Exploring Rural Women’s Perspectives on Associated Factors to Anaemia During Pregnancy in Mpumalanga Province, South Africa: A Qualitative Approach

The prevalence of late antenatal care (ANC) booking in Malaysia is higher than the target set by the Ministry of Health (20%). First ANC is suggested to be conducted within 12 gestation weeks. This study aims to investigate the prevalence and factors of late booking of ANC among pregnant women in Sepang, Selangor. A cross-sectional study using a self-administered questionnaire on 492 pregnant women in the first, second, and third trimesters was conducted randomly at government health clinics. The prevalence of late ANC booking was 27.6% (136). Multiple logistic regression showed that poor knowledge (AOR = 1.604, 95% CI:1.022,2.517, P-value = 0.040), higher parity (AOR = 1.225, 95% CI:1.003,1.495, P-value = 0.046), previous experience of spontaneous vaginal delivery (SVD, AOR = 2.855, 95% CI:1.227,6.645, P-value = 0.015) and did not have experience on delivery (AOR = 2.906, 95% CI:1.147,7.364, P-value = 0.025) associated with late ANC booking. The prevalence of late ANC booking in this study was higher than MOH targeted, therefore it is suggested to devise the appropriate program to improve knowledge and awareness of the targeted high-risk population.

Dog rabies has commonly been associated with the eastern and southern border areas in Mpumalanga province, and the Nkomazi district in the east has been most affected. In other parts of the province, canid rabies has been under control for many years; however, in 2008, dog rabies spread to other parts of the province and resulted in a widespread outbreak. The objective of this study was to genetically characterize rabies viruses in an attempt to determine the source of this recent outbreak. Fifty-five rabies viruses were recovered from domestic dogs between 2000 and 2008 from Mpumalanga province and bordering areas. The viruses were characterized through nucleotide sequencing of the cytoplasmic domain of the glycoprotein gene and the G-L intergenic region. Phylogenetic analysis of these viruses and those previously characterized from Mpumalanga province and neighboring countries and provinces clearly supported the placement of the viruses from the current outbreak and those from Nkomazi district in one lineage. This demonstrated that the recent emergence of rabies in Mpumalanga province resulted from the spread of rabies from Nkomazi district. A comparative analysis demonstrated close genetic relationships among rabies viruses from Mpumalanga and KwaZulu-Natal provinces, Swaziland, and Mozambique. Findings from this investigation have shown that rabies continues to pose a definite public health threat in South Africa, a situation similar to other African countries.

IntroductionCancer contributes to a significant proportion of morbidity and mortality globally. Low-income and middle-income countries such as South Africa tend to be characterised by poor and inequitable access to cancer...

INTRODUCTION: Lower socioeconomic status (SES) has been associated with adverse pregnancy outcomes. We determined whether ZIP-code level-based SES indicator was associated with adverse pregnancy outcomes. METHODS: Retrospective study of OHSU births from 2009–2014 compared adverse pregnancy outcomes among women living in 88 Portland metro-area ZIP-codes stratified into 3 median household income groups: Low (below 10th percentile), medium (10th-90th percentile), and high (above 90th percentile) socioeconomic status (SES). Perinatal outcomes were compared by univariate analysis; multivariable logistical regression determined strength of association of low and high SES with adverse outcomes (medium SES=reference group), adjusting for significant variables. RESULTS: Of 8,118 deliveries included, 1,654 (20%) were in low SES, 5,856 (72%) were in medium SES, and 608 (8%) were in high SES. Women in low SES were more likely to be younger, have higher BMI and tobacco use, and have less private insurance. Lower SES was associated with higher rates of preeclampsia (PEC) (9.02% vs 7.48% vs 5.93%, P<.028) and small for gestational age (SGA) (10.7% vs 9.34% v 6.61%, P<.012), and lower birth weights (mean 3,280 g vs 3,340 g vs 3,592 g, P<.001). High SES was associated with lower gestational diabetes mellitus (GDM) rates (10.8% vs 11.0% vs 7.58%, P<.036), even after adjusting for confounders (aRR high SES 0.710, 95% CI 0.507–0.995). CONCLUSION: In the Portland metro-area, low SES is associated with higher rates of PEC and SGA. High SES is associated with lower rates of GDM. ZIP-code level SES indicator detects perinatal outcome differences and may be useful for identifying healthcare disparities.

Using Trust databases to identify predictors of late booking for antenatal care within the UK

The objective of this study was to evaluate perinatal outcomes of pregnancies complicated by hypertensive disorders in pregnancy in an urban sub-Saharan African setting. A prospective cohort study of 1010 women of less than 17 weeks of gestation was conducted at two antenatal clinics in Accra, Ghana, between July 2012 and March 2014. Information about hypertensive disorders was available for analysis on 789 pregnancies. The main outcomes were pre-term birth, birthweight, Apgar scores, small for gestational age and mortality. Relative risk (RR, 95% confidence interval (CI)) for the association between hypertensive disorders of pregnancy and perinatal outcomes was assessed using logistic regression adjusting for potential confounders. A total of 88.7% of women remained normotensive, 7.5% developed pregnancy-induced hypertension, 2.0% had chronic hypertension, and 1.7% developed (pre-)eclampsia. No adverse effects were observed in women with pregnancy-induced hypertension. Women with chronic hypertension were more likely to have a lower gestational age at delivery (38.0 ± 2.3 weeks vs. 39.0 ± 1.9 weeks, P = 0.04) and higher risk of pre-term delivery (aRR 4.63, 95% CI 1.35-15.91). Women with pre-eclampsia had emergency Caesarean section significantly more often (88.9% vs. 50%, P = 0.04), with a higher risk for low birthweight infants (aRR 7.95, 95% CI 1.41-44.80) and a higher risk of neonatal death (aRR 18.41, 95% CI 1.20-283.22). Comparable to high-income countries, in Accra hypertensive disorders during pregnancy were associated with increased risk of adverse perinatal outcomes necessitating maternal and newborn care.

South Africa has committed to reducing its greenhouse emissions by sixty-five percent by 2030 in their National Integrated Energy Plan (NEIP). The lack of investment and development for renewable energy sources put the country on an uncertain trajectory in fulfilling its 2030 energy commitments. At the same time, the country has been labeled as a region with one of the highest solar energy potentials. Provinces such as Mpumalanga and Northern Cape are on opposite ends of the matter, with Northern Cape is one of the leading provinces for renewal energy, while the Mpumalanga province remains the host to eighty-five per cent of the country’s coal plants. Solar energy is an abundant renewable energy source and can be assessed using Geographic Information Systems (GIS) techniques. In this paper, the geostatistical technique, Kriging, is employed to predict, estimate, and compare the regional distribution, potential, and variability of annual optimum solar energy (irradiance) between the Mpumalanga Province and Northern Cape Province. Spot-based radiation data are available for solar energy analyses from the GIS Web-based tool Photovoltaic Geographical Information Systems (PVGIS). Kriging was used to estimate the spatial variability of solar energy at an average error of 1.98505% for the Northern Cape Province and 2.32625% for the Mpumalanga Province. It was identified that the Northern Cape receives the highest annual optimum irradiation and has a low overall spatial variation in irradiation over its provincial area. Mpumalanga receives lesser amounts of irradiation but has high overall spatial variation over its provincial area. Most of Northern Cape’s central to northwestern regions have the highest annual optimum irradiation ranging from 2583 kWh/m2 to 2638 kWh/m2, while Mpumalanga’s highest regions of annual irradiation occur primarily on its western and northwestern parts and ranges in highs of 2345 kWh/m2 to 2583 kWh/m2.

The ubiquitous occurrence of emerging micropollutants (EMPs) in water is an issue of growing environmental-health concern worldwide. However, there remains a paucity of data regarding their levels and occurrence in water. This study determined the occurrence of EMPs namely: carbamazepine (CBZ), galaxolide (HHCB), caffeine (CAF), tonalide (AHTN), 4-nonylphenol (NP), and bisphenol A (BPA) in water from Gauteng, Mpumalanga, and North West provinces, South Africa using comprehensive two-dimensional gas chromatography coupled to high resolution time-of-flight mass spectrometry (GCxGC-HRTOFMS). Kruskal-Wallis test and ANOVA were performed to determine temporal variations in occurrence of the EMPs. Principal component analysis (PCA) and Surfer Golden Graphics software for surface mapping were used to determine spatial variations in levels and occurrence of the EMPs. The mean levels ranged from 11.22 ± 18.8 ng/L for CAF to 158.49 ± 662 ng/L for HHCB. There was no evidence of statistically significant temporal variations in occurrence of EMPs in water. Nevertheless, their levels and occurrence vary spatially and are a function of two principal components (PCs, PC1 and PC2) which controlled 89.99% of the variance. BPA was the most widely distributed EMP, which was present in 62% of the water samples. The detected EMPs pose ecotoxicological risks in water samples, especially those from Mpumalanga province.

Background: Pregnancy among adolescents in South Africa is a growing concern as it may be associated with adverse socioeconomic and health impacts. Timeous initiation and optimal utilisation of antenatal care (ANC) services is imperative to ensure positive pregnancy outcomes. However, this is not always possible owing to various challenges.
 
 Methods: A multi-method study design using both retrospective record review and qualitative interviews was undertaken at a district hospital on the North Coast of KwaZulu-Natal, South Africa. Data on ANC attendance trends and obstetric/perinatal outcomes for all recorded adolescent pregnancies (13–16 years) at the district hospital under study was collected over 3 years (2011–2013) (n = 314). Qualitative interviews with randomly selected pregnant adolescents were conducted to assess experiences of ANC access and utilisation.
 
 Results: Late ANC booking and reduced ANC visits were common for adolescent pregnancies. Under-utilisation of ANC (i.e. less than 4 visits) was significantly associated with lower gestational age (< 37 weeks) (OR = 2.64; 95% CI = 1.04; 6.74; p < 0.05). Low birthweight, low Apgar scores as well as the incidence of maternal anaemia and pregnancy-induced hypertension (PIH) were found to be related to late ANC booking. In-depth interviews suggested that teenagers suffered emotional vulnerability linked to family, partner and financial support. They discussed various barriers linked with accessing ANC while acknowledging perceived benefits.
 
 Conclusion: Adolescent pregnancy was associated with late booking and reduced ANC visits, which was a risk for adverse maternal health outcomes. In-depth interviews suggested numerous challenges associated with ANC access including; financial barriers, attitude of healthcare workers (HCWs), long queues, distance travelled to access ANC services, human immunodeficiency virus (HIV) status and a lack of knowledge.
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.133378

ObjectiveTo assess the associations of gestational weight gain (GWG) in early and late pregnancy with subsequent risks of adverse pregnancy outcomes in Chinese women.DesignProspective cohort study.SettingShanghai, China.ParticipantsWe studied 2630 nulliparous...

Epilepsy is a disorder that disturbs nerve cell activity in the brain, resulting in seizures. It was noted that it occurs mostly in children, especially at the primary school level, and could result from a genetic condition. The aim of this study was to develop and validate life skills education guidelines for primary school learners of Limpopo and Mpumalanga provinces in South Africa to educate them about epilepsy with the aim of reducing stigma and discrimination towards people with epilepsy. The guidelines were developed by adapting the World Health Organization (WHO) guideline development guide, which included the formulation of PICOS (population, intervention, comparison, outcome, study design) questions, conducting a systematic review of the literature, and using GRADE (grading of recommendations assessment, development, and evaluation) to develop evidence-based recommendations. The recommendations that informed the guideline development were that epilepsy education should be included in the primary school life skills curriculum to improve learners' understanding, attitudes, and skills related to epilepsy. This epilepsy education should be tailored to the needs of primary school learners and cover topics such as seizure recognition, management, medication, and coping strategies. Collaboration between healthcare providers, educators, and policymakers is crucial to developing culturally appropriate and evidence-based epilepsy education guidelines. Teachers and healthcare providers should also receive training on how to support learners living with epilepsy. The resulting guidelines provide clear and concise guidance on epilepsy education in life skills for primary school learners, caregivers, and teachers. The guidelines are expected to improve the quality of epilepsy life skills education and contribute to the overall well-being and inclusion of learners with epilepsy in Mpumalanga and Limpopo provinces, South Africa.

Associations between Nugent-bacterial vaginosis and preterm birth and other adverse pregnancy outcomes in rural northwestern Bangladesh.

To explore stillbirth risk across gestation in three provinces of South Africa with different antenatal care schedules. Retrospective audit of perinatal death data using South Africa's Perinatal Problem Identification Programme. In 2008, the Basic Antenatal Care Programme was introduced in Limpopo and Mpumalanga provinces, reducing appointments to five visits at booking, 20, 26, 32, 38 weeks and 41 weeks if required. In the Western Cape province seven appointments remained at booking, 20, 26, 32, 34, 36, 38 and 41 weeks if required. All audited stillbirths (n = 4211) between October 2013 to August 2015 in Limpopo, Mpumalanga and Western Cape. Stillbirth risk (26-42 weeks of gestation, >1000 g) across gestation was calculated using Yudkin's method. Stillbirth risk was compared between provinces and relative risks were calculated between Limpopo/ Mpumalanga and Western Cape. Stillbirth risk across gestation. Stillbirth risk peaked at 38 weeks of gestation in Limpopo (relative risk [RR] 3.11, 95% CI 2.40-4.03, P < 0.001)and Mpumalanga (RR 3.09, 95% CI 2.37-4.02, P < 0.001) compared with Western Cape, where no peak was observed. Stillbirth risk at 38 weeks gestation in Limpopo and Mpumalanga were statistically greater than both the 37 and 39 weeks gestation within provinces (P < 0.001). As expected, a peak at 41 weeks of gestation was observed in all provinces. The increased period of stillbirth risk occurs after a 6-week absence of antenatal care. This calls for a refocus on the impact of reduced antenatal care visits during the third trimester. Reduced antenatal care in the third trimester may increase stillbirth risk.

Are increased fetal movements during pregnancy a predictor of neonatal adverse outcomes?

Fasciola spp. are the causative agents of fascioliasis in humans and livestock. Before the development of control and management measures, the geographical distribution of the species and patterns of infection must be considered. Because of difficulties in the phenotypic differentiation and morphometric classification of Fasciola spp., DNA molecular markers have become more useful for fluke differentiation and description of phylogenetic patterns. This study aimed to differentiate and describe the phylogenetic background of Fasciola spp. isolated from cattle slaughtered at three abattoirs in the Mpumalanga and KwaZulu-Natal provinces of South Africa. The cytochrome c oxidase I (COI) – FHCO1 (forward: 5′-TTGGTTTTTTGGGCATCCT-3′) and FHCO1 (reverse: 5′ -AGGCCACCACCAAATAAAAGA3′) – marker was sequenced from 55 Fasciola flukes that were collected from abattoirs in catchment areas of the KwaZulu-Natal and Mpumalanga provinces. Fasciola hepatica was demonstrated to have 100% prevalence in KwaZulu-Natal and Mpumalanga (highveld), respectively, and 76% prevalence in the lowveld (Belfast area) of Mpumalanga. Two animals from the Belfast metapopulation were co-infected with both Fasciola gigantica and F. hepatica. DNA sequence analysis of all the isolates demonstrated a sequence conservation of 0.472, nucleotide diversity of 0.082 and Tajima’s D of -1.100; however, it was not statistically significant (p > 0.05). Twenty-two haplotypes were identified, with 18 novel haplotypes being unique to the isolates from South Africa. Within the study samples, 12 haplotypes were isolated to a few individuals, with a haplotype diversity of 0.8957 indicating high genetic diversity. Principal coordinate analysis supported the clustering and distribution of the haplotypes, with 11.38% of the variation being attributed to coordinate 2 and 55.52% to coordinate 1. The distribution of Fasciola spp. has been demonstrated to be related to the distribution of the freshwater intermediate host snails, Lymnaea spp., as well as the relative altitude of the localities in South Africa. Information provided by this study serves as preliminary evidence for further studies on the mapping of the distribution of F. gigantica and F. hepatica in South Africa, which is key in designing control programmes for fascioliasis in humans and livestock.