Medical/Surgical Nursing

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The impact of co-morbidity and treatment characteristics on adherence to tuberculosis treatment in Kisumu East Sub County, Kenya
(IOSR: Journal of Nursing and Health Science, 2017-10-01) Senghor, Morris Shisanya; Arudo, John; Oloo, James Aggrey
Despite the great strides made in TB diagnosis and highly effective shorter periods of treatment, there are still poor treatment outcomes in a significant proportion of the patients. Poor adherence to TB treatment is one of the leading causes of poor outcomes of treatment. Kisumu East Sub county in Kenya records some of the highest adverse outcomes of care. Therefore a cross sectional descriptive study was conducted in the Sub county to establish the impact of co-morbidity and treatment characteristics on TB treatment adherence among tuberculosis patients above 18 years attending TB clinics in Kisumu East Sub county. The data was analyzed using SPSS version 21. Descriptive statistics, bivariate analysis and binary logistic regression were used in the analysis and data presented in contingency tables and figures. Significance was assumed at P value ≤0.05. Belief that TB treatment affects other treatments; (OR: 0.03; 95% CI:5. 0-0.1 ;P<0.001), retreatment (OR: 11; 95% CI: 4.2-29.6 ;P<0.001), not completing previous treatments (OR:19; 95% CI:6-73 ;P<0.001) self-discontinuation (OR:0.1; 95% CI: 0.01-1 ;P<0.049) were significant in predicting adherence. These aspects can serve as a guide for flagging some patient as having potential for non-adherence thus appropriate follow-up measures instituted in time. It is important to establish the effects of socio-demographic aspects on adherence in every TB care setting for appropriate follow-up.
Effects of socio-demographic factors on regimen adherence among tuberculosis patients in Kisumu Region, Kenya
(Kenyan Journal of Nursing & Midwifery, 2018-01-01) Senghor, Morris Shisanya
Introduction: Efforts to diagnose TB and patients on treatment have been very successful as per WHO targets for Kenya. However, there are still poor treatment outcomes in a significant number of the patients. These poor treatment outcomes have been significantly linked to poor adherence to TB treatment. Methods: This was a cross sectional descriptive study that was conducted in Kisumu East District to establish the effects of socio-demographic factors on regimen adherence among tuberculosis patients aged above 18 years attending TB clinics in Kisumu region, in Western Kenya. The data was analyzed using descriptive statistics and bivariate analysis and binary logistic regression. P values, Adjusted Odds Ratios with 95% confidence interval (CI) were used to demonstrate significance and strength of association between the socio-demographic factors and adherence. Significance was assumed at P value ≤0.05. Findings: Residence; (OR:21.8; 95% CI:5.4-87.5 ;P<0.001), number of family members(OR:5.7; 95% CI:1.7-19.1 ;P=0.005) and sex of the patient (OR:0.2; 95% CI: 0.0-0.9 ;P<0.036) were the significant socio-demographic aspects that predicted adherence. Conclusion: Therefore some socio-demographic aspects of TB patients key predictors of adherence. These aspects can serve as a guide for flagging some patient as having potential for non-adherence thus appropriate follow-up measures instituted in time. It is important to establish the effects of socio-demographic aspects on adherence in every TB care setting for appropriate follow-up.
Determinants of maternal satisfaction with spinal anaesthesia care for caesarian delivery at the Kisumu County Hospital
(IOSR Journal of Nursing and Health Science, 2017-02-01) Senghor, Morris Shisanya; Morema, Everlyne Nyanchera
Elective and emergency caesarean sections are increasing in the low income countries. Over the last fifteen years or so, spinal anaesthesia has been gradually escalated in Kenyan Hospitals. In Kisumu County Hospital (KCH), the cases of caesarean sections done under spinal anaesthesia have increased tremendously from one in every ten to seven in every ten cases in a span of 7 years. Despite documented safety for the procedure, complications can highly influence the mother’s perception of quality of care. This study was therefore undertaken to evaluate patient satisfaction after spinal anaesthesia for caesarean section. A crosssectional study of patients who underwent caesarean section under spinal anaesthesia in the operating rooms of KCH was conducted. Post-operative survey of patients on the day after surgery was conducted by collecting pre-operative and intra-operative data on a structured questionnaire. Post-operative data, including satisfaction and understanding the anaesthetist’s explanation regarding anaesthesia and satisfaction in receiving spinal anaesthesia were inquired by trained data personnel. A total of 99 pregnant patients, with age ranging from 17 to 40 years, were surveyed: Overall, 85 (85%) of the mothers interviewed were satisfied and 15 (15%) were dissatisfied the anaesthesia care they received. Income range (OR: 23.1; 95% CI: 2.77-192; P<0.001) and marital status (OR: 4.42; 95% CI 1.32-14.9; P<0.011) were significant demographic determinant of satisfaction with maternal satisfaction with anaesthesia care. Neonatal outcomes were also demonstrated to be associated with satisfaction were; neonate’s birth weight (OR: 3.29; 95% CI: 1.01-10.71; P:0.04) and APGAR score at 10 minutes (OR:4.74; 95% CI: 1.24-18.03; P:0.02). In comparison to studies elsewhere, maternal satisfaction in the surveyed population was low. Structured communication by anaesthesia team, exceptional clinical skill of the anaesthesia practitioners and prevention of side effects might improve patient satisfaction.
Characteristics of injuries among children attending public primary schools in Kisumu Municipality, Kenya.
(Donnish Journal of Nursing and Midwifery, 2015-05-18) Nyangahu, Drusilla N.; Odero, Wilson; Ogonda, Lilian; Senghor, Morris Shisanya; Morema, Everlyne Nyanchera
Injuries remain a major killer of children throughout the world. On average, for children in the age group 5-14 years, injury accounts for more than a quarter (27 %) of all deaths worldwide. In addition to these deaths, many other children sustain injuries that require hospitalization, outpatient treatment and sometimes result in disability. In Kenya, injuries are the third leading cause of mortality after malaria and HIV/AIDS and are the fifth leading cause of morbidity among patients attending health care facilities. Approximately 16.8 % of reported injury cases in Kisumu occur among children less than 15 years of age and accounting for 28.7 % of the total injury admissions. Although children less than 15 years of age fall within the primary school age, not much is known about the nature and factors that contribute to the occurrence of injuries among primary school children in Kisumu and programs focusing on their prevention are lacking. Methods: This was a cross-sectional study that aimed to describe the characteristics of injuries among primary school children in Kisumu Municipality. A random sample of 492 pupils aged 11 to 18 years; from 18 schools was interviewed using a structured questionnaire to collect information on the incidence of injuries during the three month period prior to the interview. Results: The most common cause of these injuries was due to falls on the same level (33.9 %). Majority of these pupils were injured while playing (48.8 %), at home (40.9 %) with cuts or open wounds being the most common injury that was sustained (42.1 %). However, injuries caused by fire / hot fluids were associated with gender (P < 0.002) with 76% of the pupils who reported having sustained these injuries being girls. Furthermore, gender was associated with occurrences of injuries at home (P < 0.001) with 115 out of the 201 (57.2%) children who reported having been injured while at home being girls. Almost half of the pupils sought medical care and a quarter of the pupils were hospitalized. Two-thirds of the pupils (66.5 %) received first aid which was mostly administered by a friend or family. More than half (56.7 %) of the pupils were absent from school due to the injury. Although 95.7 % of the pupils reported being taught about road safety in school, only 24 % of the pupils demonstrated a high level of awareness regarding road safety by being able to give a correct response regarding traffic lights and zebra crossing. The information obtained from this study will shed more light on the extent and characteristics of injuries occurring among primary school children and can be used to develop and implement injury prevention and safety promotion policies in primary schools. Conclusion: These findings suggest that most children in primary schools are affected by injuries sustained while playing at home; and girls are at a higher risk of burn injuries than boys. Moreover, there is a low level of awareness of road safety rules and regulations among the primary school pupils. Interventions such as adequate supervision by caregivers while children are playing and review of teaching strategies for road safety education for schools could aid in the reduction of injuries among the pupils.
Relationship between health care system setup and adherence to tuberculosis treatment in Western Kenya
(Quest Journals : Journal of Medical and Dental Science Research, 2017-02-12) Morema, Everlyne Nyanchera; Senghor, Morris Shisanya
Despite the concerted effort to detect and treat TB, there are still poor treatment outcomes in a significant number of the patients. These poor treatment outcomes have been significantly linked to poor adherence to TB treatment. Therefore, a cross sectional descriptive study was conducted in Kisumu East District to establish the relationship between health care system factors and TB treatment adherence among patients aged above 18 years attending TB clinics in Kisumu East District, in Western Kenya. A total sample of 250 respondents was surveyed. An interviewer administered structured questionnaire was used to collect data from the respondents on the social, demographic aspects of the patients and structural aspects of TB care. The data was analyzed using descriptive statistics for socio-demographic variables and bivariate analysis to determine the health care system factors that significantly predicted treatment adherence. P values, Odds Ratios with 95% confidence interval (CI) were used to demonstrate significance of association between the health system related predictors and adherence. Significance was assumed at P value ≤0.05. Behaviour of the health care workers (OR: 3.6; 95% CI1.1-12.1; P=0.031) and waiting time (OR: 7; 95%CI: 3-18; P<0.001) were the significant determinants of adherence related to health care set up. Health care system setup has a number of immediate modifiable predictors of adherence like waiting time and staff behaviour. It is important to establish the key predictors of adherence that are linked to health care system for quality TB treatment and care services in every TB care setting.
Women’s persistent utilisation of unskilled birth attendants in Kakamega County, Kenya
(AJOL, 2016-01-01) Namusonge, Lucy; Kabue, P.N.; Sharma, R.R.
Background: Minority of births in sub-Saharan Africa are conducted by skilled birth attendants. Having the highest world maternal mortality ratios and most deaths being associated with lack of trained supervision at delivery. Changing delivery practices is a major priority in this region. Objective: To determine the factors that contribute to persistent utilisation of unskilled birth attendance by women in Kakamega County. Design: A descriptive cross-sectional study . Setting: Kakamega County, Kenya Subjects: Post-natal mothers with children aged less than six months who delivered without skilled attendance. Results: Antenatal attendance rate of 92.7% while proportion of skilled birth attendance was at 48.6%. The following factors were found to influence utilisation of UBAs in the Study area: age (X2=8.65, df=3, P= 0.013), occupation (X2=10.04, df=3, P=0.006), religion (X2=19.73, df=5, P=0.0001), monthly income (X2=7.59, df=2, P=0.002), marital status (X2=10.10424, df=2, P=0.005) and education level (X2=9.472, df=4, P=0.002). Negative attitude of healthcare providers, socio-cultural practices and insecurity also enhanced utilisation of unskilled birth attendance. Conclusion: Birth preparedness should be advocated for every pregnant woman and health facilities to address the discrepancy between antenatal attendance and delivery by skilled birth attendance. We hope that the information generated from this study will be used by the policy makers leading to appropriate interventions or strategies which will reduce the number of home deliveries and maternal deaths.
A study of common causes of mortality among Fishermen in Lake Victoria, Kenya
(KEMRI : AJHS, 2014-01-01) Opemo, Damian Otieno; ALoo, Peninah A.; Arudo, John A.; Mbithi, John N.
The fishing industry in Kenya plays an integral role in the socio-economic development of Kenya. However, the working environment of fishermen is characterized by a wide variety of occupational hazards and mortality attributed to work related diseases or accidents and injuries, which, are poorly reported. Most of the reported cases are in the formal sector, while the informal sector such as fishing, where most people are employed, are largely ignored. The objective of this study was to determine the causes of mortality and identify factors that influence mortality among fishermen in Lake Victoria. A two-year retrospective mortality survey using verbal autopsy was carried out among fishermen in eight riparian districts of Lake Victoria in Kenya. The study successfully followed up a total of 3058 deceased fishermen. The mean age at death was 33 years (SD: ± 9.5) and a median of 32 years ranging between 15 – 54 years. Peak mortality reported among fishermen aged 25 - 29 years (19.8%) and 30 – 34 years (19.3%) was comparable. The findings revealed that the major causes of death were HIV – related infections (33.8%) followed by drowning (14.3%), pulmonary tuberculosis (12.4%), and malaria (10.4%). Results of this study show that there is an urgent need to identify strategies that would prevent HIV – related infections and drowning among the fishing community.
Early mobilization and physical activity improve stroke recovery: a cohort study of stroke inpatients in Kisumu County referral hospitals, Kenya
(Science and education publishing ; AJPHR, 2016-01-01) Ogolla, Maurice M.; Opemo, Damian Otieno; Asweto, collins otieno
Early mobilization in acute stroke care is highly recommended in a range of developed countries policy; however, in developing countries like Kenya, lack of evidence seems to hinder formulation and implementation of policy guideline on early mobilization in acute stroke care. Therefore, to estimate the safe optimal time for early mobilization of stroke patients in Kenya, we conducted a prospective cohort study in two purposively selected health facilities in Kisumu County, Kenya. About 100 stroke patients admitted in medical wards (mean age 59.1±2.3 years, females 61%) were recruited. Barthel Index’ tool was used to assess recovery and physical activity levels. It comprised of scoring scale ranging from 0-100. The participants were categorized as follows: Patients who score between 0 – 30 were considered as mildly recovered, 31 - 60 as moderately recovered and patients who score from 61 – 100 were regarded as fully recovered. Multiple logistic regression model was used to compute adjusted ORs (AOR) of early mobilization and Barthel Index variable, adjusting for age, gender and type of stroke. Early mobilization improves patient recovery. Participants in early mobilization group were more like to independently feed, groom, dress, use toilet, use wheel chair and climb stairs with help compared to late mobilization (p <0.05). Most (76%) participants who were exposed to high physical activity had full recovery than the (5%) bones in low physical activity (p< 0.001). This study provides evidence that early mobilization and high physical activity improves stroke patient recovery.
Logistic regression analysis of mortality among fishermen in the riperian counties of Lake Victoria, Kenya
(Science Publishing Group, 2019-01-21) Opemo, Damian Otieno; shem, Godfrey Juma

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