Background: Health system responsiveness (HSR) reflects how well health services meet clients’ legitimate non-clinical expectations, including dignity, communication, autonomy, confidentiality, and prompt attention. In Nairobi County, persistent structural and operational constraints within public healthcare facilities continue to influence patients’ experience, yet empirical evidence linking facility-level characteristics to HSR remains limited. This study examined facility-level factors associated with client-perceived HSR in public healthcare facilities in Nairobi County. Methods: A repeated cross-sectional analytical study was conducted among 1,508 antenatal care clients aged 18 years and above across eight public healthcare facilities in Nairobi County. Client-perceived responsiveness was measured using the World Health Organization HSR questionnaire covering seven domains on a five-point Likert scale. Facility-level data were collected using structured assessment checklists administered to key informants. Mean responsiveness scores were classified as responsive (≥4.0) or not responsive (<4.0). Descriptive statistics were computed, and Fisher’s Exact Test was used to assess associations between facility characteristics and responsiveness status due to the small number of facilities and low expected cell counts. Results: Substantial facility-level inadequacies were identified, including inadequate equipment (87.5%), insufficient supplies (100%), understaffing (100%), high workload (87.5%), and high client volume (87.5%). Client-perceived responsiveness was significantly associated with staffing levels (p = 0.011), equipment availability (p = 0.017), workload (p = 0.017), and client volume (p = 0.017). The presence of policies and guidelines was not significantly associated with responsiveness (p = 0.345). Facilities experiencing greater operational pressure were more likely to be perceived as not responsive. Conclusion: Facility readiness is a critical determinant of health system responsiveness in public healthcare facilities. Structural and operational constraints, particularly staffing shortages, inadequate equipment, and excessive workload, undermine client experience despite the presence of formal policies. Strengthening facility capacity and managing service pressure are essential for improving responsiveness and advancing people-centred care in resource-constrained urban health systems.

Purpose: In order to improve RMNCAH (reproductive, maternal, newborn, child, and adolescent health) in Kenyan public primary health facilities, the study assessed the individual characteristics of the healthcare workers using scorecards in Kwale and Kilifi counties. Materials and Methods: We selected a stratified random sample of healthcare workers (HCWs) from all public primary care health facilities in Kwale and Kilifi counties for a cross-sectional study. We collected quantitative data using a semi-structured questionnaire using kobo collect tool. Findings: The findings revealed that 62.5% of male healthcare workers used scorecards to measure RMNCAH performance, compared to 37.5% of female healthcare workers. Among married healthcare professionals, 68.8% used scorecards, compared to 25.0% of single and 6.3% of divorced or separated personnel. Only 6.3% of HCWs aged 20-29 years used scorecards, in contrast to 68.8% of those aged 30-39 years and 18.8% of those aged 40-49 years. Additionally, 62.5% of nurses used scorecards, compared to 37.5% of registered clinical officers (RCOs). A significant majority (75.0%) of healthcare professionals with a diploma used scorecards, compared to those with other educational levels. Less experienced HCWs (0-4 years and 5-9 years) were more likely to use scorecards than those with 10–14 years and 15 years or more of experience. The relationship between years of experience and scorecard use was statistically significant (p= 0.029, <0.05). The study concludes that scorecard use was more prevalent among male healthcare workers, married professionals, and those aged 30–39 years, compared to their female, single, and younger or older counterparts. Less experienced healthcare staff were more likely to use scorecards than those with longer tenures. Implications to Theory, Practice and Policy: The study recommends that healthcare facilities and policymakers promote scorecard use for RMNCAH performance monitoring, focusing on female healthcare workers, single or divorced professionals, RCOs, and those with higher education levels. It emphasizes developing targeted training programs to meet the specific needs of underrepresented groups and creating supportive environments that provide necessary resources and training for scorecard adoption. Additionally, policies should prioritize gender diversity and age inclusivity in training initiatives to ensure all healthcare workers are equipped with the skills needed for effective scorecard utilization.

Globally, health management information systems (HMIS) in strengthening health systems have gained recognition due to potential of technology to improve access to quality care in underserved communities. In Kenya, the functionality of Community based- Health Management Information System (CBHMIS) currently stands at 55% down from 64% in year 2015. The aim of this paper was to determine the influence of behavioral factors of community units personnel on CBHMIS. As a nested study, with a broader aimt to establish the operational status of CBHMIS and its use in selected counties in Kenya; The main objective of this research was: To establish whether behavioural factors of Community Health Promoters (CHPs) influence CBHMIS use in Kenya. A mixed method design. was adopted, Kiambu, Kajiado and Nairobi counties formed the study location, a target population of 156 active community units was considered to arrive at a total sample of 122 community units and out of 7800CHPs a sample of 366 respondents was drawn. Multistage sampling was used to identify the CUs, and systematic random sampling to identify 366 respondents. Quantitative data tools were semi-structured closed ended questionnaires. Qualitative data tools included observation checklist, Focus Group Discussion and Key Informant Interviews guides. Quantitative data was analyzed using SPSS to generate univariate and bivariate analysis at p<0.05 significance level; Qualitative data was analyzed using content analysis based on key themes generated from the objectives. Results were presented in form of graphs, tables, figures, and narration. This study showed that the use of Community based- Health Management Information System stood at 56.6%. Behavioural factors were found to significantly influence use of Community based- Health Management Information System. Further, of the total variations in the use of Community based- Health Management Information System, behavioral factor explains 13.7% (R2 = .137). Results show that the model was valid (F(1, 363) = 58.579, P = .001) hence the explanatory variable (X2, Behavioral factors) is good in explaining total variations in Use of CbHMIS by community units. This implies that the use of CbHMIS by Community Units (CU) improves significantly when the community units have better behavioural factors. In conclusion, behavioural factors of CHPs have strong and significant influence on the CBHMIS use. Motivation of CHPs is key as a motivator to CBHMIS use, as well as. provision of material support including reporting tools and IEC materials and capacity development technical, computer and electronic reporting skills to enhamce CHP operations and processes.

Malaria heterogeneity in the highlands is due to range of factors including seasonal weather changes, climate variability, land-use changes, topography, drug resistance, and malaria control programs. High coverage of long lasting insecticide treated nets is the basis of vector control in epidemic prone western Kenya highlands. Long lasting insecticide treated nets have effectively controlled malaria in the hypo-endemic zones, but not in meso-endemic and hyper-endemic zones where significant residue of transmission remains despite control efforts. Inadequate policy on integrated vector management application for ecologically heterogeneous ecosystems hinders effective malaria control. Advances in ecological and epidemiological studies have improved our understanding on vector distribution determinants and malaria transmission enabling us to effectively integrate indoor residual spraying into the existing long lasting insecticide treated nets programme. Data on malaria vector abundance and parasite prevalence for different malaria ecosystems within western Kenya highlands before and after mass insecticide treated bed-net distribution campaigns was gathered to assess the efficacy of the long lasting insecticide treated nets based control efforts. Field tests were carried out to determine the impact of combined indoor residual spray and long lasting insecticide treated nets on vector indoor resting densities in zones where insecticide treated nets alone had limited efficacy or zero efficacy was observed. Female An. gambiae s.l resting densities of 0.1 mosquitoes/ house/night were associated with a plasmodium falciparum (pf) prevalence rate of 10% or below. This observation enabled the development of a framework for the inclusion of indoor residual spray in integrated vector management with the suggestion that IRS should be applied in malaria eco-epidemiological zones where An. gambiae s.l resting densities exceeds 0.1 females/ house/ night. Similarly, only those houses with a resting density of 0.1 females An. gambiae s.l and above should be targeted during spraying. Such an approach would significantly reduce the cost associated with indoor residual spray and provides a rationale for judicious integration of indoor residual spray within existing long lasting insecticide treated nets control programmes.

Diabetes remains a major global public health challenge, thus the need for better methods for managing diabetes. Machine learning could provide reliable solutions to the need for early detection and management of diabetes. This study conducted experiments to compare a number of selected machine learning approaches to determine their suitability for early detection of diabetes in the primary care setting. A retrospective study was conducted using EHR dataset of confirmed cases of diabetes collected during routine care at Nairobi Hospital. Institutional ethical approvals were obtained, and data were retrieved from the database through stratified sampling based on gender. Diagnoses were confirmed using the ICD-10 codes. Records with 5% or so of missing values were excluded from this analysis. Data were processed by correction of errors and replacement of missing values using measures of central tendency. The data were transformed through normalization using the decimal-scaling method. Data analysis was conducted using selected supervised and unsupervised learning algorithms. Model performances were validated using metrics for the evaluation of classification and clustering results, respectively. Random Forest had the highest accuracy (0.95) and error rate (0.05), while Gradient Boosting and Multilayer Perceptron (MLP) with 3 hidden layers obtained accuracy (0.94) and error rate (0.06), respectively. The process of selecting machine learning algorithms needs to explore both supervised and unsupervised learning techniques. In addition, an appropriate architectural design of an MLP could present astounding results for classification tasks in primary care settings.

The Point of Care (POC) approach is the highest level of interaction between health care workers (HCW) and the information system, which generally requires interaction during clinical meetings. Although it is hard to do so, it offers the most significant benefits. The POC strategy offers the system’s benefits to healthcare workers, patients, and those who monitor and evaluate them. The study focused on identifying key determinants of point-of-care technology use among healthcare workers offering services in comprehensive care centres in Central Kenya. A Cross-sectional descriptive study was adopted, two-stage cluster sampling design method was used in determining the sample size. The study involved a sample size of 217 respondents and over a 100% was achieved. The study results revealed that social demographic factors of health care workers have no significant influence on POC technology use as a p-value of above 0.05 was observed on all the variables. Some organisational factors such as adequate workstations (p = 0.0) and EMR reducing patient time (p = 0.012) were found to have significant influence on POC technology use. Significant influence on POC use was noted on source of funding for software and hardware maintenance (p = 0.001). The utilisation of EMR to review client progress in real-time (p = 0.001) was found to have a significant influence on POC technology use as well as the use of EMR to report to the national reporting system (KHIS) (p = 0.014). 71% of respondents reported that availability of clinical decision support features in the EMR was contributing to improved use of POC. An overwhelming 72% reported that they were very motivated to use POC technology due to the ability of auto generating reports. In addition, three factors were highlighted as key contributors to the success of POC use, and these were reliable power supply (44%), adequate and trained healthcare workers (24%), standard and stable EMR Systems (17%). The study recommended for adequate training of health care workers, adequate workstations, and reliable power supply. For initial implementers of EMRs, they should consider having Standard EMRs that support both clinical decision support features and automated reporting.

Background: Risky sexual behaviors such as sexual concurrency, sexual networks (fish for sex exchange) and unprotected sex, have been reported as the main cause of sexually transmitted diseases (STIs) /HIV infections among fisher folks. Behavioral change mechanisms as condom use and abstinence are some of interventions used in prevention HIV/AIDS spread in Kenya. Risky sexual behaviors increase risk of contracting STIs including HIV/AIDSMethods: This was a cross-sectional descriptive study involving 246 randomly selected fisher folks in Mbita- and Usenge along Lake Victoria. The survey used questionnaires to collect data among respondents. Using a sample frame in the beach management unit offices, fisherfolks were identified and invited to participate. Consent was obtained from participantsResults: The mean age of respondents was 31 years old. The 72% of the participants were directly involved in fishing. Participants who had extra marital relationship though married were 56.1% in Mbita and 47% in Usenge. Respondents who took alcohol with friends were 94.1% in Mbita and 96.2% in Usenge. Respondents who indicated that they had unprotected sex under influence of alcohol were 48.3% in Mbita and 77.1% in Usenge. Those who were sexually taken advantage of while under the influence of alcohol were 23.8% in Mbita and 38.3% in Usenge while those had sexually taken advantage of under the influence of alcohol were 18.3% in Mbita and 37.8% in Usenge.Conclusions: Targeted behaviour change communication (BCC) strategies designed specifically for fisherfolks is needed to curb high incidences of risky sexual behaviours noted among the fishermen.

Background: This study set out to investigate how incentives for mothers, health workers and boda-boda riders can improve the community-based referral process and deliveries in the rural community of Busoga region in Uganda. Methods: The study was a 2-arm cluster non-randomized control trial study design; with intervention and control groups from selected health centres and communities as the units of non-randomization. The study interventions involved the provision of incentives for mothers, health workers and boda-boda riders for duration of six months. The study used a mixed methods research design with both quantitative and qualitative approaches. Descriptive statistical analysis was computed using STATA version 14 for the quantitative data and thematic analysis for qualitative data. Results: Findings revealed that incentives strongly improved community-based referrals and health facility deliveries in the study area. Mothers who delivered from health centres and transported by boda-boda transport were 70.5% in the intervention arm and only 51.2% in the control arm. Of the 70.5% of the mothers above, 69.4% were transported by trained boda-boda riders and only 30.6% were transported by un-trained boda-boda riders. The 69.4% mothers transported by trained boda-boda riders to health centres stated that boda-boda riders’ response to their calls for transport improved from 4.3% to 21.3% in the 5 – 20 minutes interval. For the 21 – 30 minutes interval, the response improved from 31.4% to 69.6% in the intervention arm compared to 37.1% to 40.3% in the control arm. As the time interval increased, the boda-boda riders who delayed to respond to mothers’ calls reduced. In the intervention arm, only 6.2% of the mothers stated that boda-boda riders’ response took 31 – 60 minutes time interval after the intervention compared to 54.9% before the intervention. There was little change in the control arm from 53.2% pre intervention to 41.2% post intervention. Similarly, the boda-boda riders’ response to mothers’ calls for transport reduced for the time interval of 60 minutes and above. Conclusion: Incentives and creation of partnerships are very critical in achieving better health facility-based deliveries as a result of proper referral processes.

Integrated Disease Surveillance and Response entails data collection, analysis, interpretation, and feedback on communicable and non-communicable diseases. It enables health workers to detect and respond to these diseases. Poor utilization of disease surveillance and response data was identified as a core factor responsible for increasing mortality and morbidity due to infectious diseases in developing countries like Kenya. This study assessed utilization of Integrated Disease Surveillance and Response data in control of infectious diseases among Public health facilities in Kiambu County, Kenya. It specifically investigated the proportion of Health workers trained on IDSR, level of knowledge regarding IDSR and Health system factors influencing IDSR utilization. This was a descriptive cross-sectional survey. It involved public health facilities with key respondents being the health care workers providing curative and preventive health services within the selected health facilities. Stratified sampling technique was used to stratify the 108 health facilities into levels of health care while proportionate sampling was used to select 143 participants in the respective level of care. An interviewer-administered questionnaire was used to collect data which was entered and analysed using the Statistical Package for Social Sciences (SPSS) software version 20. Chi-square test of independence was used to assess the associations between utilization of IDSR data, training, level of knowledge and health system factors while Regression analysis was used to establish the predictors of utilization of IDSR data. Utilization of IDSR index score shows 64.9% inadequate utilization of IDSR data. The available data has not been adequately utilized to inform action plans, public education, and resource mobilization. The study shows that 13.7% of health care workers had been adequately trained on IDSR while 75% had moderate knowledge of IDSR function. Accordingly, 54.6% of respondents had the opinion that there were inadequate essential supplies for IDSR. Chi-square analysis shows that the respondent’s duration of practice χ2 (2.437, df=3, p=0.045) and level of knowledge on IDSR were associated with utilization of IDSR data χ2 (0.227 df=2, p=0.048). Logistic regression analysis illustrates that the level of knowledge (A.O. R=1.55, p=0.041) and Cadre of respondents (A.O. R=0.827, p=0.023) were predictors of utilization of IDSR data.

This research aims to determine the applicability of routine healthcare in clinical informatics research. One of the key areas of research in precision medicine is computational phenotyping from longitudinal Electronic Health Record (EHR) data. The objective of this research was to determine how the interplay of EHR software design, the use of a data dictionary, the process of data collection, and the training and motivation of the human resource involved in the collection and entry of data into the EHR affect the quality of EHR data thus the suitability of such data for utility in computational phenotyping of diabetes mellitus. This research employed a prospective/retrospective study design at the diabetes clinic in Nairobi Hospital. The first source of data was from interviews with 32 staff; nurses, doctors, and health record officers using a referenced peer-reviewed usability questionnaire. Thereafter, a sample of EHR data collected during routine care between January 2012 and December 2016 was also analyzed by looking into the quality of clusters identified in the data using a density-based clustering algorithm and Statistical Package for Social Sciences (SPSS) version 21. Regression analysis shows that software design and the utility of a data dictionary explained 50.7% and 32.3% respectively in the improvement of the suitability of EHR data for computational phenotyping of diabetes mellitus. Also, EHR software was rated useful (82%) in accomplishing users’ daily tasks. However, EHR data were found to be unsuitable for utility in computational phenotyping of diabetes. Despite the fact that 88% of EHR data were clustered as noise, the clustering algorithm identified a total of 23 clusters from the diabetes dataset. However, with improved quality of EHR data, sub-phenotyping tasks would be achievable. This research concludes that the poor quality of EHR data is a result of employees’ unmet intrinsic factors of motivation.

Background: Effective management of today’s health systems depends on the critical use of data for the policy-making, planning, monitoring of services, and making decisions. The use of data has been limited and faced with inadequacy hence vital health decisions often relying on political opportunism, donor demand, and infrequently repeated national studies which are insensitive to changes occurring over a shorter timescale. Objective: This study was designed to identify determinants of utilization of routine data for decision making by health care providers in health facilities in Kitui County in Kenya. Methods: The conceptual framework was constructed from the literature review. This was a descriptive cross-sectional study adopting quantitative and qualitative research paradigms. The district hospital was purposively selected. Multi-stage cluster sampling was used to sample the health facilities in sub-counties and simple random sampling to select the respondents from different cadres in health facilities. The 110 participants completed a self-administered questionnaire. Key informant interviews, focused group discussions, observation, and analysis of documents in health facilities were applied. Recordings were transcribed and key concepts identified. Questionnaire results were edited, coded, tabulated, and analyzed using the SPSS 18. Results: Respondents interviewed were different cadres of health care providers including doctors, clinical officers, nurses, and midwives from different levels of health facilities. Among the respondents, 70% were females, and 30% males. The majority, 64% had a diploma level of education. Nurses/ midwives were the majority, making up 81% of the workforce. The overall extent of data utilization was 66% not using data and 34% use the routine generated data. The following actors influence utilization of routine data: frequency of meetings held ( =42.036, df=1, p=0.001), data storage and analyzing methods ( = 30.582, df=1, p=0.001), and continuous professional training ( = 49.782, df=1, p=0.0001). Organization of the district health system influenced routine data utilization through the frequency of support supervision ( =30.000, df=1, p=0.001), issues assessed during supervision ( =49.164, df=2, p=0.002) and feedback report from the supervisors ( =5.236, df=1, p=0.022). Conclusion: The study demonstrated limited utilization of routine data for decisions in health facilities and recommended the need for capacity building for data utilization through on job training and strengthening the curriculum in health training institutions in data-related areas. The ministry of health can standardize the parallel reporting levels and unify the reporting tools and finally ensure the districts have structured meetings, support supervision, and feedback to the health care providers.

Background: The COVID-19 pandemic has had a major impact on the capacity of health systems to continue the delivery of essential health services. While health systems around the world are being challenged by increasing demand for care of COVID-19 patients, it is critical to all other services including sexual reproductive health services. Countries are expected to ensure optimal balance between fighting the COVID-19 pandemic and maintenance of essential health services like sexual reproductive health. The purpose of this report was to assess and document continuity of sexual and reproductive health services with a focus on safe abortion, post abortion care and family planning services during the COVID -19 pandemic in selected countries of the World Health Organization Africa Region. Methods: A descriptive survey using a simplified and user-friendly virtual web based rapid needs assessment through a questionnaire was filled in by key informants drawn from the ministries of health from 30 countries in July 2020. The questionnaires were filled in by the World Health Organization staff in charge of sexual reproductive health services in collaboration with their counterparts in the ministries of health and uploaded in excel data sheets and categorized in to thematic areas for analysis. Results: Responses were received from 17 countries out of the 30 countries that received the questionnaires. Of the 17 countries, only 2 (12%) countries reported that sexual and reproductive health services are not integrated in the essential health services package. All the sexual reproductive health elements-family planning/contraception and comprehensive abortion care, including post abortion care are integrated in the essential health services package in 12 (80%) of the 15 countries that have sexual reproductive health integrated. Also,14(82%) countries reporting having ongoing awareness raising campaigns/communication messages about family planning, comprehensive abortion care and post abortion care during the COVID pandemic. 9(59%) of the countries reported reduction in the use of family planning services, 6(35%) indicated no changes in the use of family planning services with only 2(12%) countries providing no response. Conclusion : The survey provides information on the weak health systems of the participating member states of the WHO Africa Region and the magnitude of disruptions of sexual reproductive health services in selected countries. Further, strategies adopted by countries to ensure continuity of sexual reproductive health services amidst COVID -19 like communications, Countries finally identified key areas that need to be supported in family planning/contraception, comprehensive abortion care and post abortion care during the COVID-19 pandemic.

Focused Antenatal Care (FANC) is crucial to improving maternal and infant health. Despite the Government of Kenya' efforts to reduce maternal and neonatal morbidities and mortalities, these conditions prevail in Murunga. The current study examined how individual, organizational, and policy factors influence the utilization of focused antenatal care services amongst women in the Gatanga sub-county, Murang'a County, Kenya. The cross-sectional survey data was collected between June and July 2019 from three sampled wards. A structured questionnaire was administered to 334 women of reproductive age, aged 18 years and above, who delivered within the past one year or above 38 weeks of gestation. Descriptive statistics and chi-square tests at a 5% level of significance were done using SPSS version 22. The findings indicated that 37.3% of respondents do not utilize FANC services. Level of education (X2 (3) = 16.05; p < 0.05), occupation (X2 (3) = 16.50; p < 0.05), level of income (X2 (4) = 15.53; p < 0.05), time taken to the facility (X2 (3) = 34.72; p < 0.05), and waiting time (X2 (3) = 14.17; p < 0.05) were found to significantly influence utilization of FANC services. Therefore, women should be empowered through education and economic activities to remain financially independent. The government should also improve access to health care, especially in rural areas, by building new health facilities to improve the utilization of FANC services. Besides, more health care providers should be employed to reduce the waiting time at the facility.

Background: WHO places health information as a key pillar of an effective health system (HS). HS strengthening has become a key focus of many nations. A paradigm shift from being disease specific focus to holistic strengthening of pillars of a HS. Kenya’s functionality of CbHMIS (community based health information systems) stands at 55% down from 64% in year 2015, majorly contributed to by organization of community health volunteers (CHVs) work. The aim was to establish influence of organizational factors of CHVs on CbHMIS use in Kenya.Methods: A cross-sectional design which employed both quantitative and qualitative approaches was used. Kiambu, Kajiado and Nairobi counties formed the study location. A systematic random sample of 366 respondents was drawn. Multistage sampling was used to identify the community units (CUs). Ethical clearance was obtained from KEMU, ethics and research committee (SERC), national commission for science, technology and innovation (NACOSTI) gave a research permit. 3 FGDs and 6 KIIs were conducted. Quantitative data was analyzed using SPSS version 23 to generate univariate and bivariate analysis at p<0.05 significance level. Qualitative data was analyzed using content analysis. Results were presented in form of graphs, tables, figures and narration.Results: Use of CbHMIS stood at 56.6%. Organizational factor explains 39.9% (R2=0.399) of total variations in the use of CbHMIS. Organizational factors of the CHVs were found to positively and significantly influence use of CbHMIS.Conclusions: Organizational factors influences use of CbHMIS by CHV. Government/partners to build CUs capacity on sustainable resource mobilization strategies.

Background: A Cross-sectional Rapid Situational Assessment of People Who Inject Drug (PWIDs) applying Respondent Driven sampling techniques (RDS) was used to recruit subjects/participants in a study aimed at assessing HIV prevalence and risk behaviors among injection drug users in Nairobi and Coastal region of Kenya. There is paucity of data and information on injecting drug use in sub-Saharan Africa and there is sufficient evidence of existence of the environment for development and growth of injecting drug use. Past studies on PWID and its association to HIV and AIDS that have been conducted in Kenya do not provide sufficient information to support effective planning and comprehensive national response to the HIV and AIDS epidemic. Methods: A cross-sectional study design was adopted in which a set of initial subjects referred to as ‘seeds’ were first identified from which an expanding chain of referrals were obtained, with subjects from each wave referring subjects of subsequent wave. The seeds were drawn randomly from the population and interviewed to pick the one with the largest network and other unique characteristics. A maximum of twelve seeds were recruited. The second stage involved conducting assessment visits to the sites to identify potential collaborators that included non-governmental organizations (NGOs), drug treatment centres, health facilities, Community based organizations (CBO's) among others. Three NGOs located in the coast region and one in Nairobi region were identified to assist in identifying drug injection locations and potential participants. Key informant interviews (KIIs) and Focus Group Discussions (FGDs) were also conducted using interview guides. Results: A total of 646 individuals (344 in Nairobi and 302 at the coast) were recruited for the study between January and March 2010. Of these 590 (91%) were male and 56 (9%) were female. Findings showed that most PWIDs initiated injecting drug use between the ages of 20-29 years, with the youngest age of initiation being 11 years and oldest age being 53 years. Most commonly injected drug was heroin (98%), with a small (2%) percentage injecting cocaine. Other non-injecting methods such as smoking or combining these two drugs with other drugs such as cannabis or Rohypnol were also common. Most PWIDs used other substances (cigarettes, alcohol, and cannabis) before initiating injecting drug use. HIV prevalence of PWIDs in Nairobi was (24.4% unadjusted) compared to their counterparts residing in the Coastal region (18.5% - unadjusted). The age specific HIV prevalence showed that PWIDs who initiated injecting at 11-19 years (44.7% adjusted) were most at risk in Nairobi compared to those who initiated injecting at age 20-24 years (23.2% - adjusted) in the coastal region. While all PWIDs continue to be at risk in the two regions, those from the Western parts of Nairobi were at a relatively higher risk given their increased propensity for sharing injecting equipment and solutions. Conclusions: Compared to the national HIV prevalence of (4.9%), the results show that People Who Inject Drugs (PWIDs) are at particularly high risk of infection in Kenya and there is urgent need for intervention (KenPHIA, 2018). This study also showed clear evidence that PWIDs engage in high risky injecting and sexual behaviors comprising sharing of injecting equipment, unprotected heterosexual and homosexual sex. Given that initiation of injection drug use begins early and peaks after formal school years (20-29 years), prevention programmes should be targeted at secondary school, college and out of school youth. Further, to protect People who inject drugs (PWIDs) from HIV infection, the country should introduce free Needle Syringe Programs with provision of condoms and Methadone Assisted Therapy (MAT) as a substitute for drug use.

Background: Despite the globally acclaimed efficacy of the ICD-10 as a tool for disease classification, existing evidence focus on quality of disease coding outcomes with limited evidence on determinants of utilization. The starting point to sustaining the quality of disease coding is establishing its utilization and its determinants. There is paucity of evidence on role of health professional factors on use of ICD systems in Kenya. Objective: To determine health professionals' factors associated with utilization of ICD-10 in Public Hospitals. Methods: This study was conducted in Kiambu County, Kenya among public health facilities. Cross-sectional descriptive study design was used. A total of 46 health records and information officers [HRIOs] were sampled using total population sampling. Data was collected using self-administered questionnaires. Descriptive statistics, chi-square and regression analysis was used to analyse and synthesis the data using SPSS version 22. Results: Out of the 42 respondents, 28 (67%) indicated that the systems were utilized either frequently or always. Chi-square analysis revealed that ICD perception was the only health professional factor significantly associated with ICD-10 utilization. Positive perception of ICD-10 utility increased the likelihood of its frequent use by approximately 4.63 times (OR = 4.63; p=0.049). Conclusion: Staff perception of ICD systems is an important determinant of its utilization. Providing tailored capacity building and sensitization of ICD system benefits and value-add to staff can significantly counter negative perceptions and improve utilization in hospitals.

Many pregnant mothers miss antenatal care attendance and health facility deliveries despite several interventions either due to knowledge gap on the benefits or lack of transport means to reach the health centre. Therefore, training of “boda-boda” (motor-cycle) riders in Busoga Region in Uganda was conducted to determine its effect on health facility-based deliveries. The study was a non-randomized control trial with intervention and control groups from selected health centers and communities in Busoga Region. Interventions included the training of boda-boda riders for 5 days to give them knowledge; with a six months follow-up to determine the impact of training. Questionnaires, interviews and focus group discussions were used to collect quantitative and qualitative data. Descriptive statistical analysis was computed for the quantitative data and thematic analysis for qualitative data. Findings revealed improved knowledge of boda-boda riders on maternal referrals from 49.1% to 79.0% in the intervention arm compared to 43.8% to 45.2% in the control arm. Use of boda-boda transport by mothers improved from 0% to 70.5% in the intervention arm compared to only 0% to 51.2% in the control arm. Also, of the 70.5% of the mothers who used boda-boda transport, 69.4% were transported by trained boda-boda riders and only 30.6% by un-trained boda-boda riders. Apart from age (p=0.000; CI=2.785 – 53.284) and ownership of the motorcycle (p=0.002; CI=0.992 – 8.658), the rest of the socio-demographic determinants of health facility-based deliveries were not statistically significant. Age of boda-boda riders (25–34 years, p=0.000) and ownership of the play a pivotal role in the improvement of health facility-based deliveries. Training of boda-boda riders and other key stakeholders impacted on the community based maternal referrals in the study area.

Background: Kenya has since independence struggled to restructure its health system to provide services to its entire population especially in outbreak responses. The last decade has seen the country witness disease outbreaks across the country i.e. Rift Valley fever in June 2018, and Chikungunya and Dengue fever in Mombasa in February 2018. This exposed the country’s lack of preparedness in handling outbreaks at grass root level. Outbreak incidences tend to prevail at community level before a public health action is established, with the situation becoming dire in the lower tier health facilities. Objective: The purpose of the study was to assess the uptake of Integrated Disease Surveillance Response (IDSR) health data and utilisation at community level health systems in the six sub counties within Nairobi County of Kenya. Methodology: The study used cross-sectional descriptive research design on a target population of 1840 community health workers. The study used Yamane formula to calculate the sample size of 371 respondents, selected using stratified sampling and simple random sampling methods. The logistic regression model was used to assess the benefits of Integrated Data Surveillance and Response data in health facilities across Nairobi County. Data was collected using questionnaires, analysis done using Statistical Packages for Social Sciences, and findings presented in form of tables and bar graphs. Results: The study had 315 questionnaires were duly filled and returned, representing 85% response rate. The findings showed that 268(85%) Healthcare Workers lacked training on using disease surveillance data; 236(75%) cited lack of tools for disease surveillance in facilities, while 173(55%)cited lack of timely IDSR data as hindrance to IDSR data uptake. The regression findings showed that training of healthcare workers on IDSR, installation of disease surveillance system tools, and timely collection and dissemination of surveillance data increases the likelihood of IDSR data uptake in community health facilities. Conclusion: The study concluded that IDSR system tools should be installed in community health facilities across the six sub counties in Nairobi County. Training should be emphasised to ensure all health care workers have the required skills to use the IDSR data. There is need to ensure IDSR data is collected and disseminated on time to make it available for interpretation and use by health care workers in their respective facilities.

Background: Low utilization and poor accessibility of hospital based maternal services in low and middle-income countries (LMIC) are evident and financial barriers is a major bottleneck. Globally, an estimated 600,000 maternal deaths occur yearly with over 90% of these deaths occurring in LMICs. In Kenya, maternal mortality is still relatively high with 362 maternal deaths per 100,000 live births. Gaps in the quality of maternal health services exist due to high costs, poor staffing and inaccessibility. However, Utilization of hospital based maternal services enhances skilled delivery and consequently reduces maternal and child mortalities and morbidities. The aim of this study was to establish the trends of utilization of free maternal services (FMS) before and after implementation in counties of Nyanza, Kenya.Methods: The study adopted an analytical cross-sectional study utilizing mixed methods of data collection. Secondary quantitative data on the rate of utilization between June 2011 and May 2015 was compared. Qualitative data was collected from key informants and focused group discussants. Purposive and simple random sampling were used to select target population. Data was analysed using both parametric and non-parametric statistical methods.Results: In maternal services utilization, Kisumu county recorded the highest 98.7%. Overall, in Nyanza, there was tremendous growth on trends of FMS utilization of 53.4% from 36.7% before implementation of FMS with cases of still births, maternal deaths and neonatal deaths.Conclusion: The upsurge of FMS utilization encouraged skilled birth attendance but also caused enormous constrains to health system and reduced the quality of FMS.