• Ebola in Africa: beyond epidemics, reproductive health in crisis

      Delamou, A; Hammonds, R M; Caluwaerts, S; Utz, B; Delvaux, T (Elsevier, 2014-12-13)
    • Effectiveness of the first district-wide programme for the prevention of mother-to-child transmission of HIV in South Africa.

      Coetzee, D; Hilderbrand, K; Boulle, A; Draper, B; Abdullah, F; Goemaere, E; Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. dcoetzee@phfm.uct.ac.za (WHO, 2005-07)
      OBJECTIVE: The aim of this study was to estimate the field efficacy of the first routine programme for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) initiated in South Africa, in the subdistrict of Khayelitsha. METHODS: A consecutive sample of 658 mother-infant pairs, identified from the PMTCT register from 1 March to 30 November 2003, were identified for enrolment in this study. Details of the regimen received were established and HIV status of the infants at between 6 and 10 weeks of age was determined by qualitative DNA polymerase chain reaction. Zidovudine (AZT) was provided antenatally from week 34 of gestation and during labour. Infant formula milk was-offered to mothers who chose not to breastfeed. The protocol was amended in July 2003 such that women who had received < 2 weeks of treatment with AZT were given a single dose of nevirapine (NVP) at the onset of labour, and the infant received a weight-adjusted dose of NVP within 72 h of delivery. RESULTS: Of the 535 mother-infant pairs (81%) eventually included in the study, 410 (77%) received an effective PMTCT intervention according to the protocol. The rate of transmission of HIV from mother to child was 8.8% (95% confidence interval (CI), 6.2-10.9). A maternal age of > 25 years was the only significant independent risk factor for transmission (odds ratio, 2.12; 95% CI, 1.14-4.07). CONCLUSION: The results of this study demonstrate the feasibility and effectiveness of a large-scale PMTCT programme in an urban public-sector setting.
    • Effects of a refugee-assistance programme on host population in Guinea as measured by obstetric interventions.

      Van Damme, W; De Brouwere, V; Boelaert, M; Van Lerberghe, W; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. wvdamme@itg.be (Elsevier, 1998-05-30)
      BACKGROUND: Since 1990, 500000 people have fled from Liberia and Sierra Leone to Guinea, west Africa, where the government allowed them to settle freely, and provided medical assistance. We assessed whether the host population gained better access to hospital care during 1988-96. METHODS: In Guéckédou prefecture, we used data on major obstetric interventions performed in the district hospital between January, 1988, and August, 1996, and estimated the expected number of births to calculate the rate of major obstetric interventions for the host population. We calculated rates for 1988-90, 1991-93, and 1994-96 for three rural areas with different numbers of refugees. FINDINGS: Rates of major obstetric interventions for the host population increased from 0.03% (95% CI 0-0.09) to 1.06% (0.74-1.38) in the area with high numbers of refugees, from 0.34% (0.22-0.45) to 0.92% (0.74-1.11) in the area with medium numbers, and from 0.07% (0-0.17) to 0.27% (0.08-0.46) in the area with low numbers. The rate ratio over time was 4.35 (2.64-7.15), 1.70 (1.40-2.07), and 1.94 (0.97-3.87) for these areas, respectively. The rates of major obstetric interventions increased significantly more in the area with high numbers of refugees than in the other two areas. INTERPRETATION: In areas with high numbers of refugees, the refugee-assistance programme improved the health system and transport infrastructure. The presence of refugees also led to economic changes and a "refugee-induced demand". The non-directive refugee policy in Guinea made such changes possible and may be a cost-effective alternative to camps.
    • Factors associated with severe preeclampsia and eclampsia in Jahun, Nigeria

      Guerrier, G; Oluyide, B; Keramarou, M; Grais, R (DovePress, 2013)
      To explore traditional herbal medicines as potential risk factors of severe preeclampsia and eclampsia in Nigeria.
    • Factors Related to Fetal Death in Pregnant Women with Cholera, Haiti, 2011-2014

      Schillberg, E; Ariti, C; Bryson, L; Delva-Senat, R; Price, D; GrandPierre, R; Lenglet, A (Center for Disease Control, 2016-01-01)
      We assessed risk factors for fetal death during cholera infection and effect of treatment changes on these deaths. Third trimester gestation, younger maternal age, severe dehydration, and vomiting were risk factors. Changes in treatment had limited effects on fetal death, highlighting the need for prevention and evidence-based treatment.
    • Female Genital Schistosomiasis and HIV: Research Urgently Needed to Improve Understanding of the Health Impacts of This Important Coinfection.

      O'Brien, DP; Ford, Nathan; Djirmay, AG; Calmy, A; Vitoria, M; Jensen, TO; Christinet, V (Lippincott Williams and Wilkins, 2019-04-15)
      Evidence suggests that there are important interactions between HIV and female genital schistosomiasis (FGS) that may have significant effects on individual and population health. However, the exact way they interact and the health impacts of the interactions are not well understood. In this article, we discuss what is known about the interactions between FGS and HIV, and the potential impact of the interactions. This includes the likelihood that FGS is an important health problem for HIV-positive women in Schistosoma-endemic areas potentially associated with an increased risk of mortality, cancer, and infertility. In addition, it may be significantly impacting the HIV epidemic in sub-Saharan Africa by making young women more susceptible to HIV. We call for immediate action and argue that research is urgently required to address these knowledge gaps and propose a research agenda to achieve this.
    • Good clinical outcomes from a seven years holistic program of fistula repair in Guinea

      Delamou, A; Diallo, M; Beavogui, A H; Delvaux, T; Millimono, S; Kourouma, M; Beattie, K; Barone, M; Barry, T H; Khogali, M; et al. (Wiley-Blackwell, 2015-02-23)
      Female genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health, and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article is to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country.
    • High loss to follow-up following obstetric fistula repair surgery in rural Burundi: is there a way forward?

      Bishinga, A; Zachariah, R; Hinderaker, S; Tayler-Smith, K; Khogali, M; van Griensven, J; van den Boogaard, W; Tamura, M; Christiaens, B; Sinabajije, G (Public Health Action, 2013-06-21)
    • High maternal and neonatal mortality rates in northern Nigeria: an 8-month observational study

      Guerrier, G; Oluyide, B; Keramarou, M; Grais, R (DovePress, 2013-08)
      Despite considerable efforts to reduce the maternal mortality ratio, numerous pregnant women continue to die in many developing countries, including Nigeria. We conducted a study to determine the incidence and causes of maternal mortality over an 8-month period in a rural-based secondary health facility located in Jahun, northern Nigeria.
    • High prevalence of ESBL-positive bacteria in an obstetrics emergency hospital and neonatal care unit—Haiti, 2016

      Chaintarli, K; Lenglet, A; Beauzile, BD; Senat-Delva, R; Mabou, MM; Martino, C; Berthet, M; Wong, S; Hopman, J (The Society for Healthcare Epidemiology of America, 2018-08-30)
      Patient colonization with extended-spectrum β-lactamase–producing gram-negative bacteria (ESBL-GNB) could serve as a potential reservoir for transmission of multidrug-resistant (MDR) bacteria in a hospital setting. Individuals colonized with ESBLEnterobacteriaceae are also known to be at a higher risk of ESBLGNB infection following their colonization.1 We encountered an outbreak of MDR Klebsiella pneumoniae in the neonatal care unit (NCU) of the Médecins Sans Frontiéres (MSF) obstetric emergency hospital in Port au Prince (CRUO), Haiti, between 2014 and 2015.2 As part of ongoing surveillance activities for MDR bacteria and in an effort to better target infection, prevention, and control (IPC) measures throughout the hospital, we conducted a point-prevalence survey to estimate the prevalence of colonization with ESBL-GNB and to identify risk factors for colonization with ESBL-GNB in women and neonates admitted to this hospital.
    • HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mumbai, India: 12-month follow-up.

      Isaakidis, P; Pimple, S; Varghese, B; Khan, S; Mansoor, H; Ladomirska, J; Sharma, N; Silva, E D; Metcalf, C; Caluwaerts, S; et al. (2013-08-13)
      HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
    • "If we miss this chance, it's futile later on" - late antenatal booking and its determinants in Bhutan: a mixed-methods study.

      Dorji, T; Das, M; Van den Bergh, R; Oo, MM; Gyamtsho, S; Tenzin, K; Tshomo, T; Ugen, S (BioMed Central, 2019-05-07)
      BACKGROUND: To achieve the Sustainable Development Goal related to maternal and neonatal outcomes, the World Health Organization advocates for a first antenatal care (ANC) contact before 12 weeks of gestation. In order to guide interventions to achieve early ANC in the lower middle-income setting of Bhutan, we conducted an assessment of the magnitude and determinants of late ANC in this context. METHODS: This was a mixed-methods study with quantitative (cross-sectional study) and qualitative (in-depth interviews with pregnant women and ANC providers) component in a concurrent triangulation design. The quantitative component retrospectively analysed the socio-demographic and clinical characteristics, and the gestational age at booking of women who were provided care for delivery or miscarriages at the three tertiary hospitals in Bhutan from May-August 2018. The qualitative component involved thematic analysis of in-depth interviews with ten women attending ANC visits and four healthcare workers involved in ANC provision. RESULTS: Among 868 women studied, 67% (n = 584) had a late booking (after 12 weeks), and 1% (n = 13) had no booking. Women with only primary education and those residing in rural areas were more likely to have a late first ANC booking. While many women achieved the recommended eight ANC visits, this did not necessarily reflect early booking. Late booking was common among multigravida women. The interviews illustrated a general understanding and recognition of the importance of early ANC. Support from peers, family and co-workers, and male participation in accessing ANC were seen as enablers. The outreach clinics (ORCs) at the primary healthcare level were an important means of reaching the ANC services to women in rural areas where geographical accessibility was a barrier. Specific barriers to early ANC were gender insensitivity in providing care through male health workers, cost/time in ANC visits, and the inability to produce the documents of the father for booking ANC. CONCLUSION: Late ANC booking was common in Bhutan, and appeared to be associated with educational, geographic, socio-cultural and administrative characteristics. A comprehensive information package on ANC needs to be developed for pregnant mothers, and the quality of ANC coverage needs to be measured in terms of early ANC booking.
    • Improving Men's Participation in Preventing Mother-to-Child Transmission of HIV as a Maternal, Neonatal, and Child Health Priority in South Africa

      van den Berg, W; Brittain, K; Mercer, G; Peacock, D; Stinson, K; Janson, H; Dubula, V (Public Library of Science, 2015-04-07)
      Wessel van den Berg and colleagues outline how increasing male partner involvement in efforts to reduce mother-to-child HIV transmission in South Africa may improve maternal and infant outcomes.
    • Indirect causes of maternal death

      Schulte-Hillen, C; Cabrol, J-C (Elsevier, 2014-10)
    • Keeping it simple: a gender-specific sanitation tool for emergencies

      de Lange, R; Lenglet, A; Francois Fesselet, J; Gartley, M; Altyev, A; Fisher, J; Shanks, L (Practical Action Publishing, 2014-01)
    • Knowledge Translation in Africa for 21(st) Century Integrative Biology: The "Know-Do Gap" in Family Planning with Contraceptive Use among Somali Women

      Ahmed, A A; Mohamed, A A; Guled, I A; Elamin, H M; Abou-Zeid, A H (Mary Ann Liebert, Inc., 2014-10-21)
      Abstract An emerging dimension of 21(st) century integrative biology is knowledge translation in global health. The maternal mortality rate in Somalia is amongst the highest in the world. We set out to study the "know-do" gap in family planning measures in Somalia, with a view to inform future interventions for knowledge integration between theory and practice. We interviewed 360 Somali females of reproductive age and compared university-educated females to women with less or no education, using structured interviews, with a validated questionnaire. The mean age of marriage was 18 years, with 4.5 pregnancies per marriage. The mean for the desired family size was 9.3 and 10.5 children for the university-educated group and the less-educated group, respectively. Importantly, nearly 90% of the university-educated group knew about family planning, compared to 45.6% of the less-educated group. All of the less-educated group indicated that they would never use contraceptives, as compared to 43.5% of the university-educated group. Prevalence of contraceptive use among ever-married women was 4.3%. In the less-educated group, 80.6% indicated that they would not recommend contraceptives to other women as compared to 66.0% of the university-educated group. There is a huge gap between knowledge and practice regarding family planning in Somalia. The attendant reasons for this gap, such as level of education, expressed personal religious beliefs and others, are examined here. For primary health care to gain traction in Africa, we need to address the existing "know-do" gaps that are endemic and adversely impacting on global health. This is the first independent research study examining the knowledge gaps for family planning in Somalia in the last 20 years, with a view to understanding knowledge integration in a global world. The results shall guide policy makers, donors, and implementers to develop a sound family planning policy and program to improve maternal and child health in 21(st) century primary healthcare.
    • A Live Term Intra-Abdominal Pregnancy in a Field Hospital: a Case Report

      Abdelrahman, S; Deeter, M; Muthusami, A; Peterson, TG; Wackenier, L (Oxford University Press, 2017-03-22)
      Abdominal pregnancy is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be challenging, especially in a resource-limited setting. We report a case of abdominal pregnancy that presented to Médecins Sans Frontières field hospital in Agok, South Sudan, with abdominal pain. Examination revealed a term pregnancy and a live fetus in transverse lie. The diagnosis of abdominal pregnancy was made intraoperatively, with successful management and delivery of a healthy baby.
    • Local health workers' perceptions of Substandard Care in the Management of Obstetric Hemorrhage in rural Malawi

      Beltman, J J; van den Akker, T; Bwirire, D; Korevaar, A; Chidakwani, R; van Lonkhuijzen, L; van Roosmalen, J; Thyolo District Health Office, Ministry of Health, Thyolo, Malawi. j.j.beltman@lumc.nl. (2013-02-15)
      ABSTRACT:
    • Management of pregnant women infected with Ebola virus in a treatment centre in Guinea, June 2014

      Baggi, F M; Taybi, A; Kurth, A; Van Herp, M; Di Caro, A; Wolfel, R; Gunther, S; Decroo, T; Declerck, H; Jonckheere, S (European Centre for Disease Prevention and Control, 2014-12-11)
    • Obstetric Fistula in Burundi: a comprehensive approach to managing women with this neglected disease

      Tayler-Smith, K; Zachariah, R; Manzi, M; van den Boogaard, W; Vandeborne, A; Bishinga, A; De Plecker, E; Lambert, V; Christiaens, B; Sinabajije, G; et al. (BioMed Central Ltd, 2013-08-21)
      In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000--2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges.