Supervised and unsupervised birth and early newborn care practices in Papua New Guinea: findings of a maternal and infant health survey conducted in three provinces

@#Summary Poor women in remote areas in many countries remain the least likely to receive adequate health care during pregnancy and childbirth for various reasons. In Papua New Guinea (PNG) there is some documentation regarding why women do not attend for supervised births, but less is known about women’s perceptions and experiences of childbirth in the community or about newborn care practices in the first few hours following childbirth. As part of a wider maternal and infant health survey among 482 women in three sites in PNG, in this paper we describe women’s experiences relating to supervised and unsupervised births and newborn care practices. Among respondents, the majority (95%) reported attending for antenatal care at least once during their most recent pregnancy and almost two-thirds (65%) gave birth in a health facility. Among the health facility births, 88% were assisted by a trained health care worker. Among the women who gave birth in the community, 44% chose to do so. Primiparous women, those aged 15-24 years and women with secondary or tertiary education were significantly more likely to give birth in a health facility than multiparous women, those aged more than 24 years and women with none or only primary education. There were 489 live births, 93% of whom were breastfed. Overall 60% of women knew any danger signs in a newborn infant. Fever was the most frequently mentioned danger sign (81%). Knowledge of danger signs was significantly associated with giving birth in a health facility, being multiparous and having secondary education, compared with village birth, being primiparous and having none or only primary education. Our findings highlight the importance of using the opportunity at antenatal clinic to provide women with information and knowledge, not only on the importance of attending for a health facility birth, but also on the importance of planning and seeking transfer to the health facility early.@*@#

Women’s recall of provision of antenatal care in Papua New Guinea: findings of a maternal and infant health survey conducted in three provinces

@#SUMMARY Antenatal care from a trained health care worker provides the opportunity to promote favourable outcomes for both the woman and her unborn infant. The greatest benefit of antenatal care is seen when the first visit is initiated early in the pregnancy and continued with at least four antenatal visits throughout the pregnancy. In Papua New Guinea (PNG), 66% of women attend for antenatal care at least once during their pregnancy and 51% attend four antenatal visits. We conducted a maternal and infant health survey among 482 women in three sites in PNG, Hiri, Karkar and Asaro, to explore uptake and provision of antenatal care from women’s perspectives. Most women attended for antenatal care (95%; 459/482) at least once and 73% (313/431) attended the recommended minimum four antenatal visits. Women in Hiri (77%) and Asaro (78%) were more likely to attend four or more antenatal visits than women in Karkar (66%). No woman in any site reported receiving the full range of antenatal care, as indicated in the PNG national guidelines. Coverage for tetanus toxoid, malaria prophylaxis and provision of iron supplements were similar in all sites. Women in Asaro were more likely to report being advised about a supervised birth (91%) than women in Karkar (86%) or Hiri (68%). Our findings suggest that the opportunity to monitor for risk factors in pregnancy were missed, including the opportunity to provide messages relating to the importance of supervised, health facility births. There is a need for renewed commitment and resources to enable optimal antenatal care to be provided in accordance with established guidelines if PNG is to make significant improvements in maternal and newborn health.

Thermal stability of Ni [II] and cu [II] mixed ligand complexes derived from biologically important schiff bases, azoles and morpholine

Thermogravimetry [TG] and differential thermogravimefty [DTG] have been applied to the investigation of the thermal behavior of six mixed ligand complexes of Ni[II] and Cu[II] comprising the Schiff bases: o-hydroxyacetophenoneethanolimine [OHAE], N-salicylidene-o-iminophenol [SOP] and N-salicylidene-o-toluidine [SOT] as well as morpholine [Morph] and certain azotes. The azoles used are: 2-amino-thiazole [2-Atz], benzothiazole [Btz], 2-methylbenzothiazole [2-Mbtz], 3-methyl-2-selenoxobenzothiazole [3-Msbtz] and thiabendazole [Tbdz]. Heating the compounds first results in a release of the morpholine or the azoles. Kinetics of the decomposition reactions were studied using non-mechanistic equations

Comparative study of visual assessment of neonatal jaundice and laboratory estimation of total serum bilirubin in full-term newborn infants

Neonatal hyperbilirubinemia is the most common condition that requires medical attention in newborns. The assessment of jaundice can be carried out using several methods. The aim of this work is to compare visual assessment and laboratory estimation of TSB in full term newborn infants and to evaluate the accuracy of visual assessment of neonatal jaundice in guiding management decisions in the out-patient settings. The study was conducted in the out-patient clinic of Alexandria University Children's Hospital for a period of eight months. 57.2% of babies were male infants while 42.8% were females with a mean gestational age of 38.5 +/- 1.58 weeks and mean weight of 2.98 +/- 0.62 kg. The total agreement between the lab-based management decision and the clinically based decision was 84.2% out of 500 cases involved in the study. Sensitivity of visual assessment was 95.8% while specificity was 80.5%. The false positive rate was 39.2% and positive predictive value was 60.8%. False negative rate and negative predictive value were 1.6% and 94.8% respectively. Also, the Spearman correlation of dermal zones determined by visual assessment and lab TSB in the whole sample was 0.76 [p = 0.000]. It was highest in Infants < 3 days [0.94] and lowest in infants > 14 days [0.69]. In conclusion, visual assessment of neonatal hyperbilirubinemia is a useful clinical tool, if used correctly and by trained medical personnel in resource-poor countries, where there is little or no access to reliable laboratory-based diagnostic services

Effect of harvesting stage and some drying methods on essential oil composition of basil [ocimum basilicum, L.]

An experiment was carried out in the two growing seasons [2004 and 2005] to investigate the influence of harvesting. stage and some drying methods on the composition of the basil volatile oil [Ocimum basilicum L.]. The air drying [at room temperature] and artificial drying [in oven at 40 and 60C] are the two different methods used for drying basil leaves and herb. The results showed that the moisture loss [%] was lowest of harvest stage in September and with air drying at room temperature of both herb and leaves compared with the other treatments. The contrary was observed regarding the essential oil content in the same harvest stage results in the highest essential oil content compared with the other stages of the harvest. Significant reduction in the amount of extracted volatile oil was found in the case of drying at 60C, especially, the content of volatile oil being the highest when harvested the both herb and leaves in September and dried at room temperature. Basil leaves possessed a higher oil content and the oil was richer in oxygenated compounds [1,8 cineole, linalool, methyl chavicol and eugenol] when harvested in the September and drying at room temperature or in oven at 40C

effect of dexmedetomidine on hemodynamics, platelet aggregation and intraoperative blood loss under sevoflurane anesthesia during total hip arthroplasty

Background: sevoflurane is suggested to exert platelet anti-aggregation effect. Dexmedetomidine which is nowadays progressively used as anesthetic sparing was demonstrated experimentally to impair platelet aggregation. The purpose of the present work was to study the effect of addition of dexmedetomidine to both anesthetics on blood loss and platelet aggregation in total hip arthroplasty [THA] patients

Methods: we prospectively studied thirty adult ASA I-III patients, who were randomly allocated into two groups [15 patients each]. Group [S] received sevoflurane, while group [SD] received sevoflurane anesthesia, with dexmedetomidine infused perioperatively as an adjunct to anesthesia. Hemodynarnics [HR and MAP], bleeding time, platelet count, intraoperative blood loss and platelet aggregation induced by ADP, Adrenaline and Collagen were assessed

Results: there was no statistically significant difference between the two groups as regards the platelet count or bleeding time. Blood loss was found to be statistically significant under sevoflurane/Dexmedetomidine anesthesia, with no clinical deterioration of bleeding time or effect on blood loss. Intraoperative platelet aggregation was found to be impaired under both techniques, though more statistically significant in the Dexmedetomidine group. Dexmedetomimne still exerted inhibition of platelet aggregation 3 hours after anesthetic offset although much less inhibition was observed and limited to Adrenaline induced aggregation

Conclusion: in patients undergone THA, the present study showed that platelet aggregation was markedly depressed with the combination of Dexmedetomidine [as a loading dose of 1micro g/kg/over 20 minutes, then continued at a dose of 0.2- 0.5 micro g/kg/hour] and inhaled anesthetic sevoflurane [1-2 vol. %] which was less significant under sevoflurane only, although clinical deterioration of bleeding time or blood loss was not observed, and this may be related to the relative reduction in blood pressure and heart rate under sevoflurane anesthesia and the more reduction under dexmedetomidine/sevoflurane anesthesia

Antioxidant and hypolipidemic effect of black tea might explain the inverse relation between tea consumption and cardiovascular disease

Objective: to investigate the in vivo effect of black tea consumption on lipid profile and oxidative stress markers

Setting: biochemistry Department. Faculty of Pharmacy, Zagazig University

Patients: twenty healthy men were recruited from the student and staff population of our university for inclusion in the study. At the onset of the study, body weight and height were measured. The effects on studied parameters of hot drinks-black tea [each at a dose equivalent to 5 standard cups/day for 3 months] were matched before and after tea consumption. Main outcome measures: Reduced glutathione [GSH], lipid peroxidation [MDA], superoxide dismutase [SOD] catalase [CAT] nitric oxide [NO], cyclic guanosine monophosphate [cGMP], lipid profile and susceptibility of non HDLC to oxidation

Results: after tea drinking GSH, SOD. CAT, HDLC were significantly elevated in comparison to base line values but lipid fractions and susceptibility of non HDLC to oxidation were significantly reduced. NO and cGMP were not significantly changed

Conclusion: drinking of black tea could play a favorable role in the prophylaxis against a number of diseases for which dyslipidemia and oxidative stress are relevant

Urinary brta-2microglobulin level in urinary tract infections in infancy and childhood

Upper urinary tract infection is a serious bacterial illness among febrile infants and young children. Significant renal scarring may occur after a single episode especially with delayed diagnosis and treatment. In this study, we evaluated the value of measurement of urinary beta 2 microglobulin [B2-MG] in the differentiation between upper and lower urinary tract infections. Fifty children with urinary tract infections [UTis] aged between 1-12 years were studied: 15 children with acute pyelonephritis documented by positive DMSA scan, 15 children with acute cystitis documented by negative DMSA scan and 20 normal children as control. In all children, total leukocytic count [TLC], erythrocyte sedimentation rate [ESR], serum C reactive protein [CRP], blood urea and serum creatinine were measured. Also, B2-MG in 24 hours collected urine was measured using ELISA technique. It was found that TLc, ESR and RP were significantly higher in cases of acute pyelonephritis compared with those of cystitis. However, there was no statistically difference between the three studied groups as regards blood urea and serum creatinine. Urinary B2-MG was significantly higher in children with acute pyelonephritis compared with the other two groups [P= 0.01]. The sensitivity, specificity, and positive predictive value of urinary B2-MG in the diagnosis of acute pyelonephritis were 94.3%, 100% and 91.6% respectively. This study showed the importance of measuring of urinary B2-MG in children with urinary tract infection and the possibility of using this non invasive test in the differentiation between upper and lower UTIs