115 results on '"Ann Mwangi"'
Search Results
2. Gaussian process emulation to improve efficiency of computationally intensive multidisease models: a practical tutorial with adaptable R code
- Author
-
Sharon Jepkorir Sawe, Richard Mugo, Marta Wilson-Barthes, Brianna Osetinsky, Stavroula A. Chrysanthopoulou, Faith Yego, Ann Mwangi, and Omar Galárraga
- Subjects
Tutorial ,Emulation ,Gaussian process ,Bayesian analysis ,HIV ,Hypertension ,Medicine (General) ,R5-920 - Abstract
Abstract Background The rapidly growing burden of non-communicable diseases (NCDs) among people living with HIV in sub-Saharan Africa (SSA) has expanded the number of multidisease models predicting future care needs and health system priorities. Usefulness of these models depends on their ability to replicate real-life data and be readily understood and applied by public health decision-makers; yet existing simulation models of HIV comorbidities are computationally expensive and require large numbers of parameters and long run times, which hinders their utility in resource-constrained settings. Methods We present a novel, user-friendly emulator that can efficiently approximate complex simulators of long-term HIV and NCD outcomes in Africa. We describe how to implement the emulator via a tutorial based on publicly available data from Kenya. Emulator parameters relating to incidence and prevalence of HIV, hypertension and depression were derived from our own agent-based simulation model and other published literature. Gaussian processes were used to fit the emulator to simulator estimates, assuming presence of noise for design points. Bayesian posterior predictive checks and leave-one-out cross validation confirmed the emulator’s descriptive accuracy. Results In this example, our emulator resulted in a 13-fold (95% Confidence Interval (CI): 8–22) improvement in computing time compared to that of more complex chronic disease simulation models. One emulator run took 3.00 seconds (95% CI: 1.65–5.28) on a 64-bit operating system laptop with 8.00 gigabytes (GB) of Random Access Memory (RAM), compared to > 11 hours for 1000 simulator runs on a high-performance computing cluster with 1500 GBs of RAM. Pareto k estimates were 10 year) period, estimate longer-term prevalence of other co-occurring conditions (e.g., postpartum depression among women living with HIV), and project the impact of nationally-prioritized interventions such as national health insurance schemes and differentiated care models.
- Published
- 2024
- Full Text
- View/download PDF
3. Prevalence of lifestyle cardiovascular risk factors and estimated framingham 10-year risk scores of adults with psychotic disorders compared to controls at a referral hospital in Eldoret, Kenya
- Author
-
Edith Kwobah, Nastassja Koen, Ann Mwangi, Lukoye Atwoli, and Dan J. Stein
- Subjects
Lifestyle ,Cardiovascular risk ,Psychotic disorders ,Eldoret ,Kenya ,Risk score ,Psychiatry ,RC435-571 - Abstract
Abstract Introduction Lifestyle factors such as smoking, alcohol use, suboptimal diet, and inadequate physical activity have been associated with increased risk of cardiovascular diseases. There are limited data on these risk factors among patients with psychosis in low- and middle-income countries. Objectives This study aimed to establish the prevalence of lifestyle cardiovascular risk factors, and the 10-year cardiovascular risk scores and associated factors in patients with psychosis compared to controls at Moi Teaching and Referral Hospital in Eldoret, Kenya. Methods A sample of 297 patients with schizophrenia, schizoaffective disorder, or bipolar mood disorder; and 300 controls matched for age and sex were included in this analysis. A study specific researcher-administered questionnaire was used to collect data on demographics, antipsychotic medication use, smoking, alcohol intake, diet, and physical activity. Weight, height, abdominal circumference, and blood pressure were also collected to calculate the Framingham 10-year Cardiovascular Risk Score (FRS), while blood was drawn for measurement of glucose level and lipid profile. Pearson’s chi-squared tests and t-tests were employed to assess differences in cardiovascular risk profiles between patients and controls, and a linear regression model was used to determine predictors of 10-year cardiovascular risk in patients. Results Compared to controls, patients with psychosis were more likely to have smoked in their lifetimes (9.9% vs. 3.3%, p = 0.006) or to be current smokers (13.8% vs. 7%, p = 0.001). Over 97% of patients with psychosis consumed fewer than five servings of fruits and vegetables per week; 78% engaged in fewer than three days of vigorous exercise per week; and 48% sat for more than three hours daily. The estimated 10-year risk of CVD was relatively low in this study: the FRS in patients was 3.16, compared to 2.93 in controls. The estimated 10-year cardiovascular risk in patients was significantly associated with female sex (p = 0.007), older patients (p
- Published
- 2023
- Full Text
- View/download PDF
4. Maternal and child health indicators in primary healthcare facilities: Findings in a health systems quasi-experimental study in western Kenya
- Author
-
Fabian Esamai, Ann Mwangi, Mabel Nangami, John Tabu, David Ayuku, and Edwin Were
- Subjects
Health systems ,Maternal ,Neonatal ,Enhanced Health Care ,Find link treat and retain ,Public aspects of medicine ,RA1-1270 - Abstract
Background and purpose: Maternal and infant mortality are higher in low-income than in high-income countries due to weak health systems. The objective of this study was to improve access, utilization and quality of Maternal and Child Health care through a predesigned Enhanced Health Care System (EHC) that embodies the World Health Organization (WHO) pillars of the health system. Design and methodology: This study was conducted in two dispensaries in the Counties of Busia and Bungoma in Kenya as intervention sites and in four control clusters in Kakamega, Uasin Gishu, Trans Nzoia and Elgeyo Marakwet Counties. The study population was pregnant women and their children delivered over the study period in the intervention and control clusters.A quasi-experimental study design was used to conduct the study between 2015 and 2020 to compare the outcomes of the implementation of the EHC using the Find Link Treat and Retain (FLTR) strategy in one cluster, community owned initiatives in the other cluster and four control clusters at baseline and at the end of the study. A baseline survey was conducted in year one and an end line survey in the fifth year. Continuous data collection on maternal and childhood health indicators was done in all the six clusters and comparison made at the end of the study between the clusters. Results: We found a 26%, 10.3% and 0.8% increase in antenatal care (ANC) attendance in the intervention clusters of Obekai, Kabula and control clusters respectively. There was a 28.2%, 5.8% and 17.0% increase in attendance of 4+ ANC clinics of Obekai, Kabula and control clusters respectively. There was a 24% and 13% increase in Obekai and Kabula respectively in contraceptive use and a 2% decrease in contraceptive use in the control locations. There was a 38.2%, 25.6% and 34.7% increase in facility deliveries over the study period in Obekai, Kabula and control clusters respectively. There was a marked increase in immunization coverage in the intervention clusters of Obekai and Kabula compared to a significant decrease in control clusters for BCG, polio, pentavalent and measles. Conclusions and recommendations: In conclusion, use of the health systems approach in health care provision provides a holistic improvement in access and utilization of health services and in the improvement of health indicators.We do recommend that a systems approach be used in health services delivery to improve access, utilization and quality of health care provision at community and primary care levels.
- Published
- 2023
- Full Text
- View/download PDF
5. Are outpatient costs for hypertension and diabetes care affordable? Evidence from Western Kenya
- Author
-
Mwaleso Kishindo, Jemima Kamano, Ann Mwangi, Thomas Andale, Grace W. Mwaura, Obed Limo, Kenneth Too, Richard Mugo, Ephantus Maree, and Wilson Aruasa
- Subjects
out-patient costs ,non-communicable diseases ,catastrophic healthcare expenditure ,primary healthcare ,comorbidity. ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Diabetes and hypertension pose a significant socio-economic burden in developing countries such as Kenya, where financial risk-protection mechanisms remain inadequate. This proves to be a great barrier towards achieving universal health care in such settings unless mechanisms are put in place to ensure greater access and affordability to non-communicable disease (NCD) management services. Aim: This article aims to examine outpatient management services costs for patients with diabetes and hypertension attending public primary healthcare facilities. Setting: The study was conducted in Busia and Trans-Nzoia counties in Western Kenya in facilities supported by the PIC4C project, between August 2020 and December 2020. Methods: This cross-sectional survey included 719 adult participants. Structured interviewer-administered questionnaires were used to collect information on healthcare-seeking behaviour and associated costs. The annual direct and indirect costs borne by patients were computed by disease type and level of healthcare facility visited. Results: Patients with both diabetes and hypertension incurred higher annual costs (KES 13 149) compared to those with either diabetes (KES 8408) or hypertension (KES 7458). Patients attending dispensaries and other public healthcare facilities incurred less direct costs compared to those who visited private clinics. Furthermore, a higher proportionate catastrophic healthcare expenditure of 41.83% was noted among uninsured patients. Conclusion: Despite this study being conducted in facilities that had an ongoing NCDs care project that increased access to subsidised medication, we still reported a substantially high cost of managing diabetes and hypertension among patients attending primary healthcare facilities in Western Kenya, with a greater burden among those with comorbidities. Contribution: Evidenced by the results that there is enormous financial burden borne by patients with chronic diseases such as hypertension and diabetes; we recommend that universal healthcare coverage that offers comprehensive care for NCDs be urgently rolled out alongside strengthening of lower-level public healthcare systems.
- Published
- 2023
- Full Text
- View/download PDF
6. Network characteristics of a referral system for patients with hypertension in Western Kenya: results from the Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) study
- Author
-
Aarti Thakkar, Thomas Valente, Josephine Andesia, Benson Njuguna, Juliet Miheso, Tim Mercer, Richard Mugo, Ann Mwangi, Eunice Mwangi, Sonak D. Pastakia, Shravani Pathak, Mc Kinsey M. Pillsbury, Jemima Kamano, Violet Naanyu, Makeda Williams, Rajesh Vedanthan, Constantine Akwanalo, and Gerald S. Bloomfield
- Subjects
Hypertension ,Referral patterns ,Network analysis ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Health system approaches to improve hypertension control require an effective referral network. A national referral strategy exists in Kenya; however, a number of barriers to referral completion persist. This paper is a baseline assessment of a hypertension referral network for a cluster-randomized trial to improve hypertension control and reduce cardiovascular disease risk. Methods We used sociometric network analysis to understand the relationships between providers within a network of nine geographic clusters in western Kenya, including primary, secondary, and tertiary care facilities. We conducted a survey which asked providers to nominate individuals and facilities to which they refer patients with controlled and uncontrolled hypertension. Degree centrality measures were used to identify providers in prominent positions, while mixed-effect regression models were used to determine provider characteristics related to the likelihood of receiving referrals. We calculated core-periphery correlation scores (CP) for each cluster (ideal CP score = 1.0). Results We surveyed 152 providers (physicians, nurses, medical officers, and clinical officers), range 10–36 per cluster. Median number of hypertensive patients seen per month was 40 (range 1–600). While 97% of providers reported referring patients up to a more specialized health facility, only 55% reported referring down to lower level facilities. Individuals were more likely to receive a referral if they had higher level of training, worked at a higher level facility, were male, or had more job experience. CP scores for provider networks range from 0.335 to 0.693, while the CP scores for the facility networks range from 0.707 to 0.949. Conclusions This analysis highlights several points of weakness in this referral network including cluster variability, poor provider linkages, and the lack of down referrals. Facility networks were stronger than provider networks. These shortcomings represent opportunities to focus interventions to improve referral networks for hypertension. Trial registration Trial Registered on ClinicalTrials.gov NCT03543787 , June 1, 2018.
- Published
- 2022
- Full Text
- View/download PDF
7. Types and Outcomes of Arrhythmias in a Cardiac Care Unit in Western Kenya: A Prospective Study
- Author
-
Joan Kiyeng, Constantine Akwanalo, Wilson Sugut, Felix Barasa, Ann Mwangi, Benson Njuguna, Abraham Siika, and Rajesh Vedanthan
- Subjects
arrhythmias ,atrial fibrillation ,cardiac care unit ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Sustained arrhythmias are frequently encountered in cardiac care units (CCU), but their types and outcomes in Africa are unknown. Studies from high-income countries suggest arrhythmias are associated with worse outcomes. Objectives: To determine the types and proportion of cardiac arrhythmias among patients admitted to the CCU at Moi Teaching and Referral Hospital (MTRH), and to compare 30-day outcomes between patients with and without arrhythmias at the time of CCU admission. Methods: We conducted a prospective study of a cohort of all patients admitted to MTRH-CCU between March and December 2021. They were stratified on the presence or absence of arrhythmia at the time of CCU admission, irrespective of whether it was the primary indication for CCU care or not. Clinical characteristics were collected using a structured questionnaire. Participants were followed up for 30 days. The primary outcome of interest was 30-day all-cause mortality. Secondary outcomes were 30-day all-cause readmission and length of hospital stay. The 30-day outcomes were compared between the patients with and without arrhythmia, with a p value < 0.05 being considered statistically significant. Results: We enrolled 160 participants. The median age was 46 years (IQR 31, 68), and 95 (59.4%) were female. Seventy (43.8%) had a diagnosis of arrhythmia at admission, of whom 62 (88.6%) had supraventricular tachyarrhythmias, five (7.1%) had ventricular tachyarrhythmias, and three (4.3%) had bradyarrhythmia. Atrial fibrillation was the most common supraventricular tachyarrhythmia (82.3%). There was no statistically significant difference in the primary outcome of 30-day mortality between those who had arrhythmia at admission versus those without: 32.9% versus 30.0%, respectively (p = 0.64). Conclusion: Supraventricular tachyarrhythmias were common in critically hospitalized cardiac patients in Western Kenya, with atrial fibrillation being the most common. Thirty-day all-cause mortality did not differ significantly between the group admitted with a diagnosis of arrhythmia and those without.
- Published
- 2023
- Full Text
- View/download PDF
8. Personality traits and substance use among college students in Eldoret, Kenya.
- Author
-
Daniel Waiganjo Kinyanjui and Ann Mwangi Sum
- Subjects
Medicine ,Science - Abstract
BackgroundThere is documented evidence of the increase of alcohol and substance use among college students globally. Increased morbidity and associated maladaptive socio-occupational outcomes of the habit with early dependence and mortality have also been reported. Majority of the substance use related studies conducted in low- and middle- income countries mainly look at health- related risk behaviour control mechanisms that focus on the social environment domain, with few or almost none focusing on those embedded within the person (self- control). This study focuses on the relationship between substance use and personality traits (in the self-control domain), among college students in a low- middle- income country.MethodsDesign. A cross- sectional descriptive study that used the self- administered WHO Model Core and the Big Five Inventory Questionnaires to collect information among students in Colleges and Universities in Eldoret town, Kenya. Setting. Four (1- university campus; 3- non- university) tertiary learning institutions were randomly selected for inclusion. Subjects. Four hundred students, 100 from each of the 4 institutions; selected through a stratified multi-stage random sampling, who gave consent to participate in the study. Associations between various variables, personality traits and substance use were tested using bivariate analysis, while the strength/ predictors of association with substance use was ascertained through multiple logistic regression analyses. A finding of p ≤ 0.05 was considered statistically significant.ResultsThe median age was 21 years (Q1, Q3; 20, 23), approximately half 203 (50.8%) were male, with majority 335 (83.8%) from an urban residence and only 28 (7%) gainfully employed. The lifetime prevalence of substance use was 41.5%, while that of alcohol use was 36%. For both, a higher mean neuroticism score [substance use- (AOR 1.05, 95%CI; 1, 1.10: p = 0.013); alcohol use- (AOR 1.04, 95%CI; 0.99, 1.09: p = 0.032)] showed increased odds of lifetime use, while a higher mean agreeableness score [substance use- (AOR 0.99, 95%CI; 0.95, 1.02: p = 0.008); alcohol use- (AOR 0.99, 95%CI; 0.95, 1.02: p = 0.032)] showed decreased odds of lifetime use. A higher mean age (AOR 1.08, 95% CI; 0.99, 1,18: p = 0.02) of the students also showed an 8% increase in odds of lifetime alcohol use. The lifetime prevalence of cigarette use was 8.3%. Higher mean neuroticism (AOR 1.06, 95%CI; 0.98, 1.16: p = 0.041) and openness to experience (AOR 1.13, 95%CI; 1.04, 1.25: p = 0.004) scores showed increased odds of lifetime cigarette smoking, whereas being unemployed (AOR 0.23, 95%CI; 0.09, 0.64: pConclusionsThe prevalence of substance use among college and university students in Eldoret is high and associated with high neuroticism and low agreeableness personality traits. We provide directions for future research that will examine and contribute to a deeper understanding of personality traits in terms of evidence- based approach to treatment.
- Published
- 2023
- Full Text
- View/download PDF
9. Contraception use and HIV outcomes among women initiating dolutegravir‐containing antiretroviral therapy in Kenya: a retrospective cohort study
- Author
-
John M. Humphrey, Victor Omodi, Caitlin Bernard, Mercy Maina, Julie Thorne, Ann Mwangi, Kara Wools‐Kaloustian, and Rena C. Patel
- Subjects
Africa ,ARV ,health policy ,reproductive ,teratogen ,viremia ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Abstract Introduction The rollout of dolutegravir (DTG) in low‐ and middle‐income countries was disrupted by a potential association reported with periconceptional DTG exposure among women living with HIV (WLHIV) and infant neural tube defects. This prompted countries to issue interim guidance limiting DTG use among women of reproductive potential to those on effective contraception. Data to understand the potential impact of such guidance on WLHIV are limited. Methods We conducted a retrospective cohort analysis of WLHIV 15–49 years initiating DTG‐containing antiretroviral treatment (ART) in Kenya from 2017 to 2020. We determined baseline effective (oral, injectable or lactational amenorrhea) and very effective (implant, intrauterine device or female sterilization) contraception use among women who initiated DTG before (Group 1) or during (Group 2) the interim guideline period. We defined incident contraception use in each group as the number of contraceptive methods initiated ≤180 days post‐guideline (Group 1) or post‐DTG initiation (Group 2). We determined the proportions of all women who switched from DTG‐ to non‐nucleoside reverse transcriptase inhibitor (NNRTI)‐ (efavirenz or nevirapine) containing ART ≤12 months post‐DTG initiation, compared their viral suppression (
- Published
- 2022
- Full Text
- View/download PDF
10. Improving maternal and child health outcomes through a community involvement strategy in Kabula location, Bungoma County, Kenya
- Author
-
Fabian Esamai, Ann Mwangi, Mabel Nangami, John Tabu, David Ayuku, and Edwin Were
- Subjects
Health systems ,Maternal ,Neonatal ,Enhanced health care ,Community participation ,Community ownership ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Maternal, fetal and neonatal mortality are higher in low-income compared to high-income countries due to weak health systems including poor access and utilization of health services. Despite enormous recent improvements in maternal, neonatal and under five children health indicators, more rapid progress is needed to meet the targets including the Sustainable Development Goal 3(SDG). In Kenya these indicators are still high and comprehensive systems are needed to attain these goals. Objective: To facilitate innovative partnerships in health care provision and to assess trends in access, utilization and quality of Maternal and Child Health care through the health systems approach using community owned initiatives including use of community owned resourse persons (CORPs), establishment of Community Based Organisations (CBOs) and Income Generating Activities(IGAs). Study site: This was implemented in Kabula location, Bungoma County, Kenya between January 2016 and April 2019. Study population: Pregnant women, newborns and under-five children living in Kabula location identified by Community Owned Resource Persons (CORPs). Methods: A prospective study to show trends in maternal, neonatal and infant outcomes through the implementation of community owned initiatives. Findings: General, under five and antenatal clinic attendance increased four fold in 2016,2017 and 2018. There was a 76% full immunization coverage with 97% BCG and 84% Polio coverage respectively among children studied. There was an 87% facility delivery rate among the pregnant women enrolled in the study. Conclusions: Trends in Maternal and under-five health indicators in Kabula showed improvements over the study period following the implementation of the community owned initiatives and community participation. Recommendations: The community owned initiatives as implemented in this study is useful in primary care and universal health coverage programs in health care delivery systems in LMICs.
- Published
- 2022
- Full Text
- View/download PDF
11. Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley mother baby hospital: a longitudinal case-series study
- Author
-
Koech Irene, Poli Philippe Amubuomombe, Richard Mogeni, Cheruiyot Andrew, Ann Mwangi, and Orang’o Elkanah Omenge
- Subjects
Maternal and perinatal outcomes ,Eclampsia ,Mode of delivery ,Resource-limited settings ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Eclampsia, considered as serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0–40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1–2.0). Conclusion There is no benefit of emergency caesarean section for women with eclampsia. This study showed that induction of labour and vaginal delivery can be successfully achieved in pregnant women with eclampsia. Maternal and perinatal mortality from eclampsia can be prevented through prompt and effective care.
- Published
- 2021
- Full Text
- View/download PDF
12. Implementing enhanced patient care to promote patient engagement in HIV care in a rural setting in Kenya
- Author
-
Juddy Wachira, Becky Genberg, Diana Chemutai, Ann Mwangi, Omar Galarraga, Siika Abraham, and Ira Wilson
- Subjects
Patient engagement ,Implementation ,Adaptation ,HIV care ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Patient engagement is effective in promoting adherence to HIV care. In an effort to promote patient-centered care, we implemented an enhanced patient care (EPC) intervention that addresses a combination of system-level barriers including provider training, continuity of clinician-patient relationship, enhanced treatment dialogue and better clinic scheduling. We describe the initial implementation of the EPC intervention in a rural HIV clinic in Kenya, and the factors that facilitated its implementation. Methods The intervention occurred in one of the rural Academic Model Providing Healthcare (AMPATHplus) health facilities in Busia County in the western region of Kenya. Both qualitative and quantitative data were collected through training and meeting proceedings/minutes, a patient tracking tool, treatment dialogue and a peer confirmation tool. Qualitative data were coded and emerging themes on the implementation and adaptation of the intervention were developed. Descriptive analysis including percentages and means were performed on the quantitative data. Results Our analysis identified four key factors that facilitated the implementation of this intervention. (1) The smooth integration of the intervention as part of care that was facilitated by provider training, biweekly meetings between the research and clinical team and having an intervention that promotes the health facility agenda. (2) Commitment of stakeholders including providers and patients to the intervention. (3) The adaptability of the intervention to the existing context while still maintaining fidelity to the intervention. (4) Embedding the intervention in a facility with adequate infrastructure to support its implementation. Conclusions This analysis demonstrates the value of using mixed methods approaches to study the implementation of an intervention. Our findings emphasize how critical local support, local infrastructure, and effective communication are to adapting a new intervention in a clinical care program.
- Published
- 2021
- Full Text
- View/download PDF
13. Harmful Alcohol Use Among Healthcare Workers at the Beginning of the COVID-19 Pandemic in Kenya
- Author
-
Florence Jaguga, Edith Kamaru Kwobah, Ann Mwangi, Kirtika Patel, Thomas Mwogi, Robert Kiptoo, and Lukoye Atwoli
- Subjects
alcohol ,healthcare ,workers ,COVID-19 ,Kenya ,Psychiatry ,RC435-571 - Abstract
BackgroundHealthcare workers play a key role in responding to pandemics like the on-going COVID-19 one. Harmful alcohol use among them could result in inefficiencies in health service delivery. This is particularly concerning in sub-Saharan Africa where the health workforce is already constrained. The aim of this study is to document the burden and correlates of harmful alcohol use among healthcare workers at the beginning of the COVID-19 pandemic in Kenya with the aim of informing policy and practice.MethodsThis study was a cross-sectional analysis of data obtained from a parent online survey that investigated the burden and factors associated with mental disorders among healthcare workers during the COVID-19 pandemic in Kenya. We analyzed data obtained from a sub-population of 887 participants who completed the Alcohol Use Disorder Identification Test questionnaire. We used descriptive statistics to summarize the socio-demographic characteristics of the participants and multivariate analysis to determine the factors associated with harmful alcohol use.ResultsThree hundred and eighty nine (43.9%) participants reported harmful alcohol use. The factors significantly associated with increased odds of endorsing harmful alcohol use were: being male (AOR = 1.56; 95% CI = 1.14, 2.14; p = 0.006), being unmarried (AOR = 2.06; 95% CI = 1.48, 2.89; p < 0.001), having 11-20 years of experience as compared to having 20+ years of experience (AOR = 1.91; 95% CI = 1.18, 3.12; p = 0.009), and being a specialist (AOR = 2.78; CI = 1.64, 4.78; p = < 0.001) or doctor (AOR = 2.82; 95% CI = 1.74, 4.63; p < 0.001) as compared to being a nurse.ConclusionsA high proportion of healthcare workers reported harmful alcohol use at the beginning of the COVID-19 pandemic in Kenya. Males, the unmarried, those with 11–20 years of experience in the health field, doctors and specialists, were more likely to report harmful alcohol use. These findings highlight the need to institute interventions for harmful alcohol use targeting these groups of healthcare workers in Kenya during the COVID-19 pandemic in order to optimize functioning of the available workforce.
- Published
- 2022
- Full Text
- View/download PDF
14. Higher Clinician-Patient Communication Is Associated With Greater Satisfaction With HIV Care
- Author
-
Juddy Wachira PhD, Ann Mwangi PhD, Diana Chemutai BSc, Monica Nyambura BSc, Becky Genberg PhD, and Ira B. Wilson MSc
- Subjects
Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Provider-patient communication (PPC) skills are key in promoting patient satisfaction. Our study examined the relationship between clinician PPC skills and patient satisfaction with care among virally unsuppressed adult HIV patients in Busia County, Kenya. This cross-sectional study was conducted among 360 HIV patients on first line antiretroviral regimen and having a recent viral load ≥400 copies HIV RNA/ml. We conducted logistic regression analysis. The mean age of participants was 48.2 years [standard deviation (SD): 12.05]. Overall, the mean score on clinician PPC skills was 33.3 (SD: 9.0). A high proportion (85%) of participants reported satisfaction with the HIV care services. After adjusting for covariates, the odds of being satisfied with care increased by 19% (adjusted odds ratio: 1.19, 95% CI: 1.11-1.30) for every one unit increase in the clinician PPC skills score. Promoting good PPC skills may be key to improving patient satisfaction with HIV care.
- Published
- 2021
- Full Text
- View/download PDF
15. Mental Disorders Among Health Care Workers at the Early Phase of COVID-19 Pandemic in Kenya; Findings of an Online Descriptive Survey
- Author
-
Edith Kamaru Kwobah, Ann Mwangi, Kirtika Patel, Thomas Mwogi, Robert Kiptoo, and Lukoye Atwoli
- Subjects
prevalence ,health care workers ,Kenya ,mental disorders ,COVID-19 ,Psychiatry ,RC435-571 - Abstract
Background: Healthcare workers responding to the Corona Virus Pandemic (COVID-19) are at risk of mental illness. Data is scanty on the burden of mental disorders among Kenyan healthcare workers responding to the pandemic that can inform mental health and psychosocial support. The purpose of this study was to establish the frequency and associated factors of worry, generalized anxiety disorder, depression, posttraumatic stress disorder and poor quality of sleep among Kenyan health care workers at the beginning of COVID-19 pandemic.Methods: We conducted an online survey among 1,259 health care workers in Kenya. A researcher developed social demographic questionnaire and several standardized tools were used for data collection. Standardized tools were programmed into Redcap, (Research Electronic Data Capture) and data analysis was performed using R Core Team. In all analysis a p-value < 0.05 was considered significant.Results: 66% of the participants reported experiencing worry related to COVID-19. 32.1% had depression, 36% had generalized anxiety, 24.2% had insomnia and 64.7% scored positively for probable Post Traumatic Stress Disorder (PTSD). Depression was higher among females compared to men (36.5 vs. 26.9%, p = 0.003), workers
- Published
- 2021
- Full Text
- View/download PDF
16. Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) in western Kenya: a study protocol of a cluster randomized trial
- Author
-
Tim Mercer, Benson Njuguna, Gerald S. Bloomfield, Jonathan Dick, Eric Finkelstein, Jemima Kamano, Ann Mwangi, Violet Naanyu, Sonak D. Pastakia, Thomas W. Valente, Rajesh Vedanthan, and Constantine Akwanalo
- Subjects
Referral networks ,Hypertension ,Cardiovascular disease ,Health systems ,Health systems strengthening ,Implementation science ,Medicine (General) ,R5-920 - Abstract
Abstract Background Hypertension is a major risk factor for cardiovascular disease (CVD), yet treatment and control rates for hypertension are very low in low- and middle-income countries (LMICs). Lack of effective referral networks between different levels of the health system is one factor that threatens the ability to achieve adequate blood pressure control and prevent CVD-related morbidity. Health information technology and peer support are two strategies that have improved care coordination and clinical outcomes for other disease entities in other settings; however, their effectiveness and cost-effectiveness in strengthening referral networks to improve blood pressure control and reduce CVD risk in low-resource settings are unknown. Methods/design We will use the PRECEDE-PROCEED framework to conduct transdisciplinary implementation research, focused on strengthening referral networks for hypertension in western Kenya. We will conduct a baseline needs and contextual assessment using a mixed-methods approach, in order to inform a participatory, community-based design process to fully develop a contextually and culturally appropriate intervention model that combines health information technology and peer support. Subsequently, we will conduct a two-arm cluster randomized trial comparing 1) usual care for referrals vs 2) referral networks strengthened with our intervention. The primary outcome will be one-year change in systolic blood pressure. The key secondary clinical outcome will be CVD risk reduction, and the key secondary implementation outcomes will include referral process metrics such as referral appropriateness and completion rates. We will conduct a mediation analysis to evaluate the influence of changes in referral network characteristics on intervention outcomes, a moderation analysis to evaluate the influence of baseline referral network characteristics on the effectiveness of the intervention, as well as a process evaluation using the Saunders framework. Finally, we will analyze the incremental cost-effectiveness of the intervention relative to usual care, in terms of costs per unit decrease in systolic blood pressure, per percentage change in CVD risk score, and per disability-adjusted life year saved. Discussion This study will provide evidence for the implementation of innovative strategies for strengthening referral networks to improve hypertension control in LMICs. If effective, it has the potential to be a scalable model for health systems strengthening in other low-resource settings worldwide. Trial registration Clinicaltrials.gov, NCT03543787. Registered on 29 June 2018.
- Published
- 2019
- Full Text
- View/download PDF
17. Challenges with seeking HIV care services: perspectives of older adults infected with HIV in western Kenya
- Author
-
Jepchirchir Kiplagat, Ann Mwangi, Charles Chasela, and Susann Huschke
- Subjects
Older adults ,HIV ,Engagement in care ,Experiences ,Comorbidities ,Challenges ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background While younger adults (15–49 years) form the majority of the population living with HIV, older adults (≥50 years) infected with HIV face multiple challenges related to the aging process and HIV. We explored the experiences of older persons infected with HIV at the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya to understand the challenges faced when seeking HIV care services. Methods Between November 2016 and April 2017, a total of 57 adults aged 50 years and above were recruited from two AMPATH facilities – one rural and one urban facility. A total of 25 in-depth interviews and four focus group discussions were conducted, audio-recorded, transcribed and thematic analysis performed. Results Study participants raised unique challenges with seeking HIV care that include visits to multiple healthcare providers to manage HIV and comorbidities and as a result impact on their adherence to medication and clinical visits. Challenges with inadequate quality of facilities and poor patient-provider communication were also raised. Participants’ preference for matched gender and older age for care providers that serve older patients were identified. Conclusion Results indicate multiple challenges faced by older adults that need attention in ensuring continuous engagement in HIV care. Targeted HIV care for older adults would, therefore, significantly improve their access to and experience of HIV care. Of key importance is the integration of other chronic diseases into HIV care and employing staff that matches the needs of older adults.
- Published
- 2019
- Full Text
- View/download PDF
18. Longitudinal-Survival Models for Case-Based Tuberculosis Progression
- Author
-
Richard Kiplimo, Mathew Kosgei, Ann Mwangi, Elizabeth Onyango, Morris Ogero, and Joseph Koske
- Subjects
Markov Chain Monte Carlo method ,B splines ,joint model ,current value ,tuberculosis ,Public aspects of medicine ,RA1-1270 - Abstract
Introduction: Tuberculosis (TB) disease continues to be responsible for a high global burden with an estimated 10 million people falling ill each year and an estimated 1.45 million deaths. Widely carried out analyses to utilize routine data coming from this disease, and well-established in literature, have paid attention to time-to-event with sputum smear results being considered only at baseline or even ignored. Also, logistic regression models have been used to demonstrate importance of sputum smear results in patient outcomes. A feature presented by this disease, however, is that each individual patient is usually followed over a period of time with sputum smear results being documented at different points of the treatment curve. This provides both repeated measures and survival times, which may require a joint modeling approach. This study aimed to investigate the association between sputum smear results and the risk of experiencing unfavorable outcome among TB patients and dynamically predict survival probabilities.Method: A joint model for longitudinal and time-to-event data was used to analyze longitudinally measured smear test results with time to experiencing unfavorable outcome for TB patients. A generalized linear mixed-effects model was specified for the longitudinal submodel and cox proportional hazards model for the time-to-event submodel with baseline hazard approximated using penalized B-splines. The two submodels were then assumed to be related via the current value association structure. Bayesian approach was used to approximate parameter estimates using Markov Chain Monte Carlo (MCMC) algorithm. The obtained joint model was used to predict the subject's future risk of survival based on sputum smear results trajectories. Data were sourced from routinely collected TB data stored at National TB Program database.Results: The average baseline age was 35 (SD: 15). Female TB patients constituted 36.42%. Patients with previous history of TB treatment constituted 6.38% (event: 15.25%; no event: 5.29%). TB/HIV co-infection was at 31.23% (event: 47.87%; no event: 29.20%). The association parameter 1.03 (CI[1.03,1.04]) was found to be positive and significantly different from zero, interpreted as follows: The estimate of the association parameter α = 1.033 denoted the log hazard ratio for a unit increase in the log odds of having smear positive results. HIV status (negative) 0.47 (CI [0.46,49]) and history of TB treatment (previously treated) (2.52 CI [2.41,2.63]), sex (female) (0.82 CI [0.78,0.84]), and body mass index (BMI) categories (severe malnutrition being reference) were shown to be statistically significant.Conclusion: Sputum smear result is important in estimating the risk to unfavorable outcome among TB patients. Men, previously treated, TB/HIV co-infected and severely malnourished TB patients are at higher risk of unfavorable outcomes.
- Published
- 2021
- Full Text
- View/download PDF
19. Prevalence and correlates of metabolic syndrome and its components in adults with psychotic disorders in Eldoret, Kenya.
- Author
-
Edith Kwobah, Nastassja Koen, Ann Mwangi, Lukoye Atwoli, and Dan J Stein
- Subjects
Medicine ,Science - Abstract
BackgroundA high prevalence of metabolic syndrome and its components in patients with psychotic disorders may increase the risk for cardiovascular diseases. Unfortunately, relatively little work in this field has emerged from low-resourced contexts. This study investigated the prevalence, correlates, and treatment patterns of metabolic disorders in patients with psychotic disorders in Western Kenya.Methods300 patients with psychosis and 300 controls were recruited at Moi Teaching and Referral Hospital in Eldoret, Kenya. Data on demographic characteristics, weight, height, abdominal circumference, blood pressure, blood glucose, lipid profile, and treatments were collected. Categorical and continuous data were compared between the patient and control groups using Pearson's chi-squared tests and t-tests, respectively. Variables found to be significantly different between these groups were included in logistic regression models to determine potential predictors of metabolic syndrome.ResultsCompared to controls, patients with psychosis were found to have a higher mean random blood glucose [5.23 vs 4.79, p = 0.003], higher body mass index [5.23 vs 4.79, p = 0.001], higher triglycerides [1.98 vs 1.56, pConclusionIn the study setting of Eldoret, metabolic syndrome and its components were more prevalent among patients with psychotic disorders than in controls; and a clear treatment gap for these disorders was evident. There is a need for efforts to ensure adequate screening and treatment for these physical disorders in resource-limited settings.
- Published
- 2021
- Full Text
- View/download PDF
20. Factors Related to Maternal Adverse Outcomes in Pregnant Women with Cardiac Disease in Low-resource Settings
- Author
-
Philippe Amubuomombe Poli, Elkanah Omenge Orang’o, Ann Mwangi, and Felix Ayub Barasa
- Subjects
Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Cardiac disease is an important life-threatening complication during pregnancy. It is frequently seen in pregnant women living in resource-limited areas and often results in premature death. Aim: The aim of this hospital-based longitudinal study was to identify factors related to adverse maternal and neonatal outcomes in pregnant women with cardiac disease in low-resource settings. Methods: The study enrolled 91 pregnant women with congenital or acquired cardiac disease over a period of 2 years in Kenya. Results: Maternal and early neonatal deaths occurred in 12.2% and 12.6% of cases, respectively. The risk of adverse outcomes was significantly increased in those with pulmonary oedema (OR 11, 95% CI [2.3–52]; p=0.002) and arrhythmias (OR 16.9, 95% CI [2.5–113]; p=0.004). Limited access to care was significantly associated with adverse maternal outcomes (p≤0.001). Conclusion: Many factors contribute to adverse maternal and neonatal outcomes in pregnant women with cardiac disease. Access to comprehensive specialised care may help reduce cardiac-related complications during pregnancy.
- Published
- 2020
- Full Text
- View/download PDF
21. Trends in maternal and child health outcomes in a health systems intervention: a case of Obekai dispensary in western Kenya
- Author
-
Fabian Esamai, Ann Mwangi, John Tabu, Mabel Nangami, Edwin Were, and David Ayuku
- Subjects
Public aspects of medicine ,RA1-1270 - Abstract
# Background Maternal, fetal and neonatal mortality are higher in low-income compared to high-income countries primarily due to weak health systems that impede access and utilization of health services. Despite significant improvements in maternal, neonatal and under five children indicators, in some low-income countries, including Kenya these indicators remain relatively high prompting the search for innovative interventions to catalyze the progress towards attaining the Sustainable Development Goal (SDG) 3 target by 2030. We describe the results of a study that assessed the impact of an innovative health systems approach on maternal, neonatal and under-five children outcomes. # Methods This was a four year pre-post prospective study to describe trends in the outcomes through the implementation of the Enhanced Health Care (EHC) using the Find Link Treat and Retain (FLTR) strategy. This was implemented in the catchment population of a 'level 2' facility, Obekai dispensary in Busia County, Kenya between January 2016 and January 2019. The study population was pregnant women, newborns and under-five children identified and referred to the facility over the study period. Women were identified in the community by community health workers early in pregnancy and followed up in Obekai dispensary until delivery. The newborns were followed up for the whole period the mother baby dyads were in the study. The EHC was implemented on these pairs during the duration of study upto 2-3 years. An interrupted time series model for a single group was used to assess the effect of the intervention on the outcome. # Results Attendance in the outpatient, under five and antenatal clinic increased by 76%, 37% and 54% respectively from 2015 to 2018. There was a 90% fully immunization coverage with 97% and 94% BCG and Polio coverage respectively among children studied. There was a 91% facility delivery rate among the pregnant women enrolled in the study. After introduction of FLTR the immunization uptake increased significantly per quarter at a rate of 29.2 (95% confidence interval, CI=20.1-38.3). There was an increase in facility delivery, antenatal (ANC) attendance and decrease in neonatal death after introduction on FLTR. # Conclusions Maternal and under-five health indicators in Obekai improved over the study period following the implementation of the EHC package.
- Published
- 2020
- Full Text
- View/download PDF
22. A system approach to improving maternal and child health care delivery in Kenya: innovations at the community and primary care facilities (a protocol)
- Author
-
Fabian Esamai, Mabel Nangami, John Tabu, Ann Mwangi, David Ayuku, and Edwin Were
- Subjects
Health systems ,Maternal ,Neonatal ,Enhanced health care ,Find link treat and retain ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Maternal, fetal and neonatal mortality are higher in low-income compared to high-income countries due to weak health systems including poor access and utilization of health services. Despite enormous recent improvements in maternal, neonatal and under 5 health indicators, more rapid progress is needed to meet the targets including the Development Goal 3(SDG). In Kenya these indicators are still high and comprehensive systems are needed to attain the targets of the SDG 3 by 2030. We describe the structure and methods of a study to assess the impact of an innovative system approach on maternal, neonatal and under-five children outcomes. This will be implemented in two clusters in the Counties of Busia and Bungoma in Kenya. There will be 4 control clusters in Kakamega, UasinGishu, Trans Nzoia and Elgeyo Marakwet Counties in Kenya. The study population will be pregnant women, newborns and under-five children identified over the study period. The objective of the study is to improve access, utilization and quality of Maternal and Child Health care through a predesigned Enhanced Health Care System (EHC) that embodies six WHO pillars of the health system and community owned initiatives including Community Based Organisations and Income Generating Activities. Methods/Design A five year quasi-experimental design will be used to compare the outcomes of the implementation of the EHC using the Find Link Treat and retain (FLTR) strategy in one cluster, community owned initiatives in one cluster and four control clusters at baseline and at the end of the study. A Baseline survey will be conducted in year one and an endline in the fifth year in which maternal, neonatal and underfive childhood outcomes will be compared. Discussion The expected findings from the study include showing trends in improvement in the intervention clusters for morbidity, mortality, health service utilization and access indicators. Use of the health systems approach in health care provision is expected to provide a holistic improvement in the quality of care in the study populations in the intervention clusters that will lead to improved health indicators including morbidity and mortality. It is expected that the findings will inform health policy of the national and county governments in Kenya and worldwide.
- Published
- 2017
- Full Text
- View/download PDF
23. Low back pain among primary school teachers in Rural Kenya: Prevalence and contributing factors
- Author
-
Hussein E. Elias, Raymond Downing, and Ann Mwangi
- Subjects
low back pain ,rural ,Kenya ,teachers, primary school ,public schools ,risk factors ,disability ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Low back pain (LBP) has been recognised as a common occupational problem with a high prevalence among work-related musculoskeletal disorders. Although there appears to be a high prevalence of LBP among school teachers, there is inadequate information on the prevalence and predisposing factors of LBP among primary school teachers in rural Western Kenya. Aim: To determine the prevalence, factors associated with LBP and physical disability caused by LBP. Setting: The setting was public schools in rural Western Kenya selected by simple random sampling method. Methods: A cross-sectional study was conducted among primary teachers from public schools using a self-administered questionnaire. The questionnaire included information on LBP, demographic data, occupational and psychosocial factors and disability score. The 12-month prevalence, associated factors and LBP disability were analysed. Results: The 12-month self-reported prevalence of LBP among primary teachers was 64.98%, with close to 70% of them reporting minimal disability. The logistic regression analysis showed that female gender (odds ratio [OR]: 1.692, p < 0.02) was associated with LBP and high supervisor support (OR: 0.46, p < 0.003) was negatively associated with LBP. Conclusion: The prevalence of LBP among primary school teachers in rural Western Kenya is 64.98%, with the majority of them reporting minimal disability. The identified risk factors were female gender and low supervisor support. The presence of work-related psychosocial risk factors in this study suggests a comprehensive approach in evaluation and management of LBP. Preventive measures should be in place to prevent and reduce the progression of LBP disability.
- Published
- 2019
- Full Text
- View/download PDF
24. Prevalence and factors associated with metabolic syndrome in an urban population of adults living with HIV in Nairobi, Kenya
- Author
-
Catherine Nduku Kiama, Joyce Njeri Wamicwe, Elvis Omondi Oyugi, Mark Odhiambo Obonyo, Jane Githuku Mungai, Zeinab Gura Roka, and Ann Mwangi
- Subjects
metabolic syndrome ,prevalence ,associated factors ,hiv ,Medicine - Abstract
INTRODUCTION: Metabolic syndrome affects 20-25% of the adult population globally. It predisposes to cardiovascular disease and Type 2 diabetes. Studies in other countries suggest a high prevalence of metabolic syndrome among HIV-infected patients but no studies have been reported in Kenya. The objective of this study was to assess the prevalence and factors associated with metabolic syndrome in adult HIV-infected patients in an urban population in Nairobi, Kenya. METHODS: in a cross-sectional study design, conducted at Riruta Health Centre in 2016, 360 adults infected with HIV were recruited. A structured questionnaire was used to collect data on socio-demography. Blood was collected by finger prick for fasting glucose and venous sampling for lipid profile. RESULTS: using the harmonized Joint Scientific Statement criteria, metabolic syndrome was present in 19.2%. The prevalence was higher among females than males (20.7% vs. 16.0%). Obesity (AOR = 5.37, P = 0.001), lack of formal education (AOR = 5.20, P = 0.002) and family history of hypertension (AOR = 2.06, P = 0.029) were associated with increased odds of metabolic syndrome while physical activity (AOR = 0.28, P = 0.001) was associated with decreased odds. CONCLUSION: metabolic syndrome is prevalent in this study population. Obesity, lack of formal education, family history of hypertension, and physical inactivity are associated with metabolic syndrome. Screening for risk factors, promotion of healthy lifestyle, and nutrition counselling should be offered routinely in HIV care and treatment clinics.
- Published
- 2018
- Full Text
- View/download PDF
25. Retention in care among older adults living with HIV in western Kenya: A retrospective observational cohort study.
- Author
-
Jepchirchir Kiplagat, Ann Mwangi, Alfred Keter, Paula Braitstein, Edwin Sang, Joel Negin, and Charles Chasela
- Subjects
Medicine ,Science - Abstract
Retention, defined as continuous engagement in care, is an important indicator for quality of healthcare services. To achieve UNAIDS 90-90-90 targets, emphasis on retention as a predictor of viral suppression in patients initiated on ART is vital. Using routinely collected clinical data, the authors sought to determine the effect of age on retention post ART initiation.De-identified electronic data for 32965 HIV-infected persons aged ≥15 years at enrolment into the Academic Model Providing Access to Healthcare program between January 2008 and December 2014 were analyzed. Follow-up time was defined from the date of ART initiation until either loss to follow-up or death or close of the database (September 2016) was observed. Proportions were compared using Pearson's Chi-square test and medians using Mann-Whitney U test. Logistic regression model was used to assess differences in ART initiation between groups, adjusting for baseline characteristics. Cox proportional hazards model adjusting for baseline characteristics and antiretroviral therapy (ART) status was used to compute hazard ratios. Kaplan-Meier survival function was used to compare retention on ART at 12, 24, and 36 months post ART initiation.Of the total sample, 3924 (12.0%) were aged ≥50 years at enrolment. The median (IQR) age of young adults and older adults were 32.5 (26.6, 36.9) and 54.9 (51.7, 59.9) respectively. ART initiation rates were 70.5% among older adults and 68.2% among younger adults. Retention rates in care at 12, 24 and 36 months post ART initiation were 73.9% (95% CL: 72.2, 75.5), 62.9% (95% CL: 61.0, 64.7) and 55.4% (95% CL: 53.5, 57.3) among older adults compared to 69.8% (95% CL: 69.1, 70.4), 58.1% (95% CL: 57.4, 58.8) and 49.3% (95% CL: 48.6, 50.0) among younger adults (p
- Published
- 2018
- Full Text
- View/download PDF
26. Factors associated with Schistosomiasis control measures in Mwaluphamba Location, Kwale County, Kenya
- Author
-
Ahmad Juma, Arthur K.S. Ng'etich, Violet Naanyu, Ann Mwangi, and Ruth C. Kirinyet
- Subjects
Schistosomiasis, Control Measures, Kwale County ,Public aspects of medicine ,RA1-1270 - Abstract
The study set out to investigate the factors associated with Schistosomiasis control measures in Mwaluphamba location of Kwale County. A descriptive cross-sectional study design was used. Mwaluphamba location was purposely sampled and simple random sampling was used to select 338 respondents in villages in each location. Structured questionnaires were used to collect data. A majority of the respondents were males (60%), Muslim affiliated (85%), aged 41 years and over (39%) and most (56%) of them had achieved at least a primary level of education. Results showed that 40% of the respondents were knowledgeable of health education as a service offered by health care providers to control Schistosomiasis. Male respondents and those of Islamic affiliation were five times (OR: 4.686) and three times (OR: 3.13) more likely to seek health education in comparison to their female counterparts respectively. Respondents’ who had achieved at least a primary level of education and those that earned an income of above one thousand shillings significantly utilized mass treatment. Respondents with income levels below a thousand shillings were less likely to seek both health education and mass treatment compared to those with a higher income. In conclusion, there was a statistically significant association between respondents’ socio-demographic factors and control measures for the infection. There is need for equal implementation of all control measures to overcome the socio-demographic barriers and to ensure effective control of Schistosomiasis infection.
- Published
- 2017
- Full Text
- View/download PDF
27. Factors Associated with Uptake of Visual Inspection with Acetic Acid (VIA) for Cervical Cancer Screening in Western Kenya.
- Author
-
Elkanah Omenge Orang'o, Juddy Wachira, Fredrick Chite Asirwa, Naftali Busakhala, Violet Naanyu, Job Kisuya, Grieven Otieno, Alfred Keter, Ann Mwangi, and Thomas Inui
- Subjects
Medicine ,Science - Abstract
PURPOSE:Cervical cancer screening has been successful in reducing the rates of cervical cancer in developed countries, but this disease remains the leading cause of cancer deaths among women in sub-Saharan Africa. We sought to understand factors associated with limited uptake of screening services in our cervical cancer-screening program in Western Kenya. PARTICIPANTS AND METHODS:Using items from a previously validated cancer awareness questionnaire repurposed for use in cervical cancer and culturally adapted for use in Kenya, we interviewed 2,505 women aged 18-55 years receiving care in gynecology clinics or seeking other services in 4 health facilities in Western Kenya between April 2014 and September 2014. We used logistic regression modeling to assess factors associated with uptake (or non-uptake), associated odds ratios (ORs) and the 95% confidence intervals (95% CI). RESULTS:Only two hundred and seventy-three women out of 2505 (11%) accepted VIA cervical cancer screening. Knowledge of just how women are screened for cervical cancer was significantly associated with reduced uptake of cervical cancer screening (OR: 0.53; CI 0.38-0.73) as was fear that screening would reveal a cancer (OR 0.70; CI 0.63-0.77), and reliance on prayer with the onset of illness (OR 0.43; CI 0.26-0.71). Participants who thought that one should get cervical cancer screening even if there were no symptoms were more than twice as likely to accept cervical cancer screening (OR 2.21; 95% CI 1.24-3.93). Older patients, patients living with HIV and women who do not know if bleeding immediately after sex might be a sign of cervical cancer were also more likely to accept screening (OR 1.03, CI 1.02-1.04; OR 1.78, CI 1.01-3.14; OR 2.39, CI 1.31-4.39, respectively). CONCLUSIONS:In our population, a high percent of women knew that it is appropriate for all women to get cervical cancer screening, but only a small proportion of women actually got screening. There may be an opportunity to design educational materials for this population that will not only encourage participation in cervical cancer screening but also remediate misconceptions. The discussion illustrates how our findings could be used in such an effort.
- Published
- 2016
- Full Text
- View/download PDF
28. CD4 trajectory adjusting for dropout among HIV‐positive patients receiving combination antiretroviral therapy in an East African HIV care centre
- Author
-
Agnes N Kiragga, Judith J Lok, Beverly S Musick, Ronald J Bosch, Ann Mwangi, Kara K Wools‐Kaloustian, Constantin T Yiannoutsos, and for the East Africa IeDEA Regional Consortium
- Subjects
HIV/AIDS ,IPCW ,Resource‐limited setting ,CD4 count ,Mathematical modeling ,sub‐Saharan Africa ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Objective Estimates of CD4 response to antiretroviral therapy (ART) obtained by averaging data from patients in care, overestimate population CD4 response and treatment program effectiveness because they do not consider data from patients who are deceased or not in care. We use mathematical methods to assess and adjust for this bias based on patient characteristics. Design We examined data from 25,261 HIV‐positive patients from the East Africa IeDEA Consortium. Methods We used inverse probability of censoring weighting (IPCW) to represent patients not in care by patients in care with similar characteristics. We address two questions: What would the median CD4 be “had everyone starting ART remained on observation?” and “were everyone starting ART maintained on treatment?” Results Routine CD4 count estimates were higher than adjusted estimates even under the best‐case scenario of maintaining all patients on treatment. Two years after starting ART, differences between estimates diverged from 30 cells/µL, assuming similar mortality and treatment access among dropouts as patients in care, to over 100 cells/µL assuming 20% lower survival and 50% lower treatment access among dropouts. When considering only patients in care, the proportion of patients with CD4 above 350 cells/µL was 50% adjusted to below 30% when accounting for patients not in care. One‐year mortality diverged 6–14% from the naïve estimates depending on assumptions about access to care among lost patients. Conclusions Ignoring mortality and loss to care results in over‐estimation of ART response for patients starting treatment and exaggerates the efficacy of treatment programs administering it.
- Published
- 2014
- Full Text
- View/download PDF
29. A cross-sectional study of disclosure of HIV status to children and adolescents in western Kenya.
- Author
-
Rachel C Vreeman, Michael L Scanlon, Ann Mwangi, Matthew Turissini, Samuel O Ayaya, Constance Tenge, and Winstone M Nyandiko
- Subjects
Medicine ,Science - Abstract
Disclosure of HIV status to children is essential for disease management but is not well characterized in resource-limited settings. This study aimed to describe the prevalence of disclosure and associated factors among a cohort of HIV-infected children and adolescents in Kenya.We conducted a cross-sectional study, randomly sampling HIV-infected children ages 6-14 years attending 4 HIV clinics in western Kenya. Data were collected from questionnaires administered by clinicians to children and their caregivers, supplemented with chart review. Descriptive statistics and disclosure prevalence were calculated. Univariate analyses and multivariate logistic regression were performed to assess the association between disclosure and key child-level demographic, clinical and psychosocial characteristics.Among 792 caregiver-child dyads, mean age of the children was 9.7 years (SD = 2.6) and 51% were female. Prevalence of disclosure was 26% and varied significantly by age; while 62% of 14-year-olds knew their status, only 42% of 11-year-olds and 21% of 8-year-olds knew. In multivariate regression, older age (OR 1.49, 95%CI 1.35-1.63), taking antiretroviral drugs (OR 2.27, 95%CI 1.29-3.97), and caregiver-reported depression symptoms (OR 2.63, 95%CI 1.12-6.20) were significantly associated with knowing one's status. Treatment site was associated with disclosure for children attending one of the rural clinics compared to the urban clinic (OR 3.44, 95%CI 1.75-6.76).Few HIV-infected children in Kenya know their HIV status. The likelihood of disclosure is associated with clinical and psychosocial factors. More data are needed on the process of disclosure and its impact on children.
- Published
- 2014
- Full Text
- View/download PDF
30. Safety and immunogenicity of an Ad26.ZEBOV booster vaccine in Human Immunodeficiency Virus positive (HIV+) adults previously vaccinated with the Ad26.ZEBOV, MVA-BN-Filo vaccine regimen against Ebola: A single-arm, open-label Phase II clinical trial in Kenya and Uganda
- Author
-
Man-Lik Choi, Edward, Abu-Baker Mustapher, Ggayi, Omosa-Manyonyi, Gloria, Foster, Julie, Anywaine, Zacchaeus, Musila Mutua, Michael, Ayieko, Philip, Vudriko, Tobias, Ann Mwangi, Irene, Njie, Yusupha, Ayoub, Kakande, Mundia Muriuki, Moses, Kasonia, Kambale, Edward Connor, Nicholas, Florence, Nambaziira, Manno, Daniela, Katwere, Michael, McLean, Chelsea, Gaddah, Auguste, Luhn, Kerstin, Lowe, Brett, Greenwood, Brian, Robinson, Cynthia, Anzala, Omu, Kaleebu, Pontiano, and Watson-Jones, Deborah
- Published
- 2023
- Full Text
- View/download PDF
31. Inference for BART with Multinomial Outcomes.
- Author
-
Yizhen Xu, Joseph W. Hogan, Michael J. Daniels, Rami Kantor, and Ann Mwangi
- Published
- 2021
32. Personality traits and substance use among college students in Eldoret, Kenya
- Author
-
Kinyanjui, Daniel Waiganjo, primary and Sum, Ann Mwangi, additional
- Published
- 2023
- Full Text
- View/download PDF
33. Impact of an Enhanced Patient Care Intervention on Viral Suppression Among Patients Living With HIV in Kenya
- Author
-
Juddy Wachira, Becky Genberg, Ann Mwangi, Diana Chemutai, Paula Braitstein, Omar Galarraga, Abraham Siika, and Ira Wilson
- Subjects
Infectious Diseases ,Humans ,HIV Infections ,Pharmacology (medical) ,Patient Care ,Viral Load ,Ambulatory Care Facilities ,Delivery of Health Care ,Kenya - Abstract
Effective patient-centered interventions are needed to promote patient engagement in HIV care. We assessed the impact of a patient-centered intervention referred to as enhanced patient care (EPC) on viral suppression among unsuppressed patients living with HIV in Kenya.Two rural HIV clinics within the Academic Model Providing Access to Health care.This was a 6-month pilot randomized control trial. The EPC intervention incorporated continuity of clinician-patient relationships, enhanced treatment dialog, and improved patients' clinic appointment scheduling. Provider-patient communication training was offered to all clinicians in the intervention site. We targeted 360 virally unsuppressed patients: (1) 240 in the intervention site with 120 randomly assigned to provider-patient communication (PPC) training + EPC and 120 to PPC training + standard of care (SOC) and (2) 120 in the control site receiving SOC. Logistic regression analysis was applied using R (version 3.6.3).A total of 328 patients were enrolled: 110 (92%) PPC training + EPC, 110 (92%) PPC training + SOC, and 108 (90%) SOC. Participants' mean age at baseline was 48 years (SD: 12.05 years). Viral suppression 6 months postintervention was 84.4% among those in PPC training + EPC, 83.7% in PPC training + SOC, and 64.4% in SOC ( P ≤ 0.001). Compared with participants in PPC training + EPC, those in SOC had lower odds of being virally suppressed 6 months postintervention (odds ratio = 0.36, 95% confidence interval: 0.18 to 0.72).PPC training may have had the greatest impact on patient viral suppression. Hence, adequate training and effective PPC implementation strategies are needed.
- Published
- 2022
34. Continuity of Care is Associated with Higher Appointment Adherence Among HIV Patients in Low Clinician-to-Patient Ratio Facilities in Western Kenya
- Author
-
Juddy Wachira, Ann Mwangi, Becky Genberg, Anthony Ngeresa, Omar Galárraga, Sylvester Kimayo, Jonathan Dick, Paula Braitstein, Ira Wilson, and Joseph Hogan
- Subjects
Appointments and Schedules ,Infectious Diseases ,Social Psychology ,Public Health, Environmental and Occupational Health ,Humans ,HIV Infections ,Continuity of Patient Care ,Kenya ,Retrospective Studies - Abstract
We sought to determine the relationship between continuity of care and adherence to clinic appointments among patients receiving HIV care in high vs. low clinician-to-patient (C:P) ratios facilities in western Kenya. This retrospective analysis included 12,751 patients receiving HIV care from the Academic Model Providing Access to Healthcare (AMPATH) program, between February 2016-2019. We used logistic regression analysis with generalized estimating equations to estimate the relationship between continuity of care (two consecutive visits with the same provider) and adherence to clinic appointments (within 7 days of a scheduled appointment) over time. Adjusting for covariates, patients in low C:P ratio facilities who had continuity of care, were more likely to be adherent to their appointments compared to those without continuity (adjusted odds ratio = 1.50; 95% confidence interval, 1.33-1.69). Continuity in HIV care may be a factor in clinical adherence among patients in low C:P ratio facilities and should therefore be promoted.
- Published
- 2022
35. Classification using Ensemble Learning under Weighted Misclassification Loss.
- Author
-
Yizhen Xu, Tao Liu, Michael J. Daniels, Rami Kantor, Ann Mwangi, and Joseph W. Hogan
- Published
- 2018
36. Incorporating respondent-driven sampling into web-based discrete choice experiments: preferences for COVID-19 mitigation measures
- Author
-
Courtney A. Johnson, Dan N. Tran, Ann Mwangi, Sandra G. Sosa-Rubí, Carlos Chivardi, Martín Romero-Martínez, Sonak Pastakia, Elisha Robinson, Larissa Jennings Mayo-Wilson, and Omar Galárraga
- Subjects
Nonpharmaceutical interventions ,Discrete choice experiment ,Health Policy ,Public Health, Environmental and Occupational Health ,COVID-19 ,Respondent driven sampling ,Article - Abstract
To slow the spread of COVID-19, most countries implemented stay-at-home orders, social distancing, and other nonpharmaceutical mitigation strategies. To understand individual preferences for mitigation strategies, we piloted a web-based Respondent Driven Sampling (RDS) approach to recruit participants from four universities in three countries to complete a computer-based Discrete Choice Experiment (DCE). Use of these methods, in combination, can serve to increase the external validity of a study by enabling recruitment of populations underrepresented in sampling frames, thus allowing preference results to be more generalizable to targeted subpopulations. A total of 99 students or staff members were invited to complete the survey, of which 72% started the survey (n = 71). Sixty-three participants (89% of starters) completed all tasks in the DCE. A rank-ordered mixed logit model was used to estimate preferences for COVID-19 nonpharmaceutical mitigation strategies. The model estimates indicated that participants preferred mitigation strategies that resulted in lower COVID-19 risk (i.e. sheltering-in-place more days a week), financial compensation from the government, fewer health (mental and physical) problems, and fewer financial problems. The high response rate and survey engagement provide proof of concept that RDS and DCE can be implemented as web-based applications, with the potential for scale up to produce nationally-representative preference estimates.
- Published
- 2022
37. Development, Assessment, and Outcomes of a Community-Based Model of Antiretroviral Care in Western Kenya Through a Cluster-Randomized Control Trial
- Author
-
Cathy Toroitich-Ruto, Violet Naanyu, Monicah Nyambura, Thomas J. Spira, Constantin T. Yiannoutsos, Boaz Otieno-Nyunya, Kara Wools-Kaloustian, Abraham Siika, Ann Mwangi, Suzanne Goodrich, and Moses Bateganya
- Subjects
Adult ,Male ,medicine.medical_specialty ,Anti-HIV Agents ,MEDLINE ,Stigma (botany) ,HIV Infections ,030312 virology ,03 medical and health sciences ,symbols.namesake ,Intervention (counseling) ,Health care ,Humans ,Medicine ,Pharmacology (medical) ,Community Health Services ,Cluster randomised controlled trial ,Fisher's exact test ,Implementation Science ,0303 health sciences ,Pregnancy ,business.industry ,Standard of Care ,Middle Aged ,Patient Acceptance of Health Care ,Viral Load ,medicine.disease ,Kenya ,CD4 Lymphocyte Count ,Treatment Outcome ,Infectious Diseases ,Family medicine ,symbols ,Female ,business ,Viral load - Abstract
OBJECTIVE To develop and assess an alternative care model using community-based groups for people living with HIV and facilitate by lay personnel. METHODS Geographic locations in the Academic Model Providing Access to Healthcare Kitale clinic catchment were randomized to standard of care versus a community-based care group (ART Co-op). Adults stable on antiretroviral therapy and virally suppressed were eligible. Research Assistant-led ART Co-ops met in the community every 3 months. Participants were seen in the HIV clinic only if referred. CD4 count and viral load were measured in clinic at enrollment and after 12 months. Retention, viral suppression, and clinic utilization were compared between groups using χ2, Fisher exact, and Wilcoxon rank sum tests. RESULTS At 12 months, there were no significant differences in mean CD4 count or viral load suppression. There was a significant difference in patient retention in assigned study group between the intervention and control group (81.6% vs 98.6%; P < 0.001), with a number of intervention patients withdrawing because of stigma, relocation, pregnancy, and work conflicts. All participants, however, were retained in an HIV care program for the study duration. The median number of clinic visits was lower for the intervention group than that for the control group (0 vs 3; P < 0.001). CONCLUSIONS Individuals retained in a community-based HIV care model had clinical outcomes equivalent to those receiving clinic-based care. This innovative model of HIV care addresses the problems of insufficient health care personnel and patient retention barriers, including time, distance, and cost to attend clinic, and has the potential for wider implementation.
- Published
- 2021
38. Assessment of hepatitis B vaccination status and hepatitis B surface antibody titres among health care workers in selected public health hospitals in Kenya
- Author
-
Irene Ann Mwangi, Jesca O. Wesongah, Victor Moses Musyoki, Gloria S. Omosa-Manyonyi, Bashir Farah, Laura Gwahalla Edalia, and Margaret Mbuchi
- Abstract
Healthcare workers (HCWs) have a significant occupational risk of hepatitis B virus (HBV) infection. Vaccination remains the most effective measure recommended to avert the risk. However, there’s limited information on hepatitis B vaccine uptake rates and the seroprotection status of HCWs, especially in sub-Saharan Africa. This study aimed to assess hepatitis B vaccination status and also seroprotection status of HCWs in three selected public hospitals in Kenya. This was a cross-sectional study carried out among HCWs at Kenyatta National Hospital (KNH), Naivasha and Mbagathi County hospitals. Data on participants’ demographics and hepatitis B vaccination status was collected using an interviewer-guided questionnaire. Blood samples were collected and tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibodies (anti–HBs), and hepatitis B core antibodies (anti–HBc) using Enzyme Linked Immuno Sorbent Assay technique. Data were analyzed using Statistical Package for the Social Sciences (SPSS) and Graph pad prism. Of the 145 eligible HCWs, 120 (82.8%) were vaccinated, with 77 (53.1%) having received the recommended three doses. Three quarters (108/145) of the vaccinated HCWs were seroprotected (titres ≥10 mIU/ml) against HBV infection, while 16.6% were non–responders (titres PP = 0.013). Nearly all HCWs were vaccinated against hepatitis B virus. The majority of all HCWs were seroprotected against hepatitis B virus but a number of them had an insufficient immunity to the virus despite vaccination or prior exposure. There’s need to sensitize HCWs and enforce mandatory full vaccination as per the recommended vaccination schedule.
- Published
- 2023
39. A pseudo‐likelihood method for estimating misclassification probabilities in competing‐risks settings when true‐event data are partially observed
- Author
-
Constantin T. Yiannoutsos, Giorgos Bakoyannis, Philani Mpofu, M. W. K. Mburu, and Ann Mwangi
- Subjects
Adult ,Male ,Statistics and Probability ,Adolescent ,Computer science ,Sample (statistics) ,01 natural sciences ,Article ,Young Adult ,010104 statistics & probability ,03 medical and health sciences ,0302 clinical medicine ,Bias ,Consistency (statistics) ,Outcome Assessment, Health Care ,Statistics ,Humans ,030212 general & internal medicine ,0101 mathematics ,Information bias ,Aged ,Probability ,Aged, 80 and over ,Estimation ,Likelihood Functions ,Incidence ,Estimator ,General Medicine ,Variance (accounting) ,Middle Aged ,Missing data ,Outcome (probability) ,Research Design ,Female ,Statistics, Probability and Uncertainty - Abstract
Outcome misclassification occurs frequently in binary-outcome studies and can result in biased estimation of quantities such as the incidence, prevalence, cause-specific hazards, cumulative incidence functions, and so forth. A number of remedies have been proposed to address the potential misclassification of the outcomes in such data. The majority of these remedies lie in the estimation of misclassification probabilities, which are in turn used to adjust analyses for outcome misclassification. A number of authors advocate using a gold-standard procedure on a sample internal to the study to learn about the extent of the misclassification. With this type of internal validation, the problem of quantifying the misclassification also becomes a missing data problem as, by design, the true outcomes are only ascertained on a subset of the entire study sample. Although, the process of estimating misclassification probabilities appears simple conceptually, the estimation methods proposed so far have several methodological and practical shortcomings. Most methods rely on missing outcome data to be missing completely at random (MCAR), a rather stringent assumption which is unlikely to hold in practice. Some of the existing methods also tend to be computationally-intensive. To address these issues, we propose a computationally-efficient, easy-to-implement, pseudo-likelihood estimator of the misclassification probabilities under a missing at random (MAR) assumption, in studies with an available internal-validation sample. We present the estimator through the lens of studies with competing-risks outcomes, though the estimator extends beyond this setting. We describe the consistency and asymptotic distributional properties of the resulting estimator, and derive a closed-form estimator of its variance. The finite-sample performance of this estimator is evaluated via simulations. Using data from a real-world study with competing-risks outcomes, we illustrate how the proposed method can be used to estimate misclassification probabilities. We also show how the estimated misclassification probabilities can be used in an external study to adjust for possible misclassification bias when modeling cumulative incidence functions.
- Published
- 2020
40. Hypertension Control and Retention in Care Among HIV-Infected Patients: The Effects of Co-located HIV and Chronic Noncommunicable Disease Care
- Author
-
Ann Mwangi, Brianna Osetinsky, Edwin Sang, Becky L. Genberg, Mark N. Lurie, Sonak D. Pastakia, Omar Galárraga, Gerald S. Bloomfield, Anthony Ngressa, Joseph W. Hogan, and Stephen T. McGarvey
- Subjects
Adult ,Male ,medicine.medical_specialty ,MEDLINE ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Article ,Medication Adherence ,Internal medicine ,Retention in Care ,medicine ,Humans ,Hiv infected patients ,Pharmacology (medical) ,Disease management (health) ,Noncommunicable Diseases ,Retrospective Studies ,Hypertension control ,business.industry ,Disease Management ,Retrospective cohort study ,Middle Aged ,Retention in care ,Infectious Diseases ,Noncommunicable disease ,Hypertension ,Female ,business - Abstract
BACKGROUND: As the non-communicable disease (NCD) burden is rising in regions with high HIV prevalence, patients with comorbid HIV and chronic NCDs may benefit from integrated chronic disease care. There are few evaluations of the effectiveness of such strategies, especially those that directly leverage and extend the existing HIV care system to provide co-located care for NCDs. SETTING: Academic Model of Providing Access to Healthcare (AMPATH), Kenya, provides care to over 160,000 actively enrolled patients in catchment area of 4 million people. METHODS: Using a difference-in-differences design, we analyzed retrospective clinical records of 3603 patients with comorbid HIV and hypertension during 2009–2016 to evaluate the addition of chronic disease management (CDM) to an existing HIV care program. Outcomes were blood pressure (BP), hypertension control, and adherence to HIV care. RESULTS: Compared to the HIV standard of care, the addition of CDM produced statistically significant, though clinically small improvements in hypertension control, decreasing systolic BP by 0.76mmHg (p1 year improved by 7 percentage points (p6months increased by 10.5 percentage points (p
- Published
- 2019
41. Contraception use and HIV outcomes among women initiating dolutegravir-containing antiretroviral therapy in Kenya: a retrospective cohort study
- Author
-
John M. Humphrey, Victor Omodi, Caitlin Bernard, Mercy Maina, Julie Thorne, Ann Mwangi, Kara Wools‐Kaloustian, and Rena C. Patel
- Subjects
Adult ,Male ,Infectious Diseases ,Contraception ,Anti-Retroviral Agents ,Public Health, Environmental and Occupational Health ,Humans ,Reverse Transcriptase Inhibitors ,Female ,HIV Infections ,Kenya ,Heterocyclic Compounds, 3-Ring ,Retrospective Studies - Abstract
The rollout of dolutegravir (DTG) in low- and middle-income countries was disrupted by a potential association reported with periconceptional DTG exposure among women living with HIV (WLHIV) and infant neural tube defects. This prompted countries to issue interim guidance limiting DTG use among women of reproductive potential to those on effective contraception. Data to understand the potential impact of such guidance on WLHIV are limited.We conducted a retrospective cohort analysis of WLHIV 15-49 years initiating DTG-containing antiretroviral treatment (ART) in Kenya from 2017 to 2020. We determined baseline effective (oral, injectable or lactational amenorrhea) and very effective (implant, intrauterine device or female sterilization) contraception use among women who initiated DTG before (Group 1) or during (Group 2) the interim guideline period. We defined incident contraception use in each group as the number of contraceptive methods initiated ≤180 days post-guideline (Group 1) or post-DTG initiation (Group 2). We determined the proportions of all women who switched from DTG- to non-nucleoside reverse transcriptase inhibitor (NNRTI)- (efavirenz or nevirapine) containing ART ≤12 months post-DTG initiation, compared their viral suppression (1000 copies/ml) and conducted multivariable logistic regression to determine factors associated with switching from DTG to NNRTI-containing ART.Among 5155 WLHIV in the analysis (median age 43 years), 89% initiated DTG after transitioning from an NNRTI. Baseline effective and very effective contraception use, respectively, by the group were: Group 1 (12% and 13%) and Group 2 (41% and 35%). Incident contraception use in each group was5%. Overall, 498 (10%) women switched from DTG to an NNRTI. Viral suppression among those remaining on DTG versus switched to NNRTI was 95% and 96%, respectively (p = 0.63). In multivariable analysis, incident effective and very effective contraception use was not associated with switching.Baseline, but not incident, effective contraception use was higher during the interim guideline period compared to before it, suggesting women already using effective contraception were preferentially selected to initiate DTG after the guideline was released. These findings reveal challenges in the implementation of policy which ties antiretroviral access to contraceptive use. Future guidance should capture nuances of contraception decision-making and support women's agency to make informed decisions.
- Published
- 2021
42. Harmful Alcohol Use Among Healthcare Workers at the Beginning of the COVID-19 Pandemic in Kenya
- Author
-
Thomas S. Mwogi, Kirtika Patel, Florence Jaguga, Lukoye Atwoli, Robert Kiptoo, Ann Mwangi, and Edith Kwobah
- Subjects
Psychiatry and Mental health ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Environmental health ,Pandemic ,Health care ,Medicine ,business - Abstract
BackgroundHealthcare workers play a key role in responding to pandemics like the on-going COVID-19 one. Harmful alcohol use among them could result in inefficiencies in health service delivery. This is particularly concerning in sub-Saharan Africa where the health workforce is already constrained. The aim of this study is to document the burden and correlates of harmful alcohol use among healthcare workers at the beginning of the COVID-19 pandemic in Kenya with the aim of informing policy and practice.MethodsThis study was a cross-sectional analysis of data obtained from a parent online survey that investigated the burden and factors associated with mental disorders among healthcare workers during the COVID-19 pandemic in Kenya. We analyzed data obtained from a sub-population of 887 participants who completed the Alcohol Use Disorder Identification Test questionnaire. We used descriptive statistics to summarize the socio-demographic characteristics of the participants and multivariate analysis to determine the factors associated with harmful alcohol use.ResultsThree hundred and eighty nine (43.9%) participants reported harmful alcohol use. The factors significantly associated with increased odds of endorsing harmful alcohol use were: being male (AOR = 1.56; 95% CI = 1.14, 2.14; p = 0.006), being unmarried (AOR = 2.06; 95% CI = 1.48, 2.89; p < 0.001), having 11-20 years of experience as compared to having 20+ years of experience (AOR = 1.91; 95% CI = 1.18, 3.12; p = 0.009), and being a specialist (AOR = 2.78; CI = 1.64, 4.78; p = < 0.001) or doctor (AOR = 2.82; 95% CI = 1.74, 4.63; p < 0.001) as compared to being a nurse.ConclusionsA high proportion of healthcare workers reported harmful alcohol use at the beginning of the COVID-19 pandemic in Kenya. Males, the unmarried, those with 11–20 years of experience in the health field, doctors and specialists, were more likely to report harmful alcohol use. These findings highlight the need to institute interventions for harmful alcohol use targeting these groups of healthcare workers in Kenya during the COVID-19 pandemic in order to optimize functioning of the available workforce.
- Published
- 2021
43. Higher Clinician-Patient Communication Is Associated With Greater Satisfaction With HIV Care
- Author
-
Becky L. Genberg, Diana Chemutai, Juddy Wachira, Monica Nyambura, Ann Mwangi, and Ira B. Wilson
- Subjects
Adult ,medicine.medical_specialty ,Immunology ,Human immunodeficiency virus (HIV) ,HIV Infections ,unsuppressed patients ,Personal Satisfaction ,Dermatology ,medicine.disease_cause ,Logistic regression ,behavioral disciplines and activities ,provider-patient communication skills ,Odds ,Patient satisfaction ,Humans ,Medicine ,Original Research Article ,business.industry ,Communication ,Odds ratio ,Middle Aged ,Diseases of the genitourinary system. Urology ,Regimen ,Cross-Sectional Studies ,Infectious Diseases ,Patient Satisfaction ,Family medicine ,Patient communication ,RC870-923 ,HIV care ,business ,Viral load - Abstract
Provider-patient communication (PPC) skills are key in promoting patient satisfaction. Our study examined the relationship between clinician PPC skills and patient satisfaction with care among virally unsuppressed adult HIV patients in Busia County, Kenya. This cross-sectional study was conducted among 360 HIV patients on first line antiretroviral regimen and having a recent viral load ≥400 copies HIV RNA/ml. We conducted logistic regression analysis. The mean age of participants was 48.2 years [standard deviation (SD): 12.05]. Overall, the mean score on clinician PPC skills was 33.3 (SD: 9.0). A high proportion (85%) of participants reported satisfaction with the HIV care services. After adjusting for covariates, the odds of being satisfied with care increased by 19% (adjusted odds ratio: 1.19, 95% CI: 1.11-1.30) for every one unit increase in the clinician PPC skills score. Promoting good PPC skills may be key to improving patient satisfaction with HIV care.
- Published
- 2021
44. Cryotherapy and LEEP are Effective Treatment for CIN Lesions in HIV+ and HIV- Women in Western Kenya
- Author
-
Omenge Orang'o, Naaman Mehta, Ann Mwangi, Victor Omodi, Tao Liu, Edwin Sang, Philip Tonui, Peter Itsura, Kapten Muthoka, Stephen Kiptoo, Patrick Loehrer, and Susan Cu-Uvin
- Subjects
Obstetrics and Gynecology - Published
- 2022
45. Mental Disorders Among Health Care Workers at the Early Phase of COVID-19 Pandemic in Kenya; Findings of an Online Descriptive Survey
- Author
-
Ann Mwangi, Thomas S. Mwogi, Kirtika Patel, Lukoye Atwoli, Robert Kiptoo, and Edith Kwobah
- Subjects
Generalized anxiety disorder ,prevalence ,RC435-571 ,Psychological intervention ,health care workers ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Medicine ,030212 general & internal medicine ,Depression (differential diagnoses) ,Original Research ,Psychiatry ,business.industry ,Traumatic stress ,COVID-19 ,Mental illness ,medicine.disease ,Kenya ,Mental health ,mental disorders ,Psychiatry and Mental health ,business ,Psychosocial ,030217 neurology & neurosurgery ,Demography - Abstract
Background: Healthcare workers responding to the Corona Virus Pandemic (COVID-19) are at risk of mental illness. Data is scanty on the burden of mental disorders among Kenyan healthcare workers responding to the pandemic that can inform mental health and psychosocial support. The purpose of this study was to establish the frequency and associated factors of worry, generalized anxiety disorder, depression, posttraumatic stress disorder and poor quality of sleep among Kenyan health care workers at the beginning of COVID-19 pandemic.Methods: We conducted an online survey among 1,259 health care workers in Kenya. A researcher developed social demographic questionnaire and several standardized tools were used for data collection. Standardized tools were programmed into Redcap, (Research Electronic Data Capture) and data analysis was performed using R Core Team. In all analysis a p-value < 0.05 was considered significant.Results: 66% of the participants reported experiencing worry related to COVID-19. 32.1% had depression, 36% had generalized anxiety, 24.2% had insomnia and 64.7% scored positively for probable Post Traumatic Stress Disorder (PTSD). Depression was higher among females compared to men (36.5 vs. 26.9%, p = 0.003), workers p < 0.001), and those who were not married compared to those who were married (40.6 vs. 27.6%, p < 0.001). Generalized anxiety was commoner among workers aged p < 0.001), females (41.7 vs. 29.2%, p < 0.001), those who mere not married compared to the married (45.2 vs. 31.2%, p < 0.001) and those with p < 0.001). Younger health care professional had a higher proportion of insomnia compared to the older ones (30.3 vs. 18.6%, p < 0.001). Insomnia was higher among those with p = 0.043)Conclusion: Many Kenyan healthcare workers in the early phase of COVID-19 pandemic suffered from various common mental disorders with young, female professionals who are not married bearing the bigger burden. This data is useful in informing interventions to promote mental and psychosocial wellbeing among Kenyan healthcare workers responding to the pandemic.
- Published
- 2021
46. Anthropometric measurements as predictors of hypertension in Busia, Vihiga, Trans Nzoia and Siaya counties of Western Kenya
- Author
-
Mwaura Gw, Andale T, Jemima H. Kamano, Richard Mugo, Lwande Go, Limo Ok, Ann Mwangi, and Orango
- Subjects
Waist-to-height ratio ,Waist ,Receiver operating characteristic ,business.industry ,Medicine ,Community survey ,Anthropometry ,Logistic regression ,business ,Socioeconomic status ,Body mass index ,Demography - Abstract
Emerging data suggest a rise in the incidence rate of hypertension in many countries within Sub-Saharan Africa. This has been attributed to socioeconomic factors that have influenced diet and reduced physical activity further deranging anthropometric measurements. We assessed the predictive power of three anthropometric indicators namely: waist circumference (WC), waist to height ratio (WHtR) and body mass index (BMI) in detecting hypertension. This cross-sectional community survey was conducted in four counties within Western Kenya between October 2018 to April 2019 among 3594 adults. The participants’ sociodemographic data were collected using an interviewer-administered questionnaire and anthropometric measurements taken. We used the R-software for descriptive and inferential statistical analysis. Pearson chi-square test was used to assess the association between anthropometric measurements and hypertension while logistic regressions estimated the likelihood of hypertension. Youden method was used to identify optimal anthropometric cut-offs for sensitivity, specificity and area under the receiver operating characteristics (ROC) curve computation. The crude prevalence of hypertension was 23.3%, however it rose with advancement in age. Furthermore, obese individuals had a three-fold (AOR=2.64; 95% CI: 2.09, 3.35) increased likelihood of hypertension compared to those with a normal BMI. The optimal WC cut-off was 82.5cm for men and 87cm for women, an optimal WHtR of 0.47 for men and 0.55 for women; while the optimal BMI cut-off was 23.7 kg/m2 and 22.6 kg/m2 for men and women respectively. The sensitivity of WC, WHtR and BMI for men was 0.60, 0.65 and 0.39 respectively and 0.71, 0.65 and 0.78 respectively for women. BMI is the best predictor for hypertension among women but a poor predictor for men; WC had a high hypertension predictive power for both gender while WHtR is the best hypertension predictor for men.
- Published
- 2021
47. Awareness, Uptake and factors associated with NHIF uptake in Western Kenya: A case of 4 counties - Busia, Trans Nzoia, Vihiga and Siaya
- Author
-
Joseph Kibachio, Jemima H. Kamano, Wilson Aruasa, Ann Mwangi, Peter Itsura, Gladwell Gathecha, Thomas Andale, Lilian Lusimbo, Grace Wandia Mwaura, Kenneth Too, and Richard Mugo
- Subjects
Business ,Socioeconomics - Abstract
Background Kenya is in the process of implementing universal health care whose success and sustainability will be determined by its funding mechanism and by uptake of National Hospital Insurance Fund (NHIF) by its populace. Unfortunately, NHIF enrollment is currently voluntary hence geared to those in formal employment who represent only 16.4% of the population. To improve the voluntary uptake of the scheme, it is important to have increased awareness as well as implement strategies that address factors that currently affect NHIF uptake. Methods This was a cross sectional community-based survey conducted in Busia, Trans Nzoia, Vihiga and Siaya counties between October and December 2018. It utilized multistage stratified sampling technique. Interviewer assisted questionnaires were used to collect socio-demographic, socio-economic, Non-Communicable Diseases (NCD) knowledge, NHIF awareness and uptake data. Descriptive statistical analysis and multiple logistic regression were conducted using STATA version 15. Results Out of a representative sample of 3597 participants interviewed, NHIF awareness was noted to be 81.5%, with low uptake in the four counties ranging between 21–25%. Being older than 69 years, having a low level of education and income status as well as lower health risk were significantly associated with low rates of NHIF uptake. Conclusion Despite high rates of NHIF awareness noted in this study, there is still very low uptake to this scheme in rural western Kenya especially among those with low socioeconomic status and risk of chronic illnesses. There is need for further qualitative studies to explore contextual factors affecting NHIF uptake.
- Published
- 2021
48. Network characteristics of a referral system for patients with hypertension in Western Kenya: results from the Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) study
- Author
-
Aarti Thakkar, Thomas Valente, Josephine Andesia, Benson Njuguna, Juliet Miheso, Tim Mercer, Richard Mugo, Ann Mwangi, Eunice Mwangi, Sonak D. Pastakia, Shravani Pathak, Mc Kinsey M. Pillsbury, Jemima Kamano, Violet Naanyu, Makeda Williams, Rajesh Vedanthan, Constantine Akwanalo, and Gerald S. Bloomfield
- Subjects
Government Programs ,Male ,Medical Assistance ,Health Policy ,Hypertension ,Humans ,Kenya ,Referral and Consultation - Abstract
Background Health system approaches to improve hypertension control require an effective referral network. A national referral strategy exists in Kenya; however, a number of barriers to referral completion persist. This paper is a baseline assessment of a hypertension referral network for a cluster-randomized trial to improve hypertension control and reduce cardiovascular disease risk. Methods We used sociometric network analysis to understand the relationships between providers within a network of nine geographic clusters in western Kenya, including primary, secondary, and tertiary care facilities. We conducted a survey which asked providers to nominate individuals and facilities to which they refer patients with controlled and uncontrolled hypertension. Degree centrality measures were used to identify providers in prominent positions, while mixed-effect regression models were used to determine provider characteristics related to the likelihood of receiving referrals. We calculated core-periphery correlation scores (CP) for each cluster (ideal CP score = 1.0). Results We surveyed 152 providers (physicians, nurses, medical officers, and clinical officers), range 10–36 per cluster. Median number of hypertensive patients seen per month was 40 (range 1–600). While 97% of providers reported referring patients up to a more specialized health facility, only 55% reported referring down to lower level facilities. Individuals were more likely to receive a referral if they had higher level of training, worked at a higher level facility, were male, or had more job experience. CP scores for provider networks range from 0.335 to 0.693, while the CP scores for the facility networks range from 0.707 to 0.949. Conclusions This analysis highlights several points of weakness in this referral network including cluster variability, poor provider linkages, and the lack of down referrals. Facility networks were stronger than provider networks. These shortcomings represent opportunities to focus interventions to improve referral networks for hypertension. Trial registration Trial Registered on ClinicalTrials.gov NCT03543787, June 1, 2018.
- Published
- 2021
49. Implementing enhanced patient care to promote patient engagement in HIV care in a rural setting in Kenya
- Author
-
Becky L. Genberg, Ann Mwangi, Omar Galárraga, Ira B. Wilson, Siika Abraham, Juddy Wachira, and Diana Chemutai
- Subjects
Rural Population ,Patient engagement ,Qualitative property ,Context (language use) ,HIV Infections ,Health informatics ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Health facility ,Nursing ,Intervention (counseling) ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Adaptation ,Qualitative Research ,business.industry ,030503 health policy & services ,Health Policy ,Nursing research ,Kenya ,Implementation ,Patient Care ,Public aspects of medicine ,RA1-1270 ,HIV care ,Patient Participation ,0305 other medical science ,business ,Research Article - Abstract
Background Patient engagement is effective in promoting adherence to HIV care. In an effort to promote patient-centered care, we implemented an enhanced patient care (EPC) intervention that addresses a combination of system-level barriers including provider training, continuity of clinician-patient relationship, enhanced treatment dialogue and better clinic scheduling. We describe the initial implementation of the EPC intervention in a rural HIV clinic in Kenya, and the factors that facilitated its implementation. Methods The intervention occurred in one of the rural Academic Model Providing Healthcare (AMPATHplus) health facilities in Busia County in the western region of Kenya. Both qualitative and quantitative data were collected through training and meeting proceedings/minutes, a patient tracking tool, treatment dialogue and a peer confirmation tool. Qualitative data were coded and emerging themes on the implementation and adaptation of the intervention were developed. Descriptive analysis including percentages and means were performed on the quantitative data. Results Our analysis identified four key factors that facilitated the implementation of this intervention. (1) The smooth integration of the intervention as part of care that was facilitated by provider training, biweekly meetings between the research and clinical team and having an intervention that promotes the health facility agenda. (2) Commitment of stakeholders including providers and patients to the intervention. (3) The adaptability of the intervention to the existing context while still maintaining fidelity to the intervention. (4) Embedding the intervention in a facility with adequate infrastructure to support its implementation. Conclusions This analysis demonstrates the value of using mixed methods approaches to study the implementation of an intervention. Our findings emphasize how critical local support, local infrastructure, and effective communication are to adapting a new intervention in a clinical care program.
- Published
- 2021
50. Evaluating a patient-centred intervention to increase disclosure and promote resilience for children living with HIV in Kenya
- Author
-
Joseph W. Hogan, Winstone M. Nyandiko, Samuel Ayaya, Carole I McAteer, Rachel Vreeman, Ann Mwangi, Josephine Aluoch, Irene Marete, Michael L. Scanlon, and Alfred Keter
- Subjects
Counseling ,Male ,0301 basic medicine ,Kenya ,medicine.medical_specialty ,Adolescent ,media_common.quotation_subject ,Immunology ,HIV Infections ,Truth Disclosure ,Ambulatory Care Facilities ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Patient-Centered Care ,Surveys and Questionnaires ,Intervention (counseling) ,Humans ,Immunology and Allergy ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Cultural Competency ,Child ,Prospective cohort study ,media_common ,Depression ,business.industry ,Resilience, Psychological ,Logistic Models ,030104 developmental biology ,Infectious Diseases ,Family medicine ,Female ,Psychological resilience ,business ,Cultural competence ,Patient centred - Abstract
We evaluated the impact of a patient-centred, culturally and age-appropriate disclosure counselling intervention on HIV disclosure rates among Kenyan children living with HIV.A prospective, clinic-cluster randomized trial.We followed 285 child-caregiver dyads (children ages 10-14 years) attending eight HIV clinics (randomized to intervention or control) in Kenya. Participants at intervention clinics received intensive counselling with trained disclosure counsellors and culturally tailored materials, compared with control clinics with standard care. Disclosure was treated as a time-to-event outcome, measured on a discrete time scale, with assessments at 0, 6, 12, 18 and 24 months. Mental health and behavioural outcomes were assessed using standardized questionnaires.Mean age was 12.3 years [standard deviation (SD) 1.5], 52% were girls, with average time-on-treatment of 4.5 years (SD 2.4). Between 0 and 6 months, disclosure prevalence increased from 47 to 58% in the control group and from 50 to 70% in the intervention group. Differences in disclosure were not sustained over the following 18 months. The prevalence of depression symptoms was significantly higher in the intervention than in the control group at 6 months (odds ratio 2.07, 95% confidence interval 1.01-4.25); however, there was no evidence that these differences were sustained after 6 months.The clinic-based intervention increased disclosure of HIV status to children living with HIV in the short-term, resulting in earlier disclosures, but had less clear impacts longer-term. Although well tailored interventions may support disclosure, children may still experience increased levels of depression symptoms immediately following disclosure.
- Published
- 2019
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.