The influence of fluid management on outcomes in preeclampsia: a systematic review and meta-analysis.

BACKGROUND: The optimal fluid management strategy to ensure best outcomes in preeclamptic patients remains a controversial issue, with little evidence to support any one approach. OBJECTIVE: The aim of this systematic review was to investigate the effect of various fluid management strategies on clinical outcomes, haemodynamic indices and biochemical markers in preeclamptic women and their babies. Primary outcome measures were the occurrence of pulmonary oedema and/or the development of renal impairment. METHODS: A systematic review of randomised fluid management strategies was conducted. Five electronic databases were searched using the expanded search terms: 'intravenous fluid', 'plasma substitutes', 'intravenous fluid management', 'intravenous fluid therapy', plasma volume expansion', 'fluid restriction', 'oncotic therapy', 'crystalloids', 'colloids', 'preeclampsia', 'toxemia of pregnancy', 'pregnancy-induced hypertension', 'eclampsia' and 'gestational proteinuric hypertension'. RESULTS: Six randomised controlled trials (RCTs), from nine publications, were included in the final analysis. There were no differences between groups with respect to the incidence of pulmonary oedema, perinatal mortality, preterm delivery and caesarean section. Colloid volume expansion was associated with a significantly lower systolic and diastolic blood pressure, but had no effect on heart rate or cardiac index. Data on systemic vascular resistance (SVR), serum atrial natriuretic peptide (ANP) and urine volume could not be aggregated. CONCLUSION: Data on the ideal fluid strategy in women with preeclampsia is limited, and insufficient to make any strong recommendations. Further randomised controlled studies are needed to provide more evidence for which fluid management strategies are best suited to this heterogeneous patient group.

Strategic framework for increasing accessibility and utilization of voluntary counseling and testing services in Uganda.

Despite the usefulness of VCT service as an entry point to prevention for the HIV-uninfected people and care, treatment and support for those who test HIV positive, VCT service remains poorly utilized among the fishing communities. The aim of the study was to identify factors influencing VCT service delivery and utilisation among fishing communities in Uganda and consequently, formulated a strategic framework for improving VCT service delivery and utilisation in the fishing communities. The study followed a 3-phased approach, collecting and analyzing quantitative data from Kasenyi fishing community under phase I, collecting and analyzing qualitative data from hospital managers and VCT counselors in phases II and III, respectively. Results indicate that VCT services delivery and utilisation is affected by factors at government (macro) level, the institution (meso) level, and at the individual (micro) level. Based on this, a strategic framework was designed, expected to increase VCT service availability, accessibility, and acceptability if applied. The researcher recommends the use of this useful tool in the design of VCT programs.

A situational analysis of child-headed households in South Africa.

The aftermath of the HIV and AIDS pandemic has resulted in great suffering in terms of loss of income, poor quality of life, morbidity and mortality, with children being destitute and orphaned at an alarming rapid rate. Families and communities are currently unable to cope with the effects of HIV and AIDS with special emphasis on the care and support of the affected orphans and vulnerable children, who as a result have been compelled to look after themselves giving rise to a new type of family, the child-headed household. The emergence of this type of family requires government's response in terms of care and support. The purpose of this study was to provide a broad picture of the location, prevalence, composition, functions, needs and challenges of child-headed households in South Africa, and explore available and required services, resources and safety nets for children in child-headed households. An exploratory and descriptive design was used for the purpose. The sample consisted of children heading households and those living in the households that are headed by children; government departments responsible for child welfare, such as, the Departments of Social Development, Health, Education and Agriculture; non-profit organisations and communities where these households are predominant. From the data collected, it was found that the rights of the affected children were compromised. Those heading the households were often not at school and were responsible for domestic chores. The households needed food, clothes, money, shelter, and education. Government in attempting to address these needs required clear policies which will provide a distinction between orphaned and vulnerable children and child-headed households. The study recommended a collaborative approach as it was shown that there was no single model of best practice to appropriately and effectively address the needs of child-headed households.

Knowledge of pregnant women on transmission of HIV infection through breast feeding.

Although breast-feeding is nature's way of providing nutrition to the baby, in HIV positive mothers this has been identified as one of the means through which HIV infection is transmitted from the mother to the child. In Africa where children under the age of 5 are killed by preventable diseases like diarrhoea, the issue of HIV transmission through breast feeding poses an added huge problem. Research has, however shown that exclusive infant feeding, be it breast or formula, reduces the risk substantially. It is imperative that mothers be informed about safer methods of infant feeding so that HIV infection is kept to a minimum. The objective of the study was to explore and describe the knowledge that pregnant women had about mother to child transmission of HIV infection through breast-feeding. A non-experimental quantitative exploratory and descriptive research design was used to explore the knowledge women had on mother to child transmission of HIV infection through breast-feeding. From the data collected, it showed that although women were aware of the susceptibility of children to HIV infection if fed on breast and formula feeds simultaneously by HIV positive mothers, exclusive feeding was a problem as people associated the practise with a positive HIV status. Women who had not disclosed their HIV status and were HIV positive, found it difficult to comply with the requirement to exclusively feed their infants. These either continued with complementary feeds or did not collect the free formula milk supply preferring instead to buy the formula feeds privately. In this study it was recommended that information on transmission of HIV infection from mother to child through breast -feeding including the benefits of exclusive infant feeding, be it breast or formula, for the first three to six months be provided to the community so that relatives can support the mother on infant feeding method of choice.

Sonographic demonstration of atypical congenital anomalies in the fetus of a diabetic mother. A case report.

Uncontrolled diabetes, particularly in early pregnancy during the stage of organogenesis, increases the risk of teratogenesis. A case of mixed congenital abnormalities in a fetus demonstrated ultrasonographically during the second trimester of pregnancy in an uncontrolled insulin-dependent diabetic mother is presented. Necropsy of the abortus confirmed the findings.