Case records and commentaries

Abstract

The grand multiparous patient has almost dissappeared in the developed countries due to the advancement in family planning. In our country grand multiparity and its associated problems still exist. This study was based on 370 grand multiparous patients who were admitted to Kisii District Hospital in labour during a four month study period from November, 1990 to February, 1991. Data on this group was compared to 375 lesser multipara admitted during the same period, in sociodemographic aspects, antenatal care, pregnancy and delivery complications, and fetal outcome. The grand multipara was found to have poor antenatal care, and higher statistically significant incidences of abruptio placenta, post partum hemorrhage, large infants, perinatal morbidity and mortality rates. Various other factors showed' no significant different incidences. Conclusions and recommendations based on this study are finally given. A B s T R A c T The acceptance of vasectomy as a means of fertility control still lags that of female sterilization in Kenya. This study was based on 380 men whose spouses were having tubal ligations done in two out patient clinics in Kisii during a 5 - month period. 57.8% of the study group had knowledge of vasectomy though fewer numbers actually understood the speci•fic features of the method and how it works. 47.7% had vasectomy offered to them as an alternative to female sterelization. Majority of the men had negative attitudes towards vasectomy and 65.3% thought the same for their wives. The commonest source of knowledge for vasectomy was the mass media (22.6%) whereas that for female sterilization was the community based family planning agent (31.3%). 80.3% had an idea of where to obtain vasectomy services. The commonest reason for tubal ligation was completion of desired family size in 62.1% whereas 71.6% thought it would be a justifiable reason for vasectomy. 11.8% of the men had previously practised male contraception compared to 35.3% of the females. The husband was the main decision maker for female sterilization in 37.4% of couples. 65.5% thought the spouse's consent was not necessary for vasectomy whereas 53.2% advocated for separate male sterilization clinics.