International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology ISSN 2326-7234 Vol. 7 (1), pp. 001-009, January, 2019. © International Scholars Journals

Full Length Research Paper

Assessment of obstetric care for HIV positive women in Addis Ababa, Ethiopia

Alemnesh H. Mirkuzie^1,2*, Sven Gudmund Hinderaker¹, Mitike Molla Sisay³, Karen Marie Moland⁴ and Odd Mørkve¹

¹Centre for International Health, University of Bergen, Overlege Danielssens Hus, Årstav. 21, Bergen 5020, +47 45070113, Norway.

²College of Medical and Health Sciences, Department of Nursing and Midwifery, Hawassa University, Awassa, P. O. Box 1560, Ethiopia.

³School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.

⁴Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Norway.

Accepted 11 September, 2018

Abstract

Despite the importance of safe obstetric practice in reducing mother-to-child HIV transmission and adverse perinatal outcomes, little is known about access to intrapartum obstetric care for HIV positive women. A cohort of HIV positive women were followed to assess the rate of intrapartum transfers and associated adverse outcomes in Addis Ababa. Overall, 282 HIV positive pregnant women were followed, 75% gave birth at Emergency Obstetric and Neonatal Care facilities, 42% of them transferred between health facilities during the intrapartum period and 36% were transferred two or more times. Sixty four percent of the first time transfers were due to obstetric complications, while all subsequent transfers were due to practical constraints. Women in their second pregnancy were less likely (OR 0.3 95% CI 0.2-0.6) to be transferred than women in their first pregnancy. Transferred women experienced more stillbirths than women who were not transferred. The rate of stillbirths was not significantly associated with the syphilis test result, the CD₄ count and initiating antiretroviral therapy. There appeared to be serious challenges within the health care system compromising the intrapartum care for our participants and increasing the risk of stillbirth and MTCT. Undue transfers during the intrapartum period should be addressed at all levels of the health care system.

Key words: Delay, EmONC, Ethiopia, intrapartum, MTCT, stillbirth, transfer, PMTCT.

International Journal of Obstetrics and Gynecology ISSN 2326-7234 Vol. 7 (1), pp. 001-005, January, 2019. © International Scholars Journals

Full Length Research Paper

Attitudes of antenatal patients towards caesarean section in the University of Port-Harcourt Teaching Hospital, Nigeria

Israel Jeremiah*, Esther Nonye-Enyidah and Preye Fiebai

Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

Accepted 22 November, 2018

Abstract

Caesarean section has contributed immensely to improved obstetric care throughout the world. In developing countries especially the sub-Saharan Africa, there is a great aversion to caesarean section. This study aims to assess the attitudes of antenatal patients at the University of Port-Harcourt Teaching Hospital towards caesarean section. A cross-sectional study was conducted among 400 antenatal clients seen at the University of Port Harcourt Teaching Hospital between 1st and 31st September 2009. Information on their socio-demographic characteristics, knowledge, beliefs and attitudes were sought. The response rate was 100%. Data management was carried out with SPSS 15.0 statistical software. Chi-square tests were used to compare the groups as appropriate. P value of <0.05 was assumed to be statistically significant. Out of 400 women studied, 68.5% favoured caesarean section while 31.5% were averse to it. About 59% of them knew what caesarean section was. Increasing maternal level of education and age were associated with increased knowledge and support for caesarean section (X² =11.8, P = 0.0006). Eighty percent of the women believed caesarean section is done for medical reasons. If caesarean section is indicated in the index pregnancy, 65% would accept that the procedure be done, 19% would want to discuss with their husbands while 7.5% would default. Of the 82 women who had previous caesarean section, 73.2% would readily accept to undergo a repeat caesarean section if necessary in the index pregnancy compared to 200 (62.9%) of 318 women who had not undergone caesarean section. The difference was not significant. (X² = 3.03, P = 0.08). There is a high level of knowledge and acceptance of caesarean section in this study. This acceptance is directly linked with the educational status of the women. However, one third of the women were still averse to caesarean section.

Key words: Caesarean section, attitudes, antenatal clients.

International Journal of Obstetrics and Gynecology ISSN 2326-7234 Vol. 7 (1), pp. 001-009, January, 2019. © International Scholars Journals

Full Length Research Paper

Assessment of contraceptive use among persons living with HIV and AIDS in Kabale, Southwestern Uganda  

Othman Kakaire¹, Dan K. Kaye¹* and Michael O. Osinde²

¹Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.

²Kabale Regional Hospital, Department of Obstetrics and Gynecology, P. O. Box 7, Kabale, Uganda.

Accepted 29 November, 2018

Abstract

The choice of contraception in people living with the Human Immunodeficiency Virus (HIV) is constrained by the need to prevent both sexual transmission of HIV and unwanted pregnancies. We assessed contraceptive use among 400 HIV- positive persons attending a care and support centre in Kabale, Uganda. Participants completed a structured questionnaire on socio-demographic characteristics, sexuality, contraceptive use, sero-status disclosure and antiretroviral therapy. Bivariate analysis and multivariate modeling were conducted to analyze factors associated with contraceptive use. The rate of dual contraceptive use was low. On bivariate analysis, sex and age of respondents, education level, marital status, drinking habits, whether participant had a stable relationship, number of sexual partners in previous 6 months and frequency of sexual intercourse were significantly associated with contraceptive use. Likewise, disclosure of sero-status to sexual partners, partner’s HIV positive status, history of new sexual partners in previous 3 months and whether respondent had been treated for STD since HIV diagnosis were significantly associated with contraceptive use (p-value < 0.05) . Factors independently associated with contraceptive use were level of educational attainment and whether respondent had changed partners since HIV diagnosis.

Key words: People living with HIV, contraception, antiretroviral therapy, Uganda.

International Journal of Obstetrics and Gynecology ISSN 2326-7234 Vol. 7 (1), pp. 001-012, January, 2019. © International Scholars Journals 

Full Length Research Paper

Impact of menstrual hygiene management on adolescent health: The Effect of Go! Pads on rate of urinary tract infection in adolescent females in Kibogora, Rwanda

James  Murekezi¹, Frank Murigande², Silas Kaboneka³, Jean Nikwigize⁴ and Dismas Makuza⁵

¹Albert Einstein College of Medicine, Departments of Obstetrics, Gynecology and Women’s Health, Bronx, NY, USA;

²United Nations Multidimensional Integrated Stabilization Mission in the Central African Republic, Mbomou Prefecture, Central African Republic;

³Department of Epidemiology & Population Health, Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York;

⁴New York University School of Medicine, Department of Obstetrics and Gynecology, New York, NY, USA;

⁵ University of Rwanda, Kigali, Rwanda.

Accepted 28 December, 2018

Abstract

To determine urinary tract infection (UTI) rates in adolescent menstrual pad users versus non-users in a rural area of Rwanda. Two hundred and forty adolescent participants in rural Western Rwanda were assigned to two cohorts; 120 received menstrual pads for six months and the other 120 did not use pads. Baseline symptoms and urine cultures were obtained. Symptoms and methods of menstrual hygiene management (MHM) were assessed and urine cultures were obtained every 2 months. The primary outcome was the presence of urinary tract infection diagnosed by positive urine culture. Secondary outcomes were UTI symptoms, vulvovaginal symptoms, sexual activity, dyspareunia and self-reported sexually transmitted infection. Associations of pad use with study outcomes was assessed by employing generalized estimating equations (GEEs) with nesting to account for the possibility of within school clustering as well as within participant correlation.  Two hundred and nine participants completed the study. There was no difference in rates of positive urine culture. A decreased odds of vulvovaginal symptoms was found in self-reported “always” vs. “never” pad users (OR: 0.65 95% CI 0.44 to 0.97; p=0.04). Despite not finding any difference in rates of UTI, our study showed a decreased rate of vulvovaginal symptoms in menstrual pad users. Further research investigating rates of genital infections in this population is thus necessary.

Keywords: Menstrual hygiene, adolescent health, urinary tract infection.

International Journal of Obstetrics and Gynecology ISSN 2326-7234 Vol. 7 (1), pp. 001-008, January, 2019. © International Scholars Journals 

Full Length Research Paper

Comparing simulated client experiences with phone survey self-reports for measuring the quality of family planning counseling: The case of DMPA-SC in Nigeria

Kelvin Smith and Rebecca Philips

Department of Obstetrics and Gynaecology, School of Clinical Sciences, University of Lagos, Lagos State, Nigeria.

Corresponding author. E-mail: [email protected]

Accepted 21 January, 2019

Abstract

The quality of family planning services can have important implications for uptake and continued method use. Yet, measuring quality of care is complex, and quality itself is a multifaceted concept. In 2015, a new injectable contraceptive method, DMPA-SC (depot medroxyprogesterone acetate – subcutaneous, also known as Sayana Press®), was introduced through several private sector distribution channels in Nigeria. To examine aspects of quality for DMPA-SC service provision and contraceptive services more broadly, we compared self-reports from follow-up phone surveys with users to simulated client interactions that were designed to measure the same concepts. By using multiple methods, we sought to understand more deeply the biases associated with different data collection methods that ultimately lead to different conclusions regarding quality of contraceptive services, and to further assess to what extent these methods were suitable for detecting differences in quality across sub-groups using the case of married versus unmarried women. We found that simulated clients reported lower levels of quality across all comparable quality indicators than phone survey respondents attending the same facilities. Both methods were able to detect similar differential treatment by marital status. A mixed methods approach can provide differential insights into quality of family planning services, especially when aiming to understand both objective and subjective aspects of quality.

Keyword: Family planning counselling, contraceptive services, pregnancies, abortions, simulated client experiences.

Key words: Granuloma, cancer, metastasis.