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- Volume 12, Issue 3, 2006
South African Journal of Obstetrics and Gynaecology - Volume 12, Issue 3, 2006
Volume 12, Issue 3, 2006
Author Mitchell BesserSource: South African Journal of Obstetrics and Gynaecology 12, pp 122 –128 (2006)More Less
Extracted from text ... SAJOG November 2006, Vol. 12, No. 3 South Africa has the highest number of AIDS orphans (1.2 million) and the highest number of women (3.1 million) and children below the age of 15 (240 000) living with HIV in the world. One of the most critical elements in the fight against the HIV/AIDS epidemic is prevention of mother-to-child transmission (PMTCT) of the virus - both during and after pregnancy. In resource-rich nations with access to antiretroviral therapy (ART) and replacement feeding, transmission has been reduced to 1 - 2%, and paediatric AIDS has been virtually eliminated. In resource-poor countries this ..
Maternal deaths due to non-pregnancy-related infections : Third report on Confidential Enquiry into Martenal Deaths in South Africa, 2002 - 2004 : surveySource: South African Journal of Obstetrics and Gynaecology 12, pp 130 –138 (2006)More Less
Non-pregnancy-related infections (NPRIs) remain the leading cause of maternal deaths at all levels of care in the triennium 2002 - 2004, with AIDS deaths being the biggest challenge for the health sector. A total of 1 246 deaths from NPRIs were reported for the triennium. HIV testing of women increased from 37.6% in 1999 - 2001 to 50% in 2002 - 2004. Of all deaths from NPRI, AIDS contributed 53.1%, followed by pneumonia (25.4%), tuberculosis (8.3%) and meningitis (6.3%). Malaria deaths declined from 5.3% in 1999 - 2001 to 1.3% in 2002 - 2004. AIDS continues in this report to be underestimated because a strict definition of AIDS is used. Many women die before the results of HIV testing are known and it is conceivable that some of them would have been classified as having AIDS. In order to make a diagnosis of AIDS, a positive HIV test plus an AIDS-defining condition must be present. <BR>There are provinces that need to improve access to voluntary counselling and testing. <BR>AIDS remains the main cause of death in all age groups, followed by pneumonia, tuberculosis and meningitis, with the age category 25 - 29 years being at most risk for all four. The commonest final and contributory causes of death were respiratory failure or immune system failure, which occurred in more than 50% of patients. Deaths occurring at level 1 hospitals increased sharply. Deaths in level 2 hospitals were second highest. Patients presented with an emergency equally in the antenatal period (44.2%) and in the postpartum period (43.7%). Patient-related factors decreased from 68.8% in 1999 - 2001 to 46.2% in 2002 - 2004. These were reported as the commonest avoidable factors. Delay in seeking help was the main contributor, followed by lack of antenatal care. Lack of health care facilities, personnel and transport are the main administrative avoidable factors and may contribute to people feeling that they are not welcome in the health care system. The use of the CD4 cell count is not yet universal. There are personnel-related factors, such as fatalism and a non-caring attitude once a diagnosis of HIV infection is suspected or made. Delay in providing care is a factor in the management of many women with HIV and other infective conditions. There is also lack of utilisation of the ethical guidelines for management of women with HIV infection.
Traditional birth attendants HIV / AIDS and safe delivery in the Eastern Cape, South Africa - evaluation of a treating programme : research articleSource: South African Journal of Obstetrics and Gynaecology 12, pp 140 –145 (2006)More Less
<I>Introduction.</I> Traditional birth attendants (TBAs) are still frequently utilised in rural areas in South Africa, even when mothers have access to formal health care facilities. Studies reveal that utilisation of TBAs can be beneficial in some contexts, with support and supervision from the Western health sector. <br><I>Aim.</I> To evaluate a training programme for TBAs on HIV / AIDS and safe delivery. <br><I>Method.</I> The study used a pre-post training evaluation design of 50 TBAs in two primary health care clinic areas in rural South Africa. <br><I>Results.</I> Most TBAs had some knowledge of risk signs during pregnancy. At follow-up assessment HIV / AIDS knowledge had significantly increased and HIV risk practices when assisting during a delivery had significantly decreased. Most TBAs were involved in HIV/sexually transmitted infection (STI) management such as risk assessment, risk reduction counselling, distribution of condoms, community education and home-based care. After the training significantly more TBAs conducted prenatal check-ups, assessed the baby's position in the uterus and took the mother's and baby's pulse, and fewer TBAs conducted abnormal or complicated deliveries. <br><I>Conclusion.</I> Training of TBAs can increase their knowledge, improve their attitudes and reduce risk practices. TBAs need skilled and equipped available support to carry out basic preventive measures in the obstetric patient, anticipate and identify obstetric complications, administer nevirapine prophylaxis, and make appropriate and timely referrals backed up with efficient referral mechanisms to reduce maternal morbidity and mortality.
The association between Chlamydia trachomatis genital infection and spontaneous preterm labour : research articleSource: South African Journal of Obstetrics and Gynaecology 12, pp 146 –149 (2006)More Less
<I>Objective.</I> To determine the association between <I>Chlamydia trachomatis</I> genital infection, as found at the first antenatal visit, and spontaneous preterm labour. <br><I>Methods.</I> Low-risk obstetric patients, attending the Bishop Lavis Midwife Obstetric Unit, were screened for <I>C. trachomatis</I> infection at the first antenatal visit between 16 and 23 weeks' gestation. Using a bivalve speculum, a swab was taken directly from the endocervix and examined by the polymerase chain reaction technique. At the same time a lateral vaginal smear was taken to examine for bacterial vaginosis. Analyses were done in batches after delivery. Clinicians responsible for the management of the pregnant women were therefore unaware of these test results. Patients were followed up during pregnancy and labour for complications such as delivery before 37 weeks. <br><I>Results.</I> A total of 343 pregnant women were recruited, of whom 36 (10.5%) delivered before 37 weeks' gestation. <I>C. trachomatis</I> was found in 8 (22.2%) of women who had preterm deliveries in contrast to 32 (10.4%) women who had term deliveries (p = 0.037). The prevalence of bacterial vaginosis did not differ significantly between these two groups. There was 1 neonatal death in the preterm delivery group but no neonatal deaths among women who delivered at term. <br><I>Conclusion.</I> An association was found between preterm delivery and <I>C. trachomatis</I> infection. An intervention study is indicated to determine whether specific treatment of this infection reduces the frequency of preterm labour.
Source: South African Journal of Obstetrics and Gynaecology 12, pp 150 –154 (2006)More Less
Extracted from text ... SAJOG November 2006, Vol. 12, No. 3 According to the International Agency for Research on Cancer (IARC), cervical cancer accounts for 23% of all new cancers diagnosed in South Africa annually.1 The age-standardised incidence rate for cervical carcinoma in southern Africa is approximately 35 per 100 000 women-years. This is one of the highest incidence rates in the world. In 2002 cervical cancer was the cause of an estimated 3 700 deaths in South Africa. Screening for cervical carcinoma in well-organised programmes has been shown to be effective in reducing the incidence of and death rates due to the disease.2 ..
Source: South African Journal of Obstetrics and Gynaecology 12, pp 156 –160 (2006)More Less
Vulvar carcinoma is rare in the premenopausal age group. Depressed immunity has now been implicated as a predisposing factor in the development of vulvar cancer in young patients, particularly for the progression of VIN to invasive cancer. In the past decade an increasing incidence of vulvar cancer in young immunosuppressed women has been observed. It is important to screen for and detect the disease in the early stages. <br>A 24-year-old woman presented at our oncology clinic with a 1-year history of a fast-growing vulvar lesion involving the labia majora, labia minora, clitoris, anal mucosa and urethra and extending to the left buttock. Bilateral mobile 2 cm lymph nodes were palpable. Histological examination showed the tumour to be an invasive squamous cell carcinoma. The disease was staged as T4N2M0. Owing to low CD4 counts of 218 cells/<SPAN lang=AF style="FONT-FAMILY: Symbol; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-char-type: symbol; mso-symbol-font-family: Symbol"><SPAN style="mso-char-type: symbol; mso-symbol-font: Symbol">m</SPAN></SPAN>l and her poor general condition, palliative radiation therapy according to departmental treatment protocol was offered. The patient was followed up 6, 16 and 28 weeks after radiation therapy, and 70% tumour reduction was observed at 6 weeks, 90% at 16 weeks and complete response at 28 weeks. <br>Vulvar carcinoma related to HIV seems to be sensitive to larger than conventional daily doses of radiation therapy, as we observed in this case. Appropriate treatment guidelines are required, as invasive vulvar cancer related to immune suppression due to AIDS is common in African countries.
Source: South African Journal of Obstetrics and Gynaecology 12, pp 161 –162 (2006)More Less
Department of Obsterics and Gynaecology Refresher Course, University of Cape Town, 30 November - 2 December 2003 abstractsAuthor Edward J. CoetzeeSource: South African Journal of Obstetrics and Gynaecology 12, pp 164 –167 (2006)More Less