Course and outcome of obstetric patients admitted to a University Hospital Intensive Care Unit

Background: Obstetric Critical Care is an important service in the reduction of maternal morbidity and mortality, but few developing country data are available.Objectives: To review all maternity patients admitted to the ICU over a seven year period to determine the causes and outcomes of these admissions and the frequency and causes of maternal morbidity and mortality.Design: Retrospective patient file and ICU chart review.Subjects: ICU Charts and medical files of obstetric patients admitted to the ICU at The Aga Khan University Hospital between (November 2003 – November 2010) were reviewed.Setting: The ICU at The Aga Khan University Hospital, Nairobi, Kenya.Results: Fourty two obstetric patients were admitted to the intensive care unit for the period of November 2003 to November 2010. This constituted 0.24% of deliveries and 1.25% of ICU admissions. Seventeen patients (52%) were in the age group 30 to 40 years, 13 patients (45%) were on their second pregnancy, and 15 patients (51%) were at term. Twenty five patients (76%) did not have prior co-morbidities. Indications for ICU admission were haemorrhage 15 (44%), sepsis nine (26%), help syndrome four (12%), thromboembolism two (6%), cardiomyopathy two (6%) and anaemia two (6%). The duration of stay ranged from two to 35 days with a mean of seven and median of two days. The outcome was19 patients (58%) were discharged home, 11 patients (33%) deaths and three patients (9%) were transferred to the National referral hospital- their survival outcome unknown. Case fatality rates were three of four patients (75%) for HELLP syndrome, four of fifteen patients (26.7%) for haemorrhage and three of ten patients (30%) after sepsis.Conclusion: Critical Care Obstetrics is vital to the reduction of maternal morbidity. The main indications for ICU admission may be unpredictable but are largely preventable by improved and timely antenatal and intrapartum care. For the few but very sick patients requiring ICU care, a team based approach, as is achieved using the ‘closed’ care model may be feasible. Support to peripheral obstetric facilities via public private partnership initiatives is necessary. Healthcare planners and financiers should factor in critical care obstetric needs. Provision of a planned level of obstetric intensive care with the associated triage and referral infrastructure is a priority for the Region. As part of the drive towards Millennium Development Goal 5, health care financing models should support this essential component of life saving care, through all available channels including public private partnership

Course and outcome of obstetric patients admitted to a University Hospital Intensive Care Unit

Background: Obstetric Critical Care is an important service in the reduction of maternal morbidity and mortality, but few developing country data are available. Objectives: To review all maternity patients admitted to the ICU over a seven year period to determine the causes and outcomes of these admissions and the frequency and causes of maternal morbidity and mortality. Design: Retrospective patient file and ICU chart review. Subjects: ICU Charts and medical files of obstetric patients admitted to the ICU at The Aga Khan University Hospital between (November 2003 – November 2010) were reviewed. Setting: The ICU at The Aga Khan University Hospital, Nairobi, Kenya. Results: Fourty two obstetric patients were admitted to the intensive care unit for the period of November 2003 to November 2010. This constituted 0.24% of deliveries and 1.25% of ICU admissions. Seventeen patients (52%) were in the age group 30 to 40 years, 13 patients (45%) were on their second pregnancy, and 15 patients (51%) were at term. Twenty-five patients (76%) did not have prior co-morbidities. Indications for ICU admission were haemorrhage 15 (44%), sepsis nine (26%), help syndrome four (12%), thromboembolism two (6%), cardiomyopathy two (6%) and anaemia two (6%). The duration of stay ranged from two to 35 days with a mean of seven and median of two days. The outcome was19 patients (58%) were discharged home, 11 patients (33%) deaths and three patients (9%) were transferred to the National referral hospital- their survival outcome unknown. Case fatality rates were three of four patients (75%) for HELLP syndrome, four of fifteen patients (26.7%) for haemorrhage and three of ten patients (30%) after sepsis. Conclusion: Critical Care Obstetrics is vital to the reduction of maternal morbidity. The main indications for ICU admission may be unpredictable but are largely preventable by improved and timely antenatal and intrapartum care. For the few but very sick patients requiring ICU care, a team based approach, as is achieved using the ‘closed’ care model may be feasible. Support to peripheral obstetric facilities via public private partnership initiatives is necessary. Healthcare planners and financiers should factor in critical care obstetric needs. Provision of a planned level of obstetric intensive care with the associated triage and referral infrastructure is a priority for the Region. As part of the drive towards Millennium Development Goal 5, health care financing models should support this essential component of life saving care, through all available channels including public private partnership

Urachal Adenocarcinoma

Urachal adenocarcinoma is a rare tumor and represents 0.17–0.34% of all bladder tumors. Most of the reported cases are in western literature and to the best of our knowledge this is the first case report of urachal adenocarcinoma in sub-Saharan Africa. It has an insidious course and variable clinical presentation. We present a case report of a 45 year old female with three month history of hematuria. Imaging showed a bladder dome mass. After cystoscopy and biopsy, urachal adenocarcinoma was diagnosed histologically. After a negative screen for distant metastasis based on CT chest and abdomen, the patient underwent anterior pelvic exenteration and ileal neo-bladder reconstruction. Six months later, the patient presented with chest metastases. Clinicians should have a high degree of suspicion for these rare tumors

Reliability of Community Health Worker Collected Data for Planning and Policy in a Peri-Urban Area of Kisumu, Kenya

A general introduction of this article is as follows: Reliable and timely health information is an essential foundation of public health action and health systems strengthening, both nationally and internationally (Aqil et al. in Health Policy Plan 24(3): 217–228, 2009; Bradshaw et al. in initial burden of disease estimates for South Africa, 2000. South African Medical Research Council, Cape Town, 2003). The need for sound information is especially urgent in the case of emergent diseases and other acute health threats, where rapid awareness, investigation and response can save lives and prevent broader national outbreaks and even global pandemics (Aqil et al. in Health Policy Plan 24(3): 217–228, 2009). The government of Kenya, through the ministry of public health and sanitation has rolled out the community health strategy as a way of improving health care at the household level. This involves community health workers collecting health status data at the household level, which is then used for dialogue at all the levels to inform decisions and actions towards improvement in health status. A lot of health interventions have involved the community health workers in reaching out to the community, hence successfully implementing these health interventions. Large scale involvement of community health workers in government initiatives and most especially to collect health data for use in the health systems has been minimal due to the assumption that the data may not be useful to the government, because its quality is uncertain. It was therefore necessary that the validity and reliability of the data collected by community health workers be determined, and whether this kind of data can be used for planning and policy formulation for the communities from which it is collected. This would go a long way to settle speculation on whether the data collected by these workers is valid and reliable for use in determining the health status, its causes and distribution, of a community. Our general objective of this article is to investigate the validity and reliability of Community Based Information, and we deal with research question “What is the reliability of data collected at the Community level by Community health workers?”. The methods which we use to find an reliable answer to this question is “Ten percent of all households visited by CHWs for data collection were recollected by a technically trained team. Test/retest method was applied to the data to establish reliability. The Kappa score, sensitivity, specificity and positive predictive values were also used to measure reliability”. Finally our findings are as follows: Latrine availability and Antenatal care presented good correspondence between the two sets of data. This was also true for exclusive breast feeding indicator. Measles immunization coverage showed less consistency than the rest of the child health indicators. At last we conclude and recommend that CHWs can accurately and reliably collect household data which can be used for health decisions and actions especially in resource poor settings where other approaches to population based data are too expensive

A global metagenomic map of urban microbiomes and antimicrobial resistance

We present a global atlas of 4,728 metagenomic samples from mass-transit systems in 60 cities over 3 years, representing the first systematic, worldwide catalog of the urban microbial ecosystem. This atlas provides an annotated, geospatial profile of microbial strains, functional characteristics, antimicrobial resistance (AMR) markers, and genetic elements, including 10,928 viruses, 1,302 bacteria, 2 archaea, and 838,532 CRISPR arrays not found in reference databases. We identified 4,246 known species of urban microorganisms and a consistent set of 31 species found in 97% of samples that were distinct from human commensal organisms. Profiles of AMR genes varied widely in type and density across cities. Cities showed distinct microbial taxonomic signatures that were driven by climate and geographic differences. These results constitute a high-resolution global metagenomic atlas that enables discovery of organisms and genes, highlights potential public health and forensic applications, and provides a culture-independent view of AMR burden in cities