Semi-urban Setting Research Articles

Maternal and Infant Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Increases Infants’ Iron Status at 18 Months of Age in a Semiurban Setting in Ghana: A Secondary Outcome Analysis of the iLiNS-DYAD Randomized Controlled Trial

ABSTRACTBackgroundInterventions are needed to address iron deficiency in low-income settings.ObjectiveThis secondary outcome analysis aimed to compare the hemoglobin (Hb) and iron status [zinc protoporphyrin (ZPP)] of children born to women enrolled in the iLiNS-DYAD trial in Ghana.MethodsWomen ≤20 wk pregnant (n = 1320) were assigned to receive 60 mg Fe/d and 400 µg folic acid/d until delivery and placebo thereafter, and no supplementation for infants (IFA group); or multiple micronutrients containing 20 mg Fe/d until 6 mo postpartum and no supplementation for infants (MMN); or small-quantity lipid-based nutrient supplements (SQ-LNSs) containing 20 mg Fe/d until 6 mo postpartum, and SQ-LNSs for infants from 6 to 18 mo of age (LNS). We compared infants’ Hb (g/L) and ZPP (µmol/mol heme) at 6 and 18 mo of age.ResultsAt 6 mo of age, groups did not differ in mean ± SD Hb (overall: 113 ± 9.9 g/L) or geometric mean (95% CI) ZPP [overall: 62.6 (60.6, 64.7)]. At 18 mo of age, mean ± SD Hb (overall: 112 ± 10.4 g/L) did not differ significantly between groups, whereas geometric mean (95% CI) ZPP was lower (P = 0.031) in the LNS group [53.9 (50.7, 57.3)] than the IFA [60.4 (56.7, 64.3)] but not the MMN [58.8 (55.6, 62.2)] group. Further, the LNS group, compared with the IFA and MMN groups combined, had a lower prevalence of elevated (>70) ZPP (27.5% compared with 35%; P = 0.02) and a marginally lower prevalence of anemia (38.7% compared with 44.9%; P = 0.06). These results generally remained unchanged when controlling for prespecified covariates or correcting for inflammation.ConclusionsIn this setting, providing SQ-LNSs or multiple micronutrients with 20 mg Fe/d, compared with iron (60 mg/d) and folic acid, to pregnant women does not affect their infants’ Hb or iron status at 6 mo of age, but maternal and infant supplementation with SQ-LNSs increases infants’ iron status at 18 mo of age.This trial was registered at clinicaltrials.gov as NCT00970866.

Toilet training and parental help-seeking behavior toward elimination disorders: Our experience in a semi-urban setting

Introduction: Elimination disorders consist of enuresis and encopresis. When a child fails to successfully achieve toilet training by the age of five and has repeated voiding of urine on the bed or clothing at least twice per week for at least 3 consecutive months it is called enuresis; while bowel continence if not achieved by age 4 years, is encopresis. This study seeks to determine parental/caregiver concerns and help-seeking behaviors toward elimination disorders. Materials and Methods: This study was cross-sectional and was conducted over a 3-month period from January 2017 to March 2017. Convenience sampling method was adopted, and pretested researchers-administered questionnaires were used. Results: Two hundred individuals were recruited consisting of 104 (52%) males and 96 (48%) females with a male-to-female ratio of 1.1:1. About 194 (97%) of the respondents were aware of elimination disorders, 62 (31.0%) of them reported elimination disorder occurred in their wards, only 24.2% of the caregivers had sought for medical treatment for elimination disorder. Majority of the caregivers did not know the cause of elimination disorder, but 2% of them believed evil spirits were responsible for elimination disorders. Enuresis was the most commonly reported elimination disorder and most occurred at night (80.6%), and none had isolated encopresis. Ethnicity and educational qualification of respondents had no relationship with their help-seeking behavior toward elimination disorder ([Fishers' exact test = 11.337, P = 0.023] and [Fishers' exact test = 8.074, P = 0.089]). Conclusion: Elimination disorders were prevalent; however, few caregivers seek for medical help/treatment, and their help-seeking behavior was not influenced by their ethnicity or educational qualification.

Practice of cardiopulmonary resuscitation among health care providers in a tertiary health centre in a semi-urban setting

Objectives: To assess the basic knowledge of cardiopulmonary resuscitation (CPR) among health workers in a tertiary health facility in a semi-rural county. Methods: A questionnaire based, cross sectional study involving health care professionals was performed in Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria from April to July 2017. A purposive sampling method was adopted for subject selection. A pretested self-administered questionnaire was distributed; this included knowledge on basic life support; participation in basic life supportand outcomes. It was adopted from the American Heart Association guidelines for CPR and emergency cardiac care. Results: One hundred and two respondents were recruited (40 doctors and 62 nurses). There were 50 males (49%) and 52 females (51%). Their age ranged from 23 to 54 years with mean of (34.9± 7.4) years. Only 20% of the respondents were aware of circulation, airway and circulation in adult resuscitation; however, 61.0% of all respondents were aware of airway, breathing and circulation of resuscitation in children. Furthermore, only 10% of the respondents were aware of the correct steps of single rescuer resuscitation. Their knowledge was poor about chest compression and ventilation for both adult and children resuscitation. The overall knowledge score ranged from 0.0% to 100% with mean knowledge score of (21.2±18.6)%. The date of last training about CPR had no relationship with the knowledge scores (χ2=2.951, P=0.300). The cadre of the respondents (doctors and nurses) had no relationship with their knowledge score (χ2=0.100, P=0.633 for doctors and nurses; ,χ2=7.074, P=0.225 for doctors cadre; XX2=3.868, P=0.677 for nurses cadre) respectively. Conclusions: The knowledge about CPR among health workers is poor; furthermore, the last date of training about CPR and the cadre of staffs have no relationship with knowledge of CPR.

The prevalence of overweight and obesity and associated factors among Adults in Goni Gora Kaduna State, Northwestern Nigeria

Obesity is an epidemic disease in many developed countries and an emerging public health problem in developing countries, particularly in urban settings.The aim of this study was to determine the prevalence of overweight and obesity and the associated factors among adult residentsin Goni Gora community in Kaduna State. The study was conducted in Goni Gora a semi-urban setting in Chikun Local Government Area of Kaduna State, Northwestern Nigeria in January 2017. A multi-stage sampling technique was used to select 192 adult residents in the community. Data was collected using structured, pretested and interviewer-administered questionnaire using mobile data collection method (Epiinfo™ version 7.2). Data were analyzed using the Statistical Package for Social Sciences (SPSS) software version 21. The level of significance was set at a P value of ≤0.05. The majority of the respondents (32.3%) were within the age group of 20-29 years. The mean age of respondents was 34.6±13.1 years and males (52.1%) comprised the majority of the respondents. All the respondents were Christians with 55.2% of them being married. The prevalences of overweight and obesity were 6.7% and 1.1% respectively. Age (P=0.001), sex (P=0.001), marital status (P=0.002), average monthly income (P=0.004) and duration of physical activities per day (P=0.001) were found to be associated with overweight and obesity. There was, however, no association found between obesity and educational status (P=0.195). Overweight and obesity were found to be prevalent among the respondents in the study. Factors such as age, gender, marital status, average monthly income and duration of physical activities per day were found to be associated with overweight and obesity. There is a need to mount intervention programs that are targeted at prevention and control of overweight and obesity in the community.

Enrollment in HIV Care and Treatment Clinic and Associated Factors Among HIV Diagnosed Patients in Magu District, Tanzania.

HIV care and treatment clinics (CTC) are important for management of HIV morbidity and mortality, and to reduce HIV transmission. Enrollment in HIV care and treatment clinics remains low in many developing countries. We followed up 632 newly diagnosed HIV patients aged 15years and above from Magu District, Tanzania. Logistic regression was used to assess factors significantly associated with enrollment for CTC services. Kaplan-Meier plots and log-rank tests were used to evaluate differences in timing uptake of services. Among 632 participants, 214 (33.9%) were enrolled in CTC, and of those enrolled 120 (56.6%) took longer than 3months to enroll. Those living in more rural villages were less likely to be enrolled than in the villages with semi-urban settings (OR 0.36; 95% CI 0.17-0.76). Moreover, those with age group 35-44years and with age group 45years and above were 2 times higher odds compared to those with age group 15-24years, (OR 2.03; 95% CI 1.05-3.91) and (OR 2.69; 95% CI 1.40-5.18) respectively. Enrollment in the CTC in Tanzania is low. To increase uptake of antiretroviral therapy, it is critical to improve linkage between HIV testing and care services, and to rollout these services into the primary health facilities.

Extension of effective day length and its effect on sleep characteristics due to exposure to mobile phone screen in female students in a semi urban and urban setting

Extension of effective day length and its effect on sleep characteristics due to exposure to mobile phone screen in female students in a semi urban and urban setting

Hand hygiene practices among nurses in health facility in a semi-urban setting

INTRODUCTION: Hand is an important medium of infection transmission. This is further worsened in the hospital setting where sources of contamination are abundant. Nurses play a vital role in patient care, and while doing so, they are often exposed to health hazards. Therefore, they may act as conduits for transmitting infectious diseases to themselves, family members, and other patients. Good hand hygiene is a prerequisite for infection control; therefore, the objective of this study is to determine the knowledge and practices of hand hygiene among nurses in our institution. MATERIALS AND METHODS: This was a cross-sectional study involving 113 nurses and it was conducted over 12 weeks; it was questionnaire based, which was pretested and self-administered. Convenience sampling was adopted. RESULTS: Data from 96 (85%) respondents consisting of 41 (42.7%) males and 55 (57.3%) females with male:female ratio of 0.7:1 were analyzed. All respondents reported using water and soap for hand-washing. Furthermore, majority (59%) of the respondents were not aware of the five moments of hand hygiene. Although majority (76%) reported adhering to the principles of good hand hygiene, 54.2% of the respondents could not correctly mention the steps of hand-washing technique. Sixty-six (68.8%) respondents wash their hands before attending to patients; however, almost all (99%) of the respondents wash their hands after attending to patients and after removing hand gloves. Similarly, all respondents wash their hands after using the restroom. CONCLUSION: The act of hand-washing is common among respondents in this study; however, the major challenge is with practicing the correct technique involved in hand-washing. Furthermore, knowledge of the critical moments of hand-washing was also deficient among most of the respondents.

Over-nutrition among primary school pupils in a semi-urban Local Government Area, South-western Nigeria

Background: Studies from the developing countries suggest that childhood obesity is more prevalent in the urban settings. The search for childhood overweight/obesity (over-nutrition) needs to go beyond the urban into the semi-urban and rural areas. Objectives: To determine the prevalence of over-nutrition and the associated factor among primary school pupils in Ikenne Local Government Area of Ogun State, Nigeria. Methods: This was a cross-sectional analytic study of pupils of 15 schools (10 public and 5 private) using the multistage random sampling and the proportionate sampling techniques. Data were collected using interviewer-administered questionnaire, data on physical activity, household possessions, dietary practices and relevant physical findings were obtained. Results: A total of 422 pupils were studied; the age ranged between 18 and 192 months with a mean of 107.2 ± 36.4 months. The prevalence of Overweight/Obesity (Over-nutrition) was 6.4% with male predominance: 8.1% vs 4.4% without statistical significance (p = 0.19). Over-nutrition was significantly more prevalent among pupils aged <5 years and in the pupils of private schools (p = 0.000 and p = 0.007 respectively) and significantly related to the Dietary Diversity Score (p = 0.0001). Over-nutrition was more frequent among children whose parents had university education and were middle level civil servants without statistical significance. (p = 0.66, 0.19 respectively). Group physical activity was low in 96.3% and Food Frequency Score was poor in 87.5% of the overweight/obese pupils. Female gender, long duration of breastfeeding and delay in weaning significantly correlated with childhood over-nutrition. Conclusions: Over-nutrition is not uncommon in the semi-urban Nigerian setting. The early life feeding practices, quality of the child’s diet and physical activities appear to be important contributors to childhood over-nutrition in this setting.

Emotional Mental Problems among Adolescents: Urban and Semi-Urban Settings

Background : Emotional mental problems refer to something that complicates someone in an attempt to conform to the environment and experiences. In Indonesia the prevalence of emotional mental problems is 6.0%. In West Java province as the most populous region in Indonesia, the number of prevalence is above the national average of 9.3%. West Java province was selected for this study because in addition to being the most densely populated region, it also has urban and semi-urban areas. The purpose of this study was to identify the difference in the prevalence of emotional mental problems of adolescent in urban and semi-urban areas. Methods: This study used the cross sectional approach method. Inclusion criteria were adolescents aged 14-16 years who attended several Junior High and Senior High Schools in Cirebon City as an urban area and Sumedang Regency as a semi-urban area. Exclusion criteria were adolescents who filled out the questionnaire incompletely. The study variables consisted of adolescents, urban and semi-urban areas, and emotional mental problems. Data were analyzed by using chi square (x 2 ) test. Results: Out of 1039 respondents, 816 met the inclusion criteria. There were significant differences in emotional mental problems on the aspects of emotional symptoms, behavior, hyperactivity, interpersonal relationships, social behavior, and total value of emotional mental problems with p value <0.05. Conclusions : There is a difference in emotional mental problems of adolescents in urban and semi-urban areas. Adolescents in urban regions have higher mental-emotional problems than in semi-urban regions.

Pattern of presentation and surgical management of penile fractures in a semi-urban African teaching hospital: Case reports and literature review

IntroductionPenile fracture is relatively rare and also under-reported in our environment. There seem to be a gradual change in this pattern however, as we managed six patients over a two-year period. ObjectiveTo present the peculiarities of penile fracture presentation and surgical management in our semi-urban African setting; while also reviewing the available literature on the subject to possibly validate our practice. Patients and methodsAll patients with penile fracture managed in our university teaching hospital between January 2014 and December 2015 were prospectively studied in order to identify any peculiarities of clinical presentation, surgical reconstruction technique and management outcome. ResultsSix male patients were studied. Their ages ranged from 23 to 41 years (mean 31 years) while interval between penile fracture occurrence and clinical presentation in our emergency unit ranged from 45min to 30h (mean about 10h). The aetiologic mechanism was penile self manipulation (2, 33.2%), masturbation (1, 16.7%), sexual intercourse with the female in the dominant position (1, 16.7%), turning in bed (1, 16.7%) and motorcycle road traffic accident in a man with local aphrodisiac induced penile erection who was rushing home to his female partner (1, 16.7%). The rupture of the tunica albuginea was located on the right side in majority of cases (4, 66.7%) while none of the patients had coexisting urethral injury. All of them had surgical repair between 3 and 9h of presentation with good cosmetic and functional outcome. ConclusionThe trend of penile fracture seems to be changing in our semi-urban African community. Surgical reconstruction results in good outcome.

Challenges in the management of cardiovascular emergencies in Sub-Saharan Africa: a case report of acute heart failure complicating infective endocarditis in a semi-urban setting in Cameroon

BackgroundInfective endocarditis is a deadly disease if not promptly treated with antibiotics either in association with cardiac surgery or not. Cardiac complications are the most common complications seen in infective endocarditis. Heart failure remains the most common cause of mortality and the most common indication for cardiac surgery in patients with infective endocarditis which is increasingly available in resource limited settings.Case presentationWe report a case of native valve infective endocarditis of the aortic valve in a 27-year old female in a semi-urban setting in Cameroon complicated by severe aortic valve regurgitation and heart failure. She presented with a 2 month history of fever and a 2 weeks history of rapidly worsening shortness of breath. Emergency cardiac surgery was indicated which unfortunately could not be performed leading to the death of the patient.ConclusionsIn spite of improvement in availability of diagnostic and therapeutic modalities for cardiovascular emergencies, affordability is still a challenge. Universal health coverage is advocated else the ravages of premature mortality from cardiovascular diseases may continue to remain unchecked in Sub-Saharan Africa.

Sanitation and child health in India

Our study contributes to the understanding of key drivers of stunted growth, a factor widely recognized as major impediment to human capital development. Specifically, we examine the effects of sanitation coverage and usage on child height for age in a semi-urban setting in Northern India. Although sanitation – broadly defined as hygienic means of promoting health through prevention of human contact with the hazards of wastes, particularly human waste – has long been acknowledged as an indispensable element of disease prevention and primary health care programmes, a large number of recent impact evaluation studies on sanitation interventions in low income countries fail to find any health improvements. We address endogeneity of sanitation coverage through an instrumental variable approach, exploiting variation in raw material construction prices. Doing so, we find that sanitation coverage plays a significant and positive role in height growth during the first years of life and that this causal relationship holds particularly for girls. Our findings suggest that a policy that aims to increase sanitation coverage in a context such as the one studied here, is not only effective in reducing child stunting but also implicitly targets girls.

Urban–Rural Excellence Gaps: Features, Factors, and Implications

The purpose of this study was to examine the presence of excellence gaps (i.e., differences between subgroups of students performing at the highest levels of achievement) in a sample of 563 students nominated as gifted by their teachers in urban, semi-urban, and rural settings in Spain. In general, the results suggested the existence of excellence gaps between urban and rural students, with urban students outperforming rural students in verbal and numerical reasoning, as well as in all divergent thinking dimensions (i.e., fluency, flexibility, originality, and elaboration). Differences across geographic locations were likely to be attributed to the limited opportunities available to high-achieving students to develop their talents and achieve excellence in rural schools. Limitations of the study, directions for future research, and educational implications of the study are provided.

Prevalence, substitute diagnostic tool, risk factors of diabetic polyneuropathy and foot care awareness in diabetic patients in a semi urban setting- Cameroon

Introduction : the world is facing an epidemic of Diabetes. Polyneuropathy is a length dependent symmetric sensorimotor type of neuropathy a main risk factor of diabetic foot ulcers. The diabetic neurological examination (DNE) score and yearly foot examinations have been recommended for clinical diagnosis of Diabetic polyneuropathy (DPN). The DNE score is lengthy. Other simple tools for accurate diagnosis exist. Risk factors for DPN are not known in our setting. The objectives were to determine the prevalence of Diabetic Polyneuropathy; To compare the Vibratory Perception Threshold (VPT), Monofilament score (MS) and Diabetic Neurological Symptom Score to the DNE score. Identify risk factors of DPN; To estimate Clinician and patient awareness of foot care. Methods : we conducted a cross sectional analytic study of diabetic patients in the Buea and Limbe regional hospitals during 4 months. Co-founders of diabetic polyneuropathy, alcoholics and HIV patients were excluded. Results : 360 patients with mean age of 56 years. 236(65.6%) women and 348(9.67%) T2DM were recruited. The prevalence of DPN was 30.6% (110) using the DNE score. VPT was most specific (96%), sensitive (94.6% and correlated (0.59) to the DNE score. The monofilament and DNS had sensitivities, specificities and correlations of (95.8%, 79.5%, r = 0.48) and (62.2%, 83.5%, r = 0.16) respectively. Determinants of DPN were age>60 years (p10 (p = 0.003), treatment with insulin and oral hypoglycaemics (p = 0.005), history of foot ulcer (p = 0.03), hypertension (p=0.04). During the preceding year, 264(73%) patients’ feet were not examined, 272(80%) did not check their foot wear before wearing, 255(71%) used razor to trim their nails, 144(40%) walked barefeet, and 72(21%) wore tight shoes.

Hand hygiene practices among doctors in health facility in a semi-urban setting

INTRODUCTION: Hand hygiene is an integral part of personal hygiene; poor hand hygiene practice may result not only in self-hurt but also may serve as a vehicle for transmission of infection among patients. Hence, knowledge of proper hand hygiene practice will significantly reduce the burden of infectious diseases. MATERIALS AND METHODS: This was a cross-sectional study involving doctors at Federal Medical Centre Birnin Kebbi; it was conducted from September 2015 to November 2015. Convenience sampling method was adopted. Pretested self-administered questionnaire based was used; relevant information such as age, sex, profession, years of working experience, awareness of Global HandWashing Day, hand-washing technique, steps in hand washing, ability to list the five moments in hand washing, and principles of hand washing were obtained. RESULTS: There were 33 males and 12 females with a male to female ratio of 2.8:1. All respondents believed hand washing reduces the risk of transmitting or contracting infections. Soap and water was the most common agent for hand cleansing, majority of the respondents (86.7%) had been taught on the technique of hand washing; however, only 19 (42.2%) of them wash their hands before examining patients; but all the respondents (100%) wash their hands after examining patient or handling their secretions; similarly, they all reported washing their hands after using the restroom. Almost all of the respondents (97.8%) use water and soap for hand washing. Furthermore, only 44.4% of the respondents had their personal hand rub. CONCLUSION: Soap and water was the most common agent for hand cleansing, and there was poor utilization of hand rub; and most respondents did not wash their hands before patient contact.

Comparative Analysis of Disparity in Demand for Fresh Fish between Rural and Urban Households in Cameroon

The past decades have exhibited changes in the consumption of fresh fish. In developing countries, factors affecting fish consumption are different between urban and rural households. This study comparatively analyses the disparity in demand for fresh fish between rural and urban households in Cameroon. Using random sampling, data on the weekly consumption of fresh fish were collected between April and May 2015; 30 households lived in rural localities while 30 lived in urban areas of Buea Municipality. Consumer’s income, the price of fresh fish, family size, gender and age of consumers represented parameters of interest. These were analyzed using the independent sample t-test. Results revealed that the availability, the income level and price affected fish consumption of rural dwellers while price, taste, income and affordability determined the consumption patterns of urban dwellers. The study equally revealed that the higher the price of fresh fish, the higher the demand for its closed substitutes and the higher the size of the household, the higher the quantity demanded. Gender, education and marital status did not affect the quantity demanded; family size and age negatively influenced consumers’ decision to buy while consumers’ income and price of fresh fish positively influenced consumers’ weekly and monthly expenditure on fresh fish. The study proposes that more information be provided to consumers regarding the numerous nutritional benefits of fresh fish for both rural and urban dwellers. Also, policy makers and marketers need to improve the availability of fresh fish in rural and semi-urban settings.

Clinical Profile and Outcome of Pediatric Acute Kidney Injury in Cameroon: Comparison between an Urban and a Semi-Urban Health Facility

Introduction: Pediatric Acute Kidney Injury (AKI) seems to be a major cause of morbidity and mortality in Subsahara Africa. However, data on its epidemiology are scare and mainly originate from tertiary and urban health facilities such as large university Teaching hospitals with a nephrology service. Objective: The aim of this study was to compare the epidemiology of pediatric AKI in urban and semi-urban health facility. Patients and method: We conducted a retrospective study of 16 months in a tertiary urban hospital (General Hospital of Douala) and a secondary semi-urban health facility (Region hospital of Buea). Diagnostic of AKI was done using usual criteria. Age, sex distribution, etiologies of AKI, access to dialysis, renal recovery at hospital discharge, at 1 and 3 months and patient survival at hospital discharge was compared. Results: A total of 31 patients were included (GD 17 and RHB 14). Boys were more prevalent in the semi-urban setting (86% Vs 47% p = 0.029). Median age was comparable in the both group although most semi-rural patient were older (6.5 Vs 10 years p = 0.093). Hospital acquired AKI was only found in urban setting and account for 40% of pediatric urban AKI. Malaria related AKI (mainly black water fever) and sepsis were the main etiologies of AKI in urban and semi-urban milieu. Dialysis access was the same but 30% of children could not access to it in urban setting compare to none in semi-urban area. Reasons of non-access to dialysis were lack of pediatric material and financial constraints. In Hospital mortality was the same but was more severe amount patient who could not receive dialysis. Among the survivor, CKD was only found in urban setting. Conclusion: Although mainly due to malaria, pediatric AKI differs from urban tertiary and semi-urban secondary health facility in Cameroon. Hospital acquired AKI is only found in urban setting where children are younger and less boys. AKI in urban setting seems to be more severe with less access to dialysis and more risks of CKD.

Managing sickle cell disease in pregnancy, the success and the challenges: Our experience in a semi-urban tertiary health-care facility, Southwest, Nigeria

Background: Pregnancy complicated by sickle cell disease (SCD) is known to be associated with poor maternal and fetal outcomes. However, the challenges encountered in managing these patients in the rural and semi-urban areas are yet to be evaluated by many of these studies. Objectives: The objective of the study is to determine the maternal and fetal outcomes of pregnancy complicated by SCD, the importance of the pregestational counseling and care and the challenges faced by the health-care givers in giving them optimal care in Nigeria, especially in rural and semi-urban settings. Materials and Methods: This is a prospective study. All diagnosed SCD pregnant women seen between May 2013 and April 2016 were recruited into the study, after taking informed consent from them. They were all subjected to the standard management of sickle disease in pregnancy. The antenatal, intrapartum, immediate postdelivery and the puerperal events were documented in structured obstetric data sheets. The information obtained from these data sheets were used to generate a database for analysis. Results: The total number of the patients recruited into this study was 54. They were all booked patients or those referred from other centers with adequate antenatal records. The incidence of SCD in this study was 1.15% (HBSS; 0.49%, HBSC; 0.55%, and HBCC; 0.11%). The mean maternal ages at booking were 26.35 ± 5.76, 27.12 ± 3.28, and 27.004 ± 0.69 years for HBSS, HBSC, and HBCC, respectively. The mean gestational ages at delivery were 37.43 ± 1.36, 38.58 ± 1.21, and 35.80 ± 0.84 weeks for HBSS, HBSC, and HBCC, respectively. The antenatal bookings were all in the second and third trimesters. Similarly, only 10 (39.96%) had pregestational counseling and care before pregnancy. The patients were mostly middle social class status and with poor antenatal clinic visits. Discussion: Poor maternal and fetal outcomes were seen more in HBSS than HBSC and HBCC. However, statistical analysis showed statistically significant differences only in the prematurity, preterm labor, and the mean fetal weights. Factors such as pregestational counseling and care, social class, parity, and early antenatal booking play important roles in achieving optimal care and excellent outcomes. Conclusion: Many authors documented poor maternal and fetal outcomes in pregnancies complicated by SCD. The focus now should be identifying factors that may militate against achieving excellent results from the optimal care of these patients. This we have initiated in this study.

The evolving role of traditional birth attendants in maternal health in post-conflict Africa: A qualitative study of Burundi and northern Uganda.

Objectives:Many conflict-affected countries are faced with an acute shortage of health care providers, including skilled birth attendants. As such, during conflicts traditional birth attendants have become the first point of call for many pregnant women, assisting them during pregnancy, labour and birth, and in the postpartum period. This study seeks to explore how the role of traditional birth attendants in maternal health, especially childbirth, has evolved in two post-conflict settings in sub-Saharan Africa (Burundi and northern Uganda) spanning the period of active warfare to the post-conflict era.Methods:A total of 63 individual semi-structured in-depth interviews and 8 focus group discussions were held with women of reproductive age, local health care providers and staff of non-governmental organisations working in the domain of maternal health who experienced the conflict, across urban, semi-urban and rural settings in Burundi and northern Uganda. Discussions focused on the role played by traditional birth attendants in maternal health, especially childbirth during the conflict and how the role has evolved in the post-conflict era. Transcripts from the interviews and focus group discussions were analysed by thematic analysis (framework approach).Results:Traditional birth attendants played a major role in childbirth-related activities in both Burundi and northern Uganda during the conflict, with some receiving training and delivery kits from the local health systems and non-governmental organisations to undertake deliveries. Following the end of the conflict, traditional birth attendants have been prohibited by the government from undertaking deliveries in both Burundi and northern Uganda. In Burundi, the traditional birth attendants have been integrated within the primary health care system, especially in rural areas, and re-assigned the role of ‘birth companions’. In this capacity they undertake maternal health promotion activities within their communities. In northern Uganda, on the other hand, traditional birth attendants have not been integrated within the local health system and still appear to undertake clandestine deliveries in some rural areas.Conclusion:The prominent role of traditional birth attendants in childbirth during the conflicts in Burundi and northern Uganda has been dwindling in the post-conflict era. Traditional birth attendants can still play an important role in facilitating facility and skilled attended births if appropriately integrated with the local health system.

The Clinical Pattern and Outcomes of Acute Kidney Injury in a Semi-Urban Hospital Setting in Cameroon

Background: Acute kidney injury (AKI) is a common disorder with high morbi-mortality especially in developing countries. In contrast to high income regions, AKI in these areas tend to be more community-acquired and affect young people. As in most Subsahara countries, previous studies on AKI in Cameroon were carried out in urban tertiary hospitals. Data on the clinical pattern and outcomes in semi-urban is lacking and may be quite different of urban setting. Objective: To describe the clinical pattern and outcomes of AKI in Buea Regional Hospital. Methods: We conducted an 18 months’ hospital-based observational retrospective study in the regional hospital of Buea, a semi-urban second category health facility of the South-West region of Cameroon. We excluded patients with known CKD (Chronic Kidney Disease)and incomplete data. AKI was diagnosed and classify according to the 2012 KDIGO criteria. Renal outcome was evaluated at 1 month. Results: Of the 196 participants included, 57.7% were males and 10.7% children. The median age was 45 years. HIV infection, hypertension and diabetes were the main comorbidities. AKI was community-acquired in 95% and stage 3 was found in 59%. Sepsis (37.2%), volume depletion (25%) and nephrotoxicity from herbal remedies (15.3%) were the main etiologic factors. Renal AKI was found in 72% of patient and was mostly due to ATN (56.6%). Obstetrical AKI was mainly due to post-abortum sepsis and AKI related malaria were the main etiology of pediatric AKI. In all, 71 (36%) participants had indications for dialysis but only 52 (73%) accessed it. Lack of appropriate dialysis technique and lack of funds were the main reasons for dialysis non-access. In-hospital mortality was 37.2%. Among survivors, renal recovery was complete in 65%, partial in 21%, and no recovery in 3%. Stage 3 disease was the only predictor of poor renal recovery at one month. Conclusion: AKI in this semi-urban hospital setting is community acquired and affected young individual with previous comorbidities such as HIV/AID, hypertension and diabetes. It is mainly caused by infections, volume depletion and herbal toxins.