A brief history of South Africa's response to AIDS.

The story of the AIDS response in South Africa over the past 4 years is one of great progress after almost a decade of complex and tragic denialism that united the world and civil society in a way not seen since the opposition to apartheid. Today the country can boast > 2 million people on antiretroviral therapy, far and away the largest number in the world. Prevention efforts appear to be yielding results. The estimated number of annual new HIV infections declined by 79 000 between 2011 and 2012. New HIV infections among adults aged 15-49 years are projected to decline by 48% by 2016, from 414,000 (2010) to -215,000 (2016). The national incidence rate has reached its lowest level since the disease was first declared an epidemic in 1992, translating into reductions in both infant and under-5 mortality and an increase in life expectancy from 56 to 60 years over the period 2009-2011 alone. This is largely thanks to a civil society movement that was prepared to pose a rights-based challenge to a governing party in denial, and to brave health officials, politicians and clinicians working in a hostile system to bring about change.

Women's access to modern methods of fertility regulation.

Preventing unintended pregnancies through access to modern family planning could avert 20-35% of maternal deaths, saving the lives of more than 100,000 women each year. Obstacles to wider access still exist, but they may be overcome by overt policy commitment to reproductive health services, partnership between stakeholders, community involvement and quality programs.

Non-puerperal uterine inversions. A two case report and review of literature.

Chronic non-puerperal uterine inversions are rare but the occasional case has to be managed without previous experience. Of the 77 cases reported, 75 (97.4%) were tumour produced and 20% of these tumours were malignant. The importance of taking biopsies from tumours before definitive surgery is highlighted. Adequate surgical management requires experience in vaginal surgery.

Eclampsia at Ga-Rankuwa Hospital.

OBJECTIVES: To study the epidemiology of eclampsia and the maternal and fetal outcome of the disease. DESIGN: Observational study. SETTING: Ga-Rankuwa Hospital, a tertiary institution. SUBJECTS: Patients admitted with the diagnosis of eclampsia from 1 January 1994 to 31 December 1995. OUTCOME MEASURES: Age, parity, booking status, fits, blood pressure, gestational age, mode of delivery, fetal outcome, maternal complications and outcome. RESULTS: Out of 18145 women delivered, 66 had eclampsia (3.6/1000). Of the 36 maternal deaths in the same period, 14 (38.9%) were caused by eclampsia. The case fatality rate was 21.2%. Maternal mortality was significantly higher in the unbooked population, women aged 30 years and above, and those with multiple fits. The mean (SD) maternal age was 22.3 (6.8) years and fits occurred in the presence of high diastolic blood pressure (mean 113.7 +/- 15.6 mmHg). The majority of fits (90.1%) occurred at home and in 70.3% of patients, this happened before 37 weeks (mean gestational age 33.2 (3.9) weeks). In 77.3%, eclampsia was antepartum while it occurred postpartum in 4.5% of cases. The caesarean section rate of 66.7% is justified. The perinatal mortality rate was 47.7% and maternal complications were varied and severe. It is disturbing that health care providers failed to act on warning signs in 14 (46.7%) of the 30 booked patients that were evident long before they developed fits. CONCLUSION: Eclampsia is a problem and is responsible for a significant proportion of maternal deaths. The epidemiological factors responsible are identified and some recommendations are made. Patient and physician education, together with improved socio-economic conditions, are likely to improve the situation.