Crash characteristics and injury patterns among commercial motorcycle users attending Kitale level IV district hospital, Kenya

Introduction: motorcycle users involved in crashes are likely to die or be severely injured due to high frequency of head, chest and leg injuries. We carried out a descriptive cross sectional study to determine crash characteristics and injury patterns among motorcycle users attending Kitale district hospital, Kenya. Methods: motorcycle trauma patients were recruited between 1st August 2013 and 31st October 2013. Data collection was done using a pre-tested, coded questionnaire. Frequencies mean (SD) and chi-square was employed in the analysis. Analysis was done using SPSS V.20. Results were considered significant at α=0.05. Results: motorcycle trauma patients formed 39.4% of all road traffic injuries. Males constituted 69.8%, females 30.2% and mean age was 30(±13) years. Riders accounted for majority of injury patients (45%), passengers (38.8%) and pedestrians (15.9%). Mechanism of motorcycle crash was involving motorcycle versus vehicle (45.6%). Riders suffered severe injuries compared to passengers (χ2=129.936, p<0.001). Head injury patients were assessed as having Glasgow coma scale (GCS) of 70% 9-12, 26% GCS of 13-15 and 7% GCS of 3-8. Injuries sustained by victims included head and neck injury 40%, lower extremity injury 39.9% and chest injury 8.2%. Riders without helmets during the crash sustained head injuries (χ2=111.352, p<0.001). Conclusion: head injuries and lower extremity injuries accounted for the major proportion of injuries sustained by motorcycle users. Non helmet use was associated with increased risk of head injuries. Morbidity can be mitigated by encouraging use of protective gear like helmets

Evaluation of a Tool for Assessing Clinical Competence of Msc Nurse Students

This paper reports the first of a four phase study whose aim is to develop and validate an instrument for assessing the clinical competence of Master of Science (Msc) - medical-surgical nurse students. The objective of the first phase of the study was to evaluate the existing instrument, currently being used for assessing clinical competence of MSc nurse students pursuing medical/surgical specialty. It also explores ideas and content for the development of a new tool. The target population was nurse educators and nurse clinicians with a minimum of MSc-Medical/surgical nursing. Twenty seven (27) participants who participated in this study were drawn from eight (8) of Kenya’s recognized universities offering nursing training. The participants had been involved in the training of undergraduate and post-graduate nurse students for a minimum of two (2) years. The aim was to capture participants with current knowledge in nursing practice and those who are familiar with emerging issues in nursing education and practice.  Qualitative and quantitative research approaches were used.  Data were analyzed using SPSS version 17.  The study findings showed that the tool has a low average congruency percentage at 60%.  Only seven (20.6%) out of 34 items/competencies demonstrated the minimum content validity index (CVI) of 0.78 (Lynn, 1986).  This calls for urgent revision of the tool specifically in terms of adding some performance competencies and probably deleting others. Keywords: Instrument evaluation, Clinical competence, Clinical competence assessment instrument, Content evidence, Average Congruency Percentag

'Tweaking' the model for understanding and preventing maternal and neonatal morbidity and mortality in low income countries : "inserting new ideas into a timeless wine skin"

Background: Maternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes. The three-delay model/framework was advanced to better understand the causes and associated Contextual factors. It continues to inform many aspects of programming and research on combating maternal and child morbidity and mortality in the said countries. Although this model addresses some of the core areas that can be targeted to drastically reduce maternal and neonatal morbidity and mortality, it potentially omits other critical facets especially around primary prevention, and pre- and post-hospitalization continuum of care. Discussion: The final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. However, to effectively tackle these causes of morbidity and mortality, a broad based approach is required. Some of the core issues that need to be addressed include:-i) prevention of vertically transmitted infections, intra-partum related adverse events and broad primary prevention strategies, ii) overall health care seeking behavior and delays therein, iii) quality of care at point of service delivery, and iv) post-insult treatment follow up and rehabilitation. In this article we propose a five-pronged framework that takes all the above into consideration. This frameworks further builds on the three-delay model and offers a more comprehensive approach to understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries Conclusion: In shaping the post 2015 agenda, the scope of engagement in maternal and newborn health need to be widened if further gains are to be realized and sustained. Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to also address earlier aspects of primary prevention, and the need for tertiary prevention through ongoing follow up and rehabilitation. It takes into perspective the spectrum of new evidence and how it can be used to deepen overall understanding of prevention strategies for maternal and neonatal morbidity and mortality in LICS

Health seeking behavior, practices of TB and access to health care among TB patients in Machakos County, Kenya. A cross-sectional study

Despite efforts to implementation of the DOTS programme in Kenya since the year (1993) and achieving 100% coverage by the year 1996; new TB cases continue to emerge in communities, a significance of TB transmission. The success of the DOTS programne require total adherence to treatment for those infected with TB and appropriate control measures as stipulated in TB treatment guidelines, trained manpower to manage the infected patients and surveillance. The main objective of this study was to examine the health seeking behavior of TB patients, practices of TB and access to health care. A cross- sectional survey of TB patients was done in Athi-River, Machakos level 5 and Mutituni TB treatment health facilities in Machakos County. A pre-tested self administered questionnaire/ interviews was used to collect data. The data was analyzed by use of statistical package for social sciences (SPSS) version 16. Pearson Chi-Square analysis was used to determine the relationships between variables. Level of significance was fixed at 0.05 (p=0.05).The results of this study reveal TB is affecting  more males than females (60.4%).Most of the TB patients are young below 40 years accounting for (71.8%),  are poor and unemployed (65%).When the TB patient realized they were sick, most of them (81.4%) sought informal remedies from private practioners or self medicated. This delayed early opportunity to seek heath care for more than one month by (82%) of the respondents. Failure of the informal treatment and unbearable pains in advanced disease forced the majority (96.8%) to seek health care in designated TB treatment facilities. There is secrecy in TB status disclosure as (75.5%) declined to openly disclose. For those who disclosed (78%) was to a selected family member mainly to seek assistance (90.7%). Across age groups, educational level, marital status, disclosure of TB status was of no statistical significance p=0.462 and openness of status p=0.112 respectively as the majority remained secret. Health education received by (52.8%) in the TB clinics was observed to significantly influence clinic attendance p=0.014 and adherence to treatment p=0.008 as 78.5% attended regularly and 85.5% adhered respectively. Treatment in public facilities is free with the majority (89.9%) reporting attendance.  TB patients care in the community is  mainly by family members (74.8%), there is no follow up by heath workers and social support group is minimal at (11.4%).The ministry of health needs to address  control measures by initiating strict surveillance of TB, initiate community education on best practices of  TB and to distigmatize the disease. Key words Health seeking behavior of TB patients, practices of TB and access to health care in Machakos Count

Lay beliefs, practices of TB and HIV/AIDS among the community members living in Machakos County, Kenya: A cross sectional study

Knowledge of lay beliefs on existence, cause, mode of TB transmission, and the association of TB/HIV relationship are key entry point to initiate effective prevention and control of TB in communities. Misconceptions of this result to fear and stigma that can sustain TB transmission. The main objective of this study was to determine the study community beliefs of TB, its relationship with HIV/AIDS and to quantify prevention practices. A cross- sectional survey of community members was done in Athi-river and Central Divisions of Machakos County. A pre-tested self administered questionnaire and researcher assisted interviews was used to collect data. The data was analyzed by use of statistical package for social sciences (SPSS) version 16. Pearson Chi-Square analysis was used to determine the relationships between variables. Level of significance was fixed at 0.05 (p=0.05). The results of this study reveal a majority (90.6%) of the community is aware of the existence of TB and that 90.1% believe  it can be transmitted p<0.05 respectively. Misconceptions and lay beliefs on the cause and mode of TB disease transmission was prevalent with (90.8%) blaming these on unrelated factors such as smoking, poor hygiene, HIV/AIDS, hereditary and sharing eating utensils respectively. The community practices were discriminatory as they separated eating utensils of TB patients or isolated them as a way of preventing the disease spread which causes fear. A slight majority of the community (46.5%) believes TB is related to HIV/AIDS, a disease of stigma citing similarity of symptoms .The rest obseveve there is no relationship and said the symptoms and modes of transmission are different. The Ministry of health needs to urgently bridge this gap by disseminating health education on TB and TB/ HIV/AIDS relationships in the communities to demystify fear that result from misconceptions. Key words: Lay Beliefs and practices of TB & HIV/AIDS, Community of Machakos County Kenya

The Effect of Employee Welfare on Employee Commitment at Judicial Service of Kenya

Employee’s commitment is a major problem facing many organizations worldwide. Many organizations are therefore employing various human resource management practices as measure to improve the level of employee commitment. In Kenya the level of employee commitment in constitutional offices have been on declining trend. At Judicial Service Commission, discontent has been expressed in the area of remuneration characterized by discrimination in rewards; inadequate pay vis-à-vis the work load. The objective of this study was thus to evaluate the effect of employee welfare on employee commitment at Judicial Service Commission. A descriptive research design was adopted for this study. The population of interest was the 412 employees of Judicial Service Commission across various functions and divisions. Using a stratified random sampling technique, a sample size of 213 respondents was picked. A questionnaire was used to collect data for the study while descriptive statistics and inferential statistics were used to analyze collected data. The study findings indicated that 98% of the variation on employee commitment at judicial service commission in Kenya is determined by employee welfare. The study concluded that employee welfare in an organization is an important factor in the determination of employee commitment. The study recommended that Judicial Service Commission should design and implement an effective welfare policy for their employee. Key Words: Employee Welfare, Employee Commitment, Judicial Service Commission DOI: 10.7176/EJBM/12-30-10 Publication date:October 31st 202

Depressive Disorders among Workers in the Selected Hotels in the Capital City of Kenya: A Cross Sectional Study on Prevalence and Correlates

Background: Depressive symptoms are potential outcomes of poorly functioning and demanding work environments. Such symptoms are frequent and cause considerable suffering for the employees as well as financial loss for the employers. As a major hub of tourist attraction and the current consistent terrorism threats, workers in hotel industries in Nairobi Kenya have significant pressure not only to deliver quality services but also are faced with declining tourist flow. Accordingly, studies of psychosocial working conditions and depressive symptoms in this industry are valuable. Objective: This study measured the levels of depressive disorders and associated correlates among workers in selected luxury hotel industries in Nairobi Kenya. Methods: This cross-sectional study, consented and enrolled 360 workers in selected hotels in Nairobi. A sociodemographic based questionnaire and a mental health screening tool; Patient Health Questionnaire (PHQ-9) were used to gather information relevant to this study. The data was analyzed for central tendencies as well as for any associations and correlations. Results: The mean age of the 360 respondents was 28.4 (SD± 4.98) years. The majority 84.2% were aged 20 to 30 years, 55.3% had secondary level education, 35.3% worked as waiters. Using the PHQ-9, 9.2% had major depressive disorder while 10% were categorized as other depressive disorders. In multivariate analysis, major depressive disorders were independently associated with staying in temporary housing (OR 0.1, 95% CI 0.03 to 0.6) and those whose adult household population was between 1 to 3 persons (OR 2.7, 95% CI 1.03 to 7). The other depressive disorders were independently associated with working in low end hotels (OR 5.3, 95% CI 1.2 to 22.7); having primary education level (OR 3.9, 95% CI 1.1 to 15.9); staying in temporary houses (OR 0.3, 95% CI 0.1 to 0.8); and with monthly income of 10,000 to 50,000 KSh (100 to 500USD). The Key informant interviews identified poor remuneration, management disregard to employees input, negative attitude from work and colleagues, hostile treatment by clients, employers and colleagues, long working hours, poor diet, domestic problems, political instabilities, pressure from family members and high standards of living as some of the factors contributing to work related depression. Conclusion: Cumulatively, significantly high proportion of hotel workers suffer from depressive disorders in Nairobi. If correlates such as socio-demographic and economic, influenced by working conditions are not tackled, workers in hotel industries in Nairobi are poised to record one of the highest levels of depressive disorders in Kenya. Keywords: Depressive disorders, Workers in selected hotels, Nairobi Kenya

Understanding abortion-related stigma and incidence of unsafe abortion: experiences from community members in Machakos and Trans Nzoia counties Kenya

Introduction: The rate of unsafe abortions in Kenya has increased from 32 per 1000 women of reproductive age in 2002 to 48 per 1000 women in 2012. This is one of the highest in Sub-Saharan Africa. In 2010, Kenya changed its Constitution to include a more enabling provision regarding the provision of abortion services. Abortion-related stigma has been identified as a key driver in silencing women's ability to reproductive choice leading to seeking to unsafe abortion. We sought to explore abortion-related stigma at the community level as a barrier to women realizing their rights to a safe, legal abortion and compare manifestations of abortion stigma at two communities from regions with high and low incidence of unsafe abortion. Methods: A qualitative study using 26 focus group discussions with general community members in Machakos and Trans Nzoia Counties. We used thematic and content analysis to analyze and compare community member's responses regarding abortion-related stigma. Results: Although abortion is recognized as being very common within communities, community members expressed various ways that stigmatize women seeking an abortion. This included being labeled as killers and are perceived to be a bad influence for women especially young women. Women reported that they were poorly treated by health providers in health facilities for seeking abortion especially young unmarried women. Institutionalization of stigma especially when Ministry of Health withdrew of standards and guidelines only heightened how stigma presents at the facilities and drives women seeking an abortion to traditional birth attendants who offer unsafe abortions leading to increased morbidity and mortality as a result of abortion-related complications. Conclusion: Community members located in counties in regions with high incidence of unsafe abortion also reported higher levels of how they would stigmatize a woman seeking an abortion compared to community members from counties in low incidence region. Young unmarried women bore the brunt of being stigmatized. They reported a lack of a supportive environment that provides guidance on correct information on how to prevent unwanted pregnancy and where to get help. Abortion-related stigma plays a major role in women's decision on whether to have a safe or unsafe abortion.Pan African Medical Journal 2016; 2

Fully immunized child:coverage, timing and sequencing of routine immunization in an urban poor settlement in Nairobi, Kenya

Median age of vaccination. Table S2a: Median age of vaccination (days) among non-FIC children aged 12–23 months. Table S2b: Median age of vaccination (days) among FIC children aged 12–23 months. (XLSX 17 kb