Bell’s palsy in pregnancy as a prodromal sign of preeclampsia: A report of three cases, pregnancy outcome, and literature review

Bell’s palsy is a less common neurological disorder in the general population. Its occurrence during pregnancy can be used as a predictor of adverse obstetric outcomes including preeclampsia and its complications. We report cases of three pregnant women from Botswana who presented with Bell’s palsy in the third trimester coexisting with preeclampsia and multiple complications. One of the patient was a case of maternal near-miss with multiple life threating complications including stage 3 acute kidney injury (AKI) and required hemodialysis. The second and third patients developed Bell`s palsy and preeclampsia at term, management of preeclampsia commenced with immediate delivery resulting in good maternal and neonatal outcome. In all the three patients preeclampsia and Bell`s palsy completely resolved post-delivery. Therefore, new onset Bell’s palsy in pregnancy may be used as a prodromal sign of preeclampsia. Such patients deserve close follow up for preeclampsia or gestational hypertension for a better obstetric outcome. La paralysie de Bell est un trouble neurologique moins fréquent dans la population générale. Son apparition pendant la grossesse peut être utilisée comme un prédicteur d'issues obstétricales défavorables, y compris la prééclampsie et ses complications. Nous rapportons les cas de trois femmes enceintes du Botswana qui ont présenté une paralysie de Bell au troisième trimestre coexistant avec une prééclampsie et de multiples complications. L'un des patients était un cas de quasi-accident maternel avec de multiples complications potentiellement mortelles, notamment une insuffisance rénale aiguë (IRA) de stade 3 et une hémodialyse nécessaire. Les deuxième et troisième patientes ont développé une paralysie de Bell et une prééclampsie à terme, la prise en charge de la prééclampsie a commencé avec l'accouchement immédiat, ce qui a donné de bons résultats maternels et néonatals. Chez les trois patientes, la prééclampsie et la paralysie de Bell ont complètement disparu après l'accouchement. Par conséquent, une nouvelle paralysie de Bell pendant la grossesse peut être utilisée comme signe prodromique de prééclampsie. Ces patientes méritent un suivi rapproché de la prééclampsie ou de l'hypertension gestationnelle pour un meilleur résultat obstétrica

Bibliography of the Literatures on Tuberculosis, TB/HIV and MDRTB in Ethiopia from 2001 – 2017

Ethiopia is among the thirty-high tuberculosis (TB) burden countries with multidrug resistant tuberculosis (MDR-TB) and Tuberculosis/Human Immunodeficiency Virus (TB/HIV). Given the public health importance of the problem, it is apparent that probing the work done in this regard is essential to mitigate the problem and thus we reviewed research repositories and compile directories of researches in Ethiopia from Jan 1, 2001 to Dec 30, 2017 in order to avail evidence-based information to stakeholders and beneficiaries intervening the problem in the country. The evidences generated in this bibliography are through different databases and websites using key terms. A range of different published and unpublished literatures (journal articles, conference presentations, reports/manual/book, and graduate theses or dissertations) on TB, MDR-TB, extensively drug resistant TB (XDR-TB), or TB/HIV are presented. We presented literatures by four themes (Biomedical and clinical researches, epidemiological researches, operational or implementation researches, and health systems researches). A total of 1571 researches and reports were accessed through the above search engines and revealed 635 epidemiological researches followed by 538 clinical or biomedical researches, 257 operational or implementation research, and 141 health systems research. Interestingly, up to 2008 clinical or biomedical researchers were the leading researches and from 2009 onwards, epidemiological researches held the largest constituency. In conclusion, TB or TB/HIV and MDR-TB literatures in Ethiopia have substantially increased over years. Referred journal publications took theleading source and epidemiologic studies were the commonest one. We suggest the need to focus on operational or implementation and health system researches to plummet the disease spreading, drug resistance and impact. We also recommend a regular update of the bibliography every 3 to 4 years with annotations

Factors Associated with Intention to Donate Blood: Sociodemographic and Past Experience Variables

Background and Objectives. This study was conducted to assess the level of intention of the general public towards blood donation and the factors associated with it. Methods. A descriptive cross-sectional study was conducted in South-East Botswana amongst participants aged 21–65 years. An interviewer-administered questionnaire was completed for 384 participants. Results. Of the 384 participants, 104 (27.1%) reported that they had donated blood in the past and 269 (70.1%) stated that they were willing to donate blood in the future. Thirteen out of the 104 past donors (12.5%) reported that they had donated blood in the 12 months preceding the survey and only 10 (9.6%) participants reported that they have been regular donors. In the backward logistic regression analysis, the variables that remained significant predictors of the intention to donate blood were secondary education (adjusted odds ratio (AOR) (95% confidence interval (CI)): 2.92 (1.48, 5.77)), tertiary education (AOR (95% CI): 3.83 (1.52, 9.62)), and knowing a family member who had ever donated blood (AOR (95% CI): 2.84 (1.58, 5.12)). Conclusion. Being informed about blood transfusion and its life-saving benefits through either the education system or the experience made people more likely to intend to donate blood. Evidence-based interventions to retain blood donors as regular donors are recommended.</jats:p

Health-related quality of life and associated factors among patients with diabetes mellitus in Botswana

Background: Health-related quality of life (HRQOL) is an important aspect of diabetes mellitus care. The objective of the study was to determine the HRQOL of diabetes mellitus (DM) patients in Botswana as little known in Africa. Materials and methods: A cross-sectional study of 380 randomly selected DM patients in a tertiary clinic in Gaborone, Botswana was conducted to obtain Data on HRQOL and structured questionnaire was used to collect information on sociodemographic and clinical characteristics. Multivariate logistic regression to determine sociodemographic and clinical characteristics associated. Results: Majority of patients were female with no formal education or primary level of education. Mean HbA1c was 7.97% (SD: 2.02) and most patients had poor glycemic control. The majority had both worse physical composite score (PCS-12) and mental composite score (MCS-12), with worse proportions of the two. Female gender, older age ≥ 65 years, and the presence of three or more documented diabetic complications were associated with significant worse PCS-12. Presence of two diabetic complications, three or more diabetic complications, and musculoskeletal disease were associated with significant MCS-12. Conclusions: Diabetic patients in Botswana have relatively poor HRQOL. The fact that most patients present late with complications calls for policy attention to diagnose diabetes mellitus early and prevent associated complications, ultimately improving health-related quality of life among diabetes mellitus patients

Metabolic control and determinants among HIV- infected Type 2 diabetes mellitus patients attending a tertiary clinic in Botswana

Purpose: We primarily aimed at determining the prevalence of metabolic syndrome and abnormal individual metabolic control variables in HIV-infected participants as compared to HIV-uninfected participants given current concerns. Our secondary objective was to determine the predictors of metabolic syndrome and individual metabolic control variables among the study participants to guide future management. Patients and methods: A descriptive, case-matched cross sectional study for four months from 15th June 2019 to 15th October 2019 at Block 6 Diabetes Reference clinic in Gaborone, Botswana. We compared the proportions of metabolic syndrome and individual metabolic control variables based on gender and HIV status by means of bivariate analysis (Chi-squared test or Fisher’s exact test) to determine factors associated with metabolic control. A p-value of less than 0.05 was considered statistically significant. Results: Overall, 86% of the study participants were found to have metabolic syndrome by International Diabetes Federation (IDF) criteria with 79.8% among HIV-infected and 89.1% among HIV-negative participants (p-value = 0.018). Older age was significantly associated with metabolic syndrome (p-value = 0.008). Female gender was significantly associated with metabolic syndrome as compared to male gender (P-value < 0.001), and with a statistically significant higher proportion of low HDL-C compared to males (P-value < 0.001). Female participants were significantly more likely to be obese as compared to males (P-value < 0.001). High trigerylcerides were more common in HIV-infected compared to HIV-negative participants (P-value = 0.004). HIV-negative participants were more likely to be obese as compared to HIV-infected participants (P-value = 0.003). Conclusion: Metabolic syndrome is an appreciable problem in this tertiary clinic in Botswana for both HIV-infected and HIV-negative participants. Future prospective studies are warranted in our setting and similar sub-Saharan settings to enhance understanding of the role played by HAART in causing the metabolic syndrome, and the implications for future patient management

Antibiotic Selection Pressure and Macrolide Resistance in Nasopharyngeal Streptococcus pneumoniae: A Cluster-Randomized Clinical Trial

Jeremy Keenan and colleagues report that during a cluster-randomized clinical trial in Ethiopia, nasopharyngeal pneumococcal resistance to macrolides was significantly higher in communities randomized to receive azithromycin compared with untreated control communities

Determinants of practice of preconception care among women of reproductive age group in southern Ethiopia, 2020: content analysis

Abstract Background Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for desired outcomes. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to assess the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Methods A community-based cross-sectional study was conducted from February 1 to 30, 2020. A total of 600 mothers who have given birth in the last 12 months have been randomly selected. A two-stage sampling technique was employed. For data collection, a pre-tested, semi-structured questionnaire was used. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. Household wealth status was determined through the application of principal component analysis(PCA). The practice PCC was considered as a count variable and measured as a minimum score of 0 and a maximum of 10. A bivariable statistical analysis was performed through analysis of variance (ANOVA) and independent t-tests and variables with a p-value of &lt; 0.05 were eligible for the generalized linear regression model. To see the weight of each explanatory variable on PCC utilization, generalized linear regression with a Poisson link was done. Results Of the sampled 600 participants, 591 took part in the study, which yielded a response rate of 98.8%.The mean (± SD) score of the practice of PCC was 3.94 (± 1.98) with minimum and maximum scores of 0 and 10 respectively. Only 6.4% (95%CI: 4.6, 8.6) of mothers received all selected items of PCC services. Thecommonest item received by 67.2% of mothers was Folic acid supplementation, while 16.1% of mothers received the least item of optimizing psychological health. Education status of mother[AOR 0.74, 95%CI 0.63, 0.97], time spent to access nearby health facilities [AOR 0.69, 95%CI 0.58, 0.83], availability of PCC unit [AOR 1.46; 95%CI 1.17, 1.67], mother’s knowledge on PCC [AOR 1.34, 95%CI 1.13, 1.65], being a model household [AOR 1.31, 95%CI 1.18, 1.52] and women’s autonomy in decision making [AOR 0.75, 95%CI 0.64, 0.96] were identified as significant predictors of practice of PCC. Conclusion The uptake of WHO-recommended PCC service elements in the current study area was found to be unsatisfactory. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. Plain language summary Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for better endings. The main goal of the PCC is to improve maternal and child health outcomes, by-promoting wellness and providing preventive care. It can also be seen as an earlier chance for teenage girls, mothers, and children to live a better and longer-term healthy life. Pieces of PCC service packages suggested by the World Health Organization(WHO) are, micronutrient supplementation (Folate supplementation), infectious disease (STI/HIV) screening and testing, chronic disease screening and management, healthy diet therapy, vaccination, prevention of substance use (cessation of cigarette smoking and too much alcohol consumption), optimizing psychological health, counseling on the importance of exercise and reproductive health planning and implementation. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to evaluate the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Mothers who have given birth in the last 12 months have been randomly selected Household wealth status was determined through the application of principal component analysis(PCA). To see the weight of each explanatory variable on PCC, generalized linear regression with a Poisson type was done. Accordingly, the Education status of the mother, time spent to access nearby health facilities, availability of PCC unit, mother’s knowledge on PCC, being a model household, and women’s autonomy in decision making were identified as significant predictors of practice of PCC. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. </jats:sec

Assessment of the utilization of pre-marital HIV testing services and Shabbir Ismael determinants of VCT in Addis Ababa, 2003

Background: Pre-marital HIV testing contributes to the prevention of HIV infection by diminishing heterosexual transmission between partners and indirectly also protects any potential child from contracting the virus.Objectives: To assess the utilization and determinants of pre-marital HIV testing in civil marriages taking place at the Addis Ababa City Hall Marriage Licensing Center.Methods: A cross-sectional study was made on men and women at their civil marriage ceremonies. Interviews were conducted on a one-to-one basis, and a separate analysis was performed for each sex. Results: Out of the 640 individuals (320 males and 320 females) who underwent civil marriage, 55% reported having had pre-marital HIV testing. The main reason given for not having HIV testing was that the interviewees did not feel at risk of acquiring HIV/AIDS. Individuals of both sexes who had frank discussion as a couple about HIV were found to be more likely to have pre-marital HIV testing (adjusted ORs 10.96, 95% CI 3.7 to 33.3 for men and 7.78, 95% CI 2.86 to 20.0 for women). The VCT schemes preferred by most respondents included; integrated VCT centers, confidential testing, appointing medical doctors as counselors, and face-to face disclosure of VCT results.Conclusion: Based on these findings, the promotion of discussion between couples about HIV and VCT through intense IEC activities as well as involving marriage agencies to encourage such discussion is recommended. The Ethiopian Journal of Health Development Vol. 20(1) 2006: 18-2