Birth Outcomes in Mothers Presenting in First Stage Compared to Second Stage of Labour at Kakamega County General Hospital

Maternal mortality is unacceptably high. About 830 women die from pregnancy or childbirth-related complications around the world every day. It was estimated that in 2015, roughly 303 000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. Admission of women in second stage of labour is often associated with poor maternal and fetal outcomes. These outcomes include: postpartum haemorrhage, obstructed labour and ruptured uterus. This study aimed to compare the birth outcomes among mothers presenting in Second Stage of labour with those who presented in First Stage of labour at Kakamega County Referral hospital. Specifically, it examined maternal outcomes and reasons why mothers presented in Second Stage of labour. A cross-sectional study using mixed methods approach was conducted in the study area. Systematic sampling technique was used to recruit the participants. Data was collected using a pre-tested structured questionnaire administered to 320 women who presented in second stage and another 320 who were admitted in first stage of labour. Two focus group discussions were also conducted in groups of six mothers. Quantitative data were coded and analysed using Statistical Package for Social Sciences (SPSS) version 20. Chi-square test and multiple logistic regression were employed in the analysis. A p < 0.05 was considered significant at 95% confidence interval. Null hypothesis was tested at 5% significance level. A significantly higher proportion of mothers in second stage 90.9% (291/320) were housewives with the majority having attained primary education (98.4%) (p < 0.0001). Prolonged/obstructed labour (11.9%) and primary PPH (9.7%) were the leading complications recorded in mothers who reported in second stage compared to 3.1% and 0.3% respectively, among those who reported in first stage. The study revealed that mothers presenting in first stage of labour had higher chances of normal labour compared to those presenting in second stage of labour (df=1, χ2 =46, p<0.0001). Mothers who reported in Second Stage (28.1%) had delayed at home because progress of labour was too fast while 26.3% presented in Second Stage because the husband was not at home.In conclusion, the study found out that most of mothers presenting in second stage of labour had either no formal education or were primary school leavers with the majority being housewives with no formal employment. It was also noted that mothers who attended ANC and completed the 4-visits presented early in labour. In regard to maternal complications, prolonged/obstructed labour and postpartum haemorrhage were most prevalent among mothers who reported in second stage of labour. For the wellbeing of the neonates and mothers, labour needs to be monitored and delivery conducted by skilled personnel. Therefore, male involvement and sensitising mothers during antenatal visits on birth preparedness would encourage them to present early in the hospital during labour. Keywords: First Stage of labour, second stage, and factors for presentation in first and second stage, Term pregnancy

Predictors of Optimum Uptake of Intermittent Presumptive Treatment of Malaria During Pregnancy Among Women at Navakholo Sub-County, Kakamega County - Kenya

Introduction. Malaria in pregnancy is associated with high incidences of maternal and neonatal mortality in malaria endemic regions. World Health Organization recommends Intermittent Presumptive treatment of malaria in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP). It is recommended that every pregnant woman receives at least three doses administered one month apart up to the time of delivery. Despite increased antenatal clinic attendance and concerted efforts to address known barriers to uptake of malaria preventive measures in Navakholo Sub-County, uptake of three or more IPTp-SP doses in the Sub-County has remained low. Objective. This study aimed at determining predictors of optimum uptake of intermittent presumptive treatment of malaria in pregnancy among women in Navakholo Sub-County. Methodology. This was a cross sectional study using mixed methods of data collection. The study was carried out in Navakholo Sub-County, Kakamega County, Kenya. Multistage cluster sampling method was employed to attain sample size (n = 608). Data was analyzed using descriptive statistics, bivariate and multivariate logistic regression while thematic analysis was used for qualitative data. Strength of association between independent variables and dependent variables was measured using odd ratio and p ≤ 0.05 used to reject null hypothesis of no association between independent variables and the main outcome which was the uptake of optimum doses of IPTp-SP. Results. Out of the 587 participants, 294(50.1%) took optimum doses (three or more doses) of IPTp-SP, 248(42.2%) took IPTp-SP partially (one-two doses) and 45 (7.7%) did not take any dose.  The following variables were statistically significantly associated with uptake of optimum doses of IPTp-SP: having attained secondary level of education and above (OR = 0.6, 95% CI 0.4-0.98, p = 0.01); distance to health facility (OR = 0.2, 95% CI 0.06-0.8, p = 0.02); perception that SP drugs are not safe during pregnancy (OR = 7.3, 95% CI 1.5-35.7, p = < 0.01); opening of health facilities daily (OR = 161.8, 95% CI 29.5-885.7 p < 0.0001) and giving clients return dates (OR = 21.2, 95% CI 7.9-56.5, p = < 0 .0001). Conclusion: Key factors that determine optimum uptake of IPTp-SP in the study area are: having attained at least secondary level of education; perceived safety of SP drugs; distance to health facility; opening of health facility daily and giving of return dates to clients. Recommendation: - Community awareness through health education to increase awareness on the risks of malaria in pregnancy and safety of SPs in pregnancy.  The study further recommends that the daily opening of facilities within the study area, ensure return dates are given at every visit and introduction of mobile clinics to those who are staying far away from the nearest health facility. Keywords; IPTp-SP, Malaria in Pregnancy, Optimum uptake of IPTp-SP doses, Navakholo Sub-County. DOI: 10.7176/JHMN/60-08 Publication date:March 31st 201

An Evaluation of the Effectiveness of Behavioural Intervention Strategies Employed towards the Mitigation of HIV Risky Sexual Behaviour among Students in Institutions of Higher Learning in Western Kenya

Researchers have confirmed that the reason for the relatively high HIV incidence among people between 15-24 years globally is Risky Sexual Behaviour. Researchers subsequently identified a challenge regarding effective mitigation of the behaviour world over. They further identified Institutions of Higher Learning, which host a significant proportion of youth, as fertile breeding grounds for this behaviour. This study consequently evaluated the strategies employed in the mitigation of HIV Risky Sexual Behaviour among students in these institutions in Western Kenya overall, and specifically; evaluated the HIV prevention behavioural. The study employed qualitative and quantitative approaches to ensure triangulation and crosschecking of the research process. Employed were probability and non-probability sampling techniques generally and specifically, cluster sampling then simple random sampling. Chosen was a sample size of 399 students from a population of 13,002 students at seven institutions. Key informants were sampled purposively as follows; 5 NGO officials, 6 county government officials, 6 officials working in health care centers and 6 dean of students and 1 student counsellor. Selection of four Focus Group Discussions was purposive with each FGD having eight purposively selected student leaders from four institutions. An interview administered semi-structured questionnaire was employed to collect data from students, an FGD guide for the FGDs and Key Informant interview guides for the key informants. Descriptive statistics, an index-score, qualitative analysis and chi-square and were done for analysis. The HIV Risky Sexual Behaviour index-score revealed that a majority 269 (67.4%) of the respondents are involved in HIGH HIV Risky Sexual Behaviours. From chi-square tests, regarding behavioural strategies, information provision and counselling and other forms of psycho-social support are found to be statistically significant with p-value = 0.007 and p-value = 0.080 respectively. The study concludes that HIV incidence and prevalence rates in these institutions are likely to double in the near future if stakeholders continue to apply mitigation strategies in the exact manner they are currently doing. At behavioural level, the study thus recommends enhancing counselling and other forms of psychosocial support and stigma, and discrimination reduction programmes. Keywords: Effectiveness, Behavioural Intervention Strategies, Mitigation. HIV, Risky Sexual Behaviour, Students, Institutions, Higher Learning DOI: 10.7176/RHSS/12-16-05 Publication date:August 31st 202

Drivers of early marriage and teenage pregnancy in Kenya and Uganda during COVID-19 lockdown period: A systematic review

The present study aimed to explore the drivers of early marriage and teenage pregnancy in Kenya and Uganda during COVID-19 lockdown period. A systematic review design was adopted. The major online databases utilized were PubMed, Google Scholar, Uganda and Kenya Ministry of Health repositories, ScienceDirect, and Scopus. Studies that were originating from Kenya and Uganda that were publicly available in electronic format published from March 2020 to March 2022 were used. The thematic analysis identified major concepts that were drivers to the present research problem which were as follows: (1) school closure and (2) loss of income by parents. The COVID-19 containment measures introduced in the two countries were noted as major contributing factors. During the pandemic, lockdown led to school closures which meant the teenagers being idle at home with an increased opportunity to indulge in sexual risk behaviors. Schools have been noted to be a safe place protecting this vulnerable population. However, with their prolonged closure, the teenagers were exposed to sexual predators. Parents lost income, and this might have contributed to early marriages and teenagers' dependency on their sexual partners. Based on the reviewed evidence, the present study furthers the advocacy for the reduction of early marriages and teenage pregnancy, especially in the current COVID-19 pandemic era. The study calls upon the governments to intensify efforts toward the present research problem as the COVID-19 pandemic is eroding the earlier gains made within the regionHealth Studie