NUTRIENT INTAKE AMONG PREGNANT TEENAGE GIRLS ATTENDING ANTE-NATAL CLINICS IN TWO HEALTH FACILITIES IN BUNGOMA SOUTH DISTRICT, WESTERN KENYA.

OBJECTIVE: To assess the adequacy of nutrientintake including proteins, energy, calcium, iron, folate and vitamin C and identify the factors associated with nutrient intake. DESIGN: Cross sectional study. SETTING: Healthy facility based. Bungoma District Hospital and Bumula Health centre. SUBJECTS: Teenage pregnant girls attending Antenatal Clinic participated after providing written consent, with girls under 18 years being considered as emancipated minors. A standardised interviewer administered Food Frequency Questionnaire was used to asses the dietary intake. Nutrient calculator was used to determine the nutrient intake of the study participant. RESULTS: The intakes of all selected nutrients were significantly lower than the RDA. Protein intake was significantly associated with Education (OR: 0.537; 95% CI: 0.318-0.907), income (OR: 0.049; 95% CI: 0.919-0.128) and perceived food shortage (OR: 0.617; 95% CI: 0.389-0.890). Energy intake was significantly associated with income (p = 0.007, OR: 2.103; 95%CI: 1.225-3.608). Iron intake was significantly associated with perceived food shortage (OR: 2.548; 95% CI: 1.632-3.980). Hookworm affected calcium intake (OR: 3.074; 95% CI: 1.089-8.698) and malaria parasites affected folate intake (OR: 0.355; 95% CI: 0.226-0.557). Those with hookworm were 3 times more likely to have inadequate calcium intake as compared to those without. CONCLUSION: All the nutrients selected were lower than the Required Dietary Allowance. Level of education, income, Hookworm and malaria affected intake of various nutrients.

Stillbirths at Eldoret District Hospital: a retrospective study.

The result of a one year retrospective study on stillbirths (SBs) occurring at Eldoret District Hospital labour unit between 1st November and 31st October, 1992 is presented. The stillbirth rate (SBR) was 30.5 per 1000 births. 72.2% were fresh stillbirths (FSB). Intrapartum foetal asphyxia was the commonest probable cause of death accounting for 45.8% of all SBs while 26.4% of the SBs were unexplained. 43.9% of the SBs were low birth weight deliveries with mean gestational age for all SBs being 35.4 weeks. Spontaneous vaginal delivery was the commonest mode of delivery. 24.5% of the mothers were teenagers and 37.7% primigravidae. It is suggested that proper antenatal and intrapartum care can significantly reduce the SBR in this unit.

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.

Presentation and health care seeking behaviour of patients with cervical cancer seen at Moi Teaching and Referral Hospital, Eldoret, Kenya.

OBJECTIVE: To determine the clinicopathological characteristics and health care seeking behaviour of cervical cancer patients seen at Moi Teaching and Referral Hospital (MTRH). DESIGN: Prospective cross-sectional study. SETTING: Gynaecology Unit, Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. SUBJECTS: Forty-two consecutive cervical cancer patients seen at MTRH gynaecology unit between May 1998 and November 1999. RESULTS: The mean age of the patients was 49.4 years (95% CI 45.4 to 53.3 years) range 24 to 80 years. All had been married and 42.9% had been in polygamous unions. Slightly more than seventy six per cent had had five or more confirmed pregnancies. Contraceptive everuse was 22%. The mean duration of clinical symptoms on presentation at MTRH was 8.2 months (95% CI 6.5 to 9.8 months) range 1 to 24 months. Female relatives and husbands were the first to be told about the symptoms by 90.3% of the patients and husbands alone by 48.8% of the patients. More than ninety per cent of patients sought health for the first time at a facility manned by trained health worker, with 39% visiting a dispensary or health centre first. More than 95% of patients had tumour stage 2 and above. Histopathologically, 80.9% of the tumours were squamous cell carcinoma, 11.9% were adenocarcinoma while the rest were anaplastic. CONCLUSION: Patients with cervical cancer present late for treatment at MTRH. They are most likely to have discussed their illness with their female relatives and husbands and to have first visited peripheral facilities manned by trained healthcare workers. Interventions to improve health care seeking behaviour among cervical cancer patients need to include education of husbands in addition to increasing awareness of the disease among private medical practitioners and health workers at dispensary and health centre level.

Randomised clinical trial to determine optimum initiation time of norgestrel-progestin only contraception in Eldoret Teaching Hospital, Kenya.

In a randomised controlled trial to determine the optimum time of initiation of Ovrette, a progestin only oral contraceptive among postpartum women, who fully or nearly fully breast-fed their infants in the first six months, no difference was found between group 1 (initiating at six weeks postpartum) and group 2 (initiating the pill at return of menses or 6 months postpartum). There were no pregnancies in either group during the 18 month follow-up. There were no significant differences in the continuation rates between the two group.

PIP: The optimal time for initiation of progestin-only oral contraception (POC) among fully or nearly fully breast-feeding women was investigated in a comparative study conducted among 200 women delivering at Kenya's Eldoret Teaching Hospital in a 2-year period during 1992-94. 100 women were randomly assigned to initiate POC use at 6 weeks' postpartum (group 1), while the remaining 100 women deferred POC initiation until the onset of menses or 6 postpartum months (whichever event occurred first) (group 2). At 12 months postpartum, 53.57% of mothers in group 1 and 56.67% in group 2 were still taking Ovrette; at 18 months, these rates were 46.10% and 43.59%, respectively. The mean duration of use was 7.6 months in group 1 and 7.5 months in group 2. There were 178 episodes of adverse experiences with Ovrette, 16.9% of which involved menstrual disturbances. Adverse experiences were more likely to be perceived as serious and related to Ovrette in group 1 than in group 2. There were no pregnancies recorded, suggesting that initiation of Ovrette use at 6 months postpartum or when menses reappears is a feasible strategy. However, postpartum women should be provided with counseling on the efficacy of the lactational amenorrhea method.