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http://ir.mu.ac.ke:8080/jspui/handle/123456789/68
2024-03-29T00:23:00ZComparing adverse maternal and perinatal outcomes in primary caesarean delivery during first versus second-stage of labour in Kenya: An institution-based cohort study
http://ir.mu.ac.ke:8080/jspui/handle/123456789/8954
Title: Comparing adverse maternal and perinatal outcomes in primary caesarean delivery during first versus second-stage of labour in Kenya: An institution-based cohort study
Authors: Omwodo, Kimbley Asaso; Were, Edwin
Abstract: Background
As caesarean delivery rates continue to increase globally, so are the number of second-
stage caesarean deliveries. Second-stage caesareans may carry additional risk of compli-
cations for both the mother and fetus owing to fetal head impaction into the maternal pelvis
and manipulations required for delivery. So far, data on this procedure’s outcomes from low
resource countries are limited.
Objectives
To compare adverse maternal and perinatal outcomes between second-stage and first-
stage of labour intrapartum primary caesarean deliveries over 12 months at a tertiary refer-
ral obstetric hospital in Kenya.
Methods
In a hospital-based cohort study, 222 women with singleton, cephalic presenting fetuses at
term gestation who had intrapartum primary caesarean delivery during active labour were
recruited post-partum. Second-stage caesarean deliveries (73) were compared to 149 first-
stage caesarean deliveries. The proportion of caesarean deliveries in the second-stage of
labour was estimated and the adverse maternal and perinatal outcomes were compared.
The study was conducted from August 2021 to July 2022 at the Moi Teaching and Referral
Hospital, Eldoret.
Results
The proportion of second-stage caesarean deliveries among intrapartum primary caesarean
deliveries was 4.3% [95% CI: 2.9% - 4.7%]. Compared to first-stage caesarean deliveries,
second-stage caesarean deliveries had a significantly higher risk of adverse maternal out-
comes (RR 3.272, 95% CI 2.28–4.71, P < 0.001), including intraoperative trauma, atony,
blood transfusion, and a postoperative hospital stay of more than three days. Additionally there was a higher risk of adverse perinatal outcomes (RR 2.748, 95% CI 2.45–4.50, P <
0.001), including increased risk of a 5-min APGAR �3, admission to NBU, and neonatal
death.
Conclusions
An increased risk of adverse maternal and perinatal outcomes is associated with primary
second-stage caesarean deliveries compared to primary first-stage caesarean deliveries.2023-11-27T00:00:00ZReal-world cervical cancer screening uptake and predictors of visual inspection with acetic acid positivity among women living with HIV in care programs in Western Kenya
http://ir.mu.ac.ke:8080/jspui/handle/123456789/8953
Title: Real-world cervical cancer screening uptake and predictors of visual inspection with acetic acid positivity among women living with HIV in care programs in Western Kenya
Authors: Mungo, Chemtai; Orang’o, Omenge; Ofner, Susan; Musick, Beverly; Yiannoutsos, Constantin; Cohen, Craig R.; Brown, Darron; Wools-Kaloustian, Kara; Semeere, Aggrey
Abstract: To achieve the WHO cervical cancer elimination targets, countries globally must
achieve 70% cervical cancer screening (CCS) coverage. We evaluated CCS uptake
and predictors of screening positive at two public HIV care programs in western
Kenya.
METHODS From October 2007 to February 2019, data from the Family AIDS Care and
Education Services (FACES) and Academic Model Providing Access to Healthcare
(AMPATH) programs in western Kenya were analyzed. The study population
included women age 18-65 years enrolled in HIV care. Screening uptake was
calculated annually and overall, determining the proportion of eligible women
screened. Multivariate logistic regression assessed predictors of positive
screening outcomes.
RESULTS There were 57,298 women living with HIV (WLWHIV) eligible for CCS across
both programs during the study period. The mean age was 31.4 years (IQR, 25.9-
37.8), and 39% were on antiretroviral therapy (ART) at the first CCS-eligible
visit. Of all eligible women, 29.4% (95% CI, 29.1 to 29.8) underwent CCS during
the study period, 27.0% (95% CI, 26.5 to 27.4) in the AMPATH program, and
35.6% (95% CI, 34.9 to 36.4) in the FACES program. Annual screening uptake
varied greatly in both programs, with coverage as low as 1% of eligible WLWHIV
during specific years. Age at first screening, CD4 count within 90 days of
screening, current use of ART, and program (AMPATH v FACES) were each
statistically significant predictors of positive screening.
CONCLUSION CCS uptake at two large HIV care programs in Kenya fell short of the WHO’s 70%
screening target. Screening rates varied significantly on the basis of the
availability of funding specific to CCS, reflecting the limitations of vertical
funding programs.2024-02-15T00:00:00ZLabour pain relief practice by maternal health care providers at a tertiary facility in Kenya: An institution-based descriptive survey
http://ir.mu.ac.ke:8080/jspui/handle/123456789/8952
Title: Labour pain relief practice by maternal health care providers at a tertiary facility in Kenya: An institution-based descriptive survey
Authors: Ouma, Eliazaro Gabriel; Orango, Omenge; Were, Edwin; Omwodo, Kimbley Asaso
Abstract: Background
Although pain relief is a crucial component of modern obstetric care, it remains a poorly
established service in sub-Saharan countries such as Kenya. Maternal health care provid-
ers have an extensive role to play in meeting the analgesic needs of women during child-
birth. This study sought to examine the practice of labour pain relief among Kenyan
maternal health care providers.
Methods
This was an institution-based, cross-sectional, descriptive survey. The study included mid-
wives, obstetricians, and anaesthesiologists (n = 120) working at the second-largest tertiary
facility in Kenya. A structured, self-administered questionnaire was used. The labour pain
relief practice, knowledge, attitude, and perceived barriers to labour pain management were
described.
Results
One hundred and seventeen respondents participated in the study representing a response
rate of 97.5%. More than half of maternal health care providers routinely provided the ser-
vice of labour pain relief (61.5%). Sixty-four (88.9%) respondents reported providing phar-
macological and non-pharmacological methods, while 11.1% provided only
pharmacological ones. The most common pharmacological method prescribed was non-
opioids (12.8%). The most preferred non-pharmacological method of pain management
was touch and massage (93.8%). Regional analgesia was provided by 3.4% of the respon-
dents. More than half of the respondents (53%) had poor knowledge of labour pain relief
methods. Almost all (94%) of the respondents had a positive attitude towards providing
labour pain relief. Non-availability of drugs and equipment (58.1%), lack of clear protocols
and guidelines (56.4%), and absence of adequate skilled personnel (55.6%) were reported
as the health system factors that hinder the provision of labour analgesia.Conclusions
More than half of maternal health care providers routinely relieve labour pain. Epidural anal-
gesia is still relatively underutilized. There is a need to develop institutional labour pain man-
agement protocols to meet the analgesic needs of women during childbirth.2024-03-07T00:00:00ZSupply-side and demand-side factors influencing uptake of malaria testing services in the community: lessons for scale-up from a post-hoc analysis of a cluster randomised, community-based trial in western Kenya
http://ir.mu.ac.ke:8080/jspui/handle/123456789/8951
Title: Supply-side and demand-side factors influencing uptake of malaria testing services in the community: lessons for scale-up from a post-hoc analysis of a cluster randomised, community-based trial in western Kenya
Authors: Kirui, Joseph; Malinga, Josephine; Sang, Edna; Ambani, George; Abel, Lucy; Nalianya, Erick; Namae, Jane; Boyce, Matthew; Laktabai, Jeremiah; Menya, Diana; O'Meara, Wendy
Abstract: Objectives Maximising the impact of community-based
programmes requires understanding how supply of,
and demand for, the intervention interact at the point of
delivery.
Design Post-hoc analysis from a large- scale community
health worker (CHW) study designed to increase the
uptake of malaria diagnostic testing.
Setting Respondents were identified during a household
survey in western Kenya between July 2016 and April
2017.
Participants Household members with fever in the last
4 weeks were interviewed at 12 and 18 months post-
implementation. We collected monthly testing data from
244 participating CHWs and conducted semistructured
interviews with a random sample of 70 CHWs.
Primary and secondary outcome measures The
primary outcome measure was diagnostic testing before
treatment for a recent fever. The secondary outcomes
were receiving a test from a CHW and tests done per
month by each CHW.
Results 55% (n=948 of 1738) reported having a malaria
diagnostic test for their recent illness, of which 38.4% were
tested by a CHW. Being aware of a local CHW (adjusted
OR=1.50, 95% CI: 1.10 to 2.04) and belonging to the
wealthiest households (vs least wealthy) were associated
with higher testing (adjusted OR=1.53, 95% CI: 1.14 to 2.06).
Wealthier households were less likely to receive their test
from a CHW compared with poorer households (adjusted
OR=0.32, 95% CI: 0.17 to 0.62). Confidence in artemether–
lumefantrine to cure malaria (adjusted OR=2.75, 95% CI:
1.54 to 4.92) and perceived accuracy of a malaria rapid
diagnostic test (adjusted OR=2.43, 95% CI: 1.12 to 5.27)
were positively associated with testing by a CHW. Specific
CHW attributes were associated with performing a higher
monthly number of tests including formal employment,
serving more than 50 households (vs <50) and serving areas
with a higher test positivity. On demand side, confidence of
the respondent in a test performed by a CHW was strongly
associated with seeking a test from a CHW.Conclusion Scale- up of community-based malaria testing
is feasible and effective in increasing uptake among the
poorest households. To maximise impact, it is important to
recognise factors that may restrict delivery and demand
for such services.2023-05-31T00:00:00Z