Browsing by Author "Gitonga, Lucy"

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Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device Uptake among Mothers Delivering at Meru Hospital
(Scientific Research Publishing Inc, 2019-03-04) Kirigia, Consolata; Gitonga, Lucy; Muraya, Moses Maugu
Global contraceptive use is at 64%, Africa lagging behind at 33.4%. Kenya has an unmet need for family planning at 23%. Hormonal injections are the most used in Africa at 9.8% and Intra-Uterine Contraceptive Devices at 3.8%. Low uptake of 3.4% was reported in Meru Hospital and lack of literature on immediate Post Partum Intra Uterine Contraceptive Device (PPIUCD) uptake. Immediate Post Partum Intra Uterine Contraceptive Device is a long acting reversible contraceptive device inserted into the uterus immediately within 48 hours after delivery. The objective was to assess Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device uptake among Mothers delivering in Meru Hospital. Descriptive research design was used and a population of 289 mothers was targeted. Sample size of 74 respondents was selected using simple random sampling. Questionnaires and interview schedules were used to collect data. The collected data were entered and analyzed using Statistical Package for Social Science windows version 23.0. Descriptive analysis was used to obtain frequencies and percentages. Chi-square was used to test the relationship of study variables and presented in tables. The qualitative data were analyzed thematically. The findings revealed that provider related barriers such as none provision of the services and untimely counseling for the insertion had the highest impact to low uptake (57%). Clients lacked information where 68% reported that they were not counseled. Demographic and reproductive characteristics also played a role in low uptake. Using the chi square test, there was a significant relationship, P = 0.001 between young age of the mothers, unemployment (53%), low parity (56%) and low uptake. Preference for other alternative contraceptives (25.8%) such as hormonal methods was a barrier to the uptake. Therefore, barriers to PPIUCD uptake are provider related, alternative methods of contraception and client related such as lack of information, unemployment, young age and low parity. The findings will inform Meru hospital management on barriers to immediate PPIUCD uptake. The study recommends an investigation on why providers hinder PPIUCD uptake and create awareness on PPIUCD services to the community.
Essential Maternal and Newborn Care Skills Training for Midwives: Their Impact on Reducing Maternal and Neonatal Mortalities in Kenya
(Science Publishing Group, 2016-01-27) Gitonga, Lucy
Continuing professional development (CPD) continues to gain acceptance as a model for health care professionals to engage in lifelong learning. Little is known about how CPD participants put the experience and the new knowledge into practice and whether it has impact on patient care outcomes. The primary objective of this study was to evaluate the effectiveness of CPD of Midwives on Essential Maternal and Newborn care skills on maternal and neonatal mortality in Embu County, Kenya. The study was an interventional non-randomized pretest post test study design of midwives from the participants of the 2010 ministry of health training on essential maternal and newborn care skills. Sixty (60) midwives working in maternity unit of Embu level five hospitals were targeted. The study was carried out in two phases. Phase one involved environmental scanning of the factors that support good performance in the workplace using a questionnaire. Phase two involved evaluation of the impact by testing a hypotheses using data collected by use of questionnaires, evaluation checklist and chart audit. Data were analyzed using qualitative content analysis and presented using percentages and frequency tables. Chi-square test and correlation analysis were used to show the association between variables, which are midwives essential maternal and newborn care skills and maternal and neonatal mortality. A chi-square χ2 = 14.143, df = 9 and a coefficient = 0.357. This coefficient is less than p-value at Alpha 0.05 and therefore is not significant, proving that the essential maternal and neonatal care skills do not contribute to reduction in mortalities as such two variables are almost independent of each other, whether one exists does not necessitate the existence of another nor does it reduce maternal and neonatal mortalities in Kenya.
Essential Maternal and Newborn Care Skills Training for Midwives: Their Impact on Reducing Maternal and Neonatal Mortalities in Kenya
(Scientific Research Publishing, 2016-01-27) Gitonga, Lucy
Continuing professional development (CPD) continues to gain acceptance as a model for health care professionals to engage in lifelong learning. Little is known about how CPD participants put the experience and the new knowledge into practice and whether it has impact on patient care outcomes. The primary objective of this study was to evaluate the effectiveness of CPD of Midwives on Essential Maternal and Newborn care skills on maternal and neonatal mortality in Embu County, Kenya. The study was an interventional non-randomized pretest post test study design of midwives from the participants of the 2010 ministry of health training on essential maternal and newborn care skills. Sixty (60) midwives working in maternity unit of Embu level five hospitals were targeted. The study was carried out in two phases. Phase one involved environmental scanning of the factors that support good performance in the workplace using a questionnaire. Phase two involved evaluation of the impact by testing a hypotheses using data collected by use of questionnaires, evaluation checklist and chart audit. Data were analyzed using qualitative content analysis and presented using percentages and frequency tables. Chi-square test and correlation analysis were used to show the association between variables, which are midwives essential maternal and newborn care skills and maternal and neonatal mortality. A chi-square χ2 = 14.143, df = 9 and a coefficient = 0.357. This coefficient is less than p-value at Alpha 0.05 and therefore is not significant, proving that the essential maternal and neonatal care skills do not contribute to reduction in mortalities as such two variables are almost independent of each other, whether one exists does not necessitate the existence of another nor does it reduce maternal and neonatal mortalities in Kenya.
Integration of Cervical Cancer Screening Services in the Routine Examinations Offered in the Kenyan Health Facilities: A Systematic Review
(Scientific Research Publishing Inc., 2019-05-21) Munoru, Florence; Gitonga, Lucy; Muraya, Moses
Cervical cancer is the second most common cancer among women and the leading cause of deaths among women worldwide. In Kenya, uptake of screening services is at 3.2% below the targeted of 70%. Therefore, there is need to study the factors that lead to low uptake of the screening services. One way of increasing the uptake of the screening services is its integration with other routine services, thus leading to a reduction in morbidity and mortality rates associated with the disease. The objective of this study was to review and examine the importance of integrating cervical cancer screening services in the routine examinations offered in the Kenyan health facilities. A retrospective study design was adopted by this study. The review of articles, journals, strategic plans was done from the year 2012 to 2017. Data sources included Medline, PMC, Library, Pubmed, Google scholar, cancer prevention plans and strategies. About 28 data sources were reviewed with 78.5% indicating that increased knowledge and creation of awareness on cervical cancer would greatly improve the utilization of the screening services. More than 87% of the information collected among published work in Kenya demonstrated that knowledge on importance cervical cancer screening is inadequate. The primary results of this study suggest that all women of reproductive age (WRA) should undergo cervical cancer screening as a routine service. An integration approach should be adopted, to enhance knowledge on cervical cancer and the importance of screening, causes, preventive and treatment options. The study recommends that, the Government of Kenya through the Ministry of health should include cervical cancer screening as a routine procedure for all WRA.
Patient and Health System Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya
(Scientific Research Publishing Inc., 2021-05-08) Gikunda, Charity; Gitonga, Lucy; Kamweru, Paul
Background: Non-adherence to hypertensive medication continues to become a contributing factor to hypertensive complications like stroke, heart attacks, kidney disease heart failure. Associated factors to non-adherence are complex, are both internal and external to the patient and are difficult to extrapolate. Reports from Chuka referral hospital records showed that in 2016 there were 140 patients with hypertensive complications from 560 patients who attended the medical clinic that year. Objective: This study sought to explore the patient’s related factors that are associated with non-adherence to hypertension medication. Methods: This is a descriptive study design of (N = 575) people among them doctors, pharmacists, nurses, record officers and hypertension patients. Simple random sampling for patients (n = 81) and census sampling for health care workers was done and data collected using questionnaires and interview schedules between April 4th-May 30th 2019. Inferential and descriptive statistics were used for data analysis, aided by SPSS version 25. Results: 64% of the patients stated that they had missed medication. A significant negative correlation (rpb = −0.23, p < 0.05) between age and non-adherence, significant positive correlation with monthly income (rpb = 0.24, p < 0.04), non-significant relationship between non-adherence and marital status (rpb = −0.13, p = 0.25) and patients’ level of education (rpb = −0.06, p = 0.57). The overall model of health system related factors were found to be significant (p < 0.05) and this included; quality of health service, physician patient relationship, stock out, health education, and availability of medicine (p = 0.012). Conclusion: Lacks of funds, unavailability of drugs are the leading factors to regimen completion. This could be easily be addressed by the government.
Patients Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya
(Scientific Research Publishing Inc., 2019-09-27) Ngugi Gikunda, Charity; Gitonga, Lucy
Antihypertensive medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood pres sure control. Hypertensive medication non-adherence continues to become a contributing factor to hypertensive complications like heart attacks, heart failure, stroke, kidney disease. Prevalence of non-adherence to antihyperten sive treatment is not known but it’s thought to be increasing. Associated fac tors of non-adherence are complex, are both internal and external to the pa tient but are difficult to extrapolate. This can partly be because the determi nants of non-adherence to hypertensive may have a locality effect due to many factors such as culture and health system in a given locality. Hence, studies from one region may not have a cross-application. Therefore, there is the need to study the factors associated with non-adherence at a local scale. Descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling and a sample size of 81 patients was achieved and 10 health care providers including doctors, pharmacists, record officers and nurses were also interviewed through census method. Data was collected between the month of April and May 2019. Questionnaires were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Descriptive and inferential statistics were used for data analysis, aided by SPSS. The study re vealed a significant negative correlation (rpb = −0.227, p < 0.05) between age and non-adherent, insignificant relationship with marital status (rpb = −0.129), in significant (rpb = −0.064) correlation with patients’ level of education and a positive correlation with monthly income (rpb = 0.24). A majority of patients stated that (64%) of the hypertensive patients had missed medication. Pa tient-related factors: cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors together were found to be significant predictors of non-adherence to hypertension medication, χ 2 = 17.14, df = 1, N = 81, p < 0.05. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p < 0.05) that were individually, significant predictors to non-adherence. Non-adherence to hypertension medication is a major problem at Chuka Level Five Hospital. This was due to lack of funds, time, forgetfulness and pa tient thinking that they had healed thus continuous follow-ups to improve adherence, positive reinforcement to increase motivation in order to address forgetfulness, and supply of constant and subsidized hypertensive drugs to the hospital are necessary to prevent patients from missing the drugs. There is need to reduce out of pocket payment through establishment and streng thening of the community health insurance scheme. The study recommends that the hospital should set aside some resources for making patients’ fol low-ups especially those were treated and left to go home; discussions be made with patients on severity of non-adherence and importance of adhe rence; use of positive reinforcement to increase motivation and mechanism to be put in place to subsidize the cost of medication.
Patients Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya
(Scientific Research Publishing Inc., 2019-09-27) Gikunda, Charity Ngugi; Gitonga, Lucy
Antihypertensive medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood pressure control. Hypertensive medication non-adherence continues to become a contributing factor to hypertensive complications like heart attacks, heart failure, stroke, kidney disease. Prevalence of non-adherence to antihypertensive treatment is not known but it’s thought to be increasing. Associated factors of non-adherence are complex, are both internal and external to the patient but are difficult to extrapolate. This can partly be because the determinants of non-adherence to hypertensive may have a locality effect due to many factors such as culture and health system in a given locality. Hence, studies from one region may not have a cross-application. Therefore, there is the need to study the factors associated with non-adherence at a local scale. Descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling and a sample size of 81 patients was achieved and 10 health care providers including doctors, pharmacists, record officers and nurses were also interviewed through census method. Data was collected between the month of April and May 2019. Questionnaires were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Descriptive and inferential statistics were used for data analysis, aided by SPSS. The study revealed a significant negative correlation (rpb = −0.227, p < 0.05) between age and non-adherent, insignificant relationship with marital status (rpb = −0.129), insignificant (rpb = −0.064) correlation with patients’ level of education and a positive correlation with monthly income (rpb = 0.24). A majority of patients stated that (64%) of the hypertensive patients had missed medication. Patient-related factors: cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors together were found to be significant predictors of non-adherence to hypertension medication, χ 2 = 17.14, df = 1, N = 81, p < 0.05. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p < 0.05) that were individually, significant predictors to non-adherence. Non-adherence to hypertension medication is a major problem at Chuka Level Five Hospital. This was due to lack of funds, time, forgetfulness and patient thinking that they had healed thus continuous follow-ups to improve adherence, positive reinforcement to increase motivation in order to address forgetfulness, and supply of constant and subsidized hypertensive drugs to the hospital are necessary to prevent patients from missing the drugs. There is need to reduce out of pocket payment through establishment and strengthening of the community health insurance scheme. The study recommends that the hospital should set aside some resources for making patients’ follow-ups especially those were treated and left to go home; discussions be made with patients on severity of non-adherence and importance of adherence; use of positive reinforcement to increase motivation and mechanism to be put in place to subsidize the cost of medication.
Perceptions Towards Diagnosis Of Prostate Cancer in Tharaka Nithi County, Kenya
(Journal Of Nursing Practice, 2021-04) Kirungia, Timothy Kinoti; Kirigia, Consolata; Gitonga, Lucy; Kiruki, Silas
Background: Cancers are leading cause of death in developed nations and the second leading cause of death in developing nations. One of the most frequently diagnosed cancers among men is Prostate cancer (PCa). Purpose: This research study aimed at exploring the patient’s and family’s perceptions towards diagnosis of prostate cancer in Tharaka Nithi County, Kenya. Methods: The study population comprised of families and PCa patients attending Chogoria mission hospital, Magutuni sub-county hospital, Chuka county hospital and Tharaka subcounty hospital which were selected purposefully, from which a sample of 70 patients and 65 family members was obtained. Purposive sampling method was used to sample patients and families. Data were collected using interview schedules and focus group discussions and summarized using descriptive statistics. Statistical analysis for association between variables was done using chi-square tests. Results: The study revealed that; men in the age group 60-70 were most prone to the development of prostate cancer. A high percentage of patients and families perceived that prostate cancer was caused by genetic factors and should be treated by medical personnel. Over 50% of the patients and families had no idea of the symptoms of prostate cancer neither had they heard of it before the patient was diagnosed. The study also revealed that 50% of the patients suffered hypertension, 80% did not believe the diagnosis at first and over 50% perceived the diagnosis as a death sentence. PCa patients showed the highest level of acceptance and lung cancer patients the poorest acceptance of illness. Over 90% of the patients and families observed general health improvement after medication. Over 78% of the patients and family‟s had embraced insurance as a way of meeting the medical expenses. Conclusion: This study demonstrated that patients and families perceived the diagnosis of prostate cancer as a death sentence. They also had low level of knowledge about PCa. A strong correlation was demonstrated between family history and increased risk of PCa. However, it was demonstrated that family history of PCa did not increase levels of knowledge on the causes of PCa.
Perspectives of continuing professional development for Kenyan midwives.
(2014) Gitonga, Lucy; Muriuki, N. S.
Abstract Continuing Professional Development (CPD) provides an important strategy for reduction of ma-ternal morbidity and mortality with the aim of attaining Millennium Development goals (MDG) four and five. However, there is a lack of information about how Kenyan midwives understand and perceive CPD and how this is situated in the practice and social context. This research aimed to explore Kenyan midwives’ experience and perceptions of CPD. A descriptive explorative approach gathered focus group discussion and questionnaire data on beliefs, opinions, and perceptions, demotivating and motivating factors to CPD of a total of 25 midwives in a level five hospital in Kenya. Questionnaires were piloted and self-administered after cleaning and focus groups taped and transcribed verbatim. Data were analyzed thematically using inductive approach with the aid of SPSS computer program. Results: Four key themes emerged from the data: Midwives’ views of CPD, their motivators for undertaking CPD, the choices they made around CPD, their demotivators for undertaking CPD. Congruence with the issues evident in the literature were: the difficulties with role diversity, the importance of CPD in personal and professional growth, the importance of flexible modes of study and the importance of a supportive culture for ongoing learning. The study findings helped in identifying gaps in the literature about Kenyan midwives’ perspectives on CPD.
Socio-Demographic, Nutritional and Adherence as Determinants of Nevirapine Plasma Concentration among HIV-1 Patients from Two Geographically Defined Regions of Kenya
(IISTE, 2020-10) Mungiria, Juster; Gitonga, Lucy; Muraya, Moses; Mwaniki, John; Ngayo, Musa Otieno
Data are skewed on the role of Socio-demographic, nutritional and adherence related factors on the influence of nevirapine plasma concentrations among Kenyan population. This study rigorously determined these three factors on nevirapine plasma concentrations among HIV patients receiving HIV treatment in two regions known for high prevalence of HIV and long duration of ART uptake.Methods: Blood samples were collected from 377 consenting HIV adult patients receiving an NVP-based first-line ART regimen. A detailed sociodemographic questionnaire was administered. NVP plasma concentration was measured by liquid chromatography - tandem mass spectrometry (LC-MS/MS). Results: The majority (59.2%) of the patients were female, 72.2% were from western Kenya (predominantly Nilotic speaking community). The patients’ mean age was 41.6 (SD ± 11.5) years and the mean duration of ART was 5.1 (SD ± 4.8) years. The median BMI of the patients was 25 kg/m2 (IQR = 22.2 - 28.7 kg/m2 ). The majority 81.2% were receiving 3TC/NVP/TDF ART regimen, 30% had changed their initial ART regimen with 54.4% reporting missing taking current ARVs. Overall NVP plasma levels ranged from 4-44207 ng/mL (median 6213 ng/mL, IQR 3097–8606.5 ng/mL). There were 105 (25.5%) participants with NVP levels of <3100 ng/mL, associated with poor viral suppression. Multivariate linear regression analysis showed region of origin (adjusted β 976, 95% CI, 183.2 to 1768.82; p = 0.016), gender (adjusted β 670, 95% CI, 293.6 to 1634.2; p = 0.047), education level (adjusted β -39.0779, 95% CI, -39.07 to 1085.7; p = 0.068), initial ART regimen type (adjusted β = -548.1, 95% C = -904.2 to -192; p =0.003) and ARV uptake in the past 30 days (adjusted β = -1109, 95% C = -2135 to -83; p =0.034) remained independently associated with NVP plasma levels.Conclusion: NVP plasma concentration is highly heterogenous among Kenyan population with a significant proportion of patients reporting levels of <3100 ng/ml, correlated with poor viral suppression. The host pharmacoecologic factors, such as gender, age, weight, education level, region of origin (ethnicity), ART regimen type and adherence, are key in influencing NVP plasma concentration. Taking these factors into consideration, HIV treatment may be personalized to achieve optimal treatment success.