MST-Department of Community Health

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    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 Kahiga
    Abstract
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    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 Korir
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    Accessibility to Integrated Community Case Management Services For Childhood Pneumonia among Caregivers in Kisii County, Kenya
    (Kenyatta University, 2023-11) Mwambi, Dennis Oroo; Isaac Mwanzo
    Pneumonia 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.
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    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 Ochieng
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    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 Kimuhu
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    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. Kabiru
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    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 Owino
    Three-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.
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    Determinants of Data Use for Evidence Based Decision Making at Public Health Facilities in Kisumu County, Kenya
    (Kenyatta University, 2023) Morike, Tom; Isaac Mwanzo; George Otieno
    Effective 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.
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    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. Ngeranwa
    Menstruation 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.
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    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. Kabiru
    Food 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.
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    Barriers to Mental Health Services Utilization among Caregivers of Mental Health Outpatients at Mathari National Teaching and Referral Hospital, Nairobi City, Kenya
    (Kenyatta University, 2023-08) Chelelgo, Victor Kibichii; Gilbert M. Munyoki; Meshack Onyambu Ondora
    World Health Organization (WHO) defines mental health as a state of well-being where people realize and recognize their capacities, cope with life stressors, and contribute positively to society. Cases of mental illness in Kenya have been on the rise with an estimated prevalence of 10.7%. There is a gap between the need or demand for mental health services (MHS) and their utilization despite the government’s effort to devolve mental health care services to level 4 hospitals. There are about 284 level 4 hospitals in the country and only 29 of them offer mental health services. Psychiatric services are available in 26 out of 47 counties in Kenya. This leaves people in the remaining 21 counties to seek mental health services from other counties or MNTRH located in Nairobi. Therefore, there is need to address the barriers that limit the provision and use of mental health services if there is hope to lower the burden resulting from mental illnesses in Kenya. The main objective of the study was to investigate barriers to the utilization of mental health services at the MNTRH outpatient clinic. The study was a cross-sectional descriptive study that employed mixed (qualitative and quantitative) methods. Questionnaires were used to collect data coupled with structured interviews of key informants. 216 caregivers completed the questionnaires, and 5 key informants (healthcare workers) were interviewed. The study findings revealed that the cost of seeking mental health services is a critical barrier to accessing these services at the MNTRH outpatient clinic. More than half of the participants missed their clinics due to the cost of medication, 56% (n=120), consultation costs 55% (n=118), and transport= 54% (n=116). Pearson’s Chi-square showed statistically significant associations between the cost of transport, consultation, and medication and missing appointments among mentally ill patients at MNTRH (p < 0.01). Similarly, stigma from the community was associated with patients’ intentions to cease their attendance at clinics at MNTRH (p < 0.01). Caregivers sought other types of mental health services such as spiritual healing before taking their mentally ill relative for formal care. People with mental illness experienced social stigma 59.3% (n=128). It was concluded that the cost of mental health services was a barrier to access and utilization of mental health services. The study also concluded that stigmatizing mentally ill patients, families, and healthcare workers discourages them from seeking or offering mental health services. The study also found that there are healthcare workers’ and facility-related barriers to utilization of mental health services. The study recommended the Ministry of Health and MNTRH develop a strategic or sponsored payment plan besides NHIF for people with mental health tailored to patients' or caregivers’ level of income to reduce barriers to mental health services due to cost, particularly of medication. Future studies should use comprehensive theoretical models such as Social Ecological Model to conceptualize multiple factors that may influence the utilization of mental health services not only at MNTRH but also in Kenya.
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    Menstrual hygiene management among school going adolescent girls in Kibera, Nairobi City County, Kenya
    (Kenyatta University, 2023) Mokaya, Joy Nyanchoka; Mary Gitahi; Francisca A. O. Ongecha
    Each and every girl needs to have access to resources for learning, health, and future menstrual forecasts, as well as guidance on how to manage menstrual hygiene effectively. In line with this, the crucial stages of intellectual and social-emotional development in a person's transition from dependence to interdependence in society occur during puberty. Some teenagers experience worry and panic during transition due to inadequate menstruation information and ineffective resources to manage the physical changes. The overall objective of the study was to assess the menstrual hygiene management among the school going adolescent girls in Kibera. The study was conducted at Kibera which is located in Nairobi City County among 442 school going adolescent girls who were residing within the area when the study was carried out. A descriptive cross-sectional study design was used. This study used cluster sampling in selection of schools and purposive sampling was used to recruit respondents for the study. The study instrument used was a self-designed structured questionnaire, interview study guide and an observation checklist. The data findings were analyzed using SPSS version 23 and the results were presented in form of graphs, pie charts and tables. 80% of the school going adolescent girls in Kibera have the general knowledge on menstruation being a normal process for every girl’s transitioning into womanhood. 98.8% of the adolescent girls use some form of menstrual absorbent material with 86% using a sanitary pad during menstruation. Majority of the schools the toilets for boys and girls were separated. However, 18 out of 22 of the schools had no provision of water for menstrual hygiene. The findings of the study in Kibera recommends the Nairobi county public health office needs to train teachers on reproductive health and the school administrators should incorporate the MHM study guide for teachers in coordination with MOE.
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    Effective hand washing among pupils in selected public primary schools in Embakasi Sub – County, Nairobi City County, Kenya
    (Kenyatta University, 2023) Njiruh, Florence Muthoni; George Otieno Ochieng; Daniel N. Akunga
    The prevalence of sanitation and hygiene related diseases continue to grow over the years on a global scale. The most affected population are children, who often fall ill and may even lose their lives due to exposure to such conditions. Hence, it’s essential to investigate approaches to ensure improved sanitation and hygiene around the environment where the children are in order to reduce or even completely eliminate illness and mortality caused by poor hygiene and sanitation. The study adopted a cross sectional design. The objectives of this research therefore included to establish the proportion of children who utilize hand washing points, identification of the types of hand washing points and their number observation of the conditions of sanitary facilities in public primary schools in Embakasi Sub County. The study design used was cross-sectional survey. The study targeted public primary school attending children and the head-teachers among 37 public primary schools in Embakasi Sub-County. The total enrolment included 42,243 learners. This sample size included 40 % of the public primary school and 462 learners. The sampling technique used was purposive sampling. The data was collected by use of structured questionnaires, focus group discussion (FGD) questions and observational schedule. Analysis of data was done using Statistical Package for Social Sciences (SPSS) program version 22.0. Ethical approval was obtained prior to data collection. The data was expressed as frequencies and percentage. Chi square was used to test for statistical significance between the variables. The results are presented in tables. The finding of the study showed that fewer pupils (36.56 %) practiced hand washing while most (63.44 %) who did not wash their hands. Only 1.32 % of the pupil used detergents for hand washing while 98.64% did not. This could be attributed to the poor ratio of hand washing points to pupils which was 1:132 and 1:137 for male and female pupils respectively. Accordingly, majority (96.81 %) of the toilets were flush toilets while 3.19 % were ventilated improved pit latrines. Majorly, hand washing points comprised of running taps (53.9 %) as well as washing basin and sinks (46.1 %). On hands hygiene associated conditions of the sanitary facilities, majority (93.8 %) of the schools had dirty toilets. Majorly, 80.87 % of the toilets had muddy wet floor while 35.54% had fecal matter on the floor potential for contamination of hands if the pupil came into contact. In conclusion, there is inadequacy of sanitation facilities shown by the ratio of learners to the number of available sanitary amenities. The facilities are in poor conditions infested with muddy wet floors and faecal matter. Further, water availability is inconsistent due to water rationing. The study further, concluded that majority of the learners had poor hygienic habits since they did not observe the hand washing hygiene. The government and stakeholders should provide funds and equipment to ensure adequate sanitary facilities and adequate water supply to schools are available.
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    Households’ Hygienic Practices that Contribute to Recurrent Cholera Outbreaks in Homa-Bay County, Kenya
    (Kenyatta University, 2022) Muga, Julius Okelo; Mary Muiruri; Joan Kabaria-Muriithi
    Globally, Cholera affects approximately 3-5 million persons and causes 100000-120000 fatalities annually. Cholera is endemic in Kenya and is experienced thrice in five years. Kenya has recorded cases of cholera from 1971, 1999, 2000, 2007, 2008, 2010, 2012, and 2013 respectively. Ndhiwa Sub-County also experienced cases of cholera epidemics in these time periods. The main study objective was to determine hygienic practices among household members that contribute to severe diarrhea leading to hospitalization in Ndhiwa Sub-County. This was a survey research design, which was cross-sectional analytical in nature and involved 400 participants. Ndhiwa Sub-County was purposively selected because of repeated incidences of cholera outbreaks. Three wards sampled through simple random sampling. A sampling frame of all villages in the three wards was made and three villages were randomly selected. A household register employed to sample 400 household heads by systematic random sampling. Structured questionnaire, checklist, and key informant interviews used for quantitative and qualitative data collection. SPSS version 20 used for data analysis. Descriptive statistics included frequencies and percentages while inferential statistics included cross tabulations and chi square tests for associations testing of the independent against dependent variables. The chi-square was tested at 95% and 99% level of confidence. Results revealed that only 39% of the study respondents were knowledgeable about cholera signs/symptoms, transmission, as well as prevention measures. It emerged that 78% of the respondents had latrines, out of which 42% had functional hand washing facilities. The study revealed that the main source of water was wells/springs at 54.5%. The results showed that only 65% of the respondents could access sufficient water supply throughout the year and 87% of respondents treated drinking water. On waste management, the study revealed that 86.5% of respondents practiced crude dumping of solid wastes and 92% of respondents practiced crude dumping of liquid wastes. From cross tabulation it emerged that 60.2% of the households that had and appropriately used a facility for hand washing with soap reported severe diarrhea leading to hospitalization. This was a negative relationship because the expectation is that households owning and using hand washing facilities should report fewer cases of severe diarrhea. It was observed that 52.7% of the households having pit latrines, at least a member of the family had suffered a severe diarrhea disease leading to hospital admission in the last one year. This is a negative relationship. It was further noted that 41.7% of the households where there was observation of open defecation and 54.0% of the households with evidence of waste management reported severe diarrhea leading to hospitalization. In both cases, a negative relationship existed between the independent variables and the dependent variable. Statistically significant relationship existed between severe diarrhea leading to hospitalization and: existence of facility for hand washing (chi-square = 14.348, p = 0.000 < 0.01), existence of latrine or toilet (chi-square = 7.795, and p = 0.004 < 0.01), signs that latrine or toilet are in use (chi-square = 3.353 and p = 0.043 < 0.05), evidence of open defecation (chi-square = 3.405 and p = 0.041 < 0.05) and evidence of waste management (chi-square = 4.018 and p = 0.028 < 0.05). It is concluded that there is a relationship between households‘ hygienic practices and severe diarrhea leading to hospitalization in Ndhiwa Sub-County. Therefore, it is recommended that Homa-Bay County government and public health department to create awareness on cholera, latrine provision and use as it emerged that 37% of residents were ignorant of cholera causes, 52% of respondents were not aware of cholera transmission, and 61% respondents did not know about signs or symptoms of cholera disease. Homa-Bay County health promotion officer to carry out continuous advocacy that target raising awareness on latrine provision and use as access to latrine is inadequate because 22% of respondents do not access latrine. Public health department should create awareness on hand washing facility provision and use as it emerged that 58% of respondents lacks hand washing facilities. Ministry of health and water to ensure continuous health education on water treatment and safe storage as access to safe water is inadequate in Ndhiwa Sub County. The main water sources are wells and rivers. Water safety is affected by contamination and scarcity caused by drought or distance; all of which poses a challenge to the community members. Homa-Bay County government should carry out continuous awareness campaigns on proper household waste management. The use of dust bins and regular disposal in designated dump site must be emphasized since compounds of the respondents are dirty due to indiscriminate disposal of wastes; 58% practices crude dumping of solid wastes and 94% practices crude dumping of liquid wastes.
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    Prevalence and Associated Risk Factors of Congestive Heart Failure among Hypertensive Patients Attending Selected Health Facilities in Kiambu County, Kenya
    (Kenyatta University, 2022) Mugo, Onesmus W; Justus O. S. Osero; Eunice Chomi
    The study objective was to determine prevalence and associated risk factors of congestive heart failure among hypertensive patients attending selected health facilities in Kiambu County. The specific objectives were to determine the prevalence of Congestive Heart Failure (CHF), to determine the risk factors associated with development of CHF and to determine the health service delivery related factors associated with the development of CHF among hypertensive patients attending selected health facilities in Kiambu County. Several studies have been carried out in Kenya regarding CHF but minimal published research has been carried out in Kenya and in Kiambu County on CHF amongst hypertensive patients. This study therefore aimed to bring knowledge on the disease burden of CHF and the determinants of CHF among the hypertensive patients. The sample population was patients seen in the Medical Out-patient Clinic every week and key informants. The total sample size was 239. Data was obtained using questionnaires and key informant interviews after obtaining written consent from the research participants. The interview took place in two rooms within the MOPC facilities where privacy and confidentiality were upheld. Quantitative data was analyzed using means, percentages, standard deviation to summarize the data and to measure the prevalence of CHF among the hypertensive patients. Chi square and logistic regression were utilized to draw associations and predictions respectively between the risk factors and health service-related factors (independent variables) and the development of CHF among the hypertensive patients (dependent variable). Qualitative data was analyzed by identifying patterns after data collection. The study results showed that the prevalence of CHF among hypertension patients attending selected health facilities in Kiambu County was 9.6%. The risk factors associated with development of CHF were activity level (p=0.016), time spent sitting and travelling (p=0.042) and BMI (p=0.0001). Health service delivery related factors that were associated with development of CHF were availability of hypertension medicine (p=0.003), scheduled appropriate CHF clinic follow up (p=0.009) and availability of screening services for CHF risk factors in the hospital (p=0.001). The study concluded that modifiable risk factors and all the investigated health service delivery related factors were associated with CHF development. The study recommended that Kiambu County government investigate ways of lowering CHF prevalence, mitigate the modifiable risk factors to reduce CHF development, identify and address areas of weakness on the health service delivery systems like medicines availability and patient’s scheduled clinic follow up.
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    Risk Factors, Prevalence, Severity, and Management of Chronic Kidney Disease among Outpatients in Selected Hospitals in Nairobi City County, Kenya
    (Kenyatta University, 2022) Mbithi, Annastacia Nduku; Harun Kimani; Alloys S.S Orago
    Chronic (CKD) is a kidney disease worldwide public health issue with high prevalence (8% and 16%) among adults. The risk factors, prevalence, severity and management of CKD are less characterized in Kenya. Therefore, the study aimed at determining risk factors, prevalence, severity and management of CKD among outpatient attendees in selected hospitals in Nairobi County. An analytical cross sectional study design was used. The study was conducted at Kenyatta National Hospital, Aga Khan University Hospital, Nairobi and Mater Misericordiae Hospital among 336 CKD patients and 27 key informants. The sample size in the selected hospitals was obtained proportionately. Adult CKD outpatients aged 18 years and above who attended nephrology clinics between January and July, 2020 were recruited using a simple random sampling. A self-administered questionnaire was used to collect data on social-demographic, risk factors and factors influencing the management of CKD while data on severity and clinical features were retrieved from patients’ files of those who had given an informed consent. Key informant interviews we also conducted among nephrologists and nephrology nurses. Descriptive and inferential statistics were performed using statistical package of social science version 26.0. The qualitative data was analyzed using content analysis. Notably, the study reported a CKD prevalence of 9% among outpatients of selected hospitals. Majority of CKD patients (61.9%) had severe disease. Diabetic nephropathy (OR 3.43, 95% CI; 1.72, 5.67), glomerulonephritis (OR 2.52, 95% CI; 2.07, 4.05), hypertensive nephrosclerosis (OR 1.95, 95% CI; 1.87, 3.11), polycystic kidney disease (OR 1.26, 95% CI; 1.12, 2.61) and systemic lupus erythematosus (OR 1.16, 95% CI; 1.06, 1.39) were independently associated with severe CKD. Also, age (OR 2.73, 95% CI; 1.12, 6.67), sex (OR 2.62, 95% CI; 1.97, 6.05), family history of diabetes (OR 2.52, 95% CI; 1.2,7, 4.30) and hypertension (OR 1.16, 95% CI; 1.04, 1.93), tobacco smoking (OR 2.52, 95% CI; 1.27, 4.30), alcohol use (OR 2.01 95% CI; 1.83, 3.95), herbal medicine use (OR 1.73, 95% CI; 1.32, 2.27), obesity (OR 2.11, 95% CI; 1.52, 3.63), irregular nephrology consultation (OR 1.42, 95% CI; 1.12, 2.01), physical inactivity (OR 2.62, 95% CI; 1.97, 5.73) and poor diet (OR 1.16, 95% CI; 1.09, 2.41) were confirmed as independently associated with severe CKD. Furthermore, social (87%), physical (52%), economic (77%), emotional (46%) and hospital based factors (32%) were identified as the factors that affected provision of care to patients with CKD. Therefore, the patients with these features need proper follow up and treatment to slow down progression of CKD to severe stages. Kenyan Ministry of Health should design policies for early CKD screening on high risk populations, include CKD among the prioritized non communicable diseases and train more nephrology workers.
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    Utilization of Perinatal Verbal Autopsy and its Determinants among Community Health Volunteers in Homa Bay County, Kenya
    (Kenyatta University, 2022) Ongala, Elizabeth Achieng; Ephantus W.Kabiru; Gordon Ogweno
    Ending preventable perinatal mortality is one of the global public health priorities. Despite integrating World Health Organization’s essential maternal and newborn care package into Homa Bay County’s community health strategy in 2016, the perinatal death rate remained high at 29/1000 compared to the national ratio of 22/1000 births. To achieve Special Development Goal 3, efficient, timely stillbirths and newborn deaths surveillance and response are vital. This study’s broad objective was to assess the utilization of Perinatal Verbal Autopsy (PVA) among Community Health Volunteers (CHVs) in Homa Bay County, Kenya. The study had four specific objectives; to establish PVA utilization level, determine the influence of socio-demographic and socio-cultural factors on PVA utilization, and establish the influence of data processing issues on PVA utilization. Socio-ecological theory and descriptive cross-sectional study design were adopted for the research conducted in Kasipul Sub County of Homa Bay. All CHVs in the study area formed the study population and were systematically sampled. Mothers identified by the participating CHVs to have had stillbirths or newborn deaths in the community within six months preceding the study were interviewed. Sub County Health Managers, Program Coordinators, and Community Health leaders were purposively sampled as key informants and FGD participants. Yamane’s simplified formula was used to draw a sample size of 184 CHVs. Data collection tools included structured questionnaires, in-depth interviews, KII, and FGD guides. Software Package for Statistical analysis (SPSS v22) and thematic analysis was done for quantitative and qualitative data respectively. Chi-square and fishers’ exact analyses were used to determine associations between independent and dependent variables at 95% confidence interval and <0.05 statistical significance level. The study established a 15.4% PVA utilization among CHVs. There was an association between PVA utilization level and its application. A significant association (p=0.000) existed between previous verbal autopsy conduct and the CHVs’ readiness for PVA. Marital status (p=0.004), gender (p=0.014) and voluntarism period (p=0.012) had statistically significant associations with PVA utilization among CHVs. Bereaved family attitude and PVA utilization had a significant association (p=0.000). CHV training (p=0.020), (p=0.000); database establishment (p=0.000), (p=0.035); and feedback (p=0.032), (p=0.042) were statistically significant to PVA utilization. Meanwhile, HH coverage (p=0.615) and supervision (p=0.657) had no association with PVA utilization. PVA utilization among CHVs was low at 15.4%, far below the WHO recommendation above 80%. Interviewers’ marital status, gender, and volunteerism period are facilitative socio-demographic factors for PVA utilization. Bereaved family attitude and perception of CHV work are important socio-cultural factors for PVA utilization. Training, database, and feedback are important enablers of PVA utilization. VA has considerable potential to informing policy and closing information gaps while guiding monitoring and evaluation of the health systems. The study results will inform National and County Health Surveillance & Response programs, bringing out useful data for prioritization, planning, and resource allocation to enhance populations’ health and livelihoods. Policymakers will use the study findings to design evidence-based health promotion interventions to increase PVA practice towards reducing preventable perinatal deaths in households.
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    Impediments to Accessing Household Sanitation Facilities amongst Low-Income Urban Residents in Naivasha Town, Nakuru County, Kenya
    (Kenyatta University, 2022) Ouko, Samwel Odongo; Isaac Mwanzo; George Kimathi
    Population growth and poverty, most often in urban and peri-urban areas of developing countries continue to hinder efforts towards improving sanitation coverage. A large number of urban residents in Africa live in settlements served by inadequate sanitation facilities. In Kenya, more than 8 million people live in urban low-income areas with low access to appropriate sanitation. Many studies have been conducted to investigate challenges to improved sanitation in large cities in Africa, however, limited information still exists about sanitation access challenges in small but growing urban low-income settlements. The study sought to assess impediments to provision of household sanitation facilities in Nakuru. The study adopted cross-sectional analytical study design targeting 370 residents in randomly selected households. Mixed data collection methods were used to solicit information on the household socio-demographic profile, credit access levels, sanitation regulation and household willingness to pay for improved sanitation. Descriptive statistics were computed to display the frequency distribution of household socio-demographic variables. SPSS version 23 was used to store and analyse data. Chi-square and ANOVA tests were conducted to infer an association between the independent variables (access to credit facilities, household income and education level, occupancy, and compliance to regulation) and the outcome variable (improved household onsite sanitation). More than half 60% (222) of the respondents were earning less than ten thousand Kenyan shillings a month, while 73% were tenant households. Another 62% of those interviewed knew sanitation-related credit sources and just less than half (31%) had benefited from the credit facilities. There was an association between household characteristics and status of household sanitation facility used; education ( 2 =32.483, df =1, p<0.05), income (F=9.495, df = 2, p<0.05), willingness to pay ( 2 = 9.25, p<0.005, df =3) and tenancy ( 2 = 10.619, df =1, p<0.05).Further statistical association was noted between access to sanitation credit (2 = 16.22, df =1, p<0.05) and status of sanitation. Perception of compliance to sanitation regulation standards (2 = 11.76, df = 3, p<0.05) and status of household sanitation was equally significant at 95% level of confidence. The findings highlight the need for targeted, attractive, and affordable sanitation financing and regulatory alternatives for low-income households in Naivasha Town. There is a need for local governments to review or package onsite sanitation regulations targeting low-income households to suit their socio-economic situations and encourage compliance by offering incentives to low-income household sanitation financing.