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Item Impact of community strategy on uptake of reproductive tract infections health services among young street females in Uasin Gishu County, Kenya.(Kenyatta University, 2023) Chepchirchir, Maritim Violet; Anthony Wanyoro; John Maingi; Jackim NyamariReproductive tract pathogenic microorganisms are one of the major causes of adverse health outcomes among women in both developed and developing countries. Documented research reports that, despite the current intervention of establishing a dedicated clinic for this demographic, the uptake of reproductive health treatments among young street females (YSF) in Eldoret municipality is quite low. Community strategy as an intervention has been proven to be effective for the uptake of other reproductive health services but there is little information regarding its impacts on reproductive tract infections health service uptake among YSF in Eldoret municipality. The current study aimed to assess health-seeking behaviors and the impact of a community strategy on YSF's use of reproductive health care. A pretest-post-test quasi experimental with a qualitative and quantitative approach was applied among the YSF aged 10-24 years. The study used structured questionnaires and key informant interviews to collect data from the respondents. Vaginal swabs and blood samples were obtained from the respondents and taken to Moi Teaching and Referral Hospital laboratory for identification of pathogenic microorganisms. Data were analyzed using IBM SPSS V.26. The strength of the relationship between variables was tested using logistic regression. Community strategy which was the study intervention composed of health education, syndromic screening, and referrals to the health facility. Tables, charts, and graphs are used to present descriptive statistics. A total of 77 young street females from Eldoret municipality participated in the study. The respondents aged less than 15 years were ten (13%) while those who were aged more than twenty years were (62%). A significantly higher proportion of respondents reportedly sought treatment for RTI following the roll out of the intervention (68.1%) when compared to those who sought treatment at the preintervention phase (63.0%) difference: 5.1% (95 confidence interval (CI) 5.0% -39.2%), z = 2.534, p = 0.011). The implementation of the community strategy package revealed a positive outcome as it contributed to increased knowledge and uptake of health care services. The study also revealed T. vaginalis and T. Pallidum as the key pathogenic colonizers. The study recommended the integration of the community strategy package in policies that seek to improve the health care of young street females in Eldoret municipality. The study recommends the adoption of the community strategy as an intervention to increase the uptake of RTIs health services and promotion of the reproductive health of YSF.Item Suitability of Electronic Health Record Data for Computational Phenotyping of Diabetes Mellitus at Nairobi Hospital, Kenya(Kenyatta University, 2022) Olwendo, Amos Otieno; George Ochieng’ Otieno; Kenneth RuchaThe adoption of EHR in health care has resulted in the collection of lots of data thus the drive to utilize EHR data for secondary purposes such as research. However, EHR data are characterized by incompleteness and inconsistencies. Diabetes is a worldwide health problem and approximately 14 million persons had diabetes in Africa in the year 2015. In Kenya, type 2 diabetes makes 90% of all diabetes cases. However, a number of cases of diabetes in Kenya experience late diagnosis which result from prolonged experience of prediabetes thus the need for targeted case finding. The aim of this research was to examine the influence of EHR software design, use of a data dictionary, process of collection and entry of data into the EHR, and human resource development on the suitability of EHR data for computational phenotyping of diabetes. A retrospective study was conducted at the diabetes clinic at Nairobi Hospital located in Nairobi, Kenya. After obtaining relevant ethical approvals and informed consent from respondents, the study conducted interviews for 32 staff involved in the use of the EHR comprised of physicians (4), nurses (22), health records officers (HRIO) (4), and managers (2) for both sections. The study also sampled 652 historical records of confirmed cases of diabetes collected between January 2012 and December 2016. Data processing was conducted through outlier detection, smoothing and z-score normalization. Likert scaled results were collected using a usability questionnaire. Measures of central tendency and reliability analysis were calculated using SPSS version 2021 and inferential statistics were conducted through cluster analysis using density-based clustering algorithm. Results show that software design influenced the suitability of EHR data and usability of the EHR was acceptable with a USE mean score of 5.6/7. Regression analysis showed that software design explained 50.7% of the improvement in the suitability of EHR data. Participants 100% reported that the EHR had an inbuilt data dictionary and regression analysis showed that the use of the dictionary explained 32.3% of the improvement in the suitability of EHR data. Also, 98% of participants believed that process of data collection resulted in the collection of data of good quality and regression analysis showed that the process of data collection explained 23.5% of the improvement in the suitability of EHR data. Finally, 93% of participants believed that they had been provided with adequate training to use the EHR. Also, participants 90% reported that they were motivated to continue working at the same location due to opportunities for further training and specialization, good remuneration and working environment. Regression analysis showed that human resource development explained 16.6% of the improvement in the suitability of EHR data for computational phenotyping of diabetes mellitus. However, EHR data were determined to be unsuitable for computational phenotyping of diabetes mellitus given that the algorithm clustered 88% (574/652) of the records as noise. Nevertheless, the algorithm identified 23 meaningful clusters from 12% (78/652) of the diabetes data. However, the EHR software needs incorporate an attribute for the recording patient waist size, blood pressure, and patient-reported drug allergies. Likewise, this study recommends the need to understand the influence of HRIO on the suitability of EHR data for computational phenotyping of diabetes mellitus since they serve as mediators to the physicians for the entry of data into the EHR.Item Effects of Mhealth Technologies on Uptake of Routine Growth Monitoring among Caregivers of Children 9-24 Months in Nyamira County, Kenya(Kenyatta University, 2021) Nyanchama, Nyang’echi Edna; Andre Yitambe; Kenneth RuchaRoutine growth monitoring (RGM) of children is important in assessing their health and nutritional status. This provides opportunities for implementation of interventions aimed at reducing under five mortality rates, infectious diseases and malnutrition thus ensuring achievement of the Sustainable Development Goals (SDGs) targeting good health and wellbeing. Despite the increased use of mobile health technologies in improving child health, there is still low uptake of routine growth monitoring services for children aged 9-24 months. The main objective of this study was to find out the effects of mobile health technologies on uptake of routine growth monitoring among caregivers of children aged 9-24 months in Nyamira County, Kenya. This was a quasi-experimental study. The experiment arms received Short Text Message (STM) and Voice Call (VC). Questionnaires with open and closed-ended questions and Key Informant Interview Guide (KII) were used to collect information from the respondents. Nyamira County, health facilities and KII were chosen using purposive sampling method. Caregivers of children aged 9 months were chosen using census method and the study intervention was assigned to the selected health facilities using simple random sampling method. Results of the study at baseline revealed that only 118(65.6%) of the caregivers knew the meaning of RGM. Caregivers’ knowledge on the meaning of RGM showed a significant association with level of education (χ²=29.238; df=4; p<0.0001), occupation (p=0.001), monthly income (p=0.015) and residence (χ²=6.332; df=1; p=0.012). There was tremendous improvement in the proportion of caregivers 154(85.6%) who knew the meaning of routine growth monitoring after implementation of study intervention. All the caregivers 60(100%) who received STM as well as all caregivers 60(100%) who received VC knew the meaning RGM which was an improvement of 30% and 35% respectively at the endline. Pre-intervention result revealed that 11(18.3%) caregivers from intervention arm 1 (STM), 13(21.7%) from intervention arm 2 (VC) and 14(13.3%) caregivers from control arm maintained RGM prior to recruitment in the last 8 months. Post-intervention result analysis revealed that 51(85%) caregivers from intervention arm 1, 50(83.3%) from intervention arm 2 and 2(3.3%) caregivers from control arm complied with RGM schedule. Post intervention analysis of the results revealed that caregivers from intervention arm1 9(100%) and intervention arm2 10(100%) took their children to nearby health facilities. Caregivers from the control arm gave various reasons for skipping RGM including that they forgot their TCAs 58(100%), Healthcare providers did not tell them 53(91.4%), their children were not sick 52(89.7%) among other reasons. The analysis demonstrates that in month 1 those caregivers who received STM were 6.875 times more likely to take their children for RGM compared to the control (OR = 6.875; 95 CI: 3.591 - 13.164; χ²=73.818; df=1; p<0.001). In month 1, those caregivers who received VC and HE were 6.750 times more likely to take their children for RGM compared to those in control arm (OR = 6.750; 95 CI: 3.522 - 12.938; χ²=70.612; df=1; p<0.001). Analysis of results showed that there was no statistical association in proportion of caregivers who received STM compared to those who received VC in month 1 (χ²=0.100; df=1; p=0.752). Caregivers in intervention arm 1 27(45%), intervention arm 2 26(43.3%) and control arm 27(45%) felt that mobile health technologies were good in increasing uptake of RGM. Policy makers and implementers in the health sector will find these study findings useful in deciding whether to adopt STM, VC or both in improving uptake of routine growth monitoring for children aged 9-24 months.Item Effect of Training Mothers and Motorcycle (Boda-Boda) Riders in Community-Based Referrals on Maternal Outcome in East – Central, Uganda(Kenyatta University, 2021) Mwebaza, Muluya Kharim; Rucha Kenneth Kibaara; Peter Kithuka; John Francis MugishaUganda has a reproductive health situation characterized by delayed community maternal referrals; and yet timely referral to skilled care is essential for pregnant mothers who are at high-risk, to have immediate access to appropriate health care. This has led to few safe deliveries at health centres (52 percent in east – central region compared to 74 percent nationally). Maternal mortality ratio (MMR) at 346 per 100,000 live births and neonatal mortality rate (NMR) at 27 per 1,000 live births respectively in east – central Uganda is high compared to 211 per 100,000 live births and 20 per 1,000 live births respectively globally. This study aimed at training expectant mothers and boda-boda riders on innovation, communication and technology, fleet management, the roles of the different stakeholders and the prevention and management of emergencies. This enabled the establishment of the effect of training of boda-boda riders and expectant mothers in community-based referrals on maternal outcome. This study used a non randomized control trial study design of community intervention. Four sub-counties were selected in the intervention and 4 in the control arms respectively. The study population consisted of 503 pregnant mothers in their third trimester and 192 boda-boda riders randomly and conveniently sampled respectively. Self administered questionnaires, in-depth and key informant interviews, focus group discussions, and secondary records were used to collect both quantitative and qualitative data. Descriptive and inferential data analysis methods using STATA version 14 was conducted for quantitative data. Thematic analysis was done using Ti 7 software atlas. Findings revealed that 70.5% of mothers used boda-boda transport to health centres to deliver, of whom 69.4% were trained boda-boda riders in the intervention arm. Only 51.2% of mothers used boda-boda transport in the control arm. Socio-demographic characteristics of mothers; age (25 – 34 years OR=17.581, p=0.001 and 35 – 44 years OR=247.660, p=0.000), religion (Protestants OR=0.122, p=0.013 and Moslems OR=0.197, p=0.050) and means of transport used by mothers (Motorcycle OR=5.132, p=0.001 and Walking OR=35.732, p=0.000) influenced the maternal outcome. Only age and ownership of motorcycles for the boda-boda riders influenced maternal outcome (25 – 34 years OR=11.351, p=0.000; Personal ownership OR=3.549, p=0.002 respectively). Also, attitude of mothers on comfort of boda-boda transport influenced the maternal outcome (OR=8.352, p=0.011). Communication systems, that is, possession of phones by mothers (OR=4.200, p=0.000) and time interval boda-boda rider took to respond when contacted (21 – 30 minutes OR=0.124, p=0.002 and 31 – 60 minutes OR= 0.003, p=0.000) had effect on the maternal outcome. Lastly, knowledge attained during training by boda-boda riders on fleet management and referral systems had effect on maternal outcome (OR=1.202, p=0.022). For mothers, knowledge attained on the roles of stakeholders and fleet management and referral systems had effect on maternal outcome (OR=2.290, p=0.011 and OR=0.117, p=0.009 respectively). In conclusion, increase in knowledge of mothers and boda-boda riders, system of communication, attitude of mothers and socio-demographic characteristics increased supervised deliveries and have demonstrated its potential in addressing the challenges associated with community referral needs in rural settings. This adds credence to the need for rolling out of training of mothers and boda-boda riders to a greater geographical area. It will also be useful to policy makers whose efforts are geared towards increasing health facility-based deliveries to reduce MMR and NMR.Item Effectiveness of Training Health Unit Management Committees on Performance of Health Centres, in East Central, Uganda(Kenyatta University, 2021) Gangu, Muwanguzi David; Otieno George Ochieng'; Kenneth Bucha Kibaara; John Francis MugishaThere has been poor performance of health sector in East Central Uganda leading to the Districts in East Central Uganda perpetually being at the tail end of the Uganda National District Performance League Table. Performance of the health sector is the sum total of the performance of individual health centres. Uganda embraced decentralization and Primary Health Care Concept that provide responsibility for managing performance of health centres at lower administrative levels. The performance driven management of health centres is completed by having in place competent and knowledgeable management committees. This study investigated the effectiveness of training of Health Unit Management Committees (HUMC) on performance of health centres in East Central Uganda. Specifically, the study assessed how the socio-demographic characteristics of members of the management committees were affecting performance of health centres. The study ascertained the performance levels of health centres and assessed the effect of training members of Health Unit Management Committees on performance of the health centres. The study was interventional employing the design of a randomised community trial. The study was done in East Central Uganda in 24 health centres. These were randomly selected into two study arms as intervention and control arms each arm with 12 health centres. Out of expected 288 members, only 280 members of Health Unit management Committees participated in the study. Data from monthly reports provided the records for assessment of individual health centre performance. The dependent variable was the performance of the health centres. The independent variables were the factors that influence performance of health centres including the social demographics of the HUMC members. The intervention was training of the Health Unit Management Committees. The study used both qualitative and quantitative data collection techniques. Data was analysed using Chi-Squares for the bi-variate analysis and pearson‘s correlations. Logistic regression was then employed for the multivariate analysis on factors that drive performance of health centres in view of training of HUMC members. The results showed that Good performance of health centres was dependent on ages of members of HUMCs (P-Value 0.005), occupation of HUMCs p-value 0.006, economic level p-value 0.05 and education level of these members (P-Value-0.003). The performance of individual health centres in East Central Uganda had been poor prior to training of Health Unit Management Committees. After training of members of health unit management committees in the intervention arm, performance improved and was better than those health centres in the control arm. The t-test statistic showed that training of HUMC improved performance of HC (p value 0.000), and this had the strongest association with improved performance with odds ratio of 164.22, age had odds ratio 38.56, education level had odds ratio 59.43, profession of member of HUMC odds ratio 26.16 and economic level at odds ratio 1.41. It was concluded that performance of health centres in East Central Uganda depended on social demographic characteristics, was poor prior to training of HUMCs and training of members of health unit management committees greatly improved performance of health centres. It was recommended that average aged members that are trainable be appointed members of HUMCs, Ministry of Health of Uganda increase resources to enhance performance of HCs and enforce HUMC involvement and participation in running HCs, and all members of HUMCs be trained by policy from the Ministry of Health.Item Citizen Participation in Management of Devolved Healthcare Funds in Embu County, Kenya(Kenyatta University, 2021) Watetu, Kabeu Emma; Andrew Yitambe; George OtienoDevolution of healthcare in Africa has been advocated as a response to most healthcare ills, and to facilitate greater citizen participation. Kenya, driven by the need to bring services closer to people has now joined countries like United Kingdom, Italy and Spain in having devolved health care system, hopefully to be like South Africa and Rwanda which have successful devolved healthcare in Africa. The main objective of this study was to investigate citizen participation in management of devolved healthcare funds in Embu County. This study used cross sectional descriptive design and mixed research design. The sample comprised of 20 Members of County Assemblies, 39 chiefs, 109 sub chiefs and 1,537 voters drawn from a population of 309,468 community members aged 18 years and above. Data analysis was done using descriptive statistics, correlation and regression analysis. The study drew a response rate of 91.3%. The average age of the respondents was 41.44 (SD ± 15.83) and having lived in Embu county an average of 40.22 years. On gender, males were 53.1% and females 46.9%. Manyatta constituency had 32.0% respondents, Runyenjes 28.1% Mbeere North 23.4% while Mbeere South had 16.5%. Majority were married (54.7%) with the least being divorced (5.8%). Respondents were almost evenly distributed among casual laborers, self-employed/business and farming (24.9%, 24.1%, 23.3%). The unemployed were 12.8%. Over 70% had attained secondary education and above while 5.1% lacked formal education. Level of citizen participation was low (27.2%) with voting being the activity that showed greatest extent of participation/involvement (44.7%). Groups and organizations which influenced participation were non-governmental organizations (p = 0.012; OR=0.609) and political leaders (p=0.006; OR=0.706). Individual characteristics that significantly influenced participation in management of devolved health care funds were constituency of residence (p = 0.004; OR=1.186), occupation (p = 0.005; OR=0.866) and highest level of education (p = 0.001; OR=0.788). Budgeting and planning was the only positively significant area of citizen participation (p = 0.000; OR = 0.28). Community‘s level of awareness on legal, policy and institutional frameworks was less than 30% across all 15 frameworks examined, where five were statistically significant. The strongest was Constitution of Kenya, 2010 Article 232(1)(d) with (p=0.000; OR=3.832) others were Constitution of Kenya, 2010 Article 27 (p=0.000; OR 0.203), Constitution of Kenya, 2010 Article 33(p=0.033; OR=3.315), County Governments Act section 91(p=0.038; OR=2.104) and Public Procurement and Disposal Act 2015 Section 68(3), 125(5), 138, and 179(p=0.004; OR=0.428). M&E was the only statistically significant institutional frameworks (p<0.01; OR=0.384). On Community perception and experiences, process legitimacy and adequate access to information aspects were statistically significant with p<0.01; OR of 0.354 and p<0.05; OR of 1.298 respectively. The study concluded that Constituency of residence, awareness of the constitution of Kenya and adequate access to information were factors that greatly influence citizen participation with an OR of 1.186, 3.832 and 1.298 respectively. The study recommends that public participation needs to be facilitated and enhanced to improve service delivery in county governments in Kenya. Findings will be useful to County and National Governments policy designers as they formulate Legal and Institutional frameworks enabling Citizen Participation.Item Bioaccessibility of Iron and Zinc from Micronutrient Powder Added in Germinated Porridges among Children Aged 6-23 Months in Homabay County, Kenya(Kenyatta University, 2021) Moraa, Momanyi Susan; Judith Kimiywe; Hudson NyambakaIron and zinc deficiency remains a burden among Kenyan children. Point-of-use fortification of complementary foods using micronutrient powder [MNP] containing vitamins and minerals has been recommended to improve the health and nutrition of children aged 6-23 months. Evidence-based information on different food vehicles for optimum bioavailability of micronutrients from the MNP is lacking. The main objective of this study was to determine the bioaccessibility of iron and zinc from micronutrient powder added in germinated porridges in children aged 6-23 months in West Kwabwai location, Homabay County, Kenya. Phase 1 of the study was the in vitro bioaccessibility of iron and zinc from germinated and non-germinated maize, millet and sorghum porridges with MNP. Non-germinated or germinated cereals were milled to flour. Porridge was cooked following the local known procedures. One-gram sachet of MNP [10mg iron as NaFeEDTA and 4.1mg zinc] was added to a 250ml cup of cooked porridge. Iron and zinc bio-accessibilities [%] were measured using in vitro dialysability methods. Factorial ANOVA was used to determine the effect of germination and cereal type on iron and zinc bioaccessibility. Phase 2 was conducted to establish the acceptability of different germinated porridges with MNP among children. The trial was single blind cluster randomized parallel study for 8 weeks with four sub-locations being randomized. A total of 200 children were selected by simple random sampling. A questionnaire and a morbidity data sheet were used to collect data on the amount of porridge consumed and health status of children, respectively. The acceptability trial data was analyzed using ANOVA. Phase 3 determined the anthropometric, iron and zinc nutritional status, and dietary intake of children. A descriptive cross sectional survey was done in the location. Using a population weighted simple stratified sampling method, 314 children were selected in the three sub-locations. Structured questionnaires were used to collect data on sociodemographic status, and anthropometric measurements of children. Food frequency questionnaire and a 24-hour dietary recall questionnaire were used to identify the complementary foods and to assess the dietary adequacy, respectively. ENA for SMART software was used for analysis of anthropometric data while Nutri-survey was used for analysis of nutrient intake. Serum content of iron and zinc were determined by spectrophotometric method. Binary logistic regression models were computed to identify the association of food and nutrient patterns as independent variables with wasting, stunting, underweight, anemia, iron deficiency, iron deficiency anemia and zinc deficiency as the dependent variables. The association was considered statistically significant when the p-value obtained was less than 0.05. Both, germination and cereal type significantly affected iron and zinc bioaccessibility. Germination significantly increased bioaccessibility of added iron in maize [1.3 to 2.7%] and millet [1.8 to 5.5%] porridges, but not in sorghum [5.3 to 4.5%; p=0.192]. Germination significantly increased bioaccessibility of added zinc in all three cereal porridges [maize: 12.6 to 30.7%; millet: 10.6 to 33.7%; sorghum: 15.5 to 38.8%]. The mean amount of germinated porridges [millet 241.46ml, maize 238.69ml, sorghum 230.29ml] consumed during the trial was more than the non-germinated porridges. The survey revealed that, at <-2SD, 17.5% of children were stunted, 13.4%; underweight, 6.4%; wasted. The prevalence of anemia, iron and zinc deficiency is 50.6%, 39.5% and 43.6%, respectively. These results indicate that germination of cereal-based porridge can significantly improve the bioaccessibility of added iron and zinc from MNP.Item Influence of School-Based Sexual Risk Avoidance Education on Sexual Behavior Among Adolescent Girls in Homabay County, Kenya(Kenyatta University, 2020-09) Owaka, Isaac OgwenoAdolescent sexual and reproductive health is a priority in the global agenda because of its associated negative reproductive health outcomes. It is estimated that Homabay County contributes 11.5% of adolescents aged 10-19 years living with HIV in Kenya. The fertility rate among girls aged 15-19 is also high in Homabay with a reported teenage pregnancy rate of 33% and the age-specific fertility rate of 178 births per 1000 girls. This study aimed to determine the influence of school based sexual risk avoidance education on sexual behavior in Homabay County. Using a cluster randomized control trial study design 28 schools were randomly selected from a sampling frame of 94 schools and randomly allocated to intervention and control arm of the study at a ratio of 1:1 for a period of 12 months. Using a repeat cross-sectional study design a total of 491 and 489 participants were proportionately and randomly selected from a sampling frame of 2085 participated in the baseline and evaluation surveys respectively. The data collection tools were a self-administered questionnaire, a focused group discussion guide, and key informant interview guide. For intervention, school-based sexual risk avoidance manual, self-assessment evaluation checklist, and videos were used. Quantitative data was managed in SPSS while qualitative was analyzed by thematic content analysis. Descriptive statistics was used to determine the prevalence of high-risk sexual behavior, teenage pregnancy, level knowledge, perception of risk and sexual self-efficacy. Logistic regression analysis was used to determine factors associated with sexual behavior and effect of intervention. The study found overall high-risk sexual behavior, sexual activity, early sexual debut, inconsistent utilization of condom and multiple sexual to be 62.3%,61.7%,37.5%, 33%, and 23.1% respectively among girls. Proportion of participants with a good level of knowledge on risky sexual behavior, pregnancy and HIV/AIDS were found to be 39.4%,40.4%, and 82.9% respectively while those with high perceptions of risk on pregnancy and HIV/AIDS were found to be 54.3% and 41.9% respectively and 60% had high self-sexual efficacy. Multiple sexual partner was associated with current guardians (OR 0.327, CI 0.126-0.844, P 0.021) and perception of risk on pregnancy (OR 0.327, CI 0.115-0.929, P 0.036)while inconsistent utilization of condom was associated with current guardian (OR 0.477, CI 0.242-0.940, P 0.033), position of birth (OR 0.355 CI 0.157-0.805, P 0.013) and sexual self-efficacy (OR 0.389, CI 0.188-0.806, P 0.011).Early sexual debut was associated with knowledge on pregnancy (OR 0.353, CI0.169-0.737, P 0.006) and perception of risk on pregnancy (OR 0.316, CI 0.147-0.676, P 0.003). School-based sexual risk avoidance education significantly increased knowledge on risky sexual behavior (OR 1.525, CI 1.059-2.195, P 0.023) and strength of sexual self-efficacy (OR 1.506, CI 1.021-2.221, P 0.039). The SRAE has a protective effect on knowledge on risky sexual behavior and sexual self-efficacy which directly influences sexual behavior. Therefore, Ministry of education and the stakeholders should upscale a progressive sexual risk avoidance education from primary to secondary schools.Item Effects of Training Health Workers in Cultural Competence on Satisfaction with Maternity Services Among Women in Elgeyo-Marakwet County, Kenya.(Kenyatta University, 2020-10) Cheboi, Solomon KemoiA culturally competent health workforce is recognized as a priority reform area in health management as well as in improving maternal healthcare indicators in vulnerable and marginalized settings. Yet modalities of integrating and reorienting healthcare services to meet the cultural needs of patients are rare. This study aimed at investigating the effect of training health workers in cultural competence towards satisfaction with maternity services among women of Elgeyo-Marakwet County. This was a cluster randomized controlled trial (CRT) blended with qualitative and quantitative data collection approaches. Clusters were randomized into intervention and control arms. Health workers in the intervention arm were sensitized on patient-centered maternal health care needs. Baseline and end line assessment (after six months) were carried with 758 women of reproductive age, 379 in each arm. Simple random sampling was applied. Data was collected using exit and mystery client surveys. Statistical Package for Social Science (SPSS) was used to analyze the data. The effect of the interventions was measured using standard mean difference (Cohen’s d) and t-test. An alpha cut of 0.05 tested the hypothesis. Qualitative data was analyzed through a process of data reduction, organization, and interpretation. Known companion, continued support, and naming critically influenced pregnancy and childbirth with a mean of 4.1, 3.9 and 3.2 respectively. Other important considerations are the choice of birthing position and placenta management with a mean of 3.1 and 2.9. The study revealed diverse and multiple women’s maternity needs and requirements. Cultural needs included the choice of delivery methods, placenta interpretation, placenta disposal, naming, and celebration. Esteem needs included value, respect, and friendliness. Physiological needs were labor room cleanliness, staff grooming, hygiene, and comfort. Psychological needs ranged from encouragement, assurance, empathy, and emotional support. Information and communication are also paramount. Before the intervention, there was no statistically significant difference (t (741) =0.106, p = 0.916) between the control and intervention group on the mean scores of quality of delivery rooms settings. The mean for intervention arm however improved to 4.41 ±0.673 from 4.13±0.738 while that of control remained steady. The mean change tinkered the differences between the two groups to significant t (756) =-1.1959, p = 0.002. The mean scores quality of prompt provision of maternity services between the two groups were indifferent prior to intervening t (749) = -0.380, p = 0.704 but significant thereafter t (756) = -5.214, p < 0.001. The intervention effect size was (F (1, 756) = 10.142, p = .001, ηp2 = 0.036). The difference between the groups in the scores of trust in provider was insignificant before t (692) = -957, p = 0.339 but significant later t (690) = -6.137, p = 0.001. The mean of the intervention improved to 4.26±0.698 from 4.05±0.727. The effect size was significant (F (1, 756) = 6.395, p = 0.012, ηp2 = .018) on trust scores. ANOVA showed that there was significant effect (F (1, 756) = 11.493, p < 0.001, ηp2 = .049) on satisfaction with provided information on delivery methods. With a mean of intervention group increasing from 3.55 ±1.056 to 3.94, ±0.894 following training of the health workers. The mean of control changed somewhat from 3.57±1.187 to 3.62 ± 1.149. The mean changes tweaked the group variance from insignificant t (725) =0.290, p = 0.771 to significant t (713) =-4.336 p <0.001 after intervention. Results conclude that cultural competence training improved perceived quality and satisfaction with maternity services among women of reproductive age. Consequently, there is a need to integrate cultural knowledge and skills into existing maternal policies and training. This would elicit a broad-based impact on maternal and child health services. Similar research but biased to treatment or health outcome is advanced.Item Implementation of Free Maternal Services among Postnatal Women in Selected Public Hospitals in Nyanza, Kenya(Kenyatta University, 2018) Nyaberi, Jackline MosinyaFinancial-related barriers to accessing conventional maternal health services is a major bottleneck in Low and Middle Income Countries (LMIC) with about 600,000 maternal deaths occurring worldwide. Over 90% of these deaths occur in Africa and Asia. Currently, in Kenya Maternal Mortality Rate (MMR) is 362 deaths per 100,000 live births it is far away from achieving MMR reduction to 147 deaths per 100,000 live births. Nyanza’s MMR is higher than the national average. Approximately 1300 to 2000 deaths per 100,000 live births occur in Nyanza alone. She has the highest, 14.9% maternal deaths in Kenya with lowest, 26% hospital deliveries. Consequently, Kenya introduced Free Maternal Services (FMS) in June 2013 when there were only 44% hospital deliveries. After a short while of implementation, there was a significant rise of 66% deliveries. However, gaps in maternal service delivery still exist due to costs associated with delivery services, poor staffing, increased rates of Traditional Birth Attendants (TBAs), inadequate maternal structures and inaccessibility. There is inadequate information on studies in Kenya that have assessed the ongoing implementation of FMS in Kenya. The aim of the study was to assess the implementation of FMS among postnatal women in public hospitals in Nyanza, Kenya. Specifically, the study established the proportion of postnatal women receiving FMS, relationship of socio-demographic, economic factors with status of FMS implementation, utilization trends of FMS, satisfaction of postnatal women on FMS and health system factors for FMS implementation. This analytical cross-sectional study was conducted in 6 Sub-County hospitals in 3 counties in Nyanza among 1152 postnatal women in public hospitals. Multi-stage sampling and Simple Random Sampling (SRS) was used to select participating counties, Sub-Counties and public hospitals. Postnatal women were sampled proportionately by convenient sampling. Data was collected by use of semi-structured exit-interviews, observational checklist, Key Informant Interview (KII) and Focused Group Discussions (FGDs). Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 23 and qualitative data was analyzed using content analysis according to emerging themes. Data was presented in tables, pie charts and bar graphs. About 45.5% postnatal women paid for “FMS”. They incurred a cost on items like ANC, 26.3%; normal delivery (4.8%); caesarian (3.8%); admission fees (26.7%), diapers (46.1%); sanitary pads (52.8%) and drugs (7.2%) all with a statistically significant relationship of p<0.001. In Nyanza, there was tremendous growth on trends of FMS utilization of 53.4% from 36.7% before implementation of FMS with cases of still births, maternal deaths and neonatal deaths. Majority, 1050 (91.2%) of postnatal women were satisfied with FMS. Most health system factors statistically significant influenced FMS implementation with p< 0.001. There was inadequate FMS implementation with a substantive proportion, 45.5% of postnatal paying for “FMS”. There was high rate of FMS utilization which encouraged SBA but also caused constrains to health system factors like human resources, inadequate supplies, equipment and structures, delays in financial reimbursement and reduced the quality of FMS. FMS initiative is widely accepted and with effective implementation, more women will be encouraged to deliver in the hospital resulting to significantly less maternal and neonatal deathsItem Association of functionality and nutritional status of elderly persons: a comparison between institutionalized and non – institutionalized elderly in Nairobi County, in Kenya(Kenyatta University, 2015-10) Mugo, Wairimu JudyMalnutrition has been recognized as a common problem among the elderly persons and is associated with certain diseases and impaired functioning, but less is known about its relationship with nutrition intake and nutritional care among the elderly residents. This study determined the association of functionality and nutritional status of the Institutionalized elderly and compared with that of the elderly living with their family or community members. It also compared the functionality of the two categories of elderly men and women, and determined the extent to which functional independence impacts on the nutritional status of the elderly in the Nairobi County, Kenya. The Mini Nutritional Assessment questionnaire and the Modified Barthel Index were used to measure the nutritional status and functionality of the elderly. One Questionnaire was administered to the social welfare officer in each of the sampled institutions and a similar questionnaire administered to the care-giver of the elderly in the community to collect information on Institutions and Non- Institutional characteristics that relate to nutritional status and functionality of the elderly. Two hundred and seventy elderly men and women who met the inclusion criteria were sampled, 135 from 4 Institutions and 135 from Gumba, Kariobangi, Huruma and Kawangware divisions. Data were coded and entered using EPI Info version 9 and were analyzed using SPSS version 17. The participants were randomly selected and the response rate was 98.5% for the Non-Institutionalized elderly and 96.5% for the elderly living in the Institutions of the elderly. There was a significant relationship between gender and MUAC (2 = 12.745, df = 2, p = 0.002) with the mean MUAC measure among women (0.77 4.13) being higher than that of men (0.75 0.388), t = 4.446, df = 268, p = 0.714. There were more overweight non-institutionalized elderly (20.5%) compared to those in the institutions of the elderly (14.7%). There was a significant relationship between MUAC measure and CC (2 = 68.563, df = 2, p = 0.001), with the mean MUAC measure being higher (0.76 0.401) and mean measure of CC being 0.72 0.448, f = 45.28, df = 1, p = < 0.001. Eighty eight percent of the Institutionalized elderly consume 3 or more meals per day compared to 54.8% of the non-institutionalized elderly. There were more totally dependent elderly at Institutions (13.6%), compared to 3% who were Non-institutionalized. Functionality level was found to correlate positively with self-view of health status (r = + 0.133, p = 0.046) and the intake of 3 or more prescription drugs per day (r = + 0.139, p = 0.034). Body mass index of the elderly was found to correlate negatively to Calf Circumference (r = - 0.156, p = 0.027) and Stair Climbing (r = - 0.148, p = 0.025). Protein intake was found to correlate positively to the consumption of fruits and vegetables (r = +0.139, p = 0.029). Nutritional status of the elderly was found to correlate with functional ability. National and County governments should make and implement policies that would promote the nutritional status and functionality of the institutionalized and Non-institutionalized elderly.Item Information and communication technology adoption in HIV and aids comprehensive care centers in Nairobi county, Kenya(Kenyatta University, 2015-04) Kibaara, Rucha Kenneth; Ochieng Otieno; Michael Gicheru; Andre YitambeIn the last decade, information and communication technology (ICT) has offered huge potential to answer many of the challenges that HIV and AIDS Comprehensive Care Centres (CCCs) face in provision of quality services in Nairobi County, Kenya. The objective of the study was to investigate health workers and patients‟ ICT adoption status, indentify their perceptions about ICT, determine factors that influence ICT adoption and determine the real predictors of ICT adoption status of health workers in HIV and AIDS CCCs in Nairobi County. This was a cross sectional descriptive study. Participants (N = 196) consisted of health workers drawn through proportionate stratified random sampling from twenty eight HIV and AIDS CCCs from both public and private hospitals in the study area. Questionnaires from 183 (93%) respondents were correctly filled and returned. Data analysis reflected 183 respondents. Data was collected from the health workers using questionnaires and also from the patients attending HIV and AIDS CCCs through focus group discussion (FGDs). The collected data was analyzed quantitatively and qualitatively. Quantitative data was analyzed with the use of Predictive Analytic Software (PAS) Version 19. Inferential and descriptive statistics were used. Qualitative data was analyzed by use of content analysis. The results showed that most (57%) of health workers had not adopted ICT. Results indicated that there is significant relationship between respondents status of ICT adoption and type of CCC (χ² = 0.117; df = 1; p = 0.032) with those from private CCCs more likely to adopt compared to those from public ones. The findings revealed that majority (77%) of health workers have positive perception of ICT drivers and ICT contributors (68%). Findings showed that most (47%) respondents with positive perceptions were more likely to adopt ICT. The results also showed significant relationship between adoption and health workers‟ perceptions of ICT access, personalization, security, site aesthetics, flexibility and optimism. Chi-square results at 0.05 probability error revealed significant relationship between adoption and factors of ICT training, quality of systems, information intensity, management support, technological resources, financial resources, complexities, compatibility, affordability, information security, image of facility, competitive pressure and patients‟ pressure. Multiple Regression results showed that the perception predictors were ICT access, personalization and information security. Findings showed that some of the factors that predict adoption status are ICT quality of systems (χ² = 0.000; df = 1; p = 0.000), information intensity (χ² = 19.422; df = 4; p = 0.001), financial resources (χ² = 0.395; df = 1; p = 0.030), technological resources (χ² = 0.395; df = 1; p = 0.030) and patients‟ pressure (χ² = 0.006; df = 1; p = 0.037). The study recommends policies that will help the management of CCCs improve ICT infrastructure and capacity building in order to optimize ICT adoption by health workers. It also recommends enactment of laws and regulations which will favour factors that influence ICT adoption and the actual predictors. This will lead to improved services that will be effective and efficient in HIV and AIDS Comprehensive Care Centers.Item Predictors of community health workers retention in service in Makueni County, Kenya(2014-07-24) Kithuka, Peter Munyao; Ochieng, O.; Korir, Julius; Mwitari, J.Globally, the reported attrition rates of Community Health Workers (CHWs) vary between 3.2% and 77% with high rates being associated with volunteer CHWs. In Kenya, retention rate is estimated at 67% while in Makueni it varies between 50% and 98%. The success of community programmes is often hampered by low retention rates which affects the sustainability of interventions and increases training costs, since it needs continuous replacement which makes the programme difficult to manage. The main objective of this study was to establish predictors of community health workers retention in service in Makueni County. The study used a crosssectional study design employing mixed methods of data collection incorporating researcher-administered questionnaires, Focus Group Discussions and Key Informant Interviews. The study population consisted of 2,800 CHWs commissioned by the Ministry of Health in Makueni County. Sample size of the study was 603 CHWs selected through Cluster sampling. 552 CHWs participated in the study. Purposive sampling was used to select participants for Focus Group Discussions and Key Informant Interviews. Quantitative data was subjected to descriptive, cross-tabulation and logistic regression analysis using SPSS version 20 software. Thematic analysis was done using Nvivo to gain an in-depth understanding of the study results and triangulate quantitative findings. Results showed that of the 552 CHWs interviewed, 87.7% were married, 78.2% were aged between 30-49 years, 68.1% were females, 59.6% had completed secondary level of education, 97.6% were Christians, 62% were subsistence farmers and 64% were residents in lowland zone. The retention rate among the study participants was 69.4%. Logistic regression results showed that the predictors of retention of CHWs in Makueni County included; financial incentives (p=0.000, OR= 129.477), provision of health updates (p=0.000, OR=4.489), belonging to a self-help group (p= 0.004, OR=2.555), provision of reporting tools (p=0.000. OR=0.022 and provision of essential medical kits (p=0.000, OR=4.768). In conclusion, there is need to review community health strategy implementation guidelines to harmonize provision of regular financial incentives, essential medical kits, reporting tools and health updates (through more comprehensive training programmes, refresher trainings and regular dissemination and sharing of new health information). The national and county government and partners of the community health strategy should also create effective mechanisms for livelihood support of CHWs such as establishing self-help groups as a sustainability measure for the community health strategy.Item Drivers, decision making processes and outcomes of unsafe abortion in four districts of Siaya County, Kenya .(2013-03-18) Osur, JoakimUnsafe abortion is a major public health problem causing 13% and 30% of maternal deaths globally and in Kenya respectively. Despite this, the drivers of the practice in Kenyan communities are scarcely documented. Further, little is documented about the decision making process for women who chose unsafe abortion and whether social networks have a role on this. In addition, not much is known about the methods unsafe abortion providers use and the outcomes of the methods. The objectives of this study were, therefore, to determine the drivers of the practice; find out how social networks influence women's decisions to procure abortion; and determine outcomes of methods used in Siaya County. The study employed a mixture of quantitative and qualitative techniques including cross-sectional survey of 320 patients presenting to health facilities after attempted unsafe abortion; case studies of 8 women who had undergone unsafe abortions; one enquiry into unsafe abortion related death using Rashomon technique and in-depth interviews with 12 unsafe abortion providers and 21 key informants. The findings indicated that women procuring unsafe abortions were mostly below the age of 24 years (76%), in their first trimester of pregnancy (85%) and presenting to health facilities with incomplete abortion (87%). The most commonly reported drivers of unsafe abortion included inadequate infrastructure and equipment in health facilities with all facilities studied not having a full complement of recommended conditions. Only 5.5% of eligible health workers were competent and willing to provide termination of pregnancy services. At community level, unsafe abortions were associated with desire for a good life, pressure from social contacts, and the determination of unsafe abortion providers to give the service. Social networks were found to play a role in the woman's decision making process with 95% of the women consulting with their social networks before making a decision. These consultations led to 63% of women owning a decision to abort while the rest were either not sure or even felt compelled to abort. Logistic regression predictions showed that the man causing the pregnancy and the woman's mother were the most influential persons in cases of unsafe abortion. A case fatality rate of 0.3 per 1000 women aged 15 - 44 was recorded. Other severe complications included hemorrhage requiring blood transfusion and pelvic infection. A Chi square test revealed significant difference in the outcomes of unsafe abortion based on the methods used (X2 = 193, df = 30, p 0.05). Logistic regression predictions confirmed that the outcomes depended on methods used, genital tract injury, for example, being 30%, 120% and 370% more likely to occur with use of self -inserted gadgets, self- inserted medicine and gadget inserted by someone else respectively as compared to hemorrhage not requiring transfusion. It is recommended that the Ministries in charge of Health and NGOs running programs to reduce unsafe abortion prioritizes community involvement as a way of reducing unsafe abortion; give unsafe abortion providers capacity to counsel and refer patients to health facilities; and that the identified drivers of unsafe abortion are addressed comprehensively.