables (sociodemographic, institutional, and IT proficiency) respectively, albeit at a 95% confidence interval (CI), frequency tables, pie charts, and bar graphs were used to summarize and present the results. The current analysis confirmed that the compliance level to medical records documentation SOP was indeed very low at 47.2%. Socio-demographic factors such as Cadre (Fisher‟s exact test =24.52; p=0.002), level of education (Fisher‟s exact test =11.26; p=0.042), and work experience χ2 (8.75, df=5, N =195) p=0.047 were significantly associated with compliance to medical records documentation SOP. On both Institutional characteristics (P=0.023, exp(B)=1.454) and healthcare worker‟s Information Technology proficiency (P=0.027, exp(B)=2.156), positively influenced compliance to medical records documentation SOP. The current study concludes that, cadre, level of education, and work experience were significantly associated with compliance to medical records documentation SOP, Institutional characteristics like technical support, requisite documents, staff training and, health worker‟s information technology proficiency, positively influenced compliance to medical records documentation SOP respectively. The study therefore, recommends an urgent need for the County Government to channel additional funding towards employing more technical staff, procuring the requisite documentation tools, and training of staff on the documentation tools. Otherwise, the facility health management team needs to factor in periodic Information Technology refresher training for health workers, since the majority of health workers in Bungoma level 4 facility seem to have at least an intermediate level of IT proficiency. Future research should incorporate more robust data collection methods like observation checklists, and also consider qualitative methods like Key Informant Interviews to establish better insight on the compliance with medical records documentation SOP across all level 4 health facilities in Bungoma County and beyond.
Compliance with the Provisions of Section 126 of The Public Health Act (Cap 242) By Public Food Places in Bungoma County, Kenya
(Kenyatta University, 2015) Ogweno, C.
The public food industry in Bungoma has been experiencing numerous challenges in their quest to comply with the Public Health Act (CAP 242), especially section 126. Consequently, the study sought to establish the extent of compliance with the provisions of Section 126 of the Public Health Act (Cap 242) by public food places in Bungoma County, Kenya. The government has channeled few resources towards enforcement of public health laws in the county regardless of the high levels of court fines and summons issued to proprietors within public food places. Studies determining compliance with public health laws, especially section 126 among public food places have either not been conducted or inaccessible. One of the objectives of the study was to establish the extent of compliance with the provisions of section 126 of the Public Health Act by public food places in Bungoma County, Kenya. The second objective was to establish the factors influencing the public food places proprietors’ ability to comply with Section 126 of the Public Health Act. The last objective was to establish the association among socio-demographic characteristics, public food places characteristics, practices and compliance levels. The study took a cross-sectional survey conducted across public food places in Bungoma County. A representative sample was obtained using the fisher et al (1991) approach. The total number of public food places as per the records in the Bungoma County offices is 639. However, the respondents chosen for the study was 149 after the sampling process. The respondents were obtained using a formulated eligibility criterion (exclusion and inclusion). Data was collected using inspection checklists, structured questionnaires, interviews and focus group discussions. A database that facilitated the analysis process was then created using SPSS. However, the analysis process used stata software. The association between hotel characteristics and compliance were considered significant when the p value was equal or less than 0.001. The results on compliance out of a possible score of 5 based on likert scale was certificate of fitness (3.1), wells, tanks and cisterns (2.9), stoves, cooking apparatus and chimney (2.1), construction, repair of dilapidated buildings and escape routes for occupants (2.2) and erection of movable objects, excavations and projections (2.3). The mean compliance for sewerage system was (2.2), removal of refuse on an hourly basis was (2.6), regulating sanitary conveniences was (2.1), ventilation and dimension of rooms was (2.9) and lighting was (2.9). An independent t-test indicated that on average, there indeed was a statistically significant difference in the mean compliance level between male and females with female gender being less compliant than the male gender (p=0.0001). A one-way anova test also revealed that those with less education (primary level) were less compliant as compared to their counterparts who schooled up-to secondary and college/university (F=13.9, p=0.0001). Other factors studied included revenue, relationship with law enforcers during inspection and awareness. The factors showed a statistically significant relationship with compliance based on chi-square results (p<0.005). However, bribery did not show a positive relationship with compliance. The study recommends that the county government should adapt cooperative enforcement (co-regulation) to enhance compliance. Health literacy is an important approach that increases the understanding of the law among proprietors in the county through enhancing familiarity.
Correlates of HIV Viral Load Suppression Among HIV Positive Adults on Care in Nakuru County, Kenya
(Kenyatta University, 2020) Nakazea, Rocky Jumapili
Across the entire globe, 75% of people are aware of their HIV Status, at the same time 79% of the people living with HIV are now accessing anti-retroviral therapy while 81% of those people are at the same time accessing the treatment and have suppressed viral loads. Nakuru County viral suppression stands at 88.3 % (30,407) below the UNAIDS target and National target (2020). The purpose of the study was to determine the correlates of Viral Suppression in Naivasha Sub-County Hospital, Nakuru County. Specific objectives were to determine the socio-demographic characteristics associated with viral suppression in Nakuru County, to establish the patient health related correlates associated with viral suppression in Nakuru County and determine the health system correlates associated with viral suppression. A descriptive cross-sectional study was carried out in Naivasha Sub-District Hospital. The study focussed on Naivasha SubCounty Hospital which currently has 2986 clients on care. The study focused on Naivasha Sub-County Hospital which currently has 2986 clients on care with 2586 virally suppressed which is 85.0%. A Sample size of 192 clients was selected using systematic random sampling. Data was collected using questionnaires for patients and key informant interviews who managed HIV clients in Naivasha Sub-County Hospital. Analysis was analysed using SPSS (Version 24. 0): Descriptive statistics and inferential statistics (Measures of association and correlation was applied) inferential statistics which was done using logistic regression where likelihood or odd ratio was used to predict the correlates of viral suppression. The study response rate was 100.0% whereby out of 192 cohort’s under study, 125 (65.0%) clients had viral load suppression below 1000 viral copies/ microliter of blood and 67 (35.0%) clients with viral load suppression above 1000 viral copies/microliter of blood. The study found the following factors to be critical predictors associated with viral load suppression; distance to facility, occupation, adherence, and co-morbidity, leadership of facility and ARV regimen. The study made the following recommendations; there is need of policy makers at County Level to develop policies that focus on client’s centred management of viral load suppression. The county level should advocate to the facilities on proper use of guidelines and come up with new innovations of patient’s management through evidence based approach on the existing policies. There should be improved coordination and programs ownership at facility and County level that will foster continuity of services and facilities should develop protocols on drugs sensitivity testing before changing regimen especially clients with high viral load.
Cost -Effectiveness of Spinal and General Anaesthesia in the Surgical Treatment of Benign Prostatic Hyperplasia in Hospitals in Nakuru Municipality, Kenya. /1
(Kenyatta University, 2008-05) Macai., John N.
Anaesthesia has been cited as one of the medical practices that escalate the cost of expenditure on healthcare. In view of this, spinal anaesthesia has been proposed as a method that can lower surgical costs. However, medics in Kenya are yet to fully embrace spinal anaesthesia. The reasons for the low usage rates of the spinal anaesthesia are not well known. This study compared the cost-effectiveness of spinel! anaesthesia and general anaesthesia. It also sought to establish the factors that explain the low utilization rates of spinal anaesthesia among medics in Ken; a. 1\ survey approach was adopted in this study. The population for this study was drawn from three randomly chosen hospitals within Nakuru Municipality. Patients operated for Benign Prostatic Hyperplasia (BPH) within the period Ist January 2003 and 31q December 2006 in the three hospitals formed the sampling frame for this study. Seventy-three such patients were identified and formed the study sample. The data for this study was collected by way of document analysis. A coding scheme was developed to gather secondary data. A focus group discussion was conducted to a sample of surgeons, anaesthetists and hospital administrators/proprietors in order to collect their perceptions on spinal and general anaesthesia. An anaesthetic complication index was then developed. This is an ordinal scale that measures the degree of post operative complications after surgery. It has three levels beginning with three for the absence of any complication, two for one complication and one for multiple complications. The higher the score the less the post operative complications a patient has. The research instruments for this study were pre-tested on a Iew patients and medical staff in Naivasha Sub-District Hospital. These research tools were used to gather data by the researcher with the help of two trained research assistants. Data was coded and analysed using the statistical software package SPSS Version 13. Student's t tests were used to compare data on the cost effectiveness of spinal anaesthesia and general anaesthesia. Finally, a ratio of the net costs to the net health outcomes of both spinal and general anaesthesia was calculated. Patients in this stud) had an average of 71.19 years. The average cost of anaesthetic drugs for general anaesthesia was Kshs. 2206.30, while that for spinal anaesthesia was Kshs. 1548.60. The differences in these costs were statistically significant (t == 3.87. df == 71: p == 0.000). Patients operated under spinal anaesthesia had a mean of 2.47 011 the anaesthesia complication index, while those operated under general anaesthesia had a lower mean of 2.03. The lower complication index score obtained in general anaesthesia implies that patients had relatively 1110re post operative complications. The differences in the complication index were statistically significant at 95% confidence level (t == 2.40, df == 69: p == 0.019). The incremental cost effectiveness or this study was calculated as -1494. Adopting spinal anaesthesia ill the treatment of BPI-! results is a reduction in costs and aversion of anaesthetic complications. Medics in Nakuru have favourable knowledge, skills and attitudes towards spinal anaesthesia. Factors that explain this are the least costs, aversion of complications and the ease of performing spinal anaesthesia. However. their usage of this technique was very low. Lack of spinal kits and the tradition of using general anaesthesia explain this low usage rates. Availing spinal kits and sensitizing medics on benefits or spinal anaesthesia might help in the uptake of spinal anaesthesia where indicated.
Cost -Effectiveness of Spinal and General Anaesthesia in the Surgical Treatment of Benign Prostatic Hyperplasia in Hospitals in Nakuru Municipality, Kenya. /1
(Kenyatta University, 2008-05) Macai., John N.
Anaesthesia has been cited as one of the medical practices that escalate the cost of expenditure on healthcare. In view of this, spinal anaesthesia has been proposed as a method that can lower surgical costs. However, medics in Kenya are yet to fully embrace spinal anaesthesia. The reasons for the low usage rates of the spinal anaesthesia are not well known. This study compared the cost-effectiveness of spinel! anaesthesia and general anaesthesia. It also sought to establish the factors that explain the low utilization rates of spinal anaesthesia among medics in Ken; a. 1\ survey approach was adopted in this study. The population for this study was drawn from three randomly chosen hospitals within Nakuru Municipality. Patients operated for Benign Prostatic Hyperplasia (BPH) within the period Ist January 2003 and 31q December 2006 in the three hospitals formed the sampling frame for this study. Seventy-three such patients were identified and formed the study sample. The data for this study was collected by way of document analysis. A coding scheme was developed to gather secondary data. A focus group discussion was conducted to a sample of surgeons, anaesthetists and hospital administrators/proprietors in order to collect their perceptions on spinal and general anaesthesia. An anaesthetic complication index was then developed. This is an ordinal scale that measures the degree of post operative complications after surgery. It has three levels beginning with three for the absence of any complication, two for one complication and one for multiple complications. The higher the score the less the post operative complications a patient has. The research instruments for this study were pre-tested on a Iew patients and medical staff in Naivasha Sub-District Hospital. These research tools were used to gather data by the researcher with the help of two trained research assistants. Data was coded and analysed using the statistical software package SPSS Version 13. Student's t tests were used to compare data on the cost effectiveness of spinal anaesthesia and general anaesthesia. Finally, a ratio of the net costs to the net health outcomes of both spinal and general anaesthesia was calculated. Patients in this stud) had an average of 71.19 years. The average cost of anaesthetic drugs for general anaesthesia was Kshs. 2206.30, while that for spinal anaesthesia was Kshs. 1548.60. The differences in these costs were statistically significant (t == 3.87. df == 71: p == 0.000). Patients operated under spinal anaesthesia had a mean of 2.47 011 the anaesthesia complication index, while those operated under general anaesthesia had a lower mean of 2.03. The lower complication index score obtained in general anaesthesia implies that patients had relatively 1110re post operative complications. The differences in the complication index were statistically significant at 95% confidence level (t == 2.40, df == 69: p == 0.019). The incremental cost effectiveness or this study was calculated as -1494. Adopting spinal anaesthesia ill the treatment of BPI-! results is a reduction in costs and aversion of anaesthetic complications. Medics in Nakuru have favourable knowledge, skills and attitudes towards spinal anaesthesia. Factors that explain this are the least costs, aversion of complications and the ease of performing spinal anaesthesia. However. their usage of this technique was very low. Lack of spinal kits and the tradition of using general anaesthesia explain this low usage rates. Availing spinal kits and sensitizing medics on benefits or spinal anaesthesia might help in the uptake of spinal anaesthesia where indicated.
Cost and Quality of Healthcare Services Provided to Urban Refugees Through in-House and Outsourced Health Facilities in Nairobi, Kenya
(Kenyatta University, 2015) Kamau, E. N.
More than half of the world’s refugees reside in non-camp settings, In Nairobi, approximately 55,000 refugees had been registered with United Nations High Commission for Refugees by end of 2012 (UNHCR, 2013).In recent years the UNHCR has documented a trend towards a growing number of refugees and asylum seekers residing in urban areas. Refugees in urban areas often face numerous problems limiting them from accessing the already overstretched government health services. Most urban refugees do not have a reliable source of income and hence cannot afford to pay for healthcare services. In Nairobi, healthcare for urban refugees is provided using donor funds through two main models: In-house health facility set up to provide healthcare services exclusively for urban refugees and through outsourcing from mainly existing faith based health facilities where refugees are treated and the costs passed to humanitarian organizations for settlement. Despite the increasing humanitarian crisis in Africa, there is shrinking humanitarian resources hence overstretching the already limited donor funds. There is need therefore to use the available donor funds in the most cost efficient way and ensure quality healthcare services. The main objective of this study is to determine and compare the cost and quality of healthcare services between in-house and outsourcing healthcare among urban refuges in Nairobi Kenya. The study employed a descriptive cross sectional design. Purposive sampling method was used to select the two facilities. Structured questionnaires were administered as exit interviews on refugee patients who were treated at the two facilities with the selected five common illnesses. The quality data was analysed using SPSS version 20 and cost data using excel 2007. The direct medical cost was at an average of Kshs 130.1per patient at the in-house facility and Kshs 588.02 per patient at the outsourced facility. The overhead costs were at an average of Kshs 800 pp and Kshs 349 pp respectively. Total average cost was Kshs 930.1per patient at in-house and kshs 937.02 per patient at outsourced facility. The quality of care indicators, clinician’s understanding of patients problems was statistically significant (χ2(1) =7.635, p=.006) patients being allowed to ask questions about their health was significant (χ2(1)=38.019,p=.000), patient being examined physically was statistically significant (χ2(1) =126.95,p=.000), drugs well utilized was also significant at( χ2(1)=36.837, p=.000).Laboratory utilization was higher at the outsourced facility compared to the in-house facility was significant (χ2(1)=23.214,p=.000). Comparing the cost at the two facilities, the direct medical cost was significantly different with in-house being the cheaper model (t-test=27.639, df 302.290 and p=.000) however with additional overhead costs, there was no significant difference in cost (t-test=-.346,df 302.290and p=0.729).Comparing quality of care, the results was subjected to a quality index measure. The in-house facility scored 87.53% while the outsourced facility scored 73.99% hence there was better quality of care at in-house facility compared to the outsourced centre. The study therefore recommends that the in-house model looks for ways of reducing their overhead costs (rent and salaries) since the direct average cost was significantly lower, with lower overhead costs, then the total average costs would be lower. The facility should also increase laboratory utilization (evidence based practices) since it scored high on all other quality measures apart from laboratory utilization.
Determinants of access to healthcare among the elderly.the case of Kibera informal settlement, Nairobi County, Kenya
(2014-08-28) Wairiuko, Judy Wanjiru
Access to Health care by the elderly can be defined as the ability of the aged to get the required medical care from the health service providers when they need it. It’s a comprehensive measurement of access to health care that requires a systematic assessment of physical, financial and socio-psychological access to services. These are further defined into three basic indicators: availability, affordability and acceptability. The proportion of the elderly is increasing rapidly in Kenya. This comes up with health problems like hypertension, diabetes, cancers among others. Which can be delayed if good health care is accessed; whether the healthcare is prepared to take care of the elderly has not been extensively investigated in Kibera urban informal settlement, Nairobi County, Kenya. This was a descriptive cross-sectional study targeting both elderly men and women aged 60 years and over, in Kibera informal settlement of Kenya, to identify factors influencing access to healthcare by the elderly. Data collection tools employing both qualitative and quantitative parameters were used in the study. A multistage sampling approach was used. Kibera urban informal settlement was purposively selected while the sub-locations Gatweekera, Kianda and laini-saba were randomly selected. Probability proportionate to size sampling of the elderly was done and systematic sampling was done to identify the respondents. Data was obtained from a total of 399 elderly using interviewer administered questionnaire. Key informant interviews on health facility managers were used to provide additional information. Data was analysed by SPSS and presented using tables, graphs and cross tabulations, while association between variables was assessed using Chi-square statistics and Odds Ratio. Thematic analysis was done on qualitative data. Findings showed that access to healthcare was at 40.4 %. Marital status (χ2=8.321, df=2, p=0.016), type of house (χ2=7.069, df=2 p=0.029), education (χ2=12.521, df=3 p=0.006) was statistical significant in relation to access to health care services by elderly. The odds of access increased with those who lived in permanent houses (OR: 30.699, 95% CI 1.827-515.927 P<0.017) when compared against those who lived in temporary houses. Services of CHWs was significant (χ2=9.092,df=2,p=0.011) in relation to access. Satisfaction of health care services (χ2=257.326,df=4,p<0.001) was significantly associated with access. Availability of equipment (χ2=48.871, df=2 p<0.001) and availability of drugs (χ2=39.031, df=2 p<0.001) were significantly associated with access to healthcare. The study showed need to address access to health care factors that contribute to elderly not accessing health care. Findings in this study will be used by policy makers to develop a policy on elderly person’s welfare, ensure that there are elderly friendly services in all primary health care facilities, with trained health personnel on geriatric health, and basic drugs and medical equipments for non communicable diseases.
Determinants of Elimination of Mother to Child Transmission of Hiv among Patients at the Nakuru County Referral Hospital, Kenya
(Kenyatta University, 2022) Isindu, Boniface Ambani; Alloys Orago; Joachim Osur
Globally, 37.6 million people living with HIV around the world, 67% live in sub-Saharan Africa. Out of the 200,000 new diagnoses of HIV in Africa in 2021, young women and adolescent girls aged 15-24 made up 27% of those new cases. The United Nations reported 1,000 new infections per week in this group. Regionally, out of the 20.7 million adults living with HIV in the region in 2018, 12 million were women: young women (aged 15–24 years) account for 26% of new HIV infections: In Kenya, tremendous progress in slowing down spread of HIV has been made with new infections declining by 68.4% between 2013 and 2021.Deaths attributed to HIV/AIDS had dipped by 67% from 58,446 people in 2013 to 19,486 in 2021.Increased number of people on life-saving antiretroviral treatment ;Rise by 83%, from 656,369 in 2013 to 1,199,101 in 2021 adults prevalence stands at 4.9%;Women at 6.6% twice that of men (3.1%) as per Kenya Population-based HIV Impact Assessment (KENPHIA) 2018 survey Mother to child transmission (MTCT) of HIV, is the main route of HIV infection among infants born by HIV positive mothers. An estimated 50,000 to 60,000 infants contract HIV infection annually in Kenya through their mothers .Kenya rolled out a countrywide Prevention of Mother to Child Transmission (PMTCT) programme to reduce the HIV infection in children because the main route for HIV transmission among children is through birth .In Kenya, an estimated 37,000 to 42,000 infants are infected with HIV annually due to MTCT.During pregnancy, about 5 to 8 percent of HIV-exposed babies become infected through transmission across the placenta. In Kenya, the national MTCT rate for the year 2021 was 3.2% while the rate in Nakuru County was reported to be 4..9% with the highest reported rate being in the month of march 2021 at 9.4%.Currently the MTCT rate reported in Nakuru county (4.9%) is much higher than the National rate (3.2%).The causes of this sustained high MTCT rate are not well documented hence this study at Nakuru County Referral Hospital to investigate these determinants. The Study objective was to investigate the determinants of eMTCT among patients at Nakuru county Level 6 Referral Hospital, Kenya. A cross sectional analytical research study was carried out with data collected from ANC mothers, key informants and FGD participants using structured questioners, key informant interview guides and FGD guides. The analysis of the data collected from the ANC clients revealed that nearly seventy percent of mothers had no knowledge of services provided to seropositive pregnant mothers to reduce the risk of transmission to unborn child. Further analysis revealed that low male involvement and participation, Stigma, and discrimination, peer pressure, social groups, religious sects, ceremonies (funerals), visiting sick people in the community were key social determinants that sustained high transmission rates in the county. Cultural beliefs, practices and taboos had a significant contribution to the high MTCT rates that were reported in the county. Low level of knowledge contributes significantly to the high MTCT rate reported in Nakuru Referral Hospital as were social cultural factors. It was recommended that Ministry of Health in collaboration with Health implementing partners and all health actors to develop promotional messages and information on eMTCT and disseminate them to all pregnant women attending ANC at all health facilities in the country. Socio mobilization and awareness on Prevention of Mother to Child Transmission program to be scaled up to empower women with knowledge on PMTCT. Community and political leaders to be enlightened by health implementing partners on good health practices to discourage pregnant women from their negative cultural beliefs and practices to promote health seeking behavior among these women. Health education and health talks to pregnant women to focus more on the importance of adherence to clinic appointments during their pregnancy life to benefit from services provided.
Determinants of Self Directed Referral amongst Patients Seeking Health Services at Kenyatta National Hospital, Nairobi, Kenya
(2014-02-24) Mahinda, Faith Wambui; Otieno, George Ochieng; Karama, Mohamed
Kenyatta National Hospital (KNH) is found at the apex of the referral system of health care. Ideally, patients seen at KNH are supposed to have sought care from lower levels of health care in the referral system first before seeking health services at KNH. Referral can assume two forms: Self and Non-self. Self referral refers to the scenario where a patient bypasses lower health care levels and visits KNH as his first point of entry while non self-referral refers to the referral done by a health care practitioner from a lower level of health care where the patient is sent to KNH with a referral note. The main objective of this study was to identify determinants (individual and institutional) of self directed referral of patients seeking health services at KNH. 404 respondents participated in the study; sample size was determined using the 10% Gay principle (Mugenda and Mugenda). The researcher conducted a cross sectional, descriptive study using both qualitative and quantitative data collection methods to examine patterns of patient self-referral at KNH according to social-economic status, education level and their perception of quality of care offered in lower levels of healthcare as well as the level of awareness of referral procedures. Descriptive and inferential statistics were analyzed using Statistical Package for Social Sciences (SPSS) while Chi square test and Logistic Regression was used to derive relationships that may exist between the dependent and independent variables; results were significant at a p value <0.05 . The findings of the study indicate that only 27.7% of patients seeking health services at the hospital self refer to KNH. Amongst the patients who self refer to KNH, ailments related to surgical complications (28.6%) were found to be the most common health problems. No statistically significant association was found between individual factors and self directed referral. Institutional factors that were found to influence patients‘ decision to have KNH as their hospital of choice were: location of the hospital, availability of medicines, quality of care, clear kept surroundings and affordable deposits. The health problems that cause patients to seek health services from KNH call for high level diagnostic health care which is often unavailable in lower levels of healthcare. It may be useful to introduce reversed referral within the Kenyan health care system where consultant doctors from KNH visit lower level health facilities and see patients on site. This would go a long way in reducing the number of patients who travel from far in search of quality health service at KNH and at the same time help to decongest the hospital.
Determinants of Under-five Mortality in Kisumu North District, Kisumu County, Kenya
(2013-10-17) Akobi, William Kala
Addressing child mortality and under-five mortality (USM) has continuously been a global challenge. The world summit for children in 1990 called for a worldwide reduction in child mortality to reduce USM to below 70 deaths per thousand live births or one third reduction. Nations and organizations have continued to invest much resources and effort to promote child health. In Sub-Saharan Africa investments in health systems and interventions necessary to achieve these marks has been elusive. Despite this, maternal and child mortality and morbidities remain high. The purpose of this study was to identify the determinants of USM in Kisumu North District of Kisumu County. The specific objectives were: to examine the levels and trends of USM in Kisumu North District; to identify the determinants-of the U5M in Kisumu North District; and, to assess the influence of KAP on USM in Kisumu North District. The study design was a descriptive cross-sectional in nature targeting women of reproductive age (IS-49) living in Kisumu North District for at least six months. Data was collected using both quantitative and qualitative approaches involving structured questionnaires, key informant interviews and focus group discussion with chiefs, health workers and household heads in the district. A randomly selected sample of 265 women participated in the interviewer administered questionnaire. Data was analyzed using SPSS version 16. Chi square statistics was used to assess the association between background factors and USM at 9S% confidence interval and a p-value of O.OS.Qualitative data were analyzed thematically. Finding showed that slightly more than half (S6.3%) of the respondents were aged below 30 years and 43.7% of the respondents were aged more than 30 years. Majority (8S.9%) of the respondents were married. Most (36.9%) of the respondents had completed primary education, and only 3.1% of the respondents had post primary education. Majority (8S%) of the respondents reported to have lost a child below five years old. The USM (S2.S%) was higher among those aged below 30 years as compared to those below 30 years 47.S% (pvalue= 0.006). Level of education was a significantly association with USM (p-value = 0.007). Sign of use of latrine was also significant associated with USM (p-value ~ 0.012). The presence of latrine was significantly associated with USM (p-value = 0.03). Occupation, source of water, whether water is treated, type of dwelling place, place of delivery, immunization status of the child and whether the child had been sick in the last two weeks were not significantly associated with USM. KAP factors that were significant associated with USM included staff of the facilities being friendly (p-value = 0.01, children die due to poverty (p-value = 0.02), child with fever should be taken to the health facility without delay (p-value=O.O1), children die because they are bewitched (p-value = 0.01), a child with fever should not be given injection (p-value = 0.01), immunization makes children sick (p-value = 0.01), children should not be given drugs bought from the shops (p-value = 0.01). The findings of this study indicate that the USM is very high in Kisumu North District and is associated with socio-demographic, environmental and KAP determinants. There is need to address health factors that contribute to high mortality rates in this district, and putting in place a well defined system targeting improved socio-economic empowerment of women aged IS-49, improved enrollment of women in school, a defined health system to enable early identification and timely care to children and their mothers.
Determinants of Utilization of Electronic Medical Records Systems in Clinical Management in Public Healthcare Facilities in Mombasa County, Kenya
(Kenyatta University, 2021) Mwang’ombe, Alice; Andrea Yitambe; Stephen Titus Waithaka
The adoption of information and communication technology (ICT) in the medical field in the form of electronic medical records (EMR) systems had been promoted as a way to reduce cost, increase effectiveness and improve the quality of care. In Kenya, the EMR is being rapidly implemented in both public and private sector healthcare facilities. However, the implementation of the EMR system has been met with partial success, for example, while the patient billing component is being fully utilized, the patient clinical data capture of the system remains underperforming leading to questions about its useability and usefulness in holistic healthcare management functions. Therefore, the study sought to find out the determinants of utilization of electronic medical records systems in clinical management in public healthcare facilities in Mombasa County, Kenya. Specifically, it sought to establish how perceived usefulness of EMR, staff ICT knowledge and staff attitudes influence the use of electronic medical records systems in clinical management in public healthcare facilities in Mombasa County. It also sought to establish the moderating effect of internet connectivity on determinants of utilization of electronic medical records systems in clinical management in public healthcare facilities in Mombasa County. The study was guided by the Technological Acceptance Model. Cross-sectional study design was adopted which targeted healthcare professional drawn from various public healthcare facilities in the County. Stratified random sampling was used to acquire a sample size of 215 respondents. Data was collected using structured questionnaires. Data was analyzed using both descriptive and inferential statistical techniques with the aid of Statistical Package for Social Scientists (SPSS) version 21. The findings of multiple regression analysis revealed that two variables: staff attitudes (β = 0.221, p < 0.05) and staff ICT knowledge knowledge (β = -. 161, p < 0.05) significantly influenced the use of EMR in clinical management in public healthcare facilities in Mombasa County. However, perceived usefulness of EMR (β = 0.121, p > 0.05), and was found not to significantly influence the use of EMR in clinical management in public healthcare facilities in Mombasa County. Further, Internet Connectivity (R-square change before (β = 0.3387; P = 0.011 and after β = 0.2777; P = 0.020) had a significant moderating effect on utilization of electronic medical records systems in clinical management in public healthcare facilities in Mombasa County. The study, therefore, recommends, the EMR system designers to involve the medical staff substantially in the design of the system so as to fully capture their views and working requirements and also help domesticate the system to improve its implementation rate in the area. In addition, the Mombasa County government ought to increase funding in the health sector for acquisition of ICT resources needed to increase EMR use in the hospitals as well as sponsor regular training on EMR to encourage hospital staffs to participate in the program and also improve on their computer skills.There is need for the County health management team to organize seminars or conferences to bring together academicians, clinicians, hospital administrators and other policy makers to convince the medical staff on the advantages of using EMR in clinical management of patients. Finally, the hospitals‘ management together with other stakeholders need to re-engage the communications networks service providers to improve the network performance of the stystem to provide full coverage and access even from remote locations.
Determinants of Utilization of Routine Data for Decision MAKING IN Health Facilities in Kitui County, Kenya
(2014-02-26) Karijo, Eddah Kanini
Effective management of today’s health systems depends on critical use of data and information for the effective policy-making, planning, monitoring of services and making decisions. Following the decentralization of health, the district health management information systems (DHMIS) was established to support the districts in utilizing the generated data for the decisions made in health facility. However, data use has been limited and faced with inadequacy hence vital health decisions often relying on political opportunism, donor demand and infrequently repeated national studies which are insensitive to changes occurring over shorter timescale. This study was designed to identify for determinants of utilization of the routine data for decision making by the health care providers in health facilities in Kitui County in Kenya. This was a descriptive cross sectional study that adopted quantitative and qualitative research paradigms. Purposive sampling was used to select the district hospital, being the only one serving the eleven districts in the county. Multi stage cluster sampling to sample the health facilities in the districts and simple random sampling to select the respondents in the health facilities. The 110 participants completed a self-administered questionnaire. Key informant interviews, focused group discussions, observation and analysis of documents in health facilities were also applied. Recordings were transcribed and key concepts identified. Questionnaire results were edited, coded, tabulated and analyzed using the SPSS 16. Chi-square test was applied to determine the relationship between independent and dependent variables. The results showed that among the respondents 70% were females and 40% males. Majority, 64% had diploma level of education. Nurses/ midwifes were the majority, making up 81% of the workforce. Overall extent of data utilization was 66% not using data and 34% use the routine generated data. The following actors influence utilization of routine data: frequency of meetings held (𝑥2=42.036, df=1, p=0.001), data storage and analyzing methods (𝑥2= 30.582, df=1, p=0.001), continuous professional training (𝑥2= 49.782, df=1, p=0.0001). Organization of the district health system influenced routine data utilization through the frequency of support supervision (𝑥2=30.000, df=1, p=0.001), issues assessed during supervision (𝑥2=49.164, df=2, p=0.002) and feedback report from the supervisors (𝑥2=5.236, df=1, p=0.022). In conclusions the study demonstrates limited utilization of routine data to make decisions for health facility management and recommends the need for the government to build capacity for data utilization through on job training and strengthening the curriculum in health training institutions in data related areas. The ministry of health should standardize the parallel reporting levels and unify the reporting tools and finally ensure the districts have structured meetings, support supervision and feedback to the health care providers.

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