Antenatal care visits and pregnancy outcomes at a Kenyan rural district hospital: a retrospective cohort study

Background: The goal of antenatal care (ANC) is to improve maternal and neonatal outcomes. Fewer ANC visits in focused antenatal care (FANC) model can affect maternal and perinatal outcomes in low income settings where the number ANC visits are often low.Objective: To determine the number of ANC visits and their influence on maternal and perinatal outcomes at a rural Kenyan hospital.Study design: Retrospective cohort.Study population: Women who received ANC and were admitted at Longisa District Hospital postnatal ward after delivery at or above 28 weeks gestation.Study site: Postnatal ward, Longisa District Hospital, Bomet County, Kenya.Results: Between 1st July and 31st August 2014, 200 (83%) of the screened postpartum (n=241) women were found to be eligible. Majority (n=122, 61.0%) of the women received less than 4 ANC visits. Most women were: married (83.5%), housewives (65.5%), and had: parity of 2 to 4 (50.5%); primary education (66.5%); live births (93.0%); spontaneous vertex delivery (82.5%); spontaneous onset of labour (n=192, 96.0%) and no complication at or post-partum (n=175, 87.5%). Majority of the neonates had 5 minute APGAR score >7 (88.0%); and were with their mothers after 24 hours postpartum (81.5%). High parity (≥5) was associated with reduced frequency of ANC visits (OR=0.29, 95% CI 0.1-0.87, p=0.027). Early perinatal and maternal outcomes were not significantly associated with the number of ANC visits.Conclusion: In this rural Kenyan hospital, few women had 4 or more ANC visits. Parity of 5 or greater was significantly associated with fewer than 4 ANC visits. Early perinatal and maternal outcomes did not vary with the number of visits. Quality rather than number of ANC visits should be evaluated as a measure of ANC

Is vaginal hysterectomy the route of choice for hysterectomy for benign gynaecological conditions? A case series report of 6 patients

Introduction: Hysterectomy is one of the commonest gynaecological surgical procedures done in Kenya after caesarean section. Various approaches are used, the most preferred being transabdominal hysterectomy. However, in recent years transvaginal and laparoscopic approaches have been adopted by a few gynaecologists in Kenya. The purpose of this case series report is to enumerate the various benefits and adverse effects that were noted in the patients who underwent transvaginal hysterectomies for benign gynaecological indications in the months of January to March 2016 in Nazareth mission Hospital. Objective: To determine the benefits of vaginal approach for hysterectomy in women with benign gynaecological conditions. Study design: Case series report. Setting: Nazareth Mission Hospital. Subjects: 6 female patients who underwent vaginal hysterectomies in the months of January to March 2016 due to varies benign gynaecological conditions. Results: A total of six female patients underwent vaginal hysterectomy; none developed intraoperative or immediate post-operative complications and their hospital stay was only 2 days after surgery. Conclusion: We concluded that a more elaborate study comparing the three routes of approach to hysterectomy for benign gynaecological conditions should be conducted in Kenya