Purpose: Maternal mortality ratio and morbidity remain high and one of the strategies to reduce maternal mortality ratio is the effective implementation of focused antenatal care. This study aimed to determine factors associated with adherence to focused antenatal care by nurses and midwives. Methodology: The study adopted an analytical cross-sectional research design. It involved 55 nurses and midwives working at the antenatal clinic in the level 4 (sub-county referral) hospitals, level 3 (health centers), and level 2 (dispensaries) in selected health facilities at Imenti-South sub-county facilities of Meru County. A census was done on all nurses and midwives working at selected health facilities in the Imenti-South Sub-County of Meru County. Data was collected using an observational checklist and a researcher-administered questionnaire. Pre-testing of the data collection instruments was done at public health facilities in the Imenti-central Sub-county of Meru County. Analysis was carried out using SPSS version ­­­27. Descriptive statistics i.e. mean, standard deviation, percentages, and frequencies were used to analyze data. Quantitative data is presented in the form of tables, charts, and graphs. Findings: There were slightly more participants with good adherence to FANC guidelines (50.9%) than those with poor adherence (49.1%). Adherence was significantly associated with the level of the facility (χ2 = 9.894, df=2 and p = 0.007) although it was not a significant predictor of adherence (p>0.05). There was a significant association between adherence and availability of resources (p= 0.012, COR= 4.364; CI = 95% 1.383,13.772). Unique Contribution: The MCH unit in charge should ensure that departments have the necessary resources required to offer the ANC services. The county government in collaboration with the national government should ensure there are adequate resources in all the facilities required to offer ANC services.

Background: The most efficient and cost-effective forms of birth control are long-acting reversible contraceptives (LARC). In spite of their effectiveness, less than 15% of women globally who are of reproductive age use LARC while in Kenya, 18% of women of reproductive age are using LARC methods. The objective of the study was to determine the level of knowledge on LARC among Women of Reproductive Age (WRA) receiving care at the Meru Teaching and Referral Hospital. Methods: This study used analytical cross-sectional survey research design to collect data from ten key informants chosen through purposive sampling, and 170 women were chosen by systematic random sampling using a semi-structured questionnaire. Embu Teaching and Referral Hospital served as the pretesting site for the research tools. Chi-square tests were utilized to examine the relationship, at a 95% confidence interval, between the uptake of LARC and level of knowledge of LARC. The strength of association was tested using regression analysis. Results: The majority of the mothers (51.2%) were in the 20–29 age range, with a small percentage (n=5, 2.9%) being older than 40; the married women were more (n=106, 62.4%) and half of the mothers had secondary level of education (n=85, 50%) unlike that of the partner that was found to be mostly tertiary level of education (n=102, 60%). A larger proportion of the women had 1-2 living children (n=106, 62.4%). However, majority of the women were either house wives or students (n=63, 37.1% and n=60, 35.3%) respectively. A high percentage of the women were Christian (n=153, 90%) with a larger proportion residing on rental houses (n=122, 71.8%). The uptake rate for LARC among women who were of reproductive age was 11.2%. Good level of knowledge influenced LARC uptake at x2(N=170), 5.16, p=.018. Conclusion: The study concluded that LARC uptake among women of reproductive age was impacted by individual level of knowledge on LARC. The study recommends, the ministry of hea

Purpose: Focused antenatal care is essential to improving neonatal and maternal health by preventing, identifying, and treating medical conditions that endanger a pregnant woman’s health besides a fetus. This study aimed to determine nurses’ and midwives’ adherence to set procedures in focused antenatal care. Methodology: The study adopted an analytical cross-sectional research design. It involved 55 nurses and midwives working at the antenatal clinic in the level 4 (sub-county referral) hospitals, level 3 (health centers), and level 2 (dispensaries) in selected health facilities at Imenti-South sub-county facilities of Meru County. A census was done on all nurses and midwives working at selected health facilities in the Imenti-South Sub-County of Meru County. Data was collected using an observational checklist and a researcher-administered questionnaire. Pre-testing of the data collection instruments was done at public health facilities in the Imenti-central sub-county of Meru County. Analysis was carried out using SPSS version ­­­27. Descriptive statistics i.e. mean, standard deviation, percentages, and frequencies were used to analyze data. Quantitative data is presented in the form of tables, charts, and graphs. Findings: The mean age of the participants was 35.91 ±10.92 SD with more than half being less than 36 years (56.4%). The majority were females (60%). About three-quarters had a diploma in nursing. The majority of the facilities were level II (60%). More than half of the nurse-midwives had no in-service training on FANC (72.7%). There were slightly more participants with good adherence to FANC guidelines (50.9%) than those with poor adherence (49.1%). Adherence was significantly associated with the level of the facility (χ2 = 9.894, df=2 and p = 0.007) although it was not a significant predictor of adherence (p>0.05). The percentage of nurse-midwives with good and poor adherence to FANC guidelines was almost equal. Unique Contribution: There is a need to train the nurse-midwives on the current FANC guidelines as well as provide continuous monitoring and evaluation to enhance adherence. The county government in collaboration with the national government should come up with training manuals to train the nurses and midwives on the FANC guidelines.

Introduction: Perinatal death refers to the loss of a fetus or neonate between 28 weeks of gestation (or weighing 500 g) and 7 days after birth. Globally, 3.3 million stillbirths and 2.8 million early neonatal deaths occur each year, with 98% reported in low and middle-income countries. These losses significantly impact maternal mental health, often resulting in grief, depression, and anxiety. This study explored grief levels among postpartum mothers in Tharaka Nithi County, Kenya, following perinatal loss and how this grief affects psychological wellbeing. Methodology: Anchored in Kübler-Ross’s Stages of Grief theory, a randomized controlled trial (RCT) was implemented in three phases: baseline, intervention, and post-intervention. A total of 53 mothers and 10 counselling staff were selected using census and purposive sampling from hospital mortality records respectively. 2 data collection instruments were used-Perinatal Grief Scale (PGS) and structured questionnaires. SPSS was used to analyze data quantitatively. Descriptive statistics summarized participant data, while correlation, regression and independent and paired t-tests assessed relationships and intervention impacts. Results: Most respondents reported low to moderate grief (82.6%) post-intervention, compared to 71.4% in the control group, with a significant correlation between higher grief scores and depressive symptoms (p < 0.01). Conclusion: There was reduced mean scores among the experimental group, compared to higher scores in the control group substantially in despair, indicating that counselling helped reduce unresolved grief. Difficulty Coping also declined significantly suggesting an increase in emotional regulation and resilience, and decrease in Active Grief scores reflected a reduction in intense emotional reactions such as intrusive thoughts on the baby. The study recommended integrating psychosocial support and culturally sensitive and structured grief counselling through community-based systems to enhance awareness, reduce stigma, and improve maternal psychological wellbeing.

Globally, delayed diagnosis of Tuberculosis (TB) is a significant contributor to spread of TB despite avaiability of diagnostic aligorithm and advanced diagnostic machine. Kenya is still grouped among high TB burden nations and has the highest TB incidences in East Africa. This has been associated with delays in diagnosis, resulted to either individual or community health and economic challenges. The purpose of this study was to assess health system related factors influencing timely diagnosis of TB in Tharaka Nithi County. A descriptive crossectional survey study design was adopted among 154 randomly selected patients and 12 purposively selected key informants in selected hospitals in Tharaka Nithi County. A self administered questionaire and key informant guide were used to collect data among patients and key informants respectively. Descriptive and inferential statistics were used to analyse data. Bivariate analysis was used to test the strength of association between health system related factors and duration of TB before diagnosis. Qualitative data was analysed thematically. Study findings revealed that most (70.86%, n=107) respondents delayed in diagnosis. Bivariate regression results revealed that multiple visits (OR=3.24;95%CI:1.55-6.76,p=0.002), long turnarround time (OR=2.38 ;95% CI:1.06-5.30;p=0.035), cash payment (OR=4.53;95%CI:1.82-11.23; p= 0.001), far diagnostic centers (OR=3.86;95%CI:1.71-8.73;p=0.001),lack of prior TB health education (OR=2.71; 95%CI: 1.29-5.64;p=0.008) and long laboratory results turnarround time (OR=2.49; 95% CI: 1.29-5.64; p=0.016) as significants associated with delayed diagnosis. Machine breakdown, misdiagnosis, and inadequate counselling on TB were identified as precipiators of diagnostic delay within a hospital. The study recommends empowerment of community based-hospital referral system, strengthening of collaboration between County government and independent service providers, equiping health facility and continuous training on TB diagnosis and care. Key words: Timely diagnosis, Health System Related, Tuberculosis, Delay, Barriers

Nursing Process is a proven means of standardizing patients` care and maintaining the autonomy of the nursing profession. It is considered globally as a standard tool which gives nurses opportunity of caring for patients in a scientific, holistic, and flexible way (1, 2). If nursing process is utilized properly, it enables nurses to offer independent care to patient (2), However, certain hospital-related factors are thought to influence nurses` implementation of the nursing process (3). To assess Nurses` perspective on the effect of certain Hospital-related factors on implementation of the Nursing Process in Chuka level 5 Hospital in Kenya. A cross-sectional survey done at Chuka level 5 hospital in Kenya. Study population were nurses working in Chuka hospital. Simple random sampling was used to get 30 nurses to make the study sample. Questionnaires were employed for data collection. Data summary was done using descriptive statistics and presented in tables. Study participants` mean age was 37.2 (±9.3) with majority being females (46.7% (n=14)), married (76.7% (n=23)), and with diploma qualification (56.7 % (n=17)). The majority of the study participants felt that status of a number of hospital related factors that play critical part in implementation of the nursing process were inadequate with staffing, resources availability leading in the inadequate verdict by over 70% of the study participants. Majority (80%) of the participants felt that the nurse-patient ratio was negatively influencing their ability to implement the nursing process. However, they were more or less equally divided on their perception as to whether each of the remaining factors were influencing their utilization of the nursing process either positively or negatively. The study participants reported the presence of inadequacy of hospital-related factors which negatively impacted on their implementation of the nursing process. Hospital management should prioritize the implementation of the nursing process by allocating adequate resources and proving active leadership on the same, as it is key in the delivery of quality nursing care.

Background: Non-communicable diseases (NCDs) are the leading cause of global morbidity and mortality. Globally, more than 1.28 billion adults are hypertensive and in Kenya, 24% of adult population has elevated blood pressure and 56% of these have never been screened for hypertension. Assessment of clinical profile helps guide the management of hypertensive patients towards obtaining normal blood pressure levels. The aim of this study was to investigate the clinical profile of hypertensive patients at the Meru Teaching and Referral Hospital in Kenya. Methods: A cross sectional survey was conducted and systematic random sampling was used to sample 75 hypertensive patients who participated in the study. The collected data were summarized using frequencies and percentages. Chi square was used to assess the relationship between the participants’ demographic characteristics, clinical profile and hypertension. Statistical significance was set at p≤0.05. Results: The average mean age of the participants was 58.53 years and majority were female (52%). Thirty-three (33.3%) were overweight and 24% were obese. The mean body mass index (BMI) for both genders was 26.48±5.24, the mean waist-to-hip ratio (WHR) and waist circumference (WC) was 0.94 and 102.09 respectively with 85.3% of the participants having a substantially increased WHR. Diabetes was the most common comorbidity (70.73%). Of the five clinical profiles assessed (BMI, RBS, WHR, presence of comorbidities and drug used) only the presence of comorbidity was associated with BP levels χ2 (10.01,3), p=0.018. Conclusions: Participants had high blood pressure, BMI, WHR and WC readings as well as several comorbidities.

Background: Male participation in partner modern contraceptive use is a viable strategy for improving modern contraceptive prevalence among married women. Increasing the uptake of modern contraceptives has been shown to significantly reduce maternal deaths resulting from unsafe abortions due to unintended pregnancies. In Kenya, the level of management in their partner's use of modern contraceptives is low. Therefore, it is imperative to establish the factors that influence the participation of men. This study explored the socio-cultural factors that influence married men's participation in their partners' contraceptive use in Dallas sub-location, Embu County, Kenya. Methods: A community-based cross-sectional survey was undertaken involving married men aged 18 to 64 years. Data were collected using a semi-structured and interview-administered questionnaire developed by the researchers. Statistical Package for Social Sciences (SPSS) version 28.0 was used to analyze data. Frequencies and percentages were used to summarize study findings. Association between the dependent and independent variables was analyzed using the Chi-square test. P-value of < 0.05 was considered to be statistically significant association between the variables. Study findings were presented in narrative form and by use of tables. Results: The mean age of the participants was 38.8 (SD+9.3). The majority of the participants (82.9%) indicated that their partners were using a modern contraceptive method. Most participants (86.3%) were participating in their partner modern contraceptive use. The main socio-cultural determinants of men participation were the number of children (p

Background: The choice of maternity care model is a pivotal decision in every expectant mother's journey, influencing her pregnancy, childbirth, and postpartum experience. Objective: This integrative literature review explores various maternity care models, their long-term effects, and their impact on safety, cost-effectiveness, quality, and acceptability. Methods: The study conducted an extensive review of the literature from five databases: CINAHL, MIDIRS, SCOPUS, MEDLINE, and Web of Science. Results: The findings indicate that the midwifery-led care model emerges as the safest, most cost-effective, highest-quality, and widely acceptable approach to maternity care. Conclusion: This review underscores the significance of promoting midwifery-led care as a cornerstone in maternal healthcare. Key words: Safest, Sustainable, Cost-effective, High-Quality, Acceptable Model, Maternity Care, Integrative Literature Review.

Background: Morbidity and mortality associated with cancer significantly contribute to the increasing non-communicable disease burden. Cancer affects populations across the lifespan but its diagnosis is disproportionately higher in later years of life. The Sub-Saharan Africa region, Kenya included has a high incidence of prostate cancer. Meru County has significantly contributed to the rising incidences of cancer including cancer of the prostate (19.4%). The aim of this study was to assess the knowledge level of PCa among men with UTIs and determine the associated factors. Methods: In this descriptive cross-sectional survey sixty-five men with UTIs were purposively sampled at Meru Teaching and Referral Hospital, outpatient department. A semi-structured researcher-administered questionnaire was used to capture participant demographic data, anthropometric details and knowledge of PCa. Data were analyzed using Statistical Package of Social Sciences (v.27) and was presented in tables and graphs. Results: The mean age of the participants was 61.8(±13.5). The majority were married (73.8%) and most were living in rural parts of Meru County (72.3%). Almost 2/3 had primary education and above (64.6%). There were more Christian participants (83.1%). History of BPH and PCa was reported by 43.1% and 32.3% of the participants respectively. The highly and recognized risk factors were older age and use of alcohol and tobacco (87.7%). The highly recognized signs and symptoms for PCa were incomplete emptying of the bladder (96.9%). Participants had high knowledge of PCa risk factors (68.9%) and signs and symptoms (82.7%). In general, participants had high knowledge of PCa (69.2%), a mean score of 76.6 % (±17.23) and a range of 27-100. The knowledge level of PCa was associated with the level of education [((1, χ2n=65) = 6.532, p = 0.038] although it was not a significant predictor. Conclusion and Recommendation: Men ≥40 years with UTIs are highly knowledgeable about PCa risk factors and signs and symptoms. There is a need to establish if the high knowledge translates to the prevention of the disease. Key words: Knowledge; prostate cancer; Urinary Tract Infections; Kenya

Background: Nursing services are very crucial in the care of orthopedic patients in terms of satisfaction with quality care. Patients’ perception on the optimum nursing care is the view from the point of service delivery to assessment post-delivery. Thus, the study intended to assess patients’ perceptions to achieving optimum nursing care and health outcome in Kerugoya County Referral Hospital (KCRH). Methods: Data was collected prospectively within a period of one month using cross sectional analytical design. Census was utilized to get 70 orthopedic patients and 30 healthcare workers in orthopedic units. Result: About of the participants had a negative perception of the healthcare workers not having adequate time and also not working as a team. Despite this, more than half (54.3%) of the patients had a positive attitude towards the care offered. Overall satisfaction with the services offered (AOR= 7.8, C. I= 1.010-13.995, p-value = 0.039). Conclusion: Patients perceived sub-optimal nursing care of health worker time for their care and health worker teamwork but despite this there was better overall positive attitude on optimum healthcare offered. Key words: health outcome, optimum nursing care, perception, orthopedic patient, Kenya

The Purpose of this research was to determine how patient related perioperative risks influences surgical outcomes among patients undergoing elective surgery at Chuka County referral hospital. The study adopted a descriptive cross-sectional design. The target population consisted of 2005 patients who underwent elective surgery from the hospital records during the year 2021. A sample size of 202 patients was achieved through systematic sampling method. Both structured questionnaire and interview schedule were used to collect data. Quantitative information for each variable under examination was described using frequencies and percentages. At a 5% level of significance, a Chi square was employed to evaluate the association between patient related perioperative risks factors and surgical outcomes. The study revealed that the presence of comorbidities and the type of comorbidity, alcohol consumption and cigarette smoking had a statistically significance influence on surgical outcomes among patients undergoing elective surgery at 5% significance level. The study concluded that patient-related perioperative risks factors have adverse effects on surgical outcomes among patients undergoing elective surgery. Therefore, patients scheduled for elective surgical procedure that are found to have medical conditions, alcoholics and cigarette smokers that are known to increase perioperative risks, preoperative evaluation should include optimization or pre-habilitation. This will guarantee patients undergoing elective surgery positive surgical outcomes with minimal complications and reduced morbidity and mortality rates. Key words: Patient-related Perioperative Risks; Perioperative Risks; Elective Surgery; Surgical Outcomes

- Pressure injuries are wounds which occur on bony prominences, following prolonged hours of pressure or shear. Their incidence in community settings could be as high as 80%, but application of basic prevention knowledge can avert this trend. The objectives of the study were to determine the level of pressure injury knowledge after a training intervention, to determine the pressure injury prevention practice after the training intervention, and to examine the relationship between post training knowledge, and pressure injury prevention practice. This was a randomized controlled trial, which was conducted at multiple sites, that is, at Embu Level 5 Teaching and Referral Hospital, Kenya, and at patients’ homes. It was organized in three phases, that is, baseline survey, intervention, and evaluation phases. Phase one was conducted at the hospital, while phase two and three were conducted at patients’ homes. The overall sample size was 34 primary home caregivers, who were selected using simple random sampling technique, and assigned into experimental (n=17) and control groups (n=17) respectively. Data was collected using a researcher administered questionnaire, and an observation checklist. Approval to collect

Background: Maternal morbidity and mortality is a global health concern. Use of modern contraceptive has the potential of reducing maternal mortality by two thirds. However, the prevalence of modern contraceptives is low especially in sub–Saharan Africa region. Male participation has been promoted as one of the strategies to increase contraceptive prevalence. The objective of the study was to determine the influence of contraceptive knowledge on participation in partner contraceptive use among married or in-union men. Methods: A cross-sectional survey was carried out in Dallas Sub-location of Embu County involving married or in-union men aged 18 to 64 years. Data was corrected using a semi-structured questionnaire developed and administered by the researcher. SPSS version 28.0 was used to analyze data. Descriptive statistics were used to summarize the data whereas Chi-square was used to test relationship at 95% CI. Results: Most participants (37.9%, n=89) were aware of three or more modern contraceptive methods with about three quarter (75.2%, n=155) aware of oral contraceptive pills. A significant relationship was established between the participants contraceptive knowledge and number of children (p=0.021) as well as highest academic qualification (p=0.011). Most participants (86.3%, n=202) indicated that they participated in their partner’s use of modern contraceptives. The correlation between knowledge and men participation was not significant (p=0.674). Conclusion: Men had adequate contraceptive knowledge and high level of participation in their partner’s modern contraceptive use. The level of knowledge did not significantly influence their participation. Key words: Abortion, contraceptive knowledge, modern contraceptives, men participation, Kenya

Globally, the control of Tuberculosis (TB) has remained a public health challenge despite numerous prevention and treatment programs. Kenya is ranked among countries with a high TB burden globally and has the highest incidences of all types of tuberculosis compared to other East African Countries. The high prevalence of TB in Kenya been attributed to delays in the diagnosis of TB. The consequence of the delays has been the increased spread of the disease, disease advancement, poor treatment outcomes, and high cost of patient treatment and care the affected populations. The aim of this study was to assess patient related factors influencing timely diagnosis of TB in Tharaka Nithi County. Tharaka Nithi County is among the counties with the highest prevalence of TB in Kenya. The study adopted a descriptive cross-sectional survey study design. A sample of 154 patients randomly selected from three hospitals in Tharaka Nithi County was used. A self-administered questionnaire was used to collect data. The data was analyzed using both descriptive and inferential statistics. Associations between patient related factors and duration of TB before diagnosis was tested using Chi-square. The study findings revealed that most (70.86%) of TB patients had delayed diagnosis. Persistent cough was the major sign that led patients to seek for care, while believe that signs and symptoms would disappear was major reason for delay in seeking treatment and care. Sex, age, marital status, employment, self-medication, stigma, work and smoking history were the patients related factors significantly associated with timely diagnosis of TB (P<0.05). The study recommends promotion of care seeking behavior through raising public awareness on tuberculosis, enhancing active case findings, strengthening community-hospital referral systems, boosting health system partnerships for early detection of TB. Key words: Timely diagnosis, Patient Related, Tuberculosis, Delay.

Cancer of the cervix is the leading gynecological malignancy in women and the most prevalent cancer among HIV-positive women.HIV-positive women have up to six times higher risk of contracting cervical cancer as compared to HIV-negative women.The World Health Organization (WHO) recommends that sexually active girls and women should start screening for cervical cancer as soon as they are diagnosed with HIV.However, studies conducted in most developing countries, including Kenya, have established a low uptake of CCS services among this population.The purpose of this study was to determine patient-related factors influencing cervical cancer screening (CCS) uptake among women living with HIV (WLHIV) in PCEA Chogoria Hospital, Tharaka-Nithi County, Kenya.A cross-sectional descriptive survey design was used.A total of 130 WLHIV were recruited into the study using convenient sampling technique.Data was collected using a semi-structured questionnaire and was analyzed using both descriptive statistics and inferential statistics.Chi-square tests were used to establish the association between patient-related factors and screening for cervical cancer.The findings of the study revealed that 79% of the WLHIV had screened for cervical cancer.Most of the WLHIV screened for cervical cancer as a personal initiative or after recommendation by a health care worker.Patient-related factors such as level of education, age, marital status, partner support, and religion significantly (p < 0.05) influenced the likelihood of the WLHIV screening for cervical cancer.The study recommends that health care workers should continually initiate and support CCS to WLHIV because this modality appeared to greatly increase the uptake of CCS.Moreover, health care workers should encourage partner support for CCS.Policy formulators can use the information as a guide in formulating policies that will enhance uptake of CCS among WLHIV.

Background: Nursing process (NP) is an approach of solving problems systematically that should be utilized by nurses in identification, prevention and treatment of health problems and in promotion of wellness. However, its knowledge among nurses has been reported to be inadequate. Objective: To evaluate effectiveness of a NP training intervention on its knowledge level among nurses. Methods: A randomized controlled trial conducted in three phases: pre-intervention, intervention and post-intervention. Multi-stage cluster sampling technique was employed to get a sample of 60 nurses. Two cohorts of nurses were randomly assigned into experimental (n=30) and control group (n=30) and data was collected using questionnaires. Only the nurses in experimental cohort received training on the NP. Descriptive statistics were used to summarize data and t-test used to compare mean differences of the two groups. Results: In both groups, the participants mean age was 37.2 (±9.3), majority were females (73.3%), married (73.3%), and had diploma qualification (55.0 %). Before the intervention, the mean NP knowledge of the control group (M=17.1, SD=6.1) was higher than that of the intervention group (M=16.4, SD=4.2), t (58) =-0.52, p=0.61. However, after the intervention there was a significant increase in the mean NP knowledge of the intervention group (M=69.9, SD=11.4) compared to the control group (M=51.7, SD=11.3), t (57) =6.2, p<0.001. Conclusion: The NP training intervention had a positive effect on its knowledge level among nurses. Frequent such trainings are recommended to address the existing NP knowledge gaps among nurses. Key words: Nurses, Nursing Process, Knowledge level, Training intervention

The midwifery-led care model improves maternal and neonatal health outcomes. For midwives to autonomously utlise a midwifery-led care model, they must know what it entails within available practice guidelines. Little is known about practitioners’ knowledge and practice of this model in Embu County. The study found that there are gaps in knowledge and implementation of midwifery-led care in Embu. We recommend educating midwives about midwifery-led care, and the introduction of this model into the region as a means of strengthening midwifery practice to improve maternal and neonatal health outcomes.

Breast cancer remains the most commonly diagnosed cancer among women, affecting 34 women per every 100,000. This has led to high number of fatalities annually, which need to be mitigated. Establishing alternative conventional therapies such as working on mindfulness-based stress (MBS) may be a good alternative to improve prognosis and survival rate of breast cancer patients. However, there is little information on the effects of MBS factors on breast cancer survival. The objective of this study is to predict the effect of MBS factors on breast cancer survival rate among women in Meru and Nyeri Counties using Cox Proportional Hazard Model. Both primary data and secondary data were used. Primary data was obtained using a structured questionnaire from the breast cancer survivors and the medical practioners, while secondary data was obtained from records at Meru teaching and referral hospital and Nyeri level five hospital for the period 2012 to 2017. The MBS variables included cost burden of treatment, stress on diagnosis, prolonged time taken to access treatment, poor diet, alcohol use, physical activity and lack of awareness. . This study used mixed method research design. Data obtained were analysed using R software. Kaplain-Meier estimators were used to estimate the varying effects of MBS factors on survival rate. Log-rank test was used to perform comparisons of survival curves on the patients’ survival rate considering age. The likelihood ratio test showed that MBS factors are significant in predicting hazard rates ( X2= 66.7, p = 0.0000119). Treatment period, lack of awareness, ease of coping with stress and observing the right diet were also found to significantly (p < 0.05) affect breast cancer survival rate. Access of treatment immediately after diagnosis, availing the right information to the patients, helping patients to cope easily with stress and observing the right diet were found to be the best estimators in increasing breast cancer survival rate. The study showed the importance of using model in predicting breast cancer survival rates, which can greatly improve breast cancer prognosis.

Mental health assessment is a critical practice to promote quality health among pregnant women and unborn children. The approaches and practices that midwives adopt at the antenatal clinics determined the mental health assessment success and the effectiveness of the subsequent treatment. Different studies concerning maternal mental health assessment have focused on issues of prevalence, barriers, and factors hindering or promoting assessment. However, there are limited studies exploring approaches and practices that enhance mental health screening. A sample of 45 midwives and 85 pregnant women was selected from public health facilities in TNC. Analysis of data and coding was done using SPSS with results presented in tables, bar graphs, and pie charts. Only 14% of midwives used training as an approach towards promoting mental health. Both midwives and pregnant women registered low involvement in providing information. The county government and the hospitals’ stakeholders should invest in approaches and practices that prioritize mental health assessment to prevent any mental health complications among pregnant women.Key words: Maternal mental health; mental health assessment, pregnant women, midwives, approaches and practices.