ABSTRACT
This report describes an 11-year-old girl with systemic lupus erythematosus (SLE) with long-standing low levels of complement proteins. A disease period with lupus nephritis (class IIIa) was complicated by Staphylococcus aureus bacteraemia and osteomyelitis. She was treated with high-dose immunosuppressants and 6 weeks of high-dose intravenous antibiotics. The clinician should be aware of bacteraemia in SLE with secondary complement deficiency.
Subject(s)
Bacteremia/drug therapy , Complement System Proteins/deficiency , Lupus Erythematosus, Systemic/immunology , Staphylococcal Infections/drug therapy , Anti-Bacterial Agents/therapeutic use , Bacteremia/immunology , Child , Complement System Proteins/immunology , Female , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Lupus Nephritis/complications , Lupus Nephritis/drug therapy , Lupus Nephritis/immunology , Staphylococcal Infections/immunology , Staphylococcus aureusABSTRACT
BACKGROUND: Antenatal care (ANC) provides an important opportunity for pregnant women with a wide range of interventions and is considered as an important basic component of reproductive health care. METHODS: In 2008, severe maternal morbidity audit was established at Saint Francis Designated District Hospital (SFDDH), in Kilombero district in Tanzania, to ascertain substandard care and implement interventions. In addition, a cross-sectional descriptive study was carried out in 11 health facilities within the district to assess the quality of ANC and underlying factors in a broader view. RESULTS: Of 363 severe maternal morbidities audited, only 263 (72%) ANC cards were identified. Additionally, 121 cards (with 299 ANC visits) from 11 facilities were also reviewed. Hemoglobin and urine albumin were assessed in 22% - 37% and blood pressure in 69% - 87% of all visits. Fifty two (20%) severe maternal morbidities were attributed to substandard ANC, of these 39 had severe anemia and eclampsia combined. Substandard ANC was mainly attributed to shortage of staff, equipment and consumables. There was no significant relationship between assessment of essential parameters at first ANC visit and total number of visits made (Spearman correlation coefficient, r = 0.09; p = 0.13). Several interventions were implemented and others were proposed to those in control of the health system. CONCLUSIONS: This article reflects a worrisome state of substandard ANC in rural Tanzania resulting from inadequate human workforce and material resources for maternal health, and its adverse impacts on maternal wellbeing. These results suggest urgent response from those in control of the health system to invest more resources to avert the situation in order to enhance maternal health in this country.
