RP-Department of Health Management & Informatics

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Adherence to Standard Management Procedure of Organophosphate Poisoning in Selected Health Facilities in Nandi County, Kenya
(Clinical and Experimental Medical Sciences, 2021) Mbugua, John; Kabiru, Ephantus; Kahiga, Titus
Organophosphate poisoning is a public health problem and an important cause of morbidity and mortality worldwide with over 300,000- 350,000 deaths mostly in developing countries. Incidences of organophosphate poisoning in Nandi County has been on the rise due to widespread and increased access use of organophosphate compounds. The adherence by health care providers in Nandi County is low despite the existence of management guidelines of organophosphate poisoning. Compliance to this guidelines have been proven to improve the quality and outcome of the patient. The study main objective is to determine the level of adherence to the standard management procedure of organophosphate poisoning in selected health facilities in Nandi County. A hospital based retrospective study was carried out on 166 patient records with organophosphate poisoning in Kapsabet County Referral Hospital (87 cases), Nandi Hills County Hospital (49 cases), Kaptumo Sub-County Hospital (14 cases) and Mosoriot Sub-County Hospital (14 cases), Nandi County. Data collected was entered and analyzed using descriptive and inferential statistics. The level of significance was set at 0.05. The study findings indicated that majority of the patients were male (73.3 per cent), married (61.1 per cent), informally employed (85.5 per cent), primary level of education (64.1 per cent) and aged between 18-30 years (56 per cent) who consumed poison with the intention of dying (85.5 per cent). There was a significant association between type of organophosphate poisoning and age (2=148.178, df=4, P0.001), marital status (2=17.059, df=2, P0.001) and literacy level (2=28.767, df=3, P0.001). Management procedures carried out were ABC assessment (96.9 per cent), gastric lavage (65.9 per cent), atropine administration (97.6 per cent) and monitoring of fluids, electrolyte (98.2 per cent), resuscitation (29.4 per cent), skin irrigation (2.5 per cent), emesis (18.5 per cent), administration of activated charcoal (10.7 per cent) and administration of pralidoxime (1.5 per cent).
AGC1 Deficiency Causes Infantile Epilepsy, Abnormal Myelination, and Reduced N-Acetylaspartate.
(2014) Otieno, F. G.; Falk, M.J.; Li, D.; Gai, X.; McCormick, E.; Place, E.; Lasorsa, F.M.; Hou, C.; Kim, C.E.; Abdel-Magid, N.; Vazquez, L.; Mentch, F.D.; Chiavacci, R. M.; Liang, J.; Liu, X.; Jiang, H.; Giannuzzi, G.; Marsh, E.D.; Yiran, G.; Tian, L.; Palmieri, F.; Hakonarson, H.
BACKGROUND: Whole exome sequencing (WES) offers a powerful diagnostic tool to rapidly and efficiently sequence all coding genes in individuals presenting for consideration of phenotypically and genetically heterogeneous disorders such as suspected mitochondrial disease. Here, we report results of WES and functional validation in a consanguineous Indian kindred where two siblings presented with profound developmental delay, congenital hypotonia, refractory epilepsy, abnormal myelination, fluctuating basal ganglia changes, cerebral atrophy, and reduced N-acetylaspartate (NAA). METHODS: Whole blood DNA from one affected and one unaffected sibling was captured by Agilent SureSelect Human All Exon kit and sequenced on the Illumina HiSeq2000. Mutations were validated by Sanger sequencing in all family members. Protein from wild-type and mutant fibroblasts was isolated to assess mutation effects on protein expression and enzyme activity. RESULTS: A novel SLC25A12 homozygous missense mutation, c.1058G>A; p.Arg353Gln, segregated with disease in this kindred. SLC25A12 encodes the neuronal aspartate-glutamate carrier 1 (AGC1) protein, an essential component of the neuronal malate/aspartate shuttle that transfers NADH and H(+) reducing equivalents from the cytosol to mitochondria. AGC1 activity enables neuronal export of aspartate, the glial substrate necessary for proper neuronal myelination. Recombinant mutant p.Arg353Gln AGC1 activity was reduced to 15% of wild type. One prior reported SLC25A12 mutation caused complete loss of AGC1 activity in a child with epilepsy, hypotonia, hypomyelination, and reduced brain NAA. CONCLUSIONS: These data strongly suggest that SLC25A12 disease impairs neuronal AGC1 activity. SLC25A12 sequencing should be considered in children with infantile epilepsy, congenital hypotonia, global delay, abnormal myelination, and reduced brain NAA.
Analysis of Cost Associated with Treatment of Road Traffic Injuries among Victims at the Kenyatta National Hospital Nairobi City Kenya
(IJRISS, 2022) Lipule, Zablon.anyenda; Yitambe, Andre; Rucha, Kenneth
Background; Previous studies have pointed out that road traffic injuries (RTIs) as a leading cause to fatalities of over one million victims globally per year which bears negative impact on health, economy and development of the society as a whole. Furthermore, young men and women at their most economic age group have been identified as the most vulnerable group to road traffic injuries (RTIs) resulting to mortality and very severe morbidity due disability. However, there is little or no published evidence on healthcare resource allocations and utilization after RTIs, especially in developing countries that include those in Africa. Objective: The main objective of this study was to analyze the total hospital cost related to RTI (Road traffic injury) victims admitted for a period of 3 months. The study demonstrated effects of direct and indirect medical cost , productivity loss and hospital length of stay on total cost of road traffic injuries of RTI victims at KNH. Methods: This was a cross sectional study design done at the Kenyatta Hospital Nairobi, surgical wards and Accident & Emergency. A sample (n=124) consisted of new victims admitted to the Hospital due to RTI from January 25th 2019 to 24th April 2019., this was two thirds of the sample size at 74% respondent rate who gave consent and all ethical approvals granted. The data collection of direct and indirect medical cost was by data extraction tool, testing of the tools was done at the surgical ward. Productivity loss of the victims was calculated by use of Work Productivity and Activity Impairment Questionnaire (WPAIQ). SPSS version 22 was applied and descriptive statistics to show frequencies and Percentages for categorical variables (victim’s unique individualized characteristics). Multi Linear Regression Model Test was used test the relationship between the independent and dependent variables. Results: The study results indicated that direct cost factors (laboratory cost, A&E Charges and Diagnostic Cost) (X1: β1 =.199, P<. 047), (X3: β3 =.469, P< .037), and (X4: β4 =.029, P< .048) had a significant influence on the overall cost of treatment of RTI victims seeking treatment at the KNH, there was no significant relationship between Bed Charges (X2: β2 =.117, P>.689) and the cost of treatment of RTI victims seeking treatment at the KNH. The findings of the study also indicated that Y= 7.949+.001X1+0. 458X2+0. .239 X3+ 0. .305X4+e where a .199 change in direct cost, .117 changes in indirect cost, .469 change in total productivity cost and .029 changes in duration of stay in hospital influenced a unit change on the cost of treatment of RTI victims seeking treatment at the KNH. Most distribution of injuries was lower limbs at 51.6% Conclusion & Recommendation: The study concludes that Road traffic accident is an economic burden to individual, family and country at large. The study recommends, need for an awareness on importance of National Hospital insurance fund (NHIF) as a universal health coverage fund for people at an affordable cost, there is need to reduce the indirect cost of treatment associated indirect cost of treatment, support to from one person or two further increasing productivity time associated with the injury. Further motion study on cost analysis will give a detailed insight on these area of study.
Association analysis of the FTO gene with obesity in children of Caucasian and African ancestry reveals a common tagging SNP
(Public Library of Science, 2008-03) Grant, S.F.; Li, M.; Bradfield, J.P.; Kim, C.E.; Annaiah, K.; Santa, E.; Glessner, J.T.; Casalunovo, T.; Frackelton, E.C.; Otieno, George Ochieng; Shaner, J.L.; Smith, R.M.; Imielinski, M.; Eckert, A. W.; Chiavacci, R. M.; Berkowitz, R.I.; Hakonarson, H.
Recently an association was demonstrated between the single nucleotide polymorphism (SNP), rs9939609, within the FTO locus and obesity as a consequence of a genome wide association (GWA) study of type 2 diabetes in adults. We examined the effects of two perfect surrogates for this SNP plus 11 other SNPs at this locus with respect to our childhood obesity cohort, consisting of both Caucasians and African Americans (AA). Utilizing data from our ongoing GWA study in our cohort of 418 Caucasian obese children (BMI$95th percentile), 2,270 Caucasian controls (BMI,95th percentile), 578 AA obese children and 1,424 AA controls, we investigated the association of the previously reported variation at the FTO locus with the childhood form of this disease in both ethnicities. The minor allele frequencies (MAF) of rs8050136 and rs3751812 (perfect surrogates for rs9939609 i.e. both r2 = 1) in the Caucasian cases were 0.448 and 0.443 respectively while they were 0.391 and 0.386 in Caucasian controls respectively, yielding for both an odds ratio (OR) of 1.27 (95% CI 1.08–1.47; P = 0.0022). Furthermore, the MAFs of rs8050136 and rs3751812 in the AA cases were 0.449 and 0.115 respectively while they were 0.436 and 0.090 in AA controls respectively, yielding an OR of 1.05 (95% CI 0.91–1.21; P = 0.49) and of 1.31 (95% CI 1.050–1.643; P = 0.017) respectively. Investigating all 13 SNPs present on the Illumina HumanHap550 BeadChip in this region of linkage disequilibrium, rs3751812 was the only SNP conferring significant risk in AA. We have therefore replicated and refined the association in an AA cohort and distilled a tag-SNP, rs3751812, which captures the ancestral origin of the actual mutation. As such, variants in the FTO gene confer a similar magnitude of risk of obesity to children as to their adult counterparts and appear to have a global impact.
Association between the use of biomass fuels on respiratory health of workers in food catering enterprises in Nairobi Kenya
(2013-05-06) Keraka, M.; Ochieng, Carolyne; Engelbrecht, Jacobus; Hongoro, Charles
Introduction: Indoor air pollution from biomass fuel use has been found to be responsible for more than 1.6 million annual deaths and 2.7% of the global burden of disease. This makes it the second biggest environmental contributor to ill health, behind unsafe water and sanitation. Methods: The main objective of this study was to investigate if there was any association between use of bio-fuels in food catering enterprises and respiratory health of the workers. A cross-sectional design was employed, and data collected using Qualitative and quantitative techniques. Results: The study found significantly higher prevalence of respiratory health outcomes among respondents in enterprises using biomass fuels compared to those using processed fuels. Biomass fuels are thus a major public health threat to workers in this sub-sector, and urgent intervention is required. Conclusion: The study recommends a switch from biomass fuels to processed fuels to protect the health of the workers
Awareness and Knowledge on Cervical Cancer Screening Services Among Women Aged 30-49 Years in Kitui West Sub-County
(Journal of Health, Medicine and Nursing, 2019) Rucha, Kenneth; Ndeleva, Benjamin; Mbaluka, Jane Hannah
Purpose: The purpose of the study was to establish the utilization of cervical cancer screening services among women aged 30-49 years in Kitui west, Kenya. Methods: A cross-sectional descriptive study design was used. The study population was women aged 30-49 years of age. A Multi-stage cluster sampling technique, simple random sampling, proportionate sampling and systemic sampling was used to obtain 270 respondents from the study population. Data was collected using interviewer administered questionnaire to women aged 30-49 years in Kitui west sub-County. The study used quantitative research methods to obtain data from selected respondents. Quantitative data was collected using closed and open ended questionnaires. All interviews were done after obtaining approval from relevant bodies and consent from study respondents. Data from the respondents was analyzed using statistical package of social sciences (SPSS) in conjunction with Microsoft excel. The study used chi-square test calculated at 95% interval and a margin of 0.05% error to determine the relationship between dependent and independent study variables. Results: The results found out that Majority of the participants 145 (53,7%) were aware of the cancer screening. There was a no significant relationship (p =0 .054) between the awareness and cervical cancer screening services among women aged 30-49 years. The study established that, majority 152 (56.3) of the respondents had low knowledge on cervical cancer and there was an association between knowledge on warning signs (p=0.001) and prevention of cervical cancer (p=0.002) and utilization of cervical cancer screening services. Unique Contribution to Theory, Practice and Policy: The study recommends the Ministry of Health and other stakeholders should hold community awareness and sensitization programmes on benefits of PMTCT services to pave way for acceptance and hence use and prevent vertical and horizontal transmission of HIV. Outreach PMTCT services should be provided routinely needed to reach pregnant women with HIV-infection who reside farther away from the hospital. Patients also need to be continually encouraged to take treatment at their nearest treatment center.
Challenges Faced by Health Unit Management Committees In Rendering Health Services to Communities in East-Central Uganda
(Direct Research Journal, 2020-06) Muwanguzi, David Gangu; Otieno, George Ochieng; Kibaara, Kenneth Rucha; Mugisha, John Francis; Muluya, Kharim Mwebaza; Kithuka, Peter
Like other countries, Uganda implements programs that help to enhance health services delivery in communities. One of the strategies to ensure this is by facilitating the construction of health centres and equipping them with adequate staff including doctors, nurses and Health Unit Management Committees (HUMCs), who are the basis for this study. However, it has been established that much as HUMCs monitor the general administration of the HCIII on behalf of the Local Council and the Ministry of Local Government, done within the policy and guidelines of Ministry of Health, the environment under which they work is characterized by a number of challenges which affect the effectiveness of HUMCs services. The study was largely qualitative and only interviews were used to obtain responses from HUMCs and a few administrators. Purposive sampling technique was largely used to select the sample size of 288 respondents who were predominantly HUMcs. The challenges are multiple. Results were analyzed qualitatively. Where necessary and to a small extent, verbatim forms were used to report the original voices of HUMCs. First, HUMCs do not participate in most of the meetings even those concerning events at health centres. This limits endeavors for transparency and accountability. In addition, rewards system at health centres rarely caters for the HUMCs who are tasked with the duty to monitor all activities. This reduces the morale of HUMCs to work hard because they do not feel part of the working team at HUMCs. Another great challenge was on the lack of proper coordination between HUMCs at health centres and district health teams (DHTs) which has resulted in the design of rewards systems not catering for HUMCs. Conclusively, a number of challenges including lack of adequate training, low participation in meetings and lack of seminars as well as workshops to intimate them with various tasks of their work characterized delivery of health services to communities by HUMCs. At the moment, the HUMCs are tasked to oversee many responsibilities but are rarely appreciated, salaries come late, and the chances to have a say in the vertical planning system are minimal. Therefore, the HUMCs are not as effective as expected due to the numerous challenges they face. The key recommendation was that members of HUMCs should be trained for at least 2 weeks by a group of well-drilled mentors and the training should be hands-on (mentorship). This will enable them to appreciate the role, tasks and challenges and participate in improving services. It is also recommended that MoH trains a pool of mentors at least 10 per district to be able to train all the members of HUMC in each district.
Comparison of Machine Learning Methods for the Prediction of Type 2 Diabetes in Primary Care Setting Using EHR Data
(JAGST, 2023-10) Olwendo, Amos Otieno; Ochieng, George; Rucha, Kenneth
ABSTRACT Diabetes remains a major global public health challenge, thus the need for better methods for managing diabetes. Machine learning could provide reliable solutions to the need for early detection and management of diabetes. This study conducted experiments to compare a number of selected machine learning approaches to determine their suitability for early detection of diabetes in the primary care setting. A retrospective study was conducted using EHR dataset of confirmed cases of diabetes collected during routine care at Nairobi Hospital. Institutional ethical approvals were obtained, and data were retrieved from the database through stratified sampling based on gender. Diagnoses were confirmed using the ICD-10 codes. Records with 5% or so of missing values were excluded from this analysis. Data were processed by correction of errors and replacement of missing values using measures of central tendency. The data were transformed through normalization using the decimal-scaling method. Data analysis was conducted using selected supervised and unsupervised learning algorithms. Model performances were validated using metrics for the evaluation of classification and clustering results, respectively. Random Forest had the highest accuracy (0.95) and error rate (0.05), while Gradient Boosting and Multilayer Perceptron (MLP) with 3 hidden layers obtained accuracy (0.94) and error rate (0.06), respectively. The process of selecting machine learning algorithms needs to explore both supervised and unsupervised learning techniques. In addition, an appropriate architectural desig
Data Quality in Health Management Information Systems at Kenyatta National Hospital in Nairobi City County, Kenya: Influence of Technological Factors
(iOSR-JNHS, 2021) Kenyenga, Benjamin Oreni; Yitambe, Andre; Ochieng, George Otieno; Otiti, Mary Iwaret
Background: Efficient and effective Health Management Information System (HMIS) is critical to both the healthcare system and to people’s health, by providing the system and data that is central for target setting, policy planning and implementation. There is tremendous increase in available and accessible information; however, growth in the quantity of information has not necessarily been accompanied by improvements in quality of data. There has also been evolution and potential of information technologies in enhancing the relevance of the quality health information management. Thus, various technological aspects such as system design, knowledge, training and skills that support HMIS within these environments are key in ensuring data quality. Kenyatta National Hospital operates several stand alone information systems, making it a challenge to provide quality data that can be utilized in the management process. The study therefore, set out to examine the technological factors influencing data quality in HMIS at Kenyatta National Hospital in Nairobi City County, Kenya. Materials and Methods: We used a cross sectional descriptive design, applying both quantitative and qualitative techniques. Census was done to collect data from all the 195 employees of the department of health information using questionnaires and Key Informant Interviews after obtaining their informed consent. We excluded those who were absent and who declined consent. Pretesting was conducted at Moi Teaching and Referral Hospital (MTRH) where the validity and reliability of the research instruments were verified. All necessary ethical approvals and permits were obtained prior to commencing the study. Analysis was done using SPPS version 25.0. Mean, frequencies and percentages were used for descriptive statistics while Chi-square and linear regression were applied for inferential statistics. Results: The response rate was 98.97% (n=193). 90.2% (n=174) respondents stated that Network issues were a concern, 64.2% (n=124) stated HMIS in the hospital was user friendly, while 62.7% (n=121) stated that the hospital was keeping up with technological and innovative trends applicable to the health sector. The association between the dependent (data quality) and independent (technological factors) variables was statistically significant(X2=63.341, P-Value= 0.001). Regression analysis generated a model with predictors of data quality being age, gender, highest level of education, subsection, and technological factors, Conclusion: Technological factors are key determinants of data quality in HMIS at Kenyatta National Hospital in Nairobi City County
Demand for Health Insurance among the Elderly in Nairobi City County, Kenya
(IJIRAS, 2020) Saiti, Nelly; Yitambe, Andrea; Korir, Julius
The aging population is likely to increase the demand for health care services and social support in Kenya. As reported at the world health assembly, health systems should provide health interventions and financial protection to all individuals regardless of age. The Kenyan government has been trying to address critical issues related to older persons and their health by protecting their rights to equitable, accessible quality of health care through policy formulations such as the NSHIF bill of 2004, development of the “10/20” user fee policy at health centres and dispensaries and even incorporating their needs in the current constitution but considering the increasing number of older persons and the existing limited resources, these efforts may not be felt by most of the population more so to those who rely on their individual savings for use in accessing care. This study therefore sought to investigate demand for health insurance among the elderly in Nairobi City County, Kenya. The variables tested were socio-demographic characteristics, health system characteristics, actual barriers of health insurance ownership and their influence on the demand for health insurance. The study adopted a descriptive cross-sectional survey research design. A multi-stage sampling approach was adopted. Nairobi North administrative Unit in Nairobi City County was randomly selected as the study area. Proportionate sampling approach was used to allow for equal allocation of sample representatives in the area. Data collection tools employed both qualitative and quantitative parameters. Data was analysed using STATA to assess relationship between variables by applying the binary logistic regression technique. Thematic analysis using Nvivo 10 was done for qualitative data. The findings showed that the proportion of the elderly without health insurance cover was at 67%. Only 33% of respondents had a health insurance cover. Majority (37%) of those with a health insurance cover were covered under the National health insurance scheme. Most of the socio-demographic characteristics (age, gender, marital status and religion) were not significantly associated with demand for health insurance. For sociodemographic characteristics, income (χ 2 = 42.004a ,df=6, p=0.001) and education (χ 2 =48.572a , df=6, p=0.001) were significantly associated with demand for health insurance while for health system factors, the study found that being comfortable paying premium to health insurance firm (χ2=73.302a ,df=1, P=0.0001), health insurance affordability (χ 2 =95.262a ,df=1, P=0.001), health care workers offering information on health insurance(χ 2 =46.512a ,df=4, p=0.001) and health care providers asking for health insurance card from clients(χ 2 =37.804a ,df=4,p=0.001) were significantly associated with demand for health insurance. Age (χ 2 =4.675a df=1, p=0.031) was a barrier to health insurance demand as there was a significant relationship at 95% confidence Interval. The study found a positive relationship between odds ratio for demand for health insurance and predictors of affording health insurance premium, having knowledge of health insurance, having any post- secondary education and being comfortable paying for health insurance cover. The null hypothesis for this study was rejected as there was an association between socio- demographic characteristics, health system factors, actual barriers and demand for health insurance. Findings from the study will assist NHIF to expand their services among the elderly. A study should be done to analyse the changing patterns of health insurance demand following the recent development on health insurance subsidy program for the elderly in Kenya.
Determinants of Data Use for Decision Making in Health Facilities in Kitui County, Kenya
(QJMSS, 2021-06) Karijo, Eddah Kanini; Otieno, George Ochieng; Mogere, Stephen
Background: Effective management of today’s health systems depends on the critical use of data for the policy-making, planning, monitoring of services, and making decisions. The use of data 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 a shorter timescale. Objective: This study was designed to identify determinants of utilization of routine data for decision making by health care providers in health facilities in Kitui County in Kenya. Method: The conceptual framework was constructed from the literature review. This was a descriptive cross-sectional study adopting quantitative and qualitative research paradigms. The district hospital was purposively selected. Multi-stage cluster sampling was used to sample the health facilities in sub-counties and simple random sampling to select the respondents from different cadres in 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 applied. Recordings were transcribed and key concepts identified. Questionnaire results were edited, coded, tabulated, and analyzed using the SPSS 18. Result: Respondents interviewed were from different cadres of health care providers including doctors, clinical officers, nurses, and midwives from different levels of health facilities. Among the respondents, 70% were females, and 30% males. The majority, 64% had a diploma level of education. Nurses/ midwives were the majority, making up 81% of the workforce. The 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), and 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). Conclusion: The study demonstrated limited utilization of routine data for decisions in health facilities and recommended the need for capacity building for data utilization through on job training and strengthening the curriculum in health training institutions in data-related areas. The ministry of health can 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
Determinants of Point-of-Care Technology Use among Health Care Workers in Comprehensive Care Centres, A Case of Central Kenya
(EANSO, 2023) Muiruri, Keziah; Gitahi, Mary Wangui; Otieno, George Ochieng; King’utu, Kevin
The Point of Care (POC) approach is the highest level of interaction between health care workers (HCW) and the information system, which generally requires interaction during clinical meetings. Although it is hard to do so, it offers the most significant benefits. The POC strategy offers the system’s benefits to healthcare workers, patients, and those who monitor and evaluate them. The study focused on identifying key determinants of point-of-care technology use among healthcare workers offering services in comprehensive care centres in Central Kenya. A Cross-sectional descriptive study was adopted, two-stage cluster sampling design method was used in determining the sample size. The study involved a sample size of 217 respondents and over a 100% was achieved. The study results revealed that social demographic factors of health care workers have no significant influence on POC technology use as a p-value of above 0.05 was observed on all the variables. Some organisational factors such as adequate workstations (p = 0.0) and EMR reducing patient time (p = 0.012) were found to have significant influence on POC technology use. Significant influence on POC use was noted on source of funding for software and hardware maintenance (p = 0.001). The utilisation of EMR to review client progress in real-time (p = 0.001) was found to have a significant influence on POC technology use as well as the use of EMR to report to the national reporting system (KHIS) (p = 0.014). 71% of respondents reported that availability of clinical decision support features in the EMR was contributing to improved use of POC. An overwhelming 72% reported that they were very motivated to use POC technology due to the ability of auto generating reports. In addition, three factors were highlighted as key contributors to the success of POC use, and these were reliable power supply (44%), adequate and trained healthcare workers (24%), standard and stable EMR Systems (17%). The study recommended for adequate training of health care workers, adequate workstations, and reliable power supply. For initial implementers of EMRs, they should consider having Standard EMRs that support both clinical decision support features and automated reporting
Effect of Training “Boda-boda” Riders on Community-Based Referrals for Maternal Outcome: A Case of Busoga Region, Uganda
(SciVision Publishers, 2021) Mwebaza, Kharim Muluya; Mugisha, John Francis; Kithuka, Peter; Kibaara, Kenneth Rucha; Gangu, David Muwanguzi; Otieno, George Ochieng; Yitambe, Andre
Many pregnant mothers miss antenatal care attendance and health facility deliveries despite several interventions either due to knowledge gap on the benefits or lack of transport means to reach the health centre. Therefore, training of “boda-boda” (motor-cycle) riders in Busoga Region in Uganda was conducted to determine its effect on health facility-based deliveries. The study was a non-randomized control trial with intervention and control groups from selected health centers and communities in Busoga Region. Interventions included the training of boda-boda riders for 5 days to give them knowledge; with a six months follow-up to determine the impact of training. Questionnaires, interviews and focus group discussions were used to collect quantitative and qualitative data. Descriptive statistical analysis was computed for the quantitative data and thematic analysis for qualitative data. Findings revealed improved knowledge of boda-boda riders on maternal referrals from 49.1% to 79.0% in the intervention arm compared to 43.8% to 45.2% in the control arm. Use of boda-boda transport by mothers improved from 0% to 70.5% in the intervention arm compared to only 0% to 51.2% in the control arm. Also, of the 70.5% of the mothers who used boda-boda transport, 69.4% were transported by trained boda-boda riders and only 30.6% by un-trained boda-boda riders. Apart from age (p=0.000; CI=2.785 – 53.284) and ownership of the motorcycle (p=0.002; CI=0.992 – 8.658), the rest of the socio-demographic determinants of health facility-based deliveries were not statistically significant. Age of boda-boda riders (25–34 years, p=0.000) and ownership of the play a pivotal role in the improvement of health facility-based deliveries. Training of boda-boda riders and other key stakeholders impacted on the community based maternal referrals in the study area.
Effects of Mobile Health Technologies on Uptake of Routine Growth Monitoring Among Caregivers of Children Aged 9 to 18 Months in Kenya
(Journal of Primary Care & Community Health, 2020) Nyang’echi, Edna; Osero, Justus
This study aimed at finding out the effects of mobile health (mhealth) technologies on uptake of Routine Growth Monitoring (RGM) among caregivers of children aged above 9 months in Kenya. This was a quasi-experimental study. The experiment groups received Short Text Message (STM) and Voice Call (VC). The analysis demonstrates that in month 1, caregivers who received STM were 6.875 times more likely to take their children for RGM compared to control (OR = 6.875; 95 CI: 3.591-13.164); caregivers who received VC were 6.750 times more likely to take their children for RGM compared to those in control arm (OR = 6.750; 95 CI: 3.522-12.938). Policy makers and implementers in the health will find these study findings useful in deciding whether or not to adopt STM or VC in improving uptake of RGM for children above 9 months
An Enabling Environment for the Effective Performance of Health Unit Management Committees (Humcs) in Health Centres in Busoga Sub-Region
(direct research publisher, 2020) Muwanguzi, David Gangu; Otieno, George Ochieng; Kibaara, Kenneth Rucha; Mugisha, John Francis; Muluya, Kharim Mwebaza; Kithuka, Peter
Health Unit Management Committees (HUMCs) were introduced to provide an eye for the community to monitor and contribute ideas. It was because of poor health service delivery at some health units owing to realizations that community had stopped trusting and using services offered by the government. Health service provision and health sector performance was thus poor presumably because of dismal community monitoring. In this study, HUMCs aired out their views on what they regarded to be an enabling environment for their work to be performed as effectively as possible. A cross-sectional descriptive design was adopted with predominantly qualitative data collection methods. There were 288 respondents from HUMC that were interviewed. Data were analyzed using a computerbased qualitative data analysis software atlas Ti 7. This involved in-depth analysis of each of the main categories of data. The analysis facilitated teams to be able to describe the range of the HUMC member’s skills, training and health centre performance. During analysis, each category was considered for further assignment into subcategories. Using these subcategories gave more insight into the details of the mentors’ and trainers’ activities in each category. Findings revealed that an enabling environment for effective operation of HUMCs should comprise houses at work places to boost time management and cater for transport costs. In addition, an enabling environment for the effective performance of HUMCs should be one where hospitals are equipped with drugs so as to have more and more people healed at health centres, and well-regulated information management systems for easy follow up of activities by HUMCs. There must also be attempts to train more HUMCs so as to extend similar services to all health centres. On the side of government, there has to be an improvement in road networks especially in hard-to-reach places considering that many HUMCs do not stay at workplaces. Conclusively, an enabling environment for HUMCs operation requires the establishment of infrastructure and making the physical work environment as attractive as possible including information management systems. It is therefore recommended that the government continue training HUMCs to increase the scope of health service delivery coverage, the number of HUMCs need to be increased at health centres because in some places, there are just five members yet health centres are very big in some places. Further, there is the need for the construction of houses for HUMCs. Budget design ought to include these requirements in order to boost the speed, effectiveness, and regular rendering of services by HUMCs.
Erratum to: AGC1 Deficiency Causes Infantile Epilepsy, Abnormal Myelination, and Reduced N-Acetylaspartate
(2014) Otieno, F. G.; Falk, M.J.; Li, D.; Gai, X.; McCormick, E.; Place, E.; Lasorsa, F.M.; Hou, C.; Kim, C.E.; Abdel-Magid, N.; Vazquez, L.; Mentch, F.D.; Chiavacci, R. M.; Liang, J.; Liu, X.; Jiang, H.; Giannuzzi, G.; Marsh, E.D.; Yiran, G.; Tian, L.; Palmieri, F.; Hakonarson, H.
BACKGROUND: Whole exome sequencing (WES) offers a powerful diagnostic tool to rapidly and efficiently sequence all coding genes in individuals presenting for consideration of phenotypically and genetically heterogeneous disorders such as suspected mitochondrial disease. Here, we report results of WES and functional validation in a consanguineous Indian kindred where two siblings presented with profound developmental delay, congenital hypotonia, refractory epilepsy, abnormal myelination, fluctuating basal ganglia changes, cerebral atrophy, and reduced N-acetylaspartate (NAA). METHODS: Whole blood DNA from one affected and one unaffected sibling was captured by Agilent SureSelect Human All Exon kit and sequenced on the Illumina HiSeq2000. Mutations were validated by Sanger sequencing in all family members. Protein from wild-type and mutant fibroblasts was isolated to assess mutation effects on protein expression and enzyme activity. RESULTS: A novel SLC25A12 homozygous missense mutation, c.1058G>A; p.Arg353Gln, segregated with disease in this kindred. SLC25A12 encodes the neuronal aspartate-glutamate carrier 1 (AGC1) protein, an essential component of the neuronal malate/aspartate shuttle that transfers NADH and H(+) reducing equivalents from the cytosol to mitochondria. AGC1 activity enables neuronal export of aspartate, the glial substrate necessary for proper neuronal myelination. Recombinant mutant p.Arg353Gln AGC1 activity was reduced to 15% of wild type. One prior reported SLC25A12 mutation caused complete loss of AGC1 activity in a child with epilepsy, hypotonia, hypomyelination, and reduced brain NAA. CONCLUSIONS: These data strongly suggest that SLC25A12 disease impairs neuronal AGC1 activity. SLC25A12 sequencing should be considered in children with infantile epilepsy, congenital hypotonia, global delay, abnormal myelination, and reduced brain NAA.
Evaluation of Relationship of Sources of Health Information System (HIS) and HIS Feedback in Selected Public Health Facilities in Nairobi City County, Kenya
(Asian Journal of Research in Nursing and Health, 2020) Mairanga, G. G.; Muthee, D.; Otieno, G.
Aim: This study sought to assess the extent to which sources of Health Information System (HIS) is associated with HIS feedback in the public health facilities in Nairobi City County. Methodology: This study adopted the descriptive survey research design. Independent variable was sources of data and information in HIS while dependent variable was the HIS feedback. Public health facilities in Nairobi City County were chosen as the area of study. The research targeted public health record personnel in the public health facilities and the officials of the National HIS Coordinating Committee. To obtain suitable sample, the study used stratified, random and purposive sampling techniques. The sample size of 130 respondents was chosen in the public health facilities. The research instruments used included questionnaires and interview schedule guides. Collected data were coded and then entered into a secure database for analysis by use of Statistical Packages for Social Sciences (SPSS) version 23. Both descriptive as well as inferential statistics were used for analysis. Qualitative data were analyzed with an aim of establishing the themes. Significance was assessed at p = 0.05. Results: The sources of data had a negative association with HIS feedback with a correlation coefficient of -0.753. The relationship between sources of data and HIS feedback was significant (p = 0.0476). Conclusion: Based on the findings, it was concluded that many sources of data negatively influences HIS feedback. Thus, with more sources of data, there is less HIS feedback.
Evaluation of Technical Efficiency of County Referral Hospitals in Kenya and Its Determinants
(International Journal of Advanced Medical and Health Research, 2019) Rithaa, Gilbert; Kosimbe, George; Yitambe, Andrew; Kithuka, Peter
Government’s health expenditure as a percent of the total government budget is approximately 7% which falls below the target of 15% recommended by the World Health Organization. It is, therefore, important that the country’s health‑care resources, specifically those allocated to the health sector, are optimally used. Methods: An one‑stage data envelopment analysis (DEA) method was used to estimate the technical efficiency of county referral hospitals. Atotal of 34 county referral hospitals were randomly sampled and studied. Data analysis was performed in two stages as follows: first, input and output data were entered into MS Excel sheet after which DEA version 2.1 was used to determine the technical efficiency scores for the hospitals. In the second stage, interval regression analysis using censored interval regression model was used to identify determinants of technical efficiency for the sampled hospitals. Results: Results indicated that the mean constant return to scale technically efficient score was 82.4%, the mean variable return to scale (VRS) technically efficient score was 94.1%, and the mean scale efficiency technical score was 87.4%. The mean level of VRS technical inefficiency was 17.2%. The total inputs slacks in the inefficient hospitals were 104 beds and 840 staff which represented an input slack of 4% for the beds and 28% for the staff. Conclusions: Inefficient hospitals could have attained efficient frontiers using fewer resources, specifically 4% beds and 28% staff. The technical inefficiencies in county referral hospitals are occasioned by the use of inappropriate production functions characterized by the existence of excess production inputs and suboptimal outputs.
Evaluation of Utilization of Health Management Information System by Health Unit Management Committees in Luuka District, Uganda
(Journal of Research, Innovation and Implications in Education, 2019) Muwanguzi, David; Otieno, George; Kibaara, Keneth; Mugisha, John Francis
The study was about Management and Utilization of Health Management Information system (HMIS) by Health Unit Management Committees (HUMCs) in Luuka District. The investigation was based on a realization that inefficiency is occurring at all the levels of HMIS management within the health sector and the line sectors/ stake holders. The intention was to ascertain the type of information generated for use by HUMCs, how the information is generated and establish the information used in planning and monitoring by HUMCs. A descriptive and evaluative survey was used because the findings of the study called mainly for evaluative analysis of the utilization of HMIS by HUMCs. A sample of 68 respondents was selected using stratified and purposive sampling techniques. Data analysis was done descriptively. According to results generated, 94% of the respondents acknowledged that information generated from patients in the various health units is used by HUMCs specifically to; planning and monitoring, for returns to DDHS office at Luuka district, and for review of financial statement. The basic challenge was that though catalogued, limited information is recorded and yet patients do not want to carry information sheets whenever they come back for more treatment. It was therefore concluded that though HUMCs require information to review, plan and monitor activities/services, these tasks are difficult because in most health facilities, information required is not shared by patients and health workers. The study also concluded that in most heath units, information is well managed and the effectiveness of using HMIS is moderate. It was recommended that patients should start coming to health units with their documents to ease follow up of their treatment by health workers. In addition, health workers were recommended to make it mandatory to only serve a patient with documents to improve on information flow between patients and medical workers.
Factors contributing to malnutrition among children under five years of age in Machakos Country Level five hospital
(wjpmr, 2017) Kishoyian, Gabriel M.; Osinyo, Yunis B.; Kishoyian, Jane N.; Otieno, George O.
Background: Child malnutrition is one of the measures of health status that the World Health Organization (WHO) recommends for equity in health. According to WHO, 60% of all deaths occurring among children aged less than 5 years in developing countries is attributed to malnutrition. To improve on this condition, it is necessary to determine the determinants of malnutrition. Methods: This was a descriptive cross-sectional study conducted at Machakos Level five hospital from mothers attending MCH/FP clinic. Using random sampling, seventy (70) mothers and their children 6 months to 60 months participated in the study. Using a questionnaire, socio demographic characteristics and weaning practices were taken as well as children anthropometric measurements (mid-upper arm circumference – MUAC). SPSS version 16.0 statistical software was used for analysis. Results: Out of the seventy children who were involved in the study, 19 (27.1%) were males while 51 (72.9%) were females. The age ranged was 8 months to 60 months. The results obtained showed that socioeconomic factor, poor nutrition and mothers’ knowledge and feeding practices led to increase in the prevalence of malnutrition. Mid Upper Arm Circumference (MUAC) was measured using non-stretchable tape on left mid upper arm with the outcome showing that 17 (24.3%) had severe malnutrition, 8(11.4%) had moderate malnutrition, 31 (44.3%) had mild malnutrition while 14 (20%) were well nourished as classified according to World Health Organization. In addition, 41 (58.6%) of children were underweight and that only 22 (31.6%) practices exclusive breastfeeding for the first six months. There was a significant association between the age of the mother and child gender, weaning age of the child and baby feeding frequency per day (p˂0.05). Discussion: The findings from this study suggest that socio-economic factors such as lack of knowledge on the cause of malnutrition child feeding weaning age and the frequency of daily baby feeding practices are predictors of malnutrition in less than five. These findings are of practical importance because they can form part of preventing programs for community. Conclusion: Feeding practices (pre-lacteal feeding and complementary feeding practice) were related to malnutrition thus, nutritional intervention program in Machakos County in Kenya should focus on these factors in order to improve child feeding.

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