AN INVESTIGATION ON THE RISK OF AN INVESTIGATION ON THE RISK OF INFECTION AMONG COMMUNITY HEALTH INFECTION AMONG COMMUNITY HEALTH

WORKERS IN THIKA SUB COUNTY, KIAMBU WORKERS IN THIKA SUB COUNTY, KIAMBU COUNTY, KENYACOUNTY, KENYA

BY: FLORA NGIMA GAKUIBY: FLORA NGIMA GAKUI(PHO-THIKA)(PHO-THIKA)

NOVEMBER 2013NOVEMBER 2013

1.1 Background1.1 Background Thika Sub County is one of the sub counties in Thika Sub County is one of the sub counties in

Kiambu County. It is located 40 kilometers to Kiambu County. It is located 40 kilometers to North East of Nairobi. It has a population of North East of Nairobi. It has a population of 218,544 people (National 2009) with an area of 218,544 people (National 2009) with an area of 327:1 sq km.327:1 sq km.

It is one of the sub counties in Kenya where It is one of the sub counties in Kenya where community health strategy has been embraced. community health strategy has been embraced.

The sub county has about 7 community health The sub county has about 7 community health units with 270 trained and active community units with 270 trained and active community health workers that provide health services to health workers that provide health services to the communities they come from (Public the communities they come from (Public Health-Thika, 2012).Health-Thika, 2012).

1. INTRODUCTION1. INTRODUCTION

1.2 Statement of the Problem1.2 Statement of the Problem Community health workers (CHW) are members of a Community health workers (CHW) are members of a

community who are chosen by community members community who are chosen by community members or organizations to provide basic health and medical or organizations to provide basic health and medical care to their community. care to their community.

They are members of the communities where they They are members of the communities where they work, selected by the communities, answerable to work, selected by the communities, answerable to the communities for their activities, supported by the communities for their activities, supported by the health system but have shorter training than the health system but have shorter training than professional workers. professional workers.

The use of community health workers has been The use of community health workers has been identified as one strategy to address the growing identified as one strategy to address the growing shortage of health workers shortage of health workers

The CHWs perform a wide range of functions, which The CHWs perform a wide range of functions, which generally include:generally include:

Home visits, Environmental sanitation, Provision of Home visits, Environmental sanitation, Provision of water supply, First aid and treatment of simple and water supply, First aid and treatment of simple and common ailments, Health education , Nutrition and common ailments, Health education , Nutrition and surveillance, Maternal and child health and family surveillance, Maternal and child health and family planning activities, Communicable disease control, planning activities, Communicable disease control, Community development activities, Referrals, Community development activities, Referrals, Record-keeping and collection of data on vital Record-keeping and collection of data on vital events events

Without protective practices such as proper hand Without protective practices such as proper hand washing, use of sterile gloves, sterile and safe washing, use of sterile gloves, sterile and safe equipment, and correct waste disposal, Community equipment, and correct waste disposal, Community Health Workers are at high risk of getting infections Health Workers are at high risk of getting infections while performing their regular functions. while performing their regular functions.

This study therefore aimed atThis study therefore aimed at establishing the establishing the knowledge and practices of Infection Prevention knowledge and practices of Infection Prevention Control among Community Health Workers in Thika Control among Community Health Workers in Thika Sub County.Sub County.

1.3 Objectives1.3 Objectives The study aimed atThe study aimed at establishing the knowledge establishing the knowledge

and practices of Infection Prevention Control and practices of Infection Prevention Control among Community Health Workers in Thika among Community Health Workers in Thika Sub County. Specifically it aimed at;Sub County. Specifically it aimed at;

a)a) To determine the level of knowledge of To determine the level of knowledge of community health workers on infection community health workers on infection prevention and controlprevention and control

b)b) To determine the practices of community To determine the practices of community health workers on infection prevention and health workers on infection prevention and controlcontrol

c)c) To determine the barriers hindering community To determine the barriers hindering community health workers from practicing infection health workers from practicing infection prevention and controlprevention and control

1.4 Research Questions 1.4 Research Questions The study was out to answer the The study was out to answer the

following questions;following questions;

a)a)What is the level of knowledge of What is the level of knowledge of community health workers on infection community health workers on infection prevention and control?prevention and control?

b)b)What are the practices of community What are the practices of community health workers on Infection prevention health workers on Infection prevention and control?and control?

c)c) What are the barriers hindering What are the barriers hindering community health workers from community health workers from practicing infection prevention and practicing infection prevention and control?control?

2.1 Research Design and Sampling2.1 Research Design and Sampling Thika Sub County has a total of 7 community Thika Sub County has a total of 7 community

health units with 270 community health health units with 270 community health workers. workers.

A descriptive study design was used to carry A descriptive study design was used to carry out this study.out this study.

The study targeted all the CHWs and sampled The study targeted all the CHWs and sampled 108 of them to participate in the study. This 108 of them to participate in the study. This was 40% according to Mugenda and Mugenda was 40% according to Mugenda and Mugenda (1999). (1999).

The community health workers were selected The community health workers were selected randomly from their respective community randomly from their respective community units.units.

2: METHODOLOGY

Table 1: Sampling DesignTable 1: Sampling DesignCommunity unit

No. of CHWs targeted

Sample Percentage (%)

Kiandutu 68 27 25

Umoja 32 13 12

Komo 28 11 10

Jujafarm 28 11 10

Kiaora 45 18 17

Dekoma 35 14 13

Malaba 34 14 13

Total 270 108 100

2.2 Data Collection and Analysis2.2 Data Collection and Analysis The structured interview schedules were The structured interview schedules were

used to collect data in the study. The used to collect data in the study. The procedure for data collection entailed procedure for data collection entailed conducting of interviews to the CHWs. conducting of interviews to the CHWs.

This was done by the researcher with the aid This was done by the researcher with the aid of hired and trained research assistants. of hired and trained research assistants.

The researcher examined all the interview The researcher examined all the interview schedules for completeness and consistency schedules for completeness and consistency and then categorized all the items using and then categorized all the items using frequency distribution tables. frequency distribution tables.

It was then analyzed using Microsoft Excel It was then analyzed using Microsoft Excel and presented in pie charts and graphs. and presented in pie charts and graphs.

3: STUDY FINDINGS3: STUDY FINDINGS3.1 Respondent’s Gender 3.1 Respondent’s Gender

More than half (58%) of the CHWs that were interviewed were female while 42% were male.

3.2 Respondents’ Age3.2 Respondents’ Age

More than half (54.5%) of the respondents were between the age of 36-59 years. Slightly less than half (42.6%) were between 19-35 years. Those that were below 18 years were 0.9% while 1.9% was above the age of 60 years.

3.3. Highest Level of Education3.3. Highest Level of Education

Slightly less than half (48%) and (46%) of the CHWs interviewed had secondary and primary education respectively. Those that had tertiary education were 4.4% while those with no formal education were 1.6%.

3.4 Knowledge on Infection Prevention 3.4 Knowledge on Infection Prevention and Controland Control

Most (69%) of the CHWs had no knowledge on infection prevention control while only 31% had knowledge on IPC.

3.5 Training on Infection Prevention 3.5 Training on Infection Prevention ControlControl

Majority (98%) of the CHWs interviewed were not trained on Infection Prevention Control while only 2% of the CHWs said they had been trained.

3.6 Training Organization3.6 Training Organization

Among the 2% of the CHWs who were trained on IPC, all (100%) of them said to have been trained by the government

3.7 Handling patients during the CHWs’ 3.7 Handling patients during the CHWs’ workwork

Majority (99%) of the CHWs interviewed said they handled patients at home during their work while only 1% said they did not handle patients

3.8 Use of personal protective gloves 3.8 Use of personal protective gloves when handling patientswhen handling patients

Among the CHWs who handled patients during their work, slightly less than half (49%) of them did not use personal protective gloves while 51% used.

3.9 Disinfection of surfaces and 3.9 Disinfection of surfaces and equipment after handling patientsequipment after handling patients

Majority (84%) of the CHWs did not disinfect surfaces and equipment after handling patients while on 16% disinfected the surfaces.

3.10 Hand washing with soap after 3.10 Hand washing with soap after handling patientshandling patients

More than half (57%) of the CHWs did not wash their hands with soap after handling patients while 43% washed.

3.11 Major barriers for the practice of 3.11 Major barriers for the practice of IPCIPC

Majority (73%) of the CHWs interviewed said that lack of protective equipment was the main barrier hindering the practice of IPC while 27% said that the main barrier was insufficient knowledge and technical skills

4. SUMMARY OF THE FINDINGS4. SUMMARY OF THE FINDINGS The study found out that more than half (58%) of The study found out that more than half (58%) of

the CHWs in Thika sub county were female while the CHWs in Thika sub county were female while 42% were male. Majority of the CHWs were adults 42% were male. Majority of the CHWs were adults between the ages of 19-59 years. Only 0.9% and between the ages of 19-59 years. Only 0.9% and 1.9% were below 18 and above 60 years 1.9% were below 18 and above 60 years respectively. Majority of the CHWs had formal level respectively. Majority of the CHWs had formal level of education ranging from primary to university of education ranging from primary to university with (48%) and (46%) having secondary and with (48%) and (46%) having secondary and primary education respectively. Only 1.6% did not primary education respectively. Only 1.6% did not have formal educationhave formal education

The study established that only 31% of the CHWs in The study established that only 31% of the CHWs in Thika had knowledge on IPC while most (69%) did Thika had knowledge on IPC while most (69%) did not. Majority (98%) of them were never trained on not. Majority (98%) of them were never trained on Infection Prevention Control as opposed to only 2% Infection Prevention Control as opposed to only 2% who said to have been trained by the government.who said to have been trained by the government.

Summary of the Findings cont’Summary of the Findings cont’ The study determined that almost all (99%) The study determined that almost all (99%)

of the CHWs handled patients at home during of the CHWs handled patients at home during their work. Among them, slightly less than their work. Among them, slightly less than half (49%) did not use personal protective half (49%) did not use personal protective gloves while only 51% used. Majority of them gloves while only 51% used. Majority of them (84%) did not disinfect surfaces and (84%) did not disinfect surfaces and equipment after handling the patients and equipment after handling the patients and only 43% washed their hands with soap while only 43% washed their hands with soap while more than half (57%) did not.more than half (57%) did not.

The study found out that majority (73%) of The study found out that majority (73%) of the CHWs failed to practice IPC due to lack of the CHWs failed to practice IPC due to lack of protective equipment while 27% was protective equipment while 27% was attributed to insufficient knowledge and attributed to insufficient knowledge and technical skills.technical skills.

5. CONCLUSIONS5. CONCLUSIONS Most of the Community health workers in Thika Most of the Community health workers in Thika

sub county did not have correct Knowledge on sub county did not have correct Knowledge on Infection Prevention Control. Almost all of them Infection Prevention Control. Almost all of them had no training on IPC.had no training on IPC.

Almost all of the CHWs in the sub county handled Almost all of the CHWs in the sub county handled patients at home during their work. However, patients at home during their work. However, most of them neither used personal protective most of them neither used personal protective equipment, disinfected surfaces and equipment equipment, disinfected surfaces and equipment after handling the patients nor washed their after handling the patients nor washed their hands with soap. This risked them being infected hands with soap. This risked them being infected while performing their duties.while performing their duties.

The major barriers that hinder the practice of IPC The major barriers that hinder the practice of IPC among community health workers were lack of among community health workers were lack of protective equipment and insufficient knowledge protective equipment and insufficient knowledge and technical skills.and technical skills.

6.0 RECOMMENDATIONS6.0 RECOMMENDATIONS Train all community health workers in the sub Train all community health workers in the sub

county on infection prevention controlcounty on infection prevention control Provision of personal protective equipment to Provision of personal protective equipment to

all community health workers in the sub county all community health workers in the sub county to enable them protect themselves while to enable them protect themselves while performing their workperforming their work

Provide all community health workers with Provide all community health workers with disinfectants and other hygiene commodities disinfectants and other hygiene commodities and educate them on the sameand educate them on the same

Create awareness among the community health Create awareness among the community health workers and the community at large on the workers and the community at large on the importance of proper hand washing with soapimportance of proper hand washing with soap

Enhance support supervision and mentorship at Enhance support supervision and mentorship at the community levelthe community level

THANK YOU !!!THANK YOU !!!