Assessing Capacity and Performance of Health Systems Using Principal Component Analysis: Results from Cross Sectional Survey in Kakamega County, Western Kenya

Background: Strong health systems are fundamental if countries are to improve health outcomes and accelerate the attainment of the Sustainable Development Goal (SDGs) number 3 ‘Ensure healthy lives and promote well-being for all at all ages.’ Despite the strong consensus on need to strengthen health systems, many health systems lack the capacity to measure or understand their own weakness and constraints which effectively leaves policy makers without ideas of what they should actually strengthen. Methods: Principal Component Analysis (PCA) was used to factor weights which were used to assess individual contribution of indicators to the health system performance.  PCA is a type of a multivariable linear regression of all indicators in one model. PCA index was classify variables from heighted to the lowest indicator and further used to rank the indicator. Indicators of individual health system building block were weighted independently to measure the amount of contribution to the respective health system building block. The weights were then aggregated to produce individual health system building block indices which were the independent variables in the multivariable linear regression model. Coefficients of the regression was used to assess marginal effects and p-value<0.05 were considered statistics significant result Results: Service delivery (p<0.0001), health financing (p<0.0001), health workforce (p=0.005) and medical supplies and commodities (p<0.0001) had significant effect on service provision. Health governance was not a significant factor influencing service provision. Conclusions: Among the health system building blocks that significantly influenced service provision were service delivery, health workforce, and health financing and medical supplies. This is the first study to the best of the knowledge of the researcher to apply principal component analysis, to analyze health system performance in a devolved system Kakamega. The method provides opportunity for future application in health systems analysis even in absence of comparative data Keywords: Principal Component Analysis, Health Systems DOI: 10.7176/JHMN/59-0

Accessibility of esssential medicines for non-communicable diseases in a devolved government in Kenya – the case for trans Nzoia county of western Kenya

Objective: The study sought to determine the accessibility (affordability and physical access) to essential medicines for the four major non communicable in Trans-Nzoia County.Design: The design was a descriptive cross-sectional study carried out for three months among outpatients with non-communicable diseases.Setting: The study was conducted in five hospitals within Trans Nzoia County western Kenya using qualitative and quantitative methods.Participants and interventions: Patients and key informant personnel were interviewed. Secondary documents from the health facility were reviewed. The sample size used was 320 participants attending the medical outpatient clinics.Data obtained was analyzed using descriptive and inferential statistics. The level of significance was p = 0.05.Results: The study found the essential medicines for non-communicable diseases to be affordable on the basis of minimum daily wage calculation at 0.309 days’ wages, in contrast with the majority participant (78%) reported the medicines not affordable. Medicines for management of chronic obstructive pulmonary disease were found to be most costly with affordability rating of 0.449 days’ wages. Health facilities where participants received essential medicines for non-communicable diseases were geographically accessible with most participants at 92% using 1 hour or less to get to the facility. Cost of transport means was found to be 0.52 days’ wages constituting an impediment to accessibility.Conclusion: With an epidemiological change in Kenya from communicable diseases to non-communicable diseases, there is need for renewed focus on access to essential medicines for these conditions as reflected by the formation of division of non-communicable disease in the ministry of Health. Based on the study findings, there is need to increase healthcare funding by the county governments for purchase of essential medicines for non-communicable diseases to improve accessibility and affordability by the general population

\u3ci\u3ePlasmodium falciparum\u3c/i\u3e circumsporozoite vaccine immunogenicity and efficacy trial with natural challenge quantitation in an area of endemic human malaria of Kenya

It has been hypothesized that antibody induced by Plasmodium falciparum circumsporozoite protein vaccine would be effective against endemic human malaria. In a malaria endemic region of Kenya, 76 volunteers, in 38 pairs sleeping adjacently, were immunized with subunit circumsporozoite protein Asn-Ala-Asn-Pro tetrapeptide repeatpseudomonas toxin A, or hepatitis B vaccine. After quinine and doxcycycline, volunteers were followed for illness daily, parasitemia weekly, antibody, T-lymphocyte responses, and treated if indicated. Anopheles mosquitoes resting in houses were collected, and tested for P. falciparum antigen, or dissected for sporozoites and tested for blood meal ABO type and P. falciparum antigen. Vaccine was safe, with side-eflects similar in both groups, and immunogenic, engendering IgG antibody as high as 600 µg ml-1, but did not increase the proportion of volunteers with T-lymphocyte responses. Estimation of P. falciparum challenge averaged 0.194 potentially infective Anopheles bites/volunteer/day. Mosquito blood meals showed no difference in biting intensity between vaccine and control groups. Both groups had similar malaria-free survival curves, cumulative positive blood slides, cumulative parasites mm- 3, and numbers of parasites mm- 3 on first positive blood slide, during three post-vaccination observation periods. Every volunteer had P. falciparum parastiemia at least once. Vaccinees had 82% and controls 89% incidences of symptomatic parasitemia (P=0.514, efficacy 9%, statistical power 95% probability of eficacy ~50%). Vaccine-induced anti-sporozoite antibody was not protective in this study. Within designed statistical precisions the present study is in agreement with efficacy studies in Colombia, Venezuela and Tanzania