ABSTRACT
Background: The perinatal mortality rate remains an important indicator of maternal care and maternal health and nutrition; and also reflects the quality of obstetric and pediatric care available. The causes of most of the perinatal deaths are preventable; thus making it important to identify the risk factors in each health environment. Objective: The aim was to prospectively audit the perinatal mortality and associated risk factors in a tertiary health facility in a developing country. Materials and Methods: Data for all consecutive deliveries in the labor ward complex of Lagos University Teaching Hospital (LUTH) between June 2002 and November 2002 were obtained from the patients' record and by interviewing the mothers using a questionnaire. The babies were followed up for 7 days postdelivery. Results: There were 51 (8.5) perinatal deaths made up of 43 (7.1) stillbirths (15 fresh and 28 macerated) and 8 (6.1) early neonatal deaths giving a perinatal mortality rate of 84.6/1000. Maternal factors that significantly affected perinatal deaths were maternal age; parity; antenatal care booking and the hospital where the mother was booked for antenatal care; number of previous child deaths; and complications of pregnancy. Mode of delivery and complications of labor were the significant intrapartum factors. Fetal factors that influenced perinatal deaths were fetal presentation; birth weight; and Apgar scores at 1 and 5 min. When multiple logistic regression (multivariable analysis) of perinatal mortality on possible risk factors was done; only the Apgar score at 5 min; birth weight; and parity were significant risk factors. Conclusion: The study shows a high perinatal mortality rate with majority of perinatal deaths occurring before the delivery. Significant risk factors are a low Apgar score at 5 min; low birth weight; and high parity
Subject(s)
Perinatal Mortality , Prospective Studies , Risk FactorsABSTRACT
Despite their high levels of knowledge about HIV and AIDS; young people ages 15-24 years in South Africa remain disproportionately affected by the epidemic. Young people's continued susceptibility to HIV infection has been consistently linked to intractable higher-risk sexual behaviours. This paper uses multivariate techniques and secondary data from two nationally representative surveys to illuminate individual and socio-structural factors that play a significant role in youths' continued engagement in higher-risk behaviour; despite their high awareness about HIV and AIDS. The findings show that notwithstanding progress in terms of increased condom use and reduced incidence of other sexually transmitted infections; the average age of sexual debut remains low; multiple sexual partnerships are prevalent; and inconsistent condom use is widespread among young people. Factors significantly associated with these risk behaviours occur at the individual and structural levels and include issues of race; gender; poverty and susceptibility to peer pressure. The paper concludes by recommending that future HIV-prevention interventions in South Africa should aim at building resilience among youths by promoting affirmative; supportive interventions that emphasize the potentials of young people
Subject(s)
Adolescent , HIV Infections , Patient ComplianceABSTRACT
This work was undertaken to determine the incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections in children at a tertiary hospital and the antibiotic susceptibility profiles of MRSA compared with methicillin-sensitive (MSSA) strains. From 1994 to 1995; 4;981 admissions in the neonatal intensive care; paediatric surgical; general paediatric; and the well-baby wards of the Lagos University Teaching Hospital were prospectively monitored for nosocomial S. aureus infections. Antibiotictesting was performed on a total of 175 isolates of S. aureus obtained from 169 patients with nosocomial infections (NI) using a disk diffusion method and by E test (AB Biodisk; Sweden). In total; nosocomial MRSA infection was identified in 96 (1.9) patients; rates recorded for patients in the various wards as stated above were 4.2; 3.2; 0.5 and 0 respectively. Correspondingly; the rate of nosocomial MRSA amongst all S. aureus infections was 63.6; 44.7; 41.7 and 0; and 54.9 overall. All MRSA and MSSA were sensitive to ciprofloxacin and vancomycin. Clindamycin and rifampin (87-98) were also highly effective against MRSA and MSSA; 78.3 of MRSA and 91.7 MSSA were sensitive to fusidic acid. Gentamicin (70.9) and erythromycin (65.8) were also active on MSSA. Cotrimoxazole had low activity against all the strains. Following the high rate and multiresistant nature of nosocomial MRSA obtained in this study; there is need for intensive surveillance of such infections and initiation of stringent control measures in Nigeria and Africa at large.; 0.5 and 0 respectively. Correspondingly; the rate of nosocomial MRSA amongst all S. aureus infections was 63.6; 44.7; 41.7 and 0; and 54.9 overall. All MRSA and MSSA were sensitive to ciprofloxacin and vancomycin. Clindamycin and rifampin (87-98) were also highly effective against MRSA and MSSA; 78.3 of MRSA and 91.7 MSSA were sensitive to fusidic acid. Gentamicin (70.9) and erythromycin (65.8) were also active on MSSA. Cotrimoxazole had low activity against all the strains. Following the high rate and multiresistant nature of nosocomial MRSA obtained in this study; there is need for intensive surveillance of such infections and initiation of stringent control measures in Nigeria and Africa at large