BackgroundPreeclampsia is among the leading causes of maternal mortality and morbidity worldwide, occurs in 2-8% of all pregnancies, and is estimated to account for at least 9 % of maternal deaths in Africa. Studies from developed countries show that high pre pregnancy body mass index (BMI) increases the risk of preeclampsia. We examined the association between pre pregnancy BMI and the risk of preeclampsia in Tanzania, a low income country.MethodsData from the Kilimanjaro Christian Medical Center (KCMC) Medical Birth Registry recorded between July 2000 and May 2013 were used. We restricted the study population to singleton deliveries among women with no or one previous pregnancy. Pre pregnancy BMI (kg/m2) was categorized according to the WHO categories of underweight (less than 18.5), normal (18.5 – 24.9), overweight (25.0 – 29.9) and obese (30 or more). Potential confounders were adjusted for in multivariable analyses.ResultsAmong the 17,738 singleton births, 6.6% of the mothers were underweight, 62.1% were of normal BMI, 24.0% were overweight, and 7.3% were obese. Five hundred and eighty-two pregnancies (3.3%) were affected by preeclampsia. Compared to those with normal BMI, overweight and obese women had a higher risk of preeclampsia (aOR (95% CI) 1.4 (1.2 – 1.8) and 1.8 (1.3 – 2.4)), respectively, while underweight women had a lower risk (0.7 (0.4-1.1)).ConclusionsPre pregnancy maternal overweight and obesity were associated with an increased risk of preeclampsia in Tanzania. Risks were similar to those reported in high income countries.
Introduction Unintended pregnancy, a major global health issue resulting in unsafe terminations of pregnancy and maternal deaths in low‐ and middle‐income countries, could be significantly reduced through increased use of modern contraception, including long‐acting reversible contraceptives (LARC). Training of healthcare providers to administer such contraceptives may improve uptake. We conducted a systematic review to collate the end‐user uptake data following training of healthcare providers in low‐ and middle‐income countries. Material and methods We searched PubMed, Embase, the Global Health Library and the Cochrane Library up to 23 May 2020. The review was restricted to low‐ and middle‐income countries and focused on healthcare providers who had received training in LARC. Studies that reported contraceptive uptake among women, preference of LARC among healthcare workers and/or women, and unplanned pregnancies within 12 months of LARC initiation were included. All included studies underwent quality assessment using either the Cochrane Risk of Bias Tool or the Newcastle‐Ottawa Scale. PROSPERO registration number CRD42020185291. Results A total of 28 studies (end‐users n = 6 112 544) were included (27 cohort studies and one randomized trial). Nineteen studies were set in Africa, five in Asia, one in Central America and four were multi‐country studies. Twenty‐eight studies reported LARC use among women, and 25 studies found an increase in uptake of LARC by women using short‐acting methods switching to longer‐acting methods or by recruiting new users of LARC. The randomized controlled trial was assessed as high quality and reported positive findings; however, there was great heterogeneity in the type of intervention and of how outcomes were measured among the other included studies. Further, the quality of these studies varied, although it should be noted that the poor‐quality studies reflected the trends of those of higher quality. Conclusions Despite heterogeneity, current evidence indicates that training of healthcare providers in LARC may increase the uptake among women in low‐ and middle‐income countries. More robust studies are warranted to inform policy.
Background: HIV infection is a common risk for developing cervical cancer (CC). Routine screening for CC among women living with Human Immune Deficiency Virus (WLHIV) is recommended for early detection and control of pre-malignancies. Evidence on CC uptake and its associated factors is scanty among WLHIV in Tanzania similar to other sub-Saharan Africa (SSA) countries. This study therefore aimed to assess the uptake of CC screening and its associated factors among WLHIV in Tanzania. Methods: This cross-sectional study was conducted between June and September 2020 among WLHIV attending Care and Treatment Center (CTC) at the Kilimanjaro Christian Medical Center (KCMC). Data was collected through face to face interview using a pre-tested standardized questionnaire interviewed in Swahili. Analyses were conducted using descriptive statistics to establish the CC uptake and using regression analyses to characterize the CC screening uptake and factors associated with the CC uptake through SPSS version 23 software. Associations with P<0.05 were considered statistically significant. Results: A total of 341 WLHIV with mean age 45.6 years (SD 10.8) were recruited for interview. Of them, 184 (54%) WLHIV reported ever being screened for cervical cancer. After adjusting for confounders, knowledge of the screening methods was one of the factors associated with uptake of CC screening [AOR=15.61, (95% CI: 7.93-30.72), p<0.0001]. Other factors included living with HIV for at least 10 years since diagnosis [AOR=2.83; (95% CI: 1.11-7.26), P=0.030]; having knowledge of CC [AOR= 1.75, (95% CI: 1.02-3.01), p=0.041]; and having knowledge of the signs or symptoms of CC [AOR=1.95, (95% CI: 1.17-3.27), p=0.011]. Conclusion: More than four in ten WLHIV attending CTC at KCMC have never been screened for cervical cancer. Knowledge of the available screening methods, the disease condition, and duration since fist HIV diagnosis were associated with CC uptake of the screening. Addressing low CC screening uptake in Tanzania call strengthening WLHIV’s knowledge on cervical cancer screening methods, its signs, symptoms and their risk profiles. Moreover, strengthening CC screening capacity through integrated care and strengthening health providers’ capacity for counseling and screening will lead into a sustainable and effective care.
Trauma to the perineum following vaginal delivery is common and can lead to anal incontinence and pain but can be prevented by perineal support. However, the incidence and how to prevent perineal injury in sub Saharan Africa has not previously been described. The objective of the study was to assess the incidence of perineal trauma at vaginal delivery and to assess a training intervention in perineal support using a criterion-based audit (CBA) design. A CBA was conducted at Kilimanjaro Christian Medical Centre in Tanzania. In total, 552 women who delivered vaginally were included, of whom 80% completed a follow-up interview after three months. Perineal support as trained for this study was not performed before the intervention but was performed in 78.6% of deliveries after the intervention (p<0.000). The number of women with second degree lacerations decreased after the intervention (RR 0.74, CI: 0.61-0.90), and more had an intact perineum (RR 2.85, CI: 1.74-4.69). Anal sphincter lacerations were not significantly changed by the intervention (6.6 to 3.4%, RR 0.52, CI: 0.24-1.14). The frequency of anal incontinence changed insignificantly from 6.1 to 4.9% (RR 0.81, CI: 0.37-1.77) after intervention. Perineal pain three months after delivery was reduced by 72% (RR 0.28, CI: 0.15-0.52). The study demonstrates that CBA may be useful in introducing a simple intervention such as perineal support thereby decreasing the number of women having perineal trauma following vaginal delivery. However, the impact of our intervention on the sustainability of our observations is uncertain and must await long-term studies.
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