Challenges encountered by human immunodeficiency virus positive pregnant women on taking antiretrovirals in a public health unit of the Manzini region, Swaziland

In Swaziland, the Ministry of Health adopted the prevention of mother-to-transmission (PMTCT) Option A as a feasible and less costly way to expand the PMTCT services nationwide. Despite major success since the programme started, some barriers, such as the challenge of follow-up care for human immunodeficiency virus (HIV)-positive pregnant mothers still exist. The present study aimed to describe the challenges that HIV-positive pregnant mothers encountered on taking antiretrovirals (ARVs) in a health unit of the Manzini region, Swaziland. A qualitative, exploratory and descriptive research design was used, and data were collected through semi-structured individual interviews and field notes. Purposive sampling was used to select the study site and the population. Permission was requested from the participants to record the interviews. The study population were HIV-positive pregnant mothers, aged between 18 and 40 years, which were enrolled in the PMTCT B+ programme. The PMTCT B+ programme was perceived as preventing the transfer of HIV transmission from mother to child. It boosts the mother's immune system, prevents opportunistic infections and prolongs life. Challenges of taking ARVs emerged as a theme. The participants displayed knowledge and understanding of the programme, yet discrimination and no support from families and partners were mentioned. (Afr J Reprod Health 2022; 26[5]: 41-49).

Linfoma primario de ano en un paciente con virus de la inmunodeficiencia humana/sida / Primary lymphoma of anus in a patient with human immunodeficiency virus/AIDS

Se presenta el caso clínico de un paciente de 47 años de edad con seropositividad del virus de inmunodeficiencia humana/sida desde hacía 5 años, quien acudió a la consulta de Cirugía en el Hospital Gubernamental de Mbabane en Suazilandia, por presentar un tumor anal; se diagnosticó hemorroides, pero el tumor continuó aumentando de tamaño, unido a sangrado e intenso dolor. Se realizó una biopsia por incisión que indicó la presencia de un linfoma de alto grado de malignidad. Posteriormente el paciente fue evaluado en la consulta de Oncología, donde se le indicaron los exámenes complementarios necesarios, los que revelaron que la neoplasia se encontraba en estadio IE; de manera que fue remitido a Sudáfrica para recibir quimioterapia combinada, con la cual desapareció la lesión maligna y se controló la enfermedad

The case report of a 47 years patient with the human immunodeficiency virus/AIDS for 5 years is presented. He went to the Surgery Service in the Government Hospital of Mbabane in Swaziland, due to an anus malignancy; hemorrhoids was diagnosed, but its size continued increasing, along with bleeding and acute pain. An incision biopsy that indicated the presence of a high grade lymphoma malignancy was carried out. Later on the patient was evaluated in the Oncology Service, where the necessary complementary exams were indicated, revealing that neoplasm was in IE stage; so he was referred to South Africa to receive combined chemotherapy, with which the malignant lesion disappeared and the disease was controlled

Enfermedad de Paget de la mama en una paciente suazí / Paget´s disease of the breast in a suazi patient

Se describe el caso clínico de una paciente de 63 años de edad, quien acudió a la consulta de Oncología del Hospital Gubernamental de Mbabane, en Suazilandia, por presentar una lesión ulcerada en el pezón de la mama izquierda desde hacía 1 año. Luego de realizarle una biopsia por escisión, que reveló la presencia de la enfermedad de Paget, clasificada en el estadio 0 según los resultados de los exámenes complementarios, se decidió remitirla al Servicio de Cirugía donde le practicaron una mastectomía simple. La paciente mostró buena evolución clínica y se mantenía estable hasta la última consulta en que fuera asistida

The case report of a 63 years patient who went to the Oncology Service of the Government Hospital of Mbabane, in Swaziland is described, due to an ulcerated lesion in the nipple of the left breast for 1 year. After carrying out an excision biopsy that revealed the presence of the Paget´s disease, classified in the stage 0 according to the results of the complementary tests, she was referred to the Surgery Service where a simple mastectomy was carried out. The patient showed good clinical course and she remained stable until the last appointment when she was assisted

Carcinoma basocelular invasivo de vulva en una adulta / Basal cellular invasive vulvar carcinoma in an adult woman

Se presenta el caso clínico de una fémina de 32 años con seropositividad del virus de inmunodeficiencia humana desde hacía 2 años, quien acudió a la consulta de Ginecología del Hospital Gubernamental de Mbabane, en Suazilandia, por presentar una lesión en el labio mayor derecho de la vulva, unido a prurito y adenopatías en la región inguinal derecha. La paciente fue evaluada en la consulta de Oncología, donde se le diagnosticó un carcinoma basocelular invasivo de vulva, clasificado en estadio III luego de realizar los exámenes complementarios necesarios; posteriormente fue remitida a Sudáfrica para recibir radioterapia y quimioterapia combinadas.

The case report of a 32 years female patient is presented with seropositivity of the human immunodeficiency virus for 2 years who came to the Gynecology Service of Mbabane Government Hospital, in Swaziland, due to a lesion in the right major lip of the vulva, together with pruritus and adenopathies in the right inguinal region. The patient was examined in the Oncology Service, where a basal cellular invasive vulvar carcinoma was diagnosed. It was classified in stage III after carrying out the necessary laboratory exams; later on she was transferred to South Africa to receive combined radiotherapy and chemotherapy.

Carcinoma hepatocelular en una paciente con virus de inmunodeficiencia humana/sida y cirrosis hepática / Hepatocellular carcinoma in a woman with human immunodeficiency virus/aids and liver cirrhosis

Se presenta el caso clínico de una paciente de 42 años con positividad del virus de inmunodeficiencia humana desde hacía 3 años, quien acudió a la consulta de Cirugía del Hospital Gubernamental de Mbabane, en Swazilandia, por presentar un tumor abdominal doloroso en el cuadrante superior derecho, unido a astenia, anorexia y ligera ictericia. Fue evaluada en la consulta de Oncología y, luego de realizarle los exámenes complementarios necesarios, se le diagnosticó cáncer hepatocelular asociado a virus de inmunodeficiencia humana/sida y cirrosis hepática en estadio III. Posteriormente fue remitida a Sudáfrica para recibir radioterapia y quimioterapia combinadas.

The case report of a 42 years patient is presented with positivity of the human immunodeficiency virus for 3 years who went to the Surgery Department of the Government of Mbabane Hospital, in Swaziland, for presenting a painful abdominal tumor in the right superior quadrant, together with asthenia, anorexia and mild jaundice. She was evaluated in the Oncology Department and, after carrying out the necessary complementary exams to her, she was diagnosed hepatocellular cancer associated with the human immunodeficiency virus/aids and liver cirrhosis in stage III. Later she was referred to South Africa to receive combined radiotherapy and chemotherapy.

Nutritional Knowledge, Attitude, and Practices among Pregnant and Lactating Women Living with HIV in the Manzini Region of Swaziland.

The prevalence of HIV infection in Swaziland (26%) is among the highest in the world. We investigated nutritional knowledge, attitude, and practices (KAP) and the influence of sociodemographic factors on KAP among pregnant and lactating women living with HIV in the Manzini region of Swaziland. Interviews were conducted using a structured questionnaire to collect data from 324 subjects seeking healthcare from selected regional hospitals, health centres, and clinics in Manzini region. The results showed mean percentage scores of nutritional knowledge (67%), attitude (67%), and practices (51%) whereby educational level (p=0.002), employment status (p=0.009), income (p=0.008), religion (p=0.007), type of accommodation (p=0.006), type of transport used when going for shopping (p=0.001), and BMI (p=0.015) were significantly associated with nutritional practices. Significant positive correlations between nutritional KAP were observed: nutritional K and A (r=0.155, p=0.005), nutritional K and P (r=0.456, p=0.001), and nutritional A and P (r=0.230, p=0.001). Multiple linear regression analysis indicated that type of transport used when going for shopping (p=0.002), educational level (p=0.001), income (p=0.001), employment (p=0.038), knowledge of food proportion in a plate (p=0.000), a positive attitude towards high-fibre diet (p=0.004), and eating a variety of foods (p=0.006) were predictors of nutritional practices. Educational level was identified as a common predictor of nutritional knowledge, attitude, and practices, suggesting that both formal and informal education systems are potential factors influencing dietary practices among pregnant and lactating women living with HIV in Swaziland.