An integrative review of home care recommendations for women after caesarean section.

AIM: To describe home-based care and practices recommended for mothers after caesarean section (CS), existing in the literature. DESIGN: Systematic review. METHODS: This integrative literature review was conducted by using Google Scholar, PubMed and Hinari databases from its inception to June 2021. The search included research articles, protocols and guidelines that describe home care practice after CS and assessed for their quality. Synthesis of recommendations from the included literature was classified based on the type of study design, and the review was guided by methodology registered in Prospero (ID CRD42021276905). RESULTS: A total of 681 literatures were found, and 12 met the criteria. Recommended home care components were divided into four major categories; wound care practice (wound cleaning, drying and bandage change); nutrition (high-protein diet, vitamin C, fibre and balanced diet); exercise (pelvic floor muscle, walking and breathing exercise) and hygiene (bathing and wearing clean clothes). There was limited literature addressing the components of perineal care and home environment. Varying recommendations were found regarding wound cleaning and dressing in the studies done in low- and high-income countries.

Barriers and facilitators of people living with HIV receiving optimal care for hypertension and diabetes in Tanzania: a qualitative study with healthcare professionals and people living with HIV.

BACKGROUND: People living with HIV (PLWH) are at a higher risk for developing diabetes and hypertension. Often services are separate for HIV and non-communicable diseases (NCDs), but how this impacts NCD care among PLWH is unknown. We aimed to understand the barriers and facilitators for prevention, early diagnosis and safe effective care for diabetes and hypertension among PLWH. METHODS: Semi-structured interviews (SSIs) were conducted with 10 healthcare professionals (HCPs) that care for PLWH, 10 HCPs that care for people with diabetes and hypertension and 16 PLWH with a comorbidity of diabetes and/or hypertension. Participants were recruited from two healthcare facilities in Dodoma, Tanzania and purposively sampled based on age and sex. Interviews were conducted in Swahili using pre-developed topic guides, audio recorded then translated verbatim into English. An inductive thematic analysis was conducted using The Framework Method. RESULTS: Three themes were found: organisational/healthcare system factors, individual factors and syndemic factors. Organisational/healthcare system factors comprised the only facilitators for prevention (education on lifestyle behaviours and counselling on adherence), but included the most barriers overall: fragmented services, no protocol for NCD screening and lack of access to diagnostic equipment were barriers for early diagnosis whereas the former plus lack of continuity of NCD care were barriers for safe effective care. Individual factors comprised four sub-themes, three of which were considered facilitators: HCPs' knowledge of NCDs for early diagnosis, self-monitoring of NCDs for safe effective care and HCPs' personal practice for both early diagnosis and safe effective care. HCPs' knowledge was simultaneously a barrier for prevention and PLWH knowledge was a barrier for prevention and safe effective care. Syndemic factors comprised three sub-themes; all were barriers for prevention, early diagnosis and/or safe effective care: poverty and mental health of PLWH and HIV stigma. CONCLUSIONS: Organisational/healthcare system, individual and syndemic factors were found to be interlinked with barriers and facilitators that contribute to the prevention, early diagnosis and safe effective care of diabetes and hypertension among PLWH in Tanzania; these findings can inform future initiatives for making small and large health system changes to improve the health of aging PLWH.

Protocol for designing and testing the effectiveness of a post caesarean section home care guide in preventing surgical site infection in Central Tanzania.

BACKGROUND: The advantages of caesarean section (CS) in managing obstetric emergencies are abundant, but it is associated with several complications including surgical site infection (SSI). SSI significantly contributes to maternal morbidity and mortality rates. Mothers often do not receive adequate information about their at-home post-delivery care. Also, guidelines on post-CS care worldwide typically do not include home care recommendations. Because of the increased rate of CS and space constraints in the hospitals, mothers are often discharged home within 48 hours after CS. Therefore, it is anticipated that using an evidence-based home care guide would provide instruction to the mothers and is likely to prevent postpartum complications and promote the well-being of both the mother and the newborn. AIM: To design and test the effectiveness of a post-CS home care guide in preventing SSI in central Tanzania. METHODOLOGY: This is a sequential exploratory mixed-method interventional study conducted in two regional referral hospitals in central Tanzania. A qualitative study will be conducted to explore the experiences of nurse midwives, mothers who had caesarean deliveries and their caretakers regarding the care of mothers and newborns at home. The findings will inform the development of a post-CS home care guide. Following a series of validations of the guide, research assistants will employ the guidelines to instruct post-CS mothers about home care as part of the intervention. Thirty participants will purposively be recruited for the qualitative study and a random sample of 248 nurse-midwives and 414 post-CS mothers to assess the effectiveness of the guide in improving knowledge of home care and preventing SSI. SPSS version 25 will be used to analyse quantitative data and content analysis, and ATLAS.ti will guide in analysing the qualitative data. CONCLUSION: The post-CS home care guide will provide instructions to post-CS mothers and their caretakers about the care of the mothers after CS to enhance their recovery.

Gestational trophoblastic disease and associated factors among women experiencing first trimester pregnancy loss at a regional referral hospital in central Tanzania: a cross-sectional study.

BACKGROUND: Gestational trophoblastic diseases (GTDs) may follow any form of pregnancy or a pregnancy loss. Early detection of GTDs is important, as some benign forms of the disease may progress into a chemoresistant and metastatic disease. This study aimed at determining the frequency of GTDs among women experiencing first trimester pregnancy loss and the associated patients' characteristics. METHODS: This was a cross-sectional study that included 200 conveniently sampled women who experienced first trimester pregnancy loss from January to December 2019 at a Regional Referral Hospital in central Tanzania. The specimen obtained from products of conception were collected, formalin-fixed and paraffin-embedded and submitted for histopathological evaluation, for which haematoxylin and eosin stain was used. Data were analysed using SPSS version 23.0. The χ2 test was used to determine the association between categorical variables. p-Values ˂0.05 were considered statistically significant. RESULTS: Among 200 study participants, the overall frequency of GTDs was 42 (21%). Among those with GTDs, the most common histopathological diagnosis was partial hydatidiform mole (18 [42.9%]), followed by complete hydatidiform mole (17 [40.5%]) and choriocarcinoma (7 [16.5%]). In the studied participants, only increased human chorionic gonadotropin hormone levels were found to be statistically significantly associated with GTDs (p=0.000). CONCLUSIONS: Results from this study suggest that routine histopathological evaluation of the products of conception is recommended in order to allow early detection of GTDs, including choriocarcinoma, which usually carries a poor prognosis. The histopathological reporting of choriocarcinoma among first trimester products of conception from Tanzania is novel.

Prevalence and predictors of gestational diabetes mellitus among pregnant women attending antenatal clinic in Dodoma region, Tanzania: an analytical cross-sectional study.

INTRODUCTION: Gestational diabetes mellitus (GDM) is rapidly increasing worldwide. Globally, 18.4 million pregnancies are complicated by GDM. Despite its known effect, GDM screening is not part of routine antenatal services in Tanzania. There is paucity of data on the magnitude and risk factors for GDM. Therefore, this study sought to determine prevalence and predictors of GDM among pregnant women in Dodoma region, Tanzania from March to August 2018. RESEARCH DESIGN AND METHODS: A cross-sectional study was carried out in Dodoma region, Tanzania between April and August of 2018. A total of 582 pregnant women were recruited from four local health facilities, where purposive sampling procedure was used to select the region, districts and health facilities. Simple random sampling was used to select study participants. Screening and diagnosis of GDM were performed using the 2013 WHO criteria. Descriptive and inferential analyses were performed using SPSS V.23 to determine prevalence and independent predictors of GDM. RESULTS: Among 582 participants, 160 (27.5%) participants were diagnosed with GDM. GDM was more prevalent in urban areas than rural areas, among overweight participants, among participants with a history of a large for gestational age baby, among participants with a history of caesarean section, and among participants with college or university education. Multiple logistic regression analysis showed that maternal age above 35 years (adjusted OR (AOR) 3.115 (95% CI: 1.165 to 8.359)), pre-eclampsia (AOR 3.684 (95% CI: 1.202 to 5.293)), low physical activity level (AOR 4.758 (95% CI: 2.232 to 10.143)), lack of awareness of GDM (AOR 6.371 (95% CI: 1.944 to 13.919)), alcohol use (AOR 4.477 (95% CI: 1.642 to 12.202)) and family history of diabetes (AOR 2.344 (95% CI: 1.239 to 4.434)) were significantly associated with GDM. CONCLUSIONS: Prevalence of GDM is relatively high in Dodoma region. Most pregnant women are unaware of the condition such that it leads to a high-risk lifestyle. Besides, GDM significantly contributes to the number of high-risk pregnancies that go undetected and suboptimally managed. The antenatal care centres offer an optimum platform for screening, preventing and treating GDM by prioritising high-risk women.