Thesis:

Development of A Model to Enhance Peritoneal Dialysis Utilization Among Kidney Failure Disease Patients in Kenya

Peritoneal Dialysis (PD) is the use of the peritoneal membrane as a dialyzer. Models for PD utilization have been developed in high-income countries but only one in East Africa (Tanzania) under the International Society of PD (ISPD) funding focusing on acute kidney injury (AKI). This study was mainly to establish barriers to PD utilization and develop a model for PD utilization among kidney failure (KF) patients in Kenya. A descriptive – analytical cross-sectional study was conducted in 6 government dialysis centers purposively selected. The study targeted 346 KF patients, 125 nurses (sample size determined using Yammane’s formula), 6 nephrologists, 19 general physicians and 6 Policy makers (PM) from each hospital, 4 PM from the county governments, 2 PM from the national hospital insurance fund (NHIF) and 2 from the ministry of health (MOH). The nurses and patients were sampled using proportionate sampling (per institution) then simple random sampling was used at the unit level. Physicians were sampled through census while PM purposively sampled. A mixed method (Quantitative and qualitative) research design was adopted to conduct the three phased research. In phase one data was collected using a semi- structured questionnaire which was researcher/self-administered. In phase two and three, Delphi approach was employed in formulation and validation of the PD Model. The variables were demographic characteristics/social economic information, knowledge, attitude and practice of PD, barriers to PD utilization, awareness of PD and panelist’s views in the Delphi technique. Data were managed in Microsoft Excel then exported to RStudio for analysis, SPSS version 23 data analysis was done. Data was presented in tables and charts. Qualitative data in phase one was analyzed thematically using content analysis and presented in verbatim form. Qualitative data in phase 2 and 3 was structured, managed, and coded using NVivo (version 12.0) and presented in tables. F-test was used for statistical analysis for the Delphi technique. Hypothesis testing was done using chi-squared test. P-values of less than 0.05 were considered statistically significant with a 95% confidence interval (CI). The study significance was to understand how a good model for PD utilization will help health service providers (HSP) and PM to identify areas of improvement in PD. Results revealed 0.2% PD prevalence. The barriers were categorized as patient related, healthcare related and policy related. The chi-square test of association revealed that the HSPs knowledge of PD was significantly associated with the level of practice of PD (P= 0.003594) leading to the rejection of the null hypothesis of no association between the level of knowledge and practice among HSP. Attitude of the HSP was found not to be associated with level of practice (P= 0.8126) at 5% significance level thus the null hypothesis was sustained. Awareness of PD was significantly associated with PD utilization (P= 0.04415) thus rejecting the null hypothesis. The model developed was statistically significant F = 5.396, p<0.001. In conclusion, there is awareness gap with low utilization of PD among KF patients in Kenya. The researcher recommended implementation of the detoneal dialysis, Kidney failure, Peritoneal dialysis utilizationveloped model to guide PD utilization. KEY TERMS: Model, Pertoneal dialysis, Kidney failure, Peritoneal dialysis utilization