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Item Immunization Coverage among Children Aged Between 12-23 Months in West Pokot County, Kenya(Kenyatta University, 2024-08) Kirongo, David KiharaImmunization coverage and healthcare utilization among children aged 12-23 months significantly impact public health outcomes. However, in West Pokot County, Kenya, these indicators remain suboptimal, posing challenges to achieving optimal child health. The main aim of this research was to assess the vaccination rates among children in West Pokot County, Kenya, between the ages of 12 and 23 months. The objectives of the study were to (i) calculate the immunization coverage among children aged 12-23 months in West Pokot County, Kenya; (ii) analyze the factors influencing immunization coverage among the same demographic; and (iii) assess the effects of healthcare utilization on immunization coverage among children aged 12-23 months in West Pokot County, Kenya. A cross sectional study design was employed, involving a sample of 393 children aged 12-23 months and their caregivers in West Pokot County, Kenya. Data was collected through structured interviews, questionnaire and focus group discussion. Descriptive and inferential statistical analyses were conducted to examine the relationships between various factors and immunization coverage, as well as healthcare utilization. The study revealed that West Pokot County, 62.4% of mothers or guardians partially vaccinated their children, while 36.6% completely immunized them, and only 1.1% did not vaccinate their children at all. This indicates that only a third of children in the county have received all recommended vaccinations, revealing a significant gap in achieving desired coverage. The study identified parental age as a key determinant, with older caregivers more likely to completely vaccinate their children. Furthermore, a negative correlation was found between the number of children in a household and vaccination coverage. Teachers and farmers were more likely to have their children completely vaccinated compared to those in other occupations, highlighting the impact of parental occupation on vaccination rates. Additionally, respondents who paid for vaccination services were more likely to fully immunize their children. Healthcare utilization significantly influenced vaccination coverage, as respondents who visited a healthcare facility during the previous year were more likely to completely immunize their children. Hence the study concludes that findings underscore the importance of addressing sociodemographic factors, such as parental age, occupation, and financial capability, to enhance vaccination coverage among children aged 12-23 months in West Pokot County. Encouraging regular healthcare visits and promoting healthcare-seeking behavior among parents and caregivers are crucial for improving vaccination rates. This study recommended Conduct regular immunization coverage surveys with local health facilities and community health workers for informed decision making. Analyze factors influencing immunization coverage and develop targeted interventions. Assess healthcare utilization patterns among mothers and guardians and implement measures to enhance healthcare service deliveryItem Antibiotic Prescribing Practices of Clinical Officers for Patients with Upper Respiratory Tract Infection at Kiambu County, Kenya(Kenyatta University, 2024-11) Murigi, Kevin WambuaAccording to the World Health Organization (WHO), over 50% of all medicines are prescribed, dispensed or sold inadvertently, and more than half of all patients take them incorrectly. Antibiotics are the most routinely prescribed medications. Antibiotics are incorrectly prescribed for viral illnesses and broad-spectrum antibiotics are being used in place of narrow-spectrum antibiotics. Antibiotic resistance has emerged because of incorrect antimicrobial treatment and misuse of antibiotics. Findings from studies have shown an association between prescriber factors, patient factors, institutional factors and antibiotic prescribing. There is scarce data in Kenya about antibiotic prescribing practices, factors affecting antibiotic prescribing, how it varies between different healthcare workers and the mechanism by which interventions are effective. The goal of this study was to figure out antibiotic use among patients with upper respiratory tract infections in Kiambu County. The study design was a cross-sectional hospital-based study. The study area was one public level 5 hospital, five public level 4 hospitals and 14 public health centers within Kiambu County. Data was collected in the form of a modified WHO prescribing indicators checklist and using questionnaires. The WHO prescribing indicators checklist on rational use of medicine was used to collect data from 600 patient encounters. The questionnaire was used to collect data from 36 clinicians working in the outpatients. The data from the checklist included the total number of medications prescribed per encounter, the number of encounters with antibiotics, the proportion of generic antibiotics prescribed, the proportion of antibiotics prescribed from the Kenya Essential Medicines List (KEML), the antibiotic prescribed, its dose, frequency, duration and indication. The data from the questionnaire included prescriber age, gender, level of education, work experience, laboratory availability, availability of antibiotics and availability of guidelines. An Open Data Kit (ODK) was used to collect the WHO data collection checklist. Data was imported into a Microsoft Excel sheet from the ODK server then exported to a Statistical Package for Social Science (SPSS) version 22.0 for further cleaning and analysis. Descriptive statistics of frequencies and percentages were used to summarize categorical variables, and median (interquartile range) was used in case of continuous variables. Logistic regression was employed to find the association between antibiotic prescribing and the prescribing factors. Odds ratio with 95% confidence interval was reported in the logistic regression analysis. All analysis were considered significant when p < 0.05. Antibiotics were prescribed in 78% of patient encounters, 96.8% of encounters with an antibiotic had a generic antibiotic, and 96.6% of antibiotics prescribed were from the KEML. Over 91% of antibiotics prescribed were the right dose, 98.3% were the right frequency, 75.2% were the right duration, only 23.8% was the right indication. Availability of antibiotics p=0.026 and availability of hospital guidelines p=0.012 were significantly associated with rational antibiotic prescribing. Patient fever significantly affected rational antibiotic prescribing (OR 4.7, 95% CI 2.49, 8.89, p=<0.001), patient age and gender did not significantly affect antibiotic prescribing. Prescriber gender, p=0.63, age, p=0.92, education level, p=0.99 and work experience, p=0.22 did not significantly affect antibiotic prescribing.Item Assessment of predictors of birth preparedness among women in laikipia county, kenya(Kenyatta University, 2023-04) Wanjohi, Joseph MwangiMaternal death is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”. It’s the second leading cause of death among women after HIV/AIDS. WHO estimates that about 94% of all maternal deaths worldwide occur in developing countries. One way of reducing the occurrence of maternal mortality is through promoting the practice of birth preparedness among pregnant women. Birth preparedness is the process of strategizing for normal spontaneous vaginal delivery and anticipating the action plan in an obstetric emergency. It helps prevent the occurrence of the delays associated with maternal morbidity and mortality, namely; delay in deciding to seek care, delay in reaching care, and delay in receiving adequate care. This study assessed the predictors of birth preparedness among women in Laikipia county, Kenya. It was a cross-sectional analytical study conducted in Laikipia East sub-county, Laikipia county, Kenya. The sample size for the study was 259 women who had delivered in the last one year at the time of the study, in Laikipia East sub-county and residing in the study area. Facilities were selected through simple random sampling, whereas participants were selected through systematic sampling at a sampling interval of 4. Quantitative and qualitative data were collected using structured questionnaires and key informant interviews from mothers and maternal and child healthcare providers respectively. Quantitative data was entered into Statistical Package for Social Sciences (SPSS) version 25. Both descriptive and inferential analysis were computed, and results presented in form of tables and graphs. Thematic analysis was applied for qualitative data and presented in themes. Level of birth preparedness was measured using six essential components including the identified facility of delivery, skilled birth attendant, birth companion, finances, transport arrangement and home caretaker. The level of birth preparedness was found to be low at 23.2%. Inferential analysis was done at 95% level of confidence and Pearson’s Chi square and Fisher’s Exact Test were used to measure association. The socio-demographic factors that had significant statistical association with birth preparedness included education, occupation and income (P<0.05). Pregnancy related factors that were significantly associated with birth preparedness included history of miscarriage or still birth, number of ANC visits and trimester of first ANC visit (P<0.05). The only health system related factor that had significant statistical association with birth preparedness was the level of facility visited for ANC (P<0.05). Statistical significant independent variables were further tested using logistic regression to show the strength and direction of association. Tertiary education was associated with high odds of practicing birth preparedness (AOR=8.469), formal employment increased odds of birth preparedness (AOR=4.898), income above Kshs 39,000 was associated with high birth preparedness (AOR=4.834), having history of miscarriage or still birth increased odds of birth preparedness (AOR=3.740), and first trimester for first ANC (AOR=2.638). In conclusion, education, occupation, income, history of miscarriage or still birth and trimester of first ANC were the predictors of birth preparedness. The researcher recommended strengthening of policies aimed at increasing birth preparedness and education on its importance to be scaled up. Increase income generating programs to empower women economically and enable them to plan for their births. Further studies also recommended to evaluate the utilization and impact of birth preparedness plansItem Maternal Compliance with Recommended Dietary Diversity in Prevention of Malnutrition among Children Aged 6-23 Months in Kwale County, Kenya(Kenyatta University, 2024) Chepkirui, FrancescaDietary Diversity (DD) is a crucial element of Infant and Young Child Nutrition (IYCN). WHO and UNICEF recommends feeding of diverse diets to children aged 6- 23 months as a public health measure in curbing malnutrition. In feeding of young children, caregivers (mostly mothers) play a central role. Mothers make vital decision pertaining breastfeeding and complementary feeding. Kenyan government has input lots of resources in fighting malnutrition however, children aged 6 to 23 months still have below-average levels of mother adherence with recommended dietary diversity with only 37% countrywide meeting the minimum dietary diversity. This study was conducted in Kwale County, where persistent chronic malnutrition has been noted. The main aim was to assess level of maternal compliance with recommended DD among children aged 6-23 months. Study’s objectives included: determining mothers’ socio demographic and economic characteristics, mother’s nutritional knowledge and other factors associated with compliance or non-compliance with recommended DD. The study utilized a mixed methods study approach, randomly selecting 244 mother-child pairings with children between the ages of 6 and 23 months. In order to gather information on the socio-demographics, financial status, and nutrition education of mothers, a pre-tested, moderately structured questionnaires were employed. A qualitative 24-Hour recall and DD questionnaires were also administered. Complementary information was collected through five subsequent Focus Group Discussions (FGDs). All respondents (244) were females aged 17- 68 years with a mean of 29.3 ±9.6 years. By educational levels, 29.5% of the respondents did not have any formal education, 10.2% had lower primary education (class 1 – 4), 53.3% had upper primary education (class 5- 8), and 5.3% had secondary education while only 1.2% had post-secondary education. Most (54.1%) of the respondents were housewives. A computed wealth index classified 20.5% in the first quintile (poorest) and 21.3% in the wealthiest quintile (5th quintile). Nutritional knowledge levels of the caregivers were generally very low with more than half (57.4%) of the mothers scoring zero (0) and only 3.3% having a high score of more than 9 out of 12 of the questions asked. Children’s DD scores ranged from 1 to 6 with a mean of 2.63 ± 0.9. Only 5.5 % of the children met the minimum dietary diversity (MDD) of 5 food groups or more in a day. A bivariate regression analysis to determine factors associated with children’s dietary diversity scores showed significant positive with caregiver’s educational level (r=0.186, P<.000, α=.01), household wealth index (r=0.163, P<.011, α=.05) but not with the caregiver’s nutritional knowledge (r=0.024, P>.05) and attitude score (r=0.098, P>.05). In conclusion, diets fed to children in the study area was poor in diversity. The socioeconomic situation of the household and low maternal education level was statistically significantly associated with this. Low maternal nutrition awareness and discrepancies in attitudes about providing children with a variety of foods exist. Other factors contributing to low DD were: poverty, environmental conditions, low educational levels and unfavorable cultural practices. The study therefore recommends a multisectoral approach in identification of interventions to address the identified issues.Item Male Involvement in Partner’s Cervical Cancer Screening Services in Makueni County, Kenya(Kenyatta University, 2024-05) Wambua, Ruth TaabuIntroduction: Malignant cervical cancer affects the lowest portion of the uterus. Globally, it is the fourth cause of cancer deaths, and in Kenya, it is ranked as the second cause of cancer-related deaths among females. Men are crucial in minimizing cervical cancer burden. However, there is limited information on the determinants of their involvement in cervical cancer screening in Makueni County, Kenya. The research aimed to establish determinants of the level of male involvement in their partner’s cervical cancer screening. The study’s significance was in identifying barriers and facilitators to male involvement in their partner’s cervical cancer screening so that stakeholders might intervene. Methodology: A descriptive cross-sectional study obtained data quantitatively and qualitatively. The study was done in Mbooni Sub-County Level 4 hospitals. Study participants were married men aged 18-64 years. The hospitals were selected through purposive sampling, and respondents through a simple random sampling. The Key Informants were selected through a total sampling technique. Study variables were knowledge, socio-cultural, economic, and hospital-related factors. Respondents’ data was collected through open and closed-ended questionnaires and face-to-face interviews with key informants. Qualitative data were analyzed using descriptive statistics such as measures of frequency, central tendency, and dispersion. Inferences were drawn from Chi squares, Fisher’s Exact, Likelihood ratio, and logistic regression. Qualitative data was analyzed through codes and themes. Results: Men’s involvement in their partner’s cervical cancer screening was low (82%). All knowledge factors were associated with the level of involvement (p=<0.05). Socio-economic factors such as education (p=0.000) and employment (p=0.04) were significantly associated with the level of male involvement in their partner’s cervical cancer screening. Socio-cultural factors such as beliefs, practices, norms, myths, and misconceptions were linked to the level of involvement (p=<0.005). Hospital-related factors such as service availability, presence of signages, and cost were significantly associated with the level of male involvement in their partner’s cervical cancer screening (p<0.005). The logistic regression model done on significant variables was statistically significant, X2 (22, N =262) = 91.043, p = 0.00. The model explained 48.9 % of the variance in men’s involvement (Nagelkerke R2) and correctly classified 82.8 % of cases. From the logistic regression, the significant predictors of high men involvement were knowledge of risk factors for cervical cancer (OR = 3,274, 95% CI [1.073, 9.991],p=0.037), knowledge on whether cervical cancer can be prevented (OR = 3.414, 95% CI [1.043, 11.177],p=0.042), the knowledge that duration for cervical cancer screening is below 10 minutes(OR = 3.718, 95% CI [1.160, 11.920],p=0.027), an understanding that men have a role in cervical cancer screening(OR = 4.550, 95% CI [1.307, 15.844],p=0.017), and the notion that cervical cancer occurs in those who abort (OR = 4.121, 95% CI [1.015, 16.728],p=0.048). Conclusion: Male involvement in cervical cancer screening was low. There is a need to intensify health education for all men to improve their knowledge and dispel myths and misconceptions about cervical cancer and its screening. All facilities should ensure continuous availability of free services and create awareness of the availability of such services.Item Utilization of Sexually Transmitted Infection Health Care Services among Men Who Have Sex with Men in Nairobi City County, Kenya(Kenyatta University, 2024-01) Nyasani, Delvin KwambokaMen who engage in same-sex relationships face a higher risk of contracting sexually transmitted infections (STIs). This heightened risk is attributed to engaging in unprotected receptive anal sex and reluctance to disclose their sexual orientation and associated behaviours to healthcare workers (HCWs). This lack of disclosure complicates clinical decision-making for HCWs, hindering their ability to offer appropriate STI treatment and prevention services. To enhance MSM utilization of STI healthcare services, open communication about their high-risk practices with HCWs is essential. In turn, they can learn risk reduction measures and access STI prevention and treatment options. However, on the contrary, MSM doesn't do this due to various reasons. This study aimed to explore how MSM in Nairobi City County utilize the STI health services, focusing on MSM hotspots within the County. The research employed a cross-sectional study design incorporating both quantitative and qualitative data collection methods. A systematic sampling approach involved 404 respondents, and in-depth interviews were conducted with five key informants selected through a purposive sampling of public health facilities and MSM health provider sites. Descriptive, bivariate, and multivariate analysis was used to analyse quantitative data from the study survey using SPSS version 25 while qualitative data from key informants was analysed thematically using Nvivo version 11. Demographically, the majority of the participants were Kenyans, youth, single, and Christians. Their level of education ranged from primary to post-secondary, more than half were employed and their income ranged from Kshs <5000 to >15,000. A significant relationship was found between participants history of having ever contracted STIs (p=0.000, aOR=6.58, 95%CI 3.38-12.82). Knowledge assessment of participants revealed that 49.4% scored below 50.0%. However, participant’s knowledge score was not correlated with utilization of STI health care services. Seventy- four percent of the participants had sought sexual healthcare services within the past 12 months, with 99.0% self-reporting HIV testing. Over half (54.9%; 223) had accessed services from NGO programs and privacy they offered was correlated with utilization of STI health care services (p=0.042, aOR=1.86, 95% CI 1.02-3.37). In-depth key informant interviews highlighted health and legal system factors as the major facilitators, while health system factors, MSM individual factors, referral challenges, and political system were identified as barriers to utilizing sexual healthcare services. In conclusion, the study found low STI knowledge among participants and they sought STI healthcare services when they were infected. This is an indication that there is a need for the participants to be educated about STIs and have routine check-ups. Stigma and discrimination are the root cause of challenges faced by MSM. This emphasizes the importance of training and sensitization for all HCWs. Also, the community needs to be sensitized to avoid instances where MSM hesitate or delay to seek STI healthcare services.Item Food Handling and Safety Practices Influencing Bacteriological Contamination in Food Establishments in Nairobi City County, Kenya(Kenyatta University, 2024-02) Kinyua, Peter MuriithiFood borne illnesses are major health burden leading to high morbidity and mortality. It is a growing public health concerns worldwide resulting from food and water contaminated by pathogenic microorganism, toxins or chemical hazards. It is estimated that 10 to 20% of food borne illness are contracted from food establishments. The purpose of the current study was to determine food handling and safety practices that contributes to ready to eat foods and water contamination in food establishments in Embakasi South Sub County Nairobi County. The study design was descriptive analytical design. The study employed multi stage sampling techniques. Embakasi South Sub County was purposively selected. Probability proportionate sampling technique was used to select food establishments in each ward. The food establishments were stratified into four categories including restaurants, food kiosks, hotels and cafeteria. Simple random sampling was used to select food handlers for interview within food establishments selected. The study randomly collected 274 samples of ready to eat foods and water using sterile food bags and water bottles respectively. The samples were transported to the laboratory in cool boxes packed with ice packs and analyzed within 6 hours after collection. Microbiological analysis of food and water were borrowed from WHO and bacteriological analytical manual of foods to identify and isolate coliforms, Staphylococcus aureus, Vibrio cholera, Escherichia coli and Salmonella spp. A sample size of 230 food handlers from 137 selected food establishments were interviewed using structured questionnaire and observational checklist made. Data was coded then entered into Microsoft excel database and later analyzed by SPSS version 20’ and presented using tables, graphs while association of variable was assessed using chi-square and binary regression model. It was found that ready to eat foods and water sold and consumed in selected food establishments were contaminated with food borne microorganisms. Escherichia coli isolated in 137 food samples were at 24.1%, Vibrio cholera at 23.4%,Staphylococcus aureus at 32.8%, and Salmonella spp at 4.4%. Total coliforms detectedin 137 samples of water were at 43.8% where out of which 32.8% were of Escherichiacoli. Among food handling practices, touching foods after handling money, fondling of body parts without handwashing, and lack of pretreatment of drinking water were significantly associated with foods and water contamination (P-value<0.05). Compliance level to food safety and other health requirements were low among food handlers and in food establishments, where 72.6% of food premises were not licensed,77.5% of food handlers lacked medical certificates, 66.4% of establishments lacked toilets. The study therefore recommends regular checking of the microbial quality of ready to eat foods and water sold at food establishments, health education drives on sources of contamination to the owners and managers of food eateries establishments, regular inspection and supervision by health officers to ensure compliance to the food safety laws and other public health requirements in the food establishments.Item Prevalence of Sexually Transmitted Infections among HIV Pre-Exposure Prophylaxis Users in Selected Health Facilities in Nairobi City County, Kenya(Kenyatta University, 2024-02) Kadianga, Emmanuel KibalaSexually transmitted infections remain a significant public health problem mainly in low-income countries including Kenya. Currently, approximately half a billion new cases occur worldwide annually, and more than one million STIs are acquired per day. Of the estimated total of 357 million incident cases of the curable STIs world-wide, 131 million are from Chlamydia trachomatis, 78 million are from Neisseria gonorrhea, 5.6 million are from syphilis and 143 million are from Trichomonas vaginalis. In May 2017, the Kenya Ministry of Health, through the National AIDS and STI Control Program rolled out pre-exposure prophylaxis nationally to individuals at high risk of HIV acquisition. However, the roll out of HIV-PrEP by NASCOP has not been assessed to establish the prevalence and behavioural risk factors of STIs among those on HIV-PrEP. Additionally, attitudes toward HIV-PrEP, STIs related level of knowledge and health seeking behaviour for STIs among HIV-PrEP users in Nairobi have not been investigated. The main aim of this study therefore was to address the above gaps by assessing the prevalence of STIs among HIV PrEP users in Nairobi City County. This study employed an analytical cross-sectional research design. The study targeted 3,330 HIV-PrEP users in Nairobi with a focus on five main health facilities in Nairobi City County namely; Mbagathi District Hospital, Mama Lucy Level Five Referral Hospital, Lang‘ata Health Centre, STC MOH-Casino Heath Centre (Comprehensive Care Centre) and Sex Workers Outreach Program Kenya. Simple random sampling technique was adopted to obtain a sample size of 357 respondents. The study used primary data which was collected using structured questionnaire and secondary data (lab results). Descriptive and inferential statistics were analyzed using Statistical Packages for Social Sciences version 26.0. Chi square test and logistic regression was used to derive relationships between variables; results were considered statistically significant with p value ≤0.05. The results were presented on tables and charts. The study findings revealed that 45.8% of the PrEP users visiting health facilities in Nairobi City County had at least one curable STI. The prevalence of STIs among this groups was; 13.4% for Gonorrhea, 9.7% for Chlamydia, 7.4% for Syphilis, 6.0% for Trichomoniasis, 5.1% for Herpes (Genital herpes), 3.7% for HIV and 0.5% for Genital warts. The study also found that most of the HIV-PrEP users visiting health facilities in Nairobi City County were well informed and knowledgeable about STIs occurrence and the benefits of HIV-PrEP. The findings furthermore revealed a significant association between level of related knowledge on STIs and the prevalence of STIs among HIV-PrEP users in the County, ( 2 =62.280, p=0.033). The study further established that HIV-PrEP users in Nairobi City County were engaging in risky sexual behaviours as most of them were involved in the following behavioural risk activities: condomless sexual intercourse, greater number of sex partners, etc... This was further confirmed by having STIs diagnosis. It was shown that there existed a statistically significant association between behavioural risk factors of STIs and the prevalence of STIs among HIV-PrEP users in Nairobi City County ( 2 =31.170, p=0.005<0.05). The study concludes that the adoption of HIV-PrEP is likely to influence sexual behaviour causing a greater risk-taking tendency. The study thus recommends that there is need for the County facilities offering HIV-PrEP services to implement a continuous comprehensive routine screening tests for STIs for prompt identification and treatment of asymptomatic cases, to create awareness about STIs for risky behaviour change, in order to lower the prevalence of STIs among HIV-PrEP users.Item Prevalence and Risk Factors for Hypertension among Rural and Urban Population of Kisii County, Kenya(Kenyatta University, 2023-03) Ondieki, Alex Ontiri; Harun Kimani; Titus KahigaAbstractItem Relationship between Umbilical Cord Practices and Neonatal Cord Outcomes among Newborns at Nakuru Level Five County and Referral Hospital, Kenya(Kenyatta University, 2023-05) Kithaka, Judy Wainoi; Stephen MachariaAbstractItem Disclosure of HIV Sero-Status and Uptake of PMTCT Services by Pregnant and Breastfeeding Women in Bujumbura-Mairie Province, Burundi(Kenyatta University, 2023-05) Ndayikeza, EvelyneAbstractItem Determinants of Malaria Routine Data Reporting among Health Workers in Selected Health Facilities in Trans-Nzoia County, Kenya(Kenyatta University, 2023-04) Lagat, Nicholas Kiptoo; John Paul Oyore; Julius KorirAbstractItem Accessibility to Integrated Community Case Management Services For Childhood Pneumonia among Caregivers in Kisii County, Kenya(Kenyatta University, 2023-11) Mwambi, Dennis Oroo; Isaac MwanzoPneumonia contributes to the increased childhood deaths worldwide. Prompt diagnosis and treatment with antibiotics has resulted in the reduction of pneumonia deaths. In 2014, Kisii County had a pneumonia prevalence of 10% among children under the age of five years, which surpassed the 9% national average. Even though most caregivers (71%) in Kisii sought advice from health facilities or provider, this did not translate to treatment of the pneumonia cases, as only 41% of the cases were eventually provided with antibiotics. Although Kisii County implemented iCCM for childhood illnesses, including pneumonia, there are information gaps regarding accessibility, knowledge and factors that could influence access to iCCM for childhood pneumonia. Therefore, the main goal of this study was to ascertain whether caregivers in Kisii County had access to iCCM services related to childhood pneumonia. A descriptive cross-sectional research approach was used for this study. The research participants included 332 randomly sampled caregivers of children below 5 years in Bomachoge Borabu and Bomachoge Chache sub-counties and 10 key informants from both the county and subcounty levels. Data were collected using both structured and key informant interviews (KIIs). The variables of interest were analysed using frequency-based descriptive analysis, which was utilised to study quantitative data. Qualitative data were organised and analysed thematically. Findings revealed that only 111 (34%) of the respondents had access to iCCM for childhood pneumonia. Notably, the likelihood of access to iCCM for childhood pneumonia reduced with caregiver age, with caregivers under 20 years being 1.5 times more likely to access iCCM. Separated or single caregivers were six times as likely to access iCCM, while those ascribing to the Catholic faith increased the likelihood of access by 1.7 times. Respondents engaged in business as their main source of income increased the likelihood by 2.97 times, while employed caregivers had a 1.4 times higher likelihood to access iCCM for childhood pneumonia. This study showed a high knowledge of childhood pneumonia among the caregivers. Most respondents, 232 (70.3%), mentioned at least one pneumonia symptom and nearly all respondents, 326 (98.8%), identified at least one severe pneumonia symptom. Additionally, 26 (7.9%) mentioned at least one of the three main causes of pneumonia and 287 (87%) mentioned at least one approach to prevent pneumonia. Knowledge of pneumonia symptoms (p 0.315, df 2), severe pneumonia symptoms (p 0.125, df 3), cause of pneumonia (p 0.885, df 3) and pneumonia prevention approaches (p 0.575, df 2) were not significant predictors of access to iCCM for childhood pneumonia. Many respondents, 160 (48.5%), sought help a CHV as their first point of contact when their children started showing signs of pneumonia, with very few, 48 (15%), visiting government health facilities, 3 (1%) visiting private clinics and 3 (1%) went to chemists, while a small fraction, 4 (1.2%), visited traditional herbalists. Only 98 (29.7%) of sick children are taken through the MoH protocol for pneumonia diagnosis and treatment at the community level, posing a potential risk of mismanagement of children with pneumonia. The likelihood of access to iCCM for childhood pneumonia increased by 3.03 times for caregivers who perceived pneumonia as a serious disease, while it increased by 0.1 times for respondents who did not think pandemics affected access to iCCM. The study recommends continuous access to timely diagnosis and treatment for pneumonia among children under 5 years, investment in pneumonia awareness creation programmes targeting caregivers of children under 5 years, provision of routine support supervision to the CHVs and as such ensure compliance with the MoH protocol on pneumonia case identification and management, mechanisms for households to continue accessing health services.Item Nurses' Management of Patients with Pressure Ulcers in Selected Health Facilities in Murang'a County, Kenya(Kenyatta University, 2022-12) Njoroge, Jane Muthoni; Prkcilln Kabue; James OchiengAbstractItem Determinants of Immunization Dropout Rates among Children 12-23 Months in Kajiado County, Kenya(Kenyatta University, 2023-06) Momanyi, Ruth Bonareri; Justus O.S. Osero; Stanley Murigi KimuhuAbstractItem Sero -prevalence of helicobacter pylori infection among pregnant women attending antenatal clinic in Garissa County, Kenya(Kenyatta university, 2023-04) Mohamed, Hassan; Harun Kimani; E. W. KabiruItem Role of Social Network Structures on Birth Attendant Decisions among Women in Nakuru County, Kenya(Kenyatta University, 2023-10) Mungai, John Mwangi; Mary Gitahi; George Evans OwinoThree-fourths of maternal deaths occur from direct obstetric complications. These life-threatening pregnancy-related outcomes are avoidable through ensuring that mothers have access to adequate and proper maternal health services and prompt management of any complications during pregnancy or childbirth process. Most empirical studies that seek to assess maternal healthcare choices in the country focus on individual-level and environmental-level factors as the key barriers to healthcare service utilization. These studies make significant contributions concerning unravelling relevant variables linked to high maternal deaths. However, due to methodological and conceptual limitations, these research studies do not demonstrate the range of social influence mechanisms via which individual networks may influence behaviors and knowledge with a focus on maternal health. This study aimed at demonstrating the relationship between social network structures and birth attendant decisions among women in Nakuru County, Kenya. The study applied a mixed-method approach that employs a convergent parallel design. Interviewer-administered questionnaires and semi-structured interviews were used to collect quantitative and qualitative data among women of childbearing age and community health workers (CHWs), comprising a sample of 370 women and 18 CHWs, respectively. Chi-square tests for independence were used to assess whether the dependent variable and categorical independent variables are independent at p< 0.05 significance levels. Binomial logistic regression technique was employed to identify variables that are likely to be essential predictors for the dependent variable. Qualitative data from in-depth interviews with key informants was analyzed through content analysis using NVivo 10. Fifty percent of the mothers were married, 35% had a high school education or higher, 16% were employed, 64% lived in rural areas, 96% were Christians, and 65% delivered under skilled attendance. About 55% were embedded in homogeneous networks, 76% had high Skilled Birth Attendants (SBA) endorsement networks, and the average number of social networks was 2.4 (SD=1.1, median = 2). There was no significant relationship between social network size and birth attendant decision (χ2(2), p=.072). There was, however, a significant relationship between social network content and birth attendant decision (χ2(1)=55.604, p< 0.001). Social network homogeneity was also strongly related to birth attendant choice (χ2(1)=21.152, p<0.001). From the logistic regression model, women embedded in social networks with high SBA endorsement had 5.28 higher odds of giving birth in a health facility than their counterparts embedded in low SBA endorsement. When compared to their heterogeneous network counterparts, those embedded in a homogeneous network had a 70% reduction in odds of facility delivery. According to the study findings, social networks can either facilitate or constrain facility utilization during birth, and thus health education and mother mobilization interventions promoting facility birth should leverage on the role of social networks.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 OtienoEffective management of today’s health systems depends on critical use of data and information for the effective policy-making, planning, monitoring of services and making decisions. Following the decentralization of health, the district health information systems (DHIS) was established to support the sub-counties in utilizing the generated data for the decisions made in health facility. However, data use has been limited and faced with inadequacy hence vital health decisions often relying on political opportunism, donor demand and infrequently repeated national studies which are insensitive to changes occurring over shorter timescale. The aim of this study was to establish the determinants of data use for evidence-based decision making amongst health workers at Kisumu County. A descriptive cross-sectional research study was conducted where both quantitative and qualitative techniques were used for a minimum of 205 respondents. Multistage sampling technique was used to select health facilities and to determine the sample size of respondents. A total of three public health facility were sampled proportionately. Quantitative data from structured questionnaires were entered, checked, cleaned and analysed using SPSS version 26. Descriptive statistics and chi-square test to determine significant association was done and results presented in tables, graphs and charts. The results showed 73.6% use of routine data for decision making with level of education (ꭓ2=26.616; df 3; p=0.0001), data utilization (ꭓ2 = 8.690, df = 2, p = 0.008), overall levels of competency (ꭓ2=14.340; df 3; p=0.026), access to routine data (ꭓ2=11.823; df 1; p=0.003), functional computer (ꭓ2=9.913; df 2; p=0.023) and access to internet (ꭓ2=7.046; df 2; p=0.030) were statistically significant association with routine data use for decision making. The study demonstrates partial use of routine health information for decision making with interplay of technical, organizational, and behavioural determinants. In the view of the findings, this study recommends need for County HMT in conjunction with the national level to provide training to improve health workers’ skills with specific focus on information use through on- job trainings mentorship and enhance organizational context by providing resources that supports information use with targeted regular review meetings, feedback coupled with support supervision are also recommended.Item Relationship between Menstrual Hygiene Management and Lower Reproductive Tract Infections among Adolescent Girls in Informal Settlements in Nakuru County, Kenya(Kenyatta University, 2023) Ngaruiya, Virginia Wanjiku; Redempta Mutisya; Joseph J.N. NgeranwaMenstruation is an important aspect experienced by healthy adolescent girls, premenopausal adolescents and women monthly. Its management is influenced by the economic status of individuals, personal preferences, local beliefs, and education status. In Kenya 2019, more than 47 million (50.2%) of the population was females, with a significant percentage of these females’ facing challenges on sanitation and menstruation hygiene which makes it insufficient and hazardous to girls and women well-being. Infections of the lower reproductive tract are still public-health concerns. However, in Sub-Saharan Africa, the relationship between menstrual hygiene, water, sanitation and hygiene variables and lower reproductive tract infection have not been appropriately explored. The main objective of this study was therefore, to ascertain the relationship between menstrual hygiene management and the occurrence of lower reproductive tract infections among the adolescent girls in informal settlements in Nakuru County. Specific objectives were; determine the proportion of adolescent girls reporting lower reproductive tract infections, determine the menstrual hygiene management practices associated with occurrence of lower reproductive tract infections, establish environmental factors associated with the occurrence of lower reproductive tract infections among adolescent girls in the Informal settlements of Nakuru County. The study used a community-based cross-sectional design targeting adolescent girls in informal settlements in Nakuru County. Multi-stage and simple random sampling methods were used to obtain a sample size of 385 adolescent girls. Focus group discussions (FGDs), semi-structured questionnaires were used to obtain information from the adolescent girls, teachers, mothers and community gatekeepers on menstrual hygiene management while self-report symptoms according to the questionnaire were used to determine the presence of lower reproductive tract infections. Data was entered and analyzed using statistical software, SPSS v24. The relationship between menstrual hygiene management and lower reproductive tract infections were tested using Odds Ratio at a 95% confidence interval and statistical significance was set at p < 0.05. The findings showed the mean age of participants ranged from 14-16years, the mean menarche age 12.5 years. Majority of participants were in primary schools with most of their guardians, mothers had attained secondary education. Most participants identified as Christians. The proportion of lower reproductive tract infections (LRTIs) among the participants was 59.71%. Teenagers who changed their reusable absorbent material more than twice a day were 0.22 times less likely to report experiencing an LRTI compared to those who changed once a day, (p=0.005); those who dried their reusable absorbent material outside the house were 0.26 times less likely to be infected with LRTI compared to those who dried inside the house; and those who reported bathing three times during menstruation were 0.27 times more likely. Lower Reproductive Tract Infections and the presence of anal cleansing material had a strong correlation with environmental conditions (P-value 0.046), as did the availability of working hand washing facilities with water and soap (P-value 0.019). The study established that there was a strong correlation between lower reproductive tract infections and the kind of absorbent material, the frequency of changing absorbent material, the frequency of bathing, the presence of hand washing equipment, and the presence of anal cleansing materials in restrooms. The research recommends that the government focus on strengthens programs related to that menstrual hygiene management, women reproductive health and girls’ education especially in the informal settlements. Future studies needs to incorporate comprehensive microbiological and clinical assessments so as to get a better estimate of the prevalence of LRTI in this population.Item Bacterial Causative Agents of Food Poisoning and Associated Risk Factors among Patients Attending Thika Level 5 Hospital in Kiambu County, Kenya(kenyatta university, 2023) Karanja, Esther Nduta; Nelson Menza; Ephantus W. KabiruFood poisoning results from ingestion of contaminated food or water that contains microbial agents that cause illness or release their toxins onto the food. Examples of bacteria are Campylobacter, Vibrio cholerae, Salmonella typhi, Escherichia coli. The study was conducted in Thika level 5 to determine bacterial food poisoning and associated risk factors among patients. A cross-sectional study design and purposive sampling technique was adopted. Structured questionnaires and observation checklist were used as data collection tools. Microscopy, stool culture and biochemical tests were used to identify bacterial causative agents. Statistical package for social sciences was used to manage data. Frequencies and percentages were used to analyze bacteria, clinical signs and symptoms. Chi-square using a Confidence Interval (CI) of 0.05 determined association between socio-economic, socio-demographics, environmental, hand washing practices and kitchen hygiene risk factors to bacterial food poisoning. Multinomial logistic regression confirmed significant predictors of food poisoning. Ethical approval was sought from Kenyatta University Ethical Review Committee; permit to collect data was sought from National commission for science and Technology. Statistical analysis established significant association between gender and food poisoning (χ2=13.165, df=4, p=0.010); education level and food poisoning (χ2=22.032, df =12, p=0.037). Vibrio cholerae 45(42.1%) was the most isolated bacteria while the least was Shigella 6(5.6%). Majority 91(85%) respondents reported diarrhoea lasting three days. Results indicate hygiene practices were low which is highly linked to food poisoning. There was a significant association between not washing hands after visiting the toilet and food poisoning (χ2=15.937, df=8, p=0.043).Lastly open defecation was a significant contributing factor to food poisoning (χ2=10.529, df=4, p=0.032). Significant predictors to food poisoning were, not washing hands after using the latrine due to lack of access to a hand washing point as well as having dirty hands. Not boiling water before drinking, not washing hands before mealtime, and lastly openly defecating. Increasing the awareness on causative agents, sources of contamination and improving hygiene practices at household level through encouraging the male population to practice hygiene will influence positively towards efficient, targeted public health interventions to prevent unnecessary illness.