Department Obstetrics and Gynaecology

Effectiveness of community health worker-led educational intervention on the uptake of cervical cancer screening in rural Kisumu, Kenya

2025-01-01T00:00:00Z

Effectiveness of community health worker-led educational intervention on the uptake of cervical cancer screening in rural Kisumu, Kenya NAFULA, Clara Wanyonyi In Kenya, cervical cancer is among the most frequently diagnosed cancer in women and remains a significant contributor to illness and death, despite being preventable through screening. The national and regional cervical cancer screening rate remains low at 17%, with data paucity in rural Kisumu. In 2020, the World Health Organization (WHO) introduced a global initiative aimed at eliminating cervical cancer through a 90-70-90 target: vaccinating 90% of girls, screening 70% of women, and ensuring that 90% of those with precancerous cervical lesions receive appropriate treatment. To achieve these targets, effective, community-based strategies must be developed. Community healthcare workers (CHWs) play a pivotal role in health education and fostering a culture of health prevention. There is, however, very limited local evidence on the effect of CHW-led education on uptake of screening for cervical cancer, especially in rural populations. The main objective of this study was to evaluate the effect of CHW-led education on knowledge, perceived vulnerability, and uptake of cervical cancer screening among women seeking care at Gita and Miranga Sub-county hospitals. A quasi-experimental pre-posttest design with a control group was employed, with Gita Sub-County Hospital serving as the intervention site and Miranga Sub-County Hospital as the control. A total of 274 participants were enrolled at each site. A pretest questionnaire was administered in May and June 2024, followed by a three-month sensitization and education intervention led by trained CHWs in Gita Sub-County. A post-test questionnaire was then administered at both sites. The statistics and data software package (STATA) was used for analysis. Both descriptive and analytical statistical procedures were employed. Socio-demographic characteristics were analyzed descriptively with frequencies and percentages. Paired t-tests, Wilcoxon rank-sum, and McNemar’s tests assessed changes in knowledge, perception, and screening uptake. Generalized Estimating Equations adjusted for confounders. Baseline socio-demographics were similar between the two sites, except for health insurance coverage, which was significantly higher in Gita (25%) than in Miranga (14.4%) (p = 0.02). Knowledge, perceived self-vulnerability, and screening uptake were similar at baseline. The mean knowledge scores were 6.7 (41.8%) in Gita and 5.3 (33.1%) in Miranga. The median self-vulnerability score was 13 (IQR: 9–17), and screening uptake was 31% and 30% in Gita and Miranga, respectively (p = 0.83). Post-intervention, the mean knowledge score in Gita significantly improved from 6.7 to 8.3 (p < 0.001), perceived self-vulnerability increased to a median score of 15 (p < 0.001), and screening uptake rose to 57.7% (p < 0.001). In conclusion, CHW-led educational intervention leads to statistically significant improvements in knowledge, perceived self-vulnerability, and cervical cancer screening rates in rural Kisumu. CHW-led educational programs should be scaled up and integrated into routine community health programs to enhance knowledge and uptake of cervical cancer screening in rural settings such as Kisumu. Policy makers should invest in training, supporting and deploying CHWs as key agents in cervical cancer prevention strategies to contribute to achieving WHO cervical cancer elimination targets. Master's Thesis

Effects of covid-19 pandemic and sars cov-2 infection on maternal healthcare services and pregnancy outcomes at Jaramogi Oginga Odinga teaching and referral Hospital in western Kenya (retrospective cross sectional and cohort study)

2024-01-01T00:00:00Z

Effects of covid-19 pandemic and sars cov-2 infection on maternal healthcare services and pregnancy outcomes at Jaramogi Oginga Odinga teaching and referral Hospital in western Kenya (retrospective cross sectional and cohort study) KUBUTA, Patson Obwomu The coronavirus disease 2019 (COVID-19) pandemic occasioned significant disruptions in the delivery of healthcare services globally. There is limited knowledge on the effect of the pandemic on the utilization of maternal healthcare services, associated feto-maternal outcomes and its effects on pregnancy outcomes in the Western Kenya region. Furthermore, little knowledge is available regarding the direct effects of Covid-19 infection on pregnancy outcomes. The objective of this study was two-fold: 1) To assess the changes on maternal healthcare utilization, pregnancy outcomes, feto-maternal outcomes during the pre-COVID-19 compared to the Covid-19 era, and 2) to determine the effect of the SARS CoV-2 infection on maternal and fetal outcomes at Jaramogi Oginga Teaching and Referral Hospital (JOOTRH), Kisumu. A hospital-based retrospective cross-sectional and retrospective cohort study designs were used. The subjects were pregnant women who sought maternal healthcare services at JOOTRH between 2018 and 2022. Data was abstracted from MCH clinic and maternity ward records. For objective 1 and 2, the whole population was used (2018 to 2022) and for objective 3, a sample size of 140 participants, calculated using Fleiss formula was used. Statistical Package for Social Sciences version 27 was used for data analysis. Descriptive, inferential statistics were applied. For objective 1 and 2, unpaired t-test was used to establish the difference between pre-Covid -19 and during Covid -19. For objective 3, relative risk and odds ratios were used to estimate the risk of SARS Cov-2 infection. There was a 37.9% (17782) decline in ANC visits during COVID-19. The ¬¬total deliveries decreased by 16.7%, (1940) postnatal services reduced by 35% (5779) during the Covid-19 pandemic, indicating that the Covid-19 pandemic had a major impact on access to maternal services. Maternal and neonatal outcomes were also negatively impacted with 39.7% (23) increase maternal sepsis and a 26.4% (45) increase in fresh stillbirths and a 34.3% (333) increase in low birth weight babies during Covid-19. SARS-CoV-2 positive mothers had a higher risk of adverse maternal and fetal outcomes compared to those not infected. The pandemic interrupted maternal healthcare services access and led to adverse pregnancy outcomes. The Covid-19 infection predisposed expectant mothers to adverse maternal and fetal outcomes. Developing hospital protocols on home-based care services and safe vaccination to pregnant mothers during pandemics and prioritization of expectant women on timely diagnosis and management of Covid-19 infection. Lastly, to encourage high powered studies to evaluate the intricate effect of Covid-19 on the utero-placental unit and associated complications Master's Thesis

Evaluation of Carbetocin and oxytocin for prevention of post Partum hemorrhage in women undergoing cesarean delivery at a regional hospital in western Kenya

2024-01-01T00:00:00Z

Evaluation of Carbetocin and oxytocin for prevention of post Partum hemorrhage in women undergoing cesarean delivery at a regional hospital in western Kenya OYARO, Grace Kerubo The burden of maternal morbidity and mortality is highest in Sub Saharan Africa and Southern Asia. Moreover, postpartum hemorrhage (PPH) is the largest contributor of maternal deaths in these regions. In Kisumu County, most of these deaths occur at the regional referral hospital Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). The use of uterotonics for the prevention of postpartum hemorrhage has resulted in a significant reduction in maternal morbidity and mortality, and thus remains an integral part of active management of third stage of labor. WHO recommends use of oxytocin for prevention of PPH in all births. Oxytocin is widely and readily available in most health facilities, including JOOTRH, and continues to be the preferred first-line uterotonic drug for PPH prophylaxis. Carbetocin is a heat-stable, longer-acting synthetic analog of oxytocin that is administered as a single dose within 1minute of delivery. Proper management of PPH cannot be overemphasized because of its undisputed impact on maternal morbidity and mortality. Although oxytocin is readily and widely available at JOOTRH and is currently the preferred uterotonic agent for all births, there is paucity of data on the effectiveness of this locally available drug. It is important to address the question of effectiveness of locally available oxytocin to ensure PPH is effectively prevented. This was done in the form of a comparative study between the standard first-line uterotonic, oxytocin and its analog carbetocin. This study aimed to evaluate the effectiveness of carbetocin and oxytocin in preventing postpartum hemorrhage in women undergoing cesarean delivery at JOOTRH. The specific objectives were to compare the incidences of use of additional uterotonics between oxytocin and carbetocin, to compare blood pressure levels following administration of oxytocin and carbetocin, to compare blood loss in the oxytocin and carbetocin groups, and to compare the incidence of need for blood transfusion. This study was a quasi-experimental trial. Pregnant women who underwent elective and emergency cesarean delivery at JOOTRH who met the eligibility criteria were allocated to receive oxytocin until the desired sample size (77) was achieved, and subsequently allocated to receive carbetocin until the desire sample of 77 was reached. A total of 154 women (77 for each study arm) were recruited in the study. The intervention arm received 100mcg carbetocin IV, whereas the control arm received 10IU oxytocin (the current standard of care). The sample size was calculated using a formula by Charan & Biswas. OpenEpi, version 3, an open-source calculator, was used to confirm the power which was 84.94%. Variables of interest were use of additional uterotonics, blood pressure readings, estimated blood loss and need for transfusion. Blood pressure readings were summarized as means and standard deviations while use of additional uterotonics, blood loss and need for transfusion were summarized as frequency counts and percentages. Inferential analysis was used to analyze the collected data. Pearson's Chi-square test of independence was used to assess the association between the study arm and the sociodemographic and obstetric characteristics of the participants. Propensity score matching was used to minimize selection bias. Binary logistic regression was employed to compare the use of additional uterotonics, need for transfusion, and blood loss between the control and intervention groups, while blood pressure changes were analyzed using linear regression analysis. In this study, we observed that participants in the oxytocin arm were eight times more likely to receive additional uterotonics (OR=8.00, 95% CI 3.77,18.20, P-value <0.001). There were no statistically significant differences in systolic blood pressure (P value 0.11), diastolic blood pressure (P value 0.30) and pulse rate (P value 0.20) measurements. There was no statistically significant difference in blood loss (P-value 0.39) and need for transfusion (P-value 0.30) across the two groups. In conclusion, carbetocin was more effective in preventing PPH, as its use was associated with a reduced need for additional uterotonics. There were no significant differences in blood pressure changes, rates of blood loss, or need for transfusion. This study recommends that carbetocin be included as a first-line agent in PPH prophylaxis in women undergoing cesarean delivery. Master's Thesis

Fetomaternal outcomes among normotensive and stage one Hypertensive patients at Jaramogi Oginga Odinga teaching and Referral hospital: a prospective cohort study

2024-01-01T00:00:00Z

Fetomaternal outcomes among normotensive and stage one Hypertensive patients at Jaramogi Oginga Odinga teaching and Referral hospital: a prospective cohort study SIMIYU, Daniel, Wambaya Hypertension in pregnancy is a leading cause of adverse maternal and fetal outcomes. Complications associated with hypertension include intrauterine growth restriction (IUGR), premature delivery, poor neonatal scores at birth, prolonged admission, maternal end organ damage and increased operative delivery. Recent studies in non-pregnant subjects indicate that a blood pressure range of 130/80 to 140/90 is associated with significant cardiovascular complications. The American Heart association has consequently recommended that this range be termed stage one hypertension. The effect of this new stage one hypertension has however not been adequately studied in pregnancy. The main objective of this study was to compare the fetomaternal outcomes between normotensive patients and those with stage one hypertension attending antenatal clinic (ANC) at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). The hypothesis was that there was no statistically significant difference in the fetomaternal outcomes between normotensive and stage one patients attending ANC at JOOTRH. This was a prospective cohort study, where non-probability consecutive sampling was used to select women with singleton pregnancies presenting for ANC before 20 weeks of gestation. A total of 320 women, 160 in each arm were recruited into the study and followed to delivery. Patients with stage one hypertension were the exposed group and those in the normotensive group were the unexposed. Maternal outcome data included gestational hypertension, pre-eclampsia, eclampsia, and mode of delivery. Fetal outcomes included fetal maturity, birth weight, APGAR scores, admission to newborn unit and fetal demise. The Statistical Package for Social Sciences (SPSS) version 25 software was used for analysis. Both descriptive and analytical statistical procedures were employed in analysis. The independent t test was used to compare the sociodemographic and clinical characteristics between the independent groups. A chi-square test of association was used to compare both maternal and fetal outcomes between the independent groups. Binary logistic regression analysis with interaction effects was used to establish the influence of variables that were found to be significantly different on the maternal and fetal outcomes. The socio- demographic characteristics were comparable between the two groups. Twenty-three patients with stage one hypertension (15.9%) developed gestational hypertension compared to eight (5.5%) in the normotensive group (RR 3.23, P value 0.02).Seventeen per cent of the neonates born to patients with stage one hypertension were admitted to the newborn unit compared to ten per cent of those in the normotensive group (RR of 1.98, P value 0.045).Thirty per cent of the neonates born to patients in the stage one hypertensive group scored below 7 on the APGAR score at one minute compared to twenty per cent in the normotensive group (P value 0.04). There was no statistically significant difference in the other maternal and fetal outcomes. In conclusion, patients with stage on hypertension have worse fetal and maternal outcomes than their normotensive counterparts and should be offered a more rigorous antenatal care based on this observed higher risk of fetomaternal complications. Master's Thesis