Unsafe abortions and unwanted pregnancies contribute to maternal mortality in Zimbabwe

No Abstract

Improving Standards of Care in Obstructed Labour: A Criteria-Based Audit at a Referral Hospital in a Low-Resource Setting in Tanzania

Objective In low-resource settings, obstructed labour is strongly associated with severe maternal morbidity and intrapartum asphyxia, and consequently maternal and perinatal deaths. This study evaluated the impact of a criteria-based audit of the diagnosis and management of obstructed labour in a low-resource setting. Methods A baseline criteria-based audit was conducted from October 2013 to March 2014, followed by a workshop in which stakeholders gave feedback on interventions agreed upon to improve obstetric care. The implemented interventions included but were not limited to introducing standard guidelines for diagnosis and management of obstructed labour, agreeing on mandatory review by specialist for cases that are assigned caesarean section, re-training and supervision on use and interpretation of partograph and, strengthening team work between doctors, mid-wives and theatre staff. After implementing these interventions in March, a re-audit was performed from July 2015 to November, 2015, and the results were compared to those of the baseline audit. Results Two hundred and sixty deliveries in the baseline survey and 250 deliveries in the follow-up survey were audited. Implementing the new criteria improved the diagnosis from 74% to 81% (p = 0.049) and also the management of obstructed labour from 4.2% at baseline audit to 9.2% at re-audit (p = 0.025). Improved detection of prolonged labour through heightened observation of regular contractions, protracted cervical dilatation, protracted descent of presenting part, arrested cervical dilation, and severe moulding contributed to improved standards of diagnosis (all p \u3c 0.04). Patient reviews by senior obstetricians increased from 34% to 43% (p = 0.045) and reduced time for caesarean section intervention from the median time of 120 to 90 minutes (p = 0.001) improved management (all p \u3c 0.05). Perinatal outcomes, neonatal distress and fresh stillbirths, were reduced from 16% to. 8.8% (p = 0.01). Conclusion A criteria-based audit proved to be a feasible and useful tool in improving diagnosis and management of obstructed labour using available resources. Some of the observed changes in practice were of modest magnitude implying demand for further improvements, while sustaining those already put in place

Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia

OBJECTIVE: To estimate the effect of the severity of maternal anaemia on various perinatal outcomes. DESIGN: A cross-sectional study. SETTING: Labour Ward, Muhimbili National Hospital, Dar es Salaam, Tanzania. METHOD: The haemoglobin of eligible pregnant women admitted for delivery between 15 November 2002 and 15 February 2003 was measured. Data on socio-demographic characteristics, iron supplementation, malaria prophylaxis, blood transfusion during current pregnancy, and current and previous pregnancy outcomes were collected and analysed. Anaemia was classified according to the World Health Organization (WHO) standards: normal - Hb \u3e11.0 g/dl; mild - Hb 9.0 - 10.9 g/dl; moderate - Hb 7.0 - 8.9 g/dl; and severe - Hb \u3c7.0 g/dl. Logistic regression analysis was performed to estimate the severity of anaemia. The following outcome measures were used: preterm delivery (\u3c37 weeks), Apgar score, stillbirth, early neonatal death, low birth weight (LBW) (\u3c2 500 g) and very low birth weight (VLBW) (\u3c1 500 g). RESULTS: A total of 1 174 anaemic and 547 non-anaemic women were enrolled. Their median age was 24 years (range 14 - 46 years) and median parity was 2 (range 0 - 17). The prevalence of anaemia and severe anaemia was 68% and 5.8%, respectively. The risk of preterm delivery increased significantly with the severity of anaemia, with odds ratios of 1.4, 1.4 and 4.1 respectively for mild, moderate and severe anaemia. The corresponding risks for LBW and VLBW were 1.2 and 1.7, 3.8 and 1.5, and 1.9 and 4.2 respectively. CONCLUSION: The risks of preterm delivery and LBW increased in proportion to the severity of maternal anaemia

Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007-08 to 2018-19 : findings from two reproductive age mortality surveys

BACKGROUND: Reducing maternal mortality is a priority of Sustainable Development Goal 3.1 which requires frequent epidemiological analysis of trends and patterns of the causes of maternal deaths. We conducted two reproductive age mortality surveys to analyse the epidemiology of maternal mortality in Zimbabwe and analysed the changes in the causes of deaths between 2007-08 and 2018-19. METHODS: We performed a before and after analysis of the causes of death among women of reproductive ages (WRAs) (12-49 years), and pregnant women from the two surveys implemented in 11 districts, selected using multi-stage cluster sampling from each province of Zimbabwe (n=10); an additional district selected from Harare. We calculated mortality incidence rates and incidence rate ratios per 10000 WRAs and pregnant women (with 95% confidence intervals), in international classification of disease groups, using negative binomial models, and compared them between the two surveys. We also calculated maternal mortality ratios, per 100 000 live births, for selected causes of pregnancy-related deaths. RESULTS: We identified 6188 deaths among WRAs and 325 PRDs in 2007-08, and 1856 and 137 respectively in 2018-19. Mortality in the WRAs decreased by 82% in diseases of the respiratory system and 81% in certain infectious or parasitic diseases' groups, which include HIV/AIDS and malaria. Pregnancy-related deaths decreased by 84% in the indirect causes group and by 61% in the direct causes group, and HIV/AIDS-related deaths decreased by 91% in pregnant women. Direct causes of death still had a three-fold MMR than indirect causes (151 vs. 51 deaths per 100 000) in 2018-19. CONCLUSION: Zimbabwe experienced a decline in both direct and indirect causes of pregnancy-related deaths. Deaths from indirect causes declined mainly due to a reduction in HIV/AIDS-related and malaria mortality, while deaths from direct causes declined because of a reduction in obstetric haemorrhage and pregnancy-related infections. Ongoing interventions ought to improve the coverage and quality of maternal care in Zimbabwe, to further reduce deaths from direct causes.The United Kingdom’s Foreign, Commonwealth and Development Office, Department for International Development, UNFPA, UNICEF and WHO Zimbabwe offices, University of Zimbabwe and Ministry of Health.http://www.biomedcentral.com/bmcpublichealthSchool of Health Systems and Public Health (SHSPH

Review of Risk Assessment Models for Breast Cancer

Background Breast cancer is one of the most common cancers affecting women worldwide, with the number of new cases predicted to increase to over three million and the number of deaths to one million per year, by 2040. To prevent breast cancer, there is now increasing demand for personalization of breast cancer screening based on risk levels, considering the individual characteristics of the women. Methods We performed a synthesis of the evidence available for risk assessment models (RAMs) to predict breast cancer. Results We identified nine systematic reviews that evaluated risk assessment models for breast cancer. Across the systematic reviews, we identified five original models and 13 modifications that were externally validated. The evidence from primary studies that includes deep learning prediction models is limited. Most of the studies only report internal validation results in samples with small number of events. Conclusions Results from ongoing clinical trials and cohort studies will likely provide relevant empirical data. In addition, research on genotyping and, as shown in encouraging preliminary reports, research on deep-learning algorithm-based prediction models based on mammographic screening images should further improve the estimation of individual breast cancer risk.JRC.F.1 - Disease Preventio

Criteria-based audit on management of eclampsia patients at a tertiary hospital in Dar es Salaam, Tanzania

\ud Criteria-based audits have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the introduction of a criteria-based audit in a tertiary hospital in an African setting, assesses the quality of care among eclampsia patients and discusses possible interventions in order to improve the quality of care. We conducted a criteria based audit of 389 eclampsia patients admitted to Muhimbili National Hospital (MNH), Dar es Salaam Tanzania between April 14, 2006 and December 31, 2006. Cases were assessed using evidence-based criteria for appropriate care. Antepartum, intrapartum and postpartum eclampsia constituted 47%, 41% and 12% of the eclampsia cases respectively. Antepartum eclampsia was mostly (73%) preterm whereas the majority (71%) of postpartum eclampsia cases ware at term. The case fatality rate for eclampsia was 7.7%. Medical histories were incomplete, the majority (75%) of management plans were not reviewed by specialists in obstetrics, specialist doctors live far from the hospital and do not spend nights in hospital even when they are on duty, monitoring of patients on magnesium sulphate was inadequate, and important biochemical tests were not routinely done. Two thirds of the patient scheduled for caesarean section did not undergo surgery within agreed time. Potential areas for further improvement in quality of emergency care for eclampsia relate to standardizing management guidelines, greater involvement of specialists in the management of eclampsia and continued medical education on current management of eclampsia for junior staff.\u

Parents' Experiences of Reporting Child Sexual Abuse in Urban Tanzania

This article reports parental experiences of legally reporting child sexual abuse in Tanzania. Based on in-depth interviews, four types of sexual abuse incidents are portrayed. Each evokes different reactions from parents and the community. An incident characterized as the innocent child was associated with a determination to seek justice. The forced-sex youth elicited feelings of parental betrayal of their child. The consenting curious youth resulted in uncertainty of how to proceed, while the transactional-sex youth evoked a sense of parental powerlessness to control the child because of low economic status. Differentiating between types of sexual abuse incidents may increase awareness of the complexities of child sexual abuse reporting. Education on laws regulating sexual offenses and a functional national child protection system are needed to address child sexual abuse complexities and safeguard the rights of children in Tanzania