58 Records out of 22207 Records

A case-control study of environmental and behavioural risk factors associated with multiple parasitic infections in Western Kenya

Author: Juma, Elijah Omondi

Awarding University: University of Nairobi, Kenya

Level : MSc

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Parasites/Zoonoses/Epidemiology/Western Province/Busia, Kenya/Lake Victoria, Kenya/Health risk assessment/ ;

Abstract:

Many rural African villages are characterized by high prevalence of endemic parasitic diseases with cases of multiple parasite infections often too being common. This study was conducted in the Western Province of Kenya within a 45 km radius from Busia town, falling within the Lake Victoria Crescent Zone. The study aimed at determining whether there was a relationship between contact with particular environmental features, or specific human social behaviour and the risk of infection with multiple parasitic diseases. The sample frame for this nested case-control study comprised the 467 individuals randomly selected and sampled from this study site as part of a larger, on-going, cross-sectional study. The participants had been screened for a variety of zoonotic and non-zoonotic diseases and questionnaires administered to obtain information on specific aspects of their social behaviour. From the sample frame, 24 subjects with multiple parasitic infections defined as cases, were randomly selected and matched for age and sex with 24 other individuals who had one or no infection, herein defined as controls. Cases and controls were followed to their daily activity points using a GPS waypoint data of the activity points mapped. The study revealed high prevalence of parasitic infections. The infections co-occurred spatially within the same geographic setting with cases of sampled individuals bearing multiple infections at anyone time being common. Cases and controls displayed a relatively homogeneous social behaviour and visited nearly the same activity points. Conditional logistic regression analysis did not reveal any significant difference between cases and controls with respect to any difference in their social behaviour and . interaction with potentially risky environments and thus perceived odds of acquiring parasitic infections. These findings are an initial step to further research into the dynamics of human-environment-parasite interaction in an environment where parasitic infections are co-endemic. The findings will also be vital in helping design long-term strategies for control.

Prevalence of cardiovascular disease risk factors in urban Garissa residents

Author: Ahmed, Hassan Adan

Awarding University: University of Nairobi, Kenya

Level : MMED

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Garissa, Kenya ; Cardiovascular disease ; Somali (African people) ; Health risk assessment ;

Abstract:

Background: Cardiovascular diseases are becoming rampant in the developing countries due to such factors as urbanization, adoption of sedentary lifestyle, and change in dietary behavior. Common preventable risk factors underlie most CVD. Objective: We set out to determine the prevalence of modifiable CVD risk factors among urban Garissa residents. The residents are generally semi nomadic Somalis who also practice conventional and settled lifestyle. Methods: The study is a descriptive cross-sectional community based survey carried out at Central division, Garissa Town, North Eastern Kenya over a 3-week period. Cluster sampling of households in 15 villages of the central division, Garissa town was used to obtain the total sample size of 1850. Adults 18 years or older who were residents for more than three months were subjected to interview using WHO STEPS questionnaire on sociodemographic information, anthropometric and BP measurements. Blood samples were taken for blood sugar and total cholesterol levels. Results: A total of 1823 subjects (702 males and 1121 females) of whom 98.5%were Somalis were studied. The mean age was 38.5 ? 10 (range 18-96) years. Prevalence of modifiable CVD risk factors screened for were as follows: Hypertension 12.6% (95% CI 11.1-14.2%), Diabetes Mellitus 3.7%(95% CI 2.9-4.7%), Overweight 23.9%(95% CI 21.9-25.9%), Obesity 12.6%(95% CI 11.2-14.3%), Abdominal obesity 20.4%(95% Cl 18.5-22.3%), Smoking 5.2%(95% CI 4.4-6.5%), hypercholesterolemia 16.9%(95% CI 11.0-24.3%) and Physical inactivity 8%. Only 16% of the study population consumed the recommended ~5 servings per day of fruits and vegetables. Male sex, increasing age and overweight/obesity were independently associated with Hypertension and Diabetes Mellitus. At least 47% of the participants had one or more combination of the risk factors screened for. Conclusion: Prevalence of CVD risk factors is high in this Garissa Somali population with low levels of physical activity and fruits/vegetable consumption.

Cardiovascular risk factors in renal transplant recipients attending nephrology clinics in Nairobi, Kenya

Author: Wagude, James Allan Angawa

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Cardiovascular disease/Surgery/Kidneys/Transplants and implants/Health risk assessment/Patients/Clinical outcomes/ ;

Abstract:

Cardiovascular disease (CVD) is recognized as the leading cause of morbidity and mortality amongst patients with chronic kidney disease (CKD). Currently, 50-60% of deaths in renal transplant recipients are directly attributable to CVD. No dataeexisted on the prevalence of cardiovascular risk factors in renal transplant recipients (RTR) in Kenya. OBJECTIVE: The aim of the study was to determine the prevalence of established cardiovascular risk factors and to analyze for associations of these risk factors with age, gender, duration of dialysis pre-transplant, medications including immunosuppressant use, cause of CKD, pre-existent diabetes or hypertension, and type and number of renal allograft in RTR in Nairobi, Kenya. SETTING: The Renal Unit Transplant Clinic at Kenyatta National Hospital (KNH) and nephrology clinics at KNH Doctors Plaza, Nairobi Hospital Doctors Plaza and Parklands Nephrology Centre. STUDY POPULATION: Renal allograft recipients attending nephrology clinics in Nairobi METHODS: This study was conducted as a cross-sectional prevalence design. 91 renal allograft recipients underwent consecutive sampling and were evaluated for selected CVD risk factors including hypertension, obesity, decreased GFR, cigarette smoking, hypertension, diabetes mellitus, impaired glucose tolerance, anemia, dyslipidemia and proteinuria. DATA COLLECTION AND ANALYSIS:. Continuous variables were expressed as means and standard deviations, prevalence expressed as percentages with 95% Confidence Intervals and associations between CVD risk factors and patient variables or immunosuppressant drugs evaluated by Chi-square test. A P value less than or equal to 0.05 was considered statistically significant. RESULTS: In the study, 91 renal transplant recipients were enrolled between 151 August 2011 and 151 February 2012 with a male to female ratio of2.1 to 1 anti mean age of 44.2 years (SD12.44). Hypertension, dyslipidemia and abdominal obesity by waist-hip ratio were the most prevalent risk factors among the study population at 95.6%, 73.6% and 68.1 % respectively. Statistically significant associations were found between the presence of a second renal allograft and NODAT (P = 0.011) as well as history of pre-transplant diabetes mellitus and use of insulin with impaired graft function (P = 0.026 and P = 0.004 respectively). Most allograft recipients were on Prednisolone, Cyclosporine and Mycophenolate mofetil combination therapy with those on Azathioprine having the longest duration of exposure (142.0 months) while those on Everolimus had the shortest duration (7.5 months). No statistically significant associations were found between any of the immunosuppressant agents and the cardiovascular risk factors. LIMITATIONS: Recall bias in past medical history. Misclassification bias in use of a single occasion blood pressure reading for hypertension and single urine sample for microalbuminuria. Overestimation bias in use of estimated GFR equation. Misclassification bias in use of Caucasian cutoffs values for BMI and waist circumference in Africans. CONCLUSIONS: There is a high magnitude of cardiovascular risk factors in the renal transplant population especially hypertension, abdominal obesity and hyperlipidemia. Statistically significant associations were described between presence of a second renal allograft and development of NOD AT as well as between both history of pre-transplant diabetes mellitus and the use of insulin by renal transplant recipients with impaired graft function. The most common immunosuppressants used by the transplant recipients were Prednisolone, Mycophenolate mofetil and Cyclosporine with no statistically significant associati9ns were found between immunbsuppressant agents and the cardiovascular risk factors. RECOMMENDATIONS: Renal transplant recipients should be prioritized as a population at . high risk for cardiovascular mortality in health policy formulation for interventional measures with local adaptation

The potential role of nutrition education in reduction of overweight and the associated risk factors among school children (9-14 years) in Nairobi, Kenya

Author: Kyallo, Florence Mumbi Muthiani

Awarding University: University of Nairobi, Kenya

Level : PhD

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Nutrition education/Diet/Obesity/Health risk assessment/Children and youth/Teenagers/Nairobi, Kenya ;

Abstract:

Obesity among children is increasing at an alarming rate worldwide, With research linking both childhood malnutrition and obesity to increased risk of morbidity and mortality in adulthood, more attention is now shifting to addressing the pandemic among children so as to alleviate the generational calamity in the future. This study investigated the prevalence of overweight, the associated risk factors and the potential of nutrition education as an intervention among school children aged 9-14 years attending private and public schools in Nairobi. From two randomly selected divisions, four schools, two public and two private, were randomly selected for inclusion in the study. At baseline, nutrition status of the children was determined using anthropometric indices. Dietary practices were assessed using the 24 hour dietary intake recall method. Sociodemographic characteristics and physical activity were collected using a pre-tested questionnaire. One public and one public school were randomly allocated into two study groups, an intervention (IG) and a control group (CG). Pupils in the IG received a nutrition education package while those in the CG did not receive the intervention. The children were followed up for eleven months (3 school terms) and assessments were carried out at the end of every school term. Data were analysed using WHO AnthroPlus, OpenEpi and SPSS version 17.0. Descriptive statistics were used to describe characteristics of the study children while inferential statistics were used to establish differences in various variables between the control and intervention groups, and relationships between selected variables and overweight. Chi-square tests and Odds Ratio (OR), were used to test relationships between categorical variables. Tvtests and MannWhitney U tests were used to compare continuous variables with normal distribution and those without normal distribution, respectively. The Wilcoxon test was used to compare trends in anthropometric characteristics throughout the study. A p value <0.05 was considered significant. Out of 344 study children, 40.4% were from private schools and 52.3% were female. The mean age of the children was 12.0?0.84 years, with 79.9% within age 11-12 years. The prevalence of obesity was 5.9%, while combined overweight and obesity was 19.0%, with prevalence in private schools significantly higher (29.0%) than public schools (11.5%). Prevalence was highest among girls in private schools (30.9%), followed by boys in private schools (27.1 %). Socio-dernographic and economic factors found to be positively associated with overweight included being in a private school, not having siblings, mother's occupation, type of residence, access to a family computer with computer games, having a personal cell phone, number of cell phones, use of motorised transport to and from school and time spent on sedentary activities after school. Dietary factors included consumption of margarine, white bread, githeri and sugar sweetened black tea/coffee. On the other hand, factors found to be negatively associated with overweight included having physical education ePE) scheduled in the class timetable, participation in physical education, active commuting to and from school, having family meals and receiving food rewards, consumption of vegetables, cake, maandazi and eggs. The predictors of overweight included being in a private school, having a self-employed mother, being a single child, having access to a family mobile phone and not having family meals. The intervention resulted in significant increase in participation in physical education (PE) and swimming, decrease in consumption of white bread, maandazi and crisps and an increase in consumption of wholemeal bread and fruits (p<O.05), but no significant decrease in overweight. In conclusion, the overweight rate in the study group is of public health concern. The school curriculum should be revised to include compulsory participation of all children

Impediments to women's economic empowerment in mitigating their vulnerability to HIV/AIDs in lower Nyakach Division, Kisumu County

Author: Oruko, Elizabeth Akinyi

Awarding University: University of Nairobi, Kenya

Level : MA

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Lower Nyakach Division, Kisumu County ; HIV infection ; AIDS (Disease) ; Women ; Social life and customs ; Health risk assessment ; Socioeconomic factors ;

Abstract:

Economic powerlessness poses major threats tp, mitigation of HIV/AIDS vulnerability among women in the world. As such, exploration of the relationship between economic powerlessness and HIV/AIDS vulnerability will be the focal point of this study, Through mainly the use of literature based research, studies have indicated how low economic status and disease, most 'specifically HIV/AIDS are related. Researchers globally have argued that there is ample evidence that the high and increasing vulnerability of women to HIVIAIDS is due to gender-based social and economic inequalities; sexual violence and inequality in access to prevention, education and training. Low economic status among women and dependence on men contribute to their inability to control the conditions such as condom use and multiple sexual partners. This shapes their risk of HIV infection and their high infection rates compared to men. The purpose of this study therefore was to investigate the impediments of women's economic empowerment in mitigating their vulnerability to HIV/AIDS in Lower Nyakach Division, Kisumu County. The study was carried out to fulfill four objectives, to establish extent to which family status impedes women's economic empowerment in mitigating vulnerability to HIVIAIDS; to investigate how economic status impedes women's economic empowerment in mitigating women's vulnerability to HIV/AIDS; to examine extent to which cultural factors impedes women's economic empowerment in mitigating vulnerability to HIVIAIDS and finally to assess how lack of sensitization and training impedes women's economic empowerment in mitigating vulnerability to HIV/AIDS. The study was limited by the fact that diversity of cultural background made it difficult to generalize findings to women in other parts of the country. The study was delimited by being confined to womenin Lower Nyakach division. Literature was reviewed under the following sub themes: Family status and women's economic empowerment and vulnerability to HIVIAIDS, Economic status and vulnerability to HIV/AIDS, Cultural factors and economic empowerment and vulnerability to HIV/AIDS and lastly sensitization and training and economic empowerment and vulnerability to HIVIAIDS. The study adopted the relevant theoretical and conceptual frameworks which guided the researcher in determining variables. The descriptive design which involved qualitative and quantitative strategies to data collection was employed. 13,018 households were targeted for the study; a sample of 208was identified using multi stage sampling method. Key informants were sampled purposively. Data was collected through focus group discussions and questionnaires as the main research instruments. The data was analyzed through frequencies and percentages presented in tables and discussed as per the literature reviewed in chapter two. A cross sectional research design was used to establish the findings and revealed that impediments to women's economic empowerment have contributed to vulnerability to HIV/AIDS. From the findings, 63.7% of the respondents reported that men are the household leaders hence key decision makers. Low economic status was very critical as it led to low level of education and knowledge. It was revealed that 51.7% of the respondents earned below kshs 5,000 while only 11.9% earned above kshs 15,000. Such low income rendered women powerless in negotiations for safe sex. 49.8% of the respondents reported that men solely owned property while 17.4% reported that women owned property. The study also revealed that negative cultural practices have subjected women to unsafe sexual behaviours. For instance, 58.7% reported that men were the main decision makers in households. 60.2% reported that condoms prevent HIV infection though they lack the final say on their use. The study concluded that low economic status impedes economic empowerment hence vulnerability to HIV/AIDS. Negative cultural practices subjected women to unsa

Assessment of factors associated with breast cancer among women in Nyeri County, Kenya-a case control study

Author: Macharia, Julius Karuri

Awarding University: University of Nairobi, Kenya

Level : MPH

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Health risk assessment ; Breast cancer ; Women ; Nyeri County ; Epidemiology ;

Abstract:

Introduction: Breast cancer is the most common cancer in women in Kenya (Mulemi, 2010) and the second most common cancer among women in Nyeri County (HISR 2009), only second to cervical cancer. It is the most common cause of cancer-related mortality and morbidity among all women in the world and the commonest cause of cancer deaths in United States of America among women aged 20 to 59 years (Jemal et al, 2005). Research has long recognized risk factors for breast cancer such as a positive family history of breast cancer, early menarche, late menopause, nulliparity and lack of breast feeding (Newcomb et al, 1994; McTiernan et al, 1992; MacMahon et al, 1973; Gunnar et al, 1987; Roxanne Nelson et al, 2009). While numerous studies have been conducted in industrialized countries to assess the epidemiology of breast cancer, few have been done in Sub-Sahara African populations; Kenya included (Mutuma and Korir 2006). Such studies are of interest because different risk profiles may help to explain the differences in occurrence of the disease in different populations. This study is therefore aimed at determining the risk factors for breast cancer in Nyeri County, central Kenya. Method: A matched (1 :3) case-control study was conducted in Nyeri County of central province in Kenya in the year 2010. Data collection was done between March and May 2010 where a total of 81 biopsy/fine needle aspiration proven cases of breast cancer and 272 controls that were matched by age within a 5 year period interval were enrolled. Statistical analysis was carried out using Stata version 10.0 software where chi square test of significance and then logistic regression with odds ratios at 95% confidence intervals were estimated. Results: Data analysis showed the following independent risk factors that were predictive for breast cancer among women under study; family history of breast cancer and any other cancer, age at menarche, menstrual pattern, menopausal status and age at menopause. Those women in the study who had no first-degree family history of breast cancer were reported to be 76% (OR=0.24, 95% CI: 0.11-0.55) less likely to have breast cancer compared to those who had a family history of the disease in univariate analysis and 83% (OR =0.17,95% CI: 0.05- f 0.56) in multivariate analysis respectively, p < 0.05. Equally, women with no first-degree family history of other cancer apart from breast were reported to be less likely to have breast cancer compared to those women with positive first-degree family history by 64% (OR=0.36, 95% CI: 0.20-0.66) in univariate and 73% (OR = 0.27, 95% CI: 0.10-0.68) in multivariate analysis respectively, p < 0.05. Pre-menopausal status and late age at menopause (~ 50years) were reported to be protective factors and statistically significant in univariate analysis with an OR = 0.55 (95% CI: 0.33-0.90) and OR= 0.22 (95% CI: 0.05 - 0.94) respectively, p < 0.05. Early age at menarche was not statistically significant, p > 0.05. However, contrary to other studies late menopause ~ 50 was shown to reduce the risk of breast cancer among the women, while late age at menarche increased the risk. For menstrual pattern, in univariate analysis, the risk of developing breast cancer increased 3-fold in women with irregular menstrual pattern compared with women with regular menses, (OR = 2.88,95% CI: 1.45 -5.70), P < 0.05. The risk changed to increase by 1.5-fold in multivariate analysis, but not statistically significant. Conclusions: This study revealed the role of some modifiable determinants of breast cancer that can be focused on by public health intervention in Nyeri district. Accordingly, those women who have one or more of the following risk factors should be followed up keenly and screened regularly for breast cancer: positive family history of breast cancer and other cancers. The role of hormone replacement therapy, irregular menstrual pattern, age at menarche and menopausal status as risk factors for breas

Prevalence of accidental exposure to selected blood-borne pathogens and utilisation of post exposure prophylaxis among health workers in two Kenyan hospitals

Author: Makokha, Brenda Barasa

Awarding University: University of Nairobi, Kenya

Level : MPH

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Medical personnel ; Health risk assessment ; Occupational safety ; Needlestick injuries ; HIV infection ; Hepatitis B virus ; Hospitals ; Disease control ;

Abstract:

Worldwide it is estimated that more than 3 million Health care workers (HCWs) experience a percutaneous injury with a contaminated object annually. Half of these occur in sub-Saharan Africa (Pruss-Ustun et al., 2005). The Centre for Disease Control and Prevention (CDC) estimates that 380,000 needle-stick injuries occur in United states of America (USA) hospitals each year, and 61 % are caused by hollow-bore needles. It is estimated that 4.4 % of HIV infections and 32% of HBV infections among HCWs are due to occupational exposures (Rapiti et al., 2005). Studies in West Africa reported between 27-57.8% Needle stick Injury (NSI), while studies in the East African region reported Nxlexposure rates of 40-60% among HeWs in Uganda and Tanzania. A study conducted in Kenyan rural health facilities in Thika district, reported an occupational exposure rate of 30 % among health workers (Taegtmeyer et al., 2008) and in Kenyatta National Hospital (KNH), Ngesa reported an exposure rate of 59.5% among registered nurses in a public tertiary hospital in Kenya (Ngesa, 2006, unpublished data). Objective: The aim of the study was to determine the prevalence of occupational exposures to selected blood-borne pathogens (HIV and HBV) among health workers, in two Kenyan hospitals, one public referral and teaching hospital and the other, a private university teaching hospital. Methodology: This was a descriptive cross-sectional study carried out in Moi Teaching and Referral hospital (MTRH), Eldoret, and at the Aga Khan University Hospital, Nairobi (AKUH, N). Three hundred and sixty five (365) study participants were randomly selected by applying multi-stage probability sampling procedure. Quantitative data were collected by use of structured, close-ended questionnaires in the months of February and March, 2012 through face to face interviews. Data were analysed using EPI INFO 2000 and Statistical Products and Services solutions (SPSS) version 17.0. Patterns of association were analysed using Chi-square tests, while statistical significance was assessed using logistic regression. Results: The overall prevalence of occupational exposures in the two facilities was 36%. In the private hospital the prevalence was 23%. compared to 43% in the public hospital. Type of facility, department, availability and location of disposal container, and procedure being performed at the time of exposure were found to be significantly associated with occurrence of occupational exposures. The overall HB vaccination uptake was 53.4% fully vaccinated, 18.9% had partial, while 27.7% had never been vaccinated. Eighty percent (80%) of participants in the private hospital had received at least one dose of HBV vaccine as compared to only 68% in the public hospital. Out of all the participants who sustained percutaneous injuries in both hospitals, only 31 % utilised HIV Post Exposure Prophylaxis (PEP), with perceived low risk of infection being the commonest reason why PEP was not used. There was no statistical significant difference in use of PEP between the two hospitals (p=0.1371). The overall exposure reporting rate was 54% in both hospitals, and the most common reason cited for not reporting was perceived low risk of transmission of HIV and HBV by the participants. Conclusion: The prevalence of occupational exposures among health workers could be much higher than is documented due to under-reporting. There was a statistical significant difference between occurrence of occupational exposures and the type of facility, number of years in employment, staff category, department where one worked, type of procedure being performed and the availability of and location of the disposal container at time of exposure. There was a low PEP uptake of 31 % in both hospitals but there was no statistical significant difference in the use of HIV PEP and HBV vaccination status in the two hospitals, and socio-demographic characteristics. There is an urgent need for the health institution

Serum high-sensitivity C-reactive protein concentration in healthy blood donors at the National Blood Transfusion Centre, Nairobi, Kenya

Author: Chebii, Kipkorir Kipkulei

Awarding University: University of Nairobi, Kenya

Level : MMED

Year: 2011

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Blood ; Diagnostic tests ; Cardiovascular disease ; Health risk assessment ;

Abstract:

BACKGROUND: According to the WHO, an estimated 17 million persons die annually from cardiovascular disease (CVD). The burden of CVD is rising rapidly in the developing countries but stabilizing or declining in the developed nations. This is partly due to targeting modifiable risk factors and identifying at-risk persons for close follow-up for CVD. High Sensitivity C-Reactive Protein (hsCRP) is a novel CVD risk factor, and its inclusion in global risk stratification for CVD led to reclassifying 20% - 30% of persons at intermediate risk into clinically higher or lower risk categories for f-VD. Current hsCRP risk stratification data is drawn from Caucasian populations and at the time of the study, there was no local data. METHODS This was a cross-sectional descriptive study to determine the normative hsCRP data from 219 healthy Kenyan adult blood donors. Basic anthropometric data was obtained and the serum hsCRP level was determined using a photometric immunoturbidimetric assay method. Mean and median values were calculated and the distribution of hsCRP level was explored. We explored the effect of various exclusion criteria on the mean and median, to cater for outliers. We chose hsCRP>5mg/L exclusion criteria (n=205) to develop a normal range of values for a healthy Kenyan population. We defined a normal range as within 2.5% - 97.5% percentiles of the distribution. Bivariate and multivariate linear regression. models were used to explore the effect of gender, age. and BMI on hsCRP. RESULTS The sample was 71 % (1SSI219) male with a median age of 26 (IQR=22-33) years. The mean BMI was 24 kg/rrr' (SD=3.8) .?.. with 1 % being underweight, 68% having normal weight. 22 % overweight, 8% obese and O.S% classified as morbidly obese. The median hsCRP level was 0.6 mg/L (IQR 0.3 - 1.7mglL, Min=O.I, Max=6S.3). Excluding hsCRP >Smg/L, the median hsCRP was O.Smg/L (lQR 0.3 - 1.2 mg/L). The normal hsCRP level among Kenyan adults was calculated to lie between 0.1-3.3mglL. Bivariate and multivariate regression analysis found a significant association between hsCRP levels and gender (95% CI -0.68. 0.00 [p=0.05]), age (95%CI 0.01, 0.04 [p=O.Ol]) and BMl (9S%Cl 0.03, 0.11 [p=<O.OOl] for multivariate models). In terms of hsCRP risk categorization, 68%( 140/205) of blood donors had levels < 1 mg/L. 26% (53/20S) with 1-3 mg/L, and 6% (12/20S) with >3 mg/L. CONCLUSION The median hsCRP in healthy Kenyan blood donors is O.S mg/L (lQR 0.3 -- 1.2 mg/L) with a normal range between 0.1 and 3.51 mg/L. Gender, age, and BMl were significantly associated the hsCRP levels. Majority of our blood donors are in the low- risk category of hsCRP stratification for CVD events. R-

Factors influencing vulnerability to HIV/AIDs infection among domestic workers : a case of Malindi Constituency

Author: Tsuma, Baruwa Chakaya

Awarding University: University of Nairobi, Kenya

Level : MA

Year: 2011

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Malindi, Kenya/Domestic service/Women/HIV infection/Health risk assessment ;

Abstract:

Domestic workers, most of them come from disadvantaged backgrounds and have had to endure hardships and are not exempt from experiencing a host of reproductive health related problems such as unwanted pregnancy, unsafe abortion, STI and HIV/AIDs. The importance of domestic workers in the fight against HIV is apparent towards reduction of new HIV infection yet little is known about the factors influencing their vulnerability to HIV infection. The purpose of this study was to establish factors influencing vulnerability to HIV infection among domestic workers in Malindi constituency. The study was focused on 4 independent variables namely; knowledge levels on HIV/AIDS transmission and prevention, health seeking behaviours on HIV prevention, access to mY prevention information and sexual harassment. The study had four research objectives and these were; L) To determine the extent to which knowledge levels of HIV/AIDS transmission and prevention among the domestic workers influence vulnerability to HIV infection., 2) to examine the extent to which health seeking behaviour on HIV prevention among the domestic workers influences vulnerability to HIV infection, 3) to identify the extent to which levels of access to mv prevention information among domestic workers influence vulnerability to HIV infection and 4) to find out the extent to which incidences of sexual harassment among domestic workers influences vulnerability to HIV infection among domestic workers in Malindi constituency. Literature has indicated that domestic workers are hard to reach population and endure some hardships that compromise their health and well being. It also provides evidence on vulnerability of the domestic workers as an invisible population. However, the literature did not provide trends of mv infection among the domestic workers as seen in other most at risk populations such as injection drug users, female sex workers and men who have sex with men. The study was undertaken through a descriptive research design and used only primary data in order to generate both quantitative and qualitative data in order to understand more about the domestic workers as little was known. A sample of 42 female domestic workers of ages 15 to 34 years old were selected from 6 zones (clusters) in Malindi town through a probability sampling technique. Data collection instruments were questionnaires and focus group discussion guide in order to get knowledge level on HIV transmission and prevention, health seeking behaviour, access to HIV prevention information and incidence of sexual harassment. The data collected was analyzed using EPI Info statistical package to generate mean, mode and median, then data was presented both in text and tabular form. Study findings showed that domestic workers in Malindi constituency were vulnerable to mv infection with a vulnerability of 48.1 % and was influenced by low knowledge level on mv transmission and prevention (27.5%), low levels of health seeking behaviour on mv prevention (30.%), low access to mv information (39.4%) and high prevalence of sexual harassment (72.5%). The study recommended that National AIDS Control Council (NACC) and Non Governmental Organizations to affirmatively grant local organizations working on mv &AIDS prevention programmes to target domestic workers to increase knowledge levels on HIV&AIDS transmission and prevention, improve health seeking behaviour and promote access to justice against sexual harassment in order to reduce the vulnerability to infection. The study also recommended further research to establish whether the vulnerability to HIV infection correlates with HIV prevalence among the domestic workers.

Prevalence of opportunistic infections in relation to environmental risk factors among persons living with HIV/AIDS in Embakasi Division, Nairobi

Author: Oreta, Jacqueline A

Awarding University: University of Nairobi, Kenya

Level : MPH

Year: 2011

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Embakasi Division, Nairobi East District ; Opportunistic infections ; HIV infection ; AIDS (Disease) ; Health risk assessment ; Environmental impact ;

Abstract:

Opportunistic infections increase morbidity and mortality rates among persons living with mY/AIDS. These make populations be trapped in a vicious cycle that exacerbates the spread of the disease. Literature reveals that environmental risk factors of water, sanitation, hygiene and housing, if not properly addressed or provided, lead to prevalence of opportunistic infections. Their relation as factors has not been established as relates to prevalence of opportunistic infections. This study was sought to describe the environmental risk factors for opportunistic infections among mY/AIDS patients within Embakasi Division of Nairobi, Kenya. The study objective was to determine the prevalence of opportunistic infections, analyze the level of sanitation and hygiene status, determine the quality and quantity of water used as well as to Compare the prevalence of opportunistic infections for different environmental risk factors among Persons living with HIV / AIDS. This was a descriptive cross sectional study. Quantitative and qualitative data were collected from HIV positive asymptomatic and AIDS patients attending the comprehensive care clinics at Kayole 1, Dandora 11 and Soweto - Kayole Primary health care clinics through the use of administered structured questionnaires, verified using a check list that was developed and key informant interviews. Stratified sampling technique was adapted to aide in identification of respondents and key informants from the field. Sample of 384 clients who attended the comprehensive care clinics were interviewed. The rate response was 96%, (371 respondents). Slightly more than a half of this population was HIV positive asymptomatic patients. The main findings were pulmonary TB was the most prevalent of the opportunistic infections, 31 % among AIDS patients. As relates to levels of sanitation and hygiene, the methods of waste disposal were found not to be significantly associated with the 01 status of the study subjects, p>0.05. There was a significant association, between quality of water and opportunistic infections where quality was assessed based on water treatment methods applied p=O.OOO. Forty per cent of the study population had access to adequate amount of water (20 litres per person per day). However, results showed no significant association between quantity of water and opportunistic infections (i=<>.039, p=0.843, PR 0.95 (0.63-1.45?. Fifty four per cent of IDV positive asymptomatic patients were exposed to poor environmental risk factors as compared to AIDS patients. Results further showed that prevalence of PTB and housing, p=O.05, diarrhea and wall structure, p=O.034, safety of water and PTB, p=O.OOI and skin infections, p=0.018 had a significant association. In relation to hand washing methods, results showed a significant relationship with prevalence of diarrhea. In conclusion, the study revealed a difference in prevalence of 01 in relation to different environmental risk factors and opportunistic infection among PL WHA. There was a significant association between safety of water and PTB. On sanitation and hygiene, there was a significant association between prevalence of diarrhea and hand washing. The study recommends that the Department of Health Promotion under MOPHS to conduct awareness sessions and sensitize the community on applying appropriate hand washing methods. The study further recommends additional research is conducted to determine the association between PTB and safety of water.