Browsing by Author "Wainaina, Grace Muira"

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    A Systematic Review on Continuity of Care for Effective Coordination in Maternal and Neonatal Health Continuum: Experiences of Skilled Birth Attendants.
    (International Journal of Africa Nursing Sciences., 2024) Wainaina, Grace Muira; Kaura, Doreen; Jordan, Portia
    Background: Experiences of Skilled Birth Attendants (SBA) within and between the Maternal and Neonatal care segment is vital since they are the implementers of care. Aim: The objective of the review was to identify the experiences of Skilled Birth Attendants (SBA) with continuity of care (CoC) through the transitions of Maternal and Neonatal Health (MNH) continuum for effective care coordination. Methods: A qualitative systematic review was conducted of studies from the year 2000 to 2022 while following the Joanne Briggs Institute SUMARI critical appraisal tools. The first search was from 2/2/2021 to 16/2/2021, and a repeat search on 16/2/2022. PubMed, Cochrane, Scopus, Research 4 Life and Joanne databases were reviewed in English, French, and Spanish for data extraction and meta-aggregation done that led to the extraction of the discussed themes. Findings: The first theme on SBPs experiences was lack of timely CoC. The SBPs noted that women were not autonomous, and there was need for them to continuously update themselves with information in order to improve the Women-SBA/SBPs relationship on Continuity. The second theme acknowledged that the MNH continuum ought to be “Women Centred” (WC) and not “litigation centred” (LC). Third theme highlighted “what can be done”, from preconception to pregnancy, “what must be done” from pregnancy to birthing and “what needs to be done” from birth to postpartum. A gap was noted between the postnatal segment and the next conception segment as the “what next” segment. Conclusion: The missing segment between postpartum to preconception was suggested to be implemented immediately after birthing. The interconnectedness of continuity and coordination of care was suggested through a Midwifery Led Model (MLM).
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    Determinants of Cancer Care Pathways at Wajir County, Kenya: Patient Perspectives.
    (Ecancer Medical Science, 2025-02-07) Wainaina, Grace Muira; Affey, Fatuma; Halake, Dabo Galgalo; Osman, Hussein Ali; Ndukui, James G.; Abdourahman, Houda; Abdihamid, Omar
    Background: Cancer represents a major public health issue with substantial morbidity and mortality in low-resource settings such as Kenya. This study focuses on Wajir County in northern Kenya, a region with limited cancer care infrastructure and high unmet needs. Despite recent efforts to decentralize cancer care in Kenya, including establishing regional cancer centres in Garissa, Nakuru, and Mombasa, access to screening, diagnostics, and treatment remains constrained, particularly in rural areas. The absence of comprehensive cancer care pathways and a specialized oncology workforce in Wajir County exacerbates challenges in early detection, treatment, and palliative care. The study evaluated the availability of cancer care services at Wajir County Referral Hospital (WCRH), including screening, diagnostic services, treatment modalities, and referral systems. The study further explores the gaps in cancer care, focusing on patient perspectives, and proposes potential solutions to address these challenges. Methods: This study used mixed-methods (qualitative and quantitative) methods to understand cancer care from the perspective of patients at WCRH. It involved adult patients (over 18) with a confirmed cancer diagnosis who were receiving treatment or follow-up care between February and April 2024. Data were gathered through interviews and surveys, with research assistants helping with language translation and community navigation. The study collected information on demographics, cancer types, and prevalence rates, which were analysed using descriptive statistics. The qualitative data focused on patients' experiences with cancer awareness, treatment, and care gaps, and were analysed for common themes. Ethical approval was obtained, and informed consent was given by all participants. Results: This study involved 25 cancer patients (12 males, 13 females) receiving treatment at WCRH. The most common cancers were esophageal (44%), cervical (28%), breast (24%), and prostate (8%). Delays in diagnosis were significant, with 12% of patients waiting over 6 years, 24% waiting 4–6 years, and 40% waiting 1–3 years before seeking care. Most diagnoses were made at WCRH (64%), with others diagnosed at the Garissa Cancer Centre (22%) or in Nairobi (20%). Diagnostic tools available at WCRH included pap smears, mammograms, PSA tests, ultrasound, CT scans, and biopsies. However, access to these tools was limited, with barium swallow (32%) being the most frequently used for esophageal cancer, followed by pap smears, biopsies, and ultrasound (16% each). Patient awareness of cancer screening was higher for cervical (68%) and breast cancer (60%) but lower for prostate cancer (32%) and esophageal cancer (4%). Despite awareness, only 8% had previously undergone screening. Regarding treatment, most patients (80%) were aware of surgical options, while fewer knew about chemotherapy (28%) or palliative care (12%). When treatment was unavailable at WCRH, most patients preferred the Garissa Cancer Centre (80%) or Nairobi (52%). Financial challenges were the primary barrier to treatment for 88% of patients, and patients suggested improving local cancer care, subsidizing treatment, and enhancing early detection and screening services. Conclusion: The findings indicate a high burden of late-stage cancer diagnoses, insufficient cancer screening and treatment services, and limited access to cancer care pathways and patient navigation systems. These results underscore the urgent need for improved cancer care pathways, enhanced awareness, and increased healthcare capacity to reduce cancer morbidity and mortality in northern Kenya. This study contributes to understanding the cancer care landscape in Wajir County and provides a foundation for future health policy initiatives aimed at bridging existing gaps in cancer care
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    Women’s Experiences with Continuity for Effective Coordination during Maternal and Neonatal Continuum in Kenya: An Interpretive Phenomenology
    (African Journal of Primary Health Care & Family Medicine., 2024) Wainaina, Grace Muira
    Background: Embracing women’s experiences in decision-making is imperative for continuity in effective coordination of maternal and neonatal health (MNH); women are the end users within the care ecosystem. Through women’s continuous feedback, skilled birth attendants (SBAs) and the healthcare system get to understand emerging issues based on their needs and preferences. Aim: The purpose of this article is to describe women’s experiences of continuity for effective coordination of care through the transitions in the MNH continuum in Kenya. Setting: The study was conducted in selected counties of Kenya based on birth rates per woman as follows: Wajir (7.8) Narok (6.0) Kirinyaga (2.3) and Nairobi (2.7) (1). The clients were interviewed concerning their experiences of the MNH continuum of care in English and Kiswahili. Methods: An interpretive hermeneutic phenomenological approach was used to construct the experiences of women of continuity during transitions in the MNH continuum for effective care coordination. Twelve participants were interviewed between January and April 2023. Atlas ti 22 software was used for data analysis. Results: Four women experiences were highlighted: Women unawareness of preconception care, use of prenatal care, labour, birthing and postpartum flow and the women’s view on the MNH continuum. Conclusion: The women reported their segmental and transitional experience of the MNH continuum as one that did not consistently meet their needs and preferences in order for them to fully agree that the continuum enhanced continuity for effective coordination. They felt that they experienced continuity in some segments while in some they did not. Contribution: The embrace of women’s experience of their needs and preferences through the MNH continuum (segments and transitional segments) through the lens of continuity for effective coordination is timely towards the improvement of maternal and neonatal care by 2030.