THE IMPACT OF FORMAL MATERNAL EDUCATION ON CHILD SURVIVAL IN GHANA

Purpose: The purpose of this study is to investigated the impact of formal maternal education on child survival in Ghana using a probit model. Methodology:This study used data from the Ghana Demographic and Health Survey for the period of 1993 to 2008. It is nationally representative sample including urban and rural areas in the 10 regions of Ghana. It looks at trends in demographic and health indicators and is conducted every five years (GSS, 2009). . Findings: Mothers’ education had a positive and significant effect on child survival. In 2003 the probability of a child surviving up to age five increased by 15.4 percentage points for one year increase in mothers’ education, using control variables and 8.9 percentage points for a year increase in mothers’ education, after including socio-economic and reproductive factors of women, which revealed the true partial effect of maternal education. Unique contributions to theory practice and policy: It was observed that socio-economic and reproductive factors of women had an impact as well, hence policy makers should act to improve on these factors in order to complement the effect of formal maternal education to promote child survival in Ghana.

WORKING AND STUDYING: CHALLENGES FACED BY THE DIPLOMA NURSE WHILE UPGRADING

Background: Personal development and pursuance of higher education in nursing is considered important for the nurses to stay abreast in the dynamic medical world and promote excellence in practice. There are workplace barriers that cause challenges for nurses who are upgrading as well as after upgrading. Objectives: Determine institution related challenges that determine whether a nurse enrolls in a diploma to degree nursing program, their performance during the program and their decision to hold on to the end Methodology: The study adopted a descriptive cross sectional design, carried out among a randomly sampled population of 220 nurses who work in the hospital. Data was collected using self-administered questionnaires from a simple random sample of 140 nurses. Data analysis was done by SPSS version 22.0. Measures of central tendency mean and range were used. The findings have been presented in form of figures, tables, pie-charts and narrative texts. Results: A total of 120 participants filled questionnaires representing an 85% response rate. 78% (n=93) were female, and 22% (n=27) were male, Inferential analysis on institution related factors and their influence on upgrading nurses were assessed. Findings showed that the need for a promotion was the most important institution –related factors (n=62, 57.4%) underlying the motivation for nurses to upgrade (X2=17.601, df=7, p=0.014). Conclusion: Upgrading is a worthwhile venture for both the nurse and the work place. Promotion is one of the greatest motivational factors of upgrading. More diploma nurses think it is worth to upgrade. Recommendations: This research recommends that a caring curriculum should be designed for the working nurse and recognition and promotion according to education level and awareness of policies on promotion after upgrading.

ASSESSMENT OF NUTRITION ADVOCACY IN SOMALIA REPORT: GAPS, OPPORTUNITIES AND KEY MESSAGES

Purpose: This inception report on the comprehensive assessment through desk reviews and analysis nutrition gaps in policy, political commitment, resource allocation and multi-sectoral coordination to inform the development of guideline and messages. This is as a follow-up of preliminary discussion held and concept agreed with the office of the national coordination for Scaling Up Nutrition (SUN), Somalia housed in the Office of Prime Minister (OPM), Federal Government of Somalia. This summary report presents findings from the assessment and a discussion of methodology, challenges and opportunities. By identifying and contextualizing new findings, nutrition advocacy assessment builds consensus in Somalia with a vision and path ahead for improved nutrition messaging and guidelines that various actors will use of advocacy work. Methodology: 30 documents were gathered and reviewed, including - national legislation, policies, guidelines, strategies and action plans to assess the inclusion of adolescents and current gaps. Interviews were conducted with 20 stakeholders from government, donors, UN, communities and non-governmental institutions in Somalia. The review, analysis and stakeholder interviews assessed the extent to which nutritional aspects were being addressed, any gaps in the policy landscape, commitments, multi-sectoral coordination, advocacy initiatives and recommendations for strengthening the enabling environment. Findings: It was established that awareness of SUN as a movement in Somalia was rated highly at however participation in SUN activities was very low and was left to nutritionist in the various sector/Institutions. Government has also shown a great political will and commitment to nutrition by ensuring policies and legislative frameworks are sufficient even though multi-sectoral nutrition integration is not optimal to impact desired impact. Unique contribution to theory, practice and policy: It was recommended that there is need to advocate political and administrative authorities, to further convince them to add nutrition among the top priorities of the governments, translate policies into actions and ensure allocation of funds for nutrition interventions. Also, Government must strongly provide leadership in nutrition policy development, programing and coordination.

SCHOOL HYGIENE PROMOTION APPROACHES AND THEIR INFLUENCE ON PUPIL’S HYGIENE PRACTICES IN PUBLIC PRIMARY SCHOOLS IN DAGORETTI, NAIROBI CITY COUNTY, KENYA

Purpose: The purpose of this study was to examine hygiene promotion approaches that were being employed by public primary schools in Dagoretti North and South Sub Counties in Nairobi City County and whether the approaches influenced hygiene behaviors that were practiced by pupils. Methodology: The study applied a descriptive cross-sectional design. Questionnaires were administered to 384 pupils with the aim of collecting data on hygiene knowledge and practices. A questionnaire was also used to collect data on hygiene promotion approaches from 32 school health teachers. Pupils’ demographic data was collected from school head teachers. Five key informant interviews were conducted with Nairobi City County public health and education officers and a staff from a non-governmental organization that was implementing school hygiene activities in Dagoretti South and North Sub Counties. Observation checklists were used to triangulate information on hygiene practices by pupils. Analysis was done using SPSS software. Findings: Results indicate that 95.6% of the pupils practiced hand washing at critical times, 98.7% used the toilet while 85.4% safely disposed solid waste. The study reveals that water, sanitation and hygiene in schools approach is implemented by 31.3% of the school health teachers. There was a significant relationship between school health clubs approach and hand washing at critical times (p=0.04) and proper solid waste disposal (p=0.02). One way analysis of variance established that there is a significant difference among hygiene promotion approaches and pupils hygiene knowledge, F(5, 162) = 6.41, p <.05 ƞ²p = 0.076. Unique contribution to theory, practice and policy: The study establishes that different hygiene promotion approaches have the potential to influence hygiene practices and in particular, hand washing at critical times and proper solid waste disposal amongst pupils. The study recommends the use of school health clubs approach for hygiene promotion at public primary schools

PREVALLENCE OF SCHISTOSOMIASIS (URINARY BILHARZIA) INSINAZONGWE DISTRICT

Purpose of study: This study investigated the prevalence of Urinary Schistosomiasis in Zambia’s Sinazongwe district. Methodology: Three primary schools in Sinazongwe district were sampled by convenient sampling and these were: Mwezya primary, Sinakasikili primary and Maamba private. 542 urine samples were collected from pupils examined in the laboratory at Maamba Hospital. Snail survey was carried out along 3 streams that are near the selected schools; Siamaambo stream which is near Mwezya primary school, Kanzinze stream which is near Sinakasikili primary school and another stream also called Kanzinze which is near Maamba private school. Findings: Study revealed that schistosomiasis is still highly existent in the district despite the ongoing administration of praziquantel; nonetheless, most of the infections are of low intensity and more males were infected than females. From the snail survey, Bulinus globosus the intermediate host for Schistosoma haematobium was found to be among the several snail species in Siamaambo stream and released cercaria when exposed to a light source, therefore they were infected and were/are the source of the bilharzia infection in Mwezya (Mwezya primary school). Unique contribution to theory, practice and policy: From results obtained, it can be seen that despite the administration of praziquantel to school going children, schistosomiasis will still be a problem in Sinazongwe district because the source of infection is not dealt with; as a result, there is continuous re-infection of the treated and untreated children. Therefore, comprehensive control by chemotherapy and snail control to eradicate the disease or at least lower the prevalence is recommended; and health officials that are involved in the administration of praziquantel should make follow-ups time-to-time after drug administration to evaluate the effectiveness of prophylactic program. Health education and provision of tap water is also recommended in this area to reduce frequent contact with contaminated water in streams.

CHALLENGES AMONG CANCER PATIENTS THAT MAY INFLUENCE RECOVERY OUTCOMES IN PALLIATIVE CARE UNITS IN NAIROBI AND NYERI COUNTIES

Purpose: This study sought to establish challenges among cancer patients that may influence recovery outcomes in palliative care units in Nairobi and Nyeri Counties. Methodology: The study adopted a correlation research design. The target population were the cancer patients, attending treatment at the three palliative care units in Nairobi and Nyeri Counties. Systematic random sampling technique was used in the study to obtain a sample of 96 participants. Semi structured questionnaires were used to collect data. Data was analyzed using both descriptive and inferential statistics, namely Pearson Moment Correlation Coefficient(r). Findings: Result showed that, majority of the respondents indicated participating in the programs available at the palliative care institutions, which included; group psychotherapy (91.7%), spiritual support (91.7%) and programs on coping skills (91.7). Others (22.6%) participated in programs such as performing chorals, knitting and board games. The results also showed that 82.1% and 78.6% of the respondents noted that they experienced challenges of being isolated and lacking finances respectively. 50% of the respondents had a challenge in coping with the condition, while 2.4% experienced challenges in adhering to drugs .These findings were not unusual considering that most of the patients were newly diagnosed with cancer and for some respondent’s metastasis had set in. Unique contribution to theory, practice and policy Patients facing challenges receiving palliative care could adopt group psychotherapy, including cognitive-behavioral, informational, non-behavioral, social support, and using unusual treatments such as music and art therapy to curb cancer. Administrators and medical staff in the palliative care units should create awareness and encourage the attending patients to source for a health insurance cover e.g. National Health Insurance Fund (NHIF) to cater for the cancer disease both outpatient and incase of hospitalization. This will ease the financial burden of cancer on the patient, family and community.

RELATIONSHIP BETWEEN THE DELAY IN MAKING A TIMELY DECISION TO SEEK MEDICAL ASSISTANCE AND PERINATAL MORTALITY IN LURAMBI AND BUTERE SUB-COUNTIES, KAKAMEGA COUNTY, KENYA

Purpose: To determine the relationship between the delays in making a timely decision to seek medical assistance and perinatal mortality in Lurambi and Butere sub-counties, Kakamega County, Kenya. Methodology: A community based retrospective cross-sectional research design was adopted using mixed methods for data collection. A total of 520 respondents were randomly selected from 40 out 830 villages of Lurambi and Butere sub-counties using multistage cluster sampling. The respondents were interviewed from November 2017 to March 2018. Data entry and analysis was done using SPSS Version 21 software. Descriptive and inferential statistical analyses were used. Bivariate and multivariate logistic regressions were applied and adjusted odds ratio was used to determine the strength of association. A p-value of ≤ 0.05 was considered as statistically significant. Findings: Education level (p<0.02) and employment status (p<0.03) of mothers influenced perinatal mortality. Wrong action taken during an experience of antenatal complication (AOR= 0.6; 95% CI: 0.1 – 0.9; p = 0.03), emergency unpreparedness (AOR=0.1; 95%CI: 0.04-0.42; p=0.0007) and, lack of recognition of newborn danger signs (AOR=01; 95%CI: 01-0.4; p<0.0001) were significantly associated with perinatal mortality. Birth preparedness and complication readiness during pregnancy and childbirth, based on the study findings reduce delay in obtaining care. Strengthening maternal education and social support system along the continuum of care during pregnancy, delivery and post-natal periods is paramount to ensure newborn survival. Unique Contribution to Theory, Practice, and Policy: Unique factors are that apart from medical interventions, strengthening maternal education and social support system along the continuum of care during pregnancy, delivery and post-natal periods is paramount to ensure newborn survival in Lurambi and Butere sub counties. Interventions to promote informed decisions regarding maternal and newborn care with a strong social support system are critical. These results contribute to maternal and newborn health care practice and policy change that if implemented could result in a reduction of perinatal mortalities.

SOCIO DEMOGRAPHIC AND SOCIO ECONOMIC FACTORS ASSOCIATED WITH ADVERSE BIRTH OUTCOMES AMONG NEONATES IN KAJIADO COUNTY REFERRAL HOSPITAL

Purpose: The purpose of this study was to determine socio demographic and socio economic factors associated with adverse birth outcomes among neonates in Kajiado County Referral Hospital. Materials and Methods: Cross sectional study design was used. The study population was women admitted in post-natal ward at Kajiado county Referral Hospital having delivered within 48 hours. Systematic sampling was used to select the women admitted in post-natal ward. A total of 163 study participants were recruited through systematic sampling. Semi-structured questionnaires were used to collect data from the respondents. Data was analyzed using SPSS version 20. Pearson chi-square test was used to determine the significance of association between each outcome variable and the independent variables. Odds ratio (OR) and 95% CI were used to estimate the strength of association. The threshold for significance was set at P<0.05 at all levels of analyses. Summary statistic of independent variables was presented using frequency tables, pie charts, percentages and graphs. Results: The study found out that teenage pregnancy (giving birth at age ≤19 years) was significantly associated with preterm births and low birth weight. Neonates who were born by teenage mothers had higher odds of being preterm and low birth weight than those whose mothers were of higher ages .Neonates born to mothers who were single had higher odds of low birth weight and preterm births compared to those born to married mothers. Neonates whose mothers resided in rural area had higher odds of having low birth weight and preterm birth compared to the urban dwellers. Unique contribution to theory, practice and policy: The study recommends that there is need of prevention of teenage pregnancies. This can be achieved by including sexuality and health education in the new competence based curriculum, development of laws with stiffer penalties for punishing those responsible for impregnating teenage girls. The study also recommended the empowerment of girl child through access to education, sensitizing the community against retrogressive cultural practices that lead to early pregnancies such as early marriages.

INFLUENCE OF ACCESS DETERMINANTS ON SELF-REFERRALS AMONG PREGNANT WOMEN SEEKING DELIVERY SERVICE IN COAST GENERAL REFERRAL AND TEACHING HOSPITAL MOMBASA, KENYA

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.

COLLEGE CONVERSION INTO QUARANTINE CENTRE: PARENTS’ PERCEPTION ON SAFETY AT KENYA MEDICAL TRAINING COLLEGE, MOMBASA

Purpose: The aim of this study was to determine perception of parents on safety of their children upon resumption of face-to-face studies at Kenya Medical Training College, Mombasa after its temporary conversion into COVID-19 quarantine centre. Methodology: The study was a descriptive cross-sectional design done at KMTC-Mombasa. 85 (10%) parents were sampled by convenience method from total population of 850. Multi stage sampling was used to select 85 participants. Data was collected through structured phone administered interview. Response rate was 85.8% (73). Descriptive analyses were carried out using SPSS 26. Presentation of the results was done by use of graphs, pie charts and tables. Findings: 65.8% (48) of parents were aware of KMTC Mombasa having being converted into COVID-19 quarantine centre. Most parents 91.8% (67) felt safe for their children to go back to college. Availability of clear information about safety measures was cited by 69% (46) of the parents as the reason they felt the students would be safe. Only 6 parents (8.2%) felt unsafe for their children. They explained that COVID-19 spreads quickly in congested places like schools and that the college was ‘highly infectious’ as a quarantine centre. There was a significant relationship between parents perception of safety of the college and their proposition of dates of reopening the college (p=0.01). Parents generally considered the college facilities conducive for use (Mean=61.33%). Unique contribution to theory, practice and Policy: The views of parents as key stakeholders when learning institutions are converted into quarantine centers during a pandemic have not been explored in literature. Parents who perceived the college as safe would allow their children to go back to college and resume face-to-face learning as soon as possible. However, parents who perceived the college as unsafe would stop their children from going back to college. For smooth learning, it is important for college management to ensure that necessary safety measures are put in place and communicated to parents before reopening of college.