http://dspace.lamu.edu.zm:8080/handle/123456789/2880 2026-10-13T05:27:22Z http://dspace.lamu.edu.zm:8080/handle/123456789/2884 Title: Misoprostol for prevention and treatment of postpartum haemorrhage: A systematic review Authors: Olefile, M. Kabelo; Khondowe, Oswell; M'Rithaa, Doreen Abstract: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality especially in the developing world. Misoprostol, a highly effective drug is highly effective in inducing uterine contractions and has been proposed as a low-cost, easy-to-use intervention for PPH. Objective: This study assessed evidence of the effectiveness of misoprostol for the prevention and treatment of PPH. Method: Databases searched included MEDLINE, PUBMED, CINHAL, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. Reference lists and conference proceedings were also searched for more studies. Three studies included in the meta-analysis were limited to randomised controlled trials (RCT). Two reviewers independently screened all articles for methodological quality using a standardised instrument adapted from the Cochrane Collaboration website. Data were entered in Review Manager 5.1 software for analysis. Results: Three trials (n = 2346) compared misoprostol to a placebo. Misoprostol was shown not to be effective in reducing PPH (risk ratios [RR] 0.65; 95% confidence interval [CI] 0.40–1.06). Only one trial reported on the need for a blood transfusion (RR 0.14; 95% CI 0.02–1.15). Shivering (RR 2.75; 95% CI 2.26–3.34) and pyrexia (RR 5.34; 95% CI 2.86–9.96) were significantly more common with misoprostol than with a placebo. Conclusion: The use of misoprostol was not associated with any significant reduction in the incidence of PPH. Therefore, in order to verify the efficacious use of misoprostol in the treatment of PPH, specialised investigations of its dose and routes of administration for clinically significant effects and acceptable side effects are warranted. Description: This article can also be accessed on http://dx.doi.org/10.4102/ 2013-01-01T00:00:00Z http://dspace.lamu.edu.zm:8080/handle/123456789/2883 Title: Antispasmodics for labour Authors: Anke, C. Rowler; Khondowe, Oswell; Young, Taryn Abstract: Prolonged labour can lead to increased maternal and neonatal mortality and morbidity due to increased risks of maternal exhaustion, postpartum haemorrhage and sepsis, fetal distress and asphyxia and requires early detection and appropriate clinical response. The risks for complications of prolonged labour are much greater in poor resource settings. Active management of labour versus physiological, expectant management, has shown to decrease the occurrence of prolonged labour. Administering antispasmodics during labour could also lead to faster and more effective dilatation of the cervix. Interventions to shorten labour, such as antispasmodics, can be used as a preventative or a treatment strategy in order to decrease the incidence of prolonged labour. As the evidence to support this is still largely anecdotal around the world, there is a need to systematically review the available evidence to obtain a valid answer. Objectives To assess the effects of antispasmodics on labour in term pregnancies. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (2 September 2011), the ProQuest dissertation and thesis database, the dissertation database of the University of Stellenbosch (2 September 2011), Google Scholar (2 September 2011) and reference lists of articles.We also contacted pharmaceutical companies and experts in the field.We did not apply language restrictions. Selection criteria Randomised controlled trials comparing antispasmodics with placebo or no medication in women with term pregnancies. Data collection and analysis Two review authors independently screened abstracts and selected studies for inclusion, assessed risk of bias and extracted data. Data were checked for accuracy. We contacted trial authors when data were missing. Main results Nineteen trials (n = 2798) were included in the review. Fifteen trials (n = 2129) were included in the meta-analysis. Antispasmodics used included valethamate bromide, hyoscine butyl-bromide, drotaverine hydrochloride, rociverine and camylofin dihydrochloride. Most studies included antispasmodics as part of their package of active management of labour. Overall, the quality of studies was poor, as only four trials were assessed as low risk of bias. Eleven trials (n = 1507) reported on the duration of first stage of labour, Description: this article can also be accessed on DOI: 10.1002/14651858.CD009243.pub2. 2012-01-01T00:00:00Z http://dspace.lamu.edu.zm:8080/handle/123456789/2882 Title: Oral chlorhexidine in the prevention of ventilatorassociated pneumonia in critically ill adults in the ICU: A systematic review Authors: Snyders, Olivia; Khondowe, Oswell; Bell, Janet Abstract: Purpose. The aim of this review was to evaluate the evidence on the effectiveness of oral chlorhexidine in the prevention of ventilator-associated pneumonia (VAP) in critically ill adult mechanically ventilated patients in intensive care units (ICUs). Methodology. An extensive literature search of studies published in English was undertaken between June 2010 and June 2011. Electronic databases searched were the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index of Nursing and Allied Health (CINAHL) and MEDLINE. Reference lists of articles, textbooks and conference summaries were examined and hand searching was performed. Literature searches were done using the following Medical Subject Headings (MeSH) terms: ventilatorassociated pneumonia, VAP, chlorhexidine, hospital-acquired pneumonia, nosocomial infections, mechanically ventilated patients, intensive care, mouthwash, mouth care, oral care, oral hygiene and dental care. Selection criteria. Two reviewers selected the studies independently. Eight randomised controlled trials investigating the efficacy of oral chlorhexidine versus power tooth brushing, Listerine, placebos, bicarbonate isotonic serum rinse and normal saline in the prevention of VAP in adult mechanically ventilated, critically ill patients in ICUs met the inclusion criteria. Data collection and analysis. All relevant data were entered into Review Manager (version 5.1) for analyses. The effect measure of choice was the risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data using the random effects (Mantel- Haenszel) model (p-value 0.05). Heterogeneity was assessed using the Cochrane Q statistic and I². Results. Eight randomised controlled trials met the inclusion criteria for this review. There was a 36% higher chance of VAP in the control group compared with the chlorexidine group (RR 0.64, 95% CI 0.44 - 0.91). The variation between the included studies was very small (χ²=0.24). Conclusion. Treatment with chlorhexidine decreased the risk of VAP by 36%. The use of 2% chlorhexidine may be most effective in reducing the incidence of VAP. There was no evidence of an effect of chlorhexidine on mortality. Description: This review can also be accessed on https://hdl.handle.net/10520/EJC64645 2011-11-01T00:00:00Z http://dspace.lamu.edu.zm:8080/handle/123456789/2881 Title: Informed consent in clinical trials. Authors: Kovane, G.P.; Nikodem, V.C.; Khondowe, Oswell Abstract: Background. Informed consent (IC) is not only a regulatory but also an ethical requirement to participate in any clinical trial. It is essential to determine that research participants understand what they consent to. Studies that evaluate participants’ understanding of IC conclude that recall and understanding of IC is often low, and researchers recommend that interactive multimedia interventions should be implemented to optimise understanding. Objectives. To assess participants’ understanding of IC of the research trial that they agreed to participate in. Methods. A descriptive survey design, within a quantitative research approach, was used to conduct the study at two government hospitals in the Eastern Cape Province. A semi-structured, self-administered questionnaire was used to collect information from 170 participants in research studies. Descriptive statistics were used to analyse the results. Results. Participants were recruited from among women who enrolled in any of the three studies that were ongoing at the two sites during the recruitment period. The study participants had a mean age of 25.9 years. Nearly one-third (30%) could not recall the purpose of the original trial that they consented to. The concept of randomisation was not understood by any of the participants. Conclusion. Regardless of extensive efforts to ensure that participants understood their participation, this study unveiled poor recall of essential information on IC. It is proposed that IC should be short and only address essential components such as purpose, procedure, possible risks or benefits, alternative options if not participating and explaining the concept of voluntary participation Description: This article can also be accessed on https://doi.org/10.7196/SAJBL.2022.v15i2.802 2022-11-01T00:00:00Z