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Influence of participatory monitoring and evaluation on decision-making in maternal and newborn health programs in Mombasa County, Kenya
No full textThe study assessed the utilization of participatory monitoring and evaluation approaches (PM&E) and their influence on decision-making in maternal and newborn health programs (MNH) in Mombasa County, Kenya. We conducted a cross-sectional study with a sample of 390 participants and used a structured questionnaire, modified Quality of Decision-Making Orientation Scheme, and an interview guide to collect data. We analyzed quantitative responses using descriptive statistics and binary logistic regression (at significance level of 0.05) and qualitative responses using content analysis. The study established that quality decision-making was more likely to occur in MNH programs in Mombasa County that used PM&E approaches at the initiation (OR 1.728, p < 0.05), design and planning (OR 2.977, p < 0.05), and implementation (OR 5.665, p < 0.05) phases of MNH programs than in those that did not use the PM&E approaches. This study shapes a persuasive case for improving the provision of maternal and newborn health services
PA-773 Placental foetal-maternal innate immune responses to placental malaria
No full textBackground During malaria in pregnancy (MiP), Plasmodium falciparum-infected erythrocytes sequester in the placenta, causing placental malaria (PM) and poor pregnancy outcomes, including low birthweight, preterm birth, and stillbirth. Mouse data indicate that innate immune response to PM on the placenta’s maternal side adversely affects the foetus and in response, the placenta’s foetal side mounts an innate counterresponse that improves foetal outcomes. However, this has not been observed in human PM.
Methods We used histological and molecular analyses to characterize the PM status of bio banked placentas and corresponding maternal sera. Molecular tools were used to characterize innate immune responses to human PM in the foetal and maternal sides of the placenta.
Results Histology and molecular assays showed that 50% of women who had no history of MiP and had received malaria chemoprophylaxis, had PM. Among women with MiP history, the PM rate was 70%. RT-qPCR revealed that foetal sides of PM-negative samples had lower levels of Toll-like receptor (TLR)- 4 and 9 when compared with maternal sides of the same placentas. However, in PM-positive placentas, their levels were higher in foetal sides than maternal sides of the same placentas. Moreover, TLR4 was significantly upregulated in maternal sides of PM-positive placentas versus maternal sides of PM-negative placentas. Intriguingly, TLR4 was significantly upregulated in foetal sides of PM-positive placentas versus foetal sides of PM-free placentas. Immunohistochemical analysis revealed that when compared with PM-negative tissue, PM-positive samples expressed markedly higher levels of 8-hydroxy-2’-deoxyguanosine, a marker of oxidative DNA damage. RT-qPCR showed that this was accompanied by the upregulation of p21, a marker of DNA damage repair.
Conclusion Our data indicate that human PM drives differential innate immune response in foetal vs maternal sides of the placenta, and triggers placental oxidative DNA damage. These observations may have implications for the diagnosis and management of PM.
https://doi.org/10.1136/bmjgh-2023-EDC.29
Predictors of Unintended Pregnancy Among Adolescent Girls During the Second Wave of COVID-19 Pandemic in Oyam District in Northern Uganda
No full textBackground: In Uganda, unintended pregnancies are responsible for one in three births with detrimental consequences, a situation that worsened during COVID-19. Thus, the present examined unplanned pregnancy and its associated risks in Oyam district, northern Uganda during the COVID-19 epidemic.
Methods and Methods: This study employed a cross-sectional study among adolescent girls aged 15– 19 years who had a pregnancy during the second phase of COVID-19 in Oyam district, northern Uganda in November 2022. A consecutive method was employed to recruit the participants attending health facilities. A structured questionnaire was utilized to collect data. For data analysis, both bivariate and multivariable regression methods with adjusted odds ratio and 95% CI were used. A p-value of 0.05 was used to determine the significance level.
Results: Of the total respondents, 292 (69.5%) were aged between 18 and 19 years of age, 295 (70.2%) lived in rural areas, and 222 (52.9%) had no formal education. The results also show that 293 (69.8%) of the respondents had unintended pregnancies during COVID-19. The results indicate that participants who lacked knowledge of the ovulation period (AOR: 0.242; 95% CI: 0156– 0376; P< 0.001), sex education during COVID-19 (AOR: 0.563; 95% CI:: 0.365– 0.869; P=0.024) and lacked the freedom to discuss family planning-related issues with family members during COVID-19 (AOR: 0.228; 95% CI: 0.138– 0.376; P< 0.001) were more likely to have an unintended pregnancy compared to their counterparts.
Conclusion: Our study shows that unwanted pregnancies among adolescent girls remain a public health issue in Oyam district with more than two-thirds of adolescents having unwanted pregnancies during the crisis of COVID-19. The major correlates of unwanted pregnancies among adolescent girls during COVID-19 pandemic were inadequate knowledge of the ovulation period, sex education, and lack of freedom to discuss family planning-related issues with family members. There is a need to prioritize interventions, especially in rural settings. Sex education to improve contraceptive use and delay sexual debut. In light of the possibility that social and cultural norms in the Oyam district prohibit parents and children from discussing sexual subjects, it is crucial to promote sexual health education through the mass media, including newspapers, television, radio, and social media
Sentence Level Analysis Model for Phishing Detection
No full textPhishing emails have experienced a rapid surge in cyber threats globally, especially following the emergence of the COVID-19 pandemic. This form of attack has led to substantial financial losses for numerous organizations. Although various models have been constructed to differentiate legitimate emails from phishing attempts, attackers continuously employ novel strategies to manipulate their targets into falling victim to their schemes. This form of attack has led to substantial financial losses for numerous organizations. While efforts are ongoing to create phishing detection models, their current level of accuracy and speed in identifying phishing emails is less than satisfactory. Additionally, there has been a concerning rise in the frequency of phished emails recently. Consequently, there is a pressing need for more efficient and high-performing phishing detection models to mitigate the adverse impact of such fraudulent messages. In the context of this research, a comprehensive analysis is conducted on both components of an email message – namely, the email header and body. Sentence-level characteristics are extracted and leveraged in the construction of a new phishing detection model. This model utilizes K Nearest Neighbor (KNN)introducing the novel dimension of sentence-level analysis. Established datasets from Kaggle was employed to train and validate the model. The evaluation of this model’s effectiveness relies on key performance metrics including accuracy of 0.97, precision, recall, and F1-measure
Prevalence of musculoskeletal disorders among healthcare professionals in Africa: A systematic review and meta-analysis
No full textAbstract: Background Musculoskeletal disorders (MSDs) decrease productivity. The objective of this systematic review was to estimate the regional prevalence of MSD among healthcare professionals in Africa. Methods After prospective registration (PROSPERO CRD42023455517), a literature search was conducted in PubMed, Science Direct and Google Scholar in August 2023. Observational studies that reported the prevalence of MSDs among healthcare professionals were included. Studies were assessed for risk of bias in duplicate. The data were pooled using random effects models to estimate the prevalence of MSD with 95% confidence interval (CI) and I2 statistic captured heterogeneity. Results From 17,322 citations, 18 studies (4486 participants) were included. Of these, 8 (44%) were high-quality studies and 10 (56%) medium-quality. The overall pooled prevalence of MSDs was 70.8% (95% CI 61.9–78.961.9–78.9, I2 97.5%). The regional prevalence of MSDs in East Africa was 68.7% (95% CI 58.4–78.1, I2 94.9%; 7 studies, 1885 participants); West Africa 72.0% (95% CI 53.2–87.4, I2 95.8%; 4 studies, 604 participants); South Africa 61.6% (95% CI 53.0–70.0, I2 77.5%; 3 studies, 681 participants); and, North Africa 79.6% (95% CI 50.6–97.5, I2 99.2%; 4 studies, 1316 participants). The prevalence of MSDs among different professional groupings was: Physiotherapists 89.8% (95% CI 74.3–98.6, I2 97.4%; 4 studies, 1061 participants); Nurses 65.3% (95% CI 55.2–74.8, I2 65.3%; 8 studies, 2239 participants); Dentists 67.8% (95% CI 58.2–76.7, I2 87.5%; 4 studies, 827 participants); and, Medical laboratory staff 52.8% (95% CI 43.6–61.9, I2 52.8%; 2 studies, 359 participants). Conclusion Pooling studies of mixed quality revealed a high prevalence of MSD among healthcare professionals in Africa. This meta-analysis will help in regional occupational healthcare policy and prevention programs among various healthcare professions. Hid
Molecular Characterization of Red Blood Cell Variants Among Blood Donors at The National Testing Laboratory Nairobi –Kenya Blood Transfusion Service
Full text linkA genetic variant is an alternative nucleotide located at a specific region within a gene. To date,
48 genes encoding human red cell blood systems have been recognised. Variants within these
genes encode for alleles, which can be highly polymorphic. Red cell nucleotides exhibit
diversity among different populations worldwide. In Africa, there is limited information on the
distribution and population frequency of red cell variants. In Kenya, there lacks red cell variant
and blood group allele data to support with the investigations of alloimmunisation and
management of rare blood types. This research therefore, pursues to generate molecular
information of selected red cell variants in donated blood samples at the Kenya National Blood
Service testing Laboratory. The rationale of the study was to generate molecular data on ABO,
RH, MNS, Dantu, Kell, Kidd, Duffy red cell variants and predicated phenotypes. Also to
contribute towards construction of a biobank (gene base/gene bank repository). The study
design was experimental. Blood collected from donors for routine testing at the National
Testing laboratory Nairobi of National Blood Service -Kenya was utilised. Next generation
sequencing for molecular characterization of red cell variants was carried out using a custom
panel on an Illumina MiSeq platform. Descriptive statistics were used in data analysis and
results displayed in tabular formats. The results; ABO, O: 52%, B: 14%, A1:12%, A2: 5.6%,
Ax 4.6%, B3: 4.6%, weak A2:2.3% and the rest A1B or A2B were below <1%. RHD gene: 30%
genotyped as D+ 26% as D-, 10.2% as weak D, 4.6% as Del, with a number of other weak
variants
reported
including
1%
DAU6.
RHCE
gene:28%
were
c+e,
C+V+VS+c+e+hrB+(17.6%),C+c+e+(14%),V+VS+c+e+hrB+(13%),C+V+VS+c+hrB+(11.1
%),JAL+Partial_c/VS+WhrB+W⸍־hrS+W⸍ (6.5%).MNS system: 40% genotyped as N+s+,
M+Mc+N+ s+(36.1%),M+s+(21.3%) and M+Mc+N +S+s+ (2.8%). KEL system: 76.9%
genotyped as k+, (KEL2) Jsa (KEL6), Jsb (KEL7) at 15.7%, K+k+ (22%). Kidd system
genotyping predicted 28% were Jk (a+b-), 24.1% Jk (a+b+), 22.2% Jk (a+b-), 17.6% as Jk
(a+Wb+), 6.5% as Jk (a-b+),with 1.9% as Jk (a+ Wb-). In the Duffy system, the null phenotype
Fy (a-b-) genotype was the most common with ~90% of samples observed with this genotype.
There was limitation in the characterization of Dantu variants because there are three different
variants that are associated with Dantu and is not yet determined which one is in Kenya; thus,
this will require more data and research to establish a reference gene to align them. A number
of novel non-synonymous variants were identified in the dataset, which may be of potential
immunologic significance in blood groups systems such as KEL and Augustine. This study has
revealed a distribution of red cell variants for randomly selected Kenyan donors, in addition,
valuable knowledge is presented in relation to rare and unusual variants as a basis for future
research in Kenya. The study provides tools for extended typing in blood banks as a basis for
improved transfusion practices and possibly for development of a genomic reference library
Identification of novel Plasmodium vivax proteins associated with protection against clinical malaria
Full text linkAs progress towards malaria elimination continues, the challenge posed by the parasite species Plasmodium vivax has become more evident. In many regions co-endemic for P. vivax and Plasmodium falciparum, as transmission has declined the proportion of cases due to P. vivax has increased. Novel tools that directly target P. vivax are thus warranted for accelerated elimination. There is currently no advanced vaccine for P. vivax and only a limited number of potential candidates in the pipeline. In this study we aimed to identify promising P. vivax proteins that could be used as part of a subunit vaccination approach. We screened 342 P. vivax protein constructs for their ability to induce IgG antibody responses associated with protection from clinical disease in a cohort of children from Papua New Guinea. This approach has previously been used to successfully identify novel candidates. We were able to confirm previous results from our laboratory identifying the proteins reticulocyte binding protein 2b and StAR-related lipid transfer protein, as well as at least four novel candidates with similar levels of predicted protective efficacy. Assessment of these P. vivax proteins in further studies to confirm their potential and identify functional mechanisms of protection against clinical disease are warranted
Adherence to Tuberculosis Treatment and Its Associated Factors among Drug-susceptible Tuberculosis Patients in Lira District, Northern Uganda
Full text linkUganda has a high incidence of tuberculosis infection at 200 cases per 100,000 people. With effective therapy and adherence to medications is essential for reducing the spread of tuberculosis in the community. However, many of the initiated patients do not get to finish the entire course of treatment. The purpose of this study was to investigate the level of and factors associated with tuberculosis treatment adherence among drug-susceptible tuberculosis patients in the Lira district. A facility-based cross-sectional survey was conducted among 234 randomly selected tuberculosis patients between October and December 2022. The Morisky medication adherence scale was used to measure adherence. Using a structured questionnaire to collect data on socio-demographic characteristics, community factors, and health service delivery factors associated with adherence. Binary logistic regression analysis was used to determine the correlates of adherence to tuberculosis drugs at a p value of 0.05. Most of the respondents (135, 57.7%) were males, (93, 39.7%) aged above 45 years, and (135, 57.7%) in a marital relationship. The prevalence of adherence to tuberculosis drugs was 84.6% (198/234) and was associated with marital status (AOR: 0.307; 95% CI: 0.13-0.0724, p=0.007) and the experience of stigma (AOR: 4.39; 95% CI: 1.612-11.958, p=0.004). The study reported that 2 in 10 drug-susceptible tuberculosis patients are non-adherent, which is lower than the targeted 90%. Marital status and stigma experience are predictors of non-adherence. Interventions by the ministry of health should target how to improve tuberculosis treatment and reduce stigma
Analysis of Internal Corporate Social Responsibility Strategies on Organizational Commitment in Five Star Hotels in Kenya
Full text linkIn Kenya, five star hotels lead in employees’ turnover within the hotel industry at 68% as compared to other establishments. Turnover has great impact on contribution to the national economy and performance of the hotels. The purpose of this study was to analyse the influence of internal corporate social responsibility strategies on organizational commitment in five star hotels in Kenya. The research objectives were: to assess the influence of shareholder strategy on organizational commitment in five star hotels in Kenya; to evaluate the influence of reciprocal strategy on organizational commitment in five star hotels in Kenya; to establish the influence of altruistic strategy on organizational commitment in five star hotels in Kenya; to assess the influence of citizenship strategy on organizational commitment in five star hotels in Kenya; and to examine the effect of employee demographic features as moderating variable on the relationship between internal corporate social responsibility strategies and organizational commitment in five star hotels in Kenya. This study was anchored on Resource-Based Theory, Social Exchange Theory and Social Identity Theory. The study adopted descriptive research design with cross-sectional approach to examine the study variables. The target population was 216; Operations and Line managers in five star hotels in Kenya. A total sample of 144 managers were selected for the study and a self-administered questionnaire was used for data collection. A pilot testing for reliability of the questionnaire was conducted testing with Cronbach Alpha of 0.7 and above, while content and construct validity of the questionnaire was discussed with peers and application of Kaiser-Meyer-Olkin score greater than 0.5 respectively. The pilot data did not form part of the main study data. Actual field data was subjected to descriptive and inferential statistical analysis. The findings revealed that the independent variables used in this study (Shareholder Strategy, Reciprocal Strategy, Altruistic Strategy, Citizenship Strategy) had positive and statistically significant influence and were able to jointly explain 74.2% of the variations in Organizational Commitment in five star hotels in Kenya. The shareholder strategy was found leading among the other internal corporate social responsibility strategies with coefficient (β=0.371, P<0.05), compared to reciprocal strategy (β=0.164, P<0.05), altruistic strategy (β=0.206, P<0.05), and citizenship strategy (β=0.120, P<0.05, indicating the importance of shareholder strategy over the other strategies in achieving organizational commitment. Similarly, employee’s demographic features have statistically significant moderating effect on the relationship between internal corporate social responsibility strategies and organizational commitment in five star hotels in Kenya. The study concluded that internal corporate social responsibility strategies provide concrete foundation in ensuring employee retention through commitment. The study recommends to the managements of five star hotels in Kenya, Federation of Kenya Employers and Kenya Association of Hotelkeepers & Caterers that they should strive in implementing internal corporate social responsibility strategies because hotels with good internal corporate social responsibility strategies can better attract, motivate, and retain workers. The study suggests further studies on relations between internal corporate social responsibility strategies and organizational commitment with firm age as moderating variable and in similar or different context and research approach
Assessment of Strategies on Patient Safety Practices Among Healthcare Providers at Nakuru County Referral Hospital, Kenya
No full textQuality care is achieved through integrating all components within the healthcare delivery
system. Patient safety involves increasing awareness about errors made due to human
factors in the process of delivering healthcare services that may lead to harm and adverse
effects. This study was on Assessment of strategies on patient safety practices among
healthcare providers at Nakuru County Referral Hospital, Kenya. The study objectives
were to: Examine the organizational processes on patient safety practices, determine the
communication strategies on patient safety practices, assess monitoring strategies on
patient safety practices, and determine patient advocacy strategies on patient safety
practices among healthcare providers at Nakuru County Referral Hospital, Kenya. The
study was anchored on General Service Readiness Theory, Anderson Model of Health
Services Utilization and Donabedian Model for Assessment of Quality of Care. The study
adopted descriptive cross-sectional study design. The sampling technique was purposive,
stratified random sampling and proportionate with a sample size of 310 healthcare
providers drawn from various cadres. Data collection tools were questionnaire, interview
schedule and observational checklist. Quantitative data was analyzed using descriptive
statistics and inferential statistics. Spearman’s correlation analysis was used for
inferential statistics to determine the association between organizational processes,
communication strategy, monitoring strategy, patient advocacy on patient safety practices
using 20th version of Statistical Package for the Social Sciences (SPSS) with 0.05 level
of significance. Data was presented in tables, pie charts and graphs forms. A Permit was
obtained from National Commission for Science, Technology and Innovation, through an
introductory letter provided by Mount Kenya University Research Ethical Committee and
authority from health directorate of Nakuru County. The study findings established that
Nakuru County Referral Hospital had effective organizational processes on patient safety
practices indicated by mean of 3.6 and standard deviation of 1.2 with need for
implementation of quality improvement programmes having strongest correlation with
patient safety practices (R = 0.922 and P + 0.028). There were effective communication
strategies on patient safety practices with early clarification of information and efficient
dissemination of information facilitating timely service delivery. There was complete
handover of information, access to electronic records, prescribing systems and
coordination of patient flow, mitigating delayed diagnosis, treatment and adverse events
( mean = 3.6, standard deviation = 1.0, R value = 0.893 and P value = 0.021).However,
patients were found not to be adequately compensated in cases of erroneous medical
procedures (mean = 2.8, standard deviation = 1.2, R value = 0.945 and P value = 0.014),
indicating strong correlation with patient safety practices. The study recommends the
need for implementation of quality improvement programmes to patient safety practices.
The hospital administration should ensure there is coordination in ensuring patient flow
which enhances mitigation of delayed diagnosis, treatment and adverse events. There is
need for meetings to review and share ideas on patient safety thus achievement of
organizational culture in relation to safety. The hospital should also improve on patient
involvement in decision making while receiving healthcare services and clear guidance
that ensures patients are adequately compensated in-case of medical errors