Liver Function Markers and Associated Serum Electrolytes Changes in HIV Patients Attending Patient Support Centre of Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu County, Kenya

Objective: To determine the distribution of markers of liver function  disorders and their association with co-existing fluids and electrolytes states in ambulatory HIV infected individuals.Design: A case-control study.Setting: Jaramogi Oginga Odinga Teaching and Referral Hospital’s Patient Support Centre.Intervention: Biochemical analysis were performed for serum alanine-aminotranferase (ALT), aspartate-amino transferase (AST), total protein, albumin, glucose, urea, potassium, sodium, chloride, creatinine phosphate, total and direct bilirubin levels as well as CD4 lymphocyte levels.Results: Serum liver function markers were significantly altered in HIV infected individuals compared to uninfected individuals (mean serum aspartate-amino transferase (AST); 45.1U/l v/s 36.9U/l; alanine-aminotransferase (ALT), 36.5U/l v/s 30.7U/l; direct bilirubin, 4.9ìmol/l v/s 4.2ìmol/l; total bilirubin, 6.2ìmol/l v/s 5ìmol/l; albumin32.8g/l v/s 34.5g/l and protein 64g/l v/s 67.1g/l; p <0.0001). The prevalence of pathological levels of serum liver function markers was also higher in HIV-infectedpatients than HIV-negative participants (ALT, 4.4% v/s 0.7%, p=0.001; AST, 24.5% v/s 6.7%, p<0.0001; direct bilirubin, 43.1% v/s 36.5%, p=0.026; total bilirubin, 2.3% v/s 0%, p=0.002; serum albumin, 60.1% v/s 52.2%, p= 0.009 and serum total protein levels, 52.8% v/s 36%,  p<0.0001). Gender, age and anti-retroviral treatment were not predictors ofaberrations in levels of liver function markers in HIV infected patients. Marked CD4 depletion was associated with enhanced deterioration of liver function markers. Liver function anomalies did not conduce co-existing electrolyte anomalies as clinically altered ALT states only correlated and co-varied with AST states (r = 0.917) ; direct biliribun states co-varied with total bilirubin levels (r = 0.958) and serum album states correlated with protein levels (r = 0.917) and vice versa.Conclusion: Liver function disorders are not infrequent in HIV infected  individuals and routine review of liver health status is essential in  comprehensive care of HIV patients

Kidney function predictors and associated serum electrolytes changes in HIV out patients attending Jaramogi Oginga Odinga teaching and referral hospital, Kisumu county, Kenya

Background: Kidney disease has been recognised as one of the health challenges complicating HIV infection, prognosis and management. Early recognition, diagnosis and treatment are therefore key to ameliorating the deleterious impacts of kidney disease in HIV infected patients.Objectives: To assess serum kidney function markers in order to highlight the state of kidney health and the impact of its functional impairment on other serum electrolytes and body fluids parametersDesign: A case-control study.Setting: At Jaramogi Oginga Odinga Teaching and Referral Hospital’s Patient support centre.Subjects: Eight Hundred HIV positive and 406 HIV negative participants above 18 years of age.Results: Mean serum creatinine and urea levels was significantly elevated in HIV – infected individuals than the healthy control group (95.2μmol/l v/s 86.2μmol/l, p<0.0001 and 4.6mmol/l v/s 4.1mmol/l, p<0.0001 respectively). The prevalence of pathological levels of serum creatinine, urea and sodium was higher in HIV-infected patients than HIV-negative participants (26.1% v/s 11.8%, p<0.0001; 4.4% v/s 0.5%, P<0.0001and 26.1% v/s 10.6%, p=0.001 respectively). Females experienced more serum creatinine disorders than their male counterparts (31.8% v/s 18.1%, p<0.0001). Age and antiretroviral treatment were not predictors of aberrations in levels of kidney function markers in HIV infected patients. AIDS defining CD4 depletion was associated with enhanced deterioration of kidney function. However, kidney function anomalies were not sufficient explanation for co-existing electrolyte anomalies as clinically altered creatinine states only correlated and co-varied with urea states (r =0.715) while sodium states co-varied with chloride levels (r = 0.296).Conclusion: Kidney function disorders are not infrequent in HIV infected individuals. Serum sodium aberration is observed more frequently in seropositive than in seronegative individuals. Routine review of kidney health status in local HIV infected individuals ought to be adopted for comprehensive management of HIV patients, more so among the female gender

Community perceptions of schistosomiasis transmission, prevalence and control in relation to aquatic habitats in the Lake Victoria basin of Kenya

Background: Intestinal schistosomiasis caused by Schistosoma mansoni and urinary schistosomiasis caused by Schistosoma haematobium are widely distributed parasites in several localities of the Lake Victoria basin of Kenya, the former being more prevalent. In Kenya, transmission of the intestinal form of bilharzia (S. mansoni) tends to be closely confined to narrow zones along the shores of large bodies of water such as Lake Victoria where it is endemic and the intermediate host is found. The prevalence of S. mansoni along the Kenyan Lake Victoria basin ranges between 40% and 80%.Objective: To assess the community’s knowledge and perceptions of schistosomiasis prevalence, transmission and control in relation to aquatic habitats in the Lake Victoria basin of Kenya.Design: Community-based cross-sectional study.Setting: The Kenyan Lake Victoria basin.Subjects: Two hundred and forty three individuals (both women and men residing in the beaches and surrounding areas) were interviewed about their knowledge and perceptions regarding schistosomiasis.Results: The community regarded schistosomiasis as a naturalistic disease not caused by supernatural forces but by an agent of contamination in water. Knowledge on schistosomiasis transmission and control was low, with 42% of the respondents having no idea on how schistosomiasis is contracted, while 22% and 18% of the respondents mentioned contact with contaminated water and drinking / eating dirty water / food, respectively. Most respondents were familiar with the snails’ habitats, but had poor knowledge on aquatic plants harbouring snails, as 57% of the respondents did not know about aquatic plants being associated with schistosomiasis snails. Only 3% of the respondents associated snails with schistosomiasis transmission. Sixty percent (60%) of the respondents mentioned use of tablets and injections as means of treating schistosomiasis, while 38% had no idea how it is treated and 2% mentioned use of local herbs and services of medicine men.Conclusion: Majority of Kenyan Lake Victoria basin inhabitants had little awareness about schistosomiasis despite high prevalence of the disease in the region. There is need to adapt prevention and control strategies to the people’s livelihoods. There is also need to target the less advantaged members of the community such as women, uneducated and subsistence farmers for intense health education strategies aimed at increasing participation in the control of schistosomiasis. Study to elicit divergence between biomedical and local understandings of schistosomiasis/bilharzia is suggested.

Malaria Vectors in Lake Victoria and Adjacent Habitats in Western Kenya

The prevalence of malaria among the residents of the Lake Victoria basin remains high. The environment associated with the lake may maintain a high number of malaria vectors. Lake habitats including water hyacinths have been suspected to be the source of vectors. This study investigated whether malaria vectors breed in the lake habitats and adjacent backwater pools. Anopheline larvae were collected within the littoral zone of the lake and adjacent pools located along approximately 24.3 km of the lakeshore in western Kenya, and their breeding sites characterized. Three primary vector species, Anopheles arabiensis, Anopheles gambiae s.s. and Anopheles funestus s.s., and three potential vectors, were found in the lake habitats. Unexpectedly, An. arabiensis was the most dominant vector species in the lake sampling sites. Its habitats were uncovered or covered with short grass. A potential secondary malaria vector, Anopheles rivulorum, dominated the water hyacinths in the lake. Most breeding sites in the lake were limited to areas that were surrounded by tall emergent plants, including trees, and those not exposed to waves. Nearly half of adjacent habitats were lagoons that were separated from the lake by sand bars. Lagoons contained a variety of microhabitats. Anopheles arabiensis dominated open habitats, whereas An. funestus s.s. was found mainly in vegetated habitats in lagoons. The current study confirmed that several breeding sites are associated with Lake Victoria. Given that Lake Victoria is the second largest lake in the world, the lake related habitats must be extensive; therefore, making targeted vector control difficult. Further exploration is necessary to estimate the effects of lake associated habitats on malaria transmission so as to inform a rational decision-making process for vector control

Drug abuse in Kisumu town western Kenya

This was a cross sectional study designed to determine the factors associated with drug abuse among secondary school students in nine schools in Kisumu town, western Kenya. The objective of this study was to determine the effect of age, gender and peer influence on drug abuse and to establish the reasons why students abuse drugs. Nine schools were randomly selected for the study. A total of 458 students (243 males and215 females) were interviewed using a closed ended questionnaire. The data were then categorized into non-abusers and abusers and the degree of association between the variables was tested using Chi-square test. A total of 458 students (243 males and 215 females), were interviewed using a close-ended questionnaire. The results showed that 265 (57.9%) of the respondents had consumed alcohol at least once in their lives,159 (34.7%) had abused tobacco, 84 (18.3%) had abused cannabis, 106 (23.1%) had abused khat and 24 (5.2%) had used inhalants and/or cocaine. The age group most at risk was 16-18 years, the age at which most students are in secondary school. The reasons given for the abuse of the drugs were: experimentation 92 (38.2%), enjoyment of the feeling they experience 114 (47.3%), influence from friends 21 (8.7%),influence from relatives 5 (2.1%) and for treating stomach ailments 7 (2.9%). More boys were found to be abusing drugs (36.9%, n = 169) compared to girls (27.3%, p = 0.007). Also, drug abuse was found to be higher in students living in low socioeconomic class areas of the town (30%, n = 122) compared to high-class areas (21.6%, n = 94, p =0.004) and peer influence had no effect on drug abuse (p = 0.249). From this study it was concluded that drug abuse was widespread in secondaryschools in Kisumu and although it affected both sexes boys were more involved in the practice than girls. The study therefore recommends that early intervention should target school attendees at early age with the aim of preventing drug abuse in secondary schools in Kisumu town, western Kenya