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Linström M, Musekwa E, Nell EM, de Waard L, Chapanduka Z. The influence of hematological profiles on the transfusion management and mortality risk of mothers presenting to the obstetric unit of a South African tertiary medical facility. Transfusion 2024. [PMID: 38661229 DOI: 10.1111/trf.17849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/09/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Laboratory results are frequently abnormal in pregnant mothers. Abnormalities usually relate to pregnancy or associated complications. Hematological abnormalities and age in pregnancy may increase the likelihood for transfusion and mortality. STUDY DESIGN AND METHODS Hematological profiles and transfusion history of pregnant mothers presenting to a tertiary hospital, were evaluated over 2 years. Age, anemia, leukocytosis and thrombocytopenia were assessed for transfusion likelihood. Iron deficiency and coagulation were assessed in transfused patients. Anemia, leukocytosis, thrombocytopenia, human immunodeficiency virus (HIV) and transfusion were assessed for mortality likelihood. RESULTS There were 12,889 pregnant mothers included. Mothers <19-years-old had the highest prevalence of anemia (31.5%) and proportion of transfusions (19%). The transfusion likelihood was increased in mothers with anemia (odds ratios [OR] = 6.41; confidence intervals at 95% [95% CI] 5.46-7.71), leukocytosis (OR = 2.35; 95% CI 2.00-2.76) or thrombocytopenia (OR = 2.71; 95% CI 2.21-3.33). Mothers with prolonged prothrombin times received twice as many blood products as their normal counterparts (p = .03) and those with iron deficiency anemia five times more blood products (p < .001). Increased likelihood for mortality was seen in patients with anemia (OR = 4.15, 95% CI 2.03-8.49), leukocytosis (OR = 2.68; 95% CI 1.19-6.04) and those receiving blood transfusion (OR = 3.6, 95% CI 1.75-7.47). DISCUSSION Adolescence, anemia, leukocytosis and thrombocytopenia expose mothers to a high risk for transfusion and/or mortality. These risk factors should promptly trigger management and referral of patients. Presenting hematological profiles are strong predictors of maternal outcome and transfusion risk.
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Affiliation(s)
- Michael Linström
- Division of Hematological Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
- Division of Hematopathology, National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa
| | - Ernest Musekwa
- Division of Hematological Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
- Division of Hematopathology, National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa
| | - Erica-Mari Nell
- Division of Hematological Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
- Division of Hematopathology, National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
| | - Zivanai Chapanduka
- Division of Hematological Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
- Division of Hematopathology, National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa
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Chong KY, Solangon S, Barnhart K, Causa-Andrieu P, Capmas P, Condous G, de Waard L, Duffy JM, Horne AW, Memtsa M, Mol F, Oza M, Pesce R, Strandell A, van Wely M, Hooft JV', Vuong LN, Zhang J, Jurkovic D, Mol BW. A core outcome set for future research in ectopic pregnancy - an international consensus development study. Fertil Steril 2023; 119:804-812. [PMID: 36736812 DOI: 10.1016/j.fertnstert.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Randomised controlled trials (RCTs) evaluating ectopic pregnancy have different outcomes which are defined and measured in diverse ways, which limits their ability to inform evidence-based clinical practice. OBJECTIVE To address methodological deficiencies in published RCTs and systematic reviews, this study has developed a core outcome set to guide future research in ectopic pregnancy. DESIGN To identify potential outcomes, we performed a comprehensive literature review and interviews with individuals with lived experience in ectopic pregnancy. Potential core outcomes were then entered into a three-round Delphi survey. 154 participants from six continents, comprising healthcare professionals, researchers, and individuals with lived experience in ectopic pregnancy, completed all three rounds of the Delphi survey. Outcomes were prioritised at three consensus development meetings and recommendations were developed on how to report these outcomes where possible. SUBJECTS Healthcare professionals, researchers, and individuals with lived experience in ectopic pregnancy RESULTS: Six outcomes reached full consensus, including treatment success, resolution time, number of additional interventions, adverse events, mortality and severe morbidity, and treatment satisfaction. CONCLUSION The core outcome set with six outcomes for ectopic pregnancy will help standardise reporting of clinical trials, facilitate implementation of findings into clinical practice, and enhance patient centred care.
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Affiliation(s)
- Krystle Y Chong
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash Women's, Monash Health, Clayton, Australia.
| | - Sarah Solangon
- Institute for Women's Health, University College London, London, UK
| | - Kurt Barnhart
- Department of Obstetrics and Gynecology; Division of Reproductive Endocrinology & Infertility, Penn Medicine/University of Pennsylvania School of Medicine, Philadelphia PA, USA
| | - Pamela Causa-Andrieu
- Department of Radiology. Memorial Sloan Kettering Cancer Center, New York, United States
| | - Perrine Capmas
- Department of Obstetrics and Gynecology, Bicetre University Hospital, Paris Saclay University, Le Kremlin Bicêtre, France
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, NSW, Australia
| | - Liesl de Waard
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James Mn Duffy
- Institute for Women's Health, University College London, London, UK; King's Fertility, Fetal Medicine Research Institute, London, UK
| | - Andrew W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Maria Memtsa
- Institute for Women's Health, University College London, London, UK
| | - Femke Mol
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Netherlands
| | | | - Romina Pesce
- Department of Obstetrics and Gynecology; Division of Reproductive Medicine. Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Annika Strandell
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Madelon van Wely
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Netherlands
| | - Janneke van 't Hooft
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lan N Vuong
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, China
| | - Davor Jurkovic
- Institute for Women's Health, University College London, London, UK
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash Women's, Monash Health, Clayton, Australia; Aberdeen Centre for Women's Health Research, University of Aberdeen Aberdeen, UK
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3
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Nachega JB, Sam-Agudu NA, Machekano RN, Rosenthal PJ, Schell S, de Waard L, Bekker A, Gachuno OW, Kinuthia J, Mwongeli N, Budhram S, Vannevel V, Somapillay P, Prozesky HW, Taljaard J, Parker A, Agyare E, Opoku AB, Makarfi AU, Abdullahi AM, Adirieje C, Ishoso DK, Pipo MT, Tshilanda MB, Bongo-Pasi Nswe C, Ditekemena J, Sigwadhi LN, Nyasulu PS, Hermans MP, Sekikubo M, Musoke P, Nsereko C, Agbeno EK, Yeboah MY, Umar LW, Ntakwinja M, Mukwege DM, Birindwa EK, Mushamuka SZ, Smith ER, Mills EJ, Otshudiema JO, Mbala-Kingebeni P, Tamfum JJM, Zumla A, Tsegaye A, Mteta A, Sewankambo NK, Suleman F, Adejumo P, Anderson JR, Noormahomed EV, Deckelbaum RJ, Stringer JSA, Mukalay A, Taha TE, Fowler MG, Wasserheit JN, Masekela R, Mellors JW, Siedner MJ, Myer L, Kengne AP, Yotebieng M, Mofenson LM, Langenegger E. Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis. Clin Infect Dis 2022; 75:1950-1961. [PMID: 36130257 PMCID: PMC9214158 DOI: 10.1093/cid/ciac294] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. METHODS We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. RESULTS Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). CONCLUSIONS Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.
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Affiliation(s)
- Jean B Nachega
- Correspondence: J. B. Nachega, University of Pittsburgh School of Public Health, Department of Epidemiology, Infectious Diseases and Microbiology and Center for Global Health 130 DeSoto Street, A532 Crabtree Hall, Pittsburgh, PA 15261 ()
| | | | - Rhoderick N Machekano
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Philip J Rosenthal
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, USA
| | - Sonja Schell
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Onesmus W Gachuno
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya,Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Mwongeli
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Samantha Budhram
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
| | - Valerie Vannevel
- Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Priya Somapillay
- Maternal Foetal Medicine; Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
| | - Hans W Prozesky
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Arifa Parker
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Elizabeth Agyare
- Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Akwasi Baafuor Opoku
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aminatu Umar Makarfi
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Asara M Abdullahi
- Department of Medicine, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Chibueze Adirieje
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | | | - Marc B Tshilanda
- Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo
| | - Christian Bongo-Pasi Nswe
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo,Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo
| | - John Ditekemena
- University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Lovemore Nyasha Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michel P Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
| | - Christopher Nsereko
- Department of Medicine, Entebbe Regional Reference Hospital, Entebbe, Uganda
| | - Evans K Agbeno
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Michael Yaw Yeboah
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Lawal W Umar
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello Teaching Hospital, Zaria, Nigeria
| | - Mukanire Ntakwinja
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Denis M Mukwege
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Etienne Kajibwami Birindwa
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Serge Zigabe Mushamuka
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Edward J Mills
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - John Otokoye Otshudiema
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom,National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfred Mteta
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Nelson K Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Prisca Adejumo
- Department of Nursing, University of Ibadan, Ibadan, Nigeria
| | - Jean R Anderson
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Richard J Deckelbaum
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | - Abdon Mukalay
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judith N Wasserheit
- Departments of Global Health and Medicine, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Refiloe Masekela
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - John W Mellors
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mark J Siedner
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
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4
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van Drünick C, de Waard L, Muller CJB, Theron G. Association between gynaecological disorders and body mass index in a South African cohort: a retrospective observational study. J OBSTET GYNAECOL 2022; 42:2420-2425. [PMID: 35653780 DOI: 10.1080/01443615.2022.2069483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A retrospective observational study of new patients who visited the gynaecology outpatient clinic at Tygerberg Hospital, South Africa, between February and June 2019 was conducted to determine the association between body mass index (BMI) and gynaecological disorders. BMI was calculated and analysed concerning the presenting complaint and final diagnosis. From the sample of 651 patients, 18.4% had a normal BMI and 47.3% were classified as overweight or obese class 1. Older age was associated with a higher BMI (p = .013). Hypertension was most prevalent (26.7%) and associated with excess weight (p < .001). Disorders significantly associated with obesity were infertility (odds ratio [OR] 1.013, 95% confidence interval [CI] 0.992-1.033, p = .001), polycystic ovarian syndrome (OR 1.058, 95% CI 1.028-1.089, p = .006), pelvic organ prolapse (OR 1.027, 95% CI 0.995-1.060, p = .0291) and postmenopausal bleeding (OR 1.038, 95% CI 1.009-1.068, p = .048). Chronic pelvic pain and endometriosis were associated with a low BMI. IMPACT STATEMENTWhat is already known on this subject? It is well known that obesity has multiple negative effects on health. It affects women's health on many levels including their endocrine balance as well as pressure effects on the pelvic floor. The association between gynaecological disorders and excess weight has been described mainly in the context of separate gynaecological conditions.What the results of study add? This study described the large numbers of women with obesity in the South African context. It adds to the body of knowledge by looking at the association of BMI, not only obesity, and a large range of the most seen gynaecological conditions in the study setting.What the implications are of these findings for clinical practice and/or further research? This study highlights the importance of lifestyle and nutritional implications on women's health. For clinical practice, this knowledge needs to be applied with every opportunity to counsel women on how their weight can affect their gynaecological health. The focus of further research should focus on the most effective strategies to combat obesity in a holistic patient-centered approach.
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Affiliation(s)
- Celesté van Drünick
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Gerhard Theron
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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5
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Budhram S, Vannevel V, Botha T, Chauke L, Bhoora S, Balie GM, Odell N, Lombaard H, Wise A, Georgiou C, Ngxola N, Wynne E, Mbewu U, Mabenge M, Phinzi S, Gubu-Ntaba N, Goldman G, Tunkyi K, Prithipal S, Naidoo K, Venkatachalam S, Moodley T, Mould S, Hlabisa M, Govender L, Maistry C, Habineza JP, Israel P, Foolchand S, Tsibiyane NV, Panday M, Soma-Pillay P, Adam S, Molokoane F, Mojela MS, van Rensburg EJ, Mashamba T, Matjila M, Fawcus S, Osman A, Venter M, Petro G, Fakier A, Langenegger E, Cluver CA, Bekker A, de Waard L, Stewart C, Ngene NC, Lunda O, N Cebekhulu S, Moodley S, Koranteng-Peprah MA, Ati EMC, Maswime S, Yates LM. Maternal characteristics and pregnancy outcomes of hospitalized pregnant women with SARS-CoV-2 infection in South Africa: An International Network of Obstetric Survey Systems-based cohort study. Int J Gynaecol Obstet 2021; 155:455-465. [PMID: 34499750 PMCID: PMC9087659 DOI: 10.1002/ijgo.13917] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022]
Abstract
Objective To describe risk factors and outcomes of pregnant women infected with SARS‐CoV‐2 admitted to South African healthcare facilities. Methods A population‐based cohort study was conducted utilizing an amended International Obstetric Surveillance System protocol. Data on pregnant women with SARS‐CoV‐2 infection, hospitalized between April 14, 2020, and November 24, 2020, were analyzed. Results A total of 36 hospitals submitted data on 673 infected hospitalized pregnant women; 217 (32.2%) were admitted for COVID‐19 illness and 456 for other indications. There were 39 deaths with a case fatality rate of 6.3%: 32 (14.7%) deaths occurred in women admitted for COVID‐19 illness compared to 7 (1.8%) in women admitted for other indications. Of the women, 106 (15.9%) required critical care. Maternal tuberculosis, but not HIV co‐infection or other co‐morbidities, was associated with admission for COVID‐19 illness. Rates of cesarean delivery did not differ significantly between women admitted for COVID‐19 and those admitted for other indications. There were 179 (35.4%) preterm births, 25 (4.7%) stillbirths, 12 (2.3%) neonatal deaths, and 162 (30.8%) neonatal admissions. Neonatal outcomes did not differ significantly from those of infected women admitted for other indications. Conclusion The maternal mortality rate was high among women admitted with SARS‐CoV‐2 infection and higher in women admitted primarily for COVID‐19 illness with tuberculosis being the only co‐morbidity associated with admission. A multicenter, observational study describing the risk factors and pregnancy outcomes of women admitted with SARS‐CoV‐2 infection in South Africa, a low‐ and middle‐income country.
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Affiliation(s)
- Samantha Budhram
- Maternal Foetal Medicine Unit, Department of Obstetrics and Gynaecology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.,Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Valerie Vannevel
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
| | - Lawrence Chauke
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Shastra Bhoora
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Maternal Critical Care, Baylor College, Houston, Texas, USA
| | - Gaynor M Balie
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Natalie Odell
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Hennie Lombaard
- Department Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- Department Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Chrysanthi Georgiou
- Department Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nondumiso Ngxola
- Department of Obstetrics and Gynaecology, Frere Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Emma Wynne
- Department of Obstetrics and Gynaecology, Frere Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Unati Mbewu
- Department of Obstetrics and Gynaecology, Frere Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Mfundo Mabenge
- Department of Obstetrics and Gynecology, Dora Nginza Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Sibusiso Phinzi
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Nontsikelelo Gubu-Ntaba
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Gareth Goldman
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kay Tunkyi
- Department of Obstetrics and Gynaecology, Addington Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Sudhir Prithipal
- Department of Obstetrics and Gynaecology, Addington Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Keshree Naidoo
- Department of Obstetrics and Gynecology, Mahatma Gandhi Memorial Regional Hospital, University of KwaZulu Natal, Durban, South Africa
| | - Santhi Venkatachalam
- Department of Obstetrics and Gynecology, Mahatma Gandhi Memorial Regional Hospital, University of KwaZulu Natal, Durban, South Africa
| | - Terence Moodley
- Department of Obstetrics and Gynecology, Prince Mshiyeni Memorial Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Sean Mould
- Department of Obstetrics and Gynecology, R.K. Khan Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Mzuvele Hlabisa
- Department of Obstetrics and Gynecology, R.K. Khan Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Logie Govender
- Department of Obstetrics & Gynecology, Queen Nandi Regional Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Charlene Maistry
- Department of Obstetrics and Gynecology, Port Shepstone Regional Hospital, Port Shepstone, South Africa
| | - John P Habineza
- Department of Obstetrics and Gynecology, Port Shepstone Regional Hospital, Port Shepstone, South Africa
| | - Priya Israel
- Department of Obstetrics and Gynecology, Edendale Hospital, Pietermaritzburg, South Africa.,University of Kwazulu Natal, Durban, South Africa
| | - Serantha Foolchand
- Maternal Fetal Unit: Department of Obstetrics and Gynecology, Greys Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Nomandla V Tsibiyane
- Maternal Fetal Unit: Department of Obstetrics and Gynecology, Greys Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Mala Panday
- Department of Obstetrics and Gynaecology, King Dinizulu Hospital Complex, University of Kwazulu Natal, Durban, South Africa
| | - Priya Soma-Pillay
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics and Gynaecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Sumaiya Adam
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics and Gynaecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Felicia Molokoane
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Matthew S Mojela
- Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Elizabeth J van Rensburg
- Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Tshililo Mashamba
- Department of Obstetrics and Gynecology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Mushi Matjila
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, Cape Town, South Africa.,MRC/UCT Receptor Biology Unit, Division of Medical Biochemistry, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Sue Fawcus
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Ayesha Osman
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Mareli Venter
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gregory Petro
- Department of Obstetrics and Gynecology, New Somerset Hospital, University of Cape Town, Cape Town, South Africa
| | - Ahminah Fakier
- Department of Obstetrics and Gynecology, New Somerset Hospital, University of Cape Town, Cape Town, South Africa
| | - Eduard Langenegger
- Department of Obstetrics and Gynecology, University of Stellenbosch, Cape Town, South Africa
| | - Catherine A Cluver
- Department of Obstetrics and Gynecology, University of Stellenbosch, Cape Town, South Africa.,Translational Obstetrics Group, Mercy Perinatal, Department of Obstetrics and Gynaecology, Melbourne University, Melbourne, Victoria, Australia
| | - Adrie Bekker
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynecology, University of Stellenbosch, Cape Town, South Africa
| | - Chantal Stewart
- Department of Obstetrics and Gynecology, Mowbray Maternity Hospital, University of Cape Town, Cape Town, South Africa
| | - Nnabuike C Ngene
- Department of Obstetrics and Gynecology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Ongombe Lunda
- Department of Obstetrics and Gynecology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Sylvia N Cebekhulu
- Department of Obstetrics and Gynecology, Bongani Regional Hospital, University of Free State, Bloemfontein, South Africa
| | - Siva Moodley
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mama-Asu Koranteng-Peprah
- Department of Obstetrics and Gynaecology, Midlands/Eden Gardens private Hospital, Pietermaritzburg, South Africa
| | - Emmanuel M C Ati
- Department of Obstetrics and Gynecology, R.K. Khan Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, University of Cape Town, South Africa
| | - Laura M Yates
- Clinical Genetics Unit, Department of Paediatrics, Inkosi Albert Luthuli Central Hospital, University of Kwazulu-Natal, Durban, South Africa.,KwaZulu-Natal Research and Innovation Sequencing Platform, University of Kwazulu-Natal, Durban, South Africa
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6
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Breedt DS, Odland ML, Bakanisi B, Clune E, Makgasa M, Tarpley J, Tarpley M, Munyika A, Sheehama J, Shivera T, Biccard B, Boden R, Chetty S, de Waard L, Duys R, Groeneveld K, Levine S, Mac Quene T, Maswime S, Naidoo M, Naidu P, Peters S, Reddy CL, Verhage S, Muguti G, Nyaguse S, D'Ambruoso L, Chu K, Davies JI. Identifying knowledge needed to improve surgical care in Southern Africa using a theory of change approach. BMJ Glob Health 2021; 6:bmjgh-2021-005629. [PMID: 34130990 PMCID: PMC8208008 DOI: 10.1136/bmjgh-2021-005629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
Surgical healthcare has been prioritised in the Southern African Development Community (SADC), a regional intergovernmental entity promoting equitable and sustainable economic growth and socioeconomic development. However, challenges remain in translating political prioritisation into effective and equitable surgical healthcare. The AfroSurg Collaborative (AfroSurg) includes clinicians, public health professionals and social scientists from six SADC countries; it was created to identify context-specific, critical areas where research is needed to inform evidence-grounded policy and implementation. In January 2020, 38 AfroSurg members participated in a theory of change (ToC) workshop to agree on a vision: ‘An African-led, regional network to enable evidence-based, context-specific, safe surgical care, which is accessible, timely, and affordable for all, capturing the spirit of Ubuntu[1]’ and to identify necessary policy and service-delivery knowledge needs to achieve this vision. A unified ToC map was created, and a Delphi survey was conducted to rank the top five priority knowledge needs. In total, 45 knowledge needs were identified; the top five priority areas included (1) mapping of available surgical services, resources and providers; (2) quantifying the burden of surgical disease; (3) identifying the appropriate number of trainees; (4) identifying the type of information that should be collected to inform service planning; and (5) identifying effective strategies that encourage geographical retention of practitioners. Of the top five knowledge needs, four were policy-related, suggesting a dearth of much-needed information to develop regional, evidenced-based surgical policies. The findings from this workshop provide a roadmap to drive locally led research and create a collaborative network for implementing research and interventions. This process could inform discussions in other low-resource settings and enable more evidenced-based surgical policy and service delivery across the SADC countries and beyond.
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Affiliation(s)
- Danyca Shadé Breedt
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Balisi Bakanisi
- Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Edward Clune
- Department of Anaesthesia, University of Botswana, Gaborone, Botswana
| | | | - John Tarpley
- Department of Surgery, University of Botswana, Gabarone, Botswana
| | - Margaret Tarpley
- Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - Akutu Munyika
- Department of Surgery, University of Namibia, Windhoek, Namibia.,Department of Surgery, Onandjokwe Lutheran Hospital, Oniipa, Namibia
| | | | | | - Bruce Biccard
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Regan Boden
- Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Sean Chetty
- Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rowan Duys
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Kristin Groeneveld
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan Levine
- Department of Anthropology, Humanities Faculty, University of Cape Town, Cape Town, South Africa
| | - Tamlyn Mac Quene
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Megan Naidoo
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Priyanka Naidu
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shrikant Peters
- Executive Management, Groote Schuur Hospital, Department of Public Health and Familiy Medicine, University of Cape Town, Cape Town, South Africa
| | - Ché L Reddy
- Harvard Medical School, Boston, Massachusetts, USA
| | - Savannah Verhage
- Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Godfrey Muguti
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shingai Nyaguse
- Division of Anaesthesia, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Kathryn Chu
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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