Critical Assessment of Transfusional Practices in the Obstetrics and Gynecology Department At the University Hospital of Kinshasa.

Introduction: Gynecology and obstetrics are among the specialties where blood transfusion is most practiced. This situation requires the use of good transfusion practices. The objective of this study was to assess the quality of transfusion practice in the Gynecology and Obstetrics Department of the University Hospital of Kinshasa (UHK). Methods: This is a prospective, evaluative and descriptive study performed at the Department of Gyneco-Obstetrics of the University Hospital of Kinshasa from February 25 to June 25, 2020; which dealt with patients who received at least one blood transfusion. Results: About 498 patients, 54 patients were transfused and their average age was 36.4 years, with the extremes of 14 and 60 years, the transfusion rate was 10.8%. Most of patients (n=36: 2/3) were transfused during weekend days, sachets were used as delivery materials of blood product in 57.4% of cases (n = 31). Among the prescribers of blood products, 70.4% were nurses. All transfusions were carried out in type-specific and cross-matched Rh. All the transfused patients were not aware of the disadvantages of transfusion. Compatibility tests at the patient's bedside were not performed in 61.1% of cases and the concordance control between the patient and the blood component to be transfused was not performed in 70.4% of cases. Close monitoring of blood transfusion in the first ten minutes was not performed in 59.3% of cases. Conclusion: Transfusion encounters real practical problems in the gyneco-obstetrical environment of countries with limited resources. However, an assessment and multidisciplinary collaboration would be necessary to improve transfusion practice in medical field.

Predictors of tuberculosis incidence and the effects of multiple deprivation indices on tuberculosis management in OR Tambo district over a 5-year period.

BACKGROUND: This study investigated the associations between socio-economic deprivation and tuberculosis (TB) treatment outcomes, alongside well-known TB risk factors. The effects of healthcare expenditures and their growth on trends in TB incidence from 2009 to 2013 were also assessed. METHODS: Secondary data analysis was performed on data obtained from various sources including governmental, non-governmental and research institutions. Indicators for TB treatment outcomes included TB death rate, TB rate among the household contacts of the Index TB cases, TB treatment failure, HIV associated TB death rate, TB defaulter rate, and new TB smear positive cases. Analysis of variance (ANOVA) and Turkey's tests for post-hoc analysis were used to compare means of variables of interest considering a type I error rate of 0.05. Regression models and canonical discriminant analysis (CDA) were used to explore the associations between trends in TB incidence and independent TB predictors. During CDA, Fischer's linear functions, Eigen values, and Mahalanobis distances were determined with values of Wilk's Lambda closer to zero being the evidence for well discriminated patient groups. Data analysis was performed using SPSS® statistical software version 23.0 (Chicago, IL). RESULTS: In total, 62 400 records of TB notification were analyzed for the period 2009-2013. The average TB incidence rate over a 5-year period was 298 cases per 100,000 inhabitants per year. The incidence of TB was reduced by 79.70% at the end of the evaluation as compared to the baseline data in 2009. Multiple linear regression analysis showed that the Expenditure per patient day equivalent (PDE) and PHC expenditure per capita were significantly and independently associated with the decline of TB incidence (adjusted R2 = 60%; ρ = 0.002) following the equation: Y = (- 209× Expenditure per PDE) + (- 0.191 × PHC expenditure per capita). CDA showed that in the most socio-economically deprived communities (quintile 1), HIV associated TB death rates were significantly more likely to be higher as compared to the least socio-economically deprived group (quintile 5) [Eigen value (12.95), function coefficient (1.49) > (.77); Wilk's Lambda = .019, p < .0001]. CONCLUSIONS: Although TB control programs in OR Tambo district have averted thousands of TB incident cases, their effects on HIV associated TB deaths among the most deprived communities remain insignificant. There is an urgent need for strengthening integration of TB/HIV services in most deprived settings.

Sociodemographic inequities associated with participation in leisure-time physical activity in sub-Saharan Africa: an individual participant data meta-analysis.

BACKGROUND: Leisure-time physical activity (LTPA) is an important contributor to total physical activity and the focus of many interventions promoting activity in high-income populations. Little is known about LTPA in sub-Saharan Africa (SSA), and with expected declines in physical activity due to rapid urbanisation and lifestyle changes we aimed to assess the sociodemographic differences in the prevalence of LTPA in the adult populations of this region to identify potential barriers for equitable participation. METHODS: A two-step individual participant data meta-analysis was conducted using data collected in SSA through 10 population health surveys that included the Global Physical Activity Questionnaire. For each sociodemographic characteristic, the pooled adjusted prevalence and risk ratios (RRs) for participation in LTPA were calculated using the random effects method. Between-study heterogeneity was explored through meta-regression analyses and tests for interaction. RESULTS: Across the 10 populations (N = 26,022), 18.9% (95%CI: 14.3, 24.1; I2 = 99.0%) of adults (≥ 18 years) participated in LTPA. Men were more likely to participate in LTPA compared with women (RR for women: 0.43; 95%CI: 0.32, 0.60; P < 0.001; I2 = 97.5%), while age was inversely associated with participation. Higher levels of education were associated with increased LTPA participation (RR: 1.30; 95%CI: 1.09, 1.55; P = 0.004; I2 = 98.1%), with those living in rural areas or self-employed less likely to participate in LTPA. These associations remained after adjusting for time spent physically active at work or through active travel. CONCLUSIONS: In these populations, participation in LTPA was low, and strongly associated with sex, age, education, self-employment and urban residence. Identifying the potential barriers that reduce participation in these groups is necessary to enable equitable access to the health and social benefits associated with LTPA.

Exploring the pregnant women's perspective of late booking of antenatal care services at Mbekweni Health Centre in Eastern Cape, South Africa.

BACKGROUND: Antenatal care (ANC) services are the gateway for integrated management of several conditions that adversely affect the mother and foetus. More stillbirths than neonatal deaths in South Africa are a reflection of poor quality ANC services. Aim: The primary aim of this study was to explore the reasons for late booking, and also to determine pregnant women's knowledge, perceptions and attitude towards antenatal care services they receive in Mthatha area in Eastern Cape, South Africa. Setting: This was a qualitative study, conducted at Mbekweni Health Centre in the King Sabata Dalindyebo (KSD) subdistrict municipality of the Eastern Cape Province. Methods: This qualitative study consisted of selected pregnant women who presented after 19 weeks of gestation at Mbekweni Health Centre. Data were collected through two different methods, namely, semi-structured interviews and focus group discussions were used until saturation of the themes were reached. The interviews were transcribed verbatim and thematic analyses were undertaken. Results: Twenty women participated in the study. They were diverse in terms of age 18-41 years, gravidity 1-6 and time of ANC booking 20-28 weeks. The interviews identified a variety of personal, service and organisational reasons for late ANC booking. The themes identified for late ANC bookings were: health care system related issues, socio-economic factors, women's perceptions and knowledge, and failure of family planning services. Conclusions: Women's beliefs, knowledge and perceptions regarding antenatal services outweigh the perceived benefit of early ANC visit. The majority of women had lack of knowledge of contraception, early signs of pregnancy, purpose, timing and benefits of ANC visit.

Cross-sectional study of patients with type 2 diabetes in OR Tambo district, South Africa.

OBJECTIVES: South Africa has pledged to the sustainable development goal of promoting good health and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of healthcare services across the country. This study examines the sociodemographic and clinical determinants of uncontrolled type 2 diabetes mellitus (T2DM) in individuals attending primary healthcare in OR Tambo district, South Africa. DESIGN: A cross-sectional analytical study. SETTING: Primary healthcare setting in OR Tambo district, South Africa. PARTICIPANTS: Patients treated for T2DM for 1 or more years (n=327). PRIMARY OUTCOME MEASURE: Prevalence of uncontrolled T2DM. SECONDARY OUTCOME MEASURE: Determinants of uncontrolled T2DM (glycosylated haemoglobin (HbA1c) ≥7%). RESULTS: Out of the 327 participants, 274 had HbA1c≥7% (83.8%). Female sex (95% CI 1.3 to 4.2), overweight/obesity (95% CI 1.9 to 261.2), elevated low-density lipoprotein cholesterol (95% CI 4.4 to 23.8), sedentary habits (95% CI 7.2 to 61.3), lower monthly income (95% CI 1.3 to 6.5), longer duration of T2DM (95% CI 4.4 to 294.2) and diabetes information from non-health workers (95% CI 1.4 to 7.0) were the significant determinants of uncontrolled T2DM. There was a significant positive correlation of uncontrolled T2DM with increasing duration of T2DM, estimated glomerular filtration rate and body mass index. However, a significant negative correlation exists between monthly income and increasing HbA1c. CONCLUSIONS: We found a significantly high prevalence (83.8%) of uncontrolled T2DM among the patients, possibly attributable to overweight/obesity, sedentary living, lower income and lack of information on diabetes. Addressing these determinants will require re-engineering of primary healthcare in the district.

Diabetic patients' perspectives on the challenges of glycaemic control.

INTRODUCTION: The factors affecting the control of diabetes are complex and varied. However, little is documented in the literature on the overall knowledge of diabetic patients about glycaemic control. This study explored the patients' perspectives on the challenges of glycaemic control. METHODS: In this qualitative study, semi-structured interviews were conducted with seventeen purposively selected diabetic patients with HBA1c ≥ 9% at Mthatha General Hospital, South Africa. The interviews were conducted in the isiXhosa language and were audiotaped. Two experienced qualitative researchers independently transcribed and translated the interviews.Thematic content analysis was conducted. RESULTS: Three main themes emerged: overall knowledge of diabetes and treatment targets, factors affecting the control of diabetes and how glycaemic control could be improved.The majority of the participants demonstrated poor knowledge of treatment targets for diabetes. The majority of the participants reported that lack of money affected their control of diabetes. Some of the participants reported that the nearest clinics do not have doctors; hence,they are compelled to travel long distances to see doctors. CONCLUSION: Poverty, lack of knowledge and access to doctors affect the control of diabetes in the rural communities of Mthatha, South Africa. The government should address recruitment and retention of doctors in primary health care.