High prevalence of abnormal Pap smears among young women co-infected with HIV in rural South Africa - implications for cervical cancer screening policies in high HIV prevalence populations

Objective. To establish the relationship between HIV infection and cervical  dysplasia in young women in rural South Africa,Methods. This cross"sectional study was conducted at a primary health care clinic in Vulindlela, KwaZulu-Natal. Standardised questionnaires were used  to collect sociodemographic and clinical presentation data from women attending family planning and other reproductive health services. Pap  smears were done using standard methods. Pap smear data were linked to HIV serostatus.Results. Four hundred and sixty-six women were included in the study. The median age was 24.3 years (range 15 -55 years),and 80% were younger than 30 years. The HIV prevalence .rate was 24.5% (95% confidence interval: 20.7 - 28.7%) and the prevalence of abnormal Pap smears was 16.9- 6.4% ASCUS (atypical squamous cells of undetermined significance), 9.2% LGSIL (low-grade squamous intra epithelial lesions), and 1.3% HGSIL (high-grade squamous intraepitheliallesions). The association between BIV seropositivity and abnormal Pap results was statistically significant (p < 0.05).Conclusion. There is a need for more data on cervical changes in HIV  co-infected women and for review of guidelines on selective Pap smear screening in high HIV prevalence settings such as sub-Saharan Africa and  where access to antiretroviral treatment remains limited

High prevalence of abnormal Pap smears among young women co-infected with HIV in rural South Africa – implications for cervical cancer screening policies in high HIV prevalence populations.

Objective. To establish the relationship between HIV infection and cervical dysplasia in young women in rural South Africa. Methods. This cross-sectional study was conducted at a primary health care clinic in Vulindlela, KwaZulu-Natal. Standardised questionnaires were used to collect sociodemographic and clinical presentation data from women attending family planning and other reproductive health services. Pap smears were done using standard methods. Pap smear data were linked to HIV serostatus. Results. Four hundred and sixty-six women were included in the study. The median age was 24.3 years (range 15 - 55 years), and 80% were younger than 30 years. The HIV prevalence rate was 24.5% (95% confidence interval: 20.7 - 28.7%) and the prevalence of abnormal Pap smears was 16.9 - 6.4% ASCUS (atypical squamous cells of undetermined significance), 9.2% LGSIL (low-grade squamous intraepithelial lesions), and 1.3% HGSIL (high-grade squamous intraepithelial lesions). The association between HIV seropositivity and abnormal Pap results was statistically significant (p < 0.05). Conclusion. There is a need for more data on cervical changes in HIV co-infected women and for review of guidelines on selective Pap smear screening in high HIV prevalence settings such as sub-Saharan Africa and where access to antiretroviral treatment remains limited

A review of maternal mortality at Jimma Hospital, Southwestern Ethiopia

A retrospective review of hospital maternal deaths at Jimma Hospital, Southwestern Ethiopia, covering the period from September 1990 to May 1999 was conducted with the objectives of determining the overall maternal mortality rate, observing trend of maternal mortality during the period, and identifying major causes of maternal mortality. The overall maternal mortality rate for the period was 1965 maternal deaths per 100000 live births ranging from 1636 to 2332 deaths per 100000 live births with an overall trend showing no decrease. Ruptured uterus (33.2%) was the major cause of death with unsafe abortion responsible for 26.8% of all cases. Overall, hemorrhagic complications of pregnancy, sepsis and hypertensive disorders were responsible for 94.9% of all maternal deaths. Analysis of trends of major causes showed deaths due to ruptured uterus to be increasing over the years. Obstructed labor is found to be directly or indirectly responsible for 45.53% of all maternal deaths mainly affecting the primigravida and the grand multipara (44.9%). Concentrating on the provision of peripartum care to this subgroup of mothers is suggested as one possible strategy to effect rapid reduction in overall maternal mortality within the foreseeable future. (Ethiopian Journal of Health Development, 2000, 14(2): 215-223

Perinatal mortality audit at Jimma hospital, South- Western Ethiopia, 1990-1999

A retrospective review of perinatal deaths that occurred during 1990-1999 at Jimma hospital, a teaching hospital in South-Western Ethiopia was conducted with the objective of determining the overall perinatal mortality rate and trend, identifying major causes and suggest possible preventive strategies. Record books of the maternity and neonatal wards were used to identify all perinatal deaths and live births that occurred during the study period and relevant sociodemographic and clinical data pertaining to the perinatal deaths were documented and analyzed. The overall perinatal mortality rate during the study period was 138.9 per thousand live births with an increasing trend. While 66.5% of perinatal deaths occurred among primigravid and grandmultiparous mothers, 52.7% were in mothers aged 20-29 years of age, and 14.9% were among teenage mothers. The majority of perinatal deaths were due to mechanical factors related to the peripartum period (53.3%), with obstructed labor with or without ruptured uterus being the single most important cause responsible for 37.4% of perinatal mortality. Other causes identified were hypertensive disorders (6.7%), lethal congenital anomalies (1.4 %), antepartum hemorrhage (2.1 %), and prematurity (7.2 %). In 28.9% of perinatal deaths, the cause could not be identified. This study has shown a high perinatal mortality rate with an increasing trend, the majority of deaths being due to mechanical factors related to the peripartum period. Analytic studies to identify mothers at risk for mechanical complications of labor like obstructed labor need to be conducted to identify mothers at risk for this peripartum complication so that limited resources can be focused on the provision of peripartum care to these groups to effect reduction in perinatal mortality. (Ethiopian Journal of Health Development, 2000, 14(3): 335-344

Additional file 1: of Factors associated with intended use of a maternity waiting home in Southern Ethiopia: a community-based cross-sectional study

Data collection instrument - English version informed consent form and questionnaire. (PDF 856 kb

Le Réveil populaire : organe de la 2e circonscription de Fontenay-le-Comte : journal politique, indépendant, littéraire, commercial, agricole et industriel ["puis" journal politique indépendant]

07 avril 19341934/04/07 (N1398).Appartient à l’ensemble documentaire : PaysLoir

Challenges in Accessing and Delivering Maternal and Child Health Services during the COVID-19 Pandemic: A Cross-Sectional Rapid Survey from Six States of India

Background/Objectives: Globally, the COVID-19 pandemic and its prevention and control policies have impacted maternal and child health (MCH) services. This study documents the challenges faced by patients in accessing MCH services, and the experiences of health care providers in delivering those services during the COVID-19 outbreak, explicitly focusing on the lockdown period in India. Methods: A cross-sectional study (rapid survey) was conducted in 18 districts from 6 states of India during March to June, 2020. The sample size included 540 MCH patients, 18 gynaecologists, 18 paediatricians, 18 district immunisation officers and 108 frontline health workers. Bivariate analysis and multivariable analysis were used to assess the association between sociodemographic characteristics, and challenges faced by the patients. Results: More than one-third of patients (n = 212; 39%) reported that accessing MCH services was a challenge during the lockdown period, with major challenges being transportation-related difficulties (n = 99; 46%) unavailability of hospital-based services (n = 54; 23%) and interrupted outreach health services (n = 39; 18.4%). The supply-side challenges mainly included lack of infrastructural preparedness for outbreak situations, and a shortage of human resources. Conclusions/Recommendations: A holistic approach is required that focuses on both preparedness and response to the outbreak, as well reassignment and reinforcement of health care professionals to continue catering to and maintaining essential MCH services during the pandemic