School of Medicine
http://ir.mu.ac.ke:8080/jspui/handle/123456789/45
2024-03-28T20:24:01ZFactors associated with timing of first antenatal visit among pregnant women attending Webuye County Hospital, Bungoma County, Kenya
http://ir.mu.ac.ke:8080/jspui/handle/123456789/8957
Factors associated with timing of first antenatal visit among pregnant women attending Webuye County Hospital, Bungoma County, Kenya
Koskey, Philip Kipkoech
Background: Timely Antenatal Care (ANC) is essential for quality neonatal and maternal outcomes. World Health Organization (WHO) recommends eight ANC visits during pregnancy, with the first visit being within 12 weeks of conception. According to the Bungoma health indicator report of 2017, less than 37% of pregnant women attended their first ANC before 20 weeks gestation.
Objective: To determine and explore the factors associated with timely first ANC visits by pregnant women in Webuye County Hospital.
Methods: This was a facility-based cross-sectional study employing mixed methods. Data collection was done from December 2019 to July 2020. The researcher recruited participants from the Webuye County Hospital Maternal Child Health clinic and used systematic sampling to enroll 354 for the quantitative arm. Pretested structured questionnaire was utilized in data collection. The data were cleaned and entered into Statistical Package for Social Sciences (SPSS) version 20.0. The researcher conducted data analysis using descriptive and inferential statistics to summarize data from categorical variables. Pearson’s Chi-square test was employed in both variate and multivariate models to test for the association between dependent and independent variables. The analyzed data was presented in tables. Purposive sampling was used to enroll 22 participants for the qualitative arm. In-depth interviews using pretested structured interviewer guide questionnaires with tape recording were used. Data were entered into N*vivo software. Data were analyzed using codes and grouped in themes.
Results: Thirty-five point three percent of the women made their first visit during the first trimester (95% CI: 23–35%). Educational status of the women (secondary (OR = 3.21; CI 95%: 1.73, 6.22), the timing of antenatal care in the last pregnancy (second/third trimester) (OR = 0.19; CI 95%: 0.08, 0.41), and experiencing complications in the previous pregnancy (OR = 2.56; CI 95%: 1.43, 4.67) were significantly associated with appropriate timing of the first ANC. The research found that age was not statistically significant (p-value 0.144). A total of 22 pregnant women were interviewed for the qualitative arm. Fear of Covid-19, lack of spouse support, perceived quality of hospital services to be good, cultural beliefs, socioeconomic factors, and misconception of ANC emerged as major themes determining ANC timing.
Conclusion: Women with higher education levels, those with previous early ANC attendance, those who experienced complications in previous pregnancies, and those who perceived hospital service to be good were more likely to attend ANC in the first trimester. Fear of Covid-19, lack of partner support, and sociocultural factors contribute to late ANC attendance.
Recommendations: Efforts to improve literacy on the timing of ANC attendance in health facilities should be enhanced. Health facilities should ensure and maintain service quality.
2023-01-01T00:00:00ZHypoglycemic, hypolipidemic and biochemical effects of tithonia diversifolia aqueous root extract in western diet fed wistar albino rats
http://ir.mu.ac.ke:8080/jspui/handle/123456789/8956
Hypoglycemic, hypolipidemic and biochemical effects of tithonia diversifolia aqueous root extract in western diet fed wistar albino rats
Okuna, Damaris Akinyi
Background: Diabetes and obesity pose risks of severe complications, including cardiovascular diseases and cancer. The Luo community in Kenya uses Tithonia diversifolia root preparations for hypoglycemic and hypolipidemic effects, necessitating scientific validation.
Objectives: To determine the hypoglycemic and hypolipidemic effects of aqueous root extract of Tithonia diversifolia and its biochemical effects on the liver and kidney of western diet-fed Wistar albino rats.
Methods: This was a laboratory-based study in wistar albino rats with elevated fasting blood glucose and lipids. The rats were put on a western diet composed of rodent chow enriched with 21% animal lard and 0.15% cholesterol for 35days. Thirty-five male rats weighing 180-200g were selected, acclimatized for one week, and randomly grouped into 7 groups of normal control(G1), those fed on western diet for 35 days(G2), the ones fed on western diet for 35days and given 10mg/kg atorvastatin in the last 7 days(G3), those fed on western diet for 35days and given 0.5mg/kg glibenclamide in the last 7 days(G4), the ones fed on western diet for 35days and given 200mg/kg(G5), and 400mg/kg of the extract (G6) respectively in the last 7 days and the ones fed on western diet for 28 days and reverted to normal diet in the last seven days(G7). Blood fasting glucose levels were determined weekly by obtaining blood from the tail.
In contrast, lipid profile, kidney and liver function were determined using blood obtained by cardiac puncture at the end of the experiment. Data was stored in SPSS version 20 and analyzed for means, post-hoc Least Significance Difference, and Duncan's tests to compare the pairs of groups. A p-value ≤ 0.05 was considered statistically significant.
Result: The fasting blood glucose levels gradually increased in all the groups between weeks one to four though maintained normal range for wistar albino rats (3.95±1.31 mmol/L). There was a significant reduction (p=0.000) in serum cholesterol (normal 1.06-3.25mmol/L) when the negative control group(G2) was compared to the groups that received 200mg/kg(G5) mean 2.0mmol/L, 400mg/kg of the extract(G6) mean1.2mmol/L and 10mg/kg Atorvastatin(G3) mean 2.0mmol/L. For triglycerides (0.5-2.9mmol/L) p=0.036 the mean values in G5, G6 and G3 were 1.0, 1.0 and 0.4mmol/L respectively. There was a significant increase (p=0.000) in urea levels (normal levels 3.9-8.9mmol/L) and a significant reduction (p=0.011) in creatinine (17.68-61.88umol/L) among groups given 200mg/kg and 400mg/kg extract compared to positive control. There was no significant increase in levels of aspartate aminotransferase (p=0.264) and alanine aminotransferase (p=0.264), whose normal levels are 34-109U/L and 198.68 ±15.66U/L respectively, but there was significant (p=0.000) difference in alkaline phosphatase(95-611U/L) after administration of 200mg/kg of extract daily for seven days. Reverting to rodent chow for seven days(G7) did not significantly change all the parameters except creatinine and urea, where the changes were significant compared to the positive control group.
Conclusion: Aqueous root extract of Tithonia diversifolia administered at 200mg/kg and 400mg/kg is safe for the liver and demonstrated hypoglycemic and hypolipidemic activity similar to standard drugs glibenclamide and atorvastatin, respectively. However, it seems to be associated with glomerular damage, as evidenced by the elevated levels of urea.
Recommendation: Further studies are recommended in order to establish proper dosage and kidney toxicity.
2024-01-01T00:00:00ZOutcomes of operative management of humerus fracture nonunion among adults attending Moi Teaching and Referral Hospital, Eldoret, Kenya
http://ir.mu.ac.ke:8080/jspui/handle/123456789/8934
Outcomes of operative management of humerus fracture nonunion among adults attending Moi Teaching and Referral Hospital, Eldoret, Kenya
Terer, Erick Kiprotich
Background: Humeral fracture account for 5-8% of all fractures in adults. Most of these fractures tend to heal; however, up to 33 % will develop nonunion which is failure of fracture healing in consecutive 9 months without intervention. Humeral fracture nonunion causes major functional disability, chronic pain and reduced quality of life. The incidence of humerus fracture nonunion cases at the Moi Teaching and Referral Hospital (MTRH) has increased by 25% in the last five years. Data on the functional outcomes of operational management of humeral fracture nonunion at MTRH are scanty. This study intends to close the knowledge gap and advance the field.
Objective: To evaluate the outcomes of operative management of humeral fracture nonunion among adult patients attending the Moi Teaching and Referral Hospital, Eldoret Kenya.
Methods: This study was a hospital based descriptive prospective study involving 32 adult patients with humerus fracture nonunion attending the MTRH, Orthopedics unit. Upon meeting ethical considerations, patients who met inclusion criteria and consented were recruited and followed up for a period of 12 months (September, 2021-August, 2022). Data was collected using a structured interviewer administered questionnaire, the Non-Union Scoring System (NUSS) and the American Shoulder and Elbow Surgeons (ASES) Score sheets. The demographic characteristics, the initial injury patterns, operative modalities used and union rate were recorded and analyzed. The functional outcomes were assessed using the ASES score tool at 6, 12, 18 and 24 weeks after the operation.
Results: The mean age was 52.2 years (SD: 11.84) with male predominance. The left hand was more injured than the right (59.4%). Cigarette smoking and alcohol use were recorded in 9 and 17 respondents respectively. The humerus shaft was the most affected site (18, 56.25%). The mechanism of injuries was Road Traffic Accident (26), falls (4) and physical assaults (2). The mean time to diagnosis of nonunion was 10 months (SD: 1.9). The mean NUSS score was 23.34 points (SD: 3.15). Open Reduction Internal Fixation (ORIF) plating and autologous bone grafting were used in all the patients. Union rate of 96.2% was achieved at mean time of 21 weeks (SD: 4.5). The mean ASES score at week 6 and week 24 was 29.89 points (SD: 12.67) and 78.98 points (SD:6.86) respectively. Surgical wound infection and radial nerve palsy was encountered in 3(9.3%) and 2(6.25%) respectively. Bivariate analysis using Fischer’s exact test showed no association between smoking, alcohol use, gender and improved ASES (p >0.05). Younger age and earlier diagnosis of humerus nonunion were associated excellent union (p<0.05).
Conclusion: A union rate of 96.2% and improved functional outcomes with few complications was achieved following the use of ORIF plating with autologous bone graft in the operative management of humerus nonunion at MTRH.
Recommendations: The use of rigid plate fixation with autologous bone grafting is recommended in the operative management of humerus fracture nonunion as it is associated with good functional outcomes. Further studies are needed to evaluate long term functional outcomes
2024-01-01T00:00:00ZThe use, adherence, andevaluation ofinteractive text-messaging amongwomen admitted toprevention ofmother-to-child transmission ofHIV care inKenya (WelTel PMTCT)
http://ir.mu.ac.ke:8080/jspui/handle/123456789/8933
The use, adherence, andevaluation ofinteractive text-messaging amongwomen admitted toprevention ofmother-to-child transmission ofHIV care inKenya (WelTel PMTCT)
Nordberg, Björn; Kaguiri, Eunice; J. Chamorro de Angeles, Katrine; E. Gabriel, Erin; van der Kop, Mia Liisa; Mwangi, Winfred; T. Lester, Richard; Were, Edwin; Mia Ekström, Anna; Rautiainen, Susanne
Background To improve future mobile health (mHealth) interventions in resource-limited settings, knowledge
of participants’ adherence to interactive interventions is needed, but previous studies are limited. We aimed to inves-
tigate how women in prevention of mother-to-child transmission of HIV (PMTCT) care in Kenya used, adhered to,
and evaluated an interactive text-messaging intervention.
Methods We conducted a cohort study nested within the WelTel PMTCT trial among 299 pregnant women living
with HIV aged ≥ 18 years. They received weekly text messages from their first antenatal care visit until 24 months post-
partum asking “How are you?”. They were instructed to text within 48 h stating that they were “okay” or had a “problem”.
Healthcare workers phoned non-responders and problem-responders to manage any issue. We used multivariable-
adjusted logistic and negative binomial regression to estimate adjusted odds ratios (aORs), rate ratios (aRRs) and 95% con-
fidence intervals (CIs) to assess associations between baseline characteristics and text responses. Perceptions of the inter-
vention were evaluated through interviewer-administered follow-up questionnaires at 24 months postpartum.
Results The 299 participants sent 15,183 (48%) okay-responses and 438 (1%) problem-responses. There were 16,017
(51%) instances of non-response. The proportion of non-responses increased with time and exceeded 50% around 14
months from enrolment. Most reported problems were health related (84%). Having secondary education was associ-
ated with reporting a problem (aOR:1.88; 95%CI: 1.08–3.27) compared to having primary education or less. Younger
age (18–24 years) was associated with responding to < 50% of messages (aOR:2.20; 95%CI: 1.03–4.72), compared
to being 35–44 years. Women with higher than secondary education were less likely (aOR:0.28; 95%CI: 0.13–0.64),
to respond to < 50% of messages compared to women with primary education or less. Women who had disclosed
their HIV status had a lower rate of non-response (aRR:0.77; 95%CI: 0.60–0.97). In interviews with 176 women, 167
(95%) agreed or strongly agreed that the intervention had been helpful, mainly by improving access to and commu-
nication with their healthcare providers (43Conclusion In this observational study, women of younger age, lower education, and who had not disclosed their
HIV status were less likely to adhere to interactive text-messaging. The majority of those still enrolled at the end
of the intervention reported that text-messaging had been helpful, mainly by improving access to healthcare
providers. Future mHealth interventions aiming to improve PMTCT care need to be targeted to attract the attention
of women with lower education and younger age.
2024-01-03T00:00:00Z