A bird’s eye view of PMTCT coverage at two regional hospitals and their referral clinics in a resource-limited setting

Background. While countries strengthen their health information systems, local health managers require alternative strategies to monitor their prevention of mother-to-child (PMTCT) programmes to improve coverage and service delivery. Objective. To demonstrate the use of a postpartum audit to establish PMTCT coverage and programme deficiencies at hospitals and multiple primary health care facilities. Methods. A cross-sectional hospital-based medical chart audit of pregnant women admitted in labour to their regional hospital. Their antenatal hand-held medical records were added to a hospital-issued maternity chart that was used to record further obstetric and perinatal management during their hospital stay. Women recuperating in the postnatal wards up to 48 hours after delivery at two hospitals in KwaZulu-Natal participated. Data included their antenatal attendance, access to HIV counselling and testing (HCT), and access to nevirapine (NVP) for PMTCT. Results. Fifty-three clinics were indirectly evaluated as a result of the postpartum audit. All clinics provided HCT and the average HIV testing rate was 91% (range 40 - 100); 15% (N=8) of these clinics with HIV testing rates o

Birth outcomes following antiretroviral exposure during pregnancy : initial results from a pregnancy exposure registry in South Africa

CITATION: Mehta, U. C. et al. 2019. Birth outcomes following antiretroviral exposure during pregnancy : initial results from a pregnancy exposure registry in South Africa. Southern African Journal of HIV Medicine, 20(1):a971, doi:10.4102/sajhivmed.v20i1.971.The original publication is available at https://sajhivmed.org.zaBackground: In 2013, a pregnancy exposure registry and birth defects surveillance (PER/BDS) system was initiated in eThekwini District, KwaZulu-Natal (KZN), to assess the impact of antiretroviral treatment (ART) on birth outcomes. Objectives: At the end of the first year, we assessed the risk of major congenital malformations (CM) and other adverse birth outcomes (ABOs) detected at birth, in children born to women exposed to ART during pregnancy. Method: Data were collected from women who delivered at Prince Mshiyeni Memorial Hospital, Durban, from 07 October 2013 to 06 October 2014, using medicine exposure histories and birth outcomes from maternal interviews, clinical records and neonatal surface examination. Singleton births exposed to only one ART regimen were included in bivariable analysis for CM risk and multivariate risk analysis for ABO risk. Results: Data were collected from 10 417 women with 10 517 birth outcomes (4013 [38.5%] HIV-infected). Congenital malformations rates in births exposed to Efavirenz during the first trimester (T1) (RR 0.87 [95% CI 0.12–6.4; p = 0.895]) were similar to births not exposed to ART during T1. However, T1 exposure to Nevirapine was associated with the increased risk of CM (RR 9.28 [95% CI 2.3–37.9; p = 0.002]) when compared to the same group. Other ABOs were more frequent in the combination of HIV/ART-exposed births compared to HIV-unexposed births (29.9% vs. 26.0%, adjusted RR 1.23 [1.14–1.31; p < 0.001]). Conclusion: No association between T1 use of EFV-based ART regimens and CM was observed. Associations between T1 NVP-based ART regimen and CM need further investigation. HIV- and ART-exposed infants had more ABOs compared to HIV-unexposed infants.Publisher's versio

Multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa: An overview of patients’ reported knowledge and attitudes

Background: The incidence and prevalence of multidrug–resistant tuberculosis (MDR TB) in the province of KwaZulu-Natal, South Africa, are amongst the highest in the world. Previously, interventions have been largely biomedical based; however, there is growing opinion that interventions must include social aspects such as patient education and attitudes. Methods: This observational study assessed the knowledge and attitudes of 380 patients diagnosed with MDR TB at a centralised MDR TB unit in Durban. Data were collected using a questionnaire that was distributed to every third patient attending the outpatient MDR TB clinic. Data were collected over an 8-week period and analysed descriptively. Results: Just under half of the respondents had primary MDR TB. Most respondents were young, female unemployed and did not receive a social grant. Knowledge around diagnosis of MDR TB was generally adequate. There were important misconceptions about spread of the disease and duration of treatment. Most respondents received knowledge of MDR TB from healthcare workers. Some respondents received knowledge from friends, family and Sangomas and believed that the disease was caused by bewitchment or as a form of punishment. Discussion: The need for strengthening the role of primary care physicians in promoting education and providing support is highlighted. Further study is needed to investigate the high rate of primary MDR TB and to identify the unique challenges faced by women who have MDR TB. Future research could include the possibility of involving traditional healers in a contextually sensitive MDR TB education, training and support programme

Association between HIV Disease Stage and Anaemia in Pregnancy and Postdelivery.

<p>Association between HIV Disease Stage and Anaemia in Pregnancy and Postdelivery.</p

Obstetric and Infant Outcomes in Association with Anaemia in Pregnancy.

<p>Obstetric and Infant Outcomes in Association with Anaemia in Pregnancy.</p

Anaemia in pregnancy, within 72 hours of delivery and 2 weeks post delivery.

<p>*Microcytic Anaemia: Mean Corpuscular Volume (MCV) <83fL.</p><p>Normocytic Anaemia: Mean Corpuscular Volume (MCV) 83–101 fL.</p><p>Macrocytic Anaemia: Mean Corpuscular Volume (MCV) >101 fL.</p><p>Anaemia in pregnancy, within 72 hours of delivery and 2 weeks post delivery.</p

Prevalence, incidence and recovery of anaemia in pregnancy, within 72 hours postpartum and day 14 postdelivery.

<p>Prevalence, incidence and recovery of anaemia in pregnancy, within 72 hours postpartum and day 14 postdelivery.</p

Anaemia in Association with Antiretroviral Use and HIV Disease Stage (CD4 Count <200 cells/mm³).

<p>Anaemia in Association with Antiretroviral Use and HIV Disease Stage (CD4 Count <200 cells/mm³).</p