Incidence and bacteriological pattern of puerperal infections within the first 120 hours post caesarean section in Redemption Hospital Monrovia, Liberia

Background: Maternal infection contributes to 11% of all maternal mortalities globally, with most of these deaths in developing countries. This study was triggered by an anecdotal evidence of a high prevalence of puerperal infection following Caesarean sections at the Redemption Hospital, Monrovia Liberia.Objective: To determine the incidence and bacteriological pattern of puerperal infections within the first 120 hours among women delivered by Caesarean section.Design: Prospective descriptive cohort study.Setting: Redemption Hospital in Monrovia, Liberia.Subjects: Two hundred and thirty five immediate post Caesarean section mothers.Results: The Mean (SD) age of study participants was 27 years. The incidence of puerperal sepsis was 21% (49/235), out of which 49% (24/49) met the clinical criteria of puerperal infection and 51% (25/49) had laboratory confirmed puerperal sepsis. Of the specimens cultured, 44% were Staphylococcus aureus, 44% were Escherichia coli and 12% Pseudomonas aeuroginosum. About three quarters of Staphylococcus aureus and Escherichia coli infections are resistant to ceftriaxone, while more than half these infections are resistant to gentamicin.Conclusion: The incidence of puerperal infection in Redemption Hospital, Liberia, within the first 120 hours after Caesarean section is 21%. Staphylococcus aureus and Escherichia coli were the most common pathogens isolated and showed resistance to ceftriaxone and gentamicin

Ogilvie’s syndrome: case report of spontaneous rupture of the ceacum following caesarean section

In acute colonic pseudo-obstruction (ACPO) there is colonic distension without an organic obstacle (intrinsic or extrinsic to intestinal wall). This becomes a potential site of ceacal rapture which can lead to the demise of the patient. Presented is a case of a mother who had spontaneous caecal rapture five days after Caesarean delivery. At Laparotomy the ceacal rapture was confirmed and a colostomy was done. The patient succumbed in Intensive care unit two days post-operatively

Benefits of Shirodkar Stitch in Women with Failed McDonald Stitch

This is a case series presentation of 14 cases where Shirodkar stitch was inserted after failed McDonald stitch. The patients were either self referrals or from Obstetricians in Eastern Africa region. All the patients were able to carry the pregnancies to term and were delivered by Caesarean section. The findings show that Shirodkar stitch has a place in management of patients with recurrent pregnancy loss. There is need to familiarise obstetricians on the insertion of Shirodkar stitch

DNA Genotype of Human Papilloma Virus Infection among Adolescent Girls at Kenyatta National Hospital Youth Clinic

Background: Adolescents have risky sexual behaviour exposing them to the Human Papilloma Virus (HPV ) infection. With clear causal relationship between high risk the HPV (16 and 18) infection and invasive cancer, this study focuses on the distribution of HPV genotypes among the female adolescent and youth at the Kenyatta National Hospital (KNH) youth clinic.Objective: To determine DNA genotype of HPV infection among adolescent girls at KNH - Youth Clinic and use it as an advocacy tool for the introduction of the HPV vaccine provision in the clinic.Design: Cross-sectional study.Setting: Kenyatta National Hospital Youth clinic.Subjects: Adolescent (and youths) girls aged between 12-24 years.Results: Two hundred and sixty four participants were recruited into the study for a period of three months. The recruitment was done in the clinic till the required sample size was obtained. The prevalence of cervical HPV infection was 9.8% (95% CI : 6.13 to 13.41). There were multiple serotypes with 27% infected with HPV strain type 18 and 66. Type 16 was 5%, type 18 was 9%, and there were mixed genotype infections in the rest. There were no low risk strains isolated and 18% of the respondents who tested positive for HPV DNA had uncharacterised strains.Conclusion: The prevalence of HPV among the adolescent girls at KNH youth clinic was 9.8%. Twenty seven percent had co-infection with type 18 and 66

Parental Acceptance of Human Papilloma Virus Vaccine for Their Pre-Pubertal and Teenage Daughters

Objective: To determine the factors influencing parental acceptance of the HPV vaccine for their pre-pubertal (age group 9-14 years) daughters.Design: Cross sectional study.Setting: Four primary schools within Langata constituency in Nairobi County in June 2010.Subject: Girls in Standard five to eight were selected for the study. A self explanatory one page questionnaire was given out to take to their mothers/guardian and returned in one week. Fifty mothers were then randomly selected from the returned questionnaires and an in depth telephone interview was conducted. The data entry and coding was done and analysed using SPSS version 15.Results: In this study 68% of parents/guardians accepted that vaccination should be done but only 58% agreed that their daughters should be vaccinated, majority of the respondents were females, (women 82% and men 18 %). This observed difference across the genders was not statistically significant p=0.078. The level of education of the respondent (nil 2.7%, primary 6.6%, college /university 47.7% secondary 45.7%) the observed difference across the educational levels of agreeing to vaccination was not statistically significant p=0.898. The knowledge/awareness on cervical cancer and its relationship to HPV infection correlated with the level of education was found to have been statistically significant. The parents recommended age of vaccination was 11-13 year (58%). Parent/guardians suggested age of vaccination and HPV vaccine acceptance was significant correlated with the vaccination acceptance by the parents p=0.009. This study has shown that the recommended age of vaccination by parents is 11-13years age group which was similar to findings done in many countries.Conclusion: There was poor knowledge on the relationship between HPV infection and cervical cancer. The acceptable age of vaccine administration was 11-13 year

The prevalence of glucose intolerance among antenatal clients at Kenyatta National Hospital at, 24-36 weeks of gestation

Objectives: To determine the prevalence of and associated factors for glucose intolerance among antenatal clients at Kenyatta National Hospital at 24-36 weeks of gestation.Design: Cross-sectional analytical study.Setting: Kenyatta National Hospital antenatal clinic.Subjects: One hundred and two (102) antenatal mothers at a gestational age of 24-36 weeks were recruited into the study and underwent a 100g Oral Glucose Tolerance Test (OGTT) after consenting to participate in the study.Results: From the study 37(36%) had glucose intolerance while 65 (64%) had normal glucose tolerance. Among clients with glucose intolerance, 16.7% met the diagnostic criteria for gestational diabetes, 3.9% had impaired glucose tolerance and 15.7% had impaired fasting glycaemia. Of the clients with normal glucose tolerance 22.5% displayed flat curves. Factors significantly associated with glucose intolerance were: BMI > 25;P-value 0.036: OR 0.37 CI (1.06-6.90), history of and treatment for sub-fertility p-value 0.002: OR 8.69 CI (1.74-43.50) and family history of hypertension; p-value 0.037: OR 2.66 CI (1.04-6.78).Conclusion: The prevalence of glucose intolerance was 36%. This is much higher than the 5% previously reported. There is need to screen pregnant women for glucose intolerance to prevent the complications usually associated with it

Effectiveness of intermittent preventive treatment with sulphadoxine-pyrimethamine and insecticide treated nets on the prevention of malaria in pregnancy in non-malarial endemic area in Kenya

Background: Malaria prevention strategies have significantly reduced the prevalence of malaria in pregnant women in several studies done in malaria endemic regions.Objective: To determine the effectiveness of Intermittent preventive treatment with sulphadoxine-pyrimethamine and Insecticide treated nets on the prevention of malaria in pregnancy in a non-malaria endemic area.Design: Comparative study.Setting: Kapsabet District Hospital in Nandi County.Subjects: One hundred and fourty three non-randomised pregnant women were followed through the Antenatal clinic before 28 weeks gestation until delivery and compared with records of 600 pregnant women ( non-intervention arm), who attended ANC and delivered at the hospital.Results: The incidence of malaria infection in pregnancy was 21% in the non-intervention group compared with 8% in the intervention group, (p-value 0.000). The incidence of low birth weight was 12.5% in the non-intervention group compared with 5.6% in the intervention group (p-value 0.018); with a reduction of low birth weight by 50% in the intervention group. The incidence of Still births was 6% in the non-intervention group and 1.4% in the intervention group (p-value 0.025). There were two (0.3%) cases of maternal mortality in the non-intervention group and no mortality in the intervention group which was statistically not significant but clinically significant.Conclusion: The use of intermittent preventive treatment with sulphadoxinepyrimethamine and Insecticide Treated Nets is effective in prevention of malaria in pregnancy in non-malaria endemic region and is associated with reduction of adverse pregnancy outcome. There is therefore a need of up scaling the use of sulphadoxinepyrimethamineduring pregnancy, and availing subsidised long lasting insecticide treated bed nets to pregnant women countrywide

Lithopaedon Presenting as Intestinal Obstruction with a Previous Co-Existing Intra-Uterine Pregnancy

This is a case report of a 25 year old lady Para 4 + 0 gravida 5, who was referred to Kisii level 5 hospital from a district hospital with a diagnosis of intestinal obstruction and a four year history of an intra-abdominal mass. A year prior to the admission she conceived and delivered vaginally at home but the baby died a few hours after the delivery. On examination on admission there was a solid mass in the right upper quadrant. Ultrasound imaging showed a poor echo-calcified mass suggestive of a colonic metastatic mass and an erect abdominal x ray revealed foetal bones within the abdominal cavity. At laparatomy a lithopedion with a normal uterus was found. The presence of a lithopedion and a normal intra-uterine pregnancy followed by spontaneous vertex delivery has not been reported in Kenya.Patients with lithopaedon can present with intestinal obstruction as a complication but the presence of a co-existing pregnancy is rare

Pheochromocytoma in pregnancy: Case report

This is a case presentation of a 32 year old woman with pheochromocytoma diagnosed at 27 weeks of gestation, she was managed till term, induced and had assisted vaginal delivery. The pheochromocytoma was surgically re-sected successfully at six weeks postpartum

Organoleptic, Sensory and Biochemical Traits of Arabica Coffee and Their Arabusta Hybrids

Coffee as a cash crop, reduces food insecurity by providing regular incomes and is a major foreign exchange earner in more than fifty tropical countries where it is grown either as Arabica (Coffea arabica) or Robust (Coffea canepora). In Kenya which grow some Robusta but mostly Arabica coffee, the production has been declining, mainly because world coffee prices have plummeted to about 5 USD for a 650Kg of un-hulled beans per acre. The only way world prices are likely to increase and benefit the small-scale farmers, is by improving the cup quality and enabling these countries to sell their coffee in specialty markets. This review, underscores the importance of analyzing and estimating organoleptic, sensory and biochemical compounds diversity in Arabica coffee, since these are the factors that determine cup quality. In an attempt to do so, the chapter presents experimental data that analyzed various sensory and organoleptic traits of Arabica coffee and their Arabusta hybrids that proves that tremendous genetic diversity exists in coffee genotypes grown in Kenya and it is possible to utilize this genetic variation to improve cup quality