Browsing by Author "Mwampagatwa, I. H."
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Item Antenatal corticosteroid therapy for foetal maturation in women with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania(BioMed Central Ltd., 2016) Mooij, R.; Mwampagatwa, I. H.; Dillen, J. van; Stekelenburg, J.Preterm birth is a major cause of neonatal mortality, especially in low and middle income countries. Antenatal corticosteroid therapy for foetal maturation could have a significant impact and therefore is often referred to as an important strategy to reduce neonatal mortality. A recently conducted large multinational trial showed that antenatal corticosteroids can have adverse effects in low income countries, but this is likely to depend on the specific setting. In our hospital preterm birth is only recognized in patients with severe maternal disease, due to physician-initiated delivery. Spontaneous preterm births are rarely seen in the hospital and often take place in the community or while on the road to a health facility. To investigate the effects of antenatal corticosteroid therapy in a rural hospital in Tanzania. A secondary analysis of a retrospective medical records study of women with severe pre-eclampsia and eclampsia performed in Ndala Hospital between July 2011 and December 2012. We used data on gestational age, birth weight, Apgar score, time between admission and birth, use of corticosteroids and maternal and foetal survival. Ethical clearance was obtained from the directorate of research and publications of the University of Dodoma. Thirty-six women with forty live foetuses were analysed. Twelve women (13 neonates) were given corticosteroids and could be compared to 24 women (27 neonates) who did not get corticosteroids. The incidence of fresh stillbirths (antenatal death) was 20 %. The 13 neonates who received corticosteroids had significantly smaller birth weight, longer interval between admission and delivery and poorer outcomes (stillbirth and neonatal death). An analysis of 24 neonates with a birth weight between 1.5 and 2.5 kg showed a trend toward better outcome in neonates who did not receive antenatal corticosteroid therapy. Small retrospective studies as these have a low level of evidence, but this study helped to gain more knowledge of local conditions affecting the effectiveness of antenatal corticosteroid therapy in our setting of a small rural hospital. Reliability of estimating gestational age, epidemiology of preterm birth, exposure to infections, foetal monitoring and quality of neonatal care are likely to influence the effect of antenatal corticosteroid therapy. Further larger prospective studies should be conducted to determine the exact preconditions of antenatal corticosteroid therapy in low-income countries. Until that time, the WHO precautions seem reasonable and audits and small observational studies like ours can help in assessing whether a specific hospital is suited for antenatal corticosteroid therapy.Item Beyond severe acute maternal morbidity: a mixed‐methods study on the long‐term consequences of (severe pre‐) eclampsia in rural Tanzania(Wiley, 2021) Mooij, R.; Kapanga, R. R.; Mwampagatwa, I. H.; Mgalega, G. C.; Dillen, J. van; Stekelenburg, J.; de Kok, B. C.To explore the long‐term (perceived) consequences of (severe pre‐) eclampsia in rural Tanzania. Women were traced for this mixed‐methods study 6–7 years after the diagnosis of (severe pre‐) eclampsia. Demographic and obstetric characteristics were noted, and blood pressure was recorded. Questionnaires were used to assess physical and mental health. The qualitative part consisted of semi‐structured interviews (SSI). A reference group consisted of women without hypertensive disorders of pregnancy. Of 74 patients, 25 (34%) were available for follow‐up, and 24 were included. Five (20%) had suffered from (pre‐) eclampsia twice. Hypertension was more common after (pre‐) eclampsia than in the reference group (29% vs. 13%). Thirteen women (56%) had feelings of anxiety and depression, compared to 30% in the reference group. In SSIs, experiences during the index pregnancy were explored, as well as body functions, reproductive life course and limitations in daily functioning, which were shown to be long‐lasting. Women who suffered from (severe pre‐) eclampsia may experience long‐term sequelae, including hypertension, depression and anxiety. Women lack information about their condition, and some are worried to conceive again. To address their specific needs, a strategy along the continuum of care is needed for women following a complicated pregnancy, starting with a late postnatal care visit 6 weeks after giving birth.Item Bilateral anomalies of renal pelves presenting with supernumerary left testicular vein(IMTU, 2013) Mwashambwa, M. Y.; Gesase, A. P.; Mwampagatwa, I. H.The current observation presents a case of right duplicated renal pelvis and anomalies of right and left renal vessels. The duplicated pelvis formed anterior and posterior segments which entered the renal substance separately and each had its own set of renal major calyces. The anterior segment appeared dilated, measuring about 1.3cm wide and was associated with three major calyces. The posterior segment had a straight course and appeared narrower than the anterior segment; it measured 0.75cm wide and it was associated with one major calyx. Both anterior and posterior segments joined into a common channel that formed the ureter. The left kidney was observed to have dilated triangular renal pelvis with a base measuring 4cm, it was associated with supernumerary testicular veins both which drained into the left renal vein. Congenital anomalies of the renal pelvis can lead to pelvicoureteric obstruction, urinary tract infection, stone and cancer formation. Supernumerary testicular vein are very rare anomalies ad have been commonly observed in females than in the males. Ontological significance of such anomalies is not clearly known, but continuous documentation of congenital abnormalities of the urinary system remains to be important in medical and surgical practice