Journal of Obstetrics and Gynaecology of Eastern and Central Africa最新文献

{"title":"Nonimmune hydrops fetalis in a primigravida in the third trimester: A case report","authors":"Faiza Nassir, Rehema Omar Shee, Nawal Alyan, Abdulrahman Lavingia","doi":"10.59692/jogeca.v36i1.165","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.165","url":null,"abstract":"\u0000Background: Hydrops fetalis is abnormal fluid accumulation within at least two fetal compartments, which may include pericardial effusion, pleural effusions, ascites, and skin edema. In the absence of red cell alloimmunization, hydrops fetalis is nonimmune (NHIF) and affects approximately 1 in 2000 pregnancies.\u0000Case presentation: A 33-year-old primigravida presented to the high-risk clinic for further management following an abnormal obstetric scan. Her antenatal follow-up was uneventful. She was blood group O, and rhesus positive. Physical examination was unremarkable. Abdominal examination revealed a fundal height of 32 weeks, which corresponded to  her date. The first obstetric scan performed in the third trimester revealed a live baby with features of hydrops fetalis. Management included couple counseling, multidisciplinary discussion with a fetomaternal specialist, dexamethasone injection for  fetal lung maturation, and expectant management.\u0000Discussion: The parents agreed to keep the pregnancy to term and plan for vaginal and cesarian deliveries reserved for obstetric indications. Nonimmune hydrops fetalis is associated with severe perinatal morbidity and significant maternal risk. The main causes of NIHF are chromosomal, fetal infection, and fetal cardiovascular problems.\u0000Conclusion: NIHF is rare, and a high index of suspicion is required for antenatal diagnosis. This affords parents tailored information and choices and supports multidisciplinary care with the additional aim of recognizing cases where fetal therapy may be appropriate, including timing for delivery. \u0000 ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"32 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Every Woman Study (EWS) in Kenya: Identifying challenges and opportunities to improve survival and quality of life for women with ovarian cancer","authors":"A. Shaffi, Benjamin Elly, Amina Rashid, Anisa Mburu, Clara Mackay, Frances Reid","doi":"10.59692/jogeca.v36i1.135","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.135","url":null,"abstract":"Background: Ovarian cancer is the second most common cause of death among gynecological cancerpatients in Kenya, and the number of cases is predicted to rise from 1,130 to 2,600 per year by 2040.\u0000However, there is very limited diagnostic and treatment capacity. This study aims to establish the first-ever patient experience evidence base of women with ovarian cancer in Kenya and identify challenges\u0000and opportunities to improve survival and quality of life.Methods: This was a prospective cross-sectional observational study in which all eligible womenattending Moi Teaching and Referral and Aga Khan Hospitals with a diagnosis of ovarian cancer withinthe previous five years were recruited.Results: Of 104 eligible women with a median age of 51 years, epithelial ovarian cancers were the mostcommon (70%), particularly high-grade serous carcinoma (46%). Most respondents (66%) had advanceddisease. Approximately 24% had to travel for five hours or more to access care. The mean average timefrom experiencing symptoms to diagnosis was 7.4 months. Almost half had never heard of ovariancancer. Approximately 81% reported that their finances had been affected largely by the diagnosis, with55% of these women reporting that their household income had dropped below what they needed tosurvive.Conclusion: The inaccessibility of quality cancer care in Kenya leads to delays in diagnosis andtreatment initiation. Innovative awareness strategies, health provider education, and cost mitigation areneeded to ensure that women can seek help promptly to reduce morbidity and mortality.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resource-limited guidelines for cancer care","authors":"Khadija Warfa","doi":"10.59692/jogeca.v36i1.179","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.179","url":null,"abstract":"Background: Guidelines have been shown to improve cancer care by standardizing care. In resource-limited settings where there is a consistent increase in disease burden, we need to use finite resources\u0000well to ensure adequate care is provided nationwide. In 2016, the African Cancer Coalition wasestablished as a regional collaboration to develop comprehensive standard cancer treatment guidelinestailored to sub–Saharan Africa. Cancer experts from African countries collaborated with the NationalComprehensive Cancer Network (NCCN) and the American Cancer Society through a series oforganized meetings to harmonize cancer treatment guidelines. To date, all gynecologic malignancieshave been reviewed and updated on the website.These resource-stratified guidelines are not intended to lower the bar for cancer care in resource-limitedsettings, but to use resources adequately in already constrained settings.Objectives1. Educate members on how to use the harmonized guidelines.2. Use of the guidelines as an educational tool for gynecologic oncology fellowship programs in Kenya.3. Access the wider obstetric and gynecology fraternity to ensure appropriate use of finite resources andto avoid multiple tests before referring patients for care by the gynecologic oncologist.4. Compare the harmonized guidelines to the Kenya national guidelines.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"65 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cosmetic gynecology - positive impact mental and menstrual health: A case report.","authors":"Kristina Sule, Francis Were","doi":"10.59692/jogeca.v36i1.155","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.155","url":null,"abstract":"Background: Cosmetic Gynecology practice has previously been labelled as purely esthetic and luxurybased. This case report demonstrates that this novel practice is useful for promoting positive mentalhealth and menstrual function.Case presentation: A 16-year-old nulliparous presented with esthetically displeasing results followinggenital surgery in childhood for a perineal mass with resultant posterior fourchette webbing. The estheticresult was noted to cause her mental distress and difficulty in tampon use. Correction of the untowardsurgical effect allowed easy tampon use, prevented future dyspareunia, and improved her overall mentalhealth.Discussion: Posterior fourchette webbing resulting from poor technique in labia minoraplasty leads tochronic perineal pain and dyspareunia. The resultant esthetics can also be displeasing. Surgical revisioncan alleviate these effects and improve self-esteem and mental health.Conclusion: Previously labeled as elective and occasionally unnecessary, cosmetic gynecology canimprove menstrual and reproductive function as well as mental health in women of reproductive age andadolescents.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"542 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood loss monitoring chart, a game changer in postpartum hemorrhage detection and treatment: A direct observation study in 7 E-MOTIVE trial hospitals in Kenya","authors":"Polycarp Oyoo, Zahida Qureshi, Alfred Osoti, George Gwako, Jim Kelly Mugambi, Jennifer Okore, Joan Mwende","doi":"10.59692/jogeca.v36i1.156","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.156","url":null,"abstract":"Background: Every six minutes, a mother dies of postpartum hemorrhage (PPH) in low-resource countries. PPH, defined as blood loss of more than 500 ml, is the leading cause of maternal death worldwide, accounting for 27% of maternal deaths. The WHO published “Recommendations for the Prevention and Treatment of Postpartum Hemorrhage” in 2012 to provide evidence-informed recommendations for managing PPH. However, adherence to these recommendations is currently limited by several challenges, including poor maternal care where despite guideline dissemination, many health care providers (HCPs) do not provide effective care such as proper monitoring of vital signs which is key in hemodynamic assessments that can prompt early intervention. The E-MOTIVE trial supported 14 health facilities in Kenya, 7 intervention and 7 control sites. The trial introduced a blood loss monitoring chart to support HCPs in assessing women after delivery of the placenta and enabling early detection and treatment of PPH.\u0000Methods: Blood loss monitoring tool/Trigger chart was developed by the University of Birmingham. This tool was implemented in seven hospitals in Kenya with the capacity for comprehensive emergency obstetric care, including blood transfusion and cesarean delivery. In these hospitals, labor, delivery, and postpartum care are primarily provided by nurse-midwives and students. More senior clinicians, including medical officers and consultant physicians such as obstetrician, gynecologists and pediatricians, make periodic rounds and are available on-call to assist in emergencies. Data were collected from August 2021 to December 2021. Observations were conducted by the trial implementation midwives with the support of the on-site research midwives for two weeks in each of the study hospitals. Observations occurred 24 hours a day. Patients were observed from the second stage up to two hours after placental delivery. All data were collected on paper forms and then entered into a digital database using RedCap.\u0000Results: A total of 734 deliveries were observed cumulatively during the study period. All women received four clinical observations within the first hour using the blood loss monitoring chart. The frequency of observing blood loss in the calibrated drapes during monitoring by HCPs was 94%. There was 100% detection of PPH using the blood loss monitoring chart.\u0000Conclusion: Efforts to increase the rates of early PPH detection and treatment should emphasize improvements in the quality of care, with a particular focus on PPH blood loss monitoring. The blood loss monitoring chart is easy to use and can be easily adopted and scaled in low-resource settings. ","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"362 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139894721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abruptio placenta, Couvelaire uterus following severe early-onset preeclampsia: A case report","authors":"Felix Nyagaka, FELIX OINDI, EVAN SEQUEIRA","doi":"10.59692/jogeca.v36i1.86","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.86","url":null,"abstract":"Background: Abruptio placenta refers to premature placental detachment from the uterus. Couvelaireuterus is a rare complication of abruptio placenta marked by blood infiltration of the myometrium followinghemorrhage into the decidua basalis. This is a case of severe early-onset preeclampsia with rapiddeterioration.Case presentation: A 35-year-old primigravida presented at 26 weeks 4 days with frontal headache andelevated blood pressure. On admission, with severe preeclampsia and type 1 fetal growth restriction, thepatient received labetalol, nifedipine, magnesium sulfate, and antenatal steroids. After two days ofhospitalization, she was discharged home to be closely monitored as an outpatient. She was readmittedwith severe hypertension and developed abruptio placenta with fetal death. Following labor induction, thepatient had significant antepartum hemorrhage necessitating an emergency hysterotomy.Intraoperatively, she had postpartum hemorrhage refractory to uterotonics with a Couvelaire uterus.Hemostasis was achieved using B-Lynch brace sutures. She developed hemolysis, elevated liverenzyme and low platelet count (HELLP) syndrome and acute kidney injury. She was transfused withpacked red cells, fresh frozen plasma, and platelets. Hemodynamically unstable, she was admitted to thecritical care unit and later stepped down to ward status and allowed home.Conclusion: Abruptio placenta is a clinical diagnosis, and a high index of suspicion is required becauseprompt action may be lifesaving. Complications such as Couvelaire uterus pose a significant challenge inmanagement and may lead to hysterectomy. However, in select cases, the uterus can be preserved byapplying B-lynch brace sutures.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"117 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with sexual dysfunctions in Nairobi, Kenya.","authors":"Joachim Osur","doi":"10.59692/jogeca.v36i1.113","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.113","url":null,"abstract":"Background: Sexual dysfunctions are associated with comorbidities, which can be the cause or theresult of the dysfunctions. Little research has been done to document comorbidities in Kenya. This studydocumented comorbidities associated with sexual dysfunctions in patients treated at the Sexology Clinicin Nairobi.Objective: To provide health service providers with evidence on what to investigate when patientspresent with sexual dysfunctions so that treatment is directed to the root causes.Methods: Quantitative retrospective analysis of records of patients presenting with sexual dysfunctionswas performed at the Sexology Clinic in Nairobi. Records analysis of patients’ files seen at the clinic for12 months were analyzed. A total of 396 files were reviewed (362 males and 34 females) using astandard tool. Biopsychosocial factors and treatment correlations were performed.Results: The commonest comorbidities in male sexual dysfunctions were metabolic diseases comprisinghypertension (19%), hyperlipidemia (17%), diabetes (14%), and obesity (9%). Hormonal disorders werealso common, with testosterone deficiency being the leading factor at 16% followed byhyperprolactinemia and thyroid hormone disorders each at 2% of all male dysfunctions. Medicines usedin treating metabolic disorders also adversely affect sexual function in males. Conversely, the mostcommon comorbidities in female sexual dysfunction were menopause and female genital cutting. In bothmales and females, comorbidities included infertility, cancer and its treatment, and psychological orpsychiatric problems. Sleep deprivation, alcohol and drug abuse, stressful lifestyles, and relationshipdisharmony were associated with sexual dysfunction in both sexes.Conclusions: Lifestyle diseases are commonly associated with sexual dysfunctions, which could beindicators for lifestyle diseases.Recommendations: Service providers should use sexual dysfunctions as an entry point for full patientassessment for commonly associated disease conditions.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"113 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management challenges for Gestational Trophoblastic Neoplasia in a 54 years old perimenopausal woman ; A case report.","authors":"Faiza Nassir, Rehema Omar Shee, Tanwira Chirangdin, Rishad A Shosi","doi":"10.59692/jogeca.v36i1.166","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.166","url":null,"abstract":"Background: Gestational trophoblastic diseases (GTD) are pregnancy-related disorders that originate from trophoblast cells. They include benign and aggressive tumors, such as invasive moles, choriocarcinomas, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. Gestational trophoblastic neoplasia (GTN) mostly occur in women of reproductive age, whereas it is extremely rare in postmenopausal women.\u0000Case presentation: A 54-year-old woman presented with prolonged bleeding, abdominal fullness, and pelvic mass with a history of a missed abortion two months prior to the onset of the symptoms and was medically managed. Her general and systemic examination findings were unremarkable. On abdominal examination, the uterus was 14 weeks in size. On speculum examination, the cervix and vagina were normal. On bimanual examination, the uterus was 14 weeks, mobile, and the adnexa were normal. Investigations included serum beta-human chorionic gonadotropin (hCG), abdominopelvic magnetic resonance imaging, and chest computed tomography. Her initial hCG was 179,000 mIu/ml with a bulky uterus and endometrial mass of approximately 6 cm and multiple bilateral chest metastatic nodules. The patient was scored as stage III:10 and started on etoposide, methotrexate, actinomycin alternating with cyclophosphamide, and vincristine (EMACO). She received 11 cycles of EMACO. Her management included repeated transfusions, granulocyte-stimulating factors administration, and ICU admission.\u0000Discussion: Gestational trophoblastic neoplasia accounts for rare gynecological malignancies in postmenopausal women. The risk of GTD progressing to GTN is 5% in younger women and five-fold higher (27%) after 45 years.\u0000Conclusion: GTN is a rare gynecological malignancy in postmenopausal women. The presentation mimics other gynecological malignancies. Hence, a high index of suspicion is required. Histopathological confirmation is mostly unavailable. It carries a poor prognosis compared with younger women with a high incidence of metastatic, recurrent, and low tolerance to standard multi-agent chemotherapeutic drugs.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of sexual dysfunctions in Kenya: The case of patients seen at the Sexology Clinic, Nairobi, Kenya","authors":"Joachim Osur, R. Maithya, C. Muya, E. Muinga","doi":"10.59692/jogeca.v36i1.112","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.112","url":null,"abstract":"Background: The health system is least prepared to manage sexual dysfunctions and lacks trainedprofessionals who can adequately assess and manage individuals with sexual dysfunctions because theneed for the service has not been documented. This is because routine data are not collected on sexualdysfunctions. This study aimed to outline the distribution of sexual dysfunctions among patients seekinghealth services in a specialized sexual medicine clinic in Nairobi (Sexology Clinic).Methods: Records of all patients seen at the clinic for 12 months were analyzed. A total of 396 patientfiles were reviewed (362 males and 34 females) using a standard tool. The sociodemographic andmedical details of the patients were analyzed. Data were entered in SPSS and summarized using tablesand figures. Disease associations with sociodemographic characteristics were analyzed. Classification ofsexual disorders was performed using the International Classification of Diseases (ICD)-11.Results: The most prevalent sexual disorders in both genders were sexual arousal disorders (76.4%),sexual desire problems (16.42%), and orgasmic disorders (3.6%). Disease distribution was found to bedependent on patient age and sex. Ethnicity, religion, and profession did not affect disease distribution.Conclusion: The distribution of sexual dysfunctions observed in Nairobi was found to be similar to thoseobserved in other populations.Recommendation: Health promotion and treatment programs for sexual dysfunction should bedeveloped to mirror those in more liberal countries because sexual medicine needs are the same. Thehealth system should collect routine sexual health data to help with future planning.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"30 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superficial angiomyxoma of the vulva: A case report and literature review","authors":"Elaine","doi":"10.59692/jogeca.v36i1.187","DOIUrl":"https://doi.org/10.59692/jogeca.v36i1.187","url":null,"abstract":"Background: Angiomyxomas are rare mesenchymal tumors. Aggressive angiomyxomas aredistinguished from superficial angiomyxomas by their propensity for local recurrence and metastaticpotential. Superficial angiomyxomas occur almost exclusively in women of reproductive age. Widesurgical resection is the treatment of choice.Case presentation: A 25-year-old para 1+1 presented with a mass on the vulva that had been increasingin size over one month. Examination revealed a mushroom-like, verrucous mass on the left labia majorawith a raw surface measuring approximately 4 cm in diameter with a 2-cm stalk. It was easily bleeding ontouch and slightly tender. Biopsies were taken, and histology revealed features of superficialangiomyxoma. The patient consented to wide excision of the vulval mass. The mass was excisedtogether with approximately 1.5 cm skin margin around it and a 2 cm depth of the underlying fatty base. Afinal histological diagnosis of superficial angiomyxoma was made. The patient was followed up for threemonths with no recurrence.Conclusion: Superficial angiomyxomas are rare benign tumors of the subcutaneous tissue that occuralmost exclusively in women of reproductive age. They present as slow-growing masses on the ear,trunk, and perineum. Wide surgical resection is the treatment of choice with adjuvant therapies, such asselective estrogen receptor modulators and gonadotropin hormone-releasing hormone agonists, alsoproving beneficial. Due to high rates of recurrence, long-term follow-up should be done for up to 15 yearsfollowing primary resection.","PeriodicalId":517202,"journal":{"name":"Journal of Obstetrics and Gynaecology of Eastern and Central Africa","volume":"120 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}