Organizational, Technical and Behavioral Factors Associated with Malaria Routine Data Reporting among Health Workers in Selected Health Facilities in Trans-Nzoia County, Kenya

Purpose: Malaria remains to be among the primary causes of sickness, infirmity and cases of deaths and has continued to negatively affect health and socio-economic progress in the country. Rapid reporting of malaria cases could avert prospective epidemics which would lead to a high proportion of sickness and deaths. The study, therefore, sought to assess the determinants of malaria routine data reporting among health workers in selected health facilities in Trans-Nzoia County. Methodology: A descriptive cross-sectional study was conducted to evaluate the organizational, technical, and behavioral aspects that influence the reporting of malaria routine data among health workers. The sample size was 123 health facilities that were selected randomly based on their strata. Research tools that were utilized were structured questionnaires, focused group discussion, and key informant interview guide. Chi-square (χ2) was used to test the hypothesis with a p ≤ 0.05 being considered significant. Findings: The findings on socio-demographic characteristics indicated that majority of the research participants were females 76(62.6%), had college education 85(69.1%) and 81 (65.9%) had worked in the health facility for 5 to 10 years. Most 76(61.8%) of the health facilities were Level 3 (Health Centres). There was significant relationship between level of health facility and malaria routine data reporting at (χ2 =9.999, df=3, p-value = 0.019). Other organizational factors that had significant association with malaria routine data reporting (p< 0.001) include inadequate budget, low staffing, poor ICT infrastructure and complex data management procedures. In terms of technical aspects, limited training on technologies had significant relationship with malaria routine data reporting (p< 0.001). Regarding behavioral aspects, identified factors include lack of incentives and inadequate resources. Unique contribution to theory, practice and policy: The outcomes of the study provide proof for support, tactical organization, and collaboration in the health sector in Trans-Nzoia County as well as to the other developmental agencies working in the field of malaria control. The study recommends that the county government of Trans-Nzoia should provide adequate funds and ICT infrastructure to boost malaria routine data reporting. The county department of health with support from the national government through Division of National Malaria Program (DNMP )should consistently conduct in-service training, support supervision and data quality audits.

CORRELATION OF PANORAMIC RADIOGRAPHIC FINDINGS AND CLINICAL FINDINGS OF DENTAL PATIENTS AT MOI TEACHING AND REFERRAL HOSPITAL, KENYA

Purpose: The purpose of this study was to determine the correlation of panoramic radiographic findings and clinical findings among dental patients at Moi Teaching and Referral Hospital (MTRH), Kenya. Materials and Methods: This was a hospital based cross sectional study conducted at the Radiology and Imaging department and dental department at Moi Teaching and Referral Hospital from September, 2019 to June, 2020. A total of 93 consenting patients were enrolled using systematic random sampling. Standard chart review forms were administered, and clinical examination findings documented. Panoramic radiograph findings were then discussed with a consultant radiologists and findings recorded. Descriptive statistics were carried out. Categorical variables were summarized as frequencies and proportions, and reported in tables. Numerical variables were summarized as median and interquartile ranges. Cross tabulation was done to compare clinical examination and panoramic radiograph findings where total raw agreement was reported as proportions. Results: 93 patients whose ages ranged from 5-73 years with a mean of 29 years were included into the study. Radiographic features of dental caries were present in 54% of panoramic radiographs compared to clinical examination (50.5%) while 23.7% of radiographs revealed impacted teeth compared to clinical examination (19.4%). Radiographic features of periodontitis were observed in 14% compared to clinical examination (16.1%). Fractures (12.9%) were observed radiographically compared to (10.7%) clinically. Periapical lesions (8.6%) were observed radiographically compared to clinical examination (6.4%). Temporo-mandibular disorder (6.5%) were observed both on radiographs and clinical examination. Radiographic features of missing teeth (3.2%) were observed compared to clinical examination (1.1%) while only 1.1% of malpositioned teeth were observed radiographically compared to clinical examination (2.2%). Notably, mandibular lesions (3.2%) and nasal congestion (14%) were only discovered radiographically. The overall raw agreement between panoramic radiograph and clinical examination was 75.3% (70/93) with a p value of less than 0.001. Unique contribution to theory, practice and policy: The study recommends that all patients presenting with dental conditions should be done panoramic radiograph to improve diagnosis. Moi Teaching and Referral Hospital and the Ministry of Health to consider routine panoramic radiographs in the guidelines for the assessment of dental patients in all the hospitals offering, dental health services

EMBRYO GLUE AND CLINICAL PREGNANCY RATES IN ICSI EMBRYO TRANSFER CYCLES: A PROSPECTIVE STUDY

Purpose: One of the reasons for failed implantation after transferring good quality embryos in an intracytoplasmic sperm injection cycle is the failure of creation a viscid layer between the embryo and the endometrium. Many modifications have been made in embryo transfer medium to improve implantation and increase pregnancy rates such as adding albumin as a source of energy and adding hyaluronic acid in high concentrations such as in Embryo Glue medium: a human embryo transfer medium. To investigate whether the use of Embryo Glue had any effect on clinical pregnancy rates in intracytoplasmic sperm injection-fresh embryo transfer cycles. Methods: A prospective study included one hundred and twenty-eight infertile Iraqi women who were selected and subjected to a stimulation protocol in an intracytoplasmic sperm injection-fresh embryo transfer cycle. All patients were considered to be eligible for embryo transfer (no visible causes could prevent implantation) and only good quality embryos were transferred to them. Those women were divided randomly into two groups according to type of embryo transfer medium: group A: Embryo Glue medium. group B: Conventional medium. Then group A was subdivided according to age into: AI (34 women with age < 35 years and represented 50.7%) AII (33 women with age ≥ 35 years and represented 49.3%) While group B was subdivided into: BI (41women with age < 35 years and represented 67.3%) BII (20 women with age ≥ 35 years and represented 32.7%). Results: Although there was no significant difference between all groups in causes of infertility, the pregnancy rate was significantly higher in subgroup AII (18 pregnant from 33 women) while only 5 patients became pregnant from 20 patients in subgroup BII. In all women no more than four good quality embryos were transferred, and when total number of transferred embryos was significantly more in group B than group A (P=0.013), the significant increase in pregnancy rates was only observed in subgroup AII (P=0.048). Even though a highly significant difference in number of repeated implantation failure was in group A than group B (P=0.027), the pregnancy rates were significantly higher in group A (P=0.038). Conclusion: This study concluded that using Embryo Glue has a beneficial effect on old women and increase pregnancy rates, also it has a positive effect on pregnancy rates in repeated implantation failure and increases pregnancy rates even if the women is old.

KNOWLEDGE, ATTITUDE AND PRACTICES IN CERVICAL CANCER SCREENING IN KAKAMEGA COUNTY, KENYA

Purpose: Early cervical cancer screening (CCS) and treatment is effective method of controlling the disease, however its uptake is poor. Women only screen for cervical cancer when they experience symptoms or when advised by healthcare workers. Main objective of the study was to assess knowledge, attitude and practices of cervical cancer screening among women in Kakamega County. Methodology: The target population was 208,905 women of reproductive age residing in Kakamega County. This was a quantitative research approach utilizing descriptive study design. An interviewer administered questionnaire was used to collect data. Multi-stage sampling was used to select 872 women aged 25-49 from 16 community units of Kakamega County. Participants were assured of confidentiality, voluntary participation and freedom to exit the study at any point. Descriptive statistics were used to analyze knowledge and attitude levels towards cervical cancer screening. Logistic regression along with odds ratios at 95% confidence intervals was used to analyze factors affecting uptake of screening. Findings: Majority (81%) of participants had heard of cervical cancer screening mainly from media and Health Care workers. Only 16 % and 13% had good knowledge about signs of and risk factors of cervical cancer respectively. More than 78% had positive attitude towards cervical cancer screening. Less than 22% of participants had been screened for cervical cancer previously. Uptake of cervical cancer screening was low, and there was poor knowledge on aspects of cervical cancer. Poor to average knowledge is not sufficient to enable women make decisive actions on CCS. Unique Contribution to Theory, Practice and Policy: Women should be encouraged to seek for more information about CCS through the various sources of media available to them. Healthcare providers need to be empowered further on delivering key information about CCS. The Ministry of Health should consider and strengthen alternative sources of information on CCS by use of Community Health Volunteers to complement health care providers. The government should further initiate a monitoring and evaluation program to track trends of factors barring uptake of CCS. A qualitative research need to be conducted to establish deeper factors associated with poor knowledge and uptake of CCS despite positive attitude.

SOCIO-DEMOGRAPHIC CHARACTERISTICS ASSOCIATED WITH HEALTH-RELATED QUALITY OF LIFE AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS AT TENWEK HOSPITAL

Purpose: To determine socio-demographic characteristics associated with health-related quality of life among patients with type 2 diabetes mellitus at Tenwek hospital. Methodology: This was an analytic cross -sectional study that was done among patients with diabetes mellitus type 2 attending outpatient clinics at Tenwek Hospital. Quantitative approach was used in data collection. Systematic sampling was used to determine 227 participants who participated in the study. Quantitative data was analyzed using descriptive statistics (mean) and Inferential statistics were done using One-Way ANOVA and Factorial ANOVA. Using One-Way ANOVA, p value was used to show whether the difference between the mean is statistically significant. Factorial ANOVA was used to give a summary of the results by bring all the variables and testing their association with the overall health related quality of life (HRQoL) Findings: Age group, education level and religion were associated with overall health related quality of life with (F = 19.9, p < 0.0001; F = 3.94, p = 0.05; F = 9.46, p = 0.002, respectively). Gender, marital status and occupation were not associated with overall health related quality of life. Unique contribution to theory, practice and policy: This study has identified socio-demographic characteristics associated with health-related quality of life among patients with type 2 diabetes mellitus. The findings will provide insight to the hospital administration to come up with interventions for creating awareness in the community and identifying cases of type 2 diabetes early so as to save victims at an early stage of disease progression and to prevent development of complications and comorbidities. Also, multi-disciplinary team assessment of HRQoL among patients with type 2 diabetes mellitus early in disease course or as soon as they are diagnosed will help to identify modifiable factors that may help the patient lead an active and healthy life. The study will also establish baseline information for future studies on health- related quality of life and associated factors among patients with diabetes mellitus type 2 at the study site. This study recommends reassessment and expansion of Wilson–Cleary model of health-related quality of life.

NURSE RELATED CHALLENGES FACED BY DIPLOMA LEVEL NURSES BEFORE, DURING AND AFTER UPGRADING TO BACCALAUREATE LEVEL AT A LEVEL 5 HOSPITAL

Purpose: 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. In a world with emerging complex diseases, there is high demand for a highly skilled and critically thinking nurse. At the Baccalaureate level or higher to match international standards. Determine nurse 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, Chi-square analysis showed that there was significant correlation in some factors like the designation of a nurse impacted the motivation to upgrade (x2=20.96, df=12, p=0.05) and nursing officers III (n=46, 48.8%) were motivated to upgrade to higher education levels. Family responsibilities of the nurses affected their decision or process of upgrading (x2=6.752, df=6, p=0.03). Conclusion: Lack of motivation and difficulty balancing work and study were found to be the major nurse related challenges of upgrading. These factors should be looked into in order for the nursing fraternity to be able to serve the patient better thus having better patient outcomes. Recommendations: This study recommended that the nurse should be self-motivated to upgrade in the nursing career, the employer to provide favorable shifts in order to nurse to have life balance and policies on career progression and remuneration should be promoted

HEALTHCARE PROVIDER PATIENT VERBAL LANGUAGE USE ON DIABETES MELLITUS MANAGEMENT PRACTICES IN SELECTED HOSPITALS IN KENYA

Purpose: To establish the effect of healthcare provider patient verbal language use on diabetes mellitus management practices in selected hospital in Kenya. Methodology: This was a causal comparative research study design with application of quantitative and qualitative methodology. The study was carried out at the outpatient diabetic clinics of Kenyatta National Hospital and MP Shah Hospital. 400 patient participants were involved in the study and comprised of 313 patients at Kenyatta National Hospital (KNH) and 87 patients at MP Shah respectively studied between the months of February 2019 and November 2019. A researcher administered questionnaire was used to collect data. The results were summarized using percentages and means or medians for categorical and continuous data respectively. Comparisons were done using chi square test of association of categorical variables and independent t-test for comparison of means. Linear regression and ANOVA were used to test for associations and hypothesis between healthcare provider patient verbal language use (VLU) and diabetes mellitus management practices (DMMPs). Results: Patients at MP Shah Hospital rated the verbal language use significantly higher than the patients at KNH (p< 0.001). However, linear regression analysis showed that verbal language use was not statistically significant overall in Kenya [β=0.04, (95% CI -0.09, 0.17), p=0.552], at KNH [β=0.05, (95% CI -0.10, 0.19), p=0.513] and MP Shah Hospital [β=0.09, (95% CI -0.21, 0.39), p=0.552]; (P > 0.05), hence the failure to reject the null hypothesis. Therefore, there was no significant effect of verbal language use by the healthcare provider and the patient on diabetes mellitus management practices in selected hospitals Kenya. Unique contribution to theory, practice and policy: Verbal language use though important in healthcare provider patient interactions was not responsible for improvement in the diabetes mellitus management practices among the patients. Therefore, verbal language use by the healthcare providers in their communication interaction with patients need to be reinforced in healthcare practice to ensure improved DMMPs. Strategies should be developed to enhance verbal language use through educational curriculum development and implementation at the medical training institutions.

MEN KNOWLEDGE/AWARENESS LEVEL ON BIRTH PREPAREDNESS AND COMPLICATION READINESS IN MAGARINI SUB COUNTY

Purpose: This study sought to find out the knowledge/awareness level of men on birth preparedness and complication readiness in Magarini Sub County. Methodology: A cross-sectional study sequential mixed methods design was used where a total of 464 men will be enrolled. Quantitative data was collected using semi structured questionnaires and interview guides were used to collect qualitative data. Quantitative data was coded, and analyzed by SPSS software. Qualitative data was analyzed using NVIVO software. Chi- square test was used to determine associations between categorical variables and Logistics regression was used to identify factors associated with birth preparedness and complication readiness. The associations between awareness and each independent variable were determined by odds ratio (OR) and 95% confidence interval (CI). Thematic content analysis was applied for qualitative data analysis. Findings: The result indicated that the odds of pregnancies resulting in a baby that was born alive were 47.306 times higher for more than two pregnancies as compared to one pregnancy(Odds=47.306,p=0.000). The odds of pregnancies resulting in a baby that was born alive were 16.25 times higher for one pregnancies as compared to no pregnancy(Odds=16.25,p=0.000). Unique contribution to theory, practice and policy Birth Preparedness and Complication Readiness (BPACR) should be endorsed as an essential component of safe motherhood programs to reduce delays for care-seeking for obstetric emergencies and this has been proven to positively impact on birth outcomes Keywords: knowledge/awareness level, birth preparedness, complication readiness, Magarini Sub County

CAREGIVERS’ EXPERIENCES IN CARING FOR HIV POSITIVE CHILDREN: A QUALITATIVE STUDY AT A COMPREHENSIVE CARE CENTRE IN KENYA

Purpose: Caring for HIV positive children poses various challenges and uncertainties depending on the disclosure of their status. To explore the caregivers’ experiences in caring for HIV positive children before, during and after disclosure of their HIV positive status. Methodology: A qualitative study was conducted a Comprehensive Care Centre in a national referral Hospital in Kenya. The study population included parents/guardians of HIV positive children with complete disclosure of their HIV status. Data was collected through in-depth interviews. The socio-demographic characteristics of the respondents were analysed using descriptive statistics. The qualitative data is analysed by use of content analysis and presented in themes and narratives. Results: The results revealed that caring for these children was more challenging before disclosure than after disclosure. The main challenge was in responding to the children’s questions in regards to their health status. The questions asked by the children before disclosures include the reason for treatment, clinic follow up and when treatment will stop among others. The study further established that the parents/guardians expressed diverse fears of how the children might react during disclosure; however, the children mostly did not display the feared reactions at the moment of disclosure. Finally, the findings of this study established that care after disclosure becomes easier and that the children become more engaged in their own care. Conclusion: The study found that caring for HIV positive children is less challenging after disclosure of their HIV status. Further, fears by caregivers are unfounded and there are minimal negative reactions by the children upon disclosure. In order to become actively engaged in their own care, children as early as 11 years old need to be informed about their positive HIV status. Unique contribution to practice, theory and policy: The healthcare providers should ensure early preparation of the caregivers for disclosure to the children of their HIV status. Further, community members and school teachers need to be educated about the beneficial effects of disclosure of an HIV diagnosis to a child or adolescent. Research is needed on the development and implementation of caregiver support groups similar to that of children living with HIV. Purpose: Caring for HIV positive children poses various challenges and uncertainties depending on the disclosure of their status. To explore the caregivers’ experiences in caring for HIV positive children before, during and after disclosure of their HIV positive status. Methodology: A qualitative study was conducted a Comprehensive Care Centre in a national referral Hospital in Kenya. The study population included parents/guardians of HIV positive children with complete disclosure of their HIV status. Data was collected through in-depth interviews. The socio-demographic characteristics of the respondents were analysed using descriptive statistics. The qualitative data is analysed by use of content analysis and presented in themes and narratives. Results: The results revealed that caring for these children was more challenging before disclosure than after disclosure. The main challenge was in responding to the children’s questions in regards to their health status. The questions asked by the children before disclosures include the reason for treatment, clinic follow up and when treatment will stop among others. The study further established that the parents/guardians expressed diverse fears of how the children might react during disclosure; however, the children mostly did not display the feared reactions at the moment of disclosure. Finally, the findings of this study established that care after disclosure becomes easier and that the children become more engaged in their own care. Conclusion: The study found that caring for HIV positive children is less challenging after disclosure of their HIV status. Further, fears by caregivers are unfounded and there are minimal negative reactions by the children upon disclosure. In order to become actively engaged in their own care, children as early as 11 years old need to be informed about their positive HIV status. Unique contribution to practice, theory and policy: The healthcare providers should ensure early preparation of the caregivers for disclosure to the children of their HIV status. Further, community members and school teachers need to be educated about the beneficial effects of disclosure of an HIV diagnosis to a child or adolescent. Research is needed on the development and implementation of caregiver support groups similar to that of children living with HIV.

PREVALENCE OF HYPERTENSIVE DISORDERS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE IN SELECTED PUBLIC HOSPITALS IN ADDIS ABABA, ETHIOPIA

Purpose: This study sought to assess the prevalence of hypertension in pregnancy and associated risk factors among women attending antenatal care clinics in selected Pubic Hospitals in Addis Ababa, Ethiopia. Materials and Methods: The research employed a cross-sectional descriptive study design. Study population was pregnant women who attended ANC care in selected hospital. The respondents were randomly selected from Tikur Anbesa specialized, Zewuditu Memorial and St. Paul’s Millennium medical college hospitals. Respondents for interview were selected using systematic random sampling at an interval of nine until a sample size of 297 was reached. The study used an adopting both quantitative and qualitative data collection methods. Quantitative data was collected using structured questionnaires from pregnant women attending antenatal care clinics while qualitative data was collected using key informant interview schedules and Focused Group Discussion guides with Nurses in charge of antenatal care clinics and primary respondents respectively. Key informants and focused group discussants were purposively selected. Descriptive data was analysed using Statistical Package for Social Sciences version 20.0 with the aid of Microsoft Excel program to generate frequency tables, graphs and pie-charts. Qualitative data was analysed using thematic analysis and results triangulated with quantitative data as direct quotes or narrations. Inferential statistics were calculated using Chi-Square tests done at 95% confidence interval and a margin of error of 0.05 to establish the association between variables. Information generated were presented in the text in the form of tables, bar graphs and pie charts. Results: The study results revealed that the prevalence of pregnancy induced hypertension in Addis Ababa was 21.9%. Socio-demographic factors such as age (p=0.030), occupation (p=0.031), income (p=0.0014), highest level of education (p=0.001) and health insurance (p=0.001) were significantly associated with occurrence of hypertension in pregnancy. Rreproductive and obstetric factors such as age at first pregnancy (p=0.001), gravidity (p=0.046), parity (p=0.001), history of obesity (p=0.001) and occurrence of gestational diabetes (p=0.002) were significantly associated with hypertension in pregnancy. More than a half (51.9%) of respondents had negative attitude towards hypertensive disorder in pregnancy. The level of attitude (p=0.040) was significantly associated with occurrence of hypertension in pregnancy. Unique contribution to theory, practice and policy: The study recommends that the management of the 3 health facilities together with other stakeholders in health empower women to start income generating projects to increase their financial access to antenatal care services consequently reduces hindrances that may lead to pregnancy complications such as hypertensive disorders in pregnancy.