MST-Department of Pre-clinical Sciences

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Assessment of Knowledge, Attitude and Practices Regarding Tuberculosis among Adolescents in Kisauni-Mombasa District, Kenya.
(2009-06) Yonge, S.A.
Tuberculosis is a chronic infectious disease which is still a global health hazard. With the emergence of new more effective drugs, tuberculosis was expected to be completely eradicated; but global reports show results to the contrary. It seems that, in addition to drug regimens, individual health and social factors should be taken into consideration. This is not achievable except by increasing the knowledge and creating a positive attitude towards the disease. The aim of this study was to evaluate the level of knowledge, attitude and preventive practices of adolescents' in high school regarding tuberculosis. A cross-sectional study design was carried out in Kisauni Division, Mombasa District among the urban and sub-urban secondary schools. Qualitative data was obtained from key informant interviews while quantitative data was obtained from pre-tested structured questionnaires. A stratified of 384 respondents were used for the study. Descriptive statistics were used to summarize and analyze the data using the statistical package for social sciences (SPSS). Differences between independent and dependent variables were compared using Pearson's Chi-square and regression coefficient with the level of significance of p-values less than 0.05 (p<0.05 considered statistically significant. Some results were presented inform of tables, bar charts and pie charts. This study showed that 93.3% of the respondents had heard about T.B and medical workers were an important source of information. Knowledge about symptoms and transmission of T.B was 63.3%. Age was significantly associated with knowledge of T.B (X2=18.07; p<0.05; df=4). Knowledge of TB did not vary significantly by education level or gender (X2=0.4087; p>0.05; df=l). Tendency to discriminate TB patients was evident as 72.6% of the respondents opined to isolate TB patients from the family. Attitude towards TB patients did not vary significantly by age and gender. There was a positive relationship between the attitude and knowledge of adolescents towards TB. 50.3% of the respondents were on the opinion that TB can treated through directly observed treatments (DOTS). Mode of DOT delivery was significantly associated with knowledge (X2=9; ~<0.05). Attitude towards DOT providers did not vary significantly by age or gender (t =6.553; p>0.05; df=5). Knowledge of tuberculosis (TB) had positive correlation with confidence in preventive practices (r=0.226, p<0.05) and behaviour change (r=0.274, p<0.05). Attitude had a positive correlation with beliefs of susceptibility to T.B (r=0.141; p<0.05) but negative correlations with preventive practices (r=-0.124; p<0.05) and behavioral change (r=-0.153, p<0.05). Considering the direct correlation of attitude and knowledge and also the important role of attitude in preventive behaviors, increasing the knowledge of adolescents about tuberculosis seems to be essential. This aim can be achieved by scheduling programs for general education of all students of the country in this regard. Establishing adolescents committees in the district by the Kenya government to prevent and control tuberculosis and other infectious diseases is of paramount. A national survey on the Kenyan adolescents who are in secondary schools knowledge of and attitudes towards tuberculosis should be conducted. More research is also needed on older adolescents to investigate their knowledge of TB changes as they mature and gain more exposure and knowledge.
Effects of anti-retroviral therapy on sexual behaviour among people living with HIV/AIDS in Kibera slums in Nairobi, Kenya
(2011-11-18) Otieno, Beatrice Akinyi; Otieno, Micheal Frederick; Orinda, G. O.
The effects antiretroviral therapy on sexual behaviour among people living with HIV/AIDS has been obscure. This has implications on the ability to combat the spread of the virus through behaviour change. With the rapid urbanization amid economic deterioration, it is imperative that we understand the sexual behaviour of PLWHA in general and the poor ones in particular. Moreover as a result of the success of ART in dramatically decreasing morbidity and mortality from HIV infection, many HIV infected persons are now living healthier and more sexually active lives. Since 2002, the feasibility of providing ART in resource poor settings has been recognized in Kenya. Currently increasing attention is being focused on a comprehensive approach to the management of HIV/AIDS which involves provision of ARV drugs as well as care and support services. However risky sexual behaviour by PLWHA is an area of concern because they risk transmitting the virus and re-infecting themselves with new drug resistant strains of the virus. This work therefore taps two rich data sets (qualitative and quantitative) to present a portrait of how ART influences the sexual behaviour of PLWHA I Kibera slum. A two-stage random sampling was applied in which a total of 340 respondents were selected to participate in the study. Data was collected using questionnaires, key informant interview schedules and focus group discussions. Quantitative data analysis was done using SPSS in which data was subjected to tests such as Chi square and correlation. Verbatim reports were recorded as direct quotations. The study results indicated that most 229 (87.9%) of the respondents had improved health status following ART. There was a significant difference in having sexual partners among married and unmarried PLWHA (x2 = 35.92, p <_ 0.05). There existed a positive correlation (r = 0.162, p<_0.05) between improved health status among PLWHA and having multiple sexual partners. There was no significant difference in the PLWHA level of ART awareness (x2 = 108.84, p:5 0.05). Majority of the respondents were found to use condoms, there was a positive correlation (r=0.128, p<_0.05) between condom use and level of ART awareness. Nonetheless a significant difference was noted in condom use between the married and the unmarried PLWHA (x2 = 27.16, p _< 0.05). Less than half 57 (41.3%) of those who had disclosed their status to their sexual partners had fair level of understanding while those with poor level of awareness had the least disclosure. A few 25 (13.7%) of PLWHA who were married had other sexual partners other than their spouses while majority 117 (74.1%) of their unmarried counterparts admitted that they had multiple sexual partners in the 12 months preceding the assessment. Pearson correlation results showed that there was a significant positive correlation (r = 0.94, p <_ 0.05) between ART level of awareness and having multiple sexual partners. The findings are therefore significant to policy makers, programme managers and donors in understanding the functioning, utilization, effectiveness and sexual impact of ART in low socioeconomic set ups. The results suggest that there is a need to plan for the most efficient interventions and review of current strategies such BCC and VCT, which will ultimately enhance the quality of life of PLWHA while at the same time ensuring positive sexual behaviour change.
Risk factors associated with HIV/AIDS infections among deaf youths in selected educational institutions in Nyanza province, Kenya
(2011-11-18) Odera, Petronilla Achieng
HIV/AIDS has become one of the greatest challenges of the 21" century. Young people, though identified as the window of hope, account for 60% of all new infections in most African countries. In Kenya, HIV/AIDS is a national disaster and the Kenya Government, in conjunction with both the local and international NGOs have put measures to create awareness among the most vulnerable youth groups. Nonetheless, most measures have not been targeting the three million disabled persons in the country. Currently, little is known about HIV/AIDS and disability. Very little data on prevalence exists for any disabled population globally. Major gaps in the national HIV/AIDS prevention campaigns and treatment programmes have made disabled population more vulnerable to HIV infection than their non-disabled counterparts. The main objective of this study was to investigate risk factors associated with HIV/AIDS infection among the deaf in selected educational institutions in Nyanza Province. A cross-sectional descriptive survey was carried out, and data collected using both quantitative and qualitative methods that include structured questionnaire, focus group discussions (FGD) and key informant interviews (KII). Data was entered into SPSS programme and analyzed using descriptive statistics and chi-square tests. A sample of 384 respondents was randomly selected. Twenty eight point one percent (28.1%) of the respondents were orphans and had lost a parent or two. Nearly half, (48.7%) had had sexual contact and minimum age of first exposure was 9 years. The mean age of first exposure was 15.54 years with a standard deviation of 3.019. The findings of the study indicated that Socio-demographic factors, Behavioral factors and Knowledge of HIV/AIDS had significant influence on predisposure of the respondents to HIV/AIDS. The findings also showed high significant relationships between Socio-demographic factors and HIV/AIDS risks (p< 0.05) in the following: Age and Sexual harassment; Age and Perception of risk (x2=17.854, df=4, p=0.001; x2= 48.944, df=4, p=0.0001) respectively. Respondents less than 18years of age were more likely to be sexually harassed than those older or equal to than 18years. Level of Education and Perception of risk; Level of education and Sexual harassment (Z=14.090, df--3, p=0.135; x2=26.952, df=3, F=0.0001) respectively. Relationship with the Household head and Perception of risk; (x =20.574, df=6, p=0.002). Majority of the respondents engaged in unsafe sex practices therefore the findings of this study rejected the null hypothesis. High significant relationship between Knowledge of HIV/AIDS and HIV/AIDS risks (p< 0.05) was also recorded in the following: Knowledge of HIV/AIDS by perception of risk and condom use (x2=15.556, df=2, p=0.0001; x2=8.101, df=l, p=0.004) respectively. The study demonstrated that knowledge of HIV/AIDS did not translate into safe sex practices and personal perception of risk among the deaf youths was low. Findings consistent with UNICEF (1997-2001); and UNAIDS (2002). This study therefore recommends that the government and non-governmental organizations should fully involve the deaf youths in the designing of HIV/AIDS interventions which target them and in policy implementation.
Socio-medical factors associated with the prevalence of brucellosis among the nomads in Maikona division of Marsabit district, Kenya
(2011-11-18) Mamo, Abudo Qido
It is a common disease among pastoralists and nomadic herdsmen in developing countries, who are continually exposed to potentially infected animals. In Africa the disease incidence is largely unknown because many cases are missed out due to lack of diagnostic facilities. Human brucellosis has been known in East Africa since 1910 when Bruce described the disease known as "muhinyo " (crippler) in Uganda and the Maasai name "nange 'da " has a similar meaning. The disease is reported to be wide spread in Kenya. The Ministry of Health report shows that the cases range from as low as 100 to as high as 1000 each year. Human beings are infected by all species of Brucella. Brucella melitensis is more infective and virulent than Brucella abortus with Brucella suis being intermediate. The aim of this study was to determine the socio-medical factors underlying the disease prevalence among the nomads in Bubisa sub-location of Maikona Division of Marsabit District. Descriptive crosssectional study design was used and 400 respondents were selected following systematic random sampling method. Interview schedule for households, key informants and focus group discussions were used for data collection. Odds ratio and chi-square test was used for testing relationship between variables. A majority of the subjects (75.8%) had no formal education, with the main occupation being livestock rearing (78.2%) and the average household size being 5-6 persons. Statistical test showed that women are more susceptible to infection than men in this community (Cross products odds ratio=1.62, x2=4.02, dal and (p)<0.05). Most informants (73.3%) had knowledge on the prevalence of brucellosis in the area, locally referred to as "dukub annani"(the disease of the milk). A substantial number of households interviewed (31.8%) had experienced at least a case of human brucellosis in the last one year. Consumption of raw milk without boiling (38.5%) is among the risk factors reported to contribute to disease prevalence in the area. Statistically significant relationship was established between consumption of raw milk and the household prevalence of brucellosis (Cross product odds ratio=1.64 and )?=4.30,df--1 (p)<0.05). Similarly, a significant relationship was observed between household prevalence of brucellosis and drinking of animal blood (Cross product odds ratio=1.64 and )?=4.30,df--1(p) <0.05). Households with large livestock population reported more cases of the disease. Majority of reported cases (62.2%) were from households with livestock population of more than 100 as compared to 19.7% and 17.3% reported by households with a livestock population of 50-100 and 0-49, respectively. A large majority 347 (86.8%) reported that one container is used for milking and milk storage, a statistically significant relationship was found to exist between the household prevalence of brucellosis and milk harvesting (Cross products odds ratio=3.87, Z=17.60, df = 1 (p) <0.05). Thorough health education especially on the mode of transmission of brucellosis and the main risk factors such as consumption of raw milk, consumption of animal blood and failure to seek treatment from health institutions needs to be emphasized. Accessibility and affordability of treatment services is a matter that needs to be addressed by the health department. It is also important to note that some people opted for traditional treatment instead of modern treatment because of inaccessibility (12%) and un-affordability (13.7%).
Effect of soybean (Glycine max) supplementation on orphaned and vulnerable school children aged 6-9 years in Suba District, Kenya
(2011-11-18) Kamau, Joyce Wanjiku
HIV and AIDS, hunger and malnutrition are the most devastating problems facing majority of the world's poor including school children amid rising food insecurity in many Kenyan households. School feeding may be one of the best interventions to boost nutritional status of school children that are affected by HIV and AIDS. This study aimed to find out the effect of soybean supplementation on the health and nutrition of school children aged 6-9 years in selected schools in Suba District. A baseline survey was conducted to establish socio-demographic characteristics, nutritional status, food consumption patterns and morbidity patterns of 110 children who formed the study sample using a structured interview schedule. Two schools were involved in the feeding trial that took three months. The experimental group of 54 children received corn soybean blend porridge for three months in school as a mid morning snack. The control group of 54 children did not receive the corn soybean porridge. Anthropometric tools were used to assess nutritional status of the school children at baseline and at monthly intervals and after the feeding trial. Height, weight, and age values were used to calculate standardized Z-scores for height-for-age (HAZ), weight-for-height (WHZ), and weight-for-age (WAZ). Biochemical tests were also performed to determine serum retinol and zinc levels in the school children at baseline and after the feeding trials. A medical doctor undertook clinical assessment of all the children. Data was analyzed using the statistical package for social sciences (SPSS) version 11.5 and Nutri-survey (2005) for the dietary intake. Descriptive and inferential statistics were performed. Demographic data showed poor socioeconomic status of the respondents with food insecurity. Malnutrition levels among experimental group were 10.2%, 28.9% and 5.6% for underweight, stunting and wasting respectively which dropped to 6.2%, 18.7% and 3.4% after the trial. There was significant improvement in underweight (p<0.0121) and wasting (p<0.0193) but not stunting (p<0.304).The control group registered 11.4%, 28.5% and 8.7% underweight, stunting and wasting respectively. Underweight and wasting rose to 14.3% (p<0.215) and 9.5% (p<0.308) but stunting dropped to 21.5% (p<0.314). Severe vitamin A deficiency (VAD) dropped from 6.1% to 2.3% and moderate VAD from 69.4% to 37.2% (p<0.008) in the experimental school. Zinc deficiency also dropped significantly (p<0.001) from 95.7% to 79.4%. There was significant improvement in VAD in the control school (p<0.012) from 61.5% to 30.4% and 5.8% to 0 for moderate and severe deficiency. Zinc status unproved (not significant p>0.4291) from 94.3% to 79.4%. The staple foods were maize, sorghum, millet, and fish with no variety and adherence to balanced diets. Commonly reported diseases were malaria (21 %), upper respiratory infections (14%) and diseases (28%). School absenteeism dropped from 16% to 4% in experimental school. There is food insecurity in the District leading to macro and micronutrient malnutntion among school children. Soybean should be promoted in HIV and AIDS affected areas to alleviate malnutrition and improve food security.
Socio-Medical Factors Associated with the Prevalence of Brucellosis among the Nomads in Maikona Division of Marsabit District, Kenya
(Kenyatta University, 2014-10-28) Qido, Mamo Abudo
It is a common disease among pastoralists and nomadic herdsmen in developing countries, who are continually exposed to potentially infected animals. In Africa the disease incidence is largely unknown because many cases are missed out due to lack of diagnostic facilities. Human brucellosis has been known in East Africa since 1910 when Bruce described the disease known as "muhinyo" (crippler) in Uganda and the Maasai name "nange 'da" has a similar meaning. The disease is reported to be wide spread in Kenya. The Ministry of Health report shows that the cases range from as low as 100 to as high as 1000 each year. Human beings are infected by all species of Brucella. Brucella melitensis is more infective and virulent than Brucella abortus with Brucella suis being intermediate. The aim of this study was to determine the socio-medical factors underlying the disease prevalence among the nomads in Bubisa sub-location of Maikona Division of Marsabit District. Descriptive cross sectional study design was used and 400 respondents were selected following systematic random sampling method. Interview schedule for households, key informants and focus group discussions were used. for data collection. Odds ratio and chi-square test was used for testing relationship between variables. A majority of the subjects (75.8%) had no formal education, with the main occupation being livestock rearing (78.2%) and the average household size being 5-6 persons. Statistical test showed that women are more susceptible to infection than men in this community (Cross products odds ratio=1.62, X2=4.02, df=l and (P)<0.05). Most informants (73.3%) had knowledge on the prevalence of brucellosis in the area, locally referred to as "dukub annani "(the disease of the milk). A substantial number of households interviewed (31.8%) had experienced at least a case of human brucellosis in the last one year. Consumption of raw milk without boiling (38.5%) is among the risk factors reported to contribute to disease prevalence in the area. Statistically significant relationship was established between consumption of raw milk and the household prevalence of brucellosis (Cross product odds ratio=1.64 and X2=4.30,df=1 (P)<0.05). Similarly, a significant relationship was observed between household prevalence of brucellosis and drinking of animal blood (Cross product odds ratio=1.64 and X2=4.30,df=1(p) <0.05). Households with large livestock population reported more cases of the disease. Majority of reported cases (62.2%) were from households with livestock population of more than 100 as compared to 19.7% and 17.3% reported by households with a livestock population of 50-100 and 0-49, respectively. A large majority 347 (86.8%) reported that one container is used for milking and milk storage, a statistically significant relationship was found to exist between the household prevalence of brucellosis and milk harvesting (Cross products odds ratio=3.87, i=17.60, df= 1 (P) <0.05). Thorough health education especially on the mode of transmission of brucellosis and the main risk factors such as consumption of raw milk, consumption of animal blood and failure to seek treatment from health institutions needs to be emphasized. Accessibility and affordability of treatment services is a matter that needs to be addressed by the health department. It is also important to note that some people opted for traditional treatment instead of modem treatment because of inaccessibility (12%) and un-affordability (13.7%).
Dietary Assessment of Vitamin A and Iron Among Pregnant Women at Ndhiwa Sub-District Hospital-Kenya.
(Kenyatta University, 2014-11-26) Othoo, Dorothoy A.
The study was a descriptive case study done at Ndhiwa Sub District Hospital, Homa-Bay District. The main purpose of the study was to establish vitamin A and iron consumption levels of pregnant women as well as the relationship between vitamin A consumption levels and iron consumption levels during pregnancy. Studies on iron and vitamin A have in the past focused on children while maternal vitamin A and iron has not been exhaustively documented. Moreover few studies in Kenya have focused on the relationship between vitamin A and iron during pregnancy. The findings will be useful to policy makers and NGOs in designing and implementing programs suitable to improve vitamin A and iron among pregnant women. Data on vitamin A and iron were assessed using 24-hour recall of three days and food frequency questionnaire recommended by HellenKeller International (1999). Demographic and general health data were collected through structured interview questionnaires. Data analysis was done using Sight and Life vitamin A calculator for vitamin A consumption and Nutrisurvey for iron consumption. SPSS was used to analyse consumption frequencies of vitamin A and iron rich foods as well as demography and other qualitative data. Nutrition status was determined as BMI which was analysed using BMI calculator. Majority (80 %) had severe vitamin A inadequacy, 12% had mild inadequacy while 8% had adequate vitamin A. On the other hand, 65 % had severe iron inadequacy, 27% had mild inadequacy while 8% had adequate iron. Prevalence of dietary vitamin A and iron inadequacies at Ndhiwa Sub District Hospital was at 90%. Vitamin A and iron rich foods were irregularly consumed by most respondents. There was a positive significant relationship between vitamin A and iron consumption of pregnant women at Ndhiwa Sub District Hospital. Food cost and number of meals consumed per day are some of the factors that influenced vitamin A and iron consumption of pregnant women at Ndhiwa Sub District Hospital. Almost half of respondents (49 %) had normal nutrition status that is attributed to good nutrition status prior pregnancy. Number of meals consumed per day influenced nutrition status (BMI) of pregnant womenat Ndhiwa sub District Hospital. Number of meals consumed per day contributed to nutrition status more than vitamin A and iron consumption.
Nursing Handover Experiences and Perspectives in the Critical Care Unit at Murang’a County Referral Hospital, Kenya
(Kenyatta University, 2023-11) Mwangi, Murigi
Continuity in delivery of nursing care to patient in the critical care unit is of utmost importance. To achieve this consistency, nurses engage in a process of transfer of patients’ clinical information in the form of nursing handover. The adoption of various handover procedures result in variation of the information exchanged. In the critical care unit, the intricacy of the patient condition compounded by the advanced patient monitoring translates into a more complex nature of the nursing handover. Despite the existence of handover guidelines and formats, gaps have been detected regarding the contents of the handover and its effects on the continuity of care. The focus of the study was to explore the experiences and perspectives of nurses with nursing handover in the critical care unit. To realize the aim of the proposed study, a phenomenological qualitative design was adopted while utilizing a deductive approach. In-depth interviews were carried out on nine critical care nurses from the Murang’a County Referral Hospital after obtaining ethical approval from relevant institutions. Thematic analysis was done manually for the qualitative data. The study results showed that critical care nurses believed they were individually equipped with adequate knowledge to carry out effective departmental and interdepartmental handover. The existence of handover policies in the critical care unit was considered a major enabler of the handover. They also believed that strained human resource, lack of standardized handover tools and deviation from the set handover rules negatively impacted the handover process. Furthermore, they reported perceived insufficiency in the management’s role in handover evaluation and feedback. Moreover, all participants advocated for improvement of the current handover practices for improved quality of patient care as well as sense of self-accomplishment among the nurses. There are pertinent implications in the findings of this research for critical care nurses, nurses in other departments and policy makers. Based on the study findings the handover process would benefit from enhanced adherence to the existing handover policies. Handover training targeting nurses in other departments would promote communication of patient information between critical care unit and other departments. Periodic audits of the handover documentation and process with subsequent feedback would be a control for evaluation of the handover. Further, addressing scarcity of resources and implementing the nurses’ perceived strategies would ensure a seamless handover practice in the unit. A future comparative study in different facility and exploration of change of perception over time in the current study area would be beneficial.

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