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Item Uptake of Indoor Residual Spray as a Malaria Vector Control Strategy among Communities in Migori County Kenya(Kenyatta University, 2025-03) Odira, JohnGlobally malaria is ranked among the leading causes of morbidity and mortality. Indoor residual spray (IRS) has been tested and proven to significantly contribute to malaria vector reduction. The study is on indoor residual spray, a malaria vector control strategy among the communities in Migori County, Kenya. The specific objectives being, to establish economic factors relating to indoor residual spray among the communities in Migori County, to find out the cultural factors associated with indoor residual spray among the communities in Migori County, to assess the level of knowledge among the communities on indoor residual spray and to determine the health system factors associated with indoor residual spray. The study was conducted in Migori County, study population of 1083 and 284 sample population. A descriptive cross – sectional study design was applied. Sample size determination I applied Cochrane method and my result showed 90% uptake. There was association between culture (religion) and IRS uptake (p=0.001). From the sampled 284 household heads, there was a 278(98.8%) response rate to the interviews. Indoor residual spray one of the interventions against spread of malaria for vector transmission interruption. Informed consent was obtained from the respondents, privacy and confidentiality were ensured. The study utilized questionnaires, focused group discussion (FGDs) of 10 composed of community health promoters, opinion leaders and community members randomly selected systematically in Rongo Sub County and key informant interviews (KIIs) attended by 15 participants each session to collect data. Cross-sectional quantitative data analysis, findings were presented in tables, graphs and charts while inferential analysis was conducted at 95% confidence intervals, and p-values, as applicable with the aid of the Statistical Packages for Social Science (SPSS Version 2.6), whereas the descriptive qualitative data were analyzed thematically. The primary obstacles to adoption of IRS revolved around the criteria for selecting workers, the effectiveness of those applying the spray, unfavorable past campaign encounters and individual inclinations. Challenges in removing bulky household items and exposure to bed nets treated with insecticides choice as compared to indoor residual spraying. The study highlighted critical fields in the residents’ economic empowerment, ownership, seasonal workers engagement criteria, social mobilization approaches and health systems to be addressed through public engagements. Program managers, county and national governments, policy makers and health stakeholders to re-strategize to improve future IRS implementation. Mobilize financial support to address chemical smell and time management. Additionally, enhance communities’ health education, promote healthy choices and well-being that leads to better life, since a community-led interventions leads to lasting change in the utilizations of health interventions.Item Wash Related Factors Associated With Nutrition Status of Children under Five in Ewaso Narok Wetland, Laikipia County, Kenya(Kenyatta University, 2025-02) Kiilu, Colleta MbulwaThis study investigates the association between Water, Sanitation, and Hygiene (WASH) factors and the nutritional status of children under five in Ewaso Narok Wetland, Laikipia County, Kenya. The specific objectivves of the study were; to assess the status of nutrition among children under five years old in the Ewaso Narok wetland, to establish the socio-demographic factors influencing the status of nutrition among children under five years old in the Ewaso Narok wetland, to determine how WASH related factors impact the status of nutrition among children under five years in the Ewaso Narok wetland, and to establish the relationship between Nutrition status and selected WASH-related diseases among children under five in Ewaso Narok wetland in Laikipia county. Utilizing a mixed-method approach, both qualitative and quantitative data were collected to assess WASH-related parameters and their impact on child nutrition. The study sample comprised under-five children recruited from selected facilities every month. Data collection involved a review of hospital records and structured questionnaires. Descriptive statistics, including frequency tables, cross tabulation, pie charts, and graphs, were employed to analyze the data. Additionally, inferential statistics, such as binary logistic regression, were utilized to predict the nutritional status of children based on various WASH factors. The findings reveal significant correlations between WASH factors and child nutrition status. Notably, 62% of caregivers disposed of children's faeces immediately, indicating a positive impact on child nutrition. Moreover, children residing within 1 km of wetlands exhibited a 45% higher prevalence of malnutrition compared to those living farther away. Proper use of protective gear in wetland areas was associated with a 25% reduction in malnutrition rates among children. Furthermore, consistent handwashing before eating was linked to a 30% lower risk of malnutrition. Inferential analysis demonstrated that faeces disposal method (p = 0.045), distance to wetlands (p < 0.001), and handwashing practices (p = 0.012) emerged as significant predictors of child nutrition status. These findings underscore the importance of targeted interventions to improve WASH practices and enhance child nutrition outcomes in the study area. Based on the study's findings, recommendations are proposed to address the identified WASH-related challenges. These include implementing WASH programs targeting faeces disposal practices, wetland proximity, and handwashing behaviors. Additionally, enhancing access to improved water and sanitation facilities, promoting hygiene education, and encouraging safe disposal of children's feces are recommended strategies to improve child nutrition.Item Adherence to Anti-Tuberculosis Treatment among Patients Attending Tuberculosis Clinics in Nyatike Sub-County, Migori County, Kenya(Kenyatta University, 2024-09) Babere, Patrick KerataTuberculosis is a communicable disease whose cause is Mycobacterium tuberculosis. Main mode of spread is through coughing or sneezing from an infected person, which expels the droplets and when they remain suspended in the air, a susceptible host inhales the contaminated air, they get lodged in the lungs and later cause an active TB disease when not suppressed by the immune system. Symptoms most reported include: persistent cough with sputum, night sweats, appetite loss, weight loss among others. Approximately 10.6 M people contacted the disease and 1.30M died from it in the year 2022. Of all the TB disease burden globally, 23% are from Africa but the region led in mortalities, being 33%. Kenya had an incident rate of 233 per 100,000 and mortality rate of 32 per 100,000. Adherence in Kenya according to a national survey was 75% and several factors had been found to affect it including socio-demographic, individual and health system related factor. The study aimed determine factors affecting adherence to anti-TB treatment in all treatment phases among patients in Migori County. In Nyatike, there were concerns in rising cases of re-treated TB patients and rifampicin resistant cases. The cure rate in Nyatike was 76% which was lower than Migori County which was at 81.3%. The study therefore sought to ascertain the adherence level among the TB patients in Nyatike sub-county. This would be important to help the healthcare givers to know how much to invest in adherence given the high incidence rate in the sub-county (209 per 100,000) against that of the sub-county (155 per 100,000). The study`s main objective was to assess adherence to anti-tuberculosis treatment among patients attending tuberculosis clinics in Nyatike, Migori County, Kenya. Specific objectives were to: determine the demographic, individual and health system factors associated with adherence to anti-TB treatment, to determine the knowledge level and its association to adherence among patients in Nyatike sub-county and to determine the prevalence of adherence levels among patients in Nyatike sub-county. The study`s area was Nyatike, which is among the sub-counties in Migori with a population of 176,162 people. The area`s major economic activities include fishing, farming, livestock keeping, gold mining and bee keeping. Cross sectional was the Study design of choice. Census method was the sampling technique used to sample participants while purposive sampling was used to sample FGD and KII participants. A total of 200 participants, 18 years or more and consented to participate were included in this study. Questionnaires, key informant guide and FGD guides were the data collection tools with the pre-test done in Kuria West sub-county. Morisky medication adherence scale (MMAS-8) and Knowledge assessment was adopted from the Global TB community advisory board (TBCAB) were adopted in the study to measure adherence and knowledge levels respectively to ensure validity. Data was analysed using SPSS version 25 after a descriptive summary while qualitative data was summarised and organised into themes. Data dissemination was in form of tables, graphs and pie charts for quantitative and captions for qualitative data. Due ethical clearance was granted from KU ethics review committee, NACOSTI and Migori County health authority. Factors found to be associated with adherence following a regression analysis included: HIV status (AOR1.152; 95%CI: 0.408-3.691, p=0.029), money for other needs (AOR2.363: 95%CI: 0.934-5.981, p= 0.007), use of other non-TB drugs (AOR 0.418; 95%CI: 0.157-1.109, p=0.008) and knowledge (OR: 2.856; 95%CI: 1.282-6.365; P= 0.01). No socio-demographic and health system factors were found to be statistically significant. Adherence level among participants was 78% whereas the knowledge level was 70%. Stock-out of pyridoxine drug and lack of regular update from the TB program among healthcare givers in the private hospitals were the challenges facing the health system. Organization of Peer-to-peer groups among TB patients at the health facility level, incorporation of community health practitioners in TB care for patients, conducting health education to the communities and advocacy as well as provision of nutrition guidance for TB patients in the sub-county were among the recommendations arrived at from this study. Conducting adherence study among children under 18 years, knowledge assessment among TB patients in other parts of the County and conducting a similar study in future to ascertain whether demographic and health system factors are associated with adherence are the recommendations for future studies.Item Awareness of Stroke Risk Factors and Warning Signs among Hypertensive Patients Attending Garrissa County Refferral Hospital in Garrissa County, Kenya.(Kenyatta University, 2025-02) Bashir, Abdiweli M.Stroke is a major global health challenge that substantially impacts individuals, families, and societies. Several risk factors contribute to the development of stroke, the majority modifiable while some are non-modifiable. Despite the high prevalence of stroke risk factors among the people of Garissa County, there are no published studies evaluating the level of awareness of hypertension on risk factors and early warning signs among hypertensive patients in Garissa. Garissa County, in the former Northeastern Province of Kenya, has overall low literacy levels, which could potentially impact patients' awareness of stroke risk factors and warning signs. Therefore, the study's objective was to determine the level of awareness of stroke risk factors and warning signs among hypertensive patients in Garissa County and the factors influencing their level of awareness. It was conducted in the medical outpatient clinic of Garissa County Referral Hospital. The study population was hypertensive patients older than 18 years. A structured questionnaire and key informant interview tool were used for quantitative and qualitative data collection. Data was analyzed in SPSS version 25. Categorical data was summarized as absolute frequencies and proportions, while continuous variables were presented as measures of central tendency. A multivariate logistic regression was used to determine the association between patients' characteristics and their level of awareness. A P-value of < 0.05 was considered significant. There were 143 respondents with a mean age of 57 years, very low literacy (18%), and a low employment rate (34%). 39% (56) of the hypertensive patients also had one or more comorbidities, mostly diabetes, kidney failure and heart failure. The hypertension control rate was also suboptimal (26%). Hypertensive patients in Garissa have very low awareness levels of both stroke risk factors and warning signs at 15% and 38%, respectively. On multivariable logistic regression analysis, level of education (aOR: 7.474, CI: 1.343-41.598, p=0.022), family history of stroke (aOR: 5.552, CI: 1.200-25.682, p=0.028), and comorbidity (aOR: 0.135, CI: 0.038-0.481, p=0.002) were significant predictors of level awareness. This study recommends that the Garissa County Public Health Department develop a health education and promotion strategy to enhance stroke awareness, reduce risk factors, and improve cardiovascular health outcomes.Item Effectiveness of Utilization of Community Health Volunteers in the Identification and Management of Hypertension Cases in Kajiado County, Kenya.(Kenyatta University, 2025-06) Wanjiru, Claris JessicarHypertension, despite being a preventable and manageable non-communicable disease, significantly contributes to the overall morbidity and mortality rates. In Kajiado County, Community Health Volunteers (CHVs) offer various healthcare services, but their utilization in hypertension care has not been thoroughly explored nor emphasized. This study aims to assess the sociodemographic profiles, knowledge levels, the challenges, barriers, and facilitators that influence CHVs’ effectiveness in hypertension identification and management in Kajiado County. A cross-sectional study with a mixed-methods approach targeting 221 CHVs in Kajiado South Sub- County was conducted. Almost all respondents (99.6%) reported having a role in hypertension identification and management in the community; however, only 34.1% had ever received specific training on hypertension. The results show that CHVs play a major role in screening (32.6%), education (74.1%), and referral (99.6%). More than three-quarters stated that their work was purely voluntary, with all of them recommending a need for a monthly stipend as a motivation and enabler for their work to be effective. Hypertension screening was significantly higher among the middle-aged group (41-50 years) ( ꭓ2 8.9, p=0.031, 95% CI). A significant association was found between having received hypertension training and knowledge levels on hypertension (Fisher’s exact test, p=0.000, 95% CI). Screening was conducted more among those who had been trained on hypertension (χ2= 9.06, p= 0.003, 95% CI). Multiple logistic regression in our final model found that the odds of identifying hypertension cases in the community was 3.74 times higher among CHVs who knew the symptoms of hypertension as compared to those who lacked this knowledge. CHVs received support from healthcare personnel through training (100% for basic CHV training and 34.1% for hypertension-specific training) and supportive supervision (94.7%). Additionally, CHVs who received supportive supervision (Fisher’s exact test, p=0.029) and had automatic digital Blood Pressure machines (Fisher’s exact test, p=0.001) were more likely to identify hypertension cases in the community than the rest who lacked this support and essential equipment. The study recommends intensified training of CHVs to improve knowledge on hypertension in the basic module and continuous updates, supportive supervision, and provision of automatic digital blood pressure equipment to empower them and support their activities in hypertension care.Item Self-Management Practices among Children Presenting With Type 1 Diabetes Attending Selected Health Facilities in Nairobi City County, Kenya(Kenyatta University, 2025-06) Mugo, Ann WanjikuDiabetes is a prevalent non-communicable disease (NCD) with a significant burden in low and middle-income Countries (LMICs). Diabetes is rising globally, with an estimated 589 million individuals having diabetes in 2024 and 853 million by 2050. In sub-Saharan Africa, 25 million adults have been diagnosed with diabetes, with a prevalence rate of 4.2%. Approximately 813,300 adults in Kenya currently suffer from diabetes with projections of 1.8 million increase by 2050. Estimates suggest that 9,500 children in Africa and 5,575 in Kenya have type 1 diabetes. Most children with T1D in the region die undiagnosed at clinical onset. Self-management is necessary for effective treatment and clinical outcomes, as well as reducing healthcare utilization and costs. This study aimed to evaluate self-management practices among children presenting with T1D using an analytical cross-sectional design. The researcher obtained qualitative and quantitative data through a researcher-administered questionnaire, focused group discussions, and interviews with key informants who were the primary caregivers and health service providers. The principal investigator entered the data into Excel for management and then conducted a cleaning and verification process to ensure its accuracy and reliability. This process included performing descriptive statistical analysis, which involved calculating frequencies, percentages, means, and standard deviations. The cleaned data was then transferred for analysis purposes; the researcher employed version 23 of the Statistical Package for Social Sciences (SPSS). The study investigated the socio-demographic and economic profiles of children with type 1 diabetes, their level of knowledge regarding self-management practices, and the self-management practices carried out by these respondents and explored the relationship between socio-demographic and economic factors, knowledge levels, and self-management practices among children with T1D. The study involved children with T1D aged between 8 and 18 years in Nairobi City County, Kenya, and attained a 94.9% response rate. Most of the respondents were girls (65.6%), with a median age of 14.67 years and a standard deviation of 3; most lived in low-income residences and had completed primary education, while most caregivers were self-employed. While 95.9% of the respondents recognized self management practices, further probing revealed that only 3.3% had adequate knowledge about coping strategies and 13.7% understood medication adherence. In practice,67.4% had medication adherence, and 53.4% monitored their blood glucose daily. However, a smaller proportion engaged in healthy problem-solving (29.9%) and physical activity (43.4%). Positive correlations were identified between self management practices and factors influencing them, including the age, education, and knowledge levels of children, along with the employment and marital status of their primary caregivers. The findings indicated a need for comprehensive, focused strategies to address knowledge gaps and overcome challenges that hinder children from effectively carrying out self-management practices. There is a need for targeted education, support systems, and individualized interventions among the children to improve the way they manage their diabetes.Item Cervical cancer screening barriers and facilitators among female prisoners in selected prisons in Kenya(Kenyatta University, 2022-10) Mbindyo, Felistas SavaiItem Determinants of Home Births among Women of Reproductive Age after Antenatal Hospital Care Visits in Narok County, Kenya(Kenyatta University, 2023-04) Kirubet Purity, NgotiekAbstractItem Influencers of long term and permanent methods of family planning uptake among women of reproductive age in Baringo County, Kenya(Kenyatta University, 2023-06) Kipngo’k, Emily J.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 KenyaItem Uptake of Maternal, Neoanatal and Child Health Services Provided under Universal Health Coverage in Machakos County, Kenya(Kenyatta University, 2024-04) Kangee, Maureen NjeriUniversal 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.Item 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 NafulaEnhanced 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.Item 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 OtienoAbstractItem 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. OragoAbstractItem 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 MutisyaDiarthea 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.Item Health information utilization for decision making in health facilities in Nandi county,Kenya(Kenyatta University, 2022-11) Kiptarbei, Kisorio Ezekiel; George Otieno; Kenneth RuchaItem 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 MwanzoHypertension/ 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 therapyItem 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 MungaNutrition 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.Item 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 JudithRapid 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.Item 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 NjoguHand 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.