870 Records out of 22207 Records

A case-control study of environmental and behavioural risk factors associated with multiple parasitic infections in Western Kenya

Author: Juma, Elijah Omondi

Awarding University: University of Nairobi, Kenya

Level : MSc

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Parasites/Zoonoses/Epidemiology/Western Province/Busia, Kenya/Lake Victoria, Kenya/Health risk assessment/ ;

Abstract:

Many rural African villages are characterized by high prevalence of endemic parasitic diseases with cases of multiple parasite infections often too being common. This study was conducted in the Western Province of Kenya within a 45 km radius from Busia town, falling within the Lake Victoria Crescent Zone. The study aimed at determining whether there was a relationship between contact with particular environmental features, or specific human social behaviour and the risk of infection with multiple parasitic diseases. The sample frame for this nested case-control study comprised the 467 individuals randomly selected and sampled from this study site as part of a larger, on-going, cross-sectional study. The participants had been screened for a variety of zoonotic and non-zoonotic diseases and questionnaires administered to obtain information on specific aspects of their social behaviour. From the sample frame, 24 subjects with multiple parasitic infections defined as cases, were randomly selected and matched for age and sex with 24 other individuals who had one or no infection, herein defined as controls. Cases and controls were followed to their daily activity points using a GPS waypoint data of the activity points mapped. The study revealed high prevalence of parasitic infections. The infections co-occurred spatially within the same geographic setting with cases of sampled individuals bearing multiple infections at anyone time being common. Cases and controls displayed a relatively homogeneous social behaviour and visited nearly the same activity points. Conditional logistic regression analysis did not reveal any significant difference between cases and controls with respect to any difference in their social behaviour and . interaction with potentially risky environments and thus perceived odds of acquiring parasitic infections. These findings are an initial step to further research into the dynamics of human-environment-parasite interaction in an environment where parasitic infections are co-endemic. The findings will also be vital in helping design long-term strategies for control.

Strategic responses to external environmental factors affecting the health sector : case study of Gertrude's Children Hospital

Author: Iraki, Wanjiru Njuguna

Awarding University: United States International University-Africa, Kenya

Level : MBA

Year: 2012

Holding Libraries: ;

Subject Terms: Strategic management/Environmental management/Health services/Hospitals/Gertrude Garden Children's Hospital ;

Abstract:

ABSTRACT NOT AVAILABLE

An evaluation of the best cost sharing practices being implemented by public hospitals in Kenya

Author: Gichuru, George Kihara

Awarding University: University of Nairobi, Kenya

Level : MBA

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Health insurance ; Insurance industry ; Cost-sharing ; National Hospital Insurance Fund (Kenya) ; Hospitals ;

Abstract:

Cost sharing financing schemes are seen as an option for extending insurance coverage in low-income countries, particularly among rural and informal sectors of society. Over the years other community financing mechanisms have been added including introduction of prepaid insurance like schemes such as National Hospital Insurance Fund (NHIF), Community Health Funds (CHF), National Social Security Fund (NSSF) and National Social Health Insurance Schemes. The main purpose of this study was to determine the best Cost sharing practices being implemented by Public Hospitals in Kenya. The study adopted the descriptive research design. A descriptive survey is a process of collecting data from the members of a population in order to determine the current status of the sample under study with respect to one or more variables.The study population consisted of all the seven Provincial General Hospitals and three Referral Hospitals registered in Kenya by December,2010. A Sample of two referral hospitals was randomly selected from the population and all the seven provincial hospitals were studied. The data analysis for this study was based on quantitative approach using descriptive and inferential statistics. The data was analyzed with the help of statistical package for Social Sciences (SPSS) version. Percentages, frequencies, pie charts, tables and graphs were used where applicable to facilitate easy understanding. Multiple regression analysis was used to evaluate the statistical relationship between the variables. The findings of the study revealed that the best cost sharing practices are practices where: the Government promptly finances lost revenues due to exemptions and waivers given by hospitals, there is transparency and accountability in collecting and spending cost sharing funds, funds are regularly audited, health management boards are properly inducted to their duties, monitor and verify collection and expenditure, collection registers exist, health care staff are involved in decision making regarding use of collected funds, health care protection policy exist such that no one is denied health care services due to inability to pay and that citizens are aware of it, there is legal and political framework where political commitment and top management support exist, revenue generated should be an addition to hospital budget allocation and Government budget allocation to hospitals should not reduce with introduction of cost sharing and an accounting information system exist to enhance cost sharing revenue collection and usage. The respondents cited challenges in the implementation of cost sharing practices and from the findings the challenges included: Poverty in communities that increases waivers, difficulty in determining the patients who qualify' for waivers, inadequate budget allocation by the government, failure by the government to promptly reimburse the hospitals for costs forfeited through protection policy, inadequate staff to run the funds and that board members are not well trained on financial management and accounting. It was recommended that the government should promptly fund the exemptions and waivers to reduce the constraints experienced by tli~ public hospitals, the board members should be well trained on financial management and accounting for them to be more competent, budget allocation should be increased, the village elders and the provincial administration officers should be involved in determining the patients who qualify for waiver and more staff should be hired. The government should employ qualified personnel and train existing ones to raise their capacities in order to affirm efficiency and proper utilization of resources and revenue maximization.

Factors influencing management of HIV/AIDS in public secondary schools in Siakago division, Mbeere North district, Embu county, Kenya

Author: Gitari, Monica Cyombua

Awarding University: University of Nairobi, Kenya

Level : MA

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Siakago Division ; Mbeere North District ; Secondary school students ; HIV infection ; AIDS (Disease) ; Health education ; Socioeconomic factors ;

Abstract:

The researcher carried out a study on the factors influencing management of HJV IAIDS in public secondary schools in Siakago Division, Mbeere North District. The objectives of the study were; To investigate the social fuctors influencing HIV IAIDS status in public secondary schools in Siakago Division in Mbeere North District, to examine the economic factors influencing HIV/AIDS in secondary schools in Siakago Division, Mbeere North District, To assess HIV/AIDS education awareness and its effects on management in Secondaly schools in Siakago Division, Mbeere North District and to find out the control practices in management of HIV/AIDS in secondary schools in Siakago Division in Mbeere North District. The study adopted the descriptive research design where the target population was 2616 and the sample size of 190 students. The study used both stratified random sampling and simple random sampling techniques. Data was collected using questionnaires. Descriptive statistics was used to analyze the data. It was found from the study that alcohol and drugs were a major c:ontributor to the spread of mv I AIDS. The findings indicate that the students who came from families whose parents were employed or in business were economically empowered and that 84% had both parents, 14% were from single parents and 2% were orphans. Awareness on how the virus spreads created by the stakeholders was a major contributor on its effect on HIV I AIDS management. The control practices in maaagemeat of HIV I AIDS in public secondary schools in the area were majorty abstinence. According to the findings that were generated in the study at Siakago division, the researcher concluded this based on adequate conclusive evidence depicted from the summary of the major findings. The recommendations went to the Kenyan Government, the school management and medical praditioners and rese.ardIem. The management of HIV/AIDS in Mbeere North District was inftueoced greatly by the factors that were discussed in the study. The research findings will be of significance to the future research bodies as it will add to the existing body of knowledge on the management of HIV I AIDS in Kenya. The researchers will use the report as a reference point for future research. The policy makers in the health sector may also benefit as they will initiate? or come up with policy that addresses the various fBctors. LastIy~ 1he Government and NOOs will benefit as they will understand the management of HIV f AIDS in Siakago Division.

A study of factors associated with potential human exposure to pesticides and levels of lead, copper and organochlorine residues in fish and soil sediments in Kirinyaga South district

Author: Gathumbi, Jason Kimotho

Awarding University: University of Nairobi, Kenya

Level : MSc

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Kirinyaga South District ; Pesticides ; Environmental conditions ; Health hazards ; Soils ; Fish ; Food contamination and poisoning ;

Abstract:

Exposure to pesticides, heavy metals and other chemical residues poses health risk to human beings and farm animals. This may occur directly or indirectly especially during pesticide application by farmers when carrying out various agricultural activities. This study was therefore carried out in Kirinyaga South district with an overall objective of identifying factors that are associated with potential exposure of farmers and farm workers to commonly used pesticides and determining levels of copper, lead and organochlorine pesticide residues in fish and soil sediments. Information was gathered from one hundred and fifty two (152) farmers and farm workers on the extent of possible exposure to pesticides. Data were gathered using structured questionnaires, on some agricultural practices that may lead to exposure of human to pesticides. The levels of copper, lead and organochlorine residues were determined in tilapia, catfish and soil sediments which were sampled during the months of December 2009 and May 2010 from Thiba and Nyamindi Rivers and the Canal joining the two rivers. The concentration of Lead (Pb) and Copper (Cu) in each sample was determined using Atomic Absorption Spectrophotometry technique. The types and quantities of organochlorines were determined using Gas Liquid Chromatography technique. The data was subjected to descriptive statistics and Analysis of variance (ANOVA) to tests level of significance at 95% confidence limit using Statistical Package for Social Scientists Statistics 17.0 version. The results showed that commonly used pesticides belonged to chemical groups of organophosphates, pyrethroids, carbamates, Ivermectin, amitraz, strobilurin and neonicotinoid. The biological pesticide used was Bacillus thurigiensis. Farmers who reported having been trained on handling of the pesticides were 13.8%. Majority (85%) of the farmers kept farm chemicals in a store away from the living house. Use of Personal Protection Equipment was reported by 49.3% of the farmers. Types of Personal Protection Equipment used by famers included gumboots, coats and jackets 19.1 %, gumboots and overall 17.1 % and gumboots, overall and facial masks 8.55%. Disposal methods of empty pesticide containers were burning 27.6%, burying 16.5%, and both burning and burying 37.5%. A total of twenty nine (29) health effects were reported, where itchy skin accounted for 20.8 %, runny nose 13.1 %, eye problems 9.8% and dry throat 9.3 %. The mean concentration oflead in tilapia was 5.61?1.81 ppm ranging from 2.50 to 9.66 ppm and in catfish was 5.64?1.79 ppm ranging from 2.00 to 9.00 ppm. The mean concentration of copper in tilapia was 8.28?8.87 ppm, ranging from 0.50 to 33.33 ppm and in catfish was 3.63?5.20 ppm, ranging from 0.50 to 25.66 ppm. The mean concentration for copper was significantly different (p <0.05) between tilapia and cat fish such that tilapia had significantly high levels. Concentration of copper was also significantly different (p <0.05) between the sampling months of December and May such that December had significantly high levels. The mean concentration oflead in soil sediment was 18.73?9.59 ppm ranging from 6.80 to 66.40 ppm. The mean concentration of copper in soil sediment was 19.26?5.75 ppm ranging from 11.20 to 34.40 ppm. Soil sediment from Thiba River had the highest amount of lead, 66.40 ppm while the lowest level of 6.80 ppm was from Nyamindi River. The Canal soil sediment had the highest amount of copper, 34.40 ppm and the lowest level of 11.20 ppm was from Nyamindi river. The mean level of copper was significantly different (p <0.05) between the sampling sites such that the canal had significantly high levels. In the analysis of organochlorines in fish samples, p,p'DDE was the only detected organochlorine in 38% of the samples. The mean p,p'DDE concentration in fish from Nyamindi river was 16.9 ?5.4Jlglg ranging from 9.1 to 21.6 ug/g while that in Thiba river was 24.1? 11.48 j.lg/g ranging from 10.3 to 50 Jl

Factors influencing utilization of cervical cancer screening services at Central Provincial General Hospital, Nyeri, Kenya

Author: Gichogo, Agnes Wangechi

Awarding University: University of Nairobi, Kenya

Level : MA

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Central Provincial General Hospital ; Nyeri ; Kenya ; Cervical cancer ; Medical screening ; Health services utilization ; Women ;

Abstract:

Cervical cancer continues to be a major cause of mortality and morbidity among women worldwide with almost half a million new cases each year .. Developing countries accounts for more that 800/0 of the world cervical cancer death In Kenya, cervical cancer ranks as the second most frequent cancer among women with about 3000 new cases annually. An opportunity to prevent occurrence of cervical cancer exists through cervical cancer screening for early detection and treatment of precancerous lesions before they develop to cancer. However, only a negligible proportion of women benefit from cervical cancer screening services in developing countries, including Kenya. A descriptive survey was carried out in Central Province General Hospital Nyeri, Kenya, to determine the factors influencing utilization of cervical cancer screening services among women between 15-60 years of age seeking Maternal Child Health / Family Planning (MCH/FP). Convenient sampling method was used to identify the required sample for the study. The survey was completed by 290 women who responded to a structured questionnaire. The questions that were asked generated information on the women's level of education, awareness on issues relating to cervical cancer screening services, family support and accesibility and utilization of cervical cancer screening services. Data collected was analyzed using descriptive statistics. Utilization of cervical cancer screening services was found to be low at 24.7% despite the fact that the study group consisted of well educated women who had autonomy in decision making and good family support. Only less than 20% of the women knew the importance of cervical cancer testing and majority (80%) of the respondents could only mention one to two risk factors. The low level of awareness on cervical cancer screening services amongst the study group and the long waiting time in at the clinic are the of factors that negatively influenced in utilization of cervical cancer screening services . Therefore it is important for the Government through the Ministry of health to design and implement awareness campaigns on cervical cancer screening services. This should be done through the media, women groups and chiefs baraza's and should target both men and women in the communities. Doctors and nurses should also intensify health education on cervical cancer screening during every clinical contact. The Provincial General Hospital Should also consider outreach awareness creation and screening camps in order to take the services closer to the community instead of waiting for the women to come for the services at the hospital.

Factors influencing the uptake of voluntary counselling and testing (VCT) among youth in Garissa County, Kenya

Author: Balkheisa, Ibrahim Omar

Awarding University: University of Nairobi, Kenya

Level : MA

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Garissa County ; HIV infection ; AIDS (Disease) ; Voluntary counseling and testing ; Young adults ; Teenagers ; Disease control ; Health services utilization ;

Abstract:

When the Government of Kenya declared HIV/AIDS a national disaster in 1999, Voluntary Counseling and Testing centers were introduced as an intervention strategy to combat the pandemic. Young people are a specific target group for veT and yet they have not been studied as an independent group in reference to their attitudes and beliefs toward veT uptake. Although VCT is becoming increasingly available in the developing and middle income countries, there is still reluctance for many people to be tested. There are several possible contributing factors that must be addressed if VeT is to have an important role in HIV prevention and care. The purpose of the study was to assess the factors influencing the uptake of VCT services among youth of between 15 to 30 years in Garissa municipality. A descriptive cross-sectional study design using quantitative and qualitative methods was used. The population in this study was 8,300 youths between 15 to 30 years in Garissa municipality. A multi stage sampling procedure was used. Firstly, all the seven facilities (Garissa Provincial General hospital (GPGH),Sisters Maternity Home (SIMAHO), Iftin VCT Centre, Alfaruq VCT centre, Mororo VeT centre, Police camp and Madogo VCT center)used in the study were put into clusters on the basis of them being public or private. The second stage involves selecting facilities in which to administer the questionnaires using systematic sampling. The number of facilities from which the questionnaire was administered was allocated proportionately to the youth population visiting the facility. The sample for each stratum was then shared equally among the strata facilities selected. Finally, clients coming for VCT service in those facilities were randomly picked and requested to respond to a structured questionnaire until the required sample.in the facility was attained. A sample size of 367 respondents was chosen out of which 247 successfully filled and returned the questionnaires. The study used a semi structured questionnaire as the primary data collection tool. The questionnaires was administered at the facilities using a drop and pick later method to the sampled respondents. Closed-ended questions were analyzed using nominal scales into mutually exclusive categories and frequencies by employing descriptive statistics. The study found that there is a strong positive relationship between the level of education, accessibility of VCT services, confidentiality of health workers and uptake of voluntary counseling and testing among the youth. The study also found that there is a negative relationship between stigma, cultural beliefs and uptake of voluntary counseling and testing among the youth. The study recommends that healthcare workers should use strategies such seminars and door to door visits to educate the residents of Garissa. The study recommends that healthcare workers should keep the information on individuals HIV status confidential and give assurance to the youth since most youth could not respond honestly to the study because of fear of victimization.

Gaining sustainable competitive advantage through service differentiation among private hospitals in Nairobi

Author: Anyim, Maureen Atieno

Awarding University: University of Nairobi, Kenya

Level : MBA

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Hospitals ; Health services ; Nairobi, Kenya ;

Abstract:

Competition in both private and public hospitals in Kenya has become stiff. Hospitals therefore need to differentiate their services to remain competitive. Private hospitals especially have a challenge just like any other organization (profit or not for profit) of matching consumer preferences, providing quality service, managing productivity, controlling <Klsts and by so doing capturing and maintaining their customers. They depend entirely on the fees they collect from their clients for survival. The study objectives were to determine how private hospitals have gained competitive advantage through service differentiation. The specific objectives included a study on how these service differentiation strategies have contributed to customer satisfaction and loyalty. It was also a survey of the challenges customers face while seeking medical services from these private hospitals. This study was a descriptive survey. The population of study was private hospitals in Nairobi. The sample of interest included 30 out of the 64 private hospitals in Nairobi, according to Kenya Medical and Dentists Practitioners Directory 2012. Primary data was collected using structured questionnaires. The target respondents were the customers seeking medical services from these hospitals. Data was analyzed using descriptive statistics by SPSS software. The findings indicated that service delivery as one of the service differentiation strategies was widely practiced to a great extent consistently across the industry hence contributed to customer satisfaction and loyalty. Other factors were service people, service processes and physical facilities; contributing to a great extent to customer satisfaction and loyalty; This implied that most of the patients with their families sought medical care in these private hospitals and were very willing to recommend these private hospitals to their friends. The main challenges faced by patients while seeking medical services from these private hospitals were long waiting time and high costs of services. It is therefore recommended that the hospitals should ensure that the patients are attended to in the shortest time possible so that can have value for their money and these can be achieved by the hospitals employing sufficient staff. The limitation of this study was that the survey was based on only private hospitals in Nairobi. A more regional representation would have provided better results. The researcher recommended that a study should be conducted to cover both private and public hospitals in Kenya as well as health management organizations (HMOs).

The role of the constituency development fund on health care service delivery in Kenya : a case of Rangwe constituency

Author: Atherol, Beatrice A

Awarding University: University of Nairobi, Kenya

Level : MA

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Rangwe Constituency ; Constituency Development Fund ; Health care delivery ;

Abstract:

'Various studies have been done on the impact ofthe Constituency DevelopmentFund (CDF) and other devolved funds in Kenya. However, a few focuses on the role of such funds on health care service delivery despite health being an important factor in the development of any community. Therefore this study was geared towards bridging this knowledge gap and was undertaken in Rangwe constituency in Kenya. The objectives of this study were; to assess the influence of the annual constituency development fund allocations on health care service delivery, to assess the level of community participation in decision making and to examine the communication channels used by the CDF committee as well as to examine the influence of the monitoring and evaluation approaches used by the CDF committee on health care service delivery. The study employed a descriptive research designs with the questionnaires as the main instruments of data collection. The data analysis was performed using Statistical Package for Social Sciences (SPSS- 16) while the presentation of the infonnation was done in form of frequency tables, correlation and multivariate regression models. The study findings demonstrate that CDF has played a significant role in health care service delivery in the constituency as corrobomted by increased number of wards, consultation rooms, laboratories and even recruitment of additional medical personnel. Towards this end, 68.4 percent reported that the number of wards in the constituency has increased in the ranges of 1 to 3 in health centres while 34.8 percent of the respondents affirmed increase in consultations rooms in the dispensaries. The study established different levels of correlation between the levels of participation in the CDF funded health care projects and age of the beneficiaries, level of education and the awareness to the fund. In this regard, awareness has a positive but not significant influence on participation with correlation value (r) being 0.385 while age of the beneficiaries has a positive but not significant influence on the participation with a correlation value (r) being 0.042. This implies that the more the awareness increases, the more the likelihood of an individual to participate in the CDF health care funded projects. On the other hand, the level of education of beneficiaries had a negative and not significant influence on the level of individual's participation in the projects with correlation value (r) being 0.001. This implies that the lower the level of education of a beneficiary, the more one is likely to participate in the project. This is granted that the greatest mode of participation in the project is through labour provision, of which the highly educated and meaningfully economically engaged are not likely to be involved in. However, the level of community involvement, monitoring and evaluation are negatively but not significantly influencing the improvement in health care service delivery at correlation v-alues (r) -0.207 and- 0.024 respectively. This implies that the lower the level of community involvement, the less the improvement in health care service delivery. The study also demonstrates that there was some consultation between the CDFC and the community with the community feeling sidelined in monitoring and evaluation aspect of the fund's administration. The study therefore recommends that the facility administrators be actively involved in the entire process of the projects and that the amount of CDF allocations be increased to ensure completion and quality ofthe work done.

Health information systems reform in Kenya : an institutionalist perspective

Author: Bernardi, Roberta

Awarding University: University of Warwick, England

Level : PhD

Year: 2012

Holding Libraries: Institute of Commonwealth Studies Library ;

Subject Terms: Information and Communication Technology ; Health ; Health information ; Donors ;

Abstract:

The development outcome of ICT and information systems in developing countries is often influenced by international development policies and the action of international actors such as donor agencies. In particular, ICT adoptions and implementations in developing countries may be influenced by the contradictions arising mainly from the tension between international managerialist development policies and the main rationalities of actors in the local implementation context. Based on the case study of health information systems in Kenya, the objective of this thesis is to increase the understanding of how these contradictions may affect the development and change potential of health information systems and ICTs in developing countries in relation to international development policies. Drawing on a dialectical perspective on institutional work, the thesis argues that the change and development trajectories arising from the implementation and usage of health information systems depend on how actors involved in the restructuring of health information systems i.e. donor partners, national decision makers and local health information systems managers and users respond to the ongoing dialectic between global and local pressures of institutional change and stability. The main findings of the research presented in this thesis point to the importance of analysing political donor relations and the institutional entrepreneurship of local actors in order to understand the change and development outcomes of health information systems and ICT in developing countries.