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Cultural and religious factors hindering guardians of children with clubfoot from seeking corrective services in Embu clubfoot care for Kenya clinic.
No full textRJ 47.J47 2016Clubfoot (Congenital Talipes Equinovarus) is a condition in which the child is born with the hind foot adducted, flexed and inverted inwards. Doctors are not sure what causes clubfoot 'even though once neglected it results in significant impairment in body structure and function and may result in activity limitations and participation restrictions. For medical professionals, clubfoot is a clearly defined physical impairment or challenge. However, for guardians and children presenting with the condition, it is rarely defined. In Kenya physical di ability elates religious and cultural implications that prevent the guardians from taking their children for corrective services. In Embu County the situation is no different as the medical records indicate that many guardians fail to take their children for corrective services in Embu Clubfoot Care for Kenya Clinic, though the services are offered for free. The aim of 'this study was to find out whether there are cultural and religious factors that prevent the guardians from taking their children for corrective services and whether religion contributes towards clubfoot correction. The study was done in Embu Clubfoot Care for Kenya clinic which is situated in Embu Level Five Hospital. The target population was the guardians who brought their children for corrective services. At the time of this study the number of guardians according to the medical records at the clinic was three hundred and eighty. Out of this number fifty guardians were interviewed during the month of December 2014. Forty two were interviewed at the clinic while eight were in interviewed in their homes, two guardians from each of the four sub-counties of Embu County. A guardian's forum was conducted where they shared their views. This study used descriptive research design. Data collection was by use of questionnaire for the guardians and medical personnel and scheduled interviews. At one time the researcher had an open forum with guardians where their shared their experiences freely. Data analysis has been presented through descriptive statistics. This helped to describe the cultural and religious factors that make the guardians in not being clinic compliant. During the study it came out that there were religious and cultural factors .which prevented the guardians of children born with clubfoot from taking their children for corrective services. The major factor that came out in religion was the perceived causation of clubfoot. In culture the major reason was stigmatization from the family members, places of worship (churches and mosques), and the general public. The study also revealed that religion was contributing positively towards clubfoot management. The study contributes to our understanding of clubfoot in Kenya and the wider African continent. Recommendations made included increasing awareness and advocacy especially through the mass media, church bulletins and possibly through the social media
Determinants of availability of tracer essential medicines in public health facilities in Nyeri County, Kenya
Get PDFThe goal of the health system is to improve health and health equity in ways that are responsive, financially fair and make the most efficient use of the available resources. This is supported by six Health Systems Strengthening (HSS) pillars of medicines, vaccines and technologies, human resource, financing, leadership and governance, service delivery and health information systems. A well-functioning health care system ensures equitable access to medicines, vaccines and technologies which results in overall HSS. Tracer essential medicines are supposed to be 100% available at all times to treat the common ailments in a region. Despite the large number of patients that visit public health facilities, the inadequacy of trained pharmaceutical personnel, inefficiencies of the supply chain system and inadequate funding, no study has been carried out to ascertain the availability of tracer essential medicines in these facilities. The objectives of the study were to determine the stocking level of tracer essential medicines, to establish human resource factors affecting availability of tracer essential medicines, to find out the supply chain factors affecting availability of tracer essential medicines and to assess the organizational factors affecting availability of tracer essential medicines. A cross sectional study design with a mixed method approach was used. A questionnaire was used to collect data on the human resource factors and supply chain factors affecting availability of tracer essential medicines. A Focus Group Discussion (FGD) guide was also conducted with seven respondents comprising of six sub County public health nurses and the County pharmacist. The sample population comprised of 17 public health facilities and 30 pharmacy personnel. The response rate was 25 (83.3%). The average stocking level in tier three facilities was 94% while that in tier two facilities was 63.75%. The overall mean percentage stocking level of the 20 tracer essential medicines in all the facilities was 72.65%. Human resource factors that affected availability were unavailability of Standard Operating Procedures (SOPs), inadequate training of pharmacy personnel and pharmacy personnel not aware of tracer medicines. There was a significant relationship between availability of tracer essential medicines and pharmacy personnel awareness of tracer list (r=0.850), pharmacy personnel receiving training in commodity management (r=0.834), availability of SOPs (r=0.817) and designation of pharmacy personnel (r=0.746). The supply chain factors that affected availability of tracer essential medicines were long lead times, unavailability at Kenya Medical Supplies Agency (KEMSA), long ordering and delivery schedules and incorrect quantification. The organizational factors that affected availability were inadequate supportive supervision, inadequate financing and absence of Revolving Drug Funds (RDFs) within the facilities. The study concluded that the stocking level of tracer essential medicines in Nyeri County was below the World Health Organization recommendation of 100%. In addition, human resource factors, supply chain factors and organizational factors affected availability. The researcher recommends that a community pharmacy with subsidized medicines prices be introduced in the facilities; the County should facilitate training of all pharmacy personnel on commodity management, all facilities should have buffer stocks to cover at least two months as they await new stocks and the County should provide supportive supervision to the facilities
Household food security and coping strategies among pastoralist in Mandera county
No full textThis study focuses on causes of household food insecurity and coping strategies among households in Mandera County which has the highest percentage of food insecure households in Kenya. The study looks at the causes of food insecurity and analyzes government policy interventions carried out to address the problem. The study employed descriptive survey design. Both primary and secondary data were employed in this study. The population in this study consisted of all 128,125 households in Mandera County. From this population a sample of only three hundred and ninety eight (398) households were surveyed. Stratified and systematic sampling was used to get the sample. Questionnaires and interview schedules were the main instruments used in data collection. Pilot test was done in Wajir County. The enumerators together with the researcher moved from a household to another in data collection. The County Agricultural Extension Officers together with other front line extension staff acted as key informants for the study. Besides the primary data which was collected from the households, general information about food security was assessed in the intensive focus group discussions. Data from the completed instruments was coded and entered into the computer using SPSS software for analysis. The findings of this study show that various and interrelated factors are responsible for the problem of chronic household food insecurity in Mandera County. The study concluded that the households use various ways to cope with food insecurity especially the time of drought. They have various ways of coping with pasture shortages which include; strategic movements in search of fodder and water, various herd management strategies such as herd splitting, herd diversification and herd maximization to ensure that they spread the risk of livestock loss from droughts, diseases and theft. Opportunities for utilization of non-livestock rangeland resources which are used by the households included: medicinal plants, sand harvesting and cultivating fodder. Other types of coping strategies included social networks, reciprocity, neighborhood associations, stock associates, bond friendships and pooling resources together. Few households in Mandera County also mix their species to mitigate the effects of draught. The study also found that there are various socio-economical factors affecting food security in Mandera. These included education level of the household head, off farm income, dependants in a household, membership in the existing groups, extension services and infrastructure. The study also found out that there are various socio-cultural factors affecting food security in Mandera County which included traditions, reasons for keeping animals, relative values, responsibility and social obligations and traditional ceremonies. Based on the study's results the following interventions are recommended: Rangeland resource utilization and development, water source development and management, extension and institutional capacity building, capacity building for livestock producers and marketing associations, improvement of animal health/veterinary services, interventions for improving infrastructure for livestock disease control and marketing, adopting to climate change and enhancing early warning systems and exploitation and development of non-livestock resources
Drivers of health services' sustainability in selected mission hospitals in MT. Kenya
Get PDFMission hospitals were initiated by missionaries and were heavily subsidized. The situation has changed; donor support is no longer reliable and cost of providing services has increased tremendously. The subsidy which enabled the services to be cheap and accessible has largely ceased hence the full cost of delivering services has to be met by the patients. A number of mission hospitals are befallen by crisis due to weak governance structures leading to poor oversight of health institutions. The health providers market has also become very competitive with private and public health units mushrooming in both urban and rural areas. Due to the financial constraints, sustainability of mission hospitals has been difficult and is in dire need of exploring other factors to enable it sustain health services. The study was conducted to explore drivers of health services' sustainability in mission hospitals so as to enhance service provision, accountability and growth while embracing best practices. The specific objectives were to find out if governance, continuous quality improvement and stakeholders engagement influence sustainability. The study was carried out in 10 faith based Hospitals in Kirinyaga, Murang'a, Embu, Nyeri and Meru counties with bed capacity of 60 and above. A descriptive cross sectional study design was used and a non-probability sampling method was used to select subjects of the study. Questionnaires and key informant interviews with selected chief executive officers was used to collect data that was analyzed using Statistical Package for Social Sciences and presented in the form of frequency tables at p < 0.05. A multivariate regression model was applied to determine the relative importance of each of the three variables with respect to Health Services' Sustainability. The study found out that mission hospital adheres to quality improvement practices such as presence of quality improvement teams and standard operating procedures but lacks top management support; they have a board of directors but lack a clear documented organization structure (organogram) while board composition was biased to church leaders. Study also indicated that stakeholder's engagement was a key drive to sustainability but there was little engagement within the catchment population. The study concluded that Mission hospitals lack sufficient funds from their sources of income to sustain quality health services since main source of funds is user fee which is also affected by dwindling patient numbers. The study recommends that Governance of mission hospitals should be strengthened and professionalized to ensure that it has the essential competence and Mix of skills and employees trained on sustainable procurement concept. It is recommended to further research on how mission hospitals can gain competitive advantage through service differentiation
Challenges affecting adoption of diversification strategies in savings and credit co-operative societies in Imenti North Constituency
No full textThe rate of adoption of diversification strategies by Sacco's is considered to be facing huge predicaments. This study addresses the challenges affecting the adoption of diversification strategies by Sacco's in Imenti-North Constituency, Meru- Kenya. The study sought to look into the following objectives: - To investigate the effect of risk, competition, technology, and nature of service offered on the adoption of diversification strategies by savings and credit cooperative organizations in Imenti-North Constituency. The financial institutions in Kenya have rapidly expanded as depicted by the increased number of players venturing into the financial market which has led to increased competition. Not only has the number of players increased, but also there is an increased variety of products and service offered. The following theories were applied in this study Igor Ansoff Matrix, Organizational Adoption, Modem Portfolio Theory and Porter's Theory of Competitive Advantage. This review aids in the understanding of the concept of product diversification in the financial institutions especially the Saccos. The target population for this research included all the 35 Saccos in Imenti North Constituency, Meru County. The 35 Sacco's represented the researcher's units of analysis from North Imenti which is the chosen research area. The total number of the possible respondents for the research comprised of all the board members of these Saccos. The researcher used a census survey which implies that all the units of study (Saccos) participated. The total number of possible respondents was 315 which was the total number of all board members of the 35 Saccos in North Imenti. The researcher selected purposively three board members from each Sacco which comprised of the managing director and two non-executive board members. These formed a total of 95 respondents. The• collected data from the questionnaires was organized starting with the coding of the question items, then coded data was transformed into descriptive statistics( frequencies, means, and standard deviations)with the aid of statistical packages for social sciences(SPSS version 22). Multiple logistic regression was used to link the relationship between the dependent variable (adoption of diversification strategies by Saccos) and the independent variable (risk, technology, competition and nature of service offered) and to test the hypothesis at 95% confidence level using Wald test aided by spss (version 22). Ninety-Five (95) questionnaires were distributed to the various respondents in the 35 sampled Sacco's. Seventy-six (76) were returned representing a response rate 80%. Purposive sampling was used to select respondents from each stratum to form a sample size of 35respondents. Data were summarized and presented in the form of frequency tables and percentages. The findings revealed that the model as a block was found to be a significant predictor based on the omnibus test. From the results, all of the study variables were considered by the respondents to be significant apart from a risk which ranked the lowest. Therefore technology enhancement and competition be classified as the strongest predictors of adoption of diversification. Sacco's should embrace and strongly support diversification because from the study we can see how firms are benefiting from the use of diversification like increased market share, security advancement and automation of systems which leads to efficiency and effectiveness which encourages brand loyalty. Therefore, it is recommendable that the management should understand the importance of these study variables which refers to the top management's strategy about innovativeness and risk-taking for the sustainability of the Sacco's
Effect of phosphate fertilizer rates on cowpea planted at three different spacing intervals in Tana River County, Kenya
Get PDFS 647 .M86 2016Cowpea (Vigna unguiculata) is a major source of dietary protein for both humans and animals in many parts of the world along tropical and sub-tropical belt. Annual world production was estimated at 3.3 million tons of grain from 12.5 million ha. In Kenya it is mainly grown marginal drought prone areas. Cowpea production in Tana River is highly constrained by poor agronomic practices, prevalence of pests and diseases, frequent droughts, erratic rainfall patterns and poor soil fertility. There has been inconsistent and variable information on cowpea spacing and Phosphorus application. A field experiment was carried out to study the effect of Triple Super Phosphate fertilizer application and spacing interval on growth and yield of seed cowpea (K80) under irrigation. The treatment consisted of three spacing intervals of 60x30 cm, 60x20 cm and 60x15 cm and four different rates of Triple Super Phosphate fertilizer (TSP) i.e. 30 kg P/ha, 25 kg P/ha, 20 kg P/ha and 0 kg P/ha. The experiment was arranged in Randomized Complete Block Design with three replicates. The results revealed that there was significant difference (p<0.05) in growth and yield of seed cowpea (K80) due to spacing and Triple Super Phosphate application. The highest results obtained at 60x30 cm and at 30 kg P/ha Triple Super Phosphate level. It can be concluded that 60x30 cm and 30 kg P/ha are appropriate for better growth and yield of seed cowpea. It is therefore recommended to apply triple super phosphate fertilizer and adopt 60x30 cm spacing interval for improved cowpea production. Additionally, regular soil testing is recommended so as apply Triple Super Phosphate in appropriate rates. More research work should be done using different spacing intervals and different fertilizer application rates to determine the most appropriate spacing interval and fertilizer application rate for improved cowpea production
A case of MP shah hospital, Nairobi.
No full textStrategic planning practices allow improvement of organizations performance by establishing guidelines in form of clear vision, mission statements and performance expectations including performance indicators. The study focused on the leadership and governance pillar of health system building block. The main objective of the study was to determine challenges of implementing strategic planning practices adopted by MP Shah Hospital to achieve its performance, with the specific objectives being how communication, staff participation and capacity building influence implementation of strategic planning practices in MP Shah Hospital. This was a descriptive case study limited to MP Shah Hospital with target population being key professional employees; sample of 139 out of 349 key professionals was used to collect both qualitative and quantitative data using structured questionnaires for key professional employees and key informant interview guide for the unit managers. Data was analysed using both descriptive and inferential statistics. The study took advantage of computer software SPSS for data analysis, correlation analysis determined the significance relationship between independent variables (communication, staff participation and capacity building) and dependent variable (organizational performance), Pearson product indicated a positive correlation. Regression analysis indicated r = 0.736 that changes in the dependent variable(organizational performance) were influenced by changes in independent variable(communication, staff participation and capacity building) by 73.6%, while other factors not investigated in the study contributed to 26.4% of organizational performance. The study found out that 91.3% were aware of strategic planning practices in MP Shah Hospital, while 51.4% agreed it was highly useful in determining performance. From the findings only 62% are involved in the implementation process, this was majorly affected by communication whereby majority felt communication was not timely (64%), support supervision was lacking since majority 69.6% did not know if it exists. The study also found out that MP Shah was performing above average in clinical performance, and customer retention. It was also noted that they needed to improve on developing effective strategies and establishing priorities in order to improve its performance. The study therefore recommended that strategic planning practices be emphasized in terms of capacity building in order to improve performance of health facilitie
Factors influencing the adoption of minimally invasive approaches during surgery amongst tier four hospitals in Nairobi County, Kenya.
Get PDFSurgical service delivery is a key component in the service delivery pillar of the Health System. Due to the nature of resources required for surgical services, cost is a major concern for health systems and therefore it's difficult to discuss the delivery of good quality of surgical service without anchoring it in the financing pillar as well. Few health system facilities can afford to equip themselves for surgical services and as a result, there are is an overwhelming number of clients in the waiting lists for surgical services. Clear outlines of reasons for low uptake of these approaches are not available for use by decision makers hence no evidence based remedial actions can be taken as yet. The objectives of this study were to determine the influence of Institutional, Patient and Surgeon factors on the utilization of minimally invasive approaches to surgery in tier 4 hospitals of Nairobi County. A cross sectional survey was carried out in a population of 100 surgeons. A purposive sampling was done, 80 surgeons in two specialties namely General Surgery & Obstetrics Gynaecology who operate in tier 4 health facilities were subjected to questionnaires and key informant interviews. The data was collected for a period of five months yielding a 100% response rate and analysis done using SPSS version 23. A total of 9 surgical interventions emerged from the respondents as they were required to consider an intervention for which they had the option to use either of the two possible approaches-open and minimally invasive approaches. On a scale of 1 (least recurring) to 5(most recurring), Hospital not having the required devices/equipment and equipment being non-functional emerged as the most common impediments to MIS (mean score, 2.61) Hospital not having competent nurses came in second (mean score, 2.21). Hospital policies not encouraging adoption came in least (mean score, 2.10). For the patient related factors, Patient presentation-obesity, co-morbidities, age) emerged as the most prominent patient factor that leads to an open approach for a procedure (mean score 2.87) followed by intra-operative complications presentation (mean score, 2.80). Out of pocket came in third (mean score 2.60) while patient insistence was the least significant (mean score,1.71). Lack of confidence in the MIS approach for the cited procedure emerged as the most important consideration for surgeon related factor (mean score, 2.55). Surgeon preference followed (mean score The research concluded that the availability of functional enabling technologies was the most significant institutional factor in the adoption of MIS approaches. The absence of intra-operative complications and the surgeon's level of comfort in an approach emerged as the most significant for the patient and surgeon factors respectively. The research recommended the development of health economics driven budgets for enabling technologies, financing for surgical interventions and a review of surgical registrar training to incorporate MIS approaches for surgical procedures
Health systems support factors' influence on uptake of immunization services in Kajiado North sub-County.
Get PDFAccess to health care services is described as the ability by patients to reach and demand health services based on individual needs. Immunization is one of the most effective, safest and efficient public health interventions as it is estimated to save at least 3 million lives from vaccine preventable diseases. Many cultural, religious, or social factors may impede the demand for health care. This study focused on the service delivery pillar. The overall objective was to determine the health system support factors and their influence on access of immunization services in Kajiado North Sub-County. Specific objectives were a) to determine the socio-cultural values that contribute to low access of immunization health services, b) to assess how the packaging of immunization services in the health facilities influence access and c) to establish the relationship between the health promotion activities. This was a cross-sectional study design with a sample size of 280 respondents who were mothers with children below 12 months. Nine health workers were purposively selected for a focused group discussion. Data was analyzed using of ms-Excel, SPSS version 20 and results presented in narratives, tabulations, and graphs. The results revealed that in 2012 and 2013 in Ngong hospital and Fatima health center had a drop in immunization coverage of 128 and 273 children respectively. In addition, the comparative analysis of Kajiado sub-counties on immunization coverage indicated that the sub-county antigen specific coverage reduced as follows: BCG dropped by 4% to 61%, OPV increased by 5% to 75% and measles increased by 3% to 77%. The mean age of respondents was 26.7 years and analysis indicated that level of education negatively influenced immunization access. The distance between households and health facilities ranged from a hundred meters to 20Kms. Approximately 48(17.1%), of mothers visit facilities which are outside the 5 kilometer distance advocated by Kenya health policy. 120(42.8%) suggested that there is need for health promotion activities in the community. The correlation of visits to awareness indicated a p-value of 0.209. 233 (83%) agreed that immunization program is well explained to them when they visit health facilities. The correlation of health education with awareness indicated a p-value of 0.406. The modes of communication clearly portrays that 183(65.4%) of mothers got the information about immunization through continuous health education that is routinely offered in health facilities, whereas 39 (13.9%) mothers got the information through community health promotion. The study recommends a) form outreach teams to trace defaulters of immunization schedules, b) sub-county health office to frequently conduct community health promotion in the villages to discourage cultural believes which contribute to low access to immunization services, and c) package simplified information about the benefits of immunization services shared in health education sessions and during community health promotion