Background: Hypertension (HTN) is a global public health problem, requiring a holistic management approach of drug therapy and lifestyle modifications to achieve better treatment outcomes. The study aimed to assess the current management practices amongst healthcare professionals (HCPs) managing patients with hypertension (HTN) in Malawi’s Blantyre district. Methods: A quantitative cross-sectional design using a self-administered questionnaire with sections for socio-demographics, statements about management practices, and HCPs' habits in promoting lifestyle modification was used. Data was analysed using STATA version 14.2. Descriptive statistics were employed, and socio-demographic characteristics are presented using frequencies and percentages. The associations between categorical variables were tested using the Chi-square test at an alpha level of 0.05. Results: Sixty-seven HCPs, 37 females (55.2%) and 30 males (44.8%) participated in the study, with the majority (n = 42 [62.7%]) aged between 25- 34, with a statistically significant relationship between gender and the profession (p=0.012). Nearly half (n=33 [49.3%]) had a diploma. Almost 50% (n = 32) had less than 5 years of work experience. Most (n=46 [69.7%]) reported challenges in diagnosing HTN, and a lack of treatment guidelines (n=36 [59%]). Dietary counselling was provided by 90.8% (n = 59) of the HCPs. Conclusion: Healthcare professionals reported several challenges in the management of hypertension in Malawi’s Blantyre district, including a lack of treatment guidelines, inconsistencies in implementing lifestyle change strategies and knowledge gaps in the management of HTN. Clinical implications: There is a need to equip healthcare professionals involved in HTN management with knowledge about the disease and the importance of lifestyle modification strategies. Also, the HTN-specific treatment guidelines should be available in all health facilities in the district.
Background: Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) remain major public health challenges globally, contributing substantially to morbidity and mortality. The disease ranks sixth among the leading causes of illness and death in developing countries and third in Kenya. The burden of HIV/AIDS remains relatively high among high-risk groups, such as fisherfolk. This study aimed to determine the epidemiology of HIV/AIDS among the fishing community along the shores of Lake Victoria. Methodology: This cross-sectional study enrolled 349 consenting members of the fisherfolk community, including boat crews, boat owners, fishmongers, and fish processors, along the beaches of Lake Victoria in Bondo, Siaya County, from 2023 to 2024. Blood samples were collected, and a detailed sociodemographic questionnaire was administered. HIV positivity was confirmed through polymerase chain reaction (PCR) amplification. Descriptive statistics characterised the population, while logistic regression analysis identified factors associated with HIV infection using STATA. The significance level was set at p ≤ 0.05. Results: Out of the 349 fisherfolk recruited, most, 165 (46.3%), were boat crew, and 41 (11.5%) had completed secondary education. Overall, 108 (71%) were male, and 247 (69.4%) were married. Notably, 152 (43.6%, n = 349) tested positive for HIV. In multivariate analysis, fisherfolk not living with their sexual partner (aOR 0.33; 95% CI 0.12–0.88, p = 0.029) and those on ARV (aOR 0.36; 95% CI 0.13–0.96, p < 0.045) were less likely to test positive for HIV. Conclusions and recommendations: A large portion of the population in the fishing industry continues to test positive for HIV, indicating a high-risk group for infection. Living conditions and early ARV treatment are crucial in driving HIV infection rates among fisherfolk near Lake Victoria in Bonda.
Background: Globally, 59% of women deliver at home, predominantly in rural sub-Saharan Africa, compared to a 61% global rate for skilled birth attendance. In Kilifi County, Kenya, 85% of births are attended by skilled professionals, below the national average of 89%. The study aimed to explore predictors of unskilled birth attendance among women in Kilifi North and South Sub-counties, Kenya. Methods: A cross-sectional study was conducted among 372 women aged 18 to 49 years. Participants were eligible if they were either pregnant at the time of the interview or had previously given birth, regardless of whether the delivery was attended by a skilled or unskilled birth attendant. The data obtained was analysed using STATA version 14, where Logistic regression analysis was conducted to identify predictors of unskilled birth attendance. Results: Of the 372 women interviewed, 76 (20.4 %) reported delivering under unskilled birth attendance. The predictors of unskilled birth attendance included older maternal age (35+ years) [AOR=2.21; 95% CI: 1.19–4.16; p=0.013], higher gravidity (≥4 pregnancies) [AOR=4.27; 95% CI: 2.22–8.60; p<0.001], and being widowed or single [AOR=2.26; 95% CI: 1.19–4.30; p=0.013]. Experiencing danger signs during pregnancy was associated with reduced odds of unskilled birth attendance [AOR=0.54; 95% CI: 0.31–0.96; p=0.036]. Education level showed a protective association in unadjusted models, with tertiary education yielding the lowest odds. Conclusions: Age, income, education, and healthcare access barriers significantly hinder women's use of skilled birth attendants. Cultural practices, traditional preferences, and societal perceptions also impact childbirth decisions. Distant travel to health facilities hinders timely access, particularly in emergencies. Additionally, maternal knowledge, driven by education and awareness, plays a crucial role in reducing risks for mothers and newborns. Recommendations: To improve uptake of skilled birth attendance, targeted community education and culturally sensitive outreach should be explored, especially for older and high-parity women. Strengthening healthcare infrastructure, engaging traditional birth attendants in referrals, deploying mobile clinics, and increasing male involvement in maternal health are critical steps toward addressing access barriers and changing community perceptions.
Background: COVID-19 was a novel infection whose outcomes were not well established to be associated with any factors during the start of the pandemic that it caused globally. This research explored the relationship between clinical laboratory tests and mortality among patients hospitalized with a positive COVID-19 test at a tertiary hospital in Kiambu County, Kenya. Methods: A retrospective analytical cross-sectional study was conducted among 154 COVID-19– positive patients admitted to a private tertiary hospital in Kiambu County, Kenya, to identify laboratory tests associated with mortality. Data was analysed using SPSS version 24, with descriptive statistics summarizing clinical and outcome variables. Binary logistic regression assessed associations between laboratory parameters and mortality, while significant factors were included in multivariate models to control confounders. Kaplan–Meier analysis evaluated time to death and discharge, with statistical significance set at p < 0.05. Results: The mean age of patients admitted with a diagnosis of COVID-19 was 54.43(SD±17.1) years (54.43 years). Almost two-thirds of patients had comorbidities (n=93; 60.4%). In-hospital death was reported for 23.4% (n=36) of the investigated patients, and 76.6% (n=118) were discharged alive. Logistic regression revealed that the clinical laboratory parameter that predicted mortality was elevated C-reactive protein (adjusted odds ratio 1.067; 95% CI: 1.014–1.123; p=0.013). Conclusion: Elevated C-reactive protein levels were identified as a significant predictor of mortality among hospitalised COVID-19 patients, highlighting the prognostic value of inflammatory markers in disease outcomes. Despite this, the majority of patients recovered and were discharged alive, suggesting generally favourable clinical outcomes in this setting.
Background: Globally, Human immunodeficiency virus (HIV) is a leading cause of morbidity and mortality. The fundamental Antiretroviral Therapy (ART) goal is to curb the spread of HIV and enhance the survival of HIV infected patients. Despite the tremendous benefits of ART, HIV treatment and management failures among the youth have been attributed to non-adherence to drug regimens and viral mutations leading to the emergence of drug resistance. Therefore, this study aimed to determine the genetic diversity and HIV-1 drug resistance patterns among the youth aged 15-24 years with non-suppressed viral load in the South Rift Valley Region (SRV), Kenya. Methods: A cross-sectional study design was adopted to select a total of 120 plasma samples from HIV-1-positive youth who had been on different ART regimens for over six months. Remnant plasma samples with >1000 copies/ml from real-time PCR using the Abbott Real-Time HIV-1 m2000rt quantitative kit were sequenced using the HIV-1 genotyping kit with integrase between April 2024 and October 2024. The target genes were Reverse Transcriptase, Protease and Integrase of the pol gene. HIV-1 level of drug resistance was evaluated using the Exatype Sanger analysis tool. Mutation patterns were ascertained by analysing FASTA files using the drug resistance HIV Stanford database. The subtypes of HIV-1 were analysed by the REGA HIV subtyping tool, and Maximum-likelihood phylogenetic trees and annotations of the mutations were constructed using the integrated Tree of Life. Results: Sequencing was completed for 99 samples, and Tenofovir Disoproxil Fumarate + Lamivudine + Dolutegravir (TDF/3TC/DTG) was the most commonly prescribed antiretroviral regimen across all age groups. The predominant HIV subtype was A1 (83%). Drug resistance was attributed to mutation, M184V (31.4%) associated with resistance to Emtricitabine and Lamivudine, K103N (20.9%) and G190A (15.1%) resistance to efavirenz, nevirapine and rilpivirine, G118R (5.7%) to raltegravir, elvitegravir and bictegravir. Conclusion: There was high genetic diversity of HIV-1 among the youths aged between 15 and 24 years, and subtype A1 is the dominant circulating form of HIV-1 in the South Rift Valley region. Understanding the evolutionary relationships of these strains provides insights into their genetic diversity and transmission.
Background: Air traffic management (ATM) is vital for maintaining a safe and efficient aviation system. It requires seamless coordination of air traffic controllers (ATCOs), equipment, and procedures. ATCOs must make split-second decisions under pressure, exposing them to occupational safety and health (OSH) risks stemming from inadequately designed work environments. Existing studies prioritise the role of controllers in ensuring flight safety, with less attention given to their own well-being. Thus, this study aimed to examine workplace factors, including lighting, noise, sanitation, emergency exits, and equipment condition, that influence the health of Kenyan ATCOs. Methodology: A quantitative descriptive study was conducted among 64 ATCOs sampled from a target population of 172 at seven purposively selected airports in Kenya. Participants were selected using proportionate stratified random sampling. Data were collected via structured questionnaires and analysed using descriptive and inferential statistics in SPSS. Results: The study found high prevalence of health issues: headaches (77%), back pain (68.8%), and work-related stress (47.6%). Respondents reported environmental concerns, including inadequate lighting, screen glare, and poor access to workplace amenities. Station preference was linked to perceived stress, with 85.7% of those experiencing stress resorting to self-medication. Chi-square analysis showed significant associations between equipment unserviceability and stress (χ² = 6.24, p < 0.05), stress and help-seeking behaviour (χ² = 23.3, p < 0.001), and back pain and posture deterioration (χ² = 28.96, p < 0.001), leading to rejection of all null hypotheses. Conclusion: This study reveals critical OSH issues affecting ATCOs in Kenya, primarily driven by suboptimal work environments. Key concerns include inadequate lighting, excessive screen glare, unreliable equipment, and insufficient workplace amenities. Significant associations between equipment unserviceability, stress, reluctance to seek help, and posture-related back pain during high traffic periods highlight both technical and behavioural OSH gaps. Recommendations: The study recommends improving lighting, maintaining equipment regularly, and enhancing cleanliness to ensure a safer, healthier work environment for ATCOs.
Background: Drug-resistant tuberculosis (DR-TB) is associated with a significant health burden and poses a major impediment to TB eradication. In Kenya, the COVID-19 pandemic disrupted healthcare services between March 2020 and February 2022. Consequently, the burden of DR-TB was projected to worsen. Despite these concerns, the impact of the pandemic on its trends remains unexplored. We conducted a quasi-experimental study to compare epidemiological trends of DR-TB before, during, and after the COVID-19 pandemic, and to identify associated risk factors in Nairobi County. Methodology: A quasi-experimental design utilising single-group interrupted time series (ITSA) was employed to assess the impact of COVID-19–related health system disruptions on DR-TB trends in Nairobi County. Laboratory-confirmed DR-TB data were retrieved from the TIBULIMS database and stratified by diagnosis period: pre-pandemic (March 2018–February 2020), intra-pandemic (March 2020–February 2022), and post-pandemic (March 2022– February 2024). Analyses were performed in STATA version 15. Results: A total of 616 DR-TB patient records were analysed. Overall, DR-TB cases rose slightly by 2.82%, from 213 pre-COVID-19 to 219 intra-COVID-19, and then declined significantly by 15.98% to 184 post-COVID-19 (p < 0.001). Cases were over twice as common among males. HIV infection was significantly associated with RR-TB (43.55%; n = 248, p < 0.0001) and monoresistant TB (21.02%; n = 214, p < 0.0001). ITSA showed significant COVID-19-related level changes in RR-TB, with an upsurge trend at the onset of the pandemic (+5.96 cases per quarter, p = 0.006), followed by a non-significant decline intra-pandemic, and a subsequent moderate increase post-pandemic (+2.56 cases per quarter, p = 0.022). Level changes observed in MDR-TB and MR-TB trends were not attributable to the pandemic (p = 0.094 and p = 0.0799, respectively). Conclusion: The study revealed fluctuations in MDR-TB, RR-TB, and MR-TB trends during the period. COVID-19-related health disruptions caused significant level changes in RR-TB trends. These findings highlight the importance of sustaining DR-TB diagnostic and treatment services to safeguard progress in TB control even during future public health crises.
Background: Maternal health, encompassing pregnancy, childbirth, and the postpartum, is a key indicator of public health but remains a challenge in low- and middle-income countries due to limited skilled care, poor nutrition, and low service uptake. Maternal health services can reach many women, yet limited studies exist on the impact of digitisation on maternal health outcomes. This study assessed the utilisation of an electronic community health information system (eCHIS) in enhancing the adoption of maternal health services in Muhoroni Sub-County, Kisumu County, Kenya. Methodology: This study utilised a cross-sectional descriptive design, using a structured questionnaire to collect quantitative data from 398 lactating mothers with children younger than six months. Participants were selected by simple random sampling from a sampling frame drawn from eCHIS data across villages in Muhoroni Sub-County. Analysis was performed using SPSS, with linear regression applied to examine variable relationships. Results: eCHIS use showed a positive, significant relationship with maternal health service adoption (p = 0.001). The R² of 0.656 indicated eCHIS explained 65.6% of the variation, with the remaining 34.4% variance linked to confounders such as cultural beliefs, spousal support, accessibility, and power outages. The Smart Health App, used by Community Health Promoters (CHPs), improved service access and utilisation by 18.4%. Conclusion: The findings highlighted eCHIS as a transformative tool in improving maternal health outcomes, particularly in marginalised areas. The adoption of eCHIS by CHPs represents a critical step in Kenya's efforts to reduce maternal complications and advance maternal health equity. Recommendation: The study recommended that the Department of Health strengthen monitoring of eCHIS to improve maternal health service delivery, implement educational programs to raise community awareness and informed decision-making, and enhance health facility services to encourage care-seeking and meet the rising demand created by eCHIS.
Background: Bacterial vaginosis (BV) is one of the most common Lower genital tract infections among women of reproductive age, resulting from the imbalanced microbiota of the vaginal ecosystem. BV is a common vaginal infection caused by disruption of the normal vaginal microbiota. Despite its high burden in sub-Saharan Africa, bacterial vaginosis (BV) remains underdiagnosed, yet it is associated with adverse pregnancy outcomes and an increased risk of acquiring sexually transmitted infections, including HIV. Therefore, this study was undertaken to determine the burden and predictors of BV among women of reproductive age in Western Kenya. Methods: This cross-sectional study, conducted between January and December 2024, enrolled 227 consenting non-pregnant women of reproductive age (18-49 years) at Kakamega County General Teaching and Referral Hospital (KCGTRH), Western Kenya. Vaginal swabs were collected, and an associated demographic questionnaire was administered. BV was diagnosed using Nugent's scoring system. Descriptive statistics were used to characterise the population, while logistic regression analysis was used to determine factors associated with BV infection using STATA v 13 (StataCorp LP, Texas, USA). The significance level was established at p ≤ 0.05. Results: A total of 129/227 (64.5%) women exhibited abnormal vaginal flora with a Nugent score (NS) of 4–10, while 78 (39%) were diagnosed with BV (NS 7–10). Four (2%) women had Trichomonas vaginalis, and 19 (9.5%) had a yeast infection. Women whose partners used condoms during sexual intercourse (adjusted odds ratio - aOR 0.6; 95% confidence interval - CI 0.4 – 0.8) were less likely to be infected with BV. Women aged 26 to 30 years (aOR 2.0; 95% CI 1.0 – 4.2), experiencing lower abdominal pain (aOR 1.7; 95% CI 1.1 – 2.9), with milky vaginal discharge (aOR 1.5; 95% CI 1.0 – 2.6), and those with yeast infection (aOR 2.0; 95% CI 1.03 – 4.1) were associated with BV infection. Conclusions: This study highlights a high burden of BV among women of reproductive age in Western Kenya. Risk factors include age, lower abdominal pain, vaginal discharge, and co-infection with yeast, while condom use was protective. These findings underscore the need for improved screening, health education, and targeted interventions to reduce the impact of BV and associated reproductive health risks.
Background: Cervical cancer is a major cause of mortality among women living with HIV worldwide, especially among adolescent girls and young women (AGYW), who face a sixfold increased risk of Human Papillomavirus (HPV) infection with lower clearance rates compared to their HIV-negative peers. Despite the Ministry of Health recommendations for annual cervical cancer screening, only 23% of AGYW living with HIV in Uasin Gishu County have been screened. Identifying the client-level, healthcare worker, and service delivery factors that influence the uptake of cervical cancer screening could uncover barriers to acceptability. Methodology: A cross-sectional study was conducted to gather data from 196 HIV-positive AGYW, with enrollment carried out via systematic random sampling between November and December 2023. Data were collected using a pre-tested, structured questionnaire and analyzed using R version 4.3.1, applying chi-square tests and multiple logistic regression to explore associations between variables. Results: The study enrolled 168 AGYW, revealing that only 27% (46/168) had undergone cervical cancer screening. Key predictors of screening included familiarity with screening methods (AOR=4.71, 95% CI [ 1.71, 14.6], p=0.004), employment status (AOR= 7.45, 95% CI [2.47, 24.9], p<0.001), marital status (AOR=6.28, 95% CI [2.47, 24.9] p=<0.001), and gender preference for screening (AOR= 3.54, 95% CI [ 1.31, 10.2], p=0.015). Conclusion: The findings highlight the low acceptability of screening, therefore calling for the Ministry of Health to employ client-focused, tailor-made interventions in alignment with the identified predictors of familiarity with screening approaches, marital status, and employment, which are key to increasing cervical cancer screening acceptability.
Background: The success of the global National Pharmacovigilance to monitor adverse drug reactions relies on the health professionals' voluntary reporting of adverse drug reactions. Underreporting of adverse drug reactions by healthcare professionals in public hospitals in Lesotho remains a serious challenge. The study assessed the knowledge, attitudes and practices of healthcare professionals towards pharmacovigilance (PV) and adverse drug reaction reporting (ADRs) in government hospitals in Lesotho. Methods: A cross-sectional descriptive study was conducted across six government hospitals in the lowlands of Lesotho. Using stratified sampling, 106 KAP questionnaires were distributed between August and November 2023 and January 2024 among available healthcare professionals who were conveniently accessible. Data were analysed descriptively with the inferential statistics performed with the Chi-square test performed to assess the association between categorical data (nominal data) and statistical significance was set at p < 0.05. The analysis was conducted using IBM SPSS version 20. Results: There were 63 healthcare professionals who responded (59.4 % response rate). Participants were predominantly females (58.7%), while males were 41.3%. The predominant age group was 30-39 years (69.8 %). The majority of the HCPs (39.7 %) had more than 10 years of practical experience, and 90.5 % demonstrated awareness about pharmacovigilance (PV). Despite the HCPs showed a generally positive attitude towards adverse drug reaction, 69.8 % (n =44, p = 0.009) did not received basic training in ADR reporting, and 46.0% (n = 29, p = 0.514 encountered an ADR and did not report it. Half of HCPs (52.4%, n = 33, p = 0.048) did not submitted sufficient ADR reports Moreover, 84.1 % (n = 53, p =0.038) expressed willingness to receive more training on ADR reporting. Conclusion: ADR reporting in six public hospitals in Lesotho remains inadequate despite a higher awareness and positive attitude. Lack of access to ADR reporting forms and training on PV and ADR reporting significantly hinders ADR reporting practices. The findings highlighted significant gap between knowledge and practices which requires intervention to promote ADR reporting. Recommendation: PV and ADR reporting awareness campaigns and continuous training may address these challenges. Strengthen the dissemination of the ADR reporting tools among the within the health care facilities.
Background: Growth Monitoring and Promotion (GMP) is a multifaceted healthcare program that involves tracking the growth and welfare of children under five years through regular assessment of nutritional and physical health. Despite the apparent importance, GMP uptake remains low in low- and middle-income countries. The current study aimed to determine uptake patterns of GMP services for children 0-59 months among caregivers in Nyakach sub-county. Methodology: A community-based descriptive cross-sectional study design was employed, using a multi-stage sampling technique to select 407 caregivers. Data were collected through questionnaires and analysed using descriptive and inferential statistics in SPSS version 28. Furthermore, multivariable logistic regression analyses were performed with adjusted odds ratio (aOR) [95% CI] used to assess the strength of association. Results: The median (IQR) age of caregivers was 28 (22, 34) years, and 27 (17, 40) months for the children aged under five years. GMP services utilisation was at 47.7%; however, the major barriers included long distances to health facilities (56.3%) and extended waiting times (47.9%). Most caregivers (91.2%) had good knowledge of GMP, and 84.0% had a positive perception of the services. Several factors were significantly associated with GMP services utilization, namley, children's age 24-35 months (aOR= 6.6; 95%CI= 2.7-16.2); Employed caregivers (aOR= 1.92; 95%CI= 1.08-3.42), Caregivers who received all GMP service components (aOR=2.27; 95%CI=1.31-3.94), Caregivers with good maternal knowledge (aOR=5.01; 95%CI= 1.67-15.05); Caregiver with good perception (aOR=4.96, 95%CI= 2.20-11.17); Waiting time for at least 60 minutes (aOR=0.11,95%CI= 0.05-0.28), and time taken to the facility for at least 60 minutes (aOR=0.03,95%CI= 0.01-0.14). Conclusion and Recommendation: GMP services utilisation among the under-fives remains low post-immunisation completion. Several key barriers to the utilisation of GMP services included long distances to health facilities, long waiting times, a negative perception, low caregiver knowledge, and working caregivers reported difficulties in finding time to attend GMP sessions. Conversely, high caregiver education levels, a positive perception of GMP services, and shorter distances to health facilities were associated with higher utilisation rates. It is important to enhance community-based health education and strengthen routine follow-up mechanisms to improve consistent visits.
Introduction: Physical activity is the bodily movement that involves the skeletal muscles, and it is beneficial in human development and growth. Lack of physical activity may indirectly expose one to certain health ailments, such as non-communicable diseases, which may lead to death. Secondary school students are among the 81% of children who do not meet the recommendation for moderate to vigorous physical activity (MVPA) levels. This study aimed to assess physical activity practices among secondary school students in Kakamega County. Methods: A Descriptive survey was used with a sample size of 412 students aged 14 to 18 years. The data was collected using a structured questionnaire in line with the study aim, then coded and analysed using the Statistical Package for Social Sciences (SPSS 25.0). Results: There were more males, 194 (47.1%), compared to females, 218 (52.9%), and most of the students were in the second form, 176 (42.7%), most of whom, 110 (26.7%), were 17 years of age. The majority, 54.1% participated in physical activity, with 104 (25.2%) engaging in it 3-4 times per week. There were no significant differences (t (438) = -0.338, p=0.734) between scores for males (M=2.17, SD=0.690) and females (M=2.23, SD=0.728). With a mean difference of r=0.054, 95% CI: -0.188 to 0.081). Conclusion and recommendation: The majority of the students participated in physical activity, with most of them participating in ball games. Consequently, there is a need for more awareness and advocacy to promote physical activity practices among secondary school students.
Background: Quality of Healthcare is the degree to which health services increase the likelihood of desired health outcomes of individuals and populations in the context of prevailing professional knowledge. Despite accounting for 1% of the global disease burden, epilepsy care faces significant challenges, and treatment remains inadequate. This study aimed to determine predictors of quality of care for clients at the selected hospitals in the Nairobi metropolis. Methods: A mixed methods cross-sectional approach was adopted and quantitative data were collected from 373 sampled epilepsy patients from Mama Lucy, Kiambu, Gatundu, Thika and Machakos Level 5 Hospitals using semi-structured questionnaires. Qualitative data were collected from key informant interviews and focus group discussions in the study sites. Using (SPSS) version 26, quantitative data were analysed using chi-square to determine the distribution of observation between groups, and logistic and multiple linear regression analyses to test for association quality of care and various variables. Qualitative data were analysed into themes using NVIVO. Results: Predictors of high quality included formal employment with 3.372 OR CI (1.423-7.625) P=0.005, similarly, those who did not experience stigma were 1.98 CI (1.123-3.497) P= 0.018 likely to rate care as high quality. Less than one seizure after beginning treatment was another predictor of high-quality rating OR=2.405 CI (1.017-5.684), P= 0.045. Additionally, a shorter waiting time was a predictor of a good rating with OR= 2.692 CI (0.353-0.756) P=0.028. Patients who could afford treatment were also likely to rate care as high-quality OR=1.79 CI (2.427-3.642) P=0.045. Conclusion: Key clinical predictors of quality-of-care rating included the time to treatment initiation, type of anti-seizure medication, seizure frequency after treatment onset, and stigma experience. Hospital-related factors influencing care quality included waiting time, service availability, and affordability. Additionally, individuals with formal employment, seizure control, shorter waiting times, and the ability to afford medication were more likely to rate healthcare quality highly.
Background: Emergency Department Point-of-Care Ultrasound (ED-POCUS) has shown promise in expediting the management of patients in resource-limited settings. This study aimed to evaluate the clinical impact of triage-based ED-POCUS using the Extended Focused Assessment with Sonography for Trauma (EFAST) exam for the evaluation of blunt trauma patients in the Accident & Emergency Department (A&E) of a large tertiary public hospital in East Africa. Methods: This was a non-randomized, prospective, quasi-experimental study of adult patients presenting with blunt torso trauma to the A&E of Kenyatta National Hospital in Nairobi, Kenya. The before group received usual care, and the intervention group underwent an E-FAST exam immediately after triage in addition to usual care. The primary outcome was defined as the occurrence of and time to intervention, such as transfusion of blood products, chest tube insertion, or transfer to the operating theatre. Secondary outcomes included time to intravenous fluids (IVF), first speciality consultation, time from consult to specialist evaluation, disposition, length of hospital stay, and in-hospital mortality. Results: The usual care group (before ultrasound) included 149 patients, and 99 patients were enrolled in the E-FAST (after ultrasound) cohort. The occurrence of and time to the composite primary outcome did not differ significantly between the two groups (p=0.61 and p=0.56, respectively). Of the secondary outcomes, time to IVF was significantly shorter in the E-FAST compared with the usual care group (median 5.5 minutes (IQR 16.0) vs 32.8 (117.5). Conclusion: The use of the E-FAST exam at triage in blunt trauma victims did not significantly improve the time to surgical intervention or transfusion of blood products. However, there was improved time to IVF resuscitation.
Introduction: Menstruation is a very important aspect of any woman’s life. Changing levels of reproductive hormones during the menstrual cycle can impact the incidence and pattern of neuropsychiatric illnesses. However, little is known about the impact of neuropsychiatric illness on the menstrual cycle. Abnormal patterns of menstruation may cause difficulties in this set of patients, from issues related to hygiene, to missed comorbidities. This study aimed to study menstrual patterns and characteristics among patients with neuropsychiatric illness. Methodology: A cross-sectional study was conducted between November 1 st 2022 to January 31st 2023. Participants were adult female patients diagnosed with neuropsychiatric illness. Data were collected using the Mini International Neuropsychiatric Interview, and a questionnaire with information on general socio-demographic characteristics, menstrual characteristics and possible confounding variables which may affect cycle regularity. Data were analysed using SPSS version 22, presented in frequency tables for descriptive purposes, and the relationship between categorical variables was analysed using chi-square or Likelihood ratio. A p-value of <0.05 wasconsidered statistically significant. Results: All 285 participants were aged 18 – 40 years. Majority were Hausa (179, 62.8%), Muslims (192, 67.4%), married (149, 52.3%), had secondary/post-secondary education (200, 70.2%) and unemployed (174, 61.1%). Most participants were parous (175, 61.4%), attained menarche normally between the ages of 10 and 16 (215, 75.4%). Eighty -one participants (28.4%) had normal cycle lengths, duration of menstrual flow was abnormal in majority (193, 67.7%), most had normal volume of menstrual flow (188, 66.0%), and dysmenorrhea (212, 74.4%) which was mostly mild. The commonest diagnosis was schizophrenia (131,46%), depressive disorders (55, 19.3%) and seizure disorders (40, 14.0%). Most participants’ duration of illness was 1 -5 years (132, 46.3%), and stable (129, 45.3%). There was no significant association between diagnosis and cycle length, duration of menstrual flow and menstrual pain (p-value >0.05). Volume of menstrualflow was associated with diagnosis (p-value <0.05). Conclusion: The duration of menstrual flow was abnormal in majority of participants. Those with seizure disorders appeared to have more abnormal volumes of menstrual flow, as compared to depressive disorders or schizophrenia. Carers should routinely screen for menstrual abnormalities.
Background: Physical and emotional stressors such as pain are common among patients with incurable cancer, yet little is known regarding their coping strategies and the associated factors. This study aimed to determine the pain coping strategies and their associated factors among adult oncology patients admitted at Kenyatta National Hospital. Methodology: This study employed a mixed-method approach, combining a quantitative descriptive survey with qualitative focus group discussions to understand pain coping strategies and their associated factors. A focus group discussion (FGD) with purposive sampling was conducted with 9 patients. Results: Age, gender, household income, and residence were significantly associated with a specific number of coping strategies, including positive refrain (p=0.045), preference for emotional support (p= 0.025), and behavioural disengagement (p= 0.005), acceptance (p=0.020), denial (p=0.026), and positive refrain (p= 0.006) respectively since (p<0.05) was considered significant. Conclusion: Pain significantly influences the type of coping strategy used by cancer patients. The findings reveal that sociodemographic factors such as gender, income, and residence impact strategy selection, underscoring the need for individualised pain management approaches. Recommendations: There is a need to embrace non-pharmacological coping strategies. Further, it is critical to assess atients' attitudes and perceptions towards the existing non-pharmacological pain coping strategies as these individual factors, together with the outlined sociodemographic factors, are known to impact their utilisation significantly.
Background: Infections caused by Pseudomonas aeruginosa present a huge treatment challenge due to the high antibiotic resistance. The rapid development of carbapenem resistance is alarming and calls for implementing surveillance measures. This study aimed to detect antibiotic susceptibility of P. aeruginosa isolated from different clinical samples and to detect carbapenem resistance, metallo β-lactamase and also colistin resistance among carbapenemresistant P. aeruginosa. Materials And Methods: A cross-sectional study with a sample size of 100 clinical isolates of pathologically significant P. aeruginosa collected from patients of all age groups identified by standard methods were included. The prevalence of P. aeruginosa was estimated at 7.15% (95/1566) from a previous study. The sample size was estimated at 102 with a 95% confidence level and a margin of error of 5%. Antimicrobial susceptibility testing was done by the standard KirbyBauer disc diffusion method. Metallo β-lactamase detection done by the combined disc test and Modified Hodge test. Carbapenemase gene detection was done by Real-time polymerase chain reaction. Susceptibility to colistin was detected by the Vitek-2 system. Results: Out of 100 P. aeruginosa isolates, 52% were from pus, 22% respiratory samples,16% urine and 10% from blood respectively. In antimicrobial susceptibility testing, 30% of the strains were multidrug-resistant, 38% of the strains were sensitive and 32% were intermediate. The highest resistance was observed against fluoroquinolones. Carbapenem resistance was observed as imipenem 17 % and meropenem 16 %. Among the carbapenemresistant P. aeruginosa, 47% of the strains were metallo β-lactamase producers by thephenotypic method. Gene detection for carbapenemase revealed blaNDM to be the most common gene carried by 35.2% of the MBL-positive carbapenem-resistant strains. All the carbapenem-resistant strains were susceptible to colistin. Conclusion: Maximum number of P. aeruginosa was isolated from pus samples. Prevalence of carbapenem resistance was found to be less in our hospital, with a rate of 17%. The highest resistance was observed against fluoroquinolones. Among carbapenamase, blaNDM seems to be the most prevalent gene at 23%, followed by blaIMP at 11%, blaIMP and blaNDM at 5.8%, and blaNDM, blaIMP and blaVIM at 8 % respectively. No strains exhibited resistance against colistin when tested by the Vitek-2 system.
Background: Globally, vector-based malaria control programs, such as insecticide-treated nets (ITNs) play an essential role in reducing malaria infections. Despite evidence of their effectiveness when properly and consistently used, usage still lags. The study investigated knowledge, attitudes, and practices towards insecticide-treated nets utilisation among communities in Cherangany Sub County, Trans-Nzoia County. Methods: This cross-sectional study was conducted in the Charangany sub-county, and 326 respondents were recruited for the study. Quantitative data were collected by intervieweradministered questionnaires, and data were analysed using STATA version 15. Data werepresented using frequencies and percentages. Linear correlations were used to determine associations between the dependent variable and independent variables, and Regression analysis was carried out to test whether the independent variables were predictors of net usage. Results: Academic achievement and educational resources showed a strong correlation with net usage (r = 0.746, p < 0.01). Knowledge, attitudes, and practices (β = 0.41, p = 0.021) and socioeconomic factors (β = 0.296, p = 0.010) were also significant predictors. Individual characteristics had the strongest correlation (r = 0.872). Marital status and urban residence (β = 0.372, p = 0.000) were key predictors. Standardised results ranked knowledge (β = 0.421) highest, followed by education (β = 0.308) and socio-demographics (β = 0.291). These findings highlight education and socio-economic factors as critical for ITN adoption. Low-income households, lower education levels, and employment status were associated with lower bed net usage. Conclusion: The study highlighted education and socioeconomic status as major influences on insecticide-treated net use. We also noted the important roles of individual factors like marital status and urban residence. These findings indicate that improving bed net utilisation may require both broad public education and targeted interventions for specific groups.
Background: Despite the increasing prevalence of ocular allergies globally, there is a lack of literature regarding the awareness and knowledge levels of ocular allergies in Zimbabwe. This study aimed to assess the awareness and knowledge of ocular allergy among undergraduate students in public universities in Zimbabwe. Materials and Methods: A descriptive cross-sectional study was conducted across eleven public universities in Zimbabwe, and questionnaires were sent via WhatsApp and other social media platforms. The study was carried out between April 2022 and November 2022. A three-section self-administered online questionnaires created electronically on Google Forms were used to collect the data. Results: The study included 1000 undergraduate students, comprising 54.1% males and 45.9% females. Their age ranged between 18 and 42 years. Most students (29.3%) were from the science faculties and were in their third year (34.0%). Almost all the participants (96.1%) were enrolled in the conventional study type. A significant association was found between sex and place of origin, the year of study, and the course of study (p<0.001). Most of the students had a fair knowledge of ocular allergies, and there was a significant association with the programme of study (p<0.05). More than half of the participants (55.3%) reported that ocular allergies are eye inflammation in response to a harmless foreign substance. Most of the participants had poor knowledge of the forms of ocular allergy. Sources of information on ocular allergy, as reported by the participants, included friends or relatives, the internet, media, eye specialists, training programs, books, and schools. Conclusion and Recommendation: Awareness and knowledge of ocular allergies among University undergraduate students inZimbabwe is good, whilst significant gaps exist in their knowledge of the forms of ocular allergies. However, students enrolled in science-related programmes had a better understanding of ocular allergies compared to their counterparts. There is a need for health education on ocular allergy.
