College of Heaith Sciences JKUAT (COHES)

Prevalence and Factors Associated with Psoriatic Arthritis among Psoriasis Patients on Followup at the Dermatology and Rheumatology Units in Kenyatta National Hospital, Kenya

2026-05-28T12:37:20Z

Prevalence and Factors Associated with Psoriatic Arthritis among Psoriasis Patients on Followup at the Dermatology and Rheumatology Units in Kenyatta National Hospital, Kenya Achungo, Jane Maureen Psoriatic arthritis (PsA) is a serious and potentially debilitating condition that frequently occurs in approximately 30% of individuals with psoriasis. The burden of PsA ranges between 6 – 42 percent globally and occurs in approximately 30% of patients with psoriasis. However, the burden of PsA has not been fully investigated within the local context. The main study purpose was to determine the prevalence and clinical factors associated with psoriatic arthritis among psoriasis patients on follow-up at the Dermatology and Rheumatology units, Kenyatta National Hospital, Kenya. This was a cross-sectional study conducted at Kenyatta National Hospital over a period of five months. A consecutive sampling technique was used to sample 80 patients diagnosed with psoriasis. A structured questionnaire was used to collect data. The CASPAR criteria were used to screen for PsA. The prevalence of PsA was obtained as a proportion of patients with PsA over the total sample size and expressed as a percentage. Bivariate and multivariable analyses were done to investigate factors associated with PsA using binary logistic regression. A STATA version 16 was used to analyze the data. The findings indicated that the majority of the patients were male (65%), 47.5% were aged between 31 and 49 years, with the youngest being four years and the oldest being 75 years. Further, 52.5% had psoriasis for more than 48 months, and 33.8% had a family history of psoriasis with a first degree relative. The average PASI score was 11.5 (SD=8.9). The common type of psoriasis was plaque (70%), and the common site of psoriasis included the extremities (78.8%). The prevalence of psoriatic arthritis was 23(28.8%) with a 95%CI: 19.4% to 40.2%. The common psoriatic arthritis subtypes included polyarticular arthritis (39.1%), spondylarthritis (26.1%), and oligoarticular arthritis (21.7%). The multivariable analysis revealed that significant factors associated with Psoriatic Arthritis include gender (females, aOR = 10.11, 95% CI: 1.12, 91.61, p = 0.040), history of smoking (aOR = 21.37, 95% CI: 2.45, 186.71, p = 0.006), nail involvement (aOR = 5.44, 95% CI: 2.69, 42.1, p = 0.006), onycholysis morphology (aOR = 11.39, 95% CI: 1.42, 91.50, p = 0.022), oil drops (aOR = 12.11, 95% CI: 1.44, 34.12, p = 0.034), and the PASI score (aOR = 2.11, 95% CI: 1.34, 6.11, p < 0.001). The study concluded that Psoriatic arthritis (PsA) burden is high, with polyarticular arthritis being the most common subtype. Female gender, smoking history, nail involvement, onycholysis morphology, oil drops, and a higher PASI score are key contributors to the likelihood of developing PsA. Early monitoring for these factors is recommended. Master of Medicine in Dermatology

Prevalence of Renal Insufficiency in Patients with Major Cancers and Associated Factors at Kenyatta National Hospital, Nairobi, Kenya

2026-05-28T12:00:37Z

Prevalence of Renal Insufficiency in Patients with Major Cancers and Associated Factors at Kenyatta National Hospital, Nairobi, Kenya Qalicha, Gabriel Dokata Renal insufficiency, defined as a reduction in kidney function, represents a major global health challenge, affecting about 10% of the world’s population. In sub-Saharan Africa, the burden is estimated at 14%, while Kenya reports a prevalence of approximately 4% in the general population. Among cancer patients, earlier studies indicate that up to 27.1% experience renal insufficiency, often necessitating chemotherapy dose adjustments. This study aimed to determine the prevalence of renal insufficiency and identify associated demographic, clinical, and treatment-related factors among cancer patients receiving care at Kenyatta National Hospital. A cross-sectional study design was employed, involving 335 systematically selected oncology patients from KNH wards and clinics. Data were collected through structured interviewer-administered questionnaires and review of hospital records. After exclusion of five participants due to incomplete data, 330 patient records were analyzed. Data entry, cleaning, and analysis were conducted using R (version 4.1.2). Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI micromole/L calculator to diagnose and stage renal insufficiency. Descriptive statistics summarized patient characteristics, while associations between renal insufficiency and demographic, clinical, and treatment variables were assessed using bivariate and multivariable logistic regression. Statistical significance was set at p<0.05. Among the 330 participants, 56.1% were female. Most patients were aged 41–60 years (42.7%), followed closely by those above 60 years (41.5%). The overall prevalence of renal insufficiency was high at 38% (95% CI: 33–44%). Majority of patients had mild renal impairment (eGFR 61–89 mL/min/1.73 m²) accounting for 29.4% of cases whereas severe stages were less common, with stage 4 observed in (2)0.6% and stage 5 in (3)0.9% of patients. Multivariable logistic regression revealed two significant associations. Patients older than 60 years had a more than two-fold higher likelihood of renal insufficiency (AOR=2.33; 95% CI: 1.16–4.87; p=0.020). Conversely, the use of taxane-based chemotherapy was associated with a lower prevalence of renal insufficiency (AOR=0.47; 95% CI: 0.25–0.85; p=0.015). The study concludes that renal insufficiency is common among cancer patients at KNH, with advanced age posing a significant risk. Close monitoring of renal function, especially in elderly patients undergoing cancer treatment, is strongly recommended. Master of Medicine (Internal Medicine)

Predictors of Treatment Failure among Patients with Pulmonary Tuberculosis Attending Public Health Facilities in Nairobi County, Kenya

2026-05-28T11:32:06Z

Predictors of Treatment Failure among Patients with Pulmonary Tuberculosis Attending Public Health Facilities in Nairobi County, Kenya Mwanzui, Faith Muthoki TB treatment failure is defined as the persistence of a positive sputum smear or culture at five months or later during treatment, or the need to change treatment due to lack of clinical or bacteriological response. Tuberculosis (TB) is a major public health challenge in Kenya, which remains among the high TB burden countries despite steady progress in control efforts. In 2023, Kenya notified over 97,000 TB cases and achieved a treatment success rate of approximately 88–89% among patients started on anti-TB therapy, with an estimated 25% HIV co-infection rate among TB cases. However, a proportion of patients still experience poor outcomes, including treatment failure, relapse, loss to follow-up, and death. Identifying factors associated with treatment failure is critical to strengthening TB control and reducing morbidity, mortality, and transmission in Kenya. This study aimed to identify socio-demographic, behavioral, and clinical factors associated with TB treatment failure among TB patients in Nairobi County, Kenya. An unmatched case–control design was utilized, involving 81 TB patients with treatment failure (cases) and 162 TB patients who successfully completed treatment and were declared cured (controls). Controls were selected using simple random sampling from TB registers within the same health facilities as the cases, at a ratio of 1:2.Data was collected using structured data abstraction from patient interviews and medical records, focusing on socio-demographic, behavioral, and clinical characteristics. Statistical analysis was conducted using SPSS version 23. Univariate, bivariate, and multivariate analyses were performed, with 95% confidence intervals (CIs). Odds ratios (ORs) were calculated using unconditional logistic regression to determine factors independently associated with treatment failure. Patients with TB treatment failure were significantly more likely to have a history of prior exposure to first-line anti-TB drugs (OR = 85.0; 95% CI: 29.7–243.3; p < 0.0001). A positive sputum smear at two months of treatment, indicating delayed sputum conversion, strongly predicted treatment failure (OR = 20.63; 95% CI: 5.42–78.41; p = 0.0021). Poor adherence to treatment, shown by missed doses or appointments, was also significantly associated with treatment failure (OR = 4.7; 95% CI: 2.1–10.6; p = 0.004). Conversely, HIV-positive status (OR = 0.34; 95% CI: 0.1–0.9; p = 0.025) and participation in the Directly Observed Therapy (DOT) program (OR = 0.23; 95% CI: 0.1–0.6; p = 0.002) were associated with a reduced risk of treatment failure, suggesting a protective effect. Ethical approval was obtained from the Jomo Kenyatta University of Agriculture and Technology (JKUAT) Board of Postgraduate Studies and the Kenyatta National Hospital–University of Nairobi Ethical Review Committee. Permission to conduct the study was granted by the Nairobi County Health Department and the National Tuberculosis, Leprosy and Lung Disease Program. Written informed consent was obtained from all participants, and confidentiality of patient information was strictly maintained. In the Kenyan context, TB treatment failure is significantly associated with retreatment history, delayed sputum conversion at two months, and poor adherence to therapy, while engagement in DOT and HIV-positive status were protective against failure. To address these challenges, routine bacteriological monitoring (e.g., sputum microscopy or GeneXpert) at two months of treatment should be strengthened, along with enhanced implementation of DOT and comprehensive contact tracing for patients at risk of treatment failure. These measures are critical to improving treatment outcomes and advancing Kenya’s progress toward ending TB by 2030. Master of Science in Public Health

Utilization of Cervical Cancer Screening and Its Associated Factors among Women aged 25-49 Years in Kaloleni Sub-County, Kilifi County

2026-05-28T11:09:02Z

Utilization of Cervical Cancer Screening and Its Associated Factors among Women aged 25-49 Years in Kaloleni Sub-County, Kilifi County Onduko, Emmanuel Moffat Cervical cancer continues to pose a significant public health challenge worldwide. In Kenya, cervical cancer is the second most common cancer among women, with an incidence rate of 32.8 per 100,000 and mortality of 21.4 per 100,000 in 2022, yet national screening coverage remains 17% despite free services in public facilities(KDHS, 2022). This facility-based, mixed-methods cross-sectional study assessed cervical cancer screening utilization and associated factors among 217 women aged 25–49 years attending five health facilities in Kaloleni Sub-County, Kilifi County, between June and August 2025. Guided by Andersen’s Behavioral Model of Health Services Utilization, data collection involved interviewer-administered questionnaires, key informant interviews with 20 healthcare workers, and health facility assessments. Only 23.0% of women reported ever being screened. The analysis identified several significant associations: women unaware of cervical cancer (OR = 0.078, 95% CI [0.023, 0.262], p < 0.001), and unawareness of screening existence yielded an OR of 0.069 (95% CI [0.024, 0.201], p < 0.001). Knowledge gaps further influenced uptake, with those who didn’t know the cervical cancer symptoms associated with an OR of 0.083 (95% CI [0.038, 0.18], p < 0.001). Employed women (OR = 2.121, 95% CI [1.007, 4.218], p = 0.030) and those with health insurance (OR = 2.123, 95% CI [1.067, 4.220], p = 0.030) showed higher uptake. Husbands’ approval an OR of 0.238 (95% CI [0.117,0.487], p < 0.001). Health facility factors, such as service promotion, an OR of 0.105 (95% CI [0.048,0.228], p < 0.001), and staff training adequacy, an OR of 0.094 (95% CI [0.045,0.198], p < 0.001). Qualitative findings identified fear, low perceived susceptibility, spousal opposition, and facility-level barriers such as supply shortages as key deterrents. These findings highlight the importance of targeted awareness campaigns, staff training, and facility improvements to increase screening utilization. Master of Science in Public Health