A Cybersecurity Model for the Health Sector: A Case Study of Hospitals in Nairobi, Kenya

Internet crime is perceived to be an advanced type of crime that has not yet infiltrated third world countries like Kenya. Cybercrime is growing in all parts of the world, and most users of the internet have fallen victims at one point in time. Most victims suffer and do not speak out especially healthcare institutions due to the fear of backlash from the general public. Moreover, the cybercrimes threats to healthcare equipment, electronic healthcare technology is prevalent worldwide and creates enormous potential to improve clinical outcomes and transform the delivery of care. Overall, this study strived to come up with a cyber-security framework for fighting cybercrime in the health sector in Kenya. Specifically, this research project sought to outline the major cyber threats and vulnerabilities, develop a cyber-security framework and validate it for adoption within health sector in Kenya. A descriptive research design was adopted in the study. The population of the study consisted of Mediheal group of hospitals staff. The study focused on top and mid-level IT and other departmental heads that work for Mediheal group of hospitals in Nairobi Kenya. The hospital had a total of 206 staff in Nairobi. This study used convenience sampling. Based on the Yamane formula, the study sampled 135 employees from all departments of Mediheal group of hospitals. Primary data was gathered by use of a questionnaire. Frequency tables and percentages were used to present the findings. Correlation and simple regression analysis were used to indicate simple relationships between individual constructs with the dependent variable. For model evaluation, Structural Equation Modelling (SEM) was used. The study found that top management commitment had a moderate influence on cybersecurity (r = .338, p = .000), organizational factors had a strong influence on cybersecurity (r = .604, p = .000), IT policies had a weak influence on cybersecurity (r = .209, p = .028), and IT literacy had a strong influence on cybersecurity (r = .642, p = .000). From SEM analysis, the study confirmed that the path coefficients were positive for top management commitment, organizational factors and IT literacy with cybersecurity. The paths coefficients were, however, negative for IT policies and threats and vulnerabilities with cybersecurity. The study recommends that monitoring of the performance of cybersecurity as well as continuous awareness and training programs on cyber security for all employees are needed.

Effect of the Procurement Function on the Utilisation of Medical Devices in Public Level Five Hospitals in Kenya

The purpose of the study was to investigate effect of procurement function on the utilization of medical devices in level five hospital in Kenya. More specifically, the study set to answer three key questions namely: What is the effect of procurement practices on utilization of medical devices in public Level Five Hospitals in Kenya? What is the effect of Human capital considerations during procurement on Utilization of Medical Devices? How has maintenance and technical support considerations during procurement affected utilization of medical devices in public Level Five Hospitals in Kenya? With respect to methodological approach, the study was guided by descriptive research design, with a focus on 12 public Level Five Hospitals in Kenya and a study sample size of 138 respondents who were staffs. Stratified sampling techniques was used in selecting respondents, and data collected using self-administered questionnaires, and subsequently analyzed using Statistical Package for Social Sciences (SPSS) version 25. The findings revealed that there were glaring inadequacies in roped to maintenance and technical support of medical devices, human capital considerations during procurement and procurement practices that should otherwise enhance the utilization of medical devices. The findings on procurement practices revealed that there no collaboration while making procurement decisions and this would have resulted to poor utilization of medical devices. The findings further indicate that there was a gap in human capacity and skills and this hindered effective utilization of medical devices. On maintenance and technical support, the findings revealed procured medical devices were not properly maintained due to factors like inadequate skilled workforce responsible for maintenance of medical devices. The results revealed that the relationship between medical device utilization and procurement practices. r (98) =.179, p=.03, maintenance and technical support, r (98) =239, p=.045, and human capital considerations were fairly weak, r (98) =.231, p=.015. The study concludes that there exists fundamental gaps and practices within the procurement function in general that is aiding the effective utilization of medical devices in level five hospitals. The study recommends that human capacity and skills improvement that relate to the users of medical equipment should be a continuous operational function whose cost should be part and parcel of the procurement process as a whole. Secondly, medical equipment maintenance and technical support should be considered as a strategic procurement imperative when any buying decision processes are been done. Lastly, there is need to examine, or to evaluate whether public healthcare services would be more effective as a devolved function or managed by the national government, just like education. The study further concludes there is need for all the departments to work together to have optimal utilization of medical devices that is the procurement division work together with the human resource and the maintenance department to ensure the require medical devices are procured, staff are well trained and there is proper maintenance and if this is properly collaborated there will be optimal utilization of medical devices.

Functional assessment of long bone fracture healing in Samburu County Referral Hospital (Kenya): the squat and smile challenge

Background:
The burden of musculoskeletal trauma is increasing in low- and middle-income countries. Due to the low clinical follow-up rates in these regions, the Squat-and-Smile test (S&S) has previously been proposed as a proxy to assess bone healing (BH) capacity after surgery involving bone fractures. This study deals with various aspects of using S&S and bone radiography examination to obtain information about an individual’s ability to recover after a trauma. In summary, we performed the S&S test to assess the possibility of recovering biomechanical function in lower limbs in a remote area of Kenya (Samburu County).

Methods:
Eighty-nine patients (17.9% F; 31.7 ± 18.9 yrs) who underwent intramedullary nail treatment for femur or tibia fractures were enrolled in this study. Both S&S [evaluated by a goal attainment scale (GAS)] and x-ray (evaluated by REBORNE, Bone Healing Score) were performed at 6 and 24 weeks, postoperatively. An acceptable margin for satisfactory S&S GAS scores was determined by assessing its validity, reliability, and sensitivity.

Results:
S&S GAS scores increased over time: 80.2% of patients performed a satisfactory S&S at the 24-weeks follow-up with a complete BH. A high correlation between S&S GAS and REBORNE at the 6- and 24- weeks’ timepoint was found. Facial expression correlated partially with BH. The S&S proved to be accurate at correctly depicting the BH process (75% area fell under the Receiver Operator Curve).

Conclusion:
The S&S provides a possible substitution for bone x-ray during BH assessment. The potential to remotely follow up the BH is certainly appealing in low- and middle-income countries, but also in high-income countries; as was recently observed with the Covid-19 pandemic when access to a hospital is not conceivable.

Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial

Background
There is limited access to eye health services in many low-income and middle-income populations. We aimed to assess the effectiveness in increasing service utilisation of the Peek Community Eye Health (Peek CEH) system, a smartphone-based referral system comprising decision support algorithms (Peek Community Screening app), SMS reminders, and real-time reporting.

Methods
In this cluster-randomised controlled trial of eye health in Kenya, community unit clusters were defined as one health centre and its catchment population. Clusters were randomly allocated (1:1) to receive Peek CEH and referral (intervention group) or standard care via periodic health centre-based outreach clinics and onward referral (control group). Individuals in the intervention group were assessed at home by screeners and those referred were asked to present for triage assessment in a central location. They received regular SMS reminders. In both groups, community sensitisation was done followed by a triage clinic at the cluster health centre 4 weeks after sensitisation. During triage, individuals in both groups were assessed and treated and, if necessary, referred to a specific hospital. Individuals in the intervention group received further SMS reminders. The primary outcome was the mean attendance rate (the number of people per 10 000 population) at triage of those with confirmed eye conditions, as assessed at 4 weeks after sensitisation in the intention-to-treat population. We estimated the intervention effect using a Student’s t-test on cluster-level rates. This trial is registered with Pan African Clinical Trial Registry, number 201807329096632.

Findings
Between Nov 26, 2018, and June 7, 2019, of the 85 community units in Trans Nzoia County, Kenya, 49 were excluded. We randomly allocated 18 community units each to the intervention group (68 348 individuals) and the control group (60 243 individuals). 9387 individuals from the intervention group and 3070 from the control group attended triage assessment. The mean attendance rate at triage by individuals with eye problems was 1429 (92% CI 1228–1629) in the intervention group and 522 (418–625) in the control group (rate difference 906 per 10 000 [95% CI 689–1124; p<0·0001]).

Interpretation
The Peek CEH system increased primary care attendance by people with eye problems compared with standard approaches, indicating the potential of this mobile health package to increase service uptake and guide appropriate task sharing.

Exploring women’s childbirth experiences and perceptions of delivery care in peri-urban settings in Nairobi, Kenya

Kenya continues to have a high maternal mortality rate that is showing slow progress in improving. Peri-urban settings in Kenya have been reported to exhibit higher rates of maternal death during labor and childbirth as compared to the general Kenyan population. Although research indicates that women in Kenya have increased access to facility-based birth in recent years, a small percentage still give birth outside of the health facility due to access challenges and poor maternal health service quality. Most studies assessing facility-based births have focused on the sociodemographic determinants of birthing location. Few studies have assessed women’s user experiences and perceptions of quality of care during childbirth. Understanding women’s experiences can provide different stakeholders with strategies to structure the provision of maternity care to be person-centered and to contribute to improvements in women’s satisfaction with health services and maternal health outcomes.

Methods
A qualitative study was conducted, whereby 70 women from the peri-urban area of Embakasi in the East side of Nairobi City in Kenya were interviewed. Respondents were aged 18 to 49 years and had delivered in a health facility in the preceding six weeks. We conducted in-depth interviews with women who gave birth at both public and private health facilities. The interviews were recorded, transcribed, and translated for analysis. Braune and Clarke’s guidelines for thematic analysis were used to generate themes from the interview data.

Results
Four main themes emerged from the analysis. Women had positive experiences when care was person-centered—i.e. responsive, dignified, supportive, and with respectful communication. They had negative experiences when they were mistreated, which was manifested as non-responsive care (including poor reception and long wait times), non-dignified care (including verbal and physical abuse lack of privacy and confidentiality), lack of respectful communication, and lack of supportive care (including being denied companions, neglect and abandonment, and poor facility environment).

Conclusion
To sustain the gains in increased access to facility-based births, there is a need to improve person-centered care to ensure women have positive facility-based childbirth experiences.

Pilot study assessing the direct medical cost of treating patients with cancer in Kenya; findings and implications for the future.

Currently the majority of cancer deaths occur in low- and middle-income countries, where there are appreciable funding concerns. In Kenya, most patients currently pay out of pocket for treatment, and those who are insured are generally not covered for the full costs of treatment. This places a considerable burden on households if family members develop cancer. However, the actual cost of cancer treatment in Kenya is unknown. Such an analysis is essential to better allocate resources as Kenya strives towards universal healthcare.To evaluate the economic burden of treating cancer patients.Descriptive cross-sectional cost of illness study in the leading teaching and referral hospital in Kenya, with data collected from the hospital files of sampled adult patients for treatment during 2016.In total, 412 patient files were reviewed, of which 63.4% (n?=?261) were female and 36.6% (n?=?151) male. The cost of cancer care is highly dependent on the modality. Most reviewed patients had surgery, chemotherapy and palliative care. The cost of cancer therapy varied with the type of cancer. Patients on chemotherapy alone cost an average of KES 138,207 (USD 1364.3); while those treated with surgery cost an average of KES 128,207 (1265.6), and those on radiotherapy KES 119,036 (1175.1). Some patients had a combination of all three, costing, on average, KES 333,462 (3291.8) per patient during the year.The cost of cancer treatment in Kenya depends on the type of cancer, the modality, cost of medicines and the type of inpatient admission. The greatest contributors are currently the cost of medicines and inpatient admissions. This pilot study can inform future initiatives among the government as well as private and public insurance companies to increase available resources, and better allocate available resources, to more effectively treat patients with cancer in Kenya. The authors will be monitoring developments and conducting further research.