http://ir.mu.ac.ke:8080/jspui/handle/123456789/5 2026-04-21T08:50:29Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10155 Prevalence of obstructive sleep APNEA risk status among ambulatory type 2 diabetes mellitus patients at Moi Teaching and Referral Hospital Abdirahman, Maalim Adan Background: Obstructive Sleep Apnoea (OSA) is a prevalent yet under-diagnosed sleep-related breathing disorder associated with considerable metabolic and cardiovascular morbidity. In patients with Type 2 Diabetes Mellitus (T2DM), the coexistence of OSA exacerbates glycemic dysregulation and amplifies the risk of diabetic complications. Despite the global evidence highlighting this bidirectional relationship, data from Kenyan diabetic populations remain limited. Objectives: To determine the prevalence of OSA risk status and associated factors among ambulatory T2DM patients attending the diabetes outpatient clinic at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya, using the Berlin Questionnaire. Methods: A hospital-based cross-sectional study was conducted in 334 adult T2DM patients. Participants were systematically sampled and screened for risk of OSA using the Berlin Questionnaire. Data on sociodemographic variables, metabolic markers such as glycated hemoglobin A1C (HbA1c), anthropometric indices such as Body Mass Index (BMI), neck circumference and anatomical factors such as nasal obstruction, and Mallampati score were collected. Bivariate analyses and multivariate logistic regression were performed to identify independent predictors of high OSA risk, with significance set at p < 0.05. Results: The prevalence of OSA risk status was 41.3%, highlighting a substantial burden among patients with type 2 diabetes mellitus. Poor glycemic conrol (HBA1C > 8%) was independently associated with more than a two-fold increase in the odds of high OSA risk, while overweight status conferred a 1.5-fold higher likelihood of OSA risk. Anatomical abnormalities such as deviated nasal septum and nasal polyps, as well as advancing age above 50 years and higher Mallampati scores, were significantly associated with OSA risk. In contrast, hypertension demonstrated an inverse association with OSA risk, suggesting a potential protective effect, although this finding may reflect residual confounding or limitations within the regression Conclusion: Nearly half of patients with type 2 diabetes mellitus at MTRH were at high risk for obstructive sleep apnoea, with significant associations observed between poor glycemic control, overweight status, nasal obstruction and elevated Mallampati scores. These findings are consistent with international evidence of demonstrating a multifactorial interraction between metabolic and anatomical determinants of OSA risk among populations with type 2 diabetes.. Recommendations: Incorporating routine screening for obstructive sleep apnea (OSA) into standard diabetes care. In addition, further research is required to develop and assess practical, cost-effective and evidence-based strategies for the screening and management of OSA. 2026-01-01T00:00:00Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10154 Diabetes distress and its correlation with glycemic control among type 2 diabetes patients at Moi Teaching and Referral Hospital, Eldoret, Kenya Mahmud, Imran Mohamed Background: Type 2 Diabetes Mellitus (T2DM) presents not only a complex metabolic disorder but also imposes a substantial psychological burden in the form of diabetes distress, a condition characterized by negative emotional responses to the ongoing demands of diabetes self-management. This condition continues to emerge as a critical barrier to optimal disease control with growing evidence linking it to poor self-care behaviors, suboptimal glycemic outcomes and increased risk of complications. Despite its clinical relevance, the prevalence of diabetes distress, its associated determinants and impact on glycemic control remain underexplored in many low- and middle-income settings including Kenya. Objectives: This study aimed to determine the prevalence of diabetes distress among individuals with T2DM, assess their level of glycemic control and evaluate whether diabetes distress independently predicts poor glycemic control. Methods: A hospital-based cross-sectional study was conducted among 354 adult patients with T2DM at Moi Teaching and Referral Hospital from January 2024 to December 2024. Data on demographic, socioeconomic and clinical characteristics were collected using structured questionnaires. Diabetes distress was assessed using the validated 17-item Diabetes Distress Scale (DDS-17) while glycemic control was evaluated using glycated hemoglobin (HbA1c). Statistical analyses using descriptive statistics, Chi-square and t-tests for bivariate associations, and multivariable logistic regression, was done to assess the correlation between Diabetes distress and glycemic control. Results: The study population was predominantly female (65.3%), unemployed (67.8%), and uninsured (63.0%), with a mean age of 56.3 years. Over half (52.8%) had coexisting hypertension. The overall prevalence of diabetes distress was 15.8%, with emotional burden (50.3%) and regimen-related distress (33.1%) emerging as the most prominent subdomains. Significant associations were observed between diabetes distress and treatment modality (p < 0.001), especially combination therapy, and comorbid hypertension (p = 0.014). The mean HbA1c was 9.34%, with 57.4% of participants exhibiting poor or very poor glycemic control (HbA1c ≥ 8%). Poor glycemic control was significantly associated with treatment type(insulin) (p < 0.001) and occupational status(unemployed) (p = 0.021). Importantly, multivariable logistic regression revealed that diabetes distress independently predicted poor glycemic control (AOR = 2.31; 95% CI: 1.16–4.62; p = 0.017), indicating that distressed individuals were over twice as likely to have inadequate glycemic control. Conclusion: Diabetes distress is prevalent among patients with T2DM, with a high proportion also demonstrating poor glycemic control. Diabetes distress was independently associated with poor glycemic outcomes, with affected individuals being more than twice as likely to have inadequate control. Emotional and regimen-related distress emerged as the predominant contributors, highlighting the substantial psychological burden in this population. These findings highlight the necessity of addressing psychological distress as an integral component of diabetes care. Recommendations: Assessment of diabetes distress should be incorporated into routine diabetes care, particularly for patients with poor glycemic control, given its association with adverse outcomes. Additionally, further research is needed to explore practical and effective strategies for screening and managing diabetes distress within the Kenyan healthcare setting. 2026-01-01T00:00:00Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10139 Attitudes, preferences and barriers to E-Learning among open, distance and e-learning (ODeL) orthopaedic medicine students at the Kenya Medical Training College Okedo, Robert Ataada Background: Medical education is undergoing a global shift toward technology-enhanced learning. In KMTC, the Orthopaedics and Trauma Medicine program incorporates the Open, Distance, and e-Learning model. Understanding students’ attitudes, preferences, and barriers to e-learning is critical for optimizing digital strategies and sustaining quality training in resource-limited settings. Objective: This study aimed to assess the attitudes, learning preferences, and barriers to e-learning among ODeL othopaedic students at the Kenya Medical Training College. Methods: A mixed-methods cross-sectional design was used. Quantitative data was used to determine the relationship between variables, while qualitative data contextualized the research problem in a detailed context. The sample consisted of 156 participants drawn through stratified random sampling for the quantitative arm, and 8 FGD participants purposively sampled for the qualitative arm. Quantitative data were collected using a 5-point Likert scale questionnaire, and qualitative data using an interview guide. Data were analyzed using descriptive and inferential statistics for quantitative elements, complemented by thematic analysis for qualitative data. Results: The findings reveal a predominantly positive student attitude towards e-learning (68%), with a significant majority (70%) expressing a clear preference for a blended learning model. Prior e-learning exposure exhibited a statistically significant association with e-learning participation (OR = 3.845, p=0.001), underscoring the importance of early exposure. Critical barriers identified included internet access limitations (60%), insufficient training on e-learning platforms (45%), and the prohibitive cost of internet data bundles (35%). Conclusion: While ODeL orthopaedic students have a positive attitude towards e-learning, they prefer a balanced blended instructional approach. Recommendations: To augment ODeL orthopaedic student attitude and participation in e-learning, early exposure to e-learning should be adopted in a blended learning context. Campus internet strength and coverage should be enhanced as a key enabler for e-learning. 2026-01-01T00:00:00Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10133 Analysis of climate change impacts on plant biodiversity and livelihoods among Maasai women in Narok County, Kenya Sinteria, John Kishoyian Climate change poses critical threats to plant biodiversity and pastoral livelihoods in sub-Saharan Africa, yet knowledge gaps persist regarding gender-differentiated impacts of climate-biodiversity interactions on women's livelihood vulnerability. This study assessed climate change impacts on plant species diversity and implications for Maasai women's livelihoods in Narok County, Kenya. A mixed-methods convergent design was employed, integrating quantitative climate data analysis (1990-2020), systematic botanical surveys, structured questionnaires (n=100 Maasai women), and qualitative assessments through focus group discussions (n=24 groups) and key informant interviews (n=15 traditional experts). Climate data from Kenya Meteorological Department and NASA POWER database were analyzed using Mann- Kendall trend tests and Sen's slope estimators. Ethnobotanical surveys utilized systematic transect-quadrat sampling across eight locations. Vulnerability assessment employed Hahn's Livelihood Vulnerability Index framework. Results revealed statistically significant warming of 0.35°C per decade (Mann-Kendall τ=0.312, p<0.01) with extreme temperature events reaching 2.35°C above baseline. Precipitation showed high inter-annual variability (coefficient of variation=31.2%) with significant seasonal shifts including September increases (τ=0.338, p=0.009) and February decreases approaching significance (τ=-0.251, p=0.054). Botanical surveys documented 89 plant species across 33 families, with medicinal uses dominating (36% of species), followed by construction materials (13%) and fodder (11%). Diversity indices indicated moderate levels (Shannon-Weiner H'=1.335; Simpson's D=0.421). Critical conservation concerns emerged with 31 species (35%) occurring in single locations and 25 species at critically low densities, indicating high extinction risk. The Climate Vulnerability Index (4.4) demonstrated moderate vulnerability, with strong adaptive capacity (10.4) buffering high plant-based sensitivity (3.8) and moderate climate exposure (2.2). Climate awareness was exceptionally high (91% of respondents), with strong correspondence between women's perceptions and meteorological data validating traditional ecological knowledge systems. The study conclusively demonstrates that climate change significantly impacts plant biodiversity with direct implications for Maasai women's livelihoods. Despite strong traditional knowledge and social capital through cooperatives, communities face climate risks and biodiversity loss that threaten healthcare access, food security, and cultural practices. Key recommendations include establishing community conservancies with women as primary managers, implementing climate-smart plant management integrating traditional and scientific knowledge, strengthening women's cooperatives for economic resilience, developing integrated climate information systems, and creating intergenerational knowledge transfer programs. These findings advance understanding of the climate-biodiversity-gender nexus and inform evidence-based policy interventions for pastoral communities navigating climate uncertainty. 2025-01-01T00:00:00Z