RP-Department of Obstetrics and Gynaecology

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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.
Urogenital Infections among Women Attending Mwingi Hospital, Kitui County, Kenya: Safeguarding Antibiotics through Microbiological Diagnosis
(EAHRC, 2024) Mbuvi, Christine Musungi; Musila, Boniface Nzioki; Nyamache, Anthony Kebira
Background: Urogenital infections pose a considerable public health threat, as almost half of women will experience urinary and reproductive system infections at some point in their lives. However, the urogenital infection burden is often not clear in some regions. Nevertheless, the misuse of antimicrobial agents, including self-prescription, has increased widespread antimicrobial resistance, limiting treatment benefits. Therefore, this study aimed to identify the various urogenital infections, associated risk factors, and profile the bacterial isolates, and assess their antibiotic resistance among women attending Mwingi Hospital. Methods: A cross-sectional study was conducted on 322 women aged between the ages of 15 to 44 years. Urine and high vaginal swabs were collected from all participants and analyzed within 6 hours. Microscopic examination on wet mounts was done, bacterial isolation was done and those with significant growth were confirmed and subjected to antimicrobial susceptibility testing using specific media. Descriptive statistics were used in expressing the infection frequencies and antimicrobial resistance. Odds ratios were used to determine the risk of urogenital infection. The level of significance was considered at a P value of less than 0.05. Results: Among the 322 women, 45.3% (146) had a urogenital infection, with bacteria being the primary cause (26.4%). The infections included UTI (22.7%), Candidiasis (15.2%), Trichomoniasis (3.7%), Gonorrhea (2.5%), and Bacterial vaginitis (1.2%). Antibiotic use was 32.9%, with only 2.8% receiving a microbiological diagnosis before antibiotic use. The overall antibiotic resistance was 53%, with the lowest resistance observed against penicillin and combinations (31.4%) and 3rd Cephalosporins (39.4%). The highest resistance was observed against nalidixic acid (74.8%) and cotrimoxazole (62.6%). Conclusion: Women attending Mwingi Hospital are commonly affected by various urogenital infections. Antibiotic use without microbiological diagnosis was observed. Among the antibiotics tested, 3rd generation cephalosporins and penicillin combination agents were noted as the most effective in treating bacterial urogenital infections, while nalidixic acid and cotrimoxazole were ineffective. Improved diagnosis and targeted treatments are necessary to prevent further development of antibiotic resistance.
Treatment Outcomes of Corpus Uteri Cancer at Moi Teach-Ing and Referral Hospital, Kenya: A 10-Year Retrospective Study
(JOGECA, 2023-09) Nassir, Faiza; Itsura, Peter M.; Odongo, Benjamin E.; Orang’o, Elkanah O.; Tonui, Philliph K.; Chege, Henry; Mburu, Anisa W.; Muliro, Hellen N.; Rosen, Barry P.; Covens, Allan L.
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.
Proportion of Reproductive Age Women Utilizing Mobile Maternal Health Services in Makueni County
(jhmn, 2023) Mumo, Joyce Kanini; Tai, Sarah; Kipkalom, Rosebella
Purpose: The aim of the study was to determine the proportion of reproductive age women utilizing mobile maternal health services in Makueni County. Methodology: An analytical cross-sectional study was carried out in Makueni County. Kibwezi East and Kaiti Sub-Counties were purposively selected. Ukia ward from Kaiti sub-county and Nzambani ward from Kibwezi East sub-county were randomly selected using folded pieces of paper. Both qualitative and quantitative data were collected. Questionnaires were the tools used for quantitative data while guides for key informant were used to collect data qualitatively. The study systematically sampled 367 women of reproductive age as primary respondents from households at a sampling interval of 5. Twelve Key Informant Interviewees were purposively selected to provide additional qualitative data which were community health extension workers and healthcare providers. The research instruments were pretested at Kilome Sub County before actual data collection. Analytical correctional statistical analysis was done using the Statistical Package for Social Sciences software version 20.0. Pie-charts, frequency tables and graphs were used to present data. Triangulation of data collected qualitatively with quantitative data was done and presented as direct quotes. Findings: The study found out that 40.6% of respondents utilized mobile maternal health services in Makueni County. The most common service sought was antenatal care. Distance from health facilities was the main reason for using mobile maternal health services. However, the main reason for non-use was preference for hospitals among respondents. Unique Contribution to Theory, Practice and Policy: These results would inform policy makers to craft interventions seeking to advance mobile maternal health services utilization. Community Health Volunteers should conduct house to house campaigns on availability of mobile maternal health clinics and the designated days on their respective regions to increase awareness among women of reproductive age.
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
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.
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
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
A Rare Finding of Foreign Bodies (Iron Nails) in the Vagina: Case Report and Review of Literature
(East African Scholars Journal of Medicine and Surgery, 2022) Ngatia, Justus Waweru
Foreign objects in the genital tract are commonly encountered by clinicians in all age groups. Detailed history and clinical examination are central to diagnosis although imaging modalities may be required for misplaced objects. Proper management can prevent morbidity and mortality resulting from complications [1]. Our patient presented with a history of severe genital pain and mild per vaginal bleeding. A Cuscos bivalve speculum was inserted and four 3-inches-long iron nails were removed from the vagina. The patient had complete recovery.
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).
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.
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
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.
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.
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%.
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.
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.
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.
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.

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