The seaweeds of Kenya: Checklist, history of seaweed study, coastal environment, and analysis of seaweed diversity and biogeography

The seaweeds of Kenya are relatively well documented in comparison with the marine floras of other countries in the Indian Ocean. A checklist is provided of the seaweeds recorded, which includes a total of 386 species (214 red algae, 116 green algae and 56 brown algae), plus an additional 19 infra-specific taxa. This is the first detailed list for almost 30 years, with a 29% increase in species compared to the previous listing. The history of seaweed study in Kenya and the Kenyan coastal environment as a habitat for seaweeds are discussed in detail. An ordination analysis of the global biogeographic relationships of the Kenyan seaweed flora shows clearly the internal consistency of the Indo-Pacific seaweed flora at this large scale. Data on Indian Ocean relationships show that the Kenyan flora produces a distinct grouping of seaweed floras from Tanzania, Madagascar, Mozambique and the Indian Ocean coast of South Africa, which is somewhat separated from the floras of the rest of the Indian Ocean. The data reveal that Mozambiquan seaweeds are seriously understudied, with only 26% of the Kenyan flora having been recorded in that country, compared with 68% in Tanzania, 41% in Madagascar, and 43% in South Africa

Experiences in Care Given During Child Birth at a Referral Hospital in Kenya

The fifth Millennium development Goal (MDG) calls for a reduction in the maternal mortality ratio (MMR) by 75% between 1990 and 2015, with a key indicator being the proportion of births attended to by skilled health personnel, (United Nations, 2007). In Kenya the MMR is 400 and has made insufficient progress towards improving maternal health, (UNICEF, WHO, World Bank, 2013). According to KDHS (2014), the proportion of skilled birth attendance is 46.5%, while in Kenya it is 62% against an MDG target of 90%. According to Zaers S., et al., (2008), prior experience in delivery care by skilled attendants affects their subsequent use of these services. In Africa little research has been carried out on the experiences of mothers in facility-based delivery care. This study was therefore set to describe the experiences of women during labour and delivery at a referral hospital in Kenya This was a cross sectional descriptive study that focused on experiences of delivery care by postnatal mothers at a referral hospital in Kenya. Systematic random sampling from a sampling frame of 327 was employed to recruit post-natal mothers who delivered in labour ward and four postnatal wards. A total of 109 participants were recruited into the study. Views and experiences of recently delivered women were elicited using a five-point Likert scale questionnaire focusing on four dimensions of participants’ intrapartum experience. Data was analyzed using ANOVA. Research results were presented in frequency distribution tables, graphs and charts. P-values were used to determine the statistical significance of the results obtained. Most participants (87.7%) agreed that they were treated with respect, accorded privacy and asked to consent, prior to the initiation of the procedures. A single aspect of communication, namely health provider explanation of health status with understandable terms was poorly rated (mean 1.8 to 2.2) as was the level of genuine interest in patient well-being (mean = 1.7 to 2.0) which was significant in the study. Most participant (n = 102(93.6%) said they would recommend delivery services at KNH to friends or family, although 6% of them said they would not recommend. Majority of the participants had a positive experience of quality in delivery care. This was evidenced by the fact that majority of then stated that they would come to deliver in the same institution again or recommend a relative or friend. Aspects of care such as health providers communicating to clients in understandable terms and showing genuine interest in patients wellbeing was rated poorly. Institutional factors such as inadequate space and shortage of staff were also noted to be significantly contributing to negative experience of delivery care in the study

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

The effect of time of day on unscheduled caeserian sections on perinatal and maternal outcomes in Kenyatta National Hospital, Nairobi, Kenya

Objectives: To compare the 72 hour post delivery maternal and neonatal outcomes among patients undergoing unscheduled Caesarean section during the night and day.Design: Prospective cohort study.Setting: Kenyatta National Hospital (KNH), Nairobi, Kenya.Subjects: Two hundred and forty Post-natal mothers who had undergone unscheduled Caesarean section.Results: Between the months of February 26th and April 2nd 2015, a total of two hundred and forty patients undergoing unscheduled Caesarean sections at the KNH were recruited into the study including 120(50%) patients who had an operation performed during the night shift and 120(50%) during the day shift. Data were collected prospectively. There was no significant difference in the socio-demographic characteristics of patients according to shifts. Most procedures were conducted under regional anaesthesia with no significant differences between day and night surgeries. The leading indications for unscheduled CS during the day and night were: Non Reassuring Foetal Status (NRFS), obstructed Labour and elective CS converted to emergency CS in that order. Conversion of Elective Caesarean section to Emergency CS was significantly more common during the night compared to during daytime. Poor maternal and neonatal outcomes did not show a significant difference depending on time of surgery.Conclusion: The study showed that there was no significant difference in pregnancy outcomes between unscheduled Caesarean section done during the day compared to those done during the night

Cascaded clinical mentoring improves health workers selfefficacy in provision of integrated HIV care in rural hospitals in Kenya

Objective: To evaluate cascaded clinical mentorship strategy on access and health-worker’s self-efficacy in delivery of integrated HIV services. Design: A cross sectional survey study design. Setting: Government health facilities in the Coastal region and City of Nairobi, Kenya. Participants: Nurses and clinical officers who were recipients of cascaded mentorship. Intervention: Training of volunteer health-workers on mentorship and the HIV care package by a team of master mentors followed by support to carry out mentorship among fellow health-workers. Outcome measure: Access to HIV services, and health-worker self-reported efficacy in delivering integrated HIV care services based on an anonymous standard self-administered tool that evaluated 9 domains of HIV care. Results: There was an exponential increase in mentorship services, 126 volunteer health-workers were trained, and they formed 22 multidisciplinary District teams who extended mentorship to 231 health facilities. In the 33 months a total of 5503 mentor visits and 7724 mentoring sessions were made. The evaluated 150 health workers self-reported significant improvement in all 9 domains of HIV care compared to baseline (p < 0.001). Health-workers were exposed to a mean of 6 mentor-ship sessions. On controlling for region and cadre of staff, number of mentor-ship sessions were significantly associated with increased competence in 7 of 9 fields (p< 0.01). Compared to volunteer mentors, mentorship and site visits by master mentors were five and twice more costly respectively. Conclusions: Cascaded HIV mentorship increased staff self-efficacy and access to HIV treatment services. The impact of this cascaded mentorship on patient outcomes should be evaluated

Adherence to ministry of health guidelines in management of severe pre-eclampsia/eclampsia in Pumwani maternity hospital, Kenya

Background: Guidelines have shown to impact positively on the management of medical conditions. The impact of these guidelines has not been evaluated for severe preeclampsia and eclampsia in Kenya.Objective: To evaluate the level of adherence to Kenya Ministry of Health (MOH) guidelines in the management of severe pre-eclampsia and eclampsia at PumwaniMaternity Hospital, Kenya.Design: A cross sectionalSetting: Pumwani Maternity Hospital, Kenya.Subjects: Records of women managed for severe pre-eclampsia and eclampsia, deliveredbetween 2010 and 2013.Results: The overall adherence to guidelines was 31.4%. Adherence to specific parameters: history taking and examination, investigations, fetomaternal monitoring, use of recommended guidelines and post-partum guidelines was 67.8%, 13.9%, 26.1%, 29.5% and 20% respectively.Conclusions: Adherence to Kenya Ministry of Health (MOH) guidelines in management of severe pre-eclampsia and eclampsia in Pumwani Maternity Hospital is poor. Studies on the reasons for poor adherence and implementation need to be carried out

The CORONIS Trial. International study of caesarean section surgical techniques: A randomised fractional, factorial trial

Background: Caesarean section is one of the most commonly performed operations on women throughout the world. Rates have increased in recent years – about 20–25% in many developed countries. Rates in other parts of the world vary widely. A variety of surgical techniques for all elements of the caesarean section operation are in use. Many have not yet been rigorously evaluated in randomised controlled trials, and it is not known whether any are associated with better outcomes for women and babies. Because huge numbers of women undergo caesarean section, even small differences in post-operative morbidity rates between techniques could translate into improved health for substantial numbers of women, and significant cost savings. Design: CORONIS is a multicentre, fractional, factorial randomised controlled trial and will be conducted in centres in Argentina, Ghana, India, Kenya, Pakistan and Sudan. Women are eligible if they are undergoing their first or second caesarean section through a transverse abdominal incision. Five comparisons will be carried out in one trial, using a 2 × 2 × 2 × 2 × 2 fractional factorial design. This design has rarely been used, but is appropriate for the evaluation of several procedures which will be used together in clinical practice. The interventions are: • Blunt versus sharp abdominal entry • Exteriorisation of the uterus for repair versus intra-abdominal repair • Single versus double layer closure of the uterus • Closure versus non-closure of the peritoneum (pelvic and parietal) • Chromic catgut versus Polyglactin-910 for uterine repair The primary outcome is death or maternal infectious morbidity (one or more of the following: antibiotic use for maternal febrile morbidity during postnatal hospital stay, antibiotic use for endometritis, wound infection or peritonitis) or further operative procedures; or blood transfusion. The sample size required is 15,000 women in total; at least 7,586 women in each comparison. Discussion: Improvements in health from optimising caesarean section techniques are likely to be more significant in developing countries, because the rates of postoperative morbidity in these countries tend to be higher. More women could therefore benefit from improvements in techniques. Trial registration: The CORONIS Trial is registered in the Current Controlled Trials registry. ISCRTN31089967