East African Medical Journal

Caesarean myomectomy: A challenge or an opportunity? Case series from two centers in Addis Ababa, Ethiopia

S. N. Abebe — Tue, 13 May 2025 00:00:00 +0000

Background: There is no consensus on the management of myoma during cesarean section. The existing dictum of considering cesarean myomectomy as a dreadful practice due to serious concern for uncontrolled hemorrhage and possible peripartum hysterectomy with an increased risk for peripartum morbidity and mortality is being challenged by experts in contemporary obstetrics. Cesarean myomectomy (CM) in the properly selected patients and in experienced hands could be a better opportunity than leaving the tumor behind, especially in population like ours, where there is a common misconception of considering any “tumor” as cancer that could negatively impact the physical and the psychosocial life of the women. In addition, the presence of the tumor might demand an additional surgery which in turn necessitates multiple exposure to anesthesia and surgeries with increased risk of morbidity and mortality and imposing on patients &/families an additional out-of-pocket expenditure.

Methods: Fifteen cases of CM performed at two centers by a single senior Obstetrician and Gynecologist were presented. The details of the cases, the techniques employed, the intraoperative and postoperative events were furthered.

Conclusion: Based on the available evidences and the experiences learnt from the two centers, cesarean myomectomy could be performed in the properly selected and counselled patients. However, the expertise of the skilled surgeon to perform more advanced and conservative procedures for the anticipated complications and the need for a conducive environment is critical.

Demographic and clinical characteristics of venous thromboembolism in children

D. Owende, B. Kariuki, I. Kihurani, F. Were — Tue, 13 May 2025 00:00:00 +0000

Objective: To describe the demographic and clinical characteristics of venous thromboembolism in children at two tertiary hospitals in Kenya.

Design: Descriptive retrospective chart review.

Setting: Aga Khan University Hospital and Gertrude’s Children’s Hospital Nairobi.

Participants: Patients aged one month to 18 years diagnosed with radiologically confirmed venous thromboembolism between January 2014 and December 2022.

Main outcome measures: Continuous data: age.

Discrete data: proportion of patients, the time from onset of symptoms to the radiologic diagnosis of venous thromboembolism and the length of hospital stay.

Categorical data: sex distribution, unit of hospital admission, site of venous thromboembolism, diagnostic imaging modality and complications. Other outcome measures included factors associated with the development of venous thromboembolism, and its management.

Results: Sixty patients were included in the present study with 5.6 venous thromboembolic events/ 10,000 hospital admissions documented. Venous thromboembolism was predominantly observed in adolescents at 41.7% with a female predominance of 61.7%. Most patients (86.7%) developed venous thromboembolism during their hospital stay. The median time from admission to diagnosis was three days while the median length of hospital stay was 13 days. Underlying infection and malignancy were the most common comorbidities. Resolution of the thrombosis was documented in most patients (51.6%) and the case-fatality ratio was 11.7%.

Conclusion: The number of children with venous thromboembolism in this setting compares with that from high-income countries from two decades ago. At least a quarter of these patients had associated morbidity and mortality.

Factors associated with low-birth-weight among women with preeclampsia in a Tertiary Hospital in Western Kenya: A cross sectional study

L. Sigei, E. Nyaga, N. Kingau — Tue, 13 May 2025 00:00:00 +0000

Problem: Preeclampsia is among the leading causes of fetal mortality, attributable to over 500 000 neonatal deaths globally.

Background: It is a multifactorial disorder that causes placental insufficiency and consequent fetal growth restriction significantly contributing to low birth weight (LBW); a crucial measure of child’s vulnerability to illnesses and reduced chances of survival. Studies on preeclampsia underrepresent Africa, a region that bears the highest prevalence and adverse neonatal outcomes of pre-eclampsia.

Broad Objective: To determine factors associated with LBW among women with preeclampsia.

Methods: A descriptive cross-sectional study was conducted among 173 participants recruited using systematic random sampling. Data on social-demographic, obstetric, and environmental characteristics were gathered and analyzed. Descriptive statistics were computed; Chi square test, Wilcoxon test, and logistic regression were used to determine association between maternal characteristics and occurrence of low birthweight.

Findings: Participants mean age was 26.69±7.77 years, 93(53.8%) attended antenatal clinic 1-3 times, and 39(22.5%) had Hemolysis, Elevated Liver enzyme and Low Platelets, HELLP syndrome. A multivariate logistic regression analysis found that low birthweight was associated with maternal age 15-19 years (p=.035), prematurity (p<.001), lack of antenatal clinic attendance (p=.011), and hemolytic elevated liver enzymes and low platelet count syndrome (p<.001).

Conclusion: Younger maternal age, prematurity, lack of clinic attendance, and HELLP syndrome remain preventable factors attributable to LBW among women with preeclampsia.

Factors associated with inappropriate blood transfusion among obstetric patients at Moi Teaching and Referral Hospital, Eldoret Kenya

C. Biwot, P.K. Tonui, B.J. Locho, J. Odunga — Tue, 13 May 2025 00:00:00 +0000

Objectives: To determine the blood transfusion rate, identify the indications for blood transfusion and assess the appropriateness of blood transfusion among obstetric patients at Moi Teaching and Referral Hospital, (MTRH) Eldoret.

Methods: This was a hospital based cross-sectional study. Pregnant women from 28 weeks of gestation to 6 weeks postpartum, who received transfusion of blood and blood products, were included in the study. A total of 228 participants were enrolled in the study.

Results: The blood transfusion rate among obstetric patients at Moi Teaching and Referral Hospital was 3.82%. Obstetric hemorrhage accounted for 72% of all indications for transfusion of blood and blood products, while anemia in pregnancy explained 28% of indications. The commonest indication for transfusion of blood and blood products was uterine atony at 34.2%, followed by genital tract trauma at 14.5% and anemia in pregnancy at 14.0%. Postpartum anemia and retained placenta accounted for 13.2% and 11.4% respectively. HELLP syndrome (6.1%), placental abruption (4.8%), secondary post-partum haemorrhage (3.1%), placenta Previa (2.2%) and uterine rupture (1.8%) accounted for the remainder of the cases. Overall, 37.3% of blood transfusions were inappropriate, with pre- transfusion hemoglobin level and referral status being significantly associated.

Conclusions: The blood transfusion rate among obstetric patients at Moi Teaching and Referral Hospital was 3.82%. Uterine atony was the most common obstetric indication for blood transfusion at 34.2%. Only 37.3% of blood transfusions were inappropriate as per the Kenya National Blood Transfusion Services (KNBTS) blood transfusion guidelines. Patients who had been referred from other facilities and those with a pretransfusion hemoglobin level above 7g/ dL were more likely to receive an inappropriate blood transfusion.

Depression and anxiety among medical students at a public university in Kenya: A cross-sectional study

T.E.N. Kahihia, V.J.W. Kimando, F.M. Nageyle, M.A. Magoha — Tue, 13 May 2025 00:00:00 +0000

Background: Mental health challenges such as depression, anxiety and burnout are a rising concern among medical students globally due to the intensive nature of their training. Those in low to middle income countries experience additional socio-economic stressors that contribute further to the growing prevalence of these disorders in this population. In Kenya, there is no research available on the prevalence of these psychiatric illnesses among medical students. Our study aimed to determine the prevalence of depression and anxiety among medical students at the University of Nairobi.

Methodology: The study utilized a cross-sectional study design. A survey was conducted using validated psychometric instruments: 21- question Beck Anxiety Inventory (BAI) for anxiety and 12-question Major Depression Inventory (MDI) for depression. The survey ran from August to September 2023 and included 254 responses from enrolled medical students at the University of Nairobi. The data was analysed and tabulated using SPSS version 27.

Results: We collected 254 responses, majority of the participants, 66.9% (n=170), being female. 49.6% (n=126) of the students reported severe anxiety, while 34.6% (n=88) reported severe depression. Being female was associated with a higher likelihood of both anxiety and depression (p<0.001, p=0.002 respectively). Conversely, age and year of study demonstrated no significant association with depression or anxiety. Students with high levels of anxiety were more likely to have high levels of depression (p<0.001). 87% (n=221) of students also believe their mental health affected their academic output.

Conclusion: The study indicated a significant prevalence of anxiety and depression among medical students at the University of Nairobi. Reviewing medical school curricula and implementing systems and procedures to mitigate challenges is essential for enhancing academic performance and patient care among students. Future research should further examine the socio-demographic factors that contribute to these disorders.

Factors shaping HIV knowledge among Kenyan women: A cart analysis across individual, family and community dimensions

S.S. Moon, J. Lee, A.A. Obondo, C.M. Musyoka , T. Christian — Tue, 13 May 2025 00:00:00 +0000

Background: HIV remains a critical public health concern in Kenya, particularly affecting women aged 15-24. Despite various interventions, two-thirds of young people in Kenya lack comprehensive knowledge about HIV, which heightens their risk of infection.

Objectives: This study aims to explore the factors influencing HIV knowledge among Kenyan women, focusing on socio-demographic, behavioral, and familyrelated predictors.

Methods: Data were drawn from the 2022 Kenya Demographic and Health Survey (KDHS), analyzing a sample of 3,422 couples. The study employed Classification and Regression Tree (CART) analysis to examine how various factors—such as female educational attainment, media exposure, age at first sexual experience, and decision-making autonomy—impact HIV knowledge among women.

Results: Key predictors of HIV knowledge were identified, with significant findings showing that women with higher levels of education (1,694 women, 49.5%, χ² = 324.58, p < 0.001), increased media exposure (1,929 women, 56.4%, χ² = 216.20, p < 0.001), and greater decision-making power (2,149 women, 62.8%, χ² = 30.92, p < 0.001) exhibited a superior understanding of HIV.

Conclusions: The results highlight the critical roles of education, media access, and empowerment in enhancing HIV prevention efforts for women in Kenya. To reduce HIV transmission among young women, targeted interventions focusing on education, media exposure, and the promotion of women's decision-making power are essential.

Fetal outcomes in cesarean deliveries for non-reassuring fetal status at a Tertiary Hospital in western Kenya: A retrospective cross-sectional study

C.O. Oyolo, A. Wameyo, W. Otieno, R.N. Demba — Tue, 13 May 2025 00:00:00 +0000

Background: Non-reassuring fetal status (NRFS) encompasses feto-maternal conditions compromising fetal oxygenation, commonly presents as abnormal fetal heart rhythm and meconium-stained liquor. It is a leading indicator of emergency cesarean sections. In 2021, NRFS accounted for 36.03% of cesarean sections at Jaramogi Oginga Odinga Teaching and Referral Hospital. Owing to these numbers, we did an in-depth evaluation of the fetal outcomes from emergency caesarian sections at this hospital. The outcome would provide better knowledge base to guide decisions regarding optimal indications of emergency caesarian.

Objective: To determine the fetal outcome in cesarean deliveries for non-reassuring fetal status at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH).

Methods: A retrospective cross-sectional study, from January, 2020 to December 2022. A total of 191 patients files were reviewed. Both descriptive and inferential analyses were employed for analysis.

Results: We found that in mothers who presented with NRFS, 59 (30.9%) fetuses presented with tachycardia, 28 (14.7%) with bradycardia and 104 (54.4) had meconium-stained liquor (MSL). 51 (26.7%) were taken to new born unit and 11 (5.8%) fetal demise, persistent fetal tachycardia contributed to 1 death, persistent fetal bradycardia 6 deaths or Meconium stain liquor 4 deaths. The rate of meconium-stained amniotic fluid deliveries in our study were 46 (14.66%) infants had meconium grade three and 58 (30.83%) had meconium grade two.

Conclusion: Mothers presenting with non-reassuring fetal heart and meconiumstained liquor had an increased risk of adverse fetal outcome.

Pregnancy outcomes differences between adolescent and adult mothers at a Tertiary Hospital in western Kenya: A prospective cohort study

C. Adul, K. Muruka, P.M. Kosiyo — Tue, 13 May 2025 00:00:00 +0000

Background: Adolescent pregnancy remains a significant public health concern globally, particularly in low- and middle-income countries such as Kenya. Despite the global efforts to reduce adolescent pregnancies, the specific outcomes for adolescent mothers in Western Kenya remains understudied.

Objective: To compare maternal and neonatal outcomes between adolescent and adult pregnancies at a tertiary hospital in western Kenya.

Methods: A prospective cohort study was conducted at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). A total of 312 pregnant women, aged 10-49 years, were enrolled, with a 1:3 ratio of adolescent to adult participants. Non-random consecutive sampling was employed for both adolescent and adult participants presenting for delivery at or beyond 28 weeks of gestation. Participants were followed up to six weeks postpartum. Descriptive statistics and Chi-square tests were used to analyse sociodemographic characteristics, while inferential statistics, including Pearson Chi-square tests and multivariate logistic regression, were employed to compare maternal and neonatal outcomes.

Results: 70.5% of adolescent mothers were single compared to 25.2% of adult mothers, and 44.9% of adolescent mothers had not completed primary school, in contrast to 11.9% of adult mothers. Adolescent mothers also experienced a significantly higher prevalence of anaemia (adjusted odds ratio (aOR): 2.52; 95% CI 1.46-4.37; p=0.001) but showed similar rates of mode of delivery and postpartum haemorrhage (PPH). Neonatal outcomes, including Apgar scores and birth weight, were similar between the two groups; however, there was a non-significant higher rate of newborn unit (NBU) admission (aOR: 2.58; 95% CI 0.94-7.09; p=0.066) and neonatal deaths (aOR: 1.95; 95% CI 0.16-24.37; p=0.605) in the adolescent group.

Conclusion: Adolescent mothers are at a significantly higher risk of maternal anaemia during pregnancy and should be offered enhanced antenatal care (ANC), including targeted interventions to address anaemia

Occurrence and patterns of maxillofacial fractures at Moi Teaching and Referral Hospital, Kenya

M.K. Korir, C. Micha, M. Lofty — Tue, 13 May 2025 00:00:00 +0000

Background: The prevalence of maxillofacial fractures is rising in Kenya, leading to increased hospitalization and risk of mortality. Its etiology has been attributed to increased use of motorized transport, assault, sport and occupational injuries.

Objective: This study aimed to determine the occurrence and patterns of maxillofacial fractures at Moi Teaching and Referral Hospital (MTRH).

Methodology: A cross-sectional study conducted at the departments of dentistry, accidents and emergency as well as surgical wards of MTRH among 206 patients diagnosed with maxillofacial fractures who were sampled systematically. Physical examination and assessment of the clinical investigations were performed prior to enrollment. Sociodemographic characteristics, injury history and fracture classification data were collected using a semi-structured questionnaire. Pearson’s chi-square statistical test was used to assess the association between etiology (independent variable) and pattern (dependent variable) of maxillofacial fractures.

Results: Majority of the participants were male (86.9%; n=179) with a mean (30.8 ± 11.3) and median age of 29.0 (IQR: 23.75, 37.0) years. 114 (55.3%) and 34 (16.5%) participants were victims of motorcycle and motor vehicle accidents respectively. 80.9% did not have any protective gear at the time of injury. Maxillofacial fractures were classified as upper third (7.7%), middle third (60.8%) and lower-third of the face (24.1%) as well as combined and other fractures (7.4%). Mandibular fractures (27.6%) were the most common, followed by those on the zygoma arch (18.4%), zygoma body (14.1%) and maxilla (13.7%). Furthermore, 72 (35.0%) sustained multiple fractures on a single bone. Motorized transport accidents were significantly associated with orbital wall (p=0.023) and maxilla (p=0.003) as well as multiple fractures (p=0.006).

Conclusions: Maxillofacial fractures are common among male, married, selfemployed individuals with at least secondary level of education who are victims of motorcycle accidents. The mandible is the most fractured maxillofacial bone, with a significant association between etiology and the pattern of maxillofacial fractures seen.

Unilateral absent right pulmonary artery: A rare disorder with successful outcome

N. Adan, A. Hussein, B. Muthee, D.S. Quadros — Tue, 13 May 2025 00:00:00 +0000

Unilateral absent pulmonary artery (UAPA) is a rare congenital absence of either the right or left pulmonary artery. Congenital unilateral absence of the pulmonary artery is more often right-sided and typically an isolated defect, however absence of the left pulmoanry artery is more frequently accompanied by other heart defects. Herein we report a case of an 11-month-old infant who was diagnosed with an absent right pulmonary artery at 3 month of age and underwent successful surgical correction.