Department of Nursing

Permanent URI for this collectionhttps://repository.chuka.ac.ke/handle/chuka/255

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Adherence to focused antenatal care guidelines among nurses and midwives working in selected hospitals in Imenti South sub-county, Meru county, Kenya
(Chuka University, 2024) Mwiti Glory Kanyiri
Focused antenatal care is essential to improving neonatal and maternal health by preventing, identifying, and treating medical conditions that endanger a pregnant woman’s health besides a fetus. Maternal mortality ratio and morbidity remain and one of the strategies to reduce maternal mortality ratio is the effective implementation of focused antenatal care. This study aimed to determine nurses’ and midwives’ adherence to focused antenatal care guidelines among nurses and midwives working in selected public health facilities in the Imenti-South Sub-County, Meru County. The study adopted an analytical cross-sectional research design. It involved all 55 nurses and midwives working at the antenatal clinic in the level 4 hospitals, level 3, and level 2. Ethical clearance was obtained from the Chuka University Institutional Ethics Committee. Permit to collect data was obtained from the NACOSTI, the County director of medical services, Meru County, Imenti South health coordinator, and an informed consent signed by the respondents. Data was collected using an observational checklist and a researcher-administered questionnaire. Data was cleaned, coded, and entered in the Statistical Package of Social Sciences (SPSS) (V.27) for analysis. Descriptive statistics like mean, frequencies, median, percentages, and range were used to summarize, data was presented in tables and graphs. A chi-square test was used to show the relationship between sociodemographic characteristics and adherence to focused antenatal care guidelines. Regression analysis was used to determine predictors of adherence. The mean age of the participants was 35.91 ±10.92 SD with more than half being less than 36 years (56.4%). The majority were females (60%). About threequarters had a diploma in nursing. Average years of experience was 10.45 ±10.05 SD while working in the ANC department was 3.89 ±3.71 SD. The majority of the facilities were level II (60%). More than half of the nurse-midwives had no in-service training on FANC (72.7%). Most nurse-midwives had poor knowledge of FANC guidelines (67.3%). More than half of the facilities had adequate resources to offer ANC services (58.2%). There were slightly more participants with good adherence to FANC guidelines (50.9%) than those with poor adherence (49.1%). Adherence was significantly associated with the level of the facility. There was no significant association between adherence and knowledge level of FANC guidelines (p>0.05). However, there was a significant association between adherence and availability of resources (p= 0.012, COR= 4.364; CI = 95% 1.383,13.772). Nurse-midwives have poor knowledge of FANC guidelines. The percentage of nurse-midwives with good and poor adherence to FANC guidelines was almost equal. Adherence to FANC guidelines is significantly associated with the availability of resources. There is a need to train the nurse-midwives on the current FANC guidelines as well as provide continuous monitoring and evaluation to enhance adherence. The county government in collaboration with the national government should ensure there are adequate ANC services resources in the facilities. An interventional study should be carried out to determine if the in-service training for the nurse-midwives will improve their knowledge of FANC guidelines.
Determinants of neonatal sepsis preventive practices among postnatal mothers attending mother and child clinic at embu level five hospital, Kenya
(Chuka University, 2024-10) Alemun Elizabeth Mukade
Globally, neonatal sepsis accounts for 35% of neonatal deaths, with its burden estimated at 203,000 sepsis-associated deaths annually. The third Sustainable Development Goal (SDG 3.2) on child health aspires to end avoidable childhood and newborn deaths by 2030. However, this cannot be achieved because of the high number of sepsis-specific neonatal deaths, especially in third-world countries. This study sought to assess determinants of neonatal sepsis preventive practices among postnatal mothers attending the mother and child health clinic at Embu Level Five Hospital in Kenya. The study adopted a descriptive cross-sectional survey design. Eighty-one postnatal mothers selected by systematic random sampling from the Mother and Child Health clinic at the Embu Level Five Hospital participated in the study. Five key informants, including nurses and midwives purposively selected from the nursing department, also participated in the study. Quantitative data was collected using a researcheradministered semi-structured questionnaire and analyzed using the statistical package of social sciences (SPSS) computer software version 29.0. Qualitative data was collected using in-depth interviews and analyzed thematically. The chi-square test and multivariate logistic regression analysis were used to establish the association between the variables. The mean age of the respondents was 26.56 (SD ±6.905). The results showed that 30 (37%) were self-employed, with the majority being multiparous. The average age of the neonates was 15.02 days (SD ±4.602). The determinants associated with neonatal sepsis preventive practices among postnatal mothers included age (p = < 0.001), employment status (p = < 0.001), level of education (p = < 0.001), parity (<0.001), and marital status (p = 0.020). Home-based factors to be associated with neonatal sepsis preventive practices included decision makers for neonate care on place of delivery (AOR 0.120; 95% CI 0.016, 0.921, p-0.041), on baby’s current food (AOR 0.125; 95% CI 0.024, 0.655, p=0.014), and cultural beliefs (AOR 5.842; 95% CI 1.014, 33.670, p=0.003). Qualitative data results discussed the following themes: sepsis preventive practices, cultural beliefs detrimental to preventive practices, challenges in implementing preventive practices, and recommendations to improve neonatal sepsis preventive practices. In conclusion, the demographic characteristics and home-based factors are some of the factors that determine neonatal sepsis preventive practice among postnatal mothers. The study recommends promoting neonatal sepsis preventive practices through increased health awareness and education during pregnancy, labor, and delivery. Drafting policies and implementing strategies on neonatal sepsis prevention should be done thus reducing the risk and repercussions of neonatal sepsis
Determinants of teenage pregnancies in Tigania central sub-county, meru county, Kenya
(Chuka University, 2024) Lintari Mwirabua Stanley
Teenage pregnancy has harmful consequences on the health and wellbeing of adolescent girls. It can lead to severe complications during delivery which can result into their own morbidity and mortality and that of their infants. Though a high prevalence of teenage pregnancies was noted in Tigania Central Sub-County in Meru County, the factors behind this trend were unclear. Consequently, this study assessed the determinants of teenage pregnancies in Tigania Central Sub-County, Meru County, Kenya. The study evaluated the sociodemographic, socioeconomic and cultural factors associated with teenage pregnancies in the sub-county. This study utilized an analytical cross-sectional study design. An aggregate of 161 teenage girls and nine community health promoters (CHPs) from Tigania Central Sub-County, Meru County constituted the study sample. The teenage girls were recruited using cluster and simple random sampling methods while the CHPs were selected using purposive sampling method. The teenage girls responded to a researcher-administered structured questionnaire while the CHPs responded to an interview guide. The questionnaire was pretested among 12 teenage girls whereas the interview guide was pretested among one CHP at Amwathi in Igembe North, Meru County. The study’s quantitative data were analyzed using descriptive measures that included percentages and frequencies. The data was further subjected to bivariable logistic regression analysis to establish associations between the study variables. In addition, odds ratios were used to determine the likelihood of the independent variables influencing the dependent variable. Quantitative data analysis was performed using the Statistical Package for Social Science version 28 with the results presented in tables, charts and graphs. Qualitative data was analyzed using thematic analysis with findings reported verbatim. Ethical principles of study approval, participants’ consent, voluntary participation, confidentiality and anonymity in data handling and reporting were observed. A total of 142 teenage girls and 7 CHPs took part in the study. Most (56.3%, n = 80) of the teenage girls indicated that they had ever been pregnant. Early menarche (β = -1.615, p = 0.000, OR = 5.03), initiation to sex at an early age (β = -1.264, p = 0.011, OR = 3.54), poor awareness of contraceptives (β = -1.202, p = 0.015, OR = 3.33) and low use of contraceptives (β = -0.938, p = 0.016, OR = 2.56) were the sociodemographic factors found to be associated with teenage pregnancies in the sub-county. Teenage girls’ poor education background (β = -1.024, p = 0.003, OR = 2.78), their parents’ lack of an income source (β = 1.366, p = 0.000, OR = 3.92), living with non-parents (β = 1.093, p = 0.002, OR = 1.66) and being exposed to work labour at an early age (β = -2.774, p = 0.000, OR = 16.03) were the socioeconomic factors found to be associated with teenage pregnancies in the subcounty. Early marriages (β = 2.587, p = 0.000, OR = 13.29), adverse peer influence (β = 1.381, p = 0.013, OR = 3.98), exposure to sexual abuse or violence (β = 1.327, p = 0.001, OR = 3.77) and involvement in cultural initiation ceremonies (β = 0.824, p = 0.017, OR = 2.28) were the cultural factors found to be associated with teenage pregnancies in the sub-county. The study concludes that a wide range of sociodemographic, socioeconomic and cultural factors led to teenage pregnancies in Tigania Central Sub-County. The study recommends that teenage girls should be educated on the dangers and repercussions of teenage pregnancy and should be counselled against engaging in irresponsible sexual conduct. On policy, authorities should take firm legal actions against perpetrators of teenage pregnancies. Further research on the effects and outcomes of teenage pregnancies in the sub-county would equally be informative.
Determinants of uptake of long-acting reversible contraceptives among women of reproductive age attending meru teaching and referral hospital, meru county in Kenya
(Chuka University, 2024) Munyiri Lilian
The most efficient and reasonably priced forms of birth control are long-acting reversible contraceptives (LARC). In spite of their effectiveness, less than 15% of women globally who are of reproductive age use LARC. In Kenya, just 18% of women who are of reproductive age are using LARC procedures. The frequency in Meru County (11.2%) is much lower than it is nationwide. This study set out to evaluate the variables affecting the uptake of LARC among women who were receiving care at the Meru Teaching and Referral Hospital and were of reproductive age. Analytical crosssectional survey research design was used in the study. Women of reproductive age (WRA) requesting family planning services at Meru Teaching and Referral Hospital in Meru County were the study's target population. Ten key informants were chosen through purposive sampling, and 117 women who were of reproductive age were chosen by systematic random sampling. In order to get quantitative data for this study, the researcher utilized a semi-structured questionnaire that she had created, and to gather qualitative data, she employed a key informant guide. The Embu Teaching and Referral Hospital served as the pretesting site for the research tools. The presentation of qualitative data involved the thematic organization and narrator. The mean, mode, and standard deviation of descriptive statistics were used to assess quantitative data. Chi-square tests were utilized to examine the relationship, at a 95% confidence interval, between the uptake of LARC and variables linked to social culture, health facilityrelated characteristics, and knowledge level. The strength and connection of the factors that were discovered to be significant were tested using regression analysis. According to the study, the uptake rate for LARC among women who were of reproductive age was 11.2%. The factors that affected this rate were as follows: a good level of knowledge, which influenced LARC uptake at x2(N=170), 5.16, p=.018, the timeliness of service provision at x2(N=170), 15.62, p<.001, and distance to the health facility at x2(N=170), 10.84, p<.001. The spacing of children at x2(N=170), 20.51, p<.001, and who decides to seek family planning services at x2(N=170), 6.32, p=.012, were the main social and cultural determinants that affected LARC uptake. The study also generated three themes which are, high cost of LARC services, inadequate staff who have been trained on insertion and removal of LARC and inadequate supplies required for service provision The study came to the conclusion that LARC uptake among women of reproductive age was impacted by both individual and health facility characteristics. The study makes several recommendations, the ministry of health to launch widespread campaigns to raise awareness and knowledge about LARC among women of reproductive age, that health facilities should enhance the promptness with which they provide services, particularly family planning services, and that they should support women's autonomy in choosing when to seek family planning services. Further research should be carried out to explore on health care provider characteristics that influence uptake of LARC.
Evaluation of continuous professional development effectiveness in clinical practice among nurses and midwives in Meru county - Kenya
(Chuka University, 2024-10) Odhiambo Roselyne Akinyi
Continuous Professional Development, refers to the process through which professionals maintain and expand their knowledge and skills. Globally, the top five causes of maternal mortality in women of all ages include haemorrhage, hypertensive disorders, embolism, abortions and sepsis, accounting for over 75% of all maternal fatalities. In Sub-Saharan Africa, the need for nurses and midwives is increasing due to the heavy disease burden and increased workloads. In Meru County, the Maternal Mortality Rate (MMR) burden remains a concern. The Nursing Council of Kenya requires nurses and midwives to complete 20 hours of CPD annually. The International Confederation of Midwives’ (ICM) has emphasized on strengthening continuing midwifery education programs. The justification of the study is evidenced by high MMR and Neonatal Mortality Rates (NMR), which exceeds the Sustainable Development Goals (SDG) target. Additionally, due to the poorly structured CPD programs that has led to its poor uptake. The objective of this study was to evaluate the effectiveness of Continuous Professional Development in Clinical practice among nurses and midwives in Meru County, Kenya. This was an evaluation study that utilized both qualitative and quantitative techniques and adopted the randomized controlled trial design. The study participants included nurses and midwives from Kanyakine, Muthara, Githongo and Nyambene Sub-County Hospitals. The study was three phased. Purposive and stratified random sampling methods were used to select the four facilities and the 78 sampled participants respectively. Participants were then allocated into the control and intervention groups using systematic random sampling. Pretesting was done in Isiolo Sub-County Hospital. Permission to conduct the study was sought from Chuka University Ethics Review Committee, National Commission for Science and Technology, from the facility heads and consent taken from the participants. Data was collected using questionnaires, structured interviews and case study follow-up. Quantitative data was analysed using SPSS version 26 while qualitative data was analysed using the themes that emerged. Pearson’s chi square was used to test the association between the nurses and midwives knowledge and CPD effectiveness in clinical practice. Paired t-test was used to compare means within the two groups (control and intervention). Phase two involved training the participants belonging to the intervention, based on the results for phase one. Phase three involved evaluation of the training intervention, which was done in two levels, immediately after training and during clinical practice using the post-test structured interviews. Data was analysed and compared with those of phase one. The mean differences in performance was done between phase one and phase three using paired t-test. Phase one results revealed poor participation in CPD activities and gaps in knowledge and skills on midwifery clinical competencies, indicating an association between CPD effectiveness and knowledge (p<0.00). Phase two results revealed marked improvement in skills after the training. The results improved from a pre-test mean of 54.19% to a post-test mean of 90%, indicating a 35.81% improvement. Phase three results showed great improvements in knowledge and skills in all areas of antenatal, normal labour, immediate newborn care, postpartum and skills in management of complications. Results from the structured interviews, as compared to phase one performance improved from a mean of 79.30% to a post-test mean of 91.34%. Further, the findings were subjected to paired sample tests which were significant with a df = 24 and (p < 0.001) at 95%CI. In conclusion, there was great improvement in the participant’s knowledge and skills after the training. The study recommended that the Hospital’s management to develop strategies on how to provide continuous education forums for nurses and midwives, in liaison with the relevant stakeholders. A CPD Model was developed from the study’s findings.
Factors influencing uptake of intra-uterine contraceptive device among women of reproductive age (15-49 years) attending family planning clinic at Embu teaching & referral hospital, Kenya
(Chuka University, 2024-10) Munyoki Mercy Syombua
Contraceptives allows an individual to prevent unwanted pregnancy and control when and to become pregnant. An Intrauterine Contraceptive Device (IUCD) also called ‘coil’ is a small device made from plastic and copper which sits inside the uterus. Contraceptive information and services are fundamental to the health and human rights. It helps prevent unintended pregnancies to lower maternal ill-health and the number of pregnancy –related deaths. Delaying pregnancies in young girls who are at increased risk of health problems from early child bearing, and preventing pregnancies among older women who also face increased risks. Globally only 15 % of women of reproductive age use intrauterine device as a contraceptive method while in Sub -Saharan Africa, only 2% of women of reproductive age were using Intrauterine Contraceptive Device. In Kenya 5% of women of reproductive age were using Intrauterine Contraceptive Device as a method of family planning. In Embu County 7.5% of women of reproductive age were using Intrauterine Contraceptive Device according to KNBS 2022. The study objectives included individual, health facility factors influencing uptake of Intra-uterine Contraceptive Device among women of reproductive age attending family planning clinic at Embu Teaching & Referral Hospital and socio-cultural factors influencing uptake of Intra-uterine Contraceptive Device among women of reproductive age attending family planning clinic at Embu Teaching & Referral Hospital. The research study was analytical cross-sectional study design. Census method of sampling technique was used collect data amongst 180 respondents which was the monthly workload. Piloting was done at Meru level 5 hospital among 18 respondents and 5 health care workers, Data was collected using self-researcher administered questionnaire. Data was analyzed using statistical package for social science version 27 and NVIVO version 14.Descriptive analysis was used to obtain frequencies and percentages. The relationship between variables was tested using Chi-Square and logistic regression analysis to check for strength of association. Ethical consideration was observed. The research findings: age was a key determinant in use of IUCD, age category of 30 to 49 years 73.8% (n-177).Parity affected use of IUCD those with two children and above were using the method., majority using had two children and above and were married 69% (n-177).Those with monthly income <10000 were mostly using IUCD at 50.3%,(n-177) hence need to sensitize people on use of IUCD, Information source being Health Care Workers was influential to use of IUCD those who consulted partners were likely to use the method. Male involvement was key that partners supported use of IUCD 78.8% (n-177) Myths and misconceptions 88.9% (n-177) influenced use of IUCD negatively people believed it would migrate to other parts of the body, Cultural beliefs 71.8% (n-177) affected use of IUCD negatively clients believed it was a dirty procedure. The government of Kenya to Champion for campaigns to sensitize women of reproductive age on IUCD and provide more guidelines on IUCD to be provided for clients to have more information. Mentorship to all health care workers working at the family planning clinic at Embu Teaching and Referral Hospital on IUCD counselling, insertion and removal to improve competency.
Self-management practices for asthma control among patients with asthma attending Chuka County referral hospital - Tharaka Nithi County, Kenya
(Chuka University, 2024-10) Micheni Hellen Njeri
Asthma is a chronic inflammatory disease of the respiratory tract which arises from narrowing of the air passages leading to life-threatening symptoms of coughing, wheezing chest tightness and difficulty in breathing. It is a global public health problem that affects people of all ages contributing significantly to morbidity and mortality. According to estimates, 4.3% of the world's population has asthma with about 461 000 deaths being associated with the disease annually. In the developed countries the prevalence is estimated at 15 – 20% while in LMICs the prevalence is 12%. Kenya is depicted as having an asthma prevalence of 7.5%. At Chuka County Referral Hospital, asthma accounts for about 25% of the diseases of the lower respiratory tract. Asthma being a chronic illness requires self-management practices to achieve asthma control. Failure to engage in self-management leads to asthma exacerbations, emergency hospitalization, reduced productivity and poor quality of life (QoL). This study aimed at assessing self-management practices for asthma control among adult patients with asthma. The study was guided by the following specific objectives; to assess level of knowledge on asthma self-management, to determine asthma self-management practices, to establish determinants of asthma self-management and to determine the status of asthma control among patients with asthma at Chuka County Referral Hospital, Kenya. The study adopted a descriptive cross-sectional survey design. A sample size of 118 patients was obtained using Fisher’s et al formula and the sample was selected using simple random sampling. A researcher administered questionnaire was used to collect data. Data was analyzed using statistical package for social sciences version 26 to generate frequencies, mean and measures of central tendency. At 5% level of significance, a Chi-square test was employed to determine associations between demographic variables and asthma control while Pearson’s correlation coefficient was used to determine the relationship between knowledge on asthma as well as selfmanagement practices and asthma control. The study concluded that; knowledge on asthma and self-management is statistically significant and negatively correlated to asthma control (r=-0.251, p-value=0.006) where individuals with knowledge on asthma and its associated self-management reported asthma symptoms less frequently and vice versa. Notably, 53.1% of respondents lacked knowledge on asthma triggers while 49.6% lacked knowledge on controller medications for asthma. Self-management practices were found to be statistically significant and negatively correlated to asthma control (r=-0.19, p-value=0.045) where patients engaging in self-management practices reported less frequent asthma symptoms. The study revealed that non-adherence to asthma medication is driven by factors such as absence of symptoms and high cost of medications. Key facilitators of asthma self-management practices include; effective communication with healthcare workers, availability and affordability of medications in government hospitals. Some of the reported barriers to asthma self-management include presence of comorbidities, poor self-control and lack of knowledge on ASM. On status of asthma control, the study established that a majority of the respondents (43.3%) had partially controlled asthma, 28% had uncontrolled asthma and only 28.7% had controlled asthma. This study has concluded that there are significant gaps in asthma self-management practices hence sub optimal asthma control which calls for improvements in asthma health literacy among patients with asthma. It is anticipated that the finding of this study will lead to improvements in self-management practices for optimal asthma control among patients with asthma.

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