School of Nursing

Healthcare System Factors Influencing Access and Utilization of Skilled Birth Services among Pastoralist Women in Loima Sub- County, Turkana County, Kenya

Tue, 01 Sep 2026 00:00:00 GMT

Healthcare System Factors Influencing Access and Utilization of Skilled Birth Services among Pastoralist Women in Loima Sub- County, Turkana County, Kenya Odunga, Jack; Koskei, Peter; Kirop, Elijah; Rutto, Joshua Objectives: To determine access to skilled birth services among women of reproductive age, to asses health care interventions influencing the utilization of skilled birth services and to explore barriers influencing the utilization of skilled birth services. Methods: A mixed-methods study design was employed, conducted from March to June 2024. For the quantitative component, a sample of 384 women aged 15–49 years who had given birth within the previous two years at the time of study was selected using a two-stage cluster sampling method. First, villages were selected from each of the four wards in the sub-county using probability proportional to population size. In the second stage, households were systematically sampled with an interval of 5 households. Qualitative data were collected through 20 in-depth interviews (upon reaching data saturation) with key informants, including community health volunteers (CHVs), traditional birth attendants, and healthcare providers. Quantitative data were analyzed using logistic regression to determine factors associated with skilled birth utilization, while qualitative data were analyzed thematically to identify barriers to skilled birth utilization. Results: The bivariate analysis shows significant association at P<0.05 between marital status P<0.03, household size P< 0.01, distance to health facilities P< 0.04 availability of supplies P<0.02, reception by service providers P<0.05 and birthing experiences P< 0.02. These results suggest that women who are married, have smaller households, live closer to health facilities, and receive better care and resources are more likely to utilize skilled delivery services. The multivariate logistic analysis identifies the independent predictors of skilled delivery utilization. Factors such as being single (OR=3.75, CI=0.58-5.97), having more than five children (OR=0.60, CI=0.45-0.80), and living more than 5 km from a health facility (OR=1.96 CI=0.53-2.92) were associated with lower odds of utilizing skilled delivery services. Economic barriers included low household income, with most women engaging in small-scale farming and their spouses working as casual laborers or herders. Facility-based interventions such as health talks by nurses/midwives and community health education increased utilization of skilled birth services. Conclusion: Healthcare system barriers substantially constrain access and utilization of skilled birth services in pastoral settings. Strengthening rural health systems through improved infrastructure, staffing, supply chains, and referral systems is essential for improving maternal health outcomes.

Determinants of Clinical Learning Environment: Evidence from BScN Students in Selected Public Universities in Kenya

Sat, 01 Aug 2026 00:00:00 GMT

Determinants of Clinical Learning Environment: Evidence from BScN Students in Selected Public Universities in Kenya Murei, Sally; Mosol, Priscah; Osotsi, Franklin Background: A constructive clinical learning environment (CLE) with a focus on student learning needs is vital for nursing education. Understanding the features of a healthy CLE for under graduate nursing students continues to be a challenge for healthcare organizations and educators in application of theory to practice. Objective: The objective of the study was to investigate the determinants of the clinical learning environment as perceived by BScN students in selected public universities in Kenya Methods: A descriptive quantitative cross-sectional design was employed where data was collected from consenting participants from two selected public universities in Kenya, using a pre-tested modified clinical learning environment inventory tool. The target population comprised of 125 fourth-year Bachelor of Science nursing students. The census technique will be used in this study. Quantitative data will be analyzed using SPSS version 27 for frequencies mean and percentages then presented using tables, charts, and graphs Results: The findings indicate that ward leadership style had a significant influence on clinical learning environment (F = 9.09; t = 3.63; p = 0.000 <0.05), ward culture had an influence on the clinical learning environment (F = 8.46; t = 10.76; p = 0.000 <0.05) and supervisory relationship influenced clinical learning environment (F = 1.13; t = 1.98; p = 0.020 <0.05) Conclusions: Ward leadership style, positive ward culture and supervisory relationships can foster a supportive clinical learning environment Recommendations: Strengthening leadership support for students while creating a supportive learning environment that promotes and maintain a collaborative learning culture is needed

Sustainability starts with spending: public financial management lessons from Kenya’s universal health care pilot

Wed, 01 Jan 2025 00:00:00 GMT

Sustainability starts with spending: public financial management lessons from Kenya’s universal health care pilot Adjagba, Alex Olateju; Oguta, James Odhiambo; Akoth, Catherine; Toweet, Solomon Kimutai; Okoth, Peter; Jackson, Debra Background Effective public financial management (PFM) is a foundational enabler of sustainable progress toward Universal Health Coverage (UHC). Achieving UHC requires not only increased funding for the health sector but also the efficient, equitable, and accountable use of resources. In 2019, Kenya piloted a UHC initiative across four counties to generate evidence to inform national scale-up. This study examines the PFM processes underpinning the pilot implementation, with a focus on how financial planning, budget execution, and accountability mechanisms influenced the delivery of UHC interventions at the county level. Methods This study employed a qualitative research design to explore PFM processes during the implementation of Kenya’s UHC pilot in four counties. Data were collected through 51 in-depth interviews and five focus group discussions with key stakeholders, including healthcare workers, patient representatives, and senior members of the County Health Management Teams (CHMTs). An inductive thematic analysis approach was employed to identify patterns and themes that emerged from the data. The analysis was facilitated using Dedoose software (Version 9.0.17), which enabled systematic coding and organization of the qualitative data. Results The UHC pilot program in Kenya featured a hybrid planning model, combining top-down directives from the national government with bottom-up inputs from county stakeholders. Despite this collaborative approach, county budgeting processes remained governed by the stipulations of the PFM Act. While counties welcomed additional UHC funds, the removal of user fees led to reduced facility-level revenue, increased service demand, and strain on human and material resources. Delays in fund disbursement, rigid budget structures, and limited financial autonomy further constrained implementation. These experiences underscore the need for a more coherent integration of PFM and health financing policies at the subnational level to ensure sustainable and equitable health service delivery. Conclusion The UHC pilot offers critical lessons for future health financing reforms. Addressing PFM bottlenecks—particularly those related to timely disbursement, budget flexibility, and local revenue generation—is essential to ensure the sustainability of UHC in Kenya and similar contexts. The study’s limitations necessitate further research before scaling up nationwide.

Pressure ulcer prevention and treatment interventions in Sub-Saharan Africa: A systematic review

Mon, 01 Jan 2024 00:00:00 GMT

Pressure ulcer prevention and treatment interventions in Sub-Saharan Africa: A systematic review Zuniga, Julie; Mungai, Margaret; Chism, Lucy; Frost, Livia; Kakkar, Reha; Kyololo, O’Brien Background The high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific treatment strategies. Purpose Therefore, the purpose of this systematic review was to establish and elucidate PU prevention and treatment interventions tested in SSA. Methods This systematic review of the literature used, PRISMA to guide the search. Findings The review identified nine studies on PU prevention (three) and treatment (six). Low-cost interventions assembled from locally available materials and multifaceted policies significantly prevented and treated PUs. The interventions included wound dressing agents, simple negative pressure suction devices that significantly treated PUs, and water-based bed surfaces. Discussion There were gaps in the interventions that have been proven successful in other global settings. Conclusion In SSA, there is a need for nurses to tailor, test, and disseminate findings from evidence-based projects for PU prevention that have been successful in similar settings.