Childhood immunization in Mmakaunyane village in the North West Province of South Africa

Sat, 01 Jan 2011 00:00:00 GMT

Childhood immunization in Mmakaunyane village in the North West Province of South Africa Sehume, Kgomotso Lovey ABSTRACT BACKGROUND AND OBJECTIVE: Immunization is one of the most cost effective preventative health care interventions that is available to communities; it has greatly reduced the burden of infectious diseases in childhood. Since the W orId Health Organization launched the expanded programme of immunization in 1974, routine childhood immunization is widely available and it forms an integral part of preventative healthcare. Unfortunately, many children lack access to this life saving health care intervention. Communities in poor, rural areas often lack access to basic services, including health care and immunization services. We studied immunization coverage in a poor, rural community in South Africa and further explored what factors put children in this community at risk for under-immunization. METHOD: This was a cross sectional study, in which the immunization status of children from birth to six years of age living in Mmakaunyane was assessed. The primary caregivers of these children were also interviewed to determine their knowledge, attitudes and their practices with regards to immunizations; they were further asked about their perception of healthcare service delivery in the village. Using a map of the village, it was divided it into 30 blocks with 4 clusters in each block. Field workers were looking for a maximum of 5 eligible children in each cluster. We used the Road to Health Card to check if immunization was complete for age according to the SA EPI. RESUL TS: There were 567 children enrolled in the study. The majority of the children were above 18 months of age (64.4%) We found that 92.1 % of children were in possession of a RHC. In total, 432 (76.2%) of the children were fully immunized for their age, 97 (17.1%) had incomplete immunizations and immunization status was unknown for 38 (6.7%). The primary caregiver for most of the children was the biological mother (85.5%). There was a low level of education amongst the primary caregivers with only 15.3% having completed matric or attained higher level of education. Caregiver knowledge of immunization was poor and only 21.1 % of caregivers correctly mentioned three diseases that can be prevented by immunization. The majority of the caregivers (96.0%) believed that immunizations help to keep children healthy. Approximately half (49.9%), of the caregivers perceived immunization service delivery in Mmakaunyane village to be good. Factors that were found to be associated with incomplete immunization included age of caregiver, gender of the child and knowledge of the caregiver on immunization. CONCLUSION: Only 76.2% of children were fully immunized for their age in Mmakaunyane village. This immunization coverage rate is less than the National target of 90% for all children aged one year. The proportion of children under one year of age that are fully immunized is higher than that of the whole group. This indicates that the older children have a lesser level of immunization coverage (>18 months: 74.2%). The major factors that were found to be associated with under-immunization include lack of knowledge about immunizations, older age of the caregiver as well as poor accessibility of health care services. Female children were also found to be at increased risk for under-immunization. Measures to improve immunization coverage in this community need to take all these factors into consideration Thesis (M Med (Paediatrics and Child Health)-- University of Limpopo, 2011.

The Association between iron deficiency anaemia and academic performance of children focusing on grade II pupils in the Winterveldt region, Tshwane North, South Africa

Sat, 01 Jan 2011 00:00:00 GMT

The Association between iron deficiency anaemia and academic performance of children focusing on grade II pupils in the Winterveldt region, Tshwane North, South Africa Hlatshwayo, Bongiwe P. S. ABSTRACT BACKGROUND AND OBJECTIVES: Iron deficiency anaemia (IDA) is the most common nutritional disorder in the developing world. A large number of children under the age of 5 years do not reach their developmental potential, IDA and iron deficiency being well documented risk factors. IDA has been shown to be an important cause for decreased attention span, reduced alertness and learning difficulties in both young children and adolescents. South Africa has a growing burden of anaemia and iron deficiency and the most affected areas are the poor communities. There is vast evidence on the negative effects of iron deficiency to a child's developing brain from studies done internationally but limited data on the subject in South Africa, despite the huge burden of iron deficiency. We investigated the association between IDA and school performance and intelligence and also determined the local prevalence of IDA in the Winterveldt region, North of Tshwane, South Africa. METHODS: Three primary schools from Winterveldt were sampled. All subjects with parental consent were screened for anaemia using Hemocue 201+ Hb meter (n=194). Blood for iron studies and CRP was collected on all anaemic pupils (n=75) to define IDA (Hb

The Occurrence of parasuicide among pregnant women at Dr George Mukhari Hospital: a retrospective study

Sat, 01 Jan 2011 00:00:00 GMT

The Occurrence of parasuicide among pregnant women at Dr George Mukhari Hospital: a retrospective study Mosetlhe, T. C. BACKGROUND: Parasuicide is defined as an act with non-fatal outcome, in which an individual deliberately initiates a non-habitual behaviour that without intervention from others will cause self-harm, or when an individual deliberately ingests a substance in excess of the prescribed or generally recognized therapeutic dosage. Pregnant women experience higher rates of depression, anxiety, psychosomatic symptoms and lower level of social adjustments than nonpregnant women. Cases of parasuicide among pregnant women have been seen and treated at Dr George Mukhari Hospital over the years without any systematic assessment of the extent of the problem. OBJECTIVE: The aim of the study was to evaluate the impact of cases of parasuicide on the eventual maternal and foetal outcomes. 10 MATERIALS AND METHODS: The study was conducted retrospectively using the hospital files of those pregnant women who had been diagnosed at Dr George Mukhari Hospital. The medical records of all such cases were retrieved from the filling room for assessment. The review period covered 1st January 2004 to 31st December 2006. Analysis was predominantly descriptive in which rates of incidences as well as proportion of occurrence of variables were calculated. Evaluation was for demographics, social status, intents and methods of parasuicide. In addition, the outcome of treatment for the mothers and their babies were evaluated. All the patients had been treated with gastric lavage and ingestion of activated charcoal from their referring centres regardless of the material used. The patients were stabilized and then referred for psychological counselling. RESULTS: During the three-year review period, 54 cases of parasuicide were recorded, with files for 42 (77.7%) patients found and evaluated. The ages of the women ranged from 16 to 35 years (median=21 years). Majority of women (57.1%) were parous while 42.9% were nulliparous. Socio-economic status of the women revealed that most patients were unemployed (95%), most were living with parents (90%), pregnancy was planned by 62%, 10% reported history of 11 physical abuse and only one of the women (2%) had a problem of alcohol abuse. Materials used for parasuicide included ingestion of tablets (23; 54.8%), organophosphates (7; 16.7%), herbal potions (6; 14.3%), rat poison (2; 4.8%) and other things such as paraffin, detergent (Jik) and laxatives. Thirty five of the 42 patients (83.3%) had reasons documented for parasuicide, of which the majority had relationship difficulties with their partners (22; 62.8%), (8; 22.9%) had relationship problems with family members and (5; 14.3%) wanted to terminate the pregnancy. The gestation at admission for treatment for parasuicide ranged between 16 and 40 weeks and at delivery pregnancy ended as: abortion (6; 14.3%), preterm delivery (13; 36.1%) and term delivery (23; 63.9%). The rate of abortion (14.3%) was significantly higher in these patients (ρ-value = 0.0001) compared to non-parasuicide patients (1.2%). Most of them delivered vaginally (95%), only one patient needed ICU admission for 6 days and there was no case of maternal death. Out of the 36 women who delivered viable babies, there were 33 (91.7%) who had live births, three other women had IUFDs (8.3%) and no neonatal death was recorded. 12 CONCLUSION Although parasuicide in pregnancy occurs infrequently at DGMH, the most striking factor which could have led to attempts at parasuicide was the socioeconomic situation of the women. A scenario in which 95% of these pregnant women were unemployed, 90% were unmarried and for most of the women the reasons for parasuicide were related to relationship difficulties, provide an effective recipe for parasuicide. Thesis (M Med(Obstetrics and gynaecology))--University of Limpopo (Medunsa Campus), 2011.

The Incidence of uro-genital fistulae at Dr George Mukhari hospital : a three-year review

Mon, 01 Jan 2007 00:00:00 GMT

The Incidence of uro-genital fistulae at Dr George Mukhari hospital : a three-year review Gqamlana, S. K. BACKGROUND: Urogenital fistula is a gynaecological condition which arises as a consequence of an abnormal communication between the urinary system (comprising of ureters, urinary bladder and the urethra) and the vagina. The condition can be classified broadly as congenital or acquired fistula. The former is extremely rare but the latter broad category (acquired fistula); is a common gynaecological condition, which can arise as a result of obstetric, surgical, malignant and radiation causes. The aetiology of urogenital fistulae is dependent on the availability and adequacy of obstetric care, malignancy rates and types of previous pelvic surgery that a woman had undergone. The true incidence of this condition is difficult to ascertain because of the pattern of causes between the developed world and the third world. While fistulae arising from obstetric causes are the predominant ones seen in the developing world, previous surgery is known to be the main cause of 2 fistulae in most middle and high income countries. This is particularly true for many parts of the third world, where the battle against poverty and illiteracy prevent many patients from seeking medical help. Apart from vaginal birth trauma, intervention with the use of forceps/vacuum for assisted vaginal delivery and the need for surgical intervention for delivery by caesarean section, surgical procedures such as hysterectomies and radiation therapy for malignancy are other contributory aetiological factors, for urogenital fistulae. The annual worldwide incidence of urogenital fistulae is estimated to be 50,000 – 100,000 cases with the vast majority of these occurring in the developing world. The consequence of formation of fistula is the resultant urinary incontinence which the patient is subjected to. This often leads to physical and emotional pain, as the woman is rejected by her partner and family, due to the foul smelling product of incontinence. While some have advocated conservative management of this condition with a simple in-dwelling catheter, with the possibility of spontaneous resolution of the fistula, such an approach is known to alleviate the incontinence only in a small number of cases and is dependent on both the aetiological factor, the size of the fistula, as well as the area of the pelvic organ that is involved. Therefore, the 3 vast majority of the fistulae have to be resolved through surgical management. Urogenital fistulae, present a challenge to the gynaecological surgeon and if the condition is left untreated the vulval skin is at considerable risk for ammoniacal dermatitis and vulval excoriation. The occurrence and management of this condition constitutes an increasingly common urogynaecological service at Dr George Mukhari hospital (DGMH). However, despite years of dealing with this condition, there has been no systematic evaluation of this problem in this hospital. It is for this reason that this review was undertaken. OBJECTIVES: The review has focused on establishing both the incidence, the type of fistulae as well as prevailing factors that are associated with occurrence of urogenital fistulae at DGMH. The review also evaluated the success and adequacy of the surgical modalities used at DGMH. DESIGN: It was a retrospective, case-review of urogenital fistulae which were managed over a three-year period . 4 SETTING: The review was conducted at the Dr George Mukhari/MEDUNSA hospital complex – a tertiary referral center, situated approximately 32 kilometers from the city of Pretoria (South Africa). METHODOLOGY: All cases of urogenital fistulae which were managed between 1st June 2003 till 31st May 2006 (3-year review), were included in this review. The records of all patients treated during this period were retrieved for analysis. Information regarding pre-treatment assessment and diagnosis was extracted from each case file and entered into a data collection form. All the cases were managed surgically using either fistula repair, ureteric re-implantation or urinary diversion using the Wallace or Bricker’s technique. Outcome measures for this review were: demographics of the women, history of pregnancy and mode of delivery, types of previous surgical management and causes of the fistulae. Other information gleaned from the files, included past history of radiation therapy, history of treatment for pelvic inflammatory disease (PID) and any other treatment for infections. Records (both 5 short-term and long-term) were assessed for post-operative outcomes – i.e. total correction of incontinence. RESULTS: Over the three-year review period, 50 cases of urogenital fistulae were managed at DGMH and all the 50 case files were available for analysis. The ages of the patients ranged widely from 22 to 85 years. Malignant conditions (46% carcinoma of the cervix and 2% of endometrial carcinoma), constituted the majority of all the aetiological factors. This was followed by 26% obstetric causes and 26% caused by previous surgical procedures. The odds ratio for a woman presenting with fistula, having an underlying malignant factor rather than obstetric or previous surgery was 1.8 (95% confidence interval: 1.70 – 2.35). There were 84% vesico-vaginal fistulae (VVF); 14% uretero-vaginal and 2% of urethro-vaginal fistulae. Twenty-two patients (44.9%) had urinary diversion while 6 (12.2%) patients needed ureteric re-implantation and the remaining 18 cases had fistula repair. Three patients with malignancy as aetiological factor, did not undergo surgical correction because of either an underlying cardiac condition or deterioration in their health prior to the operation. Surgical outcome, revealed complete success with a single surgical 6 intervention in 42 cases (85.7%), 3 of which had a nephrostomy, prior to definitive surgical management and 4 patients needed re-laparotomy. Only two patients were reported to have been treated for wound sepsis following surgery. CONCLUSION: Contrary to what is reported in the literature, obstetric cause for urogenital fistulae was over shadowed by the predominance of malignant conditions in our institution. The high success rate achieved with surgical management of fistulae has made this condition, an easily treatable gynecological problem in our hospital Thesis (M Med. (Obstetrics and Gynecology)) --University of Limpopo, 2007.

Theses and Dissertations (Obstetrics & Gynecology)

Childhood immunization in Mmakaunyane village in the North West Province of South Africa

The Association between iron deficiency anaemia and academic performance of children focusing on grade II pupils in the Winterveldt region, Tshwane North, South Africa

The Occurrence of parasuicide among pregnant women at Dr George Mukhari Hospital: a retrospective study

The Incidence of uro-genital fistulae at Dr George Mukhari hospital : a three-year review