COVID-19 vaccine hesitancy among pregnant women in an antenatal clinic in Durban, South Africa

Background: Mass administration of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most efficient intervention against the coronavirus disease 2019 (COVID-19) pandemic. Recently, vaccinations were shown to be safe and effective during pregnancy. However, vaccination rates are low in low- and middle-income countries, and vaccine hesitancy is a major limiting factor. Objectives: To investigate the rate of COVID-19 vaccine hesitancy among pregnant women. Method: A cross-sectional questionnaire-based investigation of 313 unvaccinated pregnant women attending an antenatal clinic in Durban, South Africa (SA). The questionnaire included clinical and socio-demographic data, and reasons for vaccine hesitancy were recorded and evaluated. Results: Of 313 women participating, 126 (40.3%) were vaccinated against COVID-19, 21/313 = 6.7%; for those unvaccinated, 21/187 (13.9%) were planning to be vaccinated. However, most unvaccinated women, 174 of 187 (93%), showed COVID-19 vaccine hesitancy. Conclusion: The COVID-19 vaccination hesitancy among pregnant women in Durban, SA, is exceptionally high. This requires urgent attention by the relevant health authorities (both professional health organisations and the SA Department of Health) as many countries experience different waves of the variants of SARS-CoV-2 and herd immunity may not have been achieved. Contribution: This study showed a high vaccine acceptance hesitancy rate among pregnant women in SA.

COVID-19 death: A novel method of improving its identification when a patient has multiple diagnoses

Assigning a primary cause of death to a deceased patient who had multiple principal diagnoses including coronavirus disease 2019 (COVID-19) is challenging because of the difficulty in selecting the most appropriate cause. To proffer a solution, the authors reviewed the literature on assigning a primary cause of death. In 2015, the Nnabuike-Jagidesa (NJ) model II was devised to improve the International Classification of Diseases and related health problems, 10th revision (ICD-10) guideline on how to assign a primary cause of death. The NJ model II stipulates that when there are multiple diagnoses with no plausible explanation that one of the illnesses could have resulted in the other clinical conditions, the single most appropriate primary cause of death is the condition with the highest case fatality ratio in that setting. In the index report, the authors opine that if the case fatality ratios are similar, the following objective criteria (listed in the order of priority) should be used to assign a primary cause of death: condition with the highest infection fatality ratio, condition that was the main indication for the last acute surgical or invasive procedure performed (during the course of the same ill-health) before the death and the disease that theoretically affects the highest number of body organs. Additionally, a clinical descriptor should be used when none of the objective criteria are satisfied. This novel approach, termed the modified NJ model II, is expected to improve the objectivity and reproducibility of the assigned primary cause of death in a deceased who had multiple diagnoses, which may include COVID-19.

Maternal deaths due to eclampsia in teenagers: lessons from assessment of maternal deaths in South Africa

Background: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. Setting: Data extracted from the South African Saving Mothers Report: 2014­2016. Aim: To establish the clinical details in teenage maternal deaths owing to eclampsia. Method: Retrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014­2016. Results: There were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals. Conclusion: Teenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia

Characteristics of Women Having First-Trimester Termination of Pregnancy at a District Hospital in Kwazulu-Natal

Termination of pregnancy (TOP) is requested by some women for a variety of reasons and it is plausible that profiling their characteristics might help to target selected groups for counselling. This study aimed to determine the characteristics of women having a legal first-trimester TOP at a regional hospital in KwaZulu-Natal. The medical records of 254 women were retrospectively sampled and analysed from a total of 758 women who had a first-trimester TOP between January and December 2008. The women were aged 14-45 years (the most common age group was 20-29 years; a mean age of 25.3 years and a standard deviation of 5.9). The majority (75.6) reported that they had at least one child who was alive; 1.6 had previously had a TOP; 93.3 were single and 28.4 resided outside the health district in which the hospital was situated. Eighty-nine per cent had not used contraception before the index pregnancy. Fifty-eight per cent requested a TOP between 9 and 12 weeks of gestation (a mean of 8 weeks). Ninety-six per cent had a TOP because of socio-economic reasons. All of the women received counselling prior to undergoing TOP. In our patient population; women who had a legal TOP in the first trimester were in their twenties; single; parous; sexually active; not on a contraceptive and of poor socio-economic status. Women with these characteristics should be targeted for appropriate counselling on reproductive health matters

Sexual Activity during Pregnancy: a Questionnaire-Based Study

The objective of the study was to determine changes in frequency of sexual activity during pregnancy. A prospective study was conducted using a structured questionnaire to interview 611 healthy pregnant women at a regional hospital in KwaZulu-Natal. Data were analysed using descriptive statistics. Five hundred and fifty-six (91.0 ) of the 611 women were sexually active during pregnancy. Sexual desire was increased in 102 (18); decreased in 299 (40) and was unchanged in 210 (34). Four hundred and twenty-two (69) engaged in sexual activity until the third trimester of pregnancy. Three hundred and seventy-nine (62) used condoms. The majority (63) found it easier to discuss the topic of sexual activity with midwives rather than with doctors. One hundred and thirty-eight (23) experienced adverse events attributed to sexual intercourse during pregnancy. Religious and traditional practices played a minor role in guiding the practice of sexual activity during pregnancy. Twenty-eight (5) of the 611 women were guided by religious rules while 27 (4) were guided by traditional rules. Our findings confirm that sexual activity is commonly practised in pregnancy. Given the high HIV rates and sexually transmitted infections in the local population; this has important implications for information provided during antenatal care