Seroprevalence of Hepatitis B virus infection and associated factors among pregnant women at Korle-Bu Teaching Hospital, Ghana.

IntroductionHepatitis B virus infection is a global public health problem. Though, the disease is endemic in sub-Saharan Africa, little is known about its epidemiology among pregnant women in Ghana. This study sought to determine the seroprevalence of Hepatitis B virus infection and associated factors among pregnant women attending antenatal care at Korle-Bu Teaching Hospital; Ghana's largest hospital.MethodsWe conducted a facility-based cross-sectional survey among 232 antenatal attendants. Participants were recruited using systematic random sampling technique and screened with HBsAg Rapid Test. Data was analyzed with the aid of Statistical Package for Social Sciences (SPSS), version 23.0. Results were presented using descriptive statistics, Fisher's Exact test and Logistic Regression analysis.ResultsTwo hundred and twenty-one (221) of the total sample (n = 232) agreed to participate in this study; representing a response rate of 95%. The mean age of the participants was 31 years and standard deviation of 5.3. The mean gestational period at recruitment was 28 weeks and standard deviation of 6.8. Majority of the participants were married (83.3%), parous (69.6%), educated (91.4%) and employed (90.5%). The prevalence of HBsAg was 7.7%. We found no significant association between socio-demographic characteristics of the participants and HBV infection.ConclusionSeroprevalence of 7.7% indicates moderate endemicity. Socio-demographic characteristics did not influence HBV infection among pregnant women attending antenatal care at Korle-Bu Teaching Hospital. The findings provide empirical evidence that will contribute to knowledge of HBV epidemiology in Ghana

Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana : a prospective cohort study

BACKGROUND: The global increase in Cesarean section rate is associated with short- and long-term complications, including adhesions with potential serious maternal and fetal consequences. This study investigated the prevalence of adhesions and association between adhesions and postoperative complications in a tertiary referral hospital in Accra, Ghana. METHODS: In this prospective cohort study, 335 women scheduled for cesarean section at Korle-Bu Teaching Hospital in Accra, Ghana were included from June to December 2015. Presence or absence of adhesions was recorded and the severity of the adhesions was scored using a classification system. Associations between presence and severity of adhesions, postoperative complications, and maternal and infant outcomes at discharge and 6 weeks postpartum were assessed using multivariate logistic and linear regression analysis. RESULTS: Of the participating women, 128 (38%) had adhesions and 207 (62%) did not. Prevalence of adhesions increased with history of caesarean section; 2.8% with no CS but may have had an abdominal surgery, 51% with one previous CS, 62% with >1 CS). Adhesions significantly increased operation time (mean 39.2 (±15.1) minutes, absolute adjusted difference with presence of adhesions 9.6 min, 95%CI 6.4-12.8), infant delivery time (mean 5.4 (±4.8) minutes, adjusted difference 2.4 min, 95%CI 1.3-3.4), and blood loss for women with severe adhesions (mean blood loss 418.8 ml (±140.6), adjusted difference 57.6 ml (95%CI 12.1-103.0). No differences for other outcomes were observed. CONCLUSION: With cesarean section rates rising globally, intra-abdominal adhesions occur more frequently. Risks of adhesions and associated complications should be considered in counseling patients for cesarean section

Le Courrier

28 octobre 18361836/10/28 (N298)

Uterine Tonus Assessment by Midwives versus Patient self-assessment in the active management of the third stage of labor (UTAMP) : study protocol for a randomized controlled trial

BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and accounts for one third of maternal deaths in low-income and middle-income countries. PPH can be prevented by active management of the third stage of labor (AMTSL), a series of steps recommended by the World Health Organization to be performed by skilled birth attendants (SBAs). Task shifting in the AMTSL step of uterotonic drugs administration to community health workers, traditional birth attendants and self-administration has been investigated as a strategy to increase access to quality obstetric care considering persistent SBA and facility-based delivery shortages. The aim of this study is to assess task shifting in the final step of AMTSL and compare uterine tonus assessment by a SBA to self-assessment. METHODS AND DESIGN: The study is an individual-level two-arm non-inferiority randomized controlled trial (RCT). A total of 800 women will be recruited in Korle Bu Teaching Hospital in Accra, Ghana. Adult women in labor at term with an expected vaginal delivery who received antenatal instructions for self-assessment of uterine tonus will be eligible for inclusion. Women with an increased risk for PPH will be excluded. Women will be randomized to uterine tone assessment by a skilled birth attendant (midwife) or uterine tone self-assessment (with the safety back-up of a midwife present in case of PPH or uterine atony). Postpartum blood loss will be measured through weighing of disposable mats. The main study endpoints are PPH (≥500 ml blood loss), severe PPH (≥1000 ml blood loss), mean blood loss, and routine maternal and neonatal outcomes. Participants and caregivers will not be blinded given the nature of the intervention. DISCUSSION: A reduction of PPH-related maternal mortality requires full implementation of AMTSL. Task shifting of uterine tone assessment may contribute to increased AMTSL implementation in (clinical) settings where SBAs capacity is constrained. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02223806 , registration August 2014. PACTR: PACTR201402000736158 , registration July 2014. University of Ghana, Medical School Ethical and Protocol Review Committee: MS-Et/M.8-P4.1/2014-2015

Mode-of-Action-Guided, Molecular Modeling-Based Toxicity Prediction: A Novel Approach for \u3ci\u3eIn Silico\u3c/i\u3e Predictive Toxicology

Computational toxicology is a sub-discipline of toxicology concerned with the development and use of computer-based models and methodology to understand and predict chemical toxicity in a biological system (e.g., cells and organisms). Quantitative structure–activity relationship (QSAR) has been the predominant approach in computational toxicology. However, classical QSAR methodology has often suffered from low prediction accuracy, largely owing to the lack or non-integration of toxicological mechanisms. To address this lingering problem, we have developed a novel in silico toxicology approach that is based on molecular modeling and guided by mode of action (MoA). Our approach is implemented through a target-specific toxicity knowledgebase (TsTKb), consisting of a pre-categorized database of chemical MoA (ChemMoA) and a series of pre-built, category-specific classification and quantification models. ChemMoA serves as the depository of chemicals with known MoAs or molecular initiating events (i.e., known target biomacromolecules) and quantitative information for measured toxicity endpoints (if available). The models allow a user to qualitatively classify an uncharacterized chemical by MoA and quantitatively predict its toxicity potency. This approach is currently under development and will evolve to incorporate physiologically based pharmacokinetic (PBPK) modeling to address absorption, distribution, metabolism and excretion (ADME) processes in a biological system. The fully developed approach is believed to significantly advance in silico -based predictive toxicology and provide a new powerful toolbox for regulators, the chemical industry and the relevant academic communities