Association between Rift Valley fever virus seroprevalences in livestock and humans and their respective intra-cluster correlation coefficients, Tana River County, Kenya.

We implemented a cross-sectional study in Tana River County, Kenya, a Rift Valley fever (RVF)-endemic area, to quantify the strength of association between RVF virus (RVFv) seroprevalences in livestock and humans, and their respective intra-cluster correlation coefficients (ICCs). The study involved 1932 livestock from 152 households and 552 humans from 170 households. Serum samples were collected and screened for anti-RVFv immunoglobulin G (IgG) antibodies using inhibition IgG enzyme-linked immunosorbent assay (ELISA). Data collected were analysed using generalised linear mixed effects models, with herd/household and village being fitted as random variables. The overall RVFv seroprevalences in livestock and humans were 25.41% (95% confidence interval (CI) 23.49-27.42%) and 21.20% (17.86-24.85%), respectively. The presence of at least one seropositive animal in a household was associated with an increased odds of exposure in people of 2.23 (95% CI 1.03-4.84). The ICCs associated with RVF virus seroprevalence in livestock were 0.30 (95% CI 0.19-0.44) and 0.22 (95% CI 0.12-0.38) within and between herds, respectively. These findings suggest that there is a greater variability of RVF virus exposure between than within herds. We discuss ways of using these ICC estimates in observational surveys for RVF in endemic areas and postulate that the design of the sentinel herd surveillance should consider patterns of RVF clustering to enhance its effectiveness as an early warning system for RVF epidemics.

Factors affecting the success of a large embryo transfer program in Holstein cattle in a commercial herd in the southeast region of the United States.

The objectives of this study were to evaluate factors affecting in vivo embryo production and pregnancy per embryo transfer (P/ET) in Holstein cattle in the southeast region of the United States. Data from a total of 516 embryo collections and 10,297 ETs performed from 2011 to 2014 were available. For embryo production, the effects of donor parity (nulliparous [N], primiparous [P], multiparous [M]), average temperature-humidity index (THI) at embryo collection, days in milk at embryo collection, occurrence of calving problems, and occurrence of metritis postpartum were evaluated. For P/ET, the effects of donor parity (N or parous), recipient parity (N, P, and M), embryo type (fresh, frozen, IVF, and IVF-frozen), embryo developmental stage (4-7), embryo quality (1-3), recipient estrous cycle day at ET (6-9), average THI at ET, days in milk at ET, milk yield at ET, occurrence of calving problems (abortion, dystocia, twins, fetal death, or retained placenta), and occurrence of metritis postpartum were evaluated. Pregnancy was diagnosed at 41 ± 3 days of gestation. Continuous and binary data were analyzed using the MIXED and GLIMMIX procedures of SAS, respectively. Parity affected embryo production; M had greater number and percentage of unfertilized embryos and lesser percentage of viable embryos than P and N. Recipient parity, embryo type, embryo stage, embryo quality, estrous cycle day at ET, and THI at ET affected P/ET. There was an interaction between recipient parity and THI at ET. P/ET was greater for N than P and greater for P than M, greater for fresh embryos than others, greater for stage 7 than others, greater for quality 1 than 2 and greater for quality 2 than 3, and greater for ET on estrous cycle Day 7 and 8 than 6. P/ET was decreased for THI ≥80 in N and THI ≥72 in P and M. Calving problems and metritis also affected P/ET in P and M and was lesser for cows that had calving problems and metritis. In conclusion, embryo production was affected by donor parity, and P/ET was affected by embryo type, embryo stage, embryo quality, recipient estrous cycle day at ET, THI, calving problems, and metritis.

EFFECTIVENESS AND SAFETY OF 2-HOURLY 20 MCG ORAL MISOPROSTOL SOLUTION COMPARED TO STANDARD INTRAVENOUS OXYTOCIN IN LABOUR INDUCTION DUE TO PRE-LABOUR RUPTURE OF MEMBRANES AT TERM: A RANDOMISED CLINICAL TRIAL AT KENYATTA NATIONAL HOSPITAL.

BACKGROUND: Pre-labour rupture of membranes (PROM) at term is a common event whose management varies from centre to centre. The practice at the Kenyatta National Hospital (KNH) for patients with PROM at term is to initiate delivery of the patient soon on admission with intravenous oxytocin, if there are no contraindications to vaginal delivery. However, in PROM at term, if the cervix is not ripe, vaginal administration of prostaglandin pessaries for cervical ripening is not possible when there is active draining of liquor, thus use of intravenous oxytocin may take a very long time or fail all together. Oral misoprostol at low doses has been found to be a safe and effective agent for labour induction in numerous studies carried out in the developed world, where there are better resources for monitoring of labour. None of the studies has been carried out in Kenya, a limited resource country. Therefore, there is a need to determine the effectiveness and safety of oral misoprostol solution at the KNH, a limited resource set up. OBJECTIVE: To determine the effectiveness and safety of 2-hourly 20 mcg oral misoprostol solution compared to the standard intravenous oxytocin in labour induction in mothers with pre-labour rupture of membranes at term at the Kenyatta National Hospital. DESIGN: An unblinded randomised clinical trial. SETTING: Kenyatta National Hospital Labour Ward Unit. PARTICIPANTS: Eighty three pregnant women with pre-labour rupture of membranes at term without an indication for Caeserian section were consented and randomised for labour induction with either oral misoprostol at a dose of 20mcg 2-hourly up to a maximum of 4-doses, or with intravenous oxytocin according to the WHO protocol. MAIN OUTCOME MEASURES: Induction to delivery interval; maternal complications and early neonatal outcomes. RESULTS: The overall induction success rates in the misoprostol arm was 81% versus 83% in the oxytocin arm (P = 0.447). The mean induction to vaginal delivery interval in the misoprostol arm was 8.4 hours as compared to 9.45 hours in the oxytocin arm (P = 0.116). The induction to active labour interval was similar in the two study arms. The mean induction to active labour in the misoprostol arm was 4.02 hours as versus 4.51 hours in the oxytocin arm (P = 0.223 ). Two women who had failed induction with misoprostol were augmented with oxytocin and delivered vaginally. The Caesarean section rates were 19% in the misoprostol arm and 17% in the oxytocin arm (P = 0.447), which was not statistically significant. The maternal outcomes were similar in the two study arms. Four women had tachysystole in the misoprostol arm, compared to three in the oxytocin arm (P = 0.253). In the misoprostol arm two women had hypertonus compared to three in the oxytocin arm (P = 0.322).There was one case of hyperstimulation in the misoprostol arm and two in in the oxytocin arm. There were no differences in the foetal/neonatal outcomes. No baby had an Apgar score of less than seven at one or five minutes. No baby was admitted to the New Born Unit in either of the two arms. There was no case of a still birth in either of the study arms. There was no significant difference in the passage of meconium between the two arms, 39% in the misoprostol arm and 35.7% in the oxytocin arm (P = 0.755). The passage of meconium did not impact on the neonatal outcomes. CONCLUSION: Oral misoprostol solution 20mcg 2-hourly is as safe and effective as the standard intravenous oxytocin for labour induction in women presenting with prelabour rupture of membranes at term at the Kenyatta National Hospital.

Multifoetal pregnancies at a maternity hospital in Nairobi.

OBJECTIVE: To review some of the aspects of multiple pregnancies. DESIGN: A retrospective review of multiple pregnancy deliveries. SETTING: Pumwani Maternity Hospital- Nairobi Kenya, between 1st January and 31st December 2006. SUBJECTS: Three hundred and twenty eight mothers with twins and two sets of triplet deliveries. RESULTS: The total annual deliveries were 15,642. The twinning rate was one in 48 deliveries and the triplet rate was one in 7,821 deliveries. Most of the mothers were of low parity and in the lower age group. Majority had no previous history of twins and were married. The sex differences in both the first and second twins were as of the normal population with males being delivered more than females. Most of the twins were delivered alive through spontaneous vertex delivery (SVD). Majority of first twins had no complications while in second twins the majority had more complications. Most of the deliveries had no obvious congenital malformations. Most of the twins were of low birth weight and were of the same sex (monozygotic). The most common complications in both first and second twins were prematurity and asphyxia. The majority of the twins were diagnosed during the prenatal period and the most common method of diagnosis was by ultrasonography. The majority of the mothers had no complications. The most common maternal complications being preeclampia (PET) and anaemia. CONCLUSION: Most of the mothers with multiple pregnancies were of low parity and in the lower age group. Diagnosis was mainly done by ultrasonography therefore emphasis should be done to improve clinical diagnosis especially in resource constrained facilities. A more detailed study should be undertaken especially the events in the pre-pregnancy and during the antenatal period. The present study assumes that same sex twins are the same as monozygotic twins. A more detailed study on the types of placentation would be useful. As PET, anaemia, prematurity and asphyxia are the most common maternal and neonatal complications medical workers need to be made aware of the appropriate management of the conditions. These babies will need long-term follow-up.

Quality of record keeping in the intrapartum period at the Provincial General Hospital, Kakamega, Kenya.

OBJECTIVE: To assess the quality of recording critical events in the intrapartum period in Kakamega Provincial General Hospital (PGHK). DESIGN: Retrospective comparative study. SETTING: Provincial General Hospital, Kakamega, the referral hospital for Western Province, Kenya. PARTICIPANTS: Two hundred women admitted at the labour ward during the six-month period between 1st September 2000 and 28th February 2001 were compared to two hundred women admitted between 1st July 2001 and 31st December 2001. INTERVENTION: The Safe Motherhood Demonstration Project (SMDP) was introduced in four districts of Western Province, Kenya, in which PGHK is located. It included on job training in Safe Motherhood which emphasised, among others, collection and utilisation of maternal health care services data. MAIN OUTCOME MEASURES: Comprehensiveness of recording of biodata, history taking and examination findings were assessed for women in labour before and during the implementation of the SMDP. The proportion of cases in labour managed by use of partograph and its appropriate use were also determined. RESULTS: Retrieval rate of patients' notes was 86.9% and 89.6% before and during SMDP respectively. Information on sociodemographic characteristics, history taking, general and obstetric examination had a near universal recording in both groups but data on alcohol consumption, smoking, menarche, previous pregnancies and contraceptive use was poorly recorded. There was a significant improvement in recording of diagnosis and plan of management during the SMDP (p = 0.037). The partograph was used in only 11% of patients before SMDP as compared to 85% during SMDP (p = 0.000). Record on foetal condition and progress of labour were significantly improved during the SMDP (p = 0.000). Records on summary of labour likewise significantly improved during the SMDP (p = 0.02). CONCLUSION: The quality of record keeping in the intrapartum period at the PGHK greatly improved during the implementation of the SMDP. It would be worthwhile to assess the sustainability of quality of intrapartum records and care a year or so after the SMDP ended.

Socio-demographic characteristics of patients admitted with gynaecological emergency conditions at the provincial general hospital, Kakamega, Kenya.

OBJECTIVE: To determine the magnitude of gynaecological emergencies and the socio demographic characteristics of patients admitted at Provincial General Hospital Kakamega (PGHK). DESIGN: Retrospective cross-sectional study. SETTING: Provincial General Hospital Kakamega, the referral hospital for Western Province, Kenya. SUBJECTS: Four hundred patients admitted at the gynaecological wards during the period 1st January 2002 to 31st December 2002. RESULTS: In this study 80% of gynaecological patients admitted at PGH Kakamega were of an emergency nature with 45% being teenagers. The mean age was 17 +/- 3 (mean +/- SD). The majority had primary level of education or below (69%), unemployed (87%) and were rural residents (71%). Patients with abortion formed about 43% of the study group while those with inflammatory disease, pelvic abscess and ectopic pregnancy formed about 24%, 10% and 8% respectively. CONCLUSION: Most gynaecological admissions in PGH Kakamega are of acute nature, with abortion being the most common diagnosis. Hence, trained staff, equipment, supplies and drugs for management of acute gynaecological conditions should be available in hospitals in Western Kenya.

Congenital syphilis in a Nairobi maternity hospital.

OBJECTIVE: To assess adverse pregnancy outcome associated with maternal syphilis and congenital syphilis rate based on FTA-ABS-19s-IgM. DESIGN: Descriptive cross-sectional study. SETTING: Pumwani Maternity Hospital (PMH), the largest maternity unit in Nairobi, Kenya. SUBJECTS: Rapid Plasma Reagin reactive women and their live born infants. MAIN OUTCOME MEASURES: Syphilis serology in pregnant women, FTA-ABS-19s-IgM in cord blood and pregnancy outcome. RESULTS: Three hundred and seventy seven out of 12,414 women (3%) were RPR+. 4.0% of RPR+ and 1.4% of RPR- women delivered a stillbirth (OR 3.0, p<0.001). 19% of RPR+ and 10% of RPR- had low birth weight deliveries (OR 2.1, p<0.001). Mothers untreated for syphilis during pregnancy had significantly more preterm births (18.5% vs 9.2%, OR 2.3, p=0.026), and more stillbirths (5.4% vs 1.0%, OR 6.3, p=0.044). Of the 200 randomly selected cord bloods of RPR+ women, 142 (72%) were TPHA+. Nine (6.3%) of the 142 TPHA+ cords were FTA-ABS-19s-IgM+. CONCLUSIONS: Stillbirth and low birth weight rates were high in RPR+ untreated pregnant women and treatment significantly improved pregnancy outcome. Based on very stringent laboratory criteria (FTA-ABS-19s-IgM), 6.3% of live born infants with TPHA+ cord blood were considered syphilis infected.

The in vitro anti-fungal and anti-bacterial activities of beta-sitosterol from Senecio lyratus (Asteraceae).

From a methanol extract of dried-ground aerial parts of Senecio lyratus, an anti-fungal and anti-bacterial active compound was isolated and identified as beta-sitosterol by spectroscopic analysis.

Knowledge, attitudes, and practices regarding emergency contraception among nurses and nursing students in two hospitals in Nairobi, Kenya.

A cross-sectional descriptive study on knowledge, attitudes, and practice about emergency contraception (EC) was conducted among nurses and nursing students using a self-administered questionnaire. One-hundred-sixty-seven qualified nurses and 63 nursing students completed the questionnaire. Over 95% listed at least one regular contraceptive method but only 2.6% spontaneously listed EC as a contraceptive method, whereas 48% of the respondents had heard of EC. Significantly more nursing students than qualified nurses were familiar with EC. Knowledge about the types of EC, applications, and side effects was poor and 49% of the respondents considered EC as an abortifacient. Of those familiar with EC, 77% approved its use for rape victims and 21% for adolescents and schoolgirls. Only 3.5% of all respondents had personally used EC in the past, 23% of those familiar with EC intend to use it in the future, whereas 53% intend to provide or promote it. The view that EC was abortifacient negatively influenced the decision to use or provide EC in the future. The present findings suggest that the level of knowledge of EC is poor and more information is needed. These findings indicate the potential to popularize emergency contraception in Kenya among nurses and nursing students.

PIP: A descriptive research study on knowledge, attitudes and practices with regard to emergency contraception (EC) was conducted using a questionnaire among 167 nurses and 63 nursing students in Nairobi, Kenya. Results revealed that 95% recorded at least one regular contraceptive method. About 48% of the respondents had heard about EC, but only 2.6% had used it. More nursing students than qualified nurses were aware of EC. There was poor knowledge about the types, applications and side effects of EC. Some 49% of the subjects regarded EC as an abortifacient. About 77% of those knowledgeable about EC approved its use for rape victims and 21% for adolescents and schoolgirls. Only about 3.5% had personally used it. Some 23% of those aware of EC intended to use it in the future. About 53% planned to provide or promote it. The perception that EC is abortifacient affected the decision whether to use or provide it. The data imply that there is potential for effective promotion of EC among nurses and nursing students in Kenya.

Abortion: behaviour of adolescents in two districts in Kenya.

BACKGROUND: In Kenya the reported high rates of unwanted pregnancies (more than 90%), among adolescents have subsequently resulted in unsafely induced abortions with the associated high morbidity and mortality rates. OBJECTIVE: To evaluate the adolescents' behaviour regarding induced abortion. DESIGN: A cross-sectional, prospective study done from July 1995 to June 1996. SETTING: Schools and health facilities in Kiambu and Nairobi districts in Kenya. PARTICIPANTS: Interviews were conducted among adolescents aged 10-19 years in schools at the two districts and selected using a multi-stage random sampling procedure, as well as adolescent girls at two hospitals and two clinics in the immediate post-abortion period. MAIN OUTCOME MEASURES: The number of adolescents health programmes, aimed at reducing the dangers of unsafely induced abortion, which are designed and subsequently implemented. DATA COLLECTION: Demographic and health data, as well as data on behaviour regarding induced abortion were collected using a self-administered questionnaire. RESULTS: The study sample comprised 1820 adolescents. These were 1048 school girls (SG), 580 school boys (SB) and 192 post-abortion (PA). Many adolescents were aware of abortion dangers, with the awareness being significantly lower among the SB whose girlfriends (GF) had aborted than those whose GF had not (p < 0.01). The practice of abortion was reported among 3.4% SG, 9.3% SBs' GF and 100% PA. Direct and indirect costs of abortion were heavy on the girls. Knowledge of the abortion dangers had no influence on the choice of the abortionist. Abortion encounter positively influenced approval by the adolescents, of abortion for pregnant school girls (p < 0.01). CONCLUSION: Despite the costs and awareness of abortion dangers by adolescents, they will take risks.

Abortion: knowledge and perceptions of adolescents in two districts in Kenya.

BACKGROUND: Pregnancy among adolescents is unplanned in many instances. Although some pregnant adolescents carry the pregnancy to term, abortion, in many instances unsafely induced, is a commonly sought solution in Kenya. OBJECTIVE: To determine adolescents' perceptions of induced abortion. DESIGN: A cross-sectional descriptive study carried out between July 1995 and June 1996. SETTING: An urban and a rural district in Kenya. PARTICIPANTS: Adolescents aged 10-19 years in schools in Nairobi and Kiambu districts, and a group of immediate post-abortion adolescent girls in some health facilities in Nairobi. MAIN OUTCOME MEASURES: The number of health programmes formulated and put into use, which are adolescent-friendly and providing information, education and communication on abortion issues. DATA COLLECTION: One thousand eight hundred and twenty adolescents were subjected to a self-administered questionnaire that collected demographic and health data as well as perceptions of induced abortion. Focus group discussions on perceptions of abortion were held with 12 groups of adolescents in schools and the information obtained recorded on paper and in a tape-recorder. RESULTS: One thousand nine hundred and fifty two adolescents, comprising of 1048 school girls (SG), 580 boys (SB), 192 post-abortion girls (PA) and 132 adolescents in the focus group discussions, formed the study sample. More than 90% were aware of induced abortion (IA). Knowledge of IA correlated positively with level of education (P < 0.01). Seventy one per cent of SG, 84% of PA and 40% of SB were aware of abortion-related complications, the most common being infections, death and infertility. Eighty three per cent of PA felt that complications were preventable by seeking care from a qualified doctor compared to one quarter each for the SB and SG. 56% PA, 69% SB and 72% SG felt that abortions were preventable. However, less than 40% proposed abstinence as a primary strategy. The most important source of information on abortion was the media followed by friends and teachers. CONCLUSION: Adolescents are aware of abortion and the related complications, but there is more variability in their knowledge and preventive measures.

Effect of human immunodeficiency virus type 1 infection upon acute salpingitis: a laparoscopic study.

To determine the effect of human immunodeficiency virus type 1 (HIV-1) infection upon pelvic inflammatory disease (PID), a laparoscopic study of acute PID was conducted in Nairobi, Kenya. Subjects underwent diagnostic laparoscopy, HIV-1 serology, and testing for sexually transmitted diseases. Of the 133 women with laparoscopically verified salpingitis, 52 (39%) were HIV-1-seropositive. Tubo-ovarian abscesses (TOA) were found in 33% of HIV-1-infected and 15% of HIV-1-uninfected women (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.2-6.5). Among seropositive women, TOA was found in 55% of those with CD4 cell percent <14% vs. 28% with CD4 cell percent>14% (OR 3.1, 95% CI 0.6-15.3). Neisseria gonorrhoeae was detected in 37 women (28%) and Chlamydia trachomatis in 12 (9%); neither was significantly related to HIV-1 seropositivity. Length of hospitalization was not affected by HIV-1 serostatus overall but was prolonged among HIV-1-infected women with CD4 cell percent <14%. Among patients with acute salpingitis, likelihood of TOA was related to HIV-1 infection and advanced immunosuppression. In general, HIV-1-seropositive women with acute salpingitis responded well to treatment.

Median age at menopause in a rural population of western Kenya.

This was a cross sectional descriptive study to discuss the median age of menopause in a rural area of Western Kenya. The broad objective of the study was to describe the demographic and biophysical characteristics of the study population and determine the age of menopause. A review of the current and medieval records shows average age of menopause has remained relatively constant at 50 years in contrast to the receeding age of menarche. A total of 1078 women aged between 40-60 years were interviewed. The majority (98.8%) were from one ethnic group, the Luhya. Of the 1078 women, 880 (81.4%) were married and 198 (18.6%) were single. The average number of children per woman was 7.74. Most of the women (75.1%) had attained primary school education. Their husbands were unskilled workers in 30.1% of the cases. The mean weight and height of the women was 60.74 kg and 161.1 cm respectively. Using methods of probit analysis, the median and modal age of menopause was found to be 48.28 years in this group of western Kenya women. If generalised for the whole country, these results suggest that an average Kenyan woman lives for over ten years beyond menopause. It is recommended that more attention should be given to the special health problems of postmenopausal population.

PIP: This study describes the demographic and biophysical characteristics of rural menopausal women in Western Kenya. Menopause occurs as the gradual unresponsiveness of the human ovary to gonadotropins, premature ovarian failure at under 40 years, and menopause following surgical procedures of the uterus and ovaries. A 3-phase process starts with low serum estradiol and progesterone, followed by a rise in follicle stimulating hormone, and a rise in luteinizing hormone. Clinical symptoms include vasomotor ones, genitourinary ones, osteoporosis and increased incidence of bone fractures, increased incidence of thromboembolic and ischemic heart disease, and psychological symptoms of anxiety, depression, and memory loss. The age of menopause varies with socioeconomic conditions, race, parity, height, weight, skinfold thickness, lifestyle, and education. Data were obtained for this study from a sample of 1078 women from 7 sublocations in Vihiga division, Kenya. Women were aged 40-60 years. The most populous ethnic group was the Luhya. 81.6% were married, 15.6% were widowed, and 0.7% were divorced. 4 women had never been married. 75.1% had a primary school education; 18.6% had not received any formal education. 30.1% had husbands who were unskilled workers, 28.8% had husbands who were farmers, and 20.6% had husbands who were skilled workers. 1.3% had no children, and 1 woman had 17 children. The average number of children was 7.74. 9 of the nulliparous women were menopausal. The mean height was 161.1 cm. The median age at menopause was 48.28 years. Almost all women were menopausal by 55 years. The total fertility period averaged 35 years. Female life expectancy was 59 years.

Barriers to contraceptive use in Kenya.

This study was designed to identify and to better understand the barriers to contraceptive use among Kenyan-couples. Data were collected through structured interviews and focus group discussions among couples not planning for pregnancy and not using any effective contraceptive method. The study was conducted in the Baba Dogo urban slum area of Nairobi, and Chwele, a rural sub-location in Bungoma, western Kenya. Some important barriers to contraceptive use were identified in couples wishing to space or limit further births. Those barriers included lack of agreement on contraceptive use and on reproductive intentions; husband's attitude on his role as a decision maker; perceived undesirable side effects, distribution and infant mortality; negative traditional practices and desires such as naming relatives, and preference for sons as security in old age. There were also gaps in knowledge on contraceptive methods, fears, rumours and misconceptions about specific methods and unavailability or poor quality of services in the areas studied. This paper recommends that information and educational programmes should be instituted to increase contraceptive knowledge, to emphasise the value of quality of life over traditional reproductive practices and desires, and to improve availability and quality of services.

PIP: This article presents an analysis of interviews and focus group discussions among men and women from an urban slum in Nairobi, Kenya, and the rural Chwele in Bungoma District in the Western Province of Kenya. The systematic sample survey included 594 individual interviews with currently married individuals, where the wife was aged 15-49 years and not pregnant or using contraceptives. 80% of wives and 90% of husbands had at least a primary level of education. 125 couples were from Nairobi and 172 were from Bungoma. The pill was the most widely known method. Wives were more aware of female methods, and husbands were more aware of male methods. 21-28% of persons had ever used family planning. 72% of Nairobi wives who had ever used and 22% of Bungoma wives who had ever used relied on the pill. Almost all knew that family planning services were available but did not use these services. About 33% of individuals in Nairobi and 50% in Bungoma desired no more children. Husbands desired about four or more children than wives wanted. 34-38% of husbands and 63-74% of wives desired to wait at least 2 years before the next pregnancy. About 75% of couples agreed on whether or not they wanted to have additional children, but only 30% of Nairobi couples and 41% of Bungoma couples agreed on the timing of the next birth. 64% of couples in Nairobi and only 42% of couples in Bungoma had joint knowledge of family planning. 6% of Nairobi couples and 27% of Bungoma couples had a joint lack of information on where to obtain contraception. The focus groups revealed a greater range of reasons for nonuse of contraception. Lack of couple agreement and communication were primary reasons for nonuse. Couples had more than the desired family size of 2-4 children due to desired gender balance, parent-naming, and risk of child mortality. Confidence in family planning would be enhanced by better education.

Low birth weight deliveries at the Nyanza General Hospital Kisumu, Kenya.

The results of a four month descriptive study on low Birth weight (LBW) deliveries in Nyanza Provincial General Hospital, Kisumu from 15th March to 30th July 1987 are presented. The incidence of LBW was 15.0%. Premature labour accounted for 55.3% while term small for gestational age contributes 44.7% of all LBW babies. 4.8% of the mothers of LBW babies were teenagers. The mean gravidity of the mother's was 2.5 with 46.8% being primigravidae. Of the multiparae who delivered LBW babies: 26.6%, 25%, 12.9% and 12.1% gave history of previous abortion, premature delivery, neonatal death and stillbirth respectively. The most common antenatal complications associated with LBW delivery were pyrexia (20.2%), premature rupture of membranes before term (16.7%) and multiple pregnancy (14.6%). 82.4% of LBW deliveries were spontaneous vertex delivery, 12.5% vaginal breech delivery and 2.9% caesarean section. The worst perinatal outcome was associated with caesarean section while spontaneous vertex delivery had the best outcome. Other factors associated with good perinatal outcome were increasing birth weight; first stage of labour lasting less than 18 hours and small for gestational age babies.

Attitudes of males to contraception in a Kenyan rural population.

The results of a contraceptive attitudes survey on 355 men carried out between January and March 1987 in Machakos District of Kenya are presented. 93.2% indicated that they approved of Family Planning. Although 63.9% of the respondents felt that family size decision making should be a couple's responsibility and 78.6% of respondents preferred a husband and wife approach to family planning counselling, 56.9% said that the women should be the one to actually use the contraceptive. 88.7% approved of female sterilization while 64.5% disapproved of vasectomy. There is need to re-evaluate the current integrated maternal child health-family planning services to actively and effectively accommodate men.

PIP: Results from the 1977-78 Kenya fertility survey revealed that, although 88% were aware of at least one family planning method, use was only 17% among currently married women of reproductive age. In 1987, a survey was conducted in the northern part of Machakos District of Kenya among 400 men in order to obtain information on male attitudes toward contraception. Of the 355 completed questionnaires, there were 94.6% currently married men with a mean age of 38.1. 31.8% were in polygamous unions and 68.2% were monogamous. Catholic Christians comprised 51.8% and 42 were nonCatholic Christians. 95.5% had some formal education. Family planning was approved of by 93.2% of the men and 86.1% thought their wives approved. 88.4% thought the wife should take the responsibility for actually using contraception. 33.6% thought the male should be the sole decision maker about family size; 1.4% thought the woman should be and 65.3% thought a joint decision was appropriate. 67.6% of the men had discussed family planning with others, of which 79.2% had with friends, 12.1% with family planning field educators, and 6.3% with relatives. 78.6% thought family planning should be presented to couples together. 41.6% thought the man alone or jointly had a role to play in family planning. 45.9% agreed that family planning should be used after the family size was completed, and 45.6% suggested after the first child. When family size had been achieved, 88.7% thought the wife should be sterilized. 64.5% disagreed with vasectomy use ever. 53.5% considered that the right choice of contraceptive would eliminate problems. 32.1% expressed the greatest fear of contraceptive being women falling ill from contraceptive use. Effect on future fertility was the greatest fear men had about vasectomies (59.2%). 23.5% thought male sterilization led to impotence.

Hormonal patterns during the menstrual cycles in healthy black Kenyan women.

PIP: 17 regularly mentruating young black Kenyan women were studied during a mentrual cylcle for their reproductive hormonal patterns. The serum concentrations of Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and Prolactin (PRL) were determined by World Health Organization Matched Reagent Programme Radioimmunoassay (WHO-MR-RIA). A biphasic basal body temperature (BBT) record was also noted. The hormonal patterns showed a mid-cycle LH surge and rise in plasma progesterone beginning with the LH peak and lasting a maximum of 6-8 days after the LH peak. Cycle lengths ranged from 25-32 days with a mean of 28 plus or minus 2 days. The follicular phase ranged from 10-17 days, and the luteal phase lasted from 13-15 days. When the mean LH and FSH concentrations and the mean BBT curve were synchronized on the day of the mid-cycle LH peak, the temperature elevation occured about 48 days after the LH peak. Along with the LH, the FSH showed a mid-cycle peak. The results of this study are consistent with those already documented for Caucasian, Asian and African females^ieng