Browsing by Author "Njoroge, Kezia Muthoni"

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    Contribution of Health Workers and Patient Characteristics on Adherence to Antenatal Clinic Appointments in Public Hospitals: A Case of Homabay and Kisumu County Referral Hospitals, Kenya
    (PAMJ - One Health, 2020-12-21) Opon, Shadrack Ochieng; Tenambergen, Mwaura Wanja; Njoroge, Kezia Muthoni
    Introduction: missed appointments account for about 56% of wasted health resources in the world. There is about 42% missed appointment rate in African medical setting. Antenatal clinics in Kenya experience about 44% missed appointment rate accounting for about 22% of wasted health resources. About 1.7 million children born between 2013 and 2017 did not receive all prescribed vaccines. About 42% and 35% of antennal appointments in Homabay and Kisumu Counties were missed in 2019. The study assessed contribution of health workers and patient characteristics on adherence to antenatal clinic appointments in public hospitals. Methods: a crosssectional research design was employed in Homabay and Kisumu County hospitals. The study included 2 hospital managers per hospital, 70 and 63 antenatal clients in Homabay and Kisumu County hospitals respectively. Patients were stratified and proportionately sampled, while hospital managers were purposively sampled. Sample size was determined using Yamane Formula. Key informant interview and selfadministered structured questionnaire were used to collect data, and analysis done using SPSS tool. Results: findings showed, in Homabay and Kisumu County hospitals respectively, that: 50 (71.4%) and 20 (40%) missed appointments due to inadequate staff responsiveness towards their needs; 50 (71.4%) and 28 (56%) due to staff attitude. Single and separated antenatal clients miss more appointments compared to married and cohabiting clients. Conclusion: there is low adherence to appointments in antenatal clinics in Homabay and Kisumu County hospitals because of poor staff attitude, inadequate staff responsiveness; and lack of sufficient education on the importance of antenatal care among mothers
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    Effect of an Educational Intervention on the Utilization of Maternal Healthcare Services for High-Risk Obstetric Clients, Systematic Review
    (InternationalJournalof ProfessionalPractice (IJPP), 2024-05-02) Osoro, Epony Nyakong'anyi; Tenambergen, Mwaura Wanja; Njoroge, Kezia Muthoni
    This study aims to investigate how health systems can be strengthened through timely referral of obstetric patients. In many Low and Middle-Income Countries (LMICs), maternal and newborn mortality and morbidity outcomes continue to be major health issues. Most of the deaths occur in sub-Saharan Africa and South Asia where access to maternal and newborn health care is a challenge. Strengthening health systems aims at increasing access to vital services such as maternal and neonatal care to improve health outcomes. The broad objective of this systematic review was to determine the level of effectiveness of education interventions aimed at improving timely referral of obstetric patients to higher-level healthcare facilities, with the goal of strengthening health systems and improving maternal and new-born healthcare outcomes. This study adopts a systematic review of the meta-analysis approach. For articles, six electronic databases; namely, Science Direct, Scopus, EMBASE, PubMed, PLOS One, and Google Scholar were searched. The target population was publications on obstetric patients in low- and middle-income countries. Data were analysed using meta-analysis techniques. The results of the review indicated that education and training intervention had a statistically significant impact on five outcomes; namely, maternal mortality (p=0.05), service utilization (p=0.001), number of emergency referrals (p=0.00001), and referral time (0.05), though the margin was small in the latter. These outcomes were marked with significant improvement, following the implementation of the treatment of high risk obstetric patients. However, there was lack of meaningful impact of the intervention on neonatal mortality (p=0.80). The study concluded that timely referral can be enhanced by implementing education interventions such as training expectant women and healthcare providers.
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    Factors Influencing Upward Referral System of Patients in Nairobi County
    (International Journal of Community Medicine and Public Health, 2021-08-25) Tenambergen, Mwaura Wanja; Njoroge, Kezia Muthoni; Osoro, Epony Nyakong'anyi
    Background: The referral system forms main health systems coordinating a mechanism ensuring the harmonious movement of patients between different levels of health care institutions for effective and efficient service delivery. The study aimed at establishing the determinants of upward referral system of patients in Nairobi County. Methods: Cross-Sectional data collected from 204 respondents from 2May to 30June, 2021, through a structured questionnaire from level 3-5 public facilities in Nairobi County was used. Data was analyzed using SPSS. Doctors, nurses and clinical officers who have referred patients in the previous three months were included while those who had not were excluded. Results: Bivariate analysis results revealed that knowledge of referral system (r=179*, p=0.011) and complexity of patient disease (r=097, p=0.170) had positive and significant correlation with upward referral system. Multivariate analysis results showed that proximity to the referral health facility had positive and statistical significant (β4=0.640, p<0.002) to upward referral system.Conclusions: The results revealed that although healthcare workers know about the referral strategy, they lack full comprehension of the referral strategy. Patients are mostly referred when higher diagnostic equipment are needed and when the medical conditions are dire. The study recommends professional medical education to equip the human resources for health with the requisite knowledge on the referral system and establishment of effective communication systems between the lower levels health facilities and the higher or specialized facilities to ensure there a smooth referral system in Nairobi County.
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    Influence of Access Determinants on Self-Referrals Among Pregnant Women Seeking Delivery Service in Coast General Referral and Teaching Hospital Mombasa, Kenya
    (Global Journal of Health Sciences, 2021) Kivuva, Elizabeth Muthoki; Njoroge, Kezia Muthoni; Tenambergen, Mwaura Wanja
    Purpose: The purpose of this study was to establish influence of access determinants on self-referrals among pregnant women seeking delivery service in Coast General Referral and Teaching Hospital (CGTRH). Methodology: The study adopted a descriptive cross-sectional research. The study target population was all pregnant women seeking delivery services in coast general teaching and referral hospital at the maternity unit. Therefore, 6,420 formed the study population as it is from this sampling frame that a sample of mothers was obtained. A sample of 376 pregnant women was obtained. Systematic random sampling was used to select the pregnant women to be included in the sample. Data was collected using a structured questionnaire. The data collected were cleaned and coded, quantified and analyzed quantitatively. Quantitative data were analyzed using IBM SPSS where descriptive and inferential statistics were used to capture the data in order to understand the pattern and nature of relationships. Univariate analysis was done using descriptive statistics (frequencies and percentages,) in order to summarize the data, and the results were presented using charts, graph and tables. Results: The findings revealed a significant relationship between the operating hours of CGTRH and self-referrals to the facility. The results indicated that pregnant women who indicated the 24 hours operating nature of CGTRH as their reason for seeking services at the facility were 2 times more likely to make self-referrals compared to those who disagreed that they sought services at the facility because the facility is open 24 hours in a day. A multivariable logistic regression analysis at a significance level of 0.05 further indicated that the operating hours of CGTRH had a significant influence on self-referrals pregnant women seeking delivery services at the facility. Unique contribution to theory, practice and policy: The study recommended that The Mombasa county department of health should find ways of ensuring that primary health facilities in the county are open for 24 hours in a day to attract more pregnant women seeking delivery services at the facilities and thus minimize the number of pregnant women seeking delivery services directly from the Coast General Teaching and Referral Hospital.
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    Influence of Community Dialogues on Social Accountability in the Health System in Nairobi County, Kenya
    (International Journal of Community Medicine and Public Health, 2022-07-11) Abuga, Malkia Moraa; Tenambergen, Mwaura Wanja; Njoroge, Kezia Muthoni
    Background: Social accountability encompasses a variety of strategies that enable citizens to express their concerns about the performance of health-care services. Community dialogues provide a forum for community engagement and participation in the health care system. However, there is little documentation on how it is used to improve social accountability within government community health structures. The purpose of this study was to determine the influence of community dialogues on social accountability in Nairobi County, Kenya. Methods: A qualitative study was conducted that included in-depth interviews with key stakeholders purposively selected. A total of three focus group discussions with 23 participants, eight key informant interviews and document review of minutes were conducted. Data analysis was done using thematic analysis. Results: Findings showed that community dialogues were held quarterly. The forums were mostly used for education purposes with little evidence on community engagement. Minutes showed what the community health assistant and community health volunteer said to the community with minimal input from the community members. Feedback was a challenge because the health management team hardly attended community dialogues due to logistic and workload issues. Conclusions: There is need of practical strengthening community dialogues through use of tools like chalk board and community scorecard as advocated in the community health policy. However, in practice, these tools were hardly used resulting to missed opportunity for the community to voice their opinions on health services.
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    Influence of Corporate Governance Practices on Performance of Faith-Based Hospitals: A Systematic Review
    (Open Access Library Journal, 2022-05-19) Ndege, Josephine Muthoni; Tenambergen, Mwaura Wanja; Njoroge, Kezia Muthoni
    Faith-based health facilities form a key pillar in the provision of health services, especially in the rural and marginalized areas of the country where public health service provision is low, failed or non-existent. However, these institutions are exposed to the risks of continued reliance on boards of management constituted by religious leaders, leading to weak governance structures. This review focused on the effect of corporate governance on the performance of faith-based hospitals. A systematic review of the literature was conducted from January 2017 until February 2022. Google Scholar databases were searched using keywords such as corporate governance practices, hospital board shared strategic direction, hospital board accountability, and faith-based hospital performance. Studies were included if their outcome measure was hospital performance or health service delivery. The search was restricted to the English language. The methodology was aligned with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA). 10 articles met the inclusion criteria. Of these studies, 7 investigated hospital performance and 3 investigated health service delivery. 100% of the articles showed that good corporate governance practices improved performance and health service delivery. On average, there was a 30% and 40% increase in hospital performance due to accountability and shared strategic direction respectively. The shared strategic direction was effective compared with accountability. Good corporate governance such as having a shared strategic direction and holding board members accountable improved the performance of the hospitals.
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    Influence of Individual Determinants on Self-Referrals Among Pregnant Women Seeking Delivery Services in Coast General Referral and Teaching Hospital Mombasa, Kenya (CGTRH)
    (Journal of Health, Medicine and Nursing, 2021) Kivuva, Elizabeth Muthoki; Njoroge, Kezia Muthoni; Tenambergen, Mwaura Wanja
    Purpose: The purpose of this study was to establish the influence of individual determinants on self-referrals among pregnant women seeking delivery services in CGTRH Materials and Methods: The study adopted a descriptive cross-sectional research. The study target population was all pregnant women seeking delivery services in coast general teaching and referral hospital at the maternity unit. Therefore, 6,420 formed the study population as it is from this sampling frame that a sample of mothers was obtained. A sample of 376 pregnant women was obtained. Systematic random sampling was used to select the pregnant women to be included in the sample. Data was collected using a structured questionnaire. The data collected were cleaned and coded, quantified and analyzed quantitatively. Quantitative data were analyzed using IBM SPSS where descriptive and inferential statistics were used to capture the data in order to understand the pattern and nature of relationships. Univariate analysis was done using descriptive statistics (frequencies and percentages,) in order to summarize the data, and the results were presented using charts, graph and tables. Results: The findings indicated a significant relationship between education status and self-referrals whereby, the more educated the pregnant women were the more likely they were to make self-referrals at the referral facility. In particular, pregnant women with tertiary level of education were 4.2 times more likely to make self-referrals compared to those with no education. Further analysis using multivariable logistic regression at a significance level of 0.05 established that there was a significant difference between pregnant women with no education and those with tertiary education, with the latter being 4.4 times more likely to make self-referrals compared to the former. Unique contribution to theory, practice and policy: The study recommends that hospitals ought to enhance their CRM policies so as to deliver quality services that satisfy Information technology infrastructure can revolutionize healthcare with the right policy choices. IT can foster new human connectivity thresholds and is a powerful tool of global convergence through the cross-border provision of services and can as well provide new opportunities for the production of knowledge and skills.
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    Influence of Organizational and Access Factors on Adherence to Appointments in Antenatal Clinics in Homa Bay and Kisumu County Referral Hospitals, Kenya
    (2021-08-21) Opon, Shadrack Ochieng; Tenambergen, Mwaura Wanja; Njoroge, Kezia Muthoni
    Introduction: the world wastes about 40% of health resources, and African medical setting has about 42% missed appointment rate. Kenya has 44% missed appointment rate in antenatal clinics, wasting about 22% of health resources. Five hundred and two thousand eight hundred and sixty (502,860) children were not immunized in 2017. Homabay and Kisumu Counties with 91/1000 and 149/1000 under-five mortality rates, recorded 42% and 35% missed appointment rates in antenatal clinics respectively in 2019. This study assessed influence of organizational and access factors on adherence to appointments in antenatal clinics. Methods: the study adopted cross-sectional research design across two hospitals, purposively sampled (Homabay and Kisumu County Hospitals) because of high under-five mortality and high HIV prevalence rates. Stratified and proportionate sampling were used to sample patients, and purposive sampling for hospital managers. Yamane Formula was used to determine sample size. The study comprised 133 antenatal patients (Homabay County Hospital 70, Kisumu County Hospital 63) and two hospital managers per hospital. Self- administered structured questionnaire and key informant interview were used to collect data. Results: study revealed in Homabay and Kisumu County hospitals respectively, as follows: 55 (78.6%) and 35 (70%) antenatal clients missed their appointments because of waiting time; 55 (78.6%) and 30 (60%) due to facility operating hours; and 55 (78.6%) and 25 (50%) due to opportunity cost of seeking services; and 55 (78.6%) and 20 (40%) due to facility proximity. Conclusion: there is high missed appointment rates in antenatal clinics in Homabay and Kisumu County hospitals because of poor organization of antenatal services, opportunity cost and facility location.
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    Professional Health Providers’ Governance Accountability Mechanisms as a Determinant of Delivery of Quality Health Services in Kenyatta National Hospital, Kenya
    (International Academic Journal of Health, Medicine and Nursing, 2020-09-10) M'Nabea, Lumbi Wa; Tenambergen, Mwaura Wanja; Njoroge, Kezia Muthoni
    Introduction: Governance in essence is exercise of authority. It entails decision making and implementation, competent control, provision of standards and accountability. Objectives: The study set out to determine influence of professional health providers’ governance accountability mechanisms in delivery of quality health services in Kenyatta National Hospital, Kenya. Specific objectives were to establish influence of continuous professional education for health providers and peer review on delivery of quality health services in the hospital. Methods: This was a cross-sectional descriptive study, that used mixed methods design. Stratified and purposive sampling was used to get sample of 369 respondents and four key informants respectively. Results: Logistic regression results indicated that professional health providers not registered with professional bodies were 0.216 times less likely to deliver quality health services on time as compared to those who are registered. There being consequences for breach of self-regulation was 2.086 times more likely to enhance delivery of quality health services as compared to having no consequences. Significant relationship exists between continuous professional education for professional health providers and delivery of quality health services on time
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    Strengthening Social Accountability Process in Community Health Systems: Exploring the Role of Community Actors in Africa and South Asia: Systematic Review
    (International Journal of Scientific and Research Publications, 2022-05-02) Abuga, Malkia Moraa; Tenambergen, Mwaura Wanja; Njoroge, Kezia Muthoni
    Background: Despite a growing body of literature on social accountability in health systems, many questions remain unanswered about how community actors interact with health workers and demand accountability. Social accountability is viewed as an empowerment process and a social practice in which communities actively participate in changing the conditions that affect their health. Local factors, such as the role of community actors, influence the effectiveness of social accountability. The purpose of this research was to assess empirical evidence on the role of community actors in social accountability. Methods: Electronic searches were conducted for eligible studies within each of the Pubmed, Medline, Google Scholar and SciELO databases from 2012 to January 2022. Peer-reviewed English language publications describing a social accountability mechanism with a focus on the role of community actors in Africa and South Asia were eligible for inclusion. There were no restrictions on the research design. Results: The review included eleven relevant studies. According to the findings, community actors include Community Health Workers, Health Facility Committees, Community Elected Leaders, and the media, among others. Their responsibilities include monitoring services and health worker’s performance, gathering and sharing information, and resolving complaints. Some of the enablers to the role community health actors include diverse committee membership and the legitimacy of community leaders. On the other hand, knowledge and power asymmetry, the lack of a clear mandate, a lack of clarity on their roles and fear of reprisal are among the barriers to their role in Social Accountability. Conclusion: Community actors are part of the community health system, and understanding their role, strengths, and challenges has a practical impact on how they contribute to the overall health system's strength. The findings show that they can exert social pressure through their powerful coalitions, which is critical in Social Accountability activities. As a result, in order to maximize their potential, novel approaches to addressing the limitations identified in this review are required.
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    The Effect of Patient Reminders in Reducing Missed Appointment in Medical Settings: A Systematic Review
    (PAMJ - One Health, 2020-06-05) Opon, Shadrack Ochieng; Tenambergen, Mwaura Wanja; Njoroge, Kezia Muthoni
    Missed appointments are a problem to healthcare professionals worldwide. There is up to nearly 42% missed appointment rate in medical setting globally. Reducing missed appointment rates improves the efficiency of health services and health outcomes of patients. Missed appointment rates can be reduced by reminding patients about their medical appointments in advance. A simple way of doing this is via electronic notification to the patients´ phones. The aim of this paper is to review the effect of patient reminders in reducing missed appointment rates. The methodology was conducted based on the PRISMA guidelines for systematic reviews. Literature search was conducted extensively using Google Scholar and PubMed databases based on terms such as cell phone reminders, electronic notification reminders, missed appointment rates, clinic attendance and SMS reminders. Geographical and publication biases were assessed. The result of the review showed that 95% studies reviewed reported a positive effect of patient reminders on appointment rates, with an average of 41% reduction in missed appointment rates and 34% increase in clinic attendance rates in all the studies. The review revealed that patient reminders reduce missed appointment rates and improve clinic attendance rates. Multiple reminders produce better outcomes. Reducing missed appointment rates also improve the efficiency of health care facilities.
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    The Influence of Community Health Volunteers Practices on Advancing Social Accountability in Nairobi County, Kenya
    (Research Square, 2022-06-30) Abuga, Malkia Moraa; Tenambergen, Mwaura Wanja; Njoroge, Kezia Muthoni
    Abstract Background: Community Health Volunteers position in the health system allow them to act as community mouthpieces, fighting inequities and advocating for community rights and needs to government structures. However, questions about how they carry out this role, specifically how they present community concerns to the health system and vice versa, remain unanswered. The purpose of this study was to evaluate the practices of community health volunteers that promote social accountability. Methods: The study used a cross-sectional research design across two sub-counties that were purposefully chosen due to their health indicators status. The quantitative data sample size was 180 Community Health Volunteers (Embakasi North 90, Embakasi Central 90) who were sampled using stratified sampling. Focus group discussions, key informant interviews and document review were used to collect qualitative data. Results: In Embakasi North and Embakasi Central, respectively, the study found that 66 (73.3 %) and 64 (71.1 %) of Community Health Volunteers rarely recorded complaints, 68 (75.6 %) and 53 (58.9 %) of Community Health Volunteers always reported complaints to the Community Health Assistant, and 67 (74.4 %) and 47 (52.2 %) of Community Health Volunteers always provided feedback to clients on the complaints raised. Conclusion: There was sub-optimal and inconsistent implementation of social accountability practices by the Community Health Volunteers in the two sub-counties. This was influenced by inadequate information on their mandate in social accountability, a lack of reporting indicators targeting social accountability and a lack of awareness about formal channels of complaint handling mechanisms at community health systems.
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    The Role of Organizational Culture in Moderating Corporate Governance Practice Influence on Faith-Based Hospitals Performance in Kenya
    (Open Access Library Journal, 2022-07-21) Ndege, Josephine Muthoni; Tenambergen, Mwaura Wanja; Njoroge, Kezia Muthoni
    In Kenya, faith-based hospitals provide 40% health care services to the medium and low-income populations in the rural areas. These hospitals are facing sustainability challenges because of poor organizational performance. These failures have been attributed to overlooking the adoption of corporate governance practices where for instance boards of management of health facilities are largely made up of religious officials, therefore making the facilities lack proper corporate culture when compared to their more privately owned health facilities counterparts. It is against this background that this study sought to examine the influence of corporate governance on hospitals overall and the moderating effect of corporate culture on the influence. A hospital based census with mixed data collection method was employed. For quantitative data, questionnaires were used with senior managers of Christian faith-based hospitals Key Informant Interviews with 9 purposively sampled informants: 2 from CHAK secretariat, 2 from KCCB secretariat and 5 board chairpersons of governing boards in purposively selected level 5 faiths based hospital. For quantitative data, descriptive and inferential analysis techniques were used while for qualitative data, content analysis was done. From the regression results, corporate governance practices of board composition, accountability, stewardship of resources and shared strategic direction had significant and positive influences on the performance of faith-based hospitals in Kenya. The study recommends that proprietors ensure that the criteria for choosing their board members are enhanced and improved to ensure there is no bias in the selection process and that boards intentionally and actively involve all stakeholders in the decision-making process of the organization, management should ensure accountability aspects and the related policies are adhered to, board members should be properly inducted and continuously trained on governance to ensure they execute their mandate effectively.