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Determinants and management of cardiac toxicities induced by anthracycline-based regimens in adult patients
with cancer at Kenyatta national hospital.

Background: Anthracyclines are used in the standard treatment protocols for solid and hematological cancers. Despite their extensive usage, they cause cardiac toxicities. These toxicities require prompt management to reduce the risk of their complications.

Objective: To investigate the determinants and management strategies of anthracyclines induced cardiotoxicities in adult patients with cancer at Kenyatta National Hospital.

Methodology: A cross-sectional study was conducted at the Kenyatta National Hospital. A total of 149 adult cancer patients on the anthracycline-based regimen were recruited to participate in the study through consecutive sampling. Data was collected using a researcher administered questionnaire. The analysis was carried out using STATA version 13 and the level of significance set at 0.05.

Results
There was female predominance (97.3%) and twenty-two (14.8%) participants had comorbidities especially hypertension (10, 6.7%). The majority (140, 94.0%) had breast cancer and 59 (39.6%) had the disease for a duration of 1-2years. One hundred and thirty-four (89.9%) were using doxorubicin and cyclophosphamide combination. Nineteen (12.8%) participants had a reduced ejection fraction along with type I diastolic dysfunction. Independent predictors of cardiotoxicity were hypertension (p=0.026);
trastuzumab use (p=0.011), occupation (p=0.046) and Body mass index (p=0.043) respectively.
However, all the participants were not put on any intervention geared towards managing the cardiac toxicities.

Conclusion
High BMI was an independent predictor of cardiac toxicities. Similarly, the presence of hypertension and the use of trastuzumab were also identified as independent predictors of cardiac toxicities in patients using the anthracyclines-based regimen.

Recommendations
Weight reduction should be encouraged and hypertension appropriately controlled.

Supervisors

Dr. Peter Karimi
Dr. Irene Weru
Dr. Stanley Ndwigah

DETERMINANTS OF HPV VACCINE HESITANCY AMONG PARENTS ATTENDING KENYATTA NATIONAL HOSPITAL OUTPATIENT CLINICS

Background: Cervical cancer is mainly caused by the oncogenic Human Papilloma Virus (HPV) infection which is prevented among pre-adolescent girls by prophylactic administration of the HPV vaccine prior to sexual debut. Kenya has recently rolled out the HPV vaccine in the national routine Immunization initiative. There are concerns that parents may be hesitant about taking their children for vaccination.

Objective: The purpose of this study was to identify the prevalence, reasons and risk factors for HPV vaccination hesitancy among parents attending Kenyatta National Hospital (KNH) outpatient clinics.

Methods: A prospective descriptive cross-sectional study was conducted in the Kenyatta National Hospital Medical clinics in the year 2020. The study participants included both male and female patients who were parents of adolescents. Participants were selected using quasi random sampling approach. Data collection was done using a structured questionnaire that was administered by face-to-face interviews. Data that was collected included participants’ socio-demographic, their knowledge and beliefs about the HPV vaccine as well as their reasons for vaccination acceptance. STATA 13 was used to analyze the data. Descriptive, inferential statistics and logistic regression analyses were done. The levels of significance were set at 0.05.

Results: Cumulatively, 93.5% of the 195 parents recruited into the study were aged above 30 years. The largest age group were those aged above 40 years. Despite low knowledge levels about the HPV vaccine, and a high prevalence of negative beliefs (30%), parental willingness was high with 90% willing to have their children vaccinated. The main reasons given for hesitancy to have their children vaccinated were safety concerns (76%) and the feeling that the child was too young (48%). Positive beliefs, knowledge score and gender were positively associated with willingness to have the child vaccine. High education attainment was negatively associated and increasing age were negatively associated with willingness to have the child vaccinated. Male parents had lower levels of knowledge about the HPV infection, cervical cancer and the HPV vaccine compared to their female counter parts. The most widely cited source of information on HPV vaccine was fellow workers in the work place followed by the television.  Education status was positively associated knowledge levels. The beliefs on the HPV vaccine were noted to be average. More females than males believe the vaccine is effective. Beliefs were positively influenced by knowledge and occupation. We found that 59% of parents would consult their daughters before initiating the vaccination process and 77% recommended adolescents sex education.

Conclusion: Gender neutral interventions should be encouraged. Interventions that simultaneously involve both adolescents and parents should be designed and disseminated.

Supervisors

Dr. Sylvia A. Opanga (PhD)

Department of Pharmaceutics and Pharmacy Practice,

University of Nairobi.

Dr. Alfred R. Birichi  (M.Pharm)

Deputy Director, Pharmaceutical Services,

Kenyatta National Hospital.

Rational Use of Antibiotics Among Patients Admitted to Critical Care Units at Kenyatta National Hospital and Its Impact on Clinical Outcomes.

Background: Irrational use of antibiotics is associated with antimicrobial resistance and high mortality rate in the critical care units. In Kenya, there is scarce data on rational use of antibiotics within critical care units and its impact on patient clinical outcomes.

Objectives: To evaluate rational use of antibiotics among patients admitted to various Critical Care Units at Kenyatta National Hospital and its impact on clinical outcomes.

Methods: Retrospective, cross-sectional record review of admissions to the KNH CCUs conducted over two years. Socio-demographic and clinical characteristics of patients were captured in a predesigned tool. Associations between clinical characteristics and mortality were calculated at p<0.05.

Results: Cephalosporins (49.6%), 5-nitroimidazoles (18.2%) and penicillins (14.2%) were the most frequently prescribed classes of antibiotics. The prevalence of irrational use of antibiotics was high at 81.5%. Mortality at critical care units was 11.1%, with the odds of death being at least five times among intubated patients compared to those who were not (AOR 5.5, 95% CI=1.1-28.1, p=0.042).

Conclusion: The prevalence of rational antibiotic use was 18.5%. The high proportion of irrational use was contributed by incorrect choice and incorrect duration of antibiotic use.

Supervisors

Dr. David G. Nyamu,

Dr. Rosaline N. Kinuthia,

Dr. Peter Njogu

HEALTH-RELATED QUALITY OF LIFE AND DRUG THERAPY PROBLEMS IN PATIENTS WITH SICKLE CELL DISEASE ON HYDROXYUREA AT KENYATTA NATIONAL HOSPITAL

Background: Sickle cell disease is an inherited genetic disorder caused by presence of a mutated form of hemoglobin. Multi-organ involvement and painful crises are the hallmarks of sickle cell disease. Studies have revealed that patients with sickle cell disease have a lower quality of life compared to the general population. Hydroxyurea is the standard therapy for the management of sickle cell disease.

Objective: To determine the health-related quality of life and drug therapy problems with hydroxyurea use in patients with sickle cell disease at Kenyatta National Hospital.

Methods: A cross-sectional study was conducted at the Kenyatta National hospital hemato-oncology clinic. Sixty-seven participants were eligible. Enrolled participants answered questionnaires designed to collect information on the socio-demographic and medical characteristics. The World health organization Quality of Life (QoL) tool was used to determine the health-related quality of life score. 

Results: Participants had a median age of 20.7 (±7.2) years, 52% were male and had experienced several sickle cell disease-related complications with acute chest syndrome (65.7%) being the most prevalent. The most frequently reported clinical symptoms included headache (44%) and painful crisis (38.8%). Non-compliance (86.6%) was the most prevalent drug therapy problem. In the quality of life assessment, psychological health had the highest score of 68.2%. Positive family history (p=0.030) (6.58 CI 0.66, 12.50) was significantly associated with better overall quality of life scores. Vomiting (p=0.099) (4.77 CI -10.46, 0.93) and chest pain (p=0.697) (1.71 CI -10.43, 7.02) were associated with lower overall quality of life scores.

Supervisors

Dr. Peter N. Karimi

Professor Faith A. Okalebo

Degree: Doctor of Philosophy Degree in Clinical Pharmacy

School/Faculty: School of Pharmacy

Thesis title: Characterization of the Steady State Concentrations and Pharmacogenetics of Ritonavir Boosted Atazanazavir in Kenyan HIV Positive Patients.