Factors for Late Initiation of Antenatal Care in Kahama Municipal, Tanzania

Background: Maternal mortality is a major public health issue in developing countries due to its shocking magnitude and lower declining pattern, 295 000 women died of pregnancy or childbirth related complications in 2017. Late initiation of Antenatal Care (ANC) services in most low-income countries like Tanzania has been reported as a major problem which increase maternal mortality rate (MMR). However, different factors for late initiation of antenatal care are not well identified. Therefore, this study aimed to identify factors for late initiation of antenatal care both individual factors and health policy factors as per pregnant women and health care providers opinions in Kahama Municipal, Tanzania. Broad Objective: The study focused on assessment of factors for late initiation of Antenatal Care (ANC) in Kahama Municipal, Tanzania. Materials and Methods: This study was conducted using a qualitative method with exploratory approach which was carried out to explore factors for late initiation of antenatal care in Kahama Municipal. An in-depth interview (IDI) and Focus Group Discussion (FGD) were methods used to collect data. The study comprised of 14 in-depth interviews (IDIs) with pregnant women with age range of 18 years to 49 years attending antenatal care clinics in two health facilities and 4 in-depth interviews (IDIs) with health care providers attending pregnant women during antenatal care clinic visit. Furthermore, two Focus Group Discussions (FGDs), one from each health facility with pregnant women were conducted. Data Analysis: Thematic analysis was conducted through use of inductive approach. The audio recordings were conducted using the Swahili language then transcribed and translated into the English language where themes were obtained after translation. Results: Findings obtained from this study were factors for late initiation of antenatal care as reported by both pregnant women and health care providers. Factors for late initiation of antenatal care were under guidance of Health Behavioral Modal (HBM): Factors mentioned by pregnant women included pregnant women education level, negligence of pregnant women to attend clinic, unplanned pregnancy among couples, distance from pregnant women settlement to the facility, pregnant women misconceptions related to antenatal care services, use of local herbs, pregnancy complications, , unfriendly services and unequal gender power relation within a family. Factors mentioned by health care providers based on health policy and managerial factors such as Partner accompanying policy, distant allocation of health facility from people’s settlement and unfriendly services provided by health care providers. Conclusion: This study focused on assessing factors for late initiation of antenatal care in Kahama municipal council in Shinyanga, Tanzania. Different factors for late initiation of antenatal care were reported which included pregnant women and health care providers. Pregnant women education level, negligence of pregnant women to attend clinic, unplanned pregnancy among couples, and distance from pregnant women settlement to the facility, pregnant women misconceptions related to antenatal care services, use of local herbs, pregnancy complications. Health policy and managerial related factors were partner accompanying policy, unfriendly services, and allocation of health facility. Recommendation: However different improvement made on maternal health services in Tanzania but still some of pregnant women are not utilizing it efficiently because of different obstacles like distance from people’s settlement to the health facility, Partner accompanying policy and unfriendly services provided by health care providers. Through such obstacles as a policy maker, I would like to advice Government through Ministry of Health to allocate health facility nearby people’s settlement, providing outreach program to educate the community about antenatal care rather than relying on partner accompanying policy and lastly is provision of refresher training related to client’s rights during health care services provision to all staff.

Nursing Care of Low-Risk Newborns in Low Resource Setting: Nurses' Aides May Bridge the Gap at Community Hospitals

Objective: To study the role of a nurses' aide in the care for newborns weighing between 1500 and 2000 g at birth in a low resource setting. Study Design: Observational. Setting: The General hospital in 1994-95, in a public sector, located in a remote area in India Intervention: A female ward assistant with seven years of schooling trained, on-the-job, to keep babies warm, initiate maternal breastfeeding, and to detect rapid breathing. The nursing staff from the pediatric ward supervised her performance. A separate "warm room" appropriately heated for preterm and sick babies became a makeshift nursery. The nursing staff administered enteral feeding, oxygen, and antibiotics. Services of the resident doctors or general duty medical officers were not available. Results: The survival rate was nearly 100% for babies with birthweights between 1,500 and 2,000 g (none referred out). Conclusions: A nurses' aide may facilitate the delivery of special care for newborns where nursing personnel are grossly inadequate and saving babies weighing between 1,500 and 2,000 g may need minimal inputs. It may be worthwhile to target 1,500 and 2,000 g birthweight categories even when resources are meager. What is already known about this subject? Low resource settings face staff shortages, especially nursing staff. Health workers with midwifery skills can deliver nearly 90% of essential care services for maternal and neonatal health. A substantial proportion of neonatal deaths occur among moderately low birth weight babies. What does this study add? It is possible to train a semi-literate person to facilitate early breastfeeding and to keep a baby warm. A large proportion of deaths among babies with birthweight ranging from 1500 to 2000 g are preventable with meager resources. How might this impact on clinical practice or future developments? The facilities facing shortage of nursing staff in low resource settings, may employ nurses’ aide to deliver basic newborn care.

Are Changes in Thyroid Hormones Associated with Mortality in Non-Thyroidal Illness Syndrome?

Introduction: Non-thyroidal illness syndrome (NTIS) can be defined as afunctional impairment of the hypothalamic-pituitary-thyroid axis accompanied by signs of non-thyroidal disease with changes in thyroid stimulating hormone (TSH), free T3 (fT3) and free T4 (fT4) levels. NTIS and thyroid hormone levels in this syndrome are thought to be related with mortality. This study was performed to evaluate the relationship between hormone levels and mortality in this syndrome. Methods: The 5-year mortality data of patients who were hospitalized in the first 6 months of 2014 and whose thyroid hormone levels could be checked twice within 5 years were evaluated. In our study conducted with 405 patients whose thyroid function tests was repeated, the follow-up period was 5 years. Biochemical parameters including thyroid function tests were sent from all patients. NTIS was defined as a condition in patients with low fT3 levels (<2.5 pg/mL) and TSH levels within the normal range (0.38-5.33 mIU / L). Results: 128 patients died, and the number of surviving patients was 277 during the follow-up period. Positive acute phase reactants such as CRP, sedimentation, ferritin was high and albumin (negative acute phase reactant) and fT3 levels were low in patients who died. In addition, these changes in biochemical values were statistically significant. The mortality rate was increased in patients with low fT3 and high fT4 levels. In the follow-up period, changes in TSH levels were not significantly associated with mortality. Conclusion: Both the decrease in fT3 levels and the increase in fT4 levels can be used as predictors and independent risk factors for long-term mortality risk in chronically ill and hospitalized patients with NTIS.

Thermal Protection of Newborns: The World Health Organization Guidelines Need to Include Clear and Feasible Options for Low-Resource Settings

Backgorund: Hypothermia in babies may increase mortality, directly or indirectly, by potentiating the effect of the other morbidities. Guidelines published by The World health organization (WHO) on newborn health (2015) may be inadequate to address the issue in a low-resource setting. To be relevant in such a context, they should be user-friendly for the trainers of health workers (HW) who may be responsible for interpreting the recommendations and training the HW. Text: According to earlier guidelines (2013), ‘No randomized or quasi-randomized trial that evaluated the impact of keeping infants warm after discharge (hospital births) or after 24 hours (home births) was identified’. However, kangaroo mother care (KMC), a strong recommendation with moderate-quality evidence, and thermal protection are inseparable, as the most crucial component of KMC is skin-to-skin contact, which keeps a baby warm. A HW may be surprised when the guidelines or the basis change and, the move comes at a time when the earlier guidelines (1993) are just finding roots in patient care practices. Current guidelines are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, where randomized trials assume more importance. The guidelines recommend the following methods to keep infants warm after birth: KMC (strong recommendation, moderate-quality evidence), intermittent KMC (strong recommendation, moderate-quality evidence), and radiant warmers or incubators (strong recommendation, very low-quality evidence). The divergence between the evidence and the recommendations may be difficult for the HW to comprehend. Conclusions: The guidelines for postnatal care need to be revisited and revised so that clear and feasible options for keeping infants warm in low-resource settings are offered. Besides KMC, warm rooms, heated mattresses, plastic wraps and Styrofoam boxes may be suggested. What is already known about this subject? • In the absence of a randomized or quasi-randomized trial that evaluated the impact of keeping infants warm, there are fewer options in a low-resource setting. • They include Kangaroo mother care and incubators/radiant warmers. What does this study add? • Options that may not have been supported by randomized trials but have consistent results may be suggested. • They include warm rooms, heated mattresses, plastic wraps and Styrofoam boxes. • In future revisions, the level of evidence should be paired with the recommendations. How might this impact on clinical practice or future developments? The health worker may choose the most feasible option at home or at a facility.

Immunoreactivity against Dermatophagoides pteronyssinus Assessed by the Leukocyte Adherence Inhibition Test in Patients with Intrinsic Atopic Dermatitis and Correlated “Intrinsic” Non–IgE-mediated Allergic Conditions

Background: Due to the lack of standardized laboratory procedures able to demonstrate specific immune responses against the culprit allergens, the non—IgE-mediated allergy syndromes are a group of conditions diagnosed mostly by clinical examination and exclusion criteria. Objective: To evaluate the opportunity of the Leukocyte Adherence Inhibition Test (LAIT) to discriminate specific immunoreactivity against Dermatophagoides pteronyssinus (Dp) in a group of patients with non–IgE-mediated chronic allergic conditions. Methods: Ex vivo challenge tests performed with Dp were monitored by LAIT in patients presenting diverse non–IgE-mediated allergic conditions: intrinsic Atopic Dermatitis (iAD), intrinsic Allergic Rhinitis (iAR), intrinsic Ocular Allergy (iOA), intrinsic Chronic Pharyngitis (iCP), and intrinsic Asthma (iAS). Results: The mean LAI of the control group was 7%; the mean LAI of the iAR group was 34%; the mean LAI of the iCP group was 44%; the mean LAI of the iAS group was 45%; the mean LAI of the iOA group was 47%; the mean LAI of the iAD group was 55%. The non-parametric Wilcoxon-Mann-Whitney U test comparing the control group with each other group showed significance with p-value < α = 0.05 for all groups. Conclusion: The Leukocyte Adherence Inhibition Test is an easy, quick, and inexpensive ex vivo immunoassay with the potential to predict individual immunoreactivity against HDM allergens in real-world patients with non–IgE-mediated allergies.

Determination of Sensitivity and Specificity of High Resolution CT Scan in Evaluation of Cardiac and Extra-Cardiac Anomalies among Bangladeshi Children

Congenital heart disease (CHD) is one of the important causes of morbidity and mortality in the pediatric age group. Invasive angiography is considered as gold standard method for the diagnosis of pediatric cardiovascular diseases. Multi-detector CT cardiac angiogram by using 64 slice scanner is a useful modality and suitable alternative to previous invasive procedure in evaluation of congenital heart disease. The present study was conducted in the Department of Cardiology of NICVD during the period of September 2019 to August 2020 (One year). We selected 40 patients presenting in the outpatient department of National Institute of Cardiovascular Diseases and Hospital (NICVD) who were diagnosed to have congenital heart disease clinically and radiologically. CT angiogram revealed ASD in 10%, coarctation of aorta in 5%, Pentalogy of Fallot in 2.5%, Tetralogy of Fallot (TOF) in 32.5%, Ventricular septal defect (VSD) in 30.0%, PAH in 2.5%, PS in 5%, RVH with PS in 2.5%, PDA in 5% and Tricuspid atresia with ASD with VSD with PS in 2.5% patients. Conventional catheter angiogram revealed ASD in 5%, VSD in 32.5%, TOF in 30%, PS in 12.5%, Coarctation of aorta in 5% and Pentalogy of Fallots in 5%. The diagnostic performance of MDCT in the diagnosis and evaluation of congenital heart disease was high.

A Fatal Case of Severe Acute Organophosphorus Pesticide Poisoning Complicated with Secondary Hemophagocytic Lympho-Histiocytosis, Severe Lower Intestinal Hemorrhage and Intestinal Mucormycosis

A man in his 50’s, under influence of alcohol, accidentally ingested a pesticide, and was referred for further management and admitted to our hospital. An empty can of Curacron® was found at the site in his farm where he took the alleged pesticide. This raised the suspicion of organophosphorus pesticide poisoning and he was managed at two medical centres before getting admitted to our hospital. His hospital course was complicated with multiorgan dysfunction, shock, respiratory failure and intermediate syndrome. On day five he developed secondary hemophagocytic lymphohistiocytosis (sHLH) and had hematochezia on day six. Colonoscopy revealed multiple circumferential ulcerations in descending and sigmoid colon with luminal narrowing. Biopsy of colonic tissue showed evidence of intestinal Mucormycosis. The clinical presentation of organophosphorus pesticide poisoning in this patient was complicated with multiple issues and included sHLH, chemical gastroenteritis, hemorrhagic ulcers and intestinal zygomycosis. The organophosphorus pesticide ingested by the patient was a 50% emulsifiable concentrate of profenofos along with vegetable oil, soyabean oil and polyglycol ether alkyl aryl sulphate calcium salt 5.25% w/w as an emulsifier/spreading agent. The management of the patient is discussed. Due to the possibility of the emulsifier adhering to the gastrointestinal tract and causing mucosal injury, it is necessary to identify the drug composition and ingredients of the pesticide as soon as possible when managing organophosphorus poisoning.

Use and Acceptability of Birth Spacing Contraceptive Among Multiparae in Bangladesh

Background: Contraception is one of the critical components of reproductive health, enabling women to control their fertility according to their desires and circumstances. This study aimed to determine the prevalence and acceptability of contraceptives among sexually active multiparous women for birth spacing. Methods: This is a cross-sectional study among married women aged 15-40 years having at least one child from January to June 2013 in the Department of Obstetrics and Gynecology, ICMH (Institute of Child and Mother Health), Matuail, Dhaka. Findings: A total of 433 women participated in this study. A majority of the respondents were in the mid-thirty (73.9%) and housewives (94.7%). Almost half (49.0%) of the respondents had primary education. Surprisingly, close to half of the respondents married before 18 years (42.7%). Almost two-thirds (64.4%) of the respondents received oral contraceptive pills previously, followed by condoms (17.1%) and injectable contraception (14.5%). More than half (51.6%) of the participants were motivated by health workers to use a contraceptive method. In terms of reasons for using the family planning methods, convenience to use (38.1%), being safe (31.9%), and accessibility (23.1%) were the most common reasons. Whereas side effects (49.9%), shifting to other forms (43.9%), and wanting more children (6.2%) were the most common reason for changing family planning methods. The respondents mostly used the oral pill at any education level. However, injectable contraception was higher within higher education levels, and IUD was higher within the illiterate group.

Scalability of the Basic Care Model for Very Low Birth Weight Infants and Implementation Research Considerations

Objectives: To study the scalability of the rural hospital (RH) model of basic newborn care in a general hospital (GH) by including very low birth weight (VLBW) infants, and to assess the implementation aspects. Study design: Observational Settings: RH (1988-1992) and General Hospital, (GH) (2010-2013). Subjects: VLBW infants with birth weight ranging from 1000 g to 1500 g. Interventions: (1) RH: Basic care including warmth, feeding, antibiotics, and oxygen (2) GH: Basic plus circulatory care (2010-12), and continuous positive airway pressure (CPAP) support (2013). Mechanical ventilation and surfactant therapy were not available. Main outcome measure: Mortality Results: The cumulative mortality (38.5%) with basic neonatal care in the RH model declined to 26.6% at the GH with the addition of circulatory support and a “home-made” CPAP system. Conclusions: The RH package may be scaled up by adding CPAP and circulatory support to reduce the mortality among VLBW infants. The RH model is scalable horizontally and vertically. What is already known about this subject? Implementation research constitutes a relatively new and underdeveloped field, One of the facets of health system research is the implementation research. Implementation research aims at bridging the gaps between knowledge and action. What does this study add? Tertiary care center can help in developing basic newborn care at a rural hospital. The rural hospital model can be upscaled vertically as well as horizontally. Addition of circulatory support and CPAP to basic newborn care can significantly lower neonatal mortality. How might it impact on clinical practice in the foreseeable future? The study may encourage tertiary care centers to facilitate the development of basic newborn care centers at the rural hospitals. These centers, in turn, can spread horizontally.

COVID-19 Risk Perceptions, Concerns and Affecting Factors of College Students

In this study, we aimed to increase the knowledge, awareness, and normalization adaptation of university students about the disease with the pieces of training given by academicians about COVID-19 and thus contribute to the control of the epidemic. We also aimed at writing education on disease risk perceptions and anxiety levels related to COVID-19 disease. In the study, two weeks of online education were planned for university students on COVID19 disease. A questionnaire was prepared to give knowledge about the anxiety and risk perceptions of the students about COVID-19 disease. Questionnaire training and finally administered. It was analyzed with the SPSS 22.0 program. Whereas the number of students who answered the pre-education questionnaire was 116, 56 students completed the questionnaire at the end of the training. There was no intelligent difference in the risk perceptions of the students about getting sick and losing their lives from illness before and after education. There is no significant difference in the results of the Wilcoxon signed sum of ranks test for the GAD7 scale scores that made the post-test (p = 0.905, z = -0.11). Except for 9 students who did both tests, 107 pre-tests and 47 post-tests did not differ significantly between the groups in terms of disease risk and GAB7 grading (p> 0.05). As a result, the motivation of university students to participate in the struggle against the pandemic is weak. Ensuring that health-related university students, as well as students from different faculties, participate in the fight against COVID-19 with educational studies will be important in controlling the epidemic.