KNH-UoN Ethics and Research Committee

HIV continues to challenge health systems, especially in low- and middle-income countries in Sub-Saharan Africa. A qualified workforce of transformational leaders is required to strengthen health systems and introduce policy reforms to address the barriers to HIV testing, treatment, and other HIV services. The 1-year Afya Bora Consortium Fellowship in Global Health capitalizes on academic partnerships between African and U.S. universities to provide interprofessional leadership training through classroom, online, and service-oriented learning in 5 countries in Africa. This fellowship program prepares health professionals to design, implement, scale-up, evaluate, and lead health programs that are population-based and focused on prevention and control of HIV and other public health issues of greatest importance to African communities and health service settings. Afya Bora nurse fellows acquire leadership attributes and competencies that are continuously and systematically tested during the entire program. This multinational training platform promotes interprofessional networks and career opportunities for nurses.

Background: The World Health Organization estimates that approximately 16 billion injections are administered in developing countries annually. Injection safety is therefore critical in preventing occupational exposure and infection from blood borne pathogens, hence prevention is a vital part of any comprehensive plan for protecting health workers, patients and maintaining a safe environment. Objective: To determine the knowledge and practice of injection safety among clinical healthcare workers at the Garissa Provincial General Hospital. Design: A cross-sectional descriptive study. Setting: The Garissa provincial General Hospital from September 2011 to July 2012. Results: Injection safety knowledge was high with a score of 12.65 (SD ± 2.3) out of the total of 16 items. Appropriate injection safety practices were reported by most of the respondents. The level of knowledge was not significantly associated with respondents’ demographic characteristics(p>0.05), but was significantly associated with hand washing practice(p<0.05).Inferences were made on an appropriate injection safety practices like non-recapping of needles, hand washing and proper waste management. Drug administration practice varied in the different departments (p=0.043) and recapping of needles was significantly associated with training (p=0.047), designation (p=0.02) and area of deployment (p=0.017). Conclusion: Knowledge on injection safety was high but reported and observed practices were below the set standard. Risky practices such as recapping used syringes, re-use of disposable syringes and overfilling of sharp boxes were observed. There was insufficient provision of injection safety equipment, Poor waste handling and inadequate personal protective gear. Over prescription of unnecessary injections was widespread.

Mentorship is critical to develop effective leaders. The Afya Bora Fellowship in Global Health Leadership program, a consortium of four African and four US universities formed in 2008, has incorporated a robust dual mentorship component into its training of over 70 fellows. Each Fellow was assigned two mentors to guide professional growth over the fellowship period. Here, we evaluate 39 Fellows' experiences with their mentors between 2012 and 2014, and identify how these relationships prepare Fellows to lead major health programs

More than half of rural Kenyan women experience intimate partner violence (IPV) in their lifetime. Beyond physical consequences, IPV indirectly worsens maternal health because pregnant women avoid antenatal care or HIV testing when they fear violent reprisal from partners. To develop an intervention to mitigate violence towards pregnant women, we conducted qualitative research in rural Kenya. Through eight focus group discussions, four with pregnant women and four with male partners, and in-depth interviews with service providers, we explored the social context of IPV using an ecological model. We found that women experienced physical and sexual IPV, but also economic violence such as forced exile from the marital home or losing material support. Relationship triggers of IPV included perceived sexual infidelity or transgressing gender norms. Women described hiding antenatal HIV testing from partners, as testing was perceived as a sign of infidelity. Extended families were sometimes supportive, but often encouraged silence to protect the family image. The broader community viewed IPV as an intractable, common issue, which seemed to normalise its use. These results resonate with global IPV research showing that factors beyond the individual - gender roles in intimate partnerships, family dynamics and community norms - shape high rates of violence.

doi: I0.4236/ojn.20 12.23023 Published Online September 2012 (http://www.SClRP.orghoumallom/)
OJN
Nurse's knowledge, attitude and practice on the initial
management of acute poisoning amongadult casualties:
Study at Kenyatta National Hospital, Kenya
'''"heth RuffO·, James M.waura, Angeline Chepchirchi.r, Theresa Odero
School of Nursing, The University of Nairobi, Nairobi, Kenya
Email: *kolonget@yahoo.com
Received 13 June 2012; revised 10 July 2012; accepted 18 July 2012
ABSTRACT

The purpose of this study was to determine nurse's
knowledge, attitude and practice on the initial management
of acute poisoning among adult casualties
seen at Accident and Emergency Department (AED),
Kenyatta National Hospital (KNH). The study was
cross sectional. Both 'qualitative, and quantitative
methods of data collection were employed. The target
population were all nurses working at AED, KNH.
Purposive sampling was used to select study subjects.
Sample size included all Accident and Emergency
(A&E) nurses who met subject's inclusion criteria.
Structured questionnaires, observation checklist and
interview were used to collect the data. Sixty eight
(82%) of A&E nurses participated in this study. The
study found out that with higher nursing qualification
and training on courses related to emergency care,
knowledge and skills of A&E nurses on the initial
management of acute poisoning is enhanced. A&E
nurses with lower education level had a higher mean
score of positive attitude compared with nurses with
higher nursing qualification. Majority 60 (88.2%) of
the A&E nurses indicated that, they required more
training on the initial management of acute poisoning.
Study recommends that 'A&E nurses should be
trained on various types of poisoning including; assessment,
clinical presentations and management to
include gut decontaminations. In addition, refresher
courses should be organised for those already trained.
Flowcharts that will enhance easy identification and
management of poisoned casualties should be put in
place and utilized accordingly.
Keywords: Knowledge; Attitude; Practice; Initial
Management; Acute Poisoning; Adult Casualties;
Accident and Emergency Department; Kenyatta
National Hospital (KNH)

Banton InterdiscipUnary Research Journal (lOll) J (1), 11 - 21
THE INCIDENCE OF NOSOCOMIAL URINARY TRACT INFECTIONS: KENYATTA
NATIONAL HOSPITAL - INTENSIVE. CARE UNIT
'*HannahK. Inyama, 2Gunturu Revathi, lJoyce Musandu and "Theresa Odero
'*Department of Nursing Sciences, Kenyatta University
P.O BOX 356, Tiriki-50309, Kenya. hannahinyamaI23@yahoo.com
2Department of Pathology.
The Aga Khan University Hospital,
3rd Parklands Avenue,
P.O Box 30270-00100, Nairobi, Kenya
lSchool of Nursing Sciences, University of Nairobi
P.O. BOX 19676 Nairobi-00202, Kenya
*Corresponding author
BIRJ-MS-11-2-10A
Abstract
Urinary tract infectionsfl.II'Is) are the most common nosocomial infections in both. acute care
settings and long-term care facilities. Each year millions of urethral catheters are put in place in these
facilities across the United States. In the acute care settings a vast majority of UTIs occur in patients
with temporary urinary catheters. Nosocomial catheter-associated urinary tract infections (NCAUTls). .i
. .' . .
have been one of the major problems in the Intensive care uniC(ICU} and hav~ contributed to the
mortality and morbidity of the patients. Efforts to contain theproblem have resulted in the introduction
of guidelines to reduce the incidence and prevalence of the nosocomial UTI. Such measures have been.
implemented in the developed world; unfortunately the developing countries have not.duplicated the same.
This was a descriptive cross-sectional study. Urine samples were collected and analyzed
in the laboratory for growth of microorganisms to determine the incidence of NCAUTls.
The findings of the study indicate that the Incidence of NCAUTI was determined
to be' 18% with the common isolated microorganism being Escherichia coli.
It recommended that there was need for judicious use. 'of antibiotics to . prevent
.~
drug resistance and that a procedure and policy on the management of a, patient. '.~
with a urinary catheter should be developed and made available for' use 10 the ICU. .~
".
Key Words: incidence, nosocomial infections, catheter associated UTI, ICU

No Abstract!

ABSTRACT

Objective: To study the clients' perception of health workers in relation to the services provided at the centre, thus defining the relationship between the client and the health worker and the impact of this relationship on the services provided.

Study Design: A Series of Focus Group Discussions (FGDs), interviews and observations were carried out in three (3) stages: i.e baseline (T1), intervention (T2), and evaluation (T3) after nine (9) months. Qualitative and quantitative data were collected at all three levels. However, the study has laid more emphasis on the results of the qualitative data of the study.

Study population and setting: The study population were rural women who received health services from Kombewa Rural Health Centre.

Sampling: A selection of the women receiving the health services from the health facility within a five-kilometer radius who had consented to participate were identified. The were selected and grouped according to the following age groups: 12-20, 21-35, and over 35.

Results: Indicated that the initial relationship between health workers and clients were very poor, but tremendously improved after the Health Workers for Change (HWFC) intervention at T2 and improved further at evaluation after nine months (T3).

Conclusion: The clients' perspective of the health workers has an impact on how the health services are used. The poor interpersonal relationship between the clients and the health facility staff led to lack of compliance with treatment and delayed seeking of health services among the women. The health workers also developed negative attitude towards their clients, which made them lax in attending to them. The situation started improving with the initiation of HWFC intervention, where the health workers explored their situation and that of clients, which made them positive towards those that they served.

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

HEALTH POLICY AND PLANNING; 16(Suppl. 1): 33-39 © Oxford University Press 2001
The Health Workers for Change impact study in Kenya
WASHINGTON ONYANGO-OUMA,l FREDERICK W THIONG'O,2 THERESA MA ODERO.1 AND JOHN H OUMA2
'KEDAHR Project, Division of Vector-Borne Diseases, Ministry of Health, Kisumu, 2Divi§ion of Vector Borne
Diseases, Ministry of Health, Nairobi and 3Department of Nursing Sciences, University of Nairobi, Nairobi, Kenya
This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC)
workshop series on clients' perceptions of health services, relationships within the health centre and relations
between the health facility and the district health system. The study was carried out in three stages: baseline,
intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were
collected at three levels: client, facility and system. Results indicate that relations between health workers
and clients improved a great deal after the intervention while those between the facility and the system
remained to a large extent unchanged. The paper concludes that, with external support and help, especially
from the health system level, health workers can work towards improving health services and their job satisfaction,
which can lead to better health worker-client relations

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.