http://erepository.uonbi.ac.ke/handle/11295/14106 2026-05-24T04:04:11Z http://erepository.uonbi.ac.ke/handle/11295/166715 Beyond the jab: Unravelling the complexities of vaccine adoption for East Coast Fever in rural Kenya Muema, Josphat; Muthiru, Ann W; Nyamai, Mutono; Thumbi, S M; Bukachi, Salome A East Coast Fever (ECF) is one of the leading causes of livestock mortality and reduced productivity across Eastern Africa, and while a live vaccine against it known as the Infection and Treatment Method has existed for three decades now, its adoption by affected communities remains low. This study sought to provide a detailed examination of the dynamics that shape Infection Treatment Method (ITM) vaccine adoption behaviours. The study examined individual, socio-cultural and ecological- level factors influencing ITM adoption using the socio-ecological model. Analyzing data obtained from 18 focus group discussions, 30 in-depth interviews with livestock keepers, and 25 key informant interviews conducted with community stakeholders, the study identified factors associated with vaccine adoption within pastoralist communities in rural Kenya. These factors included knowledge and awareness of the Infection Treatment Method vaccine, its cost, livestock keepers' perceptions of East Coast fever relative to other livestock diseases, wildlife-livestock interactions, climate as contributing factors, and wildlife-livestock interactions influencing ECF risk and severity. Overall, the study findings emphasize the need for multifaceted strategies to increase vaccine adoption among livestock keepers. Copyright: © 2025 Muthiru et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 2025-01-01T00:00:00Z http://erepository.uonbi.ac.ke/handle/11295/164336 Quality assessment of clinical practice guidelines in Kenya using the AGREE II tool: a methodological review Sagam, Caleb K; Were, Lisa M; Otieno, Jenifer A; Mulaku, Mercy N; Kariuki, Simon; Ochodo, Eleanor Objective: To assess the quality of available and accessible national Clinical Practice Guidelines (CPGs) in Kenya using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Methods: We searched the websites of the Kenyan Ministry of Health, professional associations and contacted experts in relevant organisations. Our scope was guidelines on maternal, neonatal, nutritional disorders, injuries, communicable and non-communicable diseases in Kenya published in the last 5 years until 30 June 2022. Study selection and data extraction were done by three independent reviewers with disagreements resolved via discussion or with a senior reviewer. We conducted a quality assessment using the online English version of AGREE II tool across six domains. Descriptive statistics were analysed using Stata software V.17. The primary outcome was the methodological quality of the included CPGs assessed by the AGREE II tool score. Results: We retrieved 95 CPGs and included 24 in the analysis after screening for eligibility. The CPGs scored best in clarity of presentation and least in the rigour of development. In descending order, the appraisal scores (mean and CI) per domain were as follows: Clarity of presentation 82.96% (95% CI 78.35% to 87.57%) with all guidelines scoring above 50%. Scope and purpose 61.75% (95% CI 54.19% to 69.31%) with seven guidelines scoring less than 50%. Stakeholder involvement 45.25% (95% CI 40.01% to 50.49%) with 16 CPGs scoring less than 50%. Applicability domain 19.88% (95% CI 13.32% to 26.43%) with only one CPG scoring above 50%. Editorial independence 6.92% (95% CI 3.47% to 10.37%) with no CPG scoring above 50% and rigour of development 3% (95% CI 0.61% to 5.39%) with no CPG scoring at least 50%. Conclusion: Our findings suggest that the quality of CPGs in Kenya is limited mainly by the rigour of development, editorial independence, applicability and stakeholder involvement. Training initiatives on evidence-based methodology among guideline developers are needed to improve the overall quality of CPGs for better patient care.; Objective: To assess the quality of available and accessible national Clinical Practice Guidelines (CPGs) in Kenya using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Methods: We searched the websites of the Kenyan Ministry of Health, professional associations and contacted experts in relevant organisations. Our scope was guidelines on maternal, neonatal, nutritional disorders, injuries, communicable and non-communicable diseases in Kenya published in the last 5 years until 30 June 2022. Study selection and data extraction were done by three independent reviewers with disagreements resolved via discussion or with a senior reviewer. We conducted a quality assessment using the online English version of AGREE II tool across six domains. Descriptive statistics were analysed using Stata software V.17. The primary outcome was the methodological quality of the included CPGs assessed by the AGREE II tool score. Results: We retrieved 95 CPGs and included 24 in the analysis after screening for eligibility. The CPGs scored best in clarity of presentation and least in the rigour of development. In descending order, the appraisal scores (mean and CI) per domain were as follows: Clarity of presentation 82.96% (95% CI 78.35% to 87.57%) with all guidelines scoring above 50%. Scope and purpose 61.75% (95% CI 54.19% to 69.31%) with seven guidelines scoring less than 50%. Stakeholder involvement 45.25% (95% CI 40.01% to 50.49%) with 16 CPGs scoring less than 50%. Applicability domain 19.88% (95% CI 13.32% to 26.43%) with only one CPG scoring above 50%. Editorial independence 6.92% (95% CI 3.47% to 10.37%) with no CPG scoring above 50% and rigour of development 3% (95% CI 0.61% to 5.39%) with no CPG scoring at least 50%. Conclusion: Our findings suggest that the quality of CPGs in Kenya is limited mainly by the rigour of development, editorial independence, applicability and stakeholder involvement. Training initiatives on evidence-based methodology among guideline developers are needed to improve the overall quality of CPGs for better patient care. 2023-01-01T00:00:00Z http://erepository.uonbi.ac.ke/handle/11295/153067 Pattern and Clinical Presentation of Spondylodiscitis at Kenyatta National Hospital Abdullahi, Adan M Background: Spondylodiscitis is rare, often diagnosed late and can present with devastating complications. Spondylodiscitis accounts for 2%–4% of all cases of bone infection. To date there is limited local data that describes the patterns and clinical presentation of spondylodiscitis. Study Objective: To determine the pattern and clinical presentation of patients with spondylodiscitis at Kenyatta National hospital. Study Duration: November 2018 to January 2019 Study population: Patients diagnosed with spondylodiscitis at Kenyatta National hospital. Study Design: Cross-sectional study. Methodology: Forty-two patients with MRI diagnosis of spondylodiscitis were recruited in this study. Information on presenting symptoms, examination findings and radiological features (number and level of vertebrae involved and presence or absence of abscesses) were collected. Data Processing: The collected data was coded and analysed using the SPSS v. 25 for windows. Data was analysed for frequencies, means and variances. A student T test was used to compare means in different gender and age groups. Results: The age of the participants ranged from 16 to 72 years with a mean age of 39.7±13.4 years. The male female ratio of the participants was 2: 1. Risk factors for spondylodiscitis included smoking, HIV infection, positive history of PTB and DM in 45.2% (n=19), 17% (n = x 7), 11.9% (n=5) and 4.8% (n=2) respectively. Most patients presented with back pain, localized around the thoraco-lumbar (28.6%), lumbar (26.2%) and thoracic (50%) spine. The mean duration of the pain was 5.7±2 months. Most (97.6%) of the patients presented with limb weakness, and a sensory level in 76.2%. Eight patients (19%) had open biopsies with subsequent histology. In these eight patients, 5 were cultured and stained positive for mycobacterium tuberculosis. Using the MRI, the lesion was located in the cervical, thoracic, thoracolumbar and lumbar spine in 4, 21, 9 and 8 of the participants respectively. None of the patients presented with skip lesions. Most (n=36) of the patients presented with a single level lesion. Six patients presented with multilevel contiguous lesions. Nine patients had features of scoliosis (Cobbs angle >100). Seven participants had lumbar while two had thoracic spine scoliosis. Conclusions: In this setting, spondylodiscitis is diagnosed late, with significant neurological deficits, predominantly affects males, and is localised in the thoracic region. Smoking is an important risk factor. Recommendations: A high index of suspicion is recommended for all middle-aged patients with isolated back pain, with additional risk factors such as smoking, diabetes mellitus, pulmonary TB or HIV. 2020-01-01T00:00:00Z http://erepository.uonbi.ac.ke/handle/11295/101075 Determinants of capital structure of companies listed at Nairobi stock exchange (NSE). Odinga, George, O This paper studies the determinants of capital structure of companies listed at Nairobi stock exchange (NSE). The main objective is to investigate the relationship between capital structures and hypothesized influential variables such as asset tangibility, growth, size, business risk (earning volatility) profitability and non-debt tax shield. Using multiple regressions as the tool of analysis, the result predict that these variables influence leverage at a varying degree with profitability and non-debt tax shield being the most significant variables in determining leverage.; This paper studies the determinants of capital structure of companies listed at Nairobi stock exchange (NSE). The main objective is to investigate the relationship between capital structures and hypothesized influential variables such as asset tangibility, growth, size, business risk (earning volatility) profitability and non-debt tax shield. Using multiple regressions as the tool of analysis, the result predict that these variables influence leverage at a varying degree with profitability and non-debt tax shield being the most significant variables in determining leverage. 2003-01-01T00:00:00Z