Ultrasound Measurement of Placental Thickness: A Reliable Estimation of Gestational Age in Normal Singleton Pregnancies in Nigerian Women.

Purpose: The aim of this article is to evaluate the accuracy of placental thickness (PT) in determination of gestational age (GA) in normal singleton foetuses. Materials and Methods: The study was a cross-sectional descriptive study which recruited consecutively a total of 406 pregnant women with singleton pregnancies (at 15-40 weeks of gestation), referred for routine obstetric ultrasound (US) scan at the National Hospital, Abuja from October to December 2019. Biparietal diameter (BPD), femur length (FL), head circumference (HC), abdominal circumference (AC), and PT were measured using standard protocols. All measurements were calculated by taking three best measurements, and the mean of the measurements was taken and recorded for each participant. Pearson's correlation analysis was computed to determine linear relationships between variables. A significant statistical level was determined at a critical value of P < 0.05. Results: The mean age was 31.8 ± 4.8 years. The mean PTs in the second and third trimesters were 23.2 ± 3.1 and 34.1 ± 3.7 mm, respectively. PT had a linear relationship and a statistically significant positive correlation (r=0.99, P = 0.00) with GA. There was also a statistically significant positive correlation between PT on the one hand, and BPD, AC, HC, FL, PT, and GA, on the other hand. Conclusion: There was a significant and strong positive correlation between PT and GA. The study shows that US measurement of PT is a reliable method of estimating GA in singleton pregnancies in Nigeria.

Bland-Altman Plot: Agreement Between Ultrasound-measured Placenta Thickness and Other Biometric Parameters in the Determination of Gestational Age.

Purpose: The aim of this article is to evaluate the agreement of placenta thickness (PT) with other foetal biometric parameters in the determination of gestational age (GA) in normal singleton foetuses. Materials and Methods: The study was a cross-sectional descriptive study conducted among 406 consecutively recruited pregnant women with singleton foetuses at 15-40 weeks of gestation at the National Hospital, Abuja, Nigeria from October to December 2019. Biparietal diameter (BPD), femur length (FL), head circumference (HC), abdominal circumference (AC), and PT were measured using standard measurement protocols. Bland and Altman (BA) plots were used to compare PT and other foetal biometric parameters. The significant statistical level was determined at a critical value of P < 0.05. Results: The mean age of study participants was 31.8 ± 4.8 years. The BA plot of PT and HC demonstrated a normal distribution; the mean difference was around zero (3.968) and 95% of the measurements fell within 2SD of the mean. The BA plot of HC and AC measurements also showed that the 95% limits of agreement for differences fell within 10% of the mean of the measurements (-4.236 to 15.987 with a mean difference of 5.876), indicating good agreement between the two pairs of variables. However, BA plots between PT and BPD as well as PT and FL showed no agreement. Conclusion: This study indicates that there is good agreement or comparability between PT and HC measurements as well as between PT and AC measurements. Hence, either HC or AC measurements may be interchangeable with PT measurements in the ultrasound determination of GA. However, PT measurements did not agree well with BPD and FL measurements, respectively.

I don't know what I am doing because I am doing everything: perceptions and experiences of nurses about HIV counselling and testing among children in Free State Province, South Africa.

Although HIV/AIDS constitute a significant health burden among children in South Africa, testing and counselling of exposed children are inadequate. It is therefore imperative that factors relating to paediatric HCT services offered by health workers are examined. This study was conducted to explore and describe the perceptions and experiences of trained professional nurses regarding HIV counselling and testing among children. We conducted six focus group discussions among trained professional nurses in health facilities in a district in Free State Province, South Africa. All verbatim transcripts were analysed with a thematic approach and emergent codes were applied. Forty-seven trained professional nurses participated in the study and two of them were males. The age of the participants ranges from 38 to 60 years while the median age was 50 years. Most participants in the focus groups explained how HCT occurs during regular health talks and that lay counsellors are doing most of the counselling. While a few participants thought that children should not be bothered with HCT, most of them seek consent from caregivers for HIV test for children. While children whose parents are negative are usually not tested, most children are tested only when they become ill. Identified barriers to HCT among children include refusal of consent, work overload, lack of encouragement, and poor record keeping. Participants recommended improvement of issues relating to community mobilization and increasing trained staff strength for optimal paediatric HCT service delivery. Developing guidance and policies with respect to obtaining consent, recruiting more health providers, and addressing structural issues in the society to reduce stigma and discrimination were identified as key priority issues by majority of the participants. The perspectives of these participants who provide paediatric HCT services offer vital insight which may be useful to inform policy interventions.

Survival of smear-positive multidrug resistant tuberculosis patients in Witbank, South Africa: A retrospective cohort study.

BACKGROUND: A retrospective cohort study was carried out to compare the survival between smear-positive patients and smear-negative multidrug resistant tuberculosis (MDR-TB) patients hospitalised in a specialised TB hospital in Witbank, South Africa. METHODS: A review of medical records of MDR-TB patients treated from 2001 to 2010 was carried out. Survival time was measured from a patient's date of hospitalisation to the date when the patient died, was last treated at the hospital or the end of the study (whichever came first). All patients who were alive until the end of the study period or lost to follow-up were censored and those who died were considered as failures. Survival patterns were estimated using Kaplan Meier plots, log rank tests and life tables. Cox proportional hazards regression analyses were also conducted. RESULTS: The mean age of the 442 MDR-TB patients in the study was 37.7 ± 11.2 years. The incidence rates of mortality were 13.4 and 43.9 per 1000 person-months for smear-negative and smear-positive MDR-TB patients, respectively. Cox proportional hazard regression showed that the predictors of death among MDR-TB patients include HIV co-infection (adjusted Hazard Rate, aHR = 1.89, 95% CI = 1.02-3.52), old age (above 60 years) (aHR = 2.05, 95% CI = 1.04-3.60) and smear positivity at diagnosis (aHR = 3.29, 95% CI = 2.39-4.64). CONCLUSION: The study showed that the probability of survival during the treatment is reduced in MDR-TB patients, who are smear-positive, HIV positive or older than 60 years. Special care should be given to these patients to improve survival.