B PROFOJWANGSHADRACK, OTIENO DRODAWAFRANCISXAVIER. "
Lema VM, Ojwang SBO, Wanjala SHM Rupture of gravid uterus. E. Afr. Med. J. 1991: 68, 430.". In:
E. Afr. Med. J. 1991: 68, 430. Rao, W. O., Ogonji, J. A.. and Aywa, S.; 1991.
AbstractA total of 105 patients were treated for ruptured gravid uteri at the Kenyatta National Hospital, Nairobi, Kenya, over a five year period, January, 1984 to December, 1988. During the same period, there were 44,156 deliveries, giving an incidence of uterine rupture of 1:425 deliveries. Of these, records for 95 patients were traced and analysed, and the results are presented here. Majority (61.0%) of these patients were aged less than 30 years, and 62.1% were gravida 5 or less. 54 (56.8%) of them had rupture of scarred uteri, 33 (34.7%) had spontaneous rupture, while 8 (8.4%) had traumatic rupture. 56 (59.0%) ruptured while at the Kenyatta National Hospital. Repair of the uterus without tubal ligation was the treatment offered to most of them, while total abdominal hysterectomy was rarely done. The perinatal case fatality rate was 60% and there were two maternal deaths giving a maternal case fatality rate of 2.1%. Factors associated with uterine rupture at the Kenyatta National Hospital are discussed, and possible ways of reducing the incidence suggested. PIP: Physicians treated 105 patients with uterine rupture at Kenyatta National Hospital (KNH) in Nairobi, Kenya between January 1984-December 1988. The ruptured gravid uterus incidence during the study period was 1:425. 56.8% of the mothers were between 20-29 years old. 62.1% were gravida 5. 21.1% had received no prenatal care. 59% ruptured at this hospital. Adequate labor monitoring would have prevented rupturing. 56.8% experienced at least 1 previous cesarean section (C-section). Only 2 women had had a classical C-section. Moreover 21.1% of mothers who had prenatal care at KNH underwent a previous C-section. Perhaps health workers did not evaluate these women properly. 74% of the mothers were at least 38 weeks gestation. 34.7% had a spontaneous rupture due to prolonged labor (12 hours). 8.4% experienced a traumatic rupture. 94.7% happened during labor. Most of the tears (51.6%) occurred along the lower anterior uterine segment primarily on the transverse or on a C-section scar. Surgeons were able to repair the uterus without tubal ligation in 47.4% of the cases. They could repair the uterus of 11.6%, but also had to perform a tubal ligation. They conducted a partial hysterectomy on 38% and total hysterectomy on 3.2%. 38.9% gave birth to their infants vaginally. 55.8% of the mothers gave birth to a stillborn infant. 35.8% of the infants were delivered in good condition and survived. 4.2% were in poor condition and survived and 4.2% were in poor condition and died. All the infants in the peritoneal cavity were already dead, but not all of those in the uterus died. The case fatality rate stood at 60%. 2.1% of the mothers died, all after surgery. 1 mother actually died of injuries from an earlier assault. In conclusion, C-section was the major predisposing factor. Ruptured gravida uteri continued to be a major obstetric problem in Kenya.
B PROFOJWANGSHADRACK, OTIENO DRODAWAFRANCISXAVIER. "
Lilian W, Nasah BI Leke RJI, Ojwang SBO Determinants of Perinatal Mortaligy Hour and Day of birth and method of delivery at the central maternity .". In:
East Afr Med J. 1992 Sep;69(9):483-6. Rao, W. O., Ogonji, J. A.. and Aywa, S.; 1991.
AbstractAn audit of 381 hysterectomies performed over a 5 year period (1986-1990) was carried out. In order to assess justification of the indication for hysterectomy pre-operative diagnoses were divided into two groups: those potentially confirmable by pathologic study and those not potentially confirmable by pathologic study. Out of the 273 cases studied in the first group, 246 (90.1%) were justified, while out of the 108 cases studied in the second group, 82 (75.9%) were justified. An overall 86% justification rate was observed. Adenomyosis as a histopathologic finding was seen more commonly in Asian than African patients (P < 0.005). Morbidity rate was 20% and there were no mortalities. The procedure in general was considered safe and justified
B PROFOJWANGSHADRACK, OTIENO DRODAWAFRANCISXAVIER. "
Odongo FN, Ojwang SBO E. Afr. Med. J. 1991: 67, 830.". In:
E. Afr. Med. J. 1991: 68, 74. Rao, W. O., Ogonji, J. A.. and Aywa, S.; 1991.
AbstractAdolescent sexuality has become a major problem all over the world. This review paper describes the main problems encountered in Kenya with regards to adolescent sexuality. The role of the Government and some non-governmental organisations is outlined. Factors which contribute to the problem of adolescent sexuality in Kenya are described. The paper stresses the role of research in solving these problems and finally suggests some strategies which may be adopted in order to minimise the undesirable effects of adolescent sexuality in Kenya. PIP: Kenya's population has increased from 5.4 million in 1948 to 15.3 million in 1979 and is expected to rise to 39 million by 2000. The population growth rate has risen from 2.5% in 1948 to 3.8% in 1979. Improvements in health and economic status since independence have caused significant changes from 1948-79: the fertility rate of women has increased from 6.5-7.9, the crude death rate has decreased from 25/1000-14/1000, infant mortality has decreased from 184/1000-104/1000 births, and life expectancy has increased from 35-54 years. Adolescent girls, 15-24, contribute up to 30% of total pregnancies of females, 15-49, and will form 44.2% of the reproductive age group by 2000. Between 1960 and 1979 the fertility rate of girls 15-19 has increased from 141/1000-168/1000. The age of menarche has dropped from 17 to 12-15. In 1 rural community 41.9% of the girls and 76.1% of the boys aged 12-23 had at least one sexual experience. The mean age at first coitus was 13.7 for boys and 14.9 for girls. 42% of the girls and 74.8% of the boys had more than one sexual partner. Because of the gradual change from extended families to nuclear families, education, role models, and any established activities that initiated youth into adulthood have virtually disappeared, leaving adolescents uneducated and unprepared. Only 2-6% use any form of contraception. 58.4% of rural and 64.4% of urban pregnant girls are in primary school at the time of conception. 8340-10,400 girls drop out of school due to pregnancy each year. 46.6% of girls who get pregnant are not married. Abortions among the adolescents account for 28-64% of abortions done in hospitals, but because of strict abortion laws in Kenya, most adolescents resort to criminal abortions frequently performed by inexperienced people in unsanitary conditions. Sexually transmitted diseases (STDs) are not uncommon among adolescents: 36.8% of pregnant adolescent females had at least 1 STD, compared to 16% of those aged 25 and above. Contraceptive services, education, and laws protecting the adolescent must be instituted in response to the problems of adolescent sexuality.
B PROFOJWANGSHADRACK, OTIENO DRODAWAFRANCISXAVIER. "
Ojwang SBO, Maggwa ABN Adolescent sexuality in Kenya.E. Afr. Med. J. 1991: 68, 74.". In:
E. Afr. Med. J. 1991: 68, 74. Rao, W. O., Ogonji, J. A.. and Aywa, S.; 1991.
AbstractAdolescent sexuality has become a major problem all over the world. This review paper describes the main problems encountered in Kenya with regards to adolescent sexuality. The role of the Government and some non-governmental organisations is outlined. Factors which contribute to the problem of adolescent sexuality in Kenya are described. The paper stresses the role of research in solving these problems and finally suggests some strategies which may be adopted in order to minimise the undesirable effects of adolescent sexuality in Kenya. PIP: Kenya's population has increased from 5.4 million in 1948 to 15.3 million in 1979 and is expected to rise to 39 million by 2000. The population growth rate has risen from 2.5% in 1948 to 3.8% in 1979. Improvements in health and economic status since independence have caused significant changes from 1948-79: the fertility rate of women has increased from 6.5-7.9, the crude death rate has decreased from 25/1000-14/1000, infant mortality has decreased from 184/1000-104/1000 births, and life expectancy has increased from 35-54 years. Adolescent girls, 15-24, contribute up to 30% of total pregnancies of females, 15-49, and will form 44.2% of the reproductive age group by 2000. Between 1960 and 1979 the fertility rate of girls 15-19 has increased from 141/1000-168/1000. The age of menarche has dropped from 17 to 12-15. In 1 rural community 41.9% of the girls and 76.1% of the boys aged 12-23 had at least one sexual experience. The mean age at first coitus was 13.7 for boys and 14.9 for girls. 42% of the girls and 74.8% of the boys had more than one sexual partner. Because of the gradual change from extended families to nuclear families, education, role models, and any established activities that initiated youth into adulthood have virtually disappeared, leaving adolescents uneducated and unprepared. Only 2-6% use any form of contraception. 58.4% of rural and 64.4% of urban pregnant girls are in primary school at the time of conception. 8340-10,400 girls drop out of school due to pregnancy each year. 46.6% of girls who get pregnant are not married. Abortions among the adolescents account for 28-64% of abortions done in hospitals, but because of strict abortion laws in Kenya, most adolescents resort to criminal abortions frequently performed by inexperienced people in unsanitary conditions. Sexually transmitted diseases (STDs) are not uncommon among adolescents: 36.8% of pregnant adolescent females had at least 1 STD, compared to 16% of those aged 25 and above. Contraceptive services, education, and laws protecting the adolescent must be instituted in response to the problems of adolescent sexuality.
B PROFOJWANGSHADRACK, OTIENO DRODAWAFRANCISXAVIER. "
Ojwang SBO, Omuga B.Contraceptive use among women admitted with abortion in Nairobi. E. Afr. Med. J. 1991::68, 197.". In:
E. Afr. Med. J. 1991::68, 197. Rao, W. O., Ogonji, J. A.. and Aywa, S.; 1991.
AbstractIn this study, a total of 519 patients were interviewed. 82.5% had incomplete abortion. The implication of abortion especially when induced is emphasised. Economic implications that are contributed by the youth are stressed. 83.6% of the patients had not used any contraception. The role of contraception in preventing unwanted pregnancy and therefore induced abortion is stressed. The role of the physician in providing contraception and appropriate contraceptive knowledge is discussed. PIP: A study of 519 consecutive women admitted to Kenyatta National Hospital with the diagnosis of abortion revealed that the majority were young and had a history of nonuse of contraception. Abortion was incomplete in 428 (83%) of cases; 60 (12%) cases involved sepsis. Women 20-24 years of age accounted for 221 (43%) of the abortions; the other two most represented age groups were 25-29 years (28%) and 14-19 years (17%). 460 (89%) of the abortion patients had never used a contraceptive method. The most frequently cited reasons for nonuse were desire for pregnancy (48%), no conscious reason (13%), procrastination in getting to a family planning clinic (8%), no knowledge of family planning (6%), and fear of side effects (6%). Of the 64 cases of failed contraception, 27 were using the pill, 25 had an IUD in place, and 8 were relying on the rhythm method. Among contraceptive users, the major sources of information about contraception were nurses (52%), radio and newspapers (19%), and other women (15%). Only 4% indicated that a physician had discussed family planning with them. Given the resource drain that treatment of incomplete abortion can place on Kenya's health care system and the risk of abortion-induced pelvic infection and subsequent infertility, Kenya's health workers should be encouraged to be more aggressive in promoting family planning use among young women.
B PROFOJWANGSHADRACK, OTIENO DRODAWAFRANCISXAVIER. "
Ojwang SBO.The impact of family planning in Kenya during the last 10 years. E. Afr. Med. J. 1991:68, 69.". In:
E. Afr. Med. J. 1991:68, 69. Rao, W. O., Ogonji, J. A.. and Aywa, S.; 1991.
AbstractIn this study, a total of 519 patients were interviewed. 82.5% had incomplete abortion. The implication of abortion especially when induced is emphasised. Economic implications that are contributed by the youth are stressed. 83.6% of the patients had not used any contraception. The role of contraception in preventing unwanted pregnancy and therefore induced abortion is stressed. The role of the physician in providing contraception and appropriate contraceptive knowledge is discussed. PIP: A study of 519 consecutive women admitted to Kenyatta National Hospital with the diagnosis of abortion revealed that the majority were young and had a history of nonuse of contraception. Abortion was incomplete in 428 (83%) of cases; 60 (12%) cases involved sepsis. Women 20-24 years of age accounted for 221 (43%) of the abortions; the other two most represented age groups were 25-29 years (28%) and 14-19 years (17%). 460 (89%) of the abortion patients had never used a contraceptive method. The most frequently cited reasons for nonuse were desire for pregnancy (48%), no conscious reason (13%), procrastination in getting to a family planning clinic (8%), no knowledge of family planning (6%), and fear of side effects (6%). Of the 64 cases of failed contraception, 27 were using the pill, 25 had an IUD in place, and 8 were relying on the rhythm method. Among contraceptive users, the major sources of information about contraception were nurses (52%), radio and newspapers (19%), and other women (15%). Only 4% indicated that a physician had discussed family planning with them. Given the resource drain that treatment of incomplete abortion can place on Kenya's health care system and the risk of abortion-induced pelvic infection and subsequent infertility, Kenya's health workers should be encouraged to be more aggressive in promoting family planning use among young women.
B PROFOJWANGSHADRACK. "
Pseudo-precocious puberty in a Kenyan African child: a case report. East Afr Med J. 1991 Jul;68(7):585-9.". In:
East Afr Med J. 1991 Jul;68(7):585-9. Rao, W. O., Ogonji, J. A.. and Aywa, S.; 1991.
AbstractA female Kenyan child with pseudoprecocious puberty due to juvenile granulosa cell tumour is presented. Clinical features in this patient included a mass in the lower abdomen, a growth spurt and appearance of pubic hairs as well as enlargements of the breasts. No similar case has been reported in a Kenyan child. The management and review of literature are discussed