Background: Neonatal hemochromatosis (NH) is a rare disorder and the most common cause of acuteliver failure in neonates. NH is characterized by severe hepatic injury and iron overload with highperinatal mortality and morbidity. There is a high risk of recurrence in subsequent pregnancies of womenwho have had a child with neonatal hemochromatosis.Case presentation: A 40-year-old para 13 with one living child and three previous cesarian scarspresented at ten weeks with a history of recurrent neonatal deaths. Her last infant death was at fourmonths after she delivered a baby via cesarian birth at 36 weeks. The infant developed severe jaundicewith reduced urine output. Laboratory investigations revealed deranged liver function tests with elevatedserum ferritin levels. The infant received repeated exchange transfusions, immunoglobulin, anddexoferamine. However, she succumbed at four months. Her management for the current pregnancyrequired close follow-up and she delivered at 37 weeks gestation to a live male infant who is faring well.Discussion: The cause of NH is not fully understood. Significant evidence indicates that most cases ofneonatal hemochromatosis result from fetal liver disease due to maternal-fetal alloimmunity, a conditiontermed gestational alloimmune liver disease (GALD). In GALD, these antibodies bind to fetal liverantigen and activate the terminal complement cascade, resulting in hepatocyte injury and death.Conclusion: NH is the most common cause of neonatal acute liver injury and should be considered in allcases of severe fetal liver injury as well as in cases of stillbirth, fetal demise, and early postnatal death.
{"title":"Congenital neonatal hemochromatosis with recurrent neonatal deaths - a diagnostic nightmare: A case report","authors":"Faiza Nassir, Rehema Omar Shee, Musimbi Soita, Nawal Alyan, Abdul lavingia","doi":"10.59692/jogeca.v36i1.168","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.168","url":null,"abstract":"Background: Neonatal hemochromatosis (NH) is a rare disorder and the most common cause of acuteliver failure in neonates. NH is characterized by severe hepatic injury and iron overload with highperinatal mortality and morbidity. There is a high risk of recurrence in subsequent pregnancies of womenwho have had a child with neonatal hemochromatosis.Case presentation: A 40-year-old para 13 with one living child and three previous cesarian scarspresented at ten weeks with a history of recurrent neonatal deaths. Her last infant death was at fourmonths after she delivered a baby via cesarian birth at 36 weeks. The infant developed severe jaundicewith reduced urine output. Laboratory investigations revealed deranged liver function tests with elevatedserum ferritin levels. The infant received repeated exchange transfusions, immunoglobulin, anddexoferamine. However, she succumbed at four months. Her management for the current pregnancyrequired close follow-up and she delivered at 37 weeks gestation to a live male infant who is faring well.Discussion: The cause of NH is not fully understood. Significant evidence indicates that most cases ofneonatal hemochromatosis result from fetal liver disease due to maternal-fetal alloimmunity, a conditiontermed gestational alloimmune liver disease (GALD). In GALD, these antibodies bind to fetal liverantigen and activate the terminal complement cascade, resulting in hepatocyte injury and death.Conclusion: NH is the most common cause of neonatal acute liver injury and should be considered in allcases of severe fetal liver injury as well as in cases of stillbirth, fetal demise, and early postnatal death.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"88 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.147
Lydia Ngigi, Francis Githae, Jonathan Nthusi
Background: Bilateral tubal ligation (BTL) is a highly effective contraceptive method with more than 99%efficacy in preventing pregnancy. Its uptake remains low in Sub-Saharan Africa at 1.6%. The KenyaHealth and Demographics Survey 2014 indicated that almost half of the married women did not desirefurther childbearing. The low acceptance of BTL as a contraceptive method in this region has beenattributed to a lack of knowledge and cultural and religious misconceptions.Objective: This study aimed to determine the baseline level of knowledge about BTL and the impact ofan educational intervention among women attending antenatal care and family planning clinics at Tenwekand Longisa Hospitals in Bomet County.Methods: A quasi-experimental study design was employed. Demographic characteristics, knowledge ofBTL, perceived risks, and benefits were assessed at baseline and postintervention. A difference measurewas used to assess the impact of the intervention at 95% CI, with a p-value of 0.05 consideredsignificant. The data were analyzed using STATA version 18.Results: The mean age of the participants at baseline and postintervention was 29.0±5.8 years and29.2±5.6 years, respectively. Overall, 62% of the participants reported they would choose BTL, with 52%in the postintervention arm. When asked if their religion allowed BTL, 80.6% responded yes and weresupported by their husband (92%); however, 62% reported they could not have it if their spouse wasagainst it. In general, lower knowledge scores were obtained in the postintervention arm, implying thatthe educational intervention did not influence participants' knowledge of BTL. There was no statisticallysignificant difference in the participants' knowledge levels at baseline and postintervention [3.3 (-3.2 to9.9); p-value=0.3].Conclusion: Educating families, particularly women of childbearing age, about alternative family planningmethods would increase their adoption, allowing families to achieve desired family sizes while limiting theimpact of unwanted pregnancies and maintaining a healthy population.
{"title":"The Impact of an educational intervention on the knowledge of bilateral tubal ligation (BTL) among women attending antenatal and family planning clinics in Bomet county: An interventional study","authors":"Lydia Ngigi, Francis Githae, Jonathan Nthusi","doi":"10.59692/jogeca.v36i1.147","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.147","url":null,"abstract":"Background: Bilateral tubal ligation (BTL) is a highly effective contraceptive method with more than 99%efficacy in preventing pregnancy. Its uptake remains low in Sub-Saharan Africa at 1.6%. The KenyaHealth and Demographics Survey 2014 indicated that almost half of the married women did not desirefurther childbearing. The low acceptance of BTL as a contraceptive method in this region has beenattributed to a lack of knowledge and cultural and religious misconceptions.Objective: This study aimed to determine the baseline level of knowledge about BTL and the impact ofan educational intervention among women attending antenatal care and family planning clinics at Tenwekand Longisa Hospitals in Bomet County.Methods: A quasi-experimental study design was employed. Demographic characteristics, knowledge ofBTL, perceived risks, and benefits were assessed at baseline and postintervention. A difference measurewas used to assess the impact of the intervention at 95% CI, with a p-value of 0.05 consideredsignificant. The data were analyzed using STATA version 18.Results: The mean age of the participants at baseline and postintervention was 29.0±5.8 years and29.2±5.6 years, respectively. Overall, 62% of the participants reported they would choose BTL, with 52%in the postintervention arm. When asked if their religion allowed BTL, 80.6% responded yes and weresupported by their husband (92%); however, 62% reported they could not have it if their spouse wasagainst it. In general, lower knowledge scores were obtained in the postintervention arm, implying thatthe educational intervention did not influence participants' knowledge of BTL. There was no statisticallysignificant difference in the participants' knowledge levels at baseline and postintervention [3.3 (-3.2 to9.9); p-value=0.3].Conclusion: Educating families, particularly women of childbearing age, about alternative family planningmethods would increase their adoption, allowing families to achieve desired family sizes while limiting theimpact of unwanted pregnancies and maintaining a healthy population.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"86 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.115
Daniel Kioko, Edwin Were, Wycliffe Kosgei
Background: Maternal ‘near-miss’ and deaths, together termed severe maternal outcome(SMO) follow a pattern of deterioration that can be predicted and prevented. To prevent SMO, a Modified Early Obstetric Warning System (MOEWS) for tracking significant changes (‘triggers’) in vital signs among obstetric patients and initiating corrective measures is suggested. Objective: To determine predictors of SMO and the validity of the MEOWS for predicting SMO at Moi Teaching and Referral Hospital (MTRH), Eldoret-Kenya Methods: A retrospective cohort study was conducted at MTRH among 3200 mothers admitted from 1st January 2019. Maternal mortality and ‘near miss’ were determined by WHO criteria. Mothers were grouped into two outcome groups; either experiencing or not experiencing SMO. Their vital signs 24 hours prior to either outcome were then tabulated on a MOEWS chart and determined whether they met a vital sign trigger threshold. The sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) were determined. Relationship between sociodemographic and obstetric characteristic and SMO was determined by multivariate analysis Results: The sociodemographic and obstetric predictors of SMO were age over 35 years(aOR=1.56), having a previous caesarean delivery(aOR=2.19), caesarean delivery in the index pregnancy(aOR=2.09), being a referral(aOR=3.43), not attending antenatal care (aOR=2.53) and admission in the preterm period(aOR=2.81) and in the postpartum period(aOR 51.3). The sensitivity of MOEWS was 77%, specificity 98%, PPV 61% and NPV 98%. Conclusion: The MOEWS chart has a high specificity, sensitivity and NPV but low PPV. The MOEWS chart is a valuable tool for predicting SMO
背景：孕产妇 "险些死亡 "和死亡合称为严重孕产妇结局（SMO），其恶化模式是可以预测和预防的。为预防严重孕产妇结局，建议使用 "产科早期预警系统"（MOEWS）来跟踪产科病人生命体征的显著变化（"触发因素"），并启动纠正措施。目标：在肯尼亚埃尔多雷特的莫伊教学和转诊医院（MTRH）确定 SMO 的预测因素以及 MEOWS 预测 SMO 的有效性：MTRH 对 2019 年 1 月 1 日起入院的 3200 名产妇进行了回顾性队列研究。孕产妇死亡率和 "险情 "根据世界卫生组织的标准确定。母亲被分为两个结果组：经历或未经历 SMO。然后，在 MOEWS 图表上列出两组结果前 24 小时的生命体征，并确定其是否达到生命体征触发阈值。确定敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。通过多变量分析确定社会人口学和产科特征与 SMO 之间的关系：预测 SMO 的社会人口学和产科因素有：年龄超过 35 岁（aOR=1.56）、曾有过剖腹产经历（aOR=2.19）、头胎剖腹产（aOR=2.09）、转诊（aOR=3.43）、未参加产前护理（aOR=2.53）、早产入院（aOR=2.81）和产后入院（aOR 51.3）。MOEWS 的灵敏度为 77%，特异性为 98%，PPV 为 61%，NPV 为 98%。结论MOEWS图表具有较高的特异性、灵敏度和NPV，但PPV较低。MOEWS 图表是预测 SMO 的重要工具。
{"title":"VALIDATION OF A MODIFIED OBSTETRIC EARLY WARNING SYSTEM FOR PREDICTING SEVERE MATERNAL OUTCOME AT A TERTIARY REFERRAL FACILITY IN WESTERN KENYA","authors":"Daniel Kioko, Edwin Were, Wycliffe Kosgei","doi":"10.59692/jogeca.v36i1.115","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.115","url":null,"abstract":"Background: Maternal ‘near-miss’ and deaths, together termed severe maternal outcome(SMO) follow a pattern of deterioration that can be predicted and prevented. To prevent SMO, a Modified Early Obstetric Warning System (MOEWS) for tracking significant changes (‘triggers’) in vital signs among obstetric patients and initiating corrective measures is suggested. \u0000Objective: To determine predictors of SMO and the validity of the MEOWS for predicting SMO at Moi Teaching and Referral Hospital (MTRH), Eldoret-Kenya \u0000Methods: A retrospective cohort study was conducted at MTRH among 3200 mothers admitted from 1st January 2019. Maternal mortality and ‘near miss’ were determined by WHO criteria. Mothers were grouped into two outcome groups; either experiencing or not experiencing SMO. Their vital signs 24 hours prior to either outcome were then tabulated on a MOEWS chart and determined whether they met a vital sign trigger threshold. The sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) were determined. Relationship between sociodemographic and obstetric characteristic and SMO was determined by multivariate analysis \u0000 Results: The sociodemographic and obstetric predictors of SMO were age over 35 years(aOR=1.56), having a previous caesarean delivery(aOR=2.19), caesarean delivery in the index pregnancy(aOR=2.09), being a referral(aOR=3.43), not attending antenatal care (aOR=2.53) and admission in the preterm period(aOR=2.81) and in the postpartum period(aOR 51.3). The sensitivity of MOEWS was 77%, specificity 98%, PPV 61% and NPV 98%. \u0000Conclusion: The MOEWS chart has a high specificity, sensitivity and NPV but low PPV. The MOEWS chart is a valuable tool for predicting SMO","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.108
Cyrus Kimanthi, Hamdi Farah
Background: Globally, cancer is a leading cause of death, with cervical cancer being particularlyprevalent in sub-Saharan Africa, including Kenya. Despite being preventable, cervical cancer remains asignificant health burden due to low screening awareness and socioeconomic disparities. In Kenya, it isthe second most frequent cancer among women. This is exacerbated by high HPV infection rates,underscoring the critical need for effective screening strategies. This study assessed the knowledge,attitudes, and prevalence of cervical cancer screening among women in Garissa County.Methods: A descriptive cross-sectional study involving 480 women was conducted in Savannah RoyalHospital, Garissa from January 31st to February 4th, 2023. The study employed questionnaires toassess the knowledge and attitudes of women toward cervical cancer screening, alongside visualinspection with acetic acid (VIA) to determine the prevalence of cervical cancer. Participants wereselected through convenience sampling after a public awareness drive, and informed consent wasobtained from all participants.Results: Of 480 women screened, 96% (462) and 4% (18) tested negative and positive for cervicalcancer, respectively. Notably, 66% (315) were unaware of cervical cancer screening prior to the study,with 82.1% citing lack of awareness as the reason for not being previously screened. Regardingattitudes, 65.1% reported no discomfort during screening, 71.9% rated the experience positively, and50% felt no embarrassment in seeking a repeat VIA or Papanicolaou smear. Most women (72%)preferred receiving the results in person, and 97% were willing to undergo follow-up tests if the screeningresults were positive.Conclusion: The study highlights a significant lack of awareness of cervical cancer screening amongwomen in Garissa County, yet reveals positive attitudes toward screening. This suggests that enhancingawareness could lead to higher screening participation. The 4% positivity rate emphasizes the necessityof ongoing screening initiatives.
{"title":"Knowledge, Attitudes, and Prevalence of Cervical Cancer Screening Among Women in Garissa County","authors":"Cyrus Kimanthi, Hamdi Farah","doi":"10.59692/jogeca.v36i1.108","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.108","url":null,"abstract":"Background: Globally, cancer is a leading cause of death, with cervical cancer being particularlyprevalent in sub-Saharan Africa, including Kenya. Despite being preventable, cervical cancer remains asignificant health burden due to low screening awareness and socioeconomic disparities. In Kenya, it isthe second most frequent cancer among women. This is exacerbated by high HPV infection rates,underscoring the critical need for effective screening strategies. This study assessed the knowledge,attitudes, and prevalence of cervical cancer screening among women in Garissa County.Methods: A descriptive cross-sectional study involving 480 women was conducted in Savannah RoyalHospital, Garissa from January 31st to February 4th, 2023. The study employed questionnaires toassess the knowledge and attitudes of women toward cervical cancer screening, alongside visualinspection with acetic acid (VIA) to determine the prevalence of cervical cancer. Participants wereselected through convenience sampling after a public awareness drive, and informed consent wasobtained from all participants.Results: Of 480 women screened, 96% (462) and 4% (18) tested negative and positive for cervicalcancer, respectively. Notably, 66% (315) were unaware of cervical cancer screening prior to the study,with 82.1% citing lack of awareness as the reason for not being previously screened. Regardingattitudes, 65.1% reported no discomfort during screening, 71.9% rated the experience positively, and50% felt no embarrassment in seeking a repeat VIA or Papanicolaou smear. Most women (72%)preferred receiving the results in person, and 97% were willing to undergo follow-up tests if the screeningresults were positive.Conclusion: The study highlights a significant lack of awareness of cervical cancer screening amongwomen in Garissa County, yet reveals positive attitudes toward screening. This suggests that enhancingawareness could lead to higher screening participation. The 4% positivity rate emphasizes the necessityof ongoing screening initiatives.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"49 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.154
Kristina Sule, Francis Were
Case presentation: A 45-year-old nulliparous patient presented with a long-standing history of genitaldiscomfort in the form of friction, laceration, and dyspareunia. She was also esthetically displeased withher labia minora, which she considered too large and long. Her labia minora appearance was also notedto cause emotional distress. The patient requested labia minoraplasty. Despite correct techniqueselection, she was noted to have notching, fenestration, and pigment mismatch eight weekspostoperatively, and required revision surgery.Discussion: Wedge resection versus edge trimming is an active topic in cosmetic gynecology. Patientselection and hypertrophied labia minora are important considerations in technique selection. Thesehave a bearing on the eventual esthetic appearance and development of untoward effects.Conclusion: Even with the correct technique selection for a specific type of labial hypertrophy, untowardeffects may develop postoperatively, requiring reconstruction or revision later.
{"title":"Labia minoraplasty - the balance between technique and untoward effects: A case report","authors":"Kristina Sule, Francis Were","doi":"10.59692/jogeca.v36i1.154","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.154","url":null,"abstract":"Case presentation: A 45-year-old nulliparous patient presented with a long-standing history of genitaldiscomfort in the form of friction, laceration, and dyspareunia. She was also esthetically displeased withher labia minora, which she considered too large and long. Her labia minora appearance was also notedto cause emotional distress. The patient requested labia minoraplasty. Despite correct techniqueselection, she was noted to have notching, fenestration, and pigment mismatch eight weekspostoperatively, and required revision surgery.Discussion: Wedge resection versus edge trimming is an active topic in cosmetic gynecology. Patientselection and hypertrophied labia minora are important considerations in technique selection. Thesehave a bearing on the eventual esthetic appearance and development of untoward effects.Conclusion: Even with the correct technique selection for a specific type of labial hypertrophy, untowardeffects may develop postoperatively, requiring reconstruction or revision later.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"91 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.157
Polycarp Oyoo, Zahida Qureshi, Alfred Osoti, George Gwako, Jennifer Okore, Jim Kelly Mugambi, Joan Mwende
Background: Training healthcare providers on early detection and use of the first response bundle for postpartum hemorrhage (PPH) cases was one of the key strategies used in the intervention facilities during the E-MOTIVE trial. Results published from the E-MOTIVE trial revealed a marked reduction of 60% in the severity of PPH, idicating the need to implement the same approaches in the 11 control arm facilities. Methods: Healthcare providers (HCPs) from the 11 sites were trained on the E-MOTIVE bundle and issued with PPH emergency trollies, mannequins, and blood pressure machines. The staff was also mentored on self-PPH audits and feedback mechanisms from the data generated monthly from the labor ward. Two days of on-site training were conducted for the staff, which included knowledge tests (before and after) and skills assessment (objective skilled clinical examinations (OSCES)). EMOTIVE champions were identified from the training to promote ongoing skills practice sessions at the facility level. Monthly follow-ups were cpnducted to track individual progress using the training tracking sheet. Results: The HCPs cited confidence in detecting and treating PPH after the training with the hospitals demonstrating readiness in managing PPH through the presence of PPH emergency trollies. There was increased teamwork among the HCPs with improved documentation practices in the labor wards. Conclusion: Adoption of a sustainable training approach for healthcare providers in the prevention, early detection, and treatment of PPH that incorporates evidence-based strategies is key to improving maternal outcomes. National and county ministries of health have demonstrated a commitment to leverage the E-MOTIVE bundle approach after remarkable findings.
{"title":"E-MOTIVE Trial: Sustaining capacity building of healthcare providers in the early detection and treatment of postpartum hemorrhage in 11 facilities in Kenya","authors":"Polycarp Oyoo, Zahida Qureshi, Alfred Osoti, George Gwako, Jennifer Okore, Jim Kelly Mugambi, Joan Mwende","doi":"10.59692/jogeca.v36i1.157","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.157","url":null,"abstract":"Background: Training healthcare providers on early detection and use of the first response bundle for postpartum hemorrhage (PPH) cases was one of the key strategies used in the intervention facilities during the E-MOTIVE trial. Results published from the E-MOTIVE trial revealed a marked reduction of 60% in the severity of PPH, idicating the need to implement the same approaches in the 11 control arm facilities. \u0000 \u0000Methods: Healthcare providers (HCPs) from the 11 sites were trained on the E-MOTIVE bundle and issued with PPH emergency trollies, mannequins, and blood pressure machines. The staff was also mentored on self-PPH audits and feedback mechanisms from the data generated monthly from the labor ward. Two days of on-site training were conducted for the staff, which included knowledge tests (before and after) and skills assessment (objective skilled clinical examinations (OSCES)). EMOTIVE champions were identified from the training to promote ongoing skills practice sessions at the facility level. Monthly follow-ups were cpnducted to track individual progress using the training tracking sheet.\u0000 \u0000Results: The HCPs cited confidence in detecting and treating PPH after the training with the hospitals demonstrating readiness in managing PPH through the presence of PPH emergency trollies. There was increased teamwork among the HCPs with improved documentation practices in the labor wards.\u0000 \u0000Conclusion: Adoption of a sustainable training approach for healthcare providers in the prevention, early detection, and treatment of PPH that incorporates evidence-based strategies is key to improving maternal outcomes. National and county ministries of health have demonstrated a commitment to leverage the E-MOTIVE bundle approach after remarkable findings.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"18 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.300
Ndavi P, Balde M.D, Ahmed A.M, Diriye A.M, Soumah A.M, Sall A.O, Diallo A, Munyao J, Kemboi J, Esho T, Abdirahman S, Ahmed W, Mochache V, Stein K, Nosirov K, Thwin S.S, Pallitto C.C, Petzold M
Background: Healthcare providers are influenced by prevailing social norms. Addressing their underlying values on female genital mutilation (FGM) as well as their knowledge and skills in person-centred care could enable them to be effective change agents in the prevention of FGM. However, there is limited evidence on what works to achieve this. Objective: To test the effectiveness of an intervention involving person-centered communication (PCC) for FGM prevention in antenatal care (ANC) settings in Guinea, Kenya, and Somalia. Methods: A cluster randomized implementation study was conducted between August 2020 and September 2021. Sixty ANC clinics were randomized to the intervention and control arms in each country. ANC providers from the intervention arm received training to build their knowledge of FGM, question their FGM-related values and attitudes, and conduct FGM prevention counseling using a PCC approach. Data were collected at baseline, three months, and six months using tablets and were analyzed using multilevel regression models. Results: Over six months, 222 ANC providers (n=105 intervention; n=117 control) were followed up from 163 clinics. In month six, 1,630 new clients (n=820 intervention; n=810 control) were interviewed after their ANC clinic visit. ANC providers in the intervention arm were more likely than providers in the control arm to apply the PCC approach (p<0.001), communicate effectively about FGM prevention (p<0.05), and have higher FGM knowledge scores (p=0.005). Provider attitudes against FGM were consistently high in both arms across all time points. After the ANC clinic visit, a higher proportion of ANC clients in the intervention arm than in the control arm reported a change in their support for FGM (52% vs. 29%, p<0.001), were strongly opposed to FGM (61% vs. 47%, p<0.001), reported that they did not intend to cut their daughters (84% vs. 70%, p<0.001), and wanted to be actively engaged in FGM prevention (83% vs. 66%, p<0.001). Conclusion: This study provides robust evidence that training primary care providers to challenge their FGM-related values and attitudes and build their interpersonal communication skills using a person-centered approach is effective for strengthening FGM prevention in the health sector. Study impact and recommendations: This is the first randomized controlled trial to provide evidence on the effectiveness of a social norm change approach for FGM prevention in the health sector. The strength of the evidence should inform the scale-up of this approach to ensure effective delivery of FGM prevention services at the primary care level.
{"title":"A person-centred approach to female genital mutilation prevention: Results of a multi-country, cluster-randomized trial","authors":"Ndavi P, Balde M.D, Ahmed A.M, Diriye A.M, Soumah A.M, Sall A.O, Diallo A, Munyao J, Kemboi J, Esho T, Abdirahman S, Ahmed W, Mochache V, Stein K, Nosirov K, Thwin S.S, Pallitto C.C, Petzold M","doi":"10.59692/jogeca.v36i1.300","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.300","url":null,"abstract":"Background: Healthcare providers are influenced by prevailing social norms. Addressing their underlying values on female genital mutilation (FGM) as well as their knowledge and skills in person-centred care could enable them to be effective change agents in the prevention of FGM. However, there is limited evidence on what works to achieve this. \u0000Objective: To test the effectiveness of an intervention involving person-centered communication (PCC) for FGM prevention in antenatal care (ANC) settings in Guinea, Kenya, and Somalia. \u0000Methods: A cluster randomized implementation study was conducted between August 2020 and September 2021. Sixty ANC clinics were randomized to the intervention and control arms in each country. ANC providers from the intervention arm received training to build their knowledge of FGM, question their FGM-related values and attitudes, and conduct FGM prevention counseling using a PCC approach. Data were collected at baseline, three months, and six months using tablets and were analyzed using multilevel regression models. \u0000Results: Over six months, 222 ANC providers (n=105 intervention; n=117 control) were followed up from 163 clinics. In month six, 1,630 new clients (n=820 intervention; n=810 control) were interviewed after their ANC clinic visit. ANC providers in the intervention arm were more likely than providers in the control arm to apply the PCC approach (p<0.001), communicate effectively about FGM prevention (p<0.05), and have higher FGM knowledge scores (p=0.005). Provider attitudes against FGM were consistently high in both arms across all time points. After the ANC clinic visit, a higher proportion of ANC clients in the intervention arm than in the control arm reported a change in their support for FGM (52% vs. 29%, p<0.001), were strongly opposed to FGM (61% vs. 47%, p<0.001), reported that they did not intend to cut their daughters (84% vs. 70%, p<0.001), and wanted to be actively engaged in FGM prevention (83% vs. 66%, p<0.001). \u0000Conclusion: This study provides robust evidence that training primary care providers to challenge their FGM-related values and attitudes and build their interpersonal communication skills using a person-centered approach is effective for strengthening FGM prevention in the health sector. \u0000 \u0000Study impact and recommendations: This is the first randomized controlled trial to provide evidence on the effectiveness of a social norm change approach for FGM prevention in the health sector. The strength of the evidence should inform the scale-up of this approach to ensure effective delivery of FGM prevention services at the primary care level.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"130 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.184
P. Koigi, Angela Anzeze, Reuben Koigi Kamau, M. K. Koigi, Atul Patel
Background: Obstetric comorbidities significantly increase the risk of adverse obstetric outcomesbecause of their association with complications that can occur suddenly and escalate rapidly.Case presentation: A morbidly obese 26-year-old primigravida initially presented with first-trimesterbleeding. She consistently declined monitoring and was not adherent to the multidisciplinary treatmentplans despite serial counseling. This state persisted even when she was diagnosed with gestationaldiabetes mellitus and preeclampsia. She incurred gross fetal macrosomia and was admitted at term forinduction of labor. By the third prostaglandin, there was overt fetal tachycardia that necessitated anemergency cesarean delivery. Failed spinal anesthesia necessitated generalization. Access wasimpeded by a massive panniculus, necessitating tape retraction to reveal the surgical site. A distressedapneic baby was delivered, after which she developed an atonic uterus that necessitated uterine bracesuturing and intramyometrial PGF2α. The baby underwent therapeutic hypothermia. Postoperatively, shewas monitored and underwent repeated counseling.Discussion: This patient was noncompliant to medication and monitoring, she had multiple interactingcomorbidities, and she ended up having an avoidable multiple near-miss. There is a need to develop anobstetric comorbidity scoring index and validate it locally.Conclusion: If guided by a logical algorithmic sequence of guided responses, the development andapplication of a local risk and comorbidity scoring index may substantively reduce the risk of adverseobstetric outcomes. This is vital if sustainable development goals are to be realized.
{"title":"MANAGEMENT CONSIDERATIONS IN THE CONTEXT OF MULTIPLE OBSTETRIC COMORBIDITIES - A CASE REPORT","authors":"P. Koigi, Angela Anzeze, Reuben Koigi Kamau, M. K. Koigi, Atul Patel","doi":"10.59692/jogeca.v36i1.184","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.184","url":null,"abstract":"Background: Obstetric comorbidities significantly increase the risk of adverse obstetric outcomesbecause of their association with complications that can occur suddenly and escalate rapidly.Case presentation: A morbidly obese 26-year-old primigravida initially presented with first-trimesterbleeding. She consistently declined monitoring and was not adherent to the multidisciplinary treatmentplans despite serial counseling. This state persisted even when she was diagnosed with gestationaldiabetes mellitus and preeclampsia. She incurred gross fetal macrosomia and was admitted at term forinduction of labor. By the third prostaglandin, there was overt fetal tachycardia that necessitated anemergency cesarean delivery. Failed spinal anesthesia necessitated generalization. Access wasimpeded by a massive panniculus, necessitating tape retraction to reveal the surgical site. A distressedapneic baby was delivered, after which she developed an atonic uterus that necessitated uterine bracesuturing and intramyometrial PGF2α. The baby underwent therapeutic hypothermia. Postoperatively, shewas monitored and underwent repeated counseling.Discussion: This patient was noncompliant to medication and monitoring, she had multiple interactingcomorbidities, and she ended up having an avoidable multiple near-miss. There is a need to develop anobstetric comorbidity scoring index and validate it locally.Conclusion: If guided by a logical algorithmic sequence of guided responses, the development andapplication of a local risk and comorbidity scoring index may substantively reduce the risk of adverseobstetric outcomes. This is vital if sustainable development goals are to be realized.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"112 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.289
Hillary Mabeya
Background: Human papillomavirus (HPV) is a sexually transmitted virus found in virtually all cases ofcervical cancer that kills 275,000 women every year and is the biggest contributor to years of life lostfrom cancer among women in the developing world.Objectives: To determine barriers to HPV vaccination and cervical cancer prevention at the healthpersonnel level in low-resource settings. To evaluate the performance of cervical cancer secondaryprevention tools. To identify barriers and facilitators associated with the administration of the full HPVvaccination regimen.Methods: 150 HIV-infected women underwent conventional Papanicolaou (Pap) smear, visual inspectionwith acetic acid (VIA), colposcopy, and biopsy. Region under curve analysis was conducted to comparethe accuracies between VIA and Pap smear. 9600 doses of GARDASIL vaccines were administered togirls in Western Kenya targeting girls aged 9-14 years. A cross-sectional survey of health care providerswas also conducted.Results: VIA had a sensitivity of 69.6% (CI=55.1–81.0%), specificity of 51.0% (CI=41.5–60.4%), positivepredictive value (PPV) of 38.6% (CI=28.8–49.3%), and negative predictive value (NPV) of 79.1%(CI=67.8–87.2%). For conventional Pap smear, sensitivity was 52.5% (CI=42.1–71.5%), specificity 66.3%(CI=52.0–71.2%), PPV 39.7% (CI=27.6–51.8%), and NPV 76.8% (CI=67.0–85.6%). 1933 of 3026(63.8%) girls received a second HPV dose, whereas 1182 of 3026 (39.1%) received a third dose. 71.8%of girls had a female guardian and 28.1% had a male guardian. The median time lapse between the firstand third doses was 175 days (IQR: 168-182). High level of divergence between knowledge of HPVinfection and vaccines with a mean score of 2.27 indicating a negative attitude among health careworkers. 36.8% expressed concern that the HPV vaccine may result in promiscuity.Conclusions: Lack of proximity to vaccination centers requires an innovative vaccine delivery strategy.More education of caregivers undergoing cytological screening to raise awareness of the importance ofHPV vaccination.
{"title":"Cervical cancer prevention in Western Kenya in the vaccine era","authors":"Hillary Mabeya","doi":"10.59692/jogeca.v36i1.289","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.289","url":null,"abstract":"Background: Human papillomavirus (HPV) is a sexually transmitted virus found in virtually all cases ofcervical cancer that kills 275,000 women every year and is the biggest contributor to years of life lostfrom cancer among women in the developing world.Objectives: To determine barriers to HPV vaccination and cervical cancer prevention at the healthpersonnel level in low-resource settings. To evaluate the performance of cervical cancer secondaryprevention tools. To identify barriers and facilitators associated with the administration of the full HPVvaccination regimen.Methods: 150 HIV-infected women underwent conventional Papanicolaou (Pap) smear, visual inspectionwith acetic acid (VIA), colposcopy, and biopsy. Region under curve analysis was conducted to comparethe accuracies between VIA and Pap smear. 9600 doses of GARDASIL vaccines were administered togirls in Western Kenya targeting girls aged 9-14 years. A cross-sectional survey of health care providerswas also conducted.Results: VIA had a sensitivity of 69.6% (CI=55.1–81.0%), specificity of 51.0% (CI=41.5–60.4%), positivepredictive value (PPV) of 38.6% (CI=28.8–49.3%), and negative predictive value (NPV) of 79.1%(CI=67.8–87.2%). For conventional Pap smear, sensitivity was 52.5% (CI=42.1–71.5%), specificity 66.3%(CI=52.0–71.2%), PPV 39.7% (CI=27.6–51.8%), and NPV 76.8% (CI=67.0–85.6%). 1933 of 3026(63.8%) girls received a second HPV dose, whereas 1182 of 3026 (39.1%) received a third dose. 71.8%of girls had a female guardian and 28.1% had a male guardian. The median time lapse between the firstand third doses was 175 days (IQR: 168-182). High level of divergence between knowledge of HPVinfection and vaccines with a mean score of 2.27 indicating a negative attitude among health careworkers. 36.8% expressed concern that the HPV vaccine may result in promiscuity.Conclusions: Lack of proximity to vaccination centers requires an innovative vaccine delivery strategy.More education of caregivers undergoing cytological screening to raise awareness of the importance ofHPV vaccination.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"468 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.59692/jogeca.v36i1.129
Alice Iska
Background: According to the World Health Organization, antenatal care (ANC) is defined as “timely, appropriate, evidence-based actions related to health promotion, disease prevention, screening, and treatment with targets to reduce complications from pregnancy and childbirth, such as stillbirths and perinatal deaths”. The WHO recommends the adoption of the eight antenatal care model, whereby the health care provider interacts with the pregnant woman in eight contacts, as compared to the individual antenatal care model that had four visits. The eight ANC contacts are easily achieved through group antenatal care whereby pregnant women of similar gestational age are placed in groups or cohorts and then receive care together in the following ANC clinic days. Objective: To assess the impact of a group antenatal care model at Machakos County Referral Hospital. Methods: The group antenatal care model was rolled out at Machakos County Referral Hospital in April 2022. A record review was done from the summary report register for the following periods: February to July 2021 (before group ANC) and February to July 2023 (after group ANC). Results: The number of clients who revisited the antenatal clinic in the study period for the year 2021 was 2075, whereas those who revisited the clinic in the same study period were 4057, with 688 clients having attended the group antenatal care. Conclusion: There was an increase in the number of pregnant women who attended ANC services among pregnant women in 2023. A possible contributing factor to this may be associated with the introduction of group antenatal care where the pregnant women interacted seven times with the nurses and therefore more entries to the register.
{"title":"Impact of the group antenatal care model at Machakos County Referral Hospital, Kenya","authors":"Alice Iska","doi":"10.59692/jogeca.v36i1.129","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.129","url":null,"abstract":"Background: According to the World Health Organization, antenatal care (ANC) is defined as “timely, appropriate, evidence-based actions related to health promotion, disease prevention, screening, and treatment with targets to reduce complications from pregnancy and childbirth, such as stillbirths and perinatal deaths”. The WHO recommends the adoption of the eight antenatal care model, whereby the health care provider interacts with the pregnant woman in eight contacts, as compared to the individual antenatal care model that had four visits. The eight ANC contacts are easily achieved through group antenatal care whereby pregnant women of similar gestational age are placed in groups or cohorts and then receive care together in the following ANC clinic days.\u0000Objective: To assess the impact of a group antenatal care model at Machakos County Referral Hospital.\u0000Methods: The group antenatal care model was rolled out at Machakos County Referral Hospital in April 2022. A record review was done from the summary report register for the following periods: February to July 2021 (before group ANC) and February to July 2023 (after group ANC). \u0000Results: The number of clients who revisited the antenatal clinic in the study period for the year 2021 was 2075, whereas those who revisited the clinic in the same study period were 4057, with 688 clients having attended the group antenatal care.\u0000Conclusion: There was an increase in the number of pregnant women who attended ANC services among pregnant women in 2023. A possible contributing factor to this may be associated with the introduction of group antenatal care where the pregnant women interacted seven times with the nurses and therefore more entries to the register.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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