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RISS 인기검색어
- 검색키워드
- 저자 : ( Elizabeth Ann Bukusi ) (검색결과 15 건)
- 무료
- 기관 내 무료
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( Njeri Rahab Mbugua ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Modifi cation of lifestyle risk factors like exercise, diet, alcoholism and smoking is important in management of diabetes (5, 6). Urbanisation in Kenya is likely to affect adherence to lifestyle changes. No studies have looked at lifestyle adherence among diabetes patients in Kenya. Methods: This descriptive cross sectional survey assessed the prevalence of lifestyle risk factors among Kenyatta National Hospital diabetic clinic patients and how this relates to diabetes control. A structured questionnaire was used to collect socio demographic as well as biophysical and biochemical data (weight, height, blood pressure & random blood sugar) from each patient. Results: Majority of the respondents (85%) consume less than the WHO recommended fi ve servings of fruits and vegetables per day and a signifi cant number (42%) is not involved in any type of moderate intensity physical exercise. Forty seven percent of those who exercise do so for less than 5 days in a week. The prevalence of alcohol consumption (6. 4%) and smoking (3%) is low. Moderate physical activity and consumption of fruits and vegetables was associated with better blood sugar control while gender, level of education and working statu`s were found to be important factors in lifestyle practices. Conclusions: Lifestyle modifi cation needs to be emphasized in diabetes management. There is need for a population-based studyon the prevalence of lifestyle risk factors for diabetes and other non-communicable diseases.
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Poster Session : PS 0373 ; Immunology ; Acute HIV Infection among Kenyan Infants
( Njeri Rahab Mbugua ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Clinical signs and symptoms of acute human immunodefi ciency virus (HIV) infection in infants are not well characterized. Methods: Clinical signs and symptoms of acute human immunodefi ciency virus (HIV) infection in infants are not well characterized. Results: There were 125 acute infection visits (among 56 infants) and 3491 noninfection visits (among 306 infants). Acute HIV infection was associated with rash (odds ratio [OR], 1.8; 95% confi dence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9; 95% CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in infants <2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >or=2 months of age. Infant peak viral load and mortality were not associated with symptoms of acute HIV infection. However, infants with symptoms had higher viral levels later in the course of infection than did those without symptoms (P=.05). Conclusions: Infants may manifest symptoms early during the course of HIV infection, and symptoms of acute HIV infection may correlate with poor viral control. Rash, failure to thrive, lymphadenopathy, pneumonia, and dehydration may signify acute HIV infection in infants.
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Poster Session : PS 0371 ; Immunology ; Pediatric HIV -1 in Kenya
( Njeri Rahab Mbugua ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: There is limited information regarding the pattern and correlates of viral replication in vertically HIV-1-infected children and its role on their outcomes in resource- limited settings. Methods: HIV-1-infected infants were followed from birth to 24 months. Serial HIV- 1 RNA levels were compared in infants infected in utero (<48 hours), peripartum (48 hours-1 month), and late postnatal (after 1 month). Cofactors for viral peak [highest viral load (VL) within 6 months of infection] and set point and mortality were determined. Results: Among 85 HIV-1-infected infants, 24 were infected in utero, 41 peripartum, 13 late postnatal; 7 had no 48-hour assay. HIV-1 VL set point was signifi cantly lower in infants infected >1 month vs. =1 month (5.59 vs. 6.24 log10 copies per milliliter, P = 0.01). Maternal VL correlated with peak infant VL (P < 0.001). Univariately, infant peak and set point VL and 6-month CD4% <15% predicted mortality; and 6-month CD4% <15% remained independently predictive in multivariate analyses (hazard ratio = 4.85, 95% confi dence interval: 1.90 to 12.36). Conclusions: Infants infected after the age of 1 month contained virus better than infants infected before 1 month of age. Maternal VL predicted infant VL, which, in turn was associated with early mortality.
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( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Breast-feeding by infants exposed to human immunodefi ciency virus type 1 (HIV-1) provides an opportunity to assess the role played by repeated HIV-1 exposure in eliciting HIV-1-specifi c immunity and in defi ning whether immune responses correlate with protection from infection. Methods: Breast-feeding infants born to HIV-1-seropositive women were assessed for HLA-selected HIV-1 peptide-specifi c cytotoxic T lymphocyte interferon (IFN)-gamma responses by means of enzyme-linked immunospot (ELISpot) assays at 1, 3, 6, 9, and 12 months of age. Responses were deemed to be positive when they reached > or = 50 HIV-1-specifi c sfu/1 x 10(6) peripheral blood mononuclear cells (PBMCs) and were at least twice those of negative controls. Results: A total of 807 ELISpot assays were performed for 217 infants who remained uninfected with HIV-1 at approximately 12 months of age; 101 infants (47%) had at least 1 positive ELISpot result (median, 78-170 sfu/1 x 10(6) PBMCs). The prevalence and magnitude of responses increased with age (P = .01 and P = .007, respectively); the median log(10) value for HIV-1-specifi c IFN-gamma responses increased by 1.0 sfu/1 x 10(6) PBMCs/month (P<0.001) between 1 and 12 months of age. Of 141 HIV-1-uninfected infants with 1-month ELISpot results, 10 (7%) acquired HIV-1 infection (0/16 with positive vs. 10/125 [8%] with negative ELISpot results; P = .6). Higher values for log(10) HIV-1-specifi c spot-forming units at 1 month of age were associated with a decreased risk of HIV-1 infection, adjusted for maternal HIV-1 RNA level (adjusted hazard ratio, 0.09 [95% confi dence interval, 0.01-0.72]). Conclusions: Breast-feeding HIV-1-exposed uninfected infants frequently had HIV-1-specific IFN-gamma responses. Greater early HIV-1-specific IFN-gamma responses were associated with decreased HIV-1 acquisition.
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( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: To determine the prevalence and correlates of neonatal conjunctivitis in infants born to human immunodefi ciency virus type 1 (HIV-1) infected mothers. Methods: This was a nested case-control study within a perinatal HIV-1 cohort. HIV-1 seropositive mothers were enrolled during pregnancy and mother-infant pairs followed after delivery with assessment for neonatal conjunctivitis at 48 hours and up to 4 weeks after birth. Genital infections (chlamydia, gonorrhea, syphilis, trichomonas, bacterial vaginosis, and candida) were screened for at 32 weeks gestation. Mothers received treatment for genital infections diagnosed during pregnancy and shortcourse zidovudine. Newborns did not receive ocular prophylaxis at hospital deliveries. Multivariate logistic regression models were used to determine cofactors for neonatal conjunctivitis overall and stratifi ed for infant HIV-1 status. Results: Four hundred and fi fty-two infants were assessed and 101 (22.3%) had neonatal conjunctivitis during the fi rst month postpartum. In multivariate analyses using odds ratios (OR) and confi dence intervals (CI), neonatal conjunctivitis was associated with neonatal sepsis (adjusted OR 21.95, 95% CI 1.76, 274.61), birth before arrival to hospital (adjusted OR 13.91, 95% CI 1.39, 138.78) and birth weight (median 3.4 versus 3.3 kilograms, p=0.016, OR 1.79, 95% CI 1.01, 3.15). Infant HIV-1 infection was not associated with conjunctivitis. Conclusions: Despite detection and treatment of genital infections during pregnancy, neonatal conjunctivitis was frequently diagnosed in infants born to HIV-1 infected mothers suggesting a need for increased vigilance and prophylaxis for conjunctivitis in these infants. Neonatal sepsis, birth before arrival to hospital, and higher birthweight are factors that may predict higher risk of neonatal conjunctivitis in this population.
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( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Among children, early mortality following highly active antiretroviral therapy (HAART) remains high. It is important to defi ne correlates of mortality in order to improve outcome. Methods: HIV-1-infected children aged 18 months-12 years were followed up at Kenyatta National Hospital, Nairobi after initiating NNRTI-based HAART. Cofactors for mortality were determined using multivariate Cox regression models. Results: Between August 2004 and November 2008, 149 children were initiated on HAART of whom 135 were followed for a total of 238 child-years (median 21 months) after HAART initiation. Baseline median CD4% was 6.8% and median HIV-1-RNA was 5.98-log10 copies/ml. Twenty children (13.4%) died at a median of 35 days post- HAART initiation. Mortality during the entire follow-up period was 8.4 deaths per 100 child-years (46 deaths/100 child-years in fi rst 4 months and 1.0 deaths/100 childyears after 4 months post-HAART initiation). On univariate Cox regression, baseline hemoglobin (Hb) < -2, and WHO clinical stage 4 were associated with increased risk of death (Hb < -2 HR 3.41 [95% C.I. 1.28-9.08], p = 0.01, and WHO clinical stage 4, HR 3.08 [1.17-8.12], p = 0.02). On multivariate analysis Hb < 9 g/dl remained predictive of mortality after controlling for age, baseline CD4%, WHO clinical stage and weightfor- height z-score (HR 2.95 (95% C.I. 1.04-8.35) p = 0.04). Conclusions: High early mortality was observed in this cohort of Kenyan children receiving HAART, and low baseline hemoglobin was an independent risk factor for death.
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( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: To examine the practices of anal intercourse and dry sex within a cohort of female sex workers (FSWs) in Kenya, focusing on the prevalence and perceived risk of the practices, demographic and behavioural correlates, and association with sexually transmitted infections (STI). Methods: A survey was conducted among FSWs with 147 participants randomly sampled from an existing cohort of self identifi ed FSWs.Results: 40.8% of participants reported ever practising anal intercourse and 36.1% reported ever practising dry sex. Although the majority of women surveyed believed anal intercourse and dry sex to be high risk practices for HIV infection compared with vaginal sex, about one third of women reported never or rarely using condoms during anal intercourse, and about 20% never or rarely using condoms during dry sex. Reported consistent condom use was lower with both of these practices than with penile-vaginal intercourse. Anal intercourse was associated with experience of recent forced sexual intercourse, while dry sex was not. Anal intercourse was almost always initiated by clients, whereas dry sex was likely to be initiated by the women themselves. Sex workers reported charging higher fees for both practices than for vaginal intercourse. Both practices were associated with reported symptoms and diagnoses of STI. Conclusions: Both anal intercourse and dry sex were common in this sample, and although perceived as high risk practices, were not adequately protected with condom use. Education and other interventions regarding these high risk sexual behaviours need to be translated into safer practices, particularly consistent condom use, even in the face of fi nancial vulnerability.
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Poster Session : PS 0406 ; Infectious Disease ; Antenatal HIV Testing
( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL).Methods: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. Subjects: Women undergoing radiotherapy for inoperable cervical cancer. Results: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were signifi cant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and fi nancial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. Conclusions: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers.Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted.
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( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: This paper compares and contrasts number of partners and condom use behaviour for female sex workers and a sample of women working in other economic activities, with both samples drawn from the large informal settlement of Kibera, Nairobi. Methods: As expected, univariate analysis revealed much higher numbers of overall sexual partners and higher levels of condom use among female sex workers compared to Kibera women in other occupations. An unexpected fi nding, however, was that female sex workers with a romantic partner had signifi cantly fewer sexual partners per unit time than female sex workers without such a partner. Results: This fi nding held for multivariate analysis, with negative binomial regression analyses showing that having a romantic partner was signifi cantly associated with reductions in total number of both sexual partners overall and with sexual partners who did not use condoms. In contrast, HIV status, education, number of immediate family members and levels of alcohol consumption were non-signifi cant factors for both regression analyses. Conclusions: Results suggest that female sex workers` romantic partners act as more than sources of possible HIV infection; rather, romantic partners appear to have an important positive impact on health. We discuss this fi nding in light of possible harm-reduction programmes focusing on female sex workers and their romantic partners.
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( Njeri Rahab Mbugua ),( Asunta Wagura Wagura ),( Elizabeth Ann Bukusi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Prevalent herpes simplex virus type 2 (HSV-2) infection increases human immunodefi ciency virus acquisition. We hypothesized that HSV-2 infection might also predispose individuals to acquire other common sexually transmitted infections (STIs). Methods: We studied the association between prevalent HSV-2 infection and STI incidence in a prospective, randomized trial of periodic STI therapy among Kenyan female sex workers. Participants were screened monthly for infection with Neisseria gonorrhoeae and Chlamydia trachomatis, and at least every 6 months for bacterial vaginosis (BV) and infection with Treponema pallidum, Trichomonas vaginalis, and/or HSV-2. Results: Increased prevalence of HSV-2 infection and increased prevalence of BV were each associated with the other; the direction of causality could not be determined. After stratifying for sexual risk-taking, BV status, and antibiotic use, prevalent HSV-2 infection remained associated with an increased incidence of infection with N. gonorrhoeae (incidence rate ratio [IRR], 4.3 [95% confi dence interval {CI}, 1.5-12.2]), T. vaginalis (IRR, 2.3 [95% CI, 1.3-4.2]), and syphilis (IRR, 4.7 [95% CI, 1.1-19.9]). BV was associated with increased rates of infection with C. trachomatis (IRR, 2.1 [95% CI, 1.1- 3.8]) and T. vaginalis (IRR, 8.0 [95% CI, 3.2-19.8]). Conclusions: Increased prevalences of HSV-2 infection and BV were associated with each other and also associated with enhanced susceptibility to an overlapping spectrum of other STIs. Demonstration of causality will require clinical trials that suppress HSV-2 infection, BV, or both.
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