Papers by Mary Muyoka Nyikuri
F1000Research, 2021
This reflective opinion article arises from our experience conducting interviews with refugee wom... more This reflective opinion article arises from our experience conducting interviews with refugee women attending ante-natal and post-natal services in an urban setting in Kenya in the context of COVID‑19. First, we explain the research context in light of the study objectives. We reflect on the methodological challenges we faced, including researcher’s positionality, and argue that conducting research within the refugee context during the pandemic is unique, therefore research design must reconsider inclusive methodologies tailored to the uniqueness of refugees’ experience in order to obtain useful data. Second, we discuss these challenges in light of our experiences and the implications for addressing the gaps we identified, with particular emphasis on the ways in which professionals working with refugee communities in the context of a pandemic can build trust and obtain meaningful and uncompromised data. Lastly, we provide recommendations for researchers conducting similar research.
Frontiers in Global Women's Health, 2020
Introduction: Maternal mortality continues to be one of the biggest challenges of the health syst... more Introduction: Maternal mortality continues to be one of the biggest challenges of the health system in Kenya. Informal settlements in Kenya have been known to have higher rates of maternal mortality and also receive maternity services of varied quality. Data assessing progress on key maternal health indicators within informal settlements are also often scarce. The COVID-19 pandemic hit Kenya in March this year and so far, the impact of the pandemic on access to maternal health has not been established. This study aims to add to the body of knowledge by investigating the effects of the COVID-19 pandemic and mitigation strategies on access to health care services in informal settlements.Methods: Qualitative methods using in-depth interviews were used to assess women's experiences of maternity care during the COVID-19 era and the impact of proposed mitigation strategies such as the lockdown and the curfew. Other aspects of the maternity experience such as women's knowledge of C...
Heliyon, 2020
Introduction: Examining how nurses hand over provides an opportunity to identify opportunities fo... more Introduction: Examining how nurses hand over provides an opportunity to identify opportunities for improvement. Although recognised as a complex and dynamic interaction among nurses, there is little consensus regarding the primary function, location and structure of handover. The aim of this study was to understand from nurses' perspectives, the purpose and structure of handover in three different health sector newborn units in Nairobi. Methods: This was an ethnographic qualitative research designed study. Between January 2017 and March 2018, I carried out 150 hours of non-participant observations, conducted 29 in-depth interviews with nurses (10) public sector (8) faith based and (11) private sector. All data was managed by Nvivo 10 (QSR International) and analysed using a thematic framework. Results: The purpose of handover was to pass on the management of a patient (s) from one outgoing nurse to incoming nurse at the end of a shift. In all three hospitals, handover took place at the nurse station, but for the nurses in both public and faith based hospitals, this was followed up by bed to bed handover. The structure differed from hospital to hospital, from nurse to nurse and what was actually handed over. The shift system, time available for handover, familiarity with babies, medical emergencies and use of notes were factors that influenced the structure of handover across hospitals. Conclusion: Although the purpose of handover was similar across the newborn units, the structure was different. There is need to perhaps develop communication guidelines for this key care process sothat all relevant information about the patients is maintained across nurses.
Background: Small and sick newborns continue to die in low- and middle-income countries as a resu... more Background: Small and sick newborns continue to die in low- and middle-income countries as a result of among other causes, infection. Despite the existence of guidelines for infection prevention, little is known on practices and associated factors among nurses working in newborn units in many developing nations. Therefore, the objective of this study was to assess nurses’ practices and their perspectives on what influences their ability to adhere to infection prevention and control (IPC) norms in newborn units.Methods This qualitative study used an ethnographic research design to collect data. 150 hours of observations and through purposeful sampling, nurses working in the newborn units in three hospitals in Nairobi were interviewed using an interview guide. The face to face interviews lasted between 45-60 mins and were digitally audiotaped, transcribed verbatim and translated into English where necessary. Data were imported into Nvivo 10 software for management. All data were anony...
Social Science & Medicine, 2019
Recent global commitments to shift responsibility for Neglected Tropical Disease (NTD) control to... more Recent global commitments to shift responsibility for Neglected Tropical Disease (NTD) control to affected countries reflect a renewed emphasis on sustainability, away from aid-dependency. This calls for a better understanding of how domestic stakeholders perceive investments in different strategies for NTD control. Soil transmitted helminths (STH) are among the NTDs targeted for elimination as a public health problem by international agencies through mass drug administration, provided periodically to at-risk population groups, often using drugs donated by pharmaceutical companies. This study was conducted in Kenya at a time when responsibilities for long running STH programmes were transitioning from external to national and sub-national agencies. Following an initial assessment in which we identified key domestic stakeholders and reviewed relevant scientific and government documents, the perspectives of stakeholders working in health, education, community engagement and sanitation were investigated through semi-structured interviews with national level policymakers, county level policymakers, and frontline implementers in one high-STH burden county, Kwale. Our conceptual framework on sustainability traced a progression in thinking, from ensuring financial stability through the technical ability to adapt to changing circumstances, and ultimately to a situation where a programme is prioritised by domestic policymakers because empowered communities demand it. It was clear from our interviews that most Kenyan stakeholders sought to be at the final stage in this progression. Interviewees criticised long-term investment in mass drug administration, the approach favoured predominantly by external agencies, for failing to address underlying causes of STH. Instead they identified three synergistic priority areas for investment: changes in institutional structures and culture to reduce working in silos; building community demand for and ownership; and increased policymaker engagement on underlying socioeconomic and environmental causes of STH. Although challenging to implement, the shift in responsibility from external agencies to domestic stakeholders may lead to emergence of new strategic directions.
International Journal for Equity in Health, 2017
Background: In March 2013, Kenya transitioned from a centralized to a devolved system of governan... more Background: In March 2013, Kenya transitioned from a centralized to a devolved system of governance. Within the health sector, this entailed the transfer of service provision functions to 47 newly formed semi-autonomous counties, while policy and regulatory functions were retained at the national level. The devolution process was rapid rather than progressive. Methods: We conducted qualitative research within one county to examine the early experiences of devolution in the health sector. We specifically focused on the experience of change from the perspective of sub-county managers, who form the link between county level managers and health facility managers. We collected data by observing a diverse range of management meetings, support supervision visits and outreach activities involving sub-county managers between May 2013 and June 2015, conducting informal interviews wherever we could. Informal observations and interviews were supplemented by fifteen tape recorded in depth interviews with purposively selected sub-county managers from three sub-counties. Results: We found that sub county managers as with many other health system actors were anxious about and illprepared for the unexpectedly rapid devolution of health functions to the newly created county government. They experienced loss of autonomy and resources in addition to confused lines of accountability within the health system. However, they harnessed individual, team and stakeholder resources to maintain their jobs, and continued to play a central role in supporting peripheral facility managers to cope with change. Conclusions: Our study illustrates the importance in accelerated devolution contexts for: 1) mid-level managers to adopt new ways of working and engagement with higher and lower levels in the system; 2) clear lines of communication during reforms to these actors and 3) anticipating and managing the effect of change on intangible software issues such as trust and motivation. More broadly, we show the value of examining organisational change from the perspective of key actors within the system, and highlight the importance in times of rapid change of drawing upon and working with those already in the system. These actors have valuable tacit knowledge, but tapping into and building on this knowledge to enable positive response in times of health system shocks requires greater attention to sustained software capacity building within the health system.
Developing World Bioethics, 2016
There is a growing interest in the ethics of Health Policy and Systems Research (HPSR), and espec... more There is a growing interest in the ethics of Health Policy and Systems Research (HPSR), and especially in areas that have particular ethical salience across HPSR. Hyder et al (2014) provide an initial framework to consider this, and call for more conceptual and empirical work. In this paper, we respond by examining the ethical issues that arose for researchers over the course of conducting three HPSR studies in Kenya in which health managers and providers were key participants. All three studies involved qualitative work including observations and individual and group interviews. Many of the ethical dilemmas researchers faced only emerged over the course of the fieldwork, or on completion, and were related to interactions and relationships between individuals operating at different levels or positions in health/research systems. The dilemmas reveal significant ethical challenges for these forms of HPSR, and show that potential 'solutions' to dilemmas often lead to new issues and complications. Our experiences support the value of research ethics frameworks, and suggest that these can be enriched by incorporating careful consideration of context embedded social relations into research planning and conduct. Many of these essential relational elements of ethical practice, and of producing quality data, are given stronger emphasis in social science research ethics than in epidemiological, clinical or biomedical research ethics, and are particularly relevant where health systems are understood as social and political constructs. We conclude with practical and research implications.
PLOS ONE, 2015
Background Public primary health care (PHC) facilities are for many individuals the first point o... more Background Public primary health care (PHC) facilities are for many individuals the first point of contact with the formal health care system. These facilities are managed by professional nurses or clinical officers who are recognised to play a key role in implementing health sector reforms and facilitating initiatives aimed at strengthening community involvement. Little in-depth research exists about the dimensions and challenges of these managers' jobs, or on the impact of decentralisation on their roles and responsibilities. In this paper, we describe the roles and responsibilities of PHC managers-or 'in-charges' in Kenya, and their challenges and coping strategies, under accelerated devolution.
Mila a Journal of the Institute of African Studies, 2003
<p>Organisational capacity adopted from Ortiz Aragon, 2010.</p
<p>Network of actors that a facility in-charge is accountable to.</p
This repository contains the interview guide and COREQ checklist for "But you have to start ... more This repository contains the interview guide and COREQ checklist for "But you have to start somewhere" manuscript by Nyikuri et. al.
Background Public primary health care (PHC) facilities are for many individuals the first point o... more Background Public primary health care (PHC) facilities are for many individuals the first point of contact with the formal health care system. These facilities are managed by professional nurses or clinical officers who are recognised to play a key role in implementing health sector reforms and facilitating initiatives aimed at strengthening community involvement. Little in-depth research exists about the dimensions and challenges of these managers ’ jobs, or on the impact of decentralisation on their roles and responsibilities. In this paper, we describe the roles and responsibilities of PHC managers–or ‘in-charges ’ in Kenya, and their challenges and coping strategies, under accelerated devolution. Methods The data presented in this paper is part of a wider set of activities aimed at understanding governance changes under devolution in Kenya, under the umbrella of a ‘learning site’. A learning site is a long term process of collaboration between health managers and research-ers de...
Nursing Open, 2020
The need to reduce neonatal mortality has become a priority internationally, with Sustainable Dev... more The need to reduce neonatal mortality has become a priority internationally, with Sustainable Development Goal (SDG) 3 targeting a reduction in mortality to 12/1,000 live births or lower (WHO, 2016). Kenya has a neonatal mortality rate of 22 per 1,000 live births (Government of Kenya, 2014; WHO, 2016) with 43,600 annual neonatal deaths, the 6th highest in sub-Saharan Africa (Afolabi, 2017). In many low-and middle-income countries (LMICs), the survival of sick newborns admitted as inpatients is hampered by several factors including poor quality care (Dickson, 2014). Globally and even here in Kenya most inpatient care for
Wellcome Open Research, 2019
Background: Kenya has one of the highest rates of neonatal mortality in the world at 22/1,000 liv... more Background: Kenya has one of the highest rates of neonatal mortality in the world at 22/1,000 live births. Improving the quality of newborn care would greatly improve survival rates. There is an increasing consensus that strong health systems are key to achieving improved health outcomes. However, there is significantly less agreement on what to strengthen in low and middle-income countries such as Kenya. As nurses are the main caregivers in many inpatient settings, efforts aimed at improving the quality of facility care for sick newborn babies need to take into account nurses views and opinions. Our intent in this paper is to describe the current state of the nursing environment and what would be required to improve the quality of those environs from nurses’ perspectives. Methods: Between January 2017 and March 2018, we collected data through non-participant observations, unsolicited conversations and review of admission registers. We also conducted 29 individual in-depth interview...
International Journal of Epidemiology, 2015
Journal of Clinical Research in HIV AIDS and Prevention, 2014
Recruitment of couples is important for study success. The multi-centered HPTN 052 clinical trial... more Recruitment of couples is important for study success. The multi-centered HPTN 052 clinical trial was designed to evaluate whether immediate versus delayed use of ART by HIV-infected individuals would reduce transmission of HIV to their HIV-uninfected partners. The objective of this study was to retrospectively compare several approaches for community recruitment at our site in Kisumu, Kenya based on a) feedback from recruitment staff, b) associated cost, and c) number of eligible couples enrolled. A secondary objective was to assess the discordant couples' acceptability of the community recruitment approaches relative to the a) main recruitment venues, b) educational materials, and c) local language best suited for explaining the trial. 241 couples were screened for eligibility using nine recruitment approaches. We compared the approaches used for the 60 couples found to be eligible to those used for the 56 ineligible couples for whom that information was available. Analyses for association were carried out. In-depth interviews were conducted with 20 staff and 29 discordant couples. Records were kept of the costs associated with each approach. Overall, staff interviews revealed that acceptability of the approaches was high. Challenges were present with all approaches ranging from one member of the couple not wanting to reveal their positive HIV status to their partner (Patient Support Center or PSC approach), to not finding people at home (home based counseling and testing or HBCT approach). The PSC and the HBCT recruitment approaches were the most effective in terms of recruiting eligible participants. There was an overall significant difference between the proportion of eligible and ineligible participants among the 9 approaches (χ 2 (8) =33.5; p<0.0001). Analyses for association showed that the PSC approach resulted in attracting a greater proportion of couples who were eligible than ineligible (χ 2 (1) =6.6; p=0.016). The cost for the PSC approach was less than one-third that of the HBCT approach. All discordant couples interviewed found the two main recruitment venues (PSC and their home) acceptable. Among couples who saw the educational materials, the majority found them useful (poster 72.7%; pamphlet 90.9%; flyer 88.9%). All couples found the language they were told about the study acceptable. The evaluation of recruitment approaches indicated that working with local partners, specifically the PSC staff and HBCT staff, was the most effective way to recruit eligible discordant couples. A focus on collaborations and partnerships between research and clinical organizations will help study recruitment efforts.
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Papers by Mary Muyoka Nyikuri