Department of Health Systems Management and Public Health

Permanent URI for this collectionhttps://koha2.tukenya.ac.ke/handle/123456789/1459

Browse

Browsing Department of Health Systems Management and Public Health by Title

Filter results by typing the first few letters
Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    Demographic Factors Associated with Health-Related Quality of Life Among Urban and Rural Tuberculosis Patients in Kenya
    (Bilingual Publishing, 2019-12-31) Oguya, Francis; Mbuti, Humphrey; Mwaniki, Elizabeth
    Background: Tuberculosis is one of the deadliest and disabling diseases in the world today. The infection exacts its greatest toll on individuals during their most productive years. TB patients record different perceived health related qualities of life(PHRQoL) which could be attributed to certain environmental,social and physical factors. The objective of the study was to determine the demographic factors associated with the PHRQoL among urban and rural Tuberculosis patients in Kenya. Cross sectional design was adopted. The study applied the multi-stage sampling technique. Random sampling method was used to select the TB clinics that participated in the study. Simple random sampling according to probability proportionate to TB patient’s population was preferred to select the study participants. Chisquare test determined association between the various demographic factors and the PHRQoL while ANOVA tests demonstrated the overall association of demographic factors and PHRQoL. Statistical Significance was evaluated at p<0.05. Descriptive statistics summarized and described the data. The study established that demographic factors are associated with PHRQoL (p=0.008). Specifically, age, levels of education, marital status and house hold size (P<0.05). Gender and Household head were not significantly associated with the PHRQoL (p>0.05). These findings will persuade the TB management policy towards developing an intervention programs directed at the social-demographic characteristics of the TB patients for improved treatment outcomes.
  • Thumbnail Image
    Item
    Factors associated with default from treatment among tuberculosis patients in Nairobi province, Kenya: A case control study
    (BMC Public Health, 2011) Oguya, Francis; Keraka, Margaret N; Kimuu, Peter K
    Background: Successful treatment of tuberculosis (TB) involves taking anti-tuberculosis drugs for at least six months. Poor adherence to treatment means patients remain infectious for longer, are more likely to relapse or succumb to tuberculosis and could result in treatment failure as well as foster emergence of drug resistant tuberculosis. Kenya is among countries with high tuberculosis burden globally. The purpose of this study was to determine the duration tuberculosis patients stay in treatment before defaulting and factors associated with default in Nairobi. Methods: A Case-Control study; Cases were those who defaulted from treatment and Controls those who completed treatment course between January 2006 and March 2008. All (945) defaulters and 1033 randomly selected controls from among 5659 patients who completed treatment course in 30 high volume sites were enrolled. Secondary data was collected using a facility questionnaire. From among the enrolled, 120 cases and 154 controls were randomly selected and interviewed to obtain primary data not routinely collected. Data was analyzed using SPSS and Epi Info statistical software. Univariate and multivariate logistic regression analysis to determine association and Kaplan-Meier method to determine probability of staying in treatment over time were applied. Results: Of 945 defaulters, 22.7% (215) and 20.4% (193) abandoned treatment within first and second months (intensive phase) of treatment respectively. Among 120 defaulters interviewed, 16.7% (20) attributed their default to ignorance, 12.5% (15) to traveling away from treatment site, 11.7% (14) to feeling better and 10.8% (13) to side effects. On multivariate analysis, inadequate knowledge on tuberculosis (OR 8.67; 95% CI 1.47-51.3), herbal medication use (OR 5.7; 95% CI 1.37-23.7), low income (OR 5.57, CI 1.07-30.0), alcohol abuse (OR 4.97; 95% CI 1.56-15.9), previous default (OR 2.33; 95% CI 1.16-4.68), co-infection with Human immune-deficient Virus (HIV) (OR 1.56; 95% CI 1.25-1.94) and male gender (OR 1.43; 95% CI 1.15-1.78) were independently associated with default. Conclusion: The rate of defaulting was highest during initial two months, the intensive phase of treatment. Multiple factors were attributed by defaulting patients as cause for abandoning treatment whereas several were independently associated with default. Enhanced patient pre-treatment counseling and education about TB is recommended.
  • Thumbnail Image
    Item
    Focusing the HIV response through estimating the major modes of HIV transmission: a multi-country analysis
    (2015-09-15) Oguya
    Objective An increasing number of countries have been estimating the distribution of new adult HIV infections by modes of transmission (MOT) to help prioritise prevention efforts. We compare results from studies conducted between 2008 and 2012 and discuss their use for planning and responding to the HIV epidemic. Methods The UNAIDS recommended MOT model helps countries to estimate the proportion of new HIV infections that occur through key transmission modes including sex work, injecting drug use (IDU), men having sex with men (MSM), multiple sexual partnerships, stable relationships and medical interventions. The model typically forms part of a country-led process that includes a comprehensive review of epidemiological data. Recent revisions to the model are described. Results Modelling results from 25 countries show large variation between and within regions. In sub-Saharan Africa, new infections occur largely in the general heterosexual population because of multiple partnerships or in stable discordant relationships, while sex work contributes significantly to new infections in West Africa. IDU and sex work are the main contributors to new infections in the Middle East and North Africa, with MSM the main contributor in Latin America. Patterns vary substantially between countries in Eastern Europe and Asia in terms of the relative contribution of sex work, MSM, IDU and spousal transmission. Conclusions The MOT modelling results, comprehensive review and critical assessment of data in a country can contribute to a more strategically focused HIV response. To strengthen this type of research, improved epidemiological and behavioural data by risk population are needed.
  • Thumbnail Image
    Item
    Randomized Control Trial Study On The Effect Of Health Education In Promoting Adherence To Treatment Among The Urban And Rural Tuberculosis Patients In Kenya
    (RESEARCH SQUARE, 2020-11-18) Oguya, FRANCIS OCHIENG; Mbuti, Humphrey Kimani; Mwaniki, Elizabeth; Warutere, Peterson
    Background: Tuberculosis is a global health concern and the incident rate in Kenya remains high. Because of the long duration of standard treatment (six months), there is a risk of treatment default by patients. Low adherence to treatment may result in the emergence of resistant strains of the Mycobacterium Tuberculosis in turn increasing mortality and prolonging the treatment duration. The rising TB cases in Kenya have been associated with poor adherence and low cure rate arising from inappropriate health education. Directly Observed Therapy, Short-course (DOTS) Strategy, in combination with patient education have proved to be more effective in reducing TB incident than the DOTS Strategy alone. However, there is lack of Evidence Based Protocol to guide Medical Professionals through the implementation of health education for TB patients. Objective: The main objective of this study was to determine the effect of health education in promoting adherence to treatment among the urban and rural tuberculosis patients in Kenya. The study used the PRECEDE-PROCEED model. Design: The study adopted Randomized Controlled Trial Design with pre-and post-test assessment. The Multi-Stage Sampling Technique was applied to select the study respondents. Random sampling was adopted to select the hospitals, health centers and dispensaries. Simple random sampling method was also used to assign the patients into experimental and control groups. Setting: The study was conducted in fourteen public health facilities in Nairobi and Murang’a Counties; 2 Hospitals, 7 health centers, 5 dispensaries. Participants: A total of 450 patients were recruited from the selected health facilities by random sampling according to probability proportionate to TB patient’s population. Only 373 met the eligibility criteria for the study. Intervention: Health Education Program for 10-15 minutes on average, twice a month for the next 6+ months as the Patient went for the weekly drug ration. Main measurement outcome: Level of adherence to TB treatment in patients. Methods: The study was conducted between September 2019 and February 2020. Only patients aged 18 years and above who had been on DOTS for at least two weeks were selected. Health education was given to those in the experimental group while those in the control group did not receive the intervention. After the six months of treatment the two groups were compared. Standard Questionnaire was used to collect data. Multivariate Analysis of Variance, Odds Ratio and Chi-square tests were used to evaluate the association between health education and adherence to TB treatment. Results: 450 patients were recruited (experimental group=225, control group=225). 77 patients did not meet the eligibility criteria leaving 373 patients (experimental group=186, control group=187). 83.3% of patients in the experimental group had high level adherence after intervention in the post- test phase Page 3/29 compared to 60.4% of patients who had high level adherence in the control group in the post-test phase. Wilk’s Λ had an F value of 18.540, p<0.001, Odds Ratio was 3.274 and χ²= 24.189, p<0.001, indicating that the health education intervention improved adherence to medication. Gender, levels of education, marital status and primary occupation were also found to be significantly associated with adherence to medication (p<0.05). Conclusions: Health education enhanced patients’ adherence to TB treatment regime. A health education program should be adopted and rolled out to health facilities and health care settings that provide TB services in Kenya.
  • Thumbnail Image
    Item
    Rapid situational assessment of people who inject drugs (PWID) in Nairobi and coastal regions of Kenya: a respondent driven sampling survey
    (BMC Public Health, 2021) Oguya, FRANCIS; Kenya, Patrick R.; Ongecha, Francisca; Mureithi, Patrick
    Background: A Cross-sectional Rapid Situational Assessment of People Who Inject Drug (PWIDs) applying Respondent Driven sampling techniques (RDS) was used to recruit subjects/participants in a study aimed at assessing HIV prevalence and risk behaviors among injecting drug users in Nairobi and Coastal regions of Kenya. There is paucity of data and information on injecting drug use in sub-Saharan Africa and there is sufficient evidence of existence of the environment for development and growth of injecting drug use. Past studies on PWID and its association to HIV and AIDS that have been conducted in Kenya do not provide sufficient information to support effective planning and comprehensive national response to the HIV and AIDS epidemic. Methods: A cross-sectional study design was adopted in which a set of initial subjects referred to as ‘seeds’ were first identified from which an expanding chain of referrals were obtained, with subjects from each wave referring subjects of subsequent waves. The seeds were drawn randomly from the population and interviewed to pick the one with the largest network and other unique characteristics. A maximum of twelve seeds were recruited. The second stage involved conducting assessment visits to the sites to identify potential collaborators that included non-governmental organizations (NGOs), drug treatment centres, health facilities, community based organizations (CBO’s) among others. Three NGOs located in the coast region and one in Nairobi region were identified to assist in identifying drug injection locations and potential participants. Key informant interviews (KIIs) and Focus Group Discussions (FGDs) were also conducted using interview guides. Results: A total of 646 individuals (344 in Nairobi and 302 at the coast) were recruited for the study between January and March 2010. Of these 590 (91%) were male and 56 (9%) were female. Findings showed that most PWIDs initiated injecting drug use between the ages of 20–29 years, with the youngest age of initiation being 11 years and oldest age being 53 years. Most commonly injected drug was heroin (98%), with a small (2%) percentage injecting cocaine. Other non-injecting methods such as smoking or combining these two drugs with other drugs such as cannabis or Rohypnol were also common. Most PWIDs used other substances (cigarettes, alcohol, and cannabis) before initiating injecting drug use. The adjusted national HIV prevalence of PWIDs was 18.3% (19.62% unadjusted) with PWIDs in Nairobi region registering 18.33% (20.58% unadjusted) compared PWIDs for Coastal region indicating 18.27% (18.59% - unadjusted). The gender based HIV prevalence showed that women were more at risk of acquiring HIV (44.51%-adjusted) compared to men (15.97%-adjusted). The age specific HIV prevalence showed that PWIDs who initiated injecting at 11–19 years (44.7% adjusted) were most at risk in Nairobi compared to those who initiated injecting at age 20–24 years (23.2% - adjusted) in the coastal region. While all PWIDs continue to be at risk in the two regions, those from the Western parts of Nairobi, Kenya were at a relatively higher risk given their increased propensity for sharing injecting equipment and solutions. Conclusions: Compared to the national HIV prevalence of (4.9%), the results show that People Who Inject Drugs (PWIDs) are at particularly high risk of infection in Kenya and there is urgent need for intervention (KenPHIA, 2018). This study also showed clear evidence that 70% of PWIDs are primary school educated, engage in high risk injecting and sexual behaviors comprising sharing of injecting equipment, unprotected heterosexual and homosexual sex. Given that initiation of injecting drug use begins early and peaks after formal school years (20–29 years), prevention programmes should be targeted at primary and secondary school students, college and out of school youth. Further, to protect People who inject drugs (PWIDs) from HIV infection, the country should introduce free Needle Syringe Programs (NSP) with provision of condoms and Methadone Assisted Therapy (MAT) as a substitute for drug use.
  • Thumbnail Image
    Item
    Rapid situational assessment of people who inject drugs (PWID) in Nairobi and coastal regions of Kenya: a respondent driven sampling survey
    (BMC Public Health, 2021) Oguya, Francis O.; Kenya, Patrick R.; Ongecha, Francisca; Mureithi, Patrick
    Background: A Cross-sectional Rapid Situational Assessment of People Who Inject Drug (PWIDs) applying Respondent Driven sampling techniques (RDS) was used to recruit subjects/participants in a study aimed at assessing HIV prevalence and risk behaviors among injecting drug users in Nairobi and Coastal regions of Kenya. There is paucity of data and information on injecting drug use in sub-Saharan Africa and there is sufficient evidence of existence of the environment for development and growth of injecting drug use. Past studies on PWID and its association to HIV and AIDS that have been conducted in Kenya do not provide sufficient information to support effective planning and comprehensive national response to the HIV and AIDS epidemic. Methods: A cross-sectional study design was adopted in which a set of initial subjects referred to as ‘seeds’ were first identified from which an expanding chain of referrals were obtained, with subjects from each wave referring subjects of subsequent waves. The seeds were drawn randomly from the population and interviewed to pick the one with the largest network and other unique characteristics. A maximum of twelve seeds were recruited. The second stage involved conducting assessment visits to the sites to identify potential collaborators that included non-governmental organizations (NGOs), drug treatment centres, health facilities, community based organizations (CBO’s) among others. Three NGOs located in the coast region and one in Nairobi region were identified to assist in identifying drug injection locations and potential participants. Key informant interviews (KIIs) and Focus Group Discussions (FGDs) were also conducted using interview guides.
  • Thumbnail Image
    Item
    Social Demographic Factors Associated with Adherence to Treatment Among Urban and Rural Tuberculosis Patients in Kenya.
    (International Journal of Medical Science and Health Research, 2020) Oguya, Francis; Mbuti, Humphrey; Mwaniki, Elizabeth
    Background: Tuberculosis is a Global Public Health concern with serious Economic and Social Burden to the Patient and the Household. Because of the long duration of Standard Treatment there is a Risk of Treatment Default by Patients. The Objective of the Study was to determine the Social Demographic Factors Associated with Adherence to Treatment among the Urban and Rural Tuberculosis Patients in Kenya. The Cross Sectional Study Design was adopted. The Study applied the Multi-Stage Sampling Technique. Random Sampling Method was used to select the TB Clinics that Participated in the Study. Simple Random Sampling according to Probability Proportionate to TB Patient’s Population was preferred to select the Study Participants. Chi-Square Test determined Association between the various Social Demographic factors and the Adherence to treatment while ANOVA Test demonstrated the overall Association of Social Demographic factors and Adherence to TB Treatment. Statistical Significance was evaluated at p<0.05. Descriptive Statistics summarized and described the data. The Study established that Demographic Factors were Associated with adherence to TB treatment. Specifically, Gender, Level of Education, Place of Residence were found to be Significant (P<0.05). Age, Marital Status, Primary Occupation and Household Head were not Significantly Associated with adherence to TB treatment (p>0.05). These Findings will persuade the TB Management Policy towards developing Intervention Programs directed at the Social-Demographic Characteristics of the TB patient for improved Treatment Outcomes.