Ann Mwangi - Academia.edu (original) (raw)

Papers by Ann Mwangi

Frontiers in Public Health, 2021

Introduction: Tuberculosis (TB) disease continues to be responsible for a high global burden with... more Introduction: Tuberculosis (TB) disease continues to be responsible for a high global burden with an estimated 10 million people falling ill each year and an estimated 1.45 million deaths. Widely carried out analyses to utilize routine data coming from this disease, and well-established in literature, have paid attention to time-to-event with sputum smear results being considered only at baseline or even ignored. Also, logistic regression models have been used to demonstrate importance of sputum smear results in patient outcomes. A feature presented by this disease, however, is that each individual patient is usually followed over a period of time with sputum smear results being documented at different points of the treatment curve. This provides both repeated measures and survival times, which may require a joint modeling approach. This study aimed to investigate the association between sputum smear results and the risk of experiencing unfavorable outcome among TB patients and dyna...

East African Medical Journal, 2017

Background: Malaria remains a major public health problem in Kenya accounting for the highest mor... more Background: Malaria remains a major public health problem in Kenya accounting for the highest morbidity and mortality especially among children. Previous reports indicate that infectious agents display heterogeneity in both space and time and malaria is no exception. Heterogeneity has been shown to reduce the effectiveness of interventions. Previous studies have implicated genetic (both human and parasite) and environmental factors as mainly responsible for variation in malaria risk. Human behaviour and its potential risk for contributing to variation in malaria risk has not been extensively explored. Objective: To determine if there were behavioural differences between the people living in hotspots (high malaria burden) and cold spots (low malaria burden) within a geographically homogeneous and high malaria transmission region. Design: A prospective closed cohort study. Setting: The study was conducted in the Health and Demographic Surveillance Site in Bungoma East sub-County. Subj...

Current Journal of Applied Science and Technology, 2019

Missing data is a common problem in real word studies especially clinical studies. However, most ... more Missing data is a common problem in real word studies especially clinical studies. However, most people working with such data, often drop missing cases from individuals with incomplete observations that occur when patients do not complete the treatment or miss their scheduled visits. This may lead to misleading results and ultimately affect the decision of whether an intervention is good or bad for the patients under treatment. The comparison of Complete Case (CC) and Inverse Probability Weights (IPW) techniques of handling missing data in various models has been addressed, however little has been done to compare these methods when applied to joint models of longitudinal and time to event data. Therefore, this paper seeks to investigate the impact of assuming CC analysis on clinical data with missing cases, comparing it with IPW method when fitting joint models of longitudinal and survival data setting full data model as the baseline model. This paper made use of randomized aids cl...

Background:Little research exists in Sub-Saharan Africa on the rates of mental disorders followin... more Background:Little research exists in Sub-Saharan Africa on the rates of mental disorders following terror attacks. Available studies have examined Post-Traumatic Stress Disorder (PTSD) only. This study sought to document the burden of PTSD, Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) among survivors of the Garissa University College terror attack that occurred in North Eastern Kenyain 2015. Methods:This was a retrospective chart review of medical records of students screened for psychopathology following the attack. Screening for the terror attack related PTSD, for MDD and for GAD was done using the PTSD Checklist for Diagnostic and Statistical Manual 5 (PCL-5), the Patient Health Questionnaire -9 (PHQ-9) and the Generalized Anxiety Disorder 7 –item Scale (GAD-7), respectively. Screening was conducted 7 weeks after the attack. Results:A total of 552 subjects were screened of whom 385 (69.7%) were male. Two hundred and fifty eight (46.7% [95% CI: 42.5, 50.9...

1Adjusted according to CD4 count at ART initiation.2Including extra-p... more 1Adjusted according to CD4 count at ART initiation.2Including extra-pulmonary TB.3Surrogate marker for 1st Line ART Failure.</p

1Confidence intervals were derived based on the delta method of approximation, using est... more 1Confidence intervals were derived based on the delta method of approximation, using estimates of the variance of the parameters produced by the GEE model. Note that the overall differences in CD4 counts present in the TB versus non-TB groups, are not evident among the three CD4 groupings suggesting that differences in CD4 response are a function of higher rates of baseline immunosuppression among TB patients rather than an independent TB-associated effect.</p

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2022

Background: Effective patient-centered interventions are needed to promote patient engagement in ... more Background: Effective patient-centered interventions are needed to promote patient engagement in HIV care. We assessed the impact of a patient-centered intervention referred to as enhanced patient care (EPC) on viral suppression among unsuppressed patients living with HIV in Kenya. Setting: Two rural HIV clinics within the Academic Model Providing Access to Health care. Methods: This was a 6-month pilot randomized control trial. The EPC intervention incorporated continuity of clinician–patient relationships, enhanced treatment dialog, and improved patients' clinic appointment scheduling. Provider–patient communication training was offered to all clinicians in the intervention site. We targeted 360 virally unsuppressed patients: (1) 240 in the intervention site with 120 randomly assigned to provider–patient communication (PPC) training + EPC and 120 to PPC training + standard of care (SOC) and (2) 120 in the control site receiving SOC. Logistic regression analysis was applied usi...

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2021

Objective: To develop and assess an alternative care model using community-based groups for peopl... more Objective: To develop and assess an alternative care model using community-based groups for people living with HIV and facilitate by lay personnel. Methods: Geographic locations in the Academic Model Providing Access to Healthcare Kitale clinic catchment were randomized to standard of care versus a community-based care group (ART Co-op). Adults stable on antiretroviral therapy and virally suppressed were eligible. Research Assistant–led ART Co-ops met in the community every 3 months. Participants were seen in the HIV clinic only if referred. CD4 count and viral load were measured in clinic at enrollment and after 12 months. Retention, viral suppression, and clinic utilization were compared between groups using χ2, Fisher exact, and Wilcoxon rank sum tests. Results: At 12 months, there were no significant differences in mean CD4 count or viral load suppression. There was a significant difference in patient retention in assigned study group between the intervention and control group (...

Frontiers in Psychiatry, 2021

Background: Healthcare workers responding to the Corona Virus Pandemic (COVID-19) are at risk of ... more Background: Healthcare workers responding to the Corona Virus Pandemic (COVID-19) are at risk of mental illness. Data is scanty on the burden of mental disorders among Kenyan healthcare workers responding to the pandemic that can inform mental health and psychosocial support. The purpose of this study was to establish the frequency and associated factors of worry, generalized anxiety disorder, depression, posttraumatic stress disorder and poor quality of sleep among Kenyan health care workers at the beginning of COVID-19 pandemic.Methods: We conducted an online survey among 1,259 health care workers in Kenya. A researcher developed social demographic questionnaire and several standardized tools were used for data collection. Standardized tools were programmed into Redcap, (Research Electronic Data Capture) and data analysis was performed using R Core Team. In all analysis a p-value < 0.05 was considered significant.Results: 66% of the participants reported experiencing worry rela...

East African medical journal, 2012

OBJECTIVE To determine whether there is a relationship between male involvement in maternal healt... more OBJECTIVE To determine whether there is a relationship between male involvement in maternal health and utilisation of skilled birth attendants (SBAs) after controlling for socio-demographic and maternal characteristics. DESIGN Data from the Kenya Demographic and Health Survey (KDHS) conducted in 2008-09 were analysed. SETTING Nationally representative survey in Kenya. SUBJECTS The unit of analysis was couples who met the inclusion criteria of being married and having had a child in the three years before the survey. RESULTS The adjusted odds ratio after controlling for other factors indicates that women whose husbands attended at least one ANC visit were more likely to have skilled birth attendance than those whose husbands did not attend any ANC visits [AOR, 1.9; 95 percent CI, 1.09-3.32]. Maternal characteristics that had a statistically significant association with delivery by an SBA included educational level, employment, number of ANC visits, and parity. The province where the ...

American Journal of Epidemiology

Recovery of CD4-positive T lymphocyte count after initiation of antiretroviral therapy (ART) has ... more Recovery of CD4-positive T lymphocyte count after initiation of antiretroviral therapy (ART) has been thoroughly examined among people with human immunodeficiency virus infection. However, immunological response after restart of ART following care interruption is less well studied. We compared CD4 cell-count trends before disengagement from care and after ART reinitiation. Data were obtained from the East Africa International Epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration (2001–2011; n = 62,534). CD4 cell-count trends before disengagement, during disengagement, and after ART reinitiation were simultaneously estimated through a linear mixed model with 2 subject-specific knots placed at the times of disengagement and treatment reinitiation. We also estimated CD4 trends conditional on the baseline CD4 value. A total of 10,961 patients returned to care after disengagement from care, with the median gap in care being 2.7 (interquartile range, 2.1–5.4) months. Our model sho...

Biometrical Journal

Outcome misclassification occurs frequently in binary-outcome studies and can result in biased es... more Outcome misclassification occurs frequently in binary-outcome studies and can result in biased estimation of quantities such as the incidence, prevalence, cause-specific hazards, cumulative incidence functions etc. A number of remedies have been proposed to address the potential misclassification of the outcomes in such data. The majority of these remedies lie in the estimation of misclassification probabilities, which are in turn used to adjust analyses for outcome misclassification. A number of authors advocate using a gold-standard procedure on a sample internal to the study to learn about the extent of the misclassification. With this type of internal validation, the problem of quantifying the misclassification also becomes a missing data problem as, by design, the true outcomes are only ascertained on a subset of the entire study sample. Although, the process of estimating misclassification probabilities appears simple conceptually, the estimation methods proposed so far have several methodological and practical shortcomings. Most methods rely on missing outcome data to be missing completely at random (MCAR), a rather stringent assumption which is unlikely to hold in practice. Some of the existing methods also tend to be computationally-intensive. To address these issues, we propose a computationallyefficient, easy-to-implement, pseudo-likelihood estimator of the misclassification probabilities under a missing at random (MAR) assumption, in studies with an available internal validation sample. We present the estimator through the lens of studies with competing-risks outcomes, though the estimator extends beyond this setting. We describe the consistency and asymptotic distributional properties of the resulting estimator, and derive a closed-form estimator of its variance. The finite-sample performance of this estimator is evaluated via simulations. Using data from a real-world study with competing risks outcomes, we illustrate how the proposed method can be used to estimate misclassification probabilities. We also show how the estimated *

Background Kenya is in the process of implementing universal health care whose success and sustai... more Background Kenya is in the process of implementing universal health care whose success and sustainability will be determined by its funding mechanism and by uptake of National Hospital Insurance Fund (NHIF) by its populace. Unfortunately, NHIF enrollment is currently voluntary hence geared to those in formal employment who represent only 16.4% of the population. To improve the voluntary uptake of the scheme, it is important to have increased awareness as well as implement strategies that address factors that currently affect NHIF uptake. Methods This was a cross sectional community-based survey conducted in Busia, Trans Nzoia, Vihiga and Siaya counties between October and December 2018. It utilized multistage stratified sampling technique. Interviewer assisted questionnaires were used to collect socio-demographic, socio-economic, Non-Communicable Diseases (NCD) knowledge, NHIF awareness and uptake data. Descriptive statistical analysis and multiple logistic regression were conducted...

BMC Pregnancy and Childbirth, 2021

BackgroundEclampsia, considered as serious complication of preeclampsia, remains a life-threateni... more BackgroundEclampsia, considered as serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital.MethodsThis was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using fr...

BMC Health Services Research, 2022

Background Health system approaches to improve hypertension control require an effective referral... more Background Health system approaches to improve hypertension control require an effective referral network. A national referral strategy exists in Kenya; however, a number of barriers to referral completion persist. This paper is a baseline assessment of a hypertension referral network for a cluster-randomized trial to improve hypertension control and reduce cardiovascular disease risk. Methods We used sociometric network analysis to understand the relationships between providers within a network of nine geographic clusters in western Kenya, including primary, secondary, and tertiary care facilities. We conducted a survey which asked providers to nominate individuals and facilities to which they refer patients with controlled and uncontrolled hypertension. Degree centrality measures were used to identify providers in prominent positions, while mixed-effect regression models were used to determine provider characteristics related to the likelihood of receiving referrals. We calculated...

Health Services and Outcomes Research Methodology, 2022

To slow the spread of COVID-19, most countries implemented stay-at-home orders, social distancing... more To slow the spread of COVID-19, most countries implemented stay-at-home orders, social distancing, and other nonpharmaceutical mitigation strategies. To understand individual preferences for mitigation strategies, we piloted a web-based Respondent Driven Sampling (RDS) approach to recruit participants from four universities in three countries to complete a computer-based Discrete Choice Experiment (DCE). Use of these methods, in combination, can serve to increase the external validity of a study by enabling recruitment of populations underrepresented in sampling frames, thus allowing preference results to be more generalizable to targeted subpopulations. A total of 99 students or staff members were invited to complete the survey, of which 72% started the survey (n = 71). Sixty-three participants (89% of starters) completed all tasks in the DCE. A rank-ordered mixed logit model was used to estimate preferences for COVID-19 nonpharmaceutical mitigation strategies. The model estimates indicated that participants preferred mitigation strategies that resulted in lower COVID-19 risk (i.e. sheltering-in-place more days a week), financial compensation from the government, fewer health (mental and physical) problems, and fewer financial problems. The high response rate and survey engagement provide proof of concept that RDS and DCE can be implemented as web-based applications, with the potential for scale up to produce nationally-representative preference estimates.

Cancer is a major cause of morbidity and mortality globally. This study aimed to determine the pr... more Cancer is a major cause of morbidity and mortality globally. This study aimed to determine the preparedness of public health care facilities in the provision of breast and cervical cancer services by assessing healthcare provider’s knowledge on risk factors, screening, symptoms, diagnosis and treatment of the diseases as well as availability of medical equipment required in their management in Western Kenya. This was achieved by using a cross-sectional service provision assessment (SPA) baseline survey technique in Busia and Trans-Nzoia counties of Western Kenya between October and December 2018. Data was collected using an interviewer-assisted questionnaires from healthcare workers, while a structured facility questionnaire was used to assess the level of preparedness of the selected public healthcare facilities. We enrolled 73 healthcare workers 37 (50.6%) of whom were nurses, followed by clinical officers and medical officers. The highest proportion of knowledge on risk factors a...

Journal of the International Association of Providers of AIDS Care (JIAPAC), 2021

Provider-patient communication (PPC) skills are key in promoting patient satisfaction. Our study ... more Provider-patient communication (PPC) skills are key in promoting patient satisfaction. Our study examined the relationship between clinician PPC skills and patient satisfaction with care among virally unsuppressed adult HIV patients in Busia County, Kenya. This cross-sectional study was conducted among 360 HIV patients on first line antiretroviral regimen and having a recent viral load ≥400 copies HIV RNA/ml. We conducted logistic regression analysis. The mean age of participants was 48.2 years [standard deviation (SD): 12.05]. Overall, the mean score on clinician PPC skills was 33.3 (SD: 9.0). A high proportion (85%) of participants reported satisfaction with the HIV care services. After adjusting for covariates, the odds of being satisfied with care increased by 19% (adjusted odds ratio: 1.19, 95% CI: 1.11-1.30) for every one unit increase in the clinician PPC skills score. Promoting good PPC skills may be key to improving patient satisfaction with HIV care.