Microbial Quality of Unregulated Herbal Medicinal Products in Kenya

Background: The use of herbal medicines is global, with the majority of the world’s population depending on traditional medicines, particularly herbal remedies for their primary healthcare needs. In Kenya, it is estimated that conventional healthcare system provides for approximately 30 % of the population, while nearly 70 % rely on herbal remedies. Herbal medicines, however, present safety concerns as they carry a relatively high risk of contamination by pathogenic microbes, organic and inorganic pollutants including toxic metals and non-metals, organic, mycotoxins, endotoxins, and agrochemical residues. Objective: This study was designed to assess the microbial quality of regulated and unregulated herbal medicinal products in diverse Kenyan markets, such as the supermarkets, roadside vendors, retail pharmacies and herbal clinics, for levels of microbial contaminants. Materials and Methods: Thirty samples of registered and unregistered herbal medicinal products were collected by purposive sampling from five Kenyan provinces.  Microbial load analysis was performed in accordance to pharmacopoeial methods (BP and USP). Microorganisms were further isolated and characterized using differential and selective media and by biochemical analyses. Results: All registered products had microbial load below 100 cfu/ml, and complied with BP and USP requirements. However, none of the unregistered samples complied with pharmacopoeial limits for either or both bacterial and fungal load limits. Most of the unregistered samples had microbial loads ranging from 3.00×106 to 1.56 × 1010 cfu/ml, thus exceeding by far BP or USP standards. The microbial isolates belonged to fifteen (15) different bacterial genera and seven (7) fungal genera.  Escherichia coli was the most frequently isolated bacteria from 75 % of the unregistered product samples while Klebsiella pneumoniae, Enterobacter aerogenes, and Staphylococcus aureus followed in 70 %, 60 % and 45 % of the samples, respectively. Salmonella spp was isolated in 40 % of the samples while Shigella spp was found in 20 % of the samples. Conclusion: Unregulated herbal medicinal products that are available in diverse Kenyan markets show poor microbial quality and exhibit contamination by pathogenic microorganisms.  There is need to extend regulatory control by the drug authorities to herbal medicinal products to enhance microbial quality and safety. Keywords: Microbial contaminants, herbal medicines, microbial loa

Determinants of Discontinuation of Contraceptive Methods among Women at Kenyatta National Hospital, Kenya

Background: Contraceptive use prevalence in Kenya is at 58% according to the 2014 Kenya Demographic Health Survey. Several factors lead to discontinuation and switch of contraceptives. Discontinuation rate as per the 2008/2009 KDHS for one year was 35.8%. Objectives: To find out the determinants of discontinuation and switching of hormonal and IUD contraceptive methods. Methodology: The study was a cross-sectional hospital based one, where data was collected by use of an interviewer administered questionnaire at Kenyatta National Hospital, where 400 women were interviewed. The data was then analyzed by use of the statistical software, SPSS Version 20. Results: The study population mainly comprised married women with a mean age of 31.45±6.40 years. Most women chose a contraceptive method which they perceived had the least adverse effects. Discontinuation rate by the time of study in the study population was 60.8%, with adverse effects as the most cited reason for discontinuation. The method of contraception and presence of co-morbidity were the factors associated with discontinuation of a contraceptive. Survival analysis showed that depot injection and Jadelle® (Levonorgestrel releasing implant 75mg) had the highest median months of use and Impanon® (Etonogestrel implant 68mg) the least. Conclusion: The reasons for discontinuation of contraceptive use include primarily concerns for adverse effects, use inconvenience, desire for pregnancy, contraceptive failure, and doctor’s advice. Key words: Contraceptive discontinuation, adverse effects, duration of us

Building capacity in implementation science research training at the University of Nairobi.

BACKGROUND: Health care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science. METHODS: This paper describes how the University of Nairobi leveraged resources from the Medical Education Partnership to develop an institutional program that provides training and mentoring in implementation science, builds relationships between researchers and implementers, and identifies local research priorities for implementation science. RESULTS: The curriculum content includes core material in implementation science theory, methods, and experiences. The program adopts a team mentoring and supervision approach, in which fellows are matched with mentors at the University of Nairobi and partnering institutions: University of Washington, Seattle, and University of Maryland, Baltimore. A survey of program participants showed a high degree satisfaction with most aspects of the program, including the content, duration, and attachment sites. A key strength of the fellowship program is the partnership approach, which leverages innovative use of information technology to offer diverse perspectives, and a team model for mentorship and supervision. CONCLUSIONS: As health care systems and training institutions seek new approaches to increase capacity in implementation science, the University of Nairobi Implementation Science Fellowship program can be a model for health educators and administrators who wish to develop their program and curricula

Comparison of Zidovudine and Tenofovir Based Regimens With Regard to Health-Related Quality of Life and Prevalence of Symptoms in HIV Patients in a Kenyan Referral Hospital

Aim: Zidovudine and tenofovir form the backbone of antiretroviral therapy in Kenya. However, their side-effects may affect the quality of life (QoL) of patients. The aim was to compare the health-related quality of life (HRQoL) of adult patients on tenofovir versus zidovudine based regimens in a referral hospital in Kenya to provide future guidance.Methods: A comparative cross sectional study among 501 adult out-patients on either tenofovir or zidovudine was undertaken in Kenyatta National Hospital between 2015 and 2016. The Medical Outcome Study HIV Health Survey (MOS-HIV) was administered along with other key aspects of treatment. Linear regression analysis was performed to identify determinants of HRQoL.Results: Patients on zidovudine had a higher Physical Health Summary Score (PHSS) and Mental Health Summary Score (MHSS) compared to those on tenofovir. The presence of any symptom of the disease and a stated inability to cope were negatively associated with PHSS, whilst having a regular source of income improved PHSS. Being on tenofovir, symptom of illness [β = -1.24; 95% CI (-2.253, -0.226)], absence of pain [β=0.413; 95% CI (0.152, 0.674)] and patient stated inability to cope with HIV [β = -1.029; 95% CI (-1.441, -0.617)] affected the MHSS. Patients on tenofovir and second line regimens had more signs and symptoms of illness.Conclusion: Participants on zidovudine based regimens showed a better performance across all aspects of HRQoL. These are considerations for the future

Predictors of Adequate Ambulatory Anticoagulation among Adult Patients in a Tertiary Teaching and Referral Hospital in Kenya

Background: Local anticoagulation services are inadequate and substantially underutilized despite compelling evidence showing that their appropriate use significantly reduces the risk of thromboembolic complications. Objectives: To determine the predictors of adequate ambulatory anticoagulation services in Kenyatta National Hospital. Methodology: A cross sectional study between December 2014 and April 2015 among 102 adult outpatients on anticoagulation using consecutive sampling was done. Information abstracted into a predesigned data collection tool included participants’ sociodemographic characteristics, regular sources of supply of anticoagulant, clinic pre-appointment reminders, indications of treatment and international normalized ratio tests. Data were analyzed using IBM Statistical Package for Social Sciences version 21.0 and logistic regression was used to determine independent predictors of adequate anticoagulation, which was defined as international normalized ratio ranging 2 - 3. Results: Females were majority (76.5 %) and only 27.5 % of patients  had adequate anticoagulation control. The indication of warfarin for heart valve surgery (p=0.014) and deep venous thrombosis (p=0.021) were associated with adequate anticoagulation. Age above 60 years was associated with poor anticoagulation (p=0.006). Logistic regression revealed that the independent predictor of adequate anticoagulation was warfarin use due to heart valve surgery (OR=3.1; 95% CI: 1.2 – 7.9, p=0.017). Conclusions: Ambulatory anticoagulation control in the hospital is poor. Further investigation is required to find out the reasons behind adequate anticoagulation in heart valve surgery patients. Key Words: Ambulatory anticoagulation, anticoagulant, outpatient, international normalized ratio tests

Comparison of zidovudine and tenofovir based regimens with regard to quality of life and prevalence of syptoms in HIV patients in Kenya

Zidovudine and tenofovir form the back bone of antiretroviral therapy in Kenya, with sub-Sahara Africa having the highest prevalence of HIV worldwide. However, they have side effects which may adversely affect health related quality of life (HRQoL) and adherence. More women than men have HIV in sub-Sahara Africa; consequently, crucial to conduct studies in Africa. Objective: Compare the Health Related Quality of Life of adult patients on tenofovir versus zidovudine based regimens in a leading referral hospital in Kenya to guide future management decisions. Methods: Comparative cross sectional study conducted on adult out-patients on either tenofovir or zidovudine at Kenyatta National Hospital between 2015 and 2016. The Medical Outcome Study HIV Health Survey (MOS) was administered. Linear regression analysis was performed to identify determinants of HRQoL. Results: Of the total 501 patinets included, participants on zidovudine (39.9%, n=200) had a higher median Physical (PHS) and Mental Health Scores (MHS) (61.9, IQR: 59.5, 62.8) compared to those on tenofovir (60.1, IQR: 55.1, 62.3). Presence of any symptom of disease and stated inability to cope were negatively associated with PHS whilst having regular source of income improved PHS. Being on tenofovir, symptom of illness (β -1.24, 95 % CI; -2.253, -0.226), absence of pain (β 0.413, 95 % CI; 0.152, 0.674) and patient stated inability to cope with HIV (β -1.029, 95 % CI; -1.441, -0.617) affected the MHS. Patients on tenofovir and second line regimens also had more signs and symptoms of illness. Conclusion: Participants on zidovudine based regimens had a better performance across all aspects of HRQoL, and should be actively considered in the future where pertinent

Comparison of Zidovudine and Tenofovir Based Regimens With Regard to Health-Related Quality of Life and Prevalence of Symptoms in HIV Patients in a Kenyan Referral Hospital

Introduction: Zidovudine and tenofovir form the backbone of antiretroviral therapy in Kenya. However, their side-effects may affect the quality of life of patients. Objective: To compare the Health Related Quality of Life (HRQoL) of adult patients on tenofovir versus zidovudine based regimens in a referral hospital in Kenya to provide future guidance. Methods: A comparative cross-sectional study amongst adult out-patients on either tenofovir or zidovudine was undertaken in Kenyatta National Hospital between 2015 and 2016. The Medical Outcome Study HIV Health Survey (MOS-HIV) was administered along with other key aspects of treatment. Linear regression analysis was performed to identify determinants of HRQoL. Results: Patients on zidovudine had a higher Physical Health Summary Score (PHSS) and Mental Health Summary Score (MHSS) compared to those on tenofovir. The presence of any symptom of the disease and a stated inability to cope were negatively associated with PHSS, while having a regular source of income improved PHSS. Being on tenofovir, symptom of illness (β=‐1.24; 95% CI [‐2.253, ‐0.226]), absence of pain (β=0.413; 95% CI [0.152, 0.674]) and patient stated inability to cope with HIV (β=‐1.029; 95% CI [‐1.441, ‐0.617]) affected the MHSS. Patients on tenofovir and second line regimens had more signs and symptoms of illness. Conclusion: Participants on zidovudine based regimens showed a better performance across all aspects of HRQoL. These are considerations for the futur