MST-Depatment of Family Medicine community Health and Epidemiology

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    Determinants of Point-of-Care Technology use among Health Care Workers Offering Services at Comprehensive Care Centres in Central Kenya
    (Kenyatta University, 2024-11) Muiruri, Keziah Kanina
    The most sophisticated level of interaction between healthcare professionals and the information system is the POC approach taking place during clinical meetings. The POC strategy offers benefits HCW, the patients they serve, and the individuals tasked with overseeing and assessing their performance. In central Kenya, the health facilities have continued to use both paper systems alongside the EMR system despite having POC implementations. The objective of the study was to determine the elements that affect the utilization of Point-of-care services by healthcare professionals. The study's specific goals were to recognize the socio-demographic, organizational, technical, and financial elements, extent of clinical decisions features use and level of accuracy and consistency of automated indicator reporting in influencing POC technology use among CCC’s in Central region of Kenya. Descriptive cross-sectional design was utilized in this study. The study population included clinical officers, nurses, health records and information officers among other cadres offering services in the CCCs. The sample was determined using a multi-stage cluster sampling design, and EMR users at health facilities sampled based on population size. The sample size for health facilities was 102 and for system users it was 239 HCW. Data was collected using structured questionnaire in an in-person environment. The data gathered was inputted and examined using descriptive statistics, including percentages. Additionally, Inferential statistical methods such as the chi-square test and Fisher's exact test were utilized to establish correlations with the assistance of R software. The findings indicated that POC use was unaffected by the social demographic factors of healthcare workers, Age X2 (1, n=225)=0, p=1; by sex X2 (1, n=224)=0.507, for education level, p=0.317; for computer skills, the chi-square statistic was X2 (2, n=225)=0.038 with p=0.981; regarding profession, p=0.070; and for county, the chi-square statistic was X2 (4, n=225)=1.589 with p=0.791. The use of POC technology was significantly influenced by organizational elements including the availability of adequate workstations (p=0.0) and the decrease in patient wait times facilitated by EMR (p=0.012). The origin of financial resources for the upkeep of software and hardware had a significant impact on POC use w p=0.001. Furthermore, the application of EMR for the real-time assessment of client progress (p=0.001) and the reporting of data to KHIS (p=0.014) was observed to significantly impact the utilization of POC services. 71% of participants stated that the presence of CDS features in the EMR was enhancing the utilization of POC. Additionally, 72% expressed strong motivation to use POC technology because of its capability to automatically generate reports. The success of POC use was attributed to three main factors, with 44% emphasizing the importance of a dependable power supply, 24% stressing the need for sufficient and well-trained healthcare workers, and 17% pointing to the significance of standard and reliable EMR Systems. Recommendations include training for HCWs on EMRs, ensuring adequate workstations and power supply, and adopting standard EMRs for effective clinical decision support and reporting.
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    Predictors of Stunting Among Children Aged 6-59 Months in Kitui County, Kenya
    (Kenyatta University, 2024-10) Kangethe, Chui Morris
    Stunting in children under five years is a significant public health problem in developing countries, with Eastern and Central Africa having some of the highest stunting levels worldwide. In Kenya, 25% of children under five are stunted. Stunting has transitory and lifelong effects on people and communities, including a high risk of morbidity and death, lowered mental and physical growth, poor school performance, and decreased productivity. The goal of this study was to investigate the predictors of stunting in children aged 6 to 59 months in Kitui County. This was a cross-sectional analytical survey comprising 398 children and their caregivers. Multistage cluster sampling was used. First, clusters were selected from all the five wards of Kitui Central Sub-county based on probability proportional to population size. Secondly, two villages were randomly chosen per ward using simple random sampling. Lastly, households were picked within the selected villages using simple random sampling. Only one eligible child per household was chosen randomly. Data were gathered using structured questionnaires, KIIs, and FGDs. Anthropometric measurements were taken from 398 children to assess stunting, while their caregivers were interviewed. To estimate the rate of stunting, anthropometric data were analyzed with ENA for SMART software. The mid-upper arm circumference of mothers was measured to estimate maternal nutrition. SPSS 27 was used to input and analyze data. Descriptive statistics were generated and the chi-square test was run to determine associations between stunting and the independent variables. After the chi-square test, variables that were statistically related to stunting (p<0.05) were subjected to bivariate logistic regression analysis to calculate the Odds Ratio (OR) for each independent variable. The statistical significance was at p<0.05. The stunting rate was 26.6%. The predictors of stunting included mothers with primary education (OR = 3.153; 95% CI: 1.449-6.860; p: 0.004) or secondary education (OR = 3.143; 95% CI: 1.455-6.787; p: 0.004), mother’s MUAC < 23 cm (OR = 3.106; 95% CI: 1.288-7.493; p:0.012), birth weight < 2500 grams (OR = 2.469; 95% CI: 1.342-4.545; p: 0.004), household income below Kshs 10,000 or USD 77.5 (OR = 5.125; 95% CI: 1.965-13.364; p: 0.001), having more than one child below five years (OR = 1.676; 95% CI: 1.040-2.702; p: 0.034), partial immunization (OR = 4.719; 95% CI: 1.107-20.126), complementary feeding before six months (OR = 2.601; 95% CI: 1.221-5.543), using water from unimproved water sources (OR = 1.750; 95% CI: 1.075-2.848; p:0.024), and having no access to a latrine/toilet (OR = 6.811; 95% CI: 1.728-26.849; p: 0.006). The investigator concluded that stunting was high and was influenced by sociodemographic factors, child caring practices, and the household environment. The study recommends that the county government should enhance policies for women and girls education, sensitize the community on the benefits of family planning, provide livelihood support to families to improve income, promote knowledge on stunting among caregivers, strengthen community programs that promote timely complementary feeding, continue the current efforts to improve access to safe drinking water and sanitation, and intensify measures to reduce stunting through multisectoral interventions.