Papers by Damaris Ochanda
medRxiv (Cold Spring Harbor Laboratory), Apr 26, 2024
We draw from empirical research conducted in communities in three border counties in western Keny... more We draw from empirical research conducted in communities in three border counties in western Kenya-Homa Bay, Bungoma and West Pokot-to examine how cultural and religious beliefs and healing practices can potentially shape the vulnerability of those communities to highly infectious diseases. Fieldwork consisting of mixed methods namely, key informant interviews with traditional and religious healers as well as their patients, focus group discussions with community members knowledgeable on cultural customs and practices, and participatory inquiry workshops with health professionals and administrators were used to collect the data. We find that traditional and religious beliefs and healing practices potentially shape community vulnerability to highly infectious diseases in two major ways. First, is a dualistic illness etiology involving a biomedical and socio-cultural etiology. Unexplained illnesses and illnesses that did not respond to conventional medicine were treated using traditional medicine. Making traditional and religious healers the first mile treatment preference could potentially delay appropriate treatment and compromise safe handling in case the disease is highly infectious. Second aspect pertains to the risks in the traditional and spiritual healing practices. Shared consecrated water often fetched from a large water body, laying of hands, use of herbs and rituals involving slaughtering of animals enhanced contacts. The use of protective gears during healing was inconsistent among the healers, but largely lacking as many healers could not afford them or were considered to reduce patient's faith in the healing powers. These practices potentially predispose people to highly infectious diseases and can hasten the spread and symptom severity. To reduce the vulnerability of border communities to highly infectious diseases, we argue for a need for comprehensive strategies that consider the intersecting factors of vulnerability to outbreaks, healing beliefs and practices. This may involve policy initiatives aimed at integrating traditional medicine practice and the mainstream health system. .
Evidence - Based Nursing Research /Evidence - Based Nursing Research, Mar 17, 2024
Evidence - Based Nursing Research /Evidence - Based Nursing Research, Mar 6, 2024
African journal of health sciences, Jan 26, 2024
BACKGROUND Approximately 6.4 million women die because of unsafe abortion in Africa. Abortion con... more BACKGROUND Approximately 6.4 million women die because of unsafe abortion in Africa. Abortion contributes to 35% of maternal deaths nationally, out of these adolescents account for 17%. Homa Bay County is among the 15 high-burden counties in the country, which accounts for 97% of maternal deaths. Interestingly, 23% of the deaths are as a result of teenage pregnancy. The study aimed to determine the induced abortion intention among adolescents seeking youth-friendly services in Homa Bay County. METHODS AND MATERIAL A cross-sectional was implemented for the study from April to June 2020. Systematic random sampling was used to select 332 participants among 1652 adolescents in the study areas. Data was collected through self-administered questionnaires. Univariate analysis, stepwise selection and multivariate logistic regression were employed to find determinants of induced abortion intention. The study was approved by the Ethical Review Committee of Masinde Muliro University of Science and Technology (MMU/COR: 509099) and NACOSTI offered a research permit NACOSTI/P/20/4496. RESULTS The study revealed a significant association between induced abortion intention and being multiparous (OR: 0.064; 95% CI: 0.005-0.918: p= 0.028). The current study found a strong association between adolescents' belief that their physical health reduces the likelihood of pregnancy from unprotected sex. Respondents who had a low perception of physical health were susceptible and had higher odds of having induced abortion intention. Similarly, the respondents who agreed that they do not talk to their partners about pregnancy were thrice as likely to have had induced abortion intention (OR: 3.2; 95% CI: 1.7-6.1: p= 0.0002). In addition, those who believed that if they continued with the pregnancy their academic career would be endangered were 4.3 times as likely to have had induced abortion intention (OR: 4.3: 95% CI: 2.2-8.1; p < 0.0001). CONCLUSION In this study, induced abortion intention was significant among adolescents who had a misinformed perception of their physical health and chances of getting pregnant even if they practised unprotected sex, lacked disclosure to partners and were urged not to discontinue their career and profession. Governments should embrace and operationalize multisectoral and pre-counselling approaches coupled with comprehensive sexual reproductive health education in and out of school in Adolescents programs. Similarly, Adolescent' programs should scale up male involvement.
Bayero Journal of Nursing and Health Care, Oct 15, 2023
Background: Handover involves the transfer of health care providers' responsibility and accountab... more Background: Handover involves the transfer of health care providers' responsibility and accountability for some or all aspects of care for a patient, or groups of patients, to another clinician or nurse on a temporary or permanent basis with communication being a major factor for the transfers. Effective handover is essential for safe health care and should used in all clinical situations. In Western Kenya, there is little evidence of studies carried out on the effective handover of critically ill patients in ICUs. Material and Methods: A cross-sectional mixed method was adopted and administered to the selected study participants from the selected hospitals using a self-administered questionnaire and KII tool. The purposive sampling method was used to select the institutions while convenient sampling was used to pick 80 study participants. Quantitative data was collected by use of questionnaires and observation checklist while qualitative data was collected through key informant interviews and analysis was done thematically. Findings: Health Care Provider variables including gender, age group, cadre, level of education and years of experience in working in the ICU showed no statistically significant association with the handover of critically ill patients. The mean age of the study participants was 34 years. In addition, the handover performance of Health care providers (p=0.3) and those with higher diploma qualifications (p=0.2) was up to 11.8 and 18 times more likely to be effective in clinical handover. Recommendation/Conclusion: While the identified health care provider factors have no statistical significance to clinical handing over, having a higher diploma, being a nurse, having less than or equal to seven years of working experience and receiving formal training on clinical handover have been shown by this study to be beneficial for clinical handover. The study recommends further investigation into these factors through rigorous studies involving a larger sample size. The lack of formal standardized guidelines for clinical handover and training calls for the urgent need to establish standard guidelines and processes that can support clinical handover.
African journal of health sciences, Jan 26, 2024
BACKGROUND Globally, breast cancer, the most diagnosed cancer, affects around 2.3 million individ... more BACKGROUND Globally, breast cancer, the most diagnosed cancer, affects around 2.3 million individuals. Approximately 28% to 38% of breast cancer patients develop lymphedema post-treatment, impacting one in five patients. Without intervention, the condition leads to serious complications, affecting daily tasks. Sub-Saharan Africa reports increasing comorbidities related to lymphedema, yet no data exists on its prevalence in Kenya. This study assessed clinical management strategies for breast cancer treatment-induced lymphedema in selected Western Kenya hospitals. MATERIAL AND METHODS This was a cross-sectional analytic study. Simple random sampling was used to select healthcare facilities offering cancer screening and treatment. Healthcare providers were randomly selected from five health facilities depending on the number required at each health facility. 192 healthcare providers were selected to participate in the study. Data collection was by structured questionnaires, observation checklist and focus group discussion, analysed by SPSS version 23.1 and Qualitative data thematically analysed guided by questions on knowledge, skills and management strategies. RESULTS The results showed healthcare providers' knowledge ranging from low to average with a deficit in important areas of practice such as skincare (OR=0.56, p=0.01). stocking pressure (OR=1.841, P=0.004, positive stemmer's sign test (OR=2.217, p=0.001) with over 50% getting incorrect answers. Good history and assessment Skills were demonstrated (0R=1.6; CI;1.0-24; P=0.037) but patient education was poorly done. Focus group discussion showed a deficit in knowledge by failure to clearly define lymphedema. CONCLUSION Structured education of lymphedema is needed to increase the knowledge of healthcare providers and improving knowledge may fill the gaps in knowledge and demonstrate good practical skills in patient management.
Introduction: Many strides have been made over recent years in the reduction of mortality among c... more Introduction: Many strides have been made over recent years in the reduction of mortality among children aged under-five years though disparities still exist between and within countries. Main causes of morbidity and mortality in Kenya among this age group are attributed to acute respiratory infections and pneumonia, diarrhoea, malaria, anaemia, and malnutrition. Over time Nyanza region has been posting the highest under-five mortality rate compared to the rest of the country. Reduction of under-five mortality can be achieved through linkages between households, communities, and health care facilities. The aim of this study was to determine the role of community health volunteers (CHVs) who are key players in these linkages, in an area where the under-five mortality rate has remained the highest in the country. Methods: Cross sectional descriptive research design was used in this study. Qualitative data was collected through focus group discussions conducted with CHVs attached to pr...
The purpose of this study was to explore the practices, perceptions and needs of nurses in relati... more The purpose of this study was to explore the practices, perceptions and needs of nurses in relation to their participation in continuing professional development. A quantitative descriptive study was conducted guided by Knowles' Adult Learning Theory as the conceptual framework. Data collection was done using a structured self-administered questionnaire with a sample of 178 nurses. The findings revealed that the respondents perceived continuing professional development as important. However the study found minimal involvement of nurses during the initial stages of designing continuing professional development programmes and this may lead to incorrect identification of learning needs. Personal, organisational and professional factors were identified as barriers to nurses' participation in continuing professional development. Preparation of nurses in advance and the use of teaching strategies that recognise past experience and adults as resources were found to increase nurses' participation in continuing professional development programmes.
Bayero Journal of Nursing and Health Care
Background: Waiting time remains an important indicator of quality health services. The emergency... more Background: Waiting time remains an important indicator of quality health services. The emergency department is the most critical area of any hospital. For patients who are in urgent need of hospitalization, delayed admission often leads to exacerbation of the patient's condition and may threaten the patient's life. In recent years, the flow of patients to the Emergency Departments of Western countries has steadily increased thus generating overcrowding and extended waiting times. Developing countries face daily challenges in the Emergency Department through huge exposure to several patients seen per day on average. The study therefore sought to establish factors influencing patient waiting time in the emergency department of Khuyangu Sub-County Hospital, Busia Kenya. Material and Methods: Descriptive cross-sectional research design guided the conduct of this study. Data collection was conducted on 191 patients and healthcare workers over four weeks using an interview...
Journal of Integrative Nursing
Journal of Health, Medicine and Nursing, 2021
Purpose: This study investigated factors that influence psychiatric clinical learning for diploma... more Purpose: This study investigated factors that influence psychiatric clinical learning for diploma nursing students in western Kenya. Methodology: Cross-sectional research design was used with both qualitative and quantitative approaches in data collection. Study participants consisted of diploma nursing students on psychiatric clinical placement. Ten institutions that place their students at Kakamega County Referral Hospital for psychiatric experience were sampled. A total of 178 students, 10 lecturers and 3 psychiatric nurses participated in the study. Qualitative data was collected using interview guides; while quantitative data was collected using structured questionnaires. Descriptive statistics were used to analyse quantitative data while qualitative data was analysed thematically. The relationship between variables was set at a statistical significance of p-value < 0.05. Quantitative data was coded and entered the Statistical Package for Social Sciences version 25.0. Contin...
Journal of Health, Medicine and Nursing, 2019
Purpose: Unmet need for modern contraception is one of the most vital indicators of birth control... more Purpose: Unmet need for modern contraception is one of the most vital indicators of birth control programs and policies. It is challenging to motivate women of childbearing age to adopt contemporary means of birth control especially in urban poor settings. To determine the factors associated with unmet need for limiting and spacing births among women of reproductive age living in formal and informal settlements of Eldoret town. Methodology: A community based cross sectional and analytical study of mixed methods was conducted in Langas informal settlement and Old Uganda Road Estates of Eldoret town. 527respondents (15 to 49) were enrolled through multistage sampling. Independent variables included age, marital status and level of education among others. Dependent variable was unmet need. Descriptive statistics, bivariate and multiple logistic regressions were used in data analysis. Odds ratios with 95% confidence interval were calculated. P value of less than 0.05 was used to establi...
Background: An estimated 200 million children suffer from developmental delays, most in developin... more Background: An estimated 200 million children suffer from developmental delays, most in developing countries. Early diagnosis through screening is key to timely intervention. However, screening tools have not been assessed in developing countries. Objective: This study therefore assesses parental screening tool for evaluating developmental delays (PEDS; DM) in children under 5 years. Method: Across-sectional survey of randomly selected 870 caregivers to test sensitivity and specificity of developmental domains of children under 5 years was used. Results:Specificity above 89 % was observed in all the developmental domains and Sensitivity above 57% was observed in all the domains except for gross motor that had 35.8%. Negative predictive value was above 90% in all the domains while the positive predictive value was between 18% and 40%. In addition, an average scale reliability coefficient of 8.6 was observed and moderate likelihood ratio LR [5-10] in all the domains except for gross m...
Journal of Health, Medicine and Nursing, 2018
Sleep is essential for rest, repair, well-being, and survival of the patient. Sleep quality varie... more Sleep is essential for rest, repair, well-being, and survival of the patient. Sleep quality varies in critically ill patients and is measured by patient's satisfaction of the sleep experience, integrating aspects of sleep initiation, sleep maintenance, quantity of sleep and the refreshment upon awakening. Altered sleep is a common problem experienced by patients in critical care units. This alterations may lead to physiological and psychological dysfunctions that may affect recovery. Critically ill patients frequently experience poor sleep, characterized by frequent disruptions and loss of circadian rhythms. This study investigated factors influencing the quality of sleep among critically ill patients in hospitals in Western Kenya. A cross-sectional descriptive research design was used to examine these factors. A total of 142 patients above 18 years who were admitted to the Intensive Care Unit (ICU) and those transferred from the ICU to the general ward during the study period w...
European Journal of Medical and Health Sciences, 2020
Introduction: Academic integrity is important in training of nurses since on completion of their ... more Introduction: Academic integrity is important in training of nurses since on completion of their studies the nurses will be involved in taking care of lives. Academic dishonesty among nursing students leads to putting the lives of patients at risk. The Purpose of this study was toassess factors contributing to academic dishonesty among Nursing Students in Kenya Medical Training Colleges in Western Kenya. Methodology: A cross-sectional analytical design was employed in this study. Qualitative data was collected from lecturers, administrators, examination coordinators, disciplinary committee chair persons using Key informant interviews. Structured questionnaires for students and available records were used to collect quantitative data. Three colleges were randomly sampled to include Webuye and Bungoma in Bungoma County, kakamega in Kakamega County. Systematic sampling was used to select222 students who participated in the study while purposive sampling was used in selecting 12 key inf...
Journal of Health, Medicine and Nursing, 2019
Only 62% of the African population have access to improved water supply. In Kenya 14% of the hous... more Only 62% of the African population have access to improved water supply. In Kenya 14% of the households in the urban areas, are privately connected to improved water supply systems. However, intermittent water supply has been reported to be a constant constraint in most low income areas in Kenya, making the residents of these areas to seek for alternative water sources such as water cart vendors, with exorbitant water prices and questionable water quality. Intermittent water supply increases the risk of water contamination through breaks and leaks leading to life threatening waterborne diseases. Delegated Management Model was adopted by water utilities in developing countries to address water access and quality issues in low income areas in developing countries. The aim of the study was to investigate the impact of DMM on the quality of drinking water in low-income areas of Kisumu County in Kenya. A descriptive cross-sectional research design was adopted. A total of 80 water samples were collected with 56 collected at the water kiosks while 24 were collected from the households. A two-sample t-test was used to determine if the differences in quality of the drinking water from the two settlements was significant at 95% confidence interval and p value set at .05. The study findings at the point of supply (water kiosks), indicated that, only the PH was within the WHO recommended standards. Turbidity, residual chlorine, total coliforms and Faecal Coliforms were all above the WHO recommended levels, and were statistically significant at p < 0.05. At the household, turbidity (NTU>1), total Coliforms and faecal Coliforms were all above the WHO standards. Both turbidity, total and faecal coliforms recorded significant decrease at p <0.05 though the parameters were still not within the WHO recommended levels. Though the DMM model of water supply in Nyalenda and Manyatta has improved access to water in the two informal settlement areas, findings show alterations in water quality parameters both at the water kiosks and at the household level which indicates contamination in the water supply. The study therefore recommends closer water quality monitoring at the Supply points (water kiosks) and at the households to identify and prevent sources of contamination. Further, health education strategies should be put in place to enhance proper water handling and storage among the residents. Further research should be done to identify the source of contamination.
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Papers by Damaris Ochanda