Fertility rate of epileptic women at Kenyatta National Hospital

Background: Reproductive health issues of women with epilepsy (WWE ) are complex and multifaceted, and both epilepsy and antiepileptic drug (AE Ds) use may alter fertility and pregnancy outcomes in these women. Objective: To determine the fertility rate of women with epilepsy at Kenyatta National ospital (KNH). Design: Cross-sectional study. Setting: Neurology clinic, KNH, Nairobi, Kenya, between October 2006 and March 2007. Subjects: A total of 191 women with epilepsy (aged 15-49 years) who had been epileptic for at least one year were interviewed regarding their pregnancy and birth histories, and the information validated with medical records where available. Results: The general fertility rate (GFR) for reproductive-aged epileptic women for the three-year period (2003-2006) preceding the study was 46 livebirths per 1000 women-years (95% CI 35.13- 63.59). Conclusion: Fertility rate in epileptic women is decreased by two thirds (compared to that of general population of women in Kenya). Reasons for this are probably miltifactorial. East African Medical Journal Vol. 85 (7) 2008: pp. 341-34

Stratification of persons with diabetes into risk categories for foot ulceration

Background: Patients with diabetes mellitus are at a higher risk of lower extremity complications as compared to their non-diabetic counterparts.Objective: To study risk factors for diabetic foot ulcer disease and stratify patients with diabetes into risk categories for foot ulceration.Design: Cross-sectional descriptive study over five months period.Setting: Diabetic outpatient clinic, at the Kenyatta National Hospital.Subjects: Two hundred and eighteen ambulatory subjects with diabetes mellitus without active foot lesions.Results: The prevalence of previous foot ulceration was 16% while that of previous amputation was 8%. Neuropathy was present in 42% of the study subjects and was significantly associated with age, male gender, duration of diabetes, random blood sugar, systolic blood pressure and the presence of foot deformity. Peripheral arterial disease was present in 12% and showed significant association with male gender. Foot deformities were observed in 46% of study subjects and were significantly associated with age, male gender, and presence of neuropathy. Subsequently 57% were categorised into IWGDF group 0 - no neuropathy, 10% were placed in group 1- neuropathy alone, 16% were put in group 2 - neuropathy plus either peripheral arterial disease or foot deformity and 17% were placed in risk group 3 - previous foot ulceration/amputation.Conclusion: More than one third (33%) of diabetic patients were found to be at high risk for future foot ulceration (lWGDF groups 2 and 3). Published evidence exists that shows improved outcomes with interventions targeting individual patients with diabetes at high-risk of foot ulceration. Long term prospective studies to determine outcomes for the different risk categories should be carried out locally