Plasmid Profiling of Klebsiella Sp. and its Relation with Antibiotic Resistance at Two Hospitals of Urmia

Z.S.M. Sabahi Mohammadi, M.M. Masumeh Mosavi, M.D. Omrani, N. Hosseini Jazidi

Faculty of Medicine, Urima, Iran

Introduction: Klebsiella Sp. is a group of gram negative rods and can cause different kinds of infections. Multi-drug resistant Klebsiella has been recognized as a cause of hospital acquired infections, they are resistant to numerous antibiotics, including aminoglycosides, penicillins and cephalosporins. The source of resistance in this bacterium may be chromosomal or plasmid. The aim of the present study is to compare the antibacterial susceptibility patterns with the presence of plasmids in Klebsiella isolates.

Material and Methods: 39 isolates were collected from clinical specimens submitted to two educational hospitals in Urmia/ Iran during a three months period from December 2006 until March 2007. The susceptibility patterns were determined against antibiotics, Plasmids were extracted by alkaline lysis method, electrophoresed and investigated by a UV transilluminator. Single digestion of plasmids with EcoR1 and HincII were performed and the restriction patterns were compared using a DNA ladder.

Results: The rates of resistances were determined to antibiotics as follows: gentamicin 46.1%, tobramycin 48.7%, ceftizoxime 41%, co-trimoxazole 41%, amikacin 33.3%, cephtazidime 51.3%, ciprofloxacin 30.1%, kanamycin 53.8%, nalidixic acid 30.8% and ampicillin 100%, Nitrofurantoin 41%. 25.6% of isolates harbored plasmids. Restriction enzyme analysis of plasmids showed unique pattern for all of plasmid positive isolates. There is a meaningful correlation between the presence of plasmid in isolates and resistance to the tested antibiotics.

Conclusion: The absence of plasmids from the majority of isolates showed low typeability power of this technique, so using of other molecular typing techniques in companion with plasmid profiling and restriction enzyme analysis suggested for further studies.

Tuberculosis and HIV Coinfections – Epidemiology, Treatment and Causes of MDR-TB in Post-Soviet Country

M.M. Koscielecka

Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

Introduction: Difficulties in simultaneous treatment of HIV and TB and also inconsistent or partial therapy contribute to development of AIDS-associated multi drug resistant TB (MDR-TB). The most evident risk factor of new infections pertains to population from Post-Soviet countries. During last year in Ukraine 11.000 people died cause of TB and 680.000 still suffer epidemic. Moreover in this region almost 2% of adults live with HIV and over 60 % of HIV/AIDS deaths are attributable to tuberculosis. Situation is getting worst.

Material and Methods: Ukrainian HIV-positive and sputum smear-positive TB patients (mainly from Lvivsky Oblast) were under conventional antimicrobial treatment with rifampicin, izoniazid, pyrazinamide, ethambutol and streptomycyn. Patients were tested for HIV and MDR-TB.

Results: Due to production of pro-inflammatory cytokines by TB lessions – significant immunodepression of patients occurs. TB recurrences are more likely in patients with CD4 below 100 cell/mm3. Patients with HIV are 30 times more susceptible to developing all forms of tuberculosis.To achive the best results of treatment it is necessary to combine 5-6 drugs listed above and provide therapy during at least 15-18 months. Causes of infections: unstable condition of public health sector, insufficient finances and overpopulated prisons (for each 200.000 prisoners -12.500 have TB).

Conclusion: To avoid increasing of new MDR-TB and HIV cases in Ukraine and another Post-Soviet countries it is necessary to deliver regular and reliable treatment to TB patients, by continuation of DOTS project and urgent improvement of HIV and TB prevention.

Tuberculosis in Oncology Patients

D.C. Stefan1, A.L. Kruis2, H.S. Schaaf1, G. Wessels1

1Tygerberg Hospital, Cape Town, South Africa
2LUMC, Leiden, The Netherlands

Introduction: There is a dearth of studies addressing the incidence and clinical presentation of tuberculosis (TB) in children with cancer.

Aim: To evaluate the incidence of TB in paediatric oncology patients at Tygerberg Hospital, located in a Cape Town area of high TB prevalence, and to describe the clinical characteristics of the disease in this particular group of patients whose treatment typically suppresses their immune response.

Material and Methods: We reviewed the records of 625 paediatric oncology patients admitted from 1 January 1991 to 31 December 2005. Of these, 87 received treatment for TB; however, only 57 cases had sufficient data to support a diagnosis of TB and only these were used for further analysis.

Results: In the children with TB, acute lymphoblastic leukaemia (ALL) was the most common malignancy (13/57, 22.8%). The incidence of TB in the study group was 9117/100,000/year, which is 22 times higher than the overall TB incidence reported in children from a similar background. Importantly, 47% of the active infections appeared in the 1st 5 months of chemotherapy, suggesting reactivation of latent TB.

Conclusion: Identifying latent TB in our patients and providing prophylactic treatment during the initial months of chemotherapy might have prevented disease progression in these cases. Routine screening of paediatric oncology patients for latent TB infection and exclusion of active disease prior to initiation of cancer therapy might be indicated in TB-endemic areas.

Prevalence of Treponematosis. Study in the Pretoria Bone Collection

E. de Lijster

Leiden University, Leiden, The Netherlands

Introduction: Treponematosis is an infectious disease, which can lead to a final stage where bones can become affected. Many studies about the prevalence of bone involvement of treponemal disease are done in ancient populations, leading to the knowledge that many individuals suffered from the disease in the pre-antibiotic era. However, not much was known about the prevalence in post-antibiotic populations.

Material and Methods: With the use of 372 complete skeletons form the Pretoria Bone Collection, it was tried to obtain more information about the prevalence of treponematosis in post-antibiotic South Africa.

Results: None of the examined individuals showed specific signs of treponemal disease. Several cases with tibial periosteal bone deposition were present. For these cases the most probable diagnosis was treponematosis.

Conclusion: The fact that treponematosis still can lead to bone involvement, can have several causes. Examples of possible causes are lack in sufficient available health care, delay in ask for medical help, premature ending of the antibiotic course of infection with a resistant bacterial strain.

Strongyloides stercoralis Infections in Mozambique

D. H. Hepp

LUMC, Leiden, The Netherlands

Introduction: Recent study shows that the prevalence of intestinal parasitic infection – including Strongyloides stercoralis infection – in Inhamudima, a poor suburb of Mozambique’s second city Beira, is very high. However, in the local laboratory in Beira sufficient knowledge of the sensitive diagnostic methods necessary for detection of S. stercoralis is missing. One of the main goals of this research was to identify which diagnostic method(s) fit best in the local daily practice. The diagnostic methods compared in this study were direct smear, Ridley, Baermann and coproculture method. In recent studies real-time PCR is put forward as a – possibly very powerful – diagnostic tool in detecting S. stercoralis. Therefore this study also included a comparison between real-time PCR and the conventional diagnostic methods based on faecal examination. Detailed information on the prevalence of S. stercoralis infection – and the distribution of the infection in relation to age and gender – in Inhamudima is missing. Diarrhoea and abdominal complaints are suggested to be frequently reported symptoms in this area. Another main aim of this study was to examine the infection-index of S. stercoralis in Inhamudima and the distribution of the infection in relation to age and gender. One of the study’s main questions also included the question as to whether – and if so, in what way – a relation can be found between Strongyloides infection and diarrhoea, or abdominal complaints.

Material and Methods: Eventually, 399 persons living in Inhamudima were randomly selected. Of the total study population 303 persons delivered their faeces. This accounts for a compliance of 76 %. Of the conventional methods Baermann and culture detected most Strongyloides infections, respectively 70 and 83 – of all 146 positives. Preferable both methods are performed in the local laboratory, for their results are complementary – one is not significantly more sensitive than the other (McNemar = 0.060). Both are significantly more sensitive than direct smear and Ridley. Real-time PCR is significantly more sensitive than all other techniques together. The prevalence is 5.1 times higher based on PCR, in comparison to direct smear. The prevalence is 1.3 times higher based on PCR, in comparison to all other techniques together.

Results: The prevalence of Strongyloides infection, within the 303 persons who delivered their faeces, based on all diagnostic methods used – including real-time PCR in Leiden – was 48 %. No significant relation was found between infection and gender, or between infection and history or presence of diarrhoea. A slight peak of infection was seen in the age group of 10-19 years.

Conclusion: Despite the promising results of PCR, it seems to have missed 12 infections, which Baermann and/or culture did detect. PCR analysis of a second Baermann and culture of all ‘missed’ samples were performed and these were – in all 12 cases – found negative. A possible explanation is that the ‘missed’ infections were very light infections – this seems to be true, for 1 – 4 L1 larvae, or maximally 80 L3 larvae were found. Another possibility is microscopic misidentification in Beira. In any case, it can be concluded that real time PCR is indeed a very powerful diagnostic tool in detecting S. stercoralis infection.

Frequency of Heliobacter Pylori infections Among the Patients with Ulcer and Non-ulcer Dyspepsia

M. Ljevaja

Institute of Internal Medicine, Novi Sad, Serbia

Introduction: Helicobacter pylori is the most important cause of duodenal and gastric ulcer. According to the results of seroepidemiological studies, more than 50 percent of the world’s population is infected with this bacteria. Frequency of this infection in various areas varies depending on geographical, racial and socioeconomic conditions, and in the last 10 to 20 years, in some areas, a significant decrease in this frequency has been noted, in general population, as well as among the patients with peptic ulcer.

Aim of study is determine the frequency of Helicobacter pylori infection among the patients with peptic ulcer and non-ulcer dyspepsia, and to compare the results with the results of the study that was carried out 10 years ago in the same area.

Material and Methods: The research covered 163 patients (72 women and 92 men), aged 19-86 which were endoscope at The Clinic for Gastroenterology and hepatology in Novi Sad for dyspeptic disorder. All the patients underwent the routine antral biopsy and the corpus for pathological analysis, and the presence of Helicobacter pylori was determined by the coloring in the modified Giemsa method. The results were compared with those of the 1997 study, when this infection was found in 85.84 percent of patients with duodenum ulcer, 69.56 % of patients with stomac ulcer, and 72% of patients with non-ulcer dyspepsia.

Results: Out of 163 patients, 76 (46%) were detected positive with Helicobacter pylori. Based on endoscpic findings, three groups were formed: First group, with 75 patients with non-ulcuer dyspesion, second group of 40 patients with stomac ulcer, and third group of 48 patients with duodena ulcer. Positive findings for Helicobacter pylori wear made for 24% of patients with non-ulcer dyspepsia, 50% of patients with stomac ulcer, and 80% of patients with duodenum ulcer.

Conclusion: Helicobacter pylori is the most significant factor of emergence of peptic ulcer in this area.

Rotavirus NSP5 and NSP5-EGFP: Competition to Form Viroplasms

A. Ashfaq1, W. Cheung, A.M.L. Lever2, U. Desselberger2

1Aga Khan University, Karachi, Pakistan
2University of Cambridge, Cambridge, United Kingdom

Introduction: Rotaviruses (RVs) cause severe, acute gastroenteritis in infants worldwide, with a high mortality rate in developing countries. The RV genome encodes 6 structural viral proteins (VP1-VP4, VP6, VP7) and 6 non-structural proteins (NSP1-NSP6). NSP2 and NSP5 play a major role in the formation of viral factories, intracytoplasmic inclusion bodies termed ‘viroplasms’. We compared the capacity of native NSP5 and of NSP5-EGFP (a fusion construct) to form viroplasms.

Material and Methods: The MA104 cell line and an MA104 cell line constitutively expressing NSP5-EGFP were used. The cell lines were infected with the bovine RV RF strain (G6P6 [1]), and infectivity was determined and calculated as tissue culture infective dose 50 % (TCID50/ml). Aliquots of infected cells were fixed at 3, 6 and 9 h p.i., reacted with primary antibodies (guinea pig) specific for NSP2 and NSP5 and the reactions visualized with Texas Red-labeled species-specific secondary antibody using confocal fluorescence microscopy. RNA extraction and agarose gel electrophoresis were used to investigate RV RNA replication.

Results: Viroplasms were visualized as red (recognizing either NSP5 or NSP2 alone), green (NSP5-EGFP autofluorescence) and yellow (superimposition of red and green). In cell cultures counterstained with NSP2, the percentage of cells with green fluorescence was highest at 3h p.i. and decreased later, red fluorescence increased over time, and yellow fluorescence increased till 6h and then decreased. In cell cultures counterstained with NSP5, the percentage of cells containing NSP-EGFP containing viroplasms (yellow + green) was also highest at 3 h. Red fluorescence was maximum at 3h, decreased until 6h and then increased. Yellow fluorescence followed red fluorescence till 3h but then stayed almost constant. The mean numbers of viroplasms/cell increased until 6 h p.i. and then remained constant.

Conclusion: The results are consistent with pre-existing excess NSP5-EGFP accumulating first in viroplasms, followed by the accumulating new wild type NSP5 outcompeting the recombinant one. Viral RNA replication and infectivity yield of progeny virus were reduced in cells containing NSP5-EGFP, implying that it was less efficient at contributing to viral production than the native protein. NSP5 oligomerises and also interacts with NSP2 through its C terminus; the attachment of the EGFP at the C terminus may inhibit these functions. The work suggests that NSP5-EGFP is less efficient in promoting virus production and that homo-oligomerisation of native NSP5 and its interaction with NSP2 are important for its function.

Reasons for and Outcomes of Hospital Admissions for HIV-infected Children at the Korle Bu Teaching Hospital, Accra, Ghana

D.B.S. Shah1, A.K. Kwara1, L.R. Renner2

1Brown University, Providence, USA
2University of Ghana Medical School, Accra, Ghan

Introduction: The burden of pediatric HIV infection remains high in resource-poor settings. A high burden of opportunistic infections could lead to high mortality as healthcare delivery systems are already overwhelmed. The primary objective of this study was to determine the reasons for hospital admissions of HIV-infected pediatric patients to a tertiary teaching hospital and the outcome of these hospital admissions over a 1-year period.

Material and Methods: Retrospective chart review of all HIV-infected children aged 0 to 13 years of age admitted to the pediatric unit at Korle-Bu Teaching Hospital from 30 June 2007 to 30 June 2008. A chart abstraction form was used to gather data on age, gender, weight, presenting conditions, diagnosis, duration of hospital stay, ARV treatment, outcome, and other critical clinical information.

Results: A total of 102 admission occurred among 76 children. The mean age of the children was 4.5 (± 3.79) years and 55% were males. At the time of admission, 55 patients (64%) had a weight for age 7 days.

Conclusion: Failure to thrive and common endemic infections but not opportunistic conditions were the predominant reasons for hospitalization and death for pediatric HIV/AIDS patients in this tertiary hospital. Clinicians caring for HIV-infected children should be cognizant of these infections and institute appropriate early treatment or provide preventative measures. Hospitalized children with these conditions should be tested for HIV infection if their status is unknown. We did not find any significant predictors of in-hospital mortality in this small cohort.

Potential Role of CD133/CD117 Positive Stem Cells in Liver fibrosis Caused by Schistosoma mansoni Infection

S. Verhoeven1, C. Draelants1, E. van Marck1, S. Chatterjee1, P. Ponsaerts1, U. Gehling2

1University of Antwerp, Belgium
2Hospital Hamburg-Eppendorf, Germany

Introduction: Schistosoma mansoni infections in rodents generate liver pathology in the form of fibrosis – that is dependent on the genetic background of the mice strain. Chronic inflammation is associated with angiogenesis, whereby circulating endothelial progenitor cells play an important role. Such cells originating from the bone marrow can be distinguished into two major groups based on the stem cell markers CD133/prominin and CD117/c-kit. Partial hepatectomy leads to the mobilization of a unique population of progenitor cells with the potential to differentiate into hepatocytes in vitro and a probable role in liver regeneration. An important part of such stem cells are CD133 positive. Stem cell factor (SCF) and its receptor c-kit also play an important role in liver regeneration after almost 70% hepatectomy. There is however little known about the roles of CD133 and CD117 positive stem cells during S. mansoni induced liver fibrosis.

Material and Methods: Using immunohistochemical techniques the expression of these stem cell markers and CD34 (endothelial marker detecting newly formed blood vessels) were studied. Frozen sections from spleen, liver, kidney and brains of infected mice strains were screened at acute (8 weeks) and chronic (16 weeks) stages of pathology.

Results: Varying levels of expression were noted in kidneys and in the liver. The inbred mice strain C57BL6 depicted light pathology upon S. mansoni infection due to a balanced Th1/Th2 immune reaction to the parasite; in contrast the infected C3H mice developed serious pathology due to strong Th2 responses. In such an environment administration of CD133+/117+ cells in vivo could result in the creation of an immunologically balanced environment in the liver with diminished fibrosis and resulting liver regeneration. Further research is ongoing.

Conclusion: In normal situations, the host immune system is largely incapable of resisting primary infection with the Schistosoma parasite, and resistance to superinfection takes years to develop. So, the survival of the host seems to depend on the ability to make an appropriately balanced T-helper response that is able to orchestrate granuloma development, and minimize fibrosis and severe morbidity during chronic infection. In this context, the CD133+/CD117+ stem cells provide a novel therapeutic possibility.

Prevalence of Hepatitis Delta Virus Infection in Various Groups of HBV Infection in Imam-Khomeyni Hospital, Tehran (2006-2007)

M.a. Kahlifeh-soltani1, I. Salehian1, S. Abtahi1, S. Hedayat2

1Tehran University of Medical Sciences, Tehran
2Isfahan University of Medical Sciences, Iran

Introduction: Hepatitis B virus infection is an important cause of liver morbidity and mortality worldwide. HDV changes the natural course of HBV. The prevalence of HDV infection was not determined in the various groups of HBV infection [carriers, acute hepatitis, chronic hepatitis, cirrhosis, and hepatocellular carcinoma(HCC)] in Iran.

We aimed to research the prevalence of hepatitis D virus infection in various groups of HBV infection in Imam-Khomeyni hospital of Tehran (2006-2007).

Material and Methods: Serological markers of HBV and HDV infection [HBs Ag, HBe Ag, anti HBe Ab, anti HDV Ab(Ig M, Ig G)] were determined by ELISA test in 206 patient with HBV infection who referred to Imam-Khomeyni hospital. These patients categorized to asymptomatic carriers, acute hepatitis, chronic hepatitis, cirrhosis, and HCC according to history, physical examination, and lab findings.

Results: HDV infection was detected in 12.6%(26/206) of HBV infected patients. It was detected in 1.6%(1/62) of asymptomatic carriers, 20%(1/5) of acute hepatitis, 5.6%(5/88) of chronic hepatitis, 37.2%(16/43) of cirrhosis, and 37.5%(3/8) of HCC patients. HDV infection showed a five fold increment in chronic hepatitis.

Conclusion: The prevalence of HDV infection were 12.6%, the higher prevalence of HDV infection in more severe forms of hepatitis B virus infection suggests that HDV infection increases the severity of chronic hepatitis B. HDV infection remains a major cause of chronic liver disease in Tehran in spite of its decreasing prevalence in countries such as Italy.

Acknowledgments: 1. National Foundation of Elites of Iran, 2. Scientific Students Research Center of Tehran University of Medical Sciences.

Antitrichomonal Activity of Plant Extracts from Family Lamiaceae (Coleus blumei, Origanum vulgare, & Vitex negundo): In Vitro Study

A.E.S. Dy, P.A.A. Factor, R.A.N. Facistol, M. Esteban, M.N.R. Fajardo, A.M.M. Fausto, K. Evangelista, R.R.H. Felipe, J.A.M. Elauria, A.E. Dy, F. Heralde III, A.S. M. De Vera, K.A.R. Del Rosario, E.C. Delos Santos, N.N. P. Diansuy, V.G.C. Dimacali, J.C.F. Dumlao, L.B. Dungca, R.G. Duque, L.B.P. Dungca. M.E. Esteban

University of the Philippines, Manila, Philippines

Introduction: Trichomoniasis is an infection caused by the protozoan Trichomonas vaginalis, and is ranked as the most common nonviral sexually transmitted disease (STD) in the world. A recent Philippine study on the prevalence of trichomoniasis estimated an infection rate of 37% among Filipino women. Efforts to contain and alleviate this problem remain a continuing initiative of government health institutions. The Philippines’ numerous ecological niches provide for a vast backdrop from which effective and accessible plant herbal remedies can be obtained. One promising source of antitrichomonal extracts is the family Lamiaceae, whose members have already been shown to exhibit antibacterial, antiviral, and antiprotozoal activities. In the search for an alternative to conventional therapeutic regimen, the study was conducted to determine the activities of three crude ethanolic plant extracts from family Lamiaceae (i.e., Coleus blumei, Origanum vulgare, and Vitex negundo) against T. vaginalis. The study also aimed to characterize the biochemical components of the most potent plant extract, and determine its toxicity in mice.

Material and Methods: Crude ethanolic extracts of the plants were obtained and a minimum inhibitory concentration (MIC) assay was done using varying concentrations of C. blumei, O. vulgare and V. negundo. Phytochemical screening of C. blumei was performed by the College of Pharmacy, University of the Philippines – Manila. A mice toxicity assay of C. blumei was also done by intraperitoneal injection of the extract. Measures were taken to ensure that the least amount of pain was inflicted on the animals, and proper decapitation and disposal procedures were observed.

Results: The C. blumei crude extract exhibited the highest activity among the treatments, with a minimum inhibitory concentration (MIC) of 2 mg/mL, an activity not significantly different from metronidazole (p = 0.809), the drug of choice for trichomoniasis. Phytochemical analysis of the C. blumei extract indicated the presence of glycosides, plant acids, reducing agents, and alkaloids. Some of these substances have been reported to possess antitrichomonal or antiprotozoal activity, and would likely account for the observed activity of the C. blumei extract. The mice toxicity assay revealed minimal side effects even at several magnitudes of concentration (250-500X) higher than the MIC, suggesting a wide margin of safety for the crude extract.

Conclusion: These initial findings warrant further studies to isolate, purify, and elucidate the active antitrichomonal product present in the C. blumei extract, and to explore its potential as an alternative STD medication for human use.

Side Effects of HAART in HIV-1 infected Pregnant and Non-pregnant Women

I.J.M. Snijdewind1, C. Smit2, M.H. Godfried2, J.F.J.B. Nellen2, F. de Wolf3, K. Boer2, M.E. van der Ende1

1Erasmus MC, Rotterdam, the Netherlands
2Academic MC, Amsterdam, the Netherlands
3HIV, Amsterdam, the Netherlands

Introduction: We evaluated the risk of hepatotoxicity and rash in treatment naïve HIV-1 positive pregnant and non-pregnant women, who started HAART in the Netherlands between 1997 and 2008.

Material and Methods: Data were used from the ATHENA observational cohort. The study population consisted of HIV1-positive naïve pregnant and non-pregnant women between January 1997 and February 2008. Demographic, treatment and pregnancy related data were collected. Risk of side effects during pregnancy was determined using univariate and multivariate logistic regression. Multivariate models were built using forward-stepwise techniques. A p-value <0.05 was considered statistically significant. Analyses were adjusted for age, region of origin, baseline HIV-RNA and CD4 cell counts, HAART regimen and hepatits B and C co-infection.

Results: 485 Pregnant and 1156 non-pregnant women were included. Pregnant women were younger at the time of HIV diagnosis (28 versus 33 years), more often originated from Sub Sahara Africa (SSA) and were treated more often with a PI based regimen (70% versus 42%). Controls were more often treated with a NNRTI based regimen (51% versus 21%). The adjusted risk of hepatotoxicity was higher among pregnant women compared to controls (OR 4.31, CI 95% 1.29-14.40, p=0.02). The risk of skin rash was similar in pregnant and non-pregnant women. Sub-Saharan Africa origin was independently associated with a significant lower risk of rash compared to West-European origin (OR 0.31, CI 95% 0.15-0.63, p=<0Conclusion: Pregnancy is associated with a higher risk of hepatotoxicity. The risk of rash was associated with region of origin, and not with pregnancy.

Caesarean Sections Rate, Indications and Outcome among Women admitted at Muhimbili National Hospital From July 2007 to June 2008

N.J. Penza

Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Introduction: Based on historical data, a Caesarean Delivery (CD) rate of 5 to 15 percent appears to give the best maternal outcomes; the rate for the best infant outcomes is less clear but is likely far higher.
The CD rate worldwide is 15 percent of births, 21.1 percent rate in developed countries, but is only 2 percent is the least developed countries. The steadily increasing global rate of caesarean section has become one of the most debated topics in maternal care.

Objective: To determine caesarean section rate, indications and outcome among women who had child delivery at M.N.H. from July 2007 to June 2008.

Materials & Methods: A retrospective descriptive study. The study was conducted at M.N.H. from July 2007 to June 2008. The study population included all women who delivered during the study period, and the study sample included women admitted to M. N. H post – caesarean section. Data was obtained from the Patients’ medical records and analyzed by Epi Info version 3.5

Results: A total of 9,211 child births included; caesarean delivery rate was 42.2 percent of which 95.1 percent were singleton. The mean age was (28.46+9.26) years, 39.8 percent of the mothers were primiparae and 4.5 percent grand multiparae. All had registered for antenatal care in any health institution. The leading indications for caesarean delivery were: prolonged/obstructed labor (46.1%), previous caesarean section (26.5%) and fetal distress (11.9%) with a (p value Conclusion: The rise in caesarean delivery rates at M.N.H. is relatively high (from 15.8% in 1999, 31.8% in 2004 to 42.2% in 2007/2008). However, there are no changes in the main indications for caesarean section and the risk of caesarean delivery remains to increase among primiparae mothers.

There is a need for studies to be done to determine the causes for this steadily rising caesarean section rate. Furthermore, this may necessitate the call for a careful cost – benefit analysis to be done to see if any meaningful interventions can be implemented.