Uterine Rupture in a Primigravida with Mullerian Anomaly at 27 Weeks Gestation

Mullerian anomalies are rare and are often associated with infertility, chronic pelvic pain and pregnancy  wastage. This is a case report of a primigravida at 27 weeks gestation, who presented in shock. Intra- operatively, a mullerian anomaly with a ruptured left horn was found and excised. She made remarkable  recovery and was discharged home. Uterine anomalies should be ruled out in the evaluation of pregnancy  wastage. When present, management should be individualized based on the clinical history, presentation, anatomical aberration and the patient’s future fertility desire

Establishment of a catchment monitoring network through a participatory approach in a small rural catchment in South Africa

International audienceThe establishment of a catchment monitoring network is a process, from the inception of the idea to its implementation, the latter being the construction of relevant gauging structures and installation of the various instruments. It is useful that the local communities and other stakeholders are involved and participate in such a process as was realised during the establishment of the hydrological monitoring network in the Potshini catchment in the Bergville district in the KwaZulu-Natal Province in South Africa. The paper illustrates the participatory application of various methods and techniques for establishing a hydrological monitoring network, in a small rural inhabited catchment, to monitor hydrological processes at both field and catchment scale for research purposes in water resources management. The authors conclude that the participation of the local community and other stakeholders in catchment monitoring and instilling the sense of ownership and management of natural resources to the local communities needs to be encouraged at all times. Success stories in water resources management by local communities can be realized if such a process is integrated with other development plans in the catchment at all forums with due recognition of the social dynamics of the communities living in the catchment

Symptom screen: diagnostic usefulness in detecting pulmonary tuberculosis in HIV-infected pregnant women in Kenya

OBJECTIVE: To determine the diagnostic usefulness of tuberculosis (TB) symptom screening to detect active pulmonary TB among human immunodeficiency virus (HIV) infected pregnant women in two PMTCT (prevention of mother-to-child transmission) clinics in western Kenya that are supported by the United States Agency for International Development–Academic Model Providing Access to Healthcare partnership. DESIGN: Cross-sectional study. Participants were interviewed for TB symptoms with a standardized questionnaire (cough >2 weeks, fever, night sweats, weight loss or failure to gain weight). Those with cough submitted sputum specimens for smear microscopy for acid-fast bacilli and mycobacterial culture. Women at >14 weeks gestation underwent shielded chest radiography (CXR). RESULTS: Of 187 HIV-infected women, 38 (20%) were symptom screen-positive. Of these, 21 had a cough for >2 weeks, but all had negative sputum smears and mycobacterial cultures. CXRs were performed in 26 symptomatic women: three were suggestive of TB (1 miliary, 1 infiltrates and 1 cavitary). Of 149 women with a negative symptom screen, 100 had a CXR and seven had a CXR suggestive of TB (1 cavitary, 2 miliary and 4 infiltrates). CONCLUSION: This study did not support the utility of isolated symptom screening in identification of TB disease in our PMTCT setting. CXR was useful in identification of TB suspects in both symptomatic and asymptomatic women

Tubo-Ovarian Presentation of Burkitt’s Lymphoma: Case Report

Burkitt’s lymphoma rarely presents as a primary of the ovary. High index of suspicion is required to avoid delay of definitive management. There are a few case reports presented on ovarian Burkitt’s lymphoma. We present a case of a 23 year old, para 1+1 HIV negative patient who presented to the Kenyatta National Hospital with a one month history of progressive abdominal swelling, fatigue, lower limb swelling, nausea and vomiting. Abdominal examination, revealed bilateral adnexal masses confirmed by ultrasonography. She underwent emergency laparotomy following a diagnosis of bilateral ovarian masses with torsion. Surgical specimen  showed tubo-ovarian tissue with sheets of lymphoid cells of small to intermediate size, with numerous tangible body macrophages depicting a starry sky appearance. Immunohistochemistry demonstrated a strongly positive CD20, a positive CD 10, a 90-95% positive Ki67, a positive Bcl6 and a negative pan-CK. A definitive diagnosis of tubo-ovarian Burkitt’s was made. The patient unfortunately succumbed before commencement of chemotherapy. Autopsy, concluded the cause of death to be widely disseminated Burkitt’s lymphoma, with a most likely tubo-ovarian primary and intestinal obstruction. Burkitt’s lymphoma should be considered as a differential diagnosis in ovarian masses for timely diagnosis and management

Uptake of isoniazid preventive therapy and its associated factors among HIV positive patients in an urban health centre, Kenya

Background: Isoniazid Preventive Therapy (IPT) is an effective intervention for prevention of tuberculosis (TB) among HIV positive patients, and its use is recommended by the World Health Organization (WHO). Unfortunately the uptake of IPT in Kenya remains low (33%-40%) with limited knowledge on the factors that affect its uptake.Objective: To determine the uptake of IPT and its associated factors among HIV-positive patients enrolled in a urban health centre.Design: Hospital based cross-sectional studySetting: Riruta Health Centre, Nairobi, KenyaSubjects: HIV-positive patients ≥18 years who have been on care and treatment services in the health centre for at least six months preceding the study.Results: Four hundred and thirty six participants were enrolled with a mean age of 41 years (standard deviation± 9years). Females were 276 (63%), anti-retroviral therapy uptake of 427 (98%) and overall IPT uptake rate of 336 (77%). On multivariate analysis, fear of acquiring TB (adjusted odds ratio (AOR) 4.6, 95% confidence interval, CI 2.6-8.1), having received IPT-associated health education (AOR 5.0, 95% CI 3.0-8.4) and having a good relationship with the healthcare worker (HCW) (AOR 2.0, 95% CI 1.2-3.4) were independently associated with initiation of IPT.Conclusion: The uptake rate was above the current national coverage but fell below the national set target of 90%. Fear of acquiring TB, receipt of IPT-associated health education and favourable relationship with the HCWs promoted the initiation of IP

Editorial: Structured operational research and training in the public health sector: the Kenyan experience

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Establishment of a catchment monitoring network through a participatory approach in a rural community in South Africa

The establishment of a catchment monitoring network is a process, from the inception of the idea to its implementation, the latter being the construction of relevant gauging structures and installation of the various instruments. It is useful that the local communities and other stakeholders are involved and participate in such a process, as was highlighted during the establishment of the hydrological monitoring network in the Potshini catchment in Bergville District in the KwaZulu-Natal Province, South Africa. The paper highlights the participatory establishment of a hydrological monitoring network in a small rural inhabited catchment, in line with the overall objective of the Smallholder System Innovations (SSI) research programme, to monitor hydrological processes at both field and catchment scale for water resources management research purposes. The engagement and participation of the Potshini community precipitated a learning opportunity for both the researchers and the local community on (i) the understanding of hydrological processes inherent in the catchment (ii) appreciating the inherent dynamics in establishing a catchment monitoring network in the midst of a community (iii) paradigm shift on how to engage different stakeholders at different levels of participation. The participatory engagement in the monitoring process led to appreciation and uptake of some of the research results by the Potshini community and ensured continued support from all stakeholders. This paper is of the view that the participation of the local community and other stakeholders in catchment monitoring and instilling a sense of ownership and management of natural resources to the local communities needs to be encouraged at all times. Success stories in water resources management by local communities can be realized if such a process is integrated with other development plans in the catchment at all forums, with due recognition of the social dynamics of the communities living in the catchment

Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007-2013.

SETTING: A rural private health facility, Ruby Medical Centre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya. OBJECTIVES: Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete antenatal care (ANC) package and associated factors. DESIGN: Retrospective cross-sectional study using routine programme data. RESULTS: During the study period, 2635 women delivered at the RMC: 50% were aged 16-24 years, 60% transferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the tetanus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC elsewhere were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births. CONCLUSION: This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, increased efforts should be made to ensure earlier presentation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions

Dynamic MAIT cell response with progressively enhanced innateness during acute HIV-1 infection.

Mucosa-associated invariant T (MAIT) cell loss in chronic HIV-1 infection is a significant insult to antimicrobial immune defenses. Here we investigate the response of MAIT cells during acute HIV-1 infection utilizing the RV217 cohort with paired longitudinal pre- and post-infection samples. MAIT cells are activated and expand in blood and mucosa coincident with peak HIV-1 viremia, in a manner associated with emerging microbial translocation. This is followed by a phase with elevated function as viral replication is controlled to a set-point level, and later by their functional decline at the onset of chronic infection. Interestingly, enhanced innate-like pathways and characteristics develop progressively in MAIT cells during infection, in parallel with TCR repertoire alterations. These findings delineate the dynamic MAIT cell response to acute HIV-1 infection, and show how the MAIT compartment initially responds and expands with enhanced function, followed by progressive reprogramming away from TCR-dependent antibacterial responses towards innate-like functionality

The Structured Operational Research and Training Initiative (SORT IT), second workshop using the national tuberculosis routinely collected program data

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