Why do women not use antenatal services in low and middle income countries? A metasynthesis of qualitative studies

Background: Almost 50% of women in low & middle income countries (LMIC’s) don’t receive adequate antenatal care. Women’s views can offer important insights into this problem. Qualitative studies exploring inadequate use of antenatal services have been undertaken in a range of countries, but the findings are not easily transferable. We aimed to inform the development of future antenatal care programmes through a synthesis of findings in all relevant qualitative studies. Methods and Findings: Using a pre-determined search strategy, we identified robust qualitative studies reporting on the views and experiences of women in LMIC’s who received inadequate antenatal care. We used meta-ethnographic techniques to generate themes and a line of argument synthesis. We derived policy relevant hypotheses from the findings. We included 21 papers representing the views of more than 1230 women from 15 countries. Three key themes were identified: ‘Pregnancy as socially risky and physiologically healthy’; ‘Resource use and survival in conditions of extreme poverty’and ‘Not getting it right first time’. The line of argument synthesis describes a dissonance between programme design and cultural contexts that may restrict access and discourage return visits. We hypothesize that centralized, risk-focused antenatal care programmes may be at odds with the resources, beliefs and experiences of pregnant women who underuse antenatal services. Conclusions: Our findings suggest that there may be a mis-alignment between current antenatal provision and the social and cultural context of some women in LMIC’s. Antenatal care provision that is theoretically and contextually at odds with local contextual beliefs and experiences are likely to be underused, especially when attendance generates increased personal risks of lost family resource or physical danger during travel; when the promised care is not delivered due to resource constraints; and when women experience covert or overt abuse in care settings

Sociocultural and epidemiological aspects of HIV/AIDS in Mozambique

<p>Abstract</p> <p>Background</p> <p>A legacy of colonial rule coupled with a devastating 16-year civil war through 1992 left Mozambique economically impoverished just as the human immunodeficiency virus (HIV) epidemic swept over southern Africa in the late 1980s. The crumbling Mozambican health care system was wholly inadequate to support the need for new chronic disease services for people with the acquired immunodeficiency syndrome (AIDS).</p> <p>Methods</p> <p>To review the unique challenges faced by Mozambique as they have attempted to stem the HIV epidemic, we undertook a systematic literature review through multiple search engines (PubMed, Google Scholar™, SSRN, AnthropologyPlus, AnthroSource) using Mozambique as a required keyword. We searched for any articles that included the required keyword as well as the terms 'HIV' and/or 'AIDS', 'prevalence', 'behaviors', 'knowledge', 'attitudes', 'perceptions', 'prevention', 'gender', drugs, alcohol, and/or 'health care infrastructure'.</p> <p>Results</p> <p>UNAIDS 2008 prevalence estimates ranked Mozambique as the 8^thmost HIV-afflicted nation globally. In 2007, measured HIV prevalence in 36 antenatal clinic sites ranged from 3% to 35%; the national estimate of was 16%. Evidence suggests that the Mozambican HIV epidemic is characterized by a preponderance of heterosexual infections, among the world's most severe health worker shortages, relatively poor knowledge of HIV/AIDS in the general population, and lagging access to HIV preventive and therapeutic services compared to counterpart nations in southern Africa. Poor education systems, high levels of poverty and gender inequality further exacerbate HIV incidence.</p> <p>Conclusions</p> <p>Recommendations to reduce HIV incidence and AIDS mortality rates in Mozambique include: health system strengthening, rural outreach to increase testing and linkage to care, education about risk reduction and drug adherence, and partnerships with traditional healers and midwives to effect a lessening of stigma.</p

Surgical Experience Obtained by Urology Registrars – Changes in the Volume and Spectrum of Operative Procedures: 1975 – 2002

Objective: To analyze changes in the operative experience of Urology registrars at Tygerberg Hospital, an academic training hospital attached to the University of Stellenbosch, South Africa. Materials and Methods: Computerized analysis of 32,703 operating room cases (60,096 procedures) performed or assisted by 30 registrars in the period January 1975 to December 2002. Results: The average total number of procedures/registrar decreased by 32% (from 1752 to 1163) for those who started training in the period 1990-99 compared with 1975-90 (p=0.0005), largely due to a 35% reduction in bed numbers and theatre time resulting from budgetary restrictions. Comparison of the period 1994-2002 with 1976-84 showed a >4-fold increase in percutaneous nephrolithotomy, radical prostatectomy and inguinal herniotomy, with a moderate (&ge;50%) increase in bladder rupture repair (54%), circumcision (89%), orchidopexy (105%), insertion of peritoneal dialysis catheter (274%), laparotomy (54%) and surgical debridement (215%). There was a &ge;50% decrease in nephrectomy (57%), renal exploration for trauma (75%), open kidney stone surgery (87%), pyeloplasty (44%), reimplantation of the ureter (60%), ureterolithotomy (66%), suprapubic cysto-tomy (71%), transurethral resection of the prostate (54%), open prostatectomy (90%), urethral dilatation (78%), internal urethrotomy (54%), urethroplasty (72%), varicocelectomy (62%), and creation of arteriovenous fistula for dialysis (58%). Conclusions: There have been substantial changes in the spectrum of surgical procedures performed or assisted by Urology registrars in the period 1975 to 2002. The significant decrease in the total number of procedures per registrar in the past decade is a reason for concern, although it remains unknown what the minimum number of any given urological procedure should be in order to ensure adequate operative training. Key words: surgical training, urology, registrars, residents, operative procedures Expérience chirurgicale obtenue par les résidents d\'urologie – Changements dans le volume et le spectre des procédures en vigueur: 1975 – 2002 Objectif: Analyser les changements dans l\'expérience en vigueur des résidents d\'Urologie à l\'Hôpital Tygerberg, un hôpital de formation universitaire attaché à l\'Université de Stellenbosch, Afrique du Sud. Matériels et Méthodes: On a informatisé l\'analyse de 32.703 cas en salle d\'opération (60.096 procédures) réalisés ou assistées par 30 résidents dans la période : janvier 1975 à décembre 2002. Résultats: Le nombre total moyen de procédures/ résidents a diminué par 32% (de 1752 à 1163) pour ceux qui ont commencé à être formés dans la période 1990-99 comparés à ceux de 1975-90 (p=0.0005), en grande partie dû à une réduction de 35% dans le nombre des lits et la durée d\'hospitalisation qui résultent des restrictions budgétaires. La comparaison de la période 1994-2002 avec 1976-84 a montré une augmentation >4-fois des néphrolithotomies percutanées, prostatectomies radicales et herniotomie inguinale, avec une augmentation modéré (&ge;50%) des réparations de la rupture de la vessie (54%), circoncision (89%), orchidopexie (105%), insertion de sonde de dialyse péritonéale (274%), laparotomie (54%) et débridement chirurgical (215%). Il y avait une baisse de &ge;50% des néphrectomies (57%), exploration rénale pour trauma (75%), rein ouvert chirurgie lithiasique (87%), pyeloplastie (44%), réimplantation de l\'uretère (60%), urétérolithotomie (66%), cystostomie sus-pubienne (71%), résection transuréthrale de la prostate (54%), prostatectomie à ciel ouvert (90%), dilatation de l\'urèthre (78%), urétrotomie interne (54%), urétroplastie (72%), varicocelectomie (62%), et création de fistule artério-veineuse pour dialyse (58%). Conclusions: Il y a eu des changements substantiels dans le spectre des procédures chirurgicales exécutées ou aidées par les résidents d\'Urologie dans la période 1975 à 2002. La baisse considérable dans le nombre total de procédures par résidents dans la décennie passée est une raison d\'inquiétude, bien qu\'il reste inconnu ce que le nombre minimum de toute procédure urologique donnée devrait être pour assurer la formation adéquate en vigueur. African Journal of Urology Vol.11(2) 2005: 82-8

Ozone concentration dependent autohaemotherapy effects on baboon antioxidant capacity and DNA integrity and repair capacity of lymphocytes

Although ozone is widely used as an alternative medicine, its safety and efficiency are met with scepticism. To shed some light on this, we assessed the effect of ozone-autohaemotherapy, using anO2/O3 gas mixture containing three different O3 concentrations (20, 40 and 80 ìg/ml), on the antioxidant status and lymphocyte DNA integrity in baboons. Ultra pure O2 was used as a control because morethan 95% of the O2/O3 gas mixture consisted of oxygen. Five percent of the blood volume of a baboon was withdrawn and treated with O3. Baboons were anesthetized with intramuscular ketamine hydrochloride (±10 mg/kg). Blood was collected before ozone-autohaemotherapy and again 4, 24 and 48 h after treatment. In general, the changes in measurements were concentration dependant. Ozoneautohaemotherapyup regulated the antioxidant capacity as measured by the Oxygen Radical Absorbance Capacity assay. Total glutathione levels decreased after ozone-autohaemotherapy, most likely due to reaction with reactive oxygen species that was quenched by the GSH system. The activityof superoxide dismutase increased after ozone-autohaemotherapy with 20 ìg/ml O3. Ozoneautohaemotherapy caused a slight increase in DNA damage. However, very little DNA damage occurred following treatment with 80 ìg/ml O3, which also caused the highest increase in the antioxidant capacity. DNA repair capacity decreased and thus can have severe long term effects

Riverine influence determines nearshore heterogeneity of nutrient (C, N, P) content and stoichiometry in the KwaZulu-Natal Bight, South Africa

Riverine influences on nearshore oceanic habitats often have detrimental consequences leading to algal blooms and hypoxia. In oligo- to mesotrophic systems, however, nutrient delivery via rivers may stimulate production and even be a vital source of nutrients, as may nutrient supplements from upwelling. We investigated the nutrient content (C, N, P) and stoichiometry of sediment, and several pelagic, benthopelagic and benthic species in the KwaZulu-Natal (KZN) Bight, a narrow shelf area on the south-east coast of South Africa, bordering the Agulhas Current. Three suggested nutrient sources to the bight are the Thukela River in the central region of the bight, upwelling in the northern part and a semi-permanent eddy (Durban Eddy) in the southern part. Elemental content of the various groups studied showed significantly higher values for most groups at the site near the Thukela River. C:P and N:P were highest in the southern part of the bight, and lowest near the Thukela Mouth or at Richards Bay in the north, indicating the latter were the P-richer sites. Sediment organic matter showed lowest elemental content, as expected, and zooplankton stoichiometry was highest compared to all other biotic groups. Environmental heterogeneity played a greater role in organismal C, N and P content and stoichiometry compared to phylogeny, with the exception of the differences in C:P and N:P of zooplankton. From this bight-wide study, the higher elemental content and lower ratios at the Thukela Mouth site supported previous findings of the importance of coastal nutrient sources to the bight ecosystem. Reductions in river flow for water use in the catchment areas may therefore have negative consequences for the productivity of the entire ecosystem.Keywords: Agulhas Current, carbon, elemental content, nitrogen, phosphorus, stoichiometr