Exploring the experiences of clients receiving opioid use disorder treatment at a methadone clinic in Kenya: a qualitative study

Background: Assessing the experiences of individuals on methadone treatment is essential to help evaluate the treatment program’s efectiveness. This study aimed to explore the experiences of patients receiving methadone treatment at a clinic in Nairobi, Kenya. Method: This study employed an exploratory qualitative study design. Through purposive sampling, participants were enrolled from individuals attending a methadone clinic for at least 2 years. Semi-structured individual interviews were used to collect data on substance use and experience before methadone treatment and experiences after starting methadone treatment, including benefts and challenges. Interviews were transcribed, and NVIVO 12 software was used to code the data using the preidentifed analytical framework. Thematic analyses were utilized to identify cross-cutting themes between these two data sets. Seventeen participants were enrolled. Results: Seventeen participants were enrolled comprising 70% males, with age range from 23 to 49 years and more than half had secondary education. The interview data analysis identifed four themes, namely: (a) the impact of opioid use before starting treatment which included adverse efects on health, legal problems and family dysfunction; (b) learning about methadone treatment whereby the majority were referred from community linkage programs, family and friends; (c) experiences with care at the methadone treatment clinic which included benefts such as improved health, family reintegration and stigma reduction; and (d) barriers to optimal methadone treatment such as fnancial constraints. Conclusion: The fndings of this study show that clients started methadone treatment due to the devastating impact of opioid use disorder on their lives. Methadone treatment allowed them to regain their lives from the adverse efects of opioid use disorder. Additionally, challenges such as fnancial constraints while accessing treatment were reported. These fndings can help inform policies to improve the impact of methadone treatment

Spectrum of Microbial Diseases and Resistance Patterns at a Private Teaching Hospital in Kenya: Implications for Clinical Practice

Background: Accurate local prevalence of microbial diseases and microbial resistance data are vital for optimal treatment of patients. However, there are few reports of these data from developing countries, especially from sub-Saharan Africa. The status of Aga Khan University Hospital Nairobi as an internationally accredited hospital and a laboratory with an electronic medical record system has made it possible to analyze local prevalence and antimicrobial susceptibility data and compare it with other published data. Methods: We have analyzed the spectrum of microbial agents and resistance patterns seen at a 300 bed tertiary private teaching hospital in Kenya using microbial identity and susceptibility data captured in hospital and laboratory electronic records between 2010 and 2014. Results: For blood isolates, we used culture collection within the first three days of hospitalization as a surrogate for community onset, and within that group, Escherichia coli was the most common, followed by Staphylococcus aureus. In contrast, Candida spp. and Klebsiella pneumoniae were the most common hospital onset causes of bloodstream infection. Antimicrobial resistance rates for the most commonly isolated Gram negative organisms was higher than many recent reports from Europe and North America. In contrast, Gram positive resistance rates were quite low, with 94% of S. aureus being susceptible to oxacillin and only rare isolates of vancomycin-resistant enterococci. Conclusions: The current report demonstrates high rates of antimicrobial resistance in Gram negative organisms, even in outpatients with urinary tract infections. On the other hand, rates of resistance in Gram positive organisms, notably S. aureus, are remarkably low. A better understanding of the reasons for these trends may contribute to ongoing efforts to combat antimicrobial resistance globally

Prognosticating COVID-19: A need for Africa-specific laboratory predictors

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An M&E mobile based application for Pico PV lighting solutions for the “Kerosene Free Kenya” project

Conference paper Izael Pereira Da Silva, Geoffrey Ronoh, David Njugi Maina Ulm, Germany 2013This paper describes the use of a mobile based application used as a Monitoring and Evaluation (M&E) tool to a pilot project supported by the National Council for Science and Technology of Kenya (NCST) which seeks to research best practices and lessons learned in the dissemination of Pico PV systems to rural households in Kenya. In order to overcome the affordability barrier a microfinance institution (MFI) was brought into the system, to properly handle the challenge of access to finance while Lighting Africa will provide standards for the products to be distributed. Many of such pilot system have been used in practically all countries of East Africa. The novelty of the present one is the use of an Unstructured Supplementary Service Data (USSD) mobile based tool to collect and transmit data. This will make the analysis of the product quality, user experience and faults much simpler and given the two ways relationship between the researchers and the users, consumer satisfaction and product improvement is envisaged to happen in a to date unprecedented manner. As the clients are distributed in a known geographical region, the researchers have provided for the training of technicians to handle repairs and battery replacement locally. As the duration of the project is 2 years, it is expected that the follow up of product performance and life span will be measured way beyond its payback period.This paper describes the use of a mobile based application used as a Monitoring and Evaluation (M&E) tool to a pilot project supported by the National Council for Science and Technology of Kenya (NCST) which seeks to research best practices and lessons learned in the dissemination of Pico PV systems to rural households in Kenya. In order to overcome the affordability barrier a microfinance institution (MFI) was brought into the system, to properly handle the challenge of access to finance while Lighting Africa will provide standards for the products to be distributed. Many of such pilot system have been used in practically all countries of East Africa. The novelty of the present one is the use of an Unstructured Supplementary Service Data (USSD) mobile based tool to collect and transmit data. This will make the analysis of the product quality, user experience and faults much simpler and given the two ways relationship between the researchers and the users, consumer satisfaction and product improvement is envisaged to happen in a to date unprecedented manner. As the clients are distributed in a known geographical region, the researchers have provided for the training of technicians to handle repairs and battery replacement locally. As the duration of the project is 2 years, it is expected that the follow up of product performance and life span will be measured way beyond its payback period

Neonatal reference intervals for thyroid stimulating hormone and free thyroxine assayed on a Siemens Atellica® IM analyzer: a cross sectional study

Background Deriving population specific reference intervals (RIs) or at the very least verifying any RI before adoption is good laboratory practice. Siemens has provided RIs for thyroid stimulating hormone (TSH) and free thyroxine (FT4) determined on their Atellica® IM analyzer for all age groups except the neonatal age group which provides a challenge for laboratories that intend to use it to screen for congenital hypothyroidism (CH) and other thyroid disorders in neonates. We set out to determine RIs for TSH and FT4 using data obtained from neonates undergoing routine screening for CH at the Aga Khan University Hospital, Nairobi, Kenya. Methodology TSH and FT4 data for neonates aged 30 days and below were extracted from the hospital management information system for the period March 2020 to June 2021. A single episode of testing for the same neonate was included provided both TSH and FT4 were done on the same sample. RI determination was performed using a non-parametric approach. Results A total of 1243 testing episodes from 1218 neonates had both TSH and FT4 results. A single set of test results from each neonate was used to derive RIs. Both TSH and FT4 declined with increase in age with a more marked decline seen in the first 7 days of life. There was a positive correlation between logFT4 and logTSH (rs (1216) = 0.189, p = \u3c 0.001). We derived TSH RIs for the age groups 2–4 days (0.403–7.942 μIU/mL) and 5–7 days (0.418–6.319 μIU/ mL), and sex specific RIs for males (0.609–7.557 μIU/mL) and females (0.420–6.189 μIU/mL) aged 8–30 days. For FT4, separate RIs were derived for the age groups 2–4 days (1.19–2.59 ng/dL), 5–7 days (1.21–2.29 ng/dL) and 8–30 days (1.02–2.01 ng/dL). Conclusion Our neonatal RIs for TSH and FT4 are different from those published or recommended by Siemens. The RIs will serve as a guide for the interpretation of thyroid function tests in neonates from sub-Saharan Africa where routine screening for congenital hypothyroidism using serum samples is done on the Siemens Atellica® IM analyzer

Perspectives of International Nursing Students regarding Canadian Public Health Measures for COVID-19: An Interpretive Descriptive Study

Background: The COVID-19 pandemic and public health measures affected the well-being of international graduate nursing students in diverse ways. The migration to remote teaching and learning due to campus closures and international travel bans all contributed to sudden changes in daily routines, financial stressors, and intrapersonal connections. Aim: We aimed to explore international graduate nursing students' experiences with and response to the COVID-19 pandemic and public health measures at a Canadian university. Method: Interpretive Description (ID) was used to explore the experiences of eight international graduate nursing students in one nursing program in a Prairie province in Canada. Semi-structured individual in-depth interviews were conducted with participants via WebEx between the months of April and May 2021; the data were transcribed and analyzed using six phases of thematic analysis. Findings: The study yielded these themes: a) COVID-19’s disruptions; and b) coping withCOVID-19 disruptions. Conclusion: The COVID-19 pandemic affected study participants' well-being in various ways, particularly, the loss of connection with campus community may have been the most profound negative impact on international graduate nursing students. Despite the impact, they demonstrated resilience, continued their studies, and employed coping strategies to overcome the challenges they faced

A Comparison of the Socio- Economic Characteristics of Dairy-Crop Integrators versus Non Integrators: A Case Study in Elgeyo-Marakwet County, Kenya

The aim of this study was to compare the different inherent socio economic characteristics amongst the dairy-crop integrators and non integrators in Elgeyo-Marakwet County, Kenya. The study carried out a census of 85 integrators and 85 non integrators. The data were collected with the help of a structured questionnaire. Descriptive statistics such as means and percentages were used to present the findings. The study found out that Integrators had a higher household size mean unlike the non integrators. The integrators had a lower mean in years of schooling of as compared to that of non integrators who had a higher mean of years of schooling. On the other hand, Integrators had a larger size of land on average as compared to non integrators. The study therefore recommends policy interventions to enhance access to credit, reduce illiteracy levels among rural entrepreneurs through training and extension services. Key words: Integration, Non-integration, Off-farm income, Househol

Molecular screening for Plasmodium falciparum resistance markers for artemisinins in Mbita, Kenya

Artemisinins-based combination therapies (ACTs) are being recommended against uncomplicated malaria in endemic areas of Africa. However, in these areas data on their long term usefulness is limited. It has been demonstrated that ACTs resistance may be due to single nucleotide polymorphisms (SNPs) in the chemotherapeutic target, the SERCA-type ATPase protein (PfATPase6). This study analyzed PfATPase6 mutations in asymptomatic infections from samples collected from Mbita, a malaria endemic region in Kenya. Mutations in A623E and S769N residues were screened with gene specific primers followed by sequencing. The study demonstrates that there is no mutation in Mbita, Kenya because neither A623E nor S769N PfATPase6 mutations were detected. Resurgence of infections in this area could be due to re-infections and not drug failure. The study recommends that other sites be assessed for PfATPase 6 mutations to verify the long-term usefulness of ACT and monitor any emergency of resistance.Keywords: ACT (Artemisinins-based Combination Therapy), Molecular, Mutations, PfATPase 6doi: 10.4314/ajcem.v12i3.

Comparison of equations for estimating glomerular filtration rate in screening for chronic kidney disease in asymptomatic black Africans: A cross sectional study

Background: Several equations have been developed to estimate glomerular filtration rate (eGFR). The common equations used were derived from populations predominantly comprised of Caucasians with chronic kidney disease (CKD). Some of the equations provide a correction factor for African-Americans due to their relatively increased muscle mass and this has been extrapolated to black Africans. Studies carried out in Africa in patients with CKD suggest that using this correction factor for the black African race may not be appropriate. However, these studies were not carried out in healthy individuals and as such the extrapolation of the findings to an asymptomatic black African population is questionable. We sought to compare the proportion of asymptomatic black Africans reported as having reduced eGFR using various eGFR equations. We further compared the association between known risk factors for CKD with eGFR determined using the different equations. Methods: We used participant and laboratory data collected as part of a global reference interval study conducted by the Committee of Reference Intervals and Decision Limits (C-RIDL) under the International Federation of Clinical Chemistry (IFCC). Serum creatinine values were used to calculate eGFR using the Cockcroft-Gault (CG), re-expressed 4 variable modified diet in renal disease (4v–MDRD), full age spectrum (FAS) and chronic kidney disease epidemiology collaboration equations (CKD-EPI). CKD classification based on eGFR was determined for every participant. Results: A total of 533 participants were included comprising 273 (51.2%) females. The 4v–MDRD equation without correction for race classified the least number of participants (61.7%) as having an eGFR equivalent to CKD stage G1 compared to 93.6% for CKD-EPI with correction for race. Only age had a statistically significant linear association with eGFR across all equations after performing multiple regression analysis. The multiple correlation coefficients for CKD risk factors were higher for CKD-EPI determined eGFRs. Conclusions: This study found that eGFR determined using CKD-EPI equations better correlated with a prediction model that included risk factors for CKD and classified fewer asymptomatic black Africans as having a reduced eGFR compared to 4v–MDRD, FAS and CG corrected for body surface area

Metabolic syndrome and its predictors in an urban population in Kenya: A cross sectional study

Background: The metabolic syndrome (MetS) is a clustering of interrelated risk factors which doubles the risk of cardio-vascular disease (CVD) in 5–10 years and increases the risk of type 2 diabetes 5 fold. The identification of modifiable CVD risk factors and predictors of MetS in an otherwise healthy population is necessary in order to identify individuals who may benefit from early interventions. We sought to determine the prevalence of MetS as defined by the harmonized criteria and its predictors in subjectively healthy black Africans from various urban centres in Kenya. Method: We used data collected from healthy black Africans in Kenya as part of a global study on establishing reference intervals for common laboratory tests. We determined the prevalence of MetS and its components using the 2009 harmonized criterion. Receiver operator characteristic (ROC) curve analysis was used to determine the area under the curves (AUC) for various predictors of MetS. Youden index was used to determine optimum cut-offs for quantitative measurements such as waist circumference (WC). Results: A total of 528 participants were included in the analysis. The prevalence of MetS was 25.6% (95% CI: 22. 0%–29.5%). Among the surrogate markers of visceral adiposity, lipid accumulation product was the best predictor of MetS with an AUC of 0.880 while triglyceride was the best predictor among the lipid parameters with an AUC of 0.816 for all participants. The optimal WC cut-off for diagnosing MetS was 94 cm and 86 cm respectively for males and females. Conclusions: The prevalence of MetS was high for a healthy population highlighting the fact that one can be physically healthy but have metabolic derangements indicative of an increased CVD risk. This is likely to result in an increase in the cases of CVD and type 2 diabetes in Kenya if interventions are not put in place to reverse this trend. We have also demonstrated the inappropriateness of the WC cut-off of 80 cm for black African women in Kenya when defining MetS and recommend adoption of 86 cm