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

The stress factors and pattern of psychiatric disorders among patients with deliberate self-harm: a study in a tertiary care hospital, Rangpur, Bangladesh

Background: Deliberate self-harm (DSH) is a complex behavior of maladaptive response to acute and chronic stress, and likely to be suffering from mental health problems as well as co-morbid general medical conditions, including several non-suicidal intentions to suicide. DSH is previously included in suicide. Sir Thomas Browne first used the word ‘suicide’ in 1642 in his religion Medici. The word suicide originated from SUI (of oneself) and CAEDES (murder). According to WHO ‘suicide’ refers to the act of killing oneself intentionally, performed by the person with full knowledge or expectation of the fatal outcome. This study aimed to analyze the stress factors and pattern of psychiatric disorders among patients with DSH. Methods: This descriptive cross-sectional study was conducted at the department of medicine; emergency and OPD, Rangpur medical college, Rangpur, Bangladesh. Study conducted for 1 year; July 2008-June 2009. A total of 116 DSH cases included in study as per inclusion criteria. Convenience sampling technique was undertaken in this study. Result: The majority of patients are in the age group of 20-39 years, with 70% in a psychiatric disorder, and in the 40-59 years age group 7.778% have a psychiatric disorder. Age has a significant relationship with DSH (p<0.001). The 90 patients were suffering from psychiatric disorders among them 61 (67.778%) were suffering from depressive episodes, 12 (13.333%) were suffering from a personality disorder, 8 (8.889%) were suffering from mental and behavioral disorders due to psychoactive substance abuse, 7 (7.778%) were suffering from schizophrenia, 1 (01.111%) were suffering from adjustment disorder, 1 (1.111%) suffering from bipolar disorder. Conclusions: Out of 116 responders 90 (77.586%) were suffering from a psychiatric disorder. Among the patients with psychiatric disorders, 61 (67.778%) patients were found to be suffering from a depressive episode, which was 52.568% of total DSH cases and is an almost treatable disorder.

An electroviscous damper

A new type of vibration damper for rotor systems was developed and tested. The damper contains electroviscous fluid which solidifies and provides Coulomb damping when an electric voltage is imposed across the fluid. The damping capacity is controlled by the voltage. The damper was incorporated in a flexible rotor system and found to be able to damp out high levels of unbalanced excitation. Other proven advantages include controllability, simplicity, and no requirement for oil supply. Still unconfirmed are the capabilities to eliminate critical speeds and to suppress rotor instabilities

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

The outcome of loop electrosurgical excision procedure following treatment of cervical intra-epithelial neoplasia 2 and 3

Background: In Bangladesh, loop electrosurgical excision procedure (LEEP) is an ongoing program of government health service for the management of cervical intra-epithelial neoplasia (CIN) 2 and 3. The aim of this study was to evaluate the outcome of loop electrosurgical excision procedure following treatment of cervical intra-epithelial neoplasia 2 and 3. Methods: This descriptive cross-sectional study was conducted in outpatient department (OPD), gynaecology and obstetrics department, Rangpur Medical College Hospital, Rangpur, Bangladesh during the period from July 2011 to June 2012. In total 75 patients, underwent LEEP following treatment of CIN 2 and 3 were selected for this study as study subjects. Data analysis was done by using statistical package for social science (SPSS) 16 version. Results: In this study, majority of the participants were from 30-39 years’ age group which was 57%. Besides this 23%, 19% and 1% patients were from <30, 40-49 and ≥50 age groups respectively. The mean parity of the patients was 3.68 with standard deviation of ±1.31 and range was 1 to 7. In analyzing the parity of the participants, we observed that, in 47% and 24% patients the party were 2 and 3 respectively which were noticeable. Besides these in 11%, 8%, 7%, 1% and 3% cases the parity were found as 1, 4, 5, 6 and 7 respectively. In analyzing the histopathology among patients, we found, 76% cases were with CIN-1 whereas the rest 24% cases were with CIN-2. Conclusions: Cervical cancer is the most common malignancy and a major cause of cancer death among Bangladeshi women. This may be due to lack of awareness, scarce of screening facility, poverty and illiteracy. The LEEP procedure has many advantages including high success rate, low cost and ease of use

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

A new global model for the ionospheric F2 peak height for radio wave propagation

The F2-layer peak density height <I>hm</I>F2 is one of the most important ionospheric parameters characterizing HF propagation conditions. Therefore, the ability to model and predict the spatial and temporal variations of the peak electron density height is of great use for both ionospheric research and radio frequency planning and operation. For global <I>hm</I>F2 modelling we present a nonlinear model approach with 13 model coefficients and a few empirically fixed parameters. The model approach describes the temporal and spatial dependencies of <I>hm</I>F2 on global scale. For determining the 13 model coefficients, we apply this model approach to a large quantity of global <I>hm</I>F2 observational data obtained from GNSS radio occultation measurements onboard CHAMP, GRACE and COSMIC satellites and data from 69 worldwide ionosonde stations. We have found that the model fits to these input data with the same root mean squared (RMS) and standard deviations of 10%. In comparison with the electron density NeQuick model, the proposed Neustrelitz global <I>hm</I>F2 model (Neustrelitz Peak Height Model – NPHM) shows percentage RMS deviations of about 13% and 12% from the observational data during high and low solar activity conditions, respectively, whereas the corresponding deviations for the NeQuick model are found 18% and 16%, respectively

Evaluation of E Layer Dominated Ionosphere Events Using COSMIC/FORMOSAT-3 and CHAMP Ionospheric Radio Occultation Data

At certain geographic locations, especially in the polar regions, the ionization of the ionospheric E layer can dominate over that of the F2 layer. The associated electron density profiles show their ionization maximum at E layer heights between 80 and 150 km above the Earth’s surface. This phenomenon is called the “E layer dominated ionosphere” (ELDI). In this paper we systematically investigate the characteristics of ELDI occurrences at high latitudes, focusing on their spatial and temporal variations. In our study, we use ionospheric GPS radio occultation data obtained from the COSMIC/FORMOSAT-3 (Constellation Observing System for Meteorology, Ionosphere, and Climate/Formosa Satellite Mission 3) and CHAMP (Challenging Minisatellite Payload) satellite missions. The entire dataset comprises the long period from 2001 to 2018, covering the previous and present solar cycles. This allows us to study the variation of the ELDI in different ways. In addition to the geospatial distribution, we also examine the temporal variation of ELDI events, focusing on the diurnal, the seasonal, and the solar cycle dependent variation. Furthermore, we investigate the spatiotemporal dependency of the ELDI on geomagnetic storms