Surgical Audit of Vesico-Vaginal Fistulae Repairs by on the Job Trained Medical Officers in a Rural Hospital, Kagando, Western Uganda.

Background: For each maternal death in Africa there are fifteen mothers who suffer from some form of birth related injury, where the most devastating form is the vesicovaginal fistulae (VVF).Teachings in most training centres recommend that repair of these fistulae should be done by consultants. This study aimed at evaluating the outcome of VVF repairs done by on the job trained rural based medical officers in a rural setting.Methods: This was a retrospective cohort study using data obtained from a review of patient hospital records for the period 2000-2005. Details of patient management including the patient’s state of continence on discharge were noted. A successful operation was defined as the patientgoing home continent.Results: The majority of the repairs done by medical officers were successful (52/70, 74%). Medical officers had more success with the repair of small defects (RR 1.69 CI 1.11-2.58). The repairs done by medical officers in the presence of consultants were more likely to succeed (RR 3.19 CI 1.90-5.53).Conclusion: Medical officers in rural African hospital settings can be trained to successfully repairsmall vesicovaginal fistulae

Use of HIV-Related Services and Modern Contraception among Women of Reproductive Age, Rakai Uganda

Voluntary counseling and testing (VCT) and HIV care (HIVC) can be an opportunity for reproductive health messages and services integration. The objective of this study is to assess the association between uptakeof HIV-related services and use of modern contraception among reproductive-age women. Data are derived from community cohort data, where HIV+ respondents were referred to the Rakai Health Sciences program’s HIVC clinic. Use of modern contraceptive and VCT receipt were by self-report. Multinomial logistic regression was used to estimate relative risk ratios (RRR) of contraception use by HIVC and VCT. Receipt of VCT was significantly associated with higher use of condoms for FP, adj.RRR 1.78 (1.07, 2.95), and other modern contraceptives, adj.RRR=1.56(1.15, 2.11). Increasing level of HIVC was associated with decreasing level of unmet need for contraception. Use of condoms for family planning is common among HIV-relatedservices attendees. Utilization of other modern contraceptive methods needs to be increased (Afr J Reprod Health 2010; 14[4]: 91-101)

Contraceptive use, prevalence and predictors of pregnancy planning among female sex workers in Uganda: a cross sectional study

BACKGROUND: Unintended pregnancies are associated with negative consequences to both mother and baby. Female Sex Workers (FSWs) are at high risk of unintended/unplanned pregnancies. However, prevalence of pregnancy planning and its predictors among FSWs has not been comprehensively investigated. This study was designed to determine contraceptive use, the prevalence, and predictors of pregnancy planning among FSWs in Uganda. METHODS: In this cross-sectional study, 819 FSWs attending most at risk populations initiative (MARPI) clinics were recruited using systematic sampling and interviewed with a pretested questionnaire that included collection of data on pregnancy intention using the London Measure of Unplanned Pregnancy (LMUP). Data were analysed using STATA version 14.0. Multinomial logistic regression model was used to identify predictors of pregnancy planning, RESULTS: Of the 819 study participants, only 90 (11.0%) had planned pregnancies. Overall, 462 (56.4%) were hazardous alcohol users and 335 (40.9%) abused drugs; 172 (21.0%) had been raped in the last 2 years and 70 (40.7%) of these accessed emergency contraception post-rape. Dual contraception use (condom and other modern method) was 58.0%. Having a non-emotional partner as a man who impregnated the FSW compared to emotional partner was significantly associated with less planned relative to unplanned pregnancy, (aRR = 0.15 95%Cl =0.08, 0.30), so was lack of reported social support compared to support from friends, (aRR = 0.44; 95% CI = 0.22-0.87), keeping all factors constant in the model. Being raped (aRR = 0.51; 95% CI = 0.31-0.84) or abuse of substances (aRR = 0.65; 95% CI = 0.45-0.93) were significantly associated with lower ambivalence relative to unplanned pregnancy but not with planned relative to unplanned pregnancy. CONCLUSION: Compared to women in the general population, pregnancy planning was low among FSWs amidst modest use of dual contraceptive. There is an urgent need to promote dual contraception among FSWs to prevent unplanned pregnancies especially with non-emotional partners, drug users, and post-rape

Pre-harvest management is a critical practice for minimizing aflatoxin contamination of maize

Published online: 8 Sept 2018; Open Access ArticleMaize, the main dietary staple in Kenya, is one of the crops most susceptible to contamination by aflatoxin. To understand sources of aflatoxin contamination for home grown maize, we collected 789 maize samples from smallholder farmers’ fields in Eastern and South Western, two regions in Kenya representing high and low aflatoxin risk areas, respectively, and determined aflatoxin B1 (AFB1) using ELISA with specific polyclonal antibodies. AFB1 was detected in 274 of the 416 samples from Eastern Kenya at levels between 0.01 and 9091.8 μg kg−1 (mean 67.8 μg kg−1). In South Western, AFB1 was detected in 233 of the 373 samples at levels between 0.98 and 722.2 μg kg−1 (mean 22.3 μg kg−1). Of the samples containing AFB1, 153 (55.8%) from Eastern and 102 (43.8%) from South Western exceeded the maximum allowable limit of AFB1 (5 μg kg−1) in maize for human consumption in Kenya. The probable daily intake (PDI) of AFB1 in Eastern Kenya ranged from 0.07 to 60612 ng kg−1 bw day−1 (mean 451.8 ng kg−1 bw day−1), while for South Western, PDI ranged from 6.53 to 4814.7 ng kg−1 bw day−1 (mean 148.4 ng kg−1 bw day−1). The average PDI for both regions exceeded the estimated provisional maximum tolerable daily intake of AFB1, which is a health concern for the population in these regions. These results revealed significant levels of preharvest aflatoxin contamination of maize in both regions. Prevention of preharvest infection of maize by toxigenic A. flavus strains should be a critical focal point to prevent aflatoxin contamination and exposure