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Item Household and Community - Based Factors Associated with Universal Coverage of Insecticide - Treated Nets (ITNs). Results from a Cross - Sectional Malaria Survey in Vihiga County, Kenya(IJSR, 2024-09) Odipo, Jacob Owiti; Otieno, George; Yoos, Aliso; Wanjau, GraceBackground: Insecticide - treated nets (ITNs) are an essential tool for preventing the spread of malaria. An adequate number of ITNs in households increases the probability of its use. Unfortunately, it's still unclear what factors prevent households from achieving universal coverage of ITNs despite the free mass net distribution every three years. This paper explored the household and community - based factors associated with universal ITN coverage in Vihiga County, Kenya. Methods: A cross - sectional survey was conducted among households in Vihiga County. Households were enrolled through multistage sampling and data was collected through structured questionnaire. Universal coverage was defined as the proportion of households with at least one ITN for every two people. Bivariable analysis was conducted using the chi - square test while determinants of universal coverage of ITNs and usage were assessed using multivariable logistic regression at a statistical significance of P - value<0.05 and 95% confidence interval. Results: The study revealed that 262 (59.55%) had achieved universal coverage. Factors associated with universal coverage included household head marital status (P=0.04), ease in setting up the ITN (P=0.011). Household head married/ living with their partners also had a three times better likelihood of ITNs use (OR=3.46.95%CI= 1.47 - 8.17). Education level was not significant in the attainment of universal net coverage. Conclusion: Only 59.55% of households had attained universal ITN coverage against the global target of at least 80%. Free mass net campaigns should be encouraged with more focus on single household heads or those staying alone. Additionally, a replacement framework of destroyed ITNs should be considered in order to maintain universal ITN coverageItem Analysis of Cost Associated with Treatment of Road Traffic Injuries among Victims at the Kenyatta National Hospital Nairobi City Kenya(IJRISS, 2022) Lipule, Zablon.anyenda; Yitambe, Andre; Rucha, KennethBackground; Previous studies have pointed out that road traffic injuries (RTIs) as a leading cause to fatalities of over one million victims globally per year which bears negative impact on health, economy and development of the society as a whole. Furthermore, young men and women at their most economic age group have been identified as the most vulnerable group to road traffic injuries (RTIs) resulting to mortality and very severe morbidity due disability. However, there is little or no published evidence on healthcare resource allocations and utilization after RTIs, especially in developing countries that include those in Africa. Objective: The main objective of this study was to analyze the total hospital cost related to RTI (Road traffic injury) victims admitted for a period of 3 months. The study demonstrated effects of direct and indirect medical cost , productivity loss and hospital length of stay on total cost of road traffic injuries of RTI victims at KNH. Methods: This was a cross sectional study design done at the Kenyatta Hospital Nairobi, surgical wards and Accident & Emergency. A sample (n=124) consisted of new victims admitted to the Hospital due to RTI from January 25th 2019 to 24th April 2019., this was two thirds of the sample size at 74% respondent rate who gave consent and all ethical approvals granted. The data collection of direct and indirect medical cost was by data extraction tool, testing of the tools was done at the surgical ward. Productivity loss of the victims was calculated by use of Work Productivity and Activity Impairment Questionnaire (WPAIQ). SPSS version 22 was applied and descriptive statistics to show frequencies and Percentages for categorical variables (victim’s unique individualized characteristics). Multi Linear Regression Model Test was used test the relationship between the independent and dependent variables. Results: The study results indicated that direct cost factors (laboratory cost, A&E Charges and Diagnostic Cost) (X1: β1 =.199, P<. 047), (X3: β3 =.469, P< .037), and (X4: β4 =.029, P< .048) had a significant influence on the overall cost of treatment of RTI victims seeking treatment at the KNH, there was no significant relationship between Bed Charges (X2: β2 =.117, P>.689) and the cost of treatment of RTI victims seeking treatment at the KNH. The findings of the study also indicated that Y= 7.949+.001X1+0. 458X2+0. .239 X3+ 0. .305X4+e where a .199 change in direct cost, .117 changes in indirect cost, .469 change in total productivity cost and .029 changes in duration of stay in hospital influenced a unit change on the cost of treatment of RTI victims seeking treatment at the KNH. Most distribution of injuries was lower limbs at 51.6% Conclusion & Recommendation: The study concludes that Road traffic accident is an economic burden to individual, family and country at large. The study recommends, need for an awareness on importance of National Hospital insurance fund (NHIF) as a universal health coverage fund for people at an affordable cost, there is need to reduce the indirect cost of treatment associated indirect cost of treatment, support to from one person or two further increasing productivity time associated with the injury. Further motion study on cost analysis will give a detailed insight on these area of study.Item Perceived Indigenous Perspectives of Maternal Health Care Services among Women of Marakwet, Kenya(JAMMR, 2019) Cheboi, Solomon Kemoi; Kimeu, Anastasiah Nyamilu; Rucha, Kenneth KibaaraBackground: Recognition of the vulnerabilities and differentials in maternal indicator is a pressing concern throughout safe motherhood literature. Uptake of skilled delivery by women in Marakwet remain 44%, compared to the national rate of 68%. Accountability for improving maternal indicators calls for interrogation of indigenous practices to amend complex social causes. Methods: This was a qualitative study conducted in the thirteen patrilineal clans of Marakwet. Discussants were women of reproductive age while key informants included cultural anthropologist, traditionalist and gatekeepers. The data was analyzed manually through a process of data reduction, organization and emerging patterns interpretation then sub categories. Results: Pregnancy and delivery are not just biomedical process but culturally biosocial practice. Discipline and socialization are critical elements. Adequate self, family and community care lead tonoble pregnancy outcome. The community and midwife uses knowledge to jumpstart childbirth practices for expectant women for healthy prenatal period, delivery and postnatal running. Holiness and hygiene, controlled sex and sexual relationships, artefacts and dressing, food ways and diet, social interaction, livelihoods and lifestyle are key pregnancy and childbirth social aetiology. Conclusion: cultural stimuli and remedies inform maternal health seeking behaviour and practices of women. Continued care, hygiene, geophagy, controlled food ways and social interaction as well as avoiding heavy duties and events that trigger emotions and pressure are sound indigenous ways of improving maternal and child health. However, norms such as visiting a midwife for pregnancy confirmation and massage as well as folk activities such as the use of charms and repertoires for protection and cleansing ceremonies provide false protection. Recommendation: the results suggest the relative value for indigenous maternal health care services in enhancing client centered delivery health services. Review of policies and programs to integrate harmless indigenous practices into maternity care services may promote quality, satisfaction and uptake of facility based childbirth servicesItem Factors Influencing Adherence to Data Protection Guidelines among Researchers at the Kenya Medical Research Institute(tijst, 2019) Kebenei, Enock Kipchirchir; Otieno, George O.; Rucha, Kibaara KennethBackground A study conducted in Kenya between January and June 2014 showed that one of the important challenges facing researchers in public health data sharing is the risk to the interests of study participants. Exposure of participant’s data can lead to stigmatization, loss of privacy, and unfair competition. Data loss can be through the form of intentional and unintentional 'misuse' of data. This study sought to determine the factors influencing adherence to the data protection guidelines among the researchers at KEMRI, Kenya: the national body responsible for carrying out health research in Kenya. Objective The study sought to determine the individual and organizational factors influencing adherence to the data protection guidelines among health researchers in KEMRI, Kenya. Methods This study was conducted among health researchers at the Kenya Medical Research Institute in Nairobi, Kilifi, Kisumu, and Busia Counties, Kenya. This was a quantitative cross-sectional study design involving 141 health researchers. Stratified sampling method was used to obtain the representative sample of the whole population. Questionnaires were administered to the selected KEMRI researchers. A total of nine questions extracted from the NACOSTI guidelines were asked. A respondent was considered to have adhered if he/she has agreed to all the nine questions. A p-value of <0.05 was considered statistically significant. Results The significant individual factors that influences adherence to the national data protection guidelines among KEMRI researchers are common forms in which data may leak to unintended persons/places (p-value of 0.04) and research stages (p-value of 0.03). The availability of guidelines or policies on data protection within the institute is the organizational factor which highly influences adherence to data protection with a p-value of 0.01 (this shows that it is highly significant). Institutional Ethics Review Boards (IRB) and Data Safety & Monitoring Boards (DSMBs) clearly do not play a critical role in data protection in health research with a p-value of 0.77(this shows that it is highly insignificant). Conclusion These results imply that both the individual and organizational factors influence adherence to the data protection guidelines among health researchers.Item Determinants of Data Use for Decision Making in Health Facilities in Kitui County, Kenya(QJMSS, 2021-06) Karijo, Eddah Kanini; Otieno, George Ochieng; Mogere, StephenBackground: Effective management of today’s health systems depends on the critical use of data for the policy-making, planning, monitoring of services, and making decisions. The use of data 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 a shorter timescale. Objective: This study was designed to identify determinants of utilization of routine data for decision making by health care providers in health facilities in Kitui County in Kenya. Method: The conceptual framework was constructed from the literature review. This was a descriptive cross-sectional study adopting quantitative and qualitative research paradigms. The district hospital was purposively selected. Multi-stage cluster sampling was used to sample the health facilities in sub-counties and simple random sampling to select the respondents from different cadres in health facilities. The 110 participants completed a self-administered questionnaire. Key informant interviews, focused group discussions, observation, and analysis of documents in health facilities were applied. Recordings were transcribed and key concepts identified. Questionnaire results were edited, coded, tabulated, and analyzed using the SPSS 18. Result: Respondents interviewed were from different cadres of health care providers including doctors, clinical officers, nurses, and midwives from different levels of health facilities. Among the respondents, 70% were females, and 30% males. The majority, 64% had a diploma level of education. Nurses/ midwives were the majority, making up 81% of the workforce. The overall extent of data utilization was 66% not using data and 34% use the routine generated data. The following actors influence utilization of routine data: frequency of meetings held (x2=42.036, df=1, p=0.001), data storage and analyzing methods (x2= 30.582, df=1, p=0.001), and continuous professional training (x2= 49.782, df=1, p=0.0001). Organization of the district health system influenced routine data utilization through the frequency of support supervision (x2=30.000, df=1, p=0.001), issues assessed during supervision (x2=49.164, df=2, p=0.002) and feedback report from the supervisors (x2=5.236, df=1, p=0.022). Conclusion: The study demonstrated limited utilization of routine data for decisions in health facilities and recommended the need for capacity building for data utilization through on job training and strengthening the curriculum in health training institutions in data-related areas. The ministry of health can standardize the parallel reporting levels and unify the reporting tools and finally ensure the districts have structured meetings, support supervision, and feedback to the health care providersItem Utilization of Focused Antenatal Care among Expectant Women in Murang'a County, Kenya(ajol, 2021-05) Kiplangat, Titus Mutai; Otieno, George OchiengFocused Antenatal Care (FANC) is crucial to improving maternal and infant health. Despite the Government of Kenya' efforts to reduce maternal and neonatal morbidities and mortalities, these conditions prevail in Murunga. The current study examined how individual, organizational, and policy factors influence the utilization of focused antenatal care services amongst women in the Gatanga sub-county, Murang'a County, Kenya. The cross-sectional survey data was collected between June and July 2019 from three sampled wards. A structured questionnaire was administered to 334 women of reproductive age, aged 18 years and above, who delivered within the past one year or above 38 weeks of gestation. Descriptive statistics and chi-square tests at a 5% level of significance were done using SPSS version 22. The findings indicated that 37.3% of respondents do not utilize FANC services. Level of education (X2 (3) = 16.05; p < 0.05), occupation (X2 (3) = 16.50; p < 0.05), level of income (X2 (4) = 15.53; p < 0.05), time taken to the facility (X2 (3) = 34.72; p < 0.05), and waiting time (X2 (3) = 14.17; p < 0.05) were found to significantly influence utilization of FANC services. Therefore, women should be empowered through education and economic activities to remain financially independent. The government should also improve access to health care, especially in rural areas, by building new health facilities to improve the utilization of FANC services. Besides, more health care providers should be employed to reduce the waiting time at the facility.Item Patients’ Rights Charter Adoption among Healthcare Professionals in Mbagathi Hospital, Nairobi City County, Kenya(IAJHMN, 2024-02) Thuo, Wango’mbe Muthoni Irene; Kithuka, Peter; Rucha, KennethSince 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 Patients' Rights Charter among healthcare professionals at Mbagathi Hospital. Quantitative and qualitative methodologies in a descriptive cross-sectional research design were used for data collection, whereby a semi-structured questionnaire was administered to the selected healthcare professionals at Mbagathi Hospital. The stratified sampling method from Yamane's (1967) was used to select the desired sample in each of the six 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 pvalue 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 the 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 health care 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 and clients (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 on the process of implementing the Kenyan Charter for Patients' Rights (P = 0.00), thus correlated with the adoption of the Patient Rights Charter. The study thus concludes that respondents appeared to be familiar with the patients' rights, but they faced several obstacles that prevented them from completely embracing the Patient's Rights Charter at the public hospital. Hence, recommend that, in order to safeguard patients' legal rights and deliver higherquality care to them and their families, legislators and health care administrators have a thorough awareness of healthcare hurdles. The government should make sure that all healthcare professionals have the tools and information required.Item Financial Benefits of Enlisting in Mutual Health Schemes among Low-Income Households in Kirinyaga County, Kenya(IPRJB, 2018) Munyua, Timothy; Yitambe, Andrew; Rucha, KennethAbstract Purpose: Examining the financial benefits of enlisting in mutual health schemes among lowincome households in Kirinyaga County Material and methods: Descriptive cross-sectional study design was employed, where 315 participants were picked using multistage sampling techniques. Semi-structured questionnaire and in-depth interviews were the primary data collection methods, with both descriptive and inferential statistics being employed at the analytic stage. Results: Results indicate that 59.3% of households utilising out-of-pocket benefited from membership to cushion their family from difficulties of accessing healthcare services. Other financial benefits include protection against the cost of illness, providing access to prioritised care, third-party influence for non-members to subscribe, and productive value such as accessing quality treatment, improving living standards, avoiding debts, and increasing their saving kitty. Enlisting to MHO also reduced gender-based, education-based, and cadre-based sociodemographic differentials. Recommendations: While MHOs are critical in reducing household healthcare expense, improving financial accessibility, as well as redressing sociodemographic differentials during careseeking events among low-income households, there is a need for preparing reports on beneficiaries to help the management understand social dynamics surrounding the operations of the schemes. There is also a need for investigating healthcare seeking behaviours of beneficiaries as some persons did not utilise mutual schemes. There is also need for further research to validate the contribution of mutual health schemes in other areas as well as assess strategies of increasing the access for all socioeconomic factionsItem Comparison of Machine Learning Methods for the Prediction of Type 2 Diabetes in Primary Care Setting Using EHR Data(JAGST, 2023-10) Olwendo, Amos Otieno; Ochieng, George; Rucha, KennethABSTRACT Diabetes remains a major global public health challenge, thus the need for better methods for managing diabetes. Machine learning could provide reliable solutions to the need for early detection and management of diabetes. This study conducted experiments to compare a number of selected machine learning approaches to determine their suitability for early detection of diabetes in the primary care setting. A retrospective study was conducted using EHR dataset of confirmed cases of diabetes collected during routine care at Nairobi Hospital. Institutional ethical approvals were obtained, and data were retrieved from the database through stratified sampling based on gender. Diagnoses were confirmed using the ICD-10 codes. Records with 5% or so of missing values were excluded from this analysis. Data were processed by correction of errors and replacement of missing values using measures of central tendency. The data were transformed through normalization using the decimal-scaling method. Data analysis was conducted using selected supervised and unsupervised learning algorithms. Model performances were validated using metrics for the evaluation of classification and clustering results, respectively. Random Forest had the highest accuracy (0.95) and error rate (0.05), while Gradient Boosting and Multilayer Perceptron (MLP) with 3 hidden layers obtained accuracy (0.94) and error rate (0.06), respectively. The process of selecting machine learning algorithms needs to explore both supervised and unsupervised learning techniques. In addition, an appropriate architectural desigItem Improving Health Systems: Influence of Technical Capacities of Community Health Volunteers on Use of Community Health Information Systems in Kenya(IJCA, 2018-07) Mambo, Susan Njoki; Odhiambo-Otieno, George W.; Ochieng’- Otieno, George; MwauraTenermbergen, WanjaWHO identified six key pillars of an effective health system namely: leadership and governance; service delivery; health workforce; health information systems; medical products, vaccines and technologies and healthcare financing. This study focused on Community-based Health Management Information System (CbHMIS) of health information pillar. A Community-based Health Management Information System (CbHMIS) is a type of health information system based in the rural community and informal settlements of urban areas. CbHMIS’s main objective among others is to produce relevant and quality information to support decision making on public health issues at the community level. The importance of effective information use is still a key impediment to achievement of goals at level one of health care delivery. According to a situation analysis on the state of Community Health Services in year 2014, the functionality of CbHMIS was said to be at 64% which came down considerably to 55% in year 2015 documented by USAID, and that access to quality data was not guaranteed through the current CbHMIS.Lack of technical capacities among the CHVs is a serious gap in achievement of information use in Kenya.This study aimed at establishing the factors influencing technical capacities of community health volunteers on use of CbHMIS in Kenya.Other objectives of this study were: To establish the influence of System Availability on CbHMIS use; to find out effects of availability of skills to CHVs on CbHMIS use, To assess the influence of personnel knowledge on CbHMIS use, To identify competencies of CHVs that influence CbHMIS use. The selected counties were Kiambu, Kajiado and Nairobi which gave a rural, urban and peri-urban representation respectively of the country. This was a crosssectional analytical study design, with both quantitative and qualitative data collection methods. The target population was 156 active Community Units (CUs) from the 3 counties where a total sample of 122CUs (50 in Kiambu; 26 from Kajiado and 46 from Nairobi CUs) was derived using Mugenda and Mugenda formula of populations less than 10,000. Multistage sampling was used to identify the CUs; Systematic random sampling was used to identify total of 366 respondents 3Community Health Volunteers (CHVs) were purposively sampled form each CU to make a total of 366 (150 in Kiambu; 78 from Kajiado and 138 from Nairobi. A total of 6 KIIs (two from each county) and 3 FGDs (one from each county) were conducted for qualitative data. Interviewer administered questionnaires were used to collect quantitative data, observation checklist was also used. Quantitative data was analyzed using SPSS to generate univariate and bivariate analysis at p<0.05 significance level. Qualitative data was analyzed using content analysis based on key themes generated from the objectives. Results were presented in form of graphs, tables, figures, and narration. Use of Cb-HMIS stood at 56.6%. Slightly above half 51% of respondents agreed to having technical skills on CbHMIS, However a KII noted that “….We have challenges in training all our CHVs and refresher trainings due to funding so you will find some have been partially trained….”.There was statistical significant differences between group means (F(2,363) = 32.47,p = .000). (X1) explains 28.6% of the total variations in the use of CbHMIS (R 2 =.286). This implies that the use of CBHMIS by Community Units (CU) improves significantly when the CU personnel have better technical capacitiesItem Providers’ Understanding of Cancer Aetiology and Supportive Features for Indigenous Palliative Cancer Care Service Provision in Kenya(SAGE, 2023-08) Cheboi, Solomon K.; Lagat, Kiprop; Nyawira, Daisy; Kariuki, Peris; Mutai, Joseph; Nganga, WanjiruBackground: Palliative care is a fundamental component of providing people-centred health services to cancer patients. However, the primary pillars of indigenous palliative care such as provider understanding of cancer, its aetiology, and features are undocumented. Objective: We sought to understand Traditional Health Providers (THPs) understanding of cancer aetiology, and the functional features that support indigenous palliative cancer care service provision in Kenya. Method: The study used a mixed methods cross-sectional design. A semi-structured questionnaire was administered to 193 THPs, who self-reported to manage cancer patients. The findings were enriched and validated through member checking in 6 focus group discussions and five journey mapping in-depth interviews. Results: Despite diversity in culture and experience among the indigenous providers in Kenya, their description of cancer etiology and their management practices and primary goal were similar. Cancer was consistently described as a deadly lifedeforming disease by 61.1% of THPs (n = 118/193) and attributed to chemicals and toxins in the body 41.5% (n = 80). The indigenous palliative-care system was reported to be characterized by five tiered levels of care, diversity in expertise and experience, shared and consultative process (60%) and family involvement in medical decision (59.5%). Herbal regimen (60.1%) was found to be the cornerstone of informal palliative care blended with nutrition management 78.2% (n = 151), lifestyle changes 63.7% (n = 123) and counseling services 55.9% (n = 108). Payments for service were arbitrarily made in cash or in kind. Conclusion: The features of indigenous palliative care services are informed by the providers’ distinctive cultural terms and descriptions of cancer and cancer aetiology. Shared and consultative protocols, regimen exchange, referral to cascaded care, and caregiver involvement were all important palliative-care clues to saving and enhancing lives. The features provide context for development of indigenous palliative care framework, engagement of policy makers, and promotion of culturally-inclusive indigenous palliative care model for adoption.Item Technological Factors Influencing the Quality of Data for the Voluntary Medical Male Circumcision Program in Selected Health Facilities in Siaya County, Kenya(EANSO, 2023) Kassim, Saida M.; Otieno, George; Kirui, JoyceThe voluntary medical male circumcision (VMMC) program has been going on since 2008 with limited studies on the quality of data which is defined as data’s fitness to serve its intended purpose. The study sought to assess technological factors influencing the quality of VMMC program data in Siaya County in terms of data timeliness, accuracy, and completeness. Completeness is measured by describing whether a value for a given data element from a facility was available in the information system. Timeliness is measured by the date when data was submitted to the information system compared to the expected submission date. Accuracy is measured by recorded data in Kenya Health Information System (KHIS) with data collected from facility registers. Out of 224 health facilities sampled, 202 responded (90.1% response rate). Questionnaires and Records checklists were administered online to respondents, and Key informant interviews were done with the County team. Statistical Package for Social Sciences (SPSS) analysed quantitative data using measures of central tendencies and measures of dispersion. Pearson chi-square determined associations at a 95% confidence interval and P-value >=0.05. Data Quality Index (DQI) was calculated by aggregating all scores for timelines, accuracy, and completeness. Good data scored 1=Yes across the three variables, and poor data scored a 0- No for either of the three. Using DQI, 29.7% had good data quality. The proportion of the respondents who agreed that staff are trained in Electronic Medical Records (EMR) System (64.2%) was significantly associated with good data quality than those who did not (χ2 =9.10, df=1, p-value=0.01). Key informants reported that staff are trained on VMMC indicators through onjob training (OJT). In conclusion, EMR ensures that all the data in the KHIS is used for planning and decision-making at County and National levels and recommends that health records officers are trained effectively to improve reporting.Item Determinants of Point-of-Care Technology Use among Health Care Workers in Comprehensive Care Centres, A Case of Central Kenya(EANSO, 2023) Muiruri, Keziah; Gitahi, Mary Wangui; Otieno, George Ochieng; King’utu, KevinThe Point of Care (POC) approach is the highest level of interaction between health care workers (HCW) and the information system, which generally requires interaction during clinical meetings. Although it is hard to do so, it offers the most significant benefits. The POC strategy offers the system’s benefits to healthcare workers, patients, and those who monitor and evaluate them. The study focused on identifying key determinants of point-of-care technology use among healthcare workers offering services in comprehensive care centres in Central Kenya. A Cross-sectional descriptive study was adopted, two-stage cluster sampling design method was used in determining the sample size. The study involved a sample size of 217 respondents and over a 100% was achieved. The study results revealed that social demographic factors of health care workers have no significant influence on POC technology use as a p-value of above 0.05 was observed on all the variables. Some organisational factors such as adequate workstations (p = 0.0) and EMR reducing patient time (p = 0.012) were found to have significant influence on POC technology use. Significant influence on POC use was noted on source of funding for software and hardware maintenance (p = 0.001). The utilisation of EMR to review client progress in real-time (p = 0.001) was found to have a significant influence on POC technology use as well as the use of EMR to report to the national reporting system (KHIS) (p = 0.014). 71% of respondents reported that availability of clinical decision support features in the EMR was contributing to improved use of POC. An overwhelming 72% reported that they were very motivated to use POC technology due to the ability of auto generating reports. In addition, three factors were highlighted as key contributors to the success of POC use, and these were reliable power supply (44%), adequate and trained healthcare workers (24%), standard and stable EMR Systems (17%). The study recommended for adequate training of health care workers, adequate workstations, and reliable power supply. For initial implementers of EMRs, they should consider having Standard EMRs that support both clinical decision support features and automated reportingItem Magnitude and Determinants of Self-Referrals among Women Seeking Skilled Birth Attendance Services: A Cross-Sectional Hospital-Based Study in Marsabit County, Kenya(International Journal Of Community Medicine And Public Health, 2021) Adoyo, Joseph O; Makunyi, Eliphas G; Otieno, George O; Yoos, AlisonBackground: Self-referral to higher-level hospitals by women seeking skilled birth attendance services reflects in part their non-adherence to established referral pathways. This choice results in an inappropriate utilization of resources within health system. The Kenya Health Sector Referral Strategy aims at optimising the utilization and access of facilities. The aim of this study was to determine the prevalence and factors associated with self-referral among women seeking skilled birth attendance services in Marsabit County between 1st and 31st Oct 2019. Methods: A cross-sectional study was adopted at the maternity department in the selected public hospitals in Marsabit County, by use of interviewer-administered questionnaires to collect information from 161 women, through systematic sampling between 1st and 31st Oct 2019. Chi-square and multiple logistic regression analysis were used to test for factors associated with self-referral at 95% confidence interval. Results: Of the 161 women interviewed, 47.2% (n=76) were self-referrals. The odds of self-referral to the higher level health facilities were more likely among women: - aged 25-29 (AOR 5.174, CI 1.015-26.365, p-value 0.048); those referred for other ANC services (AOR 4.057, CI 1.405-11.720, p-value 0.010); and those, - who visited the referral facility before for delivery (AOR 5.395, CI 1.411 – 20.628, p-value 0.014). However, self-referral were less likely among women who perceived privacy and confidentiality of services at the referral hospitals (AOR 0.370, CI 0.138- 0.990, p-value 0.048). Conclusions: Almost half of women seeking skilled birth attendance were self-referrals, relates to a possible implication on an unprecedented increased workload at referral hospitals and underutilization of primary health facilities.Item Pattern of epidemics monitoring data reporting among health facilities in Nairobi City County, Kenya(Kenyatta University, 2017) Muturi, S.G.; Otieno, G.; Ngatiri, G.; Muhoho, N.Background: Weekly epidemic monitoring data reporting was adopted in Kenya after the Ministry of Health embraced Integrated Disease Surveillance and Response (IDSR) strategy from WHO - Africa region to facilitate timely detection and response to disease outbreak. The government has a reporting target of 80% but this has not been achieved by many counties including Nairobi County. Underreporting put counties at risk of untimely outbreak detection which can, in turn result in epidemic menace. There is no adequate data to explain under-reporting in Nairobi County. The aim of this study was to determine the factors associated with poor epidemic monitoring data reporting among health facilities in Nairobi County. Methods: This was a cross-sectional analytical study targeting 318 health facilities in Nairobi County, Kenya. A stratified sample of 169 health facilities was selected using simple random. Health facility records were checked for compliance to quarterly submission of reports. A self-administered questionnaire was administered to data focal persons in the health facility in order to understand background characteristics of the participants, data transmission methods at each health facility, adherence to policies, personnel and availability of data collections tools. Data was analyzed using SPSS version 17.0. Relationships among study variables were tested using Chi-square, (P < 0.05). Results: Complete reporting was recoded in a total of 47% of the health facilities within the period under review, 36% partial reporting and 17% had not reported at all. Complete reporting was higher in public facilities (74%) than in private facilities (40.8%). Non-reporting was similarly higher in private facilities (25%) particularly the clinics (33%). Among institution related factors, supervision, presence of data focal person in a health facility and data transmission methods were significantly associated with poor data reporting (P<0.001). Training and awareness of data reporting days were important individual factors which were significantly associated with poor reporting (P<0.001). Rapid response to disease outbreaks is important for control of the disease and its spread to other regions. However, with only 47% of the health facilities in Nairobi County complying with the data reporting requirements, the City is at risk of delayed response in case such outbreak occurred. There is need to streamline the system to realize, exceed and maintain the government epidemic monitoring data reporting target rate of 80%.Item Views of Secondary School Students on Adolescent Friendly Health Services in Level Two Facilities in Mombasa County, Kenya(ajhs, 2020) Amuko, Selpha; Rucha, Kenneth; Otieno, George; Awadh, Khadija; Wanjau, Grace; Yoos, AlisonBACKGROUND Sexual and reproductive health problems remain a major cause of ill health and/death among adolescents. Despite the adoption of adolescent-friendly health services in all government facilities in Kenya, incidences of teenage pregnancies and HIV infections among adolescents aged 15-19 years continue to rise. Understanding adolescents’ views on the health services offered at facilities is important to develop services that are responsive to their needs. METHODS The study was conducted to assess the views of secondary school students on adolescent-friendly health services in level 2 facilities in Kisauni Sub-County, Mombasa County, Kenya. The study looked at staff characteristics, facility characteristics, interpersonal relationships and their relationship on students’ perceptions on friendliness of services. A survey was conducted with 313 secondary school going students from two public schools in Kisauni Sub-County, Mombasa County Kenya. Students were selected using a simple random selection process and structured questionnaires used to collect data. Additionally, researchers assessedfour public primary care facilities using an observational checklist. Key informant interviews conducted on the facility in charges. Relationships between variables were assessed using Chi-Square at a 95% confidence interval. RESULTS Of all the respondents (n=313), 42% reported the services to be friendly. More than half (65.5%, n=205), of all the respondents thought the facilities had appropriate staff to provide adolescent and youth-friendly health services (AYFHS) as well as majority (98%) of all the respondents reporting preference of staff of the same sex and age to offer services to them since they could understand them easily. Media (radio, newspapers) and static advertisements significantly influenced AYFHS (p - values 0.017 and 0.004 respectively). Less than half of those who reported friendly services mentioned being aware of services offered in other settings such as drop-in centres (43.2%, n=32), community outreach (43.7%, n=44) and school health programs (39.2%, n=65). Accessing facility by use of vehicle and walking on foot had a significant influence on AYFHS (p- values of 0.001 and 0.003 respectively). Involvement of other agencies in service review had a significant influence on the friendliness of services (p-value 0.003). CONCLUSION Adolescents perceive the Adolescent and Youth Friendly Services as unfriendly, with access to service as a barrier to accessing these services.Item Suitability of Electronic Health Record Data for Computational Phenotyping of Diabetes Mellitus at Nairobi Hospital, Nairobi City County, Kenya(eajsti, 2021) OLWENDO, A.; OTIENO, George Ochieng; RUCHA, K.This research aims to determine the applicability of routine healthcare in clinical informatics research. One of the key areas of research in precision medicine is computational phenotyping from longitudinal Electronic Health Record (EHR) data. The objective of this research was to determine how the interplay of EHR software design, the use of a data dictionary, the process of data collection, and the training and motivation of the human resource involved in the collection and entry of data into the EHR affect the quality of EHR data thus the suitability of such data for utility in computational phenotyping of diabetes mellitus. This research employed a prospective/retrospective study design at the diabetes clinic in Nairobi Hospital. The first source of data was from interviews with 32 staffs; nurses, doctors, and health record officers using a referenced peer-reviewed usability questionnaire. Thereafter, a sample of EHR data collected during routine care between January 2012 and December 2016 was also analyzed by looking into the quality of clusters identified in the data using a density-based clustering algorithm and Statistical Package for Social Sciences (SPSS) version 21. Regression analysis shows that software design and the utility of a data dictionary explained 50.7% and 32.3% respectively in the improvement of the suitability of EHR data for computational phenotyping of diabetes mellitus. Also, EHR software was rated useful (82%) in accomplishing users’ daily tasks. However, EHR data were found to be unsuitable for utility in computational phenotyping of diabetes. Despite the fact that 88% of EHR data were clustered as noise, the clustering algorithm identified a total of 23 clusters from the diabetes dataset. However, with improved quality of EHR data, sub-phenotyping tasks would be achievable. This research concludes that the poor quality of EHR data are as a result of employees’ unmet intrinsic factors of motivation.Item Prevalence and Complications Associated with Diabetes Mellitus at the Nairobi Hospital, Nairobi City County, Kenya(JHIA, 2020) Olwendo, Amos; Otieno, George; Rucha, Kennethmillion people in Africa had the disease in 2015. Kenya is presently experiencing an increase in mortality and morbidity related to diabetes. Methods: This research employed a retrospective cross-sectional study design that sampled records of confirmed cases of diabetes mellitus collected during routine care between January 2012 and December 2016 at the Nairobi Hospital located in Nairobi city, Kenya. A stratified sample of 652 records of male and female patients were retrieved from the EHR database and analyzed in this research. The dataset was subjected to pre-processing; that involved handling cases of missing values, smoothing for the removal of noise, identification and removal of outliers, and resolving cases of inconsistencies. Data were normalized using the z-score standardization and analyzed based on dimensions of EHR data quality and through cluster analysis using Density-Based Spatial Clustering of Applications with Noise (DBSCAN). Results: The prevalence of T2DM is at 92% and the most common complications of diabetes include; retinopathy (12%), neuropathy (11%), and cardiovascular (11%). Hypertension was present in 39% of cases of diabetes. Conclusion: Diabetes is increasingly becoming a health problem in Kenya thus there is need for increased public awareness of the dangers of diabetes mellitus. Members of the public need to sensitized on the usefulness of physical exercise and dietary requirements to slow the development and progression of diabetes. Also, there is need for understanding the causal relationship between T1DM and T2DM and hypertension.Item Measuring the Extent of Compliance to Standard Operating Procedures for Documentation of Medical Records by Healthcare Workers in Kenya(Scientific & Academic Publishing, 2020) Omoit, David F. O.; Otieno, George O.; Rucha, Kenneth K.Poor compliance to health systems guidelines and standards are associated with a dismal performance and it contributes greatly, to high number of deaths, injury, medical errors, patients harm and ineffective care. Globally, patient harm is the 14th leading cause of disease burden. The study sought to establish the compliance to standard operating procedure (SOP) for documentation of medical records by healthcare workers, Kenya. In particular, the current study leveraged a descriptive cross-sectional methodology to determine the association between socio-demographic characteristics and compliance to SOP for documentation of medical records among 197 healthcare workers sampled from 400 healthcare workers in Bungoma level 4 hospital. Stratified proportionate and simple random sampling techniques were employed. Quantitative data was collected using self-administered questionnaires. Informed consent was nevertheless obtained from all respondents prior to the study. Moreover, data management was made possible using Microsoft Excel and analyzed using Statistical Package for Social Sciences (SPSS) version 22. On the other hand, Chi square analysis was used to test the association between dependent and independent variables, albeit at 95% confidence interval (CI). Frequency tables and pie charts were used to present the results. More importantly, the initial Chi square analysis revealed, a strong association between cadre χ2 (23.67, df=10, N=195) p=0.009, work experience χ2 (8.75, df=5, N=195) p=0.047, and level of education χ2 (10.16, df=4, N=195) p=0.048, even though the association between gender (χ2=0.412, df=1, N=195) p=0.521 and age (χ2=3.172, df=3, N=195) p=0.366 were not significant. The current analysis has confirmed the compliance level was very low at 47.2%. The immediate implication is that the county health management team needs to foster continuous in-service training and refresher courses to strengthen healthcare worker’s skills in compliance with the SOP for documentation of medical records. Future research should otherwise consider looking at the influence of institutional characteristics on healthcare worker’s compliance to SOPs for documentation of medical records in Bungoma level 4 hospital and beyond.Item Quality of Clinical Coding at Mama Lucy Kibaki Hospital, Nairobi City County, Kenya(Globeedu Group, 2018) Kiongo, J. G.; Otieno, G. O.; Yitambe, AndreIntroduction: Professionals from various cadres in the health sector raise concerns regarding the poor quality of clinical coding leading to lack of evidence-based practice. Assessing the quality of the clinical coding in one of Nairobi City County’s major hospital would be a step towards establishing the exact gaps in quality of the coding process and outcome. Method: The study aimed at establishing the quality of clinical coding within Mama Lucy Kibaki Hospital. A cross-sectional descriptive design was used, with a quality of clinical coding checklist used classify codes assignment or lack of which. The sample included 300 patient files selected randomly from a month-long list of patients. Results: The study found out that the overall code accuracy was above average given that majority (58%) of the code assignment were good as established by a composite score of the various coding quality attributes assessed. Code completion was excellent at the facility, as established from the 99% of the files that were completely coded. Conclusions: The health facility could act as a good benchmark for code completion. However, code completion without accuracy in the code assignment invalidates the overall quality of coding. There is great room for improvement as far as code accuracy is