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OBJECTIVES: Maternal mortality is one of the major Sustainable Development Goals (SDGs) of the global health community. The aim of the SDG 3.1 is to reduce global maternal mortality ratio considerably by 2030. The objective of this study was to document the epidemiological trends in maternal mortality for Mpilo Central Hospital. METHODS: This was a 10 year retrospective study using readily available data from the maternity registers. The International Classification of Diseases-Maternal Mortality (ICD-MM) coding system for maternal deaths was used. RESULTS: The maternal mortality ratio (MMR) declined from 655 per 100,000 live births in 2011 to 203 per 100,000 live births by 2020. The commonest groups of maternal mortality during the period 2011-2020 were hypertensive disorders, obstetric haemorrhage, pregnancy-related infection, and pregnancies with abortive outcomes. There were 273 maternal deaths recorded in the period 2011-2015, and 168 maternal deaths in the period 2016-2020. There was also a decline in maternal deaths due to obstetric haemorrhage (53 vs. 34). Maternal deaths due to pregnancy-related infection also declined (46 vs. 22), as well as pregnancies with abortive outcomes (40 vs. 26). CONCLUSIONS: There was a 69% decline in the MMR over the 10 year period. The introduction of government interventions such as malarial control, the adoption of life-long Option B+ antiretroviral treatment for the pregnant women, the training courses of staff, and the introduction of strong clinical leadership and accountability were all associated with a significant decline in the causes of maternal deaths.
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Muerte Materna , Mortalidad Materna , Femenino , Embarazo , Humanos , Zimbabwe/epidemiología , Estudios Retrospectivos , HospitalesRESUMEN
BACKGROUND: Reducing maternal mortality is a priority of Sustainable Development Goal 3.1 which requires frequent epidemiological analysis of trends and patterns of the causes of maternal deaths. We conducted two reproductive age mortality surveys to analyse the epidemiology of maternal mortality in Zimbabwe and analysed the changes in the causes of deaths between 2007-08 and 2018-19. METHODS: We performed a before and after analysis of the causes of death among women of reproductive ages (WRAs) (12-49 years), and pregnant women from the two surveys implemented in 11 districts, selected using multi-stage cluster sampling from each province of Zimbabwe (n=10); an additional district selected from Harare. We calculated mortality incidence rates and incidence rate ratios per 10000 WRAs and pregnant women (with 95% confidence intervals), in international classification of disease groups, using negative binomial models, and compared them between the two surveys. We also calculated maternal mortality ratios, per 100 000 live births, for selected causes of pregnancy-related deaths. RESULTS: We identified 6188 deaths among WRAs and 325 PRDs in 2007-08, and 1856 and 137 respectively in 2018-19. Mortality in the WRAs decreased by 82% in diseases of the respiratory system and 81% in certain infectious or parasitic diseases' groups, which include HIV/AIDS and malaria. Pregnancy-related deaths decreased by 84% in the indirect causes group and by 61% in the direct causes group, and HIV/AIDS-related deaths decreased by 91% in pregnant women. Direct causes of death still had a three-fold MMR than indirect causes (151 vs. 51 deaths per 100 000) in 2018-19. CONCLUSION: Zimbabwe experienced a decline in both direct and indirect causes of pregnancy-related deaths. Deaths from indirect causes declined mainly due to a reduction in HIV/AIDS-related and malaria mortality, while deaths from direct causes declined because of a reduction in obstetric haemorrhage and pregnancy-related infections. Ongoing interventions ought to improve the coverage and quality of maternal care in Zimbabwe, to further reduce deaths from direct causes.
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Síndrome de Inmunodeficiencia Adquirida , Malaria , Adolescente , Adulto , Causas de Muerte , Niño , Femenino , Humanos , Nacimiento Vivo , Masculino , Mortalidad Materna , Persona de Mediana Edad , Embarazo , Adulto Joven , Zimbabwe/epidemiologíaRESUMEN
OBJECTIVES: Stillbirth remains a global public health issue; in low-resource settings stillbirth rates remain high (>12 per 1,000 births target of Every Newborn Action Plan). Preeclampsia is major risk factor for stillbirths. This study aimed to determine the prevalence and risk factors for stillbirth amongst women with severe preeclampsia at Mpilo Central Hospital. METHODS: A retrospective cross-sectional study was conducted of women with severe preeclampsia from 01/01/2016 to 31/12/2018 at Mpilo Central Hospital, Bulawayo, Zimbabwe. Multivariable logistic regression was used to determine risk factors that were independently associated with stillbirths. RESULTS: Of 469 women that met the inclusion criteria, 46 had a stillbirth giving a stillbirth prevalence of 9.8%. The risk factors for stillbirths in women with severe preeclampsia were: unbooked status (adjusted odds ratio (aOR) 3.01, 95% (confidence interval) CI 2.20-9.10), frontal headaches (aOR 2.33, 95% CI 0.14-5.78), vaginal bleeding with abdominal pain (aOR 4.71, 95% CI 1.12-19.94), diastolic blood pressure ≥150 mmHg (aOR 15.04, 95% CI 1.78-126.79), platelet count 0-49 × 109/L (aOR 2.80, 95% CI 1.26-6.21), platelet count 50-99 × 109/L (aOR 2.48, 95% CI 0.99-6.18), antepartum haemorrhage (aOR 12.71, 95% CI 4.15-38.96), haemolysis elevated liver enzymes syndrome (HELLP) (aOR 6.02, 95% CI 2.22-16.33) and fetal sex (aOR 2.75, 95% CI 1.37-5.53). CONCLUSIONS: Women with severe preeclampsia are at significantly increased risk of stillbirth. This study has identified risk factors for stillbirth in this high-risk population; which we hope could be used by clinicians to reduce the burden of stillbirths in women with severe preeclampsia.
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Preeclampsia , Mortinato , Estudios Transversales , Femenino , Hospitales , Humanos , Recién Nacido , Preeclampsia/epidemiología , Embarazo , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Mortinato/epidemiología , Zimbabwe/epidemiologíaRESUMEN
BACKGROUND: On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a 'national disaster'. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. METHODS: This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. RESULTS: Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. CONCLUSIONS: Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women's experiences and understand how bookings and deliveries at local clinics changed during this time.
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COVID-19/prevención & control , Control de Enfermedades Transmisibles , Servicios de Salud Materna/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Servicios de Salud Materna/tendencias , Mortalidad Materna , Morbilidad , Mortalidad Perinatal , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , SARS-CoV-2 , Centros de Atención Terciaria/tendencias , Carga de Trabajo/estadística & datos numéricos , Zimbabwe/epidemiologíaRESUMEN
PROBLEM: In Zimbabwe, many health facilities are not able to manage serious obstetric complications. Staff most commonly identified inadequate training as the greatest barrier to preventing avoidable maternal deaths. APPROACH: We established an onsite obstetric emergencies training programme for maternity staff in the Mpilo Central Hospital. We trained 12 local staff to become trainers and provided them with the equipment and resources needed for the course. The trainers held one-day courses for 299 staff at the hospital. LOCAL SETTING: Maternal mortality in Zimbabwe has increased from 555 to 960 per 100,000 pregnant women from 2006 to 2011 and 47% of the deaths are believed to be avoidable. Most obstetric emergencies trainings are held off-site, away from the clinical area, for a limited number of staff. RELEVANT CHANGES: Following an in-hospital train-the-trainers course, 90% (138/153) of maternity staff were trained locally within the first year, with 299 hospital staff trained to date. Local system changes included: the introduction of a labour ward board, emergency boxes, colour-coded early warning observation charts and a maternity dashboard. In this hospital, these changes have been associated with a 34% reduction in hospital maternal mortality from 67 maternal deaths per 9078 births (0.74%) in 2011 compared with 48 maternal deaths per 9884 births (0.49%) in 2014. LESSONS LEARNT: Introducing obstetric emergencies training and tools was feasible onsite, improved clinical practice, was sustained by local staff and associated with improved clinical outcomes. Further work to study the implementation and effect of this intervention at scale is required.
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Educación Médica/métodos , Promoción de la Salud/métodos , Partería/educación , Complicaciones del Embarazo/prevención & control , Competencia Clínica , Educación Médica/economía , Servicio de Urgencia en Hospital , Femenino , Humanos , Servicios de Salud Materna , Mortalidad Materna , Médicos , Embarazo , Resultado del Tratamiento , Zimbabwe/epidemiologíaRESUMEN
COVID-19 presented countries with unprecedented health policy challenges. For low-income countries in particular, policymakers had to contend with both the direct threats posed by COVID-19 as well as the social, educational, and economic harms associated with lockdown and other infection prevention and control measures. We present a holistic and contextualised case study of the direct and indirect impacts of COVID-19 on women and children, with some assessment of their uneven distribution across socio-economic, age and gender groups. We used different types of primary and secondary data from multiple sources to produce a holistic descriptive analysis. Primary data included: qualitative data obtained from 28 in-depth interviews of key informants, six focus group discussions; and 40 household interviews. We also extracted data from government reports and announcements, the District Health Information Software version 2 (DHIS2), newspaper articles and social media, as well as from published research articles. Our findings show that the direct and indirect adverse impacts of COVID-19 were compounded by many years of severe political economic challenges, and consequent deterioration of the healthcare system. The indirect effects of the pandemic had the most severe impacts on the poorest segment of society and widened age and gender inequalities. The pandemic and its accompanying infection prevention and control measures negatively affected health service delivery and uptake. The management of COVID-19 presented enormous challenges to policymakers and public health specialists. These included managing the greatest tension between direct and indirect harms; short-term and long-term effects; and the unequal distribution of harms across different segments of society.
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BACKGROUND: Sustainable Development Goal (SDG) 3.1 target is to reduce the global maternal mortality ratio (MMR) to less than 70 maternal deaths per 100 000 live births by 2030. In the Ending Preventable Maternal Mortality strategy, a supplementary target was added, that no country has an MMR above 140 by 2030. We conducted two cross-sectional reproductive age mortality surveys to analyse changes in Zimbabwe's MMR between 2007-2008 and 2018-2019 towards the SDG target. METHODS: We collected data from civil registration, vital statistics and medical records on deaths of women of reproductive ages (WRAs), including maternal deaths from 11 districts, randomly selected from each province (n=10) using cluster sampling. We calculated weighted mortality rates and MMRs using negative binomial models, with 95% CIs, performed a one-way analysis of variance of the MMRs and calculated the annual average reduction rate (ARR) for the MMR. RESULTS: In 2007-2008 we identified 6188 deaths of WRAs, 325 pregnancy-related deaths and 296 maternal deaths, and in 2018-2019, 1856, 137 and 130, respectively. The reproductive age mortality rate, weighted by district, declined from 11 to 3 deaths per 1000 women. The MMR (95% CI) declined from 657 (485 to 829) to 217 (164 to 269) deaths per 100 000 live births at an annual ARR of 10.1%. CONCLUSIONS: Zimbabwe's MMR declined by an annual ARR of 10.1%, against a target of 10.2%, alongside declining reproductive age mortality. Zimbabwe should continue scaling up interventions against direct maternal mortality causes to achieve the SDG 3.1 target by 2030.
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Muerte Materna , Estadísticas Vitales , Estudios Transversales , Femenino , Humanos , Mortalidad Materna , Embarazo , Zimbabwe/epidemiologíaRESUMEN
OBJECTIVE: Globally, preeclampsia is a significant contributor to adverse maternal outcomes. Once women develop eclampsia, they face considerable risks especially in countries with limited resources to deal with such a life-threatening complication. This study was carried out to investigate determinants of eclampsia in pregnant mothers with severe preeclampsia. STUDY DESIGN: This institutional based study was completed at Mpilo Central Hospital, a quaternary referral unit from 1st January 2016 - 31st December 2018. In this study, pregnant women with severe preeclampsia/eclampsia were the study participants. The independent variables included socio-demographic and clinical characteristics, and maternal outcomes. Multivariable logistic regression analyses were used to determine independent association with p < 0.05 taken as statistically significant with 95% Confidence Interval (CI). MAIN OUTCOME MEASURE: Eclampsia. RESULTS: Development of eclampsia was more frequent in women aged 14-19 years compared to women aged ≥ 35 years (adjusted odds ratio (AOR) 6.64, 95% CI 1.20-22.06, p = 0.02) and in primiparous women compared to women with parity ≥ 3 (AOR 2.76, 95% CI 1.48-5.15, p = 0.001). Eclampsia was more frequent in women with diastolic blood pressure of 131-150 mmHg (AOR 5.48, 95% CI 1.05-28.75, p = 0.04), and ≥ 150 mmHg (AOR 5.78, 95% CI 1.05-31.78, p = 0.04) compared with those with diastolic blood pressure of ≤ 110 mmHg. Symptoms of visual disturbances were also associated with eclampsia (AOR 2.13, 95% CI 1.08-4.18, p = 0.03). CONCLUSIONS: This study has identified independent determinants of eclampsia which can be used to identify which women should receive magnesium sulphate prophlyaxis or more intensive monitoring to prevent deterioration in maternal condition.
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Preeclampsia/diagnóstico , Diagnóstico Prenatal , Adolescente , Adulto , Femenino , Humanos , Embarazo , Resultado del Embarazo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto Joven , ZimbabweRESUMEN
OBJECTIVES: Hypertensive disorders of pregnancy are major causes of global maternal and neonatal morbidity and mortality. This study aimed to develop and validate models to predict composite adverse maternal and neonatal outcome in severe preeclampsia in low-resource settings. STUDY DESIGN: A retrospective cross-sectional study of women with severe preeclampsia giving birth in a tertiary referral centre in Zimbabwe between 01/01/2014-31/12/2018. Candidate variables identified from univariable logistic regression (p < 0.2) were entered into stepwise backward elimination logistic regression models to predict composite adverse maternal and neonatal outcomes. Models' performance was assessed by the area under the curve of the receiver operator characteristic (AUC ROC). The models were validated internally using bootstrap-based methods and externally using the Preeclampsia Integrated Estimate of RiSk dataset. MAIN OUTCOME MEASURES: The co-primary outcomes were composite adverse maternal outcome and composite adverse neonatal outcome. RESULTS: 549 women had severe preeclampsia from whom 567 neonates were born. The predictive model for composite adverse maternal outcome included maternal age, gestational age on admission, epigastric pain, vaginal bleeding with abdominal pain, haemoglobin concentration and platelets; the AUC ROC was 0.796 (95% CI 0.758-0.833). External validation showed poor discrimination (AUC ROC 0.494, 95% CI 0.458-0.552). The model for composite adverse neonatal outcome included: gestational age, platelets, alanine transaminase and birth weight; the AUC ROC was 0.902 (95% CI 0.876-0.927). CONCLUSIONS: While the models accurately predicted composite adverse maternal and neonatal outcomes in the study population, they did not in another cohort. Understanding factors which affect model performance will help optimize prediction of adverse outcomes in severe preeclampsia.
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Pobreza , Preeclampsia/epidemiología , Adulto , Estudios Transversales , Femenino , Edad Gestacional , Humanos , Modelos Logísticos , Preeclampsia/diagnóstico , Preeclampsia/etiología , Embarazo , Resultado del Embarazo/epidemiología , Curva ROC , Estudios Retrospectivos , Medición de Riesgo/métodos , Sensibilidad y Especificidad , Zimbabwe/epidemiologíaRESUMEN
Sepsis remains a major cause of maternal deaths globally. It is one of the major causes of maternal morbidity and mortality in women of reproductive age. It is important that such a major contributor is studied in low-resource settings. The aims of this study were to document the percentage of maternal deaths from sepsis among the total number of maternal deaths in a low-resource setting and to determine factors associated with maternal mortality from sepsis at Mpilo Central Hospital. This was a retrospective, descriptive, cross-sectional study carried out at Mpilo Central Hospital. Nearly one-third (29.3%) of maternal deaths were due to sepsis. The major factor associated with maternal mortality was post-abortal sepsis (41.7%).
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Sepsis/mortalidad , Adulto , Estudios Transversales , Femenino , Hospitales , Humanos , Muerte Materna/etiología , Muerte Materna/estadística & datos numéricos , Mortalidad Materna , Estudios Retrospectivos , Sepsis/complicaciones , Zimbabwe/epidemiologíaRESUMEN
OBJECTIVES: Maternal mortality is an important global subject. This dataset was generated from a retrospective cross-sectional study carried out at Mpilo Central Hospital, covering the period January 1, 2015 to December 31, 2018. The aim of the study was to compare how frequently the exposure to a risk factor was related to maternal death. Maternal deaths that were recorded during the study period were considered as cases. Controls were selected randomly from women of child-bearing age who survived during the study period. Low-resourced countries contribute significantly to global maternal deaths. Understanding risk factors could help reduce maternal mortality. DATA DESCRIPTION: The dataset contains data of 387 pregnant women who were included in the study. Data were collected as secondary data using a data collection sheet, as recorded by the hospital staff that gave all necessary demographic details in birth and mortality registers. The data collected included socio-demographic and clinical data. The independent variables were maternal age, gravidity, parity, antenatal visits, booking status, marital status, educational status, days spent in hospital, mode of delivery, fetal outcomes, and maternal complications. The dependent variable was maternal mortality. The data can be used to determine the relationship between the independent variables and maternal death.
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Recursos en Salud , Mortalidad Materna , Adolescente , Adulto , Femenino , Humanos , Modelos Logísticos , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Adulto Joven , ZimbabweRESUMEN
OBJECTIVES: In low resource settings symptoms and signs may be used to identify which women require intervention to mitigate the risks of severe preeclampsia. This study aimed to report the frequency of signs and symptoms in women with severe preeclampsia and to determine their predictive value for adverse maternal and perinatal outcomes. STUDY DESIGN: A retrospective cross-sectional study of women with severe preeclampsia from 01/01/2016 to 31/12/2018 at Mpilo Central Hospital, Bulawayo, Zimbabwe. Multivariate logistic regression was used to determine whether symptoms and signs were independently associated with the co-primary outcomes. MAIN OUTCOME MEASURES: The co-primary outcome measures were a composite of maternal complications including major organ dysfunction or mortality and a composite measure of severe perinatal morbidity or mortality. RESULTS: Symptoms were present in 58.8% of women with severe preeclampsia; headache and epigastric pain were most commonly reported (47.9% and 22.4% of women respectively). Most symptoms and signs were not independently predictive of adverse maternal or perinatal outcomes. Vaginal bleeding with abdominal pain reduced odds of adverse maternal outcome (Adjusted Odds Ratio (AOR) 0.16, 95% Confidence Interval (CI) 0.03-0.84; p = 0.03), systolic blood pressure of 161-180 mmHg increased odds of adverse maternal outcome (AOR 2.71, 95% CI 1.14-6.41, p = 0.03) and birthweight ≤ 1500 g increased odds of adverse perinatal outcome (AOR 23.21, 95% CI 7.70-69.92, p < 0.001). CONCLUSIONS: Maternal signs and symptoms are ineffective predictors of maternal or perinatal morbidity and mortality; as such they cannot be used alone to predict which women would benefit from intervention in severe preeclampsia.
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Preeclampsia/diagnóstico , Resultado del Embarazo/epidemiología , Adulto , Estudios Transversales , Femenino , Humanos , Recién Nacido , Preeclampsia/epidemiología , Preeclampsia/fisiopatología , Embarazo , Estudios Retrospectivos , Factores de Riesgo , ZimbabweRESUMEN
Background: Zimbabwe is one of the countries in sub-Saharan Africa disproportionately affected by human immunodeficiency virus. In the "treat all" era, we assessed the gaps in routine viral load (VL) monitoring at six months for children (0-9 years) and adolescents (10-19 years) newly initiated on anti-retroviral therapy (ART) from January 2017 to September 2018 at a large tertiary hospital in Bulawayo. Methods: In this cohort study using secondary data, we considered first VL done within six to nine months of starting therapy as 'undergoing VL test at six months'. We classified repeat VL≥1000 copies/ml despite enhanced adherence counselling as virally unsuppressed. Results: Of 295 patients initiated on ART, 196 (66%) were children and 99 (34%) adolescents. A total 244 (83%) underwent VL test at six months, with 161 (54%) virally suppressed, 52 (18%) unsuppressed and 82 (28%) with unknown status (due to losses in the cascade). Switch to second line was seen in 35% (18/52). When compared to children, adolescents were less likely to undergo a VL test at six months (73% versus 88%, p=0.002) and more likely to have an unknown VL status (40% versus 22%, p=0.001). Conclusion: At six months of ART, viral suppression was low and losses in the cascade high.
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Fármacos Anti-VIH , Infecciones por VIH , Carga Viral , Adolescente , Fármacos Anti-VIH/uso terapéutico , Niño , Preescolar , Estudios de Cohortes , Infecciones por VIH/tratamiento farmacológico , Humanos , Lactante , Recién Nacido , Adulto Joven , ZimbabweRESUMEN
OBJECTIVE: Severe preeclampsia and eclampsia have dire consequences for both maternal and neonatal health. The objective of this study was to identify determinants of adverse maternal and perinatal outcomes in severe preeclampsia and eclampsia. RESULTS: Binary logistic regression showed the following were significantly associated with adverse maternal outcomes; mothers who had a baby born at 27-29+6 weeks of gestation were 8 times more likely to be associated with adverse maternal outcomes compared to mothers who gave birth at 37-39+6 weeks' of gestation (OR 8.187, 95% CI 1.680-39.911, p = 0.02), holding other variables constant. Platelet count was also statistically significant for adverse maternal outcome. Mothers with platelet counts of 0-49 × 109/l were 46 times more likely to be associated with adverse maternal outcome compared to mothers with normal counts of more than 150 × 109/l (OR 46.429, 95% CI 17.778-121.253, p = 0.001). The following determinants were significantly associated with adverse perinatal outcomes. Mothers with platelet counts of 0-49 × 109/l were 4 times more likely to be associated with adverse perinatal outcomes compared to mothers with platelet counts of above 150 × 109/l (OR 3.690, 95% CI 1.752-7.775, p = 0.001).
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Eclampsia/epidemiología , Recursos en Salud , Hospitales , Preeclampsia/epidemiología , Resultado del Embarazo , Adulto , Femenino , Feto/patología , Humanos , Embarazo , Factores de RiesgoRESUMEN
Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal morbidity and mortality, especially in low-resource settings. Identifying mothers and babies at greatest risk of complications would enable intervention to be targeted to those most likely to benefit from them. However, current risk prediction models have a wide range of sensitivity (42-81%) and specificity (87-92%) indicating that improvements are needed. Furthermore, no predictive models have been developed or evaluated in Zimbabwe. This proposal describes a single centre retrospective cross-sectional study which will address the need to further develop and test statistical risk prediction models for adverse maternal and neonatal outcomes in low-resource settings; this will be the first such research to be carried out in Zimbabwe. Data will be collected on maternal demographics characteristics, outcome of prior pregnancies, past medical history, symptoms and signs on admission, results of biochemical and haematological investigations. Adverse outcome will be defined as a composite of maternal morbidity and mortality and perinatal morbidity and mortality. Association between variables and outcomes will be explored using multivariable logistic regression. Critically, new risk prediction models introduced for our clinical setting may reduce avoidable maternal and neonatal morbidity and mortality at local, national, regional and international level.
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Modelos Estadísticos , Preeclampsia/diagnóstico , Preeclampsia/mortalidad , Adulto , Estudios Transversales , Países en Desarrollo , Femenino , Hospitales , Humanos , Recién Nacido , Modelos Logísticos , Mortalidad Materna/tendencias , Mortalidad Perinatal/tendencias , Preeclampsia/economía , Preeclampsia/fisiopatología , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Riesgo , Índice de Severidad de la Enfermedad , ZimbabweRESUMEN
OBJECTIVES: Early-onset severe preeclampsia is associated with significant maternal and perinatal morbidity and mortality especially in low-resource settings, where women have limited access to antenatal care. This dataset was generated from a retrospective cross-sectional study carried out at Mpilo Central Hospital, covering the period February 1, 2016 to July 30, 2018. The aim of the study was to determine the incidence of early-onset severe preeclampsia and eclampsia, and associated risk factors in a low-resource setting. The reason for examining the incidence of preeclampsia specifically in a low-resource setting; was to document it as women in these settings appear to suffer from poor outcomes. DATA DESCRIPTION: The dataset contains data of 238 pregnant women who had a diagnosis of early onset severe preeclampsia/eclampsia. There were 243 babies from singleton and twin gestations. There were five sets of twins. There were 21,505 live births during the study period giving an incidence of 1.1%. The dataset contains data on maternal socio-demographic, signs and symptoms, therapeutic interventions and mode of delivery, adverse outcomes characteristics, and fetal characteristics. This large dataset can be used to calculate the incidence and risk factors for adverse maternal and fetal outcomes or develop predictive models in severe preeclampsia/eclampsia.
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Eclampsia/epidemiología , Preeclampsia/epidemiología , Estudios Transversales , Demografía/estadística & datos numéricos , Femenino , Recursos en Salud/estadística & datos numéricos , Hospitales , Humanos , Recién Nacido , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , ZimbabweRESUMEN
A global concern is to end preventable stillbirths by the year 2030. The objective of this study was to document the stillbirth rate and causes of stillbirths in a low-resource setting. This was a retrospective descriptive study carried out at Mpilo Central Hospital, a tertiary teaching referral government hospital in Bulawayo, Zimbabwe during the period January to December 2016. There were 8801 live births and 268 stillbirths (rate: 30.5/1000). The majority(81.3%) were macerated. Pre-term labour, pre-eclampsia, eclampsia and abruptio placenta accounted for 51.1%. In 29.9%, the cause could not be identified. A high proportion of macerated stillbirths were unexplained; hence this calls for a renewed focus on community-based approaches to reduce delays in seeking care. Investment in robust diagnostic means and further training of healthcare workers to improve case definition are both urgently required.
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Mortinato/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Adulto , Peso al Nacer , Estudios Transversales , Atención a la Salud/normas , Femenino , Humanos , Servicios de Salud Materna/normas , Embarazo , Estudios Retrospectivos , Zimbabwe/epidemiologíaRESUMEN
A 32 year-old P4 G4 was referred from a rural hospital for fibroids in pregnancy. The pregnancy test was positive. An ultrasound scan reported a huge left extrauterine mass. The uterus was of normal size. There was no pregnancy demonstrated. A laparotomy was done through a midline incision. There was a huge left ovarian tumour occupying the pelvic/abdominal region right up to the xiphisternum. A left salpingo-oophrectomy was done. The post operative period was uneventful. The histopathological report confirmed the diagnosis of ovarian dysgerminoma FIGO stage 1A. She was referred to oncologists for adjvunt chemotherapy.
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Disgerminoma/diagnóstico , Neoplasias Ováricas/diagnóstico , Adulto , Diagnóstico Diferencial , Reacciones Falso Positivas , Femenino , Humanos , Embarazo , Pruebas de Embarazo , UltrasonografíaRESUMEN
BACKGROUND: Stillbirths are distressing to the parents and healthcare workers. Globally large numbers of babies are stillborn. A number of strategies have been implemented to try and reduce stillbirths worldwide. The objective of this study was to assess the impact of leadership and accountability changes on reducing full term intrapartum stillbirths. METHODS: Leadership and accountability changes were implemented in January 2016. This retrospective cohort study was carried out to assess the impact of the changes on fresh full term intrapartum stillbirths covering the period 6 months prior to the implementation date and 12 months after the implementation date. The changes included leadership and accountability. Fresh full term stillbirths (>37 weeks gestation) occurring during the intrapartum stage of labour were analysed to see if there would be any reduction in numbers after the measures were put in place. RESULTS: There was a reduction in the number of fresh full term intrapartum stillbirths after the introduction of the measures. There was a statistical difference before and after implementation of the changes, 50% vs 0%, P = 0.025. There was a reduction in the time it took to perform an emergency caesarean section from a mean of 30 to 15 min by the end of the study, a 50% reduction. CONCLUSIONS: Clear and consistent clinical leadership and accountability can help in the global attempts to reduce stillbirth figures. Simple measures can contribute to improving perinatal outcomes.
Asunto(s)
Cesárea/normas , Muerte Fetal/prevención & control , Liderazgo , Servicios de Salud Materno-Infantil , Responsabilidad Social , Mortinato , Adolescente , Adulto , Países en Desarrollo , Femenino , Humanos , Servicios de Salud Materno-Infantil/economía , Servicios de Salud Materno-Infantil/organización & administración , Servicios de Salud Materno-Infantil/normas , Embarazo , Estudios Retrospectivos , Adulto Joven , ZimbabweRESUMEN
Background Ectopic pregnancy contributes to maternal morbidity and mortality, especially in low-resourced countries with limited facilities for early diagnosis and treatment. It is a very challenging condition to diagnose. Patients may collapse and die while undergoing investigation. Aims To assess surgical treatment given to patients presenting at Mpilo Central Hospital, the challenges that are faced and the outcomes; and also to document how women survive this dangerous condition in a setting challenged by low resources. Results All the patients had prompt life-saving surgery within 48 h of admission despite the challenges faced. The survival rate was 100% during the period of the study. Conclusion It is possible to prevent maternal mortality in low-resource countries by maintaining basic clinical and surgical skills.