Moi Teaching And Referral Hospital Research Articles

Use of the Electronic Medical Record (EMR) to Improve Delirium Screening and Recognition (S773)

Objectives 1. Describe the AMPATH Oncology Institute Palliative Care Service and the clinical demographics of the patient case-mix index at Moi Teaching and Referral Hospital in Eldoret, Kenya. 2. Describe the clinical and educational role of a global health palliative care elective through the AMPATH Oncology Institute on the training of US-based hospice and palliative care fellows. Background. Dying patients in Sub-Saharan Africa (SSA) suffer greatly and unnecessarily and would benefit from consultation by more palliative care clinicians knowledgeable about global health (GH) challenges. In response to this need, the AMPATH Oncology Institute (AOI) at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya created a palliative care consultation service, and through its U.S. academic partners established clinical training electives for HPM fellows. Research Objectives. We evaluated clinical data from the AOI Palliative Care Service to explore the training impact of an 8-12 week global health elective on HPM fellows. Methods. Palliative care service data was prospectively collected in 2012-13, and included patient demographics, diagnosis, mortality rate, reason for consultation, and treatment interventions. We conducted descriptive, univariate analyses. Results. During a four month study period, 240 pediatric and adult patients were seen in the inpatient oncology (49%) and outpatient (51%) settings. Median age was 52 years and 51% were female. Eighteen percent of the consultation patients died while on service. Pain (76%), constipation (57%), and dehydration (16%) were the most common reasons for consultation requests. Opiates were prescribed for pain in 61% of cases. Counseling for psychological and spiritual distress was provided to 57% of patients and 52% of families. The most common adult malignancies were breast, cervical, and esophageal cancer as well as sarcoma. Pediatric diagnoses were primarily ALL and NHL. Conclusions. The AOI Palliative Care service clinical volume and case-mix index provides a strong clinical experience for US palliative care fellows rotating in Kenya, and demographic, patient volume, and clinical case mix appear on par with domestic clinical experiences needed to meet ACGME training requirements. Implications for research, policy, or practice. The implication of this clinical training for US-based palliative care fellows would be to allow for work in a resource limited setting and exposure to cross cultural aspects of bio-psychosocial-spiritual palliative care.

Risk factors for maternal mortality in a Tertiary Hospital in Kenya: a case control study

BackgroundMaternal mortality is high in Africa, especially in Kenya where there is evidence of insufficient progress towards Millennium Development Goal (MDG) Five, which is to reduce the global maternal mortality rate by three quarters and provide universal access to reproductive health by 2015. This study aims to identify risk factors associated with maternal mortality in a tertiary level hospital in Kenya.MethodsA manual review of records for 150 maternal deaths (cases) and 300 controls was undertaken using a standard audit form. The sample included pregnant women aged 15-49 years admitted to the Obstetric and Gynaecological wards at the Moi Teaching and Referral Hospital (MTRH) in Kenya from January 2004 and March 2011. Logistic regression analysis was used to assess risk factors for maternal mortality.ResultsFactors significantly associated with maternal mortality included: having no education relative to secondary education (OR 3.3, 95% CI 1.1-10.4, p = 0.0284), history of underlying medical conditions (OR 3.9, 95% CI 1.7-9.2, p = 0.0016), doctor attendance at birth (OR 4.6, 95% CI 2.1-10.1, p = 0.0001), having no antenatal visits (OR 4.1, 95% CI 1.6-10.4, p = 0.0007), being admitted with eclampsia (OR 10.9, 95% CI 3.7-31.9, p < 0.0001), being admitted with comorbidities (OR 9.0, 95% CI 4.2-19.3, p < 0.0001), having an elevated pulse on admission (OR 10.7, 95% CI 2.7-43.4, p = 0.0002), and being referred to MTRH (OR 2.1, 95% CI 1.0-4.3, p = 0.0459).ConclusionsAntenatal care and maternal education are important risk factors for maternal mortality, even after adjusting for comorbidities and complications. Antenatal visits can provide opportunities for detecting risk factors for eclampsia, and other underlying illnesses but the visits need to be frequent and timely. Education enables access to information and helps empower women and their spouses to make appropriate decisions during pregnancy.

Esophageal Cancer, the Topmost Cancer at MTRH in the Rift Valley, Kenya, and Its Potential Risk Factors

Esophageal cancer at Moi Teaching and Referral Hospital (MTRH) is the leading cancer in men with a poor prognosis. A case control study (n = 159) aimed at the histology type, gender, and risk indicators was carried out at MTRH. Mantel Haenszel chi-square and logistic regression were employed for analysis. Squamous-cell carcinoma was the common histological type occurring in the middle third portion of the oesophagus. The occurrence of the cancer in males was 1.4 times that of females. The mean age was 56.1 yrs. Low socioeconomic, smoking, snuff use, alcohol, tooth loss, cooking with charcoal and firewood, hot beverage, and use of mursik were independently associated with esophageal cancer (P < 0.05). Using logistic regression adjusted for various factors, alcohol consumption was associated with the increased risk of esophageal cancer. AHR was 0.45 and 95% CI: 0.205–0.985, P = 0.046. A societal component of low socioeconomic conditions, a lifestyle component with specific practices such as the consumption of mursik, chang'aa, busaa, snuff, smoking, hot tea, poor oral hygiene, and an environmental component with potential exposure to high levels of nitrosamines, passive smoking, and cooking with coal, could be involved. The increase in experts at MTRH capable of diagnosing could be responsible for the increase in reporting this neoplasm.

A retrospective analysis of maternal and neonatal mortality at a teaching and referral hospital in Kenya

ObjectiveTo measure the incidence of maternal and early neonatal mortality in women who gave birth at Moi Teaching and Referral Hospital (MTRH) in Kenya and describe clinical and other characteristics and circumstances associated with maternal and neonatal deaths following deliveries at MTRH.MethodsA retrospective audit of maternal and neonatal records was conducted with detailed analysis of the most recent 150 maternal deaths and 200 neonatal deaths. Maternal mortality ratios and early neonatal mortality rates were calculated for each year from January 2004 to December 2011.ResultsBetween 2004 and 2011, the overall maternal mortality ratio was 426 per 100,000 live births and the early neonatal mortality rate (<7 days) was 68 per 1000 live births. The Hospital record audit showed that half (51%) of the neonatal mortalities were for young mothers (15–24 years) and 64% of maternal deaths were in women between 25 and 45 years. Most maternal and early neonatal deaths occurred in multiparous women, in referred admissions, when the gestational age was under 37 weeks and in latent stage of labour. Indirect complications accounted for the majority of deaths. Where there were direct obstetric complications associated with the delivery, the leading cause of maternal death was eclampsia and the leading cause of early neonatal death was pre-mature rupture of membranes. Pre-term birth and asphyxia were leading causes of early neonatal deaths. In both sets of records the majority of deliveries were vaginal and performed by midwives.ConclusionThis study provides important information about maternal and early neonatal mortality in Kenya’s second largest tertiary hospital. A range of socio demographic, clinical and health system factors are identified as possible contributors to Kenya’s poor progress towards reducing maternal and early neonatal mortality.

Perceptions of risk and barriers to cervical cancer screening at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya.

Affordable screening cervical cancer methods using visual inspection with acetic acid (VIA) and with Lugol's iodine (VILI) are being developed. Scaling up of screening services requires an understanding of the user perceptions about screening. Determine the perceptions of risk and barriers to previous cervical cancer screening by women attending MCH-FP clinic of MTRH, Eldoret, Kenya. Cross-sectional questionnaire survey involving a consecutive sample of 219 consenting non-pregnant women about perceptions on cervical cancer risk, barriers to screening and previous screening. Of 219 women interviewed, 12.3% of participants had screened before. Women of over 30 years were more likely to have screened before (p=0.012). While 22.8% felt that they were at risk of the cervical cancer, 65% of all participants, nevertheless, wished to be screened. Perception of being at risk was significantly associated with a felt need for screening (p=0.002), an association that persisted only for women reporting multiple lifetime sex partners (p=0.005). Fear of abnormal results and lack of finances were the commonest barriers to screening reported by 22.4% and 11.4% of respondents, respectively. Previous screening was uncommon. Cheaper screening methods are needed. Messages about screening should clarify the meaning and consequences of possible results.

Adherence to antiretroviral drug therapy by adult patients attending HIV/AIDS clinic at a Kenyan tertiary helath institution

To determine antiretroviral drug adherence levels of HIV/AIDS in adult patients. A cross sectional study. Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Three hundred and eighty four HIV/AIDS adult patients who attended HIV/AIDS clinic in MTRH for antiretroviral treatment and had been on treatment for at least three months as confirmed by clinicians. Three hundred and eighty four respondents participated in this research; two third of whom were females (68%) and a third were males (32%). Fifty two percent of these had attained secondary or post secondary education. The mean age was 36.1+/-8.5, years and ranged 18-63 years. While 93.5% of the participants adhered to clinic appointments, only 43.2% adhered to taking the drugs as per time schedule. Adherence to time of taking medications was low and could result in reduced efficacy.

Post-Anastomotic Enterocutaneous Fistulas: Associated Factors and Spontaneous Closure at a Tertiary Centre in Western Kenya

Objective To determine the factors associated with the occurrence and spontaneous closure of enterocutaneous fistulas. Design A retrospective, hospital-based study of patients who developed enterocutaneous fistulas after resection and anastomosis. Setting The general and paediatric surgical wards of Moi Teaching and Referral Hospital (MTRH), a 550 bed tertiary teaching and referral hospital in the Western region of Kenya. Subjects Two hundred and twenty patients of all ages who underwent gut resection and anastomosis for varied reasons between 2002 and 2006. Main outcome measures The primary outcome measures were variables associated with development and spontaneous closure of fistulas while the secondary outcome measures were morbidity and mortality associated with enterocutaneous fistulas. Results Enterocutaneous fistulas formed in 22 of 220 patients and constituted 44% of all the complications after gut resection and anastomosis. Age younger than 20 years (p=0.04), female gender (p=0.032), duration of symptoms greater than one day prior to presentation to hospital (0.032), deranged electrolytes (p=0.042), delay in surgery after admission (p=0.043) and the use of ileal segment in the anastomosis (p=0.018) were significantly associated with occurrence of fistulas on univariate analysis. The use of ileal segment in the anastomosis (p=0.033), deranged electrolytes (p=0.045) and duration prior to surgery (p=0.045) were also found to be predictive of fistula formation on multivariate analysis. The spontaneous closure rate was 45.5%. Factors significantly associated with spontaneous closure were age greater than 20 years (p= 0.027) and occurrence of the fistula in an ileal segment (p=0.031). Enterocutaneous fistulas had a case specific mortality rate of 50%.The factor most significantly associated with mortality was re-operation (P<0.001) and this was also predictive of both mortality and prolonged hospital stay. Conclusion Renal dysfunction, delay before surgery and the use of ileal segments were significantly associated with the occurrence of enterocutaneous fistulas while age greater than 20 years and occurrence of fistulas in ileal segments had significant association with spontaneous closure of the fistulas. Re-operation is a strong predictor of mortality in interocutaneous fistula patients.

Patient Transfer Practices By Hospitals In Western Kenya

Patients who are critically ill and those requiring emergency care are transported within and between hospitals on a regular basis seeking diagnostic or therapeutic services not available at the bed side or within the referring institution. The emergency of specialty systems often determines the ultimate destination of patients rather than proximity of facility and this has heightened the need for patient transfer. To achieve a favorable outcome, it is necessary to ensure that any transfer is carried out safely and effectively with minimum disruption of the continuum of care. To determine the gap between existing knowledge of patient transfer principles and the practice by hospitals in Western Kenya referring patients to Moi Teaching and Referral Hospital (MTRH). Cross-sectional descriptive study. Accident and emergency department at MTRH. Patients transferred in over a period of six months for critical/emergency care. Evaluation was done for 97 transfers during the six months period. Age ranged from four days old to 70 years with a median of 28 years. A wide spectrum of diseases were seen. However in order of frequency the leading five were; trauma and accidents, vascular disorders, infections; anaemia and malignancies. Of the infections, respiratory infections topped the list with pulmonary tuberculosis as the leading disease entity. Majority of patients 43 (44%) were referred within 24 hours of being seen at the primary hospital. Only 56% were transported by ambulance; appropriate escort(nurse) was provided in 60%; documentation was provided in 85%; monitoring enroute was done in 24%; warmth was provided in 62%, 27% were dehydrated requiring resuscitation; respiratory support was inadequate as only 14% (of those who required) had airway and 32% had oxygen provided; intravenous fluids were provided in 34% of those who required; nasogastric intubation was provided in 30% of those who required; urethral catheterisation was provided in 23% of those who required; 50% of those with long bone fractures were splinted and only 3% of those who required cervical spine stabilisation had cervical collar. There was significant failure by hospitals in Western Kenya in the application of principles of patient transfer while referring patients to MTRH.

Workload Indicators Of Staffing Need Method in determining optimal staffing levels at Moi Teaching and Referal Hospital

There is an increasing demand for quality healthcare in the face of limited resources. With the health personnel consuming up to three quarters of recurrent budgets, a need arises to ascertain that a workforce for any health facility is the optimal level needed to produce the desired product. To highlight the experience and findings of an attempt at establishing the optimal staffing levels for a tertiary health institution using the Workload Indicators of Staffing Need (WISN) method popularised by the World Health Organisation (WHO), Geneva, Switzerland. A descriptive study that captures the activities of a taskforce appointed to establish optimal staffing levels. Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya, a tertiary hospital in the Rift Valley province of Kenya from September 2005 to May 2006. The cadres of workers, working schedules, main activities, time taken to accomplish the activities, available working hours, category and individual allowances, annual workloads from the previous year's statistics and optimal departmental establishment of workers. There was initial resentment to the exercise because of the notion that it was aimed at retrenching workers. The team was given autonomy by the hospital management to objectively establish the optimal staffing levels. Very few departments were optimally established with the majority either under or over staffed. There were intradepartmental discrepancies in optimal levels of cadres even though many of them had the right number of total workforce. The WISN method is a very objective way of establishing staffing levels but requires a dedicated team with adequate expertise to make the raw data meaningful for calculations.

Causes Of Delay In Diagnosis Of Pulmonary Tuberculosis In Patients Attending A Referral Hospital In Western Kenya

To determine the length of delays from onset of symptoms to initiation of treatment of pulmonary tuberculosis (PTB). Cross-sectional study. Chest/TB clinic, Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Newly diagnosed smear positive pulmonary tuberculosis (PTB) patients. Two hundred and thirty patients aged between 12 and 80 (median; 28.5) years were included in the study. They comprised 148 (64.3%, median 30 years) males and 82 (35.7%, median 28 years) females. One hundred and two (44%) came from urban and 128 (56%) came from rural setting covering a median distance of 10 (range 0-100) kilometres and paying Kshs 20 (range 0-200) to facility. Cough was the commonest symptom reported by 228 (99.1%) of the patients followed by chest pain in 214 (80%). The mean patient delay was 11 +/- 17 weeks (range: 1-78 weeks) with no significant difference between males and females, the mean system delay was 3 +/- 5 weeks (range: 0-39 weeks). The median patient, health systems and total delays were 42, 2, and 44 days respectively for all the patients. Marital status, being knowledgeable about TB, distance to clinic and where help is sought first had significant effect on patient delay. Patient delay is the major contributor to delay in diagnosis and initiation of treatment of PTB among our patients. Therefore TB control programmes in this region must emphasise patient education regarding symptoms of tuberculosis and timely health seeking behaviour.

Nasopharyngeal &lt;i&gt;Streptococcus pneumoniae&lt;/i&gt; among under-five year old children at the Moi teaching hospital, Eldoret, Kenya

To determine the prevalence, risk factors and antibiotic sensitivity of streptococcus pneumoniae carried in the upper respiratory tract of children. A cross-sectional study on consecutive clients. Maternal Child Health Clinic (MCH) at Moi Teaching and Referral Hospital (MTRH) in western Kenya. Seventy eight of children attending Maternal Child Health Clinic between March 10th 2003 and July 11th 2003. Upper airway carriage status, ventilation, housing, age, illness, sensitivity patterns. Fifty six percent were boys; the median age was six months (range 1-42 months). Streptococcus pneumoniae carriage rate was in 28 (35.9%) cases. Fifty two percent of S. pneumoniae were resistant to penicillin, 25% to ampicillin and 78% to cotrimoxazole. There was significant association between the type of floor with pneumococcal carriage (p = 0.009) with people living in earth floor houses being five times more likely to be pneumococcal carriers as compared to those living in cement floor houses. A significant resistance of S. pneumoniae to penicillin, ampicillin and cotrimoxazole was found. Earth floored houses may increase susceptibility to upper airway S. pneumoniae carriage. Similar studies should be conducted in other parts of Kenya in order to learn about susceptibility patterns and associated risk factors, including floor type, in the country and tailor better treatment regimens.

Adhesive intestinal obstruction

Adhesions after abdominal and pelvic surgery are a major cause of intestinal obstruction in the western world and the pathology is steadily gaining prominence in our practice. To determine the magnitude of adhesive intestinal obstruction; to determine the types of previous operations in patients who presented with adhesive intestinal obstruction; to determine the outcome of treatment; and to determine the factors affecting the overall management of adhesion-related intestinal obstruction. Retrospective descriptive study. The Moi Teaching and Referral Hospital (MTRH) - Eldoret, Kenya. Ninety three patients were managed for adhesive intestinal obstruction. Of these, 57 were male and 36 were female. Abdominal distension, bilious vomiting, absolute constipation and abdominal pain were the main symptoms. Forty two (45%) patients were operated on, twenty five (59%) of them being operated on more than 72 hours after the start of the symptoms. Eight (9%) patients had ischaemic gut injury by the time of operation. Fluid therapy was inadequately administered in 86 (92%) patients, and their charts were not completely filled. Adhesion-related intestinal obstruction is a common problem encountered in the surgical service at the Moi Teaching and Referral Hospital-Eldoret. It is the major cause of intestinal obstruction. Fluid therapy and delayed surgical intervention were the major challenges in the management of these patients.

Socio-economic factors predisposing under five-year-old children to Severe protein energy malnutrition at the Moi teaching and referral hospital, Eldoret, Kenya

Malnutrition is one of the leading causes of morbidity and mortality in children aged five years and below. Risk factors for severe protein energy malnutrition (PEM) have been identified as ignorance, family size, mothers and fathers education, poverty, residence, chronic infections, and congenital defects or malformations. The role of such social factors as the caretaker, extended family, homestead surroundings, and family cohesiveness have not been studied in Kenya. To determine the social and economic factors that predispose children to severe PEM as seen at the Moi Teaching and Referral Hospital (MTRH), Eldoret. Prospective and case control study. The MTRH, Eldoret, Paediatric wards, outpatient and MCH clinics over a 12 month period (June 2001 to June 2002). Sixty six children aged 3 to 36 months with severe PEM attending the MTRH outpatient clinics and those admitted in the Paediatric wards were age-matched with 66 controls. A standard pretested questionnaire was used to interview caretakers with severely malnourished children and age-matched controls. The children were weighed after interviewing the caretakers. The data was entered on a computer and analysed using the statistical package for social sciences (SPSS) programme. The social risk factors for PEM were single mothers (Odds Ratio) OR 14.93, p= 0.00001), young mothers aged 15-25 years (OR 3.95, p= 0.00020), the child's living conditions such as living in a temporary house (OR 3.627 p= 0.00257), caretaker who was not married to the child's parent (OR 0.10, p= 0.00005) and not staying with both parents in the past six months (OR 0.28606, p=0.00101). The economic risk factors were father's lack of ownership of land (OR 0.401, p= 0.01732), cattle (OR 0.24, p=0.00022), not growing maize (OR 0.15, p=0.00013), not growing beans (OR 0.36, p=0.00484) and ownership of small piece of land by grandfather (OR 6.00, p= 0.02274). Other risk factors were incomplete immunization (OR 3.87, p= 0.00151) and female sex (p=0.03721). Poverty, social conditions under which the child was living, sex of the child and incomplete immunizations were risk factors for the severe protein energy malnutrition.

The emerging problem of coronary heart disease in Kenya.

To review the literature on coronary heart disease (CHD) and its electrocardiogram (ECG) manifestations in Eastern Africa and provide medical education by increasing awareness and strengthening recognition skills of myocardial infarction (MI) through discussion of key features from representative ECGs selected from the Moi Teaching and Referral Hospital (MTRH) ECG service in Eldoret, Kenya. Peer reviewed published articles found using a Medline search. ECGs were reproduced with one complex from each of the 12 standard leads, without patient's name or other identifying information. CHD and its risk factors are increasing in prevalence in Eastern Africa over recent years. The ECG remains integral to the diagnosis of acute coronary syndromes, including MI. Representative ECGs from MTRH demonstrate the various features of the common anatomical distributions of MI, enabling medical education. Recognition of CHD and its ECG manifestations is one step on the path to decreasing resultant morbidity and mortality.

Aerobic pathogenic bacteria in post-operative wounds at Moi Teaching and Referral Hospital.

The emergence of bacterial antimicrobial resistance associated with acquired infections has made the choice of empirical therapy more difficult and expensive, hence the need for continuous research to determine their sensitivity patterns. To identify the common aerobic pathogenic bacteria in post-operative wounds at Moi Teaching and Referral Hospital (MTRH) and determine their sensitivity patterns to routine antibiotics used. Cross-sectional study. Moi Teaching and Referral Hospital (MTRH) Surgical, Obstetrics and Gynaecology wards. Sixty three patients chosen by convenient sampling between May and June 2001 were included in the study. A total of eighty four isolates were obtained from these patients. Isolation of pathogens and their antibiotic sensitivity determination was conducted in the Department of Medical Microbiology Laboratory, Faculty of Health Sciences, Moi University. The bacteria were cultured on blood agar, MacConkey and Nutrient agar followed by identification using biochemical tests (catalase urease, coagulase, triple sugar iron). Disc diffusion method on Muller-Hinton agar was used for sensitivity testing. Staphylococcus aureus species were the most common pathogenic bacteria isolated from the post-operative wounds. Other organisms included Proteus, Pseudomonas and Escherichia coli. There was a multi-drug resistance pattern observed, with minocyline being the most effective drug against S. aureus. There is need for review of policies on prescription practice on the use of existing therapeutics choice to limit the spread of resistance. This will ensure reduced patient stay and cost incurred.

Perinatal morbidity at the Moi Teaching and Referral Hospital, Eldoret.

Perinatal morbidity (PNM) is highest in the developing countries including Kenya. Studies on the perinatal morbidity in Moi Teaching and Referral Hospital (MTRH) have not been carried out. Furthermore, factors associated with PNM are unknown at the MTRH. To establish the causes and incidence of perinatal morbidity at the MTRH NewBorn Unit (NBU). A retrospective study using case notes. The NBU of the MTRH in Eldoret, Kenya. Babies who were admitted to the MTRH's Newborn Unit from January to December 1997. The perinatal morbidity was 667 per 1000 babies admitted to the NBU. The most common reason for admission was mother under anaesthesia. The most common cause of morbidity was asphyxia. The mean maternal age was 24 years. The mean level of education was 1.7 years. More than fifty five per cent of the mothers were housewives. The mean birthweight was 2.75 kg (+/- 0.9 SD), 55.9% had normal birthweight, 37% were low birthweight and three per cent were large babies. The mean duration of stay in the NBU was 3.8 days. Most of the admissions were Caesarean section babies who did not require admission. Younger mothers were more likely to have babies with neonatal sepsis, convulsions, pneumonia and asphyxia.

Presentation and health care seeking behaviour of patients with cervical cancer seen at Moi Teaching and Referral Hospital, Eldoret, Kenya.

To determine the clinicopathological characteristics and health care seeking behaviour of cervical cancer patients seen at Moi Teaching and Referral Hospital (MTRH). Prospective cross-sectional study. Gynaecology Unit, Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Forty-two consecutive cervical cancer patients seen at MTRH gynaecology unit between May 1998 and November 1999. The mean age of the patients was 49.4 years (95% CI 45.4 to 53.3 years) range 24 to 80 years. All had been married and 42.9% had been in polygamous unions. Slightly more than seventy six per cent had had five or more confirmed pregnancies. Contraceptive everuse was 22%. The mean duration of clinical symptoms on presentation at MTRH was 8.2 months (95% CI 6.5 to 9.8 months) range 1 to 24 months. Female relatives and husbands were the first to be told about the symptoms by 90.3% of the patients and husbands alone by 48.8% of the patients. More than ninety per cent of patients sought health for the first time at a facility manned by trained health worker, with 39% visiting a dispensary or health centre first. More than 95% of patients had tumour stage 2 and above. Histopathologically, 80.9% of the tumours were squamous cell carcinoma, 11.9% were adenocarcinoma while the rest were anaplastic. Patients with cervical cancer present late for treatment at MTRH. They are most likely to have discussed their illness with their female relatives and husbands and to have first visited peripheral facilities manned by trained healthcare workers. Interventions to improve health care seeking behaviour among cervical cancer patients need to include education of husbands in addition to increasing awareness of the disease among private medical practitioners and health workers at dispensary and health centre level.