School of Nursing, Midwifery and Paramedical Sciences

EVALUATION OF NURSES’ COMPETENCE IN THE PREVENTION OF PERIPHERAL VENOUS CANNULAE RELATED INFECTIONS AT SUB COUNTY HOSPITALS, ELDORET

Wed, 01 Oct 2025 00:00:00 GMT

EVALUATION OF NURSES’ COMPETENCE IN THE PREVENTION OF PERIPHERAL VENOUS CANNULAE RELATED INFECTIONS AT SUB COUNTY HOSPITALS, ELDORET Riungu, Doris Kinya Background: Peripheral intravascular cannulae, is a device that is used in hospital inpatient for patient management. The device is linked to complications such as infections, which harm patient health,satisfaction and increase healthcare costs. Objective: This study was aimed at evaluating the competence of nurses in preventing cannula related infections in newly upgraded sub-county hospitals. Methodology: Analytical cross-sectional design was used in four sub-county facilities, and applied quantitative and qualitative approach which described and analyzed the knowledge and skills of 86 nurses. Census was applied. There was direct observation which determined whether the nurses in the four facilities applied their theoretical knowledge and skills in practice. A structured questionnaire and observational checklist were used. Results: Most nurses (87%) had adequate knowledge, who correctly responded to ≥50% of the 10 knowledge items. Using the observation checklist, highest awareness was observed in areas such as skin preparation before cannula insertion (100%), wearing non-sterile gloves and adhering to aseptic technique (97.7%). However, only 36.1% correctly knew the recommended time for cannula removal (12–72 hours), which showed a significant knowledge gap. Logistic regression further revealed that nurses with ≥10 years of experience were 1.53 times more likely to be competent (OR = 1.53; 95% CI: 1.36–1.72; p < 0.001), and those with 5–9 years had 1.22 times greater odds (OR = 1.22; 95% CI: 1.17–1.81; p = 0.050) compared to nurses with <5 years of experience. The knoweldge and observed skill was used to determine the competency of nurses which was at 66.7% in nurses who scored >50% in both knowledge and application. Conclusion: The study concluded that most nurses (87%) demonstrated adequate knowledge in infection prevention practices which includes skin preparation and aseptic technique. There were gaps in specific areas of knowledge of the recommended cannula dwell time. There were few nurses who had a gap in their skills. Nursing experience was significantly associated with higher competence, underscoring the importance of continuous training and mentorship to bridge identified gaps. Recommendation: The study recommends enhancing nurses’ clinical competence and knowledge in IV cannulation through improved training, regular audits, and interdisciplinary collaboration. It also highlights the need to bridge the gap between theory and practice to ensure effective infection prevention in the insertion, removal, and care of intravenous cannulae. Key words: Peripheral intravenous cannula, Infection, prevention, Nurses’ competence

FACTORS INFLUENCING QUALITY CLINICAL CASE MANAGEMENT OF SEVERE MALARIA AMONG CHILDREN AGED 6 MONTHS TO 59 MONTHS BY HEALTHCARE PROVIDERS IN KISUMU COUNTY

Fri, 01 Aug 2025 00:00:00 GMT

FACTORS INFLUENCING QUALITY CLINICAL CASE MANAGEMENT OF SEVERE MALARIA AMONG CHILDREN AGED 6 MONTHS TO 59 MONTHS BY HEALTHCARE PROVIDERS IN KISUMU COUNTY Maoga, Rose Nyangweso Severe malaria in under 5 continues to be public health concern in malaria endemic areas. In Kisumu County, most cases of severe malaria are observed at Kisumu West and Nyakach sub counties in Kisumu West. However, quality of management of this condition is not well understood. The aim of the present study was to determine the effect of caregiver, Healthcare providers, and health system associated factors that influence quality of management of severe malaria in under-five in Kisumu County. This was a mixed methods prospective cross sectional study which took place between April and July 2023. Three hundred and forty-four under-fives, 78 healthcare providers and 8 key informants were recruited into the study. Qualitative data was collected using a key informant interview guide and analyzed using thematic analysis. Quantitative data was obtained through questionnaires and observational checklists and summarized using descriptive statistics and analyzed using SPSS version 27. Most children were ≥12 months (286/344, 83.1%), with a mean age of 12.58±1.67 (1.30 59.00). Most caregivers were between 25 and 34 years (174/344, 50.6%), had a mean age of 32.33±7.13 (18.00-56.00), had attained tertiary level of education (220/344, 63.9%). Most healthcare providers were nurses (52/78, 67%), diploma level of education (65/78, 83%), majority had received Integrated management of neonatal and Childhood illnesses training (46/78, 59%), and had attended a Continued medical education or in-service training on case management (75/78, 96%). Microscopic tests were mainly done in the study area (182/344, 52.9%), oral Artemisinin combined therapy was mainly administered (124/344, 36.0%) as compared to artemether injection(124/344, 36.0%). Under-five Males were 40% less likely to receive optimal malaria treatment (OR: 0.6; 95% CI: 0.4 – 0.9; p = 0.017). Cases managed by in integrated management of neonatal and child illnesses trained healthcare providers were 60% more likely to receive quality malaria treatment compared to non-trained (OR: 0.4; 95% CI: 0.3 – 0.7; p = 0.0005). Children of younger caregivers ≤25 years were 3.5 times more likely to have received optimal management relative those whose caregivers were ≥25 years of age (OR: 3.5; 95% CI: 1.7 – 7.3; p = 0.0005). Similarly, children whose caregivers had attained primary education had higher odds of receiving optimal malaria management unlike those whose parents had higher level of education (OR: 5.8; 95% CI: 2.6 – 12.7; p < 0.0001). The study has demonstrated that factors related to the caregivers, HCPs, and health system significantly influence the quality of management of malaria in under-five in the study area. Key findings indicate that male children are less likely to receive optimal care compared to females.. Moreover, HCPs with IMNCI training significantly enhanced the quality of malaria treatment. Interestingly, caregivers’ age and education level were among the critical determinants, where children of younger caregivers (≤25 years) and those who had primary education being more likely to receive optimal management. These results suggest that caregivers demographic factors and HCPs’ skill levels play a substantial role in the quality of malaria management in the region. These findings suggest that there should be continuous in service training programs, particularly on IMCI, to ensure that HCPs across County Hospitals are equipped with the skills required for optimal malaria management. Therefore, equitable access to quality malaria case management for under-fives is important in that awareness programs targeting gender biases and reinforcing treatment guidelines that emphasize gender neutrality in clinical decisions is in place. Caregivers to be enlightened on the importance of timely and appropriate treatment seeking behavior, regardless of their education level. Most importantly, there is need for strengthening health facilities capacity to provide accurate and timely diagnostic services and also ensuring uniformity in treatment protocol utilization. Finally, there is a need to establish robust monitoring systems to track the implementation of training, caregiver support programs, and adherence to standardized treatment protocols. This will help identify gaps and enable timely adjustments to improve malaria management outcomes.

RESPECTFUL MATERNITY CARE AND ASSOCIATED FACTORS AT KITALE COUNTY REFERRAL HOSPITAL, TRANS NZOIA COUNTY, KENYA

Sun, 01 Oct 2023 00:00:00 GMT

RESPECTFUL MATERNITY CARE AND ASSOCIATED FACTORS AT KITALE COUNTY REFERRAL HOSPITAL, TRANS NZOIA COUNTY, KENYA Sabwami, Georgeadez K. Respectful maternity care (RMC) is an avenue that ensures pregnant women preferences, needs and rights are adhered to when seeking maternity services. It remains a global challenge as most pregnant women seeking maternity services don’t receive respectful maternity care. This contributes negatively to maternal and neonatal outcomes. This study aimed at assessing RMC and associated factors at Kitale county referral hospital in Trans Nzoia county. Specifically, it sought to explore perception on RMC among women who have delivered; determine women related factors that influence RMC; assess institutional factors and examine provider factors that influence RMC at Kitale county referral hospital. A cross-sectional study design with mixed method approach was used. Purposive sampling method was used to select the facility while census method was used to arrive at the women and healthcare providers. Data collection tools used were two questionnaires and an interview guide. The postnatal women tool dealt specifically with women who had delivered while the healthcare provider tool addressed healthcare providers (HCP). Postnatal women tool had information on socio-demographic characteristics of women, obstetric features, social support, health system factors and women perspectives on RMC while healthcare provider tool dealt with HCP on RMC. An interview guide was used to explore perceptions among women on RMC. Bivariate analysis was used to recognize variables associated with RMC while multivariate analysis was used to control for confounders. SPSS version 23.0 database was used in this. A p-value of 0.05 was used to determine statistical significance. Inadequate equipment, limited supplies, limited infrastructure, facility management and working environment were institutional factors that influence RMC while Inadequate number of HCP, high workload, motivation and training on RMC were key among HCP. Moreover, marital status, place of residence, employment status, parity, previous birth place, type of delivery and having a complication at birth were significant women related factors that influence RMC. Besides, women felt dignified care and privacy were key challenges as they received care in the unit. The study recommends availability of equipment and adequate supplies in the facility as HCP to continue offering RMC despite the challenges they face. Moreover, women need to be aware of their universal rights, enlightenment on birth positions and pain care. In conclusion, limited supplies and inadequate equipment were the key facility obstacles in RMC care while HCP were faced with inadequate number, high workload and needed trainings on RMC and be motivated. Lastly, women felt that their privacy, dignity and pain relief/comfort in the maternity unit needed to be addressed.

IMPLEMENTATION OF TARGETED POSTNATAL CARE AND ITS ASSOCIATED FACTORS AMONG MIDWIVES IN SELECTED HEALTH FACILITIES IN KAKAMEGA COUNTY, KENYA

Tue, 01 Apr 2025 00:00:00 GMT

IMPLEMENTATION OF TARGETED POSTNATAL CARE AND ITS ASSOCIATED FACTORS AMONG MIDWIVES IN SELECTED HEALTH FACILITIES IN KAKAMEGA COUNTY, KENYA Shitabule, Ruth Postnatal care (PNC) is essential in improving maternal health and reducing maternal mortality, especially in low-resource settings yet studies show its largely neglected. Targeted Postnatal Care (TPNC) is an approach to postnatal care for mothers and newborns involving a set of assessments and interventions given in four scheduled visits from birth to 6 months after delivery. The goal of TPNC is to improve outcomes for these mothers and babies by implementing 100 percent of the recommended TPNC interventions. The study aimed to assess the implementation of targeted postnatal care and its associated factors among midwives at selected public health facilities in Kakamega County, Kenya. The specific objectives were to assess implementation level of TPNC, examine midwife factors, determine maternal factors, and assess facility factors influencing implementation of TPNC. This was a cross-sectional study conducted in maternity and the Maternal and Child Health (MCH) units of selected public health facilities in Kakamega County, Kenya. A cross-sectional analytic method approach was adopted in this study using interviewer administered questionnaire. The study employed multistage sampling, facilities were clustered according to KEPH levels and level four facilities selected due to high workload. KCGH was purposively selected being the only level five facility in the county. Through proportionate sampling N=1695 (Kakamega county average monthly deliveries) the calculated mothers sample size was 325 across the selected facilities. Midwives were selected through census sampling n=160. Statistical package for social sciences (SPSS) version 25 was used for data entry. Data collected was descriptively analyzed, where the mean, median, and standard deviation were computed and compared across the visits. Analysis of variance (ANOVA) was used to measure the significance of the variations in implementation across the various visits. Across the various scheduled visits, implementation level was sub-optimal and even decreased further as the mother progressed through the period. Maternal targeted postnatal care interventions declining from (66.62%) at 48hour visit to (50%) at4-6 months visit. Similarly, newborn targeted postnatal care interventions declined from (59.55%) at 48hour visit to (57.5%) at the 4-6 months. Midwife related factors like age, sex, Emergency Obstetric Newborn care (EMONC) trained, years of experience, and level of training were not significantly associated with TPNC implementation as they all were greater than the thresh hold of p ≤0.05. Maternal related factors like period after delivery(p˂0.0001), Mother came back for review as per scheduled visit (p˂0.0001), cultural beliefs (p ˂0.012) and feedback on baby’s health(p˂0.012) were significantly associated with implementation of TPNC. Facility factors like equipment’s (p˂0.026), Laboratory tests (p˂0.014), number of midwives implementing TPNC (p˂ 0.001), support supervision (p˂0.003) were significantly associated with implementation of TPNC. The study concluded that maternal and facility factors significantly influenced implementation of TPNC. The study recommended that community midwifery be emphasized through level one of care to ensure that mothers do not miss out on these important interventions especially the second visit. Advocacy on hospital delivery through level one of care, at facilities and media is key as this significantly impacts the initiation and continuity of TPNC. Further research on midwife factors influencing implementation of TPNC.