Department of Public Health

Determinants of maternal health services satisfaction at Jaramogi Oginga Odinga teaching and referral hospital, Kenya

Thu, 13 Nov 2025 00:00:00 GMT

Determinants of maternal health services satisfaction at Jaramogi Oginga Odinga teaching and referral hospital, Kenya ATELU, Charles Bin Maternal satisfaction is a multi-dimensional healthcare construct affected by; range of services, convenient access of services, interpersonal skills, and physical environment where services are delivered. Dissatisfaction with quality of maternal health services may make women shy away from using such services resulting to poor maternal health outcomes. This study aimed to assess the determinants of maternal health services satisfaction at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kenya, premised on the range of maternal services, convenient access, physical environment, and interpersonal skills of health care workers offering maternity services. Mixed Methods Cross-Sectional Study Design was adopted to collect data from 147 pre, natal and postnatal women attending JOOTRH for maternal services, with Health Care Workers subjected to KII and FGD. Systematic sampling was used, and data were analyzed using chi-square testing, binary logistic regression analysis, bivariate analysis, Overall, 53.1% of women were satisfied with maternal services at JOOTRH, Chi-square analysis revealed significant association between range of maternal services, interpersonal skills of healthcare workers which had a very strong correlation with maternal satisfaction with (p<0.001). Convenient access to maternal services and physical environment had a strong statistically significant correlation with maternal satisfaction with (p<0.05 and (p<0.01) respectively. The study at JOOTRH highlights the importance of comprehensive maternity services, convenient access, a well-maintained physical environment, and positive provider interactions in enhancing maternal satisfaction and health outcomes. Improving these areas can significantly contribute to maternal satisfaction, aligning with global health objectives. Recommendations include expanding and integrating maternal services, improving access through reduced waiting times and extended hours, upgrading facilities for comfort and safety, and enhancing healthcare providers' interpersonal skills through regular training and patient feedback mechanisms. Further research should focus on evaluating facility maintenance, provider training on maternal satisfaction and healthcare delivery improvements. Master's Thesis

Factors influencing sustainable use of electronic health records in Siaya county public health facilities- Kenya

Wed, 12 Nov 2025 00:00:00 GMT

Factors influencing sustainable use of electronic health records in Siaya county public health facilities- Kenya AWINO, Josephine Akeyo Electronic Health Record (EHR) is an interoperable digital system used by the healthcare providers to comprehensively manage patients’ health information. When applied sustainably, EHR can improve care coordination, reduce healthcare costs, support planning, and enhance decision making through timely, accurate, and accessible patient data. However, in many developing countries, including Kenya, EHR sustainability remains a challenge. In Siaya County, although development partners supported setting up EHR in public health facilities, utilization has been inconsistent. Issues such as lack of system integration, prolonged patient waiting times and data inaccuracies have hindered effective use, potentially compromising patient outcomes. Despite these challenges, limited studies exist on factors determining sustainability. This study investigated factors influencing the sustainable use of EHR in Siaya County public health facilities. Specifically, the study assessed staff attributes influencing the sustainable use of EHR; determined the infrastructural factors influencing the sustainable use of EHR; and measured the association between institutional culture and the sustainable use of EHR in Siaya County public health facilities. System operating and EHR training manuals were identified as the intervening variables. To achieve the objectives, a cross-sectional study design was adopted utilizing quantitative techniques. The Leslie Kish’s method was used to calculate the sample size setting the power of the test to 80% giving a total sample size of 224 healthcare providers. Of these 220 consented to participate giving 98% participation rate. Stratified sampling was used, with stratification based on health facilities and cadre of respondent. Quantitative data was collected using a semi-structured questionnaire. Data was analyzed using SPSS Version 25. Descriptive statistics generated frequencies and percentages, while Chi-Square tests determined the initial associations between categorical independent and dependent variables. Logistic regression performed provided adjusted odds ratio. Statistical significance was assessed at p<0.05. Out of the 220 respondents, most were aged between 20-30 years (69.7%), male was 62%, a majority (69.6%) had Diploma with nurses making up 56.0%. Chi-Square test revealed statistically significant associations between EHR sustainability and staff attributes, regular training (χ² = 9.676, p = 0.002), training frequency (χ² = 11.908, p = 0.003), training satisfaction (χ² = 6.814, p = 0.009), reduced medical errors (2 =7.869, p=0.005), improved communication, and reduced duplication (2 = 21.902, = 0.001). Logistic regression with EHR sustainability as the dependent variable yielded the adjusted odds ratio for regular training as 2.575 (p = 0.004), thrice-weekly training as 4.778 (p = 0.014), improved communication was 2.516 (p= 0.015), and reduced duplication was 3.093 (p= 0.0003). Accessing more than five computers, (χ² = 10.516, p = 0.005), and stable internet (χ² = 33.200, p = 0.001), were linked to EHR sustainable use under infrastructure. In the regression, >5 computers (AOR= 7.130, p= 0.007), and stable internet (AOR= 5.255, p= 0.001) maintained the association. Flexibility to IT changes (χ² = 13.506, p = 0.001), presence of data policy (χ² = 4.978, p = 0.026) and staff leaving (χ² = 22.546, p = 0.001) highly predicted EHR sustainability. Logistic regression, flexibility to change, (AOR 2.015 P = 0.046), data policy (AOR= 2.352, p= 0.012) and staff exit (AOR= 3.657, 95% CI, (1.845 – 7.248), p-value= 0.001) all contributed significantly too. This study recommends comprehensive, inclusive EHR training, communicating tangible benefits to foster system ownership. Stakeholders to invest in modern infrastructure, including functional computers, stable internet, power and dedicated technical support. Adaptive leadership, strong data privacy policies and strategic staff retention are also critical for the continuity of the EHR system. Master's Thesis

Human factors affecting quality of routine data collected on Tuberculosis by health workers in selected health facilities in Kiambu county, Kenya

Mon, 01 Jan 2024 00:00:00 GMT

Human factors affecting quality of routine data collected on Tuberculosis by health workers in selected health facilities in Kiambu county, Kenya CHEREDI, Josephine Otwere The quality of tuberculosis (TB) data is crucial for accurate diagnosis and effective public health strategies, significantly influenced among others, human factors. While existing studies provide insights into these human factors, they often fail to explore their interactions and collective impact on data quality. This study investigates how sociodemographic characteristics, training, data quality checking skills, and problem-solving abilities of healthcare workers affect TB data quality in Kiambu County, Kenya. Utilizing a cross-sectional design and mixed-methods approach, the research combined quantitative data from structured questionnaires with qualitative insights from interviews, involving 110 health workers, predominantly mid-career professionals aged 28-37—mainly nurses and clinicians—selected from 21 health facilities. Pretesting of data collection tool for validity and reliability. Quantitative analysis included descriptive statistics, regression analysis, and chi-square tests to assess the impact of various factors on data integrity. Qualitative data were analyzed through thematic coding and interpretation. Results indicated a significant relationship between age and training participation, with younger workers more actively engaging in training and demonstrating better error detection skills. Training emerged as a major determinant of data quality (P = 0.006), with 78.2% of respondents having over a year of experience in TB clinics, enhancing productivity and accountability. Moreover, strong correlations were found between data quality checking skills and improved data integrity, with a chi-square value of 232.5 (9 degrees of freedom). Practical applications, such as systematic verification processes, significantly enhanced data quality. Problem-solving abilities also played a crucial role, evidenced by a chi-square value of 45.32 (5 degrees of freedom, P < 0.001), indicating that respondents effectively utilized these skills through established guidelines. Qualitative findings revealed key informants emphasizing the need for improved TB management training, highlighting standardized protocols, cultural competency, ongoing education, and technology integration. These factors collectively contributed to significant reductions in data entry errors, thereby enhancing data quality as measured by accuracy, timeliness, completeness, reliability, and validity. In conclusion, the study confirmed that sociodemographic characteristics, training, data quality checking skills, and problem-solving abilities significantly influence TB data quality. Recommendations include implementing age-specific training programs, continuous structured training, specialized workshops, and supportive policies from health ministries to improve TB data quality and public health outcomes. These measures are essential for fostering reliable TB data, ultimately contributing to better health strategies and outcomes in the region. Master's Thesis

Determinants of adverse maternal and neonatal pregnancy Outcomes among pastoralist women of reproductive age in Marsabit county, Kenya

Mon, 01 Jan 2024 00:00:00 GMT

Determinants of adverse maternal and neonatal pregnancy Outcomes among pastoralist women of reproductive age in Marsabit county, Kenya OBENGA, Maryline Adverse maternal and neonatal pregnancy outcomes refer to abnormal birth outcomes that can manifest through the neonate, pregnant woman, or both. These outcomes mainly contribute to neonatal and maternal morbidity and mortality in low- and middle-income countries. In Sub- Saharan Africa, the prevalence of adverse pregnancy outcomes is 29.7%. In Kenya, an estimated 5,000 annual maternal deaths are attributable to adverse pregnancy outcomes. Marsabit County reports a Maternal Mortality Rate of 1127 deaths per 100,000 live births, which is 2.3 times more than the national rate. Adverse maternal and neonatal pregnancy outcomes and its determinants have been identified as; maternal individual-related, socio-cultural and health systems determinants. However, there is limited documentation of these determinants amongst pastoralist women of Marsabit County. The study's specific objectives were; to assess maternal-individual determinants, to investigate socio-cultural determinants and to assess health systems determinants of adverse maternal and neonatal pregnancy outcomes amongst pastoralist women of reproductive age; 15 to 49 years, in Marsabit County. The study applied a cross-sectional study design at four facilities purposively selected. The study used the Fisher et al. (1998) formula to calculate the sample size of 422 inclusive of 10% non-response. A structured questionnaire was used to collect quantitative data from 400 participants where systematic random sampling was applied. A response rate of 94.7% was attained, while, 22 sampled participants were unresponsive. Additionally, qualitative data was purposively obtained from eight healthcare providers using a Key Informant Interview schedule to triangulate with the quantitative data. Qualitative data were analyzed manually while quantitative data was analyzed with descriptive and inferential statistics. Pearson chi-square test determined the proportionality of associations between independent and dependent categorical variables. Variables showing associations underwent binary logistic regression to derive the Odds Ratio, which was used to determine the degree of associations between independent variables and dependent variables. The result demonstrated that the mean age of the participants was 25.87 (± 5.31 SD) whereby a high proportion of them; 35.3% were aged 25 to 29 years. Planning pregnancy reduced the chances of occurrence of adverse pregnancy and neonatal outcome by 69% (OR=0.309, 95% CI: 0.099- 0.967; p=0.044). Having a birth plan reduced the chances of adverse outcomes by 55% (OR=0.445, 95% CI: 0.245-0.806; p=0.008). Starting ANC attendance between 0 to 3rd month reduced the odds of occurrence of adverse pregnancy and neonatal outcome by 76% (OR=0.238, 95% CI: 0.072-0.786; p=0.018). Having a prim parous pregnancy increased the odds of determining an adverse outcome by 3.5 times (OR=3.529, 95% CI: 1.782-6.986; p<0.0001). Maternal age demonstrated a 48% reduction in odds of adverse maternal and neonatal pregnancy outcomes (OR=0.575, 95% CI: 0.449-0.735; p<0.0001). In line with socio-cultural factors, the type of marriage allowed demonstrated a 53% reduction in odds of adverse outcome (OR=0.471, 95% CI: 0.274-0.811; p=0.007). The use of native herbs during pregnancy was 2.4 times likely to increase the likelihood of adverse outcomes (OR=2.402, 95% CI: 1.038-5.557; p=0.041). Discussing contraceptive use with a male partner increased the likelihood of determining adverse maternal and neonatal pregnancy outcomes by 2.6 times (OR=2.595, 95% CI: 1.354-4.975; p=0.004). Distance to health facilities demonstrated a 72% reduction in the likelihood of adverse outcomes (OR=0.277, 95% CI: 0.075-1.022; p=0.054). Waiting time increased the chances of determining the outcome by 3.7 times (OR=3.661, 95% CI: 1.494-.8.974; p=0.005). Availability of comprehensive MCH services reduces the chances of occurrence of the outcome by 77% (OR=0.226, 95% CI: 0.060-0.859; p=0.029). Marsabit County Department of Health should adopt a multidimensional approach in addressing reported determinants of adverse pregnancy outcomes. Specifically, the county should intensify awareness of cultural sensitivity, improve health system infrastructure, education, training for health care workers, community services, and engagement as well as integration of maternal and neonatal services. Master's Thesis

Health system factors influencing up take of postpartum modern family planning methods among Hiv - seropositive women in Busia county, Kenya

Mon, 01 Jan 2024 00:00:00 GMT

Health system factors influencing up take of postpartum modern family planning methods among Hiv - seropositive women in Busia county, Kenya TEBAGALIKA, Florence Zawedde Postpartum family planning (PPFP) is crucial for promoting optimal timing and spacing of pregnancies and reducing maternal and child health risks. With the pre-existing reduced immune system, enabling human immunodeficiency virus (HIV)-seropositive women to avoid untimed pregnancies after the first 12 months of childbirth can reduce vertical transmission, child and maternal mortalities associated with HIV infection, and equally reduce the overall burden on the already stressed health care systems. Busia County, Kenya, faces unique reproductive health challenges, especially among HIV-seropositive women, where high rates of HIV incidence (6.7%) intersect with significant reproductive health needs. The county has a high unplanned pregnancy rate (78%) among HIV-seropositive women, exacerbating risks of mother-to-child HIV transmission (9.7%), which exceeds the national target of 5%. Although postpartum family planning (PPFP) is critical to address these concerns, only 56% of women in this population report using modern family planning methods postpartum. This study aimed to assess health system factors influencing the uptake of Postpartum (PP) modern FP methods among HIV-seropositive women in Busia County. Specifically, it determined the prevalence of PP modern FP method uptake, client-reported health service delivery factors, health provider-related factors, and commodity-related factors that affected the uptake of Postpartum modern FP methods among HIV-seropositive women in Busia County. It was across-sectional studythatinvolved311HIV-seropositive women who had a child 12- 24 months of age. These women were selected from Maternal and Child Health outpatient clinics within Busia County referral hospital, Alupe, Teso North, Khunyangu, Nambale, Port Victoria, and Samia Sub-County hospitals in Busia County. The respondents were selected through systematic random sampling and 14 health providers were selected through purposive sampling for the key informant insights. Quantitative data from the respondents was collected using a pretested questionnaire while qualitative data was collected using a KII guide. The quantitative data was analyzed using STATA 15, employing descriptive statistics, logistic regression, and Chi-square tests while thematic induction was done for the qualitative data. The study had a 100% response rate with the participant‘s mean age being 32.04 (± 6.02)years and 51.1% being between 25 - 34 years. Most of the women were married (74.6%), unemployed (77.4%), and had primary as the highest level of education (56.6%). At a 95% confidence interval, the study results revealed that 73.3% (95% CI 68.0 - 78.1) of the participants had utilized PP modern FP at some point. However, only 53.1% (95% CI 46.9 - 58.2) reported consistent PP modern FP method use throughout the first 12 months postpartum. After adjusting for variables significant at bivariate analysis, the study showed increased odds of PP modern FP method uptake among respondents who reported having been provided information on all types of FP methods (aOR 2.33, 95% CI 1.19 - 4.16, p=0.012). However, regarding commodity-related factors, users were more likely to have received PP modern FP methods, with significant differences in those who never found a method unavailable (57.9%). Persistent stock-outs of the different modern FP methods hindered PP modern FP service provision. Regarding health provider-related factors, PP modern FP method users were more likely to have been counseled during clinic visits (85.5%), during pregnancy (86.1%) and found waiting times acceptable (81.8%). Staffing and motivation also played important roles in FP uptake. This study found gaps in the uptake of PP modern FP methods among HIV-seropositive women in Busia County, Kenya. While initial uptake is high, consistent use through PP remains low, primarily influenced by the availability of comprehensive FP information and various health system factors. Persistent stock-outs of modern FP methods and inadequate counseling during clinic visits and pregnancy further impede consistent PP modern FP method use. Addressing these health provider and commodity-related factors is crucial to improving FP service delivery and reducing maternal and child health risks in high HIV-incidence areas like Busia County. Master's Thesis

Effectiveness of healthcare delivery system reform in optimizing care for people living with Hiv during Coronavirus pandemic era at Gateway clinic, Malawi

Mon, 01 Jan 2024 00:00:00 GMT

Effectiveness of healthcare delivery system reform in optimizing care for people living with Hiv during Coronavirus pandemic era at Gateway clinic, Malawi GENT, Felix Since the start of COVID-19 pandemic, delivery of healthcare has turned out to be more difficult because of health service delivery policy changes to accommodate COVID-19 prevention, pressure on already frail health systems and clients’ fears of interacting with health facilities hence shunning health services. HIV health services are some of the crucial services that have been affected in Malawi and policy changes (from six monthly visits to two visits every three months in the first six months of treatment and suspension of some routine services) were effected to optimize care while preventing the spread of COVID. This facility-based cross-sectional study was conducted to evaluate the effectiveness of healthcare delivery system reform in optimizing care for persons with HIV infection in the coronavirus pandemic era, at Gateway clinic, Malawi. The specific objectives were to determine the reliability of healthcare service reform, assess patient satisfaction with healthcare service reform and assess the responsiveness of the healthcare providers with regards to healthcare reform in optimizing care for persons with HIV infection in the Coronavirus pandemic era at Gateway clinic in Malawi. Participants includedrandomly selected 93 people living with HIV accessing HIV care and 5health care workers providing HIV care at Gateway clinic (purposively selected) and they provided information through interviews using questionnaires and key informant interview guide respectively. Quantitative data was analyzed using descriptive statistics, bivariate and multivariate logistic regression while qualitative analysis used thematic approach. Results showed that demographic characteristics did not have a significant association with effectiveness/optimization of healthcare but reliability, client satisfaction and responsiveness of healthcare workers did. Reliability of the healthcare system reduced during COVID-19 following the reforms by 5.4% compared to pre-COVID-19 pandemic period (95% CI: -0.4–-0.1, p0.0004)following a significant drop in capability of the facility, quality and effectiveness of care (at least 10% drop). A p-value of 0.0004 denotes a statistical significance of the difference in reliability. Similarly, there was an overall reduction in client satisfaction with healthcare during the Coronavirus pandemic (a 5% drop, 95% CI: -0.2–-0.02, p0.0108), largely because clinic operating hours became less convenient to the clients (2%). A p-value of 0.0108 denotes a statistical significance of the difference in client satisfaction over the two periods. Responsiveness of healthcare workers during COVID-19 pandemic reduced by 5.5% (95% CI: -0.9–-0.6, p<0.001). Differences were statistically significant with a p-value of <0.001. Overall, clients who perceived this reduction indicated that healthcare provided was less effective during COVID-19 pandemic. It is, therefore, important for policy makers and health system leadership to trade carefully when making policy reforms that influence changes to approaches for implementation of well-established programs and services (i.e. HIV care), especially during emergencies (i.e. pandemics). This in essence underscores the importance of wider consultations and considerations to safeguard the gains that have been realized over a long period of time in HIV program (progress towards the 95-95-95 UNAIDS targets). The following recommendations are therefore made; integration of telehealth into existing health system as an alternative to in-person engagement between clients and providers, implementation of client-centred approaches that deliberately target to meet clients’ needs i.e. flex-clinic operating hours, and training for healthcare providers to improve responsiveness and efficiency in service delivery during emergencies. Master's Thesis

Factors influencing utilization of free maternity care services among pastoralist women in Isiolo county, Kenya

Mon, 01 Jan 2024 00:00:00 GMT

Factors influencing utilization of free maternity care services among pastoralist women in Isiolo county, Kenya BAGAJA, Hassan Guyo Maternity care service (MCS) supports women during pregnancy, delivery, and postpartum. While 86% of global pregnant women access maternity care, only 44% of Kenyan women do. In Isiolo County, maternity care use has varied, not meeting the 80% target: 61% in 2016, dropping to 52% in 2017, then 69% in 2018, down to 53% in 2019, and 64% in 2020 which is attributed to the free maternity healthcare services that were expanded after the introduction of the Linda mama initiative in 2017. This study aimed to pinpoint factors affecting pastoralist women's use of free maternity services in Isiolo, focusing on cultural impact, education, and healthcare infrastructure. Grounded in the theory of planned behavior, a descriptive cross-sectional design was used. A descriptive research design was used to conduct the study. A sample of 380 pastoralist women was obtained from a target population of 73,877 women aged 19-49 years. The study used a census sampling to sample the three sub-counties in Isiolo County, purposive sampling to sample the birth attendants and simple random stratified sampling to sample the pastoralist women. Data was collected from three sub counties names Merti, Isiolo and Garba Tula in Isiolo County. Both quantitative and qualitative data was collected using questionnaire and key informant interviews. Data was analyzed using descriptive and content analysis. The relationship between the independent variables (culture, knowledge of pastoralist women and healthcare infrastructure) and dependent variable (utilization of free maternity healthcare) was analyzed using a multiple regression analysis. The findings were presented in table format and narration format. The study found that 80.1% of participants said their culture promotes home births, reducing the use of free maternity care. Only 38% were aware of free maternity services, with most maternal decisions in Isiolo County made by men as indicated by 87.4% of respondents. Infrastructure for maternity care was found lacking (63.9%), with only one theater facility for multiple sub-counties. Based on the interviews conducted, it was established that Isiolo County has one theater facility in the Isiolo sub-county, a challenge that greatly affects the pastoralist women from the Merti and Garba Tula sub-counties. The multiple regression revealed that culture negatively affects the utilization of free maternity care while knowledge and healthcare infrastructure positively influence the uptake of free maternity healthcare services. The study is significant to the County government of Isiolo, which can use the results to establish mobile medical facilities to promote the uptake of free maternity care services. The study recommended that policy makers should integrate the pastoralist culture into the healthcare services provided. Moreover, the study recommended that policy makers should create policies that ensure the healthcare facilities take up the responsibility of educating the pastoralist women and their husbands on the importance of seeking free maternity healthcare services. Master's Thesis

Determinants of diarrhoea prevention among caregivers of under-five children in households in Burumba ward, Matayos subcounty, Busia county, Kenya

Mon, 01 Jan 2024 00:00:00 GMT

Determinants of diarrhoea prevention among caregivers of under-five children in households in Burumba ward, Matayos subcounty, Busia county, Kenya WARUGURU, Hannah Kamau Diarrhoea is a leading cause of illness and death among children under five globally, and in Kenya, it ranks as the fourth most common illness in this age group. In Busia municipality, the diarrhoea prevalence stands at 16%, reflecting the national statistics as of 2017. Despite interventions such as vaccinations, breastfeeding promotion, and the 2015 declaration of Busia county as open defecation free, Burumba ward in Matayos sub-county consistently reported the highest diarrhoea cases at Busia County Referral Hospital from 2014 to 2019. Understanding the determinants of diarrhoea prevention among caregivers of young children is crucial for reducing the disease's impact. This was a cross-sectional study aimed at assessing the determinants of diarrhoea prevention among caregivers of children under five in Burumba ward. The specific objectives were to determine the prevalence of diarrhoea, examine caregivers' knowledge, attitudes, and practices (KAP) regarding diarrhoea prevention, and determine the socio-economic and sanitation factors associated with diarrhoea in this population. A sample of 207 caregivers was selected from a target population of 2255, using systematic sampling with a random start, in four out of eight randomly selected villages. Probability proportional to size method was used to determine the number of households to be sampled from each village. Data collection involved structured questionnaires and observation checklists, to verify availability of sanitation facilities. A recall period of two weeks was applied to obtain information of diarrhoea occurrence. Descriptive statistics was used to obtain data on the proportion of children under five with diarrhoea, while caregivers’ knowledge and practices was described as good or poor based on the average total scores above or below (50%) respectively. Attitude was determined using a Likert scale, and regarded as negative (mean score < 3) or positive (mean score > 3) depending on approach towards diarrhoea prevention. Chi square test of independence and Logistic regression analysis was used to test the association between socio-economic and sanitation factors with diarrhoea prevention. A p-value < 0.05 was considered as statistically significant. The diarrhoea prevalence was 42.5% based on the two-week recall period. Although 79% of caregivers had good knowledge of diarrhoea prevention, only 6.3% were aware that breastfeeding could prevent diarrhoea. Good practices towards diarrhoea prevention was observed in 71.5% of caregivers, but negative attitude was observed towards boiling and filtering of drinking water with 105 (50.7%) disagreeing to using boiled drinking water, while 172 (83.3%) also disagreeing to filtering their drinking water. Level of education was the only socio-economic factor that showed significant relationship with diarrhoea prevention (χ2 (4) =1.2298; P=0.032). Further logistic regression showed that secondary school level of education was independently associated with diarrhoea prevention (OR= 3.243; 95% CI= 1.073 – 9.806; P= 0.037). Overall, sanitation was good in 86.5% of households, and none of the sanitation factors was found to be significantly associated with diarrhoea prevention, in this study. These findings underscore the need for continuous health promotion campaigns emphasizing the role of breastfeeding in regard to diarrhoea prevention. Highlights the need of boiling or filtering drinking water in preventing diarrhoea in Burumba ward. Master's Thesis

Intrapersonal and interpersonal determinants of adolescent pregnancy among girls aged 10-18 years in Igembe north sub-county, Meru county, Kenya

Mon, 01 Jan 2024 00:00:00 GMT

Intrapersonal and interpersonal determinants of adolescent pregnancy among girls aged 10-18 years in Igembe north sub-county, Meru county, Kenya MAKENA, Emma Mbae Globally, 10% of total births occur among adolescent girls aged 10 - 18 years, 90% of whom reside in Africa. Adolescent pregnancy entails high morbidity and mortality risks yet, intervention show mixed outcomes, with those found to be effective showing small effect sizes across contexts. In Kenya, adolescent pregnancy is about 18%, with Meru being one of the high burden counties, accounting for 24% among estimated 18,123 adolescent girls countrywide. Igembe North sub-County accounts for the highest proportion (59%) of adolescent pregnancy in the County. Few studies exist in Kenya on person-centered risk factors, hence the need for research to further clarify personal and interpersonal determinants of adolescent pregnancy. This is needful to enable improvements in interventions design. The current study specifically investigated occurrence of risky sexual behavior, intrapersonal and interpersonal determinants of pregnancy among adolescents who had begun childbearing, based on the Socio–ecological theory. Through a cross-sectional mixed methods design using explanatory sequential, quantitative dominant approach, 398 participants were sampled from an estimated 18,123 adolescent girls aged 10-18 years who had begun childbearing in Igembe North sub-county. Participants were recruited from 8 sub-County hospitals through simple random sampling. Quantitative data was collected using structured questionnaires (Cronbach’s , 0.88) and qualitative data through 8 focus group discussions of 8-12 participants each. Variable characteristics were summarized descriptively and frequency distributions displayed in tables and figures. Bivariate logit regression identified determinants of adolescent pregnancy (p< 0.05). The prevalence of risky sexual behavior was 59% (p= 0.001). Early sexual debut (p= 0.01); being married (p= 0.001) and; having primary-level education (p= 0.001) had an association with adolescent pregnancy. Significant intrapersonal factors were, perceived behavioral control (OR 3.98; 95%CI -0.92, -0.84; p=0.049) and intention to have sex (OR 2.01; 95%CI -0.46, -0.076; p=0.018). Living with a single parent (OR 2.42; 95%CI 1.12, 18.95; p=0.01), maternal education (primary) (OR 2.39; 95%CI .1.23,3.48; p=0.01), living with a sibling who had had adolescent pregnancy (OR 2.10; 95%CI 1.22, 5.23; p=0.03), has communication with parents on reproductive health issues (OR 0.53; 95%CI 3.12, 13.64; p=0.01) and peer pressure (OR 4.23; 95%CI 2.22,10.98; p=0.03) were significant interpersonal predictors. Intentions to have sex was a strong predictor of pregnancy and was likely mediated by family relational environment and peer factors. It is recommended that combination multi-level interventions should harness intervention components that build protective behavioral intentions as well as strengthen social dimensions to prevent adolescent pregnancy. Master's Thesis

Evaluating the uptake of the services of community health volunteers in managing malaria and Diahrhoea in children in Kisumu west sub county, Kisumu County

Mon, 01 Jan 2024 00:00:00 GMT

Evaluating the uptake of the services of community health volunteers in managing malaria and Diahrhoea in children in Kisumu west sub county, Kisumu County OTIENO, Bernard Odhiambo Child mortality remains a public health burden in many settings in Africa including Kenya. In 2007, the Government of Kenya adopted community strategy to reverse the poor health outcomes and meet SDG 3. This strategy anticipates home visits by community health volunteers (CHV) to disseminate information and provide appropriate referrals. The under 5 mortality rate in Kisumu West Sub County is 45 per 1000 live births, with malaria and diarrhoea accounting for 40% of the deaths. Suboptimal healthcare worker density, and high prevalence of diarrhoea and malaria in Kisumu County necessitate the use of CHVs to enhance healthcare interventions. CHV programmes have however experienced challenges of acceptance, and resource shortage, compromising on their ability to deliver health for all. The study evaluated the association of the home visits and the utilisation of the interventions offered by the CHVs to prevent and manage malaria and diarrhoea in children. The study specifically sought to determine uptake of interventions offered by CHVs in prevention and basic management of malaria, to determine uptake of interventions offered by CHVs in prevention and basic management of diarrhoea, and to determine the role of CHVs in facilitating community dialogue and action days and the influence of these in promoting the uptake of interventions against malaria and diarrhoea in children in Kisumu West Sub County. This was a descriptive cross sectional study. A pre-tested semi structured questionnaire was administered to 398 randomly selected households from a population of 5721 households. The samples were derived from 5 community units. Key informant interviews was also conducted among community health assistants. The study reported that 31.2% of those who had been unwell consulted a CHV, 50% of those who experienced malaria symptoms were treated by a CHV as opposed to 32.8% of those who experienced diarrhoea symptoms. Additionally, 89.9% of caregivers reported that health education campaigns had been conducted in their communities. Binary logistic regression analysis reported significant associations on the distribution of mosquito nets (OR=0.174, 95%CI =0.097-0.311, p =0.001), drainage of pools (OR=0.212, 95%CI =0.053-0.853, p =0.029), malaria diagnosis and drugs given (OR=6.68, 95%CI =4.327-10.519, p =0.001) giving fluids to children experiencing diarrhoea (O R=0.249 95%CI =0.078-0.794, p =0.019), and taking caregivers through preparation of ORS (OR=0.348, 95%CI =0.200-0.605, p =0.001). This study concludes that CHVs are effective in offering health services in the community. The results inform primary care coordinators which interventions require improvement to enhance community health. Master's Thesis