Over the past decades increasing efforts have aimed to improve the health of pregnant women around the world. Namibia has made limited progress in reducing severe maternal outcomes. Aims of this... Show moreOver the past decades increasing efforts have aimed to improve the health of pregnant women around the world. Namibia has made limited progress in reducing severe maternal outcomes. Aims of this thesis were to enhance implementation of a national obstetric surveillance system and assess requirements to improve maternal health in Namibia. The findings of chapters 2-7 provided insight into several important drivers of severe maternal outcome. The most important contributor of the high-incidence of severe maternal outcome in Namibia was poor quality of facility-based care and particularly vulnerable women appeared to be at higher risk of severe maternal outcome. Obstetric surveillance played a crucial role in obtaining these insights. Based on these, targeted recommendations could be formulated. The maternity care system needs to be strengthened, to enable health workers to provide universal coverage of good health care to all women in Namibia. It is therefore crucial the next step will follow, which is to act on the proposed recommendations. The insights obtained through obstetric surveillance will contribute to such action, as for any intervention, it is key it addresses a local need in a context-specific manner. Show less
Heemelaar, S.; Hangula, A.L.; Chipeio, M.L.; Josef, M.; Stekelenburg, J.; Akker, T.H. van den; ... ; Mackenzie, S.B.P. 2021
Background & Aims Namibia has been suffering from an outbreak of hepatitis E genotype 2 since 2017. As nearly half of hepatitis E-related deaths were among pregnant and postpartum women, we... Show moreBackground & Aims Namibia has been suffering from an outbreak of hepatitis E genotype 2 since 2017. As nearly half of hepatitis E-related deaths were among pregnant and postpartum women, we analysed maternal and fetal outcomes of pregnancies complicated by acute hepatitis E and assessed whether HIV-status impacted on outcome. Methods A retrospective cross-sectional study was performed at Windhoek Hospital Complex. Pregnant and postpartum women, admitted between 13 October 2017 and 31 May 2019 with reactive IgM for Hepatitis E, were included. Outcomes were acute liver failure (ALF), maternal death, miscarriage, intra-uterine fetal death and neonatal death. Odds ratios (OR) and 95% confidence interval (CI) were calculated. Results Seventy women were included. ALF occurred in 28 (40.0%) of whom 13 died amounting to a case fatality rate of 18.6%. Sixteen women (22.9%) were HIV infected, compared to 16.8% among the general pregnant population (OR 1.47, 95% CI 0.84-2.57, P = .17). ALF occurred in 4/5 (80%) HIV infected women not adherent to antiretroviral therapy compared to 1/8 (12.5%) women adherent to antiretroviral therapy (OR 28.0, 95% CI 1.4-580.6). There were 10 miscarriages (14.3%), five intra-uterine fetal deaths (7.1%) and four neonatal deaths (5.7%). Conclusions One in five pregnant women with Hepatitis E genotype 2 died, which is comparable to genotype 1 outbreaks. Despite small numbers, HIV infected women receiving antiretroviral therapy appear to be less likely to develop ALF in contrast with HIV infected women not on treatment. As there is currently no curative treatment, this phenomenon needs to be assessed in larger cohorts. Show less
