School of Public Health and Community Developmenthttps://repository.maseno.ac.ke/handle/123456789/13192024-03-29T09:13:09Z2024-03-29T09:13:09ZEvaluation of a HIV predictive algorithm, geospatial analysis of new HIV diagnoses, and mapping of HIV testing uptake in Homa bay, Kisumu, and Siaya counties, western KenyaMUTTAI, Hellenhttps://repository.maseno.ac.ke/handle/123456789/59832024-02-14T13:55:56Z2023-01-01T00:00:00ZEvaluation of a HIV predictive algorithm, geospatial analysis of new HIV diagnoses, and mapping of HIV testing uptake in Homa bay, Kisumu, and Siaya counties, western Kenya
MUTTAI, Hellen
As the number of people living with HIV in the population who do not know their HIV status continues to decline, as more people are linked to ART, continuing to offer HIV testing in a universal manner becomes inefficient. Finding ways to target HIV testing to persons more likely to be HIV positive, for efficiency, is a global priority. The purpose of this study was to evaluate the useof three strategies to identify sub-populations and granular-geographic areas with higher HIV positive yield to inform efficient targeting of HIV testing among persons >15 years in Homa Bay, Siaya and Kisumu; counties with the highest HIV prevalence and incidence in Kenya. The specific objectives were to evaluate the use of a HIV predictive risk-score algorithm, geospatial analysis of new HIV diagnoses, and mapping of HIV testing uptake. Using a hospital-based retrospective cohort study design, aHIV predictive risk-score screening algorithm was developed using univariable and multivariable analyses of outpatient data, comprising 19,458 persons >15 years tested for HIV from September 2017–May 2018 from five purposively selected health facilities in Homa Bay, Siaya and Kisumu Counties. Using a community-based retrospective cohort study design, the use of geospatial analysis to assess geospatial patterns of new HIV diagnoses, and the use of mapping HIV testing uptake, were evaluated. Community home-based data comprised 365,798 clients aged >15 years offered home-based HIV testing as part of a routine public health program from May 2016–July 2017 in Siaya County. Geospatial analysis using Kulldorff’s spatial scan statistic was used to detect geographic clusters (radius <5 kilometers) of new HIV diagnoses. A Geographical Information System program was used to map HIV testing uptake. The results showed that an HIV predictive risk-score screening algorithm developed grouped patients into four risk-score categories: <9, 10–15, 16–29 and >30, with increasing HIV prevalence of 0.6% [95% Confidence Interval (CI): 0.46–0.75], 1.35% (95% CI: 0.85–1.84), 2.65% (95% CI: 1.8–3.51), and 15.15% (95%CI: 9.03–21.27), respectively. External validation of the algorithm produced similar results. The algorithm’s discrimination performance was modest, with an area under the receiver-operating-curve of 0.69 (95% CI: 0.53–0.84). The algorithm accounted for a high proportion (R2 0.89) of the variability of HIV prevalence in the study population. Results from geospatial analysis of new HIV diagnoses showed spatial variation in the distribution of new HIV diagnoses, and nine sub-location clusters in which the number of new HIV diagnoses was significantly (1.56 to 2.64 times) higher than expected were identified. Results from mapping HIV testing uptake found that268,543 (86%) clients were tested for HIV. Of the 43,680 eligible clients not tested, 32,852 (75%) were not found at home and 5,931 (14%) declined testing. Granular geographic areas with low testing uptake, a high proportion of clients not found at home and a high proportion who declined testing, yet with clusters of higher new HIV diagnoses were identified. In conclusion, the following strategies successfully identified sub-populations and granular-geographic areas with higher HIV positive yield that should be targeted in the implementation of HIV testing services: aHIV predictive risk-score screening algorithm that identified patients who are more likely to be HIV-positive; geospatial analysis that identified granular sub-location clusters (<5 kilometers) of higher new HIV diagnoses; and mapping of HIV testing uptake that identified granular-geographic areas with low HIV testing uptake yet higher HIV positive yield. These study findings inform global, national, and county government policies and strategies for targeting HIV testing, for efficient use of resources and maximal epidemiologic impact.
PhD Thesis
2023-01-01T00:00:00ZDeterminants of maternal child health service quality in tier three public health facilities, Kisumu county, KenyaIBWORO, Vincent Okitoihttps://repository.maseno.ac.ke/handle/123456789/57762023-09-13T12:19:27Z2023-01-01T00:00:00ZDeterminants of maternal child health service quality in tier three public health facilities, Kisumu county, Kenya
IBWORO, Vincent Okitoi
Compromised Maternal Child Health (MCH) service quality is increasingly being linked to
failure to attain expected healthcare improvements in Low and Middle-Income Countries.
Kenya’s Free Maternity Services (FMS) (Linda Mama) initiative removed user fees for MCH
services with the aim of increasing service uptake and improving MCH service quality. This
led to increased patient load, as a result, overstretching health facilities resources. There were
concerns of declining service quality and hence, the need to identify the determining factors.
Service quality is complex but is conventionally considered in terms of structure (facility
characteristics, equipment and human resources); process (provider-patient interaction) and
outcomes (users’ perspectives) dimensions. The study focused on tier three public health
facilities of Kisumu County. Specifically, it assessed the mothers’ socio-economic and
demographic characteristics associated with MCH service quality; healthcare workers’
characteristics associated with MCH service quality; healthcare service delivery processes
associated with MCH service quality and healthcare structural factors associated with MCH
service quality. Through analytical cross-sectional design, facility-level data were collected
from a sample of 334 mothers, 81 healthcare workers using structured questionnaires and 7
Key Informant Interviews. Variable characteristics were summarized descriptively. The
association of healthcare structural aspects and MCH service quality was assessed through
Principal Component Analysis. About 52% of mothers were aged between 20 and 29 years,
71.9% were married and 64% had achieved post-primary education while about half lived
below poverty line. Mothers of para 1 (aOR= 2.29, 95%CI=1.04-2.05, p-value= 0.040) or para
2 (aOR= 3.22, 95%CI=1.54-2.70, p-value=0.002); rural residence (aOR=2.24, 95%CI=1.05-
2.79, p-value= 0.037) perceived services to be of quality. About half (49.4%) of healthcare
workers were aged between 20 – 29 years. Of these, 46.3% were Nursing Officers of whom
57.5% were Diploma holders and 28.4% were university graduates. Being a university
graduate (aOR= 21.29, 95%CI=1.15 - 2.16, p-value=0.04) and deployment in a department for
six months (OR=7.22, 95%CI= 1.3-2.22, p-value=0.024) were healthcare workers’
characteristics associated with MCH service quality. Healthcare service delivery processes
associated with MCH service quality were clinical examination (OR=11.33, 95%CI=2.55-
3.35, p-value=0.001); laboratory malaria investigations (OR=3.21, 95%CI=1.71-2.03,
p=value=<0.001); child immunization (OR=1.82, 95%CI=0.62-1.30, p-value=0.027); health
education and mentorship (p-<0.001). Having the 5 listed staff cadres [aOR 2.16, CI=1.15-
4.05 & p=0.016) was associated with MCH service quality. Facilities with antenatal ward
(0.3189), Medical Officer (0.3189) and a suction machine (0.2867) had higher factor loading.
This study result indicated older mothers had low perception of MCH service quality while
those with low parity and residence of rural areas were more likely to report having received
MCH service quality. Healthcare workers with Higher National Diploma (HND) were less
likely to offer MCH service quality while being deployed in a department for 6 months was
more associated with MCH service quality. Received Syphilis test was less associated with
MCH service quality. Having Medical Officer, Nursing Officer, Nutritionist,
Obstetrician/gynaecologist, Pharmaceutical Technologist) contributed more to MCH service
quality as compared to physical structures and equipment. The study will help in designing
and implementation of MCH programs and training of healthcare workers for improvement of
MCH service quality in Kisumu County
2023-01-01T00:00:00ZInfluence of health-facility cold-chain storage logistics and staff capacity on thermo-stability of live-attenuated vaccines in Kisumu-county, KenyaOLUNGA, Okomo John Moseshttps://repository.maseno.ac.ke/handle/123456789/57462023-06-26T12:55:43Z2023-01-01T00:00:00ZInfluence of health-facility cold-chain storage logistics and staff capacity on thermo-stability of live-attenuated vaccines in Kisumu-county, Kenya
OLUNGA, Okomo John Moses
Vaccines are integral in the control of infectious diseases globally. Successful immunization programs require robust cold-chain logistics and efficient service-delivery systems to ensure they remain within recommended temperature range to guarantee their stability and efficacy. In sub-Sahara Africa, approximately 15-20% of vaccine equipment are faulty while transport and electricity infrastructure pose additional challenges. Despite new technologies for tracking vaccine cold-chain performance, resurgences in live attenuated vaccine preventable childhood diseases are still common indicating potential multiplicity of factors. In Kenya, between 2014 and 2016, there were resurgences of measles, rota and, tuberculosis infections mostly in Kisumu County despite over 80% immunization-coverage and investment in new fridges, these implied potentially more complex unmet cold-chain challenges. Drivers of these outbreaks which are only associated with live-attenuated vaccines were still not clear. The current study assessed influence of health-facility cold-chain storage-logistics and staff-capacity on thermo-stability of live-attenuated vaccines. Specifically, it assessed association between: functionality of fridges, cold-boxes; vaccine-carriers and thermo-stability of vaccines; staff compliance with cold-chain guidelines and thermo-stability of vaccines; staff competency in cold-chain management and thermo-stability of vaccines; and staff cold-chain management perceptions and thermo-stability of vaccines. Analytical cross-sectional design with mixed methods techniques was adapted. Qualitative and quantitative site-level data were collected from 120 of 170 health-facilities using questionnaires. Stratified random sampling and convenient were applied through multistage approach. Variable characteristics were summarized descriptively; associations were tested using chi-square and binary logistic regression to identify predictors of vaccines thermostability. Qualitative information were coded, categorized and thematically analyzed to identify evolving perspectives through N-Vivo software. Overall fully-functional cold-chain storage logistic were 44.5% (95%C.I, 0.074-0.366; OR 0.165, p<0.001); functional-fridges, 64.2% (95%C.I, 1.332-6.370; OR, 2.913; p=0.007) and vaccine-carriers, 37.5% (95%C.I, 1.462 -6.884; OR 3.172; p=0.003), all associated and predicted thermo-stability of vaccines. Overallcompliance to Cold-chain guideline, 40% (95% C.I, 0.001-0.025; OR, 6.021; p<0.001); use of VVM to dispense vaccine, 42% (95%C.I, 0.645-6.787; OR, 2.085; p=0.022); monitored temperature twice daily, 69% (95%CI, 0.052-0.651; OR, 0.185; p=0.009), were all associated and predicted thermo-stability of vaccines; however, orderly arrangement of vaccines, 49%(95%C.I, 0.000-0.025; value,8.520;p=0.004) was only associated. Competency on vaccines-transfer when fridges were faulty, 53.3%(95%C.I, 0.955-7.397; OR, 2.658; p=0.031); and use of VVM stages to dispense vaccines, 55.8%(95%C.I, 0.127-0.988; OR, 3.540; p=0.047) were associated and predicted outcome of vaccines thermo-stability; conversely overall-competency 67% was not, similar to overall perception, 61.7%, except for perception on vaccines transfer,75%(95%C.I, 0.682-5.847; OR, 1.997; p=0.007); otherwise, perception on vaccines arrangement, 61.7%(95%C.I, 0.890-9.821; value, 7.023; p=0.030), was only associated. Vaccines at substantial private-facilities were at a higher-risk of thermo-instability due to marked lapses in compliance and in-adequate support supervision. Live-attenuated vaccines comparatively showed higher level of thermo-instability except for BCG hinting the notion that associates them with occasional outbreaks of vaccines preventable child-hood illnesses. There is need for KEPI managers to strengthen support supervision and extend provision of WHO recommended fridges to private facilities.
2023-01-01T00:00:00ZEffect of community mobilization intervention on self medication with antimicrobials among households in Nyalenda informal settlement, Kisumu county, KenyaOWUOR, Isabel Akothhttps://repository.maseno.ac.ke/handle/123456789/57362023-06-22T11:27:31Z2022-01-01T00:00:00ZEffect of community mobilization intervention on self medication with antimicrobials among households in Nyalenda informal settlement, Kisumu county, Kenya
OWUOR, Isabel Akoth
Self-medication with antimicrobials (SMWA) is a common practice in the world, especially in economically deprived communities with loose regulatory systems. Previous studies in Nyalenda B Ward, found 76.9% of the households perceiving the practice as convenient and appropriate. The SMWA could result into missed diagnosis, misdiagnosis, delay in appropriate treatments and emergence of human pathogens resistance. The Nyalenda informal settlement is not empowered with knowledge of risks of SMWA nor ability to negotiate their inclusion in the health system. The aim of this study was developed in response to unsolved SMWA. The main objective of the study was to determine the effect of community mobilization intervention on SMWA among households in Nyalenda informal settlement. The specific objectives were to establish the reasons for SMWA by households, to evaluate the association of Participatory Learning and Action (PLA) with the different domains of SMWA empowerment (power within, power with and power over) and to determine the effect of empowerment on SMWA. This study was a quasi-experimental trial of a community mobilization intervention that used community empowerment as an intervention strategy, and approached through participatory learning and action (PLA). Based on the sub-divisions in Nyalenda, the intervention took place in Nyalenda B Ward and NyalendaA Ward was used as a control. Baseline and end line survey for the case and the control group used a cluster sampling method with a sample size of 380 households determined by Fisher‟s formula and the study population was all households in Nyalenda A (9,392) and Nyalenda B (10,443). The intervention had two samples, the first was determined arbitrarily and chosen randomly from all the households in Nyalenda B (1501) and the second was determined and chosen purposively from Nyalenda B CHVs (30). Data was collected through structured questionnaires. Chi square analyses were used to establish the socio-demographic characteristics of and reasons for SMWA by Nyalenda informal settlement before and after the intervention. Binary logistic regression analysis evaluated the association of PLA and different domains of empowerment and also determined reasons for SMWA and socio demographics influencing self-medication with antimicrobials among the intervention group. Difference in differences determined the effect of community empowerment on SMWA. Statistical significance was tested at P≤0.05. The intervention and the control group showed similarities in their reasons for SMWA from both their baseline and end line surveys but the intervention group decision to SMWA was informed. The association between PLA domains and all empowerment domains revealed that the odds that each and every PLA domain is associated with every empowerment domain is more than 2 (the range is 2.2-8.6) and at a P<0.0001. Community empowerment on SMWA resulted to an effect size of 52.6% (95% CI=0.469-0.563) and a study on the case community after the intervention revealed that the socio demographics and the reasons for SMWA associated with SMWA were illness or symptoms of illness (OR=1.324, 95% CI=1.129-1.554, P=0.001), age (OR=0.647, 95% CI=0.431-0.973, P=0.037) and information leading to the SMWA (OR=0.732, 95% CI=0.613-0.873, P=0.001). Health insurance schemes [health insurance cover (OR=1.772, 95% CI=0.652-2.887, P=0.133) and Universal Healthcare Services (OR=1.165, 95% CI=0.922-1.472, P=0.201)] had no effect on SMWA. Community mobilization is a successful method for increasing public knowledge and understanding of antimicrobial resistance and appropriate use of antimicrobials, it also reduces SMWA proportion especially when strengthened with structural modification such us improvement of access to antimicrobial prescription among the households in Nyalenda informal settlement in Kisumu County. This intervention should be prolonged to offer sustained change, while the health system should implement policies and laws restricting inappropriate sale of antimicrobials.
2022-01-01T00:00:00ZAnalysis of antimicrobial resistance genes encoding extended-spectrum β-lactamases in pathogenic bacteria isolated from wounds of diabetes mellitus patients at Jaramogi Oginga Odinga Teaching & Referral Hospital, Kenya.TUVEI, Susan Mamusavuhttps://repository.maseno.ac.ke/handle/123456789/57272023-06-08T13:55:50Z2023-01-01T00:00:00ZAnalysis of antimicrobial resistance genes encoding extended-spectrum β-lactamases in pathogenic bacteria isolated from wounds of diabetes mellitus patients at Jaramogi Oginga Odinga Teaching & Referral Hospital, Kenya.
TUVEI, Susan Mamusavu
The number of people with diabetes in the world is estimated to increase to 783 million by 2045 with prevalence in Africa and Kenya estimated at 54.9 million (5.2%) and 1.5milion (4.5%) by 2045 respectively. At Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), diabetes is the sixth cause of mortality. The threat to an individual with diabetes developing a wound is 25% with infected wounds being polymicrobial. Worldwide, Staphylococcus aureus, Proteus species, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli are the most common pathogens isolated from diabetic wounds. At JOOTRH, diabetic wounds are managed using penicillins, cephalosporins, aminoglycosides and carbapenems. Most common genetic variants of the pathogens worldwide include temoneira (TEM), sulphydryl variable (SHV), cefotaximase (CTX-M), pseudomonas extended-resistance (PER), Oxacillinase (OXA), mecA and vanA. Several studies show contradicting views with regard to; the most common bacteria colonizing wounds, the resistance patterns of bacteria to antibiotics and more importantly studies on resistant genes encoding extended spectrum β-lactamases in bacteria show varied occurrence of genes from region to region. These variations complicate efforts to single out the most prevalent microbes, their resistance patterns and which gene is most common for precipitating antimicrobial resistance thus calling for continued research especially in areas such as JOOTRH where no such study has been conducted. The purpose of this study was analysis of antimicrobial resistance genes encoding extended spectrum β-lactamases in pathogenic bacteria isolated from wounds of diabetes mellitus patients at JOOTRH. Specific objectives were to; phenotypically profile selected bacteria microbe, determine antimicrobial resistance patterns and genetic diversity of resistant genes encoding extended spectrum β-lactamases in bacteria isolated from wounds of diabetes mellitus patients at JOOTRH. A hospital based cross sectional study design was employed with a target population of 168 and sample size of 117 patients sampled using stratified random sampling. Data was collected using a structured questionnaire and a laboratory form for a period of 6 months. Pus swabs were collected for isolation of bacteria using conventional techniques and serology. Susceptibility was done using Kirby-Bauer disk diffusion on Mueller Hinton Agar at 37˚C for 24 hrs. Antimicrobial resistance genes encoding ESBLs were identified by Polymerase Chain Reaction and High Resolution Melting Analysis. Chi-square test analyzed prevalence, antimicrobial susceptibility in relation to clinico-demographics while independent samples t-test and binary regression analysis established relationship between resistant genes and inhibition zones. Results showed that Gram negative were most prevalent at 65.8% with 62.4% being ESBLs producers. Low resistance was established for; amikacin (7.5%) and gentamicin (7.5%) on S. aureus , imipenem (0.0%) and gentamicin (0.0%) on E. coli, imipenem (0.0%) on K. pneumoniae and Proteus mirabilis and ciprofloxacin (0.0%) on P. aeroginosa. The diverse genes present were blaSHV (17.8%), blaTEM (17.8%), blaCTX-M (10.3%), EcoblaTEM (5.3%), blaPER (10.3%), mecA (30.8%) and VanA (7.7%) with mecA being most prevalent. Findings provide effective chemotherapeutic alternatives including aminoglycosides, carbapenems and fluoroquinolones for managing diabetes patients with wounds and recommends that JOOTRH to adopt microbial screening, susceptibility and gene testing policy for the purpose of identifying the most effective treatment regimen for better patient’s care.
2023-01-01T00:00:00ZHOST-PATHOGEN ASSOCIATION AND TRANSMISSION DYNAMICS OF BRUCELLA SPECIES IN KENYA AND TANZANIAAKOKO, BY JAMES MISERhttps://repository.maseno.ac.ke/handle/123456789/55502022-12-19T13:54:44Z2022-01-01T00:00:00ZHOST-PATHOGEN ASSOCIATION AND TRANSMISSION DYNAMICS OF BRUCELLA SPECIES IN KENYA AND TANZANIA
AKOKO, BY JAMES MISER
Bacterial pathogen of the genus Brucella is a gram-negative organism with several species. It causes a disease called ―brucellosis‖ in humans, and animals worldwide. Association between animal and human Brucella sero-positive cases have been documented within Kenya and Tanzania. But data on the species of Brucella circulating in various susceptible hosts, including the zoonotic species B. abortus and B. melitensis is insufficient, thus limiting adoption of species or host-targeted control strategies. The primary objective of this study was to assess hostpathogen association and transmission dynamics of Brucella species among animal and human populations. While the specific objectives were 1) To identify Brucella species circulating in livestock and wildlife in Marsabit, Narok in Kenya and Northern Tanzania 2) To identify Brucella species responsible for human infections in Marsabit, Narok in Kenya and Northern Tanzania 3) To assess molecular diversity and transmission dynamics of Brucella species in different hosts within Kenya and Tanzania. Therefore, a cross-sectional study was undertaken at the wildlife, livestock, and human areas in Marsabit and Narok, Kenya as well as Northern Tanzania. A total of 1384 samples from cattle (709), goats (274), sheep (191), pigs (79), camels (61), buffaloes (70), and humans (257) were collected from Narok, Marsabit in Kenya and Northern Tanzania. Information on history of retained placenta or abortion, location, and age of sampled livestock were recorded. Information such as gender, location of residence, and age were obtained and recorded from the study participants. Real-time PCR assays were run on all the samples with primers that are specific for IS711 and bcsp31 targets to detect the genus Brucella. Another real-time PCR assay with AlkB and BMEI1162 targets was run to detect B. abortus and B. melitensis species, respectively in all the samples that had amplifications with both genus targets to answer objectives one and two. Mixed effects logistic regression models and descriptive analysis were done using lme4, sjstats, and gmodels packages in R-statistical software. Overall, 199 (33.3%) livestock samples and 99 (38.5%) human samples were found to be positive for the genus Brucella for the third objective. This study found B. abortus to be associated with camels (OR=2.9, 95% CI: 1.3–6.3), and cattle (OR=2.3, 95% CI: 1.1–4.6), while B. melitensis had significant association with both goats (OR=1.7, 95% CI: 1.0 – 3.1) and sheep (OR=3.6, 95% CI: 2.0 – 6.7). The DNA belonging to both B. melitensis and abortus were found in multiple livestock species, buffaloes, and humans, suggesting occurrence of crosstransmission of the two Brucella species among the different hosts. Occurrence of crosstransmission of Brucella spp. beyond their known preferential host was further strengthened by detection of B. abortus in Pigs, that has always been associated with B. suis. Animals with either retained placenta or abortion history were associated with presence of B. melitensis, and B. abortus, respectively. Therefore, retained placenta and aborted materials could be facilitating the transmission of B. melitensis and B. abortus. Persons within 21 to 40 years of age were more likely to have a PCR positive results for Brucella (OR=2.8, 95% CI: 1.2-6.6) than other age categories. Multiple livestock species are responsible for transmitting Brucella to humans. Therefore, brucellosis control in humans should target cattle, sheep, goats, pigs, and camels, while using One Health multidisciplinary approach.
2022-01-01T00:00:00ZAccess to and provider knowledge and practices on artemisinin-based combination therapy and quinine in drug outlets and their use in households in malaria endemic areas of western KenyaWATSIERAH, Carrenhttps://repository.maseno.ac.ke/handle/123456789/43142021-11-04T09:17:37Z2013-01-01T00:00:00ZAccess to and provider knowledge and practices on artemisinin-based combination therapy and quinine in drug outlets and their use in households in malaria endemic areas of western Kenya
WATSIERAH, Carren
Artemisinin-based Combination Therapy (ACT) was adopted as the most effective treatment
option against malaria in Kenya. Artemether-Lumefantrine (AL) is the first-line ACT drug
for treatment of uncomplicated malaria, while quinine is preferred for complicated and severe
malaria. Information on access and knowledge and practices of providers prior to or during
implementation of ACT and quinine is scanty. Moreover, the evaluation of how these factors
influence the use of these drugs in households is rare. The results could be used as a guideline
to step-up the activities to enhance malaria treatment and as a key bench-mark to evaluate the
success of the implementation of the malaria treatment policy in Kenya and further evaluate
the role of policy implementation in malaria burden in the study region. The study adopted
World Health Organization (WHO) and Health Action International (HAl) standardized
methodologies to evaluate access and provider knowledge and practices and use of these
drugs. A cross-sectional survey using three-stage sampling was conducted in two
Plasmodium falciparum endemic regions. Based on WHO and HAl methodologies, two main
health facilities were selected. This was followed by additional selected of five district
hospitals under each main facility and eight other facilities (health centres and dispensaries)
under each district hospitals to give a total of 96 outlets (including 4% non-response). A
matching number of private outlets were randomly selected. In addition, all (66) not-forprofit
outlets and additional 30 public facilities within the study area were sampled to get the
required sample size of 288. For every outlet targeted, one household was surveyed to give a
total of 288 households. Results revealed that most private outlets, 27 (40.5%) did not stock
the first-line anti-malarial. Quinine was the most available in private 45 (68.8%). AL was
1.88 times more expensive in private outlets relative to the government recommended price.
Private sector had 50 (52.1%) who failed to state the correct anti-malarial for complicated
and severe malaria. Only 15 (15.6%) of providers in private outlets had been trained on the
use of ACT for malaria treatment. Those trained were 2-3 times more likely to provide the
correct treatment regimen for uncomplicated (OR, 2.01; CI, 1.66-3.83; P=0.039) and severe
malaria in children (OR, 2.66; CI; 1.88-5.44; P<O.OOOI) and in adults (OR, 2.01; CI, 1.88-
4.25 P=0.002). Those who had gone through in-service training among the private providers
were almost 4 times unlikely to sell partial packs of ACT (OR, 3.79; CI, 2.77-11.2;
P<O.OOOl), were 3 times likely to request for written prescription (OR, 3.00; CI, 2.45-10.4;
P=O.OOl) Anti-malarial price (OR, 2.88; CI, 1.99-4.31; P<O.OOOl), affordability (OR, 3.01;
CI, 2.45-5.01; P=0.005) and knowledge of dosing regimen (OR, 2.67; CI, 2.02-4.33;
P<O.OOOl), sale of partial packs (OR, 2.78; CI, 2.22-4.45; P<O.OOOI) and advice given by
providers (OR, 1.24; CI, 1.10-2.67; P=0.004) were several folds likely to influence antimalaria
use in households. There is low accessibility to policy recommended anti-malarials
(ACTs and quinine) in outlets. The government should ensure continuous availability of
recommended drugs to the consumers in right package sizes, and at affordable prices in all
outlet types and train stakeholders on new policies. It is essential to educate the consumers on
the need to adhere to the correct treatment regimen and ensure that changes in treatment
guidelines are accompanied by subsequent implementation activities involving all health sector players
2013-01-01T00:00:00ZDevelopment of T cell immunity to plasmodium falciparum merozoite surface protein-1 in a population exposed to holoendemic malariaKIPROTICH, Chelimohttps://repository.maseno.ac.ke/handle/123456789/43062021-11-04T07:12:31Z2009-01-01T00:00:00ZDevelopment of T cell immunity to plasmodium falciparum merozoite surface protein-1 in a population exposed to holoendemic malaria
KIPROTICH, Chelimo
2009-01-01T00:00:00ZAssessment of nutrition, infection and immune factors in Hiv Sero-positive patients enrolled in the Ampath clinic at Chulaimbo sub-district hospital, Kisumu west district, KenyaAGATHA, Onyango Christinehttps://repository.maseno.ac.ke/handle/123456789/42812021-10-29T08:04:56Z2012-01-01T00:00:00ZAssessment of nutrition, infection and immune factors in Hiv Sero-positive patients enrolled in the Ampath clinic at Chulaimbo sub-district hospital, Kisumu west district, Kenya
AGATHA, Onyango Christine
ABSTRACT
HIy worsens the nutritional status by increasing the body's requirement for food and also leads
to opportunistic infections, which in turn, increase body nutrition requirements. This study was
conducted to assess nutrition, infection and immune factors in HIV sero-positive patients at
Chulaimbo Sub-district Hospital, Kenya. This is one of the centres for the Academic Model for
the Prevention and treatment of HIV and AIDS (AMPATH) program of Moi University covering
about 14,339 HIV and AIDS patients. Patients were followed for six months to collect
information on selected variables including CD4 cell count, white blood cells and platelet count;
to assess food consumption patterns, nutrient status and nutritional status of HIV sero-positive
patients; to establish the infection pattern in HIV sero-positive patients; to establish the
association of nutrition, infection and immune factors across the mild, moderate and severe
categories of immune status; to determine the knowledge, attitude, beliefs and practices of the
patients towards dietary management of HIV infection. A longitudinal study design was adopted
where the HIV and AIDS patients enrolled at the hospital were followed for six months. Simple
random sampling was adopted for the selection of the sample 497 patients for this study. Data
was collected between the month of February and July, 2010 using focus group discussion
guides, structured interview schedule, nutrient assessment measures, anthropometric
measurements and immune status measures. Data analysis was qualitatively carried out using
content analysis and quantitatively using descriptive statistics and inferential statistics. Food
composition tables were used to compute the nutrient intake of the HIV sero-positive patients.
Chi-square was used to establish if there was any relationship in marital status, education level,
occupation, WHO staging and categories (mild, Moderate and severe) between sexes.
Independent sample t-test was used to establish if there was any significant difference in the
means between sexes and age, family size, immune status measures, nutrient intake, nutrient
status, those who suffered infection and those who did not suffer infection, and those who had
episodes of diarrhoea and those who did not have episodes of diarrhoea. Linear regression was
used to determine mean differences of immune factors and nutrient intake, nutrient status
indicators, BMI, immune status measures and infections. Findings in this study revealed that
majority of the patients in this study were in the third WHO staging (42.3%) with CD4 cell count
ranging between 200-499 cell/rnrrr' (50.7%). There were more male patients (32.4%) compared
to females (14.0%) with CD4 cell count below 200 cells/mm3. There was inadequate nutrient
intake reported in most of the patients although majority (55.3%) had three meals per day.
Generally there was inadequate nutrient intake reported among the HIV patients in all the three
categories of immune status, except for iron (10.49 ±3.49 mg) in the males and thiamine in both
males (1.65 ±O.66 mg) and female (1.72 ±O.69 mg). Malnutrition was observed in 20.3% of 497
HIV sero-positive patients were who had a mean BMI < 18.5kg/m2. Majority of the patients in
the severe category (CD4 < 200 cell/rnrrr') had a BMI of less than 18.5kglm2. There was a
significant difference in the BMI between the male and female patients (February p = 0.001,
April, p = 0.010, May p = 0.011 and July p = 0.015). Majority of the patients (66.4%) who had
infections were in the severe category of immune status. Therefore, nutrition assessment of HIV
and AIDS patients is important at all stages of the disease in order to identify those with signs of
malnutrition. Results of this study will help to educate health workers on the relative value of
using various measurements to assess nutritional status of HIV-infected populations for
appropriate interventions. The inferences drawn from this study will assist the Government of
Kenya and health professionals in designing nutritional support for HIV-infected persons.
Phd Thesis
2012-01-01T00:00:00ZPrevalence, Antimicrobial Patterns and Evaluation Of Different Methods for Controlling Pathogenic Microbes in Water and Fish from Lake Victoria and Its Basin in KenyaONYUKA, Odhiambo H. Jacksonhttps://repository.maseno.ac.ke/handle/123456789/42512021-08-02T06:32:53Z2012-01-01T00:00:00ZPrevalence, Antimicrobial Patterns and Evaluation Of Different Methods for Controlling Pathogenic Microbes in Water and Fish from Lake Victoria and Its Basin in Kenya
ONYUKA, Odhiambo H. Jackson
Fish is a very important foodstuff in developing countries due to its high protein content and
other nutritional value. Fish contamination by microbes, mainly bacteria and fungi, may lead
to food poisoning characterized by gastrointestinal diseases, vomiting, diarrhea, acute renal
failure and nausea Developing countries are worst affected by food-borne illnesses due to the
presence of pathogenic microbes that may grow in fish. Antimicrobial resistant enteric
bacteria have been reported in various aquatic environments including lakes, rivers, drinking
water and sewage. Food including fish contaminated with antimicrobial-resistant bacteria is a
major threat to public health. Prevalence of fungi and moisture content in sun-dried fish have
been a concern due to mycotoxins produced by fungi. This study was designed to determine
the prevalence and antimicrobial susceptibility patterns of Escherichia coli, Salmonella
enterica serovar Typhimurium and Vibrio cholerae 01 Isolated from water and two fish
species Rastrineobola argentea (Dagaa) and Oreochromis niloticus (Nile tilapia) in the Lake
Victoria basin of western Kenya. It also assessed the levels of infestations of dried fish by
fungi and moisture contents and finally compared and evaluated the traditional non-selective
methods of brine salting and sanitizing with chlorinated solution with new Moringa oliefera
plant extracts and bacteriophage treatments which can be used for preserving Rastrineobola
argentea (Dagaa) and Oreochromis niloticus (Tilapia) fish and controlling the spread of fishborne
pathogenic microbes. Using a cross-sectional study design, water and fresh or sun-dried
fish (Rastrineobola argentea and Oreochromis niloticus) samples were randomly collected
from three fish landing beaches (Dunga, Luanda Rombo and Sirongo) and from three markets
(Kisumu municipality, Luanda and Bondo), in the Lake Victoria Basin of western Kenya and
taken to the laboratory within 4 hours for processing and microbiological analysis using
conventional standard procedures. Statistical difference in the prevalence of enteric bacteria in
water or fish samples between the beaches or markets, and effectiveness of the different
preservatives was determined by two way Analysis of Variance (ANOVA) with p ~0.05
value considered statistically significant. Escherichia coli, S. enterica serovar Typhimurium
and V. cholerae a1 were isolated from water and fish. The results showed that water samples
from Dunga beach were the most contaminated (282 CFU/ml) and that from Sirongo beach
was least contaminated (193 CFU/ml). Fish samples (Rastrineobola argentea and
Oreochromis niloticus) from Kisumu market had the highest total viable bacteria count (218
CFU/g) and those from Sirongo beach had the lowest viable count (130 CFU/g). Out of 162
samples analyzed, 133 (82.1%) were contaminated with various enteric bacterial species. S.
enterica serovar Typhimurium was the most prevalent with 49.6% among the isolates
followed by E. coli, 46.6% and the least was V. cholerae, 2.8%. Dunga beach had the highest
number of bacterial species isolates, 33.8% followed by Kisumu market, 15.85% and the least
was Sirongo beach with, 11.3%. The difference in prevalence between the enteric bacteria
species, and the beaches or markets was statistically significant, (p < 0.01), by two way
ANOV A. All the isolates were sensitive to ciprofloxacin. E. coli was resistant to ampicillin,
tetracycline, cotrimoxazole, chloramphenical and gentamicin while S. enterica ser.
Typhimurium exhibited resistance to ampicillin, tetracycline, and cotrimoxazole. V. cholerae
01 was resistant to tetracycline and ampicillin. Paired two-tail t-test showed that sun-dried R.
argentea and 0. niloticus from the markets had significantly higher fungal species isolates
compared to fish from the beaches (P = 0.012) sun-dried R. argentea from the markets had
significantly higher fungal species isolates compared to sun-dried 0. niloticus from the
2012-01-01T00:00:00Z