ABSTRACT
Objectives: Determining the prevalence of Pulmonary Tuberculosis (PTB) during pregnancy in Northern Tanzania. Design: In a prospective cross-sectional study. Results Latent Tuberculosis Infection (LTBI) was detected in 86 out of 287 pregnant women (29.9). Active PTB was diagnosed radiologically in four subjects (1.4). All cases were sputum smear-negative Conclusion LTBI and subsequently active PTB is a public health problem among pregnant mothers in Northern Tanzania
Subject(s)
Cross-Sectional Studies , HIV Infections , Pregnant Women , TuberculosisABSTRACT
Introduction: Periventricular leucomalacia (PVL) and intraventricular haemorrhage (IVH) are two most important antecedents of neuro-developmental outcome in very low birth weight infants.Study objective: To determine the incidence of PVL/IVH and it's associated perinatal factors among very low birth weight (VLBW) infants admitted at neonatal unit Muhimbili National Hospital.Material and methods: Prospective study with a nested case-control study was conducted at the neonatal unit from May to November 2000. Three hundred seventy two VLBW neonates were recruited to the study on admission to the neonatal unit and were followed up to the postnatal age of 4 weeks or death depending on which came first. All 372 neonates had initial cranial-ultrasound examination within 72 hours of life. Cranial-ultrasound was done on 179 and 151 neonates at the postnatal age of 2 weeks and 4 weeks respectively. Records of all 372 neonates were reviewed to determine the presence or absence of the various perinatal factors. These data were analysed as a nested case-control study whereby a case was defined as any VLBW who had been recruited in the follow up study and had diagnosis of either PVL or IVH or both by cranial ultrasound and those VLBW who had been recruited in the follow up study without a diagnosis of either PVL or IVH were taken as controls. Results: A total of 4539 neonates were admitted to the neonatal unit during the study period and among these 443 (9.8) were VLBW. Two hundred fifty seven (58) out the 443 VLBW neonates died before the postnatal age of 4 weeks. Among the 372 VLBW infants recruited in the study; PVL was seen in 121/372 (32.5) with an overall incidence rate of 0.125/infant week and IVH was seen in 230/372 (61.8) with an overall incidence rate of 0.247/ infant week. Most of the PVL and IVH occurred during the first 3 days of life. All neonates with grade IV IVH died before the postnatal age of 4 weeks. Forty-seven neonates (12.6) developed post-hemorrhagic hydrocephalus. Maternal hemoglobin and neonatal hemoglobin showed significant `association with PVL and IVH respectively.Conclusion:There is high incidence of VLBW; IVH and PVL. IVH grade IV carries a very high mortality. Routine cranial-ultrasound on all VLBW neonates along with clinical follow up for long-term neuro-developmental outcome is recommended
Subject(s)
Child Development , Infant , Infant, Very Low Birth Weight/growth & developmentABSTRACT
This incident case-control study of bleeding neonates in a Baby Friendly Hospital was done to obtain the prevalence and risk factors associated with bleeding disorders in the neonatal unit. During a 4-month period from August to November 1998; 175 out of 1628 admitted infants were found to have some sort of bleeding. These were compared with 414 control infants. Prematurity; Low Birth Weight; Caesarian Section and anesthesia; and presence of asphyxia were significantly associated with bleeding. The Prothrombin and Activated Partial thromboplastin Test were not significantly altered in bleeding infants and had a poor correlation with clinical presence of a bleeding disorder.The low prevalence of bleeding disorder and coagulation defects is discussed and suggested that Breast Feeding may not be a risk factor for bleeding disorder in this unit. Further studies are needed in this regard
Subject(s)
Hemorrhagic Disorders , Infant , Infant, Newborn , Risk Factors , Vitamin K Deficiency/therapyABSTRACT
This retrospective study from January to December 1999 reports 74 orphaned neonates admitted at the special care unit in Dar-es-Salaam; Tanzania. The commonest causes of maternal death were Anemia; Edema-Proteinuria-Hypertension -Gestosis (EPH Gestosis); Acquired Immuno-deficiency syndrome (AIDS); tuberculosis and postpartum hemorrhage (PPH). There was a very high association of maternal AIDS and tuberculosis with maternal deaths. The overall mortality rates were not significantly different between the orphans whose mothers had AIDS and those whose serostatus was unknown. However among the 3 infants who died from HIV sero-positive group; the mean age was 20 days(14-29days); while those with unknown serostatus the mean age was 28 days. HIV negative infant was twice more likely to be accepted in the orphanage. Failure to thrive was 3.5 fold more common among HIV positive infants. Diarrhea was conversely more common among babies whose HIV unknown statusWhile 20 out of 42 (47) discharged infants from among the HIV unknown serostatus were taken by the biological father; only 5 out of 18 (28) were taken by the father among HIV positive/AIDS group. There are no appropriate counseling sessions and there is lack of follow-up; especially for those discharged home. There was a 35 fold higher risk of tuberculosis and HIV co-morbidity whereby 18 out of 25 (72) mothers who were diagnosed to have AIDS had tuberculosis as well. Among the mothers with unknown serostatus; only 1 out of 49 (2) had tuberculosis. Thus; AIDS and tuberculosis both contribute to the maternal deaths. We speculate that tuberculosis in HIV pregnant mothers is associated with a more a rapid downhill course and mortality. There is a need to address this matter urgently. Moreover; there is a need to have a coordinated community based care for these orphans and their caretakers