BackgroundFemale genital mutilation/cutting (FGM/C) has been implicated in sexual complications among women, although there is paucity of research evidence on sexual experiences among married women who have undergone this cultural practice. The aim of this study was to investigate the sexual experiences among married women in Mauche Ward, Nakuru County.MethodsQuantitative and qualitative data collection methods were used. Quantitative data were obtained from 318 married women selected through multistage sampling. The women were categorized into: cut before marriage, cut after marriage and the uncut. A questionnaire was used to collect demographic information while psychometric data were obtained using a female sexual functioning index (FSFI) tool. The resulting quantitative data were analyzed using SPSS® Version 22. Qualitative data were obtained from five FGDs and two case narratives. The data were organized into themes, analyzed and interpreted. Ethical approval for the study was granted by Kenyatta National Hospital-University of Nairobi Ethics and Research Committee.ResultsThe mean age of the respondents was 30.59 ± 7.36 years. The majority (74.2%) had primary education and 76.1% were farmers. Age (p = 0.008), number of children (p = 0.035) and education (p = 0.038) were found to be associated with sexual functioning. The cut women reported lower sexual functioning compared to the uncut. ANOVA results show the reported overall sexual functioning to be significantly (p = 0.019) different across the three groups. Women cut after marriage (mean = 22.81 ± 4.87) scored significantly lower (p = 0.056) than the uncut (mean = 25.35 ± 3.56). However, in comparison to the cut before marriage there was no significant difference (mean = 23.99 ± 6.63). Among the sexual functioning domains, lubrication (p = 0.008), orgasm (p = 0.019) and satisfaction (p = 0.042) were significantly different across the three groups. However, desire, arousal and pain were not statistically different.ConclusionGenerally, cut women had negative sexual experiences and specifically adverse changes in desire, arousal and satisfaction were experienced among cut after marriage. FGM/C mitigating strategies need to routinely provide sexual complications management to safeguard women’s sexual right to pleasure subsequently improving their general well-being.

underdiagnosis of active TB disease during the antenatal and postnatal periods. HIV and TB co-infection during pregnancy have a multiplier effect on maternal morbidity and mortality, and result in poorer pregnancy outcomes. 1,11 In Pune, India, TB increased the probability of death by 2.2-fold among HIV-infected women who developed TB and by 3.4-fold for their infants compared to women who did not develop TB. 11 In Johannesburg, South Africa, 70% of obstetric deaths in HIV-infected women were mainly attributed to TB. 12 These fi gures suggest that routine screening of pregnant women for TB in endemic settings would be helpful, particularly those who are HIV-infected.The World Health Organization (WHO) recommends ruling out active TB and identifying those in need of further testing among HIV-infected adults using specifi c symptoms (current cough of any duration, fever, weight loss or night sweats). 13 Although these recommendations were not specifi c for pregnancy, Gupta et al. used this recommendation and found a 1.4% (11/799) prevalence of active TB among HIVi nfected pregnant women who were part of a clinical trial in India. 14 Another study of cough of >2 weeks, performed in Kenya by the same clinical team and by the same fi rst author in a routine setting similar to the target population for this study, failed to identify those with TB disease (n = 187). 15 The current study differs from the earlier one in its larger sample size and because it compares HIV-infected and non-infected pregnant women.Data on the utilization of symptom screening among pregnant women in routine settings are scarce. This has been attributed to signifi cant fi nancial and logistical challenges in the implementation of screening in this group of patients. 1 The objectives of the present study were 1) to explore the utility of TB symptom screening using symptoms of ⩾2 weeks' duration in a routine setting, and 2) to compare differences in diagnosis of TB among HIV-infected and non-infected pregnant women in western Kenya. METHODS Study designThis was a descriptive cohort study among HIV-infected and non-infected pregnant women. R eduction of tuberculosis (TB) transmission, morbidity and mortality relies largely on intensifi ed case fi nding, with consequent early initiation of adequate treatment. 1,2 This is particularly important among pregnant women in resource-limited settings where TB is a cause of non-obstetrical (indirect) maternal deaths. 3,4 This burden is higher in settings with a high prevalence of human immunodefi ciency virus (HIV) infection. 5,6 Kenya has an adult HIV prevalence of 6.2%, 7 with an unacceptably high maternal mortality ratio of 488 per 100 000 live births; 25% of these deaths are attributed to indirect causes such as TB, anaemia, HIV and malaria. 8 TB case notifi cation data are not stratifi ed for pregnancy, but women of reproductive age bear a higher burden of TB in sub-Saharan Africa than their male counterparts. 1,9 Data from Western Cape, South Africa, indicate that there is a 24.2-fold higher incidenc...

Background In settings with high prevalence of female genital mutilation (FGM), the health sector could play a bigger role in its prevention and care of women and girls who have undergone this harmful practice. However, ministries of health lack clear policies, strategic plans or dedicated funding to implement anti-FGM interventions. Along with limited relevant knowledge and skills to prevent the practice of FGM and care for girls and women living with FGM, health providers have limited interpersonal communication skills and self-efficacy, while some may have supportive attitudes towards FGM and its medicalization. We propose to test the effectiveness of a health system strengthening intervention that includes training antenatal care (ANC) providers on person-centred communication (PCC) for FGM prevention. Methods This will be a two-level, hybrid, effectiveness-implementation research study using a cluster randomized trial design in Guinea, Kenya and Somalia conducted over a 6 months period. In each country, within pre-selected regions/counties, 60 ANC clinics will be randomized to intervention and control arms. At baseline, all clinics will receive the level one intervention involving provision of FGM-related clinical guidelines and handbook as well as anti-FGM policies and posters. At month 3, intervention clinics will receive the level two intervention comprising of a training for ANC providers on PCC to challenge their FGM-related attitudes and build their communication skills to effectively provide FGM prevention counselling. A process evaluation will be conducted to understand ‘how’ and ‘why’ the intervention package achieves intended results. Multi-level regression modelling will be used for quantitative data analysis while qualitative data will be assessed using thematic content analysis to determine the effectiveness, feasibility and acceptability of the different intervention levels. Discussion The proposed study will strengthen the knowledge base regarding how to effectively involve health providers in FGM prevention and care. Trial registration Trial registration and date: PACTR201906696419769 (June 3rd, 2019).

Background Delayed cord clamping (DCC) is a placental to new-born transfusion strategy recommended by obstetric and gynaecological societies. Though not widely adopted, umbilical cord milking (UCM) may achieve faster transfusion when DCC cannot be performed such as when a neonate requires resuscitation. Methods Pragmatic, two-arm, randomized clinical trial in which consenting women in spontaneous labour or provider-initiated delivery at 28 to less than 37 weeks at Kenyatta National Hospital in Nairobi, Kenya, were enrolled. At delivery, stable preterm infants were randomized to UCM (4 times) or DCC (60 seconds). Neonatal samples were collected for analysis at 24 hours after delivery. Maternal primary PPH (within 24 hours) and neonatal jaundice (within 1 week) were evaluated clinically. The primary outcome was the mean neonatal haemoglobin level at 24 hours after birth. Modified Intention to treat analysis was used for all outcomes. P-value was significant at p<0.05. Results Between March 2018 to March 2019, 344 pregnant women underwent screening, and 280 eligible participants were randomized when delivery was imminent. The intervention was not performed on 19 ineligible neonates. Of the remaining 260 neonates, 133 underwent UCM while 128 underwent DCC. Maternal and neonatal baseline characteristics were similar. The mean neonatal haemoglobin (17.1 vs 17.5 grams per decilitre, p = 0.191), haematocrit (49.6% vs 50.3%, p = 0.362), anaemia (9.8% vs 11.7%, p = 0.627), maternal PPH (2.3% vs 3.1%, p = 0.719) were similar between UCM and DCC respectfully. However, neonatal polycythaemia (2.3% vs 8.6%, p = 0.024) and neonatal jaundice (6.8% vs 15.6%, p = 0.024) were statistically significantly lower in UCM compared to DCC. Conclusion UCM compared to DCC for preterm neonates resulted in similar outcomes for neonatal haemoglobin, haematocrit, anaemia and maternal primary PPH and a lower proportion of neonatal polycythaemia and clinical jaundice. UCM offers a comparable method of placental transfusion compared to DCC and may be considered as an alternative to DCC in preterm neonates at 28 to <37 weeks’ gestation.

Background: There is little evidence linking meconium stained liquor to poor perinatal outcome and clear amniotic fluid is frequently considered a reassuring sign during labour. Objective: To determine whether there are any differences in cardiotocography (CTG) tracings and perinatal outcomes in women with meconium stained compared with those with clear liquor in labour. Design: A prospective cohort study.