Tina, LD, Omoni G, Lee K, WAKASIAKA S, Campbell M, Watiti J, Mathai M.  2013.  A pilot quasi-experimental study to determine the feasibility of implementing a partograph e-learning tool for student midwife training in Nairobi. Abstract

the partograph is a tool used globally to record labour progress. Although it has the potential to improve maternal and neonatal outcomes, some midwives struggle with using it in practice. Training in partograph use is limited, and the theory is often divorced from practice. Innovative ways of improving training are urgently required. We therefore aimed to determine whether the use of an e-learning tool is beneficial for learning partograph skills. an uncontrolled before-and-after study was conducted, informed by Kirkpatrick's four-stage model of evaluation; we report on the first two stages. We included a cohort of third and fourth year midwifery students who were studying at one university in Nairobi. The same hypothetical case scenario was used, pre- and post-implementation of the World Health Organization partograph e-learning tool, to assess students' partograph completion ability. Views on the tool were also sought, using semi-structured questionnaires. Data were analysed using standard statistical techniques and framework analysis. 92 (88%) students participated. Students expressed positive views about the e-learning tool. However, the mean post-intervention score (27.21) was less than half of the maximum obtainable score. There was some improvement in test scores; year three mean score pre-intervention was 21.39 (SD 5.72), which increased to 25.10 (5.41) post-intervention (paired-t=3.47, p=0.001); year four mean score pre-intervention was 24.39 (5.98) which increased to 29.30 (6.77) post-intervention (paired t=3.85, df=91, p<0.001). In the post-test, year four students scored higher than year three students (unpaired t=3.28, df=90, p=0.001). Students were unable to plot cervical dilatation correctly, once established labour had been confirmed. e-Learning training is acceptable to student midwives and has the potential to be an effective means of teaching the practical application of the partograph. However, in this study, their inability to correctly plot transference from the latent to active phase of labour suggests that the partograph itself may be too complicated. Modifications and further evaluation of the e-learning tool would be required before any widespread implementation. Furthermore, students need the clinical support to operationalise their learning; educating qualified midwives and obstetricians to be positive role models when completing the partograph would be one potential solution. Further research is required, taking on board the recommendations from our pilot study, to investigate the impact of partograph e-learning on practice and clinical outcomes.

Khasakhala, LI, Ndetei DM, Mathai M.  2013.  Suicidal behaviour among youths associated with psychopathology in both parents and youths attending outpatient psychiatric clinic in Kenya. Abstract

Suicide is a major cause of death among youths particularly with psychiatric, alcohol abuse and substance abuse disorders. There are relatively few studies on the relationship between psychiatric and substance abuse disorders with suicidal behaviour from low-income countries. This study examines the relationship between suicidal behaviour and co-existing psychiatric or substance disorders among youths and depressive and alcohol use disorders in their parents. METHOD: The study sample had 678 respondents: 250 youths and 226 and 202 biological mothers and fathers, respectively. RESULTS: This study found a significant statistical association between depressive (p < 0.001), alcohol abuse (p <0.001) and substance abuse (p < 0.001) disorders and suicidal behaviour in youths. There was a significant relationship between maternal depressive disorder (p < 0.001) and perceived maternal rejecting parenting behaviour (p < 0.001) with suicidal behaviour in youths. There was a greater odds of a youth with two to three (odds ratio (OR) = 3.63; p = 0.009) and four or more (OR = 8.23; p < 0.001) co-existing psychiatric disorders to have suicidal behaviour than a youth with only one psychiatric disorder. The results also indicate that a higher proportion of youths between ages 16--18 years had suicidal behaviour than youths below 16 years or above 18 years of age (p = 0.004). CONCLUSION: These findings suggest that youths with psychiatric and substance abuse disorders have mothers living with a depressive disorder. Also, perceived maternal rejecting parenting behaviour contributes significantly to the development of suicidal behaviour later in adolescent years.


Kamau, JW, Kuria W, Mathai M, & LA, Kangethe R.  2012.  Psychiatric morbidity among HIV-infected children and adolescents in a resource-poor Kenyan urban community, . AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV . 24:7:836-842.
Khasakhala, LI, Ndetei DM, Mutiso V, Mbwayo AW, Mathai M.  2012.  The prevalence of depressive symptoms among adolescents in Nairobi public secondary schools: association with perceived maladaptive parental behaviour . Afr J of Psychiatry. 15: :106-113.


DM, N, M M, L K, V M, A M.  2010.  University Medical Education In Kenya: The Challenges. . Medical Teacher.; : . 32(10):812-815.


Shah, A, Fawole B, M'imunya JM, Amokrane F, Nafiou I, Wolomby JJ, Mugerwa K, Neves I, Nguti R, Kublickas M, Mathai M.  2009.  Cesarean Delivery Outcomes From The Who Global Survey On Maternal And Perinatal Health In Africa. AbstractWebsite

OBJECTIVE: To assess the association between cesarean delivery rates and pregnancy outcomes in African health facilities. METHODS: Data were obtained from all births over 2-3 months in 131 facilities. Outcomes included maternal deaths, severe maternal morbidity, fresh stillbirths, and neonatal deaths and morbidity. RESULTS: Median cesarean delivery rate was 8.8% among 83439 births. Cesarean deliveries were performed in only 95 (73%) facilities. Facility-specific cesarean delivery rates were influenced by previous cesarean, pre-eclampsia, induced labor, referral status, and higher health facility classification scores. Pre-eclampsia increased the risks of maternal death, fresh stillbirths, and severe neonatal morbidity. Adjusted emergency cesarean delivery rate was associated with more fresh stillbirths, neonatal deaths, and severe neonatal morbidity--probably related to prolonged labor, asphyxia, and sepsis. Adjusted elective cesarean delivery rate was associated with fewer perinatal deaths. CONCLUSION: Use of cesarean delivery is limited in the African health facilities surveyed. Emergency cesareans, when performed, are often too late to reduce perinatal deaths.

Muthoni, M, Levine T, and Asaah AH.  2009.  Who’s Afraid of Female Sexuality. Empathy and Rage: Female genital Mutilation in African Literature. . : Ayebia Clark. UK
Othieno, CJ, Kitazi N, Mburu J, Obondo A, Mathai MA, Loewenson. R.  2009.  Use of participatory, action and research methods in enhancing awareness of mental disorders in Kariobangi, Kenya: . International Psychiatry . 6(1)


Othieno, CJ, Kitazi N, Mburu J, Obondo A, Mathai MA, Loewenson R.  2008.  Community participation in the management of Mental disorders in Kariobangi, Kenya .


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