24 research outputs found
Tropical diseases and their impact on maternal and child health
Over a quarter of the worldâs population are at risk of
parasitic infections. The majority of these infections are
confined to the worldâs poverty belt, which is largely in sub-
Saharan Africa. Dangerous, debilitating and chronic infections
add to the burden of people already disadvantaged by
poverty. Women constitute over 67% of the total population of
Africa, and they suffer the most from the effects of poverty.
Thus, a focus on African women is vital. While HIV/AIDS,
tuberculosis and malaria are well known, the so called âbig
threeâ with substantive efforts to prevent and control these
infections in communities, there are many lesser known
infections that cause persistent morbidity. âNeglected tropical
diseasesâ (NTDs) are the tropical infections once the âbig
threeâ have been taken out.http://www.ogf.co.z
Autologous intrauterine transfusion in a case of anti-U
BACKGROUND : Minor red blood cell antibodies are becoming a more common cause of hemolytic disease of the newborn. Anti-U are a rare alloantibody found almost exclusively in people of black descent. There is limited experience to guide the management of pregnancies complicated by anti-U. Furthermore, there is often no suitable cross-matched blood available for transfusion of a patient with anti-U. CASE REPORT : A 21-year-old P0G1 presented at 25 weeks' gestation with Dâ disease in pregnancy. She had a significant indirect antiglobulin test titer of 512. Anti-U were identified and no suitable cross-matched blood was available. Maternal blood was prepared for autologous intrauterine fetal transfusion. Two such transfusions were performed. RESULTS : A healthy fetus delivered at 32 weeks that did not require phototherapy or an exchange transfusion.
CONCLUSION : Autologous transfusion of prepared maternal blood provides a safe option for intrauterine fetal therapy in pregnancies complicated by rare alloantibodies.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1537-29952017-12-31hb2017Obstetrics and Gynaecolog
Evaluating current knowledge of legislation and practice of obstetricians and gynaecologists in the management of fetal remains in South Africa
Background. In the clinical setting, the main legislative provisions governing the management and âdisposalâ of fetal remains in South Africa are the Choice on Termination of Pregnancy Act 92 of 1996 and the Births and Deaths Registration Act 51 of 1992.Objectives. To determine obstetriciansâ and gynaecologistsâ current knowledge of this legislation. Current practice with regard to certification of death and methods of disposal of fetal material was also reviewed.Methods. A questionnaire-based study was conducted. The data collected included demographic details, qualifications, years of experience, working environment (public/private practice), responses to general questions reviewing knowledge of current legislation, and practical experience.Results. Seventy-six questionnaires were returned, with practitioners from the private and public sectors nearly equally represented. It was found that there is a concerning gap in obstetriciansâ and gynaecologistsâ knowledge of the law, and that some practitioners are acting outside the scope of the law. The study further revealed that patientsâ needs are not properly accommodated under the current legislative provisions, because the law prevents certain remains from being respectfully managed. Conclusions. The study findings suggest that improved training of practitioners, together with possible law reform, are required to better serve the needs of patients.
An audit of the initial resuscitation of severely ill patients presenting with septic incomplete miscarriages at a tertiary hospital in South Africa
BACKGROUND : Septic incomplete miscarriages remain a cause of maternal deaths in South Africa. There was an
initial decline in mortality when a strict protocol based approach and the Choice of Termination of Pregnancy Act
in South Africa were implemented in this country. However, a recent unpublished audit at the Pretoria Academic
Complex (Kalafong and Steve Biko Academic Hospitals) suggested that maternal mortality due to this condition is
increasing. The objective of this investigation is to do a retrospective audit with the purpose of identifying the
reasons for the deteriorating mortality index attributed to septic incomplete miscarriage at Steve Biko Academic
Hospital.
METHODS : A retrospective audit was performed on all patients who presented to Steve Biko Academic Hospital with
a septic incomplete miscarriage from 1st January 2008 to 31st December 2010. Data regarding patient
demographics, initial presentation, resuscitation and disease severity was collected from the âmaternal near-missâ/
SAMM database and the patientâs medical record. The shock index was calculated for each patient retrospectively.
RESULTS : There were 38 SAMM and 9 maternal deaths during the study period. In the SAMM group 86.8% and in
the maternal death group 77.8% had 2 intravenous lines for resuscitation. There was no significant improvement in
the mean blood pressure following resuscitation in the SAMM group (p 0.67), nor in the maternal death group
(p 0.883). The shock index before resuscitation was similar in the two groups but improved significantly following
resuscitation in the SAMM group (p 0.002). Only 31.6% in the SAMM group and 11.1% in the maternal death group
had a complete clinical examination, including a speculum examination of the cervix on admission. No antibiotics
were administered to 21.1% in the SAMM group and to 33.3% in the maternal death group.
CONCLUSION : The strict protocol management for patients with septic incomplete miscarriage was not adhered to.
Physicians should be trained to recognise and react to the seriously ill patient. The use of the shock index in the
identification and management of the critically ill pregnant patient needs to be investigated.http://www.biomedcentral.com/bmcpregnancychildbirtham201
Comparison of the new Mycofast Revolution assay with a molecular assay for the detection of genital mycoplasmas from clinical specimensÂ
BACKGROUND: Genital mycoplasmas are opportunistic bacteria that are associated with undesirable gynaecologic
and reproductive events. Mycoplasmas are fastidious bacteria with increasing resistance to routine antimicrobials
and often fail to grow on conventional culture methods. The commercial Mycofast Revolution assay permits the
phenotypic detection and identification of genital mycoplasmas. Antimicrobial susceptibility testing against five
antimicrobial agents with MICs corresponding to the CLSI guidelines can also be performed. This study aimed to
compare the new commercially available Mycofast Revolution assay with a multiplex PCR assay.
METHODS: Self-collected swabs were obtained from pregnant women attending the antenatal clinic of a tertiary
academic hospital in Pretoria, South Africa from October 2012 to November 2012. These swabs were used to seed
UMMt and modified Amies transport media. The seeded UMMt transported medium was used to inoculate the
Mycofast Revolution assay for the identification, enumeration and antimicrobial susceptibility testing of genital
mycoplasmas. Following DNA extraction from the modified Amies transport medium, specimens were subjected to
a multiplex PCR assay for the detection of genital mycoplasmas.
RESULTS: The Mycofast Revolution kit had a sensitivity and specificity of 77.3% (95% CI: 62.15% to 88.51%) and 80%
(95% CI: 28.81% to 96.70%), respectively, against the PCR assay. The positive and negative predictive values were
97.1% (95% CI: 85.03% to 99.52%) and 28.6% (95% CI: 8.57% to 58.08%). Genital mycoplasmas were detected in
71.4% (35/49) of samples with the Mycofast Revolution assay with 49% (24/49) being Ureaplasma spp. and 22.4%
(11/49) mixed strains. The multiplex PCR assay had a positivity rate of 89.8% (44/49) for genital mycoplasmas; mixed
strains were present in 51% (25/49) of samples, Ureaplasma spp. in 16.3% (8/49) and M. hominis in 22.4% (11/49) of
samples.
CONCLUSIONS: There was a fair agreement (Îș = 0.319) between the Mycofast Revolution assay and the mPCR assay.
With the high prevalence rates of genital mycoplasmas, fast and efficient diagnostic methods are imperative to
treat infections and minimise complications. The Mycofast Revolution assay is simple to use, has a short turnaround
time and interpretation of results are straightforward. This assay circumvents common problems
experienced with conventional culture and molecular methods in diagnostic laboratories where skilled personnel
are limited and can be used as an alternative diagnostic assay.http://www.biomedcentral.com/1471-2334/13/453am201
Antimicrobial susceptibility patterns of Ureaplasma species and Mycoplasma hominis in pregnant women
BACKGROUND : Genital mycoplasmas colonise up to 80% of sexually mature women and may invade the amniotic
cavity during pregnancy and cause complications. Tetracyclines and fluoroquinolones are contraindicated in
pregnancy and erythromycin is often used to treat patients. However, increasing resistance to common
antimicrobial agents is widely reported. The purpose of this study was to investigate antimicrobial susceptibility
patterns of genital mycoplasmas in pregnant women.
METHODS : Self-collected vaginal swabs were obtained from 96 pregnant women attending an antenatal clinic in
Gauteng, South Africa. Specimens were screened with the Mycofast Revolution assay for the presence of
Ureaplasma species and Mycoplasma hominis. The antimicrobial susceptibility to levofloxacin, moxifloxacin,
erythromycin, clindamycin and tetracycline were determined at various breakpoints. A multiplex polymerase chain
reaction assay was used to speciate Ureaplasma positive specimens as either U. parvum or U. urealyticum.
RESULTS : Seventy-six percent (73/96) of specimens contained Ureaplasma spp., while 39.7% (29/73) of Ureaplasma
positive specimens were also positive for M. hominis. Susceptibilities of Ureaplasma spp. to levofloxacin and
moxifloxacin were 59% (26/44) and 98% (43/44) respectively. Mixed isolates (Ureaplasma species and M. hominis)
were highly resistant to erythromycin and tetracycline (both 97% resistance). Resistance of Ureaplasma spp. to
erythromycin was 80% (35/44) and tetracycline resistance was detected in 73% (32/44) of Ureaplasma spp.
Speciation indicated that U. parvum was the predominant Ureaplasma spp. conferring antimicrobial resistance.
CONCLUSIONS : Treatment options for genital mycoplasma infections are becoming limited. More elaborative studies
are needed to elucidate the diverse antimicrobial susceptibility patterns found in this study when compared to
similar studies. To prevent complications in pregnant women, the foetus and the neonate, routine screening for the
presence of genital mycoplasmas is recommended. In addition, it is recommended that antimicrobial susceptibility
patterns are determined.University of Pretoria, the Medical Research Council (South Africa) and the National Health Laboratory Service (NHLS)http://www.biomedcentral.com/bmcinfectdis/hb201
Challenges and controversies in prenatal genetic screening in the South African context
Prenatal genetic screening is an integral part of general antenatal care and is regarded as standard of care for all pregnant
women. All pregnant women < 20 weeks gestation should be offered some form of genetic screening and this should be
discussed in an extensive pre-test counselling session. Late screening (after 20 weeks) may also be offered but will be
limited by management options. Cell-free DNA testing has added another dimension to the landscape of prenatal
screening but has to be appropriately used for the correct indication. Interpretation of risk for Downâs syndrome is a critical
component of the screening process. A guideline would be to regard screening risks in absolute terms as there is no
provision made to interpret risk in relative risk terms. An important safeguard to overcome the ârelative riskâ conundrum
would be to inform all patients during pre-test counselling of an intermediate risk category generally between 1:300-1:1000
where cfDNA testing may be considered, at the parentsâ own discretion. If the screening risk is <1:1000, no further testing
is advised as this risk is deemed very low. A screening risk for Downâs syndrome >1:300 will be deemed high risk, as is
presently the case.http://www.journals.co.za/content/journal/medogam2018Obstetrics and Gynaecolog
Pilot social feasibility study for the establishment of a public human umbilical cord blood stem cell bank in South Africa
There is a large unmet need in South Africa for bone marrow transplantation. Umbilical cord blood (UCB) is an important source of stem cells for the treatment of haematological and non-haematological diseases. Access to the two existing private umbilical cord blood stem cell banks (UCB SCBs) in South Africa is limited to individuals that can afford it, which further aggravates the ever increasing divide between families from different socio-economic classes. The problem is compounded by a severe global shortage of genetically compatible samples, representative of the South African demographics. Establishing a public human UCB SCB in South Africa would provide more South Africans with access to previously unavailable treatment in the form of affordable, genetically compatible stem cells for bone marrow transplantation. A public UCB SCB has many facets to consider, one of which is public preparedness and support for the bank. This was assessed in a social feasibility pilot study which is reported here. In addition to the findings of this social feasibility study, other important considerations for establishing a public human UCB SCB in SA include; (a) testing the samples for HIV and other infectious diseases (required for compliance with international regulatory standards); (b) flow cytometric analysis for enumeration of CD34+ UCB stem cells; (c) mapping of HLA genotypes/alleles; and (d) a study of the economic feasibility of this endeavour.
The social feasibility study was conducted to gauge public preparedness and support for a public SCB through patient interviews and questionnaires. The process was dynamic due to its novel nature for interviewers and interviewees alike. Many obstacles were met and dealt with which lead to the compilation of results discussed here in the form of a pilot social feasibility study. In the South African context, we are faced with unique and rich challenges relating to cultural and religious differences that are further augmented by linguistic constraints, educational insufficiencies and logistical and administrative limitations. Complicating factors encountered during the informed consent process included cultural differences, religious practices, traditions and superstitions together with language constraints and an educational disparity.
Despite many initial obstacles, preliminary results from the informed consent questionnaire were favourable with regard to the establishment of a public UCB SCB. These initial results prompted the revision of the questionnaire and interview process and the compilation of a more succinct and coherent definitive social feasibility study which will form a separate study and which we hope will ultimately assist in the decision of whether or not to establish a public UCB SCB in South Africa. Nevertheless, results from this pilot study appear to be favourable and highlight particular areas which could influence community support for a public SCB. Educating the general public with regard to the workings and benefits of public stem cell banking is the first step in determining the viability of such an undertaking â a unique and rich challenge in the South African context.Medical Research Council (MRC) and the Department of Immunology.http://link.springer.com/journal/12015hb2013ay201
A cross-sectional study on the relationship of age, gestational age and HIV infection to bacterial vaginosis and genital mycoplasma infection
OBJECTIVES : Pregnant women are especially at risk of
developing complications when infected with
reproductive tract infections (RTIs). The objective of
this study was to determine the prevalence of bacterial
vaginosis (BV) and genital mycoplasmas in pregnant
women and investigate the associations between BV,
genital mycoplasmas, HIV infection, age and
gestational age.
DESIGN : Cross-sectional study with descriptive and
analytical components.
SETTING : Antenatal clinic of a tertiary academic hospital
in South Africa.
PARTICIPANTS : 220 pregnant women older than 18
were included in the study and provided self-collected
vaginal swabs.
PRIMARY AND SECONDARY OUTCOMES : BV and genital
mycoplasma colonisation and/or infection in women of
differing age, gestational period and HIV status.
RESULTS : The prevalence of BV was 17.7% (39/220)
(95% CI 12.9 to 23.4), intermediate vaginal flora (IVF)
15% (33/220) (95% CI 10.56 to 20.42), and the
overall prevalence of genital mycoplasmas was 84%
(185/220) (95% CI 78.47 to 88.58). BV was
significantly associated with HIV infection with an OR
of 2.84 (95% CI 1.08 to 7.46 and p value=0.034).
However, BV was inversely associated with gestational
age with an OR of 0.08 (95% CI 0.01 to 0.42 and p value=0.003) for second trimester pregnancies and an
OR of 0.03 (95% CI 0.01 to 0.17 and p value<0.001)
for third trimester pregnancies using the first trimester
as reference. IVF was significantly associated with HIV
infection with an OR of 2.7 (95% CI 1.07 to 6.79 and
p value=0.035) but not with age or gestational age.
Genital mycoplasmas were not significantly associated
with age, gestational age, HIV status, BV flora or IVF.
CONCLUSIONS : The high infection rate of genital
mycoplasmas and the association of BV with HIV
found in this study reiterate the importance of
screening for these RTIs in high-risk groups such as
pregnant women.The
University of Pretoria and the Medical Research Council (South Africa).http://bmjopen.bmj.comam201
Growth forms of Gardnerella spp. and Lactobacillus spp. on vaginal cells
Bacterial vaginosis (BV) is a common vaginal condition in women of reproductive age.
During BV development, BV-associated bacteria may form a polymicrobial biofilm, which
predispose women to recurrent BV. The aim of the study was to investigate the growth
forms of Gardnerella spp. and Lactobacillus spp. and to determine the association
between the bacterial growth forms and clinical characteristics [urinary tract infection
(UTI) symptoms, human immunodeficiency virus (HIV) infection and abnormal vaginal
discharge] in women attending a tertiary hospital in Pretoria, South Africa. A first-void
urine specimen was collected from 196 women and BV was diagnosed using the
Nugent scoring and the Ison-Hay criteria (vaginal smear microscopy). Fluorescence in situ
hybridisation (FISH) was performed to classify the growth forms [âdispersedâ or âbiofilmâ].
Bacterial cells were categorized as âdispersedâ if cells were scattered separately and
as âbiofilmâ if bacterial aggregates on the vaginal epithelial cells were observed. BV
was detected in 52 women (52/196; 27%) and in these women, Gardnerella spp. were
predominantly present in biofilms (46/52; 88% for Nugent scoring; and 45/50; 90% for
Ison-Hay criteria), whereas Lactobacillus spp. were predominantly present in a dispersed
form (38/52; 73% for Nugent scoring; and 37/50; 74% for Ison-Hay criteria). The odds
of having BV increased when Gardnerella biofilms were present (p < 0.001), whereas the
opposite was observed for Lactobacillus biofilms (p = 0.001). Neither Gardnerella spp.
or Lactobacillus spp. (both dispersed or biofilms) had an association with the presence of
UTI symptoms, HIV coinfection or abnormal vaginal discharge. In conclusion, this study
demonstrated and confirmed that Gardnerella biofilms are associated with BV and that
Lactobacillus spp. may form biofilms to protect against BV.The Medical Research Council (MRC) of South Africa and National Health Laboratory Service (NHLS) of South Africa.http://frontiersin.org/Cellular_and_Infection_Microbiologypm2021Medical MicrobiologySchool of Health Systems and Public Health (SHSPH