College of Heaith Sciences JKUAT (COHES)

Viral Suppression among Men Who Have Sex with Men Living with HIV Who Were on Risk Reduction Interventions and Control Group in Mvita Sub-County, Mombasa County, Kenya

Thu, 11 Jun 2026 00:00:00 GMT

Viral Suppression among Men Who Have Sex with Men Living with HIV Who Were on Risk Reduction Interventions and Control Group in Mvita Sub-County, Mombasa County, Kenya Karanja, Jane Wangui Globally, men who have sex with men (MSM) are more vulnerable to HIV as compared to men in the general population. However, if commenced promptly on ART and adherence to treatment is observed their viral load can be suppressed hence unable to transmit the virus to their partner. The aim of this study was to determine the effectiveness of the risk reduction interventions on viral load suppression levels among men who have sex with men (MSM) living with HIV versus those in the control group in Mvita sub-County, Mombasa County, Kenya between December 2020 and June 2021. A quasi-experimental study design using quantitative methods was adopted and the study population was the MSM residing in Mvita sub-County in Mombasa County. Inclusion criteria were, being biological male-sex assigned at birth, 18 years and above, had anal sex with at least one male partner in the past 3 months, a resident of Mvita sub-County, and willingness to give informed consent in writing. Exclusion criteria were those who declined to give consent or were intoxicated with alcohol or drugs. The respondent-driven sampling (RDS), a semi- probabilistic method, in the absence of a sampling frame was used to obtain the sample of respondents. A total of 114 HIV positive MSM participated in the study. Half (57) of MSM living with HIV were actively followed and risk reduction interventions (adherence to ARVs, general counseling and nutritional care), and HIV prevention measures (prompt treatment of STI/OI and condom use) were offered after every 2 months for six months. The control group (57) received no risk reduction interventions. Semi-structured questionnaire and laboratory investigations were employed to collect data. Log-binomial univariate and the multivariate regression analysis model were used to identify the variables which were associated with undetectable viral load. Undetectable viral load was defined as having an HIV viral load of less than 50 copies/ml. Data collected was cleaned, coded and analysed using STATA software, Version 17. Level of significance was fixed at 5%. Ethical approval was received from the relevant bodies. Majority of MSM were between ages 19 to 29 (54%), were single (77%), were Christian (61%), never married to a female (39%) and had an income of <5,000 ksh (65%). MSM in the control group, who reported ever use of PEP/PrEP (44%), were likely to have detectable viral load while MSM who received interventions, who reported condom break more than once during anal sex (61%), who had more than one regular anal sex partners (61% both groups), and who drunk more than 2 bottles of beer (33% both groups) were likely to have undetectable viral load. MSM in the control group who reported being always high on alcohol during anal sex (19%), were likely to have detectable viral load. MSM who received interventions and reported feeling uneasy while seeking health services (75%) had detectable viral load while those in the control group who attended private clinics (42%), had undetectable viral load. Overall, after six months, the proportion of MSM achieving viral load suppression was significantly higher in the intervention group as compared to control group by 60% (95% CI= 49‒70, p < 0.001). In conclusion, MSM in the control group had low knowledge of HIV prevention hence detectable viral load. However, high risk behaviours such as condom break were associated with undetectable viral load in the group that received risk reduction interventions. MSM in the control group who were attended in private clinics received better HIV care, thus had undetectable viral load. MSM who received risk reduction intervention had better treatment outcome with many MSM xix achieving undetectable viral load. From the study it is recommended that peer-led HIV services to be integrated in all HIV programmes targeting MSM, effective substance use intervention program be re-designed to rehabilitate the MSM on alcohol and drugs, improvement on HIV care in public health facilities and risk reduction interventions to be offered to all MSM. PhD Public Health

Vaccination Coverage and its Associated Factors among Children Aged 2 - 5 Years in Eldas Sub County, Wajir County

Thu, 11 Jun 2026 00:00:00 GMT

Vaccination Coverage and its Associated Factors among Children Aged 2 - 5 Years in Eldas Sub County, Wajir County Abdi, Cathra Childhood vaccination is crucial intervention to reduce the morbidity and mortality of vaccine-preventable diseases. It has been estimated that vaccination campaigns prevent almost 3 million deaths globally each year. However, in 2018, 19.4 million children worldwide missed all necessary vaccinations. In Africa, routine vaccination coverage remains particularly low. In Kenya, the North Eastern region has the lowest vaccination coverage; (41%). The study aimed to establish vaccination coverage and its associated factors among children aged between 2 and 5 years in Eldas Sub- County, Wajir County. The specific objectives entailed establishing individual level factors associated with complete vaccination coverage, assessing status of routine vaccination and to determine health system level factors associated with complete vaccination coverage among children aged 2 to 5 years in Eldas sub county, Wajir County. A cross-sectional design was employed on sample size of 367 caregivers. Respondents were chosen using probability proportion to size and systematic random sampling strategies. A structured questionnaire and key informants’ guide were deployed for data collection. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25.0 with descriptive and inferential statistics generated. Chi-square test examined the relationship between categorical variables at confidence interval of 95%. Demographic findings showed that households were majorly male led with majority practicing Islami religion (98.1%) and 8.37% never attended school. A considerate percentage (40.1%) was in monogamous marriage arrangement, with only 23.2% in polygamous marriage. Sixty seven percent (67.9%) were unemployed while 23.2% earned between Ksh 6,001 and 12,000 a month. Radio ownership among caregivers was quite low. More than 21% (78 caregivers) attended to non-biological children. Caregivers with formal education were 3.47 times more likely to comply and have their children complete vaccination schedule (95% CI = 1.18 – 9.57, P = 0.032). Children of those earning more than Kshs 24000 a month were 3.18 times more likely to complete vaccination (95% CI = 1.27 – 11.67, P < 0.001) while those earning g between Kshs. 12000 - 24000 per month were 2.96 times more likely to complete vaccination (95% CI = 1.15 - 10.39, P = 0.002). Children with caregivers aware of vaccination's purpose were 4.51 and 2.57 times more likely, respectively, for complete vaccination (95% CI = 1.36 – 12.75, P < 0.001; 95% CI = 1.18 – 8.62, P = 0.031). Children born with skilled birth attendants were 5.36 times more likely for complete vaccination (95% CI = 2.15 – 13.21, P < 0.001). Children from places 1 – 5 km or 5 – 10 km from the hospital were 4.28 and 2.57 times more likely, respectively, for complete vaccination (95% CI = 1.28 – 14.87, P = 0.009; 95% CI = 1.54 – 6.88, P = 0.024). Content analysis was adopted in summarizing qualitative findings. More than ninety six percent (96.2%) of the children had been vaccinated atleast once. Distant location and lack of knowledge on immunization time were cited as major barriers to complete vaccination. Around 78.5% of the studied children reported experiencing a medical issue, 42.9% opined that atleast they were late on immunization schedule. Absence of personal issues among caregivers was associated with 2.29 increased likelihood of completing vaccination (95% CI = 1.41 - 3.75, P < 0.001). Knowledge on immunization further improved completion of immunization schedule by 5.53%. Qualitative findings also revealed a considerably high coverage attributed to strong community engagement and healthcare team dedication. The high coverage implied xv increasing level of access, awareness and system strength in delivering immunization solutions to the children. The notable health system factors included lifestyle, information, access and logistics, income level, education and awareness. However, misinformation, societal beliefs, low economic capacity, language barrier and nomadic lifestyle contributed to vaccine hesitancy among caregivers. The study concluded that individual level factors associated with complete vaccination status were education, occupation, income level, and ownership of electronic devices significantly influenced complete vaccination status among children aged 2 to 5 years in Eldas sub-county, Wajir County. However, vaccination completeness performance was below the recommended set target by WHO and the Ministry of Health. Health system related predictors that explained complete vaccination status included availability of skilled healthcare professional, presence of well-equipped public healthcare facilities and caregivers’ proximity to those facilities. It was suggested that the County Health Department should implement education outreach programs, support caregivers, enhance vaccination accessibility for lower-income families, use media for awareness campaigns, and address clinic shortages to improve vaccination coverage. It also recommends implementing subsidies or incentives to bridge economic gaps, leveraging electronic devices for vaccination knowledge, and enhancing healthcare infrastructure. MSc in Public Health

Microbial Colonization of Surgical Instruments and Surgical Sites Intra-Operatively in Main Theatres of Kenyatta National Hospital, Kenya

Thu, 11 Jun 2026 00:00:00 GMT

Microbial Colonization of Surgical Instruments and Surgical Sites Intra-Operatively in Main Theatres of Kenyatta National Hospital, Kenya Shisoka, Joan Matendechere Surgical site infections (SSIs) have the highest frequency of postsurgical complications with a global range of 2.5-41.9% and have a significant impact upon the health or illness process of the patient and satisfaction levels. In addition to potential economic consequences, SSIs can have a negative impact on patient outcomes and may potentially be life-threatening. There are no practice guidelines to inform the perioperative teams on when to change the surgicals and instruments when presumed to be contaminated. This study determined surgical instruments exposure time and microbial colonization in relation to SSIs in the Main Theatres of Kenyatta National Hospital, Kenya and came up with strategies and recommendations that will lead to development of practice guidelines for the perioperative teams. A mixed method quantitative and sequential qualitative was used. In the quantitative arm; analytical cross-sectional design and purposive sampling method was adopted. Check lists and standard laboratory request forms for data collection were used. A sample of 92 patients was used. The qualitative arm Seven experts in the subject area were purposively sampled for the Key Informants Interviews. Data was analyzed using Statistical Package for Social Sciences (SPSS) software. Descriptive and Inferential statistics such as Chi-square and t-test were used to describe the data and show the relationship between variables respectively. Bivariate analysis was used to determine the strength of association between dependent and independent variables. P values less than or equal to 0.05 was considered statistically significant. Qualitative data was transcribed verbatim by using the Colaizzi thematic analysis transcription techniques. Field notes were compared with the audio recordings for validity. Data was analyzed and described verbatim. Results showed that more than half of the instruments were colonized by micro-organisms intraoperatively (51.6%; n=48). About twelve percent (11.8%; n=11) patients had microbial colonization on the surgical site pre-surgery. A few instruments were found to be contaminated at time 0. A third of the population got post-surgery microbial colonization on the surgical site (31.2%; n=29). Staphylococcus aureus was the most common microorganism in surgical sites and the surgical instruments. There was 50% of microbial colonization of instruments after 4 hours intraoperatively. The longer the surgery the more the exposure of instruments and the higher was the microbial colonization rate. There is need to enhance the processing and sterilization of surgical instruments. By the fourth hour of surgery surgical instruments should be changed and social wash should be done to all surgical sites before the actual surgical prepping. It is recommended that these strategies should be adopted by Kenyatta National Hospital management and Ministry of Health to guide the perioperative teams intraoperatively. PhD in Nursing (Medical Surgical Nursing)

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

Thu, 28 May 2026 00:00:00 GMT

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