Audit of Antenatal Care at a Rural District of KZN, South Africa

Background: Maternal and perinatal mortality remain a big challenge in developing countries, including South Africa, where the figures are amongst the highest in the world. Provision of adequate antenatal care is regarded as a cornerstone of maternal and perinatal health care and is expected to have a considerable impact on achieving the Millennium Development Goals. The detection of high-risk pregnancies through antenatal care has been advocated as a good tool to reduce maternal mortality in developing coun- tries. The South African Government\'s response in terms of providing free maternal care in public health facilities is commendable but access to quality antenatal care is still questionable. We conducted this audit to evaluate the quality of antenatal care/services provided against the set national standards at the first (booking) visit, and visits at 28 and 36 weeks of gestation, as part of a quality improvement initiative.Methods: A retrospective cross-sectional descriptive study was undertaken, targeting women who attended public health institutions for antenatal care in the Empangeni sub-district of Uthungulu, which is a health district in KwaZulu-Natal province. Data were collected from 244 pregnant mothers\' antenatal care records after delivery, and a random selection from a total of 5 109 women who delivered in Empangeni hospital during July to December 2004. Frequency tables were produced on the predetermined selective antenatal care indicators. A Pearson correlation test was conducted to determine the significant relations, if any, among variables. Results: The majority of the pregnant mothers were unemployed and poor. Virtually all of them (99.6%) had attended public healthcare (PHC) facilities for antenatal care (88% attended PHC clinics and the rest attended hospitals) and each woman had, on average, six antenatal visits. One quarter did not enrol for a prevention of mother-to-child transmission (PMTCT) programme. Only 9% of pregnant women booked a visit during their first trimester period but most of them (two-thirds) booked a visit during the second trimester of pregnancy. History-taking was done for every woman. Recording of haemoglobin (Hb) estimation was high at the first visit (95%) but low at 28 and 36 weeks (46% and 30% respectively). Recording of syphilis screening was very low (18%) at the first visit and only 2% was screened at 36 weeks. Only 16% received adequate treatment in cases where the results were positive. At 36 weeks, only 2% had a Wasserman reaction (WR) test done to screen syphilis at term. Over half (55%) of the pregnant women received three doses of tetanus toxoid vaccination before delivery. Conclusion: The study showed that the standard of antenatal care offered in the Empangeni sub-district fell short of the required level. This lack of proper care represents missed opportunities to impact optimally on maternal and perinatal health outcomes. Thus strategies are urgently needed to improve antenatal care through a quality improving initiative. South African Family Practice Vol. 50 (3) 2008: pp. 66-66

Risk Factors for Anaemia in Pregnancy in Rural KwaZulu-Natal – South Africa: Implication for Health Education and Health Promotion

Background: Anaemia in pregnancy is a major public health problem in developing countries. It is associated with an increased risk of maternal and perinatal morbidity and mortality. A high rate of anaemia in pregnancy in the rural population of KwaZulu-Natal (30% according to national and 57% according to the World Health Organization [WHO] definition of anaemia in pregnancy) is observed. The risk factors for anaemia, particularly during pregnancy, are multiple and complex and their relative contributions are known to vary by geographic areas and by seasons. In order to design an intervention for treatment and prevention of anaemia in pregnancy, studies to assess the aetiological factors are necessary. The aim of this study was to evaluate the strength of association between intestinal helminthiasis, urinary schistosomiasis and HIV infection on anaemia in pregnancy.Methods: A retrospective case-control study design was used in a rural district hospital of South Africa. A total of 300 pregnant women, 100 of them with anaemia (haemoglobin less than 10 gm/dL according to the national definition of anaemia in pregnancy) referred as cases and 200 controls were studied from Empangeni Hospital. Both cases and controls were matched for age, parity and gestational age. Data were collected from the antenatal clinic and prevention of mother-to-child transmission of HIV (PMTCT) programme registers for cases and controls at their booking visit during the months of May, June and July of 2004. Univariate and multiple logistic regression were performed to analyse the data.Results: Of the cases, 48% and 1% among the controls had intestinal helminthiasis, resulting in the odds ratio of 42 (p = 0,000 and 95% CI 9,96 – 176.59). The risk of anaemia was related to urinary schistosomiasis, as 27% of the cases compared to 1% of controls was found with anaemia. The odds ratio was 12 (p = 0,000 and 95% CI 3.58 – 41.02). These parasitic infestations are known to cause chronic haemorrhage and iron deficiency resulting in the development of anaemia in pregnancy. Transmissions of intestinal parasitic infestation occur through the faecal-oral route. Personal hygiene and other environmental factors are therefore an important factor for the transmission of the disease. To reduce the transmission of faecaloral diseases (e.g. intestinal helminthiasis and urinary schistosomiasis) key interventions recommended are: 1) safe disposal of human excreta, 2) hand-washing practices with soap after defecation, and 3) maintenance of drinking water free from faecal contamination. Similarly, HIV infection increased the chance of developing anaemia in pregnancy twofold as HIV infection was more common among cases (56%) than among controls (37%), resulting in an odds ratio of 2.11 (p = 0,003 and 95% CI 1.123 – 3.21). The prevention of HIV infection and transmission can be achieved through the improvement of knowledge of these conditions. These can be achieved through health education and health promotion.Conclusion: These findings confirm and conform to other studies on the association between anaemia in pregnancy and parasitic and HIV  infections. Antenatal care should promote de-worming and education on personal hygiene and HIV (risk factors, mode of transmission, etc.). The provision of safe water supply and toilet facilities for the rural communities should be considered urgently to prevent and promote better health for all, including pregnant women

Teenage Pregnancy and Perinatal Outcomes: Experience from Rural South Africa

Context: Teenage pregnancy is known as a risk factor for preterm birth, low birth weight and perinatal deaths, thus considered public health problem. In South Africa, most teenage pregnancy is found within the context of unstable relationship and unplanned or unwanted pregnancies. A high rate of teenage pregnancy is also an indicator of problems with the sexual and reproductive health of a country's youth.Objectives: To estimate the extent of and measure adverse perinatal outcome of teenage pregnancy and compare.Study-Design, Setting and Subjects: A retrospective comparative study was conducted targeting pregnant women delivered at Empangeni hospital from April to December 2004. All pregnant women who were less than 19 years (teenage) were chosen as cases and those who were 19 years or more were selected as controls. Data were collected from the labour warddelivery registry.Main Outcome Measures: Prevalence of teenage pregnancy, Pre-term delivery, low-birthweight and still-birth rates.Results: There were 7836 deliveries of which 1236 (16%) were teenage mothers. The pre-term delivery rate of 12% and low-birth-weight delivery rate of 14% were similar for teenage and older mothers respectively. Cesarean delivery rate was significantly lower (p < 0.05) in teenagers (20%) compared to older women (26%). Macerated stillbirth rate was significantly lower (1.1%) for teenage compared to older women of 2.1% (p < 0.05).Conclusion: Although there was a higher rate of teenage pregnancy, it did not appear that it was associated with extra perinatal outcome

Assessment and Comparison of Obstetric Characteristics and Perinatal Outcomes of Rural Population of South Africa

Context: Maternal and perinatal morbidity and mortality are the major health problems confronting many developing countries including South Africa. In developing countries, interventions that are known to be effective in lowering maternal and perinatal mortality and morbidity are not universally provided. In the past, access to maternal health services was a major problem for rural and black communities of SA.Objective: The objectives were to assess and compare the demographic and obstetric characteristics and perinatal outcome indicators over time.Study design, Setting and Subjects: A retrospective comparative study was conducted for women delivered during 1999 (3875) and 2004 (3912) at a rural Empangeni hospital. Multivariate logistic regression was undertaken to determine the significant predictors for outcome variables.Results: The prevalence of teenage pregnancy and pregnancy of younger women (<25 years) were increased significantly by 3% and 8% respectively (p < 0.05). There was a significant reduction of pregnancies among higher parity (parity 5 or more) women during 2004 (p < 0.05). There weresignificant reductions of eclampsia, anaemia, and post partum  haemorrhage during delivery for the year 2004. Breech presentation was 3.75 times more likely to deliver preterm and 5.45 times more likely todeliver low birth weight babies. Pregnancy induced hypertension was more likely to have preterm (OR =3.50) and low birth weight babies (OR = 2.09). Eclampsia was also a risk factor for preterm (OR = 6.14),and low birth weight babies (OR = 18.42).Conclusion: Further research is needed to find the causes of higher rate of teenage pregnancies and simple strategies to combat high rates of negative perinatal outcomes.Key Words: Pregnancy Complications, Outcome, Rural Healthcar

Incidence, trends and risk factors for perineal injuries of low-risk pregnant women: Experience from a midwife run obstetric unit, South Africa

Pregnant women experience perineal injuries during childbirth. The objectives of this cross-sectional retrospective study were to estimate the incidence, trends, and risk factors for perineal injuries of women who had childbirths from January 2013 to December 2017. We used logistic regression to identify risk factors for all injuries, episiotomy, and obstetric anal sphincter injury (OASI) measured by odds ratios (OR). A total of 5547 women showed gradual decreases of episiotomy from 17.6% in 2013 to 7.6% in 2017 (p<0.05). Perineal injuries were reduced from 33.3% in 2013 to 28.9% in 2017 (p<0.05). The risk factor for any perineal injury were younger ages, term pregnancy, and nil parity (p,0.05). Advanced gestational age, nil parity, and previous vaginal births were risk factors for episiotomy. However, birth weight of baby was significantly associated with OASI. Episiotomy and overall perineal injury rates were commendable. Training to midwives is needed to improve perineal care and maintain good practices during delivery.   Les femmes enceintes subissent des blessures périnéales lors des accouchements. Les objectifs de cette étude rétrospective transversale étaient d'estimer l'incidence, les tendances et les facteurs de risque de blessures périnéales chez les femmes qui ont accouché de janvier 2013 à décembre 2017. Nous avons utilisé la régression logistique pour identifier les facteurs de risque pour toutes les blessures, l'épisiotomie et l'obstétrique. lésion du sphincter anal (OASI) mesurée par les rapports de cotes (OR). Au total, 5 547 femmes ont présenté une diminution progressive de l'épisiotomie de 17,6 % en 2013 à 7,6 % en 2017 (p<0,05). Les blessures périnéales ont été réduites de 33,3% en 2013 à 28,9% en 2017 (p<0,05). Le facteur de risque de toute lésion périnéale était un âge plus jeune, une grossesse à terme et une parité nulle (p, 0,05). L'âge gestationnel avancé, la parité nulle et les accouchements vaginaux antérieurs étaient des facteurs de risque d'épisiotomie. Cependant, le poids de naissance du bébé était significativement associé à l'OASI. Les taux d'épisiotomie et de lésions périnéales globales étaient louables. La formation des sages-femmes est nécessaire pour améliorer les soins périnéaux et maintenir les bonnes pratiques lors de l'accouchement. &nbsp

Molecular characterization and DNA fingerprinting of some local eggplant genotypes and its wild relatives

Collection and characterization of local genotypes and landraces are prerequisite for any crop improvement program. Molecular diversity and DNA profiling shown exact genetic blue print of any crop. Hence, the experiment was design to establish the molecular diversity and polymorphism among some local eggplant genotypes and its wild relatives for future breeding program. The experiment was carried out at the Biotechnology Laboratory, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh, with twenty-five local and two wild relatives (Solanum sisymbriifolium and S. villosum) of eggplant to study molecular diversity and DNA fingerprinting at those genotypes. Five well-known SSR primers (EPSSR82, smSSR01, EM114, EM120 and smSSR04) were used for the molecular characterization of the genotypes. Quality DNA was isolated with 27 genotypes and PCR amplification was carried out with these primer. The amplified DNA fragment was visualized by 2% agarose gel and data were analyzed by POWERMAKER (version 3.25) and NTSYS-PC (version 2.2). Some total at 10 different alleles were generated with a range of 1 to 3 alleles per locus and an average of 2.0 alleles. The highest number (2) of polymorphic bands was observed in the primers EPSSR82 and smSSR01. The Polymorphism Information Content (PIC) of SSR markers ranged from 0.37 to 0.67 with an average value of PIC = 0.54. Gene diversity ranges from 0.49 (smSSR01) to 0.72 (EPSSR82), with an average value of 0.61. UPGMA method separated the of 27 genotypes into two major clusters (I and II). From the clusters, wild species Solanum villosum belonged to the sub-cluster (IIb), that revealed its distinct variation from the others. On the other hand, wild species Solanum sisymbriifolium showed a close relatedness by forming the same cluster together with thirteen local eggplant genotypes. Molecular diversity and DNA profiling was identified among 25 local eggplant germplasm and its wild relatives. The finding of the experiment could be used for selection of diverse parent for eggplant improvement

Improving and sustaining quality of child health care through IMCI training and supervision: experience from rural Bangladesh

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The economic cost of weeds in dryland cotton production systems of Australia

Economic losses and costs associated with weeds in dryland cotton production are important, both for growers and for industry bodies when making decisions about research priorities and research and development funding. A survey was conducted to provide information on weed types, control strategies and estimated costs to growers. We used information from the survey to estimate conventional financial losses due to weeds, and as a basis for evaluating aggregate economic (society) impacts. An economic surplus model was used to estimate the aggregate societal impact of weeds for three production regions in north-eastern Australia. The annual economic costs associated with weeds were estimated to be $41 million, and the on-farm financial costs were$25 million. While these are past (sunk) costs, and based on a total removal of weeds, the approach outlined here can be used to begin evaluating likely future returns from technologies or management improvements for different agricultural problems.Weeds, Dryland Cotton, and Economics, Crop Production/Industries, Environmental Economics and Policy,