Abortion-related stigma and unsafe abortions: perspectives of women seeking abortion care in Machakos and Trans-Nzoia Counties, Kenya

Background: The rate of unsafe abortions in Kenya increased from 32 per 1000 women of reproductive age in 2002 to 48 per 1000 women in 2012-- one of the highest in Sub- Saharan Africa. Abortion-related stigma has been linked to high levels of unsafe abortions.Objective: To explore the perspectives of women seeking abortion services in public and private health facilities in regions with high as well as low incidence of unsafe abortions in Kenya on abortion-related stigma.Design: A comparative qualitative study.Setting: Selected public and private health facilities offering post abortion care services in Machakos and Trans Nzoia CountiesSubjects: Women seeking abortion related services in private and public health facilities in Machakos and Trans Nzoia Counties.Results: Abortion-related stigma manifested in various forms including verbal abuse such as ridicule and name calling, isolation, physical abuse and denial of services. The stigma was in form of self-stigma, from the community and from health providers. Due to stigma, women preferred to seek information on abortion only from trusted friends and close relatives, regardless of their reliability so as to keep abortion confidential. Private facilities were reported as the main facilities where women could get an abortion confidentially, but costly compared to public facilities. As a result, women who could not afford private facilities chose to self-induce and present in a health facility to seek post abortion (PAC) care as the only way to access services, regardless of the dangers. Young single women seeking abortion services reported higher levels of stigma from health providers compared to older married women. Perception that abortion was illegal in Kenya perpetuated stigma and prevented women from seeking safe abortion services due to fear of being arrested.Conclusion: Stigma associated with abortion is a major barrier to women seeking and receiving safe, comprehensive abortion care. Therefore, understanding abortion-related stigma is a critical step to designing measures to address barriers to women accessing safe reproductive health services

Association between levels of pain and disability in patients with somatic and neurogenic low back pain at Mbagathi District Hospital in Nairobi County, Kenya

Background: Low Back Pain is a problem of public health importance in developed countries as well as developing ones including Kenya. Low Back Pain, sub-categorized into somatic and neurogenic pain manifests in different unknown levels which have enormous health and socio economic impact. In Kenya, information on levels of pain and disability and how the two affect each other remain scanty.Objective: To determine the relationship between levels of pain and disability among patients with somatic and neurogenic Low Back Pain at Mbagathi District Hospital in Nairobi County, Kenya.Design: A cross-sectional study.Setting: Mbagathi District Hospital from May 2016 to August 2016.Subjects: All consenting Low Back Pain patients referred for out-patient physiotherapy clinic at Mbagathi District HospitalResults: Out of 176 participants enrolled in the study, majority, (63.1%) were females compared to 36.9% who were males. The proportion of patients with somatic Low Back Pain was 72.7 %( n=128) compared to 27.3 % (n=48) that had neurogenic Low Back Pain. More than half, 55.7 % (n=98) of the participants had pain intensity of moderate level while the remainder, 44.3 %( n=78) presented with severe pain level. Most respondents, 60.8 %( n=107) had minimal disability level compared to 33.5 %( n=59), and 5.7 %( n=10) whose levels were moderate and severe disability respectively. Results showed significant association between severe pain and moderate and severe disability (P<0.001). Neurogenic pain was also significantly associated with severe and moderate disability (P=0.006).Conclusion: A great majority of patients attending out-patient physiotherapy clinic presented with somatic Low Back Pain whose disability level was Minimal. A smaller proportion of patients with neurogenic Low Back Pain had moderate and severe disability. Neurogenic pain posed the highest risk of moderate and severe disability

UTILISATION OF ANTENATAL AND MATERNITY SERVICES BY MOTHERS SEEKING CHILD WELFARE SERVICES IN MBEERE DISTRICT, EASTERN PROVINCE, KENYA

Background: Utilisation of antenatal and maternity services is an important maternal healthindicator. Increasing the proportion of mothers who are cared for in health facilities duringpregnancy, childbirth and puerperium reduces the health risks to mothers and theirchildren.Objective: To determine the utilisation of antenatal and maternity services by mothers ofMbeere District bringing their children to the child welfare clinic.Design: Cross-sectional, descriptive study.Setting: Four rural health centres in Mbeere district.Subjects: Two hundred mothers bringing their children aged one year and below to the childwelfare clinic between September and December 2000.Results: The proportion of mothers who utilised health facilities for antenatal and maternityservices was 97.5% and 52%, respectively. Utilisation of health facilities for maternityservices was significantly influenced by number of children and distance to health facility inthat, as number of children increased, utilisation of maternity services reduced (c2=8.99;p=0.027; df=1). Mothers living less than 5km to a health facility utilised the services betterthan those living 5 km and beyond (c2=7.57; p=0.0059; df=1). Among the reasons given bythe mothers (individual respondents and through Focus Group Discussions) regardingdissatisfaction with the services offered included shortage of drugs and essential supplies,lack of commitment by staff, poor quality of food and lack of cleanliness in the healthfacilities.Conclusion: Coverage for antenatal services was high among mothers during their lastpregnancy. However, only about half of the mothers interviewed utilised health facilities formaternity services (labour and delivery). The major constraints experienced by the mothersas they sought for the services (as reported by individual respondents and through FocusGroup Discussions) included lack of transport, lack of money for transport and hospital feeand delay in admission to health facility once mothers report in labour. Lack of satisfactionwith quality of care given could be the major demotivating factor in the use of health facilitiesfor maternity services