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Implementation of WHO, 2006 Child Growth Standards: Health Workers Knowledge, Attitudes and Practices in Kasarani, Kenya
(Sciencedomain International., 2018-10-31) Nabukanda, Mola C.; Cheboi, Solomon K.; Waudo, Judith; Ogada, Irene A.
Introduction: In the populous Nairobi peri-urban setting, growth assessment of children, under five years of age is wanting (20%). Stunting, wasting and underweight were 17.2%, 2.5% and 3.8% respectively against the national statistics of 27%, 11% and 4%. A study was undertaken to assess health workers current levels of knowledge about WHO 2006 child growth standards, their attitudes, and practices. Methodology: The study was undertaken in Kasarani using a facility based cross-sectional survey in 45 health facilities. Purposive sampling was used to recruit 129 participants. The data were collected using an interviewer-administered questionnaire adopted and modified from the previous studies. Data were entered and analysed using the Statistical Package for Social Science version 25. Results: The study revealed that the calibration of the weighing instrument was more pronounced in private (66.7%) than in faith-based (28.6%) and public facilities (4.8%). Health workers with moderate knowledge were five times more likely (OR: 4.886, 95% CI 1.565-15.250) to implement WHO, 2006. Respondents who perceived growth assessment using the WHO growth standards as an effective method to detect malnutrition were thirteen times (OR=12.900; 95% CI 0.427 – 389.372) more likely to plot the child’s measurements. Similarly, those who considered malnutrition as dangerous to child growth and development were three times (OR=2.671; 95% CI 1.042 – 6.573) more likely to be practitioners of the WHO growth standards. Significant positive correlations were found between knowledge with attitude (r=0.227), attitude with practice (r=0.226), as well as knowledge with practice (r=0.250). Conclusion: The study revealed that informed health workers may eventually develop a positive attitude and good practice towards the WHO 2006 child growth standards. Training interventions on the importance of adherence of growth monitoring guidelines may improve growth assessment.
Evaluating the Effectiveness of Cultural Competence Intervention in Improving Quality of Maternal Care Service among Women in Marakwet, Kenya
(Sciencedomain International, 2021-07-23) Cheboi, Solomon K.; Rucha, Kenneth K.; Kimeu, Anastasiah N.; Kithuka, Peter
Background: variances amongst the cultures of health care services providers and consumers are recognized as a fundamental obstacle for dignified quality maternal care. Few studies have exploited context specific innovations such as cultural competence to reduce health disparities for priority populations. Data in this field may provide clarity and pathways for its operationalization in achieving respectable and equitable quality health care. Methods: This was a cluster randomized trial in Marakwet, Kenya. The study aimed at evaluating the effects of cultural competence intervention in improving quality of maternal care service. Data was collected through a client exit complemented by mystery client before and after the intervention. The sample size was 758 respondents proportional distributed per cluster and sample consecutively. Statistical Package for Social Science (SPSS) was used to analyze the data. The effect of the interventions was measured using standard mean difference and t-test. Results: The results showed that intervention improved quality of delivery rooms settings. The means of two groups were indifferent pre-intervention (749) = -0.380, p = 0.704 but significant thereafter t (756) = -5.214, p < 0.001. The intervention effect size was (F (1, 756) = 10.142, p = .001, ηp2 = 0.036). The score of trust in provider was insignificant before t (692) = -957, p = 0.339 but significant later t (690) = -6.137, p = 0.001. The mean of the intervention improved to 4.26±0.698 from 4.05±0.727. The effect size was significant (F (1, 756) = 6.395, p = 0.012, ηp2 = .018). Conclusion: people first care intervention prompt facility and providers to make concerted efforts in provision of quality maternity services. Additionally, the concept of cultural competence prioritizes patients’ needs for reengineering people centered services and provide ambiance for enhanced patient-provider relationship
Performance of Community Health Workers in Njiru District, Nairobi County, Kenya
(Bluemark Publishers, 2016-02) Mulingwa, Margaret W.; Cheboi, Solomon K.; Oyore, John P.; Otieno, Ochien’g G.
In 2006, World Health Organization report recognized shortages of health workers as an ingredient in primary health services. In mitigation the Alma-Ata declaration of 1978 promoted the use of Community Health Workers (CHWs) to provide selected services at level one of health care services. In Kenya, CHWs workforce were adopted as a component of cost effective strategies however the performance of CHWs as change agents has been called into question. The study aimed at describing the factors which influence performance of CHWs in Njiru District, Nairobi County, Kenya through a descriptive cross-sectional survey. Mixed methods (quantitative and qualitative methods) and systematic sampling method were applied. Data was analyzed using Statistical Package for Social Science (SPSS) version 20.0. Findings showed that performance of CHWs was low (34.7%). The performance of CHWs was low in four key monthly targets (referral of patients; number of houses visited; CHWs meetings; number of Baraza but average in health education. Age, gender, marital status, community reception, religious practices, cultural norms, use of feedback, period of training, field allowance and social class were key factors in CHWs performance. From this study the implementation and realization of the key CHWs targets in Peri- urban setting is challenging, there is need therefore to develop a clear contextualized CHWs guideline tailored for Peri- urban settings.
Providers’ Understanding of Cancer Aetiology and Supportive Features for Indigenous Palliative Cancer Care Service Provision in Kenya
(Sage, 2023-08-16) Cheboi, Solomon K.; Kiprop, Lagat; Nyawira, Daisy; Kariuki, Peris; Mutai, Joseph; Ng'ang'a, Wanjiru
Background: Palliative care is a fundamental component of providing people-centred health services to cancer patients. However, the primary pillars of indigenous palliative care such as provider understanding of cancer, its aetiology, and features are undocumented. Objective: We sought to understand Traditional Health Providers (THPs) understanding of cancer aetiology, and the functional features that support indigenous palliative cancer care service provision in Kenya. Method: The study used a mixed methods cross-sectional design. A semi-structured questionnaire was administered to 193 THPs, who self-reported to manage cancer patients. The findings were enriched and validated through member checking in 6 focus group discussions and five journey mapping in-depth interviews. Results: Despite diversity in culture and experience among the indigenous providers in Kenya, their description of cancer etiology and their management practices and primary goal were similar. Cancer was consistently described as a deadly lifedeforming disease by 61.1% of THPs (n = 118/193) and attributed to chemicals and toxins in the body 41.5% (n = 80). The indigenous palliative-care system was reported to be characterized by five tiered levels of care, diversity in expertise and experience, shared and consultative process (60%) and family involvement in medical decision (59.5%). Herbal regimen (60.1%) was found to be the cornerstone of informal palliative care blended with nutrition management 78.2% (n = 151), lifestyle changes 63.7% (n = 123) and counseling services 55.9% (n = 108). Payments for service were arbitrarily made in cash or in kind. Conclusion: The features of indigenous palliative care services are informed by the providers’ distinctive cultural terms and descriptions of cancer and cancer aetiology. Shared and consultative protocols, regimen exchange, referral to cascaded care, and caregiver involvement were all important palliative-care clues to saving and enhancing lives. The features provide context for development of indigenous palliative care framework, engagement of policy makers, and promotion of culturally-inclusive indigenous palliative care model for adoption.
Accessibility to Integrated Community Case Management of Childhood Pneumonia Services among Caregivers in Kisii County, Kenya
(Sciencedomain International, 2022-09-19) Mwambi, Dennis O.; Osero, Justus O.; Mwanzo, Isaac; Cheboi, Solomon K.
Background: Pneumonia is the leading cause of childhood illness and mortality worldwide. The number of children under five with pneumonia in Kisii County, Kenya, was 10% compared to the national average of 9% despite the integrated Community Case Management (iCCM) roll out. In order to identify factors associated with caregivers' access to iCCM services, a study was conducted. Materials and Methods: Qualitative and quantitative approaches were used in this descriptive cross-sectional study. Purposive sampling was utilized to choose 10 informants while multistage and random sampling was applied to select 330 caregivers. Thematic content analysis and discourse analysis techniques were used to analyse qualitative data, while Statistical Package for Social Science (SPSS) version 22 was used in quantitative data. Results: Only 33.6% of caregivers accessed iCCM for childhood pneumonia services. In 49% of cases, CHVs was the first point of contact after onset of pneumonia symptoms, with only 31.2% seeking help within 24 hours. 96% of CHVs did not follow the recommended iCCM diagnostic protocols, and only 34.8% prescribed antibiotics. Age (0.011), religion (0.007), and marital status (0.024) were significantly associated with access to iCCM. Business persons were 2.97 times (OR 2.972; CI 1.232,7.167; P= 0.015) more likely to access iCCM than farmers. Caregivers who perceived pneumonia to be severe were 3.03 more likely to access ICCM (OR 3.039;CI 1.703,5.424; P< 0.001) than opposite peers. Respondents who didn't think pandemics affected access were 10% (OR 0.119; CI .058,0.246; P< 0.001) more likely to access iCCM. Conclusion: Access to iCCM was low and Community health volunteers (CHVs) were not the first point of care for pneumonia in children. Evidence of poor performance by CHVs in the areas of diagnosis, treatment, and the administration of antibiotics suggests that iCCM needs more monitoring and oversight.