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    Continuous Professional Development in Long Acting Reversible Contraception for Nurses and its influence on Services provided to women at Mbagathi County Hospital in Nairobi, Kenya
    (International Journal of Professional Practice (IJPP), 2023) Tuya, Scolastica Wabwire; Gatere, Ruth; Njuguna, Susan
    Health professionals maintain, improve and broaden their knowledge and skills in a way that helps them develop qualities and competencies during practice. Continuous Professional Development (CPD) in nursing enhances competencies grounded in evidence base as new knowledge emerges in health care, and is therefore a valuable tool for implementing best practices. Advances in reproductive health seek to reduce risk of maternal morbidity and mortality that could be as a result of women not spacing births or having unmet needs for family planning. This study sought to evaluate the influence of CPD in provision of Long Acting Reversible Contraception (LARC), and to identify challenges in provision of service by nurses at Mbagathi County Hospital, Nairobi, Kenya. A cross sectional study design was used on a population of nurses working at Mbagathi County hospital, in units that provide reproductive health services. Sixty six nurses were eligible to for the study and were therefore purposively selected due to their numbers of eligibility so as to allow every one of them to participate in the study. Data was collected using a semi structured questionnaire. Descriptive analysis was conducted in MS excel and chi square test in epi-info version 7. The response rate was 98%, where 58(88%) questionnaires were analysed. The mean age of the nurses was 33.5 (SD± 7.5). The outcome of this study showed significant association between CPD and provision of LARC: OR: 7.47, at 95 % CL: CI: 1.82-30.65 and P-Value -0.003. Inadequate supplies and equipment were the major challenges in provision of LARC. Continuous Professional Development in Long Acting Reversible Contraception influenced service delivery in provision of contraceptive method. The study recommends improved provision of commodities and supplies for family planning, improved knowledge and skills on LARC, and targeted updates in family planning practices for effective service delivery.
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    Organizational Factors Influencing the Adoption of the District Health Information System 2 in Uasin Gishu Sub County Hospitals, Kenya
    (World Journal of Medical Education and Research, 2020) Ole Kuyo, Richard; Muiruri, L; Njuguna, Susan
    Sound and reliable information is the foundation of decision making across all health system building blocks that include: service delivery; health workforce; health information; medical products, vaccines and technology; financing; leadership and governance. This study is built on the health information system pillar. The aim of this study was to assess the use of District Health Information System data in decision making in Uasin Gishu Sub County Hospitals. The specific objectives were to determine the level of knowledge, organizational, technical and behavioral factors that influence the use of DHIS2 data in Uasin Gishu Sub County Hospitals. The study was conducted in Uasin Gishu Sub County Hospitals. The study employed both quantitative and qualitative approaches using cross-sectional research design. A questionnaire was used to collect quantitative data from 283 health workers who were selected randomly while 10 key informants were selected purposefully from this sample for in-depth interviews. The quantitative data was coded and analyzed using R Software for descriptive, bivariate and multivariate logistic regression. Thematic analysis was used to analyze qualitative data using Qualitative Data Analysis (QDA) software. Bivariate association between the independent variables and the dependent variable was assessed using Pearson‘s Chi Square test and fishers exact test where chi square assumptions were violated. Multivariate analysis was done using logistic regression to assess for predictors. A P value of 0.05 was considered as significant. The results of the quantitative data were presented in the form of graphs, tables and charts, while the results for qualitative data were presented in the form of themes. Approval to conduct the study was obtained from the KeMU Scientific Ethics Research Committee (SERC) and from National Commission for Science, Technology and Innovation (NACOSTI). Consent was sought from participants for the study. The study found that 68.4% of the participants reported good, very good or excellent competence levels in data management using DHIS2 while use of information in DHIS2 to inform policy and operational decision making was reported as good, very good, and excellent by only 37.3%, 18.9%, and 8.0% respectively. A half of the participants (50.0%) acknowledged that there are adequate finances to run DHIS2, the main champions promoting use of DHIS2, information for decision making in the County were county health records and information officers (56.2%). Moreover, 61.7% of the participants agreed or strongly agreed that age influences the way health workers adopt and use DHIS2 in the hospitals while 65.4% of the participants were dissatisfied with the IT support received from the Ministry of Health. Although 80.9% of the participants had log in credentials, only 24.2% had difficulty with logging into the DHIS2. Furthermore, 79.5% had low or moderate level of training in DHIS2 but 15.0% had never trained and this could be the reason why only a third of the participants had some confidence in handling a task using DHIS2. The study concludes that the level of knowledge regarding the use of DHIS2 information is fair across the six Sub County Hospitals in Uasin Gishu County but utilization of DHIS2 information by county health managers for decision making is low. It also concludes that the main funder of the DHIS2 system is the County Government while support from National Government is minimal, while age influences the way health workers adopt and use DHIS2 data in Uasin Gishu Sub County Hospitals. Lastly, the level of training on DHIS2 is generally low while utilization of information on DHIS2 in facilitating evidence-based decision making in the Sub County Hospitals range from moderate to low. Consequently, the study recommends that the County scales up utilization of DHIS2 information and generates policy measures to ensure utilization of DHIS2 information to facilitate decision making at the County.
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    Determinants of Hospital Emergency Preparedness in Machakos County Kenya: A Case of Machakos Level 5 and Kangundo Level 4 Hospitals
    (Kahare, M. M., Mwangi, E. & Njuguna, S. (2020). Determinants of Hospital Emergency Preparedness in Machakos County Kenya: A Case of Machakos Level 5 and Kangundo Level 4 HospitalsAcademic Journal of Health Systems and Reform (AJHSR), 2020-07-29) Kahare, Munanie Mercy; Mwangi, Eunice; Njuguna, Susan
    Emergency preparedness is emerging as a key security priority globally. Plans are needed, not only for responding to the impacts of events, but also to maintain business continuing while managing the crisis, and to guide recovery and reconstruction effectively. Machakos being along Nairobi-Mombasa highway recorded 27% increase of emergency cases in 2017, 39% 2018 in Machakos level 5. During these period deaths increased from 191 to 497 from 2016. 35% increase of referrals to other hospitals was recorded. In the face of these emergencies, the ability of affected facilities like Kangundo level 4 and Machakos Level 5 Hospital Kenya to provide care to the injured can quite literally make the difference between life and death. This study assessed the determinants of Hospital Emergency Preparedness in Kangundo level 4 and Machakos Level 5 Hospitals in Machakos County. The study adopted cross-sectional design and simple random sampling method. Whereby a sample size of 128 respondents was obtained using the Yamane 2008 formula; 49 respondents from Kangundo level 4 and 79 from Machakos level 5 hospital. Simple random sampling was applied to select respondents. Self-administered questionnaire as a data collection tool was applied. The questionnaire was developed based on the objectives and identified gaps from literature review. The finding reveals high understanding of the meaning of emergency preparedness (M = 4.29; SD = 0.67), with 94 (74%) of the respondent considering themselves prepared for emergency. The mean was 3.67; SD = 1.06. While 80 (64%) considered themselves key leadership figure in emergency preparedness. One hundred and eleven (88%) of the respondents agreed with the statement that training on emergency preparedness should be conducted quarterly with mean of M = 4.27; SD = 0.95. Respondent agreed that emergency tray is well equipped with various equipment for management of emergency with a mean of 3.51± 1.101 and that hospital has a drug supply system with drug suppliers with mean of 3.51± 1.108. Majority of the respondent agreed with the statements that financial allocation for emergencies preparedness should be increased (4.07± 1.195), and that the facility has transport and logistics support in case of any emergency (3.4 ± 1.231). The respondent further agreed with proposition that the hospital has policy in place for emergency preparedness 91 (72%) and the hospital has a clear chain of command system in case of any emergencies 83 (65%). There results showed strong and positiverelationship between commodity availability, financial resources, policies and emergency preparedness with coefficient of correlation of r=0.619, p<0.001, r=0.626, p<0.001, and r=0.702, p<0.001 respectively. The study found that policy formulation and implementation, commodities and finances significantly influenced emergency preparedness. The study variables under this study are important in determining emergency preparedness, and that emergency preparedness will work well if the variables in this study are taken into account. Therefore, hospital management need to build stable drug supply system with adequate drug suppliers. Resources should be allocated to purchase ultra-modern equipment. Additionally, clear mechanism of access of emergency commodities should be developed by hospital management and staff be made aware on it. There is need for staff participation in emergency policy formulation, guidelines, emergency plans, and lobbying for emergency preparedness. Addition institution needs to make emergency drills, safety inspections regular.
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    Influence of patients’ rights charter on health systems responsiveness in selected counties in Kenya: health care provider perspective
    (School of Nursing, Daystar University, Kenya, 2019-10-14) Njuguna, Susan; Tenambergen, W. Mwaura; Mapesa, Job
    Background: The role of health care providers in the implementation of responsiveness of health systems is unclear. Responsiveness of health systems is one of the goals set out by WHO in 2000. Effective leadership and governance of health systems incorporates all players involved in policy implementation. The objectives of the study were to establish how the health care provider’s awareness of patients’ rights charter influence health systems responsiveness and to establish how the health care provider practice of patients’ rights charter influence responsiveness of health systems in primary care settings. Methods: This was an exploratory cross section descriptive study design that used a psychometric semi- structured questionnaire to collect qualitative data that was analyzed quantitatively. Respondents were 62 purposively sampled health care providers from four, primary care health facilities. Key informant interviews from the four health facilities in-charges were carried out. Data was analyzed using SPSS vs 25 and themes. Results: Health care provider awareness of the content of patients’ rights charter (r=0.612*, p<0.001) and practice of patient’s right charter (r=0.610*, p<0.001) were statistically significant and influenced health systems responsiveness. Conclusions: Implementation of patients’ rights charter has an influence on responsiveness of health systems. Leadership and Governance of health systems requires a structured approach to implementation of policies that positively influence responsiveness of health systems. Supervision of health care providers for best practice can provide a basis for replication in other primary care facilities and lead to achieving responsiveness of health systems.
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    Providers’ and patients’ perceptions on task shifting as a model for improving uptake of Provider Initiated HIV - Testing and Counselling services in Kenya
    (School of Nursing, Daystar University, Kenya, 2016-07-07) Ikahu, Ann; Njuguna, Susan; Adoyo, Maureen; Gatimu, Joseph; Dr Otiso, Lilian
    The HIV policy in Kenya recommends routine HIV testing and counselling to all clients attending public health facilities to facilitate early diagnosis and enrolment to care and treatment. The World Health Organization (WHO) recommends task shifting in HIV testing and counselling to ease the burden on medical health workers. There is limited evidence on implementation of task shifting in a public health facilities in Kenya. The study aimed 1)to establish the perspectives of health care providers on taskshifting in the public health facilities in Kenya, and 2) assess client’s satisfaction with the services offered through the task shifting model. A mixed method approach was used; a cross sectional descriptive design was adopted with qualitative and quantitative approaches. Results indicated positive response among medical health providers with regard to the task shifting; 83% of the medical health providers described the relationship between medical and non-medical health providers as excellent. Levels of clients’ satisfaction improved significantly with introduction of task shifting from 50% to 70% respectively. There was also a correlation between the number of non-medical providers who were engaged and the annual uptake of the PITC services that increased from 122,442 in 2010 to 209,022 in 2014.Task shifting strategy in HIV testing and counselling was therefore found to be feasible for scaling-up of HIV testing and counselling in the public health facilities.
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    Influence of patients’ rights charter on health systems responsiveness in selected counties in Kenya: health care provider perspective
    (International Journal of Community Medicine and Public Health, 2019-11) Njuguna, Susan; Tenambergen, Wanja Mwaura; Mapesa, Job
    Background: The role of health care providers in the implementation of responsiveness of health systems is unclear. Responsiveness of health systems is one of the goals set out by WHO in 2000. Effective leadership and governance of health systems incorporates all players involved in policy implementation. The objectives of the study were to establish how the health care provider’s awareness of patients’ rights charter influence health systems responsiveness and to establish how the health care provider practice of patients’ rights charter influence responsiveness of health systems in primary care settings. Methods: This was an exploratory cross section descriptive study design that used a psychometric semi- structured questionnaire to collect qualitative data that was analyzed quantitatively. Respondents were 62 purposively sampled health care providers from four, primary care health facilities. Key informant interviews from the four health facilities in-charges were carried out. Data was analyzed using SPSS vs 25 and themes. Results: Health care provider awareness of the content of patients’ rights charter (r=0.612*, p<0.001) and practice of patient’s right charter (r=0.610*, p<0.001) were statistically significant and influenced health systems responsiveness. Conclusions: Implementation of patients’ rights charter has an influence on responsiveness of health systems. Leadership and Governance of health systems requires a structured approach to implementation of policies that positively influence responsiveness of health systems. Supervision of health care providers for best practice can provide a basis for replication in other primary care facilities and lead to achieving responsiveness of health systems.
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    Influence of Maternal Health Education Delivered Through Community Health Referral Project on Antenatal Care Attendance: A Focus on Mirihini and Midoina Communities of Kilifi County, Kenya
    (International Journal of Scientific and Research Publications, 2016-05) Mukoshi Janet Shibonje; Wanja Mwaura-Tenambergen; Njuguna Susan
    - Timely delivery of effective, safe, quality and personal services is a key pillar of health system strengthening. A Maternal, Newborn and Child Health (MNeCH) Project was initiated by the Ministry of Health and World Vision Kenya in Bamba Division, Kilifi County. The project’s goal was to strengthen health systems at the facility and community levels, including Antenatal Care (ANC). One of the strategies used by the project to achieve its goal was to strengthen community health referral system. The objectives of the study were 1) to determine whether providing maternal health education to pregnant women had any influence on ANC attendance in the intervention and control communities and 2) to determine whether issuing referral advice forms to patients has any influence on ANC attendance in the intervention and control communities. This study adopted the static group control design to assess the influence of community health referral practices on ANC attendance in Mirihini, the intervention community in Bamba and Midoina the control community. Primary data were sourced from 246 mothers of children aged below 2 years, parents of children aged 2 to 4 years, as well as Community Health Volunteers (CHVs). Quantitative analysis yielded descriptive statistics and cross-tabulations with Chi-square (χ2 ) tests. Qualitative data were transcribed, described and analyzed systematically to reveal themes and patterns. Maternal health education: In Mirihini, there was no significant association between providing maternal health education on the ideal number of ANC visits and women’s achievement of optimal ANC attendance (χ2 = 1.423, df=1 & a ρ-value = 0.233). In Midoina, a significant relationship between the two aspects was obtained (χ2 = 3.109, df = 1 & ρ-value = 0.078. Referral documentation: In Mirihini, issuing referral documents to pregnant women was significantly associated with women’s achievement of optimal ANC attendance (χ2 = 8.308, df =1 & ρ-value = 0.004). In Midoina, there was no significant association between two aspects (χ2 = 0.823, df = 1 & ρ-value = 0.185). The study recommends the need for: CHVs to deliver more information to support care-seeking behavior change; project officers to strengthen supervisory support to CHVs by engaging with MoH to provide reporting materials and ensure consistency of monthly review meetings.
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    Influence of patients’ rights charter on health systems responsiveness in selected counties in Kenya: health care provider perspective
    (International Journal of Community Medicine and Public Health, 2019-11) Njuguna Susan; Wanja Mwaura-Tenambergen; Mapesa Job
    Background: The role of health care providers in the implementation of responsiveness of health systems is unclear. Responsiveness of health systems is one of the goals set out by WHO in 2000. Effective leadership and governance of health systems incorporates all players involved in policy implementation. The objectives of the study were to establish how the health care provider’s awareness of patients’ rights charter influence health systems responsiveness and to establish how the health care provider practice of patients’ rights charter influence responsiveness of health systems in primary care settings. Methods: This was an exploratory cross section descriptive study design that used a psychometric semi- structured questionnaire to collect qualitative data that was analyzed quantitatively. Respondents were 62 purposively sampled health care providers from four, primary care health facilities. Key informant interviews from the four health facilities in-charges were carried out. Data was analyzed using SPSS vs 25 and themes. Results: Health care provider awareness of the content of patients’ rights charter (r=0.612*, p<0.001) and practice of patient’s right charter (r=0.610*, p<0.001) were statistically significant and influenced health systems responsiveness. Conclusions: Implementation of patients’ rights charter has an influence on responsiveness of health systems. Leadership and Governance of health systems requires a structured approach to implementation of policies that positively influence responsiveness of health systems. Supervision of health care providers for best practice can provide a basis for replication in other primary care facilities and lead to achieving responsiveness of health systems
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    Providers’ and patients’ perceptions on task shifting as a model for improving uptake of Provider Initiated HIV - Testing and Counselling services in Kenya
    (International Journal of Scientific and Research Publications, 2016-07-07) Ikahu, Ann; Njuguna, Susan; Adoyo, Maureen; Gatimu, Joseph; Otiso, Dr Lilian
    The HIV policy in Kenya recommends routine HIV testing and counselling to all clients attending public health facilities to facilitate early diagnosis and enrolment to care and treatment. The World Health Organization (WHO) recommends task shifting in HIV testing and counselling to ease the burden on medical health workers. There is limited evidence on implementation of task shifting in a public health facilities in Kenya. The study aimed 1)to establish the perspectives of health care providers on taskshifting in the public health facilities in Kenya, and 2) assess client’s satisfaction with the services offered through the task shifting model. A mixed method approach was used; a cross sectional descriptive design was adopted with qualitative and quantitative approaches. Results indicated positive response among medical health providers with regard to the task shifting; 83% of the medical health providers described the relationship between medical and non-medical health providers as excellent. Levels of clients’ satisfaction improved significantly with introduction of task shifting from 50% to 70% respectively. There was also a correlation between the number of non-medical providers who were engaged and the annual uptake of the PITC services that increased from 122,442 in 2010 to 209,022 in 2014.Task shifting strategy in HIV testing and counselling was therefore found to be feasible for scaling-up of HIV testing and counselling in the public health facilities.
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    Technical Factors Affecting Electronic Medical Record System Information Use: A Case of Kakamega County Referral Hospital Outpatient Department
    (IOSR Journal of Nursing and Health Science, 2018-07) Nandikove, Peter; Tenambergen, Dr. Wanja Mwaura; Njuguna, Ms. Susan
    The recent worldwide focus on healthcare quality improvement, cost containment and enhanced patient experience has led to increased need for adoption of Electronic Medical Record systems (EMR) ( Waithera L, Muhia J, Songole R , 2017). This technology agitates for paperless transactions health care and would significantly reduce clinician workload and medical errors while saving the institution major expenses. Kenya is globally acclaimed as a leader for its Information Communication Telecommunications (ICT) innovations such as M-PESA (Graham, 2010). Many studies have been done in other countries to study the factors influencing adoption and usage of EMR technology, but a small number of studies exist in Kenyan situation (Ministry of Health, 2010). This study sought to examine why the application of EMR technology has not kept pace with its demand. This study therefore sought to answer two key research questions derived from the study objectives which include the influence of network infrastructure, EMR system design and staff ICT skill levels on information use of electronic medical records technology in a public health institution in Kakamega County The study was guided by technology acceptance model as its theoretical framework (Seok Kim, Kee-Hyuck Lee, Hee Hwang and Sooyoung Yoo, 2016). The study adopted a cross-sectional survey design with a target population of 80 respondents working in Kakamega county referral hospital. A descriptive survey research design was used. Stratified random sampling was embraced to divide the population into homogeneous subgroups as per the professional cadres then did simple random sampling in proportion to their number in the population. A questionnaire with a 5-point Likert scale was constructed and used. Data was collected using structured questionnaires and analyzed using SPSS version 23. Both content and construct validity were used to ensure validity of the research instrument’s while reliability was determined by using the Cronbach-Alpha Coefficient. Pilot testing to pre-test and validate the research instruments was done prior to the main study. One of the two hypothesis was rejected, there seemed to exist no significant differences among professionals with regards to EMR information use F (9,62) = 1.745, p > 0.05, one hypothesis was accepted, there seemed to exist a significant relationship between technical factors and EMR information use (r = 0.583, p <0.05). The study recommends that health facilities should increase infrastructure and resources that support EMR use, employees should be supported for further training on EMR operation and suppliers should regularly support and train health staff on how to use EMR effectively. The study results may be useful to hospitals as they gear towards integrating all their process by using technology.
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    Factors influencing the job satisfaction of nurses working in obstetric units in public hospitals in Kenya
    (Journal of Nursing Education and Practice, 2018-07) Kahiga, Keziah Wakonyo
    Introduction: The literature demonstrates that little research has been conducted to explore job satisfaction among nurses working in obstetric units in Kenya. The perception of job satisfaction by nurses is influenced by the environment in which they work. Methods: A cross-sectional survey design was used to carry out the study. The study tools included the work quality index (WQI) and the demographic data questionnaires. Convenience sampling method was. Data were analyzed using the SPSS version 20. The items in the WQI were organized into six subscales and Cronbach’s alpha was calculated to obtain the reliability coefficient of each subscale. An independent t-test was used to compare the subscales scores for the male and female participants. ANOVA was conducted to compare the level of satisfaction with the six subscales and the participants’ characteristics. Pearson’s product-moment correlation coefficient was calculated to assess if there was any relationships, the magnitude and the direction of the relationship between the six subscales. Results: Nurses are most satisfied with the perception that the work associated with their position provides them with the opportunity to be of service to others and least satisfied with receiving enough time to complete indirect patient care tasks. There are no significant differences in the overall level of satisfaction between males and females though males are more satisfied with autonomy of practice and professional role enactment. The six subscales strongly and positively correlate with one another. Conclusions: Nurses working in the obstetric units are relatively dissatisfied with most of the aspects of the work environment. The more educated nurses are less satisfied than less educated nurses. Since all aspects of job satisfaction are interrelated, emphasis should be put on each of them so as to create a satisfying work environment for nurses working in obstetric units.
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    Individual Attributes Influencing Cervical Cancer Screening Services in Selected Health Facilities in Machakos County
    (Journal of Cancer Treatment and Research, 2018-01) Akunga, Daniel Nyagetiria; Wanyoro, Anthony; Wanyoro, Anthony Karanja
    In Kenya, 51.2% of estimated women population of 11 million aged 15 years and older are at risk of developing cervical cancer. Research shows that screening a woman even once between the ages of 35 and 40 years reduces her lifetime risk of cervical cancer by 25–36%. However, the effective cervical cancer screening in developing countries is as low as 18.5%. Low levels of utilization of Cervical Cancer Screening Services (CCSS) among health care workers have been documented. This study sought to determine the utilization of cervical cancer screening services by healthcare workers (HCWs) in selected health facilities in Machakos County. It was also thought imperative to determine individual HCW attributes influencing utilization of cervical cancer screening services in selected health care facilities in the county. The study adopted a descriptive cross-sectional study design involving 271 female health workers drawn from all the level 4 and level 5 facilities within the county. Respondents were stratified according to level of facility and according to their cadres. Data was collected via self-administered questionnaires and a facility assessment tool. Data analysis used SPSS version 21. Association was subjected to binary logistic regression. Only 25% of HCWs had utilized cervical cancer screening services. HCWs who had certificate (OR = 0.05, p-value < 0.01), diploma (OR = 0.04, p-value < 0.01) and degrees (OR = 0.09, p-value = 0.01) were less likely to utilize CCSS as compared to HWCs who had attained graduate studies or higher. Also health workers aged 30 years and below (OR = 0.12, p-value = 0.01) and those aged between 31 and 40 years (OR = 0.30, p-value = 0.05) were less likely to utilize CCSS as compared to healthcare workers who were aged more than 50 years. The study recommends establishment of tailor-made sensitization programs on young female health care worker aimed at increasing their uptake of CCSS services among these group.
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    Influence of Maternal Health Education Delivered Through Community Health Referral Project on Antenatal Care Attendance: A Focus on Mirihini and Midoina Communities of Kilifi County, Kenya
    (International Journal of Scientific and Research Publications, 2016-05) Shibonje, Janet Mukoshi; Wanja, Mwaura-Tenambergen; Njuguna, Susan
    Timely delivery of effective, safe, quality and personal services is a key pillar of health system strengthening. A Maternal, Newborn and Child Health (MNeCH) Project was initiated by the Ministry of Health and World Vision Kenya in Bamba Division, Kilifi County. The project’s goal was to strengthen health systems at the facility and community levels, including Antenatal Care (ANC). One of the strategies used by the project to achieve its goal was to strengthen community health referral system. The objectives of the study were 1) to determine whether providing maternal health education to pregnant women had any influence on ANC attendance in the intervention and control communities and 2) to determine whether issuing referral advice forms to patients has any influence on ANC attendance in the intervention and control communities. This study adopted the static group control design to assess the influence of community health referral practices on ANC attendance in Mirihini, the intervention community in Bamba and Midoina the control community. Primary data were sourced from 246 mothers of children aged below 2 years, parents of children aged 2 to 4 years, as well as Community Health Volunteers (CHVs). Quantitative analysis yielded descriptive statistics and cross-tabulations with Chi-square (χ2) tests. Qualitative data were transcribed, described and analyzed systematically to reveal themes and patterns. Maternal health education: In Mirihini, there was no significant association between providing maternal health education on the ideal number of ANC visits and women’s achievement of optimal ANC attendance (χ2 = 1.423, df=1 & a ρ-value = 0.233). In Midoina, a significant relationship between the two aspects was obtained (χ2 = 3.109, df = 1 & ρ-value = 0.078. Referral documentation: In Mirihini, issuing referral documents to pregnant women was significantly associated with women’s achievement of optimal ANC attendance (χ2 = 8.308, df =1 & ρ-value = 0.004). In Midoina, there was no significant association between two aspects (χ2 = 0.823, df = 1 & ρ-value = 0.185). The study recommends the need for: CHVs to deliver more information to support care-seeking behavior change; project officers to strengthen supervisory support to CHVs by engaging with MoH to provide reporting materials and ensure consistency of monthly review meetings.
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    Institutional Factors that Influence the Implementation of Policy on Management of Childhood Illnesses in Bomet County
    (Journal of Medicine, Nursing &Public Health, 2018-09) Chalulot, Geoffrey Kipkorir; Njuguna, Susan; Ndirangu, Eunice
    The study aimed at establishing the institutional factors that influenced the implementation of policy on management of childhood illnesses in Bomet County. A descriptive cross sectional study design with both quantitative and qualitative approaches was used for data collection. The study population was a total of 279 health workers in Bomet County Hospital and Tenwek Hospital. A sample of 164 was arrived at which was selected using stratified and simple random sampling technique. The quantitative data was analyzed using Statistical Package for Social Sciences (SPSS version 24). The study established a significant positive relationship between institutional factors of enhancing compliance to policy procedures on implementation of policy on management of childhood illnesses at 0.824, p˃0.01. The study recommends that health institutions in Bomet County facilitate the dissemination and compliance to the implementation of the policy on management of childhood illnesses.
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    Organizational Factors Influencing the Adoption of the District Health Information System 2 in Uasin Gishu County, Kenya
    (International Journal of Medical Research & Health Sciences, 2018-10) Kuyo, Richard Ole; Muiruri, Lillian; Njuguna, Susan
    Background: Sound and reliable information is the foundation of decision-making across all health system building blocks that include service delivery, health workforce, health information, medical products, vaccines and technology, financing, leadership, and governance. This study is built on health information system pillar. Objectives: To determine the organizational factors influencing the use of DHIS2 in Uasin Gishu County. Methods: Study was conducted in Uasin Gishu-Sub County health facilities. A questionnaire was used to collect quantitative data from 283 health workers selected randomly while 10 key informants were selected purposively from this sample for indepth interviews. Results: Total 50.0% of the participants acknowledged that finances were adequate to run DHIS2. The main champions of DHIS2 used in decision-making were the county health records and information officers (56.2%) and the sub-county health records and information officers (39.0%). Up to 78.5% agreed or strongly agreed that organizational hierarchy influenced DHIS2 use and 80.8% agreed or strongly agreed that there was improved staff performance due to DHIS2 utilization. On the other hand, the major challenges experienced in the use of DHIS2 for evidenced-based decision-making were the lack of management support (34.3%), poor skills among the users (48.6%), lack of adequate computers (36.7%), unreliable internet connectivity (47.1%), lack of power backup (27.6%), and resistance to change (21.0%). Conclusion: The main funding for the DHIS2 system comes from the County government while health records and information officers are the main promoters of DHIS2 use. The main determinants of DHIS2 used are the availability of computers, network and internet services, trained staff and legislation. The main challenges inhibiting DHIS2 use are lack of management support, poor skills among the users, lack of adequate computers, unreliable internet connectivity, lack of power backup and resistance to change.
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    Technical Factors Affecting Electronic Medical Record System Information Use: A Case of Kakamega County Referral Hospital Outpatient Department
    (IOSR Journal of Nursing and Health Science (IOSR-JNHS), 2018-04) Nandikove, Peter; Mwaura-Tenambergen, Wanja; Njuguna, Susan
    The recent worldwide focus on healthcare quality improvement, cost containment and enhanced patient experience has led to increased need for adoption of Electronic Medical Record systems (EMR) ( Waithera L, Muhia J, Songole R , 2017). This technology agitates for paperless transactions health care and would significantly reduce clinician workload and medical errors while saving the institution major expenses. Kenya is globally acclaimed as a leader for its Information Communication Telecommunications (ICT) innovations such as M-PESA (Graham, 2010). Many studies have been done in other countries to study the factors influencing adoption and usage of EMR technology, but a small number of studies exist in Kenyan situation (Ministry of Health, 2010). This study sought to examine why the application of EMR technology has not kept pace with its demand. This study therefore sought to answer two key research questions derived from the study objectives which include the influence of network infrastructure, EMR system design and staff ICT skill levels on information use of electronic medical records technology in a public health institution in Kakamega County The study was guided by technology acceptance model as its theoretical framework (Seok Kim, Kee-Hyuck Lee, Hee Hwang and Sooyoung Yoo, 2016). The study adopted a cross-sectional survey design with a target population of 80 respondents working in Kakamega county referral hospital. A descriptive survey research design was used. Stratified random sampling was embraced to divide the population into homogeneous subgroups as per the professional cadres then did simple random sampling in proportion to their number in the population. A questionnaire with a 5-point Likert scale was constructed and used. Data was collected using structured questionnaires and analyzed using SPSS version 23. Both content and construct validity were used to ensure validity of the research instrument’s while reliability was determined by using the Cronbach-Alpha Coefficient. Pilot testing to pre-test and validate the research instruments was done prior to the main study. One of the two hypothesis was rejected, there seemed to exist no significant differences among professionals with regards to EMR information use F (9,62) = 1.745, p > 0.05, one hypothesis was accepted, there seemed to exist a significant relationship between technical factors and EMR information use (r = 0.583, p <0.05). The study recommends that health facilities should increase infrastructure and resources that support EMR use, employees should be supported for further training on EMR operation and suppliers should regularly support and train health staff on how to use EMR effectively. The study results may be useful to hospitals as they gear towards integrating all their process by using technology.
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    The Performance of Trained Clinical Officers in Reproductive Health Service Delivery through Task Shifting In Kenya Opportunities and Challenges
    (Journal of Health, Medicine and Nursing, 2018) Kishasha, K. Meshack; Oluoch, Musa; Njuguna, Susan
    Purpose:The purpose of this study was to determine the performance, challenges and the opprtunities in task shifting for the cadre. Methods:This was a cross-sectional study design. Purposive snowballing technique was employed. One hudred and fifty Clinical Officers were targed for study. A sample of 45 was captured for study calculated as 30% of the target population. Structured questionnaires were administered and triangulated by focus group discussions and key informant interviews. Cross tabulation and chi-square tests were used to compare performance in various reproductive health procedures. Analysis of Variance was employed to test for significance in differences on various responses. Data from focus group discussion was transcribed and analyzed by content analysis. Analysis of the Quantitative data collected was done using SPSS (Version 22). Data collected was analysed using tables, graphs and descriptive statistics Results:The study found out that motivation builds a better, more satisfied and better performing workforce as evidenced by response of further training There was significant statistical evidence of competence in performing task shifted obstetrical and gyneacological procedures at p-value 0.05, computed chi-square value of 7.134 against the critical value of 9.488. Analysis of Variance with a computed value of 95.7, p-value 0.05 and critical Value of 2.45 indicated that responses from respondence differed significantly while response for anew act of parliament for the practice of new skills was 100%. Unique Contribution to Theory, Practice and Policy: The study recommeded for the development of task shifting policy framework the, strengthening of health systems workforce through task shifting for the cadre and sensitization of workforce at health facilities on the concept of task shifting.
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    Utilization of day surgery services at Upper hill Medical Centre and the Karen hospital in Nairobi: the influence of medical providers, cost and patient awareness
    (The Pan African Medical Journal, 2015-09) Odhiambo, Mildred Adhiambo; Njuguna, Susan; Waireri-Onyango, Rachel; Mulimba, Josephat; Ngugi, Peter Mungai
    Introduction: Health systems face challenges of improving access to health services due to rising health care costs. Innovative services such as day surgery would improve service delivery. Day surgery is a concept where patients are admitted for surgical procedures and discharged the same day. Though used widely in developed countries due to its advantages, utilization in developing countries has been low. This study sought to establish how utilization of day surgery services was influenced by medical providers, patient awareness and cost among other factors. Methods: The study design was cross sectional with self administered questionnaires used to collect data. Data analysis was done by using statistical package for social science (SPSS) and presented as frequencies, percentages and Spearman's correlation to establish relationship among variables. Results: Medical providers included doctors, their employees and medical insurance providers. Most doctors were aware of day surgery services but their frequency of utilization was low. Furthermore, medical insurance providers approved only half of the requests for day surgery. Doctors' employees were aware of the services and most of them would recommend it to patients. Although, most patients were not aware of day surgery services those who were aware would prefer day surgery to in patient. Moreover, doctors and medical insurance providers considered day surgery to be cheaper than in patient. Conclusion: The study showed that medical providers and patient awareness had influence over day surgery utilization, though, cost alone did not influence day surgery utilization but as a combination with other factors.
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    Implementation of Kenya quality guidelines for improved health services in Kenya: A case of Kakamega County
    (International Journal of Scientific and Research Publications, 2016-04) Owiti, Sarah Winnie; Njuguna, Roseline Susan
    initiated across all health facilities to guide the implementation of quality standards. The use of guidelines in health management system describes the measure that can improve performance in health service delivery. Despite having guidelines there are disparities in the quality of services delivered in health facilities. The study focused on implementation of quality guidelines for improved health services. The objectives of the study were to establish the management practices used in the implementation process of the Kenya Quality Model for health and to explore the Human resources factors that influenced the implementation process of the Kenya quality model of health.A cross-sectional study involving 110 clinical managers in six public health facilities in Kakamega County, Kenya was carried out.Public health facilitieswere selected using random sampling, Clinical Managers were sampled using stratified and proportionate sampling. Quantitative data analysis yielded descriptive statistics and Chi-square (χ2) tests.The management practices used to implement guidelines was methods of quality improvement with mean 3.8, planning 3.3, continuous quality improvement 3 P-value was 0.04 indicating a significant relationship with improved quality of health services. The human resource for health factors that affected implementation of guidelines were awareness of guideline contents with a mean score 3.7 and motivation 3 and a p-value of 0.03 which indicated a relationship between human resource for health and improved quality of health services. The study recommends formation of quality improvement teams that can be responsible for the implementation process and development of quality monitoring tools. It further recommends Strategies to be put in place to increase the number of health human resources and train all health managers on the quality guidelines to prepare them for the implementation process.
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    Implementation of Hospital Management information Systems on service delivery at Moi Teaching and Referral Hospital
    (Cheruiyot, B., Muiruri, L. & Njuguna, R. S. (2019). Implementation of Hospital Management information Systems on service delivery at Moi Teaching and Referral Hospital.World Journal of Medical Education and Research: Volume 20, Issue 1, 2019) Cheruiyot, B; Muiruri, L; Njuguna, R. S
    Hospital Management Information Systems (HMIS) has the potential to improve the quality of services delivered, as well as the efficiency and effectiveness of healthcare providers through the integration of various hospital functional units. However, the benefits of this implementation in service delivery have not been adequately addressed. This study sought to appraise the impact of the implementation of HMIS, on service delivery in Moi Teaching and Referral Hospital, (MTRH). The objectives of the study were: to examine the level of implementation of HMIS in MTRH; to establish the strategies motivating implementation and utilisation of HMIS, to assess the benefits that have been realized in utilizing Hospital Management Information Systems, and to assess the effect of HMIS on service delivery in MTRH. Cross sectional descriptive research design was utilised in the study; the sample size formula proposed by Cooper and Schildler formula was used to obtain 240 respondents from a target population of 587 users of HMIS. A structured closed-ended questionnaire and interviews were administered. Quantitative data was obtained, coded using SPSS v.21. Data was analysed using descriptive statistics, i.e. mean and standard deviations and inferential statistics i.e. Pearson Correlation Analysis and Multiple Regression Analysis. Of the 240 questionnaires distributed, 192 were filled and returned, with most respondents familiar with HMIS. The respondents moderately agreed that the implementation of HMIS was done well and as per expectations. The Hospital Records module had the highest implementation level, while Consulting Doctor module scored the lowest. On the level of utilisation of HMIS, the result indicate that the mean values were above average on a five point Likert scale. The Further Records module had the highest implementation level, with the majority agreeing that the module had been adequately utilised. Conversely, the Consulting Doctor module posted the lowest utilisation level. On the strategies motivating the utilisation of HMIS results indicate that the strategy of allaying perceptions and fears among staff on the use of HMIS is the one mostly deployed by the hospital in order to improve the level of Utilisation of HMIS. Results indicated that the anticipated benefits of HMIS were all above average. The results of the regression analysis suggested that HMIS implementation (β=.215, p˂0.05), HMIS Utilisation (β= ..697, p˂0.05), motivation strategy (β= .193, p˂0.05), and HMIS benefits (β= .045, p˂0.05) had a positive significant effect on service delivery. Therefore, the null hypothesis is rejected. The value of the F-statistic is (F=172.917, p˂0.05) is robust. The coefficient of determination value of R2= .787 means that 78.7% of the variation in service delivery at the hospital can be explained by HMIS. The study recommends that a policy be drafted to entrench HMIS implementation and utilisation in the country.