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While there is evidence that child marriage (CM) is reducing globally, rates in many contexts remain far too high. To understand the persistence of high rates of CM, we searched multiple databases for peer-reviewed, English language articles published between 2000 and 2023. High CM rates are continuing in circumstances of tenacious unequal gender norms, widespread poverty, limited schooling and economic prospects for girls, and weak awareness and enforcement of CM laws. Other contributing factors were opposition to women and girls' sexual, bodily, and reproductive rights; weak birth registration systems; a high proportion of women who married young in previous generations; early puberty; improved girls' agency; and the growing number of boys and young men who, having acquired locally prized masculinity resources, feel compelled to marry. We highlight the implications of the review findings for future research, policy and programmatic efforts aimed at addressing the persistence of CM.

Access to comprehensive reproductive health care for women and girls, including access to quality maternal health services remains a challenge in Kenya. A recent government enquiry assessing close to 500 maternal deaths that occurred in 2014 revealed gaps in the quality of maternal care, concluding that more than 90% of the women who had died had received "suboptimal" maternal care. In Kenya, the Center for Reproductive Rights (the Center) has undertaken public interest litigation among other strategies to challenge human rights violations and systematic failures within the health sector. In 2014, before the High Court of Bungoma in Western Kenya, the Center filed a case on behalf of Josephine Majani who had been neglected and abused by the staff of the Bungoma County Referral Hospital, a public health facility where she had gone to deliver in 2013. This commentary addresses the situation of maternal health care in Kenya and the actions leading to litigation that was specifically aimed at enabling access to quality maternal health care. It provides an analysis of some of the outcomes of the litigation and highlights the implications thereof on implementation of maternal health care in Kenya and beyond.

Introduction: A prospective quasi experimental study was undertaken at the Thika level 5 hospital. The study aimed to compare the costs of managing femoral shaft fracture by surgery as compared to skeletal traction., Methods: Sixty nine (46.6%) patients were enrolled in group A and managed surgically by intramedullary nailing while 79 (53.4%) patients were enrolled in group B and managed by skeletal traction. Exclusion criteria included patients with pathological fractures and previous femoral fractures. Data was collected by evaluation of patients in patient bills using a standardized questionnaire. The questionnaire included cost of haematological and radiological tests, bed fees, theatre fees and physiotherapy costs. The data was compiled and analyzed using SPSS version 16. Person's chi square and odds ratios were used to measure associations and risk analysis respectively., Results: A higher proportion of patients (88.4%) in group A were hospitalized for less than one month compared to 20 patients (30.4%) in group B (p, 0.001).Total cost of treatment in group A was significantly lower than in group B. Nineteen (27.9%) patients who underwent surgery paid a total bill of Ksh 5000-7500 compared to 7(10.4%) who were treated by traction. The financial cost benefit of surgery was further complimented by better functional outcomes., Conclusion: The data indicates a cost advantage of managing femoral shaft fracture by surgery compared to traction. Furthermore the longer hospital stay in the traction group is associated with more malunion, limb deformity and shortening.

A case of an acute abdomen secondary to a ruptured spleen managed laparoscopically is presented. Laparoscopy is currently widely used for the initial diagnosis and management of such cases as an alternative to laparotomy due to the numerous advantages of the minimal access techniques. With widespread availability and adequate training in laparoscopy, minimal access surgery is likely to play a bigger role in the initial management of patients with an acute abdomen in Kenya. It is with this realisation that we present the case of a 25 year old male who presented with an acute abdomen and thrombocytopaenia due to a ruptured spleen following severe malaria that was managed laparoscopically. The aim is to highlight and encourage conservative management of acute abdomen due to splenic rupture in a patient with malaria.

A case of intestinal tuberculosis affecting the jejunum (with perforations) and the colon is presented. The objective is to highlight the challenges medical practitioners face in making a timely diagnosis of intestinal tuberculosis. It also aims to raise awareness that chronic diarrhoea and weight loss are common symptoms of colonic tuberculosis. A 26 year old university student was admitted with a three month history of diarrhoea anorexia and weight loss having been seen and treated for typhoid in several hospitals without improvement. Colonoscopy and biopsy was non conclusive. He later developed subacute intestinal obstruction that did not respond to conservative treatment. Explorative laparotomy revealed jejunal perforations with localised absesses, peritoneal adhesions with caseous nodules and mesenteric Iymphadenopathy. Histology of resected specimens was positive for mycobacterium tuberculosis.