Laboratory experiments were carried out to assess the water purification and antimicrobial properties of Moringa oleifera (MO). Hence different concentrations (25 to 300 mg/L) were prepared from a salt (1 M NaCl) extract of MO fine powder and applied to natural surface water whose turbidity levels ranged from 50 to 450 NTU. The parameters determined before and after coagulation were turbidity, pH, colour, hardness, iron, manganese and Escherichia coli. The experiments showed that turbidity removal is influenced by the initial turbidity since the lowest turbidity removal of 83.2% was observed at 50 NTU, whilst the highest of 99.8% was obtained at 450 NTU. Colour removal followed the same trend as the turbidity. The pH exhibited slight variations through the coagulation. The hardness removal was very low (0 to 15%). However, high removals were achieved for iron (90.4% to 100%) and manganese (93.1% to 100%). The highest E. coli removal achieved was 96.0%. Its removal was associated with the turbidity removal. The optimum MO dosages were 150 mg/L (50 NTU and 150 NTU) and 125 mg/L for the rest of the initial turbidity values. Furthermore all the parameters determined satisfied the WHO guidelines for drinking water except for E. coli.
BackgroundIn low-resource settings, access to emergency cesarean section is associated with various delays leading to poor neonatal outcomes. In this study, we described the delays a mother faces when needing emergency cesarean delivery and assessed the effect of these delays on neonatal outcomes in Rwanda.MethodsThis retrospective study included 441 neonates and their mothers who underwent emergency cesarean section in 2015 at three district hospitals in Rwanda. Four delays were measured: duration of labor prior to hospital admission, travel time from health center to district hospital, time from admission to surgical incision, and time from decision for emergency cesarean section to surgical incision. Neonatal outcomes were categorized as unfavorable (APGAR <7 at 5 min or death) and favorable (alive and APGAR ≥7 at 5 min). We assessed the relationship between each type of delay and neonatal outcomes using multivariate logistic regression.ResultsIn our study, 9.1% (40 out of 401) of neonates had an unfavorable outcome, 38.7% (108 out of 279) of neonates’ mothers labored for 12–24 h before hospital admission, and 44.7% (159 of 356) of mothers were transferred from health centers that required 30–60 min of travel time to reach the district hospital. Furthermore, 48.1% (178 of 370) of cesarean sections started within 5 h after hospital admission and 85.2% (288 of 338) started more than 30 min after the decision for cesarean section was made. Neonatal outcomes were significantly worse among mothers with more than 90 min of travel time from the health center to the district hospital compared to mothers referred from health centers located on the same compound as the hospital (aOR = 5.12, p = 0.02). Neonates with cesarean deliveries starting more than 30 min after decision for cesarean section had better outcomes than those starting immediately (aOR = 0.32, p = 0.04).ConclusionsLonger travel time between health center and district hospital was associated with poor neonatal outcomes, highlighting a need to decrease barriers to accessing emergency maternal services. However, longer decision to incision interval posed less risk for adverse neonatal outcome. While this could indicate thorough pre-operative interventions including triage and resuscitation, this relationship should be studied prospectively in the future.
Over 50% of referrals were completed in a timely fashion due to a strong referral system and a patient support program. Empowering district hospitals with trained staff and appropriate equipment could reduce the need for referral, and increasing surgeons at referral hospitals could reduce referral delays.
Background
There are few prospective studies of outcomes following surgery in rural district hospitals in sub‐Saharan Africa. This study aimed to estimate the prevalence and predictors of surgical‐site infection (SSI) following caesarean section at Kirehe District Hospital in rural Rwanda.
Methods
Adult women who underwent caesarean section between March and October 2017 were given a voucher to return to the hospital on postoperative day (POD) 10 (±3 days). At the visit, a physician evaluated the patient for an SSI. A multivariable logistic regression model was used to identify risk factors for SSI, built using backward stepwise selection.
Results
Of 729 women who had a caesarean section, 620 were eligible for follow‐up, of whom 550 (88·7 per cent) returned for assessment. The prevalence of SSI on POD 10 was 10·9 per cent (60 women). In the multivariable analysis, the following factors were significantly associated with SSI: bodyweight more than 75 kg (odds ratio (OR) 5·98, 1·56 to 22·96; P = 0·009); spending more than €1·1 on travel to the health centre (OR 2·42, 1·31 to 4·49; P = 0·005); being a housewife compared with a farmer (OR 2·93, 1·08 to 7·97; P = 0·035); and skin preparation with a single antiseptic compared with a combination of two antiseptics (OR 4·42, 1·05 to 18·57; P = 0·043). Receiving either preoperative or postoperative antibiotics was not associated with SSI.
Conclusion
The prevalence of SSI after caesarean section is consistent with rates reported at tertiary facilities in sub‐Saharan Africa. Combining antiseptic solutions for skin preparation could reduce the risk of SSI.
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