Contraceptive acceptability and associated factors among young women (15-24) living with HIV/AIDS: a hospital-based study in Kampala, Uganda

introduction: In Uganda, over 43% of all pregnancies among young women (15-24 years) living with HIV are either unwanted or mistimed. Unintended pregnancies account for 21.3% of neonatal HIV infections. The objective was to determine acceptability of contraceptives and associated factors among young women living with HIV attending HIV clinics in Kampala. Methods: Between February and May 2019, 450 young women attending public HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III) in Kampala were systematically enrolled in a cross-sectional study and interviewed using structured questionnaires. We used modified Poisson regression to determine the factors associated with acceptability of contraceptive. Data were analyzed using STATA 13.0. Statistical significance was determined at a P values < 0.05. Results: Contraceptive acceptability was 40.7% (95% CI: 27.6%-53.6%). Older age group (20-24 years) (aPR; 2.42, 95%CI; 1.06-5.52, P = 0.035), age at sex debut ≥ 18 years (aPR;1.25,95%CI; 1.13-1.38, P<0.001), having friend on contraceptives (aPR; 1.90, 95%CI; 1.10 - 3.26; P =0.021) and being married (aPR; 1.20, 95%CI; 1.09 - 1.32, P<0.001) were significantly associated with acceptability of contraceptives. Conclusion: There is a low acceptability for contraceptives. Younger age group who are not yet married need to be targeted

Modifiable factors within the prevention of mother-to-child transmission programme associated with failure to prevent HIV transmission in the Onandjokwe district of Namibia

Background: Ending new paediatric HIV infections continues to be a global health priority. Cuba and other countries have demonstrated that elimination of mother-to-child transmission is possible through Prevention of Mother to Child Transmission (PMTCT) interventions. As Namibia works on improving PMTCT there is a need to identify the local modifiable factors to achieve zero new HIV infections.Aim: This study aimed to identify the modifiable factors within the PMTCT programme, which contributed to the acquisition of HIV infection among children.Setting: The study was carried out in the Onandjokwe District, Northern Namibia.Methods: A descriptive audit was undertaken of 59 medical records of mothers and their children under two years, who acquired HIV despite the PMTCT programme between 2014 and 2016.Results: The study found that overall HIV transmission was only 2%, but 80% of the paediatric HIV infections could be prevented by implementing the existing Namibian PMTCT recommendations. Overall 61% of modifiable factors were related to mothers,30% to health workers and 10% to the health system. The top three modifiable factors were the mother defaulting on ART during pregnancy or breastfeeding, the health worker not intervening when the mother failed the first-line ART regimen,and poor coordination of care between the hospital and primary care.Conclusion: Although overall transmission is low with the PMTCT programme, the majority of remaining HIV infections among children under two years could be prevented by addressing the modifiable factors identified in this study

Connaissance des signes de danger de la grossesse, du postpartum et du nouveau-né par les gestantes et accouchées récentes du District sanitaire de Sig-Noghin, Ouagadougou, Burkina Faso

L'objectif était d'étudier la connaissance des signes de danger de la mère et du nouveau-né ainsi que les facteurs associés parmi les femmes du district sanitaire de Sig-Noghin. Il s'est agi d'une étude transversale analytique menée du 1er avril au 30 mai 2016. Elle a concerné un échantillon de 429 femmes. L'entretien a été la technique d'enquête utilisée. Pour l'identification des facteurs associés, une régression logistique fut réalisée. Parmi les participantes 16,5 % ; 11,1 % et 6,3 % ont pu citer au moins trois (3) signes de danger respectivement de la grossesse, du postpartum et du nouveau-né. L'âge de la femme (OR aj 6,14 [1,06-35,61]), le niveau d'instruction (OR aj 3,19 [1,59-6,38]), le nombre de grossesses (OR aj 3,30 [1,13-9,62]) et le nombre de consultations prénatales (OR aj 1,77 [1,09-3,46]) étaient les facteurs statistiquement associés à la connaissance des signes de danger de la mère. Aucun des facteurs étudiés n'était associé à la connaissance des signes de danger du nouveau-né. En somme, le niveau de connaissance des signes de danger de la mère et du nouveau-né reste faible. Il est impératif de promouvoir davantage la sensibilisation des femmes enceintes et accouchées tout en impliquant la communauté dans laquelle celles-ci vivent

Facteurs associés à une première grossesse chez les femmes Malgaches ayant accouché dans un hôpital de maternité d'Antananarivo: une étude de cohorte rétrospective

Introduction: il y a très peu de littératures africaines et Malgaches concernant les détails sur les facteurs de risques qu'encourent les primigestes en général. Le but de notre étude est de déterminer les facteurs de risques potentiels associés à une première grossesse.Méthodes: une étude cohorte rétrospective a été menée auprès des femmes primigestes et multigestes de l'hôpital Pavillon sainte Fleur entre Octobre 2014 et Décembre 2016. Les risques relatifs étaient ajustés après contrôle avec les caractéristiques sociodémographiques.Résultats: les primigestes étaient beaucoup plus exposées à un travail prolongé de plus de 12h (RRa = 2,28; IC 95% 1,74-3,00), à une césarienne en urgence (RRa = 1,47; IC 95% 1,35-1,60) et à une épisiotomie (RRa = 2,98; IC 95% 2,61-3,40). Leurs enfants étaient plus susceptibles de présenter des signes de souffrance fœtale avec anomalie du rythme cardiaque fœtale au cours de la phase de travail (RRa = 1,96; IC 95% 1,45-2,65) et un risque accru d'être admis dans une unité de soins intensifs après l'accouchement (RRa = 2,08; IC 95% 1,25-3,45).Conclusion: les complications survenues pendant le travail auraient exposé les primigestes à d'autres risques en cascades sur l'issue de leurs accouchements et sur la santé de leurs enfants. La prise en charge des primigestes nécessiterait, de la part des personnels médicaux, une attention particulière sur la durée de la phase de travail

Determinants of referral practices of clients by traditional birth attendants in Ilorin, Nigeria

A sizeable number of deliveries still take place with the assistance of Traditional Birth Attendants in Nigeria. This study aims to determine the factors that determine the referral practices of the TBAs in Ilorin of high risk and complicated pregnancies. This descriptive study was conducted among all the 162 registered TBAs in Ilorin that were traceable using pre-tested semi-structured interviewer-administered questionnaire. About 90%, whose source of skill acquisition was by inheritance did not refer their clients appropriately compared with 48% of those whose source of skill acquisition was through formal training (p<0.05). The more the numbers of trainings, the more appropriate the referral (p<0.05). Having supervisory visit by qualified personnel is associated with appropriate referral practices (p<0.05). Regular training and re-training of TBAs with routine monitoring and supportive supervision will promote prompt referral of high risk and complicated pregnancies and deliveries (Afr. J. Reprod. Health 2010; 14[2]:77-84)

A comparative study of pregnancy complications and outcomes for the years 1999 and 2004 at a rural hospital in South Africa: implications for antenatal care

Background: Detection and management of high-risk pregnancies, all the way through antenatal care, have been advocated as a high-quality mean of reducing maternal and perinatal morbidity and mortality. Objectives: This study reviewed the demographic variables, pregnancy and obstetric complications and perinatal outcomes for the years 1999 and 2004 in a rural hospital in KwaZulu-Natal Province, South Africa, with the aim of evaluating trends and gaps that may enhance appropriate strategies for improvement of antenatal care. Method: A retrospective comparative study, with representative samples of pregnant women, were randomly selected for the respective years 1999 and 2004. Descriptive statistics were calculated depending on measurement scale. A Z-test was carried out to assess the significant difference (p < 0.05) in proportions between pregnancy complications and outcomes of the groups. Multivariate logistic regression analysis was undertaken to determine the significant predictors for outcome variables. Results: The numbers of pregnancies among young women (< 25 years) increased significantly by 8% (p < 0.05) in the year 2004. Compared with 1999, the reduction in the numbers of pregnancies (1%) among higher parity (parity 5 or more) women in 2004 was remarkable. There were significant reductions of eclampsia, anaemia and post partum haemorrhage. Women with breech presentation were 3.75 times more likely to deliver preterm, and 5.45 times more likely to deliver low birth-weight babies. Similarly, women with pregnancy-induced hypertension were more likely to have preterm (OR = 3.50, 95% CI 2.83; 4.35) and low birth-weight babies (OR = 2.09, 95% CI 1.62; 2.71). Eclampsia was also a risk factor associated with preterm deliveries (OR = 6.14, 95% CI 3.74; 10.09) and low birth-weight babies (OR = 3.40, 95% CI 1.83; 6.28). Conclusion: This study suggests that further research is needed to find the causes of higher rate of teenage pregnancies and an increase in quality of antenatal care is more important in improving maternal and perinatal health. Training of staff to standard protocol and guidelines on antenatal care and care during delivery, and adherence to it, should be encouraged to improve maternal and child health in South Africa

Les caracteristiques de l'hypertension arteriellle severe au cours de la gravido-puerperalite : a propos de 389 cas colliges a la maternite du CHU de Treichville; Abidjan

INTRODUCTION : L'HTA severe se definit comme une TAS160mmHg et ou TAD110mmHg. L' HTA au cours de la gravido-puerperalite est un probleme de sante d'ampleur mondiale qui pose un probleme singulier en Afrique du fait qu'elle fait partie des 3 premieres causes de la mortalite maternelle. A Abidjan; ABHE [6] et COULIBALY [7] ont deja cible les complications. OBJECTIFS: -Principal: Identifier les caracteristiques des complications materno- foetales de 1'HTA severe au cours de la gravido-puerperalite ; -Specifiques: Determiner la frequence de I' FITA severe de la gravido-puerperalite; en preciser les types de complications et evaluer le pronostic matemo-foetal immediat. MATERIEL ET METHODOLOGIE : Cette etude; prospective; transversale et descriptive; a eu lieu dans le service de gynecologie- obstetrique du CHU; Treichville; sur douze mois. Elle a concerne les gestantes; les parturientes et les femmes en suites de couches; admises dans le service pour HTA severe. Nous avons exclu les femmes normotendues ou atteintes d'HTA legere ou moderee (TASl60minHg et TAD ll0mmHg) ainsi que celles admises pour des causes autres que HTA severe. Nos patientes ont ete recrutees des l'admission et chacune a beneficie d'evaluation journaliere selon des criteres definis. Les donnees ont ete collectees a partir des registres du service (Reanimation et Salle d'accouchement); des dossiers des patientes et de l'interrogatoire des patientes ou de l'entourage. Les logiciels EPI INFO 6 et EXCEL ont servi pour l'informatique et nous nous sommes servi des calculs de frequence et de la moyenne pour les statistiques. RESULTATS : Nos resultats etaient de 3 ordres: les caracteristiques epidemiologiques marques par une frequence elevee de 6;7pour cent; et les complications dominees par l'eclampsie et l'HRP; le pronostic maternel qui a montre des taux de letalite maternelle et de cesarienne elevees ; et quant au pronostic foetal; on remarque des taux eleves de la prematurite; de l'hypotrophie fotale; de la souffrance cerebrale et de la mortalite perinatale. COMMENTAIRES : Ces resultats ont; en general; reflete ceux de la litterature. CONCLUSION ET RECOMMANDATIONS : L'inefficacite du traitement anti-hypertenseur sur les complications et le pronostic; due au fait qu'il agit en aval des phenomenes en causes; fait concevoir la necessite du traitement preventif; afin de reduire ces complications et ameliorer le pronostic maternel et foetal