Kenya Methodist University ADHL Nodehttps://library.adhl.africa/handle/123456789/42024-03-29T04:58:47Z2024-03-29T04:58:47ZSeasonality of Cryptosporidium oocyst detection in surface waters of Meru, Kenya as determined by two isolation methods followed by PCRhttps://library.adhl.africa/handle/123456789/86942019-09-29T21:07:46ZSeasonality of Cryptosporidium oocyst detection in surface waters of Meru, Kenya as determined by two isolation methods followed by PCR
Meru, Kenya has watersheds which are shared by wildlife, humans and domesticated animals. These surface waters can be contaminated by the waterborne pathogen Cryptosporidium. To quantify the seasonality and prevalence of Cryptosporidium in Meru regional surface waters, we used a calcium carbonate flocculation (CCF) and sucrose floatation method, and a filtration and immunomagnetic bead separation method, each of which used PCR for Cryptosporidium detection and genotyping. Monthly water samples were collected from January through June in 2003 and 2004, bracketing two April-May rainy seasons. We detected significant seasonality with 8 of 9 positive samples from May and June (p<0.0014), which followed peak rainy season precipitation and includes some of the subsequent dry season. Six of 9 positive samples revealed C. parvum, and 3 contained C. andersoni. None contained C. hominis. Our results indicate that Meru surface waters are Cryptosporidium-contaminated at the end of rainy seasons, consistent with the timing of human infections reported by others from East Africa and contrasting with the onset of rainy season peak incidence reported from West Africa.
Design, implementation and operation of health management information system at Kenyatta national hospital.https://library.adhl.africa/handle/123456789/86932019-09-29T21:07:46ZDesign, implementation and operation of health management information system at Kenyatta national hospital.; NAIROBI COUNTY, KENYA.
Embracing modern technology is one among very many ways of improving efficiency and reducing costs within Health care organizations. While the integration of information and health services potential benefits cannot be disputed, there are many challenges which affect its adoption, in fact, majority of organizations have abandoned their newly acquired system only to go back to their old manual system. This study sought to review the design, implementation and operation of Health Management Information System (HMIS) in Kenyatta National Hospital (KNH) Nairobi County. Specific objectives were a) to determine the design criteria phase of HMIS at KNH, b) to assess the implementation of HMIS at KNH, and c) to evaluate the operation of HMIS at KNH. This was a descriptive cross-sectional study. The study sample was 263 respondents who filled a structured questionnaire and 40 key informant interviewees. Data collected from the field was analyzed through the use of univariate and bivariate statistics. The study revealed that in the design phase, there was significant stakeholder involvement and this manifested through definition and identification of the KNH's HMIS, clear understanding of the purpose and process in the design requirements and thus an indication that the design criteria was observed during the HMIS implementation. In the implementation phase, the fmdings indicated that while the other attributes had a significance, gender did not have a significant association with HMIS implementation p=0.901. The fmdings indicated that the level of management and duration of employment were significantly associated with HMIS implementation at KNH. In the operation phase, respondents said the benefits of electronic HMIS were improved efficiency and reduced workload. More than half (53.1%) of health workers felt that the electronic HMIS in KNH had achieved its objectives which will lead to effective utilization of HMIS and better healthcare service delivery. Overall KNH had successfully implemented HMIS. In recommendation KNH in collaboration with the MOH need to come up with a standardized policy for implementing interventions, improve the current infrastructure, and develop a plan for monitoring and evaluation of the HMIS.
Community based health insurance and utilization of health services.https://library.adhl.africa/handle/123456789/86892019-09-29T21:07:45ZCommunity based health insurance and utilization of health services.; The case of Tanykina community health insurance plan, Nandi County, Kenya.
Health financing mechanisms aims to achieve universal coverage for all and protection against the financial burden during illness. Community Based Health Insurance is one of the alternative sources of health financing especially in the rural and informal sectors. Tanykina Community Health Plan (TCHP) is a community based health insurance targeting the rural population and dairy farmers of Nandi North Sub County of Nandi County. Despite the wide coverage of the program, there is still low health care utilization in the sub-county. Using the Health Belief Model as the theoretical framework, the study purpose was to evaluate the clients and community perception of the services offered by Tanykina Community Health Plan and the influence they have on the utilization of health services by clients. The specific objectives were to evaluate the clients and community perceptions on the services offered by TCHP, to review the respondents' characteristics that determine the utilization of health services and to review the health provider factors that affect the utilization of health services by the clients of TCHP. This was a cross-sectional study design. Data was collected in March 2015 on a sample of 336 patients attending health facilities that offer services to clients of TCHP and the community at large. Systematic random sampling technique was used to determine the study sample. Data was collected using a structured interviewer administered questionnaire and analyzed by STATA version 10. Statistical tests were employed at 0.05 level of significant. Qualitative data was analyzed based on thematic framework to support the quantitative results. A total of 336 patients participated in the study of which 169(50.2%) were enrolled members of TCHP while 167(49.8%) were none members. Of all the respondents 183(54 %) were female and 163(48.5%) had attained at least secondary level of education. The enrolled members had the majority 94(55.6 %) being female and 91(53%) having attained college level of education compared to 82(49%) of the none-members. The average age of all the respondents was 41years. The level of education was highly correlated with increased healthcare utilization (p=0.069) though this was not statistically significant. Increased level of satisfaction correlated positively with increased used of outpatient services and this was statistically significant (p=0.05). The perceived availability of information was however no statistically significantly associated with increased utilization of health services in either outpatient department (p=0.112) or inpatient department (p=0.939). The increased level of perceived acceptance was highly associated with increased utilization of inpatient services (p=0.04). Being male increased the level of perceived acceptance by 10 % compared to the female counterparts. With regard to in-patient health services an additional increase in the level of education of the insured members and the duration of membership significantly increases the utilization of these services by 0.19 and 0.89 respectively. However, the duration of membership was statistically significant (p=0.008) in influencing the level of in-patient utilization. I recommend managers of community based health insurance to continuously evaluate the perceptions that the members have in order to improve utilization of health services. There is need to regularly monitor community based health insurance with respect to client satisfaction to enable prompt action by managers to act to increase the effectiveness of these schemes in achieving universal coverage.
Factors influencing rational drug use in public hospitals among doctors and pharmacists in Meru Countyhttps://library.adhl.africa/handle/123456789/86902019-09-29T21:07:45ZFactors influencing rational drug use in public hospitals among doctors and pharmacists in Meru County
Access to essential medicines, vaccines and medical technologies is the anchor pillar in this study. Medical products must be of assured quality, safety, effective, scientifically sound and cost effective. Rational use of medicines requires that a patient receives appropriate medications to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time and at the lowest cost to them. It is concerned with how commodities are selected, procured, used and stored to ensure that the patients receive quality and efficacious products appropriate to their medical needs. There are a number of challenges that have been encountered in the rational use of drugs. These include lack of essential drugs, gaps in training and weak implementation of policy guidelines. The broad objective of this study was to assess the factors that influence rational drug use among doctors and pharmacists in public hospitals in Meru County. Specifically the study sought to determine how staff awareness on policy guidelines, management practices, product selection and inventory management influence rational drug use among doctors and pharmacists. A cross sectional study design was adopted having quantitative approaches. The sample size was 102 doctors and pharmacists who work in the public hospitals in Meru County. Both stratified and simple random samplings were used to sample the staff. A five point Likert scale based questionnaire was used to collect data. Quantitative data was analyzed using SPSS Version 23. Correlations were done between the dependent variable RDU and independent variables Staff awareness, inventory management, production selection and management practices. Significance levels were done at both 5% and 1%. There was a significant relationship between RDU and staff awareness (r=.232*, p=0.019) and inventory management (r=.324**, p=0.001). Coefficient of determination (R) of 0.402 was obtained compared to overall R2 of 0.162 and this explains 40.2% of total variations that explained factors that influence rational drug use among the healthcare workers in Meru County. The ANOVA findings (F (4,97)=4.68, p=0.002) shows that there is correlation between the predictors variables Staff awareness, management practices product selection , Inventory Management, and the dependent variable Rational drug use. This study recommends: i)The hospitals develop training manuals on rational drug use that will be used to create awareness on importance of Rational drug use among doctors and pharmacists to enhance knowledge and build capacity, ii) departmental heads to offer support supervision, quarterly assessment, appraisals and implement RDU in collaboration with doctors and pharmacists, iii) All the hospitals to constitute active Drugs and Therapeutics Committees in all the facilities to ensure that formularies are developed, policies are communicated and SOPs implemented, to enhance uniformity and build capacity, iv) to constitute procurement committee with all stakeholders including the doctors and pharmacists to ensure they are involved in the budgeting, selection and monitoring of Essential drugs.
Diagnostic Accuracy of Malaria Microscopy in the Highlands of Central Kenya: Implications for Proper Treatmenthttps://library.adhl.africa/handle/123456789/86912019-09-29T21:07:45ZDiagnostic Accuracy of Malaria Microscopy in the Highlands of Central Kenya: Implications for Proper Treatment
p. 148 - 158; Over-diagnosis of malaria is a problem in many African countries and appears to be occur¬ring in the highlands of central Kenya. Blood-smear microscopy, the standard technique for malaria diagnosis in this area, relies heavily on technician skill. Hence, Rapid Diagnostic Tests (RDTs) are increasingly considered the gold standard for diagnosis, but are often not available in resource-constrained settings. We compared the results of microscopy and RDTs performed on finger-prick blood samples from 250 patients referred to laboratory malaria testing at one private and two government health facilities in/near Meru, Kenya. Across the three sites, 97 .1%-100% of microscopy-diagnosed Plasmodium-positive samples were found negative by RDT. Of the three study sites, the government district hospital had the highest microscopy-based positive rate (27.3% as compared to 5.9% and 9.3% in the other two set¬tings). These results indicate alarming levels of inaccurate malaria diagnosis in the Meru re¬gion. Many factors may play a role in this phenomenon, and it is likely that a "systems level" approach is necessary to remedy this problem.
A Comparison between Self and Clinician-collected Vaginal Swabs for Detection of Bacterial Vaginosis among Women in Kisumu, Kenyahttps://library.adhl.africa/handle/123456789/86922019-09-29T21:07:45ZA Comparison between Self and Clinician-collected Vaginal Swabs for Detection of Bacterial Vaginosis among Women in Kisumu, Kenya
p. 181 - 190; Two tests are available for diagnosis of bacterial Vaginosis (BV), Amsel and Nugent. The latter is considered more sensitive. Laboratory diagnosis for BV requires a vaginal swab specimen. In developing countries, vaginal swabs are only collected by trained health clinicians and use of speculum, examination couch and expensive equipment like autoclave is necessary. In contrast, women in developed countries have a choice of either collecting self swab or allowing a trained health clinician to collect the vaginal swab. This study sought to evaluate the validity and reliability of self collected vaginal swabs for diagnosis of BV by comparing with clinician collected ones. Ten beaches were identified based on convenience along Lake Victoria in Kisumu County from which 105 women volunteers were enrolled. Three vaginal swabs were collected from each woman. The first two swabs were self collected while the third one was collected by a qualified clinician. Smears were prepared, read and interpreted by Nugent method while demographic and clinical data were obtained by use of structured questionnaires and pelvic examination forms respectively. There was high agreement (validity) between the clinician collected and the first self collected swab, Kappa score of K=0.952 (p<0.001). The reliability of the clinician and the second self collected swab had a Kappa score of K=0.905 (p<0.001). The self collected vaginal swabs (SCVS) were found to be valid and reliable for use in diagnosis of bacterial vaginosis.
Health systems support factors' influence on uptake of immunization services in Kajiado North sub-County.https://library.adhl.africa/handle/123456789/86862019-09-29T21:07:44ZHealth systems support factors' influence on uptake of immunization services in Kajiado North sub-County.
Access to health care services is described as the ability by patients to reach and demand health services based on individual needs. Immunization is one of the most effective, safest and efficient public health interventions as it is estimated to save at least 3 million lives from vaccine preventable diseases. Many cultural, religious, or social factors may impede the demand for health care. This study focused on the service delivery pillar. The overall objective was to determine the health system support factors and their influence on access of immunization services in Kajiado North Sub-County. Specific objectives were a) to determine the socio-cultural values that contribute to low access of immunization health services, b) to assess how the packaging of immunization services in the health facilities influence access and c) to establish the relationship between the health promotion activities. This was a cross-sectional study design with a sample size of 280 respondents who were mothers with children below 12 months. Nine health workers were purposively selected for a focused group discussion. Data was analyzed using of ms-Excel, SPSS version 20 and results presented in narratives, tabulations, and graphs. The results revealed that in 2012 and 2013 in Ngong hospital and Fatima health center had a drop in immunization coverage of 128 and 273 children respectively. In addition, the comparative analysis of Kajiado sub-counties on immunization coverage indicated that the sub-county antigen specific coverage reduced as follows: BCG dropped by 4% to 61%, OPV increased by 5% to 75% and measles increased by 3% to 77%. The mean age of respondents was 26.7 years and analysis indicated that level of education negatively influenced immunization access. The distance between households and health facilities ranged from a hundred meters to 20Kms. Approximately 48(17.1%), of mothers visit facilities which are outside the 5 kilometer distance advocated by Kenya health policy. 120(42.8%) suggested that there is need for health promotion activities in the community. The correlation of visits to awareness indicated a p-value of 0.209. 233 (83%) agreed that immunization program is well explained to them when they visit health facilities. The correlation of health education with awareness indicated a p-value of 0.406. The modes of communication clearly portrays that 183(65.4%) of mothers got the information about immunization through continuous health education that is routinely offered in health facilities, whereas 39 (13.9%) mothers got the information through community health promotion. The study recommends a) form outreach teams to trace defaulters of immunization schedules, b) sub-county health office to frequently conduct community health promotion in the villages to discourage cultural believes which contribute to low access to immunization services, and c) package simplified information about the benefits of immunization services shared in health education sessions and during community health promotion.
Comparative Study of Professional Competences of Graduates of Innovative and Conventional Medical Schools in Kenya: A Case of Graduates of Moi and Nairobi Universitieshttps://library.adhl.africa/handle/123456789/86852019-09-29T21:07:44ZComparative Study of Professional Competences of Graduates of Innovative and Conventional Medical Schools in Kenya: A Case of Graduates of Moi and Nairobi Universities
p. 285 - 296; A population of 280 intern doctors was randomly sampled using Gay's (1992) sample estimate of 20%. An increase of 10% in the sample accounted for non-response. The desired random sample size was therefore 84 intern doctors. A purposively selected sample of 47 supervisors from a population of 140, which included medical doctors and nursing officer in charges, was also assessed. A total of 54 (63% questionnaires) from graduates were returned with 26 of these from graduates of school of medicine- Moi university, while 28 were returned from University of Nairobi. A total of 47 (100%) questionnaires were returned from supervisors. The graduates from the conventional school rated themselves 82% on the excellent category in the knowledge of scientific foundation of medicine while the graduates from innovative school ratings were 89% on the same category. On further analysis of the results, there was no significant difference between the graduates. The ratings of supervisors on graduates from conventional school (56%) and those from innovative school (53%) on this competence showed no significant difference either. The majority of graduates of the two schools considered themselves highly competent in clinical skills (76% IMS; and 79% CMS). However, there was no significant difference between the ratings of proportion of graduates from the two schools. The findings on supervisors ratings (70%, 30% IMS; and 70%, 30% CMS) of graduates showed no significant difference. The graduates from the two medical schools do not differ at all as perceived by their supervisors on the seven global competences. However, there seems to be significant differences in the way graduates perceive themselves with regard to six competences as shown in the study. The author notes that these differences may be due to limitation of the self assessment method used in the study, which does not always provide for objective information as was the case in graduates' ratings. However, this limitation applied equally to respondents of the two universities, the differences between the graduates from the two schools of medicine can be indicative of the effects resulting from the different curricula used.
Personal characteristic and academic help-seeking behavior of basic diploma nursing students in Kenya Medical Training College, Nairobihttps://library.adhl.africa/handle/123456789/86882019-09-29T21:07:44ZPersonal characteristic and academic help-seeking behavior of basic diploma nursing students in Kenya Medical Training College, Nairobi
Purpose: This cross-sectional mixed survey sought to describe AHSB of basic diploma nursing students in KMTC, Nairobi, Kenya. The study examined the influence of sources of help, options of help-seeking and personal characteristics on help-seeking behavior.
Methods: Data was collected using self-administered questionnaires. Descriptive statistics and inferential statistics (in particular, the chi-square, Fisher’s Exact and binary logistic regression) were derived from the data. All statistical tests of significance were at 95% confidence level.
Results: the study revealed that 90.9% (n=160) of respondents were adaptive help seekers, 72.8% (n=126) preferred peers to lecturers and 75.6% (n=133) frequently sought help from fellow students, especially during group discussions. By contrast, 54.6% (n=95) of the respondents approached instructors during class or immediately after lesson; with only 24.6% (n=43) engaging lecturers privately. Adaptive help seeking was positively associated with personal factors of self-efficacy (p=0.034), the notion that the student is of equal worth with peers (p=0.038) and a feeling that help seeking is not a sign of weakness. On binary logistic regression, students who felt that seeking help was a sign of weakness were significantly less likely to be adaptive help-seekers. The study concludes that personal factors are significant predictors of adaptive help seeking behavior of student nurses in KMTC Nairobi.
Unique contribution to theory, practice and policy: The research recommends that institutions encourage students to treat peers as people of equal worth; and that seeking help is not a sign of weakness. Moreover, schools should explore ways of increasing help seeking from lecturers, especially in their offices
Reaching out to consumer health information users through academic and public/community libraries partnership: Experience from Kenyahttps://library.adhl.africa/handle/123456789/86872019-09-29T21:07:44ZReaching out to consumer health information users through academic and public/community libraries partnership: Experience from Kenya
Consumer health information has gained prominence worldwide due to the need
for preventive as opposed to curative healthcare. Availability of diverse online
consumer health information (CHI) sources necessitates that public library users
become aware of quality CHI sources as they make important healthcare
decisions. An academic library received a grant for a project on the promotion of
consumer health literacy through public and community libraries in Central and
Upper Eastern Kenya. The first phase of the project carried out a CHI resources
training and provided seed money to two public libraries to acquire consumer
health books. The second phase of the project forms the basis of this paper aimed
to examine the impact of the first phase by evaluating the application of the
information literacy skills gained during the training and by assessing the use of
the consumer health collection by the public. A qualitative approach and survey
design were used. Data was collected from twelve users and nine librarians who
were purposely selected for a Focused Group Interview (FGI). An observation
guide was also used during physical visits on selected public and community
libraries. The results show that many public/community libraries established
health corners/hub after attending the training. There was an increase in queries
and demand for e-resources on diseases and general lifestyle information, a
change of attitude by staff and users towards CHI, improved customer care
services, and heightened image and value of a librarian in the provision of CHI.
Challenges faced included semi-illiteracy among the public, users’ insufficient
time to visit libraries, inadequate training skills and knowledge among library
staff, and insufficient funding. The paper concludes that partnership between
academic and public/community libraries in reaching out consumer health
information users was inevitable and significant in fostering community health
development.