PHD-Department of Medicine, Therapeutics, Dermatology & Psychiatry
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Item Assessment of the Quality of Medical Laboratory Service Provision in Kenya(Kenyatta University, 2014) Njoroge, Wachuka Gathigia; Michael Otieno; Geoffrey MuluviThere has been increasing interest to improve the quality of laboratory services world- wide including in many resource poor countries. In tandem with this need, the Kenya government recognizes the delivery of quality laboratory services as an integral part of the national health care strategy. Towards this goal the surveillance system for quality medical laboratory services in Kenya was instituted by the Kenya Medical Laboratory Technicians and Technologist Board. However, Kenya still has very little concrete and reliable information on the actual standard adaptation, and implementation, or the impact policy guidelines have had on laboratory services delivery. The objective of this study was to address these gaps by carrying out a situational analysis to assess the quality of medical laboratory services delivery in Kenya. The specific objectives of this research were to assess the laboratory practitioner’s competence; to determine the level of compliance to practice standards; to investigate the management of quality systems; and to analyze the extent to which the patient’s needs for quality laboratory services were met. As a representation of each of the regions in Kenya the study areas were situated in Nairobi, Mombasa, Kisumu and Nyeri counties. The study was both an observational and descriptive study using a cross sectional design. Purposeful sampling was used to select the laboratories while as random sampling was used for the laboratory practitioners and patients. The data was analyzed by the measures of central tendency mode, median and mean plus measures of variability, range, standard deviation and variance. Data was analyzed using least squares regression model, t-tests and one way analysis of variance (ANOVA) using Excel spreadsheets and SPSS version 19. The overall assessment was that the quality of medical laboratory services delivery in Kenya was good. The highest level of quality management systems were maintained by private high class laboratories p > 0.052, p > 0.05, α = 0.05 which also had the highest rating of compliance to practice quality p < 0.022, p < 0.05, α = 0.05. Faith based laboratories had the highest rating in competency of practitioners p < 0.027, p < 0.05, α = 0.05. Analysis of patients perception of quality service provided p < 0.039, α = 0.05 indicated that the private low class laboratories fared the best p < 0.030, α = 0.05. Findings of this research were that the laboratory practitioners were competent, the practice characteristics were of good standard and patients perceived the services to be of good quality. The study failed to reject the null hypothesis (p > 0.05) pertaining to the quality management systems in place p < 0.057, α = 0.05. No laboratory had adequate quality management systems in place. The recommendation of this study is there is a need for adequate internal and external quality assurance schemes to be in place to constantly monitor the quality of assay results.Item Use of mobile phone short text message service to enhance cervical cancer screening at the Thika Level 5 Hospital, Kiambu County, Kenya.(Kenyatta University, 2015-10) Wanyoro, A.K.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.Item Assessment of selected Antibiotics and Heavy Metals in untreated Wastewater, Vegetables and Soils in Eastern Nairobi, Kenya(2014-02-26) Mathenge, Scolastica Gatwiri; Wanjau, R. N.; Kenji, G.M.Untreated wastewater contains pharmaceutical compounds and heavy metals harmful to human health and the environment. People get access to untreated water through broken sewer pipes, blocked manholes and direct disposal into rivers. One such river is the Ngong River which passes through Nairobi County including Njiru and Ruai. People use untreated wastewater for growing of vegetables and washing cars. Soils and vegetables grown or irrigated with untreated wastewater may contain high levels of antibiotics and heavy metals that are detrimental to health. Sulfamethoxazole (SMX) and trimethoprim (TMP) antibiotics, administered in synergy for the management of pneumocystis carinii pneumonia, pneumocystis jiroveci pneumonia, toxaplasmosis and genitourinary tract infections in HIV-AIDS patients or in cases of oral thrush infections. The two drugs are also cheap and readily available in synergy over the counter even through self-prescription for management of upper respiratory tract and genitourinary tract infections under the brand name septrin or co-trimoxazole. In synergy, the two drugs are also administered to poultry and livestock as growth promoters, prophylaxis and to control microbial infections. Their presence in vegetables could induce microbial resistance and minimize drug sensitivity. The heavy metals may emanate from the waste water discharged by the small scale industries that are based in the study site. However, reports on levels of antibiotic residues and heavy metals in untreated waste water, vegetables and soils in Kenya are very scarce. Therefore this study aimed to determine the concentration of sulfamethoxazole (SMX) and trimethoprim (TMP), Cd, Pb, Zn, Mn, Fe and Cu in the soil, untreated waste water and vegetables irrigated with the untreated waste water in Ruai and Njiru. Untreated wastewater, soil and vegetables were collected during the dry season from various sites in Ruai and Njiru from small scale farms along Ngong River. The samples were also obtained from a control plot at the Kenyatta University. The samples for heavy metal analysis underwent wet digestion pre-analysis procedures while for antibiotics underwent solvent extraction pre-analysis. The heavy metals were determined by atomic absorption spectroscopy while antibiotic residues were determined by high performance liquid chromatography. The heavy metal concentrations in the vegetables ranged from 81.88 to 633.05 mg/kg. The mean concentration for Fe in the vegetables ranged between 481.24 to 1215.49 mg/kg for Mn, 1.94 to 4.58 mg/kg for Cd, 2.19 to 4.46 mg/kg for Pb, 3.19 to 8.70 mg/kg for Zn, 21.17 to 29.70 mg/kg for Cu, 24.71 to 27.52 ng/L for TMP, and 4.93 to 22.64 ng/L SMX. Some of these values were above the local and international safety limits. The concentrations (mg/L) of the heavy metals in untreated wastewater ranged from 3.09 to 3.54 for Mn, 0.01 to 0.03 for Zn, 0.21 to 0.28 for Pb, 4.79 to 8.07 for Fe, 0.17 to 0.22 for Cu and 0.42 to 0.47 for Cd. In the untreated wastewater SMX ranged from 62.09 to 88.66 ng/L. The vegetables TMP concentration ranged from 2.16 to 15.45 ng/L. The levels of some heavy metals and antibiotics were significantly higher than those from control samples. In all cases the results in the farms upstream were higher than in those downstream. The results from this work will be availed to relevant authorities for policy formulation and they can be used to sensitize the public, especially on the antibiotic residues.