66 research outputs found
Incidence and Predictors of Chronic Hypertension Following Hypertensive Disorders in Pregnancy at Kenyatta National Hospital,(a Descriptive Prospective Cohort Study)
No full textIntroduction: Hypertensive disorders in pregnancy complicate up to 10% of pregnancies worldwide, constituting one of the greatest causes of maternal and perinatal morbidity and mortality. In Kenya, studies conducted at Kenyatta National Hospital have noted a prevalence of 5.4% of hypertensive disease and 0.56% for eclampsia. Hypertension in pregnancy usually resolves after delivery. If it persists, it leads to chronic hypertension which in itself is an important risk factor in cardiovascular disease.
Objective: To determine the incidence and risk factors of chronic hypertension, and time to resolution of hypertension among patients with gestational hypertension and preeclampsia-eclampsiaseen at KNH up to 12 weeks postpartum.
Methodology: This was a prospective descriptive cohort study carried out at Kenyatta National Hospital, Nairobi, Kenya. The study had one hundred and sixteenparticipants with hypertensive disorders in pregnancywho were followed up until 12 weeks postpartum. Data were collected via interviewer-administered questionnaires, serial blood pressure measurements and review of medical records. They were then analyzed using SPSS IBM (Version 21). Categorical variables were subjected to the chi-square test, while continuous variables were compared using Student’s t-test. Risk factors for persistence of hypertension underwent bivariate analysis. A p value<0.05 was considered statistically significant.
Results: A quarter of the study participants were still hypertensive at the end of puerperium. Among these, 30% developed chronic hypertension. The risk factors associated with development of chronic hypertension among these parturients were higher pre-pregnancy BMI (OR=19.4, 95% CI 2.0-187.9, p=0.02), intimate partner violence(OR=2.5, 95% CI 1.0-6.1, p=0.036), lower gestational age at delivery(OR=2.6, 95% CI 1.1-6.2, p=0.035), lower gestational age at onset of hypertension(OR=2.4, 95% CI 1.1-5.7, p=0.038), family history of hypertension(OR=3.0, 95% CI 1.2-7.5, p=0.015), personal history of diabetes mellitus (OR=4.8, 95% CI 1.5-15.4, p=0.008), and thrombocytopenia (OR=2.8, 95% CI 1.1-7.3, p=0.013). Obesity was the only significant risk factor in both univariate and multivariate analysis. The time to resolution of hypertension was found to be 2 weeks postpartum for majority of the patients (57.8%).
Conclusion: Hypertension in pregnancy is a significant risk factor for developing persistent and chronic hypertension after delivery. Timely diagnosis and timely appropriate intervention are the key strategies to reduce the risk of developing future cardiovascular morbidity.
Recommendations: Women with hypertensive disorders in pregnancy should be followed up beyond 6 weeks postpartum and should be counseled on the risk of developing chronic hypertension.a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Keny
Home Visits during Pregnancy Enhance Male Partner HIV Counseling And Testing In Kenya : A Randomized Clinical Trial
No full textThesis (Master's)--University of Washington, 2013Background HIV testing of male partners of pregnant women is important to decrease HIV transmission to women and to support HIV-infected women in taking prevention of mother-to-child HIV transmission (PMTCT) interventions. However, it has been difficult to access male partners in antenatal care (ANC) settings. We hypothesized that home visits to male partners of women attending ANC would be feasible and would increase HIV testing of partners. Methods Pregnant women attending ANC were enrolled, interviewed using smartphone audio-computer assisted self-interviews (ACASI), and randomized to home visits or written invitations for male partners to come to clinic. Enrolled men were interviewed (ACASI) and offered couples HIV counseling and testing (CHCT). Participants underwent follow-up ACASI six weeks post-enrollment. Prevalence of CHCT, male HIV, couple discordance, intimate partner violence were compared using intent-to-treat analysis. Results Among 495 women screened, 312 (63.0%) were eligible, of whom 300 were randomized to clinic-based or home-based HCT. Median age was 22 years [interquartile range (IQR) 20,26]; most were monogamous (87%) and 11% reported condom use and did not differ between trial arms. Male CHCT was substantially and significantly higher in the home-visit than the clinic-invitation arm (87% vs. 36%, p<0.0001). A higher proportion of women in the home-visit than clinic-invitation arm reported improved relationship quality 6 weeks after CHCT (70% vs. 29%, p<0.0001) and there was no increased risk of intimate partner violence or relationship instability. Conclusion Home visits were safe, acceptable, and resulted in more pregnant women and their male partners learning each other's HIV status. This strategy could facilitate efforts to prevent HIV acquisition among pregnant women, improve PMTCT uptake, and accelerate male HIV diagnosis car
Metabolic syndrome following hypertensive disorders of pregnancy and among HIV infected adults: understanding cardiovascular disease risk
No full textThesis (Ph.D.)--University of Washington, 2018In this dissertation we discuss the findings of two studies that describe the burden of the Metabolic syndrome (MetS) in Kenya, a low resource setting with increasing incidence and prevalence of cardiovascular disease (CVD) and other non-communicable diseases (NCD.). In these two complementary studies, we evaluate the risk of MetS in two different study populations, HIV-infected adults and HIV-uninfected postpartum women. In the first study, we use recently collected cross-sectional data to examine the link between HIV and NCD specifically CVD by estimating the prevalence of MetS in HIV infected adults and evaluating the association between use of antiretroviral therapy (ART) and MetS. We found that the prevalence of MetS did not differ between ART experienced and ART naïve groups (16.9% versus 15.2%). However, ART experienced patients had higher prevalence of elevated fasting blood sugars and lower prevalence of low high-density lipoprotein (HDL)-cholesterol. The prevalence of the other components of the MetS; abnormal waist circumference, elevated blood pressure and hypertriglyceridemia were comparable between the two groups. Older age, female sex and high body mass index were independently associated with diagnosis of MetS. The second and main study, is a six-month postpartum prospective cohort nested within a longer 3-year cohort of postpartum women. In this study, the exposed group comprised women with two specific hypertensive disorders in pregnancy (HDP), gestational hypertension and preeclampsia, while the unexposed group were normotensive. In this section of the dissertation we evaluated: 1) the prevalence of MetS between women with and without history of HDP, 2) the sociodemographic and clinical correlates of MetS, and 3) the association between the inflammatory markers, specifically high-sensitivity C-reactive protein (hsCRP) and MetS, overall and stratified by exposure to HDP. All the analyses were conducted at 6 months postpartum. Compared to women without HDP, the risk of MetS was 3 times greater among women with HDP. Also, the risk of 3 of the 5 components of MetS (fasting plasma glucose, triglycerides, and blood pressure) was elevated 3 or more times among those with compared to those without HDP. MetS was independently associated with HDP, higher body mass index, and below secondary level of education. The mean hsCRP level and proportions of high relative CVD risk hsCRP (>3mg/L) levels were higher in women with MetS compared to those without MetS and were significantly different when women with HDP were compared with those without HDP. From this dissertation, composed of two studies conducted in a low resource setting of sub-Saharan Africa, we come to two conclusions. First, we find evidence of similar risk of MetS comparing ART experienced and ART naïve adults, suggesting that traditional CVD risk factors rather than HIV may have a larger contribution to the CVD risk in this population. Secondly, increased risk of MetS among women with HDP versus those without HDP provides evidence that HDP is associated with increased risk of CVD. Also, women with MetS and those with HDP in particular were more likely to have elevated hsCRP levels supporting the role of chronic inflammation and evaluation of inflammatory biomarkers following HDP to estimate the risk of MetS and therefore CVD risk. The elevation of specific components of MetS namely triglycerides, fasting blood glucose, and blood pressure and increased levels of inflammatory marker, hsCRP are important in understanding future research priority areas. Interventions to reduce CVD risk among women after HDP may need to modify these specific risk factors, use inflammatory markers to triage risk and could include dietary changes, exercise, and use of lipid and blood pressure lowering medications, especially statins because they can also reduce inflammatio
Clinical presentation and outcomes of pre-eclampsia and eclampsia at a national hospital, Kenya: A retrospective cohort study
No full textBackground: Hypertensive disorders in pregnancy including pre-eclampsia are associated with maternal and newborn mortality and morbidity. Early detection is vital for effective treatment and management of pre-eclampsia. This study examines and compares the clinical presentation and outcomes between early- and late-onset pre-eclampsia over a two year period. Methods: A retrospective cohort study design which examines socio-demographic characteristics, treatment, outcomes, and fetal and maternal complications among women with early onset of pre-eclampsia (EO-PE) and late onset of pre-eclampsia (LO-PE). De-identified records of women who attended antenatal, intrapartum and postnatal care services and experienced pre-eclampsia at Kenyatta National teaching and referral hospital were reviewed. We used chi square, t-test, and calculated odds ratio to determine any significant differences between the EO-PE and LO-PE cohorts. Results: Out of 620 pre-eclamptic and eclamptic patients’ records analyzed; 44 percent (n = 273) exhibited EO-PE, while 56 percent had late onset. Women with EO-PE compared to LO-PE had greater odds of adverse maternal and perinatal outcomes including hemolysis elevated liver enzymes and low platelets (HELLP) syndrome (OR: 4.3; CI 2.0–10.2; p \u3c 0.001), renal dysfunction (OR; 1.7; CI 0.7–4.1; p = 0.192), stillbirth (OR = 4.9; CI 3.1–8.1; p \u3c 0.001), and neonatal death (OR: 8.5; CI 3.8–21.3; p \u3c 0.001). EO-PE was also associated with higher odds of prolonged maternal hospitalization, beyond seven days (OR = 5.8; CI 3.9–8.4; p \u3c 0.001), and antepartum hemorrhage (OR = 5.8; CI 1.1–56.4; p \u3c 0.001). Neonates born after early onset of pre-eclampsia had increased odds of respiratory distress (OR = 17.0; CI 9.0–32.3, p \u3c 0.001) and birth asphyxia (OR: 1.9; CI 0.7–4.8; p = 0.142). Conclusions: The profiles and outcomes of women with EO-PE (compared to late onset) suggest that seriousness of morbidity increases with earlier onset. To reduce adverse neonatal and maternal outcomes, it is critical to identify, manage, referral and closely follow-up pregnant women with pre-eclampsia throughout the pregnancy continuum
An exploration of sub-national variability in institutional maternal mortality ratios in Kenya:a meta-analysis of the 2021 health facility data
No full textBackground: In many countries in sub-Saharan Africa, the burden of preventable maternal deaths is still unacceptably high. Most Maternal Mortality Ratio (MMR) estimates are national, rarely sub-national. This study explores Kenya's 2021 national health facility dataset on maternal deaths and live births for sub-national variability to describe the pattern and trend in variation in institutional maternal mortality ratios (iMMRs).Methods: Country-wide health facility data on live births and maternal deaths for 2021 were requested from the District Health Information System (DHIS-2). A descriptive comparison of sub-national (Regional and County) iMMRs to national iMMR was carried out. Against a national average iMMR for Kenya of about 100 per 100,000 live births, those regions and counties with an iMMR <75 per 100,000 live births were defined as positive outliers, and those with an iMMR >125 were defined as negative outliers.Results: In 2021, 1,162 maternal deaths and 1,174,774 live births occurred within Kenya's health facilities. The annual national average iMMR was 99 per 100,000 live births [95% confidence interval (CI): 93.3, 104.8]. There was sub-national variability in iMMR at both regional and county levels. Central, Western and Rift Valley regions were positive outliers; North-Eastern Coast and Nairobi regions were negative outliers, while Nyanza and Eastern regions had an iMMR consistent with the national average. Seventeen counties were positive outliers, namely Baringo, Siaya, Nyamira, Elgeyo-Marakwet, West Pokot, Nandi, Kiambu, Laikipia, Nyeri, Samburu, Marsabit, Vihiga, Bungoma, Nyandarua, Kajiado, Murang'a and Trans-Nzoia. Ten counties were negative outliers: Tana River, Mandera, Machakos, Kilifi, Taita–Taveta, Kisumu, Nairobi, Garissa, and Mombasa and Isiolo. The iMMR in the remaining twenty counties was consistent with the national average. The effect sizes of the observed health facility variation were zero and there was no evidence of month-to-month variation.Conclusion: There is evidence of sub-national variability in Kenya's iMMRs. Understanding these reasons for the variability is crucial for developing strategies for improving maternal health outcomes. If positively deviant behaviours and practices are identified, they could form the basis for adopting asset-based approaches such as the positive deviance approach to improve maternal healthcare delivery processes and outcomes and reduce preventable maternal deaths
Effect of extra-amniotic Foley’s catheter and vaginal misoprostol versus vaginal misoprostol alone on cervical ripening and induction of labor in Kenya, a randomized controlled trial
No full textAbstract Background The safest, most effective and fastest combined approaches to induction of labor is unknown. In an open-label randomized clinical trial we evaluated the efficacy of combination of extra-amniotic Foley’s catheter and vaginal misoprostol compared to vaginal misoprostol alone for cervical ripening and induction of labor on the incidence of failed induction, induction-to-delivery interval and adverse maternal and perinatal outcomes. Methods Pregnant women at gestational age of 28 weeks or greater admitted at Kenyatta National Hospital, Kenya for induction of labor were enrolled then randomized to either a combination of extra-amniotic Foley’s catheter inflated by 30 cm3 of normal saline and 25 micrograms of vaginal misoprostol or 25 micrograms of vaginal misoprostol alone. Women underwent 6 hourly reviews and additional misoprostol inserted if required. The primary outcome was incidence of failed induction. Secondary outcomes were induction-to-delivery interval and adverse maternal and perinatal outcomes. We conducted an intent-to-treat analysis and compared means or medians using t-test or Wilcoxon rank, proportions using Chi-square or Fishers test as appropriate. Induction-to-delivery interval were compared using the log-rank test. P-values of < 0.05 and 95% confidence intervals that excluded the null were considered statistically significant. Results Between February and May 2016, we enrolled 180 of 237 pregnant women admitted for induction of labor and randomized them to either a combination of extra-amniotic Foley’s catheter and vaginal misoprostol (n = 90) or vaginal misoprostol alone (n = 90). The socio-demographic and obstetric characteristics were similar between the two groups. Failed induction rates were lower but not statistically significant following combined extra-amniotic Foley’s catheter and vaginal misoprostol (8.9%) versus vaginal misoprostol alone (11.1%). The mean induction-to-delivery time was 4.8 h shorter in the combined extra-amniotic Foley’s catheter and vaginal misoprostol (mean 18.9, standard deviation (SD) 7.2 h) compared to misoprostol only group (mean 14.1, SD 6.9 h) (log-rank test, p < 0.001). Maternal and perinatal complications were similar between the two groups. Conclusions Extra-amniotic Foley’s catheter and vaginal misoprostol for cervical ripening and induction of labor did not significantly lower the incidence of failed induction but safely shortened induction-to-delivery time compared to vaginal misoprostol only. Trial registration Trial was retrospectively registered on 14–03-2016 PACTR201604001535825
Additional file 1: of Effect of extra-amniotic Foleyâs catheter and vaginal misoprostol versus vaginal misoprostol alone on cervical ripening and induction of labor in Kenya, a randomized controlled trial
No full textRegistered Protocol: A combination of foley baloon and misoprostol versus misoprostol alone for induction of labour at Kenyatta national hospital, a randomized controlled trial. (DOCX 84 kb
Fetal head circumference, operative delivery, and fetal outcomes: a multi-ethnic population-based cohort study
No full textRetrospective cohort study: Clinical presentation and outcomes of pre-eclampsia and eclampsia at Kenyatta National Hospital, Nairobi, Kenya
No full textPre-eclampsia has two distinct subtypes: early onset pre-eclampsia, which occurs before 34 weeks of gestation, and late onset pre-eclampsia, which occurs after 34 weeks. Few studies examine and compare early and late onset pre-eclampsia in a low- and middle-income country setting. This study’s goal was to establish a profile of patients with hypertensive disorders in pregnancy, especially pre-eclampsia and eclampsia, over a two-year period. At Kenya’s national referral hospital, clinical presentation at admission was examined, as was management of complications, along with maternal and newborn health outcomes in the hospital’s maternity unit, to ascertain any differences in health outcomes for early and late onset pre-eclampsia. This report details the study’s findings, showing that out of the 620 records reviewed, 44 percent of pre-eclamptic and eclamptic women exhibited early onset of pre-eclampsia, while 56 percent had late onset. Early onset of pre-eclampsia was associated with greater disease severity as well as adverse maternal and perinatal outcomes. Early detection, continuous monitoring, identification of risk factors, and prompt referral are critical in mitigating the serious consequences of pre-eclampsia and eclampsia
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