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Knowledge, attitude and practices on intermittent preventive treatment in pregnant women with malaria: a mixed method facility-based study in Western Kenya.
No full textIntermittent preventive treatment remains a core strategy for malaria prevention in pregnancy. Sulfadoxine-pyrimethamine is recommended for all pregnant women in malaria prone zones. It is scheduled monthly at each antenatal care visit up to 36 weeks. Here, we sought to assess the knowledge, attitude and practices on intermittent preventive treatment in pregnant women with malaria in Webuye hospital. Prior to the enrollment, ethical approval and permissions were sought from relevant institutions, as well as consents obtained from 140 participants aged between 18-49 years with gestation about 16 weeks. Malaria test was conducted via either microscopy or rapid test and participants were split into malaria positive and negative cohorts. Closed and open-ended questionnaire were administered to the participants and two focus group discussions were organized to collect their views. The results were expressed in percentage and Chi-square of association at a p-value equal or less than 0.05 (95%). Qualitative data were analyzed by the means of MAXQDA software. Our analysis revealed that there was a significant difference between the proportion of negative and positive groups among mothers’ knowledgeable on the side effects (p-value = 0.001), different doses (p-value = 0.012). Those who were informed about intermittent preventive treatment before administration (p-value = 0.003). The proportion of mothers knowledgeable about side effects and different doses were higher among the malaria positive group as compare to the negative with 52.9% versus 25.7% and 20.0% versus 5.7% respectively. Moreover, 76.3% of respondents reported that intermittent preventive treatment prevents malaria, 30.9% had the opinion that it causes abortion. Expectant women who were aware of the benefits of this strategy had this to say; “This medicine helps to reduce the effects of malaria and prevents mother to contract malaria”. However, those unaware had this to say; “I have never been told about something like that but it prevents diseases”. Those who knew about the schedule and side effects said “It is given three doses during each antenatal visit”. Therefore, good knowledge, attitude and practices of intermittent preventive treatment are key for control and prevention of malaria in endemic prone areas
Cost & Cost-Effectiveness of Implementing SD Biosensor Antigen Detecting SARs-CoV-2 Rapid Diagnostic Tests in Kenya
No full textThe COVID-19 pandemic has created a need to rapidly scale-up testing services. In Kenya, services for SARS-CoV-2 nucleic acid amplifying test (NAAT) have often been unavailable or delayed, precluding the clinical utility of the results. The introduction of antigen-detecting rapid diagnostic tests (Ag-RDT) has had the potential to fill at least a portion of the ‘testing gap’. We, therefore, evaluated the cost-effectiveness of implementing SD Biosensor Antigen Detecting SARs-CoV-2 Rapid Diagnostic Tests in Kenya.
We conducted a cost and cost-effectiveness of implementing SD biosensor antigen-detecting SARS-CoV-2 rapid diagnostic test using a decision tree model following the Consolidated Health Economic Evaluation Standards (CHEERS) guidelines under two scenarios. In the first scenario, we compared the use of Ag-RDT as a first-line diagnostic followed by using NAAT assay, to the use of NAAT only. In the second scenario, we compared the use of Ag-RDT to clinical judgement. We used a societal perspective and a time horizon of patient care episodes. Cost and outcomes data were obtained from primary and secondary data. We used one-way and probabilistic sensitivity analysis to assess the robustness of the results.
At the point of care, Ag-RDT use for case management in settings with access to delayed confirmatory NAAT testing, the use of Ag-RDT was cost-effective (ICER = US 1003.4). In a scenario with no access to NAAT, comparing the Ag-RDT diagnostic strategy with the no-test approach, the results showed that Ag-RDT was a cost-saving and optimal strategy (ICER = US$ 1490.33 per DALY averted).
At a higher prevalence level and resource-limited setting such as Kenya, implementing Ag-RDT to complement NAAT testing will be a cost-effective strategy in a scenario with delayed access to NAAT and a cost-saving strategy in a scenario with no access to NAAT assay.The project that generated data used in this study was made possible by the generous support of the World Health Organization. The study was an implementation Research on the use of Antigen Rapid Diagnostic Tests for Coronavirus Disease 2019 (COVID-19). The study entailed the assessment of field performance, feasibility, acceptability, ease of use and impact of Ag-RDTs for the diagnosis of SARS-CoV-2 infection in Kenya. The funding was awarded to JG. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Development of A Model to Enhance Peritoneal Dialysis Utilization Among Kidney Failure Disease Patients in Kenya
No full textPeritoneal Dialysis (PD) is the use of the peritoneal membrane as a dialyzer. Models for
PD utilization have been developed in high-income countries but only one in East Africa
(Tanzania) under the International Society of PD (ISPD) funding focusing on acute
kidney injury (AKI). This study was mainly to establish barriers to PD utilization and
develop a model for PD utilization among kidney failure (KF) patients in Kenya. A
descriptive – analytical cross-sectional study was conducted in 6 government dialysis
centers purposively selected. The study targeted 346 KF patients, 125 nurses (sample
size determined using Yammane’s formula), 6 nephrologists, 19 general physicians and
6 Policy makers (PM) from each hospital, 4 PM from the county governments, 2 PM
from the national hospital insurance fund (NHIF) and 2 from the ministry of health
(MOH). The nurses and patients were sampled using proportionate sampling (per
institution) then simple random sampling was used at the unit level. Physicians were
sampled through census while PM purposively sampled. A mixed method (Quantitative
and qualitative) research design was adopted to conduct the three phased research. In
phase one data was collected using a semi- structured questionnaire which was
researcher/self-administered. In phase two and three, Delphi approach was employed in
formulation and validation of the PD Model. The variables were demographic
characteristics/social economic information, knowledge, attitude and practice of PD,
barriers to PD utilization, awareness of PD and panelist’s views in the Delphi technique.
Data were managed in Microsoft Excel then exported to RStudio for analysis, SPSS
version 23 data analysis was done. Data was presented in tables and charts. Qualitative
data in phase one was analyzed thematically using content analysis and presented in
verbatim form. Qualitative data in phase 2 and 3 was structured, managed, and coded
using NVivo (version 12.0) and presented in tables. F-test was used for statistical analysis
for the Delphi technique. Hypothesis testing was done using chi-squared test. P-values
of less than 0.05 were considered statistically significant with a 95% confidence interval
(CI). The study significance was to understand how a good model for PD utilization will
help health service providers (HSP) and PM to identify areas of improvement in PD.
Results revealed 0.2% PD prevalence. The barriers were categorized as patient related,
healthcare related and policy related. The chi-square test of association revealed that the
HSPs knowledge of PD was significantly associated with the level of practice of PD (P=
0.003594) leading to the rejection of the null hypothesis of no association between the
level of knowledge and practice among HSP. Attitude of the HSP was found not to be
associated with level of practice (P= 0.8126) at 5% significance level thus the null
hypothesis was sustained. Awareness of PD was significantly associated with PD
utilization (P= 0.04415) thus rejecting the null hypothesis. The model developed was
statistically significant F = 5.396, p<0.001. In conclusion, there is awareness gap with
low utilization of PD among KF patients in Kenya. The researcher recommended
implementation of the detoneal dialysis, Kidney failure, Peritoneal dialysis
utilizationveloped model to guide PD utilization.
KEY TERMS: Model, Pertoneal dialysis, Kidney failure, Peritoneal dialysis
utilizatio
Application of nanopore sequencing to identify antimicrobial resistance 4genes, mobile genetic elements and virulence factors in clinical isolates.
No full textThe global health challenge posed by the emergence of antibiotic resistance pathogen is further exacerbated in African countries by the indiscriminate use of antibiotics, poor surveillance and lack of stewardship programs. To address this issue, we employed the Oxford Nanopore Technologies (ONT) to sequence 17 clinical isolates from a referral hospital in Kenya. Our comprehensive bioinformatics approach facilitated the assembly, identification of sequence types and prediction of antimicrobial resistance genes, mobile genetic elements (plasmids and integrons) and virulence genes. Of the 17 isolates, five were A. baumannii, four E. coli, three S. haemolyticus, three were E. cloacae, while S. aureus and E. faecalis were single isolates. For the detection of AMR genes, A. baumannii isolates harbored genes such as blaOXA-23 which mediates resistance to carbapenems, E. coli and E. cloacae carried blaCTX-M-15 which confers resistance to cephalosporins and S. haemolyticus harbored blaZ, responsible for resistance against penicillins. S. aureus co-haboured mecA and blaZ genes. In addition,, various other different AMR genes to chloramphenicol, macrolides, aminoglycosides, tetracycline were also observed. For plasmid replicons, E. coli carried the most number of plasmids and shared ColRNAI_1 and IncFIB(pB171)_1_pB171 with A. baumannii and IncR_1 with E. cloacae. Many genes encoding various virulence factors including fimA-I and ompA, senB were identified in E. coli, hlgA-C and hla/hly, hlb, hld in S. aureus and efaA, ebpA-C in E. faecalis. In conclusion, most isolates contained a combination of different AMR genes harbored in plasmids and integrons and virulence genes. This study provides significant information on genetic determinants of antibiotic resistant pathogens in clinical isolates and could assist in developing strategies that improve patient treatment
Biomolecular interactions of 1,3-bis(2-arylimino)isoindolate-based palladium(II) complexes: Substitution kinetics, DNA/protein-binding, and molecular docking approaches
No full textA series of 1,3-bis(2-arylimino)isoindoline Pd(II) complexes core viz.; Chlorido(1,3-bis(2-pyridylimino)isoindoline)palladium(II), Pd1, Chlorido(1,3-bis(4-methyl-2-pyridylimino)isoindoline)palladium(II), Pd2, Chlorido(1,3-bis(2-pyridylimino)benz(f)isoindoline)palladium(II), Pd3 and Chlorido(1,3-Bis(1-isoquinolylimino)isoindoline)palladium(II), Pd4 were synthesized, appropriately characterized and the crystal structure of Pd2 elucidated. The kinetics and mechanism of the substitution of the chloride ligand with thiourea ligands, Tu, Dmtu and Tmtu, from the complexes were investigated under pseudo-first-order conditions. The analyses were performed using stopped-flow analyzer or UV–visible spectrophotometer. The reactions proceeded through two consecutive steps for most complexes with exception of Pd4 showing only a single step. The substitution rates followed the order: Pd1>Pd2>Pd3>Pd4 due to varying degrees of steric influences and σ-/π-donations caused by the methylation and benzannulation on the cis-/trans-positions of the pyridyl rings of the BPI. The quenching of the fluorescence of CT-DNA/EB by the Pd(II) complexes suggests static quenching mechanism. The simulated docking of the complexes onto CT-DNA suggests they bind mainly in the minor grooves of DNA. The UV–Visible absorption titrations and quenching of tryptophan (Trp) fluorescence of BSA by the complexes depict reasonable interactions which occur mainly in the hydrophobic domains of the former. The order of strength of the interaction of the complexes with DNA or BSA is consistent with the rates of substitution kinetics
Determinants of COVID-19 Vaccine Uptake among Health Care Workers:A Case Study of Mogadishu City, Somalia
No full textCovid-19 disrupted the Health Care system and operations globally between 2020 and 2021 through exponential infections, disease and adverse negative economic impact as a result of the virus. Due to the high risk of infection, health care workers are a high priority target group for vaccination against COVID-19. Theobjective of current study was to assess the factors associated with COVID-19 vaccine uptake among health care workers in Mogadishu, Somalia.The study sought to establishthe proportion of vaccinated healthcare workers, determine the socio-demographic and healthcare system factors associated with COVID-19 vaccine uptake among health care workers in Mogadishu, Somalia.Methodology: Purposive sampling was used to select the six hospitals in Mogadishu while stratified random sampling was used to select a sample of 276 participants in the sampled hospitals. Structured questionnaires were use collect data. Data was analyzed SPSS to generate descriptive statistics and logistic regression
Application of Hybridization Chain Reaction/CRISPR-Cas12a for the Detection of SARS-CoV-2 Infection
No full textGlobally, the emergence of the coronavirus disease (COVID-19) has had a significant impact on life. The need for ongoing SARS-CoV-2 screening employing inexpensive and quick diagnostic approaches is undeniable, given the ongoing pandemic and variations in vaccine administration in resource-constrained regions. This study presents results as proof of concept to use hybridization chain reaction (HCR) and clustered regularly interspaced short palindromic repeats (CRISPR)/Cas12a complex for detecting SARS-CoV-2. HCR hairpin probes were designed using the NUPACK web-based program and further used to amplify the SARS-CoV-2 N gene in archived nasopharyngeal samples. The results were visualized using agarose gels and CRISPR Cas12a-based lateral flow strips. The assay was evaluated using the gold standard, real-time polymerase chain reaction (RT-PCR), as recommended by the World Health Organization (WHO). The results show the comparative efficiency of HCR to RT-PCR. This study shows that HCR and CRISPR are viable alternatives for diagnosing SARS-CoV-2 in samples.The research was funded by the African Union through the Pan African University Institute for Basic Sciences, Technology, and Innovation (PAUSTI) and the National Research Fund, Kenya
Risk Factors Associated with Pneumonia among under 5 Years Children at Banadir Hospital, Mogadishu, Somalia
No full textThe study used a systematic random sampling technique to select 188 under 5 children with pneumonia. A structured questionnaire and interview guide were employed in collecting data. Qualitative data was analyzedusing content technique. Quantitative data was analyzed using descriptive and inferential statistics. The inferential statistics entailed the multivariable logistic regression analysis to determine the risk factors that predict pneumonia among the under 5 years children.Results: The results indicated that the social demographic factors that were protective and decreased the odds of prevalence of pneumonia among under 5 years children were age of 4 -5 years (Odds=1.125, P=0.008<0.05); caretakers who had attended university (0.964;P=0.010<0.05); caretakers who earned 300-400$ (Odds=1.315; P=0.006<0.05); birth weightover 3kgs (Odds=2.422; P=0.014<0.05); permanent housing (Odds= 0.810; P=0.007<0.05). The environmental factors that were associatedwith high prevalence of pneumonia among under 5 years children were living in an environment without safe air quality (Odds= 1.402; P=0.033<0.05); and living in an environment where firewood is used for cooking (Odds=0.704;P=0.038<0.05). The health related factors that were protective and decreased the odds of prevalence of pneumonia among under 5 years children were pneumonia vaccination (Odds=0.948; P=0.008<0.05). Conclusion:The study concluded that the risk factors for pneumonia among children aged under 5 years were age, level of education, income, birth weight, exclusive breast feeding, pneumonia vaccination, postnatal care, and history of acute respiratory tract infection. The study recommends that the health centres should equip the mothers and the caregivers with the basic knowledge regarding health and the hospitals to conduct post-natal training programs to the mothers and caregivers
Factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City, Northern Uganda: a facility-based cross-sectional study
Full text linkObjective This study aimed at assessing factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City.
Design A cross-sectional study.
Settings The study was conducted in health facilities offering ANC services in Lira City, Northern Uganda.
Participants The study was among 368 pregnant mothers attending their first ANC in the three selected facilities (Lira Regional Referral Hospital, Ober Health Center IV and Pentecostal Assembly of God Mission Health Center IV) in Lira City.
Primary and secondary outcome measures Level of first ANC attendance within 12 weeks of pregnancy and associated factors.
Results Early ANC attendance was 36.1%. Women who were: unmarried (adjusted OR (aOR): 0.40, 95% CI: 0.16 to 0.99), took >2 hours to reach a health facility (aOR: 0.21, 95% CI: 0.07 to 0.62), or not visited by village health teams or healthcare workers at home (aOR: 0.33, 95% CI: 0.12 to 0.92) were less likely to attend their first ANC early. On the other hand, women who were: not knowing first that ANC guides parents on infant care (aOR: 2.22, 95% CI: 1.06 to 4.67); pregnant without consent of spouse (aOR: 4.29, 95% CI: 1.75 to 10.55); attending ANC from a private facility (aOR: 2.89, 95% CI: 1.27 to 6.15); and having two to three healthcare workers present at the ANC clinic (aOR: 1.79, 95% CI: 1.03 to 3.13) were more likely to attend ANC early.
Conclusions Despite the fact that the WHO recommends that all women begin ANC within 12 weeks after conception, Lira City in Northern Uganda had a low overall incidence of timely ANC initiation. Being unmarried, distance to reach a health facility, and being visited by village health teams or healthcare workers at home were all linked to timely ANC commencement. As a result, intervention efforts should concentrate on the highlighted determinants in order to promote ANC initiation in Lira City, Northern Uganda. This can be accomplished by providing information and education to the community on the timing and necessity of ANC in Northern Uganda
The Prevalence of Physical Violence, Drivers of Imprisonment, and Conduct of Prisoners in Mogadishu Central Prison, Somalia
Full text linkViolence is described as the intentional use of physical force against a person, oneself, or a group of people that causes trauma, psychological harm, or even death. It could take the shape of physical or psychological harm, deprivation, or emotional or sexual assault. Violence of many different kinds is committed in jails globally. However, they are frequently carried out in secrecy, which makes them challenging to establish. The target population for the study were prisoners and staff in Mogadishu Central Prison. A descriptive cross-sectional research design was applied to collect both quantitative and qualitative data. Systematic sampling was used to select prisoners, while purposive sampling was used to select key informants (staff). The study used questionnaires and key informant interviews as data collection tools. Quantitative analysis was conducted using SPSS version 27, and both Fisher’s exact test and Pearson’s Chi-square were used to test for associations and relationships between variables after descriptive analysis had been done. Qualitative analysis was conducted using thematic analysis. The study found that the overall prevalence of physical violence in the prison was 16.3%, with the majority of violence being conducted by convicts against other inmates, but there were also instances of violence committed against and committed by prison staff. The prevalence among inmates was 15%, and prisoners against warden was 1.3%. The most common types of physical violence were fist fights (11.8%), flogging (1.6%), use of weapons or other instruments (1.6%) such as razor blades, throwing shoes at each other, or use of finger rings and slapping (1.3%). The study highlights a concerning high prevalence of physical violence within Mogadishu Central Prison, primarily perpetrated by inmates against each other and occasionally involving prison staff. To address the issue, the study recommends a multifaceted approach, including heightened conflict recognition and resolution training for prison staff, increased investment in resources to alleviate overcrowding, and the establishment of rehabilitation and mental health programs to target the underlying triggers of violenc