School of Health Scienceshttp://ir.jooust.ac.ke/handle/123456789/2702024-03-28T13:59:53Z2024-03-28T13:59:53ZPredictive Analysis of Risk Factors Associated with Hepatocellular Carcinoma in Western KenyaOtedo, Amos Evans Ochienghttp://ir.jooust.ac.ke/handle/123456789/116362022-11-26T15:39:17Z2018-01-01T00:00:00ZPredictive Analysis of Risk Factors Associated with Hepatocellular Carcinoma in Western Kenya
Otedo, Amos Evans Ochieng
Hepatocellular carcinoma (HCC) or liver cancer is a malignant cancer of the liver. It is a global public health problem which is often ignored, under diagnosed or diagnosed late when patients already have severe symptoms. HCC pathogenesis is preceded by chronic inflammation of the liver. It exhibits poor response to treatment, leading to high mortality rates. Common risk factors of HCC include viral hepatitis B- (HBV) and C (HCV) and non-viral causes such as aflatoxins, excess alcohol intake, tobacco, iron overload, genetic predisposition, ur-antitrypsin deficiency, diabetes mellitus, obesity and about 18% of cases are of unknown cause. Human immunodeficiency virus (HIV) is known to independently cause liver inflammation but its relevance in the causation of liver cancer is not clear. Data to inform management and prevention of HCC is generally lacking in the developing countries such as Kenya. The general objective was to develop a predictive analysis of risk factors associated with HCC Western Kenya. The specific objectives included (i) ascertain the risk factors which play a role in the causation of HCC in western Kenya, (ii) ascertain the relevance of HIV in the causation of HCC in western Kenya, (iii) to develop a predictive mathematical model to predict the dynamics of risk factors of and burden of HCC in Western Kenya. The study was un-marched case control, prospective, of participants who were diagnosed to have liver cancer and controls. The study was based at the Kisumu County and Referral Hospital and it included 257 participants with liver cancer and 257 controls who had no liver cancer. Male: female ratio was 2.2: 1 for cases and 3 .2: 1 for controls. Mean age was 46.2 ± 25 .1 years for cases and 3 7.4 ± 14.99 years for controls. 2. 7% of cases had previous history of excessive alcohol intake compared to 8.2% of controls (p < 0.617). Mean CD4+ cell count was low in cases at 237. 7 ± 96.4 [range 50-417] cells/µ] compared to 626.3 ± 267.6 (340-910) cells/µl for controls (p < 0.001). Using adjusted odds ratio (aOR), the risk factors which were identified included; age> 35 years in cases compared to controls (88.3% vs 11.7%), [aOR =51.6; 95% confidence interval (CI) (27.8 -95.6), p < 0.001)]; HBV infection, more likely in cases than controls (47.1% vs 30.4%), [aOR = 3.3; 95% confidence interval (CI) (1.7-5.0), p < 0.0001]; HIV sero-status, more positive in cases than controls (33.5% vs 10.9%), [aOR =4.3, 95% confidence interval (CI) (2.2-8.4)), p < 0.001] and males more at risk than females (32.7 % vs 23.7), [aOR=0.4, 95% confidence interval (CI) (0.3-0.7), p < 0.001]. A compartmental model and a hybrid predictive model combining Susceptible-Infected¬Recovered and Incidence-Prevalence-Mortality of the risk factors was developed. The model shows that liver cancer burden will increase in western Kenya from 257 to 10,232 cases in two years. The study concludes that, hepatitis B virus is still a major risk factor of HCC and human immunodeficiency virus is established as a significant risk factor of liver cancer in western Kenya. Other risk factors include gender, males more than females and age greater than 35 years. The burden of liver cancer disease is likely to increase unless it is controlled.
2018-01-01T00:00:00ZDevelopment and Evaluation of an Evidence Based Quality Framework for Utilization of Maternal Healthcare ServicesMonyangi, Norah Nyangahttp://ir.jooust.ac.ke/handle/123456789/116342022-11-26T15:18:33Z2020-01-01T00:00:00ZDevelopment and Evaluation of an Evidence Based Quality Framework for Utilization of Maternal Healthcare Services
Monyangi, Norah Nyanga
The Community Health Volunteers (CHVs) :fundamental role in primary health care service delivery at household level has made them to be globally recognized for their effectiveness in reducing morbidity and averting mortality in mothers, newborns and• children. Their role includes identification of all expectant women and referral for antenatal care and skilled delivery at the health facilities. Regardless of the efforts made, women still die from preventable pregnancy related causes majorly due to unskilled attendance at birth which is 58 percent in the study area. From literature, the context factors in which the CHV s deliver their health care services has unique and critical influence on their performance. However, none of the studies done looked at individual based context factors that are likely to influence CHV performance to come up with an evidence-based context framework for improving maternal and neonatal health care outcomes in Nyando. This study was executed through a cross-sequential mixed method approach in three stages which included a census of 361 CHVs who serve in the study region. Stage (i) Establishment of contextual factors influencing performance at baseline (ii) Development and testing of the evidence-based context framework (iii) end line survey to evaluate the influence of the framework in CHVs performance. Descriptive analysis was done for the CHV s performance in frequencies and percentages while logistic regression models were run in odds ratios (COR and COR) at 95% confidence interval and p-values (p:S0.05). For qualitative data, a thematic analytical technique was used to identify emerging themes. Two Sample proportion Test was used to evaluate CHV performance between baseline and end line surveys. Results reveal that majority of the respondents were female 272 (75%) aged between 30-49(47%) years. Maternal record in use, CHVs knowledge in antenatal care services and security are the major context factors which significantly influenced CHVs performance p=0.011 ;( AOR =4.51, 95% Cl= 1.42-14.35), p=0.041 ;( AOR =2.53, 95%CI=l.04-6.19) and p<0.0001 ;( AOR =4.54, 95% CI= 2.00-10.31) respectively. This led to the development and testing of a 'CHV's Mother and Neonate Identification track booklet' as the framework. The evaluation findings show significant CHV s full performance improvement in FAN C, skilled birth attendance at HF and PNC outcomes by 222(61.52%), 285(79%) and 232(64.2%) respectively all at p <0. 0001. From this study, it is evident that the developed evidence ¬based context framework for CHV, improved the performance in maternal and neonatal health care outcomes in Nyando. Therefore, the County Health Management needs to adopt the framework to improve CHVs performance not only in maternal and neonatal health care outcomes but towards achievement of the Sustainable Development Goals (SDG) of attaining health for all.
2020-01-01T00:00:00ZAssessment of Health Related Quality of Life and Palliative Care Needs of Cervical Cancer Patients at Jaramogi Oginga Odinga Teaching and Referral Hospital in Western Kenya.Owenga, Jane Adhiambohttp://ir.jooust.ac.ke/handle/123456789/116302022-11-25T14:59:55Z2016-05-01T00:00:00ZAssessment of Health Related Quality of Life and Palliative Care Needs of Cervical Cancer Patients at Jaramogi Oginga Odinga Teaching and Referral Hospital in Western Kenya.
Owenga, Jane Adhiambo
Cervical cancer is the third most common cancer among female worldwide and causes approximately 275,000 deaths annually worldwide. ln Kenya, cervical cancer is the leading female cancer yet, eighty percent of reported cases are diagnosed at advanced stages, underscoring the need to provide palliative care services to improve the quality of life of those affected. Whereas the focus has been on clinical management of cancers, Health Related Quality of Life (HRQoL) is emerging as an important health outcome which requires to be incorporated in the holistic management of patients. However, their perceptions on HRQoL status and concerns are not adequately documented yet their mortality and morbidity is on the rise. This study was set out to assess the perception of cervical cancer patients on their HRQoL and palliative care needs in in western Kenya. Specifically the study sought to investigate the psychosocial, physical and care and informational needs of cervical cancer patients. The study was anchored on Maslow QoL theory Ill, Ersek and Ferrel ls' Quality of life models. It was conducted at Jaramogi Oginga Odinga Teaching and Referral hospital in western Kenya. The study employed cross-sectional design using both quantitative and qualitative data collection methods. Study population was estimated to be 2454 cervical cancer patients from whom a sample size of 334 was drawn. A HRQoL assessment tool FACT-Cx Version 4, a structured questionnaire, and in-depth interview guide were used to collect data. Quantitative data was analyzed using SPSS version 20 and SAS version 9.2. Descriptive statistics, chi-square and regression analysis were conducted to examine the relationship between socio-demographic, clinical characteristics of patients, their palliative care needs and their 1--IRQoL. Qualitative data was analyzed through content analysis by examining emerging themes. The results showed that the mean HRQoL was 35.35 (SD= 13.21 ). More than half of the respondents experienced poor functional and physical wellbeing 221 (66.2%) and 201 (60.2%) respectively and no patient experienced good functional and physical wellbeing. While 189 (56.6%) experienced fair overall quality of life. Multiple cumulative logistic regression analysis between age, marital status and level of education showed positive influence on overall quality of life except for religion, p-values = 0.0001, 0.012, 0.0001 and 0.26 respectively. Most patients in the in-depth interviews reported experiencing pain; vaginal bleeding and discharge; need for psychosocial support. Care providers reported cancer management challenges such as inadequate equipment, supplies and experts in oncology and palliative care. The patient's perceive their emotional and social wellbeing as fair due to supportive social culture and that they experience poor functional and physical wellbeing due to late presentation for care and cancer management cha I lenges. Efforts should be made to sensitize women to seek screening and early treatment. Moreover, HRQoL assessments should be included in routine management of cervical cancer patients to keep watch on their HRQoL.
2016-05-01T00:00:00ZInfluence of Health System Management on Occurrence of Postpartum Haemorrhage among Women of Reproductive age 15-49 Years in Homabay County, KenyaAdel, Walter Ottomanhttp://ir.jooust.ac.ke/handle/123456789/116272022-11-25T14:10:41Z2022-01-01T00:00:00ZInfluence of Health System Management on Occurrence of Postpartum Haemorrhage among Women of Reproductive age 15-49 Years in Homabay County, Kenya
Adel, Walter Ottoman
Postpartum haemorrhage is the blood loss of not less than 500 ml in 24 hours after birth. In Kenya, 34% of maternal deaths are because of postpartum haemorrhage. In Homa Bay County, postpartum haemorrhage remains the number one contributor of maternal mortality. Thirty eight percent of all maternal deaths are attributed to postpartum haemorrhage despite several strategies by the ministry of health to reduce its occurrence. Poor health care provision have been cited in some studies as contributing factor to high postpartum haemorrhage. No study, however, has explored the possible determinants, impacts, and challenges of health system management on occurrence of postpartum haemorrhage in the County. The main objective of this study was to establish the influence of health system management on the occurrence of postpartum haemorrhage. The specific objectives were to: determine the prevalence of postpartum haemorrhage, identify the determinants; determine the association; and lastly describe the challenges of health system management on occurrence of postpartum haemorrhage among women of reproductive age 15-49 years in Homa Bay County. The study was cross-sectional design in which mixed research methods were used. The study population were women who had childbirth at level four public hospitals in Homa Bay County. A sample size of 400 was arrived at using Cochran 1977 formula. The instruments for data collection were: questionnaire, observation checklist, and key informant interview guide. Information was gathered on: socio-demographics, maternal health characteristics, postpartum haemorrhage occurrences, health system determinants, effects, and challenges of health system management. Key informant interview guide was administered to the eight sub county medical officers of health and the county gynecologist. Observation checklist was filled by the researcher assisted by the hospital matrons and maternity in-charges. Information from key informant interview guide was managed thematically per objective, while quantitative data was analyzed using statistical package for social sciences stata version 13, and logistic regression method. The tests done were chi-square, bi-variate and multivariate logistic regression. The study bad 90.75% response rate. Respondents were between 15 years to 44 years of age. The mean age was 27 years while standard deviation of the ages was ±11.18. Socio-demographic profile of respondents was as follows; 77.8% were married; 20.5% had monthly income less than Ksh.1,000; salaried respondents were 8%; while 69.6% of respondents were protestants. The prevalence of postpartum haemorrhage was 9.9% with 95% CI (7.2% - 13.5%). Statistically significant determinants of occurrence of postpartum haemorrhage were: previous experience of postpartum haemorrhage (p-value=0.01 ), parity (p-value=0.004), trimester of initiation of antenatal care visit (p-value=0.0494), health care provider to client level of attention (p-value=0.046), change of work station by health care providers (p-value=0.0 17), and availability of quality healthcare services (p-value=0.017). Health systems associated with occurrence of postpartum haemorrhage were: health :financing (p-value=0.049); medicines and technologies (p-value=0.027) and; health service delivery (p-value=0.001) while the challenges of health system management were: inadequate number and skilled human resource for health (p-value=0.01); low quality and insufficient diagnostic services: lack of essential tests (p-value=0.01), venereal disease research laboratory (p-value=0.003). Inadequate essential obstetric and perinatal drugs, obstructed labour (p-value=0.001), and traditional birth attendants (p-value=0.034). The findings of this research therefore fills the gap on documentation and knowledge on prevalence of postpartum haemorrhage in Homa Bay County, identified determinants of health system management on occurrence of postpartum haemorrhage, determined functionality of health systems and their association with occurrence of postpartum haemorrhage, and established the challenges of health system management on occurrence of postpartum haemorrhage. Given the findings, the researcher recommends change of practice and development of policy on consumer centered approach on prevention of occurrence of postpartum haemorrhage detailing clear framework for improving socio-demographic determinants, maternal characteristics, health systems, and reduction of challenges of health system management.
2022-01-01T00:00:00ZDevelopment and Evaluation of an Evidence Based Quality Framework for Utilization of Maternal Healthcare ServicesObinge, Ruth Elizabethhttp://ir.jooust.ac.ke/handle/123456789/116262022-11-25T14:00:31Z2018-01-01T00:00:00ZDevelopment and Evaluation of an Evidence Based Quality Framework for Utilization of Maternal Healthcare Services
Obinge, Ruth Elizabeth
Utilization of skilled maternal healthcare services during pregnancy, delivery and post delivery can reduce maternal deaths. The high maternal mortality ratio in Siaya County (691/100,000 live births) which surpasses that of the Country - Kenya (395/100,000 live births) can be attributed to the lack of utilization of skilled maternal healthcare services. The aim of this study was to develop, pilot and evaluate an evidence based quality framework for increasing utilization of skilled maternal healthcare services in Siaya County. The study adopted longitudinal study design where a three (3) phased approach involving baseline, intervention and end line was followed. Study participants comprised service users and service providers, community leaders and community health volunteers. In total, 517 sampled pregnant mothers and 123 community health volunteers, Eighty four (84) women (previous users), Fourteen (14) skilled health providers and 9 managers participated. Data was collected using semi-structured questionnaires, KIIG and FGDS. Quantitative data were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0 while qualitative data were analyzed thematically using interpretative inductive approaches. All tests of significance were computed at p=0.05. At baseline, findings showed low utilization; 4th antenatal care was at 53.2%, skilled delivery at 55.7% and post-natal care within 48 hours at 23.6%. Further analysis showed that those with is secondary (aOR=2.62, 95% CI: 4.33-4.58) and tertiary (aOR=l .43, 95% CI: 2.87- 4.63) education were more likely to utilize maternal healthcare services relative to those with no education and those with primary education. Similarly, the respondents' whose husbands had no education (aOR=0.89, 95% CI: 2.07-1.60) or had primary education (aOR=0.89, 95% CI: 2.07-1.60) were less likely to utilize maternal healthcare services relative to those whose husbands had secondary or tertiary level of education. Barriers identified include; women's characteristics such as low education level, those whose husbands have low education, lack of awareness and knowledge on maternal health, uncertainty about pregnancy, lack of 24 hours skilled delivery services, negative providers attitude and lack of evidence of maternal healthcare continuum. Perceived strategies to overcome the above barriers informed the development of the framework which was then piloted for-one year and evaluated. At end line, 4th Antenatal visits increased from 53.2% to 63.9%, skilled deliveries from 55.7% to 64.6% and postnatal care services from 23.6% to 47.4%. Chi-square test showed p < 0.05 meaning that the differences were statistically significant. The framework proved effective in increasing utilization of skilled maternal healthcare services in Siaya County. The above results indicate that the evidence based quality framework developed proved effective in increasing utilization of skilled maternal healthcare services and should inform programming for maternal healthcare in Siaya County. Siaya County Government to develop strategies to empower women with knowledge on maternal health, scale up the provision of 24 hours skilled delivery services, sensitize health providers on respectful maternity care, empower community health volunteers with knowledge on maternal health and promote use of household health visitors log book in order to enhance evidence based maternal healthcare continuum.
2018-01-01T00:00:00ZQuality of Life-Scores and Underlying Dimensions among Palliative Care Cancer Patients at Kisii Teaching and Referral Hospital, KenyaOndimu, Thomas Orindihttp://ir.jooust.ac.ke/handle/123456789/111212022-09-17T11:50:42Z2022-01-01T00:00:00ZQuality of Life-Scores and Underlying Dimensions among Palliative Care Cancer Patients at Kisii Teaching and Referral Hospital, Kenya
Ondimu, Thomas Orindi
Cancer morbidity and mortality is rising more rapidly in the low and middle income countries, where the infrastructure for diagnosis and care is extremely limited compared to the developed countries. Cancer patients experience a wide range of physical and psychosocial effects associated with the disease and its treatment, but these are still poorly understood. Palliative care in Kenya is still emerging and considerably constrained. Its impact on individuals’ wellbeing is recognized but is still understudied. Quality of life (QOL) assessments are frequently used to identify not only related palliative care needs, but also evaluate services provided to the patient. This study aimed to determine the QOL scores and underlying dimensions among palliative care patients in Kisii Teaching and Referral Hospital. Specifically, it determined QOL scores among palliative cancer care patients, association between socio-demographic factors and QOL scores, association between clinical characteristics and QOL and dimensions underlying and the pathways through which social-demographic factors and clinical factors influences QOL. Using a descriptive cross-sectional research design, 120 palliative care cancer patients were surveyed using the Missoula Vitas Quality of Life Index (MVQOL-I). Variable characteristics were summarized descriptively. Mean QOL were estimated for each sub-scale. The association between social-demographic factors and clinical characteristic with QOL was analyzed using chi-square. Confirmatory Factor Analysis (CFA) was used to test how well the observed variables were related to socio-demographic, clinical and quality of life measures. Structural Equation Model (SEM) was used to portray relations among observed and latent variables in theoretical models, enabling to quantitatively test research hypothesis concerning these relationships. Of 120 participants, females comprised 63%; modal age-group was 45-54(30%; p=<0.001); 66% had post-primary level education (p= 0.030). Cervical and breast cancers among females and prostate cancer among males were most prevalent, especially among those25 years; leukemia was reported only among <25-year-olds (p=<0.001). At least 63% (p= <0.001) of the patients had been treated using combined therapy. Pain relief (43.3%) and psychosocial counseling (34.2%) were the most common form of palliative care (p=<0.001). The mean global QOL score was 2.8 (range 0-5) while the mean total weighted QOL score was 17.05 (range 0-30). Patients scored poorly on the wellbeing subscale (psychological dimension) mean -3.2 and highest in the symptom subscale (physical dimension) mean 8.5. Age, level of education, occupation, monthly income, marital status, types of cancer, the time since diagnosis, duration from last treatment and type of cancer treatment were the factors influencing QOL. Physical dimension showed that the total effect of patient socio-demographic characteristics and the indirect effect of socio-demographic characteristics through clinical characteristics significantly affected symptom and functional quality of life. These finding indicate variability in mean QOL score across the subscales, with symptom subscale contributing considerably more to the patients’ overall QOL. Patients’ interpersonal (social) and wellbeing (psychological) needs were not sufficiently recognized and addressed. There is need for palliative care specialist to recognize and consider the importance of psychological and social needs of patient, as well as to assess and manage symptom and functional domains.
2022-01-01T00:00:00ZThe Effects of Pyrethroid Insecticide Resistance Development on the Behaviour of Malaria Vectors and their Impact on Malaria Transmission in Western KenyaGesuge, Machani, Maxwellhttp://ir.jooust.ac.ke/handle/123456789/111072022-09-16T14:53:15Z2022-01-01T00:00:00ZThe Effects of Pyrethroid Insecticide Resistance Development on the Behaviour of Malaria Vectors and their Impact on Malaria Transmission in Western Kenya
Gesuge, Machani, Maxwell
Despite significant reductions in malaria transmission through the scaling up of vector control tools across sub-Sahara Africa since 2000, progress is stalling. This is partly attributed to the emergence of insecticide resistance and behavioral adaptations in malaria vectors. Whilst insecticide resistance has been widely investigated, the effect of specific insecticides on the rate of the emergence of insecticide resistance or the rate at which mosquitoes lose their insecticide resistance properties remains largely uncharacterized. There is sparse knowledge on the behavioral adaptations of resistant malaria vectors in response to the use of the current indoor intervention, despite their potential impact on malaria transmission. The study first, sought to understand the process of insecticide resistance development (phenotypic, genotypic, and metabolic changes), or resistance decay in the presence or absence of selection pressure, in Anopheles gambiae sensu stricto mosquitoes. Secondly, the study investigated the host-seeking behavior of resistant and susceptible phenotypes of Anopheles gambiae s.s in the presence of insecticides in the malariasphere and lastly, determined the effects of insecticide resistance on the resting behavior of malaria vectors and how it contributes to residual malaria transmission in western Kenya. To achieve the above aims, deltamethrin selected and unselected colonies of Anopheles gambiae were established in the presence and absence of insecticide pressure. The selection was done by exposing female mosquitoes to a standard diagnostic dosage of deltamethrin using the World Health Organization (WHO) tube bioassay test. The established colonies were color-marked with fluorescent powder and released inside semi-field structure to determine how the rise and change in insecticide resistance has affected whether mosquitoes feed inside or outside the house, and rest outdoors following intensified Long-lasting insecticide-treated nets (LLIN) usage. Laboratory based experimental research and cross-sectional study designs were used in this study. The indoor and outdoor resting mosquitoes were collected from highland and lowland sites in western Kenya to determine the effects of insecticide resistance on the resting behavior of malaria vectors and its impact on residual malaria transmission. The indoor collection was done using pyrethrum spray catches (PSC) and Mechanical aspiration (Prokopack). The outdoor collection was done using clay pots, pit shelter and mechanical aspiration. Polymerase Chain Reaction (PCR)-based molecular diagnostics was used for mosquito speciation, genotyping for resistance markers and to determine specific host blood meal origins. Enzyme-linked immunosorbent Assay (ELISA) was used to determine mosquito sporozoite infections. Microplate assay was performed to measure the three enzymatic activities (Monooxygenase, Esterase and Glutathione S-transferase) linked to insecticide detoxification. WHO criteria was used to classify tested mosquito populations as either resistant or susceptible. The frequency of the resistance allele was calculated using the Hardy Weinberg equilibrium test for kdr genotypes. Analysis of variance (ANOVA) was used to compare malaria vector density between indoor and outdoor locations. A generalized linear model (GLM) with binomial distribution and logit link function was used to compare the behaviors of resistant and susceptible mosquitoes between treatments. The mortality of the parent populations averaged iv 42% (ranging from 38% to 48%). Phenotypic resistance increased steadily in the selected strain (Mortality declined from 42-29%). The unselected strain progressively became more susceptible to deltamethrin over time (Mortality range; 42-97%). These two lines of mosquito populations differed significantly in monooxygenase and beta-esterase activities, but not in Voltage-gated sodium channel (Vgsc) gene mutation frequency, suggesting that metabolic detoxification mechanism plays a major role in generating moderate to high intensity of insecticide resistance. The proportion of selected resistant colony caught in the treated bed net trap was higher 43% (95% CI= [40.6-45.3]) compared to the unselected susceptible colony 28.3%. The number of unselected susceptible mosquitoes caught in the untreated bed net trap was higher 51.3% (95% CI= [48.8- 53.6]) compared to a treated bed net trap 28.3% (95% CI= [26.3-30.5]) (OR=2.65; P< 0.0001, An. funestus; F1, 655 = 36.555, p < 0.0001). The mortality rate for indoor and outdoor resting An. gambiae s.l F1 progeny was 37% vs 67%) respectively in Bungoma. In Kisian, the mortality rate was 67% vs 76%) respectively. The mortality rate for F1 progeny of An. funestus resting indoors in Bungoma was 32%. The overall sporozoite rate for indoor resting mosquitoes was 9% (An.gambiae s.s 8%, An. arabiensis 4% and An funestus 11%) and 4% ( An. gambiae s.s 5% and An. arabiensis 3%) for outdoors in Bungoma. In Kisian, the sporozoite rate was 1% for indoor resting An. gambiae. The higher indoor resting densities with increased insecticide resistance compared to outdoor resting vectors and reduced avoidance behavior of the selected resistant mosquitoes in the presence of insecticides underline the difficulties of controlling malaria vectors using the current interventions. This calls for supplemental vector control tools and the implementation of sustainable insecticide resistance management strategies in western Kenya. The rate of resistance decay to become fully susceptible from moderate-intensity resistance took 15 generations, supporting at least 1.5-2 years interval is needed when the rotational use of insecticides with different modes of action is considered for resistance management.
2022-01-01T00:00:00ZInfluence of Rehabilitation Programs on the Mental Wellbeing of Prisoners in KenyaMuseve, Judithhttp://ir.jooust.ac.ke/handle/123456789/110932022-09-15T12:55:03Z2021-01-01T00:00:00ZInfluence of Rehabilitation Programs on the Mental Wellbeing of Prisoners in Kenya
Museve, Judith
Although there has been a lot of transformation in prisons over time in pursuit of improved outcomes, many prisoners continue to be released with psychological problems they developed in prison that were never properly addressed. This increases their risk of re-offending and makes it harder to reintegrate in the society as a productive, law abiding citizen. More than half of people who have been incarcerated are arrested again within three years; and the state of mental wellbeing of inmates within prison contributes immensely to this high rate of re-offending. Despite various intervention programs being initiated by prisons, there are still many cases of mental disorders and recidivism in prisons. In view of this, this study sought to determine the influence of rehabilitation programs on the mental wellbeing of prisoners in Kenyan prisons. It specifically aimed at determining the level of mental wellbeing of prisoners, the level of influence of rehabilitation programs on the mental wellbeing of prisoners and to identify the determinants of the influence of rehabilitation programs on the mental wellbeing of prisoners. The research employed concurrent triangulation research design. The study population was 364 respondents from two selected prisons. A structured questionnaire, MINI International Neuropsychiatric Interview and Warwick-Edinburg Mental Wellbeing Scales were used to screen prisoners, detect certain mental disorders and measure the wellbeing respectively. All the tools had high validity and reliability scores. The collected data was processed and analysed using SPSS version 22. The analysis sought to determine differences between groups using chi-square test. Comparison of groups was done using independent sample t-test and ANOVA. A p-value <0.05 with 95% confidence intervals was considered a statistically significant level of precision. The data is presented using frequencies, means, percentages and standard deviation. The level of mental wellbeing of prisoners is high with 86.3% having positive mental wellbeing scores. There is a high prevalence of mental disorders among the prisoners at 63.2% with almost equal distribution between male and female prisoners’. Mental disorders influence the mental wellbeing of prisoners with suicidality, panic disorder, PTSD and mood disorder with psychotic features significantly reducing mental wellbeing at p-values = 0.001, 0.015, 0.044 and 0.019 respectively. Rehabilitation programs have a significant positive influence on the level of mental wellbeing. Rehabilitation programs do not reduce the risk of mental disorder. Uptake of rehabilitation programs is high at 89.8%, with more female (96.7%) than male (88%) prisoners participating. Reasons for non-uptake of programs were prison policy, despair due to long or life prison sentences, feeling of certificates being useless due to prison rubber stamp, indecision on choice of program, inadequate resources and wrong attitude. Majority of the prisoners have a positive attitude towards the rehabilitation programs with 92.3% willing to participate. Age, level of education of prisoner, professional training of prison staff and degree to which the program met offender needs were determinants of the influence of a rehabilitation program on the mental wellbeing of a prisoner. The study concluded that level of positive mental wellbeing among prisoners was high. Rehabilitation programs had a positive influence on the mental wellbeing of prisoners, though the effect was limited. Uptake of rehabilitation programs was high. This study recommends that the Kenya Prison Service management should develop an assessment tool to determine the prisoner needs in order to guide them appropriately; and also partner with industries to get a labour market. The respective prisoner managers should promote a change in attitude of prison staff towards the prisoners.
2021-01-01T00:00:00ZA Participatory Model for an Enhanced Adoption of ICT Innovations by Smallholder FarmersRambim, Dorothy A.http://ir.jooust.ac.ke/handle/123456789/110672022-07-27T06:23:14Z2022-01-01T00:00:00ZA Participatory Model for an Enhanced Adoption of ICT Innovations by Smallholder Farmers
Rambim, Dorothy A.
Agriculture has been identified as the main source of livelihood for a large population in Africa, with over 80% of farmers being smallholder farmers. However, despite a large group of smallholder farmers being involved in food production, the outcomes show that there is still food-deficit in low-and middle-income countries; which forms greater part of African continent. Nonetheless, sustainable food production in these countries, is only achievable through economic growth and development strategies where agriculture is given a key consideration. One of the notable strategy, is the leveraging of information and communication technology (ICT) innovation in agriculture services to support smallholder farmers in addressing their challenges, increase incomes and production. While ICT has long been acknowledged as a main driving force for sustainable development, the availability of innovations and use remain a challenge for smallholder farmers. The study, sought to investigate and determine the factors that can accelerate adoption of ICT innovations by small by smallholder farmers. To achieve this, the study set four specific objectives, viz: to identify factors that influence smallholder farmers’ decision on ICT innovations adoption in Agriculture; to examine how the factors are perceived by smallholder farmers on adoption of ICT innovations; to determine the core mechanisms/approaches for adoption of innovations by smallholder farmers and hence to develop and a model for an enhanced adoption of ICT innovations in agriculture. The study used mixed methodology, comprising of qualitative and quantitative approaches to collect data from three counties; Siaya, Uasin Gishu and Kakamega in Kenya. The counties were purposively selected based on geographical locale, and economic endowment. A pilot study was conducted to validate the research instruments. The study applied both descriptive and inferential statistics for quantitative data using SPSS v.25. An exploratory factor analysis was used to extract key factors, which were then confirmed through the use of confirmatory factor analysis using Partial Least Square Structural Equation Model (PLS_SEM); SmartPLS3. Qualitative data were analysed and presented using manual thematic analysis and confirmation of the results made. Finding indicates that economic factor has the strongest effect on the use of ICT on agriculture and participation (0.412) and (0.361) respectively, followed by social influence (0.199) and Technology factors (0.135). On the model fit, the variable explains about 84% of variance in use of ICT on agricultural, hence adoption of innovations. This was further confirmed by qualitative study. The research has made theoretical contribution in two dimension; incremental and revelatory; new constructs and development of a new model for ICT innovations adoption that employs participatory approach. Additionally, methodological contributions were also made by using mixed research method to appreciate a multidimensional perspectives. Recommendation to stakeholders: use participatory approach, farmers should works in groups to enhance knowledge uptake.
2022-01-01T00:00:00ZAssessment of Effectiveness and Sustainability of the Midwifery Practice Model at the Primary Healthcare Level of the Health SystemsSyagga, Edwina A.http://ir.jooust.ac.ke/handle/123456789/110662022-07-27T06:07:42Z2022-03-01T00:00:00ZAssessment of Effectiveness and Sustainability of the Midwifery Practice Model at the Primary Healthcare Level of the Health Systems
Syagga, Edwina A.
A midwifery practice at the basic health facilities ensures that skilled care is available during pregnancy, labour and child birth as well as post-natal care of both mother and baby at the households. However, in Kenya there is ambiguity regarding the midwifery model in practice yet women continue to access midwifery services. The research question was about the type of midwifery practice in place and the model being followed. The broad objective of this study was
to assess the effectiveness and sustainability of the functional midwifery practice model at the primary healthcare level of the health system. The specific objectives of the study were to establish the midwifery practice model, determine its effectiveness and sustainability as well as identify the challenges to the sustainability of the identified practice model at the Primary Health care settings. Research questions guiding the study were developed in tandem with the specific objectives. Literature was reviewed along the conceptual themes reflected in the specific objectives, and a theoretical model identified to ground the study as well as aid the development of a conceptual model. The study was significant in that the findings facilitate discourse on how best to ensure the challenges bedeviling the current midwifery practices are addressed, paving way for an optimally sustainable midwifery model for Kenya. This was a cross-sectional study that used both quantitative and qualitative approaches. The study sites were in Siaya sub counties of Ugenya, Ugunja, Gem and Alego-Usonga. The unit of observation and analysis was the primary health care facilities. Sampling method was both probability and non-probability sampling methods to identify the study facilities as well as the selected community respondents as appropriate. The study population included the Nurse/Midwives at the primary health care facilities, health facility administrators, the sub-county public health nurses, the community health volunteers (CHVs), and mothers within the community, who were served by the sampled health facilities. The study instruments included, individual questionnaires, observation checklists, focus group discussion guide and key informant interview guides. Quantitative data analysis was done using statistical package for social sciences (SPSS) version 24. Quantitative data was analysed using frequencies, correlation coefficient, chi square and regression analyses, while the qualitative data was analysed thematically. The findings show that the midwifery being practiced at the primary health care levels in Siaya County, is midwife-led that to a large extent, has adopted the Community Strategy and the Primary Health Care (PHC) concepts which are national concepts developed to meet the needs of the community. However, there was no guideline to that effect. The functional midwifery practiced was sustainable socially and environmentally but not financially as evidenced through the measured parameters of availability, accessibility acceptability and affordability. Data revealed that skilled birth attendance had improved, cumulatively, in the four Siaya Sub-counties (from 58% to 82%). However, daunting challenges to this sustainability were also unearthed, chief among them being insufficient and irregular funds disbursement, staffing shortage and minimal male involvement. In conclusion, the study objectives were fulfilled; the midwifery practiced in Siaya County is sustainable, being midwife-led and consistent with the team midwifery model in other developed countries, and also involving the community a lot in the promotion of skilled birth attendance. The study recommends that the model be adopted as a bottom-up team midwifery model with clear guidelines provided for standardization of the model in practice and there should be more stakeholder involvement to further enhance for its sustainability. Concerted measures should likewise be put in pace to counteract the challenges to sustainability. A home grown optical model for Kenya can be tested and fine-tuned through further research in this field.
2022-03-01T00:00:00Z