RESUMEN
OBJECTIVE: To compare vitamin D status in an African population living at 10 degrees N with a Norwegian population living at 60 degrees N. DESIGN: Serum samples from 30 healthy young Ethiopians and 31 full term pregnant women from Addis Ababa were collected in September, and from 24 healthy Norwegians in March and 23 pregnant women from Oslo in February to June. METHODS: Serum (s) levels of calcidiol and intact parathyroid hormone (iPTH) were measured. RESULTS: The median values for s-calcidiol were significantly lower in Ethiopians compared with Norwegians (young Ethiopians 23.5nmol/l vs young Norwegians 81nmol/l, P<0.001; pregnant Ethiopians 25nmol/l vs pregnant Norwegians 36nmol/l, P<0.05) while those for s-iPTH were significantly higher (young Ethiopians 5.7pmol/l vs young Norwegians 2.4pmol/l, P<0.001; pregnant Ethiopians 4.8pmol/l vs pregnant Norwegians 2.8pmol/l, P<0.02). CONCLUSION: In spite of abundant availability of ultraviolet radiation, the population from Addis Ababa had a high rate of biochemical vitamin D deficiency compared with the Norwegian group.
Asunto(s)
Población Negra/genética , Calcifediol/sangre , Población Blanca/genética , Adulto , Alelos , Etiopía , Femenino , Humanos , Masculino , Noruega , Embarazo , Receptores de Calcitriol/genética , Rayos UltravioletaRESUMEN
To induce abortion in women with intra-uterine foetal death (IUFD), during a two-year period (August 1990 to October 1992), at Yekatit 12 Hospital, Addis Abeba, Ethiopia, condom-Foley catheter method (CFCM) with oxytocin, and oxytocin infusion alone were compared. All 25 pregnant women randomly assigned to the CFCM aborted within 24 hr, a 100% success rate with an induction-abortion time interval of 14.6 hr (p < 0.001), whereas among 20 patients who were treated with oxytocin infusion alone, induction failed in all. Repeated induction in the second group resulted in a marked delay of abortion; these patients were crossed over to either combined medical and surgical induction or to the CFCM depending on their cervical status. The rapid cervical dilatation and safe abortion in pregnant women with IUFD make the CFCM a superior procedure to induction of abortion with oxytocin infusion alone. In places where there is no experience with the use of prostaglandins and the agent, which may have undesirable side-effects, is unavailable, the CFCM is a simple cost-effective technique which could be used safely.
PIP: In the Department of Obstetrics and Gynecology, Yekatit 12 Hospital, Addis Ababa, Ethiopia, during August 1990-October 1992, pregnant women at 20-28 weeks of gestation who presented with intra-uterine fetal death (IUFD) were enrolled in a comparative study after giving verbal consent. Patients were randomly assigned to two groups. In the first group, abortion was induced in the conventional method by oxytocin infusion alone. In the second group, in addition to oxytocin infusion, the condom-Foley catheter method (CFCM) was employed. All 25 patients with the CFCM aborted within 24 hours, yielding an induction abortion time interval (IATI) of 14.60 +or- 5.27 hours. In contrast, induction failed twice among the 20 patients getting oxytocin infusion alone, and 5 patients were submitted to combined medical and surgical induction (CMSI) (IATI of 59.4 +or- 8.7 hours), as they had an appropriate cervix, and they expelled the fetus within 48 hours. Among the remaining 15 patients induction failure occurred for the third time, and 8 of them had developed an appropriate cervix (Bishop scone = 4-6), but the other 7 patients did not show any cervical change. Those with the appropriate cervix were submitted to CMSI, and those whose cervical state was unchanged were transferred to the CFCM. Both groups aborted within 72 hours; the respective IATIs were 93.5 +or- 12.0 hours and 86.7 +or- 4.8 hours. In 48.9% of the patients, the cause of the IUFD was preeclampsia/eclampsia (2 patients had eclampsia). One patient was positive for syphilis and another was diabetic, both received treatment before admission. There was no abnormal bleeding or any signs of infection. Blunt curettage was performed in 37.8% of patients between 20 and 26 weeks of gestation after the expulsion of the fetus in the oxytocin group. 53.3% of the patients in the CFCM group also received this treatment.
Asunto(s)
Aborto Inducido/métodos , Muerte Fetal , Oxitocina/uso terapéutico , Cateterismo Urinario/instrumentación , Aborto Inducido/economía , Adolescente , Adulto , Terapia Combinada , Análisis Costo-Beneficio , Femenino , Humanos , Infusiones Intravenosas , Embarazo , Estudios Prospectivos , Insuficiencia del TratamientoRESUMEN
This review article is a teaching material for those who are engaged in reproductive health (RH) service delivery, managers, policy makers, professionals and the RH community. It also aims at addressing the RH concept and indicates some of the operationalization modalities, challenges and attempts to promote the realization of RH and population programmes in the country. It has been shown time and again that even five years after the International Conference on Population and Development (ICPD), policy makers, administrators and service providers still lack an understanding of not only the integrated approach of RH services, but the concept of RH also. In addition, the majority poorly perceives the RH rights notion. It is imperative that issues like understanding of the integrated approach of RH services, ensuring the adequacy of the information or choices offered to women and emphasis on the quality of care offered to clients have to be addressed urgently and adequately. The conceptualization and operationalization of RH will require full understanding of the health, population and women policies, legal and institutional implications of these concepts and the actions needed to convert them into reality. In order to achieve better results, commitment not only of relevant governmental agencies but also by non-governmental organizations (NGOs) and the RH community is a prerequisite. This includes allocation of adequate resources and proper interpretation of the RH concept in the Ethiopian context.
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Servicios de Salud del Niño/organización & administración , Protección a la Infancia , Servicios de Planificación Familiar/organización & administración , Política de Salud , Servicios de Salud Materna/organización & administración , Medicina Reproductiva , Servicios de Salud para Mujeres/organización & administración , Salud de la Mujer , Niño , Países en Desarrollo , Etiopía , Femenino , Asignación de Recursos para la Atención de Salud/organización & administración , Implementación de Plan de Salud/organización & administración , Humanos , Evaluación de Necesidades/organización & administración , Objetivos Organizacionales , Embarazo , Calidad de la Atención de SaludRESUMEN
In a three year period (September 1989 to August 1992), among 7,170 consecutive deliveries at Yekatit 12 Hospital, Addis Abeba, Ethiopia, there were 291 singleton breech deliveries with a 4% incidence rate at a gestational age of 28 weeks and above. In 28% and 57% of the infants, weight was below 2,500 grams and Apgar score was less than 7 in the first minute, respectively. The gross perinatal mortality rate for breech delivery in the first 24 hours was 330 per 1,000 deliveries, which was significantly higher than for the total number of deliveries (70 per 1,000; p < 0.001). However, the perinatal mortality rate was 1,000 per 1,000 deliveries for foetuses of less than 1,500 grams, 635 for foetuses between 1,500-2,500 grams, and 156 for foetuses of greater than 2,500 gm. In general, foetuses with low birth weight showed a high mortality rate (p < 0.001). There was also a two-fold increase in perinatal death in patients without antenatal care (p < 0.001). In order to reduce this unacceptably high perinatal mortality, emphasis must be given to appropriate training of physicians and midwives in the management of breech deliveries along with provisions of efficient prenatal care to improve birth weight. In addition, as most of the neonatal problems are preventable, measures need to be taken to establish neonatal units equipped with basic resuscitation materials and manpower.
PIP: An obstetrician-gynecologist retrospectively reviewed the delivery records of 291 singleton breech presentations (BP) that occurred during September 1989-August 1992 at Yekatit 12 Hospital in Addis Ababa, Ethiopia, to examine birth outcomes. The singleton breech delivery rate was 4%. 57% of the BP infants had a one-minute Apgar score of less than 7. These infants comprised the majority of perinatal deaths. Perinatal death was more common among the low birth weight BP infants than those weighing 2500 g (707 vs. 156/1000; p 0.001). The perinatal mortality rate (PMR) increased as the birth weight decreased (2500 g, 156; 1500-2500 g, 635; and 1500 g, 1000). Mothers of BP infants who did not receive prenatal care were more likely to experience perinatal loss than those who received prenatal care (427 vs. 216; p 0.0001). 70% of perinatal deaths among those not receiving prenatal care occurred to infants weighing no more than 2500 g. 4.8% of cesarean sections had BP as an indication for cesarean section without maternal death. Since the hospital is a big referral hospital, many women came to the hospital in established and prolonged labor, which contributed to fetal death. The lack of a neonatal unit equipped with basic resuscitation equipment and health personnel further exacerbated the chances of infant survival. Establishment of such a unit and appropriate training of physicians and midwives in the management of breech deliveries will likely contribute to better fetal outcomes.
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Presentación de Nalgas , Parto Obstétrico/estadística & datos numéricos , Resultado del Embarazo , Adulto , Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Etiopía/epidemiología , Femenino , Humanos , Incidencia , Mortalidad Infantil , Recién Nacido , Edad Materna , Obstetricia/educación , Embarazo , Estudios RetrospectivosRESUMEN
This retrospective study was carried out to examine indications for Caesarean section (CS), foetal outcome and postoperative complications and to recommend ways of reducing maternal and neonatal deaths. In a five year period (September 1987 to August 1992), among 11,657 consecutive deliveries at Yekatit 12 Hospital, Addis Abeba, Ethiopia, there were 645 CSs, an overall CS rate of 5.5%. During this study, the indications for CS were cephalopelvic disproportion (31.2%), foetal distress (21.4%), previous CS (17.5%), placenta praevia (6.6%), cord prolapse (4.2%) and others (19.1%). There were 99 perinatal deaths, a gross perinatal mortality rate of 153.5 per 1,000 live births, which was a significantly higher rate than the total rate for all deliveries (67.5 per 1,000 live births, p < 0.01). There were seven maternal deaths (case fatality rate of 1.1%). The very high perinatal mortality in this study calls for a better and more effective antenatal service to improve foetal and maternal survival. This could be achieved by strengthening the referral system for pregnant women with obstructed and prolonged labour.
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Cesárea/estadística & datos numéricos , Hospitales Urbanos , Mortalidad Infantil , Mortalidad Materna , Vigilancia de la Población , Adulto , Tasa de Natalidad , Cesárea/efectos adversos , Cesárea/mortalidad , Cesárea/tendencias , Etiopía/epidemiología , Femenino , Humanos , Mortalidad Infantil/tendencias , Recién Nacido , Mortalidad Materna/tendencias , Morbilidad , Embarazo , Derivación y Consulta , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
A randomized trial to compare two methods of umbilical cord tying in neonates, immediately after birth, was undertaken from February to April 1997 in the Department of Obstetrics & Gynaecology, Zewditu Memorial Hospital, Addis Ababa, Ethiopia. In less than 3 months, we investigated 300 neonates, of whom 150 infants were randomly assigned to the traditional ligation of the umbilical cord (using a piece of thread) and the rest to a rubber ring clamping method. Among the former group, 13.3% (20/150) of the neonates bled from their umbilical cords which necessitated re-tying, whereas in the later group, there was no sign of haemorrhage or infection within 12 h of clamping. We suggest that the rubber ring method described is a superior procedure and can easily replace the traditional, cumbersome and time-consuming umbilical cord ligation.