RP-Department of Obstetrics and Gynaecology

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Partner notification in the management of sexually transmitted infections in Nairobi, Kenya
(Kenya Medical Association, 2003) Wakasiaka, S. N.; Bwayo, J. J.; Weston, K.; Mbithi, J.; Ogol, C.
Objective: To assess utilization of partner notification as a tool in prevention and control of Sexually transmitted infections in Nairobi City Council clinics. Design: A cross-sectional study carried out between April and September 2000. Setting: Nairobi City Council health clinics were stratified into eight administrative divisions and a total of 16 out of 54 primary health clinics with at least four STIs patients per day were selected. A standard questionnaire was administered to every fourth patient with clinical diagnosis of STIs who gave consent on exist. Sexual partners referred by index cases during the five day period from each clinic were also enrolled into the study. An additional questionnaire was administered to HCP who were managing STIs patients and their sex partners. Results: Of 407 STIs patients recruited between April and September 2000, 20.6% were primary and 2% were secondary referrals giving an average referral rate of 23%. Respondents with multiple sex partners were less likely to refer their partners compared to those who had one partner (17.9% vs 82.1%, p<0.005). Counseling of STI patients on the importance of partner referral was more effective than issuing referral cards alone (72.8% vs 56.8% % p= <0.006). Barriers to partner notification included partners being out of town (44.6%) fear of quarrels and violence from partners (32.5%) and casual partners (15.1%) whose sex partners were unknown. Conclusion: Counseling and understanding of STIs patients on the need to treat all sexual partners is pivotal to the success of partner referral.
Towards achieving millenium development goal number 5: maternal mortaility at Thika District Hospital, Kenya. A one year review
(Elsevier, 2009) Wanyoro, A. K.
Background: Maternal mortality remains high in the developing countries and especially in the Sub Saharan Africa. Constant reviews will help in elucidating varies causes which in most instance are avoidable. These will help reduce maternal mortality and thus help in the attainment of millennium development goals. Objective: To review the maternal mortality at Thika district hospital for the year 2006 and to determine characteristics of patients involved. Design: A descriptive retrospective study. Setting: Thika district hospital, Kenya. Subjects: Maternal deaths from 1st January to 31st December 2006. Main outcome measures: determination of maternal mortality rates of patients who died of pregnancy related causes in the year 2006 from admission up to 6 weeks of delivery. Also determine the patient’s social demographics, obstetrics characteristics, causes of death, and modes of delivery and survival of the babies
Maternal Outcomes among Grand Multiparous and Multiparous Women in Mulago Hospital, Uganda
(East African Medical Journal, 2011-06) Njeru, J. N.; Biryabarema, C.; Kagawa, M.
Objective: To compare the incidence of intrapartum and immediate post-partum complications among grand multiparous (para 5-9) and multiparous (para 2-4) delivering at Mulago hospital, Uganda. Design: Prospective cohort study. Setting: Mulago hospital, Uganda. Subjects: One hundred and fifty six grand multiparous and multiparous women were recruited on admission in labour ward and followed up through labour and immediate post partum period. Maternal complications among the two groups were collected and analysed. Results: Women with grandmultiparity were significantly older and had a lower educational profile than multiparous women. The overall incidence of intrapartum and immediate post-partum complications for grandmultiparous women was 13.5% compared with 9.6% in the multiparous group RR 1.19 (0.88-1.61). Grand multiparous (GMP) women were more likely to have PPH than the multiparous (MP) women 6.4% vs. 1.9% RR l.61 (1.20-2.17). Conclusion: Post-partum haemorrhage (PPH) was higher among the GMPs when compared to MPs.
Depression among women with obstetric fistula in Kenya
(Elsevier, 2011-10) Mutiso, S.; Weston, K.; Mwangi, J. W.; Qureshi, Z.; Beard, J.; Venkat, P.
Objective To establish the prevalence of depression and describe associated factors among fistula patients attending an obstetric fistula surgical camp in Kenya. Methods A cross-sectional study was conducted focusing on obstetric fistula patients attending a national fistula camp held in August 2008 at Kenyatta National Hospital, Nairobi, Kenya. A structured questionnaire was used to obtain sociodemographic data and medical histories for all consenting patients before surgery. Depression measures were obtained using the Patient Health Questionnaire-9. Results Of the 70 women interviewed, 2 (2.9%) and 12 (17.1%) reported a history of psychiatric illness and suicidal ideations, respectively. Depression was present in 51 (72.9%) patients, with 18 (25.7%) meeting criteria for severe depression. Depression was significantly associated with women older than 20 years of age (P = 0.01), unemployment (P = 0.03), lack of social support following fistula (P = 0.04), and living with fistula for over 3 months (P = 0.01). Conclusion Women with obstetric fistula are predisposed to high levels of depression. A holistic management approach, including mental health care and family support, is recommended.
A Bottle Extracted from the Peritoneal Cavity: A Case Report
(2012) Ngatia, J.W.
Foreign bodies inserted in the peritoneal cavity are rare in gynecologic practice. More often, they are inserted in an attempt to induce abortion and their sizes are generally small/narrow. Presence of foreign bodies in the peritoneal cavity may be life-threatening. Doctors should consider foreign bodies as differential diagnosis in patients presenting with acute abdomen. The case presented is of a large foreign body (a soft drink bottle) after the patient was drugged. She had successful surgical and medical intervention
Barriers to safe motherhood: the morbidity pattern amongst patients presenting with incomplete abortion at Kenyatta National hospital, Nairobi, Kenya
(Elsevier, 2012) Wanyoro, A. K.
Objectives: To determine the morbidity pattern amongst patients presenting with incomplete abortion at Kenyatta National hospital. Materials: All patients admitted with a diagnosis of incomplete abortion between 1st February to 31st March were given information about the nature and purpose of the study and consent sought. Methods: This was a Prospective descriptive study. Post abortion patients were examined to determine presence and nature of any complication. This information was entered into a questionnaire and analyzed. Two hundred and fifty patients with incomplete abortion were recruited for the study
Interventional studies for preventing surgical site infections in sub-Saharan Africa - A systematic review.
(International journal of surgery, 2012) Aiken, A. M.; Karuri, David M.; Wanyoro, Anthony K.; Macleod, Jana
There is a great need for safe surgical services in sub-Saharan Africa, but a major difficulty of performing surgery in this region is the high risk of post-operative surgical site infection (SSI). We aimed to systematically review which interventions had been tested in sub-Saharan Africa to reduce the risk of SSI and to synthesize their findings. We searched Medline, Embase and Global Health databases for studies published between 1995 and 2010 without language restrictions and extracted data from full-text articles. We identified 24 relevant articles originating from nine countries in sub-Saharan Africa. The methodological quality of these publications was diverse, with inconsistency in definitions used for SSI, period and method of post-operative follow-up and classification of wound contamination. Although it was difficult to synthesise information between studies, there was consistent evidence that use of single-dose pre-operative antibiotic prophylaxis could reduce, sometimes dramatically, the risk of SSI. Several studies indicated that alcohol-based handrubs could provide a low-cost alternative to traditional surgical hand-washing methods. Other studies investigated the use of drains and variants of surgical technique. There were no African studies found relating to several other promising SSI prevention strategies, including use of checklists and SSI surveillance. There is extremely limited research from sub-Saharan Africa on interventions to curb the occurrence of SSI. Although some of the existing studies are weak, several high-quality studies have been published in recent years. Standard methodological approaches to this subject are needed.
Changing Use of Surgical Antibiotic Prophylaxis in Thika Hospital, Kenya: A Quality Improvement Intervention with an Interrupted Time Series Design
(Public Library of Science, 2013) Wanyoro, A. K.; Aiken, Alexander M.; Mwangi, Jonah; Juma, Francis; Mugoya, Isaac K.; Scott, J. Anthony G
Abstract Introduction In low-income countries, Surgical Site Infection (SSI) is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals. Methods We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design. Results From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks) and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks) in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these. Conclusion Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution.
Evaluation of surveillance for surgical site infections in Thika Hospital, Kenya.
(2013-02) Wanyoro, A. K.; Aiken, A. M.; Mwangi, J.; Mulingwa, P.; Wanjohi, J.; Njoroge, J.; Juma, F.; Mugoya, I K; Scott, J. A. G.; Hall, A. J.
BACKGROUND: In low-income countries, surgical site infections (SSIs) are a very frequent form of hospital-acquired infection. Surveillance is an important method for controlling SSI but it is unclear how this can best be performed in low-income settings. AIM: To examine the epidemiological characteristics of various components of an SSI surveillance programme in a single Kenyan hospital. METHODS: The study assessed the inter-observer consistency of the surgical wound class (SWC) and American Society of Anesthesiologists (ASA) scores using the kappa statistic. Post-discharge telephone calls were evaluated against an outpatient clinician review 'gold standard'. The predictive value of components of the Centers for Disease Control and Prevention - National Healthcare Safety Network (CDC-NHNS) risk index was examined in patients having major obstetric or gynaecological surgery (O&G) between August 2010 and February 2011. FINDINGS: After appropriate training, surgeons and anaesthetists were found to be consistent in their use of the SWC and ASA scores respectively. Telephone calls were found to have a sensitivity of 70% [95% confidence interval (CI): 47-87] and a specificity of 100% (95% CI: 95-100) for detection of post-discharge SSI in this setting. In 954 patients undergoing major O&G operations, the SWC score was the only parameter in the CDC-NHNS risk index model associated with the risk of SSI (odds ratio: 4.00; 95% CI: 1.21-13.2; P = 0.02). CONCLUSIONS: Surveillance for SSI can be conducted in a low-income hospital setting, although dedicated staff, intensive training and local modifications to surveillance methods are necessary. Surveillance for post-discharge SSI using telephone calls is imperfect but provides a practical alternative to clinic-based diagnosis. The SWC score was the only predictor of SSI risk in O&G surgery in this context.
Fetal Outcomes among Grand Multiparous and Multiparous Women In Mulago Hospital, Uganda
(East African Medical Journal, 2013-03) Njiru, J.; Biryabarema, C.; Kagawa, M.
Objective: To compare fetal outcomes among grand multiparous (para 5-9) and multiparous (para 2-4) delivering in Mulago hospital, Uganda. Design: Prospective cohort study. Setting: Mulago hospital, Uganda. Subjects: One hundred and fifty six grand multiparous and multiparous women were recruited on admission in labour ward and followed up through labour and immediate post partum period. Fetal outcomes among the two groups were collected and analyzed. Results: The admissions to SCU were similar in the two groups i.e. 11(7%) GMP vs. 11(7%) MP, the number of fresh still births was higher among the grandmultiparas 13(8.3%) GMP vs. 7(4.5%) MP though this was not statistically significant. The fetal weight did not significantly differ in the two groups. Conclusion: There was no difference in fetal outcomes among GMPs when compared to MPs. Key words: Grand multiparous (GMP), Multiparous (MP), Birth weight, Special Care Unit (SCU), Apgar score, Fresh Still Birth (FSB).
Knowledge, Attitude and use of Pain Relief in Labour among Women Attending Ante-Natal Clinic at Shalom Community Hospital, Athi River
(East African Medical Journal, 2014-07) Njiru, J.N; Esiromo, M.A; Omari, H.O.
Objective: To find out the knowledge, attitude and practice of pain relief methods during labour among mothers attending antenatal clinics at Shalom Community Hospital, Athi River, Kenya. Design: Cross Sectional study Setting: Shalom Community Hospital, Athi River, Kenya Subjects: Two hundred and seven participants attending antenatal clinics at the facility were recruited. Results: The median age of the participants was 28 years and a median parity of one. Most of the study participants, 89.4%, were not aware of any pain relief method during labour. Among the 10.6% patients that were of a pain relief method, 54% had gotten the knowledge from the doctors. All the patients had experienced pain in labour with 72% rating the pain as severe pain. Only 37% of the patients were offered a pain relief method and the intramuscular injectable was offered to all. Majority (88%) of those offered a form of pain relief rated the pain relief method as ineffective. A majority of the women 93% would use a pain relief method in the next labour with epidural method being the most preferred method. Conclusion: The level of knowledge of pain relief methods among mothers is low. There is need to integrate information on pain relief options in labour as part of antenatal services offered routinely. Epidural analgesia services should be enhanced
Cervical cancer screening adherence and the SMS: Screening adherence and availability of the mobile phone SMS in women attending the outpatient clinic at Thika Level 5 Hospital
(Kenyatta University, School of Medicine, 2015) Wanyoro, A.K.; Kabiru, Ephantus W.; Bubusi, E.
Background: Despite the availability of various cervical cancer screening methods in Kenya, few women are screened and even fewer adhere to subsequent scheduled screening. The WHO recommends that an effective cervical cancer screening program needs to in-cooperate a strong component of call and recall in order to keep eligible women in the screening cycle. With a good mobile phone network the short text message (SMS) was seen as a good tool to enhance regular screening in Kenya and in most developing countries. Objective: The objectives of the study were to determine the adherence to regular cervical cancer screening among women attending the outpatient clinic at Thika hospital, ownership and duration of mobile phones ownership and frequency of change of the mobile phone numbers among women who have ever been screened for cervical cancer as well as assess their ability to read and write short text message (SMS) and previous reception of a health promoting SMS through the mobile phone. Methods: A provider administered questionnaire in a formative cross sectional prospective survey as part of a RCT on the use of the SMS to enhance adherence to scheduled cervical cancer screening. The questionnaire was administered in 193 women attending the general outpatient clinic in Thika hospital. Questions about their adherence to scheduled screening, ownership and usage of the mobile phones and experience with usage of the SMS services were asked. Main outcomes measures: These included adherence to regular cervical cancer screening, ownership and length of ownerships of a mobile phone, change of SIM card numbers and ability to read and write an SMS. Results: It was found that few women (9%) were adherent to regular screening. Majority of these women (98%) owned mobile phones and few (13.2%) ever changed their numbers. Most (92%) were 3 able to read and write an SMS. Very few (2.1%) had ever received 'a health promoting SMS. . Conclusion and recommendation: It was concluded that since many women owned mobile phones and rarely change their numbers and also are able to read an SMS, the SMS can be used as a recall tool to enhance adherence to cervical cancer screening. It was recommended that the SMS should be in-cooperated as a recall tool in the national cervical cancer screening program as per WHO guidelines on cervical cancer screening programs.
Socio demographic characteristics, antenatal clinic attendance and PMTCT knowledge of postnatal HIV+ women at an urban public health facility in Nairobi, Kenya
(Kenyatta University School of Medicine, 2015) Imbaya, C.U.; Odhiambo-Otieno, G.W.; Okello--Agina, B.M.
Background: Women who have inadequate or poor knowledge about Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) are more likely to default on antiretroviral treatment and less likely to implement MTCT preventive measures thus a sub-optimal viral suppression and an increase in MTCT rates. Early and frequent Antenatal Clinic (ANC) attendance integrated with PMTCT services increases MTCT knowledge and uptake of the services thus optimising intervention outcomes. Objectives: To determine the sociodemographic characteristic levels that influence Antenatal Clinic (ANC) attendance, PMTCT knowledge and Antiretroviral (ARV) drugs uptake among postnatal HIV+ women. Setting: Pumwani Maternity Hospital in Nairobi, Kenya. Methodology: This was a cross-sectional descriptive study that was conducted at Pumwani Maternity Hospital which is in a low social income set up in Nairobi County. The hospital has active ANC and Postnatal Clinic (PNC) facilities that provide PMTCT and specialist referral obstetric services to more than 30,000 maternity clients annually. HIV+ positive postnatal women who were seeking health services at the hospital were identified using their health records and recruited into the study either while still in the postnatal ward after delivery or during post natal clinic visits within the period of the study. Standardized structured questionnaire was administered to collect the appropriate study data from the mothers. Results: A total of 326 HIV+ women, aged 15 - 42 years (mean 28.3 years) participated in the study. Most of the women were either married (72.9%), single East and Central Africa Medical Journal 2015; 2(1): 10-17 10 (15.7%), widowed (6.8%) or separated (4.6%) and of low levels of education. Majority were either housewives (38.3%) or engaged in small businesses such as selling vegetables and merchandising food items and second hand clothes. Their overall estimated monthly mean domestic expenditure was about US$ 102. Most of the women (92.4%) attended antenatal clinic in peripheral health facilities and only came to PMH for delivery services. Majority (94.5%) of the women received Counselling and Testing (CT) while a few (3.3%) reported being counselled but not tested at the antenatal clinic. Among the women who were counselled but not tested for HIV antenatally majority (81.8%) declined to be tested due to fear of being told that they were HIV+. They learnt about their status later after delivery when they were convinced to undertake the test. Regarding knowledge about MTCT 94.7% ofthe women agreed that they were aware that HIV can be transmitted from the mother to her child by various methods. Some of the women (14.1%) were not aware that abstaining from breastfeeding can prevent MTCT and almost half of them (45.7%) did not know that exclusive breast feeding was also another preventive measure. Almost 15% of the mothers were not aware that they could prevent MTCT by using ARV's. Some of the women (15%) had not informed their husbands regarding their HIV status. However we did not establish any significant relationship between the husband's knowledge of the wife's HIV status and the women's acceptance to use ARV's. There was also no significant relationship between the husband's consent and women's decision to use ARV's whereas most of the women (99.3%) confirmed that they would take the ARV's regardless of whether their husband agreed to the usage or not. The ARV adherence was not influenced by the number of ANC visits, parity, education status and husband's lack of awareness about the wives' HIV status. Data on ANC attendance indicated that majority (91.1 %) ofthe women attended ANC at it~1',~one or more times either in the peripheral facilities or at Pumwani Hospital but most (66%) made the first visit in the 5th to 7th month (average 6th month) of gestation. HighANC attendance rate was significantly associated with the uptake of prophylactic ARV's (1)=0.001). The frequency of ANC attendance was also significantly associated with the health facility where the mother attended the clinic (P=0.0045). Almost half (46.6%) of the women made only 1 to 3 ANC visits. Reasons for not attending ANC included not wishing to attend (66.6%), not knowing the importance of ANC (16.7%) and far distance to the clinics (16.7%). Conclusion: The main gaps that were observed in this study are the late initiation and low frequency of ANC attendance, low PMTCT knowledge and delayed first visit and uptake of ARV's among HIV+ women in this low socioeconomic set up. This calls for improvement of health services and community oriented PMTCT education in the peripheral health facilities where the bulk of ANC activities took place.
Traumatic sex with vulval haematoma formation: case report and review of literature
(Kenyatta University School of Medicine, 2015) Ngatia, J.W.
The rich vascular upply to the vulva places it at risk for bleeding from trauma. Vulval haernatornas are the most common sequelae. In adult women, the labia majora are comprised of large fat pads, which act to protect the vulva against injury. In contrast, children lack welldeveloped fat pads in this area and often engage in play activities predisposing them to vulval trauma; thus, they are more likely to sustain vulval injuries than adults eg "Straddle injuries" [1-4]. The case presented was of traumatic sex with vulval haemorhage and haernatoma formation. It was successfully managed by surgical evacuation, ligation of the bleeding sites, and use of antibiotics and analgesics.
Household-level correlates of children’s physical activity levels in and across 12 countries
(John Wiley & Sons, Inc., 2016) Harrington, D.M.; Broyles, S.T.; Chaput, J-P.; Fogelholm, M.; Hu, G.; Kuriyan, R.; Kurpad, A.; Maher, C.; Maia, J.; Matsudo, V.; Olds, T,; Onywera, V.; Sarmiento, O.L.; Standage, M.; Tremblay, M.S.; Tudor-Locke, C.; Zhao, P.; Katzmarzyk, P.T.
Objective: Household factors (electronic media equipment, play equipment, physical activity in the home, and social support) have been associated with childhood moderate- to vigorous-intensity physical activity (MVPA), but little is known about how these factors differ across diverse countries. The objective was to explore household correlates of objective MVPA in children from 12 countries. Methods: Overall, 5,859 nine- to eleven-year-old children from 12 countries representing a range of human and socioeconomic development indicators wore an accelerometer for 7 days and parents reported on household factors. Multilevel general linear models explored associations among household factors and MVPA variables controlling for age, sex, and parental education. Results: Across sites, children with at least one piece of bedroom electronic media had lower MVPA ( 4 min/day; P < 0.001) than those who did not. More frequent physical activity in the home and yard, ownership of more frequently used play equipment, and higher social support for physical activity were associated with more MVPA (all P < 0.001). The association between play equipment ownership and MVPA was inconsistent across countries (interaction P < 0.01). Conclusions: With the exception of play equipment ownership, modifiable household factors showed largely consistent and important associations with MVPA across high-, mid-, and low-income countries.
Use of Mobile Phone Short Text Message Service to Enhance Cervical Cancer Screening at Thika Level 5 Hospital, Kiambu County, Kenya: A Randomised Controlled Trial
(Wiley Online Library, 2017) Wanyoro, A.K.; Kabiru, E.W.
Cervical cancer is a major public health problem among adult women especially in developing countries hence its control is of paramount importance. Organized screening programs have led to a large decline in cervical cancer incidence and mortality in developed countries. In Kenya, very few women at risk of the disease have regular repeat screening and there exists no effective recall mechanism to enhance scheduled screening. The Short Message Service (SMS) Text may be used as a recall tool to enhance cervical cancer screening in developing countries such as Kenya, where other communication means may not be easily available. A blinded randomized controlled trial was conducted where participants were recruited from among screening naïve patients at Thika Level 5 hospital. The participants were randomly allocated to an intervention (Short Message Service (SMS) text reminders) and a control (no SMS) arm. The study aimed to determine the influence of using SMS text reminders in enhancing adherence to scheduled repeat screening for cervical cancer. The mean age of the participants was 38.8 ± 10.8, most were married and of low socio- economic status. It was found that 67.1% of participants in the intervention arm and 20.3% in the control arm re-attended to rescreening making those who received SMS reminders 8 times more likely to adhere to scheduled rescreening than those who did not receive reminders (OR 8.02; CI 95% 4.69-13.73; p-<0.001). The study recommended that the Short Text Message Service (SMS) reminders should be integrated into the cervical cancer screening programs in resource constrained countries like Kenya.
Burden of Surgical Site Infection Following Cesarean Section in Sub-Saharan Africa: A Narrative Review
(Dove Medical Press Limited, 2019) Sway, Angie; Nthumba, Peter; Solomkin, Joseph; Tarchini, Giorgio; Gibbs, Ronald; Ren, Yanhan; Wanyoro, Anthony
Cesarean section (CS) is the most common operative procedure performed in sub-Saharan Africa (SSA), accounting for as much as 80% of the surgical workload. In contrast to CSs performed in high-income countries, CSs performed in SSA are accompanied by high morbidity and mortality rates. This operation is the most important known variable associated with an increased probability of postpartum bacterial infection. The objective of this review was to assess surgical outcomes related to CS in SSA. PubMed (including Medline), CINAHL, Embase, and the World Health Organization’s Global Health Library were searched without date or language restrictions. A total of 26 studies reporting surgical site–infection rates after CS were identified, representing 14,063 women from 14 countries. The vast majority (76.7%) of CSs performed were emergency operations. The overall CS rate for women included in this review was 12.4% (range: 1.0%–41.9%). Only 17 of 26 total studies reported a significant proportion of women receiving antimicrobials of any kind. The surgical site–infection rate was 15.6% and the wound-infection rate 10.3%.
Prospective Cohort Study on Timing of Antimicrobial Prophylaxis for Post-Cesarean Surgical Site Infections
(Mary Ann Liebert, 2020) Sway, Angie; Wanyoro, Anthony; Nthumba, Peter; Aiken, Alexander; Ching, Patrick; Maruta, Anna; Gunturu, Revathi; Solomkin, Joseph
Background: Sepsis is the leading cause of maternal death in sub-Saharan Africa (SSA), a region that sees some of the highest rates of maternal death and morbidity in the world. As one of the most commonly performed surgical procedures in SSA and a proved risk factor for surgical site infection (SSI), cesarean section (CS) is an important operation to target because of its massive impact on maternal and neonatal health. There is currently insufficient published data available on the patient and facility-based context around SSI after CS to establish a true and clear understanding of this infectious category. The objective of this study was to collect accurate and valid data on the incidence of SSI after CS and the circumstances around SSI in two Kenyan hospitals. Hypothesis: Our primary analysis focused on the consequences of timing of peri-operative antimicrobial prophylaxis. We hypothesized that patients who were given antibiotics pre-operatively would show lower SSI rates than those given the agents post-operatively. Methods: This was an Institutional Review Board-approved observational study of 609 women who had CS operations at two Kenyan hospitals from September to December 2015. Thika provided antimicrobial prophylaxis prior to incision for all patients, and Kiambu provided only post-operative prophylaxis. It should be noted that this difference was the result of a previous intervention at Thika and not a part of this observational study. Results: Patients at the two hospitals had similar pre-operative characteristics indicating a relatively healthy population. The median age was 26 ± 6 years (range 18–43) at Thika and 26 ± 5 (18–44) at Kiambu. Median parity was 1 ± 1 (range 0–7) at Thika and 1 ± 1 (0–10). Patients also went through a comparable number of antenatal care visits (median 4 ± 1 at both hospitals). The number of patients with prolonged rupture of the membranes was 103 (34.4%) at Thika and 99 (32.9%) at Kiambu. There was a slightly higher number of patients with meconium-stained liquor at Kiambu Hospital (115) than at Thika (74). The SSI rate was 4.0% (12/299; 11 superficial, 1 deep) at Thika and 9.3% (28/301; 18 superficial, 7 deep, 3 organ/space) at Kiambu. Conclusions: The data show a striking difference between SSI rates in patients who were given properly timed pre-operative antibiotics and patients who were given only post-operative antibiotics. Administration of post-operative antibiotics is currently the norm in much of SSA, and there is strong evidence that many of the infectious problems encountered in this population would be reduced by the provision of antibiotic prophylaxis prior to the incision.
Association of Differential Symptoms of Stress to Hair Cortisol and Cortisone Concentrations among Pregnant Women in Kenya
(Taylor \& Francis, 2020) Musana, Joseph W; Cohen, Craig R; Kuppermann, Miriam; Gerona, Roy; Wanyoro, Anthony; Aguilar, David; Santos, Nicole; Temmerman, Marleen; Weiss, Sandra J
Objectives: The purpose of this study was to characterize the stress experienced by pregnant women in Kenya and assess the relationship between perceived stress and stress-related biomarkers of cortisol and cortisone. Background: Kenyan women are exposed to multiple stressors that may result in chronic stress. However, antenatal stress has not been examined and characterized in Kenya; nor has the relationship between pregnant women’s self-reported stress and stress biomarkers been established. Methods: One hundred and fifty women were recruited between 22 and 28 weeks gestation. Participants completed the Perceived Stress Scale (PSS) and a sociodemographic questionnaire. Hair samples were obtained for analysis of cortisol and cortisone. Factor analysis was used to extract unique clusters of stress symptoms from items in the PSS. Regression models were computed to examine relationships of stress to cortisone and cortisol, controlling for obstetric risk. Results: Mean age of the women was 25 years (SD ¼ 5, ±16–41). Their degree of perceived stress and cortisol/cortisone concentrations both indicated moderate levels of stress. There was no association between general perceived stress and either hair cortisol or cortisone. However, factor analysis of the PSS identified three clusters of stress symptoms and one cluster - a woman’s negative frame of mind regarding life and inefficacy in handling its problems - was associated with higher levels of cortisone (b¼ .231, p ¼ 0.011). Conclusions: Specific stress symptoms may have unique relationships to specific biomarkers and be more useful in assessment than general perceived stress. Assays of both hair cortisol and cortisone might enable a more comprehensive assessment of glucocorticoid activity and better prediction of health risks from stress.
Socio-Demographic and Economic Factors Associated With and Attendance among Women of Reproductive Age
(International Peer Reviewed Journals and Books (IPRJB) ·, 2020) Omar, Fardowsa; Musili, Felix; Onditi, Kodhiambo M
Purpose: The research was done to determine the socio-demographic and economic factors associated with ANC attendance among women of reproductive age. Methods: The study used descriptive cross-sectional community based survey. The study area is Guriel district in Galmudug state Somalia. The target group of the study were women of reproductive age from 15-49 in Guriel district. Guriel has population estimated around 150, 000,(UNDPA). Gurriel district was purposively selected for the study. The district had 4 villages namely Hawlwadaag, Dalsan, Tawakal and Wadajir. Hawlwadaag and Dalsan were randomly selected for the study though folded pieces of paper. Hawlwadaag had a total of 852 Households and Dalsan had 704 Households. The respondents were selected from the households using systematic random sampling with an interval of 3. The first respondent from the household was selected using simple random sampling through folded pieces of paper. Every 3rd Household selected from the villages was interviewed until the required number of respondents was reached.Since the population was a large the sample size was determined by using Fisher’s et al (2003) formula. The sample size was 384. Data from the questionnaires was cleaned, coded and entered into Microsoft excel and later exported to SPSS version 22.0. Descriptive statistics such as frequency tables, and percentage was used to summarize Quantitative variable. Inferential statistics was obtained by Chi square at 95% confidence level was used to ascertain statistically significant of the variables at p-Value <0.05, and to test null hypothesis. Results: The findings indicated that most socio-demographic factors influenced ANC attendance. In the study marital status, education level, and parity showed significant statistical association with ANC attendance. The study findings showed that most economic factors played significant role in determining ANC attendance among respondents. Unique Contribution to Theory, Practice and Policy: The researcher recommended that the state governments and community based organizations should educate the women on income generating activities as well as offer them loans to be economically empowered.

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