MST-Department of Community and Reproductive Health Nursing
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Item Utilization of Alcohol Use Screening Tool by Nurses at Mathari National Teaching and Referral Hospital, Nairobi City County, Kenya(Kenyatta University, 2023-06) Mwangi, Pius Maina; Lister Onsongo; Catherine Syombua MwendaAbstractItem Determinants of Implementation of Kangaroo Mother Care Services among Healthcare Workers in Makueni County, Kenya.(Kenyatta University, 2023-11) Matheka, Seraphine Mbinya; Priscilla Kabue; Anthony WanyoroAbstractItem Quality Of Life for Family Caregivers to Cancer Patients in Kenyatta National Hospital Nairobi City County, Kenya(Kenyatta University, 2022) Mwangi, Samuel N.; Lister Onsongo; James OgutuQuality of life (QoL) among cancer patient caregivers is significantly affected by characteristics such as age, educational level, economics, and geographical setting during the care provision. Objective: To explore the factors associated with QoL among family caregivers (FCG’s) of cancer patients in Kenya. Methodology: This was a correlational study conducted at Kenyatta National Hospital, which is the largest teaching and referral hospital in Kenya. The study enrolled 164 cancer patient family caregivers. The QoL (Family Version) was used to measure Quality of Life. Data collection was done using interviewer-administered questionnaires. A student t-test and Pearson chi-square were used to determine the association between personal, social and disease characteristics and family caregiver quality of life. Results: The average mean score of family caregiver QoL was 55.8 (SD±10.12) percent which is lower than in other countries. Conclusion: There was a significant association with family caregiver quality of life (QoL) and level of education, relationship to the patient, caregivers' ability to carry out normal activities, and caregiver knowledge of the stage of cancerItem Determinants of Sexual Function among Female Patients with Gynaecological Cancers at Kenyatta National Hospital, Nairobi City County, Kenya(Kenyatta University, 2022) Obora, Maximillar; Lister Onsongo; James O. Ogutu,Background: Gynaecological cancer impacts approximately three million women globally. The problem is much intense in resource limited countries. Sexual health is attracting great focus as a key aspect of gynecological malignancy management and a component of Quality of Life. We have paucity of information in regards to the magnitude of sexual dysfunction among survivors with gynaecological cancers in Kenya. Therefore, investigating sexual function among survivors with gynaecological cancer is an important area of inquiry. Broad objective: To assess the determinants of sexual function among female patients with gynecological cancers at Kenyatta National Hospital. Methodology: Descriptive correlational study design was utilized where by 108 Female patients diagnosed with gynaecological cancers on treatment and regular follow up were consecutively recruited by simple random sampling. The study was conducted at Kenyatta National Hospital Cancer Treatment Centre. The main variables were socio-demographic, assessed with the socio-demographic questionnaire, clinical characteristics, extracted from medical records, psychological, assessed with the Body Image Scale (BIS), social, assessed with the Multidimensional Scale of perceived Social Support (MSPSS) and cultural, and assessed with the Sexual Dysfunction Beliefs Questionnaire. Sexual function was evaluated by female sexual function index. SPSS Version 25.0 was used in analysis .Chi square test, Pearson’s 𝑟 assessed correlations and logistic Regression were done to identify the predictors of sexual function. Results: Mean total score of Female Sexual Function Index scores was 10.0. Eighty-five (85%) of respondents had sexual dysfunction. Age (p=0.004), Employment status (p=0.002), cervical cancer (p =0.016), endometrial cancer (p=0.018), cancer staging 4 (p = 0.008) and social support (p =0.037) were significant predictors of sexual dysfunction. Age (p =0.001), education level (p =0.002), employment status (p<0.0001) and lifestyle adaptation (p =0.047) were significantly associated with sexual function. Respondents who had cancer of the cervix were 7 times more likely to have sexual dysfunction Conclusion and recommendations: These results signify that Sexual dysfunction is a disturbing and under managed problem among gynecological malignancy survivors. Assessment of sexual function using Female Sexual Function Index scores has yielded important information that predicted outcome of patients with gynecological cancers. Health professionals can contribute great impact on the Quality of Life of gynecologic malignancy survivors by focusing on sexual health issues. Therapeutic intervention at multidisciplinary level should incorporate sexual rehabilitative strategies in all oncology settings in order to provide relevant supportive care in addressing physical and psychosocial needs of patients with gynecological cancers across survivorship continuum of care and broadening sexual health training within the medical curriculum for all health professionals.Item Health Related Quality of Life for Caregivers of Psychiatric Patients, Mathari National Teaching and Refferal Hospital, Nairobi City County, Kenya(Kenyatta University, 2022) Nyamwaro, Yuniah Bitutu; Lister Onsongo; Grace GithemoThe mentally ill patients have been shifted from institutions to home based care involving the family and the community than the straight in-hospital treatment. Consequently, the prevalence of mental illness is rising which is proportional to increased burden among the primary caregivers’ thus affecting their Health-related quality of life (HRQoL). The average prevalence of mental disorders in the world is 13.4%. In Kenya, mental health is a real concern and has been ranked 4th in Africa and 9th globally with highest number (1.9 million) of depressed persons leading to an increase in cases of suicides among mentally ill patients. The aim of this study was to determine the HRQoL and associated factors of primary caregivers of the mentally ill patients at Mathari National Teaching and Referral Hospital which is the largest teaching and referral psychiatry hospital in Kenya as at now. . The study used descriptive cross-sectional research design. Systemic random sampling was used to recruit 310 caregivers of mentally ill patients in the outpatient clinic. The WHOQoL-BREF questionnaire was used to assess Caregivers HRQoL. Statistical package for social sciences version 25.0 was used for analysis. Pearson was used to test relationships between variables and multivariate regression models were used to determine predictors of HRQoL. The findings revealed that on quality rating 1-5, Majority (34.4%, mean 2.61 SD 1.05) of the participants reported poor HRQoL. Caregivers’ marital status (.292, =0.000), relationship with the patient (.166, =0.004) and patient gender (.188, =0.001) significantly correlated with primary caregivers’ HRQoL. Patients’ review with compliance to treatment (61.5%), and health system support (.420, P=0.000), were significantly associated with primary caregivers’ HRQoL. The adjusted R squared revealed that jointly, caregiver characteristics, patient characteristics and health system support accounted for 20.1% of changes in the physical health, 10.3% in the mental health, 24% in the social relationships and 36.9% in environment health of primary caregivers these being the predictors of HRQoL. Specialized psychiatric, mental health professionals and policy designers to realize these characteristics which impact the caregivers ’HRQoL so as to intervene by providing psycho-education on patient care, encourage social support groups, improve environment and health support system of the primary caregivers hence improving tItem Symptom Burden and Quality of Life in Cancer Patients at Kenyatta National Hospital Nairobi City County, Kenya(Kenyatta University, 2022) Soita, Phillip; Lister Onsongo; Elizabeth AmbaniBackground: Cancer is highly ranked as a cause of morbidity and mortality globally with an estimated 9.3 million new diagnoses made in 2020 with a projected increase to 47,000 new cancer cases and 32,987 cancer deaths in Kenya. Cancer related symptoms are caused by the disease itself or the ongoing treatment, however factors like age, gender, and concurrent diseases may also influence the general symptom experience. Despite the fact that these symptoms affect the QoL of these patients, there is little being done to address this effect on the QoL. Therefore the effect of disease related burden on the QoL among the malignancy patients with these unique variables in view is an important area of study.Objective: To assess the disease related symptom burden and the QoL among cancer patients in Kenyatta National Hospital. Methodology: Descriptive, correlational study with 168 cancer patients as participants recruited through simple random sampling. Self-administered and interviewer administered questionnaires were used in the study. The research was carried out in the oncology unit of Kenyatta National Hospital targeting adult patients that are undergoing cancer treatment. Statistical program for social scientists (SPSS) version 25.00 was used to carry out data analysis and presented using graphs, tables and chats. Results: A total of 166 participants participated in the study. The overall QoL score was at 70.28. Cancer type(p=0.02), treatment period, treatment type(p=0.009),level(p=0.012), income(p=0.011) and marital status (0.039) were the key factors that affect the QoL among the study patients with symptom burden score(p=0.0001) and type of treatment p=0.035) being the main predictors of QoL.Conclusion and recommendation: Cancer and its treatment poses a risk and great symptom burden to these patients if not fully addressed. Its therefore essential to adopt a QoL assessment tool to be used by care givers to address specific patient needs, health care workers to provide relevant information to all cancer patients under treatment on symptom severity and progress, health care policy makers to incorporate symptom assessment, palliative care management and training in the health care system management and training and ensure community or public education on the common cancer predictors and drafting the right messages to pass to the people in order to improve on their QoL during and after treatmentItem Professional Quality of Life among Nurses Caring for Cancer Patients at Kenyatta National Hospital, Nairobi City County, Kenya(Kenyatta University, 2022) Gikonyo, Catherine. W.; Lister Onsongo; James O. OgutuChronic exposure to stressful situations at the workplace has been associated with health care workers low quality of life particularly if they have no adequate coping strategies in place. The compassion fatigue and burnout syndrome, affects many healthcare workers which in turn impact negatively on the quality of care given to patients. The professional quality of life (Compassion fatigue, burnout and compassion satisfaction) has been focused extensively in developed countries, however few studies have explored this concepts among oncology nurses regionally. The study aimed at assessing the level of professional quality of life (compassion fatigue, burnout and compassion satisfaction) among nurses caring for cancer patients at Kenyatta National Hospital (KNH), identify their determinants and statistical relationships between variables. The study adopted a correlation quantitative design on the target populations at KNH oncology clinic/units sample size of 90 participants. The Professional Quality of Life Version -V (ProQoL-5) and Brief COPE inventory self-administered questionnaires were used to collect data. Stratified and simple random sampling was used to select the study participants from different units. Pretesting of the study tool was done at MTRH to ascertain reliability and validity of the tool. Data was analyzed using descriptive statistics, Pearson r, and stepwise regression analysis. Ethical approval was sort from Kenyatta University, Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (KNH/UON ERC) and KNH medical research center. The findings revealed a mean score for compassion satisfaction 42+4.76, burnout 33±4.7 and compassion fatigue 27±8.7. There was a statistical significant difference in the levels of ProQoL based some demographic factors and personal factors. A negative relationship between compassion satisfaction with exposure to antineoplastic agents, workload and insufficient preparation but positively correlated with burnout and compassion fatigue. The predicting factors for all subscales of ProQoL was staff patient ratio. The participants had high compassion satisfaction levels despite poor staff patient ratio. Good interpersonal relationship and personal resilience strategies promote compassion satisfaction and reduction of burnout and compassion fatigue levels. The study recommends the hospitals to improve nurse patient ratio, Work force empowerment of oncology health care workers, bereavement and Mentorship programs to help nurses deal with unresolved grief associated with oncology care. A national wide similar mixed study with a large sample is highly recommended.Item Quality of Life for Cancer Survivors at Africa Inland Church Kijabe Hospital, Kiambu County, Kenya.(Kenyatta University, 2022) Kung’u, Mary Mugure; Lister Onsongo; James O. OgutuFollowing recent advances in cancer detection, treatment and supportive care, numbers of cancer survivors have been increasingly rising both locally and globally. With this increases, their quality of life is also affected. Few studies have explored the quality of life of cancer survivor in relation to socio-demographic, disease characteristics and spiritual factors. This study aimed to determine the relationship between socio-demographic variables, disease characteristics and spiritual factors and quality of life of cancer survivors. A descriptive cross-sectional research design was used in the study with closed self-administered and interviewed questionnaire being the method of data collection. Quality of Life Patient/Cancer Survivor Version (QOL-CSV) questionnaire was adopted and modified for the study. The study involved 108 study participants, both male and female, 21-86 years. Responses were statistically analyzed with bivariate (Spearman rho) and multivariate analysis (step wide multiple regression) conducted. Descriptive statistics showed that majority of the participants were female, married, having secondary level of education and with stage II cancer. In the bivariate analysis, relationship between socio-demographic factors and quality of life revealed that there was a statistical significant correlation of quality of life with age, gender, education level, marital status and income of the cancer patients. Also, there was a statistical significant relationship between quality of life with stage of cancer diagnosis and year of cancer diagnosis. The comparison between spiritual/religious variables and quality of life showed statistical significant correlation in relation to religious affiliation, the religion one belonged to and how contented with faith in God one was. In the multivariate analysis, age, stage of cancer diagnosis, time off treatment, educational level and religious affiliation were identified as predictors of quality of life of the cancer patients. Healthcare providers’ interventions should focus on early cancer detection and treatment as stage of cancer diagnosis is a key determinant of patients’ quality of life. Spiritual therapy should be part of holistic care provided to cancer patients to boost their quality of life.Item Women’s Experience of Unexpected Caesarean Section Birth in Kitui County, Kenya(Kenyatta University, 2022) Kimanthi, Zipporah Kasyoka; Lister Onsongo; Elizabeth AmbaniBackground: Caesarean Section (CS) is a life-saving procedure for both mother and baby. It accounts for 18.5 million births globally which is approximately 18.6% of all births (World Health Organization (WHO), 2015).Women lived experiences of unexpected caesarean section are often described as less favorable than vaginal birth or planned caesarean section. Midwife care for women with deviations from a normal birth process is currently challenging. Studies describing the experience of unexpected caesarean birth by mothers exist with none of the experience documented from Kitui County, Kenya. Objective: The study explored the lived experience of undergoing an unexpected caesarean section and the mother's cultural beliefs on the experiences of childbirth. Methods: Descriptive phenomenology design was used with purposive sampling method being used to select 15 participants who had experienced unexpected caesarean birth. Data collection was one through audiotaped 30 minutes interviews for each of the participant. The interview was analyzed using Colaizzi's method of data analysis. Results: The study emerged with eight themes and four subthemes which described the lived experience of childbirth and cultural beliefs among mothers who had unexpected CS. The themes identified included; fear, self-care deficit, worry, shattered expectations, positivism, regaining joy after CS, belief and misconception, and consequences of beliefs and misconceptions. Conclusions: The study concludes that women from Kitui County experience many negative perceptions following unexpected CS birth. These perceptions include; disruption of birth plans, dissatisfaction with the birth process and unmet birth expectations. Healthcare workers including doctors and midwives should be more sensitive when informing mothers of the unplanned CS. They should provide mothers with enough knowledge including eventualities that may crop up during the labour process to allow understanding of the eventualities of labour. They should also identify methods and means of alleviating fear and worry among mothers who are to undergo unplanned CS. Mothers support groups should be developed to allow mentoring of new CS mothers by experienced and competent mothers. Information regarding pregnancy, labour and puerperium should be availed to pregnant mothers. This will help to clear the mothers' doubts, demystify misconceptions and beliefs associated with CS birth and reduce fears related to the unexpected CS birth.Item Midwives Preparedness in Management of Postpartum Hemorrhage in Muranga County, Kenya(Kenyatta University, 2021) Muthoni, Doris Mumbi; Priscilla Kabue; Elizabeth Kurwa AmbaniABSTRACT Postpartum hemorrhage is the cumulative blood loss of about 500 milliliters in a spontaneous vagina delivery and approximately 1,000 milliliters for cesarean section birth and is one of the leading causes of maternal mortality. World Health Organization estimates that more than 300,000 women world-wide died from pregnancy-related cases in 2015, which means a total of 830 women die every day. In Kenya, it translates to 362 deaths per 100,000 live births. Postpartum hemorrhage is the major cause of maternal mortality resulting to a woman dying every 4 min, worldwide due to massive PPH. It is more tragic to have a well mother dying in the process of giving birth with complications that can be prevented. A woman’s death has some negative impact on the family, community, and the government due to the role the mother plays in a home setup. In view of the above a study was conducted in Muranga County with an objective of determining the preparedness of midwives in prevention and management of PPH. The study adopted a descriptive cross-sectional study that employed a quantitative approach through the use of a research self-administered questionnaire and an observational checklist targeting midwives. A total of 85 midwives filled the questionnaire and 71 midwives were observed respectively. The convenience sampling technique was used to select the midwives in the study sites. The analysis was done using SPSS. The study findings showed midwives factors that had an association in their preparedness in the management of PPH as follows: age ( p-value= 0.021), professional qualification (P-value= 0.047), experience in the management of PPH (P= 0.032) and training on emergency management of PPH (P= 0.010). Midwives knowledge that influenced their preparedness in the management of PPH was knowledge on; uterotonics use ( Fischer’s exact value= 0.000), recommended time for uterotonic drug administration (P= 0.043), uterine massage during 3rd stage of labour (P= 0.012), examination of the placenta (P= 0.034), management of PPH (P= 0.028), causes of PPH (P= 0.001) and on diagnosing PPH (Fischer’s exact value= 0.043). Institutional factors influencing the midwives preparedness in the management of PPH were availability of uterotonic supplies (P= 0.040), availability of transport in case of a referral (P= 0.032), staff to patient ratio (P= 0.028), and availability of Management guidelines (P= 0.012). On current practice deliveries observed showed, 27.2% competently prepared for birth, 18.3% offered emotional support, 26.2% competently prepared for the second stage, 35.5% administered uterotonics, 25.9% practiced controlled cord traction and 27.1% performed uterine massage. Finally, the study concluded that Midwives factors, institutional factors, and the use of current guidelines influence midwives preparedness in the management of PPH. The study recommends that the county government be providing continuous training to midwives on emergency management of PPH, ensure the availability of equipment, uterotonic drugs and transport facilities in case of referral. Also the Ministry of Health should provide current Standard Management Guidelines on PPH, orientate the midwives on their usage and ensure the guidelines are displayed.