Browsing by Author "Mbugua, Samuel Mungai"

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    PublicationOpen Access
    Exploring perspectives on antimicrobial stewardship: a qualitative study of health managers in Kenya
    (Global Health Research and Policy, 2020-11-17) Mbugua, Samuel Mungai; Njoroge, George; Kijogi, Caroline; Kamita, Moses; Kimani, Rachel; Mwaura, Peter; Aidi, Bibianne Waiganjo; Jesse, Gitaka
    Background: Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being increasingly obligatory. Perspectives and insights of health managers on antimicrobial stewardship (AMS), complementary health services and building blocks are imperative towards implementation of robust AMS programs. This study aimed to understand perspectives of hospital managers on AMS and identify areas of management engagement while addressing potential blockades to change. Methods: A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant interviews on perspectives on AMS were administered to hospital managers. Qualitative data was captured using audio tapes and field notes, transcribed and managed using NVivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants. Results: Perspectives on AMS are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of antimicrobial formulary and usage surveillance systems, laboratory competency and recommendations for infection prevention and management, educational resources and communications channels available, building blocks and low-lying fruits for Antimicrobial Stewardship Committees. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There lacked contextualized, hospital specific antimicrobial formulary and adequate laboratory competency. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education, and training platforms (Continuous Medical Education and Continuous Professional Development activities) and hospital leadership commitment. Conclusions: The practice of antimicrobial stewardship is not implemented and well developed as demonstrated by lack of core AMS complementary health services. However, the health managers are aware of the fundamental importance of antimicrobial stewardship programs and the vast benefits of implementation and institutionalization of AMS to hospitals and their clients. The findings underpin the importance of understanding and incorporating perspectives of health managers on existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against antimicrobial resistance. Keywords: Antimicrobial stewardship, Antimicrobial resistance, Building blocks/low-lying fruits
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    PublicationOpen Access
    Implementation of possible severe bacterial infection guidelines in selected counties in Kenya
    (Mount Kenya University, 2022-10) Mbugua, Samuel Mungai
    Severe bacterial infections fall among the leading causes of neonatal mortality (0-59 days) globally. One in every five neonates in Kenya will die due to these infections. This situation is aggravated by poor health care seeking behaviors by caregivers, poor supply chain management, low health provider staffing, low care giver and community health volunteer knowledge of PSBI presentation and management, dysfunctional referral pathways among others. The purpose of this study was the implementation of PSBI guidelines and generation of evidence aimed at addressing challenges in neonatal and young infant care in hard-to-reach resource-limited settings. The objective of this study was to demonstrate feasibility, acceptability, and sustainability of PSBI implementation within the revised IMNCI guidelines where referral is not feasible in selected counties in Kenya. The study employed implementation research where an initial formative context mapping and assessment was conducted with routine quarterly follow up assessments. Data collection entailed a capacity assessment in each of the four counties on various health system domains, facility audits in 12 purposively selected facilities to assess preparedness of facilities to manage PSBI, partner mapping to identify potential stakeholders for collaboration in each county, mapping of past, current and planned staff trainings, social costs analysis, Policy/stakeholder analysis, assessment of community/provider perceptions and practices regarding newborn care using in-depth interviews and focus group discussions. This was followed by six monthly case studies and narratives. Quantitative data was analyzed using independent T test and Pearson’s chi-square. Qualitative data was described using themes and narratives. Ethical clearance was sought from Mount Kenya University Institutional Scientific Ethics Review Committee. The data was reported using tables, graphs, pie charts and narratives. Dissemination of findings was through stakeholder forums, advocacy, local and international conferences, and publications in peer-reviewed journals. The health systems capacity assessment indicated average score of 70% across counties and service delivery domain where Turkana, Mombasa and Kilifi scored a green, but Bungoma scored amber of 65%. Only 29.2% of the facilities reported having a functional newborn unit/area for neonates from the facility assessment. Qualitative data alluded to several cultural contextual factors that predisposed young infants to infections. The data also revealed that most caregivers were able to identify danger signs of PSBI and roles of other household members were identified in line with influencing factors on care seeking behaviors. The interventions and decision support tools developed and tested to. facilitate integration of PSBI include a Job aid chart for health providers to aid in assessment and classification of sick young infants, informational pamphlets for caregivers and health providers, and a PSBI/IMNCI Assessment and Follow up tool for appropriate documentation of management of sick young infants. The findings on implementation research outcomes showed that indeed the PSBI guidelines are acceptable, adoptable, with clear indication of their fidelity, feasibility, and sustainability as public health interventions in low resource settings where referral for sick young infants is not feasible. Consideration of contextual variation, appropriate resource allocation, and training of health providers is necessary for sustainable integration of PSBI guidelines in Kenya’s healthcare system.
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    PublicationOpen Access
    Metabolic syndrome and its components among university students in Kenya
    (2017-11-28) Mbugua, Samuel Mungai; Kimani, Samuel Thuo; Munyoki, Gilbert
    Background: Metabolic syndrome refers to a cluster of interrelated disorders which occur together causing an increase in the risk of developing cardiovascular disease and diabetes. The university population is an understudied group despite the increase in the frequency of related disorders and metabolic risk factors e.g. obesity and diabetes, majorly due to the assumption that they are in their most active phase of life therefore healthy. This study looked at metabolic syndrome, the sedentary lifestyles and dietary habits present among university students attending Mount Kenya University, main campus. Methods: Stratified sampling was used to select participants. Self-administered questionnaires were issued to participants after a signed consent had been obtained following which clinical assessments and biochemical measures were performed. They included blood pressure, fasting blood glucose, triglycerides, high density lipoprotein-cholesterol, anthropometric measurements; height, weight, BMI and waist circumference. Pearson’s chisquare tests and non-parametric independent t-test were used to analyze the prevalence of metabolic syndrome criteria per gender, the number of metabolic syndrome criteria per BMI and prevalence of metabolic syndrome criteria per BMI category. Results: The study established that 1.9% of the participants met the criteria for diagnosis of metabolic syndrome according to HJSS criteria. Among the elements, there was statistical difference in gender BMI and waist circumference. 11.8% of subjects had two metabolic syndrome components while 3.1% had three components while none of the subjects had all six components. Elevated triglycerides was the most prevalent defining component for metabolic syndrome. There is a statistically significant relationship between sedentary lifestyle and dietary habits as risk factors to metabolic syndrome. Conclusion: Young adults in university have begun developing metabolic syndrome and the risk of developing the syndrome continues to increase with the components being reported in early age. Educational initiatives to encourage healthy eating should be conducted within school premises in order to reinforce the message on healthy diets and physical exercise. Pre-admission screening to identify at risk students should be conducted. Targeted interventions development through a mandatory extra co-curricular program should be enforced to positively engage those at risk.
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    PublicationOpen Access
    Reproductive health knowledge among college students in Kenya
    (BMC Public Health, 2018-07-24) Mbugua, Samuel Mungai; Karonjo, Jane Muthoni
    Background: Reproductive health knowledge is vital in the growth and development of young people and this impact greatly on their educational and personal outcome as they proceed to adulthood. There has been an increasing occurrence of sexually transmitted infections in institutions of higher learning. The study sought out the strategies used by university students to prevent unplanned pregnancy and determined their knowledge of contraception methods and sexually transmitted infections in Mount Kenya University, main campus. Methods: Stratified sampling was employed. After a signed consent was obtained, a self-administered questionnaire was used to collect data. Data were explored, analyzed and percentages used to quantify the level of knowledge. Pearson’s chi-square was used to measure associations between categorical variables and independent t-test used to measure the means and relationships of continuous variables. Results: Condom use was established as the most prevalent strategy in prevention of unplanned pregnancy at 48.5 and 46.4% in prevention of STI and HIV/AIDS. Almost two thirds (58%) of respondents reported that they were conversant with only one method of contraception, 60% had knowledge of more than two types of STIs, and 62.4% indicated that they were conversant with only hospitals as facilities providing reproductive health services. Conclusion: Young people in college require educational initiatives to sensitize them on STI, methods of contraception and positive social behaviors. There is need to improve the accessibility of reproductive health services through strengthening of services provided at campus health clinics. Keywords: Reproductive health, Sexually transmitted infections, Young adults, Contraception