The effect of family planning counselling on postpartum modern contraceptive uptake in sub-Saharan Africa: a systematic review.

OBJECTIVE: Family planning counselling at different contact points of maternal health services has been recommended for increasing the uptake of modern contraceptive methods. However, studies from sub-Saharan Africa (SSA) demonstrated inconsistent findings. The aim of this systematic review was to synthesise the available current evidence for the association between family planning counselling and postpartum modern contraceptive uptake in SSA. STUDY DESIGN: This is a systematic review of the SSA literature. METHODS: On 11 February 2021, we searched six electronic databases for studies published in English. We included quantitative observational and interventional studies that assessed the effects of family planning counselling on contraceptive uptake among women who gave birth in the first 12 months. We used Joanna Briggs Institute critical appraisal tools to evaluate study quality. The protocol for this systematic review was registered in PROSPERO (CRD42021234785). RESULTS: Twenty-seven studies with 26,814 participants comprising 18 observational and nine interventional studies were included. Family planning counselling during antenatal care, delivery, postnatal care, and antenatal and postnatal care was associated with postpartum contraceptive uptake. Moreover, the newly implemented family planning counselling interventions improved postpartum modern contraceptive uptake. CONCLUSION: Overall, the evidence suggests that family planning counselling during the different maternal health service delivery points enhances contraceptive uptake among postpartum women. SSA countries should promote and strengthen family planning counselling integrated with maternal health services, which will play a significant role in combating unintended and closely spaced pregnancies.

Associations between interpregnancy interval and preterm birth by previous preterm birth status in four high-income countries: a cohort study.

OBJECTIVE: To investigate the effect of interpregnancy interval (IPI) on preterm birth (PTB) according to whether the previous birth was preterm or term. DESIGN: Cohort study. SETTING: USA (California), Australia, Finland, Norway (1980-2017). POPULATION: Women who gave birth to first and second (n = 3 213 855) singleton livebirths. METHODS: Odds ratios (ORs) for PTB according to IPIs were modelled using logistic regression with prognostic score stratification for potential confounders. Within-site ORs were pooled by random effects meta-analysis. OUTCOME MEASURE: PTB (gestational age <37 weeks). RESULTS: Absolute risk of PTB for each IPI was 3-6% after a previous term birth and 17-22% after previous PTB. ORs for PTB differed between previous term and preterm births in all countries (P-for-interaction ≤ 0.001). For women with a previous term birth, pooled ORs were increased for IPI <6 months (OR 1.50, 95% CI 1.43-1.58); 6-11 months (OR 1.10, 95% CI 1.04-1.16); 24-59 months (OR 1.16, 95% CI 1.13-1.18); and ≥ 60 months (OR 1.72, 95%CI 1.60-1.86), compared with 18-23 months. For previous PTB, ORs were increased for <6 months (OR 1.30, 95% CI 1.18-1.42) and ≥60 months (OR 1.29, 95% CI 1.17-1.42), but were less than ORs among women with a previous term birth (P < 0.05). CONCLUSIONS: Associations between IPI and PTB are modified by whether or not the previous pregnancy was preterm. ORs for short and long IPIs were higher among women with a previous term birth than a previous PTB, which for short IPI is consistent with the maternal depletion hypothesis. Given the high risk of recurrence and assuming a causal association between IPI and PTB, IPI remains a potentially modifiable risk factor for women with previous PTB. TWEETABLE ABSTRACT: Short versus long interpregnancy intervals associated with higher ORs for preterm birth (PTB) after a previous PTB.

Interpregnancy interval and risk of perinatal death: a systematic review and meta-analysis.

BACKGROUND: Interpregnancy interval (IPI) <6 months is a potentially modifiable risk factor for adverse perinatal health outcomes. OBJECTIVE: This systematic review evaluated the international literature on the risk of perinatal death associated with IPI. SEARCH STRATEGY: Two independent reviewers screened titles and abstracts identified in MEDLINE, EMBASE and Scopus from inception to 4 April 2019 (Prospero Registration #CRD42018092792). SELECTION CRITERIA: Studies were included if they provided a description of IPI measurement and perinatal death, including stillbirth and neonatal death. DATA COLLECTION AND ANALYSIS: A narrative review was performed for all included studies. Random effects meta-analysis was used to compare unadjusted odds of perinatal death associated with IPI <6 months and IPI ≥6 months. Analyses were performed by outcome of the preceding pregnancy and study location. MAIN RESULTS: Of the 624 unique articles identified, 26 met the inclusion criteria. The pooled unadjusted odds ratio of perinatal death for IPI <6 months was 1.34 (95% CI 1.17-1.53) following a previous live birth, 0.85 (95% CI 0.73-0.99) following a previous miscarriage and 1.07 (95% CI 0.84-1.36) following a previous stillbirth compared with IPI ≥6 months. However, few high-income country studies reported an association after adjustment. Fewer studies evaluated the impact of long IPI on perinatal death and what evidence was available showed mixed results. CONCLUSIONS: Results suggest a possible association between short IPI and risk of perinatal death following a live birth, particularly in low- to middle-income countries. TWEETABLE ABSTRACT: Short IPI <6 months after a live birth was associated with greater risk of perinatal death than IPI ≥6 months.

Deep venous thrombosis in a university teaching hospital, Addis Ababa, Ethiopia.

A five-year prospective study designed to obtain information on the demographic characteristics, risk factors and complications of deep venous thrombosis (DVT) in sixty six Ethiopians is reported. There were 44 females and 22 males with a female to male ratio of 2:1. Their age ranged between 13 and 80 (mean = 34 +/- 12.8) years. Fifty one subjects (77%) were below the age of 41 years. Sixty three cases (95%) presented with lower and three with upper limb DVT. In 26 females (40%) pregnancy and pregnancy-related conditions such as childbirth, abortions and Caesarean section were the risk factors for their DVT. Immobilisation was considered a risk factor in 12 cases (18%) and 12 other patients did not have an apparent risk factor for their DVT. Post-thrombotic syndrome was observed in 26% of the study population during the follow up period which ranged from two months to seven years (median = 1 year). Twelve per cent of the patients developed recurrent DVT and 9% had non-fatal pulmonary embolism. Venous thrombosis is common in Ethiopians and usually affects pregnant and young adults. The risk factors and complications observed were similar to those documented in the literature.

Clinical profile of Ethiopian patients with breast cancer.

This prospective study was designed to obtain information on demographic characteristics, clinical profile and problems related to early diagnosis and treatment of breast cancer in 72 Ethiopian patients. There were 62 females and 10 males, the female to male ratio being 6.2:1. The age range of the females was 21-82 (mean 41.8 +/- 12.8) years and that of the males' was 38-75 (mean 52.1 +/- 12.2) years. The time interval between the onset of breast-related symptoms to diagnosis varied from 2-108 (median 12) months. Infiltrating ductal and lobular carcinoma histologic types accounted for 85% and 11%, respectively, in 62 cases who had surgical biopsies. Surgery was performed in 46 cases out of whom only 21 cases received adjuvant treatment. Eighteen females refused mastectomy at some point before they came to our clinic with metastatic disease. After a median follow up duration of 36 (range 2-120) months, 29 cases were alive, 24 died and 19 were lost to follow up. The cause of death in 17 subjects (71%) was rapidly refilling pleural effusion and superimposed infection. Both females and males had similar clinical characteristics, except that, the males were older by 10 years. Moreover, the females in this series developed breast cancer at a younger age (72% were premenopausal) and 76% had advanced disease (Stages III and IV) at presentation, similar to females from other African countries. We suggest that the attitude of Ethiopian females towards breast cancer has to change through continuous but targeted public education.

Blood pressure variation among Ethiopians on the Simien Plateau.

This report presents information on determinants of blood pressure variation in a rural sample of 263 Ethiopian highlanders 14-86 years of age, resident at 3530 m on the Simien Plateau. Mean systolic and diastolic blood pressures for males and females were 109/ 75 and 106/73, respectively, and there were no age differences. These findings confirmed that men and women can have low normal blood pressure throughout adulthood. Blood pressures increased with increasing body mass index (BMI) among adult males, although the mean BMI of 19.1 kg/m2 was low compared with US values. This illustrates that BMI variation may be associated with blood pressure variation in men even at low mean values of both. Blood pressure did not vary with adult haemoglobin concentration.

Extramedullary blast transformation in a patient with chronic myelogenous leukaemia.

Extramedullary blast transformation (crisis) of stable, chronic myelogenous leukaemia in a 71-year old male Ethiopian is presented. The difficulties encountered in the diagnosis and management of this rare but grave condition are discussed and literature is reviewed.

Chronic lymphocytic leukaemia in Ethiopians.

One hundred and two cases of chronic lymphocytic leukaemia (CLL) were seen at the Tikur Anbessa (Black Lion) Hospital, in Addis Ababa, Ethiopia, from January 1982 to December 1994. The age range was 35-91 (mean 55.6 +/- 11.08) years. The male to female ratio was 3.6:1. The commonest symptoms were weakness, weight loss, fever and sweating. The commonest signs were lymphadenopathy, splenomegaly and hepatomegaly. Fifty six per cent had Rai stage III and IV, only three patients were in stage 0. Of those treated with chemotherapy, 22.0% and 48.8% achieved complete and partial remissions respectively. Twelve patients are still alive and on follow up for 2-138 (median 18) months, 69 are lost to follow up after 0-132 (median 3) months and 21 are dead 0.5-84 (median 2.8) months after diagnosis. Of those that died, 13 were in stage IV and five in stage III. The main causes of death were septicaemia of undetermined origin in eight and pneumonia in seven. Thus CLL is not a rare disease in this centre. Its presentations are similar to cases reported in the literature. Optimal treatment is not possible due to lack of chemotherapeutic agents and supportive care. Therefore, we suggest that referral centres be equipped for better management of CLL patients.

Cryptococcal meningitis in a young Ethiopian woman with AIDS.

The case of a 20 year old Ethiopian woman with cryptococcal meningitis and acquired immunodeficiency syndrome (AIDS) is presented. Though cryptococcal infections have been reported from many countries throughout the world, this is the first case reported from Ethiopia in a patient with the acquired immunodeficiency syndrome (AIDS). The clinical manifestations, diagnosis, and treatment are discussed, with a review of recent literature.

PIP: This is the first report from Ethiopia of a case of cryptococcal meningitis in a patient with AIDS. A 20-year-old woman was admitted to Tikur Anbessa Hospital in January 1990 with complaints of generalized pruritic skin lesions of six months, and headache, fever, and poor appetite of three months duration. The headache and low-grade intermittent fever were accompanied by nausea, vomiting, anorexia, and progressive weight loss, without diarrhea. She had had multiple sex partners. Upon admission, after being bedridden for two weeks, she appeared acutely ill and restless. Her temperature was 39.5 degrees Celsius, and she had oral thrush. There was no lymphadenopathy. Widespread, irregular erythematous and whitish macular patches (3 x 5 to 8 x 10 sq. cm in size) with peripheral scaling and tiny vesicles were found on the skin, pubic and perineal regions. She had neck stiffness, but was conscious and well-oriented. Hemoglobin (Hb) was 10.5 g%; the white cell count (WBC) was 3400/cu. mm; the erythrocyte sedimentation rate (ESR) was 92 mm/hr; the platelet count was 175,000/mm; and blood films were negative for hemoparasites. Urinalysis showed 3+ albumin and many pus cells and red cells/HPF. Urine culture was negative, and the VDRL test was nonreactive. Lumbar puncture, which was performed upon arrival, showed clear cerebrospinal fluid (CSF), with normal protein and glucose levels and no cells. CSF culture showed yeast cells, and an India ink preparation was positive for Cryptococcus neoformans. Blood taken for bacterial culture grew yeast cells. Renal and liver function tests, and chest x-rays were normal. A potassium hydroxide (KOH) preparation from a skin snip showed rounded yeast cells. ELISA and Western blot tests were both positive. The patient was given supportive treatment and amphotericin B (0.6 mg/kg daily). Although the fever decreased, the patient's general condition did not improve. She complained of headache, photophobia, nausea, and vomiting. Lumbar puncture was repeated eight days after the start of treatment; CSF culture and India ink preparations were negative. Urea nitrogen (BUN) repeated two weeks later was normal. Four weeks after admission, the patient suddenly vomited massive amounts of fresh blood and died before transfusion could be given. A discussion follows regarding the clinical manifestations, diagnosis, and treatment of this disease, particularly in AIDS patients, with a review of the literature.