CHAPTER 5

5.1 HEALTH SERVICES OFFERED IN THE DISTRICT

PRIMARY HEALTH CARE (PHC) ACTIVITIES AND SERVICES OFFERED BY THE

HEALTH WORKERS AT THE DISTRICT LEVEL:

The PHC activities and services offered by the health workers at the District level had 4

characteristics, i.e. they were; affordable, acceptable, and reliable and had full

community participation. The PHC Services included;

o Water and sanitation: Sanitation and Water Quality is a big challenge within Kisii

municipal I participated in piped water mapping and its contaminants within Kisii

municipal and Bacteriological water quality testing for household’s workshop that was

conducted by the UN habitat for 3 days at St Stephens Catholic hall in Kisii. 4

classification of water related diseases were discussed:

1. Water borne diseases: Diseases caused by ingestion of contaminated water by

human or animal or urine containing bacteria or viruses.

2. Water washed diseases: Caused by poor personal hygiene as a result of poor access

to water

3. Water based diseases: Diseases caused by parasites found in the intermediate

organism leaving in water.

4. Water related diseases: Transmitted by insect’s vectors which breed in water

1
Whereby in Kisii Central District the following were found to be the most common

diseases In terms of prevalence Malaria is the highest in prevalent then typhoid,

dysentery, Amoeba, Tungiasis Water supply in Kisii Central District is divided in to two:

1. Piped water: Kegati water treatment plant that supplies The lager Kisii was visited

where conventional ways were used to treat water, The following Chemicals were used

in the following stages:

Presumptive test- where Aluminum Sulphate is used to suspend dirt in water

Confirmed test –Where Chlorine is used to disinfect and leave residue for further

decontamination.

Completed test – Where sodium carbonate is used to neutralize the water that has been

treated by Aluminum sulphate.

- treated water entering the distribution system

-Untreated water entering the distribution.

2. Un piped water: any other water not entering the distribution system which some are

protected some not is unprotected like:

-Springs

-Streams

--Wells

-Bore holes

2
-Rivers

-Rainwater.

Possible sources of water contaminant in Kisii central District are: Industrial waste e.g.

from slaughter houses, Chemicals from agricultural practices, Soil erosion, Poor

disposal of waste, Poor storage or handling of domestic water, Run offs e.g. leachates

from dump sites, Underground contamination. Existing sanitation facilities in KMC are

not well planned hence the greatest water contaminants: Latrines, Dump sites,

sewerage system, septic tanks and most of this existing sanitation were down streams

hence contribute a lot in water contamination.

o Waste management services: Kisi Central District has waste from the level five

hospitals and the Municipal waste.

Medical waste: Classified in to three categories 1. Highly infectious put in a red

polythene bag then collected every morning and taken for incineration.

Infectious waste: put in a yellow polythene bag and collected every morning for

incineration too.

Non Infectious waste: Put in black polythene and taken to the hospital dump site. The

main ways of managing hospital waste at Kisii level five hospitals are damp sites for non

infectious waste, open drains for rain water disposal, pits e.g. placental pits, sewage

drains for liquid infectious waste and safety boxes for syringes and vials, they are all

kept in a strategic point for collection for disposal.

3
Municipal waste: it has both solid and liquid wastes; municipal mainly uses sewerage

system and septic tanks for liquid wastes and damp sites for solid wastes.

o Immunization: This was also done in the Mother Child health clinic different vaccines

were learnt, their doses; routes use to administer them and participated in

administering them at Oresi health center, discussed KEPI diseases i.e.

Poliomyelitis, Pertusis/whooping cough, Tetanus, hepatitis B, Heamophilus Influenza

type B.For example we have the BCG vaccine for Tuberculosis given at birth or at

first contact with the child dose is 0.05 cc under one year and 0.1cc above one year,

route of administration is intradermal.There is also oral polio vaccine aganaist

poliomyelitis2 drops given at birth, fast polio given after 6 weeks, second polio given

at 10 weeks, and third polio given at 14 weeks. There is pentavalent vaccine given

aganaist Diptheria,Pertusis/whooping cough,Tetanus,Hepatitis B,and hemophilus

influenza type B this vaccine is given at 6 weeks in the thigh muscle the dose is

2.5cc.at 6 months or 9 months Vitamin A vaccine is given and at 9 months measles

vaccine is administered intra muscle with a dose of 0.5cc in the right hand in some

places like some parts of Rift valley yellow fever vaccine is administered so there is

a total of 8 Kepi diseases but 9 with the inclusion of yellow fever..

o Learnt Cold chain process: Keeping vaccines safe from the manufacturer to the

patient potent according to manufacturer’s instructions. They arrive at the

headquarters in Nairobi they are confirmed by the experts then transported to

Regional stores example Kisumu for Nyanza province vaccines and they are

transported by use of special vehicles purposely made for transporting vaccines this

is done by Kenya Medical Supplies Agency(KEMSA) who also confirms their safety

4
and potency at this level from the region level cool boxes and ice parks are used to

transport them to District level e.g. Kisii district then to health centers, dispensaries

and to some Non Governmental Organizations offering the services. During

transport and use health workers are required to record batch numbers of vaccines

in the ledger book for control and references. At the facility level all vaccines must be

kept at +2 and +8 degrees centigrade.

Non –K

UNIVERSITY OF EASTERN AFRICA BARATON

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF BUBLIC HEALTH

REPORT ON PROFFESSIONAL PRACTICE IN KAPTUMO DIVISION

ASSIGNMENT DONE IN PARTIAL FULFILMENT OF THE COURSE;

PHHC 420: PROFESSIONAL PRACTTICE

PRESENTED BY: WANGECI FAITH KIRAGU

ID: SWANKI0731

5
 COURSE COORDINATOR: Ms ASENATH NYANTIKA BARONGO

OCTOBER - DECEMBER

Acknowledgement
First and foremost I give thanks to my God for enabling me to successfully go through

the professional practice at kaptumo division. To the entire faculty in the department for

giving us the right knowledge in the different courses. To the course coordinator,

madam Asenath, for taking her time to prepare us by giving us the right counsel on how

to conduct ourselves and also visiting us during the period. To all the PHOs who helped

us attain our objective in addition to giving us an opportunity to take part in the different

activities. To my colleagues for being so supportive and finally to my dear friend Brenda

who accommodated me during the entire period.

6
Declaration
I hereby truthfully declare that this report is my own work and it has not been presented

by any other person.

Student name: Wangeci Faith Kiragu

Id: SWANKI0731

Sign:……………………………

Instructors name: Ms Asenath Barongo

Sign:……………………..

7
List of abbreviations
PH – public health

PHO – public health office/public health officer

DPHO –district public health office/officer

TB - tuberculosis

VCT –voluntary counseling test

PMTCT – preventive mother-to-child transmission

HAART-highly active anti-retroviral therapy

IRS- indoor residual spraying

EPI – extensive program of immunization

MOH –Ministry of health

PPE – Personal protective equipment

KEMSA –Kenya extended medical supplies association

BMI – Body mass index

KSDH –Kaptumo sub-division hospital

8
HACCP – hazardous critical control point

Contents
Acknowledgement....................................................................................................................... 2
Declaration.................................................................................................................................. 3
List of abbreviations..................................................................................................................... 4
Chapter 1..................................................................................................................................... 6
Introduction.............................................................................................................................. 6
Objectives................................................................................................................................ 8
Methodology............................................................................................................................ 8
Chapter 2..................................................................................................................................... 9
Organization of health services................................................................................................9
Water and sanitation.............................................................................................................. 11
Waste management............................................................................................................... 12
Immunization services............................................................................................................ 13
Nutritional services................................................................................................................. 15
School health services........................................................................................................... 17
Food quality........................................................................................................................... 18
Meat Inspection...................................................................................................................... 20
Maternal health services........................................................................................................ 21
Laboratory services................................................................................................................ 22
Clinical care services............................................................................................................. 24
Pharmacy and treatment services.,........................................................................................27
Filter clinic.............................................................................................................................. 27
Occupational health............................................................................................................... 28
Communicable disease control..............................................................................................30
Chronic disease control.......................................................................................................... 32
Health education and promotion.............................................................................................34
Building inspection................................................................................................................. 34

9
 Record services..................................................................................................................... 35
Chapter 3................................................................................................................................... 36
Conclusion............................................................................................................................. 36

Chapter 1
Introduction
Kaptumo division is an area of about 137.4km2 with a population of approximately

26,782 people projecting to 35,000. It comprises of 4,980 households with a projection

of 5,300 households. There are four locations, 14 sub locations and 82 villages/estates.

Looking at the level of education, there are26 established primary schools and 5

secondary schools. In addition there are also 7 established markets.

The division has an altitude of about 1860m, temperature range of 13 0c- 300c, and a

rainfall of 2100mm average p.a.

Looking at the organization of health services, the division has one health center and

three dispensaries. In addition, they have 9 major M.B sites and 8 spray teams.

There are several types of public health activities. Some of them include:

1. Pit latrines

 Auditing old latrines and pegging/sitting new ones

 Health education on the importance of pit latrines

2. Disease control and community strategy

 Formation of community units

 Mobilization for EPI

 Defaulter tracing

 Enhancing condom distribution

10
  Enhanced surveillance and reporting

 Internal residual spraying.

3. Water quality control

 Mobilization of community spring protection

 Treatment of drinking water

 Water sampling

 Intersectoral collaboration

4. Revenue

 Comprehensive inventory of businesses

 Procure adequate official and legal forms and receipts

5. Food quality control

 Enhance routine inspection/sanitation

 Medical examination of all food handlers

6. School sanitation

 Inspection of schools per term

 Formation of health clubs

 Improvement of disaster preparedness

 Improving student personal hygiene practices

7. Good housing

 Enhance approval of building plans

 Building site inspection

 Improving lighting and ventilations

 Enhance routine inspection and education

11
  Improve structural aspects

Objectives
1. To describe the organization of health services from the ministry of health to the

community level.

2. To participate in the community health services offered by the public health

officers and health center staff.

3. To describe the primary health care activities and services offered by the health

workers at the community.

Methodology
 Having discussions with the in charge of the different departments in the hospital.

 Participating in the carrying out inspections in the food premises, slaughter slab,

market, schools, buildings under constructions and building maps before

approval

 Visiting the DPHO for a short briefing on the organization of health services.

 Visiting factories for the purposes of learning more on occupational health, tea

factory and two different mala factories.

 Participating in drafting of statutory notices and issuing medical examination

certificates to food handlers.

 Participating in health talks both in the hospital and schools.

12
 Chapter 2

Organization of health services

There are six levels of health services:

National hospital

Provincial hospital

Sub-division/division hospital

Health center

Dispensaries

Community level

There are two ministries dealing with health issues:

13
 1. Ministry of medical services

2. Ministry of public health and sanitation

MINISTRY OF HEALTH

MINISTER FOR
MEDICAL SERVICES MINISTER FOR PUBLIC HEALTH

ASSISTANT MINISTER FOR ASSISTANT MINISTER FOR

PUBLIC HEALTH PUBLIC HEALTH

PERMANENT SECRETARY FOR

PUBLIC HEALTH

DIRECTOR OF MEDICAL
SERVICES (DMS)

PROVINCIAL PROVINCIAL PROVINCIAL HEALTH PROVINCIAL HEALTH PROVINCIAL

DIRECTOR OF PUBLIC MEDICAL OFFICER OF MANAGEMENT BOARD MANAGEMENT TEAM HOSPITAL
HEALTH (PDPH) HEALTH (PMOH) (PHMB) (PHMT) MANAGEMENT
TEAM (P-HMT)

SUB-DISTRICT HOSPITAL
MANAGEMENT BOARD (SD-
HMB) chaired by the DISTRICT
MEDICAL OFFICER OF HEALTH

14
DISTRICT HOSPITAL
DISTRICT HEALTH DISTRICT HEALTH DISTRICT HOSPITAL
MANAGEMENT TEAM (D-
MANAGEMENT BOARD MANAGEMENT TEAM MANAGEMENT BOARD (D-
HMT)
(DHMB) (DHMT) HMB)
 HEALTH CARE MANAGEMENT
COMMITTEE (HCMC)

HEALTH CENTER MANAGEMENT HEALTH CENTER MANAGEMENT

BOARD (HCMB) TEAM (HCMT)

Discussion

Kaptumo sub division hospital was ideally supposed to be a at level 3 but due to the fact

that it is the largest in the division and serves all the facilities near it, it has been

upgraded to level 4.

Challenge

Being the central point of all other facilities in the division it requires more recourses of

which it doesn’t have. It has limited personnel and equipments e.g surgery equipments.

Water and sanitation

A big percentage of people at kaptumo get their water from the springs. A spring is a

place where water appears from the ground. The springs are of different kinds;

protected springs, unprotected springs, gravity schemes and hydram springs. The

public health departments have the responsibility of protecting the unprotected springs

to ensure that people not only get water but safe water.

Discussion

The gravity schemes have been established in places with high gravity gradient i.e. eye

from top to bottom, while the hydram springs have been erected where the eyes are in

the low lands and there is need to reach people in the high lands.

15
For any spring to be protected, there are two things that should be of concern; the

history of the spring, from the people around the spring, and the positioning of the

spring eyes. After the excavation of the eyes, an embankment wall is constructed and a

collection point provided for. The area is later surrounded by a fence to keep off humans

and animals from the site in addition to protecting the spring from any pollution at the

source. Trees are finally planted around to provide shade preventing it from drying out.

Blue gum trees are discouraged since they take in more water.

Springs are protected to; increase spring water yield and reliability, protect the spring

from pollution as well as water contamination during water drawing and facilitates

improved access to the spring.

Critique

There being reasons as to why springs should be protected; some people especially the

children insert various objects in the collection pipe with an excuse of wanting to

increase water pressure.

Waste management
Disposal of human waste is very important and a crucial area to be attended to.

Kaptumo divisions being an area with no much water VIP latrines have the biggest

coverage. Solid waste is disposed in compost pit and a soakage pit for the liquid waste

that is later used as manure in the farms.

Discussion

There is a certain criteria used in construction of VIP latrines to ensure that they serve

the right purpose. It should have a floor space of 4” by3” with an allowance of 2-4”

outside. The hole should be trapezium shaped with the floor sloping towards the hole.

16
The vent pipe should be placed outside and should be 4” wide and 30m above the

highest point of the roof. It has several functions; passage for fowl smell, with the fly trap

present it helps control flies and thermal effect that ensures continuous suction of air.

The door should open outwards so as to maintain the inner space and also it should

have a 2” space at the bottom and no space at the top. No ventilation is required; the

latrine should be dark in the Inside.

Critic

Being in haste of providing the VIP latrines, the people at kaptumo division end up

constructing improper VIP latrines, some having their vent pipes outside, holes being

bigger than required, providing ventilation etc.

Immunization services
Administration of vaccines is a major way of preventing diseases. Children are given a

maximum of five compulsory vaccines; BCG vaccine, DPT vaccine, polio vaccine,

measles vaccine and yellow fever vaccine.

In case of any outbreak or introduction of a new vaccine, it is administered appropriately

e.g H1N1 vaccine.

The vaccines should be kept at a given temperature to maintain their potency thus the

cold chain regime/schedule should strictly be followed,

Discussion

17
The immunization schedule for all children in Kenya and that followed at kaptumo

division in all health facilities is as follows;

BCG VACCINES: at birth Dose; 0.5mls for children below 1 year

Intra-dermal left fore arm ;0.1mls for children above 1 year

DPT + Hep B/Hi b Dose;0.5mls

Intra muscular outer thigh 1st at 6 weeks

2nd at 10 weeks

3rd at 14 weeks
Oral polio vaccine Dose; 2 drops orally

Birth dose: birth/ within 2weeks OPV0

1st dose at 6 weeks OPV1

2nd dose at 10 weeks, OPV2

3rd dose at14 weeks,OPV3

Measles vaccine Dose; 0.5mls: at 9 months

Subcutaneously right upper

arm
Yellow fever vaccine: 9 Dose 0.5mls

months

Intra muscular left upper

arm

Vaccines in stock are maintained at a temperature of +2 0c to +80c either in a deep

freezer or in a normal refrigerator. When the vaccines are being transported from one

18
facility to another, they are carried using the ice box (have ice packs inside). They are

also stored temporarily in the cold box before being administered.

In the deep freezer, the vaccines are arranged in a specific format starting with the most

sensitive on trays of different colors;

Tray5 Red DPT +Hep B/ Hi b

Tray 4 Orange Tetanus

Tray 3 Yellow BCG

Tray 2 Green measles/ yellow fever

Tray 1 Blue polio

Critique

The yellow fever vaccine is not administered at kaptumo sub-division hospital.

Despite the notification of the next day of return for their child’s immunization to the

parents, some of them forget and come at a later date.

Nutritional services
The nutritional services offered at kaptumo sub-division hospital majorly favors the

HIV/AIDS patients from every category; mothers, youths, old and children.

The BMI of a HIV/AIDS patient guides the nutritionist on what kind of advice is to be

given. MUAC is also used for children, pregnant mothers and that bed ridden.

Those living near sources of water, spring, also benefit by acquiring some knowledge

from the PHOs on their mission to inspecting protected and unprotected springs on how

19
they can use the runoff water for nutritional purposes such as irrigation or fishing in

manmade fish ponds.

Discussion

Normal BMI ranges between 18.5-24.9 and those below 18.5 need supplements and

those above 24.9 need advices on how to watch their diet. Those with a BMI of below

16 are considered to severely malnourished and should be admitted and given

therapeutic feeds. These feeds are of different kinds;

On admission,

 F 75, given from day one to day three, helps to catch up growth.

 F 100, given from day3 to day5, its dense in calories and helps boost weight

gain.

For children,

 F 75;

 Day 1………11ml per kg body weight

 Day2……….16ml per kg body weight

 Day3………. 22ml per kg body weight

For adults,

 F75;

 70-80ml per kg body weight

Note: for those admitted and they can not easily eat they are given;

20
  Pedisure - for children

 En-sure –for adults

On discharge, they are given the following supplements to use at home:

 Fast food – for children

 Foundation plus – 11years- 50years

 Advantage – for pregnant and lactating mothers.

Critique

Nutritional services should not only be for those with HIV/AIDS but also for those

without for healthy life is a right to every person.

School health services

The PH departments at kaptumo division are required to offers the following health

services to schools:

 Deworming and dispensation of vitamin A tablets

 Assist and encourage the formation of school health clubs and committees.

 Health talks on basic hygiene and other matters that may benefit the pupils in

regard to their health.

 Routine inspection of schools.

Discussion

School health is considered to be one of the best ways to help make a difference in

the society. This is because, the target population, students are still willing to learn

and have a greater capacity of changing unlike the grownups or old.

21
 Deworming and administration of vitamin A drugs from in schools ensures that even

those not readily accessible to these health services benefit, with an aim of bringing

up healthy children.

The existence of health clubs or committees in a school greatly help both the

students and stuff to make it a personal initiative to take care of their health and not

wait to become sick and get treated.

Health talks on hygiene and importance of hand washing was given much emphasis

in schools in addition to providing hand washing tins with an objective to help reduce

fecal-oral diseases.

The routine inspection are done to ensure that ;the buildings are safe to the

occupants, staff and students, the sanitary facilities are adequate and well

maintained, there are proper methods of both solid and liquid waste management,

the source of water is sufficient and safe for use etc.

Critique

Deworming should be done after every three months which is not the case at

kaptumo division. There is also some reluctance in routine inspection of schools

which has led to poor running of schools with evidence of unfit structures e.g.

existence of dilapidated toilets and classrooms

Food quality
It refers to the quality characteristics of food that is acceptable to consumers i.e

both external factors (size, shape, color) and internal factors (ingredients). Cap 254,

Food and Drug Act is the relevant tool used.

22
The PHOs at kaptumo are responsible of issuing medical examination certificates to

food handlers, disposal of ceased food, seizure of unfit foods supplied to hospitals or

other institutions especially for tender cases and inspection of food eating premises

and trade premises.

Discussion

Medical examination certificates are only issued to those food handlers who have

been examined, laboratory tests – BS WIDAL, urine, stool, to be fit to handle food.

This practice helps greatly in the control of communicable diseases especially the

fecal oral infections.

The ceased foods from the trading premises are disposed specifically by the PHOs

themselves or persons strictly appointed by the officers by incineration or burial to

ensure no villagers or person get access to the foods that could actually cause harm

to them.

All foods supplied by tender contracts to be inspected to prevent mass supply of

unfit food to a larger group of people that might cause harm. The unfit foods are

seized and a seizure form issued to the supplier.

Routine inspection of both food and trade premises are done using a certain criteria

and below is a step – to – step guidance on how to do it:

Surrounding; this include the general environment, waste around the premises,

fencing etc

23
Structural aspects; both externally and internally i.e walls – presence of cracks,

paint; window openings – for ventilation and lighting; roofing – paint, condition of iron

sheets; floor – easy to clean with no potholes.

Liquid waste management; drainage system, from source of waste to the end point

(soakage pit)

Solid waste management; presence of dustbins or improvised containers and sitting/

design of the compost pit.

Ventilation and lighting; especially in kitchen, overcrowding should also be

discouraged.

Water supply; the source of water used should be safe. If spring, preferable a

protected spring. There should be storage tank(s), hot/cold water supply for

washing utensils and a hot water supply with provision of a detergent for hand

washing outside or inside the eating premises.

Excreta disposal; clean and well maintained latrines should be present. To test if a

latrine is full one should through a stone inside and listen to the variation of sound.

Facilities/Equipment for Food Preparation; they should not be plastic but galvanized.

Plastic equipment is not easy to wash and they retain oil.

Personnel; they should have adequate and appropriate PPE. i.e clean

overalls/aprons , footwear and headscarf. They should posses a medical

examination certificate to certify ones physical health.

NOTE: The inspections are done in stages, first, there is verbal warning, then a

written warning and failure to comply, the premise is closed.

Critique

24
 Follow-ups are not done effectively as stipulated in the statutory notices issued. This

is as a result of limited staff in the PHO department.

Meat Inspection
It includes both ante mortem and postmortem. Irrespective of the animal being

inspected, the slaughter slab/ slaughter house should also be inspected to ensure it

is well cleaned and maintained. The carriage containers should also be inspected

before putting in any meat. At the end of the inspection the carcass that has been

passed should be stamped before dispatching it.

Discussion

Every slaughter slab or house should have a holding area where ante mortem is

carried out. The animal is carefully examined by the vetenary doctor and treated

when necessary before slaughter. The animal is also given time to relax to prevent

hyperglycemia which affect the quality of meat. Inspection should ideally be done at

every stage to ensure no contamination at the critical points. This stages include;

stunning – a humane way should be used, bleeding, flaring, evisceration, and

splitting. The personnel should be well protected with adequate and appropriate

PPEs.

Critique

The kaptumo slaughter slab has no holding area, the animals are slaughtered as

they come thus being exposed to risks of getting hyperglycemia which leads to

rigomotis of the meat. They use the crude method of stunning the animals that

recurrently leads to hemorrhages of the carcass. Despite having the provision of

25
 separate drainage, there is sometimes mixture of blood and liquid waste which is

later released to the farms as manure.

The vetenary department having taken up the responsibility of meat inspection, the

PHOs have failed in carrying out routine inspection of the slaughter slab.

Maternal health services

Under the maternal health services at kaptumo sub-division hospital the following

services are offered to the mothers; antenatal care, delivery care and postnatal care

and family planning inclusive. In addition there is also distribution of nets during

antenatal and postnatal care.

Discussion

Antenatal care is given to pregnant mothers from time of conception. During this

period the mother makes regular visits to the hospital for checkup purposes to

ensure that the development of both the baby and the mother is fine. It involves;

weighing, measuring BP, palpation of the mother to determine the stage of the baby

in development, administration of TT vaccine, malaria prophylaxis (IPT),

supplements of FeSo4, folic acid and provision of LLITN under the PH department.

For delivery services, KDSH has a delivery room. After the onset of labor pains, the

mother reports to the hospital for close monitoring and vaginal examination after

every four hours until birth.

Postnatal care begins immediately after birth. The mother should be well cleaned

and given the baby for breastfeeding within the first 30minutes – 1hour after birth.

She then leaves the hospital after 10 – 12 hours of close observation by the nurses.

26
 Family planning is also a service given to the mothers after proper counseling for

every beginner. They are then left to make a decision of which method they would

prefer to use.

Critique

There are cases of dropout of mothers from attending the regular visits during

antenatal care. In addition, some mothers end up giving birth at home instead of

doing it in hospital. Minimal or no advice is given to mothers on the expected

postnatal outcomes.

Children do not get the BCG immunization at birth since it always take place on

Friday during immunization hours.

Uncooperative mothers during delivery which is as a result of labor pains leading to

hostility of nurses as they struggle to perform their duty.

Despite its importance, most mothers lack support from their husbands concerning

FP issues.

Laboratory services
The lab services are quite important since they confirm clinical diagnosis of patients

with an aim of ensuring appropriate management of the patients is administered.

Some of the tests doe at the KSDH include; blood sugar test, HB test WIDAL test,

urinalysis, pregnancy test, malaria test and TB test.

Discussion

It involves collection of specimens that are then examined:

27
Blood sugar test; the specimen use is blood and it is measured using an instrument

called on-call plus measuring in Mmol/Lit. Normal blood sugar is below 10Mmol/Lit.

Urinalysis; urine is the specimen. Urinalysis reagent strip is used to check the

normality or abnormality of urine content in relation of the body composition of

sugars.

WIDAL test; blood is used as the specimen. The test is for typhoid. Since serum is

used in the test, an electronic centrifuge is used to separate blood and serum. Three

reactions can be done using different reagents, hymolysis, agglutination and

neutralization.

Pregnancy test; urine is the specimen used and the pregnancy strip is the instrument

used.

HB test; blood is the specimen using the and instrument called, satili haemometer.

Malaria test; blood is the specimen. Blood smear is prepared and plasmodium

parasite observed under a microscope.

TB test; sputum is the specimen.

Critique

Despite the high reliability and validity given to results from the laboratory, there was

improper labeling specimen resulting to wrong results for different patients’ thus

wrong management. There is also failure in the use of PPEs irrespective of the risks

of being infected in the process of handling the specimens.

28
Clinical care services
This refers to the services the patients receive in the ward from the nursing staff and

clinical doctors as done in KSDH.

Discussion

On admission, every patient is required to buy an impatient book for proper record

keeping on his/her progress. The following activities take place from morning to

evening;

6:00am-6:45am – feeding, breakfast.

6:45am –7:30am – cleaning of wards.

7:30am – 8:00am – ward round, reviewing of patients.

8:00am –9:00am - handing over to day staff.

-Bed making and changing of soiled beddings.

12noon- 12:30 – lunch break

1:00pm – 2:00pm – visiting hours

3pm and 3am – are times for observation of vital signs, temperature, BP, pulse,

respiration etc.

Note: observation and treatment takes place continuously.

29
Critique

There are no restrictions on visiting hours thus leading to overcrowding of the wards at

every given time. There is also no impatient registry at the ward reception area of which

it is a very important data collection tool.

HIV/AIDS services

The HIV/AIDS services offered at KSDH include; VCT services, PMTCT services and

HAART services. They all have separate departments that care for the clients different

needs.

Discussion

At the VCT, clients voluntary visit to either get information on HIV/AIDS, to know their

status or both. There are three kind of test that are available; Determine, Bioline and

Uni-gold. Un-gold acts as a tie breaker after using the two first kits and they happen to

give different results.

PMTCT services are offered at the MCH department, as at KSDH, where women living

with HIV/AIDS are provided with appropriate counseling and support to enable them

make informed decisions about their reproductive lives. In addition, mothers are

educated on ways of preventing transmission to their infants during pregnancy, labor,

delivery and breastfeeding by use of ARVs and use of safer infant feeding practices.

Below is a dosing guide for Antiretroviral Drugs in PMTCT, program for 4 months:

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 Confirmed HIV infection in a pregnant woman during ANC

Determine;

 WHO clinical stage

 CD4 count

WHO clinical stage 3 or 4 WHO clinical stage 1 or 2

or or

CD4 count ≤ 350 CD4 count > 350

Start on ARV therapy(ART) start on ARV

prophylaxis

(if 38 weeks or less) (at 28 weeks or anytime

after)

Start 1st line ART regime start: AZT 300mg twice daily for the during

pregnancy

 AZT 300mg twice daily dispense: single dose NVP 200mg at the onset of

labor

 3TC 150mg twice daily dispense: ARV prophylaxis, to infants after birth

 NVP 200mg twice daily labor and delivery

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 Labor and delivery give preferred ARV prophylaxi

Continue ART regime after delivery of new

born

Give ARV prophylaxis as soon as possible.

Under the HAART department, those clients having a CD4 counts of below 350 is

started on ARVs and are given comprehensive care in terms of counseling and

nutritional supplements. This comprehensive care helps greatly in minimizing the

incidence rate of opportunistic infections.

Critique

There are many defaulters and follow ups is not easy due to constrains such as harsh

climatic conditions, lack of transport means and finances.

Pharmacy and treatment services.,

This department deals with dispensation of drugs, administration of injection and

dressing of wounds.

Discussion

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Drugs after supply by KEMSA and are arranged in the provided shelves in a systematic

order ready to be dispensed. There is also an area designed for injection and dressing

of minor wounds.

Critique

Every pharmacy should have a pharmacist but KSDH pharmacy lacks one thus the

nurse in charge dispenses drugs, injects and at the same time dresses wounds.

Filter clinic
This office is also called clerking office. Here the patient’s history taken and the patient

managed respectively. It is also from this office that patients are referred to the

laboratory if any tests are to be taken. In case the patient’s problem is far much

complicated, they are given referrals to higher levels of health services.

Discussion

When clerking a patient, the following procedures are followed by the clinical officer ;

 Taking of demographic data

 Chief complains

 Duration of the chief complains

 History of the present illness

 Past medical history

 Family medical history – for women, take gynecological history

 Making an impression

 Management of the patient

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Note: for children, after the necessary questions based on the chief complains seek

more on; development of the child, immunization history and nutritional history.

 Treatment and the return date

Critique

Not all clinical officers follow the above procedures in clerking of patients. There is also

a lot of misdiagnosis mainly due to overworking of the staff.

Occupational health
It refers to the identification and control of the risk arising from physical, chemical and

other workplace hazards in order to establish and maintain a safety and healthy working

environment.

These services were majorly offered to those in industries and factories and incase of

any hazardous exposure, mitigation measures are recommended.

Discussion

On a visit to kaptumo tea factory, there was much to learn on occupational health. It

was installed with all kinds of machinery; those producing a lot of noise, moving

machines and also automated ones. In general, with reference to the kaptumo tea

factory, all the factories with such kind of machines, the following precautions should be

taken:

Any personnel working with noisy machines should be provided with protective gears for

the ears, ear muffs; The moving machines such as conveyers should be guarded o help

minimize on accidents; Personnel handling automated machines should be well trained;

those handling chemicals should be well protected with the appropriate PPEs from head

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to foot wear. Note: for those working in noisy or vibrating environment, shifts could be a

good remedy since it reduces on the time of exposure of risk.

In addition there was a visit to a lala cottage industry which dealt with milk, a sensitive

product. With respect to any other sensitive product producing industry, especially those

dealing with foods, the concept of HACCP should be put to practice. E.g. the lala

industry; the receiving area, pasteurization area, cooling area, culturing area and

packaging area.

Critique

Despite the management of various industries and factories having provided the right

PPEs, some of the staff have a negative attitude and end up not wearing them.

At the tea factory, due to lack of enough personnel, the staff present end up being

overloaded and thus the risk of multiple exposure.

At the lala cottage industry, repairs of damages e.g worn out floors, takes long to be

repaired hence resulting to inefficiency and contamination of the products.

Communicable disease control

A communicable disease is one due to a specific agent or its product which arises

through the transmission of the agent or its product from a reservoir to a susceptible

host. The PH department at kaptumo is greatly involved in the control of malaria,

handling dog bites and snake bite cases.

Discussion

Malaria control program

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It involves a collection of intervention measures: distribution of nets to pregnant mothers

and children under 1 year, and IRS using icon and fendona chemicals. IRS is the

application of long-acting insecticides on the walls and internal surfaces in order to kill

the adult vector mosquitoes that land and rest on those surfaces. The primary effects of

IRS towards cartailing malaria transmission are: reduce the life span of vector

mosquitoes- no longer transmit of malaria parasite, reduce the density of the vector

mosquitoes. IRS intervention involves a great deal of involvement and planning:

1. Planning for IRS operations

The operation involves people at national level, district level and community levels.

Commodities and other consumables need to be procured in advance. All these

activities need proper coordination to ensure smooth running of events.

2. Pre and post IRS surveys

Being an expensive operation, sufficient baseline information should be gathered to

facilitate appropriate planning and implementation. The surveys include among others:

epidemiological, entomological, and demographic surveys. In addition, it also provides

indicators for identifying areas that need spraying at a particular time.

3. Mapping and targeting IRS

It helps identify areas for spraying it gives a basis upon which coverage is monitored

and evaluated. It entails identification of vector breeding sites, location and type of

house structures to target. The surveys above are of importance to delineate low and

high risk areas for prioritization. For efficiency, geo-referenced maps need to be

developed to guide the process of accessing targeted spraying structures.

4. Timing and cycles of spraying

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Malaria transmission is greatly influenced by climate and environmental factors,

particularly rains. Therefore the operation will be time d to take effect just before a rainy

season begins. The spray cycles depends on the transmission pattern and insecticides’

protective duration.

5. Estimation of IRS requirements

Several factors are considered when establishing the quantities of required resources:

required information to calculate sprayable surface areas by district, IRS supplies

estimate, IRS accessories estimation.

In establishing the number of structures for spraying, population figure from the target

areas are used. The number of house units per household is determined using

population and housing census. This information gives an estimate of the total

sprayable surface area for a target area. This guides calculation of amount of

insecticide required, number of spray operators, sprayers protective clothing, transport

needs, supervisors and the spraying duration.

Note: national supervision is coordinated from DOMC, DVBD AND DEH. Before starting

the operation at the grassroots, there is mobilization.

For dog bites, the patients are given anti-rabies vaccine and those with snake bites,

anti-venom vaccine which is administered intravenously after admission under strict

supervision due to its intense side effects.

Critique

During the IRS operations, even after mobilization, some people are uncooperative and

thus this houses end up not being sprayed.

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Irrespective of the life threatening situation the dog bite and snake bite patients are in,

there is inadequate supply of anti- rabies and anti-venom vaccine and can only be

bought in the private sectors at a high price.

Chronic disease control

A chronic disease is one that is long-lasting or recurrent. Chronicity is usually applied to

a condition that lasts more than three months. TB which can sometimes be classified as

a chronic disease is a priority at the KSDH and comprehensive care is given to the

infected patients.

During a visit at kipletito primary school a referral was recommended to a suspected

case of osteoporosis.

Most of the patients who visit KSDH present with cases of pulmonary problems as a

result of the cold climatic conditions of the area.

Discussion

A special department has been set up so as to well manage the TB patients. The

treatment of TB serves three main purposes: to cure the individual patient, to render the

patient rapidly non-infectious and to prevent the emergence of drug resistance.

On report of a patient presenting with signs and symptoms of TB, the patient is sent to

the laboratory for a sputum test for confirmation. If the test result is positive, treatment is

started immediately.

TB drug regime

Initial phase Continuation phase

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 Children 2SRHZ 4RH

Adults 2SRHZE 4RH

Note: for retreatment incase one is a defaulter, the regime is different; 2SRHZE/ RHZE/

5RHE

TB drugs are given on the basis of ones weight i.e, >54kgs- 4tablets per day; 39-54kgs-

3 tablets per day; <30-39kgs- 2 tablets per day. All the TB patients require adherence

conseling on how to take the drugs.

For defaulters, defaulter tracing is done with an aim of reducing the mortality rate as a

resulting to TB cases. Every patient with TB is entitled to free drug supply from

whichever facility one visits only if already enrolled into the program.

Critique

Despite the urgency of defaulter tracing, harsh climatic conditions and impassable roads

are a barrier to the defaulter tracers.

Control of chronic diseases at kaptumo is not well covered. This is because majority of

those suffering are faced with the challenge of limited funds to visit the hospital thus end

up staying at home with their problem.

Health education and promotion

This refers to the creation of awareness to the members of the community on health

related issues with an aim of preventing diseases. It was well done through health talks

in the hospital premises and during school health program.

Discussion

In collaboration with the nursing department the PH department gathered all outpatients

near the clerking office and a health talk on basic sanitation, prevention of fecal-oral

39
transmitted infections, treatment of water and proper use of mosquito nets was given on

different days respectively. In addition a health talk on the importance and effective

hand washing was given in different schools with a goal of reducing on the incidence of

communicable diseases.

Critque

The health talks are not regular and no evaluation is done after the talks therefore little

or no behavior change in correspondence to the information given.

Building inspection
It involves approval of building plans, inspection of buildings under construction and

inspection of existing building with an aim of ensuring the safety of the occupants.

Discussion

On approval of building plans, the PHO is required that the plan includes a provision for

sanitary facilities, proper drainage system, adequate ventilation, adequate water supply,

exit doors in case of emergencies etc.

On inspection of buildings under construction, the inspection of proper foundation

depending on the drainage of the site is very important. This is aimed at preventing

collapse of houses and settlements of buildings.

On the inspection of already existing buildings, appropriate judgment is made

concerning the condition of the building under inspection e.g. signs of dampness in a

building- it should be demolished, poor lighting- recommend installation of translucent

iron sheets, repairs on cracked floors or those with potholes should be done to prevent

breeding of fleas. For any kind of improvement to be done by the owner, a statutory

notice should be issued and follow-ups done respectively.

40
Critique

Not all buildings under construction are inspected. This has greatly led to the existence

of dilapidated structures which can not be repaired but stand to be demolished. Follow

ups of statutory notices issued is not well done as a result of limited staff.

Record services
Each department at KSDH has data collecting tools that are all assembled at the District

health records and information office located in the hospital.

Discussion.

Records from any health service starting from level 3 include both inpatients and out

patient records. They include: MOH 504- monthly surveillance report form, used by the

PHO to monitor diseases on the ground; MOH 704-child health nutrition information

system, used to monitor the growth of a child; MOH 705A- for under 5 and above

5respectively.they are used for general conditions of patients i.e disease diagnosis at

the hospital; MOH 710- immunization summary sheet; MOH 702-immunization and

vitamin A tally sheet; MOH 711A- national intergraded form for reproductive health,

HIV/AIDS, TB,and child nutrition; weekly malaria reports- used for comparison for under

5 and below 5 males and females respectively; MOH 717-work load, done by every

worker and shows the number of people received in every department; MOH 105-

service delivery, first time seen during neonatal and maintenance of patient to the date

of delivery; MOH 406- postnatal register; MOH 511-child welfare clinic; MOH 240-

laboratory register; MOH 204A and 204B-outpatient register for under 5 and over 5

respectively; MOH 715- health facility inventory for equipments in the hospital;

reproductive health records- maternity services, PMTCT services and treated nets

41
distribution; TB reports- on TB cases and defaulter tracing; AL reports; HIV/AIDS

reports; cold chain recording; quarterly reports- after a three month interval etc.

Critique

Despite the clear display of particulars in the different record books, there is poor

recording done by the personnel in charge of recording.

Chapter 3
Conclusion
The professional practice at KSDH displayed three important things;

Despite health being a right to every human being, it requires one to have an

understanding of what it is. Some people expose themselves to various hazards only

because they are not aware it is a hazard.

Having being empowered to enforce law concerning health on people, a PHO should be

humane with an aim of helping and not frustrating.

For theoretical knowledge to be applied practically, some improvisations and

modification have to be done i.e. the ideal is not always the real.

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