Nursing

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Essential Maternal and Newborn Care Skills Training for Midwives: Their Impact on Reducing Maternal and Neonatal Mortalities in Kenya
(Science Publishing Group, 2016-01-27) Gitonga, Lucy
Continuing professional development (CPD) continues to gain acceptance as a model for health care professionals to engage in lifelong learning. Little is known about how CPD participants put the experience and the new knowledge into practice and whether it has impact on patient care outcomes. The primary objective of this study was to evaluate the effectiveness of CPD of Midwives on Essential Maternal and Newborn care skills on maternal and neonatal mortality in Embu County, Kenya. The study was an interventional non-randomized pretest post test study design of midwives from the participants of the 2010 ministry of health training on essential maternal and newborn care skills. Sixty (60) midwives working in maternity unit of Embu level five hospitals were targeted. The study was carried out in two phases. Phase one involved environmental scanning of the factors that support good performance in the workplace using a questionnaire. Phase two involved evaluation of the impact by testing a hypotheses using data collected by use of questionnaires, evaluation checklist and chart audit. Data were analyzed using qualitative content analysis and presented using percentages and frequency tables. Chi-square test and correlation analysis were used to show the association between variables, which are midwives essential maternal and newborn care skills and maternal and neonatal mortality. A chi-square χ2 = 14.143, df = 9 and a coefficient = 0.357. This coefficient is less than p-value at Alpha 0.05 and therefore is not significant, proving that the essential maternal and neonatal care skills do not contribute to reduction in mortalities as such two variables are almost independent of each other, whether one exists does not necessitate the existence of another nor does it reduce maternal and neonatal mortalities in Kenya.
Factors Hindering Formal and Informal Nursing Mentorship Programs in Kenyan Public Universities
(Science Publishing Group, 2016-03-31) Oluchina, Sherry; Gitonga, Lucy K.
Introdruction: Mentorship was a one to one reciprocal relationship between a more experienced and knowledgeable mentor and a less experienced mentee. Objective: The study aim was to evaluate barriers of formal and informal nursing mentorship programs in Kenya public universities. Methods: The study utilized a cross-sectional study design. It used both qualitative and quantitative methods in data collection where 305 mentees and mentors participated. Simple random, purposive and snowball non probability samplings were used to select participants. Exploratory and thematic content analyses were done. Results: Barriers encountered were work overload, lack of recognition of mentors, roles of mentors and mentees not clear, lack of support from mentors and institutions, unavailability of mentors, unfit mentor-mentee ratio, inappropriate mentor-mentee matching, unfit personality traits and inadequate time. Recommendations: The study therefore recommended that, all the stakeholders should be encouraged to evaluate nursing mentorship programs in institutions’ of higher learning.
Contraceptive Knowledge among Men and its Influence on their Participation in their Partner’s Modern Contraceptive use in Dallas Sub-location, Embu County, Kenya
(International Journal of Health Sciences and Research, 2023-08) Ndunge Koome, Agnes; Prof. K. Gitonga, Lucy; Dr. Kiongo, Josphat
Background: Maternal morbidity and mortality is a global health concern. Use of modern contraceptive has the potential of reducing maternal mortality by two thirds. However, the prevalence of modern contraceptives is low especially in sub–Saharan Africa region. Male participation has been promoted as one of the strategies to increase contraceptive prevalence. The objective of the study was to determine the influence of contraceptive knowledge on participation in partner contraceptive use among married or in-union men. Methods: A cross-sectional survey was carried out in Dallas Sub-location of Embu County involving married or in-union men aged 18 to 64 years. Data was corrected using a semi-structured questionnaire developed and administered by the researcher. SPSS version 28.0 was used to analyze data. Descriptive statistics were used to summarize the data whereas Chi-square was used to test relationship at 95% CI. Results: Most participants (37.9%, n=89) were aware of three or more modern contraceptive methods with about three quarter (75.2%, n=155) aware of oral contraceptive pills. A significant relationship was established between the participants contraceptive knowledge and number of children (p=0.021) as well as highest academic qualification (p=0.011). Most participants (86.3%, n=202) indicated that they participated in their partner’s use of modern contraceptives. The correlation between knowledge and men participation was not significant (p=0.674). Conclusion: Men had adequate contraceptive knowledge and high level of participation in their partner’s modern contraceptive use. The level of knowledge did not significantly influence their participation.
Patient Related Factors Influencing Timely Diagnosis of Tuberculosis in Tharaka Nithi County, Kenya
(International Journal of Health Sciences and Research, 2023-10) Linda, B.K.; Gitonga, L. K.; Mukhwana E. S.; M’Kiunga, K. S.
Globally, the control of Tuberculosis (TB) has remained a public health challenge despite numerous prevention and treatment programs. Kenya is ranked among countries with a high TB burden globally and has the highest incidences of all types of tuberculosis compared to other East African Countries. The high prevalence of TB in Kenya been attributed to delays in the diagnosis of TB. The consequence of the delays has been the increased spread of the disease, disease advancement, poor treatment outcomes, and high cost of patient treatment and care the affected populations. The aim of this study was to assess patient related factors influencing timely diagnosis of TB in Tharaka Nithi County. Tharaka Nithi County is among the counties with the highest prevalence of TB in Kenya. The study adopted a descriptive cross-sectional survey study design. A sample of 154 patients randomly selected from three hospitals in Tharaka Nithi County was used. A self-administered questionnaire was used to collect data. The data was analyzed using both descriptive and inferential statistics. Associations between patient related factors and duration of TB before diagnosis was tested using Chi-square. The study findings revealed that most (70.86%) of TB patients had delayed diagnosis. Persistent cough was the major sign that led patients to seek for care, while believe that signs and symptoms would disappear was major reason for delay in seeking treatment and care. Sex, age, marital status, employment, self-medication, stigma, work and smoking history were the patients related factors significantly associated with timely diagnosis of TB (P<0.05). The study recommends promotion of care seeking behavior through raising public awareness on tuberculosis, enhancing active case findings, strengthening community-hospital referral systems, boosting health system partnerships for early detection of TB.
ORIGINAL RESEARCH: MIDWIVES’ KNOWLEDGE AND PRACTICE OF MIDWIFERY-LED CARE MODEL IN EMBU COUNTY, KENYA
(2023) Kirigia, Consolata; Prof Gitonga, Lucy; Dr Mukhwana, Sundays
The midwifery-led care model improves maternal and neonatal health outcomes. For midwives to autonomously utlise a midwifery-led care model, they must know what it entails within available practice guidelines. Little is known about practitioners’ knowledge and practice of this model in Embu County. The study found that there are gaps in knowledge and implementation of midwifery-led care in Embu. We recommend educating midwives about midwiferyled care, and the introduction of this model into the region as a means of strengthening midwifery practice to improve maternal and neonatal health outcomes.
Effectiveness of the Nursing Process Training on its Knowledge Level among Nurses in Selected County Referral Hospitals in Kenya
(International Journal of Health Sciences and Research, 2023-10-10) Gichobi, Beth; Prof. Gitonga, Lucy; Dr. Marwa, Immaculate
Background: Nursing process (NP) is an approach of solving problems systematically that should be utilized by nurses in identification, prevention and treatment of health problems and in promotion of wellness. However, its knowledge among nurses has been reported to be inadequate. Objective: To evaluate effectiveness of a NP training intervention on its knowledge level among nurses. Methods: A randomized controlled trial conducted in three phases: pre-intervention, intervention and post-intervention. Multi-stage cluster sampling technique was employed to get a sample of 60 nurses. Two cohorts of nurses were randomly assigned into experimental (n=30) and control group (n=30) and data was collected using questionnaires. Only the nurses in experimental cohort received training on the NP. Descriptive statistics were used to summarize data and t-test used to compare mean differences of the two groups. Results: In both groups, the participants mean age was 37.2 (±9.3), majority were females (73.3%), married (73.3%), and had diploma qualification (55.0 %). Before the intervention, the mean NP knowledge of the control group (M=17.1, SD=6.1) was higher than that of the intervention group (M=16.4, SD=4.2), t (58) =-0.52, p=0.61. However, after the intervention there was a significant increase in the mean NP knowledge of the intervention group (M=69.9, SD=11.4) compared to the control group (M=51.7, SD=11.3), t (57) =6.2, p<0.001. Conclusion: The NP training intervention had a positive effect on its knowledge level among nurses. Frequent such trainings are recommended to address the existing NP knowledge gaps among nurses.
Socio-cultural determinants of men participation in partner modern contraceptive use in Dallas location, Embu County, Kenya
(International Journal of Contraception, Gynaecology and Obstetrics, 2022-12-27) Ndunge Koome, Agnes; K Gitonga, Lucy; Dr. Kiongo, Josphat
Background: Male participation in partner modern contraceptive use is a viable strategy for improving modern contraceptive prevalence among married women. Increasing the uptake of modern contraceptives has been shown to significantly reduce maternal deaths resulting from unsafe abortions due to unintended pregnancies. In Kenya, the level of management in their partner’s use of modern contraceptives is low. Therefore, it is imperative to establish the factors that influence the participation of men. This study explored the socio-cultural factors that influence married men’s participation in their partners’ contraceptive use in Dallas sub-location, Embu County, Kenya. Methods: A community-based cross-sectional survey was undertaken involving married men aged 18 to 64 years. Data were collected using a semi-structured and interview-administered questionnaire developed by the researchers. Statistical Package for Social Sciences (SPSS) version 28.0 was used to analyze data. Frequencies and percentages were used to summarize study findings. Association between the dependent and independent variables was analyzed using the Chi-square test. P-value of < 0.05 was considered to be statistically significant association between the variables. Study findings were presented in narrative form and by use of tables. Results: The mean age of the participants was 38.8 (SD+9.3). The majority of the participants (82.9%) indicated that their partners were using a modern contraceptive method. Most participants (86.3%) were participating in their partner modern contraceptive use. The main socio-cultural determinants of men participation were the number of children (p<0.01) and cultural attitudes (p<0.01). Conclusion: The level of participation in partner’s modern contraceptive use is high among married men. However, cultural norms continue to hinder their engagement in modern contraceptives. There is a need to develop a programme to educate men on the importance of their involvement in order to dilute the cultural barriers thus enhancing greater participation in their partner’s modern contraceptive use.
Socio-cultural determinants of men participation in partner modern contraceptive use in Dallas location, Embu County, Kenya
(International Journal of Contraception, Gynaecology and Obstetrics, 2022-12-27) Ndunge Koome, Agnes; K Gitonga, Lucy; Dr. Kiongo, Josphat
Background: Male participation in partner modern contraceptive use is a viable strategy for improving modern contraceptive prevalence among married women. Increasing the uptake of modern contraceptives has been shown to significantly reduce maternal deaths resulting from unsafe abortions due to unintended pregnancies. In Kenya, the level of management in their partner’s use of modern contraceptives is low. Therefore, it is imperative to establish the factors that influence the participation of men. This study explored the socio-cultural factors that influence married men’s participation in their partners’ contraceptive use in Dallas sub-location, Embu County, Kenya. Methods: A community-based cross-sectional survey was undertaken involving married men aged 18 to 64 years. Data were collected using a semi-structured and interview-administered questionnaire developed by the researchers. Statistical Package for Social Sciences (SPSS) version 28.0 was used to analyze data. Frequencies and percentages were used to summarize study findings. Association between the dependent and independent variables was analyzed using the Chi-square test. P-value of < 0.05 was considered to be statistically significant association between the variables. Study findings were presented in narrative form and by use of tables. Results: The mean age of the participants was 38.8 (SD+9.3). The majority of the participants (82.9%) indicated that their partners were using a modern contraceptive method. Most participants (86.3%) were participating in their partner modern contraceptive use. The main socio-cultural determinants of men participation were the number of children (p<0.01) and cultural attitudes (p<0.01). Conclusion: The level of participation in partner’s modern contraceptive use is high among married men. However, cultural norms continue to hinder their engagement in modern contraceptives. There is a need to develop a programme to educate men on the importance of their involvement in order to dilute the cultural barriers thus enhancing greater participation in their partner’s modern contraceptive use
Patients’ Perception to Achieving Optimum Nursing Care and Health Outcomes Among Orthopedic Patients at Kerugoya County Referral Hospital, Kirinyaga County, Kenya
(International Journal of Health Sciences and Research, 2023-10) Nyanchama Onchangwa, Teresa; Kawira Gitonga, Lucy; Kiboi Kahanya, Willy
Background: Nursing services are very crucial in the care of orthopedic patients in terms of satisfaction with quality care. Patients’ perception on the optimum nursing care is the view from the point of service delivery to assessment post-delivery. Thus, the study intended to assess patients’ perceptions to achieving optimum nursing care and health outcome in Kerugoya County Referral Hospital (KCRH). Methods: Data was collected prospectively within a period of one month using cross sectional analytical design. Census was utilized to get 70 orthopedic patients and 30 healthcare workers in orthopedic units. Result: About of the participants had a negative perception of the healthcare workers not having adequate time and also not working as a team. Despite this, more than half (54.3%) of the patients had a positive attitude towards the care offered. Overall satisfaction with the services offered (AOR= 7.8, C. I= 1.010-13.995, p-value = 0.039). Conclusion: Patients perceived sub-optimal nursing care of health worker time for their care and health worker teamwork but despite this there was better overall positive attitude on optimum healthcare offered.
Factors that determine utilization of cervical cancer screening methods among women aged 21-50 years in Meru South, Tharaka Nithi County, Kenya
(Stratford Peer Reviewed Journals and Book Publishing, 2021-03) Willy, R. M.; Obuya, J.
The cervical cancer ranks as the first cause of female cancer and the first most common female cancer in women. It is also the first leading cause of cancer deaths in women aged 15 to 44 years in Kenya. Despite the introduction of cervical cancer screening and control programmes, the burden of cervical cancer remains high in Kenya. This study therefore sought to identify factors that determine utilization of cervical cancer screening methods among women aged 21-50 years in Meru South, Tharaka Nithi, Kenya. A cross-sectional descriptive study composing of 40 women aged between 20 and 50 years was carried out. An interview guide was used to collect data which was transcribed to Microsoft Excel 2017 software. The findings revealed that the respondents’ age significantly influenced uptake of cervical cancer screening. Besides, increasing age was associated with increased likelihood of screening. Only 12.5% of women aged 21-30 years had screened as compared to 50% of women in the age category 51-60. However, utilization of screening services was higher among women aged 31-40 years. Educational status was also significant in the uptake of screening services. However, tertiary education level had no much influence as many would expect. Majority of those who had tested for cervical cancer were of primary and secondary educational status. Knowledge level of respondents with regards to cervical cancer and screening also significantly influenced uptake of screening services. Knowledge and awareness of risk factors, cervical cancer test and availability of the test enhanced screening uptake. The study concluded that uptake of cervical cancer screening methods was influenced by age, educational status and knowledge level of respondents. Poor use of the screening services was majorly attributed to lack of precise information regarding cervical cancer & screening and disregard for screening services. It recommended that health care providers from all cadres should greatly be involved in the promotion of cervical cancer screening to women who seek health care in the health facilities and the community. I tend to believe that a woman devoid of information and impacts of cervical cancer will definitely test for cervical cancer when told of and asked to by the health care provider.
Post training pressure injury knowledge and prevention practice among primary home caregivers of patients discharged from a Level 5 Hospital in Kenya
(International Journal of Scientific and Research Publications, 2023-09-06) Stanley Kiarie Njau; Lucy Kawira Gitonga; Anna Kagure Karani; Henry M. Nyamu
Pressure injuries are wounds which occur on bony prominences, following prolonged hours of pressure or shear. Their incidence in community settings could be as high as 80%, but application of basic prevention knowledge can avert this trend. The objectives of the study were to determine the level of pressure injury knowledge after a training intervention, to determine the pressure injury prevention practice after the training intervention, and to examine the relationship between post training knowledge, and pressure injury prevention practice. This was a randomized controlled trial, which was conducted at multiple sites, that is, at Embu Level 5 Teaching and Referral Hospital, Kenya, and at patients’ homes. It was organized in three phases, that is, baseline survey, intervention, and evaluation phases. Phase one was conducted at the hospital, while phase two and three were conducted at patients’ homes. The overall sample size was 34 primary home caregivers, who were selected using simple random sampling technique, and assigned into experimental (n=17) and control groups (n=17) respectively. Data was collected using a researcher administered questionnaire, and an observation checklist. Approval to collect data was obtained from Chuka University Ethics Research Committee (Approval number NACOSTI/NBC/AC-0812), and a research permit was obtained from National Commission on Science, Technology and Innovation (License number: NACOSTI/P/22/21760). Data was analyzed using SPSS version 27, using descriptive and inferential statistics, at 95% confidence level. Majority of the primary home caregivers were female (88.2%, n=15), most (41.2%, n=7) of who were aged 29-38 years, with a mean age of 37.06±11.5SD. Post training knowledge mean score was 37.28±10.39SD, while the post training practice mean score was 40.4±10.4SD. There was a statistically significant association, between post training pressure injury knowledge, and pressure injury prevention practice, at 95% confidence level (ꭓ 2 =6.199, df=1, p=0.013). Both post training pressure injury knowledge and post training pressure injury prevention practice were poor. Primary home caregiver training can significantly improve pressure injury prevention practice, and therefore, continuous training and follow up is recommended.
Patients Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya
(Scientific Research Publishing Inc., 2019-09-27) Ngugi Gikunda, Charity; Gitonga, Lucy
Antihypertensive medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood pres sure control. Hypertensive medication non-adherence continues to become a contributing factor to hypertensive complications like heart attacks, heart failure, stroke, kidney disease. Prevalence of non-adherence to antihyperten sive treatment is not known but it’s thought to be increasing. Associated fac tors of non-adherence are complex, are both internal and external to the pa tient but are difficult to extrapolate. This can partly be because the determi nants of non-adherence to hypertensive may have a locality effect due to many factors such as culture and health system in a given locality. Hence, studies from one region may not have a cross-application. Therefore, there is the need to study the factors associated with non-adherence at a local scale. Descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling and a sample size of 81 patients was achieved and 10 health care providers including doctors, pharmacists, record officers and nurses were also interviewed through census method. Data was collected between the month of April and May 2019. Questionnaires were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Descriptive and inferential statistics were used for data analysis, aided by SPSS. The study re vealed a significant negative correlation (rpb = −0.227, p < 0.05) between age and non-adherent, insignificant relationship with marital status (rpb = −0.129), in significant (rpb = −0.064) correlation with patients’ level of education and a positive correlation with monthly income (rpb = 0.24). A majority of patients stated that (64%) of the hypertensive patients had missed medication. Pa tient-related factors: cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors together were found to be significant predictors of non-adherence to hypertension medication, χ 2 = 17.14, df = 1, N = 81, p < 0.05. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p < 0.05) that were individually, significant predictors to non-adherence. Non-adherence to hypertension medication is a major problem at Chuka Level Five Hospital. This was due to lack of funds, time, forgetfulness and pa tient thinking that they had healed thus continuous follow-ups to improve adherence, positive reinforcement to increase motivation in order to address forgetfulness, and supply of constant and subsidized hypertensive drugs to the hospital are necessary to prevent patients from missing the drugs. There is need to reduce out of pocket payment through establishment and streng thening of the community health insurance scheme. The study recommends that the hospital should set aside some resources for making patients’ fol low-ups especially those were treated and left to go home; discussions be made with patients on severity of non-adherence and importance of adhe rence; use of positive reinforcement to increase motivation and mechanism to be put in place to subsidize the cost of medication.
HIV/AIDS in Kisii County: Current Status and Challenges
(Science Publishing Group, 2019-12-20) Nyamoita Mokua, Gladys; Mokua Maroko, Geoffrey; Onchari Nyakundi, Augustus; Ondora Onyambu, Meshack
In 2012, adult HIV/AIDS prevalence in Kisii County was disproportionately high at 8.6%, against the national average of 5.6%. Thus, the researchers set out to investigate the current status and intervention measures in place in combating the condition. Mixed method approach combining both qualitative and quantitative data collection techniques was used. It entailed a desk review of HIV/AIDS materials for the period 2010-2018. Published data on HIV/AIDS in Kisii County from a diverse set of stakeholders was used. Quantitative data was also extracted from online databases, County reports and proposals. Qualitative data was generated from key informant interviews and focus group discussions. Comparative analysis of the qualitative information obtained from the respondents and the documented information was done and conclusions were drawn. Quantitative data was expressed as percentages and the data was presented in form of graphs and tables. Findings indicated that although HIV and AIDS remain a challenge in Kisii County, commendable strides have been made in its management and possible containment. The Kenya HIV estimates report for 2018 indicates that Kisii County has a prevalence rate of 4.4% against the national prevalence of 4.8%. The study also revealed that over 80% of HIV response is funded from external sources with more focus on biomedical interventions with less priority on the non-biomedical interventions. Based on the findings, the study recommends coordination among implementing partners for accurate data documentation and resource distribution. Deliberate efforts also need to be made to increase resources for prevention especially behavioral and structural interventions.
Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya
(Scientific Research Publishing Inc., 2019-09-25) Githae, Caroline N.; Matiang’i, Micah; Muraya, Moses
Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ 2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ 2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ 2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ 2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served; they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.
Integration of Cervical Cancer Screening Services in the Routine Examinations Offered in the Kenyan Health Facilities: A Systematic Review
(Scientific Research Publishing Inc., 2019-05-21) Munoru, Florence; Gitonga, Lucy; Muraya, Moses
Cervical cancer is the second most common cancer among women and the leading cause of deaths among women worldwide. In Kenya, uptake of screening services is at 3.2% below the targeted of 70%. Therefore, there is need to study the factors that lead to low uptake of the screening services. One way of increasing the uptake of the screening services is its integration with other routine services, thus leading to a reduction in morbidity and mortality rates associated with the disease. The objective of this study was to review and examine the importance of integrating cervical cancer screening services in the routine examinations offered in the Kenyan health facilities. A retrospective study design was adopted by this study. The review of articles, journals, strategic plans was done from the year 2012 to 2017. Data sources included Medline, PMC, Library, Pubmed, Google scholar, cancer prevention plans and strategies. About 28 data sources were reviewed with 78.5% indicating that increased knowledge and creation of awareness on cervical cancer would greatly improve the utilization of the screening services. More than 87% of the information collected among published work in Kenya demonstrated that knowledge on importance cervical cancer screening is inadequate. The primary results of this study suggest that all women of reproductive age (WRA) should undergo cervical cancer screening as a routine service. An integration approach should be adopted, to enhance knowledge on cervical cancer and the importance of screening, causes, preventive and treatment options. The study recommends that, the Government of Kenya through the Ministry of health should include cervical cancer screening as a routine procedure for all WRA.
Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device Uptake among Mothers Delivering at Meru Hospital
(Scientific Research Publishing Inc, 2019-03-04) Kirigia, Consolata; Gitonga, Lucy; Muraya, Moses Maugu
Global contraceptive use is at 64%, Africa lagging behind at 33.4%. Kenya has an unmet need for family planning at 23%. Hormonal injections are the most used in Africa at 9.8% and Intra-Uterine Contraceptive Devices at 3.8%. Low uptake of 3.4% was reported in Meru Hospital and lack of literature on immediate Post Partum Intra Uterine Contraceptive Device (PPIUCD) uptake. Immediate Post Partum Intra Uterine Contraceptive Device is a long acting reversible contraceptive device inserted into the uterus immediately within 48 hours after delivery. The objective was to assess Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device uptake among Mothers delivering in Meru Hospital. Descriptive research design was used and a population of 289 mothers was targeted. Sample size of 74 respondents was selected using simple random sampling. Questionnaires and interview schedules were used to collect data. The collected data were entered and analyzed using Statistical Package for Social Science windows version 23.0. Descriptive analysis was used to obtain frequencies and percentages. Chi-square was used to test the relationship of study variables and presented in tables. The qualitative data were analyzed thematically. The findings revealed that provider related barriers such as none provision of the services and untimely counseling for the insertion had the highest impact to low uptake (57%). Clients lacked information where 68% reported that they were not counseled. Demographic and reproductive characteristics also played a role in low uptake. Using the chi square test, there was a significant relationship, P = 0.001 between young age of the mothers, unemployment (53%), low parity (56%) and low uptake. Preference for other alternative contraceptives (25.8%) such as hormonal methods was a barrier to the uptake. Therefore, barriers to PPIUCD uptake are provider related, alternative methods of contraception and client related such as lack of information, unemployment, young age and low parity. The findings will inform Meru hospital management on barriers to immediate PPIUCD uptake. The study recommends an investigation on why providers hinder PPIUCD uptake and create awareness on PPIUCD services to the community.
Patients Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya
(Scientific Research Publishing Inc., 2019-09-27) Gikunda, Charity Ngugi; Gitonga, Lucy
Antihypertensive medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood pressure control. Hypertensive medication non-adherence continues to become a contributing factor to hypertensive complications like heart attacks, heart failure, stroke, kidney disease. Prevalence of non-adherence to antihypertensive treatment is not known but it’s thought to be increasing. Associated factors of non-adherence are complex, are both internal and external to the patient but are difficult to extrapolate. This can partly be because the determinants of non-adherence to hypertensive may have a locality effect due to many factors such as culture and health system in a given locality. Hence, studies from one region may not have a cross-application. Therefore, there is the need to study the factors associated with non-adherence at a local scale. Descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling and a sample size of 81 patients was achieved and 10 health care providers including doctors, pharmacists, record officers and nurses were also interviewed through census method. Data was collected between the month of April and May 2019. Questionnaires were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Descriptive and inferential statistics were used for data analysis, aided by SPSS. The study revealed a significant negative correlation (rpb = −0.227, p < 0.05) between age and non-adherent, insignificant relationship with marital status (rpb = −0.129), insignificant (rpb = −0.064) correlation with patients’ level of education and a positive correlation with monthly income (rpb = 0.24). A majority of patients stated that (64%) of the hypertensive patients had missed medication. Patient-related factors: cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors together were found to be significant predictors of non-adherence to hypertension medication, χ 2 = 17.14, df = 1, N = 81, p < 0.05. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p < 0.05) that were individually, significant predictors to non-adherence. Non-adherence to hypertension medication is a major problem at Chuka Level Five Hospital. This was due to lack of funds, time, forgetfulness and patient thinking that they had healed thus continuous follow-ups to improve adherence, positive reinforcement to increase motivation in order to address forgetfulness, and supply of constant and subsidized hypertensive drugs to the hospital are necessary to prevent patients from missing the drugs. There is need to reduce out of pocket payment through establishment and strengthening of the community health insurance scheme. The study recommends that the hospital should set aside some resources for making patients’ follow-ups especially those were treated and left to go home; discussions be made with patients on severity of non-adherence and importance of adherence; use of positive reinforcement to increase motivation and mechanism to be put in place to subsidize the cost of medication.
Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya
(Scientific Research Publishing Inc., 2019-09-25) Githae, Caroline N.; Matiang’i, Micah; Muraya, Moses
Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ 2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ 2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ 2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ 2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waitingtime was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served; they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.
Predictive Modelling of Benign and Malignant Tumors Using Binary Logistic, Support Vector Machine and Extreme Gradient Boosting Models
(Science and Education Publishing, 2019-11-26) Gachoki, Peter; Mburu, Moses; Muraya, Moses
Breast cancer is the leading type of cancer among women worldwide, with about 2 million new cases and 627,000 deaths every year. The breast tumors can be malignant or benign. Medical screening can be used to detect the type of a diagnosed tumor. Alternatively, predictive modelling can also be used to predict whether a tumor is malignant or benign. However, the accuracy of the prediction algorithms is important since any incidence of false negatives may have dire consequence since a person cannot be put under medication, which can lead to death. Moreover, cases of false positives may subject an individual to unnecessary stress and medication. Therefore, this study sought to develop and validate a new predictive model based on binary logistic, support vector machine and extreme gradient boosting models in order to improve the prediction accuracy of the cancer tumors. This study used the Breast Cancer Wilcosin data set available on Kaggle. The dependent variable was whether a tumor is malignant or benign. The regressors were the tumor features such as radius, texture, area, perimeter, smoothness, compactness, concavity, concave points, symmetry and fractional dimension of the tumor. Data analysis was done using the Rstatistical software and it involved, generation of descriptive statistics, data reduction, feature selection and model fitting. Before model fitting was done, the reduced data was split into the train set and the validation set. The results showed that the binary logistic, support vector machine and extreme gradient boosting models had predictive accuracies of 96.97%, 98.01% and 97.73%. This showed an improvement compared to already existing models. The results of this study showed that support vector machine and extreme gradient boosting have better prediction power for cancer tumors compared to binary logistic. This study recommends the use of support vector machine and extreme gradient boosting in cancer tumor prediction and also recommends further investigations for other algorithms that can improve prediction
Lifestyle Modification Strategies Practiced in Management of Hypertensive Patients in Imenti North Sub County, Kenya
(Medwin Publishers, 2019-06-10) Mwenda, A. K.; Gitonga, L.; Kamweru, P. K.
Globally, the prevalence of Non-Communicable diseases such as hypertension is increasing dramatically hence a burden to countries of low income countries such as Kenya. In Kenya the prevalence of hypertension has increased gradually over the last 20 years. The objective of the study was to determine level of practice of lifestyle modification strategies among hypertensive patients in relation to management and control of hypertension. A cross-sectional study design was used to collect data. The study population consisted of hypertensive patients in Imenti North sub County of Meru County. Cluster random sampling method was used to select health facilities to be included in the study. On practice of lifestyle modification strategies, each of the five lifestyle modification strategies was significantly contributing to good control of blood pressure among the participants. When each of the strategy was analyzed on how it influenced blood pressure control, it was evident that the patients who practiced the recommended strategies had their blood pressure controlled. Generally, practice of all the recommended strategies was poor among the patients involved in this study.

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