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Understanding the Context of Healthcare Access among the Elderly in Informal Settlement Kibera, Nairobi, Kenya
(Global Health and Education Projects, Inc., 2015-07-22) Wairiuko, Judy W.; Cheboi, Solomon K.; Ochieng, George; Oyore, John P.
Access to healthcare is fundamental to health. Access is the ability to get the required medical care from the health service providers when in need. The proportion of the elderly is increasing rapidly in informal settlement, Kenya. This comes up with many health problems. Whether the healthcare is prepared to take care of this elderly has not been extensively investigated. This was a descriptive cross-sectional study, targeting both elderly men and women aged 60 years and over, in Kibera informal settlement of Kenya, to identify enabling factors of access to healthcare by the elderly. The study adopted a mixed method approach encompassing qualitative and quantitative methods and multistage sampling approach based on probability proportional to size while at the village level sampling was systematic. Quantitative data was analyzed using Statistical Package for the Social Sciences version 20.0 while Manifest content analysis was used for qualitative data. The study found that access to healthcare services was low (40.4 %). Marital status, type of house, education were statistical significant in relation to access. The odds of access increased with those who lived in permanent houses (OR: 30.699, 95% CI 1.827-515.927 P<0.017) when compared against those who lived in temporary houses. Availability of equipment & drugs, services at level one, and perception of healthcare services were significantly. The likelihoods of access increased among those who had never experienced lack of equipment (OR 0.093, 95% CI -0.017-0.503), P value=0.006) against those who were regularly affected. The odds of access decreased among those who had never been served by Community Health Worker (OR 4.467, 95% CI (1.164-17.146), P value=0.029) and those served occasional (OR 3.757, 95% CI (1.096-12.878), P value=0.035) compared to those regularly by CHWs. The findings denote availability and acceptability as major challenge to access of healthcare among the elderly. Friendly policy and services framework need to be developed to mitigate availability and acceptability concerns. Special and/or additional training for health workers in the area of geriatric health is paramount. Key words: Healthcare access, elderly people.
Determinants of Patient Satisfaction in Indigenous Cancer Palliative Care Services
(SAGE Publications, 2023-04) Cheboi, Solomon K.; Nyawira, Daisy N.; Ngolo, Peter M.; Ng’ang’a, Wanjiru N.
Optimal quality of care remains an integral formal service along the continuum of care pathway. Patient satisfaction is an important health system responsiveness goal which has been shown to influence quality of care except in the indigenous settings. This study identified the determinants of patient satisfaction in the context of indigenous palliative care in Kenya. A descriptive cross-sectional study was conducted among cancer patients exiting indigenous care outlets located in 12 towns across Kenya using a structured modular questionnaire. Exit interviews were undertaken with 433 respondents leaving 193 mapped indigenous outlets. Overall services satisfaction was assessed as the dependent variable using a computed single-item satisfaction mean score. The data was analyzed using IBM Statistical Package for Social Sciences version 22. 0. Bivariate and multivariate analyses were conducted to identify the potential determinants. Against the 433 study respondents, 248 (57.3%) expressed overall satisfaction with indigenous palliative care services: Satisfaction was positively associated with waiting time (AOR = 2.663, 95% CI = 1.235-5.743), provider attention (AOR = 3.698, 95% CI = 1.657-8.254), provider politeness (AOR = 6.774, 95% CI = 3.697-12.413) and provider social communication skills (AOR = 6.520, 95% CI = 3.642-11.673). Good patient-provider interaction, provider social skills and service waiting time influence patient satisfaction with indigenous palliative care. The finding contributes to the understanding of indigenous palliative cancer care and provides scientific evidence for providers and policy makers to redesign and improve their service and outlet setting to provide patient centered holistic palliative care.
Inclusive Education for Learners with Intellectual Disability in Public Primary Schools-Kenya
(Bluemark Publishers, 2016) Mbugua, Martha W.; Cheboi, Solomon K.; Omuga, Basio O.; Madigu, Nancy O.
The move towards inclusive education remains elusive. There is dramatic difference in the educational opportunities provided for children with Intellectual Disability (ID) and without ID. In rural and Peri-urban areas of Kenya only 15% of children with ID are included in regular schools. A descriptive cross sectional survey was undertaken to identify factors influencing inclusion of children with ID in regular classrooms by teachers. The study adopted a mixed method approach and multi-stage random sampling technique. Quantitative data was analysed using statistical package for social scientists (SPSS) version 20.0. Manifest content analysis was used for qualitative data. The overall inclusion rate was (38.1%), however a few teachers 38.5% [81] adjusted lessons to suit ID pupils while 26.7% (56) offered individual attention to ID pupils. Teachers whose schools used medical report for admission were five times (AOR 5.567, 95% CI 0.728-5.556, P=0.018) more likely to include pupils with ID than teachers whose schools had no clear admission criteria. Concerning the assistance offered by teachers to children with ID in the class, teachers who offered individual pupil support and those who organized peer tutorial were highly associated with inclusion (AOR 71.697, 95% CI 1.899-4.989, P=0.029) and (AOR 25.9111, 95% CI 1.102-8.685, P=0.003) than respondents who did nothing supportive. Parents’ involvement in inclusion, number of pupils with ID in the class, enrolment criteria, and environment adjustment, and policy adoption, willingness of the school administrators to include ID children, curriculum flexibility, Funding and availability of adequate teaching facilities are central factors to the inclusion. Support, supervision, and coordination with special education teacher were are other factors. The study revealed high number of ID pupils in regular classrooms but inclusive education remains elusive. This is due to non-adjustment of lessons to fit the needs of ID pupils and failure to have an individual education plan for ID pupils in classrooms. The implementation of successful inclusion is a complex issue involving key players such as policy makers, parents, teachers, pupils and school administration. Therefore, this study calls for the development a clear contextualized inclusion guideline tailored for public schools. Keywords: Inclusive education, Intellectual Disability, teachers’ perception
Health care seeking behaviors and perspective on indigenous palliative care among cancer patients in Kenya
(MaryAnn Lieberty, 2022-02-08) Cheboi, Solomon K.; Kariuki, Peris; Mutai, Joseph; Kibet, Staline; Nyamanga, Philemon
Introduction Holistic integrated community palliative care services remain a mirage to cancer patients. Nonetheless, a number of cancer patients are jamming traditional medicinal places seeking therapy. The results of these visits are undocumented. This study explored healthcare seeking behaviors and perspectives on cancer indigenous palliative care among patients visiting traditional health practitioners in Kenya. Methods A cross-sectional study was undertaken through client exit survey. Face to face interviews were conducted using semi-structured questionnaires with all consenting cancer patients exiting mapped outlets. Data was analyzed using Statistical Package for Social Science Version 22.0. Results A total of 433 respondents were interviewed and the majority were female 59.6%, Christians 97.2%, married 89.8% and educated 85.7%. Their mean age was 48.25 ± 15. 58. Education, sex and religion were significantly associated with perceived improvement. The predominant cancer types were breast cancer (22.4%); throat (14.8%), prostate (12.9%), bone (12.5%), cervical (9.9%), stomach (6.0%) and skin cancer (5.1%). The most frequently used traditional medicine was herbal medicine that was driven by unresponsive conditions (42.2%), inaccessible biomedical services (18.8%) and yearning for second opinion (18%) over a condition. Seventy six percent of the respondents reported improved and prolonged quality of life. 78.2% reported improved eating, drinking, standing, walking and doing light duties alone. Patients felt healthier, hopeful, happier, confident and bonded to their families. Conclusions Use of indigenous palliative care is predominant to all major cancer conditions and driven by the quest for cure, successful stories, trustworthiness and beliefs, previous experience and avoiding medical procedures such as surgery.
Access to Healthcare Services in Informal Settlement: Perspective of the Elderly in Kibera Slum Nairobi-Kenya
(Nigerian Medical Association, 2017-02) Wairiuko, J. M.; Cheboi, Solomon K.; Ochieng, G. O; Oyore J. P.
Background: The world’s older population is increasing at an alarming rate. This comes up with several health problems and the preparedness of health facilities in handling the elderly is under investigated in Kibera urban informal settlement, Kenya. Aim: This study examined perceptions of the elderly on quality of care and fundamental factors to utilization of health services. Subjects and Methods: This was a descriptive cross-sectional study targeting the elderly, to identify factors influencing access to healthcare. Mixed Methods entailing qualitative and quantitative parameters and a multistage sampling approach were used. Quantitative data was analyzed using statistical package for social since. Manifest content analysis was used for qualitative data. Results: Access to healthcare is low 40.4% (161/399). Access was high among very satisfied {unadjusted OR 0.012, 95% CI (0.001-0.157), and satisfied {unadjusted OR 0.012, 95% CI (0.001- 0.157) respondents. Facility (χ2=19.763, df=3 p<0.001), health worker preference (χ2=6.819, df=2 p=0.033) and family support (χ2=21.539, df=4 p<0.001) influenced access. Respondents who preferred treatment by any health worker and those for same sex were less likely {unadjusted OR 2.701, 95% CI (1.022-7.136), p values =0.045 and OR 5.322, 95% CI (1.613-17.555), P value= 0.006} to be associated with access. Access increased with satisfaction of service received. Those very satisfied {unadjusted OR 0.008, 95% CI (0.001-0.091), p value<0.001 and satisfied (OR 0.005, 95% CI (0.001-0.026), P value<0.001) were highly associated with access. Conclusion: Access to healthcare among the elderly in informal settlement is low. Availability and acceptability are major challenges. This calls for perception change among policy and health workers to elderly clients and qualitative research to ascertain the under lying reasons for low acceptability. Keywords: Access, Healthcare, Elderly people