Use of Cervical Cerclage as a Treatment Option for Cervical Incompetence: Patient Characteristics, Presentation and Management over a 9 Year Period in a Kenyan Centre

Treatment of cervical incompetence by cerclage and other methods has yet to be standardized, as its diagnosis is not uniformly accepted. Its diagnosis, particularly in the African setting, is mostly based on past obstetric history of pregnancy losses, while in developed centres; ultrasound diagnosis is increasingly being used. The mainstay of treatment in developing countries is cervical cerclage, although the indications and contraindications of this mode of treatment are not documented. Our aim was to appraise this practice in terms of patient characteristics, the diagnostic process and management at the Kenyatta National Hospital, Nairobi, Kenya. This was a descriptive retrospective study over 9 years. Predesigned questionnaires were employed to collect data on patient’s socio-demographic profile, presentation, risk factors, diagnosis and management of cervical incompetence. Chisquared test and student’s t-test were used to correlate variables. A total of 199 patients were treated for cervical incompetence, with the patient mean age being 27.97. 87.4% of the patients (p=0.02) were in the 20 to 35 years category. Most of the patients (60.1%) were of low socio-economic status. Cervical cerclage was employed in all the patients, although ultrasound investigation was not employed in 65.8% of them. Diagnosis of cervical incompetence still relies on history of previous pregnancy losses, with the standard transvaginal ultrasound relatively unemployed. There is need to intensify investigations for this condition, standardize the indications for cerclage, and diversify management to other newer modalities.RésuméLe traitement de l’insuffisance cervicale par le cerclage n'a pas encore été standardisé, étant donné que son diagnostic n'est pas uniformément accepté. Son diagnostic en Afrique, est principalement basé sur les antécédents obstétricaux de pertes de grossesse, alors que dans les centres développés, le diagnostic échographique est utilisé. Notre objectif était d'évaluer cette pratique en termes de caractéristiques des patientes, le processus de diagnostic et de gestion à l'Hôpital National Kenyatta, à Nairobi, au Kenya. Il s'agissait d'une étude rétrospective descriptive qui a duré 9 ans. Les questionnaires préconçus ont été utilisés pour recueillir des données sur la situation sociodémographique des patientes, la présentation, les facteurs de risque, le diagnostic et la gestion d'insuffisance cervicale. Le Test du chi carré et le test de t de l’étudiant ont été utilisés pour corréler les variables. Un total de 199 patientes ont été traitées pour l’insuffisance cervicale, l'âge moyen des patientes étant de 27,97. 87,4% des patientes (p = 0,02) se trouvaient dans la catégorie des 20 à 35 ans. La plupart des patientes (60,1%) étaient de faible statut socioéconomique. Le cerclage du col utérin a été utilisé chez toutes les patientes, bien qu’on n’ait pas mené une enquête échographique auprès des 65,8% d'entre elles. Le diagnostic d'insuffisance cervicale repose toujours sur les antécédents de perte de grossesses précédentes, là où on n’a presque pas utilisé l'échographie trans-vaginale normale. Il est nécessaire d'intensifier les recherches pour cette situation, de standardiser les indications du cerclage, et de diversifier la gestion vers d'autres modalités nouvelles.Keywords: Cervical incompetence, cerclage, diagnosis, managemen

EXPOSURE OF KIANDUTU SLUM RESIDENTS TO AFLATOXIN THROUGH MAIZE-BASED PRODUCTS CONSUMPTION

Kenyans have been highly affected by aflatoxicosis for a long time because of excessive exposure to high aflatoxin containing maize-based products. Maize has been the staple food in Kenya which is more highly consumed than any other cereal product. Many countries with strict aflatoxin threshold application, have consumers who still consume maize-based products, which has not gone through testing. The more remote and lower income areas are more affected by untested maize, ending up exposing themselves to Hepatocellular carcinoma which is a health hazard. The study was designed to determine the exposure of aflatoxin in Kiandutu slum which is a marginalized area in Thika, Kiambu County, Kenya. Ninety seven households were used in the study where number of maize-based products obtained from each household was sampled. Quantitative analysis was used to determine the aflatoxin levels by use of ELISA method. Questionnaires were used to collect the consumption data and sampling of maize- based products was done purposively. Aflatoxins were found in 30.93% of maize flour at between 0 to 34.19 μg /kg, 29.33% of composite flour at between 0 to 30.06 μg /kg, 18.67% of maize grain at between 0 and 20.92 μg /kg and 6.97% of Muthokoi at between 0 to 7.14 μg /kg. Across all sampled households, daily consumption of maize-based products in kilograms per body weight was found to be highest in maize flour, followed by whole maize grains, composite flour and muthokoi in that order. Monte Carlo risk simulation was used to generate the quantitative exposure data. Daily maize flour consumption was higher than other maize-based products with a mean of 0.0038 kg/kg bw/day. It also had the highest daily aflatoxin exposure at a mean of 0.0301 μg/kg/bw/day. The percentage level of the health risk was found to be highest through maize flour consumption at 68.65. Results showed that the frequency of consumption of maize-based products is an important contributor to dietary exposure risk

EXPOSURE OF KIANDUTU SLUM RESIDENTS TO AFLATOXIN THROUGH MAIZE-BASED PRODUCTS CONSUMPTION

Kenyans have been highly affected by aflatoxicosis for a long time because of excessive exposure to high aflatoxin containing maize-based products. Maize has been the staple food in Kenya which is more highly consumed than any other cereal product. Many countries with strict aflatoxin threshold application, have consumers who still consume maize-based products, which has not gone through testing. The more remote and lower income areas are more affected by untested maize, ending up exposing themselves to Hepatocellular carcinoma which is a health hazard. The study was designed to determine the exposure of aflatoxin in Kiandutu slum which is a marginalized area in Thika, Kiambu County, Kenya. Ninety seven households were used in the study where number of maize-based products obtained from each household was sampled. Quantitative analysis was used to determine the aflatoxin levels by use of ELISA method. Questionnaires were used to collect the consumption data and sampling of maize- based products was done purposively. Aflatoxins were found in 30.93% of maize flour at between 0 to 34.19 μg /kg, 29.33% of composite flour at between 0 to 30.06 μg /kg, 18.67% of maize grain at between 0 and 20.92 μg /kg and 6.97% of Muthokoi at between 0 to 7.14 μg /kg. Across all sampled households, daily consumption of maize-based products in kilograms per body weight was found to be highest in maize flour, followed by whole maize grains, composite flour and muthokoi in that order. Monte Carlo risk simulation was used to generate the quantitative exposure data. Daily maize flour consumption was higher than other maize-based products with a mean of 0.0038 kg/kg bw/day. It also had the highest daily aflatoxin exposure at a mean of 0.0301 μg/kg/bw/day. The percentage level of the health risk was found to be highest through maize flour consumption at 68.65. Results showed that the frequency of consumption of maize-based products is an important contributor to dietary exposure risk