Includes abstract. Includes bibliographical references.

Includes abstract. / Includes bibliographical references. / Despite two decades of studies of mother to child transmission of HIV, very little data is available regarding vertical transmission in twin pregnancies. There is uncertainty whether discordance of HIV transmission exists between the first born (Twin A) and second born (Twin B) infant. Primary aim of the study was to examine if there is any discordance of HIV transmission in twin pregnancies when comparing Twin A to Twin B. Secondary objectives were to identify possible additional risk factors for HIV transmission in twin pregnancies. We assessed antenatal care, antiretroviral therapy, birth order, delivery route and feeding options as risk factors for mother to child transmission of HIV in twin pregnancies.

Bibliography: leaves 36-41. / This study was designed to identify specific patient and tumour related factors which could be used as prognostic parameters in women with stage IIIB cervial cancer, and to investigate the relationship between these factors and treatment outcome. Primary endpoints were overall survival, disease-free and pelvic recurrence-free survival rates.

The interval between one pregnancy and the next may affect the outcome of pregnancy. Both short and long interpregnancy intervals (IPI) have been associated with adverse pregnancy outcomes and most of these occur with a short IPI. Our primary objective was to determine the effects of a short IPI (< 24 months) compared with a long IPI (≥ 24 months) on the subsequent potentially viable pregnancy in women who received antenatal care (ANC) in the secondary level hospitals in the Metro-West area of Cape Town. The secondary objective was to review possible determinants of a short IPI. Methods: This was a pilot descriptive cross-sectional study conducted between 1st September 2016 and 28th November 2016. One hundred and thirty women who were Para 2 were recruited to the study in the early postnatal period. Sixty women were recruited into the short IPI group (<24 months) and 70 to the long IPI group (≥24months). Questionnaire-based interviews were conducted and data were entered using Microsoft Excel 2012 spread sheets. Statistical analysis was done using Stata® Edition 13. Results: We analysed the data for both short and long IPI and found that there were no significant differences in preterm birth, abruptio placentae, preterm prelabour rupture of membranes (PPROM) and low birth weight. There was however a significant difference in the number of small-for-gestational- age (SGA) babies. In the short IPI group, 19 women (31.7%) had SGA babies in comparison to the long IPI group where 7 women (10%) had SGA babies( p = 0.015). Of the 130 respondents, 79 women (60.8%) had unintended pregnancies, 44 (73%) with a short IPI vs 35 (50%) with a long IPI (p = 0.017). Women with a long IPI were more likely to have a different partner for the subsequent pregnancy (p= 0.002). Women in relationships longer than 5 years were more likely to have a long IPI (p = 0.049). Thirty-eight women (63.3%) with a short IPI would have preferred the pregnancy later compared to 11 women (15.7%) with a long IPI (p<0.001). There were 27 (38%) women who supported themselves financially in the long IPI group compared with 8 (13%) with a short IPI (p=0.001). A long IPI was associated with more formal employment and professional careers compared to a short IPI (p= 0.002). In the long IPI group 10 women (7%) had professional positions compared with none in the short IPI group (p=0.002). There were no significant differences in breastfeeding duration, contraception use and knowledge, social habits, previous obstetric history, educational status or emotional support between the two groups. Conclusion: In our study, of all the pregnancy outcomes investigated, small-for-gestational age was the only clinical outcome significantly associated with a short IPI. There were differences in pregnancy intendedness, duration of relationships, financial support and employment between the two groups. The majority of women with a short IPI (63.3%) would have preferred the index pregnancy to have occurred later.

Includes abstract. Includes bibliographical references.

Includes bibliographical references. / In South Africa assisted reproductive techniques (ART) are poorly covered by health insurances or government funding thereby often inflicting out-of-pocket payment (OPP) on patients. This can create treatment barriers or high financial burdens for households, with unknown consequences of the latter. This is the first study from South and sub-saharan Africa which explores the impact of ART-related OPP on households. The study was undertaken at Groote Schuur Hospital, Cape Town, where ART is subsidized but patients have to contribute to the cost of treatment. Eighty six consecutive IVF/ICS/ cycles were prospectively analysed through patient interviews. Data included socio-demographic, economic, and infertility information, emotional and financial stress among participants, as well as coping and financial strategies adopted by households. In keeping with international recommendations, catastrophic expenditure was defined as a direct cost of all ART cycles in the last 12 months equal to or exceeding 40% of the annual non-food households expenditure.

No description available.

Includes abstract. Includes bibliographical references (leaves 56-64).

Includes synopsis. Includes bibliographical references.

STUDY QUESTION: What is the evidence pertaining to availability, effectiveness and safety of assisted reproductive technology (ART) in sub-Saharan Africa? SUMMARY ANSWER: According to overall limited and heterogeneous evidence, availability and utilization of ART are very low, clinical pregnancy rates largely compare to other regions but are accompanied by high multiple pregnancy rates, and in the near absence of data on deliveries and live births the true degree of effectiveness and safety remains to be established. WHAT IS KNOWN ALREADY: In most world regions, availability, utilization and outcomes of ART are monitored and reported by national and regional ART registries. In sub-Saharan Africa there is only one national and no regional registry to date, raising the question what other evidence exists documenting the status of ART in this region. STUDY DESIGN, SIZE, DURATION: A systematic review was conducted searching PUBMED, SCOPUS, AFRICAWIDE, WEB OF SCIENCE and CINAHL databases from January 2000 to June 2017. A total of 29 studies were included in the review. The extracted data were not suitable for meta-analysis. PARTICIPANTS/MATERIALS, SETTING, METHOD: The review was conducted according to PRISMA guidelines. All peer-reviewed manuscripts irrespective of language or study design that presented original data pertaining to availability, effectiveness and safety of ART in sub-Saharan Africa were eligible for inclusion. Selection criteria were specified prior to the search. Two authors independently reviewed studies for possible inclusion and critically appraised selected manuscripts. Data were analyzed descriptively, being unsuitable for statistical analysis. MAIN RESULTS AND THE ROLE OF CHANCE: The search yielded 810 references of which 29 were included based on the predefined selection and eligibility criteria. Extracted data came from 23 single centre observational studies, 2 global ART reports, 2 reviews, 1 national data registry and 1 community-based study. ART services were available in 10 countries and delivered by 80 centres in 6 of these. Data pertaining to number of procedures existed from 3 countries totalling 4619 fresh non-donor aspirations in 2010. The most prominent barrier to access was cost. Clinical pregnancy rates ranged between 21.2% to 43.9% per embryo transfer but information on deliveries and live births were lacking, seriously limiting evaluation of ART effectiveness. When documented, the rate of multiple pregnancy was high with information on outcomes similarly lacking. LIMITATIONS, REASONS FOR CAUTION: The findings in this review are based on limited data from a limited number of countries, and are derived from heterogeneous studies, both in terms of study design and quality, many of which include small sample sizes. Although representing best available evidence, this requires careful interpretation regarding the degree of representativeness of the current status of ART in sub-Saharan Africa. WIDER IMPLICATIONS OF THE FINDINGS: The true extent and outcome of ART in sub-Saharan Africa could not be reliably documented as the relevant information was not available. Current efforts are underway to establish a regional ART data registry in order to report and monitor availability, effectiveness and safety of ART thus contributing to evidence-based practice and possible development strategies. STUDY FUNDING/COMPETING INTEREST(S): No funding was received for this study. The authors had no competing interests. TRIAL REGISTRATION NUMBER: PROSPERO CRD42016032336