Risk Factors for Anaemia in Pregnancy in Rural KwaZulu-Natal - South Africa: Implication for Health Education and Health Promotion

Background: Anaemia in pregnancy is a major public health problem in developing countries. It is associated with an increased risk of maternal and perinatal morbidity and mortality. A high rate of anaemia in pregnancy in the rural population of KwaZulu-Natal (30according to national and 57according to the World Health Organization [WHO] definition of anaemia in pregnancy) is observed. The risk factors for anaemia; particularly during pregnancy; are multiple and complex and their relative contributions are known to vary by geographic areas and by seasons. In order to design an intervention for treatment and prevention of anaemia in pregnancy; studies to assess the aetiological factors are necessary. The aim of this study was to evaluate the strength of association between intestinal helminthiasis; urinary schistosomiasis and HIV infection on anaemia in pregnancy. Methods: A retrospective case-control study design was used in a rural district hospital of South Africa. A total of 300 pregnant women; 100 of them with anaemia (haemoglobin less than 10 gm/dL according to the national definition of anaemia in pregnancy) referred as cases and 200 controls were studied from Empangeni Hospital. Both cases and controls were matched for age; parity and gestational age. Data were collected from the antenatal clinic and prevention of mother-to-child transmission of HIV (PMTCT) programme registers for cases and controls at their booking visit during the months of May; June and July of 2004. Univariate and multiple logistic regression were performed to analyse the data. Results: Of the cases; 48and 1among the controls had intestinal helminthiasis; resulting in the odds ratio of 42 (p = 0;000 and 95CI 9;96 -176.59). The risk of anaemia was related to urinary schistosomiasis; as 27of the cases compared to 1of controls was found with anaemia. The odds ratio was 12 (p = 0;000 and 95CI 3.58 - 41.02). These parasitic infestations are known to cause chronic haemorrhage and iron deficiency resulting in the development of anaemia in pregnancy. Transmissions of intestinal parasitic infestation occur through the faecal-oral route. Personal hygiene and other environmental factors are therefore an important factor for the transmission of the disease. To reduce the transmission of faecaloral diseases (e.g. intestinal helminthiasis and urinary schistosomiasis) key interventions recommended are: 1) safe disposal of human excreta; 2) hand-washing practices with soap after defecation; and 3) maintenance of drinking water free from faecal contamination. Similarly; HIV infection increased the chance of developing anaemia in pregnancy twofold as HIV infection was more common among cases (56) than among controls (37); resulting in an odds ratio of 2.11 (p = 0;003 and 95CI 1.123 - 3.21). The prevention of HIV infection and transmission can be achieved through the improvement of knowledge of these conditions. These can be achieved through health education and health promotion. Conclusion: These findings confirm and conform to other studies on the association between anaemia in pregnancy and parasitic and HIV infections. Antenatal care should promote de-worming and education on personal hygiene and HIV (risk factors; mode of transmission; etc.). The provision of safe water supply and toilet facilities for the rural communities should be considered urgently to prevent and promote better health for all; including pregnant women

Knowledge of and Attitude Towards Cervical Cancer among Female University Students in South Africa

The objectives of this descriptive cross-sectional study were to assess the knowledge of the risk factors associated with; and detection methods of cervical cancer among female undergraduate students at Mangosuthu University of Technology. A total of 389 students were selected by stratified random sampling techniques. Participants' mean age was 20 years (SD=2). Results indicated that 51.2students were currently involved in a sexual relationship; with 19.2reporting two or more sexual partners in the past year. Less than half (42.9) of the participants had heard of cervical cancer and of these; 26 (15.6) did not know any risk factors for cervical cancer; while 96 (58.6) of 164 participants who knew of risk factors; did not know that cervical cancer is preventable. One-hundred and sixty-three (41.9) participants had heard about the Pap smear test. That the Pap smear test is used for detection or prevention of cervical cancer; was known to 62 (38) of the respondents. Only 16 (9.8) participants had had a Pap smear test. Among those who knew about the Pap smear test (n=136); 86 respondents did not have the test done mainly because of personal factors such as fear of the procedure; cultural or religious reasons; and were not ill (61.1). Findings suggest low level of knowledge on cervical cancer and its risk factors and detection method among these female university students. The university should thus concentrate on developing policies on health education and promotion; particularly targeting preventable health conditions; eg. cervical cancer and strategies to prevent transmission of the human papillomavirus

Evaluation of Cervical Cancer Screening Program at a Rural Community of South Africa

Objective: Cervical cancer is a leading cause of deaths among women worldwide. But the condition is preventable through regular screening of women those are 'at risk' for abnormal changes in the cervix and treating them who have positive results. Although screening facilities are available in South Africa; the incidence and mortality from cervical cancer remains very high and many women present health facilities with late stage diseases. Purpose of the study is to determine the baseline information on knowledge and practices on risk factors for cervical cancer and Pap smear and to design an intervention to improve Pap smear uptake. Methods: A cross-sectional population based descriptive study was undertaken at a rural community of South Africa targeting women 30 years and over. The assessment was performed by means of a questionnaire survey. Outcome measures were percentage of women with the knowledge on risk factors for cervical cancer and use of Pap smear test and had undertaken Pap smear test. Binary logistic regression analysis was carried out to identify possible predictors of Pap smear test undertaken. A total of 611 women (random samples) were recruited from the selected households. Results: The mean age of the sample was 43 years and 54of them had no education. Only 6knew all and 65knew any one of the risk factors of cervical cancer whereas less than half (49) of them knew that Pap smear is used for prevention of cervical cancer. Only 43respondents received information on Pap smear from health care workers. Among all the respondents only 18(95CI; 15-21) had ever done Pap smear test. Conclusions: This study showed low uptake of Pap smear test and low level of knowledge on prevention of cervical cancer and risk factors thus warrants urgent extensive health education program for this rural communities

Changes in Hematological Indices in Different Stages of Chronic Renal Failure.

The study was carried out to observe some aspects of hematological changes like Hb concentration, PCV and TC of RBC in different stages of Chronic Renal Failure(CRF) patients suffering from anemia. For this purpose, 65 male CRF patients with anemia and 25 apparently health male (control) subjects of age ranged from 30-50 years were selected randomly from BSMMU out patient department. Hematological parameters and renal creatinine clearance were estimated by usual laboratory technique. Data were analyzed statistically by ANOVA and Pearson’s correlation coefficient test. Among the CRF patients 15 were mild, 25 were moderate and 25 were severe CRF patients with anemia. In this study, the mean Hb concentration, PCV and total count of red blood cells were significantly lower in three stages of CRF patients with anemia compared to those of healthy subjects. Again, all of these hematological values were significantly (P< 0.001) lower in moderate and severe CRF patients compared to mild cases and also in severe cases than those of moderate CRF cases with anemia. All the Hematological parameters showed positive correlation with creatinine clearance in all three stages of CRF and it was statistically significant in moderate and severe group. From the present study it may be concluded that CRF patients with anemia had lower hematological indices and the degree of changes depend on severity of renal failure.

Injury Profile in KwaZulu-Natal; South Africa: Implications for Prevention

Background: Prevention and control of injuries require generating relevant information on the magnitude; characteristics and determinants of injuries. Objective: The objective of this study was to describe the characteristics of injuries and predict the severity of injury with other variables. Design: A cross - sectional descriptive study was conducted at the hospitals of KwaZulu - Natal. Information was gathered from a total of 428 injured patients randomly selected from hospital attendances. Multivariate logistic regression analysis was performed to identify the risk factors for severity of injury. Results: Over 60of injury victims were below the age of 30 years. The economically active group (21 - 60 years) also constituted about 60of injury victims. Over half of the victims reported that the scene of incidence was private house; yard and road. One fifth was transport related injury whereas majority was violence (50). Unintentional injury was 28.8. Most of the injuries were minor (42.3) to moderate (41.1) in severity. Odds Ratio for alcohol related violence was 11. Conclusion: In order to reduce injuries appropriate multisectoral interventions; broader policies and strategies; regulating transport and alcohol use; routine testing of alcohol to identify the problem-drinkers for rehabilitation. Interventions should also include health education and health promotion and law enforcement

Chronic renal failure in children.

The study was carried out to see the etiology and outcome of chronic renal failure in children. It is a prospective study, carried out to evaluate all new cases of CRF in children < 15 years in nephrology unit of BSMMU from May 2000 to May 2002. Diagnosis of CRF was based on Ccr < 75 ml/min/m(2) along with other features of CRF with no evidence of recovery over ensuing three months. A total of 44 children with CRF having mean age of 8.73 3.56 years were diagnosed during study period, among them, 30 cases (68.19%) were male and 14 cases (31.81%) were female. Causes of CRF were obstructive uropathy in 24 cases (54.55%) followed by glomerular diseases in 15 cases (34.9%), hereditary disorders in 3 cases (6.81%), and reflux nephropathy in 2 cases (4.54%). At presentation, 13 (29.55%) children had mild to moderate CRF and 31 (70.45%) children had severe CRF and ESRD. Mean follow up period was 32.3 weeks. At the end of the study period, 8 patients of mild to moderate CRF were on conservative treatment, 6 patients of severe CRF and ESRD group attended for maintenance dialysis irregularly of which 3 died at hospital and rest of the patients did not attend at follow up due to financial reason or opted against IPD. In the present study, majority of the children with CRF is due to treatable obstructive uropathy; mostly PUV and most of them presented with advanced renal disease.