Theses and Dissertations

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

Tue, 01 Oct 2024 00:00:00 GMT

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.

RELATIONSHIP MARKETING AND CUSTOMER LOYALTY AMONG DEPOSIT-TAKING SACCOS IN WESTERN KENYA

Sat, 01 Jun 2024 00:00:00 GMT

RELATIONSHIP MARKETING AND CUSTOMER LOYALTY AMONG DEPOSIT-TAKING SACCOS IN WESTERN KENYA Akinyi, Vivienne

RELATIONSHIP MARKETING AND CUSTOMER LOYALTY AMONG DEPOSIT-TAKING SACCOS IN WESTERN KENYA

Sat, 01 Jun 2024 00:00:00 GMT

RELATIONSHIP MARKETING AND CUSTOMER LOYALTY AMONG DEPOSIT-TAKING SACCOS IN WESTERN KENYA Akinyi, Vivienne

UTILIZATION OF HIV/AIDS CLINICAL CARE AND SUPPORT SERVICES AMONG HIV-INFECTED ADULTS IN BARINGO COUNTY, KENYA

Tue, 01 Aug 2023 00:00:00 GMT

UTILIZATION OF HIV/AIDS CLINICAL CARE AND SUPPORT SERVICES AMONG HIV-INFECTED ADULTS IN BARINGO COUNTY, KENYA Otara, Danvas Nyachio The burden of HIV/AIDS in Baringo County is highest among Adults (>18 years), with over 40% of hospital beds occupied by HIV-related illnesses. Despite the majority of HIV/AIDS clients being enrolled in care programs, care interruptions (dropouts) and loss of follow-up remain major challenges with unclear reasons for defaulting. Therefore, this study aimed to investigate HIV/AIDS care and support service utilization among HIV infected adults in Baringo County, examining the relationship between client uptake, attitudes, accessibility and utilization of services. It also examined the impact of stigma and discrimination on service utilization. The study was conducted in Baringo County among HIV-infected adults enrolled in Comprehensive care centers using an analytical cross-sectional study design. A total of 580 study participants were randomly recruited u ng Fisher et al.'s (1998) formula from four purposefully selected sub-counties. Besides, an interviewer-administered questionnaire was used to collect data. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 27 with Inferential statistics (Univariate and bivariate) analyses conducted at a p = 0.05 significance level. Whereas, qualitative data was transcribed and analyzed thematically. Ethical clearance was sought from the Institutional Scientific and Ethics Review Committee at Masinde Muliro University (Ref No: MMU/COR: 403012 Vol 6 (01), the National Commission for Science, Technology and Innovation (NACOSTI) (Ref No: 963149), the Baringo County Government Department of Health (REF: BCG/HS/RES/01/VOL.1/07), and informed consent from participants. A total of 519 (89.5%) out of a sample size of 580 took part in the study. The Study found 50.7% HIV care uptake, with 80% deterred by a lack of knowledge and high transportation costs (72.3%). The majority of participants (90.6%) had positive attitudes towards HIV care and support services, but utilization was unfavorable due to low knowledge of available services (p = 0.001), fear of ARV drug use when the spouse is watching (p< 0.0001), and long distances to clinics (p 0.0001). Besides, statistically significant factors affecting the accessibility of clinic services were difficulty obtaining services (p < 0.0001), and long distance to clinics (p 0.0001), with clients unlikely to use them. HIV-related stigma and discrimination were found to negatively impact participants' utilization of services, with participants feeling ashamed to attend clinics (p<0.0001) and others judging them when seen attending clinics (p<0.0001), leading to low utilization rates with higher odds found in each case. In conclusion, the study found 50.7% of HIV-infected adults in Baringo County consistently utilize HIV care and support services, with higher education, community support services, counseling, and family support promoting utilization of services. However, factors like low socioeconomic status, long distances, high travel costs, and poor medication perception were associated with poor attitudes towards utilisation of services. Additionally, location optimization and clinic opening on holidays and weekends improve accessibility. Whereas, PLHIV were found to internalize the stigma and bigotry they face, contributing to a negative self-image and lower levels of utilization. The study recommends to the MOH increase HIV/AIDS care utilization through decentralization of services to the community or low-tier facilities, stigma reduction, integration of HIV care with other services, and scaling up services in under-resourced areas.