Browsing by Author "Greenfield, David"

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    Assessing some of the associations with perinatal mortality at Kamuzu central hospital in Lilongwe, Malawi
    (2012) Mwenyekonde, Elled; Greenfield, David; Muula, Adamson S
    The study objectives were to: determine the prevalence of perinatal mortality (PNM) and causes of early neonatal deaths (ENNDs), describe socio-demographic factors of mothers with PNM and assess some of the associations with PNM at Kamuzu Central Hospital.
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    Assessment of antenatal and intrapartum referrals to Mowbray Maternity Hospital in Cape Town, South Africa
    (2017) Mohamed, Ekram; Shea, Jawaya; Greenfield, David
    Introduction: A continuous and concerning increase in the number of deliveries at Mowbray Maternity Hospital (MMH) has been noted over the years and now comprises a greater proportion of deliveries compared to deliveries conducted by midwives at midwife obstetric units (MOUs). To date there have been no studies assessing the changes in the pattern of deliveries at MMH. This study describes the antenatal and intrapartum referrals at MMH in 2005 and 2013, to identify any changes and whether or not referrals are appropriate. Method: This is a descriptive study with an analytic component involving review of a sample of hospital folders (138 for 2005 and 246 for 2013) of women who delivered at MMH from January to December 2005 and 2013. Results: The mean age of referred women was 27.259 (SD ± 6.277) years and 27.326 (SD ± 6.025) years in 2005 and 2013, respectively, with no significant statistical difference (p = 0.918). There was also no significant statistical difference (p=0.056) in the proportion of coloured, black or white women who delivered at MMH during 2005 and 2013. In 2005, a total of 27 (52.2 %) delivered women were single, 54 (39.1%) were married and two (1.4%) were divorced. In 2013, a total of 178 (72.4%) women were single, 65 (26.4%) were married and three (1.2%) were divorced, with a significant statistical difference (p < 0.001). In 2005, 75 (54.3%) women were unemployed and 46 (33.3%) were employed, whereas in 2013, 172 (69.9%) women were unemployed and 69 (28%) were employed, which shows a significant statistical difference (p < 0.001). In 2005, women mostly resided in Mitchell's Plain (32.6%), Gugulethu (28.3%) or in Khayelitsha (27.5%). In 2013, most women resided in Mitchell's plain (33.7%), Gugulethu (24.4%), Retreat 48 (19.5%) and Southern Peninsula 31 (12.6%), which represents a significant statistical difference (p= 0.001). 2 The median parity for 2005 sample was 1 (IQR: from 0 to 2), while in 2013 it was 1 (IQR: from 0 to 1). Although most women (94.2% versus 95.1%) booked at antenatal clinics in 2005 and 2013 respectively, with no significant statistical difference (p=0.697), the gestational age at first ANC differed significantly (p < 0.001) (median 24 versus 19 weeks). In 2005, the median number of ANC visits was five (IQR: from 4 to 7) visits, whereas the median was six (IQR: from 5 to 8) visits in 2013, with a significant statistical difference (p= 0.013). Over half of referred women (55.8% and 50.8%) in 2005 and 2013 respectively were delivered by normal vaginal delivery. The remainder had either a caesarean section or assisted delivery, with no significant statistical difference (p=0.139). Most women were referred from MOUs in both 2005 and 2013, at 90.6% and 85.45% respectively, with a significant statistical difference (p < 0.001). During both years virtually all pregnancies were considered high risk and the most common reason for referral was previous caesarean section (18.8% versus 19.9% respectively). For both years most pregnancy referrals experienced one, or more, antenatal risk factors, mainly previous caesarean section at 31 (12.5%), obesity at 27 (11%), prelabour rupture of membranes at 26 (10.6%) and HIV at 24 (9.8%) in 2005 and previous caesarean section accounted for 56 (11.1%), prolonged pregnancy for 51 (10.1), obesity for 50 (9.9%), HIV for 50 (9.9%) and tobacco use for 42 (8.3%) in 2013. The difference was statistically significant (p < 0.001). In 2005, the main intrapartum risk factors were fetal distress (23.6%), failure to progress and preterm labour (18% each). In 2013, fetal distress was most common (36.2%), followed by failure to progress (16.7%). The difference is statistically significant (p=0.034). Conclusion: The Cape Town Metro West health system features a functional maternity referral system. Midwives perform well in referring pregnant women who meet the criteria for high risk. There has been an increase in the number of women referred to the MMH over the study period but in this study group all referrals were found to be appropriate and were compliant with relevant obstetric management protocols. It appears there have not been large shifts in the demographics of referred women over the period reviewed. In addition, the change in the referral pathway has seen Southern Peninsula and Retreat referring to MMH but Khayelitsha no longer referring there. Furthermore, there are emerging risk factors that reflect the epidemiological changes currently being observed in the Cape Town Metro West region.
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    Congenital syphilis : a study at Provincial Hospital Uitenhage
    (1998) Esselaar, Annette; Greenfield, David
    Aims: 1. To establish the extent of Syphilis in Pregnancy and the association of syphilis with unbooked status and perinatal deaths. 2. To determine why the diagnosis was not made in forty cases of Early Congenital Syphilis. Objectives: 1. To establish the percentage of patients with syphilis at delivery and possible association between unbooked status and positive syphilis serology. 2. To determine the Perinatal Mortality Rate and establish what percentage of perinatal death s occurred in unbooked patients and in those with positive syphilis serology. 3. To establish booking status, place of delivery, whether treated or not, serological findings, signs and symptoms of infants with Early Congenital Syphilis. Study Design: 1. A descriptive, retrospective study of deliveries in the month of March 1994. 2. A descriptive, prospective study of perinatal deaths over six-month period January to Jun e 1995. 3. A descriptive, retrospective study of Early Congenital Syphilis patients over five-year period 1990 - 1994. Setting: Maternity and paediatric wards at Provincial Hospital Uitenhage, East Cape. Patients and Methods: 1. Records were studied of 154 maternity patients delivering in March 1994 in order to ascertain booking status and serology results. 2. Data on sixty-one perinatal deaths weighing over 500 grams was examined to establish maternal booking and serological status. 3. Folders of forty patients with Early Congenital Syphilis admitted to the paediatric ward were examined. Results: 1. Syphilis in Pregnancy: i) Prevalence of syphilis at delivery was 9% for patients with titres =/> 1 :8. ii) Unbooked patients totalled 47% of deliveries (73/154). iii) Fifteen percent of deliveries had no syphilis serology tests performed and were discharged without screening (23/154). iv) No significant association was found between unbooked status and positive serology (p=0.35). 2. Perinatal Deaths: i) In instances of a perinatal death, a significant association was found between unbooked status and positive RPR serology (p=0.017). ii) Perinatal death rate due to syphilis totalled 10.8/1000 deliveries. 3. Early Congenital Syphilis: i) Eighty-five percent of cases (34/40) delivered at PHU and were mismanaged by personnel. ii) Eighteen of the thirty-four mothers had attended antenatal clinic and were untreated or inadequately treated by the time of delivery (53%). vii iii) Sixteen of the mothers had been unbooked and were discharged without screening or treatment (47%). iv) Four booked patients had negative sousveillance during the antenatal period. Conclusion: Provincial Hospital Uitenhage serves a poor community. This is reflected in the high prevalence of syphilis at delivery and the high proportion of unbooked patients. Time-consuming and inefficient methods of sero-surveillance plus separate clinics and staff for antenatal and Sexually Transmitted Diseases compounded existing problems. The standard of care anticipated at a Level 2 Referral Hospital was not delivered by Health Workers, largely due to lack of in-service training and guidelines for the management of Syphilis in Pregnancy. Recommendations: 1. In-service staff training by the Perinatal Education Programme (PEP) and adoption of protocols of management. 2. Rapid ("same-day") availability of serology results and initiation of treatment at Antenatal Clinic. 3. RPR at booking visit and repeated at delivery in all patients. 4. Monthly evaluation by Perinatal Problem Identification Programme (PPIP) and Obstetric/Paediatric meeting to monitor implementation.
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    Improving survival rates of newborn infants in South Africa
    (BioMed Central Ltd, 2005) Pattinson, Robert; Woods, David; Greenfield, David; Velaphi, Sithembiso
    BACKGROUND:The number, rates and causes of early neonatal deaths in South Africa were not known. Neither had modifiable factors associated with these deaths been previously documented. An audit of live born infants who died in the first week of life in the public service could help in planning strategies to reduce the early neonatal mortality rate. METHODS: The number of live born infants weighing 1000 g or more, the number of these infants who die in the first week of life, the primary and final causes of these deaths, and the modifiable factors associated with them were collected over four years from 102 sites in South Africa as part of the Perinatal Problem Identification Programme. RESULTS: The rate of death in the first week of life for infants weighing 1000 g or more was unacceptably high (8.7/1000), especially in rural areas (10.42/1000). Intrapartum hypoxia and preterm delivery are the main causes of death. Common modifiable factors included inadequate staffing and facilities, poor care in labour, poor neonatal resuscitation and basic care, and difficulties for patients in accessing health care. CONCLUSION: Practical, affordable and effective steps can be taken to reduce the number of infants who die in the first week of life in South Africa. These could also be implemented in other under resourced countries.