HIV-1 infection and fertility in Dar es Salaam, Tanzania

The objective of this study was to examine the association of HIV-1 infection with rates of pregnancy and pregnancy loss in Dar es Salaam, Tanzania. A retrospective cohort study of 1,006 HIV-infected women and 485 uninfected women was employed. In multivariate analyses controlling for other predictors of pregnancy, the association of HIV-seropositivity with a woman's reported number of pregnancies was of borderline significance (RR = 1.13, 95% CI = 1.00, 1.27). HIV infection was not associated with pregnancy loss in multivariate analysis. The adjusted pregnancy rate ratio comparing HIV-positive women at the earliest stages of infection to all uninfected women was 1.22 (95% CI = 1.04, 1.42). HIV infection was not associated with female fertility when comparing women in the most advanced stages of infection to all uninfected women. We conclude that HIV-1 infected women had higher pregnancy rates than uninfected women. This association disappeared when analyses were limited to women with advanced disease. Abstract word count: 150.     

Evaluation of cervical visual inspection screening in Dar es Salaam, Tanzania

Objective

To evaluate the feasibility and performance of screening for cervical cancer using visual inspection with acetic acid (VIA) or with Lugol's iodine (VILI) in Dar es Salaam, Tanzania.

Methods

The accuracy of tests for detecting cervical intraepithelial neoplasia (CIN) was assessed in a cross-sectional study of 10 378 women. All women who were screened underwent colposcopy, and biopsies were offered to those with abnormal colposcopy results.

Results

The positivity rates were 3.8% for VIA and 4.8% for VILI. The peak positivity rates for both visual tests were observed just after training or re-training and gradually declined thereafter. CIN 1 was diagnosed in 41 women, CIN 2-3 in 33 women, and invasive cancer in 200 women, showing high detection rates of invasive cancer. The sensitivity and specificity for the detection of CIN 2-3 lesions were 60.6% (95% confidence interval [CI], 42.1-77.1) and 98.2% (95% CI, 97.9-98.4), respectively, for VIA; and 93.9% (95% CI, 79.8-99.3) and 97.3% (95% CI, 97.0-97.6), respectively, for VILI. Two-thirds of the women detected with CIN 2-3 lesions were treated.

Conclusion

Both visual screening tests are useful and accurate, especially in low-income settings. Standardization of assessment of the visual inspection techniques, continual training and supervision, and quality control measures are important for successful visual screening programs.     

Maternal hyperglycemia and adverse pregnancy outcomes in Dar es Salaam,Tanzania

Objective

To evaluate maternal glucose levels during pregnancy as a predictor of adverse perinatal outcomes in Dar es Salaam, Tanzania.

Methods

Random blood glucose measurements were analyzed from 3383 pregnant women enrolled in a randomized trial to assess the impact of multivitamins on pregnancy outcomes in Dar es Salaam between August 2001 and July 2004. Information on maternal and neonatal morbidity was recorded at monthly study visits, delivery, and 6 weeks postpartum. Binomial regression and generalized estimating equations were used to determine the relationship between elevated glucose (> 7.8 mmol/L) and pregnancy outcomes.

Results

In total, 25 women had elevated glucose (0.7%). Hyperglycemia was associated with an increased risk of delivery before 37 weeks [relative risk (RR), 2.11; 95% confidence interval [CI], 1.07–4.13; P = 0.03), delivery before 34 weeks (RR, 4.15; 95% CI, 1.43–12.03, P = 0.009), incident gestational hypertension (RR, 2.90; 95% CI, 1.24–6.76; P = 0.01), low birth weight (RR, 2.87; 95% CI, 1.18–6.99; P = 0.02), reduced newborn head circumference (mean difference, –1.57; 95% CI, –2.51 to − 0.62; P = 0.001), and fetal loss (RR, 3.38; 95% CI, 1.13–10.08; P = 0.03).

Conclusion

Maternal hyperglycemia is uncommon among pregnant Tanzanian women, but nonetheless seems to increase the risk of several adverse perinatal outcomes.     

Partogram use in the Dar es Salaam perinatal care study.

OBJECTIVE: To assess the quality of partograms used to monitor labor in Dar es Salaam hospitals, Tanzania. METHODS: The study team reviewed the records of the parameters of labor, and maternal and fetal conditions in 367 partograms, and interviewed 20 midwives. RESULTS: All midwives interviewed had been previously trained to use the partogram. Of all partograms reviewed, 50% had no records of duration of labor. Although cervical dilation and fetal heart rates were recorded in 97% and 94% of the partograms respectively, 63% and 91% of these were judged to be substandard. Substandard monitoring of fetal heart rates was strongly associated with poor fetal outcome (P<0.001). Blood pressure, temperature, and pulse rates were not recorded in 47%-76% of partograms. CONCLUSION: These findings reflect poor management of labor and indicate urgent in-service training to address the importance of documentation and regular partogram audit in order to reduce maternal and perinatal deaths.     

Tetanus immunity among pregnant women attending antenatal care in Dar es Salaam,Tanzania

This study was conducted to investigate immunity to tetanus among pregnant women with verbal histories or documentation of having been vaccinated under the current five-dose tetanus toxoid (TT) schedule. It examined sera from 176 pregnant women attending antenatal care at Muhimbili Medical Centre in Dar es Salaam, Tanzania. Tetanus antitoxin level of 0.1 IU/ml was considered protective. Our findings show that 94.9% of women had tetanus antitoxin > or = 0.1 IU/ml. Multivariate analysis revealed that time after last vaccination, TT doses received and TT vaccination status explained 7.5%, 5.7% and 2.3% of variations in tetanus antitoxin levels respectively. Pregnant women with non-protective levels of tetanus antitoxin (5.1%) pose great risks of neonatal tetanus to their newborns and are also susceptible to maternal tetanus. Proper keeping of TT vaccination records is vitally important to avoid hyper-immunisation.     

The use of social media among adolescents in Dar es Salaam and Mtwara,Tanzania

Social media form part of the rapid worldwide digital development that is re-shaping the life of many young people. While the use of social media by youths is increasingly researched in the North, studies about youth in the South are missing. It therefore remains unclear how social media can be included in interventions that aim at informing young people in many countries of the global South about sexual and reproductive health. This paper presents findings of a mixed-methods study of young people’s user behaviour on the internet and specifically of social media as a platform for sexual health promotion in Tanzania. The study used questionnaires with 60 adolescents and in-depth interviews with eight students aged 15 to 19 years in Dar es Salaam, and in Mtwara, Southern Tanzania. Findings show that youth in Dar es Salaam and Mtwara access the internet mainly through mobile phones. Facebook is by far the most popular internet site. Adolescents highlighted their interest in reproductive and sexual health messages and updates being delivered through humorous posts, links and clips, as well as by youth role models like music stars and actors that are entertaining and reflect up-to-date trends of modern youth culture.     

Risk factors for HIV-1 seroprevalence among family planning clients in Dar es Salaam, Tanzania

Between March and September of 1995, women receiving family planning (FP) services in three large clinics in Dar es Salaam, Tanzania were invited to participate in a cross-sectional study. Consenting women were interviewed to obtain information about HIV risk factors, and blood for HIV testing was collected. The prevalence of HIV was 16.9% (95% CI: 14.4%-19.3%). The risk of HIV increased significantly with age. Compared with married women, the risk of HIV was significantly higher among cohabiting women (age-adjusted OR = 2.3; 95% CI = 1.5-3.5) and among women who were single, divorced or widowed (age-adjusted OR = 2.3; 95% CI = 1.2-4.4). The risk of HIV was also significantly higher among hotel workers (age-adjusted OR = 4.3; 95% CI = 1.4-12.9). Women with laboratory evidence of sexually transmitted diseases were at increased risk of HIV. This study shows that HIV is a major public health problem among FP clients in Tanzania. Innovative HIV interventions are needed to reduce further spread of HIV infection.     

The association between maternal HIV-1 infection and pregnancy outcomes in Dar es Salaam, Tanzania

Objective To examine the association between maternal HIV infection and pregnancy outcomes controlling for potential confounding factors among a cohort of HIV-uninfected and HIV-infected pregnant women in Dar es Salaam, Tanzania.
Design Prospective cohort study.
Methods A cohort of 1078 HIV-infected and 502 HIV-uninfected pregnant women between 12 and 27 weeks of gestation were enrolled and followed up until delivery. Multiple regression models were used to compare the risk of adverse pregnancy outcomes among HIV-uninfected women with those among HIV-infected women overall, and separately among asymptomatic or symptomatic HIV-infected women.
Results No significant differences between HIV-uninfected women and HIV-infected women were observed in risks of fetal loss or low birthweight or in the weight, head circumference and gestational age of infants at birth. HIV-infected women were more likely to have severe immature infants (<34 weeks) than HIV-uninfected women (multivariate RR 1.54 [95% CI 0.90–2.48]; P =0.05). There was a significantly higher risk of low birthweight (RR 2.29, 95% CI 1.34–3.92; P =0.03) and prematurity (<37 weeks) (RR 1.93, 95% CI 1.35–2.77; P =0.0003) among symptomatic HIV-infected women when compared with HIV-uninfected women.
Conclusion HIV-infected women, particularly those who are symptomatic, are at a higher risk of adverse pregnancy outcomes.     

Risk factors for syphilis among HIV-1 infected pregnant women in Dar es Salaam,Tanzania

This study was conducted to determine the risk factors for recent (active) syphilis among HIV-1 seropositive pregnant women (N = 1058) in Dar es Salaam, Tanzania, Recruitment of study participants (N = 1058) was done between April 1995 and June 1997 at four main prenatal clinics in Dar es Salaam city. Study subjects were interviewed to obtain information about potential risk factors, and blood and genital specimens were collected for detection of syphilis and other genital infections. The prevalence of active syphilis was 5.9%. After adjusting for other risk factors, women without their own source of income had a 50% lower risk of syphilis (OR = 0.5, 95% CI: 0.3-0.9). The risk of active syphilis was significantly increased among women with genital ulceration on examination (OR = 8.4, 95% CI: 1.5-47.7), and in those with trichomoniasis (OR = 2.2, 95% CI: 1.2-3.8). HIV-related immunodeficiency was not associated with increased risk of syphilis. These results show that syphilis and other genital infections are a major problem among HIV infected women. Prevention of syphilis and other genital infections is urgently needed in this population.     

Eclampsia in Dar es Salaam, Tanzania -- incidence, outcome, and the role of antenatal care

BACKGROUND: In order to assess the effectiveness of antenatal care for prevention of eclampsia, a retrospective case-control study was performed at the Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. All women with eclampsia seen at MNH during 1999-2000 and controls without eclampsia were included. METHODS: The study used a labor ward database and antenatal cards of eclamptic women and non-eclamptic controls. For each of the 741 eclamptic women who delivered at MNH, two non-eclamptic controls were chosen from the database. For 399 of the eclampsia cases and 420 non-eclamptic controls, the antenatal records could be traced and compared. Main outcome measures. Maternal and perinatal mortality, detection of antenatal risk factors, appropriate referrals, and incidence of eclampsia. RESULTS: Hospital and population-based incidences of eclampsia were 200/10,000 and 67/10,000, respectively. The case-fatality rate for eclampsia was 5.0% for women who delivered at MNH and 16% for those referred to MNH after being delivered elsewhere. The risk of low birth weight and perinatal death was significantly increased in eclamptic women (odds ratio = 6 and 10, respectively). The screening coverage for signs of pre-eclampsia was >85%, except for proteinuria (33%). Fewer than 50% of the women who developed eclampsia had been referred from the ANC clinic and <10% were admitted to the antenatal ward at MNH before onset of eclamptic fits. CONCLUSIONS: The current practice of antenatal care is insufficient as a prevention strategy for eclampsia in a low-resource setting with high incidence of eclampsia.     

Informal support to first-parents after childbirth: a qualitative study in low-income suburbs of Dar es Salaam, Tanzania

Background

Facilitating the provision of appropriate health care for immigrant and Aboriginal populations in Canada is critical for maximizing health potential and well-being. Numerous reports describe heightened risks of poor maternal and birth outcomes for immigrant and Aboriginal women. Many of these outcomes may relate to food consumption/practices and thus may be obviated through provision of resources which suit the women's ethnocultural preferences. This project aims to understand ethnocultural food and health practices of Aboriginal and immigrant women, and how these intersect with respect to the legacy of Aboriginal colonialism and to the social contexts of cultural adaptation and adjustment of immigrants. The findings will inform the development of visual tools for health promotion by practitioners.

Methods/Design

This four-phase study employs a case study design allowing for multiple means of data collection and different units of analysis. Phase 1 consists of a scoping review of the literature. Phases 2 and 3 incorporate pictorial representations of food choices (photovoice in Phase 2) with semi-structured photo-elicited interviews (in Phase 3). The findings from Phases 1-3 and consultations with key stakeholders will generate key understandings for Phase 4, the production of culturally appropriate visual tools. For the scoping review, an emerging methodological framework will be utilized in addition to systematic review guidelines. A research librarian will assist with the search strategy and retrieval of literature. For Phases 2 and 3, recruitment of 20-24 women will be facilitated by team member affiliations at perinatal clinics in one of the city's most diverse neighbourhoods. The interviews will reveal culturally normative practices surrounding maternal food choices and consumption, including how women negotiate these practices within their own worldview and experiences. A structured and comprehensive integrated knowledge translation plan has been formulated.

Discussion

The findings of this study will provide practitioners with an understanding of the cultural differences that affect women's dietary choices during maternity. We expect that the developed resources will be of immediate use within the women's units and will enhance counseling efforts. Wide dissemination of outputs may have a greater long term impact in the primary and secondary prevention of these high risk conditions.     

Rape against women: the magnitude, perpetrators and patterns of disclosure of events in Dar es Salaam, Tanzania

This cross-sectional household survey was conducted in Dar es Salaam between July and August 2000. The objectives were to establish the magnitude of rape against women, the perpetrators, disclosure of events and other related factors. Among the 1004 women who completed their interviews, 20% said they were ever raped. The known perpetrators were responsible for 92% of the most recent events. Whereas 34% of events were disclosed for non-legal purposes, only 10% were disclosed to the police. Repeated rape and patterns of disclosure were significantly associated with existing social relationships with the perpetrator. The results indicate that rape against women is a serious public health problem in Dar es Salaam commonly involving people who are close to the victims.     

Risk factors for cervical squamous intraepithelial lesions among HIV-1 seropositive women in Dar es Salaam, Tanzania.

OBJECTIVES: To determine the prevalence and risk factors for cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Dar es Salaam, Tanzania. METHODS: Between July 1996 and December 1997 we interviewed 691 HIV-infected women to obtain information about risk factors for SIL. Cervical smears and samples for lymphocyte subsets and sexually transmitted diseases (STD) diagnosis were collected. RESULTS: The prevalence of SIL was 2.9% (20/686) (95% CI = 1.7-4.2%). Eleven women had low-grade SIL while nine women had high-grade SIL. The number of lifetime sexual partners and live births was associated with a marginally non-significant increased risk of SIL. The risk of SIL was significantly increased among women with CD4+ cell count < 200/mm3 (multivariate odds ratio (OR) = 6.15, 95% CI = 1.19-41.37) and decreased by 68% for each 5-cm increase in mid-upper arm circumference (multivariate OR = 0.32, 95% CI = 0.10-0.93). CONCLUSIONS: HIV-related immunosuppression and wasting and long-term sexual behavior were the major determinants of SIL in this population. Federation of Gynecology and Obstetrics.     

Change in maternal concerns during the 6 weeks postpartum period: a study of primaparous mothers in Dar es Salaam, Tanzania

The purpose of this study was to describe the postpartum concerns of primiparas. A cohort study included 79 mothers in Dar es Salaam, Tanzania. Mothers sorted topics into worry, interest, and confidence. Trends of decreasing worry and increasing interest and confidence for baby-related and mother-related topics were observed from 1 to 6 weeks. At 1 week mothers worried about baby's eyes, respiration, temperature, safety, and crying; but, at 6 weeks only crying was a problem. Need for information was constant about general health, baby behavior, and care of the baby. At 1 week mothers worried about swollen perineum, and feeling tired and nervous. They wanted information about preventing hemorrhage and infection and taking care of the perineum, breasts, and nipples. Trends of increasing worry and decreasing confidence were observed with respect to family relationships. At 6 weeks, mothers worried about the husband/partner's reaction to themselves and to the baby. Confidence in relatives' reaction to themselves and the baby decreased. Being aware of the changes in the way concerns are expressed may guide nursing/midwifery interventions for mothers as to the content and timing.     

Trends in perinatal mortality at a Hong Kong hospital

Causes of perinatal mortality at Tsan Yuk Hospital, Hong Kong, were classified into 14 categories from the "P" list of stillbirths and neonatal mortality in the International Statistical Classification of Diseases, Injuries and Causes of Death. Trends for each category over the period 1970-1979 were examined by regression analysis. Overall perinatal mortality fell from 17.80 in 1970 to 10.94 in 1979. A low incidence of deaths from congenital abnormality and medical complication in the mother was observed. Significant statistical correlations were obtained in the trends in mortality associated with placental hemorrhage, pre-eclampsia, difficult labor, hemolytic disease of the newborn, and prematurity. Improvements in perinatal mortality in these areas as well as inadequacies in perinatal care in other areas, are discussed.     

Improving maternal mortality at a university teaching hospital in Nnewi, Nigeria

ObjectiveTo evaluate the impact of the introduction of the Service Compact with all Nigerians (SERVICOM) contract on maternal health at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.MethodsA retrospective and comparative study of maternal deaths between 2004 and 2010 was carried out. The main outcome measures were yearly maternal mortality ratio (MMR), relative risk (RR) of maternal mortality, and presentation–intervention interval. The yearly MMR and the RR of maternal mortality were compared with the figures from 2004, which represented the pre-SERVICOM era.ResultsThere were 4916 live births and 54 maternal deaths during the study period, giving an MMR of 1098 per 100 000 live births. Pre-eclampsia/eclampsia was the most common direct cause (25.0%), followed by hemorrhage (18.8%) and sepsis (8.3%). Anemia (12.5%) was the most common indirect cause. There was a progressive reduction in MMR and RR of maternal mortality, with a corresponding increase in live births. The presentation–intervention interval improved significantly from 2006.ConclusionA positive change in the attitude of health workers and the elimination of fee-for-service in emergency obstetric care would reduce type 3 delays in public health facilities, and consequently reduce maternal mortality.