PHD-Department of Community Health

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Effectiveness of a Mobile Phone Based Intervention in Improving Medication Adherence among Hypertensive Patients in Nyeri County, Kenya
(Kenyatta University, 2023-12) Mutua, Ernest Muthami
Globally, non-adherence to prescribed medications is identified as a major barrier to blood pressure control among persons living with hypertension. Uncontrolled hyperten sion is a leading risk factor for heart disease, kidney disease, stroke and general poor health. In Kenya, over a quarter of the adult population is estimated to be living with hypertension, with only 12.5% of them having their blood pressure under control. This study sought to evaluate the effectiveness of a mobile phone based intervention in im proving medication adherence among hypertensive patients on follow-up in Nyeri County. The study adopted an interventional design conducted in two phases. In phase I, a total of 339 hypertensive patients attending two tertiary care hospitals (Consolata Mathari Mission Hospital and Nyeri County Referral Hospital) were enrolled in a base line cross sectional survey to assess the extent to which they were adhering to their pre scribed medicines, and also to explore the factors associated with their medication tak ing behavior. In phase II, a two arm parallel randomized controlled trial comprising of 120 patients who had been found to be non-adherent to their prescribed medicines in phase I was undertaken to evaluate the effectiveness of a mobile phone based interven tion in supporting medication adherence. Participants in the experimental arm received the study‘s mobile phone based intervention on top of the usual care offered in the out patient clinic, while those in the control group were continued on the regular care only. The mobile phone intervention comprised of text messages and voice calls to deliver hypertension related health education to patients allocated to the experimental arm. The primary outcome variable of the study was medication adherence, which was assessed using a validated medication adherence questionnaire and calculation of the proportion of days a patient was covered with medication (PDC) during the follow-up duration. Nearly half (46.6%) of the 339 patients who participated in the baseline survey were non-adherent to their prescribed medications. After fitting a multivariate logistic regres sion model, the factors that were significantly associated with antihypertensive medica tion non-adherence included: having poor hypertension knowledge (adjusted odds ratio (AOR), 5.6, 95% CI, 3.3, 9.4); being on multiple medications (AOR, 2.8, 95% CI, 1.7, 4.7) and receiving two or more daily doses of medications (AOR, 2.3, 95% CI 1.3, 4.0). In the randomized controlled trial, it was established that the study's mobile phone based intervention led to a statistically significant medication adherence improvement effect over a 6 month period of follow up; patients who had received the mobile phone based intervention were 6.1 times more likely to be adherent than those who had been on usual care only (95% CI 2.6, 14.3). The intervention also resulted to a significant improvement in blood pressure control; at the end of follow up, patients who were in the experimental arm were 4.6 times more likely to have achieved the target blood pres sure level compared to their counterparts in the usual care group (95% CI, 2.0, 10.3). The intervention also led to an improvement in patients‘ knowledge and perceptions about hypertension and the need for persistence with medication use. Overall, this study found that use of an educational mobile phone based intervention was effective in en hancing medication adherence among patients on hypertension treatment. Given the central role of medication adherence in hypertension management, the intervention may be considered as an additional component in the comprehensive care given to patients living with hypertension.
Advancing Breast Cancer Screening Uptake, Knowledge and Attitude through Mobile Phone Text Messaging among Women in Homa Bay County, Kenya
(Kenyatta University, 2024-02) Odhiambo, Felix Blair
Breast cancer is responsible for many deaths globally, especially in poor countries like Kenya. This is attributed to inadequate screening services, low knowledge on breast cancer among women besides poor access to advanced and early treatment. The problem worsens in rural areas where most people dwell. Mobile health (m-health) can improve screening and has revolutionized health sector by increasing drug adherence and clinical patient management. The purpose of this research was to investigate the possibility of improving breast cancer knowledge, attitude and screening among women in Homa Bay County, Kenya through education given using mobile phone-based text messaging service. This was a quasi-experimental design using a sample size of 340 women with intervention arm and control arm each having 170 participants. Questionnaires were used to collect both baseline and end line data among women. Ten key informant interviews were also done. Descriptive and inferential statistics were used to analyze quantitative data. Qualitative data were categorized and analyzed thematically. Test difference between baseline and end line was done using independent t test. Chi square test was applied in testing association for categorical variables. Statistical significance was set at p value less < 0.05. Predictors of breast cancer was estblished using logistic regression analysis. The result was presented in tables and charts. The results revealed low breast cancer screening amongst women in Homa Bay County with 9.7% and 9.6 % of women having gone for BC screening in the intervention and control control respectively. At end line, the screening levels were 32.3% and 19.9 % in the intervention and control respectively. There was an increase in knowledge on breast cancer and breast cancer screening after the intervention with an attributable percentage of 12.4 %. The knowledge levels tested insignificant indicating that knowledge levels were not adequate at both baseline and end line (t=0.5925 df = 8, p value= 0.5699 and (t = 0.2849, df = 8, p value= 0.7829). Significant barriers to breast cancer screening were knowledge (t=5.503, df 571, p =0.000), distance to screening facilities (t=1.908, df 564, p=0.047), and screening cost (t=0.035 df 565, p=0.050). Furthermore, there was a significant change in knowledge towards breast cancer and breast cancer screening (M = 44.4, SD = 16.1) and after (M = 50.1, SD = 15), t (17) = 6, p < 0.001). there was no significance influence on mobile based education on the altitude of women towards breast cancer screening. Sociodemographic factors related to breast cancer screening at the baseline was religious affiliation (2 =9.651, p =0.048). A multiple logistic regression revealed those who take alcohol were more likely to go for screening of breast cancer (OR =2.909, P value =0.016, β=1.068) and having a family member ever diagnosed with cancer (OR =1.950, P value =0.017). The results of this study can inform public health practitioners on the possibility of using mobile health text messaging service as an education tool on breast cancer for increased knowledge and screening. This can be adopted by policy makers in cancer education, control and management.
Caregivers Performance in Care and Support of HIV & AIDS Orphans and Vulnerable Children in Homa-Bay County, Kenya.
(Kenyatta University, 2023-09) Misore, Juliana Achieng; Alloys Orago; Wilson Otenga
Caregiver practices, which are forms of support and resources made available at the household level within the community, may be of benefit to orphans and vulnerable children (OVC). Such a desire is essential in order to give orphans and vulnerable children access to the social determinants of health, which include health care, clean & safe water, a healthy environment, food, good housing, education, and income. The availability of all and or appropriate social determinants of health for orphans and vulnerable children is decreasing due to a number of factors. Such as high poverty, weak health, social, and community systems, and inadequate caregiver support programme. There are still no proven qualitative and quantitative methods, for measuring or quantifying caregivers‟ activities, which are critical in addressing inequities among orphans and vulnerable children. This study investigated care and support practice of caregivers toward orphans and vulnerable children in North and South Suba Sub-counties in Homa-Bay County. An analytical cross sectional survey design with mixed method was used to collect both quantitative and qualitative data. Quantitative data were collected using semi-structured questionnaires and observation checklist administered to 647 caregivers. Qualitative data were collected using focus group discussion, in depth and key Informant Interviews. Descriptive and inferential statistics were used to analyse quantitative data whereas qualitative data were thematically analyzed to complement quantitative date. Findings were presented using tables pie charts and bar graphs. A sizeable majority of caregivers, 47%, were unaware of the existence of organizations offering care and support services, demonstrating a weak organizational structure. The Cramers V test was used to determine the correlation coefficient of 0.162, which measured the “caregiver‟s inability‟‟ to provide for OVC adequately. Using chi-square P=0.008, the study found that caregiver participation in OVC initiatives was at a low level. The availability of clean, safe water and the prevalence of diarrheal morbidity were shown to be strongly negatively correlated, as indicated by the tetrachoric correlation coefficient value negative. According to the study's findings, 58% of OVC caregivers in Suba North and South Sub Counties of Homa- Bay had poor performance and make less than $1 per day. The study's findings' implications for academic researchers and MOH policy makers were also discussed. The study suggested the following for policy, practice, and additional research, in that order: Making policies that support the expansion of the Community Health Strategy accessible to caregivers and their families, improving caregivers' skills in providing personalized care for OVC, participating more in OVC programs and planning, monitoring, and assessing caregivers' activities to improve caregivers‟ performance in Suba Sub counties.
Influence of mHealth Short Message Service Utilization on Risky Sexual Behaviour among Adolescents in Homa-Bay County, Kenya.
(Kenyatta University, 2021) Muhonja, Faith Hope; Margaret Keraka; Phoebe Ndayala
Adolescents’ Risky Sexual Behaviours (ARSB) is a global public health concern as it is second among the top ten risk factors in the global burden of all diseases. It is estimated that 60% of adolescents in Homa-Bay County begin early sexual debut with 62% multiple sexual partners and low condom use. Consequently, Homa-Bay County has poor indicators of Adolescent Sexual and Reproductive Health (ASRH). Adolescent pregnancy rate is 38% and contributes 11.5% of adolescents 10-19 years living with HIV in Kenya. mHealth technology has exhibited positive Risky Sexual Behaviours (RSB) change however, it has not been optimized in the present Homa-Bay County. This study sought to assess the influence of mHealth SMS intervention on risky sexual behaviours among adolescents 15-19 years in Homa-Bay County, Kenya. Study design was experimental, Randomized Control Trial (RCT). A computer-based randomization of 28 villages/clusters was conducted and assigned to either control or treatment group at a ratio of 1:1 for a period of 6 months. A sampling frame of 1480 was generated and a sample size of 612 computed. Participants were randomly assigned to either the treatment group or control group at a ratio of 1:1. mHealth intervention was a 3 weekly interactive alert quiz text messages on ASRH. Ethical and logistical clearance was sought from relevant institutions. Data collection tools were questionnaire and key informant interview guide. Data analysis tools were Ms-Excel and Stata V 14 and thematic content analysis. Descriptive statistics was used to determine the prevalence of RSB, attitude and knowledge level. Logistic regression was used for inferential statistics (Pearson’s’ Chi-square, Fisher’s exact, Odds Ratio (OR), at a 95% Confidence Interval, C.I.) were used to determine association. The study recorded an overall RSB of 242(67.9%) at pre-test and 194(64.8%) at post-test. There was a significant association between mHealth SMS intervention and RSB (O.R.=1.728; C.I.=0.57-3.81; P=0.027; χ2=66.72). mHealth SMS showed an association with sexual activity (O.R.=1.031; C.I.=0.38-1.45; P=0.045; χ2=7.45) and condom use (O.R.=1.260; C.I.=0.93-1.19; P=0.037; χ2=23.18) but not on sexual partners and sex under drug/alcohol influence (P>0.05). Apart from sex (O.R.=2.016; C.I.=0.23-1.16; P=0.008) age (O.R.=1.033; C.I.=0.61-3.32; P=0.043) other factors showed no significant association (P>0.05) with RSB. Overall level of positive attitude towards RSB at pre-test was 79(22.1%) and 73(24.1%) at post-test. There was an association between mHealth SMS and adolescents’ attitude towards RSB (O.R.=1.916; C.I.=0.78-3.82; P=0.003; χ2=27.92). mHealth SMS had a positive influence on sexual activity P=0.075, safe sex P=0.033 and sexual partners P=0.009 but not on alcohol/drugs P=0.214. Overall score of ASRH knowledge was 131(36.7%) at pre-test and 124(40.9%) and post-test. There was an association between mHealth SMS and ASRH knowledge (O.R.=1.357; C.I.=0.16-2.79; P=0.004; χ2=34.26). mHealth SMS had a positive influence on conception & pregnancy P=0.034, condom use P=0.048 and HIV/AIDS/STI’S P=0.042 but not on contraceptives P=0.977. The study recommends public health policy makers to develop guidelines on mHealth SMS on ASRH education.
Effect of Health Education Intervention in the Management of Type-II Diabetes Mellitus among Adults Attending Garissa County Referral Hospital, Kenya
(Kenyatta University, 2022) Abdalla, Abdirahman; Ephantus W. Kabiru; Tom Were
Diabetes mellitus (DM) is a metabolic disorder that is characterized by hyperglycaemia due to defective insulin action and/or secretion. Diabetes mellitus type-2 (DM2) is the most common and a major public health burden in Kenya. It is projected to reach a prevalence of 4.5% by the year 2025. Effective interventions for DM2 comprise improving diabetes knowledge, individualized health education, lifestyle and behavioural change, monitoring body mass index (BMI) and diabetes control markers, as well as pharmacological interventions. Despite studies showing that health education and improved knowledge of diabetes predict improved plasma levels of diabetes control markers in the DM2 patients, these markers have not been used in the management and control of the disease in Garissa County. The main objective of this study was to establish effect of group health education in the control and management of DM2 at Garissa County Referral Hospital. This study utilized an unequal proportion prospective quasi-experimental study among a total of 152 adults stratified into intervention (cases, n=83) and control (n=69) groups. The cases were individuals with DM2 from among those (n=500) who were screened following fasting. The controls comprised DM2 patients on standard care. The study participants were purposively selected into each arm of the study. Structured questionnaires were used for collecting socio-demographic, socio-economic, and lifestyle data. The intervention group was offered group based standard health education program. Baseline and post-test measurements of the diabetes control markers were analysed in both the cases and the control group. Data analysis was done using IBM/SPSS version 27.0. Socio-demographic and socio-economic assessment indicated that the distribution of age, gender, education levels, marital status, monthly house-hold income, house-hold size, and familial history of diabetes was similar between the cases and controls. The prevalence of type-2 diabetes was 16.6%. Lifestyle evaluation indicated higher rates of smoking a pack of cigarettes daily (71.1% vs. 24.6%) or more than a pack of cigarettes daily (9.6% vs. 17.4%; χ2=33.289; df=2; P<0.0001) in the cases and controls, respectively. Overall levels of good knowledge in the cases and controls at baseline (57.8% vs. 72.5%; χ2=3.816; df=1; P=0.051); and after intervention (88.0% vs. 66.7%; χ2=11.058; df=1; P=0.001), respectively. Diabetic control marker analysis indicated that only HbA1c levels were significantly lower in the cases compared to controls at baseline (P=0.002). After intervention, BMI (P=0.005), HbA1c (P<0.0001) and fasting glucose (P<0.0001) were significantly lower in the cases relative to the controls. In addition, among the intervention group, the BMI, HbA1c, LDL-cholesterol, HDL-cholesterol, triglycerides and fasting glucose were significantly lower after intervention compared to baseline levels (P<0.01 for all). Altogether, these results indicate that group health education intervention had an effect in improving the levels of knowledge on diabetes as well as improving the levels of diabetes control markers. Thus, it is recommended that promotion of group-based health educational programs improves management of DM2.
Effect of Mhealth Technology in Enhancing Postnatal Visits amongst Mothers Attending Mch/Fp Clinics in Selected Hospitals in Kakamega County, Kenya.
(Kenyatta University, 2022) Ngigi, Charles Kiragu; Justus O. S. Osero; Anthony Wanyoro
Postnatal care is the provision of health services to the mother and newborn after delivery. It offers the opportunity to assess the mother for any medical, mental, emotional and social issues, and early assessment of risk factors and physical problems with the baby. Postnatal care services are offered by skilled health care workers during the postnatal visits. In Kenya mothers are expected to attend a minimum of four postnatal visits spread across the postnatal period though only a few do that. Globally, very few postnatal mothers seek postnatal services within two days. High maternal and neonatal mortality rate is observed during the first forty two days after child birth. This trend continues throughout the first year of the neonate. The main goal of the study was to determine the effect of mobile health technology in enhancing postnatal visits among postnatal mothers in Maternal Child Health and Family Planning (MCH/FP) clinics in designated health facilities in Kakamega County, Kenya. The study was designed as a cluster Randomized Controlled Trial (RCT) that involved four arms. In control arm the participants received only the routine written and verbal communication whereas in intervention arm 1, participants received routine verbal and written communication and mobile SMS, in arm 2 they received written and verbal communication and a voice call whereas in arm 3, the participants received written/verbal communication and combination of voice call plus Short Text Messages sent to remind them to visit the postnatal clinic. The reminders were packaged together with postnatal (PN) educational health messages. The research involved a study population of 320 postnatal mothers attending MCH/FP clinics. The study sites were purposively selected from four Sub Counties in Kakamega County. Study subjects were selected using a systematic sampling technique until the target was achieved. Quantitative and qualitative data was collected using interview, FGD and KII guides. Data was entered into Microsoft Access data base and analysed using SPSS version 24. At the baseline it was observed that 27% of the participants adhered to 2nd and 3rd postnatal clinic visits. After the intervention there was significant difference (χ²=28, df=3, p=0.001) between control and intervention arm. Majority of participants (82%) had no/low knowledge on postnatal care before the intervention, however there was significant difference in knowledge between control and study arms (χ²=113, df=9, p=0.000) after sending health messages. This study concluded that postnatal mothers in Kakamega County have low or no knowledge on postnatal care and only a few attend postnatal clinic within two weeks. This is likely to affect the uptake of postnatal services. Postnatal mothers had a positive attitude on use of mobile health technology in health care. There is a significant relationship between mobile phone reminders and adherence to 2nd and 3rd postnatal visit. Kakamega County government should integrate use of mobile telephone services packaged together with postnatal educational health messages in the provision of health services.
Exploring Ecological Factors and Child Sexual Abuse Disclosure at Thika Level 5 Hospital in Kiambu County, Kenya
(Kenyatta University, 2022) Wamuyu, Menja Eunice; Lucy Kathuri-Ogola; Joan Kabaria Muriithi; Taren Swindle
Child Sexual Abuse (CSA) is both a global and national social issue, as well as an epidemic in various societies. Many research studies classify CSA as a public health problem requiring early intervention practices and new policy changes to promote disclosure as well as protect children from sexual abuse. Non-disclosure of CSA only worsens and extends survivor’s suffering, and CSA long term effects can be devastating. Several studies have been done in the field of CSA and its health implications but rarely have previous studies addressed child sexual abuse disclosure (CSAD). The current study aimed at examining the Ecological Factors of CSAD at Thika Level 5 Hospital (TL5H) in Kiambu County, Kenya as explained by survivors, caregivers and service providers using a mixed method analysis. Interviews were conducted with 30 CSA survivors (25 girls and 5 boys: 5-17 years), 30 caregivers, and 10 health and service providers. Data collection included in-depth interviews and survey questionnaires. TL5H and participants were achieved through Purposive Selection. The study utilized the convergent QUAL (investigative open-ended questions and storytelling) design with a Quan component (structured survey) to identify CSA survivor’s experiences while receiving medical treatment and therapeutic intervention at TL5H. Descriptive and thematic approaches were applied to analyse qualitative data that revealed survivors’ lived experiences with CSA. For instance, survivors gave detailed accounts of types of threats and manipulation applied by perpetrators to stop them from disclosing abuse. Survivors said disclosing or not disclosing helped them cope with abuse trauma. Informed by Bronfenbrenner’s Socio-Ecological Model (SEM), saliency analysis was applied to code the recurring and important themes from the data in order to identify which factors (child, familial, perpetrator, and societal) played an important role in disclosure process. The findings showed that various factors were significant in enabling the child abuse survivors to narrate their stories. The age factor was important as those between 9-13 were more likely to disclose CSA. The gender perspective showed that the females and those with lower education levels were most likely to disclose CSA. Those under the care of females were more likely to narrate while those under threats were less likely to disclose sexual abuse. Religion was a significant factor as well as presence of institutional support in likelihood of the survivors to share their experiences. The Current findings, reinforced by literature, provide a more rational explanation of how some of the ecological factors, such as perpetrator’s characteristics, either encouraged or discouraged disclosure. Consequently, this study proposes the following multidisciplinary and multilevel approaches, aimed to increase CSAD and CSA awareness: (1) Policy makers must craft and enforce procedures to support and protect CSA victims; (2) The county government to allocate funding and resources for training service and health providers; (3) Teachers and higher education instructors to disseminate information and train caregivers, church leaders, community leaders, and first responders of Kiambu county in ways to support CSA survivors through the disclosure process. (4) All TL5H Clinical Management and Referral Centre staff be provided with more updated facilities that dispense updated treatment procedures during and after disclosure process; and (5) Kiambu County government to equip and empower all stakeholders and partners in the ecological model subsystems with CSA advocacy skills, victim protective and prevention programs; (6) All Kenyan adults should be involved in ensuring children’s safety by making mandatory reports for any CSA or any suspected cases. To close some critical gaps, further studies are recommended to address the current limitations and establish statistical significance of each of the factors in Child Sexual Abuse Disclosure.
Utilization of Mobile Phone Platform to Enhance Treatment Compliance among Type-2 Diabetes Outpatients in Thika Level 5 Hospital, Kiambu County, Kenya
(Kenyatta University, 2021) Kithuka, Beatrice A.N.; Margaret Keraka; Anthony Wanyoro
Type 2 diabetes results from body‟s ineffective use of insulin. Non-compliance to treatment makes metabolic control of type 2 diabetes mellitus impossible. There is need to educate, remind and empower patients with T2DM with knowledge about their condition. The use of SMS for reminders and health education is an innovation to improve patients‟ knowledge and perceptions on their condition with the resultant effect of enhanced treatment compliance among the patients. The main objective was to explore the utilization of mobile phone platform to enhance treatment compliance among type 2 diabetes patients in Thika level 5 Hospital, Kiambu County, Kenya. A randomized control trial was used with a sample size of 534 respondents evenly distributed into control and intervention arms. Selection of the study participants was by systematic sampling technique. Data was collected using quantitative and qualitative approaches. Descriptive statistical analysis was employed to describe participant‟s demographics characteristics. Bivariate analysis was applied on all categorical variables using chi-square and Fisher exact test. Factors that were found to be associated with the outcome at p<0.05 were considered for multivariate analysis, where binary logistic regression was applied. Treatment compliance level increased from 58.4% at baseline to 79.2% at endline in the intervention arm. Multivariate analysis using the logistic regression model showed monthly income to be a predictor of treatment compliance (P=0.0001). Respondents who earned more than or equal to Ksh 7,000 were 4.2 times more likely to comply with treatment compliance as compared to those who earned less than Ksh 7,000. Overweight/ obese as a risk factor for type 2 diabetes was a predictor of treatment compliance (P=0.0001). Respondents who knew that being overweight/obese is a risk factor for T2DM were 2.880 times more likely to comply to treatment as compared to those who did not know. Smoking as a risk factor for T2DM was a predictor for treatment compliance (P=0.012). Respondents who knew that smoking is a risk factor for T2DM were 1.9 times more likely to comply to treatment as compared to those who did not know. Knowledge that hypertension is a condition which may be complication for T2DM was a predictor of treatment compliance (P=0.02). Respondents who knew that hypertension is a complication for type 2 diabetes were 2.86 times more likely to comply to treatment as compared to those who did not know. Perception that patients are the most important persons in the management of diabetes was a predictor of treatment compliance (P=0.037). Respondents who perceived that patients are the most important persons in the management of diabetes were 2.166 times more likely to comply to treatment as compared to those who did not. Perception that untreated diabetes increases blood sugar levels was a predictor of treatment compliance (P=0.015). Respondents who perceived that untreated diabetes increases blood sugar level were 5.95 times more likely to comply to treatment as compared to those who did not. In conclusion, the use of mobile platform increased treatment compliance level by 20.8%. This study recommends introduction of mobile phone based continuous health education using mobile phone platform in creating awareness among type 2 diabetes mellitus patients at Thika level-5 Hospital thus assisting Kiambu County in allocating limited resources in high impact intervention.
Contraceptive Uptake and Adherence amongst Post Abortion Women Following Contraceptive Counselling By Physicians and Midwives in Kisumu County, Kenya
(Kenyatta University, 2020-12) Odero, Theresa Mary Awuor
Complications of unsafe abortion and those of incomplete abortion, led to 120,000 Kenyan women receiving Post Abortion Care (PAC) in 2012, and of these women, 70% had not used contraception before pregnancy and repeat abortion is common. The aim of the research was to explore contraceptive uptake, adherence to contraceptive use, associated factors and satisfaction with care among women seeking post abortion-care (PAC) in Kisumu, Kenya and to determine the technical competence of midwives as compared to physicians in terms of contraceptive counselling. The study (included 128 women in the quantitative study and 20 in the qualitative study) nested in a larger randomized controlled trial, where women sought PAC at two public hospitals in Kisumu, in October 2015–September 2017. The 128 women randomly assigned to a midwife or a physician for PAC, including contraceptive counselling, and followed-up after 7–10 days and three months. Associated factors for contraceptive uptake analyzed with binary logistic regression, and contraceptive method choice, adherence and satisfaction level examined by descriptive statistics, using IBM SPSS Statistics for Windows, Version 22.0 while framework analysis was used to analyze qualitative data. The results showed that of the 128 randomly selected PAC-seeking women, 95.3% accepted the use of contraception. The women were between the age of 15 and 40 years. Methods chosen after contraceptive counselling were hormonal injections (39%); contraceptive pills (33.3%) condoms (22.8%), hormonal implant (4.1%) and fertility (0.8%). None chose intrauterine device (IUD) or a permanent contraceptive method. After 3-months, follow-up 79.7% retained the chosen contraceptive method while 20.3% had changed the chosen type of contraception to another method. Women (96.1%) still used contraception, and were satisfied with the chosen contraceptive method (x2= 1.0112, df = 3, p =0.799). The twenty (20) women in the qualitative study selected from the 128 who had participated in the quantitative study, to determine their experiences of contraceptive counselling that was provided during counselling and provision of contraceptive methods. Women generally had positive experiences with contraceptive counselling from service providers and it helped them in making informed choice of contraceptives and were able to discuss the contraceptives in general and more in detail on the method of choice. Follow up visits well planned and women could visit facilities anytime they had a problem following post abortion care, before planned visits women were given a call a day before to remind them of visits. The counselling they received was effective in supporting contraceptive uptake and adherence. In conclusion, the study shows that there were no statistical difference in contraceptive uptake and adherence provided by midwives (98.5%) as compared to physicians (93.5%) in providing contraceptive methods to post abortion women effectively. Women have good experiences during interaction with midwives and physicians during counselling. Since the post abortion women were satisfied with the contraceptives counselling provided and services dispensed, meaning both physicians and midwives can provide services effectively therefore recommend the midwives to counsel and provide contraceptives to post abortion women.
Effectiveness of Albendazole on Soil Transmitted Nematodes Among School Going Children in Kakamega County, Kenya
(Kenyatta University, 2020-02) Ngonjo, Teresia Wambui
Soil-Transmitted Nematodes (STNs) are roundworms transmitted through faecally contaminated soil. Globally, major STNs include Ascaris lumbricoides, Trichuris trichiura and hookworm (Necator americanus and Ancylostoma duodenale). School going children are mostly affected by STN infections. STNs cause malnutrition, intellectual retardation and cognitive deficits. They are distributed worldwide, Kenya included and they are of public health importance. Kenya has embarked on mass deworming programs since 2012.The study is entrenched in school mass deworming programs. Kakamega county has high edemicity of STNs and treatment using albendazole has been going on since 2009. The main objective of the study was to determine the effectiveness of a single 400 milligram dose of albendazole against STNs infections. A longitudinal study was conducted in selected public primary schools selected through random sampling from three randomly selected sub counties, Kakamega East, Kakamega Central and Kakamega South in Kakamega County, in Kenya. A structured checklist was used to establish demographics of the school pupils and schools’ WASH conditions. Kato Katz technique examined STN infections both at baseline and follow up survey. The prevalence of infection was determined as the percentage of children that tested positive for each STNs species to the total number of children examined. Intensity of infection was determined using Arithmetic mean of the number of eggs per gram of feaces. A total of 731 children in baseline from seven primary schools provided stools and were examined for STN infections. A post treatment survey was conducted after two weeks where total of 665 children were examined. Effectiveness of albendazole was analyzed using prevalence reduction and the fecal egg reduction rate (ERR). Data was analyzed using STATA version 12.0. Associations were assessed between WASH predictors and STNs; Infection prevalence of either gender or age group was analysed using Pearson chi-square test. Infection mean intensity was assessed using two sample independent t- test and significance for age group was assessed using ANOVA test. Prevalence of infections based on 95% CIs was calculated using binomial logistic regression. Arithmetic mean expressed mean egg counts and negative binomial regression model estimated mean intensity. At baseline, STNs prevalence was 44.0% (95% CI: 35.8 – 54.2). Common STN was Ascaris lumbricoides. 43.5%. The baseline STN mean intensity was 3674 eggs per gram. There was significant prevalence reduction of combined STN prevalence infection to 2.3% (PR=94.9%, P=0.001). STNs mean intensity was significantly reduced from 3674 epg to 59 epg (ERR=98.4%, P=0.001). Prevalence of T. trichiura significantly reduced, 0.8% to 0 (100%, P<0.001). Pupil latrine ratio was significantly associate with STN infection intensity (χ2 = 3.7333, df=1, p=0.047).Imroved water source was not significantly associated with both lower infection prevalence (χ2 = 0.875, df = 1, p=0.350) or intensity (χ2 = 0.1944, df = 1, p=0.659). Hand-wash facility with water and soap did not associate with both lower infection prevalence (χ2 =0.4667, p=0.495). In this study, mass treatment with Albendazole was highly effective on the STNs. These findings are important to Ministry of Health and Ministry of Education in assessing the national deworming guidelines and policies. Mass Deworming programmes be extended to communities to ensure all possible transmission focal points are covered.
Use of Counseling to Mitigate Psychological Morbidity After Stillbirth Among Women in Kitui And Machakos Counties, Kenya
(Kenyatta University, 2019-11) Kanini, Caroline Mumbe
Stillbirth is a baby born without any signs of life weighing at least 1000grams or with at least 28 weeks gestation. There is no burden affecting families is big and yet invisible in society and global arena as stillbirth. Stillbirth is a traumatizing experience for most women and a risk factor to development of psychological morbidity. The kind of care women receive during this critical period influences exhibition of psychological morbidity such as depression, anxiety and post traumatic stress disorder which can be mitigated by counseling. Supporting psychological consequences of women enable them to take care of the present and subsequent children. The main aim of this study was to determine the use of counseling in mitigating psychological morbidity after stillbirth among women in Kitui and Machakos Counties. Specifically the study aimed to determine care offered to women after stillbirth, to evaluate psychological morbidity exhibited by women after stillbirth, to determine the effect of counseling on psychological morbidity after stillbirth, determine factors that influence psychological morbidity exhibited by women who deliver stillbirth after counseling and to determine the coping strategies employed by women after stillbirth. This was a quasi experimental study (non randomized controlled trial) with an interventional (Machakos County) and control group (Kitui County). Edinburgh Postnatal Depression Scale 1, Hopkins Symptom Checklist 25 (first 10 for assessing anxiety) and Impact of Events Scale-revised measured Depression, anxiety and post traumatic stress disorder respectively. Women in the interventional group were counseled while those in the control group received routine care offered by midwives in the ward. Descriptive and inferential statistics were used to analyze the data. Fishers exact test with significant p <0.05 was used to determine factors influencing psychological morbidity exhibited by women who delivered stillbirth after counseling. Student t test for unpaired and paired data determined the effect of the intervention between and within the study groups respectively. Significant variables were further subjected to multi-variable logistic analysis to measure the strength of the association and control for confounding factors. The study findings revealed that women received minimal psychological support on grief reaction, memories creation and need to ascertain the cause of death. Women who delivered stillbirth experienced depression, anxiety and post traumatic stress disorder. Counseling was found to mitigate the selected psychological morbidity in this study (all P values < 0.01). Various factors influenced psychological morbidity after stillbirth (p values: age = 0.05, education < 0.01, occupation = 0.04, years of marriage = 0.019, partners‘ education = 0.017, viewing the baby = 0.04, timing of death = 0.039, informed on the cause of death < 0.0108 and myths < 0.01). Key informants expressed need for professional and psychological support since they are also affected by the stillbirth experience to avoid compromising care offered to the women. The study concluded that counseling can mitigate psychological morbidity after stillbirth and women need holistic care from health care providers, families and communities where they live. The study recommends that the county governments need to integrate counseling into care of women after stillbirth, engage stakeholders to discuss stillbirth as a public health concern to address misconceptions and offer support to health care providers to offer proper care to women to mitigate the psychological morbidity.
Determinants of Psychosocial Well-Being of Children (10-17 Years) Affected by Hiv and Aids in Kiambu County, Kenya
(Kenyatta University, 2019-09) Ashioya, Damaris Shihundu
Children affected by HIV and AIDS (CAHA) are faced with psychological, social and economic challenges among others. HIV and AIDS has compounded the situation posing more suffering to children whose parents have died of the same. Children affected by HIV and AIDS have been supported in various ways by their extended families and many other organizations. While there are a number of programmes that address the material needs of CAHA, there is less emphasis in assisting these children cope with the distress associated with nursing or living with sick members of the family, witnessing deaths of their parents and suffering the consequences thereafter. The psychosocial well-being of CAHA may be affected as a result of illness and death of their parents, exploitation, stigma and separation from siblings as well as lack of adult support. The purpose of this study was to examine the determinants of psychosocial well-being of children affected by HIV and AIDS. This was a cross-sectional survey targeting 3780 children between 10-17 years affected by HIV and AIDS living in foster families from registered CBOs in Kiambu County. Multi-stage cluster sampling was used to select 345 children aged 10-17 years. First, Thika Sub County was purposively selected, in the second stage systematic random sampling was done for supporting families with CAHA and the third stage simple random sampling was carried out in foster families with more than one CAHA to select the participant for the study. Key informant interview guides, questionnaires, observation checklist and child drawings were used to collect data. Both quantitative and qualitative data were organized and categorized for analysis. Using Statistical Package for Social Sciences (SPSS) Version 20, quantitative data was analyzed using descriptive statistics; frequencies, means and percentages. Chi-square and factor analysis were used to test the formulated hypotheses. Qualitative data was transcribed, coded and categorized into themes and words to allow for analysis and presentation. Results of the study established that there was a significant relationship between care provided by foster families and psychosocial well-being of CAHA based on results of factor analysis at 61.4% and chi-square results (χ2= 4.6607; df= 4; p=0.001). This study showed that there existed a significant relationship between the types of support available in the community and psychosocial well-being of children affected by HIV and AIDS (χ2=7.8207; df =6; p=0.012). In addition, this study identified a significant relationship between coping strategies adopted by children affected by HIV and AIDS and their psychosocial well-being (χ2 = 6.4420; df= 6; p=0.003). This study concluded that there were established relationships between care provided by foster families, type of support available by the community and coping strategies adopted by children affected by HIV and AIDS and their psychosocial well-being. The study recommended that the Kenya government should commit resources to promote the psychosocial well-being of CAHA at various levels through government mandated departments. Parents can be guided to develop permanency plans for their children and finally stakeholders; County governments, schools and non-governmental organizations can work together to ensure sustainability of families and communities so that children are retained in responsive environments.
Burden of Diabetes Mellitus among Patients in Thika Level Five Hospital, Kiambu County, Kenya
(Kenyatta University, 2019-05) Kipkalom, Rosebella J.
The burden of diabetes is reflected not only in the increasing numbers of people with diabetes, but also in the growing numbers of premature deaths due to diabetes. One measure of burden of disease is disability-adjusted life years (DALYs), which combines estimates of years of life lost due to premature death (YLL) and years lived with disability (YLD) to count the total years of healthy life lost from disease and injury. In Kenya, Non-Communicable Diseases (NCDs) accounts for more than 50% of total hospital admissions and over 55% of hospital deaths. The major NCDs are cardiovascular conditions, cancers, diabetes, and chronic obstructive pulmonary diseases. In Kenya there were 1,976,337 NCDs cases in 2012. Nairobi and Kiambu led all other counties in NCDs with 155,899 and 126,754 cases respectively. The Kenyan health sector is predominantly financed by private sector sources (including out-of-pocket Expenses (OoPE) borne by patients, family members and relatives). However, there are only sparse data available from developing countries on the expenditure on diabetes care. Knowing the medical cost of diabetes is critical to understanding the long-term economic consequences of diabetes prevention. The broad objective of the study was to quantify the burden of Diabetes Mellitus among patients attending Thika level 5 Hospital, Kiambu County, Kenya. The study employed prospective prognostic study design and was carried out in Thika level 5 Hospital, Kiambu County. The study population comprised of diabetic patients attending outpatient diabetic clinic. The respondents were recruited into the study till saturation of 594 respondents. Data was collected for YLL, YLD, Direct costs and Indirect costs. EQ-5D-5L tool was used to measure HRQoL. Data analysis was done using SPSS, Microsoft Excel Worksheet and DISMOD II. The results showed that diabetic patient incurs a mean of KSHs 28,433 within six months (translating to approximately KSHs 56,866 per annum). According to the results from this study,43% was attributed to direct costs while 57% for indirect costs spent by a diabetes patient. A total of 805/1000 DALYs was lost as a result of premature mortality and disability associated with diabetes. Most of the diabetes patients in the study had a reduced Health Related Quality of Life(HRQoL) as per the EQ-5D-5L tool with a mean VAS of 0.55. Knowledge on burden of diabetes especially medical cost of diabetes is critical to understanding the long-term economic consequences of diabetes prevention. Thus, assuming prevention costs can be kept sufficiently low, effective diabetes prevention efforts would likely lead to a reduction in long-term medical costs. The results of this study informs policy makers in Kiambu County and Ministry of Health on need to work towards comprehensive and sustainable solutions in regard to diabetes. Based on the study findings, it is recommended that the National government and Kiambu County government of Kiambu to give priority to diabetes disease by providing free insulin and oral glycemic drugs to diabetes patients. It also recommends that the National government and Kiambu County government to prioritize diabetes care by ensuring all patients subscribe to NHIF and to cover management costs of diabetes, both for outpatient and in-patient services through NHIF, thereby reducing the economic burden of a diabetic patient and also improve HRQoL and reduce DALYs.
Relationship between Socio-Demographic Characteristics of Motorcycle Taxi Riders and Their Socio-Economic Wellbeing: Case of Homa Bay County, Kenya
(Kenyatta University, 2018) Owuor, Irene Awuor
Motorcycle taxis have become a popular means of transportation which generates income for many riders in Kenya. However, there are various factors which expose riders to internal and external shocks and stresses which inevitably influences the riders’ socio-economic wellbeing (SEWB). Studies that have been conducted so far largely focus on “social vices” allegedly being committed by motorcycle taxi riders (MTRs) hence a persistent knowledge gap about SEWB of riders’. Acknowledging that MTRs are a valuable community resource because they facilitate transportation of people and goods, this study investigated the relationship between socio-demographic characteristics of motorcycle taxi riders and their socio-economic wellbeing: Case of Homa Bay County, Kenya. The study objectives included to: establish the relationship between demographic characteristics of MTRs and their SEWB, assess the relationship between social connectedness among MTRs and their communities and the riders’ SEWB, determine the relationship between involvement of MTRs in groups and their SEWB, analyze the relationship between ownership status of motorcycle taxi among MTRs and their SEWB and establish the levels of socio-economic wellbeing of motorcycle taxi riders in Homa Bay County. Cross-sectional community-based analytical survey design was used to investigate the problem, guided by social capital theory. Social protection approach was adopted to conceptualize this study. Simple random sampling was used to select 322 MTRs out of which 315 participated in the study, hence a 98% response rate was established. Key informants including six traffic police officers, nine officials of Homa Bay County boda boda SACCO and 10 community leaders were purposively sampled and interviewed for additional information. Research instruments used included: questionnaires, interview guide and focus group discussion guide as well as observation checklist. Data from this study was analyzed both quantitatively and qualitatively. Descriptive and inferential statistics were used to analyze quantitative data whereas qualitative data were thematically analyzed and also used to complement quantitative data. Findings were presented using tables and bar graphs. Chi-square test statistically confirmed a significant relationship (p=0.013) between localities of motorcycle taxi operation (rural and urban) and SEWB and a significant relationship (p=0.036) between ownership status of motorcycle taxi and SEWB of MTRs. Chi-square tests also revealed that there is no significant relationship (p=0.622) between genders of MTRs and their SEWB, MTRs riding license possession status and their SEWB (p=0.783), social connectedness among MTRs and their communities and the riders’ SEWB (p=0.226) as well as MTRs involvement in groups and their SEWB (p=0.176). The study concluded that motorcycle taxi riders in Homa Bay County experience high levels of SEWB at 63% with probability error of 5%. Implications of the study findings to MTRs, policy makers and academic researchers were also outlined. The study recommended the following for policy, practice and further study respectively: Designing policies that promote the establishment of medical facilities within reach for MTRs and their families, promotion of riding of self-owned motorcycle taxi if disposable income of MTRs were to increase hence possibility of higher SEWB and comparative study of socio-economic wellbeing of motorcycle taxi riders who operate in the rural and urban locality.
The Effects of Using Oral HIV Self-Testing Kits on Uptake of Male Partner Testing Among Pregnant Women in Selected Counties In Kenya
(Kenyatta University, 2018) Machera, Tom Marwa
Adult HIV prevalence peaked at 14% in Kenya in the mid-nineties and has since continued to drop and thereafter stabilized at below 5% since 2014 due mainly to a scale up of various evidence based HIV interventions including HIV care and treatment, PMTCT, VMMC, HTS among other. HIV-testing and counselling (HTC) is a very effective strategy in getting those infected with HIV into care and treatment and in making appropriate referrals to other HIV support services. Kenya has adopted a number of strategies including Provider initiated testing and counselling (PITC), outreach testing and counselling and home based testing and counselling. Women are more likely to be tested for HIV (79.8%) than their male counterparts (62.5%) are. Other strategies that have proved effective are integration of HTC in antenatal care and reproductive health services. The Kenya AIDS Indicator Survey (KAIS) of 2012 showed that up to 6.5% of pregnant women in Kenya were living with HIV, and that each year, close to about 45,000 infants becomes infected with HIV through mother-to-child transmission of HIV (MTCT). PMTCT is offered as part of routine ANC for pregnant women, alongside other important services such as HTC, linkages to care and treatment, and helps to prevent infant exposure to HIV during pregnancy, delivery and breastfeeding. However, many approaches to promote male involvement in HIV counselling and testing during ANC services, such as having male-only clinics on special days or evening clinics have been tried without much success. ANC in Kenya have the potential of being key entry points to HTC not only for pregnant women, but also their partners. This study was designed as randomized controlled trial (RCT) with three study arms, where 475 study participants were to be rolled randomly into each arm. The study participants were women attending ANC clinic for the first time in their current pregnancy. Fourteen (14) study sites were selected randomly from 180HIV testing, care and treatment sites in Eastern and Central regions of Kenya. The aim of the study was to determine if provision of oral HIV home testing kits would increase male partner testing rates, self-testing acceptability rates and identify operational challenges experienced by the ANC mothers when providing test kits to their male partners. Data was collected using pre-tested questionnaire which were administered to each of the 1217 women and 1133 men randomized into the three study arms. Four focus group discussions were conducted for females whose partners tested and those who never tested. Data analysis was done using SPSS and “R” statistical software and descriptive statistics used to examine the frequency and analysis of variance. The equivalence t-test showed a statistically significant differences (p-value=0.01, n=737, df= 2) between arm one and two while arm three was superior to arm 2 with significantly higher testing rates (P-value<0.001,n=758,df=2).Men who got the two intervention (special letter and a test kit)were 5.08 times more likely to test compared to men who got the special letter alone when controlling for age, employment, education and if the couples discussed HIV testing)The study presented a new understanding and dynamics of self-testing among men while also bringing about health impact for their pregnant partners, because it did not require men to go to ANC clinics in person. In arm three (those who got two interventions), over 80%of the men took HIV test compared to only 37.0 %in arm two (those who got one intervention; a card with HIV prevention messages alone) and 28.3%in arm one (standard package, a letter given to the ANC mother inviting her male spouse to come to the clinic, this is the current practice in Kenya). Men who discussed HIV testing with their wives were twelve times more likely to test for HIV compared to men who did not discuss HIV testing with their wives. This findings will inform HIV programs and policy makers on the best way to improve low testing rates among partners of ANC clients and also demonstrates how self-testing may provide males who are not currently reached by HTS an opportunity to test in private.
Predictors of HIV and Pulmonary TB Infections among Injection Drug Users in Mombasa County, Kenya
(Kenyatta University, 2015-09) Budambula, Valentine
Effects of Public Health Interventions on Intestinal Parasitic Infections among School-Going Children in Murang’a County, Kenya
(Kenyatta University, 2016-06) Muiruri-Gitahi, Mary G. Wangui
Intestinal parasitic infections have been found to form at least a quarter of all human infections globally. School-going children are the worst affected by these infections as it impairs their growth and cognitive development. Following the WHO recommendation, the Government of Kenya rolled out a school deworming programme under the School Health Programme in 2009. The study was embedded in the School Health Programme. The main objective of the study was to investigate the effects of public health interventions against intestinal parasitic infections among school going children in Murang’a County. It was a quasi-experimental study with schools assigned to intervention and control groups. The schools were selected through multi-stage sampling. Data was collected in three phases: baseline, intervention and post intervention evaluation. A total of 446 pupils from six primary schools provided stool samples for examination of intestinal parasitic infections. Structured interview guides and observation were used to collect more information on school sanitation, pupils’ hygiene practices and their level of knowledge of intestinal parasites. Qualitative data was collected through Key Informants Interviews and observations of school sanitation and hygiene practices compared with School Health Policy. Installation of tippy taps, provision of soap and water, and health education were some of the public health interventions which were implemented in intervention group. A post intervention evaluation was conducted to determine the effect of these interventions. Data was analyzed using SPSS version 20. Association of variables was tested using chi-square while t-test was used to compare means. At the baseline phase the overall prevalence of intestinal protozoan infections was 51.2% and 55.1% in the intervention and control group respectively. Prevalence of intestinal helminthic infections was 12% and 16.5% in intervention and control groups respectively. A comparison of mean percentage of infected pupils at baseline revealed that there was no statistically significant difference in the prevalence of intestinal parasites between intervention and control groups (t =0.32, P = 0.37). Level of knowledge of intestinal parasites was 52.3% and 48.8% in the intervention and control group respectively. The difference between the two was not statistically significant (2= 3.4, df = 5, P=0.13). There was a statistically significant relationship between protozoan infections and school sanitation (2= 10.3, df = 1, P = 0.001). Association between helminthic infections and school sanitation was also found to be significant (2= 2.4, df = 1, P=0.01). Key informants interview revealed that there were no health clubs at schools through which health promotion would be propagated among the pupils. After intervention a comparison of mean percentage of infected pupils revealed that there was a statistically significant reduction in intestinal protozoan infections in intervention group from 55.1% to 6.0% (t=12.6, P=0.001). There was also a statistically significant reduction in the prevalence of helminthic infections in the intervention group from 12.4% to 0.0% (t = -3.78, P<0.001). This has led to the conclusion that public health interventions influenced the reduction of the prevalence of intestinal parasites. The findings of this study are useful to the ministry of Education in formulating policies that will shape the future of the School Health Programme in Kenya. There is a suggestion to conduct a community based study to rule out the infections from the home environment.
Use of mobile phone short text message service to enhance cervical cancer screening at the thika level 5 hospital, Kiambu County, Kenya
(2015) Wanyoro, Anthony Karanja
Cervical cancer is a major public health problem among adult women especially in developing countries and its control is of paramount importance. Organized screening programmes have led to a large decline in cervical cancer incidence and mortality in developed countries. In Kenya very few women at risk have regular repeat cervical cancer screening and there exists no effective recall mechanism to enhance scheduled screening. The Short Message Service (SMS) Text may be used as a recall tool to enhancing cervical cancer screening in developing countries such as Kenya where other communication means may not be easily available. This blinded randomized controlled trial where participants were recruited from among eligible women attending the general female outpatient clinic at Thika Level 5 hospital; randomly allocated to an intervention (SMS text reminders) arm and a control (no SMS) study aimed to determine the influence of using SMS text reminders in enhancing adherence to scheduled repeat screening for cervical cancer. Data was collected using interview guide and analyzed using STATA version 11. Categorical variables were summarized by frequencies and proportions while continuous variables were summarized by means, medians and standard deviations. Chi square test was used to establish the relationship between categorical variables while logistical regression analysis was conducted to evaluate the influence of the independent variables on adherence to scheduled screening while using the SMS reminders. The mean age of the participants was 38.8 ± 10.8, most were married and of low socio- economic status. Only 20% of the eligible women attending the general outpatient’s clinic had ever been screened with only 8.8% having had regular screening. A total of 7.4% of the study population had abnormal cytological smears of which 3.2% were invasive cancer. It was found that 67.1% of participants in the intervention arm and 20.3% in the control arm re-attended to rescreening at end line as scheduled. The participants who received SMS text reminders were 8 times more likely to adhere to scheduled rescreening than those who did not (OR 8.02; CI 95% 4.69-13.73; p-<0.001). The age group 30-34 years, participants those whose spouses were employed and those who used public transport to access the hospital were significantly associated with return to scheduled screening after sending SMS text reminders (OR 2.24 P<0.005); (OR 2.2 P<0.05); (OR3.29 P< 0.005) respectively. On multiple logistical analyses having owned a mobile phone for more than two years was found to be more important in influencing re-attendance if one was educated above secondary school level. It was concluded that many women attending the general outpatient’s clinic were not screened and almost 10% of such women had abnormal cervical lesions including cervical cancer. Screening such women and reminding them of the next screening dates increases their chances of adherence to scheduled screening by up to 8 times when compared to those not reminded. The study recommended that the Short Text Message Service (SMS) reminders should be integrated into the cervical cancer screening programmes and cervical cancer screening services should be integrated in the female general outpatient clinic
Epidemiology of tuberculosis and human immunodeficiency virus co-infection, clinical presentations and impact on immunohaematological parameters in Mombasa county, Kenya.
(Kenyatta University, 2015-01) Ayieko, Yonge Shadrack; Otieno, Michael F.; Sharma, Rekha R.
Tuberculosis still represents an important global public health threat and it is one of the world‘s leading causes of death and HIV/AID has substantially altered the epidemiology of the infection especially in Sub-Saharan Africa. Most of death due TB and TB-HIV co-infection could be averted if clinicians recognized the signs and symptoms of the two diseases and instituted appropriate measures without delay. The magnitude of TB and TB-HIV co-infection is increasing despite progress made in the ART/DOTs control programs. There is no adequate knowledge on TB-HIV coinfection and effect on immune system since immunohaematological cell counts are not routinely carried out on TB patients. This hospital and laboratory based descriptive cross-sectional study was carried in Mombasa County. The main objective was to determine the magnitude of TB and TB-HIV co-infection and their relationship with clinical markers. Sputum from five hundred tuberculosis suspects were examined for AFB and cultured on solid and liquid media. Drug susceptibility test was done using BACTEC MGIT 960 incubator. Blood samples from tuberculosis suspects were screened for human immunodeficiency virus. Complete blood cell count was done using Sysmex Kx-2 and CD4+T cells analysed using FACS count flow cytometer. A questionnaire was used to collect demographic and medical history of the tuberculosis suspects. The data was entered in MS Excel 8.0 and analysed using Epi-Info 6.04b and statistical package for social sciences (SPSS) version 16.0 software. Pearson‘s chi-square test of independence was used to determine level of associations between TB-HIV co-infection and clinical outcomes. Student t test was used to test differences of means between two or more groups and Odds ratio to assess risk factors related to outcomes. Results showed tuberculosis prevalence was 42.0% and it was significantly higher in females (45.9%) than males 38.7% (P<0.05). Two hundred and two patients (96.2%) had pulmonary tuberculosis and eight (3.8%) extra-pulmonary tuberculosis. Smear positivity rate was 81.1% and culture positives 100%. Tuberculosis recurrence rate was 14.3% and was significantly associated with HIV infection (p<0.05). The majority of the TB cases (38.6%) were aged between 25-34 years (OR=58; CI; 0.340.94; p<0.05). Tuberculosis-HIV co-infection rate was 37.1% and it was not significantly associated with gender (P>0.05). Clinical features of chronic dry cough, fever, night sweats and weight loss were common in both TB and TB-HIV co-infected patients. Tuberculosis patients had higher CD4+T cell counts (474.5±198.8 cells/mm3) than co-infected patients (276.44±142.71) (t=5.6,df=461,p<0.05) but lower than reference group (1054.9 ± 156.1 cells/mm3, t=34.6, df=485, p<0.05). HIV/AIDS patients had significantly higher body mass index (19.9±2.2 kg/m2) than tuberculosis HIV/AIDS co-infected patients (BMI 18.8±2.7, t=0.70, df=58, p<0.05). The mean packed cell volume in TB-HIV co-infected patients was (32.31±4.8%) lower than TB patients without HIV/AIDS (34.21±4.4%) and the control group (36.41±4.2%). A high rate of drug resistance was observed in isoniazid (17.6%) and rifampicin (2.1%). Eight patients had multi-drug resistant-TB (4.8%). Any type of drug resistance in TBHIV co-infection patients was 19.1% suggesting a positive correlation (p<0.05). The high prevalence of tuberculosis and high co-infection in this study underscores the need for more efforts and resources to increase knowledge and access health care. There is also need to improve drug susceptibility testing to all newly diagnosed tuberculosis patients in all health facilities to monitor drug resistance. Immunohaematological indices (CD4 count, FBC and ESR) be performed routinely to monitor both TB and TB-HIV co-infection patients.
Effectiveness of Isoniazid Prophylaxis in Prevention of Tuberculosis in Child Household Contacts of Adults With Pulmonary Tuberculosis in Nairobi County, Kenya
(Kenyatta University, 2015) Okwara, F. N.
Sub-Saharan Africa continues to document high burden of pediatric TB, driven by the HIV epidemic. The urban poor are at highest risk of infection. Infected children experience rapid disease progression and severer disease. Contacts‟ tracing and isoniazid prophylaxis is an effective prevention strategy, but has been administered inconsistently in most resource poor countries. Perceived obstacles have been sub-optimal effectiveness in view of continuous transmission and re-infections, as well as adherence and safety concerns. The objectives of this study was to evaluate the effectiveness of IPT in preventing TB related morbidity in children in household contact with adults with TB from informal settlements in Nairobi. A prospective longitudinal cohort study was done. Child contacts of recently diagnosed PTB smear-positive adults were enrolled. Recruitment started in December 2011 to July 2013. Consent was sought. A structured questionnaire was used to get information on source case TB treatment, socio-demographic characteristics and TB knowledge. Contacts underwent baseline clinical evaluations to exclude TB disease using clinical algorithms. TST, microscopy and histology were done whenever indicated. Contacts with chronic illnesses were excluded. A blood sample was obtained at baseline for liver enzymes assays and for PCR for HIV DNA. Contacts were then put on isoniazid for 6 months and followed up monthly for 1 year for new TB infection, and compliance and adverse events monitored. Qualitative data was provided by 2FGD and KIIs. Data was analyzed using SPSS. IPT acceptability was 320 out of 366(87.3%) of eligible source cases. Most (96%) were from poor social backgrounds, and 83.4% had below tertiary level of education. All source cases were on first line anti-TB treatment. Of 428 contacts screened, 6.3% were HIV positive. The baseline prevalence of latent TB was 92 (22.2%), while 14 (3.2%) had TB disease. IPT completion rate was 368 of 414 (88.8%). Overall compliance rate was 89%. IPT failure was documented in 6 (1.6%) cases, the relative risk of new TB disease in contacts on IPT was 0.49 (95% CI 0.21 -0.86). IPT effectiveness in preventing TB in exposed contacts was 50%. On multivariate logistic regression of factors influencing IPT failure, only weight faltering of contact was significant (p= 0.005). The leading programmatic challenges reported were too many hospital visits (65.2%) and difficulties in administering tablets to children (44.3%). Side effects were documented in 22.2%, mainly skin rash (12.5%), but significant hepatotoxicity occurred in only 3(0.08%). In conclusion, child TB is prevalent in exposed contacts in informal settlings. Contact screening and IPT is an effective, acceptable and safe child TB prevention strategy for exposed child contacts in these settings, however its implementation is fraught by various social and programmatic challenges minimizing overall benefits realized. Therefore, there is need to prioritize these children in informal settlements in TB screening programs. Furthermore, linkage of IPT strategy to nutrition interventions programs, and the provision of minimal adherence support to households could greatly optimize overall effectiveness attained.

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