*FACTORS ASSOCIATED WITH RELAPSE AMONG PATIENTS WITH ALCOHOL DEPENDENCE WHO HAVE UNDERGONE REHABILITATION AT MATHARI NATIONAL TEACHING AND REFERRAL HOSPITAL*
DR. EUGENE MALOBA (H58/76487/2015)
DEPARTMENT OF PSYCHIATRY, STRATHMORE UNIVERSITY
A thesis submitted in partial fulfillment for the award of degree of master of Medicine (Psychiatry)
This research proposal is my original work and has not been presented for a degree in any other university
Dr. Eugene Maloba
PO BOX 22358-00100 Nairobi
This research proposal has been submitted for examination with our approval as University supervisor
Prof Mary Waweru
Department of Psychiatry (Strathmore University)
PO BOX 18676-00202
Dr. John Mwangi
Department of Psychiatry (Strathmore University)
PO BOX 18676-00202 NAIROBI
Table of Contents
DECLARATION.. ii <#_Toc23176405>
List of abbreviations iv <#_Toc23176406>
List of tables. v <#_Toc23176407>
List of Figures. vi <#_Toc23176408>
CHAPTER ONE. 1 <#_Toc23176409>
CHAPTER TWO.. 2 <#_Toc23176410>
2.1 Problem Statement 4 <#_Toc23176411>
CHAPTER THREE. 5 <#_Toc23176412>
CHAPTER FOUR.. 7 <#_Toc23176413>
4.2 Specific Objectives. 7 <#_Toc23176414>
CHAPTER FIVE. 8 <#_Toc23176415>
5.1 Study Design. 8 <#_Toc23176416>
5.2 Study Area. 8 <#_Toc23176417>
5.3 Study Population. 8 <#_Toc23176418>
5.3.1 Inclusion criteria. 8 <#_Toc23176419>
5.3.2 Exclusion criteria. 9 <#_Toc23176420>
5.4 Sample Size Determination and Formula Used. 9 <#_Toc23176421>
5.6 Recruitment and Data Collection Procedures 9 <#_Toc23176422>
5.8 Quality Assurance Procedures. 11 <#_Toc23176423>
5.9 Data Collection Instruments. 11 <#_Toc23176424>
5.10 Ethical Considerations. 11 <#_Toc23176425>
5.11 Study Limitations 11 <#_Toc23176426>
5.12 Potential Benefits to Study Participants. 11 <#_Toc23176427>
5.13 Potential risks. 12 <#_Toc23176428>
CHAPTER SIX.. 13 <#_Toc23176429>
Data Management and Statistical Analysis Plans. 13 <#_Toc23176430>
6.1 Study Timeline. 13 <#_Toc23176431>
*6.2* Budget 15 <#_Toc23176432>
Questions. 16 <#_Toc23176433>
Audit 16 <#_Toc23176434>
Ethical consideration. 17 <#_Toc23176435>
Data management and statistical analysis plans. 17 <#_Toc23176436>
References 18 <#_Toc23176437>
APPENDICIES. 21 <#_Toc23176438>
Appendix I: Part A: Socio-demographic Questionnaire/Treatment Information (English) 21 <#_Toc23176439>
Appendix II: Part A: Socio-demographic Questionnaire/Treatment Information (Kiswahili) 21 <#_Toc23176440>
Appendix III: Statement of Consent (English) 22 <#_Toc23176441>
Appendix IV: Consent Form (Kiswahili)/ Fomu ya Ridhaa. 22 <#_Toc23176442>
List of abbreviations
AUD Alcohol Use Disorder
AUDIT Alcohol Use Disorders Identification Test MNTRH Mathari National Teaching and Referral Hospital MOH Ministry of Health
NACADA National Authority for the Campaign against Alcohol and Drug Abuse WHO World Health Organization
List of tables
Table 1: A table of data management and statistical analysis plan. 13 <#_Toc23175646>
Table 2: Budget 15 <#_Toc23175647>
Table 3: Socio-demographic Questionnaire (English) 21 <#_Toc23175648>
Table 4:Socio-demographic Questionnaire (Kiswahili) 21 <#_Toc23175649>
List of Figures
Figure 1: Flow chart 10 <#_Toc23175584>
Figure 2: A graph of data management and statistical analysis plan. 14 <#_Toc23175585>
Figure 3: A graph showing cost of general categories. 16 <#_Toc23175586>
Alcohol is a psychoactive substance that has been consumed by nearly all cultures in the world from time immemorial. It is a potent drug that causes both acute and chronic changes in almost all neurochemical systems.
Alcohol dependence is characterized by cognitive, physiological and behavioral patterns whereby the individual prioritizes obtaining or using the substance above any other activity. It is diagnosed in the individual when he/she has three or more of the following criteria: compulsion, withdrawal symptoms after cessation of the substance or active avoidance of the withdrawal symptoms, tolerance, increased amount of time spent obtaining and using the substance, persistent use despite harmful effects, narrowing of personal repertoire, lack of control or inability to cut down (WHO, 1993)
There are three general steps involved in treating the person: intervention, detoxification and rehabilitation. Psychiatric and medical emergencies are attended to first before this process. Rehabilitation includes the three major components: continual efforts to increase and maintain high levels of motivation for abstinence, work to help the patient readjust to a lifestyle free of alcohol, and relapse prevention.
Relapse is a recurrence of symptoms of a disease after a period of improvement.
Although there is no standard definition of relapse in treatment research, lack of abstinence is the most commonly used definition because of emphasis placed on abstinence by treatment providers. There are diverse consequences of alcohol abuse including the ultimate price of addiction which is death
*2.0 Literature Review*
In 2010, persons above the age of 15 years in Kenya consumed an average of 18.9 liters of pure alcohol, with males consuming 22.8 litres of pure alcohol and females consuming 9.6 liters of pure alcohol per annum. Worldwide, the consumption per capita was
6.2 litres of pure alcohol with males consuming 21.9 litres and females 8.9 litres per annum. (WHO, 2014) The consumption in Kenya is notably higher than the worldwide average.
Alcohol use disorders (AUDs) are found in 3.2% of the population with 1.4% having Alcohol Dependence (AD) in the African region. However, in Kenya, AUDs are found in 5.8% of the population, with 2.4% having AD. In comparison, Zambia, which is a low middle-income country like Kenya, AUDs are found in 4.5% of the population, with 1.4% having AD. In South Africa, which is an upper-middle-income country, AUDs are found in 5.6% of the population with 2.4% having AD. (WHO, 2014)
A national survey done in Kenya revealed that the lifetime use of alcohol was 59.3% among males and 21% among females, with the Central region recording rates of 31.8%, Eastern region 27.3% and Nairobi 24.4%. Out of all the respondents who consumed alcohol, 10% needed further diagnostic evaluation and treatment. With the use of AUDIT (Alcohol Use Disorders Identification Test) manual, 1.8% of Kenyans lay in zone 4, thus requiring specialist care as they have alcohol use disorders. (NACADA, 2013)
Analysis of the current usage of alcohol among respondents aged between 15-65 years show that the prevalence at the rate of 12.2 in 2017.The trend shows a decline from 13.6 in 2012 and 14.2% in 2017(NACADA,2017). The trend of alcohol and drug abuse entirely is on a downward shift. On the contrary, across the regions, Eastern, Nairobi and coast regions have recorded an increasing trend in the drug and alcohol abuse. Rehabilitation has been described as the relearning or reestablishing of healthy functioning, skills and the values as well as regaining the physical and emotional health(Musyoka,2013).Kurk (2015) further notes that rehabilitation is meant to provide full or partial restoration of physical, psychological or social function that had been dismissed by previous diseases or condition through counselling.
Harmful use of alcohol has been cited as the leading risk factor for death in males aged between the ages of 15-59 years with further evidences that women may be more vulnerable to alcohol related from a given level of alcohol use or a particular dividing pattern. Although severe and persistent alcohol and deer drug problems or SUD has been identified as a chronic disease (Spicer, 1993, O’Brian and Mchellan.1996) AOD addictions have been typically treated by using an intervention parading much the same as an acute medical
2.1 Problem Statement
Substance Use Disorders (SUDs) are a major source of health and social problems, hence a public health concern. A study done at Mathari National Teaching and Referral Hospital (MNTRH) found that 34% of patients afflicted had SUDs. (Ndetei, et al, 2008) According to Otieno, et al (2000), substances commonly abused were alcohol, tobacco, khat and cannabis. The consequences of substance abuse are varied. They include medical, socioeconomic and criminal justice effects and affect people of all ages (NIDA, 2012)
The harmful use of alcohol has negative impacts on the individual, community and country in terms of disease, social and economic issues. Globally, 7.6% of deaths in men and 4% in women are attributed to alcohol, with 5.9% in both sexes in 2012. Alcohol consumption contributes to 25% of deaths occurring in persons between the ages of 25-39 years globally, thus having a great impact on the workforce, leaving many young families without parents. (WHO, 2015)
At the national level, the government of Kenya has recognized the threat caused by alcohol and drug abuse and ratified many international and regional conventions dealing with the control of alcohol and drug abuse. The united states general assembly special session (UNGAAR, 1988) as cited in NACADA (2011) requested that member states including Kenya to address drug abuse in a holistic manner and that they set up effective drug prevention, treatment and rehabilitation programs which are culturally valid and they are based on the knowledge that is acquired from research as well as lessons derived from passed programs
*3.1 **Rationale for the Study*
*3.2.1 **Null hypothesis*. There is no association between social, economic and environmental factors and relapse after rehabilitation for alcohol dependence.
*3.2.2 **Alternate hypothesis*. There is an appreciation between social, economic and environmental factors, and relapse after rehabilitation for alcohol dependence.
*3.2.3 **Research question*. What are the factors associated with relapse after rehabilitation for alcohol dependence?
It is apparent to those who work in the addiction treatment field that relapse is a common and test stable recovery from substance use disorder (Sup) is generally not attained until the patient has achieved 4-5 years of continues recovery (White and Kurtz, 2006).Recent literature suggest that peer driven or support communities may be an effective approach to reduce the number of replaces of alcohol and after drug use (White et al, 2007). The primary goal of alcohol treatment in other areas of medicine is to have patients to achieve and maintain long-term remissions for alcohol dependent persons remission means the continuous maintenance of sobriety please continuing and growing concern among clinicians about the High rate of relapse among their patients and the increasingly adverse Consequences continuing diseases. For this reason play, preventing relapse is perhaps the fundamental issue in alcohol treatment today.
Rationale. Relapse is a major issue in addiction science identifying the predictor of reckless is critical for effective interventions in substance use disorder (Ransavile, 1986). Identification of these factors may help to better tailor services to the needs of service users and improve their effectiveness. Up to now that information is rather sparse already. Already identified dominance of relapse are: Personal situation, Body be changed (e.g. in the brain contextual factors and staff, treatment and program characteristics (Bottlender & Soyka, 2005; Becker 2008).
Alcohol dependency can be regarded as a chronic condition(Koob and Volkow,2009) characterized by high rate of relapse into a problematic drinking soon after initial successful treatment(Witkiewwitz and Marlat 2007).Insight Into other factors that promote relapse could provide a starting point for developing treatments that reduce relapse.
*4.1 **Broad Objective*
To determine the factors associated with relapse after rehabilitation for alcohol dependence.
4.2 Specific Objectives
• To determine if craving reduces after rehabilitation for alcohol dependence
• To determine if illness is associated with relapse
• To determine if peer pressure is associated with relapse after rehabilitation for alcohol dependence
• To determine if work stress is associated with relapse after rehabilitation for alcohol dependence
• To determine if social strife is associated with relapse after rehabilitation for alcohol dependence
*Study Design and Methodology*
5.1 Study Design
The study will be a cross-sectional analytical survey.
5.2 Study Area
The Mathari National Teaching and Referral Hospital (MNTRH) is located about 8km from Nairobi City Centre, along the Thika Super Highway in Nairobi County and has been in operation since 1910. It is a major referral hospital for psychiatric patients who come all over Kenya, although the major catchment areas are in the former Central, Eastern and Nairobi provinces. It offers medical outpatient, comprehensive care, family planning, dental services, diagnostic investigations, and inpatient and outpatient psychiatric services.
Patient management is multidisciplinary. Staff includes doctors, nurses, clinical officers, psychologists, social workers, public health officers, occupational therapists, probation officers, laboratory technicians, and administrative and support staff. The hospital has a rehabilitation unit for patients with substance abuse disorders. They offer community based rehabilitation. 5.3 Study Population
Patients who have undergone rehabilitation at MNTRH and have relapsed.
5.3.1 Inclusion criteria.
188.8.131.52 Patients who have undergone rehab at MNTRH
184.108.40.206 Patients who have relapsed after rehab at MNTRH
220.127.116.11 Patients who are above 18 years
18.104.22.168 Patients who did not complete the programme at MNTRH
5.3.2 Exclusion criteria.
22.214.171.124 Patients who completed the rehab programme at MNTRH
126.96.36.199 Patients who did not relapse after completing the rehab programme
188.8.131.52 Patients who decline to give consent to the study
5.4 Sample Size Determination and Formula Used
*5.5 **Sampling Method*
Systematic random sampling will be used.
5.6 Recruitment and Data Collection Procedures
Approval from the MNTRH management. Files of patients who have undergone Rehabilitation will be retrieved from the records department. The study will be explained to the patients. If they meet the criteria, informed consent will be obtained. Those with active psychopathology will be counselled and treatment continued.
Approval from MNTRH
Files obtained from records department
*5.7 **Flow Chart*
Figure 1: Flow chart
5.8 Quality Assurance Procedures
Emphasis will be put to ensure that study participants fully understand the questions being asked and what the study is all about. Information collected will be recorded and stored in locked cabinets only accessible to the researcher. 5.9 Data Collection Instruments
Study will be conducted using a socio-demographic questionnaire designed by the researcher, which gathers personal information including age, sex, and marital status, county Of residence, employment status, and education level.
5.10 Ethical Considerations
Approval will be sought from Ethics and Research Committee of Kenyatta National Hospital and University of Nairobi management. A written authority will be obtained from the management of MNTRH to conduct the study.
A signed informed consent will be obtained from the participants after the study has been explained to them. They are also at liberty to opt out at any time and may choose not to answer questions they find distressing. Explain that there are no rewards or monetary gain for participating in the study. Patients with any needs will be referred as appropriate. 5.11 Study Limitations
The study will be carried out in one rehab center and generalization to other rehab centers may be difficult.
Further studies in different rehabilitation centers with different rehabilitation approaches would help overcome this limitation. 5.12 Potential Benefits to Study Participants
Data from the study may help the patients and clinicians to understand factors associated with relapse and help in improving the treatment outcomes. 5.13 Potential risks
Discussion of alcohol use is a sensitive topic and participants may be uncomfortable
CHAPTER SIX Data Management and Statistical Analysis Plans
Questionnaires will be reviewed for completeness before data entry. Hard copies of documents will be kept in a locked cabinet only accessible to the researcher.
Data will be edited, coded and keyed into a computer for analysis only accessible to the data manager and principal investigator.
Statistical analysis will be done using statistical Package for Social Sciences (SPSS) version 2.2.
Data will be presented in tables, figures, charts and interpretive analysis given. *6.1 *
6.1 Study Timeline
Table 1: A table of data management and statistical analysis plan
Drafting the proposal
Seeking approval from the committee
Data Analysis & Report Writing
Figure 2: A graph of data management and statistical analysis plan
Table 2: Budget
Printing, photocopying, Internet charges
Questionnaires Stationery Transport
5 days/week for
2 months (40days)
Data analysis and report writing
Biostastician Printing report
10% of total
Figure 3: A graph showing cost of general categories
In this context, around 3 million or 5.1 of all the global deaths were attributed to alcohol consumption in the year 2016(WHO, 2018). There is no consensus on the definition of the term relapse (Witheiewwitz and Marlat, 2007)
i. Data collection instruments
ii. Socio-demographic questionnaire
iii. This has been the same by the researcher and gathers Arsenal information from the participants such as the year age, marital status, religion, education and employment
This study for alcohol use disorders. Identification test was done in the year 1982 by a group of instructional investigators selected by WHO. It has since been used in continuing studies and surveys is how the following benefits. It identifies hazardous harmful use of alcohol and dependency and is consistent with ICDYO definitions of the statue, it is brief, rapid and flexible to use. It can be used in various eating and by various professions. Lastly, it mainly focuses and the revenues of alcohol (WHO, 2001)
The question has proven to be a good screening tool for determining the procedure of alcohol use disorder (Gache P, 2005) .The psychometric properties include sensitivity of 76 and specify of.79 with an area under the curve of.84 scoring better than CAGE at 70. This study is self-sponsored hence the researcher will meet all the costs in the budget
Approval will be sought from ethics and research committee of Kenyatta National Hospital and University of Nairobi management. A Written authority will be obtained from participants after the study has been explained to them. Confidentiality will be reserved in data management and no identifier will be put on the study having trouble hearing you instruments except serials#8. Patients with any needs will be referred to as appropriate
Data management and statistical analysis plans
Questionnaires will be reviewed for completeness before data entry. Hard copies of documents will be stored in a stocked cabinet
Data will be entered into passwords and protected. Microsoft access database accessible only to data manager and principal investigator. The study will be presented in tables, graphs, charts and interpretive analysis will be given
NACADA. (2013). National Survey on Alcohol Related Illnesses and Deaths in Kenya. Nairobi: NACADA
World Health Organization. (2014). *Global status report on alcohol and health. *Geneva. World Health Organization.
Othieno, C. J., Kathuku, D. M., & Ndetei, D. M. (2000). Substance abuse in outpatients attending rural and urban health centres in Kenya. *East African medical journal*, *77*(11).
Ndetei, D. M., Khasakhala, L., Maru, H., Pizzo, M., Mutiso, V., Ongecha-Owuor, F. A., & Kokonya, D. A. (2008). Clinical epidemiology in patients admitted at Mathari psychiatric hospital, Nairobi, Kenya. *Social Psychiatry and Psychiatric Epidemiology*, *43*(9), 736.
National Institution of drug abuse (2012). The science of drug abuse and addiction and addiction: medical consequences of drug abuse. Retrieved from http//www.drugabuse.gov/publication/mdiaclconsequences ofdrugabuse
WHO.(2015).Global Tuberculosis Report. Generic: WHO.
WHO. (1993). ICD-10. Classification of mental and behavioral disorder. Generic: WHO
NACADA (2011). National Fact Finding Mission Report on the Extent of Alcohol and Drug Abuse in Kenya. Nairobi: NACADA.
NACADA (2017). Rapid Situation Assessment of Drug and Substance Abuse in Kenya. Nairobi: NACADA.
World Health Organization. (2018). *Global status report on alcohol and health. *Geneva. World Health Organization.
MUSYOKA, C. M. (2013). A SITUATION ANALYSIS OF THE TREATMENT MODELS USED IN REGISTERED INPATIENT ALCOHOL AND DRUGS REHABILITATION CENTRES IN AND AROUND NAIROBI.
Kuria M. (2015). Cost Effective Of Community Based And Institution Based And Institution Based Detoxification And Rehabilitation Of Alcohol Dependent Persons In Kenya. IOSR Journal of Humanities and Social Science.
White w, kurtz e (2016). The rarietler of recovery experience: a primer for addiction treatment professional and recovery Advocator. In while
WL, Kurtz E, Scrunders M (edn). Recovery management. Chicago, IL: Great Lakes Addiction Technology Transfer Centre
White W, Boyle M, Loveland D (2004). Recovery from addiction and recovery from mental illness: shared and contrasting lessons.in Ralph and Corrigan P (eds) Recovery and mental illness. Consumer vislam and research paradigams. Washington, DC: American Psychological Association
White W, Kurtz E (2006). Recovery linking addiction treatment and communities of recovery: a primer for addiction counsellor and recovery coacher. Northwest addiction technology transfer network. Pilthroburg, PA: Institute for research, education and training in addiction
Spicer J(1993). The Minnesota model. Center city, MN: Hazelden
O’Brien CP, McLellan AT (1996). Myths about the treatment of addiction. The lancet 347:237-240
White WL (2006. Recovery management 🙂 what if we really believed that addiction war is a chronic disorder? In white WL,
Kurtz E, Sanders M (edr). Recovery management. Chicago, K: Great Laleer addiction technology transfer center.
Rounsaville BJ (1986) clinical implications of relapse research. Relapse recover drug abuse Natl INS drug abuse research management.
Allen J, Lwman C, Miller WR (1996) Perspective on precipitator of relapse addiction 81:53-54
Bottlender M, Soylaa M. outpatient alcoholism treatment: Predictor of outcome after 3 years. Derug alcohol depend 2005; 80(1) : 83-9
Becher HC. Alcohol dependence, withdrawal and relapse. Alcohol Res health 2008; 31(4):348-61
Koob GF, Volkow NP (2009). Neurocirniticty of addiction. Neuropsychology-35:217-238
Witkeiwitz K, Marlat GA (2007). Modeling the complexity of port treatment drinking: it’s a rocky road to relapse. Clinic psychology rex 27: 724-738
WHO.(2001). Audit: Guidelines for use in primary care, generic: WHO
GACHE P, M.P. (2005). The alcohol use disorder identification test (Audit) as a screening tool for excessive drinking in primary care rehabilitation and validity of a French version. Alcohol cline exp rer, 29(11), 2001-7
Menesser-Gaya, C.d, Zuaradi, A.W, Loureior, S.R., and crippa, J.A.(2009). Alcohol use disorder identification test (audit): an updated systematic review of psychometric properties. Psychology and neuroscience, 2(1), 83-97
APPENDICIES Appendix I: Part A: Socio-demographic Questionnaire/Treatment Information (English)
Kindly fill in or tick the box where appropriate:
Table 3: Socio-demographic Questionnaire (English)
Area of Residence:
4. Have you attended a rehabilitation?
2. Yes, When?
5. What led to your relapse?
2. Peer pressure
3. Illness ( physical / mental)
4. Family related problems (disputes, abuse)
5. Personal problems ( lack of employment or money, legal problems, dropping out of school)
6. Other (please specify)
Appendix II: Part A: Socio-demographic Questionnaire/Treatment Information (Kiswahili)
Tafadhali Jaza Pengo au weka alama X:
Table 4:Socio-demographic Questionnaire (Kiswahili)
Nambari ya kisiri:
Nambary ya Simu:
Siku la kuanzishwa matibabu:
1.Hali ya Ndoa:
4. Ushawahi hudhuria kituo cha ukarabati?
2. Ndio, Lini?
5. Nini kilisababisha kutorudi tena?
2. Shinikizo la marafiki
3. Kuugua ( kimwili / kiakili)
4. Shida za kifamilia (mizozo, hujma)
5. Matatizo za kibinafsi ( kukosa kazi ama pesa, shida za kisheria , kuacha shule)
Appendix III: Statement of Consent (English)
I………………………………………………………………………………… (Name of participant) have read/heard and understood about this study entitled *“**factors associated with relapse among patients with alcohol dependence who have undergone rehabilitation at Mathari national teaching and referral hospital**”*.
The questions I have asked have been answered by
………………………………………………………………………………………………….. (Name of person taking
consent/researcher) in the language I understand.
I understand that participation in this study is voluntary and that I can withdraw my participation at any time without repercussions. I am aware that all the information given, including personal information will be kept confidential. I consent to give information that will assist in this study. I am aware that information received will be published but identification data will be kept confidential such that the findings will not be traced back to me.
I agree to participate in this study.
Name of participant:…………………………………………………………………………
Signature/thumb stamp of participant:…………………………………………. Date:……………….
Signature of witness:……………………………………………….. Date:……………….
Name of person taking consented. Dr. Eugene Maloba (Researcher) Date:……………..
Appendix IV: Consent Form (Kiswahili)/ Fomu ya Ridhaa
Mimi …………………………………………. …………………………………….. (Jina la mshiriki) nimesoma /
nimesikia na kuelewa kuhusu utafiti huu “*mambo yanayohusiana na kurudi tena miongoni mwa wagonjwa wenye utegemezi wa pombe ambao wamepata ukarabati katika mafundisho ya kitaifa katika hospitali ya rufaa ya Mathari* “.
Nimeuiliza maswali na nikajibiwa na ………………………………….. …………………………………………..
…………………. (jina la mtu kuchukua kibali / mtafiti) katika lugha ambayo naelewa.
Naelewa kwamba ushiriki katika utafiti huu ni wa hiari na kwamba naweza ondoa ushiriki wangu wakati wowote bila madhara. Ninatambua kwamba taarifa zote zitatolewa, lakini taarifa binafsi itakuwa siri. Nakubali kutoa taarifa itakayosaidia katika utafiti huu. Ninatambua kuwa habari hii tachapishwa lakini maelezo kunihusu binafsi haitachapishwa wala haitutumiwa kunitambua.
Mimi nakubali kushiriki katika utafiti huu.
Jina la mshiriki: ………………………………………. ………………………………..
Sahihi / muhuri wa kidole gumba wa mshiriki: ………………………………………… Tarehe:……………….
Saini ya shahidi: ……………………………………………….. Tarehe:……………….
Jina la mtu anayechukua ridhaa: Dr. Eugene Maloba (Mtafiti) Tarehe: …………… ..