Anaemia in Pregnancy: Assessing the Role of Socio-demographic Factors
Mohamed Omar, Ronnie Midigo*, Isaac Okeyo, Samuel Otieno
In the world, more than half of pregnant women are anaemic. The burden of disease is heavy yet poorly estimated. Knowledge of the current situation in our environment is necessary. This knowledge will enhance early detection and timely management of anaemia in pregnancy. This was an analytical cross-sectional study that employed both qualitative and quantitative data collection methods. The aim of the study was to determine the socio-demographic factors associated with anaemia among women of reproductive age attending antenatal clinics in Garissa County Referral Hospital. Data were collected using structured questionnaires and the Key Informant Interview Guide by two research assistants. Validity and reliability were ensured by pre-testing the questionnaires. A total of 366 out of 384 expected women were interviewed. Six Key Informant Interviews were also conducted. The Nursing officer-in-charge of maternal and child health Clinic, as well as five nurses attending to the antenatal clinic, were interviewed. Data analysis was done using SPSS version 20. Results are presented in tables, graphs, and charts. Pearson’s Correlation coefficient was applied to the linear relationship between variables. The prevalence of anaemia was found to be very high among the participants of the study (64%). The study established that that education, religion, and the number of deliveries are significant predictive factors for anaemia (P>0.05). The study recommends that the community through government agencies and non-governmental organization partners need to invest in educating the girl child beyond the primary level, special education campaigns on the nutritional requirements and the benefits of iron supplements issued at the health facilities targeting this group be developed and to empower women economically. Finally, the study recommends that the magnitude of the contribution of the various factors to the outcome variable being investigated. The direction of the relationship between the various factors and the outcome variable also to be investigated for this community.
Still Grappling With Menstrual Hygiene: Explaining Uptake By Socio-Cultural Factors Among School Going Girls in Kenya
Mary Wambui Mathenge, Ronnie Midigo*
Mary Wambui Mathenge1 and Ronnie Midigo2*
Globally, approximately 52% of the female population (26% of the total population) is of reproductive age. Most of these women and girls will menstruate each month for between two to seven days. Menstrual hygiene is an important part of the basic hygiene, sanitation, and reproductive health services to which every woman and girl has a right. Most girls lack adequate information on menarche, puberty, and Menstrual Hygiene Management. This predisposes them to reproductive tract infections. This study sought to establish the socio-cultural factors influencing the adoption of menstrual hygiene practices among adolescent girls in public secondary schools in Malindi Sub County. The study adopted a cross-sectional analytical. Data was collected using both qualitative and quantitative methods. The study established that most of the school-going adolescents in Malindi Subcounty (64%) have good menstrual hygiene practices. The socio-cultural factors influencing menstrual hygiene practices include cultural expectations, provisions, restrictions and cultural significance, religious restrictions and parent’s levels of education (P>0.05). Future studies could investigate the influence of structural factors both in the general environment, the school and the households where these adolescents come from. The study also recommends awareness drives on the importance of menstrual hygiene among adolescents and the development and implementation of policies on menstrual hygiene practices.
The Prevalence of Chlamydia Trachomatis Infection Among Gynecological Outpatients Attendees at Central Basra Hospitals Using One-Step Chlamydia Test
Ali Falih Al-Assadi*, Zaynab Yassin, Huda Salih Abood
Objective: The objective of this study is to estimate the prevalence rate of chlamydia infection among gynecological outpatients attendees at central Basra hospitals and assessing the predisposing factors and clinical features. Methods: This is a cross-sectional study that was conducted at central Basra hospitals during the period from 15 February 2018 to 10 May 2019. The distribution of cases according to the hospitals was 290 patients from Basra maternity and child hospital, 85 patients from Basra general hospital, 75 patients from AL Mawani hospital and 50 patients from AL Fayhaa hospital, this variation in the number depend on outpatient clinics attendees. participants were assessed according to a predesigned questionnaire and screening test for Chlamydia Trachomatis was done for all patients under study by using one-step chlamydia test (Chlamydia Rapid Test Device). Results: Among 500 patients 60% of them were from the age group 20-40 year, 62% were P2-4 and 89% from multipara and grand multipara, 60% were illiterate and 38% were having primary and secondary school, 61% from low socioeconomic class, nonusers of contraception were 23.7% and about 90% of patients were living at the central areas of Basra. Several factors have a statistically significant effect on the Chlamydia Trachomatis infection like being infertile p-value 0.000 or having high parity p-value 0.013 or non-barrier contraceptives users p-value 0.035. While other factors have no statistically significant effect like age p-value 0.506, socioeconomic state p-value 0.779, and level of education p-value 0.986. Conclusion: The prevalence rate of Chlamydia infection is low among the population in the central areas of Basra city compare to other countries. Being infertile or of high parity are among the significant risk factors. Barrier contraceptives significantly reduced the risk of infection and can be used to protect against the transmission of infection.
Developmental Origins of Disease
At any age one can become sick, however, it is pathetic when someone is born with a disease that too which is not expressed immediately. Such diseases show up weeks later and some years later. The causes of such diseases are multifactorial. In this mini-review, we are trying to focus on some important risk factors which should be considered before getting pregnant; in some genetic disorders, genetic analysis is important, even before pregnancy, for others prenatal diagnosis is recommended.
Multiple Pregnancies Are Not Often
When more than one fetus develops in the uterus of a woman, such a pregnancy is called multiple. Physiologically, the uterus of a woman is scheduled to give birth to one fetus at a time, so multiple pregnancies are considered rare. Multiple pregnancies are not so common in the world, but with more frequent fertilization by assisted methods and the treatment of female infertility, there is a greater number of ovulations than once, so multiple pregnancies are possible. However, it should be noted that multiple pregnancies can be associated with a high risk of premature pregnancy, early delivery and miscarriage, and even intrauterine death of one of the fetuses.
Primary Squamous Cell Carcinoma of the Endometrium : A Rare Case in the Philippines
Doris R Benavides*, Alan T Koa
Introduction: Primary Squamous Cell Carcinoma of the Endometrium (PSCCE) is an extremely rare case accounting for only 0.1% of all endometrial cancer cases. It usually occurs in post-menopausal women. Case: We reported a case in the Philippines, a 64-year-old, multiparous, post-menopausal woman who presented with post-menopausal bleeding. Procedure: Endometrial curettage showed squamous cell carcinoma. She then underwent Exploratory Laparotomy, Radical Hysterectomy with Bilateral Salpingo-oophorectomy, with Bilateral Pelvic Lymph Node Dissectionand Peritoneal Fluid Cytology. Results: Histopathology of the uterus showed squamous cell carcinoma, keratinizing, with full thickness myometrial invasion. Postoperative diagnosis was primary squamous cell carcinoma, keratinizing, endometrium, stage IIIA. Patient was advised to undergo chemotherapy and radiotherapy. Conclusion: The etiology of PSCCE is still unclear and usually presents with vaginal bleeding in post-menopausal women. To diagnose, histology should meet three criteria asdefined by Fluhmann. The prognosis is poor and related to stage at diagnosis.
Arnold Chiari Malformation Mimicking Postdural Puncture Headache in a Postpartum Female
Brittany N. Robles*, Angel Troche, Ana Munoz-Matta, Daniel Faustin, Ralph Ruggiero
Arnold Chiari malformations are a group of structural defects ranging from herniation of the hindbrain to skeletal deformities and neurological dysfunction. Type I Arnold Chiari is the most common type of malformation with a prevalence of 1 in 1000 births. Patients are frequently asymptomatic; however, if symptoms do develop, it is typically during the reproductive age. Suboccipital headaches and neck pain are the most common symptoms that one with type 1 Arnold Chiari will experience. Here we present a case of a 29 year old, Afican American female, G4P1021, who presented to our labor and delivery unit at forty weeks and two days of gestation complaining of regular painful uterine contractions. She delivered a healthy neonate vaginally with vacuum assistance and developed an occipital headache associated with neck pain on postpartum day 1. Her symptoms did not resolve after 2 blood patches at which point she was evaluated by neurology. Head imaging was performed and notable for an Arnold Chiari malformation.
The Negligible Effect of Metformin Addition to Letrozole in Treating Overweight Women with PCOS
Mohamed Nabih EL-Gharib*, Mona Tawfeek EL-Ebiary, Manal Abdel Raoof Farahat
Aim: To compare the effects of letrozole alone and letrozole plus metformin on ovulation induction, endometrial thickness, number of ovarian follicles and, the pregnancy rate in overweight, infertile women with the polycystic ovarian syndrome. Study design: Prospective, randomized clinical trial. Material and methods: This study was conducted on 120 patients with polycystic ovarian syndrome, recruited from the infertility clinic of Tanta University Hospital, January 2017 to December 2019. Sixty women were assigned at random to each group. In a group, 1 patient received only daily 5 mg letrozole between days 3 and 7 of the menstrual cycle, and in group 2, continuous metformin was used at the dose of 500mg/TDS/day for three months; afterward, daily 5 mg letrozole between 3 and 7 days of the menstrual cycle was added to the metformin therapy. The patients were treated until pregnancy occurred, or three cycles were reached without pregnancy. Results: There was an insignificant increase in the cumulative pregnancy rate between the metformin-letrazole and the letrazole group. In the metformin-letrozole group, 28.33% of the patents got pregnant, compared with 25% of the patients in the letrazole group. There was no significant difference between the letrazole and the metforminletrazole group regarding ovulation rate, number of the follicle, endometrial thickness, and progesterone level. Conclusion: The addition of metformin to letrazole does not improve the outcome of overweight PCOS women.
Prevention of Cerebral Palsy and Fetal Demise with Hypoxia Index, FHR Score and Pathologic Sinusoidal FHR in Fetal Monitoring
Kazuo Maeda*, Masaji Utsu
Although fetal deaths was decreased by intrapartum Fetal Heart Rate (FHR) monitoring, infantile cerebral palsy was not decreased in Dublin trials of Electric Fetal Monitor (EFM), thus, an analysis to reduce cerebral palsy was studied, where cerebral palsy is prevented by setting the threshold of hypoxia index at 24 or less, in the analysis of FHR deceleration.
Low Serum-Derived Syncytin-2 Levels in Exosome at Early Pregnancy is a Predictor of Preeclampsia: A Prospective Pilot Study in Benin, West Africa
Lokossou AG Gatien*, Davito Lucien, Badarou Amyrath, Accrombessi Manfred, Azonnakpo Julien, Kounoudji Giscarde, Lozes E Josette Marie, Dossou-Gbété Lucien, Hounkpatin Benjamin, Perrin René-Xavier, and Barbeau Benoit*
Preeclampsia (PE) affects 2 to 8% of pregnant women and represents one of the major causes of maternal and perinatal morbidity and mortality, particularly in sub-Saharan Africa. A limited number of biomarkers have been proposed for the identification of pregnant women predisposed to preeclampsia. Syncytin-2 is an endogenous retrovirus envelope protein playing a key role in placental formation through the fusion of villous cytotrophoblasts, resulting in syncytiotrophoblast formation. The reduction of Syncytin-2 levels detected in placental tissue and on the surface of exosomes has been shown to strongly correlate with the severity of symptoms in preeclamptic patients. We were thus interested in conducting an analysis of a Benin cohort of pregnant women over the predictive value of this marker. From July 2015 to January 2017, 260 pregnant women were recruited in two health facilities. Blood samples were monthly collected from the beginning of pregnancy up to 20 weeks of gestation and exosomes were then isolated. We then compared Syncytin-2 levels in exosome preparations from women who presented PE to those with normal pregnancy. Our results showed that Syncytin-2 significantly decreased between 7 to 10 weeks of gestation in pregnant women with PE compared to normal pregnant women (p=0.02). Our study thereby suggests that Syncytin-2 could be a promising biomarker for early diagnosis of PE.
Quality of Antenatal, Labour and Delivery Services in Selected Districts in Malawi, Zambia and Zimbabwe: A Descriptive Cross-Sectional Study
Clara Opha Haruzivishe*, Chirwa Ellen, Maimbolwa Margaret, Maluwa Alfred, Mukwato-Katowa Patricia, Mambulusa Janet, Kwaleyela Concepta, Gomo Exnevia, Chidzonga Midion
Background: High Maternal and Neonatal Mortality Ratios persist in Sub-Saharan Africa despite increasing perinatal care coverage. This suggests that coverage alone is not adequate to reduce maternal and neonatal morbidity and mortality. Quality of care should be the emphasis of maternal and child care services. Materials and Methods: A descriptive cross-sectional multicentre study was conducted in selected health facilities in Zambia, Malawi and Zimbabwe using purposive sampling. A World Health Organization-WHO 2016 Quality of Maternal and New-born assessment Framework and the WHO (2015) Service Availability and Readiness Assessment tool were used for data collection. Data was analyzed using Statistical Package for Social Scientist (SPSS) version 24.0. Results: Less than 43% of the health facilities satisfied at least three of the five Performance Standards of availability and adequacy of Antenatal infrastructure and supplies. Regarding Antenatal processes/care, an observation was the most common performance standard satisfied by 70.6% of all health facilities assessed while less than 30% fulfilled all other standards. Only 57.1% of the health facilities satisfied 5 of the 11 standards for labour and delivery infrastructure, while only 55.6% of the Health facilities satisfied only two of the 13 standards of Labour and delivery care. Conclusion: To achieve a significant and sustainable reduction in maternal and neonatal morbidity and mortality, there is a need for investment and improvement in maternity care services infrastructure and processes as opposed to focusing on mere attendance of Antenatal, and deliveries by trained birth attendants.