Comparison of a private midwife obstetric unit and a private consultant obstetric unit

Background: The role of Midwife Obstetric Units (MOUs) as lead caregivers for low risk pregnancies has been a topic of much debate in recent years. It has been suggested that MOUs are more cost effective, and have a less interventionist approach to low risk pregnancies, when compared to Consultant Obstetric Units (COUs). Objectives: The primary objective of this study was to compare intrapartum delivery procedures, methods of delivery, and maternal and neonatal wellbeing for low risk pregnancies between a MOU and a COU. The second objective was to investigate the predictors of key outcomes such as caesarean sections and perineal tears. The research was carried out at a private obstetric unit in Gauteng from January 2005-June 2006. Materials and Methods: The study design was a retrospective cohort study, by means of a record review of routinely collected data. 808 subjects (212 COU and 596 MOU patients) satisfied the criteria for a low risk pregnancy during the defined period and were included in the analysis. Results: Overall the MOU had fewer interventions than the COU, but had very similar maternal and neonatal outcomes. MOU patients were less likely to have an epidural than COU patients (p<0.001), and more likely to utilise a bath for pain relief (p<0.001). The MOU was also less likely to induce a patient than the COU (p=0.002). Primiparous patients accounted for more than 95% of the caesarean section (C/S) rate (p<0.001), with the COU performing 2.2 times more C/S on primiparous patients than the MOU. Vaginal birth in the MOU was 2.6 times more likely to be an underwater birth (UWB) than the COU (p<0.001). Positive predictors for C/S were COU care, primiparous status and induction of labour. UWB was a positive predictor for grade 1 and 2 perineal tears. There were no maternal or neonatal deaths, in either unit, during the study period. There were no significant differences between the MOU and COU for maternal morbidity indicators (tears, postpartum haemorrhage, and retained placenta) or neonatal morbidity indicators (Apgar < 7 at 5 minutes and neonatal ICU admission). Conclusion: The MOU had fewer intrapartum interventions (epidurals and induction of labour) and lower C/S rates than the COU for low risk pregnancies, yet maternal and neonatal outcomes were similar. This study suggests that the MOU can function just as effectively as the COU for low risk pregnancies. Therefore the establishment of more MOUs would have immense resource implications for both the public and private health sectors in South Africa

Tracheal tube cuff pressure monitoring: assessing current practice in critically ill patients at Chris Hani Baragwanath Academic Hospital

A research report (Paed 7036) submitted to the Faculty of Health Sciences, University of the Witwatersrand, in part fulfilment towards the degree of Master of Medicine in Paediatrics, in the sub-speciality of Paediatrics, in the sub-speciality of Paediatric Clinical Care (MFOSPACC60)Background Intubated patients with a high tracheal tube cuff pressure (CP) are at risk of developing tracheal or subglottic stenosis. Recently an increasing number of patients have presented to our hospital with these complications. Objectives To determine the frequency of tracheal tube cuff pressure measurements (CPM), the range of CP and explore nursing knowledge regarding CP monitoring. Methods Frequency of CPM was assessed using a prospective intensive care unit (ICU) chart review. An interventional component of CPM was performed next. Finally a self-administered questionnaire was completed by nurses. Results Chart reviews and CPM were completed on 304 charts from 61 patients. Patients’ ages ranged from one to 71 years, with a male preponderance (1.5:1). Eighty seven percent of charts did not have a documented CPM and only 12 charts had at least one measurement per shift. Only 17% of CP were within the recommended range, with 59% being low. The nursing questionnaire was administered to 75 professional nurses with a response rate of 51%. Intensive care nursing experience ranged from 3 to 35 years with 92% being critical care trained. Seventy two percent of respondents reported measuring CP at least once per shift and knew the recommended cuff pressure range. Almost all respondents (94%) knew of at least one complication of abnormal CP. Conclusion Current practice requires urgent revision. Development of a nursing guideline together with in-service training may improve compliance with CPM and potentially decrease complications that arise from abnormal cuff pressures.XL201

Modeling Routing Overhead Generated by Wireless Proactive Routing Protocols

In this paper, we present a detailed framework consisting of modeling of routing overhead generated by three widely used proactive routing protocols; Destination-Sequenced Distance Vector (DSDV), Fish-eye State Routing (FSR) and Optimized Link State Routing (OLSR). The questions like, how these protocols differ from each other on the basis of implementing different routing strategies, how neighbor estimation errors affect broadcast of route requests, how reduction of broadcast overhead achieves bandwidth, how to cope with the problem of mobility and density, etc, are attempted to respond. In all of the above mentioned situations, routing overhead and delay generated by the chosen protocols can exactly be calculated from our modeled equations. Finally, we analyze the performance of selected routing protocols using our proposed framework in NS-2 by considering different performance parameters; Route REQuest (RREQ) packet generation, End-to-End Delay (E2ED) and Normalized Routing Load (NRL) with respect to varying rates of mobility and density of nodes in the underlying wireless network

The impact of a peer-mentoring programme on English reading proficiency of second language grade 9 learners.

Since South Africa’s democratic government was elected to power in 1994, much attention has been given to restructuring the country’s education system. Peer-mentoring is one approach to meet current challenges in education given high teacher:learner ratios, greater diversity in student population and majority of learners being taught in English, their second and even third language. This research examined the impact of a peermentoring reading intervention with second language Grade 9 learners. The study utilized a sample of Grade 9 learners (N = 173) from a school in Gauteng. Biographical information was obtained and these learners were pre-tested in Grade 8 and post-tested in Grade 9 2007, using the Stanford Diagnostic Reading Test (SDRT). The entire Grade 9 group received the reading intervention for three months and their results were compared to a comparison group from the previous year who received no intervention. Results of learners’ vocabulary, comprehension and academic achievement scores were compared. Although both the comparison and the experimental groups showed an improvement on their vocabulary and comprehension scores, the experimental group’s gains were significantly higher. Of the Grade 9 experimental group, 30 learners (mentees) received individual paired reading mentoring and their scores were examined to determine the extent of improvement. The mentees group showed similar significant gains in their vocabulary and comprehension scores, and showed an overall improvement in their academic marks. Challenges faced, limitations and recommendations for future study are discussed

The biological activity and phytochemistry of selected Hermannia species

Student Number : 0000127R - MPharm dissertation - School of Pharmacy and Pharmacology - Faculty of Health SciencesTraditional medicines form a significant part of the lives of many people around the world and in South Africa almost 60 % of people consult traditional healers in addition to the modern medical services available. Plants form a significant part of traditional healing and hence, selected species of a traditionally used plant genus, Hermannia, were chosen for biological and chemical investigation to determine a scientific basis for the traditional use of these plants. A phytochemical investigation was carried out, firstly using thin layer chromatography (TLC) and high performance liquid chromatography (HPLC) and then isolation and identification of compounds from various Hermannia species. TLC analysis indicated significant similarities between the various species with only H. saccifera displaying chemical anomalies. This was further corroborated by the HPLC analysis although very conservative profiles were produced. Isolation of compounds from H. saccifera yielded a novel labdane compound, E-17, 19-diacetoxy - 15 - hydroxylabda - 7,13 - diene, as well as two flavones, 5,8- dihydroxy-6,7,4’- trimethoxyflavone and cirsimaritin which have previously been isolated. In addition, two commonly found compounds, lupeol and β- sitosterol were isolated from H. cuneifolia and H. salviifolia respectively. This is the first report on the isolation and identification of all five compounds from Hermannia species. Antimicrobial activity was assessed using two methods i.e. minimum inhibitory concentrations as well as the death kinetics assay. Minimum inhibitory concentrations were determined using four Gram-positive and two Gram-negative bacteria as well as two yeasts. All species investigated indicated antimicrobial activity with H. saccifera showing good activity against S. aureus and B. cereus. E-17, 19-diacetoxy - 15 - hydroxylabda - 7,13 - diene isolated from H. saccifera indicated activity (MIC = 23.6 μg/ml against S.aureus) although the activity was less than that of the crude extract (MIC = 19.5 μg/ml), thus, demonstrating that there are a number of compound contributing to the promising activity of the crude extract. This was further corroborated by the bioautograms developed of the H. saccifera extract. Time-kill studies on H. saccifera against S. aureus indicated that at concentrations of 0.1, 0.25 and 0.5 % bacteriostatic activity was observed while at 0.75% the extract achieved complete bactericidal activity after 240min. Free radical scavenging activity was assessed using the 2,2-diphenyl-1-picrylhydrazy (DPPH) and 2,2′-azino-bis(3-ethyl-benzthiazoline-6-sulfonic acid) (ABTS) assays. Ten of the twelve species indicated good activity with H. cuneifolia demonstrating the most promising activity (IC50 = 10.26 μg/ml for DPPH and 10.32 μg/ml for ABTS). Two of the isolated compound, 5,8- dihydroxy-6,7,4’- trimethoxyflavone and cirsimaritin displayed insignificant activity. The 5-lipoxygenase assay was used to assess the anti-inflammatory activity of Hermannia species. All species exhibited intermediate activity with the exception of H. cuneifolia (IC50 = 15.32 μg/ml). In addition, four isolated compounds, 5,8- dihydroxy-6,7,4’- trimethoxyflavone, cirsimaritin, lupeol and β-sitosterol showed moderate inhibition of the enzyme indicating that while these compounds do contribute to the activity of the extracts they are not individually responsible for any significant activity. Antimalarial activity was assessed using the titrated hypoxanthine incorporation assay while toxicity was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) cell proliferation assay. Only three species indicated any good antimalarial activity i.e. H. saccifera, H. muricata and mostly H. trifurca (IC50 = 25.30, 28.17 and 18.80 μg/ml respectively). However, the activity of H. saccifera and H. trifurca are probably due to a general cytotoxicity as these species exhibited a low safety index. All other species appear safe for use. Several Hermannia species have indicated in vitro biological activity in a number of assays which is related to their use in traditional medicines to treat a number of disease states. Hence, a scientific basis, albeit in vitro, has been established for the use Hermannia species in traditional healing

Microbiology of vaginal discharge with emphasis on gardnerella vaginalis.

Thesis (M. Med. Sci.)- University of Natal, Department of Microbiology. 1990The microbiological aetiology of vaginal discharge was studied in 208 women attending various outpatient clinics at King Edward VIII Hospital. Specimens from the lower genital tract were collected for microscopy and culture. Vaginal wet smear examination, amine liberation test and vaginal pH estimation were performed and assessed for their reliability for the rapid diagnosis of vaginal infections. Vaginal and endo-cervical infections were present in 163 (78,4%) women. G. vaginalis (65,4%), T. vaginalis (37,9%), genital yeasts (37,0%), M. hominis (59,6%), g. urealyticum (48,1%), anaerobic bacteria (32,6%), N. gonorrhoeae (11,1%), f. trachomatis (22,1%) and Herpes simplex virus (0,9%) were detected. Of the 104 women in • whom vaginal infections were detected, bacterial vaginosis was present as the sole infection in 32 (22,2%), I. vaginalis in 35 (24,3%) and C. albicans in 23 (15,9%). Bacterial vaginosis occurred concurrently with T. vaginalis and f. albicans in 24 (16,5%) and 11 (7,5%) women respectively; whilstT. vaginalis and f. albicans occurred concurrently in 14 (9,7%) women. In 6 (4,1%) women all three infections were present. No vaginal or endo-cervical pathogens were detected in 45 (21,6%) women. Women with bacterial vaginosis were found to be significantly colonised with G. vaginalis, M, hominis, anaerobic bacteria and curved Gram-negative bacilli (p < 0,05). Vaginal wet smear microscopy detected T.. vaginalis in 29% and "clue" cells in 41,3% of smears. The presence of "clue" cells (91,8%) and a positive amine test (76,7%) was significantly associated with bacterial vaginosis. Although a raised vaginal pH was also significantly associated with bacterial vaginosis, this test was less specific (65,2%) than "clue" cells (85,9%) and the amine test (95,5%). The vaginal Gram stain, as performed in this study, was found to be unreliable for the detection of "clue" cells. G. vaginalis biotypes 1 and 5 were significantly associated with bacterial vaginosis, however the serotyping scheme did not distinguish between strains isolated from women with and without bacterial vaginosis. The antimicrobial susceptibility pattern of 93 strains of G. vaginalis was not typical of either Gram-positive or Gram-negative bacteria. Serological tests revealed reactive syphilis serology in 47 (22,6%) and the presence of hepatitis B surface antigen in 16 (7,7%) women. Antibody to human immunodeficiency virus was detected in 4 (1,9%) women attending the colposcopy clinic. This study clearly demonstrates the high prevalence of vaginal and/or endo-cervical infections in women locally, the majority of whom were asymptomatic. The high frequency of concurrent infections is of concern and there is a need for the recognition, and appropriate management of such infections

Calymmatobacterium granulomatis: culture, electron microscopic studies and molecular analysis.

Doctoral Degree. University of KwaZulu-Natal, Durban.Abstract available in PDF.Publications on page vi. Presentations at scientific meetings on page vii