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1
Obengo, Tom. "Medical debt during epidemics: A case for resolving the situation in low- and middle-income countries such as Kenya." Wellcome Open Research 7 (October 4, 2022): 245. http://dx.doi.org/10.12688/wellcomeopenres.18403.1.
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This paper evaluates the problem of medical debt in Kenya during the COVID-19 pandemic. The medical debt problem is compounded during pandemics such as COVID-19 when patients seek treatment and end up in insurmountable debt because illnesses related to the pandemic are not covered by the Kenyan National Health Insurance Fund (NHIF), the public health coverage body under government control. As a result, discharged patients may be detained in hospitals and dead bodies are locked away in mortuaries, until relatives and friends fundraise and clear the bills. Apart from causing vulnerability, fear, and emotional stress among the poor, this practice leads to a growing lack of trust in the healthcare system, with patients deliberately avoiding hospitals whenever they suspect they have COVID-19. The resulting vicious cycle makes healthcare more inaccessible by limiting the choices that people may have. User fees, which were introduced in all public health facilities by the Kenyan government as part of a World Bank prescription for cost-sharing, normally affect more women than men. Although Kenya has implemented a general waiver system in public hospitals for those who cannot pay their medical bills, the process of obtaining this waiver can be burdensome, demeaning, and dangerous for the health of the patients. This undermines the government’s commitment to the provision of equitable and affordable health care for the citizens. In this article, the problem of medical debt in Kenya is addressed as a multi-faceted problem drawing on issues of justice and fairness, human dignity, good governance, the interplay between global and local policies, as well as politics and law. It argues that it is in the best interest of Kenya and other African countries to ensure that public health coverage covers pandemics so that the majority poor can afford and access healthcare.
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Musyoka, Peter K., Julius Korir, Jacob Omolo, and Charles C. Nzai. "An Empirical Analysis of the Effect of Poverty on Health Care Utilization in Kenya." European Scientific Journal, ESJ 14, no. 22 (August 31, 2018): 101. http://dx.doi.org/10.19044/esj.2018.v14n22p101.
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Background Good health is a fundamental huma right, a valued asset, and a prerequisite for improved productivity. However, high poverty can lead to under utilization or lack of utilization of health care leading to poor health. Thus, poverty reduction and improvement of health care utilization are important in ensuring enjoyment of good health. Since 1982, poverty has remained above 40 per cent despite Kenya’s commitment to poverty reduction. Kenya’s health indicators have also not been impressive and health care utilization has remained low. Evidence shows that those who fell sick and reported lack of finances as the main reason for not seeking medical attention constituted 44 per cent, 38 per cent and 21.4 per cent in 2003, 2007 and 2013, respectively. These statistics point to poor health care utilization due to poverty. In Kenya, studies have concentrated on small segments of the population or parts of the country hence limiting generalization of the findings. Objective The objective of this paper was to determine the effect of poverty on health care utilization in Kenya. Method The study used a Negative Binomial Regression and the 2013 Kenya Household Expenditure and Utilization Survey dataset. The study also used Two Stage Residual Inclusion approach and a Control Function Approach to test and control for potential endogeneity and unobserved heterogeneity problems, respectively. Results The estimation results showed that reduction in poverty increased health care utilization. Other factors that had a positive and statistically significant effect on health care utilization were household size, early levels of education, and distance to the nearest health facility. Conclusion The study concludes that health care utilization is negatively affected by poverty other factors held constant. Thus, policies and strategies aimed at reducing poverty are needed. In particular the study recommends introduction of universal health care for all.
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Murphy, Georgina A. V., Vivian N. Nyakangi, David Gathara, Morris Ogero, and Mike English. "A hidden burden of neonatal illness? A cross-sectional study of all admissions aged less than one month across twelve Kenyan County hospitals." Wellcome Open Research 2 (December 18, 2017): 119. http://dx.doi.org/10.12688/wellcomeopenres.13312.1.
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Background: Small and sick newborns need high quality specialised care within health facilities to address persistently high neonatal mortality in low-income settings, including Kenya. Methods: We examined neonatal admissions in 12 public-sector County (formerly District) hospitals in Kenya between November 2014 and November 2016. Using data abstracted from newborn unit (NBU) admission registers and paediatric ward (PW) medical records, we explore the magnitude and distribution of admissions. In addition, interviews with senior staff were conducted to understand admission policies for newborns in these facilities. Results: Of the total 80,666 paediatric admissions, 28,884 (35.8%) were aged ≤28 days old. 24,212 (83.8%) of newborns were admitted to organisationally distinct NBU and 4,672 (16.2%) to general PW, though the proportion admitted to NBUs varied substantially (range 59.9-99.0%) across hospitals, reflecting widely varying infrastructure and policies. Neonatal mortality was high in NBU (12%) and PW (11%), though varied widely across facilities, with documentation of outcomes poor for the NBU. Conclusion: Improving quality of care on NBUs would affect almost a third of paediatric admissions in Kenya. However, comprehensive policies and strategies are needed to ensure sick newborns on general PWs also receive appropriate care.
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Murphy, Georgina A. V., Vivian N. Nyakangi, David Gathara, Morris Ogero, and Mike English. "A hidden burden of neonatal illness? A cross-sectional study of all admissions aged less than one month across twelve Kenyan County hospitals." Wellcome Open Research 2 (January 30, 2018): 119. http://dx.doi.org/10.12688/wellcomeopenres.13312.2.
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Background: Small and sick newborns need high quality specialised care within health facilities to address persistently high neonatal mortality in low-income settings, including Kenya. Methods: We examined neonatal admissions in 12 public-sector County (formerly District) hospitals in Kenya between November 2014 and November 2016. Using data abstracted from newborn unit (NBU) admission registers and paediatric ward (PW) medical records, we explore the magnitude and distribution of admissions. In addition, interviews with senior staff were conducted to understand admission policies for neonates in these facilities. Results: Of the total 80,666 paediatric admissions, 28,884 (35.8%) were aged ≤28 days old. 24,212 (83.8%) of neonates were admitted to organisationally distinct NBUs and 4,672 (16.2%) to general PWs, though the proportion admitted to NBUs varied substantially (range 59.9-99.0%) across hospitals, reflecting widely varying infrastructure and policies. Neonatal mortality was high in NBUs (12%) and PWs (11%), though varied widely across facilities, with documentation of outcomes poor for the NBUs. Conclusion: Improving quality of care on NBUs would affect almost a third of paediatric admissions in Kenya. However, comprehensive policies and strategies are needed to ensure sick neonates on general PWs also receive appropriate care.
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Taiko, Winfred, and Dr Asenath Onguso. "Effect of Human Resource Management Practices on Employee Performance of Public Hospitals in Kajiado County, Kenya." Journal of Human Resource &Leadership 6, no. 3 (August 5, 2022): 21–36. http://dx.doi.org/10.53819/81018102t2085.
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Healthcare is one of the fastest growing sector and to offer quality care to patients, a large pool of well trained, dedicated and motivated medical professionals are required. Given the healthcare workforce-intensive nature, the human resource management practices come in handy to facilitate and support the recruitment, hiring, development of the employees, with the goal of raising levels of employee performance and satisfaction. This study sought to determine the effect of human resource management practices on employee performance of public hospitals in Kajiado County, Kenya. The specific objectives were to determine the effect career development, compensation, performance appraisals and recruitment on employee performance of public hospitals in Kajiado County, Kenya. The study was conducted in Kajiado County where the performance of public hospitals had been rated poor since devolving of healthcare services to the county governments. The study employed descriptive research design. Primary data was collected by means of a structured questionnaire. The study was conducted in the 5 public hospitals in Kajiado County (Kajiado County Referral Hospital, Ngong Sub County, Oloitoktok Sub County, Kitengela Sub County and Ongata Rongai Sub County). The unit of observation was the medical staff in each of the health cadres. The findings indicated that career development and employee performance in public hospitals in Kajiado County, Kenya is positively and significantly related. Compensation and employee performance in public hospitals in Kajiado County, Kenya is positively and significantly related. Performance appraisals and employee performance in public hospitals in Kajiado County, Kenya was positively and significantly related. Recruitment and employee performance in public hospitals in Kajiado County, Kenya is positively and significantly related. The study recommends the management of public hospitals should consider organizing for trainings and seminars for the employees as this will help to increase employee skills, loyalty and competence making them more willing to work harder for the success of the public hospitals. Keywords: Career development, compensation, performance appraisals, recruitment & employee performance
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Gitahi, Nyawira, Sheila Juliet Eshiwani, Kenneth Mutai, Jared Ongechi Mecha, and James Njogu Kiarie. "Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya." Obstetrics and Gynecology International 2020 (June 9, 2020): 1–6. http://dx.doi.org/10.1155/2020/1675987.
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Introduction. A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care uptake. This study aimed at documenting fertility desire (desire to conceive), determining the uptake of preconception care, identifying HIV prevention strategies used during preconception care, and determining immediate conception outcomes among HIV discordant couples in Kenya. Methods. We retrospectively extracted electronic medical record data on discordant couples at an HIV care discordant couples’ clinic. We included data on couples who expressed a desire to conceive and were offered preconception care and followed up for 29 months. We collected data on sociodemographic characteristics, preconception prevention methods, and associated outcomes. Results. Among couples, with male HIV-positive partners, there was a twofold likelihood of accepting preconception services (OR = 2.3, CI 95% (1, 1, 5.0)). A shorter discordant union was independently associated with the uptake of preconception services (OR = 0.92, CI 95% (0.86, 0.98)). The most used prevention intervention (38.5%) among discordant couples was a combination of pre-exposure prophylaxis (PrEP) by the uninfected partner, alongside HAART by the partner living with HIV. Pregnancy rates did not significantly (p = 0.06) differ among those who took up preconception care versus those who did not. HIV-negative partners of couples who declined preconception care had a significantly (p = 0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.Conclusion. The study demonstrates the feasibility of implementing safe and effective preconception servicesas part of routine HIV care for discordant couples living in low resource settings. The provision and the utilisation of safer conception services may be hindered by the poor retention to follow-up and care of HIV-negative partners. This challenge may impede the expected benefits of preconception care as an HIV prevention intervention.
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Abuya, Timothy, Charlotte E. Warren, Charity Ndwiga, Chantalle Okondo, Emma Sacks, and Pooja Sripad. "Manifestations, responses, and consequences of mistreatment of sick newborns and young infants and their parents in health facilities in Kenya." PLOS ONE 17, no. 2 (February 22, 2022): e0262637. http://dx.doi.org/10.1371/journal.pone.0262637.
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Background Despite efforts to incorporate experience of care for women and newborns in global quality standards, there are limited efforts to understand experience of care for sick newborns and young infants. This paper describes the manifestations, responses, and consequences of mistreatment of sick young infants (SYIs), drivers, and parental responses in hospital settings in Kenya. Methods A qualitative formative study to inform the development of strategies for promoting family engagement and respectful care of SYI was conducted in five facilities in Kenya. Data were collected from in-depth interviews with providers and policy makers (n = 35) and parents (n = 25), focus group discussions with women and men (n = 12 groups), and ethnographic observations in each hospital (n = 64 observation sessions). Transcribed data were organized using Nvivo 12 software and analyzed thematically. Results We identified 5 categories of mistreatment: 1) health system conditions and constraints, including a) failure to meet professional standards, b) delayed provision of care; and c) limited provider skills; 2) stigma and discrimination, due to provider perception of personal hygiene or medical condition, and patient feelings of abandonment; 3) physically inappropriate care, including providers taking blood samples and inserting intravenous lines and nasogastric tubes in a rough manner; or parents being pressured to forcefully feed infants or share unsterile feeding cups to avoid providers’ anger; 4) poor parental-provider rapport, expressed as ineffective communication, verbal abuse, perceived disinterest, and non-consented care; and 5) no organized form of bereavement and posthumous care in the case of infant’s death. Parental responses to mistreatment were acquiescent or non-confrontational and included feeling humiliated or accepting the situation. Assertive responses were rare but included articulating disappointment by expressing anger, and/or deciding to seek care elsewhere. Conclusion Mistreatment for SYIs is linked to poor quality of care. To address mistreatment in SYI, interventions that focus on building better communication, responding to the developmental needs of infants and emotional needs for parents, strengthen providers competencies in newborn care, as well as a supportive, enabling environments, will lead to more respectful quality care for newborns and young infants.
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Gathara, David, George Serem, Georgina A. V. Murphy, Nancy Abuya, Rose Kuria, Edna Tallam, and Mike English. "Quantifying nursing care delivered in Kenyan newborn units: protocol for a cross-sectional direct observational study." BMJ Open 8, no. 7 (July 2018): e022020. http://dx.doi.org/10.1136/bmjopen-2018-022020.
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IntroductionIn many African countries, including Kenya, a major barrier to achieving child survival goals is the slow decline in neonatal mortality that now represents 45% of the under-5 mortality. In newborn care, nurses are the primary caregivers in newborn settings and are essential in the delivery of safe and effective care. However, due to high patient workloads and limited resources, nurses may often consciously or unconsciously prioritise the care they provide resulting in some tasks being left undone or partially done (missed care). Missed care has been associated with poor patient outcomes in high-income countries. However, missed care, examined by direct observation, has not previously been the subject of research in low/middle-income countries.Methods and analysisThe aim of this study is to quantify essential neonatal nursing care provided to newborns within newborn units. We will undertake a cross-sectional study using direct observational methods within newborn units in six health facilities in Nairobi City County across the public, private-for-profit and private-not-for-profit sectors. A total of 216 newborns will be observed between 1 September 2017 and 30 May 2018. Stratified random sampling will be used to select random 12-hour observation periods while purposive sampling will be used to identify newborns for direct observation. We will report the overall prevalence of care left undone, the common tasks that are left undone and describe any sharing of tasks with people not formally qualified to provide care.Ethics and disseminationEthical approval for this study has been granted by the Kenya Medical Research Institute Scientific and Ethics Review Unit. Written informed consent will be sought from mothers and nurses. Findings from this work will be shared with the participating hospitals, an expert advisory group that comprises members involved in policy-making and more widely to the international community through conferences and peer-reviewed journals.
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Opanga, Yvonne, Sarah Karanja, Zena Abdullahi, Richard Gichuki, Aneesa Ahmed, Viola Tupeiya, Daniel Omolo, et al. "Enablers and Barriers to Chlorhexidine Use in Umbilical Cord Care: Voices of Care Givers and Healthcare Providers in Selected Counties in Kenya." East African Journal of Health and Science 5, no. 2 (December 7, 2022): 72–86. http://dx.doi.org/10.37284/eajhs.5.2.995.
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Neonatal sepsis contributes to increased rates of mortality among newborns during their first month of life. Chlorhexidine (CHX) has proven effective in the prevention of neonatal sepsis due to umbilical stump infection after birth. Despite shifting from dry cord care techniques to CHX use, there is still a high prevalence of improper cord care in low-resource settings in Kenya. This study sought to explore barriers and enablers to CHX use in Kwale, Vihiga and Machakos counties in Kenya. We adopted mixed methods cross-sectional survey with 582 women of reproductive age with a young child less than one year as respondents to the quantitative survey. Qualitative data entailed thirty (30) key informant interviews with healthcare workers and national policymakers. Six (6) focus group discussions with mothers, caregivers, community health volunteers (CHVs) and traditional birth attendants were conducted. An observation checklist was used to assess the availability of CHX services and supplies in fourteen (14) health facilities was conducted. Results indicated variation in umbilical cord care practices for newborns across counties. Of 582 caregivers, only 1.3% reported having ever used CHX. Majority mentioned using methylated spirits (41.6%), other antiseptics (23.3%) and salty water (11.3%). Other substances used for cord care included plain water, herbal extracts, cow dung, soil, and breast milk. Despite 100% awareness of CHX among health workers, only a third of caregivers (38.7%) had heard of CHX. About 76.9% of participants preferred the gel formulation and 8.9% did not know where to get the product. Drivers of CHX use included faster cord healing, infection control in hospitals, ease of use, cost implications, ease of access, influence from key decision makers and preferred CHX formulation. Barriers included minimal awareness among caregivers, cultural practices and taboos on cord care, inadequate capacity building of CHVs on CHX, unclear CHX user guidelines for caregivers, prolonged stockouts and inadequate knowledge of CHX in communities. Healthcare workers highlighted poor dissemination of CHX guidelines by the Ministry of Health, unavailability in the Kenya Medical Supplies Authority (KEMSA) and Mission for Essential Drugs and Supplies logistic management information system making it difficult to procure. There is a need for advocacy to promote the uptake of CHX in facilities and increase knowledge of communities on CHX as well as manage the supply chain to increase CHX availability
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Migowa, Angela N., William M. Macharia, Pauline Samia, John Tole, and Alfred K. Keter. "Effect of a voice recognition system on pediatric outpatient medication errors at a tertiary healthcare facility in Kenya." Therapeutic Advances in Drug Safety 9, no. 9 (June 20, 2018): 499–508. http://dx.doi.org/10.1177/2042098618781520.
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Background: Medication-related errors account for one out of every 131 outpatient deaths, and one out of 854 inpatient deaths. The risk is threefold greater in the pediatric population. In sub-Saharan Africa, research on medication-related errors has been obscured by other health priorities and poor recognition of harm attributable to such errors. Our primary objective was to assess the effect of introduction of a voice recognition system (VRS) on the prevalence of medication errors. The secondary objective was to describe characteristics of observed medication errors and determine acceptability of VRS by clinical service providers. Methods: This was a before–after intervention study carried out in a Pediatric Accident and Emergency Department of a private not-for-profit tertiary referral hospital in Kenya. Results: A total of 1196 handwritten prescription records were examined in the pre-VRS phase and 501 in the VRS phase. In the pre-VRS phase, 74.3% of the prescriptions (889 of 1196) had identifiable errors compared with 65.7% in the VRS phase (329 of 501). More than half (58%) of participating clinical service providers expressed preference for VRS prescriptions compared with handwritten prescriptions. Conclusions: VRS reduces medication prescription errors with the greatest effect noted in reduction of incorrect medication dosages. More studies are needed to explore whether more training, user experience and software enhancement would minimize medication errors further. VRS technology is acceptable to physicians and pharmacists at a tertiary care hospital in Kenya.
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Nakphong, Michelle Kao, Emma Sacks, James Opot, and May Sudhinaraset. "Association between newborn separation, maternal consent and health outcomes: findings from a longitudinal survey in Kenya." BMJ Open 11, no. 9 (September 2021): e045907. http://dx.doi.org/10.1136/bmjopen-2020-045907.
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ObjectivesDisrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors or associated outcomes. This study examined these experiences and associations with healthcare satisfaction, use and breast feeding.DesignProspective cohort study.Setting3 public hospitals, 2 private hospitals, and 1 health centre/dispensary in Nairobi and Kiambu counties in Kenya.ParticipantsData were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1014 women surveyed at baseline and at least one follow-up at 2–4 or 10 weeks post partum.Primary and secondary outcome measures(1) Outcomes related to satisfaction with care and care utilisation; (2) continuation of post-discharge newborn care practices such as breast feeding.Results17.6% of women reported newborn separation at the facility, of whom 71.9% were separated over 10 min. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 min) were 44% less likely to be exclusively breast feeding at 2–4 weeks (adjusted OR (aOR)=0.56, 95% CI: 0.40 to 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95% CI: 1.67 to 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95% CI: 1.05 to 1.55), and 33% greater likelihood of exclusive breast feeding at 10 weeks (aOR=1.33, 95% CI: 1.10 to 1.62).ConclusionsNewborns, mothers and families have a right to high-quality, respectful care, including the ability to stay together, be informed and properly consent for care. The implications of these experiences on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care.
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Bulinda, Hudson Shilibwa, and Felix Kiruthu. "Effects of Devolution on Maternal Health Care: The Case of Level Four Hospitals in Nairobi City County, Kenya." International Journal of Current Aspects 3, no. II (April 29, 2019): 98–116. http://dx.doi.org/10.35942/ijcab.v3iii.9.
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Maternal healthcare is an integral part of the Millennium development goals. However, most developing countries have been experimenting with different types of interventions to increase access and utilization of maternal care services. Health care devolution was greeted with great anticipation in Kenya as a means of bringing services closer to the people. However, since the implementation of the recent devolution reforms, criticism has mounted, with evidence of corruption, poor management, late payment of county staff and considerable disaffection among service providers, especially health professionals. Thus, this study assessed the effects of devolution on maternal health care in Nairobi City County in Kenya. Particularly, the study examined the situation of maternal healthcare before and after devolution and how devolution as affected provision of maternal healthcare in Nairobi City County. The study also assessed how devolution affected maternal health care programs implementation and the challenges facing the devolved maternal health care in Nairobi City County. The study adopted the systems approach and the decentralization theorem. This study employed a descriptive research design and the population of the study was made up of the 4 level four hospitals in Nairobi County and all the 189 selected medical health workers in the hospitals. A sample of 57 respondents was selected through simple random sampling. Additionally, the study used questionnaires and an interviews guide to collect data. The questionnaires were administered to the sampled medical workers and the interviews schedules were administered to the key informants who comprised of the medical superintendent from every hospital. Quantitative data was collected through the use of the questionnaires was analyzed using descriptive statistics with the aid of the Statistical Package for Social Sciences. Qualitative data was analyzed using content analysis. The study found that the status of maternal healthcare infrastructure under devolution of health services in Nairobi was good. The findings also established that most health workers preferred that the national government should manage maternal health care infrastructure as opposed to county governments. The study further revealed that county governments had not instituted and implemented effective maternal healthcare programs formulated by the national government. Finally, the study concludes the major challenges influencing the implementation of maternal healthcare services include attitude and perception of health professionals, resistance of devolution by health workers, strikes by health workers, shortage of healthcare workers corruption and tribalism, increased pressure on hospital equipment and infrastructure and stock outs of essential commodities in the facilities affect devolved maternal health care. The study recommended that both the county and national government should work together and combine their efforts to enhance the devolved systems of healthcare so that they can enhance maternal healthcare.
This is an open-access article published and distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License of United States unless otherwise stated. Access, citation and distribution of this article is allowed with full recognition of the authors and the source.
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Wafula, Martin Alfred Wekesa, David Masinde, and Sherry Olichina. "Effect of devolution of healthcare services on the motivation and retention of medical personnel in Bungoma County." International Journal Of Community Medicine And Public Health 8, no. 6 (May 25, 2021): 2685. http://dx.doi.org/10.18203/2394-6040.ijcmph20211970.
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Background: In struggle to achieve sustainable development goal (SDGS) number three ‘good health and well-being,’ populace is at liberty to be treated by a trained, motivated and valued medical workers. Nevertheless, the challenge of medical workers’ motivation and retention persist in Bungoma County, Kenya, Africa and universally. In a devolved healthcare system implementation, medical workers ‘motivation and retention is vital, but it has grown a predicament of devolution of healthcare. Transition of power from national to county governments has however created turbulence in enthusiasm and retention of medical workers at Bungoma County marked within consistency, poor understanding of health system, management issues and lack of coordination between the two levels of government.Methods: A cluster sample design was used to select 299 health care providers to participate in the study. Data was collected using structured questionnaires and a Focus Group discussion guides.Results: In view of retention: 50.9% (152) of the respondents affirmed their zeal to remain working for Bungoma county while 49.1% (147) would walk out of which 26.9% (40) would prefer NGO, 11.7% (18) out of the country, 6.3% (10) in FBOs and 4.2% (7) in private institutions. Inadequate staff, transport, inadequate supportive supervision, essentials (gloves) contribute to dissatisfaction of medical workers.Conclusions: Senior medical professionals in specialized services are leaving Bungoma County for better working condition and the morale of staff is low due to remunerations.
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Pineda-Antunez, Carlos, David Contreras-Loya, Alejandra Rodriguez-Atristain, Marjorie Opuni, and Sergio Bautista-Arredondo. "Characterizing health care provider knowledge: Evidence from HIV services in Kenya, Rwanda, South Africa, and Zambia." PLOS ONE 16, no. 12 (December 2, 2021): e0260571. http://dx.doi.org/10.1371/journal.pone.0260571.
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Background Identifying approaches to improve levels of health care provider knowledge in resource-poor settings is critical. We assessed level of provider knowledge for HIV testing and counseling (HTC), prevention of mother-to-child transmission (PMTCT), and voluntary medical male circumcision (VMMC). We also explored the association between HTC, PMTCT, and VMMC provider knowledge and provider and facility characteristics. Methods We used data collected in 2012 and 2013. Vignettes were administered to physicians, nurses, and counselors in facilities in Kenya (66), Rwanda (67), South Africa (57), and Zambia (58). The analytic sample consisted of providers of HTC (755), PMTCT (709), and VMMC (332). HTC, PMTCT, and VMMC provider knowledge scores were constructed using item response theory (IRT). We used GLM regressions to examine associations between provider knowledge and provider and facility characteristics focusing on average patient load, provider years in position, provider working in another facility, senior staff in facility, program age, proportion of intervention exclusive staff, person-days of training in facility, and management score. We estimated three models: Model 1 estimated standard errors without clustering, Model 2 estimated robust standard errors, and Model 3 estimated standard errors clustering by facility. Results The mean knowledge score was 36 for all three interventions. In Model 1, we found that provider knowledge scores were higher among providers in facilities with senior staff and among providers in facilities with higher proportions of intervention exclusive staff. We also found negative relationships between the outcome and provider years in position, average program age, provider working in another facility, person-days of training, and management score. In Model 3, only the coefficients for provider years in position, average program age, and management score remained statistically significant at conventional levels. Conclusions HTC, PMTCT, and VMMC provider knowledge was low in Kenya, Rwanda, South Africa, and Zambia. Our study suggests that unobservable organizational factors may facilitate communication, learning, and knowledge. On the one hand, our study shows that the presence of senior staff and staff dedication may enable knowledge acquisition. On the other hand, our study provides a note of caution on the potential knowledge depreciation correlated with the time staff spend in a position and program age.
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Kirengo, Thomas Onyango. "Frugal digitization of analog video endoscopic medical records in a Kenyan rural medical center." Annals of African Surgery 20, no. 1 (January 18, 2023): 3–6. http://dx.doi.org/10.4314/aas.v20i1.2.
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Background: Digitization of healthcare data has led to widespread healthcare transformation. This has been enhanced by the availability of new technologies at lower costs. Video recording can improve the quality of care, provider skills, education, and patient follow-up. However, limitations such as the risk of litigation, patient privacy, and poor legal framework have curtailed adoption. Rural hospitals have older analog equipment due to limited financial resources. Objectives: This study aims to present an alternative low-cost option. Methods: We present an economical method of recording and digitizing endoscopic and laparoscopic procedures performed on analog video processing towers. We showcase a video of the step-by-step procedure that involves connecting a digital video home system (VHS) video recorder to an analog Olympus endoscopy machine (Model CV-100) and transferring media via a portable storage device to an electronic medical record database. Conclusion: Using simple home video recording devices provides a low-cost solution to creating digital records from analog video endoscopic machines. The technique, however, creates additional steps to the endoscopy process and the need for capacity building of the endoscopist. Patient consent forms should cover video creation. Medical centers should have a robust information management system to securely store and retrieve digitized video records.
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Anino, OC, GM Were, and JW Khamasi. "Impact evaluation of positive deviance hearth in Migori county, Kenya." African Journal of Food, Agriculture, Nutrition and Development 15, no. 72 (December 7, 2015): 10578–96. http://dx.doi.org/10.18697/ajfand.72.15395.
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A Positive Deviance (PD) Hearth intervention is a home and neighborhood-based nutrition program for children who are at risk for protein-energy malnutrition in a low resource community. The intervention uses the ‘Positive Deviance’ approach to identify those behaviors practiced by the mothers or caretakers of well-nourished children from poor families and transfers such positive practices to other mothers who are equally disadvantaged economically. Positive Deviance Hearth intervention is designed to treat malnourished children, enable the families to sustain their rehabilitation at home on their own and to prevent malnutrition in younger siblings. However, PD Hearth intervention monitoring system in Migori only assesses a program’s ability to treat, one of the three PD Hearth objectives. Thus, there was need for impact evaluation to measure outcomes of the PD Hearth intervention to sustain rehabilitation and prevent malnutrition in younger siblings. The objectives of the study were to determine the level to which PD Hearth enables families to sustain rehabilitation at home on their own and to identify the practices which influence PD Hearth outcomes. The study was designed as a pipeline quasi-experimental and mixed method was used to collect data and perform statistical analyses. Single stage cluster sampling was used to identify 53 and 54 children on the intervention and comparison group in five communities. Weight measurements of the children on the intervention aged 6 to 59 months at the entry, exit and graduation stages were retrieved from Kenya Medical Research Institute Family AIDS Care and Education Services programme activities reports. Anthropometry (height measurements) for the children on the intervention and comparison children was taken. Caregivers filled in a questionnaire, assisted by the researchers as necessary. At entry, 18.9% children on the intervention had moderate underweight while 43.4% had mild underweight. At current status though, 3.8% and 34.0% had moderate and mild underweight respectively. The regression model predicted that Weight-for-Height (WAZ) of the children on the intervention at current status lied on 51.5 percentile, thus, normal for underweight. Increased feeding frequency made the largest contribution to weight gain than other caregiver practices. Therefore, the Migori County government in collaboration with the Ministry of Health needs to scale up PD Hearth intervention to reverse cases of Moderate Acute Malnutrition (MAM) and prevent Severe Acute Malnutrition (SAM) in the County.
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Karisa, Joseph Yaa, and Lawrence Wainaina. "Balanced Scorecard Perspectives and Organizational Performance: Case of Kenyatta National Hospital, Kenya." International Journal of Business Management, Entrepreneurship and Innovation 2, no. 3 (October 20, 2020): 102–13. http://dx.doi.org/10.35942/jbmed.v2i3.140.
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The balanced scorecard is a framework that organizations follow in aligning the organization strategy, communicate organization’s mission, prioritize projects, services and products as well as monitoring and measuring the advancement towards attaining the strategic objectives or targets. The overall organizational performance of Kenyatta National Hospital is still not up to standard even though it is anticipated to established high health-care standards offered to the public so that private and public hospitals can follow. Reports have revealed that cancer, heart, and kidney patients receive delayed treatment. In addition, the hospital is said to lack enough functional specialized medical equipment as well as inadequate financial support, industrial unrests, patients overcrowding, claims of medical negligence and poor service delivery. Therefore, it a major concern to the government and other stakeholders. Based on these challenges, Kenyatta National Hospital introduced a five-year strategic plan 2013 to 2018 centred on the Balanced Scorecard approach. It was within this context that the study sought to establish the influence of balanced scorecard perspectives on organizational performance of Kenyatta national hospital. The study was guided by the following specific objectives; to find out whether focus on customer perspective, financial perspective, internal business processes perspective, learning and growth perspective influence the performance of KNH Kenya. The study was also guided by Stakeholder theory, Resource based view theory and institutional theory. The study adopted a descriptive research design with quantitative techniques. The target population for the study were 80 management staff of KNH. The sample size for the study was calculated to be 67. The study used stratified random sampling procedure and simple random sampling to recruit a sample that represented the target population. Data was collected using a pre-tested structured questionnaire to capture participants insight on balanced scorecard perspectives and the overall organizational performance. Their responses on several items were scored and the scores were used in bivariate analysis and Multiple regression analysis. Descriptive statistics like measures of central tendency were used for continuous data while frequencies were used for categorical data. The data analysis was done using SPSS version 23. These results show that financial perspective and customer perspectives focus were statistically significant predictor of organizational performance at (p<0.05) while internal business process and learning and growth were not statistically significant when regressed together. An R squared of 0.593 which implied that focusing on all of the balanced scorecard perspectives contributed up to 59.3% of organizational performance. The study concludes that focus on balanced scorecard perspectives have a positive influence on organizational performance. However, there are variation on the magnitude of influence among the perspective. Therefore, the balanced scorecard can be used as a strategic management tool in public facilities and not only as a measurement tool. The study recommends that KNH should continue using the balanced scorecard and other public hospitals or institutions should also adopt it. The continuous usage and new adoption of the balanced scorecard would ensure better organizational performance.
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Wangari, Isaac Mwangi, Stanley Sewe, George Kimathi, Mary Wainaina, Virginia Kitetu, and Winnie Kaluki. "Mathematical Modelling of COVID-19 Transmission in Kenya: A Model with Reinfection Transmission Mechanism." Computational and Mathematical Methods in Medicine 2021 (October 16, 2021): 1–18. http://dx.doi.org/10.1155/2021/5384481.
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In this study we propose a Coronavirus Disease 2019 (COVID-19) mathematical model that stratifies infectious subpopulations into: infectious asymptomatic individuals, symptomatic infectious individuals who manifest mild symptoms and symptomatic individuals with severe symptoms. In light of the recent revelation that reinfection by COVID-19 is possible, the proposed model attempt to investigate how reinfection with COVID-19 will alter the future dynamics of the recent unfolding pandemic. Fitting the mathematical model on the Kenya COVID-19 dataset, model parameter values were obtained and used to conduct numerical simulations. Numerical results suggest that reinfection of recovered individuals who have lost their protective immunity will create a large pool of asymptomatic infectious individuals which will ultimately increase symptomatic individuals with mild symptoms and symptomatic individuals with severe symptoms (critically ill) needing urgent medical attention. The model suggests that reinfection with COVID-19 will lead to an increase in cumulative reported deaths. Comparison of the impact of non pharmaceutical interventions on curbing COVID19 proliferation suggests that wearing face masks profoundly reduce COVID-19 prevalence than maintaining social/physical distance. Further, numerical findings reveal that increasing detection rate of asymptomatic cases via contact tracing, testing and isolating them can drastically reduce COVID-19 surge, in particular individuals who are critically ill and require admission into intensive care.
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N Tanyi, William, Onesmus Gachuno, Theresa Odero, Carey Farquhar, David Kimosop, and Allan Mayi. "Factors affecting adherence to antiretroviral therapy among children and adolescents living with HIV in the Mbita Sub County Hospital, Homa Bay- Kenya." African Health Sciences 21 (May 23, 2021): 18–24. http://dx.doi.org/10.4314/ahs.v21i.4s.
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Background: Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adoles- cents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance.
Objectives: To describe the uptake of HIV treatment services among children and adolescents in the Mbita Sub-County Hospital, Homa Bay and determine how schooling, clinic attendance, and type of pill/regimen affect adherence to ART and viral suppression.
Methods: This retrospective study was conducted at the Mbita Sub-County Hospital. Medical chart data was abstracted from the hospital files of children and adolescents between the ages of 0-19 years on antiretroviral therapy, between the periods of October 2016 and September, 2017. Data was analyzed using measures of central tendency, and cross-tabulations were done to compare schooling, clinic attendance, type of pill/regimen and viral suppression. Univariate and multivariate logistic regression analyses were conducted to determine associations between groups.
Results: According to patient files reviewed, majority of patients, 244(91.4%) were enrolled into care within 2 weeks of HIV diagnosis according to guidelines, and 193(73.1 %) remained enrolled in care at end of study period. An overall viral suppression of 74.2 %( 132) was recorded. Of all the files reviewed, 121(74.7%) of patients attending school suppressed against 11(68.8 %) out of school, p=0.280. Suppression among Day and boarding reported at 78.6 %( 11) and 74.8 %( 113) of those out of school, respectively, p=0.533. Participants in primary school, 17(85.0%) suppressed better than those in secondary school, 102(73.4%), p=0.263. Keeping clinic appointments among eligible patient files reviewed decreased from 83.1% at 3 months, p=0.016, to 76.6%, p=0.526 at 6 months and to 52.9% at 12 months, p=0.278. Only 3- month clinic appointment return rates and Enhanced Adherence Counseling (EAC) were significant predictors of viral supression χ2 (2) = 0.280, p = 0.869 (> 0.05).
Conclusion: The clinic attendance rate within the first 3 months, and Enhanced Adherence Counseling (EAC) were signif- icant predictors of viral suppression, and therefore adherence to antiretroviral therapy.
Keywords: Adherence; clinic attendance; antiretroviral therapy; HIV; virologic suppression.
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N Tanyi, William, Onesmus Gachuno, Theresa Odero, Carey Farquhar, David Kimosop, and Allan Mayi. "Factors affecting adherence to antiretroviral therapy among children and adolescents living with HIV in the Mbita Sub County Hospital, Homa Bay- Kenya." African Health Sciences 21, no. 1 (May 23, 2021): 18–24. http://dx.doi.org/10.4314/ahs.v21i1.4s.
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Background: Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adoles- cents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance.
Objectives: To describe the uptake of HIV treatment services among children and adolescents in the Mbita Sub-County Hospital, Homa Bay and determine how schooling, clinic attendance, and type of pill/regimen affect adherence to ART and viral suppression.
Methods: This retrospective study was conducted at the Mbita Sub-County Hospital. Medical chart data was abstracted from the hospital files of children and adolescents between the ages of 0-19 years on antiretroviral therapy, between the periods of October 2016 and September, 2017. Data was analyzed using measures of central tendency, and cross-tabulations were done to compare schooling, clinic attendance, type of pill/regimen and viral suppression. Univariate and multivariate logistic regression analyses were conducted to determine associations between groups.
Results: According to patient files reviewed, majority of patients, 244(91.4%) were enrolled into care within 2 weeks of HIV diagnosis according to guidelines, and 193(73.1 %) remained enrolled in care at end of study period. An overall viral suppression of 74.2 %( 132) was recorded. Of all the files reviewed, 121(74.7%) of patients attending school suppressed against 11(68.8 %) out of school, p=0.280. Suppression among Day and boarding reported at 78.6 %( 11) and 74.8 %( 113) of those out of school, respectively, p=0.533. Participants in primary school, 17(85.0%) suppressed better than those in secondary school, 102(73.4%), p=0.263. Keeping clinic appointments among eligible patient files reviewed decreased from 83.1% at 3 months, p=0.016, to 76.6%, p=0.526 at 6 months and to 52.9% at 12 months, p=0.278. Only 3- month clinic appointment return rates and Enhanced Adherence Counseling (EAC) were significant predictors of viral supression χ2 (2) = 0.280, p = 0.869 (> 0.05).
Conclusion: The clinic attendance rate within the first 3 months, and Enhanced Adherence Counseling (EAC) were signif- icant predictors of viral suppression, and therefore adherence to antiretroviral therapy.
Keywords: Adherence; clinic attendance; antiretroviral therapy; HIV; virologic suppression.
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Abubakar, Aisha Halako, and Lawrence Wainaina. "Staff Turnover and Organizational Performance of Selected Private Hospitals in Kilifi County, Kenya." International Journal of Current Aspects 3, no. VI (December 4, 2019): 309–26. http://dx.doi.org/10.35942/ijcab.v3ivi.91.
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The performance within most of the private hospitals in Kilifi County has been deteriorating as more of its staff is leaving the private hospitals in search of the county government jobs. The study took a look at the results of personnel turnover on the organizational performance of chosen private hospitals in Kilifi County. The specific goals that assisted the research study were to evaluate the impact of voluntary turnover, involuntary turnover, functional turnover and dysfunctional turnover on the organizational performance. Theories utilized consisted of equity theory, human capital theory expectancy theory and balance score card model. The study embraced the descriptive research study design. The reliability of the survey was tested utilizing a pilot study. Main data was gathered utilizing close-ended questions. The study utilized a population of 53 top and middle-level managers in 6 private hospitals in Kilifi County. The sample size was accomplished using Stratified sampling. The population studied was subdivided into three strata; personnel supervisors, administrators and assistant administrators and departmental heads. SPSS was utilized to examine the information. The findings of the study developed that the four types of turnover under investigation had either a weak or moderate relationship with organizational efficiency. The study, for that reason, concluded that voluntary and practical turnover favorably relates with the organizational efficiency of the personal medical facility while both uncontrolled turnover and inefficient turnover negatively related with the organizational performance of the personal healthcare facilities in Kilifi County. Based on the conclusion, the study recommended that management should improve employee compensation and offer training to their employees as they contribute to employee voluntary exit. Management should put measures in place to reduce cases of indiscipline and fraud which causes involuntary turnover among the employees. Measures should also be implemented to help improve the health of the staff and reduce stress levels. Concerning functional turnover, the study recommended that private hospitals should have a good system of employment that promotes the retention of good performers and the release of poor performers. Finally, the study recommended that dysfunctional turnover should be avoided as it negatively affects organizational performance. Measures should, therefore, be put in place to discourage the departure of competent and high performing employees.
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Wamithi, S. "Cross-Sectional Survey on Prevalence of Attention Deficit Hyperactivity Disorder Symptoms at A Tertiary Care Health Facility in Nairobi." Paediatrics & Child Health 21, Supplement_5 (June 1, 2016): e66a-e67. http://dx.doi.org/10.1093/pch/21.supp5.e66a.
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Abstract BACKGROUND: Attention deficit hyperactivity disorder is considered the most common childhoodneurobehavioral disorder worldwide with well documented adverse consequences in adolescence and adulthood, yet 60-80% of cases go undiagnosed. Routinescreening for the condition is not practiced in most pediatric outpatient services andlittle information exists on factors associated with the condition in developingcountries. OBJECTIVES: This was a questionnaire based cross-sectional survey whose primary objective was to determine prevalence of attention deficit hyperactivity disorder (ADHD) symptoms in children aged 6-12 years attending the Accidents and Emergency unit of a tertiary care hospital in Nairobi. Secondary objectives were to (i) ascertain if physical injury and poor academic performance were associated with ADHD, (ii) compare diagnostic utility of parent-filled Vanderbilt Assessment Scale (VAS) against Statistical Manual of Mental Disorders-IV (DSM-IV) as the gold reference and (iii) establish if there exists an association between ADHD symptoms cluster and comorbid conditions. DESIGN/METHODS: The study was undertaken at the paediatric accidents and emergency (A&E) section of the Aga Khan University Hospital (AKUHN) between March and June 2012. AKUHN is a private, not for profit, tertiary health care facility based in Nairobi, Kenya. Paediatrics A&E offers a 24-hour service provided by paediatric residents and senior house officers under the supervision of paediatric registrars. Children aged 6-12 years were enrolled provided guardians demonstrated ability to read and write in English. A written signed informed consent was also required from the primary care provider. Children on methylphenidate, antidepressants or behavioral therapy and those with neurological disorders, hearing and visual impairments or need for emergency care were excluded. Those who consented were clinically evaluated and treated for the ailments that brought them to hospital prior to completion of the self-administered study questionnaire. Sample size was estimated at 240 based on estimated ADHD prevalence of 6% reported by Kashala et al from a neighboring country with similar socio-economic setting as Kenya. Study approval was obtained from the Aga Khan University Hospital Scientific and Ethical Review Committees. Enrolling of children was done after written consent from parents or primary guardians as required by the institutional review board for children under the age of 18 years. It was made clear that recruitment was entirely voluntary and that refusal to participate would not in any way compromise provision of care. Study records were secured in a locked cabinet to safeguard confidentiality. Study was carried out using a two-stage ascertainment procedure. Children were evaluated for eligibility after registration at the reception between 9am to 8pm during week days. A maximum of 10 participants were recruited on any given day to minimize burden in the department and to hopefully capture a wider spectrum of medical conditions. Details about the study were explained to the parents by the principal investigator or the research assistant after patients had been seen by the clinician for the presenting problem. Information necessary for DSM-IV classification was obtained from parents who also completed VAS form. Care providers of study children were requested to complete the risk assessment form with assistance provided as needed. It contained questions about school performance such as repetition of class and average end of term marks which was categorized as; below 25%, 25-50%, 50-75% or above 75%. A grade above 50% was considered as acceptable performance. Only injuries for which medical treatment was sought were considered for inclusion and categorized into burns,fractures and open wounds. Information on causes of injuries was classified under falls, fight, car accident and others. Completion of an assessment form took approximately 15 minutes after which questionnaire was scored and tabulated before providing feedback to parents. Data were entered in Microsoft Excel® and analysis done using STATA®Version 11 (StataCorp). Prevalence of ADHD symptoms was calculated using the number of positive cases as numerator and study population as denominator. Chi square or Fischer’s exact test were used as appropriate to compare categorical variables with P-value below 0.05 considered significant. Wilcoxon test was used for ordinal data. Odds ratios (OR) were used to determine association between ADHD symptoms and categorical variables and 95% confidence interval (CI) to determine precision around individual estimates. RESULTS: Prevalence of cluster of symptoms consistent with ADHD was 6.3% (95% CI; 3.72-10.33) in 240 children studied. Those affected were more likely to repeat classes than the asymptomatic (OR 20.2; 95%CI 4.02-100.43). Additionally, 67% of the symptomatic had previously experienced burns and 37% post-traumatic open wounds. The odds of having an injury in the symptomatic was 2.9 (95%CI; 1.01-8.42) compared to the asymptomatic. Using DSM-IV as the reference, VAS had a low sensitivity of 66.7% (95%; CI 39.03-87.12) but specificity of 99.0% (95%CI; 96.1-99.2). Its positive predictive value was 83.0% (95%CI; 50.4-97.3) and the negative predictive value 98.0% (CI 95.1-99.1). Positive and negative likelihood ratios were 75(95%CI; 18.3-311.2) and 0.3 (95%; CI 0.21-0.73) respectively. Oppositional defiant disorder symptoms, anxiety, depression and conduct problems were not significantly associated with ADHD cluster of symptoms. CONCLUSION: A relatively high prevalence of symptoms associated with ADHD was found inchildren visiting the Paediatric Accidents and Emergency department. Symptomaticchildren had also experienced more poor school performance. These findings makea strong case for introduction of a policy on routine screening for ADHD in pediatricoutpatient service in a similar setting. Positive history of injury, especially burns, and poor academic performance is associated with symptoms of ADHD which should trigger need forfurther evaluation for ADHD and appropriate referral. Even though easier toadminister than DSM-IV, Vanderbilt assessment scale has low sensitivity hence itwould not be appropriate for use in ADHD screening. However, in view of its highspecificity and ease of administration, it could be used as an alternative confirmatorytest to determine who among clinically symptomatic patients would require referral to a psychiatrist for further evaluation and management.
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Allbrook, David. "Palliative Care in Kenya." Journal of Pain & Palliative Care Pharmacotherapy 17, no. 3-4 (January 2004): 185–89. http://dx.doi.org/10.1080/j354v17n03_27.
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Allbrook, David. "Palliative Care in Kenya." Journal Of Pain & Palliative Care Pharmacotherapy 17, no. 3 (January 28, 2004): 185–89. http://dx.doi.org/10.1300/j354v17n03_27.
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Mwabu, Germano, Joseph Wang'ombe, and Benjamin Nganda. "The Demand for Medical Care in Kenya." African Development Review 15, no. 2-3 (December 2003): 439–53. http://dx.doi.org/10.1111/j.1467-8268.2003.00080.x.
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Storlie, Frances. "Medical Care for Nicaraguan Poor." Nurse Practitioner 15, no. 4 (April 1990): 11. http://dx.doi.org/10.1097/00006205-199004000-00006.
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Saini, Vikas, Sandra Garcia-Armesto, David Klemperer, Valerie Paris, Adam G. Elshaug, Shannon Brownlee, John P. A. Ioannidis, and Elliott S. Fisher. "Drivers of poor medical care." Lancet 390, no. 10090 (July 2017): 178–90. http://dx.doi.org/10.1016/s0140-6736(16)30947-3.
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Lusambili, Adelaide, Stefania Wisofschi, Constance Shumba, Jerim Obure, Kennedy Mulama, Lucy Nyaga, Terrance J. Wade, and Marleen Temmerman. "Health Care Workers’ Perspectives of the Influences of Disrespectful Maternity Care in Rural Kenya." International Journal of Environmental Research and Public Health 17, no. 21 (November 6, 2020): 8218. http://dx.doi.org/10.3390/ijerph17218218.
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While disrespectful treatment of pregnant women attending health care facilities occurs globally, it is more prevalent in low-resource countries. In Kenya, a large body of research studied disrespectful maternity care (DMC) from the perspective of the service users. This paper examines the perspective of health care workers (HCWs) on factors that influence DMC experienced by pregnant women at health care facilities in rural Kisii and Kilifi counties in Kenya. We conducted 24 in-depth interviews with health care workers (HCWs) in these two sites. Data were analyzed deductively and inductively using NVIVO 12. Findings from HCWs reflective narratives identified four areas connected to the delivery of disrespectful care, including poor infrastructure, understaffing, service users’ sociocultural beliefs, and health care workers’ attitudes toward marginalized women. Investments are needed to address health system influences on DMC, including poor health infrastructure and understaffing. Additionally, it is important to reduce cultural barriers through training on HCWs’ interpersonal communication skills. Further, strategies are needed to affect positive behavior changes among HCWs directed at addressing the stigma and discrimination of pregnant women due to socioeconomic standing. To develop evidence-informed strategies to address DMC, a holistic understanding of the factors associated with pregnant women’s poor experiences of facility-based maternity care is needed. This may best be achieved through an intersectional approach to address DMC by identifying systemic, cultural, and socioeconomic inequities, as well as the structural and policy features that contribute and determine peoples’ behaviors and choices.
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Kimani, Diana N., Mercy G. Mugo, and Urbanus M. Kioko. "Catastrophic Health Expenditures And Impoverishment In Kenya." European Scientific Journal, ESJ 12, no. 15 (May 30, 2016): 434. http://dx.doi.org/10.19044/esj.2016.v12n15p434.
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Background: Out-of-pocket health expenditures leave households exposed to the risk of financial catastrophe and poverty whenever they entail significant dissaving or the sale of key household assets. Even relatively small expenditures on health can be financially disastrous for poor households and similarly, large health care expenditures can lead to financial catastrophe and bankruptcy for rich households. Objective: There is increasing evidence that out-of-pocket expenditures act as a financial barrier to accessing health care, and are a source of catastrophic expenditures and impoverishment. This paper estimates the burden of out-of-pocket payments in Kenya; the incidence and intensity of catastrophic health care expenditure and impoverishment in Kenya. Methods: Using Kenya Household Health Expenditures and Utilization Survey data of 2007, the study uses both descriptive and econometric analysis to investigate the incidence and intensity of catastrophic health expenditures and impoverishment as well as the determinants of catastrophic health expenditures. To estimate the incidence and intensity of catastrophic expenditures and impoverishment, the study used both Wagstaff and van Doorslaer, (2002) and Xu et al. (2005) and applied various thresholds to demonstrate the sensitivity of catastrophic measures. For determinants of catastrophic health expenditures, a logit model was employed. Findings: Among those who utilized health care, 11.7 percent experienced catastrophic expenditures and 4 percent were impoverished by health care payments. In addition, approximately 2.5 million individuals were pushed into poverty as a result of paying for health care. The poor experienced the highest incidence of catastrophic expenditures. Conclusion: The paper recommends that the government should establish avenues for reducing the burden of out-of-pocket expenditures borne by households. This could be through a legal requirement for everyone to belong to a health insurance and targeting the poor, the elderly and chronically ill through the devolved system of the government and devolved funds.
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Jacobson, Mark L. "Primary Health Care and Protestant Medical Missionaries in Kenya." Tropical Doctor 15, no. 4 (October 1985): 198–99. http://dx.doi.org/10.1177/004947558501500420.
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Sharma, Jigyasa, Hannah H. Leslie, Francis Kundu, and Margaret E. Kruk. "Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya." PLOS ONE 12, no. 1 (January 31, 2017): e0171236. http://dx.doi.org/10.1371/journal.pone.0171236.
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Ali, Z. "Integrating Palliative Care in Cancer Care in Kenya." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 164s. http://dx.doi.org/10.1200/jgo.18.35700.
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Background and context: Most Africa countries now recognize the pain and suffering of many patients and families who have no access to cure (where cure is possible), cannot afford treatment of cancer or other progressive chronic illnesses, are stigmatized or discriminated against because of their illness among many other dehumanizing issues. This project aims to ensure that all those in need of palliative care and pain relief have access close to their homes. Aim: This project aims to ensure that all those in need of palliative care and pain relief have access close to their homes. Strategy/Tactics: In the recent past Kenya Hospices and Palliative Care Association has extensively advocated for the integration of palliative care into the Kenya health services; thus, resulting in many health care professionals being trained in palliative care; integration of palliative care in public, private and mission health institutions and integration of palliative care in undergraduate medical and nursing curricula, as well as policy documents. Program/Policy process: The process of integrating palliative care in public hospitals involved advocacy at the national level as well as at the institutional level, training of health care professionals and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Outcomes: Palliative care units have been set up in over 25 government hospitals across the country. National Palliative Care Guidelines have been developed. A Diploma in Palliative Care for nurses has been initiated at the Kenya Medical Training College since 2012. Palliative care has been included in all the relevant health policies/strategies. Kenya Essential Medicines List includes Opioids. The Ministry of Health is supplying morphine powder for the country. More patients are now able to access quality palliative care. What was learned: National associations are challenged by an enormous need for services, education and training of health care professionals as well as educating the public and policy makers. The government has no budget for palliative care and most of the work is donor funded. Cultural beliefs are a big barrier to accessing PC. Only a small fraction of patients in need of opioids for pain medication are receiving opioids due to lack of awareness; reluctance of HPCs to prescribe. For many years PC in Kenya has been provided by a few hospices, thus making access very limited to many who are in need. Regional and national associations in Africa should work together with African Ministries of Health and other relevant stakeholders to ensure that there is greater access to palliative care for cancer patients. This encompasses addressing issues of accessibility, affordability, quality palliative care (PC) and a human's right approach to PC.
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Cornetta, Kenneth, Susan Kipsang, Gregory Gramelspacher, Eunyoung Choi, Colleen Brown, Adam B. Hill, Patrick J. Loehrer, Naftali Busakhala, and F. Chite Asirwa. "Integration of Palliative Care Into Comprehensive Cancer Treatment at Moi Teaching and Referral Hospital in Western Kenya." Journal of Global Oncology 1, no. 1 (October 2015): 23–29. http://dx.doi.org/10.1200/jgo.2015.000125.
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Purpose The prognosis for the majority of patients with cancer in Kenya is poor, with most patients presenting with advanced disease. In addition, many patients are unable to afford the optimal therapies required. Therefore, palliative care is an essential part of comprehensive cancer care. This study reviews the implementation of a palliative care service based at the Moi Teaching and Referral Hospital in Eldoret, Kenya, and describes the current scope and challenges of providing palliative care services in an East African tertiary public referral hospital. Methods This is a review of the palliative care clinical services at the only tertiary public referral hospital in western Kenya from January 2012 through September 2014. Palliative care team members documented each patient's encounter on standardized palliative care assessment forms; data were then entered into the Academic Model Providing Access to Health Care (AMPATH)-Oncology database. Interviews were also conducted to identify current challenges and opportunities for program improvement. Results This study documents the implementation of a palliative care service line in Eldoret, Kenya. Barriers to providing optimal palliative cancer care include distance to pharmacies that stock opioids, limited selection of opioid preparations, education of health care workers in palliative care, access to palliative chemoradiation, and limited availability of outpatient and inpatient hospice services. Conclusion Palliative care services in Eldoret, Kenya, have become a key component of its comprehensive cancer treatment program.
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WELLSTONE, HONORA-BLE PAUL O. "SAEM Kennedy Lecture: Medical Care for the Poor." Academic Emergency Medicine 5, no. 12 (December 1998): 1140–44. http://dx.doi.org/10.1111/j.1553-2712.1998.tb02684.x.
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Iglehart, John K. "Medical Care of the Poor — A Growing Problem." New England Journal of Medicine 313, no. 1 (July 4, 1985): 59–63. http://dx.doi.org/10.1056/nejm198507043130134.
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Ginzberg, Eli. "Medical Care for the Poor: No Magic Bullets." JAMA: The Journal of the American Medical Association 259, no. 22 (June 10, 1988): 3309. http://dx.doi.org/10.1001/jama.1988.03720220055027.
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Ginzberg, E. "Medical care for the poor: no magic bullets." JAMA: The Journal of the American Medical Association 259, no. 22 (June 10, 1988): 3309–11. http://dx.doi.org/10.1001/jama.259.22.3309.
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Nyamute, Linda, Muthoni Mathai, and Anne Mbwayo. "Quality of sleep and burnout among undergraduate medical students at the university of Nairobi, Kenya." BJPsych Open 7, S1 (June 2021): S279. http://dx.doi.org/10.1192/bjo.2021.742.
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AimsThe main objective was to determine whether quality of sleep is associated with burnout among undergraduate medical students at the University of Nairobi.The null hypothesis in our study population was; 'There is no significant association between poor sleep quality and burnout'.BackgroundIn a pressure prevailing environment, medical students find themselves in a vicious cycle of cutting down on sleep in attempts to cope and adjust to increasing workloads. Students with poor sleep quality have been found to perform worse in their board exam and have strained social engagements. Ultimately, this chronic sleep deprivation may lead to burnout which may cause diminished sense of accomplishment and impaired professional conduct, that may be carried on to the career as a physician. High levels of burnout have been associated with suicides.MethodThe sample size obtained was 384 and participants were selected by a mixed sampling method. Data collection was through self-administered questionnaires. Scales used for this study were the Pittsburg Sleep Quality Index(PSQI) and the Oldenburg Burnout Inventory(OLBI).Ethical considerations were adhered to and approval obtained from the Kenyatta National Hospital-University of Nairobi(KNH-UON) Ethics Board. Data entry and analysis was by SPSS v23. Data from 336 questionnaires were deemed fit for analysis.ResultWith a response rate of 87.5%, the prevalence of poor sleep quality and burnout were 69.9% and 74.7% respectively. There was a significant positive association between poor sleep quality and female gender, clinical years of study, living with family, poorly perceived socio-economic state and poor subjective academic performance. In addition, being female, younger, pre-clinical years, living independently off-campus and poor subjective academic performance were significantly associated with higher levels of burnout.Burnout had a significant correlation with poor sleep quality. Daytime functioning, a component of sleep quality had the highest correlation with components of burnout, disengagement and exhaustion. Overall, 57% of the respondents had both poor sleep quality &burnout, while only 12% were good sleepers with no burnout. Furthermore, having poor sleep increased the risk of having burnout by 2.8times. It is crucial that students adopt better sleeping habits to reduce the risk of burnout.ConclusionWith the high prevalence of poor sleep quality and burnout, peer-support groups and peer-led mentorship programs are recommended within this population to help deal with expectations, challenges and difficulties encountered within the course of medical education, in addition to preparing for the early future careers.
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Mwabu, Germano, Martha Ainsworth, and Andrew Nyamete. "Quality of Medical Care and Choice of Medical Treatment in Kenya: An Empirical Analysis." Journal of Human Resources 28, no. 4 (1993): 838. http://dx.doi.org/10.2307/146295.
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Nguyen, Quynh-Uyen P., Neil Flynn, Morris Kitua, Esther M. Muthumbi, Daniel M. Mutonga, Jamilla Rajab, and Elizabeth Miller. "The Health Care Sector Response to Intimate Partner Violence in Kenya: Exploring Health Care Providers’ Perceptions of Care for Victims." Violence and Victims 31, no. 5 (2016): 888–900. http://dx.doi.org/10.1891/0886-6708.vv-d-13-00146.
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Intimate partner violence (IPV) is prevalent in Kenya, yet few studies have examined the role of health care providers (HCPs) in addressing IPV. Interviews with 18 Kenyan HCPs explored how they recognize and support IPV victims, including barriers to care. HCPs most commonly see victims of physical abuse. Medical responses to victims included counseling, treatment, and referrals, although rural HCPs reported fewer available services than in urban settings. HCPs attributed the limited response to IPV victims to unclear laws and fragmented care, especially in a culture where IPV remains largely unspoken and underreported. These results underscore the need for increased training on IPV assessment and response for HCPs in Kenya, with emphasis on standardized care guidelines for victims.
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Mutuku, J., and Dr M. Githae. "Delays in Africa Accessing Emergency Obstetric Care in Sub-Saharan; Kenya Situation." International Journal of Contemporary Research and Review 9, no. 07 (July 11, 2018): 20484–96. http://dx.doi.org/10.15520/ijcrr/2018/9/07/549.
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Delay in accessing facility for delivery by a skilled person has huge impact on maternal health outcomes in developing countries. However, women’s deaths at birth in Sub-Saharan countries remain high due to challenges associated with accessing immediate Emergency Obstetric Care (EmOC) at birth.
While the deaths are preventable through availability of EmOC and skilled persons attending to delivery, access to these services remain poor and most women continue to give birth at home without the assistance of a skilled person.
The purpose of the study was to identify barriers to accessing EmOC in order to suggest ways of increasing skilled birth attendance in Kenya, a strategy that is known to reduce maternal mortality and morbidity. Relevant literature from abstracts of scholarly journals from major search engines were scanned and analyzed for results.
Significant factors that were identified to cause delay in accessing EmOC are maternal education, financial status, ignorance, delay in decision making by family, preference for Traditional Birth Attendants (TBA), travel cost, means of transport, distance, and impassable roads. Further barriers are poor quality of care due to supplies and equipment shortage, rude, unwelcoming staff, user fees paid on admission and long waiting hours in the facilities.
Based on the findings, various barriers that hinder women from accessing EmOC exist. To increase the number of births assisted by skilled professionals and reduce maternal deaths, these barriers need to be tackled from family, community, and facility levels.
The recommendations include community sensitization and health education on pregnancy related danger signs, strengthening of health care systems to ensure availability of supplies, equipment, and improving referral systems. Integration of TBAs role to health care system will ensure timely referral and increased facility deliveries.
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Ilesanmi, Olayinka Stephen, Oladele Olufemi Ayodeji, Ayobami A. Bakare, Nelson Adedosu, Anthonia Adeagbo, Adedamola Odutayo, Felix Olugbenga Ayun, and Ayomide E. Bello. "Infection prevention and control (IPC) at a Lassa fever treatment center before and after the implementation of an intensive IPC program." Journal of Ideas in Health 3, no. 3 (October 21, 2020): 213–16. http://dx.doi.org/10.47108/jidhealth.vol3.iss3.66.
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Background: Infection prevention and control (IPC) programs are important to control the Lassa Fever (LF) outbreak. We reported IPC's status at the Federal Medical Centre, Owo, southwest Nigeria, before and after implementing the IPC program during a surge in the LF outbreak.
Methods: We conducted a longitudinal observational study among five health care professionals at the Federal Medical Centre, Owo, between February 2019 and May 2019 using the IPC Assessment Framework (IPCAF). The tool has eight core components with a score of 0-100 per component and provided a baseline assessment of the IPC program and evaluation after three months. We interviewed relevant unit heads and IPC committee members in the first phase. In the second phase, we designed and implemented the IPC program, and in the third phase, we conducted a repeat interview similar to the first phase. The program initiated included training healthcare workers and providing relevant IPC items according to identified gaps and available funding.
Results: We interviewed five health care professionals, two female nurses, and three male doctors responsible for organizing and implementing IPC activities at the Federal Medical Centre, Owo, with an in-depth understanding of IPC activities. The overall IPC level score increased from 318.5 at baseline to 545 at three months later. IPC improvements were reported in all the components, with IPC education and training [baseline (20), final (70)], IPC guidelines [baseline (50), final (92.5)] and monitoring/audits of IPC practices and feedback [baseline (40), final (82.5)] recording the highest improvements. Healthcare-associated infection [baseline (10), final (25)], and built environment, materials, and equipment for IPC [baseline (43.5), final (55)] had the least improvement. Poor motivation to adopt recommended changes among hospital staff were major issues preventing improvements.
Conclusion: Promotion of IPC program and activities should be implemented at the Federal Medical Centre, Owo.
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Kiragu, Charles, Justus SO Osero, and Anthony K. Wanyoro. "Factors influencing women's knowledge at scheduled postnatal visits: a multi-centre study in Kakamega, Kenya." African Journal of Midwifery and Women's Health 15, no. 4 (December 2, 2021): 1–8. http://dx.doi.org/10.12968/ajmw.2020.0044.
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Background/aims Postnatal care is offered to mothers and their babies from birth and across the postnatal period. Visits are spread over the postnatal period, and a minimum of four visits is recommended. In many studies, postnatal visits in Africa have been reported to be low compared to antenatal visits. As a result of low postnatal visits, mothers are not able to utilise postnatal care services, resulting in delayed detection of and interventions for maternal and neonatal health problems, leading to high rates of maternal and neonatal morbidity and mortality. In Kenya, only 53% of mothers attend postnatal clinics; in Kakamega county, only 34% of mothers attend. This study aimed to establish factors influencing postnatal knowledge among mothers in selected hospitals in Kakamega, Kenya. Methods The study was a descriptive cross-sectional study involving 320 postnatal mothers recruited from four sub-counties. Systematic sampling was used to select eligible study participants. Data were collected using questionnaires that assessed the participants' knowledge of postnatal care in terms of what postnatal care is, recommended postnatal care, when to attend a clinic and the services offered at postnatal care clinics. The data were entered into a database and analysed using the Chi-squared test to assess how sociodemographic and socioeconomic characteristics were associated with knowledge of postnatal care. Results The majority of participants (73.1%) had poor or no knowledge of postnatal care and 89.7% had poor or no knowledge on when postnatal visits should be carried out. Most postnatal mothers (71.9%) received postnatal health information from health workers. Occupation (P<0.000), income (P<0.000), transport (P<0.000) and time taken to travel to hospital (P=0.034) were significantly associated with postnatal knowledge. Conclusions Knowledge on postnatal care is poor among postnatal mothers in Kakamega. The majority of participants obtained postnatal care information from health workers, and so it is recommended that Kakamega establishes other strategies for giving information on postnatal care, such as pamphlets to mothers.
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Aluvaala, Jalemba, Rachael Nyamai, Fred Were, Aggrey Wasunna, Rose Kosgei, Jamlick Karumbi, David Gathara, and Mike English. "Assessment of neonatal care in clinical training facilities in Kenya." Archives of Disease in Childhood 100, no. 1 (August 19, 2014): 42–47. http://dx.doi.org/10.1136/archdischild-2014-306423.
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ObjectiveAn audit of neonatal care services provided by clinical training centres was undertaken to identify areas requiring improvement as part of wider efforts to improve newborn survival in Kenya.DesignCross-sectional study using indicators based on prior work in Kenya. Statistical analyses were descriptive with adjustment for clustering of data.SettingNeonatal units of 22 public hospitals.PatientsNeonates aged <7 days.Main outcome measuresQuality of care was assessed in terms of availability of basic resources (principally equipment and drugs) and audit of case records for documentation of patient assessment and treatment at admission.ResultsAll hospitals had oxygen, 19/22 had resuscitation and phototherapy equipment, but some key resources were missing—for example kangaroo care was available in 14/22. Out of 1249 records, 56.9% (95% CI 36.2% to 77.6%) had a standard neonatal admission form. A median score of 0 out of 3 for symptoms of severe illness (IQR 0–3) and a median score of 6 out of 8 for signs of severe illness (IQR 4–7) were documented. Maternal HIV status was documented in 674/1249 (54%, 95% CI 41.9% to 66.1%) cases. Drug doses exceeded recommendations by >20% in prescriptions for penicillin (11.6%, 95% CI 3.4% to 32.8%) and gentamicin (18.5%, 95% CI 13.4% to 25%), respectively.ConclusionsBasic resources are generally available, but there are deficiencies in key areas. Poor documentation limits the use of routine data for quality improvement. Significant opportunities exist for improvement in service delivery and adherence to guidelines in hospitals providing professional training.
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Murphy, Joseph G., and William F. Dunn. "Medical Errors and Poor Communication." Chest 138, no. 6 (December 2010): 1292–93. http://dx.doi.org/10.1378/chest.10-2263.
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Hwang, In Soo, Kyeong Soo Lee, Chang Yoon Kim, Pock Soo Kang, and Jong Hak Chung. "Medical care expenditure of residents in urban poor area." Yeungnam University Journal of Medicine 10, no. 1 (1993): 91. http://dx.doi.org/10.12701/yujm.1993.10.1.91.
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Mulligan, Kate. "State Budget Woes Threaten Medical Care for the Poor." Psychiatric News 36, no. 23 (December 7, 2001): 17. http://dx.doi.org/10.1176/pn.36.23.0017.
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Mwita, Clifford Chacha, Johnstone Muthoka, Stephen Maina, Phillip Mulingwa, and Samson Gwer. "Early management of traumatic brain injury in a Tertiary hospital in Central Kenya: A clinical audit." Journal of Neurosciences in Rural Practice 7, no. 01 (January 2016): 97–101. http://dx.doi.org/10.4103/0976-3147.165390.
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ABSTRACT Background: Traumatic brain injury (TBI) is a major cause of death and disability worldwide and is mostly attributed to road traffic accidents in resource-poor areas. However, access to neurosurgical care is poor in these settings and patients in need of neurosurgical procedures are often managed by general practitioners or surgeons. Materials and Methods: A retrospective clinical audit of the initial management of patients with TBI in Thika Level 5 Hospital (TL5H), a Tertiary Hospital in Central Kenya. Seventeen audit criteria divided into five clinical domains were identified and patient case notes reviewed for compliance with each criterion. Data were analyzed separately for those below 13 years owing to differences in response to brain trauma in those below this age. Results: Overall, there was poor compliance with audit criteria in both groups. Among those below 13 years of age, only 3 out of 17 criteria achieved compliance and 4 out of 17 criteria achieved compliance for those above 13 years of age. Assessment for the need for a cervical radiograph (7.1% and 8.8% compliance) and administration of oxygen (21.4% and 20.6% compliance) had the worst performance in both groups. Conclusion: Poor compliance to audit criteria indicates the low quality of care for patients with TBI in TL5H. Quality improvement strategies with follow-up audits are needed to improve care. There is a need to develop and enforce evidence-based protocols and guidelines for use in the management of patients with TBI in sub-Saharan Africa.
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MAGADI, MONICA, IAN DIAMOND, NYOVANI MADISE, and PETER SMITH. "PATHWAYS OF THE DETERMINANTS OF UNFAVOURABLE BIRTH OUTCOMES IN KENYA." Journal of Biosocial Science 36, no. 2 (February 17, 2004): 153–76. http://dx.doi.org/10.1017/s0021932003006163.
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This paper explores the pathways of the determinants of unfavourable birth outcomes, such as premature birth, the size of the baby at birth, and Caesarean section deliveries, in Kenya using graphical log-linear chain models. The results show that a number of factors that do not have direct associations with unfavourable birth outcomes contribute to these outcomes indirectly through intermediate factors. Marital status, the desirability of a pregnancy, the use of family planning and access to health facilities have no direct associations with poor birth outcomes, such as premature births and the small size of the baby at birth, but are linked to these outcomes through antenatal care. Antenatal care is identified as a central link between various sociodemographic or reproductive factors and birth outcomes.
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Korir, Evans Kiptoo. "Health Insurance in Kenya." Volume 5 - 2020, Issue 9 - September 5, no. 9 (October 4, 2020): 963–66. http://dx.doi.org/10.38124/ijisrt20sep694.
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Health insurance in Kenya was launched by the government in 1967 when they introduced National Health Insurance Fund (NHIF) to provide health care to Kenyans. Since then, the sector has grown widely due to liberalization of the industry and increase in the medical costs. In Kenya, the health care insurance is provided by both government and private insurers. This article aims to study the concept, benefits, and the growth of the health insurance in Kenya. It also highlights the health insurance plans available in the country. The study is based on secondary data collected from journals, articles, and Insurance Regulatory Authority (IRA) website. To study the growth of the health insurance in the country, premium, claims, and expense of 22 insurance companies offering health insurance from 2010 to 2018 were taken into consideration. Microsoft Excel was utilized for the analysis. The paper outlined the concept, health insurance plans, and their importance to the insured. The paper also revealed that the premium, claims, and expenses of the insurance companies increased constantly during the study period.