Utilization of free maternity services among women of child bearing age in Machakos County, Kenya.

INTRODUCTION: globally, the rate of maternal mortality is unacceptably high with Kenya recording a rate of 362 maternal death per 100,000 live births. Even so, only 62% of women deliver under skilled health care. The government of Kenya introduced Free Maternity Services (FMS) to all women delivering in public health facilities as a way of increasing facility-based deliveries. Despite this, intervention, health facility deliveries in Machakos County are still low. This study aimed to identify hindrances and enablers of the FMS program in Machakos County. METHODS: it was a cross-sectional study conducted among postnatal women who delivered between September 2018 and September 2019 in Machakos County. A total of 394 women were enrolled. Data was collected using questionnaires and focus group discussions. Key informant interviews were conducted using nursing officer in charge of selected health facilities. Qualitative data was analyzed using chi-square and fishers exact. Multivariate logistic regression was used to determine predictors of utilization of FMS. Statistical significance was set at p < 0.05. RESULTS: utilization of FMS in Machakos County was 75.6%. Factors that were associated with utilization of FMS included marital status (p = 0.006), parity (p = 0.038), distance from health facility (p = 0.000), services offered during labour (p = 0.000), treatment of mothers by healthcare workers during labour (p = 0.000), provision of adequate food (p = 0.005), quality of service (p = 0.000) and cleanliness of the maternity ward (p = 0.000). CONCLUSION: utilization of FMS in Machakos County is optimal. Health facilities should be supported to offer FMS by providing them with necessary supplies.

Management of diabetes mellitus at the household level using community health strategy in Embu County, Kenya.

INTRODUCTION: diabetes mellitus (DM) causes 1% of the mortality in Kenya and 2% of the population in Kenya has diabetes mellitus. Embu County was the 5th leading county in diabetes mellitus morbidity in Kenya in 2019. This study aimed at assessing the management of diabetes mellitus at the household level using the community health strategy in Embu County. Community health strategies in the county is implemented using Community Health Volunteers. METHODS: it was a cross-sectional study using 422 household participants in Embu County and 150 community health volunteers´ (CHVs). Key informant interviews were used on community health strategy managers involved in diabetes management programmes in the County. Data was analyzed using SPSS version 25. RESULTS: factors that were positively associated with effective management of DM at household level in the County were financial support and supervision of community health units, provision of tools and commodities, use of health information system, training of level of CHVs in management of hypertension and diabetes mellitus and subsequent knowledge on symptoms, defining and classifying DM, treatment, prescription of drugs, knowledge of risk factors of DM and prevention of DM at household level. CONCLUSION: success of utilization of community health strategies for diabetes management will require adequate training of CHVs in management of hypertension and diabetes mellitus, financial support of community health units, adequate supervision of community health units, financial support of community health units, provision of tools and commodities and community health units (CHU) utilizing health information system.

Assessment of Integrated Disease Surveillance Data Uptake in Community Health Systems within Nairobi County, Kenya.

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.

Awareness, Beliefs, and Actions Concerning Zika Virus Among Pregnant Women and Community Members - U.S. Virgin Islands, November-December 2016.

As of May 2, 2017, the U.S. Virgin Islands (USVI), comprising St. Thomas, St. John, and St. Croix, had reported 1,021 probable or confirmed cases* of Zika virus disease in its population of approximately 100,000 (1); 222 symptomatic and asymptomatic pregnant women in the USVI had tested positive for Zika virus. In January 2016, USVI Department of Health (USVI DOH) initiated Zika response measures, including surveillance, vector control, and a communications program. Interventions included education and outreach, distribution of Zika prevention kits† to pregnant women in the USVI, and provision of free Zika virus laboratory testing and vector control services. In November 2016, USVI DOH staff members conducted interviews with convenience samples of community members and pregnant women to gather feedback about current and proposed interventions (2). Pregnant women reported taking a median of two actions to protect themselves from Zika, with repellent use being the most commonly reported action. Community members reported taking a median of one action and were supportive of several proposed vector control approaches. Whereas multiple pregnant women and community members reported hearing messages about the cause and consequences of Zika virus infections, few recalled messages about specific actions they could take to protect themselves. Integrating evaluation into response measures permits ongoing assessment of intervention effectiveness and supports improvement to serve the population's needs.