Evaluation of the use of barrier contraceptives in women requesting termination of pregnancy at CHBAH

A RESEARCH REPORT SUBMITTED TO THE UNIVERSITY OF THE WITWATERSRAND IN FULFILLMENT OF THE MASTER OF MEDICINE DEGREEIntroduction South Africa has a high prevalence of unintended pregnancies and HIV. Sixty eight thousand women die due to unsafe abortion annually worldwide, making it a leading cause of maternal mortality. In SA the maternal mortality has decreased from TOP. Maternal mortality from HIV is the leading cause of maternal mortality in South Africa. Unintended pregnancies are mainly a consequence of inconsistent and incorrect contraceptive use. The condom is the only contraceptive method which has the dual ability of preventing HIV and unintended pregnancies. We postulate that the failure of barrier contraception is a risk for both HIV and unwanted pregnancy. This study describes the contraceptive methods used by women at a TOP clinic and evaluates the use of barrier contraceptives amongst women requesting TOP, and the prevalence of HIV. Methods CHBAH is tertiary hospital in Southern Gauteng. Women with medical or surgical comorbidities that request a TOP are referred to the hospital. A prospective study using a cross sectional study design was performed at the Chris Hani Baragwanath Academic Hospital TOP clinic between February and October 2011. Data was collected using interviews and medical files. Results One hundred and nineteen women were interviewed. Most women 56 (47.06%) did not use any contraception at the time of conception. The most common reason for TOP was financial constraints, followed by relationship conflict. Pregnancy despite condom use was 34.45% (n=41). The percentage of women with condom failure, who were HIV positive was 34.14% (n=14). True condom failure was experienced by 12 women (pregnancy due to breakage/slippage of the condom. Conclusion Unintended pregnancy is mainly associated with not using contraceptives. The male condom was the most widely used contraceptive. The HIV prevalence in the group with condom failure was higher than the general antenatal population. There is a need for education regarding correct and consistent use of contraception

Call for amendment of Declaration of Geneva of the World Medical Association

The Declaration of Geneva serves as a guide to ethical medical practice. It primarily addresses the duties of the physician in relation to an individual physician–patient relationship and implicitly advocates a ‘first come, first served’ model. It assumes the availability of adequate resources to treat all patients. However, no health system can meet all the requirements of its intended beneficiaries, and resource allocation, priority-setting and triaging are inevitable. Yet the Declaration of Geneva ‘does not permit considerations of age, disease or disability, gender …, social standing or any other factor’ to be considered. Neither does it permit consideration of ‘financial toxicity of treatment’ on patients, families and struggling healthcare systems. Making resource allocation, priority-setting, and triaging decisions is ethically complex. Yet in many resource-limited settings, such difficult and ethical judgement calls are left to individual physicians to make; this applies especially in low- and middle-income countries where practitioners are often faced with overwhelming burdens of disease and simply cannot treat everyone requiring care. The Declaration of Geneva should be amended to recognise limitations of physicians to deliver care because of health system constraints and should speak not only of a physician’s duty towards the individual patient but also to broader society. It should provide ethical guidance to those practising in limited resource settings about triaging, protecting elective care, ensuring training of well-rounded physicians, ensuring financial wellness of patients and healthcare systems and ensuring accountability for health and wellness of patients and healthcare systems

Stillbirth rate by maternal HIV serostatus and antiretroviral use in pregnancy in South Africa : an audit

The global perinatal mortality burden is high, with over 2.6 million stillbirths annually. The plurality (41%) of stillbirths occur in sub-Saharan Africa, which also has the highest HIV burden (20% prevalence) in the world. The extent to which these two phenomena are related has not been fully characterised.http://www.samj.org.zadm2022Obstetrics and Gynaecolog

Who seeks care after intimate partner violence in Cameroon? sociodemographic differences between a hospital and population sample of women

IntroductionLittle is known regarding health care seeking behaviors of women in sub-Saharan Africa, specifically Cameroon, who experience violence. The proportion of women who experienced violence enrolled in the Cameroon Trauma Registry (CTR) is lower than expected.MethodsWe concatenated the databases from the October 2017-December 2020 CTR and 2018 Cameroon Demographic and Health Survey (DHS) into a singular database for cross-sectional study. Continuous and categorical variables were compared with Wilcoxon rank-sum and Fisher's exact test. Multivariable logistic regression examined associations between demographic factors and women belonging to the DHS or CTR cohort. We performed additional classification tree and random forest variable importance analyses.Results276 women (13%) in the CTR and 197 (13.1%) of women in the DHS endorsed violence from any perpetrator. A larger percentage of women in the DHS reported violence from an intimate partner (71.6% vs. 42.7%, p<0.001). CTR women who experienced IPV demonstrated greater university-level education (13.6% vs. 5.0%, p<0.001) and use of liquid petroleum gas (LPG) cooking fuel (64.4% vs. 41.1%, p<0.001). DHS women who experienced IPV reported greater ownership of agricultural land (29.8% vs. 9.3%, p<0.001). On regression, women who experienced IPV using LPG cooking fuel (aOR 2.55, p = 0.002) had greater odds of belonging to the CTR cohort while women who owned agricultural land (aOR 0.34, p = 0.007) had lower odds of presenting to hospital care. Classification tree variable observation demonstrated that LPG cooking fuel predicted a CTR woman who experienced IPV while ownership of agricultural land predicted a DHS woman who experienced IPV.ConclusionWomen who experienced violence presenting for hospital care have characteristics associated with higher SES and are less likely to demonstrate factors associated with residence in a rural setting compared to the general population of women experiencing violence

National priorities for perioperative research in South Africa

BACKGROUND. Perioperative research is currently unco-ordinated in South Africa (SA), with no clear research agenda. OBJECTIVE. To determine the top ten national research priorities for perioperative research in SA. METHODS. A Delphi technique was used to establish consensus on the top ten research priorities. RESULTS. The top ten research priorities were as follows: (i) establishment of a national database of (a) critical care outcomes, and (b) critical care resources; (ii) a randomised controlled trial of preoperative B-type natriuretic peptide-guided medical therapy to decrease major adverse cardiac events following non-cardiac surgery; (iii) a national prospective observational study of the outcomes associated with paediatric surgical cases; (iv) a national observational study of maternal and fetal outcomes following operative delivery in SA; (v) a steppedwedge trial of an enhanced recovery after surgery programme for (a) surgery, (b) obstetrics, (c) emergency surgery, and (d) trauma surgery; (vi) a stepped-wedge trial of a surgical safety checklist on patient outcomes in SA; (vii) a prospective observational study of perioperativeoutcomes after surgery in district general hospitals in SA; (viii) short-course interventions to improve anaesthetic skills in rural doctors; (ix) studies of the efficacy of simulation training to improve (a) patient outcomes, (b) team dynamics, and (c) leadership; and (x) development and validation of a risk stratification tool for SA surgery based on the South African Surgical Outcomes Study (SASOS) data. CONCLUSIONS. These research priorities provide the structure for an intermediate-term research agenda.The workshop was funded by the Discipline of Anaesthesiology and Critical Care, University of KwaZulu-Natal.http://www.samj.org.zaam2016Anaesthesiolog

COVID-19 in pregnancy in South Africa : tracking the epidemic and defining the natural history

South Africa (SA) has seen a rapid increase in COVID-19 infections in recent weeks, with cases exceeding 40 000 in early June and anticipated to escalate rapidly as lockdown is eased. The country also has the largest HIV burden globally, and poor maternal and child health indices in many parts. Although early indications were that COVID-19 infection does not worsen pregnancy and birth outcomes, recent reports have raised fresh concerns. Preterm birth, neonatal pneumonia[9-11] and cases of vertical transmission and postpartum infections have been reported, including in SA. Some maternal deaths related to COVID-19 have occurred, possibly linked to haemodynamic changes immediately postpartum and/or to the thrombogenic nature of both pregnancy and COVID- 19. Maternal wellbeing in pregnant women with COVID-19 infection is a major concern, as these women often have high anxiety about infecting their newborn child, and may experience challenging interactions with healthcare providers and community stigma. Most evidence on COVID-19 and pregnancy to date is limited to case series, involves only symptomatic women without HIV, and is almost exclusively from high-income countries. Cohort data across a range of settings and population groups are the only means of fully understanding the natural history, clinical disease spectrum and risks of COVID-19 in pregnant women, fetuses and infants.http://www.samj.org.zaam2021Obstetrics and Gynaecolog

Determining the minimum dataset for surgical patients in Africa : a Delphi study

BACKGROUND : It is often difficult for clinicians in African low- and middle-income countries middle-income countries to access useful aggregated data to identify areas for quality improvement. The aim of this Delphi study was to develop a standardised perioperative dataset for use in a registry. METHODS : A Delphi method was followed to achieve consensus on the data points to include in a minimum perioperative dataset. The study consisted of two electronic surveys, followed by an online discussion and a final electronic survey (four Rounds). RESULTS : Forty-one members of the African Perioperative Research Group participated in the process. Forty data points were deemed important and feasible to include in a minimum dataset for electronic capturing during the perioperative workflow by clinicians. A smaller dataset consisting of eight variables to define risk-adjusted perioperative mortality rate was also described. CONCLUSIONS : The minimum perioperative dataset can be used in a collaborative effort to establish a resource accessible to African clinicians in improving quality of care.https://link.springer.com/journal/268AnaesthesiologySDG-03:Good heatlh and well-bein