Assessment of Patient Satisfaction with Nursing Care at a Large Public Referral Hospital in Kenya

Patient satisfaction with nursing care is known to predict patient outcomes. Nursing care offered by the largest single technical group in any hospital, is known to often determine the overall quality of care offered. This study hence examined the extent to which patients at a Referral hospital in Western Kenya are satisfied with the nursing care they receive. A cross sectional exit survey of discharged patients using a self-administered patient questionnaire was used. 274 patients participated, of which 65.6% were female. 94.1% had formal education with 59.1% reporting that this was their maiden visit to the hospital. Overall, 87% of patients felt satisfied with nursing care received. Most (81.8%) of the patients interviewed felt they had been promptly attended to, with a further 71.6% rating the nurses as competent and knowledgeable in their clinical care. The ward in which the patient had been admitted and the number of days a patient had spent in hospital were found to be significantly associated with reporting of overall satisfaction with nursing care (p=0.037 & 0.03 respectively). Since nursing care is determinant of patient outcomes during hospitalization, clinical care administrators should often emphasize on the Nurses’ technical competence and interpersonal relationships throughout patient care. Prompt quality nursing care should be prioritized to match with patient expectations in each hospital units and ensure patient satisfaction through reduction of length of stay in hospital. Key words: Assessment, patient satisfaction, nursing car

Symptomatic malaria enhances protection from reinfection with homologous Plasmodium falciparum parasites

A signature remains elusive of naturally-acquired immunity against Plasmodium falciparum. We identified P. falciparum in a 14-month cohort of 239 people in Kenya, genotyped at immunogenic parasite targets expressed in the pre-erythrocytic (circumsporozoite protein, CSP) and blood (apical membrane antigen 1, AMA-1) stages, and classified into epitope type based on variants in the DV10, Th2R, and Th3R epitopes in CSP and the c1L region of AMA-1. Compared to asymptomatic index infections, symptomatic malaria was associated with reduced reinfection by parasites bearing homologous CSP-Th2R (adjusted hazard ratio [aHR]:0.63; 95% CI:0.45–0.89; p = 0.008) CSP-Th3R (aHR:0.71; 95% CI:0.52–0.97; p = 0.033), and AMA-1 c1L (aHR:0.63; 95% CI:0.43–0.94; p = 0.022) epitope types. The association of symptomatic malaria with reduced hazard of homologous reinfection was strongest for rare epitope types. Symptomatic malaria provides more durable protection against reinfection with parasites bearing homologous epitope types. The phenotype represents a legible molecular epidemiologic signature of naturally-acquired immunity by which to identify new antigen targets

Household concentrations and female and child exposures to air pollution in peri-urban sub-Saharan Africa: measurements from the CLEAN-Air(Africa) study.

BackgroundRelatively clean cooking fuels such as liquefied petroleum gas (LPG) emit less fine particulate matter (PM2·5) and carbon monoxide (CO) than polluting fuels (eg, wood, charcoal). Yet, some clean cooking interventions have not achieved substantial exposure reductions. This study evaluates determinants of between-community variability in exposures to household air pollution (HAP) across sub-Saharan Africa.MethodsIn this measurement study, we recruited households cooking primarily with LPG or exclusively with wood or charcoal in peri-urban Cameroon, Ghana, and Kenya from previously surveyed households. In 2019-20, we conducted monitoring of 24 h PM2·5 and CO kitchen concentrations (n=256) and female cook (n=248) and child (n=124) exposures. PM2·5 measurements used gravimetric and light scattering methods. Stove use monitoring and surveys on cooking characteristics and ambient air pollution exposure (eg, walking time to main road) were also administered.FindingsThe mean PM2·5 kitchen concentration was five times higher among households cooking with charcoal than those using LPG in the Kenyan community (297 μg/m3, 95% CI 216-406, vs 61 μg/m3, 49-76), but only 4 μg/m3 higher in the Ghanaian community (56 μg/m3, 45-70, vs 52 μg/m3, 40-68). The mean CO kitchen concentration in charcoal-using households was double the WHO guideline (6·11 parts per million [ppm]) in the Kenyan community (15·81 ppm, 95% CI 8·71-28·72), but below the guideline in the Ghanaian setting (1·77 ppm, 1·04-2·99). In all communities, mean PM2·5 cook exposures only met the WHO interim-1 target (35 μg/m3) among LPG users staying indoors and living more than 10 min walk from a road.InterpretationCommunity-level variation in the relative difference in HAP exposures between LPG and polluting cooking fuel users in peri-urban sub-Saharan Africa might be attributed to differences in ambient air pollution levels. Thus, mitigation of indoor and outdoor PM2·5 sources will probably be critical for obtaining significant exposure reductions in rapidly urbanising settings of sub-Saharan Africa.FundingUK National Institute for Health and Care Research

Post-Fieldwork Workshop Report

The project worked to develop an education model and implementation plan for the training and provision of health services in refugee contexts, that fits the cross-sector experiences of the partner institutions (University of Toronto, Canada; York University, Canada; and Moi University, Kenya). At this workshop, the partners deliberated on the implications of research results and focus group discussions and the way forward in developing the envisioned new health degree program. This report outlines activities of the workshop regarding development of curricula and implementation of the proposed Community Health Education degree program

Training and utilization of refugees as community health workers in protracted displacement situations : policy brief

The goal is to inform an education model for building health care capacity in disadvantaged communities in Kenya. The Daadab refugee camps represent a protracted displacement situation in an extreme resource-limited setting with an acute shortage of community health workers (CHWs). Here, refugees trained as CHWs play an important role in extending primary health care services. Yet their training is limited and may not adequately prepare them to deal with challenges arising in this context. The research investigates CHWs’ current training, their scope of responsibilities, their challenges, and whether they would be interested in a university degree program in community health

Education model for building health care capacity in protracted refugee contexts : policy brief

Reliance on humanitarian NGOs for health care in protracted displacement situations like Dadaab is not sustainable. Refugees need to be equipped to play a greater role in providing primary health care for their communities. Findings of project research clearly indicated overwhelming support for the development of a health-related degree, with most prospective students and community health workers expressing interest in taking the degree. As a result, a BSc degree in Community Health Education has been developed and ready for implementation. This policy brief highlights the importance of developing education models aimed at addressing health and higher education equity issues in protracted refugee situations

Changes in the burden of malaria in sub-Saharan Africa.

The burden of malaria in countries in sub-Saharan Africa has declined with scaling up of prevention, diagnosis, and treatment. To assess the contribution of specific malaria interventions and other general factors in bringing about these changes, we reviewed studies that have reported recent changes in the incidence or prevalence of malaria in sub-Saharan Africa. Malaria control in southern Africa (South Africa, Mozambique, and Swaziland) began in the 1980s and has shown substantial, lasting declines linked to scale-up of specific interventions. In The Horn of Africa, Ethiopia and Eritrea have also experienced substantial decreases in the burden of malaria linked to the introduction of malaria control measures. Substantial increases in funding for malaria control and the procurement and distribution of effective means for prevention and treatment are associated with falls in malaria burden. In central Africa, little progress has been documented, possibly because of publication bias. In some countries a decline in malaria incidence began several years before scale-up of malaria control. In other countries, the change from a failing drug (chloroquine) to a more effective drug (sulphadoxine plus pyrimethamine or an artemisinin combination) led to immediate improvements; in others malaria reduction seemed to be associated with the scale-up of insecticide-treated bednets and indoor residual spraying

What Is Threatening the Effectiveness of Insecticide-Treated Bednets? A Case-Control Study of Environmental, Behavioral, and Physical Factors Associated with Prevention Failure.

Insecticide-treated nets are the cornerstone of global malaria control and have been shown to reduce malaria morbidity by 50-60%. However, some areas are experiencing a resurgence in malaria following successful control. We describe an efficacy decay framework to understand why high malaria burden persists even under high ITN coverage in a community in western Kenya.We enrolled 442 children hospitalized with malaria and paired them with age, time, village and gender-matched controls. We completed comprehensive household and neighborhood assessments including entomological surveillance. The indicators are grouped into five domains in an efficacy decay framework: ITN ownership, compliance, physical integrity, vector susceptibility and facilitating factors. After variable selection, case-control data were analyzed using conditional logistic regression models and mosquito data were analyzed using negative binomial regression. Predictive margins were calculated from logistic regression models.Measures of ITN coverage and physical integrity were not correlated with hospitalized malaria in our study. However, consistent ITN use (Adjusted Odds Ratio (AOR) = 0.23, 95%CI: 0.12-0.43), presence of nearby larval sites (AOR = 1.137, 95%CI: 1.02-1.27), and specific types of crops (AOR (grains) = 0.446, 95%CI: 0.24-0.82) were significantly correlated with malaria amongst children who owned an ITN. The odds of hospitalization for febrile malaria nearly tripled when one other household member had symptomatic malaria infection (AOR-2.76, 95%CI:1.83-4.18). Overall, perfect household adherence could reduce the probability of hospitalization for malaria to less than 30% (95%CI:0.12-0.46) and adjusting environmental factors such as elimination of larval sites and growing grains nearby could reduce the probability of hospitalization for malaria to less than 20% (95%CI:0.04-0.31).Availability of ITNs is not the bottleneck for malaria prevention in this community. Behavior change interventions to improve compliance and environmental management of mosquito breeding habitats may greatly enhance ITN efficacy. A better understanding of the relationship between agriculture and mosquito survival and feeding success is needed

What Is Threatening the Effectiveness of Insecticide-Treated Bednets? A Case-Control Study of Environmental, Behavioral, and Physical Factors Associated with Prevention Failure

<div><p>Background</p><p>Insecticide-treated nets are the cornerstone of global malaria control and have been shown to reduce malaria morbidity by 50–60%. However, some areas are experiencing a resurgence in malaria following successful control. We describe an efficacy decay framework to understand why high malaria burden persists even under high ITN coverage in a community in western Kenya.</p><p>Methods</p><p>We enrolled 442 children hospitalized with malaria and paired them with age, time, village and gender-matched controls. We completed comprehensive household and neighborhood assessments including entomological surveillance. The indicators are grouped into five domains in an efficacy decay framework: ITN ownership, compliance, physical integrity, vector susceptibility and facilitating factors. After variable selection, case-control data were analyzed using conditional logistic regression models and mosquito data were analyzed using negative binomial regression. Predictive margins were calculated from logistic regression models.</p><p>Results</p><p>Measures of ITN coverage and physical integrity were not correlated with hospitalized malaria in our study. However, consistent ITN use (Adjusted Odds Ratio (AOR) = 0.23, 95%CI: 0.12–0.43), presence of nearby larval sites (AOR = 1.137, 95%CI: 1.02–1.27), and specific types of crops (AOR (grains) = 0.446, 95%CI: 0.24–0.82) were significantly correlated with malaria amongst children who owned an ITN. The odds of hospitalization for febrile malaria nearly tripled when one other household member had symptomatic malaria infection (AOR–2.76, 95%CI:1.83–4.18). Overall, perfect household adherence could reduce the probability of hospitalization for malaria to less than 30% (95%CI:0.12–0.46) and adjusting environmental factors such as elimination of larval sites and growing grains nearby could reduce the probability of hospitalization for malaria to less than 20% (95%CI:0.04–0.31).</p><p>Conclusion</p><p>Availability of ITNs is not the bottleneck for malaria prevention in this community. Behavior change interventions to improve compliance and environmental management of mosquito breeding habitats may greatly enhance ITN efficacy. A better understanding of the relationship between agriculture and mosquito survival and feeding success is needed.</p></div