Research Articles (Obstetrics and Gynaecology)

Permanent URI for this collectionhttp://hdl.handle.net/2263/2376

Browse

Now showing 1 - 20 of 453

Fertility care in low- and middle income countries : public sector access to medically assisted reproduction in South Africa : a case study
(Bioscientifica Ltd., 2025-07) Boshoff, Gerhardus Marthinus; Ombelet, Willem; Huyser, Carin; gerhard.boshoff@up.ac.za
In South Africa, approximately 10% of the calculated need for medically assisted reproduction is being met due to limited access and unequal availability of these services. To facilitate understanding of challenges associated with access to assisted reproduction, a retrospective case study spanning 6 years was performed at one public sector hospital in South Africa offering these services. Demographic profiles, including income, region of residency and access to medical insurance, of patients seeking assistance to become pregnant were investigated. Patients were categorised as those who underwent diagnostic investigations only vs those who returned for therapeutic procedures, and the difference in demographic profiles between the two groups was determined. This investigation showed that patients from the lower-income classification group, without medical insurance, tend to return for therapeutic procedures less often than those with a higher income and medical insurance, even though these low-income patients qualify for a therapeutic procedure subsidy. An inverse relationship existed where patient numbers decreased as their travel distance increased, but patients who were required to travel further for assisted reproductive therapy tended to return for these procedures more often than patients who resided closer to the medical facility. In conclusion, access to medically assisted reproduction facilities is critically undersupplied and limited in the region. In order to ease the travel distance of patients, alternative primary diagnostic routes with accessible clinics are needed. In addition, costs of therapeutic procedures in the public sector should be re-evaluated to be offered at affordable rates for marginalised patients.
What do women with epilepsy know about pregnancy?
(AOSIS, 2024-08-16) Baloyi, Miyalani G.; Khalema, Rethabile; Adam, Sumaiya; sumaiya.adam@up.ac.za
BACKGROUND : Understanding the intersection of epilepsy and pregnancy, including knowledge gaps and healthcare access for women with epilepsy (WWE), is critical. This study evaluated WWE knowledge gaps and information needs concerning epilepsy’s impact on their sexual and reproductive health during pregnancy and examined healthcare system factors affecting their access to information, aiming to identify areas for improvement in educational and healthcare strategies to enhance health management for WWE. METHODS : From July 2022 to June 2023, 111 WWE aged 18 to 40 years were recruited from the family medicine and internal medicine outpatient departments at Steve Biko Academic Hospital, Tembisa Tertiary Hospital (TTH), and Kalafong Hospital. Interviews assessed various aspects related to epilepsy in pregnancy and contraceptive use. RESULTS : The study found strong links between WWE, their demographics, and their awareness of pregnancy-related epilepsy issues. Participants from TTH showed notably higher awareness (85.5%) of risks from epilepsy and AED during pregnancy (p < 0.05). Age and education significantly influenced pregnancy planning and understanding of medication risks. Younger women (20–25 years) were more inclined towards future pregnancies, and those with more education were better informed about medication risks (p < 0.05); and 68.5%had received counselling on AED and contraceptive interactions, yet only 16.2% knew AED could reduce contraceptive effectiveness. CONCLUSION : The study reveals significant knowledge gaps in WWE regarding the impact of epilepsy and AED on pregnancy, suggesting tailored educational and counselling initiatives to improve WWE health outcomes and quality of life, advancing chronic disease management and public health objectives. CONTRIBUTION : The study highlights substantial knowledge gaps in epilepsy during pregnancy among WWE, urging tailored counselling and information to empower informed decisions.
Sociodemographics, behaviour and knowledge of first South African HPV-vaccine recipients
(AOSIS, 2024-04-24) Adams, Robyn A.; Visser, Cathy; Dreyer, Greta; Snyman, Leon Cornelius; Van der Merwe, Frederick; Botha, Matthys H.
BACKGROUND : Infection with the human papillomavirus (HPV) is a necessary cause of cervical cancer and is one of the most prevalent sexually transmitted infections worldwide. Primary prevention strategies target reducing HPV acquisition through vaccination, limiting exposure (e.g. delayed sexual debut, barrier contraception) and health education focusing on sexual behaviour and tobacco use. METHODS : The ImmunoVACCS study, conducted from 2019 to 2022 in two provinces in South Africa, examined sociodemographic characteristics, sexual practices, and knowledge of cervical cancer and the HPV vaccine among young female vaccine recipients. It encompassed participants from the previously conducted vaccine implementation trials, VACCS 1 and VACCS 2 (2011–2014). Recruitment involved telephonic contact with eligible potential participants. Data were collected through self-administered questionnaires. RESULTS : One hundred and eleven participants took part in the current study (median age: 20years; age range: 16–22 years). Most sexually active participants had their first engagement in secondary school (96.2%), and 77.2% used contraception during their last sexual activity. Knowledge gaps were evident, with only 13.5% recognising cervical cancer’s cervix origin and 3.6% attributing it to a virus. Despite this, 70.3% had heard of a vaccine for cervical cancer. Less than half knew about the importance of regular Pap smears (49.5%), vaccine protection (44.1%) or condom use (20.7%) against HPV and cervical cancer. CONCLUSION : The current study demonstrates that young women still lack complete information on cervical cancer and its risk factors even after receiving health education linked with vaccination. CONTRIBUTION : This study underscores the necessity of ongoing education about HPV, its risks and preventive measures among young women to combat cervical cancer.
Diagnosis of female genital schistosomiasis and other genital infections in young South African women : challenges in the syndromic approach
(Frontiers Media, 2024-04-09) Søfteland, Solrun; Sebitloane, Motshedisi; Galappaththi-Arachchige, Hashini Nilushika; Kleppa, Elisabeth; Holmen, Sigve; Pillay, Pavitra; Ndhlovu, Patrica Doris; Taylor, Myra; Vennervald, Birgitte Jyding; Naidoo, Saloshni; Staff, Anne Cathrine; Makua, Manala; Gundersen, Svein Gunnar; Kjetland, Eyrun Floerecke
INTRODUCTION : Female genital schistosomiasis is a common but neglected disease, which results in symptoms similar to sexually transmitted infections in Schistosoma haematobium-endemic areas of Africa and Middle East. In primary healthcare of low-income countries, healthcare professionals use syndromic management protocols for guidance when treating symptoms of genital infection, due to lack of laboratory resources. These protocols do not include treatment for female genital schistosomiasis, despite the overlap of symptoms. Women are at risk of not receiving the appropriate treatment. The aim of this study was to investigate challenges and missed opportunities when using syndromic management protocols for sexually transmitted infections in female genital schistosomiasis-endemic areas. METHODS : This is a secondary analysis of data from a large cross-sectional prevalence study conducted in 2011 in KwaZulu-Natal, South Africa. Young women in schistosomiasis-endemic areas were asked about genital symptoms and underwent laboratory testing and gynecological examinations to look for common genital infections including female genital schistosomiasis. We used the current South African syndromic management protocols as the basis and analyzed the associations between the reported genital symptoms and the differential diagnoses with logistic regression. RESULTS : By use of the syndromic approach the conditions gonorrhea, trichomoniasis and herpes could be identified. The symptom “lower abdominal pain” was significantly associated with documented female genital schistosomiasis. However, the same association was not found with gonorrhea or chlamydia. We found no significant association between reported vaginal discharge syndrome and female genital schistosomiasis or between genital ulcer syndrome and female genital schistosomiasis. DISCUSSION : Female genital schistosomiasis frequently co-exists with, and mimics other genital infections in rural areas of Sub-Saharan Africa. The management protocols in schistosomiasis endemic countries should include advice on how to diagnose and manage this chronic, waterborne genital condition. There is an urgent need to upscale laboratory and diagnostic resources in low-and middle-income countries and specifically schistosomiasis-endemic areas, to diagnose these common genital infections more accurately and to treat affected women accordingly.
Resilience in the time of crisis : a review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa
(South African Medical Association, 2024-05) Fawcus, S.; Gebhardt, S.; Niit, R.; Pattinson, Robert Clive
BACKGROUND : The COVID-19 pandemic had a profound effect on the health sector globally and in South Africa (SA). OBJECTIVE : To review the effects of COVID-19 on maternal, perinatal and reproductive health outcomes and service utilisation in SA. METHODS : Three routine national data collection systems were sourced: the District Health Information System, the Saving Mothers reports of the National Committee on Confidential Enquiry into Maternal Deaths and the Saving Babies reports from the National Perinatal Morbidity and Mortality Committee using data from the Perinatal Problem Identification Program. RESULTS : There were 35% and 8% increases in maternal and stillbirth mortality rates, respectively, in 2020 and 2021, which correlated with the COVID-19 waves. However, in 2022, rates returned to pre-COVID levels. Antenatal visits and facility births showed little change, but there was a shift to more rural provinces. The use of oral and injectable contraceptives and termination of pregnancy services decreased markedly in 2020 and 2021, with a sustained shift to long-acting reversible contraceptives. The increase in maternal deaths was predominantly due to COVID-19 respiratory complications, but also an increase in obstetric haemorrhage. Stillbirths increased significantly (10%) for birthweights between 2 000 g and 2 499 g, categorised mostly as unexplained stillbirths or preterm labour, but no increase in neonatal deaths was observed. Administrative avoidable factors increased by 24% in the 2020 - 2022 triennium, but there was no increase in patient/community level or healthcare provider-related avoidable factors during the pandemic years. CONCLUSION : COVID-19 caused a marked increase in maternal death and stillbirth rates in 2020 and 2021 due to both direct effects of the virus and indirect effects on functioning of the health system. The continued, although modified, health-seeking behaviour of women and the rapid return to pre-COVID-19 mortality rates demonstrates enormous resilience in women and the health system.
A randomised trial comparing preoperative administration of single-dose kefazolin to kefazolin plus metronidazole as prophylactic antibiotics at caesarean section
(South African Medical Association, 2024-06) Lanfel, R.; Snyman, L.; Seopela, Louisa; Jahn, G.; Becker, Piet J.
BACKGROUND : Caesarean section is a life-saving procedure which is associated with high rates of maternal and neonatal complications. It has been estimated that globally, 29.7 million births occur by caesarean section annually. The risk of postpartum infection is estimated to be five to ten times higher compared with normal vaginal delivery. Pregnancy-related sepsis was listed as a top-six cause of maternal mortality in the South African Saving Mothers report between 2017 and 2019. Multiple trials have been conducted in an attempt to optimise administration of prophylactic antibiotics in an effort to reduce postpartum infection and maternal sepsis, and current practice guidelines suggest that there is sufficient evidence that extended-spectrum antibiotics, in combination with kefazolin, result in reduction of postpartum infections OBJECTIVES : To investigate the effect of perioperative administration of kefazolin alone compared with kefazolin plus metronidazole on postpartum infection in women undergoing caesarean section at Kalafong Provincial Tertiary Hospital, Pretoria, South Africa METHOD : All patients undergoing emergency or elective caesarean section were randomised and then sequentially numbered in opaque sealed envelopes, which were placed in the caesarean section operating theatre. The intervention group received kefazolin and a sealed envelope with metronidazole. The control group received kefazolin and a sealed envelope with normal saline RESULTS : A total of 57/1 010 patients (5.64%) had surgical site infections, of which 27 (5.33%) were in the control group, and 30 (5.96%) were in the intervention group (p=0.66). Two patients in each arm (0.40% in the intervention arm and 0.39% in the control arm) underwent laparotomy procedures, while three women (0.60%) in the intervention arm and four women (0.79%) in the control arm underwent hysterectomy procedures. There were no statistically significant differences in all the measured secondary outcomes between the two groups CONCLUSION : The overall sepsis rate in this study was 5.64%. Postpartum infection is multifactorial and there are multiple factors that can be addressed in strengthening the sepsis care bundle. We do not recommend the addition of metronidazole to kefazolin as prophylaxis at caesarean section.
Now is the time to introduce new innovative assisted reproduction methods to implement accessible, affordable, and demonstrably successful advanced infertility services in resource-poor countries
(Oxford University Press, 2025-02) Ombelet, Willem; Van Blerkom, Jonathan; Boshoff, Gerhardus Marthinus; Huyser, Carin; Lopes, Federica; Nargund, Geeta; Sallam, Hassan; Vanmechelen, Koen; Campo, Rudi
Nearly 200 million people worldwide suffer from infertility. Disparities exist between developed and developing countries due to differences in the availability of infertility care, different reimbursement policies and socio-cultural differences surrounding procreation. In low- and middle-income countries, specialized infertility centres are either scarce or non-existent, mostly in private settings, and accessible only to the fortunate few who can afford them. The success and sustainability of ARTs will depend on our ability to optimize these techniques in terms of availability, affordability, and effectiveness. A low-cost, simplified IVF system has been developed and shown to be safe, cost-effective, and widely applicable to low-resource settings. Combined with inexpensive mild ovarian stimulation protocols, this could become a truly effective means of treating infertility and performing assisted reproduction at affordable prices, but only if such programmes are sincerely desired and supported by all relevant stakeholders. A receptive political, governmental, and clinical community is essential.
A core outcome set for future male infertility research : development of an international consensus
(Elsevier, 2025-06) Rimmer, Michael P.; Howie, Ruth A.; Anderson, Richard A.; Barratt, Christopher L.R.; Barnhart, Kurt T.; Beebeejaun, Yusuf; Bertolla, Ricardo Pimenta; Bortoletto, Pietro; Bran; Brannigan, Robert E.; Cantineau, Astrid E.P.; Caroppo, Ettore; Collura, Barbara L.; Coward, Kevin; Duncan, William Colin; Eisenberg, Michael L.; Gellatly, Steven A.; De Geyter, Christian; Goulis, Dimitrios G.; Henkel, Ralf R.; Ho, Vu N.A.; Hussein, Alayman F.; Huyser, Carin; Kadijk, Jozef H.; Kamath, Mohan S.; Khashaba, Shadi; Khattak, Hajra; Kobori, Yoshitomo; Kopeika, Julia; Kucuk, Tansu; Lujan, Saturnino; Matsaseng, Thabo Christopher; Mathur, Raj S.; McEleny, Kevin; Mitchell, Rod T.; Mol, Ben W.; Murage, Alfred M.; Ng, Ernest H.Y.; Pacey, Allan; Perheentupa, Antti H.; Du Plessis, Stefan; Rives, Nathalie; Sarris, Ippokratis; Schlegel, Peter N.; Shabbir, Majid; Smiechowski, Maciej; Subramanian, Venkatesh; Sunkara, Sesh K.; Tarlarzis, Basil C.; Tuettelmann, Frank; Vail, Andy; Van Wely, Madelon; Vazquez-Levin, Monica H.; Vuong, Lan N.; Wang, Alex Y.; Wang, Rui; Duffy, James M.N.; Farquhar, Cindy M.; Niederberger, Craig
ENGLISH OBJECTIVE : To develop a core outcome set for male infertility trials. DESIGN : A two-round Delphi survey and consensus development workshop were undertaken with healthcare professionals, researchers and clinicians globally. SUBJECTS : 334 participants from 39 countries participated in the Delphi Survey, while 44 participants from 21 countries participated in the consensus development workshop. EXPOSURE : NA MAIN OUTCOME MEASURES : The core outcome set for male infertility trials has been developed by the inclusion of specific male-factor outcomes in addition to the general infertility core outcome set which focuses on female-factor outcomes. RESULTS : The outcomes identified include assessment of semen using the World Health Organisation recommendations for semen analysis; viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin and higher multiple pregnancies); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Although not a requirement as part of the core outcome set, other outcomes were identified as potentially useful in certain study settings. CONCLUSION : Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection and reporting of core outcomes, which are inconsistently reported at present. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Fertility and Sterility and Human Reproduction, have committed to implementing this core outcome set for male infertility trials. TRIAL REGISTRATION NUMBER : Core Outcome Measures in Effectiveness Trials (COMET) initiative registration No: 1586. Available at www.comet-initiative.org/Studies/Details/1586.
A core outcome set for future male infertility research : development of an international consensus
(Oxford University Press, 2025-06) Rimmer, Michael P.; Howie, Ruth A.; Anderson, Richard A.; Barratt, Christopher L.R.; Barnhart, Kurt T.; Beebeejaun, Yusuf; Bertolla, Ricardo Pimenta; Bortoletto, Pietro; Brannigan, Robert E.; Cantineau, Astrid E.P.; Caroppo, Ettore; Collura, Barbara L.; Coward, Kevin; Duncan, William Colin; Eisenberg, Michael L.; Gellatly, Steven A.; De Geyter, Christian; Goulis, Dimitrios G.; Henkel, Ralf R.; Ho, Vu N.A.; Hussein, Alayman F.; Huyser, Carin; Kadijk, Jozef H.; Kamath, Mohan S.; Khashaba, Shadi; Khattak, Hajra; Kobori, Yoshitomo; Kopeika, Julia; Kucuk, Tansu; Luján, Saturnino; Matsaseng, Thabo Christopher; Mathur, Raj S.; Mceleny, Kevin; Mitchell, Rod T.; Mol, Ben W.; Murage, Alfred M.; Ng, Ernest H.Y.; Pacey, Allan; Perheentupa, Antti H.; Du Plessis, Stefan; Rives, Nathalie; Sarris, Ippokratis; Schlegel, Peter N.; Shabbir, Majid; Smiechowski, Maciej; Subramanian, Venkatesh; Sunkara, Sesh K.; Tarlarzis, Basil C.; Tüttelmann, Frank; Vail, Andy; Van Wely, Madelon; Vazquez-Levin, Mónica H.; Vuong, Lan N.; Wang, Alex Y.; Wang, Rui; Duffy, James M.N.; Farquhar, Cindy M.; Niederberger, Craig
STUDY QUESTION : Can a core outcome set be developed through a global consensus to standardize outcome selection, collection, comparison, and reporting in future male infertility trials? SUMMARY ANSWER : A minimum dataset, known as a ‘core outcome set’, has been developed for randomized controlled trials (RCTs) and systematic reviews evaluating potential interventions for male infertility. WHAT IS KNOWN ALREADY : Numerous factors, including a failure to consider the perspectives of men with lived experiences of infertility or their partners when developing and conducting RCTs can limit their clinical utility. Selection of outcomes, variations in outcome definitions, and the selective reporting of outcomes based on statistical analysis make the results of infertility research challenging to interpret, compare, and implement. For male infertility, this is further compounded by there being potentially three participants, the male, their female partner, and any offspring born, all with outcomes to be reported. This has led to significant heterogeneity in trial design and reporting. While a core outcome set for general infertility trials has been developed, there is no such outcome set for male infertility trials. STUDY DESIGN, SIZE, DURATION : A two-round Delphi survey (334 participants from 39 countries) and consensus development workshops (44 participants from 21 countries). PARTICIPANTS/MATERIALS, SETTING, METHODS : Healthcare professionals, researchers, and men and women with infertility were brought together in a transparent process using formal consensus science methods. MAIN RESULTS AND THE ROLE OF CHANCE : The core outcome set for male infertility trials has been developed by the inclusion of specific male-factor outcomes in addition to the general infertility core outcome set. These outcomes include assessment of semen using the World Health Organization recommendations for semen analysis; viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin, and higher multiple pregnancies); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth, and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Although not a requirement as part of the core outcome set, other outcomes were identified as potentially useful in certain study settings. LIMITATIONS, REASONS FOR CAUTION : We used consensus development methods in this work, which have inherent limitations, including the representativeness of the participant sample, Delphi survey attrition, and an arbitrary consensus threshold. WIDER IMPLICATIONS OF THE FINDINGS : Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection, and reporting of core outcomes, which are inconsistently reported at present. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Fertility and Sterility and Human Reproduction, have committed to implementing this core outcome set for male infertility trials. STUDY FUNDING/COMPETING INTEREST(S) : This work was funded by The Urology Foundation, Small Project Fund awarded to Michael P Rimmer at the University of Edinburgh, UK. RTM was supported by a United Kingdom Research and Innovation (UKRI) Future Leaders Fellowship (MR/Y011783/1). C.L.R.B. is the co-editor in chief of Human Reproduction and recipient of a BMGF grant and received consultancy fees from Exscentia and Exceed sperm testing, paid to the University of Dundee and speaking fees or honoraria paid personally by Ferring, Copper Surgical and RBMO. R.P.B. receives royalties from Flow diagnósticos. M.L.E. is an advisor to the companies Hannah, Illumicell, Next, Legacy, Doveras, Vseat and received a consultancy fee for this. B.W.M. is a paid consultant for Norgine and Organon and has received research funding from Ferring and Merck, he also receives consultancy and travel support from Merck. R.R.H. received royalties from Elsevier for a book, consultancy fees from Glyciome, and presentation fees from GryNumber Health and Aytu Bioscience. Attendance at Fertility 2020 and Roadshow South Africa by Ralf Henkel was funded by LogixX Pharma Ltd. R.R.H. is also Editor in Chief of Andrologia and has been an employee of LogixX Pharma Ltd. since 2020. M.S.K. has been an associate editor with Human Reproduction Open. K.Mc.E. received funding to attend Fertility 2025 by the British Fertility Society and is the Chair of the British Fertility Society. He is a member of the HFEA’s Scientific and Clinical Advances Advisory Committee and a Committee Member of the NICE Fertility Problems Guideline Group. M.H.V.L. receives consultation fees for the WHO Manual Spanish translation, and travel expenses for the ESHRE MRHI meeting in Budapest. She is a member of the editorial board for Fertility & Sterility, F&S Science, Human Reproduction, and Frontiers in Endocrinology. She is also a panel member of the World Health Organization (WHO) Human Reproduction Programme (HRP) Research Project Review Panel. R.S.M. is a member of the NICE Guideline Committee on Fertility and former chair of the British Fertility Society. A. Perheentupa receives an honoraria for lecturing from Merck for the Tackling Infertility manifest, Gedeon Richter & Ferring. A. Perheentupa declares lecture honoraria from Merck, Gideon Richter, and Ferring; and payment from Merck for the Tackling Infertility manifesto. A. Pacey receives consultancy fees for Carrot Fertility and Cryos International as well as lecturing for IBSA Institut Biochimique SA and Mealis Group—all fees paid to The University of Manchester. He is also a Trustee of Progress Educational. Trust (Charity Number 1139856) and Chairman of UKNEQAS Reproductive Sciences Advisory Committee. F.T. is the recipient of a Bayer research grant, as well as DFG Clinical Research Unit ‘Male Germ Cells’ (CRU326, project number 329621271) and BMBF Junior Scientist Research Centre ‘ReproTrack.MS’ (grant 01GR2303), he has received travel support from IBSA and Organon. M.v.W. is the Editor-in-Chief of Human Reproduction Update. R.W. is a former Deputy Editor of Human Reproduction and is currently a Deputy Editor of Human Reproduction Update. TRIAL REGISTRATION NUMBER : Core Outcome Measures in Effectiveness Trials (COMET) initiative registration No: 1586. Available at www.comet-initiative.org/Studies/Details/1586.
Triage of HPV positivity in a high HIV prevalence setting : a prospective cohort study comparing visual triage methods and HPV genotype restriction in Botswana
(Wiley, 2024-05) Luckett, Rebecca; Ramogola-Masire, Doreen; Gompers, Annika; Moraka, Natasha; Moyo, Sikhulile; Sedabadi, Leatile; Tawe, Leabaneng; Kashamba, Thanolo; Gaborone, Kelebogile; Mathoma, Anikie; Noubary, Farzad; Kula, Maduke; Grover, Surbhi; Dreyer, Greta; Botha, Matthys H.; Makhema, Joseph; Shapiro, Roger; Hacker, Michele R.
OBJECTIVE : Guidelines for effective triage following positive primary high-risk human papillomavirus (HPV) screening in low- and middle-income countries with high human immunodeficiency virus (HIV)-prevalence have not previously been established. In the present study, we evaluated the performance of three triage methods for positive HPV results in women living with HIV (WLHIV) and without HIV in Botswana. METHODS : We conducted baseline enrollment of a prospective cohort study from February 2021 to August 2022 in South-East District, Botswana. Non-pregnant women aged 25 or older with an intact cervix and no prior diagnosis of cervical cancer were systematically consented for enrollment, with enrichment of the cohort for WLHIV. Those who consented completed a questionnaire and then collected vaginal self-samples for HPV testing. Primary HPV testing for 15 individual genotypes was conducted using Atila AmpFire® HPV assay. Those with positive HPV results returned for a triage visit where all underwent visual inspection with acetic acid (VIA), colposcopy, and biopsy. Triage strategies with VIA, colposcopy and 8-type HPV genotype restriction (16/18/31/33/35/45/52/58), separately and in combination, were compared using histopathology as the gold standard in diagnosing cervical intraepithelial neoplasia (CIN) 2 or worse (CIN2+). RESULTS : Among 2969 women enrolled, 1480 (50%) tested HPV positive. The cohort included 1478 (50%) WLHIV; 99% were virologically suppressed after a mean of 8 years on antiretroviral therapy. In total, 1269 (86%) women had histopathology data for analysis. Among WLHIV who tested positive for HPV, 131 (19%) of 688 had CIN2+ compared with 71 (12%) of 581 in women without HIV. Screening by 8-type HPV genotype restriction was more sensitive as triage to detect CIN2+ in WLHIV 87.79% (95% CI: 80.92–92.85) and women without HIV 85.92% (95% CI: 75.62–93.03) when compared with VIA (WLHIV 62.31% [95% CI: 53.39–70.65], women without HIV 44.29% [95% CI: 32.41–56.66]) and colposcopy (WLHIV 70.77% [95% CI: 62.15–78.41], women without HIV 45.71% [95% CI: 33.74–58.06]). However, 8-type HPV genotype restriction had low specificity in WLHIV of 30.88% (95% CI: 27.06–34.90) and women without HIV 37.06% (95% CI: 32.85–41.41). These results were similar when CIN3+ was used as the outcome. When combining 8-type HPV genotype restriction with VIA as the triage strategy, there was improved specificity to detect CIN2+ in WLHIV of 81.65% (95% CI: 78.18–84.79) but dramatically reduced sensitivity of 56.15% (95% CI: 47.18–64.84). CONCLUSIONS : Eight-type HPV genotype restriction is a promising component of effective triage for HPV positivity. However, novel triage strategies in LMICs with high HIV prevalence may be needed to avoid the trade-off between sensitivity and specificity with currently available options. CLINICAL TRIALS REGISTRATION : This study is registered on Clinicaltrials.gov no. NCT04242823, https://clinicaltrials.gov/ct2/show/NCT04242823.
Determining the relationship between severity of proteinuria and adverse maternal and neonatal outcomes in patients with preeclampsia
(Elsevier, 2024-12) Jansen van Rensburg, Elizabeth; Seopela, Louisa; Snyman, Leon Cornelius
OBJECTIVES : To investigate the relationship between the severity of proteinuria and adverse maternal and neonatal outcomes in patients with preeclampsia (PE). DESIGN : Prospective cohort study conducted in Gauteng, South Africa over 12 months. Patients with PE 18 years or older with singleton pregnancies were recruited. We included 248 in the final analysis. METHODS : Proteinuria was quantified using urine protein: creatinine ratio (UPCR). Preeclamptic patients’ outcomes were compared according to the UPCR values using regression models and by generating receiver operator characteristic (ROC) curves. Primary maternal outcomes were gestational age (GA) at diagnosis, GA at delivery, development of eclampsia, development of severe features and the need for more than one antihypertensive agent. Neonatal outcomes were admission to neonatal unit, 5-min APGAR score, need for ventilatory support and early neonatal death. RESULTS : There was a weak but significant negative correlation between GA at delivery and UPCR (Spearman’s correlation coefficient (SCC) − 0.191, p = 0.002). Most patients (77 %) required >1 agent to control their blood pressure, however there was no correlation between UPCR and the need for additional agents (SCC − 0.014, p = 0.828). There was a statistically significant correlation between UPCR and severe features, especially the development of haemolysis, elevated liver enzymes and low platelet (HELLP) syndrome (p = 0.005). There was no significant correlation between neonatal outcomes and UPCR. CONCLUSION : Severity of proteinuria correlated with earlier delivery and development of severe features, specifically HELLP syndrome and pulmonary oedema. There was no correlation between UPCR and requiring additional antihypertensive agents or neonatal outcomes.
Exploring models, practice and strategies in mentorship within health professions education in the Southern African context : short report
(South African Medical Association, 2024-12-18) Naidoo, Kimesh Loganathan; Badlangana, Ludo Nlambiwa; Adam, Sumaiya; Maart, Ronel; Van Wyk, Jacqueline Marina
BACKGROUND. Despite benefits, structured mentorship needs to be better recognised within health profession training institutions (HPI) in Southern Africa (SA). Given the need to transform faculties and retain skilled personnel, mentoring programmes can be used to address these needs and warrant further exploration. OBJECTIVE. To explore mentorship models within HPI in SA. METHODS. During the annual South African Health Educationalists Conference (SAAHE) in 2022, five academics from HPIs in the region conducted an interactive national workshop on mentorship in health professions education. Following a presentation on mentorship models, participants were allowed to share their perspectives on current mentorship practices, gaps and recommendations for enhancing mentorship. Key concepts and themes generated are reported. RESULTS. Three key approaches to mentorship models were identified during the workshop. These were ‘top-down’, ‘ad-hoc’ and ‘supportive’ approaches. Mentorship models were largely self-initiated and followed a traditional dyadic style with little innovation. Mandatory ‘top-down’, over-regulated programmes compared with ‘grassroots’ approaches were the two extremes reflected on the spectrum of models. While the benefits of mentorship were recognised, institution-wide implementation is lacking, reflecting varied or no widescale adoption. Mentorship could serve as a focused, formal strategy to ensure the demographic transformation of HPIs. Recommendations were made to measure the effectiveness of mentorship programmes against academic promotion criteria and research outputs. CONCLUSION. While mentorship is positively viewed as a means to ensure improved equity and outputs, practical implementation is lacking. Mentorship programmes require further exploration of models and processes to facilitate successful implementation.
Acceptability and safety of thermal ablation treatment for cervical cytological abnormalities in Pretoria, South Africa
(Medpharm Publications, 2025-02) Malaza, C.K.; Dreyer, Greta; Snyman, Leon Cornelius; Visser, Cathy; Buchmann, E.J.
BACKGROUND : Cervical cancer is one of the leading causes of cancer deaths in women, and 90% of the deaths occur in low- to middle-income countries (LMICs). Accessible cervical cancer screening and treatment options are an urgent priority. Thermal ablation (TA) is an alternative treatment option available for cervical premalignant conditions. The World Health Organization (WHO) has endorsed TA and published guidelines on its use. Most studies on the treatment’s efficacy, safety, and acceptability are from high-income countries. METHODS : A prospective cohort study that recruited women who presented with abnormal cytology results from three hospitals in Pretoria, South Africa. Colposcopy examinations were done to assess patients’ eligibility for TA. Post-treatment questionnaires were completed by participating doctors and women to assess the acceptability and safety profile of the treatment. Follow-ups were scheduled on day 7 to assess the safety profile further, and adverse events (AEs) were recorded. RESULTS : The analysis included 58 women. The mean age was 42.4 years. Our findings showed a safety rate of 91.4% and a patient satisfaction rate of 96.6%. All the participating doctors and women recommended the treatment. Most of our findings were consistent with those from previous studies. CONCLUSION : Our study demonstrated TA as a safe and acceptable treatment method for cervical premalignant conditions in low- resource settings. The treatment does not require expensive infrastructure and can be performed by generalist doctors.
Incompleteness and misclassification of maternal deaths in Zimbabwe : data from two reproductive age mortality surveys, 2007-2008 and 2018-2019
(Springer, 2024-12) Musarandega, Reuben; Nystrom, Lennarth; Murewanhema, Grant; Gwanzura, Chipo; Ngwenya, Solwayo; Pattinson, Robert Clive; Machekano, Rhoderick; Munjanja, Stephen Peter; Zimbabwe Maternal and Perinatal Mortality Study Group
INTRODUCTION : We implemented two cross-sectional reproductive age mortality surveys in 2007–2008 and 2018–2019 to assess changes in the MMR and causes of death in Zimbabwe. We collected data from health institutions, civil registration and vital statistics, the community, and surveillance. This paper analyses missingness and misclassification of deaths in the two surveys. METHODS : We compared proportions of missed and misclassified deaths in the surveys using Chi-square or Fisher’s exact tests. Using log-linear regression models, we calculated and compared risk ratios of missed deaths in the data sources. We assessed the effect on MMRs of misclassifying deaths and analysed the sensitivity and specificity of identifying deaths in the surveys using the six-box method and risk ratios calculated through Binomial exact tests. RESULTS : All data sources missed and misclassified the deaths. The community survey was seven times [RR 7.1 (5.1–9.7)] and CRVS three times [RR 3.4 (2.4–4.7)] more likely to identify maternal deaths than health records in 2007–08. In 2018–19, CRVS [RR 0.8 (0.7–0.9)] and surveillance [RR 0.7 (0.6–0.9)] were less likely to identify maternal deaths than health records. Misclassification of causes of death significantly reduced MMRs in health records [RR 1.4 (1.2–1.5)]; CRVS [RR 1.3 (1.1– 1.5)] and the community survey/surveillance [RR 1.4 (1.2–1.6)]. CONCLUSION : Incompleteness and misclassification of maternal deaths are still high in Zimbabwe. Maternal mortality studies must triangulate data sources to improve the completeness of data while efforts to reduce misclassification of deaths continue.
Evaluating the therapeutic potential of curcumin and synthetic derivatives : a computational approach to anti-obesity treatments
(MDPI, 2024-02-23) Moetlediwa, Marakiya T.; Jack, Babalwa U.; Mazibuko-Mbeje, Sithandiwe E.; Pheiffer, Carmen; Titinchi, Salam J.J.; Salifu, Elliasu Y.; Ramharack, Pritika
Natural compounds such as curcumin, a polyphenolic compound derived from the rhizome of turmeric, have gathered remarkable scientific interest due to their diverse metabolic benefits including anti-obesity potential. However, curcumin faces challenges stemming from its unfavorable pharmacokinetic profile. To address this issue, synthetic curcumin derivatives aimed at enhancing the biological efficacy of curcumin have previously been developed. In silico modelling techniques have gained significant recognition in screening synthetic compounds as drug candidates. Therefore, the primary objective of this study was to assess the pharmacokinetic and pharmacodynamic characteristics of three synthetic derivatives of curcumin. This evaluation was conducted in comparison to curcumin, with a specific emphasis on examining their impact on adipogenesis, inflammation, and lipid metabolism as potential therapeutic targets of obesity mechanisms. In this study, predictive toxicity screening confirmed the safety of curcumin, with the curcumin derivatives demonstrating a safe profile based on their LD50 values. The synthetic curcumin derivative 1A8 exhibited inactivity across all selected toxicity endpoints. Furthermore, these compounds were deemed viable candidate drugs as they adhered to Lipinski’s rules and exhibited favorable metabolic profiles. Molecular docking studies revealed that both curcumin and its synthetic derivatives exhibited favorable binding scores, whilst molecular dynamic simulations showed stable binding with peroxisome proliferator-activated receptor gamma (PPARγ), csyclooxygenase-2 (COX2), and fatty acid synthase (FAS) proteins. The binding free energy calculations indicated that curcumin displayed potential as a strong regulator of PPARγ (−60.2 ± 0.4 kcal/mol) and FAS (−37.9 ± 0.3 kcal/mol), whereas 1A8 demonstrated robust binding affinity with COX2 (−64.9 ± 0.2 kcal/mol). In conclusion, the results from this study suggest that the three synthetic curcumin derivatives have similar molecular interactions to curcumin with selected biological targets. However, in vitro and in vivo experimental studies are recommended to validate these findings.
A scoping review on continuing professional development programs for midwives : optimising management of obstetric emergencies and complications
(BMC, 2025-02) Musie, Maurine Rofhiwa; Tagutanazvo, Oslinah Buru; Sepeng, Nombulelo Veronica; Mulaudzi, Fhumulani Mavis; Hlongwane, Tsakane; maurine.musie@up.ac.za
BACKGROUND : Midwives play a pivotal role in ensuring safe childbirth, particularly in the management of obstetric emergencies and complications (EmONC). Continuous Professional Development (CPD) programs are essential to keep midwives updated with the latest skills and knowledge, ensuring high-quality maternal care. AIM : The study aimed to map and synthesize evidence on continuing professional development for midwives optimising management of obstetric emergencies and complications to reveal evidence to address the knowledge gap and implementation of policy. METHODS : This scoping review was guided by the adapted version of Arksey and O’Malley methodological framework (2005). We searched databases from 2013 to 2023: PubMed, SCOPUS, Web of Science, EBSCOhost (CINAHL, MEDLINE and Academic search): and ProQuest central. The studies were appraised using mixed methods appraisal tool (MMAT) version 2018. Content analysis and synthesis of the findings were conducted using Nvivo 12. RESULTS : Of the 752 articles identified through database searching, 31 articles met the inclusion criteria and reported according to the Preferred reporting items for systematic reviews and meta-analyses extension for scoping review (PRISMA-ScR) checklist. After data extraction, content analysis yielded the following 4 major themes: Types of CPD training programs, Effectiveness of CPD on management of obstetric emergencies, Barriers/Challenges with lack of implementation of CPD programs and Suggestion for implementation of CPD programs. CONCLUSION : The findings revealed the significance of CPD programs in equipping midwives with the necessary skills and knowledge to handle obstetric emergencies effectively. The program can be offered in various approaches including simulation-based training, technology-based simulation, online modules, workshops, and interdisciplinary/interprofessional learning sessions, have shown to be effective. Each method offers unique advantages, such as hands-on practice in simulations and flexibility in online learning with smart applications such as SAFE delivery applications.
Gestational diabetes and the gut microbiota : fibre and polyphenol supplementation as a therapeutic strategy
(MDPI, 2024-04) Pheiffer, Carmen; Riedel, Sylvia; Dias, Stephanie; Adam, Sumaiya
Gestational diabetes mellitus (GDM) is an escalating public health concern due to its association with short- and long-term adverse maternal and child health outcomes. Dysbiosis of microbiota within the gastrointestinal tract has been linked to the development of GDM. Modification of microbiota dysbiosis through dietary adjustments has attracted considerable attention as adjunct strategies to improve metabolic disease. Diets high in fibre and polyphenol content are associated with increased gut microbiota alpha diversity, reduced inflammation and oxidative processes and improved intestinal barrier function. This review explores the potential of fibre and polyphenol supplementation to prevent GDM by investigating their impact on gut microbiota composition and function.
Gestation-dependent increase in cervicovaginal pro-inflammatory cytokines and cervical extracellular matrix proteins is associated with spontaneous preterm delivery within 2 weeks of index assessment in South African women
(Frontiers Media, 2024-08) Amabebe, Emmanuel; Ikumi, Nadia; Oosthuizen, Ally; Soma-Pillay, Priya; Matjila, Mushi; Anumba, Dilly O. C.
INTRODUCTION: Inflammation-induced remodelling of gestational tissues that underpins spontaneous preterm birth (sPTB, delivery < 37 weeks’ gestation) may vary by race and context. To explore relationships between markers of these pathological processes, we (a) characterised the cervicovaginal fluid (CVF) cytokine profiles of pregnant South African women at risk of PTB; (b) determined CVF matrix-metalloproteinase-9 (MMP-9) and its regulator tissue inhibitor of metalloproteinase-1 (TIMP-1); and (c) explored the predictive potential of these markers for sPTB. METHOD OF STUDY: The concentrations of 10 inflammatory cytokines and MMP-9 and TIMP-1 were determined by ELISA in CVF samples from 47 non-labouring women at high risk of PTB. We studied CVF sampled at three gestational time points (GTPs): GTP1 (20–22 weeks, n = 37), GTP2 (26–28 weeks, n = 40), and GTP3 (34–36 weeks, n = 29) and analysed for changes in protein concentrations and predictive capacities (area under the ROC curve (AUC) and 95% confidence interval (CI)) for sPTB. RESULTS: There were 11 (GTP1), 13 (GTP2), and 6 (GTP3) women who delivered preterm within 85.3 ± 25.9, 51.3 ± 15.3, and 11.8 ± 7.5 (mean ± SD) days after assessment, respectively. At GTP1, IL-8 was higher (4-fold, p = 0.02), whereas GM-CSF was lower (~1.4-fold, p = 0.03) in the preterm compared with term women with an average AUC = 0.73. At GTP2, IL-1b (18-fold, p < 0.0001), IL-8 (4- fold, p = 0.03), MMP-9 (17-fold, p = 0.0007), MMP-9/TIMP-1 ratio (9-fold, p = 0.004), and MMP-9/GM-CSF ratio (87-fold, p = 0.005) were higher in preterm compared with term women with an average AUC = 0.80. By contrast, IL-10 was associated with term delivery with an AUC (95% CI) = 0.75 (0.55–0.90). At GTP3, IL-1b (58-fold, p = 0.0003), IL-8 (12-fold, p = 0.002), MMP-9 (296-fold, p = 0.03), and TIMP-1 (35-fold, p = 0.01) were higher in preterm compared with term women with an average AUC = 0.85. Elevated IL-1b was associated with delivery within 14 days of assessment with AUC = 0.85 (0.67–0.96). Overall, elevated MMP-9 at GTP3 had the highest (13.3) positive likelihood ratio for distinguishing women at risk of sPTB. Lastly, a positive correlation between MMP-9 and TIMP-1 at all GTPs (r ≥ 0.61, p < 0.01) for women delivering at term was only observed at GTP1 for those who delivered preterm (r = 0.70, p < 0.03). CONCLUSIONS: In this cohort, sPTB is associated with gestation-dependent increase in pro-inflammatory cytokines, decreased IL-10 and GM-CSF, and dysregulated MMP-9-TIMP-1 interaction. Levels of cytokine (especially IL-1b) and ECM remodelling proteins rise significantly in the final 2 weeks before the onset of labour when sPTB is imminent. The signalling mechanisms for these ECM remodelling observations remain to be elucidated.
Assessment of current biomarkers and interventions to identify and treat women at risk of preterm birth
(Frontiers Media, 2024-07) Gravett, Michael G.; Menon, Ramkumar; Tribe, Rachel M.; Hezelgrave, Natasha L.; Kacerovsky, Marian; Soma-Pillay, Priya; Jacobsson, Bo; McElrath, Thomas F.
Preterm birth remains an important global problem, and an important contributor to under-5 mortality. Reducing spontaneous preterm birth rates at the global level will require the early identification of patients at risk of preterm delivery in order to allow the initiation of appropriate prophylactic management strategies. Ideally these strategies target the underlying pathophysiologic causes of preterm labor. Prevention, however, becomes problematic as the causes of preterm birth are multifactorial and vary by gestational age, ethnicity, and social context. Unfortunately, current screening and diagnostic tests are nonspecific, with only moderate clinical risk prediction, relying on the detection of downstream markers of the common end-stage pathway rather than identifying upstream pathway-specific pathophysiology that would help the provider initiate targeted interventions. As a result, the available management options (including cervical cerclage and vaginal progesterone) are used empirically with, at best, ambiguous results in clinical trials. Furthermore, the available screening tests have only modest clinical risk prediction, and fail to identify most patients who will have a preterm birth. Clearly defining preterm birth phenotypes and the biologic pathways leading to preterm birth is key to providing targeted, biomolecular pathway-specific interventions, ideally initiated in early pregnancy Pathway specific biomarker discovery, together with management strategies based on early, mid-, and-late trimester specific markers is integral to this process, which must be addressed in a systematic way through rigorously planned biomarker trials.
Comparative effects of tumor necrosis factor alpha, lipopolysaccharide, and palmitate on mitochondrial dysfunction in cultured 3T3-L1 adipocytes
(Springer, 2025-03) Jack, Babalwa U.; Dias, Stephanie; Pheiffer, Carmen
We have previously reported that dysregulated lipid metabolism and inflammation in 3T3-L1 adipocytes is attributed to tumor necrosis factor alpha (TNFα) rather than lipopolysaccharide (LPS) and palmitate (PA). In this study, we further compared the modulative effects of TNFα, LPS, and PA on mitochondrial function by treating 3T3-L1 adipocytes with TNFα (10 ng/mL), LPS (100 ng/mL), and PA (0.75 mM) individually or in combination for 24 h. Results showed a significant reduction in intracellular adenosine triphosphate (ATP) content, mitochondrial bioenergetics, total antioxidant capacity, and the mRNA expression of citrate synthase (Cs), sirtuin 3 (Sirt3), protein kinase AMP-activated catalytic subunit alpha 2 (Prkaa2), peroxisome proliferator-activated receptor gamma coactivator 1 alpha (Ppargc1α), nuclear respiratory factor 1 (Nrf1), and superoxide dismutase 1 (Sod1) in cells treated with TNFα individually or in combination with LPS and PA. Additionally, TNFα treatments decreased insulin receptor substrate 1 (Irs1), insulin receptor substrate 2 (Irs2), solute carrier family 2, facilitated glucose transporter member 4 (Slc2a4), and phosphoinositide 3 kinase regulatory subunit 1 (Pik3r1) mRNA expression. Treatment with LPS and PA alone, or in combination, did not affect the assessed metabolic parameters, while the combination of LPS and PA increased lipid peroxidation. These results show that TNFα but not LPS and PA dysregulate mitochondrial function, thus inducing oxidative stress and impaired insulin signaling in 3T3-L1 adipocytes. This suggests that TNFα treatment can be used as a basic in vitro model for studying the pathophysiology of mitochondrial dysfunction and related metabolic complications and screening potential anti-obesity therapeutics in 3T3-L1 adipocytes.

Browse

Recent Submissions