Community Health
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Item Determinants of adherence to prevention of mother-tochild transmission (PMTCT) of HIV protocols among seropositive mothers at chuka referral hospital, kenya(Chuka University, 2025) Kiunga Judith KabugiGlobally, vertical transmission during pregnancy, labour, delivery, and breastfeeding remaining a major route of new HIV infection among children. Prevention of Mother to Child Transmission (PMTCT) protocols aim to reduce these risks. However, despite the government's efforts, adherence to PMTCT protocols in Tharaka Nithi County remain low resulting in increased HIV-related child morbidity and mortality. This study’s aim was to assess the determinants of adherence to PMTCT protocols among seropositive mothers in Chuka referral hospital, Tharaka Nithi County. Specifically, the study sought to determine the level of adherence to PMTCT of HIV protocols and the individual-related and sociocultural determinants of adherence. An analytical crosssectional design was used in this study. The study involved 80 participants from among the seropositive mothers attending the PMTCT clinic and 15 healthcare providers at Chuka referral hospital, selected through census and purposive sampling respectively. The study employed a semi-structured questionnaire and key informant interviews to collect quantitative and qualitative data respectively. Statistical package for social scientists (SPSS) 29.90 was used in analysing quantitative data. Descriptive statistics among them mean, standard deviation, frequency and percentages were used to summarizing data. Chi square and binary regression analysis were used for relationship testing at 95%CI. Qualitative data from key informants was transcribed verbatim, and thematically analyzed using NVivo version 14.0 computer software. The study revealed that the mean age of the mothers was 27+ 7.11 years with most mothers (50%, n=40) aged between 22 and 31 years. Almost half of the participants (48.8%, n=39) were married with 47.5%, (n=38) having attained college education. Overall, adherence to PMTCT protocols was 56%. Mothers who were aware of safe delivery practices were 10 times more likely to adhere to PMTC protocols than those who were not aware (χ² = 5.000, p = .025, aOR=10.029, 95%CI, p=.025). Among sociocultural determinants, social support emerged as the only significant predictor (χ² = 4.366, p = .037; AOR = 10.366), whereas stigma and religion were non-significant. In conclusion, overall adherence to PMTCT protocols remained below the WHO-recommended 95%. Awareness of PMTCT guidelines and social support increased adherence to PMTCT protocols among HIV-positive mothers. It is recommended that Ministry of Health strengthen policies integrating PMTCT education into routine care, and promote family- and community-based support systems to enhance adherence. Chuka Hospital should prioritize structured awareness programs and actively connect mothers to peer and community networks, as well as innovative support models, to sustain and enhance PMTCT outcomes. The study suggest that future research should explore longitudinal adherence patterns to PMTCT and examine innovative support systems, such as digital tools, peer networks, and family-centered interventions, to strengthen sustainable PMTCT outcomes.Item Determinants of adherence to anti-tuberculosis treatment among patients with tuberculosis attending Meru teaching and referral hospital, Kenya(Chuka University, 2025) Wagithi Sr. Mary EstherTuberculosis (TB) is an infectious disease and a leading cause of morbidity and mortality globally. Adherence to standard anti-TB drugs is crucial in the control of the TB epidemic. Despite Meru County being ranked among the top ten counties with a high burden of the TB epidemic in Kenya in 2022, the adherence levels are low, yet little is known about the factors influencing adherence in this setting. This study therefore sought to determine individual and health facility factors that influence adherence to anti-TB treatment among TB patients attending the TB clinic at Meru Teaching and Referral Hospital (MeTRH). This was an analytical crosssectional study involving 176 TB patients. Simple random sampling was used to select participants. In addition, a purposive sampling technique was used to select participants for Focused Group Discussions (FGDs). A researcher administered semi-structured questionnaire was used to collect quantitative data. Qualitative data was collected through four FGDs involving 8 participants each and facilitated using a semi-structured discussion guide. Quantitative data from questionnaires were analyzed using Statistical Package for the Social Sciences (SPSS) 29.0. Mean, standard deviation, frequencies, and percentages were used to summarize quantitative data. The relationship between variables was tested using the Chisquare test and logistic regression analysis at 95% Confidence Level. Qualitative data from FGD was analyzed thematically using NVIVO 14.0. Data was presented using narratives, tables, and figures. The findings revealed that slightly more than half of the participants (55.1%, n=97) were male. The mean age of the participant was 37± 14.8 SD years, with the largest proportion (40.9%, n=76) aged 18-30 years. Most of the participants (46%, n=81) had been on TB treatment for three months. The majority of participants (46%, n=81) had attained secondary education. Furthermore, most participants (63.1%, n=69) were married and also served as the primary breadwinners in their families (63.6%, n=112). Almost all participants (93.8%, n=165) had pulmonary TB, with 48.8% (n=86) in the second phase of treatment. The level of adherence to Anti-TB treatment was 75.0%. Individual related factors that significantly influenced adherence to Anti-TB treatment were Age (AOR=1.609, p = 0.001, 95%CI), Marital status (AOR = 0.20, p<0.001,95% CI, level of Education (AOR=4.94, p=0.002, 95% CI) and level of Knowledge AOR=7.6, p<0.001, 95% CI. Health facility-related factors that significantly influenced adherence included distance (AOR=17.3, p=0.001 95% CI) and support from healthcare (AOR=10.59, p<0.001, 95%CI). The study concludes that the level of adherence to Anti-TB treatment is below the WHO-recommended level of at least 90%. The study recommends that the Ministry of Health should develop targeted health messages about TB and TB treatment to improve the level of knowledge, and also consider decentralizing TB drugs picking points to the lowest level of care. The health care providers need to consider adjusting the clinic operating hours to cater for patients who are working as well as strengthen counseling and health information sharing with TB patients at the commencement and throughout the treatment period. Further research may be carried out to determine the effect of patient education on adherence to anti-TB treatment.Item Factors influencing the utilization of public primary health care facilities in Tetu Sub County, Nyeri County, Kenya(Chuka University, 2025-10) Maina Isaac WamaiPrimary health care institutions are optimally situated to provide person-centred and community-oriented care necessary to prevent or delay morbidities. This insight prompted Nyeri County to spend significantly in the development and equipping of health centres and clinics to enhance accessibility of services for the populace. Nevertheless, just 14% of the adult population availed themselves of these services. Demographic, economic, regional, and health-system issues may be contributing to this issue. Nonetheless, it remains unclear which of these reasons may be contributing to the underutilisation in Nyeri County. This research aimed to evaluate the variables affecting the use of public primary health care services in Tetu Sub-County, Nyeri County, Kenya. The research aimed to assess the extent of use of public primary healthcare facilities and identify individual and health facility-related variables affecting this utilisation. Two hundred and seventy-one adult residents of Tetu Sub County were the subjects of this analytical cross-sectional study, which included quantitative and qualitative methods of data collection. Using a multi-stage sampling process, the participants were chosen. The National Commission for Science and Technology granted a research authorisation, and the Chuka University Ethical Review Committee granted ethical approval. The researcher administered a semi-structured questionnaire to collect quantitative data. The qualitative data was gathered via the use of a conversation guide in focus groups. To ensure the data collection instruments were viable, a pre-test was carried out in Mukurwe-ini Sub-county. Our quantitative data was analysed using SPSS version 28, which is a statistical package for the social sciences. Descriptive statistics, chi-square, and logistic regression were used to the data. Qualitative data was analysed using thematic analysis in NVIVO version 14. Narratives, tables, and figures all contributed to the presentation of the study's findings. Results showed that 38.7 percent made use of free or low-cost primary care clinics. Women used public primary healthcare facilities 1.14 times more often than males, and this difference was statistically significant (p=0.01). People with lower levels of education were 2.5 times more likely to utilise public primary healthcare facilities, suggesting a strong correlation between education and the use of these services (p<0.01). Among health-facility related factors, the results showed a substantial association (p<0.001) between the availability of medication and the utilisation of public primary healthcare facilities. The research determined that the use rate of public basic healthcare facilities in Tetu Sub-County, Nyeri County, Kenya, was low primarily owing to the lack of medicine and other supplies. It is advised that the Nyeri county government guarantee primary healthcare facilities are routinely supplied with critical pharmaceuticals and equipped with required diagnosis and treatment services.Item Factors influencing the uptake of tuberculosis preventive therapy among nurses and midwives in tier 2 - 4 public health facilities in Imenti North Sub-County, Kenya(Chuka University, 2025) Kiambi, Nancy KendiOccupational exposure to tuberculosis puts nurses at a higher risk of contracting the disease. To mitigate this risk, tuberculosis preventive therapy (TPT) is recommended for healthcare workers who have not yet progressed to TB disease. However, despite the high risk and the availability of the drugs, TPT uptake remains below the expected level, particularly in Kenya where the burden of TB is significant. This study investigated factors influencing TPT uptake among nurses and midwives in tier 2-4 public facilities in Imenti North Sub- County, Meru County, Kenya. Specifically, the study examined the uptake of TPT and identified both health facility and individual related factors that influenced TPT uptake. The study employed an analytical crosssectional survey design. A total of 154 nurses and midwives were selected from among 215 nurses and midwives via stratified random sampling method. Quantitative data were gathered through a self-administered, semi-structured questionnaire developed by the researcher. Qualitative data was collected through eleven key informant interviews with the nursing service managers purposively selected from the facilities where the study was undertaken. Pre-testing of the study instruments was conducted in Tigania East, Mikinduri sub- county hospital among 15 nurses. Quantitative data was manually cleaned and analyzed using Statistical package for social sciences (SPSS) version 29.0. Descriptive statistics among them mean, standard deviation, frequency and percentages were used in summarizing the data. Chi-square and multivariate logistic regression analysis were used to identify relationship between independent and dependent variables at 95% confidence interval. Qualitative data was transcribed verbatim from audio records and thematic analysis via NVIVO version 12.0. Results were presented through tables, figures and in narrative form. Results showed that most participants (82.8%, n=125) were from Meru teaching and Referral Hospital. The mean age of the participants was 37.03+ 8.124 and the mean years of practice was 10.17+ 7.52. About two thirds of the participants (66.2%, n=96) were female. Majority (60.9%, n-93) had a diploma in Nursing and 51.0%(n=77) were married. Most participants (97.7%, n=147) were aware of TPT and 72.8%(n=110) had good knowledge of TPT. Majority of the participants (95.4%, n=144) supported the use of TPT. Only 33.1%(n=50) of the participants had taken TPT. Among these, 46.0%(n=21) had taken Rifapentine Isoniazid and 68.9% had taken it within the last year. None of the individual related factors was significantly associated with the uptake of TPT since they had p >0.05. Among the health facility related factors, availability of policy(X2=7.729(1), p=.005) and guidelines on TPT (X2=4.457, p=.035) as well as receiving verbal instructions/ training (X2=5.121, p=.024) on TPT were significantly associated with uptake of TPT. In conclusion, the uptake of TPT among nurses and midwives was low. None of the individual related factors investigated influenced the uptake of TPT. Availability of policy and guidelines as well as receiving instructions on TPT increased the uptake. It is recommended that the ministry of health should make TPT mandatory among all the health care providers rather than voluntary and disseminate policy and guidelines on TPT to all levels of the health care additionally, more CMEs should be carried out to demystify TPT among health care workers. A large scale study involving all health care providers on factors that influence adherence to TPT is recommended.