Prevalence and Risk Factors for Perineal Trauma among Women at a Teaching and Referral Hospital in Kenya

Perineal trauma is classified according to the degree of structures involved or according to the depth of the injury. Mild perineal trauma is very common following vaginal delivery. Risk factors for perineal trauma include primiparity, precipitate labour, instrumental deliveries, pushing techniques and birth positions. Perineal trauma is associated with significant short-term and long-term complications. The objective of the study was to determine the prevalence and risk factors for perineal trauma among women at teaching and referral hospital in western Kenya. A cross-sectional study was carried out at the teaching hospital between April and May 2015. Two hundred and nine women who had come to deliver at the facility were consented to participate in the study. A structured checklist was used to obtain data from the women and make observations as skilled care givers attended to deliveries. All analyses were performed at 95% level of confidence. Two hundred and nine (209) deliveries were observed. Majority of the women, 76 (36.40%), were in the 20-24 age group. Ninety seven (46.10%) of them were para 0. Eighty one (38.8%) of the women sustained various types of perineal trauma. Supine position during delivery was the most preferred position, in 201 (96.2%), of the women. Age of the mother, parity, infant birth weight, and history of previous trauma, were statistically significant, associated with trauma in the univariate analysis (p=0.013; p=0.000; p= 0.010; p= 0.033) respectively. Adjusting for other factors, the odds of sustaining perineal trauma increased with increased birth weight (OR 2.878; p= 0.005) and decreased with increasing parity (OR 0.037; p=0.000). The prevalence of perineal tears as revealed by the study was 38.8%. This study recommended evidence based practice during labour and delivery in order to improve pelvic floor outcomes as well as reduce operative deliveries and long term morbidities. Key words: Perineal trauma, Risk factors, Prevalence, Women DOI: 10.7176/JHMN/65-09 Publication date: August 31st 201

Kenyan General Elections 2022: A game of pledges, promises and service to self-interest

The relatively new democratic system in Kenya is complex and often negotiable, further complicated by the shifting landscape and impact of social media. This working paper explores the history of democracy in Kenya and presents the instrumentalisation of ethnic identities by key political figures using Social Cleavage Theory. A web-based analysis of social and news media, and qualitative data collected from focus group discussions with key community leaders are presented to interrogate the drivers of the 2022 election outcome. From the findings we offer recommendations on how the electoral system in Kenya can be further safeguarded to ensure that democracy in Kenya works for the prosperity of the citizens, not just of the politicians

A literature review on interconnected reading and writing instruction

Lezen en schrijven worden binnen het standaardtaalonderwijs verkaveld aangeboden. Vanuit functioneel, cognitief en sociocognitief perspectief bezien staan de vaardigheden echter niet los van elkaar. Daarom is het aannemelijk dat samenhangend onderwijs in lezen en schrijven beide vaardigheden ten goede komt. Dit artikel presenteert een onderbouwde definitie van samenhangend lees- en schrijfonderwijs en bespreekt het empirische onderzoek naar de effecten van samenhangend lees- en schrijfonderwijs. Samenhangend lees- en schrijfonderwijs (i) bevat een gebalanceerde instructie die in gelijke mate op beide vaardigheden is gericht met als doel het verbeteren van beide vaardigheden, (ii) stelt verbindende elementen van functionele, cognitieve of sociocognitieve aard aan de orde en (iii) maakt de samenhang tussen lezen en schrijven voor leerlingen expliciet door deze te benoemen of door het onderwijs te richten op een van de verbindende elementen. Een systematische zoektocht naar literatuur over effectief samenhangend leesen schrijfonderwijs leverde slechts enkele studies op. In onze literatuurreview concluderen we dat deze studies methodologisch dermate verschillen dat we geen algemene conclusies kunnen trekken over effectiviteit. We identificeren in onze analyse wel drie mogelijk effectieve elementen, namelijk inzet van: overeenkomstige strategieën, kennis van tekstkenmerken en kennis van retorische overeenkomsten tussen lezen en schrijven.Since reading and writing are considered interconnected language skills from a functional, cognitive and socio-cognitive perspective, interconnected reading and writing instruction (IRWI) may therefore benefit both skills. This article presents and substantiates a definition of IRWI and discusses the empirical research into the effects of IRWI. IRWI entails quantitatively balanced instruction of both skills while aiming to improve them. IRWI also integrates elements from the functional and/or (socio-)cognitive models for reading and writing, and it explicitly outlines the relationship between reading and writing for students. A systematic literature search into the effects and design of IRWI resulted in a limited number of results and allowed no general conclusions regarding the effectiveness of IRWI. We did, however, identify potentially effective elements: the use of common strategies, knowledge of text characteristics, and knowledge of rhetorical similarities between reading and writing

Nature and sources of poisoning in patients admitted to a referral hospital in Gaborone, Botswana : findings and implications

Background: Intentional poisoning is becoming an important public health concern particularly among young women globally. Consequently, there is a need to analyse this further within countries to establish pertinent policies to reduce current incidence rates. This includes sub-Saharan African countries where there has been a scarcity of information. Consequently, we sought to establish the nature and sources of poisoning in patients admitted to a leading hospital in Botswana to help develop pertinent future policies for Botswana and surrounding countries. Methods: Retrospectively reviewing the medical records of all patients admitted to Princess Marina Hospital (PMH), which is a leading tertiary hospital in the capital city of Botswana, due to acute poisoning over a six-year period. Results: The records for 408 patients were reviewed. The majority of admissions (58%) were females, and the mean age of patients was 21(±14) years. Most poisoning cases (53%) were intentional. The 15-45 years age group was most likely to intentionally poison themselves compared to other age groups, with females four and half times more likely to intentionally poison themselves compared to males (AOR 4.53, 95% CI: 2.68- 7.89, p < 0.001). Half of the patients were poisoned by medicines followed by household chemicals (22%), with females overall four times more likely to be poisoned by medicines compared to males. The medicine mostly ingested was paracetamol (30%). Failing relationships (57%) were the principal reason for intentional poisoning. Six patients died from poisoning representing a 1.5% mortality rate. Conclusions: The findings suggest in-depth and urgent investigations on intentional poisoning are needed among young women across countries including sub-Saharan African countries to inform future policies on prevention strategies. Further, strategies for poisoning prevention should target social and family relationship problems. We will be following this up in the future

Biomanufacturing and testbed development for the continuous production of monoclonal antibodies

Please click Additional Files below to see the full abstract

Assessment and comparative analysis of a rapid diagnostic test (Tubex®) for the diagnosis of typhoid fever among hospitalized children in rural Tanzania

Background: Typhoid fever remains a significant health problem in many developing countries. A rapid test with a performance comparable to that of blood culture would be highly useful. A rapid diagnostic test for typhoid fever, Tubex&reg;, is commercially available that uses particle separation to detect immunoglobulin M directed towards Salmonella Typhi O9 lipopolysaccharide in sera.Methods: We assessed the sensitivity and specificity of the Tubex test among Tanzanian children hospitalized with febrile illness using blood culture as gold standard. Evaluation was done considering blood culture confirmed S. Typhi with non-typhi salmonella (NTS) and non - salmonella isolates as controls as well as with non-salmonella isolates only.Results: Of 139 samples tested with Tubex, 33 were positive for S. Typhi in blood culture, 49 were culture-confirmed NTS infections, and 57 were other non-salmonella infections. Thirteen hemolyzed samples were excluded. Using all non - S. Typhi isolates as controls, we showed a sensitivity of 79% and a specificity of 89%. When the analysis was repeated excluding NTS from the pool of controls we showed a sensitivity of 79% and a specificity of 97%. There was no significant difference in the test performance using the two different control groups (p &gt; 0.05).Conclusion: This first evaluation of the Tubex test in an African setting showed a similar performance to those seen in some Asian settings. Comparison with the earlier results of a Widal test using the same samples showed no significant difference (p &gt; 0.05) for any of the performance indicators, irrespective of the applied control group

Evaluation of the Widal tube agglutination test for the diagnosis of typhoid fever among children admitted to a rural hdospital in Tanzania and a comparison with previous studies

BACKGROUND: The diagnosis of typhoid fever is confirmed by culture of Salmonella enterica serotype Typhi (S. typhi). However, a more rapid, simpler, and cheaper diagnostic method would be very useful especially in developing countries. The Widal test is widely used in Africa but little information exists about its reliability. METHODS: We assessed the performance of the Widal tube agglutination test among febrile hospitalized Tanzanian children. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of various anti-TH and -TO titers using culture-confirmed typhoid fever cases as the "true positives" and all other febrile children with blood culture negative for S. typhi as the "true negatives." RESULTS: We found that 16 (1%) of 1,680 children had culture-proven typhoid fever. A single anti-TH titer of 1:80 and higher was the optimal indicator of typhoid fever. This had a sensitivity of 75%, specificity of 98%, NPV of 100%, but PPV was only 26%. We compared our main findings with those from previous studies. CONCLUSION: Among febrile hospitalized Tanzanian children with a low prevalence of typhoid fever, a Widal titer of > or = 1:80 performed well in terms of sensitivity, specificity, and NPV. However a test with improved PPV that is similarly easy to apply and cost-efficient is desirable