Analysis of caesarean section and neonatal outcome using the Robson classification in a rural district hospital in Tanzania: An observational retrospective study

OBJECTIVE: Caesarean section (CS) rates have increased worldwide in recent decades. In 2015, the WHO proposed the use of the 10-group Robson classification as a global standard for assessing, monitoring and comparing CS rates both within healthcare facilities over time and between them. The aim of this study was to assess the pattern of CS rates according to the Robson classification and describe maternal and perinatal outcomes by group at the Tosamaganga Hospital in rural Tanzania. DESIGN: Observational retrospective study. SETTING: St. John of the Cross Tosamaganga Hospital, a referral centre in rural Tanzania. PARTICIPANTS: 3012 women who gave birth in Tosamaganga Hospital from 1 January to 30 June 2014 and from 1 March to 30 November 2015. RESULTS: The overall CS rate was 35.2%, and about 90% of women admitted for labour were in Robson groups 1 through 5. More than 40% of the CS carried out in the hospital were performed on nulliparous women at term with a single fetus in cephalic presentation (groups 1 and 3), and the most frequent indication for the procedure was previous uterine scar (39.2%). The majority of severe neonatal outcomes were observed in groups 1 (27.7%), 10 (24.5%) and 3 (19.1%). CONCLUSION: We recorded a high CS rate in Tosamaganga Hospital, particularly in low-risk patients groups (Robson groups 1 and 3). Our analysis of Robson classification and neonatal outcomes suggests the need to improve labour management at the hospital and to provide timely referrals in order to prevent women from arriving there in critical conditions

Factors associated with mortality among asphyxiated newborns in a low-resource setting

Objective: Neonatal asphyxia accounts for a quarter of neonatal deaths. We aimed to assess factors associated with mortality among asphyxiated neonates in a low-resource setting. Methods: A retrospective observational study evaluating all neonates who were admitted for asphyxia to the Neonatal Intensive Care Unit (NICU) at Tosamaganga Hospital (Tanzania) in 2017\u20132018. Inclusion criteria were: Apgar score <7 at 5 min and/or failure to initiate spontaneous breathing and/or presence of sentinel events and/or clinical signs suggesting encephalopathy not explained by other obvious factors or early convulsions. Newborns with congenital malformations, birth weight <2000 g or those who died in the delivery room were excluded. Results: NICU admission for perinatal asphyxia was 17.5%. In 169 neonates, mortality rate was 23% and was associated with being outborn, low 5-minute Apgar score, depressed clinical status at NICU admission, occurrence of infection or seizures within 24 h from admission, and receiving aminophylline during the hospital stay. Conclusions: Perinatal asphyxia was responsible for a relevant proportion of NICU admissions and neonatal deaths in a low-resource setting. Appropriate clinical examination remains the main asset in settings with limited availability of diagnostic tools. Improvements in antenatal and perinatal care are needed to reduce mortality in asphyxiated newborns. Future studies should assess long-term outcome in survivors

The impact of the COVID-19 pandemic on health service use in sub-Saharan Africa

SETTING: Six hospitals in four sub-Saharan African countries.OBJECTIVE: To examine the indirect effects of COVID-19 on health service utilisation and to explore the risk of bias in studies on prediction models.DESIGN: Monthly data were analysed using interrupted time-series modelling. We used linear mixed-effect models for the analysis of antenatal care visits, institutional deliveries, vaccinations, outpatient visits and hospital admissions, and generalised linear mixed-effect models for hospital mortality.RESULTS: During 2018-2020, the six hospitals recorded a total of 57,075 antenatal care visits, 38,706 institutional deliveries, 312,961 vaccinations, 605,925 outpatient visits and 143,915 hospital admissions. The COVID-19 period was associated with decreases in vaccinations (-575 vaccinations, P < 0.0001), outpatient visits (-700 visits, P < 0.0001) and hospital admission (-102 admission, P = 0.001); however, no statistically significant effects were found for antenatal care visits (P = 0.71) or institutional deliveries (P = 0.14). Mortality rate increased by 2% per month in the pre-COVID-19 period; however, a decreasing trend (by 2% per month) was observed during the COVID-19 period (P = 0.004). Subgroup and sensitivity analyses broadly confirmed the main findings with only minor inconsistencies. A reduction in outpatient visits was also observed in hospitals from countries with a higher Stringency Index and in urban hospitals.CONCLUSIONS: The pandemic resulted in a reduction in health service utilisation. The decreases were less than anticipated from modelling studies

Medical Electives in Sub-Saharan Africa: A 15-Year Student/NGO-Driven Initiative

Medical schools are developing global health programmes, and medical students are requesting global health training and creating opportunities when these are not provided by medical schools. This article described the Wolisso Project (WP), a medical experience on clinical electives in Sub-Saharan Africa, driven by a collaboration between a student organisation and a Nongovernmental Organization (NGO). Preclinical medical students spent 4 weeks as part of a multidisciplinary medical team in Africa. Post-elective questionnaires were administered to all subjects who participated in the project. Of all, 141 students responded to the questionnaire. The participants came from 30 Italian universities. The main difficulties reported are due to the lack of resources for the exercise of the medical activity, and difficulties related to language and communication. The African experience had a positive impact on the progress of the studies upon return, with an increase in determination and motivation. The experience had also positive influences on the future professional choices and carriers. The experience seems to contribute not only to the professional growth, but also to the personal development. A key factor in the positive outcomes of this experience is it being implemented by an NGO with long-term working relationships with the African populations. Another is that the project is carried out in health facilities where NGO staff have been working for a long time. These factors reduce the potential risks connected with this type of experience. They ensure a satisfactory level of supervision, the lack of which has been a serious problem in many similar experiences. A well-structured, mentored experience in international health can have a positive impact on preclinical students' attitudes, including their compassion, volunteerism, and interest in serving underserved populations. Only a small number of Italian universities facilitate pre-graduate medical elective experiences in LMICs. The WP seems to be attempting to compensate for the lack of international experience in LMICs offered by universities. Italian medical schools should incorporate changes in their curricula to train socially responsible physicians

The impact of the COVID-19 pandemic on health service use in sub-Saharan Africa

SETTING: Six hospitals in four sub-Saharan African countries. OBJECTIVE: To examine the indirect effects of COVID-19 on health service utilisation and to explore the risk of bias in studies on prediction models. DESIGN: Monthly data were analysed using interrupted time-series modelling. We used linear mixed-effect models for the analysis of antenatal care visits, institutional deliveries, vaccinations, outpatient visits and hospital admissions, and generalised linear mixed-effect models for hospital mortality. RESULTS: During 2018–2020, the six hospitals recorded a total of 57,075 antenatal care visits, 38,706 institutional deliveries, 312,961 vaccinations, 605,925 out-patient visits and 143,915 hospital admissions. The COVID-19 period was associated with decreases in vacci-nations (− 575 vaccinations, P < 0.0001), outpatient visits (− 700 visits, P < 0.0001) and hospital admission (− 102 admission, P = 0.001); however, no statistically significant effects were found for antenatal care visits (P = 0.71) or institutional deliveries (P = 0.14). Mortality rate increased by 2% per month in the pre-COVID-19 period; however, a decreasing trend (by 2% per month) was observed during the COVID-19 period (P = 0.004). Subgroup and sensitivity analyses broadly confirmed the main findings with only minor inconsistencies. A reduction in outpatient visits was also observed in hospitals from countries with a higher Stringency Index and in urban hospitals. CONCLUSIONS: The pandemic resulted in a reduction in health service utilisation. The decreases were less than anticipated from modelling studies

Progress towards rabies elimination from Pemba Island, Southern Tanzania.

Online Journal of Public Health Informatics. Volume 9(1); 2017Using active surveillance approaches to investigate the transmission dynamics of rabies on Pemba Island and across Southern Tanzania, whilst a large-scale dog vaccination program was underway1 , to gain a greater understanding of the dynamics of infection as the disease is driven towards eliminatio

On Stirling functions of second kind

SIGLETIB Hannover: RN 5141(373) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Mobile phones as potential tools for surveillance in Tanzania.

<p>(A) Access and use of mobile phones versus computers by surveillance system users and 95% confidence intervals. The effects are shown of user (B) age and (C) self-reported use of text messaging (short message service or SMS), on the standardized time to complete surveillance forms on mobile phones, with boxes shaded in proportion to the sample size in the group (<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002002#pmed.1002002.s002" target="_blank">S2 Data</a>). Time to completion in minutes was standardized by computing z-scores by sector, because forms used by health workers for recording bite patients were longer than forms used by livestock field officers to record mass dog vaccination campaigns (<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002002#pmed.1002002.s005" target="_blank">S3 Table</a>, <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002002#pmed.1002002.s008" target="_blank">S1 Text</a>). (D) Number and percentage of mobile phone form submissions where helpline support was used (<8% overall and <3% for the most commonly used form, that for bite patient records, data in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002002#pmed.1002002.s003" target="_blank">S1 Table</a>). Additional forms submitted by staff involved in system development and therefore familiar with the mobile phone application were excluded.</p

Example of mobile phone surveillance application.

<p>Mobile phone interface showing form being (A) completed for an example bite patient and (B) submitted.</p

The mobile-phone–based surveillance system.

<p>In the map, blue dots represent facilities that provide post-exposure prophylaxis (PEP) and report using the surveillance system (large dots represent hospitals, small dots represent health centres). The map is shaded by population density with wildlife-protected areas in white. The panels illustrate example surveillance data (<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002002#pmed.1002002.s001" target="_blank">S1 Data</a>) from different districts that are annotated on the map by their initials. These data show monthly incidence of bite patients per 100,000 people on Pemba Island (P) and Ulanga (U), PEP use and shortages for Kibaha rural (KR) and Kisarawe (K), progress switching from intramuscular (IM) to intradermal (ID) administration of PEP for Morogoro rural (MR) and Rufiji (R), and numbers of dogs vaccinated each month for Nachingwea (N) and Masasi (M).</p