1. What is ANC?

ANC is an acronym for Ante Natal Care. This is the clinical and psychological care and support given to pregnant mothers from conception up to delivery.

2. When can I start ANC care?

An expectant lady displaying an ultrasound image

ANC care varies from patient to patient depending on the dynamics of the pregnancy. For mothers with normal non-high-risk pregnancies, the 1st clinic should be before 16 weeks gestation (4 months). As for those with high-risk pregnancies, ANC clinics may start as earlier than this.

  1. What does ANC entail?

ANC basically ensures a smooth and safe pregnancy and where complications are noted, timely intervention is instituted.

It entails a full history and physical examination for the mother, laboratory investigations for the mother to check for hemoglobin levels, blood group and Rhesus factor, syphilis, HIV, and TB screen, malaria screen, Hepatitis B screen, and urinalysis.

An ultrasound image showing the foetus

Ultrasounds may be done to assess fetal development, placenta location, and adequacy of the amniotic fluid, the number of fetuses in the womb and weight of the baby.

Iron and folic acid are supplemented throughout the pregnancy period, tetanus vaccine is administered, deworming is done in the second trimester and treated mosquito nets are issued.


Thereafter at least 3 more visits are recommended during which fetal development is monitored as well the mother’s health.

  1. Does Imara Mediplus Hospital offer these services and what makes them different from other facilities?

Imara Mediplus Hospital runs a dedicated ANC clinic every Wednesday and Thursday from 2pm to 5pm by a resident medical officer.

During delivery, Imara provides a comprehensive service package where we have our resident doctor admitting patients in one of the local hospitals under his care for normal or caesarian delivery, doing daily reviews as well post-discharge follow-up.


Dr. Erick Musyima Musau, MBChB (UoN)

Stanford Seed Alumni (Cohort 3)



Hepatitis refers to an inflammatory condition of the liver commonly caused by a viral infection. Other possible causes include autoimmune hepatitis and hepatitis secondary to medication, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue.


  1. Hepatitis A-caused by hepatitis A virus(HAV) through consuming food or water contaminated by feces from a person infected with hepatitis A.
  2. Hepatitis ­B –it’s transmitted through contact with infectious blood, vaginal secretions or semen containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner or sharing razors with an infected person increase your risk of getting hepatitis B.
  3. Hepatitis C- Caused by hepatitis C virus. It’s transmitted through direct contact with infected body fluids through injection drug use or sexual contact.
  4. Hepatitis D- is a serious liver disease caused by Hepatitis D virus (HDV). it’s contracted through direct contact with infected blood. HEP D is a rare form of hepatitis that only occurs in conjunction with hepatitis B
  5. Hepatitis E- is a waterborne disease caused by the hepatitis E virus (HEV). Mainly found in areas with poor sanitation. Transmitted through ingestion of contaminated water with fecal matter from an infected person.

Common signs and symptoms of hepatitis

Signs and symptoms of acute hepatitis appear quickly. They include fatigue, flu-like symptoms, dark urine, pale stool, and abdominal pain or discomfort especially on the upper right side beneath lower ribs, loss of appetite, unexplained weight loss, yellow skin and eyes which may be signs of jaundice.

Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle to notice.

How is it diagnosed?

  • History and physical exam-the doctor will ask you some questions to determine any risk factors you may have for infectious or noninfectious hepatitis. During a physical examination, your doctor may press down gently on your abdomen to see if there’s pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam.
  • Liver function test-blood sample is obtained to determine how efficiently your liver is working. Abnormal results will indicate there is a problem
  • Other blood tests- If your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. These tests can check for the viruses that cause hepatitis.
  • Ultrasound-This test allows your doctor to take a close at your liver and nearby organs to detect anomalies.
  • Liver biopsy-it’s an invasive procedure that involves taking a small sample of liver tissue through your skin using a needle using an ultrasound guide in which the sample will be used to detect any anomalies in your liver.

How is hepatitis treated?

Treatment options are determined by the type of hepatitis and whether the infection is acute or chronic.

Hepatitis A

Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea, follow your doctor’s orders for hydration and nutrition.

Hepatitis B

Acute hepatitis B doesn’t require specific treatment. Chronic hepatitis is treated with antiviral medications for several months or years.

Hepatitis C

Antiviral medications are used to treat both acute and chronic forms of hepatitis C.

People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant.

Hepatitis D

No antiviral medications exist for the treatment of Hep D at this time.

Hepatitis E

adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care.

How can it be prevented?

  1. Hygiene

Practicing good hygiene is one key way to avoid contracting hepatitis A and E.

Hepatitis B, C, and D contracted through contaminated blood can be prevented by Not sharing drug needles, not sharing razors, not using someone else’s toothbrush, not touching spilled blood.

Practicing safe sex by using condoms can help decrease the risk of infection by hepatitis B and c.

   2. Vaccines

The use of vaccines is an important key to preventing hepatitis. Vaccinations are available to prevent the development of hepatitis A and B. The CDCTrusted Source recommends hepatitis B vaccinations for all newborns. The vaccine is also recommended for all healthcare and medical personnel.

Hepatitis D can be prevented by getting the vaccination for Hep B, as infection with Hep B is necessary for hepatitis D to develop

The hepatitis A vaccine is available to prevent this infection. Most children begin vaccination between the ages of 12 and 18 months. It’s a series of two vaccines

What are the possible complications?

People with chronic hepatitis B or C are at risk of chronic liver disease, cirrhosis, and liver cancer

  • Liver failure can occur when the liver stops functioning completely. Complications of liver failure include bleeding disorders, kidney failure, and a buildup of fluid in your abdomen known as ascites.



Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. It can range from a mild illness lasting a few weeks to a severe illness lasting several months. Although rare, hepatitis A can cause death in some people.


Hepatitis  A can be got from contaminated food or water or from close contact with a person or object that’s infected including sexual encounters. It does not spread through sneezing or coughing.


  • Fatigue
  • Sudden nausea and vomiting
  • Abdominal pain or discomfort, especially on the upper right side beneath your lower ribs (by your liver)
  • Clay-colored bowel movements
  • Loss of appetite
  • Low-grade fever
  • Dark urine
  • Joint pain
  • Yellowing of the skin and the whites of your eyes (jaundice)
  • Intense itching


You’re at increased risk of hepatitis A if you:

  • Travel or work in areas of the world where hepatitis A is common
  • Attend childcare or work in a childcare center
  • Live with another person who has hepatitis A
  • Have any type of sexual contact with someone who has hepatitis A
  • Are HIV positive
  • Have a clotting-factor disorder, such as hemophilia
  • Use any type of illegal drugs (not just those that are injected)


  • Through a blood screening test
  • The test cost the average rage of Kes.  1,500-4,500
  • The tests are available at trusted labs and hospital. You can follow this link for an offer at Imara Mediplus Hospital for a discounted test.

If I have had hepatitis A in the past, can I get it again?

  • Once you recover from hepatitis A, you develop antibodies that protect you from the virus for life. (An antibody is a substance found in the blood that the body produces in response to a virus. They protect the body from disease by attaching to the virus and destroying it.)

How soon after exposure to hepatitis A will symptoms appear?

  • If symptoms occur, they usually start appearing 4 weeks after exposure, but can occur as early as 2 and as late as 7 weeks after exposure. Symptoms usually develop over a period of several days.


How long do hepatitis A symptoms last?

  • Symptoms usually last less than 2 months, although some people (10%–15%) with hepatitis A can have symptoms for as long as 6 months.


Can a person spread hepatitis A without having symptoms?

  • Many people, especially children, have no symptoms. In addition, a person can transmit the virus to others up to 2 weeks before symptoms appear.


How is hepatitis A treated?

  • Un-vaccinated people who have been exposed recently (within 2 weeks) to the hepatitis A virus should get the hepatitis A vaccine or a shot of immune globulin to prevent severe illness. To treat the symptoms of hepatitis A, doctors usually recommend rest, adequate nutrition, and fluids. Some people will need medical care in a hospital. It can take a few months before people with hepatitis A begin to feel better.


  • Vaccinations
  • Practice hygiene eg. Proper hand hygiene after using the bathroom, using clean uncontaminated water for drinking or cooking



  1. Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
  2. Lai M. Hepatitis A virus infection in adults: An overview. Accessed Aug. 8, 2017.



  • It is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated even to previously healthy people.


  • It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.
  • The bacteria are usually found in food or water contaminated by feces from a person with the infection.


  • When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhea.
  • Therefore, it is highly unlikely that you will catch cholera just from casual contact with an infected person.


  • Symptoms of cholera can begin as soon as a few hours or as long as five days after infection and are as follows;
  1. severe watery diarrhea.
  2. Nausea and vomiting.
  3. Dehydration which may lead to a rapid loss of minerals in your blood (electrolytes) that maintain the balance of fluids in your body. This is called an electrolyte imbalance.


  1. Rapid heart rate
  2. Loss of skin elasticity (the ability to return to original position quickly if pinched)
  3. Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids
  4. Low blood pressure
  5. Thirst
  6. Muscle cramps

If left untreated, dehydration can lead to shock and death in a matter of hours


  • Although the symptoms are unmistakable, it is advisable to perform a cholera Antigen test that is later confirmed by a stool culture test


  • Yes, through vaccination that lasts for up to five years and observance of clean hygienic procedures.



  • Cholera is highly treatable, but because dehydration can happen quickly, it’s important to get cholera treatment right away.
  • Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids.
  • Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.



Sal Mukinda, Lab Superintendent, IMH


  1. The incubation period of cholera: a systematic review. Azman AS, Rudolph KE, Cummings DA, Lessler J. J Infect. 2013;66(5):432-8. doi: 10.1016/j.jinf.2012.11.013. PubMed PMID: 23201968; PubMed Central PMCID: PMC3677557.
  2. Cholera Annual Report 2017
    Weekly Epidemiological Record 21 September 2018, Vol 93, 38 (pp 489-500).
  3. Debasish S, LaRocque RC. Cholera and Other Vibrios. In: McGill, A; Ryan, E; Hill, D; Solomon, T, eds. Hunter’s Tropical Medicine and Emerging Infectious Diseases. 9thed. New York: Saunders Elsevier; 2013: 448-453.
  4. David A Sack, Mohammed Ali. Protection from killed oral cholera vaccine continues for 4 years.



human milk does not suddenly turn to water after a certain length of time! Mothers can nurse their babies for as long as both they and their children wish to continue. Children will wean all by themselves when they are developmentally ready to do so.

Your milk continues to provide both food and health benefits even after your baby has begun to eat other foods. In fact, it continues to be the most important part of your baby’s diet until he is about a year old. Doctors recommends that babies continue to nurse until they are at least a year old and that the World Health Organization (WHO) recommends continuing to nurse for at least two years.

Weaning is a process, not an event!

As he gets older, your baby will gradually eat more table foods. You will notice that he needs to nurse less frequently or for shorter periods of time. However, babies nurse for many reasons besides the need for food. Even when he becomes a toddler, your baby may still need to nurse when it’s time to go to sleep.

There will also be days when he needs to nurse more than usual: perhaps when he is teething or coming down with a cold. Nursing can help him cope with these upsets as he progresses in natural weaning, your little one will be too busy exploring the world to nurse as often.

Remember, you can always get a second opinion!

Start by substituting a bottle for one nursing a day for about a week. Keep your baby’s favorite nursing sessions for the last. Follow your baby’s lead as much as possible. For example, if he is sick, you may want to nurse a little more often until he is feeling better again. Unless there is an urgent reason for immediate weaning, it is easier on both of you to go slowly.

Remember, you know your baby best, and you know what is best for your family. Trust your instincts, and you won’t go far wrong


1. The American Academy of Pediatrics (AAP)
2. The World Health Organization (WHO)



Pap smear procedure

It is a procedure to test for cervical cancer in women that involves collecting cells from the cervix, the lower, narrow end of the uterus.


It helps in early detection of cervical cancer, hence improving chances of cure.

A Pap smear also detects changes in the cervical cells that suggest cancer may develop in the future. Detecting these abnormal cells early with a Pap smear is the first step in halting the possible development of cervical cancer.


To screen for cervical cancer.

The test is usually done in conjunction with a pelvic exam. In women older than age 30, the Pap test may be combined with a test for human papillomavirus (HPV) — a common sexually transmitted infection that can cause cervical cancer. In some cases, the HPV test may be done instead of a Pap smear.



Any female above 21 years.


Once every year. If combined with HPV test, the repeat can take even 5 years. However, depending on certain conditions, it can be repeated severally, of course with the doctor’s advice. These conditions include;

1.A diagnosis of cervical cancer or a Pap smear that showed precancerous cells

2.Exposure to some hormones eg. diethylstilbestrol (DES) before birth

3.HIV infection

4.Weakened immune system due to organ transplant, chemotherapy or chronic corticosteroid use

5.A history of smoking


  1. After an hysterectomy (complete removal of the uterus and cervix)
  2. Old age i.e. 65 years and above.


Sally Gakii, Lab Superintendent, Imara Mediplus Hospital

Date posted: 6/10/18



  1. Smith RA, et al. Cancer screening in the United States, 2017: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians. 2017;67:100.
  2. Curry SJ, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. Journal of the American Medical Association. 2018;320:674.

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