163 research outputs found

    Birth preparedness among antenatal clients

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    Objective: To evaluate birth preparedness and complication readiness among antenatal care clients. Design: A descriptive cross- sectional study. Setting: Antenatal care clinic at Kenyatta National Hospital, Nairobi, Kenya. Subjects: Three hundred and ninety four women attending antenatal care at Kenyatta National hospital were interviewed using a pre-tested questionnaire between May 2006 and August 2006. Clients who were above 32 weeks gestation and had attended the clinic more than twice were recruited. Systematic sampling was used to select the study participants with every third client being interviewed. Main outcome measures: Health education on birth preparedness, knowledge of danger signs, preparations for delivery and emergencies. Results: Over 60% of the respondents were counselled by health workers on various elements of birth preparedness. Eighty seven point three per cent of the respondents were aware of their expected date of delivery, 84.3% had set aside funds for transport to hospital during labour while 62.9% had funds for emergencies. Sixty seven per cent of the respondents knew at least one danger sign in pregnancy while only 6.9% knew of three or more danger signs. One hundred and nine per cent of the respondents did not have a clear plan of what to do in case of an obstetric emergency. Level of education positively influenced birth preparedness. Conclusions: Education and counselling on different aspects of birth preparedness was not provided to all clients. Respondents knowledge of danger signs in pregnancy was low. Many respondents did not know about birth preparedness and had no plans for emergencies. East African Medical Journla Vol. 85 (6) 2008: pp. 275-28

    Prevalence and risk factors of previous or active Hepatitis B infection among HIV-1 discordant heterosexual couples

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    Background: Hepatitis B Virus (HBV) and HIV spread in the same manner, but HBV is more infectious  than HIV-1. Active HBV requires modification of HIV-1 therapy and is associated with increased risk for sexual transmission of HBV.Objective: To determine the prevalence and knowledge of HBV among HIV-1 discordant couples.Design: A cross-sectional study.Setting: Couple Counselling Centres in Nairobi and Thika clinics in Kenya.Subjects: HIV discordant couples attending Couples Counselling Centres in Nairobi and Thika clinics in Kenya.Results: One hundred and sixty one couples with a mean age of 33 years (Standard Deviation 8.4) were enrolled into the study. HBV prevalence was higher among HIV positive women than among HIV negative women (10.2% vs. 5.9%, OR=0.5, 95% CI 0.2-1.0; p=0.05). However, among men, prevalence of HBV was higher among the HIV negative than the HIV positive participants (8.4 vs. 6.2%, OR=3.0, CI  1.3-6.5; p=0.04). There was no association between HBV and HIV (p=0.4) or gender (p=0.5). HIV  positive participants were more likely to have adequate knowledge compared to HIV negative participants (13% vs. 3.7%, OR=2.7, 95% CI 1.95-7.9; p=0.05)Conclusions: Female index participants had the highest HBV prevalence. Knowledge on HBV was lacking, particularly among the HIV negative; a target group for health education regarding risk factors and prevention of HBV infection

    Unilateral spontaneous tubal twin ectopic pregnancy: A rare occurrence

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    Unilateral tubal twin pregnancy remains rare despite a rise in the incidence of singleton ectopic pregnancies. A 27-year-old  Gravida 1 Para 0+0 at 12 weeks gestation, presented to our institution with a 1-month history of lower abdominal pain, that  progressively worsened and became very severe. An abdominal ultrasound revealed an extrauterine gestational sac that looked like a single viable fetus in the right adnexa at about 12 weeks by crown rump length. Free fluid was noted in the right iliac fossa and Morrison’s pouch. A conclusion of a right-ruptured ectopic pregnancy was made. The patient underwent laparotomy and a diagnosis of twin right-sided fimbrial ectopic pregnancy was made. The crown rump lengths of the twins were 6cm and 4cm. We present this case because unilateral tubal twin pregnancy is still a rare phenomenon, and clinicians as well as clinical  embryologists need to acknowledge its existence considering the diagnosis of this case was not made pre-operatively.Key words: Twin Tubal, ectopic pregnancy, unilatera

    Factors influencing cervical cancer screening in a Kenyan Health Facility: a mixed qualitative and quantitative study

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    Background: Cervical cancer is the commonest cause of cancer-related morbidity and mortality among women in developing countries in sub-Saharan Africa. Screening for cervical cancer among HIV infected women is crucial as they are more at risk of developing the disease and progressing faster once infected with Human Papilloma Virus (HPV).Methods: We aimed to determine the factors affecting the utilization of cervical cancer screening among HIV infected women above 18 years of age at Kenyatta National Hospital by conducting a cross-sectional mixed quantitative and qualitative methods study. Descriptive and inferential analysis was carried out on quantitative data to determine significant associations with cervical cancer utilization. Qualitative data were analyzed after coding for significant clauses and transcribing to determine themes arising.Results: Three hundred and twenty eight of the total 387 women enrolled reported they had been advised by their health providers to go for screening. However, only 179 (46%) reported cervical cancer screening.  Women were more likely to report cervical cancer screening if recommendation by a staff was made (p <0.001), and prior to joining KNH CCC (p <0.001). Qualitatively the main barrier to screening included fear of screening due to concerns about excessive pain or bleeding, lack of proper communication on screening procedures and long waiting timeConclusions: The utilization of cervical cancer screening services was low despite high rates of health care recommendation. The women were more likely to utilize the service if recommendation from the health care worker was made, and if they had ever screened before

    Injection safety knowledge and practices among clinical health care workers in Garissa provincial general hospital

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    Background: The World Health Organization estimates that approximately 16 billion injections are administered in developing countries annually. Injection safety is therefore critical in preventing occupational exposure and infection from blood borne pathogens, hence prevention is a vital part of any comprehensive plan for protecting health workers, patients and maintaining a safe environment.Objective: To determine the knowledge and practice of injection safety among clinical healthcare workers at the Garissa Provincial General Hospital.Design: A cross-sectional descriptive study.Setting: The Garissa provincial General Hospital from September 2011 to July 2012.Results: Injection safety knowledge was high with a score of 12.65 (SD ± 2.3) out of the total of 16 items. Appropriate injection safety practices were reported by most of the respondents. The level of knowledge was not significantly associated with respondents’ demographic characteristics(p&gt;0.05), but was significantly associated with hand washing practice(p&lt;0.05).Inferences were made on an appropriate injection safety practices like non-recapping of needles, hand washing and proper waste management. Drug administration practice varied in the different departments (p=0.043) and recapping of needles was significantly associated with training (p=0.047), designation (p=0.02) and area of deployment (p=0.017).Conclusion: Knowledge on injection safety was high but reported and observed practices were below the set standard. Risky practices such as recapping used syringes, re-use of disposable syringes and overfilling of sharp boxes were observed. There was insufficient provision of injection safety equipment, Poor waste handling and inadequate personal protective gear. Over prescription of unnecessary injections was widespread

    Do clinicians adhere to practice guidelines? A descriptive study at a referral hospital in Kenya

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    Background: Clinical guidelines when implemented correctly have shown to improve disease outcomes. This study describes utilization of Kenya National guidelines in managing ante partum haemorrhage (APH) in 3rd trimester.Objective: To describe adherence to clinical guideline in management of antepartum haemorrhage at Garissa Provincial General Hospital Design: Crossectional mixed methods studySetting: Garissa Provincial General HospitalSubjects: Medical records of patients managed for APH between 2002 and 2012 and Key Informant Interviews (KIIs) of Health workers.Results: 36.1% of the cases assessed were managed with strict adherence to guidelines. 90% of health care workers had high levels of awareness of the existence of guidelines and sited utilization challenges attributed to resource inadequacies.Conclusion: Clinicians are skilled on APH guidelines, but adherence levels are still low. Therefore, continuous appraisal of clinical practices, availing equipment, facilities and supplies to reinforce adherence is recommended

    The Gender Context of HIV Risk and Pregnancy Goals in Western Kenya

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    Background: Intentional childbearing may place heterosexual couples at risk of HIV infection in resource-limited settings with high HIV prevalence areas where society places great value on having children.Objective: To explore cognitive, cultural, and spatial mapping of sexual and reproductive health domains and services in western Kenya among men and women.Design: Community-based formative qualitative study design.Setting: Five administrative/geographical divisions of Nyando District, western Kenya.Subjects: Adult male 18 years and older and female who were of reproductive-potential ages (15 to 49 years for females)(n=90).Results:Men and women have disparate goals for number of children and engage in gendered patterns of protective method use (contraceptives used by women often in secret, condoms by men but rarely).Conclusion: HIV infection was still seen as stigmatising. These study results are relevant to design of effective integrated delivery for reproductive and HIV services in high-burden sub-Saharan African countries
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