PROF. OJWANG SHADRACK B.

Almost 30 years after its introduction into the management of ovarian carcinoma, second-look laparotomy remains controversial. Although its supporters agree on its indications, there is a considerable number of conflicting reports on the actual benefits of the procedure. Diagnostic inaccuracy, invasiveness and expense are some of the reasons raised by opponents against its routine performance and their recommendations range from limited selective application to total avoidance. The role of second-look laparotomy is reviewed, with particular reference to developing countries where scarcity of resources must always be balanced against the need to provide the best care possible to the individual cancer patient. A management schedule for ovarian carcinoma, including second-look laparotomy, appropriate under these circumstances is given.

Obstetrical and gynaecological articles related to safe motherhood published in the East African Medical Journal between 1924 and 1989 were reviewed. A total of 133 topics were published. Out of these, 84 (63.2%) were obstetrical and 49 (36.8%) gynaecological. Out of the obstetrical topics, 66 were pregnancy related, 12 were public health and the rest medical topics. A rapid increase in the number of the relevant topics is seen especially after 1970. This is probably due to the increase in the number of of obstetricians training locally in the African region and the international nature of the Journal during the last two decades. PIP: A review of all published articles in the East African Medical Journal between 1924 and 1989 was presented. All articles pertaining to obstetrical and gynecological topics related to maternal care were reviewed. The aim was to identify the role the journal has played in distributing information about safe motherhood research. This journal is one of the oldest to present information originating in Africa and recently has gained international recognition. Articles that were studies conducted in other parts of the world are now published. The number of topics devoted to obstetrics and safe motherhood has increased during the past 20 years. Publication by researchers in this journal has contributed to specialists advancement within universities and medical areas. The first maternal-related article was published in 1024 and was devoted to performance of a cesarean section on a woman in Mombasa, an article of particular importance for African countries with high maternal mortality and morbidity from child birth. There have been a total of 133 articles on motherhood since 1924, of which 84 were on obstetrics and 49 on gynecology. World War II probably affected the decline in articles during the period 1940-49. There was a rapid increase in motherhood articles between 1950 and 1989, which also corresponded to an increase in trained obstetricians and gynecologists. Prior to 1970, most specialists were trained outside of Africa and did not publish in this journal. By subject area, there were 12 topics on public health related issues, 43 on prenatal care, 19 on delivery, 4 on postpartum care, and 6 on medically related issues such as infections, diabetes mellitus in pregnancy, hypertension, and heart disease.

In order to determine the magnitude of teenage pregnancy and also to determine the demographic and socio-economic problems associated with these pregnancies, a prospective study was conducted in two major delivery centres in Nairobi. The incidence of teenage pregnancy was found to be 10.5%. For Kenyatta National Hospital (KNH), the incidence was 13.1% and Pumwani Maternity Hospital (PMH) recorded an incidence of 8.8%. Most of the teenagers (82.8%) were from large families, and upto 59.4% had been pregnant at least once. They had low education; 66.7% had only primary level education. Both the teenager and their parents were unemployed. Their average age at menarche was 14.2 years. 70% had had intercourse by 16 years. Up to 60% had no knowledge of contraceptives and; most of those who knew, had it from informal sources. Only 1% had used any known contraceptive method. It is concluded that intervention programme like adolescent antenatal clinics, adolescent sexuality education and appropriate use of contraceptives be provided as a matter of priority. All health facilities should open special units for handling adolescent sexuality. This should include both sexes. Teachers, parents and respectable community leaders should effectively be involved in formulation of programmes that would reduce teenage pregnancies. These measures should be started right at the primary school level.

A cross-sectional study was carried out in Kisii District in the western part of Kenya between April 1 and April 28, 1991, with the objectives of ascertaining the attitude of nurses towards induced abortion, patients, and their involvement in abortion. Data were collected using a structured, self-administered questionnaire. All nurses present at the various institutions were recruited. A total of 218 nurses were recruited into the study. 75-83% were married, female nurses younger than 40, and therefore in the reproductive age group. 134 (61.5%) nurses were Protestant and 51% worked in the government district hospital. The nurses displayed a deficient knowledge of all aspects of induced abortion. Among clinically safe methods only intraamniotic saline instillation and dilation and curettage were mentioned by 4% and 11%, respectively. This deficiency in knowledge may be explained by the fact that most nurses work in the government hospitals, where induced abortion is not a routine procedure. Only 26-28% of the nurses thought it was safe to induce abortion at 1 and 2 months of gestation. 31-43% either did not know or were uncertain. Abortion is illegal in Kenya except when the life of the mother is in danger. Most nurses seemed to favor the law. A previous study in Nairobi revealed that only 38% of the nurses favored abortion on demand under a liberalized abortion law. 24 (11%) of nurses admitted to have induced abortion before. Their knowledge of induced abortion needs to be improved in order to prevent an increase in mortality and morbidity associated with improperly performed abortions

This survey, conducted between October 1989 and March 1990, to determine the knowledge, attitude, practice, and provision of family planning of a sample of 376 Kenyan medical doctors, reports on the aspects of knowledge of family planning (FP) methods. Kenyan medical doctors had low-to-average knowledge of the association between oral contraceptives (OCs) and the risk of various medical conditions and the mechanism of action of steroidal contraceptives. Their knowledge of the effectiveness of various program methods was average to high. There was a linear relationship between monthly income and knowledge of effectiveness of OCs, according to which physicians earning more had less knowledge than their colleagues who earned less (Z = 2.318, p = 0.02). A stepwise unconditional logistic regression model showed that two variables, department where most work is performed and sex, are significantly associated with better knowledge. Use of these operational variables for assessing medical doctors' knowledge of FP methods gave a better resolution of the extent and perhaps the quality of counseling and advice they provided to their FP clients. At the same time, the need for update courses in FP for medical doctors is unquestionable and long overdue. author's modified author's modified