Obimbo Moses M, MD, Ph.D.
JOGECA 2020; 32(4): 95-96, December 2020
Postpartum depression (PPD) defined as a blend of physical and behavioral changes commonly occurring within 4 to 6 weeks after childbirth has a high prevalence (1). It has been considered as a spectrum of major depressive disorder in the DSM-IV classification whose symptoms include low mood, vacillation, disturbed sleep and appetite, anxiety, irritability and sometimes suicidal tendencies (2). There are a variety of events that may result in PPD, they include a change in the physiology, circumstances and sometimes combined events that are multifactorial in nature.
Wanjohi P.W1, Idyoro J.O2
JOGECA 2020; 32(4): 97-100, December 2020
Background: Breast cancer is the most commonly diagnosed cancer among women and the leading cause of cancer deaths globally. Some studies have reported an association between breast cancer management and subsequent development of endometrial cancer.
Case presentation: A 61-year-old female patient presented to the Kenyatta National Hospital (KNH) with postmenopausal per vaginal bleeding. She gave a history of diagnosis and management for breast cancer managed in 2016 at the same facility. She was started on tamoxifen therapy for two years and was subsequently diagnosed with metachronous endometrial cancer in 2020.
Conclusion: Tamoxifen therapy is beneficial in the treatment of breast cancer in women. However, clear protocols on follow up of these patients are required, especially in postmenopausal women with endometrial biopsy offered before or during tamoxifen therapy. This will increase the suspicion index and allow early diagnosis and management of endometrial cancer.
Badamana S.M, Karangau S.W1, Ndiema R.C
JOGECA 2020; 32(4): 101-103, December 2020
Background: Ovarian tumors and tumor-like lesions are relatively uncommon in pregnancy. A Large Solitary Luteinized Follicle Cyst of Pregnancy and Puerperium (LSLFCPP) is a rare benign cystic lesion, characterized by its rapid enlargement and large size that may mimic malignancy. Complications including rupture, torsion, and hemorrhage may arise, and as a result, these lesions require surgical excision.
Case presentation: A 22-year-old, para 1 gravida 2, presented with abdominal distension two days postpartum to the Kenyatta National Hospital (KNH). Abdominopelvic computed tomography (CT) scan showed a left cystic ovarian mass, 20 cm diameter, excised laparotomically. On histologic examination, a diagnosis of a solitary corpus luteum cyst lined by follicular cells was made.
Conclusion: Large solitary luteinized follicle cyst of pregnancy and puerperium is a rare cause of ovarian enlargement. A high index of suspicion should be considered when a large simple cyst is encountered during pregnancy and puerperium.
JOGECA 2020; 32(4): 104-106, December 2020
Background: Post-Hypoxic Myoclonus (PHM) is the occurrence of involuntary muscle jerks following hypoxia. Myoclonus Status Epilepticus (MSE) and the Lance-Adams Syndrome (LAS) are the primary PHM types. The Lance-Adams syndrome has better clinical outcomes compared to myoclonus status epilepticus.
Case presentation: A 24-year-old para 1 gravida 2 at term gestation presented at the Mbarara Regional Referral Hospital with obstructed labor as a referral. She was scheduled for emergency cesarean delivery, during which she suffered two cardiac arrests. She was diagnosed with anoxic post-hypoxic myoclonus on the fourth postoperative day. She was managed with haloperidol, antibiotics, clonazepam and rehabilitated on physiotherapy.
Conclusion: Post-hypoxic myoclonus was previously associated with a poor prognosis. However, recent findings have demonstrated positive clinical outcomes with pharmacotherapy and physiotherapy. Early diagnosis is critical for effective management.
Wong L.P, Suleiman M.I, Jesani J.K, Odongo B.E
JOGECA 2020; 32(4): 107-110, December 2020
Background: Subcapsular Hepatic Hematoma (SHH) is not uncommon in the Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome and preeclampsia setting. Management of SHH is usually conservative; however, when ruptured, surgical exploration and management are required. Surgical treatment protocols include perihepatic packing and liver transplantation in severe cases.
Case presentation: A 44-year-old, para 6 gravida 7 at 35 weeks gestation in the active phase of labor presented with a diagnosis of severe preeclampsia with HELLP syndrome to the Moi Teaching and Referral Hospital (MTRH) as a referral. The patient was taken for emergency cesarean section and discovered a ruptured subcapsular hepatic hematoma, which was managed conservatively.
Conclusion: Conservative management should be considered in patients with ruptured SHH who remain hemodynamically stable, with no apparent active bleeding during surgery.
JOGECA 2020; 32(4): 111-116, December 2020
Background: Postpartum Depression (PPD) is a non–psychotic mood disorder that affects women postpartum. The prevalence of PPD in Africa is estimated between 10 – 28%, while the local prevalence is between 10.6% - 13.5%.
Objective: This study aimed to determine the prevalence and the awareness level of postpartum depression among mothers seeking postnatal care at Nakuru level five hospital, Kenya.
Methodology: A cross-sectional descriptive study design was used in this study. A sample size of 381 postpartum mothers was identified through systematic random sampling. Data were collected using a researcher-administered semi-structured questionnaire. The Edinburgh Postnatal Depression Screening tool was used to screen for postpartum depression. Data were analyzed using the IBM Statistical Package for Social Sciences (SPSS), version 23.
Results: Forty-three (11.3%) of the total study population were positively screened for postpartum depression. Only 32% (n=122) and 2% (n=7) of the study population were aware of PPD or ever screened for PPD previously.
Conclusion: This study contributes towards the growing evidence of the burden of postpartum depression in our local setting and overall in Sub-Saharan Africa. However, there is a need for more prospective studies to examine the clinical profile of postpartum depression objectively.
Jombo S.E, Enabudoso E.J, Nkoku A.N, Afekhobe J.B
JOGECA 2020; 32(4): 117-124, December 2020
Background: Maternal mortality is a global public health burden, worse in Sub-Saharan Africa. In Nigeria, the maternal mortality rate is 512 in 100,000 live births. This study aimed to assess the availability and quality of Emergency Obstetric and Newborn Care (EmONC) services in Esan Central Local Government Area (LGA), Edo State, Nigeria.
Methodology: Mixed research, which included a descriptive cross-sectional study design and in-depth interviews, were used in this study. Data were collected using the United Nations’ Averting Maternal Death and Disability (UN-AMDD) handbook. Forty key informants’ interviews with facility managers, pregnant women, and healthcare providers were done and triangulated. Descriptive data were analyzed using the IBM Statistical Package for Social Sciences (SPSS), version 20. In-depth interviews were audiotaped, transcribed, and analyzed thematically.
Results: Twenty healthcare facilities were included in this study. Seventeen (85%) of these were primary healthcare centers, two secondary (10%), and one tertiary (5%). Seventeen were publicly-owned, while three were privately-owned. The availability of EmONC services in Esan Central LGA was 3.7 in 500,000 population. The met need for EmONC was 62.6%, and the obstetric case fatality was 1.2%. Respondents had adequate knowledge and concern about the burden of maternal mortality. The major causes of maternal mortality were hemorrhage, hypertension/convulsion in pregnancy, and prolonged labor. Lack of money, negative healthcare providers’ attitudes, and poor referral systems were the major contributors to maternal mortality.
Conclusion: The availability of EmONC services is limited in both primary and secondary healthcare facilities in a low-resource setting. Therefore, there is a need to educate pregnant mothers and healthcare providers on obstetric risks and contributors to reduce maternal mortality. Supplies and equipment necessary to manage obstetric and newborn cases should also be available at all healthcare levels and affordable rates.
Kiptoo S, Tonui K.P, Otieno G.P, Itsura M.P, Omenge E.O, Muthoka K, Oguda J.O, Loehrer L.P, Cu-Uvin S5, Mwangi A
JOGECA 2020; 32(4): 125-131, December 2020
Background: Cervical cancer is a significant cause of mortality among Kenyan women. Centralized prevention programs have not effectively reduced the Loss to Follow-Up (LTFU) burden following positive cervical cancer screening. Little or no information exists on the extent of LTFU in cervical cancer in Kenya.
Objective: This study aimed to determine the proportion, predictors, and reasons for defaulting from follow-up care following positive cervical cancer screening in Western Kenya.
Methods: This was a prospective study, where 100 women presenting for cervical cancer screening were recruited. Descriptive statistics and the Cox proportional hazards model, were used to summarize the data and determine factors associated with LTFU, respectively.
Results: The study participants’ mean age was 44.5 years, and the range was between 21 – 77 (SD 12). The mean age was 44.9 and 44.3 for those who were lost to follow-up and those who were not lost to follow-up, respectively. The median distance covered to the health facility was 15 kilometers (IQR: 6-30). Twenty-five (25%) of the women defaulted from scheduled appointments and were categorized as LTFU. HIV-positive women were more likely to be lost to follow-up with OR 2.18 (0.82,6.34). The loss to follow-up was mainly due to clients opting for alternative treatment, myths, perceptions, and stigma.
Conclusion: High loss to follow-up rate remains a setback to all research or care programs, and better strategies should be implemented to reduce the rate and associated factors.
Chege H, Itsura P.M, Tonui P.K, Omenge E.O, Oyiengo V.N, Odongo B.E, Muliro N.H, Faiza A.N, Mburu A.W, Achia T, Rosen B
JOGECA 2020; 32(4): 132-137, December 2020
Background: Vulva cancer is a rare gynecological disease, and its management experience is limited to studies from a few tertiary centers. Most of these studies are retrospective. Vulva cancer usually affects postmenopausal women, but there is an increased incidence in younger women with Human Papilloma Virus (HPV) infection.
Objective: To determine the treatment outcomes in patients diagnosed with vulva cancer at the Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya.
Methodology: This was a retrospective chart review of vulva cancer patients managed between 2010 and 2018 at the MTRH. Data were analyzed using the STATA software, version 15.
Results: Medical charts of 61 patients diagnosed with vulva cancer during the study period were reviewed. The mean age for the patients was 54.3 (SD 15.1). The majority, 52.5% (n=32) of the patients, were married. The HIV positivity rate was high, 63.9% (n=39). Pain was the most common presentation symptom, 44.3% ( n=27), followed by irritation at 32.8% (n=20). Squamous cell carcinoma was the most common histological type, 68.9% (n=42). Labia majora and minora were the most common tumor sites, 47.5% (n=29). The majority of the patients presented in stage II or higher 50.9% (n=31). Most patients, 75.4% (n=46) were managed surgically followed by chemo-radiation 6.6% (n=4). Thirty patients were referred for radiotherapy, but only 12 received it. Postoperative complications were reported in five patients. Postoperatively, 20 patients had positive inguinal nodes. The most common site for recurrence was local in six patients.
Conclusion: Many patients present with advanced-stage vulva cancer. Positive outcomes are low in vulva cancer as a majority of patients are lost to follow-up. Limited expertise and radiotherapy worsen treatment outcomes.