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Article ; Online: Multiple uterine perforations during manual vacuum aspiration: the need to increase the clinical awareness of attending healthcare professionals.

Ngene, Nnabuike C

2022 Volume 22, Issue 1, Page(s) 180–182

Abstract: Background: The risk of uterine perforation during manual vacuum aspiration (MVA) is reduced by using Karman cannula (which has a rounded tip) during the procedure.: Methods: A 35-year-old multigravida at 13 gestational weeks presented with vaginal ... ...

Abstract	Background: The risk of uterine perforation during manual vacuum aspiration (MVA) is reduced by using Karman cannula (which has a rounded tip) during the procedure. Methods: A 35-year-old multigravida at 13 gestational weeks presented with vaginal bleeding of a day duration and ultrasound evidence of retained products of conception suggestive of incomplete miscarriage. The patient was rhesus D positive and stable. She had MVA which was performed using Karman cannula, and developed severe vaginal bleeding. The differential diagnoses were incomplete uterine evacuation and uterine perforation. Results: During a laparotomy in Lloyd-Davies position, haemoperitoneum and six uterine perforations on the anterior and fundal parts, each approximately 5 mm in length (Figure 1), were found. The perforations were repaired and a check uterine curettage under oxytocic cover showed an empty uterus. The abdominal cavity was washed and closed. She was transfused three units of red blood cell concentrate and had a normal six weeks follow-up. Conclusion: When an instrument inserted into the uterus is pushed beyond the estimated depth of the uterus, a perforation must be suspected and the condition may be managed conservatively. A surgical procedure complicated by surgeon's loss of perception (in this case tactile) of tissues' anatomy is hazardous.
MeSH term(s)	Abortion, Incomplete ; Delivery of Health Care ; Female ; Humans ; Uterine Hemorrhage ; Uterine Perforation ; Vacuum Curettage
Language	English
Publishing date	2022-08-13
Publishing country	Uganda
Document type	Journal Article
ZDB-ID	2240308-5
ISSN	1729-0503 ; 1680-6905
ISSN (online)	1729-0503
ISSN	1680-6905
DOI	10.4314/ahs.v22i1.23
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Article ; Online: COVID-19 death: A novel method of improving its identification when a patient has multiple diagnoses.

Ngene, Nnabuike C / Moodley, Jagidesa

Southern African journal of infectious diseases

2022 Volume 37, Issue 1, Page(s) 349

Abstract: ... of death. In 2015, the Nnabuike-Jagidesa (NJ) model II was devised to improve the International ...

Abstract	Assigning a primary cause of death to a deceased patient who had multiple principal diagnoses including coronavirus disease 2019 (COVID-19) is challenging because of the difficulty in selecting the most appropriate cause. To proffer a solution, the authors reviewed the literature on assigning a primary cause of death. In 2015, the Nnabuike-Jagidesa (NJ) model II was devised to improve the International Classification of Diseases and related health problems, 10th revision (ICD-10) guideline on how to assign a primary cause of death. The NJ model II stipulates that when there are multiple diagnoses with no plausible explanation that one of the illnesses could have resulted in the other clinical conditions, the single most appropriate primary cause of death is the condition with the highest case fatality ratio in that setting. In the index report, the authors opine that if the case fatality ratios are similar, the following objective criteria (listed in the order of priority) should be used to assign a primary cause of death: condition with the highest infection fatality ratio, condition that was the main indication for the last acute surgical or invasive procedure performed (during the course of the same ill-health) before the death and the disease that theoretically affects the highest number of body organs. Additionally, a clinical descriptor should be used when none of the objective criteria are satisfied. This novel approach, termed the
Language	English
Publishing date	2022-04-26
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	3046282-4
ISSN	2313-1810 ; 2312-0053
ISSN (online)	2313-1810
ISSN	2312-0053
DOI	10.4102/sajid.v37i1.349
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Article ; Online: Blood pressure control in hypertensive patients attending a rural community health centre in Gauteng Province, South Africa: A cross-sectional study.

Onwukwe, Sergius C / Ngene, Nnabuike C

South African family practice : official journal of the South African Academy of Family Practice/Primary Care

2022 Volume 64, Issue 1, Page(s) e1–e9

Abstract: Background: Hypertension is a major cause of morbidity and mortality and its control has important clinical and socio-economic benefits to the family and community. Unfortunately, the extent of blood pressure (BP) control and its potential predictors in ...

Abstract	Background: Hypertension is a major cause of morbidity and mortality and its control has important clinical and socio-economic benefits to the family and community. Unfortunately, the extent of blood pressure (BP) control and its potential predictors in hypertensive patients in many rural communities in low-resource settings are largely unknown. This study assessed the extent of uncontrolled BP and its predictors amongst hypertensive patients accessing primary health care in a rural community in South Africa. Methods: This cross-sectional study included 422 randomly selected hypertensive patients. Demographic and clinical data were collected using structured face-to-face questionnaire supplemented by respondents' clinical records. Results: Obesity plus overweight (n = 286, 67.8%) and diabetes (n = 228, 54.0%) were the most common comorbidities. Treatment adherence was achieved in only 36.3% and BP was controlled to target in 50.2% of the respondents. Significant predictors of uncontrolled BP were poor treatment adherence (odds ratio [OR] = 15.88, 95% confidence interval [CI] = 8.96, 28.14, p 0.001), obesity compared with normal weight and overweight (OR = 3.75, 95% CI = 2.17, 6.46, p 0.001) and being a diabetic (OR = 2.83, 95% CI = 1.74, 4.61, p 0.001). Conclusion: Poor adherence to treatment was the major predictor of uncontrolled BP. The increase in uncontrolled BP in the presence of diabetes and/or obesity as risk predictors, indicates the need for appropriate behaviour change/interventions and management of these conditions in line with the health belief model (HBM). We also propose the use of Community-Based Physical and Electronic Reminding and Tracking System (CB-PERTS) to address poor treatment adherence.
MeSH term(s)	Antihypertensive Agents/pharmacology ; Antihypertensive Agents/therapeutic use ; Blood Pressure ; Community Health Centers ; Cross-Sectional Studies ; Diabetes Mellitus ; Humans ; Hypertension/epidemiology ; Obesity/drug therapy ; Obesity/epidemiology ; Overweight/drug therapy ; Overweight/epidemiology ; Rural Population ; South Africa/epidemiology
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2022-03-28
Publishing country	South Africa
Document type	Journal Article
ISSN	2078-6204
ISSN (online)	2078-6204
DOI	10.4102/safp.v64i1.5403
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Article: Inequality in health care services in urban and rural settings in South Africa.

Ngene, Nnabuike C / Khaliq, Olive P / Moodley, Jagidesa

African journal of reproductive health

2023 Volume 27, Issue 5s, Page(s) 87–95

Abstract: In low- and middle-income countries, urban and rural settings are distinct communities with the latter being more likely to have limited resources, particularly in health care services. We assessed the inequality in health care services in urban and ... ...

Abstract	In low- and middle-income countries, urban and rural settings are distinct communities with the latter being more likely to have limited resources, particularly in health care services. We assessed the inequality in health care services in urban and rural settings in South Africa, highlighting the disparities between public and private health services, given that the latter are located mainly in urban settings. Rural settings suffer the highest inequality in the availability of drugs and supplies, overcrowding of health care facilities, delays in transporting patients, inadequate emergency medical services, and lack of experienced health care professionals. Rural settings also preferentially have a shortage of various levels of health care services, and increased security threats by criminals. In addition to specific remedies, the overarching key to solving these challenges is socio-economic growth, as well as visionary and compassionate leadership with integrity and accountability, which ensures policy development, implementation, monitoring, and evaluation.
MeSH term(s)	Humans ; South Africa ; Health Services ; Health Services Accessibility ; Health Facilities ; Rural Health Services
Language	English
Publishing date	2023-08-16
Publishing country	Nigeria
Document type	Journal Article ; Review
ZDB-ID	2111906-5
ISSN	1118-4841
ISSN	1118-4841
DOI	10.29063/ajrh2023/v27i5s.11
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Article ; Online: Transient gestational hypertension and pre-eclampsia: Two case reports and literature review on the need for stringent monitoring.

Ngene, Nnabuike C / Daef, Ghadah

South African family practice : official journal of the South African Academy of Family Practice/Primary Care

2021 Volume 63, Issue 1, Page(s) e1–e6

Abstract: Transient gestation hypertension is a contributor to adverse pregnancy outcomes particularly when it progresses to pre-eclampsia (PE). This requires frequent monitoring. We illustrate the need for stringent monitoring of gestational hypertension, ... ...

Abstract	Transient gestation hypertension is a contributor to adverse pregnancy outcomes particularly when it progresses to pre-eclampsia (PE). This requires frequent monitoring. We illustrate the need for stringent monitoring of gestational hypertension, transient gestational hypertension (TGH) and PE without severe features and conducted a brief rapid review of the literature. Two cases are presented: Firstly, a 25-year-old primigravida at 30 gestational weeks who had an isolated TGH with high blood pressure (BP) of 141/87 mmHg, which was not investigated. Four weeks later, she presented with a BP of 202/128 mmHg, imminent eclampsia and intrauterine foetal death and had an uncomplicated induction of labour and delivered a 1400 g macerated male stillborn. Secondly, a 30-year-old primigravida at 30 gestational weeks who developed PE but her monitoring was compromised initially by inadequate healthcare capacity including unavailability of hospital bed-space for inpatient care and later by poor clinic attendance as a result of poor finances. At 32 gestational weeks, she presented with decreased foetal movement and was diagnosed as haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome and intrauterine foetal death. She was stabilised, had induction of labour and delivered a 1400 g male macerated stillborn. Thereafter, the need for her to go home to complete the cultural burial rites of her baby and the pressure from her workplace resulted in an inadequate postpartum follow-up care. In conclusion, transient gestational hypertension is associated with adverse maternal and foetal outcomes, including foetal demise. Unavailability of hospital bed-space and poor personal finances interfere with stringent monitoring of hypertensive disorders and can be associated with adverse pregnancy outcomes. Stringent laboratory monitoring in these cases is defined by the authors as testing at least blood levels of serum Creatinine, Haemoglobin concentration, Alanine transaminase and Platelet count (abbreviated as 'CHAP') weekly.
MeSH term(s)	Adult ; Eclampsia ; Female ; Humans ; Hypertension, Pregnancy-Induced/diagnosis ; Male ; Pre-Eclampsia/diagnosis ; Pregnancy ; Pregnancy Outcome
Language	English
Publishing date	2021-03-16
Publishing country	South Africa
Document type	Case Reports ; Journal Article ; Review
ISSN	2078-6204
ISSN (online)	2078-6204
DOI	10.4102/safp.v63i1.5236
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Article ; Online: Transient gestational hypertension and pre-eclampsia

Nnabuike C. Ngene / Ghadah Daef

South African Family Practice, Vol 63, Iss 1, Pp e1-e

Two case reports and literature review on the need for stringent monitoring

2021 Volume 6

Abstract	Transient gestation hypertension is a contributor to adverse pregnancy outcomes particularly when it progresses to pre-eclampsia (PE). This requires frequent monitoring. We illustrate the need for stringent monitoring of gestational hypertension, transient gestational hypertension (TGH) and PE without severe features and conducted a brief rapid review of the literature. Two cases are presented: Firstly, a 25-year-old primigravida at 30 gestational weeks who had an isolated TGH with high blood pressure (BP) of 141/87 mmHg, which was not investigated. Four weeks later, she presented with a BP of 202/128 mmHg, imminent eclampsia and intrauterine foetal death and had an uncomplicated induction of labour and delivered a 1400 g macerated male stillborn. Secondly, a 30-year-old primigravida at 30 gestational weeks who developed PE but her monitoring was compromised initially by inadequate healthcare capacity including unavailability of hospital bed-space for inpatient care and later by poor clinic attendance as a result of poor finances. At 32 gestational weeks, she presented with decreased foetal movement and was diagnosed as haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome and intrauterine foetal death. She was stabilised, had induction of labour and delivered a 1400 g male macerated stillborn. Thereafter, the need for her to go home to complete the cultural burial rites of her baby and the pressure from her workplace resulted in an inadequate postpartum follow-up care. In conclusion, transient gestational hypertension is associated with adverse maternal and foetal outcomes, including foetal demise. Unavailability of hospital bed-space and poor personal finances interfere with stringent monitoring of hypertensive disorders and can be associated with adverse pregnancy outcomes. Stringent laboratory monitoring in these cases is defined by the authors as testing at least blood levels of serum Creatinine, Haemoglobin concentration, Alanine transaminase and Platelet count (abbreviated as ‘CHAP’) ...
Keywords	hypertensive disorders of pregnancy ; intrauterine foetal death ; pre-eclampsia ; stringent monitoring ; transient gestational hypertension ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	AOSIS
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Expectant management of retained abnormally adherent placenta complicated by uterine prolapse after vaginal delivery.

Ngene, Nnabuike C / Siveregi, Amon

Tropical doctor

2020 Volume 50, Issue 2, Page(s) 160–162

Abstract: The placenta accreta spectrum (PAS) describes invasion and adherence of the placenta onto or beyond the myometrium. Prenatal imaging improves management outcomes. In low- and middle-income countries (LMIC), however, the unavailability of ultrasonography ... ...

Abstract	The placenta accreta spectrum (PAS) describes invasion and adherence of the placenta onto or beyond the myometrium. Prenatal imaging improves management outcomes. In low- and middle-income countries (LMIC), however, the unavailability of ultrasonography in some health facilities delays the diagnosis, particularly if the prenatal period is asymptomatic. Following vaginal delivery, it often manifests as failure to remove a retained placenta manually. In the absence of haemorrhage, expectant management involving leaving the placenta in situ, is an option. In the presence of haemorrhage and/or sepsis, hysterectomy is usually recommended. We present a case of an expectantly managed PAS following a spontaneous preterm vaginal birth. The patient developed puerperal uterine prolapse with the placenta in situ, a previously unreported complication, but this was successfully reduced manually.
MeSH term(s)	Adult ; Female ; Humans ; Obstetric Labor, Premature ; Placenta Accreta/therapy ; Placenta, Retained/therapy ; Pregnancy ; Treatment Outcome ; Uterine Prolapse/etiology ; Uterine Prolapse/therapy ; Watchful Waiting
Language	English
Publishing date	2020-01-08
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	193169-6
ISSN	1758-1133 ; 0049-4755
ISSN (online)	1758-1133
ISSN	0049-4755
DOI	10.1177/0049475519898557
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Zs.A 1056: Show issues

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bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Blood pressure control in hypertensive patients attending a rural community health centre in Gauteng Province, South Africa

Sergius C. Onwukwe / Nnabuike C. Ngene

South African Family Practice, Vol 64, Iss 1, Pp e1-e

A cross-sectional study

2022 Volume 9

Abstract	Background: Hypertension is a major cause of morbidity and mortality and its control has important clinical and socio-economic benefits to the family and community. Unfortunately, the extent of blood pressure (BP) control and its potential predictors in hypertensive patients in many rural communities in low-resource settings are largely unknown. This study assessed the extent of uncontrolled BP and its predictors amongst hypertensive patients accessing primary health care in a rural community in South Africa. Methods: This cross-sectional study included 422 randomly selected hypertensive patients. Demographic and clinical data were collected using structured face-to-face questionnaire supplemented by respondents’ clinical records. Results: Obesity plus overweight (n = 286, 67.8%) and diabetes (n = 228, 54.0%) were the most common comorbidities. Treatment adherence was achieved in only 36.3% and BP was controlled to target in 50.2% of the respondents. Significant predictors of uncontrolled BP were poor treatment adherence (odds ratio [OR] = 15.88, 95% confidence interval [CI] = 8.96, 28.14, p 0.001), obesity compared with normal weight and overweight (OR = 3.75, 95% CI = 2.17, 6.46, p 0.001) and being a diabetic (OR = 2.83, 95% CI = 1.74, 4.61, p 0.001). Conclusion: Poor adherence to treatment was the major predictor of uncontrolled BP. The increase in uncontrolled BP in the presence of diabetes and/or obesity as risk predictors, indicates the need for appropriate behaviour change/interventions and management of these conditions in line with the health belief model (HBM). We also propose the use of Community-Based Physical and Electronic Reminding and Tracking System (CB-PERTS) to address poor treatment adherence.
Keywords	blood pressure control ; adherence to treatment ; diabetes ; hypertension ; obesity ; Medicine ; R
Subject code	616
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	AOSIS
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Maternal deaths due to eclampsia in teenagers: Lessons from assessment of maternal deaths in South Africa.

Moodley, Jagidesa / Ngene, Nnabuike C

African journal of primary health care & family medicine

2020 Volume 12, Issue 1, Page(s) e1–e6

Abstract: Background: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome.: Setting: Data ... ...

Abstract	Background: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. Setting: Data extracted from the South African Saving Mothers Report: 2014-2016. Aim: To establish the clinical details in teenage maternal deaths owing to eclampsia. Method: Retrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014-2016. Results: There were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals. Conclusion: Teenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia.
MeSH term(s)	Adolescent ; Adult ; Blood Pressure ; Eclampsia/mortality ; Eclampsia/physiopathology ; Female ; Gestational Age ; Heart Disease Risk Factors ; Humans ; Hypertension, Pregnancy-Induced/mortality ; Hypertension, Pregnancy-Induced/physiopathology ; Maternal Death/etiology ; Maternal Mortality/trends ; Pregnancy ; Pregnancy in Adolescence/statistics & numerical data ; Retrospective Studies ; South Africa/epidemiology ; Young Adult
Language	English
Publishing date	2020-07-09
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2526836-3
ISSN	2071-2936 ; 2071-2928
ISSN (online)	2071-2936
ISSN	2071-2928
DOI	10.4102/phcfm.v12i1.2305
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Article ; Online: Maternal deaths due to eclampsia in teenagers

Jagidesa Moodley / Nnabuike C. Ngene

African Journal of Primary Health Care & Family Medicine, Vol 12, Iss 1, Pp e1-e

Lessons from assessment of maternal deaths in South Africa

2020 Volume 6

Abstract	Background: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. Setting: Data extracted from the South African Saving Mothers Report: 2014–2016. Aim: To establish the clinical details in teenage maternal deaths owing to eclampsia. Method: Retrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014–2016. Results: There were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals. Conclusion: Teenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia.
Keywords	teenage pregnancies ; eclampsia ; clinical lessons ; obstetrics ; gynaecology ; Medicine ; R ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2020-07-01T00:00:00Z
Publisher	AOSIS
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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