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Item Defaulting Rate Among Patients Attending Methadone Maintenance Clinics in Nairobi City County, Kenya(Kenyatta University, 2025-11) Owuor, Sharon AkothDefaulting from MMT clinics is a major public health problem affecting people globally resulting into high transmission of HIV, hepatitis B and C, increased crime rate and reduced productivity of an individual. There is a global increase in the use of opioids with a prevalence of 1.2 % and in Kenya the prevalence stands at 0.3 %. The objective of this study was to investigate the defaulting rate and its associated factors, and the strategies that can be put in place to improve retention. This study was done at Ngara MMT clinic and Mathari MMT in Nairobi City County, Kenya. A cross-sectional analytical study design was employed, and the study population was the patient’s currently taking methadone in both clinics. There was use of simple random sampling with a sample size of 369 being recruited in both facilities. Stratified Sampling was used to select 8 members of the FGD and purposive sampling done for the key informants in both facilities. A researcher-administered questionnaire, a key informant guide, and a focus group discussion guide were used to collect data. Quantitative data analysis was done using SPSS version 24.0. Chi-Square and regression analysis were used for descriptive and inferential statistics for the quantitative data, and the qualitative data was analysed thematically. All study participants signed informed consent. Sociodemographic data was collected and the mean age of the patients was 33.91. The defaulting rate of patients attending MMT clinics was 53% with no significant association between defaulting and type of MMT clinic (χ2 = 2.731, df = 1, p = .098). The study found significant associations between MMT defaulting and marital status (χ2 = 44.592, df = 3, p < .001), religion (χ2 = 47.653, df = 2, p < .001), education level (χ2 = 72.125, df = 3, p < .001), and income source (χ2 = 44.784, df = 2, p < .001). Age and MMT benefits awareness had no association with defaulting. Social support from friends and family was also significantly associated with MAT defaulting (χ 2 =34.453, df=1, p<0.001). The institutional factors such as affordability of transportation, HCW friendliness, clinic hour’s convenience, and waiting time for attendance were also significantly associated with defaulting. This study identified several strategies to improve the retention rate among MMT clients including extension of clinic hours, expanding mobile van clinic, staff training on dealing with patients, fare provision, reduced stigmatization, defaulter tracing, family and community support, and avoiding peer influence. Additionally, frequent patient counselling and education were suggested as ways to improve retention. To improve patient retention and improve methadone effectiveness, this study recommends the implementation of the suggested measures. The Ministry of Health should ensure the implementation of the retention measure within the MMT clinics to improve methadone effectivenessItem Prevalence and Risk Factors Associated with Geohelminths and Intestinal Protozoa Infections among Pupils Aged 7–12 Years in Nyeri County, Kenya(Kenyatta University, 2025-10) Muthee, Anthony MenaineHelminths and protozoa are the two categories into which intestinal parasites fall. Schoolage children are highly susceptible to intestinal protozoa and soil-transmitted helminth (STH) infections. Geo-helminth and intestinal protozoa infections remain a significant public health burden in many parts of Kenya, especially among school-going children in rural and peri-urban regions. Despite the implementation of Mass Drug Administration (MDA) programs, the prevalence of these infections among school-aged children continues to rise. The study aimed to determine the prevalence and associated risk factors of STH and intestinal protozoa infections among school-going children in selected primary schools in Konyu area. The Specific Objectives were: To determine the prevalence of geohelminths and intestinal protozoa infection among school children; to identify the risk factors associated with geohelminths and intestinal protozoa infection among pupils, and To identify the environment related risk factors associated with geohelminths and intestinal protozoa infection in Nyeri County. The Epidemiological Triangle Model (ETM) guided this study. A cross-sectional study design was employed involving 164 pupils from Kihuro, Gathuini, and Gikumbo primary schools. The study was conducted in 3 primary schools which were purposively selected and the study population comprised pupils in Grades 1 to 6, aged between 7 and 12 years. This study employed a cluster random sampling technique to select participants from public primary. Using the Cochran formula, a total number of 178 study subjects was calculated, though only 164 pupils provided complete date. Pre-testing of the research instruments was conducted in a school setting, to ensure consistency with the actual study environment. The reliability of the study tools and laboratory procedures, quality control measures were implemented and a coefficient of 0.84 was obtained. The data collection process began with a community sensitization meeting supported by local leaders, followed by a focus group discussion involving key stakeholders. Pupils and their guardians completed structured questionnaires on hygiene and environmental risk factors before being given labeled containers for stool sample collection. Samples were collected and analysed using the Kato-Katz technique for helminths and the Formal Ether Concentration technique for protozoa. Laboratory SOPs were rigorously followed, with quality checks to ensure accuracy and confidentiality. Data were cleaned, coded, and analysed using SPSS version 28.0. Descriptive statistics were used to summarize participant characteristics, while Chisquare tests evaluated associations between risk factors and infection prevalence. The prevalence of intestinal protozoa was 21.4%, 33%, and 20.4% in Kihuro, Gathuini, and Gikumbo, respectively, while STH prevalence was 10.7%, 13%, and 13%. There was a significant association between pupil and environmental risk factors and the prevalence of infections (p < 0.05). Risk factors related to hygiene practices, sanitation, and environmental exposure were significantly associated with infection rates, underscoring the need for integrated interventions beyond routine deworming. The study concluded that infection prevalence was high and significantly linked to personal and environmental risk behaviours, leading to targeted recommendations for health education, hygiene infrastructure, regular deworming, and improved WASH practices in schools.Item Determinants of Health-Seeking Behaviours Leading to Total Delay in Tuberculosis Treatment among Adult Patients in Kirinyaga County, Kenya(Kenyatta University, 2025-10) Wambui, Milkah WanjiruTuberculosis (TB) remains a significant global and national public health concern, especially in low- and middle-income countries. A major barrier to effective TB control is the presence of delays at different stages, including patient delay in seeking medical attention, diagnostic delay, and delay in starting treatment after diagnosis. Most transmission occurs between symptom onset and treatment initiation, with one untreated patient capable of infecting 10–15 others. Timely health-seeking behaviour and early treatment initiation are therefore essential to interrupt transmission and improve prognosis. This study determined the prevalence and determinants of total TB treatment delay among adult patients in Kirinyaga County, Kenya. A descriptive cross-sectional design was applied across five sub-counties, targeting adults newly diagnosed or in the intensive phase of TB treatment. A total of 246 patients participated. Quantitative data were collected using structured questionnaires on Kobo Toolbox, while qualitative data were gathered through focus group discussions (FGDs) and key informant interviews (KIIs). Total TB treatment delay was measured as the number of days from symptom onset (as recalled by patients) to treatment initiation, verified from facility registers. The study analyzed quantitative data using descriptive statistics, chi-square tests, and logistic regression, while qualitative data were analyzed thematically. Overall, 60.6% of patients experienced total TB treatment delay, with 27% reporting short, 28% moderate, and 45% long delays. Education level (p = 0.028), employment status (p = 0.010), and comorbidity (p < 0.001) were significant individual predictors. Socio-cultural factors such as stigma (p = 0.023) and discrimination (p < 0.001) were also associated with delay. Healthseeking behaviour strongly influenced delay: patients who sought care after weeks were less likely to delay compared to those who sought care within days (AOR = 0.47; 95% CI: 0.231–0.963; p = 0.039). In conclusion, the study established that total tuberculosis treatment delay remains prevalent in Kirinyaga County, largely influenced by stigma, socio-demographic factors, and health-seeking behaviors. Addressing these requires integrated community education, stigma reduction, and strengthened health-system measures for same-day diagnosis and prompt treatment initiationItem Access to Healthcare among Residents in Kiandutu Urban Informal Settlement, Kiambu County(Kenyatta University, 2025-06) Kikuvi, Charlotte NdungeAccess to healthcare refers to the ability to get the required medical care from the health service providers when needed. Most low- and middle-income countries (LMICs) have limited access to healthcare, especially in urban informal settlements. Informal settlements are characterised by people of low socio-economic status, lack of education, and lack of employment along with substandard housing and overcrowding, poor sanitation, limited water supply, and inadequate or no public infrastructure. Due to the high poverty rate in informal settlements, there is limited access to healthcare, which may cause many health problems. The study assesses determinants of access to healthcare by residents in Kiandutu urban informal settlement, Kiambu County. The study employed a descriptive cross-sectional study design to determine predisposing, enabling and need factors that influence access to healthcare among the residents. A multi-stage sampling approach. Kiandutu urban informal settlement was purposively selected, random sampling was used to select four out of the eight villages and systematic sampling was used to select households. The study covered a total of 318 households. Data collection tools used both quantitative and qualitative approaches. Descriptive statistics were presented using frequency and percentages, tables and graphs. Chi-square and Fisher's exact test statistics were used to evaluate the associations between the variables. Qualitative data were subjected to thematic analysis. The results revealed that religion (ꭙ2=4.193; df=1; p<0.041), education (ꭙ2=7.854; df=2; p<0.020), income (ꭙ2=6.921; df=2; p<0.031), and distance to the facility (ꭙ2=25.818; df=2; p<0.0001) all had an impact on access to healthcare. In conclusion, the seriousness of illness mainly influenced health-seeking behaviour. Education level, religion, income earning and distance to the health facility outside informal settlements influenced access to healthcare. The study recommended, the County Government should carry out health awareness measures to reduce the time gap between symptoms and seeking care. The County Government and Stakeholders should influence and promote the advancement of health services. The County Government and NGOs should ensure health services are affordable and accessible to the residents. The County Government and policy makers to ensure that the health facilities within informal settlements offer specialist clinics.Item Determinants of Iron and Folic Acid Supplementation Adherence among Women of Reproductive Age in Kilifi South Sub-County, Kilifi County, Kenya(Kenyatta University, 2025-11) Machini, Bochaberi MarionIron Deficiency Anemia (IDA) among expectant women causes severe consequences for both productive and reproductive health, resulting in a major public health problem. Iron Folic Acid supplementation (IFAS) is the foremost approach put in place to curb pregnancy-related anemia. Despite this implementation, poor adherence remains to be a big problem. The Kenyan Ministry of Health recommends that pregnant women take 60mgs of iron and 400 μg of folic acid daily from conception till birth. In Kilifi County, 22.2% of pregnant women were reported to adhere to IFAS intake in the year 2017. The major objective of this research was to find out the determinants of IFAS adherence among women of reproductive age, with children 0-23 months in Kilifi South SubCounty, Kilifi County, Kenya. The study aimed to establish the proportion of women who were anemic, the proportion adhering to IFAS intake and how social, economic, demographic and health system factors influenced IFAS intake. A total of 324 mothers were recruited. The research was conducted in two purposively selected public hospitals at the community level, where mothers were selected using cluster sampling. A cross-sectional study design was used. Qualitative data was collected through Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). Quantitative data was collected using structured questionnaires. Qualitative data was analyzed thematically. Analysis of Quantitative data was conducted using the Statistical Package for Social Sciences version 25. A descriptive summary was made before testing relationships. Association between dependent and independent variables was determined using Chisquare and logistic regression at p<0.05. Odds Ratio was used to test the strength of association. The Graduate School of Kenyatta University approved the research, ethical approval was given from the Kenyatta University Ethics and Review Committee, permit to do the research was given by the National Commission for Science, Technology and Innovation and permits were also obtained from the county government of Kilifi, department of health services, both county and sub-county offices. Adherence to IFAS intake in Kilifi South subcounty was low at 31.2% below the required 65% but higher than that of the national level. Factors positively associated with IFAS intake included education level of mother (x2 =16.884; df=4; p=0.002), age(p=0.03, OR=1.26), monthly income (p=0.044, OR=1.622), Number of ANC visits (x 2=7.586; df=4; p=0.000), knowledge of IFAS and its importance (x2=7.586; df=2; p=0.023), knowledge of anemia (x2=8.020; df=1; p=0.005), knowledge of anemia causes (x2=14.575; df=1; p=0.000), knowledge of effects of anemia in pregnancy (x2=17.332; df=1; p=0.000), Being anemic during pregnancy (x2=22.877; df=1; p=0.000; OR=3.35) and challenges faced when taking and acquiring IFAS (x2=4.717; df=1; p=0.03). Some of the challenges listed were late ANC attendance (57.1%), side effects (53.4%), forgetfulness (32.4%), long distance to the facility (59.4%) and stockouts (29.9%). Anemia was found to be high at 69.4%. The study concluded that mothers who sufficiently took IFAS had improved hemoglobin levels by delivery time. It recommends that the Kilifi County health department and stakeholders address knowledge gaps on IFAS and anemia, create awareness on early ANC registration among pregnant women, ensure enough stock of the supplements and strengthen patient referral system by community health volunteersItem Utilization of Female Condoms among Women Living with Human Immunodeficiency Virus (HIV) in Murang’a County, Kenya(Kenyatta University, 2025-09) Ndwiga, Dorothy NjokiTo prevent the risk of transmission of the Human Immune Deficiency Virus (HIV) and other sexually transmitted infections (STIs), as well as achieve family planning targets, the use of Female Condom, a women-initiated method, has been prioritized across the globe. Nevertheless, knowledge regarding utilization of Female Condoms among HIV positive women remains inconclusive. The main objective of this study was to establish the utilization of Female Condom (FC) among women living with HIV (WLHIV) in Murang’a County, Kenya. The study concentrated on a number of objectives that included assessment of the level of knowledge, Consistent utilization and establishing the factors that influence the use of female condoms in Murang’a County. This study adopted Analytical cross-sectional survey design. A total of 204 women living with HIV (WLHIV) were recruited in the study. Multi-stage sampling was conducted to get three participating Sub-Counties and three clinics. Purposive and systematic sampling techniques were used to select the County, WLHIV and healthcare workers. Structured questionnaires, interviews schedule and focus group discussions were used to collect data. Descriptive and inferential statistics were generated using Statistical Package for Social Sciences (SPSS) version 25.0. The association between variables was determined using Pearson's Chi-square test at a significance level of p≤0.05. The response rate was 100%. The study revealed that most of the respondents 93.1% had heard about female condoms whereas 57.8% admitted to have ever seen the pack. Women’s knowledge on correct fitting of female condoms was not significantly affected by the age (χ2 = 5.093, P = 0.273), education level (χ2 = 7.348, P = 0.119), marital status (χ2 = 3.624, P = 0.605) nor religion (χ2 = 4.628, P = 0.104). The findings showed that 71.4% of younger women, aged 21 - 30 years, 66% of University graduates, divorced (71.4%) and Catholic (57.1%) women had the knowledge on how to correctly fit the FC. A majority of those who supported that there is need for FC cited reasons related to protection and safety 105 (58 %). Women’s views that overall use of FC is easy had a significant association with their current utilization of device (χ2 = 10.689, P = 0.005). The result also found out that those who got advises from the doctor/nurse currently used the device (χ2 = 6.247, P = 0.012.) Only 17.6% revealed to have ever used while 14 (6.9%) put/insert the device all the time. Women who feel comfortable and those who notice no difference when using FC currently used them (χ2 = 25.397, P = 0.0001 and χ2 = 32.541, P = 0.0001 respectively). The WLHIV were of the opinion that female condoms are not readily available (43.1%), are expensive (42.2%) and women feel shy to buy them (41.7%). In conclusion, there was low level of consistent utilization of FC among WLHIV in the study area. The study findings will be useful to policy makers and other stakeholders during planning, developing, and managing targeted capacity building on HIV/STIs resource needs and unwanted pregnancies prevention measures.Item Access to Reproductive Health Services by Female Survivors of Sexual Gender-Based Violence in Selected Hospitals in Nairobi City County, Kenya.(Kenyatta University, 2025-04) Oredo, Pascal OnyangoWomen and girls ages 15-49 years married are estimated to form 30% of the victims of Sexual Gender Based Violence. World Health Organization reports that women who have experienced SGBV are at a higher risk of gynecological morbidities, miscarriages, unsafe abortions, pregnancy complications, HIV, and unwanted pregnancies. This study therefore aimed to determine the access to reproductive health services by female survivors of sexual gender-based violence in Nairobi City County, Kenya. The study used a descriptive cross-sectional design with pretested questionnaires. The study involved female survivors of sexual gender-based violence. The sample size comprised 269 survivors and 10 key informants. A pretest of research tools was carried out at the Mathare sub-county hospital. Data analysis was done by use of thematic content and quantitative data presented by use of percentages and frequency distribution tables. For inferential quantitative analysis, a binary logistic regression was used to determine the availability of reproductive health services, knowledge, attitude, and type of reproductive health services predictors of access to reproductive health services by female survivors of sexual gender-based violence. Odds Ratios were evaluated for significance by considering the 95% Confidence Interval or at a p-valueItem Arthritis Risk Factors among Adults in Tombe Location, Nyamira County, Kenya; a Community-Based Study(Kenyatta University, 2025-05) Kinara, Shem NyarundaArthritis is a significant global health problem, with osteoarthritis being the most common type worldwide. The increasing prevalence of arthritis leads to substantial societal and personal costs. In Nyamira County, Arthritis is the second of morbidity as per the county integrated development plan 2018-2022. This study therefore, aimed assess arthritis risk factors among adults in Tombe Location, Nyamira County, Kenya. The specific objectives included: to establish the prevalence of arthritis among adults in Tombe location, Nyamira County, Kenya, to assess the risk factors associated with arthritis among adults in Tombe location, Nyamira County, Kenya, and to determine the association between level of knowledge and arthritis among adults in Tombe location, Nyamira County, Kenya. A cross-sectional research technique with multistage random sampling was used to select the study area through random balloting. Simple random sampling was used to select participants above 40 years from the selected households in the two sub-locations in Tombe location. Inclusion criteria was for those above 40 years who were willing to be part of the study. Those mental ill were excluded from the study. Data was collected used a structured interviewer based questionnaire. A self-reported doctor diagnosis and symptom-based screening criterion were used to identify participants with arthritis. Descriptive and inferential statistics were used in the data analysis. The level of significance for this study was set at 95% confidence level with variables having a p value of ≤ 0.05 being considered significant. Ethical clearance and other approvals were obtained from relevant authorities. A total of 307 participants from 258 households were included in this study. The prevalence of arthritis was 44.6%. Knee arthritis was the most common type (76.0%). Among the participants with arthritis, 88.3% experienced activity limitation. Joint injury/infection [AOR=2.74; 95% CI=1.59-4.77; p<0.01)], being unemployed [AOR=2.77; 95% CI=1.50-5.21; p = 0.00], staying in a town center [AOR=2.02; 95% CI=1.08-3.83; p=0.03), age 51+ years, and hypertension [AOR=1.90; 95% CI=1.03-3.53; p=0.04] were associated with an increased risk of developing arthritis. Conversely, being male [AOR=0.42; 95% CI 0.23-0.75; p=0.01], standing for > 2 hours [AOR=0.48; 95% CI 0.29-0.81; p=0.01)], and constant shifting from sit to stand positions [AOR=0.45; 95% CI=0.26-0.76; p<0.01)] were correlated with a lower risk of arthritis. The level of knowledge of arthritis was 71.8%. The Kaplan-Meier analysis showed that the estimated median age for having arthritis in this population was about 67 years, with females having a shorter median age of 63 years compared to 75 years in males. In conclusion, residents in this study area experienced a high rate of arthritis. Modifiable and non-modifiable risk factors were found to be statistically significant thus the need to address them to avoid further disability at the community level. This is despite there being a high level of knowledge. Further study is need to address differences in arthritis and its impact, with adequate control of confounders, and assess multiple arthritis risk factors.Item Barriers and Facilitators to Human Immunodeficiency Virus Self-Testing among Undergraduate Students in Kenyatta University, Kenya(Kenyatta University, 2024-10) Muendo, Nicholas KyaloOver 36.9 million people worldwide live with HIV, with 21.7 million receiving ART. In Africa, 1.5 million individuals aged 15-24 are affected, with teenage girls and young women being disproportionately affected. KENPHIA Preliminary Report revealed a nationwide HIV prevalence rate of 4.9%, with women having a higher rate of 6.6% compared to men at 3.1%. HIVST aims to increase accessibility to testing services for at-risk populations. The WHO has preapproved three HIV self-testing kits for Kenya, including OraQuick®, Atomo®, and INSTI®. However, only 62% of young individuals are aware of their HIV-positive status, with university students at a higher risk due to risky sexual behaviors and cross-generational relationships. The UNAIDS aims to achieve 95% HIV status awareness by 2030, but current conventional HIV testing has not effectively ensured widespread availability of HIV prevention, treatment, and care. This cross-sectional analytical study targeted undergraduate students, utilizing multi-stage cluster sampling and self-administered questionnaires to collect comprehensive data on their demographic characteristics, HIV testing practices, and factors influencing HIVST uptake. The results revealed that 24.4% of participants had ever used HIVST, with 65.3% having tested for HIV overall. Among those who had tested, 44.6% had last done so more than a year ago, with facility-based testing being the most common method (71.2%). Age and gender were significant determinants of HIVST uptake; females (50.8%) and older students aged 22-25 years had higher odds of using HIVST. Awareness of HIV prevention methods like PrEP was a particularly strong facilitator, with participants aware of PrEP being 2.4 times more likely to use HIVST. Additionally, 69.1% of participants found HIVST kits affordable, though 57.7% reported difficulty accessing them. Social media emerged as the primary source of information for 56.7% of participants, while 86.6% found the instructions on the kits easy to understand. Despite these barriers, 78.4% of participants were confident in interpreting their HIV status at home, and 88.7% agreed that HIVST kits should be made available free of charge in public health facilities. The study underscored the importance of addressing persistent barriers such as stigma, cost, and accessibility to significantly increase HIVST uptake. Key recommendations include enhancing HIV prevention education, leveraging successful media campaigns like "Chukua Selfie," integrating HIVST into campus health services, and tailoring interventions to specific demographic groups such as young adults. The study provided a nuanced understanding of the determinants affecting HIVST uptake and offered actionable strategies to enhance HIV prevention and control efforts among young adults in Kenya.Item Prevalence and Determinants of Postpartum Depression among Women Attending Postnatal Clinics in Selected Facilities in Kiambu County, Kenya(Kenyatta University, 2025-05) Mugambi, MaureenPostpartum depression (PPD) refers to non-psychotic depressive episodes that begin in or extend into Postpartum period. Postpartum depression affects women from all races and ethnic backgrounds and therefore there is a need to understand the signs, symptoms, causes as well as its treatment. The number of postpartum cases may be higher than available statistics reveal because some cases are undiagnosed. Available statistics indicate that the disorder is more prevalent in underdeveloped and developing countries compared to the developed ones. In Kenya, several health care facilities are set aside to improve maternal health care, however there is little emphasis placed on the mental health of pregnant women in the antenatal clinics. PPD can affect both mother and child negatively resulting in poor growth and development of the child. This study investigated factors contributing to postpartum depression among post-natal women attending the post-natal clinic at selected facilities in Kiambu County. Specifically, the study examined prevalence of PPD among women attending post-natal clinic in the three facilities as well as its determinants. The study was conducted in three referral hospitals; Kiambu, Gatundu and Thika through cross sectional descriptive survey design. Respondents were 321 consenting postnatal mothers at the postnatal clinics six weeks after delivery. Simple random sampling was employed and data collection carried out using a questionnaire which comprised of the Edinburgh Postnatal Depression Screening tool and key informant interview guides. To analyze data, strata version 13 was used on quantitative data, with an examination of qualitative data using themes. Chi-square test and regression were applied to identify interactions among the variables at a p-value of 0.05. Findings indicated a prevalence of 10.9% of PPD among PNC women. The woman’s mode of child delivery was significant, with those delivered through caesarean carrying a three times probability of being diagnosed with PPD compared to those with normal child delivery (OR 2.65185, P<0.020) times. It was also noted that woman’s education level was also significant, women with tertiary, secondary and primary level of education were 4 (OR 4.4508, P<0.000), 2 (OR 2.100821, P<0.010), and 1 (OR 1.230769, P<0.020) times respectively less likely to have PPD compared to women without formal education. Household wealth index is a significant predictor of postpartum depression. Women from households with high income (OR=2.988664, p=0.000) and from households with middle-income (OR= 2.178261, p=0.002) were not likely to be diagnosed with postpartum depression than those in low income category. The socio demographic determinants found to lead to PPD among women were education level, women’s source of income, partner’s working status, and household wealth index. The study also indicated that women's awareness of postpartum depression was connected with health systems associated with postpartum depression. Women who have recently delivered are more prone to suffering from PPD compared to others, and depressed mothers need emotional support. It may be beneficial for women's social network to know that PPD is prevalent and that many other women have had similar feelings.Item Sustainability of Post-Open Defecation-Free Status and Contributing Factors among Households in Kakamega County, Kenya(Kenyatta University, 2025-03) Okumu, Maitabel Achieng’Sanitation serves as a crucial metric of developmental progress, with over 24.4% of the global population currently without essential sanitation and 8.4% continuing to engage in open defecation in public areas. In Kenya, open defecation poses a considerable healthcare issue, facilitating occurrences of water-related diseases and neglected tropical diseases such as intestinal worms, schistosomiasis, and trachoma. The purpose of this study was to find out the sustainability of post-ODF status among certified households and factors that affect ODF in Butere Sub-County, Kakamega County in Kenya. The specific objectives include determining the current ODF status of households; identifying the socio-demographic, cultural, and environmental factors affecting post-ODF sustainability; and assessing the role of behaviour change communication (BCC) in sustaining post-ODF status. A cross-sectional survey design was employed. The research focused on 6,286 households from 66 ODF-certified villages in Butere Sub-County, which had a total population of 139,780 individuals. The research used multi-stage sampling to select the three wards (Marama Central, Marama West, and Marenyo-Shianda). The study targeted household heads from a sample of 376 households were selected using a proportionate random sampling technique. Quantitative data was collected using a structured questionnaire and observational checklist. Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) were conducted with the members of the community and health officials to yield qualitative information regarding post-ODF sustainability. A pre-test was done in two neighbouring villages within Kisa wards in Khiwisero Sub-County. A validity test was used to assess the study method and make sure it answered the researcher's questions about the suggested topic. Cronbach's alpha was used to test for reliability and an alpha value of 0.78 was obtained. SPSS (version 30.0) was used to analyse the quantitative data, employing statistical techniques such as univariate, bivariate, and multivariate analysis. NVivo 12 software supported the thematic analysis of qualitative data. The study found that only 9% of households sustained their post-ODF status. A significant correlation existed between demographic variables, including gender, age, level of education, employment, and post-ODF sustainability (p<.05). Employed individuals were 1.333 times more likely to maintain ODF status. Cultural factors, such as taboos on sharing sanitation facilities among in-laws, and environmental factors such as poor soil conditions had a statistically significant association with post-ODF sustainability. Communication on behaviour change, particularly through regular follow-ups by Community Health Promoters (CHPs), was crucial in reinforcing post-ODF sustainability. The study found that households that participated in CLTS triggering increased the likelihood of sustaining ODF by 1.491 times. The study concluded that socio-demographic, cultural, environmental factors and behaviour change communication influenced post-ODF sustainability. The study recommended that the Department of Public Health and Sanitation should enhance door-to-door monitoring and follow-up systems to effectively track post-ODF sustainability at the household level. WASH stakeholders should design and support economic empowerment programs tailored to increase household income and invest in research and innovation aimed at developing cost-effective and environmentally sustainable sanitation facilities.Item Antibiotic Prescribing Practices of Clinical Officers for Patients with Upper Respiratory Tract Infection at Kiambu County, Kenya(Kenyatta University, 2024-11) Murigi, Kevin WambuaAccording to the World Health Organization (WHO), over 50% of all medicines are prescribed, dispensed or sold inadvertently, and more than half of all patients take them incorrectly. Antibiotics are the most routinely prescribed medications. Antibiotics are incorrectly prescribed for viral illnesses and broad-spectrum antibiotics are being used in place of narrow-spectrum antibiotics. Antibiotic resistance has emerged because of incorrect antimicrobial treatment and misuse of antibiotics. Findings from studies have shown an association between prescriber factors, patient factors, institutional factors and antibiotic prescribing. There is scarce data in Kenya about antibiotic prescribing practices, factors affecting antibiotic prescribing, how it varies between different healthcare workers and the mechanism by which interventions are effective. The goal of this study was to figure out antibiotic use among patients with upper respiratory tract infections in Kiambu County. The study design was a cross-sectional hospital-based study. The study area was one public level 5 hospital, five public level 4 hospitals and 14 public health centers within Kiambu County. Data was collected in the form of a modified WHO prescribing indicators checklist and using questionnaires. The WHO prescribing indicators checklist on rational use of medicine was used to collect data from 600 patient encounters. The questionnaire was used to collect data from 36 clinicians working in the outpatients. The data from the checklist included the total number of medications prescribed per encounter, the number of encounters with antibiotics, the proportion of generic antibiotics prescribed, the proportion of antibiotics prescribed from the Kenya Essential Medicines List (KEML), the antibiotic prescribed, its dose, frequency, duration and indication. The data from the questionnaire included prescriber age, gender, level of education, work experience, laboratory availability, availability of antibiotics and availability of guidelines. An Open Data Kit (ODK) was used to collect the WHO data collection checklist. Data was imported into a Microsoft Excel sheet from the ODK server then exported to a Statistical Package for Social Science (SPSS) version 22.0 for further cleaning and analysis. Descriptive statistics of frequencies and percentages were used to summarize categorical variables, and median (interquartile range) was used in case of continuous variables. Logistic regression was employed to find the association between antibiotic prescribing and the prescribing factors. Odds ratio with 95% confidence interval was reported in the logistic regression analysis. All analysis were considered significant when p < 0.05. Antibiotics were prescribed in 78% of patient encounters, 96.8% of encounters with an antibiotic had a generic antibiotic, and 96.6% of antibiotics prescribed were from the KEML. Over 91% of antibiotics prescribed were the right dose, 98.3% were the right frequency, 75.2% were the right duration, only 23.8% was the right indication. Availability of antibiotics p=0.026 and availability of hospital guidelines p=0.012 were significantly associated with rational antibiotic prescribing. Patient fever significantly affected rational antibiotic prescribing (OR 4.7, 95% CI 2.49, 8.89, p=<0.001), patient age and gender did not significantly affect antibiotic prescribing. Prescriber gender, p=0.63, age, p=0.92, education level, p=0.99 and work experience, p=0.22 did not significantly affect antibiotic prescribing.Item Uptake of Modern Contraception among Postpartum Women in Vihiga County, Kenya(Kenyatta University, 2025-04) Obobe, Judith AririContraception is achieved by use of modern contraceptives including emergency pills, barriers, oral pills and injectable contraceptives and implants. Vihiga County reported a contraception rate of 53% in 2018, lower than the national rate of 61%. Therefore, the specific objectives of this study were: To find out the level of knowledge on contraception, to determine the rate of modern contraceptive use and to identify factors influencing the uptake of modern contraception by postpartum women in Vihiga Sub-County. To fulfil these objectives, a cross-sectional study design was conducted. Research was based in Vihiga Sub-County, specifically in Central Maragoli and Lugaga-Wamulama Wards. Study respondents were selected using simple random sampling whereas through purposive sampling health facilities were selected. Dispensation of questionnaires, KII and FGD were developed as research instruments for data collection. Qualitative data was analyzed using CITAVI and then categorized into related themes and represented according to the objectives of this study. Quantitative data was analyzed using SPSS version 22. Multiple regression and chi-square tests were used to compare the results between pairs. Knowledge for individual contraceptive methods including o DMPA, implants, pills and coils was high as each method was known by more than 50% of participants. The current rate of contraceptive use in Vihiga Sub-County is 62.8%, an increase from the previously reported 53%. DMPA in 2022 and implants were the most used methods. Age (p=0.003), marital status (p<0.0001), number of children (p=0.048), and period since the last birth (0.003) were the most significant demographic influencers of contraceptive use. Reasons for or against use, duration of use of contraceptives, and future intent to use them were the attitude factors associated with contraceptive use. Social factors influencing contraceptive use were Religion allowing contraceptive (p=0.044), the husband agreeing with the use (p<0.001), quality of contraceptive services (p=0.001).In terms of contraceptive accessibility, quality of contraceptive services best influenced the uptake of contraceptives (p=0.001). This study recommends the following: The Vihiga County Department of Health Services, should launch a comprehensive health education and promotion campaign, The Vihiga County Department of Health Services, should initiate and support community-based family planning programs specifically targeting postpartum women, Community leaders and religious organizations should be engaged in dialogue and partnership to co-create and endorse family planning programsItem Prevalence And Risk Factors Associated with Chronic Kidney Disease among Hypertensive Patients in Wajir County, Kenya.(Kenyatta University, 2024-12) Ali, Abdirahman MohamedChronic Kidney Disease (CKD) is a significant public health challenges both locally and globally, with its prevalence increasing, particularly in developing countries especially in Sub Saharan Africa. CKD is common among older adults and is strongly associated with medical conditions such as hypertension, diabetes and obesity. However, to our knowledge there is no published data on prevalence of CKD and risk factors associated among the hypertensive adult patients in Wajir County. This study aimed at estimating the prevalence and establishing risk factors associated with CKD among hypertensive patients in Wajir County and sought to recommend viable preventive measures. An analytical cross-sectional study was conducted among sampled 293 hypertensive patients. This study utilized consecutive sampling where the subject who meet the selection criteria were interviewed. Structured questionnaires were administered for data collection. Key findings revealed that nearly half of hypertensive patients have CKD (45.40%), highlighting a critical health concern in the region. The study revealed most CKD cases were in early stages (Stages1 and 2), some had progressed to severe stages (Stages 4 and 5). Regression analysis identified several demographic and clinical factors associated with CKD development, including age, gender, and education, and employment status, family history of CKD, stroke history, and difficulty in medication compliance. Moreover, analysis of results revealed that notable associations, with individuals aged 51-60 years having significantly higher odds of developing CKD compared to younger counterparts (OR=2.462, CI 2.623-44.612, P-value < 0.001), and females being more susceptible than males (OR=5.928, CI 0.401-0.921, P-value < 0.001). Clinical factors like uncontrolled blood pressure and difficulty in taking medication also emerged as key risk factors; hypertensive patients non compliant to medication are at a significantly higher risk of CKD (OR=3.036, CI 2.948-6.937, P-value< 0.001) and CKD (OR=5.271, CI 3.816-11.838, P-value < 0.001), history of stroke (OR=3.283, CI 2.182-2.910, P-value < 0.001), BMI between 25 and 29.9 (OR=2.462, CI 2.381-6.712, P-value < 0.001), and proteinuria (OR=2.722, CI 2.361-4.381, P-value < 0.001) were identified as significant contributors to CKD development. The study concludes that there is high prevalence of CKD among hypertensive adults in Wajir County. With nearly half of hypertensive patients also suffering from CKD, these poses significant public health concern at hand in Wajir County. In view of these findings, the study recommends that the county government of Wajir should focus on viable preventing measures such as targeted screening programs of CKD in hypertensive population, health education on medication compliance and engaging in healthy behavior like exercise.Item Level of Knowledge, Perceptions and Utilization of Antenatal Care Services among Women of Reproductive Age in Nimba County, Liberia(Kenyatta University, 2023-05) Smythe, EdwinaAbstractItem Cardiovascular Disease Risk Factors and Prevalence among People Living with Human Immunodeficiency Virus in Nairobi City County, Kenya.(2024-09) Nyabera, Roseanne Aloo OgolaThe life expectancy of people with HIV living in developed countries is fast approaching general population norms. While this is because of better treatments, this optimism is tempered by a range of other conditions that are appearing as people living with human immunodeficiency virus (PLHIV), get older and live longer predisposing them to nonmodifiable risk factors for cardiovascular diseases. (CVDs). The dual burden of CVDs and HIV in sub–Saharan Africa is of public concern. People living with HIV are 1.5-2fold increased risk of coronary artery diseases mechanism based on a pro-inflammatory state due to HIV diseases and more likely to develop CVD risk factors compared to the non-infected individuals. Studies on associations between ARVs and CVD risk factors prevalence are mainly from developed countries thus need to get data from this region and document. This survey determined the CVD risk factors among PLHIV in Nairobi City County. Further, the study determined the relationship between the sociodemographic characteristics associated with CVD, biological CVD risk factors, the relationship between behavioural factors and CVD risk factor, and the relationship between the use of ARVs and biological and behavioural CVD risk factors among PLHIV. A descriptive cross-sectional study design, conducted in four (4) comprehensive care clinics, purposively selected, sampling technique used to determine the sample size of 405 participants. A data collection form with measurable elements used. The prevalence of CVD was found to be higher in male than female (7.2: 4.0), mean age at 47 years compared to the older population. Prevalence of 25.2% was found compared with the national data of 25.4%. The results indicated that 25.2% were overweight, 35.8% had elevated RBS, and 20.3% had 200 mg/dL and above, 48.1% of PLHIV had Prehypertension (Stage 1)130-139 <90 and 12.8% had stage 2 hypertension (>140 or >90). Gender and age significant at (P<.05), Frequency of BP measurements resulted in CVD risk factor at 0.010, CD4 count levels significant at 0.04. (Lower levels below 500cells/mm). Regression analysis results indicated that with other factors held constant at 7.744, then a .310 change in socio-demographic characteristics, .419 change in Use of ARVs factors and a .360 change in behavioural factors will contribute to a unit change in the CVD risk factors. In conclusion prevalence of CVD risk factors was high in PLHIV. Male patients at a higher risk than female and Mean age of 47years. The prevalence of Pre-hypertension Stage I and Stage II, obesity and elevated blood sugar levels was significant, but no association was observed with ART regime or duration of ARV use. There is a need to integrate CVD management into regular HIV care.Item Compliance to Food Hygiene Practice Standards among Food Handlers in Selected Restaurants in Nairobi City County, Kenya.(Kenyatta University, 2024-02) Mosota, Lilian K.Like any other food establishment or catering operation, there is a risk of getting food borne diseases after consuming contaminated restaurant foods. Food service establishments are expected to implement food hygiene practice requirements in all food handling processes including receiving, storage, preparation, processing, cooking and service of food. Restaurants which operate as food establishments therefore have a responsibility in ensuring food is protected from contamination or deterioration and should implement food hygiene practice requirements that will ensure food safety to the consumer. In efforts to mitigate the risk of food borne diseases, food handlers should observe food hygiene practice and should also have food hygiene knowledge since they are involved in all food handling processes. The already developed Kenya Standard - KS 2573:2015 outlines hygiene requirements for food service establishments including restaurants. The broad objective of the study was to establish compliance to food hygiene practice standards among food handlers in selected restaurants in Nairobi City County. This was a descriptive, cross-sectional study design. The study targeted 39 purposively and proportionately sampled restaurants and 316 food handlers in the selected restaurants in Nairobi City County. Data was collected using observation checklist, interview guide and questionnaire on self-reported practices measured using a 4-point Likert scale. Data to establish the food hygiene knowledge by food handlers was collected using a knowledge score questionnaire. Statistical Package for Social Sciences (SPSS) version 26 was used to analyze the data and these findings are reported in a descriptive and inferential manner. Qualitative method was used to analyze content from interviews for themes. The gap identified in restaurant food hygiene practice standards was on maintenance of building and facilities in matters cleanliness, repair of damaged building and facilities and compliance to personnel hygiene requirements. Major gaps were noted in food time and temperature control practices for high risk foods. Food handlers consistently reported poor food hygiene practice in aspects analyzed under food time and temperature control. The mean knowledge score of all food handlers was 55.33%. Food handlers’ knowledge was significantly lower than the minimum acceptable score of 70%. In accordance with food hygiene practice standards requirements, restaurants should implement prerequisite programmes regarding maintenance and repair of established restaurant building and facilities and adhere to personnel hygiene requirements. Restaurants should also implement food hygiene requirements regarding food time and temperature monitoring in all food handling critical control points. Restaurant food handlers should be continuously trained by qualified food hygiene trainers and their practice monitored in order to realize improvement in food hygiene knowledge and practice thus reduced transmission of food borne diseases.Item Utilization of Sexual Reproductive Health Services among Public Service Vehicle Operators in the Transport Industry in Nairobi City County, Kenya(Kenyatta University, 2024-08) Oenga, DavisPublic service vehicle operators and owners are a susceptible demographic in need of specialized treatments due to their high vulnerability to these problems. Most studies have focused on long-distance truck drivers, ignoring potential connections between commercial transport industry and sexual reproductive health. The purpose of this re-search was to learn on utilization of SRH among PSV operators in Nairobi County use sexual and reproductive health care services. A descriptive cross-sectional study de-sign was adopted for the study. Operators at bus terminals, taxi drivers, motorbike drivers and digital taxi drivers made up the bulk of the research population. The Cochran's Formula was used to estimate a sample's contribution to a population and the sampling estimate had a variance of 0.5. Data collection methods like Interviews as well as administration of structured questionnaires were used. Statistical Package for the Social Sciences (SPSS) was used for the quantitative analysis and NVIVO 12 used for the qualitative analysis. Logistic regression model showed that female PSV operators were 97% likely to use SRH services on at least four separate occasions than their male counterparts. Results showed PSV operators levels of education were corre-lated with how often they sought SRH services. PSV operators from universities like-ly to use SRH services than those from primary schools and those from secondary schools are 68% more likely to use SRH services than those from primary schools. The knowledge on sexual reproductive health is associated with education and marital sta-tus. The study confirmed that most drivers have attained higher academic levels and have interactions on SRH practices. 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. This study recommends that institutions need to intensify advocacy on the importance of uptake of SRH services with PSV operators, need to address social demographic barriers that affect the utili-zation of SRH services through integrated dialogues, outreaches and MoH should al-locate more resources to strengthen the health care system building blocks and ensure access to healthcare through UHC.Item 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 KaninaThe 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.Item Predictors of Stunting Among Children Aged 6-59 Months in Kitui County, Kenya(Kenyatta University, 2024-10) Kangethe, Chui MorrisStunting 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.