PREDICTORS OF PRESUMPTIVE TREATMENT OF UNCOMPLICATED MALARIA AMONG CHILDREN IN PRIVATE RETAIL OUTLETS IN KENYA: MIXED EFFECTS LOGISTIC REGRESSION MODELLING

A Masters Degree Research Proposal by Diana Kemunto Omache

W62/6828/2017

University of Nairobi

 ABSTRACT

Introduction: Malaria is a global health problem and the World Health Organization (WHO) estimates that nearly a half (3.4 billion) of the world’s population is at risk of the disease. WHO African region continues to have a disproportionately global malaria burden. According to the 2018 WHO malaria report, the estimated morbidity and mortality reported currently is 92% and 93% respectively which is the malaria burden in Africa.

Although the burden of Malaria is high in the Sub-Saharan Africa, the Ministry of Health through the National Malaria Control Program has implemented comprehensive evidence-based strategies and policies to fight this disease in Kenya. About 25% of the population in Kenya seeks medical care form the private retail sector. To attain the Sustainable Development Goals (SDGs), Universal Health Coverage is key in ensuring quality of care for all malaria patients.

The WHO recommends that all suspected malaria cases should be tested with RDTs or microscopy before treatment. However, inappropriate treatment practices (presumptive treatment) of uncomplicated malaria among children has been a major challenge in Kenya.  Several studies have been conducted on presumptive treatment of malaria among children with a major gap in literature identified on predictors of this treatment. The study results will strengthen interventions in malaria management in the private retail sector.

Objectives: The objectives of this study are to determine the proportion of health care providers who treat uncomplicated malaria presumptively; factors associated with presumptive treatment of uncomplicated malaria and predictors of presumptive treatment of uncomplicated malaria among children in private retail outlets in Kenya.

Methodology: The study design will be a secondary data analysis from a cross-sectional, nationally representative, private retail outlet survey. The study populations will include the health care providers in the retail outlets sampled randomly in both the rural and urban settings in Kenya. Descriptive statistics will form the basis of analysis for the selected indicators through frequencies and percentages. Bivariate analysis will be conducted using the chi-square test to determine the factors associated with presumptive treatment of uncomplicated malaria among children. Mixed effects logistic regression modelling to adjust for clustering at the county level will be done to determine the predictors of presumptive treatment of uncomplicated malaria among children. The best fitting model will be examined using the Akaike Information Criterion (AIC).   Data will be cleaned, coded and analyzed using the R software and presented in tables.

ENHANCING ANTIRETROVIRAL THERAPY ADHERENCE AMONG THE YOUTH AT MBAGATHI DISTRICT HOSPITAL

Fellow: Angela WairimuMaina (BSc. BMED, MPH) 

Registration Number: W82/89467/2016

Track: Program Management, University of Nairobi HIV Capacity Building Fellowship

PROJECT SUMMARY

Mbagathi District Hospital is one of three hospitals in Nairobi County. It provides several preventive and curative services. The comprehensive care centre provides antiretroviral therapy to several clients who include approximately three hundred youth. Youth is at times characterized by high-risk sexual behaviour and a lack of engagement with healthcare services that can affect adherence to antiretroviral therapy. The issue of non-adherence among the youth was raised during the organizational capacity assessment and this was evident by the high viral load results among the youth. The objective of the project is to improve adherence to HIV treatment among youth at the hospital. This is imperative because viral suppression is key in the reduction of new HIV infections and it also contributes to the achievement of the second and third UNAIDS targets. The project seeks to adopt best practices for adolescent and youth friendly HIV services in a bid to increase adherence. Similarly, selected youth will undergo capacity building in peer counseling/mentorship. Treatment literacy will be employed in the form of a standard training manual which will be converted into an App, edutainment videos and IEC materials. It is expected that the youth will be more open to discuss their health issues with their peers and that adoption of the best practices will be more acceptable to the youth. Clinicians will also be encouraged to take up UoN online short courses and embrace CMEs to increase their knowledge on HIV care and service delivery. The project will employ verbal and written communication strategies. The project will establish partnership with AMPATH who have a successful youth program for sustainability purposes. Baseline and summative viral load statistics will be used to monitor the successful implementation of the project. Progress reports will be generated and shared with all stakeholders.

APPRAISAL OF ANTIMICROBIAL STEWARDSHIP AT MBAGATHI COUNTY REFERRAL HOSPITAL, NAIROBI CITY COUNTY, KENYA: A MIXED METHODS SURVEY

Masters Research Project by Doricah Ivayo Sikuku

W64/81396/2015

University of Nairobi

ABSTRACT

Background: Antimicrobial Resistance has been described as a public health emergency. Antimicrobial stewardship programs have been recommended as one of the ways of combating AMR. Stewardship Programs have been implemented and studied in many parts of the world. We found no studies in literature documenting antimicrobial stewardship in Kenya.

Objective: The study sought to identify existing antimicrobial stewardship guidelines in Kenya; and to appraise antimicrobial stewardship at Mbagathi County Referral Hospital in Nairobi City County, Kenya.
Methodology: This was a cross-sectional mixed methods survey conducted among health practitioners who prescribe, dispense or administer antimicrobials at the Mbagathi County Referral Hospital. It included a preliminary quantitative followed by a qualitative phase. A self-administered questionnaire was used to collect quantitative data. Qualitative data was collected through key informant interviews.
Descriptive data analysis was done. Variables were analyzed using counts and percentages and results presented using tables and graphs. Audio records of the interviews were transcribed. The data was analyzed using the content analysis approach. Codes were identified and extracted from the transcripts.
The codes were used to build themes on the respondents' views on guidelines, stewardship practices, challenges and opportunities for antimicrobial stewardship.

Results: A total of 171 respondents filled the questionnaire from the 242 that were distributed. Standard documentation of antibiotic prescriptions in patient charts was the most widely used stewardship activity at Mbagathi County Referral Hospital.

Conclusion and recommendations: We found no formal stewardship structure or local policy document available to guide antimicrobial use at the facility. Challenges to be addressed include laboratory capacity for microbiological diagnosis, drug supply and training. We recommend the establishment of an antimicrobial stewardship team to spearhead antimicrobial stewardship at Mbagathi County Referral Hospital.

ALTERED BIOMARKERS OF CARDIOVASCULAR DISEASES IN PEOPLE WITH HIV: THE ASSOCIATION WITH ART DRUGS

PhD Proposal by Robert Rutayisire

W80/53711/2018

University of Nairobi

 

ABSTRACT

Background: In sub-Saharan Africa, a home of more than 70% of people with HIV globally, the emerging NCDs related to lifestyle risk factors raises major concerns to developing countries that requisite to find the right balance in resource distribution to healthcare agendas. In developed countries, the prevention of cardiovascular diseases (CVDs) as a common NCDs in people with HIV, to proper screen for, timely diagnose and treat and more essentially well control its risk factors (such as insulin resistance and hyperlipidemia) have turned out to be the  priorities for clinical care of HIV. This study will determine the impact of ART and HIV-infection on biomarkers of  CVDs among adult people with HIV.

Problem statement: In sub-Saharan Africa, the association of ART and HIV-infection with CVDs has been confounded by the increased prevalence and incidence of NCDs due to changes in lifestyle. Additionally, in Rwanda, only liver and kidney function biological assessments are routinely done during follow-up excluding any assessments for CVD risk factors. Besides there is no clear evidence about the effect of HIV-infection and ART on cardiovascular biomarkers. This study will provide informed evidence about the combined effects of ART and HIV-infection with biomarkers of CVD as risk factors to guide policies for further interventions for prevention and treatment of CVDs among adult people with HIV.

Aim: To determine whether ART and HIV-infection are associated with altered biomarkers of cardiovascular diseases in adult people with HIV living in Rwanda.

Methods: A cohort study will be conducted in people with HIV, attending the Kigali University teaching Hospital (KUTH/CHUK) HIV Clinic and Health Centers in this catchment area for treatment and follow-up health care. Participants will be randomly sampled. Repeated measures design will be used; baseline and 6 months’ follow-up assessments, including an individual interview, completion of a comprehensive health questionnaire, anthropometric measures, biomarkers of cardiovascular diseases including lipid profile, glycated hemoglobin, and insulin, vascular and endothelial function tests, inflammatory and coagulation markers, where blood collection will be performed for CVD related biomarkers assessments.Multivariate analysis of variance (MANOVA) will allow us to test the hypothesis regarding the effect of ART and HIV-infection on CVD related biomarkers.

Expected results: This study will provide longitudinal data about the association of ART and HIV-infection with biomarkers of cardiovascular diseases.

Keywords: HIV-infection, cardiovascular diseases, cardiovascular disease risk factors, highly active antiretroviral therapy, Rwanda.