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Lwamulungi E, Qureshi Z, Obimbo M, Ogutu O, Cheserem E, Kosgei RJ, Walong E, Inyangala D, Nyakundi GG, Ndavi PM, Osoti AO, Ondieki DK, Pulei AN, Njoroge A, Masyuko S, Wachira CM. Placental characteristics and neonatal weights among women with malaria-preeclampsia comorbidity and healthy pregnancies. PLoS One 2023; 18:e0291172. [PMID: 37856468 PMCID: PMC10586625 DOI: 10.1371/journal.pone.0291172] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/16/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Malaria and preeclampsia are leading causes of maternal morbidity and mortality in sub-Saharan Africa. They contribute significantly to poor perinatal outcomes like low neonatal weight by causing considerable placental morphological changes that impair placental function. Previous studies have described the effects of either condition on the placental structure but the structure of the placenta in malaria-preeclampsia comorbidity is largely understudied despite its high burden. This study aimed to compare the placental characteristics and neonatal weights among women with malaria-preeclampsia comorbidity versus those with healthy pregnancies. METHODOLOGY We conducted a retrospective cohort study among 24 women with malaria-preeclampsia comorbidity and 24 women with healthy pregnancies at a County Hospital in Western Kenya. Neonatal weights, gross and histo-morphometric placental characteristics were compared among the two groups. RESULTS There was a significant reduction in neonatal weights (P<0.001), placental weights (P = 0.028), cord length (P<0.001), and cord diameter (P<0.001) among women with malaria-preeclampsia comorbidity compared to those with healthy pregnancies. There was also a significant reduction in villous maturity (P = 0.016) and villous volume density (P = 0.012) with increased villous vascularity (P<0.007) among women with malaria-preeclampsia comorbidity compared to those with healthy pregnancies. CONCLUSION Placental villous maturity and villous volume density are significantly reduced in patients with malaria-preeclampsia comorbidity with a compensatory increase in villous vascularity. This leads to impaired placental function that contributes to lower neonatal weights.
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Affiliation(s)
- Everett Lwamulungi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Zahida Qureshi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Moses Obimbo
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Omondi Ogutu
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Eunice Cheserem
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Rose J. Kosgei
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Edwin Walong
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Pathology, University of Nairobi, Nairobi, Kenya
| | - Dennis Inyangala
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Pathology, University of Nairobi, Nairobi, Kenya
| | - George G. Nyakundi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Patrick M. Ndavi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Alfred O. Osoti
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Diana K. Ondieki
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Anne N. Pulei
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Anne Njoroge
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United states of America
| | - Sarah Masyuko
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United states of America
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Okinyi HM, Wachira CM, Wilson KS, Nduati MN, Onyango AD, Mburu CW, Inwani IW, Owens TL, Bukusi DE, John-. Stewart GC, Wamalwa DC, Kohler PK. “I Have Actually not Lost any Adolescent Since I Started Engaging Them one on one:” Training Satisfaction and Subsequent Practice among Health Providers Participating in a Standardized Patient Actor Training to Improve Adolescent Engagement in HIV Care. J Int Assoc Provid AIDS Care 2022; 21:23259582221075133. [PMID: 35068204 PMCID: PMC8793424 DOI: 10.1177/23259582221075133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Poor health care worker (HCW) interactions with adolescents negatively influence engagement in HIV care. We assessed the impact of standardized patient actor training on HCW competence in providing adolescent HIV care in Kenya. Methods: We conducted pre-post cross-sectional surveys and qualitative exit interviews during a stepped wedge randomized trial. Cross-sectional surveys assessed self-rated competence in providing adolescent services before and after the intervention, and training satisfaction. In-depth interviews with a subset of HCW participants one year after training. Results: Over 90% of HCWs reported satisfaction with the training and there was significant improvement in self-rated competence scores (mean = 4.63 [highest possible score of 5] post-training vs 3.86 pre-training, p < 0.001). One-year following training, HCWs reported using skills in patient-centered communication and structuring an adolescent clinical encounter. Conclusions: This SP training intervention improved self-rated competence and showed sustained perceived impact on HCW skills in adolescent HIV service provision one year later.
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Omballa VO, Musyoka RN, Vittor AY, Wamburu KB, Wachira CM, Waiboci LW, Abudo MU, Juma BW, Kim AA, Montgomery JM, Breiman RF, Fields BS. Serologic Evidence of the Geographic Distribution of Bacterial Zoonotic Agents in Kenya, 2007. Am J Trop Med Hyg 2015; 94:43-51. [PMID: 26598574 PMCID: PMC4710443 DOI: 10.4269/ajtmh.15-0320] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 04/30/2015] [Accepted: 09/25/2015] [Indexed: 12/18/2022] Open
Abstract
Diseases of zoonotic origin contribute to the burden of febrile illnesses in developing countries. We evaluated serologic evidence of exposure to Bacillus anthracis, Brucella spp., spotted fever group rickettsioses (SFGR), and typhus group rickettsioses (TGR) from samples of persons aged 15–64 years collected during a nationwide human immunodeficiency virus (HIV) serosurvey conducted in 2007 in Kenya. The seropositivity observed for pathogens was B. anthracis 11.3%, Brucella spp. 3.0%, SFGR 23.3%, and TGR 0.6%. On univariate analysis, seropositivity for each pathogen was significantly associated with the following risk factors: B. anthracis with province of residence; Brucella spp. with sex, education level, and wealth; SFGR with age, education level, wealth, and province of residence; and TGR with province of residence. On multivariate analysis, seropositivity remained significantly associated with wealth and province for B. anthracis; with sex and age for Brucella spp; and with sex, education level, and province of residence for SFGR whereas TGR had no significance. High IgG seropositivity to these zoonotic pathogens (especially, B. anthracis and SFGR) suggests substantial exposure. These pathogens should be considered in the differential diagnosis of febrile illness in Kenya.
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Affiliation(s)
- Victor O. Omballa
- *Address correspondence to Victor O. Omballa, Center for Global Health Research, Kenya Medical Research Institute, P.O. Box 606-00621, Nairobi, Kenya. E-mail:
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