Medical Specialties Commons^™

Antiseptics And Disinfectants For The Treatment Of Bacterial Vaginosis: A Systematic Review, Hans Verstraelen Verstraelen, Rita Verhelst, Kristien Roelens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV).

Methods: A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970-2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin …

Maternal Tetanus Toxoid Vaccination And Neonatal Mortality In Rural North India, A. Singh, S. Pallikadavath, R. Ogollah, W. Stones

Obstetrics and Gynaecology, East Africa

Objectives: Preventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India.

Methods and Findings: Using the third round of the Indian National Family Health Survey (NFHS) 2005-06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT) …

Antenatal Care And The Occurrence Of Low Birth Weight Delivery Among Women In Remote Mountainous Region Of Chitral, Pakistan, Z. Ahmed, S. Khoja, Suha S. Tirmizi

Obstetrics and Gynaecology, East Africa

Objective: Low birth weight (LBW) is closely associated with perinatal morbidity and bears an increased risk for subsequent infant morbidity. The study aimed to assess low birth weight delivery factors among women in Chitral, Pakistan.

Methodology: Mixed Methodology was adopted. Structured data collection tool was used to collect information from medical records of 1316 mothers, followed by interviews and focus group discussions to understand the causes and their remedies. The main outcome measure was infants born with low birth weight LBW (<2.5kg).

Result: There was a significant association between the occurrence of low birth weight and maternal education, paternal education, …

Effectiveness Of A Peer-Led Hiv Prevention Intervention In Secondary Schools In Rwanda: Results From A Non-Randomized Controlled Trial, Kristien Michielsen, Roxanne Beauclair, Wim Delva, Kristien Roelens, Ronan Van Rossem, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: While the HIV epidemic is levelling off in sub-Saharan Africa, it remains at an unacceptably high level. Young people aged 15-24 years remain particularly vulnerable, resulting in a regional HIV prevalence of 1.4% in young men and 3.3% in young women. This study assesses the effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda on young people’s sexual behavior, HIV knowledge and attitudes.

Methods: In a non-randomized longitudinal controlled trial, fourteen schools were selected in two neighboring districts in Rwanda Bugesera (intervention) and Rwamagana (control). Students (n= 1950) in eight intervention and six control schools participated …

“That Pregnancy Can Bring Noise Into The Family”: Exploring Intimate Partner Sexual Violence During Pregnancy In The Context Of Hiv In Zimbabwe, Simukai Shamu, Naeemah Abrahams, Marleen Temmerman, Tamara Shefer, Christina Zarowsky

Obstetrics and Gynaecology, East Africa

Background: Globally, studies report a high prevalence of intimate partner sexual violence (IPSV) and an association with HIV infection. Despite the criminalisation of IPSV and deliberate sexual HIV infection in Zimbabwe, IPSV remains common. This study explored women’s and health workers’ perspectives and experiences of sexuality and sexual violence in pregnancy, including in relation to HIV testing.

Methods: This qualitative study was part of a larger study of the dynamics of intimate partner violence and HIV in pregnancy in Zimbabwe. Key informant interviews were conducted with health workers and focus group discussions were held with 64 pregnant or nursing mothers …

Hidden Violence Is Silent Rape: Sexual And Gender-Based Violence In Refugees, Asylum Seekers And Undocumented Migrants In Belgium And The Netherlands, Ines Keygnaert, Nicole Vettenbu, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Although women, young people and refugees are vulnerable to sexual and gender-based violence (SGBV) worldwide, little evidence exists concerning SGBV against refugees in Europe. Using community-based participatory research, 223 in-depth interviews were conducted with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Responses were analysed using framework analysis. The majority of the respondents were either personally victimised or knew of a close peer being victimised since their arrival in the European Union. A total of 332 experiences of SGBV were reported, mostly afflicted on them by (ex-)partners or asylum professionals. More than half of the reported violent …

Comparison Of Conventional Cervical Cytology Versus Visual Inspection With Acetic Acid (Via) Among Hiv-Infected Women In Western Kenya, Hillary Mabeya, Kareem Khozaim, Tao Liu, Elkanah Omenge, David Chumba, Latha Pisharodi, J. Carter, Susan Cu-Uvin

Obstetrics and Gynaecology, East Africa

Objective: To determine the accuracy of visual inspection with Acetic Acid (VIA) versus conventional Pap smear as a screening tool for cervical intraepithelial neoplasia (CIN)/cancer among HIV-infected women.

Materials and Methods: 150 HIV-infected women attending the Moi Teaching and Referral Hospital HIV clinic in Eldoret underwent conventional Pap smear, VIA, colposcopy and biopsy. VIA and Pap smears were done by nurses while colposcopy and biopsy were done by a physician. Receiver Operating Characteristic (ROC) analysis was conducted to compare the accuracies between VIA and Pap smear in sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results: Among …

Reminder Systems For Self Uterine Massage In The Prevention Of Postpartum Blood Loss, S. K. Ngichabe, B. W. Gatinu, M. A. Nyangore, R. Karuga, Sikolia Wanyonyi, Jn Kiarie

Obstetrics and Gynaecology, East Africa

Background: Uterine massage may significantly reduce post partum blood loss and could be patient-driven.

Objective: To assess the effectiveness of an alarm reminder system for self uterine massage in the prevention of post partum blood loss.

Design: A random controlled trial.

Setting: Meru District Hospital, Kenya.

Subjects: One hundred and twenty seven (127) women were randomly assigned to a 15 minute alarm reminder system (71) and non-alarm (56) control arm during the fourth stage of labour.

Results: Uterine massage compliance was better in the alarm group compared to the non-alarm group ( Average massage …

Conscientious Objection And Reproductive Health Service Delivery In Sub-Saharan Africa, V. M. Lema

Obstetrics and Gynaecology, East Africa

Lack of access to quality reproductive health services is the main contributor to the high maternal mortality and morbidity in sub-Saharan Africa (SSA). This is partly due to a shortage of qualified and experienced health care providers. However conscientious objection amongst the available few is a hitherto undocumented potential factor influencing access to health care in SSA. Provision of certain reproductive health services goes counter to some individual’s religious and moral beliefs and practices. Health providers sometimes refuse to participate in or provide such services to clients/patients on moral and/or religious grounds. While the rights to do so are protected …

Nothing As Practical As A Good Theory? The Theoretical Basis Of Hiv Prevention Interventions For Young People In Sub-Saharan Africa: A Systematic Review, Kristien Michielsen, Matthew Chersich, Marleen Temmerman, Tessa Dooms, Ronan Van Rossem

Obstetrics and Gynaecology, East Africa

This paper assesses the extent to which HIV prevention interventions for young people in sub-Saharan Africa are grounded in theory and if theory-based interventions are more effective. Three databases were searched for evaluation studies of HIV prevention interventions for youth. Additional articles were identified on websites of international organisations and through searching references. 34 interventions were included; 25 mentioned the use of theory. Social Cognitive Theory was most prominent (n = 13), followed by Health Belief Model (n = 7), and Theory of Reasoned Action/Planned Behaviour (n = 6). These cognitive behavioural theories assume that cognitions drive sexual behaviour. Reporting …

Raising The Bar In Publishing: The Future Of Jogeca, Alfred Murage

Obstetrics and Gynaecology, East Africa

Excitement is in the air in Kenya, what with the looming elections and constitutional changes? JOGECA has not been left behind in these exciting times, we have a booming issue that readers will enjoy reading. And there are exciting developments in the pipeline to propel our journal into new heights.

Severe Propylthiouracil-Induced Hepatotoxicity In Pregnancy Managed Successfully By Liver Transplantation: A Case Report, Evan Sequeira, Sikolia Wanyonyi, Raj Dodia

Obstetrics and Gynaecology, East Africa

Introduction: Propylthiouracil-induced severe hepatotoxicity is a relatively rare occurrence, with very few cases reported in the literature. The management of this complication in pregnancy can be a challenge because of the effects of the various treatment options on the fetus.

Case presentation: We report a rare case of fulminant hepatic failure in a 36-year-old gravida 2 black woman of African descent that occurred at 17 weeks gestation following propylthiouracil treatment for Graves’ disease. Her liver failure was managed by liver transplantation and thyroidectomy. Her pregnancy was continued to term, though with not so favorable early childhood sequelae.

Conclusion: This case …

Domestic Violence And Pregnancy: The Challenge Of Framing A European-Wide Research Question., Caroline Andries, Nicola Buckley, Kristien Roelens, Ingunn Studsrød, Marleen Temmerman, An-Sofie Van Parys, Elisabeth Willumsen

Obstetrics and Gynaecology, East Africa

No abstract provided.

Parental Control And Monitoring Of Young People's Sexual Behaviour In Rural North-Western Tanzania: Implications For Sexual And Reproductive Health Interventions, Joyce Wamoyi, Angela Fenwick, Mark Urassa, Basia Zaba, William Stones

Obstetrics and Gynaecology, East Africa

Background

Parenting through control and monitoring has been found to have an effect on young people's sexual behaviour. There is a dearth of literature from sub-Saharan Africa on this subject. This paper examines parental control and monitoring and the implications of this on young people's sexual decision making in a rural setting in North-Western Tanzania.

Methods

This study employed an ethnographic research design. Data collection involved 17 focus group discussions and 46 in-depth interviews conducted with young people aged 14-24 years and parents/carers of young people within this age-group. Thematic analysis was conducted with the aid of NVIVO 7 software. …

Participating In A Community Of Learners Enhances Resident Perceptions Of Learning In An E-Mentoring Program: Proof Of Concept, Timona Obura, William. E. Brant, Fiona Miller, I. J. Parboosingh

Obstetrics and Gynaecology, East Africa

Background

Community learning and e-mentoring, learning methods used in higher education, are not used to any extent in residency education. Yet both have the potential to enhance resident learning and, in the case of community learning, introduce residents to basic lifelong learning skills. We set out to determine whether residents participating in an Internet based e-mentoring program would, with appropriate facilitation, form a community of learners (CoL) and hold regular community meetings. We also determined resident and faculty perceptions of CoL and Internet sessions as effective learning experiences.

Methods

A six-month e-mentoring pilot was offered to 10 Radiology residents in …

Bacterial Vaginosis Is Associated With Uterine Cervical Human Papillomavirus Infection: A Meta-Analysis, Evy Gillet, Joris Fa Meys, Hans Verstraelen, Carolyne Bosire, Philippe De Sutter, Marleen Temmerman, Davy Vanden Broeck

Obstetrics and Gynaecology, East Africa

Background: Bacterial vaginosis (BV), an alteration of vaginal flora involving a decrease in Lactobacilli and predominance of anaerobic bacteria, is among the most common cause of vaginal complaints for women of childbearing age. It is well known that BV has an influence in acquisition of certain genital infections. However, association between BV and cervical human papillomavirus (HPV) infection has been inconsistent among studies. The objective of this meta-analysis of published studies is to clarify and summarize published literature on the extent to which BV is associated with cervical HPV infection.

Methods: Medline and Web of Science were systematically searched for …

The Epidemiology Of Bacterial Vaginosis In Relation To Sexual Behaviour, Hans Verstraelen, Rita Verhelst, Mario Vaneechoutte, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Bacterial vaginosis (BV) has been most consistently linked to sexual behaviour, and the epidemiological profile of BV mirrors that of established sexually transmitted infections (STIs). It remains a matter of debate however whether BV pathogenesis does actually involve sexual transmission of pathogenic microorganisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour.

Discussion: G. vaginalis carriage and BV occurs rarely with children, but has been observed among adolescent, even sexually non-experienced girls, contradicting that sexual transmission is a necessary prerequisite to disease acquisition. G. vaginalis carriage is enhanced …

Examining The "Urban Advantage" In Maternal Health Care In Developing Countries, Zoe¨ Matthews, Amos Channon, Nyovani Madise, William Stones

Obstetrics and Gynaecology, East Africa

Although recent survey data make it possible to examine inequalities in maternal and newborn health care in developing countries, analyses have not tended to take into consideration the special nature of urban poverty.

Using improved methods to measure urban poverty in 30 countries, we found substantial inequalities in maternal and newborn health, and in access to health care.

The ‘‘urban advantage’’ is, for some, non-existent. The urban poor do not necessarily have better access to services than the rural poor, despite their proximity to services.

There are two main patterns of urban inequality in developing countries: (1) massive exclusion, in …

Parent-Child Communication About Sexual And Reproductive Health In Rural Tanzania: Implications For Young People's Sexual Health Interventions, Joyce Wamoyi, Angela Fenwick, Mark Urassa, Basia Zaba, William Stones

Obstetrics and Gynaecology, East Africa

Background

Many programmes on young people and HIV/AIDS prevention have focused on the in-school and channeled sexual and reproductive health messages through schools with limited activities for the young people's families. The assumption has been that parents in African families do not talk about sexual and reproductive health (SRH) with their children. These approach has had limited success because of failure to factor in the young person's family context, and the influence of parents. This paper explores parent-child communication about SRH in families, content, timing and reasons for their communication with their children aged 14-24 years in rural Tanzania.

Methods …

Reproductive Health Services For Populations At High Risk Of Hiv: Performance Of A Night Clinic In Tete Province, Mozambique, Yves Lafort, Diederike Geelhoed, Luisa Cumba, Carla Das Dores Mosse Lázaro, Wim Delva, Stanley Luchters, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability.

Methods: In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held …

Hiv Prevention Through Sport: The Case Of The Mathare Youth Sport Association In Kenya., Wim Delva, Kristien Michielsen, Bert Meulders, Sandy Groeninck, Edwin Wasonga, Pauline Ajwang, Marleen Temmerman, Bart Vanreusel

Obstetrics and Gynaecology, East Africa

Sport has become a popular tool for HIV prevention, based on claims that it can foster life skills that are necessary to translate knowledge, attitudes and behavioural intentions into actual behaviour. Empirical evidence of the effectiveness of sport-based HIV prevention programmes is, however, sorely lacking. We therefore conducted a cross-sectional survey assessing sexual behaviour and the determinants thereof among 454 youth of the Mathare Youth Sport Association (MYSA) in Kenya and a control group of 318 non-MYSA members. Multiple (ordinal) logistic regression models were applied to measure the association between MYSA membership and attitudes, subjective norms and self-efficacy related to …

‘Maternal Intensive Care’: A Systematic Literature Review, An-Sofie Van Parys, Hans Verstraelen, Kristien Roelens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: The objective of this systematic literature review is to review current scientific knowledge on the definition of and the indications for maternal/obstetric intensive care (MIC).

Methods: We conducted a extensive search in OVID MEDLINE, EMBASE, COCHRANE, CINHAL and CEBAM using the keywords: maternal/obstetric intensive care, subacute care, intermediate care, postacute care, critical care, sub intensive care, progressive patient care, postnatal care, perinatal care, obstetrical nursing, neonatology, pregnancy, maternal mortality/morbidity and pregnancy complication. A total of 180 articles and one guideline were identified and supplemented by a hand search. After title, abstract and full text evaluation, the articles and guideline …

Association Of Hiv Infection With Distribution And Viral Load Of Hpv Types In Kenya: A Survey With 820 Female Sex Workers, Stanley Mf Luchters, Davy Vanden Broeck, Matthew F. Chersich, Annalene Nel, Wim Delva, Kishor Mandaliya, Christophe E. Depuydt, Patricia Claeys, John-Paul Bogers, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Human papillomavirus (HPV) and HIV are each responsible for a considerable burden of disease. Interactions between these infections pose substantial public health challenges, especially where HIV prevalence is high and HPV vaccine coverage low.

Methods: Between July 2005 and January 2006, a cross-sectional community-based survey in Mombasa, Kenya, enrolled female sex workers using snowball sampling. After interview and a gynaecological examination, blood and cervical cytology samples were taken. Quantitative real-time PCR detected HPV types and viral load measures. Prevalence of high-risk HPV was compared between HIV-infected and -uninfected women, and in women with abnormal cervical cytology, measured using conventional …

Perspectives On The Practice Of Vaginal Birth After Caesarean Section In East Africa, Sikolia Wanyonyi, Abraham Mukaindo, William Stones

Obstetrics and Gynaecology, East Africa

Background: The increasing Caesarean section rates being observed in most facilities will ultimately result in a larger proportion of women with previous scar. Choices need to be made by both the patient and the health worker between attempted vaginal birth after Caesarean section (VBAC) and Elective Repeat Caesarean section (ERCS). Both practices are associated with perinatal risks and benefits that call for certain objectivity and prudence in decision making especially where resources are scarce.

Objective: To determine perceptions on the practice of vaginal birth after Caesarean section among maternity service providers in East Africa.

Design: A semi-qualitative cross sectional survey …

The Utility Of Clinical Care Pathways In Determining Perinatal Outcomes For Women With One Previous Caesarean Section; A Retrospective Service Evaluation, Sikolia Wanyonyi, Robinson N. Karuga

Obstetrics and Gynaecology, East Africa

Background: The rising rates of primary caesarean section have resulted in a larger obstetric population with scarred uteri. Subsequent pregnancies in these women are risk-prone and may complicate. Besides ensuring standardised management, care pathways could be used to evaluate for perinatal outcomes in these high risk pregnancies. We aim to demonstrate the use of a care pathway for vaginal birth after caesarean section as a service evaluation tool to determine perinatal outcomes.

Methods: A retrospective service evaluation by review of delivery case notes and records was undertaken at the Aga Khan University Hospital, Nairobi, Kenya between January 2008 and December …

Longitudinal Analysis Of The Vaginal Microflora In Pregnancy Suggests That L. Crispatus Promotes The Stability Of The Normal Vaginal Microflora And That L. Gasseri And/Or L. Iners Are More Conducive To The Occurrence Of Abnormal Vaginal Microflora, Hans Verstraelen, Rita Verhelst, Geert Claeys, Ellen De Backer, Marleen Temmerman, Mario Vaneechoutte

Obstetrics and Gynaecology, East Africa

Background: Despite their antimicrobial potential, vaginal lactobacilli often fail to retain dominance, resulting in overgrowth of the vagina by other bacteria, as observed with bacterial vaginosis. It remains elusive however to what extent interindividual differences in vaginal Lactobacillus community composition determine the stability of this microflora. In a prospective cohort of pregnant women we studied the stability of the normal vaginal microflora (assessed on Gram stain) as a function of the presence of the vaginal Lactobacillus index species (determined through culture and molecular analysis with tRFLP).

Results:From 100 consecutive Caucasian women vaginal swabs were obtained at mean gestational ages …

Identification And Genotyping Of Bacteria From Paired Vaginal And Rectal Samples From Pregnant Women Indicates Similarity Between Vaginal And Rectal Microflora, Nabil Abdullah El Aila, Inge Tency, Geert Claeys, Hans Verstraelen, Bart Saerens, Guido Lopes Dos Santos Santiago, Ellen De Backer, Piet Cools, Marleen Temmerman, Rita Verhelst

Obstetrics and Gynaecology, East Africa

Background: The vaginal microflora is important for maintaining vaginal health and preventing infections of the reproductive tract. The rectum has been suggested as the major source for the colonisation of the vaginal econiche.

Methods: To establish whether the rectum can serve as a possible bacterial reservoir for colonisation of the vaginal econiche, we cultured vaginal and rectal specimens from pregnant women at 35-37 weeks of gestation, identified the isolates to the species level with tRNA intergenic length polymorphism analysis (tDNA-PCR) and genotyped the isolates for those subjects from which the same species was isolated simultaneously vaginally and rectally, by RAPD-analysis. …

Genotyping Of Streptococcus Agalactiae (Group B Streptococci) Isolated From Vaginal And Rectal Swabs Of Women At 35-37 Weeks Of Pregnancy, Nabil Abdullah El Aila, Inge Tency, Geert Claeys, Bart Saerens, Ellen De Backer, Marleen Temmerman, Rita Verhelst, Mario Vaneechoutte

Obstetrics and Gynaecology, East Africa

Background: Group B streptococci (GBS), or Streptococcus agalactiae, are the leading bacterial cause of meningitis and bacterial sepsis in newborns. Here we compared different culture media for GBS detection and we compared the occurrence of different genotypes and serotypes of GBS isolates from the vagina and rectum.

Methods: Streptococcus agalactiae was cultured separately from both rectum and vagina, for a total of 150 pregnant women, i) directly onto Columbia CNA agar, or indirectly onto ii) Granada agar resp. iii) Columbia CNA agar, after overnight incubation in Lim broth.

Results: Thirty six women (24%) were colonized by GBS. Of these, 19 …

The Vaginal Microflora In Relation To Gingivitis, Rutger Persson, Jane Hitti, Rita Verhelst, Mario Vaneechoutte, Rigmor Persson, Regula Hirschi, Marianne Weibel, Marilynn Rothen, Marleen Temmerman, Kathleen Paul

Obstetrics and Gynaecology, East Africa

Background: Gingivitis has been linked to adverse pregnancy outcome (APO). Bacterial vaginosis (BV) has been associated with APO. We assessed if bacterial counts in BV is associated with gingivitis suggesting a systemic infectious susceptibilty.

Methods: Vaginal samples were collected from 180 women (mean age 29.4 years, SD ± 6.8, range: 18 to 46), and at least six months after delivery, and assessed by semi-quantitative DNA-DNA checkerboard hybridization assay (74 bacterial species). BV was defined by Gram stain (Nugent criteria). Gingivitis was defined as bleeding on probing at ≥ 20% of tooth sites.

Results: A Nugent score of 0–3 (normal vaginal …

Hiv/Aids And Pregnancy-Related Deaths In Blantyre, Malawi, V. M. Lema, C. Kanyighe, J. Changole, E. V. Malunga

Obstetrics and Gynaecology, East Africa

Background: HIV/AIDS epidemic is one of the major factors affecting women’s health and impeding national efforts to improve it especially in sub-Saharan Africa. Current evidence indicates that HIV/ AIDS is increasingly becoming a major cause or contributing factor to pregnancy-related deaths, almost overtaking the “traditional” causes and factors.

Objectives: To survey the contribution of HIV infection and AIDS to pregnancy-related deaths in Blantyre, Malawi.

Design: A retrospective, descriptive, facility-based survey.

Setting: The Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi.

Subjects: All women recorded to have had pregnancy-related deaths between January 1, 1999 and December 31, 2000.

Results: There were …