Justus Hofmeyr - Academia.edu (original) (raw)

Papers by Justus Hofmeyr

Cochrane Database of Systematic Reviews, Apr 22, 1996

Management of breech presentation is controversial, both in regard to manipulation of the positio... more Management of breech presentation is controversial, both in regard to manipulation of the position of the fetus and the method of delivery. External cephalic version may reduce the number of breech presentations and caesarean sections, but there also have been reports of increased perinatal mortality with the procedure. The objective of this review was to assess the effects of external cephalic version at term on measures of pregnancy outcome. The Cochrane Pregnancy and Childbirth trials register was searched. Date of last search: October 1997. Randomised trials of external cephalic version at term (with or without tocolysis) compared with no attempt at external cephalic version in women with breech presentation. Eligibility and trial quality were assessed by GJH and checked by RK. Six studies were included. External cephalic version at term was associated with a significant reduction in non-cephalic births (relative risk 0.42, 95% confidence interval 0.35 to 0.50) and caesarean section (relative risk 0.52, 95% confidence interval 0.39 to 0.71). There was no significant effect on perinatal mortality (relative risk 0.44, 95% confidence interval 0.07 to 2.92). Attempting cephalic version at term appears to reduce the chance of non-cephalic births and caesarean section. There is not enough evidence to assess any risks of external cephalic version at term.

The Cochrane library, Oct 15, 2015

Analysis 1.6. Comparison 1 Routine fetal movement counting versus mixed or undefined fetal moveme... more Analysis 1.6. Comparison 1 Routine fetal movement counting versus mixed or undefined fetal movement counting, Outcome 6 Other fetal testing (cardiotocogram) on presentation with DFM rate per cluster (mean).. .. . Analysis 1.7. Comparison 1 Routine fetal movement counting versus mixed or undefined fetal movement counting, Outcome 7 Other fetal testing (cardiotocogram) on presentation with DFM.. .. .. .. .. .. . Analysis 1.8. Comparison 1 Routine fetal movement counting versus mixed or undefined fetal movement counting, Outcome 8 Other fetal testing (ultrasound) on presentation with DFM.

South African Medical Journal, 2011

The authors report 3 cases of advanced abdominal pregnancy in HIV-positive women managed at the E... more The authors report 3 cases of advanced abdominal pregnancy in HIV-positive women managed at the East London Hospital complex between 2005 and 2009. Despite the complexity of diagnosis and management of this life-threatening condition no adverse effects occurred in the women in our series and 2 of the babies survived.

Annals of the New York Academy of Sciences, 2020

Low calcium intake is common worldwide and can result in nutritional rickets in children and oste... more Low calcium intake is common worldwide and can result in nutritional rickets in children and osteomalacia in adults. Calcium‐fortified foods could improve calcium intake. However, there is limited calcium fortification experience, with technical and practical issues that may hamper its adoption. The objective of this landscape review is to summarize these issues to help policymakers guide the planning and design of calcium fortification as a public health strategy. One challenge is the low bioavailability of calcium salts (∼20–40%); thus, large amounts need to be added to food to have a meaningful impact. Solubility is important when fortifying liquids and acidic foods. Calcium salts could change the flavor, color, and appearance of the food and may account for 70–90% of the total fortification cost. Safety is key to avoid exceeding the recommended intake; so the amount of added calcium should be based on the target calcium intake and the gap between inadequate and adequate levels. ...

SSRN Electronic Journal, 2020

Background: There is limited evidence on the impact of the use of progestin-only hormonal contrac... more Background: There is limited evidence on the impact of the use of progestin-only hormonal contraception (POC) on weight change. We conducted a secondary analysis of prospective weight change among women enrolled in the Evidence for Contraceptive options and HIV Outcomes (ECHO) trial. Methods: The ECHO trial was conducted at 12 sites in eSwatini, Kenya, South Africa and Zambia. HIV negative, women aged 16-35 years, desiring contraception, were randomized (1:1:1) to either 3-monthly intramuscular depot medroxyprogesterone acetate (DMPA-IM), levonorgestrel (LNG) implant or copper intrauterine device (IUD). Follow-up was up to 18 months. Weight (kgs) was measured at baseline and study exit. Analysis was performed as intention to treat (ITT) and time on continuous contraceptive use. Findings: 7829 women were randomly assigned to DMPA-IM (n=2609), copper IUD (n=2607) or LNG implant (n=2613). The ITT population included 7014 women 2293 DMPA-IM group, 2372 copper IUD group and 2349 LNG group) who were not lost to follow-up, pregnant on study, or missing weight data. The mean weight increased in all groups but was significantly different in magnitude: 3.5kg (SD=6.3), 2.4kg (SD=5.9) and 1.5kg (SD=5.7) in the DMPA-IM, LNG implant and copper IUD groups, respectively. Comparative differences between groups were (2.02 kg 95% CI, 1.68,2.36, p<0.001 ) for DMPA-IM versus copper IUD, 0.87kg (0.53,1.20 p<0.001) for LNG implant compared to copper IUD and 1.16kg (0.82, 1.50, p<0.001) for DMPA-IM compared with LNG implant. Results for continuous contraceptive use were similar. Interpretation: We found differences in weight gain between POC users compared to the non-hormonal copper IUD group over 12-18 months of use. Women using POCs should be counselled about this potential side effect when choosing a contraceptive method. Trial Registration: This study is registered with ClinicalTrials.gov, number NCT02550067. Funding Statement: Bill & Melinda Gates Foundation, US Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief, Swedish International Development Cooperation Agency, South African Medical Research Council, and UNFPA. Declaration of Interests: None to declare Ethics Approval Statement: Ethics review committees at each study site, FHI 360, and the World Health Organization (WHO) approved the study protocol. Women provided written informed consent in a language of their choice prior to the conduct of any study related procedures.

Clinical Infectious Diseases, 2019

BackgroundPerinatal treatment with lopinavir boosted by ritonavir (LPV/r) is associated with ster... more BackgroundPerinatal treatment with lopinavir boosted by ritonavir (LPV/r) is associated with steroidogenic abnormalities. Long-term effects in infants have not been studied.MethodsAdrenal-hormone profiles were compared at weeks 6 and 26 between human immunodeficiency virus (HIV)-1–exposed but uninfected infants randomly assigned at 7 days of life to prophylaxis with LPV/r or lamivudine (3TC) to prevent transmission during breastfeeding. LPV/r in vitro effect on steroidogenesis was assessed in H295R cells.ResultsAt week 6, 159 frozen plasma samples from Burkina Faso and South Africa were assessed (LPV/r group: n = 92; 3TC group: n = 67) and at week 26, 95 samples from Burkina Faso (LPV/r group: n = 47; 3TC group: n = 48). At week 6, LPV/r-treated infants had a higher median dehydroepiandrosterone (DHEA) level than infants from the 3TC arm: 3.91 versus 1.48 ng/mL (P < .001). Higher DHEA levels (>5 ng/mL) at week 6 were associated with higher 17-OH-pregnenolone (7.78 vs 3.71 ng/m...

Journal of Family Planning and Reproductive Health Care, 2017

Curationis, 1996

Doctors, as part of the healthcare team, can have a significant impact on the successful initiati... more Doctors, as part of the healthcare team, can have a significant impact on the successful initiation and maintenance of breastfeeding. There is a need for ongoing education and intervention programmes to update current knowledge on breastfeeding management.

PLOS ONE, 2017

Objectives Drawing from a baseline sample of a cohort study, the study examines the extent and co... more Objectives Drawing from a baseline sample of a cohort study, the study examines the extent and correlates of serostatus non-disclosure to sex partners and family members, and reasons for non-disclosure among HIV-infected pregnant women in the Eastern Cape Province, South Africa. Methods This longitudinal cohort study recruited 1709 pregnant women living with HIV who attended three of the largest maternity centres in the Eastern Cape, South Africa, for delivery between September 2015 and May 2016. Relevant items on demographics, serostatus awareness, disclosure to sex partners and family members, and lifestyle behaviours were obtained using structured interviews. Age-stratified binary logistic regression models were used to determine the significant correlates of non-disclosure among the participants.

Cochrane Database of Systematic Reviews, 2009

PEARLS are succinct summaries of Cochrane Systematic Reviews for primary care practitioners. They... more PEARLS are succinct summaries of Cochrane Systematic Reviews for primary care practitioners. They Local anaesthetic reduces need for analgesia after caesarean section Clinical question How effective are local anaesthetic agent wound infiltration/irrigation and/or abdominal nerve block on post-caesarean section pain and the mother's wellbeing and interaction with her baby?

BMC Pregnancy and Childbirth, 2009

Background: Stillbirths need to count. They constitute the majority of the world's perinatal deat... more Background: Stillbirths need to count. They constitute the majority of the world's perinatal deaths and yet, they are largely invisible. Simply counting stillbirths is only the first step in analysis and prevention. From a public health perspective, there is a need for information on timing and circumstances of death, associated conditions and underlying causes, and availability and quality of care. This information will guide efforts to prevent stillbirths and improve quality of care. Discussion: In this report, we assess how different definitions and limits in registration affect data capture, and we discuss the specific challenges of stillbirth registration, with emphasis on implementation. We identify what data need to be captured, we suggest a dataset to cover core needs in registration and analysis of the different categories of stillbirths with causes and quality indicators, and we illustrate the experience in stillbirth registration from different cultural settings. Finally, we point out gaps that need attention in the International Classification of Diseases and review the qualities of alternative systems that have been tested in low-and middle-income settings.

Best Practice & Research Clinical Obstetrics & Gynaecology, 2011

Frontiers in Global Women's Health

BackgroundPostpartum haemorrhage (PPH) is the leading cause of maternal death globally. Most PPH ... more BackgroundPostpartum haemorrhage (PPH) is the leading cause of maternal death globally. Most PPH deaths can be avoided with timely detection and management; however, critical challenges persist. A multi-country cluster-randomised trial (E-MOTIVE) will introduce a clinical care bundle for early detection and first-response PPH management in hospital settings. This formative qualitative study aimed to explore healthcare providers' knowledge and practices of PPH detection and management after vaginal birth, to inform design and implementation of E-MOTIVE.MethodsBetween July 2020–June 2021, semi-structured qualitative interviews were conducted with 45 maternity healthcare providers (midwives, nurses, doctors, managers) of nine hospitals in Kenya, Nigeria, and South Africa. A thematic analysis approach was used.ResultsFour key themes were identified, which varied across contexts: in-service training on emergency obstetric care; limited knowledge about PPH; current approaches to PPH d...

Reproductive Health

Background The World Health Organization (WHO) published the WHO Labour Care Guide (LCG) in 2020 ... more Background The World Health Organization (WHO) published the WHO Labour Care Guide (LCG) in 2020 to support the implementation of its 2018 recommendations on intrapartum care. The WHO LCG promotes evidence-based labour monitoring and stimulates shared decision-making between maternity care providers and labouring women. There is a need to identify critical questions that will contribute to defining the research agenda relating to implementation of the WHO LCG. Methods This mixed-methods prioritization exercise, adapted from the Child Health and Nutrition Research Initiative (CHNRI) and James Lind Alliance (JLA) methods, combined a metrics-based design with a qualitative, consensus-building consultation in three phases. The exercise followed the reporting guideline for priority setting of health research (REPRISE). First, 30 stakeholders were invited to submit online ideas or questions (generation of research ideas). Then, 220 stakeholders were invited to score "research avenues...

Implementation Science

Background Postpartum haemorrhage (PPH) is the leading cause of global maternal deaths, accountin... more Background Postpartum haemorrhage (PPH) is the leading cause of global maternal deaths, accounting for 30–50% of maternal deaths in sub-Saharan Africa. Most PPH-related deaths are preventable with timely detection and initiation of care, which may be facilitated by using a clinical care bundle. We explore influences on current PPH detection and management and on the future implementation of a new PPH bundle (E-MOTIVE) in low-resource, high-burden settings. Methods Semi-structured qualitative interviews based on the Theoretical Domains Framework were conducted with 45 healthcare providers across nine hospitals in Nigeria, Kenya and South Africa, to identify barriers and enablers to current PPH detection and management and future implementation of a new PPH care bundle. Data were analysed using thematic and framework analysis. The Behaviour Change Wheel was used to identify potential interventions to address identified barriers and enablers. Results Influences on current PPH detection...

The Cochrane library, Jan 10, 2017

Analysis 1.14. Comparison 1 Manual fundal pressure versus no fundal pressure, Outcome 14 Neonatal... more Analysis 1.14. Comparison 1 Manual fundal pressure versus no fundal pressure, Outcome 14 Neonatal trauma-fractures......... Analysis 1.15. Comparison 1 Manual fundal pressure versus no fundal pressure, Outcome 15 Neonatal trauma-haematoma...... Analysis 1.16. Comparison 1 Manual fundal pressure versus no fundal pressure, Outcome 16 Admission to neonatal intensive care unit.

Objective To assess the perception, knowledge, and practices regarding maternal perception of fet... more Objective To assess the perception, knowledge, and practices regarding maternal perception of fetal movements (FMs) among women and their healthcare providers in a low-resource setting. Design Qualitative study. Setting The maternity unit of Mnazi Mmoja Hospital, Zanzibar, Tanzania. Population Pregnant and postpartum women, and health providers. Methods Semi-structured interviews, questionnaires and focus group discussions were conducted with 45 Zanzibar women (18 antenatal, 28 postpartum) and 28 health providers. Main outcome measures Descriptive and thematic analyses were conducted to systematically extract subthemes within four main themes 1) knowledge/awareness, 2) behavior/practice, 3) barriers, and 4) improvements. Results Within the main themes it was found that 1) Women were instinctively aware of (ab)normal FM-patterns and healthcare providers had adequate knowledge about FMs. 2) Women often did not know how to monitor FMs or when to report concerns. There was inadequate as...

BJOG: An International Journal of Obstetrics & Gynaecology

Aim: To develop an evidence based clinical algorithm for management of common intrapartum urinary... more Aim: To develop an evidence based clinical algorithm for management of common intrapartum urinary abnormalities Population: Women with singleton, term pregnancies in active labour and immediate postnatal period, at low risk of complications. Setting: Health care facilities in low-and middle-income countries. Search strategy: A systematic search and review were conducted on the current guidelines from WHO, NICE, ACOG and RCOG. Additional search was done on PubMed and The Cochrane Database of Systematic Reviews up to May 2020. Case scenarios: Four common intrapartum urinary abnormalities were selected: proteinuria, ketonuria, glycosuria and oliguria. Using reagent strip testing, glycosuria was defined as ≥ 2+ on 1 occasion or of ≥ 1+ on 2 or more occasions, proteinuria as ≥ 2+ andpresence of ketone indicated ketonuria. Oliguria was defined as hourly urine output ≤ 30ml. Thorough initial assessment using history, physical examination and basic investigations helped differentiate most of the underlying causes, which include diabetes mellitus, dehydration, sepsis, preeclampsia, shock, anemia, obstructed labour, underlying cardiac or renal problems. A clinical algorithm was developed to facilitate intrapartum management and referral of complicated cases for specialized care. Conclusions: Four simple, user friendly and evidence based clinical algorithms were developed to enhance intrapartum care of commonly encountered maternal urine abnormalities. These algorithms may be used to support health care professionals in clinical decision-making when handling normal and potentially complicated labour, especially in low resource countries.

Annals of the New York Academy of Sciences, 2022

Most low-and middle-income countries present suboptimal intakes of calcium during pregnancy and h... more Most low-and middle-income countries present suboptimal intakes of calcium during pregnancy and high rates of mortality due to maternal hypertensive disorders. Calcium supplementation during pregnancy is known to reduce the risk of these disorders and associated complications, including preeclampsia, maternal morbidity, and preterm birth, and is, therefore, a recommended intervention for pregnant women in populations with low dietary calcium intake (e.g., where ≥25% of individuals in the population have intakes less than 800 mg calcium/day). However, this intervention is not widely implemented in part due to cost and logistical issues related to the large dose and burdensome dosing schedule (three to four 500-mg doses/day). WHO recommends 1.5-2 g/day but limited evidence suggests that less than 1 g/day may be sufficient and ongoing trials with low-dose calcium supplementation (500 mg/day) may point a path toward simplifying supplementation regimens. Calcium carbonate is likely to be the most cost-effective choice, and it is not necessary to counsel women to take calcium supplements separately from iron-containing supplements. In populations at highest risk for preeclampsia, a combination of calcium supplementation and food-based approaches, such as food fortification with calcium, may be required to improve calcium intakes before pregnancy and in early gestation.