Awareness of Danger Signs during Pregnancy and Post-Delivery Period among Women of Reproductive Age in Unguja Island, Zanzibar: A Qualitative Study.

Zanzibar is part of the United Republic of Tanzania with high levels of maternal mortality due to obstetric complications. Women's awareness on obstetric danger signs and early seeking of medical care is the first intervention in reduction of maternal deaths. This study explored awareness of danger signs among women of reproductive age in Unguja Island, Zanzibar. A community-based qualitative study using focus group discussions among women of reproductive age was conducted to explore awareness of danger signs between March and April 2016. Data was analyzed using thematic analysis. The study found that women were aware of danger signs during pregnancy but not during the post-delivery period. The mentioned danger signs during pregnancy included vaginal bleeding, fits, swelling of the legs and leaking of vagina fluid. Some women still believed that danger signs during pregnancy and post-delivery period were due to witchcraft leading to consultations with traditional healers and hence delays in seeking skilled medical care. In this context of misconceptions and cultural beliefs there should be investment in health education on danger signs to the community in general with involvement of traditional birth attendants and traditional healers who might play a role in advising and referring women with danger signs to the health facilities for care.

Awareness of danger signs during pregnancy and post-delivery period among women of reproductive age in Unguja Island, Zanzibar: a qualitative study

Zanzibar is part of the United Republic of Tanzania with high levels of maternal mortality due to obstetric complications. Women's awareness on obstetric danger signs and early seeking of medical care is the first intervention in reduction of maternal deaths. This study explored awareness of danger signs among women of reproductive age in Unguja Island, Zanzibar. A community-based qualitative study using focus group discussions among women of reproductive age was conducted to explore awareness of danger signs between March and April 2016. Data was analyzed using thematic analysis. The study found that women were aware of danger signs during pregnancy but not during the post-delivery period. The mentioned danger signs during pregnancy included vaginal bleeding, fits, swelling of the legs and leaking of vagina fluid. Some women still believed that danger signs during pregnancy and post-delivery period were due to witchcraft leading to consultations with traditional healers and hence delays in seeking skilled medical care. In this context of misconceptions and cultural beliefs there should be investment in health education on danger signs to the community in general with involvement of traditional birth attendants and traditional healers who might play a role in advising and referring women with danger signs to the health facilities for care

Liver and renal safety of tenofovir disoproxil fumarate in combination with emtricitabine among African women in a pre-exposure prophylaxis trial.

BACKGROUND: Safety of tenofovir disoproxil fumarate/emtricitabine (TDF-FTC) has been studied more extensively among HIV-infected patients than among HIV-uninfected people. Using data from a pre-exposure trial - FEM-PrEP -, we determined the cumulative probabilities of grade 1+ ALT, AST and creatinine and grade 2+ phosphorus toxicities; ALT/AST toxicities by baseline hepatitis B status; and change in mean creatinine, phosphorus, ALT and AST levels controlling for TDF-FTC adherence. METHODS AND FINDINGS: FEM-PrEP was a randomized, blinded, placebo-controlled trial of daily TDF-FTC among women in Africa. Enrolled women were in general good health, HIV antibody negative, 18 to 35 years old, hepatitis B surface antigen negative, and had normal hepatic and renal function at baseline. AST, ALT, phosphorus and serum creatinine were measured regularly throughout the trial. TDF-FTC concentrations were measured to assess adherence to TDF-FTC. The cumulative probabilities of grade 1+ creatininemia and grade 2+ phosphatemia toxicities were not statistically different between TDF-FTC and placebo arms. The cumulative probabilities of grade 1+ ALT and AST toxicities were higher among participants in the TDF-FTC arm than in the placebo arm (p = 0.03 for both). The proportions of grade 1+ and grade 2+ ALT or AST toxicities were significantly higher in participants who were hepatitis B virus surface antibody (HBsAb) positive than in those who were HBsAb-negative. Women with good adherence had higher mean change from baseline to week 4 in their AST levels (2.90 (0.37, 5.42); p = 0.025) than women with less than good adherence. CONCLUSIONS: We did not observe a significant relationship between randomization to TDF-FTC and creatinine or phosphorus toxicities. Women randomized to TDF-FTC had higher rates of mild to moderate ALT/AST toxicities, especially women with prior hepatitis B virus exposure. We also observed a significant increase in AST from baseline to week 4 among women who had higher adherence to TDF-FTC during that interval. TRIAL REGISTER: #NCT00625404, February 19, 2008.