Postnatal salivary cortisol and sense of coherence (SOC) in Eritrean mothers

This pilot study explores possible physiological correlates of maternal sense of coherence (SOC) by looking at salivary cortisol levels in Eritrean mothers during the immediate pre‐ and postnatal period. Samples of pre‐ and postnatal resting whole saliva were obtained from 19 mothers and from 31 controls in Ghinda. Radioimmunoassay results revealed no differences between prenatal and control concentrations of salivary cortisol, but postnatal levels were significantly lower (P < 0.014). Mothers who delivered in hospital had significantly higher SOC scores compared to those who opted for home birth (P < 0.045). This difference was particularly pronounced in the comprehensibility subscale of the SOC scores (P < 0.037). Moreover, mothers with higher comprehensibility scores showed significantly lower postnatal cortisol levels (P < 0.017). No associations were found between cortisol and age or parity. The implications of these findings for maternity health service policy and practice in Eritrea are considered. Am. J. Hum. Biol. 17:376–379, 2005. © 2005 Wiley‐Liss, Inc.     

Trauma Care in Africa: A Status Report From Botswana, Guided by the World Health Organization’s “Guidelines for Essential Trauma Care”

Background

Trauma represents a significant and increasing challenge to health care systems all over the world. This study aimed to evaluate the trauma care capabilities of Botswana, a middle-income African country, by applying the World Health Organization’s Guidelines for Essential Trauma Care.

Methods

All 27 government (16 primary, 9 district, 2 referral) hospitals were surveyed. A questionnaire and checklist, based on “Guidelines for Essential Trauma Care” and locally adapted, were developed as situation analysis tools. The questionnaire assessed local trauma organization, capacity, and the presence of quality improvement activity. The checklist assessed physical availability of equipment and timely availability of trauma-related skills. Information was collected by interviews with hospital administrators, key personnel within trauma care, and through on-site physical inspection.

Results

Hospitals in Botswana are reasonably well supplied with human and physical resources for trauma care, although deficiencies were noted. At the primary and district levels, both capacity and equipment for airway/breathing management and vascular access was limited. Trauma administrative functions were largely absent at all levels. No hospital in Botswana had any plans for trauma education, separate from or incorporated into other improvement activities. Team organization was nonexistent, and training activities in the emergency room were limited.

Conclusions

This study draws a picture of trauma care capabilities of an entire African country. Despite good organizational structures, Botswana has room for substantial improvement. Administrative functions, training, and human and physical resources could be improved. By applying the guidelines, this study creates an objective foundation for improved trauma care in Botswana.     

Perceptions of home and self-injection of Sayana® Press in Ethiopia: a qualitative study

Objective

Sayana® Press,¹ a new subcutaneous formulation and presentation of a popular injectable contraceptive, has the potential to expand non-clinic access to contraception, including home and self-injection (HSI). This study collected information from potential users and stakeholders on their perceptions and preferences, the feasibility of an HSI of Sayana Press program and key policy considerations.

Study design

PATH conducted 62 interviews and 7 focus groups with family planning users, non-users, physicians, other health care providers and key informants in the Oromia region of Ethiopia. Participants watched a demonstration and tested the device on a model mid-interview. The study did not involve product use in humans.

Results

Women found the product easy to use, liked the simple design and valued the time and expense that could be saved through HSI of Sayana Press (HSI-SP). Of those with inhibitions about their ability to self-inject, most shifted their opinion favorably after demonstration. The majority of other stakeholders also supported HSI-SP and thought it could increase contraceptive use in Ethiopia, and they suggested that any successful program must include proper training and supervision, particularly regarding product storage and waste management.

Conclusion

The data provide findings to stimulate further research and support future planning. They suggest that HSI-SP may meet the needs of many women if key requirements and challenges are met. It may also be necessary to revise policies and guidelines to integrate the approach with national family planning strategies.

Implications

This study provides the first available data on perceptions, feasibility and requirements for HSI of Sayana Press in a low-resource setting. Findings provide insights that may guide future implementation strategies, strengthen non-clinic family planning access programs and stimulate continued research.     

Magnitude of metabolic syndrome and its predictors among patients on second-generation antipsychotic drugs at six psychiatry clinics and mental hospitals,in Addis Ababa,Ethiopia, 2019; Multicenter cross-sectional study

AimsSecond-generation antipsychotics are an important component in the management of psychiatric conditions but their use can also lead to weight gain, diabetes, and dyslipidemia. Thus, this study aimed to assess the magnitude of metabolic syndrome and its predictors among patients who were on second-generation antipsychotic drugs at six psychiatry Hospitals, in Addis Ababa, Ethiopia, 2019.MethodThis study was conducted using a Multicenter cross-sectional study design. Medical charts of 510 patients on second-generation antipsychotic drugs who were selected by convenience sampling method and complete patients' charts were included in this study. Data was gathered using a checklist from patients’ medical charts. To identify the determinants of metabolic syndrome, a logistic regression model was used.ResultFrom a total of 510 patients’ Medical charts on the second-generation antipsychotic drugs, 270 (52.9%) of them were females and 240 (47.1%) were males. The magnitude of metabolic syndrome among patients receiving second-generation antipsychotic drugs was found to be 88 (17.8%). Age, education, family history of cardiovascular disease, and type of second-generation antipsychotic drugs are found to be significantly associated factors with metabolic syndrome.ConclusionsConsiderable proportion of patients receiving second-generation antipsychotic medications have metabolic syndrome.     

Cardiovascular disease management: the need for better diagnostics

Current diagnostic testing for cardiovascular pathology usually rests on either physiological or anatomic measurement. Multiple tests must then be combined to arrive at a conclusion regarding treatment of a specific pathology. Much of the diagnostic decisions currently made are based on rough estimates of outcomes, often derived from gross anatomic observations or extrapolation of physical laws. Thus, intervention for carotid and coronary disease is based on estimates of diameter stenosis, despite data to suggest that plaque character and lesion anatomy are important determinants of outcome. Similarly, abdominal aortic aneurysm (AAA) intervention is based on maximal aneurysm diameter without regard for arterial wall composition or individual aneurysm geometry. In other words, our current diagnostic tests do not reflect the sophistication of our current knowledge of vascular disease. Using a multimodal approach, computer modeling has the potential to predict clinical outcomes based on a variety of factors including arterial wall composition, surface anatomy and hemodynamic forces. We term this more sophisticated approach “patient specific diagnostics”, in which the computer models are reconstructed from patient specific clinical visualizing modalities, and material properties are extracted from experimental measurements of specimens and incorporated into the modeling using advanced material models (including nonlinear anisotropic models) and performed as dynamic simulations using the FSI (fluid structure interaction) approach. Such an approach is sorely needed to improve the effectiveness of interventions. This article will review ongoing work in “patient specific diagnostics” in the areas of carotid, coronary and aneurismal disease. We will also suggest how this approach may be applicable to management of aortic dissection. New diagnostic methods should allow better patient selection, targeted intervention and modeling of the results of different therapies.     

Primary care treatment of epilepsy in rural Ethiopia: Causes of default from follow-up

BackgroundIn 1998, we set up nurse-led epilepsy clinics in five rural health centres around Gondar in northern Ethiopia. Despite good treatment outcomes, two years after registration only 40% of patients were still under follow-up.AimThe purpose of this study was to examine the causes of default and factors that might improve adherence to follow-up.MethodThe study was carried out at one of the five health centres. Patients who had defaulted from follow-up were identified from the clinic register. Trained enumerators visited the patients’ villages and administered a questionnaire to the patients, or relatives if the patient was not available.Results113 patients were traced. 28 (25%) had died and 21 (19%) had moved from the area. Of the remaining 64 patients, seven were accessing treatment from another source and 13 were in remission off treatment. 44 patients were still experiencing seizures and were on no treatment or had reverted to traditional remedies. The main reason given for default, in 44% of the patients, was difficulty in travelling to the health centre. 12% claimed that they preferred traditional remedies and 9% felt that they had not been improved by medical treatment.ConclusionDespite decentralisation of care to rural health centres, the most common reason for default was the distance to travel to the health centre. Further decentralisation of care to a community level coupled with improved education may reduce default from follow-up.     

Child health in arid areas of Ethiopia: longitudinal study of the morbidity in infectious diseases.

We describe the incidence of some childhood infections in drought prone areas of southern Ethiopia. Our results are based on 24 months' biweekly observations of 828 children aged 0-5 years in the pastoralist community of Dubluk and the agricultural community of Elka. An average of 23% of the children in Dubluk and 13% in Elka were sick during any 2-week period. Diarrhoeal diseases represented the main cause of morbidity, but the yearly number of diarrhoeal episodes were lower than previously reported from Ethiopia. Respiratory tract infections and to a lesser extent diarrhoeal diseases, showed highest incidence rates during the main dry season. The highest incidence of lower respiratory tract infections coincided with an outbreak of measles. In Dubluk, children who lived near to the wells had higher incidence rates than those who lived further away, probably reflecting the importance of crowding on transmission rates. In Elka, literacy of mothers was associated with reduced incidence of both diarrhoeal and respiratory tract infections, whereas the use of open pit latrines was associated with increased diarrhoeal incidence. The decline in disease incidence in this region during the last months of our study may reflect an improvement of nutritional status.