Background Kenya is in the process of implementing universal health care whose success and sustainability will be determined by its funding mechanism and by uptake of National Hospital Insurance Fund (NHIF) by its populace. Unfortunately, NHIF enrollment is currently voluntary hence geared to those in formal employment who represent only 16.4% of the population. To improve the voluntary uptake of the scheme, it is important to have increased awareness as well as implement strategies that address factors that currently affect NHIF uptake. Methods This was a cross sectional community-based survey conducted in Busia, Trans Nzoia, Vihiga and Siaya counties between October and December 2018. It utilized multistage stratified sampling technique. Interviewer assisted questionnaires were used to collect socio-demographic, socio-economic, Non-Communicable Diseases (NCD) knowledge, NHIF awareness and uptake data. Descriptive statistical analysis and multiple logistic regression were conducted using STATA version 15. Results Out of a representative sample of 3597 participants interviewed, NHIF awareness was noted to be 81.5%, with low uptake in the four counties ranging between 21–25%. Being older than 69 years, having a low level of education and income status as well as lower health risk were significantly associated with low rates of NHIF uptake. Conclusion Despite high rates of NHIF awareness noted in this study, there is still very low uptake to this scheme in rural western Kenya especially among those with low socioeconomic status and risk of chronic illnesses. There is need for further qualitative studies to explore contextual factors affecting NHIF uptake.
Purpose: To assess the preparedness of public health care facilities in the provision of breast and cervical cancer services. Specifically, healthcare providers knowledge on risk factors, screening, symptoms, diagnosis and treatment as well as availability of medical equipment required for breast and cervical cancer management. Methods: A cross-sectional service provision assessment (SPA) survey conducted in Busia and Trans-Nzoia counties of Western Kenya between October and December 2018. Interviewer assisted questionnaires were used to collect data from healthcare workers while a structured facility questionnaire was used to assess the level of preparedness of the selected public healthcare facilities stratified by their level of care. Statistical analysis was done using STATA version 15. Results: We enrolled 73 healthcare workers 37 (50.6%) of whom were nurses, followed by clinical officers and medical officers. The highest proportion of knowledge on risk factors and screening of breast and cervical cancer was reported among medical officers or consultant physicians, followed by clinical officers. Nurses scored highly on the symptoms of breast and cervical cancer. The medical equipment required for breast and cervical cancer screening and diagnosis were found in most facilities; however, there were no core-biopsy needles or mammograms found. A single LEEP equipment was found in a health center within Trans Nzoia while two LEEP equipment were stationed at the Busia county hospital. Conclusion: A below average level of knowledge on breast and cervical cancer among the healthcare workers attending to patients in public healthcare facilities was found in both Busia and Trans Nzoia counties. Furthermore, there was a disparity in the distribution and quantity of priority medical equipment for the screening, diagnosis and treatment of breast and cervical cancer in the two county hospitals.
Emerging data suggest a rise in the incidence rate of hypertension in many countries within Sub-Saharan Africa. This has been attributed to socioeconomic factors that have influenced diet and reduced physical activity further deranging anthropometric measurements. We assessed the predictive power of three anthropometric indicators namely: waist circumference (WC), waist to height ratio (WHtR) and body mass index (BMI) in detecting hypertension. This cross-sectional community survey was conducted in four counties within Western Kenya between October 2018 to April 2019 among 3594 adults. The participants’ sociodemographic data were collected using an interviewer-administered questionnaire and anthropometric measurements taken. We used the R-software for descriptive and inferential statistical analysis. Pearson chi-square test was used to assess the association between anthropometric measurements and hypertension while logistic regressions estimated the likelihood of hypertension. Youden method was used to identify optimal anthropometric cut-offs for sensitivity, specificity and area under the receiver operating characteristics (ROC) curve computation. The crude prevalence of hypertension was 23.3%, however it rose with advancement in age. Furthermore, obese individuals had a three-fold (AOR=2.64; 95% CI: 2.09, 3.35) increased likelihood of hypertension compared to those with a normal BMI. The optimal WC cut-off was 82.5cm for men and 87cm for women, an optimal WHtR of 0.47 for men and 0.55 for women; while the optimal BMI cut-off was 23.7 kg/m2 and 22.6 kg/m2 for men and women respectively. The sensitivity of WC, WHtR and BMI for men was 0.60, 0.65 and 0.39 respectively and 0.71, 0.65 and 0.78 respectively for women. BMI is the best predictor for hypertension among women but a poor predictor for men; WC had a high hypertension predictive power for both gender while WHtR is the best hypertension predictor for men.
Background Kenya is in the process of implementing universal health care whose success and sustainability will be determined by its funding mechanism and by uptake of National Hospital Insurance Fund (NHIF) by its populace. Unfortunately, NHIF enrollment is currently voluntary hence geared to those in formal employment who represent only 16.4% of the population. To improve the voluntary uptake of the scheme, it is important to have increased awareness as well as implement strategies that address factors that currently affect NHIF uptake. Methods This was a cross sectional community-based survey conducted in Busia, Trans Nzoia, Vihiga and Siaya counties between October and December 2018. It utilized multistage stratified sampling technique. Interviewer assisted questionnaires were used to collect socio-demographic, socio-economic, Non-Communicable Diseases (NCD) knowledge, NHIF awareness and uptake data. Descriptive statistical analysis and multiple logistic regression were conducted using STATA version 15. Results Out of a representative sample of 3597 participants interviewed, NHIF awareness was noted to be 81.5%, with low uptake in the four counties ranging between 21–25%. Being older than 69 years, having a low level of education and income status as well as lower health risk were significantly associated with low rates of NHIF uptake. Conclusion Despite high rates of NHIF awareness noted in this study, there is still very low uptake to this scheme in rural western Kenya especially among those with low socioeconomic status and risk of chronic illnesses. There is need for further qualitative studies to explore contextual factors affecting NHIF uptake.
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