Department of Nursing

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

Browse

Now showing 1 - 20 of 38

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.
Comparative effectiveness of cognitive behavioural therapy combined with motivational enhancement therapy versus cognitive behavioural therapy alone in managing cannabis use severity among patients at selected methadone clinics in Kiambu county, Kenya
(Chuka University, 2025) Muatha Francisca Mbathe
Cannabis Use Disorder (CUD) is an increasing epidemiological issue in the world. The world prevalence of cannabis use is 12.0 percent in those countries where cannabis has been legalized and 5.4 percent in countries where cannabis is not legal. Lifetime prevalence of cannabis use amongst Kenyan people age 15-65 is 3.4%. Poor treatment outcomes have been linked to continued use of cannabis by patients under methadone therapy. Cognitive Behavioural therapy (CBT) is an evidence-based intervention to substance use disorders; it will be more effective when paired with motivational enhancement therapy (MET). This is a cluster randomized controlled trial study design which evaluated the comparative efficacy of CBT+MET and CBT in the treatment of the severity of cannabis use disorder. Forty-nine patients who met the inclusion criterion were enrolled. The study involved cluster-randomization in which the groups of interventions group were assigned CBT+MET (n=33) at Ruiru and the control group engaged in CBT only (n=16) at Karuri methadone clinic. Within group change in scores was tested using paired sample t-tests and between group change after the intervention was tested using independent sample t-test. Diagnostic and Statistical Manual of Mental Disorders-5 (DSM -5) diagnostic criteria on Cannabis Use Disorder symptom checklist were used to measure the outcomes of cannabis use disorder severity scores at baseline and post-treatment. The improvements in both interventions were statistically significant (p<0.001) and CBT+MET demonstrated higher therapeutic improvement (mean reduction: 6.21 points, Cohens d =4.08) than CBT alone (mean reduction: 4.26 points, Cohens d = 2.22). Clinical significance analysis showed that CBT + MET intervention exhibited superior clinical results with the post-treatment mean of 2.15 (SD = 1.25). Most significantly, there was no severe category threshold at which all participants scored below that mark, and 42.4% scored no disorder category. The CBT only group posttreatment assessment showed significant therapeutic improvements with mean score change to 4.50 (SD = 1.90). Although 56% of the participants showed clinical improvement as a result of transitioning to moderate or no disorder categories, 44% were still in the severe range, which means that further intervention is necessary. The sociodemographic characteristics had no statistical significance with Cannabis Use Disorder. The results elicit solid support on the implementation of motivational enhancement factors, in addition to cognitive-Behavioural therapies within the addiction setting, to encourage an implementation of both CBT and motivational enhancement therapy model within methadone maintenance programs in Kenya and resource-constrained settings.
Determinants of adherence to recommended lifestyle modification practices among patients with hypertension aged 30-79 years attending Embu level five hospital, Kenya
(Chuka University, 2025) Muchoki Magdalene Waithera
Achievement of adequate blood pressure control among patients with hypertension requires a combination of pharmacological therapy and lifestyle modifications. The patients’ adherence to lifestyle modification strategies to control hypertension is not well documented in Embu County. Therefore, this study assessed the determinants of adherence to lifestyle modification strategies among patients with hypertension. The study adopted an analytical cross-sectional survey design. It was conducted at Embu Level 5 Hospital in Embu County, Kenya among 179 patients with hypertension aged 30-79 years attending the medical outpatient clinic. The participants were selected using systematic sampling method. Participants for focus group discussion(FGD) were purposively selected from among those who had the highest or the lowest adherence scores. Quantitative data were collected using semi-structured researcher developed and administered questionnaires and modified H-scale test. Qualitative data were collected by use of three FGDs facilitated using a semi-structured discussion guide. Prior to data collection, Ethical approval was sought from Chuka University Research and Ethics Committee as well as authorization from the National Commission for Science, Technology and Innovation (NACOSTI). Quantitative data was analyzed via Statistical Package for Social Science (SPSS) 29.0. Descriptive statistical methods among them frequency distribution, percentages, mean and standard deviations were used for summarizing the data. The relationship between study variables was tested using Chi-square tests and multivariate logistic regression analysis at 95% confidence interval. The results of the study were presented in tables, figures and in narrative form. The results showed that the mean age of the participants was 58.2+12.21 with most participants (29.8%, n=69) aged between 60-69 years. Most participants (63.5%, n=115) were married and 47.5% (n=86) had been on treatment for more than three years. Approximately two thirds (65.2%, n=118) attended follow-up clinic for hypertensive patients monthly. Only 29.3%(n=53) of the participants adhered to the recommended lifestyle modification practices. Employment status (aOR = 0.30, 95% CI [0.10, 0.91], p = .033), level of income (aOR = 2.71, 95% CI [1.28, 5.72], p = .009) and perception of the importance of lifestyle modification practices (aOR = 2.93, 95% CI [1.39, 6.16], p = .005) were significant individual related predictors of adherence to lifestyle modification practices. None of the home-based factors were significant predictors of adherence to lifestyle modifications since all p > .05. However, in the FGD, availability of social support emerged as an important determinant of adherence. In conclusion, the level of adherence to lifestyle modification is low. Unemployment, higher income levels, perceived importance of lifestyle modifications practices and availability of social support increased adherence to recommended lifestyle modification practices. It is recommended that the Ministry of Health need to develop and implement targeted health messages on lifestyle and offer subsidy for drugs used in management of hypertension. Further, the health care providers should use every available opportunity to counsel patients on lifestyle modification practices. Further research is recommended on the effect of patient education on adherence to recommended lifestyle modification practices.
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.
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 men involvement in partner modern Contraceptive use in Chuka sub-county, Tharaka nithi, Kenya
(Chuka University, 2025) Mutegi Doreen Karimi
Men involvement in partner modern contraceptive use is important in achieving universal healthcare through reducing unwanted pregnancies and unsafe abortions. However, only a few men were involved in modern contraceptive use in Kenya and in Chuka Sub-county in Tharaka-Nithi County. This study therefore sets out to investigate determinants of men involvement in partner modern contraceptive use in Chuka Subcounty, Tharaka-Nithi, Kenya. The specific objectives of the study were to determine the level of men involvement in partner modern contraceptive use, identify the individualrelated factors influencing men involvement in partner modern contraceptive use and determine the social-cultural factors influencing men involvement in partner modern contraceptive use. The study was guided by the theory of planned behaviour. This study was carried out in Chuka Sub-county. Analytical cross-sectional study design with a mixed methods approach was used. The study population comprised adult men residing in Chuka Sub-county who are married or cohabiting. Simple random sampling was used to draw a sample of 423 men in the study. Data for the study was collected using a semistructured researcher-administered questionnaire and focus group discussions. Three focus group discussions were conducted in each of the 3 wards of Chuka Sub-county. Participants were purposively recruited to ensure variation by age and level of involvement in partner contraceptive decisions. A pre-test of the data collection instruments was carried out in Igambang’ombe sub-county. Ethical approval was provided by Chuka University-Ethical Review Committee while a research permit was obtained from national commission of science technology and innovation. The researcher ensured voluntary participation, informed consent, anonymity and confidentiality. Quantitative data was analysed using descriptive statistics, chi-square and logistic regression analysis with the help of Statistical Package for the Social Sciences version 29. Tables and charts were used to present the results of quantitative analysis. Qualitative data was analysed through thematic analysis, and reported in narrative form. The study found that only 38.2% of the respondents were involved in modern contraceptive use. Among the individual-related factors, level of education (p=0.024), average monthly income (p=0.041) and knowledge (p<0.001) were significant. Cultural belief (p=0.034) was influencing men involvement in partner modern contraceptive use. Key themes included the influence of individual-related factors such as education, income, and knowledge, as well as cultural beliefs that shaped attitudes and behaviours towards contraceptive use. The study concluded that men involvement in partner modern contraceptive use at Chuka Sub-county in Tharaka-Nithi, Kenya is low and it is influenced by individual-related factors and social-cultural factors. The low prevalence of men involvement in partner modern contraceptive use calls for the establishment of targeted, male-friendly reproductive health programs that actively integrate men into family planning decision-making and service delivery processes. Future studies ought to include female respondents to give opinion of their male partner involvement. The study recommends that the ministry of health should launch a public awareness campaign to promote the uptake of modern contraceptives. There is also need for community health promoters to sensitise the community and especially men on modern contraceptive use and the important role that men play. In addition, healthcare worker perspectives ought to be sought in future studies in order to understand supply side factors affecting men involvement in partner modern contraceptive use.
Determinants of mental health status of primary care givers of children with mental disorders attending Chuka county referral hospital, Kenya
(Chuka University, 2025) Kiraithe Lucy Wanja
Primary caregivers play a crucial role in supporting children with mental disorders. Approximately 1 out 9 children with serious mental disorders have a significant degree of disability and this makes them very dependent on care givers to meet physical and emotional needs. Therefore, mental illness in children will affect primary caregiver personal, physical, mental, social, and financial life thus increasing the risk of psychological distress. This study aimed to assess the determinants of mental health status among primary caregivers of children with mental disorders attending Chuka County Referral Hospital. An analytical cross-sectional design was employed and 156 caregivers recruited through census sampling. Quantitive data was collected using questionnaires and qualitive data using key informant interview where 3 Health care workers were purposively sampled. Instruments were pretested at Embu Level 5 Hospital. Permit to collect data was sort from NASCOSTI, Chuka University and Chuka County Referral Hospital. Participation was voluntary, informed consent were signed, confidentiality was maintained throughout the process. Quantitative data obtained was edited, coded and analyzed using statistical package for social science version 23 computer software using frequencies, percentages, mean and standard deviation. Chi square and regression were used to explore the association between individual/health facility related determinants of caregivers with mental health status at p < 0.05. Qualitative data were transcribed verbatims and analyzed thematically using NVivo 12. Results showed that 71% (n = 110) of caregivers experienced poor mental health, with stress (20.4%) being the most prevalent, followed by depression (17.2%) and anxiety (15.8%). On social demographic characteristics, there was significant associations between mental health status and age of caregiver (χ² = 25.05, p = 0.012) and caregiver child relationship (χ² = 13.66, p = 0.003). On individual related factors, source of income (χ² = 19.6, p < 0.001), financial ability (χ² = 38.0, p < 0.001), frequency of social gatherings (χ² = 31.9, p < 0.001), support group membership (χ² = 10.8, p = 0.001), caregiver knowledge (χ² = 28.4, p < 0.001) and stigma were positively correlated with poorer mental health outcomes (r = 0.46, p = 0.001). On health facility related determinants, staff attitude (χ² = 7.36, df = 2, p = 0.025), medication availability (χ² = 22.1, df = 3, p = 0.001), staff availability (χ² = 17.1, df = 2, p < 0.001), cost of care (χ² = 27, df = 3, p < 0.001) were significantly associated mental health status. Caregivers who reported high cost of care were 11.5 times more likely (AOR = 11.455, 95% CI: 3.607–36.372, p < 0.001) to develop poor mental health status. In summary age and relationship to the child were significantly associated with caregivers’ mental health status with young and the elderly caregivers demonstrating poor mental health status. Caregivers experienced significant emotional distress predominantly depression, anxiety, and stress. Individual determinants were, economic status, social network, stigma, and poor knowledge. Facility related determinants were high treatment costs, poor staff attitudes and shortage of medical drugs and medical staff. The study recommends integration of mental health services in primary health care services to make the services affordable and available, rolling out social support groups both in facilities and community. Further study on evaluating the effectiveness of psychological counselling services in improving care givers mental health status.
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 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.
Determinants of pregnancy- related anxiety among women attending antenatal care at coast general teaching and refferal hospital, Kenya
(Chuka University, 2025) Muchiri Juster Muthoni
Pregnancy-Related Anxiety (PRA) is linked to poor health outcomes for both mother and child, yet evidence from Kenya, particularly the Coastal region, remains limited. This study investigated the determinants of PRA among pregnant women attending antenatal care at Coast General Teaching and Referral Hospital (CGTRH). The objectives were to establish level of Pregnancy related anxiety and find maternal and psychosocial factors influencing it. Cross-sectional study design was used. Data was collected from 177 sampled pregnant women who were selected through systematic random sampling technique. Pregnancy related anxiety questionnaire-revised (PRAQR2) was used to measure the outcome valuable. Quantitative data were collected using structured questionnaires. Qualitative insights were gathered from key informant interviews with antenatal care providers. Quantitative data were analyzed using descriptive and inferential statistics, and qualitative data were thematically analyzed to contextualize the findings. Results revealed that most participants experienced moderate to high levels of Pregnancy related anxiety. Maternal factors such as younger age, higher education, previous obstetric complications, higher parity, employment, and low income significantly increased risk. Psychosocial factors including limited social support, family history of psychological problems, underlying health conditions, and unplanned pregnancies were also strongly associated with PRA. The study concludes that pregnancy related anxiety is prevalent and influenced by both maternal and psychosocial determinants. It recommends routine screening with validated tools in antenatal care and targeted psychosocial support for high-risk groups. Broader studies across different regions of Kenya are needed to enhance generalizability and address cultural variations
Determinants of risk of relapse among patients treated for alcohol addiction at selected rehabilitation centres in Meru county, Kenya
(Chuka University, 2025) Kisomo Mary Syombua
Alcohol addiction constitutes a severe public health concern globally and locally. Though there are many treatments available, the rate of relapse in alcohol addiction worldwide is often much higher than 50%. In Kenya, many adults have alcohol use disorder and the rate of relapse is similarly high ranging between 20 and 80%. This study aimed at examining the prevalence of risk of relapse, psychosocial factors related to the risk of relapse, and the environmental factors related to the risk of relapse among patients treated for alcohol addiction at selected rehabilitation centres in Meru County. The study employed analytical cross-sectional design and mixedmethods of collection of data. Prior to the data collection, a pretest was carried out on 13 patients in comparable facility to test the validity of the semi questionnaire and key informants. A reliability coefficient of 0.804 was obtained. One hundred and thirty (130) primary respondents participated in the study and six (6) key informants. Census method was used to include participants in the study. The research instruments used included a semi-structured questionnaire and standardized tool called Advanced Warning of Relapse Questionnaire (AWARE), which were used to collect quantitative data. Key informant schedule was used to collect qualitative data. Quantitative data was analysed using a computer software, IBM SPSS Statistics 29, while qualitative data was analysed by use of thematic network analysis. Descriptive statistic, chisquare test, and logistic regression analysis was carried out. Results revealed that from the 130 patients, 98(75.4%) patients were at high risk of relapse while 32(24.6%) patients were at low risk of relapse. Majority of them 79(60.8%) were aged between 20 to 34 years. Males, 113 (86.9%) were majority. The urge to drink alcohol (p=0.004), thinking about relapsing (p=0.040), experiencing feeling of low mood, hopelessness and feeling depressed (p=0.012) were identified as the psychosocial determinants while living with alcohol users (p= 0.015) and ease access of alcohol (p=0.032) were the environmental factors influencing the risk of relapse among patients treated for alcohol addiction. The findings underscore the role played by psychosocial and environmental factors in the risk of relapse among patients treated for alcohol addiction. The insights from the study can be used by psychologists and counsellors to improve in their clinical approaches thus promoting long term recovery. There is a need of collaborative working between the clinicians, the society, recovering patients and policy makers in order to ensure long term recovery of those recovering from alcohol addiction. Intervention-based studies of the effectiveness of certain programs that limit environmental access to alcohol can be carried out to obtain evidence-based methods of dealing with relapse.
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.
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
HNDS 371: NUTRITION EPIDEMIOLOGY
(Chuka University, 2024-12-19) Chuka University
HNDS 423: FOOD AND NUTRITION SECURITY
(Chuka University, 2024-12-16) Chuka University
HRIM 251: MEDICAL DATA CLASSIFICATION
(Chuka University, 2024-12-19) Chuka University
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.

Browse

Browsing Department of Nursing by Title