Theses & Dissertations

Factors affecting the Utilization of Cancer Health Care Services: a case study of breast cancer screening among women in Kenya

Wed, 01 Jan 2020 00:00:00 GMT

Factors affecting the Utilization of Cancer Health Care Services: a case study of breast cancer screening among women in Kenya Waweru, Eric, M The study sought to examine the factors affecting the utilization of cancer health care services: a case study of breast cancer screening among women in Kenya. Specifically, the study sought to estimate the demand function for breast cancer screening in Kenya as well as assess the household characteristics, social and economic factors that determine utilization of breast cancer healthcare services in Kenya. The study utilized secondary data mainly the Kenya Demographic and Health Survey data of 2014. For the empirical model estimation, the study employed the dummy variable models namely LPM, Logit and Probit models. The results of the study reveal that breast cancer screening by medical practitioner remain minimal at best with only 11.4 percent of woman having had breast cancer screening done by a medical practitioner. The regression model results for LPM, logit and probit model indicate the demand function for breast cancer screening is downward sloping. This is supported by the finding that distance to health facility proxied by time taken to get water has a negative effect on seeking for breast cancer screening. However, upon controlling for the household income, the effect of distance remains negative but not significant implying that the income well – off households can pay the cost of travel to seek for health services. This calls for the need to subside the cost of breast cancer screening. Woman education level and household head education level were found to have positive effect on demand for breast cancer screening. However, the household size was found to reduce the probability of a women seeking for breast cancer screening services. lastly, women from male – headed households were found to have a lower probability of seeking for breast cancer screening services. Based on these findings, the study recommends the need for sensitization and awareness creating among women on the need and importance for breast cancer services, expansion of the health infrastructure to trade – off the negative effect of distance to health facility and subsidizing women breast cancer screening for women in the low wealth quartiles.

Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study.

Thu, 17 Jan 2019 00:00:00 GMT

Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study. Kimani, S; Mirie, W; Chege, M; Okube, OT; Muniu, S OBJECTIVE: Association of lifestyle modification and pharmacological adherence among patients with hypertension attending a national referral hospital in Kenya. DESIGN: Descriptive, cross-sectional. SETTING: Medical wards and outpatient clinic of a national referral hospital. PARTICIPANTS: Patients (n=229) diagnosed with primary hypertension for at least 6 months. PRIMARY OUTCOMES: Clinical makers, cholesterol levels, anthropometrics, lifestyle/dietary habits adjusted for age, gender and education; antihypertensive adherence; views on prevention of hypertension and adequacy of hypertension information. RESULTS: Ageing was associated with elevated diastolic blood pressure (BP) (p<0.05), heart rate (HR) and cholesterol. Females had higher body mass index (BMI). More males reported drinking alcohol and smoking (p<0.001), especially the highly educated. Higher BPs were observed in smokers and drinkers (p<0.05). Daily vegetables and fruits intake were linked to lower BP, HR and BMI (p<0.05). Intake of foods high in saturated fat and cholesterol were associated with raised HR (p<0.05). Respondents on antihypertensive medication, those engaged in healthy lifestyle and took their prescribed medications had lower mean BPs than those on medication only (138/85 vs 140/90). Few respondents (30.8%) considered hypertension as preventable, mainly the single and highly educated (p<0.05). Respondents (53.6%) believed they should stop taking their antihypertensive medication once hypertension is controlled. CONCLUSION: Missed targets for BP control and hypertension-related risks are associated with ageing, female gender, fast food and animal fat intake. Alcohol and smoking is common in males associated with poor BP control. Daily vegetables and fruits intake are associated with better BP control and overall hypertension risk reduction. Observed suboptimal BP control despite pharmacological adherence suggests lifestyle modification is needed besides antihypertensive medication. Interventions should address modifiable risk factors aggravated by age and adverse lifestyles through adopting combined lifestyle modification, pharmacological adherence and tailored expert delivered hypertension-related information.

Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans.

Thu, 20 Jun 2019 00:00:00 GMT

Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans. Ojji, DB; Mayosi, B; Francis, V; Badri, M; Cornelius, V; Smythe, W; Kramer, N; Barasa, F; Damasceno, A; Dzudie, A; Jones, E; Mondo, C; Ogah, O; Ogola, E; Sani, MU; Shedul, GL; Shedul, G; Rayner, B; Okpechi, IG; Poulter, N; Sliwa, K The prevalence of hypertension among black African patients is high, and these patients usually need two or more medications for blood-pressure control. However, the most effective two-drug combination that is currently available for blood-pressure control in these patients has not been established. METHODS: In this randomized, single-blind, three-group trial conducted in six countries in sub-Saharan Africa, we randomly assigned 728 black patients with uncontrolled hypertension (≥140/90 mm Hg while the patient was not being treated or was taking only one antihypertensive drug) to receive a daily regimen of 5 mg of amlodipine plus 12.5 mg of hydrochlorothiazide, 5 mg of amlodipine plus 4 mg of perindopril, or 4 mg of perindopril plus 12.5 mg of hydrochlorothiazide for 2 months. Doses were then doubled (10 and 25 mg, 10 and 8 mg, and 8 and 25 mg, respectively) for an additional 4 months. The primary end point was the change in the 24-hour ambulatory systolic blood pressure between baseline and 6 months. RESULTS: The mean age of the patients was 51 years, and 63% were women. Among the 621 patients who underwent 24-hour blood-pressure monitoring at baseline and at 6 months, those receiving amlodipine plus hydrochlorothiazide and those receiving amlodipine plus perindopril had a lower 24-hour ambulatory systolic blood pressure than those receiving perindopril plus hydrochlorothiazide (between-group difference in the change from baseline, -3.14 mm Hg; 95% confidence interval [CI], -5.90 to -0.38; P = 0.03; and -3.00 mm Hg; 95% CI, -5.8 to -0.20; P = 0.04, respectively). The difference between the group receiving amlodipine plus hydrochlorothiazide and the group receiving amlodipine plus perindopril was -0.14 mm Hg (95% CI, -2.90 to 2.61; P=0.92). Similar differential effects on office and ambulatory diastolic blood pressures, along with blood-pressure control and response rates, were apparent among the three groups. CONCLUSIONS: These findings suggest that in black patients in sub-Saharan Africa, amlodipine plus either hydrochlorothiazide or perindopril was more effective than perindopril plus hydrochlorothiazide at lowering blood pressure at 6 months. (Funded by GlaxoSmithKline Africa Noncommunicable Disease Open Lab; CREOLE ClinicalTrials.gov number, NCT02742467.).

Healthy Heart Africa-Kenya: A 12-Month Prospective Evaluation of Program Impact on Health Care Providers' Knowledge and Treatment of Hypertension.

Thu, 14 Mar 2019 00:00:00 GMT

Healthy Heart Africa-Kenya: A 12-Month Prospective Evaluation of Program Impact on Health Care Providers' Knowledge and Treatment of Hypertension. Ogola, EN; Okello, FO; Herr, JL; Macgregor-Skinner, E; Mulvaney, A; Yonga, G Given the rising burden of hypertension in Africa, the Healthy Heart Africa program was developed to improve access to quality hypertension care in the primary care setting. The Healthy Heart Africa program provides a comprehensive, coordinated intervention directed at health care providers (HCPs) and the general public. OBJECTIVE: The impact of Healthy Heart Africa on HCPs' knowledge of hypertension and facility-level services in Kenya was evaluated by a 12-month prospective study. METHODS: Intervention facilities were selected by stratified random sampling and matched to similar control facilities. Intervention facilities received a hypertension treatment protocol, equipment, training and patient education materials, and improved medical supply chain, whereas control facilities did not. HCPs responsible for hypertension care were surveyed at baseline and 12 months later. Hypertension screening and treatment data were abstracted from service delivery registers. A differences-in-differences analysis estimated the impact of Healthy Heart Africa on HCPs' knowledge, hypertension services, and the number of patients diagnosed with and seeking treatment for hypertension. RESULTS: Sixty-six intervention and 66 control facilities were surveyed. Healthy Heart Africa improved HCPs' knowledge of ≥5 hypertension risk factors and ≥5 methods for reducing/managing hypertension but not hypertension consequences. At end line, more intervention than control facilities measured blood pressure more than once during the same visit to diagnose hypertension, dedicated days to hypertension care, used posters to increase hypertension awareness, and provided access to hypertension medications. The number of patients diagnosed with hypertension and those seeking treatment for hypertension increased with intervention, but the change was not significant relative to control subjects. CONCLUSIONS: HCP-directed hypertension education and provision of basic resources positively influenced hypertension care in Kenya in the first 12 months of implementation.