Determination of dilution and quality control of total and anti-measles immunoglobulin G antibody assays

Objective: To determine the correct dilution and Quality control commercial ELISA of total and anti-measles antibodies for HIV infected pregnant women.Design: A laboratory based studySetting: The University of Nairobi, Department of Paediatrics laboratory.Subjects: HIV infected pregnant women enrolled and exposed to different ARVs depending on their degree of immunosuppression for prevention of mother-child transmission of HIV-1.Results: The dilution used in this study, was 1:400000. Tight error bars of +/-0.1 were produced hence testing was done in singles not in duplicates as recommended. Validation steps did not pass for measles ELISA.Conclusion: Despite the recommendations of the manufacture each laboratory should always optimize an assay before performing tests and reporting the result. Every laboratory should determine the best dilution to use for quantitative TIgG assays and should perform internal and external quality control before reporting the results. These results will give insight on good laboratory practice during trouble shooting while assays are failing

Factors Influencing Adherence to ARVs among Patients Attending Comprehensive Care Clinic within Jomo Kenyatta University of Agriculture and Technology, Kiambu County, Kenya

Background: The efficacy of anti-retroviral Therapy (ART) depends on adherence to the prescribed regimen. However, lack of adherence leads to treatment failure and drug resistance among other negative outcomes.Objective: To determine factors influencing adherence to ARVS among patients attending the Comprehensive Care Clinic (CCC) within Jomo  Kenyatta University of Agriculture and Technology (JKUAT).Design: A descriptive cross sectional study.Setting: Comprehensive Care Clinic within JKUAT.Subjects: Three hundred HIV positive patients, undergoing ART treatment and follow up at the JKUAT clinic for a minimum duration of one month before the study, were recruited.Results: Of the 300 patients enrolled for the study (70% females and 30% males), 81%were adhering to ARV treatment. The factors that were significantly associated with adherence included; Support (encouragement and reminder to take drugs) (P=0.025); the number of meals respondents took in a day (P = 0.001); pill burden (P = 0.002) and forgetfulness (P = 0.001). However, there was no significant relationship between adherence and age, marital status, education, employment status or time taken to travel to the clinic.Conclusion: This study concluded that, the observed level of sub-optimal adherence to ART (19%) is of public health concern. These patients are vulnerable to treatment failure and development of resistant viral strains. Consequently the modifiable factors (Support, Number of meals taken, pill burden, and forgetfulness, should be addressed to change the current trea

Knowledge, Attitude and Practice factors associated with condom use among undergraduate Students of a Public University in Kenya (A case of Jomo Kenyatta University of Agriculture and Technology)

Condoms offer protection against unwanted pregnancy and some sexually transmitted infections including HIV. Interventions to promote condom use are essential in efforts to slow the spread of HIV. This study sought to find out factors associated with condom use among undergraduate university students at JKUAT, given that majority of the students fall within the vulnerable I5-24 year’s age bracket. The study focused on condom use and students (knowledge, attitudes and practices (KAP) on specific issues of HIV). A cross sectional study design was adopted. Simple random sampling was used to obtain the required sample size for both quantitative data (461 respondents) and snowball sampling for qualitative data (64 respondents). Data analysis was conducted using MS Access, SPSS and MS Excel applications. The findings of this study revealed among 461, 66.2% (305) had experienced sexual intercourse. The overall level of condom use was high 72.8% (222). There was a significant relationship between condom use and general attitude (P<0.001). However, there was no significantrelationship between condom use and (knowledge on specific issues of HIV and practices). Continuous health education campaigns on sexuality, proper usage and advantages of condoms should be enhanced

Potential health-care associated respiratory syncytial virus in three referral Hospitals in Kenya, 2009-2011

Background: Respiratory syncytial virus (RSV) is a major cause of community acquired severe respiratory illness in infants, immunocompromised individuals and the elderly. Limited information exists on the contribution of RSV in respiratory Hospital Associated Infection (rHAI) in developing countries.Objective: To characterize Respiratory Syncytial Virus in the three Kenyan referral setting as a potential contributor to respiratory hospital acquired infection.Methods: The study targeted all patients whose samples tested positive for RSV from the ongoing surveillance on healthcare associated respiratory infections. The study collected nasal and oropharyngeal samples from patients who developed new-onset axilla fever and influenza like illness, in patients who had been afebrile for at least three (3) days in the wards and tested them for different respiratory pathogens (Influenza A and B, Parainfluenza, Human metapneumovirus and adenovirus) alongside RSV. During this period A total of 37 samples tested RSV positive. These were characterized as RSV-A and -B using RT-PCR. Those that typed successfully were then sequenced in the attachment G protein and phylogenetically analyzed.Results: Of the 37 samples, 13(35%) were RSV A, 6 (16%) RSV B, 1 (3%) was AB and 17 (46%) did not type. Twenty out of the 37 attained the sequencing criteria and only seventeen gave successful sequences. Three RSV- A and 2 RSV-B sequenced samples from KNH were 100% identical in the G ectodomain sequences. One RSV-A specimen from MDH and one RSV-A positive from NNPGH had 100% identity. Three sequences from KNH clustered with high nucleotide sequence identity. Children below 2years were significantly more at risk of RSV than those aged 5years and above (aOR=0.21,p=0.012).Conclusions: The study inferred possibility of spread of RSV within the hospitals especially the paediatric ward. Any interventions to curb the spread should specifically target all children ≤ 2 years.Afr J Health Sci. 2016; 29(1):1-1

In vivo efficacy of oral and intraperitoneal administration of extracts of Warburgia ugandensis (Canellaceae) in experimental treatment of old world cutaneous leishmaniasis caused by Leishmania major.

The antileishmanial activity of extracts of Warburgia ugandensis Spraque (Canellaceae), a known traditional therapy in Kenya was evaluated in vivo. Treatment of infected BALB/c mice with W. ugandensis extracts orally resulted in a reduction of the size of lesions compared to the untreated control. The lesion sizes differed significantly for the four extracts (p=0.039) compared to the untreated control. For mice treated by intraperitoneal injection, the lesion sizes increased initially for the hexane, dichloromethane and ethyl acetate extracts and healed by day 42. The lesion sizes for mice treated with methanol increased steadily from 2.47mm to 3.57mm. The parasitic burden was significantly higher (

On-farm maize storage systems and rodent postharvest losses in six maize growing agro-ecological zones of Kenya

Rodents are one of the major postharvest pests that affect food security by impacting on both food availability and safety. However, knowledge of the impact of rodents in on-farm maize storage systems in Kenya is limited. A survey was conducted in 2014 to assess magnitudes of postharvest losses in on-farm maize storage systems in Kenya, and the contribution of rodents to the losses. A total of 630 farmers spread across six maize growing agro-ecological zones (AEZs) were interviewed. Insects, rodents and moulds were the main storage problems reported by farmers. Storage losses were highest in the moist transitional and moist mid-altitude zones, and lowest in the dry-transitional zone. Overall, rodents represented the second most important cause of storage losses after insects, and were ranked as the main storage problem in the lowland tropical zone, while insects were the main storage problem in the other AEZs. Where maize was stored on cobs, total farmer perceived (farmer estimation) storage weight losses were 11.1 ± 0.7 %, with rodents causing up to 43 % of these losses. Contrastingly, where maize was stored as shelled grain, the losses were 15.5 ± 0.6 % with rodents accounting for up to 30 %. Regression analysis showed that rodents contributed significantly to total storage losses (p < 0.0001), and identified rodent trapping as the main storage practice that significantly (p = 0.001) lowered the losses. Together with insecticides, rodent traps were found to significantly decrease total losses. Improved awareness and application of these practices could mitigate losses in on farm-stored maize

Policy Options for the Effective Management of Acute Pain among Households in Nakuru

Background: The effective management of acute pain remains a challenge to many households especially in resource-poor countries. In Kenya, the healthcare seeking behaviour associated with management of acute pain has not been clearly documented. Methods: A pre-tested questionnaire was used to collect data from 404 randomly selected households in Nakuru County. The sampled households were surveyed three times, the first was to establish the prevalence of acute pain and subsequent surveys assessed the effectiveness of treatment methods used by the patients. It was hypothesized that the interplay between perception of pain, human capital, social capital and burden of pain would be associated with effective management of acute pain. A logit model that utilizes Gibbs sampling and data augmentation was used to establish factors that explain the use of effective healthcare services following the onset of acute pain. Results: The mean age of the respondents was 28.85 years (SD = 10.30), with 53 percent being males. The prevalence of acute pain was estimated to be 51 percent (95% credible interval 46% to 56%). Effective management of acute pain was found to be related with perception of pain with a one additional unit of pain perception being associated with a 0.006 increase in effectiveness. In turn perception of pain was related to human capital, social capital and the burden of pain. Males and membership to voluntary associations were negatively associated with the perception of pain. However, age and pain intensity had positive relationships with perception of pain. Conclusion: In order to effectively manage acute pain, the primary measure upon which health educationists and policy planners should focus attention on is to enhance the perception of pain. Such a policy option could be effected by a variety of techniques, including reduction in the number of voluntary groups one belongs to, or instead, by increasing the general experience of patients. Pain perception could also be effected by reducing the intensity of pain of the patients. Keywords: Acute Pain, Perception of Pain, Pain Intensity, Social Capital, Human Capita

Current approaches to prevention of venous thromboembolism following major orthopaedic surgery: A review of recommendations by international guidelines

Objectives: Venous Thromboembolism (VTE) is an important cause of  morbidity and mortality amongst patients who undergo major orthopaedic surgical procedures. The perioperative use of thromboprophylactic agents with or without mechanical compression has demonstrated significant  lowering of the incidence of VTE among post-operative patients. Various pharmacological and mechanical agents are available locally in both oral and injection forms but there are no standard guidelines or a consensus statement on their utilization. This is the case despite there being a  gradual rise in the number of patients who undergo hip and knee  replacement surgery in Kenya. The purpose of this paper is to review the current approaches being used to reduce post hip and knee replacement incidences of VTE as recommended by various external guidelines for benchmarking purposes in the Kenyan context.Data Sources: This article relies on published scientific data from various online resources including journals and electronic databases.Data selection and extraction: The data that is cited in this article has been referenced from health publications that are available online through internet literature search and googling Cochrane review, Pub Med, MedScape and Medline websites.Conclusions: The use of mechanical and pharmacological methods to prevent VTE following major orthopaedic surgery is recommended and practiced worldwide. The choice of the prophylactic regimes should be  adapted to patient needs taking into consideration their risk profiles for bleeding and development of VTE as well as the availability and access to the prophylactic treatment. Several countries have developed VTE  prevention guidelines in line with international practice and adapted them to their local situations. In the Kenyan context a gap remains for  development of local VTE prevention guidelines that will inform and enable clinicians to make rationale choices while selecting appropriate VTE prevention measures

Determinants of Fertility Desires and Intentions among HIV Infected and Uninfected Women and Contraceptive use among HIV-infected women in the study at Six hospitals in two regions of Kenya

HIV epidemic in Kenya is geographically diverse ranging from a prevalence of 26 percent and 0.4 percent. Evidence indicates that a higher proportion of HIV infected women are more likely to be associated with unintended pregnancies.Despite this evidence, little is known about determinants of fertility desires and intentions of HIVinfectedand HIV-uninfected women in Kenya. 437 HIV-infected and 365 HIV-uninfected women were enrolled in the study. Using a cross-sectional mixed method, the study sought to investigate determinants of fertility desires and intentions among HIV-infected and uninfected women, and further determined factors associated with desire and intention to use contraceptives among HIV-infected women. Focus group discussions and key informant interviews were conducted with HIV-infected and uninfected women and Health providers respectively. Sampling was proportionate to the size based on client volumes at each study hospital. Similar factors including; age, region ofresidence, place of residence, level of education, employment and marital status were found to significantly influence desire and intention to have children among HIV-infected and uninfected women. Older women were more likely to desire or intend to have more children P&lt;0.001), marital status was the only factor that influenced desire and intention to utilize contraceptives among HIV-infected women. Myths and misconception and poor provider -client interactions on family planning methods were some of the demand and supply system gaps that hinder utilization of family planning methods Innovative approaches are required to promote use of contraceptives among HIV infected women to reduce maternal morbidity, mortality and vertical transmission of HIV

Predictors of maternal mortality among women of reproductive age seeking health care services at Kisii Level 5 Hospital

Background: The safe motherhood initiative was launched in 1987 as a flagship to set a base to reduce maternal mortality. Despite efforts by government and international agencies, Kenya has continued to experience a rise in maternal mortality.Objective: The purpose of this study was to identify the antecedents’ factors which have contributed to maternal deaths in Kisii County, Kenya.Methodology: A retrospective review of 72 maternal deaths which occurred between 1st January 2009 and 30th June 2010 was undertaken by an independent obstetrician. Interviews were conducted with relatives of the deceased women using a confidential questionnaire for female death based on distant as well as proximate factors that may have contributed to maternal death. Health care workers were also interviewed to assess the ability and readiness of the hospital to offer emergency obstetric care. Results: Among the 72 maternal deaths recorded during the study period 42 (58.3%) were as a result of direct obstetric complications which included haemorrhage, post-partum sepsis, pre-eclampsia and abortion. Thirty-three (45.8%) were as a result of indirect causes such as peritonitis, heart disease, HIV/AIDS, anaemia and convulsive disorders. Access to care was hampered by lack of money for transport and hospital user fees. Transport was also unavailable in some cases where money was not the problem. Besides, long distance to the hospital caused delay to seek care. But even for those who were prompt at the hospital also experienced delayed care as health service providers were unavailable as they were attending to other cases. Delay in service provision by healthcare workers, delayed quality obstetric emergency response and delayed care while at the hospital continue to be a challenge to maternal care. Conclusion: Maternal mortality continues as a result of failure of the health system, lack of access to quality care, poor health infrastructure, women empowerment and socio-economic  issues.Key words: Maternal mortality, Quality of care, Women empowerment, Health infrastructur