Access to postpartum tubal ligation services in Cape Town, South Africa - an observational study

Background: Many women receiving antenatal care in public health services in Cape Town choose bilateral tubal ligation as their preferred method of postpartum contraception during their antenatal course. If the sterilisation does not occur immediately, these women are discharged on an alternative form of contraception and, ideally, an interval date for bilateral tubal ligation is arranged. Objectives: To assess the access to tubal ligation services in the Metro West area of Cape Town, South Africa, in women who request permanent contraception following delivery, looking specifically at the number of women requesting bilateral tubal ligation who receive the procedure intrapartum, immediately postpartum or as an interval procedure. Other objectives included determining the reproductive outcomes if bilateral tubal ligation was not performed, investigating the alternative forms of contraception provided and to study the demographics of the population requesting bilateral tubal ligation as a form of contraception. Methods: The study was conducted as a cross-sectional observational study collecting data over a period of 3 months, from June 2019 to August 2019. Maternity case records for deliveries between June 2019 and August 2019 from four facilities were reviewed. The facilities, representing all levels of care, were Vanguard Midwife Obstetric Unit, Wesfleur Hospital (district hospital), New Somerset Hospital (regional hospital), Groote Schuur Hospital (tertiary hospital). Results: There were 260 women who requested tubal ligation as their choice of contraception. Only 50% of these received a tubal ligation. Of the 131 tubal ligations performed, 2 were interval sterilisations. Ninety-one percent (120/131) of the tubal ligations were done at the time of caesarean section. Of the 129 women who received alternative forms of contraception, 13 women had a recurrent pregnancy. Conclusion: The study suggests that only 50% of women requesting tubal ligation as form of contraception actually end up receiving the procedure. Alternative forms of contraception are widely used and relied upon, but not without risks of recurrent pregnancy. Interval tubal ligation was not easily accessed by those women who were referred for the procedure.

HIVin South Africa - depression and CD4 count

Objective: Published studies on the prevalence of depressive symptoms using rating scales and the relationship between depression and immune status offer inconsistent results. Depressive symptoms are common and impact on functioning; quality of life; and health status; highlighting the importance of diagnosis and treatment of patients with HIV infection. The aim of the study was to determine the occurrence of depression among HIV-positive patients using the Beck's Depression Inventory (BDI) and to determine a relationship; if any; between depressive symptoms and CD4 count. Method: 41 patients aged 18 years or more were recruited from an HIV outpatient clinic in South Africa [date not given]. All the subjects completed the 21-item BDI and their CD4 counts were determined. Patients who had a score of 10 or more on the BDI were considered positive for a depressive disorder. Results: More than half (56) of the study sample had a BDI of =10 indicating significant symptoms of depression. There was no significant difference in the CD4 counts between the depressed and non-depressed groups (p0.05); and no correlation between CD4 counts and BDI scores in the total study sample (r=0.27; p0.05). The affective components of the BDI contributed significantly to the overall BDI score compared with the somatic component (p0.05). Conclusion: The evidence from the study supports the BDI as a suitable measure for identifying those patients who meet the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for minor or major depression. The HIV epidemic is the most serious health challenge in South Africa and it is imperative that HIV-infected patients who complain of fatigue or insomnia be screened routinely for major depression; followed by a structured interview to confirm the diagnosis