Nursing

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Evaluation of midwives’ and nurses’ continuing professional development in reducing maternal and neonatal mortality in embu county, Kenya.
(Open Journal of Obstetrics and Gynecology 4:249-259, 2014) Gitonga, L.K.; Muriuki, N.S.
Continuing professional development (CPD) is one of the principal means by which health professionals (Nurses and midwives) maintain, improve, and broaden the knowledge and skills required for optimal patient care and safety, to be more specific reduction of maternal and neonatal mortality and morbidity. However, the lack of a widely accepted instrument to assess the impact of CPD activities on clinical practice thwarts researchers’ assessment of the effectiveness of CPD activities. The objective of the study is to develop a theory and practice-based, valid, reliable nation-al instrument to assess the impact of accredited CPD activities on reducing maternal and neonatal mortality in Kenya using an integrated model for the study of healthcare professionals’ behavior through environmental scanning of the factors that promote good performance. The researcher will analyze the instruments identified in a systematic review of factors motivating and demotivating nurses and midwives’ behaviours using criteria that reflect the literature on measurement development of CPD leaders and providers’ priorities. The outcome of this phase will be an inventory of instruments using a competence-based model. Working from this inventory, the most relevant items for assessing the concepts listed will be selected. Then, the researcher will verify whether these items are acceptable or need modification, what aspects need revision, and whether important items are missing and should be added. The outcome of this phase will be a new national instrument integrating the most relevant tools to fit our integrated model of healthcare professionals’ behavior. Two data collections are planned: 1) pretesting of the new instrument, to assess its reliability and validity and 2) a study using the instrument before and after CPD activities with randomly selected groups, one acting as control group to assess measurement effect. The researcher will conduct individual interviews and focus groups with CPD providers and leaders to identify anticipated barriers and enablers for implementing the new instrument in CPD practice. Drawing on the results from the previous phases, we will use consensus-building methods with the decision makers to develop a plan to implement the new instrument.
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.
Assessment, Training and Evaluation of Emergency Obstetric and Neonatal Care Competences for Midwives in Tharaka-Nithi and Embu Counties, Kenya.
(Science Publishing Group, 2016) Gitonga, Lucy Kawira Gitonga
Abstract: Midwifery education in many countries currently follows a didactic curricular model where students learn through classroom lecture with little opportunity for skills practice, simulation and role play needed to develop critical thinking, values and the clinical decision making abilities needed for effective practice. Many midwifery students graduate having attended a limited number of women in labour and some with minimal clinical experience in antepartum, family planning or newborn care. In addition, the assessment of student progress and readiness for practice may not be linked to the intended outcomes of learning and targeted clinical competencies. The aim of the study was to assess, train and evaluate training in "Emergency Obstetric and Newborn Care" for midwives in order to improve the availability of emergency obstetric and Newborn care (EmONC) in Embu and Meru hospitals, Kenya. A three phase explorative study was used involving assessment, training and evaluation of 113 midwives from the maternity units of two hospitals I Kenya. Data was collected by use of a questionnaire, case study and checklist. Data was analysed using SPSS 2.0. Correlational analysis was also used. The results indicated that respondents on assessment of antenatal skills scored an average of 95.2% while on normal labor, childbirth and immediate newborn care skills they scored an average of 89.63% on postpartum care (mother and baby) an average of 87.92%, on management of complications they scored a mean of 88.22%. Based on the findings, CPD in EmONC should be provided to all midwives at all levels of health care delivery in the country including incorporating such activities in the induction programmes for midwives.
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.
Factors Hindering Formal and Informal Nursing Mentorship Programs in Kenyan Public Universities
(Science Publishing Group, 2016-03-31) Oluchina, Sherry; Gitonga, Lucy K.
Introdruction: Mentorship was a one to one reciprocal relationship between a more experienced and knowledgeable mentor and a less experienced mentee. Objective: The study aim was to evaluate barriers of formal and informal nursing mentorship programs in Kenya public universities. Methods: The study utilized a cross-sectional study design. It used both qualitative and quantitative methods in data collection where 305 mentees and mentors participated. Simple random, purposive and snowball non probability samplings were used to select participants. Exploratory and thematic content analyses were done. Results: Barriers encountered were work overload, lack of recognition of mentors, roles of mentors and mentees not clear, lack of support from mentors and institutions, unavailability of mentors, unfit mentor-mentee ratio, inappropriate mentor-mentee matching, unfit personality traits and inadequate time. Recommendations: The study therefore recommended that, all the stakeholders should be encouraged to evaluate nursing mentorship programs in institutions’ of higher learning.
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.
Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device Uptake among Mothers Delivering at Meru Hospital
(Scientific Research publishing, 2019-03-04) Kirigia,Consolata, Gitonga,Lucy
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 im- mediate 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 hoursafterdelivery.TheobjectivewastoassessBarrierstoImmediate Post-Partum Intra-Uterine Contraceptive Device uptake among Mothers de- livering in Meru Hospital. Descriptive research design was used and a popu- lation of 289 mothers was targeted. Sample size of 74 respondents was se- lected using simple random sampling. Questionnaires and interview sche-dules 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 usedto test the relationship of study variables and presented in tables. The qualita- tive data were analyzed thematically. The findings revealed that provider re- lated barriers such as none provision of the services and untimely counselingfor the insertion had the highest impact to low uptake (57%). Clients lacked information where 68% reported that they were not counseled. Demographic andreproductivecharacteristicsalsoplayedaroleinlowuptake.Usingthe 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 methodswasabarriertotheuptake.Therefore,barrierstoPPIUCDuptake are provider related, alternative methods of contraception and client relatedsuchaslackofinformation,unemployment,youngageandlowparity.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.
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.
Lifestyle Modification Strategies Practiced in Management of Hypertensive Patients in Imenti North Sub County, Kenya
(Medwin Publishers, 2019-06-10) Mwenda, A. K.; Gitonga, L.; Kamweru, P. K.
Globally, the prevalence of Non-Communicable diseases such as hypertension is increasing dramatically hence a burden to countries of low income countries such as Kenya. In Kenya the prevalence of hypertension has increased gradually over the last 20 years. The objective of the study was to determine level of practice of lifestyle modification strategies among hypertensive patients in relation to management and control of hypertension. A cross-sectional study design was used to collect data. The study population consisted of hypertensive patients in Imenti North sub County of Meru County. Cluster random sampling method was used to select health facilities to be included in the study. On practice of lifestyle modification strategies, each of the five lifestyle modification strategies was significantly contributing to good control of blood pressure among the participants. 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. Generally, practice of all the recommended strategies was poor among the patients involved in this study.
Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya
(Scientific Research Publishing Inc., 2019-09-25) Githae, Caroline N.; Matiang’i, Micah; Muraya, Moses
Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ 2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ 2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ 2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ 2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waitingtime was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served; they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.
Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya
(Scientific Research Publishing Inc., 2019-09-25) Githae, Caroline N.; Matiang’i, Micah; Muraya, Moses
Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ 2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ 2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ 2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ 2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served; they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.
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.
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.
Predictive Modelling of Benign and Malignant Tumors Using Binary Logistic, Support Vector Machine and Extreme Gradient Boosting Models
(Science and Education Publishing, 2019-11-26) Gachoki, Peter; Mburu, Moses; Muraya, Moses
Breast cancer is the leading type of cancer among women worldwide, with about 2 million new cases and 627,000 deaths every year. The breast tumors can be malignant or benign. Medical screening can be used to detect the type of a diagnosed tumor. Alternatively, predictive modelling can also be used to predict whether a tumor is malignant or benign. However, the accuracy of the prediction algorithms is important since any incidence of false negatives may have dire consequence since a person cannot be put under medication, which can lead to death. Moreover, cases of false positives may subject an individual to unnecessary stress and medication. Therefore, this study sought to develop and validate a new predictive model based on binary logistic, support vector machine and extreme gradient boosting models in order to improve the prediction accuracy of the cancer tumors. This study used the Breast Cancer Wilcosin data set available on Kaggle. The dependent variable was whether a tumor is malignant or benign. The regressors were the tumor features such as radius, texture, area, perimeter, smoothness, compactness, concavity, concave points, symmetry and fractional dimension of the tumor. Data analysis was done using the Rstatistical software and it involved, generation of descriptive statistics, data reduction, feature selection and model fitting. Before model fitting was done, the reduced data was split into the train set and the validation set. The results showed that the binary logistic, support vector machine and extreme gradient boosting models had predictive accuracies of 96.97%, 98.01% and 97.73%. This showed an improvement compared to already existing models. The results of this study showed that support vector machine and extreme gradient boosting have better prediction power for cancer tumors compared to binary logistic. This study recommends the use of support vector machine and extreme gradient boosting in cancer tumor prediction and also recommends further investigations for other algorithms that can improve prediction
HIV/AIDS in Kisii County: Current Status and Challenges
(Science Publishing Group, 2019-12-20) Nyamoita Mokua, Gladys; Mokua Maroko, Geoffrey; Onchari Nyakundi, Augustus; Ondora Onyambu, Meshack
In 2012, adult HIV/AIDS prevalence in Kisii County was disproportionately high at 8.6%, against the national average of 5.6%. Thus, the researchers set out to investigate the current status and intervention measures in place in combating the condition. Mixed method approach combining both qualitative and quantitative data collection techniques was used. It entailed a desk review of HIV/AIDS materials for the period 2010-2018. Published data on HIV/AIDS in Kisii County from a diverse set of stakeholders was used. Quantitative data was also extracted from online databases, County reports and proposals. Qualitative data was generated from key informant interviews and focus group discussions. Comparative analysis of the qualitative information obtained from the respondents and the documented information was done and conclusions were drawn. Quantitative data was expressed as percentages and the data was presented in form of graphs and tables. Findings indicated that although HIV and AIDS remain a challenge in Kisii County, commendable strides have been made in its management and possible containment. The Kenya HIV estimates report for 2018 indicates that Kisii County has a prevalence rate of 4.4% against the national prevalence of 4.8%. The study also revealed that over 80% of HIV response is funded from external sources with more focus on biomedical interventions with less priority on the non-biomedical interventions. Based on the findings, the study recommends coordination among implementing partners for accurate data documentation and resource distribution. Deliberate efforts also need to be made to increase resources for prevention especially behavioral and structural interventions.
Multinomial Logistic Regression Analysis of Factors Influencing Food Safety, Hygiene Awareness and Practices Among Street Food Vendors In Kiambu County, Kenya.
(Enviro Research Publishers., 2020) Mwove, Johnson; Imathiu, Samuel; Orina, Irene; Karanja, Paul
Street food vending is a very popular and unique part of the informal sector, particularly in developing countries. However, the safety of street vended foods is a major public health concern since poor food safety and hygiene knowledge and practices are often reported among street food vendors (SFVs). The objective of this study was to identify the factors influencing food safety, hygiene awareness and practices (FSHAP) among SFVs in Kiambu County, Kenya. Structured questionnaires and an observation checklist were administered to randomly selected 345 SFVs. Results showed that good food safety and hygiene awareness scores were significantly (P less than 0.05) influenced by education level, food hygiene and safety training, mobility of SFVs, public health inspection, and the category of SFVs. Public health inspection was the only factor that significantly (P less than 0.05) influenced all FSHAP score categories. Mobile vendors were 1.86 and 2.20 times more likely to have poor working conditions and poor food handling practices scores compared to those who were not mobile, respectively. Training and education level significantly (P less than 0.01 and P less than 0.05, respectively) increased food safety and hygiene awareness score whereas the duration of time in street food vending significantly (P less than 0.05) improved food handling practice score. Public health inspection of SFVs was found to be the most effective way of improving FSHAP among SFVs. The study recommends regular inspections of SFVs by public health officials to enhance compliance with food hygiene and safety standards and regulations governing the street food sector as well as scheduled training on food safety and hygiene targeting all categories of street food vendors.
THE RESPONSIVENESS OF SEXUAL REPRODUCTIVE SERVICES TO THE NEEDS OF STUDENTS OF CHUKA UNIVERSITY
(African Journal of Emerging Issues (AJOEI), 2020) Willy, R. M.; Murithi, W. N
Purpose: Reproductive health is essential component of public health and can considerably influence the quality of life. No previous studies had been carried out to establish status of access to these crucial services amongst the students in Kenyan universities. However, studies from other universities in other parts of the world and Africa highlighted numerous issues impending access to these crucial services. The study sought to determine whether available services were responsive to the needs of the student of Chuka University. Methodology: It adopted a descriptive cross-section research design. Findings: The results indicated that 51% (n=18) of the respondents visited the facility because they knew that the facility was offering a HIV test, 24% (n=8) visited the facility because it had convenient opening time, 14% (n=5) said that the facility had enough privacy, while 11% (n=4) had enough good service providers. Conclusions and Recommendation: The study concluded that the available services are not packaged in a way that is attractive to clients who are university students. The phenomenon leads to student seeking services in private clinics which are more appealing and responsive to their needs. Also from the findings, it was concluded that there exists a gap in sharing on issues regarding sex between parents, service providers and the students which is attributed to mystery surrounding reproductive health issues which have a bearing from religious teaching and our African culture. The study recommended that University health services should step up investment in reproductive health services targeting the student needs like, family planning, post abortion care, screening for reproductive health cancers and STI/HIV screening and treatment. These services to be offered at convenient hours and at cost which the student can afford in order to ensure access. Reproductive health component to be included among common units taught to undergraduate students, with the intention of creating awareness to the students on issues of reproductive health since most them are very naïve on these issues.
Dietary diversity interventions and its impact on iron status of preschool children 36-59 months in Emali, Kenya
(Food Science & Nutrition Research, 2020) Kimiywe, J.O; Lubeka, C.B; Kiboi, W.K
Background: Dietary diversity is considered crucial in ensuring adequate micronutrient intake, especially among children since they have increased nutrient requirements. Iron deficiency is the most common nutrient deficiency in the world and a major public health risk particularly in the developing countries. This study assessed the impact of dietary diversity interventions on iron status of preschool children in Emali Kenya. Methods: A non-randomized pre-post intervention trial involving 495 pre-school children aged 36-59 months in Early Childhood Development (ECD) schools was conducted. Dietary diversity of the children was enhanced by establishing school gardens in the early-childhood education centers and innovative home-gardening techniques in the homes of selected children’s caregivers. Poultry houses for rearing chicken were also constructed at the ECD centers to provide the children with good sources of protein and minerals. Structured nutrition education on appropriate child feeding was also offered to the children’s caregivers. Children were clustered in two communities the Kamba and Maasai to represent the different ecological settings. Results: Dietary diversity score improved significantly in the Kamba community which recorded a high uptake of the dietary diversity intervention programs. Only 9.1% of the children did not meet the minimum acceptable dietary diversity after the intervention from the 48.1% pre-intervention. The intake of iron-rich foods also improved considerably (77.5%) after the intervention with the prevalence of anemia reducing to 3.4%. Prevalence of anemia among the Maasai children remained high (58.3%) due to low intake of iron-rich foods such as green leafy vegetables (34.6%) and meat (21.8%). Conclusion: Anemia is a matter of public health concern among preschool children. Dietary diversity interventions such us; kitchen gardening, nutrition education (enhancement of food nutritional value through better food preparation methods) and implementation of other nutrition-sensitive agriculture interventions can significantly enhance dietary diversity score and iron status of children.
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.

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