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Skytte TB, Holm-Hansen CC, Ali SM, Ame S, Molenaar J, Greisen G, Poulsen A, Sorensen JL, Lund S. Risk factors of stillbirths in four district hospitals on Pemba Island, Tanzania: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:288. [PMID: 37101264 PMCID: PMC10131471 DOI: 10.1186/s12884-023-05613-6] [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: 12/07/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND More than 2 million third-trimester stillbirths occur yearly, most of them in low- and middle-income countries. Data on stillbirths in these countries are rarely collected systematically. This study investigated the stillbirth rate and risk factors associated with stillbirth in four district hospitals in Pemba Island, Tanzania. METHODS A prospective cohort study was completed between the 13th of September and the 29th of November 2019. All singleton births were eligible for inclusion. Events and history during pregnancy and indicators for adherence to guidelines were analysed in a logistic regression model that identified odds ratios [OR] with a 95% confidence interval [95% CI]. RESULTS A stillbirth rate of 22 per 1000 total births in the cohort was identified; 35.5% were intrapartum stillbirths (total number of stillbirths in the cohort, n = 31). Risk factors for stillbirth were breech or cephalic malpresentation (OR 17.67, CI 7.5-41.64), decreased or no foetal movements (OR 2.6, CI 1.13-5.98), caesarean section [CS] (OR 5.19, CI 2.32-11.62), previous CS (OR 2.63, CI 1.05-6.59), preeclampsia (OR 21.54, CI 5.28-87.8), premature rupture of membranes or rupture of membranes 18 h before birth (OR 2.5, CI 1.06-5.94) and meconium stained amniotic fluid (OR 12.03, CI 5.23-27.67). Blood pressure was not routinely measured, and 25% of women with stillbirths with no registered foetal heart rate [FHR] at admission underwent CS. CONCLUSIONS The stillbirth rate in this cohort was 22 per 1000 total births and did not fulfil the Every Newborn Action Plan's goal of 12 stillbirths per 1000 total births in 2030. Awareness of risk factors associated with stillbirth, preventive interventions and improved adherence to clinical guidelines during labour, and hence improved quality of care, are needed to decrease the stillbirth rate in resource-limited settings.
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Affiliation(s)
- Tine Bruhn Skytte
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark.
| | - Charlotte Carina Holm-Hansen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
| | | | - Shaali Ame
- Public Health Laboratory, Ivo de Carneri, Pemba, Tanzania
| | - Jil Molenaar
- Reproductive and Maternal Health Research Group, Public Health Department, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Family Medicine and Population Health (FAMPOP), Faculty of Medical Sciences, University of Antwerp, Antwerp, Belgium
| | - Gorm Greisen
- Department of Neonatology, Juliane Marie Center, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
| | - Jette Led Sorensen
- Juliane Marie Centre for Children, Women and Reproduction, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stine Lund
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Neonatology, Juliane Marie Center, University Hospital Copenhagen, Copenhagen, Denmark
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Salim H, Shariff Ghazali S, Lee PY, Cheong AT, Harrun NH, Mohamed Isa S, Pinnock H. Health literacy levels and its determinants among people with asthma in Malaysian primary healthcare settings: a cross-sectional study. BMC Public Health 2021; 21:1186. [PMID: 34158013 PMCID: PMC8218499 DOI: 10.1186/s12889-021-11194-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/27/2020] [Accepted: 06/03/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Limited health literacy among people with asthma is associated with poor adherence to self-management activities, thus poor clinical outcomes. This study aimed to determine the prevalence of health literacy level and its determinants among people with asthma in the Malaysian primary healthcare settings. METHOD A cross-sectional study was conducted among participants aged > 18 years with asthma who attended five primary health clinics in Malaysia. Systematic random sampling was employed with a final sample of 550 participants. The questionnaires included the validated Malay version of Health Literacy Scale (HLS) and asthma control questionnaire (ACQ). Statistical analysis was done using SPSS version 25. Multiple logistic regression was performed to determine the determinants for limited health literacy. RESULTS The participants mean age of the participants was 48 (SD15.4) years. Most of the participants were women (64%) and of Malay ethnicity (51.1%). Nearly half had a secondary level of education, n = 112, (45.8%). Mean duration of asthma diagnosis is 20.6 (SD 15.9) years. More than half (62.5%) had a family history of asthma. About half (50.9%) had uncontrolled asthma, with 87.3% self-rated themselves as having controlled asthma. About a third (29.1%) received education on of asthma action plan, but only 7.1% of these owned a written version an asthma action plan. Limited health literacy accounts for 60.5% of the participants. The significant determinants for limited health literacy included lower educational attainment (p < 0.001), family history of asthma (p = 0.034), < 20 years duration of asthma diagnosis (p = 0.031) and not receiving asthma action plan education (p < 0.001). CONCLUSION In this study population, more than half of the people living with asthma were found to have limited health literacy, which was associated with not having received self-management education supported by an asthma action plan. Future interventions should include strategies that ensure they meet the needs of people with limited health literacy.
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Affiliation(s)
- H Salim
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia. .,NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, EH89AG, United Kingdom.
| | - S Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.,Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, 43400, Selangor, Malaysia
| | - P Y Lee
- UM eHealth Unit, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Petaling Jaya, Kuala Lumpur, Malaysia
| | - A T Cheong
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - N H Harrun
- Pandamaran Health Clinic, Ministry of Health, Persiaran Raja Muda Musa, Klang, 42000, Selangor, Malaysia
| | - S Mohamed Isa
- Botanik Health Clinic, Ministry of Health, Jalan Langat, Klang, 41200, Selangor, Malaysia
| | - H Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, EH89AG, United Kingdom
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Solomon SS, Boon D, Saravanan S, Srikrishnan AK, Vasudevan CK, Balakrishnan P, Persaud D, Ray SC, Mehta S, Mehta SH. Diversity of hepatitis C virus infection among HIV-infected people who inject drugs in India. Virusdisease 2019; 30:490-497. [PMID: 31897414 PMCID: PMC6917681 DOI: 10.1007/s13337-019-00553-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022] Open
Abstract
The availability of generic direct acting antivirals (DAAs) for hepatitis C virus (HCV) treatment has prompted many low-and-middle-income countries to launch HCV elimination programs. Because the efficacy of some of these generic DAAs varies by HCV viral subtype, information on subtype distribution can contribute important information to these elimination programs. We conducted a cross-sectional serosurvey to characterize HCV subtype diversity among HIV positive people who inject drugs (PWID) across 14 cities in India. Of 801 HIV positive PWID sampled, 639 tested HCV antibody positive (78.9%). Among 105 samples sequenced, genotype 3 (58.1%) was the most commonly observed followed by genotype 1 (36.2%) and genotype 6 (5.7%). Of the genotype 3 infections, 65% were subtype 3a and 35% were subtype 3b. Of the genotype 1 infections, 94% were subtype 1a and 6% were subtype 1b. All genotype 6 samples were subtype 6n. There was some variability in genotype diversity depending on geographic region and PWID epidemic stage with greater diversity observed in older PWID epidemics. One sequence, HY018, did not cluster with any known reference sequences in phylogenetic analysis. Nearly 80% of HIV infected PWID across India are co-infected with HCV, and subtype prevalence and genetic diversity varied by region and PWID epidemic stage. HCV elimination programs in India will need to consider HCV subtype.
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Affiliation(s)
- S. S. Solomon
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - D. Boon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - S. Saravanan
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - C. K. Vasudevan
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - P. Balakrishnan
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - D. Persaud
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - S. C. Ray
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - S. Mehta
- Department of Medicine, University of California at San Diego School of Medicine, La Jolla, CA USA
| | - S. H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Dookeeram D, Bidaisee S, Paul JF, Nunes P, Robertson P, Maharaj VR, Sammy I. Polypharmacy and potential drug-drug interactions in emergency department patients in the Caribbean. Int J Clin Pharm 2017; 39:1119-27. [PMID: 28795285 DOI: 10.1007/s11096-017-0520-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 08/02/2017] [Indexed: 10/31/2022]
Abstract
Background Potential Drug-Drug Interactions (DDI) account for many emergency department visits. Polypharmacy, as well as herbal, over-the-counter (OTC) and combination medication may compound this, but these problems are not well researched in low-and-middle-income countries. Objective To compare the incidence of drug-drug interactions and polypharmacy in older and younger patients attending the Emergency Department (ED). Setting The adult ED of a tertiary teaching hospital in Trinidad. Methods A 4 month cross sectional study was conducted, comparing potential DDI in older and younger patients discharged from the ED, as defined using Micromedex 2.0. Main outcome measure The incidence and severity of DDI and polypharmacy (defined as the use of ≥5 drugs simultaneously) in older and younger patients attending the ED. Results 649 patients were included; 275 (42.3%) were ≥65 years and 381 (58.7%) were female. There were 814 DDIs, of which 6 (.7%) were contraindications and 148 (18.2%) were severe. Polypharmacy was identified in 244 (37.6%) patients. Older patients were more likely to have potential DDI (67.5 vs 48.9%) and polypharmacy (56 vs 24.1%). Herbal products, OTC and combination drugs were present in 8, 36.7 and 22.2% of patients, respectively. On multivariate analysis, polypharmacy and the presence of hypertension and ischaemic heart disease were associated with an increased risk of potential DDI. Conclusion Polypharmacy and potential drug-drug interactions are common in ED patients in the Caribbean. Older patients are particularly at risk, especially as they are more likely to be on multiple medications. The association between herbal medication and polypharmacy needs further investigation. This study indicates the need for a more robust system of drug reconciliation in the Caribbean.
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