Skilled birth attendance is critical in the provision of child birth related services. Yet, liter... more Skilled birth attendance is critical in the provision of child birth related services. Yet, literature is scanty on the outcomes of child birth related complications in situations where majority of women deliver under the care of non-skilled birth attendants compared to those who are assisted by skilled providers. The study sought to assess the nature of childbirth related complications among the skilled and the non-skilled birth attendants in Western Kenya. A case-control study was conducted among women aged 15-49 years at the household. Controls were individually matched to cases on the basis of age and socio-economic status. A total of 294 cases and 291 controls were interviewed. Data were collected on various demographic and socio-economic characteristics and women's perception on the quality of care. All independent variables were analysed initially in bivariate models and those that were significantly associated with obstetric complications were included in multiple logist...
African Journal of Midwifery and Women's Health, 2013
ABSTRACT The ‘community midwifery approach’ is an innovation involving the engagement of skilled ... more ABSTRACT The ‘community midwifery approach’ is an innovation involving the engagement of skilled midwives residing in communities to take critical maternal health services to women's homes, thus improving maternal, newborn and infant health. This paper is based on a study that aimed to assess the effect of expanding community midwives’ mandate to go beyond the provision of delivery services alone, to incorporate a more comprehensive package of reproductive health and HIV services. This operations research project involved pre- and post-intervention data collection without a comparison group to assess intervention effects. The project was implemented in the Bungoma and Lugari Districts of Western Province, Kenya. Findings from the project indicate that the expanded community midwifery model improved clients’ access to a comprehensive package of family planning, reproductive health and HIV services at the community level. However, the intervention was less successful in improving the provision of a continuum of care by community midwives.
Nepal's carpet sector is one of the main economic contributors that plays a significant role in m... more Nepal's carpet sector is one of the main economic contributors that plays a significant role in many areas of the country's well being. However, this sector has seen a major downturn in recent years that is related to resource constraints, environmental problems and management inefficiency. Implementation of pollution prevention strategies has brought significant changes in similar sectors elsewhere in the world. Therefore, Nepal's carpet sector can also benefit from such strategies. This paper is written to provide an overview of the problems that the carpet manufacturing sector of Nepal faces. It also provides recommendations to the government, public and the carpet sector on some of the pollution prevention methods that can be implemented in Nepal to revive the ailing carpet sector. The information presented in this paper will also be useful to similar other industries elsewhere in the world that are directly or indirectly involved in carpet sector.
Background: Sino-implant (II) is a two-rod subcutaneous contraceptive implant used up to 4 years,... more Background: Sino-implant (II) is a two-rod subcutaneous contraceptive implant used up to 4 years, containing 150 mg of levonorgestrel. We conducted two observational studies of Sino-implant (II) to evaluate its performance in routine service delivery settings. Methods: We enrolled 1326 women age 18-44 who had Sino-implant (II) inserted at clinics in Pakistan and Kenya. Women were followedup using either an active or passive follow-up scheme in each study. Study outcomes were: one-year cumulative pregnancy and discontinuation rates; rates of insertion and removal complications; adverse event and side effect rates; reasons for discontinuation; and implant acceptability and satisfaction with clinic services. Results: A total of 754 women returned for at least one follow-up visit. The overall Pearl pregnancy rate was 0.4 per 100 woman-years [95% confidence interval (CI) 0.1, 0.9] resulting from 1 confirmed post-insertion pregnancy in Kenya and 4 in Pakistan. Country-specific Pearl rates were 0.2 (95% CI 0.0, 0.9) in Kenya and 0.6 (95% CI 0.2, 1.6) in Pakistan. The total cumulative 12-month probability of removal was 7.6% (95% CI 6.1, 9.1), with country-specific removal probabilities of 3.7% in Kenya (95% CI 2.1, 5.3) and 10.8% in Pakistan (95% CI 8.5, 13.2). Four serious adverse events occurred in Kenya and none occurred in Pakistan; one SAE (an ectopic pregnancy) was possibly related to Sino-implant (II). Most women in both countries said they would recommend the implant to others. Conclusion: The results from these studies reveal high effectiveness and favorable safety and acceptability during the first year of use of Sino-implant. Implication: The favorable Sino-implant (II) findings from Kenya and Pakistan provide further evidence from disparate regions that Sinoimplant (II) is safe, effective and acceptable during routine service delivery.
Skilled birth attendance is critical in the provision of child birth related services. Yet, liter... more Skilled birth attendance is critical in the provision of child birth related services. Yet, literature is scanty on the outcomes of child birth related complications in situations where majority of women deliver under the care of non-skilled birth attendants compared to those who are assisted by skilled providers. The study sought to assess the nature of childbirth related complications among the skilled and the non-skilled birth attendants in Western Kenya. A case-control study was conducted among women aged 15-49 years at the household. Controls were individually matched to cases on the basis of age and socio-economic status. A total of 294 cases and 291 controls were interviewed. Data were collected on various demographic and socio-economic characteristics and women's perception on the quality of care. All independent variables were analysed initially in bivariate models and those that were significantly associated with obstetric complications were included in multiple logist...
African Journal of Midwifery and Women's Health, 2013
ABSTRACT The ‘community midwifery approach’ is an innovation involving the engagement of skilled ... more ABSTRACT The ‘community midwifery approach’ is an innovation involving the engagement of skilled midwives residing in communities to take critical maternal health services to women's homes, thus improving maternal, newborn and infant health. This paper is based on a study that aimed to assess the effect of expanding community midwives’ mandate to go beyond the provision of delivery services alone, to incorporate a more comprehensive package of reproductive health and HIV services. This operations research project involved pre- and post-intervention data collection without a comparison group to assess intervention effects. The project was implemented in the Bungoma and Lugari Districts of Western Province, Kenya. Findings from the project indicate that the expanded community midwifery model improved clients’ access to a comprehensive package of family planning, reproductive health and HIV services at the community level. However, the intervention was less successful in improving the provision of a continuum of care by community midwives.
Nepal's carpet sector is one of the main economic contributors that plays a significant role in m... more Nepal's carpet sector is one of the main economic contributors that plays a significant role in many areas of the country's well being. However, this sector has seen a major downturn in recent years that is related to resource constraints, environmental problems and management inefficiency. Implementation of pollution prevention strategies has brought significant changes in similar sectors elsewhere in the world. Therefore, Nepal's carpet sector can also benefit from such strategies. This paper is written to provide an overview of the problems that the carpet manufacturing sector of Nepal faces. It also provides recommendations to the government, public and the carpet sector on some of the pollution prevention methods that can be implemented in Nepal to revive the ailing carpet sector. The information presented in this paper will also be useful to similar other industries elsewhere in the world that are directly or indirectly involved in carpet sector.
Background: Sino-implant (II) is a two-rod subcutaneous contraceptive implant used up to 4 years,... more Background: Sino-implant (II) is a two-rod subcutaneous contraceptive implant used up to 4 years, containing 150 mg of levonorgestrel. We conducted two observational studies of Sino-implant (II) to evaluate its performance in routine service delivery settings. Methods: We enrolled 1326 women age 18-44 who had Sino-implant (II) inserted at clinics in Pakistan and Kenya. Women were followedup using either an active or passive follow-up scheme in each study. Study outcomes were: one-year cumulative pregnancy and discontinuation rates; rates of insertion and removal complications; adverse event and side effect rates; reasons for discontinuation; and implant acceptability and satisfaction with clinic services. Results: A total of 754 women returned for at least one follow-up visit. The overall Pearl pregnancy rate was 0.4 per 100 woman-years [95% confidence interval (CI) 0.1, 0.9] resulting from 1 confirmed post-insertion pregnancy in Kenya and 4 in Pakistan. Country-specific Pearl rates were 0.2 (95% CI 0.0, 0.9) in Kenya and 0.6 (95% CI 0.2, 1.6) in Pakistan. The total cumulative 12-month probability of removal was 7.6% (95% CI 6.1, 9.1), with country-specific removal probabilities of 3.7% in Kenya (95% CI 2.1, 5.3) and 10.8% in Pakistan (95% CI 8.5, 13.2). Four serious adverse events occurred in Kenya and none occurred in Pakistan; one SAE (an ectopic pregnancy) was possibly related to Sino-implant (II). Most women in both countries said they would recommend the implant to others. Conclusion: The results from these studies reveal high effectiveness and favorable safety and acceptability during the first year of use of Sino-implant. Implication: The favorable Sino-implant (II) findings from Kenya and Pakistan provide further evidence from disparate regions that Sinoimplant (II) is safe, effective and acceptable during routine service delivery.
Uploads
Papers by Shiphrah Kuria