REMINDER SYSTEMS FOR SELF UTERINE MASSAGE IN THE PREVENTION OF POSTPARTUM BLOOD LOSS.

BACKGROUND: Uterine massage may significantly reduce post partum blood loss and could be patient-driven. OBJECTIVE: To assess the effectiveness of an alarm reminder system for self uterine massage in the prevention of post partum blood loss. DESIGN: A random controlled trial. SETTING: Meru District Hospital, Kenya. SUBJECTS: One hundred and twenty seven (127) women were randomly assigned to a 15 minute alarm reminder system (71) and non-alarm (56) control arm during the fourth stage of labour. RESULTS: Uterine massage compliance was better in the alarm group compared to the non-alarm group (Average massage of seven and two in two hours respectively P-value <0.0001), however the difference in blood loss was not significant 45.6 ml (95% CI 43-46) vs 47.1 ml (95% CI 43-52)ml p-value 0.892. CONCLUSION: Uterine massage compliance is remarkably increased by the use of an alarm reminder.

Conformity to the surviving sepsis campaign international guidelines among physicians in a general intensive care unit in Nairobi.

BACKGROUND: There are emerging therapies for managing septic critically-ill patients. There is little data from the developing world on their usage. OBJECTIVES: To determine the conformity rate for resuscitation and management bundles for septic patients amongst physicians in a general intensive care unit. DESIGN: Cross sectional observational study. SETTING: The general intensive care unit, Aga Khan University Hospital,Nairobi. SUBJECTS: Admitting physicians from all specialties in the general intensive care unit. RESULTS: The physicians had high conformity rates of 92% and 96% for the fluid resuscitation and use of va so pressors respectively for the initial resuscitation bundle. They had moderate conformity rates for blood cultures prior to administering antibiotics (57%) and administration of antibiotics within first hour of recognition of septic shock (54%). There was high conformity rate to the glucose control policy (81%), use of protective lung strategy in acute lung injury/Acute respiratory distress syndrome, venous thromboembolism prophylaxis (100%) and stress ulcer prophylaxis (100%) in the management bundle. Conformity was moderate for use of sedation, analgesia and muscle relaxant policy (69%), continuous renal replacement therapies (54%) and low for steroid policy (35%), administration ofdrotrecogin alfa (0%) and selective digestive decontamination (15%). CONCLUSION: There is varying conformity to the international sepsis guidelines among physicians caring for patients in our general ICU. Since increased conformity would improve survival and reduce morbidity, there is need for sustained education and guideline based performance improvement.

Knowledge, attitude and use of labour pain relief methods among women attending antenatal clinic in Nairobi.

BACKGROUND: Labour analgesia has rapidly gained popularity in obstetric practice. Low usage in the developing world has raised concern. OBJECTIVES: To assess the knowledge, attitude and use of labour pain relief methods in women attending antenatal clinic in Nairobi. DESIGN: A prospective study. SETTING: Aga Khan University Hospital, a teaching and referral hospital in Nairobi, Kenya. SUBJECTS: Two hundred and two consecutive expectant mothers attending antenatal clinic at the Aga Khan University Hospital, Nairobi. RESULTS: Fifty six per cent of the participants had knowledge about labour pain relief methods. Friends, the antenatal clinic and books/leaflets were the major source on information. Ninety per cent indicated they would intend to have some form of labour pain relief at their next delivery. Eighteen percent had been offered some form of pain relief at their last delivery with 82% of those offered having effective pain relief (P < 0.001). CONCLUSIONS: While most of our participants were well educated, level of knowledge of labour analgesia is still low. Use of labour analgesia is also still quite low in comparison to the western World. It is recommended that obstetricians and anaesthetists participate in knowledge dissemination and setup of dedicated labour analgesia services in this region.