BackgroundIn 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) set out a treatment target with the objective to help end the AIDS epidemic by 2030. This was supported by the UNAIDS ’90-90-90’ target that by 2020, 90% of all people living with HIV (PLHIV) will know their HIV status; 90% of all those diagnosed with HIV will be on sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression. The concept of offering differentiated care services using community-based models is evidence-based and is suggested as a means to bring this target into reality. This study sought to explore the possible predictors and acceptability of Community-based health service provision among PLHIV accessing ART services at the Cape Coast Teaching Hospital (CCTH) in Ghana.MethodsA qualitative study, using 5 focus group discussions (FGD) of 8 participants per group, was conducted at the HIV Clinic in CCTH, in the Central Region of Ghana. Facilitators administered open-ended topic-guided questions. Answers were audio recorded, later transcribed and combined with notes taken during the discussions. Themes around Facility-based and Community-based service delivery and sub-themes developed from the codes, were verified and analyzed by the authors, with the group as the unit for analysis.ResultsParticipants expressed preference for facility–based service provision with the construct that, it ensures comprehensive health checks before provision of necessary medications. PLHIV in this study wished that the facility-based visits be more streamlined so “stable clients” could visit twice in a year to reduce the associated time and financial cost. The main barrier to community-based service delivery was concerns about stigmatization and abandonment in the community upon inadvertent disclosure of status.ConclusionsAlthough existing evidence suggests that facility-based care was relatively more expensive and time consuming, PLHIV preferred facility-based individualized differentiated model to a community-based model. The fear of stigma and discrimination was very strong and is the main barrier to community-based model among PLHIV in this study and this needs to be explored further and managed.
Acute leukaemia is encountered rarely in obstetric practice, occurring once in every 100,000 pregnancies. Such cases are usually diagnosed in the second and third trimesters. We describe a patient who developed a postpartum haemorrhage (PPH) as the presenting feature of acute promyelocytic leukaemia, which, to the best of our knowledge, has not been reported previously.
SUMMARYAim: To estimate the rate of IUFD/Stillbirths (SB) Study design: This is a retrospective review of delivery suite records from Jan 1 2013 to Dec 31 2014. Methods: Study was undertaken at the Cape Coast Teaching Hospital (CCTH) in the Central region of Ghana. All pregnant women who had their babies at the delivery suite of CCTH have their records hand written in Ghana health service approved and distributed delivery records book. We identified all patients with IUFD/SB from this delivery suite record book which is kept on the delivery suite. The data collected included the age, parity, mode of delivery, total blood loss, sex of the foetus and condition of foetus i.e. Macerated stillbirth (MSB) or fresh still birth (FSB). Of the 315 IUFDs found in the records book, 26 were incompletely filled, and 13 were abortions (<28 weeks) and therefore excluded. The analysis is therefore based on 276 completed documentations. The data collected from the delivery suite records were analysed using STATA version 11.0. Results: Of the 315 IUFD/SBs documented in the delivery suite record book, 13 were abortions (<28 weeks), leaving 302 IUFD/SBs. Of this number, 26 had incomplete data and were excluded from the analysis. The analysis was thus based on 276 IUFD/SBs with complete data. Over the study period there were 5176 deliveries, giving a stillbirth rate of 58.5/1000 deliveries. Majority of the IUFD occurred in women 20-35 years of age (74.7%), and who have had two or less births (66.7%). The mean maternal age at which IUFD occurred was 29 years. Conclusion: Our review shows that the SBR of 58.5/1000, over the two years, at CCTH is high. We suggest further studies to focus on the reasons for IUFDs and what interventions can be applied to reduce it.
Funding:No internal or external funds sourced.
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