School of Public Health and Community Development

Factors associated with drug resistance patterns among antiretroviral therapy-experienced adolescents in south rift valley, Kenya

2025-12-02T08:57:59Z

Factors associated with drug resistance patterns among antiretroviral therapy-experienced adolescents in south rift valley, Kenya ODHIAMBO, Argwings Miruka Even though antiretroviral (ART) has greatly improved survival of people living with HIV, resistance mutation is an emerging threat to scale up of ART globally. Adolescents have higher risk of drug resistance mutations (DRM). Factors associated with DRM in South Rift Valley remain unknown. The objective of study was to investigate factors associated with DRM among ART-experienced adolescents aged 10-19years enrolled in Nandi, Kericho, Bomet, and Narok counties. Specifically, study aimed to characterize HIV drug resistance patterns, assess biomedical; behavioral; and determine health systems factors associated with DRM. This cross-sectional cohort study comprised of 226 participants selected through simple random sampling using mixed method conducted between August-November 2024. Data on DRM was extracted using standardized tool and interpreted using Stanford HIVDR database. Questionnaires and interview guide used to collect data on biomedical, behavioral and health systems factors. Descriptive statistics, Chi-square test, and bivariate and multivariate logistic regression performed to examine association between variables and DRM. Quantitative data analyzed using SPSS Ver.27, with statistical significance set at p ≤ 0.05 while qualitative data used NOVO approach. Overall, 145 (64%) adolescents exhibited resistance. Mean age 16.3 years (SD = 2.7); 51.3% male and 65% orphans. Dual resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTIs) occurred in 53%, while resistance to protease inhibitors (PIs) and integrase strand transfer inhibitors (INSTIs) was 9.3% and 7.1%, respectively. NNRTIs, resistance was highest to NVP (50.4%) and EFV (49.6%), commonly driven by K103N (23.9% and 28.8%). NRTI resistance included 3TC (40%, M184V 31%), AZT (20%, M184V 5.8%), ABC (26.3%, M184V 13.3%), and TDF (2.7%, M184V 1.8%). PI resistance featured ATV/r (V82A, L33F), DRV/r (L89V), and LPV/r (V82A). INSTI resistance included DTG, CAB, and RAL with S230R, G118R, R263K, and Y143R mutations. Bivariate analysis revealed factors associated with DRMs include duration on ART (p = 0.030), number of enhanced adherence counseling EAC sessions (p = 0.001), ART regimen type (p = 0.001), CD4 count (p = 0.030), caregiver occupation [p = 0.029], and orphan status [p = 0.049]. Multivariate logistic regression, ART duration, ART regimen, and EAC sessions associated with drug resistance. Longer ART duration, EAC sessions, and use of NNRTI-based regimens were associated with DRM. Thematic analysis suggests adherence among adolescents is shaped by both individual motivation and by social, family, and systemic factors. Participants suggested that empowering caregivers through education on ART adherence, HIV literacy, and adolescent development could foster a more supportive home environment PhD Thesis

Dysregulation of mycobacterium tuberculosis and HIV-specific T cell immunity among HIV-tuberculosis co-infected adults from western Kenya.

2025-11-11T11:32:25Z

Dysregulation of mycobacterium tuberculosis and HIV-specific T cell immunity among HIV-tuberculosis co-infected adults from western Kenya. KHAYUMBI, Jeremiah Human immunodeficiency virus (HIV) and Mycobacterium tuberculosis (Mtb) as single infections are clinically manageable. However, their presentation as a co-infection leads to accelerated progression to acquired immunodeficiency syndrome and active tuberculosis. The underlying immunological mechanisms leading to this end-point clinical phenomenon could be associated with dysregulated HIV and Mtb-specific T-cell immunity. This study investigated the changes in T cell frequency, absolute count and phenotype in individuals presenting with Mtb-HIV coinfections, at Jaramogi Oginga Odinga Teaching and referral hospital, the biggest referral facility in western Kenya. Specifically, it determined the effect of Mtb infection and disease on HIV-specific CD4+ and CD8+ T cell immune responses, the effect of HIV on Mtb-specific CD4+ and CD8+ T cell immune responses and evaluated phenotypic expression of selected markers of immune activation and cytotoxicity in individuals with Mtb infection with or without HIV. In this analytical cross-sectional study, a total of 300 participants were screened, 100 enrolled and categorized into 4 groups: 25 with Latent TB infection (LTBI), no HIV, 25 with LTBI and HIV, 25 with active TB and HIV, and 25 with HIV but no form of TB. Approximately 50ml of venous blood was drawn, and peripheral blood mononuclear cells (PBMCs) separated for phenotyping of cell surface molecules and intracellular cytokine staining of T cells by flow cytometry. The frequency, absolute count, and phenotypes of total and antigen-specific CD4+ and CD8+ T cells expressing markers of activation and cytotoxicity were analyzed in response to Mtb Whole Cell Lysate (WCL) and HIV group-specific antigen (gag). Control stimulation conditions included an unstimulated control, Staphylococcus enterotoxin B (SEB), Cytomegalovirus (CMV), and Mycobacterial ESAT6-CFP-10. CD4+ and CD8+ T cell frequencies expressing HLA-DR, CD40L, Ki-67, IFN-γ, Perforin, Granzyme B, CD107a, and Caspase 3 were analyzed using the FACSDiva® version 8.0.1. Flow data was analyzed on FlowJo® version 9. Background subtraction was done and antigen-specific T cells quantified using MIISMOSA software. Mann-Whitney U test was used to test for any significant difference between two groups, while Kruskal Wallis test was used to compare three groups, followed by Dunns pairwise test. Results were considered significant at p≤0.05. The findings showed evidence of depletion of HIV-specific CD4+ and CD8+ T cells in people with ATB, but not LTBI. Expression of HLA-DR, granzyme B, and perforin were increased in total CD4+ and CD8+ T cell populations in individuals with ATB but not HIV-specific CD4+ and CD8+ T cells, which did not differ by Mtb infection and disease status. Furthermore, HIV led to depletion of Mtb-specific CD4+ T cells. IFNγ+ WCL-specific CD4+ T cells (CD40L-IFNγ+) were depleted in both arms with a significant difference (p=0.036), while CD40L+ CD4+ T cells were not. HIV increased immune activation in WCL-specific CD4+ T cells among LTBI individuals. HIV also induced HLADR within Mtb-specific CD4+ T cells in people with LTBI. No significant increase in Ki67 expression was noted. There was no significant difference in expression of the other phenotypic markers (CD38, HLA-DR, Ki67, active caspase-3, granzyme B, and perforin-A) among HIV specific CD4+ and CD8+ T cells. CD40L+ Mtb-specific CD4+ T cell responses were found to predominate in people with and without HIV. These findings suggest that ATB is associated with overall increased T cell activation and cytotoxicity and depletion of HIV-specific CD4+ and CD8+ T cell responses, which may contribute to further impairment of T cell-mediated immune control of HIV replication in the setting of ATB, leading to AIDS. Mtb also leads to depletion of IFN+ cells among people with and without HIV. HIV-associated depletion of Mtb-specific CD4+ T cells suggests that HIV contributes to Mtb T cell-specific dysfunction, leading to active TB. Therefore, interventions targeted toward prevention of progression from LTBI to active TB would be useful among HIV co-infected individuals. They would similarly prevent the progression of HIV to AIDS due to reduced immune activation. Induction of mechanisms that restore functionally depleted T cells, as well reverse the functional impairment, would counter the HIV-induced impairment among co-infected individuals. CD40L+ T cells would offer new frontiers as a new biomarker of immunity in HIV-Mtb co-infection studies. The ability of Mtb and HIV infections to interfere with functional ability of specific T cell immunity points towards the need for early diagnosis and intervention of Mtb and HIV infections, especially in co-infected individuals as this will decrease early progression to ATB and AIDS. PhD Thesis

Widowhood stigma as a determinant of HIV risk behaviours among widows in gem sub-county, Siaya county, Kenya

2025-11-11T08:17:51Z

Widowhood stigma as a determinant of HIV risk behaviours among widows in gem sub-county, Siaya county, Kenya ATIENO, Jackline Odhiambo The United Nations named widowhood stigma as one of the triple burdens of widowhood alongside sexual and economic vulnerabilities. However, widowhood stigma is hardly measured and its health effects less understood. The overall aim of this study was to assess widowhood stigma as a determinant of HIV risk behaviors among widows in Gem sub-County, Siaya County, Kenya. The specific objectives included 1) to estimate the prevalence of HIV risk behaviors since widowhood, 2) to explore widows’ experiences with widowhood stigma, 3) to develop a measure for widowhood stigma, and 4) to determine the association between widowhood stigma and HIV risk behaviors. Gem sub-County was chosen as the study site because of reported concerns with widowhood stigma, a 27% HIV prevalence among widows higher than 16% in Siaya County, and a unique population-based sampling frame. Using a mixed methods exploratory sequential design, 56 purposively sampled widows first participated in in-depth interviews (n=21), three focus group discussions (n=28), and narrative life histories (n=7). Their data were analysed thematically and used to generate themes and items for measuring widowhood stigma that were used in the subsequent survey. Before the cross-sectional survey with an age-stratified random sample of 480 widows, the widowhood stigma items were first reviewed by 10 local experts for relevance and comprehensiveness and then tested and revised through cognitive interviews with six widows for comprehension, clarity and ease of response. Survey data were analyzed in three steps: 1) exploratory factor analysis, reliability and validity tests to develop the widowhood stigma scale, 2) descriptive statistics to estimate the prevalence of widowhood stigma and HIV risk behaviors, and 3) multivariable logistic regression to determine the association between widowhood stigma and HIV risk behaviours. From the qualitative data, widows experienced structural, interpersonal and intrapersonal widowhood stigma. Interpersonal widowhood stigma included negative labels and stereotypes, social isolation and loss of social status. The widowhood stigma scale had 19 items across 3 sub-scales (internalized stigma, loss of social status and social isolation) measured on a Likert scale of 1-4 with higher mean scores showing more widowhood stigma. The scale’s overall Cronbach’s alpha of 0.93 showed high reliability and its strong positive correlation (rs=0.51) with depression and moderate negative correlation (rs=-0.41) with functional social support showed preliminary construct validity. On prevalence, 1 in 2 widows experienced widowhood stigma and 1 in 2 widows engaged in any HIV risk behaviors, most commonly condomless sex (55.6%), widow inheritance (partnering of widows with the deceased husband’s relative) (60.2%) and sexual cleansing (sex to purify widow from the shadow of death) (60.0%). After adjusting for confounders such as age, education, income source and HIV status, for every unit increase in widowhood stigma scores, the odds of condomless sex (AOR: 1.72, 95%CI: 1.24, 2.41), widow inheritance (AOR: 1.58, 95%CI: 1.14, 2.18), sexual cleansing (AOR: 1.71, 95%CI: 1.24, 2.37), sex with older partners (AOR: 1.41, 95%CI: 1.06, 1.88), multiple sequential widow inheritors (AOR: 1.70, 95%CI: 1.21, 2.40), and widows receiving gift for sex (AOR: 1.52, 95%CI: 1.04, 2.22) increased. Widowhood stigma was highly prevalent and increased HIV risk behaviors since widowhood. Interventions to address widowhood stigma as driver of HIV vulnerability in widowhood is needed. While needing validation in new populations, the widowhood stigma scale should catalyze research on widows’ wellbeing and contribute to the design and evaluation of widowhood stigma reduction interventions and policies in Gem sub-County and other settings of high HIV prevalence. PhD Thesis

Factors associated with cervical intraepithelial neoplasia among women in Kisumu County and the diagnostic performance of p16/ki-67 Biomarkers

2025-11-06T12:08:52Z

Factors associated with cervical intraepithelial neoplasia among women in Kisumu County and the diagnostic performance of p16/ki-67 Biomarkers ONYANGO, George Calleb Cervical intraepithelial neoplasia (CIN) is a premalignant lesion of the cervix that can progress to cervical cancer (CC) if not identified early and treated as appropriate. Globally, incidence of CC is estimated at 660,000 annually with the greatest burden found in sub-Saharan Africa (SSA) and about 40.1 per100,000 reported in Kenya of which 9 per 30,000 screened are admitted in Kisumu County with advanced stage cancer annually. Besides HPV infection, the definitive factors promoting CC burden in SSA are still not clear; although imbalance in cervicovaginal microbiome especially HSV-2 and CT have been suggested in studies conducted in Africa, differently from those conducted in other regions. Moreover, controversy surrounding hormonal contraceptives use and incidence of CIN in some regions remained unresolved. This study examined the effects of coinfections and contraceptives use on incidence of CIN in the region. Currently, HPV DNA test is the primary tool for CC screening with VIA serving as a triage test where Pap cytology is not available. However, Pap cytology is more subjective and inaccessible to majority patients while VIA is limited by low sensitivity. A more efficient point of care test (POCT) that guarantees a one-day patient visit complete with test results and treatment is still lacking. Integration of p16/ki-67 biomarkers in the current CC screening program, specifically to identify cases of cervical dysplasia with subsequent treatment in a single visit is currently explored in a number of countries. This study compared the diagnostic performance of p16/ki-67 biomarkers with VIA using histology as a standard. In a hospital based cross-sectional study, the risk factors associated with CIN and the diagnostic performance of p16/ki-67 cytology among women in Kisumu County were assessed. The specific objectives were to determine the associations between coinfections and hormonal contraceptive use with incidence of CIN; and compared the diagnostic performance of p16/ki-67 cytology with that of VIA. A total of 517 referrals with cervicovaginal abnormalities were sequentially enrolled at a referral center. Blood samples were collected for HIV1/2 and HSV-2 tests; cervical swabs collected for HPV and p16/ki-67 tests; urine collected for CT test; and biopsy collected for histology. HIV infection was tested via Determine HIV-1/2 and confirmed via first response HIV1/2 card tests; HSV-2 was tested via HerpeSelect-2 enzyme immunoassay; HPV was tested via GeneXpert HPV assay; p16/ki-67 biomarkers were tested via CINtec PLUS test; CT was tested via GeneXpert CT/NG assay and biopsies were tested via hematoxylin and eosin stains. Categorical variables were summarized using test of proportions and the differences examined using Pearson's Chi-square test. Logistic regression was used to test the associations between coinfections and contraceptives use with incidence of CIN, and McNemar χ2.test used to compare the performance of p16/ki-67 and VIA with a p-value < 0.05 considered as statistically significant. Among 189 colposcopic biopsy confirmed, CIN1, CIN2, ≥CIN3 and normal biopsy were 56(29.6%), 27(14.3%), 12(6.3%), and 94(49.7%) respectively. The overall prevalence of CIN was 18.4% (95/517) with high grade ≥CIN2 of 7.54% (39/517) equivalent to 32.5 per 100,000 women per year. HPV/HIV coinfection (infected vs. uninfected: aOR 4.45; 95% CI 2.53–7.92, p < 0.001); HPV/HSV-2 coinfection (infected vs. uninfected: aOR 5.67, 95% CI: 2.61–12.40, p <0.001); HPV/CT coinfection (infected vs. uninfected: aOR 6.03; 95% CI 3.00-12.2, p < 0.001) were significantly associated with CIN, but not contraceptives use [aOR 0.73, 95% CI 0.41–1.25, p = 0.079]. Regarding the diagnostic performance of p16 /ki-67 and VIA; the sensitivity of p16/Ki-67 test was 84.6% (95%CI: 69.5-94.1) greater than VIA 59.0% (95%CI: 42.1–74.4), p = 0.024; specificity was 44.0% (95%CI: 35.9-52.3) lower than VIA 62.0% (95%CI: 53.7- 69.8); p= 0.003; PPV was 28.2 (95%CI, 21.7–36.3) similar to VIA 28.8% (95%CI, 28.1 – 34.5); p = 0.251; NPV was 91.7% (95%CI, 87.8–94.7) greater than VIA 85.3% (95%CI, 80.0–89.7); p = 0.002 with a fair agreement of kappa 0.109; (95%CI, 0.02-0.196), p= 0.012. In conclusion, coinfections with HIV, HSV-2 and CT were associated with CIN but not contraceptives use. Immunostain p16/ki-67 is a fairly improved diagnostic test than VIA and can serve as an alternative test. PhD Thesis

Utilization and effectiveness of symptothermal method as a strategy to ameliorate unmet need for family planning among women of reproductive age in Kisumu county, Kenya

2025-11-06T11:59:05Z

Utilization and effectiveness of symptothermal method as a strategy to ameliorate unmet need for family planning among women of reproductive age in Kisumu county, Kenya EROSIE, Catherine Igben The associated adverse effects of hormonal/device contraceptives ranging from displaced IUDs, excessive/continuous haemorrhage, pelvic pain, headache, weight gain, osteoporosis, backache, hypertension, deep venous thrombosis amongst others, have contributed to the high unmet need for family planning among women of reproductive age. Unmet need due to lack of safe contraceptives, cultural and religious ideology are part of the factors that have served as threats to the health and well-being of women. In Kisumu County, unmet need for family planning (FP) is 16.4%, depicting lack of safe and adequate contraceptive methods. In line with Sustainable Development Goals (SDGs) 3- target 3.7, addressing unmet need for FP to prevent unintended pregnancies is a high priority for women‘s health, and the symptothermal method (STM) is deemed to be an effective strategy. It is effective, affordable, have no side-effects, accessible and supported by religious/cultural groups. Hitherto, this technique has not been exploited as a better alternative to make up for the unmet need for family planning, as there is no evidence of STM utilization and effectiveness rate in Kisumu County, which therefore requires that field trial be done to test this new method. This study assessed utilization and effectiveness of STM as a strategy to ameliorate unmet need for FP among women of reproductive age (WRA) in Kisumu County. The specific objectives included assessment of baseline knowledge and attitude towards STM; assessment of training (intervention) on knowledge, attitude and satisfaction of STM; to determine the use-effectiveness of STM; and to assess healthcare providers‘ factors influencing usage of STM. This study adopted mixed method (quantitative and qualitative) study design. Quantitative approach adopted quasi-experimental study design, while qualitative approach adopted qualitative research design of two-way focus group discussion (FGD) technique. The quantitative approach (Objective 1, 2, & 3) entailed three phases which were phase 1, recruitment of participants (intervention group-STM, and control group- Oral Contraceptive Pills-OCPs); phase 2, training of participants (intervention group); and phase 3, longitudinal monitoring of participants (intervention and control group). The qualitative study design (Objective 4), employed focus group discussion technique that enabled the application of the phenomenology approach to enquiry. Simple random and purposive non-random sampling techniques were adopted. Simple random sampling technique gave each County and Sub-County an equal chance of being selected, and purposive non random sampling technique enabled only WRA and healthcare providers that met the inclusion and exclusion criteria to participate in the study. Participants consisted WRA 15-49yr and healthcare providers in maternal, reproductive and family planning units. 260 participants comprising 136 STM users (interventional group) and 124 OCPs users (Control group), were recruited. 14 healthcare providers for FGD were also recruited. The intervention was conducted for 3 months with longitudinal monitoring for 12 months. Questionnaires, cycle charts and audio recorder were used for data collection and data analysed using SPSS-IBM 23 and Dedoose 9.2.005 software. Continuous variables were represented as mean, median and interquartile ranges (IQRs) and categorical variables expressed as frequency counts. For comparison of variables between groups, multiple response, Chi-square, Paired sample t-Test and Univariate-ordinal logistic regression models were used at p<0.05. In examining distribution of time to events variables to estimate use-effectiveness of STM, survival analysis of Kaplan–Meier and life table were employed. In analysis of difference between STM and OCPs in the probability of an event (pregnancy) at any point in time, log rank test was performed at significant level of 0.05. A reflexive thematic analysis was performed on FGD transcript data. Objective one; most (87.7%), of participants had very low level of knowledge of STM, established at (Cal. X2 val. 2.853; p-value, 0.808 @ df, 6) and majority (97.0%), of participants had very high positive attitude towards STM, established at (Cal. X2 val. 43.351; p-value, 0.002 @ df, 6). Objective two; Paired sample t-Test established that women have significant (t = -058.716, p = 0.001) knowledge post-training (1.0000 ± .00000) compared to pre-training (.0682 ± .01587) on STM. There was no significant (t= -1.419, p = 0.158) difference in attitude towards STM pre-and-post training. There was significant level of satisfaction (p = 0.001). Objective three; in STM category, no pregnancy occurred. Cumulative survival/ use-effectiveness of STM for 12 months was 100% while in category of OCPs, 3 pregnancies occurred between months 2-5, with use-effectiveness of 97-99% and probability of failure of 1-2%. To establish significant difference between use-effectiveness of STM and OCPs, Log rank test established significance of 0.058 at degree of freedom (df) 1, implying no significant difference between use-effectiveness of STM and OCPs. Objective four; primary strategies for successful integration of STM in healthcare facilities, include training of healthcare providers and creating of community awareness. Conclusively, based on WHO Algorithm (number of unintended pregnancies per 100 women per year), indicating < 1 pregnancy as highly effective, STM is considered to be very effective in ameliorating unmet need for family planning among participants. The study therefore recommends that training of healthcare providers is paramount to foster thorough understanding of STM for effective dissemination of information on STM with clarity and confidence to women/couples who will be needing such services, for sustainability to ameliorate unmet need for family planning. PhD Thesis

Effectiveness of dialogue-trained community health promoters in promoting uptake of cervical cancer screening in Nyando and Nyakach sub-counties, Kenya

2025-11-06T11:52:21Z

Effectiveness of dialogue-trained community health promoters in promoting uptake of cervical cancer screening in Nyando and Nyakach sub-counties, Kenya OCHOMO, Edwin Onyango Cervical cancer burden keeps rising with Kenya recording 5845 cases and 3591 deaths in 2022. The burden is higher in the developing countries due to lower screening rates. The low screening rates are due to low knowledge on cervical cancer among women of reproductive age (WRA) resulting from ineffective communication strategies. This study assessed the effectiveness of dialogue-trained CHPs in promoting uptake of cervical cancer screening among WRA in Nyando and Nyakach sub-Counties. Specifically, the study; assessed CHPs’ knowledge on cervical cancer following the dialogue-based training, compared the pre- and post-intervention knowledge on cervical cancer and screening rates among WRA following dialogue-trained CHPs intervention, and investigated the factors affecting uptake of cervical cancer screening among the WRA in Nyando and Nyakach sub-Counties. In this quasi-experimental study, 384 WRA were recruited. The educational intervention using CHPs was conducted in Nyando while Nyakach was the control. The knowledge was assessed using questionnaires and screening rates using self-reports before and after the intervention. Focus group discussion (FGD) with the WRA explored the factors affecting screening uptake. Change in knowledge and screening rate was analysed using Wilcoxon rank-sum test and difference in difference, while the factors affecting screening uptake using chi-square. Statistical significance was assessed at p≤0.05. The CHPs’ knowledge significantly improved from 30.1%, to 53.4% following the dialogue-based training (MD=23.3, Z=9.507, 95%CI, p<0.001). For WRA in the intervention arm, knowledge improved from 19.41% to 28.23% (SE=1.1, Z=-7.152, 95%CI, p<0.001) at post-intervention. At pre-intervention the control arm recorded better mean score than the intervention arm (SE=0.7, Z=7.671, 95%CI, p<0.001), this changed post-intervention with the intervention arm posting a better mean score than the control (SE=1.2, Z=-2.114, 95%CI, p=0.035). Those who scored average knowledge category in the intervention arm also increased at post-intervention (=28.372, 95%CI, p<0.001). Only 27.37% and 28.00% had been screened, in the intervention and control arms, respectively. This improved at post-intervention to 40.53% (Z=7.335, 95%CI, p=0.007) in the intervention arm. The number of those screened due to the health talks conducted by the CHPs also increased significantly at post-intervention (=4.385, 95%CI, p=0.036). The barriers to screening included violation of ones’ privacy (=17.504, 95%CI, p<0.001) and not feeling at risk (=30.001, 95%CI, p=0.001). Staff shortage, long waiting time, and male providers were reported as some of the barriers to screening from the FGD. Dialogue-based communication improved the knowledge on cervical cancer and the uptake of screening services in Nyando and Nyakach sub-Counties. PhD Thesis

Distribution, molecular characterization and insecticide resistance of Malaria vectors in Kakamega county, western Kenya

2025-11-06T11:37:54Z

Distribution, molecular characterization and insecticide resistance of Malaria vectors in Kakamega county, western Kenya KITUNGULU, Nicholas Ligayo Despite a significant global decline in malaria cases and mortality over the past two decades, recent years have seen resurgence in Western highlands of Kenya. This study aimed to assess the distribution, genetic diversity, and insecticide resistance of malaria vectors in Kakamega County located in the highlands of Western Kenya. Ecological distributions, productivity, species composition of anopheline mosquito in various aquatic habitats were cross-sectionally surveyed. Furthermore, the genetic analysis of Cytochrome Oxidase gene 1 (Cox1) gene from mitochondrial deoxyribonucleic acid (mtDNA) was performed. Additionally, phenotypic and mechanisms of resistance was conducted using World Health Organization (WHO) tube bioassays tests and genotyping of alleles associated with resistance to An. gambiae s.l to evaluate mortality rates against deltamethrin, permethrin, Dichlorodiphenyltrichloroethane (DDT) and pirimiphos-methyl was conducted respectively. Data analysis, which is Analysis of Variance (ANOVA), was done to compare mosquito abundance, distribution and species composition among study sites at 0.05 significance level. Genetic analysis was performed by Clustal 1.81 and genetic distances calculated using Kimura’s 2-parameter model in MEGA6. For resistance mechanisms of allele’s analysis, a Hardy-Weinberg equilibrium test for kdr and Ace-1R genotypes was applied. A total of 1,566 habitats were sampled; mean aquatic densities varied by species and habitat type. Highest densities of An. gambiae s.l (20.4) were observed in farmland, while artificial forests favored An. funestus s.l (8.2) and An. coustani s.l (4.0). A total of 1,566 aquatic habitats were sampled in various land use types. The mean aquatic densities of An. gambiae s.l. (46.2 ± 5.54 SD), An. funestus s.l. (5.3), An. coustani s.l. (1.7), An. implexus (0.13) and An. squamosus (2.0) were observed in fish ponds, burrow pits, drainage ditches, and tire tracks, respectively. A high mean density of An. gambiae s.l. was reported in farmland (20.4) while high mean abundance of An. funestus s.l. (8.2) and An. coustani s.l. (4.0) were observed in artificial forests. The isolates had minimal genetic diversity with 28 (90%), 2 (7%) and 1 (3%) clustering with An. gambiae, An. macupalpis and An. Rufipes, respectively, on a phylogenetic tree. The study revealed that, Anopheles arabiensis was predominant species in all exposed tests, Mumias east (62%), Malava (68%), Ikolomani (77%) and Lurambi (82%). Results showed mortality was low in Mumias east (80.6%) and high in Lurambi (89.0%). Resistance to pyrethroids (Deltamethrin and Permethrin) and organochlorines (DDT) were observed in all mosquito populations with < 90% mortality. Pirimiphos-methyl resistance in An. arabiensis and An. gambiae s.s were observed in mosquitoes collected from Mumias East and Malava subcounties. Kdr L1014 mutations observed were heterozygous in both An. arabiensis and An. gambiae s.s with all populations being consistent with Hardy-Weinberg equilibrium (P>0.05). A low frequency of G119S mutation was observed in resistance population. Populations tested for PhD Thesis

Elucidation of anti-prostate activities of berries of solanum aculeastrum dunal: a novel approach to management of benign prostatic hyperplasia and prostate cancer

2025-11-06T11:39:06Z

Elucidation of anti-prostate activities of berries of solanum aculeastrum dunal: a novel approach to management of benign prostatic hyperplasia and prostate cancer CRUCIFIX, Gift Pender The prevalence of benign prostatic hyperplasia (BPH) increases with age and may progress to prostate cancer (PC). In Kenya, about 64,600 cases of BPH were recorded in 2000 which increased to 126,000 in 2019, making it worthwhile to take preventive measures of managing BPH to halt progression to PC. This study elucidated anti-prostate activities of Solanum aculeastrum Dunal berries (SADB). About 4500g of dried SADB sampled from Kakamega forest in western Kenya were extracted using methanol; from which n-hexane, dichloromethane, ethyl acetate, n-butanol, and aqueous fractions were generated and subjected to phytochemical and GC-MS profiling, except aqueous fraction. Swiss ADME and pKCSM tools were used to screen and select drug-like candidates from bioactive compounds identified with GC-MS from MESADB, HFSADB, EFSADB and DFSADB. DisGeNET and related databases were used to identify targets for bioactive compounds of extracts, BPH and PC. Molecular roles, biological processes, cellular components, and crucial pathways associated with biological processes of gene enrichment were obtained using GO & KEGG pathway analysis, respectively. Molecular docking was achieved with VINA tool. Antiproliferative and gene expression profiling were determined using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) bioassay, and RT-qPCR respectively, and data analyzed using Graph Pad Prism (version 8.4) at p < 0.05. Glycosides, alkaloids, tannins, flavonoids, terpenoids, phenols, and saponins were identified. GC-MS profiling identified 32 compounds in methanol extracts, 25, 22, 20, and 11 compounds in the hexane, ethyl acetate, dichloromethane, and n-butanol fractions, respectively. Drug-likeness compounds of MESADB included Undecane, D-Arabinitol, and 9-Oxabicyclo [3.3.1] nonan-2-one,6-hydroxy-, with D-Arabinitol; and 9-Oxabicyclo [3.3.1] nonan-2-one,6-hydroxy-] demonstrating high binding affinity with PTGS2 and EGFR genes, significantly (p < 0.0001) inhibited growth of DU-145 cells with IC50 value and selectivity index of 5.11μg/ml and 14.84, respectively, while sparing Vero CCL-81 cells, significantly (P < 0.0001) downregulated PTGS2, EGFR and BCL-2, in treated DU-145 cells. Drug-likeness compounds of HFSADB included [(-)-cis-.beta.-Elemene; beta-Humulene; and Cadina-1(10),4-diene], with, [(-)-cis-.beta.-Elemene; and Cadina-1(10),4-diene] demonstrating strong binding affinity with PTGS2 and CYP19A1 genes, which was corroborated by in vitro studies as HFSADB significantly (p < 0.0001) inhibited growth of DU-145 cells with IC50 value and selectivity index of 5.478μg/ml and 10.67, respectively, while sparing Vero CCL-81 cells, significantly (P < 0.0001) down regulated PTGS2 and BCL-2 in treated DU-145 cells. Drug-likeness compounds of EFSADB were Thunbergol and Cycloheptane, 4-methylene-1-methyl-2-(2-methyl-1-propen-1-yl)-1-vinyl-, which showcased strong binding affinity with PIK3CA and MARK 8 genes, significantly (p < 0.0001) inhibited growth of DU-145 cells with IC50 value and selectivity index of 5.478μg/ml and 11.29, respectively, while sparing Vero CCL-81 cells, with significant (P < 0.0001) down regulation of MAPK-8 and BCL-2 in treated DU-145 cells. Drug-likeness compounds of DFSADB included Ingol 12-acetate and 1-Ethylsulfanylmethyl-2,8,9-trioxa-5-aza-1-sila-bicyclo [3.3.3] undecane with predicted activities against targets, and significantly (p < 0.0001) inhibited growth of DU-145 cells with IC50 value and selectivity index of 5.210μg/ml and 13.16, respectively, while sparing Vero CCL-81 cells, with significant (P < 0.0001) down regulation of MAPK-8, EGFR, PTGS2n and BCL-2 in treated DU-145 cells. This study strongly demonstrates anti-prostate potentials of SADB and would benefit BPH and PC patients, curb occurrence of the conditions and improve public health. PhD Thesis

Determinants and effect of health education intervention on patients’ adherence to artemisinin-based combination Therapy in Kamuli district, Uganda

2025-11-06T11:39:58Z

Determinants and effect of health education intervention on patients’ adherence to artemisinin-based combination Therapy in Kamuli district, Uganda BAWATE, Charles Malaria control strategies aimed at accelerating patients‘ adherence to artemisinin-based combination therapy are needed in the fight to control and eradicate malaria. Previous studies have shown the power of health education campaigns in improving patients‘ adherence to antimalarials. Patients in Kamuli district have low adherence and do not complete their prescribed ACT. The study assessed the determinants and effect of health education intervention on patients‘ adherence to ACT in Kamuli District, Uganda. Specifically, to determine the level of patients‘ adherence to ACT, to determine the factors influencing patients‘ adherence to malaria ACT, and to establish the effect of a health education intervention on the patients‘ adherence to malaria ACT. This was a quasi-experimental (pre-post-test intervention study design without a control group and unpaired) using quantitative and qualitative approaches. Trained health professionals conducted the health education training on patients‘ adherence to malaria ACT. The study was anchored on the diffusion of innovation theory. At pre- and post-test phases, participants were enrolled at eight randomly selected facilities. The study enrolled 2532 participants, equal numbers at pre and post phases. At each time, equal numbers (422) were assigned to any of the three arms (no follow-up, day 2 and 4). In addition, 24 key informants were purposively selected. At the health education intervention phase, 3496 participants were trained during the intervention. Data was collected by use of a questionnaire, interview guides, and observation and review checklist. Logistic regression used to establish the influence of predictor variables on the dependent variable. A Mann-Whitney U test used to establish the effect of health education intervention. At phase two, a paired sample t-test done to determine the effectiveness of the health education training. The study reported a 13.2% increment in patients‘ adherence to ACT, from 588/844 (69.7%) pre-test to 700/844 (82.9%) post-test, with a mid-term assessment of 677/844 (80.2%). Multivariate analysis showed at pre-test that adhering to ACT is 3.07 times higher for someone satisfied with getting ACT at the facility (OR = 3.07; p < 0.0001; 95% CI = 1.85-5.10), 4.23 times for someone with history of saving ACT (OR = 4.23; p < 0.0001), 2.19 times for someone who shared ACT (OR = 2.19; p = 0.025; 95% CI = 2.24-7.99), 2.61 times for someone with a household head as a mother (OR = 2.61; p = 0.014; 95% CI = 1.21-5.65). At post-test, the odds of one adhering to ACT prescription were 1.88 times for one who prefers ACT to other anti-malarials (OR =1.88; P = 0.009; 95% CI = 1.172-3.019), and 2.17 times for someone with history of saving ACT (OR = 2.17; p = 0.04; 95% CI = 1.28-3.69), and all factors were statistically significant. Qualitatively, key informants decried that, ―health workers do not explain clearly how to use the different medicines properly. They only put drugs in the book, call your name and tell you that where there is a star – those are not available. No clear instructions are given especially at busy facilities and on busy days‖. At intervention phase, the training had overall positive and significant effect on the community members and health care workers knowledge. A Mann-Whitney U test showed a statistically significant difference in the patients‘ adherence to ACT of pre-test and post-test after the intervention (U = 308904, Z = -6.409, p < 0.0001), with higher adherence at post-test (median = 900.5) than pre-test (median = 788.5) and small effect (0.156). There was an improvement in the patients‘ adherence to ACT, and the health education intervention had a positive effect on patients‘ adherence to ACT in the studied population. However, patients‘ tendencies to save and share ACT is a threat, amidst the benefits and well-known dangers associated with adherence. There is a need to continuously educate all about adherence to medicines as prescribed and tighten government medicine supply. The study underscores the value of a tailored health education intervention in enhancing patients‘ adherence to ACT. PhD Thesis

Effectiveness of behavior change intervention in enhancing utilization of health data for decision making by community members in Nyando sub-county, Kenya

2025-11-06T11:40:41Z

Effectiveness of behavior change intervention in enhancing utilization of health data for decision making by community members in Nyando sub-county, Kenya MUNYAO, Henry Kilonzo Utilization of health data is key because it enables individuals and communities to make decisions on their health seeking behaviour. However, studies show low utilization of health data for this purpose with data generated in communities under-utilized especially in the Low- and Middle-Income Countries (LMICs). This can be attributed to the ineffective methods of providing feedback to communities resulting in poor health problem identification. In Kenya, majority of health programs provide feedback on health data to communities through conventional methods such as health talks in health facilities, use of mass media, posters and billboards. Despite these, less than 38% of health data is analyzed and used for decision making by communities. This calls for a paradigm shift in the way health data is communicated to communities. This study therefore investigated the effectiveness of a Behavior Change Intervention on enhancing use of health data for decision making among community members in Nyando Sub- County, Kenya. Specifically, the study sought to: establish the health data needs of community members; examine the factors influencing utilization of health data for decision making; determine trends in utilization of health data for decision making during the intervention; and establish the effectiveness of the Behavior Change Intervention in improving use of health data for decision making. This was a longitudinal interventional (pre-post) study that adopted both quantitative and qualitative approaches to data management over a period of 12 months. The study was implemented in five phases namely: Phase 1: Baseline study to identify community health data needs and factors influencing utilization; Phase 2: Curriculum development and training of Community Health Promoters (CHPs) on how to sensitize households in utilization of health data for decision making; Phase 3: Implementation of the Behaviour Change Intervention in households and community forums through dialogue; Phase 4: Longitudinal Monitoring; Phase 5: End-line survey. A total of 440 participants were sampled using Taro Yamane’s formula (1967). Quantitative data for the baseline and end-line surveys was collected using semi-structured questionnaires while qualitative data was collected through Focus Group Discussions and Key Informants Interviews. Quantitative data was analyzed using SPSS version 25 and R, while qualitative data was thematically summarized and analyzed using the NVivo application. Chí-square test was used to determine association between categorical independent and the dependent variables while Cochran’s Q test determined statistical significance of the differences in utilization of health data for decision making at the different observation points during the intervention.McNemar’s test was used to confirm statistical significance of the differences in utilization of health data for decision making between the baseline and end-line. At baseline, 50.2% of the study participants needed health data on HIV/AIDS, 44.5% needed data on prevention of malaria, 52.95% on TB prevention, 34.55% needed data on child immunization, while 54.3% needed data on hygiene and sanitation. Utilization of specific health data for decision making at baseline showed thatuse of prevention of malaria data was at 187(42.5%), TB prevention management was at188 (42.7%), HIV/AIDS prevention was at 210(47.8%), ANC was at 123(28%), Deworming was at 146(33.2%), Child Immunization was at 156(35.5%) and hygiene and sanitation was at 117 (26.6%). Findings from the qualitative survey resonated with these results. Key informants and Focus Group discussants pointed out specific reasons for use and non-use of the health data. The main factors that influenced utilization of health data for decision making were; Education Level, for HIV data use (P=0.01, OR=2.5); Age,for malaria data use (p=0.07, OR=2.05);Education Level, for TB management data use (P=0.00, OR=2.3); Religion, for ANC data use (P=0.02, OR 2.2);and Gender, for child immunization data use (p=0.03, OR=1.7).The study revealed an increased trend in utilization of health data at 4 months(n=235, 53.5%), at 8months (n=282, 64.6%) and at 12months (n=378, 85.9%). Cochran Q test revealed a statistical significance in the increased trends with a cumulative P-value of 0.025.McNemers test revealed statistical significance in the changes in utilization of health data recorded at the baseline and end-line phases of the study (P=0.019) hence confirming that the Behaviour Change Intervention is effective in enhancing utilization of health data for decision making by communities. These findings will therefore inform national and county level efforts to enhance utilization of health data for decision making among communities in order to improve their health seeking behaviour. PhD Thesis