African Journal of Health Sciences

Prevalence of Wuchereria bancrofti and Plasmodium Spp. infection in Anopheles mosquitoes and human blood sampled from Matayos in Busia County, Western Kenya

Caroline Maina — 2024-10-30

INTRODUCTION

Lymphatic filariasis and malaria are mosquito-borne diseases and are co-endemic in coastal Kenya. We evaluated the occurrence of co-infections with Wuchereria bancrofti and Plasmodium falciparum, the causative agents of Lymphatic filariasis and malaria, respectively, in humans and known Anopheles vectors from Matayos constituency, Busia County, western Kenya.

MATERIALS AND METHODS

The samples were collected purposively based on clinical case reports. Members of the An. gambiae and An. funestus species complexes present and the presence of W. bancrofti and P. falciparum were detected using Polymerase Chain Reaction (PCR). Positive PCR amplicons were purified and Sanger sequenced.

RESULTS

In this study, 292 Anopheles mosquitoes were analyzed, and 288 of these (98.63%) were successfully identified by PCR. The majority of mosquitoes identified belonged to the An. funestus complex (85.76%) while An. gambiae complex mosquitoes comprised 14.24%. Two W. bancrofti infections were detected in the mosquitoes, one each in An. leesoni and An. funestus s.s. with an infection rate of 0.46% and 4.17% respectively. No P. falciparum was detected in the mosquito or human blood samples and only 2 blood samples (2.17%) were positive for W. bancrofti. Phylogenetic analysis based on the sequenced 18S rRNA gene showed that all W. bancrofti sequences from this study shared a close relationship with W. bancrofti sequences distributed in other regions. No case of co-infection of P. falciparum and W. bancrofti was found in the mosquito or blood samples analyzed.

CONCLUSION

This study confirms the presence of W. bancrofti infection in the human population and mosquito vectors in Matayos. The study also indicated that the majority of Anopheles mosquitoes from the study area belong to An. funestus complex. This study recommends additional screening before Mass Drug Administration, and that mosquito control programs be strengthened in the study area.

Virulence and resistance genes in Campylobacter spp isolated from asymptomatic children at Kibera slum in Nairobi, Kenya

Gachau Mureithi — 2024-10-30

BACKGROUND

Campylobacter spp. are among the global causes of food poisoning and harbour virulence and resistance genes which play a role in invasion and antibiotic resistance. This study aimed to detect selected resistance and virulence genes in archived Campylobacter spp. isolated from children in Kibera, Nairobi, Kenya.

MATERIALS AND METHODS

This was a retrospective laboratory-based cross-sectional study on archived samples of Campylobacter spp. at the Department of Public Health, Pharmacology and Toxicology, University of Nairobi. Campylobacter isolates were cultured on modified charcoal cefoperazone deoxycholate agar (mCCDA) media. The presence of selected virulence genes and resistance genes was detected by multiplex polymerase chain reaction (mPCR). STATA13 was used in data analysis. Binary logistic regression was used to ascertain the association between the genes and the Campylobacter spp.

RESULTS

The Campylobacter spp. under this study were Campylobacter jejuni (C. jejuni) (50%), Campylobacter coli (C. coli) (38%) and Campylobacter lari (C. lari) (12%). The virulence genes detected were cgtB 37 (25%), pldA (20%), cdtA (17%), cdtB (16%), cdtC (6%), wlaN (5%), iam (4%), ciaB (4%) and VirB11 (3%). The virulence gene waaC was not detected in any of the isolates. The resistance genes detected were TetA (42%), Tet B (26%), GyrB (18%) and GyrA (14%).

CONCLUSION

The study revealed the presence of various virulence and resistance genes in Campylobacter spp. isolated from children. This information could help guide the development and enhancement of guidelines for the management of Campylobacter infections.

Sensorineural hearing loss among hypertensive patients attending cardiac institute in Tanzania: A cross-sectional study

Enica Richard Massawe — 2024-10-30

INTRODUCTION

Hypertension is among non-communicable diseases worldwide and it has been associated with sensorineural hearing loss. Almost 1.39 billion people (1 out of 4 adults) have hypertension and this figure is expected to increase. In Sub-Saharan Africa, hypertension is the leading cause of death and disability. Hypertension is associated with sensorineural hearing loss by compromising the blood supply in the cochlea.

MATERIALS AND METHODS

An assessment of the proportion and patterns of sensorineural hearing loss among hypertensive patients was conducted. 191 patients aged 18 years and above were recruited. History and physical examination including blood pressure, and otoscopy were done. Pure tone audiometry (PTA) was conducted.

RESULTS

Patients aged from 36 to 88 years with a mean age of 60 years and a standard deviation of 10. The patients aged between 61–76 years accounted for 85 (44.5%), whereas 29–44 and > 76 years accounted for 12 (6.3%) each. The female-to-male ratio was 1:1. Sensorineural hearing loss was detected in 144 (75.4%), commonly above 76 years of age which was 11 (91.7%. Mild sensorineural hearing loss was the most common degree revealed. There was no relationship between the degree of sensorineural hearing loss and the grades of hypertension (p-value of 0.113). No relationship between the duration of hypertension with the severity of hearing loss, p-value =0.369.

CONCLUSION

The prevalence of sensorineural hearing loss among hypertensive patients was 75.4%. The bilateral and mild degree was the commonest presentation. Increasing age was found to be associated with increased hearing loss. The duration and grade of hypertension were not related to the severity of hearing loss.

Factors related to sepsis in critical care setting in Rwanda selected referral hospital

Innocent Mwiseneza — 2024-10-30

BACKGROUND

Sepsis is described as potentially fatal organ failure induced by an unbalanced host response to infection. Annual estimates put the number of sepsis cases at over 19 million. The number of sepsis-related deaths is estimated to reach 5 million, with the vast majority happening in LMICs. However, such information is required to increase awareness of sepsis's global impact, especially in developing countries like Rwanda. The study aimed to evaluate the factors related to sepsis in a critical care setting in Rwanda's selected referral hospital.

METHODOLOGY

A cross-sectional study design with a quantitative approach was conducted and simple random sampling was used. Files of 191 study participants and a structured questionnaire were used in data collection, bivariate and multivariate logistic regression in SPSS version 21 was used in data analysis, and results were presented in tables.

RESULTS

The prevalence of sepsis was 40.3%. By plotting bivariate analysis the results showed that sepsis was significantly associated with the following variables; self-employed as an occupation with (OR=0.216, 95%CI:0.047-0.987) p 0.48 taking reference for unemployed; pneumonia with sepsis at (OR=1.993, 95%CI:0.657-6.043) p 0.023, systemic infection (OR=0.329, 95%CI:0.104-1.044) p 0.059; other procedure with (OR=4.735,95%CI:1.509- 14.855); procedure timeframe not mentioned with (OR=0.123,95%CI:0.027-0.553) p 0.032; hospitalized 15 days and more with OR=6.697 (95%CI:0.809-59.863) and p 0.032.

CONCLUSION

The prevalence of sepsis was 40.3% and factors related to sepsis include; occupation, having pneumonia, systemic infection, timeframe for carrying out the procedure, and patient being hospitalized for 15 days and more.

Patient factors associated with complementary and alternative medicine use among cancer patients at a county referral hospital, Kenya

Bravin George Etole — 2024-10-30

BACKGROUND

Despite numerous global reports on the use of complementary and alternative medicine (CAM), no studies have been published regarding its use at Machakos Level 5 Hospital. Therefore, this study aims to identify patient-related factors associated with CAM use among cancer patients at this Level 5 hospital in Kenya.

METHODOLOGY

A mixed method, cross-sectional design was implemented at Machakos level five hospital in Kenya. A Census was carried out, using a face-to-face researcher-administered questionnaire among 80 cancer patients receiving treatment at the clinic. Critically ill and mentally unstable patients were excluded. A Chi-square test assessed variable associations, considering p < 0.05 as statistically significant. Logistic regression analyzed variable relationships.

RESULTS

Gender was significantly associated with CAM use (p=0.014). Regression analysis revealed that Male patients were 79% less likely to use CAM (OR=0.21, 95% CI 0.042-1.003, p=0.050). Patients who had received radiotherapy were likely to use CAM (p=0.032), however, on regression analysis there was no significant association. Believes that CAM improves health (χ²=9.231, p-0.010), supports conventional treatment (χ²=15.620, p-0.001), cures cancer (χ²=12.661, p-0.002), manages treatment side effects (χ²=11.045, p-0.004), relieves cancer symptoms (χ²=9.008, p-0.011), promotes self-healing (χ²=16.969, p-0.001), and gives hope (χ²=17.512, p-0.001) were significantly associated with CAM use.

CONCLUSION AND RECOMMENDATION.

There was a significant association between patient characteristics and CAM use among cancer patients. Improving patient-healthcare worker communication could encourage reporting of CAM usage. Further research is needed to explore the efficacy, safety, and tolerability of CAM in cancer patients.

Prevalence and determinants of distress at the start of chemotherapy among adult cancer patients in two tertiary hospitals in Kenya

Francisca Mumbua Mwangangi — 2024-10-30

BACKGROUND

Chemotherapy is considered the cornerstone in the treatment of many cancers, but it also comes with its challenges. The distress experienced by patients at the commencement of chemotherapy is a critical aspect of their cancer journey, with profound implications for their overall well-being and treatment outcomes. This study aimed to assess the prevalence and determinants of distress before the first dose of chemotherapy among adult cancer patients in two tertiary hospitals in Kenya.

METHODOLOGY

This was a cross-sectional study. A total of 438 patients who were scheduled for the first dose of chemotherapy were interviewed using a structured questionnaire. Those who were not able to give consent, those who were only on oral chemotherapy and those who were not chemotherapy naïve were excluded. Distress was measured using the Distress thermometer with a cutoff point of four. Data analysis was performed using SPSS V26.

RESULTS

The study participants interviewed were predominantly women (63%), older than 50 (53%), unemployed (87%), married (65%), Christian (99%), lived less than 100 Kilometers (55%), lived with family (90%), educated up to the primary level (49%), and had insurance (92%). The most prevalent cancers were reproductive organ tumours, and 43% of the participants had stage four disease. A total of 89 % of the participants were clinically distressed (DT ≥ 4). In a chi-square analysis, there was a significant relationship between unemployment (P=0.003), residence (P=0.002), income level (P=0.001), insurance status (P= 0.004), living conditions (P=0.003), education level (P=0.001), tumour type (P=0.004), goal of therapy (P=0.001) and stage of disease (P=0.000) with clinical distress. On a multi-variate regression analysis, the strongest predictors were the cancer stage with (aOR: 8.4 P=0.000), education level (aOR: 8.3 P=0.001) along with unemployment (aOR: 4.1 P=0.003) and goal of therapy (aOR: 6.32 P=0.001)

CONCLUSION

The prevalence of distress at the start of chemotherapy is high, and interventions should be initiated before chemotherapy. Sociodemographic and disease characteristics should be considered when developing targeted interventions to manage distress among patients starting chemotherapy.

Utilization of cervical cancer screening services among women aged 18 to 59 years in Laikipia East Sub-County, Kenya

Lily N. Njoroge — 2024-10-30

INTRODUCTION

Cervical cancer, a preventable disease, continues to be the leading cause of death resulting from cancers in Kenya. Despite free cervical cancer screening services in all government hospitals in Laikipia County, the screening uptake remains low at 19% compared to the WHO target of 70%. Hence, understanding the barriers and facilitators is important in informing targeted interventions.

MATERIALS AND METHODS

A mixed-method cross-sectional study was done in Laikipia East Sub-County, Kenya, between July and August 2022. The participants were women aged between 18 to 59 years. Data was collected on demographic factors and cervical cancer screening utilization. Also, qualitative data was collected using 5 FGDs and 6 KIIs to get more insights. Chi-square tests and odds ratios were calculated using STATA version 15 to assess associations and determine the level of significance.

RESULTS

Out of the 272 participants, 32.4% (n=88) had ever screened for cervical cancer. The logistic regression analysis indicates that as women age, their likelihood of undergoing screening increases, particularly for those aged 50-59, who show a tenfold higher likelihood of screening [ OR 10.40 (3.20-33.82), p-value <0.001]. Conversely, unemployment is associated with a reduced likelihood of screening [OR 0.42 (0.18-0.99), p-value 0.047] while individuals earning 50-200 USD per month exhibit an increased likelihood [OR 2.25 (1.30-3.87) p-value 0.004]. However, religion, marital status, and education level factors do not show a significant association with the utilization of cervical cancer screening as indicated by p-values of 0.735, 0.069, and 0.765, respectively.

CONCLUSION AND RECOMMENDATIONS

Laikipia county government offers free cervical cancer screening in all government-run facilities but many, especially those aged 25-49, lack awareness. It is vital to boost awareness through community education on cervical cancer causes and prevention, emphasizing screening as preventive. Affordable treatment is also crucial for community reassurance post-diagnosis.

Effect of an educational intervention program on pregnant women’s ability to cope with childbirth pain in Western Kenya

Mable Wanyonyi — 2024-10-30

INTRODUCTION

Childbirth pain has remained a major challenge to women of child-bearing age over the years. Studies have shown that most women are not aware of the coping strategies to employ during childbirth. Severe childbirth pain can lead to adverse maternal and neonatal outcomes. Therefore, it is imperative to develop safe and innovative methods to cope with childbirth pain. The study aimed to investigate the effects of an educational program on women's ability to cope with childbirth pain in the context of lower and middle-income countries.

MATERIALS AND METHODS

A Quasi-experimental design was used to assess the impact of an educational intervention built on self-efficacy theory. Pregnant mothers were recruited at antenatal care services and were assigned to either the control group or the intervention group. The intervention group received two sessions of 2 hours each of the intervention between the 32^nd– 35^th weeks of gestation. Follow-up and evaluation on outcome measures were conducted within 48 hours after delivery. The strength of pain was measured by the visual analogue pain scale and the Mac-Gill pain questionnaire.

RESULTS

Findings indicate that relative to the control group, the intervention group was significantly more likely to demonstrate lower perceived pain both on the visual analogue scale (P<0.001) and the McGill pain questionnaire (P<0.001). Further analysis revealed that the non-intervention group had increased severe pain [OR=3.099,95% CI (1.080-8.887), P=0.035], unbearable pain [OR=27.930,95% CI (9.354-83.399), P=<0001], while permanent employment reduced unbearable pain [OR=0.038 95% CI (0.003-0.549), P=0.016].

CONCLUSION AND RECOMMENDATIONS

The educational intervention program was effective in decreasing pain intensity and severity during childbirth. Training programs should be integrated into the antenatal care program and offered to mothers during the third trimester of pregnancy to enhance women's coping skills during childbirth.

Factors influencing healthcare access for persons with disabilities in Kakamega County, Kenya during COVID-19: A qualitative study

Stephene Osongo Maende — 2024-10-30

INTRODUCTION

Access to healthcare for persons with disabilities is an indicator of the overall effectiveness of the healthcare system in terms of equity, accessibility and the right to health. This study explores factors affecting access to healthcare among persons with disabilities in Kakamega County in the context of COVID-19.

MATERIALS AND METHODS

Materials used in this study are part of a larger study that looked at access to healthcare and its effect on the quality of life of persons with disabilities in Kakamega County. In this paper, we present data generated from the qualitative component of the study that comprised 7 focus group discussions, 15 in-depth interviews, and 8 key informants who provided contextual information on health services for persons with disabilities. Data was coded and analysed thematically.

RESULTS

The study established key barriers to healthcare access for persons with disabilities during the COVID-19 pandemic period ranging from availability, affordability, discrimination, accommodation, assistive devices, and appropriateness of healthcare. In addition, the results show that these obstacles are not limited to the pandemic, but represent everyday challenges that persons with disability experience; but were exacerbated during the pandemic.

CONCLUSION AND RECOMMENDATIONS

This study highlights the need for disability-friendly infrastructure in healthcare facilities, subsidized medical costs, and the provision of assistive technologies to improve healthcare access for persons with disabilities. We also recommend increasing community and provider awareness of disability rights, enforcing existing laws and policies, and ensuring equal employment opportunities to support full social participation for individuals with disabilities.

Evaluating quality of services in community differentiated service delivery model. A case of Kakamega county

Winnie Sarah Owiti — 2024-10-30

BACKGROUND

The provision of high-quality services is a prerequisite for the successful implementation of community-differentiated service delivery. The service quality influences the clients' satisfaction, perceived value trust in the model and eventual utilization. Evaluating the quality of services in community differentiated service delivery will inform policymakers of existing quality gaps and in turn, this will assist in formulating strategies that will improve service quality and increase utilization.

METHODOLOGY

This was a cross-sectional study conducted in Kakamega County between September and December 2021 involving 402 participants. using purposive sampling, clients already established on ART were selected and data was collected through a structured questionnaire. Descriptive and inferential statistics were used to analyze data using SPSS version 25.

RESULTS

The results on dimensions of service quality established a high mean score (4.27) related to client literacy and a low score (2.64) on the package of services. There was a moderate positive relationship between client literacy and package of services (0.641) and a strong positive relationship between package of services and competence of the service provider (0.894). On the package of services (79.9%) of participants reported that ART refill and referral services were available, (12.7%) adherence and psychosocial support, 11.7% and 5% viral load sample collection. Regarding quality, the Freidman test ranged from client literacy (7.84), cost of services (7.79), accessibility (5.71), competence of the provider (4/06) and comprehensive package (2.54).

CONCLUSION

The study established a service quality gap in the package of services and the competence of the provider. The package of service provided is not comprehensive enough to address the needs of the clients.

RECOMMENDATION

Policymakers and leaders should re-distribute resources to allow for the training of providers using the differentiated service delivery manual 2023. The dimensions of quality can be reorganized to prioritize the appropriate package of services followed by the competence of lay health providers and lastly client literacy.

A qualitative study on experiences and perceptions of screening for enrolment in HIV clinical research among volunteers in Kenya

Emily Nyariki — 2024-10-30

INTRODUCTION

Screening volunteers to determine their eligibility to enrol in clinical research is an important phase in clinical research. However, little is known about how volunteers view and experience this phase of research implementation. This study explored volunteers’ perceptions and experiences of screening for enrolment into HIV clinical research studies.

MATERIALS AND METHODS

A qualitative study was conducted with 44 research participants purposively selected from a sample of 164 participants drawn from six research studies at the Kenya Aids Vaccine Initiative-Institute of Clinical Research (KAVI-ICR) in Nairobi, Kenya. Data was collected between March and June 2014, through in-depth interviews that were audio recorded and transcribed verbatim. Data were managed and thematically analyzed using the Atlas ti software.

RESULTS

Participants expressed mixed views and experiences about screening. A majority had initial fears about HIV testing and being screened for possible chronic diseases. Discomfort with physical examination, amounts of blood collected and associated pain were reported. On a positive note, participants were appreciative of the free comprehensive screening, and confirmations of being in good health. Those found with minor ailments reported receiving treatment before enrolment. HIV risk reduction behaviours following post-test counselling were also reported by some.

CONCLUSIONS

Evaluating participants’ experiences of screening for enrolment is important for the design of research that meets ethical requirements and responds to research participants’ fears and concerns for optimal enrolment and retention.

Valuation of prescription patterns of Helicobacter pylori drugs in outpatient department, Meru Teaching and Referral Hospital

Harshika Patel — 2024-10-30

BACKGROUND

Helicobacter pylori infects up to half of the world’s population. Infection with Helicobacter pylori is a major contributing factor for gastric ulcers, gastric carcinoma, and extra gastric disease. The main aim of this study was to observe the prescription patterns of Helicobacter pylori drugs at Meru Teaching and Referral Hospital, Meru. This infection is mostly treated by a triple-drug regimen for successful eradication. The available regimens are a combination of proton pump inhibitors, antibiotics, bismuth sulfate, and histamine blockers.

METHODOLOGY

A cross-sectional retrospective review of the patient files for Helicobacter pylori was done at Meru Teaching and Referral Hospital (MeTRH). Systematic random sampling was used to select 262 medical records for review. Data was collected using the pre-tested abstraction forms and was coded and analyzed for descriptive statistics.

RESULTS

Out of the 262 medical records that were reviewed, 147 (56.4%) were males prescribed the Helicobacter pylori drug regimen. Among all the young adults (age: 12-39 years) were more likely to get Helicobacter pylori infection. The medication regimens that were highly preferred at MeTRH were 14-day and 7-day clarithromycin triple-based therapy. The 14-day triple therapy accounted for 74.5% of all patient files. The most administered drug class for Helicobacter pylori were proton pump inhibitors at 45.3% followed by antibiotics at 38.8% and the least prescribed drugs were the H2 blockers with 15.9%.

CONCLUSION

Regarding the most prescribed drug, the proton pump inhibitors while the most preferred regimen was the 14-day clarithromycin triple-based therapy. This data will certainly be important for the pharmaceutical management chain to manage the stock of analyzed drugs and also can spread awareness regards the appropriate handling of drugs which can improve adherence and reduce the rate of treatment failure and the emergence of antibiotic drug resistance.