Focus Group Discussion Guides Research Articles

Knowledge, attitude and practices around breast cancer and screening services among women of reproductive age in Turbo sub-county, Kenya

BackgroundOnly 12% of Kenyan women use breast cancer (BC)screening programs. Early identification is critical for reducing the condition's associated morbidity and mortality. Unfortunately, few studies have been conducted on the screening program's implementation and the causes for the low usage rates in Turbo Sub-County, Kenya. The purpose of this study was to learn about women of reproductive age's (WRA) practices, attitudes, and knowledge regarding BC screening programs, as well as to investigate the potential association between lifestyle factors and BC screening service utilization. MethodsMixed-method approaches were used in an analytical cross-sectional study design. The study included 317 participants selected randomly. An interviewer-administered questionnaire was used to collect quantitative data while focus group discussion (FGD) and key informant interview (KII) guides were used for collecting qualitative data. The Statistical Package for Social Sciences (SPSS) version 26 was used to manage quantitative data, whereas NVivo version 12 was used to analyze qualitative data. Chi-square, Fisher's exact test, and multiple logistic regression were used to assess the degree of relationship between BC screening service uptake and independent variables. The qualitative data was transcribed verbatim, and the transcripts were automatically coded to generate themes. ResultsThe participants' mean age was 30.14 (9.64). Breast cancer screening services were used by 10.21% of the population. Women who were aware of the signs and symptoms of BC were 71.5 times more likely to undergo screening than their counterparts. Similarly, those with positive attitudes toward BC and screening programs were 84 times more likely to get screened than those with negative attitudes. Breastfeeding increased the likelihood of BC screening by OR = 37 (95% CI: 0.00–0.32), physical activity by OR = 37 (95% CI: 0.00–0.25), and chronic illnesses by OR = 37 (95% CI: 0.00–0.17). ConclusionKnowledge of signs and symptoms of BC and a positive attitude towards perceived barriers enhanced the probabilities of BC screening. Being physically active, breastfeeding, and having a chronic disease all increased the odds of BC screening uptake. To improve screening rates, it is necessary to provide sufficient information to those who are least likely to be screened.

Health System-Related Factors that Influence Retention in Care among HIV Infected Pregnant Women in Narok County, Kenya

Purpose: The aim of the study was to establish the health system-related factors that influence retention in care among HIV infected pregnant women in Narok County, Kenya. Methodology: The study adopted a cross-sectional mixed method design. Purposive sampling method was used to sample the required sample size of 117 HIV infected pregnant women, the participants of the Focus Group Discussions (FGD) and Key Informant Interviews (KII). The study was carried out at Narok County Referral and all the sub-county hospitals in Narok County. A structured questionnaire was used to collect quantitative data. Focus group discussion and KII guides were used to collect qualitative data. Quantitative and qualitative data was analyzed using SPSS version 21 and Nvivo version 14 respectively. Chi square test and logistic regression analysis were used to determine the health system-related factors that influence retention in HIV care. Thematic content analysis was done for qualitative data. The mean age of participants was 30 years (SD=6.48). The study results generated were presented in bar graphs and tables for quantitative data. Results were presented as narrations and triangulated with qualitative data. Findings: This study established that health system-related factors (waiting time, health care workers services and ARV availability) influenced retention in care among HIV infected pregnant women. However, only ARV availability had a significant association with retention in care (P<0.001, OR=0.19). The multiple logistic regression was used to predict the influence of grouped variables. Overall, the model was a significant predictor of retention in care. Health system related factors was found to increase the likelihood of being retained in care (OR=5.14), though not significant predictors of retention in care (P<0.34). Unique Contribution to Theory, Practice and Policy: Health system-related factors particularly ARV drug stocks, healthcare workers staffing and timely access of services should be strengthened in order to avert stock outs, minimize waiting time and follow up patients who miss clinic appointments to increase retention among pregnant women in HIV care. Advocate for policy reforms aimed at addressing structural barriers to retention in care, including increased investment in healthcare infrastructure, workforce capacity building, and integration of HIV services within maternal and child health programs. By aligning policy initiatives with the unique needs of HIV-infected pregnant women, policymakers can foster an enabling environment for retention in care, ultimately contributing to the achievement of national and global HIV/AIDS targets.

Collaboration or Contravention? Ramifications For Effective Participatory Decision-Making in Collaborative Forest Management at Echuya Central Forest Reserve, South Western Uganda

Participatory decision-making has been extensively adopted worldwide as an essential mechanism and a good governance principle to reach a consensus in natural resource management. However, in most communities, local people who depend on forests are not involved in the decision-making process regarding conserving protected areas. This research assesses the ramifications of collaboration or contravention on effective participatory decision-making in collaborative forest management in Echuya Central Forest Reserve. It provides insights into how community consultations and participation of forest-adjacent communities in planning meetings influence the conservation of protected areas. We collected data from a total of 639 respondents, including Collaborative Forest Management (CFM) group members and non-CFM community members, government institutions, conservation organizations, and local community leaders, using semi-structured questionnaires, interview guides, and Focus Group Discussion guides. Results indicate that community consultations allow CFM stakeholders, particularly community members, to give ideas on how such projects can be implemented without destroying forest resources, promoting the goal of conserving the forest reserve. Community members’ participation in planning meetings allows them to contribute ideas about relevant and appropriate forest conservation approaches. However, the National Forestry Authority (NFA) and other non-community actor groups dominate the decision-making process mainly because the NFA has the legal mandate to manage the forest reserve on behalf of the Government. We concluded that the connivance of government forestry officials with unauthorized forest resource users undermines the spirit of participatory decision-making. Dishonesty and lack of accountability hampered effective participatory decision-making, and low attendance at meetings undermines effective participation in decision-making. Thus, community members’ consistent attendance of meetings is paramount for positive outcomes of participatory decision-making for the conservation of forests

Assessing the Influence of Behavioural Factors of Community Health Promoters on Use of Community Based Health Information Systems in Selected Counties, Kenya

Globally, health management information systems (HMIS) in strengthening health systems have gained recognition due to potential of technology to improve access to quality care in underserved communities. In Kenya, the functionality of Community based- Health Management Information System (CBHMIS) currently stands at 55% down from 64% in year 2015. The aim of this paper was to determine the influence of behavioral factors of community units personnel on CBHMIS. As a nested study, with a broader aimt to establish the operational status of CBHMIS and its use in selected counties in Kenya; The main objective of this research was: To establish whether behavioural factors of Community Health Promoters (CHPs) influence CBHMIS use in Kenya. A mixed method design. was adopted, Kiambu, Kajiado and Nairobi counties formed the study location, a target population of 156 active community units was considered to arrive at a total sample of 122 community units and out of 7800CHPs a sample of 366 respondents was drawn. Multistage sampling was used to identify the CUs, and systematic random sampling to identify 366 respondents. Quantitative data tools were semi-structured closed ended questionnaires. Qualitative data tools included observation checklist, Focus Group Discussion and Key Informant Interviews guides. Quantitative data was analyzed using SPSS to generate univariate and bivariate analysis at p<0.05 significance level; Qualitative data was analyzed using content analysis based on key themes generated from the objectives. Results were presented in form of graphs, tables, figures, and narration. This study showed that the use of Community based- Health Management Information System stood at 56.6%. Behavioural factors were found to significantly influence use of Community based- Health Management Information System. Further, of the total variations in the use of Community based- Health Management Information System, behavioral factor explains 13.7% (R<sup>2</sup> = .137). Results show that the model was valid (F<sub>(1, 363)</sub> = 58.579, <I>P </I>= .001) hence the explanatory variable (X<sub>2</sub>, Behavioral factors) is good in explaining total variations in Use of CbHMIS by community units. This implies that the use of CbHMIS by Community Units (CU) improves significantly when the community units have better behavioural factors. In conclusion, behavioural factors of CHPs have strong and significant influence on the CBHMIS use. Motivation of CHPs is key as a motivator to CBHMIS use, as well as. provision of material support including reporting tools and IEC materials and capacity development technical, computer and electronic reporting skills to enhamce CHP operations and processes.

School-Parent Engagement on Stimulation Activities in Pre-Primary Schools in Kira Municipality in Wakiso District, Uganda

Stimulation activities are events that parents and other caregivers give to the children to support their cognitive, emotional, and physical needs right from birth onwards. For instance, playing and talking with them (even before children can respond verbally), and exposing them to words, numbers, and simple concepts while engaging in daily routines. Whereas School-parent engagement is where schools tend to create partnerships between themselves and the parents so that they are able to work together, most especially pertaining to their children’s education and holistic development. Schools can work with parents in making decisions, setting goals and attaining academic outcomes. This contributes to the enhancement of children’s holistic growth and development. This research study, therefore, aimed at examining school-parent engagement in Pre-primary schools in Kira Municipality, Wakiso District, Uganda which has remained a gap for long. The study used a descriptive cross-sectional survey design. Data was collected using both quantitative and qualitative instruments. These included; Focus group discussion guides, document analysis guide, observation checklist, and questionnaires. The respondents included; headteachers, Centre Management Committee (CMC) chairpersons, parents, and teachers. The findings of this study show that parents were not closely working with the school to stimulate children’s learning. Schools reported significantly lower levels of parents came in to check on their children’s books or to submit homework, or drop and pick a child from school. Parents were majorly coming in for meetings and any event that had been organised by the school or to pay fees dues. Three major recommendations regarding parent engagement in stimulation activities were given. These included; ensuring that parents understand what stimulation activities mean, the materials to use and their role in supporting their children’s learning. Then, it also suggested the best approach to ensure that stimulation activities are provided to the children both at Pre-primary school and at home for continuity of learning. The paper concludes by suggesting recommendations on the need for school-parent engagement to ensure that effective stimulation activities are provided at the Pre-primary schools. Thus, enabling children to receive integrated stimulation opportunities that are contextualised

Government and Program Implementation Bodies Policies on Performance of Women Empowerment Projects in Dagoretti Area, Nairobi County, Kenya

Purpose: Women’s social, political and economic empowerment is a prerequisite for sustainable development and pro poor growth. Achieving women’s economic empowerment requires sound public policies, a holistic approach and long-term commitment and gender-specific perspectives must be integrated at the design stage of policy and programming. Accordingly, this study was designed to investigate the influence of government and program implementation bodies’ policies on the performance of women’s empowerment projects in Dagoretti area, Nairobi County, Kenya. To achieve this, the following specific objectives were utilized; to examine distribution of resources policies on the performance of women empowerment projects in Dagoretti area, Nairobi County, Nairobi, to assess decision making policies on the performance of women empowerment projects in Dagoretti area, Nairobi County, Nairobi, to assess monitoring and evaluation policies on the performance of women empowerment projects in Dagoretti area, Nairobi County, to examine leadership and coordination policies on the performance of women empowerment projects in Dagoretti area, Nairobi County.
 Methodology: The research design that was adopted was descriptive research design. The study involved interviewing of key actors involved in women’s empowerment programs (particularly in the community based organizations (CBOS). The target population comprised of 33 women groups in Dagoretti Area, 4 county officials and 20 Chair persons of Program Implementing Bodies. The sample drawn from the target population was based on the basis of 30% of 33 that resulted to a selection of 10 women groups that were randomly selected. 3 officials from the county office dealing with Youths and women affairs and 7 officials from implementing bodies were purposively selected. The scope of study was Dagoretti Area, Nairobi County. Data was collected through a semi-structured questionnaire which was administered to the county official. Focus group discussion guides were carried out on women who were selected randomly during their meetings. Data collected was analyzed qualitatively and quantitatively through the help of SPSS computer software and presented through themes percentages, frequencies, tables and bar graphs.

Structural normative of consumer textile technologies entrepreneurship and the sustainability in Southwest Rural Areas of Nigeria

The study examined the sustainability of consumer textile technology entrepreneurship amidst its structural normative in southwest rural area of Nigeria. It explicitly analyzed entrepreneurial cultural traits and economics agility needs related variables of the entrepreneurship influences on sustainability. The study was conducted in the rural southwestern region of Nigeria. Four states (Lagos, Ondo, Oyo, and Ogun) were randomly selected from the region. Multi-stage and stratified sampling techniques were used in selecting 1,649 consumer textile entrepreneurs across the states. Questionnaire, key informants and focus group discussion (FGD) guides were employed in data collection. While descriptive statistics were used in describing the data, correlation analysis was applied in establishing direction of influence between sustainability and structural normative of consumer textile technologies entrepreneurship Sustainability level of the entrepreneurship in southwest rural area of Nigeria was average. Respondents were independent entrepreneurs of favorable attitude towards the enterprise. While 52.7 percent were averagely proactive, 58.8 percent were averagely risk-averse with exhibition of low creativities skill on the entrepreneurship. The entrepreneurs possessed average knowledge of competitive advantage and networking strategies needs on the job but skills practices was poor. While 33.0 percent exhibits fairly good managerial skill on the job, 20.8 percent displayed high, and 46.2 percent was low. CTT entrepreneurial traits needs related variables {proactive aptitude (r = 0.620), autonomy value (r = 0.591), fatalism (r = -0.317), marketing system (r=0.574), disposition (r= 0.409), risk averse (r= -0.344), and economic agility needs {(competitive strategic skill (r = 0.318), networking (r = 0.501), labor accessibility (r = 0.321)} showed significant relationship with sustainability. It was established that respondent’s proficient in CTTE entrepreneurial traits related variables and economic agility were paramount in the sustainability, nevertheless there is need to establish related schools or vocational training centers for skill acquisitions and updating on the entrepreneurship in the studied area. Change agents and other related organizations that were involve in technology transfer and rural development should create awareness program on potential values and benefits of the entrepreneurship mostly in turning wastes to wealth. This would enhance enlightenment for building better positive attitudes toward CTTE. The environment must be made livable through job creation and accessible infrastructure to prevent migration and attracts youth’s influxes into the community. This would also enhance labour availability and patronage. Standard cluster market should be established in the vicinity to enhance expertise and inputs supply.

Evaluation of Strategic Options for Enhancing Community Resilience to Drought in Kitui County, Kenya

In Kenya, Arid and semi-arid Lands are more affected by drought due to their fragile ecosystems, unfavourable climate, and historical marginalization. Kitui County is one of the counties that have been hit hard by protracted droughts over the past decades. This study aimed at addressing the increasing global, regional, and national attention on building community resilience to disasters. The overall objective of the study was to evaluate the strategic options for enhancing community resilience to drought in Kitui County. The study was conducted in Mwingi North and Mwingi West Sub-Counties which were selected using purposive sampling technique. The study utilized data collected from 385 households sampled using simple random sampling technique. Descriptive, correlation, and evaluation research designs were employed. Data was collected using structured questionnaires; focus group discussion guides; key informant interview guides and observation checklists and analysed using statistical package for social scientists (SPSS) software Version 28, STATA Version 15 and MS Excel. The results based on Spearman’s weighting revealed support for more sustainable water sources had the highest rank 34.4%; followed by increased access to credit facilities 15.1%; livestock/crop insurance schemes 11.9% and support for food storage facilities 11% among others. R =0.534 and R2 = 0.286 revealed that the contribution of strategic options to community resilience to drought was significant. The study recommends use of both ex-ante and ex post strategies to enhance community resilience to drought. These findings will be beneficial in guiding the policy makers in improving strategies for enhancing community resilience to drought.

An introduction to qualitative research for resident doctors

Qualitative research involves systematically collecting, organising, and interpreting textual or other non-numeric data to better understand experiences and context, convey different perspectives on a complex issue, explore new concepts, and understand attitudes and perceptions of phenomena of interest. Qualitative research is also used to identify ‘intangible’ factors, such as social norms, gender roles, ethnicity, religion, and religiosity/spirituality. Unlike quantitative methods that ask the questions ‘how many’ or ‘how much’, qualitative methods focus on the ‘what’, ‘how’ or ‘why’ of a phenomenon. Resident doctors across disciplines can use qualitative research methods but often lack the skills and training to use these methods in their research work. Qualitative and quantitative methods can complement each other through mixed methods approaches. This mixed methods approach to research may be useful across medical and surgical disciplines when one data source is insufficient, thus a second data source can enhance or complement the first. Combining multiple data sources allows researchers to triangulate the information they obtain. Qualitative research most often entails conducting interviews (in-depth interviews, key informant interviews), focus group discussions or observations (participant, non-participant). Tools used to obtain qualitative data include in-depth interview or focus group discussion guides; case studies and vignettes may be introduced into such data collection endeavours. Qualitative data in the form of transcripts and field notes is obtained by using these tools. Observation checklists and diaries (e.g. time use, food diaries) may also be used to collect qualitative data. Qualitative data analysis is often thematic, done either manually or using Computer Assisted Qualitative Data Analysis Software. In reporting the findings of qualitative research, illustrative quotes are usually employed. Qualitative research can be subjective and full of nuance, thus the need to assess its quality using criteria such as credibility, member checking and reflexivity. Ethical considerations, especially confidentiality is primarily important because of the relatively small sample sizes and the need to ensure participants’ responses are not traceable to them.

Influence Of Principals’ Leadership Practices on Collaborative School Culture in Public Secondary Schools in Tiaty East and Tiaty West Sub-Counties, Kenya.

An ideal collaborative school culture in the two sub-counties should entail teacher’s collaboration, teacher’s involvements in decision-making practices, effective open communication and high teacher motivation. The current situation in Tiaty East and Tiaty West sub counties is that the area is plagued by poverty and frequent banditry, this has made the school environment in the areas to be hostile and the safety of both the learner and the teacher is not assured. A hostile school culture of collaboration can cause the problem of poor performance to persist since there are no harmonious relations among teachers, and teachers work in isolation. As a result, the principals’ task is to create an enabling school climate towards the creation of a collaborative culture of the school. The purpose of this study was to find out influence of school principals’ leadership practices on collaborative school culture in public secondary schools in Tiaty East and Tiaty west sub-counties. The objectives of this study were : to determine influence of principals’ mentorship practices on collaborative school culture and to establish how principals’ communication practices influence collaborative school culture. The research approach was the qualitative research and a cross-cultural study design with two cases and multiple units of analysis within each case. This study was grounded on the perspective that valuable insights about the issue of principal leadership practices and collaborative school culture can be obtained from a target population of 77 comprising of principals (1), teachers (156), support staff (276) and student leaders (328). A sample of 161 respondents; 1 principals, 31 teachers, 56 support staff and 64 student leaders was selected using purposeful sampling. The main instrument for primary data collection was use of interview schedules for principals, teachers and support staff and focus group discussion guides for student leaders. Data analysis was done using Computer Assisted Qualitative Data Analysis Software (CAQDA); ATLAS. Ti 9. The study found that the principals invited mentors for staff development to improve collaboration, ultimately positively impacting on student outcomes to promote a collaborative secondary school culture. Moreover, on principals communication practices, school meetings and social media especially Whatsapp groups are used to engage the school community in communication.The study concluded that principal's mentorship practices, and principal's communication practices are integral and symbiotic in creating a positive and collaborative school culture. On building positive collaborativecultures, the study is beneficial to future researchers in the field as they can expound more on other principals’ leadership practices and it will also contribute to existing research data. The study recommended that principals should involve teachers and other stakeholders in mentorship process in the schools. Key words: Collaboration, decision-making, motivation, mentorship, communication.

The Significance of Primary Social Studies Content Organization in Fostering Knowledge, Skills, and Values for Cohesion and Integration in Kenya

The field of Social Studies (SS) plays a crucial role in nurturing students' knowledge, intellectual abilities, and democratic disposition, all of which are essential for active engagement in society. The SS curriculum is designed to address the demands, challenges, and aspirations of society, aiding students in developing appropriate and virtuous values. This study aimed to explore the structure of primary Social Studies content and assess its potential for cultivating the knowledge, skills, and values necessary to promote national cohesion and integration. It adopted a descriptive survey design, employing stratified and random sampling methods to select 1,195 participants, including 940 students, 188 social studies teachers, 47 head teachers from primary schools, and 12 Curriculum Support Officers from six sub-counties within Uasin Gishu County. Data collection involved the use of questionnaires for teachers and CSOs, observation guides for social studies teachers, interview schedules for head teachers and CSOs, and focus group discussion guides for pupils. The data was analyzed descriptively and presented in the form of tables, percentages, means, and figures. The study findings revealed that the primary school Social Studies curriculum is well-structured with a systematic breakdown into smaller units that promote social cohesion. Moreover, it aligns with eight national education goals, six of which are closely linked to interpersonal relationships. However, there is room for improvement, and the study recommends the inclusion of areas that have been omitted, particularly citizenship education, to enhance the curriculum's comprehensiveness in educating students about peaceful coexistence. In conclusion, the study emphasizes the necessity for a more holistic approach that encompasses all facets of citizenship education to better equip students for peaceful and harmonious coexistence in a diverse society.

Dietary Diversity and Iron Status in Pregnant Women Attending the Antenatal Clinic at Narok County Referral Hospital, Kenya

Dietary diversity is widely acknowledged as a fundamental factor influencing the iron status of pregnant women. Iron deficiency anemia constitutes a pervasive nutritional concern on a global scale, particularly during pregnancy, and it is linked to an array of adverse consequences such as prenatal mortality, low birth weight, preterm birth, and intrauterine growth retardation. Despite this recognition, there exists a notable gap in our understanding of the dietary habits and iron status of pregnant women attending the antenatal clinic at Narok County Referral Hospital, Kenya. To address this gap, we conducted a cross-sectional study, targeting a cohort of 178 pregnant women receiving antenatal care at the aforementioned hospital. The study used a cross-sectional study design with a target population of 178 pregnant mothers attending the antenatal clinic (ANC) in Narok County Referral Hospital, Kenya. A researcher-administered questionnaire, focus group discussion guides (FGD), and key informant interviews (KII) were used to collect data. Logistical regression and Odds ratio were used to control for other factors that affect iron status, and the Odds ratio was used to determine the likelihood of iron deficiency as influenced by dietary diversity. The results revealed that a significant proportion of the pregnant women were aged between 18-24 years (44.4%), were married (71.3%), and engaged in small businesses (52.2%). Approximately one-third of the participants had two children, with 25.3% having had four live births. The majority (68%) reported consuming four meals daily, but the nutrient intake of pregnant mothers generally fell below-recommended levels, with 57.9% failing to meet the minimum dietary diversity score for women. A considerable portion (62.4%) exhibited normal nutritional status, while 68.5% were under Iron Folic Acid Supplementation (IFAS); however, adherence to the supplementation regimen was poor. Moreover, 52.2% had hemoglobin levels below 12g/dl, indicating a potential issue with iron deficiency. This study uncovered significant demographic characteristics among pregnant women, particularly noting a significant presence of young, married individuals engaged in small-scale businesses. The dietary patterns highlighted a prevalent intake of four meals, but nutrient intake often fell short of recommended levels. Alarmingly, a substantial percentage exhibited low hemoglobin levels, underscoring the critical necessity for improved nutritional interventions. Specifically, enhancing iron supplementation and promoting dietary diversity is imperative to address the potential risk of iron deficiency among this vulnerable population.

Mothers' experiences and perceptions about care provided during home deliveries in Alwa sub county, Kaberamaido district, Uganda- a qualitative study.

In Uganda 27% of deliveries take place outside a health facility. The existing gaps in quality of maternal and newborn health care must be addressed for Uganda to attain its health targets and consequently its economic targets. Some of the gaps include but are not limited to; ill-equipped healthcare facilities in rural settings, inadequate client/customer care skills by healthcare providers, and health worker absenteeism especially in the night hours. In Kaberamaido District, only 38.3% of the deliveries in Alwa sub county took place at a health facility. Despite the district local government and stakeholder efforts to promote health facility-based deliveries, sadly, a very low proportion of women use the health facilities for delivery. We sought to explore mothers' experiences and perceptions about care provided during home deliveries in Alwa sub county, Kaberamaido district. The study adopted a cross-sectional descriptive qualitative design. We purposively included 115 mothers who delivered outside the health facility and consented to participate and those who lost their babies within the last 24 months preceding the study. Other participants included in the study were village health team (VHT), traditional birth attendants (TBA) and older women. The main instruments used to collect data were focus group discussion (FGD) and in-depth interview (IDI) guides. All voice recordings from FGDs and interviews were transcribed and translated from the local language (Kumam) into English. Thematic content analysis was used to synthesize data by applying codes to segments of the transcripts upon which major domains were derived. Key findings were synthesized and quotes were carefully selected based on their relevance and representativeness to the analysis and study objective. Our findings indicated general satisfaction with the care provided during and after home delivery by TBAs as expressed by mothers. Motivation to seek services from TBAs was attributable to their vast experience spanning decades with history of safe delivery. Few mothers expressed discontent with TBA services citing abuse and rudeness. Our study underscored the common view that TBAs effectively managed home deliveries, providing satisfactory care to mothers. However, concerns emerged on TBAs' capacity to manage complications, emphasizing a need for their reintegration into formal healthcare systems, alongside further training, and standardization in maternal care practices.

Family Emotions Expressed towards Clients Re-admitted for Alcohol Use Disorder in Rehabilitation Centres in Eldoret, Kenya

Alcohol use disorder remains one of the socioeconomic challenges in Kenya. The study investigated the effect of expressed family emotions on relapsed clients with alcohol use disorder in rehabilitation centres located in Eldoret town, Uasin Gishu County, Kenya. This was in the light of concern that recovered clients with alcohol use disorder relapse soon after re-joining their families. The study was anchored on structural family therapy and used concurrent explanatory mixed methods approach. The quantitative strand of the study used ex post facto, causal comparative design while the qualitative strand used phenomenological research design. Stratified and systematic random and purposive sampling techniques were used to obtain a sample size of 92 respondents, comprising 38 clients with alcohol use disorder, 38 family members, 12 relapsed clients and 4 counsellors in the selected registered and licensed rehabilitations centres. Data was collected using a questionnaire and focus group discussion guides. Quantitative data was cleaned, organized, coded and analysed with the aid of Statistical Package for the Social Sciences (SPSS), version 23. The generated descriptive statistics were summarized and presented in distribution frequency tables. Qualitative data was coded and analysed thematically. The main findings showed that family members expressed high hostility, criticism and over-involvement but low empathy and positive comments towards clients with alcohol use disorder. The study concluded that expressed family emotions affected clients with alcohol use disorder and was a risk factor to relapse. The study recommends that rehabilitation programmes need to involve family members in the treatment of clients with alcohol use disorder.

Quality assessment of childhood immunisation services in primary health centres in Oron, Akwa Ibom State, Nigeria

Introduction. With 20% of the African population, low routine immunization coverage, and a wild poliovirus reservoir, Nigeria contributes significantly to the overall regional burden of vaccine-preventable diseases. Since the introduction of the EPI in 1974 (which later became the National Programme on Immunization), Nigeria’s immunization program has suffered declining coverage. Poor quality affects service utilization, even where the services are provided free, just as immunization services are. Quality assessment will give an indication of the degree of satisfaction of clients with services as well as provide a framework for review of program priorities, strategies, and componentsPurpose of the study. The purpose of the study is to evaluate the quality of immunisation services provided to children in primary health centres in Oron, Akwa Ibom State, Nigeria. The study aims to identify the strengths and weaknesses of the immunisation services, assess the level of compliance with national and international standards for immunisation, and make recommendations for improvement where necessary. Additionally, the study seeks to contribute to the body of knowledge on the quality of childhood immunisation services in Nigeria, particularly in the context of primary health centres. Ultimately, the findings of this study may help to improve the delivery of immunisation services in the region and ensure that more children are vaccinated and protected against vaccine-preventable diseases. Materials and methods. This was a cross-sectional descriptive study of the quality of immunization services in Primary Health Centers in Akwa Ibom State, Nigeria. This study utilized some variables as indicators which included physical environment, resource availability, client satisfaction etc. formed into a questionnaire. The study involved 402 caregivers and 156 healthcare providers in 12 Primary Health Centers. The study utilized six instruments namely the Client questionnaire, Facility staff questionnaire, Facility Checklist, Personal Observation, Focus Group Discussion Guide, and Client Flow Chart.Outcomes. The results showed that the quality of immunization services was poor. The caregivers were dissatisfied with the reception by the providers. They were also not satisfied with the waiting time which they complained of as being too long. The attitude of the health care providers was also a cause of dissatisfaction.Discussion. This study found that the Community Health Extension Workers constituted the majority (39,4%) of the immunization service providers. Of the 152 healthcare providers that participated in the study, 92 (60,9%) had attended in-service training on immunization within the previous two years while 59 (39,1%) had not. A comparison of staff categories with attendance at in-service training showed a statistically significant difference (p=0.0072),suggesting that whether one attended in-service training or not depended on the category of staff he/she belongs to. One hundred and twelve (73,3%) of staff knew the correct vaccine storage temperature while 40 (26,7%) did not know. Healthcare providers who do not know the correct vaccine storage temperature may administer vaccines whose potency has been compromised. One-hundred and forty-nine (98,0%) healthcare providers were aware that clients have certain rights collectively referred to as clients’ rights. It is only by knowing the rights of clients that providers would be expected to respect these rights. The clients’ right to which most providers indicated strong agreement that clients are entitled to, was the right to information as indicated by 105 (70,2%) providers while the right to which most providers indicated disagreement was the right to choice of where and when to access services. Fifty-two (34,0%) health care providers felt clients were not entitled to this right.Conclusion. In conclusion, the study conducted a thorough quality assessment of childhood immunisation services in primary health centres in Oron, Akwa Ibom State, Nigeria. The findings reveal both strengths and weaknesses in the delivery of immunisation services to children in the region. While there were areas of average performance, such as experienced and trained healthcare workers, there were also areas of concern, such as inadequate cold chain storage and insufficient record-keeping practices.The study recommends that steps be taken to improve the quality of immunisation services in the region, including strengthening the cold chain system, ensuring adequate record-keeping practices, and implementing regular training and supervision of healthcare workers. These measures are crucial to ensuring that more children are vaccinated and protected against vaccine-preventable diseases.Overall, the findings of this study contribute to the body of knowledge on the quality of childhood immunisation services in Nigeria and underscore the importance of continued efforts to improve the delivery of immunisation services to children. It is hoped that the recommendations put forth in this study will inform policy decisions and ultimately lead to better health outcomes for children in Oron, Akwa Ibom State, and beyond

Factors Affecting Sustainability of Cocoa Life Project Interventions in Ghana: Views of Beneficiaries in Wassa East District

This study interrogated the factors affecting the sustainability of project interventions implemented in the Wassa East District by World Vision Ghana (WVG) under the Cocoa Life Project in the country. Based on a mixed method research approach, a total of 406 respondents who were farmers, members of village savings and loans associations, gari processors, and soap makers were involved in the study using stratified, simple random, and convenience sampling methods. Structured interviews and focus group discussion guides were the instruments used for data collection. For the quantitative data analysis, frequencies, percentages, means, standard deviation and chi-square were used whereas qualitative data obtained was analyzed thematically. The study observed that project interventions implemented in the District by WVG were generally sustainable. Factors such as local ownership, commitment of community members, teamwork, and supportive relationship between WVG team and community members aided the sustainability of the interventions. Despite the flexibility in the delivery of the project interventions, community members who benefited from the interventions had some concerns about the Project. Concerns were particularly raised with respect to the level of participation, the nature of communication, and the level of accountability and transparency which characterized the Project. We recommend that World Vision Ghana, Mondelez International, and Cocoa Life Division team up with local authorities and community members to come out with clear measures to: increase local participation, improve communication, and enhance transparency and accountability throughout the delivery of Cocoa Life Project interventions in the country.

Facilitators and Barriers to National COVID 19 Guideline Adherence among Healthcare Providers in Ethiopia.

Evidence-base practice needs to be supported by guidelines and decision-making protocols. This study aimed to look into the barriers and facilitators of adherence to national protocols in Ethiopia. Exploratory qualitative method was implemented to explore adherence to protocol. The national COVID-19 case management guideline was used as this study's prototype reference. A total of five FGDS were conducted among 26 healthcare providers. A total of 14 physicians and 12 nurses participated in the FGDs. Semi-structured focus group discussions guides were used to facilitate the discussion among healthcare workers involved in COVID-19 case management. The FGDs were audio recorded, transcribed and analyzed thematically. Three broad themes have emerged from the content analysis. These include individual factors, environmental factors and system factors. System factors barriers to utilization include unclear guidelines, discordant guidelines and a lack of live national guidelines, while the main facilitator was supportive management. The environmental factors that were barriers to adherence included limited infrastructure and shortages of drugs suggested in the protocols. Outdated and discordant guidelines and a shortage of suggested managements were barriers. Future similar works should consider the identified barriers and need regular updates to facilitate effective implementation.

Private sector engagement in humanitarian financing, logistics and technology and implementation of humanitarian aid projects in Kenya

Humanitarian crisis across the globe continue to increase in size, frequency, and complexity in the 21 Century challenging the ability of Organizations in disaster relief to save lives of persons in distress. This has been a challenge in Countries prone to natural disaster as well as those prone to human conflict such as Syria, Southern Sudan, Central Africa Republic, Yemen, Somalia and Democratic Republic of Congo. In Kenya, humanitarian crises have occurred in the form of recurrent drought, floods, malnutrition and food security, disease outbreak, post election violence; resource based intercommunal conflicts as well as terror attacks. These crises often require immediate response in order to save lives, as a result there is increasing need to engage private sector in humanitarian logistics, financing and technology when implementing humanitarian aid projects. The objective of this study was to examine the influence of combined private sector engagement and the implementation of humanitarian aid projects. The paradigm guiding the study is pragmatism and the study employed a cross sectional-survey design. The sample was drawn from Organizations in disaster relief programmes using both probability and non-probability sampling technique. Both primary and secondary data was utilized in data collection. Primary data was collected using self administered questionnaires, Key Informant Interview, and Focus Group Discussions Guides. Questionnaires issued were 117 out of these, 85 which is 72.6% were returned for analysis. The data was analysed using both descriptive and inferential statistics. For descriptive analysis, mean, percentages and frequencies were used. For inferential analysis, correlations and regressions were used. For p<0.05, H 0 was rejected and H1 accepted. For the strength of the relationships, r values were considered where: +0.10< r <+0.29; weak correlation +0.30< r <+0.49; moderate correlation +0.5 < r <+1.0; Strong correlation. The qualitative data was analyzed using content analysis. The study findings indicate that combined private sector engagement influence on implementation of humanitarian aid projects in Kenya. The study concludes that combined private sector engagement is critical in implementation of humanitarian aid projects and there is need to put more emphasis on collaboration. The study recommended that there is need for more academic research on humanitarian aid.

Prevalence of Missed Opportunities for Immunization and Associated Factors in Urban and Rural Areas of Southwest, Nigeria

Purpose: The study determined and compared the prevalence of missed opportunities for immunization among children aged 12-23months in urban and rural areas of southwest, Nigeria. The study identified and compared the associated factors (cultural, religious, ethnic, political and economic).
 Methodology: This cross -sectional study was carried out among mothers of children aged 12-23 months, community and opinion leaders in urban and rural areas of southwest, Nigeria. The data was collected using semi structured questionnaire, focus group discussion and in-depth interview guides.
 Findings: The prevalence for missed opportunities for immunization was 9.6% with 11.8% in urban as compared with 7.5% in rural areas. The dose specific prevalence of missed opportunities for immunization in rural areas was highest for BCG, HBV0 and OPV0 but lowest for BCG and OPV0 in urban areas. The reasons given in both areas were non-availability of vaccines, long wait time, unscheduled visits, child brought to facility ill but not vaccinated, and distance from the facilities. After controlling for confounders, child factors (age of the child, place of delivery), socio-economic characteristics (mothers and fathers educational and occupational status) were significantly associated with missed opportunities for immunization. Most of the participants of the qualitative survey believed immunization is important as it prevents children from diseases. There were divergent views in both areas on traditions, cultures, and customs as associated factors for missed opportunities for immunization. Government is involved in immunization as reported by participants in both areas.
 Conclusion: The study concluded that missed opportunities for immunization is prevalent in both areas and reasons were non-availability of vaccine, unscheduled visits, long wait time and distance from facilities. Parent socioeconomic characteristics, child’s age, place of delivery and mothers receiving immunization messages were the factors associated with missed opportunities for immunization.
 Recommendation: There is a need for improvement of quality of interventions and advocacy to the government for continual support for immunization to reduce missed opportunities for immunization.

Influence of health institution related factors on health seeking behaviors among men suffering from lower urinary tract symptoms attending surgical outpatient clinic at a county referral hospital Meru Kenya

Background: Currently there is an increase in cases of men presenting with lower urinary tract symptoms (LUTS) especially in low resource countries. The purpose of this study was to establish the influence of health institution related factors on health seeking behaviors among men suffering from LUTS attending surgical outpatient clinic at Meru county referral hospital, Kenya. Methods: Descriptive cross-sectional study design was used. Population involved 120 men suffering from LUTS, 2 physicians and 2 nurses. The study tools used were questionnaires, key informant interview guides and focus group discussion guides. The quantitative data was analyzed using chi-square test and binary logistic regression. Hypothesis testing was done at an alpha level of significance of 0.05 such that any p-values below the alpha were deemed significant. Qualitative data was analyzed thematically Results: Health institutional related factors which included adequate personnel 2.57 [95% CI=1.09-6.06, p=0.032], adequate drugs 3.14 [95% CI=1.36-7.23, p=0.007], treated well by the health care workers 2.95 [95% CI=1.18-7.36, p=0.021], short duration time taken to be served in the hospital 2.40 [95% CI=1.12-5.16, p=0.025] and distance to the health facility 2.21 [95% CI=1.01-4.84, p=0.047], significant parameters associated with health seeking behaviors Conclusions: There was significance influence of health institution related factors on health seeking behaviors among men suffering from LUTS.