IntroductionMiscarriages are a common pregnancy complication and positive depression screen after a miscarriage has been shown to be high in our population. Various factors are associated with an increased risk of developing depression after a miscarriage. However, these factors vary across populations studied with no studies existing in our region. We set out to determine the factors associated with a positive depression screen among post-miscarriage women at the Aga Khan University hospital, Nairobi.MethodsPatients were recruited at the 2 weeks clinic review after a miscarriage in the gynaecological clinics. They were screened using the Edinburgh postnatal depression scale for depression after a miscarriage. Analysis was done using Univariate and multivariate analysis to compare clinical variables between the screen - positive and screen - negative women in order to delineate the potential pattern of association between the two among the study subjects.ResultsPositive depression screen was detected in 34.1% of the patients recruited. Univariate analysis revealed that education level (p = 0.039) and mode of conception (p = 0.005) impacted on the outcome of the depression screen. In multivariate analysis, multiple factors impacted on the depression screen and these included: age (p = 0.009), education level (p = 0.001), gestation at miscarriage (p = 0.04), marital status (p = 0.043), prior miscarriage (p = 0.011) and mode of conception (p = 0.03).ConclusionFactors that seem to impact on the positive depression screen include a younger age, low education level, an older gestational age at miscarriage, being single, an assisted mode of conception and prior miscarriage. These factors may be used to triage women after a miscarriage in order to pick up those who may screen positive for depression after a miscarriage.

Introduction Müllerian duct anomalies represent a group of congenital malformations that result from failure to complete bilateral paramesonephric duct elongation, fusion, canalization, or septal resorption. These anomalies are rare in the general population with a bicornuate or didelphys uterus being among the common ones. Bicornuate uterine malformations are of clinical significance due to their adverse reproductive outcomes. Metroplasty has been shown to improve reproductive outcomes of bicornuate uterine malformations. We document a case of bicornuate uterus that was managed with Strassman metroplasty and a subsequent successful pregnancy outcome. Case A Black African lady was seen with a history of six prior miscarriages. Her diagnostic workup revealed a bicornuate uterus for which she had a Strassman metroplasty performed. She later conceived and was followed up to term with a successful live birth. Conclusion Strassman metroplasty is a rare procedure in Sub-Saharan Africa and this case seeks to add to the body of knowledge on surgical management of Müllerian duct anomalies specifically bicornuate uterus in this region. This case report aims to increase the awareness of Müllerian duct abnormalities specifically bicornuate uterus in cases of recurrent miscarriages and highlight the diagnostic strategies to investigate and to demonstrate management options in low resource settings.

Background Preconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could contribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in rural areas. Little is known regarding PCC use in Kenya that could help in addressing this shortfall. This study aimed to qualitatively assess the determinants of PCC in urban and rural settings in Kenya. Methods A qualitative approach was employed to assess determinants of PCC using a semi-structured interview guide. The study was conducted from May to October 2017. Selected pregnant women seeking antenatal care (ANC) were recruited by quota sampling, at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). The interviews were thereafter transcribed verbatim and analyzed thematically. Findings A total of 26 women were invited, of whom 21 accepted to participate in in-depth interviews (IDIs). Saturation of themes occurred with 13 interviews (7 at AKUH and 6 at MLFH). Transcription, coding and thematic analysis of the IDIs yielded 12 themes. Eleven of these themes were identified as determinants of PCC. The twelfth theme contained suggested strategies of increasing PCC awareness and utilization, such as using the media, setting up PCC clinics and integrating PCC into other clinics. The dominant themes were awareness about PCC and attitudes towards PCC and pregnancy. The broad determinants of PCC were similar in urban and rural settings – with a few notable exceptions. For example, in the rural setting, women’s level of education and a pervasive history of poor interactions with healthcare providers were major determinants of PCC. Conclusion From this study we conclude that women’s lack of awareness about PCC, in conjunction with attitudes towards PCC and pregnancy impact strongly on its utilization. This lack of awareness could be addressed through health education programs for both the public and for healthcare providers, as well as integrating PCC in the curricula of the later.

BACKGROUNDPreconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could contribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in the rural areas. Little is known regarding PCC use in Kenya that could help in bridging this gap. This study aimed to assess the determinants of PCC in urban and rural settings in Kenya.METHODSSelected pregnant women seeking antenatal care (ANC) were recruited by purposive sampling at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). A qualitative approach was employed to assess determinants of PCC using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed thematically.RESULTS A total of 26 women were invited, of whom 21 accepted to participate in in-depth interviews (IDIs). Saturation of themes occurred after 13 interviews (7 at AKUH and 6 at MLFH).Transcription, coding and thematic analysis of the IDIs yielded 12 main themes. Eleven of the main themes were identified as determinants of PCC while the twelfth theme contained suggested strategies of increasing PCC awareness and utilization, such as using the media, setting up PCC clinics and integrating PCC into other clinics. The dominant themes were awareness about PCC and attitudes towards PCC and pregnancy.The broad determinants of PCC were similar in urban and rural settings – with a few notable exceptions. For example, in the rural setting, women’s level of education and a pervasive history of poor interactions with healthcare providers were major determinants of PCC.CONCLUSIONFrom this study we conclude that women’s lack of awareness about PCC, in conjunction with attitudes towards PCC and pregnancy impact strongly on its utilization. This lack of awareness could be addressed through health education programs for both the public and for healthcare providers, as well as integrating PCC in the curricula of nurses and doctors.