Lydia Okutoyi

A Pinhead-sized hymenal opening can permit spontaneous pregnancy. A 26-year-old primigravida presented to our institution for antenatal care in the late 2nd trimester. She reported to have conceived through contact of semen with her vulva, but had never had penetrative vaginal sex. On subsequent follow up, a decision to have an elective caesarean at 39 weeks was made. We report this example because management of such cases can be challenging especially if a timely diagnosis is not made due to lack of awareness and the patient presents when pregnant.Keywords: Pregnant virgin, Elective caesarean, Microperforate hymen, Dilation

Background : Cancer of the cervix is not only the second most common cancer affecting women worldwide but is also the most common gynecological cancer in Kenya. An estimated 500,000 cases occur every year of which 80% are from the developing countries. Presentation is usually during late stages requiring radiotherapy as the main form of management. Radiotherapy has its side effects which could be late or early. Objective : This study sought to evaluate the complications of radiotherapy among patients with advanced carcinoma of the cervix treated at the Kenyatta National Hospital. Patient and Methods : This was a descriptive retrospective study of the data collected from the radiotherapy unit of Kenyatta National Hospital, which is the only public hospital with radiotherapy facilities in Kenya. The study population was from that of women treated for cervical cancer at Kenyatta National Hospital between 2000 to 2004. The data collected included age, parity, histological type, stage at...

Purpose: The current study sought to investigate the practice of IT-based discharge communication in general surgery wards at the Kenyatta National Hospital. Methodology: The study used the descriptive research design approach. A stratified sampling technique was used to recruit 180 patients who had been discharged in the last one month prior to the study from surgical wards namely General surgery ward, Urology ward and Neurology ward. A semi structured questionnaire was used to collect both qualitative and quantitative data with the use of SPSS version 25. Results: The findings revealed that there is a significant difference between the mean responses of the patients in General surgery ward and Neurology ward (-.299*, P= 0.001). Likewise, there is a significant difference between the mean responses of the patients in Urology ward and General surgery ward (-.417*, P= 0.000). The correlation findings indicated that there is a positive and significant association between IT-based disc...

Background Zika virus (ZIKV), first discovered in Uganda in 1947, re-emerged globally in 2013 and was later associated with microcephaly and other birth defects. We determined the incidence of ZIKV infection and its association with adverse pregnancy and fetal outcomes in a pregnancy cohort in Kenya. Methods From October 2017 to July 2019, we recruited and followed up women aged ≥ 15 years and ≤ 28 weeks pregnant in three hospitals in coastal Mombasa. Monthly follow-up included risk factor questions and a blood sample collected for ZIKV serology. We collected anthropometric measures (including head circumference), cord blood, venous blood from newborns, and any evidence of birth defects. Microcephaly was defined as a head circumference (HC) < 2 standard deviations (SD) for sex and gestational age. Severe microcephaly was defined as HC < 3 SD for sex and age. We tested sera for anti-ZIKV IgM antibodies using capture enzyme-linked immunosorbent assay (ELISA) and confirmed positi...

ObjectiveMultidrug-resistant organisms (MDRO), especially carbapenem-resistant organisms (CRO), represent a threat for newborns. This study investigates the colonization prevalence of these pathogens in a newborn unit at a Kenyan tertiary hospital in an integrated approach combining routine microbiology, whole genome sequencing (WGS) and hospital surveillance data.MethodsThe study was performed in the Kenyatta National Hospital (KNH) in 2019 over a four-month period and included 300 mother-baby pairs. A total of 1,097 swabs from newborns (weekly), mothers (once) and the hospital environment were taken. Routine clinical microbiology methods were applied for surveillance. Of the 288 detected MDRO, 160 isolates were analyzed for antimicrobial resistance genes and phylogenetic relatedness using whole genome sequencing (WGS) and bioinformatic analysis.ResultsIn maternal vaginal swabs, MDRO detection rate was 15% (n=45/300), including 2% CRO (n=7/300). At admission, MDRO detection rate fo...

Introduction Poor quality health care is a significant cause of preventable deaths, especially in low- and middle-income countries (LMICs). Quality improvement is multifaceted and includes strategies such as standard setting, quality assurance and clinic audits. In order to move quality improvement in health care into every day practice it is essential to fully engage the frontline where health care is delivered. The objective of this scoping review is to investigate front line health care worker line led quality improvement in Sub Saharan Africa (SSA). Methods We conducted a scoping review to identify, map and synthesize evidence on health care worker led quality improvement initiatives in Sub Sahara Africa using electronic databases PubMed, Cochrane, Embase, CINAHL, Scopus and Psychinfo to identify peer-reviewed literature published between January 2000 and January 2021. To identify grey literature, we used the same search terms in google search to a maximum of 10 pages or when th...

Purpose: The current study sought to investigate the practice of person-based discharge communication practices in general surgery wards at the Kenyatta National Hospital. Methodology: The study used the descriptive research design approach. A stratified sampling technique was used to recruit 180 patients who had been discharged in the last one month prior to the study from surgical wards namely the General surgery ward, Urology ward and Neurology ward. A semi-structured questionnaire was used to collect both qualitative and quantitative data. A statistical Package for Social Sciences (SPSS version 25) was used in the data analysis. Results: The findings show that 77 of the respondents in the Neurology unit (mean = 2.97), 51 of them in the general surgical unit (mean = 1.80) and 52 of them in the urology unit (mean = 2.11) agreed that person-based discharge communication practices affect patient health outcomes. There was also a significant difference between the mean responses of t...

Background The impact of Human Immunodeficiency Virus (HIV) on pregnancy outcomes for women on antiretroviral therapy (ART) in sub-Saharan Africa remains unclear. Methods Pregnant women in Kenya were enrolled in the second trimester and followed up to delivery. We estimated effects of treated HIV with three pregnancy outcomes: loss, premature birth, and low birthweight and factors associated with HIV-positive status. Results Of 2,113 participants, 311 (15%) were HIV-infected and on ART. Ninety-one of 1,762 (5%) experienced a pregnancy loss, 169/1,725 (10%) a premature birth (<37 weeks), and 74/1,317 (6%) had a low birthweight newborn (<2500 g). There was no evidence of associations between treated HIV infection and pregnancy loss (adjusted relative risk [aRR]: 1.19 [95% confidence interval: 0.65-2.16], p = 0.57), prematurity (1.09 [0.70-1.70], p = 0.69) and low birthweight (1.36 [0.77-2.40], p = 0.27). Factors associated with an HIV-positive status included older age, food ins...