RP-Department of Family Medicine, Community Health and Epidemiology

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Accessibility of Anal Cleansing Materials for Public Primary School Pupils in Kajiado County, Kenya
(ajol, 2022) Umuro, Sabla Abduba; Karama, Mohammed; Akunga, Daniel Nyagetiria
INTRODUCTION Anal cleansing is the hygienic practice of cleaning the anal area after defecation. Inaccessibility to anal cleansing materials leads to inappropriate methods resulting in faecal hand contamination. This study assessed the accessibility of anal cleansing materials for public primary school pupils in Kajiado County, Kenya. MATERIALS AND METHODS The researchers used a descriptive cross-sectional study approach, applying a cluster sampling technique to sample eighteen (18) schools to the study. Three hundred and eightyfour (384) pupils were selected from the schools using simple random sampling. The Headteacher and a teacher in charge of school health were purposively sampled due to their knowledge of school resources about hygiene. A total of thirty-six teachers participated in the key informant interviews. Data were analysed using SPSS version 21, and Chi-square was used to test the hypothesis at p<0.05 significance level. RESULTS Accessibility to anal cleansing materials was low at 22.9%. Pupils' class (p-value = 0.036) and level of material awareness (p-value <0.001) influenced accessibility. For Institutional factors, material sensitisation was associated with accessibility (p-value = 0.001). The following sustainability measures were proposed; sensitisation on anal cleansing materials, provision through cost sharing, management of the materials by class teachers and prefects, and continued support by government ministries of health and education. CONCLUSION Anal cleansing materials access was low; pupils' predisposing characteristics and institutional factors influenced access. RECOMMENDATION We recommend that school management and ministries of health and education improve access to anal cleansing materials in schools and develop sustainability measures
Antibiotic Prescribing Practices for Upper Respiratory Tract Infection among Clinical Officers at Kiambu County
(Journal of Family Medicine, 2024-03-21) Murigi, Kevin; Thigiti, Joseph; King’ang’a, Muiruri
Background Antibiotics are the most prescribed medications worldwide. Global consumption rose by 65% in 76 low and middle-income countries between the years 2000 and 2015. According to the World Health Organization, improper administration of antibiotics occurs in over 60% of people with upper respiratory tract infections. Inadvertent antibiotic use has been identified as a contributor to antimicrobial resistance. Outpatient antibiotic use accounts for around 80-90% of all antibiotic use in patients. Clinical officers are non-physician healthcare workers who have received less training, have a more restricted scope of practice than physicians. Clinical officers are key service providers in this country especially at the primary healthcare level. Objective The study assessed the factors that influence antibiotic prescribing for upper respiratory tract infections by clinical officers. Method A prospective study was carried out at 20 public hospitals in Kiambu County, on 36 clinical officers and 600 patient prescriptions. The parameters measured were patient factors, prescriber factors, institutional factors and how they affected the antibiotic prescribing practices by either being rational or irrational. Rational prescribing was identified as prescribing the right drug, at the right frequency, in the right duration, right dose for the right indication. Prescriptions were considered irrational if they did not satisfy any of the rational indices. Data was collected via a questionnaire from the clinical officers while WHO prescription checklist was used to collect data from patient encounters. Data was analyzed using Statistical Package for Social Sciences version 22.0 (SPSS v22.0) with P-value, Confidence Interval and Odds Ratio. Results A total of 600 patient encounters were recorded and 79.8% of the 479 encounters had an antibiotic prescription for URTI, 91% of the antibiotic the right dose, 98% had the right frequency, 75% had the right duration, and only 23% had the right indication. Patients above 65 years were more likely to receive an antibiotic prescription OR 3.98 CI 0.91,17.41 P=0.17 compared to children under 12 years old. Males were more likely to receive an antibiotic, but this was not significant OR 1.06 CI 0.70, 1.59 P=0.79. A total of 28 (4.6%) patients had fever, and all received antibiotics. A total of 36 clinical officers were sampled and only 5 (13.8%) were found to have rational prescriptions (P=0.63), prescriber age (P=0.92), prescriber level of education (P=0.99) and prescriber work experience (P=0.22) were not associated with antibiotic prescription. As per institutional factors, availability of antibiotics (P=0.026) and availability of prescription guidelines (P=0.012) were associated with rational prescription of antibiotics. Conclusion The study indicated that there was a high antibiotic prescription rate deviating from the WHO standard. It demonstrated that most antibiotic prescriptions were irrational.
Exploring HIV Self-Testing: Barriers and Facilitators among Undergraduate Students
(IJGP, 2024-04) Muendo, Nicholas; Thigiti, Joseph; Tembu, Osborn
Introduction: Globally, 36.7 million individuals live with HIV/AIDS, with 2.5 million new cases annually. Youth (14-25 years) account for 45% of these new infections. Those aged 15-24 years are less likely to be aware of their HIV status and engage in HIV care compared to older adults. This study explores the use of HIV self-testing to improve access to HIV care among Kenyatta University undergraduates. Objective: To identify barriers and facilitators to HIV self-testing in this group. Methodology: Employing multistage cluster sampling, 398 students were surveyed using a self-administered questionnaire. Results: Of the participants (median age 21 years, 1:1.03 male-to-female ratio), 91.7% understood HIV's seriousness, with sexual intercourse as the primary transmission mode. Self-testing usage was 28.8%. Key barriers included fear of partner reaction, stigma, and lack of confidence. Significant facilitators were being female, knowledgeable about HIV, and sexually active. Conclusion: Only 24% had prior HIV testing experience. The study highlights the importance of addressing fears and misconceptions while leveraging knowledge and sexual activity awareness to promote HIV self-testing.
Exploring the Interplay of Socio-demographic Enablers in Sustaining Open Defecation-Free Status among Households in Kakamega County, Kenya
(AJOL, 2023) Okumu, Maitabel Achieng’; Mwanzo, Isaac; Nyambura, Anthony
This study aimed to explore the interplay between socio-demographic enablers and the sustainability of post-open-defecation-free status among households in Butere Sub-County, Kakamega County, Kenya. The research adopted a cross-sectional survey to assess the sustainability of the open defecation-free status at the household level, surveying 6286 certified Open Defecation Free (ODF) households through stratified random sampling. A sample size of 376 households across three wards was selected for the study. Both quantitative and qualitative data were employed; quantitative data was analysed using SPSS Version 28.1, summarized using descriptive statistics, and presented in tables, pie charts, and frequency tables, whereas qualitative data was analysed thematically. Data analysis involved three stages; univariate, bivariate and multivariate analyses. Chi-square tests analysed the statistically significant association between dependent and independent variables. Binary logistic regression predicted the probability of post-ODF status (whether the ODF status was sustainable or not), and 2x2 contingency tables were used to compute the odd ratio. Results revealed that only 9% of households sustained post-ODF status. The chi-square tests revealed a significant association between respondents' gender (χ² = 0.124, p = 0.009*), age distribution (χ² = 6.471, p < 0.05), presence of children under 5 years old in the household (χ² = 1.884, p = 0.004*), level of education (χ² = 5.726, p = 0.006*), employment status (χ² = 9.602, p = 0.006*), and monthly earning brackets (χ² = 11.783, p<0.001*). However, there was no statistically significant association between marital status (χ² = 10.409, p = 0.94>0.05), household size (χ² = 1.782, p = 0.56>0.05), and the sustainability of ODF. On the other hand, the odds ratio for employment status suggests that significant association (OR=1.333; p = 0.007*<0.05; 95% CI: 1.082-1.642), where employed individuals were 1.333 times more likely to sustain ODF status. Further analysis revealed that employment status was a statistically significant predictor of post-ODF sustainability (aOR=1.837 P=0.011; 95% CI: 1.132-2.980). The study concluded that most households (91%) did not sustain post-ODF status after the ODF declaration. It was recommended that health practitioners improve door-to-door monitoring and develop post-ODF tracking tools at the household level, focusing on important parameters from Ministry of Health guidelines. The government and other Water sanitation and hygiene (WASH) stakeholders should support communities in establishing and enhancing economic empowerment programs to increase household income and encourage investments in sanitation infrastructure and hygiene promotion activities
Factors Influencing Women’s Knowledge at Scheduled Postnatal Visits: A Multi-Centre Study in Kakamega, Kenya
(magonline library, 2021) Kiragu,Charles; Osero,Justus SO; Wanyoro,Anthony K
Background/Aims Postnatal care is offered to mothers and their babies from birth and across the postnatal period. Visits are spread over the postnatal period, and a minimum of four visits is recommended. In many studies, postnatal visits in Africa have been reported to be low compared to antenatal visits. As a result of low postnatal visits, mothers are not able to utilise postnatal care services, resulting in delayed detection of and interventions for maternal and neonatal health problems, leading to high rates of maternal and neonatal morbidity and mortality. In Kenya, only 53% of mothers attend postnatal clinics; in Kakamega county, only 34% of mothers attend. This study aimed to establish factors influencing postnatal knowledge among mothers in selected hospitals in Kakamega, Kenya. Methods The study was a descriptive cross-sectional study involving 320 postnatal mothers recruited from four sub-counties. Systematic sampling was used to select eligible study participants. Data were collected using questionnaires that assessed the participants’ knowledge of postnatal care in terms of what postnatal care is, recommended postnatal care, when to attend a clinic and the services offered at postnatal care clinics. The data were entered into a database and analysed using the Chi-squared test to assess how sociodemographic and socioeconomic characteristics were associated with knowledge of postnatal care. Results The majority of participants (73.1%) had poor or no knowledge of postnatal care and 89.7% had poor or no knowledge on when postnatal visits should be carried out. Most postnatal mothers (71.9%) received postnatal health information from health workers. Occupation (P<0.000), income (P<0.000), transport (P<0.000) and time taken to travel to hospital (P=0.034) were significantly associated with postnatal knowledge. Conclusions Knowledge on postnatal care is poor among postnatal mothers in Kakamega. The majority of participants obtained postnatal care information from health workers, and so it is recommended that Kakamega establishes other strategies for giving information on postnatal care, such as pamphlets to mothers
Prevalence and Predictors of Arthritis among Adults in A Rural Set-Up in Kenya: A Cross-Sectional Study
(pan-african medical journal, 2024-04) Kinara,Shem Nyarunda; Kimani,Harun Mbugua; Ogweno, Gordon Oluoch
ntroduction: arthritis is a significant public health problem affecting many people globally. Exposure to various risk factors puts individuals at risk of developing arthritis. Therefore, this study aimed to assess the prevalence and predictors of arthritis among residents of a rural set-up in Nyamira County, Kenya. Methods: a community-based cross-sectional study design was employed. Simple random sampling was utilized to select households from a household list. All the residents of the sampled household above 40 years were included. Descriptive analysis was done to describe the study population. Bivariate and multivariate analysis was Article Shem Nyarunda Kinara et al. PAMJ - 47(158). 03 Apr 2024. - Page numbers not for citation purposes. 2 also done to identify statistically significant arthritis-related variables. Results: the prevalence of arthritis was 44.6%. Previous joint injury/infection [AOR=2.74; 95%CI=1.59-4.77; p<0.001], being unemployed [AOR=2.77; 95%CI=1.50-5.21; p=0.001], age above 51 years, and hypertension [AOR=1.90; 95%CI=1.03-3.53, p=0.040] were associated with an increased risk of arthritis. Conversely, being male [AOR=0.42; 95% CI=0.22-0.75; p=0.005], standing for > 2 hours [AOR=0.48; 95%CI=0.29-0.81; p=0.006], and constant shifting from sit to stand positions [AOR=0.45; 95% CI=0.26-0.76; p=0.003] were associated with a lower risk of arthritis. Most participants (75%) had an arthritis knowledge score of more than 66%. Conclusion: the study found a high prevalence of arthritis in the community. Arthritis was strongly associated with various risk factors under study. Therefore, there is a need to take preventive measures for modifiable factors to enhance a reduced prevalence of arthritis
Prevalence and Predictors of Arthritis among Adults in a Rural Set-Up in Kenya: A Cross-Sectional Study
(Pan African Medical Journal, 2024-04) Kinara, Shem Nyarunda; Kimani, Harun Mbugua; Ogweno, Gordon Oluoch
Introduction: arthritis is a significant public health problem affecting many people globally. Exposure to various risk factors puts individuals at risk of developing arthritis. Therefore, this study aimed to assess the prevalence and predictors of arthritis among residents of a rural set-up in Nyamira County, Kenya. Methods: a community-based cross-sectional study design was employed. Simple random sampling was utilized to select households from a household list. All the residents of the sampled household above 40 years were included. Descriptive analysis was done to describe the study population. Bivariate and multivariate analysis was also done to identify statistically significant arthritis-related variables. Results: the prevalence of arthritis was 44.6%. Previous joint injury/infection [AOR=2.74; 95%CI=1.59-4.77; p<0.001], being unemployed [AOR=2.77; 95%CI=1.50-5.21; p=0.001], age above 51 years, and hypertension [AOR=1.90; 95%CI=1.03-3.53, p=0.040] were associated with an increased risk of arthritis. Conversely, being male [AOR=0.42; 95% CI=0.22-0.75; p=0.005], standing for > 2 hours [AOR=0.48; 95%CI=0.29-0.81; p=0.006], and constant shifting from sit to stand positions [AOR=0.45; 95% CI=0.26-0.76; p=0.003] were associated with a lower risk of arthritis. Most participants (75%) had an arthritis knowledge score of more than 66%. Conclusion: the study found a high prevalence of arthritis in the community. Arthritis was strongly associated with various risk factors under study. Therefore, there is a need to take preventive measures for modifiable factors to enhance a reduced prevalence of arthritis.
Utilization of sexual reproductive health services among public service vehicle operators in Nairobi City County, Kenya
(International Journal of Community Medicie and Public Health, 2023) Oenga, Davis; Mugo, Judy; Kiplalom, Rosebella
Background: Public service vehicle operators and owners are a susceptible demographic in need of specialized treatments due to their high vulnerability to these problems. The primary purpose of this research was to learn on the utilization of sexual reproductive health services (SRH) among public service vehicle (PSV) operators in Nairobi County use sexual and reproductive health care services. Methods: A descriptive cross-sectional study design was adopted for the study. The research approach used both qualitative and quantitative techniques. Operators at bus terminals made up the bulk of the research population. The Cochran's formula was used to precisely estimate a sample's contribution to a population, and the sampling estimate had a variance (margin of error) of 0.5. Results: The logistic regression model results showed that, after controlling for demographics, female PSV operators were 97% more likely to use SRH services on at least four separate occasions than their male counterparts (95% CI (0.21 to 0.96), p=0.015). When controlling for age, marital status, and education, PSV operators from universities are 75% more likely to use SRH services than those from primary schools (95% CI (1.12 to 0.75), p=0.001), and those from secondary schools are 68% more likely to use SRH services than those from primary schools (95% CI (0.241 to 0.679), p=0.004). Conclusions: This study concluded that, the utilization of SRH services among PSV is at 36.6%, married PSV operators utilize sexual reproductive health services was more than unmarried PSV operators. Age, level of education and employment status are determinants to utilization of the selected sexual reproductive health services.

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