Introduction: Quality of care is acknowledged as a critical facet of the unfinished maternal and newborn health agenda. Yet modalities of reorienting maternity services to respectful services are rare. This study investigated the effect of training health workers in cultural competence towards satisfaction with maternity service. Materials and Methods: This was a Cluster Randomized Controlled Trial undertaken in public hospitals. The intervention was provision of culturally sensitive maternity services by health workers after cultural competence training. Three hundred and seventy nine women were interviewed per group using exit and mystery client surveys. The effect was measured using standard mean difference (Cohen’s d) and t-test. Results: There was significant effect on satisfaction with provided information on delivery methods (F (1, 756) = 11.493, p < 0.001, ηp2 = .049). The mean of intervention group increased from 3.55 ±1.056 to 3.94, ±0.894 while the control changed from 3.57±1.187 to 3.62 ± 1.149. The mean changes tweaked the group variance from insignificant t (725) =0.290, p = 0.771 to significant t (713) =-4.336 p <0.001. Conclusion: Cultural competence training is effective in creating room for desired maternal needs and improving perceived satisfaction with maternity services. Consequently, there is a need to integrate cultural knowledge and skills into existing maternal policies and training.

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; Many studies have reported Road traffic injuries (RTIs) leading to fatalities of over one million victims annually and negatively impacting on health, economy and development of the society as a whole, furthermore, young men and women at their most economic age group, are highly affected by RTIs and in most cases it causing mortality and very severe morbidity due disability. With projection by the year 2030, RTIs will be ranked as the fifth cause of disability adjusted life years (DALYs) lost. There is little or no any published Evidence on healthcare resource utilization and allocations after RTIs, especially in developing countries. Africa included. Locally in Kenya road accident remains a major public health concern, with high mortality and morbidity rates reported annually. Aim: The Main objective of this study was to analyze the total hospital Expenditure/cost related to RTI (Road traffic injury) admitted at the Kenyatta National Hospital for a period of 3 months from the start of the study. Methods: This was a cross sectional study design; the study location was the Kenyatta National Hospital Nairobi, surgical wards and Accident & Emergency. A sample (n=124) comprising of victims admitted to the Hospital due to RTI from January 25th 2019 to 30 th May 2019. Systematic sampling was used. The independent variable was the cost of treatment while the dependent variable was direct medical treatment cost, non-medical treatment cost, productivity loss and length of stay. Primary Data collections was done through interviews of all victims admitted at the KNH through A&E and qualify as per the inclusion criteria, the victims were admitted at the surgical unit level 4,5, and 6. The data collection of direct and direct non-medical cost, was by data extraction tool, testing of the tools was done at the surgical ward. Productivity loss of the victims was calculated by use of Work Productivity and Activity Impairment Questionnaire (WPAIQ). Data was analyzed by SSPS version 22. Results: From the study 76.6% of the road users were male, while female was 23.4%. Most of injuries were lower limbs, head and upper limbs in that order. Leading injuries by mode of transport was Motorcycle at 43.5%, pedestrian and public transport at 23.4 % and 17.7%. Daily bed charges and Surgery were the leading cost component followed by pharmacy. Average length of stay was 24.1 days, average medical cost was at (KSH 66,482, 642 USD), productivity loss at (KSH19, 061, USD 184) and indirect cost at KSH10, 745 USD 107). There was significance correlation between total bed charges, medical cost and productivity loss at P=0.01. (Cl 95%) chi square showed linear by linear association of P value of .000 Conclusion: Road traffic accident is an economic burden to individual, family and country at large, males more affected at their most economic age groups. Findings will aid policy makers in review on resource allocation. Further Motion studies on cost analysis of RTIs, over a longer period to be conducted to provide more insight on the subj...

Background: Recognition of the vulnerabilities and differentials in maternal indicator is a pressing concern throughout safe motherhood literature. Uptake of skilled delivery by women in Marakwet remain 44%, compared to the national rate of 68%. Accountability for improving maternal indicators calls for interrogation of indigenous practices to amend complex social causes. Methods: This was a qualitative study conducted in the thirteen patrilineal clans of Marakwet.  Discussants were women of reproductive age while key informants included cultural anthropologist, traditionalist and gatekeepers. The data was analyzed manually through a process of data reduction, organization and emerging patterns interpretation then sub categories. Results: Pregnancy and delivery are not just biomedical process but culturally biosocial practice. Discipline and socialization are critical elements. Adequate self, family and community care lead to noble pregnancy outcome. The community and midwife uses knowledge to jumpstart childbirth practices for expectant women for healthy prenatal period, delivery and postnatal running.  Holiness and hygiene, controlled sex and sexual relationships, artefacts and dressing, food ways and diet, social interaction, livelihoods and lifestyle are key pregnancy and childbirth social aetiology. Conclusion: cultural stimuli and remedies inform maternal health seeking behaviour and practices of women. Continued care, hygiene, geophagy, controlled food ways and social interaction as well as avoiding heavy duties and events that trigger emotions and pressure are sound indigenous ways of improving maternal and child health. However, norms such as visiting a midwife for pregnancy confirmation and massage as well as folk activities such as the use of charms and repertoires for protection and cleansing ceremonies provide false protection. Recommendation: the results suggest the relative value for indigenous maternal health care services in enhancing client centered delivery health services. Review of policies and programs to integrate harmless indigenous practices into maternity care services may promote quality, satisfaction and uptake of facility based childbirth services.

Background: The health and nutritional status of children can be assessed through routine growth monitoring (RGM). This provides opportunities for implementation of interventions aimed at reducing under five mortality rates, infectious diseases and malnutrition. The objective of the study was to find out the level of uptake of routine growth monitoring among caregivers of children aged below 9 months in Nyamira County, Kenya.Methods: This was a cross-sectional study.Results: Only 21.1% of the caregivers consistently took their children for RGM. About 78.9% of caregivers had skipped RGM visits for their children in the last eight months at least once or more. About 45.8% of caregivers skipped RGM visits twice, 31.7% thrice, 20.4% once and 2.1% skipped four times. Uptake of RGM was not significantly associated with caregivers’ level of education (p=0.052), marital status (p=0.099), occupation (p=0.081), monthly income (p=0.941), distance to nearby health facility (p=0.774) and place of residence (p=0.330). Caregivers who skipped RGM visits gave various reasons including forgetting to come again  dates (91.5%), child not sick (77.5%), healthcare providers advising them not to go for RGM since there was no scheduled vaccination (67.6%), among others.Conclusions: There is need for healthcare providers capacity building on their role in improving RGM since most of them discourage caregivers unless for those with scheduled immunization. Policy makers and implementers in the health sector should formulate relevant policies especially targeted at reminding caregivers on monthly RGM for their children aged below 9 months.