Predictors of foeto-maternal outcome of patients with abruptio placenta at Bugando Medical Centre, Tanzania

Background: Abruptio placenta (AP) is one of the life-threatening obstetric complications for both the foetus and mother. We conducted this study to determine the incidence and predictors of adverse outcomes of abruptio placenta at Bugando Medical Centre (BMC) in northwest Tanzania.Methods: This descriptive cross-sectional study was conducted from October 2012 to April 2013. Women with clinical features of abruptio placenta attending BMC were recruited. Data were collected using a structured checklist and analysed with STATA 11.Results: A total of 3,800 deliveries occurred during study period. The incidence of AP was 2.5% (95/3800). Among patients with AP, 49 (51.6%) delivered by Caesarean section. Three (3.2%) maternal deaths occurred. These deaths were strongly associated with the presence of maternal anaemia (p<0.05), and postpartum haemorrhage (p<0.05). The foetal adverse outcomes were prematurity 78 (82.1%), foetal distress 65 (68.4%), low birth weight 46 (48.4%) and intrauterine foetal deaths 30 (31.6%). Perinatal deaths occurred in 52 (54.7 %) of the cases, and were predicted by low birth weight (p<0.001), vaginal delivery (p=0.001), birth asphyxia (p<0.001), and retroplacental clot (>700ml) (p<0.001).Conclusion: The incidence of AP at BMC is high and characterised by poor maternal and foetal outcomes. Patients with AP should be delivered promptly to improve their survival

Giant vulva fibroma presenting as a genital mass: a case report

Introduction: Even though vulva fibroma is rare, it is among the solid tumors of the vulva. Its cause is unknown although it has been associated with physiological hormonal changes. We report a patient with a unique vulva fibroma which has grown to the extent of interfering with her gait and urination. Case presentation: A 22-year-old woman presented with a genital mass which had been present for the duration of 2 years and felt embarrassed to report to the hospital early as the growth was in the genital area, with the perception of it being a sexually related illness, despite having not yet started engaging in sexual activity. On physical examination, a palpable pendulous mass of about [30 x 22] cm was seen originating from the right labia and extending to the right perineum. The mass was firm, nodulated, non-tender and had limited mobility. Surgical excision was performed under spinal anesthesia. Histologically, features suggestive of mixoid fibroma were reached after the mass was excised.  No recurrence has been observed. Conclusion: Clinicians should be aware of this rare disease which can be associated with recurrence if there is incomplete excision. Again, the unusual finding of the genital mass can be very embarrassing to the patient affecting her psychosocial well-being. It needs to be treated immediately upon diagnosis. &nbsp

Hydatidiform moles among patients with incomplete abortion in Mwanza City, North western Tanzania

Background: Prevalence of hydatidiform mole is not clearly defined, partly because most studies have reported different prevalence rates from different regions. However, there is no previous study that has determined the prevalence and associated risk factors of HM among patients with incomplete abortion evacuated at Bugando Medical Centre (BMC) and Sekou Toure Regional Hospital (STRH).Methods: A total of 180 patients with incomplete abortion were enrolled between February 2013 and April 2013. The products of conception were collected and analyzed using Haemotoxylin and Eosin staining technique for hydatidiform moles.Results: One hundred and eighty patients with incomplete abortion scheduled for uterine evacuation agreed to participate in this study. The overall prevalence of HM was 12.8%. Majority of patients (27.5%) with HM were those aged below 20 years. No significant association was observed with risk factors such as parity, contraceptive use, previous abortion and blood group.Conclusion: The prevalence of HM (12.8%) was high and age between 15-20 years was the only significant associated risk factor with the presence of HM among patients with incomplete abortion. Therefore, we recommend submission of evacuated products of conception for histopathological analysis to minimize missed opportunity.Keywords: Prevalence, hydatidiform mole, incomplete abortion, Mwanza, Tanzania

Factors Associated with Women with Multiple Caesarean Deliveries Presenting in Labour and their Fetomaternal Outcomes in Mwanza Region, Tanzania.

Background: Emergency caesarean section(C-section) for women with two or more uterine scars is documented to be associated with poor fetomaternal outcomes. The World Health Organization recommends elective C-section for women with two or more previous scars. However, in Tanzania there is a paucity of data for women with two or more prior C-sections and how it contributes to increased maternal and perinatal morbidity and mortality when they come in active labour without a planned delivery. The purpose of the study was to determine factors associated with pregnant women with multiple C-section deliveries presenting in labour and their fetomaternal outcomes. Methods: This was a cross-sectional, hospital-based study, involving 275 pregnant women who underwent C-section due to multiple uterine scars in the Mwanza region. Socio-demographic and clinical characteristics were collected serially until the sample size was reached using a structured questionnaire and patients’ files. Data were analyzed using STATA version 13.0 software. Results: All pregnant women with two or more previous uterine scars attended antenatal care (ANC) and the majority, 62.2%, had four or more visits. However, 61.9% were not told of the need for elective C-section. In addition, 26% were not counselled about the obstetric danger signs. Among the study participants, 66.6% presented with labour pain requiring emergency C-section, 13.1% had postpartum hemorrhage and 3.3% had ruptured uterus. There were 3.3% peri-natal deaths and 10.9% required newborn resuscitation. The associated factors for women with two or more C-section scars presenting in active labour were: having the last ANC visit at primary healthcare (PHC) facility (p=0.046), unemployment (p<0.001), visiting ANC <4 visits (p=0.002) or being attended by a non-physician health provider in her last ANC visit(p<0.001). Conclusion: Parturient women with uterine scars, when attending primary health care facilities for their ANC visits, ought to be counselled and referred to high facilities with clinicians who can plan an elective c-section delivery

Adolescents in rural Tanzania : a qualitative study

Pregnant adolescents (ages 10-19) seeking antenatal services are compromised by a complex power imbalance that involves financial dependence, lack of choice, lack of personal autonomy in decision making, experiences of social stigma, judgement, violence and abuse. The study analyzed experiences of pregnant adolescents in accessing antenatal care in Misungwi district, Mwanza Region, Tanzania. Low and middle-income countries, including Tanzania, bear the largest proportion of adolescent perinatal deaths globally. Most adolescent girls in Tanzania do not access antenatal care at health facilities. Multi-level interventions are needed to empower adolescent girls, and to address policies and social constructs that may contribute to power imbalances.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Maximizing engagement for readiness and impact (MERI) : MERI approach technical review

System readiness approaches move towards better understanding and managing challenges that governments and development partners face in advance of programme delivery. The Maximizing Engagement for Readiness and Impact (MERI) Approach is the focus of this brief. The term “system readiness” is used in implementation science, rather than “system strengthening.” Readiness theory suggests that motivation factors are critical in implementation. For example, if there are gaps identified in leadership capacity, one would incorporate and emphasize strategies to build leadership skills within implementation activities and to encourage leader buy-in. Because general capacity and motivation are improved, beneficiaries are more ‘ready’ to take on other interventions

Hydatidiform moles among patients with incomplete abortion in Mwanza City, North western Tanzania

Background: Prevalence of hydatidiform mole is not clearly defined, partly because most studies have reported different prevalence rates from different regions. However, there is no previous study that has determined the prevalence and associated risk factors of HM among patients with incomplete abortion evacuated at Bugando Medical Centre (BMC) and Sekou Toure Regional Hospital (STRH). Methods: A total of 180 patients with incomplete abortion were enrolled between February 2013 and April 2013. The products of conception were collected and analyzed using Haemotoxylin and Eosin staining technique for hydatidiform moles. Results: One hundred and eighty patients with incomplete abortion scheduled for uterine evacuation agreed to participate in this study. The overall prevalence of HM was 12.8%. Majority of patients (27.5%) with HM were those aged below 20 years. No significant association was observed with risk factors such as parity, contraceptive use, previous abortion and blood group. Conclusion: The prevalence of HM (12.8%) was high and age between 15-20 years was the only significant associated risk factor with the presence of HM among patients with incomplete abortion. Therefore, we recommend submission of evacuated products of conception for histopathological analysis to minimize missed opportunity

Barriers to receiving the recommended standard care during pregnancy by illiterate women in rural, Northern Tanzania

Three key themes emerged from this research in relation to health care access by illiterate women who were pregnant: 1) they could not read their health care cards or public health messaging; 2) they spoke the local language, not Swahili, the language of care providers; 3) they endeavour to develop coping strategies to overcome these obstacles. Additionally, health care workers were unaware of those who are illiterate. This study explores the experiences related to care-seeking by illiterate, pregnant women in rural Tanzania. In 2017, 810 women died every day from pregnancy or childbirth related complications, most commonly in rural areas in low- and middle-income countries.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Rater training for standardised assessment of objective structured clinical examinations in rural Tanzania

In this study, six healthcare providers assessed and scored 42 training scenarios. Raters identified average test proficiency 50% of the time. Experts in the field of clinician-based training for frontline staff recommend that all examiners undergo rater training prior to becoming an Objective Structured Clinical Examination (OSCE) assessor. Helping Babies Breathe, Essential Care for Every Baby and Bleeding after Birth are standardised training programmes in maternal and child health care. Studies examining the reliability of assessments are rare. This study shows that rater training is critical to ensure that the potential of training programmes translates to improved outcomes for mothers and babies.Innovating for Maternal and Child Health in Africa (IMCHA) initiativeGlobal Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR