School of Nursing

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Influence of Foot-Care on Foot Ulcer Development Among Type 2 Diabetes Mellitus Patients Attending Clinics in Embu County, Kenya
(Chuka University, 2019-09) Mbisi, Annastacia Munzi
Type 2 Diabetes Mellitus (T2DM) has become a global epidemic of 21st century with disproportionately high socioeconomic burden in the developing world. The prevalence of T2DM continues to rise resulting in significant morbidity and mortality caused by complications such as cardiovascular, eye, renal diseases and foot problems. Diabetic Foot complication is among the worst and most common complications which have led to devastating health outcomes including substantial disability related to amputation, impairment of quality of social life and high treatment cost among patients. The incidence of amputation can be reduced by half if the best foot care practices are adopted. The increasing prevalence of T2DM from 6.3 percent,2017 to 11 percent 2018 raises a concern for the researcher to establish foot care practices among the patient attending diabetic clinics in Embu County, with the specific objective being establishing knowledge level, foot care practice and barriers to diabetes foot self-care practices. A descriptive survey targeting population of 1413 T2DM and 12 key informants from whom a sample size of 301 was systematically drawn and 12 key informants was conveniently sampled from the selected Diabetes Mellitus(DM) clinic respectively. Then Self-administered questionnaires, observational checklist and focused group discussion were performed to collect data. This data was analysed using SPSS version 24. Chi square was used to test the relationship between categorical variables. Statistical significant was be set at α = 0.05. A logistic regression model was used to predict the relationship between foot care practices and diabetes foot ulcer. Qualitative data was analysed thematically using Nvivo version 11. Data was presented in summary tables. Majority of the respondents were female and aged between 40 and 70 years old. The duration that a patient had lived with diabetes, history of smoking and respondents age were significantly associated with foot ulcers at p value <0.05. on Knowledge of patients regarding foot complications; knowing what foot self-care entails, having knowledge on effects of smoking in diabetes and the source of information were significant predictors of diabetic foot ulcer prevention. Walking bare foot in and out of the house and dressing of blisters with sterile dressings was associated with prevention of foot ulcers. Based on the researchers findings; the age of the respondent, their smoking status and the duration they had lived with the diabetes disease significantly determined development of foot ulcers. Also, Knowledge on effects of smoking on diabetes was significantly associated with prevention of developing foot ulcers. However, it was evident that the diabetic patients in Embu County had knowledge deficit on details of self-foot care; however, there was good general knowledge on diabetes management among the patients who got the information from the health care providers. On practice of foot care practices, wearing shoes without socks, and walking bare foot was associated with risk of developing foot ulcers while dressing of blisters with a sterile dressing, drying feet after washing and drying in between the toes was associated with prevention of developing foot ulcers. The County government to develop policies on implementation of support groups among diabetic patients in all hospitals, to empower the patients with knowledge on diabetes management and prevention of its complications and the health care providers to champion for empowering practice of diabetic foot care practices through support group linkages and counseling as the country tries to achieve sustainable development goals.
Patient’s and Family’s Perceptions Towards Diagnosis of Prostate Cancer in Tharaka Nithi County, Kenya
(Chuka University, 2019-09) Kirungia, Timothy Kinoti
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 cancer among men is Prostate cancer (PCa) which is a disease process whereby cells of the prostate proliferate abnormally, ignoring growth-regulating signals in the environment surrounding the cells. Perceptions influence health and well-being outcomes of PCa patients. It is important that health professionals understand the patient‟s and family‟s perceptions to the diagnosis so that they can provide optimal care. Unfortunately, the perceptions associated with the diagnosis of PCa are not directly addressed in many countries including Kenya. In Tharaka Nithi County, reviewed literature shows that perceptions of prostate cancer patients and their families are largely unknown despite their effect on the prostate cancer management and health seeking behaviour. This is because no such research has been done in Tharaka Nithi County. Therefore, this research study aimed at exploring the patient‟s and family‟s perceptions towards diagnosis of prostate cancer in Tharaka Nithi County, Kenya. The study population comprised of families and PCa patients attending Chogoria mission hospital, Magutuni sub-county hospital, Chuka county hospital and Tharaka sub-county 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 where the required patient and family was identified and participated in the study. Data was collected using interview schedules and focus group discussions and summarized using descriptive statistics. Statistical analyses for association between variables was done using chi-square tests. 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. A study in Tanzania showed that men had poor health seeking behaviour after diagnosis with PCa and this was because they felt that their masculinity had been eroded. The statistics in this study portray a good health seeking behaviour following the diagnosis of prostate cancer. In conclusion, the outcome of this study demonstrated that patients and families 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. The study recommends national policy on Prostate Cancer diagnosis and public health information on the diagnosis and treatment of prostate cancer.
Secondary Prevention Practices Among Adult Patients with Type 2 Diabetes Mellitus at Meru Level Five Hospital and Consolata Hospital Nkubu, Kenya
(Chuka University, 2019-09) Ngari, Dennis Mugambi
Diabetes is chronic metabolic disorder characterized by states of hyperglycemia with disturbances of carbohydrates, fat and protein metabolism. Diabetes affects millions of people globally every day and the prevalence of the disease is on the rise due to unhealthy diet and lifestyle. The ailment is associated with significant disability, premature deaths, and enormous medical costs. The disorder usually results to chronic complications including cardiovascular diseases, diabetic nephropathy, diabetic neuropathy, foot ulcers and diabetic eye diseases that are all preventable through secondary preventive measures. Once an individual has been diagnosed with T2DM, secondary preventive approaches are essential in preventing the occurrence of chronic complications. However, lack of awareness of these measures has been cited as the common reasons for the development of complications. The study aimed to assess the practice and factors influencing secondary prevention among patients with Type 2 Diabetes Mellitus (T2DM) at Consolata Hospital Nkubu and Meru Level Five Hospital. A descriptive correlational study design was adopted to collect data from 357purposively sampled participants with T2DM using questionnaires and Focus Group Discussion Guide. Quantitative data was analyzed using SPSS version 25 at 95% confidence interval and a significance level p 0.05.Frequency tables, bar graphs and pie charts were used for descriptive statistics while Chi squares and logistic regression were used for inferential analysis. Most respondents attended Meru Teaching and Referral Hospital. Majority of the respondents were aged between 40- 60 years. Most respondents 31.6% had secondary level of education and majority 67% was employed. Concerning secondary prevention, majority did foot examination on every visit 70.6% and BP monitoring 69.5%while 56.5% did annual eye screening. Most respondents were married and did not engage in harmful social habits such as smoking and alcohol use. The following factors were significantly predicting practice of secondary preventive measures among diabetes patients at a p value ≤0.05; knowledge on complications for diabetes, distance to the facility, availability of drugs, good staff reception, receiving health education and counseling, good care-giver communication, availability of DM services, availability of supplies for screening DM complications, and client satisfaction all significantly influenced DM secondary prevention. Affordability of services, health insurance cover of the patients, monthly cost of DM management and traditional beliefs in managing DM all significantly influenced DM secondary prevention. The level of secondary prevention was poor which was influenced by a number of factors that needs be addressed to reduce the global burden posed by the disease.
Health Seeking Behaviour and Lifestyle Modification Strategies of Hypertensive Patients in Imenti North Sub County, Kenya
(Chuka University, 2019-09) Mwenda, Annarita Kajuju
Globally, the prevalence of Non-Communicable diseases such as hypertension is increasing dramatically hence a burden to low income countries such as Kenya. In Kenya the prevalence of hypertension has increased gradually over the last 20 years. Cases of hypertension remains persistently high in Imenti North Sub County despite compliance to a range of drugs administered. The patient‟ knowledge of lifestyle modification and how they apply complementary strategies such as lifestyle modification strategies is not documented. The objective of the study was to determine knowledge, practice of lifestyle modification strategies and factors affecting health seeking behaviour of hypertensive patients in relation to management and control of hypertension. The research study was a cross-sectional study design. The study population consisted of hypertensive patients in Imenti North sub County of Meru County. Cluster random sampling method was used to select five (5) health facilities for study. Then purposive sampling was used to select total of 212 patients from the selected health facility proportionally. Data was collected using selfadministered questionnaires. The collected data was analysed using statistical package for social science (SPSS) for windows version 23.0. Descriptive analysis was used to obtain frequencies and percentages. The relationship between study variables was tested using Spearmans Rho correlation and bivariate logistic regression to check for the strength of the associations. The research found out that most of the patients seeking health care services in Imenti North Sub County have an average mean of 51 years and higher proportions were above 40 years of age. Majority of the patients were married and female (66.5%), and 60% respectively. An average number of participants (42%) had a secondary level of education with some having tertiary education and others non-formal education. The study findings showed that knowledge on lifestyle modification strategies used in management of hypertension was above average (68%) among the patients in this County, and this was attributed to various factors including health education given during hypertensive clinics. On practice of lifestyle modification strategies, five strategies were assessed;regular physical exercise, low salt diet, limited alcohol intake if any, cessation of smoking, and monitoring body weight gain.Each of the strategy was significantly contributing to good control of blood pressure among the participants; regular physical exercise(χ2=4.259, N=200, p=0.039), low salt diet(χ2=4.259, N=200, p=0.039), limited alcohol intake if any(χ2=23.159, N=200, p=0.000), cessation of smoking(χ2=3.705, N=200, p=0.049), and monitoring body weight gain(χ2=3.999, N=200, p=0.046). When each of the strategy was analyzed on how it influenced blood pressure control, it was evident that the patients who practiced the recommended strategies had their blood pressure controlled. Slow service delivery, long queues and the long waiting times for the laboratory results for investigations demotivated patients from seeking the health care services. The study recommends the Government of Kenya to develop policies on implementation of support groups among hypertensive patients in all hospitals and intensify campaigns on practice of lifestyle modification strategies in management of hypertension to reduce the burden on drug procurement and promote good health of her citizens. This will empower the patients on knowledge of hypertension management. The study also recommends health care providers to ensure availability of the drugs used in management of hypertension and reduce the waiting time for the patients. vii TABLE OF
DETERMINANTS OF HIGH INCIDENCE RATE OF MENTAL DISORDERS AMONG YOUTHS IN CHUKA SUB-COUNTY, KENYA
(Chuka University, 2019-09) Kaburi, John Mwiti
Youth are most vulnerable to mental disorders and psychological disturbances than any other group in the society. Globally, mental disorders amongst the youths have been on increase with one fourth to one-third of the youths and adolescents experiencing these disorders across their lifetime. Kenya mental health policy 2015 – 2030 states that: about 40% of in patients youths in hospitals suffer from mental illness. In Tharaka Nithi County, statistical reports for the year 2014 indicate that there was a total of 1,966 mentally ill persons who visited the health facilities. Chuka sub-county hospital had a total of 806 in-patients diagnosed with mental disorders. Out of the 806 patients, 216 were youths aged 15 – 35 years representing 41%. This high percentage of youths admitted with mental disorders necessitated the study. The current study sought to find the risk factors for mental disorders among the youths in Chuka Sub County. Six locations were conveniently sampled, after which proportion of participants from each selected location was calculated. Individual participants were purposively sampled. The study adopted a cross-sectional survey design to collect data from 384 youths who were sampled through convenience sampling technique. Structured questionnaires were used to collect data. Data was analyzed using Statistical Package for Social Science (SPSS) version 24. Frequencies and percentages were used to present descriptive statistics while Chi Square test of independence was used to test the relationship between the dependent and independent variables. Significant results were then be subjected to logistic regression analysis. Majority of the youths were male, 74%. Those who were aged between 21-25 were 42.5%, 15-20 years were 28%, 31-35 years were 28% and 25-30 years were 0.5%. Majority of the youths had secondary education, 58.8%, followed by college 21.5%, primary 12.2% and university at 7.5%. A big percentage of the youths, 63% were single by the time of study, 34.7% were married and 2.3% had divorced or separated. The following demographic factors were associated with high risk of developing mental disorders; age of the youth (p=0.022), level of education of the youth ( p<0.001), marital status of the youths (p=0.018), significant social risk factors included; youth discrimination (p=0.016), bullying by fellow students (p<0.001), mistreatment while growing up (p=0.013), and frequency of family conflicts, on economic risk factors, significant factors included; satisfaction with income earned (p=0.018), youth straining to fund social needs (p=0.046), and family financial support (p<0.001). Significant environmental risk factors included; area of residence (p=0.025), youths’ participation in societal civic activities (p=0.020) and crime rate at the youths’ area of residence (p<0.001). In conclusion, the study found interplay between social and economic variables which increased the risk of developing mental disorders among the youths. These socioeconomic risk factors compounded with environmental exposures increased the risk of developing mental disorders among the youths. The study recommended, that these interpretations of these findings should be done with caution, as inferences about real cause cannot be made.
Patients and System Related Factors Associated With Non –Adherence to Antihypertensive Medication Among Patients at Chuka Referral Hospital, Kenya
(Chuka University, 2019-09) Gikunda, Charity Ngugi
Non-adherence to hypertensive medication continues to become contributing factor to hypertensive complications like stroke, heart attacks, kidney disease heart failure Non-adherence prevalence to treatment with antihypertensive is not known but it’s thought to be on the rise. Associated factors of non-adherence are complex, are both internal and external to the patient but 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. A descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among them doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling for patients and a sample size of 81 was achieved, and census sampling for health care workers to include doctors, pharmacist, record officers and nurses and a sample size of 10 health care workers was also achieved. Data was collected between the month of April and May 2019. Questionnaire were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Inferential and descriptive statistics were used for data analysis, aided by SPSS version 25. The study revealed 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 . 64% of the patients stated that they had missed medication. The overall model of patient related factors were found to be significant (p< 0.05) and these included ,cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p< .05) that were individually, significant predictors to non-adherence. 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) Hypertension medication nonadherence 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 is necessary to prevent patients from missing the drug. There is need for a continuous supply of hypertension to the hospital to prevent patients from missing the drugs especially those who cannot afford to purchase them from private chemists. 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 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. vii
DETERMINANTS OF HIGH INCIDENCE RATE OF MENTAL DISORDERS AMONG YOUTHS IN CHUKA SUB-COUNTY, KENYA
(Chuka University, 2020-12) MWITI, KABURI JOHN
DETERMINANTS OF HIGH INCIDENCE RATE OF MENTAL DISORDERS AMONG YOUTHS IN CHUKA SUB-COUNTY, KENYA
DETERMINANTS OF PERIOPERATIVE RISKS ASSOCIATED WITH SURGICAL OUTCOMES AMONG ADULT PATIENTS UNDERGOING ELECTIVE SURGERY AT CHUKA COUNTY REFERRAL HOSPITAL, KENYA
(Chuka University, 2023-10) MWANGI VIRGINIA MUTHONI
More than 313 million surgical procedures are carried out annually worldwide, with surgical mortality and complications estimated to range in affluent countries between 0.4-0.8% and 3-17%, respectively as reported by World Health Organization. In Africa, surgical patients are twice as likely to die following surgery when compared to the global average for postoperative fatalities. In Kenya, a national system for tracking perioperative mortality rate and surgical volume has not been established although a surgical target 5000 procedures per 100,000 populations has been set. It is important to understand the perioperative risks and their prevention in order to reduce length of hospital stays and avoid suffering and loss of life that result from complications of surgical procedures. This study aimed at determining the perioperative risks associated with surgical outcomes among patients undergoing elective surgery at Chuka County Referral Hospital, Kenya. The study was guided by the following specific objectives; to determine how patient related perioperative risks influences surgical outcomes, to determine how procedure related perioperative risks influences surgical outcomes, to establish how health system related perioperative risks influences surgical outcomes among patients undergoing elective surgery at Chuka County referral hospital. The study adopted a descriptive cross-sectional design. The study targeted all the surgical patients that were undergoing elective surgery annually at Chuka County Referral hospital. Published reports from the hospital records during the year 2021 indicated that 2005 patients underwent elective surgery at the hospital. A sample size of 202 patients was achieved through systematic sampling method. Both structured questionnaire and interview schedule were used to collect data. Quantitative information for each variable under examination was described using frequencies and percentages. At a 5% level of significance, a Chi square was employed to evaluate the association between perioperative risks factors and surgical outcomes. The study concluded that risks factors such as obesity, malnutrition, presence of comorbidities as well as harmful alcohol consumption and cigarette smoking have adverse effects on surgical outcomes among patients undergoing elective surgery with a p-value<0.05. Therefore, appropriate interventions for the surgical environment should be considered. Complexity of a surgical procedure and duration of procedure are firmly regarded to be risk factors for surgical outcome (pain levels, blood loss Post-operative nausea and vomiting) among patients undergoing elective surgery with p-value<0.05. Thus, surgical team should use judgment to accurately determine the risks associated with the surgery's perioperative period and whether further testing is necessary. Also, prolonged hospital stay was attributed to slow wound healing, wound infections, elevated blood sugar and financial constraints. Out-of-pocket payment can result in high medical expenditure such as surgical charges and other associated cost. Thus there is need for emphasis on importance of enrollment of general population in NHIF scheme. It is anticipated that the findings of this study will provide necessary information useful to policy makers in policy formulation and implementation of vision 2023, health workers and patients undergoing elective surgery on perioperative risks and associated surgical outcome. This will guarantee patients’ undergoing elective surgery positive surgical outcomes with minimal complications and reduced morbidity and mortality rates.

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