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Purpose: The current study sought to investigate the practice of IT-based discharge communication in general surgery wards at the Kenyatta National Hospital. Methodology: The study used the descriptive research design approach. A stratified sampling technique was used to recruit 180 patients who had been discharged in the last one month prior to the study from surgical wards namely General surgery ward, Urology ward and Neurology ward. A semi structured questionnaire was used to collect both qualitative and quantitative data with the use of SPSS version 25. Results: The findings revealed that there is a significant difference between the mean responses of the patients in General surgery ward and Neurology ward (-.299*, P= 0.001). Likewise, there is a significant difference between the mean responses of the patients in Urology ward and General surgery ward (-.417*, P= 0.000). The correlation findings indicated that there is a positive and significant association between IT-based discharge communication practices and patient health outcomes at KNH (r=0.533**, p=0.000). This was supported by the regression findings that indicated that IT-based discharge communication practices have a positive and significant effect on patient health outcomes at KNH (β = 0.305, p=0.000). This implies that improvement in 1 unit of IT-based discharge communication practices leads to an improvement in patient health outcomes at KNH by 0.305 units (vice versa is also true). Unique contributions to theory, policy and practice: Since, well-designed and implemented IT systems increase communication, coordination, and knowledge retention, resulting in better results for discharged patients, their families, caregivers, and primary healthcare professionals, Kenyan hospitals are encouraged to pursue the IT direction and put into practice the best IT-based communication infrastructure for current and future quality service delivery

Introduction Poor quality health care is a significant cause of preventable deaths, especially in low- and middle-income countries (LMICs). Quality improvement is multifaceted and includes strategies such as standard setting, quality assurance and clinic audits. In order to move quality improvement in health care into every day practice it is essential to fully engage the frontline where health care is delivered. The objective of this scoping review is to investigate front line health care worker line led quality improvement in Sub Saharan Africa (SSA). Methods We conducted a scoping review to identify, map and synthesize evidence on health care worker led quality improvement initiatives in Sub Sahara Africa using electronic databases PubMed, Cochrane, Embase, CINAHL, Scopus and Psychinfo to identify peer-reviewed literature published between January 2000 and January 2021. To identify grey literature, we used the same search terms in google search to a maximum of 10 pages or when there was no new information. All evidence was scored based on the 6 criteria described by Backhouse et al., which clearly distinguish quality improvement from clinical audit and research. Inclusion criteria were studies that involved frontline health care workers to test “change ideas” and used data systems to measure improvement in service delivery. Results A total of 75 records were identified and including 52 from the peer review search and 23 records from the grey literature search. Only 15 of 47 countries had publications (peer-review or grey literature) describing QI initiatives. Most quality improvement (QI) initiatives were multicomponent and included knowledge transfer, skills building, mentorship and learning visits. Most publications reported QI initiatives aimed at reproductive, maternal, neonatal and child health (n=23) and HIV (n=14) service delivery. Only 6 had experimental designs. No publications were identified prior to 2012 and a rapid escalation of published quality improvement initiatives from 2012 to 2020 was seen. Conclusion QI is in the very nascent stage in SSA. Most large-scale public health QI initiatives are sector specific, siloed, and donor driven. QI initiatives within sector specific programs have not moved horizontally and have had limited ability to change the broader system. Energy must be exerted to change the status quo. Making health care safer and more effective is not spontaneous.

Purpose: The current study sought to investigate the practice of written discharge communication practices in general surgery wards at the Kenyatta National Hospital Methodology: The study used the descriptive research design approach. A stratified sampling technique was used to recruit 180 patients who had been discharged in the last one month prior to the study from surgical wards namely the General surgery ward, Urology ward and Neurology ward. A -semi-structured questionnaire was used to collect both qualitative and quantitative data. A statistical Package for Social Sciences (SPSS version 25) was used in the data analysis. Results: The findings revealed that there is a positive and significant association between written discharge communication practices and patient health outcomes at KNH (r=0.587**, p=0.000). It was further noted that 77 of the respondents in the Neurology unit (mean = 2.07) and 52 of them in the general unit (mean = 2.65) agreed with the statements regarding the written discharge communication practices affecting patient health outcomes. However, 51 of them in the general unit (mean = 3.19) were of neutral opinion. There was also a significant difference between the mean responses of the patients in the Neurology ward and General surgery ward (.312*, P=0.011). Likewise, there was a significant difference between the mean responses of the patients in the Urology ward and General surgery ward (-.538*, P=0.000). This was supported by the regression findings that indicated that written discharge communication practices have a positive and significant effect on patient health outcomes at KNH (β= 0.373, p=0.000). This implies that improvement in 1 unit of written discharge communication practices leads to an improvement in patient health outcomes at KNH by 0.373 units. Unique contributions to theory, policy and practice: Based on the study findings, the current study, therefore, recommends an urgent demand for the widespread application of standardized procedures, paperwork, and training to enhance crucial discharge information exchanged between healthcare providers and between Health care providers and discharged patients

Purpose: The current study sought to investigate the practice of person-based discharge communication practices in general surgery wards at the Kenyatta National Hospital. Methodology: The study used the descriptive research design approach. A stratified sampling technique was used to recruit 180 patients who had been discharged in the last one month prior to the study from surgical wards namely the General surgery ward, Urology ward and Neurology ward. A semi-structured questionnaire was used to collect both qualitative and quantitative data. A statistical Package for Social Sciences (SPSS version 25) was used in the data analysis. Results: The findings show that 77 of the respondents in the Neurology unit (mean = 2.97), 51 of them in the general surgical unit (mean = 1.80) and 52 of them in the urology unit (mean = 2.11) agreed that person-based discharge communication practices affect patient health outcomes. There was also a significant difference between the mean responses of the patients in the Neurology ward and Urology ward (-.267*, P=0.026). Likewise, there was a significant difference between the mean responses of the patients in the Urology ward and General surgery ward (-0.313*, P=0.017). Furthermore, the findings indicated that there is a statistically significant relationship between person-based discharge communication practices at KNH given the Neurology ward, Urology ward and General surgery ward departments {(F (2, 177) =3.517, p=0.032< 0.05}. This was supported by the regression findings that indicated that person-based discharge communication practices have a positive and significant effect on patient health outcomes at KNH (β= 0.305, p=0.000). This implies that improvement in one unit of person-based discharge communication practices leads to an improvement in patient health outcomes at KNH by 0.305 units (vice versa is also true). Unique contributions to theory, policy and practice: Based on the study findings, the current study, therefore, recommends the health care practitioners to continuously appreciate the importance placed on constant and regular use of this discharge communication for better patient health outcomes and staff satisfaction, as well as contribute to cost savings to the organization.

Background The impact of human immunodeficiency virus (HIV) on pregnancy outcomes for women on antiretroviral therapy (ART) in sub-Saharan Africa remains unclear. Methods Pregnant women in Kenya were enrolled in the second trimester and followed up to delivery. We estimated effects of treated HIV with 3 pregnancy outcomes: loss, premature birth, and low birth weight and factors associated with HIV-positive status. Results Of 2113 participants, 311 (15%) were HIV infected and on ART. Ninety-one of 1762 (5%) experienced a pregnancy loss, 169/1725 (10%) a premature birth ( Conclusions Currently treated HIV was not significantly associated with adverse pregnancy outcomes. HIV-infected women, however, had a higher prevalence of other factors associated with adverse pregnancy outcomes.

One of the cardinal pieces of the Hippocratic Oath is "do no harm"; yet, even in the very best of contexts, errors, at times fatal, do occur as was reported by the Institute of Medicine. Surgical procedures are known to cause the majority of serious adverse events. The Joint Commission report indicates that 60% of serious adverse events are caused by the lack of physician-patient communication. Some of the factors that make surgical processes prone to medical errors include the number of steps and people involved and the fact that the interventions intended for the healing are often in themselves invasive and can also complicate. The involvement of more than one discipline and individual requires communication that is clear, understandable, culturally sensitive, and contextually relevant. One of the center pieces of quality care is its patient-centeredness. This refers to providing service that is not only respectful but also responsive to individual patients involving them in the decisions, ensuring their values and preferences are taken into consideration. It also demands that the care giver provides the patients with relevant and understandable information to enable them in the decision-making and make informed choices.