Can training non-physician clinicians/associate clinicians (NPCs/ACs) in emergency obstetric, neonatal care and clinical leadership make a difference to practice and help towards reductions in maternal and neonatal mortality in rural Tanzania? The ETATMBA project.

OBJECTIVES: During late 2010, 36 trainees including 19 assistant medical officers (AMOs) 1 senior clinical officer (CO) and 16 nurse midwives/nurses were recruited from districts across rural Tanzania and invited to join the Enhancing Human Resources and Use of Appropriate Technologies for Maternal and Perinatal Survival in the sub-Saharan Africa (ETATMBA) training programme. The ETATMBA project was training associate clinicians (ACs) as advanced clinical leaders in emergency obstetric care. The trainees returned to health facilities across the country with the hope of being able to apply their new skills and knowledge. The main aim of this study was to explore the impact of the ETATMBA training on health outcomes including maternal and neonatal morbidity and mortality in their facilities. Secondly, to explore the challenges faced in working in these health facilities. DESIGN: The study is a pre-examination/postexamination of maternal and neonatal health indicators and a survey of health facilities in rural Tanzania. The facilities surveyed were those in which ETATMBA trainees were placed post-training. The maternal and neonatal indicators were collected for 2011 and 2013 and the survey of the facilities was in early 2014. RESULTS: 16 of 17 facilities were surveyed. Maternal deaths show a non-significant downward trend over the 2 years (282-232 cases/100,000 live births). There were no significant differences in maternal, neonatal and birth complication variables across the time-points. The survey of facilities revealed shortages in key areas and some are a serious concern. CONCLUSIONS: This study represents a snapshot of rural health facilities providing maternal and neonatal care in Tanzania. Enhancing knowledge, practical skills, and clinical leadership of ACs may have a positive impact on health outcomes. However, any impact may be confounded by the significant challenges in delivering a service in terms of resources. Thus, training may be beneficial, but it requires an infrastructure that supports it.

A qualitative process evaluation of training for non-physician clinicians/associate clinicians (NPCs/ACs) in emergency maternal, neonatal care and clinical leadership, impact on clinical services improvements in rural Tanzania: the ETATMBA project.

OBJECTIVES: The Enhancing Human Resources and Use of Appropriate Training for Maternal and Perinatal Survival in sub-Saharan Africa (ETATMBA) project is training non-physician clinicians as advanced clinical leaders in emergency maternal and newborn care in Tanzania and Malawi. The main aims of this process evaluation were to explore the implementation of the programme of training in Tanzania, how it was received, how or if the training has been implemented into practice and the challenges faced along the way. DESIGN: Qualitative interviews with trainees, trainers, district officers and others exploring the application of the training into practice. PARTICIPANTS: During late 2010 and 2011, 36 trainees including 19 assistant medical officers one senior clinical officer and 16 nurse midwives/nurses (anaesthesia) were recruited from districts across rural Tanzania and invited to join the ETATMBA training programme. RESULTS: Trainees (n=36) completed the training returning to 17 facilities, two left and one died shortly after training. Of the remaining trainees, 27 were interviewed at their health facility. Training was well received and knowledge and skills were increased. There were a number of challenges faced by trainees, not least that their new skills could not be practised because the facilities they returned to were not upgraded. Nonetheless, there is evidence that the training is having an effect locally on health outcomes, like maternal and neonatal mortality, and the trainees are sharing their new knowledge and skills with others. CONCLUSIONS: The outcome of this evaluation is encouraging but highlights that there are many ongoing challenges relating to infrastructure (including appropriate facilities, electricity and water) and the availability of basic supplies and drugs. This cadre of workers is a dedicated and valuable resource that can make a difference, which with better support could make a greater contribution to healthcare in the country.

Comparison of prevalence of chronic atrophic gastritis in Japan, China, Tanzania, and the Dominican Republic.

PURPOSE: To compare the prevalence of chronic atrophic gastritis (CAG) in Japan, China, Tanzania, and the Dominican Republic and to assess the usefulness of Helicobacter pylori infection and serum gastrin level as markers of CAG. METHODS: The subjects were volunteers from local communities in Japan (n=859), China (n=1741), Tanzania (n=573), and the Dominican Republic (n=1215). Each individual underwent a health checkup and blood sampling for measurement of serum pepsinogen I and II, pepsinogen I /II ratio, serum gastrin, and H. pylori antibodies, and responded to a questionnaire on upper digestive tract diseases. RESULTS: The prevalences of H. pylori infection (23.5-96.1%), CAG (5.6-60.4%), and serum gastrin (62.0-136.5 pg/ml) varied by age, sex, and country. Serum gastrin level for men differed in each country according to age. In Tanzanian men, the median gastrin level (101.0 pg/ml) was the highest in the 40 to 49 years age group (p < 0.01) while there was no significant difference among different age groups in Tanzanian women. Serum gastrin level in subjects > or = 70 years was higher than in other age groups in both sexes in the Dominican Republic (males, 92.5, females, 136.5 pg/ml). The prevalence of H. pylori infection increased (p < 0.01) with advancing age in Japan (only for women) and the Dominican Republic but was high in all age groups of both sexes in China and Tanzania. The prevalence of CAG increased (p < 0.01) with age in both sexes in Japan, China (women only), and the Dominican Republic, but not in Tanzania. The odds ratio of CAG in H. pylori infected subjects was 5.3 times that in H. pylori-negative subjects. The odds ratio of CAG increased by 0.6%/1 pg/ml increase in serum gastrin. CONCLUSIONS: Our results indicated that H. pylori infection, serum gastrin, and advancing age are good markers of CAG and that the prevalence of CAG is the highest in Japan.

Prospective assessment of Y-chromosome microdeletions and reproductive outcomes among infertile couples of Japanese and African origin.

BACKGROUND: To compare the frequency of Y-chromosome microdeletions in Japanese and African azoospermic and oligozoospermic men and describe embryo characteristics and reproductive outcome following in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). METHODS: Our study was performed prospectively at two centers, a private IVF clinic and a university hospital. Japanese and African (Tanzanian) men with nonobstructive azoospermia (NOA) and oligozoospermia (concentration < 5 x 10(6) /ml) were evaluated for Y-chromosome microdeletions (n = 162). Of the 47 men with NOA, 26 were Japanese and 21 were Africans. Of the 115 men with oligozoospermia, 87 were Japanese and 28 were Africans. Reproductive outcomes of patients with Y-chromosome microdeletions were then compared with those of 19 IVF+ICSI cycles performed on couples with Y-chromosome intact males/tubal factor infertility which served as a control group. RESULTS: Seven azoospermic and oligozoospermic patients had Y-chromosome deletions; the total number of deletions in the AZFc region was five. There was only one deletion in the AZFa region and one complete deletion involving all three regions (AZFa, b, and c) within AZF. In our study population, microdeletion frequency among Japanese men was 6.2% (95% CI, 4.25%-14.45%), whereas no deletions were identified in the African group (95% CI, 0.0%-7.27%). The difference between the two groups was not statistically significant, however. Embryos derived from ICSI utilizing sperm with Y-chromosome microdeletion showed reduced rates of fertilization, blastocyst development, implantation, and pregnancy compared to the Y-chromosome intact group, although these observed differences were not statistically significant. CONCLUSION: The observed frequency of Y-chromosome microdeletion was 6.2% among Japanese azoospermic and oligozoospermic males; no microdeletions were identified among our African study patients. In this population of couples undergoing IVF+ICSI, there was no statistically significant difference in embryo characteristics or pregnancy outcome between patients with Y-chromosome microdeletion and those with an intact Y-chromosome.

Are sperm parameters the best indicator of 2,5-hexanedione reproductive toxicity in male rats?

In this study on 40 male Wistar rats of approximately 3-weeks-old, the effects of 2,5-hexanedione on sperm principal parameters were examined by subcutaneously administering 100, 200 and 400 mg/(kgday) for 12 weeks. Other indicators of 2,5-hexanedione intoxication were examined: testes, epididymides, body weight, limb paralysis and histology. The sperm motility was adversely affected in all of the three treatment groups. No sperm motility at all was observed in the 200 and 400 mg/(kgday) treatment groups and rapid progressive motility was significantly reduced in the 100 mg/(kgday) group (P<0.05). The sperm concentration and morphology, testes, epididymides and body weight were significantly affected in the 200 and 400 mg/(kgday) groups but not in the 100 mg/(kgday) group (P<0.05). All the rats in the 400 mg/(kgday) group could not move due to leg paralysis, whereas only 50% of the rats in the 200mg/(kgday) group and none in the 100 mg/(kgday) were affected. Histological examination of the testes in the 400, 200 and 100 mg/(kgday) groups revealed Sertoli cell-only syndrome in 70, 30 and 0% of the rats, respectively. In conclusion, this study has shown that sperm motility was the most significantly sensitive indicator of 2,5-hexanedione intoxication in all the treatment groups.

Embryo outcome in Y-chromosome microdeleted infertile males after ICSI.

UNLABELLED: A prospective study involving 118 infertile Japanese couples to assess the embryo outcomes in both azoospermic and oligoasthenoteratoazoospermic (OAT) patients with Y-chromosome microdeletion. The men were divided into two groups; azoospermia (n = 27), and OAT, sperm concentration <5 x 10(6)/ml (n = 91). They were investigated for Y-chromosome microdeletions by a polymerase chain reaction (PCR) amplification of the Y-chromosome-specific sequence tag site (STS). The embryo outcomes of patients found to have Y-microdeletion were determined. The frequency of microdeletion was 8.8% (9) and two had microdeletions distal to DAZ. The mean fertilization rate and the cleavage rate in the eight cycles of both azoospermic and oligospermic patients were 59.3 and 87.5%, respectively. The percentages of grade 1 & 2 embryos, > or =6 cells embryos, and blastocyts were 51.7, 65.6, and 45.3%, respectively. Three pregnancies resulted from the eight cycles (37.5%). CONCLUSION: in Y-chromosome microdeletion cycles in which sperm cells were available for intracytoplasmic sperm injection (ICSI), embryo outcome was comparable to conventional IVF.

Seroprevalences ofHelicobacter pylori infection and chronic atrophic gastritis in the united Republic of Tanzania and the Dominican Republic.

OBJECTIVE: The aim of this survey was to compare the seroprevalences ofHelicobacter Pylori (H. pylori) and chronic atrophic gastritis (CAG) in Tanzania and the Dominican Republic, both of which are tropical countries, and thereafter compare the prevalences in Tanzania and the Dominican Republic with prevalences from our previous studies done in Japan (1991) and China (1996/97). METHODS: Community-based study in which 573 inhabitants of Tanzania and 1,215 inhabitants of the Dominican Republic answered detailed questionnaires on upper digestive tract diseases, and then underwent screening for gastric cancer by serum pepsinogen and testing for antibody toH. pylori. RESULTS: After adjusting to the 'Age-Standardized Rate' (ASR) using the world population in 1995, the seroprevalences ofH. pylori infection in male and female subjects for Tanzania (m=85.3% & f=88.2%) were very high compared to those for the Dominican Republic (m=63.5% & f=62.4%) and Japan (m=62.0% & f=46.8%), and similar to those of China (m=78.0% & f=77.3%). Also, the agestandardized prevalences of CAG in males and females for Tanzania (m-0.237& f=0.458). were higher than those of the Dominican Republic (m=0.168 & f=0.211) and China (m=0.111 & f=0.107) and compared well with those of Japan (m=0.266 & f=0.352). CONCLUSIONS: Although Tanzania and the Dominican Republic are both developing countries, Tanzania had a very high age-standardized prevalence ofH. pylori and CAG compared to that of the Dominican Republic, which showed a trend similar to that of Japan.

Reproductive toxicity of 2,5-hexanedione in male rats.

Background, Aims and Method: 2,5-Hexanedione is an industrial solvent which causes peripheral neuropathy. In the current study, the effect of 2,5-hexanedione on testicular histology of adult rats as well as sperm concentration, motility, and morphology were studied by administering 100 mg, 200 mg, 400 mg/kg per day for 12 weeks. Results: No sperm motility was observed in the 200 mg and 400 mg/kg per day treatment groups and significantly reduced motility was observed in the 100 mg/kg per day group. The morphology were also significantly reduced in the 200 mg and 400 mg/kg per day groups compared to the control group, but the sperm concentration was significantly reduced only in the 400 mg/kg per day group. Histological examination of the testes in the 400 mg/kg per day group revealed that two-thirds of the testes had Sertoli cell only syndrome, whereas in the 200 mg/kg per day group half of the testes showed maturation arrest and sperm as well as spermatids were observed in 83% of the testes. Conclusions: In conclusion, we have shown that 2,5-hexanedione severely affected sperm motility even at low doses, whereas high doses adversely affected all the sperm parameters as well as causing testicular injury. (Reprod Med Biol 2004; 3: 59-62).

Peritonitis after a ruptured left pyosalpinx in a patient undergoing in vitro fertilization.

OBJECTIVE: To report acute abdomen in a young woman with infertility due to small asymptomatic bilateral hydrosalpinges who was on the 12th day of an IVF cycle. DESIGN: Case report. SETTING: Private IVF clinic. PATIENT(S): A 35-year-old woman with asymptomatic bilateral hydrosalpinges. INTERVENTION(S): Abdominal laparoscopy. MAIN OUTCOME MEASURE(S): Pus and a ruptured left pyosalpinx. RESULTS: The patient suddenly developed acute abdomen while lifting a disabled person at a nursing home where she worked as a nurse. About 200 mL of pus was aspirated, and the patient had a ruptured left pyosalpinx. Bilateral salpingectomy was done by laparoscopy; the patient's postoperative recovery was uneventful. CONCLUSION: We report a rare case of acute abdomen due to peritonitis after a ruptured pyosalpinx in an IVF patient who lifted a disabled person.

Comparison of sibling oocyte outcomes after intracytoplasmic sperm injection and in vitro fertilization in severe teratozoospermic patients in the first cycle.

To follow up the outcome of sibling oocytes subjected to both conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in the first cycles of severe teratozoospermic patients with normal sperm morphology (NSM)or=6 cell embryos on day 3 and blastocyst formation on days 5 and 6, did not differ significantly between the two groups. There was a trend towards a high pregnancy rate cycle in mixed ICSI/IVF embryo transfer (ET) (49.1%). In conclusion, this study showed that in couples with only severe teratozoospermia, there was a benefit in subjecting sibling oocytes to both IVF and ICSI in the first cycle because 24 (28.2%) cycles of total fertilization failure were avoided. Furthermore, despite initially significant higher fertilization rates in ICSI than IVF oocytes, subsequent rates of development from >or=6 cells up to blastocyst stage were the same suggesting that ICSI should be used with caution, as after day 3, ICSI-derived embryo development was compromised compared with IVF.