A new measurement for optimal antenatal care: determinants and outcomes in Cameroon.

A combined measure of optimal antenatal care can provide more information on the role it plays in maternal health. Our objectives were to investigate the determinants of a measure of optimal antenatal care and the associated pregnancy outcomes. Data on 7,557 women taken from the 2004 Demographic and Health Survey in Cameroon were used to develop a new measurement of optimal antenatal care based on four indicators: at least four visits, first visit in first trimester, last visit in third trimester and a professional provider of antenatal care. We studied the relationship of this new variable with other related variables in a multivariate analysis, taking into account the complex study design. Almost sixty six percent of the women had optimal antenatal care. Secondary or higher education (OR 1.74; 95% CI 1.28-2.36), greater wealth (OR 2.31; 95% CI 1.73-3.1), urban residence (OR 1.42; 95% CI 1.12-1.82) and parity of 3-4 (OR 0.79; 95% CI 0.62-0.99) were independently associated with optimal antenatal care. Women with optimal antenatal care were more likely to deliver in a health unit (OR 2.91; 95% CI 2.42-3.49), to be assisted by a skilled health worker during delivery (OR 1.88; 95% CI 1.49-2.37) and to have a baby with a normal birthweight (OR 1.62; 95% CI 1.11-2.38). Obtaining and using a new measure for ANC is feasible. The association of optimal antenatal care to education, wealth and residence in this study, consistent with others, highlights the role of the country's development in maternal health.

Gravid uterus in an umbilical hernia.

Umbilical hernias large enough to contain a gravid uterus are rare. We report a case of a woman with prolapse of a gravid uterus through a previously repaired umbilical hernia. Our plans for elective surgery with caesarean section and hernia repair were foiled by poor compliance. The hernia was repaired during an emergency caesarean section. We provide details of her management and briefly review the literature on umbilical hernias and pregnancy. Surgical management offers an opportunity for hernia repair and can ensure a safe delivery for the mother and child.

Male participation in prevention programmes of mother to child transmission of HIV: a protocol for a systematic review to identify barriers, facilitators and reported interventions.

BACKGROUND: Infection with the HIV and AIDS are leading causes of morbidity and mortality among women and children worldwide. Prevention of mother-to-child transmission of HIV (PMTCT) programs were developed to protect women and their babies from having HIV infection. However, knowledge on how male participation has been applied to these programs is limited. We present a research protocol for a review which seeks to determine the effects of male participation on female uptake of PMTCT programs, and assess how this male participation has been investigated and documented worldwide. METHODS: This is a systematic review of published literature. We will attempt to identify all studies relevant to the subject written in the English language from January 1998 to June 2011. Electronic searches of the PubMED, EMBASE, CINAHL, and LILACS databases will be conducted using the relevant medical subject headings. Reference lists of identified studies and previous reviews will be manually checked for articles of interest. We shall also contact authors on the field for any relevant material. Two authors (FM and LM) will independently screen potential articles for eligibility using well-defined inclusion and exclusion criteria. They will independently assess the methodological quality of each included paper using the Jadad scale for randomized controlled trials, and the Newcastle-Ottawa scale for observational studies. Then they will independently extract data from the studies using a pre-established data extraction form. The primary outcome data will be female uptake of PMTCT services following a male/couple intervention, while secondary outcome measures will include indicators and barriers of male participation in PMTCT activities among others. During the data extraction process, discrepancies between the two authors will be sorted out by discussion or consultation with a third party (LT). The analysis and reporting of the review will be according to the PRISMA and MOOSE guidelines. Any identified clinical or statistical heterogeneity will be explored. Where possible, a random-effects meta-analysis will be performed to obtain aggregate estimates. We will also assess publication bias using funnel plots. Analysis of other outcomes will be descriptive.