Articles: School of Nursing

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    1H NMR-based metabolomics study on repeat dose toxicity of fine particulate matter in rats after intratracheal instillation
    (Elsevier, 2017-07) Zhang, Y.; Hu, H.; Shi, Y.; Yang, X.; Cao, L.; Wu, J.; Asweto, Collins O.; Feng, L.; Duan, J.; Sun, Z.
    Systemic metabolic effects and toxicity mechanisms of ambient fine particulate matter (PM2.5) remain uncertain. In order to investigate the mechanisms in PM2.5 toxicity, we explored the endogenous metabolic changes and possible influenced metabolic pathways in rats after intratracheal instillation of PM2.5 by using a 1H nuclear magnetic resonance (NMR)-based metabolomics approach. Liver and kidney histopathology examinations were also performed. Chemical characterization demonstrated that PM2.5 was a complex mixture of elements. Histopathology showed cellular edema in liver and glomerulus atrophy of the PM2.5 treated rats. We systematically analyzed the metabolites changes of serum and urine in rats using 1H NMR techniques in combination with multivariate statistical analysis. Significantly reduced levels of lactate, alanine, dimethylglycine, creatine, glycine and histidine in serum, together with increased levels of citrate, arginine, hippurate, allantoin and decreased levels of allthreonine, lactate, alanine, acetate, succinate, trimethylamine, formate in urine were observed of PM2.5 treated rats. The mainly affected metabolic pathways by PM2.5 were glycine, serine and threonine metabolism, glyoxylate and dicarboxylate metabolism, citrate cycle (TCA cycle), nitrogen metabolism and methane metabolism. Our study provided important information on assessing the toxicity of PM2.5 and demonstrated that metabolomics approach can be employed as a tool to understand the toxicity mechanism of complicated environmental pollutants.
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    Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device Uptake among Mothers Delivering at Meru Hospital
    (Scientific Research Publishing, 2019-03) Kirigia, Consolata; Gitonga, Lucy; Muraya, Moses Mahugu
    Global contraceptive use is at 64%, Africa lagging behind at 33.4%. Kenya has an unmet need for family planning at 23%. Hormonal injections are the most used in Africa at 9.8% and Intra-Uterine Contraceptive Devices at 3.8%. Low uptake of 3.4% was reported in Meru Hospital and lack of literature on immediate Post Partum Intra Uterine Contraceptive Device (PPIUCD) uptake. Immediate Post Partum Intra Uterine Contraceptive Device is a long acting reversible contraceptive device inserted into the uterus immediately within 48 hours after delivery. The objective was to assess Barriers to Immediate Post-Partum Intra-Uterine Contraceptive Device uptake among Mothers delivering in Meru Hospital. Descriptive research design was used and a population of 289 mothers was targeted. Sample size of 74 respondents was selected using simple random sampling. Questionnaires and interview schedules were used to collect data. The collected data were entered and analyzed using Statistical Package for Social Science windows version 23.0. Descriptive analysis was used to obtain frequencies and percentages. Chi-square was used to test the relationship of study variables and presented in tables. The qualita-tive data were analyzed thematically. The findings revealed that provider related barriers such as none provision of the services and untimely counseling for the insertion had the highest impact to low uptake (57%). Clients lacked information where 68% reported that they were not counseled. Demographic and reproductive characteristics also played a role in low uptake. Using the chi square test, there was a significant relationship, P = 0.001 between young age of the mothers, unemployment (53%), low parity (56%) and low uptake. Preference for other alternative contraceptives (25.8%) such as hormonal methods was a barrier to the uptake. Therefore, barriers to PPIUCD uptake are provider related, alternative methods of contraception and client related such as lack of information, unemployment, young age and low parity. The findings will inform Meru hospital management on barriers to immediate PPIUCD uptake. The study recommends an investigation on why providers hinder PPIUCD uptake and create awareness on PPIUCD services to the community.
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    Cardiovascular health risk posed by polycyclic aromatic hydrocarbon and ultrafine particles.
    (2018-01) Asweto, Collins O.
    There is increased cardiovascular disease incidence attributed to ambient air pollution. It is estimated that ischaemic heart disease and stroke account for 80% of ambient air pollutionrelated early deaths. The most deleterious are the ultrafine particles (UFPs) which have more prominent potential health threat, since they can act as carriers of other strong air pollutant such as polycyclic aromatic hydrocarbons (PAHs). UFPs are small in size, hence can easily penetrate and reach cardiovascular tissues and organs. To understand their mechanisms, studies on UFPs and PAHs induced cardiovascular diseases were reviewed. The studies showed that UFPs and PAHs initiate events in atherogenesis including oxidative stress, expression of cell adhesion molecules on the surface of the endothelium, inflammation, and endothelial dysfunction. Endothelial dysfunction is associated with cardiovascular diseases such as hypertension, coronary artery disease, chronic heart failure, and peripheral vascular disease. The current review provides useful information on deleterious effect of UFP and PAH exposure on cardiovascular system. Thus advancing knowledge on UFP and PAH toxicity underscores the importance of the cardiovascular effects of air pollutants.
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    Cellular pathways involved in silica nanoparticles induced apoptosis: A systematic review of in vitro studies.
    (Elsevier, 2017-12) Asweto, Collins O.; Wu, J.; Alzain, M. A.; Hu, H.; Andrea, S.; Feng, L.; Yeng, X.; Duan, J.; Sun, Z.
    Silica nanoparticles (SiNPs) have been found to pass through biological barriers and get distributed in the human body. They induce cell apoptosis via various mechanisms in body organs. To understand these mechanisms, we carried out systematic review of in vitro studies on SiNPs-induced cell apoptosis. Office of Health Assessment and Translation approach for Systematic Review and Evidence Integration was used to identify 14 studies dating from the year 2000 to current. Four studies showed an increase in DNA damage, cell cycle arrest, proapoptotic factors and decrease in antiapoptotic factors resulting to apoptosis. Eight studies showed induction of mitochondrial dysfunction, Bax upregulation, Bcl-2 downregulation, and caspase-3, -7, -9 activities increase. Increase in FADD, TNFR1 and Bid proteins was observed in one study, while the other NO production and caspase-3 activity was increased. These studies found the potency of SiNPs to induce cell apoptosis through DNA damage, mitochondrial, tumor necrosis factor, and nitric oxide related pathways.
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    Cervical cancer screening during the COVID-19 Crisis: Africa view point
    (eCancer, 2020-05) Kirigia, Consolata
    There are approximately 570,000 cases of cervical cancer and 311,000 deaths from cervical cancer globally (1). Approximately 70% of cancer deaths occur in low and middle income countries and cervical cancer is the most common cancer in Africa (2). Therefore cervical cancer screening saves lives by early detection of cases for early management.
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    Co-exposure to amorphous silica nanoparticles and benzo[a]pyrene at low level in human bronchial epithelial BEAS-2B cells
    (SpringerLink, 2016-11) Wu, J.; Shi, Y.; Asweto, Collins O.; Lin, F.; Xiaozhe, Y.; Zhang, Y.; Duan, J.; Sun, Z.
    Both ultrafine particles (UFP) and polycyclic aromatic hydrocarbons (PAHs) are widely present in the environment, thus increasing their chances of exposure to human in the daily life. However, the study on the combined toxicity of UFP and PAHs on respiratory system is still limited. In this study, we examined the potential interactive effects of silica nanoparticles (SiNPs) and benzo[a]pyrene (B[a]P) in bronchial epithelial cells (BEAS-2B). Cells were exposed to SiNPs and B[a]P alone or in combination for 24 h. Co-exposure to SiNPs and B[a]P enhanced the malondialdehyde (MDA) contents and reduced superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities significantly, while the reactive oxygen species (ROS) generation had a slight increase in the exposed groups compared to the control but not statistically significant. Cell cycle arrest induced by the co-exposure showed a significant percentage increase in G2/M phase cells and a decrease in G0/G1 phase cells. In addition, there was a significant increase in BEAS-2B cells multinucleation as well as DNA damage. Cellular apoptosis was markedly increased even at the low-level co-exposure. Our results suggest that co-exposure to SiNPs and B[a]P exerts synergistic and additive cytotoxic and genotoxic effects.
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    Comprehensive gene and microRNA expression profiling on cardiovascular system in zebrafish co exposured of SiNPs and MeHg
    (Elsevier, 2017-12) Hu, H.; Shi, Y.; Zhang, Y.; Wu, J.; Asweto, Collins O.; Feng, L.; Yang, X.; Duan, J.; Sun, Z.
    Air pollution has been shown to increase cardiovascular diseases. However, little attention has been paid to the combined effects of PM and air pollutants on the cardiovascular system. To explore this, a high-throughput sequencing technology was used to determine combined effects of silica nanoparticles (SiNPs) and MeHg in zebrafish. Our study demonstrated that SiNPs and MeHg co-exposure could cause significant changes in mRNA and miRNA expression patterns in zebrafish. The differentially expressed (DE) genes in profiles 17 and 26 of STC analysis suggest that SiNPs and MeHg co-exposure had more proinflammatory and cardiovascular toxicity in zebrafish than single exposure. Major gene functions associated with cardiovascular system in the co-exposed zebrafish were discerned from the dynamic-gene-network, including stxbp1a, celf4, ahr1b and bai2. In addition, the prominently expressed pathway of cardiac muscle contraction was targeted by 3 DE miRNAs identified by the miRNA-pathway-network (dre-miR-7147, dre-miR-26a and dre-miR-375), which included 23 DE genes. This study presents a global view of the combined SiNPs and MeHg toxicity on the dynamic expression of both mRNAs and miRNAs in zebrafish, and could serve as fundamental research clues for future studies, especially on cardiovascular system toxicity.
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    Corona Virus Disease among Pregnant Women: A Systematic Scoping Review
    (Scientific Research Publishing, 2020-05) Kirigia, Consolata
    Corona Virus Disease 2019 (COVID-19) is a deadly respiratory viral disease that started in China in the year 2019 before spreading to the world. It affects everybody regardless of race, religion, social economic status or age. However, literature indicates that people with compromised immune status are at a higher risk of contracting viral infections. During pregnancy, the immune status of the woman is suppressed because it acts to protect both the mother and her unborn baby. The purpose of this study was to provide an overview of available evidence on the risk of contracting COVID-19 and COVID-19 infection prevention among pregnant women. Relevant and recent articles were identified from various databases. Article selection was aligned to the study questions. Articles that were related to study objectives were included and those not related to study objectives were excluded. A narrative report was produced and results were described according to study objectives. Approximately 8 data sources were included and most of the reviewed articles indicated that pregnant women are at a higher risk of getting COVID-19. The reviews further indicated that pregnant women can be prevented from this deadly virus by providing community antenatal services instead of visiting the Journal of Obstetrics and Gynecology, 10, 671-677. https://doi.org/10.4236/ojog.2020.1050060 Received: April 16, 2020 Accepted: May 8, 2020 Published: May 11, 2020 Copyright © 2020 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access health facilities. If a pregnant woman develops symptoms of respiratory infection, it is advisable to seek immediate diagnosis to rule out COVID-19 and get appropriate management to avoid complications. The selected studies’ quality was appraised through Mixed Methods Appraisal Tool (MMAT) version 2018. Knowledge on the risk of COVID-19 infection among pregnant women will help health workers especially midwives who take care of pregnant women to design confidently and put into action preventive programs to address health needs of pregnant women who are at a higher risk of contracting COVID-19 as compared to other people in the general population. This also will assist health workers to provide appropriate care to pregnant women on the basis of their COVID-19 infection risk status at health facility and community levels. This study review is also creating more awareness on the risk of COVID-19 to pregnant women even in communities. It serves as evidence to guide health policymakers to put emphasis on addressing the preventive measure of this greatly vulnerable group of population. To prevent COVID-19 infection during pregnancy, pregnant women should strictly follow the laid down measures of prevention by World Health Organisation (WHO) and their local health authorities
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    Does Breast Cancer Risk Awareness Motivate Personal Prevention Practices: Findings from a Community-based Assessment?
    (2016-01) Ouma, J.; Olang’, S.; Asweto, Collins O.; Obago, I. T.; Kaseje, D.
    Breast cancer, is the leading cause of cancer specific mortality. But nearly 80% of the mortality is preventable by early diagnosis. We assessed knowledge and practice of breast cancer prevention by women in a rural community setting. Data was collected on demographics, family history, knowledge and practice of breast cancer by interviewer administered questionnaire. Knowledge (including knowledge of risk) and practice were measured using a response-based score to a set of 9 and 10 questions respectively. Prevalence odds ratio was calculated to estimate association between independent and outcome variables. Knowledge of breast cancer risk was low (14.2%). Family history and socioeconomic status were significantly associated with knowledge; respondents with more than eight years of school were more likely to have higher knowledge (OR=2.859; CI=1.578-5.178). Practice of prevention was equally low (17.2%). Practice was significantly associated with knowledge; respondents with higher knowledge of prevention were more likely to practice prevention (OR=6.8; CI=3.308-14.104). We propose that community-based risk communication and awareness creating programs may motivate breast cancer prevention practices. Women of lower socio-economic status should especially be targeted with such interventions. There is need to develop these into a sustainable community-based health education program.
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    Early growth in preterm infants after hospital discharge in rural Kenya: longitudinal study
    (Pan African Medical Journal, 2016-06-22) Mawia, Diana S.; Chege, Margaret N.; Oyieke, Jennifer
    Prematurity is the single most important cause of mortality during the neonatal period. The early growth of these infants has been shown to be a predictor of their later growth and neurodevelopmental outcomes. The objective of this study was to establish the determinants of early growth in preterm infants after hospital discharge at the Kitui District Hospital, Kenya. Methods: A short longitudinal study design was adopted to execute the study. During the period of April and June 2014, all the preterm infants who were discharged from the Kitui District Hospital Newborn Unit were enrolled in the study by obtaining written informed consent from their guardians. The anthropometric measurements of these infants were taken at discharge and repeated two weeks later at the Pediatric Outpatient Clinic and the Maternal Child health Clinic. A questionnaire guided interview was held with the guardians to establish infant and maternal characteristics which influenced the infants' early growth. Results: A total of 112 participants were enrolled for the study with 106 (94.4%) of them being available for reassessment after two weeks. Majority (72.6%) had deficit in growth by failing to attain the recommended WHO average weight gain of 15g/kg/day. Most of the mothers (63.4%) were between the ages of 20-29 years with half of them being first time mothers. Many of them (66.1%) had only attained primary education and were married (66.1%) to self-employed husbands (56%). Conclusion: Most of the preterm infants at discharge were females who were born between 33 and 36 weeks gestation. Growth deficit was present in the majority and gestational age at birth was a major determinant of the early growth in these preterm infants.
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    Early Mobilization and Physical Activity Improve Stroke Recovery: A Cohort Study of Stroke Inpatients in Kisumu County Referral Hospitals, Kenya
    (2016-01) Ogolla, M. M.; Opemo, D. O.; Asweto, Collins O.
    Early mobilization in acute stroke care is highly recommended in a range of developed countries policy; however, in developing countries like Kenya, lack of evidence seems to hinder formulation and implementation of policy guideline on early mobilization in acute stroke care. Therefore, to estimate the safe optimal time for early mobilization of stroke patients in Kenya, we conducted a prospective cohort study in two purposively selected health facilities in Kisumu County, Kenya. About 100 stroke patients admitted in medical wards (mean age 59.1±2.3 years, females 61%) were recruited. Barthel Index’ tool was used to assess recovery and physical activity levels. It comprised of scoring scale ranging from 0-100. The participants were categorized as follows: Patients who score between 0 – 30 were considered as mildly recovered, 31 - 60 as moderately recovered and patients who score from 61 – 100 were regarded as fully recovered. Multiple logistic regression model was used to compute adjusted ORs (AOR) of early mobilization and Barthel Index variable, adjusting for age, gender and type of stroke. Early mobilization improves patient recovery. Participants in early mobilization group were more like to independently feed, groom, dress, use toilet, use wheel chair and climb stairs with help compared to late mobilization (p <0.05). Most (76%) participants who were exposed to high physical activity had full recovery than the (5%) bones in low physical activity (p< 0.001). This study provides evidence that early mobilization and high physical activity improves stroke patient recovery.
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    Effects of female genital mutilation on physical, social and psychological health of the victims
    (EuroSciCon, 2018-06) Kirigia, Consolata
    Female circumcision also known as female genital mutilation (FGM), involves none medical cutting or removal of some parts or the entire external female genitalia. FGM is known to cause physical health problems such as scaring or formation of keloids, infertility, infections and menstrual difficulties. FGM also causes complications during labor and delivery, which include prolonged labor, post-partum hemorrhage and perineal tears. Psychological problems are major effects such as depression, low self-esteem and post-traumatic stress syndrome. Social health problems to victims and indirectly to significant others may include lack of intimacy related to sexual dysfunction like arousal, orgasm, lubrication and satisfaction. The practice is very rampant in most African countries and the effects have global impacts. Much is being done to try and alleviate the suffering of the victims as well as trying to eradicate the practice by educating communities through their leaders, men involvement and coming up with policies that protect the rights of women against such gender based violence. Studies have been done on FGM but still there is literature gap on the global physical, social and psychological effects of FGM. These effects need to be studied specifically on the victims as the study group and the survivors as the control group. Such studies will provide evidence to healthcare providers to effectively initiate high quality medical care to both the victims and the survivors of FGM.
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    Effects of increased residential mobility and reduced public spaces Effects of increased residential mobility and reduced public spaces mobility in containing COVID-19 in Africa
    (Global Reports, 2020-09) Asweto, Collins O.; Onyango, Patrick O.; Alzain, Mohamed A; Wang, Wei
    Background Background The rising COVID-19 crisis threatens to disproportionately hit African countries. As a result, most African governments have temporarily closed schools and non-essential businesses or banned social gatherings to contain the disease. It is therefore important to estimate the level of transmission reduction as a result of these measures. This study aimed at predicting COVID-19 cases in Africa based on COVID-19 community mobility report. Methods Methods Our study focused on 26 African countries whose community mobility data were available online. The number of daily confirmed cases for the period of February 15th, 2020 to May 29th, 2020 for each country was obtained from European Center for Disease Prevention and Control (ECDC) COVID-19 cases geographic distribution data. Multiple linear regression was performed to investigate the relationship between COVID-19 community mobility and confirmed cases. Results Results The maximum public place mobility change was -38.15% with an average of -18.85% (±3.47); residential mobility was at 23.17% with an average of 11. 268% (±1.448). The number of confirmed cases had a significant negative correlation with residential mobility change (r = -0.878, P<0.01) and positive correlation with public place mobility change (r = 0.881, P<0.05). Both mobility changes in public spaces and residential are significant predictors of COVID-19 cases. More specifically, about 1% change in a public place and residential mobility would result in 167 less COVID-19 daily cases, while total lockdown would result in 581 fewer daily cases. Conclusions Conclusions Our analysis shows that a COVID-19 containment strategy that focuses on increasing residential mobility and reducing public spaces mobility is effective. Therefore, the finding supports containment measures that aim to limit the movement of people.
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    Effects of increased residential mobility and reduced public spaces mobility in containing COVID-19 in Africa.
    (UoEm, 2020-09-28) Asweto, Collins O; Onyango, Patrick O; Alzain, Mohamed A; Wang, Wei
    The rising COVID-19 crisis threatens to disproportionately hit African countries. As a result, most African governments have temporarily closed schools and non-essential businesses or banned social gatherings to contain the disease. It is therefore important to estimate the level of transmission reduction as a result of these measures. This study aimed at predicting COVID-19 cases in Africa based on COVID-19 community mobility report.
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    Experience and Perceptions on Preterm Births among Women Attending ANC Clinic at Kisumu County Hospital, Kenya.
    (researchjournali, 2018-03) Samba, Benard O.; Ayodo, George; Amimo, Fred; Asweto, Collins O.
    Preterm birth is one of the main causes of neonatal death, and it is now the second leading cause of death after pneumonia in children under the age of five. Kenya is estimated to have 12.3% preterm births and 22 neonatal deaths per 1000 live births. It is important to explore the experience and perceptions on preterm births among women attending ANC clinic. A survey was conducted at Kisumu County hospital, Kenya. Focus Group Discussion (FGD) and In Depth Interview (IDI) were used to collect data on preterm birth (PTB) experiences. The four-step iterative process of qualitative data analysis to generate the final interpretation was employed. This study established that mothers are aware of the gestation period (9 months or 39 weeks) in pregnancy, are able to monitor how close they are to the Estimated Date of Delivery (EDD). Mothers with history of PTB or with twin/multiple births had a high risk of premature delivery. Information on PTB was not provided during ANC. ANC services should be expanded to be effective for the detection, treatment or prevention of conditions associated with PTB (serious morbidity or mortality). There is need to investigate the capacity of health care providers to provide quality ANC health information and services with regard to PTB.
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    Facilitators to Immediate Post Partum Intra Uterine Contraceptive Device Uptake among Mothers Delivering in Meru Hospital
    (Scientific Research Publishing, 2019-04) Kirigia, Consolata; Gitonga, Lucy; Muraya, Moses Mahugu
    Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is important to promote uptake of family planning services because it is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. It is also enshrined in health related Sustainable Development Goals. Post Partum Intra Uterine Contraceptive Device (PPIUCD) is the oldest methods of family planning. During the ancient times, foreign bodies like stones were introduced into the woman’s uterus for prevention of pregnancy. Post partum method of contraception is highly recommended because it is long acting, convenient, safe and highly effective with minimal side effects compared to the hormonal methods. Despite these advantages, the method is the lowest in use globally, regionally and locally. According to the Meru Hospital records for the year 2017, the immediate PPIUCD uptake was very low at 3.4%. The broad objective of this study was to assess the factors that facilitate uptake of PPIUCD at Meru Hospital. The study site was post natal ward maternity department of Meru Hospital for a period of two months that is September and October in the year 2018. A descriptive research design was used and the study population was the mothers who were admitted in the ward during the study period. A sample size of 74 respondents was used as the representative to the target population of 289 mothers. Simple random sampling was used to get the sample for the facilitators. Data were collected using structured questionnaires and interview schedules. The data collection instruments were pretested at Embu Level five Hospital and split half reliability test technique used. Validity was ensured through review of literature from similar studies and by consulting supervisors in the department. Permission to conduct the study was sought from National Commission for Science, Technology and Innovation through Chuka University Ethics and Research Committee. De-scriptive analysis was done to get percentages using Statistical Package for Social Science (SPSS) for windows version 23.0. Qualitative data were analyzed by grouping data into themes according to the study objectives. The analyzed data were presented in tables, charts and narratives. The findings of the study revealed that; the main client related facilitators to PPIUCD uptake were older age above 30 years, employment, tertiary level of education and knowledge on the method as a result of the providers’ effort to share information. That is 70% of older aged mothers, 60% of the employed and 40% with tertiary education had the insertion. The main provider facilitator to PPIUCD uptake was timely counseling and insertion services. 20% of those who had the insertion said that timely counseling was done during antenatal period. The main method related facilitator to PPIUCD uptake was past experience and preference to alternative methods of contraception. 50% of those who accepted the insertion had previous bad experience and side effects of other alternative methods. Some 30% of users perceived that the method was effective and convenient because once inserted no need for frequent visits to the clinic. The study concluded that clients, providers and method factors facilitated uptake of immediate PPIUCD. The study recommends putting in place strategies to improve the uptake of the method by considering the client, provider and method related facilitators.
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    Factors affecting health seeking behaviour in hypertensive patients of Imenti North sub county, Kenya
    (2021-01-14) Kirigia, Consolata; Kamweru, Paul Kuria; Mwenda, Annarita Kajuju,
    Background: Prevalence of non-communicable diseases like hypertension is raising hence a burden to low resource countries like Kenya. Purpose of the study was to determine factors affecting health seeking behaviour in hypertensive patients in Imenti North sub county, Kenya. Methods: A cross-sectional study design and cluster random sampling method was used to select five health facilities for study. Purposive sampling was used to select total of 212 patients from selected health facility proportionally. Spearman’s Rho correlation and bivariate logistic regression was used to check for strength of associations. Results: Patients interviewed had an average of 51 years and higher proportions were above 40 years of age. Married and female patients were (66.5%), and 60% respectively. An average of (42%) had a secondary level of education. Knowledge on lifestyle modification strategies was above average (68%). Conclusions: Health education given during hypertensive clinics had positive influence. Slow service delivery, long queues and the long waiting times for laboratory investigation results influenced patients’ health seeking behavior negatively. The study recommends the government of Kenya to develop policies on implementation of support groups among hypertensive patients in all hospitals and intensify campaigns on importance of seeking medical attention early. This will empower the patients on knowledge of hypertension management. The study also recommends health care providers to ensure reduced waiting time for the patients.
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    Factors Contributing To Abortions among Youths Aged 18 -25 in Rift Valley Provincial General Hospital Nakuru
    (2016) Maingi, Nancy; Ndungu, J.; Ndungu, E.; Okova, R.
    Background Worldwide, unsafe abortion persists as a serious and continuing public health challenge (WHO, 2011). Unsafe abortion mainly endangers women in developing countries where it is highly restricted by law and countries where, although legally permitted, safe abortion is not easily accessible (WHO 2012). Of estimated 464,690 induced abortions in Kenya, majority is unsafe; involving girls and young women aged 10-24 years (APHRC, MOH, 2013). In Kenya, severe complications of unsafe abortions were most common among women aged 10- 19 (45%), divorced women (56%) (MOH, 2013) . The Cost of unsafe abortion to healthcare system is approximated at Ksh 250–300 million annually (CRR, 2010). In Nakuru provincial general hospital there were total of 604 abortions in 2014 out of which 63% involved the youth in the range of 18 to 25 years. Abortions are currently claiming 30-40% of maternal deaths in Kenya, far more than the worldwide average of 13% (WHO, 2011). Methods The study was a descriptive cross sectional study .Systematic random sampling technique was used to pick 192 participants. The sample was determined using the formula by W. G. Cochran (2011). Data collection was through questionnaires, key informant interview and focused group discussions. Ethical clearance was sought from Mount Kenya University ethics review committee. Results Majority 57.3% of the respondents have had an abortion while 42.7% have never had an abortion. 67% of the respondents had unprotected sex, 21% undertook abortion following rape, while 12% did it because of medical reasons. 33.3% respondents’ parents don’t know their daughters have had an abortion 37% of the respondents agreed they would never attempt an abortion again. 55.7% of the respondents think youths require guidance and counseling. 85.9% of the respondents are comfortable talking to a friend matters concerning sexuality, 9.4% are comfortable talking to parents, 3.6% would be comfortable talking to the teacher, while 1% would be comfortable talking to a health worker. On whether the respondents attributed their getting pregnant to the influence of the drugs, 61% attributed it to influence of the drugs, while 39% did not attribute it to drug influence. A key informant indicated, “reasons for inducing an abortion included: wanting to continue with studies, relationship problems and socio-cultural factors.” “Misoprostol was revealed to be the most frequently used method to end pregnancy while mechanical means, such as insertion of a foreign object or substance through the cervix and use of herbs were however commonly reported.” Key informant interview revealed that lack of information on sexual reproductive health (SRH) was a major issue among youths. Conclusion Use of drugs has a role to play in the high rate of abortions among youth 18-25 as 66.1% of youth were under influence of alcohol during their first sex and these affected the decision making and negotiating for safer sex. There is a dire need for sexual health education.
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