Poster presenting a comparative study examining maternal perception of outcomes of delivery and future pregnancies in Parirenyatwa Hospital, Zimbabwe and the Queen Alexandra Hospital, Portsmouth, England; Poster Global Health

Chase, S.

Guirgis, R.

Sawdy, R.

van Teijlingen, Edwin

Bournemouth University Research Online

Poster PresentationsGlobal Health (PG)PG.01Can the presence of an additional senior doctorreduce caesarean section rates in a regional referralhospital in Western Uganda?Nelson, J1,21Bradford Royal Infirmary, Bradford, West Yorkshire, UK; 2Fort PortalRegional Referral Hospital, Fort Portal, UgandaIntroduction The World Health Organization suggests thatcaesarean rates above 15% can result in wasted financial/humanresources, with no improvements in maternal/neonatal outcomes.Senior doctor involvement in labour-ward care is the model usedin resource-rich countries, but in this unit most care is by first-year doctors. This study looked at the caesarean rates in this unitand whether the presence of an additional senior doctor couldreduce the high rate (32%).Methods A retrospective analysis of the caesarean rate on the days asenior doctor was present was made compared with days he was notpresent from October 2014 to February 2015. The activity of the seniordoctor comprised a ward round with juniors, aiding with clinicaldecisions, bedside teaching and being available for reviews of cases.Results Ninety-two days were analysed including 1487 deliveries,with an overall caesarean rate of 29.1%. On the 42 days when thesenior doctor was present the caesarean rate was 26.2% comparedwith 31.3% on the 50 days he was not present (P < 0.05).However, there was not an overall reduction in caesarean ratewhen compared with historical data.Conclusion It appeared that the presence of an additional seniordoctor reduced the caesarean rate for comparable midweek days. Itremains to be seen if this can have any long-term impact on highcaesarean rates when this doctor leaves. Senior support/presence islikely to improve standards of care. However, in Uganda there aremany barriers to this in terms of human resources, and morale,motivation and leadership of senior doctors.PG.02Improving management of pre-eclampsia inMulago Hospital, UgandaBharmal, AV1; Bell-Webb, C1; MacDougall, J1;Patient, C1; Nakimuli, A21University of Cambridge, Cambridge, UK; 2Mulago Hospital,Kampala, UgandaIntroduction Pre-eclampsia is more prevalent among people ofAfrican ancestry than other ethnicities. From 21 August 2014 afive-bed specialist unit for pre-eclampsia has been in use inMulago Hospital, Uganda, the national referral hospital forobstetrics and gynaecology.We aim to evaluate maternal and fetal outcomes for women inthe pre-eclampsia unit to develop protocols, regarding treatment,monitoring and delivery interval. The current protocol states thatwomen with severe pre-eclampsia should deliver within 24 hoursof admission to the unit.Methods For all the women admitted to the pre-eclampsia unitfrom 6 to 19 June 2015, we assessed: treatment received;appropriate monitoring; delivery interval (time from admission tounit until delivery); and maternal and fetal outcomes.Results Ten women were analysed in the study. The majority(nine women) received appropriate treatment (antihypertensivesand magnesium sulphate). Blood pressure monitoring varied infrequency for each woman, and only four women had urineoutput measured. Only one woman met the 24-hour deliveryinterval criteria. Analysis of outcomes showed 0 maternal deaths;one fetal death; and three neonatal admissions to intensive care.Conclusion Treatment is appropriately administered; however,monitoring is inconsistent. Monitoring could be improved by theintroduction of an observation chart, and an increase in resourcingof the unit. Due to a limited sample size it was difficult to determineif a longer delivery interval affected fetal outcome.PG.03Assessment of the obstetric referral system inUgandaBharmal, AV1; Bell-Webb, C1; Ackers, L2,31University of Cambridge, Cambridge, UK; 2Knowledge for Change,Manchester, UK; 3University of Salford, Manchester, UKIntroduction Uganda has the structural capacity for a referralsystem, where women can be referred from a healthcare centre(HC) to a regional hospital. The system requires assessment ofwomen at a HC, prompt transport and then appropriatemanagement at the place of referral.Our aim was to identify if women had appropriate referrals froman HC to a regional referral hospital and to compare weekday andweekend service provision.Methods The study was conducted between 1 May 2015 and 30June 2015. The number, reason and outcome for each referralwere identified. Weekdays and weekends were compared;evaluating mode of delivery and number of referrals.Results Fifty-one women were referred, with a mean referral of5.2 women per weekday and eight per day on a weekend. Thirty-ª 2016 The Authors BJOG An International Journal of Obstetrics and Gynaecology ª 2016 RCOG 107DOI: 10.1111/1471-0528.13990www.bjog.orgAbstractsAsia. The sufferer is incontinent of urine and/or faeces and mayhave features of the obstetric fistula complex including stillbirth,social isolation, poverty and suicidal ideation.Methods Women were invited to attend surgical camps atKitovu, Uganda for assessment and treatment of vesicovaginalfistula. In all, 122 women completed questionnaires about theindex birth that caused their fistula between March 2013 and2015.Results Fifty-eight of the 122 (48%) women were recruited to thecamps via radio advertising. The average age was 30.5 years oldwith average symptom duration of 5.9 years. Thirty-three of the98 (33%) married women were subsequently divorced by theirspouses because of the fistula, despite divorce being hugelystigmatised in Uganda. Ninety-five of 117 (81%) suffered astillbirth or an early neonatal death with 75/117 (64%) deliveredby caesarean section, of which 11 were caesarean hysterectomies.Conclusion Despite large international programmes for fistulaprevention there remain significant challenges in managingobstructed labour in Sub-Saharan Africa. The majority (48%) ofour patients were responding to radio-campaigns. We suggest thata similar model to the highly successful case-finding programmesfor prevention-of-mother-to-child-transmission and HIV/tuberculosis could be used to improve identification of obstetricfistulas. An 81% incidence of stillbirth/neonatal death suggests animprovement from previously quoted figures of 95%. This mayindicate improved access to caesarean section. However, this mayco-exist with the higher incidence of iatrogenic fistula frominadequately trained staff.PG.13Supporting evidence-based midwifery practicethrough audit and feedback: an LAMRN project inKenya, Uganda, Zambia and ZimbabweSmyth, R1; Mwebaza, E2; Omoni, G3;Maimbolwa, M4; Mudokwenyu-Rawdon, C5;Bedwell, C1; Porteous, C1; Lavender, T1,31University Of Manchester, Manchester, UK; 2Uganda Nurses andMidwives Union, Kampala, Uganda; 3University of Nairobi, Nairobi,Kenya; 4University of Zambia, Lusaka, Zambia; 5Freelance MidwiferyResearcher and WRA Zimbabwe Coordinator, Harare, ZimbabweIntroduction The LAMRN is a partnership between TheUniversity of Manchester and focal group leaders and theirinstitutions from six countries: Kenya, Uganda, Malawi, Tanzania,Zambia and Zimbabwe. The LAMRN network is aimed atincreasing the research capacity of midwives within the East,Central and Southern Africa region, so improving maternal andnewborn health.Aim: To strengthen capacity to conduct clinical audit amongmidwives in Kenya, Uganda, Zambia and Zimbabwe.Objectives: To implement a series of workshops on principles ofclinical audit, in order to: (i) improve midwives’ understanding ofthe clinical audit process, (ii) strengthen midwives’ ability toidentify, and collect and analyse data on auditable problems, (iii)encourage midwives to act on audit findings, and (iv) helpmidwives establish audit as a routine activity in their facilities.Also, to share lessons and audit tools within country and withLugina Africa Midwives Research Network (LAMRN) midwives.Methods Criterion-based audit comparing aspects of currentpractice with agreed evidence-based standards is used. The projecttrains teams of 12 midwives in each country, comprising fourworkshops. UK partners from The University of Manchester helpfacilitate workshops and mentor the country teams. Areas ofclinical care with direct applicability to the midwives’ ownpractice have been identified through consensus. Audit topicsinclude; partograph initiation and completion, Identification andtreatment of postpartum haemorrhage, early (within 6 hours ofbirth) postnatal care, health information given to women onpostnatal discharge and stillbirth.Funding Department for International Development and managedthrough the Tropical Health Education Trust.PG.14A comparison study examining maternalperception of outcomes of delivery and futurepregnancies in Parirenyatwa Hospital, Zimbabweand the Queen Alexandra Hospital, Portsmouth,EnglandChase, S1; van Teijlingen, E2; Sawdy, R2; Guirgis,R31University of Southampton, Southampton, UK; 2University ofBournemouth, Bournemouth, UK; 3Queen Alexandra Hospital,Portsmouth, UKIntroduction There are major political, cultural and economicdifferences between England, a more developed country, andZimbabwe, a less developed country. The maternal mortality rateis significantly higher in Zimbabwe, and there are limitedresources available. This may lead to differences in reporting ofperceptions of care.The study aim was to obtain evidence primarily assessing theperceptions of care during childbirth within two contrastinghealthcare environments, in Zimbabwe and England.Methods The study retrospectively looked at patients’ perceptionson both their management and immediate maternal complicationsin delivery within two settings via a structured questionnaire.Ethical approval was sought on both sites prospectively. While inZimbabwe, all interviews and forms were completed withparticipants by Stephanie Chase. In England, the participantsthemselves completed the forms. The first arm of the studycollected data from 200 completed questionnaires from womenwho had delivered in the main government referral hospital,Parirenyatwa Hospital, in Harare, Zimbabwe. The second armcollected 75 completed questionnaires from women who deliveredat an NHS hospital, Queen Alexandra Hospital, Portsmouth,England.Results There was a higher complication rate during childbirth inZimbabwe of 59.7% versus that of England at 50.7%. However,overall 64.5% of participants in Zimbabwe gave complimentaryª 2016 The Authors BJOG An International Journal of Obstetrics and Gynaecology ª 2016 RCOG 111Poster Presentations: Global Healthcomments on the care they received from healthcare professionalsversus 73.4% in England.Conclusion The results highlighted that the standards of care,resources and care provided by healthcare professionals variedgreatly between the two settings. Despite this there was an overallappreciation of care within both hospitals.PG.15Maternal and fetal outcomes of tuberculosis duringpregnancy and the postpartum period: a systematicreview and meta-analysisSobhy, S1; Khan, K1; Zahir, B3; Kunst, H21Womens Health Research Unit, Queen Mary’s University, London,UK; 2Queen Mary’s University, London, UK; 3Barts Health, London,UKIntroduction Our objective was to identify outcomes ofpregnancies in women with maternal tuberculosis (TB).Methods Systematic review and meta-analysis.Data sources: Major electronic databases until October 2015.Eligibility criteria: Studies that compared pregnant women withand without active TB for outcome data.Data extraction and synthesis: Study selection, quality assessmentand data extraction were carried out by two independentreviewers. Information on study design, setting, populationcharacteristics, TB diagnosis and treatment as well as obstetricoutcomes was obtained. Risk of bias was assessed using theNewcastle-Ottawa scale. Data were pooled and odds ratios usingrandom effects modelling were calculated for maternal andperinatal outcomes.Results Out of 7521 citations, 13 studies were included; (3384pregnancies associated with active TB, 119 480 pregnant womenwithout TB). Using the Newcastle-Ottawa scale, seven studies hada low risk or medium risk of bias and six had a high risk of bias.There was a significantly increased risk of poor fetal outcomes;with quadruple the odds of perinatal death and asphyxia anddouble the odds of preterm birth and low birth rate. Maternaloutcomes were also significantly worse with double the odds ofmaternal morbidity, anaemia and caesarean delivery, comparedwith pregnant women without active TB. Women who werediagnosed and treated in first trimester had better outcomes thanthose diagnosed and treated in second and third trimester.Conclusion TB in pregnancy results in poor maternal and fetaloutcomes. A wider screening programme and case detection areneeded to start early treatment and reduce poor outcomes.PG.16Intake of folate and genes polymorphismsassociated with folate cycle disorder amonghealthy female studentsFrolova, N; Belokrinitskaya, TChita State Medical Academy, Chita, RussiaIntroduction Our objective was to assess the consumption offolate and the frequency of the main gene polymorphismsMTHFR-677C>T, MTHFR-1298A>C, MTRR-66A>G associatedwith folate cycle disorder in female students.Methods A cross-sectional study. The questionnaire survey aboutthe adequacy of nutrition and reproductive plans and geneticexamination were conducted among 100 healthy female studentsaged between 19 and 25 years. Genomic DNA was extracted fromblood leucocytes with a simple salting-out method. Genepolymorphisms were detected by the technique of real-timepolymerase chain reaction. We have analysed the frequencies andHardy–Weinberg equilibria.Results We found that all female students consumed poor folatefoods. Nobody took folic acid supplements or folate-containingcombined oral contraceptives. No students excluded the possibilityof pregnancy and childbirth during the period of study at theacademy. The frequency of MTHFR-677TT mutant genotype was6%, MTHFR-1298CC was 9%, MTRR-66GG was 31%. CombinedMTHFR-677TT//MTHFR-1298CC and MTHFR-677TT//MTRR-66GG mutant genotypes, which significantly increased risk ofpregnancy loss and neural-tube defects, were found in 2% ofcases.Conclusion Healthy female students are characterised byinadequate intake of folate with food, increased prevalence of themutant genotype of the MTRR-66GG, the average frequency ofmutant genotypes of the MTHFR-677TT and MTHFR-1298CC,that increases risks of fetal malformations and pregnancycomplications. These facts in addition to a high frequency ofunplanned pregnancies, explains the necessity to include inreproductive educational programmes for students informationabout the need of systematic and adequate intake of folate.PG.17Risks associated with anaesthesia in women withpre-eclampsia in low- and middle-income countries.Systematic review and mata-analysisSobhy, S1; Dharmarajah, K2; Zamora, J3; Wilson,M4; Coomarasamy, A5; Navaratnarajah, R6;Thangaratinam, S11Women’s Health Research Unit, Barts and The London School ofMedicine and Dentistry, Queen Mary University of London, London,UK; 2Northwick Park hospital, London, UK; 3Clinical BiostatisticsUnit, Hospital Ramon y Cajal, Madrid, Spain; 4School of Health &Related Research, University of Sheffield, Sheffield, UK; 5School ofClinical and Experimental Medicine, College of Medical and DentalSciences, University of Birmingham, Birmingham, UK; 6Barts HealthNHS Trust, London, UK112 ª 2016 The Authors BJOG An International Journal of Obstetrics and Gynaecology ª 2016 RCOGPoster Presentations: Global Health

A comparison study examining maternal perception of outcomes of delivery and future pregnancies in Parirenyatwa Hospital, Zimbabwe and the Queen Alexandra Hospital, Portsmouth, England.

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BJOG An International Journal of Obstetrics & Gynaecology

Poster Global Health

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A comparison study examining maternal perception of outcomes of delivery and future pregnancies in Parirenyatwa Hospital, Zimbabwe and the Queen Alexandra Hospital, Portsmouth, England.

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