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Kenya Medical Research Institute (KEMRI))
© 2024 The authors. This work is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0).
Trends and Risk Factors for Drug-Resistant Tuberculosis in Nairobi County, Kenya: A Comparative Analysis Before, During and After COVID-19
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.
Copyright (c) 2025 Sum Kipkurgat Naphtali, Vincent Omondi Were, Jane Rahedi Ong'ang'o, George Alliwa Makalliwa (Author) https://creativecommons.org/licenses/by/4.0
Bacterial Vaginosis in Women of Reproductive Age: Burden and Predictors in Western Kenya
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.
Copyright (c) 2025 Rosemary A. Okuku, Christine Bii, Ernest Makokha, Musa Otieno Ngayo, Juster Mungiria, Joseph Gikunju (Author) https://creativecommons.org/licenses/by/4.0
Treatment Outcomes and Associated Clinical Laboratory Parameters among Patients Hospitalised with COVID-19 at a Private Hospital in Kiambu County, Kenya
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.
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
Determinants of Optimal Antenatal Care Services Uptake among Adolescent Mothers in Bomachoge Borabu Subcounty, Kisii County
Background: Pregnancy and childbirth complications are leading causes of death among adolescent girls. Due to the high number of teenage pregnancies in Bomachoge Borabu Sub-County, this study aimed to determine adherence levels and factors associated with the uptake of antenatal care services among adolescent mothers in Bomachoge Borabu Sub-County, Kisii County, Kenya. Methods: This study employed a quantitative cross-sectional design. Five government health facilities were purposively selected, and 293 adolescent mothers aged between 15 and 19 years randomly sampled. Structured questionnaires were used in the study. Fisher’s exact test of association and multivariable analysis were carried out to determine the association between adherence and various variables. Results: A majority of the sampled adolescent mothers (88.3 %) had access to at least one Antenatal Care (ANC) visit during their pregnancy. Their mean age was 17.4 (STD± 1.38) years. The majority (96.1 %) did not adhere to optimal ANC uptake, with 25.2 % and 48.8% adhering to the scheduled visits in the 1st and 2nd trimester, respectively. None came for the 3rd trimester. Gestational age at 1st ANC, knowledge of recommended number of ANC visits and mode of reminders to attend scheduled ANC visits were significantly associated in univariable analysis (p <.001). Mothers who sought ANC between 8-12 weeks and 16 weeks, respectively, were 24.5% (p<.00425) and 18.75 % (p<.0228) times more likely to adhere, respectively, compared to those who sought ANC at 4 weeks. Similarly, mothers without knowledge of the recommended number of ANC visits were 89% (p<.006) more likely to adhere compared to those who had the knowledge. Conclusion: Most adolescent women were at risk of maternal morbidity and mortality due to high levels of non-adherence to optimal ANC uptake, despite having knowledge of the ANC recommendations. Early ANC contact initiation and use of ANC reminders boost adherence to optimal ANC uptake among adolescent mothers.
Copyright (c) 2025 Jacinta Omariba, Joseph Mutai, George Alliwa Makalliwa, Charles K. Syengo (Author) https://creativecommons.org/licenses/by/4.0
Genetic Diversity and Drug Resistance Patterns among HIV-1 Positive Youths with Non-Suppressed Viral Load in South Rift Valley, Kenya
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.
Copyright (c) 2025 Loice Chelangat, Janet Kombich, Daud Ibrahim (Author) https://creativecommons.org/licenses/by/4.0
Burden and Drivers of HIV Infection among High-Risk Fisherfolk Populations along the Shores of Lake Victoria
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.
Copyright (c) 2025 Gilchrist Lokoel, Zipporah Nga’ng’a, Charles Mbakaya (Author) https://creativecommons.org/licenses/by/4.0
Determinants of Underweight among Children of Adolescent Mothers in Western Kenya
Background: Underweight among adolescent mothers' children remains a significant public health issue, especially in Low and middle-income countries [LMICs]. Understanding context-based determinants of underweight is important in the formulation of specific interventions necessary for addressing it. Therefore, this study investigated the determinants of underweight among children of adolescent mothers in Vihiga County, Western Kenya. Methodology: This hospital-based cross-sectional study was carried out across 25 health facilities in Vihiga County. A total of 121 adolescent mothers were interviewed using a semi-structured questionnaire to obtain their children's health status data. Additional information was obtained from the antenatal, postnatal and maternity records. Data was analysed using descriptive statistics, bivariate analyses, and multivariable logistic regression models in STATA version 18. Results: Overall, 15.3% of children born to adolescent mothers were undernourished, with 4.7% underweight and 10.6% severely underweight. Maternal primary-level education was associated with higher odds of child underweight [aOR = 6.66, 95% CI: 2.02–21.96, p = 0.002]. Preterm delivery emerged as the strongest predictor [aOR = 17.6, 95% CI: 3.24–96.44, p = 0.001]. Additional determinants included lack of parental support and guidance [aOR = 7.31, 95% CI: 1.89–28.38, p = 0.004] and limited access to healthcare [aOR = 4.86, 95% CI: 1.26–18.71, p = 0.021]. Conclusion: Maternal education, parental support, preterm delivery and challenges in accessing health services are key determinants of underweight in children of adolescent mothers in Vihiga. There is an urgent need for programmatic interventions to address these determinants to promote these vulnerable children's health outcomes.
Copyright (c) 2025 Martin Osotsi, Winnie Majanga, Dorothy Okemo, Antony Ochung', Daniel Onguru, George Ayodo (Author) https://creativecommons.org/licenses/by/4.0
The Impact of COVID-19 on HIV Services in Kajiado County, Kenya: An interrupted time series analysis
Background: Globally, approximately forty million people are living with HIV, indicating HIV/AIDS is a major global public health issue. The World Health Organisation (WHO) projected that disruptions to HIV treatment caused by the COVID-19 pandemic could result in over 500,000 additional AIDS-related deaths in sub-Saharan Africa between 2020 and 2021. In recent decades, Kenya has made significant progress in HIV/AIDS care, leading to notable declines in incidence, morbidity, and mortality. However, limited data exist on the impact of the COVID-19 pandemic on HIV/AIDS care in sub-Saharan Africa. Methodology: This was an interrupted time series study design, where aggregate monthly HIV care services data were collected from the health information systems of Loitoktok, Ongata Rongai, Kitengela sub-County Hospitals and Entasopia Health Centre in Kajiado County. The pre-COVID-19 period (June 2018 to February 2020) and the COVID-19 period (March 2020 to November 2021) were analysed. Results: ART continuation remained stable at the beginning of COVID-19 pandemic (p = 0.200) and significantly increased over time (p = 0.048). New HIV care enrolments sharply declined at the pandemic's onset (p < 0.001), and HIV testing services showed a sustained decrease (p = 0.009). In contrast, PrEP use rose steadily throughout (p < 0.001). Conclusions: In Kajiado, COVID-19 negatively impacted HIV treatment and prevention services. Decreasing trends indicated COVID-19 disruption, while increasing trends indicated that healthcare systems have successfully evolved to continue delivering HIV care despite COVID-19 disruptions.
Copyright (c) 2025 Regina Malit, Kenneth Ngure, Moses Kinayia, Benjamin Ngugi (Author) https://creativecommons.org/licenses/by/4.0
Seroprevalence of Anti-Sars-Cov-2 Antibodies among Patients Visiting Hospital-Based Sentinel Sites in the Rift Valley Region, Kenya
Background: Accurate estimation of the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is crucial for guiding public health prevention strategies. Underreporting from polymerase chain reaction (PCR) based testing, especially in low- and middle-income countries, often obscures the true extent of exposure and immunity to coronavirus disease 2019 (COVID-19). This study aimed to determine the seroprevalence and antibody levels against SARS-CoV-2 among patients visiting hospital-based sentinel sites in Kenya’s Rift Valley region. Method: A cross-sectional study was conducted at four hospital-based sentinel sites among patients with symptoms of acute respiratory infection. Patients aged six months or older visiting the sites between January 2022 and December 2022, presenting with symptoms of acute respiratory infection, were enrolled. Clinical and sociodemographic data were collected using a structured questionnaire. A quantitative enzyme-linked immunosorbent assay (ELISA) kit detected IgG antibodies against SARS-CoV-2 S protein in serum samples. Results: Among 557 individuals enrolled in the study, the seroprevalence of SARS-CoV-2 antibodies was 97.8% (n=545). Vaccinated individuals demonstrated significantly higher odds of seropositivity compared to unvaccinated counterparts, with an odds ratio of 3.33 (95% CI: (0.4, 27.87). While seropositivity remained consistent across age groups, older adults exhibited the highest odds. Site-specific differences in enrolment and vaccination rates highlight potential access-related disparities. Conclusion: Our findings indicate prior exposure to SARS-CoV-2 within the study region, underscoring the significant impact of natural infection and vaccination efforts in driving SARS-CoV-2 seroprevalence within the Rift Valley region. Despite the underestimation of infections and disparities in vaccination access, this study demonstrates the effectiveness of vaccination for conferring SARS-CoV-2 immunity. To ensure equitable vaccination coverage, targeted interventions should focus on increasing vaccine accessibility through mobile clinics and community-based vaccination campaigns while addressing vaccine hesitancy through targeted public health messaging and community engagement.
Copyright (c) 2025 Vincent Kiplangat Ruttoh, Brian Kipkoech, Ronald Tonui, Ruth Omoti John, Ibrahim Mwangi, Ruth Wambui Gicho, Sally Wambui Kamau, Maureen Njihia, Samwel Symekher, Timothy Mwanzia, James Gikunda, Matthew Munyao, Caroline Njoroge, Samson Nzou (Author) https://creativecommons.org/licenses/by/4.0
Assessment of Bacteriological Quality and Physicochemical Properties of Borehole Water Supplies in Eastleigh, Nairobi County, Kenya
BACKGROUND A borehole is a valuable source of fresh, potable water that globally feeds around 1.5 billion people daily. It is, however, vulnerable to both microbial and chemical pollution, which poses health risks to the population if consumed without proper treatment. It is from this perspective that this study aimed to assess the quality of borehole water supplies in Eastleigh, considering their implications for human health. METHODOLOGY A repeated cross-sectional design was employed to study physicochemical and microbiological parameters of the boreholes. A proportionate stratified sampling method was used to sample 25 boreholes. Water samples from the storage tanks of the boreholes were collected in sterilised 250 ml glass bottles and transported to Kenyatta University microbiology laboratories for analysis. Temperature, pH, Turbidity and Fluoride levels were measured by their respective meters. Lead, cadmium and Arsenic levels were determined by the Atomic Absorption Spectrophotometer. The Most Probable Number technique quantified the coliform and Microbial culturing for bacterial detection. A 12-month retrospective case-control design determined the prevalence of waterborne illnesses from the Eastleigh Community Wellness Centre, Eastleigh Health Centre and Biafra Health Facility hospitals. Mean values obtained for physicochemical and microbiological parameters during the wet and dry seasons (April-May, 2024 and July, 2024, respectively) and across the road streets were analysed using one-way analysis of variance, with p ≤0.05 being significant. RESULTS All physicochemical parameters were generally within Kenya Bureau of Standards (KEBS) permissible standards for drinking water, except for cadmium, fluoride and pH. The total coliform exceeded the KEBS permissible requirements. At least one of the pathogenic bacteria of interest (Escherichia coli, Vibrio cholerae, Salmonella spp and Shigella spp) was detected in every borehole. Review of the patient’s clinical data showed an overall prevalence rate of 8.5%, with patients <5 years and >5 years recording 11.06% and 7.33%, respectively. CONCLUSION Borehole water in Eastleigh is contaminated, and with the prevalence rate of 8.5%, it concludes waterborne diseases in the region as a public health concern. Consumption of water from questionable sources like these boreholes should be limited.
Victor Onyango School of Pure and Applied Sciences, Kenyatta University, Nairobi, Kenya
Copyright (c) 2025 Victor Onyango Otieno, Anncarol Karanja, John Maingi (Author) https://creativecommons.org/licenses/by/4.0
Healthcare Professionals' Knowledge, Attitudes and Practices Towards Pharmacovigilance and Adverse Drug Reaction Reporting in Public Hospitals in Lesotho
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.
Copyright (c) 2025 Rasemoko P. Polile, Lineo Maja, Relebohile Mautsoe, Mohale Mokonyana, Mpho Shelile, Marelebohile Mabuzela (Author) https://creativecommons.org/licenses/by/4.0
Enhancing Uptake of Maternal Health Services Using an Electronic Community Health Information System in Muhoroni Sub-County of Kisumu County, Kenya
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.
Electronic Community Health Information System
Copyright (c) 2025 Kennedy Akani, Alexander Mbeke, John Kariuki (Author) https://creativecommons.org/licenses/by/4.0
Time to Sputum Smear Conversion in Patients with Bacteriologically Confirmed Pulmonary Tuberculosis in Kiambu County, Kenya
Introduction: Tuberculosis (TB) remains a significant global health burden, with 8.3 million new cases and 1.25 million deaths reported in 2023. Africa accounted for 24% of these cases, with Kenya ranking among the top 30 high-burden countries, reporting 97,126 TB cases. Kiambu County is among Kenya's top 12 high-burden counties, with a case notification rate of 189 per 100,000. Consequently, this study aimed to assess the time to sputum smear conversion and identify demographic, clinical, and socio-economic factors associated with delayed conversion among TB patients in Kiambu County. Methods: A prospective longitudinal study was conducted among 316 newly diagnosed TB patients, who were followed from treatment initiation with weekly sputum smear assessments and monthly measurements of blood sugar and weight until smear conversion. Data were analysed using R Version 4.3.4 employing descriptive statistics, Cox Proportional Hazards Models, and survival analysis. Results: Delayed sputum conversion was significantly associated with a high initial bacillary load (hazard ratio, HR = 1.52, p < 0.001), diabetes (HR = 1.20, p = 0.036), and poor socioeconomic status (HR = 1.16, p = 0.007). Conversely, older age groups 35–44 years (HR = 0.61, p = 0.037) and 55+ years (HR = 0.73, p = 0.032) demonstrated faster conversion rates. Conclusion: This study underscores the importance of addressing demographic, socioeconomic, and clinical factors, such as area of residence, employment status, baseline bacillary load, diagnosis delays, and diabetes, to optimise sputum smear conversion. The findings highlight the need for targeted interventions and tailored strategies to enhance treatment success across diverse populations.
Copyright (c) 2025 Annfreshia Wangari Maina, Jane Rahedi Ong’ang’o, Magoma Kwasa , Richard Kiplimo, Simon Njuguna Ndungu, Moses Ndiritu, Moses Mucugi Njire (Author) https://creativecommons.org/licenses/by/4.0
Acceptability of Cervical Cancer Screening among Adolescent Girls and Young Women Living with HIV in Uasin Gishu County, Kenya
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.
Copyright (c) 2025 Annet Awuor Oyoyo, Shehu Awandu, Dickens Omondi, Daniel Onguru (Author) https://creativecommons.org/licenses/by/4.0
Endoscopic Retrograde Cholangiopancreatography Utilisation and Outcomes in Mater Misericordiae Hospital, Nairobi: A retrospective cohort study
INTRODUCTION Endoscopic management of hepatobiliary conditions is becoming increasingly important. This includes the use of endoscopic retrograde pancreatography (ERCP) and endoscopic ultrasound. The objective of this retrospective review was to report on the utilisation and outcomes of Endoscopic Retrograde Cholangiopancreatography. These include the success rate, incidence and risk factors for procedure-related complications and outcomes in Mater Misericordiae Hospital, Nairobi, for the first 122 cases since the introduction of ERCP, from August 2023 to January 2025. METHODOLOGY This is a retrospective review of records made before, during and after ERCP procedures between October 2023 and January 2025. Data on the clinical status of patients before the procedure, the procedure conducted, complications and patient treatment outcomes after 48 hours and at two weeks following the procedure were abstracted using a standardised tool. Statistical significance was set at p<0.05 and confidence interval at 95%. RESULTS Records for 122 patients were recovered. There was a male-to-female ratio of 1:1.39, where males were 51 and females 71. The mean age was 51.38 years, with the mean age for males as 54.67 years and 49.01 years for females. The procedure success rate was 95%, while reported complications were less than 5%. Biliary duct strictures were the most common condition observed, and most patients with this condition were older than 50 years. The average time taken for the procedures was 64.79 minutes (SD±37.11), with a minimum of 25 minutes and a maximum of 220 minutes. CONCLUSIONS These findings report early outcomes from the first 122 Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures conducted at the Mater Misericordiae Hospital in Nairobi, Kenya. A procedural success rate of 95% was achieved, with complication rates reported at under 5%. Biliary duct strictures were the most common indication, particularly among patients over 50 years. The findings reflect safe and effective service initiation at the facility, within the study period.
Endoscopic Retrograde Cholangiopancreatography
Copyright (c) 2025 Hudson Lodenyo, Imelda Leitich (Author) https://creativecommons.org/licenses/by/4.0
Adherence to Self-Care Practices and Associated Factors among Patients Diagnosed with Hypertension Visiting the Medical Outpatient Clinic at Kenyatta National Hospital
Background: Self-care practices in hypertension describe proactive behaviours undertaken by patients to manage their condition and prevent complications. These include medication adherence, dietary changes, such as low-sodium intake and adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, regular physical activity, weight control, alcohol moderation, and smoking cessation. This study assessed adherence to self-care practices and associated factors among hypertensive patients attending the medical outpatient clinic at Kenyatta National Hospital (KNH), Kenya's largest national referral hospital. Methodology: A hospital-based analytical cross-sectional study was conducted among 167 adult patients receiving antihypertensive treatment at KNH. Systematic random sampling was used, where every third eligible patient was selected after the first was chosen via lottery. Data were collected using an interviewer-administered structured questionnaire incorporating the validated Hypertension Self-Care Activity Level Effect (H-SCALE) and Hypertension Evaluation of Lifestyle and Management (HELM) scale. Data analysis was done using SPSS version 26. Descriptive statistics and binary logistic regression were used to determine associations between independent variables and self-care adherence. Results: The mean age of participants was 43.4 years (SD±6.1). Only 34.7% demonstrated good adherence to self-care practices, while 65.3% had poor adherence. Among individual behaviours, smoking cessation had the highest adherence (92.7%), followed by medication adherence (86.5%) and alcohol moderation (57.8%). Lower adherence was observed for weight management (30.9%), physical activity (27.3%), and low-salt diet (15.1%). Sociodemographic characteristics were not significantly associated with self-care adherence. However, participants with good knowledge of hypertension were significantly more likely to adhere to self-care practices (OR = 3.20, 95% CI: 1.64–6.24, p = 0.001), indicating that knowledge is a key independent predictor. Conclusion and Recommendations: Adherence to self-care among hypertensive patients remains low, especially in dietary salt reduction and physical activity. While sociodemographic factors were not significant, adequate knowledge of hypertension markedly improved self-care adherence. This underscores the importance of structured, culturally sensitive health education in outpatient settings. Programmes should focus on diet and physical activity, use interactive approaches, and involve family support to sustain long-term behavioural change.
Copyright (c) 2025 Anne Adhiambo Opiyo, Grace Mbuthia, Joan Shisoka (Author) https://creativecommons.org/licenses/by/4.0
Prevalence, Distribution, and Antifungal Susceptibility Patterns of Yeast Isolates at the Nairobi South Hospital
BACKGROUND Yeast infections significantly impact global morbidity and mortality but remain underdiagnosed and underreported. Treatment failure due to antifungal resistance, particularly in critically ill patients, limits treatment options. The aim of this study was to retrospectively describe the proportion and distribution of yeast isolates recovered from inpatient records at The Nairobi South Hospital over five years and to describe the isolates' antifungal drug susceptibility patterns. METHODOLOGY We reviewed inpatient records from 2018 to 2022, focusing on 308 fungal culture records that met the inclusion criteria. Clinical data included age, sex, ward, and year of admission. Laboratory data included sample type, yeast species, and antifungal susceptibility. Identification and antifungal susceptibility testing were performed using VITEK-2, and interpreted as per the Clinical and Laboratory Standards Institute guidelines (CLSI). RESULTS Out of 2006 records, 308 (15%) yielded yeast isolates. Distribution was: Candida albicans (38%), non-albicans Candida (NAC) species (50%), Cryptococcus species (10%), and Trichosporon species (2%). The yeasts demonstrated reduced susceptibility to all tested antifungal agents. Based on Minimum Inhibitory Concentration (MIC) data and CLSI breakpoints, 90% of the isolates exhibited high MICs and were classified as resistant to amphotericin B, 70% to itraconazole, and 61% to fluconazole. In contrast, 74% and 44% of the isolates had low MICs and were susceptible to flucytosine and voriconazole, respectively. CONCLUSION AND RECOMMENDATIONS Candida albicans remained the most common yeast species, although non-albicans Candida species are on the rise. Widespread antifungal resistance necessitates tracking yeast profiles and susceptibility patterns for effective patient management.
Copyright (c) 2025 Charity Lyavuli Akweya, Winnie C. Mutai, Kenneth Omollo, Gloria Omosa-Manyonyi, Florence Mutua (Author) https://creativecommons.org/licenses/by/4.0
Assessment of the Particle Filtration Efficiency of N95 Masks Protecting Quarry Workers in Erongo, Otjozondjupa, and Kunene Regions of Namibia
Background: Quarry workers use different types of N95 masks to protect themselves from occupational respirable dust. However, little is known about the filtration efficiency of N95 masks among Namibian quarry workers. Hence, this study measured the filtration efficiency of the different N95 masks used in quarry mines following respirable dust exposure. Methodology: The study employed a quantitative experimental design in a controlled environment with a sample of seven (7) N95 masks labelled A, B, C, D, E, F, and G from seven (7) quarry mining sites, with one mask from each site. Samples were selected using purposive sampling, focusing on the availability of masks FFP1 and FFP2, which are considered standard respiratory protection masks used in quarry mines. Masks' particle filtration efficiency and effectiveness were assessed by an experiment that included gravimetric weighing, mask testing, and particle size analysis techniques. Results: The seven N95 masks collected insignificant dust compared to the amount of dust that passed through them, through gravimetric weighing. Site G recorded the highest dust exposure at 0.015mg, above the technique's standard uncertainty of ±0.010mg. Sites A and B had lower filtered dust weights, whereas Sites C, D, F, and G had higher values. The mass on filters increased significantly with a 5-minute sample period. The particle size analyser method showed that Sites A, B, and C showed smaller particles with 100% of the PM10 range, while sample Site D showed the highest particle size, with at least 60% below the PM10 range. Conclusions: The N95 mask efficiently filters respirable dust particles at the initial stages. However, their filtration efficiency diminishes following prolonged use. Accordingly, Efficacy decreases as respirable dust exposure increases. Recommendations: Based on the study findings, all the N95 masks met the filtration efficiency standards that attain the ideal respiratory protection; therefore, quarry workers should just increase the frequency of changing the masks. Additionally, masks should be tested upon fitting, properly fitted when used, and frequently replaced to complement the desired filtration efficiency.
Copyright (c) 2025 Saima Shihepo, Roswitha Mahalie, Omotayo Awofolu (Author) https://creativecommons.org/licenses/by/4.0
Predictors of Unskilled Birth Attendance among Women of Reproductive Age: A case of Kilifi county, Kenya
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.
Copyright (c) 2025 Nicholas Sewe, Daniel Onguru, Philomena Munga, Dorothy Anjuri, Diid Boru, George Ayodo (Author) https://creativecommons.org/licenses/by/4.0
Knowledge, Attitude and Practices on Bed Net Usage among Communities in Cherangany Sub-County, Kitale, Kenya
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 interviewer-administered questionnaires, and data were analysed using STATA version 15. Data were presented 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 socio-economic 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. CONCLUSIONS 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.
Copyright (c) 2025 Titus Kibet Kiprono (Author); Alexander Mbeke, Dominic Mogere https://creativecommons.org/licenses/by/4.0
Child Oral Health: Practices among Parents Attending Child Welfare Clinics in Murang’a County, Kenya
BACKGROUND Early childhood caries affects half of Kenya's under-five-year-old children. This high disease burden suggests possible gaps in child oral healthcare practices among their parents. To facilitate change in practice towards reducing early childhood caries, there was a need to identify current practice gaps. This study thus aimed at assessing child oral healthcare practices among parents attending child welfare clinics in Murang’a County, Kenya. METHODOLOGY This was a baseline cross-sectional study targeting 357 parents of children aged 6-18 months attending the child welfare clinics in Murang’a County, Kenya. An interviewer-administered questionnaire was used to collect data on child oral healthcare practices. The chi-square test and logistic regressions were used to determine the association between predictor variables and practices. RESULTS Fifty-one (14.3%) of the parents cleaned their children's teeth, majority brushed occasionally. Brushing was significantly (p<0.001) influenced by the child's age. Parents' age, sex or level of education did not influence teeth cleaning. Only 2.0% used toothbrush and toothpaste, while a piece of cloth was the preferred cleaning tool (10.9%) and only 1.1% used toothbrush only. Additionally, only 14.3% of participating parents referred to dental health notes in the mother-child booklet, none had filled the baby's teeth development chart. Notably, no parent had taken their child for an index dental visit, consumption of a cariogenic diet was prevalent (32.8%), and uvulectomy (6.7%) was practised among the study population. CONCLUSION AND RECOMMENDATIONS Parents visiting the child welfare clinics had poor child oral health practices, consequently, they should be educated on child oral health practices and how to utilize the mother-child booklet for oral health.
Copyright (c) 2025 Kaguru George, Mutave Regina James, Ayah Richard, Karimi Peter, Mugambi Cosmas https://creativecommons.org/licenses/by/4.0
Level of Awareness of PrEP among the General Population and HealthCare Providers in Kisumu County
BACKGROUND Even though the Human Immune Deficiency Virus (HIV) prevalence has stabilized, the disease continues to pose challenges, with about 1.3 million cases reported globally and over 22,000 reported in Kenya, making it necessary to use Pre-Exposure Prophylaxis (PrEP) as one of the effective ways used to prevent infection among individual at risk. The study aimed to assess the awareness level of PrEP among the general population in Kisumu County, Kenya. METHODOLOGY The study used a cross-sectional mixed-methods design where data were collected in January 2024 using a questionnaire and key informant interviews with health care providers (HCPs). We used random systematic sampling to select 435 participants from the outpatient departments of selected facilities in Kisumu. Purposive sampling was used in the selection of eight health care providers in these facilities. Descriptive statistics were used to analyse the quantitative data, while narrative analysis was used to analyse the qualitative data. RESULTS Out of the total number of participants, a majority was female (73.79%) and married (63.91%). In addition, 8 health care providers (HCPS) were purposively sampled for in-depth interviews. Most of the participants (97.24%) had ever heard of Prep, with more than half (58.85%) first hearing about it from a healthcare provider. However, this knowledge varied with some participants having poor or scanty knowledge (28.74%), average knowledge (32.64%) and good knowledge (35.86%). Most of the participants (88.97%) would recommend PrEP to others. There was a low proportion of participants (9.89%) who said that their associates had myths concerning PrEP, with some believing that it lowers libido, causes infertility and continual use can make one acquire HIV. Healthcare providers revealed a high level of knowledge and understanding of PrEP and suggested the creation of awareness not only to the PrEP clients but also to the larger community. CONCLUSION There was a general high level of PrEP awareness among participants. However, the varying knowledge levels among participants, as well as the existence of myths and misconceptions, emphasise the need for targeted educational campaigns among the general population on this subject.
Copyright (c) 2025 Munala Anangwe Samson, Odongo Alfred Owino, Mungai Samuel, Muhinji Arnold, Odhiambo Fredrick Oluoch (Author) https://creativecommons.org/licenses/by/4.0
Factors Associated with Mental Health Illness among Construction Workers in Nakuru East Sub-County, Nakuru County, Kenya
Background: According to the World Health Organisation (WHO), mental health is a state of well-being enabling individuals to cope with daily life and contribute to society. In Nakuru Town East Sub-County, construction workers face unique mental health challenges due to short deadlines, long hours, financial stress, and stigma. This study explored the factors influencing their mental health. Methodology: A cross-sectional study was conducted with 275 participants to determine the factors impacting the mental health of workers in construction sites. Data was collected using questionnaires and IBM SPSS Statistics version 28.0.1.0 was used for analysis. Results: This study examined factors influencing mental health among construction workers in Nakuru East Sub-County. Findings revealed that 60.4% lacked safety training, and trained workers were 0.29 times less likely to report mental health issues (95% CI: 0.11–0.72). Awareness of mental health conditions was moderate (41.7%), with knowledgeable individuals being 0.64 times less likely to experience mental health problems (95% CI: 0.52–0.88). Stigma was prevalent, with 34.2% of participants holding negative views about mental health. Workers who experienced stigma, such as ridicule or discrimination, were 2.21 times more likely to face mental health issues (95% CI: 1.85–3.24). Only 32.9% were aware of mental health resources, which was associated with reduced risk (OR=0.29; 95% CI: 0.07–0.87). Additionally, 52.9% reported inadequate workplace support, which doubled the likelihood of mental health challenges (OR=2.08; 95% CI: 1.23–3.55). Short deadlines were reported by 68.8%, 67.5% lacked sufficient rest, 50.4% experienced job stress, and 29.2% were dissatisfied with their jobs. Conclusion: The safety training and awareness of mental health conditions act as protective factors against mental health issues in the construction industry in Nakuru East Sub-County. However, the likelihood of mental health issues is increased by the existence of stigma around mental health, a lack of safety training and knowledge about the resources that are accessible. Recommendation: Implementation of safety training, stigma-reduction campaigns, anti-stigma policies, anonymous assessments, and improved access to care through mobile clinics and workplace support systems should be enhanced. Structured workplace support systems and employee assistance programs will provide ongoing support. Further research will be necessary to assess the long-term impact and inform future policy development.
Depression and Anxiety in Construction workers
Copyright (c) 2025 Patrick Kiplelgo, Alexander Mbeke, Joseph Muchiri (Author) https://creativecommons.org/licenses/by/4.0
Determinants of Nurses' Ethical Decision-Making in Acute Care: A case study of Thika level V hospital
BACKGROUND Nurses in acute care settings often face complex ethical challenges, requiring them to make rapid and skilled decisions despite having limited clinical support. Moreover, novice nurses with limited experience frequently adopt linear decision-making approaches, which focus on single tasks and problems. However, in critical care environments, these decisions could significantly affect patient outcomes. Therefore, this study aimed to identify determinants influencing ethical decision-making among nurses working in the intensive care unit, renal unit, and emergency unit of Thika level V hospital, in Kiambu County, Kenya. METHODOLOGY Adopting an analytical cross-sectional design with quantitative and qualitative methods through a census approach, we recruited 36 registered nurses working in critical care settings of Thika Level V hospital. A self-administered questionnaire and a key informant interview guide were instruments used to collect quantitative and qualitative data, respectively. We analysed the quantitative data using SPSS version 26.0 for descriptive and inferential statistics and thematically analysed qualitative data using NVivo version 21.2. The Mantel-Haenszel chi-square test was used in the inferential analysis with P<0.05 considered statistically significant. The confidence interval was set at 95%. RESULTS The majority of nurses (75%) demonstrated low adherence to the ethical decision-making process. Work-related factors did not significantly influence adherence levels. Emerging thematic areas of ethical issues were three namely, resource allocation, paediatric care, and challenges affecting patient care in acute settings. CONCLUSION AND RECOMMENDATIONS Most nurses in Thika Level V Hospital’s acute care settings exhibited low adherence to ethical decision-making processes and work-related factors did not significantly affect their adherence. The ethical dilemmas the nurses faced were: the allocation of resources, handling of paediatric patients and ethical issues affecting care. To address these gaps, healthcare institutions should provide targeted support to nurses for navigating ethical challenges. We also recommend further research, inter-institutional collaborations, and dissemination of best practices to enhance ethical decision-making in critical care environments.
Copyright (c) 2025 Rachael Nyarangi Simeka, Sherry Oluchina, Jostine Mutinda https://creativecommons.org/licenses/by/4.0
Clinical and Hospital Level Predictors of Quality of Healthcare for Clients with Epilepsy attending Treatment at Selected Hospitals in Kenya
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.
Copyright (c) 2025 Tiberry D.O. Nyakwana, Simon Karanja, John Gachohi (Author) https://creativecommons.org/licenses/by/4.0
Impact of Point-of-Care Ultrasound in Triage on Diagnosis and Treatment of Trauma Patients in a Resource-Limited Setting in East Africa
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 (E-FAST) 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.
Copyright (c) 2025 Justin Myers , Janet Sugut, Sarah Ashley, Betty Ngila, Alice Maingi , Travis Wieland, Patricia Othieno , Timothy Platts-Mills, Rayad Shams (Author); Ali Wangara; Stephen Dunlop, Castro Jasper, Paul Mbuvi, Katherine M. Hunold , Adam Aluisio, Mark Hoppens, Philemon Kimathi, Daniel Ojuka , Grace Wanjiku (Author) https://creativecommons.org/licenses/by/4.0
Awareness and Knowledge of Ocular Allergy among Undergraduate Students in Public Universities in Zimbabwe: An online survey
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 in Zimbabwe 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.
Copyright (c) 2025 Michael Agyemang Kwarteng, Mitchel Goto, Samuel Kyei, Ngozika Esther Ezinne, Selassie Tagoh, Eugene Buah Enimah (Author) https://creativecommons.org/licenses/by/4.0
Knowledge and Practice of Relapse Prevention among Family Caregivers of Patients with Schizophrenia in Kano State, Nigeria
Background: Schizophrenia is a severe mental disorder which causes significant disability and burden. Primary caregivers, who are often family members, are responsible for relapse prevention by monitoring medication, detecting early warning signs, and facilitating hospital follow-ups. Caregiver knowledge and practices significantly influence the success of this role. Poor knowledge and practices can lead to high relapse rates. The study aimed to assess caregivers' knowledge and practices regarding relapse prevention and management among patients with schizophrenia. Materials and Methods: Using a cross-sectional design, this study investigated the knowledge and practices of relapse prevention among 166 family caregivers of patients with schizophrenia in Kano State, Nigeria. Data was collected using a socio-demographic questionnaire and an adapted Knowledge, Attitude and Practice (KAP) questionnaire. Analysis was carried out using chi-square tests and logistic regression. Results: Caregivers demonstrated good understanding of relapse, signs and preventive measures, with most utilising medication (93.4%) and regular clinic follow-up (94.6%) as relapse prevention strategies. The highest attributions as cause of relapse were poor compliance with medication (75.9%) and poor social support (74.7%), while positive symptoms (4.7%) were more readily identified as signs of relapse. Caregiver practices regarding relapse prevention independently predicted the number of admissions in the past year (OR=0.110, 95% CI= 0.014 – 0.832). Harmful practices such as physical restraints, confinement and visiting prayer houses during a relapse highlight a need for intervention. Conclusion: Study findings emphasise the importance of enhanced family interventions, family psychoeducation and tailored relapse prevention education in the management of schizophrenia. While caregivers demonstrate good knowledge and practices regarding relapse prevention, gaps remain. To enhance schizophrenia care, we recommend individualised psychoeducation to family caregivers, while policymakers should establish supportive frameworks and ongoing evaluations to foster caregiver empowerment and early interventions.
Copyright (c) 2025 Salman Mamman Shata, Aishatu Abubakar-Abdullateef, Hayat Gommaa, Fatima Balarabe, Hadiza Danjuma Mohammed (Author) https://creativecommons.org/licenses/by/4.0
Menstrual Cycle Patterns among Adult Females Attending a Neuropsychiatric Facility in Kaduna, Northwestern Nigeria
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 1st 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 was considered 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 menstrual flow 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.
Copyright (c) 2025 Mohammed-Durosinlorun Amina, Lasisi Marufa Dupe, Umar Abubakar, Taiwo Oduguwa (Author) https://creativecommons.org/licenses/by/4.0
A Comparative Study of Sexual and Reproductive Health Knowledge among Adolescents in Rural and Urban Secondary Schools of Ekiti-State, Nigeria
BACKGROUND Adolescents without adequate knowledge of sexual reproductive health are predisposed to high-risk sexual behaviours. Knowledge of sexual and reproductive health among adolescents is generally low, especially in rural areas. This study aimed to compare sexual and reproductive health knowledge and likely disparities among adolescents in rural and urban secondary schools. METHODOLOGY The study was a comparative cross-sectional design. Pre-tested, semi-structured, adapted questionnaires were administered to 669 students selected through a multistage sampling technique. Univariate, bivariate and multivariate analyses were conducted after entering data using SPSS version 25. Descriptive statistics (percentages, the sample mean, and frequency tables) were computed. Chi-square was used to determine the association between socio-demographic characteristics and knowledge. Multivariate analyses were conducted using binary regression, considering a p-value threshold of < 0.05. RESULTS Overall knowledge was 257 (65.2%) and 207 (75.3%) in the urban and rural, respectively. In the urban area 72.5% (n=150) of the females had good knowledge compared to only 57.2% (n=107) of the boys (p=0.006). Sex of participant was associated with knowledge of sexual reproductive health (p < 0.05). CONCLUSIONS The knowledge of sexuality, reproductive anatomy, and physiology among adolescents in rural schools was better than in urban schools. Knowledge of female adolescents was better than that of male adolescents, and the differences were statistically significant. RECOMMENDATIONS Culturally gender-sensitive educational intervention should be employed by the government, teachers, and parents.
Knowledge of Reproductive Anatomy and Physiology
Copyright (c) 2025 Oluremi Olayinka Solomon , Olusoji Abidemi Solomon , Victor Mayowa Adeleye , Eyitope Oluseyi Amu https://creativecommons.org/licenses/by/4.0