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Prevalence of obstructive sleep APNEA risk status among ambulatory type 2 diabetes mellitus patients at Moi Teaching and Referral Hospital

Thu, 01 Jan 2026 00:00:00 GMT

Title: Prevalence of obstructive sleep APNEA risk status among ambulatory type 2 diabetes mellitus patients at Moi Teaching and Referral Hospital Authors: Abdirahman, Maalim Adan Abstract: Background: Obstructive Sleep Apnoea (OSA) is a prevalent yet under-diagnosed sleep-related breathing disorder associated with considerable metabolic and cardiovascular morbidity. In patients with Type 2 Diabetes Mellitus (T2DM), the coexistence of OSA exacerbates glycemic dysregulation and amplifies the risk of diabetic complications. Despite the global evidence highlighting this bidirectional relationship, data from Kenyan diabetic populations remain limited. Objectives: To determine the prevalence of OSA risk status and associated factors among ambulatory T2DM patients attending the diabetes outpatient clinic at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya, using the Berlin Questionnaire. Methods: A hospital-based cross-sectional study was conducted in 334 adult T2DM patients. Participants were systematically sampled and screened for risk of OSA using the Berlin Questionnaire. Data on sociodemographic variables, metabolic markers such as glycated hemoglobin A1C (HbA1c), anthropometric indices such as Body Mass Index (BMI), neck circumference and anatomical factors such as nasal obstruction, and Mallampati score were collected. Bivariate analyses and multivariate logistic regression were performed to identify independent predictors of high OSA risk, with significance set at p < 0.05. Results: The prevalence of OSA risk status was 41.3%, highlighting a substantial burden among patients with type 2 diabetes mellitus. Poor glycemic conrol (HBA1C > 8%) was independently associated with more than a two-fold increase in the odds of high OSA risk, while overweight status conferred a 1.5-fold higher likelihood of OSA risk. Anatomical abnormalities such as deviated nasal septum and nasal polyps, as well as advancing age above 50 years and higher Mallampati scores, were significantly associated with OSA risk. In contrast, hypertension demonstrated an inverse association with OSA risk, suggesting a potential protective effect, although this finding may reflect residual confounding or limitations within the regression Conclusion: Nearly half of patients with type 2 diabetes mellitus at MTRH were at high risk for obstructive sleep apnoea, with significant associations observed between poor glycemic control, overweight status, nasal obstruction and elevated Mallampati scores. These findings are consistent with international evidence of demonstrating a multifactorial interraction between metabolic and anatomical determinants of OSA risk among populations with type 2 diabetes.. Recommendations: Incorporating routine screening for obstructive sleep apnea (OSA) into standard diabetes care. In addition, further research is required to develop and assess practical, cost-effective and evidence-based strategies for the screening and management of OSA.

Diabetes distress and its correlation with glycemic control among type 2 diabetes patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Thu, 01 Jan 2026 00:00:00 GMT

Title: Diabetes distress and its correlation with glycemic control among type 2 diabetes patients at Moi Teaching and Referral Hospital, Eldoret, Kenya Authors: Mahmud, Imran Mohamed Abstract: Background: Type 2 Diabetes Mellitus (T2DM) presents not only a complex metabolic disorder but also imposes a substantial psychological burden in the form of diabetes distress, a condition characterized by negative emotional responses to the ongoing demands of diabetes self-management. This condition continues to emerge as a critical barrier to optimal disease control with growing evidence linking it to poor self-care behaviors, suboptimal glycemic outcomes and increased risk of complications. Despite its clinical relevance, the prevalence of diabetes distress, its associated determinants and impact on glycemic control remain underexplored in many low- and middle-income settings including Kenya. Objectives: This study aimed to determine the prevalence of diabetes distress among individuals with T2DM, assess their level of glycemic control and evaluate whether diabetes distress independently predicts poor glycemic control. Methods: A hospital-based cross-sectional study was conducted among 354 adult patients with T2DM at Moi Teaching and Referral Hospital from January 2024 to December 2024. Data on demographic, socioeconomic and clinical characteristics were collected using structured questionnaires. Diabetes distress was assessed using the validated 17-item Diabetes Distress Scale (DDS-17) while glycemic control was evaluated using glycated hemoglobin (HbA1c). Statistical analyses using descriptive statistics, Chi-square and t-tests for bivariate associations, and multivariable logistic regression, was done to assess the correlation between Diabetes distress and glycemic control. Results: The study population was predominantly female (65.3%), unemployed (67.8%), and uninsured (63.0%), with a mean age of 56.3 years. Over half (52.8%) had coexisting hypertension. The overall prevalence of diabetes distress was 15.8%, with emotional burden (50.3%) and regimen-related distress (33.1%) emerging as the most prominent subdomains. Significant associations were observed between diabetes distress and treatment modality (p < 0.001), especially combination therapy, and comorbid hypertension (p = 0.014). The mean HbA1c was 9.34%, with 57.4% of participants exhibiting poor or very poor glycemic control (HbA1c ≥ 8%). Poor glycemic control was significantly associated with treatment type(insulin) (p < 0.001) and occupational status(unemployed) (p = 0.021). Importantly, multivariable logistic regression revealed that diabetes distress independently predicted poor glycemic control (AOR = 2.31; 95% CI: 1.16–4.62; p = 0.017), indicating that distressed individuals were over twice as likely to have inadequate glycemic control. Conclusion: Diabetes distress is prevalent among patients with T2DM, with a high proportion also demonstrating poor glycemic control. Diabetes distress was independently associated with poor glycemic outcomes, with affected individuals being more than twice as likely to have inadequate control. Emotional and regimen-related distress emerged as the predominant contributors, highlighting the substantial psychological burden in this population. These findings highlight the necessity of addressing psychological distress as an integral component of diabetes care. Recommendations: Assessment of diabetes distress should be incorporated into routine diabetes care, particularly for patients with poor glycemic control, given its association with adverse outcomes. Additionally, further research is needed to explore practical and effective strategies for screening and managing diabetes distress within the Kenyan healthcare setting.

Attitudes, preferences and barriers to E-Learning among open, distance and e-learning (ODeL) orthopaedic medicine students at the Kenya Medical Training College

Thu, 01 Jan 2026 00:00:00 GMT

Title: Attitudes, preferences and barriers to E-Learning among open, distance and e-learning (ODeL) orthopaedic medicine students at the Kenya Medical Training College Authors: Okedo, Robert Ataada Abstract: Background: Medical education is undergoing a global shift toward technology-enhanced learning. In KMTC, the Orthopaedics and Trauma Medicine program incorporates the Open, Distance, and e-Learning model. Understanding students’ attitudes, preferences, and barriers to e-learning is critical for optimizing digital strategies and sustaining quality training in resource-limited settings. Objective: This study aimed to assess the attitudes, learning preferences, and barriers to e-learning among ODeL othopaedic students at the Kenya Medical Training College. Methods: A mixed-methods cross-sectional design was used. Quantitative data was used to determine the relationship between variables, while qualitative data contextualized the research problem in a detailed context. The sample consisted of 156 participants drawn through stratified random sampling for the quantitative arm, and 8 FGD participants purposively sampled for the qualitative arm. Quantitative data were collected using a 5-point Likert scale questionnaire, and qualitative data using an interview guide. Data were analyzed using descriptive and inferential statistics for quantitative elements, complemented by thematic analysis for qualitative data. Results: The findings reveal a predominantly positive student attitude towards e-learning (68%), with a significant majority (70%) expressing a clear preference for a blended learning model. Prior e-learning exposure exhibited a statistically significant association with e-learning participation (OR = 3.845, p=0.001), underscoring the importance of early exposure. Critical barriers identified included internet access limitations (60%), insufficient training on e-learning platforms (45%), and the prohibitive cost of internet data bundles (35%). Conclusion: While ODeL orthopaedic students have a positive attitude towards e-learning, they prefer a balanced blended instructional approach. Recommendations: To augment ODeL orthopaedic student attitude and participation in e-learning, early exposure to e-learning should be adopted in a blended learning context. Campus internet strength and coverage should be enhanced as a key enabler for e-learning.

Building a comprehensive sickle cell disease program in Western Kenya: a decade of experience and growth

Tue, 20 Jan 2026 00:00:00 GMT

Title: Building a comprehensive sickle cell disease program in Western Kenya: a decade of experience and growth Authors: NJUGUNA, FESTUS; KILACH, CAROLE; NJUGUNA, CYRUS; AYAYE, ERICK; WANJIKU, CHRISTOPHER; KORIR, RACHAEL; BOR, CONSOLATA; MIDIWO, NANCY; ALIWA, EVERLYNE; OBURAH, ELVIS; MBUNYA, SAMUEL; KIPKOECH, JOSEPH; ANN ETLING, MARY; SEVERANC, TYLER; NATHANIEL NESSLE, CHARLES; VIK, TERRY; KUMAR, MANJUSHA; ROBERSON, CHRIS; GREIST, ANNE Abstract: Background: Globally, approximately 515,000 infants with Sickle Cell Disease (SCD) are born every year. Approximately 80% of these cases occur in Sub-Saharan Africa (SSA) annually, including 14,000 newborns in Kenya. In SSA, 50%–80% of children will die before the age of 5 years due to a lack of comprehensive SCD care compared to 3% in better-resourced settings. The Academic Model Providing Access to Healthcare (AMPATH) SCD Program started in 2010 as a partnership between Moi University, Moi Teaching and Referral Hospital (MTRH), and Indiana Hemophilia and Thrombosis Center (IHTC) with a goal to improve access to comprehensive SCD care by increasing capacity through training, clinical care, research, and advocacy. Findings: The program has trained over 5,000 healthcare workers on different aspects of SCD through face-to-face instruction, virtual training and one-on-one mentorship programs. Early infant screening and support for access to medications like hydroxyurea and antibiotics have been key in improving clinical care. The program has also participated in several research projects and has been a strong advocate for the provision of comprehensive SCD care by the health facilities within the high SCD burden areas in Kenya and the Ministry of Health. Conclusion: The strategies implemented by the program can serve as a template for establishment of SCD care programs in similar resource-limited settings