African Journal of Health Sciences

Effect of health insurance on catastrophic health expenditure among households of people with non-communicable diseases in Busia County, Kenya

Wilson Kemei — 2024-12-17

INTRODUCTION

Non-communicable diseases (NCDs) are increasingly becoming important causes of illness and premature deaths globally, causing up to 41 million deaths annually, mostly occurring in Low and Middle-Income Countries. However, NCD treatment is lengthy and expensive forcing households to incur catastrophic expenditure. Thus, NCDs deepen inequality and are major drivers of unending poverty due to their lengthy treatment. Kenya successively reformed the National Health Insurance Fund to include a package that covers the plight of NCDs and transform it into a primary enabler for achieving Universal Health Coverage. This study examined whether health insurance affects catastrophic health expenditure among households of people with NCDs.

METHODOLOGY

A quasi-experimental design was conducted among eligible households with health insurance and those without, involving a representative sample of 350 households. Trained interviewers conducted interviews at baseline and after one year with household heads.

RESULTS

Households without cover spent a higher proportion of their total income (23%) on NCD care compared to households with insurance (11.7%). The mean total expenditure on NCD care for insured households was Ksh. 8,657.37 (95% CI 7,061.6 - 10,253.1) while that for non-insured was Ksh. 16,851.20 (95% CI 15,255.4 - 18,445.0), p = 0.000. Although the proportion of un-insured households that incurred catastrophic health expenditure (CHE) was higher than that of insured households, the study failed to establish that the incidence of CHE was different for non-insured and insured households (χ²= 33.89, df =1, p = 0.062).

CONCLUSION

NHIF cover was unable to protect Households of People with NCDs from CHE. The study recommends that NHIF's benefits package be further reformed to adequately cover all NCD's care needs. County government to strengthen the health system and boost capacity at lower levels of care to enhance NHIF coverage.

Is exposure to inter-parental violence associated with recent intimate partner violence among women in Kibra informal settlements?

Stephen Ochieng Ombija — 2024-12-17

BACKGROUND

Exposure to inter-parental violence has been associated with Intimate Partner Violence (IPV). However, research in Kenya's informal settlements (ISs) has been limited in determining this empirical link. This study aimed to examine if inter-parental violence exposure (IPVE) is associated with IPV in the ISs of Kibra, Nairobi, Kenya.

METHODOLOGY

A cross-sectional study design was employed with 1,068 women living in Kibra ISs selected through systematic random sampling. A modified questionnaire from the Demographic Health and Survey (DHS) targeting women's experience of IPV measured by combining physical, sexual, and emotional violence was used. The main explanatory variable was women or their partner’s IPVE during childhood. Data were analysed using STATA v.15.

RESULTS

The study revealed that 73% of women exposed to inter-parental violence had experienced IPV. Meanwhile, of women whose partners had been exposed to inter-parental violence, 75% had experienced IPV. Women exposed to inter-parental violence had increased odds of experiencing IPV AOR=2.27 (95% CI: 1.56-3.29), while women whose partners were exposed to inter-parental violence were positively associated with IPV AOR=1.59 (95% CI: 1.01-2.48).

CONCLUSION

This study shows that IPV is associated with IPVE among women in Kibra ISs. Targeted interventions may require social and behavioural change implementation that can break the cycle of violence among women and partners exposed to inter-parental violence during childhood. Further research can delve into robust evidence-based study designs to understand IPV and IPVE.

Evaluating the impact of a care model on skilled delivery service utilization among women in Kandara, Murang'a County, Kenya

Daniel Muya Gachathi — 2024-12-17

BACKGROUND

Addressing maternal and neonatal mortality rates in Kenya requires improving skilled delivery services, as unskilled deliveries contribute significantly to negative maternal and child health outcomes. This study aimed to evaluate the effectiveness of a model of care designed to enhance the utilization of skilled delivery services among women of reproductive age in the Kandara sub-county, Murang’a County, Kenya.

MATERIALS AND METHODS

Using a quasi-experimental study design, 154 pregnant women in their second trimester were equally assigned to test and comparison groups. The test group received tailored strategies promoting skilled birth attendance, while the comparison group received standard antenatal care. Data were collected continuously from the 28th week of gestation until delivery. Interventions for the test group included education on skilled delivery benefits and improved access to skilled attendants. All participants completed follow-up, achieving a 100% response rate.

RESULTS

Skilled birth attendance significantly increased in the intervention group compared to the comparison group. The intervention group had 98.7% skilled deliveries, while the comparison group had 85.7%. The overall proportion of skilled deliveries across both groups was 88%. Statistical analysis (Z = 3.08, p = 0.002) supports these findings, resulting in the rejection of the null hypothesis.

CONCLUSION AND RECOMMENDATIONS

The tested model of care proved effective, suggesting its potential for implementation in low-skilled delivery areas. Collaborative efforts involving the National and county governments through the health departments, NGOs, and community health workers are recommended to scale up implementation in maternal and neonatal care. Advocacy with policymakers is crucial for integrating the model into maternal healthcare systems and shaping supportive policies. Additionally, government and stakeholder research collaborations are recommended to evaluate the model's long-term impact and sustainability.

A comparative study of access to healthcare and health-related quality of life among adults with disabilities during COVID-19 pandemic in Kakamega County, Kenya

Stephene Osongo Maende — 2024-12-17

BACKGROUND

This study compared the health-related quality of life of adults with disabilities against a control group in Kakamega County. The effect of access to health care on healthrelated quality of life during COVID-19 was also assessed.

METHODOLOGY

A case-control study was undertaken with 212 persons with disabilities and a comparator group of 212 individuals. Matching between persons with and without disabilities was based on age (+ or -5 years) and sex. The World Health Organisation Quality of Life Questionnaire and WHO Module on disabilities were adopted to assess Health-related Quality of Life (HRQOL) and access to healthcare respectively. Data was analysed using descriptive and inferential statistics.

RESULTS

Persons with disabilities had significantly lower HRQOL scores compared with the control group (mean difference, 6.89 p<0.01). They were also more likely to encounter barriers to healthcare access. Access to healthcare was positively associated with the HRQOL for the two groups (0.29 p<0.05) but, those with disabilities who experienced limited access to healthcare had lower HRQOL (-0.09 p<0.038).

CONCLUSION

Disability was associated with lower HRQOL. In both groups, access to healthcare was linked to higher HRQOL. Policies to enhance access to healthcare for persons with disabilities; subsidies on medical costs, and ensuring disability-friendly hospitals, are imperative. Awareness of the rights of persons with disabilities, and solving inequities in education and labour market access, is necessary to achieve full participation of persons with disabilities in social life.

The effectiveness of an education intervention on the health-related quality of life of adolescents with type 1 diabetes mellitus

Sherry Oluchina — 2024-12-17

INTRODUCTION

The increasing prevalence rate has made diabetes a world epidemic. Type 1 diabetes mellitus has an impact on everyday life and in general, it reduces the healthrelated quality of life (HRQoL) of adolescents. Considering diabetes and its associated effects on patients' health-related quality of life, this interventional study was performed to promote the health-related quality of life using education based on the self-care model in Kiambu County, Kenya.

METHODOLOGY

The study was conducted from January to August 2021 at diabetic clinics of Thika Level 5 Hospital (TL5H) and Kiambu Level 5 Hospital (KL5H). The study employed a pre-test post-test non-equivalent quasi-experimental study design. There were 96 adolescents with Type 1 Diabetes Mellitus (T1DM) obtained by stratified random sampling technique, and assigned into experimental (48 respondents) and control group (48 respondents). Health-related quality of life (HRQoL) was evaluated in the first and seventh months using a Short Form health survey (SF-12) questionnaire. A paired sample T-test and an Independent T-test were used to analyze data.

RESULTS

Paired sample T-test statistics revealed a significant difference in increasing HRQoL (p<0.05) before and after the intervention; Independent T-test discovered a significant difference in HRQoL (p<0.05) between the intervention and control group at post-intervention.

CONCLUSIONS

Education intervention based on a self-care model is an effective program that can improve HRQoL. In addition, the education intervention based on the self-care model needs to be implemented continuously to prevent diabetes-related complications and improve HRQoL for diabetic patients.

Diarrhoea management practices among adolescent mothers as predictors of diarrhoeal diseases: A cross-sectional study

Justinah Kavata Maluni — 2024-12-17

BACKGROUND

In sub-Saharan Africa, diarrhoeal diseases accounts for over 88% of deaths in children below five years old. In Kenya, the prevalence of under-5 diarrhoeal diseases was at 15% and 14% as per the as per Kenya Demographic Health Information Survey(KDHIS) of 2014 and 2022 respectively. This study aimed at examining the poor practices by adolescent mothers that function as predictors of diarrhoeal diseases among children under five years of adolescent mothers.

METHODOLOGY

The study was a mixed method, cross-sectional study involving 284 adolescent mothers aged 15-19 years in Kobura ward, Nyando sub-county, Kisumu County. The study employed both qualitative and quantitative data collection methods. Data was collected using a researcher-administered survey and 3 focus group discussions. Multivariable logistic regression was used to estimate the association between proper management of diarrhoea and sociodemographic and environmental factors using STATA version 17, while qualitative data was transcribed and analysed using NVivo Version 12 using inductive thematic analysis.

RESULTS

The study found that, the diarrhoea prevalence within the study area was higher (22.5%) than the national one (14%) and that 34% of the adolescent mothers had poor diarrhoea management practices which were predictors of diarrhoea among their children. Further, having a handwashing facility and the child’s vaccination status were predictors of diarrhoea.

CONCLUSION

Poor diarrhoea management practices are prevalent among adolescent mothers. Adolescent mothers need education on proper feeding, vaccination, and household sanitation to improve diarrhoea management and reduce prevalence, thereby improving the health of under-five children.

Factors associated with hospitalisation among diabetes patients in Western Kenya

Achieno Tessy — 2024-12-17

BACKGROUND

Diabetes patients routinely visit hospitals and often get admitted for periods. However, drivers of routine hospital visits and admissions (here defined as hospitalisation) are poorly understood to inform improved management of diabetes at the household level. This study determined factors associated with hospitalisation among diabetes patients in Busia County, Kenya.

METHODOLOGY

The study adopted a hospital-based cross-sectional study design and employed systematic sampling to select 155 participants from diabetes patients seeking healthcare services at Busia County Referral Hospital. Data was collected in March 2023, six months retrospectively using a structured questionnaire. Bivariate and adjusted multivariable logistic regressions were used to assess factors associated with hospitalisation.

RESULTS

More than one-half (n = 89, 57.4%) of the participants were females. Over 85% of the participants enrolled were aged 40 years and above (40-59 years [n = 66, 42.6%]; 60+ years [n = 67, 43.2%]). Approximately 53% of respondents reported at least one hospital admission within six months, whereas 47% had routine visits. Participants aged at least 60 years old had higher odds of hospital admission and routine clinic visits; 16.07 (Adjusted Odds Ratio [AOR] = 16.07, 95% CI = 4.47 – 57.72, p-value <0.001) and 7.30 (AOR = 7.30, 95% CI = 2.35 – 22.62, p-value <0.010), respectively. Diabetes patients who reported to be taking alcohol had a higher proportion of hospital admissions, p-value = 0.004. Diabetes patients with concurrent HIV had more routine hospital visits compared to their counterparts without HIV (AOR =2.74, 95% CI = 1.03-7.25, p-value <0.001).

CONCLUSIONS

The study shows that old age, employment status, alcohol consumption, and comorbid HIV were associated with hospitalisation. These findings underscore the urgency of targeted interventions to address the socioeconomic disparities and strengthen diabetes management policies in Kenya. Further studies targeting; behavioral status, host diabetes, and comorbidity conditions will be important to inform improved management of diabetes at the household level to reduce hospitalisation.

Factors influencing supportive supervision practice among Frontline Nurse Managers at Thika Level 5 Hospital, Kiambu County, Kenya

Lucy Waithira Waweru — 2024-12-17

BACKGROUND

Supportive supervision (SS) is a process that aims at improving healthcare staff performance through the identification of knowledge and skill gaps, giving feedback and on jobtraining. This study aimed to assess the factors influencing SS practice among Frontline Nurse Managers at Thika Level 5 Hospital (TL5H) in Kiambu County, in Kenya.

METHODOLOGY

The study applied a mixed methods study design using both quantitative (analytical crosssectional) and qualitative approaches (FGDs and KII). The study population was the Nursing Services Manager, Frontline Nurse Managers and their deputies. Quantitative data was collected using a semi-structured questionnaire and observation checklist. For qualitative data study applied purposive sampling was to recruit Frontline Nurse Managers and their deputies. Qualitative data was collected through Focused Group Discussions (FGDs) and Key informant interviews (KIIs). Quantitative analysis was done using SPSS version 25.0. Quantitative data was presented using frequency distribution tables and charts. Qualitative data were analysed using NVivo version 12 and then presented in themes. The analytical statistic was not done since there was no observed SS at Thika Level 5 Hospital (TL5H).

RESULTS

On observation, all wards and sections at TL5H scored below expectation on SS. From the semi-structured questionnaire, 82% of the respondents indicated SS performance as “none” per week. 64.1% of the respondents reported that they were not trained on SS and their knowledge score was AT 40%. 90% of the respondents identified staff shortage as a barrier to SS practice, 55 % as lack of time for SS and 20% identified lack of tools as a barrier to performing SS.

CONCLUSION AND RECOMMENDATION

Frontline Nurse Managers’ SS practice was below expectation and their knowledge of SS was marginal. Frontline Nurse Managers lacked time for SS since they also performed patient care roles due to hospital staff shortage. The study recommends the introduction of a structured SS tool, training of Frontline Nurse Managers on SS, and addressing staff shortage in hospitals.

Prevalence, knowledge, and occupational risk factors for tuberculosis among health workers in Siaya County Hospitals, Kenya

Mary Juma Wambura — 2024-12-17

BACKGROUND

TB is a known occupational hazard for healthcare workers (HCWs), especially in countries with high TB burdens. It is estimated that HCWs have a 2- to 3-fold increased risk of developing TB compared with the general population. This study sought to determine the burden of TB among healthcare workers in hospitals in Siaya County and establish their knowledge of TB, and the associated occupational risk factors.

METHODOLOGY

This analytical cross-sectional study investigated the burden, knowledge and occupational risk factors for TB among HCWs in Siaya County, using a sample of 275 participants. Sputum samples were collected for TB testing using GeneXpert. Selfadministered structured questionnaires and observation checklists were used to collect data from the HCWs. Chi-square test of association and logistic regression were conducted to test for the presence and/or strength of association between participant characteristics, HCW knowledge of TB, and TB prevalence (α =0.05).

RESULTS

Among the 275 respondents, 18 (6.5%) reported a TB diagnosis within the past five years. Diagnostic tests used included Gene Xpert (69.2%), chest X-ray (19.3%), and smear microscopy (3.8%). Only 68 (24.7%) had received TB training, and 71 (25.8%) strongly disagreed that TB-related manuals were available at their health facilities. Health facilities that provided health talks and prioritized coughers for treatment were significantly associated with lower TB occurrence among health workers (χ² = 11.125, p = 0.012). However, factors such as consistent N95 mask supply (χ² = 7.505, p = 0.069), mask usage (χ² = 6.335, p = 0.135), designated sputum collection areas (χ² = 6.714, p = 0.116), functional IPC measures (χ² = 7.796, p = 0.067), scheduled health talks (χ² = 8.353, p = 0.052), and adequate lighting and ventilation (χ² = 6.065, p = 0.144) were not significantly associated with TB incidence among health workers.

CONCLUSION

The unavailability of certain infection prevention and control (IPC) interventions is associated with the occupational risk of TB among healthcare workers. The Ministry of Health should enhance the dissemination of relevant TB manuals to update health care staff on IPC and availing N95 masks to all healthcare workers.

Unmasking the effects of the COVID-19 pandemic on tuberculosis diagnosis and care in Bungoma County, Kenya

Gabriel Muyiemba Wamalwa — 2024-12-17

INTRODUCTION

After the declaration of COVID-19 as a pandemic by the World Health Organization (WHO) in March 2020, the global focus solely shifted to fighting the pandemic. Tuberculosis (TB) services were affected in that the number of newly diagnosed tuberculosis patients decreased from 7.1 million in 2019 to 5.8 million in 2020. This study investigated the effects of COVID-19 on the diagnosis of tuberculosis patients and their treatment outcomes in Bungoma County, Kenya

MATERIALS AND METHODS

A retrospective cohort study was conducted using TB data from all health facilities in Bungoma County. A total of 5,981 TB patient records were collected, 3337 before COVID-19 and 2644 during COVID-19. An interrupted time series analysis was done to assess the impact of COVID-19 on TB case notification, comparing the period before COVID-19 (April 2018–March 2020) and during the pandemic (April 2020–March 2022). TB cases diagnosed were defined as the number of clinically diagnosed and bacteriologically confirmed TB treatment patients. Treatment outcomes were assigned to patients at the end of treatment according to WHO guideline. Data analysis on proportions was done using Epi Info 7 software.

RESULTS

The number of new patients diagnosed during the pandemic dropped compared to the period before the pandemic. The cure rate among the bacteriologically confirmed patients decreased from 86.9% before COVID-19 to 66.9% during COVID-19. The death rate among the patients increased during the COVID-19 pandemic to 10.8%, compared to 9.3% before the pandemic.

CONCLUSIONS AND RECOMMENDATIONS

COVID-19 not only negatively impacted the number of TB patients diagnosed in Bungoma County but also led to an increase in unfavorable TB patient outcomes. Bungoma County should invest in strategies to safeguard the health system in the future against similar pandemics.

Uptake of Drug Susceptibility Testing and factors associated among TB Patients in Bungoma County, 2018-2022

Callistus Muliro Barasa — 2024-12-17

BACKGROUND

Drug Susceptibility Tests play an important role in developing strategies to identify and treat patients at high risk of Drug-Resistant Tuberculosis. Kenya is among countries with a high burden for Tuberculosis, and Multidrug-resistant/Rifampicin Resistant Tuberculosis. Early diagnosis and detection of drug-resistant Mycobacterium tuberculosis is a priority to identify patients not responding to treatment and avoid transmission of resistant strain. This study aimed to determine the uptake of the Drug Susceptibility Test and associated factors among tuberculosis patients in Bungoma County from 2018 to 2022

METHODOLOGY

Descriptive analysis was done, and patients’ characteristics were summarized in tables. Logistic regression was used to calculate the odds ratio at a 95% confidence interval (CI) and to check the association between drug susceptibility uptake and varied patient characteristics. P value ≤ 0.05 was considered statistically significant.

RESULTS

A total of 3204(42%), accessed a DST. Patients 25-44 years of age were 3262(37%). Females were more likely to have a DST with OR 1.03 (p<0.0123; 95% (1.04, 1.35). A patient being HIV negative was more likely to access a DST with OR 1.1 (p<0.0001; 95% (1.63, 2.15).

CONCLUSION

Access to a DST test among TB patients was sub-optimal. Most patients were found in the age group 25-44 years. Being a female, you were more likely to access a DST, and HIV-positive patients were unlikely to receive a DST test.

Factors associated with loss to follow up among Tuberculosis patients in Embu County, 2016-2021

Beth Muthoni Nduati — 2024-12-17

INTRODUCTION

Loss of follow-up among Tuberculosis patients is a significant challenge for Tuberculosis control. It may lead to prolonged infectiousness of Tuberculosis cases, increased rate of treatment failure, relapse, progression to drug-resistant TB, and deaths. The study aimed at identifying factors associated with loss to follow-up among TB patients in Embu County.

METHODOLOGY

A retrospective cohort study was carried out among all patients (n = 8983) notified between the years 2016-2021 in Embu County, Kenya. The data was obtained from the routinely collected TB data stored in the National Tuberculosis Program database. Descriptive statistics and multivariate logistic regression were performed to identify factors associated with treatment loss to follow-up. Data analysis was conducted using R statistical software.

RESULTS

Out of 8,983 patients notified, 657(7.3%) of them had a treatment outcome of loss to follow-up. The majority were; males (78%), age groups 15-44 (68%), Embu West Sub County (67%), public sector (91%), clinically diagnosed (51%), obesity (30%), and the HIV positive (19%). Being a male (aOR=1.6(95% _CI: 1.3 – 1.9), being in age-group 15-44 years, being clinically diagnosed (aOR=1.58(95% _CI: 1.31– 1.92), being previously treated (aOR=1.38(95%_CI: 1.03-1.83), and having HIV as a comorbidity (aOR=1.48 (95%_CI: 1.19-1.83) increased the risk of being loss to follow up during TB treatment.

CONCLUSION

Loss to follow-up among TB patients is still a challenge in Embu County. Sex, age, and HIV status were shown to increase the risk of loss to follow-up among TB patients; thus highlighting the need for strategic interventions to improve treatment adherence.