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Item Determinants of Quality of Hemodialysis Services in Selected County Dialysis Centers in Nyanza Region, Kenya(Kenyatta University, 2024-05) Nyabaro, DoreenBackground: Hemodialysis is a common management intervention in patients with Chronic Kidney Disease and End-Stage Renal Disease. Globally, there are approximately 1 billion renal patients on hemodialysis. Despite the increase in utilization of maintenance hemodialysis in low- and medium-income countries, there have been fewer efforts to assess the quality of hemodialysis services. Thus, there is a need to assess the quality of hemodialysis services. Objective: To evaluate the quality of hemodialysis services at selected county dialysis centers. Methodology: The study was a cross-section descriptive study. The study adopted a census method where 118 hemodialysis patients was considered. The participants were sampled consecutively based on the inclusion criteria. SERV-QUAL tool was used to measure perceived quality of hemodialysis services. Chi squares test for the association was used to determine the association between the patient, institutional factors, healthcare professional factors, and the quality of Hemodialysis services. Binary logistic regression analysis was used to determine predictors of quality hemodialysis services. Statistical Package for Social Sciences (SPSS version 26) was used for data analysis. Results: Majority of the patients 61.9%(n =73)were male, with 28.8%(n =34) of the respondents being aged 60 years and above. The findings further showed that 44.1% of the participants had secondary level education. The perceived quality of hemodialysis services was moderate with 56%. Bivariate analysis revealed that gender, level of education, presence of comorbidities, admission due to side effects, receiving social support, waiting time, receiving education before dialysis session and satisfaction with care were associated with quality of hemodialysis services. Multivariate analysis using logistic regression established that being male (AOR =3.75, 95%CI: 1.11 – 12.64, p =0.033), having secondary level education (AOR =2.31, 95%CI: 1.41 – 4.97, p =0.046), having been admitted due to side effects since the beginning of hemodialysis sessions (AOR =0.22, 95%CI:0.15 – 0.86, p<0.001), having received social support from family and friends (AOR =11.49, 95%CI: 1.79 -73.95, p =0.010) and not waiting longer to be allocated a HD (AOR = 0.21, 95%CI: 0.05 – 0.93, p =0.041) were significant predictors of perceived good quality of hemodialysis services: Conclusion and recommendation: The perceived quality of hemodialysis services remains moderate. Gender, education level, admission due to side effects waiting time and receiving social have been identified as predictors of perceived quality of hemodialysis services. Therefore, increased health education, training more staff on the needs of patients and reviewing appointment period based on the number of machines available is essential to improved care.Item Determinants of Chronic Kidney Disease among Type 2 Diabetes Mellitus Patients at Gatundu Level 5 Hospital, Kiambu County, Kenya(Kenyatta University, 2023-12) Mwega, BernardThe prevalence of chronic kidney disease (CKD) is rising throughout the world, and it is one of the major public health menaces due to the significant morbidity and mortality it is associated with. The burden of CKD inexplicably affects low-income nations like Kenya, where the two main public health concerns responsible for the growing prevalence of CKD are hypertension and diabetes mellitus. The aim of this study was to assess the determinants of chronic kidney disease among type 2 diabetes mellitus patients. A hospital-based cross-sectional study design was conducted at Gatundu level 5 Hospital in Kiambu County, central Kenya, among adult (≥18 years) diabetes mellitus patients. Sample size was determined using Yamane Taro formula. Informed written consent was obtained from each participant and data was collected by interview and chart review. Glomerular filtration rate (GFR) was estimated from serum creatinine using modification of diet in renal disease (MDRD) formula, while CKD was defined as estimated GFR (eGFR) of less than 60mls/min/1.73m2 for more than three months. Multivariate logistic regression was used to identify independent determinants of CKD and a p-value of <0.05 was considered statistically significant. Majority of the participants (43.42%) were aged between 50-60 years and 95 (62.5%) of them were female. The researcher found out low level of patient awareness (25.8%) and high prevalence of CKD (78.2%). Factors associated with chronic kidney disease were gender, high blood pressure, type 2 diabetes mellitus, smoking, family history of CKD, obesity, poor knowledge of CKD and long duration of hypertension. The researcher observed a high prevalence rate of CKD amomg diabetic patients and hence recommended that the National and County Governments‟ Department of Health should take measures to increase the awareness about CKD prevention among high risk populations such as patients with diabetic mellitus.Item Unmet Palliative Care Needs of Patients on Maintenance Hemodialysis at Thika Level 5 Hospital, Kiambu County, Kenya(Kenyatta University, 2024-06) Githuku, Stephen. NGlobally, a huge gap exists between the required and the available renal palliative care services. The gap is particularly worse in low-and-medium income countries despite having the highest percentage of patients requiring palliative care. Maintenance hemodialysis patients contribute a sizable percentage of the global renal patient population in need of palliative care. Successful provision of adequate palliative care services requires a holistic understanding of the patients’ needs. In Kenya, however, data on palliative care needs of patients on maintenance hemodialysis is limited. This study was conducted to explore the unmet palliative care needs of patients on maintenance hemodialysis at Thika Level 5 Hospital, Kiambu County. The specific objectives of the study were to assess the physical, psychological and social palliative care needs of patients on maintenance hemodialysis and identify the patient related barriers to meeting these needs. A descriptive qualitative study anchored by the 6-S model for person centered palliative care was conducted using twelve purposively sampled patients on maintenance hemodialysis at Thika Level 5 Hospital’s renal unit. Participants in the study were 18 years and above, had been receiving maintenance hemodialysis therapy at the renal unit for more than six months and could speak either English or Kiswahili. Those with cognitive impairment, critical illness and had undergone kidney transplantation were excluded. Data collection was done using semi-structured audiotaped interviews which lasted between 30-45 minutes. An interview guide based on the Integrated Palliative Outcome Score (IPOS) renal survey was used to conduct the interviews. Data collection was done until saturation was reached. The recorded interviews were transcribed verbatim and analyzed using thematic analysis. NVIVO 14 qualitative data analysis software was used to analyze the data. The six general principles of thematic analysis including familiarizing with the data set, initial generation of codes, searching for themes, reviewing themes, defining and naming themes and producing the report were used to guide the process. Ethical approval to conduct the study was obtained from Kenyatta University Graduate School, Kenyatta University Ethics and Review Committee (KUERC), the National Commission for Science, Technology and Innovation (NACOSTI), County Government of Kiambu and Thika Level 5 Hospital Training, Research and Ethics Committee (TREC). Eight major themes including distressing physical symptoms, difficult thoughts, interrupted relationships, financial burden on the family, abandonment by friends, spiritual coping and barriers to palliative care emerged from the data analysis. Also, eleven sub-themes including fatigue, fluctuations in appetite, skin changes, uncertainty about the future, stress and worry, inability to get more children, caregiver burden, prayers, material support, lack of knowledge and fear of being judged were identified. This study reports that patients on maintenance hemodialysis experience numerous unmet palliative care needs. The needs regard to physical, psychological and social aspects. Also, lack of knowledge on palliative care is the primary patient related barrier to meeting palliative care needs. The study underscores that the provision of timely, specific and adequate palliative care is needed to enhance the coping and survival of patients on maintenance hemodialysis. Furthermore, the study urges more strategies to be put in place to ensure patients on maintenance hemodialysis and their families are well educated on renal palliative care.Item Uptake of Chronic Kidney Disease Preventive Practices Among Diabetic and Hypertensive Patients at the Nyeri County Referral Hospital, Kenya(Kenyatta University, 2024-02) Wakhungu, LinerChronic kidney disease (CKD) has been ranked as the 17th top cause of worldwide years loss of life and a key cause of deaths rising at a fast rate, having increased by 31.7% from 2005 to 2015. Patients with hypertension and diabetes are at a higher risk of developing CKD. The study objective was to establish the factors that influence CKD preventive practices among diabetes and hypertension patients at Nyeri County Referral Hospital (NCRH). Data was obtained from 190 participants by the use of a questionnaire. Data was analyzed using SPSS and presented using descriptive statistics. Chi-square was used to test for association among variables while logistic regression analysis was used to test for the predictors of CKD prevention uptake. From the findings, 84.2% of the participants had good CKD prevention uptake. Gender 2 (1) = 6.243, p= .012 age 2 (4) = 13.146, p= .011, and income 2 (4) = 25.467, p <0.001 were significantly associated with CKD preventive practice uptake. Health care provider communicating to DM/HTN patients in a language they could understand 2 (2) = 18.102, p<0.001, accessing all the laboratory services within the hospital 2 (2) = 8.469, p=.014 and being able to obtain the prescribed drugs from the hospital pharmacy 2 (2) = 6.361, p=.043 were significantly associated with CKD prevention uptake. The predictors for CKD prevention uptake included gender, income, age, and being well informed about the disease condition. In conclusion the study participants had good CKD prevention practices uptake. Communication with health care providers, accessibility of laboratory services and being informed of the disease conditions influence uptake of CKD. The study recommends that health care providers in Nyeri County Referral Hospital should provide CKD prevention health education program especially to the at-risk population. The health care services should also be made accessible, available and affordable to diabetic and hypertensive patients.Item Psychosocial Burden and Its Determinants among Caregivers of Children with Colostomy at Kenyatta National Hospital, Nairobi City County Kenya(Kenyatta University, 2023-06) Ronoh, Lilian Chebet; Grace Githemo; Sarah TaiAbstractItem Determinants of Kidney Transplantation Uptake among Patients with End Stage Kidney Disease on Haemodialysis at Selected National Referral Hospitals in Kenya(Kenyatta University, 2023-05) Nduati, Joseph Mwororo; Joseph Nduati; Grace GithemoAbstractItem Stressors and Coping Strategies among Women Breast Cancer Survivors at Kenyatta National Hospital, Nairobi City County, Kenya(Kenyatta University, 2023-11) Chege, Kuria Patrick; Grace Githemo; Nelson MenzaAbstractItem Determinants of the Quality of Life of Caregivers of Children with Sickle Cell Disease at Siaya County Referral Hospital, Kenya(Kenyatta University, 2023-07) Okinyi, Joash; Sarah Bett; Grace GithemoAbstractItem Nursing Handover Experiences and Perspectives in the Critical Care Unit at Murang’a County Referral Hospital, Kenya(Kenyatta University, 2023-11) Murigi, Mwangi; Nickcy Mbuthia; Lucy Meng’anyiContinuity in delivery of nursing care to patient in the critical care unit is of utmost importance. To achieve this consistency, nurses engage in a process of transfer of patients’ clinical information in the form of nursing handover, The adoption of various handover procedures result in variation of the information exchanged. In the critical care unit, the intricacy of the patient condition compounded by the advanced patient monitoring translates into a more complex nature of the nursing handover. Despite the existence of handover guidelines and formats, gaps have been detected regarding the contents of the handover and its effects on the continuity of care. The focus of the study was to explore the experiences and perspectives of nurses with nursing handover in the critical care unit. To realize the aim of the proposed study, a phenomenological qualitative design was adopted while utilizing a deductive approach. Indepth interviews were carried out on nine critical care nurses from the Murang’a County Referral Hospital after obtaining ethical approval from relevant institutions. Thematic analysis was done manually for the qualitative data. The study results showed that critical care nurses believed they were individually equipped with adequate knowledge to carry out effective departmental and interdepartmental handover. The existence of handover policies in the critical care unit was considered a major enabler of the handover. They also believed that strained human resource, lack of standardized handover tools and deviation from the set handover rules negatively impacted the handover process. Furthermore, they reported perceived insufficiency in the management’s role in handover evaluation and feedback. Moreover, all participants advocated for improvement of the current handover practices for improved quality of patient care as well as sense of self-accomplishment among the nurses. There are pertinent implications in the findings of this research for critical care nurses, nurses in other departments and policy makers. Based on the study findings the handover process would benefit from enhanced adherence to the existing handover policies. Handover training targeting nurses in other departments would promote communication of patient information between critical care unit and other departments. Periodic audits of the handover documentation and process with subsequent feedback would be acontrol for evaluation of the handover. Further, addressing scarcity of resources and implementing the nurses’ perceived strategies would ensure a seamless handoverItem Compliance with Hemodialysis Treatment among End Stagekidney Disease Patients in Nyeri County, Kenya.(Kenyatta University, 2022) Chege, Jacinta Wanjiku; Grace Githemo; Lister OnsongoThe number of End Stage Kidney Disease (ESKD) patients on hemodialysis (HD) globally has become a public health concern. Compliance with hemodialysis recommendation aids to improve health outcomes and prevent complications. However, non-compliance to hemodialysis among ESKD patients has been a major problem. The purpose of the study was aimed at describing the level of compliance with hemodialysis and the associated factors among ESKD patients in three selected dialysis centers in Nyeri County. A descriptive cross-sectional study, utilizing quantitative research method and targeting 80 participants was done. Census method was used to recruit the study participants. Data was collected through administration of a questionnaire and analyzed by use of computer software, statistical package for the social science (SPSS) version 24. Descriptive statistics was used to determine the level of compliance to hemodialysis. Inferential statistics was used to determine factors associated with compliance to hemodialysis. SPSS version 24 was used in data analysis.The study findings revealed that compliance with hemodialysis treatment was 53%. The findings showed that there was significant association between compliance and; marital status, x2 (2, N=30) = 5.151, p =0.029, income, x2 (4, N=12) = 11.322, p =0.045, and number of hospital admissions, x2 (3, N=I) = 38.069, p =0.0001. Shortened hemodialysis,(aOR = 5.5, p = 0.002) and waiting time for two hours prior to start their hemodialysis session (aOR =4.11, p =0.005) were independent predictors of noncompliance with hemodialysis treatment.Despite opening new hemodialysis centers in Nyeri County to increase availability and accessibility of hemodialysis services, compliance still remains a major challenge among patients. Shortening of hemodialysis sessions, low economic status, inadequate machines and failure to repair machines when they break down were major barriers to hemodialysis compliance. Therefore, adequate resource allocation should be considered when opening new hemodialysis centers.Item Determinants of Neonatal Care Practices among Postnatal Mothers at the Kiambu and Thika Hospitals, Kiambu County, Kenya(Kenyatta University, 2022) Kariuki, Lilian .W.; Grace Githemo; Maina NgugiNeonatal health is necessary in decreasing child mortality but often gets minimal attention. Research evidence in third world countries has shown that practices such as poor cord care and breastfeeding practices impact on neonatal health. This study aimed to determine the neonatal care practices among postnatal mothers and the relationships between various factors and these practices at the Kiambu and Thika County Hospitals. This was a cross sectional descriptive study design. Stratified sampling method was used to identify the sample for the study. Self-administered and interviewer administered questionnaires were used to collect data, practice was assessed through a likert scale, analyzed through SPSS and presented using descriptive statistics. Chi square test of significance (p ≤0.05) was used to test the relationships between the various explanatory factors and the neonatal care practices among postnatal mothers. A total of 128 postnatal mothers participated in the study with the mean age being 26 ±5.8 years. There was negative relationship between information received on breastfeeding, eye care, thermoregulation, immunization and actual care practices (p<0.05). Adequate knowledge was found towards cord care with gaps in practice existing in breastfeeding, eye care and thermoregulation. Social demographic, socio-economic, socio-cultural and institution factors did not influence neonatal care practices. More emphasis should be put on maternal education regarding neonatal care practices (thermoregulation, eye care, skin care and breastfeeding practices). Further research is recommended to find out why there are negative practices on breastfeeding and eye care despite being knowledgeable on those practices.Item Self-Care Abilities of Patients on Maintenance Hemodialysis at Kenyatta National Hospital Renal Unit, Nairobi City County, Kenya(Kenyatta University, 2022) Tangus, Cecily C.; Grace GithemoHaemodialysis is the most common management modality for patients suffering from End Stage Renal Disease. A high number of haemodialysis patients have been reported to have inadequate self-care abilities which negatively affect their haemodialysis treatment outcomes. This cross-sectional study aimed at evaluating self-care abilities among patients on maintenance haemodialysis at Kenyatta National Hospital Renal Unit. Census method was used to identify study participants who met the eligibility criteria. Self- and interviewer administered semi-structured questionnaire was used in data collection. SPSS version 24 was used in the analysis of data. Descriptive statistics was used to summarise the data. Chi square was used to determine the relationship between independent and dependent variables while predictors of self-care abilities were determined using logistic regression. The findings revealed that majority of the patients on hemodialysis treatment had adequate self-care ability. Patients with secondary and tertiary education were more likely to follow recommended diet (OR 0.824, 95% CI 0.545-1.739) and (OR 0.428, 95% CI 0.251-0.834) respectively. The married and widowed patients were more likely to practice AVF arm site care (OR 1.44, 95% CI 0.671-23.259) and (OR 1.17, 95% CI 0.928-11.32) respectively. The patients who received social support on compliance to fluid restriction were more likely to follow recommended fluid (OR 2.714, 95% CI 1.856-5.21). Clients who received social support on care of vascular access site were more likely to keep catheter access site clean and dry (OR 5.819, 95% CI 1.05-29.187).The study concluded that self-care ability was significantly influenced by marital status, education level, social support and healthcare provider support. It was recommended that health care team should provide education on self-care to clients with low level or no education in simple ways that they will be able to understand so as to improve self-care abilities. Health care providers to continue offering frequent support to their patients in order to improve their self-care knowledge and skills. Multidisciplinary team to encourage social support as it was shown from the study findings to positively influence self-care abilities among hemodialysis patients.Item Adherence to Post Kidney Transplant Treatment and Lifestyle Changes among Kidney Recipients at Kenyatta National Hospital, Nairobi City County, Kenya(Kenyatta University, 2021) Nyambura, Anne Mumbi; Grace Githemo; Jonathan WalaEnd stage kidney disease (ESKD) prevalence has become a global public health burden. Kidney transplantation is the best remedy for cases suffering from ESKD. Adherence to post kidney transplant treatment and lifestyle changes is critical in maintaining graft function. However, non-adherence leads to graft loss necessitating the patients to revert to dialysis or re-transplantation. This descriptive cross-sectional study aimed at describing adherence to post kidney transplant treatment and lifestyle changes among kidney recipients at Kenyatta National Hospital. Census sampling method was used to recruit 106 study participants attending transplant clinic. Data collection was done using interviewer and self-administered questionnaire. Descriptive statistics were used to describe patients’ characteristics. Chi square test of significance was used to determine the relationship between the independent and dependent variable. A p value of less than 0.05 was considered statistically significant. Logistic regression was used to determine the predictors of adherence. The study findings revealed that most of the respondents 63(60%) were non adherent to clinic attendance while 49(46%) were non-adherent to medication. Forgetfulness and cost of medication were reported to be the major contributing factors to non-adherence to medication. Frequency of medication dosing was a statistically significant factor influencing non-adherence to medication (x2 (1) = 6.61, p = .019, p= <.005) while distance to the hospital statistically significance influence of non-adherence to clinic attendance, (x2 (2) = 12.63, p = .002, p<.005). The study concluded that non adherence is a major concern in post kidney transplant recipients occasioned by drug cost and distance to the hospital. The study recommends that the government and non-governmental organizations should offer financial support for medicines. Also decentralization of post kidney transplant services to the county referral hospitals and use of daily dose drugs should be embraced.Item Stressors and Coping Strategies among Hemodialysis Patients in Selected Counties Dialysis Centers in Kenya.(Kenyatta University, 2021) Mugi, Elizabeth Wambui; Grace Githemo; Jonathan WalaPatients with chronic kidney disease (CKD) depend on renal replacement modalities that act to substitute the function of the compromised kidney. Hemodialysis remains the most sought form of treatment modality among Patients with CKD. Despite its health benefits, patients receiving hemodialysis services experience multiple physiological, psychological and physical stressors that results into a different level of perceived health status. As a result, the patients develop various individualized and unique coping strategies to help them cope with the disease. Aim: The study aimed at describing the stressors and coping strategies among hemodialysis patients. Methodology: This was a descriptive correlational study among hemodialysis patients in four selected county dialysis centers in Kenya. Sample size was determined through a census method. Data was collected by means of a semi structured questionnaire. Data was analyzed using a Statistical Package for Social Sciences (SPSS) version 25.0 and presented using graphs, frequency tables, and chi-square to test for the significance. Results. The major physiological stressors were decreased sexual drive, feeling tired and difficulties in falling asleep while the major physical stressors were joint pains and being uncomfortable with the physical body changes. Despite government initiative to devolve hemodialysis services, the major psychological stressors were inadequate hemodialysis machines, lack of commodities and difficulties in raising the cost of treatment. Major problem based coping strategies used were sharing with family members, sharing with health care workers and seeing the good side of the problem while the major emotion based strategies used were wishing the problem could go away, blaming others and keeping the problem to one self. There was statistically significant association between sharing with health care worker and perceived health status. There was statistically significant association between problems based strategies and perceived health status. Conclusion and recommendations: Nurse Counsellors should provide counseling to patients prior to start of hemodialysis on the physiological stressors especially issues of decreased sexual drive. Patients should be assessed on the physical stressors by the nurses and doctors to ensure the appropriate remedies are provided. Nurse Counsellors should counsel patients on the use of problem coping strategies as they are significantly associated with better perceived health status. Health workers should also be readily available to listen to the patients’ needs as sharing with health care workers was significantly associated with better perceived health status. Recommend the County government to increase the number of HD machines in line with the number of patients so that to reduce on waiting timeItem Predictors of Quality of Life of Kidney Donors at Kenyatta National Hospital, Nairobi City County, Kenya(Kenyatta University, 2021) Nyarera, Diviner Kemunto; Grace Githemo; Lister OnsongoBackground: There‟s an increasing prevalence of End Stage Kidney Disease (ESKD) globally and the disease is an important contributor of morbidity and mortality among these patients. Compared to dialysis Kidney transplantation is well established as the best treatment for restoring quality of life to patients with ESKD. The information regarding living donors‟ QoL has been reported to have a positive influence towards the prospective donor‟s attitude to kidney donation. The aim of the study was to examine the socio-demographic, socio-economic, and psychological and health factors that impact on the donors‟ QoL in Kenya. Aim: The study aimed at assessing QoL of kidney donors after kidney donation at Kenyatta National Hospital. Methodology: This was a descriptive cross-sectional study design of Kidney donors at Kenyatta National Hospital Renal department, between January 2010 and December 2017. A convenience sampling method was used with an anticipated sample size of 105 kidney donors. Data was collected through the use of questionnaires administered directly to individual participants. Data was analyzed using descriptive and inferential analysis. Multiple regression analysis was also applied to identify the predictors of QoL of the kidney donors. Qualitative data was analyzed thematically. Ethical approval was sort from KU and KNH ethics committees before data collection. Results: A total of 99 donors were interviewed, 54.5%, (n=54) were male while 45.5% (n =45) were female. The mean age of the respondents at the time of donation was M =38.65 SD ± 9.04. The QoL of kidney donors in this study was high as represented by 83% of the respondents. The predictors of QoL were, Current monthly income, =24.793, (p 0.05) (QoL-psychological factors), marital status after kidney donation =10.261(p 0.05), Employment status after kidney donation =11.474 (p 0.05) and BMI r(0.835), p<0.05 in health and functioning.Conclusions: the overall quality of life of kidney donors at Kenyatta National Hospital was high. The study concluded that socio-demographic and economic factors particularly, BMI, marital status after kidney donation, current employment and current monthly income had significant contribution towards quality of life of kidney donors at Kenyatta National Hospital. Current employment had a positive significant predictive association with donor‟s quality of life