MST-Department of Pharmacy & Complementary / Alternative Medicine
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Item Klebsiella Pneumoniae Prevalence, Antibiotic Susceptibility and Social Demographic Factors Among Patients with Nosocomial Infections in Kiambu County, Kenya(Kenyatta University, 2021) Kibuchi, Mwangi Joseph; Scholastica Gatwiri MathengeKlebsiella pneumoniae is regarded as a major contributor to nosocomial infections and it has led to medical conditions such as soft tissue infections and sepsis. This microorganism is spread through fecal oral route and contamination from health care workers. The overall goal of this research was to establish prevalence of Klebsiella pneumoniae among inpatients admitted at African Inland Church, Kijabe Hospital, Kiambu County. The study involved inpatients suspected to have acquired bacterial infection, 48 hours after hospital admission as per World Health Organization case definition. A descriptive cross-sectional study design included 384 participants. Study participants were recruited using the systemic random sampling method. Cerebral spinal fluid, urine and blood were collected and inoculated on the MacConkey, chocolate, Cystine-Lactose-Electrolyte-Deficient agar, and blood agar culture media. All Klebsiella species were subjected to analytical profile index, and susceptibility testing. The findings showed that 18 (4.7%) of the patients were males and had Klebsiella pneumoniae infection while 82(21.4 %) males had no Klebsiella pneumoniae infection. About 10 (2.6%) of the females had Klebsiella pneumoniae while 274 (71.3 %) were females and did not have Klebsiella pneumoniae infection. The study indicated that 28 out of 384 patients developed Klebsiella pneumoniae making a prevalence of 7.29%. About 21 patients (75.0%) were from pediatric ward, 5 patients (17.9%) were from newborn unit, and 2 patients (7.1%) were from intensive care unit. Antimicrobial susceptibility testing showed five blood samples had Klebsiella. Pneumoniae with a total resistance to Ampicillin, while other isolates revealed resistance to Cefazolin, Ceftadime and Ceftriaxone as 83%, 98%, and 86% respectively. Blood and Cerebral Spinal Fluid samples that tested positive were subjected against a total of 14 antibiotics and positive Klebsiella pneumoniae urine sample subjected to a total of 13 antibiotics. Besides Ampicillin other antibiotics with highest resistance included Ceftadime and Cefazolin .Isolates from urine, Cerebral Spinal Fluid and blood revealed almost the same susceptibility when tested against antibiotics, Meropenem showed the least antibiotic resistance represented by 7%, 6% and 0% respectively. Other antibiotics with the least resistance in urine samples included Amikacin 25%, Nitrofurantoin 36% and Chloramphenicol 39%. Analysis of variance was used to assess the difference in antibiotics resistance in Klebsiella pneumoniae isolates and found a significant difference with a mean of 5.547 at 0.05. Findings from this study showed that Klebsiella pneumoniae with multidrug resistance was isolated in the cases with nosocomial infections. Based on this study Klebsiella pneumoniae prevalence at African Inland Church Kijabe Hospital was 7.29%. Meropenem, exhibited the highest sensitivity outcomes as compared to other drugs with respect to isolated microorganisms. Despite a large number of inpatients were using prophylactic drugs, majority had either developed antibiotic resistance or had multiple resistance to antibiotics, thus rendering patients to infections mostly hospital acquired infections. This study recommends regular audits of antimicrobial resistance and surveillance reports to enable frequent update of antimicrobial formulas.Item Maternal Complications among Women Managed Through Focused Antenatal Care in Public County Hospitals in Nairobi City County, Kenya(Kenyatta University, 2020-10) Mukhwana, Raheli MisikoFocused Antenatal Care is antenatal care that provides individualized counseling, targeted assessment and provides safe, cost effective, and evidence-based intervention. The noted public health major problem has been maternal mortality in developing countries. Majority of maternal deaths occur due to complication during pregnancy and eventual child delivery. The rate of maternal mortality was estimated at 686/100,000 live births in Sub-Saharan Africa. In Kenya maternal mortality rate is at 362/100,000 live birth. The implementation of Focused Antenatal Care was a strategy aimed at improving maternal health in developing countries. Utilization of Focused Antenatal Care has influenced pregnancy outcomes and this varies from country to country. This study therefore aimed at investigating maternal complications among women managed through Focused Antenatal Care in selected public county hospitals in Nairobi City County, Kenya. The study was conducted in postnatal wards of Mbagathi, Mama Lucy Kibaki and Pumwani Maternity Hospitals. The study adopted a cross-sectional descriptive study design. The study used quantitative and qualitative data collection methods. Quantitative data was collected using questionnaires administered to women in their postnatal period who had attended their antenatal care clinics at the selected public county hospitals. A total of 397 postnatal women were interviewed for the study. Qualitative data was collected using Key Informant Interview guides with 12 health care providers who were involved in provision of focused antenatal care services to clients. Quantitative data was analyzed using Statistical Package for Social Sciences to generate descriptive statistics and results presented as frequency tables, bar graphs, pie charts and percentages. Qualitative data from key informants was triangulated with quantitative data as direct quotes and narrations. Inferential statistics were done using Chi Square tests to determine the association between study variables at 95% confidence interval (p<0.05). Before data collection, the study sought approval from Kenyatta University Graduate School, ethical approval from Kenyatta University Ethics and Review Committee, research permit from the National Commission for Science, Technology and Innovation, research authorization from Nairobi City County, research permission from relevant hospital management and consent from study respondents. The study was conducted between 2nd January to 28th February 2019. The study results revealed that 30% of respondents reported to have encountered a maternal complication during their current delivery outcome. Socio-demographic factors such as age (p=0.002), occupation (p=0.001), income (p=0.011), number of deliveries (0.001) and mode of delivery (p=0.001) were significantly associated with maternal complications. The study results further revealed that 54.7% of respondents had high knowledge levels with 63.7% having positive attitude towards FANC utilization. Knowledge level of FANC was significantly associated (p=0.017) with maternal complications among respondents. The study concludes that the women managed through FANC from Nairobi City County had relatively low maternal complications with majority of socio-demographic characteristics playing a significant influence. The respondents further had high knowledge levels and positive attitude towards FANC utilization. These results would be of use to the Ministry of Health for purposes of health education, policy formulation and implementation concerning workable short and long-term maternal and child health interventions. This will ensure strict adherence to FANC utilization thus improved maternal outcomes during pregnancy and eventual child delivery.Item The Influence of Gender Related Factors on Access to Art in Selected Treatment Sites in Nairobi, Kenya(Kenyatta University, 2008) Kamau, Richard ThuoGlobally, it is estimated that there are 33.2 million people living with HIV/AIDS, of which 22.8 million are in Africa. In Africa 13.7 (61%) of the people living with HIV/AIDS are women. Kenya's HIV/AIDS prevalence stands at 6.1%, with 6.7% prevalence amongst women and 3.5% amongst the men. In Nairobi, the gender based prevalence is 12.3% for women and 8.0% for men. The indications are that there are more HIV -positive women than men globally and nationally. The objectives of the study were to establish the influence of socio-demographic, socio-economic and socio-cultural GRFs on access to ART in Nairobi, through a survey study. Two hundred and fifty five patients derived from 8 ART sites took part in the study. A multistage sampling technique was used to select the elements of the sample population. The first stage involved stratifying the hospitals on the basis of whether the hospital was public, non-governmental organisation (NGO) or private for profit. From each stratum, the study treatment centres were selected using a systematic sampling technique and proportionate to size sampling. From the selected treatment centres, patients were further stratified into male and female, and from each stratum, they were recruited for inclusion in the sample by simple random proportionate to size sampling. Permission to undertake the research was secured to conform to ethical protocol. An investigatoradministered questionnaire was used for data collection. Data was analysed by use of SPSS version-IO software, and presented using descriptive statistics. The Chi-square was used to test significance. The results showed that the number of females visiting ART clinics is twice that of males. Moreover, in the 18-26 years age bracket, females were 3 times more affected than males, an indication that sex of the patient has an influence on access to ART. The marital status carried a 5-fold risk of carrying the virus while women were twice as likely to be infected by their husbands as compared to men getting the virus from their wives. The lower the formal education, the higher the chances of carrying the virus, and this affected women more than men. This would be expected to force a positive influence on access to ART in favour of women. However, the findings suggest men have a slight advantage over women on access to ARVs. The number of men with income was double that of women, suggesting that if services were to be paid for, men would have an advantage for ART access over women. Access to ART services was negatively affected by the distance from residence to the clinic, and about 50% of all patients had problems getting time-off from workplace to visit clinics. Patient perception of the attitude of health staff, and the quality of ART services was up to 90% good, but the clinic schedules preclude about 10% of the patients from access. Social stigma was low (about 10%) within spouses, and very high (about 90%) outside the institution of marriage, and women bore the larger burden of the stigma. The results also suggest that gender segregated clinics would have no influence on the number of patients attending the clinics. The overall conclusion is that gender related factors have an influence on access to ART. The potential usefulness of these findings lies in their use as an advocacy tool for gender equity in provision of ART services.Item Determinants of pre-primary school teachers’ provision of guidance and counseling services in Kasarani sub-county, Nairobi county, Kenya(2017-10) Ouma, DoryceHistorically, guidance and counselling of young children at pre-school level were primarily the responsibility of their parents. However, the demands of modern life have so intensified that the normal home, school and community influences are no longer adequate to assist children. Despite many studies carried out on guidance and counselling in primary, secondary and tertiary institutions, not much is known on what happens at the pre-school level. Therefore, the study sought to investigate the determinants of pre-school teachers’ provision of guidance and counseling services in pre-schools in Kasarani Division, Nairobi County. The study was guided by five objectives: to find out the influence of teachers’ training on the provision of guidance and counseling services in pre-schools; to determine the influence of teachers’ academic level on their provision of guidance and counseling services in pre-schools; to find out the influence of teachers’ experience on the provision of guidance and counseling services in pre-schools; to determine the influence of teacher-pupil ratio on the provision of guidance and counseling services in pre-schools; and to find out the influence of the school administrator’ support on the provision of guidance and counseling services in preschools. The study was grounded on the basic assumptions that respondents would be willing to give information objectively and honestly and that the study sample would represent the target population in its major characteristics. Literature was reviewed against the key study variables and Albert Bandura’s Social Cognitive Theory provided the platform upon which the study was grounded. The study adopted a descriptive survey research design. It targeted a population of 242 teachers and 184 administrators in Kasarani Division, Nairobi County from which a 30% sample size of the respondents was selected using stratified random sampling technique. Data was collected using both questionnaire and interview schedule. To ascertain the reliability and content validity of the data collection instruments, a test-retest method was employed on a sample that was similar but was not in the actual study. The questionnaire was prepared in such a manner that different items were integrated to ensure collection of maximum data. Data collected was coded and analyzed using descriptive statistics such as frequency and percentages with the aid of Statistical Package for Social Sciences (SPSS) software version 21. The analyzed data were presented in form of tables, charts and graphs. Thematic analysis was used to present qualitative data. The study found out that the administrators’ support to guidance and counseling is inadequate and this is coupled with challenges such as heavy workload, lack of resource materials, lack of support from parents, inadequate time, lack of experience and limited knowledge due to lack of training which make guidance and counseling not achieve its intended purpose in pre-school. The study concludes that training, academic level and experience of teachers were significant factors in provision of guidance and counseling. The study recommends that the Ministry of Education should consider professionalizing guidance and counseling services in pre-schools. The findings of this study may be beneficial to the school administrators by enabling them to have a better understanding of the guidance and counseling services being offered to preschool children in their schools.Item Cervical cytomorphologic presentations: association with pre-cervical cancer determinants in women from Nakuru county(2017-11) Wanjiku, Muitta EstherCervical cancer disease is among leading global cancers in women and it causes reproductive tract ill health. The disease is preceded by pre cancer status identified by detection of abnormal cells in smears from the cervical wall. High risk genotype16 and 18 human papilloma virus is implicated. Other predisposing determinants include Chlamydia trachomatis infections, lifestyle and nutritional factors for example healthy diet inadequacies, and chronic reproductive tract ill health. The link between these determinants and pre cervical cancer grades has only partially been examined with no studies reported among women from Nakuru County. This descriptive cross-sectional study was conducted at Nakuru County referral hospital to examine the relationship of determined pre cervical cancer grades in regards to cervical epithelial cytomorphologic features with outcomes of select microbial STI, lifestyle and reproductive health characteristics among women participants. A total of 142 women participants, ≥ 20years of age, were purposively enrolled into the study. Manifested clinical signs, lifestyle and diet practices were collected using a questionnaire. Anthropometric physical measurements were recorded. Serum extracted from whole blood was screened for Treponema pallidum and HIV antibodies. In addition endocervical swabs were used for Neisseria gonorrhea, Chlamydia trachomatis antigen and HPV oncoprotein detection while endocervical scrape smears were examined for cyto-morphological profiling and categorization of enrolled subjects using the Bethesda 2014 classification into four pre cervical cancer study groups of: 1) LSIL; n=35; 2) HSIL; n=59; 3) AGC/AIS; n=8 and 4) controls; (No evidence of cellular lesion) n=40.Cytomorphologic findings indicated that in all participants,~67% subjects manifested koilocytic cells, while ~28% had high grade cellular atypia in their smears. Select STI screened indicated that ≥11% subjects were positive for HIV1/2 and at least 10% for HR HPV 16/18. Collectively at least ~6% of test subjects tested positively for Treponema pallidum, Neisseria gonorrhoea and Chlamydia trachomatis. Additionally, multivariate logistic modeling indicated that HPV16/18 was associated with likelihood of having LSIL, HSIL and AGC/AIS pre cancer grade (P<0.0001; β>3.600; OR>2.0; 95% CI). Lifestyle and nutritional assessment illustrated that anthropometric median values ≤99 cm for bust girth and ≤86cm for waist circumference were associated with higher risks of presenting with HSIL and AGC/AIS grades (P<0.04; β>1.681; OR>5.0; 95% CI), while history of consuming unhealthy diet was associated with higher odds of presenting with LSIL (P=0.012; β, -1.433; OR; 4.190; 95% CI;). Reproductive health evaluation revealed that history of lower abdominal pain and vaginal bleeding was associated with higher chance of presenting with LSIL (P=0.003; β=1.758; OR=5.800; 95% CI); HSIL (P=0.001; β=2.183; OR=8.873; 95% CI) or AGC/AIS (P<0.0001; β=25.347; OR=1.019; 95% CI). These results confirm that a high koilocytic atypia magnitude in examined smears is a true pointer of pre cervical cancer genesis. Moreover, HR HPV16/18 infection, upper trunk and abdominal wasting gauged from low median scopes of bust and waist, consumption of unhealthy diet and clinical history of protracted symptomatic manifestation of abdominal pain and vaginal bleeding are important predictors of the development of pre cervical cancer in women from Nakuru County. Therefore, maximum atypia detection should further be enhanced through employment of LBC. Screening of HR HPV infections, integration of anthropometric measure, adopting nutritional counseling and reproductive tract sign monitoring and care in the MCH would reduce risk of developing pre cervical cancer signs.Item Assessment of the pharmaceutical manufacturing industry in Kenya to forecast local production sufficiency(2017-10) Vugigi, Sarah KadesaThe World Health Organization’s global strategy on public health aims to support Member States to improve access to essential medicines. The desire of Kenya Government to implement this is expressed by formulation of Kenya National Pharmaceutical Policy (2010) which encourages local production of essential medicines for self-sufficiency. The pharmaceutical manufacturing industry in Kenya is engaged in production of various types of dosage forms but its capacity and capability to produce essential medicines for Kenyans have not been determined. The aim of this study was to assess the pharmaceutical manufacturing industry in Kenya to forecast local production sufficiency. This was attained by evaluating the manufacturing capability, production capacities and compliance with international marketing authorization standard of the Kenyan pharmaceutical industry. The 24 licensed manufacturers of medicines for human use were assessed. Data was collected on the current drug situation in Kenya by scanning Pharmacy and Poisons Board database to determine range of products that are registered in Kenya. Local pharmaceutical manufacturer’s product lists, Kenya Essential Medicines list and pharmaceutical tender lists of three major procurers in Kenya (Kenya Medical Supplies Authority, Kenyatta National Hospital and Mission for Essential Drugs and Supplies) were examined to establish the proportion of products which was manufactured locally. Prices competitiveness and market share of local products were evaluated and subsequently, pharmaceutical equivalents of 150 locally manufactured essential medicines were determined. Data on production capacity for 5 years (2010-2014) and compliance of facilities with good manufacturing practices standard and other prerequisites of marketing authorization was obtained using a structured questionnaire. Results showed that solid dosage forms were majority (54.9 %) of local products and sterile preparations were minority (2.7 %). Locally manufactured products accounted for 14.5 % of registered and 21.5 % of retained products. Local firms manufactured 38.4 % of products listed as essential medicines and 55.6 %, 24.5 % and 21.8 %, respectively, of pharmaceutical products procured by Kenya Medical Supplies Authority, Kenyatta National Hospital and Mission for Essential Drugs and Supplies. The overall percentage of local pharmaceutical equivalents was 32.5 % for registered products. There was no variation between mean prices of local and imported pharmaceutical equivalents. Scatter diagrams demonstrated that imported pharmaceutical products comprised both low and highly priced brands. The overall utilized production capacity (two shifts) was 21.5 %; tablets (24.1 %), capsules (12.8 %), liquids (25.3 %), dry syrups (21.8 %), external preparations (21.3 %) and oral rehydration salts (23.6 %). This study projected the year for self-sufficiency in non sterile medicines produced in the local industry as 2043. Good manufacturing practices standard was satisfactory at 11 facilities while the rest were striving to achieve compliance. Research and development of new products was limited in most facilities with 1 % of the workforce deployed in this department. It is concluded from this study that Kenya depends heavily on imported drugs for her essential medicines needs. Majority of local products were less competitive than imported products and production capacity was underutilized. Majority of manufacturers adhered to current good manufacturing practice standards but were inadequate in research. This study recommends augmentation of research and development by the local pharmaceutical industry to generate new products. In addition, substantial government support is required to propel the industry to improve product range, product competitiveness and production capacity utilization.