RP-Department of Obstetrics and Gynaecology

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Adapting the Preterm Birth Phenotyping Framework to a Low-Resource, Rural Setting and Applying It to Births from Migori County in Western Kenya
(BMC, 2023) Miller, Lara; Schmidt, Christina N.; Wanduru, Phillip; Wanyoro, Anthony; Santos, Nicole; Butrick, Elizabeth; Lester, Felicia; Otieno, Phelgona; Walker, Dilys
Background Preterm birth is the leading cause of neonatal and under-fve mortality worldwide. It is a complex syndrome characterized by numerous etiologic pathways shaped by both maternal and fetal factors. To better understand preterm birth trends, the Global Alliance to Prevent Prematurity and Stillbirth published the preterm birth phenotyping framework in 2012 followed by an application of the model to a global dataset in 2015 by Barros, et al. Our objective was to adapt the preterm birth phenotyping framework to retrospective data from a low-resource, rural setting and then apply the adapted framework to a cohort of women from Migori, Kenya. Methods This was a single centre, observational, retrospective chart review of eligible births from November 2015 – March 2017 at Migori County Referral Hospital. Adaptations were made to accommodate limited diagnostic capabilities and data accuracy concerns. Prevalence of the phenotyping conditions were calculated as well as odds of adverse outcomes. Results Three hundred eighty-seven eligible births were included in our study. The largest phenotype group was none (no phenotype could be identifed; 41.1%), followed by extrauterine infection (25.1%), and antepartum stillbirth (16.7%). Extrauterine infections included HIV (75.3%), urinary tract infections (24.7%), malaria (4.1%), syphilis (3.1%), and general infection (3.1%). Severe maternal condition was ranked fourth (15.6%) and included anaemia (69.5%), chronic respiratory distress (22.0%), chronic hypertension prior to pregnancy (5.1%), diabetes (3.4%), epilepsy (3.4%), and sickle cell disease (1.7%). Fetal anaemia cases were the most likely to transfer to the newborn unit (OR 5.1, 95% CI 0.8, 30.9) and fetal anomaly cases were the most likely to result in a pre-discharge mortality (OR 3.9, 95% CI 0.8, 19.2). Conclusions Using routine data sources allowed for a retrospective analysis of an existing dataset, requiring less time and fewer resources than a prospective study and demonstrating a feasible approach to preterm phenotyping for use in low-resource settings to inform local prevention strategies.
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.
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
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
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%.
Case Report: Deep Vein Thrombosis Following a Wild Bee Sting
(East African Scholars Journal of Medicine and Surgery, 2022) Nyatogo, Joel Bramwel; Ngatia, Justus Waweru
Deep vein thrombosis is one of the rare reactions that can occur after bee envenomation. A 40-year-old female presented at our facility for evaluation and management of a left lower limb swelling two weeks after suffering a bee sting. She was diagnosed with deep vein thrombosis (DVT). The development of DVT was attributed to thrombogenic properties of bee venom and endothelial injury caused by released inflammatory cytokines. The patient’s mainstay treatment was with anticoagulants
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.
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.
Coronavirus Disease 2019 and the Placenta: A Literature Review
(Elsevier, 2022) Gesaka, Samwel R; Obimbo, Moses M; Wanyoro, Anthony
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) virus has been implicated in the clinical pathology of multiple organs and organ systems. Due to the novelty of the disease, there is a need to review emerging literature to understand the profile of SARS-CoV-2 in the placenta. This review sought to evaluate the literature on the mediators, mechanism of entry, pathogenesis, detection, and pathology of SARS-CoV-2 in the placenta. Systematic literature searches found 96 eligible studies. Our review revealed that SARS-CoV-2 canonical mediators, angiotensin-converting enzyme-2 (ACE2), and transmembrane serine protease-2 (TMPRSS2) are variably expressed in various placenta compartments, including the villous cytotrophoblasts, syncytiotrophoblasts (STBs), and extravillous trophoblasts (EVTs) throughout pregnancy. Placental SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs), including basigin (BSG/CD147), dipeptidyl peptidase-4 (DPP4/CD26), cathepsin B/L (CTL B/L), furin, interferon-induced transmembrane protein (IFITM1-3), and lymphocyte antigen 6E (LY6E) may increase or reduce the permissiveness of the placenta to SARS-CoV-2. EVTs express genes that code for proteins that may drive viral pathogenesis in the placenta. Viral RNA, proteins, and particles were detected primarily in the STBs by in situ hybridization, immunohistochemistry, electron microscopy, and polymerase chain reaction. Placental pathology in SARS-CoV-2-infected placentas included maternal and fetal vascular malperfusion and a generally nonspecific inflammatory-immune response. The localization of SARS-CoV-2 receptors, proteases, and genes involved in coding proteins that drive viral pathogenesis in the placenta predisposes the placenta to SARS-CoV-2 infection variably in all pregnancy trimesters, with antecedent placental pathology. There is a need for further studies to explicate the mechanism of entry and pathogenesis of SARS-CoV-2 in the placenta
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.
Determinants of Measles Vaccine Uptake among Mothers of Children between 9 and 24 Months in Narok North Subcounty
(Stratford Peer Reviewed Journals and Book Publishing, 2023-05) Kiplagat, Alice; Bett, Sarah; Masika, Jacob
The low uptake of measles vaccines in Kenya is a noticeable public health problem. Therefore, the study assessed the determinants of low uptake and hesitancy of measles vaccination among mothers of children aged 9 – 24 months in Narok North Sub-County, Narok. Cross-sectional quantitative study was done. The study was conducted in four purposively selected health centers in Narok North Sub-County. A structured and pretested questionnaire was used to collect data from 100 mothers. The multistage sampling method was used in this study to select the mothers who participated in the current study. The data were analysed descriptively. Additionally, Pearson’s chi-square, Kruskal-Wallis H, and logistic regression tests were conducted to determine the significance of the relationships and associations between the determinants and MCV uptake. A total of 69(69%) of the children (N =100) who had qualified for the first dose of measles vaccines (MCV1) had received the vaccines, while 31(31%) had not. Thirteen (26.5%) of the children (n = 49) who had qualified for the second dose of measles vaccine (MCV2) had received the vaccine, while 36(73.5%) did not. The significant maternal determinants of MCV uptake included; maternal age (p = .019) and maternal level of education (p = .030). The significant child’s determinants were birth order (p = .032) and place of birth (p = .001). The significant socioeconomic factors included; low socioeconomic background (p = .004) and cultural and religious issues (p = .003). The significant healthcare determinants included distance from the health facility (p = .020) and availability of vaccines in the health center (p = .000). Measles vaccine uptake was very low compared to the World Health Organization (WHO) recommended coverage rate of >95%. Thus, there is a need to provide health education and information to mothers or caregivers on measles vaccine uptake.
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).
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.
Impact of Community Strategy Package on Uptake of Reproductive Tract Infections Health Services Among Young Street Females in the Municipality of Eldoret, Kenya
(Elsevier, 2023) Wanyoro, Anthony; Maingi, John; Nyamari, Jackim; Ng'ang'a, Murima; Maritim, C Violet
Background: Despite the intervention of free medical care services for street children by a dedicated clinic in Eldoret municipality, health care service of young street females (YSFs) is still deficient. The present study aimed to evaluate the impact of the community strategy package on the uptake of reproductive tract infections (RTI) health services among the target population. Materials and methods: A pre-test-post-test quasi-experimental with a qualitative and quantitative approach was applied among the YSFs aged 10–24 years. The study used structured questionnaires and key informant interviews to collect data from the respondents. Results: The study enrolled a total of 77 young street females in Eldoret municipality. A significantly higher proportion of respondents reportedly first sought treatment for RTI at a health facility after the implementation of the community strategy package (97.1%) when compared to the proportion of respondents who first sought treatment at a health facility in the pre-intervention phase (51.0%)(p＜0.001). Early seeking of treatment improved significantly after the introduction of the intervention; 72.0% and 94.1% of the respondents sought treatment early during the pre-intervention and post-intervention phase, respectively (p ¼ 0.011). Conclusion: The study recommends the adoption of the community strategy as an intervention to increase the uptake of RTIs health services and promotion of the reproductive health of young street females
Individual-level Determinants of Cervical Cancer Screening Uptake among Women in Kirinyaga County in Kenya
(Editon Consortium Publishing, 2021) Wambugu, Monica W.; Wanyoro, Anthony K.; Keraka, Margaret N.
This study aimed to assess the determinants of uptake of cervical cancer screening among women in Kirinyaga County, Kenya. The study adopted a randomised control trial study design with a sample size of 206 women aged between 25-69 years. Respondents were randomised into control and intervention arms. Both qualitative and quantitative data was collected. Analysis was done using thematic content for qualitative data; descriptive statistics were used to summarise categorical variables. Bivariate analysis using the Fisher exact and Chi-square was also applied. Factors with a p<0.05 were further analysed in multivariate analysis. Respondents who had a high perception of being susceptible to cervical cancer were 4.26 times most likely to attend cervical cancer screening than those who did not. Respondents who had a high perception of cervical cancer as a serious disease were 3.46 times more likely to stick to cervical cancer screening than those who did not. This study concluded that it was essential to ensure that the girls were educated to a higher level and increase the knowledge of cervical cancer screening in the communities. In addition, an increase in formal employment and household income would lead to increased uptake of cervical cancer screening. This study recommendsthat Kirinyaga County and Kerugoya County Referral Hospital's management provide health education through mobile phone technology to bring positive perceptionson the importance of cervical cancer screening.
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.
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
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.
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.

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