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Patterns of antimicrobial use in the neurosurgical ward of Kenyatta National Hospital
Get PDFBackground: Antibiotics in neurosurgery are used for prophylaxis and treatment of already established infection. Guidelines state that prophylactic antibiotics should be given for up to 24 hours. For treatment of already established infections, empiric therapy with intravenous antibiotics for four to eight weeks is indicated. Studies have shown no distinction between antibiotic use for prophylaxis and treatment of established infection in neurosurgery. Objectives: To identify antibiotic use patterns and medication errors and their association with development of surgical site infections. Methods: A prospective cohort study involving adult neurosurgical patients was carried out at Kenyatta National Hospital, between April 2015 and July 2015. Patient demographic data as well as data on surgical procedures carried out, antibiotics used and medication errors was collected. Descriptive data analysis was done for all variables. To test for association between antibiotic use patterns and development of surgical site infections, the Fischer exact Chi square test was used. Results: Out of the 84 participants recruited in the study, 87.2% (n=68) used antibiotics. Ceftriaxone was the most commonly used (63.7%, n= 44), followed by metronidazole (40.4%, n=23). Medication errors that were noted involved inappropriate choice and use of antibiotics. There was no distinction between use of antibiotics for prophylaxis and treatment of infection. There was no statistically significant association between patterns of antibiotic use and development of surgical site infection. Conclusion: Antibiotic use patterns do not affect the incidence of neurosurgical site infections. Prescribing errors of various types were prominent. An antibiotic use protocol should guide antimicrobial selection and use in neurosurgery. Key words: antibiotic, prophylaxis, medication error
Analysis of Ethyl succinate and Ethyl β-riboside from Acalypha wilkesiana var. golden-yellow (Muell & Arg.)
Get PDFBackground: The genus, Acalypha is one of the many genera in the Euphorbiaceae family. A. wilkesiana var. golden-yellow (Muell & Arg.) syn. A. wilkesiana var. tropical tempest is a species and variety employed in traditional medicine for the treatment of gastrointestinal disorders, inflammations, bacterial and skin fungal infections amongst many others. Before now, some biological investigations had been done but very limited chemical studies have been carried out on the plant. Objectives: This study was principally done to isolate chemical compound(s) inherent in the plant and also evaluate their antimicrobial potential. Methodology: The leaves were to extracted cold with 50% ethanol and the resultant aqueous crude extract partitioned with butanol. Isolates obtained from the silica-gel column chromatography of the butanol fraction were analysed for antimicrobial activities using the hole-in agar diffusion technique. The compounds were screened for both antibacterial and antifungal activities using the microbes namely, B. subtilis, S. aureus, E. coli, P. aeruginosa, S. typhi, V. cholerae and C. albicans. Results: Two compounds, designated as compounds W-1 [Rf (0.76); [n]20D (1.4333 )] and W-2 [Rf (0.58)] were isolated. The structures of W-1 and W-2 have been established to be 4-ethoxy-4-oxobutanoic acid (ethyl succinate) and 2-ethoxy-5(hydroxymethyl)-oxalane-3,4-diol (ethyl β-riboside) respectively using the 1H NMR, 13C NMR, MS and IR spectral techniques. Both compounds were inactive against B. subtilis, S. aureus and E. coli. Interestingly, W-1 and W-2 demonstrated very minimal activity against P. aeruginosa, S. typhi and V. cholerae. However, neither gave any anticandidal activity. Conclusion: The two isolates (though generally weakly active) would serve as chemotaxonomic markers for this species and variety in particular and the genus, Acalypha in general. Keywords: Ethyl succinate; ethyl β-riboside; A. wilkesiana var. golden-yellow (Muell & Arg.
Determinants of Discontinuation of Contraceptive Methods among Women at Kenyatta National Hospital, Kenya
Get PDFBackground: Contraceptive use prevalence in Kenya is at 58% according to the 2014 Kenya Demographic Health Survey. Several factors lead to discontinuation and switch of contraceptives. Discontinuation rate as per the 2008/2009 KDHS for one year was 35.8%. Objectives: To find out the determinants of discontinuation and switching of hormonal and IUD contraceptive methods. Methodology: The study was a cross-sectional hospital based one, where data was collected by use of an interviewer administered questionnaire at Kenyatta National Hospital, where 400 women were interviewed. The data was then analyzed by use of the statistical software, SPSS Version 20. Results: The study population mainly comprised married women with a mean age of 31.45±6.40 years. Most women chose a contraceptive method which they perceived had the least adverse effects. Discontinuation rate by the time of study in the study population was 60.8%, with adverse effects as the most cited reason for discontinuation. The method of contraception and presence of co-morbidity were the factors associated with discontinuation of a contraceptive. Survival analysis showed that depot injection and Jadelle® (Levonorgestrel releasing implant 75mg) had the highest median months of use and Impanon® (Etonogestrel implant 68mg) the least. Conclusion: The reasons for discontinuation of contraceptive use include primarily concerns for adverse effects, use inconvenience, desire for pregnancy, contraceptive failure, and doctor’s advice. Key words: Contraceptive discontinuation, adverse effects, duration of us
Intellectual Capital and Performance of Firms Listed on Nairobi Securities Exchange
Get PDFBased on a survey of 50 firms listed on Nairobi Securities Exchange, this study examines the relationship between intellectual capital (human capital, social capital and organizational capital) and organizational performance. In order to test the study’s hypotheses and their effecton organizational performance, a series of hierarchical multiple regression models were performed. In the first step we entered control variables (years of operation, ownership structure and size of the organization measured by number of employees) in all the analyses. In the second step, we entered the composite index of each of the three constructs of intellectual capital. Four hypotheses were formulated and were tested one at a time, beginning with nonfinancial where linear regression analysis were conducted to explain the variation among the variables. The study found that there was significant relationship between social capital, organizational capital and non-financial performance. Using optimal scaling the resultsindicated that intellectual capital had a significant influence on financial performance measured by return on assets. The findings also indicated that there was no significant relationship between intellectual capital and return on equity and Dividend Yield of firms listed on NairobiSecurities Exchange. The results provide support for the Resource based view of the firm (RBV), that the integration of intellectual capital constructs leads to competitive advantage and higher performance.Keywords: Intellectual capital, human capital, social capital, organizational capital, organizational performance
Joint and Individual Effects of Human Resource Management Practices, Organizational Learning, Employee Outcomes and Competitive Strategy on Performance of Firms Listed on the Nairobi Securities Exchange
Get PDFThis paper is based on empirical research carried out on firms listed on the Nairobi Securities Exchange in Kenya, focusing on the joint and individual effects of Human Resource Management Practices (HRMP), organizational learning, employee outcomes and competitive strategy on firm performance. Previous research demonstrating the link between HRMP andfirm performance has mainly focused on the private sector in the Developed World but has not used the selected variables, yet nderstanding this relationship in publicly listed firms, in the Developing World setting is equally important. The joint effect of HRMP, organizational learning, employee outcomes and competitive strategy on firm performance has not been established with the selected set of variables, yet theory has demonstrated that these variables can have an effect on firm performance. This study was motivated by the desire to fill this gapin knowledge. The objective of the study was to establish whether the joint effect of HRMP, organizational learning, employee outcomes and competitive strategy on firm performance is greater than the independent effect of HRMP, employee outcomes, organizational learning and competitive strategy on firm performance. The research design was cross sectional descriptive survey. Data was collected using a self-administered questionnaire, from a population of 60 NSE listed firms. The response rate was 60%. Descriptive statistics, correlation and regression techniques were used to analyze the data. The results of the study show that there was empirical evidence that the joint effect of HRMP, employee outcomes, organizational learning and competitive strategy on firm performance was greater than the individual independent effects of HRMP, employee outcomes, organizational learning and competitive strategy on firmperformance. This study contributes to understanding of the effect the predictor variables on firm performance, while at the same time confirms the findings of previous studies that have found a significant link between HRMP and firm performance. The study also established that the combined effect of predictor variables on firm performance was greater than the individual independent effects of the predictor variables on firm performance. It is recommended that firms have to ensure that they synergistically combine various variables that they choose to usein order to attain and sustain a superior competitive advantage in their operations. Key words: Human Resource Management Practices (HRMP); Employee Outcomes;Organizational Learning; Competitive Strategy; firm performanc
Toxicological Assessment of Co-treatment with Rifampicin and Tenofovir on Serum Electrolytes and Kidney Histology of Albino Rats
Get PDFBackground: Tenofovir and rifampicin have been individually implicated in renal toxicity characterized by electrolytes imbalance; hence concurrent use in human immunodeficiency virus/tuberculosis co-infection might induced synergistic electrolytes imbalance and kidney damage. Objectives: This study comparatively evaluated the effects of treatment with tenofovir, rifampicin and a combination of tenofovir-rifampicin on serum electrolytes levels and kidney histology of male albino rats. Methodology: Healthy adult male albino rats used for this study were divided into five (5) groups of sixteen animals (16) each. Animals in group A (placebo control) were treated orally with water while animals in group B (solvent control) were treated orally with arachis oil. Animals in groups C-E were treated orally with 80mg/kg of rifampicin, 32 mg/kg of tenofovir and tenofovir-rifampicin combination for 1-8 weeks respectively. At the end of drug therapy the animals were sacrificed and blood samples collected. Serum was extracted from the blood samples and analyzed for chloride, sodium, calcium, potassium and bicarbonate levels. Animals were dissected, kidney collected and analyzed for histopathological changes. Results: Treatment with a combination of tenofovir-rifampicin for 1-8 weeks did not produce significant (p>0.05) time-dependent effects on serum electrolytes when compared to treatment using individual doses of these agents. Kidneys of animals treated with these agents showed tubular necrosis, collapsed glomerular and collection of fibrous material on bowman’s space. Discussion and Conclusion: Treatment with a combination of tenofovir-rifampicin did not produce synergistic effects on serum electrolytes and kidney damage. The use of tenofovir – rifampicin combination in human immunodeficiency virus/tuberculosis co-infection may not be associated with electrolytes imbalance and kidney damage considering the dose level used for this study. Keywords: Tenofovir, Rifampicin, Toxicity, Electrolytes, Kidney, Rat
Abandonment of treatment and loss to follow up: a potential cause of treatment failure in patients with AIDS-related Kaposi’s sarcoma
Get PDFBackground: Management of patients with cancer is complex, multi-disciplinary, longitudinal and costly. Abandonment of treatment by patients and loss to follow up is a common scenario, especially in resource poor countries and severely compromises health outcomes. Objective: To assess the commitment to drug treatment protocol of patients with Acquired Immunodeficiency Syndrome (AIDS)-Related Kaposi’s Sarcoma at Kenyatta National Hospital, Kenya, over a 10 week period . Methods: The study design was prospective, observational, cross-sectional period prevalence study on patients infected with human immunodeficiency virus (HIV) with Kaposi’s sarcoma. Patients with histological diagnosis of Kaposi’s sarcoma were sequentially enrolled into the study as they attended either the Haematology or Radiotherapy clinic or during their admission in the wards. The choice of the treatment protocol was left at the discretion of the attending physician. A pretested data collection form was used to collect demographic and clinical information about the patients, including treatments prescribed and completion of follow up. Results: A total of 74 patients were enrolled into the study, 42 (56.8%) males and 32 (43.2%) females. The age ranged between 13 years to 55 years. Their treatment protocols included: Vincristine only, Vincristine plus Bleomycin, Vincristine plus Bleomycin plus Doxorubicin, Radiotherapy plus Vincristine and Radiotherapy only. Few of the patients were not assigned any antitumor treatment. Antiemetic and other conventional medicines were also prescribed when necessary. Fifty four (73%) of the patients abandoned treatment, five (6.8%) died, 15(20.3%) continued to attend clinic over the 10 week period. There was no significant association between sex and outcome (p=0.661). Discussion: The results of this study demonstrate that abandonment of treatment is a major problem among patients on treatment for cancer in Kenyatta National Hospital in Kenya. Abandonment of treatment heavily contributes to poor clinical outcome hence complicating the burden of cancer in the country. It is therefore important to develop and establish follow-up systems to improve adherence to treatment for the cancer patients at Kenyatta National Hospital. Key words: Abandonment of treatment, Loss to follow up, AIDS-Related Kaposi’s Sarcom
Assessment of the analgesic activity of methanolic leaves extract of Spondias mombin Linn (Anarcadiaceae)
No full textBackground: Spondias mombin belongs to the family of Anacardiaceae. It is a fruitiferous tree and all parts of the plant are reported to be used in traditional medicine. It is also a well-known febrifuge, treats spasms, relieves stomach cramps and reduces pain during childbirth. Objective: The present study was designed to investigate the analgesic properties of methanolic leaves extract of Spondias mombin in male and female mice. Methodology: the analgesic activity of the methanolic leave extract of Spondias mombin at a dose range of 420 mg/kg, 210 mg/Kg and 105 mg/Kg was evaluated in mice using, as standard drugs, paracetamol at a dose of 100 mg/Kg for the writhing test and morphine at a dose of 10 mg/Kg for the tail flick test Results: The methanolic leaves extract of Spondias mombin injected intraperitoneally to mice at a dose range of (420 mg/Kg b.wt; 210 mg/kg b.wt and 105 mg/Kg b.wt) respectively decreased abdominal writhing induced by the acetic acid at a rate of 65.75%; 50.97% and 33.07%. However, the extract of Spondias mombin showed no effect using the Tail flick test. Discussion: The methanolic extract of Spondias mombin at the doses of (420 mg/kg; 210 mg/kg and 105 mg/kg) caused a dose dependant inhibition of pain. The methanolic extract of Spondias mombin showed no effect on tail withdrawal. The analgesic activity of the methanolic extract of Spondias mombin may be peripheral and could be due to the bioactive metabolites it contains. Conclusion: The methanolic leaves extract of Spondias mombin might have a peripheral analgesic property. Keywords: Spondias mombin, Writhing test, Tail flick test, methanolic extrac
Poverty And Food Security Among Female-Headed Households in Kenya: The Case of Nyatike Constituency, Migori County, Western Kenya
Get PDFThe increase in female-headed households in Kenya has contributed to increased poverty levels leading to deliberate efforts by the national government as well as other stakeholders to develop strategies to help alleviate poverty. However, in spite of substantial efforts to eradicate poverty, studies have shown an increase in prevalence, especially in female headed households both globally and locally. This paper aims at establishing the causes of poverty among female headed households in Nyatike constituency, Migori County in Western Kenya. The study sought to assess the poverty and food security situation in Nyatike Constituency using a cross-sectional descriptive research design, which adopted both qualitative and quantitative methods. The study population consisted of female-headed households with the unit of analysis based on individual, female respondents. A sample of 29 female heads of households was purposely selected from the clusters identified by the Kenya National Bureau of Statistics. Moreover, questionnaires and a focus group discussion were the primary data collection tools inequality is costly and that by reducing it, both men and women benefit
Women’s Organising for Self Improvement in Colonial and Post Colonial Kenya: A Historical Analysis
Get PDFResearch on women’s activities and interests was spurred by the feminist movement in the 1960s and has sustained its recognition as a genuine field of investigation. Since early 1970s national and international attention has focused on women. In Africa, research on women grew intermittently in the wake of the global feminist movement and despite numerous setbacks it has grown incredibly. It was particularly boosted after the UN Declaration of Women’s Decade in 1975. The declaration of the UN decade for women produced both rhetoric from government officials and feminist leaders about women’s significance in all aspects of life and determined efforts to improve women’s education, economic situation, social status and political participation. Consequently discussions by and about women began to take centre stage and continues to play an important role in contemporary political debate. This means that what was considered the women question in the 19th Century became a central or core issue in the 20th Century. The potential and actual contribution of women to political, cultural, and socio-economic development of Africa and their special needs and problems in development have been reiterated in the expanding literature on women.[1] There is generally an expanded database on the operation of women in society and group context internationally. Such publications have increased as the production of social knowledge on women proliferates. In Kenya women are currently remaining in several research agenda and efforts of many scholars have made the literature on gender and women to increase enormously. Although it is recognised that women are agents of historical change and objects of policy consideration there is still paucity in what can be considered her story in Africa and Kenya specifically. [1] See Ndeda 2002