Medicine and Health Sciences Commons^™

E-Learning For Research Capacity Strengthening In Sexual And Reproductive Health: The Experience Of The Geneva Foundation For Medical Education And Research And The Department Of Reproductive Health And Research, World Health Organization, Karim Abawi, Venkatraman Chandra-Mouli, Igor Toskin, Mario Philip Festin, Lynn Gertiser, Raqibat Idris, Hanan Hamamy, Moazzam Ali, Ameyo Masakhwe Bonventure, Marleen Temmerman, Aldo Campana

Obstetrics and Gynaecology, East Africa

Abstract: Technological advancement has resulted in the increasing use of e-learning and online education, initially in high-income countries and increasingly in low- and middle-income countries.

Background: In 2010, the Geneva Foundation for Medical Education and Research, in collaboration with the World Health Organization and partner institutions, developed an online postgraduate course “From Research to Practice: Training Course in Sexual and Reproductive Health Research”. This course takes advantage of the advancing Internet technology to provide training opportunities to health professionals mostly from low- and middle-income countries whose access to quality education is constrained by time, financial resources, or both.

Case presentation: …

Referral Pattern Of Emergencies In Obstetrics: Implications For Defining Scope Of Services And Policy, Rahat Najam Qureshi, Rozina Sikandar Sultanali, Zahra Hoodbhoy, Raffat Bano, Nigar Jabeen

Department of Obstetrics & Gynaecology

Objective: To analyse referral pattern of high-risk obstetric cases from secondary to tertiary care hospitals and to assess their maternal and neonatal outcomes.

Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised all referred obstetric cases from secondary-level hospitals to tertiary-level care within and outside the Hospital between January 2011 and December 2014. Day and time of referral, reason for referral as well as maternal and neonatal outcomes were collected. SPSS 19 was used for data analysis.

Results: Of the 634 obstetric referrals, 279(44%) patients were referred to the study site, while 355(56%) …

Breech Delivery At A University Hospital In Tanzania, Ulf Högberg, Catrin Claeson, Lone Krebs, Agneta Skoog Svanberg, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background There is a global increase in rates of Cesarean delivery (CD). A minor factor in this increase is a shift towards CD for breech presentation. The aim of this study was to analyze breech births by mode of delivery and investigate short-term fetal and maternal outcomes in a low-income setting.

Methods The study design was cross-sectional and the setting was Muhimbili National Hospital (MNH), Dar-es-Salaam, Tanzania. Subjects were drawn from a clinical database (1999–2010) using the following inclusion criteria: breech presentation, birth weight ≥ 2,500 g, single pregnancy, fetal heart sound at admission, and absence of pregnancy-related complication as …

Improving Standards Of Care In Obstructed Labour: A Criteria-Based Audit At A Referral Hospital In A Low-Resource Setting In Tanzania, Andrew H. Mgaya, Hussein Kidanto, Lennarth Nystrom, Birgitta Essén

Faculty of Health Sciences, East Africa

Objective In low-resource settings, obstructed labour is strongly associated with severe maternal morbidity and intrapartum asphyxia, and consequently maternal and perinatal deaths. This study evaluated the impact of a criteria-based audit of the diagnosis and management of obstructed labour in a low-resource setting.

Methods A baseline criteria-based audit was conducted from October 2013 to March 2014, followed by a workshop in which stakeholders gave feedback on interventions agreed upon to improve obstetric care. The implemented interventions included but were not limited to introducing standard guidelines for diagnosis and management of obstructed labour, agreeing on mandatory review by specialist for cases …

Criteria-Based Audit To Improve Quality Of Care Of Foetal Distress: Standardising Obstetric Care At A National Referral Hospital In A Low Resource Setting, Tanzania, Andrew H. Mgaya, Helena Litorp, Hussein Kidanto, Lennarth Nyström, Birgitta Essén

Faculty of Health Sciences, East Africa

Background In Tanzania, substandard intrapartum management of foetal distress contributes to a third of perinatal deaths, and the majority are term deliveries. We conducted a criteria-based audit with feedback to determine whether standards of diagnosis and management of foetal distress would be improved in a low-resource setting.

Methods During 2013–2015, a criteria-based audit was performed at the national referral hospital in Dar es Salaam. Case files of deliveries with a diagnosis of foetal distress were identified and audited. Two registered nurses under supervision of a nurse midwife, a specialist obstetrician and a consultant obstetrician, reviewed the case files. Criteria for …

Obstetric Patients In Intensive Care Unit: Perspective From A Teaching Hospital In Pakistan, Rahat Qureshi, Sheikh Irfan Ahmed, Amir Raza, Ayesha Khurshid, Uzma Chishti

Department of Obstetrics & Gynaecology

Objective: Review of obstetric cases admitted to the intensive care unit.
Design: Ten year retrospective review of individual patients' medical records.
Participants: Records of obstetric patients admitted from 2005-2014.
Setting: Aga Khan University Hospital Karachi.
Main outcome Measures: Diagnosis at the time of admission, associated risk factors, and intervention required aspects of management and rate of mortality.
Findings: A total of 194 obstetric patients were admitted out of which 86.2% of patients had ventilator support. Mortality was not seen to be significantly associated with parity and antenatal/postnatal status. The median age of patients was 34 years, minimum length of stay …

Addressing The Intersection Between Alcohol Consumption And Antiretroviral Treatment: Needs Assessment And Design Of Interventions For Primary Healthcare Workers, The Western Cape, South Africa, M. Schneider, M. Chersich, Marleen Temmerman, C. D. Parry

Obstetrics and Gynaecology, East Africa

Background: At the points where an infectious disease and risk factors for poor health intersect, while health problems may be compounded, there is also an opportunity to provide health services. Where human immunodeficiency virus (HIV) infection and alcohol consumption intersect include infection with HIV, onward transmission of HIV, impact on HIV and acquired immunodeficiency syndrome (AIDS) disease progression, and premature death. The levels of knowledge and attitudes relating to the health and treatment outcomes of HIV and AIDS and the concurrent consumption of alcohol need to be determined. This study aimed to ascertain the knowledge, attitudes and practices of primary …

Comparing Effectiveness Of Active And Passive Client Follow-Up Approaches In Sustaining The Continued Use Of Long Acting Reversible Contraceptives (Larc) In Rural Punjab: A Multicentre, Non-Inferiority Trial, Waqas Hameed, Syed Khurram Azmat, Moazzam Ali, Muhammad Ishaque, Ghazunfer Abbas, Erik Munroe, Rebecca Harrison, Wajahat Hussain Shamsi, Ghulam Mustafa, Omar Farooq Khan

Community Health Sciences

Background: The use of long-acting reversible contraceptive (LARC) methods is very low in Pakistan with high discontinuation rates mainly attributed to method-related side effects. Mixed evidence is available on the effectiveness of different client follow-up approaches used to ensure method continuation. We compared the effectiveness of active and passive follow-up approaches in sustaining the use of LARC-and within 'active' follow-up, we further compared a telephone versus home-based approach in rural Punjab, Pakistan.
Methods: This was a 12-month multicentre non-inferiority trial conducted in twenty-two (16 rural- and 6 urban-based) franchised reproductive healthcare facilities in district Chakwal of Punjab province, between November …

Lessons Learnt From The Cerca Project, A Multicomponent Intervention To Promote Adolescent Sexual And Reproductive Health In Three Latin America Countries: A Qualitative Post-Hoc Evaluation., Olena Ivanova, Kathya Cordova Pozo, Zoyla Esmeralda Segura, Bernardo Vega, Venkatraman Chandra-Mouli, Michelle J. Hindin, Marleen Temmerman, Peter Decat, Sara De Meyer, Kristien Michielsen

Obstetrics and Gynaecology, East Africa

The Community-Embedded Reproductive Health Care for Adolescents (CERCA) Project was implemented in Bolivia, Ecuador and Nicaragua (2011–2014) to test the effectiveness of interventions preventing teenage pregnancies. As the outcome evaluation showed limited impact, a post-hoc process evaluation was carried out to determine if and how CERCA’s design, implementation, monitoring and evaluation affected the results. We did a document analysis and conducted 18 in-depth interviews and 21 focus group discussions with stakeholders and beneficiaries. Transcripts were analyzed using directed content analysis.

Data showed that CERCA sensitized stakeholders and encouraged the discussion on this sensitive issue. In terms of design, a strong …

Comparative Effects Of Ballooning Intracervical Catheter And Prostaglandin Pessary On Cervical Ripening, Raheela Baloch, Qamarunissa Muhabat, Fakhrunissa Waheed, Waqarunissa Ahmed

Department of Obstetrics & Gynaecology

Labor is induced to stimulate the uterine contraction in effort to have vaginal birth. Induction may be advocated to reduce fetal or neonatal morbidity and mortality. Indication of labor needs to be considered when risk and benefits analysis indicates that delivering the baby is safe option for mother or both rather than continuing the pregnancy and when there are no clear indications for caesarean section and no contraindication for vaginal delivery.

Comparison Of The Prevalence And Characteristics Of Inpatient Adverse Events Using Medical Records Review And Incident Reporting, William Macharia, Charles Muteshi, Sikolia Wanyonyi, Abraham Mukaindo, Ahmed Ismail, Herman Ekea, Abdallah Abdulkarim, John Tole, Anthony Ngugi

Paediatrics and Child Health, East Africa

No abstract provided.

Progestogen-Only Contraceptive Use Among Breastfeeding Women: A Systematic Review., Sharon J. Phillips, Naomi K. Tepper, Nathalie Kapp, Kavita Nanda, Marleen Temmerman, Kathryn M. Curtis

Obstetrics and Gynaecology, East Africa

Background: Postpartum women need effective contraception. Concerns have been raised that use of progestogen-only contraceptives (POCs) may affect breastfeeding performance and infant health outcomes.

Objectives: We investigated the clinical outcomes of breastfeeding duration, initiation of supplemental feeding and weaning, as well as infant outcomes including infant growth, health and development among breastfeeding women using POCs compared with breastfeeding women not using POCs.

Search strategy: We searched the PubMed database for all articles published from database inception through December 2014.

Selection criteria: We included primary research studies of breastfeeding women of any age or parity who received POCs, including progestogen-only pills, …

Countdown To 2015 Country Case Studies: What Can Analysis Of National Health Financing Contribute To Understanding Mdg 4 And 5 Progress?, Carlyn Mann, Courtney Ng, Nadia Akseer, Zulfiqar Ahmed Bhutta, Josephine Borghi, Tim Colbourn, Patricia Hernández-Peña, Luis Huicho, Muhammad Ashar Malik, Melisa Ashar Martinez-Alvarez, Spy Munthali, Ahmad Shah Salehi, Mekonnen Tadesse, Mohammed Yassin, Peter Berman

Community Health Sciences

Background

Countdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies.

Methods

This paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania), supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in …

Global Burden Of Maternal And Congenital Syphilis In 2008 And 2012: A Health Systems Modelling Study, N. Saman Wijesooriya, Roger W. Rochat, Mary L. Kamb, Prasad Turlapati, Marleen Temmerman, Nathalie Broutet, Lori M. Newman

Obstetrics and Gynaecology, East Africa

Background: In 2007, WHO launched a global initiative for the elimination of mother-to-child transmission of syphilis (congenital syphilis). An important aspect of the initiative is strengthening surveillance to monitor progress towards elimination. In 2008, using a health systems model with country data inputs, WHO estimated that 1·4 million maternal syphilis infections caused 520 000 adverse pregnancy outcomes. To assess progress, we updated the 2008 estimates and estimated the 2012 global prevalence and cases of maternal and congenital syphilis.

Methods: We used a health systems model approved by the Child Health Epidemiology Reference Group. WHO and UN databases provided inputs on …

True Knot Of Umbilical Cord: Case Report And Review Of Literat, Momna Khan, Sana Zahiruddin, Maria Iftikhar

Department of Obstetrics & Gynaecology

True knot of umbilical cord (TKUC) is a rare abnormality. When it becomes tight, it may lead to the obstruction of the foetal circulation and intrauterine death (IUD). We present two cases of TKUC managed at The Aga Khan University Hospital with two extreme outcomes. A 22 years old primigravida was diagnosed with unexplained intrauterine foetal demise at 28th week gestation. She delivered vaginally after induction and tight TKUC was identified as a cause of IUD. The second patient delivered an alive healthy male baby vaginally who was found to have a lose TKUC.

Participatory Approaches Involving Community And Healthcare Providers In Family Planning/Contraceptive Information And Service Provision: A Scoping Review., Petrus S. Steyn, Joanna Paula, Peter Gichangi, Jennifer A. Smit, Theresa Nkole, James Kiarie, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

As efforts to address unmet need for family planning and contraception (FP/C) accelerate, voluntary use, informed choice and quality must remain at the fore. Active involvement of affected populations has been recognized as one of the key principles in ensuring human rights in the provision of FP/C and in improving quality of care. However, community participation continues to be inadequately addressed in large-scale FP/C programmes. Community and healthcare providers’ unequal relationship can be a barrier to successful participation. This scoping review identifies participatory approaches involving both community and healthcare providers for FP/C services and analyzes relevant evidence. The detailed analysis …

Caesarean Section Surgical Techniques: All Equally Safe, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Since 1985, a caesarean section rate of 10–15% has been deemed optimum by the international health-care community.1 When caesarean section rates rise towards 10% across a population, maternal and newborn deaths decrease; when they are higher than 15%, there is no evidence of reduced mortality.1 Complications of caesarean sections can be substantial and sometimes permanent for both mothers and babies, and can result in disability or death, especially in settings with inadequate facilities or capacity to undertake safe surgery and treat surgical complications.

‘Essential But Not Always Available When Needed’ – An Interview Study Of Physicians’ Experiences And Views Regarding Use Of Obstetric Ultrasound In Tanzania, Annika Åhman, Hussein Kidanto, Matilda Ngarina, Kristina Edvardsson, Rhonda Small, Ingrid Mogren

Faculty of Health Sciences, East Africa

Background The value of obstetric ultrasound in high-income countries has been extensively explored but evidence is still lacking regarding the role of obstetric ultrasound in low-income countries.

Objective We aimed to explore experiences and views among physicians working in obstetric care in Tanzania, on the role of obstetric ultrasound in relation to clinical management.

Design A qualitative study design was applied. Data were collected in 2015, through 16 individual interviews with physicians practicing in obstetric care at hospitals in an urban setting in Tanzania. Data were analyzed using qualitative content analysis.

Results Use of obstetric ultrasound in the management of …

Important Strategies For Effective Family Planning Counseling, Savera Aziz Ali, Minaz Mawani, Gulshan Bano, Sumera Aziz Ali

School of Nursing & Midwifery

No abstract provided.

Modern Contraceptive Use Among Migrant And Non-Migrant Women In Kenya, Rhoune Ochako, Ian Askew, Jerry Okal, John Oucho, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Manifest socio-economic differences are a trigger for internal migration in many sub-Saharan settings including Kenya. An interplay of the social, political and economic factors often lead to internal migration. Internal migration potentially has significant consequences on an individual’s economic growth and on access to health services, however, there has been little research on these dynamics. In Kenya, where regional differentials in population growth and poverty reduction continue to be priorities in the post MDG development agenda, understanding the relationships between contraceptive use and internal migration is highly relevant.

Methods: Using data from the 2008–09 Kenya Demographic and Health Survey …

A Novel Point-Of-Care Testing Strategy For Sexually Transmitted Infections Among Pregnant Women In High-Burden Settings: Results Of A Feasibility Study In Papua New Guinea, Steven G. Badman, Lisa M. Vallely, Pamela Toliman, Grace Kariwiga, Bomesina Lote, William Pomat, Caroline Holmer, Rebecca Guy, Stanley Luchters, Chris Morgan

Population Health, East Africa

Background: Sexually transmitted and genital infections in pregnancy are associated with an increased risk of adverse maternal and neonatal health outcomes. High prevalences of sexually transmitted infections have been identified among antenatal attenders in Papua New Guinea. Papua New Guinea has amongst the highest neonatal mortality rates worldwide, with preterm birth and low birth weight major contributors to neonatal mortality. The overall aim of our study was to determine if a novel point-of-care testing and treatment strategy for the sexually transmitted and genital infections Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) in pregnancy is …

Factors Associated With Uptake Of Visual Inspection With Acetic Acid (Via) For Cervical Cancer Screening In Western Kenya, Elkanah Omenge, Juddy Wachira, Fredrick Chite Asirwa, Naftali Busakhala, Violet Naanyu, Job Kisuya, Grieven Otieno, Alfred Keter, Ann Mwangi, Thomas Inui

Obstetrics and Gynaecology, East Africa

Purpose: Cervical cancer screening has been successful in reducing the rates of cervical cancer in developed countries, but this disease remains the leading cause of cancer deaths among women in sub-Saharan Africa. We sought to understand factors associated with limited uptake of screening services in our cervical cancer-screening program in Western Kenya.

Participants and Methods: Using items from a previously validated cancer awareness questionnaire repurposed for use in cervical cancer and culturally adapted for use in Kenya, we interviewed 2,505 women aged 18–55 years receiving care in gynecology clinics or seeking other services in 4 health facilities in Western Kenya …

Maternal Inflammatory Markers In The Diagnosis Of Chorioamnionitis And Prediction Of Neonatal Sepsis In Preterm Pre-Labour Rupture Of Membranes: A Systematic Review, Angela Koech Etyang

Theses & Dissertations

Background: There is no consensus on the potential role of inflammatory markers in identifying chorioamnionitis in women with Preterm Pre-labour Rupture of Membranes (PPROM) or in predicting Early Onset Neonatal Sepsis (EONS) in their neonates.

Objectives: To perform a quantitative review on the accuracy of maternal C reactive protein (CRP), Procalcitonin (PCT) and Interleukin 6 (IL6) in the diagnosis of Histological Chorioamnionitis and/or Funisitis (HCA/Funisitis) and their role in the prediction of EONS in PPROM.

Methods: MEDLINE, EMBASE and The Cochrane Library databases were searched from inception to October 2015, for studies where these markers were assessed against a reference …

Association Of 24-32wk Maternal Triglyceride Levels And Neonatal Birth Weight At The Aga Khan University Hospital, Demetrius Mududa Omondi

Theses & Dissertations

Introduction: The association of neonatal birth weight and mid-term maternal lipid levels has been demonstrated in several studies with elevated serum triglyceride levels shown to be a strong predictor of the large for gestational age baby/ fetal macrosomia. Maternal diabetes remains the strongest risk factor for developing a LGA/macrosomic baby explained by the Pederson hypothesis. However non-diabetic macrosomia is still an obstetric dilemma with the attendant fetal and maternal complications. This phenomenon could be explained by altered maternal lipid metabolism as lipids have been shown to be important for normal fetal growth and development.

Objective: Our primary objective was to …

The Global Strategy For Women's, Children's And Adolescents' Health (2016-2030): A Roadmap Based On Evidence And Country Experience., Shyama Kuruvilla, Flavia Bustreo, Taona Kuo, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

The Global strategy for women’s, children’s and adolescents’ health (2016–2030) provides a roadmap for ending preventable deaths of women, children and adolescents by 2030 and helping them achieve their potential for and rights to health and well-being in all settings.1 The global strategy has three objectives: survive (end preventable deaths); thrive (ensure health and well-being); and transform (expand enabling environments). These objectives are aligned with 17 targets within nine of the sustainable development goals (SDGs),2 including SDG 3 on health and other SDGs related to the political, social, economic and environmental determinants of health and sustainable development.

Like the SDGs, …

Intimate Partner Violence In Early Adolescence: The Role Of Gender, Socioeconomic Factors And The School, A. J. Mason-Jones, P De Koker, S. M. Eggers, Marleen Temmerman, E. Leye, P. J De Vries, H De Vries

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) among adolescents is common worldwide, but our understanding of perpetration, gender differences and the role of social-ecological factors remains limited.

Objectives: To explore the prevalence of physical and sexual IPV perpetration and victimisation by gender, and associated risk and protective factors.

Methods: Young adolescents (N=2 839) from 41 randomly selected public high schools in the Western Cape region of South Africa (SA), participating in the PREPARE study, completed a self-administered questionnaire.

Results: The participants’ mean age was 13.65 years (standard deviation 1.01), with 19.1% (541/2 839) reporting being victims/survivors of IPV and 13.0% (370/2 839) …

Effect Of Body Mass Index On Outcome Of Labour Induction, Farheen Yousuf, Tahira Naru, Sana Sheikh

Department of Obstetrics & Gynaecology

The retrospective study to explore the adverse effect of obesity on pregnancy and labour was conducted at Aga Khan University Hospital, Karachi, Pakistan, and comprised data of all patients booked between 12-14 weeks and required induction of labour from January 1 to December 31, 2012. Women were grouped into two body mass index categories: normal weight (23 kg/m2). Obesity increased the risk of development of gestational hypertension and diabetes. Therefore obese women were more likely to be induced due to medical indication whether primiparous or multiparous adjusted odds ratio =2.89(95% confidence interval 1.29-6.48) and 2.77 (95% confidence interval 1.07-7.19) respectively. …

Fallopian Tube Cyst: A Rare Complication Of Tubal Sterilization, Sana Zahiruddin, Momna Khan, Maria Iftikhar

Department of Obstetrics & Gynaecology

Tubal sterilization is one of the most commonly employed permanent method of contraception, although it is considered very safe, rarely a cyst may develop in the fallopian tube after sterilization which may undergo torsion resulting in patient presenting with acute abdomen. We are presenting a case of a middle aged women presenting to emergency room with severe lower abdominal pain, she had past history of tubal ligation done 12 years back. Pelvic ultrasound showed right sided ovarian cyst, emergency laparotomy was performed for suspected torsion of ovarian cyst, which revealed normal ovary, however a right sided fallopian tube cyst was …

Iron Deficiency Anemia Among Women Of Reproductive Age, An Important Public Health Problem: Situation Analysis, Minaz Mawani, Savera Aziz Ali, Gulshan Bano, Sumera Aziz Ali

Section of Internal Medicine

Background: Iron deficiency is a major cause of anemia and is more prevalent in developing countries, posing additional burden on health care systems, in the presence of scarcity of resources. The high-risk group consists of females and children but comparatively it is higher in females due to physiological reasons. Multiple factors can predict anemia, which in turn leads to various adverse outcomes.

Objective: The purpose of this literature review was to review and synthesize the findings from literature about the burden, causes, outcomes and important interventions of iron deficiency anemia for developing countries.

Methods: An extensive literature review was carried …

Engaging With Community-Based Public And Private Mid-Level Providers For Promoting The Use Of Modern Contraceptive Methods In Rural Pakistan: Results From Two Innovative Birth Spacing Interventions, Syed Khurram Azmat, Waqas Hameed, Hasan Bin Hamza, Ghulam Mustafa, Muhammad Ishaque, Ghazunfer Abbas, Omar Farooq Khan, Jamshaid Asghar, Erik Munroe, Safdar Ali, Wajahat Hussain, Sajid Ali, Aftab Ahmed, Moazzam Ali, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Family planning (FP) interventions aimed at reducing population growth have negligible during the last two decades in Pakistan. Innovative FP interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society - Pakistan implemented an operational research project - ‘Evidence for Innovating to Save Lives’, to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan.

Methods: We conducted a quasi-experimental (pre - and post-intervention with control arm) study to assess the effectiveness of …