East African Medical Journal

Determination of asbestos hazards exposure among maintenance workers in public Universities in Kenya

2024-03-07T06:24:30+00:00

Background: Asbestos are a group of minerals that are resistant to heat, fire, and chemicals and do not conduct electricity. They are divided into two distinct groups: serpentine (Chrysotile) and amphiboles (Crocidolite, amosite and tremolite). Workers in the maintenance departments in public Universities are involved in renovation, demolition & maintenance works and hence disturbs therefore contaminating themselves and the environment.

Objective: The main objective of this study was to determine the asbestos hazards exposure among maintenance workers in public universities in Kenya. Research Design: The study was conducted in 15 public universities out of the total 35 established by the Universities Act, 2012. The study adopted both descriptive and experimental research designs. Laboratory tests, air quality monitoring, microscopy approaches and questionnaires were used to collect primary data.

Outcome Measures: Microscopic observation, of the asbestos roofing materials indicated a grey brown color, positive sign of elongation, physical properties and appearances indicative of amphibole asbestos group.

Results: Chemical results revealed 4 main elements of calcium, magnesium, iron and silica in varying percentages. The mean area air sampling during sweeping of debris showed high levels exceeding the Occupational exposure limit (OEL) of 0.1 f/mL standard and had a significant mean F (2, 13) = 5.081, p<.05).

Conclusion: The study concluded that public universities environment and maintenance workers were exposed to asbestos fibres.

Recommendation: Public universities in Kenya need to increase their personal and area air concentrations measurements to help in early detection of the dangerous asbestos fibre exposure to personnel and environment.

Genexpert(MTB)Rif in culture confirmed cases of pulmonary tuberculosis sensitivity of sputum

2024-03-07T06:37:26+00:00

Background: Tuberculosis (TB) is a major public health problem worldwide with the highest mortality occurring in low-income countries. Accurate and early diagnosis is key to effective treatment, stopping the transmission and ultimately reducing the mortality associated with the disease.

Aim: To determine the sensitivity of sputum genexpert(mtb)rif for diagnosis of pulmonary tuberculosis (PTB) in culture confirmed cases.

Methods: This was a cross-sectional study where samples from 80 presumptive cases of PTB were analyzed with geneXpert at National Hospital Abuja (NHA) and University of Abuja Teaching Hospital (UATH) while the solid culture using Lowenstein Jensen media was conducted in Bingham University Research laboratory, Nasarawa state.

Results: A total of 80 sputum samples were evaluated in the final analysis. The mean age of the study participants was 40.18± 14.12 years. Out of the 80 samples analyzed, 24 (30%) were positive with GeneXpert, while 25 (31.3%) were positive with Mycobactrium tuberculosis (MTB) culture. For geneXpert: accuracy (98.8%), sensitivity (96.0%), specificity (100%), positive predictive value (PPV) (100%) and negative predictive value((NPV)98.2%). 24 out of 80 sputum samples that tested positive with GeneXpert (MTB)Rif, 4 were rifampicin resistant (RR) representing 16% of MTB isolates positive with GeneXpert (MTB)Rif.

Conclusion: GeneXpert (MTB)Rif is highly specific for the diagnosis of PTB in sputum samples. The prevalence of RR with GeneXpert (MTB)Rif in our study was higher compared to previous studies. This further increased the diagnostic performance of geneXpert(MTB)Rif and makes it a useful tool for early, accurate diagnosis of PTB and for simultaneous detection of RR which is usually considered a marker for DRTB.

Fetomaternal outcomes among normotensive and stage one hypertensive patients at a tertiary hospital in western Kenya: A prospective cohort study

2024-03-07T06:45:59+00:00

Background: The American Heart Association now defines blood pressure range between 130/80 to 139/89 as stage one hypertension. The effect of this blood pressure range on pregnancy outcomes is not well studied especially in SubSaharan Africa. Major obstetric authorities recognize the need for further studies on the effects of the newly defined stage one hypertension on pregnancy.

Objective: To compare the fetomaternal outcomes between normotensive and stage one hypertensive patients at a tertiary hospital in Western Kenya.

Methods: A prospective cohort study of 320 women between 15 to 49 years at Jaramogi Oginga Odinga Teaching and Referral Hospital. Non-probability consecutive sampling was used to recruit participants who were either normotensive or stage one hypertensive per the revised American Heart Association criteria. Both descriptive and inferential analyses were employed. Covariates with p-value < 0.05 were considered significant.

Results: 15.9% of the participants in the stage one hypertensive group developed gestational hypertension compared to 5.5% in the normotensive group. 17.9% of neonates born to participants with stage one hypertension required NBU admission compared to 10.3% in the normotensive group. 30.3% of neonates born to participants in the stage one hypertensive group had APGAR scores below 7 at one minute compared to 20.0% in the normotensive group.

Conclusion: Patients with stage one hypertension per the new American Heart Association criteria have an increased risk of getting both adverse fetal and maternal outcomes.

Bacterial aetiological agents of neonatal sepsis, risks associated with acquisition, and the susceptibility of these organisms to commonly used antimicrobial agents

2024-03-07T06:57:10+00:00

Background: Neonatal sepsis is estimated to cause 26% of all neonatal deaths worldwide. The incidence is higher in developing countries, responsible for about 30-50% of neonatal deaths.

Objective: This study aimed to determine the bacterial aetiological agents of neonatal sepsis, risks associated with acquisition, and the susceptibility of these organisms to commonly used antimicrobial agents.

Design, Setting and study participants: This was a retrospective cross-sectional study involving a review of inpatient and laboratory records of neonates admitted to Kenyatta National Hospital in period of January 2013 to December 2013.

Outcome measures: Bacterial agents from positive blood cultures and their antibiotic susceptibility pattern.

Results: A total of 226 positive blood culture reports were randomly selected for this study, with 116 (51.3%) isolates from female patients and 110 (48. 7%) from male patients. Coagulase-negative staphylococcus was the most commonly isolated organism (30.1%), followed by Enterobacter spp (19.9%), Citrobacter spp (12.8%), Klebsiella spp (11%) spp, with 26.2% divided among others. There was high resistance to antibiotics such as ceftriaxone (75.2%), cefuroxime (72.6%), ampicillin (82.9%), ceftazidime (67.1%) and gentamicin (65.6%). There was high sensitivity to vancomycin (100%), amikacin, piperacillin-tazobactamobactam (89.7%), teicoplanin (93.5%), imipenem (93.3%), meropenem (90.8%), piperacillin-tazobactamobactam (89.7%), amikacin (87.0%) and levofloxacin (83.8%).

Conclusions: Gram-negative organisms and Coagulase Negative Staphylococci were the leading cause of neonatal sepsis, most of which were resistant to multiple antibiotics. Continuous surveillance for antibiotic susceptibility should be done to look for resistance patterns.

Risk perception as a determinant of uptake of malaria prevention strategies among pregnant women in Busia county, western Kenya

2024-03-07T07:23:32+00:00

Background: Malaria mainly affects pregnant women and children under five. Insecticide Treated Nets and Sulphadoxine Pyrimethamine for intermittent preventive treatment in pregnancy are affordable methods of preventing malaria. Little is known on how risk perception affects utilization of malaria prevention strategies.
Objective: We investigated how risk perception affects uptake of malaria prevention strategies; specifically, uptake of nets and SP and prevalence of malaria among pregnant women.
Methodology: A total of 308 pregnant women proportionately sampled participated in a mixed study design done in 7 ANC clinics in Busia County. Questionnaires were used to collect data; descriptive statistics and the chi-square test was used to analyze quantitative data while qualitative data was analyzed using thematic analysis.
Results: With a response rate of 101.98%, malaria prevalence was 21.15%, the uptake of SP and ITNs was at 78% and 85.1%, respectively. Knowledge on malaria was significantly associated with uptake of malaria prevention interventions (x² = 4.427, p = 0.035). Risk perception was significantly associated with uptake of SP (x² = -0.128, p = 0.721). Risk perception positively influenced uptake and use of malaria prevention interventions among pregnant women. On thematic analysis, most women were knowledgeable about malaria and its transmission. Majority could not isolate the female anopheles as the vector.
Conclusion: The prevalence of malaria in pregnant women was 21.15%, net uptake was 85% while net use was 91%, and SP use was 78%. Knowledge on malaria and malaria risk perception were found to influence uptake of SP but not use of nets.

Quality of selected immunological and immunohematological tests in clinical laboratories in Kiambu County, Kenya

2024-03-07T07:40:04+00:00

Objective: This study is aiming at assessing the quality of external quality assessment control results of standard Immunological and Immunohaematological control samples generated by clinical laboratories in Kiambu County.

Design: This is a multi-site descriptive cross-sectional study. A total of 25 laboratories participated from all level in the external Quality Assurance program to determine the accuracy of the diagnostic results generated.

Results: The findings are that the immune-haematological test results are reliable, with the overall Intra-class correlation coefficient (ICC) being 0.994. Four out of seven immunological results shows no variation from the control results. For those with variations, Cronbach’s alpha is 0.515, the interclass correlation was 0.245, and the level of significance is 0.01; therefore, the four results are unreliable and are examined individually to ascertain the cause of variation

Conclusion: The diagnostic immune-haematological control results generated by different laboratories in Kiambu County have excellent reliability, meaning that the aspect of good laboratory practice towards quality is good. Some immunological results show variation; however, most are highly specific and sensitive.

Recommendations: The government and stakeholders establish more working continuous external quality assessment programs. Further studies to be done on tests with significant variation to establish if it is the test kits or just misdiagnosis.

COVID-19 prevalence, vaccination uptake and infection prevention and control among dentists and dental students in Nairobi, Kenya

2024-03-07T07:53:01+00:00

Objective: To determine prevalence of COVID-19, vaccination uptake and infection prevention and control (IPC) practices among dentists and dental students in Nairobi, Kenya.

Design: Descriptive cross-sectional study

Setting: Dental practices and the University of Nairobi Dental Hospital, Nairobi, Kenya

Participants: Dentists and dental students

Main outcome measures: Descriptive summaries of COVID-19 prevalence, vaccination uptake and IPC practices. For hypothesis testing, χ2 test and odds ratio was used to determine differences in COVID-19 prevalence among dentists and dental students (α=0.05).

Results: The response rate was 144 out of 168 (85.7%), 69 from dentists and 75 from dental students. Age range of dentists was 20–74yrs with more females 43 (62.3%) than males 26 (37.7%). Age range of dental students was 19–32yrs, and again, more females 39 (52%) than males 36 (48%) responded. PCR COVID-19 tests were positive for 14 (20.3%) dentists and 5 (6.7%) dental students. Participants who had obtained at least one vaccine dose were 66 (95.7%) dentists and 59 (78.7%) dental students. PPEs and other recommended IPC measures were routinely employed while attending to patients. As compared to dental students, odds ratio of a positive COVID-19 test among dentists in Nairobi was 3.56 (OR=3.56, χ2=5.823, df=1, p=0.0158).

Conclusion: Prevalence of COVID-19 among dentists and dental students in Nairobi was high despite observing IPC guidelines including a high COVID-19 vaccination uptake. A broader study is recommended for a definitive representation of oral healthcare workers in Kenya.

Correlates of missed visits by participants enrolled in a HIV prevention clinical trial in Eldoret, Kenya

2024-03-07T08:03:51+00:00

Objectives: To identify the factors associated with missing at least one visit among participants enrolled in the HSV/HIV Transmission Study, Eldoret Site.

Design: This was a retrospective study. Descriptive statistics for categorical and continuous variables were used to summarize data. Association between categorical variables was assessed using Pearson’s Chi-square test. Continuous variables were compared using two- sample Wilcoxon rank sum test. The relationship between the binary outcome and independent variables was assessed using logistic regression model. We reported the adjusted odds ratios (AOR) alongside the 95% confidence intervals.

Setting: The records of the participants enrolled in the Partners HSV/HIV Transmission Study, Eldoret Site formed the study population for this study.

Results: The median number of missed visits was 2 (IQR: 1-4). More female participants missed at least a visit (45% vs 34%). Fifty-seven percent of participants who reported social harm missed at least a visit. HIV status and distance > 100km to the clinic were associated with increased odds of missing at least 1 visit; AOR: 7.40 (95% CI: 3.95, 13.84); AOR: 4.49 (95% CI: 2.07, 9.73) respectively. A participant from a family with one additional child compared to another was associated with reduced odds of missing at least 1 visit, AOR: 0.84 (95% CI: 0.73, 0.96).

Conclusion: HIV status, distance of more than 100 kilometers and number of children were associated with missing at least one visit among individuals in HIV-1 sero-discordant relationships participating in the HIV prevention clinical trial in Eldoret.

Antepartum factors associated with primary postpartum haemorrhage among women seeking maternity care at Thika Level Five Hospital in Kiambu county, Kenya

2024-03-07T08:16:31+00:00

Objective: This study sought to assess the antepartum factors associated with primary postpartum haemorrhage among women seeking maternity care at Thika level five hospital in Kiambu county, Kenya

Design: The study adopted an unmatched case control study.

Setting: The study was carried out in maternity unit at Thika level five hospital in Kiambu County, Kenya

Subjects: The study population comprised of women of reproductive age who had delivered at Thika Level five hospital and had or did not have Postpartum Haemorrhage (PPH).

Study tools: The study used semi-structured questionnaire to gather data from mothers who experienced PPH within 24 hours of delivery for case group; while for control group on mothers who did not have PPH within 24 hours of delivery.

Data analysis: Data was analyzed using descriptive and inferential statistics (Binary logistic regression).

Results: Therefore, the study focused on 76 women (19 cases and 57 controls) Among the antepartum factors, history of postpartum haemorrhage was significantly associated with primary postpartum haemorrhage. Mothers’ with history of postpartum haemorrhage were 14.04 times more likely to have PPH than their counterparts (OR = 14.04; 95% CI[2.40 – 82.20]; P=<0.001).

Conclusion: The study concludes that the history of postpartum haemorrhage was significantly associated with PPH. This study’s result highlights the importance of clinicians being aware of a woman's history of PPH during antepartum care. Such awareness could lead to better monitoring and timely interventions to prevent or manage PPH

A rare case of renal fusion anomaly detected by renal scintigraphy

2024-03-07T08:24:48+00:00

Congenital renal tract anomalies are not infrequent and are an important entity to consider as they are often associated with congenital anomalies of other organs. If left untreated they may present with pathological sequalae eventually leading to kidney failure. Although many anomalies have been described previously by radiological modalities, there are few reports of detection on Technetium-99m diethylene triamine penta-acetic acid/dimercaptosuccinic acid (99m Tc-DTPA/DMSA) renal scans. We present a case of partial renal fusion with intact renal parenchymal function detected on 99mTc-DTPA/DMSA renal scans.