Marshal Mutinda Mweu

Objective: To estimate the sensitivity (Se), specificity (Sp) and predictive values (negative and positive predictive values (NPV and PPV)) of the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS) as screening tools for antepartum depression (APD) among pregnant women attending antenatal care (ANC) in Kenya.Methods: This cross-sectional study enrolled pregnant women attending ANC at Mutuini Hospital, Nairobi County and Karatina Sub-County Hospital, Nyeri County between June and August 2020. Participants completed the PHQ-9 and EPDS alongside a sociodemographic questionnaire. A Bayesian latent class model was used to infer the tests’ accuracy along with their posterior credible intervals (PCI).Results: A total of 488 women were included in the analysis. At the optimal cut-off of ≥10, ≥9 (for PHQ-9 and EPDS, respectively) PHQ-9 recorded a Se of 82.7% (95% PCI: 71.3, 87.8) and Sp of 87.5% (95% PCI: 85.7, 88.0), while EPDS recorded a Se of 86.7% (95% PCI: 69.4, 98.5) and Sp of 87.7% (95% PCI: 86.5, 88.0). Both tests had statistically similar accuracy. They exhibited high NPVs but considerably low PPVs. Conclusions: The PHQ-9 and EPDS perform comparably and adequately as first-line APD screening tools in Kenyan ANC settings. Their use within a serial evaluation strategy (involving an initial step of screening all subjects with either of the tests followed by a confirmatory clinical assessment) should guide the identification of patients requiring therapy in this low-prevalence setting.

Background: Oesophageal carcinoma (OC) is a prominent cause of morbidity and mortality in low and middle-income countries yet little evidence exists about its contextual drivers. The objectives of this study were to assess the association between traditional fermented milk (FM) (mursik) consumption and OC independent of known socio-demographic and lifestyle risk factors as well as to quantify its population impact among patients presenting to two referral hospitals in Nandi County, Kenya. Methods: A hospital-based case-control study was employed to assess the FM-OC relationship among patients presenting to Kapsabet Surgical Care Centre and Kapsabet County Referral Hospital in Nandi County, Kenya for care between 23^rd November 2023 and 13^th January 2024. All 33 cases meeting specific eligibility criteria were prospectively recruited whilst 131 controls were simple randomly sampled and frequency-matched to the cases by hospital and day of presentation. A logistic regression model was fitted to assess the FM-OC association while adjusting for potential confounders. Subsequently, a population attributable fraction (PAF) for the association (along with its confidence interval) was estimated. Results: A strong association between FM and OC was noted; the odds of OC among frequent and infrequent consumers of FM being over nine (OR 9.1, 95% CI: 3.1–26.6) and three (OR 3.2, 95% CI: 1.1–9.2) times higher, respectively, than non-consumers. This association was not substantially confounded by the studied socio-demographic and lifestyle factors. The PAF estimate for this association was 65.2% (95% CI: 40.1–90.7). Conclusions: In this study setting, mursik consumption was strongly associated with OC independent of other risk factors. This association registered a high PAF suggesting that up to 65% of OC in the population could be prevented if mursik was not consumed. This finding calls for safe, community-owned alternatives for fermenting milk in order to mitigate the risk of OC in this population.

Uterine fibroids (UFs) precipitate significant morbidity in low and middle income countries, yet evidence on their contextual drivers remains scarce. The objective here was to assess the association between HR use and UFs independent of known risk factors as well as to quantify HR use impact in the population of women of reproductive age. A facility-based case control study was employed to assess the HR-UF association among 264 women presenting to the gynaecologic clinic within Kenyatta National Hospital between 23 ^rd October and 19 ^th December 2024. All cases were prospectively recruited while controls were simple randomly sampled from the clinic’s appointment schedule and frequency-matched to cases by day of presentation. A logistic regression model was used to evaluate the HR-UF association, adjusting for the effect of potential confounders. Thereafter, a population attributable fraction (PAF) (along with its confidence interval) was estimated. The odds of UFs among HR users was approximately five times higher than non-users (OR=5.12, 95% CI: 3.00-8.73, P <0.001). This relationship was not confounded by the studied covariates. The PAF estimate for the association was 59.2% (95% CI: 47.2-71.7) – suggesting that about three-fifths of UFs in this population could be prevented if HRs were not used. These findings call for more rigorous enforcement of existing legislations that regulate the supply and use of HRs in the country, with a view to safeguarding consumer health.

Despite extensive research on the risk factors for breast cancer, little is known about the factors contributing to other breast lesions, of which some pose an increased risk for this disease. The objective of this study was to identify the factors associated with breast lesions among women presenting to referral facilities in Kenya for care between December 2016 and December 2019. An analytical cross-sectional study design was used to investigate the factors associated with breast lesions among 651 women with breast lumps. Data was collected using a semi-structured questionnaire. A multivariable logistic regression model was used to evaluate the impact of the factors on the breast lesions. The median age of participants was 30 years (range: 16−87), with the majority having secondary education and belonging to the Kikuyu ethnic group. Parity, exercise, and contraceptive use were significant factors identified. Nulliparous women had significantly lower odds of developing malignant [aOR: 0.11; 95% CI: 0.05–0.26] and suspicious [aOR: 0.23; 95% CI: 0.07–0.71] lesions. Regular exercise was associated with lower odds of both malignant and suspicious lesions. Conversely, contraceptive use increased the odds of developing atypical [aOR: 0.92; 95% CI: 0.28–2.98] lesions, suspicious [aOR: 0.33; 95% CI: 0.14–0.78], and malignant lesions [aOR: 0.31; 95% CI: 0.18–0.55]. Exercise, parity, and hormonal contraception were independently found to be significant factors associated with breast lesions in this study. These findings underscore the necessity for personalized risk reduction strategies and emphasize the importance of understanding the risk factors for both benign and malignant breast disease to inform public health policies.

Background: Oesophageal carcinoma (OC) is a prominent cause of morbidity and mortality in low and middle-income countries yet little evidence exists about its contextual drivers. The objectives of this study were to assess the association between fermented milk (FM) ( mursik ) consumption and OC independent of known socio-demographic and lifestyle risk factors as well as to quantify its population impact among patients presenting to two referral hospitals in Nandi County, Kenya. Methods: A hospital-based case-control study was employed to assess the FM-OC relationship among patients presenting to Kapsabet Surgical Care Centre and Kapsabet County Referral Hospital in Nandi County, Kenya for care between 23 ^rd November 2023 and 13 ^th January 2024. All 33 cases meeting specific eligibility criteria were prospectively recruited whilst 131 controls were simple randomly sampled and frequency-matched to the cases by hospital and day of presentation. A logistic regression model was fitted to assess the FM-OC association while adjusting for potential confounders. Subsequently, a population attributable fraction (PAF) for the association (along with its confidence interval) was estimated. Results: A strong association between FM and OC was noted; the odds of OC among frequent and infrequent consumers of FM being over nine (OR 9.1, 95% CI: 3.1-26.6) and three (OR 3.2, 95% CI: 1.1-9.2) times higher, respectively, than non-consumers. This association was not substantially confounded by the studied socio-demographic and lifestyle factors. The PAF estimate for this association was 65.2% (95% CI: 40.1-90.7). Conclusions: In this study setting, FM consumption was strongly associated with OC independent of other risk factors. This association registered a high PAF suggesting that up to 65% of OC in the population could be prevented if FM was not consumed. This finding calls for safe, community-owned alternatives for fermenting milk in order to mitigate the risk of OC in this population.

Although the highlands of East Africa lack the geo-ecological landmarks of Rift Valley fever (RVF) disease hotspots to participate in cyclic RVF epidemics, they have recently reported growing numbers of small RVF clusters. Here, we investigated whether RVF cycling occurred among livestock and humans in the central highlands of Kenya during inter-epidemic periods. A 2-year prospective hospital-based study among febrile patients (March 2022–February 2024) in Murang’a County of Kenya was followed by a cross-sectional human–animal survey. A total of 1468 febrile patients were enrolled at two clinics and sera tested for RVF virus RNA and antiviral antibodies. In the cross-sectional study, humans (n = 282) and livestock (n = 706) from randomly selected households were tested and questionnaire data were used to investigate sociodemographic and environmental risk factors by multivariate logistic regression. No human (n = 1750) or livestock (n = 706) sera tested positive for RVFV RNA. However, 4.4% livestock and 2.0% humans tested positive for anti-RVFV IgG, including 0.27% febrile patients who showed four-fold IgG increase and 2.4% young livestock (p < 0.05, 95% CI) in males (aOR: 4.77, 2.08–12.4), those consuming raw milk (aOR: 5.24, 1.13–17.9), milkers (aOR: 2.69, 1.23–6.36), and participants residing near quarries (aOR: 2.4, 1.08–5.72). In livestock, sheep and goats were less likely to be seropositive (aOR: 0.27, 0.12–0.60) than cattle. The increase in RVF disease activities in the highlands represents a widening geographic dispersal of the virus, and a greater risk of more widespread RVF epidemics in the future.

Although highlands of East Africa lack the geo-ecological landmarks of Rift Valley fever (RVF) disease hotspots to participate in cyclic RVF epidemics, they have recently reported growing numbers of small RVF clusters. Here, we investigated whether RVF cycling occurred among livestock and humans in the central highlands of Kenya during inter-epidemic periods. A 2-year prospective hospital-based study among febrile patients (March 2022 - February 2024) in Murang’a County of Kenya, was followed by a cross-sectional human-animal survey. A total of 1,468 febrile patients were enrolled at two clinics and sera tested for RVF virus RNA and antiviral antibodies. In the cross-sectional study, humans (n=282) and livestock (n=706) from randomly selected households were tested and questionnaire data used to investigate sociodemographic and environmental risk factors by multivariate logistic regression. No human (n=1,750) or livestock (n=706) sera tested positive for RVFV RNA. However, 4.4% livestock and 2.0% humans tested positive for anti-RVFV IgG, including 0.27% febrile patients who showed 4-fold IgG increase and 2.4% young livestock (<12 months old), indicating recent virus exposure. Among humans, odds of RVF exposure increased significantly (P<0.05, 95% CI) in males (aOR:4.77, 2.08–12.4), those consuming raw milk (aOR 5.24,1.13–17.9), milkers (aOR:2.69, 1.23–6.36), and participants residing near quarries (aOR:2.4, 1.08–5.72). In livestock, sheep and goats were less likely to be seropositive (aOR: 0.27, 0.12–0.60) than cattle. The increase in RVF disease activities in the highlands represents widening geographic dispersal of the virus, and greater risk of more widespread RVF epidemics in future.

Background Malnutrition is a common feature among oncology patients. It is responsible for poor response and tolerance to anticancer therapy, increased morbidity, and mortality. More than half of malnourished cancer patients remain undetected owing to lack of effective screening. Body mass index is the main indicator for assessing malnutrition in Kenyan public hospitals. However, it underestimates weight loss in patients with chronic illnesses. The Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment have been widely used in research and clinical practice and have both reported good validity and reliability. However, their diagnostic evaluation has not been performed in Kenya. Methods A cross-sectional study was conducted among 138 and 76 cancer outpatients from Kenyatta National Hospital and Texas cancer treatment centres, respectively. Participants had a confirmed disease, stage 1-4 cancer, and aged 18 years and above. They were screened for malnutrition using both Malnutrition Universal Screening Tool and Patient Generated-Subjective Global Assessment. A separate study questionnaire was utilized to gather participant’s socio-demographic and clinical characteristics. A Bayesian latent class modelling framework was employed to infer the tests’ estimates based on participants ‘cumulative scores from the two tests. Results The cut-off value of ≥ 1 and ≥ 4 gave the best combination of sensitivity and specificity of Malnutrition Universal Screening Tool and Patient Generated-Subjective Global Assessment. Both tests yielded statistically similar sensitivities and specificities. Predictive values were comparable between the tests and across the two populations. The posterior median true prevalences of malnutrition were high (˃ 54%) and numerically similar between the studied populations. Conclusions The performance of both tests among patients with cancer is similar. Healthcare workers are therefore at liberty to use either of them to inform treatment. Given the high true prevalence of cancer-related malnutrition, routine screening is critical and should be included as part of cancer care.

Background: Sick children frequently have antibiotics prescribed as part of their treatment. Inappropriate use of antibiotics, especially broad-spectrum antibiotics, can result in the development of antibiotic resistance and the consequences of antibiotic resistance. In this study, we use routinely collected data to describe the patterns and identify factors influencing antibiotic prescription among admitted children. Methods: Routine data collected from medical records of children aged 2 months or older admitted between 2014 and 2020 to paediatric wards of 12 hospitals which are part of a Clinical Information Network (CIN) are used. Multivariable mixed effects logistic regression is used to assess determinants of antibiotic prescription with a random slope and intercept for hospital level. Results: A total of 127,984 antibiotic prescriptions were made in 107,500 participants included in the study where 81.1% (87,183/107,500) had one or more antibiotic prescriptions. The commonly prescribed antibiotics were a combination of benzylpenicillin and gentamicin (37,939/127,984 - 29.6%), ceftriaxone (31,172/127,984 - 24.6%) and oral amoxicillin (12,593 /127,984 - 9.8%). Factors associated with antibiotic prescription were history of cough (adjusted odds ratio (aOR), = 2.06, 95% confidence interval (CI):1.966 - 2.152), bloody diarrhoea (aOR=5.6, CI:4.453 - 7.036), diagnoses of pneumonia (aOR=27.66, CI:21.768 - 35.154), malnutrition (aOR=6.3, CI:4.558 - 8.701) and meningitis (aOR=11.85, CI:9.502 - 14.779). Antibiotic prescription was less likely in children diagnosed only with severe anaemia (aOR=0.8, CI:0.742 - 0.870), malaria (aOR:0.22, CI:0.201 - 0.231), diarrhoea (aOR:0.36, CI:0.331 - 0.398), and dehydration (aOR=0.4, CI:0.347 - 0.464). Conclusion: Antibiotics are prescribed in approximately four of every five children admitted to paediatric wards of Kenyan hospitals. Prescriptions are mainly in patients who fulfil syndromic clinical criteria where antibiotics are indicated. Without the introduction of reliable pathogen diagnostics, it will be difficult to reduce antibiotic prescriptions among admitted children.

Background: The growing number of people on antiretroviral therapy in Kenya has led to a decrease in HIV morbidity and mortality. However, virologic failure (VF) threatens to reverse these gains. In Makueni County, existing data indicate challenges in achieving viral load (VL) suppression among persons living with HIV (PLHIV). Few studies have been carried out investigating VF in the region despite its high incidence of HIV infections. Methods: An analytical cross-sectional study was conducted among PLHIV in Makueni County to investigate the determinants and estimate the prevalence of VF. The prevalence of VF and its associated 95% exact binomial confidence interval was estimated, and a mixed-effects logistic regression model used to evaluate the relationship between the predictors and VF. Results: The estimated period prevalence of VF between October 2018 and June 2019 was 13.2% (95% CI: 12.7%–13.8%). Being 15 years or older (aOR=0.53; 95% CI: 0.44 – 0.645) and having blood samples tested for reasons other than baseline VL measurement was associated with lower odds of VF: breastfeeding mothers (aOR=0.1; 95% CI: 0.01 – 0.97); clinical failure (aOR=0.08; 95% CI: 0.01 – 0.44); confirmation of VF (aOR=0.2; 95% CI: 0.07 – 0.62); no VL data (aOR=0.06; 95% CI: 0.01 – 0.31); routine VL (aOR=0.04; 95% CI: 0.01 – 0.12); drug substitution (aOR=0.03; 95% CI: 0.01 – 0.08). Taking ABC-based, AZT-based, or other non-TDF-Based regimens increased the odds of VF (aOR=1.61; 95% CI: 1.34 – 1.94), (aOR=1.75; 95% CI: 1.52 - 2.01), and (aOR=1.55; 95% CI: 0.99 - 2.44) respectively. Conclusion: This study showed that over 13% of HIV patients on ART in Makueni County had VF between October 2018 and June 2019. The significant risk factors associated with VF were found to be age lower than 15 years, taking a non-TDF-based ART regimen, and blood sampling for baseline VL measurements.