Internal Medicine

Fetal outcome in cesarean deliveries for non-reassuring fetal status at Jaramogi Oginga Odinga teaching and referral hospital

2024-01-01T00:00:00Z

Fetal outcome in cesarean deliveries for non-reassuring fetal status at Jaramogi Oginga Odinga teaching and referral hospital OYOLO, Grievance Calvin Otieno Non-reassuring fetal status (NRFS) encompasses a spectrum of feto-maternal conditions that causes hypoxia in utero and commonly presents as abnormal fetal heart rate and meconium-stained liquor, these abnormal changes are leading indicators for emergency cesarean sections (EMCS). In 2021 NRFS accounted for 36.03% of cesarean sections (CS) done at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). Research is recommended to provide better knowledge base to guide decision regarding CS and to encourage policy changes. The broad objective was to determine the fetal outcome in cesarean deliveries for NRFS at JOOTRH. The specific objectives were to assess the immediate consequence of non-reassuring fetal heart rate on fetal outcome among mothers in labor at JOOTRH. To evaluate the decision to delivery interval (DDI) on fetal outcome among mothers with Non-Reassuring Fetal Heart rate who underwent emergency CS at JOOTRH. To determine the significance of meconium stain liquor (MSL) on fetal outcome among mothers who underwent emergency CS at JOOTRH. This was an institutional-based retrospective cross-sectional study, simple random selection was used to select files from January, 2020 to December, 2022. Fisher’s formulae was used to calculate the desired sample size of 191 patient files. Statistical Package for Social Sciences (SPSS) version 25, Chicago IL was used to analyze quantitative data. Both descriptive and inferential statistics was used to analyze the three specific objectives. Chi-square test was used to determine the association between the following dependent variables; APGAR score at 1 and 5 minutes, new born unit admission, resuscitation and fetal demise by the following independent variables; bradycardia, tachycardia and meconium stain liquor. It was also used to evaluate the mediator variable decision to delivery interval on fetal outcome among mothers with NRFHR who underwent emergency CS at JOOTRH. The study found that NRFHR had significant association with the APGAR score at 1 minute with a P value of <0.0001, APGAR score at 5 minutes with a P value of 0.002 and Neonatal demise with a P value of 0.001. DDI had a significant association with APGAR score at 5 minutes with a P value of 0.005 and Neonatal demise with a P value of <0.0001, There was no statistically significant difference in the other fetal outcomes. Only 1 (0.5%) emergency cesarean section was done under 30 minutes. MSL was found to have no significant association with the fetal outcomes. In conclusion, bradycardia was associated with poor neonatal outcomes, the average DDI is longer than the recommended target and MSL was not associated with poor fetal outcomes. We therefore recommend expediated interventions in all cases with fetal bradycardia and a review of the factors contributing to DDI with a view of reducing the waiting time. Master's Thesis

Restorative activities of curcuma longa on sildenafil induced nephrotoxicity among male albino rats (Rattus norvegicus)

2023-01-01T00:00:00Z

Restorative activities of curcuma longa on sildenafil induced nephrotoxicity among male albino rats (Rattus norvegicus) KHISA, Wanjala Allan Nephrotoxicity is the leading cause of acute kidney injury worldwide with majority of population affected being of African population as it accounts for 18- 27% of acute kidney injuries managed in hospital set up. Its clinical manifestation includes acute and chronic injuries. Sildenafil is among the drugs postulated to affect the kidneys because it releases active radical scavenger chemicals that damage the renal glomerular, capsules and blood vessels. Curcuma longa commonly known as turmeric is used because of its high levels of antioxidants and anti-inflammatory nature. There is paucity of data on its pharmacokinetics, dynamics and restorative benefits, therefore the main objective of this study was to investigate restorative activities of Curcuma longa on sildenafil induced nephrotoxicity among male albino rats. Specific objectives being; to assess the gross histomorphological and stereological changes on kidneys on administration of sildenafil, to determine the different doses of Curcuma longa required to provide restorative effects in sildenafil induced nephrotoxicity, to evaluate the renal biochemical parameters of BUN and creatinine following administration Curcuma longa on sildenafil toxicity and lastly assess gross histomorphological and stereological changes on kidneys on administration of Curcuma longa in sildenafil nephrotoxicity. The study was a post-test only true experimental design, conducted at Maseno University in Kisumu County, Kenya. A total of 25 male albino rats of the species Rattus norvegicus were used and grouped into two groups as control or experimental. The experimental groups were subjected to sildenafil then Curcuma longa respectively at calculated doses. The ethical approval was sought from both the school of postgraduate research committee and animal research committee. Data was entered into excel spread sheet, analyzed using the statistical package for social sciences version 22.0. The kidney biochemical markers were compared before and after restoration using t-Test. One way ANOVA with post hoc Bonferroni was used and a P value ≤0.05 was considered significant. The mean body weight of rats in SIN group was statistically significant(P=0.0001) as compared to Control group and experimental groups. The mean weight of right kidney was slightly higher than left kidney in SIN group although their weight respectively was statistically significant (P=0.0001) as compared to control and experimental groups. The mean volume of right and left kidney in SIN group was statistically significant as compared to control and experimental group. The mean length and thickness in SIN group were statistically significant (P=0.0001) as compared to control and experimental groups. On histological changes in SIN group; the glomerulus was shrunk, bowman`s space dilated, proximal convoluted tubule dilated and epithelial cells appeared necrotic. In experimental groups, medium and high Curcuma longa; the glomerulus appeared normal, bowman`s space narrow, proximal convoluted tubule constricted and epithelial cells were normal and appeared cuboidal in shape. On stereological findings in SIN group; the absolute glomerulus volume was statistically significant (P=0.0001) as compared to control and experimental groups whereas the number weighted volume fraction of epithelial cell was statistically significant (P=0.0001) in SIN group as compared to control and experimental groups. The renal biochemical parameters in SIN group were statistically significant (P=0.0001) as compared to control group. In conclusion, Sildenafil citrate had toxic effects on kidney as demonstrated by the gross morphometrical, histological and stereological changes. Medium and high Curcuma longa dose were more effective as demystified by the gross morphological, histomorphological and stereological changes. There were no changes in biochemical parameters in SIN group as compared to experimental groups. Medium and high Curcuma longa doses were found to improve the gross morphometrical, histomorphological and stereological changes. Therefore, this research recommends that sildenafil has effects on kidney histoarchitecture when used at high dose or prolonged period of time and should be regulated. Curcuma longa has restorative effects on histoarchitectural changes caused by sildenafil and there is need to do further research to ascertain the pharmacokinetics and pharmacodynamics of the different components responsible for the changes. Master's Thesis

Effect of quercetin on industrial trans fatty acids induced glucose intolerance in rattus norvegicus albinus

2023-01-01T00:00:00Z

Effect of quercetin on industrial trans fatty acids induced glucose intolerance in rattus norvegicus albinus LEKAKENY, Naiyomah Globally climate change has been a major impediment to achieving sustainable development among natural resource dependent livelihoods. Impact-based weather forecasting (IBF) has been recommended as prerequisite tools toward the adoption of adaptation strategies to curb climate risks. Owing to the severity of climate change and variability in the fishing economies, the fisher-folk have been a key target by meteorological departments and other climate change adaptation actors. With this understanding, in 2017 the Highway-Wiser project with Kenya meteorological department launched IBF in 10 beaches in Homa Bay County to reduce deaths, and destruction of property, and reduce loss of livelihoods. However, evidence shows that the uptake of IBF among fisher folk is limited at these sites. Additionally, there is a scarcity of systematic works into the issues pertaining to the uptake of IBF. Consequently, this study explored the factors that influence the uptakeof IBF among fisher-folk at the sites where it had been piloted in Kenya. Specific objectives were to: assess the fisheries-based determinants of fisher-folk access to IBF; explore the influence of fisher folk's perceptions on IBF uptake; examine the level of utilization of IBF, and finally, investigate the effects of IBF on fisher-folk's livelihoods. This study employed a conceptual framework based on Weather information dissemination, contextual adaptation, and usable weather information models to understand the uptake of IBF on fisher folk’s adaptation to storms. This study adopted sequential explanatory research design to enable a holistic exploration of the research questions. This thesis combined quantitative and qualitative research methods to allow the triangulation of data and methods. A proportional stratified sampling design was used and simple random sampling was applied to select respondents from each stratum. The total study population was 5, 760 out of which 422 respondents were drawn using the Fisher et al. (1991) formula. Quantitative data was systematically collected by the use of semi structured questionnaire. Qualitative data was collected using 6 focus group discussions (FGDs) and 35 key informant interviews (KIIs) from purposefully selected respondents from the user categories, and policy makers. Descriptive statistics; frequencies, percentage, graphs, and cross-tabulation were used to analyze quantitative data. Qualitative data were analyzed through thematic analysis. The research found a moderate level of fisher folk accessibility to impact-based forecasts. The determinant of fisher folk access to IBF varied on the basis of demographic, fisheries -context and IBF design and delivery factors. The key factors that explain variation on fisher folk access to IBF included; the BMU leadership, social network, adoption of flags and notice boards, exposure to storms, boat size and source of energy, fisher folk years of experience, channels and timing communication. The fisher folks were more aware about the existence of IBF. They also perceived IBF to be salient, fairly accurate but a good number lacked understanding on their spatial and temporal scale and perceived them to be unreliable and untrustworthy. This restricted the uptake of IBF to a few fishers’ folk. The study found out that only 18% of fisher folk surveyed were using IBF in their decision-making. However, the level of utilization of IBF varied across landing sites, gender, and fisher folk categories. Factors that explain the lower level of its utilization include fisher folk's over-reliance on their personal weather information, laxity among fishers, lack of involvement in mainstream fishing, lack of sensitization by BMU leaders, the need to fend for one's household, ignorance of the value of IBF among fishers, late provision of IBF information by BMU officials, and fisher folk false perception of safety particularly those using outboard boats. Factors contributing to the high utilization of IBF included; a high level of awareness, display of flags and notice boards, and training and understanding of the value of the IBF to their fishing decisions. The research found out the uptake of IBF benefited the fisher folk livelihoods. The study recommends involvement of community-based organizations to improve awareness and accessibility, need for more training on the use of IBF in fisheries decision making context. This research contributes to weather service uptake by illuminating the key factors that determine the uptake of IBF among fisher folk that can be applied to fisher folk communities in developing countries. Master's Thesis

Association of liver biochemical profile and clinical outcome of covid-19 infection in patients admitted at Mount Kenya hospital Nyeri, Kenya

2023-01-01T00:00:00Z

Association of liver biochemical profile and clinical outcome of covid-19 infection in patients admitted at Mount Kenya hospital Nyeri, Kenya KANYUGO, Anne Murugi Coronavirus disease 2019 (covid-19) pandemic is the most recent significant global health crisis after the influenza pandemic of 1918. It has caused consequential global economic decline with loss of over 6 million lives with most of the deaths occurring in the early days of the pandemic when little was known about the virus. The disease is associated with diffuse lung injury causing acute respiratory distress syndrome which is the principal cause of death. Liver injury of variable magnitude has been documented in numerous studies. The aim of this study was to determine the association between liver biochemical profile and clinical outcome of hospitalized covid-19 patients. The specific objectives were; to determine the association between age and clinical outcome of covid-19 infection, to evaluate the association between cholestatic-hepatocellular enzymes and clinical outcome of covid-19 infection, to assess the association between serum albumin levels and clinical outcome of covid-19 infection and to determine the association between serum total bilirubin levels and clinical outcome of covid-19 infection among covid-19 patients admitted at Mount Kenya Hospital, Nyeri, Kenya. This was a retrospective cross-sectional study involving 117 covid-19 patients admitted at Mount Kenya Hospital, Nyeri. A census approach was used. Inclusion criteria was patients with positive covid-19 tested using rqRTPCR with LFTs done on admission. Exclusion criteria was patients with positive covid-19 rqRTPCR whose medical records were incomplete, patients with positive covid-19 tested using rapid antigen test, patients with comorbidities, recent history of alcohol use and pregnant women. Severity of covid-19 was based on at least one of the following: respiratory rate >/ 30 breaths/minute, oxygen saturation < 93%, mechanical ventilation, shock and need for ICU admission. Data on age, liver biochemical parameters and clinical outcome was gathered from medical records. LFT abnormalities were defined as elevation of liver enzymes in reference to Mount Kenya hospital laboratory reference range: ALT (0-42 U/L), AST (0-37 U/L), ALP (40-150 U/L), GGT (8-46U/L), TBIL (0-22 UMOL/L), DBIL (0-6.8 UMOL/L), total protein (66-87 G/L), albumin (37-57 G/L) and graded as mild liver injury (x 1-2 ULN), moderate liver injury (x 3-5 ULN) and severe liver injury (> x 5 ULN). Primary data was entered and cleaned using statistical package for social sciences version 26.0 (SPSS 26.0, 2019). Data was presented as mean ± standard deviation and frequency for normally distributed data and categorical data respectively. Statistical differences for categorical data were compared using chi-square test. Logistic regression analysis was used to assess for association between serum ALP level and clinical outcome (survival or non-survival).Statistical analysis was performed in SPSS (version 26.0, 2019) and P < 0.05 was considered statistically significant. The study established a significant association between patient’s age, serum ALP and albumin levels and clinical outcome of covid-19.Notably increasing age, high serum ALP levels and hypoalbuminemia were found to associate with clinical outcome. The study concluded that these parameters may be used for risk stratification and prognostication with prompt scaling up of clinical interventions for better health outcomes. Master's Thesis

Variations in the anatomical origin and distribution of coronary artery among black African population: a cadaveric study in western Kenya.

2023-01-01T00:00:00Z

Variations in the anatomical origin and distribution of coronary artery among black African population: a cadaveric study in western Kenya. OLGAH, A. Otieno The coronary artery and its branches is the main blood vessel that supplies the myocardium. The principal branches of ascending aorta are the right and left coronary artery. Variations of the coronary arteries are vessels that do not conform to the normal anatomy of coronary arterial branching tree. These variations can be compensatory, collateral, alternate or a duplication of another vessel and can have both positive or negative attributes. Cardiac dominance is depicted with the artery that gives rise to the posterior descending artery which is key in the perfusion of the intraventricular septum. Social demographic factors may influence diseases like diabetes and hypertension due to these variations. Variations in coronary arteries are thought to be among the leading cause of sudden death thus giving cardiologists and heart surgeons challenges during the management of heart conditions. This study sought to determine these variations among the black African population in Western Kenya by assessing the variations in origin and distribution of the principal coronary arteries, investigating the dominance of the heart and associating the variations to demographic characteristics of the study population. Crossectional study design was adopted. The study sites were Maseno University, Uzima University and Masinde Muliro University anatomy laboratories. The sample size of 89 cadavers was estimated using Crochan’s formula leading to 72 samples in total. Data sheets were designed to capture the variables while descriptive statistics was used to determine the mean, mode, median and standard deviation of the variations. Chi square test was used to test the association between the right, left and co dominance while Pearson’s correlation test was used to analyze the relationship between the variables with a P ≤ 0.05 considered as significant. All ethical considerations were observed. Luo were the leading ethnic group in the study ethnicity at 54.2% while being the Kuria and Kalenjin were the lowest and at 2.8%. Dual aortic origin had the most common occurrence at 55.6%. Both coronary arteries showed bifurcation with a mean length of 12.22cm on the right artery and 9.32mm on the left. Termination of the left coronary artery was at the crux while on the right coronary artery was between the crux and the obtuse margin of the heart. There was right dominance of the heart with statistical significance between gender and right heart dominance at P ≤ 0.0260. There was no statistical significance between gender and ethnicity to the variations There were variations in the origin of the coronary artery with right dominance being more expressed. Population specific variation like race and geographical location to be considered for further study. Master's Thesis

Age estimation using orthopantomograms with demirjian and willems methods among children attending dental clinics in western Kenya

2023-01-01T00:00:00Z

Age estimation using orthopantomograms with demirjian and willems methods among children attending dental clinics in western Kenya ODE, Brian Odhiambo An individual’s age forms an important part of their biodata and is not only necessary for the living but for the deceased. In addition, it is a vital requirement in identifying children who are victims of child abuse, trafficking and murder. Verification of an individual’s age can be done through authentic documents such as certificate of birth, national identity cards or passports. Nevertheless, there are situations where the age of an individual cannot be confirmed due to entrenched documents, hence the actual age has to be estimated. Therefore, various methods have been used to estimate age in different population among them being Demirjian and Willems methods that have widely been utilized. This has been achieved majorly through assessment of morphological changes of teeth as displayed by individual orthopantomograms. However, in Kenya, there is hardly any approved method that can be used to achieve this purpose, hence the need to determine the available methods in estimating the age of children in Western Kenya. Objective: To estimate age using orthopantomograms with Demirjian and Willems methods among children attending dental clinics in Western Kenya. Materials and methods: A cross-sectional study was conducted at Dental and Maxillofacial Imaging Centre in Kisumu County, Western Kenya. A total of 171 panoramic radiographs of children aged between 5-17 years were examined in order to determine the tooth maturity stages(A-H) for the first seven mandibular teeth on the left side. Each maturity stage was then assigned a corresponding maturity score as per Demirjian and Willems conversion tables, summed up and converted into dental age. The age difference was then obtained by subtracting dental age from chronological age. Descriptive and inferential statistics were used and data analyzed through SPSS version 26.0 and presented in tables and figures. Results: A sample of 171 panoramic radiographs of children aged 5-17 years were assessed, 91(54%) males and 80(46%) females. The study samples were divided into 6 age cohorts and comparison between sexes were tested. The mean chronological age for the entire age cohort was 9.11 years with a median age of 9.13 years. The overall mean dental age using Demirjian was 8.16±2.7. Among the females the deviation from the chronological age was ±2.22 years while in males it was ±1.68 at 95% CI. This depicted a wider margin of error in females than in males. There was an overall underestimation of the entire age cohort using Willems method with mean dental age of 8.94±2.264 with a standard error of 0.173 years. Among the females the deviation from the chronological age was ±2.062 years while in males it was ±1.95 at 95% CI. This depicted a wider margin of error in females than in males and a significant delay in dental maturity in both females and males. The comparison between dental age and chronological age was found not to be significant using both methods at P=<0.05. Pearson’s correlation test revealed a strong positive association between the dental and chronological age in both methods (r= 0.767). Demirjian had a strong association in only two age cohorts (7-8.99 & 9.-10.99 years) while Willems had a stronger association in four age cohorts (5-6.99, 7-8.99. 9-10.99, 11-12.99 years). Conclusion: Use of both Demirjian and Willems method resulted in statistically significant underestimation of age. In terms of accuracy, both methods had a strong positive correlation, however, Willems method was found to be more accurate in estimating age among children in Western Kenya because it had a strong association in majority of the age cohorts as compared to Demirjian. Master's Thesis

Variation in morphology of brachial artery and its branching pattern among black African population: a cadaveric study in western Kenya

2023-01-01T00:00:00Z

Variation in morphology of brachial artery and its branching pattern among black African population: a cadaveric study in western Kenya OYALE, Warren Ayonga The brachial artery (BA) is the main arterial supply to the upper limb, BA commences at the inferior border of teres major muscle as a direct continuation of the 3rd part of axillary artery and courses to the arm anterior to triceps and brachialis muscle, it terminates at the neck of the radius, about 1cm by dividing into its two terminal branches, radial and ulnar arteries. There is paucity of data on its anatomical variations and its branching pattern among black African population, thus the purpose of the study was to evaluate anatomical variations of the BA and its branching pattern among black African population. Specifically, the study focused on establishing variation in origin and termination of BA, its branching pattern, length, correlation of variation, and branching pattern between laterality and gender among the black African population. The current study adopted a cross-sectional descriptive study design with purposive sampling as a sampling technique. The study was carried out in three universities in western Kenya due to their functional human anatomy laboratory. The study involved 77 cadavers (38 females and 39 males) with a total of 154 upper limb specimens. It was observed that there were 3.8% variation in origin of BA, the most common variation was superficial origin of BA. In termination of BA 89% terminated at radial neck,7.8% at radial tuberosity,1.9% at proximal arm and 1.3% midarm. 93.4% of the specimen had bifurcation of BA into radial and ulnar arteries, trifurcation was seen in 4.1% of the specimens, High bifurcation of BA was seen in 2.4% of the specimens. Mean length of BA was found to be 26 cm. There was no statistically significant difference variation (p=>0.05) in the origin of BA when compared with the normal origin, however there was statistically significant variation in termination of BA between the right and left upper limbs (p=0.000). The BA is of clinical importance for health care professionals worldwide, it is used clinically for brachial pulse identification, blood pressure monitoring, arteriography, percutaneous arterial catheterization, and arteriovenous fistula (AVF) for dialysis patients, various surgical and radiological procedures thus clinicians should treat each patient as special case to avoid mismanagement, misdiagnosis and improve clinical outcome on procedures involving BA. Master's Thesis

Anatomical variations in morphology of the brachial plexus among black African population; a cadaveric study in western Kenya

2023-01-01T00:00:00Z

Anatomical variations in morphology of the brachial plexus among black African population; a cadaveric study in western Kenya OMUGA, Philip C.A. Brachial plexus (Bp) is a network of nerve bundle in the spinal cord around neck and axillar formed by union of ventral primary rami of C5 - C8 and T1. Bp may be affected by trauma, irradiation, neoplasm, infection, and autoimmune inflammatory disease. Aim was to identify anatomical variations in morphology of Bp among black African population in western Kenya. The specific objectives were to find out variation differences in demographic characteristics (male and female); determine variation differences of right and left, investigate anatomical variations in origin, course, and distribution. Descriptive Cross-sectional design adopted. The sample population of 86 cadavers (Maseno 43, Uzima 23 and Masinde Muliro 20) calculated based on Yamane taro formula giving sample size of (35,19,16) 70 respectively. Descriptive statistics used to determine mean, mode, median and standard deviation. Chi- square test used to find statistical significance between variables with p–value of (α = 0.05). Pearson’s correlation test used to analyze statistical evidence for a linear relationship among variables. Ethical consideration observed. Posterior neck & axillar incisions made exposing and identifying variations at roots, trunks, divisions, cords, and terminal branches. Gender variable, 50% (35) female and 50% (35) male. Most frequent variation was the pre-fixed 20.9% least at division 2.2%. Highest variation in branching was musculocutaneous at 18.6% whilst lowest was radial 5%. The total 17.8% variations in the origin and segments of Bps, majority were from left whilst 7.9% from the right. Highest frequency occurred at pre-fixed root with 8.6% left and 12.1% right. The lowest was division with anterior division of the medial trunk connecting with medial nerve. Females had highest variations of terminal branches at 37.8% followed by males at 32%. There was statistical significance difference (p=0.008) in variation distribution of median nerve in relation to the sexes. No statistical significance variation observed in all the branching patterns. Levine’s test didn’t show any strong variation from the normal anatomical standards. Musculocutaneous nerve variations were most common and occurred on right-side affecting females hence gender specific variations should be considered for further studies. Study has prospective to enhance clinical correlation and medical research diversity. Master's Thesis

Effects of aqueous garlic extract intervention on plasma glucose, lipid profile and alkaline phosphatase concentrations in atazanavir treated rattus norvegicus albinus

2023-01-01T00:00:00Z

Effects of aqueous garlic extract intervention on plasma glucose, lipid profile and alkaline phosphatase concentrations in atazanavir treated rattus norvegicus albinus ARISI, Jephter Patients on Highly Active Antiretroviral therapy (Protease inhibitors) are prone to complications including abnormalities in glucose metabolism, lipid derangement, and increased risk of cardiovascular disease. Studies have shown that Garlic can improve glycemic status and changes in lipid profiles. The objective of this study was to evaluate the effect of aqueous garlic extract intervention on the plasma glucose, lipid profiles and alkaline phosphatase concentration in atazanavir treated Rattus norvegicus albinus. The specific objectives were to determine the effect of aqueous garlic extract intervention on plasma fasting blood glucose, triglycerides, high density lipoproteins cholesterol and low-density lipoproteins cholesterol and alkaline phosphatase concentrations in atazanavir treated male Rattus norvegicus albinus. This was a randomized experimental study which lasted fourteen weeks.The study used thirty-nine (39) male Rattus norvegicusthat were randomly divided into three (3) groups, (control, treat 1 and treat 2) consisting of 13 animals each. Treat 1 rats received a daily atazanavir treatment at 10mg/Kg. Treat 2 rats received daily atazanavir treatment as in treat 1 above plus garlic extract 250mg/kg body weight as from the third week. The control rats received 2ml of normal daily throughout the study period. The plasma total triglycerides, high density lipoproteins cholesterol, low-density lipoproteins cholesterol and alkaline phosphatase concentrations were done using automated analyzer for lipid profile and liver enzymes respectively. The differences between meanconcentrations of fasting blood glucose, total triglycerides, high density lipoproteins cholesterol and low-density lipoproteins cholesterol were analyzed using one- way ANOVA. Test of significance was set at P <0.05. Treat 1 showed a significant (P=0.000) increase in the mean concentration of fasting blood glucose of 5.4mmol/L at the end of the study while treat 2 rats showed an increase to 4.7mmol/L as at the eight week with a significant decline at end of the study to 4.4mmol/L compared to the controls whose FBG levelranged between4.0mmol/Land 4.3mmol/Lduring the study period. Treat 1 animal exhibited significant (P=0.00) increase in total tryglycerides to 64mg/dL while treat 2 also recorded an increase to 63mg/dL followed by a decline to 47mg/dL by the end of the study. The mean LDLc increased significantly (P=0.000) to about 74mg/dl by the end of the study in treat 1 whereas in treat 2 this increased to 72mg/dL by the sixth week before declining to 62mg/dL. Treat 1 exhibited a significant (P=0.000) decline of HDL from…..to 47mg/dL during the fourth week and down to 41mg/dL by the end of the study while Treat 2 showed an initial decline to 42mg/dL at six weeks before significantly(p=?) rising to 52mg/dL at the end of the study. Treat 1 showed a significant (P=0.000) elevation of the mean plasma ALP in the fourth week (65U/L. Treat 2 on the other hand showed a significant increase to 63U/L by 4th week before declining to 56U/L by the end of the study. The findings of this study show that atazanavir caused elevation of FBG, TTGLD, LDLc and ALP and a decline in HDLc concentration. Aqueous garlic extract reversed all the atazanavir treatment effects hence can be considered as an adjunct therapy in patients on PI based regimen. These findings suggest that garlic can be used as a supplement for intervening the metabolic effects of atazanavir. Master's Thesis

Determinants of Art Initiation and Perceptions On Antiretroviral Drugs Uptake During Pregnancy and Puerperium at Homa Bay County Referral Hospital In Homa Bay, Kenya

2020-01-01T00:00:00Z

Determinants of Art Initiation and Perceptions On Antiretroviral Drugs Uptake During Pregnancy and Puerperium at Homa Bay County Referral Hospital In Homa Bay, Kenya OCHOLA , Charles Olelo Use of effective antiretroviral therapy (ART) in Human Immunodeficiency Virus (HIV) positive pregnant women has been proven to be the most effective technique of preventing mother-to-child transmission (PMTCT) of HIV. This strategy has been shown to drastically reduce the incidence of HIV in newborns. It is however noteworthy that this service has not achieved its full potential in terms of utilization in most counties in Kenya as the rates of maternal HIV transmission remains high with the national average at 6.2%. Some of the determinants of ART initiation and perceptions on its use for PMTCT are not fully understood. The objective of the study was to outline the determinants of the timing of initiation and perceptions on uptake of ART by HIV positive pregnant women on PMTCT in Homa Bay County, Kenya. The perceptions of healthcare workers were also determined. Specifically, the study sought to determine the perceptions of HIV positive pregnant women and healthcare workers on the use and barriers to ART for PMTCT services. The study also assessed antenatal attendance for PMTCT and timing of ART initiation. A cross-sectional study design was used and study conducted at Homa Bay County Referral Hospital (HCRF). The study targeted expectant HIV positive women who presented ante-natal, during labor and post-partum at HCRH during clinic. A sample size of 290 HIV positive women as determined by Fisher et al., (1998) formula was used. Data on study participants‟ socio-demographic status, awareness and perceptions on PMTCT services, antenatal clinic attendance, timing of ART initiation and the proximity to PMTCT services was collected using a pretested interviewer administered questionnaire. Healthcare workers running PMTCT clinics were also interviewed on their experience and barriers to PMTCT services as may have been reported to them by the women. Socio-demographic characteristics of the respondents was expressed using descriptive statistics. The number and timing of antenatal attendance was expressed in percentages. The timing of initiation of ART was expressed in frequencies and percentages and chi square test used to determine the association between income and level of education and the timing of ART initiation. Perceptions on barriers to PMTCT were weighted and expressed in percentages. The timing of Antenatal attendance was categorized and chi square used to compare the time of ANC initiation and the likelihood of facility delivery. The participants‟ views on the possible things to be improved were coded into thematic areas. The level of training of the PMTCT providers and their views on barriers to PMTCT was expressed in frequency and percentages. Most women‟s perception on barriers to PMTCT included stigma at 45%, lack of spouse support (23%), lack of knowledge (15%), distance (12%). The women expressed knowledge about PMTCT with 86.6% of them having heard about the services. Other than use of PMTCT for prevention of infections, only 67.2% cited safe delivery as a preventive strategy. 22% of them thought that not breastfeeding would confer additional benefits while safe sexual practices was only mentioned by 18.6 % of the respondents. In the timing of initiation of ART for PMTCT, 55.1% of the respondents started it before being pregnant. This included a small subset (7.2%) of women who were themselves survivors of vertically transmitted infection and had now reached child bearing age. Antenatal visit attendance for PMTCT was mostly initiated late after 3 months into pregnancy by 53.6 % of the respondents. Total attendance of ANC across the continuum of pregnancy was high with 92.4 % of the respondents reporting to have attended at least once. All the respondents indicated having attended ANC at least once. Rate of institutional deliveries was however at 87.4%. Occupation(p=0.011), level of education (p=0.000) and level of income (p=0.015) were positively associated with the decision to deliver at home or in the health facility. Health care workers expressed lack of laboratory support, drugs stock outs and clients‟ refusal to take medication as the challenges they encountered. In addition, they cited stigma, lack of spouse support and attitude of health care workers as some of the barriers women reported to them as they sought PMTCT services