Medicine and Health Sciences Commons^™

The East Africa Consortium For Human Papillomavirus And Cervical Cancer In Women Living With Hiv/Aids, Y. Tong, Elkanah Omenge, M. Nakalembe, P. Tonui, P. Itsura, K. Muthoka, M. Titus, S. Kiptoo, A. Mwangi, J. Ong’Echae

Obstetrics and Gynaecology, East Africa

The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for …

Acceptability And Feasibility Of A Low-Cost Device For Gestational Age Assessment In A Low-Resource Setting: Qualitative Study, Angela Koech, Peris Muoga Musitia, Grace Mwashigadi, Mai-Lei Woo Kinshella, Marianne Vidler, Marleen Temmerman, Rachel Craik, J. Alison Noble, Peter Dadelszen Von Dadelszen, Aris T . Papageorghiou

Obstetrics and Gynaecology, East Africa

Background: Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference.

Objective: The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting.

Methods: A descriptive study using qualitative methods was conducted in …

Rare Causes Of Genital Fistula In Nine African Countries: A Retrospective Review, Carrie J. Ngongo, Thomas J.I.P. Raassen, Marietta Mahendeka, Ladeisha Lombard, Jos Van Roosmalen, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Most genital fistulas result from prolonged, obstructed labor or surgical complications. Other causes include trauma (from accidents, traditional healers, or sexual violence), radiation, carcinoma, infection, unsafe abortion, and congenital malformation.

Methods: This retrospective records review focuses on rare fistula causes among 6,787 women who developed fistula after 1980 and sought treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia, and South Sudan. We compare fistula etiologies across countries and assess associations between rare causes and type of incontinence (urine, feces, or both).

Results: Rare fistula accounted for 1.12% (76/6,787) of all fistulas, including traumatic …

Vaginal Microbiota In Women With Spontaneous Preterm Labor Versus Those With Term Labor In Kenya: A Case Control Study, Edgar Gulavi, Fridah Mwendwa, David Atandi, Patricia Okiro, Michael Hall, Robert G. Beiko, Rodney Adam

Obstetrics and Gynaecology, East Africa

Background: Preterm birth is a global problem with about 12% of births in sub-Saharan Africa occurring before 37 weeks of gestation. Several studies have explored a potential association between vaginal microbiota and preterm birth, and some have found an association while others have not. We performed a study designed to determine whether there is an association with vaginal microbiota and/or placental microbiota and preterm birth in an African setting.

Methods: Women presenting to the study hospital in labor with a gestational age of 26 to 36 weeks plus six days were prospectively enrolled in a study of the …

A Retrospective Review Of Genital Fistula Occurrence In Nine African Countries, Carrie J. Ngongo, Thomas J. I. P. Raassen, Marietta Mahendeka, Ladeisha Lombard, Jos Van Roosmalen, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Female genital fistulas are abnormal communications that lead to urinary and/or fecal incontinence. This analysis compares the characteristics of women with fistulas to understand how countries differ from one another in the circumstances of genital fistula development.

Methods: This retrospective records review evaluated demographics and circumstances of fistula development for 6,787 women who sought fistula treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia.

Results: Most women developed fistula during childbirth, whether vaginal (3,234/6,787, 47.6%) or by cesarean section (3,262/6,787, 48.1%). Others had fistulas attributable to gynecological surgery …

Prenatal Allostatic Load And Preterm Birth: A Systematic Review, Shahirose Sadrudin Premji, Gianella Santos Pana, Alexander Cuncannon, Paul E. Ronksley, Aliyah Dosani, K. Alix Hayden, Sharifa Bashir Lalani, Wangira Musana, Kiran Shaikh, Ilona S. Yim

Obstetrics and Gynaecology, East Africa

Objective: Allostatic load refers to cumulative neuroendocrine burden and has been postulated to mediate and moderate physiological and psychological stress-related responses. This may have important implications for the risk of preterm birth. This systematic review examines the evidence on the association between prenatal allostatic load and preterm birth.

Data sources: A comprehensive search of seven electronic databases was conducted from inception to August 23, 2022 to identify all English-language observational and mixed methods studies examining allostatic load and preterm birth with no year or geographic restrictions.

Study eligibility criteria: Studies were included if they measured allostatic load, evaluated as the …

Symptoms Of Maternal Psychological Distress During Pregnancy: Sex-Specific Effects For Neonatal Morbidity, Sandra J. Weiss, Joseph Musana

Obstetrics and Gynaecology, East Africa

Objectives: Maternal psychological distress during pregnancy has been associated with preterm birth. However, little is known about the relationship of a woman’s psychological symptoms during pregnancy to the infant’s morbidity at birth or any differential effects of these symptoms on female vs. male fetuses. Our research aims addressed these gaps.

Methods: A total of 186 women were enrolled between 24 and 34 weeks gestation when demographic information was acquired and they completed the Brief Symptom Inventory to measure psychological distress. Data on gestational age at birth, fetal sex, and neonatal morbidity was extracted from the medical record. To control for …

The Covid-19 Pandemic And Disruptions To Essential Health Services In Kenya: A Retrospective Time-Series Analysis, Helen Kiarie, Marleen Temmerman, Mutono Nyamai, Nzisa Liku, Wangari Thuo, Violet Oramisi, Lilly Nyaga, Janette Karimi, Phidelis Wamalwa, Gladwell Gatheca

Obstetrics and Gynaecology, East Africa

Background: Public health emergencies can disrupt the provision of and access to essential health-care services, exacerbating health crises. We aimed to assess the effect of the COVID-19 pandemic on essential health-care services in Kenya.

Methods: Using county-level data routinely collected from the health information system from health facilities across the country, we used a robust mixed-effect model to examine changes in 17 indicators of essential health services across four periods: the pre-pandemic period (from January, 2018 to February, 2020), two pandemic periods (from March to November 2020, and February to October, 2021), and the period during the COVID-19-associated health-care workers’ …

Exploring The Impact Of Health Worker Strikes On Maternal And Child Health In A Kenyan County, Abdu Mohiddin, Eva Langat, James Orwa, Violet Naanyu, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Studies of the impact of health care workers’ strikes tend to look at facility-level activity rather than populations, with evidence from low and middle-income countries relatively sparse. This study explored the effect of national strikes on maternal and child health. It looked at the impact on health system activity in both public and non-public sectors (e.g. private, faith-based), on health promotion investments like immunisation, and on disease detection like post-partum haemorrhage (PPH). A 100 day doctors’ strike started in December 2016, a 150 day nurses strike from June 2017 and then the clinical officers for 21 days that …

Generalisability Of Deep Learning Models In Low-Resource Imaging Settings: A Fetal Ultrasound Study In 5 African Countries, Carla Sendra-Balcells, V´Ictor M. Campello, Jordina Torrents-Barrena, Yahya Ali Ahmed, Mustafa Elattar, Benard Ohene Botwe, Pempho Nyangulu, William Stones, Sikolia Wanyonyi, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Most artificial intelligence (AI) research and innovations have concentrated in high-income countries, where imaging data, IT infrastructures and clinical expertise are plentiful. However, slower progress has been made in limited-resource environments where medical imaging is needed. For example, in Sub-Saharan Africa the rate of perinatal mortality is very high due to limited access to antenatal screening. In these countries, AI models could be implemented to help clinicians acquire fetal ultrasound planes for diagnosis of fetal abnormalities. So far, deep learning models have been proposed to identify standard fetal planes, but there is no evidence of their ability to generalise in …

Cervical Cancer Programme, Kenya, 2011–2020: Lessons To Guide Elimination As A Public Health Problem, Valerian Mwenda, Woki Mburu, Joan-Paula Bor, Mary Nyangasi, Marc Arbyn, Steven Weyers, Philippe Tummers, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer is the leading cause of cancer mortality in Kenya, with an estimated 3,200 deaths in 2020. Kenya has implemented cervical cancer interventions for more than a decade. We describe the evolution of the cervical cancer programme over the last 20 years and assess its performance.

Methods: We searched the Ministry of Health’s archives and website (2000–2021) for screening policy documents and assessed them using seven items: situational analysis, objectives, key result areas, implementation framework, resource considerations, monitoring and evaluation and definition of roles/responsibilities. In addition, a trend analysis was performed targeting screening and disease burden indicators in …

Are Kenyans Likely To Use Covid-19 Self-Testing Kits? Results From A Cross-Sectional Survey, Griffins Manguro, Sonjelle Shilton, Sharon Omenda, Patrica Owira, Deepshikha Batheja, Abhik Banerji, Sophie Chabeda, Marleen Temmerman, Walter Jako, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Objectives: To understand the public’s perceptions around rapid SARS-CoV-2 antigen self-testing in Kenya, including the drivers of acceptability, willingness to pay, and adherence to hygiene and prevention recommendations following a positive self-test.

Methods: A household-based, cross-sectional survey, using a 35-item questionnaire, was conducted in Mombasa and Taita–Taveta counties, Kenya, during August 2021. Individuals aged ≥18 years were enrolled using a stratified sampling approach.

Results: There were 419 participants (mean age 35.7 years). A minority (10.5%) had ever tested for SARS-CoV-2. If SARS-CoV-2 self-testing were available, 39.9% and 41.5% would be likely and very likely, respectively, to use it. If unavailable …

Obstetric Risk In Pregnancy Interacts With Hair Cortisone Levels To Reduce Gestational Length, Wangira Musana, Craig R. Cohen, Miriam Kuppermann, Roy Gerona, Anthony Wanyoro, David Aguilar, Nicole Santos, Sandra J. Weiss, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Maternal psychological stress has been linked to preterm birth. However, the dierential contribution of psychological stress versus stress hormones is not clear. Studies focus primarily on perceived stress and cortisol, with few assessing its inter-convertible hormone cortisone. Furthermore, little is known about the potential moderating roles of obstetric risk and fetal sex in the relationship between maternal stress and gestational length. This gap in knowledge is particularly evident for rural women who typically experience chronic multiple stressors during pregnancy. We explored the relationship of hormonal and psychological stress to gestational length and the eects of obstetric risks and …

Differences In Hiv, Sti And Other Risk Factors Among Younger And Older Male Sex Workers Who Have Sex With Men In Nairobi, Kenya, Nicholas Muraguri, Jerry Okoth Okal, Marleen Temmerman, Helgar Musyoki, Peter Gichangi

Obstetrics and Gynaecology, East Africa

Introduction: Previous surveys of male sex workers (MSW) in sub-Saharan Africa have not fully documented the HIV and sexually transmitted infections (STIs) rates and vulnerabilities by age category.

Methods: The bio-behavioral survey of MSW in Nairobi, Kenya, utilized respondent-driven sampling to recruit MSW. Structured interviews captured MSW's behavioral aspects, and biological tests for HIV and other STIs.

Results: Analysis of the two age categories, 18–24 years (younger MSW) and 25 years and above (older MSW), shows that of all participants, a significantly higher proportion of younger MSW (59.6% crude, 69.6% RDS-adjusted) were recruited compared to older MSW …

Are Sexual And Reproductive Health And Rights Taught In Medical School? Results From A Global Survey, Margit Endler, Taghreed Al-Haidari, Chiara Benedetto, Sameena Chowdhury, Jan Christilaw, Faysal El Kak, Diana Galimberti, Miguel Gutierrez, Shaimaa Ibrahim, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Our aim was to investigate the inclusion of sexual and reproductive health and rights (SRHR) topics in medical curricula and the perceived need for, feasibility of, and bar-riers to teaching SRHR. We distributed a survey with questions on SRHR content, and factors regulating SRHR content, to medical universities worldwide using chain referral. Associations between high SRHR content and independent variables were analyzed using unconditional linear regression or χ2 test. Text data were analyzed by thematic analysis. We collected data from 219 respondents, 143 universities and 54 countries. Clinical SRHR topics such as safe pregnancy and childbirth (95.7%) and contraceptive methods …

Provision Of Labour Analgesia And Its Related Barriers Among Maternal Health Care Providers In Kenya: An Institution-Based Descriptive Survey., Gabriel Ouma, Elkanah Omenge, Edwin Were, Kimbley Omwodo

Obstetrics and Gynaecology, East Africa

Background: Although pain relief is a key component of modern obstetric care, it remains a poorly established service in sub-Saharan countries, such as Kenya. Maternal health care providers have an extensive role to play in meeting the analgesic needs of women, during childbirth. This study sought to examine the practice of labour pain relief and its deterrents among Kenyan maternal health care providers.

Methods: This was an institution based, cross-sectional, descriptive survey. The study population included midwives, obstetricians, and anaesthesiologists working at the second largest tertiary facility in Kenya. A structured, self- administered questionnaire was used. The patterns …

Urban Family Planning In Sub-Saharan Africa: An Illustration Of The Cross-Sectoral Challenges Of Urban Health, Trudy Harpham, Moses Tetui, Robert Smith, Ferdinand Okwaro, Adriana Biney, Judith Helzner, James Duminy, Susan Parnell, John Ganle

Obstetrics and Gynaecology, East Africa

The multi-sectoral nature of urban health is a particular challenge, which urban family planning in sub-Saharan Africa illustrates well. Rapid urbanisation, mainly due to natural population increase in cities rather than rural–urban migration, coincides with a large unmet urban need for contraception, especially in informal settlements. These two phenomena mean urban family planning merits more attention. To what extent are the family planning and urban development sectors working together on this? Policy document analysis and stakeholder interviews from both the family planning and urban development sectors, across eight sub-Saharan African countries, show how cross-sectoral barriers can stymie efforts but also …

Fetal Movement Trials: Where Is The Evidence In Settings With A High Burden Of Stillbirths?, Natasha Housseine, Joyce Browne, Nanna Maaløe, Brenda Sequeira Dmello, Sam Ali, Muzdalfat Abeid, Tarek Meguid, Marcus J. Rijken, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

No abstract provided.

Protocol For A Sequential, Prospective Meta-Analysis To Describe Coronavirus Disease 2019 (Covid-19) In The Pregnancy And Postpartum Periods, Emily R. Smith, Erin Oakley, Siran He, Rebecca Zavala, Kacey Ferguson, Gargi Wable Grandner, Ibukun-Oluwa Omolade Abejirinde, Yalda Afshar, Homa Ahmadzia, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to …

Early Neonatal Mortality Is Modulated By Gestational Age, Birthweight And Fetal Heart Rate Abnormalities In The Low Resource Setting In Tanzania – A Five Year Review 2015–2019, Aisa Shayo, Pendo Mlay, Emily Ahn, Hussein Kidanto, Michael Espiritu, Jeffrey Perlman

Obstetrics and Gynaecology, East Africa

Background: Early Neonatal mortality (ENM) (<7days) remains a signifcant problem in low resource settings. Birth asphyxia (BA), prematurity and presumed infection contribute signifcantly to ENM. The study objectives were to determine: frst, the overall ENM rate as well as yearly ENM rate (ENMR) from 2015 to 2019; second, the infuence of decreasing GA (<37weeks) and BW (<2500g) on ENM; third, the contribution of intrapartum and delivery room factors and in particular fetal heart rate abnormalities (FHRT) to ENM; and fourth, the Fresh Still Birth Rates (FSB) rates over the same time period.

Methods: Retrospective cohort study undertaken in a zonal referral teaching hospital located in Northern Tanzania. Labor and delivery room data were obtained from 2015 to 2019 and included BW, GA, fetal heart rate (FHRT) abnormalities, bag mask ventilation (BMV) during resuscitation, initial temperature, and antenatal steroids use. Abnormal outcome was ENM<7days. Analysis included t tests, odds ratios (OR), and multivariate regression analysis.

Results: The overall early neonatal mortality rate (ENMR) was 18/1000 livebirths over the 5 years and did not change signifcantly comparing 2015 to 2019. Comparing year 2018 to 2019, the overall ENMR decreased signifcantly (OR 0.62; 95% confdence interval (CI) …

A Community-Based Approach To Cervical Cancer Prevention In Western Kenya: An Ampath Feasibility Project, Elkanah Omenge, Philip Tonui, Kapten Muthoka, Stephen Kiptoo, Titus Maina, Mercy Agosa, Aaron Ermel, Yan Tong, Darron Brown

Obstetrics and Gynaecology, East Africa

Objectives: Centralized programs have been ineffective in reducing the burden of cervical cancer among Kenyan women. A community-based pilot study was initiated to screen Kenyan women for cervical cancer and to vaccinate their children against human papillomavirus (HPV).

Methods: Women were educated about cervical cancer prevention at community meetings. Women then provided self-collected vaginal swabs for oncogenic HPV testing using the Roche Cobas Assay. All women were then referred to the local clinic for Visual Inspection with Acetic Acid (VIA). Women were offered the quadrivalent HPV vaccine for their children if and when it became available for the …

Epidemiological Profile And Clinico-Pathological Features Of Pediatric Gynecological Cancers At Moi Teaching & Referral Hospital, Kenya, Anisa W. Mburu, Peter M. Itsura, Elkanah Omenge, Philiph K. Tonui, Elly B. Odongo, Afrin F. Shaffi, Hellen N. Muliro, Thomas N. Achia, Allan L. Covens, Barry P. Rosen

Obstetrics and Gynaecology, East Africa

Background: The main pediatric (0–18 years) gynecologic cancers include stromal carcinomas (juvenile granulosa cell tumors and Sertoli-Leydig cell tumors), genital rhabdomyosarcomas and ovarian germ cell. Outcomes depend on time of diagnosis, stage, tumor type and treatment which can have long-term effects on the reproductive career of these patients. This study seeks to analyze the trends in clinical-pathologic presentation, treatment and outcomes in the cases seen at our facility. This is the first paper identifying these cancers published from sub-Saharan Africa.

Method: Retrospective review of clinico-pathologic profiles and treatment outcomes of pediatric gynecologic oncology patients managed at MTRH between 2010 and …

Scaling Up Locally Adapted Clinical Practice Guidelines For Improving Childbirth Care In Tanzania: A Protocol For Programme Theory And Qualitative Methods Of The Partoma Scale-Up Study, Jane Brandt Sørensen, Natasha Housseine, Nanna Maaløe, Ib Christian Bygbjerg, Britt Pinkowski Tersbøl, Flemming Konradsen, Brenda Sequeira Dmello, Thomas Van Den Akker, Columba Mbekenga, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Effective, low-cost clinical interventions to improve facility-based care during childbirth are critical to reduce maternal and perinatal mortality and morbidity in low-resource settings. While health interventions for low- and lower-middle-income countries are often developed and implemented top-down, needs and circumstances vary greatly across locations. Our pilot study in Zanzibar improved care through locally co-created intrapartum clinical practice guidelines (CPGs) and associated training (the PartoMa intervention). This intervention was context-tailored with health-care providers in Zanzibar and now scaled up within five maternity units in Dar es Salaam, Tanzania. This PartoMa Scale-up Study thereby provides an opportunity to explore the co-creation process …

Nevirapine Hair And Plasma Concentrations And Hiv-1 Viral Suppression Among Hiv Infected Ante-Partum And Post-Partum Women Attended In A Mother And Child Prevention Program In Maputo City, Mozambique, Rosa Marlene Cuco, Osvaldo Loquiha, Adelino Juga, Aleny Couto, Bindiya Meggi, Adolfo Vubil, Esperança Sevene, Nafissa Osman, Marleen Temmerman, Olivier Degomme

Obstetrics and Gynaecology, East Africa

Introduction: Prevention of mother to child transmission of HIV (PMTCT) is frequently challenged by irregular access to more effective anti-retroviral therapy. Nevirapine single dose (sdNVP), sdNVP+AZT+3TC for MTCT prophylaxis and NVP+ AZT+3TC for treatment and PMTCT were withdrawn due to low genetic resistance barrier and low efficacy. However current PMTCT lines in Mozambique include DTG+3TC+TDF, TDF+3TC+EFV, DTG +ABC+3TC, and AZT + NVP syrup prophylaxis for exposed babies. We assessed NVP hair and plasma concentrations and association with HIV-1RNA suppression among HIV+ ante-partum and post-partum women under PMTCT in Maputo, Mozambique.

Methods: From December 2013 to November 2014, prospectively …

Cryotherapy And Leep Are Effective Treatment For Cin Lesions In Hiv+ And Hiv- Women In Western Kenya, Elkanah Omenge, Naaman Mehta, Ann Mwangi, Victor Omodi, Tao Liu, Edwin Sang, Philip Tonui, Peter Itsura, Kapten Muthoka, Stephen Kiptoo

Obstetrics and Gynaecology, East Africa

Objectives: Cervical cancer is the third most common cancer worldwide and the most common cancer among Kenyan women, with an age-standardized incidence rate of 33.8% in 2018. Cervical intraepithelial neoplasia (CIN) caused by human papillomavirus (HPV) in HIV+ women is over twice as likely to progress in severity compared to HIV- women. Conflicting reports exist as to the efficacy of cryotherapy or loop electrosurgical excision procedure (LEEP) as treatment for CIN among HIV+ women. This study assesses the results of cryotherapy or LEEP for CIN among HIV+ compared to HIV- women in Western Kenya.

Methods: One-hundred and twenty HIV+ (60 …

Hiv-1 Rna Genital Tract Shedding After Cryotherapy For Visual Inspection With Acetic Acid-Positive Cervical Lesions In Western Kenya, Anne Bocage, Elkanah Omenge, Tao Liu, Peter Itsura, Philip Tonui, Kapten Muthoka, Stephen Kiptoo, Soya S. Sam, Angela Caliendo, Susan Cu-Uvin

Obstetrics and Gynaecology, East Africa

Objectives: To quantify genital tract HIV-1 RNA (GT-HIV RNA) shedding among women living with HIV (WLHIV) before and after cryotherapy treatment for visual inspection with acetic acid (VIA) positive cervical lesions.

Methods:We conducted a prospective, longitudinal study of 39 WLHIV on antiretroviral treatment (ART) undergoing cryotherapy for VIA positive lesions in Kenya from 2015-2017. Eligibility for cryotherapy were lesions that covered

Results: Detectable GT-HIV RNA was found in 4/39 (10%) participants pre-cryotherapy, 1/30 (3.3%) and 3/26 (11.5%) participants at the 2- and 8-weeks post-cryotherapy, respectively. Only 6/39 (13%) participants had detectable GT-HIV RNA at any point during the study. …

Missed Opportunities For Family Planning Counselling Among Postpartum Women In Eleven Counties In Kenya, Mary N. Thiongo, Peter B. Gichangi, Michael Waithaka, Amy Tsui, Linnea A. Zimmerman, Scott Radloff, Marleen Temmerman, Saifuddin Ahmed

Obstetrics and Gynaecology, East Africa

Background: Mothers may access medical facilities for their babies and miss opportunities to access family planning (FP) services. This study was undertaken to describe missed opportunities for FP among women within the extended (0–11months) postpartum period from counties participating in Performance Monitoring and Accountability 2020 (PMA2020) surveys.

Design and setting: This study analysed cross-sectional household survey data from 11 counties in Kenya between 2014 and 2018. PMA2020 uses questions extracted from the Demographic and Health survey (DHS) and DHS defnitions were used. Multivariable logistic regression was used for inferential statistics with p-value of <0.05 considered to be signifcant.

Participants: Women aged 15-49 years …

Busting Contraception Myths And Misconceptions Among Youth In Kwale County, Kenya: Results Of A Digital Health Randomised Control Trial, Peter Gichangi, Lianne Gonsalves, Jefferson Mwaisaka, Mary Thiongo, Ndema Habib, Michael Waithaka, Tigest Tamrat, Alfred Agwanda, Hellen Sidha, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objectives: The objective of this randomised controlled trial in Kenya was to assess the effect of delivering sexual and reproductive health (SRH) information via text message to young people on their ability to reject contraception-related myths and misconceptions.

Design and setting: A three-arm, unblinded randomised controlled trial with a ratio of 1:1:1 in Kwale County, Kenya.

Participants and interventions: A total of 740 youth aged 18–24 years were randomised. Intervention arm participants could access informational SRH text messages on-demand. Contact arm participants received once weekly texts instructing them to study on an SRH topic on their own. Control arm participants …

Delivery Room St Segment Analysis To Predict Short Term Outcomes In Near-Term And Term Newborns, Jørgen Linde, Anne Lee Solevåg, Joar Eilevstjønn, Ladislaus Blacy, Hussein Kidanto, Hege Ersdal, Claus Klingenberg

Obstetrics and Gynaecology, East Africa

Background: ST-segment changes to the fetal electrocardiogram (ECG) may indicate fetal acidosis. No large-scale characterization of ECG morphology immediately after birth has been performed, but ECG is used for heart rate (HR) assessment. We aimed to investigate ECG morphology immediately after birth in asphyxiated infants, using one-lead dry-electrode ECG developed for HR measurement.

Methods: Observational study in Tanzania, between 2013-2018. Near-term and term infants that received bag-mask ventilation (BMV), and healthy controls, were monitored with one-lead dry-electrode ECG with a non-diagnostic bandwidth. ECGs were classified as normal, with ST-elevations or other ST-segment abnormalities including a biphasic ST-segment. We analyzed ECG …

Genetic Diversity In L1 Orf Of Human Papillomavirus In Women With Cervical Cancer With And Without Human Immunodeficiency Virus In Botswana And Kenya, Leabaneng Tawe, Wonderful T. Choga, Giacomo M. Paganotti, Ontlametse T. Bareng, Tlhalefo D. Ntereke, Pleasure Ramatlho, Doreen Ditshwanelo, Simani Gaseitsiwe, Ishmael Kasvosve, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Background: The variation of human papillomavirus (HPV) genotypes shapes the risks of cervical cancer and these variations are not well defined in Africa. Nucleotide changes within the L1 gene, nucleotide variability, and phylogeny were explored in relation to HIV in samples from Botswana and Kenya. Methods: A total of 98 HPV-positive cervical samples were sequenced to identify diferent HPV variants. Phylogenetic inferences were used to determine HPV genotypes and investigate the clustering of sequences between women living with HIV (WLWHIV) and -women not living with HIV (WNLWHIV). Results: Out of 98 generated sequences, 83.7% (82/98) participants had high-risk (HR) HPV …