MST-Department of Public Health

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Uptake of Maternal, Neoanatal and Child Health Services Provided under Universal Health Coverage in Machakos County, Kenya
(Kenyatta University, 2024-04) Kangee, Maureen Njeri
Universal health coverage (UHC) offers an essential package of health services to a wide range of people while protecting citizens financially in case of an illness. UHC is given a high priority globally by the UN sustainable development goal (SDG) as a health-related aim. Hence, the national health system of Kenya prioritized UHC. The WHO has been monitoring of UHC progress through follow up of four MNCH (Maternal, Neonatal, Child Health) indicators; Antenatal care, skilled deliveries, immunization and family planning. MNCH services have received a lot of investment over the years but still women and children are dying. MNCH services are part of essential services in Kenya. This study aimed at assessing the uptake of universal health coverage provided MNCH services along with factors affecting the uptake. This has remained undocumented since the initiation of UHC pilot study in December 2018 in Kenya’s Machakos County. A descriptive cross-sectional study design was used with a sample size of 422 respondents. This study was undertaken in Machakos Sub-County, focusing on women of reproductive age (WRA). A researcher administered questionnaire, interviews and focused group discussions were adopted for data collection. SPSS version 26 application was used to analyse data. Both descriptive and inferential statistics were deployed in the analysis. Overall, first level analysis showed that there was a significant association between demographic factors at (.05), χ² (9, N = 145) = 27.118, P <.001, supply side factors significance at (.05), χ² (13, N = 145) = 21.872, P <.001, patient related factors at (.05), χ² (9, N = 145) = 24.553, P <.001and level of uptake of MNCH services. Further a second level analysis divulged that, time taken to reach facility (OR 12.26; 95% CI 1.07 to 140.48) and a perception that a CHV could attend to them during an emergency (OR 4.14; 95% CI 1.23 to 13.91) were significant patient related factors. Supply side factors found to be significant were visit from a CHV (OR 125.93; 95% CI 18.37 to 863.27), a perception that services were of quality (OR 684.411; 95% CI 50.65 to 9248.93, adequacy of staff (OR 1.00; 95% CI 1.0004 to 0.021 and adequacy of hospital commodities (OR 19.83; 95% CI 1.67 to 235.93). The study recommends that the National and county governments should conduct social mobilization to increase FP uptake, make increasing CHV coverage a priority, conduct community action to increase insurance coverage. In addition, the County government should conduct customer care trainings on their staff. Similarly, it would be progressive for national government to develop a UHC policy that puts into consideration both supply side and patient related factors.
Uptake of Enhanced Adherence Counseling Among Adolescents with High HIV Viremia in Selected Health Facilities in Nairobi City County, Kenya
(Kenyatta University, 2024-06) Makokha, Violet Nafula
Enhanced adherence counselling (EAC) is a structured method of assessing current adherence levels, exploring barriers, and developing individualized adherence intervention plans to improve viral suppression. Adherence to treatment among adolescents has been reported to impede good treatment outcomes. WHO recommends EAC for patients with high Human Immunodeficiency Virus (HIV) viremia and suspected treatment failure and EAC has been associated with high re-suppression, yet limited information exists on the uptake of EACs among the adolescent population. In the UNAIDs goal of 95-95-95, the third ninety aims at achieving 95% viral suppression among those individuals who started on ART. The third ninety, especially among adolescents has remained a challenge. High HIV viremia is defined as individuals who have Viral Load (viral load less than one thousand copies of the virus in their blood. In 2017, only 66% of Adolescents living with HIV (ALHIV) had achieved viral load suppression. Nairobi City reported a viral load suppression of 56% among adolescents and young people. The study focused on assessing the uptake of enhanced adherence counseling among ALHIV on Antiretroviral Therapy (ART) with a documented high viremia in selected health facilities in Nairobi City County. The study investigated the knowledge of adolescents with high viremia, their compliance levels to enhanced adherence counseling, and the identification of factors that affect the uptake of enhanced adherence among adolescents with high viremia. The study used a cross-sectional analytical design and purposively sampled 379 respondents who were interviewed in the forty-five facilities. Data were collected utilizing questionnaires and key informant interview methods and conducted focus group discussions (FDG). Qualitative data were collected, coded, and categorized to come up with emerging themes. The Data analysis was done using Stata version 16. Continuous variables and categorical variables were described by measures of central tendencies and frequency tables, respectively. Calculation of inferential statistics was done using tests of Chi-Square tests at a confidence interval of 95% and an error of precision of 0.05 to show variable associations. According to this study's findings, only 41% of responders received satisfactory Enhanced adherence counseling (EAC). It was found that 55% were females and the median age was 14 years. The study observed high knowledge levels and level of compliance on enhanced adherence counseling at 73% and 80%, respectively. Respondents with adequate compliance ratings were more likely than those with inadequate compliance to take up EAC sessions (Odds ratio: 0.41, C.I 0.26 – 0.65) and respondents with adequate knowledge scoring were less likely to take up EAC successfully compared to those with inadequate knowledge (Odds ratio: 0.48, C.I: 0.29 – 0.8). Age, level of education and type of treatment supporter were among the factors associated with uptake of enhanced adherence counseling. The study concludes that ALHIV from selected facilities had low uptake of EAC and having adequate knowledge did not result in increased uptake similar to having high compliance ratings. Age and level of education influenced Knowledge levels while type of treatment supporter was found to be associated with uptake of enhanced adherence counseling. The study recommends structured EAC by age, reviewing the necessity of the 3 EAC sessions to define satisfactory EAC and necessity of treatment supporter for adolescents with high viremia.
Determinants of Data Use for Evidence Based Decision Making at Public Health Facilities in Kisumu County, Kenya
(Kenyatta University, 2023) Morike, Tom; Isaac Mwanzo; George Otieno
Abstract
Prevalence of Asymptomatic Bacteriuria and Associated Factors among Pregnant Women in Nairobi City County, Kenya
(Kenyatta University, 2023-03) Wambogo, Ceciliah Njeri; John Paul Oyore; Alloys. S. S. Orago
Abstract
Determinants of Dehydration among Chilbren Under Five Years with Acute Diarrhea Attending Mbagathi Hospital in Nairobi City County, Kenya
(Kenyatta University, 2023-11) Muriu, Mary Wanjeri; Judy Mugo; Redempta Mutisya
Diarthea in the developing countries is the second death causing infection among children below five years of age. Millions of these deaths are caused by dehydration which is the most frequent and dangerous complication of diarrhea. Identification of determinants of dehydration among under five years old would help in predicting the children with acute diarrhea who are likely to die due to dehydration. The aim of the study was to establish predictors of dehydration among under five years old seeking treatment for acute diarrhea at Mbagathi County hospital in Nairobi county, Kenya. The specific objectives were to determine the socio- demographic characteristics of primary care givers (PCGs) and child associated with dehydration in under five years old with acute diarrhea attending Mbagathi county hospital, to identify the social- cultural beliefs of PCGs which are associated with dehydration in under five years old with acute diarrhea attending Mbagathi county hospital, 10 establish whether there was an association between the PCGs level of knowledge in diarrhea management and dehydration in under five years old with acute diarrhea at Mbagathi county hospital and to determine whether there was an association between the prior actions taken by PCGs to manage the acute diarrhea at home and dehydration in children under five years at Mbagathi county hospital. The study applied a hospital based unmatched case- control analytical design with mixed method approach. Purposive sampling was used to select 110 cases and 110 controls who met the inclusion criteria at a ratio of 1:1. The study participants were interviewed using a structured questionnaire, The same sampling method was used to select PCGs to participate in focus group discussions (FGDs). Qualitative data was thematically analyzed by Nvivo software then transcribed and coded into themes. Quantitative data was analyzed using SPSS Version 25. A mixed effect logistic regression model was used to evaluate the association between the predictors of dehydration. The results of the logistics regression analysis are presented in terms of odd ratios (OR) and the corresponding 95% confidence intervals (Cls). The socio demographics characteristics of PCGs in cases and controls were almost similar in terms of proportion in both groups. The characteristics of child demographics were also almost similar in both groups. In univariate analysis the variables that were statistically significant at cut off p< 0.2 were then offered to the multivariable model. Findings from the adjusted multivariate model the variables that were statistically significant were highest level of education at p< 0.05 and initiation of zinc supplement at home immediately diarrhea started p<0.05. After adjusting for duration of diarrhea, results of the logistic regression showed that the variables median age of the PCGs at p<0.01 and initiating zinc supplement at home immediately diarrhea started at p< 0.02 were significant predictors of dehydration among children below five years. In conclusion there is risk of developing diarrhea- associated dehydration among children under five years with acute diarrhea attending Mbagathi hospital mainly in young mothers with low education and also due to delay in initiating zine supplement when children develop diarrhea. Recommendation was that there is need for more focused health education on diarrhea management in young mothers and health promotion activities at the community level so as to sensitize the community and dispel myths and misconceptions on causes and management of diarrhea.
Health information utilization for decision making in health facilities in Nandi county,Kenya
(Kenyatta University, 2022-11) Kiptarbei, Kisorio Ezekiel; George Otieno; Kenneth Rucha
Determinants of Compliance to Prescribed Antihypertensive Therapy among Adult Hypertensive Patients in Kilifi County Kenya
(Kenyatta University, 2022) . Moss, John T. K; Harun Kimani; Isaac Mwanzo
Hypertension/ High Blood Pressure is a condition that presents with elevated BP. Globally the overall prevalence of high BP is estimated to be 31%. Non-compliance to anti-hypertensive therapy is both public health and medical problem worldwide. Compliance to prescribed anti-hypertensive therapy is key in avoiding hypertension complications. This study aimed to evaluate the determinants of compliance to prescribed anti-hypertensive therapy among adults with hypertension condition in Kilifi County. A facility-based cross-sectional study was undertaken in four public health facilities in Kilifi County. Two hundred and thirteen patients were recruited in this study. Data was collected using a pretested questionnaire and analysed using Statistical Package for Social Sciences (SPSS) version 23. Chi-square test was utilized in establishing the associations between compliance to anti-hypertensive therapy and variables while logistic regression was adopted to determine independent risk factors of compliance. Compliance to anti-hypertensive therapy was recorded in 31(14.6%) of the hypertensive patients. A statistically significant association was established between compliance to anti-hypertensive therapy and patients’ knowledge (p<0.001); age (p=0.024); education level (p=0.05); income (p=0.013); duration on treatment (p=0.005); cost (p=0.029); health care provider advises (p=0.009); consistency of therapy (p=0.002); availability of medicines (p=0.021); and health facility distance (p=0.013). Independent risk factors for compliance to anti-hypertensive therapy were duration on treatment (OR=0.383; 95% CI 0.151-0.972); Knowledge on hypertension (OR= 2.715; 95% CI 1.598-4.615); Consistency of therapy (OR= 0.452; 95% CI 0.282-0.726); and cost of medication (OR =2.682; 95% CI 1.134-6.345). Prescribed anti-hypertensive therapy compliance among patients was low. This could be attributed to factors such as social-demographic, patient, and health service-related in nature as demonstrated in this study. Prompt public health interventions that are patient-community centered are required to improve the compliance to anti-hypertensive therapy
Effect of Structured Caregiver Nutrition Education on Management of Pediatric Type 1 Diabetes in Uganda: A Cluster Randomized Trial
(Kenyatta University, 2022) Bari, Ndahura Nicholas; Judith Kimiywe; Judith Munga
Nutrition education is a vital component in the successful management of diabetes among pediatric type 1 diabetes mellitus (T1DM) patients. However, in Uganda, no published study has been done to find out if nutrition education affects the nutrition knowledge of caregivers and the glycaemic and dietary outcomes of their children.This study, therefore, evaluated the effect of the provision of a structured nutrition education course to caregivers of children and adolescents with T1DM on their level of type 1 diabetes nutrition knowledge and their children’s glycaemic control, dietary intake and diversity (DDS) in Uganda. The study was a cluster-randomised controlled trial in which study participants were randomly assigned to two groups; a control group and an intervention group at a ratio of 1:1. The total sample size was 100 caregiver-child dyads. Data was collected at baseline and 3 months post-intervention. The participants in the control group continued to receive routine medical care, while those in the intervention group received routine medical care and attended a structured group nutrition education course. The intervention lasted 12 weeks, it consisted of eight face-to-face sessions lasting 45 minutes each. The primary outcome was glycated haemoglobin (HbA1c) and the secondary outcomes (caregivers’ level of nutrition knowledge, children’s DDS and mean adequacy ratio (MAR). Data was collected using researcher-administered questionnaires. The data was analysed using SPSSVersion 26. Descriptive statistics such as frequencies, percentages, mean, standard deviation and medianwere used to describe the demographic, socioeconomic, diabetes-related characteristics, nutrient and dietary adequacy from the 24-hour recall. Independent samples t-test, Mann–Whitney U-test, analysis of variance (ANOVA) and Kruskal-Wallis Htest were used to determine the differences in continuous variables between the study groups. A Chi-square test was used to test for associations among categorized variables between the study groups.Spearman’s rank correlation coefficient was used to test for an association between the caregiver’s T1DM nutrition knowledge and dietary intake indices. The baseline findings revealed that 87.6%of the caregivers had low T1DM nutrition knowledge and this was significantly different across the levels of education (Kruskal-Wallis Htest: p = 0.007). Most type 1 diabetic children and adolescents had a mean DDS of 5.5 with adequate carbohydrate and protein but were found to be at risk of essential fatty acid and micronutrient deficiencies. The children’s mean HbA1c, DDS and MAR after the intervention were HbA1c (intervention: 10.87 versus control: 10.86; p= 0.347), (intervention: 5.93 versus control: 5.26; p=0.006) and (intervention: 0.81 versus control: 0.77; p = 0.021) respectively. The intervention group had a higher mean type 1 diabetes nutrition knowledge score (45.14%) compared to the control group (33.73%). There was no significant difference in the children’s HbAlc levels following their caregiver’s participation in the structurednutrition education course (Wilcoxon signed-rank test: p = 0.748). However, there was a 0.7 % decrease in the children’s HbAlc levels in the intervention group 3 months after the intervention compared to a 0.1 increase in the control group. A significant positive correlation between the caregiver’s nutrition knowledge scores and nutrient adequacy ratios (NARs) of vitamin B6, biotin, folic acid, and iron were observed (Spearman’s rank correlation: p< 0.05). Based on the gaps in the existing nutrition education module, a nutrition education guide for caregivers of children with T1DM in Uganda was developed and used during the intervention. This study concluded that structured nutrition education for caregivers of paediatric T1D patients can improve their nutrition knowledge and their children’s overall dietary adequacy. Therefore, the study recommends the developed contextualized guide should be used to conduct nutrition education sessions with caregivers of children with T1DM.
Growth and Development of Breastfed and Non-Breastfed Children (0 - 23 Months) at the Young Child Clinic, Kabale Hospital, Uganda
(Kenyatta University, 2022) Ivy-Marie, Komutambo; Judith Kimiywe; Munga Judith
Rapid growth and development are expected in the first two years of a child’s life. During this period, breastfeeding plays an important role. Poor optimal breastfeeding practices interfere with the intake of essential nutrients from breast milk leading to poor growth and development. In Uganda, 66% of children below six months are exclusively breastfed. Rapid growth during this time requires nutrient-dense foods like breast milk; without these foods, a child is prone to stunting, poor brain development, delayed achievement of milestones and malnutrition. The Uganda Demographic and Health Survey report indicates a decrease in the proportion of breastfed children from 82% to 50% among children 18-23 months. In Kabale, this manifests through increased malnutrition rates, specifically stunting (47%). This research focused on the growth and development of breastfed and non-breastfed children 0-23 months of age at the young child clinic, Kabale Hospital. A comparative cross-sectional study was used with both quantitative and qualitative approaches in data collection, analysis and presentation. The study targeted a sample of 250 children (0-23 months) and their caregivers, 125 breastfed children and 125 non-breastfed children. Structured researcher-administered questionnaires were used to determine socio-demographic characteristics and morbidity. Anthropometric measurements such as weight, length and MUAC were assessed using anthropometric measurements while the ages and stages questionnaire was used to cumulate information on developmental milestones. Data was analysed using SPSS version 22.0, and ENA for smart was used to analyse anthropometry. Data was presented in tables, and descriptive statistics were used to describe the different variables of the study. Bivariate analysis was used to establish the association of different variables in breastfed and non-breastfed children. The prevalence of undernutrition based on the three indices was wasting (5.2%), underweight (12%) and stunting (49.6%). Regression analysis revealed a significant relationship between the caregiver’s education level and fine motor skills (AOR=0.29, p=0.04), caregiver’s age and gross motor skills (AOR=15.34, p=0.020), child’s age and fine motor skills (AOR=7.594, p=0.002), weight for age and problem- solving skills (AOR=3.91, p=0.042), length for age and communication skills (AOR=3.68, p=0.033). Findings from the study showed that breastfed children had a better minimum dietary diversity score and nutritional status than non-breastfed children; however, there was no significant difference in morbidity and developmental milestones between the study groups. In addition, breastfeeding was not a predictor of developmental milestones. Factors like the caregiver’s age, education, child’s age, weight for age, length for age, and minimum dietary diversity score determined early childhood development. Caregivers should be encouraged to meet the minimum meal frequency. Mothers should receive continuous support and counselling on breastfeeding so their children can have a normal nutritional status, ultimately contributing to the achievement of developmental milestones. The government of Uganda should implement effective interventions like growth monitoring and promotion to decrease the high prevalence of stunting. Similar studies should be done with the inclusion of the home environment to observe its effect on developmental milestone.
Compliance to Hand Hygiene Standards amongst Health Care Providers in Selected Public Hospitals in Uasin Gishu County, Kenya.
(Kenyatta University, 2022) Sharon, Koech Jerop; Jackini Nyamari; Eunice Njogu
Hand hygiene is described as a simple act of cleansing hands and utmost effective measure of decreasing healthcare-associated infections among the health care workers. The infections not only lengthen the hospitalization period but also increase financial burden to individual, family and a country at large for example in Europe approximately €13–24 billion is spent annually. Hand hygiene compliance has remained unacceptably as low as 40% worldwide with the developing countries reporting a lower percentage. The broad objective of this study was to determine the level of compliance with hand hygiene standards amongst the health care providers in selected public hospitals in Uasin Gishu County. The study used the cross-sectional study design. The lower level health facilities were selected randomly while higher level health facilities were selected purposively. Sample size determination was done using Fisher’s (1999) formula and the study used Cochran’s correction formula because the population of the health care providers was below 10,000. A total of 301 sample size was arrived at an additional 10% of the 301 was included to accommodate for attrition hence having a total sample size of 331 respondents. The 331 health care providers were identified using simple random sampling technique taking into consideration the use of probability proportionate to sample size technique in obtaining the number of health care providers from each health facility. The Data collection instruments included a self-administered questionnaire and observational checklist. Quantitative Data analysis was carried out by utilizing the Statistical Package for Social Sciences (SPSS) software version 20. The findings revealed a compliance rate of 49.8%. Pearson’s test of correlation revealed that the main determinants of compliance with hand hygiene standards were professional cadre (r=014; P=0.015), training (r=0.371; P=<0.01) level of education (r= 0.168; P=0.004), availability of clean running water (r=0.271; P=<0.01) and hand washing soap (r=0.168; P=0.003). The study suggests that the policy makers and health stakeholders need to come up with a strategy that ensures that the health care workers adhere to hand hygiene standards and ensure adequate provision of hand hygiene facilities so as to enhance compliance with hand hygiene standards.
Exposure to Respirable Dust and Factors Associated with Abnormal Pulmonary Function among Stone Diggers in Kayole Quarries, Nairobi City County, Kenya.
(Kenyatta University, 2022) Mwangi, Fredah Wanjiku; Peterson Warutere; Anthonony W. Nyambura
Quarrying activities generate huge quantities of dust particles that cause a variety of respiratory illnesses among quarry workers. In Kenya, the quarry industry suffers several constraints: some quarry workers get injured, others get chronic diseases, while some die. Quarry dust control measures are not implemented, and quarry workers are exposed to dust that increases their risk of respiratory diseases. This study assessed occupational exposure to respirable dust and factors associated with abnormal pulmonary function among quarry stone diggers in Mihang’o and Matopeni quarries in Kayole Nairobi City County, Kenya. The study was done in Mihang’o and Matopeni quarries which are mainly involved in stone digging and crushing. An analytical cross-sectional design was used and a sample size of 165 respondents was taken to represent the study population. An interviewer administered semi structured questionnaire was used to assess quarry workers’ respiratory symptoms which were diagnosed by a qualified clinician. Spirometry tests were done by a qualified technician to assess pulmonary function. Respirable dust levels were determined with the aid of a particle counter. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. Descriptive statistics like frequency, means were used to summarize data and results were presented in frequency tables and graphs. Chi square tests and logistic regression were done to establish relationships between different variables. T tests were done to compare the means of dust levels in the two quarries. This study found the daily mean levels of PM2.5 and PM10 were higher than the levels recommended by WHO. The prevalence of respiratory symptoms among quarry workers was 24.2%. This study found that 12.7% of the respondents had restrictive pulmonary disorders and 10.3% had obstructive pulmonary disorders. The age of the respondents, presence of respiratory symptoms, years of work experience, nostril covering, and smoking were factors associated with abnormal pulmonary function at (p=<0.05). In conclusion the level of respirable dust (PM2.5 and PM10) in Kayole quarries was three times higher than the daily level of 25 ug/m3 for PM2.5 and 50 ug/m3 for PM10 recommended by WHO, chronic exposure to quarry dust increases the risk of developing respiratory symptoms and abnormal pulmonary function. This study recommended that routine particulate matter monitoring should be done in Nairobi quarries to provide data that can inform decisions on air pollution control actions.
Sexting and Risky Sexual Behaviour among Students in Machakos University, Machakos County, Kenya
(Kenyatta University, 2022) Elizabeth, Musyimi; Judy Mugo; Priscilla Kabue
Progressively, the digital world has certainly modified the sharing of information and social interactions and as a result, the virtual world has become commonplace in people’s lives, especially for the younger populace. What's more, young people have embraced the space for learning, exchange of new ideas, seeking information on any subject, and also for socializing with their peers. Sexting is the digital recording of nude or sexually suggestive or explicit images and their distribution by mobile phone messaging or through social networking platforms such as Facebook, Instagram, and Snapchat. The objective of the study was to investigate sexting and identify the risky sexual behaviors associated with sexting among students at Machakos University. The study adopted a descriptive cross-sectional study design. The target sample was 347 students aged 18-24 years at Machakos University. Convenience sampling was adopted for the selection of respondents for quantitative data and purposive sampling for qualitative data as well as the study area. Interviewer-administered questionnaires were utilized in gathering quantitative data while in-depth interviews facilitated the qualitative data collection. Data for the study were analyzed using descriptive statistics to describe the socio-demographic characteristics, sexting practice, prevalence, motivation for sexting, and the relationship between sexting and risky sexual behavior. A Chi-square test was carried out to identify variables associated with sexting and the odds ratio to measure the association between sexting and risky sexual behavior. The IBM SPSS version 26.0 was used for data analysis. Additionally, thematic analysis was used to analyze the qualitative data. Overall Sexting prevalence was 57% and the sexting prevalence of 48% for two-way sexters. Male respondents engaged more in sexting as compared to female respondents at 67%and 33% respectively. Essentially, students sexted to keep or get a boy/girlfriend (23%). Accordingly, students engaged in risky sexual behaviors with 74% having had sexual intercourse out of which 54% used no protection. Altogether sexting and risky sexual behavior were found to be associated with P= .000, and an odds ratio of 8.271, the perception of whether sexting leads to having sex with the person (P= .000), and an odds ratio of 6.939. In conclusion, sexting was prevalent among Machakos university students, and getting or keeping a relationship partner emerged as a key motivation for sexting although a sizeable number indicated no reason for engaging in sexting. Most students were involved in risky sexual behaviors like sexual intercourse without protection and there was a very high likelihood to engage in risky sexual behavior if one was sexting. The study recommends that the Ministry of Higher Education design programs in consultation with the students centered around how the students can utilize their smartphones, social platforms, and availability of the internet to learn about the benefits and dangers of sexting, the potential short and long term consequences associated with sexting, ways to reduce or avoid sexting, and ways to utilize sexting for sexual health promotion.
Utilization Of Focused Antenatal Care Among Expectant Women Aged 18-49 Years In Murang’a County, Kenya
(Kenyatta University, 2021) Mutai, Kiplangat Titus; Otieno G.O
Focused Antenatal Care (FANC) is crucial to improving maternal and infant health. Survey data from sub-Saharan Africa indicates that most women initiate FANC visits after the first trimester and hence do not achieve the recommended number of visits. Despite various efforts by the government of Kenya towards reduction of maternal and neonatal morbidities and mortalities, these conditions remain the leading cause of morbidity and mortality in Murung’a.The main objective of the study was to examine the determinants of Focused Antenatal Care among expectant women aged 18-49 years in Murang’a County. This study therefore sought to examine how individual, organization and policy factors influence the utilization of focused antenatal care services amongst women in Gatanga sub county, Murang’a County, Kenya. Data for this cross-sectional study were conducted between June and July 2019, using a stratified sampling technique from 3 selected wards. Structured questionnaire was administered to 334 women of reproductive age, aged 18 years and above, who delivered within the past one year or above 38 weeks of gestation. Key informant interviews and focus group discussions were conducted to obtain additional information on the factors that influence utilization of ANC services. Observation checklist was also used to assess service provision readiness at various sites. Data was analyzed using SPSS version 22 and presented in summary tables. Descriptive statistics and chi-square tests at 5% level of significance was used to examine the influence of predictors of FANC. The findings indicated that 37.3% of respondents had visited the FANC clinic. Level of education (X2(12)= 16.05; p < 0.05), occupation (X2(3)= 16.50; p < 0.05) level of income (X2(4)= 15.53; p < 0.05) time taken to the facility (X2(3)= 34.72; p < 0.05) and waiting time (X2(3)= 14.17; p < 0.05) were found to significantly influence utilization of FANC services. Women therefore should be empowered through education and economic activities so that they are able to support themselves and obtain the necessary services they need. Full implementation of free maternity services should be enforced in all health facilities and increase insurance coverage to all mothers. The Government should also improve access to health care especially in rural areas by building new health facilities increase human resource to enable service provision all days in a week to ensure adequate utilization of focused antenatal care services.
Household Factors Influencing Child Mortality Levels in Kilifi District, Kenya
(Kenyatta University, 2011) Maweu, Esther Nzilani
Dyslipidemia and Blood Pressure Control among Adult Hypertensive Patients at Kiambu County Hospital, Kenya.
(Kenyatta University, 2020-09) Nderitu, Monica. N.
Non-communicable diseases are on the rise globally. Hypertension is one of the most common non-communicable diseases. Globally, the prevalence of hypertension among adults was estimated to be 24.1% in men and 20.1% in women in 2015 and the global prevalence of raised cholesterol was found to be 39%. Across WHO regions, Africa was found to have the highest hypertension prevalence at 27%. Blood pressure control among hypertensive patients still continues to be a major challenge. Findings from several studies suggest an association between dyslipidemia and suboptimal blood pressure control among hypertensive patients. There is limited data in Kenya on whether dyslipidemia causes poor blood pressure control. This study aimed to assess the relationship between dyslipidemia and blood pressure control among hypertensive patients attending Kiambu county hospital. This was to help in early diagnosis and management of dyslipidemia in the management of hypertension thus improve blood pressure control and help reduce complications related to uncontrolled blood pressure. The main objective of this study was to assess the relationship between dyslipidemia and blood pressure control among hypertensive patients. This was an analytical cross-sectional study. The study population was hypertensive patients attending Kiambu County hospital. Structured questionnaires were administered by a clinician for data collection. Data collected was entered and stored in Microsoft Excel 2013. Data was cleaned, coded and analyzed. Blood pressure control was associated with socio-demographic characteristics, clinical factors and lipid profile using chi square tests for categorical variables and independent t test for comparison of means. Multiple logistic regression models were conducted to determine independent factors associated with poor blood pressure control. Statistical significance was determined at 5% level (p value less or equal to 0.05). 251 hypertensive patients in Kiambu hospital were studied. Their mean age was 55.7 with females being more than males at 80.9% and 19.9% respectively The mean systolic blood pressure was 145.1 mmHg and diastolic BP of 87.4 mmHg. Blood pressure was poorly controlled in 142(56.6%) (95% CI 50.6-62.9%). High LDL levels was diagnosed in 82.1% of the patients, 23.1% had low HDL levels, 31.9% had high triglycerides and 59.8% had high total cholesterol. Patients with poorly controlled hypertension had a significantly higher mean total cholesterol (221.4 mg/dl) compared to the well-controlled group (mean 193.4 mg/dl), p<0.001. Similarly, LDL levels were significantly higher in the poorly controlled group (mean 142.3 mg/dl) compared to the well-controlled group (mean 121.4 mg/dl), p=0.001. HDL and triglycerides were not significantly associated to hypertension control (p>0.05). Drug adherence, male gender and total cholesterol were independently associated with poor blood pressure control. In conclusion, majority of the patients studied had poor blood pressure control and. Dyslipidemia was a major problem and it was associated with uncontrolled blood pressure. However, more studies are recommended for correlation.
Health Information Technology Utilization in Patient Safety Promotion by Health Care Workers, Mama Lucy Kibaki Hospital, Nairobi City County, Kenya
(Kenyatta University, 2019-08) Kathini, Esther
Health IT is an application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision-making. The advantages of health information technology (IT) in health care includes facilitating communication between health care providers; improving medication safety, tracking, and reporting; and promoting quality of care through optimized access to and adherence to guidelines. Health IT systems permit the collection of data for use for quality management, outcome reporting, and public health disease surveillance and reporting. The study aimed at assessing Health Information technology utilization in patient safety promotion in Mama Lucy Kibaki Hospital (MLKH), while focusing on the following objectives; establish the role of Health Information Technology (HIT) in promoting Patient safety at MLKH, Nairobi City County Kenya. Specifically, identifying HIT technological factors, determining HIT organizational factors and describing the individual system components influencing utilization of HIT in promoting patient safety. The researcher adopted a Descriptive cross-sectional research design where a sample size of 147 derived using Fisher‟s formula. The researcher adopted a questionnaire and Key Informant guides for data collection. Pretesting for validity and reliability of tools was done at Mbagathi Sub County Hospital. Cronbach‟s alpha was used to calculate the reliability of the data collection tools, with the test conducted on 32 items for the questionnaire and 8 items for the Key informant guide. The reliability results produced alphas of 0.80 and 0.84 respectively, compared to an alpha of 0.7, which was the lower bound for acceptable reliability. Quantitative data was analyzed using content analysis; qualitative data was coded and analyzed using Statistical Package for Social Science (SPSS) version 22.0 and STRATA 12 software for windows where association of variables was tested using chi-square for comparisons. The study found out that 1) Most respondents 66 (56%) felt that HIT played a key role in promoting patient safety. EMR, CPOE and DSS were found to be important HIT useful in ensuring patient safety at the hospital. Following binary logistic regression, the study found sufficient evidence to suggest associations between effective patient safety promotions through HIT as follows; similarity of access passwords (OR=1.2 [95% CI 1.075-1.600]); periodic trainings on HIT (OR =2 [95% CI 1.456-2.027]); involvement of HIT users (OR=1.5 [95% CI 1.180-1.654]); auto logout of users (OR=0.2 [95% CI 0.052-0.801]), knowledge and use of EMR (OR=0.4 [95% CI 0.195-0.877]); notification on patients‟ identification number (OR=3.6 [CI 0.072-0.572]) and presence of backups to the systems (OR=0.2 [95% CI 1.306-9.916]). The study also observed that doctors were more likely to perceive the utility of HIT in promoting patient safety compared to pharmacists (OR= 0.56 [95% CI 0.131-2.135]) this showed that the results were significant at 95% CI. Based on the findings, it was concluded that staff knowledge and experience on use of HIT improved patient safety, while HIT effectively improved storage, retrieval, automation and confidentiality issues pertaining to patient safety. The study recommended continuous evaluation and monitoring of patient safety outcomes by promotion and modification of HIT in the healthcare delivery in MLKH.
Impact of Use of Biofuels on Respiratory Health among Workers in Food Establishments in Nairobi.
(Kenyatta University, 2007-09) Ochieng, Caroline A.
Indoor air pollution from biofuel use has been found to be responsible for more than 1.6million annual deaths and 2.7% of the global burden of disease. This makes it the second biggest environmental contributor to ill health, after unsafe water and sanitation. Respiratory system is the most affected. However, nearly all studies have been conducted in households, leaving out occupational environments where the same fuels are used. The main objective of this study was therefore to investigate the impact of use of biofuels on respiratory health among workers in food catering enterprises in Nairobi. A crosssectional design was employed, and data collected using structured questionnaires, observation checklist and interviews. Data was analysed using descriptive statistics and chi square tests. Of the 370 respondents in the 250 randomly selected enterprises, 56% were males and 44% females, mostly aged between 20 to 40 years. Majority (86%) had not gone beyond secondary school, and were mostly casual employees or own account workers. Most of the enterprises (71%) were unregistered, and 81% utilized biofuels because they were cheaper than processed fuels. The study found significantly higher .prevalence of respiratory symptoms among workers in enterprises using biofuels compared to those using processed fuels. p values were significant for cough (X2=38.16;df=l; P=O.OOO), phlegm (X2=6.46; df=l; P=O.OII), breathlessness (l=8.29; df=l;P=0.004) and wheezing (l=16.56; df=l; P=O.OOO). Within the biofuels, fuelwood users recorded higher prevalence of symptoms compared to charcoal users. Prevalence of respiratory health outcomes was also considerably higher in those who were aged 40 years and above and who spent longer hours indoors, similar to findings by Ezzati et at (2000) and Shrestha et at (2005) in household studies. Significantly higher prevalence was also recorded in respondents in unregistered enterprises (p=0.002), and those that were poorly ventilated (p=0.000). The study has demonstrated that biofuels are a major public health threat to workers in food establishments, and urgent intervention is required. It therefore recommends a switch from biofuels to processed fuels in order to protect the health of the workers. Other measures that can be employed include a switch from more polluting biofuels such as fuelwood to less polluting ones such as charcoal, ensuring adequate ventilation, spending less hours indoors and awareness creation. However, for such interventions to occur, the activities of the sector needs to be formalised, because this would encourage investments in the sector that would lead to adoption of cleaner fuels and healthy work environments. Targeted energy sector policies that would make processed fuels more affordable and financial support measures are also required.
Knowledge of the Relationship between Sexually Transmitted Infections and HIV Transmission Among Secondary School Students in Kabartonjo Division, Baringo District
(Kenyatta University, 2004-11) Amiami, A. P.
A descriptive cross-sectional study was conducted among secondary schools in Kabartonjo Division of Baringo District, Kenya, between October 2002 and April 2003. The study aimed at establishing the students' knowledge of the relationship between Sexually Transmitted Infections and the transmission of IDV. A total of three hundred and sixty five sampled respondents were interviewed and four Focus Group Discussions (FGDs) held, in addition to interviews with key informants. Data was analyzed using the SPSS and figures done using MS-Excel before being transferred to MS-Word. The results show that more than half of the respondents (55.3%) were males with females constituting (44.7%). The knowledge of STI among the respondents was highest on gonorrhoea (99.6%), syphilis (97.1%) and IDV (84.7%) while poor on Herpes (35.4%), Chlamydia (19.4%), genital warts (14.5%), trichomoniasis (10.2%), Candidiasis (7.8%) and Hepatitis B were (6.5%). About 50% of the respondents were aware of clinical symptoms of STI in both males and females. Only few respondents (14.8%) reported noticing symptoms of STI in the last 12 months. The results further show that (86.0%) considered STI to be a serious problem, (39.7%) perceived themselves as being at risk of contracting STI and (39.7%) reported being at risk of contracting IDV. The respondents who had suffered from STI had poor health seeking behaviour as only (8.2%) sought professional help from health workers in clinics or health centre, while (4.7%) visited traditional healers, (5.8%) bought medicines from shops or pharmacies and (7.7%) asked friends for advice. The low knowledge of STI (X2 =19.287, df= 3, p= 0.000) accounts for the small percentage of respondents who reported symptoms of STI and the general poor health seeking behaviour elicited. There was good knowledge of relationships between common STI and mv being spread through sexual intercourse (89.3%). Chi-square test shows (X2 =8.766, df=3, p<0.05), that STI and IDV being spread through sexual intercourse; the presence of STI and IDV increases the chances of one acquiring IDV (83.6%) X2 =7.600, P< 0.05 did not agree with the working hypothesis. Knowledge of IDV infection prolonging the duration of STI was not significant (X2 =2.540, df=3, p> 0.05). The study revealed that knowledge of the relationship between STI and transmission of HfV was not significant with the level of education (X2 =1.360, df =3, p> 0.05) but only as individuals (X2 =1.360, df= 1, p< 0.05). The study therefore concludes that there is need to strategize on information, education and communication targeting adolescents on knowledge of STI as a measure of curbing the transmission of HIV.
Effect of health education and hygine on blood lead levels, among lead battery workers in Nairobi and Athi River, Kenya.
(Kenyatta University, 2014-10-13) Ngara, Jared Ochieng; Afullo, A.
Lead is a highly toxic, non-degradable metal that can result in damage to the brain, kidneys, blood, central nervous and reproductive systems. This study sought to identify the effect of health education and improvement on hygiene standard interventions on blood lead levels among factory workers at Associated Battery Manufacturers (Nairobi) a-n'd Chl=oride Metals Kenya (Athi-river). The study design was quasi experimental time series, where data on blood lead levels collected from April 2003 to December 2005, before the interventions were compared to the samples collected from April 2006 to December 2009, when the intervention measures were put in place. Purposive sampling technique was applied where a total of97 respondents participated in the study. Data for this study was collected using four instruments: questionnaires, laboratory results on blood lead levels, interview to key informants and direct observation. The statistical package for the social sciences (SPSS) was used for data processing and analysis. The data was mainly analyzed using descriptive statistics in form of frequency distribution, cross tabulation and percentages. A 2 tail t- test at 95% confidence interval was performed on the mean of various variables. From the study results, a comparison was made on the mean blood lead levels in ug/dl before and after the intervention measures were put in place and the calculated t- value was 2.03 against the table value of 1.96 with a p-value of 0.045. It was concluded in general that, the intervention measures put in place brought significant change towards lowering the mean blood lead level value among factory workers. Specifically, the study revealed that there was statistical significant difference in the blood lead level mean values on the following tested variables; use of personal protective equipment with a calculated t- value of 6.66 against table value of 2.26. Average level of knowledge on lead and its effects on health with a calculated t-value of 2.05 against the table value of 1.96. Daily intake of water of up to one litre per day with a calculated t-value of 2.02 against the table value of 1.96, thus; just enough water is adequate in blood lead level reduction but not too much of it. Among the hygiene measures tested; daily bathing after work was significant with a calculated t-value of 2.36 against the table value of 1.96. For respondents who took alcohol, the calculated t-value was 2.04 against the table value of 1.96 with a p-value of 0.045, hence statistical evidence that alcohol consumers could have benefited more from the interventions especially with regard to hygiene interventions. Emanating from the findings and conclusions drawn from this study, the study recommends that the stake holders in the lead industry provide correct and adequate personal protective equipment (PPE) for its entire workforce, enhance health education to improve knowledge on lead and its ill health effects, provide bathroom facilities for the ladies working in the lead industry and to scrap off the use of rewards and warning letters as a form of intervention. Further research has been suggested to establish the role of vitamin C, fruits and alcohol on blood lead levels. It is important to carry out the same study on other battery manufacturing companies and lead industries for a bigger sample size and to compare results.
Effects of integration of hiy- aids care into reproductive health service on utilization of reproductive health services in Kenya
(2014-10-01) Waweru, Lucy Anne Wanjiru
In most settings throughout the world, reproductive health and HIV and AIDS services are offered with little or no integration. Reproductive health services primarily target married women of reproductive health age bracket while HIV and AIDS services target individuals at high risk of HIV and AIDS infection. However the potential benefits of integrating these services are increasingly apparent as ever more women of reproductive age are becoming infected with HIY and AIDS or are at risk of getting infected. In addition to the potential of reproductive health providers reaching women who account for nearly half of all adults living with HIV and AIDS with HIV prevention, information and treatment. This has resulted to many types of integration being explored but their effects on reproductive health services have not been rigorously evaluated and are largely unknown. Therefore the study sought to expose the effects of integration of HIV and AIDS care into reproductive health services on the utilization of reproductive health services in Kenya. The study was carried out at Nairobi-west and Thika family care medical clinic which were conveniently sampled. A longitudinal study design was employed where records of clients utilizing reproductive health services from the study sites were reviewed. Retrospectively and prospectively for six months from the onset of integration. The results of the retrospective review generated the baseline data while the prospective review generated results that would be compared against the baseline data to assess whether the integration had affected the utilization of the reproductive health services. In addition to how the integration had affected the utilization of the reproductive health services. To build on the data generated from the review of records, primary data was collected from a sample of a hundred and ninety four clients and service providers from the study sites. The clients were sampled on availability while all service providers were considered. Interview schedules and self-administered questionnaires were used to collect the data from clients. Key informant interviews were used to collect the views of service providers regarding integration. Data analysis was done using SPSS software. Descriptive statistics were done to determine frequencies, means and percentages. A paired sample t-test was used to determine whether there was a significant difference.in uptake of reproductive health services before and after integration. Chi-square was used to establish associations of various variables. Data from key informant was summarized and discussed under various themes. Data was presented in graphs and tables. Integration had improved the access of services because of the increments in the total number of clients that were registered in general and in the respective study sites after integration. Moreover it had improved the quality of services and it was widely accepted among the clients and service providers. While most of the clients were aware of existence of HIV/AIDS services, only a minority could specify the nature of services available at the facilities. Awareness was mainly acquired through pamphlets and brochures. In addition the utilization of HIV/AIDS services integrated into reproductive health services was low. The fmdings of the study will be used by the players in the health sector in the formulation of policies, conceptual and legislative frame works in support of integration.

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