scholarly journals Performance of Integrated Emergency Surgical Officers at Mizan-Tepi University Teaching Hospital, Mizan-Aman, Ethiopia: A Retrospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Margo S. Harrison ◽  
Ephrem Kirub ◽  
Tewodros Liyew ◽  
Biruk Teshome ◽  
Andrea Jimenez-Zambrano ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
University Teaching ◽  
Provider Type ◽  
Convenience Sample ◽  
Cesarean Birth ◽  
Cesarean Births ◽  
Sample Data ◽  
Sub Saharan ◽  
Level Of Training ◽  
Physician Extenders

Introduction. Surgical physician extenders are used in Ethiopia and sub-Saharan Africa where there is a lack of surgical providers. Methods. We tested characteristics associated with and outcomes of births attended by an integrated emergency surgical officers (IESOs) as compared to midwives and physician providers. Results. Of 1,000 women in our convenience sample, data on birth attendant was missing on 5 women (0.5%). Of the remaining women, almost three-fourths (73.6%, n = 732) of women were attended by a midwife, almost a quarter were attended by an IESO (24.4%, n = 243), 10 women were attended by a physician with a General Practitioner level of training (1.0%), 5 women were delivered by an Ob/Gyn resident (0.5%), and 5 women were attended by an Ob/Gyn (0.5%). Women had a higher likelihood of being attended by an IESO than a midwife if they underwent forceps-assisted (RR 88.4, p < 0.05 ), vacuum-assisted (RR 45.2, p < 0.05 ), or cesarean birth (RR 161.8, p < 0.05 ) as compared to an unassisted vaginal birth. IESOs are performing more operative vaginal and cesarean births than other delivery providers. Outcomes of their deliveries are worse than those of midwives, but this is likely due to the acuity level of the patients and not the provider type.

scholarly journals Use of Cesarean Birth among Robson Groups 2 and 4 at Mizan-Tepi University Hospital, Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Margo S. Harrison ◽  
Tewodros Liyew ◽  
Ephrem Kirub ◽  
Biruk Teshome ◽  
Andrea Jimenez-Zambrano ◽  
...  
Keyword(s):  
Risk Factors ◽  
University Teaching ◽  
University Hospital ◽  
Study Cohort ◽  
Convenience Sample ◽  
Cesarean Birth ◽  
Group 4 ◽  
Increased Risk ◽  
Group 2 ◽  
Failed Induction

Background. Primary cesarean birth rates were high among women who were either nulliparous (Group 2) or multiparous (Group 4) with a single, cephalic, term fetus who were induced, augmented, or underwent cesarean birth before labor in our study cohort. Objectives. The objective of this analysis was to determine what risk factors were associated with cesarean birth among Robson Groups 2 and 4. Methods. This study was a prospective hospital-based cross-sectional analysis of a convenience sample of 1,000 women who delivered at Mizan-Tepi University Teaching Hospital in the summer and fall of 2019. Results. Women in Robson Groups 2 and 4 comprised 11.4% (n = 113) of the total population (n = 993). The cesarean birth rate in Robson Group 2 (n = 56) was 37.5% and in Robson Group 4 (n = 57) was 24.6%. In Robson Group 2, of all prelabor cesareans (n = 5), one birth was elective cesarean by maternal request; the intrapartum cesarean births (n = 16) mostly had a maternal or fetal indication (93.8%), with one birth (6.2%) indicated by “failed induction or augmentation,” which was a combined indication. In Robson Group 4, all 4 women delivered by prelabor cesarean had a maternal indication (one was missing data), and 3 of the intrapartum cesareans were indicated by “failed induction or augmentation.” In multivariable modeling of Robson Group 2, having a labor duration of “not applicable” increased the risk of cesarean delivery (RR 2.9, CI (1.5, 5.4)). The odds of requiring maternal antibiotics was the only notable outcome with increased risk (RR 11.1, CI (1.9, 64.9)). In multivariable modeling of Robson Group 4, having a labor longer than 24 hours trended towards a significant association with cesarean (RR 3.6, CI (0.9, 14.3)), and women had a more dilated cervix on admission trended toward having a lower odds of cesarean (RR 0.8, CI (0.6, 1.0)). Conclusion. Though rates of primary cesarean birth among women who have a term, single, cephalic fetus and are induced, augmented, or undergone prelabor cesarean birth are high, those that occur intrapartum seem to be associated with appropriate risk factors and indications, though we cannot say this definitely as we did not perform an audit. More research is needed on the prelabor subgroup as a separate entity.

DENOMINATIONAL AFFILIATION AND FERTILITY BEHAVIOUR IN AN AFRICAN CONTEXT: AN EXAMINATION OF COUPLE DATA FROM GHANA

2008 ◽  
Vol 40 (3) ◽  
pp. 445-458 ◽  
Author(s):  
STEPHEN OBENG GYIMAH ◽  
BAFFOUR TAKYI ◽  
ERIC YEBOAH TENKORANG
Keyword(s):  
Religious Affiliation ◽  
Sub Saharan Africa ◽  
Fertility Behaviour ◽  
Sample Data ◽  
African Context ◽  
Lower Fertility ◽  
Sub Saharan ◽  
The Impact ◽  
The Relationship ◽  
Religious Differences

SummaryAlthough studies have examined religious differences in fertility in sub-Saharan Africa, it is argued in this paper that using women-only sample data may be conceptually problematic in patriarchal African societies where the influence of husbands on their wives’ reproductive preferences is paramount. The present study contributes to this discourse by examining the relationship between religion and fertility behaviour using matched-couple data from Ghana. Guided by the ‘religious values’ and ‘characteristics’ hypotheses, the results indicate significant religious differences in fertility. Compared with Traditionalists, Christians and Muslims have lower fertility, albeit these differences diminish significantly after controlling for socioeconomic variables. The impact of wife’s religious denomination on marital fertility is attenuated after controlling for husband’s religious affiliation. Also, fertility was found to be higher if couples belong to the same faith compared with those of different faiths.

scholarly journals Arterial stiffness is associated with oxidative stress and endothelial activation among persons with treated HIV in Zambia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Theresa Chikopela ◽  
Fastone Goma ◽  
Longa Kaluba ◽  
Wilbroad Mutale ◽  
Chris Guure ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Arterial Stiffness ◽  
Endothelial Activation ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Stiffness Index ◽  
Intercellular Adhesion Molecule ◽  
Vascular Compliance ◽  
Sub Saharan ◽  
Hiv Negative

Background: Cardiovascular disease (CVD) prevalence is rising among persons with HIV (PLWH) in sub-Saharan Africa. Oxidative stress and endothelial activation, resulting in reduced vascular compliance, are contributors to CVD risk. However, there is a paucity of vascular health data in this population.Objectives: To assess the relationships of oxidative stress and endothelial activation with vascular stiffness among PLWH.Method: Fifty-four PLWH on antiretroviral therapy 5 years and 57 HIV-negative controls, all aged 18–45 years, were enrolled from the University Teaching Hospital, Lusaka, Zambia. Oxidative stress was measured by nitrotyrosine, a peroxynitrite biomarker, and endothelial activation by soluble intercellular adhesion molecule-1 (sICAM-1) plasma levels. Vascular compliance was measured using carotid-radial pulse wave velocity (crPWV) and arterial stiffness index (crASI).Results: PLWH had higher sICAM-1 levels (median 345 ng/mL) compared to controls (275 ng/mL, p 0.01), as well as higher nitrotyrosine levels (297 versus 182 nM; p = 0.02). Median crPWV was similar between the groups, but PLWH had higher crASI (2.4 versus 2.2 cm/ms; p 0.05). After adjusting for age, fat mass, and blood pressure, the estimated effect of a one unit increase in nitrotyrosine on crPWV were twofold higher in the PLWH, but neither reached significance. In a model pooling all participants, there were significant differences in the relationship of nitrotyrosine with crPWV and crASI by HIV status.Conclusion: PLWH in sub-Saharan Africa had significantly greater oxidative stress and endothelial activation compared to HIV-negative individuals. These factors may contribute to increased arterial stiffness and higher CVD prevalence in this population.

scholarly journals Prevalence of HIV Infection among Adolescents and Young People at a Tertiary Health Facility in Ekiti State, Southwest, Nigeria

2019 ◽  
pp. 1-5
Author(s):  
G. O. Daramola ◽  
O. O. Oni ◽  
H. A. Edogun ◽  
A. O. Ojerinde ◽  
O. D. Ajayi ◽  
...  
Keyword(s):  
Young People ◽  
Health Facility ◽  
Significant Proportion ◽  
Young Person ◽  
The State ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
People Living With Hiv ◽  
Southwest Nigeria ◽  
Sub Saharan

Background: Nine out of every 10 of the world’s 1.8 billion adolescents and young people (AYP) live in developing nations, Nigeria inclusive. In Nigeria as in the rest of sub-Saharan Africa, 1 out of every 3 persons is an adolescent or a young person. As at 2016, there were about 240, 000 AY) aged 10-19 years in Nigeria, which roughly makes 7% of the total number of people living with HIV (PLWH) in Nigeria. According to 2017 national survey, about 70% of the country’s AYP lack knowledge of how HIV is transmitted or how it can be prevented. Since AYP, aged 10-19 years, constitute a significant proportion of the nation’s burgeoning population, it is very important and critical to fully understand the dynamics of the HIV epidemic among AYP. This study aimed at determining the prevalence of HIV among AYP at a tertiary health facility in Ekiti State, Southwest Nigeria and comparing it with national and regional prevalence among same group. Methodology: The study was a retrospective study of AYP, aged 13-20 years at Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Southwest Nigeria. Convenience and consecutive sampling method was used in retrieving subjects’ data. One hundred subjects whose ages were between 13 and 20 years were consecutively sampled over a period of six months, July to December, 2018. Results: Out of the one hundred subjects retrospectively sampled, 46 (46%) were males, while 54 (54%) were females. Four (4%) of the subjects were 13 years of age, while 6(6%), 5(5%), 8(8%), 27(27%), 17(17%), 12(12%) and 21(21%) respectively were aged 14, 15, 16, 17, 18, 19 and 20 years. Three (3%) of the subjects were positive to HIV, 1 (%) was male, while 2 (20%) were female, thus giving a sero-prevalence rate of 3%. Disaggregation of the positive subjects reveals that 33.3% were male, while 66.7% were females. Conclusion: Though the general prevalence of HIV in Ekiti State ranks among the lowest in Nigeria, group-specific interventions targeting the AYP should be put in place in the State to address the disproportionately high prevalence among the AYP in the State.

scholarly journals Pediatric hydrocephalus outcomes in Lusaka, Zambia

2020 ◽  
Vol 26 (6) ◽  
pp. 624-635
Author(s):  
Rebecca A. Reynolds ◽  
Arnold Bhebhe ◽  
Roxanna M. Garcia ◽  
Shilin Zhao ◽  
Sandi Lam ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Descriptive Analysis ◽  
Multivariable Analysis ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Shunt Revision ◽  
Shunt Insertion ◽  
Middle Income ◽  
Pediatric Hydrocephalus ◽  
Sub Saharan

OBJECTIVEHydrocephalus is a global disease that disproportionally impacts low- and middle-income countries. Limited data are available from sub-Saharan Africa. This study aims to be the first to describe pediatric hydrocephalus epidemiology and outcomes in Lusaka, Zambia.METHODSThis retrospective cohort study included patients < 18 years of age who underwent surgical treatment for hydrocephalus at Beit-CURE Hospital and the University Teaching Hospital in Lusaka, Zambia, from August 2017 to May 2019. Surgeries included ventriculoperitoneal shunt insertions, revisions, and endoscopic third ventriculostomies (ETVs) with or without choroid plexus cauterization (CPC). A descriptive analysis of patient demographics, clinical presentation, and etiologies was summarized, followed by a multivariable analysis of mortality and 90-day complications.RESULTSA total of 378 patients met the inclusion criteria. The median age at first surgery was 5.5 (IQR 3.1, 12.7) months, and 51% of patients were female (n = 193). The most common presenting symptom was irritability (65%, n = 247), followed by oculomotor abnormalities (54%, n = 204). Postinfectious hydrocephalus was the predominant etiology (65%, n = 226/347), and 9% had a myelomeningocele (n = 32/347). It was the first hydrocephalus surgery for 87% (n = 309) and, of that group, 15% underwent ETV/CPC (n = 45). Severe hydrocephalus was common, with 42% of head circumferences more than 6 cm above the 97th percentile (n = 111). The median follow-up duration was 33 (IQR 4, 117) days. The complication rate was 20% (n = 76), with infection being most common (n = 29). Overall, 7% of the patients died (n = 26). Postoperative complication was significantly associated with mortality (χ2 = 81.2, p < 0.001) with infections and CSF leaks showing the strongest association (χ2 = 14.6 and 15.2, respectively, p < 0.001). On adjusted multivariable analysis, shunt revisions were more likely to have a complication than ETV/CPC or primary shunt insertions (OR 2.45 [95% CI 1.26–4.76], p = 0.008), and the presence of any postoperative complication was the only significant predictor of mortality (OR 42.9 [95% CI 12.3–149.1], p < 0.001).CONCLUSIONSPediatric postinfectious hydrocephalus is the most common etiology of hydrocephalus in Lusaka, Zambia, which is similar to other countries in sub-Saharan Africa. Most children present late with neglected hydrocephalus. Shunt revision procedures are more prone to complication than ETV/CPC or primary shunt insertion, and postoperative complications represent a significant predictor of mortality in this population.

scholarly journals Retrospective Review of Virologic and Immunologic Response in Treatment-Experienced Patients on Third-Line HIV Therapy in Lusaka, Zambia

2021 ◽  
Vol 20 ◽  
pp. 232595822110224
Author(s):  
Paul Msanzya Zulu ◽  
Mona-Gekanju Toeque ◽  
Lottie Hachaambwa ◽  
Lameck Chirwa ◽  
Sombo Fwoloshi ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Viral Suppression ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Line Therapy ◽  
Resource Limited ◽  
Third Line Therapy ◽  
Sub Saharan ◽  
Third Line ◽  
The Impact

Established antiretroviral therapy (ART) programs in sub-Saharan Africa have well-defined first-and second-line therapies but no standard third-line ART regimen. The impact of third-line ART on patients with multiclass-resistant HIV in resource-limited settings has not been well characterized. We conducted a retrospective review of patients on third-line ART at the University Teaching Hospital in Lusaka, Zambia. We assessed virologic and immunologic outcomes following 6 months of third-line therapy and found among those with a documented viral load, viral suppression (≤1000 copies/ml) at 24 weeks was 95% (63/66) with a mean increase in CD4 count of 116 cells/mm3 and viral suppression of 63% (63/100) by imputation of missing data. This study suggests that third-line therapy is clinically and virologically effective among patients with multiclass-resistance in a resource-limited setting in sub-Saharan Africa.

scholarly journals Obstructed labour in a Nigerian tertiary health facility: a mixed-method study

2021 ◽  
Vol 10 (8) ◽  
pp. 2937
Author(s):  
Akaninyene Eseme Ubom ◽  
Omotade Adebimpe Ijarotimi ◽  
Ifeoluwa Emmanuel Ogunduyile ◽  
Ayobami Omilakin ◽  
Solomon Nyeche ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Birth Asphyxia ◽  
Case Fatality ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Mortality And Morbidity ◽  
Obstructed Labour ◽  
Sub Saharan ◽  
University Teaching Hospitals

Background: Obstructed labour remains a leading cause of maternal and perinatal mortality and morbidity in sub-Saharan Africa. This study aimed to determine the incidence, causes, complications and outcomes of obstructed labour at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun state, Nigeria.Methods: A mixed methods approach was employed for this study. A 10-year retrospective review of all cases of obstructed labour managed at the OAUTHC, between January 1, 2008, and December 31, 2017, was done. Ten in-depth interviews were conducted for some selected patients. The quantitative data was analysed using SPSS version 24, while the qualitative data was analyzed with NVivo version 12.Results: The incidence of obstructed labour was 1.99%. Most of the patients were unbooked (217, 90.4%), primigravid (138, 57.5%), and either had no formal or only primary/secondary education (120, 50%). Cephalopelvic disproportion (CPD) was the commonest cause of obstructed labour (227, 94.6%). The most common maternal complication was wound infection (48, 20%). There were three maternal deaths, giving a case fatality rate of 1.25%. The most common foetal complication was birth asphyxia (85, 34.7%). The perinatal mortality rate was 18.8 %. From the qualitative arm of the study, reasons given by parturients who suffered obstructed labour, for avoiding hospitals for delivery, included religion, finance, fear of hospitals, faith/belief in mission homes/maternity houses, and proximity.Conclusions: Obstructed labour remains an important obstetric problem in our environment, contributing significantly to the burden of maternal and perinatal mortality and morbidity. 

scholarly journals Endoscopic third ventriculostomy success score in predicting short-term outcome in 68 children with hydrocephalus in a resource-limited tertiary centre in sub-Saharan Africa

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
E. Morgan ◽  
O. B. Bankole ◽  
B. O. Mofikoya ◽  
O. O. Kanu ◽  
O. A. Ojo ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Third Ventriculostomy ◽  
Predictive Tool ◽  
Term Outcome ◽  
Female Ratio ◽  
Tertiary Centre ◽  
Sub Saharan ◽  
Endoscopic Third Ventriculostomy Success

Abstract Background Endoscopic third ventriculostomy (ETV) is becoming a popular option of treatment in carefully selected patients with hydrocephalus (Drake et al., Childs Nerv Syst 25:467-472, 2009). The success or possible outcome of its application in treating hydrocephalus can be predicted by employing a preoperative scoring system. An example of such a system is the endoscopic third ventriculostomy success score (ETVSS). It could form a basis for decision-making and prognostication. This study aimed to evaluate ETVSS as a preoperative predictive tool in children with hydrocephalus who satisfy the inclusion criteria for the option of ETV procedure as treatment modality. Methodology This is a prospective hospital-based study of 68 children under 2 years of age that presented at the Lagos University Teaching Hospital (LUTH) out of 161 children with hydrocephalus from November 2014 to April 2016. The predicted ETVSS was calculated by the addition of patients’ age, presumed aetiology and prior shunting. These children were stratified into three groups according to ETVSS as higher score predicts better ETV outcome and vice versa. They were followed up for 6 months to determine the success rate of ETV. Results The age of the study population ranged from 0 to 24 months with a mean age of 5.52 ± 5.48 months. 69.1% of these patients were male and 30.9% were female with a male to female ratio of 2.2:1. The mean predicted ETVSS (48.82 ± 19.20%) and actual ETV success score (56.20 ± 15.10%) using the ANOVA were significantly related (p value < 0.05). Conclusion This study concluded that the early outcome of ETV in children below 2 years of age with hydrocephalus is directly related to the preoperative ETVSS.

scholarly journals Myomectomy under Cervico-Isthmic Tourniquet: Experience of the Gynecologic-Obstetric Department at the University Teaching Hospital of Cocody (Abidjan)

2021 ◽  
pp. 1-3
Author(s):  
Adjoby Cassou Roland ◽  
◽  
Akobé Priva ◽  
Keyword(s):  
Blood Loss ◽  
Teaching Hospital ◽  
Foley Catheter ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Control Group ◽  
Sub Saharan ◽  
The University ◽  
Control Study

Objective: To report the experience of Cocody’s University Teaching Hospital in the practice of myomectomies under cervico-isthmic tourniquet and to assess its impact on per and post-operative blood loss. Methodology: It was a case control study covering a 10-year period (that is from January 2009 to December 2018), and a population of 600 patients divided into two groups (A and B). The first (A) includes all patients admitted and operated on uterine myomas after the introduction of a cervico-isthmic tourniquet (CIT) by Foley catheter (case) and the second all patients admitted and operated on without CIT(Control). Results: The average age of patients was 37 years with extremes of 24 and 50 years They were nulligestous in 38.3% of cases and nulliparous in 61.7% of cases. Hemorrhagic complications made up 65% of the surgical indications. The practice of myomectomy under cervico-isthmic tourniquet was associated with a relatively significant reduction in the duration of intervention including 20 minutes of time saved and a considerable reduction in blood loss(p<0,001). Blood loss was estimated at 438.8 ml (+/- 127) in the CIT group, compared to 685.4 ml (+/- 182) in the control group(p<0,001). The postoperative hemoglobin rate in the cervico-isthmic tourniquet patients was 10.1 g/dl compared to 8.7 g/dl in the non-distort patients(p<0,0012). No complications related to the presence of CIT were observed after sufficient follow-up. The length of stay in the hospital was estimated to be 2.8 days compared to 4.4 days in patients who did not use a tourniquet (p=0,15). Conclusion: The use of the cervico-isthmic tourniquet in myomectomy, considerably limiting blood loss and reducing postoperative morbidity, appears to be an alternative to blood transfusion in countries of sub-Saharan Africa, where the dispensing of blood products remains a problem.

scholarly journals Profile of Hepatitis B Sero Markers Among Blood Donors Attending Usmanu Danfodiyo University Teaching Hospital, Sokoto-Nigeria

2021 ◽  
Vol 2 (5) ◽  
pp. 412-417
Author(s):  
Hussaini Mohammed Alhassan ◽  
Saudetu Haruna Shinkafi ◽  
Ibrahim Yakubu ◽  
Hamisu Abdullahi ◽  
Ahmad Hamidu Marafa ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Blood Donors ◽  
Adult Population ◽  
Age Groups ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
B Virus ◽  
Test Component ◽  
Sub Saharan

Introduction: Hepatitis B Virus (HBV) is a double-stranded circular DNA virus, it is one of the major blood transmissible infections. The prevalence of HBV is highest in sub-Saharan Africa and East Asia, where 5-20% of the adult population are infected. In Africa, up to 15 to 60% of the population are positive for at least one of the serological markers of HBV. This study aimed to determine the prevalence markers of HBV among prospective blood donors in Sokoto. Materials/methods: About 170 blood donors were randomly recruited into this research study and 5ml of blood was aseptically collected from each of the research participants, the sample was screened for Hepatitis B virus, using a rapid step-wise HBV-5 panel immunoassay of Combo Cassette Manufactured by Lusys Laboratories Inc U.S.A. The HBV-5 is capable of detecting HBsAg, HBsAb, HBeAg, HBeAb and HBcAb simultaneously. The test component was opened from the notch, and the device was removed, 2-3 drops (60-90µl) plasma sample was added into the sample wells in the device. The result was read within 15 minutes. Results: The prevalence rates of the markers are HBsAg 8(4.7%), HBeAg 1(0.6%), HBsAb 7(4.1%), HbeAb 8(4.7%), and HBcAb 9(5.3%). Donors aged (20-30) years had the highest prevalence rate of HBV infection compared to other age groups. Male blood donors had higher seropositivity for the five markers than their female counterpart. The prevalence of HBV markers was high among the First time donors (non-vaccinated donors) who have a higher prevalence than other donors (vaccinated donors). Conclusion: This study has shown that screening for HBsAg alone may not be sufficient for the diagnosis of hepatitis B virus infection, and thus other markers should be included in the routine screening.

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