RP-Deparment of Medical Laboratory Sciences

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    Carbapenem-Resistant Gram-Negative Bacterial Infections and Risk Factors for Acquisition in a Kenyan Intensive Care Unit
    (BMC, 2024-05) Maina, Jane Wairimu; Mutua, Jeniffer Munyiva; Musyoki, Abednego Moki
    Background Carbapenem-resistant Gram-negative bacteria (CR-GNB) are a critical public health threat globally; however, there are inadequate surveillance data, especially in intensive care units (ICU), to inform infection prevention and control in many resource-constrained settings. Here, we assessed the prevalence of CR-GNB infections and risk factors for acquisition in a Kenyan ICU. Methods A hospital-based cross-sectional study design was adopted, recruiting 162 patients clinically presenting with bacterial infection after 48 h of ICU admission, from January to October 2022 at the Nairobi West Hospital, Kenya. Demographics and clinical data were collected by case report form. The type of sample collected, including blood, tracheal aspirate, ascitic tap, urine, stool, and sputum depended on the patient’s clinical presentation and were transported to the hospital Microbiology laboratory in a cool box for processing within 2 h. The samples were analyzed by cultured and BD Phoenix system used for isolates’ identity and antimicrobial susceptibility. Results CR-GNB infections prevalence was 25.9% (42/162), with Klebsiella pneumoniae (35.7%, 15/42) and Pseudomonas aeruginosa (26.2%, 11/42) predominating. All isolates were multidrug-resistant (MDR). P. aeruginosa and A. baumannii were 100% colistin-resistant, while K. pneumoniae (33.3%) was tigecycline-resistant. History of antibiotics (aOR=3.40, p=0.005) and nasogastric tube (NGT) use (aOR=5.84, p=<0.001) were the risk factors for infection. Conclusion Our study highlights high MDR- and CR-GNB infections in ICU, with prior antibiotic exposure and NGT use as risk factors, and diminishing clinical value of colistin and tigecycline. In this study setting and beyond, strict implementation of antimicrobial stewardship programs and adherence to infection prevention and control through monitoring, evaluation and feedback are warranted to curb CR-GNB infections, especially among the risk groups.
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    Prevalence of High-risk HPV Infection in Women Presenting with Chronic Leucorrhoea at Kenyatta National Hospital, Nairobi City County, Kenya
    (IJRRGY, 2024-03) Onyango, Willbrod Ochieng’; Muitta, Esther; Mutuku, Onesmus Muia
    Chronic leucorrhoea is the most common symptom caused by infections of the vagina itself or infections/inflammation of the cervix. These inflammations are mostly associated with Candida spp, the parasite Trichomonas vaginalis infection, and the human papillomavirus. Oncogenic HPV sub-types 16,18,31,33 and 45 have been greatly associated and contributed to nearly 70% of all cervical cancers. HPV infections may clear within a period of up to 2 years. However, for every 1 million women infected with the virus, approximately 10% (100,000) will develop cervical dysplasia. Persistent infections with high-risk HPV lead to chronic inflammation through various mechanisms. This inflammation induces oxidative stress on the infected host cells thus leading to the release of molecules that may cause cellular damage e.g. white, creamy discharge that is known as leucorrhoea. Objective: This study aimed to investigate the prevalence of high-risk HPV infection in women presenting with chronic leucorrhoea at Kenyatta National Hospital, Nairobi City County in the Gynecology and Obstetrics department. Study Design: The study adopted a prospective cross-sectional design. Place and Duration of Study: Department of Gynecology and Obstetrics Kenyatta National Hospital between October and December 2023. Methodology: The study included 107 women presenting with chronic leucorrhoea aged 18 years and above who were purposely sampled and screened for high-risk HPV genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 and 73 using real-time PCR. Results: Among the 107 women in this study, 38 (35.5%) tested positive for high-risk HPV strain whereas 69 (64.5%) tested negative. The highest positives were observed in HPV 16 (42.1%), then other hrHPV (36.8%), and finally HPV 18 at 21.0% Out of all the risk factors analyzed (age, history of substance abuse, number of lifetime sexual partners, age at sexual debut, marital status, level of education, status of income, and choice of family planning) none was found to have a statistically significant association with HPV infection. Conclusion: The prevalence of high-risk HPV infection in women presenting with chronic leucorrhoea was 35.5% in this study with genotype 16 being the most prevalent. Of all the risk factors analyzed, none had a statistically significant association with high-risk HPV infection.
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    Diagnostic Performance of Saliva Samples in Asymtomatic COVID-19 Infected Patients in Kakamega Kenya
    (EASJID, 2024-01) Njue, Lilian G.; Ali, Iddah M.; Menza, Nelson C.
    Abstract: The pandemic coronavirus SARS‐CoV‐2 in the world has caused a large infected population suffering from COVID‐19. To curb the spreading of the virus, WHO urgently demanded an extension of screening and testing; thus, a rapid and simple diagnostic method is needed which is non-invasive. Use of self-collected saliva can minimize healthcare worker exposure and expand testing capabilities for symptomatic and asymptomatic patients. The main aim of this study was to document the ability of patients to self-collect sufficient saliva specimens for SARS-CoV-2 in the quantitative detection by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) in asymptomatic patients by themselves under observation by a healthcare provider. The researcher recorded whether the patients were confident and the suitability of the specimen for laboratory testing that would inform clinical decision making. Seventy-one patients aged from 13 years and above were included between December 2020 and July, 2021. Saliva samples and Nasopharyngeal samples were taken from each patient. Quantitative PCR was performed to detect SARS-CoV-2 viral load in the nasopharyngeal samples and qualitative Reverse Transcriptase Loop-mediated isothermal amplification (RTLAMP) was used to detect the presence of the virus in saliva samples. Results of saliva vs. nasopharyngeal samples testing using the two different methods were compared. Statistical analyses were performed. Out of the 350 samples tested, 314 samples were found to be Covid 19 positive. Result of the test was validated by the RT-PCR test. This showed that only 314 samples were tested both by saliva rapid test and PCR test while the rest 36 samples were not tested using RT-PCR method but were tested using saliva test. Thus, the salivary test based on pure oral saliva samples easily obtained by noninvasive techniques using RT-LAMP has the same agreement with the nasopharyngeal technique using RT-PCR one in asymptomatic COVID-19 patients.
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    Risk Factors Associated with MDR and CR Acinetobacter baumannii Carriage among ICU Patients Hospitalized at MOI Teaching and Referral Hospital, Kenya
    (SCIRP, 2023) Kipsang, Fred; Musyoki, Abednego M.; Menza, Nelson C.
    Background: Multi-drug resistant and Carbapenem-Resistant Acinetobacter baumannii (CRAB) infections present a significant challenge in hospital ICU settings worldwide and the threat posed is worse in developing countries including Kenya. Despite the limited treatment options, there is inadequate comprehensive data on factors associated with MDR and CR Acinetobacter baumannii carriage among ICU patients hospitalized at hospitals. This study therefore aimed to address this gap and determined risk factors associated with MDR and CR Acinetobacter baumannii carriage among ICU patients hospitalized at MOI Teaching and Referral Hospital, Kenya. Methods: Through cross-sectional study design, a total of 132 ICU admitted patients were purposively enrolled in this study between July 2019 and July 2020. Demographic and risk factors associated with MDR and CR Acinobacter baumannii were collected using structured questionnaire. Descriptive statistics and bivalent analysis were used for data analysis obtained. Level of statistical significance was 95% confidence interval (CI) for all analysis. Results: Bivariable analysis showed that employed participants were 3.4 times more likely to have A. baumannii compared to the unemployed (cOR = 3.38, 95%, CI: 1.09 - 10.43, p = 0.035). Patients who were having high BMI were likely to be infected by A. baumannii compared to those who had normal/low BMI (aOR = 11.2, 95%, CI: 3.57 - 21.11, p = 0.004). Those who were aged ≥50 years were 21 times more likely to be carbapenem-resistant Acinetobacter baumannii, COR = 21.0, 95% CI: 1.83 - 240.52, p = 0.011. Those who stayed in ICU for more than 30 days were 16 times more likely to be carbapenem-resistant Acinetobacter baumannii compared to those who had been admitted (COR = 16.0, 95% CI: 1.45 - 176.45, p = 0.019). Conclusion: Increased length of hospital stay, obesity and marital status were the factors found to be significantly associated with A. baumannii infections among ICU admitted patients. On the other hand, gender, age, level of education, occupation, referral status and presence of infection were found to have no significant association with A. baumannii infections among ICU admitted patients. All patients admitted to the intensive care units should be screened for colonization with A. baumannii, owing to the poor treatment outcomes associated with carriage of this multidrug resistant pathogen. Proper infection control in the ICU settings should be upheld to mitigate the spread of A. baumannii in the intensive care units.
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    Asymptomatic Gastrointestinal Carriage of Multidrug-Resistant Carbapenemase-Producing Enterobacteriaceae among Children Under Five Years in a Kenyan Hospital
    (Elsevier, 2023-07) Mutuma, Caroline Kirito; Maingi, John; Maina, Anthony Karoki; Njeru, John; Musyoki, Abednego Moki
    Objectives: Asymptomatic gastrointestinal carriage of carbapenem-resistant Enterobacteriaceae (CRE) is a threat to global health in developing countries with inadequate safe drinking water, poor hygiene, and weak antimicrobial stewardship; however, epidemiological data to guide CRE infection prevention and control is limited in these settings. We assessed asymptomatic CRE and carbapenem-producing Enterobacteriaceae (CPE) fecal carriage rates and associated risk factors among hospitalized children aged under 5 years. Methods: We adopted a cross-sectional study at Mama Lucy Kibaki Hospital in Nairobi-City County, Kenya, between June and September 2022. We collected demographic and clinical characteristics using a structured questionnaire and clinical reports and analyzed stool/rectal swab samples by standard and automated bacteriological methods. Results: Asymptomatic CRE and CPE fecal carriage rate was 2.25% (6/267), with six isolates recovered, predominated by Escherichia coli (33.33%) and Enterobacter cloacae subsp dissolvens (33.33%). Third-generation cephalosporin and ciprofloxacin resistance were highest in Citrobacter farmer and E. cloacae subsp cloacae. All CRE and CPE were multidrug-resistant, and except E. cloacae subsp cloacae, were 100% colistin-resistant. Conclusions: Asymptomatic gastrointestinal carriage of multidrug-resistant-CRE among hospitalized children under 5 years, presents a substantial public health threat. This calls for continuous surveillance including molecular characterization of isolates, to inform infection prevention and antimicrobial stewardship adherence in line with local and global plans on AMR.
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    Human Papillomavirus Types Associated with Cervical Dysplasia among HIV- and Non-HIV-Infected Women Attending Reproductive Health Clinics in Eastern Kenya
    (hindawi, 2021) Njue, James Kinoti; Muturi, Margaret; Kamau, Lucy; Lwembe, Raphael
    Background. Human papillomavirus (HPV) causes over 99% of all cervical cancer globally. In 2019, it was responsible for 3286 deaths in Kenya. Data on the epidemiological distribution of HPV genotypes by cervical dysplasia and HIV-infected women which is important in designing prevention strategy monitoring treatment and management of cervical cancer is lacking in Eastern Kenya. Objective. To determine HPV genotype prevalence and their association with cervical dysplasia among HIVinfected (cases) and noninfected (control) women aged 18-48 years seeking reproductive healthcare. Methods. A cervical broom was softly rotated 360 degrees five times to exfoliate cells from the region of the transformation zone, squamocolumnar junction, and endocervical canal for HPV genotyping. Social-demographic and risk factors responsible for HPV acquisition were collected using a questionnaire. Laboratory outcome and questionnaire data statistical relationships were computed using Pearson chi-square test. Results. 317 women (cases: 161 (50.8%), control 156 (49.2%), mean age: 34.3,SD ± 10:4, range 18-46 years) were recruited from Embu (85/317 (26.8%)), Isiolo (64/317 (20.2%)), Kirinyaga (56/317 (17.7%)), Meru (81/317 (25.6%)), and Tharaka-Nithi (31/317 (9.8%)). The frequency HPV genotypes detected by cervical dysplasia were CIN1 (cases: HPV81 (12/317 (3.8%)), HPV11 (2/317 (0.6%)); control: HPV53 and 66 coinfection (1/317 (0.3%)), CIN2 (cases: HPV11, HPV16, HPV66 ((1/317 (0.3%) each), HPV81 (6/317 (1.9%)), and single case (1/317 (0.3%)) of HPV11 and 66, HPV81 and 44, HPV81 and 88, HPV9 and 53, and HPV16 and 58 coinfection; control: HPV81 (2/317 (0.6%)) and invasive cervical cancer (cases: HPV16 (1/317 (0.3%)) and HPV81 (3/317 (0.9%)); control: HPV16 and 66 (1/317 (0.3%))).Conclusions. There was a higher frequency of both high-risk and low-risk HPV genotypes associated with cervical dysplasia among HIV-infected than HIV-uninfected women seeking reproductive health care. This study provides epidemiological data on the existence of nonvaccine HPV types associated with cervical dysplasia in the region.
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    Primary and Triage Cervical Screening Diagnostic Value of Methods for the Detection of Cervical Dysplasia
    (Hindawi, 2022-09-17) Njue, James Kinoti; Muturi, Margaret; Kamau, Lucy; Lwembe, Raphael
    Background. Cervical cancer is a leading cause of mortality among women globally. Approaches to reduce cervical cancer incidence and mortality are “screen-and-treat,” where positive primary test only is used in the treatment and “screen, triage and treat,” where treatment is based on positive primary and triage tests with/without histological analysis. Objectives. To determine cervical screening outcomes among HIV-infected and noninfected women using VIA, Pap smear, and HPV-PCR cervical screening methods and to determine the sensitivity, specificity, PPV and NPV of VIA, Pap smear, and HPV-PCR as primary test and sequential triage based on abnormal histopathology among HIV-infected and noninfected women. Methodology. This was a comparative cross-sectional study where women aged 18-46 years women underwent cervical screening and colposcopy-biopsy test as a positive-confirmatory test in the Referral Hospitals of Eastern Kenya. Results. A total of 317 (HIV negative: 156/317 (49.2%) and HIV positive: 161/317 (50.8%)) women were enrolled. Of these 81/317 (25.6%), 84/ 317 (26.5%), 96/317 (30.2%), and 78/122 (63.9%) participants had VIA, HPV DNA-PCR, Pap smear, and cervical histology positive results, respectively; average: 27.4% (HIV positive: 21.5%; HIV negative: 5.9%). Majority of women with LSIL [17/317 (5.4%)], HSIL [22/317 (6.9%)], invasive cancer [5/317 (1.6%)], cervicitis [45/317 (14.2%], and candidiasis 47/317 (14.8%) were HIV-infected (p < 0:001). 78/317 (24.6%) participants had positive histology test [ASCUS: 34/317 (10.7%) CIN1:17/317 (5.3%), CIN2: 16/317 (5.0%), CIN3:6/317 (1.9%), and ICC: 5/317 (1.6%)] (p > 0:001). A higher primary diagnostic accuracy was established by HPV DNA-PCR (sensitivity: 95.5%; specificity: 92.6%) than Pap smear and VIA test while in triage testing, high sensitivity was obtained by HPV DNA-PCR parallel testing with VIA test (92.6%) and Pap smear test (92.7%) and VIA cotesting with Pap smear (99.9%). HIV-infected women had increased specificity and reduced sensitivity and diagnostic accuracy by both primary and triage testing approaches. Discussion. Abnormal cervical screening outcome was high among HIV-infected than noninfected women. HIV-infected women had significantly high cases of cervical neoplastic changes. The diagnostic value of primary tests increased upon concurrent testing with other test methods hence reducing the number of women who would have been referred for biopsy. Conclusion. High sensitivity and specificity in detection of CIN+ were established among HIV-infected than HIV noninfected women by HPV DNA-PCR and Pap smear than VIA test. HPV DNAPCR test and Pap smear are more accurate in primary and sequential triage cervical screening based on abnormal histopathology outcomes among HIV-infected than noninfected women
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    Human Papillomavirus Types Associated with Cervical Dysplasia among HIV- and Non-HIV-Infected Women Attending Reproductive Health Clinics in Eastern Kenya
    (Hindawi, 2021) Njue, James Kinoti; Muturi, Margaret; Kamau, Lucy; Lwembe, Raphael
    Background. Human papillomavirus (HPV) causes over 99% of all cervical cancer globally. In 2019, it was responsible for 3286 deaths in Kenya. Data on the epidemiological distribution of HPV genotypes by cervical dysplasia and HIV-infected women which is important in designing prevention strategy monitoring treatment and management of cervical cancer is lacking in Eastern Kenya. Objective. To determine HPV genotype prevalence and their association with cervical dysplasia among HIVinfected (cases) and noninfected (control) women aged 18-48 years seeking reproductive healthcare. Methods. A cervical broom was softly rotated 360 degrees five times to exfoliate cells from the region of the transformation zone, squamocolumnar junction, and endocervical canal for HPV genotyping. Social-demographic and risk factors responsible for HPV acquisition were collected using a questionnaire. Laboratory outcome and questionnaire data statistical relationships were computed using Pearson chi-square test. Results. 317 women (cases: 161 (50.8%), control 156 (49.2%), mean age: 34.3,SD ± 10:4, range 18-46 years) were recruited from Embu (85/317 (26.8%)), Isiolo (64/317 (20.2%)), Kirinyaga (56/317 (17.7%)), Meru (81/317 (25.6%)), and Tharaka-Nithi (31/317 (9.8%)). The frequency HPV genotypes detected by cervical dysplasia were CIN1 (cases: HPV81 (12/317 (3.8%)), HPV11 (2/317 (0.6%)); control: HPV53 and 66 coinfection (1/317 (0.3%)), CIN2 (cases: HPV11, HPV16, HPV66 ((1/317 (0.3%) each), HPV81 (6/317 (1.9%)), and single case (1/317 (0.3%)) of HPV11 and 66, HPV81 and 44, HPV81 and 88, HPV9 and 53, and HPV16 and 58 coinfection; control: HPV81 (2/317 (0.6%)) and invasive cervical cancer (cases: HPV16 (1/317 (0.3%)) and HPV81 (3/317 (0.9%)); control: HPV16 and 66 (1/317 (0.3%))).Conclusions. There was a higher frequency of both high-risk and low-risk HPV genotypes associated with cervical dysplasia among HIV-infected than HIV-uninfected women seeking reproductive health care. This study provides epidemiological data on the existence of nonvaccine HPV types associated with cervical dysplasia in the region.
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    Dengue Virus and Blood Safety: A Mini-Review of Research Publications
    (EAHRC, 2023-03-30) Mulakoli, Festus; Gachara, George; Ndombi, Eric; Khamadi, Samoel
    The growing demand for donated whole blood and blood products to save lives has both health benefits and health risks for blood recipients at the same time. Dengue virus, a re-emerging viral disease poses a threat to blood safety, and it has spread to over 128 countries in the world. Several studies have documented transfusion-transmitted (TT) dengue, with the first cases being reported in China in 2002 and Singapore in 2008. To understand the magnitude and broader picture of the dengue virus and blood safety, we conducted a mini-review of published literature from the Scopus database. The review focused on the number of publications related to the dengue virus among blood donors. Using keywords ‘Dengue virus’ AND ‘Blood safety’, ‘ Dengue virus’ AND ‘Blood donors’ and ‘Emerging infectious diseases’ AND “Blood safety” were used to extract data from the Scopus database which was downloaded as a CSV Excel file covering a period 2004 to 2021. This was followed by a data-cleaning exercise and a descriptive analysis to generate the frequency of the number of publications. Most studies, as can be seen in the review, were concentrated in tropical regions of the world. Globally, South America and the Asian regions had the largest number of publications; while at the country level, Brazil and India had the highest number. More research output was witnessed during the years 2014 and 2018. The regions that experienced more frequent outbreaks of the disease, with the exception Africa, published most of the research work. Therefore, much more research work is needed to protect the safety of blood donors in Africa
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    Knowledge, Attitude and Perceptionof Hiv, Art and Pmtct Among Hiv Infected Pregnant Women in Narok Sub-County Hospitals.
    (Global Journal of Health Sciences, 2021) Gakii, Jackline; Menza, Nelson; Maoga, Winfreda Nyamota
    Purpose: The purpose of the study was to determine knowledge, attitude and perception of HIV, ART and PMTCT among hiv infected pregnant women in Narok Sub-County Hospitals Methods: The study was a cross-sectional study using simple random sampling method to sample the required sample size for the study of 117 HIV infected pregnant women. The study was conducted in all Narok sub-county hospitals. Semi-structured questionnaire was used to collect quantitative data. Focused group discussions and key informant interviews were used to collect qualitative data. Data entry and coding was done in SPSS v21. Descriptive statistics was used to compute proportions, mean and standard deviation. Qualitative data was categorized into themes based on the study objectives. To test the association between dependent and independent variables logistic regression analysis was used to generate odds ratios of association. Results: Knowledge of HIV, ART and PMTCT and good attitude and perception towards HIV, ART and PMTCT services among HIV+ pregnant women are predictors of retention in care among HIV positive women. Unique Contribution to Theory, Practice and Policy: The study recommeded that the Ministry of Health and other stakeholders should hold community awareness and sensitization programmes on benefits of PMTCT services to pave way for acceptance and hence use and prevent vertical and horizontal transmission of HIV. Key Words: Attitude, Perception and Proportion, Knowledge HIV, ART and PMTCT
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    Serologic and Genotypic Characterization of Hepatitis B Virus in HIV-1 Infected Patients From South West and Littoral Regions of Cameroon
    (Virology Journal, 2016) Magoro, Tshifhiwa; Gachara, George; Mavhandu, Lufuno; Lum, Emmaculate; Kimbi, Helen K.; Ndip, Roland N.; Bessong, Pascal
    Background: HBV and HIV share similar transmission routes. Concurrent infection with the two viruses usually results in more severe and progressive liver disease, and a higher incidence of cirrhosis, liver cancer and mortality. Further, this co-infection may lead to cross-resistance between HIV and HBV drugs and increased liver injury, either due to direct hepatotoxicity or drug-related immune-reconstitution hepatitis. These challenges necessitate continuous surveillance for HBV among HIV infected individuals to guide patient management. We conducted this study to understand the serologic and genotypic characteristics of HBV among HIV/HBV infected patients in South West and Littoral Regions of Cameroon. Methods: Plasma samples were screened for HBsAg, HBeAg, Anti-HBs and anti-HBc using ELISA followed by DNA extraction from all HBsAg positive samples. A 366 bp region covering the overlapping surface/polymerase gene was amplified by a nested PCR and the product sequenced using Big Dye sequencing chemistry. The resulting sequences were then analyzed for genotypes and both escape and drug resistance mutations. Results: Of the 455 samples in this study, 25.5 % (n = 116) were HBsAg positive and 46 of these had their DNA successfully amplified. Genotype E was found in 32 samples (69.6 %) and genotype A in the rest of the samples. Escape mutations associated with failure of diagnosis (Y100C, R122K and Q129H) and with vaccine escape (Q129R and T131N) were detected in varying frequencies in the population. Polymerase mutations implicated in resistance to lamivudine and other ʟ-nucleoside analogues were detected in seven patients (15.2 %), while all the samples lacked mutations associated with resistance to adefovir and tenofovir. Conclusions: These findings suggest the endemicity of HBV and the predominance of genotypes A and E in the study population. Also, drug resistance findings support the use of tenofovir based ART regimens among HIV/HBV co-infected persons. There is need for continuous HBV screening and monitoring in HIV infected individuals in these regions. Keywords: Hepatitis B virus, HIV/HBV co-infection, HBV genotypes, Phylogenetic analysis
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    Prevalence and Patterns of Cervical Cytological Lesions among HIV-Positive Women in Machakos County Hospital Kenya
    (International Research Journal of Oncology, 2021) Mutuku, Onesmus Muia; Mathenge, Scholastica Gatwiri; Njoroge, Wachuka Gathigia; Karuga, Titus Kamau; Kyama, Cleophas Mutinda
    Background: Cervical cancer remains to be a major threat to health among women globally with highest incidences in the developing countries. Studies have showed that HIV-positive women are at higher risk of HPV infection which is the causative agent of cervical cancer. The aim of this study was to determine the prevalence of cervical cytological lesions among HIV infected women in Machakos county hospital Kenya. Study Design: Cross-sectional study. Place and Duration of Study: Machakos County Hospital Comprehensive Care Centre and Machakos Cancer Care and Research Centre, between August 2020 and December 2020. Methodology: A total of 400 women who were HIV-positive and attending the comprehensive care center at the facility were enrolled in this study. Cytological samples obtained using a cytobrush were processed using manual liquid based cytology technique. All smears were stained using the Papanicolaou staining method and examined microscopically for cervical cytological lesions. Chisquare test was performed to evaluate the association between cervical cytological lesions and the demographic variables. Results: A total of 400 participants were enrolled in this study. 15 had unsatisfactory smears and thus excluded from analysis. The prevalence of cervical cytological lesions in this study was 30 out of 385 (7.8%). Of the cervical cytological lesions observed, Atypical Squamous Cells of Undetermined Significance (ASCUS) had the highest number of cases 9 (30%) while Atypical Squamous Cells cannot exclude High grade (ASC-H) had the least number of cases 2 (6.6%). Of all the demographic variables studied, none was found to have any statistical significant association with cervical cytological lesions. Conclusion: The prevalence of cervical cytological lesions among HIV-positive women in this study was 7.8%. There was no statistical significance association between any of the demographic variables studied and cervical cytological lesions.
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    Uropathogens Antibiotic Resistance Patterns Among Type 2 Diabetic Patients in Kisii Teaching and Referral Hospital, Kenya
    (Pan African Medical Journal, 2018) Mageto, Vincent Mogaka; Gatwiri, Mathenge Scholastica; Njoroge, Wachuka
    Introduction: Non-insulin dependent diabetes mellitus is a major risk factor for urinary tract infections. Irrational use of antibiotics has led to the emergency of uropathogens resistant to available antibiotics. The main objective was to determine the bacterial causative agents of urinary tract infections and their antibiotic resistance patterns. Methods: One hundred and eighty (180) type 2 diabetic patients were recruited to take part in the study. Urine samples were collected and cultured for urinary tract infections diagnosis and antibiotic sensitivity. Results: A total of 35 isolates were obtained from the study. All the isolates were sensitive to gentamicin. All 21 (100%) isolates of E. coli were sensitive to gentamicin and cephalexin. All 10 (100%) K. pneumoniaeisolates were sensitive to gentamicin and nitrofurantoin. Out of the 21 E. coli isolates, five of them showed resistance to ampicillin, three E. coli isolates showed resistance to nitrofurantoin and another three E. coliisolates showed resistance to cotrimoxazole. Out of 10 K. pneumoniae isolates, two of them were found to be resistant to ampicillin, one K. pneumoniae isolate was resistant to cephalexin and two K. pneumoniaeisolates were resistant to co-trimoxazole. Out of the four P. mirabilis isolates, there were three cases where one isolate was each resistant to ampicillin, nitrofurantoin and co-trimoxazole. Conclusion: There is a need to have a regular screening of bacterial isolates causing urinary tract infection in diabetic patients and their antibiotic sensitivity in order to have effective therapy. Present findings show that there is increased resistance to the commonly prescribed antibiotics
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    Zoonotic Pathogens Detected In Ticks In Kenyan Game Reserves
    (Scientific Research Publishing, 2022) Godani, Salim Kobo; Chengo, Menza Nelson; Muturi, Margaret W
    Little is known on tick-borne pathogens and their role in disease in game reserves in Kenya. Ticks were collected by sterile forceps from restrained cattle hide and placed into labeled falcon tubes. Ticks were screened for pathogens by High Resolution Melting (HRM) analysis and sequencing of specific RT-PCR products of Anaplasma, Ehrlichia , and Rickettsia species. A total of 317 ticks (281 adult ticks and 36 nymphs) comprising seven species were collected around the Tsavo National Reserve (TNR) in Taita Taveta County with Amblyomma gemma being the most commonly collected species (n = 135, 42.6%). From near Shimba Hill game reserve (SHNR), a total of 240 adult’s ticks were sampled, representing eight species, with again Amblyomma gemma being the most sampled species (n = 156, 65%). From Tsavo, a total of three pools of Rhipicephalus appendiculatus were positive for Theileria parva , two pools of Rhipicephaline evertsi for Anaplasma platys and one pool of Amblyomma variegatum nymphs for Rickettsia africae . Rickettsia africae , which causes African tick-bite fever, was detected in two pools of Am. variegatum and one pool of Amblyomma gemma collected near Shimba Hill game reserve. Rickettsia sp. and Anaplasma sp. were detected in Am. gemma and Rh. evertsi respectively. Rickettsia aeschlimannii was detected in a pool of Am. gemma. These findings highlight the risk of transmission of zoonotic pathogens to humans in regions with high human-wildlife interfaces. Of specific importance, we provide evidence of R. aeschlimannii in A. gemma for the first time, representing a potential new R. aeschlimannii vectors
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    Prevalence of Iron Deficiency and Anemia among Eligible Blood Donors at Kenyatta National Hospital, Kenya
    (Researchgate, 2022-01) Njenga, John K.; Mathenge, Scholastica G.; Menza, Nelson C.; Githanga, Jessie N.
    Aims: To determine the prevalence of iron deficiency and anemia among eligible whole blood donors attending Kenyatta National Hospital in Nairobi, Kenya. Study Design: Cross-sectional study Place and Duration of Study: Kenyatta National Hospital, Blood Transfusion Unit, between March 2021 and August 2021. Methodology: A total of 202 prospective donors were allowed to donate whole blood based on donor recruitment creteria. Of these, 173 were males and 29 were females donors aged 18-57 years. Participants included, 119 (58.9%) first-time donors and 83 (41.1%) repeat donors. Eight mililitres (8 ml) of blood sample was drawn from each donated unit, 4ml was put into plain tube and the remaing was put into ethylene diamine tetraacetic acid tube. Serum ferritin levels were analyzed by Mini Vidas ® using enzyme linked florescent assay technique while hemoglobin levels was estimated by cell count analyzer (Humacount 5D ®). Results were summarized in medians and 95% interquartile ranges and compared using either Kruskal-Wallis test or Mann–Whitney U test as appropriate. Results: The overall prevalence of iron deficiency (serum ferritin <15 μg/ml) was 2.48%. The prevalence of iron deficiency in female donors was 6.98% compared with 1.73% in males. The overall prevalence of anemia was 7.42% (males Hb <13.0/dl and female Hb <12.0g/dl). The median serum ferritin concentration was 128 μg/ml. The median ferritin levels among male donors (131 μg/ml) were significantly higher compared to female donors (84.65 μg/ml) (P=0.01). There was also a significant difference between donors age group and serum ferritin levels (P=0.008). The study further observed a significant positive correlation between donors’ hemoglobin concentrations and serum ferritin levels (P=0.001). Conclusion: Iron deficiency and anemia are prevalent among eligible blood donors in Nairobi, Kenya. There is need to review hemoglobin cut-off values based on gender and to incorporate serum ferritin tests in routine donor screening protocols. Furthermore, repeat donors should be educated on iron deficiency and iron supplementation.
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    Hematological Profiles of Eligible Blood Donors at Kenyatta National Hospital, Kenya
    (International Blood Research & Reviews, 2022-03) Njenga, John K.; Menza, Nelson C.; Mathenge, Scholastica G.; Githanga, Jesse N.
    Aim: To determine hematological profile of eligible blood donors at Kenyatta National Hospital (KNH), Kenya. Study Design: Adopted a cross-sectional study. Place and Duration of Study: Kenyatta National Hospital, between March 2021 and August 2021. Methodology: This study recruited 202 eligible blood donors comprising of 173 males and 29 females aged 18-57 years. Blood samples (4ml) were drawn from donated units into ethylene diamine tetraacetic acid (EDTA) tube. Hematological parameters were estimated using a complete blood count (CBC) analyzer (Humacount 5D®). A total of eighteen hematological parameters were analyzed. These parameters included; red blood cell (RBC) count, hemoglobin concentration, RBC indices, white blood cell (WBC) count, absolute and differential WBC and platelet (PLT) count. Results were presented in medians and 95% interquartile ranges and compared using Mann– Whitney U test. Results: The median counts for all hematological parameters were within the accepted reference ranges for the adult urban population in Kenya. The median and interquartile range for total red cell count was 4.9×106/µL [0.74], hemoglobin level was 14.3g/dL[1.8], hematocrit was 44.9% [5.1], white blood count was 4.9×103/µL [1.4] and platelet was 234×103/L [64]. Among the red cell parameters analyzed, male donors had a significantly higher RBC count (P<0.001), hematocrit (P=0.001) and hemoglobin (P<0.001) than female donors. Among white blood cell parameters analyzed, only lymphocytes (P=0.011) were significantly higher in female donors than male donors. Platelet count (P<0.001) was also significantly higher in females than male donors. Conclusion: This study showed eligible donors at KNH had significant differences in red cell count, hematocrit, hemoglobin, lymphocytes and platelets between male and female donors. Additionally, it highlighted that some blood donors had hematological parameters below and above the recommended reference ranges. These findings support the need to review the current donor recruitment criteria recommending the inclusion of complete blood count in screening.
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    Occurrence of Aflatoxigenic Aspergillus Species in Peanut Varieties in Busia and Kisii Central Districts, Kenya
    (Scientific Research Publishing, 2018) Menza, C. Nelson; Muturi, W. Margaret
    Recent studies have shown that peanuts in Kenya are highly contaminated with aflatoxins, however, information gaps exist on the characterization of the Aspergillus species that produce aflatoxins. Therefore, this gap necessitated the determination of the Aspergillus species producing aflatoxins in peanuts from the main growing districts of Busia and Kisii central. One hundred and two (102) peanuts samples were collected from farmers’ in each district and Aspergillus species were isolated using the dilution plate technique on modified Rose Bengal Agar. Phenotypical characterization of the identified Aspergillus flavus isolates from the samples was determined using the procedure of Mellon and Cotty. This study identified 5 Aspergillus species as contaminants in peanut analyzed. They were Aspergillus flavus L-strain, Aspergillus flavus S-strain, Aspergillus parasiticus, Aspergillus niger and Aspergillus tamari. Overall, the occurrence of Aspergillus flavus L-strain and A. flavus S-strain was significantly higher than other species identified (H = 15.55, df = 4, P = 0.004) in peanuts from the two districts. Aspergillus flavus L-strain was the most common isolate (58.8%) in peanut from Busia district while A. flavus S-strain was the most common strain (60.2%) in peanuts from Kisii central district. However, A. flavus S-strain was the most dominant species (F = 3.15, df = 25, P = 0.031) with an overall mean occurrence of 45.1%. The confirmation of occurrence of other species that produce toxins such as A. niger and A. tamarii which also produces cyclopiazonic acid, points to the need of screening peanuts for other carcinogenic mycotoxins.
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    Seroprevalence of Cytomegalovirus Infection and Associated Risk Factors among Human Immunodeficiency Virus Infected Patients Attending Thika Level 5 Hospital, Kenya
    (Scientific Research Publishing, 2018) Nchagwa, Edward Mangare; Muturi, Margaret W.; Gachara, George
    Cytomegalovirus (CMV) is an important pathogen in immunocompromised individuals. Coupled with Human Immunodeficiency Virus (HIV), it causes end organ diseases leading to increased morbidity and mortality in the population. The prevalence of Cytomegalovirus infection is above 93% in HIV infected children in Kenya. Despite, a high Cytomegalovirus seroprevalence found in children, few studies have documented CMV in adults. This study was done to determine the seroprevalence of CMV infection and its associated risk factors among HIV patients attending Thika level 5 Hospital in Kiambu County, Kenya. The study also evaluated the effect CMV infection on the immunity of HIV infected patients. A cross-sectional study involving 163 HIV positive participants from different age groups was carried out. A questionnaire was used to assess the socio-demographic and specific risk factors associated with cytomegalovirus. Blood was collected and analyzed for CD4 counts, CMV IgG and IgM. The seroprevalence of CMV was found to be 89% (CMV IgG) while the incidence was 10.4% (CMV IgM). The study found that CMV infection leads to more suppression of the immunity among the HIV infected patients. In addition, education, economic status, having other sexual transmitted infections, sharing drinks, immune status and blood transfusion were associated with CMV infection (p < 0.05). The study recommends adoption of CMV screening services and education on CMV risk factors as CMV infection preventive strategies.
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    Identification and Susceptibility Profile of Vaginal Candida Species to Antifungal Agents among Pregnant Women Attending the Antenatal Clinic of Thika District Hospital, Kenya
    (Scientific Research Publishing, 2013) Menza, Nelson; Wanyoike, Wanjiru; Muturi, Margaret
    Fungal infections have emerged as a world-wide health care problem in recent years, owing to the extensive use of broad-spectrum antibiotics. We screened 104 pregnant women with symptoms of vaginal candidiasis in the antenatal clinic of Thika District Hospital, Kenya in order to identify vaginal Candida species and determine their susceptibility profile to commonly used antifungal drugs for treatment of the infection. The drugs tested were fluconazole, ketoconazole, itraconazole, clotrimazole and topical nystatin. Vaginal swabs were collected and subjected to mycological and biochemical tests for Candida species identification. Susceptibility profile of the identified vaginal Candida species to the antifungal drugs was carried out using broth micro-dilution minimum inhibiting concentration method based on the approved National Committee for Clinical Laboratory Standards (NCCLS, 2002) guidelines. Candida albicans was susceptible to most of the azoles drugs while the other species had varying responses. Candida krusei and Candida glabrata species isolated were resistant to fluconazole and ketoconazole. Candida albicans isolates had a high susceptibility to itraconazole (88.33%). Five percent (5%) of the isolates were susceptible in dose dependent (S-DD) with Minimum Inhibitory Concentrations (MICs) of 0.25 - 0.5 µg/ml while 11.67% of C. albicans isolates were resistant (MICs ≥ 1 µg/ml). Itraconazole resistance was highest among C. glabrata isolates (50%) while 32.14% were S-DD (MICs 0.25 - 0.5 µg/ml). Only 17.85% of the C. glabrata isolates were susceptible (MICs of ≤ 0.125 µg/ml). All isolates of Candida isolates were susceptible to itraconazole and clotrimazole except C. krusei which was 100% resistant to clotrimazole. All Candida species isolates had low susceptibility to topical nystatin except Candida parapsilosis that was 100% susceptible. Data also showed an emerging resistance of Candida krusei to most of the drugs used except itraconazole. The results of this study support the continued use of these antifungal drugs for the treatment of vaginal candidiasis in the pregnant women except topical nystatin.
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    Bacterial Agents Causing Food Poisoning among Patients Attending Thika Level 5 Hospital, Kiambu County, Kenya
    (Scientific Research Publishing, 2019) Esther, Karanja N.; Nelson, Menza C.; Ephantus, Kabiru W.
    Food poisoning is caused by the ingestion of contaminated food or water that contains microbial agents that cause illness or release their toxins onto the food. Examples of these microbial agents are Staphylococcus aureus, Listeria monocytogens, Clostridium botulinum, Salmonella typhiridium, and Salmonella enteritidis. Epidemiological monitoring of food poisoning is highly desirable for continuous determination of the existing causative species and disease trends. The study was conducted at Thika level 5 hospital. The objective of the study was to establish the prevalence of food poisoning at Thika level 5 hospital. A cross-sectional study design and purposive sampling technique was adopted in this study. Interview scheduled questionnaires and collection of stool samples from in-patients presenting with suspected food poisoning at Thika level 5, hospital was used for data collection. Stool culture tests were used to identify the bacterial causative agents of food poisoning. Statistical package for social sciences (SPSS) was used in the analysis of the data. Ethical approval was sought from Kenyatta University Ethical Review Committee, the Ministry of Education Science and Technology and Kiambu County Government. Informed consent was sought from the respondents after they had been informed about the study. The study findings showed that of the sample taken 28 (26.4%) were positive of Cholera while 78 (73.6%) were positive of Salmonella. The study recommends early set-up of emergency wards to contain outbreaks of infectious diseases together with well-equipped diagnostic labs for prompt response.