Acceptability and experience of supportive companionship during childbirth in Malawi.

OBJECTIVE: To study the acceptability and experience of supportive companionship during childbirth by mothers, health professionals and supportive companions. DESIGN: Cross-sectional surveys before and after introducing supportive companionship. SETTING: Maternity facilities in Blantyre City, Malawi. POPULATION: Mothers who had normal deliveries before discharge from hospital, health professionals in health facilities and women from the community, who had given birth before and had interest in providing or had provided support to fellow women during childbirth. METHODS: Combined qualitative and quantitative methods. MAIN OUTCOME MEASURE: Perceptions on labour companionship among participants. RESULTS: The majority of supported women (99.5%), companions (96.6%) and health professionals (96%) found the intervention beneficial, mainly for psychological and physical support to the labouring woman and for providing assistance to healthcare providers. Some companions (39.3%) unwillingly accompanied the women they were supporting and 3.5% of companions mentioned that their presence in the labour ward was an opportunity for them to learn how to conduct deliveries. CONCLUSION: Supportive companionship for women during childbirth is highly acceptable among mothers and health professionals, and the community in Malawi, but should be governed by clear guidelines to avoid potential harm to labouring women. Women require information regarding the need for a supportive companion and their expected role before they present at a health facility in labour. Such notification will provide an opportunity for the pregnant woman to identify someone of their choice who is ready and capable of safely taking up the role of a companion.

HIV-1 incidence among women of reproductive age in Malawi.

The aim of this study was to determine HIV-1 incidence among women of reproductive age in Malawi. A prospective study design was followed. HIV-1 uninfected women were followed up for nine visits during a period of 12 months. At baseline, women received HIV-1 counselling and testing. At each visit, venous blood was collected for HIV-1 testing. Incidence rate for HIV-1 was estimated using person-years of follow up (PYFU). Risk factors for HIV acquisition were assessed using Cox proportional hazard models. A total of 842 HIV-1 negative women were enrolled in the study. Of these, 787 had subsequent HIV testing and 31 were found HIV-1 infected; an overall incidence rate of 4.51 (95% confidence interval: 2.96-6.06) per 100 PYFU was obtained. Young age, using hormonal injectable contraceptives and bacterial vaginosis were the main predictors of HIV acquisition. The incidence of HIV continues to be high among women in Malawi, and young women appear to be at higher risk.

Leptin and pre-eclampsia in black African parturients.

OBJECTIVE: To measure serum concentrations of the hormone leptin during late pregnancy in Black African women with pre-eclampsia, healthy normotensive pregnant women as controls and healthy normotensive non-pregnant women; secondly, to explore the relationship between leptin and obesity. DESIGN: Observational, cross sectional study. SETTING: Antenatal clinics, antenatal wards, gynaecology out patient and family planning clinics of a tertiary hospital, Durban, South Africa. POPULATION: Pregnant and non-pregnant Black African women. METHOD: Serum leptin was measured by a homologous radio-immunoassay technique. Simple anthropometric parameters were used to explore the relationship between leptin and obesity. In each group, leptin levels were compared between obese (body mass index, BMI > or = 30 kg m(-2)) and lean women. MAIN OUTCOME MEASURES: Serum leptin concentrations, anthropometric parameters, mean blood pressures and proteinuria. RESULTS: There were 68 women with pre-eclampsia, 92 healthy normotensive pregnant women (controls) and 32 healthy normotensive non-pregnant women. Serum leptin levels were higher in pregnant compared with non-pregnant women [26.66 (1.96) and 25.89 (1.65) vs 17.97 (2.11) ng/mL, P = 0.02]. Weight and BMI showed the greatest correlation with leptin both in pregnant (r = 0.61 and r = 0.58, respectively) and non-pregnant women (r = 0.74 and 0.79, respectively). There was no significant difference in the mean concentrations of leptin between women with and those without pre-eclampsia [26.66 (1.96) vs 25.89 (1.65) ng/mL, respectively, P = 0.95]. CONCLUSION: Pregnancy is a hyperleptinaemic state. There is no difference in serum leptin levels between Black African women with pre-eclampsia and healthy normotensive pregnant women. Serum leptin concentration is largely determined by the degree of adiposity.

Leptin levels in the obese African parturient.

Prolactin, HCG and oestrogen are reported to have a role in regulating serum leptin levels and therefore adiposity in pregnancy. The aim of this study was to determine serum leptin levels during pregnancy in African women, and was conducted in the Antenatal Clinic, King Edward VIII Hospital, Durban, South Africa. Eighty-two obese and non-obese women were studied. Demographic details and anthropometric measurements were recorded, and serum leptin levels determined by radio-immunoassay in all women. Age, parity and gestational age showed a weak correlation with leptin levels. Weight (4=0.6); body mass index (r=0.5), and the circumference of midarm (r=0.4), waist (4-0.6, hip (5=0.5) and thigh correlated positively with leptin values. Serum leptin values in African pregnant women are not dissimilar to that of studies in other racial groups.