Journal of Medical and Biomedical Laboratory Sciences Research

Determination of Diversity of Mold Species and Aflatoxins in Local Traditional Cereal Based Brews Within Nkubu Municipality, Meru County, Kenya

Lawrence Ireri — 2024-06-15

Background: Molds produce mycotoxins such as Ochratoxins, Deoxynivalenol, and Aflatoxins which contaminate more than 25% of the global food produced annually. Most traditional brews consumed in Kenya are produced from cereals contaminated with molds and mycotoxins. This poses a public health concern since it exposes consumers to the risk of nephrotoxicity, cancer, teratogenicity and immune-toxicity. However, data on local brew mycotoxin contamination in Nkubu municipality, Meru County remains limited. This study sought to determine the diversity of molds and aflatoxins in cereal based local brews in Nkubu municipality, Meru County, Kenya.

Methods: A total of sixty-two (62) Marua, seventeen (17) Busaa, and five (5) Chang’aa samples were randomly collected from different brewers in the study area and shipped in sterile containers to the Kenya Methodist University Mycology laboratory for isolation and identification of molds. Molds were isolated using culture method while Aflatoxins were detected using ELISA method.

Results: Marua brew 62/84 (73.8%) was the most common brew in Nkubu followed by Busaa 17/84 (20.2%), and chang’aa 5/84 (6.0%). Co-occurrence of Aspergillus, Penicillium, and yeast was reported in all the cereal based brews. Aspergillus plus yeast was the most abundant mold species in all the three types of brews: Marua (69.4%), Busaa (70.6%), and Chang’aa (60.0%). The co-existence of molds in Marua and Busaa varied significantly (P<0.001). Busaa had a marginally higher aflatoxin mean concentration, and range (6.40±2.45, [1.12-25.70] ppm) compared to Marua (5.74±3.29, [1.12-25.70] ppm) and chang’aa (2.35±3.07, [1.41-3.55] ppm), though this was not statistically significant (P=0.195). 21/62 (33.9%) and 6/17 (35.3%) of Marua and Busaa samples, respectively had aflatoxin levels > 10 ppb.

Conclusion: Occurrence of molds and Aflatoxins in cereal based brews in Nkubu municipality beyond the tolerable levels recommended by the Kenya Bureau of Standards warrants mycotoxicological quality control of cereal based brews to avoid exposing the consumers to high aflatoxins.

Haematological and Immunological Abnormalities in People Living With HIV: A Review

Esther Wangui Mandania — 2024-08-18

Haematological and immunological abnormalities abound in HIV infections. Reduced CD4+ T cells, changes in cytokine profiles, and impaired immunity are the key immunological changes seen in HIV infection. The immune system becomes dysregulated when HIV targets multipotent haematopoietic progenitor cells, which disrupts the bone marrow microenvironment. This affects proper haematopoiesis due to cytokine imbalances and disruption of other elements necessary for haematopoiesis. Hence, haematological abnormalities, especially cytopenias often manifest in HIV- infected individuals. A number of reasons contribute to the complicated pathophysiology of these disorders, including HIV's direct effects on haematopoiesis, suppression of the bone marrow due to cancer or infection, adverse effects of antiretroviral (ARV) medications, immune-related issues, and opportunistic infections. This research compiles and analyses regional data on the frequency of cytopenias in HIV-infected individuals, including anaemia, leukopenia, and thrombocytopenia and their causes. Additionally, it evaluates the effects of antiretroviral medication on cytopenias and CD4 counts, and investigates the connection between these cytopenias and immunological indicators like CD4 count. Also included are suggestions for future studies and areas where studies are lacking.

Distribution OF ABO Predicated Phenotypes among Voluntary Blood Donors applying Next Generation Sequencing - Insights from Kenya

Rachel Githiomi — 2024-05-10

Background: ABO system is a major determinant for blood transfusion and organ transplantation incompatibility. ABO histo-blood group antigens are sugars attached to glycolipids and glycoproteins on the surface of human cells and readily recognizable by antibodies which are naturally present in each person plasma/serum. Laboratory testing for ABO antigens and isoagglutinins is essential for safe and effective transfusion and transplantation. Testing for ABO antigens has traditionally depended on serologic testing which is limited in the determination of the weak subtypes risking the recipients to alloimmunisation especially those we are receiving ongoing transfusions with red cell such as sickle cell disease and oncology. . It has also impacted negatively in the management of rare red cell units. However, there is increasing need for evaluation of genetic analysis of ABO antigens, to enable evaluation of ABO blood group in cases where serologic testing may be ambiguous or impossible to accurately determine the presence of these antigens; plus having such data in a country. Thus, there is need to investigate the genotypes/Alleles responsible for ABO blood group phenotypes in the blood donor population to enhance safety in transfusion and transplantation practices.

Methods: The study site was Kenya National Blood Transfusion Service and Red Cross lifeblood Brisbane, experimental design was employed, sample size determination was determined using Slovin's Formula Sampling Techniques, and purposeful sampling method was employed to achieve a representative sample. Next generation sequencing was employed to determine red cell alleles and predicted phenotypes. Sequencing was performed using the Illumina MiSeq platform with 12-plex pools and standard 300-cycle V2 chemistry.

Results: Out of the total 119 samples sequenced, ten phenotypes combinations were predicted: O (52.3%), A1 (16.2%), B (10.5%), A1 or B (6.8%), A1 or A2 (5.8%), A1 or Ax/Aweak (1.6%), B or B3 (1.6%), A1B (2%) A2B (2%).and Bweak (0.5%). This can be expressed as (O> A1> B > A1 or B > A1 or A2 > A1 or Ax/Aweak > B or B3 > A1B > A2B > Bweak.

Conclusion: The study findings elucidated the genotypes that are responsible for the ABO thirteen phenotypes in the identified Kenyan population. This data forms the basis or evidence to advocate for a blood group reference laboratory and a red cell panel that is African specific.

Impact of Simulation-Based Training on Nursing Students' Knowledge of Chest Respiratory Assessment at Mount Kenya University

Vera Akinyi Okoth — 2024-07-12

Background: Simulation allows nursing students to perform skills they have learned in class. It allows them to apply theory into practice. The available manikin for simulation include low, medium and high fidelity manikin. Globally, simulation is among the teaching methods used to train nurses and other healthcare professionals. Despite the benefits of high fidelity simulation illustrated in other studies, there is paucity of research done on the effectiveness of simulation using medium fidelity manikin among nursing students. Currently, the healthcare education system focuses on basic science education and leaves most skills training in an unsystematic process and unstructured. Since the laboratory sessions are not examined or assessed for the students to \be awarded marks, students do not attend laboratory simulation sessions as expected. This study evaluated effectiveness of medium fidelity simulation.

Methods: It adopted a cross-sectional quantitative pretest-posttest quasi experimental design. It was conducted at Mount Kenya University among undergraduate nursing students. Purposive sampling will be used. Simple random assignment was used to sort out the sample participants into control and experimental groups. Cluster randomization was used for quality assurance of control group. Data was collected through a pretest quiz, Structured Observation Checklist and Questionnaire. Data was analyzed using Statistical Package for Social Sciences.

Results: On assessment of knowledge, experimental group had a mean score of 91.8% with Standard Deviation 9.68. Control group had a mean of 88.11% with Standard Deviation of 10.38. At 95% confidence level, p-value of 0.016 suggested that there was difference in knowledge on chest respiratory assessment between experimental and control groups. Clinical competency between the experimental and control groups was compared using an independent sample t-test. Experimental group had a mean of 92.67 with standard deviation of 6.602. Control group had a mean of 62.23 with standard deviation of 12.118. The P-value = .001. With 95% confidence level, there was statistical difference in clinical competency between the two groups.

Conclusion: Students who participated in simulation displayed better performance in knowledge and clinical competency than those who did not participate in simulation. Further research can be done determine factors that can motivate nursing students to attend laboratory simulated sessions.

Decoding Kidd (JK) Blood System Phenotype in Kenya: Unveiling the Diversity with Cutting-Edge Next-Generation Sequencing Technology

Rachel Githiomi — 2024-05-05

The Kidd blood group system plays a crucial role in transfusion medicine, and understanding the molecular basis of Kidd red cell alleles is essential for effective blood matching and preventing alloimmunization. In Africa there are limited reports on the phenotype distribution for the 45 blood group systems recognised by the ISBT. Most of the blood group determination is via serological methods however, only the major blood groups antigens are identified (ABO & RhD) despite the evidence of some of the rare blood group antigens such as Kidd types being associated with clinical significance in transfusions, pregnancy and transplantation. In adverse complicated undetermined cases, genomic typing has become useful in determining the involved red cell variant. The study sought to investigate the genotypic and phenotypic distribution of Kidd blood group alleles in the blood donor population to enhance safety in transfusion practice.

Methodology: The study site was Kenya National Blood Transfusion Service and Red Cross lifeblood Brisbane, experimental design was employed, sample size determination was by Slovin's Formula Sampling Techniques, and purposeful sampling method was employed to achieve a representative sample. Molecular genotyping were employed to determine red cell genotypes and phenotypes. Sequencing was performed using the Illumina MiSeq platform with 12-plex pools and standard 300-cycle V2 chemistry.

Results Of the 119 samples sequenced, thirteen JK genotype combinations were identified in the cohort, with the following predicted phenotype distribution: Jk(a+b-) 45.5%, Jk(a+b+) 25.7%, Jk(a+wb+) or Jk(a+b+w) 9.9%, Jk(a-b+) 9.4%, Jk(a+wb-) 5.8%, Jk(a+wb-) or Jk(a+b-) 2.1%, and Jk(a+wb+) 1.6%. These frequencies are consistent with global and sub-Saharan Kidd frequencies, highlighting the importance of population-specific data. Accurate genotyping and phenotype matching are essential to ensure safe and effective transfusions

Phytochemical and Antifungal Analysis of Root Bark, Inner Seed and Seed Coat Crude Extracts of Jatropa curcas

Kennedy Muna — 2025-03-12

Background: Jatropha curcas, a member of the Euphorbiaceae family, is known for its medicinal and biofuel applications. Rich in phytochemicals such as alkaloids, flavonoids, tannins, and phenolics, it has shown antimicrobial properties, though its antifungal potential remains underexplored. This study evaluated the antifungal activity of Jatropha curcas root bark, inner seed, and seed coat crude extracts while identifying bioactive compounds responsible for this activity.

Materials and methods: Samples were harvested from Kitui, Kenya, authenticated at the National Museums of Kenya, air-dried, ground, and extracted using hexane and methanol in a Soxhlet apparatus. Phytochemical screening employed standard qualitative tests to detect alkaloids, glycosides, phenols, tannins, flavonoids, terpenoids, and coumarins. Antifungal activity was assessed by measuring inhibition zones of different extract concentrations (50 µl/ml and 100 µl/ml) against Candida auris.

Results: Phytochemical screening revealed that glycosides and terpenoids were present in all extracts, while phenols, flavonoids, tannins, and coumarins were mainly detected in methanol extracts. Alkaloids were absent in root bark and seed coat but moderately present in inner seed extracts. Antifungal tests showed that hexane extracts exhibited higher inhibition zones than methanol extracts. Among the plant parts, root bark hexane extract at 100 µl/ml demonstrated the highest antifungal activity, with a 15 mm inhibition zone.

Conclusion: These findings confirm the presence of bioactive compounds in Jatropha curcas with potential antifungal properties. The hexane-extracted root bark exhibited the strongest antifungal activity, suggesting its possible use in developing natural antifungal agents. Further research is recommended to isolate specific active compounds and understand their mechanisms.

Assessment of Morbidity Status of Children Aged 6-59 Months in Kericho County, Kenya

Daniel Kipngeno Cheruiyot — 2024-06-25

Background: The growth and well-being of a child is dependent on their eating habits. One of the leading causes of morbidity and mortality in Kenya and countries worldwide is poor nutritional status. There are few studies on factors affecting the nutritional status among children aged 6 and 59 months in Kenya, even though malnutrition is a major cause of illness and mortality in these groups. Consequently, this research set out to identify the factors that influence the nutritional status of children in Kericho County, Kenya, ranging from six months to five years.

Methods: The study utilized a cross-sectional analytical design to uncover factors influencing the nutritional status of children attending outpatient child welfare clinics at Kericho County Referral Hospital and Kapkatet Sub-County Hospital.

Results: A sample of 172 children was chosen through systematic random sampling, and data was collected using a structured questionnaire. Analysis involved ENA for SMART for anthropometric data and Statistical Package for Social Sciences version 27 for all other variables. Findings revealed that 75 (43.6%) children were aged between 24 and 59 months, and 88 (51.2%) were male. Additionally, approximately two-thirds of caregivers had attained secondary education (n=77, 44.8%). Stunting was prevalent in 25% of the children, while both wasting and underweight affected 23.8%. Morbidity data revealed that 45.3% of children had been sick in the past month, with varying durations of symptoms. Children whose caregivers lacked formal education were more likely to be underweight (AOR=0.70, 95% CI: 1.82-2.99, p = 0.01). Delayed introduction to complementary food reduced the likelihood of wasting and stunting (AOR = 0.25, 95% CI: 0.05-0.91, p = 0.03) and (AOR = 0.44, 95% CI: 0.16-1.08, p = 0.04) respectively. Children experiencing symptoms for over 6 days were more likely to be underweight (AOR = 1.27, 95% CI: 0.98-2.66, p = 0.01), and those not sick in the past month were less likely to be stunted (AOR=0.56, 95% CI: 0.27-0.89, p = 0.03).

Conclusion: Caregiver education level, childbirth method, timing of complementary feeding, and illness duration significantly influence child nutrition. Hence, implementing targeted nutrition interventions for children aged 6 to 59 months in Kericho County is imperative.

Human Papilloma Vaccination Hesitancy Among Parents With 10-14 Years In Athi River Sub-County Machakos County

Walter Ochieng — 2024-10-25

Background: Cervical cancer can be prevented by human papillomavirus (HPV) vaccination. However, parents can have concerns about vaccinating their daughters. Consequently, there is a need to identify factors associated with vaccine hesitancy among adolescent females aged 10-14 yrs. The study used a descriptive cross sectional study design research, conducting in-depth interviews with parents of eligible children to gain a comprehensive understanding of their views on the vaccine within the community living in Athi River Sub-County.

Material and Methods: This study used descriptive cross-sectional approach. The Chi Square formula t-test and correlation analysis was utilized to generate study respondents for this study. Single stage sampling was employed in this study to recruit study respondents. The cut off for statistical significance was p≤0.05.

Results: Data on sociodemographic traits females were 110(71.9%) and males 43(28.10%), education level 80(52.3%) were from college, 64(40.52%) employed and religion 128(83.66%) were Christian, Muslim 18(11.76%)Buddhist 0(0.00%) and African church 7(4.58%). HPV knowledge, attitude, beliefs and vaccine hesitancy were collected. Out of 153 participants, 74(48.37%) were aged 31-40 years. Source of information was media whereby 52 (34.0%%) were females while 34(22.2%) were males. Most of the parents are moderately familiar with the HPV vaccine 68(44.4%), Factors like necessity, effectiveness, financial concerns, daughter's age, and healthcare professionals' opinions were found to influence parental decision-making regarding HPV vaccination.

Conclusion: Findings revealed that a notable majority of parents expressed confidence in the vaccine's effectiveness, perceived the accessibility of HPV vaccination services as substantial, and regarded healthcare providers' recommendations as pivotal. Societal stigmas or misconceptions about HPV and its vaccine were seen as barriers, along with concerns about vaccine safety and financial barriers. Educational campaigns and outreach efforts were considered influential, while lack of awareness or knowledge about HPV and its vaccine was perceived as a significant barrier. To address vaccine hesitancy and improve HPV vaccination rates, targeted interventions are needed. These interventions should focus on providing accurate information to address safety concerns and misconceptions, fostering trust in healthcare providers.

Prevalence and Underlying Factors of Anemia Among Adult HIV Patients Undergoing Highly Active Antiretroviral Therapy at Murang’a Level 5 Hospital, Kenya

David Muhunyo Kamau — 2024-06-27

Background: Anemia is a disorder whereby the body has inadequate healthy erythrocytes. Erythrocytes' function is to carry oxygen throughout the body. Anemia affects over 2billion people worldwide. In Human Immunodeficiency Virus (HIV) infected patients, the highest anemia prevalence in Africa was in Congo at 63%, in Ethiopia, it was as low as 26.2%. In Kenya, among adult pregnant women not initiated on antiretroviral therapy, anemia was at 65.2% while negative control group was 19.6%. In Murang’a County Kenya, there was paucity of data on anemia in HIV patients.

Methods: A cross-sectional study was implemented, 295 study participants were enrolled. Demographic and clinical data were obtained using structured questionnaires. Body mass Index (BMI) calculated. 4ml of blood was collected into an anticoagulant vacutainer for analysis of hematological indices. Baseline CD4, defaulter history, antiviral regimen, prophylaxis and current World Health Organization (WHO) HIV staging were obtained from the Kenya Electronic Medical Record (EMR). Current CD4 value determined using BD FACS PRESTO. Complete blood count (CBC) done using Medonic hemolyzer.

Results: prevalence of anemia was 42.03%. Among n=124 anemic participants mild, moderate and severe anemia was 50.8%, 27.9% and 21.3% respectively. Prevalence related with: year of diagnosis(P-value 0.001) , age( P value 0.012),HIV staging(P-value 0.001), viral load (P value 0.03,BMI(P value=0.002),Defaulter history (P value 0.001)and hematological indices . At CV=0.174: Low HB correlation with HCT was (0.81), MCV (P-value 0.49), MCH (0.40), MCHC (-0.36) and WBC (-0.53), PLT (-0.09) and VL (-0.40). P value=0.008. No linear relation between the CD4 count and HB levels.

Conclusion: There is need for regular monitoring of HB and other related hematological parameters in HIV patients. Collaboration of healthcare workers including hematologists and nutritionists would ensure a more holistic approach in HIV management. Trends like year of diagnosis should be understood and involved in anemia management. Continuous research to determine the complex correlation between anemia and opportunistic infections is necessary

Relationship Between ABO, Rhesus D Blood Groups And Diabetes Mellitus In Patients Attending Kandara Sub-County Hospital In Murang’a County, Kenya

Moureen Nyawira Muchoki — 2024-09-28

Background: Blood is categorized into types depending on the presence or absence of antigens on red blood cell surfaces. Currently, there are four blood groups: A, B, AB, and O. In addition to blood grouping, blood can be classified as rhesus negative or positive based on the lack or presence of a protein on the surface of red blood cells known as the rhesus D antigen. Diabetes is one of the four most common non-communicable diseases, accounting for around 4 million deaths globally. Diabetes is classified into three types: T1DM, T2DM, and GDM. DM is a group of disorders that impact how the body processes blood glucose. Gestational diabetes is described as varying degrees of glucose intolerance that develops during pregnancy. To yet, there is insufficient evidence linking the ABO and rhesus D blood groups to diabetes mellitus. The link between ABO blood type distribution and diabetes mellitus is always ambiguous because no diseases have been linked to a lack of ABO blood group antigen expression. The link between ABO, rhesus D blood types, and diabetes mellitus was investigated at Kandara Sub-County Hospital in Murang'a County.

Methods: Participants in the study were recruited at random from individuals with high blood sugar levels. The subjects' blood groups and sugar levels were determined using Anti A, Anti B, and Anti D sera and a Ceracheck glucometer, respectively. The data from this study was documented on an Excel Spread Sheet. The data was analyzed with SPSS version 20. The frequency, mean, median, and standard deviation of blood groups as well as blood sugar levels were calculated. A correlation analysis was performed to investigate the association between blood types, the rhesus factor, and diabetes. The majority of diabetic patients were female (69.4%), with 30.6% being male. The age range was 2 to 85 years, with a mean of 30.97.

Results: Blood group O+ had the highest occurrence in both male and female diabetic patients, at 47% and 51% respectively. However, the prevalence of blood groups did not differ substantially between male and female diabetes patients (F (1, 14) =1.20, p=0.29). The study individuals' glucose concentrations ranged from 7 mmol/L to 17 mmol/L. The mean glucose levels ranged from 7.5 to 12.95 mmol/L among diabetes individuals of diverse ages. Females aged 61-65 years had the highest mean glucose levels (14.9mmol/l). Males aged 26-30 had the highest mean glucose levels (13.3 mmol/l). However, there was no significant difference in glucose concentrations between male and female diabetes patients throughout age groups (t15=1.10, p=0.287). Diabetic patients with blood group AB+ had the highest blood sugar level, 11.21 mmol/L. However, blood sugar concentrations in male and female diabetic patients did not change substantially among age groups (t6=0.27, p=0.79). The Pearson correlation coefficient was R=0.24, SE=0.45, 95% CI, p>0.05. This implies that there is no link between blood groups and blood sugar levels, with the blood group effect accounting for 5% of the variation in blood sugar level. It is established that there is no link between diabetes and ABO blood groups, and persons with Group-AB+ are more likely to develop the condition.

Conclusion: The current study had several limitations, including the prevalence of blood groups being affected by geographical distribution, race, and ethnicity, as well as underage children whose parents did not consent for them to participate in the study, resulting in a low number of children participants: However, these findings are insufficient to draw a strong conclusion. Other genetic factors may be involved, necessitating more broad and thorough analysis. This study's findings were valuable to stakeholders involved in diabetes management. The Ministry of Health and non-governmental organizations working on diabetes used the gathered data to develop strategies for effective diabetes management.

A review of Carbapenems Resistance in the Current World

Racheal Kimani — 2024-05-15

Carbapenems are a subgroup of beta-lactam antibiotics, which have been effective in treating Gram-negative bacteria. These groups of drugs are particularly effective for resistant Gram-negative bacteria that are multi-drug resistant mainly to all types of penicillins and cephalosporins. It is a reality now that there is a looming crisis due to emergence of resistance to these groups of drugs. Efforts to fight resistance is by new therapies that are combining cephalosporins with inhibitors such as vaborbactam, avibactam and relebactam. However, already resistance has been noted against ceftazidime-avibactam according to recent studies. The effectiveness of carbapenems has gone down due to beta-lactamases, production of efflux pumps and target modification. Commonly encountered carbapenemases conferring resistance to this group of drugs include KPCs (Klebsiella pneumoniae carbapenemases), which are class A beta lactamases, NDMs, in full New Dehli metallo-β-lactamases, VIM (Verona Integron encoded metallo-β-lactamases), IMPs (Iminpenemases) which are class B metallo-β-lactamases and OXA-48 (oxacillinases) which are Class D β-lactamases. This review gives a global distribution overview and the evolution of carbapenemases, which are spreading at a fast rate. There are measures to overcome this menace such as enhancing infection prevention control (IPC) measures. Another approach is implementing and upholding diagnosis and antibiotic stewardship especially in Low-middle-come-countries (LMICs).

Examining Major Sources of Bacterial Contaminants, Distribution and Their Susceptibility to Antibiotics in Kitui County Referral Hospital

Charity Mutave Kimwele — 2024-07-08

Background: Bacterial contaminants are the major sources of nosocomial infections which causes hospital acquired infections among health care workers patients and visitors in health facilities. Nosocomial infections are acquired during provision of health care services. The buildings provide the space used to provide hospital care while the equipment entails the tools and machines used to run the operations of the hospital. The people could be patients, healthcare workers or visitors. Thus, patient environment in surgical and medical wards has a huge impact on health safety of patients. The study sought to determine antimicrobial susceptibility patterns of bacteria isolated in Kitui County Referral Hospital.

Methods: This study was done by collection of 195 swabs samples in the patient care and treatment environment which involved the floors, beds, drugs trolleys, infusion stands, sinks, door handles, chairs, tables and bedside lockers of the medical and surgical wards. A total of 177 bacteria isolates contaminants were identified from both surgical and medical wards. The study was done through culturing of specimen in MacConkey, Sheep blood agar and chocolate blood agar media. The identification was done by gram staining technique and biochemical tests which included citrate utilization test, catalase, coagulase, indole, Methyl Red, Voges Proskauer and oxidase test.

Results: The study found that the primary types of bacteria in hospital setting being Staphylococci aureus, Escherichia coli, Klebsiella oxytoca, and Pseudomonas aeruginosa. S. aureus had the highest prevalence at 43% while the least was Pseudomonas aeruginosa at 13%. Lockers were the major source of contaminants (28%) whereas the least contaminants’ source was infusion stand (5.5%). Antimicrobial susceptibility test showed that all the isolated bacteria were sensitive to Meropenem. P. aeruginosa showed high sensitivity to Meropenem (100%) but averaged 33.3 % against Piperacillin Tazobactam, Ampicillin -clavulanic acid, and Ciprofloxacin and no sensitivity (0%) on other drugs. E. coli was only susceptible to Tazobactam, Ciprofloxacin, and Ceftazidime (20%), Augmentin (40%), and Meropenem (80%). Similarly, K. oxytoca was (100%) susceptible to Meropenem and ranked second with the most sensitivity to drugs tested: Tazobactam, Cefixime, Gentamicin, Ciprofloxacin, Ceftazidime (50%), and Augmentin, Ampicillin (25%). Vancomycin, Oxacillin, Penicillin, and Levofloxacin had no activity on bacteria isolates. S. aureus showed sensitivity to most of the drugs tested: Clindamycin (5.55%), Tazobactam, Ciprofloxacin, Ampicillin (38.88%), Augmentin (66.66%), and Meropenem, Linezolid and Gentamicin (88.8%).

Conclusion: Hospital surfaces, including doors, were the primary source of contaminants. S. aureus was distributed mainly on doors, while lockers, beds, sinks, and drug trolleys were contaminated with all bacteria isolates.

Opportunities for Therapies for Graft-Versus-Host Disease Following Hematopoietic Stem Cell Transplantation: Is Africa Prepared?

Caroline Mangare — 2024-05-04

Hematopoietic stem cell transplantation is a therapeutic approach used to cure many malignant and non-malignant, acquired and congenital/genetic as well as benign disorders of the bone marrow. This procedure is considered to be among the major advances of modern medicine which has been marked by a growing need globally. Graft-versus-host disease (GVHD) and failure of engraftment continues to be major hurdles to the success of allogeneic hematopoietic stem cell transplantation (HSCT) as well as adoptive T cell causing high morbidity and mortality. The limited understanding of the pathogenesis of acute and chronic GvHD, coupled with the suboptimal response to front-line corticosteroid treatment and poor outcomes for patients with steroid-refractory disease, present major hurdles. Additionally, the inconsistencies in the design of prospective clinical studies evaluating new agents for GvHD have hindered progress, with few multicenter studies being conducted. While advancements have been made in grading GvHD and developing biomarkers for improved prognostic information, there is a critical need for uniform inclusion criteria and endpoints in prospective studies to facilitate multicenter research and advancements in GvHD prevention. In developing countries, HSCT is further limited by high cost, limited infrastructure, availability of HLA-identical donors and management of complications such as GvHD. Several modalities have been employed to curb GvHD such as (drugs), additional inventions have been employed that include molecular methods that will be described in this review.

Empowering Women to Promote Prostate Cancer Screening: Effects of Message Framing in Brochures

Peterson Kimani — 2025-03-30

Background: Prostate cancer is a leading cause of cancer mortality among men globally as well as in Kenya. Successful detection, treatment, and management of prostate cancer are dependent on emotional, social, physical, and financial support. Female partners have been shown to motivate, counsel, and enhance their self-esteem. Therefore, the present study aimed to assess the effect of gain-framed and loss-framed brochure interventions on knowledge and recommendations for prostate cancer screening among female partners.

Material and Methods: The study adopted a randomized controlled trial design, whereby the control and the two intervention sites were randomly selected from a sampling frame of the sub-counties in Kiambu County. At the control and intervention sites, female partners of men above the age of 40 years who were the study participants were randomly selected. Intervention involved the use of gain-framed and loss-framed brochures. The sample size was determined using Magnani formulae, and 279 respondents from the control and intervention sites were recruited into the study. The chi-square test was used to assess differences in recommendations for prostate cancer screening, general knowledge of prostate cancer, knowledge of signs of prostate cancer (PC), and prostate cancer screening (PCS) methods between the control and intervention groups at baseline and end line. Further, data were subjected to structural equation modeling to assess the influence of knowledge on recommendations for prostate cancer screening.

Results: there was a significant difference in female partner recommendations for prostate cancer screening among male partners in the control and intervention groups (χ2 =14.591, p= 0.001). Both intervention groups (gain- and loss-framed) had dramatically higher recommendation rates compared to the control group. The difference between gain-framed (93.4%) and loss-framed (91.2%) was relatively small, and the two approaches were highly effective, nearly doubling the recommendation rate compared with the control group. The gain- and loss-framed brochure intervention significantly improved general knowledge on PC, knowledge of PC signs, and knowledge of PCS compared to the control group. Improvements from zero baseline knowledge of PC screening methods are particularly noteworthy. Gain-framed messaging was most effective for general knowledge of PCS methods, which increased by 63% and 31.9%, respectively, while loss-framed messaging was more effective in increasing knowledge of PC signs by 27.4%.

Conclusion: The study therefore recommends the need for partners in health to ensure provision of hybrid educational materials using both gain- and loss-framed approaches in healthcare settings, as well as ensuring education for both female and male about prostate cancer.

Biochemical and Hematological Changes Among People With Active Pulmonary Tuberculosis Infection Living in Densely Populated Areas in Nairobi County

Milca Cherono — 2024-07-16

Background: People living in Kenyan slums are at a higher risk of developing tuberculosis. The risk includes infection with multi-drug-resistant tuberculosis strains. With the latest data reported in the year 2021 on Kenya’s tuberculosis prevalence, the survey identified a prevalence of 251 per 100,000 adult populations. It is important to continuously update knowledge on the prevalence of tuberculosis to ensure 2030 tuberculosis end strategy control measures are effectively leading to a decrease.

Methods: Performing tests for the identification of bacteria using the GeneXpert technique. Positive GeneXpert results counted against negative results and hence the prevalence of tuberculosis determined. Hematological and biochemical alterations associated with tuberculosis infection was done. Complete blood count and erythrocyte sedimentation was performed to determine hematological changes and liver function test to determine biochemical changes. The liver functions test was performed using a biochemistry auto analyzer where manufacturers’ instructions was followed. Sensitivity of anti-TB drugs was accessed by Culture and sensitivity

Results: Twenty-nine (29) sputum specimens generated positive results for Mycobacterium tuberculosis while one hundred and thirty-three (133) negative. The percentage distribution of Mycobacterium tuberculosis infection was 17.9% positive and 82.1% negative. Out of the twenty-nine study subjects, whose results were positive, eighteen (18) were males 62% while eleven were females 38%. The overall prevalence of mycobacterium tuberculosis was 17.9 % with a male and female distribution of 18 (11.1 %) and 11 (6.8 %) respectively. Many hematological and biochemical changes were significantly high compared to their controls. Among 25 sputum specimens which were cultured, 18 had growth of mycobacterium tuberculosis. The culture growth was subjected to drug sensitivity testing using the following anti-biotic i.e. streptomycin, isoniazid, rifampicin and ethambutol. Twelve (67%) culture growths were sensitive to streptomycin and six (33%) were resistant to streptomycin. Five (28%) culture growths were sensitive to isoniazid and thirteen (73%) were resistant to isoniazid. Five (28%) culture growths were sensitive to rifampicin and thirteen (73%) were resistant to rifampicin. Eight (44%) culture growths were sensitive to ethambutol while ten (56%) culture growths were resistant to ethambutol.

Conclusion: Improved TB treatment regimens and quick antibiotic sensitivity testing are necessary in light of the rise of multi-drug resistant and extreme drug resistant tuberculosis infection.

Predictors of Non-Adherence to Type II Diabetes Management Among Adult Inmates in Machakos County Prisons, Kenya

EVABEATRICE NJOKA — 2024-04-26

ABSTRACT

Background: While the management of Type II diabetes continues to enjoy progressive changes, non-compliance with medications has emerged as a threat that could jeopardize public health gains. The incarcerated population best captures the 21^st-century concern, where the special group is faced with limited decision-making capabilities. The aim of this study was to establish the predictors that influence non-compliance to type II diabetes treatment among adult inmates in Machakos County Prisons.

Materials and Methods: A mixed methods was used to conduct interviews from 258 staff and 556 inmates. The study area encompassed inmates and staff of Yatta and Machakos GK prison in Machakos County. Data were collected through the use of structured questionnaires and KII. Data was analyzed using SPSS version 20 software, Chi square and logistical regression. Results were presented using tables, charts and bar graphs.

Results:The findings shows that involvement in treatment decisions has a significant influence on non-adherence to type II diabetes management (p=0.000). The respondents who are not involved in treatment decisions (OR= 0.154, 95%CI [0.061-0.385], p = 0.000) were more likely to be non-adherent to type II diabetes management as compared to those who are involved in treatment decisions. The findings indicates that doctors giving prisoners information on diabetes has a significant influence on non-adherence to type II diabetes management (p=0.000). The prisoners who don’t receive information on diabetes (OR= 6.577, 95%CI [3.043-14.213], p = 0.000) were more likely to be non-adherent to type II diabetes management as compared to prisoners who receive information on diabetes.

Conclusion: Doctors giving prisoners information on diabetes and involvement in treatment decisions, feeling comfortable to ask questions to the doctor had an influence on non-adherence to type II diabetes management

Recommendations: The study found that adult inmates were not involved in treatment decisions. This study therefore recommends that the doctors in prison clinics should spend adequate time with the inmates explaining important information on diabetes to help the patient understand his condition and encourage him to start and maintain therapy. Patient satisfaction and a good understanding of the content given by the provider improve compliance to type II diabetes management among adult inmates.

Keywords; Predictors, Patient-Provider relationship, Non- compliance

Effect of Antiretroviral Regimens on Haematological and Immunological Abnormalities of People Living With Hiv in a Comprehensive Care Centre in Kiambu County, Kenya

Esther Wangui Mandania — 2024-11-24

Abstract

Background: Haematological abnormalities are linked to a higher risk of HIV disease progression and mortality. Quality of life is enhanced via the restoration and maintenance of immune function through the efficient administration of antiretroviral treatment (ART). Nevertheless, ART has the potential to favorably or adversely affect haematological parameters. The purpose of this study was to compare the effects of various ART regimens on immunohaematological parameters abnormalities in adult patients living with HIV.

Methods: This cross-sectional study enrolled 237 participants, between July 2022 to December 2023 at Thika Level Five Hospital's Comprehensive Care Centre (CCC) in Kiambu County, Kenya. Total blood count and the CD4+ T cells count were measured using standard laboratory procedures. Sociodemographic data, clinical characteristics and type of ART regimens were collected by use of a structured questionnaire and review of patient medical records.

Results: The mean levels of PLT, ALC, HB, MCV, MCH, PCV, of ART – treated was significantly higher compared with those of ART – naïve (p <0.05). However, the mean levels of CD4 count showed no statistically significant difference between ART-treated and ART-naïve individuals (p=0.5045). TDF/3TC/DTG regimen was associated with higher lymphopenia rates ((50.00 %, p = 0.0252) while AZT/3TC/ATV/r was associated with high rates of macrocytosis (35.29%, p<0.0001). Hypochromia was significantly higher in those on TDF/3TC/DTG (94.12%, p=0.0268). Elevated RDW was more frequent in patients on TDF/3TC/DTG (60.00%, p=0.0044).

Conclusion: PLT, ALC, HB, MCV, MCH, PCV, of ART – treated were significantly higher compared with those of ART – naïve. TDF/3TC/DTG regimen significantly influenced lymphopenia while AZT/3TC/ATV/r was associated with high rates of macrocytosis. Regular monitoring and treatment of HIV- infected patients on ART for haematological and immunological abnormalities is vital in order to reduce HIV- related morbidities. Clinicians should consider ART –associated adverse effects when selecting ART regimens.

Evaluation of Antimicrobial Resistance Patterns of Bacteria Isolates From Chronic Wounds of Patients Attending Murang’a Level 5 Hospital, Kenya

Magdaline Wairimu Kamande — 2024-07-16

Background: Chronic wounds pose a serious public health risk. Therapy of chronic wound infections is significantly hampered by the unchecked and rapid spread of bacterial pathogens. In Kenya there is a scarcity of the statistics on antimicrobial sensitivity and resistance of bacteria isolated from chronic wound infections. This study has determined the colonizing bacteria of chronic wounds and their antibacterial resistance pattern to most used antibiotics. Risk factors associated with chronic wounds was also evaluated. This analysis was carried out in Murang’a Level 5 Hospital which is located in rural area of Central region in Kenya.

Methods: It was a hospital-based cross-sectional study. Swabs were aseptically picked from chronic wounds and transported in Amies transport media in a cooler box to Microbiology laboratory. Inoculation was done on SBA and MAC and incubated at 37⁰c for 24 to 48 hours. Gram stain followed for the provisional isolate’s identification. The isolated microorganisms were evaluated for drug sensitivity and resistance using Kirby Bauer disk diffusion method on Mueller Hinton Agar.

Results: The positivity rate was 81.3%. Staphylococcus aureus lead at 29.7%, Pseudomonas aeruginosa 16.3% and E. coli 15.2%. Levofloxacin was the most sensitive antibiotic to S. aureus, doxycycline and gentamicin followed closely. All Gram-negative bacteria in this study demonstrated high susceptibility to meropenem, piperacillin/tazobactam, gentamicin, imipenem, cefepime and ciprofloxacin in that order. They all showed resistance to ceftriaxone, Augmentin, co-trimoxazole and ampicillin. 22.6% of all Staphylococcus aureus isolated were methicillin resistance (MRSA) strains. 5.95% were induced clindamycin resistance (ICR) strains. 2.38% had both MRSA and ICR strains. In all Enterobacteriaceae isolated, 19 (16.23%) are Extended spectrum beta-lactamase (ESBL) producing strains. E. coli accounted for 10 ESBL strains while the rest 9 ESBLs were from Klebsiella pneumoniae.

Conclusion: Frequent monitoring of antimicrobial susceptibility pattern is necessary to curb the spread of antibacterial resistance.

Assessment of Exclusive Breastfeeding Practice and Associated Factors Among Lactating Mothers In Waberi Location, Garissa County

Adan Mohamud — 2024-10-26

Background: The importance of breastfeeding and infant nutrition has been acknowledged by the Kenyan government during the last ten years. Breastfeeding is acknowledged as the most natural way to nourish a baby. It's critical for moms to comprehend the variables influencing exclusive breastfeeding in order to be able to breastfeed for the full six months as advised. The main of the study was to assess exclusive breastfeeding practice and associated factors among lactating mothers in the Waberi location, Garissa County.

Material and Methods: This study used an analytical cross-sectional approach. The Fischer exact formula was utilized to generate 124 study respondents for this study. Multistage sampling was employed in this study to recruit study respondents. The chi-square test was used for bivariate analysis, and binary logistic regression was used for multivariate analysis. The cutoff for statistical significance was p≤0.05.

Results: More than a quarter(43.5%) of the study respondents reported practicing exclusive breastfeeding. From this study. being employed(OR=5.6,95%CI=0.07-0.41), the presence of social support(OR=2.8,95%CI=0.17-0.77), having a smaller family size(OR=2.5,95%CI=0.11-1.41), lactating mothers who sought ANC attendance(OR=2.3,95%CI=0.18-1.05), and having a secondary level of education(OR=3.5,95%CI=0.72-8.33) increased the odds of practicing exclusive breastfeeding while the presence of harmful cultural practices(OR=3.2,95%CI=1.46-6.86) reduced the odds of practicing exclusive breastfeeding.

Conclusion: From this study, poor exclusive breastfeeding practices was noted. In addition, being employed, the presence of social support, having a smaller family size, lactating mothers who sought ANC attendance, and having a secondary level of education increased the odds of practicing exclusive breastfeeding while the presence of harmful cultural practices reduced the odds of practicing exclusive breastfeeding.