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Author: Ouma, Jack Busalile Mwimali

Awarding University: University of Birmingham, England

Level : PhD

Year: 2013

Holding Libraries: ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; Institute of Commonwealth Studies Library ;

Subject Terms: Criminal justice ; Trials ; Constitutions ; Criminal law ; Judicial process ;

Abstract:

This thesis explores issues concerning the conceptualisation and operationalisation of the right to a fair trial in the Kenyan criminal justice system. In particular, it looks at how and why there have been many difficulties with the implementation of this universal set of values that have been recognised since the adoption of the formal legal system in Kenya, and which have been enshrined in the Constitution since independence. It addresses a number of overarching questions. First, it identifies the factors that hindered the full realisation of the right to a fair trial. Secondly, it enquires into whether the shortcomings of the recently repealed Constitution in that regard have been fully addressed by the new Constitution adopted in 2010. Thirdly, it identifies and analyse the impact of factors outside the formal law which may have affected the practical operation of certain core elements of the right to a fair trial. Finally, in light of the above, it explores a number of approaches that might be used to address these other factors so as to help achieve at least a better, enforcement of fair trial rights in the country.

Author: Yegon, Peter Kipkurui

Awarding University: University of Nairobi, Kenya

Level : MSc

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Predictions/Mortality/HIV infection/Patients/Antiretrovirals/Drug therapy/Clinical outcomes/Clinical trials/Rural areas/ ;

Abstract:

Despite widespread Antiretroviral Therapy (ART) availability, patients put on treatment suffer early mortality due to a number of factors. The Clinic-based ART Diagnostic Evaluation (CLADE) study is an open label, randomized control trial (RC'f) evaluating feasibility and superiority of2 ART treatment monitoring approaches in treatment-naive adults in district-level, non-research clinics in rural Kenya. A secondary objective is to examine baseline characteristics and mortality outcomes. Descriptive summary statistics and multivariate logistic regression (RR, 95% CI) are used to evaluate baseline characteristics and relationships with 6 month mortality. 820 adults were enrolled in the study (57.6% female, Mean age=37.6 (SD 9.0) years) with advanced disease: Mean CD4 count =166 (SDI06) cells/rum', Mean Viral Load = 231,901 (SD 246,242) copies/ml, WHO Stage III or IV= 28.8%, and Body Mass Index (BMI) <18.5=23.3%. 818 (99.7%) of those enrolled started ART treatment and were followed up in the study. Overall there were 70 deaths in the study (8.6%), the majority occurring within 6 months of initiating ART (80.0 %,). There was no significant study Arm differences (p=O.I) at 6 months. Univariate Logistic regression showed CD4 count (p<O.OOOI), Viral Load (p=0.0~6), World Health Organization (WHO) Staging (p<O.OOOI), Body Mass Index (BMI p<O.OOOl) and Hemoglobin (Hgb p=0.005) were independently associated with early mortality. In Multivariate analysis WHO staging (p=0.045) and Hemoglobin (Hgb p=0.023) levels were the only significant factors predicting early mortality controlling for CD4 count result, viral load and Body Mass Index (BMI). and early initiation of ART treatment. Intervention measures to deal with malnutrition and anemia need to be put in place to improve survival. Early Mortality still remains a challenge in HIV positive patients starting ART in rural clinics of South Rift Valley, Kenya. However this can be reduced by early HIV diagnosis

Author: Murei, Dorcas J

Awarding University: University of Nairobi, Kenya

Level : MSc

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Anxieties ; Depressed persons ; HIV infection ; Mothers ; Psychological aspects ; Babies ; Vaccines ; Clinical trials ;

Abstract:

The study was carried out to determine the prevalence of anxiety and depression in HIV positive mothers whose infants were participating in a HIV vaccine study. The participants were interviewed when they were exiting the vaccine study. Many pharmacological interventions and vaccine studies have been conducted which thereafter leave psychological problems unaddressed that necessitated this study to be conducted. The findings of this study will be used by Researchers to consider and introduce psychological interventions for HIV positive mothers whose infants are participating in HIV infection vaccine trials or any other studies in future. OBJECTIVE: To determine the prevalence of anxiety and depression among HIV positive mothers whose infants were participating in an HIV vaccine trial and find out whether there were any differences with the normal population. METHODOLOGY: This study was a cross-sectional survey in which all the one hundred participants were eligible to be interviewed but only ninety five of them consented for this study. All the participants were mothers whose infants were participating in a HIV vaccine trial. A standardized questionnaire was administered that had sociodemographic questions as well as the Beck anxiety (BDA) and Beck depression inventory (BDI) were used. The questions also asked about the participants experiences as their infants participated in the vaccine study. The data collected was analyzed according to the severity of both anxiety and depression. Those who were found to have minimum to mild levels of anxiety and depression were considered to be within normal range that can resolve normally. For moderate to severe anxiety and depression ?. they required treatment that included referral to Kenyatta National Hospital. RESULTS Out of the 95 participants who were intervened, the results can be presented as 4.2% (4) had minimal anxiety, 70.5% (67) had mild anxiety,' 10.5% (10) had moderate anxiety and 14.7% (14) had severe anxiety. The findings of this study showed that the participants in the lower age were more affected by anxiety than the older participants (P=0.003). The prevalence of depression in this study population was 31.6%. The breakdown of the categories of depression was as follows: 68.4% (65) had minimal depression, 14.8% (14) had mild depression, and 11.5% (11) had moderate depression while 5.3% (5) and 5.3% (5) had severe depression. The participants who were more educated were more likely to be depressed than the ones who had little or no formal education (P = 0.013). Similarly, the participants who were earning less money were more likely to be depressed than their colleagues who were earning more money. (P = 0.000). In conclusion the research showed that the prevalence of anxiety and depression in the study population was higher than that of the normal population.

Author: Muthaa, Titus Kiriinya

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 2012

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Clinical outcomes ; Thyroidectomy ; Disease management ; Thyroid gland ; Clinical trials ;

Abstract:

Prophylactic drainage in thyroid surgery has been a regular but experimental practice with no scientific evidence to support its gain. Current results recommend that postoperative haematoma cannot be averted by using drains after total thyroidectomy for benign thyroid disorders. Moreover, the use of drains may augment postoperative pain and the pain reliever requirement, and prolong the hospital stay. In view of these findings, the regular use of prophylactic drains might not be essential after thyroid surgery for benign disorders. In our setup there is no protocol on usage of drains after thyroid surgery. Most studies on drain use have been done in the western countries where goiters are much smaller. Furthermore, they are done in sub specialist endocrine centers as opposed to our general surgical centers, hence a need for local study. This study aimed at evaluating the difference in outcomes in drained versus non- drained groups after total thyroidectomy and total lobectomy for benign thyroid disorders. Objective: This prospective randomized clinical study sought to evaluate the difference in outcomes in drained versus non-drained groups after total thyroidectomy and total lobectomy for benign thyroid disorders. Study design: Prospective randomized clinical study consisting of 90 patients who were admitted for either total thyroidectomy or total lobectomy, who were randomized into two groups of 45 participants each to receive a post-operative drain or not. Setting: The general surgical wards and theatres at Kenyatta National Hospital. Patients and Method Ninety consecutive patients with benign thyroid disorders scheduled for total thyroidectomy or total lobectomy, who met the inclusion criteria were recruited over a study period of 9 months from January to September 2011. Postoperative outcomes evaluated included haematoma and seroma formation, postoperative pain; assessed by the visual analogue scale rv AS), duration of hospital stay, histological diagnosis and necessity for re-operation. The data was collected using a structured questionnaire. It was entered into the MS ExcefM spreadsheet exported to STATA? version 10 (College Station, Texas, USA) for analysis. Participants were randomly assigned to one group in whom closed drains were used and another in whom no drains were used. Randomization was carried out using a computerdeveloped table of random numbers. This randomization was done by an autonomous infonnation technologist consultant. The surgeon was made aware of the group designation just before the closure ofthe wound. Results The mean V AS score was noted to be significantly reduced in the non-drained group patients at 6 hours, 12 hours and 24 hours postoperatively (p= 0.001). Four cases of hematoma (8.9%) occurred in the drained group, whereas none of patients in the non-drained group developed hematoma (0.00%). There was no one among the patient in the non-drain group who had post-surgery wound infection whereas four (9%) of those who had drains developed wound sepsis. No participant required re-operation for any complication nor developed seroma and all complications were successfully managed conservatively. Patients in the non-drained group had a significantly shorter length of hospital stay compared to those in drained group (p = 0.001). On average, patients in the non-drained group stayed in hospital for 1.2 days [SD 0.06] and those in the drained group stayed on for 3.2 days [SD 0.12]. Conclusion The present prospective randomized study verifies that regular drainage of thyroid bed after total thyroidectomy or total lobectomy for benign disorders is not essential and may induce rather than avert fluid collection. The use of drains was found not to be useful in decreasing the rate of postoperative complications such as haematoma, seroma and wound infection. It was also found to elevate pain after surgery, prolong the hospital stay and may be related to an increased risk of surgical site infec

Author: Kibor, David K

Awarding University: University of Nairobi, Kenya

Level : MMED

Year: 2011

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Burns/Clinical outcomes/Medical treatment/Pseudomonas aeruginosa/Amino acids/Clinical trials ;

Abstract:

Background: Post burn infection is a major cause of morbidity and mortality in patients with Severe burns in developing countries, Kenya included. Glutamine is a non essential amino acid which has been found to reduce the incidence of burn wound infection and mortality in patients with severe burns. There is no published local prospective data on the positive effects of _mile glutamine supplementation on reduction of postburn infection and mortality in severely burned patients. Objective: This study sought to determine the effect of enteral glutamine in reducing the incidence of postburn infections and mortality in patients with severe burns. Study design: A double blind randomized clinical trial. Setting: Bums unit and ward 4D of Kenyatta National Hospital, Kenya Methods: This was a double blind randomized clinical trial running for a period of 6 months from September 2010 to February 2011, involving 60 patients with severe burns who were randomized to 2 arms of treatment: (1) the glutamine group arm and the (2) isonitrogenous arm acting as the control. The patients randomized to the intervention group received glutamine in fonn of B-immune. 5 g of glutamine was provided every 8 hours to make a total of 15 g every day. Nasogastric tube feedings or patient-assisted feedings of a mixture of B-immune and milk were initiated on day 1 postburns and continued for a period of 28 days. Patients in the control arm received Fresubin Original, which is isonitrogenous to B- immune. Samples for blood cultures and wound surface swab cultures were taken aseptically from each recruited patient on week 1, 2, 3 and 4 respectively. Specimen analysis involved gram staining, culture and biochemical tests in accordance to the standard microbiological procedures. In this study, a postbum infection was defined as a positive culture obtained on pus swab sample or blood culture. Results: Patients' demographic and baseline clinical chacteristics were similar in both arms of treatment. For the entire 4-week treatment period, the odds ratio of a positive blood culture was almost three-fold higher (2.7 (1.3-5.6) among patients in the control group compared to those in the Glutamine group (p= 0.04). In this particular study, glutamine reduced the incidence of Pseudomonas spp by 3.3-4.5 times. There were no significant differences in the incidence of Staphylococcus aureus in the two groups for the entire treatment period at p<0.05. The odds ratio of death was approximately 6-fold higher in the control group than in the glutamine group . PIIientS receiving glutamine had a statistically significant shorter length of stay compared to Implementation in severely burned adult patienm reduces Pseudomonas aerugirwsa, mortality rate and shortens duration of hospital stay.

Author: Onyango, Peter Nyamthimba

Awarding University: University of Nairobi, Kenya

Level : MA

Year: 2011

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Karemo Division, Siaya District ; Teenagers ; Tuberculosis ; Vaccines ; Clinical trials ;

Abstract:

The success of a TB vaccine trial in adolescents would be reliant in adolescents' willingness to participate. It is thus considered to be important to investigate Tuberculosis vaccine trials knowledge and awareness among adolescents. It is necessary to develop a new Tuberculosis vaccine that can protect people from getting Tuberculosis even in adulthood. Since the development of bacillus Calmette Guerin (BCG) in 1921, its efficacy has gone down and it no longer protects adults against pulmonary TB, which is the most prevalent form of TB. Though it has saved some children's lives by protecting them against severe forms of pediatric TB, but it has not prevented millions of TB deaths. The adolescent age group is often considered a priority group for vaccination against tuberculosis since it has been shown that the incidence of tuberculosis begins to increase at about 12 years of age and to peak at about 19 years of age. The purpose of this study was to determine the factors influencing adolescents' participation in tuberculosis vaccine trials, in Karemo division in Siaya District in Kenya. Among the objectives that this study investigated are influence of knowledge levels, attitude, Health seeking Practices and Economic factors on adolescents' participation in tuberculosis vaccine trials. The research employed a descriptive survey and 384 Adolescents aged between 12-18 years old were interviewed. Data was collected using questionnaires at the household level. Data was entered into the computer using SPSS application. A statistical analysis was done after data validation. All questionnaire parameters were entered into the Statistical Package for Social Scientists (SPSS) for analyses. Univariate and bivariate statistics analyzed study data. Study found that majority of adolescents are aware of TB vaccine trials in Karemo division and Community health workers are the major source of information. It also revealed that all adolescents who have participated in vaccine trials in the past are willing to participate in future and the major motivating factor is to be part of a new vaccine development. A significant finding was that adolescents are not sure whether vaccines are tested on people who are sick or well. Adolescents will always seek medication when they fall sick and most adolescents are relatively healthy thus making them a prime target for vaccine trials. Socioeconomic status influences participation and adolescents participate if their parents are not able to pay for their healthcare and are able and willing to consent to their participation. Adolescents who stay near hospital tend to participate more than the ones from far. The study concludes that adolescents are aware and willing to participate in future vaccine trials. The study recommends the use of community health workers to disseminate trial information and incorporation of parents at the planning stages.

Author: Mwaeke, Panuel J M

Awarding University: University of Nairobi, Kenya

Level : MA

Year: 2011

Holding Libraries: University of Nairobi Jomo Kenyatta Memorial Library ;

Subject Terms: Litigation ; Acquittals and mistrials ; Witnesses ; Testimony ;

Abstract:

This study set out to assess the nature of non-cooperation by witnesses during trial of criminal cases, a case of Kiambu Law courts. The main objective of the study was to establish the nature of non-cooperation by witnesses during trial of criminal cases in Kenyan courts. The study was guided by the following specific objectives:- to establish the magnitude and typologies of criminal cases that were terminated due to non-cooperation by witnesses at the Kiambu Law Courts between the years 2008 and 2010; to establish personal and socio-economic characteristics of non-cooperative witnesses; to identify specific factors that account for noncooperation by witnesses during the trial of criminal cases and to elicit remedial measures for ensuring cooperation by witnesses during the trial of criminal cases at the Kiambu Criminal Courts. The units of observation were the court registers, court files, witnesses and the key informants. The unit of analysis was pertinently, the problem of non-cooperation by witnesses during trial of criminal cases at Kiambu Law Courts. The study was qualitative and purposive in nature, and adopted an exploratory study design. 30 witnesses (main respondents) and 10 Key informants that include; Magistrates, Advocates, Prosecutors, Police investigating officers and Court clerks were also interviewed. The study found that, a total of 272 serious cases were terminated between the years 2008 and 2010 due to non-cooperation by witnesses during trial. Terminated cases cut across all typology of criminal cases. The magnitude of criminal cases terminated was thus very high. The Study identified six major factors responsible for non-cooperation by witnesses during trial of criminal cases. These include; Intimidation, Lack of trust in Law enforcement, the adversarial nature of the trial process, lengthy trial process due to frequent adjournments and community ties. Other factors include personal and socio-economic characteristics of individual witnesses such as age, gender, social class and status. The following major recommendations were suggested to planners, policy makers and administrators of Criminal Justice System There is an urgent need to fully operationalize the Witness Protection Act (2006) and establish VictimlWitness Agency and Programs that would factor in Emergency Relocation and Support of intimidated Witnesses. Where appropriate a specific contact person should be on call 24 hours to mitigate on victim or witness intimidation concerns. To build trust in the Agencies of the Criminal Justice System, the government should criminalize the sharing of confidential court reports with criminals and weed out corrupt police investigating officers. The study suggested the establishment of cooperation between agencies of the Criminal Justice System and other State Corporations with related agencies e.g. Communication Commission of Kenya (C.C.K) and Safaricom Limited. Such cooperation should aim to monitor and recover all phones sneaked into prison unnoticed. The study also recommended that Kenya's adversarial model of trial be replaced. To avert lengthy trial processes through frequent adjournments, the study recommended an Increase of government experts so that processing of expert reports (such ballistic reports and government chemist reports) can be prompt in order to expedite trial processes.

Author: Ogaro, Francis Omari

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 1990

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Measles ; Vitamin A ; Clinical trials ; Clinical outcomes ; Babies ; Children and youth ;

Abstract:

A double blind controlled clinical trial, on the effect of Vitamin A supplementation on the immediate outcome of measles, was carried out at the infectious disease Hospital (IDH), of Kenyatta National Hospital (KNH) Nairobi, Kenya. A total of 294 children admitted with measles (146 treatment and 148 controls) were randomly allocated into the treatment and control groups. A single oral dose of Vitamin A or Placebo was given at admission. There was comparability between the two groups in age and sex distribution, nutritional status, vaccination status against measles, residence in Nairobi, duration of measles illness before admission, serum retinol level and in prevalence of malarial parasitaemia. 39.8% of the children were malnourished and 33 were below the age recommended for vaccination against measles in Kenya. 48.1% of the children had serum retinol level less than 20.0pg/dl. The most prevalent complications were L.T.B., diarrhoea, pneumonia and otitis media. Vitamin A supplementation significantly reduced the severity of diarrhoea and L.T.B. as well as the incidence of otitis media P < 0.05. Vitamin A supplemented children had a better weight gain at one month after discharge. The overall mortality was 2.7%.