Institutional Characteristics Influencing Bachelor of Science Nursing Student Performance in the Nursing Council of Kenya Licensure Examinations in Kenya

Kenya has seen a paradigm shift in nursing education sector recording high rates of enrolment of students to training while their performance in Nursing Council of Kenya (NCK) examination remained variable and unpredictable. This study evaluated performance of BSc nursing students in NCK examinations by examining institutional characteristics in relation to performance. NCK identified it as priority area of research. The study used qualitative and quantitative approach to collect data retrospectively. The records of 1292 students who sat examinations in the period between the period July 2012 - June 2015 from NCK nurses database was used. Cluster and purposive sampling were done for key informants interviewed from nursing schools. Quantitative data was converted from MS Access to SAS and analyzed. Odds ratio was used to measure strength of association between institutional characteristics and performance with p ≤ 0.05 being considered significant. Qualitative data was recorded and transcribed for content analysis. The proportion of those who passed and aged 30 years and above (upgraders) was significantly higher than those who were less than 30 years (OR: 1.6, 95% CI: 1.2-2.2, p= 0.002). Both Class attendance policy and faculty experience had marginal positive association (OR: 0.4, 95%CI: 1.0-2.0, p=0.068) and (OR: 0.7, 95%CI: 0.5-1.0, p=0.068) respectively. Admission criteria was reported by key informants to be influencing performance, In conclusion the study identified faculty years of experience and class attendance policy were associated with performance. Mode of study was reported to influence performance by key informants. The study recommended training institutions to continue with upgrading Programmes, uphold class attendance policy, select faculty based on experience. Results can be used to predict performance and facilitate development of policies for recruitment and examination

Birth Outcomes in Mothers Presenting in First Stage Compared to Second Stage of Labour at Kakamega County General Hospital

Maternal mortality is unacceptably high. About 830 women die from pregnancy or childbirth-related complications around the world every day. It was estimated that in 2015, roughly 303 000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. Admission of women in second stage of labour is often associated with poor maternal and fetal outcomes. These outcomes include: postpartum haemorrhage, obstructed labour and ruptured uterus. This study aimed to compare the birth outcomes among mothers presenting in Second Stage of labour with those who presented in First Stage of labour at Kakamega County Referral hospital. Specifically, it examined maternal outcomes and reasons why mothers presented in Second Stage of labour. A cross-sectional study using mixed methods approach was conducted in the study area. Systematic sampling technique was used to recruit the participants. Data was collected using a pre-tested structured questionnaire administered to 320 women who presented in second stage and another 320 who were admitted in first stage of labour. Two focus group discussions were also conducted in groups of six mothers. Quantitative data were coded and analysed using Statistical Package for Social Sciences (SPSS) version 20. Chi-square test and multiple logistic regression were employed in the analysis. A p < 0.05 was considered significant at 95% confidence interval. Null hypothesis was tested at 5% significance level. A significantly higher proportion of mothers in second stage 90.9% (291/320) were housewives with the majority having attained primary education (98.4%) (p < 0.0001). Prolonged/obstructed labour (11.9%) and primary PPH (9.7%) were the leading complications recorded in mothers who reported in second stage compared to 3.1% and 0.3% respectively, among those who reported in first stage. The study revealed that mothers presenting in first stage of labour had higher chances of normal labour compared to those presenting in second stage of labour (df=1, χ2 =46, p<0.0001). Mothers who reported in Second Stage (28.1%) had delayed at home because progress of labour was too fast while 26.3% presented in Second Stage because the husband was not at home.In conclusion, the study found out that most of mothers presenting in second stage of labour had either no formal education or were primary school leavers with the majority being housewives with no formal employment. It was also noted that mothers who attended ANC and completed the 4-visits presented early in labour. In regard to maternal complications, prolonged/obstructed labour and postpartum haemorrhage were most prevalent among mothers who reported in second stage of labour. For the wellbeing of the neonates and mothers, labour needs to be monitored and delivery conducted by skilled personnel. Therefore, male involvement and sensitising mothers during antenatal visits on birth preparedness would encourage them to present early in the hospital during labour. Keywords: First Stage of labour, second stage, and factors for presentation in first and second stage, Term pregnancy

Experience of Nursing Students in Mental Health Training in Kenya

Introduction: In Kenya, there are few psychiatric nurses available to provide mental health services. Few students pursue psychiatric nursing specialty.Objective: The aim of this study was to investigate the factors affecting psychiatric clinical experience of students of nursing during mental health nursing placement and its influence on the choice of psychiatric nursing specialty training.Methods: A descriptive cross sectional study was conducted with a sample size of 241 participants was carried out in 3 universities and 6 diploma training colleges in Kenya. Cluster and systematic random sampling was used to select the study participants. Statistical significance was set at p≤0.05.Results: Based on two-sided t-test, a significant relationship existed between value of mental health and willingness to pursue psychiatric nursing. Students who liked psychiatric nursing had a higher mean in the domain of value of mental health with a mean of 4.8 (95% CI= 4.7-4.9) unlike their counterparts with a mean of 4.5 (95% CI=4.4-4.6); p<0.0001. A significant relationship between the willingness to pursue mental health and preparation for mental health clinical placement existed. Students who had a valuable experience were willing to pursue mental health and they had a higher mean of 2.9 (95% CI = 2.9-3.0, p<0.0001).Conclusion: The findings from this study show that psychiatric experience of students influences the desire of a student to pursue the specialty. All people responsible with the training of students should ensure that the students have a pleasant psychiatric experience

Predictors of Optimum Uptake of Intermittent Presumptive Treatment of Malaria During Pregnancy Among Women at Navakholo Sub-County, Kakamega County - Kenya

Introduction. Malaria in pregnancy is associated with high incidences of maternal and neonatal mortality in malaria endemic regions. World Health Organization recommends Intermittent Presumptive treatment of malaria in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP). It is recommended that every pregnant woman receives at least three doses administered one month apart up to the time of delivery. Despite increased antenatal clinic attendance and concerted efforts to address known barriers to uptake of malaria preventive measures in Navakholo Sub-County, uptake of three or more IPTp-SP doses in the Sub-County has remained low. Objective. This study aimed at determining predictors of optimum uptake of intermittent presumptive treatment of malaria in pregnancy among women in Navakholo Sub-County. Methodology. This was a cross sectional study using mixed methods of data collection. The study was carried out in Navakholo Sub-County, Kakamega County, Kenya. Multistage cluster sampling method was employed to attain sample size (n = 608). Data was analyzed using descriptive statistics, bivariate and multivariate logistic regression while thematic analysis was used for qualitative data. Strength of association between independent variables and dependent variables was measured using odd ratio and p ≤ 0.05 used to reject null hypothesis of no association between independent variables and the main outcome which was the uptake of optimum doses of IPTp-SP. Results. Out of the 587 participants, 294(50.1%) took optimum doses (three or more doses) of IPTp-SP, 248(42.2%) took IPTp-SP partially (one-two doses) and 45 (7.7%) did not take any dose.  The following variables were statistically significantly associated with uptake of optimum doses of IPTp-SP: having attained secondary level of education and above (OR = 0.6, 95% CI 0.4-0.98, p = 0.01); distance to health facility (OR = 0.2, 95% CI 0.06-0.8, p = 0.02); perception that SP drugs are not safe during pregnancy (OR = 7.3, 95% CI 1.5-35.7, p = < 0.01); opening of health facilities daily (OR = 161.8, 95% CI 29.5-885.7 p < 0.0001) and giving clients return dates (OR = 21.2, 95% CI 7.9-56.5, p = < 0 .0001). Conclusion: Key factors that determine optimum uptake of IPTp-SP in the study area are: having attained at least secondary level of education; perceived safety of SP drugs; distance to health facility; opening of health facility daily and giving of return dates to clients. Recommendation: - Community awareness through health education to increase awareness on the risks of malaria in pregnancy and safety of SPs in pregnancy.  The study further recommends that the daily opening of facilities within the study area, ensure return dates are given at every visit and introduction of mobile clinics to those who are staying far away from the nearest health facility. Keywords; IPTp-SP, Malaria in Pregnancy, Optimum uptake of IPTp-SP doses, Navakholo Sub-County. DOI: 10.7176/JHMN/60-08 Publication date:March 31st 201

Exploring the contribution of general self-efficacy to the use of self-care symptom management strategies by people living with HIV infection

General self-efficacy (GSE), the expectation that one is able to perform a behavior successfully, may differentiate those who are able to successfully utilize self-care symptom management strategies (SCSMS). This subanalysis (n = 569) of an international 12 site longitudinal randomized controlled trial (RCT) (n = 775), investigated GSE as an important factor determining symptom burden, SCSMS, engagement with the provider, and medication adherence over time, and identified differences in those with high and low GSE ratings concerning these variables. Parametric and nonparametric repeated-measures tests were employed to assess GSE and the perceived effectiveness of SCSMS for anxiety, depression, diarrhea, fatigue, nausea, and neuropathy. Symptom burden, engagement with the provider, and antiretroviral adherence were analyzed with regard to GSE. Our data indicated that there were differences in the perceived symptom burden over time of HIV infected individuals by GSE. Those individuals with higher GSE had fewer symptoms and these symptoms were perceived to be less intense than those experienced by the low GSE group. There were few meaningful differences in the SCSMS used by those with high versus low GSE other than the use of illicit substances in the low GSE group. The low GSE group was also significantly ( p= \u3c 0.001) less engaged with their healthcare providers. Given the difference in substance use by perceived GSE, and the importance of engagement with the healthcare provider, more attention to the resolution of the concerns of those with low GSE by healthcare providers is warranted

Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS

Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n = 775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care

Does “Asymptomatic” Mean Without Symptoms for Those Living with HIV Infection?

Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as ‘‘asymptomatic’’ by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003 - 2005 and 2005 - 2007. The results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and symptom management with their clients at all stages of the disease

Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS

Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n=775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care