KeMU Digital Health Repository

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Welcome to African Digital Health Library community Kenya node. The African Digital Health Library (ADHL), Kenya node, makes available health-related content ranging from theses, dissertations,from the School of Medicine, Kenya Methodist University. ADHL currently operates in 5 Sub Saharan African Countries and is supported by the medical librarians. It is a collaborative effort among medical librarians at major universities in sub-Saharan Africa Kenya, Mali, Nigeria, Zambia and Zimbabwe and is funded by the Office of Global AIDS/US Department of State and the U.S. National Library of Medicine / National Institutes of Health. The Kenyan node is managed through the Kenya Methodist University Library and The University of Nairobi.

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Seasonality of Cryptosporidium oocyst detection in surface waters of Meru, Kenya as determined by two isolation methods followed by PCR
(Journal of Water and Health |, 2008-10) Muchiri, John M.; Ascolillo, Luke; Mutuma, Mugambi; Mutwir, Titus; Ward, Honorine D.; Naumova, Elena N.; Egorov, Andrey I.; Cohen, Seth; Else, James G.; Griffiths, Jeffrey K.
Meru, Kenya has watersheds which are shared by wildlife, humans and domesticated animals. These surface waters can be contaminated by the waterborne pathogen Cryptosporidium. To quantify the seasonality and prevalence of Cryptosporidium in Meru regional surface waters, we used a calcium carbonate flocculation (CCF) and sucrose floatation method, and a filtration and immunomagnetic bead separation method, each of which used PCR for Cryptosporidium detection and genotyping. Monthly water samples were collected from January through June in 2003 and 2004, bracketing two April-May rainy seasons. We detected significant seasonality with 8 of 9 positive samples from May and June (p<0.0014), which followed peak rainy season precipitation and includes some of the subsequent dry season. Six of 9 positive samples revealed C. parvum, and 3 contained C. andersoni. None contained C. hominis. Our results indicate that Meru surface waters are Cryptosporidium-contaminated at the end of rainy seasons, consistent with the timing of human infections reported by others from East Africa and contrasting with the onset of rainy season peak incidence reported from West Africa.
Comparative study on quality of life among married and non- married women living with HIV/ AIDS
(IJPP, 2010-09) Luhahi, Yema
Human immunodeficiency virus (HIV) infection is a serious health problem among married and non-married women. It has become a health problem for women of all ages. Antiretroviral therapies introduced in the mid 1990s have allowed many women with HIV infection to live long~ before progressing to AIDS, and to have longer survival time following an AIDS diagnosis. Then the issue of quality 0£.life becomes important for these women. The progression of HIV disease most often results in a decreasing quality of life. While examining quality of life among women living with HIV/AIDS, limited attention has been paid to study addressing the issue of whether there is a difference in the levels of quality of life between married and non-married women living, with HIV/AIDS. This study will assess and compare the levels of quality of life in married and non-married women living with HIV/AIDS. Random systematic sampling of 114 women living with HIV/ AIDS who participated in the study were-administered well structured questionnaires by the palliative care nurses. Quality of life was evaluated using World Health Organization's Quality of Life HIV short form (WHOQOL HIV BREF) instrument. The data reported in this study suggest that there is no significance difference with regard to quality of life between married and non-married women. The independent t test revealed that the levels of quality of life differed significantly in the married and the non-married respondents, t (112) = -2.64; p value =.01. But controlling the effect of the covariates in both groups, the result revealed that there was no significant difference in the levels of quality of life in non-married and married women, t (1J2) = -1.4, p value = .17. The apparent difference (t (112) = -2.64; p value =.01) in the levels of quality of life was found to be due to covariates variables.
Alcohol, tobacco and other Drug Use and Bullying among High School Students in Nakuru District, Kenya
(IJPP, 2010-09) Kariuki, M.; Oteyo, J.s.; Ndege, P.K.
The objective of this study was to determine the prevalence of alcohol, tobacco and other drugs (ATOD) use among secondary school students in Nakuru District, Kenya, and its association with bullying. A total of 1000 form one to four male and female students aged between 13 and 19 years were selected from 40 private and 45 public secondary schools were surveyed between January and June, 2009. The mean or median age for male students was 14 (SD=4.90) and for female students 13.8 (SD=4.8). GSHS was used to collect data which was analyzed by frequencies, chi-square and logistic regressions. In the study, 33.7% of students reported having been bullied by students abusing ATOD in the last 30 days preceding the survey and 15.9% reported the use of alcohol, 12% cigarettes and 8% smokeless tobacco in the last 30 days preceding the survey. Cumulatively, 9.6% of students recorded having used other drugs. There was a significant relationship between alcohol and tobacco use with bullying. However, there was no statistically significant association between the use of other drugs and bullying (X2 = 3.583, df= 1, p=0.058). The prevention of ATOD and bullying among students represents an essential public health measure that may allow for total children's development, qualifying them for a healthy and safe social coexistence. The researchers recommend that focus on prevention programs against alcohol and drug use in secondary schools in general should be mounted to reduce or eliminate bullying altogether.
The Caves of Mount Elgon and Their Sandfly Fauna David K
(IJPP, 2011-01) Sang, David K.
A survey of the Kenyan side of Mount Elgon revealed numerous caves which were found harbouring phlebotomine sandflies. Among the morphologically identifiable males of rwo species of the genus Phlebotomus, sub-genus Larroussius were indistinguishable females, a proportion of which were infected with promastigotes of Leishmania. The suspected vector of this parasite, Phlebotomus pedifer was found predominant in a relatively low altitude escarpment belt at l 750- l 900m, and represented over half of the identified male sandflies detected from the slopes of Mount Elgon. These male sandflies were associated with females infected with Leishmania and those which bit man. At intermediate and higher altitudes, the caves harboured mainly P.elgonensis and were associated with river valleys and major promontories. The escarpment which is a proven focus of cutaneous leishmaniasis was approximately 257 sq km and 10% of the study area, and took the form of a narrow, elongate cliff along the entire southern slopes of the mountain. Details of the distribution of caves on the slopes of Mount Elgon and their sandfly fauna are presented.
The role of teacher trainees' in the management of behaviour change programmes in prevention and protection aganist HIV and AIDS
(KeMU, 2011-05) Gikunda, Susan Maigene
Over the past 25 years, nearly 25 million people have died from AIDS in the world. In 2007, globally about one million people were living with HIV and AIDS and about 2.5 million people were newly infected with the virus. HIV causes debilitating illness and premature death in people during their prime years of life and devastated families and communities (UNAIDS, 2007). The purpose of the study was to establish the role of teacher trainees in the management of behavior change programs in preventing and protecting themselves against HIV and AIDS in three public primary teacher training colleges in Meru and Embu counties. The study involved 356 respondents (15 tutors and 341 teacher trainees). The researcher used questionnaires to collect data from tutors and teacher trainees. Stratified random sampling was used to get the sample size. The descriptive research design was used as it described the state of affairs as they were. A pilot study was carried out to help validate the research instruments. The data was tallied and frequencies got. Descriptive statistics such as percentages, means, graphs, and charts were used. The study found out that teacher trainees and tutors were aware and were involved in behavior change programs in place in colleges and social-cultural and religious factors affected the implementation of these programs. The study recommended that dark comers or pairing zone be lit and patrols made. The college administration to encourage tutors and trainees to be more involved in the management of behavior change programs and check on detrimental cultures. The research was conducted in an ethical manner so as to build, uphold trust and cooperation that was aimed at generating valid and reliable
A Comparison between Self and Clinician-collected Vaginal Swabs for Detection of Bacterial Vaginosis among Women in Kisumu, Kenya
(IJPP, 2011-06) Mwangi, JN; Kisia, A; Bukusi, EA; Wamae, CN
Two tests are available for diagnosis of bacterial Vaginosis (BV), Amsel and Nugent. The latter is considered more sensitive. Laboratory diagnosis for BV requires a vaginal swab specimen. In developing countries, vaginal swabs are only collected by trained health clinicians and use of speculum, examination couch and expensive equipment like autoclave is necessary. In contrast, women in developed countries have a choice of either collecting self swab or allowing a trained health clinician to collect the vaginal swab. This study sought to evaluate the validity and reliability of self collected vaginal swabs for diagnosis of BV by comparing with clinician collected ones. Ten beaches were identified based on convenience along Lake Victoria in Kisumu County from which 105 women volunteers were enrolled. Three vaginal swabs were collected from each woman. The first two swabs were self collected while the third one was collected by a qualified clinician. Smears were prepared, read and interpreted by Nugent method while demographic and clinical data were obtained by use of structured questionnaires and pelvic examination forms respectively. There was high agreement (validity) between the clinician collected and the first self collected swab, Kappa score of K=0.952 (p<0.001). The reliability of the clinician and the second self collected swab had a Kappa score of K=0.905 (p<0.001). The self collected vaginal swabs (SCVS) were found to be valid and reliable for use in diagnosis of bacterial vaginosis.
Comparative Study of Professional Competences of Graduates of Innovative and Conventional Medical Schools in Kenya: A Case of Graduates of Moi and Nairobi Universities
(IJPP, 2011-09) Kimeu, Anastasiah; Mengech, Harun arap K.; Kangethe, Simon
A population of 280 intern doctors was randomly sampled using Gay's (1992) sample estimate of 20%. An increase of 10% in the sample accounted for non-response. The desired random sample size was therefore 84 intern doctors. A purposively selected sample of 47 supervisors from a population of 140, which included medical doctors and nursing officer in charges, was also assessed. A total of 54 (63% questionnaires) from graduates were returned with 26 of these from graduates of school of medicine- Moi university, while 28 were returned from University of Nairobi. A total of 47 (100%) questionnaires were returned from supervisors. The graduates from the conventional school rated themselves 82% on the excellent category in the knowledge of scientific foundation of medicine while the graduates from innovative school ratings were 89% on the same category. On further analysis of the results, there was no significant difference between the graduates. The ratings of supervisors on graduates from conventional school (56%) and those from innovative school (53%) on this competence showed no significant difference either. The majority of graduates of the two schools considered themselves highly competent in clinical skills (76% IMS; and 79% CMS). However, there was no significant difference between the ratings of proportion of graduates from the two schools. The findings on supervisors ratings (70%, 30% IMS; and 70%, 30% CMS) of graduates showed no significant difference. The graduates from the two medical schools do not differ at all as perceived by their supervisors on the seven global competences. However, there seems to be significant differences in the way graduates perceive themselves with regard to six competences as shown in the study. The author notes that these differences may be due to limitation of the self assessment method used in the study, which does not always provide for objective information as was the case in graduates' ratings. However, this limitation applied equally to respondents of the two universities, the differences between the graduates from the two schools of medicine can be indicative of the effects resulting from the different curricula used.
Saphenous Varicose Veins in the Kenyan Population
(IJPP, 2011-10) Ongeti, K.
Lower extremity venous insufficiency is a common condition and increases with age. In addition to classical symptoms, it may result in skin changes and venous ulcers ... I his disease has a great impact on the patients' quality of life and is associated with considerable health care cost. We assessed the age distribution, mode of presentation and management of saphenous varicose veins in a Christian Mission Hospital in Kenya. Forty adult patients (26 females and 14 males) with a diagnosis saphenous varicose vein at PCEA Kikuyu Hospital were evaluated. The patients' bio data, presenting complains, investigations, management and outcome were noted. The data collected was analyzed for means and variances using the SPSS version 17 for Windows and represented using charts and graphs. Most varicosities were bilateral and affected both the thighs and legs. Six patients were pregnant while 15% of the patients presented with venous ulcers. Most (90%) ulcers were found in the elderly patients. Saphenous varicose veins are common in the Kenyan population. Lack of adequate public education predisposes the elderly in the community to are presentation of saphenous varicose veins with ulcers
An Occupation-Based Framework for Changing Human Occupational Behavior to Address Critical Global Issues
(IJPP, 2011-12) Ikiugu, M. N; Larissa, McCollister
The purpose of this study was to investigate the effectiveness of the Modified Instrumentalism in Occupational Therapy (MIOT) in facilitating change in occupational choices and performance patterns to help address global issues of concern to humanity. Such issues include poverty, diseases, environmental destruction and climate change, overpopulation, corruption and institutional dysfunction. The MIOT is an occupation-based framework for individual empowerment which is based on the pragmatic notion that the mind (and ideas or intellectual activities of the mind, including scientific investigation) is an instrument to help humans shape the environment to ensure that it is suitable for their survival. The investigation was a mixed method embedded multiple-case study with an experimental-type pretest-posttest and naturalistic-type phenomenological designs. Three graduate occupational therapy students from a mid-western university in the USA participated in the study. Our findings indicated that participants' occupational choices and performance patterns changed after intervention guided using MIOT guidelines so that they engaged more frequently in occupations chat were likely to impact global issues positively. We concluded that the MIOT was a potentially useful tool that occupational therapists and scientists could use to guide meaningful occupation-¬based interventions to help ameliorate global issues of concern.
Factors influencing non-adherence to antitroviral therapy (ART) among people living with hiv/aids (PLWHA): A case of Isiolo district, Kenya
(KeMU, 2012-06) Godana, Robe
In HIV/AIDS treatment adherence to antiretroviral therapy is of paramount importance. To achieve suppression of viral replication, decrease in viral load and improving quality of life needs near perfect adherence of 95%. The researcher had sort to establish factors influencing non adherence among people living with HIV/AIDS in Isiolo District. The researcher used descriptive survey design. Sample population of 193 participants which is 30% of the 640 total study populations was used. This was obtained from the district comprehensive care clinic through document analysis. The raw data was collected using structured questionnaires and focused group discussion which was cleaned, classified, coded processed, analyzed and presented using pie-charts, graphs and tables. Findings show: individual’s income, multiple drugs combination, health care workers perceptions, beliefs and taboos influence non adherence to antiretroviral therapy while counseling helps to create positive altitude and minimizes stigma. The study recommends: Ministry of Health with other stakeholders to solicit funds to form support groups that will stabilize clients emotionally, psychologically and economically. To improve infrastructure, health care workers and public perceptions and altitudes through trainings, public education, barazas and pamphlets. Free treatment of opportunistic infections for patients with pneumonias, malaria and others infections to minimize admissions and improve quality of life.
Assessment of nutrition counseling services offered to diabetic patients and its effect on adherence to therapies and treatment at the Nakuru Provincial General Hospital, Kenya
(KeMU, 2012-06) Karanja, Lucy W
Poor health has been a global issue which has been associated with the impediment of productivity, economic growth and poverty eradication. It has been estimated that 32 percent of the global burdens of disease are caused by dietary complications. All millennium development goals are in one way or the other related to good nutrition intake. Nutritional Counseling has been credited for ensuring that people are aware of their dietary choices hence avoiding nutritional complications. This is more essential to diabetic patients. The purpose of this study was to assess the effectiveness of Counseling services offered to diabetic patients in Nakuru Provincial General Hospital, Kenya. In order to have the study carried out successfully, a descriptive survey was used to assess the effectiveness of nutritional Counseling services. The sample consisted of 283 respondents that included 8 dieticians and 275 diabetic patients. Stratified random sampling where the total population was split into two distinct samples (diabetic patients and dieticians) based on their demographics. After obtaining permission from all relevant authorities, the researcher collected the data in form of responses through structured questionnaires. Expert judgment was used to improve on content and construct validity of the items. The Statistical Package for Social Sciences (SPSS) was used to analyze the data. The study established that there was a significant relationship between the patient’s nutritional knowledge and recovery rate. Majority of the patients were not adhering to the recommended therapy. There was a statistically significant influence of nutritional counselors’ knowledge of diabetic management and diabetics’ recovery rate. There was also a significant relationship between the economic status of patients and adherence to therapy. This study recommends that the government must take an active role in promoting the nutritional counseling services offered in hospitals by employing more dieticians, intensifying awareness campaigns on the recommended diet for the diabetics. Civil society and religious groups must also take an active role by holding workshop and seminars to sensitize the community about the diabetic condition, psychological support and fighting against stigma to the patients. Additionally, dieticians need to be aware of the current recommendations for diabetic patients so as to pass it on to their clients. Male nutritionists/dieticians should also be trained to encourage more male patients to attend counseling sessions. The researcher suggests a further research on the level of stakeholders input in promoting nutritional counseling in hospitals and an assessment on whether patients actually adhere to the diet by doing a 24 hour recall.
Prevalence of CCR2 gene polymorphisms among HIV infected individuals from different regions in Kenya
(IJPP, 2012-07) Wachira, Dorcas; Khamadi, Samoel; Wamachi, Alex; Mueke, Jones; Ng'ang'a, Zipporah; Maraka, Moureen
Chemokine receptor-2 (CCR2) is a co-receptor for the entry of human immunodeficiency virus- I (HIV-I) into the target cells. Patients with the CCR2 mutations may progress to AIDS at least 2-4 years later than individuals carrying the normal gene. A G-to-A transition at position 190 characterizes the CCR2-64I mutation. This mutation has been identified as an important factor for delaying progression to AIDS. The effect of CCR2 polymorphism on HIV-1 disease progression has not been explored in depth within Africa. The status of CCR2 gene polymorphisms among HIV infected individuals in the Kenyan population is unknown. The objective of this study was to determine the existence and distribution of CCR2 gene mutations and to identify the different polymorphic groups of the co-receptor gene among HIV infected individuals in the Kenyan population.
Factors that would influence the utilization of healthcare services by KeMU Nairobi campus undergraduate degree university students.
(KeMU, 2012-07) Muturi, Lucy W. Njogu
The Kenya healthcare system has been making varied efforts towards improvement. Utilisation of healthcare services continues to be a concern, with the need for interventions that can strenghthen the current weaknesses. Accepted models of healthcare service utilisation may not apply to university students due to their unique socio-demographic characteristics and health challenges. This study focussed on the service delivery pillar of health systems. The absence of a healthcare facility in KeMU-Nairobi campus that can cater for the healthcare needs of the students, remains a weakness in the service delivery pillar and hence an area that needs strengthening. The purpose of this study was to establish the factors that would influence the utilisation of healthcare services by undergraduate degree students if a facility were to be availed at the campus. The Andersen and Newman framework (1995) of health service utilisation was used as the theoretical framework. The objectives were to investigate the need, enabling and predisposing factors that influence the utilisation of healthcare services by undergraduate degree university students at KeMU Nairobi Campus. This was a cross-sectional study with qualitative and quantitative aspects. Random sampling was used to select respondents from the various degree courses. Systematic sampling was used to arrive at the required sample size. Respondents were 390 undergraduate degree university students at KeMU Nairobi Campus. Data was collected using pre-structured and pre-tested questionnaires. Data was analysed using a logistic regression mode of analysis which was done using SPSS version 17. The undergraduate degree student utilisation model designed by this study established nine predictors of utilisation of healthcare services by this target group. These were: need factors - awareness of services offered by the institution, purpose of utilising healthcare services; enabling factors — location of a healthcare facility, availability of healthcare services and source of income; predisposing factors — gender, marital status, academic performance, and interruption of academics due to health related reasons. The respondents had a 1.4 chance of utilising healthcare services if they were aware of the existence of the services and the facility; 78% of the respondents sought services when sick or in the event of an emergency; 63% of the respondents were concerned about the availability of health services; those who were self employed had an odds ratio of 0.32 of utilisating healthcare services; 61% of the respondents were female; 73% of the respondents were single; 52% of the respondents were students who got at least a grade of B+ and above; and 92% of the respondents had their studies interrupted due to healthcare related reasons. Conclusions of this study were that the students' population would specifically seek healthcare services when sick or in the event of an emergency; location was a key influence of utilisation of healthcare services; those who were not married had a higher chance of seeking healthcare services, and were not particular about which type of physician they saw. This study recommended that deliberate efforts must be made to create awareness of services that would be offered at the healthcare facility that would be established for the students population at KeMU Nairobi campus; the healthcare facility should be located in an area that can be easily accessed by the student population; and that there should be training and counselling services offered on student-work-life balance at the healthcare facility that would be set-up for the students.
Occupational stress among probation officers in central province of Kenya
(KeMU, 2012-07) Muteshi, Eugene Musoga
Probation is a people business, oftentimes requiring intense, stressful confrontations with unmanageable offenders. Presently, there are more felons receiving probation than ever before. The impact of current probation supervision conditions on probation officers has not been fully documented. Since human capital is the greatest investment an organization can make, the ongoing assessment and management of employee stress effects becomes critical to maximizing the effectiveness of probation. Considering the fact that probation officers have contact with more offenders than most other justice practitioners, and probation caseloads have continued to increase at unprecedented levels, there is a need to understand more about the work of probation. The proposed study sought to investigate occupational stress among probation officers in Central Province of Kenya. It aimed at determining the prevalence, the causes and effects of occupational stress among probation officers, and the role of counseling in addressing occupational stress among the officers. The Rational Emotive Behavioral and Person-Environment Fit Theories formed the theoretical framework of understanding the concept of occupational stress. The study was conducted in Central province of Kenya. The population of the study comprised of 98 probation officers serving in Central Province at the time of the study. The study employed convenient sampling of the existing five counties in Central Province to arrive Nyandarua and Nyeri Counties. All the officers in these two counties totaling to 24 were the respondents of this study. Structured questionnaires were used for data collection. Descriptive and inferential statistics were used, and methods of data analysis included percentage score and mean. Data presentation was done by the use of tables. The findings revealed that probation officers experienced normal range of occupational stress with mild levels of stress on Role Ambiguity and Responsibility with combined T-scores of 57.92 and 51.04 respectively. Low remuneration, lack of sufficient resources to carry out job responsibilities and lack of opportunities for career development were found to be significant causes of occupational stress among probation officers. These causes of occupational stress were organizational in nature and not job related. The effects of occupational stress on the officers that were found to be statistically significant (p<0.05) were burnout, demotivation, anxiety/depression, conflict with colleagues, and low productivity. Counseling was cited by the respondents as being functional and pivotal in addressing incidences of occupational stress among them through referrals for counseling, psych education, supervision and debriefing. The study findings are useful to the probation department in Kenya in developing policies and effective Employee Assistance Programs (EAP) and other strategies for prevention and management of stress among probation officers. Furthermore, this study on occupational stress among probation officers in Kenya enlightens the public more on this crucial yet less recognized element of the criminal justice system.
Factors that Contribute to Non-Adherence to Antiretroviral Therapy among HIV and AIDS Patients in Central Province, Kenya
(IJPP, 2013-01) Nyambura, Anthony Wanjohi; Odhiambo-Otieno, George W.; Otieno, Michael F.
Adherence concerns have been one reason expressed by opponents of antiretroviral therapy in developing countries or resource poor settings. The objective of the study was to determine factors contributing to non-adherence to Anti-retroviral therapy among HIV and AIDS patients. This was a Cross sectional, descriptive study carried out in Provincial General Hospital Nyeri, Karatina and Thika District Hospitals. The participants included 300 interviewees, 15 Key Informant Interviews (KIIs) and 3 Focus Group Discussions (FGDs) with 8 members each. In regards to the results, the Odds ratio was used to test for association between variables and level of significance. Results also showed that the prevalence of adherence to ART was 7 4%. Risk factors associated with non-adherence were: age (p<0.039 OR=l.287 95% CI 1.013-1.634), occupation (p<0.0001 OR=l.675 95% CI 1.449-1.937), food (p<0.002 OR=0.419 95% CI 0.242-0.726), level of education (p<0.023 OR=0.593 95% CI 0.378-0.930), and stigma (p<0.002 OR=2.456 95% CI 1.375-4.389). 23% of those who lacked community support were found to be suffering from stigma and did not adhere to Antiretroviral Therapy (ART). Through the FGDs the study revealed that co-treatment of HIV and other diseases like tuberculosis, diabetes, epilepsy and mental illness remains a major challenge. 66% of Key Informants reported pediatric ARV drugs formulations were inappropriate, unpalatable and inadequate, dependence on care givers and the laboratories were ill-equipped in terms of facilities, reagents and personnel. In conclusion, the level of adherence (74%) was sub optimal (less than 95% which is the acceptable) but comparable to that of other developing countries. Taking ARV drugs without eating any food made patients suffer from side effects thus making them avoid the medication. Stigma, discrimination, lack of family and community support were huge obstacles to ART adherence. Co-treatment of HIV and other infections remain a major challenge. Shortage of appropriate pediatric formulations, unpalatability of some ARV drugs and dependence on care givers contributed to pediatric ART non-adherence. Health facilities with functioning laboratory, adequate personnel and stock of ARV drugs enhanced ART adherence.
Factors influencing demand for healthcare insurance:A study of jua kali workers in Nairobi
(IJPP, 2013-01) Nalebeson, Mugubi Robert N.; Odhiambo-Otieno, George W.
Health systems are a means to achieving better health outcomes for all. However, where patients depend largely on out of pocket (OOP) payments to access health services, there is often lack of care for those who cannot afford. This study aimed at establishing the fac¬tors influencing the demand for health insurance among Jua Kali workers in Nairobi. This was a cross-sectional research study involving mixed approach (simple random, purposive sampling, qualitative and quantitative methods) involving 130 Jua Kali workers from Associations/Cooperatives and 258 Jua Kali workers from non-organized groups; key informants from NHIF and the Department of Micro and Small Enterprise Department and was. The study was conducted between January to March 2012 within Pumwani Division in Nairobi County. Findings indicated that 113 (29.1%); 21.1% members of Jua Kali association and 11.8% individualJua Kali workers out of 388 were enrolled in NHIF while 262 (67.5%) were not enrolled in NHIF. Inadequate Knowledge of NHIF benefit and the KShs. 480 upfront NHIF premium payment were the main contributing factors to non-enrolment of262 (67.5%) of Jua Kali workers. 42.3 % individual Jua Kali and 6.1 % members of association with a monthly income less than KShs. 9,000 did not enrol in NHIF. To enhance more enrolment of Jua Kali workers, the study recommends that NHIF should design strategies that target the younger, low income and Jua Kali workers with low level of education with key information on health insurance benefits and the benefits of enrollment in NHIF , establish satellite pay¬ment offices within Jua Kali working zones to bring services closer to them, apply KShs. 160 per month instead of KShs. 480 and enhance networking and engage Jua Kali association as strategic partners for the purpose of motivating Jua Kali workers enrollment.
Haematological and serological findings in Cercopithecus aethiops(African green monkeys) with Cyclospora infections in Kenya
(IJPP, 2013-01) Nguhiu, Purity N.; Wamae, Claire N.; Magambo, Japheth K.; Yole, Dorcas S.
Cyclospora,is a common cause of gastroenteritis in humans resulting in protracted life threat¬ening diarrhoea in immunocompromised patients worldwide.Cyclospora infections have been reported in African green monkeys. The objective of the study was to determine the haema¬tological and serological parameters in African green monkeys with Cyclospora infections.A cross-sectional laboratory based study was done at Institute of Primate Research, Nairobi, from March 2008 to June 2009. Thirty three African green monkeys comprising of 10 male adults, 7 female adults, 3 male juveniles and 13 female juveniles were analysed for blood cell counts using a haematological analyser and screened for Cyclospora by ELISA. The red blood cell counts decreased in all study animals with mean decline of 1.2-1.5 (x 106/µl). The white blood cell counts varied among the study animals with highest increase among female adults from4.3-7.1 to 5.4-8.8 (x 103 /µl) and a decrease among the male adults from 3.9-8.7 to 1.5-5.3 (x 103/µl). Positive antibody responses to Cyclospora were observed in 20 of the study animals with highest mean optical density (OD) values of 0.816 ± 0.100 observed among the female juveniles and lowest among the male juveniles at mean OD value of 0.646 ± 0.055. In conclusion, Cyclospora infections triggered both cellular and humoral responses in the African green monkeys.
Assessment of nutritional status and biomarkers among chronic haemodialysis patients
(IJPP, 2013-06) Barwecho, M.J; Thaimuta, Z.L;
Although biomarkers have significance on the nutritional status, there is little information about its relationship among patients on maintenance haemodialysis (MHD). The study was done to determine the significance of the relationship between nutritional status and biochemical markers among chronic haemodialysis patients. The study was done at Kenyatta National Hospital (KNH), Nairobi-a teaching and a referral hospital. This was a cross-sectional, prospective study among chronic haemodialysis patients. Fifty patients on chronic maintenance haemodialysis for 3 months and more were included in the study which was carried out May 2012. All eligible study subjects gave informed consent. Biochemical tests of albumin, electrolytes: sodium and potassium and urea were done and anthropometric measurements taken. The reagents for all biochemical analysis were provided by JAS INC., Court Miami Lakes Florida. The relationship between nutritional status and dietary intake, anthropometric status primary diagnosis, co-morbid, socio-demographic factors and dialysis related factors were determined. Fifty subjects were recruited in the study. The consent for the study was sought at Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (KNH/UON ERC). Electrolytes mainly potassium were elevated. Sodium and albumin was low. There were significant correlations between albumin and hospital attendance, albumin and nutritional counseling and BMI with anthropometric parameters. The electrolyte levels of sodium and potassium are useful nutritional biomarkers for HD patients coupled with regular nutritional advice. Anthropometric parameters and BMI can be used for nutritional status assessment.
Diagnostic Accuracy of Malaria Microscopy in the Highlands of Central Kenya: Implications for Proper Treatment
(IJPP, 2013-06) Batra, Neale S.; Ndege, Peter K.; Kaburu, Mercy; Clauw, Daniel J.; Wilson, Mark L.
Over-diagnosis of malaria is a problem in many African countries and appears to be occur¬ring in the highlands of central Kenya. Blood-smear microscopy, the standard technique for malaria diagnosis in this area, relies heavily on technician skill. Hence, Rapid Diagnostic Tests (RDTs) are increasingly considered the gold standard for diagnosis, but are often not available in resource-constrained settings. We compared the results of microscopy and RDTs performed on finger-prick blood samples from 250 patients referred to laboratory malaria testing at one private and two government health facilities in/near Meru, Kenya. Across the three sites, 97 .1%-100% of microscopy-diagnosed Plasmodium-positive samples were found negative by RDT. Of the three study sites, the government district hospital had the highest microscopy-based positive rate (27.3% as compared to 5.9% and 9.3% in the other two set¬tings). These results indicate alarming levels of inaccurate malaria diagnosis in the Meru re¬gion. Many factors may play a role in this phenomenon, and it is likely that a "systems level" approach is necessary to remedy this problem.
Lived Clinical Experience of Kenya Registered Community Health Nursing Students in Murang'a Kenya Medical Training College
(KeMU, 2013-08) Ndegwa, Njeri Agnes