School of Medicine

Effectiveness of community health worker-led educational intervention on the uptake of cervical cancer screening in rural Kisumu, Kenya

2026-02-17T10:55:33Z

Effectiveness of community health worker-led educational intervention on the uptake of cervical cancer screening in rural Kisumu, Kenya NAFULA, Clara Wanyonyi In Kenya, cervical cancer is among the most frequently diagnosed cancer in women and remains a significant contributor to illness and death, despite being preventable through screening. The national and regional cervical cancer screening rate remains low at 17%, with data paucity in rural Kisumu. In 2020, the World Health Organization (WHO) introduced a global initiative aimed at eliminating cervical cancer through a 90-70-90 target: vaccinating 90% of girls, screening 70% of women, and ensuring that 90% of those with precancerous cervical lesions receive appropriate treatment. To achieve these targets, effective, community-based strategies must be developed. Community healthcare workers (CHWs) play a pivotal role in health education and fostering a culture of health prevention. There is, however, very limited local evidence on the effect of CHW-led education on uptake of screening for cervical cancer, especially in rural populations. The main objective of this study was to evaluate the effect of CHW-led education on knowledge, perceived vulnerability, and uptake of cervical cancer screening among women seeking care at Gita and Miranga Sub-county hospitals. A quasi-experimental pre-posttest design with a control group was employed, with Gita Sub-County Hospital serving as the intervention site and Miranga Sub-County Hospital as the control. A total of 274 participants were enrolled at each site. A pretest questionnaire was administered in May and June 2024, followed by a three-month sensitization and education intervention led by trained CHWs in Gita Sub-County. A post-test questionnaire was then administered at both sites. The statistics and data software package (STATA) was used for analysis. Both descriptive and analytical statistical procedures were employed. Socio-demographic characteristics were analyzed descriptively with frequencies and percentages. Paired t-tests, Wilcoxon rank-sum, and McNemar’s tests assessed changes in knowledge, perception, and screening uptake. Generalized Estimating Equations adjusted for confounders. Baseline socio-demographics were similar between the two sites, except for health insurance coverage, which was significantly higher in Gita (25%) than in Miranga (14.4%) (p = 0.02). Knowledge, perceived self-vulnerability, and screening uptake were similar at baseline. The mean knowledge scores were 6.7 (41.8%) in Gita and 5.3 (33.1%) in Miranga. The median self-vulnerability score was 13 (IQR: 9–17), and screening uptake was 31% and 30% in Gita and Miranga, respectively (p = 0.83). Post-intervention, the mean knowledge score in Gita significantly improved from 6.7 to 8.3 (p < 0.001), perceived self-vulnerability increased to a median score of 15 (p < 0.001), and screening uptake rose to 57.7% (p < 0.001). In conclusion, CHW-led educational intervention leads to statistically significant improvements in knowledge, perceived self-vulnerability, and cervical cancer screening rates in rural Kisumu. CHW-led educational programs should be scaled up and integrated into routine community health programs to enhance knowledge and uptake of cervical cancer screening in rural settings such as Kisumu. Policy makers should invest in training, supporting and deploying CHWs as key agents in cervical cancer prevention strategies to contribute to achieving WHO cervical cancer elimination targets. Master's Thesis

Hepatoproctive effects of benincasa hispida on paracetamol induced hepatotoxity among the wister albino Rats

2026-02-17T08:40:03Z

Hepatoproctive effects of benincasa hispida on paracetamol induced hepatotoxity among the wister albino Rats MODI, Elkana Paracetamol is an over-the-counter medication commonly used for managing low grade pain and fever. However, despite its clinical effectiveness it has been associated with liver disease when taken in overdose. From literatures, Benincasa hispida has been associated with the hepatoprotective effects on drug induced hepatotoxicity. However, there is paucity of literature showing the hepatoprotective effects of Benincasa hispida on paracetamol induced hepatotoxicity. The aims of the study were to evaluate the hepatoprotective effects of Benincasa hispida on paracetamol induced hepatotoxicity, determine the gross histomorphological changes that occur on liver following paracetamol induced hepatotoxicity to also determine the hepatoprotective effect of Benincasa hispida seed extracts on paracetamol induced hepatotoxicity and to lastly evaluate different levels of biochemical parameters required in hepatoprotection in paracetamol induced hepatotoxicity. A controlled- experimental study design where a post-test group of wister albino rats was used. The modified resource equation was used to select twenty- five animals and separate them into five groups each. The first group was the control and the other remaining four were the experimental group one, two, three and four. The control was only administered with water adlibitum, the group one experimental group was administered with an induction dose of 1500mg of paracetamol, the second, third and fourth experimental groups were administered with a constant dose of 1500mg of paracetamol and later administered with different doses of 100mg/kbwt, 200mg/kbwt and 300mg/kbwt Benincasa hispida respectively. All the animals the animals were humanely sacrificed on the twentieth day. Blood was collected, liver tissue were histologically prepared, and photomicrographs taken. The collected data were entered into the excel and uploaded into SPSS. One way ANOVA was used to test the difference between the group means and the Bonferroni post hoc test was used to find the significance, P-value of < 0.05 at a 95% confidence interval was found to be statistically significant. Data were presented in tables, and figures. There was significance (p≤ 0.001) reduction in the weight, length, width and thickness of the liver in the Paracetamol group as related with the control group. There was statistical (p≤ 0.001) difference of the weight, length, width and thickness of the liver of the HBH group as compared to the Paracetamol group. There was statistical (p ≤ 0.001) significance in the level of the alkaline phosphatase aspartate aminotransferase, Alanine aminotransferas and alkaline phosphatase in the High dose of Benincasa Hispida group as compared to the paracetamol group. The High Dose of Benincasa Hispida was alble to protect the hepatoprotective effects of Paracetamol induced hepatotoxicity Master's Thesis

Effects of covid-19 pandemic and sars cov-2 infection on maternal healthcare services and pregnancy outcomes at Jaramogi Oginga Odinga teaching and referral Hospital in western Kenya (retrospective cross sectional and cohort study)

2025-11-13T07:46:15Z

Effects of covid-19 pandemic and sars cov-2 infection on maternal healthcare services and pregnancy outcomes at Jaramogi Oginga Odinga teaching and referral Hospital in western Kenya (retrospective cross sectional and cohort study) KUBUTA, Patson Obwomu The coronavirus disease 2019 (COVID-19) pandemic occasioned significant disruptions in the delivery of healthcare services globally. There is limited knowledge on the effect of the pandemic on the utilization of maternal healthcare services, associated feto-maternal outcomes and its effects on pregnancy outcomes in the Western Kenya region. Furthermore, little knowledge is available regarding the direct effects of Covid-19 infection on pregnancy outcomes. The objective of this study was two-fold: 1) To assess the changes on maternal healthcare utilization, pregnancy outcomes, feto-maternal outcomes during the pre-COVID-19 compared to the Covid-19 era, and 2) to determine the effect of the SARS CoV-2 infection on maternal and fetal outcomes at Jaramogi Oginga Teaching and Referral Hospital (JOOTRH), Kisumu. A hospital-based retrospective cross-sectional and retrospective cohort study designs were used. The subjects were pregnant women who sought maternal healthcare services at JOOTRH between 2018 and 2022. Data was abstracted from MCH clinic and maternity ward records. For objective 1 and 2, the whole population was used (2018 to 2022) and for objective 3, a sample size of 140 participants, calculated using Fleiss formula was used. Statistical Package for Social Sciences version 27 was used for data analysis. Descriptive, inferential statistics were applied. For objective 1 and 2, unpaired t-test was used to establish the difference between pre-Covid -19 and during Covid -19. For objective 3, relative risk and odds ratios were used to estimate the risk of SARS Cov-2 infection. There was a 37.9% (17782) decline in ANC visits during COVID-19. The ¬¬total deliveries decreased by 16.7%, (1940) postnatal services reduced by 35% (5779) during the Covid-19 pandemic, indicating that the Covid-19 pandemic had a major impact on access to maternal services. Maternal and neonatal outcomes were also negatively impacted with 39.7% (23) increase maternal sepsis and a 26.4% (45) increase in fresh stillbirths and a 34.3% (333) increase in low birth weight babies during Covid-19. SARS-CoV-2 positive mothers had a higher risk of adverse maternal and fetal outcomes compared to those not infected. The pandemic interrupted maternal healthcare services access and led to adverse pregnancy outcomes. The Covid-19 infection predisposed expectant mothers to adverse maternal and fetal outcomes. Developing hospital protocols on home-based care services and safe vaccination to pregnant mothers during pandemics and prioritization of expectant women on timely diagnosis and management of Covid-19 infection. Lastly, to encourage high powered studies to evaluate the intricate effect of Covid-19 on the utero-placental unit and associated complications Master's Thesis

Effects of prescribed low-intensity resistance exercise on prehypertension and other related factors in individuals living within Homa bay township, western Kenya

2025-11-12T08:52:00Z

Effects of prescribed low-intensity resistance exercise on prehypertension and other related factors in individuals living within Homa bay township, western Kenya ELIAKIM, Konje moses Prehypertension is the precursor to hypertension stage I which can gradually lead to hypertension stage II in case there is no intervention It is anticipated. that prehypertension will affect up to one-third of the adult population worldwide by 2025. In Homa Bay County, the Homa Bay County Teaching and Referral Hospital has reported an increase in the number of patients diagnosed with prehypertension over the past 5 years, mostly emerging from individuals living within Homa Bay Township. This study examined the effects of low-intensity resistance exercise on prehypertension and other related factors in individuals living within Homa Bay Township. Its specific objectives were; to find out the awareness of lifestyle risk factors of prehypertension in individuals with prehypertension, to determine the effects of prescribed low-intensity exercise on anthropometric measures, and to quantify the effects of prescribed low-intensity resistance exercise on fasting blood glucose, blood pressure, and lipid levels. This was a hospital-based study in which a randomized controlled trial study design was employed. Thirty-four (17 experimental and 17 controls) adults were purposively recruited into the study and followed for three months. Participants performed four, 2 minutes weight lifting contractions of the upper extremities at 30% maximum voluntary contraction (MVC) with ½ minute rest between contractions for 30 minutes. For the lower extremities exercise; participants performed four, 2 minutes contractions at 40% MVC with 1 minute’s rest between contractions for 30 minutes. Biochemical and anthropometric data were collected on pre-training, mid-training, and post-training. In pre, mid and post-training sessions, blood samples (5ml) were obtained by venipuncture for the assessment of LDL, HDL, Cholesterol, triglyceride, and fasting blood sugar levels. Blood pressure and anthropometric measurement were also taken. ANOVA with a within-subjects factor of time of the study (pre, mid, and post-study) and a between-subject factor of treatment type (experimental and control groups) was used to determine the differences between the two groups. The majority of the respondents statistically did not know the lifestyle risk factors of prehypertension at the start of the study for instance smoking tobacco (χ2=5.93, df=2, p-value=0.049) and less consumption of fruits (χ2=6.59, df=2, p-value=0.04). Except for BMI [F (1, 32) =8.06, p-value=0.008], the study statistically found that the prescribed low-intensity resistance exercise did not affect the weight, waist circumference, and waist-hip ratio of prehypertensive individuals. Low-intensity resistance exercises significantly, F (1, 32) =5.01, p-value=0.03, lowered the prehypertensive pressure in the experimental group to normal pressure at post-study (from 127.59+5.01 to 115.88+6.06 mmHg systolic pressure) as compared to the control group (from 128.94+4.64 to 122.47+2.87 mmHg systolic pressure). Although Total Cholesterol (TC), Low-Density Lipoprotein (LDL), and Fasting Blood Glucose (FBG) decreased in both experimental and control groups, the decline was more marked in the experimental group, suggesting that prescribed low-intensity exercise could decrease the variables. In conclusion, this study provides evidence that low-intensity resistance exercises prescription in prehypertension can prevent progression to hypertension. Master's Thesis

Effects of Allium sativum extract on atazanavir induced Nephrotoxicity in male winstar rats

2025-03-12T13:31:11Z

Effects of Allium sativum extract on atazanavir induced Nephrotoxicity in male winstar rats KIPYEGON, Langat Robert Introduction of highly active antiretroviral therapy in 1998 in the treatment of HIV led to dramatic decrease in morbidity and mortality among HIV infected patients translating it into a chronic manageable condition. Atazanavir was a recommended first line therapy for HIV treatment. However, it is nephrotoxic with prolonged use and may lead to irreversible renal damage. Allium sativum, a common food supplement is known for its antioxidant properties but its nephroprotective properties in Atazanavir nephrotoxicity has not been studied. The present study investigated the effects of A. sativum extract on serum creatinine, Urea, Uric Acid and Electrolytes (Sodium, Potassium & Chloride) on male laboratory wistar rats. The study also determined effects of the A. sativum extract on kidneys histology. This was an experimental study conducted at the University of Eldoret, Department of Biological Sciences, Zoology laboratory. Thirty-nine (39) male wistar rats of approximately the same age and weighing between 150g- 250g were sourced from Chiromo campus of the University of Nairobi and transported to the University of Eldoret – zoology laboratory where they were allowed two weeks to acclimatize. During the acclimatization period all the experimental animals were accustomed to handling by the animal attendant. Thereafter, the animals were randomly divided into 3 groups (Control, Treatment and Intervention groups) of 13 animals each. Treatment group received Atazanavir 10mg/kg, Intervention group received Atazanavir (10mg/kg.bwt) and A. sativum extract (250mg/kg.bwt) while control group received normal saline (1.5ml). Administration of drugs was by gavage. Blood sampling was done twice (14 days apart) during pre-treatment and later 2 weekly for 6 weeks during treatment phase. The blood samples we used to determine electrolytes (Na+, K+& Cl-), nitrogenous metabolites (Creatinine and Urea) and Uric Acid levels using automated clinical Chemistry analyzer (Reflectron Automated Analyzer, Beckman, U.S.A). At the end of the study, 4 representative animals from each group were sacrificed and kidney tissue were harvested for histological examination. Quantitative data were expressed as Mean ± standard Error of Mean (SEM) and the difference of means among treatment groups was measured by one-way analysis of variance (ANOVA) followed by Tukey’s Honest Significant Difference test. Values were statistically significant when P < 0.05. The study showed that Atazanavir administration caused increased in Creatine, Urea, Electrolytes (Na+, K+& Cl-) and Uric acid while co-administered with A. sativum extract, the levels significantly (p<0.05) decreased to near normal as compared to control animals. Kidney tissue from experimental animals showed features of renal cell nephritis characterized by clear and enlarged podocytes, irregular infiltrating cells with hyperchromatic nuclei, marked pleomorphism and expanded mesangial matrix. The Atazanavir effects on the kidney histology were reversed when the treatment was co-administered with A. sativum extract. A. sativum extract exhibited nephroprotective activity. The findings of the present study showed that A. sativum extract ameliorates effects of Atazanavir leading to reduction in Creatinine, Urea, Electrolytes (Na+, K+& Cl-) and Uric Acid. Therefore, A. sativum extract can be further tested and recommended for use as a supplement in Atazanavir treatment. Master's Thesis

Evaluation of Carbetocin and oxytocin for prevention of post Partum hemorrhage in women undergoing cesarean delivery at a regional hospital in western Kenya

2025-03-12T13:58:55Z

Evaluation of Carbetocin and oxytocin for prevention of post Partum hemorrhage in women undergoing cesarean delivery at a regional hospital in western Kenya OYARO, Grace Kerubo The burden of maternal morbidity and mortality is highest in Sub Saharan Africa and Southern Asia. Moreover, postpartum hemorrhage (PPH) is the largest contributor of maternal deaths in these regions. In Kisumu County, most of these deaths occur at the regional referral hospital Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). The use of uterotonics for the prevention of postpartum hemorrhage has resulted in a significant reduction in maternal morbidity and mortality, and thus remains an integral part of active management of third stage of labor. WHO recommends use of oxytocin for prevention of PPH in all births. Oxytocin is widely and readily available in most health facilities, including JOOTRH, and continues to be the preferred first-line uterotonic drug for PPH prophylaxis. Carbetocin is a heat-stable, longer-acting synthetic analog of oxytocin that is administered as a single dose within 1minute of delivery. Proper management of PPH cannot be overemphasized because of its undisputed impact on maternal morbidity and mortality. Although oxytocin is readily and widely available at JOOTRH and is currently the preferred uterotonic agent for all births, there is paucity of data on the effectiveness of this locally available drug. It is important to address the question of effectiveness of locally available oxytocin to ensure PPH is effectively prevented. This was done in the form of a comparative study between the standard first-line uterotonic, oxytocin and its analog carbetocin. This study aimed to evaluate the effectiveness of carbetocin and oxytocin in preventing postpartum hemorrhage in women undergoing cesarean delivery at JOOTRH. The specific objectives were to compare the incidences of use of additional uterotonics between oxytocin and carbetocin, to compare blood pressure levels following administration of oxytocin and carbetocin, to compare blood loss in the oxytocin and carbetocin groups, and to compare the incidence of need for blood transfusion. This study was a quasi-experimental trial. Pregnant women who underwent elective and emergency cesarean delivery at JOOTRH who met the eligibility criteria were allocated to receive oxytocin until the desired sample size (77) was achieved, and subsequently allocated to receive carbetocin until the desire sample of 77 was reached. A total of 154 women (77 for each study arm) were recruited in the study. The intervention arm received 100mcg carbetocin IV, whereas the control arm received 10IU oxytocin (the current standard of care). The sample size was calculated using a formula by Charan & Biswas. OpenEpi, version 3, an open-source calculator, was used to confirm the power which was 84.94%. Variables of interest were use of additional uterotonics, blood pressure readings, estimated blood loss and need for transfusion. Blood pressure readings were summarized as means and standard deviations while use of additional uterotonics, blood loss and need for transfusion were summarized as frequency counts and percentages. Inferential analysis was used to analyze the collected data. Pearson's Chi-square test of independence was used to assess the association between the study arm and the sociodemographic and obstetric characteristics of the participants. Propensity score matching was used to minimize selection bias. Binary logistic regression was employed to compare the use of additional uterotonics, need for transfusion, and blood loss between the control and intervention groups, while blood pressure changes were analyzed using linear regression analysis. In this study, we observed that participants in the oxytocin arm were eight times more likely to receive additional uterotonics (OR=8.00, 95% CI 3.77,18.20, P-value <0.001). There were no statistically significant differences in systolic blood pressure (P value 0.11), diastolic blood pressure (P value 0.30) and pulse rate (P value 0.20) measurements. There was no statistically significant difference in blood loss (P-value 0.39) and need for transfusion (P-value 0.30) across the two groups. In conclusion, carbetocin was more effective in preventing PPH, as its use was associated with a reduced need for additional uterotonics. There were no significant differences in blood pressure changes, rates of blood loss, or need for transfusion. This study recommends that carbetocin be included as a first-line agent in PPH prophylaxis in women undergoing cesarean delivery. Master's Thesis

Investigation of haemostatic effects and the mechanism of Action of croton megalocarpus leaf extract on male new Zealand white rabbits

2025-03-12T14:00:57Z

Investigation of haemostatic effects and the mechanism of Action of croton megalocarpus leaf extract on male new Zealand white rabbits IRUNGU, David Mwangi Trauma death being a serious issue that take people’s lives has many causes whose main cause is hemorrhage (bleeding). The body's natural ability to halt bleeding inside the vascular compartment is called hemostasis, which is brought on by hemostatic drugs. Three processes—vascular constriction, platelet plug creation, and blood coagulation—achieve this. In Kenya and many other nations, freshly cut Croton megalocarpus leaves are frequently used as a hemostatic agent to stop bleeding. On the other hand, not much is known about the hemostatic properties of this plant extract. This study was conducted at three different universities. In the biochemistry lab of Maseno University, the extract was prepared and transported to Nairobi using a cooler box at 2 to 8 degree celcius. At the University of Nairobi's medical physiology laboratory, tests on bleeding and clotting were conducted. At Kenyatta National Hospital's hematology department, tests for prothrombin and active partial thromboplastin duration were performed. The primary goal is to ascertain the impact and mode of action of dried leaf extract from Croton megalocarpus on rabbits from New Zealand's hemostasis activity. A freeze-dried plant extract was made, and the dose for the research was calculated. Randomly assigned to five groups (control and test), forty New Zealand white rabbits were used. For measuring bleeding time, Duke's technique was employed, and for measuring clotting time, the capillary method. Prothrombin time was measured using the ACL Elitepro equipment, which also activated partial thromboplastin time. Biological data was statistically analyzed using SPSS version 23.0 (IBM SPSS, Inc., Chicago, IL, USA). Using one way analysis of variance, analysis of hematological data, including blood loss duration, clotting time, prothrombin time, and partial thromboplastin activation time, was compared between the control group and treatment groups for categorical variables. Turkeys Tests for Pairwise Comparison between means was used to compare. The relationship between leaf extract concentrations and hematological parameters... P< 0.05 was used to determine if differences were significant. The extraction yield was 45%, or 450g, of the total weight. The mean bleeding time for animals receiving normal saline (control) (A) was 125.9 -/+ 3.5 seconds, compared to aspirin, 28 mg/kg body weight (B), 227.1 ±7.6 seconds, 200 mg/kg body weight leaf extract (C), 103.3± 2.9 seconds, 300 mg/kg body weight leaf extract (D), and 81.9 ±2.6 seconds (E), respectively. In the clotting time assay, Tukey's test for pairwise comparison of means revealed that the difference between the means for the control and croton megalocarpus leaf extract tests C (200 mg/g), D (300 mg/kg), and E (400 mg/kg) was significant at 0.05 (DF, within groups = 92, Mean Square = 8.6046, N = 24, n = 4, T = 2.215). Prothrombin time reduction was not significant as observed in means of control, (13.0±1.23 verses. 200mg/ml leaf extract, 13.0±1.32 seconds (C), (DF =1, p = 0.9105), control (13.0±1.2 (c) verses. 300 mg/ml 12.6±1.41 seconds (D), (DF =1, p = 0.237), and control (13.0±1.2 (c) verses 400mg/ml, 13.2±1.5 seconds (E), (DF =1, p = 0.750). Turkeys Tests for Pairwise Comparison between means between normal saline and 200mg/kg (C), 300mg/kg (D) and 400mg/kg (E) body weight leaf extract, showed that the effect of CM leaf extract on activated partial thromboplastin time (APTT) was significant at 5% (DF =92, N=24, MSE = 4.6675, T=1.6317). The results obtained in the current study have revealed a significant coagulant activity of aqueous extract of Croton megalocarpus plant species in accordance with a reduction in bleeding period of time, clotting duration and the amount of active partial thromboplastin duration as compared to that of the control (normal saline) with no cytotoxicity impact. The use of aqueous extracts of Croton megalocarpus in enhancement of blood hemostasis is recommended subject for further studies on safety and clinical trials on human subjects. Master's Thesis

Effects of aqueous garlic extract treatment on plasma Glucose, cortisol and electrolytes concentration in male Rattus norvegicus on daily atazanavir therapy

2025-03-12T14:01:33Z

Effects of aqueous garlic extract treatment on plasma Glucose, cortisol and electrolytes concentration in male Rattus norvegicus on daily atazanavir therapy YARALIMA, Jackson, Mnangat Patients with HIV/AIDS now have longer life expectancies, thanks to the widespread use of highly active antiretroviral treatment (HAART). On the other hand, a high frequency of endocrine and metabolic diseases has been linked to the medications. Cortisol secretion dysregulation has been documented in studies focusing specifically on the hypothalamic-pituitary-adrenal (HPA) axis. Reports of insulin resistance, hyperglycemia and electrolyte abnormalities raise the possibility that the HAART medications may affect the pancreas, kidneys and adrenal glands. Garlic, a popular food additive, has been shown to have hypoglycemic properties and affects how the adrenal gland reacts to stress. This study sought to evaluate the effects of aqueous garlic extract treatment on plasma glucose, cortisol and electrolyte (sodium, potassium, calcium, and chloride) concentrations in male rats on daily atazanavir therapy (one of the HAART drugs). The study also sought to determine the effects of aqueous garlic extract treatment on the adrenal gland histology in atazanavir-treated and non-treated male laboratory rats. This was a laboratory-based experimental study in which thirty-nine (39) male rats aged 15–18 months weighing 350–400 grams were used. The study was conducted at the University of Eldoret Animal House in the Department of Zoology. The animals, fed on rat pellets and water ad libitum, were randomly divided into three groups, A, B, and C, of thirteen animals each. About 1ml of tail blood was obtained from all the rats in the three groups fortnightly, twice before the treatment, to determine baseline data of all the study parameters. After two weeks, the group A rats served as the control animals and received 1.5 ml of normal saline daily throughout the study. Group B rats received daily atazanavir treatment at 10mg/Kg, and group C rats received a daily atazanavir (10mg/Kg) plus aqueous garlic extract treatment (250mg/kg body weight) from the third week to the end of the study. All treatments were administered through the oral gavage route. Blood sampling (1ml) was continued fortnightly in all the groups for five sessions before the termination of the study. Each bleeding session began with the measurement of blood glucose levels immediately using a glucometer. The remaining blood samples were processed for plasma and stored at -20°C until needed for the measurements of sodium, potassium, calcium and chloride ions using an automated hemoanalyzer, and cortisol using an ELISA assay kit. At the end of the study, some of the animals were sacrificed, and the adrenal gland tissues of both control and experimental rats were carefully harvested, sectioned, and processed for histological examination. All values were expressed as mean levels ± SEM. One way ANOVA test at P<0.05 significance level was used to compare the means of all the parameters between the three experimental groups. Atazanavir therapy caused increased mean glucose concentration in the blood, which declined with garlic treatment. Atazanavir therapy caused increased mean cortisol concentration in blood, while garlic reduced the mean blood cortisol level. Atazanavir therapy caused hypokalemia, while garlic improved potassium concentration in the blood and restored it to its normal range. Atazanavir therapy and garlic treatment in this study showed slight comparison effect on the mean plasma chloride level. Atazanavir therapy caused hypocalcaemia, while garlic treatment increased the calcium ion concentration and reversed the hypocalcaemia to its normal range. Atazanavir caused hyponatremia. Garlic treatment caused increased mean plasma sodium ion concentration and normalized the sodium level in blood. Atazanavir therapy caused metabolic changes in the zona fasciculata cells with foamy cytoplasm of the adrenal gland. Garlic did not reverse the metabolic changes. Master's Thesis

Fetomaternal outcomes among normotensive and stage one Hypertensive patients at Jaramogi Oginga Odinga teaching and Referral hospital: a prospective cohort study

2025-03-12T10:36:03Z

Fetomaternal outcomes among normotensive and stage one Hypertensive patients at Jaramogi Oginga Odinga teaching and Referral hospital: a prospective cohort study SIMIYU, Daniel, Wambaya Hypertension in pregnancy is a leading cause of adverse maternal and fetal outcomes. Complications associated with hypertension include intrauterine growth restriction (IUGR), premature delivery, poor neonatal scores at birth, prolonged admission, maternal end organ damage and increased operative delivery. Recent studies in non-pregnant subjects indicate that a blood pressure range of 130/80 to 140/90 is associated with significant cardiovascular complications. The American Heart association has consequently recommended that this range be termed stage one hypertension. The effect of this new stage one hypertension has however not been adequately studied in pregnancy. The main objective of this study was to compare the fetomaternal outcomes between normotensive patients and those with stage one hypertension attending antenatal clinic (ANC) at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). The hypothesis was that there was no statistically significant difference in the fetomaternal outcomes between normotensive and stage one patients attending ANC at JOOTRH. This was a prospective cohort study, where non-probability consecutive sampling was used to select women with singleton pregnancies presenting for ANC before 20 weeks of gestation. A total of 320 women, 160 in each arm were recruited into the study and followed to delivery. Patients with stage one hypertension were the exposed group and those in the normotensive group were the unexposed. Maternal outcome data included gestational hypertension, pre-eclampsia, eclampsia, and mode of delivery. Fetal outcomes included fetal maturity, birth weight, APGAR scores, admission to newborn unit and fetal demise. The Statistical Package for Social Sciences (SPSS) version 25 software was used for analysis. Both descriptive and analytical statistical procedures were employed in analysis. The independent t test was used to compare the sociodemographic and clinical characteristics between the independent groups. A chi-square test of association was used to compare both maternal and fetal outcomes between the independent groups. Binary logistic regression analysis with interaction effects was used to establish the influence of variables that were found to be significantly different on the maternal and fetal outcomes. The socio- demographic characteristics were comparable between the two groups. Twenty-three patients with stage one hypertension (15.9%) developed gestational hypertension compared to eight (5.5%) in the normotensive group (RR 3.23, P value 0.02).Seventeen per cent of the neonates born to patients with stage one hypertension were admitted to the newborn unit compared to ten per cent of those in the normotensive group (RR of 1.98, P value 0.045).Thirty per cent of the neonates born to patients in the stage one hypertensive group scored below 7 on the APGAR score at one minute compared to twenty per cent in the normotensive group (P value 0.04). There was no statistically significant difference in the other maternal and fetal outcomes. In conclusion, patients with stage on hypertension have worse fetal and maternal outcomes than their normotensive counterparts and should be offered a more rigorous antenatal care based on this observed higher risk of fetomaternal complications. Master's Thesis

Protective effects of rosmarinus officinalis on gentamicin - Induced acute Kidney injury in male albino Rats (Rattus norvegicus)

2025-03-12T09:34:41Z

Protective effects of rosmarinus officinalis on gentamicin - Induced acute Kidney injury in male albino Rats (Rattus norvegicus) WANYONYI, Kennedy,Waswa Acute Kidney injury (AKI) is a worldwide public health challenge associated with high morbidity, mortality, and high healthcare costs in developing countries. Studies have established that one cause of these injuries is the use of gentamicin (GN) which is an affordable and efficacious first- line drug for managing all gram-negative bacteria thus preferred, especially in low-income populations. Approximately 30% of patients treated with GN for more than seven days exhibits signs and symptoms of AKI and 20% to 55 develops AKI. When AKI progresses to chronic kidney disease, dialysis, done three times a week at a cost of Ksh7,000 per session, is inevitable. This cost is unaffordable to many therefore, calls for intervention of a potent, affordable compound with antioxidant activity to reduce the oxidative stress during GN medication. Rosmarinus Officinalis (RO) which is easily available and affordable natural antioxidant can be used to stop oxidation. Minimal research has been done to develop high-quality interventions to prevent the GN effects using RO herbs. The purpose of this study was to evaluate the protective effect of RO on GN- induced acute Kidney injury in male albino rats. The study determined the protective gross morphological and histological effects of RO on gentamicin induced AKI in albino rats, established histo-stereological changes in the kidney after administration of different doses of RO on gentamicin-induced acute kidney injury in albino rats, and assessed changes in the biochemical parameters of the kidney; Serum creatinine and blood urea after administration of GN and different doses of RO in albino rats. A total of 25 albino rats were simple randomly divided into a control of 5 rats and an experimental of 20 rats. The control received a rat diet plus water. The experimental group was further sub-divided into four sub-groups of 5 rats each: Gentamicin GN100mg/kg/bwt/i.p, low dose RO 100mg/kg/bwt+GN 100mg/kg, medium dose RO150mg/kg/bwt +GN100mg/kg, and high dose RO 200mg/kg/bwt + GN100mg/kg groups. One- way ANOVA was used to test the means within control and treatment groups for the histo- stereology, the weight of the rats, biochemical parameters, and gross morphometric data. The findings showed that there was a significant P< 0.0001 reduction in the parameters: mean terminal weights of the rats, weight, volume, thickness, width, length ,and the glomerulus volume of the Gentamicin group compared with the control groups. Further, there was a significant P<0.0001 increase in urea and creatinine levels recorded in the Gentamicin group to signify nephrotoxicity induced in the kidneys. In comparing the gentamicin group and the RO groups, there was no significant difference in the above-mentioned parameters in the gentamicin group, and the low and medium dose RO groups. However, a significant reduction was recorded in the high dose RO and control group. While the glomerulus, proximal, and distal convoluted tubules, and Bowman’s space for the low RO, medium RO, and gentamicin group were shrunken and dilated respectively, those for the high dose RO and the controls were normal and comparable. The Biochemical parameters further revealed that there was no significant difference observed between the high dose RO and the control group. Similar results were also found in the stereological findings where the glomerulus volume of the high dose RO and the controls were comparable unlike for the low and medium doses RO. In conclusion, the high dose RO has a protective effect on gross morphological, histological, stereological, and biomarkers against gentamicin-induced AKI. Therefore, there is need to do further research to ascertain its pharmacokinetics and pharmacodynamics so that it can be used alongside Gentamicin treatment to counteract kidney injuries which has led to chronic kidney disease, ultimately reducing Kidney related mortalities. Master's Thesis