Obstetrics and Gynaecology

This research looks at the role of alcohol drinking in HIV transmission. A history of heavy alcohol drinking has been associated with a lifetime tendency toward high-risk sexual behaviors, including multiple sex partners, unprotected sexual intercourse, sex with high-risk partners, and the exchange of sex for money or drugs. The objective of the study was to investigate the role played by alcohol consumption in the promotion of high-risk sexual behavior and therefore transmission of HIV infection among sexually active moderate alcohol drinkers and abusers aged 15 – 49 years in Grootfontein district, Namibia. The study was a Knowledge, Attitude, Behaviour and Practice (KABP) survey. Data on individual knowledge about HIV/AIDS and alcohol drinking, personal attitudes towards HIV/AIDS and alcohol, beliefs about HIV/AIDS and sexual practices was collected on 217 study participants aged between 15-49 years through an intervieweradministered questionnaire and through the cluster sampling ...

In Lusaka, Zambia, where malaria prevalence is low, national guidelines continue to recommend that all pregnant women receive sulfadoxine-pyrimethamine (SP) for malaria prophylaxis monthly at every scheduled antenatal care visit after 16 weeks of gestation. Human immunodeficiency virus (HIV)-positive women should receive co-trimoxazole prophylaxis for HIV and not SP, but many still receive SP. We sought to determine whether increased dosage of SP is still associated with a reduced risk of low birth weight (LBW) in an area where malaria transmission is low. Our secondary objective was to determine whether any association between SP and LBW is modified by receipt of antiretroviral therapy (ART). We analyzed data routinely collected from a cohort of HIV-positive pregnant women with singleton births in Lusaka, Zambia, between February 2006 and December 2012. We used a log-Poisson model to estimate the risk of LBW by dosage of SP and to determine whether the association between SP and LBW varied by receipt of ART. Risk of LBW declined as the number of doses increased and appeared lowest among women who received three doses (adjusted risk ratio [ARR] = 0.78; 95% confidence interval [CI] = 0.64-0.95). In addition, women receiving combination ART had a higher risk of delivering an LBW infant compared with women receiving no treatment or prophylaxis (ARR = 1.18; 95% CI = 1.09-1.28), but this risk was attenuated among women who were receiving SP (risk ratio = 1.09; 95% CI = 0.99-1.21). SP was associated with a reduced risk of LBW in HIVpositive women, including those receiving ART, in a low malaria prevalence region.

LEARNING OBJECTIVE: 1. Recognize that postpartum infection currently represents a major reason for postpartum readmissions. 2. Recognize that for certain cases, an outpatient management strategy may have been appropriate, given our center's access to a community IV program.

IAI among CSTs. No difference in the rate of histological chorioamnionitis was found among CSTs. CONCLUSIONS: The cervical microbiota in PPROM women in this study was characterized by four CSTs. The presence of non-Lactobacillus CSTs was associated with a strong cervical inflammatory response and higher rates of MIAC, both MIAC and histological chorioamnionitis, and IAI representing a PPROM subtype with pronounced inflammation. CST I represents the dominant type of PPROM with a low rate of MIAC, IAI, and the combination of MIAC and histological chorioamnionitis. LEARNING OBJECTIVE: Learners will be able to identify different community state types of cervical microbiota and their association with MIAC and/or histological chorioamnionitis and IAI.

Objective: Cesarean delivery (CD) may be associated with stillbirth in future pregnancies. We investigated prior CD as a risk factor for stillbirth in Lusaka, Zambia. Methods: We conducted a retrospective cohort analysis of women with only one prior pregnancy who delivered between February 1, 2006, and May 31, 2013. We analysed data from the Zambia Electronic Perinatal System. Maternal and infant characteristics were analyzed for association with stillbirth using Pearson's χ2 test or the Wilcoxon rank-sum test. We calculated risk of stillbirth (antepartum vs intrapartum) by prior CD, with a log Poisson model to adjust for confounding. Results: Of 57,320 women in our cohort, 1933 (3.4%) reported a prior CD. There were 1012 (1.8%) stillbirths in the no prior CD group and 81 (4.2%) in the prior CD group (P<0.001). In multivariate models adjusting for stillbirth risk factors, prior CD was associated with antepartum (adjusted risk ratio 1.56, 95% confidence interval 1.08-2.24) and intrapartum (3.26, 2.40-4.42) stillbirth compared with no prior CD. The difference between groups was most apparent at 36-37 weeks' gestation (log-rank P<0.001). Conclusion: Prior CD was associated with increased risk of stillbirth. Improved monitoring during labor and safe methods for induction are urgently needed in low-resource settings.

Objective-To evaluate whether maternal HIV serostatus and plasma viral load (VL) are associated with midtrimester cervical length (CL). Methods-The Zambian Preterm Birth Prevention Study (ZAPPS) is an ongoing prospective cohort that began enrolling in Lusaka in August 2015. Pregnant women undergo ultrasound to determine gestational age and return for CL measurement at 16-28 weeks. We evaluated crude and adjusted associations between dichotomous indicators and short cervix (≤2.5 cm) via logistic regression, and between VL and CL as a continuous variable via linear regression. Results-This analysis includes 1171 women enrolled between August 2015 and September 2017. Of 294 (25.1%) HIV-positive women, 275 (93.5%) had viral load performed close to CL measurement; of these, 148 (53.8%) had undetectable virus. Median CL was 3.6 cm (IQR 3.5-4.0) and was similar in HIV-infected (3.7 cm, IQR 3.5-4.0) versus uninfected (3.6 cm, IQR 3.5-4.0) participants (P=0.273). The odds of short CL were similar by HIV serostatus (OR 0.64; P=0.298) and detectable VL among those infected (OR 2.37, P=0.323). We observed no association between log VL and CL via linear regression (-0.12 cm; P=0.732). Conclusion-We found no evidence of association between HIV infection and short CL.

Purpose-Drawing on social exchange theory and a cultural perspective, this study examines the relationship between workplace ostracism and job engagement by focusing on the mediating role of felt obligation and the moderating role of collectivism. Design/methodology/approach-A two-wave survey was conducted over four months in a private service business in China. The participants comprised 108 Chinese employees. Findings-The results indicate that workplace ostracism has a negative relationship with job engagement through a reduced sense of felt obligation. Collectivism strengthens the main effect of workplace ostracism on felt obligation and its indirect effect on job engagement via felt obligation. Research limitations/implications-This study contributes to understanding of the internal mechanism of the workplace ostracism-job engagement model by identifying the mediating role of felt obligation. It also emphasizes that collectivist cultures can enhance the effects of workplace ostracism. However, the generalizability of our findings may be limited due to this cultural factor. Practical implications-Our findings show that workplace ostracism plays a significant role in reducing job engagement. Therefore, it is essential to reduce the incidence of ostracism in the workplace. Originality/value-By addressing the previously unexplored mechanism that mediates the relationship between workplace ostracism and job engagement, this study provides new directions for research on workplace ostracism and job engagement.

Background Testing men for HIV during their partner's pregnancy can guide couples-based HIV prevention and treatment, but testing rates remain low. We investigated a combination approach, using evidence-based strategies, to increase HIV testing in male partners of HIV-positive and HIV-negative pregnant women. Methods We did two parallel, unmasked randomised trials, enrolling pregnant women who had an HIV-positive test result documented in their antenatal record (trial 1) and women who had an HIV-negative test result documented in their antenatal record (trial 2) from an antenatal setting in Lusaka, Zambia. Women in both trials were randomly assigned (1:1) to the intervention or control groups using permuted block randomisation. The control groups received partner notification services only, including an adapted version for women who were HIV-negative; the intervention groups additionally received targeted education on the use of oral HIV self-test kits for their partners, along with up to five oral HIV self-test kits. At the 30 day follow-up we collected information from pregnant women about their primary male partner's HIV testing in the previous 30 days at health-care facilities, at home, or at any other facility. Our primary outcome was reported male partner testing at a health facility within 30 days following randomisation using a complete-case approach. Women also reported male partner HIV testing of any kind (including self-testing at home) that occurred within 30 days. Randomisation groups were compared via probability difference with a corresponding Wald-based 95% CI. The trial is registered at ClinicalTrials.gov (NCT04124536) and all enrolment and follow-up has been completed. Findings From Oct 28, 2019, to May 26, 2020, 116 women who were HIV-positive (trial 1) and 210 women who were HIV-negative (trial 2) were enrolled and randomly assigned to study groups. Retention at 30 days was 100 (86%) in trial 1 and 200 (95%) in trial 2. Women in the intervention group were less likely to report facility-based male partner HIV testing in trial 1 (3 [6%] of 47 vs 15 [28%] of 53, estimated probability difference-21•9% [95% CI-35•9 to-7•9%]) and trial 2 (3 [3%] of 102 vs 33 [34%] of 98, estimated probability difference-30•7% [95% CI-40•6 to-20•8]). However, reported male partner HIV testing of any kind was higher in the intervention group than in the control group in trial 1 (36 [77%] of 47 vs 19 [36%] of 53, estimated probability difference 40•7% [95% CI 23•0 to 58•4%]) and trial 2 (80 [78%] of 102 vs 54 [55%] of 98, estimated probability difference 23•3% [95% CI 10•7 to 36•0%]) due to increased use of HIV self-testing. Overall, 14 male partners tested HIV-positive. Across the two trials, three cases of intimate partner violence were reported (two in the control groups and one in the intervention groups). Interpretation Our combination approach increased overall HIV testing in male partners of pregnant women but reduced the proportion of men who sought follow-up facility-based testing. This combination approach might reduce linkages to health care, including for HIV prevention, and should be considered in the design of comprehensive HIV programmes.

Low pre-pregnancy body mass index (BMI) increases the risk of small for gestational age (SGA) infants. Alternative anthropometric measures such as mid-upper arm circumference (MUAC) that are easier to obtain than height and weight are needed where resources are scarce. We aimed to quantify the relationship between

Background:It is estimated that one in every five pregnancies globally ends up as abortion, with about 40% being unsafe. Abortions account for approximately 5.9% of all maternal mortalities and 50% of gynaecological admissions in Zambia. Despite implementing Comprehensive Abortion Care (CAC), which aims to provide high quality, safe and affordable services to women, unsafe abortions rates remain high. In this study, we explored the barriers and facilitators to CAC provision in selected health facilities of Lusaka and Copperbelt provinces in Zambia.Materials and methods: A qualitative case study using in-depth interviews with health care providers was conducted between July – August, 2021 in nine selected public health facilities of Zambia. A total of 17 interviews were conducted with participants purposively sampled. The interviews were digitally recorded and transcribed verbatim. Data analysis was done using content analysis. Results: The study revealed a number of barriers and fac...

Obstetric outcomes associated with adolescent pregnancies and those of older women at the UTH, identify factors associated with and compare the obstetric outcomes between the two age groups with determining the scale of adolescent pregnancy.