Medicine and Health Sciences Commons^™

Nursing Leaders’ Ethical Decision-Making About Professional Boundaries And Nurse-Patient Relationships: A Mixed Methods Explanatory Sequential Design, Pamela Scott

Theses & Dissertations

The purpose of this mixed methods explanatory sequential design study was to ascertain nursing leaders’ knowledge and skill in ethical decision-making when evaluating and managing professional nurse-patient relationship boundaries. It was also the purpose of this study to better understand nursing leaders’ perception of moral, cognitive, and organizational factors influencing their ethical decision-making in evaluating and managing professional nurse-patient relationships, with the intent of generating a theory grounded in the views of the participants as a final outcome of the study. The two theories, virtue ethics and self-efficacy comprise the ethicality construct of the conceptual framework explaining the nurse leaders’ …

Diagnostic Accuracy Of Multi-Parametric Mri In Diagnosis Of Clinically Significant Prostate Cancer, Mariah Obino

Theses & Dissertations

Background: Traditionally, the diagnosis of prostate cancer has been based on an elevated prostate specific antigen or an abnormal digital rectal examination and confirmed histologically following prostate biopsy. This has led to a number of men without cancer or with clinically insignificant disease undergoing unwarranted prostate biopsies and suffering consequent complications. Pre-biopsy multi-parametric MRI plays a vital role in determining men with clinically significant cancer who need biopsy and those with a negative MRI who can safely avoid an unwarranted biopsy. Whereas studies on the value of multi-parametric MRI have been done elsewhere, there is variation in prevalence of prostate …

Prevalence Of Suspicious Mammographic Calcification In Newly Diagnosed Breast Cancer Patients At The Aga Khan University Hospital, Nairobi., Mariam Abdullahi Omar

Theses & Dissertations

Introduction: The most common cancer affecting women in Kenya is breast cancer with an incidence of 40.3 per 100 000 at risk population in 2018(1) while Nairobi has a higher incidence of (ASR 51.7 per 100,000) (2).This constitutes a major public health problem so early diagnosis plays a major role in mortality reduction and improving prognosis of breast cancer(3). Mammography is the most sensitive technique for detecting non palpable lesions. Over the decades it has been shown that in the USA there has been significant reduction in breast cancer mortality by 40% due to screening mammogram (4). On mammography the …

Magnitude Of Screening For Gestational Diabetes Mellitus In An Urban Setting In Tanzania, Akampa Mukuve

Theses & Dissertations

Background: Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During pregnancy it is important to detect conditions which may harm the mother and fetus during antenatal care (ANC). Gestational diabetes mellitus (GDM) is one such condition which causes adverse effects during pregnancy, acutely and in the long term. There is lack of consensus on uniform screening and diagnostic guidelines for GDM both internationally and locally. Furthermore, there is evidence that recommendations in antenatal care guidelines are not routinely performed by health care providers …

Comparison Of The Sofa And Qsofa Scores In Predicting In-Hospital Mortality Among Adult Critical Care Patients With Suspected Infection., Mohammed Said

Theses & Dissertations

Background: Sepsis is global health priority and the commonest cause of death in critical care. SEPSIS 3 criteria introduced in 2016 is the latest tool in diagnosing sepsis, uses qSOFA and SOFA scores in place of the SIRS based definition for better prediction of mortality in patients with suspected infections. Their performance in predicting mortality in critical care units outside high- income countries remains largely unknown.

Objective: We compared the SOFA and qSOFA scores in predicting the hospital mortality of adult critical care patients admitted with suspected infection at the Aga Khan University Hospital Nairobi, Kenya.

Methods: We did a …

Complementary Feeding Practices And Their Determinants In Infants And Young Children On Follow Up At A Private Tertiary Hospital In Nairobi, Catherine Muthoni

Theses & Dissertations

Background: More than a third of all deaths in children under five years of age worldwide, are linked to maternal and child under-nutrition. Appropriate complementary feeding is one of the interventions with the greatest potential for reduction of nutrition-related diseases and mortalities, yet uptake of the recommended World Health Organisation (WHO) infant and young child feeding practices in Kenya remains low. Despite provision of nutrition education at Aga Khan University Hospital- Nairobi (AKUH-N), both growth faltering and over-weight trends have been observed, pointing to both under- and over-nutrition.

Objectives: This study investigated caregivers' knowledge , attitude and practice (KAP) of …

Male Nurses’ Experience Of Gender Stereotyping Over The Past Five Decades: A Narrative Approach, Michael W. Finnegan

Theses & Dissertations

Negative stereotyping of men in nursing has been a chronic problem that has a direct effect on males and detracts from efforts to recruit and retain them. At this time in American history (2018), traditionally male-dominated professions are making significant progress toward the goal of a gender-balanced workplace. However, the opposite is not true. Traditionally female-dominated professions are not attracting or appealing to men. In the nursing profession, the number of male nurses is relatively small and has remained relatively fixed over time. Estimates vary between 6-15 percent, with the current average being approximately 11 percent (American Nurses Association, 2014). …

The Predictive Value Of Urine Dipstick Glucose Test In The Screening For Gestational Diabetes Mellitus In A Tertiary Private Hospital In Kenya, Janet Maranga

Theses & Dissertations

Background: Worldwide, there is no consensus on the best approach to diagnose gestational diabetes mellitus (GDM) and though oral glucose tolerance testing (OGTT) is considered the gold standard, practices in the administration and interpretation of the test differ depending on the guidelines in use. Previous studies have questioned the utility of glycosuria as a screening test for GDM. Since the studies were conducted, there have been diagnostic threshold changes that might impact its utility.

Justification: Diagnostic cut-offs of OGTT used in GDM diagnosis have evolved over time necessitating re-evaluation of glycosuria. The study was aimed at re-assessing the utility of …

Is There An Association Between Placental Inflammatory Lesions And Vaginal Microbiota In Preterm Labour? A Case Control Study, David Ogechi Atandi

Theses & Dissertations

Background: Preterm birth continues to be a significant contributor to neonatal mortality and morbidity despite diverse unique interventional strategies. There is need for better understanding of differences and influences of the now characterized vaginal microbiome on terminal inflammatory effects in the uterine microenvironment in term and preterm labour to improve on current strategies. How the existence of a postulated placenta microbiome also affects this understanding should be considered.

Objectives: The aim of this study was to explore the association between the maternal vaginal microbiota and placental inflammatory lesions in preterm labour and to determine the presence of a placenta microbiome …

Does The Theory Of Reasoned Action Inform The Willingness Of Individuals Undergoing Genetic Testing To Seek Disclosure Of Incidental Findings Related To The Risk For Alzheimer Disease?, Alisa M. Forrest

Theses & Dissertations

Background: In recent years, researchers have increasingly employed genetic testing as a means for understanding and treating diseases like Alzheimer disease, a common progressive disease affecting cognition and behavior. Genetic studies hold the potential for major breakthroughs in treatment of diseases like Alzheimer disease. However, with the increase in the use of genomewide association, microarray, and whole genome sequencing comes the potential for a greater number of incidental findings in genetic research—findings not central to the aim of a study but nonetheless informative about a participant’s health. Although many studies have documented the ethical implications around disclosure of such findings …

The Experience Of Female Veterans’ Transitioning To Post—Active— Duty Health Care, Sarah A. Bradwisch

Theses & Dissertations

Problem Statement: Female veterans are growing in record numbers and are the fastest growing segment of the veteran population in the United States(U.S.). After discharge from the military, female veterans face a difficult challenge in finding quality, efficient, and gender-specific health care following active duty. The growing number of female veterans in the Department of Veterans Affairs (VA) health care facilities has highlighted gaps in access to care and quality of care for female veterans. Methodology: Interpretive phenomenology was used to better understand the meaning of 11 U.S. female veterans’ experiences. Semi-structured telephone interviews and the analytic approach of Martin …

Eligibility And Patient Barriers To Peritoneal Dialysis In Patients With Advanced Chronic Kidney Disease, Saleem Mohamed Abdulkarim

Theses & Dissertations

Introduction: The burden of chronic kidney disease is on the rise in Kenya and is a significant cause of morbidity and mortality. While definitive treatment is renal transplantation, many patients require renal replacement therapy in the form of hemodialysis or peritoneal dialysis. The predominant modality utilized in Kenya is currently hemodialysis despite peritoneal dialysis having similar survival outcomes with the potential benefit of cost-effectiveness. There is need therefore to explore why peritoneal dialysis remains underutilized and whether patient factors may be contributory to barriers that limit the uptake of peritoneal dialysis.

Purpose: The main objective of this study is to …

Factors Associated With Cardiac Dysfunction Following Anthracyline-Based Chemotherapy In Adults In A Tertiary Hospital In Nairobi, Joseph Odunga Abuodha

Theses & Dissertations

Introduction: Anthracyclines are known to improve survival in some malignancies, but may also be associated with irreversible cardiotoxicity, which is partly dose dependent. Early detection of cardiotoxicity provides an opportunity for treatment adjustment. Several parameters predict development of clinically manifest cardiac dysfunction. The study aimed to evaluate clinical and echocardiographic parameters which predict development of cardiac dysfunction in a sub-Saharan African population.

Methods: Patients with a diagnosis of cancer and receiving anthracyclines at AKUH,N were evaluated if they met eligibility criteria (≥18years at first anthracycline administration, archived baseline echocardiogram, no prior history of heart disease or use of anthracyclines). …

Barriers To Definitive Hyper-Acute Management Of Stroke At A Tertiary Facility In Nairobi, Kenya, Caroline Wangui Mithi

Theses & Dissertations

Background: Stroke is a sudden neurological deficit due to a vascular cause, which can be ischaemic, haemorrhagic stroke or another cause. It is a leading cause of disability and long term functional impairment in the world. The definitive management of an acute ischaemic stroke is thrombolysis and/or mechanical thrombectomy, both of which has been shown to improve functional outcome but the utilization remains quite low in most hospitals, especially in Africa. This is due to certain pre-hospital and in-hospital barriers, and these factors have been shown to differ from country to country.

Objective: To determine the pre-hospital barriers that prevent …

Comparison Of Vaginal Microbiota In Women With Spontaneous Preterm Labour Versus Those With Term Labour, Edgar Gulavi

Theses & Dissertations

Background: Preterm birth presents a challenge on a global scale with a disease burden that is on the rise. It is a leading cause of perinatal morbidity and mortality worldwide with approximately 15 million preterm births every year. Kenya has a 12% preterm birth rate with about 190,000 babies born preterm every year. The female lower genital tract bacterial community plays a vital role in maternal and neonatal health. An association between altered vaginal microbial composition and preterm birth has been demonstrated in previous studies. However, findings in terms of composition and diversity of these bacteria across the few studies …

Chronic Post Mastectomy Pain In Adult Female Patients At Aga Khan University Hospital Nairobi, Jared Owour Mbete

Theses & Dissertations

Introduction: Breast cancer is a major cause of morbidity and mortality worldwide among women. The improvement in diagnostic and treatment strategies has led to a larger number of survivors who have breast cancer. However, there are complications attributed to breast cancer treatments, including chronic post mastectomy pain (CPMP). CPMP causes physical, social, emotional and functional disability. Once established, it is difficult to treat and negatively impact quality of life of the affected patients. Despite the big number of patients with breast cancer who undergo mastectomy at AKUHN, the burden of CPMP and factors associated with it remain unknown.

Objectives: To …

Quality Of Life And Its Determinants In Subfertile Patients Seeking Fertility Care At Two Urban Fertility Centres In Nairobi, Lawrence Makoha Sikuku

Theses & Dissertations

Introduction: Subfertility affects one in six couples worldwide with devastating psychosocial consequences impacting on quality of life (QoL). Assessment of QoL and institution of appropriate interventions in subfertility patients complements clinical management by reducing the psycho-social effects of subfertility and its treatment. No local or regional data exist on impact of subfertility on QoL using a fertility-specific QoL assessment tool.

Objective: The study sought to determine the QoL of subfertile patients seeking fertility care at two urban fertility centres in Nairobi using the Fertility Quality of Life (FertiQoL) tool.

Methods: This was a cross sectional study. Subfertile women of reproductive …

Relationship Between Gestational Diabetes And A Positive Depression Screen, Onegarach Herbert Ozelle

Theses & Dissertations

Introduction: Gestational diabetes mellitus (GDM) and its treatment have a marked effect on women’s lives consequently aggravating psychosocial disruptions of a normal pregnancy. The demand for behavioural adaptation as well as postulated biological interactions are likely to increase the risk of maternal depression in GDM patients. There is however inadequate literature concerning the relationship between GDM and depression.

Objective: To compare the proportion of women with GDM who screen positive for depression and the proportion of women without GDM who screen positive for depression at the Aga Khan University Hospital, Nairobi. Socio-demographic factors associated with a positive depression screen were …

Disease Activity And Functional Status And Their Relation To Depression In Patients With Rheumatoid Arthritis, Joe Rosana Rakiro

Theses & Dissertations

Introduction: Rheumatoid Arthritis, one of the commonest forms of inflammatory arthritis, has significant societal impact with regards to cost, induction of disability and loss of productivity. This impact is magnified in the presence of comorbid mood disorders, as these constitute independent factors for unexplained flares and relapses.

Purpose: The primary purpose of this study was to determine the correlation between disease activity and depression in Rheumatoid Arthritis patients.

Methods: Patients with Rheumatoid Arthritis attending rheumatology clinic at Aga Khan University Hospital, Nairobi were recruited into the study. The patients’ disease activity and functional status were assessed using the Clinical Disease …

Acceptability And Adequacy Of Vaginal Self Sampling For Hpv Dna Testing In Cervical Cancer Screening Among Women Attending A Tertiary Hospital Clinics In Nairobi Kenya, Sagal Omar Salad

Theses & Dissertations

Background: Cervical cancer is a main concern of women’s health globally. In Kenya, Cervical cancer is the second most common cancer in women and the leading causes of cancer related deaths.

Several screening methods exist including cytology, human papilloma virus DNA test and visual inspection with Acetic Acid or Lugol’s Iodine (VIA/VILI). The current screening rate uptake in Kenya is poor, HPV DNA self-sampling may have a role in increasing the screening uptake as many studies have shown that self-sampling for HPV DNA testing is acceptable, though some others favoured over self-sampling. This study aims to assess whether vaginal HPV …

Knowledge, Attitudes, Practices And Barriers In Use Of Evidence-Based Medicine Among Resident Physicians In Aga Khan University Hospital, Nairobi., Megha Unadkat

Theses & Dissertations

Background: Evidence based medicine (EBM) helps clinicians to integrate latest research evidence into their daily clinical practice. There is a need for all healthcare professions to adopt it in order to provide scientific, safe, efficient and most cost-effective care. Postgraduate residents are at the frontline of healthcare delivery and all medical institutions should strive to produce practitioners of EBM. Studies have shown that physicians are still struggling to adapt to this paradigm shift in the practice of medicine, especially in Sub Saharan Africa (SSA). However, very few studies have been done in SSA and none in East Africa to explore …

The Effect Of Premedication With Intravenous Lornoxicam On Propofol Injection Pain At Induction Of General Anaesthesia In Adults: A Randomised Placebo-Controlled Trial, Dennis Omari Onyancha

Theses & Dissertations

Background: Propofol is widely used for the induction and maintenance of general anaesthesia and offers many key attractive pharmacological qualities that make it suitable for these indications. However, pain on injection is one of its major drawbacks and can be very distressing to patients. There is a paucity of studies that have looked at the effect of lornoxicam on propofol injection pain either as a sole intervention or in combination with any other method.

Primary objective: To determine whether premedication with intravenous lornoxicam had any effect on the intensity of propofol injection pain at induction of general anaesthesia in …

The Effect Of Saline Flush After Rocuronium Bolus On The Proportion Of Patients With Excellent Intubating Conditions In Adult Patients Undergoing Elective Surgery At Akuh-N, Ian Odari

Theses & Dissertations

Background: In emergency surgeries requiring endotracheal intubation, the time to effect of neuromuscular blocking drugs is a crucial time in which patients are predisposed to hypoxia and aspiration into the lungs. Various strategies have been undertaken to shorten this time, including the timing and the priming techniques, dose changes and use of a flush following the muscle relaxant. All these methods had positive results but some are associated with side effects. The effectiveness of a muscle relaxant can either be assessed using the train of four or intubating conditions on the Goldberg scale. In this study, the plan is to …

Effect Of Video-Based Information On Pre-Operative State Trait Anxiety Inventory Scores In Adult Patients Presenting For Elective Caesarean Section, Timothy Kanyeki

Theses & Dissertations

Background: Preoperative anxiety is a common occurrence in patients presenting for surgery with a reported incidence of up to 80%. Higher incidences have been reported in the female population and in the obstetric population compared to general surgical patients. Increased preoperative anxiety has been associated with increased anaesthetic requirements, a more turbulent immediate postoperative course, poor patient satisfaction, protracted hospital stays, and poorer surgical outcomes. Provision of information relating to surgery and anaesthesia to patients has been proven to have benefit in allaying anxiety. However, the best format of information dissemination remains unknown and especially so targeting a specific patient …

Prevalence And Correlates Of Comorbid Depression In Patients With Type 2 Diabetes Attending Clinic At Aga Khan University Hospital, Nairobi, Alamin Suleiman

Theses & Dissertations

Introduction: Type 2 diabetes affects 500,000 people in Kenya and is a single cause of morbidity and mortality. It also co-exists with depression, increasing the disease severity and the likelihood of a lower quality of life.

Objectives: The primary aim of this study was to examine the depression prevalence as well as factors associated with depression among patients with Type 2 diabetes attending clinic at Aga Khan University Hospital Nairobi (AKUHN). The study also assessed the differences in depression severity with Type 2 diabetes alone and with Type 2 diabetes and other comorbid conditions.

Methodology: An analytic cross-sectional methodology was …

Patients Perspective On The Non-Urgent Use Of The Emergency Department In Kenya, Carolyne Robai Matifary

Theses & Dissertations

Background: Globally, there is an increasing demand for emergency department (ED) care in many countries accompanied by the dire need to optimize scant resources. Sub Saharan Africa (SSA) is facing a rapid surge in the prevalence of non-communicable diseases (NCDs) compounded by an already prevailing significant problem of communicable diseases and injuries. This has led to increased demand for emergency care expertise owing to acute complications of all these conditions. The impact includes ED overcrowding, increased healthcare costs, extended waiting periods and overstretched essential services. To mitigate this, it is imperative that EDs be utilized appropriately to continue providing quality …