Introduction: Adolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adve... more Introduction: Adolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adverse risks and warrant a critical review in low-and middleincome countries where the burden of adverse pregnancy outcomes is highest. Objective: To describe the prevalence and adverse pregnancy (maternal, perinatal, and neonatal) outcomes associated with extremes of maternal age across six countries. Patients and methods: We performed a historical cohort analysis on prospectively collected data from a population-based cohort study conducted in the
IntroductionMaternal and neonatal infections are among the most frequent causes of maternal and n... more IntroductionMaternal and neonatal infections are among the most frequent causes of maternal and neonatal mortality, and current antibiotic strategies have been ineffective in preventing many of these deaths. A randomised clinical trial conducted in a single site in The Gambia showed that treatment with an oral dose of 2 g azithromycin versus placebo for all women in labour reduced certain maternal and neonatal infections. However, it is unknown if this therapy reduces maternal and neonatal sepsis and mortality. In a large, multinational randomised trial, we will evaluate the impact of azithromycin given in labour to improve maternal and newborn outcomes.Methods and analysisThis randomised, placebo-controlled, multicentre clinical trial includes two primary hypotheses, one maternal and one neonatal. The maternal hypothesis is to test whether a single, prophylactic intrapartum oral dose of 2 g azithromycin given to women in labour will reduce maternal death or sepsis. The neonatal hyp...
Interdisciplinary Perspectives on Infectious Diseases, 2014
Background. To date the effect of pregnancy on the immune activation of CD8 T cells that may affe... more Background. To date the effect of pregnancy on the immune activation of CD8 T cells that may affect HIV disease progression has not been well studied and remains unclear.Objective.To determine the effect of pregnancy on CD8 T lymphocyte activation and its relationship with CD4 count in HIV infected pregnant women.Study Design. Case control.Study Site. AMPATH and MTRH in Eldoret, Kenya.Study Subjects. Newly diagnosed asymptomatic HIV positive pregnant and nonpregnant women with no prior receipt of antiretroviral medications.Study Methods. Blood samples were collected from the study participants and levels of activated CD8 T lymphocytes (CD38 and HLA-DR) were determined using flow cytometer and correlated with CD4 counts of the study participants. The descriptive data focusing on frequencies, correlation, and cross-tabulations was statistically determined. Significance of the results was set atP<0.05.Results. HIV positive pregnant women had lower activated CD8 T lymphocyte counts t...
International journal of public health research, 2015
Background: This paper presents information on needs, barriers, and approaches to access and use ... more Background: This paper presents information on needs, barriers, and approaches to access and use of contraception by adolescents in low and middle income countries (LMIC). Despite the various strategies and policies, total fertility rate still remains high at 4.6 percent, while CPR and unmet need for family planning are estimated at 46 percent and 24 percent, respectively. These are aimed at increasing contraceptive prevalence rate (CPR), reduction in both total fertility rate (TFR) and unmet need for family planning services. Methods: An electronic search of the published literature was conducted using the search terms contraceptive use”, “contraception”, “family planning”, and “Sub-Saharan Africa”. This was supplemented by including search terms for the various types of contraceptive methods, e.g., Dual Contraception, Hormonal contraception, Female Sterilization, and Barrier methods, in combination with “Sub-Saharan Africa”, “Socio-cultural”, “Socio-Economic” and then comparing th...
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2021
OBJECTIVE We hypothesized that addition of oxytocin to cervical ripening with a Foley catheter (F... more OBJECTIVE We hypothesized that addition of oxytocin to cervical ripening with a Foley catheter (FC) among nulliparous women shortens the time to delivery. METHODS In this double blinded randomised trial conducted at Moi Teaching and Referral Hospital (MTRH), 220 women were randomly assigned to FC plus low dose oxytocin as treatment or FC plus placebo as controls in a 1:1 ratio. A modified intention to treat analysis was performed using SPSS v24. The protocol was approved by the institutional ethics committee and registered at www.ctr.pharmacyboardkenya.org; ECCT/19/08/02. RESULTS Baseline characteristics were similar. Time to delivery was shorter by 3 hours in the treatment group compared to the controls (25.4 vs 28.4 hours, p=0.002). The treatment group had a 22% increased likelihood of delivery within 24 hours compared to the controls (53.3% vs 43.1%, RR 1.22, 95% CI 0.938-1.579, p=0.135). The controls were however twice more likely to deliver by caesarean section than the treatme...
Background Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of ... more Background Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation’s (UN’s) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization’s Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness. Methods Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD’s Global Network’s (GN) Maternal Newborn Health Registry (MNHR) between 2010 and 2013, were included. We evaluated if all 8 practices (Care around Delivery – CAD), combined as an index was associated with reduced early neonatal mortality rates (days 0–6 of life). Results A total of 150,848 live births were included in the analysis. The individual indicators varied ac...
This study sought to establish the challenges that the Reproductive Health Division (High Risk Pr... more This study sought to establish the challenges that the Reproductive Health Division (High Risk Pregnancy Clinic) at Moi Teaching and Referral Hospital based in Eldoret city, one of the two referral hospitals in Kenya, faces in adopting e-medical consultation as a way of improving maternal healthcare for patients with hypertension in pregnancy and reducing maternal deaths. In this paper, an outline of the strategies and pillars that the Clinic needs to adopt to embrace the use of e-medical consultation for the diagnosis, treatment and management of hypertension in pregnancy is presented. The survey conducted established that the division is still lagging behind and has not adopted the use of e-health, especially in the consultation sessions between the doctors and patients. The outlined strategies when implemented will help steer the Reproductive Health Division (High Risk Pregnancy Clinic) towards making healthcare services available in an efficient and effective way to expectant wo...
I dedicate this work to all expectant mothers in need of reproductive health care services and to... more I dedicate this work to all expectant mothers in need of reproductive health care services and to my Husband, Gilbert Magut and my children; Lindsay ,Joy and Kipruto.
BACKGROUND: The daily use of low-dose aspirin may be a safe, widely available, and inexpensive in... more BACKGROUND: The daily use of low-dose aspirin may be a safe, widely available, and inexpensive intervention for reducing the risk of preterm birth. Data on the potential side effects of low-dose aspirin use during pregnancy in low- and middle-income countries are needed. OBJECTIVE: This study aimed to assess differences in unexpected emergency medical visits and potential maternal side effects from a randomized, double-blind, multicountry, placebo-controlled trial of low-dose aspirin use (81 mg daily, from 6 to 36 weeks’ gestation). STUDY DESIGN: This study was a secondary analysis of data from the Aspirin Supplementation for Pregnancy Indicated Risk Reduction In Nulliparas trial, a trial of the Global Network for Women’s and Children’s Health conducted in India (2 sites), Pakistan, Guatemala, Democratic Republic of the Congo, Kenya, and Zambia. The outcomes for this analysis were unexpected emergency medical visits and the occurrence of the following potential side effects—overall ...
Background: Maternal mortality is a public health problem that disproportionately affects low and... more Background: Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. Methods: We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. Results: We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites.
Background Maternal mortality is a public health problem that disproportionately affects low and ... more Background Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. Methods We analyzed data from women enrolled in the NICHD Global Network for Women’s and Children’s Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. Results We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI ...
Low-dose aspirin for the prevention of preterm delivery in Low-dose aspirin for the prevention of... more Low-dose aspirin for the prevention of preterm delivery in Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial. randomised, double-blind, placebo-controlled trial. McClure, Elizabeth M.; Koso-Thomas, Marion; Miodovnik, Menachem; Silver, R.; Derman, Richard J.; and ASPIRIN Study Group, "Lowdose aspirin for the prevention of preterm delivery in nulliparous women with a singleton
Introduction: Adolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adve... more Introduction: Adolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adverse risks and warrant a critical review in low-and middleincome countries where the burden of adverse pregnancy outcomes is highest. Objective: To describe the prevalence and adverse pregnancy (maternal, perinatal, and neonatal) outcomes associated with extremes of maternal age across six countries. Patients and methods: We performed a historical cohort analysis on prospectively collected data from a population-based cohort study conducted in the
IntroductionMaternal and neonatal infections are among the most frequent causes of maternal and n... more IntroductionMaternal and neonatal infections are among the most frequent causes of maternal and neonatal mortality, and current antibiotic strategies have been ineffective in preventing many of these deaths. A randomised clinical trial conducted in a single site in The Gambia showed that treatment with an oral dose of 2 g azithromycin versus placebo for all women in labour reduced certain maternal and neonatal infections. However, it is unknown if this therapy reduces maternal and neonatal sepsis and mortality. In a large, multinational randomised trial, we will evaluate the impact of azithromycin given in labour to improve maternal and newborn outcomes.Methods and analysisThis randomised, placebo-controlled, multicentre clinical trial includes two primary hypotheses, one maternal and one neonatal. The maternal hypothesis is to test whether a single, prophylactic intrapartum oral dose of 2 g azithromycin given to women in labour will reduce maternal death or sepsis. The neonatal hyp...
Interdisciplinary Perspectives on Infectious Diseases, 2014
Background. To date the effect of pregnancy on the immune activation of CD8 T cells that may affe... more Background. To date the effect of pregnancy on the immune activation of CD8 T cells that may affect HIV disease progression has not been well studied and remains unclear.Objective.To determine the effect of pregnancy on CD8 T lymphocyte activation and its relationship with CD4 count in HIV infected pregnant women.Study Design. Case control.Study Site. AMPATH and MTRH in Eldoret, Kenya.Study Subjects. Newly diagnosed asymptomatic HIV positive pregnant and nonpregnant women with no prior receipt of antiretroviral medications.Study Methods. Blood samples were collected from the study participants and levels of activated CD8 T lymphocytes (CD38 and HLA-DR) were determined using flow cytometer and correlated with CD4 counts of the study participants. The descriptive data focusing on frequencies, correlation, and cross-tabulations was statistically determined. Significance of the results was set atP<0.05.Results. HIV positive pregnant women had lower activated CD8 T lymphocyte counts t...
International journal of public health research, 2015
Background: This paper presents information on needs, barriers, and approaches to access and use ... more Background: This paper presents information on needs, barriers, and approaches to access and use of contraception by adolescents in low and middle income countries (LMIC). Despite the various strategies and policies, total fertility rate still remains high at 4.6 percent, while CPR and unmet need for family planning are estimated at 46 percent and 24 percent, respectively. These are aimed at increasing contraceptive prevalence rate (CPR), reduction in both total fertility rate (TFR) and unmet need for family planning services. Methods: An electronic search of the published literature was conducted using the search terms contraceptive use”, “contraception”, “family planning”, and “Sub-Saharan Africa”. This was supplemented by including search terms for the various types of contraceptive methods, e.g., Dual Contraception, Hormonal contraception, Female Sterilization, and Barrier methods, in combination with “Sub-Saharan Africa”, “Socio-cultural”, “Socio-Economic” and then comparing th...
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2021
OBJECTIVE We hypothesized that addition of oxytocin to cervical ripening with a Foley catheter (F... more OBJECTIVE We hypothesized that addition of oxytocin to cervical ripening with a Foley catheter (FC) among nulliparous women shortens the time to delivery. METHODS In this double blinded randomised trial conducted at Moi Teaching and Referral Hospital (MTRH), 220 women were randomly assigned to FC plus low dose oxytocin as treatment or FC plus placebo as controls in a 1:1 ratio. A modified intention to treat analysis was performed using SPSS v24. The protocol was approved by the institutional ethics committee and registered at www.ctr.pharmacyboardkenya.org; ECCT/19/08/02. RESULTS Baseline characteristics were similar. Time to delivery was shorter by 3 hours in the treatment group compared to the controls (25.4 vs 28.4 hours, p=0.002). The treatment group had a 22% increased likelihood of delivery within 24 hours compared to the controls (53.3% vs 43.1%, RR 1.22, 95% CI 0.938-1.579, p=0.135). The controls were however twice more likely to deliver by caesarean section than the treatme...
Background Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of ... more Background Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation’s (UN’s) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization’s Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness. Methods Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD’s Global Network’s (GN) Maternal Newborn Health Registry (MNHR) between 2010 and 2013, were included. We evaluated if all 8 practices (Care around Delivery – CAD), combined as an index was associated with reduced early neonatal mortality rates (days 0–6 of life). Results A total of 150,848 live births were included in the analysis. The individual indicators varied ac...
This study sought to establish the challenges that the Reproductive Health Division (High Risk Pr... more This study sought to establish the challenges that the Reproductive Health Division (High Risk Pregnancy Clinic) at Moi Teaching and Referral Hospital based in Eldoret city, one of the two referral hospitals in Kenya, faces in adopting e-medical consultation as a way of improving maternal healthcare for patients with hypertension in pregnancy and reducing maternal deaths. In this paper, an outline of the strategies and pillars that the Clinic needs to adopt to embrace the use of e-medical consultation for the diagnosis, treatment and management of hypertension in pregnancy is presented. The survey conducted established that the division is still lagging behind and has not adopted the use of e-health, especially in the consultation sessions between the doctors and patients. The outlined strategies when implemented will help steer the Reproductive Health Division (High Risk Pregnancy Clinic) towards making healthcare services available in an efficient and effective way to expectant wo...
I dedicate this work to all expectant mothers in need of reproductive health care services and to... more I dedicate this work to all expectant mothers in need of reproductive health care services and to my Husband, Gilbert Magut and my children; Lindsay ,Joy and Kipruto.
BACKGROUND: The daily use of low-dose aspirin may be a safe, widely available, and inexpensive in... more BACKGROUND: The daily use of low-dose aspirin may be a safe, widely available, and inexpensive intervention for reducing the risk of preterm birth. Data on the potential side effects of low-dose aspirin use during pregnancy in low- and middle-income countries are needed. OBJECTIVE: This study aimed to assess differences in unexpected emergency medical visits and potential maternal side effects from a randomized, double-blind, multicountry, placebo-controlled trial of low-dose aspirin use (81 mg daily, from 6 to 36 weeks’ gestation). STUDY DESIGN: This study was a secondary analysis of data from the Aspirin Supplementation for Pregnancy Indicated Risk Reduction In Nulliparas trial, a trial of the Global Network for Women’s and Children’s Health conducted in India (2 sites), Pakistan, Guatemala, Democratic Republic of the Congo, Kenya, and Zambia. The outcomes for this analysis were unexpected emergency medical visits and the occurrence of the following potential side effects—overall ...
Background: Maternal mortality is a public health problem that disproportionately affects low and... more Background: Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. Methods: We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. Results: We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites.
Background Maternal mortality is a public health problem that disproportionately affects low and ... more Background Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. Methods We analyzed data from women enrolled in the NICHD Global Network for Women’s and Children’s Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. Results We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI ...
Low-dose aspirin for the prevention of preterm delivery in Low-dose aspirin for the prevention of... more Low-dose aspirin for the prevention of preterm delivery in Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial. randomised, double-blind, placebo-controlled trial. McClure, Elizabeth M.; Koso-Thomas, Marion; Miodovnik, Menachem; Silver, R.; Derman, Richard J.; and ASPIRIN Study Group, "Lowdose aspirin for the prevention of preterm delivery in nulliparous women with a singleton
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