Women's experiences of pregnancy, childbirth, and the postnatal period in the Gambia: A qualitative study

Objective: In sub-Saharan African countries, there are unique cultural factors and adverse physical conditions that contribute to women's experiences of pregnancy and birth. The objective of this study was to qualitatively explore women's experiences of pregnancy, childbirth, the postnatal period, and maternal psychological distress in The Gambia. Design and methods: Semi-structured interviews were carried out with 55 women who had given birth within the previous year. Results: Thematic analysis identified five themes: (1) transition to adulthood, (2) physical difficulties, (3) value of children in relation to others, (4) children as a strain, and (5) going through it alone. The results suggest that having a child is a defining point in women's lives associated with happiness and joy. However, women also described situations which could lead to unhappiness and distress in the perinatal period. A child conceived out of wedlock or a baby girl can be sources of distress because of negative cultural perceptions. The strain of having a child, particularly the additional financial burden, and minimal support from men were also a concern for women. Finally, women recognized the danger associated with delivery and expressed recurrent worries of complications during childbirth which could result in the death of them or the baby. Conclusions: Further research is needed to identify women vulnerable to psychological distress so that health services and target interventions can be developed accordingly

Observational study of vaccine efficacy 24 years after the start of hepatitis B vaccination in two Gambian villages: no need for a booster dose.

OBJECTIVES: To determine the duration of protection from hepatitis B vaccine given in infancy and early childhood and asses risk factors for HBV infection and chronic infection. METHODS: In 1984 infant HBV vaccination was started in two Gambian villages. Cross sectional serological surveys have been undertaken every 4 years to determine vaccine efficacy. In the current survey 84.6% of 1508 eligible participants aged 1-28 years were tested. A spouse study was conducted in females (aged 14 years and above) and their male partners. RESULTS: Vaccine efficacy against chronic infection with hepatitis B virus was 95.1% (95% confidence interval 91.5% to 97.1%), which did not vary significantly between age groups or village. Efficacy against infection was 85.4% (82.7% to 87.7%), falling significantly with age. Concentrations of hepatitis B antibody fell exponentially with age varying according to peak response: 20 years after vaccination only 17.8% (95% CI 10.1-25.6) of persons with a low peak response (10-99 mIU/ml) had detectable HBs antibody compared to 27% (21.9% to 32.2%) of those with a high peak response (>999 mIU/ml). Time since vaccination and a low peak response were the strongest risk factors for HBV infections; males were more susceptible, marriage was not a significant risk for females. Hepatitis B DNA was not detected after infection, which tested soley core antibody positive. An undetectable peak antibody response of <10 mIU/ml and a mother who was hepatitis B e antigen positive were powerful risk factors for chronic infection. CONCLUSIONS: Adolescents and young adults vaccinated in infancy are at increased risk of hepatitis B infection, but not chronic infection. Married women were not at increased risk. There is no compelling evidence for the use of a booster dose of HBV vaccine in The Gambia

Probability of remaining anti-HBs positive by time since vaccination and peak response for HBsAb.

<p>Table shows number at risk, number of subjects with undetectable HBsAb (HBsAb <10), and the percent of subjects with detectable HBsAb (HBsAb>9) at 0, 5, 10, 15, 20 and 23 years post-infant vaccination, by HBsAb peak response category (10–99, 100–999, >999).</p

Probability of remaining uninfected (as determined by lack of anti-HBc) by time since vaccination and peak response for anti-HBs (1256 individuals).

<p>Table shows number of subjects at risk, number of subjects with HBV infection, and the percent of subjects remaining uninfected at 0, 5, 10, 15, 20 and 23 years post-infant vaccination, by HBsAb peak response category (<10, 10–99, 100–999, >999).</p

Risk factors for HBV infections.

<p>The analysis includes 1040 subjects; 211 out of the 1251 subjects were missing information on peak bleed.</p

Frequency of HBV infection and chronic infection in 2008, by age group and village, among all vaccinated subjects (regardless of peak bleed).

<p>Frequency of HBV infection and chronic infection in 2008, by age group and village, among all vaccinated subjects (regardless of peak bleed).</p

Decrease in antibody to hepatitis B surface antigen (anti-HBs) by time since vaccination, and peak anti-HBs response (mlU/mL).

<p>Decrease in antibody to hepatitis B surface antigen (anti-HBs) by time since vaccination, and peak anti-HBs response (mlU/mL).</p