Induction of labour practices at Botshabelo District Hospital: Assessing the institutional guidelines

Induction of labour (IOL) is defined as an artificial stimulation administered to initiate the delivery process before the onset of spontaneous labour. Setting-adapted guidelines need to be developed to promote safe maternal and neonatal care in line with the needs of a specific institution. This study aimed to describe and assess the current IOL practices at Botshabelo District Hospital, focusing on incidence, indications, induction methods, complications, and outcomes. A retrospective-descriptive study included all relevant data from IOL cases over six months between July and December 2017. From 168 attempted inductions of labour, 153 files were retrieved. The majority of cases (69.7%) were for post-dates. Normal vaginal delivery (NVD) was achieved in most patients (69.3%), while one patient had an assisted delivery. Thus, 30.1% of inductions failed and required caesarean sections. The incidence, indications, methods of induction, complications, and outcomes of IOL in BDH are in line with international guidelines; however, including the sweeping of membranes at term and balloon catheters as methods could improve the current guidelines.

Rhumatismes chroniques et covid-19 : recommandations thérapeutiques des sociétés savantes

Le SARS-CoV-2 est la pandémie la plus redoutable depuis un siècle. Son évolution est caractérisée par une phase initiale virale infectieuse et une autre immunologique réactionnelle qui peut être létale. L'inhibition de la réplication virale n'est donc qu'une partie du traitement et la gestion de l'emballement dysimmunitaire constitue une étape cruciale dans la prise en charge des patients. Cette phase immunologique fait appel à des molécules largement utilisées en rhumatologie et Prise en charge de la maladie dont l'efficacité dans le COVID-19 (en dehors du conformisme scientifique requis) doit interpeler l'importance de notre arsenal thérapeutique dans la prise en charge des maladies auto inflammatoires dont l'évolution sans traitement adéquat pourrait être une image au ralenti de celle du COVID-19

Une mise au point sur les recommandations actuelles sur la pandémie à COVID-19 et prise en charge obstétricale

Peu de choses sont encore connues au sujet des effets de l'infection à COVID-19 sur la grossesse à ses différents stades d'évolution. Les recommandations actuelles sont basées sur les données factuelles des études sur le SARSCoV 1 et des rares études sur la COVID-19 disponibles. Ces recommandations sont susceptibles d'évoluer si des nouvelles découvertes étaient faites dans les jours avenirs

Les modalités de prise en charge pratique de la polyarthrite rhumatoïde par les rhumatologues au Maroc

Introduction : L'objectif de notre travail est d'évaluer les modalités de la prise en charge de la PR par les rhumatologues marocains afin de vérifier leur degré d'adhésion aux recommandations de la société Marocaine de Rhumatologie (SMR).Matériels et Méthodes : Un questionnaire a été élaboré, validé par un comité d'expert, puis adressé à l'ensemble des rhumatologues marocains. Le questionnaire a été réalisé sur Google forms et envoyé par mail à trois reprises entre octobre et novembre 2015. Le questionnaire comprend des questions à choix multiples et des cas cliniques passant en revue les différents items des recommandations de la SMR. Le degré d'adhésion aux recommandations est évalué sur une échelle d'évaluation.Résultats : Parmi les 300 rhumatologues exerçant au Maroc, seuls 235 avaient une adresse mail valide. Le taux de participation était de 32,3%.Le pourcentage de patients qui consultaient à un stade précoce de la PR (moins de 3 mois) était de 26%. Le traitement de fond était immédiatement débuté par 96% des rhumatologues. Le méthotrexate (MTX) était utilisé dans 94,4% des cas, associé à la corticothérapie par voie orale chez la moitié des patients. La moitié des rhumatologues assuraient le suivi de manière systématique par le DAS 28.En cas d'échec thérapeutique d'une PR séronégative et non érosive sous MTX, 92.8 % des praticiens optimisaient la dose de MTX jusqu'à 25 mg/j et 64,2% proposaient une association (MTX +SLZ+APS).En cas d'échec thérapeutique d'une PR sévère active, séropositive et érosive sous MTX, 67,6% proposaient une biothérapie. Le pourcentage des patients atteints de PR qui ont eu une biothérapie était de 24%. Dans 64,3% des cas, le Rituximab était la biothérapie utilisée en première intention. En cas d'échec à un premier anti TNF, 52,6 % des rhumatologues proposaient un autre anti TNF. En cas de rémission persistante, seuls 37%des rhumatologues arrivaient à arrêter la corticothérapie, 81,3% continuaient la prescription du traitement de fond tandis que 60% réussissaient l'arrêt du biologique.Seuls 38,2 % vaccinaient systématiquement leurs patients recevant les biothérapies

Outcomes in Malnourished Children at a Tertiary Hospital in Swaziland after Implementation of the World Health Organization Treatment Guidelines

Background. Swaziland adopted the World Health Organization (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007; with the aim of reducing high case fatality rates for childhood malnutrition. However; no follow-up studies have been conducted to determine the reduction in these rates after implementation of the guidelines.Objectives. To determine the case fatality rate for childhood malnutrition after implementation of the WHO treatment guidelines.Methods. A retrospective observational study was undertaken. Demographic; anthropometric and clinical characteristics and outcomes for all children aged under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 were recorded and analysed. Results. Of the 227 children who met the study inclusion criteria; 179 (64.6) were severely malnourished and 98 (35.4) had moderate malnutrition; 111 children died during admission; giving an overall case fatality rate of 40.1. Mortality was significantly higher among severely malnourished children than among those with moderate malnutrition (46.9 v. 27.6) (odds ratio (OR) 3.0; 95 confidence interval (CI) 1.7 - 5.3). Co-morbid pneumonia and gastroenteritis were significant predictors of mortality (OR 2.0; 95 CI 1.2 - 3.4 and OR 1.9; 95 CI 1.1 - 3.2; respectively). Conclusion. Case fatality rates for childhood malnutrition remain high despite adoption of the WHO treatment guidelines. There is a need for periodic clinical audits and mortality review meetings to reduce deaths from childhood malnutrition so as to meet the WHO mortality target of less than 5 and improve child survival

Utility of Kangaroo Mother Care in Preterm and Low Birthweight Infants

Preterm birth ( 37 completed weeks of gestation) is the largest direct cause of neonatal mortality; accounting for an estimated 27 of the 4-million neonatal deaths every year. Kangaroo mother care (KMC) is a type of care for preterm and premature infants whereby the infant is placed in an upright position against the parent's chest; with early skin-to-skin contact between the parent and infant. Mothers who practise KMC exhibit less maternal stress and fewer symptoms of depression; and have a better sense of the parenting role and more confidence in meeting their babies' needs than those who don't. Despite the apparent feasibility of KMC; currently; only a few preterm babies in low-income countries have access to this intervention. Knowledge of the effectiveness and safety of KMC in the community and home setting; and its effects on growth; is still incomplete. Only one study has examined KMC initiation at home. There is an immense need for the promotion of research to improve the delivery of existing cost-effective interventions in low-resource settings and to address key gaps in knowledge. KMC improves growth in low birthweight and preterm infants; and has a significant role to play in protecting them from hypothermia and sepsis; as well as promoting exclusive breastfeeding. KMC helps to reduce neonatal mortality; and inculcates confidence and a better sense of parenting in mothers with regard to their babies' needs

Acidified Infant Formula Explained

The development of effective methods to prevent acute gastroenteritis is an important goal for infant health. Exclusive breastfeeding and postponement of complementary foods until the age of six months is recommended for healthy infants. However; at times; infant formula is required. Various types are commercially available. Acidified cow's milk formula has been found to prevent the growth of pathogenic bacteria and concurring diarrhoeal disease

Achieving Optimal Feeds for Preterm Babies; Recommendations and Realities in Practice: Nigerian Perspective

Preterm deaths are responsible for the highest number of neonatal mortality in Nigeria. Preterm nutrition contributes significantly to overall outcome particularly as it relates to neurodevelopment. Recently; new guidelines for enteral feedings in premature infants were issued by the American Academy of Paediatrics and European Society of Pediatric Gastroenterology; Hepatology and Nutrition Committee on Nutrition. Nevertheless; in clinical practice it is often difficult to attain suggested intakes at all times. The situation is worse in Nigeria where there are no specific national guidelines and recommendations derived from local data targeting Preterms. There is a high possibility of significant potential cumulative nutritional deficits occurring in Nigerian preterms. The inevitable suboptimal intake contributes significantly to the incidence of neonatal diseases and outcome. This review describes practical ways of optimizing nutritional intake in these vulnerable neonates with reference to Nigerian situation. Understanding the preterm gut; initiation of parenteral nutrition; need for minimal enteral feeds; ensuring adequate macro and micronutrients intake and need for follow up are discussed. There are limitations to the practice of the recommended preterm nutrition in Nigerian settings; nevertheless the interventions like early commencement of minimal enteral feeds and preference for human breast milk should be practiced optimally. Hence; all health professionals should acknowledge that preterm nutrition may be an emergency and need to improve their knowledge on when and how to achieve optimal feeds in them. There is a dare need through both clinical practice as well as research; to reduce nutritional deficits in these vulnerable infants

The Appropriateness of the South African Thoracic Society's Guidelines for Antibiotic Treatment of Patients with Chronic Obstructive Pulmonary Disease Exacerbation in the Universitas Academic Hospital; Bloemfontein

Chronic obstructive pulmonary disease (COPD) is a progressive disease predominantly associated with smoking. Exacerbation of COPD frequently results from respiratory infections. The South African Thoracic Society (SATS) recommends treatment with amoxicillin/ clavulanate; cefuroxime or a fluoroquinolone. The study aimed to determine the appropriateness of these guidelines regarding organisms isolated from sputum of patients with COPD exacerbation at Universitas Academic Hospital; Bloemfontein. A descriptive study was performed. Seventeen hospitalised patients diagnosed with COPD exacerbation from July - October 2007; not treated with antibiotics or corticosteroids or having a respiratory infection four weeks prior to admission; were included. Demographic information (age; gender; area of residence; smoking history) was obtained from patients' files; as well as FEV1 values; FEV1/FVC ratio; infection markers; microorganisms isolated from sputum and their antibiotic susceptibility profiles. Nine patients were male and eight female; with a median age of 72 years (range 53 - 82 years). Twelve (70.6) patients resided in the Bloemfontein urban area. Three patients (18.8) never smoked; 25smoked previously and 56.3were active smokers (median pack years 45 years; range 17 - 70 years). Eight patients had culture-positive sputum specimens. Haemophilus influenzae; H. parainfluenzae; Streptococcus pneumoniae; Staphylococcus aureus; Pseudomonas aeruginosa; Serratia marcescens and Escherichia coli were isolated from sputa. With the exception of S. aureus; all isolates were susceptible to at least one antibiotic recommended by SATS. The guidelines proposed by SATS for treatment of COPD exacerbation were appropriate and would be effective in the management of these patients in the Free State region

Status of Health Sector Strategic Plans in Five Countries of the WHO African Region

Objectives: To assess the adequacy of the existing strategic plans and compare the format and content of health sector strategic plans with the guidelines in selected countries of the African region. Data source: The health strategic plans for Gambia; Liberia; Malawi; Tanzania and Uganda; which are kept at the WHO/AFRO; were reviewed. Data extraction: All health strategic plans among the Anglophone countries (Gambia; Ghana; Kenya; Liberia; Malawi; Mauritius; Tanzania; Uganda; Zambia and Zimbabwe) that were developed after the year 2000 were eligible for inclusion. Fifty percent of these countries that fitted this criterion were randomly selected. They included Gambia; Liberia; Malawi; Tanzania and Uganda. The analysis framework used in the review included situation analysis; an assessment of appropriateness of strategies that are selected; well developed indicators for each strategy; the match between the service and outcomes targets with available resources; and existence of a clear framework for partnership engagement for implementation. Data synthesis: Most of the strategic plans identify key ill health conditions and their contributing factors. Health service and resource gaps are described but not quantified in the Botswana; Gambia; Malawi; Tanzania strategic documents. Most of the plans selected strategies that related to the situational analysis. Generally; countries' plans had clear indicators. Matching service and outcome targets to available resources was the least addressed area in majority of the plans. Most of the strategic plans identified stakeholders and acknowledged their participation in the implementation; providing different levels of comprehensiveness. Conclusion: Some of the areas that are well addressed according to the analysis framework included: addressing the strategic concerns of the health policies; identifying key partners for implementation; and selection of appropriate strategies. The following areas needed more emphasis: quantification of health system gaps; setting targets that are cognisant of the local resource base; and being more explicit in what stakeholders' roles are during the implementation period

Nouvelles recommandations pour le traitement de l'infection a VIH

A l'occassion de la journee mondiale de la lutte contre le sida (1er decembre); l'organisation mondiale de la sante (OMS) a formule de nouvelles recommandations dans le cadre de la lutte cntre le VIH sur le traitement; la prevention; et l'alimentaion en particulier des nourrissons; en se fondant sur les donnees recents

Training of health personnel in Sierra Leone for primary health care

Sierra Leone; like many African countries; has experienced considerable delay in implementing programmes geared towards the achievement of health for all by the year 2000 through primary health care. There is widespread dissatisfaction towards health care delivery not only as a result of inadequate financing but also due to the general incompetence of health personnel to meet new challenges. A primary health care policy calls for the the training of health personnel of all types and in numbers to meet the needs of the entire country. Training is thus regarded as a priority intervention to meet these challenge. A guideline to relate education and training innovations to the elements of primary care is presented

Strategies to improve immunization services in urban Africa

The urban poor constitute a rapidly increasing proportion of the population in developing countries. Focusing attention on underserved urban slums and squatter settlements will contribute greatly to immunization programme goals, because these areas account for 30-50% of urban populations, usually provide low access to health services, carry a large burden of disease mortality, and act as sources of infection for the city and surrounding rural areas. Improvement of urban immunization programmes requires intersectorial collaboration, use of all opportunities to vaccinate eligible children and mothers, identification of low-coverage neighbourhoods and execution of extra activities in these neighbourhoods, and community mobilization to identify and refer persons for vaccination. Improved disease surveillance helps to identify high-risk populations and document programme impact. New developments in vaccines, such as the high-dose Edmonston-Zagreb vaccine, will allow changes in the immunization schedule that facilitate the control of specific diseases. Finally, operational research can assist managers to conduct urban situation assessments, evaluate programme performance at the "micro" level, and design and monitor interventions

Integrating HIV voluntary counselling and testing services into reproductive health settings

This guide aims to provide sexual and reproductive health (SRH) programme planners; managers; and providers with the information necessary to integrate voluntary counselling and testing (VCT) for HIV/AIDS within their services. VCT has been shown to be an effective strategy to facilitate behaviour change for HIV prevention. It offers an entry point for early care and support for those infected with HIV and prevention of mother to child transmission. VCT also plays a role in reducing stigma and discrimination. The cost of establishing VCT services within existing SRH settings is lower than establishing them in freestanding sites. In particular; the guide considers integration within the context of family planning (FP) service provision. FP and VCT service provision have similar aims of reaching sexually active people and promoting safe and healthy sexuality; including the prevention of HIV; sexually transmitted infections (STIs); and unwanted pregnancy. FP settings offer specific opportunities for reaching women with VCT. (excerpt)

The logistics handbook: a practical guide for supply chain managers in family planning and health programs

This handbook describes the major aspects of logistics management with an emphasis on contraceptive supplies. It defines and explains key terms and concepts. The design and implementation of management information systems and inventory control are also discussed; as well as storage and quality control practices with overviews of forecasting and procurement processes