Task Shifting/Sharing on Contraceptive Counselling Services between Midwives and Physicians A Randomized Control Trial in Kisumu County, Kenya

Introduction: Unsafe abortion, led to 120,000 Kenyan women receiving Post Abortion Care (PAC) in 2012. 70% of those women, had not used  contraceptives before pregnancy. The aim of the study was to determine if post abortion contraceptive counselling could be shared between  physicians and midwives in Kisumu County, Kenya. Methodology: A total of 128 women were included in this cohort study that was nested in a larger randomized controlled trial, whereby women  sought PAC at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) and Kisumu County Hospital (KCH) from October 2015 to September 2017. The 128 women were randomly assigned to a midwife or a physician for contraceptive counselling. Then a follow up after 7–10 days or three months. Associated factors for contraceptive uptake, contraceptive method choice, adherence, and satisfaction level, were analyzed using chi square, Fishers exact test , IBM SPSS Statistics for Windows, Version 22.0. Results: In the study, there was no difference between midwives (98.5%) and physicians (93.5%) in providing contraceptive counselling to post abortion women. 95.3% of the participants accepted while 4.7% did not accept use of contraceptives. The most commonly used contraceptive  method after counselling was hormonal injection at 39%. After 3-months follow-up 79.7% retained the chosen contraceptive method while 20.3% had changed the usual type of contraception and 3.9% had stopped using contraceptives. Among the respondents who still used a method, 96.1% were satisfied with the chosen methods, with no difference between midwifes and physicians (p=0.799). Parity had significant influence on contraceptive uptake and adherence (p= 0.000.). Conclusion: Post abortion seeking women were satisfied with contraceptive counselling they received regardless of whether the provider was a  midwife or a physician. The result emphasizes that physicians task sharing of contraceptive counselling with midwives is conceivable, with possibilityfor physicians focusing on more complicated cases. Keywords: Contraceptive counselling, Contraceptive uptake, Post Abortion Women, Midwives, Physicians, Kenya

Post Abortion Women’s Perception On Contraceptive Counselling Provided By Service Providers: A Qualitative Study In Kisumu County, Kenya

Background: Contraceptive Counselling is the process in which service providers engage with Patients to help them identify a suitable  contraceptive method and in a follow up interaction until the effectiveness of the process is achieved. Establish good rapport between the service providers and the recipients. Contraceptive uptake among post abortion patients is affected by the perception the women have on contraceptive counselling by the service providers. Contraceptive knowledge is high and its usage is low among post abortion patients. Aim: The main aim of this study was to explore how patients seeking post abortion care perceived contraceptive counselling provided by service providers in Kisumu County, Kenya. Methodology: A sample of 20 post abortion patiens participated in the In-depth interviews where open ended questions with probes were used to collect data. The interviews were conducted in two facilities, Jaramogi Oginga Odinga Teaching and Referral Hospital and Kisumu East DistrictHospital (Kisumu County Hospital) (both in Kisumu County, Kenya). The interviews were recorded and verbally transcribed. NVivo version 11 was used to sort out the data. Thematic analysis was used to analyse data. The sorted data was coded and structured in nine themes with regard to quality of care in contraceptive services. Choice of contraceptive method, information provided to recepients, interpersonal relationship, continuityand follow up, technical competence, affordability of contraceptive services, partner preference, myths and misconceptions, suggestions and concerns was emphasized. Results: The patients were able to obtain information about the various methods of contraception enabling them to make informed choices as a result of the discussions with the service providers. The good interpersonal relationship of the service providers with the respondents establishedgood rapport and reduced the stigma. Respondents were now able to revisit clinics after abortion without fear and contraceptives provided free of charge after discussions with the respondents who felt comfortable using them. Partners were important in contraceptive decision making, suchthat those who had partners found it easy to decide. Conclusion: The Respondents perceived contraceptive counselling positively indicating the friendliness of the service providers that made them feel confident with the contraceptive counselling and comfortable to discuss abortion with them. Respondents did not like the term abortion because itdemoralized them. Keywords: Contraceptive counselling, Contraceptive experience, Missed  Opportunities, Contraceptive Uptake, Physicians and Midwives, Post  Abortion Car

Provider experiences with improvised uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage in Kenya

AbstractObjectiveTo understand healthcare providers’ experiences with improvised uterine balloon tamponade (UBT) for the management of uncontrolled postpartum hemorrhage (PPH).MethodsIn a qualitative descriptive study, in-depth semi-structured interviews were conducted between November 2014 and June 2015 among Kenyan healthcare providers who had previous experience with improvising a UBT device. Interviews were conducted, audio-recorded, and transcribed.ResultsOverall, 29 healthcare providers (14 nurse-midwifes, 7 medical officers, 7 obstetricians, and 1 clinical officer) were interviewed. Providers perceived improvised UBT as valuable for managing uncontrolled PPH. Reported benefits included effectiveness in arresting hemorrhage and averting hysterectomy, and ease of use by providers of all levels of training. Providers used various materials to construct an improvised UBT. Challenges to improvising UBT—e.g. searching for materials during an emergency, procuring male condoms, and inserting fluid via a small syringe—were reported to lead to delays in care. Providers described their introduction to improvised UBT through both formal and informal sources. There was universal enthusiasm for widespread standardized training.ConclusionImprovised UBT seems to be a valuable second-line treatment for uncontrolled PPH that can be used by providers of all levels. UBT might be optimized by integrating a standard package across the health system

Safety of a condom uterine balloon tamponade (ESM-UBT) device for uncontrolled primary postpartum hemorrhage among facilities in Kenya and Sierra Leone

Background: Postpartum hemorrhage is the leading cause of maternal mortality in low- and middle-income countries. While evidence on uterine balloon tamponade efficacy for severe hemorrhage is encouraging, little is known about safety of this intervention. The objective of this study was to evaluate the safety of an ultra-low-cost uterine balloon tamponade package (named ESM-UBT) for facility-based management of uncontrolled postpartum hemorrhage (PPH) in Kenya and Sierra Leone. Methods: Data were collected on complications/adverse events in all women who had an ESM-UBT device placed among 92 facilities in Sierra Leone and Kenya, between September 2012 and December 2015, as part of a multi-country study. Three expert maternal health investigator physicians analyzed each complication/adverse event and developed consensus on whether there was a potential causal relationship associated with use of the ESM-UBT device. Adverse events/complications specifically investigated included death, hysterectomy, uterine rupture, perineal or cervical injury, serious or minor infection, and latex allergy/anaphylaxis. Results: Of the 201 women treated with an ESM-UBT device in Kenya and Sierra Leone, 189 (94.0%) survived. Six-week or longer follow-up was recorded in 156 of the 189 (82.5%). A causal relationship between use of an ESM-UBT device and one death, three perineal injuries and one case of mild endometritis could not be completely excluded. Three experts found a potential association between these injuries and an ESM-UBT device highly unlikely. Conclusion: The ESM-UBT device appears safe for use in women with uncontrolled PPH. Trial registration Trial registration was not completed as data was collected as a quality assurance measure for the ESM-UBT kit

Nurse-midwives’ ability to diagnose acute third- and fourth-degree obstetric lacerations in western Kenya

Background: Obstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings. Unrepaired third- and fourth-degree perineal lacerations have been shown to be the source of approximately one-third of the fistula burden in fistula camps in Kenya. In this study, we assessed potential barriers to accurate identification by Kenyan nurse-midwives of these complex perineal lacerations in postpartum women. Methods: Nurse-midwife trainers from each of the seven sub-counties of Siaya County, Kenya were assessed in their ability to accurately identify obstetric lacerations and anatomical structures of the perineum, using a pictorial assessment tool. Referral pathways, follow-up mechanisms, and barriers to assessing obstetric lacerations were evaluated. Results: Twenty-two nurse-midwife trainers were assessed. Four of the 22 (18.2%) reported ever receiving formal training on evaluating third- and fourth-degree obstetric lacerations, and 20 of 22 (91%) reported health-system challenges to adequately completing their examination of the perineum at delivery. Twenty-one percent of third- and fourth-degree obstetric lacerations in the pictorial assessment were incorrectly identified as first- or second-degree lacerations. Conclusion: County nurse-midwife trainers in Siaya, Kenya, experience inadequate training, equipment, staffing, time, and knowledge as barriers to adequate diagnosis and repair of third- and fourth-degree perineal tears

A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015.

BACKGROUND: On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a "strange disease" that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures. METHODS: We defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples. RESULTS: From 17 February-12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (ORM-H = 8.90; 95%CI = 1.60-49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (ORM-H = 4.60; 95%CI: 1.90-11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination. CONCLUSION: Contaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas

Predictive Factors for Uptake of Post-Abortion Care in Western Kenya

The objective of this study was to establish factors associated with the receipt of post-abortion contraceptive counselling and uptake at private health facilities in western Kenya. A crosssectional study was conducted at 25 private health facilities from July 2004–October 2004. A total of 403 women were interviewed following post-abortion care(PAC) via manual vacuum aspiration (MVA). Nurse-midwives provided the majority of PAC (55%). Only 44% of women received contraceptive counselling and 31% adopted a method. The strongest predictor for receipt of counselling was obtaining PAC at a low MVA volume facility (odds ratio 5.63). Women who received contraceptive counselling, and those who had an unplanned pregnancy, were three times more likely to adopt a method. Uptake of a method was also influenced by counselling time. Busy facilities in western Kenya should consider training staff specifically for post-abortion contraceptive counselling to increaseuptake following PAC

Facteurs qui influent sur le rôle du mâle dans la santé de reproduction et sexuelle à l'ouest de Kenya : une étude qualitative.

This study explored factors that influence male involvement in reproductive health in western Kenya. Qualitative study design was used. From December 2008 to February 2009, data were collected via in-depth interviews and focus group discussions (FGDs) at three provinces of western Kenya. Twelve in-depth interviews and eight FGDs were conducted. Five participants in in-depth interviews were female, seven were male. Four of the FGDs had all-male participants, four all-female. The factors that influence male involvement in reproductive health emerged in two themes, namely gender norms and the traditional approaches used to implement reproductive health and family planning programs. Any strategy taken to involve men in reproductive health must therefore consider addressing these two factors. A review of the traditional approaches of implementing reproductive health is necessary to make them more male-friendlyCette étude a exploré les facteurs qui influent sur le rôle du mâle dans la santé de reproduction é l'ouest du Kenya. On a employé l'organisation d'une étude qualitative. A partir du mois du décembre 2008 jusqu'au février 2009, nous avons recueilli des données à travers des interviews en profondeur et les discussions à groupe cible (DGC) dans trois provinces du Kenya de l'ouest. Nous avons recueilli douze interviews en profondeur et avons organise huit DGCs. Parmi les participants aux interviews en profondeur, cinq étaient des femelles, sept étaient des mâles. Quatre parmi les DGCs étaient composés entièrement de mâles et quatre étaient composés entièrement de femelles. Les facteurs qui influent sur la participation des mâles à la santé de reproduction ont émergé en deux thèmes : 1) les normes du genre et 2) les approches traditionnelles dont on se sert pour mettre en œuvre les programme de santé de reproduction et de planification familiale. Toute stratégie adoptée pour assurer la participation des hommes à la santé de reproduction doit donc penser à s'occuper de ces deux facteurs. Une révision des approches traditionnelles de la mise en application de santé de la reproduction est nécessaire pour les rendre plus favorables aux homme