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Item Data Quality in Voluntary Medical Male Circumcision Program in Selected Health Facilities in Siaya County, Kenya(Kenyatta University, 2025-11) Saida, Mjema KassimSince 2008, Kenya has implemented the voluntary medical male circumcision program as a strategy for preventing HIV. Siaya County's male circumcision rate was 56%, well below the recommended 80% according to the Kenya Demographic Health Survey, 2015 data. From 2008 to June 2019, 299,261 circumcisions were performed in Siaya County, according to the Kenya Health Information System. The completion, timeliness, and accuracy reporting rates for the VMMC program in KHIS were consistently lower than the required standard of 80%. Even though the VMMC program has been in operation since 2008, little research has been done on the data's quality. The goal of the study was to evaluate the organizational, technological, and behavioral aspects that affect Siaya County's VMMC program data quality. Data accuracy, timeliness, and completeness were three characteristics that were evaluated. By stating whether a value for a certain data element from a particular facility was or was not available in the information system, completeness was evaluated. Timeliness was measured by the date when the data was submitted to the information system compared to the anticipated submission date. Data from individual facility registers and data stored in KHIS were compared to determine the correctness of the data. Out of the 224 health facilities sampled for this research, only 202 answered (90.1% response rate). The personnel in charge of VMMC data collecting and reporting were subjected to the study questionnaire and the records checklist through the online open data toolkit (ODK). The County Health Management Team was the subject of key informant interviews. SPSS was used to analyse quantitative data. Measures of dispersion (standard deviation and range) and measures of central tendency (mode, mean, and median) were used to summarize the data. With a 95% confidence interval and a P-value of >=0.05, Pearson chi-square was utilized to analyze the relationships between the technological, organizational and behavioral factors and the data quality index. After being categorized into themes using the objectives and responses into three thematic areas as behavioral, technological, and organizational, qualitative data was analysed thematically and verbally conveyed. The scores for accuracy, completeness, and timeliness were summed up to create the Data Quality Index. For all three aspects associated with good data quality, the response was 1=Yes. For each of the three aspects of data quality, bad data scored a 0-No value. It was evident that 44.1% of the facilities had accurate data, 77.2% was timely and complete in 80.2% of the facilities. Only 29.7% of the 202 facilities had good data quality, according to the data quality index. There was a significant relationship between good data and education level (χ2 =5.25, df =3, p-value =0.02), cadres (χ2 =7.22, df =4, p-value =0.01), and length of stay at the health facility (χ2 =6.48, df =2, p- value =0.04). None of the behavioral variables had a strong correlation with good data quality. The proportion of respondents (64.2%) who agreed that staff members receive training on the national EMR system were substantially more likely to have good quality data than those who disagreed (χ2 =9.10, df =1, p-value =0.01). The respondents who agreed that systems are put in place to identify and address data quality (49%), were significantly related with good data (χ2 =13.85, df =1, p-value =0.01) for organizational characteristics. The percentage of respondents (50.6%) who agreed that VMMC data is used to guide facility decision-making had a significant association with good data quality (χ2 =131.67, df =1, p- value =0.01). The study recommends Siaya County integrate VMMC supervision and DQA with other health services in an effort to improve the quality of the data. It also recommends the national VMMC program to ensure that all VMMC indicators are incorporated in the national EMR and that all staff members be educated to improve reporting. For the purpose of informing choices about policies and other programmatic matters, the Ministry of Health would gather information from the various data sources and build a consensus based on data from the national surveys.Item Patients’ Rights Charter Adoption among Healthcare Professionals in Mbagathi Hospital, Nairobi City County, Kenya.(Kenyatta University, 2025-12) Wango’mbe, Muthoni Irene ThuoSince 1946, health has been recognized as a basic human right in the World Health Organization’s Constitution and it is the organization’s purpose for all. While progress has been made in achieving the right to health, there are still substantial gaps. There are no documented studies that illustrate the factors that influence healthcare professionals' adoption of the 2013 Patients' Rights Charter in Kenya, specifically in the study area. This study's main goal was to investigate the factors that influence healthcare professionals at Mbagathi Hospital, Nairobi City County, Kenya, to adopt the Patients' Rights Charter of 2013. This study therefore examined the determinants of the adoption of the Charter among healthcare professionals at Mbagathi Hospital. The study was guided by the following study objectives; to identify the individual factors associated with the adoption of the Patients’ Right Charter, to determine the level of awareness of the Charter and to ascertain healthcare system characteristics linked to the adoption of the Charter all among healthcare professionals at Mbagathi Hospital in Nairobi City County, Kenya. A quantitative and qualitative methodology in a descriptive cross-sectional research design was used for data collection, whereby a semi-structured questionnaire was administered to the selected healthcare professionals. Stratified sampling method from Yamane's (1967) was used to select the desired sample in each of the cadres of healthcare professionals. The study targeted 186 healthcare professionals who were chosen purposively. The results indicated that the average of the female respondents was 96 (51.6%), respondents aged 20–30 had 101 (54.3%), and medical doctors had 37 (19.9%) adopted patients’ rights charter in public health facilities. The respondents’ level of education was, however, statistically significant with a p-value of 0.002. Majority 174 (93.5%) of the respondents were aware that the Kenyan constitution contains a Patients’ Rights Charter. While 135 (72.6%) said there were challenges that hindered the full adoption of patients’ rights, which included the large number of patients in the facility, 112 (61%), 34 (18%) as a lack of equipment and 10 (5%) as incompetent staff in the facility. Most of the Healthcare system factors were statistically significant such as workload (P = 0.014), workload effect (P=0.052), confidential handling of patient/client communications and records (P = 0.003), information provided to patients (P = 0.007), adequate workspace (P = 0.007), a copy of patients' rights and responsibilities offered to patients (P = 0.000), parties involved in the disputes (P =0.003), hospital investigated for medical legal issues (P = 0.050), issues resolution (P = 0.018), and documentation implementing the Kenyan Charter for Patients' Rights (P = 0.00), thus correlated with the adoption of the Charter. According to the study's findings, respondents appeared to be familiar with the patients' rights, but they faced several obstacles that prevented them from completely embracing the charter at the public hospital. Therefore, recommend that, to safeguard patients' legal rights and deliver quality care to them, all healthcare stakeholders have thorough awareness of healthcare hurdles. The government should ensure that healthcare professionals have the tools and information requiredItem The Diffusion of Electronic Medical Record Towards Universal Health Care at the Outpatient Department in Selected Public Health Facilities in Kenya.(Kenyatta University, 2025-01) Muritu, Maryanne WanjuhiHealthcare organizations are increasingly adopting electronic Medical Records(EMR) as a means to enhance their services and mitigate rising costs associated with the pursuit of Universal Health Care. The diffusion of EMR in public health facilities has become a pivotal aspect of modern healthcare systems globally. There is a significant increase in countries with significant diffusion of EMR, with over half of WHO Member States now having an EMR framework that aligns with UHC objectives. In Kenya, the diffusion of EMR in public healthcare facilities has exhibited a comparatively slow pace of adoption. The problem of slow diffusion has arisen as a notable barrier within the healthcare industry in Kenya. The current investigation was guided by the diffusion of innovations theory which seeks to explain how, why and at what rate new ideas and technology spread. The principal objective of this study was to evaluate the extent of EMR diffusion in Nyeri County Referral Hospital, Thika Sub County Hospital, and Mbagathi Sub County Hospital. The study utilized a hospital based descriptive design, incorporating simple random and proportionate sampling techniques. The study's target population comprised health records and information officers, physicians, nurses, administrators, and other personnel directly engaged in the utilization of electronic medical records (EMR). A sample size of 285 participants was chosen for the study. The process of data collection encompassed the utilization of a meticulously designed questionnaire and the conduction of Key Informant Interviews (KIIs). The data was subjected to analysis using SPSS version 26.0. At least 160 (56.1%) of health facilities partially adopted electronic medical record between different departments, however, the diffusion varied with functions with the registration of patients being the most EMR reliant services, which was reported by 65.7% of the respondents. Working experience ( =15.301; df 3; p=0.018), lack of training ( =10.919; df 4; p=0.031), lack of effective leadership ( =8.062; df 4; p=0.041), adequacy of technical skills on IT systems ( =11.508; df 4; p=0.025), level of computer literacy ( =6.562; df 4; p=0.044), understanding of working with EMR system (p=0.0001), assigning EMR security privileges to staff (p=0.046), and lack of adequate infrastructure ( =7.879; df 2; p=0.046) were affecting diffusion of EMR. Additionally, inadequate sources of funding ( =9.186; df 2; p=0.017), lack of technical personnel to install and operate EMR technology resources ( =8.615; df 2; p=0.042), the consistency rate of internet connection (bandwidth) ( =14.882; df 2; p=0.005), lack of training new hospital staff on EMR usage & operations ( =8.170; df 1;p=0.019), lack of technical personnel to install and operate EMR technology ( =10.071; df 1; p=0.015), absence of computer skills amongst health care staff ( =7.404; df 1; p=0.038), and inadequate internet bandwidth ( =9.504; df 1; p=0.032) were affecting diffusion of EMR. Thus, the hospital management should improve the diffusion of EMR from one department to another, more training should be undertaken, and the county governments should strengthen organizational resources to support information use.Item Analysis of Patients’ Direct and Indirect Costs at the National Spinal Injury Hospital in Nairobi City County, Kenya(Kenyatta University, 2025-04) Karanja, Lorna WangariGlobal statistics indicate that based on the extent of spinal cord injury, the first-year cost ranges between $300,000 and $1,000,000. A review of 68 studies by Hadley et.al 2013, revealed that the average cost of an accident varied greatly, from $14 to $17,400. The cost per disability-adjusted life year saved by injury-prevention measures ranged from $10.90 for the installation of speed bumps to $17,000 for campaigns against drunk driving and breathalyser testing in Africa. This study aimed to determine the economic burden of spinal cord injury (SCI) by analyzing patients’ spinal injury costs at the National Spinal Injury Hospital (NSIH) in Nairobi, Kenya. The specific objectives were to: (i) determine the total costs of SCI in the first year of diagnosis and treatment; (ii) analyze variations in costs due to health insurance ownership; (iii) assess cost variations based on the extent of injury; and (iv) examine cost variations based on the employment status of patients. A cross-sectional analytical study was conducted using purposive sampling to select the hospital, the only referral facility for SCI in East Africa. SCI inpatients and outpatients meeting the inclusion criteria were recruited using consecutive sampling until the sample size of 169 was reached. Data were collected through structured questionnaires and secondary data review and analyzed using SPSS version 25. Findings revealed that the average first-year cost of SCI per patient was KSh. 928,326.73, comprising KSh. 187,048 in direct medical costs, KSh. 173,541 in direct non-medical costs, and KSh. 567,738 in indirect productivity losses. Statistical analysis showed no significant difference in total spinal cord injury costs between patients with medical cover and those without medical cover (df=2t=0.6129) or patients with different extents of injury (df=3; P=0.6617), but patients’ employment statuses significantly influenced the total spinal cord injury costs (df=4; P=0.0000). The conclusions were (i) There is no significant difference in the total SCI costs between the SCI patients with medical cover and those without medical cover (ii) There is a significant difference in the total SCI costs amongst SCI patients of different employment statuses (iii) There is no significant difference in the total SCI costs among the SCI patients with different extents of the injury. Recommendations include reducing indirect costs through modern treatment technologies and affirmative actions, promoting the full implementation of the Social Health Insurance Act, providing direct cash transfers to SCI patients, and encouraging employers to support SCI patients with flexible work arrangements and workplace modifications. These findings emphasise the need for targeted interventions to alleviate the economic burden of SCI and enhance patient care at NSIH.Item Health Information Use for Decision Making among Health Personnel in Elgeyo Marakwet County, Kenya(Kenyatta University, 2025-05) Bayas, Leonidah ChepchirchirUsing health information is an essential component in the health industry thus it is factored in as one of the major building block. Health personnel can be able to monitor and evaluate their programs effectiveness using information from the health facilities. Information will guide health professions to identify a problem and it will give varied interventions to solve the problem using information not intuition. Health personnel carry out routine information collection, collation and reporting on all health activities. Studies indicate that local health management at Sub County levels or health facility and the persons collecting the information use very little of this vast amount of information. Ideally, to support local and national use by health management, collection, analysis and use of local information should be done. The study design was cross sectional descriptive study design, simple random sampling was used as this avoided bias. Self-administered questionnaire, key informant interview guide and focus group discussion guide were tools used to collect data. A total of 142 health workers participated in the study. Descriptive statistics and chi-square test to determine significant association was done and results presented in tables, graphs and charts. The results showed 85% use of health information for decision making. The study established that the health information level in usage in decision making among health personnel in Elgeyo Marakwet County was high. The level of motivation among the health personnel to use health information for making of decisions was also high. The study also established that cadre, age, professional training and years of working experience of the health personnel had significant relationship with health information use for decision making. Additionally, the findings indicated that health personnel training on information management, quality of information, and ease of accessing information had significant relationship with health information use for decision making (P<0.05). Lastly, the study found that display of information on key performance indicators, and support from management on matters pertaining to information management had significant relationship with health information utilization in decision making. Therefore, the study recommends that institutions’ management should ensure frequent display of information on key performance indicators in order to enhance health information use among the health personnel. The in-charges, county and sub-county health management teams should facilitate effective supportive supervision on information and information management at the health facilities in order to enhance health information use among the health personnel and policy makers at the National and County level.Item Uptake of Electronic Medical Record System by Health Workers in Selected Public Hospitals in Kiambu County, Kenya(Kenyatta University, 2025-05) Ndemi, Caroline KaburaElectronic Medical Records (EMRs) are transforming healthcare delivery globally, yet implementation in resource-constrained settings faces significant challenges. In Kiambu County, Kenya, despite substantial telecommunications infrastructure (98% mobile coverage), EMR utilization remains fragmented across healthcare facilities, with many continuing to rely predominantly on paper-based documentation. This study aimed to establish the uptake of electronic medical record systems among healthcare workers in Kiambu County. Specifically, the study sought to determine the level of uptake of the Electronic Medical Record system among health workers in Kiambu County; establish the individual characteristics influencing its uptake; examine the technological factors affecting adoption; and analyse the organizational factors contributing to its use among health workers in the county. The research was anchored in the Technology Acceptance Model (TAM) and Unified Theory of Acceptance and Use of Technology (UTAUT), which explain how perceived usefulness, ease of use, facilitating conditions, and performance expectancy determine technology adoption behaviours. A descriptive cross-sectional research design was employed using quantitative and qualitative methods. The study targeted 2,703 healthcare workers in Kiambu County public facilities. Using Fisher's formula and proportionate sampling, 370 participants were selected, with 359 responding (97% response rate). Data was collected using structured questionnaires and analysed through descriptive statistics, chi-square tests, and logistic regression. The study found 88% of healthcare workers using EMRS despite 68.4% reporting systems did not save time. Healthcare workers who perceived patient information as secure were 3.6 times more likely to utilize EMRS (p=0.005). System performance significantly influenced adoption, with respondents reporting "very good" retrieval speeds three times more likely to use EMRS (OR=2.513; p=0.012). System usability similarly impacted adoption, with users finding systems easy to use being nearly four times more likely to utilize electronic documentation (OR=3.802; p=0.014). Regular system maintenance was significantly associated with higher utilization rates (p=0.024), while demographic characteristics showed no significant relationships with adoption (all p>0.05). The study concludes that while EMRS adoption among health workers in Kiambu County is notably high, this uptake is largely driven by organizational mandates. Technological performance and ongoing system maintenance emerged as critical enablers of meaningful use, while demographic factors played a minimal role. The findings underscore the need to prioritize user-centred design, targeted training, and responsive technical support to transform formal adoption into effective utilization. Addressing infrastructure and usability challenges is essential for sustaining and scaling EMRS implementation in similar settings.Item Influence of Hospital Environment on Vicarious Trauma among Health Care Workers in Public Hospitals in Laikipia County, Kenya(2023-10) Wekesa,Eroll MwichabeAbstractItem Health System Determinants of Job Satisfaction among Mortuary Staff in Selected Public and Private Mortuaries in Nairobi City County, Kenya(Kenyatta University, 2024-11) Ogira, A DosilaJob satisfaction has been widely studied and presented on published account as a key factor that influences efficiency and effectiveness among workers including healthcare workforce. Due to the interlinkage between job satisfaction and performance and the organizational efficiency, a lot of attention has been paid to the job satisfaction amongst various occupations of various groups. However, one notable category that has been largely overlooked by researchers are the mortuary staff in part because of the stigma surrounded in the topic of death. This study sought to address this gap by examining health system determinants of job satisfaction among mortuary staff in selected public and private mortuaries in Nairobi. More specifically, investigated how work environment, remuneration and training affect the job satisfaction of mortuary staff. The theory underpinning this study was the Maslow Hierarchy of Needs Theory and Herzberg’s Two-Factor Theory. For this study, cross sectional study design was applied since it gives an image of a population at the time and makes it possible to draw conclusions. Stratified sampling was also applied to ensure representativeness with each mortuary facility constituting a stratum. This study used both quantitative and qualitative data collection methods to obtain information. Quantitative data was collected using pretested open and closed ended questionnaires, whereas qualitative data was collected through Key Informant Interviews with mortuary superintendents. A sample size of 193 respondents were selected from public, private and institutional mortuaries in Nairobi City County and the study had a 79% response rate. Quantitative data analysis was done using Statistical Package for Social Sciences (SPSS) version 2.0 with additional use of Microsoft Excel Programme to generate tables, graphs and pie charts. Inferential statistics were calculated using Chi-Square tests (p<0.05) done at 95% confidence interval to establish the association between study variables. Qualitative data from the key informants was organized into thematic areas, coded using NVivo and further presented as quotes and extracts to support the qualitative data. The study revealed that the overall satisfaction level was 44.7%. Chi-square analysis revealed significant relationship between; marital status (p=0.033), workload appropriateness (p=0.035), solidarity among employees in the department (p=0.024), timely payment (p=0.001), rewards for working overtime (p=0.001) and opportunities for continued learning and training (p=0.001). To conclude, the study revealed a suboptimal job satisfaction level among mortuary staff in the selected facilities in Nairobi City Council. The study recommends that mortuaries in Nairobi City County should invest in good work environment, fair and timely remuneration and presence of training opportunities to enhance job satisfaction. This research will create a better understanding of the dynamics of job satisfaction among mortuary staff by facility administrators as well as policy makers. Such information is integral to future policy development and decisions about appropriate strategies for intervention.Item Utilization of Electronic Medical Records by Doctors and Clinical Officers in Comprehensive Care Centres in Nairobi County, Kenya(Kenyatta University, 2024-08) Adundo, Lydiah AkinyiElectronic medical records (EMRs) have been introduced to replace the paper-based health records system at comprehensive care clinics (CCCs) in hospitals across Nairobi County, Kenya. The objective of this study was to assess the utilization and effects of EMRs as a continuous quality improvement tool among doctors and clinical officers in these hospitals. Specifically, the study aimed to determine the levels of EMR utilization among doctors and clinical officers in HIV and AIDS CCCs in Nairobi County, identify health workers' perceptions about EMR utilization in these services, and establish the factors influencing EMR utilization in HIV and AIDS services provided by the CCCs in Nairobi County. This was a descriptive cross-sectional study. Participants, consisting of 100 doctors and clinical officers, were selected through proportionate stratified random sampling from 41 HIV and AIDS CCCs across both public and private hospitals in Nairobi County. Data were collected using questionnaires and analyzed with Statistical Packages for Social Sciences (SPSS) Version 21. Both inferential and descriptive statistics were employed. The study revealed high levels of EMR adoption among health workers, with all CCCs in Nairobi having installed EMRs, allowing personnel to use these systems daily. The adoption of EMRs resulted in improved efficiency within the CCCs of Nairobi County. However, the study also identified challenges, such as difficulties in accessing records during power blackouts. Regarding the influence of health workers' perceptions on EMR utilization, the study found that factors such as access and speed, ease of navigation, and efficiency impacted the use of EMRs in CCC services. Additionally, organizational factors were found to affect EMR adoption, with management support of innovation significantly influencing health professionals’ willingness to adopt EMRs. Technical factors also played a role, as facilities that adopted EMRs experienced relative advantages that influenced their decision to implement these systems. Furthermore, external environmental factors impacted EMR adoption, as EMRs helped health facilities address competitive pressures. The study also identified challenges in EMR implementation, including issues with selecting appropriate EMR systems and the transition from paper-based to electronic systems, which require careful planning. The study concluded that EMR adoption has enhanced the efficiency of services in health centers in Nairobi County. It recommends a concerted effort by all stakeholders to address potential barriers to EMR adoption and utilization in CCCs.Item Utilization of Routine Health Data in Decision Making by Management Teams in Selected Level 4 Hospitals in Nakuru County, Kenya(Kenyatta University, 2024-11) Kagwiri, MaryHealth data are the relevant information routinely collected in health institutions by health workers. The health population needs can only be identified through data collection, collation and analysis as this provides information that should be used by the hospital management teams (HMT), in prioritizing resource allocation for service delivery, health work force, essential medicines, and governance. In most hospitals, these crucial managerial responsibilities seem to be lacking the support of data use for evidenced decisions, leading to poor service delivery and unnecessary referral of patients, yet the same hospitals, task their health workers with data collection and monthly submission of reports. In light of this, this cross-sectional study, assessed the utilization of routine health data for decision-making by HMTs of the selected level 4 hospitals in Nakuru County; Molo, Subukia, Olenguruone, and Naivasha sub-county hospital. This was achieved by determining the extent of use of the data collected for decision-making, examining data quality and identifying organizational factors influencing the utilization of routine health data in decision-making. The study population was 146 Hospital management team members, selected by use of the census sampling method. The study used three data collection tools; the questionnaire and the interview schedule. An observation checklist was used to identify the presence or absence of list of items representing quality data and evidence of data. A pre-test was conducted on a group of 15 hospital management team members (10% of the sample size) from the Langa-Langa sub-county hospital. A Cronbach reliability coefficient of 0.72 was achieved for each of the constructs and thus considered reliable. Analysis for Descriptive and inferential statistics was done by utilizing Statistical Package for the Social Sciences (SPSS) version 25. The study found that Nakuru county had an average data utilization index of 62.9%, good use and that the accuracy of data collected, as well as the use of registers as a data collection tool were significantly associated with the use of Health data at a p-value of 0.025 and 0.043 respectively. The study recommended that the CHMT and HMT train, mentor, and empower health managers and all health workers on data management, data integration in policy development, standardize data collecting tools and data use through SOPs for all health facilities, develop a data quality assessment tool and provide support towards evidence-based interventionsItem Level of User Satisfaction with Electronic Medical Records System among Health Workers in Kakamega County Teaching and Referral Hospital, Kenya(Kenyatta University, 2024-02) Okumu, Olivia BukachiStudies have reported low adoption of Electronic Medical Records (EMR) mainly because of lack of EMR use by end users. The main objective of this study was to establish the level of satisfaction by users with electronic medical records system among health workers in Kakamega County Referral Hospital by determining the level of user satisfaction levels with the EMR system by examining the influence of user characteristics and system factors on the level of user satisfaction with EMR system. A descriptive cross-sectional research design was adopted. The study targeted health care workers who had ever used the EMRS system in the hospital before and during the time of the study. The respondents were stratified into homogeneous groups according to cadre and randomly sampled. Fisher et al. (1998) formula was used to determine a sample size of 252 respondents. Structured questionnaires and Key informant interviews were used to collect data. Instrument reliability was by use of Cronbach Alpha coefficient (0.743) and content and construct validity was verified by field experts. Data analysis was both descriptive and inferential analysis. Response rate was 98.01% and the average satisfaction index of EMRS was 54.5%. Key informant (KI) 1“Generally Satisfied with the system because it is easy to use and there is faster and easier retrieval of patient information…” Majority of user characteristics and system factors did influence the level of satisfaction of health workers on the use of ERMS. Age (𝝌𝟐 11.66(p value 0.03) Gender (𝝌𝟐15.566 (p value <0.001) Profession ((Fisher exact) <0.001) Computer Literacy 𝝌𝟐 15.159(p value < 0.001), Training 𝝌𝟐 5.955(p value 0.015) Attitude 𝝌𝟐 95.675(p value < 0.001), significantly associated with overall satisfaction of EMR system. Years worked in hospital were not associated with user satisfaction (p value of 4).KI3 “All staff are required to have a certificate in basic IT this enables the staff to use the system but regular trainings on the EMRs would be appreciated to increase competency of the staff on the system...” The system factors were Information quality 𝝌𝟐 39.314(p value < 0.001), 𝝌𝟐 6.352(p value < 0.012) System quality 𝝌𝟐 8.062(p value < 0.005) 𝝌𝟐 4.452(p value < 0.033) were all associated with user satisfaction while Service quality 𝝌𝟐 2.047(p value < 0.153) 𝝌𝟐 3.333(p value 0.068) was not associated with user satisfaction. KII “The system is secure you cannot access the Emr without a password. Though Users can easily manipulate the system thus the Information Is not taken as being 100% truthful e.g. you can be able to change past patient information...” The binary logistic regression model of overall satisfaction (Omnibus test χ2= 141.055, p < 0.001) and could correctly predict 84.1% of the users who were satisfied with EMRS systems.The study recommendations included a periodical review of user satisfaction levels plus frequent trainings on the system by users and lastly system developers should upgrade system factors such as security, clinical decision support and ability to generate end month reports. A study can be conducted to check why different healthcare professional’s level of user satisfaction differs.Item Patients Health Information and Hypertension Management at Kenyatta National Hospital; Kenya(Kenyatta University, 2023-05) Alembi, Osanya Ayub; Joyce C. Kirui; Eliphas GitongaAbstractItem Livelihood Diversification Strategies and Livelihood Outcomes among Agro-Pastoral Households in Laikipia North Sub-County, Kenya(Kenyatta University, 2022) Irungu, Martin Waithaka; Joan Kabaria- Muriithi; Jane Rose NjueDespite the existing efforts by the agro-pastoral communities to seek livelihood alternatives, they still encounter persistent livelihood insecurity. The growing burden of the need to address food scarcity, among other crises, reflects Arid and Semi-Arid Lands communities' inability to survive without external aid. This study aimed to investigate livelihood diversification strategies and the subsequent livelihood outcomes among agro-pastoral households in Laikipia North Sub-County, Kenya. The specific objectives of the study were; to establish the demographic characteristics of the agro-pastoral households; to investigate the livelihood outcomes; to explore the influence of assets on livelihood outcomes; to establish the relationship between livelihood challenges and livelihood outcomes among agro-pastoralists and to establish the relationship between livelihood diversification and livelihood outcomes in Laikipia North Sub-County. The study adopted a cross-sectional survey design where a sample of the population was selected, and from these individuals, data was collected to help answer the research questions. A total of 422 households were systematically sampled. Data was collected from household heads using household questionnaires and key informant interview guide with County Agriculture and Livestock Officer. Analysis of data was done using SPSS (version 20). Pie charts, frequency tables, and bar graphs present study findings. Significant correlations between variables were tested using the Chi-square test and Spearman rank correlation coefficient at a significance level of 0.05. The study realized a response rate of 90.3% of whom 55.9% were household heads. The average years the respondents had lived in the area was 43. The study found that climate change was a major cause of disparity between the past and current livelihood diversification strategies at 40.7%. Assets (physical, financial and social) were found to significantly influence livelihood outcomes. However, the challenges the respondents faced were found to have no significant influence on the livelihood outcomes (χ=1.017, df =1, p=0.313). Finally, there was a significant relationship between the adopted livelihood strategies and livelihood outcomes (χ2=14.730, df =1, p=0.000, r=-0.197). The study made recommendations to the relevant entities to strengthen extension services, improve infrastructure and provide a conducive business environment.Item Referral for Health Services among Outpatients at Nyeri County Referral Hospital, Kenya(Kenyatta University, 2022) Murithi, Gatwiri; Kenneth RuchaOne of the fundamental human rights is right to health. To achieve this within a health system with different levels of care there is need for a functional referral system that enables continued uninterrupted care across different levels. Data available in Nyeri county health department however shows that clients bypass the primary level facilities and present themselves to referral facilities thus placing huge demands for health services on tertiary facilities. This research therefore sought to establish factors associated with referral for health care services at the County Referral hospital during (Universal Health Coverage) UHC implementation in Nyeri County. The study employed a cross-sectional study design targeting patient, health care professionals and managers at the County Referral hospital in Nyeri. Administration of structured questionnaires and key informant interviews were carried out to acquire qualitative and quantitative data. A sample size of 402 respondents was estimated proportionate to the population from a sampling frame of patients seeking outpatient services at the County Referral hospital. Purposive sampling was used to pick key informant respondents while patient respondents were picked by systematic random sampling. Acquired data was analyzed by use of SPSS version 23 and MS excel. Inferential statistics included Chi-Square tests done at a confidence interval of 95% to ascertain association between the study variables while thematic analysis was applied for qualitative data. The study found that majority of respondents were female, young, self-employed, had low income and lived in rural areas. Chi-square tests showed that sex (p=0.004), level education (p=0.000) and residence (p=0.000) were significant. Majority of the respondents said that they had never been given information about the referral process. Even among those who had received information, majority reported information given was not clear. Lack of awareness was also highlighted as a factor influencing referral during key informant interview. Awareness (p=0.000) was significant. Slightly less than half responded they were dissatisfied with health care services they received Chi-square results showed that distance (p=0.000), infrastructure (p=0.004) and general satisfaction (p=0.000) were significant. The odds of females practicing referral as compared to males (OR= 0.54;95% CI 0.35-0.82), awareness (OR=0.21;95% CI 0.13-0.34) residence (OR=23.47 95% CI 13.54-40.69) remained significant in the logistic regression analysis. Descriptive results showed that respondents were dissatisfied with waiting time and patient-doctor relationship. Lack of medicine and lack of information were other factors cited for dissatisfaction. The study therefore concluded that referral for health care services among outpatients was predicted by socio-demographics, awareness and health system factors with awareness being the most important predictor. The findings of this study therefore call for a public sensitization campaign to enhance the utilization of primary healthcare facility with the ultimate goal of having a smooth referral process. The county governments also need to ensure that primary health facilities are adequately staffed and well equipped especially with medicines.Item Tuberculosis Treatment Adherence among Patients Taking Anti-TB Drugs in Kilifi County, Kenya.(Kenyatta University, 2022) Chebet, Nancy Auguct; Joyce KiruiTuberculosis is a still global public health problem, despite numerous interventions in place to reduce its spread and burden among the poor. Despite TB being a treatable, curable and preventable disease, there has been very minimal decline of below 2% to TB incidence in the past years, with over 4 million cases neither diagnosed nor treated. TB has no empirical measure for treatment adherence. WHO, defines treatment adherence as either process or outcome oriented. Process oriented include the use of pill count and appointment date keeping, whilst outcome orient includes use of cure rate as a measure of success. Kilifi County has case notification rate of 189/100000 which are higher than the national standing of 154/100000. Malindi subcounty reported low treatment success rate and cure are of 68% and 68% respectively which are way below the national target of 90% cure rate, less than 5% loss to follow-up (LTFU), <5% TB deaths and 0% patients not accounted for. Further in the recent years there has been increasing loss to follow up cases of 8% in 2017, to 42% in 2018 as reported by TIBU. The study adopted a descriptive cross-sectional study to determine individual factors, behavioural factor, societal factors and health facility factors that influence TB patients into adhering to treatment in Malindi subcounty, Kilifi County. The data was collected from structured questionnaire from Morisky adherence scale and focused group discussion. The study was pretested in Kilifi County Referral Hospital-TB clinic for Validity and reliability. The findings were analysed using SPSS version 20.0, further analysed through using Odd Ratio to measure the strength of variables to treatment adherence. The findings indicated TB treatment adherence in Kilifi County was at 75% which was below the National target of 90%. Sociodemographic factors like living with family and level of knowledge on TB specifically what causes TB, who can get TB and duration of treatment were associated with TB treatment adherence. Behavioural factors of perceived severity, perceived susceptibility, Societal factors like stigma and health facility factors like patients’ satisfaction were factors associated to TB treatment adherence. We recommend the Ministry of Health increase health advocacy on TB at the community to increase knowledge and reduce stigma. Secondly, Policy makers should recommend regular patient trainings on behaviour change campaigns to increase perceived severity and perceived susceptibility during treatment regime. Thirdly, refresher trainings for health care workers on service delivery to patient satisfactionsItem Utilization of Free Maternity Services among Mothers Aged 18- 49 Years in Nakuru County, Kenya(2022-04) Najoli, Priscilla Jemeli; Dr. Joyce KiruiIn response to sustainable development goal (SDG) 3,all countries were expected by 2030 to have improved maternal and neonatal health indicators.In Kenya,the hope of free maternity services (FMS) was to increase the demand for maternity health care services offered by certified health professionals.This,inturn would contribute to reversing MMR and neonatal mortality and improve the uptake of skilled birth attendance(SBA).Nakuru County has indicated poor maternal child health indicators as demonstrated by increased MMR,neonatal mortality and low SBA.Thus,this study aimed to determine and understand the utilization level of FMS among mothers aged 18-49 living in Naivasha Sub-County,Kenya.The research employed a crosssectional and descriptive design that involved 392 women who utilized FMS 2018- 2019.A mixed-methods approach collected quantitative and qualitative data through structured questionnaires,health records reviews,focus group discussions, and key informant interviews.The quantitative and qualitative data were analyzed by use of SPSS 20 and content analysis respectively.The results were further subjected to multiple regression analysis.The findings showed that over 80% utilized antenatal care, facility deliveries and postnatal care, but 68% of respondents utilized family planning. The mothers were found active in their first, second and third pregnancies in utilizing FMS followed by a sudden decline.The mothers preferred the public health facilities to the private, mission and NGOs.The significant findings influencing the utilization of FMS among the mothers were age (P=.004), the number of children (P=.000), age at first birth (P=.025), household income (P=.008) and residential area (P=000).The mothers in rural and periurban settings utilized the FMS than their counterparts in the urban areas.The mothers' level of knowledge on FMS was notably at 80%.The radio, television,health facility and community sources were significant with (P=.000) as effective sources of information for the mothers in the community.The decision makers consider age, the number of children, age at first birth, household income and residential area in formulation of FMS policies.Further,utilize relevant sources of information on FMS in the community.Item Determinants of Elimination of Mother to Child Transmission of Hiv among Patients at the Nakuru County Referral Hospital, Kenya(Kenyatta University, 2022) Isindu, Boniface Ambani; Alloys Orago; Joachim OsurGlobally, 37.6 million people living with HIV around the world, 67% live in sub-Saharan Africa. Out of the 200,000 new diagnoses of HIV in Africa in 2021, young women and adolescent girls aged 15-24 made up 27% of those new cases. The United Nations reported 1,000 new infections per week in this group. Regionally, out of the 20.7 million adults living with HIV in the region in 2018, 12 million were women: young women (aged 15–24 years) account for 26% of new HIV infections: In Kenya, tremendous progress in slowing down spread of HIV has been made with new infections declining by 68.4% between 2013 and 2021.Deaths attributed to HIV/AIDS had dipped by 67% from 58,446 people in 2013 to 19,486 in 2021.Increased number of people on life-saving antiretroviral treatment ;Rise by 83%, from 656,369 in 2013 to 1,199,101 in 2021 adults prevalence stands at 4.9%;Women at 6.6% twice that of men (3.1%) as per Kenya Population-based HIV Impact Assessment (KENPHIA) 2018 survey Mother to child transmission (MTCT) of HIV, is the main route of HIV infection among infants born by HIV positive mothers. An estimated 50,000 to 60,000 infants contract HIV infection annually in Kenya through their mothers .Kenya rolled out a countrywide Prevention of Mother to Child Transmission (PMTCT) programme to reduce the HIV infection in children because the main route for HIV transmission among children is through birth .In Kenya, an estimated 37,000 to 42,000 infants are infected with HIV annually due to MTCT.During pregnancy, about 5 to 8 percent of HIV-exposed babies become infected through transmission across the placenta. In Kenya, the national MTCT rate for the year 2021 was 3.2% while the rate in Nakuru County was reported to be 4..9% with the highest reported rate being in the month of march 2021 at 9.4%.Currently the MTCT rate reported in Nakuru county (4.9%) is much higher than the National rate (3.2%).The causes of this sustained high MTCT rate are not well documented hence this study at Nakuru County Referral Hospital to investigate these determinants. The Study objective was to investigate the determinants of eMTCT among patients at Nakuru county Level 6 Referral Hospital, Kenya. A cross sectional analytical research study was carried out with data collected from ANC mothers, key informants and FGD participants using structured questioners, key informant interview guides and FGD guides. The analysis of the data collected from the ANC clients revealed that nearly seventy percent of mothers had no knowledge of services provided to seropositive pregnant mothers to reduce the risk of transmission to unborn child. Further analysis revealed that low male involvement and participation, Stigma, and discrimination, peer pressure, social groups, religious sects, ceremonies (funerals), visiting sick people in the community were key social determinants that sustained high transmission rates in the county. Cultural beliefs, practices and taboos had a significant contribution to the high MTCT rates that were reported in the county. Low level of knowledge contributes significantly to the high MTCT rate reported in Nakuru Referral Hospital as were social cultural factors. It was recommended that Ministry of Health in collaboration with Health implementing partners and all health actors to develop promotional messages and information on eMTCT and disseminate them to all pregnant women attending ANC at all health facilities in the country. Socio mobilization and awareness on Prevention of Mother to Child Transmission program to be scaled up to empower women with knowledge on PMTCT. Community and political leaders to be enlightened by health implementing partners on good health practices to discourage pregnant women from their negative cultural beliefs and practices to promote health seeking behavior among these women. Health education and health talks to pregnant women to focus more on the importance of adherence to clinic appointments during their pregnancy life to benefit from services provided.Item Use of Routine Health Information for Decision Making among Health Care Workers in Marsabit County, Kenya(Kenyatta University, 2021) Asafa Aila, Mohamed; Peter KithukaGlobally, health agencies have delved in strengthening health systems as a means of improving health outcomes. In Kenya today, the management of the public health facilities at different levels is more concerned about the collection and reporting of routine health data through District Health Information Software (DHIS2) but little is known on how individual facilities analyze report and disseminate the same for use in making informed decisions at the facility level. Yet in spite of the introduction of DHIS2, recent evidence has shown very low levels of data demand and use by the targeted stockholders in Kenya. Generally, there is a concerted effort by both the government and the international bodies to accelerate the collection of health data, but little efforts have been made to ensure its utilization at facility levels. The current study assessed the factors associated with the use of routine health information for decision making among health care workers. The study employed descriptive cross-sectional design. Researchers purposively stratified 201 health workers by cadre, and then probability proportionate sampling was applied to get the required number from every cadre. Both qualitative and quantitative data were collected. Quantitative data was entered into the SPSS software, descriptive statistics and Chi-square tests were used to analyze the data. Whereas qualitative data was analyzed thematically. The study found that the overall Routine Health Information (RHI) used was evidently below average at 47.1% in decision-making across six management functions. However, RHI was above averagely used for medical supply at 54%, service delivery at 57%, and identification of gaps at 56%. It was below averagely used for the formulation of plans, budgeting, and staffing decisions. It was also found that the health facilities lacked sufficient IT accessories. Nevertheless, internet access was at 71 % and electricity supply at 84 % implying access was not limited. The type of software use had a significant association with the frequent use of RHI at a p-value (0.028<0.05). The majority 74% of respondents had basic computer skills but 80% of respondents lacked training in health information management. The study concluded that the use of RHI in decision-making was below average and training increases the likelihoods of healthcare workers utilizing RHI. Also, computers and the types of software were likely to influence the use of RHI. The study recommends that the County government of Marsabit should embrace the adoption of the electronic medical record system in all health facilities to strengthen the practice of RHI use in decision-making across all health system blocks. In addition, the County government should increase the availability of IT accessories in health facilities to enhance data management practices. Further, the study recommends that the County should provide continuous training for HCWs by focusing computer literacy and data management through on-job training, and refresher courses.Item Assessment of Anti-Female Genital Mutilation Program in Garissa County, Kenya(Kenyatta University, 2021) Derow, Yasmin Hassan; Eliphas GitongaFemale genital mutilation (FGM), is a social traditional practice performed by cutting parts of the external female genitalia. Globally, over three million women take part in the practice each year. The practise of this rite was made illegal in Kenya in 2011 and a board established to spearhead its abandonment in a program referred to as AntiFGM campaign. Garissa County in north eastern Kenya has the highest practise of FGM with a prevalence of 94%. This study aimed to investigate the success of the antiFGM programs in Garissa County with specific objectives being to determining the level of knowledge of adolescents/youth of Garissa County towards the anti FGM law, to determine the attitude of area residents towards the anti FGM law and to determine factors that influenced the implementation of the antiFGM law in Garissa County. Mixed methods study design was used in this study. A cross-sectional design using interviewer guided questionnaires to collect data was conducted among 108 randomly selected participants and results used to answer objectives one to three. Desktop review of previous studies was use to answer objective four. Data was analyzed using SPSS version 25. Chi-square and Fishers exact were used to compare participants characteristics against study outcome variable. Of the 108 participants, 53.7% were female. The median age of participants was 23 years (Interquartile range [IQR] 15-40). The prevalence of FGM was 62% with the mean age of circumcision being 8.3 years (SD 2.7 years). There was a statistically significant association between practicing Islam and FGM (p=0.001). There was an improvement on the level of awareness of the antiFGM law among youth in Garissa at 84%. Two thirds of participants did not support FGM. Mothers were the main influencers and decision makers on having FGM practiced. Excision was the main type of FGM practiced with traditional circumcizers being the preferred circumcizers followed by trained nurses and midwives. Introduction of the antiFGM law and advocacy by NGOs focused on combating FGM has led to a reduction in the prevalence of FGM and a reduction in the support of the act. There is an increase in the medicalization of FGM in Garissa with evidence of the practice going underground. This study recommends NGOs to have a clearer focus on the method chosen in advocating for abandonment of FGM.Item Preparedness for Ebola amongst Healthcare Workers in Public Health Facilities in Nairobi City County, Kenya(2021) Elyas, Mohamed Ali; Andrew YitambeEbola virus disease, a highly infectious viral condition, has caused the worst epidemics in the West African countries of Guinea Bissau, Sierra Leone and Liberia in 2014-2016.In 2018 the virus re-emerged in Democratic Republic of Congo prompting WHO to declare it a public health emergency of international concern with the most recent outbreak in Guinea Bissau in 2021. Kenya is at high risk due to its proximity to the affected countries of DRC and Uganda, its porous borders and its high volume of international flights. Thus, Kenya’s preparedness mode is heightened with measures including reactivation of Ebola Contingency Plan, conducting simulation exercise at Kenyatta National Hospital and mapping of the counties based on their Ebola risk levels instituted albeit at the national level. However, less attention has been given in terms of preparedness to the healthcare workers at critical service delivery points at the Public health facilities in high risky Nairobi City County. This prompted the need to identify the organizational support for healthcare workers, their risk perceptions and socio-demographic characteristics associated with Ebola preparedness amongst healthcare workers in Public health facilities in Kibra sub-county. A cross-sectional descriptive study design was adopted and 165 established as the sample size. Response rate stood at 95% with 157 of the 165 health care workers fully participating. Probability proportionate to size together with simple random sampling was used. Data was analysed using statistical packages for social sciences (SPSS) version 23, where both descriptive frequencies and inferential statistics generated. Chi-square was used to establish associations between variables. Ebola preparedness was assessed using three criteria of capacity to detect Ebola case, protect staffs and notify for action. Majority of the healthcare workers felt unprepared (66%). Socio-demographic characteristic was found to be associated with healthcare workers’ Ebola preparedness with age (χ2=21.; df=3; P<0.001) and professional cadre (χ2=28.901; df=7,P<0.001) emerging significant predictors. Younger respondents were found to be less prepared for Ebola. It further revealed that healthcare workers with low perceived risk were more prepared for Ebola (χ2=6.854, df=1, P=0.009). Besides, several organizational support factors such as access to hand sanitizers (χ2 =13.893,df=1,P<0.001), pairs of gloves (χ2=11.863,df=1,P=0.001), holding Ebola related briefs (χ2=11.144,df=1,P=0.001), risk alert sharing (χ2=27.081,df=1,P<0.001) having participated in Ebola training (χ2 =11.144,df=1, P=0.001) and whether contents of the preparedness plan was availed (χ2 =7.303,df=1,P=0.007) were established to be associated with Ebola preparedness. Conclusively, the study established socio-demographic characteristics, risk perceptions and organizational support to be significantly associated with Ebola preparedness. To fill the limitation of this study, there is need to undertake similar study on healthcare workers preparedness for Ebola in both Public and private health facilities across counties with a view to increase sample size for wider generalizability of the findings.