Accuracy of sonographic lower segment thickness and prediction of vaginal birth after caesarean in a resourced‐limited setting; Prospective study

Objectives: To assess the accuracy of ultrasound measurement of the lower uterine segment (LUS) thickness against findings at laparotomy, and to investigate its correlation with the success rate of vaginal birth after one previous caesarean delivery (CD) in a resource‐limited setting. Design: Prospective study. Setting: Obstetrics and Gynaecology department in a tertiary hospital in Ghana. Population: Women with one previous CD undergoing either a trial of labour (TOLAC) or elective CD. Methods: Myometrial lower uterine segment thickness (mLUS) and full lower uterine segment thickness (fLUS) were measured with transvaginal ultrasound (TVUS). The women were managed according to local protocols with the clinicians blinded to the ultrasound measurements. The LUS was measured intraoperatively for comparison with ultrasound measurements. Main outcome measures: Lower uterine segment findings at laparotomy, successful vaginal birth. Results: A total of 311 pregnant women with one previous CD were enrolled; 147 women underwent elective CD and 164 women underwent a TOLAC. Of the women that underwent TOLAC, 96 (58.5%) women had a successful vaginal birth. The mLUS was comparable to the intraoperative measurement in the elective CD group with LUS thickness <5 mm (bias of 0.01, 95% CI −0.10 to 0.12 mm) whereas fLUS overestimated LUS <5 mm (bias of 0.93, 95% CI 0.80–1.06 mm). Successful vaginal birth rate correlated with increasing mLUS values (odds ratio 1.30, 95% CI 1.03–1.64). Twelve cases of uterine defect were recorded. LUS measurement ≤2.0 mm was associated with an increased risk of uterine defects with a sensitivity of 91.7% (95% CI 61.5–99.8%) and specificity of 81.8% (95% CI 75.8–86.8%). Conclusion: Accurate TVUS measurement of the LUS is technically feasible in a resource‐limited setting. This approach could help in making safer decisions on mode of birth in limited‐resource settings

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Etude sur l’utilisation de Primolut N comme un comprimé contraceptif dans la métropole de Kumasi au Ghana.

This study investigated the use of Primolut N tablet which contains norethisterone 5mg popularly called N- tablet by users as a precoital contraceptive by women in the Kumasi metropolis of Ghana. Clients who called at any of the twenty (20) selected Pharmacies in residential areas within the Kumasi metropolis demanding the drug, with or without valid prescriptions were interviewed using a guide. Of the two hundred and twenty (220) users interviewed, 94% demanded the drug for contraception and 6% for menstrual disorders. Sixty one percent of those demanding it for contraception were between the ages 20-25 years. Respondents preferred the use of norethisterone tablets as a contraceptive to other methods because it worked for them and they also found it easy and convenient taking a tablet just before coitus than taking daily oral contraceptive pills. Norethisterone is being used as a pre-coital contraceptive, though the efficacy, safety and reliability of the drug for that purpose is unknown. Until these are known, women must be discouraged from using the drugCette étude a examiné l’utilisation de Primolut N (comprimé) qui contient la noréthistérone 5mg et qui est communément connue comme le comprimé N par les usagers comme un contraceptif pré coïtal dans la métropole au Ghana. Les clients qui se sont présentées à n’importe quelle pharmacie parmi les vingt (20) pharmacies dans les quartiers résidentiels au sein de la métropole de Kumasi pour chercher le médicament avec ou sans l’ordonnance valable, ont été interrogées à l’aide d’un guide. Sur les deux cent vingt (220) usagères interrogées, 94% ont demandé le médicament pour la contraception et 6% pour les troubles menstruels. Soixante et un pour cent de celles qui le demandaient pour la contraception étaient âgées d’entre 20 et 25 ans. Les interrogées préféraient utiliser les comprimés de la noréthistérone comme contraceptif par rapport aux autres méthodes parce qu’il a marché pour elles et elles le trouvaient facile et plus convenable de prendre des pilules contraceptives orales tous les jours. La noréthistérone est utilisée comme un contraceptif pré coïtal, bien que l’efficacité, la sureté et la fiabilité du médicament ne soient pas connues. Il faut décourager les femmes d’utiliser le médicament jusqu’à ce qu’on se renseigne sur ces détail

Etude sur l’utilisation de Primolut N comme un comprimé contraceptif dans la métropole de Kumasi au Ghana.

This study investigated the use of Primolut N tablet which contains norethisterone 5mg popularly called N- tablet by users as a precoital contraceptive by women in the Kumasi metropolis of Ghana. Clients who called at any of the twenty (20) selected Pharmacies in residential areas within the Kumasi metropolis demanding the drug, with or without valid prescriptions were interviewed using a guide. Of the two hundred and twenty (220) users interviewed, 94% demanded the drug for contraception and 6% for menstrual disorders. Sixty one percent of those demanding it for contraception were between the ages 20-25 years. Respondents preferred the use of norethisterone tablets as a contraceptive to other methods because it worked for them and they also found it easy and convenient taking a tablet just before coitus than taking daily oral contraceptive pills. Norethisterone is being used as a pre-coital contraceptive, though the efficacy, safety and reliability of the drug for that purpose is unknown. Until these are known, women must be discouraged from using the drugCette étude a examiné l’utilisation de Primolut N (comprimé) qui contient la noréthistérone 5mg et qui est communément connue comme le comprimé N par les usagers comme un contraceptif pré coïtal dans la métropole au Ghana. Les clients qui se sont présentées à n’importe quelle pharmacie parmi les vingt (20) pharmacies dans les quartiers résidentiels au sein de la métropole de Kumasi pour chercher le médicament avec ou sans l’ordonnance valable, ont été interrogées à l’aide d’un guide. Sur les deux cent vingt (220) usagères interrogées, 94% ont demandé le médicament pour la contraception et 6% pour les troubles menstruels. Soixante et un pour cent de celles qui le demandaient pour la contraception étaient âgées d’entre 20 et 25 ans. Les interrogées préféraient utiliser les comprimés de la noréthistérone comme contraceptif par rapport aux autres méthodes parce qu’il a marché pour elles et elles le trouvaient facile et plus convenable de prendre des pilules contraceptives orales tous les jours. La noréthistérone est utilisée comme un contraceptif pré coïtal, bien que l’efficacité, la sureté et la fiabilité du médicament ne soient pas connues. Il faut décourager les femmes d’utiliser le médicament jusqu’à ce qu’on se renseigne sur ces détail

Assessment of â freshâ versus â maceratedâ as accurate markers of time since intrauterine fetal demise in lowâ income countries

ObjectiveTo compare provider assessment of fetal maceration with deathâ toâ delivery interval to evaluate the reliability of appearance as a proxy for time of death.MethodsCohort chart abstraction was performed for all stillbirth deliveries at or above 28 weeks of gestation during a 1â year period in a teaching hospital in Ghana.ResultsOf 470 stillborn infants, 337 had adequate data for analysis. Of 47 fetuses alive on admission with deathâ toâ delivery intervals estimated to be less than 8 hours (expected to be reported as fresh), 14 (30%) were actually reported as macerated. Of 94 cases in which the fetus was deceased on admission with deathâ toâ delivery interval of more than 8 hours (expected to be macerated), 17 (18%) were described as fresh.ConclusionProvider description of fetal appearance may be an unreliable indicator for time since fetal death. The findings have significant implications for stillbirth prevention and assessment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135680/1/ijgo223.pd

Seroprevalence of Taenia solium and Trichinella spiralis among Humans and Pigs in Ghana

In this study, the seroprevalence of the intestinal worms Taenia solium and Trichinella spiralis in humans and pigs was assessed. A cross-sectional serological study design was performed. Blood samples were collected from 322 humans and 245 pigs used in the study. These were tested for markers of antibodies for Taenia solium and Trichinella spp. Demographic data such as sex, age, education, pig farming practices, and water source used were also obtained. An overall seroprevalence of 3.1% was recorded for Taenia solium in humans. There was also a statistical association between pig management system employed by pig farmers and seropositivity to Taenia solium ( p = 0.005 ). Factors such as mode of waste disposal ( p = 0.003 ) and water source used statistically correlated with Taenia solium seroprevalence among humans. For the pig samples, a Taenia solium seroprevalence of 24.9% was recorded. All the pig samples which tested positive for Taenia solium were reared on the free-ranged system. This study also recorded a seroprevalence of 0.31% for Trichinella spp. for humans and a seroprevalence of 4.5% for Trichinella spp. for pigs. Again, all the samples that showed serological evidence of Trichinella spp. among pigs came from those pigs which were raised on the free-ranged system. Proper pig management practice is a very important tool for controlling these intestinal parasites in both humans and animals. This study recommends public health education among the general public and good pig farming practices.</jats:p

Knowledge, Attitude, and Practice of Geriatric Care Among Health Care Professionals in Kumasi, Ghana

Background: The Ghanaian elderly population is increasing at the fastest rate and this has become a burden as the rate is not proportional to the investment in health to meet their deteriorating health needs. This creates discrepancies and inequalities in healthcare access and coupled with poor healthcare provider services, the inequalities widen. Poor care services are related to poor knowledge and bad attitudes of care providers hence this study seeks to explore the health practitioners’ level of knowledge, attitude, and practice (KAP) toward geriatric care. Methods: The study used a cross-sectional survey design with a simple stratified random technique to select study participants. Out of 257 participants who were sampled for the study, 215 responses were received, representing 83.6% response rate. However, 200 questionnaires were complete (93%) and valid for analysis, which consisted of 166 nurses, representing 83% valid responses, and 34 medical officers, physician assistants, and other allied health care providers, representing 17% valid responses from these professionals. A structured questionnaire was used to assess KAP using the knowledge about Older Patients Quiz (KOP-Q) and Kogan’s Attitudes toward Old People Scale (KAOP). Using a mean score of 80%, knowledge, attitude, and practice were dichotomized into good or bad. The Kruskal-Wallis H test was used to compare mean rank across health professionals’ knowledge, attitude, and practice of geriatric care. Results: It shows that the majority (94%) of participants have low levels of knowledge in geriatric care. The majority (84%) of participants do not practice good geriatric care. Differences in knowledge exist among health providers and were statistically significant ( P  = .045). Doctors had the lowest mean knowledge score (78.61). Nurses (100.27) and physician assistants (106.15) had moderate mean knowledge score ranks. Although not statistically significant, the rank order for practice scores from highest to lowest was: physician assistants (112.95), nurses (99.19), and doctors (79.21). There were however no statistically significant differences between professions in practice scores ( P  = .067), or attitude scores ( P  = .097). Conclusion: Health care providers have low knowledge and, bad attitude toward aged care and this may be related to their service delivery which may affect the aged patronage of healthcare services. This is a wake-up call for authorities to organize continuous professional development to enable care providers to improve their service delivery

Factors influencing women’s satisfaction with well-woman services at the Manhyia Government Hospital, Ghana

Introduction: The provision of well-woman services to women is a very good intervention for promoting good health and well-being among women. Despite data needed to inform increasing accessibility to well-woman services, there is limited information about client’s satisfaction with well-woman services. Objective: This study was conducted to determine factors influencing women’s satisfaction with well-woman services at Manhyia Government Hospital. Design: An analytical cross-sectional study was conducted among women attending the well-woman clinic at the Manhyia Government Hospital, Kumasi from 10 May 2023 to 15 November 2023. Methods: A systematic sampling method was employed. A pretested structured questionnaire was used to collect data on participants’ socio-demographic and clinical characteristics, health-facility-related factors, barriers to utilization and client satisfaction. A face-to-face interview was conducted for every woman included in the study. Data were analyzed using multivariable logistic regression analysis. p -Value for statistical significance was set at p  < 0.05. Results: Of the 344 women who were recruited for the study, majority (65.7%) of them were satisfied with care at the well-woman clinic. About 59.3% of the women were willing to continue care at the clinic. The age range was 18–60 with mean of 34.6 ± 12.0 years. Some of the challenges the women reported in accessing well-woman services at the clinic included long waiting times (17.7%) and inadequately skilled staff (8.1%). After adjusting for significant variables in the multivariable logistic regression analysis (adjusted odds ratio (AOR)), comfortability of the waiting area (AOR: 7.71, 95% CI: 1.54–38.60), <6 months duration of accessing care (AOR: 8.82, 95% CI: 3.25–23.98) and friendly attitude of health workers (AOR: 27.03, 95% CI: 4.28–170.83) were significantly associated with the client’s satisfaction with well-woman services. Conclusion: There was high satisfaction with well-woman services at the clinic, and this was associated with factors such as duration of service, comfortability of the waiting area and the attitude of health workers. Training more skilled staff and expanding the clinic will help improve well-woman services