Socio-Demographic Factors, Clinical Characteristics and Maternal Prognosis of Hypertensive Disorders in Pregnancy at Panzi General Referral Hospital

Background: Hypertensive disease in pregnancy is an important cause of morbidity, long-term disability, and maternal and neonatal mortality. The aim is to determine the socio-demographic characteristics and maternal prognosis of these women with Hypertension during pregnancy. Material and Method: We conducted a cross-sectional study, we interview patients and after discussion we transcripts in a database in Excel software before analysis with SPSS version 20.0 and Stata 14.0 The qualitative variables have been summarised by the Percentage and the quantitative variables will be summarised by Means and Standard Deviation. The associations of the variables were calculated by Pearson’s chi-square test with a significance level set at a p-value Result: The average age of the patients was 30.33 ± 7.020 years, 92.1% were married, 79.8% lived in urban areas, most of the patients were overweight (43%), 92.1% of them had monofetal pregnancies, 36% were multiparous, 34.2% had a previous history of preeclampsia in pregnancy and 14% were known to have hypertension. Pre-eclampsia was the most frequent form of hypertension in pregnancy with 73.68% of cases and represents 84.8% of severe forms of hypertension in pregnancy, 53.4% of the patients delivered vaginally. Eclampsia was the most frequent complication in our patients with 31.7% frequency and among the socio-demographic parameters, age and body mass index were significantly associated with maternal complications. Conclusion: Maternal age and body mass index are important socio-demographic factors associated with the occurrence of maternal complications in women with hypertensive disorders in pregnancy.

Primary Non-Hodgkin’s Malignant Lymphoma of the Uterus at the Reference Hospital of Maradi/Niger: A Case Report

Malignant non-Hodgkins lymphoma (MHNL) of the uterus is uncommon. We report a case diagnosed on the basis of histologic and immunohistochemical studies of a hysterectomy specimen induced by a very painful pelvic mass in a 50-year-old patient with no previous history of the disease. It was classified as Ann Arbor IV Bb after imaging, given the medullary infiltration and signs of clinical and biological evolutivity: the patient had received two courses of chemotherapy, CHOP protocol. She died 23 days after the second treatment due to a hypertensive crisis.

Epidemiologic Profile of Maternal Deaths in Two Referral Hospitals in Cameroon

Introduction: Our objective was to compare the epidemiologic profile of maternal mortality in two structures serving as referral levels of care in Cameroon. Methodology: This cross-sectional, comparative study took place at the maternities of the Yaoundé Central Hospital (YCH) and the Bamenda Regional Hospital (BRH) from December 1st 2014 to May 31st 2015, a 6 months’ period. The medical records of deceased women over 5 years, from January 2010 to December 2014, were collected. We calculated the MMR (Maternal mortality rate) and studied the causes and risk factors associated with maternal death. The Epi info software 3.5.4 was used to analyze data with a significance level of P < 0.05. Results: The maternal mortality ratio (MMR) was 964 and 247 per 100,000 live births for YCH and BRH, respectively. More deaths occurred within the aged group range 20 to 34 years, 76.8% at YCH and 64.7% at BRH. At YCH, 70.7% of these patients were referrals versus 32.4% at BRH. Complication from abortion was often implicated at BRH (P = 0.007;OR = 0.31;CI = 0.13 - 0.74). Others causes were hemorrhage (YCH = 43.4%;BRH = 35.5%), hypertensive diseases (YCH = 17.2%;BRH = 14.7%) and infections (YCH = 8.1%;BRH = 17.6%). At YCH time elapsed from admission to death was <3 h (P = 0.005;OR = 6.63;CI = 1.49 - 29.5). Conclusion: Both hospitals have similar causes of maternal deaths, differing only in the context within which the deaths occurred. Improving access to good quality health care, satisfying unmet needs for family planning, availability of blood products and the establishment of health insurance could decrease the maternal mortality rate.

Profile of Pregnant Women and Success of the Uterine Test on a Uni or Bi-Scar Uterus at the Maternity Ward of Panzi Hospital, in the Democratic Republic of the Congo

Introduction: Trial of labor after a previous cesarean section (TOLAC) is a method that requires strict monitoring to decrease the cesarean section (CS) rate and improve the maternal and neonatal prognosis. The objective is to determine the profile and outcome of patients with one and two previous CSs who performed TOLAC at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of data of 111 patients with one and two previous CSs at Panzi Hospital from January 2021 to August 2022. Statistical Package for the Social Sciences SPSS version 23 software was used to analyze the collected data. The percentages of categorical variables were summarized in a frequency table. The mean or median with standard deviation was used to summarize quantitative variables. Results: The overall success rate of the TOLAC was 64%, with 63.8% following one previous CS and 64.3% following two CSs. The mean age of the patients was 27.09 years, with an age range of 25 - 34 years. They were mostly pauciparous (52.2%), married (88.3%), with a high school education (60.4%). The inter-delivery interval > 18 months was noted (64.1%) and overweight in 63.9%. More than three antenatal consultations were performed (58.6%). We found a mean gestational age of 38 (34 - 41) weeks. The perinatal mortality rate was 0.9%. However, we did not record any cases of maternal mortality during the study period. Conclusion: TOLAC after one and two previous CS is implemented in the maternity Unit of Panzi Hospital for well-selected patients. In addition, the success rate is similar after TOLAC with an acceptable maternal-neonatal prognosis.

First Hour Initiation of Breast Feeding &Associated Factors, among Mothers at Post Natal Ward in Fort Portal Referral Hospital, Uganda

Background: Breast milk is recommended as the best feeding option to neonates and infants for it confers immunological benefits that help to reduce neonatal and infant morbidities and mortalities. WHO recommends that all infants should start breast feeding within one hour of birth i.e. early initiation of breast feeding (EIBF). Unfortunately, studies show that less than 40% of infants in resource limited settings Uganda inclusive are initiated on breast feeding practice, with no documented study done in Kabarole district to assess the problem. This study therefore, set out to establish the prevalence and associated factors with the practice of first hour initiation of breast feeding at Fort Portal Regional Hospital, Kabarole district, Uganda. Methods: With a cross-sectional design, we collected data from 330 post natal mothers and their live-born infants at Fort Portal Regional Referral hospital from 5th-20th August 2019. With a standard interviewer administered tool, mothers who initiated breast feeding within the first hour after delivery of their newly born babies responded with yes and those that did not with a no. Prevalence of one hour initiation was got considering infants that were initiated on breast within one hour over the total live birth times 100 to get the percent prevalence. With Stata version 13 software, statistically significant relationships of the predisposing factors were determined at a p-value (p ≤ 0.05) at bivariate and at multivariate regression coefficient. Results: A total of 330 postnatal mothers targeted for this study, 100% response rate was covered. Mothers’ age ranged from 18 - 45 years with mean age 31 SD ± 6. The prevalence of initiation of breast feeding in the first hour of birth was 68%, a third of (32%) mothers had not initiated breast feeding in the first hour. A half (50%) of the direct predisposing factors for non-initiation of timely breastfeeding were due to birth asphyxia, almost a quarter 23% due to mother’s ill health and 7% due mother not being guided by the health worker on what to do. In this study mothers’ knowledge and awareness of the practice were very low at 20% while that of health workers was fair at 53%. Social demographic factors that influence 1st hour breast feeding practice were;young maternal age being less than 34 years, mothers occupation being self-employed (83%) or unemployed (73%) with 3 times higher odds of initiating breastfeeding within 1st (OR = 3, p = 0.003) than working class mothers (civil servants). Marital status of mothers being married (73%) significantly influenced early breastfeeding practice (p = 0.001). Health workers’ knowledge of the practice was significantly associated (OR = 2.7, X2 = 11.32, *p = 0.00078) with enforcement of mother initiation of breast feeding in first hour compared to the less knowledgeable ones. Conclusion: The practice of timely initiation of breastfeeding at Fort Portal Regional Referral hospital at 68.2% was sub-optimal against WHO universal practice recommendations. Mothers’ low knowledge on timely initiation of breast feeding practice was the most deterrent factor for first hour initiation of breastfeeding practice. Providing breastfeeding counselling to all mothers during ANC and training on best breastfeeding practices and counselling skills for health staff at Fort Portal Referral hospital are urgent recommendation in this study to improve the practice.

Prevalence and Factors Associated with Raised Intraocular Pressure among Hypertensive Patients—A Hospital-Based Study, Uganda

Background: Raised intraocular pressure (IOP) is a major risk factor for glaucoma. Hypertensive patients are at a risk of developing and progression of Open Angle Glaucoma (OAG) which is a major cause of blindness in the world. The aim of this study was to determine the prevalence of raised IOP and associated factors among hypertensive patients attending the hypertension clinic at Mulago National Referral Hospital in Uganda. Materials and Methods: A cross-sectional study was conducted from December 2018 to March 2019. Our sample comprised hypertensive patients recruited after obtaining consent. Participants were sampled consecutively and underwent both a general medical and ocular examination. A questionnaire was used to collect data on socio-demographic characteristics, ocular and medical factors. Data were entered into the computer using the statistical data package of Epidata version 3.1 and exported to STATA version 14 for analysis. Results: Of the 405 hypertensive study participants, mean age was 57.1 years (range 25 to 90 years, SD = 12.4 years). The overall prevalence of raised intraocular pressure was 11.6% (95% CI 8.8 - 15.1). The mean IOP among all participants was 15.2 mmHg (SD = 4.3) with a range of 3 - 34 mmHg. The factors with a statistically significant association with raised intraocular pressure after multivariate analysis were a positive family history of Glaucoma (OR 57, CI 10.33 - 315.34, P < 0.001) and Eye trauma (OR 7.84, CI 1.02 - 60.02 P = 0.047). Conclusions: The prevalence of raised intraocular pressure among hypertensive patients attending the hypertension clinic in Mulago National Referral hospital, Uganda was found to be high.

Drug-related problems among type II diabetes mellitus patients with hypertension: a cross-sectional study

Patients with type II diabetes mellitus(T2DM)and hypertension(HTN)are at increased threat for long experiencing various problems related to medicine as they frequently received different medications for managing their condition.Recently,there were no studies done locally on drug-related problems(DRPs)among T2DM patients with HTN.Thus,this study aims to assess the DRPs among T2DM patients with HTN admitted at Kibuye Referral Hospital(KRH).DRPs were drug safety problems,drug effectiveness problems and other drug problems.Methods:A retrospective cross-sectional study involved patients'files with T2DM and HTN,who were admitted at KRH from January 2013 to December 2017.The identification and classification of DRPs were based on pharmaceutical care network Europe(PCNE)classification system version 8.02.A simple random sampling technique was used to choose study participants from the target population.Data that met inclusion and exclusion criteria were analyzed using STATA version 13.The Fisher exact test(bivariate analysis)and logistic regression(multivariate)were used to test association and p-value≤0.05 was considered as statistically significant.An adjusted odd ratio(AOR)with a confidence interval(CI)of 95% was determined using binary logistic regression.Results:Findings revealed that the prevalence of DRPs was 81.29%(313/385)and most of them each patient had at least two DRPs(69.05%).The patients aged above 55 years old were more likely to develop DRPs than those with age below 35 years(AOR=1.2;P=0.02;95%CI:0.2-2.3).Nevertheless,there was no significant association between DRPs and middle age(between 35 and 54 age of old).The patients who consumed more than or equal to 5 drugs were 2.4 times more likely to develop DRPs than those who took the number of medicines less than 5(AOR=15.4;P<0.001;95%CI:8.8-26.8).Also,traditional medicines use(AOR=1.9;P=0.016;95%CI:1.1-3.5)and having drug-related complication(AOR=2.4;P<0.001;95%CI:1.9-3)had shown significant associations.The total causes of DRPs identified were 1626 and most causes of DRPs were arisen from drug use(45.01%)and prescribing(37.83%).The drug/dose selections were the most frequent causes of DRPs(36.97%).Conclusion:Since the prevalence of DRPs were relatively high,various factors influencing DRPs were established and most causes of DRPs were arising from drug use&drug prescribing among T2DM patients with HTN.Early detection needed to enhance patient’s life quality.Conducting studies in other hospitals needed to establish the national planning of DRPs to eradicate DRPs among patients T2DM with HTN.

Comparative Seroprevalence of Hepatitis B Virus among in-Mates and Low Risk Voluntary Blood Donors in Garissa, Kenya

Hepatitis B virus (HBV) infection is a potentially life-threatening infection that attacks the liver and can cause both acute and chronic disease. This creates a high risk of death from cirrhosis and liver cancer. Hepatitis B infection poses a major health concern globally. It is estimated that 257 million people are infected globally with 780,000 deaths reported annually. In Kenya, HBV prevalence stands at chronic states of intermediate range (5% - 7%) and high (≥8%) with regional variations. Garissa County carries a high HBV infection risk with a reported prevalence of 14.1% in pregnant women attending antenatal care (ANC) clinics. This study was carried out to determine and compare the seroprevalence of HBV among in-mates and voluntary blood donors at Garissa Main Prison and Garissa County referral hospital respectively in Garissa, Kenya. A total of 130 in-mates and 130 voluntary blood donors were sampled in this study. Serum was tested for Hepatitis B surface antigen (HBsAg) using a rapid test cassette (Amitech Diagnostics Inc.). A questionnaire was also used to collect socio-demographic factors of the study participants. Data were entered and analyzed using SPSS version 20. Majority of the study participants were males (86.9% among inmates and 95.4% among blood donors). Majority (76.2%) of the in-mates and of the donors (83.1%) were aged between 20 - 40 years while majority (51.4% of the donors and 81.5% of in mates) had only a primary school level of education. HBV seroprevalence was significantly higher among in mates compared to blood donors. Out of the total number of in-mates tested, 7 (5.4%) were HBV seropositive. Conversely, among blood donors 4 (3.1%) were seropositive. There was a significant association between HBV seropositivity and gender among both the blood donors and in-mates. There was no significant association between HBV seropositivity and both level of education and age. No data currently exists on HBV seroprevalence in Kenyan prisons and these study findings may be used as a proxy for other prisons within the country. Further studies to determine other predisposing risk factors should be conducted. Additionally, molecular studies to determine circulating HBV genotypes in this group of people and region are required.