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A Cross-Sectional Study of Self-Perceived Educational Needs of Emergency Nurses in Two Tertiary Hospitals in Nairobi, Kenya.
(Journal of Emergency Nursing, 2022) Ndung’u, Anthony; Ndirangu, Wambui Eunice; Sarki, Ahmed; Isiaho, Lilian
Background: Many low- and middle-income countries lack resources for well-functioning emergency care systems. Emergency nurses interact with injured and critically ill patients as the first contact in many health care settings. However, insufficient training limits nurses from providing ideal emergency care. The purpose of this research was to highlight educational needs specific to nurses working in 2 emergency departments in Nairobi, Kenya. Methods: A descriptive cross-sectional study involving emergency units of 2 of the largest referral and teaching hospitals (Aga Khan University Hospital, Nairobi, and Kenyatta National Hospital) in Nairobi, Kenya, was conducted. Data were collected by using an adapted structured, self-administered questionnaire. The data were analyzed using descriptive statistics. The skills and competencies of the participants were assessed. In addition, the educational gaps and needs of the participants around emergency care such as trauma, cardiovascular diseases, and respiratory and neurological illnesses were described. Results were presented in frequencies and percentages. Results: The questionnaire response rate was 63.6% (n ¼ 84). Most of the respondents held associate degrees in nursing (72.6%), whereas 19% had a bachelor’s degree in nursing. Most respondents (84.5%) perceived themselves as being highly competent in basic skills such as performing cardiopulmonary resuscitation and assessment of body systems. Less than half of the respondents (48.8%) perceived themselves as being highly competent in intermediate skills such as assisting with endotracheal intubation. In advanced competencies, such as analyzing electrocardiograms and administering thrombolytic medications, only 16.7% perceived themselves as highly competent. Conclusion: The results of this study suggest there is a knowledge gap and educational needs among emergency nurses in Nairobi, Kenya. It identified injuries/trauma; cardiovascular, respiratory, and neurological disease; and other emergencies as topics of focus areas with a high need. To address these knowledge and skills needs, a future specialty training in emergency nursing is recommended and this could be achieved through continuing professional development and short courses or postgraduate-level training.
A Randomized Trial of Artemether-Lumefantrine and Dihydroartemisinin-Piperaquine In The Treatment of Uncomplicated Malaria among Children in Western Kenya
(Malaria Journal, 2013) Onyango, Peter; McMorrow, Meredith; Otieno, Kephas; Agarwal, Aarti; Odero, Christopher; Williamson, John; Kariuki, Simon; Kachur, Stephen Patrick; Slutsker, Laurence; Desai, Meghna
Background: Artemether-lumefantrine (AL) was adopted as first-line treatment for uncomplicated malaria in Kenya in 2006. Monitoring drug efficacy at regular intervals is essential to prevent unnecessary morbidity and mortality. The efficacy of AL and dihydroartemisinin-piperaquine (DP) were evaluated for the treatment of uncomplicated malaria in children aged six to 59 months in western Kenya. Methods: From October 2010 to August 2011, children with fever or history of fever with uncomplicated Plasmodium falciparum mono-infection were enrolled in an in vivo efficacy trial in accordance with World Health Organization (WHO) guidelines. The children were randomized to treatment with a three-day course of AL or DP and efficacy outcomes were measured at 28 and 42 days after treatment initiation. Results: A total of 137 children were enrolled in each treatment arm. There were no early treatment failures and all children except one had cleared parasites by day 3. Polymerase chain reaction (PCR)-uncorrected adequate clinical and parasitological response rate (ACPR) was 61% in the AL arm and 83% in the DP arm at day 28 (p = 0.001). PCR-corrected ACPR at day 28 was 97% in the AL group and 99% in the DP group, and it was 96% in both arms at day 42. Conclusions: AL and DP remain efficacious for the treatment of uncomplicated malaria among children in western Kenya. The longer half-life of piperaquine relative to lumefantrine may provide a prophylactic effect, accounting for the lower rate of re-infection in the first 28 days after treatment in the DP arm.
A Review of Leishmaniasis in Eastern Africa.
(Elsevier, 2009-03) Ngure, Peter Kamau; Ng'ang'a, Zipporah W.; Rukunga, Geoffrey; Kimutai, Albert; Tonui, Willy K.
The review presents the epidemiology of leishmaniasis in the Eastern Africa region. We searched PUB MED and MEDLINE with several key words-namely, “leishmaniasis”;“cutaneous”, “diffuse cutaneous”, “mucosal”, and “visceral leishmaniasis”; “kala azar”, and “post kala azar dermal leishmaniasis”, -for recent clinical and basic science articles related to leishmaniasis in countries in the Eastern Africa region. Poverty, wars, conflicts and migration have significantly aggravated leishmaniases in Eastern Africa. Of particular concern is the increasing incidence of Leishmania-HIV co-infection in Ethiopia where 20∼40% of the persons affected by visceral leishmaniasis are HIV-co-infected. Sudan has the highest prevalence rate of post kala-azar dermal leishmaniasis(PKDL) in the world, a skin complication of visceral leishmaniasis(VL) that mainly afflicts children below age ten. In view of its spread to previously non-endemic areas and an increase in imported cases, leishmaniasis in Eastern Africa should be considered a health emergency.
A Storytelling Program for Women Living with HIV in an Informal Settlement in Kenya: Addressing Psychological Trauma, Depression and Stigma
(Archives of Palliative Care and Medicine, 2018-09-24) Njuguna, Susan; Tuikong, Sylvia; Ngure, Peter Kamau
Awareness of HIV and AIDS in Kenya is high but stigma is still experienced among women living with HIV. The supportive environment in support groups is correlated with reducing apprehension and depression among people living with HIV although psychological issues are not adequately addressed. A randomized control study with the intervention of narrative approach was carried out for Women living with HIV. Eligibility included a score of above 21 on the Impact of Event (IES- R) Scale, severe depression (CES-D) and scored high on the Internal Stigma Scale (HIV ISS). A structured group therapy session using narrative approach was conducted weekly for twelve (12) weeks for five groups of ten (10) members each. The finding was a reduction in the impact of event for all intervention groups on the Impact of Event Scale (IES-R). On the depressive scale, all members in the intervention groups moved from severe depression to moderate 37(75%) and mild 13(25%). The stigma scale indicated that 30(60 %) of the participants improved to moderate and mild while 20(40%) remained with severe stigma. Group therapy should be structured and adopt the narrative approach for women living with HIV. This will complement measures to reduce trauma from the impact of event, depression and internal stigma.
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).
Altogether Now ... Understanding the Role of International Organizations in ICCM Policy Transfer
(Health Policy and Planning, 2015-07) Bennett, Sara; Dalglish, Sarah L; Juma, Pamela A. ; Rodrı´guez, Daniela C
Introduction Policy transfer theories explain how policy ideas move across time and geography and offer an approach to understanding waves of policy change, a common phenomenon in global health. Four primary mechanisms for the transfer of policies from global to national levels are posited: learning, coercion, socialization and competition. Methods We used six concurrent country case studies of policy change for child survival followed by a global study to analyse (1) mechanisms for policy transfer and (2) the roles of international organizations in promoting policy transfer. Our six country cases drew upon early adopters of integrated Community Case Management of Childhood Illness policy (Malawi, Niger), as well as countries that were slower to adopt due either to practical implementation challenges (Mozambique, Mali) and/or policy resistance (Burkina Faso, Kenya). In total, 145 semi-structured interviews and 283 document reviews were conducted across the six country cases, and 25 semi-structured interviews and 72 document reviews for the global study. Results Three of the four diffusion mechanisms (learning, coercion and socialization) were important in these cases, but not competition. Multiple strategies were employed by multilateral organizations to support policy transfer, such as regional meetings or academic publications, frequently serving multiple diffusion mechanisms simultaneously (e.g. both learning and socialization). In just one country case, funding conditionalities were used to press for policy change. The emphasis of policy transfer mechanisms varied between early and later adopters. Early adopters, for example, were more likely to engage in learning. International multilateral organizations were active policy transfer agents, and national policy-makers perception of them as “trusted partners” made them well suited for this role. However, on occasion their role became more that of advocates than neutral facilitators. Conclusions International actors use multiple synergistic channels to promote uptake of global health policies in low- and middle-income countries, and tailor strategies employed to country contexts.
An Analysis of Health Seeking Behaviour on Utilization of Skilled Delivery Services by Maasai Women in Kiekonyokie Sub location of Kajiado County in Kenya
(2017) Simel, Laban L.; Nanduri, Lakshmi; Juma, Pamela A.; Omuga, Blasio O.
Introduction: Maternal health is one of the eight Millennium Development Goals, is central to poverty reduction and overall development, and it increased international attention for monitoring progress on maternal health and improving access to skilled attendants at deliveries. In Kenya, 44 percent of births are delivered under the supervision of a health professional, mainly a nurse or midwife. Traditional birth attendants continue to play a vital role in delivery, assisting with 28 percent of births. Objectives: This research paper aimed to analysetherole of Health Seeking Behaviour onthe utilization of skilled delivery services by Maasai women, the study population belonging to a community of nomadic life style in North of Kajiado County inKenya. Methodology: The study design was a cross sectional descriptive study adopting both quantitative and qualitative methodologies. The sample size was 264 women of reproductive age obtained by using formula given by Fisher et al., when the population is more than 10,000. The quantitative data has been analyzed using (SPSS) version 17.0 while the qualitative data was analyzed by summarizing of the themes. Results: Results show that 57.2% Maasai women go to the health facility in case of illnesses, while 7.6% consulted their mother in law., husbands make most of the decisions (40.2%) on the place of delivery of the expectant mothers whereas as the relatives make the least decisions 5.7%.Preparation of the expectant mother for delivery did not have a statistical significant p-0.046. The traditional rite of passage practices had no statistical significance p-0.190. 72% of womencould mention at least one correct danger sign for pregnancy out of the posssible four. 97.7% of the Maasai women take more than 1hour to reach to the nearest health facility and less than 1% of them take less than 30minutes to reach to the health facility, 56.1%, of the women had delivered at home while 11.4% were assisted by health personnel at the facility, 69% of those who delivered in the hospital paid > 500 shillings compared to 8% of those who paid < 500 shillings. A mount paid for skilled delivery had a statistical significance, (p<0.001).
An Analysis of Views on the Perspective of Staff Behaviour on Utilization of Skilled Delivery Services by Maasai Women in Kiekonyokie Sub Location of Kajiado County in Kenya. IOSR Journal of Nursing and Health Science
(IOSR Journal of Nursing and Health Science, 2017) Simel, Laban Lebahati; Nanduri, Lakshmi; Juma, Pamela A.; Omuga, Blasio O.
Maternal health is one of the eight Millennium Development Goals, is central to poverty reduction and overall development efforts and it increased international attention for monitoring progress on maternal health and improving access to skilled attendants at deliveries. In Kenya, 44 percent of births are delivered under the supervision of a health professional, mainly a nurse or midwife. Traditional birth attendants continue to play a vital role in delivery, assisting with 28 percent of births. This research paper aimed to study the role of views on staff behaviour on the utilization of skilled delivery services by Maasai women, the study population belonging to a community of nomadic life style in North of Kajiado County in Kenya population. The study design was a cross sectional descriptive study adopting both quantitative and qualitative methodologies. The sample size was 264 women of reproductive age obtained by using Fisher et al., formula when the population is more than 10,000.The quantitative data has been analyzed using (SPSS) version 17.0 while the qualitative data was analyzed by summarizing of the themes. Results show the role of health seeking behaviour in relation to the views on staff behaviour on utilization of skilled delivery services in Maasai women in Kiekonyokie area of Kajiado County of Kenya.57.2% in the Kajiado study went to the health facility for other illnesses. Mothers in laws played the least role when it came to illnesses compared to pregnancy. The women acknowledged that delivering in the hospital is good but it has no communal support. Over 60% of the women in the study rated the staff behaviour as good with less than 10% rating as unacceptable. This indicated clearly that the staff behaviour towards women during delivery did not have a negative effect nor serve as a hindrance to them. Involvement of the mothers in laws and husbands during antenatal care visits till delivery time is important to enhance skilled delivery services among the Maasai women in this study. Health education to the stake holders is also essential in ensuring the safety of the mother and the newborn.
An Evaluation of Economic and Education Determinants on Utilization of Skilled Delivery Services by Maasai Women in Kiekonyokie Sub location of Kajiado County in Kenya
(International Journal of Community Medicine and Public Health, 2018) Simel, Laban Lebahati; Nanduri, Lakshmi; Juma, Pamela A.; Omuga, Blasio
Background: Maternal health is one of the eight Millennium Development Goals, is central to poverty reduction and overall development efforts and it increased international attention for monitoring progress on maternal health and improving access to skilled attendants at deliveries. This research paper aimed to study economic and education determinants on the utilization of skilled delivery services by Maasai women, the study population belonging to a community of nomadic life style in North of Kajiado County in Kenya. Methods: The study design was a cross sectional descriptive study adopting both quantitative and qualitative methodologies. Results: Utilization of skilled delivery was higher among women who had a source of income (34%) compared to women who had no source of income (19%) indicating a statistical significance p=0.003. Women who had higher level of education were more likely to use skilled delivery 50% compared to 22% who had no education at all hence p=0.002. Education level had a statistical significance, (p-0.002). 69% of those who delivered in the hospital paid > 500 shillings compared to 8% of those who paid < 500 shillings. The amount paid for skilled delivery had a statistical significance, (p<0.001). 97.7% of the Maasai women in the Kajiado North study takes more than 1hour to reach to the nearest health facility while less than (1%) of them in this study takes less than 30minutes to reach to the health facility. Conclusions: In conclusion this study shows that high level of illiteracy, low economic status, distance away, cost to pay for skilled delivery hindered skilled delivery service utilization among the Maasai women.
An Evaluation of The Effectiveness of an Updated Pre-Service Midwifery Curriculum Integrated with Emergency Obstetric and Newborn Care in Kenya: A Cluster Randomized Controlled Trial
(BMC Medical Education, 2024) Shikuku, Duncan N.; Mwaura, Catherine; Nandikove, Peter; Uyara, Alphonce; Allott, Helen; Waweru, Lucy; Nyaga, Lucy; Tallam, Edna; Bashir, Issak; Ndirangu, Wambui Eunice; Bedwell, Carol; Bar-Zeev, Sarah; Ameh, Charles
ntroduction Quality midwifery education is central to improving midwifery service delivery and maternal and newborn health outcomes. In many settings, midwifery educators insufficiently prepared for their teaching role and deficient curriculum compared to international standards affect the quality of healthcare provided by the midwifery graduates. This study assessed the effectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in Kenya. Methods A cluster randomised controlled trial in 20 midwifery colleges (12 intervention, 8 control colleges). Educators in both arms received training in teaching/EmONC skills to deliver the updated national midwifery curriculum. The intervention arm received additional 3-monthly post-training mentoring for 12 months. Educators’ knowledge and confidence in EmONC/teaching skills was assessed before and after training and at 3, 6, 9 and 12 months. Teaching skills observations at baseline and endline in both study arms were also assessed. Knowledge, self-rated confidence and three OSCE in EmONC practical skills among final year midwifery students were assessed. Linear mixed effects models were used to evaluate the effect of intervention on educators and students. Results Seventy four educators and 146 students participated. Training significantly improved educators’ mean knowledge (61.3%-73.3%) and confidence to teach EmONC (3.1–4.2 out of 5). Observed teaching skills mean scores of educators in the intervention arm were significantly higher compared to those of controls at endline (89.4%-vs72.2%, mean difference 17.2 [95%CI, 3.2–29.8]). Mean scores for students in the intervention arm were significantly higher than those in controls for knowledge (59.6%-vs-51.3%, mean difference 8.3 [95%CI, 1.6–15.0]) and the three skills assessed (means; mean difference (95%CI): shoulder dystocia (64.5%-vs-42.7%; 21.8 (10.8–33.9); newborn resuscitation (43.9% vs 26.1%; 17.8 (2.0–33.9); and maternal shock resuscitation (56.5%-vs-39.2%; 17.3 (8.0–26.0) and combined average skills scores (55.0%-vs-36.0; 19.0 (8.7–29.5). Conclusion Training and supportive mentoring improved the quality of educators’ teaching pedagogy and EmONC skills and enhanced students’ learning. Overall performance in EmONC knowledge and skills was significantly higher for students who were taught by trained and mentored educators compared to those who received training alone. Thus, a local mentoring system is effective to enhance learning and effectiveness of an EmONC-updated midwifery curriculum.
Analysis of Non-Communicable Disease Prevention Policies in Five Sub-Saharan African Countries: Study Protocol
(Archives of Public Health, 2016) Oti, Samuel; Juma, Pamela A.; Mohamed, Shukri F.; Wisdom, Jennifer; Kyobutungi, Catherine
Background: The burden of non-communicable diseases (NCDs) and their risk factors is increasing in sub-Saharan Africa, and there have been calls for adopting a multi-sectoral approach in developing policies and programs to address this burden. Evidence exists largely from high-income countries on the success (and lack thereof) of multi-sectoral approach in improving population level health outcomes. In sub-Saharan Africa, there is limited research on the application and success of multi-sectoral approach in the formulation and implementation of policies aimed at prevention of non-communicable diseases. Therefore, this protocol describes a study that aims to primarily generate evidence on the extent to which multi-sectoral approach has been applied in developing policies to prevent non-communicable disease in six countries in sub-Saharan Africa –Kenya, Malawi, Nigeria, Cameroon, Togo and South Africa. Methods/Design: The study applies a multiple case study design. Data will be collated mainly through document reviews and key informant interviews with the relevant decision makers in various sectors. In each country, a detailed case study analysis will be undertaken of any policy/policies developed, adopted and implemented, aimed at implementing the World Health Organization recommended “best buys” for non-communicable disease prevention. These case studies will be conducted by research teams in each country; each team includes a senior research fellow supported by a doctoral student, and research assistants. Discussion: Uptake of the evidence generated from the case studies will be ensured by systematic engagement with policy makers in each country throughout the research process. Ultimately, a forum of experts will be convened to generate actionable recommendations on the use of multi-sectoral approach in non-communicable disease prevention policies in the region.
Assessing The Impact of A Partnership‐Based Work/Study Nursing Upgrade Programme in a Low‐ and Middle‐Income Setting.
(Journal of Clinical Nursing, 2018) Brownie, Sharon; Maina, Gatimu Samwel; Wahedna, Abdul Haq; Kambo, Isabel; Ndirangu, Wambui Eunice
Aims and objectives: To evaluate the 15‐year impact of the work/study nursingupgrading programme in East Africa.Background: Working nurses in Africa are often primary family income earners, withlimited ability to leave jobs and upgrade qualifications. In 2001, the university estab-lished a work/study upgrade programme for enrolled‐ and diploma‐level nurses,allowing them to upgrade their qualifications while continuing to work and supportfamilies. Donor partnerships provided scholarships to further increase programmeaccess.Design: A mixed‐method design was used involving an online alumni survey and 24interviews and 23 focus groups with 172 purposively selected representatives ofnursing graduates, employers, regulatory bodies, professional associations and seniornursing officials.Method: Quantitative data were analysed using frequencies and percentages. Induc-tive thematic analysis was used for qualitative data. Equator guidelines informedreporting of both qualitative and quantitative results.Results: Of the 549 graduates who completed the survey, 81.2% (n = 446) werefemale, 93.1% were currently employed and 98% worked within East Africa. Theyreported improved professional competence (69.4%), nursing practice (25.9%) andpatient outcomes (4.6%) on graduation. Extracted themes included the following:flexible/accessible programme; friendly learning environment; effective teaching andlearning strategies; acquisition of nursing knowledge, skills and competencies; stake-holders’ role in the programme; career/professional advancement; and strengthenedhealth systems.Conclusion: The work/study programme was an effective nursing workforce capac-ity development strategy. Programme access was strengthened via the supportingdonor partnership. Positive outcomes were achieved with respect to the university'svalues of quality, access, relevance and impact.Relevance to clinical practice: Long‐term sustainable development of nurses andmidwives is fundamental to achieving sustainable development goals. Work/studyprogrammes and private–public partnerships are effective mechanisms to strengthenthe development of nursing and the overall healthcare workforce in low‐resourcesettings
Assessment of Institutional Support on Healthcare Workers in Safe Handling of Cytotoxic Agents and Related Waste at Kenyatta National Hospital
(International Journal of Health Sciences and Research, 2019-09) Mitheu, Kilemi Henry; Mwaura, James; Bitok, Lucy W. Kivuti
Background: Healthcare workers are exposed to cytotoxic agents and waste in their day to day practice as they handle them. These agents are known to be carcinogenic, mutagenic and teratogenic. Institutions need to protect their workers from exposure to cytotoxic agents. Objective: To assess the institutional support of healthcare workers in safe handling of cytotoxic agents and related waste at Kenyatta National Hospital. Methodology: This was a descriptive cross-sectional using quantitative method. A questionnaire and an observation check list were used to collect data. The sample size was 162 respondents. Stratified simple random sampling was used to select the study participants. Data analysis was done using SPSS. Results: Majority (77.3%) of the respondents were females. The mean age of the respondents was 35.9±9.98 years. Only 12% of the healthcare workers had a specialized oncology training. Fifty four percent of the respondents had no training on handling of the cytotoxic drugs and wastes. Majority, 52% of the respondents were not aware of existence of any policy document. There was reported stock outs of PPEs especially the shoe covers eye and face shields and hair covering. There was lack of spill kits as reported by 82% of the respondents. Conclusion: There was lack of necessary support to healthcare workers in handling cytotoxics as shown by shortage and lack of appropriate personal protective equipment, lack of knowledge on the available policy at the operational level and most healthcare workers lacking specialized training in oncology
Assessment of Participation of Nursing Faculty in Clinical Practice in The Kenyan Universities
(American Journal of Health, Medicine and Nursing Practice, 2018) Waweru, Beth; Mapesa, Job; Ndirangu, Wambui Eunice
Purpose: The purpose of this study was to assess the participation of nursing faculty in faculty clinical practice in the Kenyan universities. Methodology: This was a cross sectional descriptive survey. All the universities with nursing programs in the country were purposively selected. Data was then analyzed through descriptive statistics using the Statistical Package for Social Science (SPSS version 23.0).Chi-square test was used to test associations between selected independent and dependent variables. Results: The study found out that most nursing faculty is participating in clinical practice though they have limited knowledge of the models of faculty clinical practice. However there are barriers and enablers that seem to influence their practice. Freedom to choose level of engagement and universities’ administrative support were the top most enablers of faculty clinical practice. The top most barriers towards faculty clinical practice were increased workload and insufficient time to practice. Unique contribution to theory, practice and policy: Faculty clinical practice is vital and for it to be successful universities need to come up with a defined framework
Barriers to Postpartum Contraception: Differences among Women Based on Parity and Future Fertility Desires
(Culture, Health & Sexuality, 2017) Keesara, Sirina; Juma, Pamela A. ; Harper, Cynthia C.; Newmann, Sara J.
Timely use of contraception in the postpartum year is critical for pregnancy spacing, which protects a mother’s health and improves her ability to care for children. This qualitative study explored contraceptive decision-making among postpartum women in Nairobi, Kenya, with a focus on accounts of how women overcame barriers to postpartum contraceptive use. Focus groups (n = 61) and in-depth interviews (n = 30) explored experiences, barriers and actual use of postpartum contraception. Data were analysed using framework analysis, a method that organises qualitative data into themes and then interprets the data by mapping participant characteristics to these themes. Contraceptive use among women who desired future fertility was hindered by fear of side-effects and concern for partner disapproval. However, women who were satisfied with their family size more easily overcame these barriers. Tailoring postpartum contraceptive counselling to both assuage the concerns of women who desire future fertility and address the long-term contraceptive needs of mothers who desire to stop child-bearing could play a role in reducing the unmet need for contraception.
Beyond the Metrics of Health Research Performance in African Countries
(BMJ Global Health, 2021) Wenham, Clare; Mijumbi-Deve, Rhona; Parkhurst, Justin; Jones, Catherine; Juma, Pamela A.; Sobngwi-Tambekou, Joelle L.
While it is important to be able to evaluate and measure a country’s performance in health research (HR), HR systems are complex and multifaceted in nature. As such, attempts at measurement can suffer several limitations which risk leading to inadequate indices or representations. In this study, we critically review common indicators of HR capacity and performance and explore their strengths and limitations. The paper is informed by review of data sources and documents, combined with interviews and peer-to-peer learning activities conducted with officials working in health and education ministries in a set of nine African countries. We find that many metrics that can assess HR performance have gaps in the conceptualisation or fail to address local contextual realities, which makes it a challenge to interpret them in relation to other theoretical constructs. Our study identified several concepts that are excluded from current definitions of indicators and systems of metrics for HR performance. These omissions may be particularly important for interpreting HR performance within the context and processes of HR in African countries, and thus challenging the relevance, utility, appropriateness and acceptability of universal measures of HR in the region. We discuss the challenges that scholars may find in conceptualising such a complex phenomenon—including the different and competing viewpoints of stakeholders, in setting objectives of HR measurement work, and in navigating the realities of empirical measurement where missing or partial data may necessitate that proxies or alternative indicators may be chosen. These findings are important to ensure that the global health community does not rely on over-simplistic evaluations of HR when analysing and planning for improvements in low-income and middle-income countries.
Challenges Facing Implementation of Referral System for Quality Health Care Services In Kiambu County, Kenya
(Health Systems and Policy Research, 2017) Kamau, Kariri James; Osuga, Ben Onyango; Njuguna, Susan
The right to the highest attainable standard of health is a fundamental human right and, central to this right within a hierarchical health system, is the existence of a well-functioning referral system that allows for continuity of care across the different tiers of care. A referral system enables management of client health needs comprehensively with resources locally unavailable. This study sought to establish challenges facing implementation of the referral system for quality health care services in Kiambu County, Kenya. Specifically, investigated the influence of infrastructure, capacity of health care workers, health information systems and financial resources on implementation of health care referral system. A crosssectional research design was done targeting health care workers in public health care facilities Tier 2 and Tier 3 in Kiambu County and two hundred and seventy one respondents took part in the study. A statistical analysis was done using SPSS 20 and Excel 2013. Both questionnaires and interview guide were employed as data collection tools which attained quantitative and qualitative data. Inferential statistics was used to conduct regression analysis. From the findings of the study it was established there existed a relationship between independent and dependent variables as revealed by infrastructure with coefficient 4.457; capacity of health care workers with coefficient 4.105; health information systems with coefficient 4.405; and financial resources with coefficient.4.013. The p value was <0.001. The study concluded that infrastructure, health information systems, capacity of health care workers, and financial resources are challenges in implementation of health care referral system in Kiambu County and should be strengthened. The study recommended that Kiambu County Health care facilities should improve infrastructure; implement a standard referral system monitoring toolkit and curriculum to train health workers on the referral policies and guidelines; develop standard referral forms/registers and provide adequate funds for implementation monitoring and evaluation.
Childbirth experiences and post-partum depression among mothers in selected hospitals in Kiambu, Kenya
(International Journal of Midwifery and Nursing Practice, 2024-05) Kahiga, Keziah Wakonyo; Makworo, Drusilla; Ndegwa, Stephen
Assessing for the psychosocial status and management of risks for post-partum depression among pregnant mothers is an indispensable aspect of peri-partum care. Two groups of mothers were assessed for post-partum depression, one having gone through the routine antenatal care, and one having been taken through supplementary teaching on emotional management, social support, health lifestyle, economic empowerment, and group therapy.
Cognitive Factors and Development of Boy Child in Kenya.
(Arch Epidemiol Pub Health Res, 2024) Nzioka, Agnes Wavinya
The place of the boy child and man in society is changing at a frenetic pace. The majority of society's systems work in favour of the girl child. Society has created the best environment for the girl child to thrive, to the disadvantage of the boy child. As such, more resources are committed to the development of the girl child than ever before. More than ever before, we are seeing numerous campaigns, workshops, and seminars dubbed "girl child empowerment." Especially in Africa and particularly in Kenya, one of the most significant advantages of conducting this research is that the country has significant gender disparities in the development of boys and girls, giving girls an advantage and the ideal atmosphere in which to thrive. As a result, boys have grown into dysfunctional adults that disrupt families, communities and societies across all spheres. To establish the role of cognitive factors on the development of boy child in Kenya. The main objective of this research was to establish the role of cognitive factors on the development of boy child in Kenya. The study used an explanatory research design. The target population unit of analysis was all the 3,500,000 students, 113,200 teachers, 10,463 principals, 3,400,000 parents, 14 heads of mental health hospitals, 129 heads of prisons, and 47 county education officers respectively in Kenya. Stratified-Systematic sampling and purposive sampling were used to identify a sample size of 1,682 respondents selected using the Krejcie and Morgan Table formula. The findings revealed a statistically significant positive correlation between cognitive factors and the development of the boy child: reasoning (r=0.33, p<0.05) and memory (r=0.23, p<0.05), indicating that enhanced cognitive abilities are associated with more favourable developmental outcomes. The findings from this study offer valuable insights for policymakers and implementers in addressing critical gender disparities and enhancing the development and performance of boys. This has broader implications for achieving the Sustainable Development Goals (SDGs), Africa Vision 2050, and Kenya Vision 2030. different medical conditions and risk factors that potentially led to a child developing a recurrent TIA
Congenital Malformations among Newborns in Kenya
(African Journal of Food Agriculture, Nutrition and Development, 2009) Muga, R. O.; Mumah, S. C. J.; Juma, Pamela A.
Available literature suggests that congenital malformations are a major cause of prenatal infant deaths and postnatal physical defects [1, 2]. Therefore, a study was conducted to determine the patterns and incidence of congenital malformations at birth in newborns in Kenya and thereby analyze associated predisposing factors in their mothers. This single cross-sectional survey adopted the quasi-experimental study design to investigate a total of 7,355 consecutive births at the maternity unit of Kenyatta National Referral Hospital over a period of uninterrupted 12 months beginning 8th September to 7th September of the following year. Data collection involved clinical examination of the malformed newborns for final diagnosis using a standard proforma. The study included a control group of new born babies selected systematically among babies who were born during the same study period but had no recognizable defects at birth (n=210). These included normal babies delivered immediately after the malformed newborns. The experimental group comprised the malformed babies (n=207). Mothers were also interviewed for demographic information and data on life style and behavioral risk factors. In this paper only the results of the experimental group are described. A total of 207 malformations were documented. Results showed overall incidence of externally discernible malformations of 28.1 per 1000 total births (28.1/1000). The incidence of major malformations was 15/1000 births. Malformations of musculoskeletal system were the most frequently observed, accounting for 33.9% of all the major malformations, followed by malformations of the central nervous system (28.6%). Polydactyl was the most common single malformation with an incidence of 10/1000 total births. Neural tube defects (with an overall incidence of 4.6/1000 births) and chromosomal disorders were also common. On the overall, congenital malformations occurred in proportions that were comparable to other findings in Africa and other parts of the world. These findings highlight the need for stepping up nutritional prevention efforts, for instance, folic acid supplements; strengthening surveillance to monitor trends; and the establishment of a genetic centre in Kenya in order to strengthen local capacity for chromosomal studies, prenatal diagnosis, and genetic counseling on these complex issues.

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