MST-Department of Pathology

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    Determinants of Prostate Cancer Screening Uptake among Men Aged 40 Years and Above in Kiambu County, Kenya
    (Kenyatta University, 2023-01) Mureithi, Margaret; Maurice Onditi K’Odhiambo; James Mureithi
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    Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome Services Uptake among Lesbians, Gay and Bisexual Youths in Nairobi City County, Kenya
    (Kenyatta University, 2024-11) Lanyo, John
    The Kenyan constitution assures every Kenyan the highest attainable quality of health, without discrimination on any basis including the sexual orientation. Studies have shown a high HIV prevalence among non-heterosexuals. This study assessed the general uptake of HIV and AIDS care among the Lesbian, Gay, and Bisexual (LGB) identifying youths in Nairobi County. Studies have been conducted among the key populations particularly the MSM whereas this study focused on sexual orientation aspect particularly among the LGB community. This research sought to unpack the depth in which socio-cultural, religious, systemic, personal attitudes and perceptions base contribute to the uptake of HIV and AIDS care and interventions to be scaled up. To achieve its objectives, the study employed a analytical cross-sectional design, involving qualitative and quantitative methods of collecting data. A pretest was conducted to enhance validity and reliability of the tool and final study sample size of n=84 was recruited. Respondents were then sampled through snowballing sampling technique and beefed up using a virtual snowball sampling to reach the population. Purposive sampling was applied to determine the qualitative aspect and reached 5 key informants for interviews. The study employed self-administered questionnaires. Analytical statistical analysis was utilized using Stata15.0 and cross tabulation and spearman’s rank correlation was used to compare outcome of different variables whereas qualitative analysis supplemented the results and discussion of presented data. The uptake of HIV and AIDS services was found to be 86% among the Lesbian, Gay and Bisexual youths in Nairobi. Majority identified as Gay (43%) and 15% were non-Kenyans/asylum seekers. The majority of these youths’ access HIV prevention and care services from government/public health facilities followed closely by NGO led facilities. Personal attitude and perception base play a significant role in utilization; despite majority having known their status and having adequate information about transmission, 57% engaged in risky activities such as sexual activities with more than one partner. 87% of the respondents experienced injustices at home and while accessing HIV and AIDS services. This included stigmatization, violence, isolation, discrimination which affected mentally, socially, and emotionally. A majority (98%) attributed the experiences to their sexual orientation. A significant proportion of the respondents demonstrated that culture, family, and religious support influenced their uptake of HIV and AIDS services. The study recommends that health care facilities should be improved and inclusive as 71% stated that the facilities are not friendly. The health care providers should be adequately trained to provide comprehensive, non-judgmental services and policies evaluated to provide non-discriminatory services to eliminate stigmatization of the population. The results of this study intend to inform programming of HIV and AIDS for this subset of Key Population and bridge the information gap.
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    Platelet function in adult human immuno-deficiency virus- 1 infected heart naïve patients at Kenyatta National Hospital, Kenya
    (2017-06) Awuor, Onjula Rael
    Occurrence of cardiovascular diseases (CVDs) in adult human immuno-deficiency virus-1 (HIV-1) infected patients is associated with 18% of HIV-1 deaths. Availability of highly active antiretroviral therapy (HAART) has prolonged and improved quality of life in HIV patients. However it has led to the appearance of pre-mature cardiovascular events (CVEs) of athero-thrombotic origin with its continued use. It is still unclear whether thrombotic risks associated with increased platelet function are as a consequence of HIV-1 infection alone or of the long-term use of these antiretroviral drugs. This study aimed at determining platelet function in adult HIV-1infected patients not on HAART. In a case-control study design, using convenient and consecutive sampling method a total of 28 participants were recruited. Fourteen adult HIV-1positive HAART naive patients and fourteen HIV negative participants attending Kenyatta National Hospital, comprehensive care clinic (CCC) were enrolled to the study after consenting. Blood samples were collected and platelet concentrates prepared from each sample. Platelet aggregation was determined by measuring time dependent light transmission in response to known agonists (adenosine tri-phosphate (ADP), collagen and arachidonic acid (A.A) on chrono-log 100 aggregometer. Platelet activation was done by measuring P-selectin expression using flow cytometry. In both groups, participants were of similar age and sex. The results show that median Platelet % PSelectin expression levels in HIV positive group was 1.5 times that of the control group (34.5 (IQ) 10.3-63.3 vs 21.1 (IQ) 2.7-46.2),and had a positive correlation with viral load (r=0.634, P= 0.019) but not with CD4 count (r= -0.532, P= 0.7229). Among the three agonists platelet aggregation showed a significant higher response to collagen compared to arachidonic acid and ADP (P=0.00087, P=0.00056 and P=0.019) respectively. Importantly, less percentage maximum platelet aggregation was observed in HIV positive group compared to HIV negative group for all the agonists (Collagen:75±4.8% cases vs 80.4±6.7% controls at 10μg/ml; AA 64±8.1% cases vs 88.4±6.2% controls at 10μg/ml; ADP 60.7±6.7% cases, 71.1±8.1% controls at 5μmol/l). Furthermore, % maximum platelet aggregation correlated inversely with viral load (ADP r=-0.286, P=0.0424; Collagen r=-0.4663, P=0.0177 and A.A r=-0.3, P=0.259) and directly with CD4 counts ADP r= 0.614, P=0.0528; collagen r=0.384, P=0.0273 and A.A r=0.850, P=0.002).This study was able to demonstrate that platelet function in HIV-infected patients is altered. This offered insights into the complex mechanisms underlying occurrences of thrombotic events in HIV positive patients.
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    Seroprevalence of cytomegalovirus infection and associated risk factors among human immunodeficiency virus infected patients attending Thika level 5 hospital, Kenya.
    (2017-11) Mangare, Nchagwa Edward
    Cytomegalovirus (CMV) is an important pathogen in immunocompromised individuals. In Human Immunodeficiency Virus (HIV) patients, it causes end organ diseases leading to increased morbidity and mortality in the population due to down-regulation of the immune system of the affected individuals. The prevalence of Cytomegalovirus infection is high in the general population. Its prevalence in Kenya has been found to be above 93% (CMV-IgG) in HIV infected children. Despite, a high Cytomegalovirus seroprevalence found in children few studies have documented CMV among adults. This study was done to determine the seroprevalence of CMV infection and its associated risk factors among HIV patients attending Thika level 5 Hospital in Kiambu County, Kenya. The study also evaluated the effect CMV infection on the immunity of HIV infected patients. A cross-sectional study involving 163 HIV positive participants from different age groups were enrolled. Blood samples were collected; ELISA was used to confirm the HIV status of the participants. The CD4+ cell counts were determined immediately after blood collection using BD FACSCount and CMV IgG and IgM specific antibodies were analyzed by ELISA. Demographic and behavioural risk factors were collected by the use of a structured questionnaire. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20. Chi-square test was used to assess the statistical significance of different demographic and behavioural risk factors to CMV serostatus. The seroprevalence was found to be 89% (CMV IgG) while the incidence was 10.4% (CMV IgM). The study found that CMV infection leads to more suppression of the immunity among the HIV infected patients. The study also found out that education, economic status, other sexual transmitted infections, sharing drinks, immune status and blood transfusion were associated with CMV infection (p<0.05). Adoption of CMV screening services and education on CMV risk factors are recommended as CMV infection preventive strategies.
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    Utilization of antenatal tetanus toxoid immunization services among women in Bahati division, Nakuru district, Kenya
    (2013-06-27) Maina, Mary Marcellin Wanjiku; Kabiru, Ephantus W.; Kamau, L. M.
    Neonatal tetanus is still a major cause of morbidity and mortality in the developing countries where it accounts for over 7.5 million deaths annually. The world health organization adopted the goal of eliminating neonatal tetanus worldwide, and a major strategy for its prevention is the administration of at least two properly spaced doses of Tetanus toxoid, to pregnant women to protect newborns passively at birth. National tetanus toxoid vaccination rate in pregnant women is below the universal target of 80%. Kenya Expanded Programme of Immunization routine reports indicate a drop-out rate of 21 between tetanus toxoid vaccine one and two. This warrants a study to establish factors that influence the utilization of antenatal tetanus toxoid immunization services among women of child bearing age. A cross-sectional descriptive survey was therefore carried out among the rural community of Bahati division Nakuru District to; (1) Establish the level of knowledge on antenatal immunization services with tetanus toxoid vaccine. (2) Identify barriers towards utilization of TT1 and TT2 immunization services among child bearing age women. (3) Determine the factors contributing to dropout rate between TT1 and TT2 among child bearing age women in Bahati. The study population was composed of child bearing age women who had delivered a baby within the last 2 years to facilitate recall, and the health facilities managers providing maternal child health services. Purposive sampling, simple random sampling and cluster sampling were used to identify the locations sub locations and villages respectively. Data was obtained by the researcher using pretested interview schedule from 400 respondents. The Statistical Package for Social Sciences software was used for data analysis. Derived data was subjected to statistical tests such as Chi-square to test associations between variables under study and ANOVA was used to compare sample mean in different sub-locations, t-test was used to compare means derived from health facility data. The results indicate that provision of health education to clients played a significant role in influencing TT coverage. (c2=118.863; P=0.000; df--4). Antenatal services perception towards antenatal services by CBAW influenced significantly TT uptake (c2=125.528; P=0.000; df=8). Waiting time at ANC clinic had significant influence on TT coverage (c2 =110.758; P=0.000; df=8). The number of personnel in MCHIFP clinic with TT2 coverage (t=5.669; P=0.001; df=7). However TT coverage was independent of knowledge, majority had access to antenatal services; despite a TT coverage of 62.5% and a dropout rate of 29.25%. Clients education on importance of antenatal immunization using various methods would offer short term solution to improving tetanus toxoid coverage, while service providers, regular update and adequate staffing in rural health facilities coupled with adequate vaccine and other logistics constitute long term solutions. The study recommends research on the implementation of 5TT schedule. The information derived from the study could be incorporated in drawing policies that may be generalized to other parts of the country.