Browsing by Author "Mathenge, Scholastica Gatwiri"

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    Assessing Cardiovascular Risk Using the Framingham Risk Score Among People Living with HIV on HAART at Machakos County Referral Hospital, Kenya
    (MJ&M Biolabs, 2025-11) Syengo, Sarah Malinda; Mathenge, Scholastica Gatwiri; Menza, Nelson Chengo
    The widespread availability of HAART has significantly extended the survival of people living with HIV. With this increased life expectancy, NCDs such as cardiovascular disease have emerged as major health concerns. Both HIV infection and long-term exposure to antiretroviral therapy contribute to metabolic changes and early vascular aging. This study assessed cardiovascular risk using the Framingham Risk Score (FRS) among people living with HIV (PLHIV) receiving HAART at Machakos County Referral Hospital, Kenya. It examined demographic and clinical factors associated with elevated risk. A cross-sectional study was conducted among 406 adult PLHIV who had been on HAART ≤ 3 months. Data was collected through structured questionnaires, interviews, health records review, and laboratory analyses. The 10-year CVD risk was estimated using the Adult Treatment Panel III (ATP III) Framingham algorithm, categorizing patients as low, moderate, moderately high, or high risk. Most participants (71.2%) were classified as low cardiovascular risk; 18.5% as moderate risk, 9.8% as moderately high cardiovascular risk and 0.5% as high cardiovascular risk individuals. Older age {25–40 years (AOR = 37.11, 95% CI: 10.12–140.16, p < 0.001), 41–59 years (AOR = 31.01, 95% CI: 9.04–140.16, p < 0.001), and ≥60 years (AOR = 9.75, 95% CI: 7.14–31.74, p < 0.001)}, male gender (AOR = 3.44, 95% CI: 1.67–8.09, p = 0.001), elevated HDL (AOR = 8.23, 95% CI: 3.92–17.26, p < 0.001), smoking (AOR = 6.80, 95% CI: 1.53–31.25, p < 0.001), shorter duration on antiretrovirals (<5 years) (AOR = 5.17, 95% CI: 1.94–13.79, p = 0.001), and systolic BP ≥140 mmHg (AOR = 30.16, 95% CI: 12.43 73.18, p < 0.001) were significantly associated with higher CVD risk. Thus, although most PLHIV on HAART at Machakos County Referral Hospital had low cardiovascular risk, older age, male gender, hypertension, smoking, short duration on antiretrovirals, and dyslipidemia were found to be key contributors to elevated FRS. These findings underscore the need to integrate routine cardiovascular risk screening and lifestyle modification interventions into HIV care programs in Kenya.
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    Determination of the Accuracy of Quantitative Measurement Methods in the Clinical Chemistry Laboratory at Machakos Level V Hospital, Kenya
    (International Journal of Current Aspects, 2023) Mutie, Charles Kyalo; Mathenge, Scholastica Gatwiri; Warutere, Peterson
    Accuracy is the extent to which measurements are closely related to the actual values of the analyte. Accuracy is one of the key requirements in Laboratory method verification. Verification is a method of ensuring that tests are carried out per the manufacturer's specifications when tested by laboratory staff and patients at the facility. Other elements of verification include precision, linearity verified with reportable range, uncertainty of measurement, carry-over studies, reference ranges and limit of detection. This study aims to determine the accuracy of the quantitative measurement methods in the Clinical Chemistry laboratory in the month of January 2023. It also provides an alternative method for meeting accreditation requirements on accuracy by medical laboratories seeking accreditation in farstretched laboratories where interlaboratory comparison may not be feasible. A systematic review and meta-analysis at Machakos County, Kenya. The procedure involved analysing commercially available internal quality control material five (5) times a day for eight (8) days bearing the same lot number. Roche Diagnostics, Mannheim, Germany supplied all the reagents, internal quality control materials and calibrators. Accuracy was determined using Roche Cobas® Intergra 400 Clinical Chemistry analyser to perform a comparative descriptive analysis of albumin, alanine aminotransferase (ALT), alkaline phosphatase (Alk Phos), aspartate aminotransferase (AST), chloride, creatinine, Direct Bilirubin (D. Bil), Gammaglutamyl transferase (GGT), potassium, sodium, total bilirubin, total protein, and urea. The study followed guidelines issued by the Clinical Laboratory Improvements Amendment 1988 (CLIA) and Clinical Laboratory Standards Institute (2014). Data analysis was carried out using Excel Windows 10 MS Office 2021. Mean, standard deviation (SD), Z-score, bias %, coefficient of variation (CV) %, and total error allowable (Tea) were calculated from the results of measurement of the analytes. All the analytes achieved a mean which fell within the manufacturer verification interval and hence passed. The bias % score for the analytes was as follows 5 analytes level (19.2%) scored 0 - ±1, 10 analytes level (38.5%) scored ±1.1 - ±2, 7 analytes level (26.9%) ±2.1 - ±3 and 4 analytes level (15.4%) scored above ±3. All analytes were found to have an excellent Z-score performance between 0 to ± 1.96. The total error allowable was found to fall within CLIA and CLSI specifications limits except for chloride PCC1/ Normal control which failed at 5.82% (CLIA target being ± 5%). Analytes' mean was expected to fall within the given manufacturer's mean. The bias % for the analytes which was at zero or near ± zero was considered an excellent score the further away the score was, the poorer the performance. The Z-score was also calculated to establish how far the observed mean fell from the target mean. All analytes were found to have an excellent Z-score performance between 0 to ± 1.96. A Z-score of ± 1.96 to ± 2.57 indicates good performance while a Z-score of over ± 2.58 indicates failed performance. These good results are attributable to the fact that analysis was carried out within a very short duration by the same person, on the state-of-the-art instrument, in a well-controlled environment hence no room for analytical variation. Chloride being an electrolyte failed since it is physiologically controlled in a strict and narrow range.
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    Risk Factors Associated with Dyslipidemia and Cardiovascular Disease among People Living with HIV on HAART at Machakos Level V Hospital, Kenya
    (J Chem Edu Res Prac, 2025-10) Syengo, Sarah Malinda; Mathenge, Scholastica Gatwiri; Chengo, Nelson
    The introduction of highly active antiretroviral therapy (HAART) has transformed HIV infection into a manageable chronic condition. However, the long-term use of antiretrovirals has been associated with metabolic complications such as dyslipidemia and an increased risk of cardiovascular disease (CVD). These emerging comorbidities threaten to offset the gains achieved in HIV management, particularly in low-resource settings. This study aimed to determine the risk factors associated with dyslipidemia and cardiovascular disease among PLWHIV on HAART at Machakos Level V Hospital, Kenya. A hospital-based cross-sectional study employing systematic sampling was conducted among 406 HIV-positive adults on HAART. Blood samples were collected for lipid profile analysis, and the Framingham Risk Score was used to assess 10-year cardiovascular risk. The Framingham model incorporated seven parameters: total cholesterol, high-density lipoprotein cholesterol (HDL-C), systolic blood pressure, age, sex, duration on antiretrovirals, and cigarette smoking. Additional demographic and clinical data were obtained through structured questionnaires. Descriptive statistics summarized prevalence rates, while bivariable and multivariate analyses identified exposure variables significantly associated with dyslipidemia and cardiovascular risk (p ≤ 0.05). The overall prevalence of dyslipidemia was 74.1% (n = 301). Age (p = 0.005), elevated systolic blood pressure (p = 0.049), and hypertension (p < 0.001) were significantly associated with dyslipidemia. The total cholesterol-to-HDL ratio was significantly linked to antiretroviral regimen (p < 0.05), with patients using protease inhibitors being four times more likely to have an elevated ratio compared to those on non-nucleoside reverse transcriptase inhibitors (OR = 4.19, 95% CI: 1.03–17.02). According to the Framingham Risk Score, 71.2% of participants had low CVD risk, 18.5% moderate, 9.8% moderately high, and 0.5% high risk. Age, low HDL-C, smoking, high systolic pressure, gender, and duration on HAART were significantly associated with higher Framingham risk (p ≤ 0.001). These findings demonstrate a high burden of dyslipidemia and considerable cardiovascular risk among individuals on HAART. Integrating lipid monitoring, blood pressure control, and lifestyle interventions into routine HIV care is essential to mitigate long-term metabolic and cardiovascular complications in this population.