Cesarean section deliveries in one health insurance hospital in Alexandria.

Cesarean section (CS) rates have been increasing world wide, raising the question of the appropriateness of the selection of cases for the procedure. The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. The aim of the work was to determine the trend of cesarean section deliveries in Gamal Abdel Naser Hospital which is affiliated to the Health Insurance Organization (HIO). The study was conducted through a descriptive retrospective approach. The study sample included the a)recorded deliveries between 1998-2005 (n=15917) for estimating the trend of cesarean section deliveries, and b) the medical records of CS deliveries at 2002 in the hospital (n=837) for identifying the indications of CS and their adequacy as a source of information for evaluation of CS deliveries . The study revealed that; cesarean section rate was high and increasing during the period from 1998 - 2005. The highest percent was in the year 2004 (57.9%). The trend of increase was significant (c for linear trend = 162.717, p= 0.000). Thursdays accounted for the highest percent of both admissions and deliveries, while Fridays accounted for the lowest percent . More than one half of deliveries occurred between 2 pm to before 8 pm. More than three quarters of the study sample (77.9%) did not have trial labour. Only 12.8% of the total study sample had induction and the outcome of induction was dystocia in 85%. The main indication of cesarean section was previous CS (41.2%), fetal distress (17.6%), failed trial and failure to progress (11.4%), cephalo-pelvic disproportion (10.3%), abnormal presentation (5.6%) and ante-partum hemorrhage (3.2%). Patient's records lack most of the essential information so it was not possible to verify recorded indication to justify caesarean section.

Indoor air pollution and acute lower respiratory infections in the first two years of life.

The relationship between outdoor air pollution and acute respiratory infections (ARI) was previously documented. There are recent indications for connection between indoor air pollution and ARI in infants and young children. The aim of this study was to identify the relationship of indoor air pollutants to acute lower respiratory infection (ALRI) in children (< 2 years). The indoor air pollutants concentrations were measured in the homes of the sample. The sample consisted of 115 children (< 2 years) representing the control group (24), ALRI but no pneumonia (24), pneumonia (30), severe pneumonia or very severe disease (37). Air sampling was performed to measure the concentration of total suspended particulates (TSP), SO2 and CO. These pollutants were found in higher concentrations in cases' homes (52.46 +/- 19.68 microg/m3, 298.15 +/- 669.37 microg/m3, and 1.92 +/- 3.60 ppm) than in controls' homes (31.92 +/- 8.76 microg/m3, not detected, and 0.33 +/- 1.63 ppm respectively). Whereas SO2 was detected only in houses using kerosene, TSP and CO were detected with the different types of cooking fuels. Their mean concentrations were highest for biomass (88.86 +/- 13.30 microg/m3 and 9.29 +/- 2.50 ppm) and lowest for gas (40.78 +/- 15.25 microg/m3 and 0.76 +/- 2.19 ppm). Measures to improve indoor air quality are highly required.

A prospective study of morbidity pattern and nutritional status of a group of healthy newborns during their first year of life in a rural area near Alexandria.

The present work was planned to study morbidity pattern and nutritional status of a group of healthy new borns in a rural area near Alexandria (Abbis II, VIII villages) through a prospective follow up approach. Eighty two infants were followed up for 12 months. Each infant was subjected to 15 visits within the first year of life. Morbidity was recorded either from mother's history, records from rural health centres or detected by the researcher and expressed as morbidity risk exposures based on a tested scoring system. Anthropometric standards issued by WHO were used to classify the children's length for age, weight for age and weight for length in terms of a cut off point of 2 SD below the median of that of the reference. Gomez classification was used to diagnose undernutrition and Waterlow system was used to diagnose growth stunting. Socioeconomic status of infants' families was also assessed. Results indicated a high prevalence of morbidity risk exposure, growth retardation and under nutrition with a tendency for gradual increase towards the end of the follow up. The results also proved that diarrheal diseases were still the most common illness among infants followed by respiratory tract infections. Investigation of the effects of socioeconomic status on morbidity risk exposure proved its significance at the end of the follow up. The results also illustrated a significant effect of morbidity risk exposure on the nutritional status at the end of the first year.

PIP: Health workers visited 82 healthy newborns in 2 villages near Alexandria, Egypt 15 times during their 1st year of life. The morbidity pattern, the nutritional status, and the morbidity pattern's effect on the nutritional status of the infants were studied. At the end of 1 year, 40.24% of the children had diarrhea. The mean annual number of diarrheal episodes was 4.3%. Poor environmental sanitation and the presence of animals and birds in and around the infants homes probably contributed to the high prevalence of diarrhea. 35.37% had either an upper or lower respiratory tract infection at the end of follow up. The mean annual number of respiratory infections stood at 2.2. Skin disease was the 3rd most common disease during the 1st year particularly during the 1st 3 quarters (14.13%, 12.36%, and 11.91%). Eye disease especially conjunctivitis were the 4th most common diseases among these children, especially during the 3rd quarter (13.10). The only infectious disease was measles which afflicted only 3.66% of the infants. None of the infants from high middle socioeconomic households were considered at high morbidity risk exposure. Almost all (93.33%) of these infants were at low morbidity and low average risk exposures. 24.39% of infants from low socioeconomic households were at high morbidity risk exposure, however. The percentage of infants growing normally decreased over time. For example, at the 1st quarter, 91.3% grew normally and by the 4th quarter this decreased to 57.32%. By 1 year almost 1.5 were either stunted or wasted and 3.66% were both stunted and wasted. an association existed between morbidity and nutritional status of the infants. Children with high morbidity scores were also the children suffering from the most severe malnutrition. Health workers should encourage mothers to use child health services at the rural health centers. They also should use growth charts to monitor infant and child growth.

Construction of a local standard symphysis fundal height curves for monitoring intrauterine fetal growth.

The aim of the present study was to construct standard symphysis fundal height percentile curves to be used as a reference chart in monitoring fetal growth. The construction was based on 1185 observations (symphysis fundal height measured to the nearest 0.5 cm by a malleable elastic tape) obtained from follow up of 105 cases of healthy pregnant women who were: sure of date of their last menstrual period, confirmed by early dating scan "before 20th gestational week", experienced a very strict normal course of pregnancy, giving birth to normal term newborn with appropriate weight for gestational age and sex. The selection of the study sample went through several screening levels starting by 4088 cases and ending by 105 cases. The measurements were taken biweekly from the 18th week of gestation to delivery "37-42 weeks of gestation." Tenth, 25th, 50th, 75th, 90th and 95th percentiles were calculated and represented graphically. Mean, mean-1 SD, mean-2 SD, mean +1 SD, mean + 2 SD were also calculated and represented graphically. The curve of best fit was determined by polynominal regression. The resulted percentile curves and mean values were found to be comparable to those in both developed and developing countries. It was recommended to incorporate the reference charts of symphysis fundal height into the maternity services after using it in routine antenatal examination for large number of cases and establishing its sensitivity and specificity.

Malnutrition among children 6-24 months attending MCH centres in Alexandria an epidemiologic study. Part I: Prevalence.

A cross-sectional nutritional survey of children aged 6-24 months (weaning period) attending MCH centres in Alexandria governorate through the year 1988-1989 was conducted with the aim of determining the prevalence of protein calorie malnutrition. The sample size was 1000 children chosen from 6 MCH centres in Alexandria (one centre for each zone). The sample was distributed along the six centres in proportion to the total number of infants recorded to have attended those centres through 1985. The centres were visited during the period starting November 1988 through June 1989. Each centre continued to be visited until the number decided to be included was completed. The study included the determination of age and the measurement of height and weight. Anthropometric standards issued by WHO were used to classify the children's length for age, weight for age, and weight for length in terms of a cut off point of 2 SD below the median of that of reference (Waterlow system). Gomez classification using weight/age as a parameter was used to diagnose undernutrition. The results of the study revealed a prevalence rate of undernutrition of 25.6% which was mostly of the first degree as expressed by Gomez categories. When expressed using waterlow system a prevalence of stunting of 29.7% was observed while wasting was observed in only 0.7% and concurrent wasting and stunting constituted 0.1%. These results were considered to be relatively lower in comparison to earlier similar studies. It was thus recommended that similar surveys for preschool age children in Alexandria and other regions of Egypt would be valuable.

Screening of high risk pregnancy among mothers attending MCH centers in Alexandria.

A cross-sectional study was carried out on a sample of 900 pregnant women attending MCH centers in Alexandria to determine the incidence of high risk pregnancy and to demonstrate the common risk factors among them. The simplified scoring system developed by Morrison and Olsen (1979) was used. Mothers with scores 0-2 were considered at low risk those with score 3 and more were categorised as high risk. Results revealed that high risk women constituted 27.78% of the sample. Twenty three risk factors were identified among all pregnant women screened. The most frequently encountered were anaemia (37.33%), age 35+ (15.66%), parity 5+ (16.66%), previous gynecological surgery (8.88%) and history of previous stillbirth or neonatal death (6.11%). The mean number of risk factors in the low risk group was 0.95 compared to 3.03 in the high risk group. Stepwise regression analysis indicated that the reproductive history score was the best one variable predictor of total risk score explaining about 74% of the variation in the total score while the present history score explained a further 16% of the variation and the associated conditions score explained 9% only of the variation. The use of scoring technique is recommended to be used in identification of high risk pregnant women in MCH centers.

PIP: Data on 900 pregnant women attending 4 maternal and child health (MCH) centers in Alexandria, Egypt between June-August 1989 were analyzed to screen for high risk pregnancies and identify common risk factors among these pregnancies. The Morrison and Olsen scoring system revealed high or extreme risk pregnancy in 27.78% of the women. Women in the low risk group had a mean of 0.95 risk factors. Women in the high risk group had a mode of 2 risk factors and a mean of 3.03. The most frequent combination of 3 risk factors were maternal age of at least 35, parity =or 5, and anemia. Total scores ranged form 0 to 14. Among women of the high risk group, 49.6% received scores of 3-4, 28% of 5-6, and 22.3% of =or 7. The mean total risk score for the low risk group was 1.03 compared with 5.25 for the high risk group. The most common risk factors in order of frequency were anemia (37.33%), parity =or 5 (16.66%), maternal age of at least 35 (15.66%), previous gynecologic surgery (8.88%), and history of stillbirth or neonatal mortality (6.11%). All of these risk factors except anemia occurred significantly more often in the high risk group than in the low risk group. Reproductive history accounted for 74% of the variation in the total risk score. Present pregnancy score and associated conditions accounted for 16% and 9% respectively. It is suggested that health workers use a scoring system to screen pregnant women attending antenatal clinics. They should also learn how to identify and manage high risk pregnancies. Trained personnel should design and distribute uniform records for assessment of high risk pregnancy to all primary health care units with antenatal services. Each MCH center should register perinatal deaths so health workers can use the data to make antenatal diagnoses and determine care.

Patterns of blood pressure among pregnant mothers attending MCH centres in Alexandria.

The present study was conducted to illustrate the range of normal blood pressure among pregnant mothers attending MCH centres and its biological and socioeconomic determinants. A total sample of 630 pregnant mothers were selected from 6 centres representing the 6 zones of Alexandria. Mothers of blood pressure above 140/90 mm Hg were excluded. The results showed that the mean systolic blood pressure in the first trimester was 112.16 mm Hg, decreased to 109.42. mm Hg for mothers in the 2nd trimester and raised again to 114.41 mm Hg in the 3rd trimester. A variety of socioeconomic and biological factors were involved in changing the range of blood pressure within normal limits specially during specific trimesters of pregnancy. It is recommended to record blood pressure for pregnant mothers from the first antenatal visit at any trimester. Single value can be used as potential marker. Those with higher trends of normal pressure values should be systemically followed.