Department of Nursing
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Item Determinants of risk of relapse among patients treated for alcohol addiction at selected rehabilitation centres in Meru county, Kenya(Chuka University, 2025) Kisomo Mary SyombuaAlcohol 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.Item Determinants of pregnancy- related anxiety among women attending antenatal care at coast general teaching and refferal hospital, Kenya(Chuka University, 2025) Muchiri Juster MuthoniPregnancy-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 variationsItem 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 WanjaPrimary 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.Item Determinants of men involvement in partner modern Contraceptive use in Chuka sub-county, Tharaka nithi, Kenya(Chuka University, 2025) Mutegi Doreen KarimiMen 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.Item 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 WaitheraAchievement 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.Item 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 MbatheCannabis 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.Item Evaluation of continuous professional development effectiveness in clinical practice among nurses and midwives in Meru county - Kenya(Chuka University, 2024-10) Odhiambo Roselyne AkinyiContinuous 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.Item 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 MukadeGlobally, 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 sepsisItem 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 SyombuaContraceptives 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.Item Self-management practices for asthma control among patients with asthma attending Chuka County referral hospital - Tharaka Nithi County, Kenya(Chuka University, 2024-10) Micheni Hellen NjeriAsthma is a chronic inflammatory disease of the respiratory tract which arises from narrowing of the air passages leading to life-threatening symptoms of coughing, wheezing chest tightness and difficulty in breathing. It is a global public health problem that affects people of all ages contributing significantly to morbidity and mortality. According to estimates, 4.3% of the world's population has asthma with about 461 000 deaths being associated with the disease annually. In the developed countries the prevalence is estimated at 15 – 20% while in LMICs the prevalence is 12%. Kenya is depicted as having an asthma prevalence of 7.5%. At Chuka County Referral Hospital, asthma accounts for about 25% of the diseases of the lower respiratory tract. Asthma being a chronic illness requires self-management practices to achieve asthma control. Failure to engage in self-management leads to asthma exacerbations, emergency hospitalization, reduced productivity and poor quality of life (QoL). This study aimed at assessing self-management practices for asthma control among adult patients with asthma. The study was guided by the following specific objectives; to assess level of knowledge on asthma self-management, to determine asthma self-management practices, to establish determinants of asthma self-management and to determine the status of asthma control among patients with asthma at Chuka County Referral Hospital, Kenya. The study adopted a descriptive cross-sectional survey design. A sample size of 118 patients was obtained using Fisher’s et al formula and the sample was selected using simple random sampling. A researcher administered questionnaire was used to collect data. Data was analyzed using statistical package for social sciences version 26 to generate frequencies, mean and measures of central tendency. At 5% level of significance, a Chi-square test was employed to determine associations between demographic variables and asthma control while Pearson’s correlation coefficient was used to determine the relationship between knowledge on asthma as well as selfmanagement practices and asthma control. The study concluded that; knowledge on asthma and self-management is statistically significant and negatively correlated to asthma control (r=-0.251, p-value=0.006) where individuals with knowledge on asthma and its associated self-management reported asthma symptoms less frequently and vice versa. Notably, 53.1% of respondents lacked knowledge on asthma triggers while 49.6% lacked knowledge on controller medications for asthma. Self-management practices were found to be statistically significant and negatively correlated to asthma control (r=-0.19, p-value=0.045) where patients engaging in self-management practices reported less frequent asthma symptoms. The study revealed that non-adherence to asthma medication is driven by factors such as absence of symptoms and high cost of medications. Key facilitators of asthma self-management practices include; effective communication with healthcare workers, availability and affordability of medications in government hospitals. Some of the reported barriers to asthma self-management include presence of comorbidities, poor self-control and lack of knowledge on ASM. On status of asthma control, the study established that a majority of the respondents (43.3%) had partially controlled asthma, 28% had uncontrolled asthma and only 28.7% had controlled asthma. This study has concluded that there are significant gaps in asthma self-management practices hence sub optimal asthma control which calls for improvements in asthma health literacy among patients with asthma. It is anticipated that the finding of this study will lead to improvements in self-management practices for optimal asthma control among patients with asthma.Item 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 LilianThe 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.Item Determinants of teenage pregnancies in Tigania central sub-county, meru county, Kenya(Chuka University, 2024) Lintari Mwirabua StanleyTeenage 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.Item 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 KanyiriFocused 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.Item PUHE 473: HUMAN POPULATION DYNAMICS AND HEALTH(Chuka University, 2024-12-19) Chuka UniversityItem PUHE 371: BEHAVIORAL SCIENCE(Chuka University, 2024-12-19) Chuka UniversityItem PUHE 251: ANATOMY AND PHYSIOLOGY OF FOOD ANIMALS(Chuka University, 2024-12-19) Chuka UniversityItem PUHE 241/PUHU 141: COMMUNITY HEALTH I(Chuka University, 2024-12-19) Chuka UniversityItem PUHE 241/PUHU 141: COMMUNITY HEALTH I(Chuka University, 2024-12-19) Chuka UniversityItem NURU 132/HRIM 131: MEDICAL SOCIOLOGY AND ANTHROPOLOGY(Chuka University, 2024-12-19) Chuka UniversityItem NURU 123: CLINICAL CHEMISTRY(Chuka University, 2024-12-19) Chuka University