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Survival of cervical cancer patients at Moi teaching and Referral Hospital, Eldoret in western Kenya. BMC Cancer 2023; 23:1104. [PMID: 37957644 PMCID: PMC10644535 DOI: 10.1186/s12885-023-11506-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/10/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Cervical cancer is a major health burden and the second most common cancer after breast cancer among women in Kenya. Worldwide cervical cancer constitutes 3.1% of all cancer cases. Mortality rates are greatest among the low-income countries because of lack of awareness, screening and early-detection programs and adequate treatment facilities. The main aim was to estimate survival and determine survival predictors of women with cervical cancer and limited resources in western Kenya. METHODS Retrospective charts review of women diagnosed with cervical cancer and follow-up for two years from the date of the histologic diagnosis. The outcome of interest was death or survival at two years. Kaplan Meier estimates of survival, log-rank test and Cox proportional hazards regression were used in the survival analysis. RESULTS One hundred and sixty-two (162) participants were included in the review. The median duration was 0.8 (interquartile range (IQR) 0.3, 1.6) years. The mean age at diagnosis was 50.6 years (SD12.5). The mean parity was 5.9 (SD 2.6). Fifty percent (50%) did not have health insurance. Twenty six percent (26%) used hormonal contraceptives, 25.9% were HIV positive and 70% of them were on anti-retroviral treatment. The participants were followed up for 152.6 person years. Of the 162 women in the study, 70 (43.2%) died giving an overall incidence rate (IR) of 45.9 deaths per 100 person years of follow up. The hazard ratios were better for the patients who survived (0.44 vs 0.88, p-value < 0.001), those who had medical insurance (0.70 vs 0.48, p-value = 0.007) and those with early stage at diagnosis (0.88 vs 0.39, p-value < 0.001). Participants who were diagnosed at late stage of the disease according to the International Federation of Gynecology and Obstetrics staging for cervical cancer (FIGO stage 2B-4B) had more than eight times increased hazard of death compared to those who were diagnosed at early stage (1-2A): Hazard Ratio: 8.01 (95% CI 3.65, 17.57). Similarly, those who underwent surgical management had 84% reduced hazard of mortality compared to those who were referred for other modes of care: HR: 0.16 (95% CI: 0.07, 0.38). CONCLUSION Majority of the participants were diagnosed late after presenting with symptoms. The 1 and 2-year survival probability after diagnosis of cervical cancer was 57% AND 45% respectively. It is imperative that women present early since surgery gives better prognosis or better still screening of all women prioritized.
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O-108 Con: Reproductive rights are trampled every day. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Determinants of preconception care among pregnant women in an urban and a rural health facility in Kenya: a qualitative study. BMC Pregnancy Childbirth 2021; 21:752. [PMID: 34743694 PMCID: PMC8573977 DOI: 10.1186/s12884-021-04201-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Preconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could contribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in rural areas. Little is known regarding PCC use in Kenya that could help in addressing this shortfall. This study aimed to qualitatively assess the determinants of PCC in urban and rural settings in Kenya. Methods A qualitative approach was employed to assess determinants of PCC using a semi-structured interview guide. The study was conducted from May to October 2017. Selected pregnant women seeking antenatal care (ANC) were recruited by quota sampling, at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). The interviews were thereafter transcribed verbatim and analyzed thematically. Findings A total of 26 women were invited, of whom 21 accepted to participate in in-depth interviews (IDIs). Saturation of themes occurred with 13 interviews (7 at AKUH and 6 at MLFH). Transcription, coding and thematic analysis of the IDIs yielded 12 themes. Eleven of these themes were identified as determinants of PCC. The twelfth theme contained suggested strategies of increasing PCC awareness and utilization, such as using the media, setting up PCC clinics and integrating PCC into other clinics. The dominant themes were awareness about PCC and attitudes towards PCC and pregnancy. The broad determinants of PCC were similar in urban and rural settings – with a few notable exceptions. For example, in the rural setting, women’s level of education and a pervasive history of poor interactions with healthcare providers were major determinants of PCC. Conclusion From this study we conclude that women’s lack of awareness about PCC, in conjunction with attitudes towards PCC and pregnancy impact strongly on its utilization. This lack of awareness could be addressed through health education programs for both the public and for healthcare providers, as well as integrating PCC in the curricula of the later. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04201-w.
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Routine third-trimester ultrasound for the detection of small-for-gestational age in low-risk pregnancies (ROTTUS study): randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:910-916. [PMID: 33619823 DOI: 10.1002/uog.23618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/30/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare the proportion of small-for-gestational-age (SGA) infants detected by routine third-trimester ultrasound vs those detected by selective ultrasound based on serial symphysis-fundus height (SFH) measurements (standard care) in low-risk pregnancy. METHODS This was an open-label randomized controlled trial conducted at a hospital in Kenya between May 2018 and February 2020. Low-risk pregnant women were randomly allocated (ratio of 1:1) to routine ultrasound for fetal growth assessment between 36 + 0 and 37 + 6 weeks' gestation (intervention group) or to standard care, which involved a selective growth scan on clinical suspicion of fetal growth abnormality based on serial SFH measurements (control group). During ultrasound examination, fetal growth was assessed by measurement of the abdominal circumference (AC), and AC < 10th centile was used to diagnose a SGA fetus. The main prespecified outcomes were the detection of neonatal SGA, defined as birth weight < 10th centile, and of severe neonatal SGA, defined as birth weight < 3rd centile. The predictive performance of routine third-trimester ultrasound and selective ultrasound based on serial SFH measurements was determined using receiver-operating-characteristics (ROC)-curve analysis. RESULTS Of 566 women assessed for eligibility, 508 (89.8%) were randomized, of whom 253 were allocated to the intervention group and 255 to the control group. Thirty-six babies in the intervention group and 26 in the control group had a birth weight < 10th centile. The detection rate of SGA infants by routine third-trimester ultrasound vs that by standard care was 52.8% (19/36) vs 7.7% (2/26) (P < 0.001) and the specificity was 95.5% (191/200) and 97.9% (191/195), respectively (P = 0.08). The detection rate of severe SGA was 66.7% (12/18) by routine ultrasound vs 8.3% (1/12) by selective ultrasound based on SFH measurements (P < 0.001), with specificities of 91.7% (200/218) and 98.1% (205/209), respectively (P = 0.006). The area under the ROC curve of routine third-trimester ultrasound in prediction of SGA was significantly greater than that of selective ultrasound based on SFH measurements (0.92 (95% CI, 0.87-0.96) vs 0.68 (95% CI, 0.58-0.77); P < 0.001). CONCLUSIONS In low-risk pregnancy, routine ultrasound performed between 36 + 0 and 37 + 6 weeks is superior to selective ultrasound based on serial SFH measurements for the detection of true SGA, with high specificity. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Delivery mode for prolonged, obstructed labour resulting in obstetric fistula: a retrospective review of 4396 women in East and Central Africa. BJOG 2020; 127:702-707. [PMID: 31846206 PMCID: PMC7187175 DOI: 10.1111/1471-0528.16047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the mode of delivery and stillbirth rates over time among women with obstetric fistula. DESIGN Retrospective record review. SETTING Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia and Ethiopia. POPULATION A total of 4396 women presenting with obstetric fistulas for repair who delivered previously in facilities between 1990 and 2014. METHODS Retrospective review of trends and associations between mode of delivery and stillbirth, focusing on caesarean section (CS), assisted vaginal deliveries and spontaneous vaginal deliveries. MAIN OUTCOME MEASURES Mode of delivery, stillbirth. RESULTS Out of 4396 women with fistula, 3695 (84.1%) delivered a stillborn baby. Among mothers with fistula giving birth to a stillborn baby, the CS rate (overall 54.8%, 2027/3695) rose from 45% (162/361) in 1990-94 to 64% (331/514) in 2010-14. This increase occurred at the expense of assisted vaginal delivery (overall 18.3%, 676/3695), which declined from 32% (115/361) to 6% (31/514). CONCLUSIONS In Eastern and Central Africa, CS is increasingly performed on women with obstructed labour whose babies have already died in utero. Contrary to international recommendations, alternatives such as vacuum extraction, forceps and destructive delivery are decreasingly used. Unless uterine rupture is suspected, CS should be avoided in obstructed labour with intrauterine fetal death to avoid complications related to CS scars in subsequent pregnancies. Increasingly, women with obstetric fistula add a history of unnecessary CS to their already grim experiences of prolonged, obstructed labour and stillbirth. TWEETABLE ABSTRACT Caesarean section is increasingly performed in African women with stillbirth treated for obstetric fistula.
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Effects of free maternity service policy in Kenya: an interrupted time series analysis. THE LANCET GLOBAL HEALTH 2019. [DOI: 10.1016/s2214-109x(19)30106-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Physical violence based on SOGIE among sexual and gender minorities: a systematic review. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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HIV/STD: the women to blame? Knowledge and attitudes among STD clinic attendees in the second decade of HIV/AIDS. Int J STD AIDS 2017. [DOI: 10.1177/095646249901000810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to determine the knowledge and attitudes towards HIV/STDs among women attending an STD clinic by interviewing 520 randomly selected women. Nearly all had heard of HIV/AIDS/STDs, with posters, pamphlets and the radio being the main source of their information. The years of schooling was the only predictive factor of knowing a preventive measure of HIV. Two-thirds thought they were at risk of contracting HIV from their regular partner. Knowledge of the sexual habits of their male partners was low with 260 (50%) of the women distrusting their partner. Only 52 (10%) of respondents admitted to sex in exchange for gifts or money. In the event of a positive HIV test result, the perceived partner response would be to blame the woman for introducing the infection into the relationship. After a positive HIV test result, only 3.5% would resort to using condoms while another 3.7% would try to pass on the disease to other people. The quality of their knowledge of the transmission of HIV was low in spite of the fact that most respondents have heard of HIV/AIDS/STDs. Violence against women was expected in relation to a positive test result. There is a need for better educative effort on the modes of transmission and prevention of HIV, also in ‘low risk’ populations.
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Declining syphilis prevalence in pregnant women in Nairobi since 1995: another success story in the STD field? Int J STD AIDS 2017. [DOI: 10.1177/095646249901000609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Does place and attendance at birth improve early neonatal mortality? Secondary analysis of nine Demographic and Health Surveys. BJOG 2016; 124:1558-1565. [PMID: 27862850 DOI: 10.1111/1471-0528.14422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the relation between place and skilled birth attendance at birth and early neonatal mortality. DESIGN Retrospective analysis using data from Demographic and Health Surveys on obstetric complications. SETTING Nine low and middle income countries between 2006 and 2013. POPULATION 71 758 women aged 15-49 years. METHODS A secondary analysis was carried out to investigate the occurrence and effect of obstetric complications on early neonatal mortality and association with place and attendance at birth. Obstetric complications studied were prolonged labour, puerperal infection and eclampsia. MAIN OUTCOME MEASURES Association between early neonatal mortality and place and attendance at birth, unadjusted and adjusted for presence of severe obstetric complications. RESULTS Thirty-five percent of all births were at home: 70% of these were without skilled attendamts. Obstetric complications were reported in 17 079 women: 82% of these women gave birth in health facilities. Overall, no association was observed between place of birth or attendance at birth and early neonatal mortality. When adjusted for obstetric complications, the odds of early neonatal deaths for births at home without a skilled attendant were 1.3 (95% CI 1.1-1.5) compared with 1.2 (95% CI 1.0-1.5) with a skilled attendant and births in health facilities. CONCLUSIONS When adjusted for obstetric complications, births in health facilities were associated with reduced early neonatal mortality. However, reporting and referral bias account for at least part of the association. TWEETABLE ABSTRACT Births in health facilities are linked with fewer early newborn deaths when adjusted for obstetric complications.
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Sexual competence as an indicator of sexual health, results from SIALON II, a European multi-country bio-behavioral survey among men who have sex with men. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw173.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Family Planning needs and induced abortion in China: two cross-sectional studies. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Addressing the intersection between alcohol consumption and antiretroviral treatment: needs assessment and design of interventions for primary healthcare workers, the Western Cape, South Africa. Global Health 2016; 12:65. [PMID: 27784302 PMCID: PMC5080779 DOI: 10.1186/s12992-016-0201-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 09/27/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND At the points where an infectious disease and risk factors for poor health intersect, while health problems may be compounded, there is also an opportunity to provide health services. Where human immunodeficiency virus (HIV) infection and alcohol consumption intersect include infection with HIV, onward transmission of HIV, impact on HIV and acquired immunodeficiency syndrome (AIDS) disease progression, and premature death. The levels of knowledge and attitudes relating to the health and treatment outcomes of HIV and AIDS and the concurrent consumption of alcohol need to be determined. This study aimed to ascertain the knowledge, attitudes and practices of primary healthcare workers concerning the concurrent consumption of alcohol of clinic attendees who are prescribed antiretroviral drugs. An assessment of the exchange of information on the subject between clinic attendees and primary healthcare providers forms an important aspect of the research. A further objective of this study is an assessment of the level of alcohol consumption of people living with HIV and AIDS attending public health facilities in the Western Cape Province in South Africa, to which end, the study reviewed health workers' perceptions of the problem's extent. A final objective is to contribute to the development of evidence-based guidelines for AIDS patients who consume alcohol when on ARVs. The overall study purpose is to optimise antiretroviral health outcomes for all people living with HIV and AIDS, but with specific reference to the clinic attendees studied in this research. METHODS Overall the research study utilised mixed methods. Three group-specific questionnaires were administered between September 2013 and May 2014. The resulting qualitative data presented here supplements the results of the quantitative data questionnaires for HIV and AIDS clinic attendees, which have been analysed and written up separately. This arm of the research study comprised two, separate, semi-structured sets of interviews: one face-to-face with healthcare workers at the same primary healthcare clinics from which the clinic attendees were sampled, and the other with administrators from the local government health service via email. The qualitative analysis from the primary healthcare worker interviews has been analysed using thematic content analysis. RESULTS The key capacity gaps for nurses include the definition of different patterns and volumes of alcohol consumption, resultant health outcomes and how to answer patient questions on alcohol consumption while on antiretroviral treatment. Not only did the counsellors lack knowledge regarding alcohol abuse and its treatment, but they were also they were unclear on their role and rights in relation to their patients. Doctors highlighted the need for additional training for clinicians in diagnosing alcohol use disorders and information on the pharmacological interventions to treat alcoholism. CONCLUSION Pertinent knowledge regarding patient alcohol consumption while taking ARVs needs to be disseminated to primary healthcare workers.
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Gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis in Kenya. Int J Tuberc Lung Dis 2016; 19:1176-81. [PMID: 26459529 DOI: 10.5588/ijtld.15.0070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis (PTB) and factors associated with poor outcomes in Kenya. DESIGN Retrospective descriptive cohort. RESULTS Of 16 056 subjects analysed, 38% were female and 62% male. Females had a higher risk of poor treatment outcome than males (12% vs. 10%, P < 0.001; adjusted OR 1.29, 95%CI 1.16-1.44, P < 0.001). In the first multivariate model, restricting the analysis to human immunodeficiency virus (HIV) positive patients and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor outcome (OR 0.99, 95%CI 0.86-1.13, P = 0.844). In the model restricted to HIV-negative patients, a non-significantly lower risk was found (OR 0.89, 95%CI 0.73-1.09, P = 0.267). In the second model, restricting analysis to patients on antiretroviral therapy (ART) and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor PTB treatment outcomes (OR 0.98, 95%CI 0.84-1.14, P = 0.792). In the model restricted to HIV-positive patients not on ART, a non-significantly higher risk was found (OR 1.15, 95%CI 0.79-1.67, P = 0.461). CONCLUSION Females of reproductive age are likely to have poorer treatment outcomes than males. Among females, not commencing ART during anti-tuberculosis treatment seemed to be associated with poor outcomes.
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Heavy episodic drinking among Kenyan female sex workers is associated with unsafe sex, sexual violence and sexually transmitted infections. Int J STD AIDS 2016; 18:764-9. [DOI: 10.1258/095646207782212342] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined patterns of alcohol use and its association with unsafe sex and related sequelae among female sex workers in Mombasa, Kenya. A community-based cross-sectional study was conducted using snowball sampling. Binge drinkers (≥5 alcoholic drinks on ≥1 occasion in the previous month) were compared with non-binge drinkers. Of 719 participants, 22.4% were lifetime-alcohol abstainers, 44.7% non-binge and 33.0% binge drinkers. Compared with non-binge drinkers, binge drinkers were more likely to report unprotected sex (adjusted odds ratio (AOR)=1.59, 95% confidence interval [CI]=1.00–2.53; P=0.047) and sexual violence (AOR=1.85, 95% CI=1.27–2.71; P=0.001) and to have either syphilis, Neisseria gonorrhoeae or Trichomonas vaginalis infection (AOR=1.56, 95% CI=1.00–2.41; P=0.048). HIV prevalence was higher among women having ever drunk (39.9%) than lifetime abstainers (23.2%; P<0.001), but was not associated with drinking patterns. Interventions are needed to assist female sex workers adopt safer drinking patterns. Investigation is needed for the effectiveness of such interventions in reducing unprotected sex, sexual violence and sexually transmitted infections.
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Screening for tuberculosis in pregnancy: do we need more than a symptom screen? Experience from western Kenya. Public Health Action 2015; 3:294-8. [PMID: 26393049 DOI: 10.5588/pha.13.0073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/27/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES 1) To explore the utility of tuberculosis (TB) symptom screening for symptoms of ≥2 weeks' duration in a routine setting, and 2) to compare differences in TB diagnosis between human immunodeficiency virus (HIV) infected and non-HIV-infected pregnant women in western Kenya. DESIGN Comparative cross-sectional study among pregnant women with known HIV status screened for TB from 2010 to 2012, in Eldoret, western Kenya. RESULTS Of 2983 participants, respectively 34 (1%), 1488 (50.5%) and 1461 (49.5%) had unknown, positive and negative HIV status. The median age was respectively 30 years (interquartile range [IQR] 26-35) and 26 years (IQR 24-31) in HIV-infected and non-infected participants. A positive symptom screen was found in respectively 8% (119/1488) and 5% (67/1461) of the HIV-infected and non-infected women. The median CD4 count at enrolment was 377 cells/μl (IQR 244-530) for HIV-infected women. One non-HIV-infected patient was sputum-positive. For HIV-infected women, TB was presumptively treated in 1% (16/1488) based on clinical symptoms and chest X-ray. Cumulatively, anti-tuberculosis treatment was offered to 0.6% (17/2949) of the participants. CONCLUSION This study does not seem to demonstrate the utility of TB symptom screening questionnaires in a routine setting among pregnant women, either HIV-infected or non-infected, in western Kenya.
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A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study. BJOG 2015; 123:427-36. [PMID: 26259689 PMCID: PMC4873961 DOI: 10.1111/1471-0528.13509] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 12/01/2022]
Abstract
Objective To generate a global reference for caesarean section (CS) rates at health facilities. Design Cross‐sectional study. Setting Health facilities from 43 countries. Population/Sample Thirty eight thousand three hundred and twenty‐four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing. Methods We hypothesised that mathematical models could determine the relationship between clinical‐obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three‐step approach to generate the global benchmark of CS rates at health facilities: creation of a multi‐country reference population, building mathematical models, and testing these models. Main outcome measures Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. Results According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C‐Model, with summary estimates ranging from 0.832 to 0.844. The C‐Model was able to generate expected CS rates adjusted for the case‐mix of the obstetric population. We have also prepared an e‐calculator to facilitate use of C‐Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). Conclusions This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C‐Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. Tweetable abstract The C‐Model provides a customized benchmark for caesarean section rates in health facilities and systems. The C‐Model provides a customized benchmark for caesarean section rates in health facilities and systems.
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Abstract
The QUALMAT research project aims to improve maternal and newborn health by improving the quality of antenatal and childbirth care provided in primary healthcare facilities. Within the frame of this project, a comprehensive quality assessment took place in selected health centres in northern Ghana. The results of this assessment showed that overall quality of routine antenatal and childbirth care was satisfactory, although some critical gaps were identified. Counselling and health education practices need to be improved; laboratory investigations are often not performed; examination and monitoring of mother and newborn during childbirth are inadequate; partographs are often not used and poorly completed; and equipment to provide assisted vaginal deliveries was absent.
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Advancing the sexual and reproductive health and human rights of women beyond 2015. BJOG 2014; 121 Suppl 5:1-2. [PMID: 25335831 DOI: 10.1111/1471-0528.13139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Obstetric transition: the pathway towards ending preventable maternal deaths. BJOG 2014; 121 Suppl 1:1-4. [PMID: 24641529 DOI: 10.1111/1471-0528.12735] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 11/28/2022]
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Pregnancy outcomes in Benghazi, Libya, before and during the armed conflict in 2011. EASTERN MEDITERRANEAN HEALTH JOURNAL = LA REVUE DE SANTE DE LA MEDITERRANEE ORIENTALE = AL-MAJALLAH AL-SIHHIYAH LI-SHARQ AL-MUTAWASSIT 2014; 20:175-180. [PMID: 24950075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/11/2013] [Indexed: 06/03/2023]
Abstract
Stressful life events experienced by pregnant women may lead to adverse obstetric outcomes. This study in Benghazi compared the rates of preterm, low-birth-weight and caesarean-section births at Al-Jamhouria hospital in the months before and during the armed conflict in Libya in 2011. Data were collected on all women admitted to the delivery ward during February to May 2011 (the months of the most active fighting in the city) (n = 7096), and October to December 2010 (the months immediately before the war) (n = 5935). Compared with the preceding months there was a significant rise during the conflict in the rate of deliveries involving preterm (3.6% versus 2.5%) and low-birth-weight (10.1% versus 8.5%) infants and caesarean sections (26.9% versus 25.3%). Psychosocial stress may have been a factor (among others) in an increase in negative pregnancy outcomes, and obstetric hospitals should be aware of these issues in times of war.
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Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014; 121 Suppl 1:40-8. [DOI: 10.1111/1471-0528.12630] [Citation(s) in RCA: 469] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/26/2022]
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Pregnancy outcomes in Benghazi, Libya, before and during the armed conflict in 2011. EASTERN MEDITERRANEAN HEALTH JOURNAL 2014. [DOI: 10.26719/2014.20.3.175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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CD4 T-LYMPHOCYTE SUBSETS IN WOMEN WITH INVASIVE CERVICAL CANCER IN KENYA. EAST AFRICAN MEDICAL JOURNAL 2013; 90:309-315. [PMID: 26862640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Invasive cervical cancer (ICC) and HIV are common in sub-Sahara Africa. Both ICC and HIV are immunosuppressive, and are associated with decreased CD4 and CD8 profiles. In a group of women with ICC starting radiotherapy, we determined their CD4 profiles. DESIGN A cross-sectional study. SETTINGS Kenyatta National Hospital, Nairobi, Kenya, radiotherapy unit. SUBJECTS Women with invasive cervical cancer (344) seeking radiotherapy treatment for the first time between January 2000 and March 2003, had blood samples analyzed for CD4 and CD8 cell counts by flow cytometry. Haemoglobin, white cell count, lymphocyte and platelet counts were determined using coulter machine. All patients had received pre- and post HIV counseling. RESULTS The mean age was 49+13 years. About 13.1% of the women with ICC were HIV positive. Overall, mean and median CD4 cell count was 829+355 cells/mm and 792 cells/mm3. Among HIV+ patients, mean and median CD4 cell counts were 451+288 cells/mm and 405 cells/mm respectively. The mean CD4 cell count for the HIV+ womenwas 886+329 cells/mm3 with median of 833 cells/mm3, range 147-2065 cells/mm3. Only nine (20%) of the 45 HIV+ women had CD4 cell count of 0-200. HIV+ women had lower CD4 percentage and cell count and higher CD8 percentage and cell count as compared to HIV negative women, p < 0.001. HIV infection was significantly and independently associated with high proportion of women who had CD4 cell count of less than 200 cells/mm3 or less than 350 cells/mm3, p < 0.0001. CONCLUSIONS Women with ICC and concurrent HIV infection have decreased CD4 cell subset. These results suggest HIV infection may be associated with more severe CD4 depletion in women with ICC.
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Smoking patterns and Depression among Flemish Women during Pregnancy and the Postpartum period. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Make it work!: Training Manual for sexual health promotion and prevention of sexual and gender-based violence in the European reception & asylum sector. (8 European MS, 2008-2010). Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Quality of antenatal and childbirth care in selected rural health facilities in Burkina Faso, Ghana and Tanzania: similar finding. Trop Med Int Health 2013; 18:534-47. [PMID: 23398053 DOI: 10.1111/tmi.12076] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To measure pre-intervention quality of routine antenatal and childbirth care in rural districts of Burkina Faso, Ghana and Tanzania and to identify shortcomings. METHODS In each country, we selected two adjoining rural districts. Within each district, we randomly sampled 6 primary healthcare facilities. Quality of care was assessed through health facility surveys, direct observation of antenatal and childbirth care, exit interviews and review of patient records. RESULTS By and large, quality of antenatal and childbirth care in the six districts was satisfactory, but we did identify some critical gaps common to the study sites in all three countries. Counselling and health education practices are poor; laboratory investigations are often not performed; examination and monitoring of mother and newborn during childbirth are inadequate; partographs are not used. Equipment required to provide assisted vaginal deliveries (vacuum extractor or forceps) was absent in all surveyed facilities. CONCLUSION Quality of care in the three study sites can be improved with the available human resources and without major investments. This improvement could reduce maternal and neonatal mortality and morbidity.
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Terminations of pregnancy in Europe: the East-West divide. BJOG 2012. [DOI: 10.1111/j.1471-0528.2012.03354.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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sTREM-1 levels are elevated in maternal serum during term and preterm labour. J Reprod Immunol 2012. [DOI: 10.1016/j.jri.2012.03.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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A call for a family planning surge. Facts Views Vis Obgyn 2012; 4:25-9. [PMID: 24753885 PMCID: PMC3991444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 1994, the International Conference on Population and Development (ICPD) held in Cairo, Egypt, laid out in its Programme of Action an impressive and ambitious set of goals for improving sexual and reproductive health and rights (SRHR) all over the world, by the target date of 2015 (International Conference on Population and Development 1994). One of these goals was the provision of universal access to a full range of safe and reliable family-planning methods. However, notwithstanding increases in budgets for family planning during the years following the ICPD (Organisation for Economic Co-operation and Development), there has been an alarming neglect from the international community for the topic since the year 2000. As a result, the progress made during the second half of the nineties slowed down considerably between 2000 and 2010; in a sense, one could say that ten years were almost wasted! This is astonishing, the more since meeting the need for family planning would have beneficial impacts on public health, environmental sustainability and social and economic development. In this paper, we explore these impacts and urge for a strong renewed commitment of the global community in the form of a global family planning decade.
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Pregnancy outcome of Moroccan and Turkish women in Belgium. CLIN EXP OBSTET GYN 2012; 39:181-185. [PMID: 22905459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To compare perinatal outcome in women from Turkish and Moroccan descent versus autochthonous women in Belgium. METHODS Retrospective cohort study, data from an existing database, coupled with sociodemographic data from birth certificates. RESULTS There were more teenage pregnancies in the Moroccan and Turkish group, Moroccan women delivered more frequently after age 40 but Turkish women less frequently. In Moroccan and Turkish women the level of education was lower, they had less hypertension, fewer pregnancies after artificial reproductive technology and preterm deliveries, more diabetes and more grand multiparity. Moroccan women demonstrated more HIV infection. Planned cesarean section was less frequent in the Moroccan and Turkish group, and there was no difference for secondary cesarean section. Belgian women had more induction of labor, instrumental vaginal delivery and epidural anesthesia. There were more babies with low birth weight in both the Moroccan and Turkish group. Moroccan woman had more babies with a birth weight above 4500 g. Total perinatal death rate was higher for Moroccan women while there was no difference between Belgian and Turkish babies. CONCLUSION Moroccan women demonstrated higher rates of HIV infection and perinatal mortality, while in both Turkish and Moroccon women diabetes was higher and hypertension less frequent. Belgian women underwent more interventions during pregnancy.
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Birth weight for gestational age among Flemish twin population. Facts Views Vis Obgyn 2012; 4:42-9. [PMID: 24753888 PMCID: PMC3991447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop birth weight references for twins. Mean birth weights of individual twins are lower than those of singletons, hence singleton birth weight curves may not be suitable to assess twin birth weights. STUDY DESIGN Twin birth weight curves were developed according to gestational age, gender, parity and mode of -conception. The curves are based on population-based data of 40,494 twins born in Flanders, Belgium between 1987 and 2007. RESULTS A different growth potential was found comparing the birth weights of twins and singletons. Twins deviate from the singleton curve from 30 weeks gestational age on. CONCLUSION Our study underlines that singleton birth weight curves differ from twin birth weight curves. We developed specific twin birth weight curves can be used in clinical practice in order to follow growth patterns of twins in utero.
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Abstract
OBJECTIVE To study the current legislation and trends in terminations of pregnancy in the European Union (EU). DESIGN Data were collected on legislation and statistics for terminations of pregnancy. SETTING Population-based statistics from the EU member states. POPULATION Women in reproductive age in the 27 EU member states. METHODS Information on legislation was collected for all 27 EU member states. Statistical information until 2008 was compiled from international (n = 24) and national sources (n = 17). Statistical data were not available for Austria, Cyprus and Luxembourg. MAIN OUTCOMES MEASURES Terminations of pregnancy per 1000 women aged 15-49 years. RESULTS Ireland, Malta and Poland have restrictive legislation. Luxembourg permits termination of pregnancy on physical and mental health indications; Cyprus, Finland, and the UK further include socio-economic indications. In all other EU member states termination of pregnancy can be performed in early pregnancy on a women's request. In general, the rates of termination of pregnancy have declined in recent years. In total, 10.3 terminations were reported per 1000 women aged 15-49 years in the EU in 2008. The rate was 12.3/1000 for countries requiring a legal indication for termination, and 11.0/1000 for countries allowing termination on request. Northern Europe (10.9/1000) and Central and Eastern Europe (10.8/1000) had higher rates than Southern Europe (8.9/1000). Northern Europe, however, had substantially higher rates of termination of pregnancy among teenagers. CONCLUSION A more consistent and coherent reporting of terminations of pregnancy is needed in the EU. The large variation of termination rates between countries suggests that termination of pregnancy rates may be reduced in some countries without restricting women's access to termination. Sexual education and provision of access to reliable and affordable contraception are essential to achieve low rates of termination of pregnancy.
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'Mama and papa nothing': living with infertility among an urban population in Kigali, Rwanda. Hum Reprod 2011; 26:623-9. [PMID: 21216790 DOI: 10.1093/humrep/deq373] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Not being able to procreate has severe social and economic repercussions in resource-poor countries. The purpose of this research was to explore the consequences of female and/or male factor infertility for men and women in Rwanda. METHODS Both quantitative and qualitative methods were used. Couples presenting with female and/or male factor infertility problems at the infertility clinic of the Kigali University Teaching Hospital (n = 312), and fertile controls who recently delivered (n = 312), were surveyed about domestic violence, current and past relationships and sexual functioning. In addition, five focus group discussions were held with a subsample of survey participants, who were either patients diagnosed with female- or male-factor fertility or their partners. RESULTS Domestic violence, union dissolutions and sexual dysfunction were reported more frequently in the survey by infertile than fertile couples. The psycho-social consequences suffered by infertile couples in Rwanda are severe and similar to those reported in other resource-poor countries. Although women carry the largest burden of suffering, the negative repercussions of infertility for men, especially at the level of the community, are considerable. Whether the infertility was caused by a female factor or male factor was an important determinant for the type of psycho-social consequences suffered. CONCLUSIONS In Rwanda, as in other resource-poor countries, infertility causes severe suffering. There is an urgent need to recognize infertility as a serious reproductive health problem and to put infertility care on the public health agenda.
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International Centre for Reproductive Health (ICRH). Facts Views Vis Obgyn 2011. [PMCID: PMC3987490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The International Centre for Reproductive Health (ICRH) was established by Prof. dr. Marleen Temmerman in the aftermath of the UN Conference on Population and Development in Cairo in 1994. This conference called for world-wide action to improve the sexual and reproductive health situation of the global population in general and for vulnerable groups in particular, and this is exactly what ICRH is striving for and has been working on for the last 15 years. ICRH is a multidisciplinary centre of excellence, in research, capacity building and fieldwork in sexual and reproductive health and HIV prevention, and an advocate for sexual and reproductive health and rights. Right from the start, ICRH has opted for a global approach, which has resulted in a broad geographical spread of activities, with projects in Africa, Latin America, Asia and Europe. Since its inception, ICRH has participated in more than 120 projects, often as the coordinator, and through this work it has contributed considerably not only to scientific knowledge, improvement of health systems and increased accessibility of health services for vulnerable groups, but also to the quality of live of numerous individuals. Since 2004, ICRH has been recognized as a WHO Collaborating Centre for Research on Sexual and Reproductive Health.
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De doelen declaration april 8, 2011. Facts Views Vis Obgyn 2011; 3:75. [PMID: 24753852 PMCID: PMC3987494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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HIV infection and sexual behaviour in primary and secondary infertile relationships: a case-control study in Kigali, Rwanda. Sex Transm Infect 2010; 87:28-34. [DOI: 10.1136/sti.2010.042879] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sexual violence, HSV-2 and HIV are important predictors for infertility in Rwanda. Hum Reprod 2010; 25:2507-15. [DOI: 10.1093/humrep/deq189] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Female genital cutting and sexual function: in search of an alternate theoretical model. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/14725843.2010.491614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gender differences and factors associated with treatment-seeking behaviour for infertility in Rwanda. Hum Reprod 2010; 25:2024-30. [PMID: 20573675 DOI: 10.1093/humrep/deq161] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study examines perceptions of infertility causes, treatment-seeking behaviour and factors associated with seeking medical care in an urban infertile population in Rwanda, as well as the response of health providers. METHODS Between November 2007 and May 2009 a hospital based survey was conducted among 312 women and 254 male partners in an infertile relationship. RESULTS Infertility causes based on a medical diagnosis were mentioned by 24% of women and 17% of men. Male infertility awareness was low in both sexes with 28% of men and 10% of women reporting male-related causes. Seventy-four per cent of women and 22% of men had sought care for their infertility in the past. Seeking treatment in the formal medical sector was associated with higher income, being married and infertility duration of more than 5 years in both sexes. In women, higher education and being nulliparous and in men blaming oneself for the infertility was also associated with seeking formal medical care. Participants reported a wide array of treatments they received in the past, often including ineffective or even harmful interventions. CONCLUSION Health authorities should invest in improving information, education and counselling on issues pertaining to causes and treatments of infertility, and in drawing up guidelines for the management of infertility at all levels of health care.
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A Safe Motherhood project in Kenya: assessment of antenatal attendance, service provision and implications for PMTCT. Trop Med Int Health 2010; 15:584-91. [PMID: 20230571 DOI: 10.1111/j.1365-3156.2010.02499.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate uptake and provision of antenatal care (ANC) services in the Uzazi Bora project: a demonstration-intervention project for Safe Motherhood and prevention of mother-to-child transmission of HIV in Kenya. METHODS Data were extracted from antenatal clinic, laboratory and maternity ward registers of all pregnant women attending ANC from January 2004 until September 2006 at three antenatal clinics in Mombasa and two in rural Kwale district of Coast Province, Kenya (n = 25 364). Multiple logistic and proportional odds logistic regression analyses assessed changes over time, and determinants of the frequency and timing of ANC visits, uptake of HIV testing, and provision of iron sulphate, folate and single-dose nevirapine (sd-NVP). RESULTS About half of women in rural and urban settings (52.2% and 49.2%, respectively) attended antenatal clinics only once. Lower parity, urban setting, older age and having received iron sulphate and folate supplements during the first ANC visit were independent predictors of more frequent visits. The first ANC visit occurred after 28 weeks of pregnancy for 30% (5894/19 432) of women. By mid-2006, provision of nevirapine to HIV-positive women had increased from 32.5% and 11.7% in rural and urban clinics, to 67.0% and 74.6%, respectively. Equally marked improvements were observed in the uptake of HIV testing and the provision of iron sulphate and folate. CONCLUSION Provision of ANC services, including sd-NVP, increased markedly over time. While further improvements in quality are necessary, particular attention is needed to implement evidence-based interventions to alter ANC utilization patterns. Encouragingly, improved provision of basic essential obstetric care may increase attendance.
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[Single embryo transfer]. VERHANDELINGEN - KONINKLIJKE ACADEMIE VOOR GENEESKUNDE VAN BELGIE 2010; 72:137-147. [PMID: 21072957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Thanks to assisted reproduction technology (ART) most couples with infertility can be helped today. Since the beginning of ART, however, two major problems have existed. In the first years of IVF more than one embryo was transferred in order to reach acceptable pregnancy rates, but this entails a risk of multiple pregnancy with all its morbidity and mortality due to premature birth. Also, studies comparing the outcome of children following ART with the outcome of children who were spontaneously conceived, showed that ART increased the risk of prematurity and low birth weight, even in singleton pregnancies. The transfer of just one embryo (single embryo transfer or SET) in IVF/ICSI treatment cycles appeared to be the only answer to the epidemic of multiple pregnancies. The studies which analyze the outcome of SET singletons are promising, since they suggest that a broader application of SET could have a positive influence on the outcome of pregnancies after ART as well.
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Surviving pregnancy and childbirth is a human right: the silent tragedy of maternal mortality. Facts Views Vis Obgyn 2010; 2:21-30. [PMID: 25206963 PMCID: PMC4154334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
More than two decades after the launch of the Safe Motherhood Initiative (Nairobi 1987) , maternal health in many developing countries has shown little or no improvement. Year after year, more than half a million mothers continue to die in silence. The specificities of the complex cross-cutting issue only partly explain why tireless efforts have led to insufficient progress so far. While some success stories prove that results can be obtained quickly, the dissensions and deficiencies the Initiative has encountered have strongly weakened its impact. However, recent developments over the past 3 years allow to foresee the silence will soon be -broken. While advocacy begins to subsequently raise awareness, more financial means are mobilized. As a consensus on priority interventions has finally been reached, more coordinated actions and initiatives are being developed. The strive for achieving the Millennium Development Goals helps to create the political momentum strongly needed to generate new leadership, and to develop and implement adequate strategies. Sensible focus on resources and structures as well as innovative management will be crucial in that process.
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Maternal Intensive Care': a systematic literature review. Facts Views Vis Obgyn 2010; 2:161-7. [PMID: 25013706 PMCID: PMC4090585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The objective of this systematic literature review is to review current scientific knowledge on the definition of and the indications for maternal/obstetric intensive care (MIC). METHODS We conducted a extensive search in OVID MEDLINE, EMBASE, COCHRANE, CINHAL and CEBAM using the keywords: maternal/obstetric intensive care, subacute care, intermediate care, postacute care, critical care, sub intensive care, progressive patient care, postnatal care, perinatal care, obstetrical nursing, neonatology, pregnancy, maternal mortality/morbidity and pregnancy complication. A total of 180 articles and one guideline were identified and supplemented by a hand search. After title, abstract and full text evaluation, the articles and guideline were subjected to critical appraisal. RESULTS Out of 180 potentially relevant articles, we identified 44 eligible articles of which 14 relevant MIC-articles of relatively good quality were selected. The concept 'maternal intensive care' was not found elsewhere, "high-dependency care" and "obstetrical intermediate care" appeared to be best comparable to what is understood as a MIC-service in Belgium. This thorough literature search resulted in a limited amount of scientific literature, with most studies retrospective observational tertiary centre based. No clear definition and admission criteria for maternal intensive care were found. CONCLUSION This systematic literature review revealed that 1) there is no standard definition of maternal intensive care and 2) that admission criteria to a MIC unit differ widely. Further research is needed to create an evidence-based triage system to help clinicians attribute women to the appropriate level of care and thus stimulate an efficient utilization of maternal/obstetric intensive care services.
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O830 Women's preference for caesarean section and history of sexual abuse - preliminary results from a multi-country study; the BIDENS study. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Safety and availability of dapivirine (TMC120) delivered from an intravaginal ring. AIDS Res Hum Retroviruses 2009; 25:483-8. [PMID: 19388819 DOI: 10.1089/aid.2008.0184] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Vaginal delivery of 200 mg or 25 mg dapivirine from intravaginal rings (IVRs) was evaluated over a 7-day period in two phase 1 safety trials (IPM001 and IPM008, respectively) in a total of 25 healthy women 19 to 46 years of age. The IVR was generally safe and well tolerated with similar adverse events observed in the placebo and dapivirine groups. Across both studies, dapivirine concentrations in vaginal fluids measured at the introitus, cervix, and ring area were within the mean range of 0.7-7.1 microg/ml. Mean dapivirine concentrations in vaginal and cervical tissues on day 7 were 0.3-0.7 microg/g in IPM001 and 1.5-3.5 microg/g in IPM008. Mean plasma concentrations of dapivirine were <50 pg/ml. Dapivirine from both IVRs was successfully distributed throughout the lower genital tract at concentrations >1000x the EC(50) against wild-type HIV-1 (LAI) in MT4 cells suggesting that IVR delivery of microbicides is a viable option meriting further study.
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Intimate Partner Violence. The gynaecologist's perspective. Facts Views Vis Obgyn 2009; 1:88-98. [PMID: 25478074 PMCID: PMC4251275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intimate partner violence (IPV) is an important public health problem, which has been extensively studied all over the world, yet Belgian data are limited. IPV remains a taboo resulting in denial and underreporting. For an obstetrician-gynaecologist (OB/GYN), IPV, committed by a male partner to a woman, is of particular interest, because of its negative impact on women's and children's health. In Belgium there are few data on IPV and guidelines for OB/GYN are -missing. In a multi-centered survey surveillance study which was carried out among pregnant women attending 5 large hospitals in the province of East Flanders, the lifetime prevalence of IPV was estimated to be 10.1% and the period prevalence during pregnancy and/or in the year preceding pregnancy 3.4%. In our highly medicalised society, only 19.2% and 6.6% of the victims of physical and sexual abuse respectively sought medical care. Routine screening for IPV by a general practitioner or OB/GYN was found to be largely acceptable. In a questionnaire-based Knowledge, Attitude, and Practice survey among OB/GYN in Flanders, OB/GYN prove -unfamiliar with IPV and largely underestimate the extent of the problem. Merely 6.8% of the respondents ever received any education on IPV. They refute the incentive of universal screening, even during pregnancy and one of the major barriers is fear of offending patients. Physician education was found to be the strongest predictor of a positive attitude towards screening and of current screening practices. Hence, there is a definite need to improve women's awareness regarding abuse and to endorse physician training on IPV.
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