School of Public Health and Community Development

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

2025-11-13T08:38:45Z

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

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

2025-11-12T06:41:19Z

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

Knowledge, attitude and practices of teenage mothers on prevention of diarrhoea in children less than five years old in Ndhiwa sub-county, Homa bay county, Kenya

2025-11-12T06:27:18Z

Knowledge, attitude and practices of teenage mothers on prevention of diarrhoea in children less than five years old in Ndhiwa sub-county, Homa bay county, Kenya ODODA, Everlyne Achieng Diarrhoea is the passage of loose, watery or liquid stools three or more times a day. Diarrhoea may be acute, persistent, or chronic and is often preventable and treatable. Diarrhoea disease is the second leading cause of mortality in children <5 years of age, resulting in approximately 1.7 billion cases globally and 525,000 deaths each year. The low- and middle-income countries account for about 90% of these deaths, with sub-Saharan Africa and South Asia reporting 88%. In Kenya, over 50% of children <5 years hospital admission results from diarrhoeal related infections. In Ndhiwa Sub-County, diarrhoea is among the leading causes of hospital admission among children aged <5 years old. Although the causes of morbidity and mortality associated with diarrhoeal diseases in children <5 years including the mothers‟ knowledge, perception and management factors has been reported, the impact of these factorsamong teenagemothers remain largely unknown. With the proportion of teenage mothers estimated at 18 % in Kenya, and 33% in Homa Bay County (ranked 1st of 47counties), this study aimed to determine the knowledge, attitude and practices of teenage mothers on diarrhoea prevention among their children aged <5 years in Ndhiwa Sub-County, Homa Bay County. Specifically, the study investigated socioeconomic factors among teenage mothers with children <5 years old, and determined their knowledge, attitude, and prevention practices on diarrhoea outcomes. A cross sectional descriptive study design was used. Total of 320 teenage mothers were recruited using multistage sampling technique. Data was collected using semi-structured questionnaires andanalyzed using SPSS software. Statistical significance was set at P≤0.050. Results from binary logistic regression model showed that the marital status of teenage mother; namely never married (P=0.016) or divorced (P=0.023) increased odds of diarrhoea in children, while mothers‟ occupation (fulltime student, P=0.027) significantly increased the odds of diarrhoea. Poor knowledge on general prevention of diarrhoea (P<0.001), rubbish dumping (P=0.010) and Rota/ measles vaccination (P<0.001) were associated with increased incidences of diarrhoea in children aged <5 years. Analysis of general prevention practices of teenage mothers and diarrhoea outcome among their children revealed that poor practices (P<0.001) increased the odds of diarrhoeal episodes. Furthermore, negative attitudes of teenage mothers towards diarrhoea prevention practices increased the odds of children presenting with diarrhoea (P=0.006). In conclusion, these results show that the teenage mother characteristics, knowledge, practices and attitudes on childhood diarrhoea and prevention were associated with reported incidences of diarrhoea among children <5 years. The study recommends that the County Government of Homa Bay develop intervention measures to mitigate identified factors associated with increased incidences of diarrhoea cases in children aged <5 years of teenage mothers. Master's Thesis

Relationship between glycated haemoglobin 1c and red blood cell parameters in type 2 diabetes patients at Bungoma county referral hospital, Kenya

2025-11-11T12:07:50Z

Relationship between glycated haemoglobin 1c and red blood cell parameters in type 2 diabetes patients at Bungoma county referral hospital, Kenya MALABA, Joseph Sifuna Diabetes mellitus (DM) is among the leading global health concerns, causing over 1.5 million deaths alongside other significant comorbidities and complications. Conventional diagnoses have revolved around estimating fasting, random blood glucose levels and glucose tolerance test. For monitoring purposes, long-term glycaemic control has been achieved through the measurement of glycated haemoglobin (HbA1c), which is considered a reliable and preferred marker for DM. However, it could be affected by red blood cell parameters such as haemoglobin levels (Hb), Mean corpuscular haemoglobin (MCH), Mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC).Furthermore, it could be affected by haemoglobin types like HbA, HbA2, and HbF concentrations whose magnitude remains unclear. As such, the current study investigated these potential interferences, which constitute the problem under investigation. It sought to determine the association between HbA1c and red cell parameters, assess the relationship between HbA1c and haemoglobin types, and find out the association between haemoglobin types and red cell parameters among patients with type 2 diabetes mellitus. The purpose of the study was to explore possible HbA1c interference and how it relates to red blood cell parameters and haemoglobin types. The study sought to supplement the existing literature on possible HbA1c interferences, which has been unavailable in reference to the local population, and help inform the formulation of local policies regarding DM monitoring. In this cross-sectional study, 72 participants presenting with T2DMand 72 controls at the Bungoma County Referral Hospital were recruited using simple random sampling. Bungoma County was a suitable study due to a cited higher T2DM burden within the region. Red cell parameters were analysed using the Celtac G MEK-9100K machine (Nihon Kohden Europe). HbA1c and other Haemoglobin variants were measured using ion-exchange high-performance liquid chromatography (HPLC) by the Bio-Rad D-10 machine (Bio-Rad Laboratories, Inc). Chi-square (2) analysis was used to determine the differences between proportions. Mann-Whitney U test was used to compare laboratory characteristics between type 2 DM and non-diabetics. With HbA as the reference group, the association between HbA1c and red blood cell parameters was determined using binary logistic regression while controlling for uncontrolled diabetes status. The relationship between HbA1c and haemoglobin types was determined using binary logistic regression. Association between haemoglobin types and red blood cell parameters was determined using Pearson correlation. Haemoglobin p=0.003, MCH p=0.007 and MCHC p=0.001 were markedly increased in diabetic patients relative to non-diabetics. With non-diabetics as the reference group, HbA1c was associated with increased HbA0 [OR=1.059, 95% CI=1.020-1.099, p=0.003] and increased HbA2 [OR=3.893, 95% CI=2.161-7.014, p=0.001]. However, there was no significant association between HbA1c and HbF[OR=2.062, 95% CI=0.873-4.875, p=0.099].HCT had a negative correlation with HbAO (r= -0.271, p=0.021) and a positive correlation with HbAS (r= 0.292, p=0.013) in participants with controlled diabetes.MCV and MCH had a negative correlation with HbF, (r= -0.291, p=0.013) and(r= -0.298, p=0.011) respectively. MCH had a negative correlation with HbA2 (r= -0.389, p=0.001) in participants with uncontrolled diabetes. In conclusion,HbA1c was not significantly associated with red blood cell parameters while it significantly correlated with haemoglobin types in T2DM. Additionally, HCT correlated negatively with HbA0 and positively with HbAS, while MCV and MCH had a negative correlation with HbF for the diabetic participants. Thus, Hb types are potential interferences in HbA1c estimation while RBC parameters are not. Master's Thesis

Influence of perceptions of caregivers with children under 5 years on utilization of insecticide treated nets in Butere Sub County, Kakamega county Kenya

2025-11-10T12:05:53Z

Influence of perceptions of caregivers with children under 5 years on utilization of insecticide treated nets in Butere Sub County, Kakamega county Kenya KURUI, J. Jacklyne Malaria remains one of the leading public health challenges globally, affecting approximately 263 million people and causing an estimated 597,000 deaths annually. Sub-Saharan Africa bears the greatest burden, accounting for 94% of global cases. In Kenya, malaria continues to pose a significant threat, with an estimated six million cases reported annually. This study examined behavioral determinants of insecticide-treated net (ITN) utilization among caregivers of children under five years in Butere Sub-County, Kakamega County, Kenya, using the Health Belief Model (HBM) as a guiding framework. A community-based cross-sectional study design was employed, involving 422 caregivers selected through multistage cluster sampling. Quantitative data were collected using structured, interviewer-administered questionnaires, while qualitative data were obtained through 22 focus group discussions (FGDs) and 12 key informant interviews (KIIs) with caregivers and community health promoters. Quantitative data were analyzed using chi-square and logistic regression at a 95% confidence level (p < 0.05), and qualitative data were thematically analyzed using NVivo 12. The dependent variable was ITN utilization, while the independent variables—perceived vulnerability, severity, benefits, and barriers—captured caregivers’ beliefs regarding malaria risk and prevention. Results indicated that 74.6% of caregivers perceived children under five as vulnerable to malaria, and 88.6% believed they were at greater risk than adults. Caregivers who perceived malaria as a serious illness were 2.5 times more likely to use ITNs [AOR = 2.517; 95% CI: 1.175–5.391; p = 0.002], while those associating malaria with anemia were less likely to use them. A significant association was found between perceived vulnerability and ITN utilization (χ² = 4.219; p = 0.040; OR = 0.343; 95% CI: 0.119–0.995). Qualitative findings revealed that although caregivers acknowledged the effectiveness of ITNs, consistent use was hindered by discomfort from heat, torn nets, limited supply, and cultural beliefs such as the ―bad eye.‖ These insights highlight a paradox within the HBM: despite high awareness of malaria’s severity and children’s vulnerability, consistent ITN use remains suboptimal due to behavioral and contextual barriers. The study concludes that targeted, culturally sensitive interventions—integrating health education, improved ITN access, and community engagement—are essential to strengthen caregivers’ perceived benefits and reduce practical and cultural barriers. Addressing these factors will enhance ITN utilization and contribute to sustainable malaria prevention among children under five in endemic regions. Master's Thesis

Prevalence and factors associated with visceral leishmaniasis and distribution of sandfly vectors in Tiaty west sub county, Baringo County, Kenya

2025-11-10T11:55:44Z

Prevalence and factors associated with visceral leishmaniasis and distribution of sandfly vectors in Tiaty west sub county, Baringo County, Kenya KEITANY, Charles Yator Visceral leishmaniasis is a parasitic disease caused by Leishmania donovani, transmitted by Phlebotomine sandflies. It affects the reticuloendothelial system and causes high morbidity and mortality. Globally, an estimated 500,000 new cases occur annually. In Kenya, VL is endemic in arid and semi-arid regions such as Machakos, Kitui, Baringo, and West Pokot counties. Baringo County, specifically Tiaty Sub-County which has been historically hotspot for VL due conducive ecological climate, vegetation, pastoralist and housing which create ideal environment for sandfly survival. Multiple VL outbreaks have been reported in Tiaty sub counties as documented by Ministry of Health and WHO, therefore Chemolingot Sub County Hospital (CSCH) was selected as the study site and as main referral facility in Tiaty sub-county. The hospital serves as a primary health center for VL cases, however there is scarcity of data on disease prevalence and associated risk factors in patients attending the hospital. The study aimed to determine the prevalence of VL, determine associated risk factors, and establish the distribution, abundance and diversity of sandfly vectors. A hospital based cross-sectional study design coupled with an entomological field survey was used. A sample size of (331) patients was consecutively recruited using Fisher’s formula from a target population of 1,800. Blood samples were tested for VL using recombinant antigen, derived from a kinesin-like protein of leishmania chagasi, (rk39). This diagnostic kit is suitable for use in rural hospitals like CSCH. Socio-demographic data were collected using a pre- tested structured questionnaire. Sandflies were collected using castor oil sticky traps and CDC light traps which enhanced chances of capture. Traps were placed at five randomly selected sites in Lorwatum village, Tiaty West Sub County to ensure adequate representative sampling of diverse habitats. Traps were set between 17:00 and 06:00 hours to coincide with the peak activity period of sandflies which are nocturnal. Descriptive statistics was used to summarize prevalence and vector abundance. Chi-square tests assessed associations between variables and those statistically significant (p < 0.05) were further analyzed using binary logistic regression to estimate odds ratios. Captured sandflies were identified using standard taxonomic keys, Paleontological Statistics (PAST) v4.0. software was used to compute data. Shannon’s diversity index was calculated and further diversity t-tests done for significance difference in the 5 selected sites. The hospital-based prevalence of VL was 39.57% (131/331). Most participants were aged 1–10 years were 131 (38.57%). Significant risk factors for VL; unemployment (OR = 9.50, 95% CI: 3.30–27.40, p < 0.001) animals near compound (OR = 5.27, 95% CI ≈ 2.60–10.70, p < 0.001) house roof material (OR = 3.70, 95% CI: 2.10–6.50, p < 0.001), protective factors include awareness of VL transmission (OR = 0.20, 95% CI: 0.11–0.36, p = 0.001). Phlebotomus vectors were 8 (4.5%), with a male- female ratio 1:6.25. Sandfly diversity was highest indoors (Shannon diversity index H’ = 1.38; evenness = 0.66). Statistically significant differences in diversity were between inside house and tree holes’ t (7.97) = 17.51, p < .001 and between open fields and beehive t (7.79) = 5.96, p < .001. In conclusion, there is high prevalence of VL among patients at Chemolingot Sub County Hospital. Major risk factors included unemployment, house material, with Phlebotomus martini available in four habitats This study confirms the endemicity of VL in Tiaty Sub-County and highlights the importance of rapid diagnostic tools like rK39 in field settings. Strengthened surveillance, public awareness, and integrated control measures are recommended. Master's Thesis

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

2025-03-13T06:56:30Z

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

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

2025-03-12T13:58:08Z

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

Prevalence and factors associated with shisha smoking by youth In tertiary institutions, Kisumu county, Kenya

2025-03-12T13:46:57Z

Prevalence and factors associated with shisha smoking by youth In tertiary institutions, Kisumu county, Kenya MUTEI, Redempta david The tobacco epidemic has a significant public health challenge worldwide, affecting approximately 1.1 billion smokers, with a particularly high prevalence in low- and middle- income countries, with over 7 million deaths annually; a figure projected to rise. shisha smoking has rapidly gained popularity among youth, often surpassing traditional cigarette use. This trend was attributed to social acceptance and the appealing flavours of shisha, despite the severe health risks associated with its use, which are frequently underestimated. In Kenya, 37% of university students in Nairobi County were engaging in shisha smoking, coupled with a widespread lack of awareness regarding its health implications. Despite the growing prevalence of shisha smoking among the youth, data specifically focusing on its use in Kenya remains limited. Consequently, this study aimed to assess the prevalence and factors influencing shisha smoking among youth in tertiary institutions in Kisumu County. The study set out to determine the prevalence of shisha use, to explore individual and environmental factors influencing its consumption among students in tertiary institutions. A cross-sectional study design with a sample of 398 students from a target population of 26,384 students aged 18 - 24 years reflecting a known prevalence of 37% was drawn from institutions: Maseno University, Uzima University College, Great Lakes University, Kenya Medical Training College-Kisumu, and the Kisumu National Polytechnic. Institutions were purposely sampled, and each sample was determined using population proportionate to size, stratified sampling was employed to obtain students across all academic years and simple random sampling was used to achieve the sample size. Reliability of the questionnaires was assessed using a Cronbach’s Alpha with a score of 0.718, and data collection was conducted by trained research assistants using pre-tested questionnaires. Data analysis was conducted using SPSS version 25. Frequencies and percentages were used to determine prevalence and reasons for shisha smoking. Cramer’s V and Chi-square p-value <0.05 were used to establish associations. Twenty-nine percent of students had smoked Shisha in the past one year, with current smokers at 32.3%. Curiosity (26.6%), pleasure-seeking (21.8%), the appeal of flavours (19.4%) and peer pressure influenced (33.9%) of the students to smoke shisha. There was no significant association between self-esteem and shisha smoking (p-value 0.407). In conclusion high prevalence of shisha smoking among tertiary students was significantly driven by social dynamics, peer pressure, and misconceptions about its safety compared to cigarettes. Psychological peer counsellors should educate the youth population on the health effects associated with shisha smoking. Master's Thesis

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

2025-02-11T18:43:30Z

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