The effect of HIV status on perinatal outcome at Mowbray Maternity Hospital and referring MOUs

Includes bibliographical referencesBackground: 33,4 Million people were living with the Human Immune Deficiency virus by the end of 2009 with sub-Saharan Africa the most affected region. Maternal HIV infection is the leading cause of maternal and child morbidity and mortality in South Africa. A meta-analysis of world literature suggests a clear association between HIV infection and perinatal mortality. Aims and Objectives: To study the effect of HIV status on perinatal outcome at Mowbray Maternity Hospital (a secondary level hospital in Cape Town, South Africa.) and its catchment MOUs. Specific aims: 1) To compare the perinatal mortality rate in the group of HIV exposed with the HIV negative group and the untested group. 2) To determine where possible, the primary obstetric cause of adverse outcome and compare this in HIV exposed to the HIV negative and the untested group. 3) To compare the incidence of Neonatal Encephalopathy in the group of HIV exposed with the HIV negative group and the untested group. Methods: The study was a retrospective descriptive and comparative audit. All deliveries at MMH and its referral midwife obstetric units from January 2008 to December 2008 were audited with respect to HIV status and other demographic data. All deliveries with perinatal mortality and or neonatal encephalopathy were identified and analyzed in detail. Results: There was a total of 18 870 deliveries at the units being studied. The number of deliveries to HIV positive mothers were 3259 (17,2 %). The stillbirth rate in the HIV positive population for the units being studied was 17,1 per 1000 deliveries. In the HIV negative population this rate was 8,3 per 1000 deliveries. The odds ratio was 2,07 [CI, 1.5-2.8] with a p-value of <0,0001. The neonatal death rate in the HIV positive population was 4,6 per 1000 deliveries, this as opposed to a rate of 3,1 per 1000 in the HIV negative population. The odds ratio was calculated as 1,46 [ CI, 0.8-2.6] with a p-value of 0,26. The perinatal mortality rate in the HIV population was 21,7 per 1000 deliveries. In the HIV negative population this rate was 11,7 per 1000 deliveries. The odds ratio was 1,91 [CI, 1.4-2.5] with a p-value of <0,0001. A comparison of the pattern of primary obstetric cause for perinatal mortality showed that infection, intra uterine growth restriction and ante partum haemorrhage were significantly more common as a cause for perinatal death in the HIV positive population. The risk of neonatal encephalopathy in the HIV exposed population was 4,9 per 1000 deliveries as opposed to 2,07 per 1000 deliveries in the HIV negative group. Comparing the two groups found an odds ratio of 2,36 [CI, 1.28- 4.35] with the p-value 0,008. The untested group of patients is shown in this study to be at particularly high risk of adverse perinatal outcome. This consists mostly of mothers who have had no antenatal care in the index pregnancy. Discussion: The perinatal mortality rate in the group of HIV exposed mothers was significantly higher than the HIV negative group due to a higher stillbirth rate. The lack of difference in neonatal death rate could be due to the high standard of neonatal care at the hospital. There was no significant difference in demographic data between the HIV positive and negative groups. Conclusion: Parturients who were infected with HIV were at significantly increased risk of perinatal mortality. Infection, intra uterine growth restriction and antepartum haemorrhage were significantly more common obstetric causes for mortality in the HIV infected population. The risk of neonatal encephalopathy was also significantly higher in the HIV positive population

How is own account transport well adapted to urban environments?

Own account transport is commercially invisible but its importance in urban freight is significant: it represents half of deliveries. Generally research efforts focus mainly on third-party transportation because data is more available in spite of a lack of urban data. Nevertheless, the organization of transport by a shipper is not the same than third-party transport. The products transported, the constraints, the demand of transport are different. This analysis shows that own account transport is well-adapted to urban areas because of the density of deliveries and an increase of the number of establishments of the shipper who extends its areas of customer and makes profitable its fleet.urban freight ; own account transport ; density of deliveries ; time delivery

Severe acute maternal morbidity and associated deaths in conflict and post-conflict settings in Africa

SETTING:  Five hospitals in four conflict and post-conflict countries (Democratic Republic of Congo, Somaliland, Sierra Leone and Burundi). OBJECTIVES:  To report among hospital deliveries: 1) the proportion of severe acute maternal morbidity (SAMM), 2) the pattern of SAMM, and 3) maternal deaths according to type of SAMM. METHODS:  An audit of data from a standardised database implemented in all the sites in the study. RESULTS:  Of the 18 675 deliveries, there were 6314 (34%) known SAMM cases with 63 associated deaths, implying that for every 100 SAMM cases there was one maternal death. In descending order, the death-to-SAMM ratios per 1000 deliveries were: 1:7 for sepsis, 6 for haemorrhage 1:70 for hypertensive disorder and 1:398 for obstructed labour. A substantial proportion of deaths (38%) that occurred in hospitals could not be categorised into the standardised SAMM conditions available in the database. CONCLUSION:  As this is the first study using multi-centre data from conflict and post-conflict countries, these findings are relevant to improving maternal health in such settings. Findings, implications and possible ways forward in addressing various challenges are discussed

The Vehicle Routing Problem with Divisible Deliveries and Pickups

The vehicle routing problem with divisible deliveries and pickups is a new and interesting model within reverse logistics. Each customer may have a pickup and delivery demand that have to be served with capacitated vehicles. The pickup and the delivery quantities may be served, if beneficial, in two separate visits. The model is placed in the context of other delivery and pickup problems and formulated as a mixed-integer linear programming problem. In this paper, we study the savings that can be achieved by allowing the pickup and delivery quantities to be served separately with respect to the case where the quantities have to be served simultaneously. Both exact and heuristic results are analysed in depth for a better understanding of the problem structure and an average estimation of the savings due to the possibility of serving pickup and delivery quantities separately

Keeping Continuous Deliveries Safe

Allowing swift release cycles, Continuous Delivery has become popular in application software development and is starting to be applied in safety-critical domains such as the automotive industry. These domains require thorough analysis regarding safety constraints, which can be achieved by formal verification and the execution of safety tests resulting from a safety analysis on the product. With continuous delivery in place, such tests need to be executed with every build to ensure the latest software still fulfills all safety requirements. Even more though, the safety analysis has to be updated with every change to ensure the safety test suite is still up-to-date. We thus propose that a safety analysis should be treated no differently from other deliverables such as source-code and dependencies, formulate guidelines on how to achieve this and advert areas where future research is needed.Comment: 4 pages, 3 figure

Bar codes lead to frequent deliveries and superstores

This paper explores the consequences of new information technologies, such as bar codes and computer-tracking of inventories, for the optimal organization of retail. The first result is that there is a complementarity between the new information technology and frequent deliveries. This is consistent with the recent move in the retail sector toward higher-frequency delivery schedules. The second result is that adoption of the new technology tends to increase store size. This is consistent with recent increases in store size and the success of the superstore model of retail organization.Technological innovations

Diagnosis and management of postpartum hemorrhage and intrapartum asphyxia in a quality improvement initiative using nurse-mentoring and simulation in Bihar, India.

BackgroundIn the state of Bihar, India a multi-faceted quality improvement nurse-mentoring program was implemented to improve provider skills in normal and complicated deliveries. The objective of this analysis was to examine changes in diagnosis and management of postpartum hemorrhage (PPH) of the mother and intrapartum asphyxia of the infant in primary care facilities in Bihar, during the program.MethodsDuring the program, mentor pairs visited each facility for one week, covering four facilities over a four-week period and returned for subsequent week-long visits once every month for seven to nine consecutive months. Between- and within-facility comparisons were made using a quasi-experimental and a longitudinal design over time, respectively, to measure change due to the intervention. The proportions of PPH and intrapartum asphyxia among all births as well as the proportions of PPH and intrapartum asphyxia cases that were effectively managed were examined. Zero-inflated negative binomial models and marginal structural methodology were used to assess change in diagnosis and management of complications after accounting for clustering of deliveries within facilities as well as time varying confounding.ResultsThis analysis included 55,938 deliveries from 320 facilities. About 2% of all deliveries, were complicated with PPH and 3% with intrapartum asphyxia. Between-facility comparisons across phases demonstrated diagnosis was always higher in the final week of intervention (PPH: 2.5-5.4%, intrapartum asphyxia: 4.2-5.6%) relative to the first week (PPH: 1.2-2.1%, intrapartum asphyxia: 0.7-3.3%). Within-facility comparisons showed PPH diagnosis increased from week 1 through 5 (from 1.6% to 4.4%), after which it decreased through week 7 (3.1%). A similar trend was observed for intrapartum asphyxia. For both outcomes, the proportion of diagnosed cases where selected evidence-based practices were used for management either remained stable or increased over time.ConclusionsThe nurse-mentoring program appears to have built providers' capacity to identify PPH and intrapartum asphyxia cases but diagnosis levels are still not on par with levels observed in Southeast Asia and globally

Accelerated HIV testing for PMTCT in maternity and labour wards is vital to capture mothers at a critical point in the programme at district level

TORONTO AIDS Conference 200

Pregnancies complicated by maternal osteogenesis imperfecta type III: a case report and review of literature.

The restrictive lung disease can be exacerbated by growing fundus in women with osteogenesis imperfecta type III. Regional anesthesia can be performed in these women. Mode of delivery for women with osteogenesis imperfecta type III is generally cesarean delivery. Neonatal outcomes are complicated due to indicated preterm deliveries