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Item Correction to: Non-Communicable Disease Prevention Policy Process in Five African Countries(BMC Public Health, 2018) Juma, Pamela A.; Mohamed, Shukri F.; Matanje, Mwagomba Beatrice L.; Ndinda, Catherine; Mapa-tassou, Clarisse; Oluwasanu, Mojisola; Oladepo, Oladimeji; Abiona, Opeyemi; Nkhata, Misheck J.; Wisdom, Jennifer P.; Mbanya, Jean-ClaudeAfter publication of the article [1], it was noticed that the title has erroneously included ‘authors’ in the end. The correct title should be as follows which herewith has been corrected in this erratum: Non-communicable disease prevention policy process in five African countries We apologize for the inconvenience caused.Item La recherche pour la santé à Madagascar: état des lieux, défis et perspectives(Pan African Medical Journal, 2021) Juma, Pamela A.; Sobngwi, Joelle; Marie, Jones Catherine; Wenham, Clare; Ratsimbason, Michel; Ratsimbazafy, Marie-Rolland; Andriamizarasoa, Fidelis Adolphe; Mijumbi-Deve, Rhona; Parkhurst, JustinThe evolution and contemporary challenges of health research (HR) in Madagascar are poorly documented. We aim to gain insights on the factors that shape Madagascar's National Health Research System (NHRS) to better understand their influence. We conducted a qualitative case study, which included a documentary review and semistructured interviews with 38 key informants. We carried out a thematic analysis and used the WHO/AFRO NHRS Barometer to structure the presentation of the results. There is no legislative framework to support HR activities and institutions. There is, however, a policy document outlining national priorities for HS. Human resources for HR are insufficient, due to challenges in training and retaining researchers. International collaboration is almost the only source of HR funding. Collaborations contribute to developing human and institutional capacity, but they are not always aligned with research carried out locally and the country's priority health needs. Incomplete efforts to improve regulation and low public investment in research training and research implementation reflect an insufficient commitment to HR by the government. Negotiating equitable international partnerships, the availability of public funding, and aligning HR with national health priorities would constitute a solid basis for the development of the NHRS in MadagascarItem Non-Communicable Diseases and Urbanization in African Cities: A Narrative Review.(IntechOpen, 2019) Juma, Pamela A.; Juma, Kenneth; Shumba, Contance; Otieno, Peter O.; Asiki, GershimRapid urbanization in Africa has been linked to the growing burden of noncommunicable diseases (NCDs). Urbanization processes have amplified lifestyle risk factors for NCDs (including unhealthy diets, tobacco use, harmful alcohol intake, andphysical inactivity), especially among individuals of low and middle social economic status. Nevertheless, African countries are not keeping pace with the ever increasing need for population-level interventions such as health promotion through education, screening, diagnosis, and treatment, as well as structural measures such as policies and legislation to prevent and control the upstream factors driving the NCD epidemic. This chapter highlights the NCD burden in urban Africa, along with the social determinants and existing interventions against NCDs. The chapter concludes by offering insights into policy and legislative opportunities and recommends stronger efforts to apply multisectoral and intersectoral approaches in policy formulation, implementation, and monitoring at multiple levels to address the NCD epidemic in African citiesItem Introduction: Non-Communicable Disease Prevention Policies in Six African Countries.(BMC Public Health, 2018) Juma, Pamela A.; Wisdom, JenniferNon-communicable disease (NCD) are increasing in lowand mid income countries (LMICs). The greatest burdenof NCDs is from cardiovascular diseases, diabetes, cancers and chronic respiratory illnesses. These four diseases/disease groups share a set of four risk factors: tobacco use, unhealthy diets, harmful alcohol consumption and physical inactivity. Developing NCD prevention policies that target the major risk factors is critical in LMICs that have weak health care systems and policies as well as inadequate resource capacity to implement existing health interventions. Following global commitments to address the increasing burden of NCDs, African countries have been developing policies and programs to address NCDs.Item 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, Charlesntroduction 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.Item People are Creating Policy up There, they are not Coming Down': Nurses' Views on The Expansion of Routine Provider-Initiated HIV Testing and Counselling in Nairobi, Kenya.(eCommons, 2009) Ndirangu, Wambui Eunice; Evans, CatrinIn this report, we present selected findings from an exploratory piece of qualitative research on HIV testing that was undertaken in 2007-2008 with nurses in Nairobi, Kenya. At the same time, we share our own story of how this research came about and how NHIVNA research funding was able to lay the foundations for a larger study that will hopefully give voice to patients and HIV nurses in Nairobi and will develop HIV nursing research capacity in the country.Item The Importance of HIV Specialist Services for African Women Living with HIV in Nottingham: Results of a Qualitative Study(eCommons, 2009) Ndirangu, Wambui Eunice; Evans, Catrinhis article reports the results of a qualitative study of the experiences of African women living with HIV in Nottingham, UK. Globally, sub-Saharan Africa is the region most severely affected by the HIV pandemic [1]. This pattern is also reflected in the UK where African migrants make up 27% of those diagnosed with HIV despite the fact that they constitute less than 1% of the population [2–4]. Healthcare staff play a central role in meeting the prevention and care needs of people living with HIV/AIDS [5]. In contexts of increasing migration, health workers are called upon to recognise the diverse cultural, social, economic and political histories of their patients, and to understand how these interface with their current living situation, including their HIV-related health and treatment needs [6]. Relatively little research has been conducted to investigate the health experiences of migrant populations living with HIV in the UK, or on their patterns of access to, and utilisation of, HIV treatment and care [7]. Findings from the available, but limited, studies indicate that African migrants tend to present later than other population groups for HIV testing and treatment [8]. This is attributed to a number of obstacles to seeking or accessing care, including individual/community characteristics (such as AIDS-associated stigma, lack of perceived risk and denial), and factors associated with service and welfare provision in the host country – such as perceived discrimination, language and cultural differences, financial constraints and uncertain legal/immigration status [8–10]. Migrant African communities in the UK have traditionally congregated in London, where a large range of HIV specialist medical and communitybased services are available, and where material and social resources can be accessed through existing social networks. It is estimated that 81% of HIV-infected Africans live in London [4]. This situation is slowly changing however, attributed in part to the Government’s policy of ‘dispersal’ whereby, since 1999, asylum seekers have been ‘dispersed’ to locations across the country. Questions have been raised as to whether HIV services outside the capital are able to provide specialist care that is appropriate and accessible for African migrant groups. Very little research has been done, however, to explore the HIV NURSING • SPRING 2009 experiences of HIV-positive Africans living outside London [10–12].Item Training institutional Factors Influencing Curriculum Implementation on Emergency Obstetrics and Neonatal Care for Faith-Based Diploma Nursing Students in Meru and Tharakanithi County(EdinBurg Peer Reviewed Journals and Books Publishers, 2024) Kivuva, Mirriam Muendi; Njuguna, Susan; Odhiambo, Roselyne A.Purpose: Maternal and newborn healthcare is fundamental to achieving positive health outcomes in a country. The implementation of the curriculum on emergency obstetrics and neonatal care (EmONC) plays a crucial role in preparing skilled birth attendants. This study aimed to assess training institutional factors influencing curriculum implementation on emergency obstetrics and neonatal care for faith-based diploma nursing students in Meru and Tharakanithi County. Methodology: A total of n=216 (84.7%) responses (second-year and third-year diploma in nursing programs students) were received out of a target population of N=255 (100%) respondents while a total of n=10 (90.9%) responses (nurse educators) were received out of a target population of N=11(100%) respondents. Data was collected through an onlineadministered questionnaire to nursing students and nurse educators. In addition, key informant interviews were used to collect qualitative data from nurse educators. Data was cleaned coded, and entered into the scientific package for social sciences (SPSS) software vs. 27. Descriptive and inferential statistics were used to interpret findings. Results: Bivariate correlation, showed a strong positive correlation coefficient of 0.898 and 0.640 for nurse educators and students respectively, and are all statistically significant (p<0.05). Conclusion: This study concluded that training institutional factors positively influence implementation of curriculum on EmONC in Meru and Tharakanithi County. Based on the findings of this study the study recommends several actions to improve curriculum implementation in EmONC. The college administration needs to avail necessary resources in the classroom and skill lab to facilitate learning in EmONC and make arrangementsfor students to get preservice EmONC if possible before graduation.Item Policy Factors Associated with Nurse Managers' Preparedness in Mentorship Role at Kenyatta National Hospital, Kenya.(Journal of Medicine, Nursing and Public Health, 2024) Thirindi, Mwasi Julita; Njuguna, Susan; Mulu, MosesPurpose: Mentorship plays a crucial role in the professional development of nurses, emphasizing a patient-centric approach to nursing care. However, there exists a lack of clarity regarding the preparatory measures for nurses in charge who, at the same time, are ward managers, posing challenges in effectively conveying their multifaceted responsibilities. This research aimed to assess policy factors associated with the preparedness of nurse managers for mentorship roles at Kenyatta National Hospital. Methodology: The study employed a descriptive cross-sectional design, utilizing a simple random sampling strategy to engage 88 respondents. Data collection involved a carefully designed self-administered questionnaire comprising a blend of open-ended and closed-ended inquiries to ensure a comprehensive exploration. Data analysis was done using descriptive statistics and correlation analysis. Results: Key findings revealed that 42% of participants were moderately prepared for mentorship roles, while 58% were inadequately prepared due to time constraints, workload, and lack of management support. Correlation results revealed that nurses’ level of involvement in policymaking was significant at r(87)= .281, p=.008). The nurse managers are best placed to offer mentorship to other nurses, especially to junior nurses who have joined the profession. Conclusion and Recommendations: The study concluded that while nurses were actively involved in policy-making processes, their contributions were often disregarded during policy development, leading to a lack of clear guidelines for mentorship programs despite existing standard operating procedures within nurse manager units. It is imperative for the hospital management to actively involve all stakeholders, including nurse Managers in the policy development process. Considering the input of nurse managers alongside other stakeholders will ensure that policies regarding mentorship programs are comprehensive and inclusive.Item 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.Item 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 EunicePurpose: 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 frameworkItem 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 EuniceAims 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‐resourcesettingsItem Stakeholders’ Expectations of Graduates of a WorkStudy Nursing Upskilling Programme in East Africa.(Africa Journal of Nursing and Midwifery, 2020) Brownie, Sharon; Kambo, Isabel; Maina, Gatimu Samwel; Mwizerwa, Joseph; Ndirangu, Wambui EuniceSound alignment of stakeholders’ expectations and graduate ability forms the reputational hallmark of a university’s education programmes. However, little is currently known about stakeholders’ expectations of graduates of work-study nursing upskilling programmes in low- and middle-income settings. Information is needed to ensure the quality and adequacy of curricula in such settings. The main aim of the current study was to explore the nursing stakeholders’ expectations of graduates of work-study nursing upskilling programmes. An exploratory qualitative study was conducted between March and October 2016 in three low- and middle-income countries in East Africa. Forty-two representatives of nursing employers, regulators and professional associations (PAs) participated. The data was collected during 27 key informant interviews (KIIs) and three focus group discussions (FGDs) using a pretested interview guide. Content analysis of the data was completed. Consolidated criteria for reporting of qualitative research guidelines were used as the standard for collecting data and reporting results. Stakeholders reported their expectations of a clinically and professionally competent nurse (an “all-round” graduate) with nursing management and leadership skills that facilitated sound clinical judgement and decision making and a high level of professionalism. The study highlighted nursing stakeholders’ expectations of nursing graduates who had completed a work-study upskilling programme. These expectations should inform curriculum planning and development, and highlight the need for a strong focus on clinical competence, leadership, critical thinking and professionalism in nursing upskilling programmes.Item Evaluation of The Feasibility of a Midwifery Educator Continuous Professional Development (CPD) Programme in Kenya and Nigeria: A Mixed Methods Study.(BMC Medical Education, 2024) Shikuku, Duncan N.; Mohammed, Hauwa; Mwanzia, Lydia; Ladur, Alice Norah; Nandikove, Peter; Uyara, Alphonce; Waigwe, Catherine; Nyaga, Lucy; Bashir, Issak; Ndirangu, Wambui Eunice; Bedwell, Carol; Bar-Zeev, Sarah; Ameh, CharlesBackground Midwifery education is under-invested in developing countries with limited opportunities for midwifery educators to improve/maintain their core professional competencies. To improve the quality of midwifery education and capacity for educators to update their competencies, a blended midwifery educator-specific continuous professional development (CPD) programme was designed with key stakeholders. This study evaluated the feasibility of this programme in Kenya and Nigeria. Methods This was a mixed methods intervention study using a concurrent nested design. 120 randomly selected midwifery educators from 81 pre-service training institutions were recruited. Educators completed four self-directed online learning (SDL) modules and three-day practical training of the blended CPD programme on teaching methods (theory and clinical skills), assessments, effective feedback and digital innovations in teaching and learning. Pre- and post-training knowledge using multiple choice questions in SDL; confidence (on a 0–4 Likert scale) and practical skills in preparing a teaching a plan and microteaching (against a checklist) were measured. Differences in knowledge, confidence and skills were analysed. Participants’ reaction to the programme (relevance and satisfaction assessed on a 0–4 Likert scale, what they liked and challenges) were collected. Key informant interviews with nursing and midwifery councils and institutions’ managers were conducted. Thematic framework analysis was conducted for qualitative data. Results 116 (96.7%) and 108 (90%) educators completed the SDL and practical components respectively. Mean knowledge scores in SDL modules improved from 52.4% (± 10.4) to 80.4% (± 8.1), preparing teaching plan median scores improved from 63.6% (IQR 45.5) to 81.8% (IQR 27.3), and confidence in applying selected pedagogy skills improved from 2.7 to 3.7, p < 0.001. Participants rated the SDL and practical components of the programme high for relevance and satisfaction (median, 4 out of 4 for both). After training, 51.4% and 57.9% of the participants scored 75% or higher in preparing teaching plans and microteaching assessments. Country, training institution type or educator characteristics had no significant associations with overall competence in preparing teaching plans and microteaching (p > 0.05). Qualitatively, educators found the programme educative, flexible, convenient, motivating, and interactive for learning. Internet connectivity, computer technology, costs and time constraints were potential challenges to completing the programme. Conclusion The programme was feasible and effective in improving the knowledge and skills of educators for effective teaching/learning. For successful roll-out, policy framework for mandatory midwifery educator specific CPD programme is needed.Item Experiences, Barriers and Perspectives of Midwifery Educators, Mentors and Students Implementing The Updated Emergency Obstetric and Newborn Care-Enhanced Preservice Midwifery Curriculum in Kenya: A Nested Qualitative Study.(BMC Medical Education, 2024) Shikuku, Duncan N.; Bar-Zeev, Sarah; Ladur, Alice Norah; Allott, Helen; Mwaura, Catherine; Nandikove, Peter; Uyara, Alphonce; Tallam, Edna; Ndirangu, Wambui Eunice; Waweru, Lucy; Nyaga, Lucy; Bashir, Issak; Bedwell, Carol; Ameh, CharlesIntroduction To achieve quality midwifery education, understanding the experiences of midwifery educators and students in implementing a competency-based pre-service curriculum is critical. This study explored the experiences of and barriers to implementing a pre-service curriculum updated with emergency obstetric and newborn care (EmONC) skills by midwifery educators, students and mentors in Kenya. Methods This was a nested qualitative study within the cluster randomised controlled trial investigating the effectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in 20 colleges in Kenya. Following the pre-service midwifery curriculum EmONC update, capacity strengthening of educators through training (in both study arms) and additional mentoring of intervention-arm educators was undertaken. Focus group discussions were used to explore the experiences of and barriers to implementing the EmONC-enhanced curriculum by 20 educators and eight mentors. Debrief/feedback sessions with 6–9 students from each of the 20 colleges were conducted and field notes were taken. Data were analysed thematically using Braun and Clarke’s six step criteria. Results Themes identified related to experiences were: (i) relevancy of updated EmONC-enhanced curriculum to improve practice, (ii) training and mentoring valued as continuous professional development opportunities for midwifery educators, (iii) effective teaching and learning strategies acquired – peer teaching (teacher-teacher and student-student), simulation/scenario teaching and effective feedback techniques for effective learning and, (iv) effective collaborations between school/academic institution and hospital/clinical staff promoted effective training/ learning. Barriers identified were (i) midwifery faculty shortage and heavy workload vs. high student population, (ii) infrastructure gaps in simulation teaching – inadequate space for simulation and lack of equipment inventory audits for replenishment (iii) inadequate clinical support for students due to inadequate clinical sites for experience, ineffective supervision and mentoring support, lack/shortage of clinical mentors and untrained hospital/clinical staff in EmONC and (iv) limited resources to support effective learning. Conclusion Findings reveal an overwhelmed midwifery faculty and an urgent demand for students support in clinical settings to acquire EmONC competencies for enhanced practice. For quality midwifery education, adequate resources and regulatory/policy directives are needed in midwifery faculty staffing and development. A continuous professional development specific for educators is needed for effective student teaching and learning of a competency-based pre-service curriculum.Item Duty Versus Distributive Justice during the Covid-19 Pandemic.(Nursing Ethics, 2021) Shaibu, Sheila; Wangari, Kimani Rachel; Shumba, Constance; Maina, Rose; Ndirangu, Wambui Eunice; Kambo, IsabelThe COVID-19 pandemic exposed vulnerabilities in inadequately prioritized healthcare systems in low- and middle-income countries such as Kenya. In this prolonged pandemic, nurses and midwives working at the frontline face multiple ethical problems, including their obligation to care for their patients and the risk for infection with severe acute respiratory syndrome coronavirus 2. Despite the frequency of emergencies in Africa, there is a paucity of literature on ethical issues during epidemics. Furthermore, nursing regulatory bodies in African countries such as Kenya have primarily adopted a Western code of ethics that may not reflect the realities of the healthcare systems and cultural context in which nurses and midwives care for patients. In this article, we discuss the tension between nurses’ and midwives’ duty of care and resource allocation in the context of the COVID-19 pandemic. There is an urgent need to clarify nurses’ and midwives’ rights and responsibilities, especially in the current political setting, limited resources, and ambiguous professional codes of ethics that guide their practice.Item 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, LilianBackground: 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.Item Experiences of African Immigrant Women Living with HIV in the U.K.: Implications for Health Professionals.(J Immigrant Minority Health, 2009) Ndirangu, Wambui Eunice; Catrin, EvansIn the U.K. immigrant women from Africa constitute an increasingly large proportion of newly diagnosed cases of HIV. A significant minority of these are refugees and asylum seekers. Very little is known about their experiences of living with HIV/AIDS, their psychosocial needs or their views of health care provision. This paper reports the results of a qualitative study that explored these issues by interviewing eight African women living with HIV in the British city of Nottingham. Women’s ability to live positively with HIV was found to be strongly shaped by their migration history, their legal status, their experience of AIDS-related stigma and their Christian faith. Significantly, health services were represented as a safe social space, and were highly valued as a source of advice and support. The findings indicate that non-judgemental, personalised health care plays a key role in encouraging migrant African women to access psychosocial support and appropriate HIV services.Item Professional Image of Nursing and Midwifery in East Africa: An Exploratory Analysis.(BMC Nursing., 2021) Ndirangu, Wambui Eunice; Mohammed, Sarki Ahmed; Mbekenga, Columba; Edwards, GraceBackground: Evidence suggests that there is a negative image of nursing and midwifery that does not promote these professions as attractive career options. Furthermore, there is a paucity of studies documenting how nursing and midwifery is perceived in East Africa and where such studies exist they are country-specific. The aim of this study was to explore views regarding the image of nursing and midwifery among nurses and midwives in three East African countries, Kenya, Tanzania and Uganda. Methods: An exploratory descriptive cross-sectional study administered online using Survey Monkey Questionnaires assessed the views and perceptions of nurses and midwives regarding the image of nursing and midwifery professions. Descriptive statistics and Pearson’s Chi square tests were used to analyse the data. The semi-structured questions were analysed using content analysis. Results: A total of 551 participants took part in the study. The majority were females (61.8%), registered nurses/ midwives (45.8%), and aged 30–39 years (34.2%). Most of the respondents were from Kenya (39.7%) and Uganda (32.9%). About two-thirds of the nurses and midwives in this study perceived nursing/midwifery as both trusted and respected professions and expressed having a level of control over how their image was portrayed. Conversely, the nurses and midwives were conscious that the public had mixed responses about the nursing/midwifery professions specifically, some members of the public described nurses/midwives as professionals, knowledgeable and caring, others perceived nurses/midwives to be rude, cruel, unkind, lazy, unkempt, and maids. Conclusion: This study offers an interesting insight about the image of nursing/midwifery in East Africa. Findings from this study will inform policy makers and educators about key concepts that affect the image of nursing and midwifery in East Africa. The findings will be used to design marketing materials to help improve the image of nursing and midwifery in the region and other African countries.Item Reorienting Nurturing Care for Early Childhood Development during the COVID-19 Pandemic in Kenya: A Review(International Journal of Environmental Research and Public Health, 2020) Ndirangu, Wambui Eunice; Shumba, Constance; Maina, Rose; Mbuthia, Gladys; Kimani, Rachel; Mbugua, Stella; Shah, Sweta; Abubakar, Amina; Luchters, Stanley; Shaibu, SheilaIn Kenya, millions of children have limited access to nurturing care. With the Coronavirus disease 2019 (COVID-19) pandemic, it is anticipated that vulnerable children will bear the biggest brunt of the direct and indirect impacts of the pandemic. This review aimed to deepen understanding of the e ects of COVID-19 on nurturing care from conception to four years of age, a period where the care of children is often delivered through caregivers or other informal platforms. The review has drawn upon the empirical evidence from previous pandemics and epidemics, and anecdotal and emerging evidence from the ongoing COVID-19 crisis. Multifactorial impacts fall into five key domains: direct health; health and nutrition systems; economic protection; social and child protection; and child development and early learning. The review proposes program and policy strategies to guide the reorientation of nurturing care, prevent the detrimental e ects associated with deteriorating nurturing care environments, and support the optimal development of the youngest and most vulnerable children. These include the provision of cash transfers and essential supplies for vulnerable households and strengthening of community-based platforms for nurturing care. Further research on COVID-19 and the ability of children’s ecology to provide nurturing care is needed, as is further testing of new ideas.