Master of Public Health

Permanent URI for this collectionhttps://192.168.0.29/handle/123456789/127

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A comparative analysis of knowledge, attitudes and practices on occupational safety and health compliance among small-scale bakeries in Harare, Zimbabwe
(Adventist University of Africa, 2023-04) Busangavanye, Gelien
This study sought to analyze the knowledge, attitudes, and practices on Occupational Safety and Health compliance among small-scale bakeries. Data were collected from 137 participants from the small-scale bakeries in Willowvale industrial area, Harare, Zimbabwe period (September to October 2021). Questionnaires, interviews, observation checklists and heat and light measurements were used for data collection. Negative binomial regression was used to assist in establishing the strength of the relationship between variables and know which independent variable was a significant predictor of compliance with OSH standards. Statistical Package for Social Sciences SPSS, version 23 was used for data analysis. The majority of the participants were males 99% and their age range was 19-30 years. The study revealed that 83% of small-scale bakeries functioned outside the requirements of the Zimbabwean OSH legislation and regulations by failing to register their operations under the Factories and Works Act Chapter 14:08. OSH management structures were essentially not there and OSH programs implementation was very poor and minimum. Employees were unprotected from several hazards including heat exposure and poor lighting. The findings obtained from the study are not statistically significant. This is shown by the P values (P > | z |) obtained which are all greater than 0.05. In conclusion, several recommendations were made for improved OSH knowledge, attitude, practices and compliance in the small-scale bakery industry. These include, management taking responsibility of the employee’s safety and health through implementation of occupational safety and health programs including OSH training. Employees need to develop a positive attitude towards OSH and implement daily safety practices. The legislators should offer tailor made and considerate interventions for such operations with main thrust on awareness and training promotions to develop and foster the essential knowledge, attitudes as well as positive practices that will result in sustainable OSH compliance in small-scale bakery industry.
Sources, types of stress, stress burnout, and their coping strategies among gospel ministers in Ghana
(Adventist University of Africa, 2023-02) Amoako, Prince Kwasi
Stress is a common issue that affects individuals in various fields, including the clergy. This study aimed to identify the sources and types of stress encountered by gospel ministers in Ghana and their coping strategies. The study used a cross-sectional descriptive research design and a quantitative approach to analyze data collected from a target population of 500 gospel ministers in the Central Region of Ghana. The sample population for the study was 217 ministers selected using the simple random technique and purposeful techniques. The research revealed that gospel ministers face stress from various sources, including meeting schedules, church programs, sermon preparation, church finances, and home and church demands. The study also identified acute stress, episodic stress, and chronic stress as the main types of stress encountered by ministers. While most of the ministers did not visit professionals to be diagnosed, they mentioned the stress they experienced. The study found a positive relationship between age, years of employment, marital status, and stress burnout. Coping strategies used by ministers included annual leave, reducing daily work schedules, delegating duties, quality sleep, regular physical exercise, religious activities, and seeking help from professionals, friends, and spouses. In conclusion, stress is a significant concern for clergy people and should be appropriately managed to avoid health challenges. The study recommends that ministers should regularly check their health status with medical practitioners to maintain their physical and mental well-being.
Residents’ perception of factors affecting solid waste management practices: An assessment in Plumtree Town, Zimbabwe
(Adventist University of Africa, 2023-04) Ndiweni, Yvonne Duduzile
This research assesses the residents’ perception of factors affecting solid waste management practices in Plumtree Town, Zimbabwe. The study revealed a medium positive correlation between stakeholder involvement and solid waste management practices, emphasizing the importance of engaging stakeholders in waste management processes to improve solid waste management practices. Furthermore, the research found that enabling factors had a medium positive correlation with solid waste management practices, underscoring the need for better infrastructure and equipment to support effective waste management practices. The study also identified financial constraints as major obstacles to solid waste management, highlighting the significance of addressing these issues to ensure adequate resources are available to support sustainable waste management practices. Future research recommendations include expanding the sample size to include a more diverse group of residents, evaluating the effectiveness of specific interventions aimed at improving solid waste management practices and exploring the role of technology in waste management practices. The study suggests increasing stakeholder involvement in waste management processes, improving enabling factors such as infrastructure and equipment, and enforcing compliance with relevant legislation and regulations to create a more sustainable and efficient waste management system that benefits both the environment and the community. Despite some limitations limited time frame which may not reflect changes in solid waste management practices or factors affecting them that may occur in the future, this research provides valuable insights into the perception of residents regarding solid waste management practices in Plumtree Town, Zimbabwe, and identifies key areas for future research.
Determinants of dietary diversity among children aged 6–23 months in Mwenezi District, Zimbabwe
(Adventist University of Africa, 2022-04) Huturume, Tarusenga
Poor dietary diversity during the complementary feeding period has detrimental effects on children’s growth, health, and development. During this period, a lack of a diverse diet increases the risk of malnutrition, morbidity, and mortality. Ensuring dietary diversity is critical to promoting child survival, adequate growth, and development. The study aimed to identify determinants of dietary diversity among children aged 6-23 months in Mwenezi district of Zimbabwe. The study examined determinants of dietary diversity at the child, caregiver, household, and community levels. The study was a quantitative cross-sectional design with a sample size of 417 children selected through multi-stage random sampling. As children are not able to report their food intake, their caregivers responded on their behalf. Data was gathered by five trained field assistants using an interviewer-administered questionnaire and was analyzed using Statistical Package for Social Sciences (SPSS 20 for windows). The study established a very low minimum dietary diversity, (21.3%) in Mwenezi district. Except for staples (grains, roots, and tubers), the consumption of other food groups was below 50%. Consumption of vitamin A-rich fruits, eggs, and dairy products were least consumed by children, ranging from 7-16%. Determinants at the child level were age, sex, and birth weight. Caregiver knowledge of IYCF was the only caregiver level determinant identified. Household level determinants included poultry possession, possession of a nutrition garden, and joint decision-making by both spouses while community level determinants were presence of child growth monitoring services and village savings and lending associations. Interventions to improve the quality of diets consumed by children ought to target child, caregiver, household and community levels for synergy and greater impact. These interventions should purpose to increase caregivers’ knowledge of age specific child feeding practices while also creating a conducive and supportive socio-economic environment for caregivers to plan and prepare diverse diets. A comprehensive social and behaviour change program using the care group model, employing a ‘‘whole of family approach’’ to improve feeding behaviors and practices, empowering women and engaging men to support joint decision making, production of a wide range of crops and vegetables and small animals will improve consumption of diverse diets by children in Mwenezi district.
Factors associated with utilization of cervical cancer screening services among sexually active women in Gutu District, Zimbabwe
(Adventist University of Africa, 2022-10) Moyo Theresa Avilla Diana
Cervical cancer is a prevalent type of cancer that ranks fourth among women and eighth overall. It disproportionately affects individuals residing in developing countries, where inadequate screening programs and poor uptake of traditional diagnostic methods such as pap smears or pelvic examinations are common. Early detection and timely treatment significantly improve the chances of a complete cure. In Zimbabwe, despite the availability of free cervical cancer screening services to all eligible women, rural women from the Gutu district exhibit low utilization rates. This research aims to investigate the underlying factors contributing to the inadequate uptake of cervical cancer screening services by rural women in the Gutu District. A cross-sectional study design with an exploratory approach was employed to investigate the subject matter at hand. Quantitative data was collected in May 2021 through a self-administered questionnaire. The sample size of 450 participants was acquired using a multistage stratified random sampling method. Findings from this investigation have revealed that rural women residing in the Gutu district lack fundamental knowledge regarding cervical cancer, where only half of the participants demonstrated awareness of its signs and symptoms. Furthermore, risk perception among the study's respondents remained limited, with only 36.7% acknowledging high susceptibility to developing cervical cancer. The outcomes of this research also indicate that multiple factors, including age, outreach availability, proximity to the VIAC centre, perceived severity of cervical cancer, and spousal support, independently influence the uptake of cervical cancer screening among rural women in the Gutu district. The study concludes that accessibility to cervical cancer screening services remains inadequate within the area of interest. To address this issue, measures such as enhancing risk communication, expanding screening sites, and increasing outreach activities are necessary to bring the service closer to individuals who require it. Additionally, there should be a concerted effort to prioritize rural women in cervical cancer screening programs, dispel any myths or misconceptions, and eliminate gender and cultural barriers.
Practices and barriers to healthcare worker compliance with guidelines preventing nosocomial infections among severely acutely malnourished children at a national referral hospital nutrition unit in Uganda
(Adventist University of Africa, 2023-05) Asiimwe Kyoma Lydia
Globally, malnutrition is a rapidly growing public health concern that is associated with high costs of healthcare and increased mortality. Undernutrition is associated with an overwhelming percentage of child deaths aged 5 years and below. The stakes are even higher when it comes to Severely acutely malnourished children. The condition is further complicated by nosocomial infection attacks hence increasing the risk of death. Nosocomial infections are common occurrence in facilities in Sub-Saharan Africa like Uganda and prevention measures and guidelines have been put in place for them. Nonetheless, nosocomial infections continue to be a difficulty in the management of severe acute malnutrition. There remains scanty information on the practices and barriers to the prevention of Nosocomial Infections among severely acutely malnourished children in Ugandan nutrition rehabilitation units. While there are standard recommendations on practices, the prevalence of nosocomial infections remains a concern. This study, therefore, looked into which practices are employed in the nutrition unit. How well and consistently the practices are carried out since poor execution and lapse in behaviour create a gap that hinders the success of nosocomial infection control. For this study 18 eligible healthcare workers employed by the nutrition unit were recruited to participate in this study as respondents since they interact with patients daily and are custodians of patients’ health. Informed consent was obtained from all participants before responding to any questions on the interview protocol. Additional information was obtained by observation with the guidance of an observation checklist. Document analysis of the IMAM and MIYCAN guidelines was carried out and the findings added to those of interviews and observation. Interview data and document analysis data were analyzed using the interactive model of data analysis. While observation data were analyzed using attached numeric scores that are interpreted on a Likert scale. The themes developed that informed the results and implications of the study were proper use of personal protective equipment, proper hygiene, health education, presence of environmental cues and routine surveillance were the practices mentioned. The themes under predisposing factors were skills gap, and poor knowledge while themes under barriers to a nosocomial-free hospital stay were limited financial and human resources as well as infrastructural setup. Results of the study indicate that despite some prevention practices being known, they are neither practised well nor consistently in the cases were they are well done and therefore are not effective. There is a lot of room for improvement. Practices such as cohorting patients according to arrival, giving systemic antibiotics to all patients and an active surveillance system are important prevention practices that were not mentioned and respondents. Recommendations following the finding of the study are for caretakers to heed advice and guidance offered during health education and to ask for help when needed to bridge the knowledge and skills gap. Healthcare workers carry out routine health education for patients and caretakers while on the ward and acquaint themselves with the guidelines used by the nutrition unit. Hospital authorities to avail appropriate environmental cues, ensure reliable access to supplies used in infection prevention, and offer training and retaining of health care workers on Infection prevent Control measures. To carry out IPC audits and put in place surveillance systems to monitor occurrence, actions taken and the prevalence of NIs. For future research, interventions and investigations of IPC behaviour change with a focus on consistence is ideal. Planning interventions in key areas such as hand washing and health education. Future surveillance studies through laboratory investigations to find out the prevalence of NIs among SAM children in nutrition units around Uganda.
Occupational hazards and mitigating measures among healthcare workers in Shinyanga Regional Referral Hospital, Tanzania
(Adventist University of Africa, 2023-04) Muhoja, Joel James
This study sought to identify occupational hazards and mitigating measures among Healthcare Workers in Shinyanga Regional Referral Hospital. The objective of the study was to assess risks associated with occupational health, identify factors (causes) of occupational health hazards among HCWs, and build the capacity of healthcare workers on measures to mitigate health hazards in their workplace. The study engaged 105 HCWs all from Shinyanga regional hospital. The study project imparted knowledge through lectures, discussions, questions and answers, and one-on-one consultations. Data were gathered through questionnaires and observation. The project’s data were analyzed about planned target objectives. All data were analyzed by using descriptive statistics comprising frequencies and percentages. This was done to examine participants’ knowledge of occupational health hazards and mitigating measures. The study found that HCWs in Shinyanga are at higher risk of being exposed to health risk factors due to insufficient and uneven provision of personal protective equipment. In addition, poor hospital waste management and disposal might accelerate needle-stick injuries by that Hepatitis B, Hepatitis C, and HIV to mention a few are spread from patients to HCWs. Moreover, the reporting on OHHs and new infections was too low. HCWs are the potential for national development and are well educated but not protected to play their roles effectively to constitute national economic development. Some HWCs including health facility in-charge, heads of departments, and specialists are more exposed to health risk factors than others due to overworking. Besides, the study found that the knowledge of HCWs on health risk factors is too low. This calls for external health development stakeholders to intervene in improving safety, health, and well-being.
A comparative analysis of knowledge, attitudes and practices on occupational safety and health compliance among small-scale bakeries in Harare, Zimbabwe
(Adventist University of Africa, 2023-04) Busangavanye, Gelien
This study sought to analyze the knowledge, attitudes, and practices on Occupational Safety and Health compliance among small-scale bakeries. Data were collected from 137 participants from the small-scale bakeries in Willowvale industrial area, Harare, Zimbabwe period (September to October 2021). Questionnaires, interviews, observation checklists and heat and light measurements were used for data collection. Negative binomial regression was used to assist in establishing the strength of the relationship between variables and know which independent variable was a significant predictor of compliance with OSH standards. Statistical Package for Social Sciences SPSS, version 23 was used for data analysis. The majority of the participants were males 99% and their age range was 19-30 years. The study revealed that 83% of small-scale bakeries functioned outside the requirements of the Zimbabwean OSH legislation and regulations by failing to register their operations under the Factories and Works Act Chapter 14:08. OSH management structures were essentially not there and OSH programs implementation was very poor and minimum. Employees were unprotected from several hazards including heat exposure and poor lighting. The findings obtained from the study are not statistically significant. This is shown by the P values (P > | z |) obtained which are all greater than 0.05. In conclusion, several recommendations were made for improved OSH knowledge, attitude, practices and compliance in the small-scale bakery industry. These include, management taking responsibility of the employee’s safety and health through implementation of occupational safety and health programs including OSH training. Employees need to develop a positive attitude towards OSH and implement daily safety practices. The legislators should offer tailor made and considerate interventions for such operations with main thrust on awareness and training promotions to develop and foster the essential knowledge, attitudes as well as positive practices that will result in sustainable OSH compliance in small-scale bakery industry.
Relationship between channels of communication, knowledge, and utilization of cervical cancer screening services among women in Chileka, rural Blantyre District, Malawi
(Adventist University of Africa, 2023-01) Gunsaru, Charles Fatsani
The alarmingly high prevalence of cervical cancer and deaths due to it among women in Malawi implores a solution to reduce the disease. In their efforts towards the same, the Malawi government and other stakeholders provide free screening services and also have strived to increase the knowledge of the disease among women in the country which other studies have suggested positively affects the utilization of the services. Despite these efforts, the level of utilization of the services is still low. The purpose of this study, therefore, was to assess the moderating effect of channels of communication on the relationship between knowledge of cervical cancer and the utilization of the services among women in Traditional Authority (T/A) Kuntaja, rural Blantyre district, Malawi. This analytical cross-sectional study collected quantitative data using a questionnaire translated in Chichewa with closed-ended questions from 428 women aged between 30-49 years selected from 19 villages from T/A Kuntaja using multistage sampling. Data were analyzed using descriptive statistics, one-way analysis of variance, Pearson product-moment correlation coefficient, and moderated regression analysis. Findings revealed that the level of overall knowledge of cervical cancer among the women in the study area was 29% (very poor). The level of knowledge of the description and causes of the disease was average (79%) and above average (81%), respectively, whereas the level of knowledge of risk factors, symptoms, prevention, treatment, and side-effects of its treatment was very poor, ranging from 13% to 43%. In general, channels of communication did not make a significant difference in women’s knowledge of cervical cancer but it made a difference in their utilization of screening services. Knowledge of cervical cancer has a significant positive relationship with utilization of screening services but channels of communication have no significant moderating effect on this relationship. The level of knowledge of cervical cancer among the women in the study area could be increased when effective communication channels, uniquely designed and taking into consideration women’s specific socio-demographic characteristics. In addition, the information about cervical cancer communicated through these channels could enhance knowledge that can influence the utilization of screening services. Keywords: channels of communication, knowledge of cervical cancer, utilization of cervical cancer screening services
Factors Contributing to Compliance of COVID-19 Safety Protocols among Students in Ikageng JSS, (Metsimotlhabe)
(Adventist University of Africa, 2023-05) Nkadile, Emang Mmaboipuso
Noncompliance with COVID-19 safety protocols has been associated with poor health outcomes. The COVID-19 pandemic has had a profound impact on the education system, with schools around the world implementing various safety protocols to reduce the spread of the virus. Compliance with these protocols, such as wearing masks, practising social distancing, and frequent hand washing, is crucial to protecting the health and safety of students, teachers, and staff. However, compliance with these protocols among students has been a challenge in many educational settings. This paper explores the factors that contribute to compliance with COVID-19 safety protocols among students. The literature review suggests that several factors influence compliance with safety protocols, including individual factors, such as knowledge, attitudes, and beliefs, as well as contextual factors, such as social norms and information dissemination. Descriptive statistics were used to describe the factors that contribute to noncompliance. Studies indicate that students who have higher levels of knowledge about COVID-19 and its transmission are more likely to comply with safety protocols. Additionally, positive attitudes and beliefs towards safety protocols, as well as a sense of personal responsibility, have been associated with increased compliance. Social norms and information also play a significant role, as students are more likely to comply with safety protocols when they perceive that the information they have is sufficient. School support, such as well-laid infrastructure, clear communication of safety protocols and adequate resources for compliance, can also contribute to increased compliance. In conclusion, compliance with COVID-19 safety protocols among 55 students aged 12-17 years was influenced by various factors, including individual knowledge, attitudes, and beliefs, social norms and information dissemination, and institutional support. Understanding these factors can help educators and policymakers develop effective strategies to promote compliance with safety protocols and protect the health and well-being of students and staff.
A Case-Control Study of Caregiver’s Feeding Knowledge and Practices, in Relation to Etiology of Diarrhea Among Children Aged 0-23 Months in Gokwe North District, Zimbabwe
(Adventist University of Africa, 2023-03) Chiketa Takudzwanashe Moses
Diarrhea prevalence among children under-five in Gokwe North district was estimated at 16.5% in 2018, surpassing the national average of 10% in the same period. The World Health Organization confirms that 54% of deaths due to diarrhea and other causes in under-fives have malnutrition as an underlying factor. The current study sought to investigate the possible relationship between the high diarrhea burden and Nutrition by examining the knowledge and practices of primary caregivers in the feeding of infants. The research followed a matched case-control study design. A Case was defined as the mother of a child who had had one or more episodes of diarrhea two weeks before the interview date. The selection of seven clinic catchment areas, 149 cases, and 149 controls was done through multi-stage sampling. Chi-Square tests for association and a binomial logistic regression model were conducted using SPSS version 16. Controls tended to be more knowledgeable than cases on the recommended IYCF practices. In the 0 to 5-month age group, practices that were significantly associated with diarrhea were mixed feeding (p=0.001), exclusively breastfeeding (p=0.000), and IYCF knowledge (p=0.001). For the 6 to 23 months age group significant associations were noted with the number of handwashing times (p=0.035), access to improved pit latrine (p=0.022), source of water for household use (p=0.007), type of container used (p=0.040), Mid Upper Arm Circumference (p=0.000) and IYCF Knowledge (p=0.001). Significant predictors of diarrhea in children of 0-5 months of age were IYCF knowledge [AOR 1.15, (CI 1.06; 1.24) P = 0.001], water source [AOR 20.9, (CI 1.77; 28.4) P = 0.016]. as well as the use of a nipple bottle [AOR 0.057, (CI 0.01, 0.48) P = 0.009]. For the 6 to 23-month age group significant predictors were IYCF Knowledge [AOR 1.034, (CI 1.01; 1.06) P = 0.001] and meal frequency [AOR 0.254, (CI 0.09; 0.71) P = 0.010]. Both IYCF and WASH practices were found to be having an association with diarrhea incidence in under-five children, particularly the 0-23-month age group. IYCF practices mostly affected the 0-5 months age range whereas as the child grows further into the 6-23 months range WASH-related factors have the greater influence in determining diarrhea.
Customer Perceptions of Quality in Selected Healthcare Franchises in Kenya
(Adventist University of Africa, 2023-04) Osiemo, Alice Kwamboka
This thesis investigated customer perceptions of healthcare quality in selected healthcare franchises in Kenya, concentrating on sociodemographic characteristics and perceptions of reliability, assurance, tangibles, empathy, and responsiveness, including aspects such as ambience, equipment, staff appearance, and staff knowledge and courtesy. The study employed a cross-sectional design using a semi-structured telephone questionnaire, with a purposive sample of 302 customers from four franchises. Data analysis using SPSS version 28 revealed significant differences in customer perceptions of reliability quality (F(3,298)=4.56, p<0.01) and tangibles (F(3,298)=3.27, p<0.05) across age groups, with customers aged 31-40 years having the highest ratings (M=4.12, SD=0.68 and M=4.20, SD=0.71, respectively). Differences were also observed in perceptions of reliability (t(300)=2.36, p<0.05) and assurance (t(300)=2.12, p<0.05) between male and female customers, with males rating higher (M=4.08, SD=0.66 and M=4.17, SD=0.69, respectively). Responsiveness significantly differed among customers with different marital statuses (F(2,299)=3.83, p<0.05), with single customers having higher ratings (M=4.19, SD=0.72) compared to married and divorced/widowed/separated customers. Additionally, differences were identified in the assurance dimension among customers with varying education levels (F(2,299)=4.17, p<0.05), with bachelor's degree holders rating highest (M=4.21, SD=0.70). However, no significant differences were found across different residences (F(2,299)=1.25, p>0.05). The study recommends that healthcare franchise providers prioritize delivering quality healthcare services and tailor their practices to the diverse needs of different customer segments. The findings have implications for healthcare providers in Kenya seeking to improve service quality and customer satisfaction, contributing to the knowledge on healthcare franchising and offering valuable insights for healthcare franchise providers.
Prevalence of Hypertension and Associated Risks among Gospel Workers of the Seventh-day Adventist Church in Northern Ghana Union Mission
(Adventist University of Africa, 2017-04) Amponsem-Boateng, Cecilia
This study was conducted on 200 gospel workers who were mainly Seventh-day Adventists from the South Central, Ashanti South, Ashanti Central and the Central Ghana Conferences of Ghana, as means of addressing hypertension and its associated risks. It had a broad objective of determining the prevalence of hypertension and its associated risks, among Gospel workers of the Northern Ghana Union Mission (NOGH) of the Seventh-day Adventist Church, and specific objectives of firstly determining the level of knowledge on hypertension among them; secondly to identify the nature of management of hypertension among gospel workers; and lastly, to determine the risk factors associated with hypertension among the gospel workers. The study adopted the mixed method approach by using a combination of cross-sectional, descriptive and non-experimental survey design. Data was collected by using both quantitative and qualitative approaches. These were questionnaires, interviews, documentary analysis and field survey. The questionnaires which contributed the larger part were analyzed by using SPSS, while interviews response were interpreted as the respondents meant them. The results of the study discovered that the majority of the gospel workers had adequate knowledge about the causes and symptoms of hypertensive disease. Regardless of this high knowledge, there was a high prevalence rate (38%) of hypertension. Though some gospel workers claimed they were aware of being hypertensive and had adopted various anti-hypertension management and prevention measures, there was still a poor health behavior and lifestyle among the gospel workers leading to the prevalence of hypertension. It was therefore concluded that, in the case of Gospel workers such as pastors, elders of churches and church financial officers where most activities are taken to be more spiritual in nature, less attention is typically paid to the prevention and management of lifestyle/medical conditions like hypertension. Based on the findings of the study and the conclusions, it is recommended that various measures, such as effective nutrition/health education on topics such as My-plate guidelines, as well as enlightenment on the causes and symptoms of hypertension, will be a step toward the reduction in the prevalence of hypertension. General improvement of the lifestyle and health behavior of gospel workers such as engaging in good dieting system, exercising regularly, and having enough rest. Part of a good prevention intervention would also include visiting the hospitals, clinics, and other health centers regularly to assess health status. Of course, it is also vital to report cases of hypertension to the health centers as another method to manage and prevent the prevalence of hypertension.
Customer perceptions of quality in selected healthcare franchises in Kenya
(Adventist University of Africa, 2023-04) Osiemo, Alice Kwamboka
This thesis investigated customer perceptions of healthcare quality in selected healthcare franchises in Kenya, concentrating on sociodemographic characteristics and perceptions of reliability, assurance, tangibles, empathy, and responsiveness, including aspects such as ambience, equipment, staff appearance, and staff knowledge and courtesy. The study employed a cross-sectional design using a semi-structured telephone questionnaire, with a purposive sample of 302 customers from four franchises. Data analysis using SPSS version 28 revealed significant differences in customer perceptions of reliability quality (F(3,298)=4.56, p<0.01) and tangibles (F(3,298)=3.27, p<0.05) across age groups, with customers aged 31-40 years having the highest ratings (M=4.12, SD=0.68 and M=4.20, SD=0.71, respectively). Differences were also observed in perceptions of reliability (t(300)=2.36, p<0.05) and assurance (t(300)=2.12, p<0.05) between male and female customers, with males rating higher (M=4.08, SD=0.66 and M=4.17, SD=0.69, respectively). Responsiveness significantly differed among customers with different marital statuses (F(2,299)=3.83, p<0.05), with single customers having higher ratings (M=4.19, SD=0.72) compared to married and divorced/widowed/separated customers. Additionally, differences were identified in the assurance dimension among customers with varying education levels (F(2,299)=4.17, p<0.05), with bachelor's degree holders rating highest (M=4.21, SD=0.70). However, no significant differences were found across different residences (F(2,299)=1.25, p>0.05). The study recommends that healthcare franchise providers prioritize delivering quality healthcare services and tailor their practices to the diverse needs of different customer segments. The findings have implications for healthcare providers in Kenya seeking to improve service quality and customer satisfaction, contributing to the knowledge on healthcare franchising and offering valuable insights for healthcare franchise providers.
Prevalence of hypertension and its risk factors among women aged 25 years or older in Kpone-Katamanso District, Ghana
(Adventist University of Africa, 2017-04) Acheampong, Kwabena
Hypertension in Ghana is a common problem of enormous public and fiscal consequence because of its high occurrence and the severity of its complications. Population-based studies estimate the prevalence of hypertension in Ghana at 19% to 48% (Bosu, 2010).This study’s main objective was to determine the prevalence of hypertension and its associated risk factors among women aged 25 years or older in Kpone-Katamanso District, to determine socio-demographic characteristics and lifestyle factors associated with prevalence of hypertension, and determine co-morbidities and family related factors associated with prevalence of hypertension. In addition, assess the knowledge on cause, prevention and treatment of hypertension among the target population. This study employed across sectional study design. A total population of 216 consenting participants aged 25 years or older from four communities in Kpone Katamanso District were involved in the study. Data were collected from the study population by household visits using a pre-designed semi-structured questionnaire after taking their consent. The data were entered in SPSS version 20.0. to be presented in tables, and analyzed using Chi-square and binary logistic regression. The significance threshold was set at 0.05. A total of 73 out of 216 participants were hypertensive, giving the overall prevalence of 33.8%. Its prevalence increased with age (from 13.3% to 56.4%, p<0.000). Among hypertensive participants, the mean SBP reading was 145.75±14.13mmHg and the mean DBP reading was 93.70± 9.50mmHg whereas the non-hypertensive participants, the mean systolic blood pressure reading was 114.76 ± 9.13mmHg and the mean diastolic blood pressure reading was 72.73±7.24mmHg. Forty-six (21.3%) of the subject were previously diagnosed of hypertension (aware of hypertension status). The Binary logistic regression analysis showed that age 65 and above 8.788 [3.829-92.188: p˂0.000), obesity 5.513 [2.013-15.098: p˂0.001]) and family history of hypertension72.132 [19.43-267.613:p˂0.000] were found to be significantly associated with hypertension. The study established that the prevalence of hypertension was high and its associated risk factors included age, obesity and family history of hypertension. Women with a very high risk of developing hypertension like high systolic blood pressure, marked obesity, or a strong familial history of hypertension should undertake blood pressure screening regularly for early detection and prompt treatment.
Factors associated with overweight/obesity among children of Mogoditshane Adventist School children in Botswana
(Adventist University of Africa, School of Postgraduate Studies, 2020-05) Mponwane, Mpho
The epidemic of childhood overweight/obesity, which in the developed world is mainly found in rural areas, has increased the incidence of plaguing cities and towns of the developing world. This is particularly the case in developing nations that are also experiencing nutritional transition, such as Botswana. The hypothesis of this study stated that there is no statistically significant association between demographic profiles/eating behavior/activity habits/parental factors with overweight/obesity status amongst children of the Mogoditshane Adventist School in Botswana. Both the questionnaires for the teachers and the parents were mainly interviewer-administered, although there were instances where some participants took the questionnaire and filled it independently. A certified Tanita scale was used to measure BMI for validity and reliability. Scales were calibrated and checked by the Botswana Bureau of Standards and certified to be appropriate for use in this study. Height measurements for the children were taken by trained measurers with thechildren standing in a standardized position of up straight with their legs and feet together and head vertical for precision. Both quantitative and qualitative data were analyzed. Chi-square was used for testing the socio-demographic variables, as well as the factors, eating behavior, and activity habits for association with overweight/obesity status (BMI z scores). Furthermore, multivariate logistic regressions were used to assess the independent factors associated with overweight/obesity. Data were collected from 152 parents of children 6-13 years of age to describe the aforementioned factors. Mothers were the majority at 63.6% of the sample. Batswana comprised 81.6 % of the sample. Child male participants were 42.8% while females comprised 57.2%. The children’s weight status was categorized using BMI z scores. 14.5% had BMI z scores > +2SD (Obesity), 19.1% had BMI z scores > +1SD (Overweight), 63.2% had BMI z scores between +1 and -2 (Normal), 2.6% had BMI z scores of <-2 (Underweight), and 0.7% had BMI z scores <-3 (Severe underweight). There was only one statistically significant variable (factor) found to be associated with overweight/obesity: Parental concern for child’s body weight [PV = 0.000; AOR = 4.659 (2.207-9.955)]. Additionally, whether the child eats fast food weekly [PV = 0.007; AOR = 0.207 (0.066-0.649)], whether child eats breakfast in the morning before school [PV = 0.048; AOR = 2.790 (1.008-7.727)], education of participant parent [PV = 0.036; AOR = 0.155 (0.027-0.886)] were the three statistically significant variables (factors) found to be associated with children’s obesity status. Therefore, we failed to reject the null hypothesis. The recommendations of the study show that consideration of the socio-demographics, healthy diet and activity factors is needed in developing child overweight and obesity prevention programs.
Assessment of exclusive breastfeeding knowledge and practices among post-natal mothers attending Ashaiman Polyclinic in the greater Accra region of Ghana
(Adventist University of Africa, School of Postgraduate Studies, 2019-04) Ofosuhene, Frank
It is expected that every country promotes, protects and supports breastfeeding program for infants and the mother’s health (WHO 1990). This study was designed to assess the knowledge and the extent to which breastfeeding was practiced among postnatal mothers who accessed Ashaiman Polyclinic in the Greater Accra Region of Ghana. The study utilized a survey as a research design by employing structured questionnaire as data collection technique. A sample size of 422 breastfeeding mothers whose children were less than two years old was used for the study. The data was analyzed using the Statistical Package for Social Sciences (SPSS version 21). The results were presented in frequency, percentages and inferences were made using a paired sample test. The significant values were computed to check for the relationship between the participants’ knowledge and the practice of exclusive breastfeeding and the P-value was set at 0.05.The exclusive breastfeeding rate according to WHOs recommendation was found to be 71%. Although there were considerably variations in the exclusive breastfeeding duration, the mothers generally had good knowledge (98%) and practices (96%) regarding exclusive breastfeeding.
Determinants of breast cancer awareness and screening practices of women within Tamale, Ghana
(Adventist University of Africa, School of Postgraduate Studies, 2019-04) Adams, Patsy Ago
Breast cancer is now ranked the most common cancer worldwide, increasing from 1.7 million incident cases in 2005 to 2.4 million cases in 2015. Both early detection and treatment have been shown to be the most effective methods to address the impact of this devastating disease. This study assessed the determinants of breast cancer awareness and practice of breast cancer screening among women in the Tamale, Ghana. A cross-sectional survey of 396 adult women, chosen by stratified random sampling was undertaken using a questionnaire. Results showed that the majority of the respondents were below 40 years of age (75.5%). Almost all participants (99.0%) had heard of breast cancer (awareness). Interestingly, the majority (51.3%) knows the cause of breast cancer to be bacteria. The most practiced method of screening was breast self-examination (86.4%), clinical breast examination and mammogram had 77.3%. We found that 93.4% of the population respectively never practiced either. Age, religious affiliations and ethnicities were seen to have statistically significant relations to awareness and practice.
Solid waste disposal practices of primary school children in Kajiado North Sub-County, Kenya
(Adventist University of Africa, School of Postgraduate Studies, 2020-03) Mugo, Dorcas Wanjiku
Littering is rampant in Kenya and leads to numerous environmental health challenges by contributing to unsanitary conditions that proliferate diseases. Although the national and county governments are increasing investments in solid waste management systems and banning the generation of certain waste material such as single-use plastic bags, it is clear that the behavior of littering is a factor that needs to be addressed to significantly reduce littering. Numerous studies have been done all over the world to profile litterers and study littering trends to identify the factors that contribute to littering behavior and suggest ways to change littering behavior. However, such studies have not been done in Kenya and especially in Kajiado North Sub-County, which is a settlement area for people who work in Nairobi due to its proximity to the capital city. Being so, it, therefore, experiences waste generation levels and trends akin to those of an urban area. This study examined the solid waste disposal practices of primary schoolchildren to determine reasons for these, and identify potential solutions to curb littering behavior. This is reasonable because by addressing the behavior in children it may be that the cycle of littering can be broken from one generation to another since behavior change usually takes a long time to happen. The target population consisted of primary school children aged 6-14 years in both private and public schools in Kajiado North Sub-county from which a total of 400 students were sampled. Questionnaires were administered and interviews carried out for the younger children. The data collected was coded, entered, and analyzed using PSPPIRE Data Editor version 3, and both descriptive and inferential analyses were conducted. The findings of the self-reported littering frequency are that 46.73% of primary school children never litter, while 8.72% always litter and 25.23% litter sometimes. There is also no difference in littering frequency between children in public and private schools, meaning that socio-economic status does not affect littering frequency. Also, boys litter slightly more than girls. An ordinal logistic regression analysis was carried out between littering frequency and environmental attitude of the children, which was considered a significant factor, and with location significance values of p=0.3, p=0.49, and p=0.453 for the three categories Action-Oriented, Concern, and Apathy, there is no significant relationship between environmental attitude and littering behavior. This pointed to the fact that other significant factors also affect littering behavior and not just environmental attitude, and so though most children have a positive attitude toward the environment, it is not a significant explanatory variable of their littering behavior. Other factors examined were: understanding of what litter is, parental behavior, lack or presence of punitive measures, size and nature of litter, and place of littering. Students believe that most people have a wrong environmental attitude which makes them litter, but they recommend that proper infrastructure, especially more littering bins, to be put in place to empower them to reduce littering. Therefore, even though environmental attitudes can be addressed in the long run, the infrastructure to enable proper disposal should be the first intervention that creates immediate impact. The study recommends that county government, national government, schools, and companies enable primary school children to dispose of litter properly by availing the infrastructure for proper disposal, maintaining cleanliness, educate children on proper waste disposal, carry out environmental awareness campaigns and anti-littering campaigns to the general population, and not over-rely on punitive measures to change littering behavior.
Determinants Of diarrhoea among under-five children in Umzingwane District, Zimbabwe: a case-control study
(Adventist University of Africa, School of Postgraduate studies, 2018-03) Mkandla, Sifelani
Diarrhoeal disease remains a leading cause of mortality and morbidity among children less than five years old in the developing world. The average annual incidence rate of diarrhoea in children less than five years of age (under-fives) is estimated to be 2.6 episodes in developing countries. It is also estimated that there are 100 million episodes and 3.3 million deaths occurring each year among under-fives globally. In Africa, a child typically experiences five episodes of diarrhoea per year, and 800,000 children die each year from diarrhoea and dehydration. In Zimbabwe diarrhoea is the fourth highest cause of death for children under five and is the reason for 12% of child hospital admission (Zimbabwe Maternal and Child Health Integrated Programme, 2014). According to World Bank Collection of Development Indicators, 2014 the prevalence of diarrhoea in under-fives in Zimbabwe was 16%. Umzingwane District recorded a high number of diarrhoea cases in underfives in 2016. The total number of diarrhoea cases from under- fives was 1 018 andconstituted 40% of the total number of diarrhoea cases in the district. The figure constitutes an overrepresentation of morbidity among this age group since the underfives make up 13.7% of the total population. The cause for the upsurge of diarrhoea cases was not documented by epidemiological studies or the literature. The aim of this study was to examine or discover context-specific conditions in Umzingwane district that may have led to an uptick in diarrhoea cases among under-fives in 2016. The study was a 1:1 unmatched case-control study. The research surveyed 200 cases and 200 controls. The cases were under-fives in Umzingwane District who had diarrhoea in 2016. The researcher used the standard case definition for diarrhoea as cited in the literature. The controls were under-fives who did not have diarrhoea in 2016 and came from the same neighbourhood as cases. A pre-tested, interviewer-administered questionnaire, was used to collect data from caregivers of cases and controls and under-fives. The questionnaire was filled by trained research assistants. Sanitary inspections were conducted through visual assessment of the infrastructures and the sanitary state surrounding the household water supply, water-holding containers, household sanitary conditions, food storage, personal hygiene, kitchen hygiene and vaccination status of the children as these factors have a potential risk to health and wellbeing of the child. Water samples were collected from boreholes and shallow unprotected wells to check for Escherichia Coli (E. coli) contamination and turbidity Data were analyzed using Epi Info 7.2.1.0 version. Odds ratios and Chi-square tests at 5% significant levels and 95% confidence intervals were generated using the software. Forward stepwise logistic regression analysis was used to control for confounding and effect modification. The adjusted odds ratios were calculated toquantify the strength of association between risk factors and outcome and factors with a p-value less than 0.05 were considered significant. Out of 35 borehole water samples tested, 33(94.29%) were below the threshold limit for contamination with Escherichia coli and 2 of the 35 (5.71%) borehole water samples tested were above the threshold for contamination with Escherichia coli. Out of 50 unprotected shallow wells water samples tested 9(18%) were below the threshold limit for contamination with Escherichia coli and 41(82%) unprotected shallow wells water samples tested were above the threshold for contamination with Escherichia coli. Independent risk factors for contracting diarrhoea were: source of water [OR=2.2457, CI=1.0924-4.6164, p-value=0.0278], disposal of solid waste [OR=4.62, CI=1.9380-11.0330, p-value=0.0006], sanitary state of the kitchen [OR=2.2307, CI=1.0185-4.8854, p-value=0.0449]. Independent protective factors for contracting diarrhoea were: household income [OR=0.2273, CI= 0.1180-0.4378, pvalue=0.0000], caregiver knowledge on diarrhoea prevention and control [OR=0.2940, CI=0.1316-0.6566, p-value=0.0028], washing hands by caregivers at all critical times [OR=0.0461, CI=0.0227-0.0937, p-value=0.0000] The study has highlighted the disaggregated household level risk factors for diarrhoea in under-fives in Umzingwane District. The environmental risk factors were drinking water from contaminated sources, indiscriminate disposal of waste around the home and unsanitary status of the kitchen where food is prepared. This clearly indicates the importance of environmental health as a determinant of child health. Therefore, there is a need for effective measures to enhance universal access to safe water, improved food hygiene practices and appropriate waste management strategies at the household level. The socioeconomic protective factors were knowledge of diarrhoea prevention and economic stability of the caregivers. The behavioural protective factor was washing of hands at all critical times by caregivers. This implies that hygiene promotion interventions should prioritise protective factors such as increasing caregiver knowledge of diarrhoea prevention, establishment and use of hygienic hand washing facilities and improving socioeconomic status of households.

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