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Defect dependent memory switching in amorphous silicon alloys [a-Si xC1-x:H]
(Electronics Letters, 2002) Shannon, J. M.; Gateru, Robert; Gerstner, Ed
It is shown that memory switching in amorphous silicon alloys is affected by ion bombardment. In particular, ion damage lowers the voltage required to form devices and switch them into the on-state. This technique enables optimised non-volatile memory devices to be made with improved switching ratios.
Polarity-dependent forming in ion bombarded amorphous silicon memory devices
(Journal of Applied Physics, 2005) Gateru, Robert; Orwa, J.O; Shannon, J. M.
Polarity-dependent forming in ion bombarded metal±semiconductor±metal (MSM) memory devices of hydrogenated amorphous silicon is reported. It is shown that prior to ion bombardment, current transport in the MSM devices is asymmetric and is controlled by the Schottky barriers at two MS junctions. Upon bombardment, however, there is a bulk component to the current and the I±V characteristics of the devices become symmetric at low bias voltages. The forming voltage in the bombarded devices shows polarity dependence. For positive bias applied on the top contact, we ®nd that devices form at the same electric ®eld independent of the thickness of the amorphous silicon while for negative voltage on the top contact, the electric ®eld needed for forming increases with the thickness. A model involving the difference in energy deposition and heat sinking for the two polarities is proposed
Access to Health Care: The Role of a Community Based Health Insurance in Kenya
(Pan African Medical Journal, 2012-06-19) Mwaura, Judy Wanja; Pongpanich, Sathirakorn
Background: Out-of-pocket payments create financial barriers to health care access. There is an increasing interest in the role of community based health insurance schemes in improving equity and access of the poor to essential health care. The aim of this study was to assess the impact of Jamii Bora Health Insurance on access to health care among the urban poor. Methods: Data was obtained from the household health interview survey in Kibera and Mathare slums, which consisted of 420 respondents, aged 18 and above who were registered as members of Jamii Bora Trust. The members of Jamii Bora Trust were divided into two groups the insured and the non-insured. Results: In total, 17.9% respondents were hospitalized and women (19.6%) were more likely to be admitted than men (14.7%). Those in the poorest quintile had the highest probability of admission (18.1%). Those with secondary school education, large household size, and aged 50 and above also had slightly greater probability of admission (p<0.25). 86% of admissions among the insured respondents were covered JBHI and those in the poorest quintile were more likely to use the JBHI benefit. Results from the logistic regression revealed that the probability of being admitted, whether overall admission or admission covered by the JBHI benefit was determined by the presence of chronic condition (p<0.01). Conclusion: Utilization and take up of the JBHI benefits was high. Overall, JBHI favoured the members in the lower income quintiles who were more likely to use health care services covered by the JBHI scheme.
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 Wanja
Introduction 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.
Relationship Between Macro-economic Variable, Investor Herding Behavior and Stock Market Volatility in Kenya
(International Journal of Economics, Commerce and Management, 2016) Amata, Evans Ombima; Muturi, Willy; Mbewa, Martin
This study sought to examine the relationship between interest rate, inflation, gross domestic product (GDP), foreign exchange, investor herding behaviour and stock market volatility. Published time series data from January 2001 to December 2014 was obtained from the Central Bank of Kenya, Kenya National Bureau of Statistics, Capital Market Authority and the Nairobi Securities Exchange. Granger causality test was used to determine the short run causality while the Vector Error Correction Model (VECM) was used to test the long run causality between predictor variables and stock market volatility. Result from the regression model show a positive and significant relationship between inflation and stock market volatility both in the short run and long run. The study finds that an increase in inflation by 1% leads to an increase in stock market volatility by approximately 24%. Results also revealed that there is a negative and significant relationship between interest rate and stock market volatility both in the short run and long run. GDP, Foreign exchange and herding behaviour had no significant relationship with stock market volatility in Kenya
The Design Criteria in Implementation of a Health Management Information System: A Case of Kenyatta National Hospital
(International Journal of Sciences: Basic and Applied Research (IJSBAR), 2016) Omambiaa, Salim Matagi; Odhiambo-Otieno, George W.; Tenambergen, Mwaura Wanja; Adoyo, Maureen Atieno
Embracing modern technology is one among very many ways of improving efficiency and reducing costs within healthcare organizations. While the integration of information and health services potential benefits cannot be disputed, there are many challenges which affect its adoption, in fact, majority of organizations have abandoned their newly acquired systems only to go back to their old manual systems. The objective of this study was to determine the design phase of the implemented Health Management Information System at Kenyatta National Hospital. This study was a cross-sectional descriptive study, the targeted population of the study were 35 healthcare workers who were involved in the designing of the Health Management Information System at Kenyatta National Hospital, and the sample technique used was snowball sampling. The study utilized an in-depth interview schedule for 33 respondents in the design phase who were selected using snow-ball, the data collected from the field was analyzed through the use of univariete and bivariete statistics. Data presentation was in form of descriptive statistics such as frequency distribution, percentages, pie charts, bar graphs and tables. The data from the design phase were summarized in three main evaluation areas targeting the perception of the HMIS, purposes and processes From the findings, in the design stage although the respondents did not show systematic ordering there was evidence to the effect that the steps were followed during the design phase. From the findings majority of the key informants were able to define HMIS and distinguish the key features of the HMIS. Out of the 33 participants, 13 (33.4%) reported that they knew the persons who originated the idea of the electronic HMIS in KNH, a similar number were involved in the conceptualization of the system, while 4 (12.2%) indicated that they were involved in designing the HMIS and 18 (54.6%) were involved in implementation. Despite the general lack of knowledge on HMIS policy the informants demonstrated adequate understanding of the objectives of the electronic HMIS in KNH. Based on the responses obtained during interviews there were multiple problems related to the manual system that existed in KNH during the pre-implementation stage and these issues served as the basis for objective setting for the current HMIS in the hospital. Most key informants felt that the hypothesized benefits of the current HMIS were being realized including improved efficiency while four key informants felt that the benefits had been partially realized. An evaluation of the manual HMIS was done during which deficiencies of the HMIS were identified through consultations involving HMIS users and stakeholder. A HMIS needs assessment was conducted and formed the basis of the electronic system requirements with specific proposals for improvement of the deficiencies identified in the manual HMIS. An evaluation of the manual HMIS was done during which deficiencies of the HMIS were identified through consultations involving HMIS users and stakeholder. During the interviews the participants were able to highlight various aspects of the IS development cycle and there was evidence to the effect that the steps were followed during the design phase plus an evaluation of the manual system was done during which deficiencies of the system were identified through consultations involving HMIS users and stakeholders. Based on the results and discussions, among the main problems that key informants described during the design phase was major inefficiencies characterized by evident mismatching of resources input and output which spanned several areas including time, human resources and finances however, participants were able to highlight various aspects of the IS development cycle and there was evidence to the effect that the steps were followed during the design phase, planning plus an evaluation of the manual system was done during which deficiencies of the system were identified through consultations involving HMIS users and stakeholders. As a recommendation we can say that NH and the MOH needs to come up with an established standardized policy for implementing interventions.
Health Insurance Plan and Utilization of Health Services: The Case of Tanykina Community Health Plan; Nandi County, Kenya
(International Journal of Scientific and Research Publications, 2016-03) Terer, Erick; Tenambergen, Mwaura Wanja; Osuga, Ben
Community Based Health Insurance mechanism of Health financing targets the informal sector and the Rural who cannot access the national social health insurance. Tanykina Community Health Plan was established to help dairy farmers in Nandi North Sub county of Nandi to access quality health services using monthly milk deductions as the premiums. Despite this financial access, there is still low health care utilization by these residences. This study aimed to evaluate the effect of the perceptions of residents and clients on the utilization of health services. A cross-sectional study was conducted on patients attending the contracted health facilities. Of the 336 respondents (84% response rate) 169(50.2%) were enrolled members of TCHP, with most of them being female (95,55%) and over 50 % having at least college level of education. The level of education was highly correlated with increased healthcare utilization (p=0.069) though this was not statistically significant. Increased level of satisfaction correlated positively with increased used of outpatient services and this was statistically significant (p=0.05). The perceived availability of information was however no statistically significantly associated with increased utilization of health services in either outpatient department (p=0.112) or inpatient department (p=0.939). The perception of increased accessed to information increased with additional age of the clients. The belief that the services offered through TCHP target the poor in the society was highly associated with increased education level of the clients (p<0.05) and the duration of membership of the clients (p<0.05). There was also a 15% increase in the outpatient services use and 19% increased likelihood to increased inpatient use with the perception that the services target the poor in the society. Almost all the respondents n=325(97%) perceived that the services of TCHP are highly acceptable. The increased level of perceived acceptance was highly associated with increased utilization of inpatient services (p=0.04). Being male increased the level of perceived acceptance by 10 % compared to the female counterparts. With regard to in-patient health services an additional increase in the level of education of the insured members and the duration of membership significantly increases the utilization of these services by 0.19 and 0.89 respectively. However, the duration of membership was statistically significant (p=0.008) in influencing the level of in-patient utilization. We recommend managers of community based health insurance to continuously evaluate the perceptions that the members have in order to improve utilization of health services.
Influence of Maternal Health Education Delivered Through Community Health Referral Project on Antenatal Care Attendance: A Focus on Mirihini and Midoina Communities of Kilifi County, Kenya
(International Journal of Scientific and Research Publications, 2016-05) Shibonje, Janet Mukoshi; Tenambergen, Mwaura Wanja; Njuguna, Susan
Timely delivery of effective, safe, quality and personal services is a key pillar of health system strengthening. A Maternal, Newborn and Child Health (MNeCH) Project was initiated by the Ministry of Health and World Vision Kenya in Bamba Division, Kilifi County. The project’s goal was to strengthen health systems at the facility and community levels, including Antenatal Care (ANC). One of the strategies used by the project to achieve its goal was to strengthen community health referral system. The objectives of the study were 1) to determine whether providing maternal health education to pregnant women had any influence on ANC attendance in the intervention and control communities and 2) to determine whether issuing referral advice forms to patients has any influence on ANC attendance in the intervention and control communities. This study adopted the static group control design to assess the influence of community health referral practices on ANC attendance in Mirihini, the intervention community in Bamba and Midoina the control community. Primary data were sourced from 246 mothers of children aged below 2 years, parents of children aged 2 to 4 years, as well as Community Health Volunteers (CHVs). Quantitative analysis yielded descriptive statistics and cross-tabulations with Chi-square (χ2 ) tests. Qualitative data were transcribed, described and analyzed systematically to reveal themes and patterns. Maternal health education: In Mirihini, there was no significant association between providing maternal health education on the ideal number of ANC visits and women’s achievement of optimal ANC attendance (χ2 = 1.423, df=1 & a ρ-value = 0.233). In Midoina, a significant relationship between the two aspects was obtained (χ2 = 3.109, df = 1 & ρ-value = 0.078. Referral documentation: In Mirihini, issuing referral documents to pregnant women was significantly associated with women’s achievement of optimal ANC attendance (χ2 = 8.308, df =1 & ρ-value = 0.004). In Midoina, there was no significant association between two aspects (χ2 = 0.823, df = 1 & ρ-value = 0.185). The study recommends the need for: CHVs to deliver more information to support care-seeking behavior change; project officers to strengthen supervisory support to CHVs by engaging with MoH to provide reporting materials and ensure consistency of monthly review meetings.
Utilization of Service Charters in Public Hospitals in Kenya: A Case of Thika Level 5 Hospital, Kiambu County
(International Journal of Scientific and Research Publications, 2016-06) Masese, Charles Onyambu; Tenambergen, Mwaura Wanja; Muiruri, Lillian
Service delivery in government health facilities in Kenya still faces multiple challenges. These challenges can still be identified ten years down the line since the introduction of Service Charter. The objective of the study was to assess how the service charter utilization would influence health service delivery in Thika Level 5 Hospital (TL5H) in Kiambu County. Cross sectional study design was employed. Quantitative data was collected using questionnaires. A sample size of 156 technical employees of TL5H and patients participated in this study. Collected data was edited, coded, and entered into the computer using the Statistical Package for Social Scientists (SPSS v 23). The respondents strongly agreed that the hospital charter content is not viewed annually creating unfriendly services (mean 1.73, SD 0.97), (mean 1.74, SD 0.997) indicated the respondents strongly agreed that the service charter is not clearly understood by the majority of patients informing them of their rights when seeking services. The respondents disagreed that the hospital management is always active in monitoring performance and playing the oversight duty according to the SC (mean 2.19, SD 1.20) on whether failure to utilize the service charter may lead to deterioration of quality and equity of healthcare, the respondents agreed (mean 2.05, SD 1.54). Most of the respondents strongly agreed there is availability of support for the service charter (Mean 1.72, SD 0.93), while the respondents also indicated that the waiting time has not improved despite the availability of service charter (Mean 2.98, SD 1.09). The study also established that there was uncertainty in the amount of waiting time in TL5H (Mean 1.775, SD 0.91). The channels used for communication were not clear (Mean 1.993, SD 1.12) while the communication at TL5H does not ensure clarity on issues (Mean 1.9, SD 1.07) while the respondent agreed on communication at TL5H was not always done to get commitment from staff (Mean 1.923, SD 1.047) and there was inadequate open communication of most issues at TL5H (Mean 1.846, SD 1.075). The study recommends that 1) TL5H should improve the contents of the service charter to make it clear, to ensure that the patients fully understand the contents, 2) there should be proper monitoring of the members of staff to ensure that the service charter is fully implemented to minimize the amount of complaints by patients, 3) the service charter contents should be embedded in the organization culture to ensure that is fully and properly implemented to the satisfaction of the service users.
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 Atieno
Primary 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.
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 Atieno
Background: 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 activities
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 Atieno
The 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.
Provision of Essential Health Package in Public Hospitals: A Case of Homabay County Hospitals, Kenya
(Pan African Medical Journal, 2016-08-26) Opon, Shadrack Ochieng; Tenambergen, Mwaura Wanja
Introduction: Essential Health Packages (EHP) delivery is likely to strengthen service delivery. Healthcare utilization rate is 77% for the sick. 44% and 18% who don't seek care are hindered by cost and distance respectively. The overall child mortality rate in Kenya is 121/1000. In Homabay County, child mortality rate is 91/1000, and maternal mortality rate of 583/100000. The study looked into the provision of EHP in public hospitals in Homabay County. Methods: cross-sectional research design was used. Two hospitals were conveniently due to their municipality location. The study targeted 213 Health workers and 350 patients. Stratified sampling and proportionate sampling was used among different health workers. Sample size was determined by Yamane Formula. The study sampled 138 health workers and 186 patients. Questionnaire and key interview guide were used to collect data. Results: there are inadequate health workers based on 138 (100%) health workers. Insufficient drugs were reported by 138 (100%) health workers, and 120 (64.5%) patients. 115 (83.3%) health workers say ambulances are not operational. 26 (18.8%) health workers noted lack medical equipment, 138 (100%) are aware of patients referred elsewhere due to lack of medical equipment. 153 (82.3%) and 135 (72.6%) patients' health access is hindered by cost and distance respectively. 159 (85.5%) patients don't always find services needed. 159 (85.5%) patients affected by long waiting time. Conclusion: low service provision/utilization rate in Homabay County results from lack of health workers, inadequate drugs, poor health infrastructure, and lack of access in terms of affordability, availability and distance.
Effects of Credit Card Incentives on Consumer Borrowing In Kenya: A Case of Commercial Banks in Kenya
(International Journal of Academic Research in Economics and Management Sciences, 2017) Mwende, Joyce; Wachira, David Muturi; Amata, Evans Ombima
Financial institutions have mainly relied on incentive programs as their main strategic driver to increase electronic payments, such as through use of credit cards. Credit cards have been globally acclaimed for their benefits that range from their ability to ensure tax-compliance, security, instant cash and their ability to facilitate settlement of cross-border transactions. However, there exists a great challenge of credit card usage, such as ease of accumulation of debts and high interest charges. The purpose of this study was to determine the effect of credit card incentives on consumer borrowing in Kenya. The study employed a descriptive study approach using a sample size of 18 commercial banks offering credit card services. Selfadministered questionnaires were used to collect information. Credit card incentives were found to be a major contributor to credit card uptake. The study also found that most banks used incentives such as rewards for repeated use, low interest rates, traveling awards and benefits to influence the spending behavior of their clients. The study found credit card also affected spending behavior. It is concluded that credit card incentives can be effectively used by banks to increase use of credit cards. It is recommended that financial institutions should educated their customers on how to use their credit cards so that they do not fall into a debt trap.
The impact of corporate diversification on firm value in Kenya
(African Journal of Business Mangement, 2017) Manyuru, Anthony; Wachira, David Muturi; Amata, Evans Ombima
This study investigates the impact of corporate diversification on the value of firms listed at the Nairobi Securities Exchange (NSE). Panel regression techniques were used as the estimation methods. The overall findings of the study where somewhat mixed. The study finds that industrial diversification reduces firm value, but geographical diversification does not have a significant impact on firm value. When examining each industry individually, the study established that industrial diversification enhanced firm value in the agricultural industry but did not significantly influence firm value in the other industries.
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, Perngparn
Background: 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.
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 Wafula
Health 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.
Evaluation of Alcohol Screening and Community-Based Brief Interventions in Rural Western Kenya: A Quasi-Experimental Study
(Alcohol and Alcoholism, 2017-10-26) Takahashi, Risa; Wilunda, Calistus; Magutah, Karani; Tenambergen, Mwaura Wanja; Atwoli, Lukoye; Usaneya, Perngparn
Aims To assess the effectiveness of community-based alcohol brief interventions (ABI) implemented by community-health workers with and without motivational talks (MT) by former drinkers, in reducing harmful and hazardous alcohol consumption. Methods We conducted a three-arm quasi-experimental study (one control and two intervention groups) between May and December 2015 in Kakamega County, Kenya. Participants were hazardous or harmful alcohol drinkers with an Alcohol Use Disorders Identification Test (AUDIT) score of 8–19 at baseline. One intervention group received only ABI while the other received ABI + MT. The interventions’ effects on AUDIT scores were analysed using linear mixed models. Logistic regression was used to analyse the interventions’ effects on low-risk drinking (AUDIT score <8) after 6 months. Results The study included 161 participants: 52 in the control group, 52 in the only ABI group and 57 in the ABI + MT group. The mean AUDIT scores were lower in the intervention groups at 1, 3 and 6 months post-intervention; the ABI + MT group showed a greater reduction. The mean AUDIT scores over a 6-month period were lower in both intervention groups compared with the control group. The odds of low-risk drinking were almost two times higher in both intervention groups than in the control group, although the effect of only ABI on low-risk drinking was not significant. Conclusions ABI + MT and only ABI were associated with a reduced mean AUDIT score among hazardous and high-risk drinkers in this resource-limited setting. ABI + MT was also associated with low-risk drinking in this population. Short summary Community-based alcohol brief interventions implemented by community-health workers accompanied by motivational talks by former drinkers were associated with reduced hazardous and harmful alcohol consumption in a rural setting in western Kenya.
Factors Influencing Collecting of Blood Donor Test Results in Nairobi County – A Case Study of Nairobi Regional Blood Transfusion Centre
(Journal of Health, Medicine and Nursing, 2018) Gititu, George; Oluoch, Musa; Tenambergen, Mwaura Wanja
Background: The Kenya National Blood Transfusion Services screens all donated blood for HIV, Hepatitis B&C and syphilis with each blood donor being informed of testing of his or her donated blood and availability of test results for collection at the Regional Blood Transfusion Centers. The study-assessed factors influencing collection of blood test results by blood donors as only less than 10% blood donor’s return to collect their test results. Method: The study utilized descriptive cross-sectional study approach employing a mix of both quantitative and qualitative approach. 385 blood donors and seven key informants interviewed using a pre-designed questionnaire and Key informant respectively. Quantitative data was analyzed using Epi info 6.04 while qualitative data was transcribed and analyzed using content thematic framework approach. Results: 95% of participants did not return to collect their test results with 90% not being aware that test results are available for collection. 50% of those who had not collected their test results would not have collected even after being adequately informed. 93% would not collect their test results in presence of friends fearing stigmatization and would not share the outcome of the test even with their families. Conclusion: The study concluded that the collection of donor test results is greatly influenced by knowledge, location of result collection sites, working hours of collection sites, stigma and cultural beliefs. The Study recommends mass sensitization on availability of test results, where to collect results and demystify social cultural beliefs.
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 Wanja
Purpose: 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.

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