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The 3rd Pan African Thoracic Society (PATS) Biennial Congress: Lessons Learnt to Advance Lung Health in Africa
(PATS, 2024-03) Kagima, Jacqueline; Irungu, Anne; Ongaya, Asiko; Miheso, Barbara; Chakaya, Jeremiah; Masekela, Refiloe
Lung health in Africa is of great public health concern. To exchange knowledge, communicate the latest scientific advances in lung health, build the capacity of young researchers, and provide a platform for networking of lung health stakeholders in Africa, the Pan African Thoracic Society (PATS), in partnership with the Respiratory Society of Kenya organized and held the 3rd Biennial PATS congress, from June 7–10, 2023 in Mombasa, Kenya. There were a total of 30 conference sessions, which included six skills building workshops, two research dissemination workshops, six plenary sessions, and five each of pediatric, adult, and thoracic surgery symposia. A total of 60 abstracts were presented, including 27 oral abstracts and 33 posters. A wide range of issues for lung health in Africa emerged. These include the emerging role of the environment, especially climate change and global warming, on lung health, the threat posed by the use of tobacco and other nicotine products in Africa, the high burden of lung infections, insecurity of medical oxygen supply systems, and high burden of chronic respiratory disease. In this paper, we summarize the proceedings of this conference and draw lessons that can be used to advance lung health in the African continent.
Abagusii Traditional Environmental Knowledge and HIV/AIDS Management: Implications for English Language Teaching
(International Ecolinguistics Association, 2021) Maroko, Geoffrey Mokua; Mokua, Gladys Nyamoita; Nyakundi, Augustus Onchari; Onyambu, Meshack Ondora
Multidisciplinary and multisectoral interventions are necessary for the management of chronic conditions such as HIV/AIDS. One such intervention is the promotion of socially responsible teaching. Anchored within an eclectic theoretical framework involving traditional environmental knowledge, the Sapir-Whorf Hypothesis, and Vygotsky’s theory of thought, language and culture, this paper analyses the link between Abagusii traditional environmental knowledge and management of HIV/AIDS. Seven groups of people living with HIV/AIDS were engaged in focus group discussions on the management of HIV/AIDS treatment adherence through sustainable production and use of natural products. The paper reveals that the Abagusii have rich ecological knowledge on the production and use of natural products, which could improve treatment outcomes of people living with HIV/AIDS. This ecological knowledge can be harnessed, documented and ploughed into ELT materials for English Language Teaching. A three-tier ELT framework comprising classroom activities, integrated tasks and practical actions could be adopted for teaching integrated English in interesting ways while at the same time restoring the environment, food sufficiency and health.
Abnormal Intra-aural Pressure Waves Associated with Death in African Children with acute Nontraumatic Coma.
(Nature Publishing Group, 2015) Gwer, S.; Kazungu, M.; Chengo, E.; Ohuma, E. O.; Idro, R.; Birch, T.; Marchbanks, R.; Kirkham, F. J.; Newton, C. R.
BACKGROUND: We explored the relationship between tympanic membrane displacement (TMD) measurements, a tool to monitor intracranial pressure noninvasively, and clinical features and death in children with acute coma in Kilifi, Kenya. METHODS: Between November 2007 and September 2009, we made serial TMD measurements and clinical observations on children with acute coma (Blantyre coma score (BCS) ≤ 2) on the pediatric high dependency unit of Kilifi District Hospital, and on well children presenting to the hospital's outpatient department for routine follow-up. We examined middle ear function using tympanometry and measured cardiac pulse (CPA) and respiratory pulse pressure amplitudes (RPA) using the TMD analyzer. RESULTS: We recruited 75 children (32 (43%) females; median age 3.3 (IQR: 2.0, 4.3) years). Twenty-one (28%) children died. Higher TMD measurements predicted death. Adjusting for diagnosis, every 50 nl rise in both semirecumbent and recumbent CPA was associated with increased odds of death associated with intracranial herniation (OR: 1.61, 95% confidence interval (CI): 1.07, 2.41; P = 0.02 and OR: 1.35, 95% CI: 1.10, 1.66; P ≤ 0.01 respectively). CONCLUSION: Raised TMD pulse pressure measurements are associated with death and may be useful in detecting and monitoring risk of intracranial herniation and intracranial pressure in childhood coma.
Accessibility of Anal Cleansing Materials for Public Primary School Pupils in Kajiado County, Kenya
(ajol, 2022) Umuro, Sabla Abduba; Karama, Mohammed; Akunga, Daniel Nyagetiria
INTRODUCTION Anal cleansing is the hygienic practice of cleaning the anal area after defecation. Inaccessibility to anal cleansing materials leads to inappropriate methods resulting in faecal hand contamination. This study assessed the accessibility of anal cleansing materials for public primary school pupils in Kajiado County, Kenya. MATERIALS AND METHODS The researchers used a descriptive cross-sectional study approach, applying a cluster sampling technique to sample eighteen (18) schools to the study. Three hundred and eightyfour (384) pupils were selected from the schools using simple random sampling. The Headteacher and a teacher in charge of school health were purposively sampled due to their knowledge of school resources about hygiene. A total of thirty-six teachers participated in the key informant interviews. Data were analysed using SPSS version 21, and Chi-square was used to test the hypothesis at p<0.05 significance level. RESULTS Accessibility to anal cleansing materials was low at 22.9%. Pupils' class (p-value = 0.036) and level of material awareness (p-value <0.001) influenced accessibility. For Institutional factors, material sensitisation was associated with accessibility (p-value = 0.001). The following sustainability measures were proposed; sensitisation on anal cleansing materials, provision through cost sharing, management of the materials by class teachers and prefects, and continued support by government ministries of health and education. CONCLUSION Anal cleansing materials access was low; pupils' predisposing characteristics and institutional factors influenced access. RECOMMENDATION We recommend that school management and ministries of health and education improve access to anal cleansing materials in schools and develop sustainability measures
Acetyl salicylic acid attenuates cardiac hypertrophy through Wnt signaling
(Springer Verlag, 2015) Gitau, Samuel C.; Li, Xuelian; Zhao, Dandan; Guo, Zhenfeng; Liang, Haihai; Qian, Ming; Lv, Lifang; Li, Tianshi; Xu, Bozhi; Wang, Zhiguo; Zhang, Yong; Xu, Chaoqian; Lu, Yanjie; Du, Zhiming; Shan, Hongli; Yang, Baofeng
Ventricular hypertrophy is a powerful and independent predictor of cardiovascular morbid events. The vascular properties of low-dose acetyl salicylic acid (aspirin) provide cardiovascular benefits through the irreversible inhibition of platelet cyclooxygenase 1; however, the possible anti-hypertrophic properties and potential mechanism of aspirin have not been investigated in detail. In this study, healthy wild-type male mice were randomly divided into three groups and subjected to transverse aortic constriction (TAC) or sham operation. The TAC-operated mice were treated with the human equivalent of low-dose aspirin (10 mg$kg–1$d–1); the remaining mice received an equal amount of phosphate buffered saline with 0.65% ethanol, which was used as a vehicle. A cardiomyocyte hypertrophy model induced by angiotensin II (10 nmol$L–1) was treated with the human equivalent of low (10 or 100 μmol$L–1) and high (1000 μmol$L–1) aspirin concentrations in plasma. Changes in the cardiac structure and function were assessed through echocardiography and transmission electron microscopy. Gene expression was determined through RT-PCR and western blot analysis. Results indicated that aspirin treatment abrogated the increased thickness of the left ventricular anterior and posterior walls, the swelling of mitochondria, and the increased surface area in in vivo and in vitro hypertrophy models. Aspirin also normalized the upregulated hypertrophic biomarkers, β-myosin heavy chain (β-MHC), atrial natriuretic peptide (ANP), and b-type natriuretic peptide (BNP). Aspirin efficiently reversed the upregulation of β-catenin and P-Akt expression and the TAC- or ANG II-induced downregulation of GSK-3β. Therefore, low-dose aspirin possesses significant anti-hypertrophic properties at clinically relevant concentrations for anti-thrombotic therapy. The downregulation of β-catenin and Akt may be the underlying signaling mechanism of the effects of aspirin
Acne vulgaris in general population of rural western Kenya: cross-sectional community survey
(International Society of Dermatology, 2015) Kiprono, Samson K.; Wamburu, Grace
Activation in Cancer Survivorship in Kenya: Results of a Cluster-Randomized Trial
(Journal of Clinical Nursing & Reports, 2024-07) Mchidi, Nebert K.; Oyore, John P.; Ogweno, Gordon
Introduction: Kenya’s cancer situation, as in the rest of the developing world, is marred by treatment access deficiencies arising from multiple foci in the continuum of health care that make survival difficult. These challenges, stemming from patient, service, and service provider points of view, place the patient at an increasing need for continuous support through the survivorship. This study, aimed at improving the patient’s knowledge, skills, and confidence in self-care; and has been conceptualized as activation. Data on patient activation have demonstrated the positive influence of activation on different survivorship outcomes, including symptom management, adherence, and improved quality of life. In Kenya, there is a dearth of data on the utility of SMS interventions to shape patient activation, particularly for cancer. Methods: This multisite study evaluated the effectiveness of mobile phone SMS support on patient activation among adult cancer patients in Kenya. Specifically, the study sought to determine the influence of individual factors and the intervention on patient activation. Data were collected using questionnaires. Ethical approval was obtained from the Kenyatta University Ethics Review Committee and various Hospital Ethics Review Boards. A permit to conduct the study was obtained from the National Commission for Science, Technology, and Innovation (NACOSTI), while consent was obtained from individual participants. A DSMB was formed to address any SAE of the study. Results: The mean age of the participants was 52.9 ±12.9 years. Most of the participants reported delayed initiation of cancer treatment. Furthermore, the majority, 56.9% (n = 230), of the participants were activated in care. The majority of 95.7% (n-=220) of those activated in care were in the intervention arm and this was statistically significant (χ²dd = 326.550, p=<0.001). Conclusions: the SMS support intervention has shown superiority in influencing patient activation and several demographic factors have a significant influence on patient activation. There is a need to redesign the initiation of cancer treatment to prevent delayed initiation of treatment.
Acute Medical Conditions in under Five Year Old Children at a Public Hospital in Kenya.
(East African Medical Journal, 2010-08) Makworo, D.; Laving, A. M.
OBJECTIVE: To determine the prevalence of childhood preventable and treatable medical conditions and the parent's/guardian's knowledge about the conditions and their management. DESIGN: A descriptive cross-sectional study. SETTING: Paediatric medical wards at Kenyatta National hospital SUBJECTS: All children aged 0-60 months with preventable conditions (that included pneumonia, malaria, diarrhoea/dehydration, meningitis and malnutrition) in paediatric wards who had stayed in the ward for 24 to 48 hours. RESULTS: Two hundred and fifty six parents/guardians staying with their children were recruited into the study. The vast majority (85.5%) of the children were aged less than two years. The prevalence of the acute treatable and preventable medical conditions was 88.6% over a one month period. The leading cause of admission for most children was pneumonia (31.6%) followed by malnutrition (16.8%) and gastro-enteritis (16%). Other conditions included neonatal sepsis (9.1%), measles (6%) and malaria (4.8%). The parents'/guardians' mean and median age was 26 years and the majority (89.8%) were mothers. A great proportion (46.5%) of the parents/guardians had attained at least some primary education. More than 70% of the parents/guardians were found to lack knowledge about their children's health problems and the drugs they were using. This was regardless of the parent's/guardians level of education and the frequency of admission of the child. CONCLUSION: Acute preventable and treatable medical conditions at KNH are highly prevalent, and the leading conditions include pneumonia, malnutrition and gastroenteritis. Most parents/guardians did not understand their children's health problems regardless of their level of education.
Adapting the Preterm Birth Phenotyping Framework to a Low-Resource, Rural Setting and Applying It to Births from Migori County in Western Kenya
(BMC, 2023) Miller, Lara; Schmidt, Christina N.; Wanduru, Phillip; Wanyoro, Anthony; Santos, Nicole; Butrick, Elizabeth; Lester, Felicia; Otieno, Phelgona; Walker, Dilys
Background Preterm birth is the leading cause of neonatal and under-fve mortality worldwide. It is a complex syndrome characterized by numerous etiologic pathways shaped by both maternal and fetal factors. To better understand preterm birth trends, the Global Alliance to Prevent Prematurity and Stillbirth published the preterm birth phenotyping framework in 2012 followed by an application of the model to a global dataset in 2015 by Barros, et al. Our objective was to adapt the preterm birth phenotyping framework to retrospective data from a low-resource, rural setting and then apply the adapted framework to a cohort of women from Migori, Kenya. Methods This was a single centre, observational, retrospective chart review of eligible births from November 2015 – March 2017 at Migori County Referral Hospital. Adaptations were made to accommodate limited diagnostic capabilities and data accuracy concerns. Prevalence of the phenotyping conditions were calculated as well as odds of adverse outcomes. Results Three hundred eighty-seven eligible births were included in our study. The largest phenotype group was none (no phenotype could be identifed; 41.1%), followed by extrauterine infection (25.1%), and antepartum stillbirth (16.7%). Extrauterine infections included HIV (75.3%), urinary tract infections (24.7%), malaria (4.1%), syphilis (3.1%), and general infection (3.1%). Severe maternal condition was ranked fourth (15.6%) and included anaemia (69.5%), chronic respiratory distress (22.0%), chronic hypertension prior to pregnancy (5.1%), diabetes (3.4%), epilepsy (3.4%), and sickle cell disease (1.7%). Fetal anaemia cases were the most likely to transfer to the newborn unit (OR 5.1, 95% CI 0.8, 30.9) and fetal anomaly cases were the most likely to result in a pre-discharge mortality (OR 3.9, 95% CI 0.8, 19.2). Conclusions Using routine data sources allowed for a retrospective analysis of an existing dataset, requiring less time and fewer resources than a prospective study and demonstrating a feasible approach to preterm phenotyping for use in low-resource settings to inform local prevention strategies.
Alcohols and Denaturants Hand Rub Sanitizers Used to Curb COVID-19 Pandemic in Kiambu County, Kenya
(International Journal of Scientific Research in ________Chemical Sciences___________________ Research Paper., 2022) Gacuiga, Martha W; Wanjau, Ruth N; Murigi, martin K.M; Mbugua, Gerald W; Ndiritu, Antony M; Gikonyo, Nicholas K
The coronavirus disease outbreak in 2019 (COVID-19) became a pandemic that led to tremendous increase in the use of alcohol-based hand sanitizers globally. Governments and public health agencies across the world advocated for hand hygiene as one of the preventive measures against COVID-19 pandemic. Consequently, washing of hands with water and soap or use of alcohol-based hand sanitizers became mandatory. The efficacy of these sanitizers is dependent on the alcohol concentration in the hand sanitizer. Alcohols commonly used in sanitizers include ethanol and isopropyl alcohol at levels of 60% to 80%. Ethanol used to manufacture the sanitizers is of industrial grade and is usually denatured to prevent human consumption. Denaturants include methanol, pyridine, acetone and denatonium benzoate at levels of ≤ 630 ppm for methanol and 20 to 50 ppm for denatonium benzoate. This paper mull over comparing levels of alcohols and denaturants with label claims of alcohol-based hand sanitizers used to curb the COVID-19 pandemic in Kiambu County, Kenya. Samples of alcohol-based hand sanitizers of different brands were analyzed in triplicates using Attenuated Total Reflectance- Fourier Transform Infrared spectrometry (ATR-FTIR). Each hand sanitizer was given a unique sample identifier code ranging from HS1-HS12. The findings indicated that alcohol-based hand sanitizers contain significant amount of either ethanol or isopropyl alcohol and low concentration of methanol or denatonium benzoate. The percentage of ethanol ranged from 4.607±0.0 to 81.23±0.3. Nine samples showed concentrations above 70% ethanol. The levels found in the study were not in agreement with levels indicated on the labels. Isopropyl alcohol was found in only two samples contrary to the label claims in five samples. The analysis showed that all samples contained either isopropyl alcohol, methanol or denatonium benzoate as denaturants with levels ranging from 0.040±0.02% to 72.6857±0.4241%, while the label claim indicated the presence of denaturants in only five samples. However, two samples gave methanol levels that exceeded threshold limits of 630 ppm (0.063% v/v). In conclusion, the concentration levels of alcohols and denaturants in all alcohol-based hand sanitizers analysed in this study didn’t match with the label claim. This calls for stringent measures by regulatory bodies to ensure compliance with set standards in the manufacture of alcohol-based hand sanitizers.
Amphotericin B Toxicities among HIV Infected Adults with Cryptococcal Meningitis in Kiambu District Hospital
(Pharmaceutical Society of Kenya, 2018) Karita, A.W; Nyamu, D.G; Karimi, P.N; Gitau, S.C
Background: HIV infection is a worldwide epidemic with the highest prevalence in sub-Saharan Africa. This has increased the prevalence of cryptococcal meningitis which is a common AIDS-related opportunistic infection with a high rate of morbidity and mortality. Amphotericin B is the standard treatment for cryptococcal meningitis but its use is limited by toxicities resulting from a number of factors such as cumulative dosage and concomitant drugs. Published local studies on patterns of toxicities are scanty. Objectives: The main objective of the study was to assess toxicities associated with Amphotericin B in the management of cryptococcal meningitis among HIV infected patients aged 18 years and over in Kiambu District Hospital. Methodology: A cross- section design was used that involved review of patients’ records at Kiambu District Hospital medical records department between January 2010 to December 2014. One hundred and six files of HIV infected adults with cryptococcal meningitis and treated with amphotericin B were used. Data on amphotericin B toxicities, risk factors, and preventive strategies were extracted from the files using a predesigned semi-structured data collection form. This data was entered into Microsoft Access version 2013 to create a database and then exported to IBM Statistical Package for Social Sciences Version 22.0 for analysis. Bivariate analysis using chi-square test and logistic regression were used to determine statistical significance at 0.05. P values that were equal or less the 0.05 were considered significant Results: Prevalence of infusion-related toxicities was high at 87.7%, with fever being the most common (58.1%). The overall prevalence of nephrotoxicity was at 27.4% but principally characterized by hypokalemia (41.4%) and elevated creatinine at 58.6%. Dosing of the drug was not weight based and higher amphotericin B doses were important risk factors for toxicity (p=0.045). Prevention of toxicities associated with amphotericin B involved monitoring of serum levels of potassium (p=0.028) and creatinine (p=0.019) as well as patients hydration status A.W. Karita , D.G. Nyamu , P.N. Karimi , S.C. Gitau University of Nairobi, College of Health Sciences, Department of Pharmaceutics & Pharmacy Practice, P.O Box 19676-00202, Nairobi, Kenya. Emails- P.N. Karimi- ndirang@yahoo.com, D.G.Nyamu-dgnyamu@gamil.com, A.W Karita-aggienjane@gmail.com. Kenyatta University, Department of Pharmacy and complementary/Alternative medicine, P.O Box 43844-00100, Nairobi, Kenya, email—gitaus2009@gmail.com *Corresponding author 1 2 1 2 (p=0.026). Monitoring of toxicity was only prevalent (70%) at the initiation of therapy but declined to less than 20% in the course of treatment. Conclusion and recommendation: Prevalence of toxicity of amphotericin B in Kiambu District Hospital was high and related to the dose given. Therefore, care should be taken when dosing the drug. In addition, frequent patient monitoring, adequate hydration, and premedication are key to preventing the toxicity and should be encouraged.
The Anterior Curve of the Adult Femur in a Kenyan Population and its Mismatch with Available Intramedullary Nails
(AJOL, 2016) Lakati, K.C.; Ndeleva, B.M.
Background: There are currently no studies which have documented the anterior femoral curvature in Kenya or elsewhere in Africa, and compared it to the curvature of the available intramedullary nails. Objective: To determine the anterior femoral curvature in cadaveric femora and to compare this with the curvatures of locally available femoral intramedullary nails. Methods: We determined the radii of 66 cadaveric femora by the method described by Karakas and Harma. The radii of locally available femoral intramedullary nails were also obtained from the respective product monographs. Results: We found that the radius of the curvature ranged from 52.02cm to 165.82cm with a mean of 96.4cm and standard deviation of 25.61cm. The radii of locally available intra-medullary nails ranged from 127cm to 200cm. Conclusion: The radius of curvature of the adult femora in Kenyans is less than that of other populations. There was a large mismatch between the available intramedullary nails and the femoral curvature. Further study of the complications resulting from this mismatch and a review of the design of the nails for local use is recommended.
Antibiotic Prescribing Practices for Upper Respiratory Tract Infection among Clinical Officers at Kiambu County
(Journal of Family Medicine, 2024-03-21) Murigi, Kevin; Thigiti, Joseph; King’ang’a, Muiruri
Background Antibiotics are the most prescribed medications worldwide. Global consumption rose by 65% in 76 low and middle-income countries between the years 2000 and 2015. According to the World Health Organization, improper administration of antibiotics occurs in over 60% of people with upper respiratory tract infections. Inadvertent antibiotic use has been identified as a contributor to antimicrobial resistance. Outpatient antibiotic use accounts for around 80-90% of all antibiotic use in patients. Clinical officers are non-physician healthcare workers who have received less training, have a more restricted scope of practice than physicians. Clinical officers are key service providers in this country especially at the primary healthcare level. Objective The study assessed the factors that influence antibiotic prescribing for upper respiratory tract infections by clinical officers. Method A prospective study was carried out at 20 public hospitals in Kiambu County, on 36 clinical officers and 600 patient prescriptions. The parameters measured were patient factors, prescriber factors, institutional factors and how they affected the antibiotic prescribing practices by either being rational or irrational. Rational prescribing was identified as prescribing the right drug, at the right frequency, in the right duration, right dose for the right indication. Prescriptions were considered irrational if they did not satisfy any of the rational indices. Data was collected via a questionnaire from the clinical officers while WHO prescription checklist was used to collect data from patient encounters. Data was analyzed using Statistical Package for Social Sciences version 22.0 (SPSS v22.0) with P-value, Confidence Interval and Odds Ratio. Results A total of 600 patient encounters were recorded and 79.8% of the 479 encounters had an antibiotic prescription for URTI, 91% of the antibiotic the right dose, 98% had the right frequency, 75% had the right duration, and only 23% had the right indication. Patients above 65 years were more likely to receive an antibiotic prescription OR 3.98 CI 0.91,17.41 P=0.17 compared to children under 12 years old. Males were more likely to receive an antibiotic, but this was not significant OR 1.06 CI 0.70, 1.59 P=0.79. A total of 28 (4.6%) patients had fever, and all received antibiotics. A total of 36 clinical officers were sampled and only 5 (13.8%) were found to have rational prescriptions (P=0.63), prescriber age (P=0.92), prescriber level of education (P=0.99) and prescriber work experience (P=0.22) were not associated with antibiotic prescription. As per institutional factors, availability of antibiotics (P=0.026) and availability of prescription guidelines (P=0.012) were associated with rational prescription of antibiotics. Conclusion The study indicated that there was a high antibiotic prescription rate deviating from the WHO standard. It demonstrated that most antibiotic prescriptions were irrational.
Antibiotic Susceptibility Profile of the Klebsiella Pneumoniae Isolated from Africa Inland Church Hospital Kijabe, Kenya
(International Journal of Advanced Multidisciplinary Research, 2019) Mwangi, Joseph Kibuchi; Mathenge, Scholastica; Njoroge, Wachuka
The emergence of antimicrobial resistance is primarily due to excessive and often unnecessary use of antibiotics in humans and animals. A study done in low and middle income countries showed a considerable increasing resistance in Enterobacteriaceae (Ashley et al., 2011). The data revealed that affordable first line agents such as ampicillin and gentamicin are unlikely to be clinically efficacious in a substantial proportion of infections. This results in increasing reliance on the third generation cephalosporins for empirical treatment of serious infections. However, the spread of extended-spectrum beta-lactamase producing strains into the community (Ashley et al., 2011), probably accelerated by this increased consumption, is eroding the usefulness of these drugs. Alternative agents for treating multi-resistant coliform infections, such as the carbapenems, are unaffordable for treatment of community- acquired infections in low-income countries. The clinical specimens which were used included; urine, aspirates, blood, cerebral spinal fluid (CSF), swabs of wound, device swabbing. The design was a prospective observational. Ethical approval was sought from the Kenyatta University ethical review committee and the Ethical committee in AIC Kijabe hospital as attached. antimicrobial susceptibility among the 55 blood samples infected with K. pneumoniae showed that 100% was resistant to Ampicillin, 98% was resistant to Ceftadime, 86% was resistant to Ceftriaxone, 83% was resistant to Cefazolin, and none of the isolates was resistant to Meropenem. To test whether the difference in means in relation to antibiotics resistance in Klebsiella pneumoniae isolates was significant, analysis of variance (ANOVA) statistic was used. This parametric test was used to test the hypothesis that there is no antibiotics resistance in Klebsiella pneumoniae isolates from AIC Kijabe hospital. The result of analysis indicated that there was statistically significant difference among the means scores 5.547 at 0.05. It was concluded that use of antibiotics has influence on effective management in Klebsiella pneumoniae isolates from AIC Kijabe hospital. This study through its findings recommends that; Regular antimicrobial audits and reviews of laboratory data (surveillance) should be done so as to have proper documentation of drug resistance patterns and timely updates of antibiotic formularies. The study focused on AIC Kijabe Hospital Kiambu County only, therefore, the same study can be extended in other hospitals and other counties for comparison purposes
Antimicrobial resistance patterns among E. coli isolates from children presenting with diarrhoea at a cosmopolitan hospital in Kenya
(Kenyatta University, 2015-08) Kangethe, S. K.; Kiiru, J.; Kabiru, Ephantus W.; Kariuki, S.
Diarrhoea is a serious infection that kills at least 2 million children globally. Children under the age of 5 years are particularly predisposed to diarrhoea especially if the surrounding environment is contaminated or polluted with human sewerage. Due to frequent episodes of diarrhoea, children may unjustifiably be subjected to antibiotics and this could in turn lead to emergence of multi drug resistant strains. In this study, we isolated and determined antimicrobial susceptibility profiles of 384 E. coli isolates from rural and urban children with chronic and acute diarrhoea.
Antimicrobial Resistant Pattern among Foodhandlers in Nairobi (Kenya)
(2007) Otieno, Micheal Frederick; Hussein, Ahmed Abdulrahman; sharma, R. R.; kombe, Y.
Antibiotic resistance represents a serious problem for clinicians, veterinarians, community and government at large. This involves cost implications as far as treatment is concerned. Multiple drug resistance as a result of empirical treatment have rendered most drugs ineffective. In view of the above, this descriptive cross-sectional study, aimed at isolating resistant entero-bacteria E. coli from food-handlers working in both high and low budget hotels. Specimens in the form of stool were collected from 297 food-handlers in their respective hotels were considered and analyzed for resistant E. coli bacteria at KEMRI-Centre for Microbiological. Research (CMR), in Nairobi. Besides, questionnaires were administered in order to assess health-seeking behaviour of the study subjects prior to medical examination. Antibiotics used in this study were amoxicillin-clavulanic acid, co-trimoxazole,ampicillin tetracycline, kanamycin, gentamycin, cefuroxime and chloramphenicol. These antibiotics were chosen on the basis of their use in the management of enteric bacterial nfections. The results from high budget hotels (i.e. three, four hotels ( i. e two stars and below) indicates high frequency of resistance in both hotel categories was seen in co-trimoxazole.and five stars) and low budget resistance. The highest level of 66.3% in high budget hotels and 66.4% in low budget hotels. Resistance difference between high budget hotels and low budget hotels was not statistically significant (P=0.56681). This was followed by ampicillin showing resistance of 55% in high budget hotels and 46% in low budget hotels, (P=0.8235). Tetracycline showed a resistance level of 34% in high budget hotels and 58% in low budget hotels, (P=0.2835) and co-amoxyclav showed resistance of 37% in high budget hotels and 38% in low budget hotels, (P=0.5074). The P-value results clearly indicate no significant relationship between taking medication by food-handlers prior to medical examination and the pattern of antibiotic resistance. Comparatively, the resistance pattern for the antibiotics tested is somehow the same for low and high budget hotels, indicating that, irrespective of the hotel category, if those working in hotels are potential carriers of drug resistant E. coli, then the category of hotel is irrelevant and either has a potential of transmitting resistant E. coli.
Arboviruses and Blood Meal Sources in Zoophilic Mosquitoes at Human-Wildlife Interfaces in Kenya
(Mary Ann Liebert, 2020) Musa, Ali A.; Muturi, Margaret W.; Musyoki, Abednego M; Ouso, Daniel O.; Oundo, Joseph W.; Makhulu, Edward E; Wambua, Lillian; Villinger, Jandouwe; Jeneby, Maamun M.
Background: Zoophilic mosquitoes play an important role in the transmission of arboviruses of medical importance at human-wildlife interfaces, yet arbovirus surveillance efforts have been focused mostly on anthropophilic mosquitoes. Understanding the diversity of zoophilic mosquitoes and their associated feeding patterns and arboviruses can inform better vector control strategies. Materials and Methods: We morphologically identified mosquitoes collected from two game reserves in Kenya, the Maasai Mara National Reserve (MMNR) and locations near the Shimba Hills National Reserve (SHNR). Representative mosquitoes were also identified by cytochrome c oxidase subunit 1 (COI) barcode sequencing. In addition, we identified the vertebrate hosts of mosquito blood meals from the contents of each mosquito’s abdomen by high-resolution melting (HRM) analysis and sequencing of COI, 16S ribosomal RNA, and cytochrome b gene PCR products. Similarly, mosquito arbovirus infections were identified by HRM analysis and sequencing of Alphavirus- and Flavivirus-specific RT-PCR products. Results: Of 2858 mosquitoes collected, 51 were engorged with blood meals from seven different vertebrate hosts, including humans, birds, domestic, and peridomestic animals and wildlife. Culex was the most abundant mosquito genus, with Culex pipiens being the most abundant species in both study regions. Among MMNR samples, we detected dengue serotype-2 virus (DENV-2) for the first time in Aedes tarsalis and Aedes tricholabis, as well as Sindbis virus in male Cx. pipiens.We also detected DENV-2 in Aedes aegypti sampled from locations near the SHNR. Human and diverse wildlife blood meals were identified, including bushbuck blood in the dengue-infected Ae. tarsalis and both human and hippopotamus blood in a single Eretmapodites chrysogaster mosquito. Conclusions: Our findings highlight the potential risk of sylvatic dengue and Sindbis transmission to humans by zoophilic mosquitoes at human-wildlife interfaces in Africa. Of specific importance, we provide evidence of sylvatic DENV-2 in Ae. tarsalis and Ae. tricholabis, representing potential new dengue vectors.
Assessment of electrolyte imbalance among benign prostate hyperplasia patients in Western Kenya
(International Journal of Research in Medical Sciences, 2023) Ongong’a, Royronald O.; Menza, Nelson; Demba, Rodgers N.
Background: Benign prostate hyperplasia (BPH) results in the enlargement of the gland and ultimately obstructs the bladder and the kidney. The effect on the kidney results in the dysregulation of the electrolyte causing electrolyte imbalance. Methods: An analytical cross-sectional study conducted at a tertiary teaching hospital aimed at assessing the levels and severity of electrolyte imbalance among BPH patients. The blood samples were analyzed for electrolytes and PSA levels for both patients and control group. An Independent t-test was used to compare the means of the BPH patients and healthy control subjects. Chi-square was used to determine the association between the electrolyte imbalance and the PSA levels of the BPH patients. Results: The mean age of the BPH patients and the healthy individuals was 65.47±12.55 and 64.52±12.19 years respectively. Hyponatremia, and hypernatremia were observed in 26.08% (n=104) and 4.22% (n=8) of the BPH patients respectively. There was a statistical significance positive correlation between potassium (K) and sodium (Na) concentrations (r=0.350, p<0.01) as well as a notable positive association between chloride (Cl) and magnesium (Mg) levels (r=0.288, pp<0.01). PSA biomarker levels varied among the patients. There was a statistical significance (<0.0001*) difference in PSA levels between the BPH patients and the control group. Conclusions: With high prevalence of electrolyte imbalance among BPH patients there is a need to monitor the electrolytes and PSA levels in the management of BPH aiming at restoration of kidney function.
Assessment of voiding function in inhabitants infected with Schistosoma haematobium.
(Tropical Pediatrics, 2011-08) Muhoho, ND; Watanabe, K; Mutua, WR; Kiliku, FM; Awazawa, T; Moji, Kazuhiko; Aoki, Y
Voiding function of Schistosoma haematobium infected students was evaluated in 45 schoolboys in Kwale district, Coast province, Kenya, using a questionnaire and uroflowmetry. Sixty-eight schoolboys who were S. haematobium negative were also examined. Symptoms related to the lower urinary tract were qualitatively assessed using the International Prostate Symptoms Score (I-PSS) questionnaire. The I-PSS showed that S. haematobium infected boys felt the need to strain to urinate and post voiding some urine still remained. To examine the disturbances revealed by I-PSS quantitatively, voiding was assessed by a portable uroflowmeter and a bladder scanner. Unexpectedly, no significant residual urine post voiding and no decline in urine flow rates were found in S. haematobium infected boys. However, volume-corrected maximum and average flow rates in S. haematobium infected boys were higher than in those not infected. These results suggest that cystitis associated with S. haematobium infection causes irritation and hypercontraction of the bladder.
Association between transient receptor potential melastatin genotypes and the prostate surface antigen levels in BPH patients
(International Journal of Research in Medical Sciences, 2024) Ongong’a, Royronald Ochieng; Menza, Nelson; Demba, Rodgers Norman
Background: Benign Prostate Hyperplasia (BPH) is a prevalent condition among older males, characterized by an enlarged prostate gland leading to lower urinary tract symptoms and impacting quality of life. Transient receptor potential melastatin (TRPM) genes regulate various physiological processes. Methods: We studied 194 BPH patients and 194 healthy controls, genotyping six selected TRPM gene SNPs. PSA levels were measured using the Cobas® e411 analyzer. Results: Prostate-specific antigen (PSA) levels were significantly higher in BPH patients (135.76±578.03 ng/mL) than in controls (2.01±1.09 ng/mL). TRPM2 (rs168355) and TRPM7 (rs2362295) genotypes were significantly associated with elevated PSA levels. The TRPM2 GG genotype was associated with decrease in the likelihood of severe PSA levels (OR=0.34, 95% CI: 0.12-0.96, P=0.034), while the TRPM7 CC genotype showed increased odds for severe PSA levels (OR=1.48, 95% CI: 1.08-3.56, P=0.041). Conclusions: Our findings suggest a potential link between TRPM gene variants and the severity of prostatic changes reflected in PSA secretions, indicating the need for further research to understand the underlying mechanisms and clinical implications.

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