Community Health
https://repository.maseno.ac.ke/handle/123456789/707
2024-03-29T05:51:33ZFactors associated with exclusive breast feeding among formally employed women seeking maternal and child health services at Kenyatta national Hospital, Kenya
https://repository.maseno.ac.ke/handle/123456789/5993
Factors associated with exclusive breast feeding among formally employed women seeking maternal and child health services at Kenyatta national Hospital, Kenya
KAWIRA, Caroline Gitari
Kenyan prevalence of exclusive breastfeeding is currrently at 60% which is a slight decline from 61% in 2014 and still falls short of the World Health Organization recommendation for global coverage. At Kenyatta National Hospital, 48% of the women with children attending the Mother and Child Health (MCH) clinic are in formal employment with only 29% of its health professionals exclusively breastfeeding while 51.2% of mothers with newborn babies have good breastfeeding practices with majority intending to breastfeed exclusively for 6 months. A better understanding of the factors that influence EBF is important in order to promote appropriate infant feeding practices especially among the formally employed women in contribution to the attainment of Sustainable Development Goals. This study sought to determine factors associated with exclusive breastfeeding among formally employed women seeking Maternal and Child Health services at Kenyatta National Hospital (KNH). The study objectives were to; establish the maternal, family, and workplace – related factors that associated with exclusive breastfeeding among formally employed women seeking MCH services at KNH, Kenya. A cross-sectional study design was employed which targeted 195 mothers with children below 6 months out of approximately 688 formally employed women seeking MCH services at Kenyatta National Hospital (KNH). Systematic Random Sampling technique was used. The study employed questionnaires to collect data on maternal, family and workplace related factors and how they associate with exclusive breastfeeding. Data from questionnaires was cleaned, coded and entered into IBM SPSS version 23 for analysis. Descriptive statistics was used to analyse the population characteristics of maternal, family and workplace related factors and their association with exclusive breastfeeding among formally employed women seeking MCH services at KNH was computed using Pearson‟s chi square at 95% confidence level. A P-value of < 0.05 was utilized as the statistical significance criterion. The study found that slightly over half 53.5% (n=104) are classified as having exclusively breastfed while 46.5% (n=91) are classified as non-exclusive breastfeeding. The maternal and work-related factors were not significantly associated with exclusive breastfeeding while family related factors were found to be significantly associated with exclusive breastfeeding among formally employed women. The study concludes that the rate of exclusive breastfeeding is significantly associated with family support. The study thus calls for more community sensitization on breast-feeding and the need for employers to strengthen their measures to support breastfeeding employees.
Master's Thesis
2023-01-01T00:00:00ZFactors influencing nutritional status of infants in informal settlement of Obunga Kisumu city, Kenya
https://repository.maseno.ac.ke/handle/123456789/5988
Factors influencing nutritional status of infants in informal settlement of Obunga Kisumu city, Kenya
ATIENO, Rosemary Otiende
Undernutrition is common in children under five years of age globally, especially infants, due to their high nutrient needs for growth and development, which increases their susceptibility to infectious and chronic diseases. Informal urban settlements are characterized by high levels of poverty, making them high-risk areas for infant undernutrition. They tend to bear a high burden of undernutrition with varied context-based risk factors. The main objective of this study was to identify factors influencing the nutritional status of infants in the informal urban settlement of Obunga, Kisumu County. The specific objectives were to: explore the community perception of factors influencing the nutritional status of infants; assess the nutritional status of infants; and assess the relationship between socio-demographic, economic, and health-related factors and the nutritional status of infants in the informal urban settlement of Obunga. A cross-sectional mixed-methods study design was used. Purposive sampling was used to select participants for three focus group discussions, each with between 12 and 14 participants, for a total of 40. Infants 0–12 months (n = 124) were randomly selected from a list of 186 infants in Obunga. Data on perceptions of undernutrition and potential localized influencing factors was collected using a focus group discussion guide and analyzed using thematic analysis. A consolidated, structured questionnaire was used to collect quantitative data. Descriptive statistics were used to establish the prevalence of undernutrition, and regression analysis was used to identify factors associated with undernutrition. Results showed that undernutrition was perceived to be due to exclusive breastfeeding, giving too little food, a lack of a varied diet, intestinal worms, low income, carelessness of caregivers, diseases, and giving birth too soon. Stunting was perceived to be due to cold weather or eating cold foods. Prevalence of stunting, wasting, and underweight, were 27.9%, 15.7% and 19.7%, respectively. The prevalence of multiple anthropometric deficits was stunted-wasted 7.4%, stunted-underweight 13.1%, wasted-underweight 14%, and underweight-wasted and stunted 7.4%. Risk of stunting increased with age of infant (AOR=1.16*; 95% CI: 1.01-1.34). Diet diversity and minimum meal frequency was low but did not influence nutritional status. Risk of wasting was associated with diarrhoea (3.57*; 95% C.I:1.05-12.12). Risk of underweight was influenced by age of infant (AOR=1.27*; 95% CI: 1.03-1.57), mother‟s age (AOR= 0.83**; 95% CI: 0.73-0.94) and caregiver being employed (AOR= 6.07*; 95% C.I:1.54-23.93). Risk of being stunted-underweight increased by not handwashing after visiting the toilet (AOR= 0.18*; 95% C.I:0.03-0.86) and having grandmother as caregiver (AOR= 6.15*; 95% C.I:1.09-34.73). Risk of underweight-wasted decreased with increasing mother‟s age (AOR= 0.82*; 95% C.I:0.71-0.95) and increased with caregiver being employed (AOR=5.22**; 95% C.I:1.16-23.53). Risk of stunted-wasted (AOR=9.07**; 95% C.I:1.73-47.51) and stunted-underweight-wasted (AOR= 9.07*; 95% C.I:1.73-47.51) was associated with diarrhoea. Community perceptions, mother‟s age, handwashing after visiting the toilet, caregiver being employed, having grandmother as caregiver and diarrhoea are significantly associated with undernutrition in Obunga and should be addressed when designing community based nutrition interventions in this and similar populations.
Master's Thesis
2023-01-01T00:00:00ZDeterminants of prevention of mother to child HIV transmission outcomes among women at the Homa bay county referral Hospital, Kenya
https://repository.maseno.ac.ke/handle/123456789/5984
Determinants of prevention of mother to child HIV transmission outcomes among women at the Homa bay county referral Hospital, Kenya
OSOTI, Osoti Robert
Homa Bay County had 10% of the children 0-14 years diagnosed with HIV in Kenya in 2017. The county also reported 9.7% of the national annual AIDS-related mortalities among children and 8.8% of new HIV infections among children for the same age group nationally in the same year. Different determinants have been related to varying Prevention of Mother-to-Child Transmission (PMTCT) OF HIV outcomes across different regions. However, the Homa Bay County's determinants have not been investigated. This study assessed maternal, health systems, and male involvement related determinants of PMTCT outcomes among PMTCT mothers at the Homa Bay County Referral Hospital. The research used a descriptive cross-sectional study on a sample of 274 mothers drawn from 4129 women of reproductive age attending care and treatment at the study setting. Eligible participants were required to have been on PMTCT follow up at the study setting and with documented HIV test results (PMTCT outcome) for their child. Simple random sampling was used to sample study participants until the required sample size was achieved. Purposive sampling was used to identify participants for Key Informant Interviews. A mixed-method approach was used to collect quantitative and qualitative data. Quantitate data were collected using a structured questionnaire, while qualitative data were collected using interview guides customized for Key Informants. All the sampled participants; 274, were accessible. However, one (1) questionnaire was rejected because of incompleteness; hence, data is reported for 273 participants. A majority of the participants; 158(57.9%) were aged between 30 to 39 years with the mean age being 32.16 (± 5.54 SD) years. In terms of PMTCT outcome, 10(3.7%) of the participants had a HIV sero-positive child. Chi-square (χ²)test established existence of statistically significant associations between maternal factors; reason for missing scheduled clinic visit, missing to take ART medications, reasons for missing to take ART medications, and missing to provide ART prophylaxis to infant/child, and PMTCT outcome at α ≤ 0.05 (χ²:p=0.002, p=0.005, p=0.006, and p=0.05) respectively. Reason for missing scheduled clinic visit and reason for missing to take ART medications demonstrated higher likelihood (odds) of determining PMTCT outcome (OR=5.122, 95% CI: 0.139-189.53; p=0.002) and (OR=5.751, 95% CI: 0.615-53.781; p=0.006) respectively. Statistically significant associations were further evident between health systems factors; provision of routine pre-conception counseling and provision and discussion of infant diagnosis results with health care provider and PMTCT outcome (χ²: p=0.018 and p=0.000) respectively. Provision and discussion of infant diagnosis results with health care provider had a higher likelihood (odds) of determining PMTCT outcome (OR=1.530, 95% CI: 0.361-6.486; p=0.000). In terms of male involvement, statistically significant associations were evident of male partner knowing HIV status of participant(s) and male partners reaction to discussions on HIV transmission to infant/child (χ²: p=0.000 and p=0.000) respectively. Nonetheless, male partner knowing HIV status of participant(s) had higher odds of determining PMTCT outcome (OR=6.0, 95% CI: 0.655-54.997; p=0.000). Qualitative data were analyzed manually based on emerging themes and presented verbatim with the quantitative findings. The findings of this study identify determinants with higher likelihood of determining PMTCT outcomes. This may help in formulation of interventions geared towards reducing the high MTCT rates in Homa Bay County.
Master's Thesis
2023-01-01T00:00:00ZDeterminants of linkage to HIV care and treatment among men who have sex with men (msm) in Kisumu county, Kenya
https://repository.maseno.ac.ke/handle/123456789/5981
Determinants of linkage to HIV care and treatment among men who have sex with men (msm) in Kisumu county, Kenya
KEBAYA, Emily Bonita
HIV remains a global and national public health challenge, with significant impacts on the lives of those affected by the virus. Kisumu County in western Kenya has one of the highest rates of HIV infection in the country. This situation is further exacerbated by the vulnerability of MSM, who often face a disproportionate burden of HIV infection. HIV prevalence among MSM in Kisumu County is higher than the general population, highlighting the urgent need to address this problem. Early and consistent access to HIV care and treatment is paramount to reducing HIV-related morbidity and mortality, and is also critical to reducing HIV transmission in the community. However, significant gaps remain in our understanding of the factors that promote or impede linkage to care and treatment among MSM in this region. Therefore, this study examined the determinants of the linkage to HIV care and treatment among MSM in Kisumu County, Kenya. The specific objectives of the study were; to determine the (1) individual factors, (2) interpersonal factors, (3) the socio-cultural factors, and (4) the institutional factors influencing linkage to HIV care and treatment among MSM in Kisumu County, Kenya. A descriptive cross-sectional study design was employed. The questionnaire for quantitative was administered to 400 respondents who consented and 11 KIIs were also conducted. Quantitative data was analysed with the aid SPSS version 21. Frequencies, means and percentages were used to analyse socio-demographic characteristics of study population and to determine prevalence of LARC. Chi-square test was used to check for association while logistic regression model was used to establish the strength of the association at 95% CI. Qualitative data was analysed using thematic analysis approach in coding and development of the emerging themes using NVivo software. From the analysis, the mean age of respondents was 26.22 with standard deviation of 6.58, majority 232(58.0%) attained secondary education whereas 190 (47.4%) of MSM were informally employed. The individual determinants associated with not accessing HIV care and treatment were religion (OR=0.3;95%CI,0.13-0.72; p=0.007), primary education (OR=0.5;95%CI,0.23-0.97; p=0.040), earns less monthly (OR=0.1;95%CI,0.01-0.26; p=0.001). Additionally, the factors associated with accessing HIV care and treatment included: The interpersonal factors disclosing sexual orientation to family/friends (OR=2.3;95%CI,1.29-4.26; p=0.005), disclosing sexual orientation to health care provider (OR=4.4;95%CI,2.35-8.37; p<0.0001) discrimination by family (OR=10;95%CI,3.45-30.12; p<0.0001); The socio-cultural factors were MSM who felt community members were uncomfortable with them (OR=2.4;95%CI,1.11-5.01; p=0.027), MSM felt they would lose respect (OR=2.5;95%CI,1.13-5.31; p=0.031); The Institutional factors were MSM who had gone for treatment at health facilities and MSM who were HIV positive (OR=5.9;95%CI,1.67-21.27;p<0.0001), (OR=14.9;95%CI,2.86-5.08; p<0.0001) respectively. MSM believe that government institutions do have conversation with them (OR=70.4;95%CI,9.64-513.74; p<0.0001), MSM who thinks that there are systems that guards them (OR=10.8;95%CI,5.87-19.72; p<0.0001). In conclusion, the findings of the study highlight the need for comprehensive, targeted interventions, including cultural sensitivity training, income support programs, and legal reforms, to enhance healthcare access and reduce disparities within this marginalized community
Master's Thesis
2023-01-01T00:00:00ZPsychological stress predictors of low birth weight among post natal mothers in Kilifi county, Kenya
https://repository.maseno.ac.ke/handle/123456789/5980
Psychological stress predictors of low birth weight among post natal mothers in Kilifi county, Kenya
AMONDI, Mary Goretty
Worldwide, low birth weight (LBW, <2500gms) remains pervasive despite focused antenatal care interventions. Children with LBW have increased risk for death and multiple morbidities whose consequences track through life span. They require advanced medical care to manage effectively yet, these are often meagre in the high burden regions. Maternal psychosocial stress and determinants are insidious and subtle risk factor for LBW but is not routinely screened for during antenatal visits, indicating missed opportunities in the care continuum. By 2019, the global prevalence of was approximately 20 million comprising 14.6% of live births. Of these 95% were born in the developing countries with 13.7% being in Africa, 13.4% in East Africa and 11.5% in Kenya. Coastal region in Kenya is leading with a prevalence of 12.7%. Understanding the occurrence and predictors of maternal psychosocial stress could enable early identification and referral for definitive care to improve health outcomes. The current study aimed to investigate the antenatal psychological stress predictors of LBW among postnatal mothers in Kilifi County, Kenya. Specifically, the study determined prevalence of LBW infants among mothers who had psychological stress during antenatal period; socio-demographic characteristics of mothers with LBW infants; the association between antenatal psychological stress and LBW infants. Througha cross-sectional design, data was obtained from 387 postnatal mothers at Rabai and Mariakani Sub-County Hospitals. Eligible participants were identified through simple random sampling from the postnatal clinic. Structured questionnaires were used alongside perceived stress scale (PSS) and Edinburgh depression scale (EDS). The PSS has 10 items, each scored between 0-4. Iindividual scores range from 0 to 40 with higher scores indicating higher perceived stress; EDS has 10 items each scored between 0-3, with summated scores of 10 or more indicating possible depression. Data was analysed descriptively with chi-square test of association employed to establish the association between categorical variables. Statistically significant variables were modelled using logistics regression with crude and adjusted odds ratios estimated. The mean age was 25.9 years (±5.1); 30(7.8%) had no formal education, 160(41.3%) had primary level education, 125(32.3%) had secondary level education and 72(18.6%) had tertiary education. Majority (86.8%, n=336) were married;50.4% (n=195) were unemployed, 59.4%(n=230) were multiparous and 47.8%(n=185) had attended at least four antenatal care visit. The overall prevalence of low birth weight was 25.1% with 54.3%(n=19) of the births being from mother with psychosocial stress. Mothers with tertiary level of education (OR 0.32; 95% CI=0.12,0.89, p=0.028) and those who were formally employed(OR 0.35; 95% CI=0.14,0.86, p=0.022) had lower odds of delivering infants with low birth weight. Maternal age-group25-34 years was a significant predictor of low birth weight(95%CI=1.05, 3.46, p=0.035).Frequency of ANC visit did not reach statistical significance, although the odds of giving birth to LBW child was lower among mothers who attended at least 4 ANC visits (OR=0.58, 95% CI=0.21, 1.61). Bivariate analyses were performed to determine the association between prenatal psychological stress and LBW. Women with moderate (OR=2.30, 95%CI=1.41, 3.78, p=0.001) or high stress levels (OR=9.94, 95%CI=1.74,56.64, p=0.01) and those with depression (AOR=1.87, 95%CI=1.15-3.04)) had higher odds of giving birth to LBW infants. The burden of LBW associated with stress, and depression were considerable in this population. Findings from this study highlight the need for routine early screening for antenatal psychosocial stress and depression during routine visits as well as providing program postnatal monitoring interventions to aimed to reduce the risk of LBW.
Master's Thesis
2023-01-01T00:00:00ZFactors affecting immunization of children (12-24 months) in Nyatike sub-county, Migori county Kenya
https://repository.maseno.ac.ke/handle/123456789/5979
Factors affecting immunization of children (12-24 months) in Nyatike sub-county, Migori county Kenya
OKONGO, Ochieng Stephen
Despite increasing worldwide immunization coverage, most under five children globally especially in low-income countries are not vaccinated. Poor immunization coverage remains an issue in less developed countries. In Kenya, about 8 out of 10 children (79%) aged 24 months have received all basic vaccinations (BCG, measles, and three doses each of DPT and polio vaccine, excluding polio vaccine given at birth). In 2018, Migori County immunization coverage stood at 57%. This study aimed to assess factors influencing the immunization of children aged between 12 and 24 months in Nyatike Sub–County Migori County, Kenya. Specifically, the study sought to determine immunization coverage of children, missed opportunities for immunization, and predictors of complete child immunization in Nyatike Sub-County, Migori County, Kenya. A descriptive cross-sectional study design was used while stratified random sampling was used to sample the ward. Using community unit household registers, simple random sampling was employed to select a sample size of 415 households with children (12-24 months). The target population were children aged between 12-24 months, while data was collected using a structured questionnaire. Data was pretested in Awendo Sub-County. Chi-square and Logistic regression were used to determine predictors of complete child immunization while descriptive statistics were analyzed using means, standard deviation, and confidence interval set at a p ≤0.05 level of significance. Immunization coverage stood at 281 (67.7%). On missed opportunities, measles (at 18 months) was the most defaulted (28.2%). Predictors which were found to be significant about immunization coverage were health system and socio-demographic factors. The health system factors included distance to the health facility, (p=0.001), and presence of the facility (p=0.001), There was a significant relationship between place of delivery and immunization coverage of children (p=0.000, CI=95%) with those who delivered at the health institution likely to immunize their children (OR=1.360 CI=95% [1.070-2.496]., health care providers attitude (p=0.001), availability of immunization service (p=0.001). The socio-demographic factors included cultural/religious practices (p=0.001), There was a significant relationship between level of income and immunization coverage (p=0.0001, CI=95%)., age of mother/caregiver (p=0.001 there was a strong relationship between the level of education and immunization coverage (x^2=4.113, df =1, p=0.001, CI=95%) with respondents of minimum level of education more likely to complete immunization (OR=0.693 CI=95% [1.876-1.322]. The study findings are significant and can be used to design intervention programs to improve immunization coverage, this study further recommend additional effort by community health workers to promote skills among pregnant mothers, provision of more mobile clinics to increase community reach with immunization services, there is also need for national and county department of health to scale up health education and training on maternal and child health matters while ensuring community participation to promote community ownership and sociocultural consideration which will lead to promotion of child survival and development through reduction in child morbidity and mortality.
Master's Thesis
2023-01-01T00:00:00ZPredictors and prognostic survival factors of patients undergoing hemodialysis at Kakamega county general teaching and referral hospital, Kenya
https://repository.maseno.ac.ke/handle/123456789/5952
Predictors and prognostic survival factors of patients undergoing hemodialysis at Kakamega county general teaching and referral hospital, Kenya
DEMBA, Rodgers Norman
The global, regional, and national burden of kidney diseases (acute kidney injury and chronic kidney disease) are attributed to impaired kidney function. The birth and death registry office in Kakamega County has recorded increased morbidity and mortality attributed to acute kidney injury (AKI) and chronic kidney disease (CKD). Most of the studies done in Kenya were on the prevalence of AKI and CKD among the population that are in Nairobi and Nyeri. The findings of this study were the first of its kind in Kenya on the survival analysis of AKI and CKD patients undergoing haemodialysis. The broad objective of this study was to determine the factors influencing survival in hemodialysis patients in Kakamega County general teaching and referral hospital (KCGT&RH). The specific objectives were to determine the demographic characteristic influencing the survival of patients undergoing hemodialysis, to establish the renal biochemical parameters as a survival predictor of patients undergoing hemodialysis, and to evaluate the prognostic factors as a survival indicator of patients undergoing hemodialysis in the renal unit, at KCGT&RH. This was hospital-based retrospective cohort study where records from the renal unit were reviewed from December 2021 to January 2015. Approval to conduct the study was obtained from the Secretary of Eastern Africa, Baraton (UEAB) Research Ethics Committee. Permit to conduct the study was also be obtained from National Commission for Science, Technology, and Innovation (NACOSTI). The clinical chemistry autoanalyzer Olympus 640 (Olympus Diagnostica GmbH, Hamburg, Germany) was used for measuring renal biochemical parameters and Huma Count 5D was used for estimating the Hb levels. The statistical package for social sciences (SPSS) version 23 was used for cleaning of data and analysis. The total number of 174 cases that had CKD and 69 cases diagnosed to have AKI were recruited and studied. Descriptive statistics were used to present frequency and proportion for the categorical variables. Inferential statistics involved the binary logistic regression analysis to establish the relationship between demographic characteristics (age and gender) and survival of both AKI and CKD patients. Whereas multinomial logistic regression was used to determine relationship between the types of comorbidities, number of comorbidities and survivals status of AKI and CKD patients. To estimate the survival functions, Kaplan Meier analysis was used, and Cox-proportional hazard regression analysis was also used to identify independent predictors and prognostic of time to death. The study was able to perform a crude and adjusted hazard ratios with a confidence interval of 95%, and p-values of less than 0.05 were used to declare the presence of statistically significant. The demographic characteristic of AKI patients showed that 33 (47.8%) were males and 36 (52.2%) Females, 36 (52.2%) were 18 – 33 years and 33 (47.8%) above 33 years whereas CKD patients showed that 99 (56.9%) were males, 75 (43.1%) Females and 33 (19%) were 18 – 33 years and 14 1(81%) above 33 years. Majority 64.03% (89) of the patients with CKD died in less than one month, 27.34% (38) died between one to six months and 8.63% (12) died > six months after the clinical diagnosis despite being on hemodialysis. The results showed statistically significant relationship between survival status and time-to-event at a p value of < 0.0001 at 1 df with a 95% CI of 0.055 – 0.218. Majority 55.56% (10) of the AKI patients died in less than one month and 44.44% (8) died > one month after clinical diagnosis despite being on hemodialysis. The results showed no statistically significant relationship between survival status and time of event at a p value of 0.923 at 1 df with a 95% CI of 0.357 – 3.112. Potassium levels were a significant (p value 0.038) parameter that acted as a survival predictor of AKI patients. Prognostic factors did not significantly influence the survival of AKI patients whereas in CKD patients it was observed that the predictors and prognostic factors significantly (p value <0.05) influenced their survival.
Master's Thesis
2023-01-01T00:00:00ZPredictors of unfavorable tuberculosis treatment outcomes: prospective cohort study among notified cases in Vihiga County, Kenya
https://repository.maseno.ac.ke/handle/123456789/5904
Predictors of unfavorable tuberculosis treatment outcomes: prospective cohort study among notified cases in Vihiga County, Kenya
WALIAULA, Paul Wekunda
Each year, tuberculosis (TB) causes an estimated 10 million illnesses and 1.4 deaths globally. Kenya, one of 30 high-TB burden countries, has made progress in identifying more TB cases, but achieving the global treatment success rate target of >90% has remained a challenge. With TB mortality rate of 13% and treatment interruption rate of >5%, Vihiga is one of the counties with highest rates of unfavorable TB treatment outcomes in Kenya. Understanding their predictors is critical for improving TB epidemiology and advancing the global zero TB epidemic targets. A prospective cohort study was conducted among 291 notified TB patients from 20 health facilities in Vihiga County to: describe distribution of TB disease and treatment outcomes by patients’ characteristics; identify determinants of treatment interruption; and investigate factors associated with survival distribution and the occurrence of mortality. Baseline and follow-up data were gathered using questionnaires, while qualitative data was obtained using treatment interruption tracing form and the mortality audit tool. Patients’ demographic, socioeconomic, behavioral, and clinical characteristics were summarized descriptively, while probabilities of treatment completion, survival, and event-time intervals were estimated using Kaplan-Meier estimator. Log-rank test was used to quantify statistical differences in survival probability based on univariable patients’ characteristics. Cox proportional hazard model was fitted to identify determinants of TB treatment interruption and factors associated with the occurrence of all-cause mortality through the calculation of hazard ratios (HR) at 95% Confidence Intervals (CI) and p ≤ 0.05. Qualitatively, reasons for treatment interruption were identified thematically while causes of mortality, and associated circumstances were categorized by HIV status. Of the 291 patients, 72% were male, and nearly half were aged 25-34 years (23.4%) and 35-44 years (23.4%). During follow-up, 32 (11%) patients interrupted treatment while 45 (15%) died. Higher incidences of treatment interruption (59%, p <0.001) and mortality (78%, p<0.001) occurred during the intensive phase of treatment. Alcohol consumption (HR = 9.2, 95% CI; 2.6–32.5, p< 0.001); being female (HR = 5.01, 95% CI; 1.68–15.0, p = 0.004) and; having primary or lower of education level (HR = 3.09, 95% CI; 1.13–8.49, p < 0.029) increased risk for treatment interruption, while having a treatment supporter (HR = 0.33, 95% CI; 0.14–0.76, p = 0.009) was protective. The main reasons for treatment interruption were feeling better soon after beginning treatment and alcohol use. Severe illness (HR = 5.06, 95% CI; 1.59–16.1, p = 0.006); HIV coinfection (HR = 2.56, 95% CI; 1.28–5.12, p = 0.008); comorbidities (HR = 2.72, 95% CI; 1.36–5.44, p = 0.005); and smoking (HR = 2.79, 95% CI; 1.01–7.75, p = 0.049) were associated with increased risk of occurrence of mortality. Mortality among HIV-negative patients was ascribed to lung complications while advanced HIV disease was the leading cause of mortality among the HIV-positive. This study's findings indicate that interruption of treatment and mortality from TB remain problematic and occur early in the treatment. The study also acknowledges the important role person's characteristics play in the distribution of TB disease and predicting unfavorable treatment outcomes. Comprehensive public health interventions using multisectoral approach may help reduce rates of unfavorable TB treatment outcomes.
PhD Theses
2023-01-01T00:00:00ZDeterminants of a ccess and uptake of universal health coverage among households of Mwingi west sub-county, Kitui county, Kenya
https://repository.maseno.ac.ke/handle/123456789/5895
Determinants of a ccess and uptake of universal health coverage among households of Mwingi west sub-county, Kitui county, Kenya
MUTUNGA, Dominic Kikuyu
The focus towards the achievement of Universal health coverage (UHC) has been hampered
by a number of challenges which includes inadequate sensitization and enforcement of set
guidelines, more focus by counties on high-cost interventions rather than on Primary Health
Care (PHC), inadequate staff at national and county levels to offer health care service,
inadequate financing, poor reporting on the quality-of-service delivery among others. The
aim of this study was determinants of access and uptake of universal health coverage among
households of Mwingi West Sub-County- Kitui County. The specific objectives were; to
determine the awareness levels of UHC, determine socio-economic factors influencing
uptake of UHC and determine health systems factors influencing uptake of UHC. Descriptive
cross-sectional study design was employed where quantitative and qualitative data was
collected using a structured questionnaire and Key Informant Interviews. The study
population was households and health workers of Mwingi west. Stratified random sampling
was employed to sample wards while simple random sampling was used to sample 422
respondents in the study area using household registers. Data collection tools were piloted in
Mwingi North of which was not included in the study. The data was managed using SPSS
version 25. Descriptive data was analyzed using measures of central tendency i.e., means,
percentages and standard deviation The chi-square test was carried out to establish
association between social economic, health system factors and uptake of universal health
care. While confidence interval was set at 95%, data was summarized and presented using
graphs, tables and charts. Ethical clearance was obtained from Jaramogi Oginga Odinga
Teaching and Referral Hospital Institutional and Ethics Research committee. The study
targeted 422 participants; however, only 322 of them were accessible. Almost a half, 151
(46.9%) of the participants were aged between 26 to 35 years. More than average, 183
(56.8%) of the respondents were females. Self-employment was the primary mode of
livelihood for a high proportion 194(60.2%) of the participants. Most of the study sample,
183 (56.8%) were aware of Universal Health Coverage (UHC). There was a significant
association between occupation, educational level, belonging to a social welfare group and
awareness of UHC at α ≤ 0.05 (Chi-square: p=0.001, p=0.001, p=0.725, and p=0.0.027)
respectively. There was no association between adequate drug availability in health facilities,
rating of health service received and awareness of UHC (Chi-square: p=0.800, p=0.120)
respectively. An association was found to exist between treatment waiting time, rating of
health care workers and awareness of UHC (Chi-square: p=0.001, p=0.002) respectively.
There is a need to foster patient experiences at facilities offering UHC services through
enhanced quality of service tenable through sustained health care education of health care
workers on emerging disease trends. This will allow provision of adequate evidence-based
care, which meets the patient’s needs. The County Government of Kitui should develop
adequate health promotion strategies aimed at enhancing the awareness of its populace on
matters UHC
Master's Thesis
2023-01-01T00:00:00ZEffectiveness of mobile short message service reminders on antenatal care and skilled delivery attendance among pregnant women in West Pokot County, Kenya
https://repository.maseno.ac.ke/handle/123456789/5737
Effectiveness of mobile short message service reminders on antenatal care and skilled delivery attendance among pregnant women in West Pokot County, Kenya
MSHAMBALA, Alexia Wadime
Maternal mortality ratio (MMR) is still high in Kenya at 362, stifling the achievement of the Sustainable Development Goal (SDG) 3.1, which aims to reduce MMR to less than 70 per 100,000 live births by 2030. With MMR of 565 out of 100,000 live births and 73.6% of home deliveries, according to the Kenya Demographic Health Survey (KDHS, 2014), West Pokot County is ranked among the counties contributing to the slow progress. Despite high mobile penetration in Kenya (>100%), evidence is lacking on the use of this technology to improve maternal health outcomes. The purpose of this study was to establish the efficacy of Short Messaging Service (SMS) reminders on improving antenatal care (ANC) and skilled delivery attendance (SDA) among pregnant women in West Pokot County. Specifically, the study was exploring the demographic variables associated with ANC and SDA, comparing outcomes between the study arms, and identifying challenges experienced by women, while seeking maternal health services. A prospective cohort quasi-experimental study design was applied among 462 eligible consenting women, in the control (231) and intervention (231) arms for 3 years from 2017. Upon exit from the first ANC service delivery point at Kapenguria County Referral Hospital, participants were sampled systematically into the study. Only women in the intervention group received SMS reminders 24 hours before appointment dates. Structured questionnaires and Focus Group Discussion (FGD) guides were used for collection of both quantitative and qualitative data respectively. Ministry of Health (MOH), ANC and maternity registers, were used together with study-designed appointment registers to track scheduled appointments. Chi-square test of association and binomial logistics regression were used to test variable relationships while relative risks and relative effects were used to compare study outcomes. Framework analysis was used for qualitative data. Marital status, gravidae, and parity had a statistically significant association with ANC across all the levels: first to the fourth plus ANC appointment. Parity was not statistically significant only at the fourth ANC appointment. Gestation age at first ANC, marital status, education level, mobile phone ownership, gravidae and parity had a statistically significant association with SDA. SMS reminders increase ANC appointment adherence by 61.9% (RR=1.6190); 78.3% (RR=1.7830) and 147.7% (RR=2.477) for 2nd, 3rd and 4th ANC appointments. For more than four ANC appointments, adherence was increased by 284% (p-value 0.000, RR=3.84). SDA is increased by 125.6% (RR=2.256). The null hypotheses are rejected, and the study concludes that there is a significant difference between women who receive SMS reminders and those who do not for both ANC and SDA. Financial constraints, distance from the health facilities and lack of general awareness on the importance of seeking health facility care were among the leading challenges experienced by women in the county. SMS reminders are an effective way to improve ANC and SDA, in conjunction with community education, women empowerment and enhanced male involvement, in West Pokot County
Masters Thesis
2022-01-01T00:00:00Z