Background: Conflict and displacement substantially affect maternal reproductive health by increasing the risks formorbidity and mortality. However, most literature on pregnancy outcomes is from cross-border refugees ...Background: Conflict and displacement substantially affect maternal reproductive health by increasing the risks formorbidity and mortality. However, most literature on pregnancy outcomes is from cross-border refugees and migrants. To date, scanty literature is available on pregnancy outcomes of internally displaced women. South Sudan, with 16 women dying daily is badly affected by internal conflicts of which by the end of December 2013 about 2.2 million people were internally displaced. The aim of this study was to determine pregnancy outcomes of women living in the United Nations House Internally Displaced People (UN IDP) camp and factors associated with poor outcomes. The study was ethically cleared by MUHAS and the Ministry of Health in South Sudan. Methods: A cross sectional study was conducted in UN House IDP Camp in Juba among internally displaced women who attended antenatal services in the camp, from September to November 2016. Among them, women who became pregnant in last 3 years, excluding the index, were interviewed about their immediate past pregnancy experiences. Additionally, the women were interviewed on reproductive health and gender violence matters. Interviews were guided by a structured questionnaire. Data were analyzed using SPSS software version 20. Descriptive and multivariate logistic regression analyses were computed for associations with poor pregnancy outcome. Results: A total of 300 internally displaced women participated in the study. Data for 289 participants were analyzed for poor pregnancy outcome. More than half of the women, 157 (54.3%), had poor pregnancy outcome. Poor Maternal outcome was established in 47% of the women and poor fetal outcome in 27.7%. Delivery in IDP camp compared with outside the camp, was independently associated with a 3-fold increase in risk for poor pregnancy outcome, OR = 2.9 (95% CI: 1.47 - 5.56). Conclusion: The prevalence of poor pregnancy outcome is unacceptably high among internally displaced women seeking antenatal services in the IDP camp in Juba and delivery in the camp seems to increase the risk.展开更多
Background: Maternal mortality in developing countries is unacceptably high with eclampsia being consistently among the top causes. As yet, primary prevention of this complication is not possible since causes of preec...Background: Maternal mortality in developing countries is unacceptably high with eclampsia being consistently among the top causes. As yet, primary prevention of this complication is not possible since causes of preeclampsia are largely unknown and bio-chemical, hematological and radiological markers have proved unsuitable for routine prediction of eclamptic fits. Although headache, visual disturbance, abdominal pain, nausea, and vomiting are routinely elicited when managing pre-eclampsia and have been reported to predict eclamptic fits, the literature attempting to characterize them is scanty. We sought to establish characteristics of the prodromal symptoms of eclampsia and compare them with similar symptoms as experienced by normotensive pregnant women at Muhimbili National Hospital (MNH) in Tanzania. Methods: This study was conducted at MNH in 2010 by enrolling 123 eclamptic and 123 normotensive women. Women in the two groups were interviewed about their experiences and characteristics of headache, visual disturbances, abdominal pain, nausea and vomiting using a semi structured questionnaire. The severity, nature and other characteristics of the symptoms were assessed using standard scale/methods and data compared among the two groups. Results: Prodromal symptoms of eclampsia were present in 90% of eclamptic women. Headache was more frequent among eclamptic women (88%) than the normotensive (43%), p < 0.001). The symptom was also more perceived as severe among eclamptic (46.3%) than the normotensive (5.7%), p < 0.001. The most frequent location for headache was frontal in 65.7% of eclamptic women compared to frontal (41.5%) or generalized (39.6%) for the normotensive. Likewise, visual problems were significantly more frequent among eclamptic women (39%) compared to the normotensive (3%), p < 0.001. Upper abdominal pain was significantly more reported by eclamptic (36%) than normotensive women (0.9%), p = 0.001. The general occurrence of abdominal pain, nausea and vomiting was not significantly different in the two groups. The time lag from development of a symptom to eclamptic fit was up to seven days for most symptoms except visual disturbances of which 98% developed fits within 12 hours. Conclusion: Whereas the prodromal symptoms of eclampsia and similar symptoms in normotensive women were common, the characteristics of headache and visual disturbance differ significantly in the two groups. The knowledge of these differences could be utilized to improve the quality of management of pre eclamptic women in order to prevent eclampsia.展开更多
Background: Extremes of reproductive age are associated with adverse pregnancy outcomes. Although varieties of adverse outcomes are reported across international studies, it has been difficult to compare the results d...Background: Extremes of reproductive age are associated with adverse pregnancy outcomes. Although varieties of adverse outcomes are reported across international studies, it has been difficult to compare the results due to inconsistencies in design partly due to arbitrary age cut offs for low and high risk groups. This study utilized the international consensus age cut offs to separate low and high risk age groups and compared pregnancy outcomes among them. Methods: Data of all deliveries at the Muhimbili National Hospital in Dar es Salaam, Tanzania from 1st January, 2005 to 31st December, 2011 were analyzed retrospectively and compared using IBM SPSS statistics 19. Ages 12 - 17 years (teenage) and 35 - 50 years were classified as high risk and 18 - 34 years as low risk. We treated the presence of any prenatal complication as primary outcome and intra/postpartum variables as secondary outcomes. Chi square test was used to compare proportions and t-test for continuous data among two independent groups. ANOVA with Bonferroni adjustment was used to compare differences in means across age groups. Binary logistic regression analyses were performed to determine odds of developing primary and secondary outcomes with age as an independent (categorical) variable. P-values of 0.05 or less were interpreted as statistically significant. Results: In total 65,453 singleton deliveries were identified of which 64,818 (99%) were analyzed including 1680 (2.6%) teenage and 7961 (12.3%) deliveries at 35 - 50 years. Teenage deliveries had progressively declined from 39/1000 in2005 to 16/1000 in2011 incontrast to a rise from 103/1000 to 145/1000 deliveries for the 35 - 50 years. Across all age groups, prenatal complications were least for teenage (11.4%) and most for 35 - 50 years (32.7%, χ2 = 51.3, P e minutes (OR = 2.2, 95% CI: 1.9 - 2.6) and low birth weight (OR = 1.6, 95% CI: 1.4 - 1.8). In contrast, deliveries at 35 - 50 years had increased risks for Cesarean section (OR = 1.4, 95% CI: 1.3 - 1.5), low birth weight (OR = 1.2, 95% CI: 1.1 - 1.3), babies weighing 4.0 kg or more (OR = 1.2, 95% CI: 1.08 - 1.2) and maternal death (OR = 1.4, 95% CI: 1.1 - 2.0). The risks for prenatal complications and stillbirths were also increased for the 35 - 50 years but not after adjusting for confounders. Conclusion: Deliveries at 35 years or above were on increase and were associated with the worst pregnancy outcomes at MNH.展开更多
文摘Background: Conflict and displacement substantially affect maternal reproductive health by increasing the risks formorbidity and mortality. However, most literature on pregnancy outcomes is from cross-border refugees and migrants. To date, scanty literature is available on pregnancy outcomes of internally displaced women. South Sudan, with 16 women dying daily is badly affected by internal conflicts of which by the end of December 2013 about 2.2 million people were internally displaced. The aim of this study was to determine pregnancy outcomes of women living in the United Nations House Internally Displaced People (UN IDP) camp and factors associated with poor outcomes. The study was ethically cleared by MUHAS and the Ministry of Health in South Sudan. Methods: A cross sectional study was conducted in UN House IDP Camp in Juba among internally displaced women who attended antenatal services in the camp, from September to November 2016. Among them, women who became pregnant in last 3 years, excluding the index, were interviewed about their immediate past pregnancy experiences. Additionally, the women were interviewed on reproductive health and gender violence matters. Interviews were guided by a structured questionnaire. Data were analyzed using SPSS software version 20. Descriptive and multivariate logistic regression analyses were computed for associations with poor pregnancy outcome. Results: A total of 300 internally displaced women participated in the study. Data for 289 participants were analyzed for poor pregnancy outcome. More than half of the women, 157 (54.3%), had poor pregnancy outcome. Poor Maternal outcome was established in 47% of the women and poor fetal outcome in 27.7%. Delivery in IDP camp compared with outside the camp, was independently associated with a 3-fold increase in risk for poor pregnancy outcome, OR = 2.9 (95% CI: 1.47 - 5.56). Conclusion: The prevalence of poor pregnancy outcome is unacceptably high among internally displaced women seeking antenatal services in the IDP camp in Juba and delivery in the camp seems to increase the risk.
文摘Background: Maternal mortality in developing countries is unacceptably high with eclampsia being consistently among the top causes. As yet, primary prevention of this complication is not possible since causes of preeclampsia are largely unknown and bio-chemical, hematological and radiological markers have proved unsuitable for routine prediction of eclamptic fits. Although headache, visual disturbance, abdominal pain, nausea, and vomiting are routinely elicited when managing pre-eclampsia and have been reported to predict eclamptic fits, the literature attempting to characterize them is scanty. We sought to establish characteristics of the prodromal symptoms of eclampsia and compare them with similar symptoms as experienced by normotensive pregnant women at Muhimbili National Hospital (MNH) in Tanzania. Methods: This study was conducted at MNH in 2010 by enrolling 123 eclamptic and 123 normotensive women. Women in the two groups were interviewed about their experiences and characteristics of headache, visual disturbances, abdominal pain, nausea and vomiting using a semi structured questionnaire. The severity, nature and other characteristics of the symptoms were assessed using standard scale/methods and data compared among the two groups. Results: Prodromal symptoms of eclampsia were present in 90% of eclamptic women. Headache was more frequent among eclamptic women (88%) than the normotensive (43%), p < 0.001). The symptom was also more perceived as severe among eclamptic (46.3%) than the normotensive (5.7%), p < 0.001. The most frequent location for headache was frontal in 65.7% of eclamptic women compared to frontal (41.5%) or generalized (39.6%) for the normotensive. Likewise, visual problems were significantly more frequent among eclamptic women (39%) compared to the normotensive (3%), p < 0.001. Upper abdominal pain was significantly more reported by eclamptic (36%) than normotensive women (0.9%), p = 0.001. The general occurrence of abdominal pain, nausea and vomiting was not significantly different in the two groups. The time lag from development of a symptom to eclamptic fit was up to seven days for most symptoms except visual disturbances of which 98% developed fits within 12 hours. Conclusion: Whereas the prodromal symptoms of eclampsia and similar symptoms in normotensive women were common, the characteristics of headache and visual disturbance differ significantly in the two groups. The knowledge of these differences could be utilized to improve the quality of management of pre eclamptic women in order to prevent eclampsia.
文摘Background: Extremes of reproductive age are associated with adverse pregnancy outcomes. Although varieties of adverse outcomes are reported across international studies, it has been difficult to compare the results due to inconsistencies in design partly due to arbitrary age cut offs for low and high risk groups. This study utilized the international consensus age cut offs to separate low and high risk age groups and compared pregnancy outcomes among them. Methods: Data of all deliveries at the Muhimbili National Hospital in Dar es Salaam, Tanzania from 1st January, 2005 to 31st December, 2011 were analyzed retrospectively and compared using IBM SPSS statistics 19. Ages 12 - 17 years (teenage) and 35 - 50 years were classified as high risk and 18 - 34 years as low risk. We treated the presence of any prenatal complication as primary outcome and intra/postpartum variables as secondary outcomes. Chi square test was used to compare proportions and t-test for continuous data among two independent groups. ANOVA with Bonferroni adjustment was used to compare differences in means across age groups. Binary logistic regression analyses were performed to determine odds of developing primary and secondary outcomes with age as an independent (categorical) variable. P-values of 0.05 or less were interpreted as statistically significant. Results: In total 65,453 singleton deliveries were identified of which 64,818 (99%) were analyzed including 1680 (2.6%) teenage and 7961 (12.3%) deliveries at 35 - 50 years. Teenage deliveries had progressively declined from 39/1000 in2005 to 16/1000 in2011 incontrast to a rise from 103/1000 to 145/1000 deliveries for the 35 - 50 years. Across all age groups, prenatal complications were least for teenage (11.4%) and most for 35 - 50 years (32.7%, χ2 = 51.3, P e minutes (OR = 2.2, 95% CI: 1.9 - 2.6) and low birth weight (OR = 1.6, 95% CI: 1.4 - 1.8). In contrast, deliveries at 35 - 50 years had increased risks for Cesarean section (OR = 1.4, 95% CI: 1.3 - 1.5), low birth weight (OR = 1.2, 95% CI: 1.1 - 1.3), babies weighing 4.0 kg or more (OR = 1.2, 95% CI: 1.08 - 1.2) and maternal death (OR = 1.4, 95% CI: 1.1 - 2.0). The risks for prenatal complications and stillbirths were also increased for the 35 - 50 years but not after adjusting for confounders. Conclusion: Deliveries at 35 years or above were on increase and were associated with the worst pregnancy outcomes at MNH.
