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

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

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

The impact of COVID-19 on obstetrics and gynaecology care

The COVID-19 pandemic is the biggest global disturbance in living memory. Much debate has focused on economic outlay to various communities or groups by governments and health services, including access to personal protective equipment (PPE), and interventions to prevent transmission. Following the outbreak in early March 2020, South Africa, along with many other countries, is now in the midst of a 'second wave' of COVID-19 infections. The virus has forced us to question the evidence for the 'scientific' advice that is given to politicians and society. Predictions of the extent of COVID-19, for example, have often been based on calculations founded on statistical modelling, and not actual trends. This has produced diverse predictions, and may have fostered mistrust and fear among clinicians as well as society at large. One issue raised by the current COVID-19 pandemic is the conflict that exists between the needs to protect health and to preserve the economy. If simply applying maximum safety was the overriding consideration for COVID-19, all populations would be living and working from their homes and segregated from one another to prevent transmission. However, the world is based on an economic system, and no individual, family, section of society, community, region or nation can survive without resources. For many, those resources are acquired in the short term, and not stored.http://sajog.org.za/index.php/SAJOGhj2021Obstetrics and Gynaecolog

Clinical profiles of individuals with orofacial clefts: Results from fourteen Eastern African countries.

Background: More than 100,000 cleft lip and palate patients have benefited from reconstructive surgeries in Africa because of surgical support from non-governmental organizations such as Smile Train. The Smile Train Express is the largest cleft-centered patient registry with over a million records of clinical records, globally. In this study, we reviewed data from the Eastern African patient registry to analyze and understand the clinical profiles of cleft lip and palate patients operated at Smile Train partner hospitals in East Africa. Method: A cross-sectional study design was undertaken through a retrospective database review in fourteen Eastern African countries. The study population included all patients who had cleft lip and palate surgeries recorded in the Smile Train database between 2001 and 2019. Findings: 86,683 patient records from 14 Eastern African countries were included in this study. The mean age was (8.8), the mean weight was 22.3 kg and 20.8 kg for males and females, respectively, and 61.9% of the surgeries were performed on male patients. Left cleft lip and palate (21,062, 24.62%) and left cleft lip only (17,155, 20.05%) were the most common types of clefts, with bilateral cleft lip only (3958, 4.63%) being the least frequent. complete left cleft lip with complete left alveolus was the most frequent cleft combination observed (n = 21,746) and Cleft lip to cleft lip and palate to cleft palate ratio (CL:CLP: CP) was 4.73:7.1:1. Unilateral primary lip-nose repairs were the most common surgeries (66%). General anesthesia was used for 74,783 (86.2%) of the procedures. Interpretation: Most children with cleft lip and/or palate were underweight, possibly due to malnutrition or related to socioeconomic status. There were more male patients compared to females, which could be related to gender disparities. Access to surgical care for children born with congenital defects needs to be improved, and inequities need to be addressed via more evidence-based collaborative intervention strategies. Funding: Non