Health systems' capacity in availability of human resource for health towards implementation of Universal Health Coverage in Kenya

INTRODUCTION

Kenya faces significant challenges related to health worker shortages, low retention rates, and the equitable distribution of Human Resource for Health (HRH). The Ministry of Health (MOH) in Kenya has established HRH norms and standards that define the minimum requirements for healthcare providers and infrastructure at various levels of the health system. The study assessed on the progress of Universal Health Coverage (UHC) piloting on Human Resource for Health in the country.

METHODS

The study utilized a Convergent-Parallel-Mixed-Methods design, incorporating both quantitative and qualitative approaches. The study sampled diverse population groups and randomly selected health facilities. Four UHC pilot counties are paired with two non-UHC pilot counties, one neighboring county and the second county with a geographically distant and does not share a border with any UHC pilot counties. Stratification based on ownership and level was performed, and the required number of facilities per stratum was determined using the square root allocation method. Data on the availability of human resources for health was collected using a customized Kenya Service Availability and Readiness Assessment Mapping (SARAM) tool facilitated by KoBo ToolKitTM open-source software. Data quality checks and validation were conducted, and the HRH general service availability index was measured on availability of Nurses, Clinician, Nutritionist, Laboratory technologist and Pharmacist which is a minimum requirement across all levels of health facilities. Statistical analyses were performed using IBM SPSS version 27 and comparisons between UHC pilot counties and non-UHC counties where significance threshold was established at p < 0.05. Qualitative data collected using focus group discussions and in-depth interview guides. Ethical approval and research permits were obtained, and written informed consent was obtained from all participants.

RESULTS

The study assessed 746 health facilities with a response rate of 94.3%. Public health facilities accounted for 75% of the sample. The overall healthcare professional availability index score was 17.2%. There was no significant difference in health workers' availability between UHC pilot counties and non-UHC pilot counties at P = 0.834. Public health facilities had a lower index score of 14.7% compared to non-public facilities at 27.0%. Rural areas had the highest staffing shortages, with only 11.1% meeting staffing norms, compared to 31.8% in urban areas and 30.4% in peri-urban areas. Availability of health workers increased with the advancement of The Kenya Essential Package for Health (KEPH Level), with all Level 2 facilities across counties failing to meet MOH staffing norms (0.0%) except Taita Taveta at 8.3%. Among specific cadres, nursing had the highest availability index at 93.2%, followed by clinical officers at 52.3% and laboratory professionals at 55.2%. The least available professions were nutritionists at 21.6% and pharmacist personnel at 33.0%. This result is corroborated by qualitative verbatim.

CONCLUSION

The study findings highlight crucial challenges in healthcare professional availability and distribution in Kenya. The UHC pilot program has not effectively enhanced healthcare facilities to meet the standards for staffing, calling for additional interventions. Rural areas face a pronounced shortage of healthcare workers, necessitating efforts to attract and retain professionals in these regions. Public facilities have lower availability compared to private facilities, raising concerns about accessibility and quality of care provided. Primary healthcare facilities have lower availability than secondary facilities, emphasizing the need to address shortages at the community level. Disparities in the availability of different healthcare cadres must be addressed to meet diverse healthcare needs. Overall, comprehensive interventions are urgently needed to improve access to quality healthcare services and address workforce challenges.

Association between sociodemographic characteristics and knowledge and practice of COVID-19 measures among households in Mombasa and Kilifi County, Kenya

BACKGROUND

Coronavirus disease 2019 (COVID-19), declared a global pandemic by the World Health Organization (WHO), is a severe acute respiratory disease. The Kenyan Ministry of Health (MoH) put in place measures that included mandatory face masking, hand and cough hygiene and social and physical distancing to reduce disease transmission and increase prevention efforts. The primary objective of this study was to determine how sociodemographic characteristics affect knowledge and practice of the above measures.

METHODS

A cross-sectional study was conducted to assess water, sanitation and hygiene practices for the prevention and control of COVID-19 in Kilifi and Mombasa Counties, Kenya. Data collection was accomplished through a mobile data collection tool. Principal component analysis was used to create a wealth index using data on asset ownership and housing characteristics. Bloom cut-off points of 80-100%, 60-79% and ≤59% were used to determine knowledge and practice.

RESULTS

Of the 612 households, 339 (55.4%) were from Kilifi County and 273 (44.6%) were from Mombasa County. A total of 431 (70.4%) were female and the mean age of the household members was 38.2±14.8 y.Almost all (99.2%) respondents were aware of COVID-19, with 60% knowing prevention, symptoms and persons at a higher risk of contracting the virus. Females had the highest knowledge of COVID-19 and were likely to practice prevention and control measures, unlike males. Age was significant (p<0.05) with knowledge and practice.

CONCLUSIONS

The sociodemographic characteristics of populations play a key role in behavioural aspects as far as prevention and control of COVID-19 are concerned. There is a need for partnerships between the MoH and county governments to put in place a multisectoral community approach to advance feasible behavioural interventions among targeted populations towards combating the spread of COVID-19.

Factors associated with tungiasis among school-age children in Kwale County, rural Kenya

BACKGROUND

The parasitic disease tungiasis, caused by the flea Tunga penetrans, remains an important public health problem among children and the elderly. The study assessed the factors influencing prevention and control of tungiasis infection among school-age children in Kwale County, Kenya.

METHODS

A cross-sectional survey was conducted in five villages in Lunga Lunga subcounty among 538 children ages 5-14 y. The study employed a mobile application tool in collecting sociodemographic, knowledge, perception and practice data on prevention and control of tungiasis with frequencies and bivariate and multivariate regression analysis used.

RESULTS

The prevalence of tungiasis was found to be 62.1% (328/528), with fathers' education level, place of residence and wearing shoes being factors associated with infection. Those who wore shoes were less likely to be infected compared with those who did not (odds ratio 0.059 [95% confidence interval 0.29 to 0.12]). Children living in Dzombo B and Kinyungu were less likely to be infected with tungiasis compared with those living in Bandu, holding other factors constant.

CONCLUSION

Creating awareness of the cause of tungiasis remains of key public importance. Hygiene promotion, including wearing of shoes and the general cleanliness of the environment at the community level, needs to be implemented.

Assessment of water, sanitation and hygiene practices for prevention and control of COVID-19 in Kenya

Background

Safely managed water, sanitation and hygiene (WASH) services are an essential part of preventing and protecting human health during infectious disease outbreaks, including the current coronavirus disease 2019 (COVID-19) pandemic. Additionally, adherence to COVID-19 measures, including washing hands using soap and proper waste disposal, no doubt can improve containment of the virus.

Methods

A cross-sectional survey was conducted in Kilifi and Mombasa Counties in Kenya. A total of 612 quantitative data were collected using a mobile data collection tool Open Data Kit. Parametric and non-parametric tests were used to examine factors associated with WASH practices and control of COVID-19 in Kenya.

Results

More than half of the respondents were from Kilifi, 431 (70.4%) were female and the mean age was 38.2±14.8 y. Households in Kilifi were most likely not to have enough water, while Mombasa households were more likely to pay for water. Sanitation coverage was 47.6%, with more than half sharing sanitation facilities. Sharing of latrines was significantly associated with county and income level. Accessing soap was worse compared with the month prior to the survey, only 3.9% had their garbage collected by formal service providers and only 17% reported wearing any protective gear while handling waste at home.

Conclusions

Water is disproportionately available in the two counties, with low sanitation coverage. There is low knowledge on hand washing and inadequate waste disposal services.

Environmental factors influencing Prevention and Control of Schistosomiasis Infection in Mwea, Kirinyaga County Kenya: A cross sectional study

Background

Schistosomiasis remains a major public health problem in Kenya. Environmental factors are critical in creating a medium for growth and spread of schistosomiasis vectors. The study investigated the environmental factors influencing prevention and control of schistosomiasis infection in Mwea West Sub County, Kirinyaga County-Kenya.

Methods

A multi stage sampling was used to identify four hundred and sixty-five (465) household. Analytical descriptive cross-sectional design that utilised quantitative data collection method was used. Data was collected using a pretested structured questionnaire and analysed using Chi square tests or Fisher's exact tests where applicable.

Results

Study results indicated a significant association p<.001 between household level of education, members being affected by floods during the rainy season and schistosomiasis infection. The result further indicates level of significance (p<0.047) in the association between sources of water in a household and schistosomiasis infection. No level of significance was posted between having a temporary water body in the area p (=.072) and schistosomiasis infection. In addition, there was no significant association between proximity to the nearest water source, p=.074 and proximity to the nearest health facility p=0.356 with schistosomiasis infection.

Conclusions

The study recommends carefully designing safe water sources in order to match the goal of effectively controlling and reversing the trends of schistosomiasis infections. The community should be made aware of the risk factors of schistosomiasis including water utilised in the household's alongside raising health seeking behaviours for diagnosis and treatment of schistosomiasis as a way of reducing the spread of infection.

Environmental factors influencing Prevention and Control of Schistosomiasis Infection in Mwea, Kirinyaga County Kenya: A cross sectional study

Background

Schistosomiasis remains a major public health problem in Kenya. Environmental factors are critical in creating a medium for growth and spread of schistosomiasis vectors. The study investigated the environmental factors influencing prevention and control of schistosomiasis infection in Mwea West Sub County, Kirinyaga County-Kenya.

Methods

A multi stage sampling was used to identify four hundred and sixty-five (465) household. Analytical descriptive cross-sectional design that utilised quantitative data collection method was used. Data was collected using a pretested structured questionnaire and analysed using Chi square tests or Fisher's exact tests where applicable.

Results

Study results indicated a significant association p<.001 between household level of education, members being affected by floods during the rainy season and schistosomiasis infection. The result further indicates level of significance (p<0.047) in the association between sources of water in a household and schistosomiasis infection. No level of significance was posted between having a temporary water body in the area p (=.072) and schistosomiasis infection. In addition, there was no significant association between proximity to the nearest water source, p=.074 and proximity to the nearest health facility p=0.356 with schistosomiasis infection.

Conclusions

The study recommends carefully designing safe water sources in order to match the goal of effectively controlling and reversing the trends of schistosomiasis infections. The community should be made aware of the risk factors of schistosomiasis including water utilised in the household's alongside raising health seeking behaviours for diagnosis and treatment of schistosomiasis as a way of reducing the spread of infection.

Diagnostic Accuracy of Unattended Automated Office Blood Pressure Measurement in Screening for Hypertension in Kenya

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Despite increasing adoption of unattended automated office blood pressure (uAOBP) measurement for determining clinic blood pressure (BP), its diagnostic performance in screening for hypertension in low-income settings has not been determined. We determined the validity of uAOBP in screening for hypertension, using 24-hour ambulatory BP monitoring as the reference standard. We studied a random population sample of 982 Kenyan adults; mean age, 42 years; 60% women; 2% with diabetes mellitus; none taking antihypertensive medications. We calculated sensitivity using 3 different screen positivity cutoffs (≥130/80, ≥135/85, and ≥140/90 mm Hg) and other measures of validity/agreement. Mean 24-hour ambulatory BP monitoring systolic BP was similar to mean uAOBP systolic BP (mean difference, 0.6 mm Hg; 95% CI, −0.6 to 1.9), but the 95% limits of agreement were wide (−39 to 40 mm Hg). Overall discriminatory accuracy of uAOBP was the same (area under receiver operating characteristic curves, 0.66–0.68; 95% CI range, 0.64–0.71) irrespective of uAOBP cutoffs used. Sensitivity of uAOBP displayed an inverse association (P<0.001) with the cutoff selected, progressively decreasing from 67% (95% CI, 62–72) when using a cutoff of ≥130/80 mm Hg to 55% (95% CI, 49–60) at ≥135/85 mm Hg to 44% (95% CI, 39–49) at ≥140/90 mm Hg. Diagnostic performance was significantly better (P<0.001) in overweight and obese individuals (body mass index, >25 kg/m²). No differences in results were present in other subanalyses. uAOBP misclassifies significant proportions of individuals undergoing screening for hypertension in Kenya. Additional studies on how to improve screening strategies in this setting are needed.

Knowledge, attitude and practices in relation to prevention and control of schistosomiasis infection in Mwea Kirinyaga county, Kenya

Background

Schistosomiasis remains a major public health problem in Kenya. Inadequate knowledge, attitudes and practices (KAP) on causative factors are some of the critical factors for the increased prevalence. The study assessed KAP on the control and prevention of schistosomiasis infection in Mwea division, Kirinyaga County-Kenya. Four hundred and sixty five house-hold heads were enrolled in this study by use of simple random sampling technique.

Methods

The study employed an analytical descriptive cross sectional design utilizing both quantitative and qualitative data collection methods. A pretested structured questionnaire, Focus Group Discusions (FGDs) and Key Informant Interviews (KII) guides were used for data collection. Descriptive statistics and Chi square tests and Fisher’s exact tests were computed where applicable. Data from the FGDs and KIIs were analyzed using NUID.IST NUIRO.6 software.

Results

Significant associations between knowledge and demographic factors i.e. age (p = 0.011), education level (p = 0.046), were reported. Handwashing after visiting the toilet (p = 0.001), having a toilet facility at home (p = 0.014); raring animals at home (p = 0.031), households being affected by floods (p = 0.005) and frequency of visits to the paddies (p = 0.037) had a significant association with respondents practices and schistosomiasis infection. Further significance was reported on households being affected by floods during the rainy season (p < 0.001), sources of water in a household (p < 0.047) and having a temporary water body in the area (p = 0.024) with increase in schistosomiasis infection. Results revealed that respondents practices were not significantly associated with gender (p = 0.060), marital status (p = 0.71), wearing of protective gear (p = 0.142) and working on the paddies (p = 0.144).

Conclusions

This study reveals that knowledge about the cause, transmission, symptoms and prevention of schistosomiasis among the Mwea population was inadequate, and that this could be a challenging obstacle to the elimination of schistosomiasis in these communities. Due to various dominant risk factors, different control strategies should be designed. Therefore, there is a need for integrated control programme to have a lasting impact on transmission of schistosomiasis infection. Control programs like mass drug administration need to go beyond anti-helminthic treatment and that there is a need of a more comprehensive approach including access to clean water, sanitation and hygiene. School and community-based health education is also imperative among these communities to significantly reduce the transmission and morbidity from schistosomiasis.

A comparative study on the reliability of the fluorescence microscopy and Ziehl-Neelsen method in the diagnosis of pulmonary tuberculosis

Pulmonary tuberculosis (PTB) is the most common presentation of tuberculosis (TB) in Kenya. For the diagnosis of PTB the sputum smear is used because it is technically simple, non-invasive and cheap. The reliability of direct smear examination for the diagnosis of TB has however frequently been questioned. To address this problem, a study comparing the reliability of fluorescence microscopy (FM) and Ziehl-Neelsen (ZN) staining method for examination of direct smear in the diagnosis of PTB was carried out at the Respiratory Disease Research Unit Laboratory, Nairobi, Kenya. A total of 1480 sputum specimens collected from patients with suspected PTB were analyzed. Two direct smears were prepared from each specimen, one stained using FM and the other using the ZN method. Culture results were used as the gold standard for assessment. Specificity was 97% and 96% for FM and ZN methods, respectively. The sensitivity of the FM method was 80% and that of the ZN method 65% (p < 0.001). Overall agreement was 86.8%. Positive smears which were missed on the ZN stained smears (15%) contained low density bacilli on both FM stained smears and on culture. The use of FM greatly improves the diagnostic value of the sputum smear especially in patients with a low density of bacilli who are likely to be missed on ZN stained smears. The method is economical in both time and expense and is recommended for laboratories handling large numbers of sputum specimens.