PT-School of Health Sciences

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    Analysis of technical efficiency in hospital settings in Kenya
    (Kenyatta University, 2014-10-07) Rithaa, Koome Gilbert
    The World Health organization called attention to the importance of efficiency in all functions of a health system and in ultimately achieving the goals of health improvement, stewardship, responsiveness and fairness in financing (WHO, 2000). Although, efficiency improvement should be seen as a strategy for mobilizing domestic resources and utilizing the available resources. without waste to achieve the desired health sector goals; it is not usually the case especially in low income countries like Kenya. Practically, there is not much consideration to efficiency by health care administrators in contrast to it being mentioned in health policies (~ollingsworth, 2008). Currently, Kenyan health system is under intense pressure to deliver improved health services using proportionately fewer resources. Quantifying the current level of inefficiency in the hospital system helps provide insight into the 'degree to which these pressures could be met by a more effective use of resources (Kirigia, 2004). The general objective of this study is to analyze the technical efficiency in hospital settings in Kenya. The study will use a mix of analytical and descriptive study design employing econometric techniques for its analysis. Simple random sampling will be used to select a study sample of 30 County referral hospitals from the 47 main County referral hospitals in Kenya for the study. A cross sectional model will be used to analyze secondary data collected using Data Envelopment Analysis (DEA) to determine efficiency levels followed by Tobit regression analysis of environmental variables using STATA version 10 to determine explanatory variables for inefficiencies in the hospitals. The findings of this study will be useful to the policy-makers, county and health facility managers in their effort of designing appropriate policy anq managerial interventions for ensuring efficient mobilization and use of health care resources
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    Determination of the cytokine profile and the psa levels in prostate cancer patients at Kenyatta National Hospital
    (2014-07-31) Mwirigi, Liza K.; Muturi, M.
    Prostate cancer (pCa) is Kenya's second most frequently diagnosed cancer of men with an incidence rate of 15.2 per 100,000 and mortality rate of 12.2 per 100,000. The International Agency for Research on Cancer (IARC) estimates that it is the leading cancer in terms of incidence and mortality in men from Africa and the Caribbean. It is predicted that the numbers will almost double by 2030. Men of the Sub-Saharan Africa descent around the world appear to suffer disproportionately compared to men of other races and ethnicities. Early diagnosis of PCa would prove crucial in lowering the mortality rates. Prostate Specific Antigen (PSA) is the main diagnostic biomarker used for screening currently. Its use is controversial because normal PSA levels have been found in men suffering from PCa. The PSA variations in the different stages of PCa have not been established. Biopsy histology is invasive and tedious and yet it is the only confirmatory test. Cytokines have been found to playa role in the growth and differentiation of normal and PCa cells but they have not been studied as biomarkers. There is an urgent need to develop other diagnostic modalities of PCa to lower the mortality and morbidity rates. The objectives of this study are to evaluate thecytokine profile and determine the PSA levels in PCa and to determine the risk factors that lead to the development of PCa. There is need to develop other accurate and precise non-invasive biomarkers that can be used for screening and diagnosis. Comparing the PSA levels with those of the cytokines in PCa will help in understanding their role in the progression of the disease. Since cytokines are used as screening biomarkers in other diseases, determining the cytokine profile could help single out various cytokines that could be used as biomarkers of Pea. A cross sectional study will be carried out to determine the cytokine profile and the PSA levels using serum samples involving 45 male patients aged 50 years and above at the KNH Urology Outpatient Clinics. Cytometric Bead Array technique on a flow cytometer will be used to determine the cytokine profile. Sandwich ELISA technique will be used to determine the PSA levels. A questionnaire Will be used to deterinine the demographic and risk factors that lead to the development of PCa. Data will be coded and statistical analysis will be performed using the Statistical Package for Social Sciences (SPSS) version l.5. Chisquare test and ANOVA will be used to assess the relationship between the variables. The fmdings from the study may lead to the implementation of various mitigation measures such as creating awareness, encouraging early screening and provision of proper treatment to the sick. This could in turn lower the morbidity and mortality rates from PCa. A comprehensive cytokine cataloging may provide information on cytokines that can be used as biomarkers for PCa
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    Ecological footprint of rural communities in Homa Bay County, kenya
    (Kenyatta University, 2014) Ogalo, Tom Osewe
    Environmental sustainability of a nation or region is a major concern to governments, industrialists, academicians, environmental practitioners and even ordinary individuals living on planet earth. The rate of exploitation of natural resources is not matched by the regenerative capacity of these resources for sustainable existence. There are several methods of quantifying the earth's natural resources as well as sustainability. Natural capital accounting with the ecological footprint is one method of auditing our relation with nature. Ecological Footprint analysis was pioneered by Dr.Rees and Dr.Mathis Wackernagel in 1999 and has since been modified and is in use all over the world. This research aims to assess the sustainability of the rural communities in Homa Bay District in Homa Bay County of the Republic of Kenya. It will seek to answer questions as to whether the natural wealth available in the district is enough to sustain the resident population, what is the technological level of exploitation of the natural resources, means of waste disposal. The final determination is the Ecological Footprint, or natural resource demand, imposed on the region. The study will also seek to establish the biocapacity or the natural resource supply available. The research design will use structured questionnaires administered at household level to capture the six parameters of Ecological Footprint analysis, that is, crop land area, grazing land, forest land, fishing grounds, built-up land as well as fossil energy land. The individual component areas will be converted into global hectares using weighting factors. The sampling frame is based on the 2009 National population census. The data generated will be analyzed using the Sta~~sticalPackage for the Social Sciences (SPSS) software and Microsoft excel. The Ecological Footprint will be determined using National Footprint Account developed by the Global Footprint Network. Visual presentation will include bar charts, pie charts. frequencies amongst other descriptive statistics.
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    Identification of antitrypanosomal constituents of some meliaceae species and screening of selected structural variants by in vitro and in vivo assays
    (2015) Wanzala, Everlyne Nafuna
    African human trypanosomiasis (sleeping sickness) and animal trypanosomiasis (nagana) are vector-borne parasitic diseases, which are causing major health and economic problems in rural sub-Saharan Africa. The current chemotherapeutic options are very limited and far from ideal. There are serious social, economical and environmental repercussions associated with their usage and this has prompted researchers to improve on the existing methods of controlling the disease vectors and to discover new compounds for treating the diseases. Some of the major problems encountered in the treatment of trypanosomiasis include high cost of the few old drugs, high toxicity, low efficacy and increasing resistance of trypanosomes to these drugs, as well as general lack of research and development aimed at developing new drugs. The use of natural products derived from metabolic activities of plants is one of the strategies being explored to address some of the problems encountered with allopathic chemical drugs. This is because natural products are renewable, readily available, more selective and much less toxic. Some Meliaceae species have been found to contain such metabolic components with antiprotozoal, insecticidal, antifungal and antimicrobial activities. This has prompted the screening of more Meliaceae species with the hope of identifying candidates that can be developed into new efficient trypanocidal drugs that are safer and more affordable compared with existing synthetic drugs. The current research sought: to undertake in vitro screening of some Meliaceae species growing in Kenya; to isolate and structurally characterize trypanocidal constituents of the screened species; to evaluate in vivo activities of all compounds that demonstrate in vitro activities; to compare the structural details of active compounds, and to identify candidate natural products that show promise for downstream development into drugs for treating both human African trypanosomiasis (HAT) and animal African trypanosomiasis (AAT)
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    Molecular Diversity of Hepatitis B Virus in HIV Infected Patients at Mbagathi district Hospital, Nairobi
    (2013-12-23) Khaemba, S. B.; Arodi, W.; Warigia, M.
    With increasing access to antiretroviral therapy across Sub-Saharan Africa, HIV-infected individuals live longer and the effects of co-infection with chronic viral hepatitis is an emerging critical public health problem. Chronic HBV infection is a leading cause of progressive complications of liver cirrhosis, hepatocellular carcinoma and liver failure in most Sub-Saharan and Asian countries. Patients infected with HIV are at particular risk for HBV infection due to similar transmission routes and up to 10% of patients infected with HIV are also chronically infected with HBV, with 13 times higher risk of death in HIV -HBV dual infection than in monoinfected patients. HIV co-infection accelerates HBV-related liver damage, leading to earlier cirrhosis and end-stage liver disease. Conversely, the presence of HBV co-infection complicates the management of HIV and increases the morbidity and mortality of HIV -infected patients. Both HIV and HBV infections are considered to be hyperendemic in Sub-Saharan continent, with approximately 2% of all annual deaths in Africa resulting from clinical consequences of HBV infection and 25% of all annual deaths resulting from the clinical consequences of HTV infection. Kenya is among the countries that are affected by hepatitis B, with a high HTVburden, leading to frequent HIV /HBV co-infection. Considerable molecular variations are reported to occur throughout the HBV genome and the resultant genetic diversity is correlated with geographical distribution of genotypes and clinical outcome, immunization and antiviral therapy response. This study will assess the molecular genetic variation in HIV infected patients attending Mbagathi District Hospital. The prevalence of HBV in HIV patients will be assessed using SPSS v. 17.0 and Pearson Chi-square test. The data generated will be reported as percentages. Genetic variation will be evaluated using PCR amplification of the S gene and subsequent sequencing of the amplicons. Phylogenetic analysis of the sequences and comparison of identified genotypes with other identified genotypes elsewhere will be carried out using MEGA v 4. Understanding the prevalence and the HBV genotypes will better the knowledge of individual risk factors for hepatocellular carcinoma and form the basis for disease management and for designing preventive strategies.
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    Therapeutic Potential of Bacteriophage in Treating methicillin Resistant Staphylococcus au reus Bacteremia in Mice
    (2013-12-24) Ochieng, O. J. M.; Arodi, W. O.; Atunga, N.
    Methicillin resistant Staphylococcus aureus (MRS) causes infections in human especially in immunocompromised patients (serious burnt victims or after major surgery). About 80% of nosocomial infections are caused by Staphylococcus aureus strains. The emergence of antibiotic- resistant bacterial strains has necessitated the exploration of alternative antibacterial therapies. This studies aims at evaluating the ability of bacterial viruses (bacteriophage or phages) to treat mice challenged with MRSA. Phages specific for Staphylococcus aureus will be isolated from sewage water, sampled from Dandora sewage treatment plant in Nairobi City. Thereafter, they will be cultured and their therapeutic potential evaluated in an experimental model of staphylococcal induced bacteremia in mice. Mice shall be challenged by intravenous (I.V) inoculation with bacteria (108 CPU/ml). A single I.V injection of live phage (108 PPU/ml) shall be administered to one group of five mice, while another will receive antibiotics (clindamycin at Smg/kg body weight) and another physiological saline. These groups shall be compared with a control group that will be inoculated with physiological saline. The mice will then, be observed for 72 hours while collecting data on survival rates. Also, they shall be bled after every 24 hours to determine bacteria titer in their blood. The titer shall be used to evaluate decrease or increase of bacteria c.P.U and phage P.P.U number in the animal body. The mice organs shall be evaluated histopathologicaly for bacterial and phage damage. The data will be fed into MS office Excel 2007 software for analysis using parametric tests (one way ANOV A and Tukey's post hoc test). This work is geared towards production of cheap and efficient alternative antibiotic agents against drug resistant bacteria in livestock and . human with an aim of improving human health.