1
|
Legge H, Halliday KE, Kepha S, Mcharo C, Witek-McManus SS, El-Busaidy H, Muendo R, Safari T, Mwandawiro CS, Matendechero SH, Pullan RL, Oswald WE. Patterns and Drivers of Household Sanitation Access and Sustainability in Kwale County, Kenya. Environ Sci Technol 2021; 55:6052-6064. [PMID: 33826310 PMCID: PMC8154356 DOI: 10.1021/acs.est.0c05647] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 05/08/2023]
Abstract
Many sanitation interventions suffer from poor sustainability. Failure to maintain or replace toilet facilities risks exposing communities to environmental pathogens, yet little is known about the factors that drive sustained access beyond project life spans. Using data from a cohort of 1666 households in Kwale County, Kenya, we investigated the factors associated with changes in sanitation access between 2015 and 2017. Sanitation access is defined as access to an improved or unimproved facility within the household compound that is functional and in use. A range of contextual, psychosocial, and technological covariates were included in logistic regression models to estimate their associations with (1) the odds of sustaining sanitation access and (2) the odds of gaining sanitation access. Over two years, 28.3% households sustained sanitation access, 4.7% lost access, 17.7% gained access, and 49.2% remained without access. Factors associated with increased odds of households sustaining sanitation access included not sharing the facility and presence of a solid washable slab. Factors associated with increased odds of households gaining sanitation access included a head with at least secondary school education, level of coarse soil fragments, and higher local sanitation coverage. Results from this study can be used by sanitation programs to improve the rates of initial and sustained adoption of sanitation.
Collapse
Affiliation(s)
- Hugo Legge
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Katherine E. Halliday
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Stella Kepha
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Carlos Mcharo
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Stefan S. Witek-McManus
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Hajara El-Busaidy
- Department
of Health, County Government of Kwale, P.O. Box 4-80403, Kwale, Kenya
| | - Redempta Muendo
- Department
of Health, County Government of Kwale, P.O. Box 4-80403, Kwale, Kenya
| | - Th’uva Safari
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Charles S. Mwandawiro
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Sultani H. Matendechero
- Division
of Vector Borne and Neglected Tropical Diseases Unit, Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya
| | - Rachel L. Pullan
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - William E. Oswald
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| |
Collapse
|
2
|
Nyamu GW, Kihara JH, Oyugi EO, Omballa V, El-Busaidy H, Jeza VT. Prevalence and risk factors associated with asymptomatic Plasmodium falciparum infection and anemia among pregnant women at the first antenatal care visit: A hospital based cross-sectional study in Kwale County, Kenya. PLoS One 2020; 15:e0239578. [PMID: 33031456 PMCID: PMC7544053 DOI: 10.1371/journal.pone.0239578] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Prevalence of Prevalence of malaria in pregnancy (MiP) in Kenya ranges from 9% to 18%. We estimated the prevalence and factors associated with MiP and anemia in pregnancy (AiP) among asymptomatic women attending antenatal care (ANC) visits. Methods We performed a cross-sectional study among pregnant women attending ANC at Msambweni Hospital, between September 2018 and February 2019. Data was collected and analyzed in Epi Info 7. Descriptive statistics were calculated and we compared MiP and AiP in asymptomatic cases to those without either condition. Adjusted prevalence Odds odds ratios (aPOR) and 95% confidence intervals (CI) were calculated to identify factors associated with asymptomatic MiP and AiP. Results We interviewed 308 study participants; their mean age was 26.6 years (± 5.8 years), mean gestational age was 21.8 weeks (± 6.0 weeks), 173 (56.2%) were in the second trimester of pregnancy, 12.9% (40/308) had MiP and 62.7% had AiP. Women who were aged ≤ 20 years had three times likelihood of developing MiP (aPOR = 3.1 Cl: 1.3–7.35) compared to those aged >20 years old. The likelihood of AiP was higher among women with gestational age ≥ 16 weeks (aPOR = 3.9, CI: 1.96–7.75), those with parasitemia (aPOR = 3.3, 95% CI: 1.31–8.18), those in third trimester of pregnancy (aPOR = 2.6, 95% CI:1.40–4.96) and those who reported eating soil as a craving during pregnancy (aPOR = 1.9, 95%CI:1.15–3.29). Conclusions Majority of the women had asymptomatic MiP and AiP. MiP was observed in one tenth of all study participants. Asymptomatic MiP was associated with younger age while AiP was associated with gestational age parasitemia, and soil consumption as a craving during pregnancy.
Collapse
Affiliation(s)
- Gibson Waweru Nyamu
- Technical University of Mombasa, Mombasa, Kenya
- Department of Health, Kwale County, Kwale County, Kenya
- * E-mail:
| | | | - Elvis Omondi Oyugi
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Victor Omballa
- Center for Global Health Research—Kenya Medical Research Institute, Nairobi, Kenya
| | | | | |
Collapse
|
3
|
Mochache V, Wanje G, Nyagah L, Lakhani A, El-Busaidy H, Temmerman M, Gichangi P. Religious, socio-cultural norms and gender stereotypes influence uptake and utilization of maternal health services among the Digo community in Kwale, Kenya: a qualitative study. Reprod Health 2020; 17:71. [PMID: 32448327 PMCID: PMC7245746 DOI: 10.1186/s12978-020-00919-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background Maternal health outcomes in resource-limited settings are typically influenced by supply-side factors affecting the provision of quality health services. The extent to which demand-side factors contribute to this influence is unclear. We aimed to explore how individual and community-wide factors influenced uptake and utilization of maternal health services among the Digo community residing in Kwale County of coastal Kenya. Methods Between March and December 2015, we conducted 5 focus group discussions (FGDs) and 15 in-depth interviews (IDIs) with members of the Digo community predominant in Kwale county, Kenya. Respondents were sampled purposively and included female (pregnant and postpartum) as well as male adult community members. A thematic content analytic approach was used. Results There were a total of 47 FGD respondents, including 15 (32%) females with a median (interquartile, IQR) age of 38 (27–55) years and 6 (3–8) children. Majority (40%) reported attaining secondary-level education. All IDI respondents were female with a median (IQR) age of 27 (24–35) years and 4 (2–5) children. Majority (80%) had attained primary-level education. We found that religious and socio-cultural norms as well as gender stereotypes were important influences on the uptake and utilization of maternal health services, including facility-based delivery and contraception. Key amongst this was the unspoken deference to the counsel of a prominent matriarchal figure in the decision-making process. Conclusions Among the Digo community of coastal Kenya, a unique social-cultural context comprising of a religious and gendered value belief system influences women’s reproductive health and rights. These findings highlight the important role of demand-side factors in influencing maternal health outcomes. In addition to addressing supply-side factors, programs in such settings should aim to address factors that leverage inherent social capital to drive demand for maternal health services ensuring that they are not only effective, but also responsive to the local context.
Collapse
Affiliation(s)
- Vernon Mochache
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya. .,University of Ghent, Ghent, Belgium.
| | - George Wanje
- Department of Medical Microbiology, University of Nairobi, Mombasa Field Site, P.O Box 91276-80103, Mombasa, Kenya
| | - Lucy Nyagah
- Community Health Department, Aga Khan University, P.O Box 83013-80100, Mombasa, Kenya
| | - Amyn Lakhani
- Community Health Department, Aga Khan University, P.O Box 83013-80100, Mombasa, Kenya
| | - Hajara El-Busaidy
- Department of Health, County Government of Kwale, P.O Box 6-80403, Kwale, Kenya
| | - Marleen Temmerman
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,Community Health Department, Aga Khan University, P.O Box 83013-80100, Mombasa, Kenya.,Aga Khan University Hospital, 3rd Parklands Avenue, Limuru Road, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,Technical University of Mombasa, P.O Box 90420-80100, Mombasa, Kenya
| |
Collapse
|
4
|
Halliday KE, Oswald WE, Mcharo C, Beaumont E, Gichuki PM, Kepha S, Witek-McManus SS, Matendechero SH, El-Busaidy H, Muendo R, Chiguzo AN, Cano J, Karanja MW, Musyoka LW, Safari TK, Mutisya LN, Muye IJ, Sidigu MA, Anderson RM, Allen E, Brooker SJ, Mwandawiro CS, Njenga SM, Pullan RL. Community-level epidemiology of soil-transmitted helminths in the context of school-based deworming: Baseline results of a cluster randomised trial on the coast of Kenya. PLoS Negl Trop Dis 2019; 13:e0007427. [PMID: 31398204 PMCID: PMC6719894 DOI: 10.1371/journal.pntd.0007427] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 09/03/2019] [Accepted: 04/30/2019] [Indexed: 11/19/2022] Open
Abstract
TRIAL REGISTRATION ClinicalTrials.gov NCT02397772.
Collapse
Affiliation(s)
- Katherine E. Halliday
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - William E. Oswald
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carlos Mcharo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emma Beaumont
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paul M. Gichuki
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Stella Kepha
- School of Public Health, Makerere University, Kampala, Uganda
| | - Stefan S. Witek-McManus
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sultani H. Matendechero
- Neglected Tropical Diseases Unit, Division of Communicable Disease Prevention and Control, Ministry of Health, Nairobi, Kenya
| | | | - Redempta Muendo
- Department of Health, County Government of Kwale, Kwale, Kenya
| | | | - Jorge Cano
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mary W. Karanja
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Leah W. Musyoka
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Tuva K. Safari
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lennie N. Mutisya
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Idris J. Muye
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maureen A. Sidigu
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Roy M. Anderson
- Faculty of Medicine, Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research, School of Public Health, St Mary’s Campus, Imperial College London, London, United Kingdom
| | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Simon J. Brooker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charles S. Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sammy M. Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel L. Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
5
|
Mochache V, Irungu E, El-Busaidy H, Temmerman M, Gichangi P. "Our voices matter": a before-after assessment of the effect of a community-participatory intervention to promote uptake of maternal and child health services in Kwale, Kenya. BMC Health Serv Res 2018; 18:938. [PMID: 30514292 PMCID: PMC6280535 DOI: 10.1186/s12913-018-3739-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 11/20/2018] [Indexed: 11/12/2022] Open
Abstract
Background Community-participatory approaches are important for effective maternal and child health interventions. A community-participatory intervention (the Dialogue Model) was implemented in Kwale County, Kenya to enhance uptake of select maternal and child health services among women of reproductive age. Methods Community volunteers were trained to facilitate Dialogue Model sessions in community units associated with intervention health facilities in Matuga, Kwale. Selection of intervention facilities was purposive based on those that had an active community unit in existence. For each facility, uptake of family planning, antenatal care and facility-based delivery as reported in the District Health Information System (DHIS)-2 was compared pre- (October 2012 – September 2013) versus post- (January – December 2016) intervention implementation using a paired sample t-test. Results Between October 2013 and December 2015, a total of 570 Dialogue Model sessions were held in 12 community units associated with 10 intervention facilities. The median [interquartile range (IQR)] number of sessions per month per facility was 2 (1–3). Overall, these facilities reported 15, 2 and 74% increase in uptake of family planning, antenatal care and facility-based deliveries, respectively. This was statistically significant for family planning pre- (Mean (M) = 1014; Standard deviation (SD) = 381) versus post- (M = 1163; SD = 400); t (18) = − 0.603, P = 0.04) as well as facility-based deliveries pre- (M = 185; SD = 216) versus post- (M = 323; SD = 384); t (18) = − 0.698, P = 0.03). Conclusions A structured, community-participatory intervention enhanced uptake of family planning services and facility-based deliveries in a rural Kenyan setting. This approach is useful in addressing demand-side factors by providing communities with a stake in influencing their health outcomes. Electronic supplementary material The online version of this article (10.1186/s12913-018-3739-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Vernon Mochache
- International Centre for Reproductive Health, Mombasa, Kenya. .,University of Ghent, Ghent, Belgium.
| | - Eunice Irungu
- International Centre for Reproductive Health, Mombasa, Kenya
| | | | - Marleen Temmerman
- International Centre for Reproductive Health, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,Aga Khan University, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,University of Nairobi, Nairobi, Kenya
| |
Collapse
|
6
|
Mochache V, Lakhani A, El-Busaidy H, Temmerman M, Gichangi P. Correlates of facility-based delivery among women of reproductive age from the Digo community residing in Kwale, Kenya. BMC Res Notes 2018; 11:715. [PMID: 30305159 PMCID: PMC6180567 DOI: 10.1186/s13104-018-3818-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Objective This study sought to describe factors associated with facility-based delivery among women of reproductive age in Kwale County, Kenya. Results Between March and December 2015, 745 women from 15 villages were interviewed through a cross-sectional household survey. Respondents were selected using stratified, systematic sampling and completed a sexual and reproductive health questionnaire. Of 632 (85%) women who had a previous birth, 619 (98%) reported antenatal care attendance. Of these, 491 (79%) subsequently had a facility-based delivery. Factors associated with increased likelihood of facility delivery included respondent’s education (odds ratio, OR = 2.0, 95% confidence interval, CI 1.2–3.2, P = 0.004), ideal antenatal care attendance (OR = 2.3, 95% CI 1.4–3.7, P = 0.001) and pregnancy intention (OR = 1.5, 95% CI 1.0–2.2, P = 0.040). Being in a polygamous relationship (OR = 0.6, 95% CI 0.3–0.9, P = 0.024) and having a husband ≥ 40 years (OR = 0.5, 95% CI 0.3–0.9, P = 0.013) were associated with reduced likelihood of facility delivery. Respondent’s education (aOR = 1.9, 95% CI 1.1–3.3, P = 0.030) as well as ideal ANC attendance (aOR = 2.0, 95% CI 1.0–3.8, P = 0.040) remained significantly associated with facility delivery in multivariate analyses. Electronic supplementary material The online version of this article (10.1186/s13104-018-3818-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Vernon Mochache
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya. .,University of Ghent, Ghent, Belgium.
| | - Amyn Lakhani
- Community Health Department, Aga Khan University, Mombasa, Kenya
| | | | - Marleen Temmerman
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,Community Health Department, Aga Khan University, Mombasa, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health, P.O. Box 91109-80103, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,University of Nairobi, Nairobi, Kenya
| |
Collapse
|
7
|
Mochache V, Lakhani A, El-Busaidy H, Temmerman M, Gichangi P. Pattern and determinants of contraceptive usage among women of reproductive age from the Digo community residing in Kwale, Kenya: results from a cross-sectional household survey. BMC Womens Health 2018; 18:10. [PMID: 29310654 PMCID: PMC5759252 DOI: 10.1186/s12905-017-0497-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/15/2017] [Indexed: 11/22/2022]
Abstract
Background Contraceptive usage has been associated with improved maternal and child health (MCH) outcomes. Despite significant resources being allocated to programs, there has been sub-optimal uptake of contraception, especially in the developing world. It is important therefore, to granulate factors that determine uptake and utilization of contraceptive services so as to inform effective programming. Methods Between March and December 2015, we conducted a cross-sectional survey among women of reproductive age (WRA) from the Digo community residing in Kwale County, Kenya. The study aimed to describe the pattern and determinants of contraceptive usage in this population. Respondents were selected using stratified, systematic sampling and completed a household sexual and reproductive health (SRH) questionnaire. Results We interviewed 745 respondents from 15 villages in 2 out of 4 sub-counties of Kwale. Their median (interquartile range, IQR) age was 29 (23–37) years. 568 (76%) reported being currently in a marital union. Among these, 308 (54%) were using a contraceptive method. The total unmet need, unmet need for spacing and for limiting was 16%, 8% and 8%, respectively. Determinants of contraceptive usage were education [adjusted Odds Ratio, aOR = 2.1, 95% confidence interval, CI: 1.4–3.4, P = 0.001]; having children [aOR = 5.0, 95% CI: 1.7–15.0, P = 0.004]; having attended antenatal care (ANC) at last delivery [aOR = 4.0, 95% CI: 1.1–14.8, P = 0.04] as well as intention to stop or delay future birth [aOR = 6.7, 95% CI: 3.3–13.8, P < 0.0001]. Conclusions We found high levels of contraceptive usage among WRA from the Digo community residing in Kwale. To further improve uptake and utilization of contraception in this setting, programs should address demand-side factors including ensuring female educational attainment as well as promotion of ANC and skilled birth attendance. Electronic supplementary material The online version of this article (10.1186/s12905-017-0497-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Vernon Mochache
- International Centre for Reproductive Health, Mombasa, Kenya. .,University of Ghent, Ghent, Belgium. .,, P.O. Box 3921, Nakuru, 20100, Kenya.
| | - Amyn Lakhani
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | | | - Marleen Temmerman
- International Centre for Reproductive Health, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya.,University of Ghent, Ghent, Belgium.,University of Nairobi, Nairobi, Kenya
| |
Collapse
|
8
|
Ogeng'o JA, El-Busaidy H, Mwika PM, Khanbhai MM, Munguti J. Variant anatomy of sciatic nerve in a black Kenyan population. Folia Morphol (Warsz) 2011; 70:175-179. [PMID: 21866528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Knowledge of variant anatomy of the sciatic nerve is important in avoiding inadvertent injury during operations in the gluteal region and interpreting nondiscogenic sciatica. This variant anatomy may cause piriformis syndrome and failure of sciatic nerve block. The variations differ between populations but data from Africans is scarce. This study, therefore, investigated variations of sciatic nerve in a black Kenyan population. One hundred and sixty-four sciatic nerves from 82 cadavers of black Kenyans were exposed by dissection at the Department of Human Anatomy, University of Nairobi, Kenya. The level of bifurcation, relationship to piriformis, and topographic relations between the branches were studied. The results were analysed by SPSS version 16.0 and are presented by macrographs. In 33 (20.1%) cases division occurred in the pelvis, while in 131 (79.9%) it occurred outside the pelvis. A single trunk sciatic nerve exited below the piriformis muscle in 131 (79.9%) cases. In cases of pelvic division, the tibial nerve was always infrapiriformic, while the common peroneal nerve passed below piriformis in 16 (9.8%) cases, pierced the piriformis in 13 (7.9%), and passed above it in 4 (2.4%). For those in which division was extrapelvic, 110 (67.1%) were in the popliteal fossa, 17 (10.4%) in the middle third of the thigh, and 4 (2.4%) in the gluteal region. Where the division was pelvic, in 19 (11.6%) cases they continued separately, in 8 (4.9%) the two nerves reunited, and in 6 (3.7%) they were connected by a communicating nerve. The sciatic nerve in the Kenyan population varies from the classical description in over 30% of cases, with many high divisions, low incidence of piriformic course of common peroneal nerve, reunion, and unusual connection between common peroneal and tibial nerves. These variations may complicate surgery and interpretation of sciatic neuropathy. Preoperative nerve imaging and extra operative diligence in the gluteal region and the back of the thigh are recommended.
Collapse
Affiliation(s)
- J A Ogeng'o
- Department of Human Anatomy, University of Nairobi.
| | | | | | | | | |
Collapse
|