Date of Award

5-2022

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Sayed Ali Karar

Second Supervisor/Advisor

Dr. Jasmit Shah

Third Supervisor/Advisor

Dr. Nancy Kunyiha

Department

Internal Medicine (East Africa)

Abstract

Background: Discrimination is defined as the unequal or disadvantageous treatment of an individual or a group of individuals. Discrimination in the health care setting can take many forms, including gender, race, verbal or emotional abuse, physical abuse, and sexual abuse. The prevalence of discrimination varies, with common forms being gender and racial discrimination as well as verbal and emotional abuse. Workplace discrimination often leads to a hostile environment for healthcare workers, resulting in significant mental strain. Patients, their relatives, and consultants are the foremost perpetrators of discrimination and abuse across the globe. Little is known about discrimination and abuse within the healthcare sector in Kenya.

Objective: To determine the prevalence of discrimination and abuse of healthcare workers at the Aga Khan University Hospital, Nairobi

Methods: We conducted a prospective cross-sectional survey beginning with an introductory electronic mail sent to all eligible participants at the study site introducing the study, objective, and a request to participate. Filling out the survey voluntarily reflected consent to participate in this study. The questionnaire was already used in a previous study published in The New England Journal of Medicine, “Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training’. The publishing authors obtained the relevant permissions prior to its use in our study. Other surveys used were the Patient Health Questionnaire 9 (PHQ-9) to assess for depression and the Stanford professional fulfillment index. The survey was sent via email with a maximum of four reminders (sent at regular time intervals). Multivariate analysis using logistic regression was used to look at the association between gender and factors that may have been associated with discrimination.

Results: Out of 633 health care workers, 549 responded (86.7%), and 12 of these responses were excluded due to incomplete responses. Of the 537 responses (84.8% response rate) included in the final analysis, 39.1% were male, and 65.9% were female. Discrimination based on gender discrimination was reported by 39.9% of doctors, 17.2% of nurses, and 10.9% of allied health staff. Physical abuse was reported by; 2.1% of doctors, 7.1% of nurses, and 2.2% of allied staff. Verbal and emotional abuse was reported by; 62.1% of doctors, 56.8% of nurses, and 34.8% of allied staff. Sexual abuse was reported by; 9.3% of doctors, 4.7% of nurses, and 4.3% of allied staff.

Conclusion: There is a significant prevalence of discrimination and abuse amongst health care workers of both genders at the study site. Mitigating strategies to address these systemic issues to promote a safe working environment for all healthcare workers are needed. A safe working environment should be made a priority for healthcare workers to prevent its continuation and possible propagation.

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