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Basic nursing training and leadership preparedness of nurse managers in South Rift and South Nyanza, Kenya

2026-03-17T08:53:55Z

Title: Basic nursing training and leadership preparedness of nurse managers in South Rift and South Nyanza, Kenya Authors: Chebet, Annah Towett Abstract: Background: Effective leadership and management are vital for strengthening global health systems, yet they remain under-prioritized in low- and middle-income countries (LMICs). Despite the essential role of nurse leaders in maintaining service delivery amid evolving epidemiological demands, training deficiencies often leave them feeling underprepared for managerial responsibilities. In Kenya, Mid-Level Nurse Managers (MLNMs) are central to hospital unit operations; however, significant knowledge gaps exist regarding whether basic nursing training sufficiently prepares them for these leadership roles. Objectives: The objectives were to assess nurse managers' level of preparedness for MLNMs’ leadership role, determine the level at which basic nursing training prepares nurses for MLNMs’ leadership roles, assess the contribution of role-induction programs to MLNMs’ leadership role preparedness, and determine MLNMs’ training needs for leadership role preparation. Methods: The study was grounded on Henri Fayol’s management theory and Frederick Taylor’s principles of scientific management. A mixed-methods study design employing a descriptive, cross-sectional approach was conducted in 9 hospitals and 4 Diploma nursing training institutions selected in South Rift and Nyanza, using a multi-level sampling process. The study population involved 68 purposively selected MLNMs and 7 Nursing Directors (NDs). Data was collected using pretested instruments adapted from validated tools, including self-administered questionnaires, Focus Group Discussions (FGDs), Key Informant Interviews (KII), and a document review checklist. Quantitative data was analyzed using frequency tables, percentages, mean, and mode, while Qualitative data was analyzed thematically. Results: More than half (56.9%) of the MLNMs perceived their level of preparedness for leadership roles as above average, 24.6% excellent, 15.4% average, and 3.1% below average. About 57%, 41%, and 2% of respondents rated their satisfaction with nursing training for leadership roles as satisfied, somewhat satisfied, and dissatisfied, respectively. This is largely due to a focus on theory (65%) through lectures, a change in assessment focus, and a one-month clinical rotation in leadership. Role induction programs contributed to leadership role preparation as follows: formal leadership training (M=4.84, SD = .412, Skw -2.502), Mentorship (M=4.69, SD = .499, Skw -1.196), Supportive supervision (M=4.66, SD = .565, Skw -1.430), ‘On-the-job (M=4.60, SD = .552, Skw -.955), and Preceptorship (M=4.35, SD = .734, Skw -.899). Nurse managers stated that formal leadership training, on-the-job training, mentorship, and supportive supervision significantly contribute to preparedness for the leadership role. They noted being appointed to leadership directly or through progressive promotion without structured leadership role preparation. Managers felt least prepared for budgeting and expressed a need for formal training in resource management. Conclusion: Majority of the respondents rated their leadership preparedness as suboptimal. Basic nursing training was inadequate due to overemphasis on theory, a shift in assessment focus, and limited clinical experience. Formal leadership training, on-the-job training, mentorship, preceptorship, and supportive supervision play a significant role in improving leadership readiness. To effectively fulfill their leadership roles, MLNMs require formal leadership training, resource management training, particularly in budgeting, and training in emotional intelligence. Recommendation: Hospital management teams (HMTs) should develop strategies to enhance the leadership preparedness of MLNMs. Nursing training institutions should reassess the leadership and management aspects of basic nursing programs, focusing on budgeting content and the length of clinical rotations for leadership training. Moreover, HMTs should introduce formal leadership training, structured role-induction programs, and training in emotional intelligence to build the capacity of their MLNMs.

Early surgical outcomes of children with mechanical intestinal obstruction at Moi teaching and referral hospital, Kenya

2026-03-10T08:49:24Z

Title: Early surgical outcomes of children with mechanical intestinal obstruction at Moi teaching and referral hospital, Kenya Authors: Agade, Ivy W; Saula, Peter W.; Maiyo, Francis Abstract: Background: Intestinal obstruction constitutes the largest proportion of abdominal surgical emergencies in the paediatric and adult patients in Sub-Saharan Africa, including Kenya. It is associated with high postoperative surgical complication and mortality rate in low resource healthcare systems. Methods: A prospective mixed methods study with consecutive sampling procedure was carried out from September 2021 to June 2023. Pediatric patients from birth to 14 years, with mechanical intestinal obstruction were included in the study. Categorical data was analyzed in frequencies and percentages and continuous data was analyzed using measures of central tendency and measures of dispersion. Bivariate and multivariate associations between the dependent and independent variables were assessed with a p value of less than 0.05 being statistically significant. Results: The final study population was 318 participants. Majority of participants were male with neonates comprising almost one third of participants. Classical symptoms were present in a majority of patients at initial presentation. Intussusception (34.6%) was the leading acquired aetiology of paediatric mechanical intestinal obstruction. Operative surgical management was in 94.6% of participants. Surgical complications were present in 61.1% of participants. The commonest surgical complication was surgical site infection in 16.9%. Overall mortality rate was 10.2% with 23.3% among neonates and 4.9% in older children. Referral status was statistically associated with mortality (p<0.001). Intestinal atresia had the highest case-specific mortality rate. Age, presence of comorbidity were factors associated to postoperative complications and mortality (p<0.05). Conclusions: The overall mortality rate was 10.2%. A higher mortality was seen among neonates compared to older children.

“Kuchoka”: Investigation of research fatigue in Mosoriot, Kenya

2026-02-23T06:55:17Z

Title: “Kuchoka”: Investigation of research fatigue in Mosoriot, Kenya Authors: Cherop 1*, Felishana; Naanyu, Violet; Wachira3, Juddy; Atwoli, Lukoye Abstract: Health research is key to the promotion of population and community health, how ever, conducting many research studies in a community can cause research fatigue. Purpose We determined the prevalence of research fatigue and associated factors in Mosoriot, Kenya. Methods We conducted a cross-sectional study in the Mosoriot community from Wednesday 28, May 2014, to Thursday 30, April 2015, involving (n = 327) community members who were randomly sampled to respond to self-administered and/or guided question naires. We analyzed descriptive statistics to summarise the data and used the Pear son Chi-Square test to assess the bivariate associations between the variables and conducted multivariate analyses using logistic regression models to test the hypothe ses. The odds ratios and the corresponding 95% confidence limits were reported. Results Research fatigue prevalence was 56.3% and the factors associated included being >35 years (OR: 2.28, 95% CL: 1.27, 4.15), being male (OR: 2.80, 95% CL:1.59, 5.00), self-employment (OR: 2.05, 95% CL: 1.06, 4.01), participating in hospital- based studies (OR: 3.59, 95% CL:1.88, 7.09), involvement in multiple researches (OR: 3.86, 95% CL:1.87, 8.27), desire to drop out of a study (OR: 11.49, 95% CL: 3.69, 43.83) and being asked personal questions (OR: 6.23, 95% CL: 3.28, 12.23)There is a high prevalence of research fatigue (56.3%) among community members in Mosoriot who have participated in repeated research, which is associated with age, gender, income source, research setting, frequency of research engagement, desire to drop out of studies, and discomfort with questions. Addressing research fatigue would enhance ethical research conduct and promote sustained community participa tion in research. Background The value of health research in promoting the health of communities cannot be understated because it addresses community and patients’ needs and fosters a col laborative and ethical foundation for scientific discovery [1]. Engaging communities in research ensures recognition of community priorities, values, and interests that would have intrinsic ethical importance [2]. However, conducting too many research studies in one community causes research fatigue [3], raises ethical issues [4], and influ ences data quality [5] and future participation [6]. Research fatigue is a state where individuals or groups tire of participating in research due to high-volume research projects [7], long or sensitive interviews [3,8,9], and lack of tangible benefit, often resulting to distrust [10]. Although the global prevalence of research fatigue is still unknown [4], evidence shows substantial prevalence of 42% among injecting drug users (IDUs) in HIV stud ies in Karachi [11], and 52% in pooled cancer studies [5]. As a result, research fatigue has several undesired outcomes including research participants may become hostile [12–14], distrustful, or feel coerced [12,15–18], hence undermining the Belmont ethi cal principles and guidelines for the protection of human subjects in research includ ing respect for persons, beneficence, and justice [4,6,12,19–24]. It also threatens scientific validity of research through selection and non-response biases and social desirability effects [4,17,18], which may compromise data quality and generalizability of findings [19,20,22]. In recognition of the presence of research fatigue in health research and insuf ficient data in communities that have been involved in multiple studies, there is a need to document its prevalence and ethical implications in contexts such as Kenya. This study reports findings from a community frequently engaged in multiple health research projects in Kenya.

Clinical, Ultrasound, and Endometrial Histopathological features of Perimenopausal and Postmenopausal women with abnormal uterine bleeding at a tertiary hospital in Western Kenya

2026-02-23T06:39:03Z

Title: Clinical, Ultrasound, and Endometrial Histopathological features of Perimenopausal and Postmenopausal women with abnormal uterine bleeding at a tertiary hospital in Western Kenya Authors: Moshey, Issa; Elly, Benjamin; Itsura, Peter; Mburu, Anisa; Shaffi, Afrin; Kibet, Kibor; Chesori, Erick; Tonui, Philliph Abstract: Background: Abnormal uterine bleeding (AUB) affects 3–30% of perimenopausal women and 5–10% of those who are postmenopausal. While the aetiology of the condition in these women is mostly benign, it could also be a symptom of endometrial hyperplasia (EH) and endometrial cancer (EC). Conditions linked to EH and EC, such as obesity, diabetes, and hypertension, are on the rise in Kenya. Despite studies in various populations reporting differences in endometrial histopathology and the prevalence of EH and EC, data from sub-Saharan Africa remain scarce. Objectives: To describe the clinical, ultrasound, and endometrial histopathological features; determine the prevalence of EH and EC; and identify factors associated with the diagnosis of the two conditions in peri- and postmenopausal women with AUB at the Moi Teaching & Referral Hospital (MTRH), a tertiary hospital in Eldoret, Kenya. Methods: This was a cross-sectional study of women aged ≥40 years with AUB, conducted between June 2019–May 2020 at MTRH. A total of 64 perimenopausal women and 36postmenopausal women were enrolled. Endometrial biopsies were performed using a Pipelle® (Cooper Surgical Inc., Trumbull, Connecticut, USA) endometrial suction curette, followed by histopathological evaluation by two pathologists. Data on sociodemographic, clinical and reproductive characteristics (BMI, chronic illness, bleeding patterns, parity, contraception use), and ultrasound findings (presence of uterine mass, endometrial thickness) were recorded. Associations between these characteristics and the diagnosis of EH/EC were tested using χ² or Fisher’s exact test, and significance was accepted at a p value ≤0.05. Results: Of 64 perimenopausal women, 42 (65.6%) were either overweight or obese, and 11 (17.2%) had at least one chronic illness linked to EC. Of the 36 postmenopausal women, 31 (86.1%) were either overweight or obese, and 20 (55.5%) had at least one chronic illness linked to EC. From the perimenopausal group, 40 (62.5%) had cyclical or benign patterns, 23 (35.9%) had EH with or without atypia, and one (1.6%) had EC. EH without atypia was the most frequently seen individual pattern in this group (32.8%). Among the 36 postmenopausal women, 15 (41.7%) had cyclical or benign patterns, 14 (38.9%) had EH with or without atypia, and seven (19.4%) had EC. EH without atypia was also the most frequently seen individual pattern in this group (25.0%). None of the clinical and reproductive characteristics were significantly associated with the diagnosis of EH/EC. A thickened endometrium on ultrasound was the only feature associated with the diagnosis of EH/EC (p=0.004) on multivariate analysis. Conclusion: The most frequently observed histopathological features in perimenopausal women with AUB and in women with postmenopausal bleeding at MTRH were normal cyclical patterns (secretory or proliferative) in the perimenopausal group, benign pathologies (chronic endometritis in perimenopausal and atrophic endometrium in postmenopausal), and EH without atypia in both groups of women. Only a small proportion of perimenopausal women were diagnosed with EH with atypia (3.1%) and EC (1.5%), the two pathologies of greatest clinical concern. Based on these findings, the authors do not recommend the routine performance of endometrial biopsies for perimenopausal women with AUB unless symptoms persist despite medical therapy and risk factor modification. Conversely, in women with postmenopausal bleeding, the authors strongly recommend histological evaluation of the endometrium, particularly in those with an endometrial thickness >4 mm on ultrasound, given the relatively high prevalence of EH with atypia (13.8%) and EC (19.4%) observed in this study.