Medical Laboratory; Agriculture & environmental Biotecthology; Biochemistry; Molecular Medicine, Applied Epidemiology; Medicinal PhytochemistryPublic Health; http://localhost/xmlui/handle/123456789/1279 2026-04-06T18:51:13Z 2026-04-06T18:51:13Z Ndege, Jane Wanjiku http://localhost/xmlui/handle/123456789/6927 2026-03-31T07:33:48Z 2026-03-31T00:00:00Z

Determinants of Surgical Site Infections among Post Caesarean Section Women at Thika Level 5 Hospital, Kiambu County Ndege, Jane Wanjiku Surgical site infection refers to an infection that occurs at or near a surgical incision site within 30 days post operation. Caesarean section is one of the most performed surgical procedures carried out in obstetrics and constitutes about 15% of all deliveries globally, with Latin America being the highest at 29.2%. The study aimed to assess the determinants of surgical site infection following caesarean section among women at Thika level 5 hospital. The study design was a mixed unmatched case-control study which followed women who had undergone caesarean section in maternity unit at Thika Level 5 Hospital and who had or did not have surgical site infection from delivery up to two weeks post-delivery and nurse in-charges of maternity unit. The researcher adopted a census technique to sample clients who came for review at maternal child health clinic at 14th day post caesarean section. Study participants who met the inclusion criteria were recruited into the study as they sought the routine clinical care services in the clinic. Purposive sampling was used for the nurse in charges in maternity unit and maternal child health clinic. They provided qualitative data for the study. The findings revealed that factors associated with surgical site infections among post caesarean section women at Thika Level 5 Hospital were; age, duration of labor, duration of ruptured membrane and indication of CS. Women who were aged more than 35 years were 3.82 times more likely to have surgical site infections compared to those who were aged less than 35 years [3.82 95%CI=2.67 – 11.21, p=0.007]. Women who had labor more than 8 hours were 3.12 times more likely to have surgical site infections compared to those who had labor for a period of 4 to 8 hours [OR=3.12; 95%CI=1.88 – 8.28, p=0.003]. Also, women who experienced rupture of the membrane for more than 24 hours were 3.85 times more likely to have surgical site infections compared to women that experienced membrane rapture for 24 hours or less [OR=3.85; 95%CI=2.81 – 12.03, p=0.010]. Furthermore, women who experienced prolonged labor were 6.19 times more likely to have surgical site infections compared to women who did not have prolonged labor [OR=6.19; 95%CI=3.11 – 9.54, p=0.009]. Management of Thika Level 5 Hospital should pay a close attention to the maternal, labor and health systems related factors that are likely to cause surgical site infections among post caesarean section women admitted in the facility. Also, a continuous education program for healthcare workers and young new women is necessary and can be feasible and potentially successful, given the interest expressed by healthcare workers in the management of surgical site infections. MSc in Nursing (Midwifery and Reproductive Health)

2026-03-31T00:00:00Z Kibet, Suge Titus http://localhost/xmlui/handle/123456789/6922 2026-03-26T09:13:44Z 2026-03-26T00:00:00Z

Subjects’ Sociodemographics Influence the Transmission Patterns of Diarrheagenic Escherichia coli Pathotypes among Children under 5 Years in Nakuru County Kibet, Suge Titus Background: Diarrheagenic Escherichia coli (DEC) infections constitute the leading causes of morbidity and mortality among children in Sub‑Saharan Africa. However, little has so far been done to properly reveal the pathogenic endowments of DEC in these populations. Aims and Objectives: We evaluated 4 DEC strains among children under 5 years. Materials and Methods: A cross‑sectional study design was employed among 384 positive cases. Results: There was a significant decline in infections associated with DEC as the children grew older (χ2[12] = 87.366: P = [0.000]. A total of 56 (14.6%) cases were 0–12 months, 168 (43.8%) were 13–24 months, 88 (22.9%) were 25–36 months, 40 (10.4%) were 37–48 months, and 32 (8.3%) were 49–60 months. A total of 248 (64.6%) male subjects exhibited more susceptibility to DEC infections than their female counterparts (n = 136 [35.4%]) (χ2[3] =13.313: P = [0.004]. Subjects from urban areas (n = 248 [64.6%]), significantly bored the brunt of infections than those from rural areas (n = 136 [35.4%]) (χ2[3] = 35.147: P = [0.000]. The prevalence of DEC appeared significantly higher during rainy seasons (n = 269 [70.1%]). Conclusion: Young age, male gender, crowding, and rainy season play a central role in the transmission of DEC pathotypes. Keywords: Children, diarrheagenic Escherichia coli, Nakuru County, pathotypes, prevalence PhD Research Publication

2026-03-26T00:00:00Z Kibet, Titus Suge http://localhost/xmlui/handle/123456789/6921 2026-03-26T09:08:03Z 2026-03-26T00:00:00Z

Antimicrobial Resistant Escherichia Coli Isolates From Stool Samples of Children Under Five Years against Selected Beta-Lactams and Associated Risk Factors in Nakuru County Referral Hospital Kibet, Titus Suge Background: Multidrug‑resistant (MDR) diarrheagenic Escherichia coli (DEC) are a leading cause of morbidity and treatment failure among children under five, yet Kenyan data on circulating DEC pathotypes, resistance profiles, and modifiable risk factors remain scarce. Objective: To characterise DEC pathotypes isolated from stool samples of under‑five children in Nakuru County Referral Hospital, describe their phenotypic and genotypic resistance to selected β‑lactams, and identify environmental, clinical and behavioural determinants—including household water quality and recent steroid therapy—associated with antimicrobial resistance. Methods: We conducted a hospital‑based matched case–control study (1: 1) between November 2017 and October 2018. Cases (n = 192) were children harbouring β‑lactam‑resistant DEC; controls (n = 192) carried susceptible DEC and were matched by age and sex. DEC pathotypes were confirmed by multiplex PCR, antimicrobial susceptibility by CLSI disc‑diffusion, and ESBL genes by conventional PCR. Structured caregiver interviews captured antibiotic access, water‑handling practices, and systemic steroid use. Conditional logistic regression estimated adjusted odds ratios (aOR). Results: EAEC predominated (40 %), followed by ETEC (32 %) and EPEC (28 %). Seventy‑two percent of isolates were resistant to ≥ 3 antibiotic classes, and blaCTX‑M was detected in 45 %. Independent predictors of MDR DEC were self‑medication with β‑lactams in the previous three months (aOR 6.2, 95 % CI 3.9–9.4), use of untreated household water (aOR 3.4, 1.8–6.2), and recent systemic steroid therapy (aOR 2.6, 1.4–4.7). Water isolates shared identical ESBL genotypes with paired stool isolates in 78 % of households. Conclusion: MDR DEC, especially EAEC harbouring blaCTX‑M, are widespread among Nakuru under‑fives. Unregulated β‑lactam access, steroid exposure, and contaminated household water together accelerate resistance. Strengthening community antibiotic stewardship, limiting non‑prescription sales, and promoting point‑of‑use water treatment are urgent priorities PhD in Epidemiology

2026-03-26T00:00:00Z Kikwai, Gilbert Kipkorir http://localhost/xmlui/handle/123456789/6916 2026-03-11T14:10:36Z 2026-03-11T00:00:00Z

Genetic Relationships among Antibiotic-Resistant Escherichia Coli from Households in Kibera, Nairobi County, Kenya Kikwai, Gilbert Kipkorir Drug-resistant bacteria kill hundreds of thousands of people every year. In 2019, an estimated 1.3 million deaths globally were attributable to bacterial antimicrobial resistance (AMR). The resistance genes in bacteria can be carried on horizontally transmissible elements such as plasmids and the dissemination of these genes, even if infrequent, to commensal or pathogenic bacteria can lead to amplification and further dissemination of AMR. This study aimed to identify antibiotic-resistance genes and assess the genetic diversity of antibiotic-resistant Escherichia coli in randomly selected households in Kibera (Nairobi), Kenya. The work formed part of a sanitation study on antimicrobial-resistant E. coli conducted under the auspices of Washington State University (WSU) in collaboration with KEMRI/CDC. A subset of isolates (n=16) with resistance phenotypes was randomly selected, genotyped, and characterized for the resistance genes. Genomic DNA was extracted from overnight cultures followed by library preparation before paired-end sequencing using an Illumina Miseq instrument. Raw data were quality assessed before de novo assembly, genome annotation, and resistome prediction using bioinformatics tools. Ten (77%) of the E. coli isolates were resistant to three or more antibiotic classes, confirming a high prevalence of antibiotic resistance. Identified E. coli harboured antibiotic resistance genes with a predominance to beta-lactam, aminoglycoside, sulphonamide, tetracycline, and trimethoprim classes of antibiotics. There was between 62-80% consensus between predicted resistance based on sequence data and the original phenotype-based resistance to all drugs tested. blaTEM-1B was the only resistance gene identified among beta-lactamase producers. Among aminoglycoside-resistant E. coli, aph(3”)-lb, aph(6)-ld, and aadA1 were identified whereas tet(A) and tet(B) were attributed to tetracycline resistance. IncF plasmids, associated with carriage of broad spectrum antibiotic resistance genes, were the predominant plasmid marker. Multilocus sequence typing (MLST) identified 12 different sequence types (STs) among 13 isolates, reflecting a high degree of genetic diversity. Diversity indices (Shannon, Simpson and Richness) further highlighted a substantial within household variation, while chi-square analysis showed no significant association between genotype distribution and household clustering (χ², p = 0.385). The detection of globally relevant STs such as ST10, ST335 and ST398 underscores the public health importance of resistant E. coli circulating in community settings. The study demonstrates widespread carriage of diverse, multidrug resistant E. coli in households in Kibera and that non-classical mechanisms contribute to phenotypic resistance beyond recognized genes. This study recommends strengthened genomic surveillance of AMR at community level to better elucidate transmission dynamics and inform targeted public health interventions and for further research to understand non classical mechanisms of antibiotic resistance in bacteria. MSc in Molecular Biology and Bioinformatics

2026-03-11T00:00:00Z