Pregnancy outcome among adolescents and non-adolescents delivering at Kiambu Country Hospital, Kenya

Objective: To determine the pregnancy outcome among adolescents and non-adolescents.Design: A retrospective cross sectional study.Setting: Kiambu County Hospital, Kenya.Subjects: Three hundred and thirty six patients who delivered at Kiambu County Hospital.Main outcome measures: Maternal and foetal morbidity and mortality.Results: More adolescent were single and of lower level of education than the nonadolescents with a statistical significance of 0.025 and 0.031 respectively. Anaemia occurred in 16.0% of adolescents compared to 2.4% among the non-adolescents with a statistical significance of p(<0.001). Cepholopelvic Disproportion (CPD) occurred in 8% of the adolescents vs.1.6% among the non-adolescents vs. 1.6% among the non –adolescents with a statistical significance (P<0.018). Preterm deliveries occurred in 5.6% of the adolescents compared to 0.8% with a statistical significance of 0.031. Postpartum haemorrhage occurred in 7.2% of the adolescents compared to 0.8% of the non-adolescents with a statistical significance of P<O.O1. Puerperal sepsis occurred in 7.2% of the adolescent vs 1.6% among the non-adolescents (P<0.031). The mean birthweight of the adolescents was 2.9 kgs compared to 3.1 kgs with the difference being statistically significant with a P-value of 0.015.Conclusion: Socio-economic status was worse among the adolescents. Intra-partum complications like malpresentation, cephalopelvic disproportion and preterm deliveries were more common among the adolescents than the non-adolescents. Mean birth weight was lower for the adolescents. Post-partum complications like haemorrhage and sepsis were also more common in the group. Adolescent pregnancy is high risk and should be prevented but if it occurs, comprehensive antenatal follow-up is mandator

Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda.

Integrated community case management (iCCM) strategies aim to reach poor communities by providing timely access to treatment for malaria, pneumonia and diarrhoea for children under 5 years of age. Community health workers, known as Village Health Teams (VHTs) in Uganda, have been shown to be effective in hard-to-reach, underserved areas, but there is little evidence to support iCCM as an appropriate strategy in non-rural contexts. This study aimed to inform future iCCM implementation by exploring caregiver and VHT member perceptions of the value and effectiveness of iCCM in peri-urban settings in Uganda.A qualitative evaluation was conducted in seven villages in Wakiso district, a rapidly urbanising area in central Uganda. Villages were purposively selected, spanning a range of peri-urban settlements experiencing rapid population change. In each village, rapid appraisal activities were undertaken separately with purposively selected caregivers (n = 85) and all iCCM-trained VHT members (n = 14), providing platforms for group discussions. Fifteen key informant interviews were also conducted with community leaders and VHT members. Thematic analysis was based on the 'Health Access Livelihoods Framework'.iCCM was perceived to facilitate timely treatment access and improve child health in peri-urban settings, often supplanting private clinics and traditional healers as first point of care. Relative to other health service providers, caregivers valued VHTs' free, proximal services, caring attitudes, perceived treatment quality, perceived competency and protocol use, and follow-up and referral services. VHT effectiveness was perceived to be restricted by inadequate diagnostics, limited newborn care, drug stockouts and VHT member absence - factors which drove utilisation of alternative providers. Low community engagement in VHT selection, lack of referral transport and poor availability of referral services also diminished perceived effectiveness. The iCCM strategy was widely perceived to result in economic savings and other livelihood benefits.In peri-urban areas, iCCM was perceived as an effective, well-utilised strategy, reflecting both VHT attributes and gaps in existing health services. Depending on health system resources and organisation, iCCM may be a useful transitional service delivery approach. Implementation in peri-urban areas should consider tailored community engagement strategies, adapted selection criteria, and assessment of population density to ensure sufficient coverage

Gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis in Kenya

Objective: To determine gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis (PTB) and factors associated with poor outcomes in Kenya. Design: Retrospective descriptive cohort. Results: Of 16 056 subjects analysed, 38% were female and 62% male. Females had a higher risk of poor treatment outcome than males (12% vs. 10%, P \u3c 0.001; adjusted OR 1.29, 95%CI 1.16-1.44, P \u3c 0.001). In the first multivariate model, restricting the analysis to human immunodeficiency virus (HIV) positive patients and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor outcome (OR 0.99, 95%CI 0.86-1.13, P = 0.844). In the model restricted to HIV-negative patients, a non-significantly lower risk was found (OR 0.89, 95%CI 0.73-1.09, P = 0.267). In the second model, restricting analysis to patients on antiretroviral therapy (ART) and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor PTB treatment outcomes (OR 0.98, 95%CI 0.84-1.14, P = 0.792). In the model restricted to HIV-positive patients not on ART, a non-significantly higher risk was found (OR 1.15, 95%CI 0.79-1.67, P = 0.461). Conclusion: Females of reproductive age are likely to have poorer treatment outcomes than males. Among females, not commencing ART during anti-tuberculosis treatment seemed to be associated with poor outcomes