http://ir.mu.ac.ke:8080/jspui/handle/123456789/1 2026-07-14T14:57:04Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10332 Title: CLINICOPATHOLOGICAL FEATURES OF URINARY BLADDER CANCER MANAGED AT A TERTIARY HOSPITAL IN WESTERN KENYA Authors: Oduor, Charles Sore; Mugalo, Edward; Kirongo, Geoffrey Abstract: Background: Urinary bladder cancer is the ninth leading cause of morbidity and mortality globally, necessitating characterization of clinical and pathological features for early detection and improved management. Objective: To profile and document the clinicopathological features of urinary bladder cancer at Moi Teaching and Referral Hospital (MTRH). Materials and methods: A prospective assessment of patients diagnosed with urinary bladder cancer. Patient characteristics and associated causal factors obtained from full clinical evaluation and review of clinical records. Tumour characterization was based on examination and review of radiological imaging and histopathology findings and documented in structured questionnaires. Descriptive statistics and tests of association used Fisher’s exact tests for socio-demographic characteristics, causal factors, histological type, and Tumor, Node, Metastasis (TNM) stage of bladder cancer. Results: Forty-five patients aged between 21 to 85 (mean: 61.84 ± 14.46) years with urinary bladder cancer were evaluated. Males were 68.9% and painless hematuria was most common symptom. Exposure to agrochemicals (60%) and cigarettes smoking (mean pack years = 9.43 ±6.198) in 31%. Clinical staging showed 71.1% with T1, while 6.7% had metastatic disease. 55.6% had TNM stage I, while 91.1% had low-grade tumors. Transitional cell carcinoma (51.1%) was the most common histological type. Agrochemicals exposure was associated with low-grade tumors (p=0.013), TNM clinical stage I (p=0.021), and adenocarcinoma (p=0.029). Conclusions: Urinary bladder cancer affected males over 60 years old with a history of smoking and agrochemical exposure. Majority presented with classical symptoms of early disease and low-grade tumors. History of exposure to agrochemicals was a significant risk factor. 2024-12-01T00:00:00Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10329 Title: THE EFFECTS OF ADVANCED PROSTATE CANCER MANAGEMENT ON HEALTH SERVICE CARE PROVIDERS IN WESTERN KENYA REGION Authors: Musau, Pius; Mugalo, Edward; Akello, Walter; Rono, Dennis Abstract: Background: The management of advanced prostatic cancer patients in hospitals are known to impact on the patient as well as the core health care services providers, and patient’s relatives. This study was purposed to examine for the effects and put forward suggestions to ameliorate the negative impacts. Objective: To establish the effects of advanced prostate cancer management outcome on the involved health care service providers. Design: Cross-sectional study with in-depth interviews of core healthcare service providers. Setting: County Referral Hospitals of the 8 counties in western Kenya region. Subjects: Fifty-six healthcare service providers involved in the management of prostate cancer patients in the region. Results: The respondents’ ages ranged between 27 years and 59 years with a mean ±standard deviation of 40.1 ± 7.7 years. Majority of the patients (92.9%) presented with advanced disease. Major treatment options offered were palliative care and symptoms control. The stated effects on the healthcare providers included disappointment with the management processes, limited options of care, low morale, and poor job satisfaction. The suggested ways to improve the care were focused on cancer health support, improved human resources, and infrastructural quality for dedicated services. Conclusion: Advanced prostate cancer management in the Western region of Kenya was limited to palliative care and symptoms control. The health care service providers were negatively impacted by the poor outcome of management and the suggestions were to improve human and infrastructural support for better outcomes. 2024-10-10T00:00:00Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10231 Title: Burden of Cardiac Disease among Patients Undergoing Chronic Haemodialysis at Moi Teaching and Referral Hospital, Eldoret, Kenya Authors: Hagembe, Mildred N; Barasa, FA; Njiru EW1, EW Abstract: Cardiovascular Disease (CVD) is the leading cause of mortality in patients with End Stage Renal Disease (ESRD) globally. Renal replacement therapy improves the quality of life of these patients but CVD remains a threat to their survival. Whereas atherosclerotic coronary artery disease is the leading culprit in high income countries, this has not been characterized in Kenya. Objective: To determine the prevalence and spectrum of cardiac disease in patients with ESRD undergoing haemodialysis at Moi Teaching and Referral Hospital (MTRH), a tertiary medical centre in Western Kenya. Methods: This was a cross sectional study conducted at MTRH renal unit. Consenting consecutive adults with ESRD undergoing chronic heamodialysis were enrolled into the study after obtaining ethical approval from the institution’s review board. Data on socio demographics, medical and drug history was collected using a structured questionnaire followed by a focused cardiovascular examination. A standard trans-thoracic echocardiogram was done by a study dedicated sonographer and interpreted by a cardiologist using American Society of Echocardiography guidelines. A standard 12 lead resting ECG was also done and read by the same cardiologist. Outcomes of interest included Left Ventricular Hypertrophy (LVH), Left Ventricular Ejection Fraction (LVEF), pathological valve disease, pathological Q waves and arrhythmias. The prevalence estimates were reported with the corresponding 95% confidence intervals. Results: Seventy two participants were included in the final analysis. Their median age was 41 (29.8, 60) years and 51.3% were male. Majority (93%) were on two sessions of dialysis per week, with 97.2% being known hypertensives. Almost three quarters of them (72.2%) had some form of cardiac disease as follows; left ventricular hypertrophy 58%, left ventricular systolic dysfunction 49%, pathological valvular disease 15.3%, arrhythmias 9.7% and pathological Q waves 6.9%. Conclusion: There is a high burden of cardiac disease in patients with ESRD on heamodialysis at MTRH with the predominant lesions being LVH and left ventricular systolic dysfunction. 2018-09-01T00:00:00Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10230 Title: Patient-Specific Mobile Phone-Generated Reminders and Quality of Hypertension Care in Western Kenya Authors: KIRUIa, Nicholas; KAMANO, Jemimah; SAVAI, Simon; MISOI, Lawrence; RONO, Steven; WERE, Martin C. Abstract: To evaluate the impact of clinician-targeted mHealth-generated care suggestions on compliance with hypertension care guidelines in a resource-limited setting. This study was conducted in 10 rural health clinics in Western Kenya that offered hypertension care through nurses and clinical officers. Sites were grouped into intervention and control groups. Intervention group clinicians had patientspecific care suggestions triggered and displayed on a mobile application, mUzima, for their action. Care suggestions were also triggered in the mHealth application for control arm clinicians but were not displayed. Differences in compliance with hypertension care guidelines were evaluated. The study involved 378 patients with hypertension who had care suggestions generated during visits (217 in intervention group and 161 in control group). There was a higher proportion of adherence to hypertension care guidelines in the intervention group compared to the control group (91.1% vs. 85.7%, p=0.014). The random effects model showed significant variability in compliance rates among study clinicians (variance of 0.44, 95% CI: 0.12 -1.62). When displayed care suggestions were rejected by intervention providers, the most common reason given was ‘Previously ordered’ (58.8%). Clinicians felt that care suggestions improved awareness of hypertension care guidelines. The successful scaled implementation of mUzima with patient specific care suggestions led to higher adherence to hypertension care guidelines and improved quality of hypertension care. Tailormade m-Health applications in resource constrained settings for hypertension care and other chronic noncommunicable diseases has the potential to lead to better adherence to care guidelines and quality of care. 2024-01-01T00:00:00Z