Perception of Labour Pain among Rural Women Presenting to A Tertiary Hospital in Kenya

Background: Childbirth results in severe pain for many women. In many hospitals in Resource-Limited Countries (RLCs), women endure the pain of labour with little or no pain relief. There have not been any studies done within 36 hours of a recent delivery to determine how rural Kenyan women perceive the pain of labour, and whether they have embraced the concept of labour analgesia.Objectives: To find out how rural women who had recently given birth at the Moi Teaching and Referral Hospital (MTRH) rate the severity of their pain, and whether the expectations of these women with regards to pain relief for labour were met.Design: A retrospective cohort study.Setting: The Moi Teaching and Referral Hospital (MTRH) post-natal wards.Subjects: Women who had had a normal vaginal delivery in the preceding 36 hours.Interventions: A structured questionnaire was administered.Results: Three hundred and eighy nine women who fulfilled the eligibility criteria were interviewed. Two hundred and eighty seven (73.8%) of 389 women rated their pain as severe to unbearable. Only 43 (11.0%) received any labour analgesia. This was in the form of an anti-spasmodic injection (Buscopan®). Thirty four (79%) of the 43 women who received an anti-spasmodic rated the pain relief obtained as good to very good. The level of knowledge of possible labour analgesia options was very low. Three hundred and thirty four (86%) of 389 women indicated that they would want to be given analgesia for future deliveries.Conclusion: The majority of rural women who give birth at the MTRH do so without any labour analgesia. Although the level of knowledge is low regarding possible labour analgesia options, the majority of these women would welcome medical intervention that would reduce their discomfort. There is need to  establish a formal labour analgesia service at MTRH and to educate rural Kenyan women on the various labour analgesia options, to enable them make informed choices regarding their use

Ventilator-associated pneumonia in critically ill African patients on stress ulcer prophylaxis

Background: Stress ulcer prophylaxis is an integral part of the care of the criticallyill. Agents that alter gastric pH may predispose these patients to gastric colonisation,with subsequent pneumonia and/or sepsis. Cytoprotective agents such as sucralfatepreserve gastric acidity and may be protective.Objective: To determine whether African patients on sucralfate as stress-ulcer prophylaxis have a lower incidence of gastric colonisation and ventilator-associated pneumonia than those on ranitidine.Design: Randomised case-control studySetting: Kenyatta National Hospital Intensive Care UnitSubjects: Patients on ventilatory support for 48 hours or more Interventions: Sixty-eight critically ill patients were randomly assigned to either ranitidine or sucralfate as stress ulcer prophylaxis. Paired samples were taken from gastric and tracheal aspirates at admission, 48 hours and day six. Pneumonia was diagnosed using the Clinical Pulmonary Infection Score.Main outcome measures: Death or the development of pneumonia.Results: Although gastric colonisation rates were similar in the two groups, the incidence of pneumonia was lower in the sucralfate group (17.6% vs. 23.5%, p=0.4). In 63.6% of patients with both gastric colonisation and airway infection, the same organism was isolated from the two sites (p<0.01). The majority of the organisms isolated were multi-drug resistant.Conclusion: Compared with ranitidine, sucralfate did not offer significant reduction in either gastric colonisation or ventilator-associated pneumonia in critically ill African patients

Human-Wildlife Conflicts: The Case of Livestock Grazing Inside Tsavo West National Park, Kenya.

In Tsavo West National Park, human wildlife conflict is more prevalent due to high human populations and the incompatible land use practices in the adjacent areas. Human settlement in adjacent areas and illegal grazing in the park by the pastoralists contribute to direct conflict between wildlife, livestock and human beings. In this research a total of 220 households were sampled from different areas adjacent to Tsavo West national park. Key informants interviews of about 50 respondents were conducted. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) computer soft-ware version 11.5. Both descriptive and analytical procedures were used in data analysis. The research investigated the root causes and impacts of the livestock and wildlife interactions that perpetuate the problems and suggested potential effective remedial measures to curb the conflicts. The observations in the study reveal that livestock incursion exist in Tsavo West National park. Keywords; Wildlife, Livestock, National park, and Conflic

Assessment of Status, Challenges and Viability of Slum Tourism: Case Study of Kibera Slum in Nairobi, Kenya.

The status of slum tourism was carried out in Kibera slum in Nairobi. The study applied structured and semi- structured questionnaires which were administered to the target population from six villages randomly selected in Kibera slum in Nairobi, Kenya. The Snowball sampling method was used to select respondents in these villages. Observing residents’ life style and taking photographs were identified as major tourist activities in Kibera slum while improvement of security and involvement of residents in tourism activities were identified as key ways for promoting slum tourism. The data was analyzed using the Statistical Package for Social Sciences (SPSS). Poor understanding of slum tourism concept and lack of involvement of residents was identified as the major challenge while lack of policy was the other challenge. The data was analyzed using the Statistical Package for Social Sciences (SPSS). Poor understanding of slum tourism concept and lack of involvement of residents was the major challenge while lack of policy was the other challenge. It was identified that there was need for the Government to develop a comprehensive slum tourism policy which would guide on ways of conducting slum tours so that it can benefit both the government and the Resident communities in these slums. The Ministry of Tourism needs to sensitize the slum residents on how they can take advantage of their living conditions to establish Community Based tourism businesses Key words: Slum, Tourism, Status, Challenges, Benefit

Association between household food access and livelihood food strategy factors in Githunguri and Mwala sub-counties, Kenya

Household food access is a critical concern for every government, community and household as it touches on the basic sources for human energy to do work and also for survival. Access to food is an essential component of good nutrition, health and well-being. Knowledge of food access risk sources and coping strategies can contribute to forward planning to avert food security hazards. This study analyzed the extent to which household food access was determined by livelihood food strategy factors employed during hazards. A sample size of three hundred and eighty four (384) was used. The study was carried out in two different livelihood zones i.e. high potential livelihood zone (Githunguri Sub-County) versus a medium potential livelihood zone (Mwala Sub-County). Household data were collected within two seasons using a structured household questionnaire. In addition, focus group discussions with a group of men, women and the youth were also conducted in each of the sampled sub-location. Data were analyzed using SPSS statistical data package for social sciences version 17. Pearson correlation index on factors that influence food access indicated a strong and significant relationship in total HH income (.718), total food available (.631) and HH storing ability (.545). There was a weak relationship in distance from household to the local market (.029) and household food strategy (.009). The study concluded that households in Githunguri Sub-County were mildly food insecure while households in Mwala Sub-County were moderately food insecure, implying that households in Githunguri Sub-County had better food access than households in Mwala Sub-County. The study recommends two studies that include: (i) Determination of opportunities and constraints to optimal income generation for improved food access (ii) Opportunities and constraints to increased food production hence food access Key words; Food security, Food access, Hazards, livelihood strategies, Food strategy factor

Strategies Implemented to Stop FGM/C: A Case Study of Kenya and Ethiopia

The purpose of this article is to investigate the western influence and implications for the discourses and practices of Female Genital Mutilation/Cutting (FGM/C) and this is presented with the two case studies: Kenya and Ethiopia. The article seeks to understand why FGM/C has taken such a long time to be eliminated considering it has been presented to be harmful to the lives of women. The main focus lies on the arguments of universal human rights, which is heavily depicted by those who oppose the practice whereas the right to culture is supported by cultural relativism theory. As a conclusion the author notes that the influence from “the west” has had an impact on the discourse of FGM/C. It also points out that the current argument of FGM/C being a violation of human rights may be the ideology that seems to fit in well with most countries, but it still faces criticisms and these objections reflect the slow rate of eradication of this practice

Metastatic bronchogenic carcinoma to the mandible

A case of a metastasis of adenocarcinoma of the lung to a secondary site in the mandible, in a 53-year-old woman, is presented. The patient complained of trismus, swelling and numbness over the left side of face for 8-weeks. Examination revealed limited left condylar mobility, a firm tender swelling the angle of the mandible and paresthesia of the left inferior alveolar nerve. Computed Tomography revealed an osteolytic lesion in the left angle and ascending ramal region suggestive of a malignant tumor. Her chest radiograph findings were of a diffuse homogenous opacification with ipsilateral pleural effusion pointing to a pneumonic process. Histology features were of moderately differentiated adenocarcinoma. A search for the primary included a bronchial biopsy which revealed, the primary lesion was from the lung. This rare case highlights the difficulty and challenges in making the diagnosis clinicians may encounter in establishing the primary site of metastatic disease. There is need to develop high index of suspicion with regards to metastasis to the Craniofacial and mandibular bones. Multidisciplinary team approach is recommended when dealing with such patients.Keywords: Bronchogenic Carcinoma, Metastasis, Mandibl

The effects of lake Ol’Bolossat’s sediments application on soil-chemical characteristics and productivity of swiss chard (Beta vulgaris L.)

Sediments dredged from the lakes have emerged as successful soil amendment solutions, especially in alleviating soil fertility problems in poor soils. This study aimed to assess the effect of sediments from lake Ol’Bolossat on soil quality and the growth and yield of Swiss chard (Beta vulgaris L.). A pot experiment was carried out in January-April and July-October 2020 in a polyethylene greenhouse using a completely randomized design at the Jomo Kenyatta University of Agriculture and Technology. To achieve the study's objective, Swiss chard (Ford hook giant variety) was grown in pots, and five treatments were applied; (T1)-sediments from lake depth of 0-30 cm + soil, (T2)-sediments from lake depth of 30-60 cm + soil, (T3)-sediments from lake depth of 60-90 cm + soil, (T4)-inorganic fertilizer (NPK 150 kg/acre) + soil, (T5)-soil with no lake sediments or inorganic fertilizers, which acted as the control experiment. The sediments were mixed with soil at a ratio of 1:4

Utility of brush cytology in evaluation of pre-malignant and malignant oral mucosal lesions among dental patients attending Kenyatta National Hospital

Objectives: The main objective was to determine the utility of brush cytology in evaluation of pre-malignant and malignant oral mucosal lesions.Methodology: This was a prospective cross sectional descriptive study which was carried out at Kenyatta National Hospital (KNH), Dental clinic, Surgery unit and University of Nairobi, Dental Hospital (UoN DH) from November, 2015 to April, 2016 after obtaining ethical clearance from Kenyatta National Hospital – University of Nairobi Ethics and Research Committee (KNH-UoN ERC) on participants who presented with pre malignant and malignant oral lesions. Participation in the study was voluntary and an informed consent was obtained from all participants. A structured questionnaire was used to collect socio-demographic information and clinical history. A cervical cytobrush brush (Andwin Scientific – Woodland Hills, CA 91303 USA) was used to sample oral mucosal lesions and later biopsy performed for histopathology. Oral brush cytology samples were fixed in 95% ethanol, cytospined and stained with Pap stain. Data was entered and analyzed using SPSS v 22. The results were presented using tables, charts and disseminated through presentations in conferences and publication in peer reviewed journals.Results: A total of 47 cytology and histology specimens were taken during the study and all samples were satisfactory for evaluation. The female to male ratio of participants was 1: 1.2 with an age range of 25-79 years and mean of 55 years. The main cytological patterns established at KNH and UoN Dental School Hospital was HSIL and SCC representing 97% of dysplastic and malignant lesions. Histology confirmed dysplasia and malignancy in 28 of 30 cytologically diagnosed cases. There were 2 false positives and 1 false negative cases reported. The sensitivity, specificity, positive predictive value and negative predictive values were 97%, 89%, 93% and 94% respectively with a substantial diagnostic agreement (kappa value) between cytopathology and histopathology of 86% and a p-value of ≤ 0.001.Conclusion: Brush cytology has been shown to be a reliable cytological technique for screening and early detection of oral mucosal abnormalities as it has a high sensitivity and a substantial diagnostic agreement with histopathology

Utility of healthcare-worker-targeted antimicrobial stewardship interventions in hospitals of low- and lower-middle-income countries: a scoping review of systematic reviews

Background Antimicrobial stewardship (AMS) initiatives in hospitals often include the implementation of clustered intervention components to improve the surveillance and targeting of antibiotics. However, impacts of the individual components of AMS interventions are not well known, especially in low- and lower-middle-income countries (LLMICs). Objective A scoping review was conducted to summarize evidence from systematic reviews (SRs) on the impact of common hospital-implemented healthcare-worker-targeted components of AMS interventions that may be appropriate for LLMICs. Methods Major databases were searched systematically for SRs of AMS interventions that were evaluated in hospitals. For SRs to be eligible, they had to report on at least one intervention that could be categorized according to the Effective Practice and Organisation of Care taxonomy. Clinical and process outcomes were considered. Primary studies from LLMICs were consulted for additional information. Results Eighteen SRs of the evaluation of intervention components met the inclusion criteria. The evidence shows that audit and feedback, and clinical practice guidelines improved several clinical and process outcomes in hospitals. An unintended consequence of interventions was an increase in the use of antibiotics. There was a cumulative total of 547 unique studies, but only 2% (N=12) were conducted in hospitals in LLMICs. Two studies in LLMICs reported that guidelines and educational meetings were effective in hospitals. Conclusion Evidence from high- and upper-middle-income countries suggests that audit and feedback, and clinical practice guidelines have the potential to improve various clinical and process outcomes in hospitals. The lack of evidence in LLMIC settings prevents firm conclusions from being drawn, and highlights the need for further research