Browsing by Author "Tenambergen, Mwaura Wanja"
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Item Assessing How the Packaging of Immunization Services Influence Uptake of the Immunization Services in Selected Health Facilities of Kajiado North Sub-County Kenya(International Journal of Scientific Research in Science, Engineering and Technology (IJSRSET), 2016-06-26) Toweett, John Kipngetich; Tenambergen, Mwaura Wanja; Adoyo, Maureen AtienoBackground: Immunization as a preventive measure to diseases is vital to organizational performance. Among the six pillars of the health system, this research focused on service delivery. A desk review indicated that there was low immunization coverage in the County. The objectives of the study was to determine how the cultural values, packaging of immunization and health promotion supports the uptake of immunization services Methods: A cross-sectional study utilizing a guided questionnaire, targeting 280 mothers and an interview guide targeting 9 health workers were used. Data analysis was done using SPSS version 21 using descriptive statistics. Qualitative analysis was done by thematic content analysis and framework analysis. Results: Majority of the respondents (mothers) were young with a mean age of 26 years. 233 (83%) agreed that immunization program is well explained to them when they visit health facilities. More than half 183(65.4%) of mothers got the information about immunization through continuous health education routinely offered in health facilities, whereas a significantly low 39 (13.9%) mothers got the immunization information through community health promotion. The correlation of health education with awareness indicated a (P-value = 0.406**) A p-value of 0.209** indicates that frequent visits to the health facilities did not influence the awareness of mothers on the immunization services offered in health facilities. Conclusion: The researcher concluded that there is a relationship between immunization uptake and immunization health promotion activities and recommended that the County Government of Kajiado should introduce outreach services and intensify health promotion activitiesItem Assessing the Influence of Behavioural Factors of Community Health Promoters on Use of Community Based Health Information Systems in Selected Counties, Kenya(World Journal of Public Health, 2024-04-28) Mambo, Susan Njoki; Odhiambo-Otieno, George W.; Ochieng’-Otieno, George; Tenambergen, Mwaura WanjaGlobally, health management information systems (HMIS) in strengthening health systems have gained recognition due to potential of technology to improve access to quality care in underserved communities. In Kenya, the functionality of Community based- Health Management Information System (CBHMIS) currently stands at 55% down from 64% in year 2015. The aim of this paper was to determine the influence of behavioral factors of community units personnel on CBHMIS. As a nested study, with a broader aimt to establish the operational status of CBHMIS and its use in selected counties in Kenya; The main objective of this research was: To establish whether behavioural factors of Community Health Promoters (CHPs) influence CBHMIS use in Kenya. A mixed method design. was adopted, Kiambu, Kajiado and Nairobi counties formed the study location, a target population of 156 active community units was considered to arrive at a total sample of 122 community units and out of 7800CHPs a sample of 366 respondents was drawn. Multistage sampling was used to identify the CUs, and systematic random sampling to identify 366 respondents. Quantitative data tools were semi-structured closed ended questionnaires. Qualitative data tools included observation checklist, Focus Group Discussion and Key Informant Interviews guides. Quantitative data was analyzed using SPSS to generate univariate and bivariate analysis at p<0.05 significance level; Qualitative data was analyzed using content analysis based on key themes generated from the objectives. Results were presented in form of graphs, tables, figures, and narration. This study showed that the use of Community based- Health Management Information System stood at 56.6%. Behavioural factors were found to significantly influence use of Community based- Health Management Information System. Further, of the total variations in the use of Community based- Health Management Information System, behavioral factor explains 13.7% (R2 = .137). Results show that the model was valid (F(1, 363) = 58.579, P = .001) hence the explanatory variable (X2, Behavioral factors) is good in explaining total variations in Use of CbHMIS by community units. This implies that the use of CbHMIS by Community Units (CU) improves significantly when the community units have better behavioural factors. In conclusion, behavioural factors of CHPs have strong and significant influence on the CBHMIS use. Motivation of CHPs is key as a motivator to CBHMIS use, as well as. provision of material support including reporting tools and IEC materials and capacity development technical, computer and electronic reporting skills to enhamce CHP operations and processes.Item Assessing the Influence of Process Interventions of Community Health Volunteers on Use of Community Based Health Management Information Systems in Selected Counties, Kenya.(International Journal of Scientific and Research Publications, 2018-08) Mambo, Susan Njoki; Odhiambo-Otieno, George W.; Ochieng’-Otieno, George; Tenambergen, Mwaura WanjaThe World Health Organization (WHO) identified information as one of the six key pillars of an effective health system. In this context, the need to strengthen community health information has been felt globally. African countries have faced the greatest challenges in collecting, analyzing, evaluating and interpreting indicator data to guide evidence based policy-making. The generation of health information starts at the community level through the Community-Based health information system (CbHMIS) (Kaburu, Kaburi, & Okero, 2016). At the community level, this source of information is complete in coverage and in planning and action-oriented (Odhiambo-Otieno, 2005). High health threats characterized by low levels of life expectancy, deteriorating healthcare facilities, high disease incidences, high levels of infant mortality (73/1000) and maternal mortality (488/100,000) specifically on communicable diseases are currently facing Kenya (Flora, Margaret, & Dan, 2017). The importance of effective information use is still a key impediment to these problems, hence affecting greatly the health care service delivery at all levels, and the worst level in its information use is level 1 – the community. In Kenya, According to a situation analysis on the state of Community Health Services in year 2014, the functionality of CbHIS was said to be at 64% which came down considerably to 55% in year 2015 documented by USAID, and that access to quality data was not guaranteed through the current CbHMIS. Some known and assumed barriers include: lack of proper processes, lack of physical access, lack of awareness of what is available; lack of relevance of available information (i.e. not meeting peoples' needs in terms of scope, style or format); lack of time and incentives to access information; and lack of interpretation skills (Flora et al., 2017). Processes forms an integral part of performance (Aqil et al., 2009). In Kenya, the Kenyan Health Information System has had several weaknesses which include weak linkages, data sharing, inadequate feedback, and lack of an operational CBHMIS manual, among others. The purpose of the study was to assess the influence of process interventions of the CHVs on CBHIS use in Kiambu, Kajiado and Nairobi Counties, Kenya. The study objectives were to 1. examine the influence community units assesments on CbHMIS use; 2. Assess the influence of feedback on CbHMIS use; 3. Assess dialogue and action days influence on CbHMIS use; 4. Determine the influence of reporting channels on CbHMIs use. A cross-sectional analytical study design was adopted, utilizing both quantitative and qualitative approaches. The target population was 156 active CUs from the 3 counties, from whence a total sample of 122 CUswasderived. Multistage sampling was used to identify the CUs, and systematic random sampling to identify 366 respondents. One Focus Group Discussion with the members of the community health committees and two Key Informant Interviews (KIIs) were conducted in each of the three counties. The respondents in the KIIs were County Community Strategy Coordinators and Sub-county Community Strategy Officers. Quantitative data was analyzed using SPSS to generate univariate and bivariate analysis at p<0.05 significance level and results were presented in form of graphs, frequency tables, figures, and narration. Qualitative data was analyzed using content analysis based on key themes generated from the objectives. Majority were Females 72.4% n=265; majority attained secondary level education 42.6% (n=156); Non-formal occupation stood at 84.7% (n=310); Use of CBHMIS stood at 56.6% (n=207). Process interventions, 36% of the respondents agreed that the Sub-county team and CU leadership are quick to act on the feedback of our MIS reports. Process interventions (X4) explains 67.4% of total variation in CbHMIS use. (R2 = .674). Attention should be given to reporting channels by ensuring that CUs are technologically enabled to be reporting in a timely manner The study recommends that CUs should be provided with enabling technology and further capacity development in technical, computer and electronic reporting skillsItem Assessment of Factors Influencing Ease of Access on Intentional Organophosphates Self-poisoning among Persons Aged 15-30 Years in Kericho County, Kenya(International Journal of Tropical Disease & Health, 2023-03-02) Langat, Sigey K.; Maathai, Ronald; Tenambergen, Mwaura WanjaAims: The aim of this study was to assess factors influencing ease of access on intentional organophosphate self-poisoning among persons aged 15-30 years in Kericho County, Kenya. Study Design: The study adopted prospective cross-sectional study design and purposive sampling technique. Place and Duration of Study: The study was conducted in 3 level 4 health facilities (Kericho County Referral Hospital, Kapkatet Sub-County Hospital, Londiani Sub- County Hospital and Sigowet Sub- County Hospital) in Kericho County, Kenya; which were systematically sampled base on the highest monthly workload one year prior to the study period. Study was conducted between December 2021 and March 2022. Methodology: 100 participants of age between 15 year and 30 years old were included in the study (88 males and 12 females). It was a study of all cases of intentional organophosphate self- poisoning, relied majorly on the diagnosis made by clinicians and doctors at emergency departments. Participants were sampled based on the presenting symptoms and history from the respondents. All respondents brought to hospital presenting to emergency department with a history of intentional organophosphate self-poisoning were recruited for the study depending on their eligibility where only respondents who were admitted and recovered after treatment were enrolled after signing or assenting to the consent voluntarily. Results: A sampled of 100 participants were eligible and managed to have 100% response rate. The study found out that there was a statistical relationship between the parameters since the chi square value were 0.001 which was less than the standard p value which is 0.05 at 95% confidence interval. Bivariate analysis showed a strong positive correlation was found between self-poisoning and easy access to organophosphate (p<0.05, r=0.631). With regard to easy access to organophosphate, the majority indicated yes with 71(71%) responses while those who indicated no were 29 (29%) respondents out of 100 respondents. Conclusion: It was concluded that ease of access of organophosphate poisons predisposed the high-risk group to find easiest way of committing suicide when they encountered challenges in their daily lives, therefore, laxity on sales, storage and distribution of pesticides give those at risk a chance to fulfill their suicidal ideation.Item Attitudes of Primary Health Care (PHC) Gatekeepers Towards Patient Referral Policy, Machakos County, Kenya(Science Journal of Public Health, 2016-06-13) Nshimirimana, Desire Aime; Tenambergen, Mwaura Wanja; Kokonya, Donald; Adoyo, Maureen AtienoPrimary Health Care (PHC) serves as the foundation for building a working healthcare system that provide good health outcomes. The quality of PHC delivery and the decision to refer patients depends on some behavioural factors (knowledge, skills and behaviour) of primary care providers. The study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for analysis. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). About 62% of the respondents reported to know about PHC gatekeeper system and 38% don’t know about PHC gatekeeper system. The gate keepers at a majority rate 86.7% reported to have participated in workshops of which at least 40.3% participated in at least one workshop per year, means that the majority of gatekeepers don’t fill the required continuing professional development (CPD) to renew their licenses. Bad behavior, poor communication, don’t care attitude, long waiting time and no courtesy were mentioned by patients by 60% of respondents as the main contributing factors to non-compliance of patients with the national patient referral policy. Attitudes (knowledge, skills and behaviour) are crucial in primary care gatekeeper policy implementation. It has been made clear that nurses acquire enough knowledge from college to take care of patients but still need more practical knowledge and experience to increase their performance. This study recommends an innovative plan using incentive driven model and performance rewards in the implementation process.Item Citizen Engagement in Social Health Insurance Purchasing, in Selected Counties in Kenya(International Journal of Community Medicine and Public Health, 2019-09-05) Mwangi, Eunice Muthoni; Tenambergen, Mwaura Wanja; Mapesa, Job O.; Mutai, Isaac K.Background: National hospital insurance fund (NHIF) uses capitation as a strategic purchasing model to provide primary care health services (PCHS). This study sought information on citizen knowledge of PCHS benefit package, NHIF communication to citizens, determination of citizen views and values, NHIF accountability to citizens, citizen choice of PCHS provider and how these factors influence citizen access to NHIF, PCHS. Methods: This was a cross sectional research conducted between March 2017 to March 2018. 426 patients were sampled from Nyandarua and Nakuru Counties. Results: 366 (93%) patients knew the PCHS benefit package, 226 (57%) said NHIF communication to them was adequate, 280 (71%) said NHIF does not take into account their view and values, 272 (69%) said NHIF is not accountable to them, 269 (68%) knew how to select an outpatient facility, 111 (28%) said they did not receive NHIF, PCHS. Multivariate logistics regression analysis of citizen engagement factors and access to PCHS, indicate that NHIF communication to citizens (p<0.05, OR=2.358, 95% CI [1.399-3.975]), purchaser accountability (p<0.05, OR=2.073, 95% CI [1.017-4.226]) and provider choice (p<0.05, OR=2.990, 95% CI [1.817-4.920]) added significantly to the regression model. Conclusions: There is inadequate engagement of citizens in NHIF decision making which may hinder access to NHIF PCHS, therefore NHIF should establish citizens’ needs and preference through public forums, elicit citizens’ feedback, act on complains when raised, inform citizens on how the capitation system works and NHIF should visit health facilities regularly to establish if patients are accessing PCHS.Item 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 MuthoniIntroduction: 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 mothersItem Coordination Mechanisms and Implementation of Public Privatepartnership in Public Health Sector: A Case Study of Isiolo Sub County(International Journal of Innovative Research and Knowledge, 2024-07) Wario, Boru Tore; Tenambergen, Mwaura Wanja; Osuga, BenThe public health sector has overtime been unable to effectively provide the badly needed health care to the public on its own owing to lack of resources and management challenges. The promise of universal coverage of health services financed through tax revenue has proved untenable in the face of increase in demand for quality health services and other competing demand for the same revenue. The need for properly structured and executed public private partnership has become a necessity. There has been growing concern that despite much presence and effort by public and private health actors over the years, nationally and in Isiolo Sub County, a number of health indicators are either on downward trend or have stagnated. The unacceptably high maternal mortality rate of 448/100,000 live births nationally (KDHS 2008), Isiolo county having the 5th highest maternal mortality in the country at 790/100,000 live births is a case in point. This has put to question how public private partnership in health sector has been conceived, structured, regulated and coordinated. This research therefore sought to establish how coordination mechanisms influence success of public private partnership in health sector in Isiolo Sub County, of Isiolo County. This will be a cross sectional study that involves a census of all health NGOs and health facilities operating in Isiolo Sub County. Health workers in all the twenty one (21) health facilities and workers of nine (9) Nongovernmental organizations supporting health services were the subject of the study. A structured questionnaire will be used to gather data. The questionnaires generated quantitative data, which was analyzed using descriptive and inferential statistics with the help of statistical software known as Statistical Package for Social Sciences (SPSS) version 25 statistical software. Descriptive statistics comprised of frequency distribution, percentages, standard deviation and mean. Inferential data analysis was carried out using Pearson correlation coefficient and multivariate linear regression. The results indicated that coordination mechanisms has a positive and significant effect on implementation of public private partnership in the health sector in Isiolo Sub-County (β2=0.240, p value=0.002). The study concluded that an improvement in coordination mechanisms would lead to an implementation of public private partnership in the health sector. The study also recommends that the government of Kenya should organize workshops and training sessions specifically designed to educate stakeholders on partnership agreements. Further, the management of health sector in Kenya should foster a participatory approach by engaging key stakeholders from the public and private sectors, civil society organizations, and local communities.Item Correlates of Alcohol Consumption in Rural Western Kenya: A Cross-Sectional Study(BMC Psychiatry, 2017-05-10) Takahashi, Risa; Wilunda, Calistus; Magutah, Karani; Tenambergen, Mwaura Wanja; Wilunda, Boniface; Usaneya, PerngparnBackground: Studies on alcohol consumption in rural areas in sub-Saharan Africa are scarce. This study aimed to determine the prevalence and determinants of alcohol consumption in rural western Kenya. The study was conducted as a preliminary stage of a community-based intervention to reduce hazardous alcohol consumption. Methods: A cross-sectional survey of 478 participants aged 18–65 years residing in Ikolomani Sub-county, Kakamega County was conducted in April 2015. Data were collected using an interviewer-administered questionnaire. We defined current drinkers as participants who consumed any alcoholic product in the preceding one month, and hazardous/high-risk drinkers as participants with an Alcohol Use Disorders Identification Test (AUDIT) score of 8 and above. We summarised data using descriptive statistics and used logistic regression to explore for the correlates of each of current alcohol consumption and hazardous/high-risk alcohol consumption. Results: The sex-standardized prevalence of current alcohol drinkers was 31.7% (95% confidence interval (CI): 26.8%–37.2%). The prevalence was higher in men (54.6%) than in women (8.9%). The mean AUDIT score among current drinkers was 16.9 (SD 8.2) and the sex-standardized prevalence of hazardous/high-risk alcohol drinking was 28.7% (95% CI: 24.1%–34.0%). Traditional brews were the most commonly consumed types of alcohol and most drinkers took alcohol in the homes of alcohol sellers/brewers. In multivariate analyses, the number of drinkers in the family, the number of friends who are drinkers and the attitude towards alcohol intake were positively associated with current alcohol drinking status, and with hazardous/high-risk alcohol consumption. Women were less likely to be current drinkers and hazardous/high-risk drinkers than were men. Other socio-demographic factors were not significantly associated with alcohol consumption. Conclusions: The prevalence of alcohol consumption in the study area was higher than the national level estimate of 13.3%. The results suggest that the social environment is the main determinant of alcohol consumption in this setting. These findings imply that interventions to mitigate alcohol consumption in this area will have to target the social networks of the alcohol consumers, change the drinkers’ attitude towards alcohol, and tackle the issue of availability of unlicensed homemade brews.Item Determinants of Efficient Health Commodity Management in Maternal Child Health: A Case of Meru County, Kenya(International Journal of Scientific and Research Publications, 2021-08) Mbatia, Elvis Mwandawiro; Mwangi, Eunice Muthoni; Tenambergen, Mwaura WanjaEmergency Obstetric and Neonatal Care (EmONC) has become a priority especially in developing countries like Kenya. However, access to obstetric and neonatal care has been hindered by lack of medical commodity, equipment’s and vaccines related to Maternal Child Health (MCH), resulting to high maternal and neonatal mortality rates. The study is anchored in the health products, vaccines and technologies pillar of a health system. The study seeks to establish the determinants of an efficient health commodity management in MCH in public health facilities in Meru County. Specific objectives were to establish the influence of i) logistic management information system, ii) medical staff competency, iii) inventory management, and iv) supply chain management practices on efficient health commodity management in maternal child health in Meru County. The study adopted a cross-sectional design with quantitative methods for data collection. The study sample was 116 health care workers from all public health facilities in Meru County. Results indicated that logistic management information system was positively and significantly associated with the efficient health commodity management in MCH (2 = 4.450, P=0.035). This implied that LMIS had a positive and significant association influence on the efficient management of health commodity in MCH services. Medical staff competency was positively and significantly associated with the efficient health commodity management of MCH (2= 7.0489, P=0.008).The study recommends the County Health Department of Meru should i) invest in health information systems for quantification, forecasting reporting and procurement of medical goods and equipment; ii) conduct continuous professional education among health workers to ensure efficient management of healthcare commodities in the health facilities. Child mortality rates which stands at 362/100,000 live births its major contributing factors lies to poorly managed commodities and health care delivery and little access to Reproductive maternal child health care services. Pastakia et al., (2018) stated that a reliable and efficient healthcare management system is dependent on having work force that has technical and administrative skills and experience and capacity to man it effectively. Workforce challenges stretch an already overworked health system and reduces the opportunities to improve interventions that are needed to develop efficient health care system including an efficient logistic management system. Desale et al., (2013) noted that, in spite of the existence of a well-designed laboratory management information system (LMIS), the quality of reports generated from Daily Activity Register and stock cards were very low. As a consequence of this there were regular stock outs of key commodities in many health facilities” A study by Bray and Awuah, (2019), showed that inventory management is important facet to commodity management, since systems of the inventory that are poorly maintained will lead to a negative impact that will severely affect the optimal delivery of service. The broad objective of the study was to explore the determinants of an efficient health commodity management in maternal child health in government health facilities in Meru County. The specific objectives were to establish the influence of i) logistic management information system, ii) medical staff competency, iii) inventory management, and iv) supply chain management practices on efficient health commodity management in maternal child health in Meru County.Item Determinants of Electronic Medical Records Use Among Health Care Workers in HIV Care Facilities in Kenya In Nairobi County(Journal of Health, Medicine and Nursing, 2018-07-18) Nziwa, Pamela; Oluoch, Musa; Tenambergen, Mwaura Wanja; Kimemia, Fredrick M.Purpose: Recognizing that high-quality data are essential to HIV prevention, the study investigated the use of EMR and its determinants among healthcare workers in HIV care in Nairobi County, Kenya. The study’s aim was to assess the determinants of electronic medical records use among health care workers in HIV care facilities in Nairobi County. Methods: The study adopted a cross-sectional study design. Five sub-counties within Nairobi County were randomly selected and in each two health facilities with EMR systems were randomly selected. A total of 64 respondents from health information departments of the selected facilities were purposively recruited into the study. A self–administered structured questionnaire was used for data collection. Statistical Package for Social Science (SPSS) version 22 was employed during data analysis. Spearman correlation test was used to find relationships at a significance level of 0.05. Results: From the findings, over a half (58%) of the respondents used EMR data. Less than a third (28%) and a third (33%) of the respondents reported to have fully and partially utilised the EMR data respectively. Functionality of the system was significantly (rs=0.251, p=0.045) related with the type EMR tool. Update of records was significantly (rs=0.283, p=0.023) associated with EMR data use. Further, integration of EMR with other systems was significantly (rs=0.296, p=0.018) associated with extent of EMR utilisation. Other factors were not significantly (p>0.05) associated with use of EMR. A fair proportion of health care providers use EMR system in HIV care. Unique Contribution to Theory, Practice and Policy: The study recommend that the whole aspect of HIS and EMR be considered as a study area in the curriculum of all healthcare workers to help ensure a seamless transition at the workplace and at the same time dealing with the issue of the human barrier.Item Determinants of Health Facility Preparedness in the Management of Gender Based Violence in Kenya: A Case of Primary Health Facilities in Mombasa County(Journal of Popular Education in Africa, 2024-09) Onkoba, Phyllys Kemunto; Tenambergen, Mwaura Wanja; Oluoch, MusaGender based violence (GBV) is a significant obstacle to achieving human rights and sustainable development goals. the study aimed at establishing the determinants of health facility preparedness in the management of GBV: A case of PH facilities in Mombasa County. Descriptive cross-sectional research design was used in establishing the factors influencing health facility preparedness in the management of GBV. The study focused on health workers working Mombasa County Primary health (PH) facilities including the hospital administrators, medical officers, clinical officers, nurses, counsellor, psychiatrists, pharmacists and lab technicians working in Level 2, Level 3 and Level 4 health facilities. The study employed the random sampling approach where all the elements had equal chances of being chosen. The study sample was 334 which was 16.4% of the target population. A questionnaire was used in collecting the necessary data aimed at fulfilling the purpose of this study. Data was analyzed using SPSS version 25 and both descriptive and analytic statistics were done. Pearson correlations was used to assess the strength of the association between the study variables. Finally, the multiple regression was run in order to find out the collective predictive power of the independent factors on the dependent variables. The study found and concluded that that budget allocation, health information management system and professionalism were significant factors in influencing the PH facilities preparedness in the management of GBV with significant value of .000 each. Further, the study concludes that physical infrastructure was an insignificant determinant of the PH facilities preparedness in the management of GBV with significance value of .084Item Determinants of Nurses Performance in Tier Three Health Facilities: A Case Study of Kajiado County, Kenya(Journal of Health, Medicine and Nursing, 2018) Kokwaro, Brenda; Oluoch, Musa; Adoyo, Maureen Atieno; Kimemia, Fredrick M.; Tenambergen, Mwaura WanjaPurpose: Human Resources for Health (HRH) is critical for improved productivity and efficient delivery of health services. However, insufficient health personnel in terms of numbers and level of performance are a major constraint in disease control and maintenance of a health population. A study was carried out to determine the relationship between job related factors, the work environment, organizational factors and policy practices that affect the performance of nurses in tier three health facilities in Kajiado County. Method: A cross sectional, descriptive study design was utilized, adopting qualitative and quantitative data collection approaches. Four tier three health facilities were included and one hundred and thirty (130 ) respondents were involved in the study. Purposive sampling was used Nurses working in the various departments in the respective facilities were issued with questionnaires to fill in and return. The heads of the different departments were interviewed using an interview guide. Inferential statistics was used to analyze the data. Quantitative data was analysed using SPSS version 23 .0 and qualitative data was analysed through thematic content analysis. Results: Results on organizational-relation aspects revealed lack of necessary support provision for incompetent nurses. It also revealed a substantial lack of an appraisal and review system. The findings on job related factors showed that most of the nurses were diploma holders hence the need for opportunities for further training and enhancement in education levels to advance their knowledge. Findings on organizational factors showed that inadequate staff levels led to increased workload on available staff which in turn affected the performance of nurses. Unique Contribution to Theory, Practice and Policy: The study recommends that there should add more refresher and training courses for the nurses, recruitment of more nursing staff and improvement of resources available.Item Determinants of Uptake of Health Insurance Cover Among Adult Patients Attending Bungoma County Referral Hospital(International Journal of Health Economics and Policy, 2017-06-12) Masengeli, Nathan Lukhale; Tenambergen, Mwaura Wanja; Mutai, Joseph; Simiyu, Ben WafulaHealth insurance is currently being considered as a mechanism for promoting progress to Universal health Coverage and reducing out-of-pocket payments in many African countries including Kenya which is prompting the use of NHIF. In Kenya, penetration of health insurance is 20% and 11% in Bungoma County. The main objective of the study was to establish the scheme-related factors influencing uptake of health insurance cover among patients attending Bungoma County Referral hospital. The study adopted across sectional descriptive survey of 300 systematically sampled patients, 4 purposively sampled departmental heads in Bungoma County Referral Hospital and all the 5 insurance company branch managers. Data was collected using questionnaires administered and Key Informant Interview schedule. Crude odds ratio was used to establish association between ownership of health insurance and scheme-related factors. Findings showed that 37% of patients owned health insurance covers mostly public health insurance cover (NHIF). Ownership of health insurance covers increased with age, household income, education levels, awareness of insurance benefits and concepts. Covers were also more prevalent among married patients. Ownership of health insurance covers increased 12.5 times with affordability of covers premiums. Stock-out of essential drugs and supplies and longer waiting time in covered health facilities discouraged enrollment to schemes.Item Determinants of Uptake of National Hospital Insurance Fund Primary Care Health Services by Health Facilities in Nakuru Town, Kenya(Health Systems Management Journal, 2019-08-16) Wagura, Elizabeth Wanjiku; Tenambergen, Mwaura Wanja; Mwangi, Eunice MuthoniIntroduction: There is a growing international consensus on the importance of providing social protection by governments and international bodies against extreme poverty, disease, inequality, and vulnerability that could be barriers to the achievement of the Sustainable Development Goals. Of great importance is financing of healthcare services, specifically the National Health Insurance Fund primary care. Despite the provision of accessible and adequate health services being the primary goal of financing healthcare, the uptake of the primary care services scheme among service providers is still low. This paper analysis the level of uptake of National Hospital Insurance Fund (NHIF) primary care scheme amongst service providers in Nakuru Town. Specifically: It explains the influence of knowledge of service providers about the scheme on the uptake of NHIF primary care scheme. Methods:The study adopted a cross-sectional research design targeting 120 service providers from 60 health facilities that are accredited by National Hospital Insurance Fund (NHIF) within the scope of NHIF Nakuru branch. A random sample of 96 service providers was drawn from 48 health facilities. Data was collected using a structured questionnaire and an in-depth guide. Quantitative data was analyzed using descriptive and inferential statistics with the aid of SPSS version 21.0. Results:The study findings indicated that there was a significant positive correlation between the knowledge of the service providers and uptake of the scheme. Conclusions:The study recommended need for the government and particularly the ministry of health to increase the level of knowledge and awareness among the general public about the membership and benefits of the scheme. Need for stakeholders to come up with mechanisms of addressing the various barriers affecting uptake of the scheme. A similar study be conducted in more health facilities in both rural and urban settings to relate the results of this study with all settings. Need for a study targeting the general public and other stakeholders to have a holistic understanding of the perception of all the critical stakeholders.Item 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 MuthoniThis 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.Item Effect of Socio-demographic Characteristics on Health System Responsiveness in Diabetic and Hypertensive Clinics: A Cross-sectional Study in Tier Three Hospitals in Kenya(International Journal of Professional Practice (IJPP), 2024-04-19) Kibiriti, Hillary; Tenambergen, Mwaura Wanja; Mapesa, Job O.This study aimed to investigate the effect of socio-demographic characteristics on health system responsiveness within diabetic andhypertensive clinics in tier three hospitals in Kenya. Responsiveness, which refers to meeting non-health-improving expectations, is crucial for a well-functioning health system, and gaps in responsiveness can compromise the quality of healthcare. While both client and health system factors contribute to responsiveness, the specific influence of socio-demographic characteristics on health systems responsiveness remains unexplored in Kenyan chronic care centers.The cross-sectional descriptive survey involved 308 respondents from Kimilili, Uasin Gishu, and Gatundu hospitals. Data were collected using a structured questionnaire that assessed responsiveness domains such as promptness, respect, communication, involvement, confidentiality, choice, cleanliness, social support access, and overall trust, rated on a five-point Likert scale. Socio-demographic factors investigated included facility location, gender, age, medical condition, religion, marital status, education levels, income level, occupation, and insurance enrollment. The mean responsiveness score was 98.8 (63.7%), with only 38.3% of respondents reporting favorable outcomes. Chi-square analysis revealed significant associations (p<0.05) between responsiveness and facility location, religion, marital status, occupation, and medical condition. Age, gender, insurance enrollment, education, and income level showed no significant association (p>0.05) with responsiveness. The study concluded that favorable responsiveness was less likely than unfavorable outcomes, highlighting the significance of socio-demographic factors. It recommends that healthcare managers prioritize holistic, patient-centered interactions to improve responsiveness in chronic care clinics, taking into account the influence of socio-demographic characteristics on patients' experiences and expectations.Item Effectiveness of Ng’adakarin Bamocha model in improving access to ante-natal and delivery services among nomadic pastoralist communities of Turkana West and Turkana North Sub-Counties of Kenya(Pan African Medical Journal, 2015-04-23) Jillo, Ali Jillo; Ofware, Peter Obonyo; Njuguna, Susan; Tenambergen, Mwaura WanjaIntroduction Access to maternal and child health care services among the nomadic pastoralists community in Kenya and African continent in general is unacceptably low. In Turkana, only 18.1% of the women had seen a nurse or a midwife for antenatal care during pregnancy while only 1.3% of pregnant women reported delivery at health facilities in 2005. Ng'adakarin BAMOCHA model, based on migratory routes of the Turkana pastoralists and container clinics was adopted in 2007 to improve access to maternal and child health services by the nomads. Methods A cross-sectional study design was used to establish the effectiveness of Ng'adakarin BAMOCHA model on accessibility and uptake of ante-natal care and delivery services. A total of 360 households and 400 households were interviewed for pre-intervention and post-intervention respectively. The study compared the pre-intervention and post-intervention findings. Structured questionnaires and focus group discussion were used for data collection. Results There was no improvement in the fourth ante-natal care visits between pre-intervention and post-intervention groups at 119(51.5%) and 111(41.9%) respectively (p < 0.05). Knowledge of the community on the importance of ANC visits improved from 60%-72% with significance level of p < 0.05. There was a significant increase 6%-17% of deliveries under a skilled health worker (p < 0.05). TBA assisted deliveries increased from 7.5%- 20.2% with a p < 0.05. There was significant reduction in home deliveries from 89.5%-79.5% with a p < 0.05. Conclusion The Ng'adakarin Bamocha model had a positive effect on the improving maternal health care among the nomadic pastoralist community in Turkana.Item Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya(sciencepublishing group.com, 2016-06-30) Nshimirimana, Desire Aime; Tenambergen, Mwaura Wanja; Kokonya, Donald; Adoyo, Maureen AtienoThe low health outcomes and inequities problems in developing countries are due to ineffective gate keeping at the Primary Health Care (PHC) level, non-adherence to policy and dysfunctional health infrastructure. This study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for data analysis. Correlation was done using the Spearman rho test and significance was set at <0.05. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) nurses and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). A proportional relationship (rho=0.383, p< .001) existed between the number of out-patients received and cases referred to hospitals. Most gatekeepers were ignorant (p=0.04) about the Policy on the patients’ referral yet they did not officially refer patients (80.7%). Most (63.5%) of the hospitals receiving self-referrals did not ask for referral letters. Policy and referral letters were found to be necessary (p=0.004). The gatekeepers’ non-adherence to policy, lack of laboratory services and shortages of drugs contributed to self-referral by patients, creating a burden on the resources for healthcare, resultingin inefficiency at the PHC level. This study recommends a review of the gatekeeping system at the PHC level, capacity building, quality assurance, redefinition and strengthening of the office of the gatekeepers, regularization of supplies and reinforcement of the patient referral policy, staff motivation and best practices in customer care.Item Effects of Health Insurance Schemes on Utilization of Healthcare Services and Financial Risk Protection: A Systematic Review(Public Health Research, 2020) Njuguna, David K.; Tenambergen, Mwaura Wanja; Mapesa, Job O.Universal health coverage (UHC) assures healthcare utilization and financial risk protection. Health insurance schemes are highly variable in the scope of the benefits package, the magnitude of premiums, deductibles, copayments, and the range of providers and health facilities participating in the networks. The variability has different effects utilization and financial risk protection. This systematic review explores the effect of various models of health insurance on utilization of healthcare services, and financial risk protection. We included 22 studies conducted in 17 countries that implement different health insurance schemes. Overall, evidence on the impact of health insurance on financial protection varied across studies reviewed. Seven studies reported a reduction in out-of-pocket expenditure, two studies had no statistically significant effect; and one study reported an increase in out-of-pocket expenditure. While 14 studies found a positive effect on healthcare utilization, six studies had no statistically significant impact on utilization of healthcare. The findings of this review show that enrollment in various insurance schemes can protect households and individuals from catastrophic out-of-pocket spending and increase healthcare utilization. The consistent evidence of the positive effects of health insurance highlights the need to explore creative and responsive insurance schemes contextualized to meet the needs of different groups and achieve UHC.