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
    Abstract
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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.