School of Public Health, Biomedical Sciences and Technology

LABORATORY REFERENCE INTERVALS FOR ROUTINELY ANALYZED IRON PROFILE PARAMETERS IN ADULT POPULATION AGED 18-64 YEARS, IN UASIN GISHU COUNTY, KENYA

2024-10-01T00:00:00Z

LABORATORY REFERENCE INTERVALS FOR ROUTINELY ANALYZED IRON PROFILE PARAMETERS IN ADULT POPULATION AGED 18-64 YEARS, IN UASIN GISHU COUNTY, KENYA MUTUNGA, KASIMU WILLINGTON Reference intervals are regarded as golden tools used to guide clinicians to correctly diagnose and monitor diseases, assess patients' responses to therapy, and forecast any probable risk factors. However, reference intervals vary largely across different populations due to multiple factors. To address these issues, the Clinical Laboratory Standards Institute (CLSI) advocates for the use of locally established and verified RIs. The literature on iron profile RIs for adults in Kenya remains scanty, and no known publications or research has been done for the Uasin Gishu population. The interpretation of these results is currently based on the manufacturer’s provided RIs, derived from other regions. This study was aimed at establishing and verifying normal reference intervals for four routinely analyzed iron profile parameters for the adults in Uasin Gishu County, Kenya. The study was a cross-sectional population study and was carried out at Moi Teaching and Referral Hospital, with 290 healthy participants enrolled for the study using the multi-stage sampling technique. Using a fully automated clinical chemistry and immunochemistry analyzer (Cobas 6000 series), the levels of iron and unsaturated iron binding capacity were analyzed using the ferrozine method, while ferritin and transferrin were analyzed based on the immunoturbidimetric method. Reference values were determined by using the non-parametric method at a confidence interval of 95%, this entailed computing the 2.5th and 97.5th percentiles as the lower and upper limits, respectively. Sigma diagnostics method was used for the verification of the established reference intervals. Statistical analysis was performed using IBM SPSS version 23.0. The established reference intervals were as follows: Ferritin: males: 28.41–425.60 ng/mL, females: 11.15–155.87 ng/mL; Iron: males: 8.27–32.02 umol/L, females: 5.21–25.45 umol/L; Transferrin: males: 2.13–4.01 g/L, females, 2.08–4.04 g/L; UIBC: males, 20.50–64.08 umol/L, females: 20.07–64.21 umol/L. Comparisons between genders for significant differences were done using Mann-Whitney U tests, revealing statistically significant differences in ferritin and iron levels with p=<0.001. Conversely, transferrin and UIBC exhibited no significant gender-based differences with p values of 0.829 and 1.00 respectively. Notably, the manufacturer's given RIs were verified, with the majority aligning with the established RIs except for iron values in women. Despite this, the RIs showed a broader interval spread between the upper and lower limits, which is clinically significant. In conclusion, the established reference intervals are sex, and age specific for the adult population in Uasin Gishu County, Kenya. These intervals are crucial for accurate clinical diagnosis and effective patient management.

PREVALENCE AND DETERMINANTS OF HIV PRE EXPOSURE AND POST EXPOSURE PROPHYLAXIS USE AMONG YOUNG ADULTS IN KHWISERO SUBCOUNTY, KENYA

2024-11-01T00:00:00Z

PREVALENCE AND DETERMINANTS OF HIV PRE EXPOSURE AND POST EXPOSURE PROPHYLAXIS USE AMONG YOUNG ADULTS IN KHWISERO SUBCOUNTY, KENYA ABDALLAH, ABUBAKAR GURRE HIV/AIDS remains a major global public health threat despite the emergence of biomedical prevention strategies such as HIV Pre Exposure Prophylaxis and Post Exposure Prophylaxis. Despite their efficacy, utilization rates are low among youths aged 15-24, who account for approximately 27% of new infections globally and 33% in Kenya. While the determinants of HIV Pre Exposure Prophylaxis and Post Exposure Prophylaxis usage have been documented among men who have sex with men, female sex workers, adolescent girls, and women, there are limited studies focusing on young adults, a high-risk population for HIV infection. This study aimed to address this gap by focusing specifically on young adults aged 18-24 in Khwisero sub-county, Kenya. The study investigated the prevalence and determinants of HIV Pre Exposure Prophylaxis and Post Exposure Prophylaxis use among young adults, with specific objectives including the determination of uptake prevalence and the exploration of demographic, health system, and socio-cultural determinants. Guided by the Health Belief Model, a cross-sectional design was adopted. The target population comprised young adults aged 18-24, with a sample size of 426 respondents determined using the Yamane formula. Two wards in Khwisero Sub-County were selected using simple random sampling, and systematic sampling was employed to select young adults from community units within these wards. Quantitative data were collected via a semi-structured questionnaire, while qualitative data were obtained through Key Informant Interviews. The Statistical Package for Social Sciences version 26 was used to analyze quantitative data through descriptive and inferential statistics, including chi-square and logistic regression at a significance level of 0.05. Thematic analysis was employed for qualitative data, and findings were presented in tables, figures, narratives, and direct quotes. The study revealed low prevalence of Pre Exposure Prophylaxis (23.4%) and Post Exposure Prophylaxis (22.6%) utilization. Significant determinants of Pre Exposure Prophylaxis use included education level (χ2=8.1, OR=0.21, P=0.04), religion (χ2=5.0, OR=0.40, P=0.03), affordability (χ2=9.74, AOR=1.89, P=0.002), provider-initiated counseling (χ2=17.09, AOR=2.69, P<0.001), and stigma (AOR=0.37, P=0.002). Factors affecting Post Exposure Prophylaxis utilization encompassed education level (χ2=17.76, OR=0.43, P<0.001), marital status (χ2=6.47, OR=0.33, P=0.04), living arrangement (χ2=9.91, OR=1.95, P<0.001), and provider-initiated counseling (χ2=5.71, AOR=1.49, P=0.02). Qualitative data highlighted additional factors such as adherence support and cultural beliefs. These results highlight the urgent need for targeted interventions to enhance Pre Exposure Prophylaxis and Post Exposure Prophylaxis utilization among young adults. By addressing the identified barriers and leveraging facilitators, policymakers can formulate strategies and interventions to strengthen uptake, ultimately reducing new HIV infections among young adults.

NUTRITION STATUS OUTCOMES OF ESOPHAGEAL, HEAD AND NECK CANCER PATIENTS UTILIZING GASTROSTOMY TUBE AT KENYATTA NATIONAL HOSPITAL, NAIROBI, KENYA

2024-07-01T00:00:00Z

NUTRITION STATUS OUTCOMES OF ESOPHAGEAL, HEAD AND NECK CANCER PATIENTS UTILIZING GASTROSTOMY TUBE AT KENYATTA NATIONAL HOSPITAL, NAIROBI, KENYA Kasimu, Elizabeth Ndunge Esophageal, head, and neck cancers present significant challenges in maintaining adequate nutrition due to the anatomical and functional impairments associated with these malignancies and their treatments. The aim of the study was to determine the nutrition status outcomes of esophageal, head and neck outpatients utilizing gastrostomy tubes at Kenyatta National Hospital. The study design was descriptive institutional-based cross-sectional with an analytical component and was carried out between October 2023 to March 2024 with a sample size of 103 outpatients. The study employed a purposive sampling with criterion technique. Nutrition data was collected using Patient Generated-Subjective Global Assessment tool (PG-SGA), with caloric intake from 24-hour recall. Socio-demographics, anthropometrics, biochemical parameters, and subcutaneous fat were recorded via a questionnaire. Statistical Package for Social Sciences version 25.0 was used for data analysis at 0.05 significance level. The Socio-demographic analysis revealed that Central region had the highest number of patients 54.4% (n=56) having esophageal, head and neck cancers. Gender distribution was 61.2% male and 38.8% female, with a mean age of 56.2 years. Majority (81.6%) of patients consumed less than 500 Kcal/day, below the European Society for Parenteral and Enteral Nutrition recommendations of 25-30 Kcal/kg/day for cancer patients, thus indicating a high risk of undernutrition. Protein intake was suboptimal, with 58.1% not meeting the minimum recommendations of 0.8 g/kg body weight. Malnutrition assessment revealed varying degrees of nutritional deficits among patients, with a significant association found between energy intake and nutritional status (p=0.047). The average Body Mass Index (BMI) was 18.03±3.39 kg/m2, with 56.3% underweight, 40.8% normal, and 2.9% overweight. In terms of muscle status, 31.1% had no abnormalities, 23.3% had mild, 22.3% moderate, and 23.3% had severe muscle wasting. According to PG-SGA, 34.0% had normal nutritional status, 45.6% mild and 20.4% were severely malnourished. Independent sample t-test was conducted to compare the mean BMI between patients consuming a modified diet and those consuming a normal diet. There was a significant difference in BMI scores between the two groups where the mean BMI for the modified diet group was 16.1 kg/m² (SD = 1.68), and for the normal diet group was 20.7 kg/m² (SD = 2.10). This difference was statistically significant, t (101) = 8.95, p<0.001, indicating that patients on a modified diet had a significantly lower BMI compared to those on a normal diet. Furthermore, a Pearson correlation coefficient was computed to assess the relationship between food modification and BMI. The analysis revealed a strong, positive significant relationship, r (101) = 0.694, p<0.001. PG-SGA indicated varied levels of malnutrition, highlighting the need for tailored nutritional interventions in cancer care. The findings show the need for establishing a multidisciplinary nutritional support and monitoring programs specifically tailored for esophageal, head, and neck cancer patients utilizing gastrostomy tubes. This will be crucial in improving the nutritional status, treatment outcomes, and overall quality of life for the patients, thereby addressing the critical issue of malnutrition among this vulnerable population.

KNOWLEDGE, ATTITUDE AND FACTORS INFLUENCING THE UPTAKE OF MYOPIA CONTROL STRATEGIES AMONG TEENAGERS AND EYECARE PRACTITIONERS IN LURAMBI CONSTITUENCY, KENYA.

2024-09-01T00:00:00Z

KNOWLEDGE, ATTITUDE AND FACTORS INFLUENCING THE UPTAKE OF MYOPIA CONTROL STRATEGIES AMONG TEENAGERS AND EYECARE PRACTITIONERS IN LURAMBI CONSTITUENCY, KENYA. Sarai, Delilah Nangoi The global rise in myopia has emerged as a significant public health issue, with 27% of the world population affected by 2020, and projections indicate that by 2050, nearly half of the global population will be myopic. Despite the increasing prevalence and the availability of effective myopia control strategies such as combination treatments, children with progressive myopia are often still prescribed single vision (SV) spectacles, which offer minimal to no control over myopia progression. This study aimed to evaluate the knowledge, attitude, and factors influencing the uptake of myopia control strategies among teenagers and Eye Care Practitioners (ECPs) in Lurambi Constituency, Kenya. An analytical cross-sectional design was employed, with 115 myopic teenagers and 22 ECPs purposively selected from 12 eye clinics in Lurambi Constituency participating. Teenagers completed a questionnaire assessing their knowledge, attitudes, and factors affecting the adoption of myopia control strategies, while ECPs responded to a questionnaire on their strategies and attitudes toward myopia management. The uptake of myopia control strategies among teenagers was 55.7%, with SV spectacles being the most commonly used at 70.3%, while none had used Ortho-K. Among ECPs, 86.36% had adopted effective myopia control strategies, with 84.2% prescribing SV spectacles, and Ortho-K was not prescribed. Knowledge of myopia control strategies was reported by 69.8% of teenagers and 100%of ECPs, with a significant relationship observed between knowledge and the uptake of myopia control strategies among teenagers (p-value <0.001). Good attitudes toward myopia control were reported by 48.3% of teenagers and 95.45% of ECPs. Cost emerged as the most influential factor in the uptake of myopia control strategies, affecting 79.7% of teenagers and 54.5% of ECPs. Increased cost was associated with a decreased likelihood of adopting myopia control strategies among teenagers, with an odds ratio of1.367 (95% CI [1.013-1.845]). Additionally, refractive error significantly influenced the uptake of myopia control strategies, with a p-value of 0.010 for teenagers and 0.031 for ECPs. The criteria for selecting an initial myopia control strategy in young myopes showed significant relationships with binocular vision status and other unspecified factors (p-values of 0.002 and 0.010, respectively). In conclusion, despite high levels of knowledge and positive attitudes toward myopia control strategies among both teenagers and ECPs, the actual uptake of effective myopia control strategies remains relatively low. The study found a significant relationship between knowledge and the uptake of myopia control strategies among teenagers (p-value ≤0.001) and identified cost as a critical barrier, decreasing the likelihood of adopting these strategies. Given these findings, the Ministry of Health of Kenya (Ophthalmic Division) is advised to develop a pediatric management guideline to support the utilization of myopia control strategies by ECPs in Kenya.