College of Health Sciences JKUAT (COHES)

Effect of an Educational Intervention on Patients’ Rights Awareness among pregnant women attending Antenatal Care Clinics in Kirinyaga County, Kenya

2026-09-29T08:52:59Z

Effect of an Educational Intervention on Patients’ Rights Awareness among pregnant women attending Antenatal Care Clinics in Kirinyaga County, Kenya Chepkorir, Egla Patients' rights are a fundamental human right and is a global health concern in health services delivery. The majority of maternal health intervention programmes across sub-Saharan Africa have focused on improving coverage of skilled birth attendance and emergency obstetric and newborn care however there has been a lack of focus on interventions and programmes that seek to provide comprehensive and individualized care for women and their babies before and after childbirth. Pregnant women frequently experience abuse, which may significantly contribute to maternal morbidity and mortality. In 2020, 95% of maternal deaths in the world occurred in low and lower-middle-income countries, Kenya’s maternal mortality rate stands at 355 per 100,000 births which is significantly higher than the WHO's SDG target goal 3.1 of less than 70 per 100,000 by 2030. Awareness of the patients’ rights increases maternal health literacy. The study’s main objective was to determine the effect of an educational intervention on patients’ rights awareness among pregnant women attending antenatal clinics. Educational intervention involved the use of health talks and bookmarks where a mixed method with a quasi-experimental quantitative arm study design that utilized convergent parallel was employed with two health centers purposively sampled. The study targeted 168 respondents where convenience sampling was used to sample pregnant women attending ANC clinics and purposive sampling for health care providers. An interviewer administered semi structured questionnaire, a key informant interview and focus group discussion guide were used to collect qualitative and quantitative data at pre-intervention and post-intervention phases. Quantitative data were analyzed using SPSS version 26.0, with chi-square used to assess associations and variables that were included into the multivariable model to show the effect of the intervention. Qualitative findings were transcribed and analyzed thematically using NVIVO version 12. Ethical approvals were sought from SERU. Majority of the participants 66(68%) were between the ages of 18-30years, married 74(77%), and had attained secondary education 54(56%). The level of awareness of patient rights was 19(19.8%) Of those who had knowledge of patient rights, 60(68.4%) of them reported that healthcare providers were their source of information. The quantitative analysis demonstrated pregnant women in the intervention group reported higher proportions of good awareness 40(41.7%) compared to the control group 15(20.8%, χ² = 8.11, df = 2, p = 0.017). Similarly, tertiary education and three or more ANC visits were strongly associated with good awareness (χ² = 18.566, p = 0.017 and χ² = 19.035, p = 0.015, respectively). There was a significant improvement in awareness of patient rights from 19(19.8%) to 61(67.8%) at post-intervention. The multiple linear regression model demonstrates that the intervention significantly enhances perceived quality of care and patient rights awareness, with a 6.314-unit increase for the intervention group and an additional 6.806-unit increase over time (DiD effect). Significant variables include education level (β = 1.643, p = 0.001), ANC visits (β = 1.770, p = 0.002), and service quality (β = 0.845, p < 0.001. From the qualitative findings, pregnant women acknowledged the role of HCP in sensitizing ANC clients, the need to translate the PRC into local languages and frequent monitoring of implementation for efficiency. In conclusion, healthcare provider-led health education proved effective in improving the knowledge of patient rights and awareness. With these findings, the study underscores the importance of integrated continuous sensitizations using translated educational materials which are sustainable. The Ministry of Health should scale up interventions, implement regular training and develop educational materials to sustain these initiatives. Doctor of Philosophy in International Health

Two Levels of Negative Pressure in Open Tracheal Suctioning and their Effect on Cardiorespiratory Indices and Care Outcomes among Adult Patients in Critical Care Unit at Machakos Level Five Hospital

2026-09-29T08:49:19Z

Two Levels of Negative Pressure in Open Tracheal Suctioning and their Effect on Cardiorespiratory Indices and Care Outcomes among Adult Patients in Critical Care Unit at Machakos Level Five Hospital Ngui, Mark Lewa Tracheal Tube Suctioning is performed on intubated patients to clear secretions by sucking them out by means of negative pressure via a suction catheter. Disparities exist among practitioners on amount of suction pressure. Negative suction pressures ranging from 80-300mmHg have been tested. The Nursing Council of Kenya prescribes a suction pressure of 80-120mmHg. Suction levels beyond 200mmHg pose risks. ICU mortality in Kenya is 38.6% compared to world-wide level of 19.9%. This study was formulated to establish effect of open tracheal tube suctioning at 180mmHg and 100mmHg on cardiorespiratory indices and care outcomes among mechanically ventilated adult patients at Machakos level five county hospital. Ethical approval was granted by Jomo Kenyatta University Ethics Review Committee (JKU/ISERC/02316/0914) and permit issued by NACOSTI (P/23/28497). All ethical principles were upheld. A Randomized Controlled Trial, involving 76 mechanically ventilated adult patients was conducted with random allocation to 180mmHg and 100mmHg suction groups in 2024. Data was collected pertaining to cardiorespiratory indices at four suction-time points during open tracheal tube suctioning, on critical care outcome metrics, safety and effectiveness measures and suction catheter passes that cleared tracheal secretions. Independent t-test and Mann–Whitney U test were used for statistical comparison of quantitative indices; Chi-square test was used to determine homogeneity between the groups; and Repeated Measures Analysis of Variance and Friedman test were used to assess differences in the means within each group at Alpha level of 0.05. Results showed that the higher pressure was more effective in tracheal secretion clearance (p < .001) and both suction levels cause significant changes in cardiorespiratory indices (p < .05). There were significant differences (p < .05) between the two groups on diastolic and mean arterial blood pressure with the 100mmHg suction pressure causing bigger increment. There were no significant differences in metric patient care outcomes, Ventilator Associated Events and on incidences of bloody tracheal secretions (p > .05). The 180mmHg suction pressure did not therefore show additional harm compared 100mmHg suction level. Further research is recommended to establish the relationship between such suctioning and tracheal mucosal damage, intracranial pressure, pneumonia and for validation in a multi-center study. PhD in Nursing (Critical Care Nursing)

Determinants of Dental Caries among Patients Attending Malindi Sub-County Dental Clinic, Kenya

2026-09-29T08:37:15Z

Determinants of Dental Caries among Patients Attending Malindi Sub-County Dental Clinic, Kenya Ajuck, Hossan Dennis Good oral health is one of the essential building blocks of living well. Oral health is fundamental to the ability to breathe, eat, swallow, speak or even smile. Despite importance of this oral diseases are on the rise with 47.3% of adults and 23.9% of children suffer from dental caries in Kenya. Most of the oral conditions are largely preventable by simple, effective, and low-cost measures. There is untreated dental diseases especially dental caries which leads to severe physical, social, and psycho-biological disorders. The aim of this study was to establish determinants of dental caries among patients attending Malindi sub-county dental clinic, Kenya. A mixed cross-sectional analytical study design was used. Study data were collected using standard questionnaire and cleaned before analysis. Regression analysis to determine socio-demographic factors, reported underlying medical conditions and dental risk behavior factors associated with presence of dental caries was conducted using generalized linear models and a logit link function. All categorical variables were reported as counts with their respective percentages. The regression coefficients from the regression models were log-transformed and reported as Risk Ratios and their respective 95% confidence intervals. Univariable analysis was conducted for each independent variables and crude Risk Ratios reported. The multivariable regression model included independent variables with a p-value <0.1 in the univariable model. Statistical significance was evaluated using 95 % confidence interval and a two-tailed p-value <0.05. In-depth interviews were conducted, translated into English then later transferred to Nvivo qualitative data management software version 12 for thematic analysis International, Melbourne, Australia) for management, cleaning and coding. The coded data was analyzed verbatim. The study recruited 223 participants, 117 (52.5%) female and 106 (47.5%) males. Majority of participants were aged 30 to 49, 76 (34.1%) and the least were aged ≥50 years that is 35 (15.7%). The prevalence of dental caries was 72.6% with majority aged 18 to 29 years old. This study found out that socio-demographic factors such as low income and cash as mode of payment of hospital fees are associated with dental caries among patients attending Malindi sub-county dental clinic, Kenya. Dental risk behavior factors associated with dental caries among patients were found to be the patients who had never visited the dental clinic having a higher likelihood of dental caries compared to those who visit when necessary (OR = 2.05, 95% CI: 1.15–3.65, p = 0.014). Clinical factor associated with dental caries were statistically significant among patient who had diabetes as indicated by an odds ratio (OR) of 6 (95% CI: 2.50 - 15.00, p < 0.001). Socio-demographic factors such as low income and cash as mode of payment of hospital fees are associated with dental caries. This study found out that those who had never visited the dental clinic had a higher likelihood of dental caries compared to those who visit dental clinic when necessary. Clinical factor associated with dental caries were statistically significant among patient who had diabetes. This study recommends Ministry of Health to increase access to affordable dental care services by lowering the cost of care. Integrating Social Health Authority, subsidies with other insurance scheme and out of pocket to provide wide coverage and increase campaign on important of regular dental checkup. Master of Science in Public Health

Evaluation of Cellulose-Matrix DNA Extraction and DadApp for Non-Invasive Paternity Analysis and Learning in Wild Baboons

2026-09-28T11:30:32Z

Evaluation of Cellulose-Matrix DNA Extraction and DadApp for Non-Invasive Paternity Analysis and Learning in Wild Baboons Mwaura, David Kiragu Since the 1990s, non-invasive genetic sampling has transformed research in genetics, evolutionary biology and ecological dynamics in natural animal populations. However, existing approaches are labour- and time-intensive relative to their limited data output, necessitating further optimization. Developing new laboratory methods, analytical tools and software can achieve this goal. This study evaluated the effectiveness of cellulose-matrix based nucleic acid extraction, developed a Shiny-based web application for non-invasive genotyping and paternity analysis in wild baboons and tested the suitability of the application as an educational tool in both molecular and computational aspects of parentage analysis. Faecal samples were collected from thirteen known individuals in one baboon troop from the Amboseli ecosystem in Kenya. Faecal samples were processed using two variant protocols of the cellulose extraction method (single Whatman and four Whatman) and a modified column-based extraction method as a positive control. While the cellulose extraction method failed to amplify DNA for paternity analysis using microsatellite primers, it showed potential for DNA extraction for bacterial identification using the 16S rRNA gene. Additionally, a Shiny web application named ‘DadApp’ https://kiragu-mwaura.shinyapps.io/dadapp/ was developed for paternity analysis using R programming language. Tested with validated non-invasive data from the ABRP, DadApp achieved a 100% success rate in correctly assigning paternity in confirmed triad relationships. In every case, the top log-likelihood ratio (LOD) scoring candidate father was consistent with the paternity assignment in the ABRP pedigree, which had been established through independent verification methods. Further, DadApp as an active educational tool, significantly improved participants’ knowledge of paternity concepts, with participants’ mean scores improving from 70.54 (range 45-90) on pre-test to 97.86 (range 80-100) on post-test. The difference was significant based on a paired Wilcoxon Signed-Rank test (p = 3.75 x 10-6), indicating enhanced learning outcomes. Additionally, participants’ interest and confidence in paternity inference were significantly enhanced after a practical session with DadApp (p-values = 9.485 x 10⁻⁵and 8.103 x 10⁻⁴, respectively). This research highlights the potential, despite limited success, of the cellulose extraction method in non-invasive genotyping and demonstrates the effectiveness of DadApp for paternity assignment and education. Master of Science in Bioinformatics and Molecular Biology