http://localhost/xmlui/handle/123456789/1154 2026-06-26T07:07:35Z http://localhost/xmlui/handle/123456789/7054 Viral Suppression among Men Who Have Sex with Men Living with HIV Who Were on Risk Reduction Interventions and Control Group in Mvita Sub-County, Mombasa County, Kenya Karanja, Jane Wangui Globally, men who have sex with men (MSM) are more vulnerable to HIV as compared to men in the general population. However, if commenced promptly on ART and adherence to treatment is observed their viral load can be suppressed hence unable to transmit the virus to their partner. The aim of this study was to determine the effectiveness of the risk reduction interventions on viral load suppression levels among men who have sex with men (MSM) living with HIV versus those in the control group in Mvita sub-County, Mombasa County, Kenya between December 2020 and June 2021. A quasi-experimental study design using quantitative methods was adopted and the study population was the MSM residing in Mvita sub-County in Mombasa County. Inclusion criteria were, being biological male-sex assigned at birth, 18 years and above, had anal sex with at least one male partner in the past 3 months, a resident of Mvita sub-County, and willingness to give informed consent in writing. Exclusion criteria were those who declined to give consent or were intoxicated with alcohol or drugs. The respondent-driven sampling (RDS), a semi-probabilistic method, in the absence of a sampling frame was used to obtain the sample of respondents. A total of 114 HIV positive MSM participated in the study. Half (57) of MSM living with HIV were actively followed and risk reduction interventions (adherence to ARVs, general counseling and nutritional care), and HIV prevention measures (prompt treatment of STI/OI and condom use) were offered after every 2 months for six months. The control group (57) received no risk reduction interventions. Semi-structured questionnaire and laboratory investigations were employed to collect data. Log-binomial univariate and the multivariate regression analysis model were used to identify the variables which were associated with undetectable viral load. Undetectable viral load was defined as having an HIV viral load of less than 50 copies/ml. Data collected was cleaned, coded and analysed using STATA software, Version 17. Level of significance was fixed at 5%. Ethical approval was received from the relevant bodies. Majority of MSM were between ages 19 to 29 (54%), were single (77%), were Christian (61%), never married to a female (39%) and had an income of <5,000 ksh (65%). MSM in the control group, who reported ever use of PEP/PrEP (44%), were likely to have detectable viral load while MSM who received interventions, who reported condom break more than once during anal sex (61%), who had more than one regular anal sex partners (61% both groups), and who drunk more than 2 bottles of beer (33% both groups) were likely to have undetectable viral load. MSM in the control group who reported being always high on alcohol during anal sex (19%), were likely to have detectable viral load. MSM who received interventions and reported feeling uneasy while seeking health services (75%) had detectable viral load while those in the control group who attended private clinics (42%), had undetectable viral load. Overall, after six months, the proportion of MSM achieving viral load suppression was significantly higher in the intervention group as compared to control group by 60% (95% CI= 49‒70, p < 0.001). In conclusion, MSM in the control group had low knowledge of HIV prevention hence detectable viral load. However, high risk behaviours such as condom break were associated with undetectable viral load in the group that received risk reduction interventions. MSM in the control group who were attended in private clinics received better HIV care, thus had undetectable viral load. MSM who received risk reduction intervention had better treatment outcome with many MSM achieving undetectable viral load. From the study it is recommended that peer-led HIV services to be integrated in all HIV programmes targeting MSM, effective substance use intervention program be re-designed to rehabilitate the MSM on alcohol and drugs, improvement on HIV care in public health facilities and risk reduction interventions to be offered to all MSM. PhD in Public Health 2026-06-26T00:00:00Z http://localhost/xmlui/handle/123456789/7052 A Positive Deviance Nutrition Education Intervention to Improve Nutritional Intake, Sputum Conversion and Clinical Signs among Tuberculosis Patients in Kericho County, Kenya Kirui, Collins Kipkosgei Tuberculosis (TB) is one of the leading causes of death worldwide. In the recent years, Kenya has recorded a high prevalence of TB and a greater proportion of patients with negative treatment outcomes. This study addressed the challenge of negative treatment outcomes through a positive deviance-based nutrition education intervention for patients with active TB. The objectives of the study were: to determine the practices associated with TB treatment outcomes; the influence of nutrition education on nutritional status; the influence of the intervention on sputum smear conversion; and the effects of the nutrition intervention on clinical signs among TB patients. A quasi-experimental with pre-post-test design was adopted. Positive deviance inquiry was used to identify best practices among 216 persons who had completed treatment within the year preceding the study. The best practices were adopted for the intervention. For the intervention and control arms, 192 newly diagnosed TB patients were recruited through multistage cluster sampling. The sample was distributed such that 96 were enrolled in the intervention arm and 96 in the control arm. The intervention included fortnightly nutrition education on nutrient-dense meal, dietary diversity, and the provision of nutrient-rich meals for six months. Nutritional status and nutrient intake were determined through anthropometric measurements and food frequency questionnaires. Sputum smear microscopy and clinical signs were also assessed at critical points. Data analysis was conducted using R to obtain independent t tests, chi-square, logistic regression, and difference-in-difference (DID). Anthropometric data were converted into BMI and categorized into nutritional status indicators using WHO cut-offs, while food frequency data were converted into daily nutrient yields and compared against Recommended Dietary Allowances (RDA). The significance level was set at p < 0.05. The results revealed that socio-demographic factors, health-seeking, lifestyle (alcohol, tobacco), low baseline BMI, comorbidities, and lack of adherence support were significantly linked to negative treatment outcome (p < 0.01). The intervention group showed significant increases in BMI at 2nd, 5th, and 6th months (p = 0.01, 0.01, 0.001). Adherence to recommended dietary intake for energy, protein, carbohydrates, vitamins A and C, zinc, and selenium improved remarkably (AOR = 1.84 – 2.14, p < 0.01). Sputum conversion rates in the intervention group exceeded 90% at all critical points of study, compared to 85.2% in the control group (p < 0.01). In the control group, only fat intake improved sputum conversion at month two (β = 0.15, p = 0.026). In the intervention group, higher energy (β = 0.76–0.91, p < 0.007), protein (β = 0.67–0.95, p < 0.004), carbohydrates (β = 0.17–0.47, p < 0.004), vitamin A (β = 0.75–0.88, p < 0.003), vitamin C (β = 0.80–0.89, p < 0.001), zinc (β = 0.67–0.82, p < 0.005), and selenium (β = 0.53–0.79, p < 0.007) were significantly associated with sputum conversion. Clinical signs such as cough and weight loss improved significantly in the intervention group. Higher odds of improvement were observed at 2nd, 5th, and 6th months of the study with AOR = 1.98 (95% CI: 1.02 - 3.82; p = 0.041), 1.79 (95% CI: 1.03 - 3.10; p = 0.039), and 2.46 (95% CI: 1.29 - 4.71; p = 0.034), respectively (p < 0.05). A possible limitation for this study was recalling bias and social desirability in diet reporting. In conclusion, multiple ‘best’ practices influenced treatment outcomes. The intervention improved nutritional status, sputum conversion and clinical signs and therefore enhanced treatment response. xix The study recommends that: context specific factors should be used to design targeted interventions; nutrition education should be individually tailored to the patient needs with specific focus on locally available, and nutrient-dense foods rich in vitamins A and C, zinc, and selenium; nutritional support should be strengthened to accelerate sputum smear conversion during the treatment period. Further longitudinal research is recommended to assess the sustained effects of nutrition education interventions on the improvement and stability of clinical signs. PhD in Public Health 2026-06-23T00:00:00Z http://localhost/xmlui/handle/123456789/7051 Value Creation Strategies and Performance of Commercial Banks in Kenya Mukira, Abubaker Ramathan This study examines the effect of value creation strategies on the financial performance of commercial banks in Kenya, with a specific focus on cost efficiency, revenue diversification, elimination of Non-Productive activities, and financial innovation. It further evaluates the moderating role of bank size in shaping the relationship between these strategies and financial performance. The study is anchored on an integrated theoretical framework comprising the Resource-Based View, Efficiency Structure Theory, Innovation Diffusion Theory, and Economies of Scale Theory. A positivist research philosophy and a quantitative explanatory research design were adopted. Using a census approach, the study covered all 40 licensed commercial banks in Kenya over the period 2015–2019. Secondary data were obtained from audited financial statements and Central Bank of Kenya reports, resulting in a balanced panel dataset of 200 observations. Panel regression analysis was employed, with the Fixed Effects Model selected based on the Hausman test. The findings indicate that cost efficiency, measured by the cost-to-income ratio, has a negative and statistically significant effect on financial performance, implying that operational inefficiencies reduce profitability. Revenue diversification, proxied by non-interest income, exhibits a positive and significant effect, indicating that diversified income streams enhance performance and resilience. The elimination of Non-Productive activities also shows a positive and significant relationship with financial performance, underscoring the importance of operational optimization. Financial innovation, measured through digital products and transaction volumes, emerges as a strong positive determinant of performance, highlighting the critical role of digital transformation in the banking sector. The study further establishes that bank size has a statistically significant moderating effect, with larger banks deriving greater benefits from financial innovation and revenue diversification, while also experiencing amplified efficiency effects. The study concludes that value creation strategies significantly influence bank performance and that their effectiveness is enhanced when implemented in an integrated and coordinated manner. The findings contribute to theory by providing empirical support for a multi-theoretical framework and extending existing literature through the incorporation of moderation effects within a panel data context. The study recommends that bank management adopt integrated strategic approaches that align cost efficiency, financial innovation, and revenue diversification. Policymakers are encouraged to develop innovation friendly regulatory frameworks that support digital transformation while maintaining financial stability. Overall, the study contributes to knowledge by developing an integrated strategic framework for value creation in banking and providing context specific empirical evidence on the moderating role of bank size. PhD in Strategic Management 2026-06-23T00:00:00Z http://localhost/xmlui/handle/123456789/7050 Investigation of Synergistic Antimalarial Activity of Corymbia citriodora, Maytenus senegalensis and Warbugia ugandensis Used in Traditional Medicine in Kenya Atambo, Sarah Bosibori Malaria is majorly caused by Plasmodium falciparum in Kenya where 30% of the population relies on traditional medicine for treatment due to cost and accessible medical facilities especially in the rural areas. W. ugandensis (W), M. senegalensis (M) and C. citriodora (C) are plants used in herbal medicine for treating malaria. However, their combined antimalarial efficacy and safety is yet to be determined. The negative control and solvent used was water and chloroquine as positive control. Cytotoxic properties (CC50) of the plants were carried out against Vero cell-lines in vitro via MTT assay. Acute oral toxicity (LD50) was conducted according to OECD protocol. Antimalarial properties (ED50) of aqueous plant extracts were analyzed against Plasmodium berghei in vivo. The combinations of C: M: W (1:1:1) used in the study exhibited no cytotoxicity, (CC50) of 101.47±3.17 µg/ml. All the plant extracts demonstrated LD50 above 2000 mg/kg with no adverse effects hence recognized as safe. The result indicated that the combination of M:W (1:1) had the highest antimalarial activity, ED50 of 1.05mg/kg and C:M:W (1:1:1) (ED50 of 2.26 mg/kg). Phytochemical profile of plant extracts not conducted but activity attributed to individual plant tannins, flavonoids, sesquiterpenes, and saponins. The SFIC determines the interaction between two or more drug compounds. Two-plant extracts exhibited synergistic effect whereas C.M.W in the ratio 1:1:1 showed antagonism with SFIC 1.92. Non-linear analysis was used to determine CC50, ED50 and LD50, one- way ANOVA for means between treatment groups and Tukey’s post hoc for pairwise control of means. From a molecular medicine perspective, this study elucidates the potential of combination therapy at the molecular level by evaluating the interactions between plant-derived compounds through the Synergistic Fractional Inhibitory Concentration (SFIC) index. The determination of cytotoxicity and effective concentrations provides critical insights into the molecular mechanisms underlying the safety and efficacy of these herbal extracts, paving the way for their optimization as targeted antimalarial therapies. MSc in Molecular Medicine 2026-06-22T00:00:00Z