Community Health

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    Factors influencing the utilization of public primary health care facilities in Tetu Sub County, Nyeri County, Kenya
    (Chuka University, 2025-10) Maina Isaac Wamai
    Primary 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.
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    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 Kendi
    Occupational 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.