Units In Kenya Research Articles

Dynamics of Public Participation on Sustainable Resource Management in County Government of Kericho, Kenya

Sustainable resource management involve managing resources in a way that their sources are not depleted; so that the future generations can also benefit from it. Africa is endowed with diverse and abundant natural resources and stands at a critical juncture where responsible and sustainable management of these resources is paramount for the continent's development. The Kenyan governments (national-level and county-level) recognize the need for sustainable resource management for the good of the citizens. In devolved government units in Kenya, sustainable resource management is a critical. This study sought to assess the dynamics of public participation on sustainable resource management in county government of Kericho, Kenya. The study was guided by Resource-based view theory, administrative theory, transformational leadership theory and the theory of Planned Behaviour. This study adopted a pragmatism approach that took a practical and flexible approach, focusing on the usefulness and applicability of research findings, rather than an all-or-nothing, mutually exclusive philosophical position. A descriptive research design with a mixed method of quantitative and qualitative data collections was adopted. The target population of the study comprised a total of 213 senior, middle and lower level management staff of the county government of Kericho. The Stratified random sampling was used to develop a sample from different management groups. A sample of 139 management staff was selected using Slovin’s formula. Reliability of the study was ensured by conducting a pilot study in the neighbouring County Government of Nakuru while context, content and criterion validity were ascertained by the researcher in the field of study. Quantitative data was analysed using descriptive statistics which described the nature of ethical leadership and sustainable resource management. Inferential statistics (Pearson’s correlation and regression analysis) were used to determine the nature of influence between the variables. This was done with the help of Statistical Package for Social Sciences (SPSS) version 25. Qualitative data was analysed by themes and content analysis. The study findings revealed that, public participation had a statistically significant influence on sustainable resource management. The study concluded that there exists a strong and significant relationship between public participation (r=0.832 and p=0.000) and sustainable resource management in Kericho County, Kenya. The study recommends that in order to enhance public participation members of the public should be empowered by giving the information and documents containing information on development activities and legislations that require their input in advance so that they know and understand what they are coming to do in public forums.

A mixed-methods study to investigate feasibility and acceptability of an early warning score for preterm infants in neonatal units in Kenya: results of the NEWS-K study

Preterm birth (< 37 weeks gestation) complications are the leading cause of neonatal mortality. Early-warning scores (EWS) are charts where vital signs (e.g., temperature, heart rate, respiratory rate) are recorded, triggering action. To evaluate whether a neonatal EWS improves clinical outcomes in low-middle income countries, a randomised trial is needed. Determining whether the use of a neonatal EWS is feasible and acceptable in newborn units, is a prerequisite to conducting a trial. We implemented a neonatal EWS in three newborn units in Kenya. Staff were asked to record infants’ vital signs on the EWS during the study, triggering additional interventions as per existing local guidelines. No other aspects of care were altered. Feasibility criteria were pre-specified. We also interviewed health professionals (n = 28) and parents/family members (n = 42) to hear their opinions of the EWS. Data were collected on 465 preterm and/or low birthweight (< 2.5 kg) infants. In addition to qualitative study participants, 45 health professionals in participating hospitals also completed an online survey to share their views on the EWS. 94% of infants had the EWS completed at least once during their newborn unit admission. EWS completion was highest on the day of admission (93%). Completion rates were similar across shifts. 15% of vital signs triggered escalation to a more senior member of staff. Health professionals reported liking the EWS, though recognised the biggest barrier to implementation was poor staffing. Newborn unit infant to staff ratios varied between 10 and 53 staff per 1 infant, depending upon time of shift and staff type. A randomised trial of neonatal EWS in Kenya is possible and acceptable, though adaptations are required to the form before implementation.

Hypothermia amongst neonatal admissions in Kenya: a retrospective cohort study assessing prevalence, trends, associated factors, and its relationship with all-cause neonatal mortality.

Reports on hypothermia from high-burden countries like Kenya amongst sick newborns often include few centers or relatively small sample sizes. This study endeavored to describe: (i) the burden of hypothermia on admission across 21 newborn units in Kenya, (ii) any trend in prevalence of hypothermia over time, (iii) factors associated with hypothermia at admission, and (iv) hypothermia's association with inpatient neonatal mortality. A retrospective cohort study was conducted from January 2020 to March 2023, focusing on small and sick newborns admitted in 21 NBUs. The primary and secondary outcome measures were the prevalence of hypothermia at admission and mortality during the index admission, respectively. An ordinal logistic regression model was used to estimate the relationship between selected factors and the outcomes cold stress (36.0°C-36.4°C) and hypothermia (<36.0°C). Factors associated with neonatal mortality, including hypothermia defined as body temperature below 36.0°C, were also explored using logistic regression. A total of 58,804 newborns from newborn units in 21 study hospitals were included in the analysis. Out of these, 47,999 (82%) had their admission temperature recorded and 8,391 (17.5%) had hypothermia. Hypothermia prevalence decreased over the study period while admission temperature documentation increased. Significant associations were found between low birthweight and very low (0-3) APGAR scores with hypothermia at admission. Odds of hypothermia reduced as ambient temperature and month of participation in the Clinical Information Network (a collaborative learning health platform for healthcare improvement) increased. Hypothermia at admission was associated with 35% (OR 1.35, 95% CI 1.22, 1.50) increase in odds of neonatal inpatient death. A substantial proportion of newborns are admitted with hypothermia, indicating a breakdown in warm chain protocols after birth and intra-hospital transport that increases odds of mortality. Urgent implementation of rigorous warm chain protocols, particularly for low-birth-weight babies, is crucial to protect these vulnerable newborns from the detrimental effects of hypothermia.

Quantifying health facility service readiness for small and sick newborn care: comparing standards-based and WHO level-2 + scoring for 64 hospitals implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania

BackgroundService readiness tools are important for assessing hospital capacity to provide quality small and sick newborn care (SSNC). Lack of summary scoring approaches for SSNC service readiness means we are unable to track national targets such as the Every Newborn Action Plan targets.MethodsA health facility assessment (HFA) tool was co-designed by Newborn Essential Solutions and Technologies (NEST360) and UNICEF with four African governments. Data were collected in 68 NEST360-implementing neonatal units in Kenya, Malawi, Nigeria, and Tanzania (September 2019-March 2021). Two summary scoring approaches were developed: a) standards-based, including items for SSNC service readiness by health system building block (HSBB), and scored on availability and functionality, and b) level-2 + , scoring items on readiness to provide WHO level-2 + clinical interventions. For each scoring approach, scores were aggregated and summarised as a percentage and equally weighted to obtain an overall score by hospital, HSBB, and clinical intervention.ResultsOf 1508 HFA items, 1043 (69%) were included in standards-based and 309 (20%) in level-2 + scoring. Sixty-eight neonatal units across four countries had median standards-based scores of 51% [IQR 48–57%] at baseline, with variation by country: 62% [IQR 59–66%] in Kenya, 49% [IQR 46–51%] in Malawi, 50% [IQR 42–58%] in Nigeria, and 55% [IQR 53–62%] in Tanzania. The lowest scoring was family-centred care [27%, IQR 18–40%] with governance highest scoring [76%, IQR 71–82%]. For level-2 + scores, the overall median score was 41% [IQR 35–51%] with variation by country: 50% [IQR 44–53%] in Kenya, 41% [IQR 35–50%] in Malawi, 33% [IQR 27–37%] in Nigeria, and 41% [IQR 32–52%] in Tanzania. Readiness to provide antibiotics by culture report was the highest-scoring intervention [58%, IQR 50–75%] and neonatal encephalopathy management was the lowest-scoring [21%, IQR 8–42%]. In both methods, overall scores were low (< 50%) for 27 neonatal units in standards-based scoring and 48 neonatal units in level-2 + scoring. No neonatal unit achieved high scores of > 75%.DiscussionTwo scoring approaches reveal gaps in SSNC readiness with no neonatal units achieving high scores (> 75%). Government-led quality improvement teams can use these summary scores to identify areas for health systems change. Future analyses could determine which items are most directly linked with quality SSNC and newborn outcomes.

EPidemiology, clinical characteristics and Outcomes of 4546 adult admissions to high-dependency and intensive care units in Kenya (EPOK): a multicentre registry-based observational study.

to describe clinical, management and outcome features of critically ill patients admitted to intensive care units (ICUs) and high dependency units (HDUs) in Kenya. prospective registry-based observational study. three HDUs and eight ICUs in Kenya. consecutive adult patients admitted between January 2021 and June 2022. none. data was entered in a cloud based platform using a common data model. Study endpoints included case mix variables, management features and patient centred outcomes. Patients with Coronavirus disease 2019 (COVID-19) were reported separately. Of the 3892/4546 patients without COVID-19, 2445 patients (62.8%) were from HDUs and 1447 (37.2%) from ICUs. Patients had a median age of 53 years (interquartile range [IQR] 38-68), with HDU patients being older but with a lower severity (APACHE II 6 [3-9] in HDUs vs 12 [7-17] in ICUs; p<0.001). One out of four patients were postoperative with 604 (63.4%) receiving emergency surgery. Readmission rate was 4.8%. Hypertension and diabetes were prevalent comorbidities, with a 4.0% HIV/AIDS rate. Invasive mechanical ventilation (IMV) was applied in 3.4% in HDUs vs. 47.6% in ICUs (P<0.001), with a duration of 7 days (IQR 3-21). There was a similar use of renal replacement therapy (4.0% vs. 4.7%; P<0.001). Vasopressor use was infrequent while half of patients received antibiotics. Average length of stay was 2 days (IQR 1-5). Crude HDU mortality rate was 6.5% in HDUs versus 30.5% in the ICUs (P<0.001). Of the 654 COVID-19 admissions, most were admitted in ICUs (72.3%) with a 33.2% mortality. We provide the first multicenter observational cohort study from an African ICU national registry. Distinct management features and outcomes characterise HDU from ICU patients. Clinicaltrials.gov (reference number NCT05456217, date of registration 07 Nov 2022).

Supplier Evaluation Management Practice and Supply Chain Performance of Kenyan Selected County Governments in Nyanza Region

Adequate supplier evaluations reduce the cost of projects. Therefore, inadequate supplier monitoring can lead to high costs, non-performance risks, and poor quality of the deliverables. The study examined the influence of supplier evaluation management practices on the supply chain performance of selected Kenyan county governments in Nyanza Region. The study used a number of methods, first utilising a descriptive and correlational research design. The study targeted 112 staff in the procurement department as well as nine lead prequalified suppliers. Data was collected using closed-ended questionnaires and an interview schedule. For data analysis, descriptive and inferential statistics were used. The study utilised both descriptive and inferential statistics. Supplier evaluation management practice had a positive and significant effect on supply chain performance (t = 5.789, p&lt;0.05). The study recommends that devolved units in Kenya should evaluate suppliers to ensure that effectiveness, efficiency, customer satisfaction, and a shortened lead time are realized. This can be achieved through quality commitments, distributions, and delivery strategies and evaluating the cost, thus leading to improved performance of the supply chain of devolved units.

Organisation, staffing and resources of critical care units in Kenya.

To describe the organisation, staffing patterns and resources available in critical care units in Kenya. The secondary objective was to explore variations between units in the public and private sectors. An online cross-sectional survey was used to collect data on organisational characteristics (model of care, type of unit, quality- related activities, use of electronic medical records and participation in the national ICU registry), staffing and available resources for monitoring, ventilation and general critical care. The survey included 60 of 75 identified units (80% response rate), with 43% (n = 23) located in government facilities. A total of 598 critical care beds were reported with a median of 6 beds (interquartile range [IQR] 5-11) per unit, with 26% beds (n = 157) being non functional. The proportion of ICU beds to total hospital beds was 3.8% (IQR 1.9-10.4). Most of the units (80%, n = 48) were mixed/general units with an open model of care (60%, n = 36). Consultants-in-charge were mainly anesthesiologists (69%, n = 37). The nurse-to-bed ratio was predominantly 1:2 with half of the nurses formally trained in critical care. Most units (83%, n = 47) had a dedicated ventilator for each bed, however 63% (n = 39) lacked high flow nasal therapy. While basic multiparametric monitoring was ubiquitous, invasive blood pressure measurement capacity was low (3% of beds, IQR 0-81%), and capnography moderate (31% of beds, IQR 0-77%). Blood gas analysers were widely available (93%, n = 56), with 80% reported as functional. Differences between the public and private sector were narrow. This study shows an established critical care network in Kenya, in terms of staffing density, availability of basic monitoring and ventilation resources. The public and private sector are equally represented albeit with modest differences. Potential areas for improvement include training, use of invasive blood pressure and functionality of blood gas analysers.

Audit and risk control among devolved units in Kenya

The purpose of this paper was to evaluate audit function in relation to risk control among Kenyan devolved units. The county audit reports can provide a good source of knowledge on whether the devolved units have met the objectives for which resources were allocated. Using mixed-method survey, the study was conducted among Kenyan county government’s auditors. The target population comprised 94 auditors from whom primary data was gathered by the use of questionnaire with both closed-ended and open-ended questions. The study variables were measured using both the ordinal scale and Likert-type of scale. The Partial correlation analysis, multiple linear regression analysis, andstatistical tests such as the F-test and ANOVA were used. Multiple regression analysis was used to determine the relationship between the audit function and risk control. The study findings showed that, having easy access to all required audit information (M=3.49, SD=1.332) had an averagely high influence on risk control while having separate departments for accounting and audit staff (M=4.47,SD=0.959) had the greatest influence on risk control. On the other hand, establishing a corporate governance structure to safeguard the Kenyan County Governments’ assets from loss due to theft and other fraudulent activities (M=3.59, SD=1.055) measured above average on its influence on risk control. The top risks faced by devolved units in Kenya according to the findings of this study included financial risk (22.7%), internal control risk (12.0%), and fraudulent risk (9.3%). In conclusion, internal controls, human capital adequacy, audit information, timely implementation of audit findings had a substantially positive impact on risk control. This study recommends that Kenyan Counties should focus more on adequacy of audit information and human capital. Multi-unit approach to Kenyan Counties’ audit is also recommended owing to its effectiveness in financial risk control for enriched livelihoods of the Kenyan people.

Influence of Transformational Leadership on Change Management in the County Governments in Kenya

The environment in which the County Governments in Kenya operate is dynamic and changes often. The 2017 elections brought in new changes such as 3 female governors for the first time in the history of Kenya. Despite this the county governments continue to apply old and traditional methods to solve new kind of problems. This has led to numerous reported cases of corruption, political rivalry, conflict of interest, mismanagement of funds and undue procedures followed contrary to the existing regulations. The general objective of this study was to establish the influence of transformational leadership on change management among devolved units in Kenya. Specifically, the study aimed at determining the influence of idealized influence, inspirational motivation, intellectual stimulation and individual consideration on change management. This research adopted the Transformational-Transactional Leadership Theory, Kotter’s 8 Step Change Model and ADKAR model of change. A descriptive research design was used in this research. The 47 devolved units in Kenya served as the research population. This research relied on primary data collected through questionnaires. The collected data was converted into quantitative format to make analysis using statistical package for social sciences. The statistics generated were descriptive statistics which included mean and standard deviation and inferential statistics which included both correlation analysis and multiple linear regression analysis. The study revealed a significant positive relationship between idealized influence, inspirational motivation, intellectual stimulation, individual consideration and change management among devolved units. Regression analysis revealed that 51.5% of changes in change management among counties were attributed to the four indicators of transformational leadership. In conclusion, idealized influence, inspirational motivation, intellectual stimulation and individual consideration are essential in enhancing change management. Based on the findings, intellectual stimulation had the greatest influence on change management followed by inspirational motivation while individual consideration and idealized influence had the least influence. As a result, it is recommended that policy makers among the county governments should concentrate on transformational leadership because this improves change management.

Molecular surveillance reveals widespread colonisation by carbapenemase and extended spectrum beta-lactamase producing organisms in neonatal units in Kenya and Nigeria

ObjectivesNeonatal sepsis, a major cause of death amongst infants in sub-Saharan Africa, is often gut derived. Gut colonisation by Enterobacteriaceae producing extended spectrum beta-lactamase (ESBL) or carbapenemase enzymes can lead to antimicrobial-resistant (AMR) or untreatable infections. We sought to explore the rates of colonisation by ESBL or carbapenemase producers in two neonatal units (NNUs) in West and East Africa.MethodsStool and rectal swab samples were taken at multiple timepoints from newborns admitted to the NNUs at the University College Hospital, Ibadan, Nigeria and the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, western Kenya. Samples were tested for ESBL and carbapenemase genes using a previously validated qPCR assay. Kaplan–Meier survival analysis was used to examine colonisation rates at both sites.ResultsIn total 119 stool and rectal swab samples were taken from 42 infants admitted to the two NNUs. Colonisation with ESBL (37 infants, 89%) was more common than with carbapenemase producers (26, 62.4%; P = 0.093). Median survival time before colonisation with ESBL organisms was 7 days and with carbapenemase producers 16 days (P = 0.035). The majority of ESBL genes detected belonged to the CTX-M-1 (36/38; 95%), and CTX-M-9 (2/36; 5%) groups, and the most prevalent carbapenemase was blaNDM (27/29, 93%).ConclusionsGut colonisation of neonates by AMR organisms was common and occurred rapidly in NNUs in Kenya and Nigeria. Active surveillance of colonisation will improve the understanding of AMR in these settings and guide infection control and antibiotic prescribing practice to improve clinical outcomes.

Assessment of the Influence of Selected Procurement Practices on the Performance of Devolved Government Units in Kenya: A Case of Machakos County Government

In the devolved units in Kenya, despite the formulation of strategic plans, majority of the counties remain underdeveloped with the employees remaining reluctant thus citizens’ demand for better services remain un met. The devolved systems of governments in Kenya have also been experiencing major challenges in the execution of procurement practices. Counties continue to be criticized for corruption cases, stalled projects, under-development and massive wastage of public resources. All these aspects have been strongly linked to weak procurement management practices which raises concern. The purpose of the study was to determine the influence of contract management practices and procurement policies practices, on performance of Machakos County government. The methodology was descriptive research design that guided the study. The study was carried out in County government offices. The target population and unit of observations was 77 employees in procurement department in Machakos County comprising of senior managers and procurement employees, head of other departments as well budget committee members who were selected using a purposeful sampling approach. Data for the study was collected using questionnaires which were self-administered. The collected data was analyzed using descriptive and inferential analysis using SPSS version 24. Tables and figures were used in presenting the data. The study found out that Contract Monitoring and, Procurement policies had a positive influence on the performance of Machakos County. The study also concluded that for Machakos County to perform, the procurement department must be able to properly implement, monitor and evaluate these practices. The study recommends that the management of the county to improve on the level of compliance with procurement regulations compliance.

THE INFLUENCE OF MOTIVATION ON THE PERFORMANCE OF NURSING OFFICERS IN DEVOLVED UNITS, A CASE OF NYERI COUNTY, KENYA

Purpose: The management of human resources in healthcare institutions is vital to enable the delivery of efficient and effective medical and nursing services and to achieve clientele satisfaction. Motivation of human resources for health enhance quality service provision hence better outcomes. This study therefore sought to establish the influence of motivation on the performance of nursing officers, in devolved units, a case of Nyeri County, Kenya.&#x0D; Methodology: This study adopted a cross sectional descriptive research design. The respondents constituted all nursing staffs and managers in Nyeri County health facilities and at the County Director’s Office. Stratified random sampling was used to come up with a sample of 248 respondents. Data was collected using questionnaire. Descriptive statistics were used in the analysis of data with the help of SPSS 23. Chi-square analysis was used to establish relationships.&#x0D; Findings: The researcher found that motivation of nurses was not well done with a mean of 2.84, SD=1.090, and there were no upgrading and promotion opportunities (M=1.81, SD=1.133) for nurses in the county. There was a moderate performance of nurses with a mean value of 3.75, SD=1.100. Chi-square analysis showed that motivation (χ2 = 28.860, df=16, p=0.025) significant at 95% confidence level. The Cramer’s V value was positive indicating that motivation (v=0.473) enhance performance.&#x0D; Contribution to theory, practice and policy: The study concluded that motivation influences the performance of nursing officers, in devolved units in Kenya. Specifically, motivation approaches and techniques used in the health sector should be overhauled and/or reviewed as they are not effective. In particular, remuneration of staffs who have upgraded should be reviewed according to human resources policy.

Procedural Pain in Hospitalized Neonates in Kenya

PurposeThe study was conducted to understand the nature and frequency of painful procedures and use of analgesia in neonatal units in Kenya. Design and methodsDescriptive prospective study was conducted in a regional Level I and a university-affiliated Level II neonatal unit in Western Kenya. Two hundred term and preterm neonates who were hospitalized during the first day of life were recruited. A validated checklist was used to audit medical charts of hospitalized neonates. Painful procedures and pain treatment interventions accompanying all procedures performed during the first seven days of hospitalization were documented. Descriptive statistics, t-tests and χ2 were usedto determine frequency and factors influencing the frequency of procedures. ResultsA total of 1693 painful procedures (mean = 1.6 ± 1.1) were performed with most of them being tissue-damaging (n = 1291) including intravenous cannulation and intramuscular injection. Neonates were less likely to undergo procedures if there were born at term (RR 0.85; 95% CI, 0.76–0.95, p = .003) but more likely to experience procedures if admitted in a higher level of care (RR 1.57, 95% CI, 1.43–1.74, p < .001). Only one procedure was accompanied by analgesia. ConclusionsNeonates underwent few but highly invasive procedures without analgesia. Prematurity and a high level of care predisposed neonates to a higher burden of pain. ImplicationsOur findings underscore the urgent need for development of context-specific clinical practice guidelines on procedural pain treatment in sub-Saharan Africa.

Influence of Risk Taking on Performance of Healthcare Units in Nairobi, Kenya

The main purpose of this study was to explore how risk-taking influences the performance of healthcare units in Kenya. The study specifically sought to determine how the six indicators of risk taking namely: taking bold actions necessary to achieve the healthcare units’ objectives, undergoing threats from patients other employees, undergoing injuries while lifting lowering equipment or patients, contracting infectious diseases from patients, getting injuries caused by needle stick while injecting patients and getting blood and body fluid spills from patients influence the performance of healthcare units in Nairobi County, Kenya. To compete effectively, healthcare units must constantly improve their performance by reducing maternal mortality, reducing child mortality and increasing the number of referrals to the healthcare unit. The study adopted a survey research design with the target population being healthcare units in Nairobi, County. The healthcare units comprised of County Hospitals, Health Centres and Health Clinics totalling to 71 and the sample size was 49. Data was collected using questionnaires and analysed using SPSS version 23 software. Inferential data analysis was carried out by the use of factor and correlation analysis. Regression models were fitted and hypothesis testing carried out using multiple regression analysis and standard F and t tests. The findings of this study from multiple regression analysis indicated that risk taking positively influences performance of healthcare units in Nairobi, County. The study results lead to the conclusion that risk taking improves the performance of Healthcare units in Nairobi, County. The study recommends that healthcare units should equip their healthcare units with personal protective equipment to avoid exposing their employees to body injuries and infections while at work since their practice is necessary to ensure improved performance.

Burden of prehypertension among adults in Kenya: a retrospective analysis of findings from the Healthy Heart Africa (HHA) Programme

BackgroundHypertension is the leading risk factor for mortality globally. African countries, including Kenya, have a high and rising prevalence of hypertension. Prehypertension is associated with an increased risk of progression to overt hypertension and a higher risk of cardiovascular disease and mortality. Despite this, little is documented on the prevalence and distribution of prehypertension in sub-Saharan Africa. This study sought to estimate the overall burden of prehypertension in Kenyan adults enrolled in a large hypertension control programme, Healthy Heart Africa. The distribution and determinants of prehypertension in the sample were explored as secondary objectives.MethodsThis was a post hoc analysis of cross-sectional data obtained from population-level blood pressure (BP) screening of adults aged ≥18 years in the community and ambulatory care facilities in 17/47 sub-national administrative units in Kenya. All participants with a complete record for systolic and diastolic BP were included. Descriptive analyses were performed for sociodemographic characteristics. Pearson’s chi-square test was used to assess differences in categorical variables. Multivariate logistic regression analysis was performed to identify factors independently associated with prehypertension.ResultsOf 5,985,185 participant records that were included in the analysis, 34% were men (mean age: 45 [SD 2.9] years). The majority (63%) lived in rural Kenya. The prevalence of prehypertension was 54.5% and that of hypertension was 20.8%. Characteristics that were independently associated with prehypertension (adjusted odds ratio [95% CI]) included male sex (1.23 [±0.0023], p < 0.001 for all age groups > 25 years) and rural residence (1.60 [±0.023], p < 0.001).ConclusionsApproximately one in every two Kenyan adults has prehypertension. This calls for urgent development and roll-out of a national BP screening and control programme. It also provides a strong basis for the formulation of multisectoral national policies that will ensure implementation of evidence-based, low-cost public health interventions geared towards primary prevention of hypertension, especially in population groups that are traditionally considered at low risk, such as young adults and rural residents.

Handover among nurses working in selected newborn units in Kenya; its purpose and structure

IntroductionExamining how nurses hand over provides an opportunity to identify opportunities for improvement. Although recognised as a complex and dynamic interaction among nurses, there is little consensus regarding the primary function, location and structure of handover. The aim of this study was to understand from nurses’ perspectives, the purpose and structure of handover in three different health sector newborn units in Nairobi. MethodsThis was an ethnographic qualitative research designed study. Between January 2017 and March 2018, I carried out 150 hours of non-participant observations, conducted 29 in-depth interviews with nurses (10) public sector (8) faith based and (11) private sector. All data was managed by Nvivo 10 (QSR International) and analysed using a thematic framework. ResultsThe purpose of handover was to pass on the management of a patient (s) from one outgoing nurse to incoming nurse at the end of a shift. In all three hospitals, handover took place at the nurse station, but for the nurses in both public and faith based hospitals, this was followed up by bed to bed handover. The structure differed from hospital to hospital, from nurse to nurse and what was actually handed over. The shift system, time available for handover, familiarity with babies, medical emergencies and use of notes were factors that influenced the structure of handover across hospitals. ConclusionAlthough the purpose of handover was similar across the newborn units, the structure was different. There is need to perhaps develop communication guidelines for this key care process sothat all relevant information about the patients is maintained across nurses.

A Qualitative Exploration of Gaps and Challenges in Knowledge and Practices of Electroconvulsive Therapy by Key Personnel in Public and Private Mental Health Units in Kenya.

Background: Evidence-based research for electroconvulsive therapy (ECT) practice in Kenya is scarce. This has seemingly stifled knowledge with regard to ECT practice among key personnel in the country. Research shows that evidence-based guidelines not only harmonize clinical practice in a certain region but also improve health outcomes and quality of clinical decisions made by key personnel. This study aimed at assessing knowledge and administration of ECT by key personnel in psychiatric units in Kenya. Method: This is a qualitative study targeting multiple stakeholders in mental health facilities. The study was undertaken in three counties: Nairobi, Nakuru and Eldoret. Snowballing sampling method was used to interview 33 targeted respondents who work in ECT departments or actively interacted with the procedure in both private and public facilities. Researcher-designed respondent profile questionnaire and interview guides focusing on knowledge, practice and barriers in delivery of ECT were used as tools. Data collected were transcribed from the audio recordings. Thematic and content analyses of these semi-structured interviews were carried out based on the patterns that were noted across the data collected. The interviews were read by the research team and re-read to highlight the core ideas. Findings were presented in form of themes, which were illustrated along with representative verbatim quotations. Results: Overall, the key personnel were knowledgeable about ECT in different stages of the procedure, but we noticed methodological incongruence in their practice with regard to the pre-ECT preparation, stimulus dose calculation adequacy of seizure and in the procedure for dose adjustment of psychotropic medication before and after ECT sessions. The identified barriers to the uptake of evidence-based practice were lack of infrastructure, inadequate funding, lack of adequate training and negative perception by patients, relatives and even some participants. Conclusion: Though key personnel in this study showed that they had knowledge on ECT administration, lack of standard guidelines on ECT practice led to lack of standardized training on the procedure hence the methodological incongruence. Inadequate infrastructure, knowledge and negative perception towards the procedure seemed to interfere with uptake of ECT as an intervention. Recommendations: The study makes the following recommendations: adoption of a guideline by psychiatrists, intense training on ECT, specialized training for nurses in ECT and dose calculation for psychiatrists and registrars. Funding should be made available for new ECT machines. Lastly, education and awareness creation should be done about ECT to help deal with negative perception towards the intervention.

Factors Influencing Performance of Devolved Government Units in Kenya: A Case of Department of Agriculture, Meru County, Kenya

The international unresponsive approach by centralized governments to the social, cultural and economic needs of the citizenry at the grassroots did inform the devolution of both political and administrative powers to sub-national levels of governments. This was with the view that bringing government officers closer to the people would improve public services delivery. This study investigated the factors influencing the performance of devolved government units in Kenya, a case of the department of agriculture in Meru county. In particular, it examined the influence of employee motivation, staff training and development, resources mobilization and staff accountability on the performance of devolved government units. The study was hinged on three theories; Agency, Stakeholders and Contract theories. The study made use of a correlational survey research design since it was interested in unearthing the influence of each of the independent variable factors on the performance of the devolved units of government in Kenya, a case of the department of agriculture in Meru county. The target population for the study were all employees of the department of Agriculture in Meru county, that is 68 employees, a census was therefore conducted. Questionnaires and interview guides were be used to collect both quantitative and qualitative primary data in the study locale, while secondary data was gotten from the agriculture department in the county government of Meru offices. Quantitative data was coded into SPSS v23 for analysis using correlation and regression techniques, while qualitative data was put into put into themes so as to get patterns which were used to beef up the quantitative output. Data was presented in frequency tables. The study found out that the following; that there is a very strong positive correlation between employee motivation and performance of devolved units of government in Kenya, a case of the department of agriculture in Meru county, a positive and significant correlation was established between staff training and development and performance of devolved units of government in Kenya, a case of the department of agriculture in Meru county, as well as a positive and significant correlation between resources mobilization and performance of devolved units of government in Kenya, a case of the department of agriculture in Meru county, and lastly, a very strong positive correlation was established between accountability and performance of devolved units of government in Kenya, a case of the department of agriculture in Meru county. In conclusion, the performance of the agriculture department which is a devolved unit of government is positively and significantly influenced by employees’ motivation, staff accountability, staff training &amp; development and resource mobilization. Based on the findings, the research recommends that emphasis should be put on staff accountability and employee motivation, as they are considered to be the greatest influences of performance of devolved units of government in Kenya, a case of the department of agriculture in Meru county. Since 79.4% of the variations in the performance of the devolved government units was explained by the four independent variables chosen, a study should be carried to find out which other variables influence the performance of devolved units of government. This study will therefore be useful to the national government and other 47 county governments in their quest to fulfill their mandates within their jurisdictions

Competing risk survival analysis of time to in-hospital death or discharge in a large urban neonatal unit in Kenya

Background: Clinical outcomes data are a crucial component of efforts to improve health systems globally. Strengthening of these health systems is essential if the Sustainable Development Goals (SDG) are to be achieved. Target 3.2 of SDG Goal 3 is to end preventable deaths and reduce neonatal mortality to 12 per 1,000 or lower by 2030. There is a paucity of data on neonatal in-hospital mortality in Kenya that is poorly captured in the existing health information system. Better measurement of neonatal mortality in facilities may help promote improvements in the quality of health care that will be important to achieving SDG 3 in countries such as Kenya. Methods: This was a cohort study using routinely collected data from a large urban neonatal unit in Nairobi, Kenya. All the patients admitted to the unit between April 2014 to December 2015 were included. Clinical characteristics are summarised descriptively, while the competing risk method was used to estimate the probability of in-hospital mortality considering discharge alive as the competing risk. Results: A total of 9,115 patients were included. Most were males (966/9115, 55%) and the majority (6287/9115, 69%) had normal birthweight (2.5 to 4 kg). Median length of stay was 2 days (range, 0 to 98 days) while crude mortality was 9.2% (839/9115). The probability of in-hospital death was higher than discharge alive for birthweight less than 1.5 kg with the transition to higher probability of discharge alive observed after the first week in birthweight 1.5 to <2 kg. Conclusions: These prognostic data may inform decision making, e.g. in the organisation of neonatal in-patient service delivery to improve the quality of care. More of such data are therefore required from neonatal units in Kenya and other low resources settings especially as more advanced neonatal care is scaled up.

Mothers' Perceptions about Pain in Hospitalized Newborn Infants in Kenya

PurposeExplore views of mothers about pain and pain treatment practices in hospitalized newborn infants. Design and methodsA Qualitative descriptive study using photo-elicitation technique was conducted in a level I and a level II neonatal units in Kenya. Fifteen semi-structured interviews were conducted with mothers of hospitalized infants. The interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis approach. ResultsMothers described the experience of witnessing their infants undergo painful procedures as emotionally and psychologically traumatic. Participants felt helpless for not being able to protect their infants from pain a situation which was made worse by health care providers who appeared less concerned about pain relief during procedures. Mothers' views demonstrated a good understanding of pain-relief strategies; they identified strategies that health care providers should routinely use to relief pain in hospitalized infants. Furthermore, participants desired to be involved in comforting their infants during clinical procedures. ConclusionRepeated and untreated painful procedures continue to define the hospitalisation experience of newborn infants despite the presence of mothers who desire to be involved in comforting their infants during procedures. Practice implicationMinimizing the burden of pain and using pain-relieving interventions could reduce parental stress and optimize parental role attainment following hospitalisation.