Morbidity and Mortality Pattern of Neonates Admitted into Nursery Unit in Wad Medani Hospital; Sudan

Background: Neonatal outcome is an important indicator of obstetrics and health care. Few or no published data are available concerning neonatal morbidity and mortality in Sudan. Objectives: To study morbidity and mortality pattern amongst inborn neonates admitted into nursery unit in Wad Medani Hospital; Sudan during the period Jan-June; 2009. Results: A total of 1211 (29.5) out of 4098 in-born neonates were admitted during study period. The major indications for neonatal admission were; infections 300 (24.8); low birth weight (LBW) 307(25.4) and asphyxia 130(10.7). There were 133(11) neonatal deaths; preterm delivery; LBW and birth asphyxia were the major causes of death among these neonates. Conclusion: neonatal infection; preterm birth and LBW were the common causes of neonatal morbidity and mortality. There is an urgent need for more research throughout the country concerning these common causes of morbidity and mortality

Quinine therapy in severe Plasmodium falciparum malaria during pregnancy in Sudan.

A prospective study was carried out in an area of unstable malaria transmission in central Sudan to determine the efficacy and toxicity of quinine in pregnancy. Thirty-three pregnant women with severe Plasmodium falciparum malaria at mean 28.8 weeks gestational age were treated with quinine for 7 days. The mean body temperature on presentation for 3 patients who delivered prematurely was significantly higher than for those who delivered at term (39.2 +/- 0.7 degrees C versus 38.7 +/- 1.3 degrees C). There were no significant difference between the 2 groups in other clinical or biochemical parameters. There were no clinically detectable congenital malformations and no auditory, visual or other neurological deficits in the babies at birth or 6 months later. Quinine may be safe in the treatment of severe falciparum malaria during pregnancy.

Ceftriaxone versus ampicillin/cloxacillin as antibiotic prophylaxis in elective caesarean section.

We carried out a prospective, randomized, controlled clinical trial to evaluate the clinical efficacy of ceftriaxone and ampicillin/cloxacillin prophylaxis in decreasing the frequency of post-caesarean section infection-related morbidity. Two hundred patients randomly received either ceftriaxone (single dose) or ampicillin/cloxacillin (3 doses) intravenously at induction of anaesthesia. There was no statistical difference in incidence of endometritis (P = 0.34), wound infection (P = 0.44), or other febrile morbidity (P = 0.5). Eleven babies had a low Apgar score (< 8) in the ceftriaxone group and 13 in the ampicillin/cloxacillin group (P = 0.82). There were 2 perinatal deaths in each group. One dose of ceftriaxone was as effective as ampicillin/ cloxacillin in preventing post-caesarean section complications and is easier to administer.

Ceftriaxone versus ampicillin/cloxacillin as antibiotic prophylaxis in elective caesarean section

We carried out a prospective, r and omized, controlled clinical trial to evaluate the clinical efficacy of ceftriaxone and ampicillin/cloxacillin prophylaxis in decreasing the frequency of post-caesarean section infection-related morbidity. Two hundred patients randomly received either ceftriaxone [single dose] or ampicillin/cloxacillin [3 doses] intravenously at induction of anaesthesia. There was no statistical difference in incidence of endometritis [P = 0.34], wound infection [P = 0.44], or other febrile morbidity [P = 0.5]. Eleven babies had a low Apgar score [< 8] in the ceftriaxone group and 13 in the ampicillin/cloxacillin group [P = 0.82].There were 2 perinatal deaths in each group. One dose of ceftriaxone was as effective as ampicillin/ cloxacillin in preventing post-caesarean section complications and is easier to administer

Quinine therapy in severe Plasmodium falciparum malaria during pregnancy in Sudan

A prospective study was carried out in an area of unstable malaria transmission in central Sudan to determine the efficacy and toxicity of quinine in pregnancy. Thirty-three pregnant women with severe Plasmodium falciparum malaria at mean 28.8 weeks gestational age were treated with quinine for 7 days. The mean body temperature on presentation for 3 patients who delivered prematurely was significantly higher than for those who delivered at term [39.2 +/- 0.7 degrees C versus 38.7 +/- 1.3 degrees C]. There were no significant difference between the 2 groups in other clinical or biochemical parameters. There were no clinically detectable congenital malformations and no auditory, visual or other neurological deficits in the babies at birth or 6 months later. Quinine may be safe in the treatment of severe falciparum malaria during pregnancy

Methyldopa versus no drug treatment in the management of mild pre-eclampsia.

OBJECTIVES: To evaluate the efficacy of methyldopa in the treatment of mild pre-eclampsia, to prevent its progress and to investigate its effect on the pregnancy outcomes. DESIGNS: Randomised clinical trial. SETTING: Wad Medani Hospital in the central Sudan. SUBJECTS: Seventy primigravidae with single, alive baby of 28-36 weeks gestational age suffering from true mild pre-eclampsia were enrolled. The patients were randomised in two groups, treatment group who received methyldopa 750-4000 mg/day (n=34) and a control group who received no treatment (n=36). All the (treatment and control) patients were drug followed as in-patients till the delivery, seen with their babies on the days 7, 42 after the delivery. MAIN OUTCOMES MEASURES: The outcomes examined were, rise of the diastolic blood pressure to 110 mm Hg or more, occurrence of imminent eclampsia or the eclampsia, if the maturity could be achieved, occurrence of intrauterine growth retardation, abruptio placentae, mode of delivery, birth weight, placental weight, perinatal death, Apgar score and referral of the babies to the pediatrician. RESULTS: Three out of 34 (8.8%) of the treatment group had a rise in the diastolic blood pressure of 110 mm Hg, 18/36 (50%) of the control had a rise in the diastolic blood pressure of 110 mmHg (p < 0.05). Three out of thirty four (8.8%) of the treatment group developed imminent eclampsia, while 10/36 (27.8) of the control group developed imminent eclampsia (p < 0.05). The maturity was achieved in 82.3% and 88.8% of the treatment and the control, respectively (p > 0.05). There were ten (14.2%) perinatal deaths, four of them in the treatment group, while six in the control (p > 0.05). There was no difference regarding birth weight, occurrence of intrauterine growth retardation, placental weight, mode of delivery, Apgar score, referral of the babies to the paediatrician. No patient developed eclampsia or abruptio placenta; there was no maternal death in both groups. CONCLUSION: Methyldopa can prevent the progress of the mild pre-eclampsia to severe pre-eclampsia, without affecting the maturity, birthweight or the neonatal outcomes.

A simplified management of diabetic pregnant woman.

OBJECTIVE: To evaluate a simplified management of diabetic pregnant women. METHODS: A prospective study of the management of all diabetic pregnant women (74) during 2 years from March 1995-March 1997 was carried out in the Department of Obstetrics & Gynecology, Wad Medani Teaching Hospital, Sudan. Diabetes was diagnosed by an oral glucose tolerance test according to the World Health Organization criteria. Patients were controlled by insulin and monitored by urine for glucose and pre-prandial blood sugar. They were delivered by induction of labor or cesarean section at 38 weeks. Basic resuscitation was carried out for all babies. Intravenous glucose was given to babies when hypoglycemia was diagnosed. Early breast feeding was the rule. Babies who developed complications were managed at the special care unit in the Children's Hospital. RESULTS: Seventy one patients completed the management, 2 ended in abortion and 69 proceeded to 30 weeks or more. There was one maternal death and 14 perinatal deaths. The main causes of perinatal deaths--Wigglesworth classification--were macerated stillbirth (5), congenital malformation (4) and intrapartum asphyxia (5). A reasonable control of diabetes (pre-prandial 179 or less) was achieved in 56 patients (79%). Seventy percent of the patients were delivered by cesarean section and the main indications were big baby (16 cases) and a previous cesarean section (20 cases). Fifty four percent of all the patients had a history of perinatal death, 28% had a history of repeated abortions and there was a definite family history of diabetes in 53%. Sixty nine percent of the patients were at the age 30 years or more and 50% of them were of the parity 5 or more. CONCLUSION: This simplified management of diabetic pregnant women is satisfactory and feasible under our present circumstances. It is hoped that improvement in ante-natal care, delivery care and control of diabetes around the time of conception and care of the newborn will reduce the perinatal mortality rate.

Experience with gynaecological laparoscopies in Wad Medani Hospital, Sudan.

OBJECTIVE: To assess the value and safety of laparoscopy in gynaecological practice in a tertiary care centre in Sudan to determine the magnitude of tubal disease as an aetiological factor in female infertility. DESIGN: A prospective case series study. SETTING: Department of Obstetrics and Gynaecology in a tertiary care Teaching Hospital in Sudan. SUBJECTS: Seven hundred and three women selected for laparoscopy for various reasons. MAIN OUTCOME MEASURES: Indications for laparoscopy findings and complications. RESULTS: Infertility was the main indication (94.32%). Tubal disease was diagnosed in 46.6% of all infertile women studied. The overall complication rate was 22.76 per 1000; two major complications and no death. CONCLUSION: Laparoscopy is a valuable and safe procedure and and is useful in solving patients' problems, especially infertility. Tubal disease is a major aetiological factor in female infertility.

PIP: This prospective case series study determined the main indications and complications of laparoscopy, evaluated the role of laparoscopy in infertility management at Medani Hospital in Sudan, and examined the magnitude of tubal diseases as an etiological factor in infertility. A total of 703 women selected for laparoscopy for different reasons were enrolled in the study. Infertility, both primary and secondary, was the main indication for laparoscopy, accounting for 94.32% of cases. Of all infertile women studied, 46.6% were diagnosed as having tubal disease. The overall complication rate was 22.76/1000, with two major complications and no death. The rest were minor complications, which required only 24-hour monitoring with no further management. In conclusion, the study results suggest that laparoscopy is a valuable and safe procedure in the management of various gynecological problems, especially infertility.

Viral hepatitis in pregnancy.

Fifty pregnant women with viral hepatitis were compared with 31 non-pregnant women with viral hepatitis in a prospective case-control study. The two groups were matching except for the serum bilirubin level and area of residence. Seven pregnant women died while none of the control patients died and the difference between the two groups was significant. More than 80% of the deaths occurred in the third trimester and most of them were post-partum deaths. Except for a higher incidence of pre-term birth, the outcome of pregnancy in the case group was not affected. It is concluded that pregnancy is a risk factor which increases the mortality of viral hepatitis and that viral hepatitis does not affect the outcome of pregnancy except for pre-term birth.

PIP: 50 pregnant women and 31 nonpregnant women (age 15-40 years) with viral hepatitis admitted to Wad Medani Teaching Hospital, Sudan, during the period January 1987-January 1990 were compared in a prospective case control study. The mean serum bilirubin level was higher in the control group and the difference was statistically significant (p = 0.0084). Significantly more case came from rural settings (76%) compared with control patients (48%) (p 0.01). The criteria for admission were the presence of symptoms and signs of hepatitis and bilirubin in the urine. Almost all patients admitted to the study had viral hepatitis caused by type A virus, type B virus, or non-A, non-B viruses, however, a very small number of diseases of patients could be attributed to rare viruses like EB or cytomegalovirus. No specific medication was given and patients were managed by bed rest and parenteral multivitamins (Parentrovit). All patients were kept in the hospital until they became asymptomatic and serum bilirubin dropped to less than 2 mg/100 ml. All cases and controls were followed up for 6 weeks. All the control patients were discharged after recovery and none of them died or developed recurrence of disease. Out of the 50 pregnant women, 7 died, giving a maternal mortality rate of 14%; the rest recovered and none of them developed recurrence of disease during the follow-up period. The difference between the 2 groups was statistically significant (p = 0.04). The estimated relative risk of death in viral hepatitis with pregnancy was 9.93. Among 5 deaths that occurred after delivery during the 3rd trimester 1 was at term and the baby was normal; 4 were preterm deliveries. Out of the 50 pregnant women, 1 died before delivery and 1 delivered at home. The outcome of pregnancy in the remaining 48 was: 2 abortions (4.2%), 10 preterm (20.8%), and 36 (75%) term deliveries. There were 2 stillbirths (4.2%) one at term and one at 34 weeks.

A pilot study on family spacing attitudes and practices in rural Gezira.

The attitudes towards, and practice of, modern contraception among the rural population of the Gezira area of the Sudan were analyzed using a structured questionnaire. This was part of a comprehensive community survey carried out by the Faculty of Medicine, University of Gezira, Sudan, as part of a rural development program. Eight villages belonging to the Sennar Sugar Scheme were included in the survey. The result showed a low percentage of contraceptive users in all villages. The main reasons given by mothers for not using contraceptives were that contraceptives were against religion, mothers had not heard about them, mothers wanted more children, and contraceptives were not available. These villages were also characterized by high illiteracy rate and large family size. There is a need for health education concerning child spacing. This should be combined with religious education by religious leaders to remove misunderstandings concerning modern contraceptive use. Adult education programs, especially for females, will also have an impact.

A combined course of primary health care practice and family medicine at the University of Gezira.

The community-based course presented is a longitudinal course running through four semesters in the Faculty of Medicine, University of Gezira, Sudan. Students combine their regular work in primary health care centres with attachments to a number of families in Wad Medani town. They continue to visit these families regularly throughout their entire medical course with the aim of studying them and helping them with some of their medical and psychosocial problems.