A National Survey of Oxytocin Use during Caesarean Section in Zimbabwe

Background: Post-partum haemorrhage is the leading cause of mortality for labouring women in Zimbabwe. Current literature supports the use of low dose oxytocin to prevent bleeding during Caesarean section. Internationally; clinical practice has been slow to change and the use of potentially harmful; higher than recommended dose is common.Objective: To describe the current clinical practice in Zimbabwe.Design: A self-administered questionnaire survey. Descriptive statistics were used to report the study results.Setting: In 2013 a national survey was conducted on the use of oxytocin by different types of clinicians; who provide either anaesthesia or surgery for Caesarean section.Results: Of a total of 221 (61%) questionnaires returned; 170 (80%) were completed fully. Only 23% of respondents would give an intravenous dose of 5.0 IU or less of oxytocin for elective Caesarean section. The majority of clinicians (77%) would administer more than 5.0 IU of oxytocin at elective. A significant number of nurse anaesthetists 16/59 (27%); and a non-negligible number of specialist anaesthetists 3/48 (6%) would even give 20 IU of oxytocin in elective cases rising to 30% and 13% respectively for emergency cases. In case of persistent bleeding due to uterine atony; oxytocin was more likely to be repeated (45%); rather than using misoprostol (25%) or ergometrine (19%). Conclusion: Most clinicians in Zimbabwe use oxytocin doses well above current internationally recommended. This illustrates the urgent need for updated national guidelines for the prevention of post-partum haemorrhage during Caesarean section

Sanctuary or Double-Edged Sword? Challenges Confronting Adolescents Living at Nkosi's Haven in Johannesburg; South Africa

Living in an institution associated with HIV and AIDS is likely to exacerbate difficulties experienced by teenagers who have to cope with the normal stresses of adolescence. The aim of the study was to explore the challenges that adolescents living at Nkosi's Haven encounter and whether they experience any problems when interacting with their peers and other members of the community. The study was located within a qualitative research paradigm and utilised a purposive; non-probability sample of 15 participants recruited from two Nkosi's Havens. A semi-structured interview schedule was employed as the research tool; with in-depth one-on-one interviews adopted as the method of data collection. Thematic content analysis was used to analyse the data collected during the interviews. The main finding that emanated from the study was that Nkosi's Haven is indeed a place of care and nurturing as adolescents are afforded the opportunity to continue with their educational needs while basic and psychosocial needs are also addressed. However; it also emerged that rejection; discrimination; social exclusion and stigmatisation associated with the setting make it difficult for resident adolescents to integrate freely with their peers at school and in the community. The conclusion drawn is that Nkosi's Haven can be regarded as a double-edged sword as it presents both positive and negative factors that impact on its resident adolescents. Results are discussed in terms of their implications for community awareness programmes; policies and practice changes regarding employment and training of staff; and visiting of parents as well as future research