Association between psychosis and substance use in Kenya. Findings from the NeuroGAP-Psychosis study

Background: Substance use is prevalent among people with mental health issues, and patients with psychosis are more likely to use and misuse substances than the general population. Despite extensive research on substance abuse among the general public in Kenya, there is a scarcity of data comparing substance use among people with and without psychosis. This study investigates the association between psychosis and various substances in Kenya. Methods: This study utilized data from the Neuro-GAP Psychosis Case-Control Study between April 2018 and December 2022. The KEMRI-Wellcome Trust Research Programme recruited participants from various sites in Kenya, including Kilifi County, Malindi Sub-County, Port Reitz and Coast General Provincial Hospitals, and Moi Teaching and Referral Hospital, as well as affiliated sites in Webuye, Kapenguria, Kitale, Kapsabet, and Iten Kakamega. The collected data included sociodemographic information, substance use, and clinical diagnosis. We used the summary measures of frequency (percentages) and median (interquartile range) to describe the categorical and continuous data, respectively. We examined the association between categorical variables related to psychosis using the chi-square test. Logistic regression models were used to assess the factors associated with the odds of substance use, considering all relevant sociodemographic variables. Results: We assessed a total of 4,415 cases and 3,940 controls. Except for alcohol consumption (p-value=0.41), all forms of substance use showed statistically significant differences between the case and control groups. Cases had 16% higher odds of using any substance than controls (aOR: 1.16, 95%CI: 1.05-1.28, p=0.005). Moreover, males were 3.95 times more likely to use any substance than females (aOR:3.95; 95%CI: 3.43-4.56). All the categories of living arrangements were protective against substance use. Conclusion: The findings of this study suggest that psychotic illnesses are associated with an increased likelihood of using various substances. These findings are consistent with those of previous studies; however, it is crucial to investigate further the potential for reverse causality between psychosis and substance abuse using genetically informed methods

Genetic mutations in African patients with atrial fibrillation: Rationale and design of the Study of Genetics of Atrial Fibrillation in an African Population (SIGNAL)

BACKGROUND: There is an urgent need to understand genetic associations with atrial fibrillation in ethnically diverse populations. There are no such data from sub-Saharan Africa, despite the fact that atrial fibrillation is one of the fastest growing diseases. Moreover, patients with valvular heart disease are underrepresented in studies of the genetics of atrial fibrillation. METHODS: We designed a case-control study of patients with and without a history of atrial fibrillation in Kenya. Cases with atrial fibrillation included those with and without valvular heart disease. Patients underwent clinical phenotyping and will have laboratory analysis and genetic testing of >240 candidate genes associated with cardiovascular diseases. A 12-month follow-up assessment will determine the groups' morbidity and mortality. The primary analyses will describe genetic and phenotypic associations with atrial fibrillation. RESULTS: We recruited 298 participants: 72 (24%) with nonvalvular atrial fibrillation, 78 (26%) with valvular atrial fibrillation, and 148 (50%) controls without atrial fibrillation. The mean age of cases and controls were 53 and 48 years, respectively. Most (69%) participants were female. Controls more often had hypertension (45%) than did those with valvular atrial fibrillation (27%). Diabetes and current tobacco smoking were uncommon. A history of stroke was present in 25% of cases and in 5% of controls. CONCLUSION: This is the first study determining genetic associations in valvular and nonvalvular atrial fibrillation in sub-Saharan Africa with a control population. The results advance knowledge about atrial fibrillation and will enhance international efforts to decrease atrial fibrillation-related morbidity

Use of Flow Cytometry Immunophenotyping for Diagnosis of Acute Leukemia at Moi Teaching and Referral Hospital, Eldoret, Kenya

The main objective of the study was to compare morphological and flow cytometric diagnosis in patients previously diagnosed with leukemia. The retrospective study was carried out at Moi Teaching and Referral Hospital and patient’s data for the period of July 2013 and June 2014 was used. After Institutional Research Ethics approval was granted. Consecutive sampling was done and information was extracted from patient’s files. Data for all who were previously diagnosed with leukemia through both morphology and immunophenotyping was recorded. The data was collected using a data collection form where socio-demographic data, morphological and flow cytometry results were recorded. The findings were based on 33 patients who underwent both flow cytometry and bone marrow morphology tests for diagnosis of leukemia between July 2013 and June 2014. The ages of the patients ranged from 3 to 76 years. The ratio of male to female was 1:1.1.Using the Bone marrow morphology, 17 patients had AML and 15 had ALL, one case was inconclusive There were five categories for the flow cytometry. They comprised of B-ALL-6 cases, T-ALL-13 cases, AML-10 cases, Biphynotypic-1 case and inconclusive-1case. There was concordance between the morphological and flow cytometry on 25 out of the 33 cases. As a conclusion we can say that at MTRH, Flow cytometry had a role to play to confirm a definite and a probable diagnosis of patients with acute leukemia.

Sickle cell trait frequencies in blood donors and its effect among recepients in Bungoma County, Kenya

Objective: This study aimed at evaluating the prevalence of sickle cell trait among the blood donors and its impact in transfused patients in Bungoma County. Design: A cross sectional study targeting healthy blood donors and patients transfused with sickle cell trait blood in Bungoma County from January 2019 to January 2020. Participants: A total of 350 blood donors and 10 patients transfused with sickle cell trait blood were enrolled. Results: The sickle cell trait prevalence amongst the blood donor population in Bungoma County was deduced to be 14.28%. White, red blood cell counts, haemoglobin, haematocrit, mean cell volume, mean cell haemoglobin and mean cell haemoglobin concentration parameters were not affected in patients transfused with sickle cell trait blood (p= 0.466, 0.980, 0.787, 0.886, 0.971, 0.476 and 0.524). Also, liver function tests in the same patients was not affected (p= 0.2193, 0.4678, 0.3052 and 0.7263) respectively for Alanine, Aspartate, Direct and Total Bilirubin levels respectively. Conclusion: There were no clinical abnormalities in patients transfused with sickle cell trait, however it was observed that acquired haemoglobin AS (Sickle cell trait) was detected among the transfused population

Drug Resistance Testing in HIV Infected Individuals on Treatment and Naive: Implications on Treatment Outcome

Background: The Government of Kenya started offering ART in the public sector since 2003. Despite the dramatic reduction in AIDS related morbidity and mortality, the emergence and spread of drug resistance (DR) threatens to negatively impact on treatment regimens and compromise efforts to control the epidemic. Therefore, there is a need for information on the situation of DR Mutations (DRMS) and their implications on treatment.Objectives: To evaluate DRMS and their implications on treatment in HIV infected individuals attending Moi Teaching and Referral Hospital (MTRH) clinics.Method: In 2009, we consecutively collected plasma samples from two groups of HIV infected individuals, antiretroviral (ARV) naive and ARV experienced for more than 12 months and failing therapy according to world health organisation (WHO) guidelines. We performed genotypic DR using well established in-house Sanger sequencing methods. We then followed up the patients and compared the DRMS in relation to their drug regimens at the time of sample collection and16 months later.Results: We successfully extracted and sequenced 75 samples. Median age was 36.7 years.Out of 41 drug naive individuals only 3 had DRMS. Out of the 34 ARV experienced, 29 had DRMS to nucleoside reverse transcriptase inhibitor (NRTI), and 31 to non NRTI (NNRTI). After 16 months from sample collection date, 20/31(64%) ARV experienced patients with DRMS had not been changed therapy and only 5/20(25%) were susceptible to primary ARV while 12/14 changed were susceptible to new ARV.Conclusion: The information obtained in our study can serve as an indicator of ARV program efficiency in patients still on treatment, those who are to start treatment and those who are to be changed therapy due to failure. DR testing would be necessary before initiating and /or changing ART in order to achieve optimal clinical outcome.</p

Accuracy of oral HIV self-tests in Kenya

De-identified data used in the analysis published in the final report to 3ie on the project, "Accuracy of Oral HIV Self-tests in Kenya" (project code TW2.1.02). This project was funded under Thematic Window 2 on HIV self-testing

Clinical characteristics and 12-month outcomes of patients with valvular and non-valvular atrial fibrillation in Kenya

Background: Atrial fibrillation (AF) is a major contributor to the global cardiovascular disease burden. The clinical profile and outcomes of AF patients with valvular heart diseases in sub-Saharan Africa (SSA) have not been adequately described. We assessed clinical features and 12-month outcomes of patients with valvular AF (vAF) in comparison to AF patients without valvular heart disease (nvAF) in western Kenya. Methods: We performed a cohort study with retrospective data gathering to characterize risk factors and prospective data collection to characterize their hospitalization, stroke and mortality rates. Results: The AF patients included 77 with vAF and 69 with nvAF. The mean (SD) age of vAF and nvAF patients were 37.9(14.5) and 69.4(12.3) years, respectively. There were significant differences (p<0.001) between vAF and nvAF patients with respect to female sex (78% vs. 55%), rates of hypertension (29% vs. 73%) and heart failure (10% vs. 49%). vAF patients were more likely to be taking anticoagulation therapy compared to those with nvAF (97% vs. 76%; p<0.01). After 12-months of follow-up, the overall mortality, hospitalization and stroke rates for vAF patients were high, at 10%, 34% and 5% respectively, and were similar to the rates in the nvAF patients (15%, 36%, and 5%, respectively). Conclusion: Despite younger age and few comorbid conditions, patients with vAF in this developing country setting are at high risk for nonfatal and fatal outcomes, and are in need of interventions to improve short and long-term outcomes

Comparison of outcomes of atrial fibrillation patients.

<p>Comparison of outcomes of atrial fibrillation patients.</p

Medication use before study entry for atrial fibrillation patients.

<p>Medication use before study entry for atrial fibrillation patients.</p