Mount Kenya University Institutional Repository
Not a member yet
5772 research outputs found
Sort by
Coronavirus Disease 2019 Diagnostics: Key to Africa's Recovery
No full textWith the coronavirus disease of 2019 (COVID-19) becoming a full-blown outbreak in Africa, coupled with many other challenges faced on the African continent, it is apparent that Africa continues to need diagnostics to enable case identification and recovery to this and future challenges. With the slow vaccination rates across the continent, reliable diagnostic tests will be in demand, likely for years to come. Thus, access to reliable diagnostic tools to detect the severe acute respiratory syndrome of the coronavirus-2 (SARS-CoV-2), the virus responsible for COVID-19, remain a critical pillar to monitor and contain new waves of COVID-19. Increasing the local capacity to manufacture and roll-out vaccines and decentralized COVID-19 testing are paramount for fighting the pandemic in Africa
Assessment of performance and implementation characteristics of rapid point of care SARS-CoV-2 antigen testing
No full textBackground: The COVID-19 pandemic has resulted in a need for rapid identification of infectious cases. Testing barriers have prohibited adequate screening for SARS-CoV-2, resulting in significant delays in commencement of treatment and outbreak control measures. This study aimed to generate evidence on the performance and implementation characteristics of the BD Veritor™ Plus System rapid antigen test as compared to reverse transcription polymerase chain reaction (RT-PCR) for diagnosis of SARS-CoV-2 in Kenya.
Methods: This was a field test performance evaluation in adults undergoing testing for SARS-CoV-2. Recruited participants were classified as SARS-CoV-2-positive based on RT-PCR carried out on nasopharyngeal swabs. Antigen tests were performed with simultaneous RT-PCR on 272 participants, allowing estimation of sensitivity, specificity, positive and negative predictive values for the rapid antigen test. Implementation characteristics were assessed.
Results: We enrolled 97 PCR negative symptomatic and 128 PCR negative asymptomatic, and 28 PCR positive symptomatic and 19 PCR positive asymptomatic participants. Compared to RT-PCR, the sensitivity of the rapid antigen test was 94% (95% confidence interval [CI] 86.6 to 100.0) while the specificity was 98% (95% CI 96 to 100). There was no association between sensitivity and symptom status, or between the cycle threshold value and sensitivity of the BD Veritor. The rapid test had a quick turnaround time, required minimal resources, and laboratory personnel conducting testing found it easier to use than RT-PCR.
The relatively high sensitivity of BD Veritor may be partially attributed to shortages of RT-PCR testing materials, resulting in specimen analysis delays and potential degradation of viral genetic material. Therefore, in resource-constrained settings, rapid antigen tests may perform better than the reference RT-PCR, resulting in prompt institution of isolation and treatment measures.
Conclusion: The BD Veritor rapid antigen test’s high sensitivity should be interpreted with consideration to the challenges occasioned by RT-PCR testing in resource-constrained settings
Development of an assessment and referral tool for alcoholic liver injury among adults in selected counties in Kenya
No full textAlcohol consumption has been practised for many years in different cultures and
societies in the world. Persons who consume alcohol for long periods usually
experience adverse bodily harm yet the assessment and referral system on the harm
caused is inadequate. Alcohol screening through the use of Alcohol Use Disorders
Identification Test (audit) tool is widely acceptable globally. Other alcohol testing tools
that are paramount in detection of alcoholic liver injury include the laboratory test for
liver biomarkers. This study aimed to correlate the alcohol use disorder identification
tests results with the results of the liver biomarkers and then develop an assessment and
referral tool for alcoholic liver injury among adults in selected Counties in Kenya. The
study was a non-experimental correlational study carried out in Murang’a and Uasin
Gishu Counties. The study was divided into three phases. Phase I which included the
use of audit tool to evaluate alcohol consumption, was achieved through administration
of a structured questionnaire. Participants were required to donate blood samples for
evaluation in the laboratories for liver biomarkers. An indpth interview was conducted
on clinicians regarding their referral system. Phase II involved analysis of data from the
audit tool and laboratory tests for liver biomarkers. Correlation of the blood samples
with the audit screening results was an activity of phase II. Phase III involved
formulation of an assessment and referral tool for alcoholic liver injury guided by the
results of phase II. The study adopted Cochran formula for determination of the sample
size. Data was scrutinized, cleaned and entered into a spread sheet using Statistical
Package for Social Sciences version 24. Quantitative data was analyzed using
descriptive statistical methods of mean, mode, median and standard deviation.
Inferential statistics involves Chi-square to show relationships between variables. The
analyzed data was then presented in tables, pie charts and frequency graphs.
Cumulative score for the audit results were correlated with the biomarker results to
develop an assessment and referral tool. Study results on Alcohol Use Disorder
Identification Test from the domain of hazardous alcohol use found that on the
sequence of alcohol consumption, 71% of the participants consumed alcohol 4 or more
times in a week. The test on dependence alcohol use found that on daily or almost daily
most of the participants were unable to stop drinking once started, were unable to meet
expectations due to drinking and needed a first drink in the morning after a heavy
session, they were represented by 51.6%, 51.6% and 66.7% respectively. On harmful
alcohol use 82% of the participants desired to cut down on their drinking. Results from
the liver biomarkers found that majority (97%) of the participants had alanine
aminotransferase levels of 41 to 80 IU/L. Eighty two (88.2%) participants had aspartate
aminotransferase elevated to between 35 and 68 IU/L. Gammaglutamyl
aminotransferase was elevated in all 93 (100%) of the participants. From the qualitative
data the clinicians were not well informed about the World Health Organization and the
government referral system for alcoholic liver diseas
African-specific polymorphisms in Plasmodium falciparum serine repeat antigen 5 in Uganda and Burkina Faso clinical samples do not interfere with antibody response to BK-SE36 vaccination
No full textBK-SE36, based on Plasmodium falciparum serine repeat antigen 5 (SERA5), is a blood-stage malaria vaccine candidate currently being evaluated in clinical trials. Phase 1 trials in Uganda and Burkina Faso have demonstrated promising safety and immunogenicity profiles. However, the genetic diversity of sera5 in Africa and the role of allele/variant-specific immunity remain a major concern. Here, sequence analyses were done on 226 strains collected from the two clinical trial/follow-up studies and 88 strains from two cross-sectional studies in Africa. Compared to other highly polymorphic vaccine candidate antigens, polymorphisms in sera5 were largely confined to the repeat regions of the gene. Results also confirmed a SERA5 consensus sequence with African-specific polymorphisms. Mismatches with the vaccine-type SE36 (BK-SE36) in the octamer repeat, serine repeat, and flanking regions, and single-nucleotide polymorphisms in non-repeat regions could compromise vaccine response and efficacy. However, the haplotype diversity of SERA5 was similar between vaccinated and control participants. There was no marked bias or difference in the patterns of distribution of the SE36 haplotype and no statistically significant genetic differentiation among parasites infecting BK-SE36 vaccinees and controls. Results indicate that BK-SE36 does not elicit an allele-specific immune response
Tuning the reactivity of ruthenium(II) terpyridyl complexes using auxiliary ligands: kinetic and mechanistic studies.
No full textSubstitution behavior of the labile aqua ligand in four mononuclear ruthenium(II) terpyridyl complexes with different auxiliary N (pyridine) (Ru1), N^N (2,2′-bipyridyl (Ru2), 2′-(2-pyridyl)quinoline (Ru3), 2,2′-biqunoline (Ru4) ligands was investigated using three nucleophiles; thiourea, 1,1-dimethylthiourea and 1,1,3,3-tetramethylthiourea. The effect of concentration and temperature on the substitution behavior of the complexes were studied under pseudo-first order conditions using UV–Vis spectrophotometer. The second order rate constants (k2) of the aqua complexes decreased in the order: Ru4 > Ru3 > Ru1 > Ru2. The results showed that the rate of substitution of the aqua ligand increased with an increase in the π-surface area of the N^N bidentate auxiliary ligands. This is attributable to an upsurge in π-back-donation and electrophilicity of the complexes as the π-extension of the auxiliary ligands increases. Ru2 is less reactive than Ru1 due to the increased steric hinderance introduced by the 2,2′-bipyridyl bidentate auxiliary ligand in Ru2 compared to Ru1 which has two independent trans pyridines. From computational results, it was observed that as the aromatic surface area of the auxiliary ligand increased from Ru1–Ru4, the HOMO–LUMO gap decreased accordingly. Consequently, the chemical softness and electrophilicity of the complexes increased accordingly. This is corroborated by the decrease in pKa values of the complexes as one moves from Ru1 to Ru4. As a result, the nucleophilic attack becomes facile from Ru1 to Ru4. All the reactions follow an associative interchange mechanism as indicated by the positive activation enthalpy and negative activation entropy. The crystal structure of bipyridylterpyridylthiourearuthenium(II) perchlorate show that the substitution product obtained is stable
Heterodinuclear Ru–Pt Complexes Bridged with 2,3-Bis(pyridyl)pyrazinyl Ligands: Studies on Kinetics, Deoxyribonucleic Acid/Bovine Serum Albumin Binding and Cleavage, In Vitro Cytotoxicity, and In Vivo Toxicity on Zebrafish Embryo Activities
No full textDi- and poly-homo/heteronuclear complexes have great potential as anticancer drugs. Here, we report their reactivity, deoxyribonucleic acid (DNA)/bovine serum albumin (BSA) binding and cleavage interactions, in vitro cytotoxicity, and in vivo zebrafish embryo toxicity of [(phen)2Ru(μ-L)PtCl2]2+ (phen = 1,10-phenanthroline and L = 2,3-bis(2-pyridyl)pyrazine, bpp, C1; 2,3-bis(2-pyridyl)quinoxaline, bpq, C2ial; 2,3-bis(2-pyridyl)benzo[g]quinoxaline, bbq, C3) anticancer prodrugs. The substitution reactivity increases from C1 to C3 owing to an increase in the π-conjugation on the bridging chelate which facilitates π-back bonding. As a result, the electrophilicity index on the C3 complex increases than that on the complex C2 followed by C1 which leads to higher rates of substitution and thus the reactivity order follows C1 9 μM); furthermore, the selectivity index and SI values were higher (>3). Complex C3 showed the highest cytotoxicity with IC50 = 3.1 μM and SI value (5.55) against MCF7 cell lines and these values were comparable to those of the cisplatin (IC50 and SI values are 5.0 μM and 4.02, respectively). In vivo toxicological assessments on zebrafish embryos revealed that all the Ru–Pt complexes (CI/2/3) have poor embryo acute toxic effects over 96 h postfertilization, hpf with LC50 > 65.2 μM. The complex C3 has shown the lowest embryo toxicity (LC50 = 148.8 μM), which is comparable to that of commercial cisplatin (LC50 = 181.1 μM). Based on the cytotoxicity results, complexes C2 and C3 could be considered for further development as chemotherapeutic agents against MCF breast cancer cells
Application of Richmond agitation sedation scale among nurses in critical care units at Aga kkhan University hospital, Nairobi, Kenya.
No full textThe Richmond Agitation Sedation Scale (RASS) is a useful tool used in CCU settings
to determine the level of alertness or agitation. If properly applied, the tool can reduce
common mortalities and morbidities as well as improve patient comfort. However, its
application and determinants of its application are not well studied by previous
researchers. The study sought to assess the application of the tool among the critical
care unit nurses at Aga Khan University Hospital, Nairobi. A sample of 92 nurses was
drawn from the target population of 106 nurses through stratified proportionate random
sampling to minimize errors of precision that can occur while conducting the study
without observing proper representation. Data was obtained from the participants
through a checklist and self-administered questionnaires. However, a pretest involving
9 nurses at Intensive care unit of Aga Khan University Hospital which is equated to
mean 10% of 92 nurses taken as the sample size was utilized to evaluate the validity
and reliability of the tool to be utilized. Data coding and entry was done via SPSS
version 25 which helped in the analysis and interpretation of the data. On data
presentation, tables, graphs, pie charts, and histograms were utilized. The outcome was
then disseminated to Mount Kenya University, presented in seminars and conferences
and published in a journal made to contribute to the pool of knowledge on this field.
Results were utilized to inform decisions on its application at AKUH with involvement
of policy makers. The response rate was 97% and as for socio-demographic
characteristics, majorities (51.7%) were aged 31-40years. The mean RASS application
score was 85.6% and a standard deviation of 16. Majority (71.9%) had high RASS
application level. The findings revealed that, none of the institutional factors influenced
RASS application. This necessitates follow-up of nurses through support supervision
and regular audits, to oversee the application of RASS. The level of application of
RASS was found to be high at AKUH. This was justified by the high application mean
score (85.6%) and the high application level by majority (71.6%) of the respondents.
The study recommended that; the nurses in conjunction with AKUH administration
should strive to increase the number of nurses attending critical care courses.
Attendance of these refresher courses actually translates to better RASS application and
as such, they need to be taken a bit more resolute. The institution should put in place
policy and RASS guidelines
Influence of personality traits on domestic gender based abuse among prisoners in Kiambu county, Kenya
No full textDomestic gender based abuse is a world-wide health issue and is the foremost
widespread form of abuse. The prevalence of domestic gender based abuse in Kenya is
about 39% and is heavily exacerbated by individuals‘ personality traits and their past
experiences. The purpose of this research was to determine the prevalence of domestic
gender based abuse among prisoners in Kiambu County, Kenya, to investigate the
Influence of personality traits on domestic gender based abuse among Prisoners in
Kiambu County, Kenya. The objectives were; to determine how openness influences
domestic gender based abuse, to establish the relationship between conscientiousness
and domestic gender based abuse, to investigate the extent to which extroversion affect
domestic gender based abuse, to determine the extent to which agreeableness affects
domestic gender based abuse and to determine the relationship between neuroticism and
domestic gender based abuse. The study location was prisons in Kiambu County,
Kenya. The study used a correlational research design. The theory that informed the
study was McLeod‘s Five Factor Model. The target population was 10,334 inmates
convicted of domestic related crimes. To select a sample size of 370 participants, a
random sampling was used. Data collected using questionnaires. Using the Pearson
correlation test, Hypotheses were tested at 0.05 level of significance. The study found
that 75.7% of the inmates experienced domestic gender based abuse. with 85.7% of
female inmates reporting that they experienced domestic gender based abuse compared
with male inmates who reported at 75%. The study found that 22.8% inmates with
openness personality trait were cautious, consistent, and conservative while 77.2% were
curious, inventive, and imaginative. The study also found that 41.8% inmates with
conscientiousness personality were easy going, disorganized and perhaps careless,
while 57.8% were efficient, disciplined and well organized. The study further found that
66.2% of inmates with extroversion personality had a more solidary, quiet, and reserved
trait while 33.5% had an outgoing, friendly, and energetic, trait. The findings also
demonstrate that 49.5% inmates with agreeableness personality type had a more
detached, proud, and uncooperative trait while 49.8% had a friendly, good natured and
compassionate trait. The study found domestic gender based abuse is due to the
extroversion and neuroticism personality traits. The study concluded that forgiveness
and reconciliation, family counselling, and education of the male child to appreciate
women responsibilities in the family and society are strategies that can be adopted to
reduce occurrences of domestic gender based abuse in society. The study recommends
personality testing of inmates to determine those with extroversion and neuroticism
personality traits associated with abuse for further counseling on anger management
strategies as they are vulnerable to perpetrating domestic gender based abuse
Factors influencing the uptake of antenatal care services among pregnant women in South Gaalkacyo district, Mudug region, Somalia
No full textPrenatal attention is necessary for health care of pregnant mothers. The purpose of this
research was to determine issues that influence the uptake of antenatal care service by
expectant mothers in South Gaalkacyo district in Mudug Region, Somalia. Specific
objectives of the study were: To assess pregnant women’s awareness of Antenatal Care
services (ANC); Determining the socio-economic factors that act as barriers to the uptake
of ANC among pregnant women; Evaluating infrastructural factors that act as Barriers to
uptake of ANC care services among pregnant women; and Assessing cultural factors that
contribute to underutilization of ANC, in South Galkayo District, Mudug Region, Somalia.
Maternal Mortality Rate (MMR) is 732 deaths of mothers for every 100,000 live births.
The high maternal mortality is attributed to a number of factors some of which were
investigated in this study. A sample population of 460 was selected from a target
population of 6,847 pregnant women in the study area using Yamane formulae of
1967.This research used a descriptive cross-sectional study design. The target population
was pregnant women aged between (15-49) years of age who met the inclusion criteria.
The sampling techniques of this study were systematic and simple random sampling
techniques. A Semi- structured questionnaire was used to collect quantitative data. Focus
Group Discussion (FGD) and Key Informant Interview (KII) guides were used to collect
qualitative data. Quantitative data was analyzed and presented in figures and pie Charts.
Qualitative data was analysed using themes and sub-themes and presented in summaries of
individual “quotes in boxes” after transcription and triangulation of saturated FGD and KII
participation. Chi-square test was used to test the associations while logistic forward
simple linear regression analysis using bi-variate and multi-variate was used to detect the
relationship between study variables. The result showed that knowledge was poor among
women (p=0.0001), source of income and family income influenced mothers’ use of ANC
services (P=0.002), accessibility and availability of ANC services affect the utilization at
p-value of 0.016 and 0.005 respectively. Cultural belief on TBA and husbands’ control
over their wives were listed among reasons why women underutilize the ANC services.
The study concluded that underutilization of ANC among expectant mothers is influenced
by women’s knowledge, level of education, socio-economic and cultural factors as well as
infrastructural factors. Cultural beliefs in patriarchy negatively influenced wives to seek
care. The study recommended the awareness by the government and health partners to
sensitize women on the importance of ANC service utilization using the Community health
workers and TBAs. Girl child education and micro-finance support to women group have
to be undertaken by the Government and partners to address the education and poverty
gaps. Taking health services to remote areas and use of mobile clinic outreaches were
among the recommendation to address the accessibility and availability of health services
gaps. The parliament should enact laws that reinforce women rights to alleviate men’s
control over their choice for ANC services
Implementation of possible severe bacterial infection guidelines in selected counties in Kenya
No full textSevere bacterial infections fall among the leading causes of neonatal mortality (0-59
days) globally. One in every five neonates in Kenya will die due to these infections.
This situation is aggravated by poor health care seeking behaviors by caregivers, poor
supply chain management, low health provider staffing, low care giver and community
health volunteer knowledge of PSBI presentation and management, dysfunctional
referral pathways among others. The purpose of this study was the implementation of
PSBI guidelines and generation of evidence aimed at addressing challenges in neonatal
and young infant care in hard-to-reach resource-limited settings. The objective of this
study was to demonstrate feasibility, acceptability, and sustainability of PSBI
implementation within the revised IMNCI guidelines where referral is not feasible in
selected counties in Kenya. The study employed implementation research where an
initial formative context mapping and assessment was conducted with routine quarterly
follow up assessments. Data collection entailed a capacity assessment in each of the
four counties on various health system domains, facility audits in 12 purposively
selected facilities to assess preparedness of facilities to manage PSBI, partner mapping
to identify potential stakeholders for collaboration in each county, mapping of past,
current and planned staff trainings, social costs analysis, Policy/stakeholder analysis,
assessment of community/provider perceptions and practices regarding newborn care
using in-depth interviews and focus group discussions. This was followed by six monthly case studies and narratives. Quantitative data was analyzed using independent
T test and Pearson’s chi-square. Qualitative data was described using themes and
narratives. Ethical clearance was sought from Mount Kenya University Institutional
Scientific Ethics Review Committee. The data was reported using tables, graphs, pie
charts and narratives. Dissemination of findings was through stakeholder forums,
advocacy, local and international conferences, and publications in peer-reviewed
journals. The health systems capacity assessment indicated average score of 70% across
counties and service delivery domain where Turkana, Mombasa and Kilifi scored a
green, but Bungoma scored amber of 65%. Only 29.2% of the facilities reported having
a functional newborn unit/area for neonates from the facility assessment. Qualitative
data alluded to several cultural contextual factors that predisposed young infants to
infections. The data also revealed that most caregivers were able to identify danger
signs of PSBI and roles of other household members were identified in line with
influencing factors on care seeking behaviors. The interventions and decision support
tools developed and tested to. facilitate integration of PSBI include a Job aid chart for
health providers to aid in assessment and classification of sick young infants,
informational pamphlets for caregivers and health providers, and a PSBI/IMNCI
Assessment and Follow up tool for appropriate documentation of management of sick
young infants. The findings on implementation research outcomes showed that indeed
the PSBI guidelines are acceptable, adoptable, with clear indication of their fidelity,
feasibility, and sustainability as public health interventions in low resource settings
where referral for sick young infants is not feasible. Consideration of contextual
variation, appropriate resource allocation, and training of health providers is necessary
for sustainable integration of PSBI guidelines in Kenya’s healthcare system