Monjurul Hoque

Objectives. The explicit objectives of the present study were to assess the level of knowledge on pregnancy “danger signs” and HIV status, estimate the proportion of pregnant women uses health care facilities, and identify sociodemographic predictors. Methods. A cross-sectional community-based study was conducted by means of a questionnaire survey among 340 black pregnant women from the province of KwaZulu-Natal. Results. The mean age of the pregnant women was 26 years where teenage pregnancy rate was 13%. Most of the pregnant women were single (78%), less educated (60%), and unemployed (92%). Though most of the study population (92%) attended health care facilities, only half (52%) of them knew about some of the “danger signs” of pregnancy, and 39% of them knew about their HIV status. Known HIV status was related to the knowledge of pregnancy complication (P = .018). Knowledge of “danger signs” of pregnancy was significantly (P = .012) associated with the age of the expectant mother. Conclusion. Low level of knowledge on “danger signs” of pregnancy and their HIV status are observed among pregnant women. This warrants an urgent attempt to introduce health education strategies to rural population of South Africa.

Objectives: Adolescent pregnancies are known to be associated with increased risk of adverse outcomes. The objectives were to calculate the incidences of the obstetric and perinatal complications at the time of delivery of early adolescent and late adolescent mothers and then compare the same with adult pregnant mothers. Methods: A retrospective comparative study was conducted by targeting women delivered at Empangeni hospital. Mothers aged from 13-15 years were deemed as early adolescents, mothers aged from 16 – 18 years old were deemed as late adolescents and mothers aged from 19 – 21 years considered as adult pregnant mothers and were used as control groups in regards to perinatal and obstetric complications. Results: Anaemia in pregnancy was considerably high among the early adolescent pregnant mothers (23%) compared to older adolescent (15%) and adult pregnant mothers (14%). Other conditions such as pregnancy induced hypertension, eclampsia, and diabetes were not notably different among the groups. Early adolescents mothers were twice (OR = 2.022, 95% CI: 1.226 – 3.337) as likely to be anaemic during pregnancy compared to adult mothers. Low birth weight delivery, FSB and MSB rates among the groups were significantly different (p>0.05). Conclusions: Early adolescent pregnancies did not show any extra risks of obstetrics and pregnancy outcomes but socioeconomic problems may still exist. Thus to delay early conception with a view to let the young adolescent South African girls to improve their socioeconomic conditions appropriate strategies should be devised without any further delay.

Background: Detection and management of high-risk pregnancies, all the way through antenatal care, have been advocated as a high-quality mean of reducing maternal and perinatal morbidity and mortality.Objectives: This study reviewed the demographic variables, pregnancy and obstetric complications and perinatal outcomes for the years 1999 and 2004 in a rural hospital in KwaZulu-Natal Province, South Africa, with the aim of evaluating trends and gaps that may enhance appropriate strategies for improvement of antenatal care.Method: A retrospective comparative study, with representative samples of pregnant women, were randomly selected for the respective years 1999 and 2004. Descriptive statistics were calculated depending on measurement scale. A Z-test was carried out to assess the significant difference (p < 0.05) in proportions between pregnancy complications and outcomes of the groups. Multivariate logistic regression analysis was undertaken to determine the significant predictors for outcome variables.Results: The numbers of pregnancies among young women (< 25 years) increased significantly by 8% (p < 0.05) in the year 2004. Compared with 1999, the reduction in the numbers of pregnancies (1%) among higher parity (parity 5 or more) women in 2004 was remarkable. There were significant reductions of eclampsia, anaemia and post partum haemorrhage. Women with breech presentation were 3.75 times more likely to deliver preterm, and 5.45 times more likely to deliver low birth-weight babies. Similarly, women with pregnancy-induced hypertension were more likely to have preterm (OR = 3.50, 95% CI 2.83; 4.35) and low birth-weight babies (OR = 2.09, 95% CI 1.62; 2.71). Eclampsia was also a risk factor associated with preterm deliveries (OR = 6.14, 95% CI 3.74; 10.09) and low birth-weight babies (OR = 3.40, 95% CI 1.83; 6.28).Conclusion: This study suggests that further research is needed to find the causes of higher rate of teenage pregnancies and an increase in quality of antenatal care is more important in improving maternal and perinatal health. Training of staff to standard protocol and guidelines on antenatal care and care during delivery, and adherence to it, should be encouraged to improve maternal and child health in South Africa.

Background: The study was undertaken among the rural and black communities of the Uthungulu health district of the KwaZulu-Natal province, South Africa.Method: A cross-sectional community-based descriptive study was conducted. A multi-stage sampling strategy was adopted to obtain a representative sample of the communities.Results: The mean age of the population was 27 years and majority was female (54%). Among the adult population only 30% were educated, 19% were engaged in some form of economic activities while 9% were in the formal employment sector. The average monthly income per household was R1 301 (95% CI, R1 283; R1 308). The illnesses were reported by 27% of the total population over a period of one month. Notably higher rates of female individuals (29%) were sick compared to males (24%, p < 0.001). The rates of illnesses among adult females (39%) were also significantly higher than among males (31%, p < 0.009). Most of them (69%) attended primary health care (PHC) clinics for medical services, while 67% reported chronic conditions. Age (OR = 1.4), gender (OR = 0.711), education (OR = 0.64) and economic activities (OR = 1.9) were found to be associated with being ill or not.Conclusion: The rural black communities are underdeveloped and deprived, which results in higher prevalence of illnesses; however, the utilisation of PHC facilities is comparatively higher than in the rest of the province and other parts of the country. Interventions to improve community health care services among the deprived population should be focused through public health strategies such as all-encompassing PHC that includes health promotion, education and basic essential amenities.

Background: Anaemia in pregnancy is a major public health problem in developing countries. It is associated with an increased risk of maternal and perinatal morbidity and mortality. A high rate of anaemia in pregnancy in the rural population of KwaZulu-Natal (30% according to national and 57% according to the World Health Organization [WHO] definition of anaemia in pregnancy) is observed. The risk factors for anaemia, particularly during pregnancy, are multiple and complex and their relative contributions are known to vary by geographic areas and by seasons. In order to design an intervention for treatment and prevention of anaemia in pregnancy, studies to assess the aetiological factors are necessary. The aim of this study was to evaluate the strength of association between intestinal helminthiasis, urinary schistosomiasis and HIV infection on anaemia in pregnancy. Methods: A retrospective case-control study design was used in a rural district hospital of South Africa. A total of 300 pregnant women, 100 of them with anaemia (haemoglobin less than 10 gm/dL according to the national definition of anaemia in pregnancy) referred as cases and 200 controls were studied from Empangeni Hospital. Both cases and controls were matched for age, parity and gestational age. Data were collected from the antenatal clinic and prevention of mother-to-child transmission of HIV (PMTCT) programme registers for cases and controls at their booking visit during the months of May, June and July of 2004. Univariate and multiple logistic regression were performed to analyse the data. Results: Of the cases, 48% and 1% among the controls had intestinal helminthiasis, resulting in the odds ratio of 42 (p = 0,000 and 95% CI 9,96–176.59). The risk of anaemia was related to urinary schistosomiasis, as 27% of the cases compared to 1% of controls was found with anaemia. The odds ratio was 12 (p = 0,000 and 95% CI 3.58 - 41.02). These parasitic infestations are known to cause chronic haemorrhage and iron deficiency resulting in the development of anaemia in pregnancy. Transmissions of intestinal parasitic infestation occur through the faecal-oral route. Personal hygiene and other environmental factors are therefore an important factor for the transmission of the disease. To reduce the transmission of faecal- oral diseases (e.g. intestinal helminthiasis and urinary schistosomiasis) key interventions recommended are: 1) safe disposal of human excreta, 2) hand-washing practices with soap after defecation, and 3) maintenance of drinking water free from faecal contamination. Similarly, HIV infection increased the chance of developing anaemia in pregnancy twofold as HIV infection was more common among cases (56%) than among controls (37%), resulting in an odds ratio of 2.11 (p = 0,003 and 95% CI 1.123–3.21). The prevention of HIV infection and transmission can be achieved through the improvement of knowledge of these conditions. These can be achieved through health education and health promotion. Conclusion: These findings confirm and conform to other studies on the association between anaemia in pregnancy and parasitic and HIV infections. Antenatal care should promote de-worming and education on personal hygiene and HIV (risk factors, mode of transmission, etc.). The provision of safe water supply and toilet facilities for the rural communities should be considered urgently to prevent and promote better health for all, including pregnant women.

Background: Maternal and perinatal mortality remain a big challenge in developing countries, including South Africa, where the figures are amongst the highest in the world. Provision of adequate antenatal care is regarded as a cornerstone of maternal and perinatal health care and is expected to have a considerable impact on achieving the Millennium Development Goals. The detection of high-risk pregnancies through antenatal care has been advocated as a good tool to reduce maternal mortality in developing countries. The South African Government's response in terms of providing free maternal care in public health facilities is commendable but access to quality antenatal care is still questionable. We conducted this audit to evaluate the quality of antenatal care/services provided against the set national standards at the first (booking) visit, and visits at 28 and 36 weeks of gestation, as part of a quality improvement initiative. Methods: A retrospective cross-sectional descriptive study was undertaken, targeting women who attended public health institutions for antenatal care in the Empangeni sub-district of Uthungulu, which is a health district in KwaZulu-Natal province. Data were collected from 244 pregnant mothers' antenatal care records after delivery, and a random selection from a total of 5 109 women who delivered in Empangeni hospital during July to December 2004. Frequency tables were produced on the predetermined selective antenatal care indicators. A Pearson correlation test was conducted to determine the significant relations, if any, among variables. Results: The majority of the pregnant mothers were unemployed and poor. Virtually all of them (99.6%) had attended public healthcare (PHC) facilities for antenatal care (88% attended PHC clinics and the rest attended hospitals) and each woman had, on average, six antenatal visits. One quarter did not enrol for a prevention of mother-to-child transmission (PMTCT) programme. Only 9% of pregnant women booked a visit during their first trimester period but most of them (two-thirds) booked a visit during the second trimester of pregnancy. History-taking was done for every woman. Recording of haemoglobin (Hb) estimation was high at the first visit (95%) but low at 28 and 36 weeks (46% and 30% respectively). Recording of syphilis screening was very low (18%) at the first visit and only 2% was screened at 36 weeks. Only 16% received adequate treatment in cases where the results were positive. At 36 weeks, only 2% had a Wasserman reaction (WR) test done to screen syphilis at term. Over half (55%) of the pregnant women received three doses of tetanus toxoid vaccination before delivery. Conclusion: The study showed that the standard of antenatal care offered in the Empangeni sub-district fell short of the required level. This lack of proper care represents missed opportunities to impact optimally on maternal and perinatal health outcomes. Thus strategies are urgently needed to improve antenatal care through a quality improving initiative.

Background An estimated 30% of the world's population is affected with anaemia. Anaemia in pregnancy is a leading cause of maternal and perinatal deaths in developing countries. In developing countries, anaemia affects almost two thirds of the pregnant population. It is also estimated that anaemia is responsible for as much as 20% of all maternal deaths in sub-Saharan Africa. Maternal anaemia is a risk factor for infant iron deficiency anaemia and, if left uncorrected, can be associated with adverse behavioural and cognitive development in children. The prevalence of anaemia in pregnancy is estimated at between 35% and 75% in sub-Saharan Africa, however, the area-specific health problems during pregnancy are not known. In order to improve maternal health and the health of the foetus during pregnancy, knowledge of the prevalence or incidence of pregnancy-related conditions would be useful for district management teams, as well as for provincial and national maternal, child and women's health programme development. The objectives of this study were to describe haemoglobin levels and estimate the prevalence of anaemia among pregnant women at their booking visit. Methods A retrospective cross-sectional descriptive study was conducted using the antenatal clinic registers of primary healthcare (PHC) clinics in the Empangeni subdistrict of the Uthungulu Health District from July to December 2003. Data were gathered from 1 214 consecutive pregnant women who attended for antenatal care at three randomly selected primary healthcare clinics during the study period. We examined the distribution of Hb values to determine the percentages of women with anaemia (Hb < 10 gm/dL) and severe anaemia (Hb < 7 gm/dL), and compared this with the prevalence of anaemia according to the WHO definition (Hb < 11 gm/dL). Results In terms of the South African National Department of Health definition of anaemia in pregnancy, (haemoglobin < 10 gm/dL), 30.1% of the attendees were anaemic. According to the World Health Organisation (WHO) criteria (Hb < 11 gm/dL), the prevalence of anaemia was 57.3%. The difference in the prevalence of anaemia on the basis of the two different criteria was significant (p = 0.000). This finding was comparable to studies conducted in other Sub-Saharan African countries. Conclusion The prevalence of anaemia in pregnancy in this community is high. The prevalence of anaemia varied greatly when the WHO definition was used. The pregnant women of this community attend the healthcare facility very late for their booking visit, in spite of free maternity services at public health facilities. There is an urgent need for health education and health promotion programmes in this population for early booking for antenatal care. Further investigations are needed to establish the risk factors for, causes of and preventive interventions for anaemia in pregnancy.