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This collections contains bibliographic information and abstracts of PHD theses and dissertation in the School of Health Sciences held in Kenyatta University Library
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Item Aflatoxins in peanuts and the prevalence of aflatoxin induced hepatocellular carcinoma in Busia and Kisii Central Districts, Kenya(Kenyatta University, 2015-12) Chengo, Nelson MenzaAflatoxin is a carcinogenic toxin produced mainly by Aspergillus jlavus and contaminates foods including peanuts. Aflatoxin is associated with liver failure, hepatocellular carcinoma (HCC) and death. Many people are exposed to chronic levels of aflatoxins through consumption of contaminated foods. In Kenya, most efforts have been focused on aflatoxin in maize while other highly predisposed foods such as peanuts have received little attention. Also limited studies have been done to link aflatoxin to HCC. This study identified aflatoxin producing Aspergillus species and the type and levels of aflatoxin contamination of various varieties of peanuts (Arachis hypogaea L.) in Busia and Kisii Central districts. It also determined the peanut producers' exposure to aflatoxins and the prevalence of aflatoxin induced HCC among patients from the study districts. Cross-sectional and retrospective study designs with systematic random sampling technique were adopted. One hundred and two (102) peanut and urine samples were collected from peanut growers in each district and transported to Cooppers Labs, Nairobi for analysis. Aspergillus species' were identified using plate technique of serially diluted samples on modified Rose Bengal agar. Types and levels of aflatoxins were analyzed using high performance liquid chromatography (HPLC) technique while aflatoxin B (AFB) gual in urine was determined using fluorescence Spectrophotometer. Analysis of records for patients from Busia and Kisii Central districts who attended Moi Teaching and Referral Hospital in January 2010 to December 2012 was done to determine the prevalence of HCC among the study population. The diagnosis of HCC was confirmed by the presence of AFB 1 guanine adducts in urine or AFB 1 albumin adduct in blood. The levels of total aflatoxin ranges were 0.1 to 2681lg/kg and 1.63 to 591.11lg/kg in peanuts from Busia and Kisii Central respectively. Majority of peanuts samples had levels within Kenya Bureau of Standards (KEBS) and European Union (EU) regulatory limits for total aflatoxins. Aflatoxin type Bl was the most dominant (t = 12.4, df= 3, P = 0.034). Overall, the occurrence of Aspergillus jlavus L strain and A. flavus S strain were significantly higher than other species identified (H = 15.55, df= 4, P = 0.004) in peanuts from the two districts. However, A. jlavus S-strain was the most dominant species (F=3.15, df=25, P=0.031) with an overall mean occurrence of 45.1%. Oil content in peanuts decreased with an increase in aflatoxin levels (r = -0.496, P = 0.031) except in peanuts of Uganda local red variety from Kisii Central. Overall, males in both districts had slightly higher incidences (9.8%) of exposure to urinary Aflatoxin B than females at 5.4%. The prevalence of aflatoxin induced HCC among the patients was 19.73%. There is need for urgent awareness through campaign among the peanuts producers on the aflatoxin levels and promote sound practices when handling peanuts. Continuous screening of patients with liver disorders should be done for early detection of HCC. The high levels of aflatoxins in peanuts suggest the necessity to screen other foods consumed in the study areas. The findings will form basis of policy development for aflatoxin contamination control and management of aflatoxin induced HCC in Kenya.Item Analyses of class and subclass antibody of circulating immune complexes in children with severe plasmodium Falciparum malaria in endemic regions of Western kenya(2011-08-04) Mibei, Erick KipsangPlasmodium falciparum infection is characterized by deadly complications such as severe malaria-associated anaemia (SMA) and cerebral malaria (CM)The exact mechanisms underlying pathogenesis of these severe forms of Plasmodium falciparum malaria are not fully understood yet they are associated with a lot of morbidity and mortality. Studies have shown a link between severe P. falciparum malaria and levels of circulating immune complexes (CIC) but the exact role of these CICs in the pathogenesis of severe P. falciparum malaria is still unclear. This study aimed to investigate the quantitative and qualitative differences in antibody classes and subclasses in serum immune complexes (ICs) between children with the severe forms of P. falciparum malaria and those with uncomplicated malaria as well as identifying the predominant P. falciparum antigens that contribute to IC formation in these clinical groups. A total of 75 children with SMA and 32 children with CM were enrolled from hospitals in western Kenya and matched with 74 and 52 control children respectively with uncomplicated symptomatic malaria. IC levels were measured using solid phase ELISA protocols and antibody classes and subclasses were identified using polyspecific sera for the classes or monoclonal antibodies for the subclasses. ICs were purified using polyethylene glycol (PEG) precipitation. The isolated ICs were dissociated by using an acidic buffer (GlycineHCL pH 2.0). These were then electrophoresed on one-dimensional and two-dimensional polyacrylamide gel blotted by Western transfer and probed using human anti-P. falciparum antibodies. The study showed a general increase in levels of ICs as a result of P. falciparum infection in severe malaria cases and their symptomatic controls. Although IgG IC levels were elevated in children with severe malaria upon enrolment, children with CM had the highest levels of ICs for all the antibody classes. Conditional logistic regression showed a borderline association between IgG4-contaning ICs and increased risk of SMA (OR = 3.11, 95% CI 1.01 to 9.56, P = 0.05). Total IgGcontaining ICs (OR = 2.58, 95% CI 1.20 to 5.53, P < 0.02) and IgE-containing ICs (OR 3.27, OR I .38 to 7.78, P < 0.01) were associated with increased risk of CM. Six specific falciparum antigens were found to be associated with severe malarial anaemia while another three antigens were associated with cerebral malaria when compared to their specific controls. While when SA and CM where compared together, a 91Kda antigen was highly associated with SA (P < 0.01), while a slightly lighter antigen of about 87 Kda was significantly associated with CM (P < 0.01). These findings have demonstrated quantitative and qualitative differences in ICs in children with SMA and CM and this underscores the potential mechanisms of the pathophysiology of the disease. Furthemore the findings of this study suggested having higher IgG4-containing ICs is a risk factor for SMA while higher IgG and also IgE-containing ICs are both associated with CM pathology. This suggest that although SMA and CM were characterized by high levels of ICs, the class and subclass make up of these IlCs as well as the role that they play in each may be distinct. This study demonstrated an association between malaria antigens and severity of the disease hence there is need for full characterization of the parasite antigens. These findings may contribute to a better understanding of the role of different antibody classes and subclasses in protective or damaging mechanisms and may provide new insights into development of effective malaria control strategies and vaccine development.Item Analyses of class and subclass antibody of circulating immune complexes in children with severe Plasmodium Falciparummalaria in endemic regions of Western Kenya(Kenyatta University, 2010-06) Mibei, Erick KipsangPlasmodium falciparum infection is characterized by deadly complications such as severe malaria-associated anaemia (SMA) and cerebral malaria (CM).The exact mechanisms underlying pathogenesis of these severe forms of Plasmodium falciparum malaria are not fully understood yet they are associated with a lot of morbidity and mortalitv. Studies have shown a link between severe P. falciparum malaria and levels of circulating immune complexes (CIC) but the exact role of these CICs in the pathogenesis of severe P. falciparum malaria is still unclear. This study aimed to investigate the quantitative and qualitative differences in antibody classes and subclasses in serum immune complexes (lCs) between children with the severe forms of P. falciparum malaria and those with uncomplicated malaria as well as identifying the predominant P. falciparum antigens that contribute to IC formation in these clinical groups. A total of 75 children with SMA and 32 children with CM were enrolled from hospitals in western Kenya and matched with 74 and 52 control children respectively with uncomplicated symptomatic malaria. IC levels were measured using solid phase ELISA protocols and antibody classes and subclasses were identified using polyspecific sera for the classes or monoclonal antibodies for the subclasses. ICs were purified using polyethylene glycol (pEG) precipitation. The isolated ICs were dissociated by using an acidic buffer (Glycine- HCL pH 2.0). These were then electrophoresed on one-dimensional and two-dimensional polyacrylamide gel blotted by Western transfer and probed using human anti-F. falciparum antibodies. The study showed a general increase in levels of ICs as a result of P. falciparum infection in severe malaria cases and their symptomatic controls. Although IgG IC levels were elevated in children with severe malaria upon enrolment, children with CM had the highest levels of ICs for all the antibody classes. Conditional logistic regression showed a borderline association between IgG4-containing ICs and increased risk of SMA (OR = 3.11, 95% Cl 1.01 to 9.56, P = 0.05). Total IgG-containing ICs (OR = 2.58, 95% Cl 1.20 to 5.53, P < 0.(2) and IgE-containing ICs (OR = 3.27, OR 1.38 to 7.78, P < 0.01) were associated with increased risk of CM. Six specific P. falciparum antigens were found to be associated with severe malarial anaemia while another three antigens were associated with cerebral malaria when compared to their specific controls. While when SA and CM where compared together, a 91Kda antigen was highly associated with SA (P < 0.01), while a slightly lighter antigen of about 87 Kda was significantly associated with CM (P < 0.01). These findings have demonstrated quantitative and qualitative differences in ICs in children with SMA and CM and this underscores the potential mechanisms of the pathophysiology of the disease. Furthemore the findings of this study suggested having higher IgG4-containing ICs is a risk factor for SMA while higher IgG and also IgE-containing ICs are both associated with CM pathology. This suggest that although SMA and CM were characterized by high levels of ICs, the class and subclass make up of these KCsas well as the role that they play in each may be distinct. This study demonstrated an association between malaria antigens and severity of the disease hence there is need for full characterization of the parasite antigens. These findings may contribute to a better understanding of the role of different antibody classes and subclasses in protective or damaging mechanisms and may provide new insights into development of effective malaria control strategies and vaccine development.Item Analysis of manual liquid-based cytology, histopathology and HPV DNA testing among HIV positive women at Machakos level 5 hospital, Machakos County, Kenya(Kenyatta University, 2022) Mutuku, Onesmus Muia; Scholastica Mathenge; Mutinda C. Kyama; Wachuka NjorogeLiquid-based cytology is a technique of preparing a monolayer of cells by washing the cells in a phial of liquid fixative and spreading a thin layer of the sample on a glass slide. This enables a better morphological assessment of the cells, thus increasing the detection rate of cytological abnormalities. In the developed countries, the liquid based cytology technique is fully automated; however, in developing countries, the approach is undermined by its unavailability and related costs. Although conventional Pap smear examination is the primary approach for early detection of cervical cancer, it has shortcomings such as presence of obscuring materials like blood, mucus, and inflammation; hence, the sensitivity is reduced considerably. Contrary, manual liquid based cytology technique increases specimen adequacy rate and improves precursor lesions and cervical cancer detection by its ability to overcome the shortcomings experienced in Conventional Pap Smear. The main objective of this research was to compare the performance of manual liquid based technique versus that of histopathology and assess the utility of its remnant samples in detection of high risk Human Papilloma Virus. Through the use of a Manual liquid-based cytology, a prospective study of 400 cases was evaluated for pre-cancerous lesions and cervical cancer at Machakos County Hospital among women attending the Comprehensive Care Centre. Purposive sampling method was applied to obtain the study population. The principal investigator screened all the Pap smears and a pathologist reviewed all the abnormal smears. All participants with features of high-grade squamous intraepithelial lesions and above based on cytological results were referred for histopathology. In all remnant samples with abnormal lesions encompassing atypical squamous cells of unknown significance and above, detection of Human Papilloma Virus 16 and 18 was done using a real time Polymerase Chain Reaction. Chi-Square test was used to relate the groups’ nominal categorical data appropriately. Cohen Kappa test was performed to establish the exact level of agreement among HPV DNA testing, histopathology, and Manual liquid based cytology. The prevalence of cervical lesions in this study was 7.8%. There were 41 (10.3%) cases of bacterial vaginosis recorded in this study. Out of the 25 samples tested for High-risk HPV DNA, 18 (72%) were positive while 7 (28%) were negative. Ten women were referred for biopsy and histopathological examination. Of those 10, 4 (40%) had CIN II, 3 (30%) had CIN III, 2 (20%) showed features of squamous cell carcinoma while 1 (10%) was found to have chronic cervicitis. There was moderate agreement between histopathology and high risk HPV DNA testing; k=0.574, (95% CI, .41 to .60), p =0.11. There was substantial agreement between histopathology and high risk HPV DNA testing; k=0.615, (95% CI, .61 to .80), p =0.035. Overall, manual liquid based cytology was found to have a moderate level of agreement with histopathology with ability to preserve remnant samples for adjunctive tests such as HPV DNA detection; therefore, it can be considered a substitute screening method in limited resource settings.Item Anti-leishmanial activity of acacia mellifera (leguminosae: momosoideae) against leishmania Major(2011-12-02) Mburu, Faith WambuiLeishmaniasis is a major group of parasitic diseases in the tropical regions. Their public health importance requires integrated measures in order to ensure effective control of the disease. Chemotherapy is the mainstay of control with pentavalent antimomal agents still widely used as the drugs of choice. However. these drugs are associated with many undesired effects, which include renal and cardiac toxicity. nlyalgia, anthralgia. pancreatitis, gastrointestinal problems. cardiac arrhythmia and sudden death. I he antimonials are also very expensive, and require a long period of administration. Subsequently. the search for compounds with possible antileishmanial activity is growing. A lot of locus is currently being given to natural products. It has long been known that plants are a rich source of compounds with potential medicinal uses. ,Acacia mellifera subsp. mellifera is a recognized medicinal plant used for conditions such as malaria pneumonia, sterility, stomach problems and primary stages of syphilis. However_ limited information is Available on its isolated metabolites. The main objective of this study was to determine whether A. mellifera has any antileisllnlanial activities. To achieve this. the stem bark and leaves of .A. mellifera were extracted using methanol and dichloromethane then extracts evaluated against Leishmania major promastigotes and alnastigotes in limo. Further fractionation on dichloromethane extracts yielded nine fractions designated as fractions I-IX. The effects of extracts as well as fractions were evaluated both in cell free media and using infected macrophages. To evaluate the immunostimulatorv activities of the extracts, production of nitric oxide in supernatants from macrophages stimulated with extracts was detected by Griess test. All tests were done in triplicate. Statistical analyses of the results obtained were done by analysis of variance. chi-square and Kluskal-Wallis test. Results revealed that extracts containing a combination of methanol and dichloromethane had the highest activity against L. major promastigotes in cell-free culture. 100%) mortality was observed on promastigotes cultured with 5mg/ml of the methanol and dichloromethane crude extracts. The methanol and dichloromethane stem bark extracts, however. did not inhibit the transformation of L. major alnastigotes into promastigotes (P>0.05). The stem bark methanol extract had the lowest infection rate of 41.35%. Infection rates of' the extracts compared to a positive control had a difference (x2 =13.89; df=9: P>0.05). The fractions of dichloromethane had a statistically significant difference in their infection rates (F=6.827: df=4.15: P<0.01). Fraction VII had the lowest infection rates of 30% at 250mg/ml and also the lowest IC50 of' 54.19pg/ml. Close in its activity were fractions Vlll and IX. Results for immunostimulatory activity among the fractions of dichloromethane indicated that there was no significant production of nitric oxide (P>0.05). These results suggest another possible mechanism of action of the fractions other than through stimulation of nitric oxide production. A comparison of the immunostimulatory effects between the methanol and dichloromethane indicated production of nitric oxide by the methanol extract. There was a difference (H4,4,4,4= 14.04: P<0.05). The results from this study demonstrate that Acacia mellifera indeed has activity against Leishmania major parasites. This is a major contribution toward attainment of the Millenium Development Goal that seeks to combat disease.Item Anti-ulcer activity and safety of mupal ® in a rat model: a herbal product for management of peptic ulcer disease in Kenya(Kenyatta University, 2021-08) Kahiga, Titus Muhu; Nicholas K. Gikonyo; Peter. K. Gathumbi; Julius W. MwangiPeptic ulcer disease (PUD) is a deep gastrointestinal erosion that affects the stomach and the duodenum. There are pharmacological (using conventional drugs) and surgical interventions that form part of management. These interventions have drawbacks, including resistance and adverse effects of conventional drugs. In Kenya, Mupal® powder, a herbal product, has been used to treat peptic ulcers and related disorders for many years. However, a full scientific audit on Mupal® has never been done. The objective of this study was to evaluate Mupal® through an animal model to provide background information on its efficacy, safety, and identification and do a comparative analysis with conventional therapy (Omeprazole) and banana powder in the treatment of peptic ulcer disease. Water and methanol extracts of Mupal® and banana powders were prepared by maceration at room temperature. Mupal® and banana water suspension were prepared by suspending Mupal® powder in distilled water. White albino rats were used as animal models for both toxicity and efficacy investigations. Ulcer induction in animals was done using 1 ml of 100 % ethanol, and treatment was done with water as a negative control, Omeprazole as a positive control, and Mupal® as the test. Histopathological changes were observed on the first day and the sixth day. For acute toxicity, 250,500 and 1000 mg/kg doses of Mupal® suspension were administered daily for 14 days, and their weights, food intake were monitored; any signs of toxicity were noted. On the 14th day, the animals were sacrificed to study gross histology. The animals were subjected to three doses of Mupal® suspension (250, 500, and 1000 mg/kg) for the sub-acute toxicity study for 28 days and a ten-day recovery period. Their weights and food intake were monitored, and gross histology was studied. In vivo studies were done to test the effect of a Mupal® extract on clinical isolates of H. pylori. Some pharmaceutical parameters of Mupal® powder were determined. Efficacy results indicated that Mupal® suspension was comparable to Omeprazole in ulcer scores, acid-lowering, and histological findings. The results showed Mupal® was safe on both acute and sub-acute studies at 250 mg/kg doses. However, Mupal® did not have any antimicrobial effect on Helicobacter pylori. Pharmaceutical parameters investigations revealed that Mupal® contains high levels of saponins and moderate levels of flavonoids. TLC results showed that Mupal® had more compounds as compared to bananas. The current study demonstrated that Mupal® is a safe alternative, efficacious herbal medicine in managing ethanol-induced peptic ulcers in rats. The results warrant further studies that could involve long-term double-blind clinical trials.Item Antimicrobial Resistant Escherichia Coli Genes in Children Aged Below Five Years Presenting with Diarrhoea at Thika Level 5 Hospital, Kiambu County, Kenya(Kenyatta University, 2015-10) Kang'ethe, Kamwati StanleyDiarrhoea is one of the leading causes of illness and death among children in developing countries, where an estimated 1.3 billion episodes and 4 to 10 million deaths occur each year in children less than 5 years of age. The study envisioned to determine the genetic basis of extended spectrum β-lactam (ESBL) resistance in E. coli isolated from children aged below 5 years attending Thika Level 5 Hospital Kiambu County in Kenya. Faecal samples were obtained from 384 children presenting with diarrhoea. A questionnaire was used to collect data concerning the age of the child, gender and additional information recorded included on history of hospitalization and antibiotic use. Samples were sub-cultured on MacConkey agar and suspect E. coli isolates identified. Antimicrobial susceptibility profiles were determined for the most common antimicrobials against Gram-negative bacteria. The types and prevalence of Extended-Spectrum βeta-Lactamases were also determined. Polymerase Chain Reaction methods were used for detection of the Extended-Spectrum βeta-Lactamases genes and carriage of integrons. Conjugation experiments were performed to determine the potential of horizontal transfer of resistance genes. The plasmid content for defining diversity of plasmid replicon types was also determined among donors and transconjugants. Approximately 25% of all isolates were resistant to ampicillin, tetracycline, chloramphenicol, streptomycin, amikacin sulphamethoxazole-trimethoprim and amoxicillinclavulanic acid (p=0.0051; OR=2.27; 95% CI: 2.01-2.33). Isolates (50%) had a Minimum Inhibitory Concentration mode50 value within the resistance range except for ceftazidime, Gentamicin, chloramphenicol, Nalidixic acid, Ciproflocin and Kanamycin. Factors identified to predispose children to carry highly resistant isolates included recent history of hospitalization and antimicrobial use and having acute diarrhoea (p=0.0026; OR=4.21; 95% CI: 3.76-4.98 ) There was no significant difference in antimicrobial resistance patterns for isolates from rural and urban children (p=0.049). Carriage of a combination of blaCTX-M+ blaTEM or a combination of blaCTX-M+blaOXA genes was highly associated with resistance to multiple β-lactams (p=0.00015; OR=2.31; 95% CI: 1.99-2.65). Isolates with multiple β-lactamases were also likely to carry integrons encoding resistance to other antimicrobials. Plasmids that mediated resistance to most antimicrobials belonged to incL/M, HI2 and F-type. In conclusion, most of isolates recovered from these children were resistant to first line treatment for diarrhoea and therefore a need to revise the existing empiric treatment of E. coli infections. Resistance was transferrable via conjugation and integrons were significantly implicated in resistance dispersion hence increase in the prevalence of multidrug resistant isolates (p=0.0017; OR: 4.03; 95% CI: 3.81- 4.04). There is a need to encourage parents and doctors to follow the treatment guidelines for diarrhoea in which case, the oral re-hydration therapy zinc and vitamin C rather than antibiotics should be administered in cases of watery bacillary diarrhoea, implement proper antimicrobial use polices and launch national surveillance programs to monitor emergence and spread of MDR isolates.Item Antivenin activity of herbs commonly used in Kenya against dendroaspis polylepis (black mamba) snake bite(Kenyatta University, 2023) Mwangi, Gladys Wangechi; Nicholas Kamindu Gikonyo; Joseph Kangangi Gikunju; Charles Githua GithinjiItem Assesment of health-related fitness status of 6-9 year old primary shool pupils in Mukono and Wakiso Districts, Central Uganda(2011-08-10) Nsibambi, Constance Adron NakayizaDespite a world-wide increase in health-related diseases and conditions among children, little information is known about the children's health-related fitness status in Uganda. Assessment of the fitness status of pupils aged between 6 and 9 years in Mukono and Wakiso districts in central Uganda was conducted using physical fitness testing. The study also determined their level of engagement in physical activities. A cross-sectional survey research design was used to assess four health-related fitness components. These were cardiovascular endurance using a 9-minute run test, body composition using BMI method, low back flexibility using the sit and reach test and abdominal muscular strength/ endurance using the sit up test. The target population comprised of 25,500 school children drawn from public and private schools. Four thousand pupils formed the sample for the study. The actual sample consisted of 1929 pupils with 922 day scholars and 1,007 in boarding schools. Data was analysed using frequencies, percentages, means and standard deviation and one way analysis of variance at 0.05 level of significance. The AAHPERD (1980) percentiles and the WHO (2007) CDC-BM1 for sex- age-growth charts percentiles to determine the fitness status of the pupils. The results showed that out of the 922 day scholars 250 (27.1%) had weak cardiovascular endurance, 27 (2.9%) were underweight, while 58 (6.3%) were overweight, 29 (3.1%) were obese; 707 (76.7%) had poor flexibility and 798 (86.5%) had weak abdominal muscles. On the other hand, out of the 1007 pupils in boarding schools 307 (30.5%) had weak cardiovascular endurance, 50 (5%) were underweight, while 79 (7.8%) were overweight, 50 (5%) were obese, 824 (81.8%) had poor flexibility and 814 (80.9%) had weak abdominal muscles. The results revealed significant differences in cardiovascular endurance, hody composition and abdominal muscular strength/endurance between day and boarding pupils (p>0.05) with day scholars having higher mean distance run scores, lower mean BMI scores and lower mean sit up scores. There were no significant differences in the mean sit and reach scores between day and boarding pupils. However, majority of pupils achieved the recommended standard for the cardiovascular endurance and normal body composition. There were also significant gender differences in all the health-related fitness components. The boys had higher mean distance run scores, lower mean BMI scores, lower mean sit and reach scores and higher mean sit up scores. This implies that more boys had better cardiovascular endurance, normal weight and better muscular strength/endurance than girls. On the other hand, more girls were flexible than boys. The study revealed that the pupils demonstrated poor health-related fitness status especially in abdominal muscular endurance and low back flexibility. The study also revealed that most pupils met the recommended 60 minutes of daily physical activity although the activities they engaged in were not appropriate enough to develop most of the health related fitness components. It is recommended that more physical activities that develop the health-related fitness should be integrated in the school curriculum and children need to engage in more active behaviours.Item Assessment of risk behaviour and HIV prevalence among people who inject drugs in Nairobi county, Kenya(2014-08-18) Oguya, Francis Ochieng’Kenya is experiencing a mixed HIV epidemic with characteristics of both „generalised‟ epidemic among the mainstream population, and a „concentrated‟ epidemic among specific Most at Risk Populations including Injecting Drug Users (IDUs). The KNASP 2009-2013 recognizes that this group has a high potential to transmit HIV and present a lot of challenges for effective intervention because of overall lack of data on how to access them, their numbers and distribution. The objectives of the study were to document Injecting Drug Use Practices, assess the behaviours that predispose IDUs to risk of HIV infection, estimate the HIV prevalence among IDUs and determine the services available for HIV and AIDS prevention, care and treatment among IDUs in Nairobi county. Using a cross-sectional survey design on IDUs who had been injecting drugs for the last twelve months in Nairobi. The study used Respondent Driven Sampling methodology for its proven effectiveness in sampling hidden populations. Key Informant Interviews, Focus Group discussions and a structured questionnaire were used for data collection. The study was approved by the KNH/UoN Ethical Review Board. The study comprised 344 (322 men, 22 women) respondents from the eastern and western regions of Nairobi. Written and verbal informed consent was voluntary provided by all respondents. RDSAT software, MS Access, MS Excel and SAS were used for data management, presentation and statistical analyses. Statistical methodology comprised descriptive statistics, cross tabulations and Multivariate Logistic Regression on HIV status with other predictor variables. Chi squared tests were used to test significance at 0.05. The age range for study respondents were from 17 to 55 years. Although awareness of HIV was universal, their knowledge of HIV transmission and prevention ranged from limited and severely limited. The HIV prevalence for IDUs was determined to be 18.3% with women exhibiting higher prevalence (37%) compared to men (17%). Injecting drug use commenced early from 11 years and the age group exhibiting the highest HIV prevalence ranged between 15-29 years among both genders. Residential location (χ2 =19.2, 2df, p<0.0088) and sex of respondent (χ2 =25.1, 1df, p<0.0001) were found to be highly associated with HIV status. Significant behavioral variables were age at first drug injection (χ2 =11.4, 4df, p<0.04), Reason for starting to inject - a better high (χ2 =5.0, 1df, p<0.02), sharing needles and syringes (χ2 =8.9, 2df, p<0.01), Injecting with HIV positive person (χ2 =18.3, 2df, p<0.0001), Injecting with a female injector (χ2 =5.8, 2df, p<0.04). Significant risky sexual behaviours comprised Unprotected sex with multiple partners (χ2 =9.2, 3df, p<0.03), casual sex with HIV positive partners (χ2 =6.3, 2df, p<0.04) and transactional sex (χ2 =20.6, 6df, p<0.0021). The study found that specialised health and support services for IDUs were minimal or non-existent. HIV prevention, health management and drug treatment services for IDUs do not exist and may be contributory to the high HIV risk being experienced by this group. Due to risky injecting and sexual behaviours, HIV prevalence for IDUs was three times the national average. The findings in this study showed extensive vulnerability of IDUs to HIV infection and identified lack of knowledge and awareness of HIV transmission and prevention; lack of IDU friendly health and drug treatment services, antagonistic national policies and negative societal attitudes were the key associative factors. Based on this, the study recommends urgent, comprehensive and targeted intervention programs comprising of contextualized IEC and BCC interventions on risks associated with drug use; provision of free injecting equipment; national campaign to in school and out of school youths at risk of drug use; provision of free, convenient and IDU friendly medical treatment and drug treatment for IDU; HTC and ART treatment.Item Assessment of selected Antibiotics and Heavy Metals in untreated Wastewater, Vegetables and Soils in Eastern Nairobi, Kenya(2014-02-26) Mathenge, Scolastica Gatwiri; Wanjau, R. N.; Kenji, G.M.Untreated wastewater contains pharmaceutical compounds and heavy metals harmful to human health and the environment. People get access to untreated water through broken sewer pipes, blocked manholes and direct disposal into rivers. One such river is the Ngong River which passes through Nairobi County including Njiru and Ruai. People use untreated wastewater for growing of vegetables and washing cars. Soils and vegetables grown or irrigated with untreated wastewater may contain high levels of antibiotics and heavy metals that are detrimental to health. Sulfamethoxazole (SMX) and trimethoprim (TMP) antibiotics, administered in synergy for the management of pneumocystis carinii pneumonia, pneumocystis jiroveci pneumonia, toxaplasmosis and genitourinary tract infections in HIV-AIDS patients or in cases of oral thrush infections. The two drugs are also cheap and readily available in synergy over the counter even through self-prescription for management of upper respiratory tract and genitourinary tract infections under the brand name septrin or co-trimoxazole. In synergy, the two drugs are also administered to poultry and livestock as growth promoters, prophylaxis and to control microbial infections. Their presence in vegetables could induce microbial resistance and minimize drug sensitivity. The heavy metals may emanate from the waste water discharged by the small scale industries that are based in the study site. However, reports on levels of antibiotic residues and heavy metals in untreated waste water, vegetables and soils in Kenya are very scarce. Therefore this study aimed to determine the concentration of sulfamethoxazole (SMX) and trimethoprim (TMP), Cd, Pb, Zn, Mn, Fe and Cu in the soil, untreated waste water and vegetables irrigated with the untreated waste water in Ruai and Njiru. Untreated wastewater, soil and vegetables were collected during the dry season from various sites in Ruai and Njiru from small scale farms along Ngong River. The samples were also obtained from a control plot at the Kenyatta University. The samples for heavy metal analysis underwent wet digestion pre-analysis procedures while for antibiotics underwent solvent extraction pre-analysis. The heavy metals were determined by atomic absorption spectroscopy while antibiotic residues were determined by high performance liquid chromatography. The heavy metal concentrations in the vegetables ranged from 81.88 to 633.05 mg/kg. The mean concentration for Fe in the vegetables ranged between 481.24 to 1215.49 mg/kg for Mn, 1.94 to 4.58 mg/kg for Cd, 2.19 to 4.46 mg/kg for Pb, 3.19 to 8.70 mg/kg for Zn, 21.17 to 29.70 mg/kg for Cu, 24.71 to 27.52 ng/L for TMP, and 4.93 to 22.64 ng/L SMX. Some of these values were above the local and international safety limits. The concentrations (mg/L) of the heavy metals in untreated wastewater ranged from 3.09 to 3.54 for Mn, 0.01 to 0.03 for Zn, 0.21 to 0.28 for Pb, 4.79 to 8.07 for Fe, 0.17 to 0.22 for Cu and 0.42 to 0.47 for Cd. In the untreated wastewater SMX ranged from 62.09 to 88.66 ng/L. The vegetables TMP concentration ranged from 2.16 to 15.45 ng/L. The levels of some heavy metals and antibiotics were significantly higher than those from control samples. In all cases the results in the farms upstream were higher than in those downstream. The results from this work will be availed to relevant authorities for policy formulation and they can be used to sensitize the public, especially on the antibiotic residues.Item Assessment of the Quality of Medical Laboratory Service Provision in Kenya(Kenyatta University, 2014) Njoroge, Wachuka Gathigia; Michael Otieno; Geoffrey MuluviThere has been increasing interest to improve the quality of laboratory services world- wide including in many resource poor countries. In tandem with this need, the Kenya government recognizes the delivery of quality laboratory services as an integral part of the national health care strategy. Towards this goal the surveillance system for quality medical laboratory services in Kenya was instituted by the Kenya Medical Laboratory Technicians and Technologist Board. However, Kenya still has very little concrete and reliable information on the actual standard adaptation, and implementation, or the impact policy guidelines have had on laboratory services delivery. The objective of this study was to address these gaps by carrying out a situational analysis to assess the quality of medical laboratory services delivery in Kenya. The specific objectives of this research were to assess the laboratory practitioner’s competence; to determine the level of compliance to practice standards; to investigate the management of quality systems; and to analyze the extent to which the patient’s needs for quality laboratory services were met. As a representation of each of the regions in Kenya the study areas were situated in Nairobi, Mombasa, Kisumu and Nyeri counties. The study was both an observational and descriptive study using a cross sectional design. Purposeful sampling was used to select the laboratories while as random sampling was used for the laboratory practitioners and patients. The data was analyzed by the measures of central tendency mode, median and mean plus measures of variability, range, standard deviation and variance. Data was analyzed using least squares regression model, t-tests and one way analysis of variance (ANOVA) using Excel spreadsheets and SPSS version 19. The overall assessment was that the quality of medical laboratory services delivery in Kenya was good. The highest level of quality management systems were maintained by private high class laboratories p > 0.052, p > 0.05, α = 0.05 which also had the highest rating of compliance to practice quality p < 0.022, p < 0.05, α = 0.05. Faith based laboratories had the highest rating in competency of practitioners p < 0.027, p < 0.05, α = 0.05. Analysis of patients perception of quality service provided p < 0.039, α = 0.05 indicated that the private low class laboratories fared the best p < 0.030, α = 0.05. Findings of this research were that the laboratory practitioners were competent, the practice characteristics were of good standard and patients perceived the services to be of good quality. The study failed to reject the null hypothesis (p > 0.05) pertaining to the quality management systems in place p < 0.057, α = 0.05. No laboratory had adequate quality management systems in place. The recommendation of this study is there is a need for adequate internal and external quality assurance schemes to be in place to constantly monitor the quality of assay results.Item Associating genetic resistance to plasmodium falciparum malaria infection with ethnic groups residents of malaria endemic and non-endemic regions of Kenya(2011-08-11) Ayodo, GeorgeMalaria causes death of millions of people in sub-Saharan Africa and about 80% are children and women under 5 years of age. Infection has therefore exerted pressure on human genome and as a consequence clinical manifestations appear variable in endemic and non-endemic populations. Part of the reason for this epidemiological difference is hypothesized that over the last few thousand years, endemic populations have built up genetic resistance to severe malaria infection. To test this hypothesis, the study searched for evidence of natural selection in malaria exposed and unexposed populations by (a) carrying out a large-scale collection in Kenya of severe malaria cases and controls from the Luo ethnic group and also of population controls from the Masai and Kikuyu ethnic groups, (b) carrying out an association study at 10 genetic variants previously associated with malaria resistance, (b) studying frequency differences across populations to determine which of these variants have been subject to selection for malaria resistance in the past few thousand years, and (c) also studying haplotype and linkage disequilibrium patterns around malaria resistance genes to search for evidence of natural selection. In the Luo case-control samples, the previously described associations at CD36-GT (P value < 0.004) and HbAS (P value = 0.015) were replicated. Strikingly, there was unusually high frequency differentiation of the HbAS and CD36-GT variants in the exposed (Luo and Yoruba) vs. relatively unexposed (Kikuyu and Masai) populations compared to a panel of 1,454 randomly chosen markers that were studied in the same samples (P < 0.00036 and 0.00096 respectively). By statistically combining the case-control association and frequency differentiation statistics, the power of the association analysis was increased by several orders of magnitude (HbAS with P value < 0.0000 18 and CD36-GT with P value < 0.00043), which provides a potential tool for researchers to find risk factors for infectious disease in future. Further assessment o€ haplotype blocks flanking HbAS-T, CD36-G and ICAM-T suggested that exposed and un-exposed populations exhibit different haplotype block patterns, supporting the evidence of natural selection. CD 36GT appears to be under selection in both the Luo and Yoruba ethnic group, whereas HbAS is under selection in the Yoruba ethnic only but not in Luo ethnic groups. These results suggest Yoruba and Luo-perhaps because they are on different sides of the African continent-evolved different genetic response to malaria because they had been exposed to the disease for thousand years. This study has not only developed a novel method to identify malaria variants but has also provided an insight on the possibility of exploiting haplotype block patterns to map causal genesItem Community integrated management of childhood illness: role of the "dialogue model" as an interactive communication tool(2011-08-15) Othero, Doreen MalobaCommunity Integrated Management of Childhood Illnesses (CIMCI) is one of the three components of the Integrated Management of Childhood Illness (IMCI) strategy, a holistic approach that aims at lowering Infant and child morbidity and mortality in developing countries. CIMCI targets changing household child care practices in order to enhance child survival. Implementation of CIMCI is majorly based on interactive communication between health service providers and mothers/caregivers of children aged below five years. The aim of this study was to test the effectiveness of the "Dialogue Model" as an interactive communication tool for implementing Community IMCI. The model was applied to 18 key household childcare practices that were identified to cause infant and child morbidity and mortality. A longitudinal comparative study was carried out in three out of the five divisions of Nyando district, Kenya. The study was done in six distinct phases. Both qualitative and quantitative approaches were used in data collection, analysis and presentation. Baseline quantitative data was collected using a semi-structured questionnaire that was administered to 930 randomly sampled mothers and caregivers. Qualitative data was collected through Key Informant Interviews and Focus Group Discussions. Quantitative data was analyzed using SPSS and Epi Info and generated frequencies, cross tabulations, ODDS Ratios and Chi-Square computations. Results of the baseline survey on key household childcare practices revealed that majority 481(77.0%) and 222(73.5%) of the mothers in the proposed intervention and control areas weaned their children before 4 months of age hence the strong correlation between weaning and prevalence of diarrhoea (CI 1.11-2.96 and 1.11-2.96) respectively. Only 64(10.2%) and 49(16.3%) of the children in the two study areas underwent growth monitoring after 9 months of age. A minority 91(14.6%) and 43(14.2%) of respondents in the proposed intervention and control areas confirmed that fathers' participated in the daily care of the children implying that the burden of routine childcare rests on the mothers. Treatment of drinking water was found to be minimal as only 199(31.8%) and 110(36.4%) respondents in the two study areas affirmed that their children drunk treated water. It was also established that only 196(31.4%) and 79(26.2%) of the mothers underwent HIV testing during pregnancy. Following training of health workers on the "Dialogue Model" majority 176(72.2%) of mothers/caregivers reported that health service providers spent at least 15 minutes examining their children, 181(74.0%) acknowledged having been counseled while 206(84.4%) received follow-up dates. Results following implementation of the "Dialogue Model" showed significant improvement in most of the household child care practices. Majority 430 (68.8%). of the children in the intervention area now undergo growth monitoring beyond 9 months unlike only 73(24.3%) in the control area. A large proportion 552(88.3%) of mothers in the intervention area is currently treating drinking water compared to 158(52.4%) in the control area. However, culture bound household practices such as fathers' participation in child care showed no improvement despite implementation of the "Dialogue Model". Similarly, HIV testing during pregnancy showed very minimal improvement. Prevalence of IMCI classified diseases such as measles, diarrhoea and aneamia showed significant reduction following implementation of the "Dialogue Model". The conclusion from this study was that the "Dialogue Model" was an effective tool for enhancing household child care practices and also improved communication between health workers and the mothers/caregivers. However, it was recommended that further research be done to establish another communication approach that could positively change culture bound household child care practices such as fathers' participation in routine childcare. To enhance uptake of HIV testing during pregnancy, there was need for change in the implementation policy so that male partners are involved in the counseling and testing process together with their female partnersItem Consistency of stools as an indicator of type of intestinal parasites harboured by patients with abdominal pain at Kenyatta National hospital, Nairobi, Kenya(2011-12-02) Githigaro, Peter MathengeAbdominal pain is a common problem reported to clinicians for various ailments. Hospital records in Kenya show that high percentage of patients suffers from abdominal pain. Among the causes of abdominal pain are intestinal parasites. Intestinal parasites include protozoa and helminthes living in the intestine of animals and human. They are among the most common infections in developing countries. About 3.5 billion people worldwide are infected with intestinal parasites without considering those with abdominal pain. There are many people living with intestinal parasites without knowing. The impact of these parasites on public health has been under estimated, although they cause considerable morbidity and mortality. The main objective of this study was to determine whether consistency of stool could be used as an indicator of type of intestinal parasites causing abdominal pain in a patient. Patients being investigated for intestinal parasitic infections in the clinical laboratory were interviewed and a sample size of 400 patients suffering from abdominal pain selected. Stools of patients were macroscopically examined to determine their consistency; both direct saline and formal-ether concentration methods were used to identify parasitic agents. Stool specimens with eggs of Taenia species were stained and eggs differentiated to species using modified Ziehl-Neelsen stain technique. Harada-Mori culture technique was done on positive stools with hookworm looking like eggs in order to differentiate the worm species. Data was analyzed, and association among stool consistency, age groups, sex and intestinal parasites were tested using chi-square. Of the 400 patients 164(42.0%) had acute abdominal pain, 181(45.3°/x) had chronic abdominal pain and 55(13.8%) had recurrent abdominal pain. The consistency of stools from those patients were 218(54.5%) formed, 95(23.8%) soft, 78(19.5%) loose and 9(2.3%) watery. Stools from 79(19.75%) patients had inclusions; those with pus cells were 44(11.0%), mucus 33(8.25%), blood 23(:5.75%) and yeast cells 15(3.75%). The results show 27.5% of patients complaining of abdominal pain had intestinal parasitic infections. The most prevalent helminth was hookworm (2.5%) while the most prevalent protozoan was Blastocystis hominis (10.75°/). The study show stools from patients complaining of acute abdominal pain had higher amount of water than stools from patients with ether chronic or recurrent abdominal pain (x2=47.3, df=6, P=0.000). Patient's complains of different duration of abdominal pain was not related to presence of intestinal parasitic agents in stools (x2=72.55, df 64, P=0.207). There was no association between intestinal parasitic infections and consistency of stools (x2=0.000, df 3, P=1.000). Patients of 36-40 years age group had the highest number 50% of parasitic infection eases than any other age group (x2=38.52, df=10, P<0.001). The findings from this study provide a general awareness among KNH practicing physicians the need of laboratory diagnosis of stools, in confirming clinical findings when treating patients with abdominal pain.Item Determinants of adherence to anti-retroviral therapy and high risk behavior among HIV infected patients on treatment in Nairobi Province, Kenya.(Kenyatta University, 2009-10) Oyore, J. P.Anti-retroviral therapy (ART) has been successful in dramatically decreasing the morbidity and mortality caused by HIV infection. Levels of adherence in excess of 95% are required to ensure treatment success, adequate viral load suppression, improved immune status and slowing of the disease progression. It has also been reported that a lot of complacency during ART and feeling of reduced infectivity by the patients on ART could lead to high risk sexual behaviour and enhance transmission of HIV. To date there is very little scientific data on ART adherence, factors influencing it and any resultant high risk behaviour in Nairobi, Kenya. This was a non -interventional cross-sectional study using rapid appraisal techniques for collecting both qualitative and quantitative data. The main objective of this study was to determine the levels of adherence, factors influencing it and identify any resultant high-risk behavioural changes during ART among patients in selected treatment sites in Nairobi Province, Kenya. A combination of data collection tools was used to gather the information in this study including semi -structured questionnaires, adherence measurement tool and FGDs. Qualitative data was consolidated using data matrices. Analysis of qualitative data was done by triangulation based on major themes or constructs. Quantitative data was analyzed using the statistical package for social scientists (SPSS) version 16.0. Hypothesis testing was done using Chi-square and Kruskal-Wallis tests to test the significance of the categorical variables. T-tests and Mann U Whitney tests (non -parametric tests) were used to assess the differences between groups for continuous variables. Multistage sampling design was used since convenience sampling was used to determine the health facilities after which systematic sampling was used to select the patients to be interviewed. The results indicated that just about half ,216 (48%) of the PLWHA had accurate knowledge of what ARVs were and what they do to the body. There was a significant relationship between knowledge of ARVs and adherence with those having more accurate knowledge more likely to adhere (X2 = 106.432 df = 7, p :s 0.001). The composite adherence ART level of adherence from the three methods used among patients in Nairobi was found to be 85% with 43% of the patients not achieving optimal adherence. The major factors that were found to constrain adherence were costs (X2 = 306.02, df= 7, p:S0.001), lack of social support (X2 = 0.804, df= 7, p~O.997), side effects (X2 = 92.583, df= 7, p:S 0.00), distance to the facility, gender (X2 = 104.006, df= 7, p:S0.02) , CD4 count at start of treatment. The results also indicated that a good proportion 342 (76%) of the patients who had been on treatment for over six months had engaged in high risk HIV transmission behaviour by either having sexual intercourse without protection or with partners of unknown HIV status. Quality of care is affected by lack of adequate supply of drugs and training of health workers. These findings will help policy intervention towards improving access and adherence to ARV through carefully planned and evaluated interventions. Furthermore, it will lead to the improvement of the quality of medication discussions and care so that both patients and care providers receive and understand the information they need, enable patients to accurately assess their readiness to initiate and adhere to ARV, identify gaps between knowledge and actual practice both for health workers and PL WHA. The information will also be given to the PL WHA to enable them reduce the high risk sexual behaviour that may predispose them to HIV re-infection. Itis recommended that there should be more education and information provided to the patients prior to initiating ART so that they know the facts about ARVs. In conclusion, the study found that majority of patients on ART does not achieve optimum adherence levels and that 342 (76%) of patients on ARVs are engaging in risky sexual behaviour. The study also recommends more targeted counseling be provided by the care providers highlight the importance of adherence hence promoting adherence among the patients. There should also be improved education targeting the PLWHA to sensitize them and remind them that they are not free of HIV and AIDS v n af r b ing on tr atm nt and that th y would still t r -infected by other strains of HIV.Item Determinants of adherence to Anti-Retroviral therapy and high risk behaviour among HIV infected patients on treatment in Nairobi province, Kenya(2011-07-25) Oyore, J. P.Anti-retroviral therapy (ART) has been successful in dramatically decreasing the morbidity and mortality caused by HIV infection. Levels of adherence in excess of 95°/, are required to ensure treatment success, adequate viral load suppression, improved immune status and slowing of the disease progression. It has also been reported that and feeling of reduced infectivity by the patients on ART could lead tonhance transmission of HIV. To date there is very little scientific data on ART adherence, factors influencing it and any resultant high risk behaviour in Nairobi, Kenya. cross-sectional study using rapid appraisal techniques for collecting both qualitative and quantitative cl.ita. The main objective of this study was to determine the levels of adherence, factors influencing it and identify any resultant high-risk behavioural changes during ART treatment sites in Nairobi Province, Kenya. A combination of data collection tormation in this study including semi -structured questionnaires, adherence measurement tool and FGD,. Qualitative data was consolidated using data matrices. Analysis of qualitative data was done by triangulation based on major themes or constructs. Quantitative data was analyzed using the statistical package for social scientists (SPSS) version 16.0. Hypothesis testing was done using Chi-square and Kruskal-Wallis tests to test the significance of the categorical variables. T-tests arametric tests) were used to assess the differences between groups for continuous variables. Multistage sampling design was used since convenience sampling was used to determine the health facilities alter which systematic sampling was used to select The results indicated that just about half ,216 (48%) of the PLWHA had accurate knowledge of what ARVs were and what they do to the body. There was a significant relationship between knowledge of ARVs and adhere (x2 imal adherence. The major fact((x2 rt= 0.804, df = 7, p<_0.997), side effects = 92.583, df = 7, p <_ 0.00), distance to the facility, gender 104.006, df =7, p<0.02) , CD4 count at start of treatment. The resproportion 342 (76%) of the patients who had been on treatment for over six months had engaged in high risk HIV transmission behaviour by either. having sexual intercourse without protection with partners of unknown HIV status. Quality of care is affected by lack of adequate supply of drugs and training of health workers. These findings will help policy intervention towards improving access and adherence to ARV through carefully planned and evaluated interventions. Furthermore, ii will lead to the improvement of the quality of medication discussions and care so that both patients and care providers receive and understand the information they need, enable patients to accurately as their readiness to initiate and adhere to ARV, identify gaps between knowledge and actual practice both for health workers and PLWHA. The information will althem reduce the high risk sexual behavior that may predispose them tded that there should be more education and information provided to the patients prior to initiating ART so that they know the facts about ARVs. In conclusion, the study found that majority of patients )n ART does not achieve optimum adherence levels and that 342 (76%) of patients on ARVs are engaging in risky sexual behaviour. The study also recommends more targeted counseling be provided by fie care providers highlight the importance of adherence hence promote. There should also be improved education targeting the PLWHA to sensitize them and remind then that they are not free of HIV and AIDS even after being on treatment and that they would still get re-infected by other Strains of HIV.Item Determinants of socio-cultural risks factors in HIV infections among the muslim community in Kenya(2011-08-11) Karama, Mohamed; Orago, A. S.; Moji, KazuhikoHIV and AIDS continue to devastate many areas of the world. Africa and especially Sub Saharan Africa remains the epicenter for the pandemic. In Kenya despite declining prevalence, the incidence remain high. This is as a result of among others risk taking behaviours and resistance to change. Muslims form 25 to 30% of the population of Kenya and despite the low prevalence among them, little is known about their socio-cultural risk factors in relation to HIV infection. The aim of this study was therefore to determine the knowledge and perception of the Muslim on HIV and AIDS, to identify risk practices among them. This was a cross sectional study where both qualitative and quantitative data collection methods were used countrywide and during two national Muslim leaders consultative workshops and other workshops at the district levels. Focus group discussions, in-depth interviews with key informants and administration of a questionnaires for quantitative data on knowledge and attitude was undertaken. Data analysis included running frequencies for percentages and the use of chi-square to determine the difference in risk perceptions between males and females. There are about 2300 mosques 4800 madrassas (Muslim schools), 99 secular schools, 20 Muslim managed health facilities and about 1000 community organizations. There is an extensive Islamic teaching that can be useful in addressing HIV related problems. Knowledge levels measured as percentages of the community who got the right answers ranged between 38% to 97% with women being less informed but the difference is not significant (p=<0.06). Knowledge levels were superficial with less details on prevention and management of HIV. National average for perceived prevalence was 2.6% with Northern Kenya being lowest at less than 1 % and Nyanza being highest at average of 5.5% an indicator of recognition of HIV as problem for all Kenyans. Risk priorities varied between regions with the coast identifying tourism related risk and the Northern region identifying cultural practices including polygamy divorce and female circumcision as a possible risk practices. In Northern Kenya and the Coast, divorce rates and polygamous marriages were estimated to range between 15 and 30% and 10 to 30% respectively. The transport industry especially long distance truck drivers a preference for Muslim businessmen, taxis, and other public transport are of general concern countrywide. There was significant difference in the perception of risk between men and women (p =<0.001). There is need for more coordinated involvement of Muslims and the mainstreaming of HIV control and prevention within the physical and social infrastructure and the Islamic teachings. More research should be undertaken to better understand the implications of the risk practices in the spread of HIV in the Muslim community in Kenya. The results of this study helped in the development of a Muslim policy on HIV in KenyaItem Development and application of a geo-medical information decision support system (geo medinfo) for malaria surveillance and risk modelling in Nyanza Province, Kenya(2011-08-04) Mogere, Nyaribo StephenIn sub-Saharan Africa, malaria is a leading cause of morbidity and mortality. Detailed knowledge of spatial variation of malaria epidemiology and associated risk factors is important for planning and evaluating malaria-control measures. This study therefore investigated an approach in the development and application of a GIS-based healthcare management system with abilities to incorporate climate-based risk predicators of malaria transmission in Nyanza Province. Two sites, Siaya district and Kisii Highlands were selected to implement this study. The PMIS was designed with capabilities to carry out both micro- and macro-levels spatial epidemiologic analyses of malarial transmission. Using Universal Modeling Language (UML) and Microsoft Visio 2003 health data classes, relationships, attributes and data types were modeled which formed the basis for customizing and design of the Patient Management Information System (PMIS). A tailor-made PMIS was then implemented to capture malarial data alongside patient care in Siaya District Hospital, a rural health facility in Nyanza Province, Kenya. A total of 822 malarial case households were tracked and mapped using the Global Positioning System (GPS) and entered into the PMIS. In addition, malaria monthly cases from a total of 127 health facilities in Kisii Highlands were obtained for the period between 1996 and 2005 alongside data on rainfall, Normalised Difference Vegetation Index (NDVI), temperature and Digital Elevation Model (DEM) as possible predicators of malarial risk in the study area. Spatial analyses results revealed that the average distance traveled by study participants to Siaya District Hospital (SDH) was 6km while the longest distance was about 13.15km. There was a significant positive correlation between distances of malaria case households to the health facility, proximity to water bodies and malarial outcomes at 0.05 level of significance (P<0.005). However, no significant differences (p<0.005) were found between malarial case households and controls with regard to proximity to local road network. Regression modelling of malarial transmission in the Kisii Highlands revealed associations between rainfall, NDVI, temperature and DEM and malaria cases in the three administrative districts of Nyamira, Kisii and Gucha. These factors had varied influence on malaria risk transmission with the DEM found to explain most of the malaria case variations in the study area. Geospatial risk models developed for malaria transmission predictions were validated using F-test. The study recommends further testing and validation of both PMIS and the spatial predictive malaria risk model in other parts of the country. The study concludes that it is feasible to develop GeoMedlnfo in broader health information sharing nationally, designed as a tool for improved diagnostics, planning and management programming of malarial surveillance system.Item The effect of selenium intake in progression of asymptomatic hiv type 1 infected children in Nyamasaria Sub county Kisumu County Kenya(2015) Otieno, Samwel BoazThe prevalence of the Human-Immuno-deficiency Virus has been observed to be inversely related to selenium levels in foods. More recent Demographic Health Surveys have shown that despite the prevalence of HIV reducing by half in Kenya the prevalence in Kisumu County still remains twice the National prevalence, which suggests that there could be other factors involved in HIV epidemiology in the County. The hypothesis of this study was that selenium intake does not cause rapid progression of to AIDS from HIV infected children in Kisumu County. The main objective was to determine the effect the intake of yeast selenium on CD4 T cells and Weight for Age Z Score in HIV positive children (3-16 years). In this study a total of 68 HIV positive children were registered in the study to asses the efficacy of selenium. Yeast selenium (50μgm) was given to 34 children while the remaining 34 were put on a placebo.Blood samples and weight of the both groups were taken at 3 months intervals from 0, 3months and 6 months. The blood samples were analyzed by Enzyme Linked Immunosorbent Assay for CD4T cells while Weight for Age Z score was analyzed by Epi.Info version 3.4 and SPSS version16 for significance.In the study it was shown that children on selenium had progressive improvement of WAZ and which was significantly different at six months between children on selenium and the controls {F (5,12) = 5.758, P=0.006}.By using -2 standard deviations Z scores as a measure of cut-off, 15% boys and no girl on selenium was wasted at six months. Among the controls 64% of boys and 38% of girls were wasted at six months. The children on selenium had weight gain of up to 2.5 kilograms in six months. There was a significant mean increase CD4 T cell count at six months among the children on selenium,{ t( 1, N=30) = -2.943, p=0.006} compared to the matched controls {t =(1,N=30) =1.258 p= 0.0.0218}. CD4 T cell count increased among all age groups on test,3-5years (+ 267.1),5-8 years (+200.3) 9-15 years (+71.2) cells/mm3 . In matched controls a decrease was observed in all age categories, 3-5 years (-71),5-8 years (-125) and 9-13years (-10.1) cells/mm3 . There was no significant difference in CD4 T cell count between boys {F (2, 32) = 1.531 p= 0.232} and between girls {F (2, 49) = 1.040, p= 0.361} and between boys and girls {F (5, 81) = 1.379, p= 0.241} among the children on test. Similarly no significant difference was observed between boys and girls {F (5, 86) = 1.168, p= 0.332} in matched controls. In the test group there was a significant positive correlation between weight for age (WAZ), and CD4 T Cell Count p=0.007, R2= 0.252, F<0.05, β =252.23.There was a significant correlation observed between Weight for Z score and CD4 T cell count{ t( 2, N=27) = 2.94 p=0.007} with β = +252.23 and adjusted R² of 0.2016..In matched controls no significant correlation between weight for age Z-Score and CD4 T cell count change was observed at six months{ t (2, N=26) =0.08 p = 0.934} with β coefficient of +3.366 and adjusted R² =0.0337 .No positive correlation was observed among the children on selenium between CD4 T Cell count, and gender {t (2,27) = -0.69 p=0.0.495} with β coefficient of -138.23. Similarly in a matched control there was no significant correlation between CD4 T cell count and gender {t (2, N=26) = -0.90 p= -0.380} with β coefficient of -135.50.Majority (96.78%) of children on test either remained or progressed to WHO immunological stage I. It can be concluded that selenium intake slowed the rate of progression to AIDS from HIV positive patients as shown by increase in CD4 T cell count and further that there was no significant response between girls and boys. It is recommended that selenium be given as supplement to the HIV positive children on WHO clinical stage I to III as away of delaying progression to WHO stage IV.
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