Teresa Nyanchama Onchangwa’s research while affiliated with Chuka University and other places

Globally, delayed diagnosis of Tuberculosis (TB) is a significant contributor to spread of TB despite avaiability of diagnostic aligorithm and advanced diagnostic machine. Kenya is still grouped among high TB burden nations and has the highest TB incidences in East Africa. This has been associated with delays in diagnosis, resulted to either individual or community health and economic challenges. The purpose of this study was to assess health system related factors influencing timely diagnosis of TB in Tharaka Nithi County. A descriptive crossectional survey study design was adopted among 154 randomly selected patients and 12 purposively selected key informants in selected hospitals in Tharaka Nithi County. A self administered questionaire and key informant guide were used to collect data among patients and key informants respectively. Descriptive and inferential statistics were used to analyse data. Bivariate analysis was used to test the strength of association between health system related factors and duration of TB before diagnosis. Qualitative data was analysed thematically. Study findings revealed that most (70.86%, n=107) respondents delayed in diagnosis. Bivariate regression results revealed that multiple visits (OR=3.24;95%CI:1.55-6.76,p=0.002), long turnarround time (OR=2.38 ;95% CI:1.06-5.30;p=0.035), cash payment (OR=4.53;95%CI:1.82-11.23; p= 0.001), far diagnostic centers (OR=3.86;95%CI:1.71-8.73;p=0.001),lack of prior TB health education (OR=2.71; 95%CI: 1.29-5.64;p=0.008) and long laboratory results turnarround time (OR=2.49; 95% CI: 1.29-5.64; p=0.016) as significants associated with delayed diagnosis. Machine breakdown, misdiagnosis, and inadequate counselling on TB were identified as precipitators of diagnostic delay within a hospital. The study recommends empowerment of community based-hospital referral system, strengthening of collaboration between County government and independent service providers, equipping health facility and continuous training on TB diagnosis and care.

Background: Nursing services are very crucial in the care of orthopedic patients in terms of satisfaction with quality care. Patients’ perception on the optimum nursing care is the view from the point of service delivery to assessment post-delivery. Thus, the study intended to assess patients’ perceptions to achieving optimum nursing care and health outcome in Kerugoya County Referral Hospital (KCRH). Methods: Data was collected prospectively within a period of one month using cross sectional analytical design. Census was utilized to get 70 orthopedic patients and 30 healthcare workers in orthopedic units. Result: About of the participants had a negative perception of the healthcare workers not having adequate time and also not working as a team. Despite this, more than half (54.3%) of the patients had a positive attitude towards the care offered. Overall satisfaction with the services offered (AOR= 7.8, C. I= 1.010-13.995, p-value = 0.039). Conclusion: Patients perceived sub-optimal nursing care of health worker time for their care and health worker teamwork but despite this there was better overall positive attitude on optimum healthcare offered. Key words: health outcome, optimum nursing care, perception, orthopedic patient, Kenya