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Prevalence of Opportunistic Infections in HIV-infected adult patients at Kenyatta National Hospital, Kenya
Get PDFBackground: Opportunistic Infections (OIs) constitute the first manifestation of HIV infection, indicating significant immunodeficiency. OIs remain a leading cause of morbidity and mortality in HIV-infected persons. Since most of OIs are readily treatable and preventable, every effort should be made to facilitated their management. However, there is a need to establish local prevalence of OIs and evaluate their management. This would guide in prioritizing resource and support development of suitable management strategies. Objective: The main objective of this study was to establish the prevalence of HIV-related OIs in adult patients. Methodology: A hospital-based cross-sectional study conducted between July and August 2011 at Kenyatta National Hospital –Comprehensive Care Center (KNH-CCC). Adult patients who were HIV positive and attending outpatient clinic at KNH-CCC were included. Information was collected on patients’ demographics, clinical characteristics and presence of new or active OIs. Data was analyzed using Statistical Package for social Sciences (SPSS) version 11.5. Results: The prevalence of opportunistic infections was 14.1 % (95% CI: 10.7-18.5). Overall, the most commonly reported bacterial infection was pneumonia (6.4%) whereas pulmonary tuberculosis was reported in 3.6% of patients. Significant association was found between a patients’ current OI status and WHO stage when HIV was diagnosed (AOR= 3.79 [95% CI = 1.43 – 10.03], P=0.007) and duration since HIV diagnosis (AOR 3.89 [95% CI= 1.58-9.59], P=0.003. 90% of patients were prescribed Co-trimoxazole as chemoprophylaxis agent. Conclusion: There was a high prevalence of OIs among the HIV/AIDS patients at KNH-CCC. Bacterial Pneumonia and pulmonary tuberculosis were the most commonly observed OIs. Keyword: Prevalence, Opportunistic-Infections, HIV, Patients
Beyond Victims: Re-Representation of Women in Conflict
Get PDFAbstract The intransigent nature of war in parts of Eastern Africa continues to be a grave concern to the world. Periods of violence within the region have invoked memories of conflict by both men and women. Drawing on feminist studies of women’s autobiographical writings, this paper examines the experience of women during conflict. The memoirs highlight the special concerns of women, such as: malnutrition; shelter; reproductive health including childbirth and family planning; rape and sexual abuse; relocation stress; role strains and role change; family separation and perceived helplessness. Of specific interest is the manner in which female memoirs of conflict contest stereotypical images of women as passive victims of war. I argue that stereotypic images of women as apathetic victims of conflict overshadow their agency and contribution to peace building. The memoirs examined from Uganda, Sudan and Somali disprove the portrayal and treatment of women solely as victims. The writers under study help to institute a female role in national conflict and female literature of conflict. They provide concrete examples of how women demonstrate resilience in overcoming despair, participating in conflict prevention, management and resolution. This paper aims to contribute to the discourses on the inclusion of women in the different phases of conflict and peace building processes
Invoking Memories of Legendary African Women: A Reading of Rocha Chimera’s Trilogy Siri Sirini
Get PDFAbstract This article examines how legendary representations enable reinterpretation of the histories of women in Africa. It shows that ascribing heroic and revolutionary qualities to re-membered African women seeks to significantly transform societal gender perceptions of women as victims of history. Through a critical reading of Rocha Chimera’s trilogy Siri Sirini (2013), I attempt to show that legendary representations transcend victimhood by envisioning women as capable of confronting injustices in a quest to establish a new order where human dignity for allcan be realised. I also indicate that the power of interpretation of histories enshrined in literary texts is vital because this power usually embodies particular political investments with, in this case, regard to gender relations. The article concludes that legendary representations reinterpret, rewrite, and reinvent women’s histories and significantly transform readers’ worldviews in regard to gender relations. Key words: Gender, Swahili women, Siri Sirini, patriarchy, hypermasculinity
TRANSFORMATIONAL LEADERSHIP, EMPLOYEE OUTCOMES, AND PERFORMANCE OF UNIVERSITIES IN KENYA
Get PDFABSTRACT University education in Kenya has undergone major reforms in the last ten years thatpose challenges to both employees and universities. To address these challenges, universities needproactive leadership and a motivated workforce which transformational leadership can provide asit has the ability to motivate and empower employees to better organizational performance. Thisstudy sought to determine the factors that influence the relationship between transformationalleadership and performance and if this relationship is direct or it is mediated by other factors. Thestudy employed a positivist approach to research and used a descriptive survey research design.Data was collected from the top leadership of the 52 fully-fledged universities in Kenya using aquestionnaire. A response rate of 73% was realized. Descriptive statistics were used to obtain ageneral understanding of the universities while different statistical techniques such as regressionanalysis and correlation analysis were used to analyse data and test the hypotheses. The resultssupported all the hypotheses and showed positive and statistically significant relationships betweentransformational leadership and performance and between transformational leadership andemployee outcomes. Employee outcomes fully mediate the relationship between transformationalleadership and performance. It emerged that transformational leadership behaviour of the topleadership of universities in Kenya led to high employee performance and organizationaleffectiveness. Specifically the findings suggest that in terms of policy, universities need visionaryleadership and sound policies that will strengthen their position as a fundamental sector ingenerating human capital for the county’s developmental and economic needs. In terms of practice,the findings of this study are useful to the leadership of Kenyan universities in the formulation ofstrategies for improving performance and in developing leadership training policies for universitiesin Kenya. The results of this study have significant implications for theory in that they add to thebody of knowledge on the mediating effect of employee outcomes on the relationship betweentransformational leadership and performance as well as the universality of the transformationaltransactionaltheory across nations and societie
Human Resource Practices and Teacher Engagement in the Rural setting of Ugandan Schools
Get PDFThe study sought to examine the relationship between human resource practices andteacher engagement in secondary schools in the far north district of Arua. The study waspremised on the counter- productive work behaviors of some secondary school teachersworking in the rural setting of Uganda. There was however, lack of local empirical studieson the factors driving this trend. Cross sectional research design was adopted for thepurpose of the study using a sample of 226 respondents out of the total population size of514 teachers in the selected local government. Pearson Correlation and regression analysiswere used to find out the extent to which HR practices predict teacher engagement. Theresearch findings showed a positive Correlation between the study variables. The studyconcludes that there is need for the policy makers and school administrators to introduceand effectively apply HR practices namely recruitment and selection, reward, performancemanagement, staff development programmes and employee involvement aimed at inducingteachers’ engagement despite the upcountry setting in which they work. An earlier versionof this paper was presented at the 19thAnnual international management conference ofMakerere University Business School, September 2 -5, 2014
Treatment of chronic heart failure in adults at a referral hospital in Kenya: adverse drug reactions and determinants of adherence
Get PDFBackground: Chronic Heart Failure is a major health problem with a prevalence of between 1 and 12% in USA and Europe, and approximately 5.7% in Sub-Saharan Africa, and has socio-economic relevance owing to its high prevalence, mortality and impact on young economically active individuals. In 1999 chronic heart failure constituted 3.3% of all medical admissions at Kenyatta National Hospital. Objective: The purpose of the current study was to determine factors that affect adherence to treatment among patients with Chronic Heart Failure at Kenyatta National Hospital and assess any association between any such factors Methodology: This was a descriptive cross-sectional study involving patients >18 years diagnosed with Chronic Heart Failure at Kenyatta National Hospital. Eighty three eligible and consenting study participants were recruited into the study using a convenient sampling technique. Data were collected by means of an interviewer administered questionnaire adapted from the Revised HF Adherence Questionnaire. Results: Data from 83 patients was analyzed majority (n=51, 61.4%) of whom were women. The age of the patients ranged from 18 to 80 years with the majority (n= 37, 44.6%), between 21-40 years. Majority (n=58, 68.9%) of the patients considered appointment keeping, compliance to medication (n= 64, 77.1%), dietary restriction (n=59, 72%), regular exercise (n=49 59.0%), smoking cessation (n=59, 71%), and alcohol cessation (n=58, 69.9%) as very important. Fifty three (63.9%) respondents had not failed to take their medicines at any time. Majority (n=72, 86.8%) of the study participants were aware of the disease condition they were suffering from while valvular heart disease was the commonest comorbidity (n= 17 27.9%). The study revealed an association between sex and some adverse drug reactions using Pearson χ² test through bivariate analysis. Sleep disturbances and nausea occurred more in males than females while headache and drowsiness were more prevalent in females and in both cases the relationships were statistically significant (p< 0.05) Conclusions: Adherence to medicines among patients with Chronic Heart Failure is reasonably high at Kenyatta National Hospital despite patients’ knowledge level about the condition being generally low. Valvular heart disease was the most common comorbidity while hyponatremia was the most prevalent electrolyte disturbance, and tachycardia, vomiting and rash the most common adverse drug effects. Key words Chronic heart failure; adherence; compliance; adverse drug reactions
Antioxidant Activity of Acalypha wilkesiana var. lace-acalypha (Muell &Arg.)
Get PDFBackground: The incidence of free-radicals has become a major concern in health issues such as wounds, respiratory dysfunctions, heart troubles, cancers and inflammations amongst many others. The search for natural antioxidant drug templates led to the screening of Acalypha wilkesiana var. lace- acalypha for potential antioxidant activity. Objectives of study. The crude extract, butanol fraction and four compounds previously obtained from the plant were to be screened for antioxidant activity. Methodology: The extract, butanol fraction and four compounds designated as 5A-II (3), 5B (1), 5C (2) and 5D (H-2) obtained from silica-gel column chromatography of the butanol fraction were to be screened for antioxidant activity using DPPH reagent. Results and Discussion: The extract and butanol fraction of A. wilkesiana var. lace-acalypha demonstrated marginal antioxidant activity (IC50) of at 0.79 and 0.77 μg mL-1 respectively. However, 5B (1) and 5C (2) (both polyphenols) gave moderate antioxidant activities of 0.47 and 0.56 μg mL-1 respectively which compare favourably with the IC50 values obtained with vitamins C and A at 0.46 and 0.58 μg mL-1 respectively. However, 5D (H-2) demonstrated a relatively similar antioxidant activity as vitamin E at 0.66 and 0.60 μg mL-1 respectively. The antioxidant activities demonstrated by the plant extract/ fraction/compounds were not surprising because the phytochemical investigations carried out on the plant revealed the presence of terpenes and tannins which have been reported in previous studies to exhibit antioxidant activities. Conclusion: The results of the antioxidant assays have revealed that compounds isolated from the plant especially 5B (1) and 5C (2) could serve as potential antioxidant templates which could be further investigated in detailed in-vitro and in-vivo studies with the aim of improving on their activities for the fights against the destructive free-radical oxygenated species. Keywords: Free-radicals; antioxidant activity; DPPH; assay; Acalypha wilkesian
Are antepartum urinary tract infections associated with adverse perinatal outcomes in Kenya?
Get PDFBackground: Pregnant women are considered immuno-compromised because of the physiologic changes associated with pregnancy. Consequently, they often host urinary tract infections which have been implicated as a risk factor for numerous complications. Objective: To investigate the antepartum urinary tract infection profile among pregnant women in Kenya and their association with perinatal outcomes. Methodology: A retrospective cohort of expectant women admitted at Kisii Level 5 hospital in 2012 were studied to determine the prevalence of urinary tract infections in pregnancy. The antenatal records were also correlated with adverse perinatal outcomes. Results: Out of the 2014 pregnant women attending clinic in this study, 14.4% were diagnosed with urinary tract infections in the third trimester. The prevalence rate of the infections was affected by the age, with pregnant women below 25 years showing higher susceptibility (P= 0.018) compared to pregnant women above 35 years age group. There was a significant association between preterm delivery, low birth weights and urinary tract infections in pregnant women (P<0.01). However, there was no significant correlation between maternal urinary tract infections and the incidence of neonatal sepsis at P=0.05. Discussion: Pregnant women under the age of 25 are vulnerable to urinary tract infections resulting in adverse perinatal outcomes in the study population. This reinforces the need for screening of pregnant women and treatment of urinary tract infections to reduce perinatal complications. Further research is required to elucidate the underlying risk factors for neonatal sepsis. Key Words: pregnancy, urinary tract infections, perinatal outcomes, preterm delivery, low birth weigh
In vitro antileishmanial activity and phytochemical analysis of Carissa edulis against Leishmania major
Get PDFBackground: However, there is need to carry out scientific studies in order to confirm the medicinal properties of many plants used traditionally. Carissa edulis Forskk. (Gentiales: Apocynaceae) used by local communities for the treatment of various diseases has showed antiviral, antibacterial and antiprotozoal properties although there are no studies demonstrating its antileishmanial activity. Objective: To investigate in vitro antileishmanial activity of extracts of Carissa edulis on promastigote and amastigote forms of Leishmania major. Methodology: Solvent extraction of the stem parts of C. edulis was performed using water, methanol, petroleum ether, dichloromethane and ethyl acetate. Minimum inhibitory concentration (MIC), anti-amastigote and nitric oxide production assays were carried out to demonstrate antileishmanial activity of C. edulis extracts against the two forms of L. major parasite species: promastigote and amastigote. The extracts were also screened for phytochemical constituents present. Cytotoxicity assay was then done to assess their safe use as herbal medicinal products. Results: The C. edulis petroleum ether extract showed the strongest antileishmanial activity against L. major promastigotes (MIC=625μg/ml) with the water, dichloromethane and ethyl acetate extracts recording the weakest activity (MIC=2500μg/ml). The successive methanol extract reduced the number L. major amastigotes by 88.29% compared to the negative control (RPMI). The water (13.37μM), petroleum ether (12.93μM) and successive methanol extracts (12.82μM) produced nitrite values lower than the standard drugs Pentostam® (14.35μM) and Amphotericin B (14.13μM). Discussion: All C. edulis extracts have potential antileishmanial activity against L. major. Preliminary phytochemical screening of these extracts showed presence of alkaloids, terpenoids, phenols, anthraquinones and saponins. These phytochemicals were previously reported to have antileishmanial activity. Therefore, the plant extracts could offer an opportunity to develop cheaper antileishmanial alternatives to the more expensive pentavalent antimonials. Key words: C. edulis, L. major, promastigote, amastigot