Morbidity and quality of life among head and neck cancer patients treated with radical radiotherapy.

OBJECTIVES: To determine the relative frequency of acute radiation morbidity and their perceived effect on quality of life among head and neck cancer patients treated with radical radiotherapy. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Thirty eight patients comprising 28 males and 10 females with ages ranging between 21 and 69 years were evaluated. RESULTS: Most of the tumours occurred in the nasopharynx (38.6%). The rest of the tumours were equally divided between the oral cavity and larynx (31.6%). All tumours except two were carcinomas. The two exceptions were a glomus tumour and a malignant melanoma. The patients had received doses of radiotherapy ranging between 58.5 Grey and 75.5 Grey. Of the 38 patients, 22 (53%) completed their treatment in the prescribed time while 16 (47%) had treatment interruption on account of radiation morbidity. The cumulative radiation done at the time of interruption ranged between 20 and 46 Grey. The most frequent symptom was dryness of the mouth while the most troublesome symptom was difficulty in tasting foods. The quality of life (QOL) did not vary by age, gender or tumour site. Patients who had treatment interruption had a better QOL than those who did not. CONCLUSION: This study provides information that should aid in communicating with the head and neck cancer patients scheduled for radiotherapy and in the design of preventive and interventional strategies aimed at enhancing patient support and rehabilitation.

Low educational level: a risk factor for sexually transmitted infections among commercial sex workers in Quito, Ecuador.

Few studies have assessed the effect of educational level on sexually transmitted infections (STIs) and risk-taking behaviours among commercial sex workers (CSWs). This study analysed this association among female CSWs in Quito, Ecuador. Eighty-five CSWs were given a Spanish-language questionnaire on behaviours, socioeconomics and demographics. The correlation between years of education and number of prior STIs was calculated. Three groups of varying education level were formed and risk factors were analysed by Chi-square tests and analysis of variances. Lower educational level was associated with more STIs (r= -0.36; F=4.2; P=0.04), poorer knowledge of HIV/AIDS (P=0.03), earlier first prostitution (P=0.05) and first sex (P=0.00), willingness to engage in group sex (P=0.05) and work on the street (P=0.02), and presence of non-paying sexual partners (P=0.05). CSWs with lower educational levels were disproportionately afflicted with STIs and participated in more high-risk behaviours. Low educational level may predispose CSWs to STIs and associated risk factors.

A survey on the knowledge and attitudes of men in Machakos town towards vasectomy.

PIP: In November and December, 1993, a self-administered questionnaire was distributed to men in the town of Machakos and to nonmedical hospital workers of Machakos General Hospital. The purpose of the study was to assess their knowledge about and attitude towards vasectomy. The majority of men were in the age group of 30-44 years and were married; the hospital group was more educated. The town men perceived the pill to be the best contraceptive method for women in contrast to the hospital group who gave more importance to bilateral tubal ligation. The hospital group also perceived vasectomy as the best method for men. Overall, 53.2% men were aware of the correct procedure of vasectomy, but only 24% had correct knowledge of how the procedure affects masculinity. The knowledge of the procedure among hospital workers was not very different from that of the town group. Recommendations were made to increase information and education to all groups of people through various media.^ieng

A needs assessment study of traditional birth attendants in rural Kenya.

For several reasons traditional birth attendants (TBAs) still deliver the majority of women in many developing areas of the world. A needs assessment study of TBAs serving one area of Kenya was conducted for the purpose of designing an appropriate intervention program. Thirty-six TBAs were interviewed. Together, they had attended to a total of 116 deliveries within 1 month. The local hospital was conducting an average of 37 deliveries per month. Although most TBAs were good at abdominal palpation, they did not conduct routine prenatal checks and rarely referred their clients to hospital. Several risky practices were identified from which a training program has been designed. The findings and their implications are discussed within the context of improved MCH/FP services.

PIP: For several reasons traditional birth attendants (TBAs) still deliver the majority of women in many developing areas of the world. A needs assessment study of TBAs serving 1 area of Kenya was conducted for the purpose of designing an appropriate intervention program. 36 TBAs were interviewed. Together, they had attended to a total of 116 deliveries within 1 month. The local hospital was conducting an average of 37 deliveries per month. Although most TBAs were good at abdominal palpation, they did not conduct routine prenatal checks and rarely referred their clients to hospitals. TBAs practice several risky methods including external cephalic version (ECV) without knowing the contraindications; lack of antenatal referral when patients are anemic or suffering from antepartum hemorrhage; lack of referrals for prolonged labor; lack of sterility and asepsis; poor handling of the cord; and use of poorly chosen instruments during delivery. The delay of referrals gives hospitals only a minimal chance of saving both mother and child. Recommendations included training and articulation of TBAs, especially on antenatal care, labor, sterility, asepsis, the referral system, postnatal care, and family planning. Further research on the composition of the herbal medications used by TBAs was also recommended. (Author's Modified).