Department of Obstetrics & Gynecology

Phase I study on the pharmacokinetics of intravaginal, self-administered artesunate vaginal pessaries among women in Kenya

Mon, 08 Jul 2024 00:00:00 GMT

Phase I study on the pharmacokinetics of intravaginal, self-administered artesunate vaginal pessaries among women in Kenya Chemtai Mungo, Katherine Sorgi, Cirillus Ogollah, Brenda Misiko, Cynthia Cheserem, George Githongo, Jackton Omoto Cervical cancer remains a significant global health issue, especially in low- and middle-income countries (LMICs), where access to prevention and treatment is limited and women are at a higher risk of cervical cancer. Artesunate, a widely available drug used to treat malaria, has shown promise in treating human papillomavirus (HPV)-associated anogenital lesions including high-grade cervical precancer, in a recent Phase I studies in the United States. Data on the pharmacokinetics of artesunate following intravaginal use, and its implications on malaria resistance, are lacking. The article can be accessed in full via:https://www.medrxiv.org/content/10.1101/2024.07.08.24309596v2.full

“There is nothing that can prevent me from supporting her:” men’s perspectives on their involvement and support of women’s use of topical therapy for cervical precancer treatment in Kenya

Tue, 12 Mar 2024 00:00:00 GMT

“There is nothing that can prevent me from supporting her:” men’s perspectives on their involvement and support of women’s use of topical therapy for cervical precancer treatment in Kenya Chemtai Mungo, Konyin Adewumi, Everlyn Adoyo, Graham Zulu, Supreet Kaur Goraya, Cirillus Ogollah, Jackton Omoto, Renée M Ferrari, Lisa Rahangdale Cervical cancer disproportionately impacts women in low- and middle-income countries (LMICs). The World Health Organization’s (WHO) 90/70/90 strategy aims to eliminate cervical cancer by 2030 by increasing HPV vaccination coverage to 90%, screening 70% of eligible women, and effectively treating 90% of those with abnormal results by 2030, potentially preventing 62 million deaths in LMICs. LMICs, however, struggle with limited access to cervical precancer treatment, in part due to a lack of trained professionals and weak health systems. Effective non-surgical, self-administered, which have demonstrated efficacy in high-income countries, could bridge the treatment gap in LMICs and may be more scalable and cost-effective than provider-administered therapies. To inform feasibility studies in LMICs, data are needed on the role of male partners in influencing the acceptability and uptake of self-administered topical therapies, including their support of recommended abstinence and contraception guidelines associated with these therapies. https://doi.org/10.3389/fonc.2024.1360337

Perceived acceptability of self-administered topical therapy for cervical precancer treatment among women undergoing cervical cancer screening in Kenya

Tue, 05 Mar 2024 00:00:00 GMT

Perceived acceptability of self-administered topical therapy for cervical precancer treatment among women undergoing cervical cancer screening in Kenya Mungo, Chemtai; Ellis, Grace; Rop, Mercy; Zou, Yating; Omoto, Jackton; Rahangdale, Lisa Innovative strategies are urgently needed to meet the World Health Organizations 2030 target of treating 90% of women with precancerous cervical lesions, especially in countries most affected by cervical cancer. We assessed the acceptability of self-administered intravaginal therapies for treating cervical precancer in women undergoing cervical cancer screening and precancer treatment in Kenya.

Efficacy of thermal ablation for treatment of biopsy‐confirmed high‐grade cervical precancer among women living with HIV in Kenya

Fri, 15 Sep 2023 00:00:00 GMT

Efficacy of thermal ablation for treatment of biopsy‐confirmed high‐grade cervical precancer among women living with HIV in Kenya Mungo, Chemtai; Osongo, Cirilus Ogollah; Ambaka, Jeniffer; Omoto, Jackton; Cohen, Craig R The World Health Organization recommends thermal ablation (TA) as an alternative to cryotherapy within “screen-and-treat” cervical cancer programs in low- and middle-income countries (LMICs), including among women living with HIV (WLWH). Data on TA efficacy among WLWH are limited, however. We conducted a clinical trial to evaluate efficacy of TA for treatment of biopsy-confirmed cervical intraepithelial neoplasia grades 2 and 3 (CIN2/3) among WLWH in Kenya. Nonpregnant HPV-positive WLWH age 25 to 65 years underwent colposcopy-directed biopsy, and same-day treatment with TA, if eligible. Women with biopsy-confirmed CIN2/3 at baseline had colposcopy-directed biopsies at 12 months to determine cure. A total of 376 participants underwent TA during the study period. At baseline, 238 (63.3%) had normal histology, 39 (10.4%) had CIN1, 15 (4.0%) had CIN2, 55 (14.6%) had CIN3, 7 (1.9%) had microinvasive cancer and 22 (5.6%) had indeterminate results. Twelve-month follow-up pathology results are available for 59 of 70 (84.3%) participants with CIN2/3 at baseline. Of these, 39 (66.1%, 95% CI 0.54-0.99) had successful treatment, defined as biopsy-confirmed CIN1 or normal findings, while 20 (33.9%, 95% CI 0.22-0.46) had treatment failure, defined as persistent biopsy-confirmed CIN2 or worse. Treatment failure was 23.1% (95% CI 0.17-0.46) and 39.9% (95% CI 0.23-0.51) among women with CIN2 and CIN3 at baseline, respectively. HIV-positive women with CIN2/3 have high rates of treatment failure at 1-year following thermal ablation. This highlights a significant limitation in the current WHO cervical cancer secondary-prevention strategy and calls for strategies to optimize cervical precancer treatment in this population. DOI: 10.1002/ijc.34737Int. J. Cancer.2023;1–7.wileyonlinelibrary.com/journal/ijc©2023 UICC.1

Association of Plasma Aflatoxin With Persistent Detection of Oncogenic Human Papillomaviruses in Cervical Samples From Kenyan Women Enrolled in a Longitudinal Study

Sun, 01 Jan 2023 00:00:00 GMT

Association of Plasma Aflatoxin With Persistent Detection of Oncogenic Human Papillomaviruses in Cervical Samples From Kenyan Women Enrolled in a Longitudinal Study Yan Tong, Philip Tonui,Omenge Orang’o,Jianjun Zhang,Titus Maina,Kapten Muthoka,John Groopman,Joshua Smith,Erin Madeen,Aaron Ermel,Patrick Loehre,Darron Brown Cervical cancer is common among Kenyan women and is caused by oncogenic human papillomaviruses (HR-HPV). Identification of factors that increase HR-HPV persistence is critically important. Kenyan women exposed to aflatoxin have an increased risk of cervical HR-HPV detection. This analysis was performed to examine associations between aflatoxin and HR-HPV persistence.

Effects of Training Small-Scale Farmers on Food Security in Moiben Sub County in Uasin Gishu County

Sat, 01 Jan 2022 00:00:00 GMT

Effects of Training Small-Scale Farmers on Food Security in Moiben Sub County in Uasin Gishu County Cheruto, Margaret Yator, Ouma Peter, Ndiema Alice Food security revolves around equality in the availability, access, and intake of nutritious food. The main purpose of this research is to determine the effectiveness of the adoption of agricultural technologies by small-scale farmers on food security, with a particular focus on Moiben Subcounty in Uasin Gishu County. The research adopted a mixed-methods design. A sample size of 179 small-scale farmer households was obtained using purposive and simple random sampling. The instruments used for the research were both questionnaires and interview schedules. To assess validity and reliability, the instruments were piloted. The data collected was organised and analysed using frequencies and%ages and then presented with the aid of Statistical Package for Social Sciences (SPSS) version 23.0. The findings of the research will enable better training methods for small-scale farmers to enhance food security in the Moiben Subcounty of Uasin Gishu County, Kenya. The researcher used inferential analysis of the study data to determine the strength of the relationship between the food security variable and the success of the adoption of agricultural technology. The researcher did a correlation analysis and examined the study’s correlation coefficient in detail. Adoption of agricultural technology was significantly and positively connected to food security (r = 0.943; P < 0.05), according to the findings. The correlations were higher than 94.3%, implying that there are large positive relationships between the adoption of agricultural technology and food security. The study findings revealed that an increase in one unit of training small-scale farmers on agricultural techniques decreased food security by 0.146 units. The study will be beneficial to students and other researchers’ intent on the knowledge of small-scale farmer training and its relationship to food security. The adoption of agricultural technologies increased food security by 52.1%. The recommendation of the study was Agricultural technologies will make the work on the farm efficient and will result in more first-grade production of farm produce, improving food security.

Negotiating Access to Maternal Health Services During COVID-19 Pandemic in Kilifi County, Kenya: Rapid Qualitative Study

Sat, 01 Jan 2022 00:00:00 GMT

Negotiating Access to Maternal Health Services During COVID-19 Pandemic in Kilifi County, Kenya: Rapid Qualitative Study Stephen Okumu Ombere Globally, women do a lot of unpaid work even before the onset of the COVID-19 pandemic. COVID-19 has delivered a blow to existing gender systems that could recalibrate gender roles, positively affecting population health. Initial research suggests that the crisis and its consequent shutdown responses have resulted in an intense increase in this burden. There is a dearth of information on expectant mothers’ negotiation mechanisms to access maternal health services during COVID-19 in Kenya. This rapid qualitative study draws data from purposefully selected 12 mothers who were either pregnant or had newborn babies during the COVID-19 pandemic in Kilifi county. Data were analyzed thematically and presented in a textual description, with at least five ideal typologies of emic alternatives to negotiating access to maternal health care. This chapter describes experiences of of women with their husbands’ presence or absence and how this impacted access to maternal health services. In this study, the household economic situation, in particular, emerged as a crucial gendered factor associated with negotiation for access to maternal health care. For the migrant husbands, most women used a range of other options to ensure that they fed or get money to sustain their families. Therefore, most households had minimax strategies to buffer risk in accessing maternal health services during COVID-19. The findings show that gender norms sustain a hierarchy of power that reinforces a systemic inequality that undermines women’s rights and restricts them from accessing maternal health services during pandemics. https://link.springer.com/chapter/10.1007/978-981-19-0809-5_7 This is a preview of subscription content, access via your institution.

Food Security Status During The Covid-19 Pandemic Among Vulnerable Groups In Keiyo South, Elgeyo Marakwet County, Kenya

Fri, 01 Jan 2021 00:00:00 GMT

Food Security Status During The Covid-19 Pandemic Among Vulnerable Groups In Keiyo South, Elgeyo Marakwet County, Kenya Peter O Ouma Health guidelines to manage the COVID-19 pandemic could have led to unintended changes in states and processes that affect food systems, food security, and nutrition. The study conducted in Elgeyo Marakwet County, Kenya focused on the impacts of the pandemic on food security and post-harvest losses. A cross-sectional survey was used to gather information on food security concerns from household heads in Keiyo South. Questionnaires were administered to 400 household heads derived from 99,861 households. Analysis of variance results indicated significant (p<0.01) differences among the vulnerable groups such as infants of less than six months (F= 4.665) pregnant women (F= 6.474) and people living with chronic diseases (F=4.838). According to World Bank report of 2020, the pandemic has resulted in an economic recession with significant loss of livelihoods and income and the consequent decline in purchasing power. Household income during the pandemic was correlated to diet change especially among vulnerable groups. There was a significant correlation (p<0.01) between household income during the COVID-19 pandemic and diet change for infants (r= 0.457), breastfeeding mothers (r= 0.609), pregnant women (r= 0.695) and those with chronic disease (r= 0.577). A relationship between household income and diet change for children between the age of six (6) months and five (5) years p (χ2= 27.657, df 8) =0.001 at α 0.05. Because of the disruption of household income occasioned by the pandemic, external interventions should target increasing income for households with the most vulnerable persons for improved food and nutrition security URI: http://41.89.164.27:8080/xmlui/handle/123456789/1628

Healthcare provider and pregnant women’s perspectives on the implementation of intermittent screening and treatment with dihydroartemisinin–piperaquine for malaria in pregnancy in western Kenya: a qualitative study

Fri, 01 Jan 2021 00:00:00 GMT

Healthcare provider and pregnant women’s perspectives on the implementation of intermittent screening and treatment with dihydroartemisinin–piperaquine for malaria in pregnancy in western Kenya: a qualitative study Jenna Hoyt, Jenny Hill, Florence Achieng, Peter Ouma, Simon Kariuki, Meghna Desai, Jayne Webster In malaria endemic regions in Kenya, pregnant women are ofered long-lasting insecticidal nets and intermittent preventive treatment (IPTp) with sulfadoxine–pyrimethamine (SP) at antenatal care (ANC) to prevent the adverse efects of malaria. Fears of growing SP resistance have heightened the search for alternative strategies. The implementation feasibility of intermittent screening and treatment (ISTp) with dihydroartemisinin–piperaquine (DP) in routine ANC settings was evaluated using qualitative and quantitative methods, including the exploration of healthcare provider and pregnant women’s perceptions https://malariajournal.biomedcentral.com/articles/10.1186/s12936-021-03826-8

Validation of Chloe SED, a Low-Cost, Reusable Syringe Extension Device for the Provision of Paracervical Analgesia [A21]

Sat, 01 Jan 2022 00:00:00 GMT

Validation of Chloe SED, a Low-Cost, Reusable Syringe Extension Device for the Provision of Paracervical Analgesia [A21] Aparna Ramanathan, Stephen Gwer, Javan L Imbamba, Stella Odenyo, Jackton Omoto, Robert C Bailey Women in Kenya and other low- and middle-income countries often do not receive analgesia during manual vacuum aspiration (MVA). This pilot study evaluated the efficacy of a novel, ultra-low-cost syringe extension device (Chloe-SED) developed by this research team for provision of paracervical block (PCB) during MVA. 10.1097/01.AOG.0000826420.52581.33