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I ASSESSMENT of the HEALTHCARE PROVIDERS KNOWLEDGE and CAPACITY to DETECT RIFT VALLEY FEVER INFECTIONS in MARAGUA SUB-COUNTY OF

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I ASSESSMENT of the HEALTHCARE PROVIDERS KNOWLEDGE and CAPACITY to DETECT RIFT VALLEY FEVER INFECTIONS in MARAGUA SUB-COUNTY OF i ASSESSMENT OF THE HEALTHCARE PROVIDERS KNOWLEDGE AND CAPACITY TO DETECT RIFT VALLEY FEVER INFECTIONS IN MARAGUA SUB-COUNTY OF MURANG’A COUNTY OF KENYA GACHERU STEPHEN GITAU (HND) I57/6472/03 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF MASTER OF PUBLIC HEALTH (EPIDEMIOLOGY AND DISEASE CONTROL) IN THE SCHOOL OF PUBLIC HEALTH OF KENYATTA UNIVERSITY APRIL 2016 ii DECLARATION This thesis is my original work and has not been presented for a degree or other awards in any other university. Signature …………………………………… Date …………………………. Stephen G. Gacheru (I57/6472/2003) Department of Community Health SUPERVISORS We confirm that the work reported in this thesis was carried out by the candidate under our supervision Signature …………………………………… Date …………………………. Prof. Joseph N. Ngeranwa Department of Biochemistry and Biotechnology Kenyatta University Signature …………………………………… Date …………………………. Dr. Anne W. Kamau Department of Sociology Kenyatta University Signature …………………………………… Date …………………………. Dr. Yatinde S. Binepal Biotechnology Centre Kenya Agriculture and Livestock Research Organization (KALRO) Nairobi iii DEDICATION To my family; Elvis, Joel, Hannah and Knollecah. iv ACKNOWLEDGEMENTS My gratitude goes to my supervisors, Prof. Joseph. J. N. Ngeranwa, Dr. Yetinde S. Binepal and Dr. Anne W. Kamau for their inspiration and scientific guidance. Dr. Isaac Mwanzo is appreciated for his guidance in choosing the topic of study and also encouragement throughout the entire course. I sincerely thank, The Kenya Veterinary Service Department who facilitated funding support for this study. Thanks to the Murang’a South Public health staff for their support, not forgetting the District Public Health Nurses for Kigumo, Murang’a South and Kandara, namely; Esther Wahome, Catherine Gachanja and Njeri Kande respectfully for their dedication and tireless effort in assisting me during the visit to the health facilities during the study. The dedication of the drivers Daniel Irungu, Stephen Muturi and Joseph Okong’o all of Kabete who worked beyond the normal working hours and at times driving tirelessly in the rains on unfamiliar routes is highly appreciated. Thanks also go to Mrs. Bilha Muna of epidemiology unit Kabete for providing the map of the study area. Thank to Timothy Kinoti of African Medical Research Foundation for guidance and support in data analysis work and the use of the Statistical Package for Social Sciences. I am grateful to Mr. Antony D. Bojana and Mr. David Mainge both of Kenyatta University who assisted in the final editorial work of the thesis. v TABLE OF CONTENTS DECLARATION ................................................................................................. ii DEDICATION ...................................................................................................iii ACKNOWLEDGEMENT .................................................................................. iv ACRONYMS/ABBREVIATIONS .................................................................... xii TABLE OF CONTENTS ..................................................................................... v LIST OF TABLES ............................................................................................ viii LIST OF FIGURES ............................................................................................ ix LIST of APPENDICES........................................................................................ x LIST OF PLATES .............................................................................................. xi ABSTRACT ...................................................................................................... xii CHAPTER ONE: INTRODUCTION ................................................................... 1 1.1 Background to the study ................................................................................. 1 1.2 Statement of the Problem ............................................................................... 2 1.3 Research Questions ........................................................................................ 5 1.4 Hypotheses..................................................................................................... 5 1.5 Objective....................................................................................................... 5 1.5.1 General ....................................................................................................... 5 1.5.2 Specific Objectives ...................................................................................... 5 1.6 Significance of the study ................................................................................ 5 CHAPTER TWO: LITERATURE REVIEW ....................................................... 7 2.1 Rift Valley Fever (RVF) Virus ....................................................................... 7 2.1.1 Structure of Rift Valley Fever Virus. ........................................................... 8 2.1.2 Replication of Rift Valley Fever Virus ........................................................ 9 2.2 History of Rift Valley Fever Outbreaks ........................................................ 10 2.3 Distribution of Rift Valley Fever in Africa and Middle East ......................... 11 2.4 Rift Valley Fever in Kenya .......................................................................... 12 2.5 Socio- Economic Impact of Rift Valley Fever Infection ............................... 13 2.6 Transmission of Rift Valley Fever................................................................ 14 2.6.1 Rift Valley Fever Vectors .......................................................................... 14 vi 2.7 Pathogenesis of Rift Valley Fever in Primates .............................................. 15 2.8 Clinical features of Rift Valley Fever Infections ........................................... 17 2.9 Detection and Diagnosis of the RVF Agent .................................................. 18 2.10 Control of RVF .......................................................................................... 19 2.10.1 Controlling RVF in Animals ................................................................... 19 2.10.2 Controlling RVF in Humans .................................................................... 19 2.10.3 Vector control ......................................................................................... 20 2.10.4 RVF forecasting and climate models ....................................................... 21 2.11 Treatment and Vaccination......................................................................... 21 CHAPTER THREE: RESEARCH METHODOLOGY ...................................... 23 3.1 The Study Area ............................................................................................ 23 3.2 Research Design and Study Location Description ........................................ 24 3.3 Sites Selection and Study Design ................................................................. 26 3.4 Study Population .......................................................................................... 24 3.5 Sample size and sampling procedures .......................................................... 27 3.6 Research Instruments and Data Collection ................................................... 28 3.7 Data Analysis ............................................................................................. 28 3.8 Ethical Consideration ................................................................................... 25 CHAPTER FOUR: RESULTS AND DISCUSSION .......................................... 30 4.1: Types of Health Facilities in the Study Area ............................................... 30 4.2 Healthcare Providers in the Study Area ........................................................ 31 4.2.1 Healthcare Providers Level of Education ................................................... 32 4.2.2 Healthcare Providers Training on RVF Detection ..................................... 33 4.2.3 Healthcare Providers’ Knowledge on When to Expect Cases of RVF ........ 35 4.2.4 Healthcare Providers’ Knowledge on Economic Importance of RVF ......... 36 4.2.5 Healthcare Providers Knowledge on People Likely to Suffer from RVF .... 37 4.2.6 Healthcare Providers’ Knowledge on Clinical Manifestation of RVF ........ 38 4.2.7 Healthcare Providers’ Knowledge on the Cause of RVF ............................ 40 4.2.8 Healthcare Providers’ Knowledge on Control of RVF ............................... 40 4.2.9 Healthcare Providers’ Knowledge on Diagnosis of RVF ........................... 42 vii 4.2.10 Healthcare Providers’ Training on Management of RVF ......................... 43 4.2.11 Healthcare Providers Training in the Past Year ........................................ 44 4.2.12 Challenges Healthcare Providers Face When Managing RVF .................. 45 4.2.13 Addressing Challenges Healthcare Providers Face in Diagnosis of RVF .. 47 4.2.14 Additional Information Shared by Healthcare Providers .......................... 48 4.3: Laboratory Facilities in the Healthcare Institutions ...................................... 48 4.3.1 Source of Laboratory Reagents ................................................................. 50 4.3.2 Facilities Capacity for RVF Detection ....................................................... 51 4.3.3 Medical Waste Disposal ...........................................................................
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