Masters Theses

Determinants of utilization of skilled birth attendants in maternal and neonatal health centres of excellence in Kibish Subcounty, Turkana County

Thu, 01 Jan 2026 00:00:00 GMT

Determinants of utilization of skilled birth attendants in maternal and neonatal health centres of excellence in Kibish Subcounty, Turkana County Lopodo, Gabriel Ekal Background: Skilled birth attendance (SBA) is an important intervention for reducing preventable maternal and neonatal morbidity and mortality. It enables timely identification and management of complications during childbirth and referral for advanced care when required. However, utilisation of SBA remains uneven, particularly in remote and underserved settings. In Kenya, SBA was 89% nationally in 2022, compared with 53% in Turkana County. Despite the establishment of Maternal and Newborn Health Centres of Excellence (MNH CoEs) to improve access to quality maternal and newborn services, there is limited evidence on utilisation of SBA in Kibish Sub-County. This study therefore assessed utilisation of SBA and factors influencing its utilisation among women of reproductive age in MNH CoEs in Kibish Sub-County, Turkana County. Objectives: The broad objective of the study was to assess the determinants influencing the utilisation of SBA among women of reproductive age in MNH CoEs in Kibish Sub-County, Turkana County. The specific objectives were to assess socio-demographic characteristics associated with utilisation of SBA; to assess obstetric factors associated with utilisation of SBA; to determine the influence of health facility accessibility on utilisation of SBA; and to explore perceived cultural factors influencing utilisation of SBA among women of reproductive age in MNH CoEs. Methods: The study employed a cross-sectional mixed-methods design using a convergent parallel approach. The study involved 369 participants aged 15–49 years who had at least one delivery in the preceding two years and had lived in Kibish Sub-County for at least two years before the study. Quantitative data were collected through structured questionnaires, and qualitative data were collected through eight FGDs conducted in each of the catchment villages and four KIIs involving County and Sub-County RH coordinators and in-charges of the two health facilities. Quantitative data were entered into SPSS v20 and analysed using statistical tests such as frequencies, Prevalence, and Logistic regression, as applicable. Qualitative data were translated, transcribed, and thematically analysed both manually and with NVivo. Ethical approval was obtained from MTRH /Moi University IREC (Approval no: 0003543) and NACOSTI (License No. NACOSTI/P/20/5223). Findings: Most of the respondents were aged 25-34 years (65.0%, n=240), had no formal education (93.2%, n=344), and lived within 5 km of a healthcare facility (59.9%, n=221). Hospital delivery was reported by 58.0% (n=214) of participants; 213 (57.7%) reported being attended by a skilled health professional at their last birth; 55.3% (n=204) had parity of ≥4, and 93.1% (n=344) had at least one ANC visit. Reduced utilization of SBA was associated with husbands who were herdsmen [95% CI: 2.35-20.91; p=0.001, AOR = 7.01], parity ≥5 [AOR = 8.86; 95% CI: 2.77–28.33; p<0.001], and transport cost ≥500 [AOR = 9.30; 95% CI: 3.08–28.09; p<0.001], while having ≥4 ANC visits [AOR = 0.092; 95% CI: 0.019–0.451; p=0.003] increased utilization of SBA. Six main themes emerged from the FGDs and five from the KIIs: highlighting cultural practices related to placenta disposal, umbilical cord care, preferred birthing position, gender of the birth attendant, domestic responsibilities, breastfeeding and naming practices, and the roles of husbands and mothers-in-law in childbirth decisions. Conclusion: SBA utilisation in Kibish Sub-County was suboptimal. Higher parity, having a husband who was a herdsman, and higher transport costs were associated with increased likelihood of home delivery, while attending four or more ANC visits was associated with reduced likelihood of home delivery. Qualitative findings indicated that cultural practices, family decision-making, and challenges in accessing and using health facilities influenced childbirth decisions. Interventions to improve SBA utilisation should therefore address transport-related barriers, strengthen ANC engagement, and incorporate culturally responsive approaches to maternal and newborn care. Recommendations: The findings highlight the need for community-based interventions to improve access to maternal and newborn health services in remote areas through strengthened health infrastructure, transport systems, and community-based ANC outreach. There is also a need to invest in operationalising and optimizing the use of Maternity Waiting Homes (MWHs) for expectant women residing away from health facilities. Culturally responsive and respectful maternity care should also be strengthened through community engagement and promotion of practices that do not compromise maternal and newborn safety.

Prevalence and determinants of undiagnosed diabetes mellitus among patients presenting for elective surgery at Moi Teaching and Referral Hospital, Eldoret Kenya

Thu, 01 Jan 2026 00:00:00 GMT

Prevalence and determinants of undiagnosed diabetes mellitus among patients presenting for elective surgery at Moi Teaching and Referral Hospital, Eldoret Kenya Kimetto, Joan Background: Diabetes mellitus (DM) is a group of metabolic disorders characterized by chronic hyperglycemia due to defects in insulin secretion, action, or both. The International Diabetes Federation estimates that over 10.5% of adults aged 20–79 years globally have diabetes, with half undiagnosed. In Kenya, the true prevalence is unclear, and the reported 3% likely underestimates the burden. Routine diabetes screening is uncommon, particularly among elective surgical patients. Known risk factors include age, overweight/obesity, physical inactivity, poor diet, family history, and comorbidities such as hypertension and dyslipidaemia. However, local evidence on these determinants remains limited, underscoring the need to assess undiagnosed diabetes among elective surgical patients. Objective: To determine the prevalence of undiagnosed DM and describe the social, demographic, economic, lifestyle and clinical factors associated with undiagnosed DM among patients presenting for elective surgery at Moi Teaching and Referral Hospital (MTRH). Methods: This was a descriptive cross-sectional study conducted in four surgical wards of MTRH (Kilimanjaro, Longonot, Rehema, and Sergoit). A total of 540 adult patients (≥18 years) admitted for elective surgery with unknown diabetes status were recruited through consecutive sampling. Data was collected using a structured questionnaire and clinical measurements, including fasting plasma glucose. Undiagnosed diabetes mellitus was defined as fasting plasma glucose ≥7.0 mmol/L with no prior history of diabetes. Ethical approval was obtained from the Institutional Research and Ethics Committee (IREC) of Moi University/MTRH, and permission to undertake the study was granted by hospital management. Written informed consent was obtained from all participants. Data were analyzed using SPSS version 20. Descriptive statistics were used to summarize variables as frequencies and percentages (n, %). Associations were assessed using binary logistic regression, with results presented as odds ratios (OR) and 95% confidence intervals (CI). Statistical significance was set at p<0.05. Results: The prevalence of undiagnosed DM among patients presenting for elective surgery in MTRH was 3.5%. The highest prevalence was found in the age group 36-55 years, with a rate of 6.3%. Single individuals exhibited a significantly higher likelihood of undiagnosed DM (p-value of 0.029). Additionally, business persons and those employed portrayed a higher likelihood of undiagnosed DM with statistically significant associations (p-values of 0.04, 0.01 and 0.02 respectively). Although clinical, lifestyle and dietary factors were found to be associated with the undiagnosed DM, these relationships were not statistically significant. Conclusion: There is a higher proportion of persons with undiagnosed diabetes among those presenting for elective surgery at MTRH compared to the general population. Among those presenting for elective surgery, the middle-aged, and employed are at a higher risk of undiagnosed diabetes. Recommendations: Routine screening is recommended in all adults undergoing elective surgery at the Moi Teaching and Referral Hospital and similar healthcare facilities to enable early detection and appropriate management of undiagnosed diabetes. The Ministry of Health Kenya should incorporate opportunistic diabetes screening into national guidelines and strengthen implementation across hospital settings

Factors associated with the uptake of assisted partner notification services among newly diagnosed HIV-positive adults on care in Ndhiwa Sub-County; Homa Bay County, Kenya

Wed, 01 Jan 2025 00:00:00 GMT

Factors associated with the uptake of assisted partner notification services among newly diagnosed HIV-positive adults on care in Ndhiwa Sub-County; Homa Bay County, Kenya Masila, Hellen Mulalya Background: With over 38 million people living with HIV worldwide, the virus continues to be a serious public health challenge. Kenya and other countries continue to carry the greatest burden of HIV, with almost 67% of incidences. Homa Bay County has an HIV prevalence of 19.6% and recorded 5,643 new HIV infections in 2022. Ndhiwa sub-County reported 892 new cases, the highest among all sub-counties in the county. Objectives: To determine what percentage of newly diagnosed HIV-positive people receiving treatment informed their sexual partners through assisted partner notification services (aPNS), determine the preferred method of referral and describe the factors that influence the uptake of aPNS. Methods: A cross-sectional study was conducted among newly diagnosed HIV clients enrolled in HIV care and treatment services in Ndhiwa Sub-County. Using systematic sampling, a total of 254 participants were selected from the sampled health facilities. Data was collected through semi-structured questionnaires. The analysis of continuous variables was done using measures of central tendency and dispersion, whereas categorical variables were presented using frequencies and percentages. Associations between independent variables and the uptake of aPNS were assessed using crude odds ratios (cOR) with 95% confidence intervals (CI). Variables with a p- value <0.05 were considered statistically significant Results: Of the 254 participants in the study, 63.4% were female. The proportion of index clients who disclosed their HIV status to their sexual partners was 78.7%. The provider referral method was preferred by the majority of the study participants, accounting for 43.7%. Uptake of aPNS was independently associated with the testing location of the index client (aOR=3.8; 95% CI: 1.46-9.83, p-value=0.006), knowledge of the HIV status of their sexual partner(s) (aOR =5.2; 95% CI: 2.09–11.43; p-value= 0.002) and absence of intimate partner violence (aOR=15.0; 95% CI: 4.92-45.80, p- value <0.001). Conclusion: There was a high uptake of aPNS among newly diagnosed HIV-positive clients. The provider referral was the most preferred method. Testing location, knowledge of partner’s HIV status, and absence of intimate partner violence increased the uptake od aPNS. Recommendation: Provider referral should be promoted as the preferred option among index clients. The HIV care settings should incorporate routine IPV screening, counseling, and support services to ensure client safety and facilitate safe disclosure. Longitudinal studies should be recommended to monitor trends in aPNS uptake and associated factors over time.

Contextual challenges of implementing adolescent and youth-friendly health services in Uasin Gishu county Kenya: a qualitative analysis

Wed, 08 Jul 2026 00:00:00 GMT

Contextual challenges of implementing adolescent and youth-friendly health services in Uasin Gishu county Kenya: a qualitative analysis Embleton, Lonnie; Ashimosi, Celestine; Kirwa, Sheila; Boal, Ava; Chory, Ashley; Kodituwakku, Thiyasha; Johanek, Camila; A. Ott, Mary; C. Vreeman, Rachel; Marete, Irene Objectives: Substantial gaps in the implementation of adolescent and youth-friendly health services (AYFHS) have been identified in Uasin Gishu (UG) county, Kenya, across all eight domains of the WHO global standards, particularly with respect to adolescent health literacy, community sup- port, provider competencies, and equity and non-discrimi- nation. To respond, we undertook a qualitative analysis to explore contextual challenges of implementing AYFHS from the perspectives of adolescents and young adults (AYA) aged 10-24 years, policymakers, caregivers of AYA, healthcare providers, peer mentors, and community leaders. Methods: We used a hybrid inductive/deductive thematic analysis to explore contextual and systems-level de- terminants of implementing AYFHS in UG county, Kenya. Results: Our analysis generated four major themes: 1) pri- orities of political leadership and health systems manage- ment; 2) financial challenges; 3) human resources andfacility infrastructure; and 4) social-cultural barriers. Par- ticipants perceived political will, leadership, and health systems management to be obstacles to implementing AYFHS. Further, participants stated that financial challenges were a leading barrier to the implementation of AYFHS in the county, and that dispersion of funds from the county government to facilities was inadequate. Intersecting with the political-economic context, participants discussed limited human resources, poor facility infrastructure, and supply issues as determinants of implementation. Lastly, social-cultural norms in association with sexual and repro- ductive health discussed as a substantial issue. Conclusions: Addressing implementation determinants of AYFHS, including political, economic, and social-cultural barriers, can enable adoption and facilitate implementation and scale of AYFHS that are a fundamental component of living healthy and productive lives for AYA in Kenya.