KNH-UoN Ethics and Research Committee

Parents/guardians participation in care of their hospitalized children has been shown to have benefits to both the child and the parent/guardian. However, this is faced by challenges like negative staff attitudes and inadequate knowledge. The study aimed at establishing factors influencing parents/guardians participation in the care of their hospitalized children under five years old at the paediatric medical wards of Kenyatta National Hospital. The study was conducted in August and September 2009. A descriptive cross-sectional survey used both quantitative and qualitative methods to gather information. A sample of 178 parents/guardians and 54 nurses were selected. The statistical package for social sciences (SPSS) was used to analyze data. ANOVA test was used to analyze for the relationship between the independent variables and participation in care as the dependent variable. The tests level of significance was set at 5%.The data was presented in form of descriptive statistics, frequency tables and graphs. Results showed that parents/guardians were willing to participate in the care f their hospitalized children. Participation was influenced by their level of education (p= 0.014) and age group (p= 0.039). There was a varied opinion among the parents and nurses on who should perform some care activities. Twenty nine (55.8%) of the nurses thought that parents/guardians should not be involved in the decisions of their child's management. Guidelines or policies on parents/guardians' participation in the care of hospitalized children should be put to standardize and maximize the benefits of this practice. Nurses should be trained to enhance effective parents/guardians participation in care.

Abstract
The daily nursing procedures are those aspects of nursing that occur most frequently, affect a large number of patients andplace patients at ·riskby not providing care correctly or providing care that is not indicated. There has been an increasing outcry of falling standards of health care in hospitals. Many a times health care providers including the nurse do not follow recommended procedures or do not carry out required tasks at all. Checks on procedures performed to hospitalized children and their parents has been documented as one way of evaluating the quality of care. This was a descriptive cross-sectional study carried at KNHwith the aim of determining the daily nursing procedures and the adherence to oral drug administration' procedure. The children whose parents/ guardians participated in the study were selected through systematic random
sampling using the admission registers while the nurses were purposely selected. A total of 256 parents/guardians staying with the selected children, 78 nurses and 4 nurse in- charges were recruited into the study. Data was analysed by use of the "Statistical Package for Social Science (SPSS)".Drug administration was established as one of the procedures that almost all nurses carried out on a daily basis. However, the procedure for administration of oral medications was not adhered to by all the nurses observed. Other daily procedure.s.mentioned invariably included nutritional care (50%),hygiene (50%),taking of
vital observations (46.4%),comfort caring (44%);health education (36%)and infection control (2.5%).It was concluded that there is minimal performance of the expected daily nursing procedures and non-adherence to the laid down procedures for the administration of oral medications thus indicating that the quality of care is sub-optimal. The study recommended that standards of paediatric nursing be developed and emphasis be laid on the performance of the daily procedures and adherence to the laid procedures for oral drug administration to minimize drug errors.

Protein energy malnutrition (PEM) results from deficiency of proteins and energy. Children under five years old are the most affected because of their immature immunity. Social, demographic, economic, environmental, political and medical factors have been found to interrelate and cause PEM.
This study sought to determine the influence of maternal and children demographic factors on PEM in under five years old children at KNH. 118 children under five years old plus their biological mothers participated in this cross-sectional quantitative study. Questionnaires were administered to the biological mothers of the children and anthropometric measurements were taken from the children. Systematic random sampling was used to select eligible children pus their biological mothers. Analysis of data was done using SPSS. Chi-square was used to test the significance of the relationship between independent and dependent variables that were categorical in nature. Logistic regression was used to predict relationship between variables. The study found moderately high prevalence of underweight (59.3%) and stunting (53.3%) and low prevalence of wasting (33.9%) among children aged 0 to 59 months in KNH. The odds of the stunted child having a mother who is educated was approximately a third (OR = 0.28) (95% CI 0.12-0.65; P=0.003)) that of a non stunted child.

The aim of the study was to determine the factors influencing infection control practices among nurses at the medical and surgical wards of Kenyatta Hospital, Nairobi.

Study Design: This was a descriptive cross sectional study conducted at medical and surgical wards of Kenyatta National Hospital.

Setting: Kenyatta National Hospital, is in Nairobi. Is a National Referral Hospital and a teaching hospital for the University of Nairobi and other institutions such as the Kenya Medical Training College, Nairobi.

Subjects: A total of 171 nurses were identified for the study and included qualified nurses who were deployed at the medical and surgical wards of the hospital.

Methodology: Systematic random sampling was used t select the 171 nurses who were interviewed using semi structured questionnaires. Additional data was obtained using structured observation checklists that were assess the status of infection prevention and control and injection safety practices in the wards and among the selected nurses. Data was analyzed using Statistical Package for Social Science (SPSS).

Results: There were 158 respondents ranged from 26 to 56 years with a mean age of 37 (SD=6.6) years. Majority of the study participants were females constituting 72.78% while the males constituted 27.22%

Out of all the trained nurses 39.04% (n=57 nurses) had received training in only one of the four possible areas of training while 31.03% (n=45 nurses) of the nurses had received training in all the four areas of infection control. Of those who received training in a single area, 87% (of 57 nurses) received training in injection safety only.

Results showed that most demographic factors were statistically significant in influencing the practice of infection prevention and control and injection safety.

Conclusions and Recommendations: The study findings indicated that there is still sub optimal level of infection prevention and control and injection safety practices among nurses at KNH whereby the practices were mainly influenced by personal and organizational factors.

There is need to strengthen the ward infection control surveillance team and also review the infection control trainings currently being undertaken in the hospital in view of harmonizing it in order to provide a comprehensive training contact with body fluids e.g. dressings as well as wastes from operating theatres and laboratories.

High level disinfection - A process that kills Mycobacterium Tuberculosis and enteroviruses in addition to other vegetative bacteria, fungi and more sensitive viruses.

Research-based practice in nursing and midwifery is regarded as
, a means of ensuring that quality care is provided by integrating
individual clinical expertise with the best available clinical
evidence from systematic research. Previous studies indicate
that few midwives strive to achieve their role of safe motherhood
by helping women and their families through the pregnancy and
childbirth process using research-based practice. The study
documents the practice of episiotomy by midwives in an urban
setting.

This is a cross-sectlonal qualitative and quantitative descriptive
study. All midwives working in the labour ward at Pumwani
Maternity Hospital in June-July 2009 were eligible for the study.
A standard questionnaire was used to collect data regarding
soclo-demographlc characteristics, professional training and
evidence-based knowledge. Consenting and qualifying midwives
were eligible for study. In-depth interviews were conducted
among key informants over the same period. Data were analyzed
using Statistical Package for the Social Sciences (SPSS).
The most common types of episiotomy preferred by the midwives
was medio-Iateral and midline. Various factors were reported to
have influenced the midwives practices: very tight perineum,
breech presentation, premature labour, female genital mutilation,
instrumental delivery and status of the fetus. In-depth interviews
, demonstrated lack of specific guldellnes on specific procedures,
personal attitudes and inadequate administration support.
The study recommends an urgent need to put in place modalities
to ensure that guidelines are developed and used appropriately in order to standadize
provision of services.

Aim: To establish the prevalence of pica behaviour during pregnancy; to identify the substances commonly ingested and their prevalence; and to determine the characteristics of women who reported practicing pica.

Method: Was descriptive, cross sectional study involving use of questionnaire administered in interview format. Study was conducted at Pumwani Maternity Hospital, Nairobi, Kenya. Participants included a convenience sample of 1071 ante natal women with a mean age of 28.1 (+_ 7.3) years. Subjects were selected based on availability, accessibility, and willingness to participate in the study.

Results: Seven hundred and ninety three (74.0%) participants reported practicing pica regularly on a daily basis. Pica prevalence categorised by substances ingested was as follows: soft stones (odowa), 89.8%; soil, 61.2%; and others, 9.6% and no pica, 26.0%. Majority of women who reported practicing pica (62.5%) ingested more than one substance. Most women who practiced pica reported having experienced strong cravings prior to ingestion of pica items, childhood pica, pica before pregnancy, pica in previous pregnancy and a history of pica in family members and significant others in the community.

Conclusions: Pica prevalence was significantly high among the subjects indicating that pica in pregnancy might be more common and widespread in Kenya than health care providers assume or observe. There is no need to routinely screen pregnant women for pica during antenatal visits as this will provide a more systematic and a less expensive way of establishing its epidemiologic status. A nationwide investigation of pica prevalence is also recommended in order to establish possible health consequences of pica on mother and child.

The study was conducted from 30th May 2006 - July 3rd 2006 at Kenyatta and Pumwani hospitals in Kenya. The aim was to determine the socio-economic and cultural factors that influence women's reproductive health decision making. It was cross-sectional and descriptive study on a sample size of 384 subjects. A semi structured questionnaire and focus group discussion on 3 groups of eight mothers each was used.

The study revealed that age, marital status, level of education and employment status influences women's reproductive health decision making. The main cultural factors found to influence women's reproductive health decision making were; FGM, wife inheritance, sex of baby (preference for boys) and dowry.

The conclusions arrived at was that majority of women are participating in their own reproductive health decision making though many need to be given education on different areas of reproductive health to encourage informed decision making. It was recommended that education opportunities for women on reproductive health issues be given more emphasis.

In this study, a total of 519 patients were interviewed. 82.5% had incomplete abortion. The implication of abortion especially when induced is emphasised. Economic implications that are contributed by the youth are stressed. 83.6% of the patients had not used any contraception. The role of contraception in preventing unwanted pregnancy and therefore induced abortion is stressed. The role of the physician in providing contraception and appropriate contraceptive knowledge is discussed. PIP: A study of 519 consecutive women admitted to Kenyatta National Hospital with the diagnosis of abortion revealed that the majority were young and had a history of nonuse of contraception. Abortion was incomplete in 428 (83%) of cases; 60 (12%) cases involved sepsis. Women 20-24 years of age accounted for 221 (43%) of the abortions; the other two most represented age groups were 25-29 years (28%) and 14-19 years (17%). 460 (89%) of the abortion patients had never used a contraceptive method. The most frequently cited reasons for nonuse were desire for pregnancy (48%), no conscious reason (13%), procrastination in getting to a family planning clinic (8%), no knowledge of family planning (6%), and fear of side effects (6%). Of the 64 cases of failed contraception, 27 were using the pill, 25 had an IUD in place, and 8 were relying on the rhythm method. Among contraceptive users, the major sources of information about contraception were nurses (52%), radio and newspapers (19%), and other women (15%). Only 4% indicated that a physician had discussed family planning with them. Given the resource drain that treatment of incomplete abortion can place on Kenya's health care system and the risk of abortion-induced pelvic infection and subsequent infertility, Kenya's health workers should be encouraged to be more aggressive in promoting family planning use among young women.

Part of a detailed analysis of 864 unmarried teenage mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital is presented. Teenage pregnancy amounted for 42.3% of all deliveries of unmarried mothers. Most teenage patients were above 16 years of age, had a religious background of wide coverage, had low quality antenatal care and low education. 94.6% were found to be primigravidas. This dominance has also been found by other workers. PIP: A prospective cross-sectional descriptive study of unmarried mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital, Nairobi, Kenya, from December 1986-April 1987, was conducted with a pretested open-ended questionnaire: the 864 teen mothers are described here. They ranged from 13.4-19 years, most were 17-19. 49.4% were Catholic and 45% Protestant. 88.5% attended prenatal clinics once; 51.5% attended 5 times, although only 13% went to hospital clinics for specialized care. For reasons for not going for prenatal care teens stated that they were too shy to undergo a clinical exam, afraid of parents' reaction, unaware of the pregnancy or of the existence of prenatal care, they had not menstruated, or were in school, in prison, or had long work hours. Most girls had primary education, and 97.9% had dropped out of school. 34% dropped out because of pregnancy, and 32% for lack of tuition fees. Reasons for dropping out of school were tabulated, encompassing a broad range of social problems such as war, death, divorce, alcoholism or illness of parents, no tuition or uniform funds, poor grades, and running away from school. In Africa, teen pregnancy is probably increasing because of decreasing age at menarche and relaxing of traditional values.