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Showing posts with label mother and child health. Show all posts
Showing posts with label mother and child health. Show all posts

Saturday, October 21, 2023

TeleCTG: Impacts of use of portable cardiotocographs (CTG) gadgets to monitor fetal wellbeing in low access regions

 


Impacts of use of portable cardiotocographs (CTG) gadgets to monitor fetal wellbeing in low access regions.

The use of portable cardiotocographs (CTGs) in low-access regions can have a significant impact on fetal wellbeing. CTGs are non-invasive devices that measure the fetal heart rate (FHR) and uterine contractions. By monitoring the FHR, CTGs can help to identify potential problems with the fetus, such as hypoxia (lack of oxygen), distress, or abnormalities in the heart rhythm.

In low-access regions, such as rural Kenya, where access to healthcare is limited, CTGs can be a valuable tool for improving fetal outcomes. By providing early warning of potential problems, CTGs can help to ensure that women receive timely and appropriate care. This can lead to a reduction in stillbirths, neonatal deaths, long-term disabilities and overall neonatal complication rates.

In addition to their clinical benefits, portable CTGs can also have a number of social and economic benefits. For example, by reducing the need for women to travel long distances for antenatal care, CTGs can help to save time and money. Additionally, by providing women with information about their fetus's health, CTGs can help to reduce anxiety and stress.

Overall, the use of portable CTGs in low-access regions can have a significant impact on fetal wellbeing. By providing early warning of potential problems, CTGs can help to ensure that women receive timely and appropriate care. This can lead to a reduction in stillbirths, neonatal deaths, and long-term disabilities.

Here are some specific global examples of the impacts of portable CTGs on fetal wellbeing in low-access regions:

  • In a study conducted in rural India, the use of portable CTGs was associated with a 50% reduction in stillbirths.

  • In a study conducted in sub-Saharan Africa, the use of portable CTGs was associated with a 25% reduction in neonatal deaths.

  • In a study conducted in Latin America, the use of portable CTGs was associated with a 15% reduction in the number of babies born with long-term disabilities.

These studies demonstrate that the use of portable CTGs can have a significant impact on fetal wellbeing in low-access regions. 

In context of Kenya, the adoption of new generation cardiotocograph is limited possibly due to cost of purchase or hire, awareness and technical expertise of CTG use. Despite this challenge, there has been good reception of the idea particularly in tier II health facilities with a diverse clientele. The approach of teleCTG as an element of telemedicine has been backed up by resilient healthcare managers, CMOs, CNOs midwifes and obstetricians enthusiastic of patient safety and quality improvement. The paper lies on the desk of economic resource movers.


Monday, July 31, 2023

Lamaze as a Safari ya Mama engagement approach


Lamaze as a Safari ya Mama engagement approach

Lamaze is a childbirth education method that was developed in the 1940s by French obstetrician Dr. Fernand Lamaze. The Lamaze method focuses on natural childbirth techniques, such as breathing and relaxation exercises, to help mothers cope with the pain of childbirth.

Pregnancy can be a daunting experience for any expectant mother, especially for first-time mothers. Lamaze classes are a popular form of childbirth education that can help pregnant women in Kenya prepare for childbirth and make informed decisions about their childbirth experience. 

These are some of feedback from mothers after taking Lamaze classes in Kenya.

“I liked that everything was evidence and study-based.”

“All aspects of the class were particularly effective and helpful. I wanted to learn birthing techniques for a successful childbirth and compare the pros and cons of my birthing experience.” 

“It was very helpful to know that breastfeeding isn't supposed to hurt, it just means the latch is wrong. This class also changed my birth plan in the sense that I will hold my baby after birth. Thank you xxxx (Midwife),”

click on link to see full description in the case of tier two hospital in Nairobi, Kenyahttps://youtu.be/Tssf10CzVzc?si=ds-XTndbAL6x_rsq

Friday, June 23, 2023

Safari ya Mama: A Tech Health Revolution in Maternal Health


Safari ya Mama: Antenatal-Birth-Childcare (ABC)

Imagine a world where nearly one in twenty children don't live to see their first birthday. This is the sobering reality in Kenya where maternal and infant mortality rates are alarmingly high. But what if technology could provide a lifeline?

I will always affirm that 'Safari ya Mama' program is one of many steps towards reducing maternal and infant mortality rates, and it's just the beginning.

Technology has the potential to revolutionize healthcare as we know it, making it more accessible, more affordable, and more efficient. 

Follow my video for more content:  https://youtu.be/-DbY2omwG9k?si=-0cq8WANt4dPueiu

Wednesday, April 19, 2023

Understanding Surrogacy in a Kenyan Perspective

 

What is Human Surrogacy

Human surrogacy is a type of assisted reproductive technology (ART) in which a woman, known as the surrogate mother, agrees to carry a pregnancy to term and give birth to a child for another person or couple, known as the intended parents. For human gestation surrogacy, the surrogate mother is not genetically related to the child, and the intended parents will become the legal parents of the child after birth.

Traditional Surrogacy versus Gestational surrogacy

The main difference between traditional surrogacy and gestational surrogacy is the biological connection between the surrogate mother and the child.

In traditional surrogacy, the surrogate mother is inseminated with the sperm of the intended father. Now you are wondering who is the biological mother. YES!, you are right, the surrogate mother is the biological mother of the child in this case.

In gestational surrogacy, the surrogate mother is implanted with an embryo that has been created using the sperm and egg of the intended parents, or using donor sperm and egg. This means that the surrogate mother is NOT the biological mother of the child.

Which type of surrogacy is right for you?

By now you might be wondering which is the best option for surrogacy and particularly in our African set of life.

Based on my observation and research, I will advise that the best type of surrogacy for you will depend on your individual circumstances and preferences. If you are looking for a more affordable option, traditional surrogacy may be a better choice. However, it is important to be aware of the legal and ethical challenges associated with traditional surrogacy.

On the other hand, if you are looking for a more straightforward legal process and a less ethically controversial option, gestational surrogacy may be a better choice. However, it is important to note that gestational surrogacy is typically more expensive than traditional surrogacy.

Remember that, It is important to discuss your options with a fertility specialist or surrogacy agency or legal adviser to determine which type of surrogacy is right for you.

Surrogacy in Kenya

Surrogacy is a complex and controversial issue in Kenya. There is no specific law on surrogacy, but the Kenyan constitution through Article 45(1) guarantees the right to form and be part of a family. My wakili friend will term this as a ‘legislative lacuna’.

This loophole has led to a growing number of people seeking surrogacy services in Kenya, both from within the country and from abroad. Yes, it is the true state of affairs; foreigners would travel all the way from their surrogacy-restrained countries to our legally open state for the convenience to start an ideal family. Thanks to the loophole.

Implications of surrogacy in Kenya:

Ethical concerns: Surrogacy raises a number of ethical concerns, such as the potential for exploitation of surrogate mothers, the commercialization of the human body, and the impact on children born through surrogacy.

Legal issues: The lack of a legal framework for surrogacy in Kenya creates a number of legal challenges, such as determining parental rights and responsibilities.

Social impact: Surrogacy is a relatively new phenomenon in Kenya, and its social impact is still being debated. Some people argue that it is a threat to traditional family values, while others argue that it is a positive development that expands the possibilities for family formation.

S
pecific examples of the implications of surrogacy in Kenya

Petition case 78 of 2014 (Kenya Law JL N & 2 others v. Director of Children Services & 4 others [2014] eKLR); DCS had seized two children born out of a surrogacy arrangement between a Kenyan couple (the Petitioners) and a surrogate mother. The DCS had argued that the surrogacy agreement was illegal and that the children were at risk of being exploited. This case was a big landmark of surrogacy in Kenya as the High Court of Kenya held that the Director of Children's Services (DCS) has no power to seize children born out of surrogacy agreements.

Petition 443 of 2014 (AMN & 2 others v. Attorney General & 5 others eKLR, BKN, TMK) In 2014, a Kenyan couple who had twins through surrogacy were unable to obtain birth certificates for their children because the Kenyan government did not recognize the surrogacy arrangement. The ruling in this Petition was another significant victory for surrogacy in Kenya. It established that surrogacy is legal in Kenya and that children born through surrogacy have the same rights as children born through natural conception. The ruling also required the government to take steps to implement the court's rulings, including developing a national policy on surrogacy and amending the relevant laws and regulations.

In 2018, a group of people were arrested in Kenya on charges of child trafficking for their involvement in a surrogacy arrangement.

There have been reports of surrogate mothers in Kenya being exploited by surrogacy agencies, who may offer them inadequate compensation or fail to provide them with adequate medical care.

Despite the challenges, surrogacy is a growing phenomenon in Kenya. It is important to have a public conversation about the ethical, legal, and social implications of surrogacy in order to develop a regulatory framework that protects the rights of all parties involved.

The Awakening Path

The awakening journey cannot be described without mention of various individuals who made a mark in the acknowledgement of Surrogacy.

Hon. Majanja, an high court judge was very instrumental through his guidance and ruling of surrogacy and parenting petitions brought before him. In 2014, he ruled that ''Surrogacy is not a hypothetical issue any more. It is real and many Kenyans are resulting to surrogacy as an alternative to being parents especially those who cannot for medical reasons have their own children''

The late Prof. Magoha, and then chairperson of Kenya Medical and Dentists Board (KMDB), was a strong advocate for Assisted Reproductive Technology (ART) and surrogacy in Kenya. In 2018, he authorized the expansion of ART services in Mombasa, which was a significant step towards making ART more accessible to Kenyans.

In 2018, Prof Marion Mutugi and Justice Isaac Lenaola co-authored the book Bioethics of Medical Advances and Genetic Manipulation: Legal, Philosophical and Moral Perspectives. I have had time to peruse this book and can agree that this is an important work that contributes to the understanding of the ethical, legal, and philosophical implications of surrogacy and other genetic manipulation in Kenya and beyond.

In 2014, a tough speaking female parliamentarian, Hon. Millie Othiambo tabled the Assisted Reproductive Technology(ART) Bill that opened the start of legal guidance on surrogacy. 

Evolution of Surrogacy in Kenyan History

Before Assisted Reproductive Technology (ART), surrogacy practices in Kenya were largely informal and unregulated. There were no clear legal guidelines or regulations governing surrogacy arrangements, and surrogate mothers and intended parents were often left to negotiate their own agreements.

One common practice was for surrogate mothers to be recruited from within the extended family or community of the intended parents. This was often seen as a way to build trust and ensure that the surrogate mother was known and respected by the intended parents.

Another common practice was for surrogate mothers to be paid in cash or in kind for their services. The amount of compensation paid varied depending on the circumstances of the arrangement, but it was typically lower than the amount paid to surrogate mothers in developed countries.

There were also some cases of commercial surrogacy in Kenya before ART. However, this practice was less common, as it was not widely accepted by society. 

In general, surrogacy practices in Kenya before ART were less sophisticated and less regulated than they are today. Surrogate mothers and intended parents often faced legal and social challenges, and there was a lack of support for surrogacy arrangements.

I did  some report digging and here are some specific examples of surrogacy practices in Kenya before ART:

In 1989, a Kenyan woman became the first known surrogate mother in the country. She was paid 100,000 Kenyan shillings (approximately $1,000 at the time) to carry a child for a British couple.

In 1994, a Kenyan woman gave birth to twins through surrogacy for a Kenyan couple. The arrangement was negotiated between the two couples without any legal contract or third-party involvement.

In 1997, a Kenyan woman gave birth to a child through surrogacy for a Japanese couple. The arrangement was facilitated by a commercial surrogacy agency, and the surrogate mother was paid 500,000 Kenyan shillings (approximately $5,000 at the time).

The development of ART in Kenya has made surrogacy more accessible and affordable for intended parents. However, there is still a need for clear legal guidelines and regulations to protect the rights of surrogate mothers and intended parents. Let us understand more about the ART bill, 2014 on surrogacy.

Kenya Reproductive Health Care Bill, 2014 on surrogacy:

The Kenya Reproductive Health Care Bill, 2014 (the Bill) is a proposed law that would regulate assisted reproductive technology (ART) in Kenya, including surrogacy. The Bill was introduced in Parliament in 2014, but it has not yet been passed into law.

The Bill defines surrogacy as "an arrangement in which a woman agrees to carry a pregnancy to term and give birth to a child for another person or persons." It sets out a number of requirements for surrogacy arrangements, including that:

  • The commissioning parent(s) and the surrogate mother must all be of legal age and capacity to consent to the arrangement.

  • The surrogate mother must be medically fit to carry a pregnancy.

  • All parties to the arrangement must have received genetic counseling.

  • The arrangement must be in writing and signed by all parties.

  • The surrogate mother must be paid reasonable compensation for her services.

Take note that the Bill also prohibits certain practices related to surrogacy, such as:

  • Commercial surrogacy, where the surrogate mother is paid more than reasonable compensation for her services.

  • Altruistic surrogacy, where the surrogate mother is not paid any compensation for her services.

  • Surrogacy for single people or same-sex couples.

The Bill has been praised by some for its attempt to regulate surrogacy and protect the rights of all parties involved. However, others have criticized the Bill for being too restrictive and for failing to adequately address the needs of infertile couples, same-sex couples(gay couples), and single people.

Overall, the Kenya Reproductive Health Care Bill, 2014 is a significant step towards regulating surrogacy in Kenya. However, it is important to note that the Bill has not yet been passed into law, and it is possible that it could be amended before it is passed.

Please leave your comment below on this complex and controversial discussion.

Wednesday, March 8, 2023

International Patient Safety Goals (IPSGs) utilization for maternal and childcare improvement


International Patient Safety Goals (IPSGs) utilization for maternal and childcare improvement

The International Patient Safety Goals (IPSGs) are a set of evidence-based standards developed by the Joint Commission International (JCI) to help healthcare organizations improve patient safety. The IPSGs are widely recognized as a global benchmark for patient safety and are used by accredited organizations in over 100 countries.

The IPSGs can be used to improve maternal and childcare safety in a number of ways. For example:

  • Improve the accuracy and completeness of patient identification. This can help to prevent misidentification of mothers and babies, which can lead to medication errors and other problems.

  • Improve the effectiveness of communication among caregivers. This can help to ensure that all members of the care team are aware of the mother's and baby's condition and are working together to provide safe care.

  • Improve the safety of high-alert medications. This can help to prevent medication errors, which are a leading cause of harm in healthcare.

  • Reduce the risk of healthcare-associated infections (HAIs). HAIs are a major cause of morbidity and mortality in mothers and babies. By implementing IPSGs related to hand hygiene, environmental cleaning, and safe injection practices, healthcare organizations can reduce the risk of HAIs.

  • Reduce the risk of patient falls. Falls are a leading cause of injury in mothers and babies. By implementing IPSGs related to fall prevention, healthcare organizations can help to keep mothers and babies safe.

In addition to these specific IPSGs, all of the IPSGs can contribute to improved maternal and childcare safety by promoting a culture of safety within healthcare organizations. By focusing on patient safety, healthcare organizations can create a safer environment for mothers, babies, and all patients.

Here are some specific examples of how IPSGs have been used to improve maternal and childcare safety:

  • In one study, the implementation of an IPSG on patient identification was associated with a significant reduction in the rate of medication errors in newborns.

  • In another study, the implementation of an IPSG on communication among caregivers was associated with a reduction in the rate of adverse events in the neonatal intensive care unit (NICU).

  • In a third study, the implementation of an IPSG on the safety of high-alert medications was associated with a reduction in the rate of medication errors in the maternity ward.

These studies provide evidence that the IPSGs can be effective in improving maternal and childcare safety. During my clinical practice in a busy obstetrics and newborn unit, I have seen tremendous reduction of incidences and quality improvement after adoption and utilization of IPSGs. I will affirm that, by implementing the IPSGs, healthcare organizations can make a significant contribution to improving the safety of mothers and babies in Kenya and around the world.


Justice for Daniel Muthiani a.k.a Sniper is Justice for Meru Youths

  Daniel Muthiani, popularly known as Sniper, was a Meru-based blogger and political activist. He was reported missing on December 2, 2023, ...