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Christopher J M Whitty

Publications and source records attributed to Christopher J M Whitty.

7 recordsLinked to original sources
PubMed2003

Caesarean section in Malawi: prospective study of early maternal and perinatal mortality.

OBJECTIVE: To examine potentially modifiable factors that may influence the high maternal and perinatal mortality associated with caesarean section in Malawi. DESIGN: A prospective observational study of 8070 caesarean sections performed between January 1998 and June 2000 and associated complications. SETTING: 23 district and two central hospitals in Malawi. PARTICIPANTS: 45 anaesthetists from hospitals that carried out caesarean sections. MAIN OUTCOME MEASURES: Associations between maternal or perinatal deaths in the first 72 hours and various quantifiable risk factors. RESULTS: Questionnaires were returned for 5236 caesarean sections in district hospitals and 2834 in central hospitals; 7622 (94%) were emergencies, 5110 (63%) were because of obstructed labour. Preoperative haemorrhagic shock was present in 610 women (7.6%), anaemia in 503 (6.2%), and ruptured uterus in 333 (4.1%). Eighty five women died (1.05%), 68 of whom died postoperatively on the wards. Higher maternal mortality was associated with ruptured uterus (adjusted odds ratio 2.3, 95% confidence interval 1.3 to 4.0), little anaesthetic training (2.9, 1.6 to 5.1), general as opposed to spinal anaesthesia (6.6, 2.3 to 18.7), and blood loss requiring transfusion of >or= 2 units (21.0, 11.7 to 37.7). Perinatal mortality up to 72 hours was 11.2% overall and was significantly associated with ruptured uterus and general rather than spinal anaesthesia. CONCLUSION: In sub-Saharan Africa high maternal and perinatal mortality at caesarean section is associated with major preoperative complications that are unusual in developed countries. Improved training in anaesthetics, wider use of spinal anaesthesia, and improved surveillance and resuscitation in postoperative wards might reduce mortality.

Cesarean Section↗
PubMed2003

Clinical presentation and diagnostic sensitivity of laboratory tests for Strongyloides stercoralis in travellers compared with immigrants in a non-endemic country.

OBJECTIVES: To assess whether the clinical and laboratory methods for diagnosing Strongyloides stercoralis infection in non-endemic countries is different between those who are chronically exposed and those who travel. METHODS: Analysis of laboratory and clinical data from 204 patients having S. stercoralis infection at the Hospital for Tropical Diseases, London. RESULTS: Sixty-four travellers and 128 immigrants from endemic countries had laboratory-proven strongyloides. In those with microscopically proven disease, serology was 73% sensitive in travellers and 98% sensitive in immigrants (P < 0.001). There was no difference in the eosinophil count between the two groups with 19% having a normal count. Patterns of symptoms varied between the groups, and around one-third were asymptomatic in both groups. Serology was of limited use in follow-up. CONCLUSIONS: Eosinophil count and stool microscopy are insufficiently sensitive to be used alone for screening strongyloides. The sensitivity of serology is good in immigrants with chronic infection, but lower in travellers.

Adolescent↗
PubMed2002

Malaria.

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Animals↗
PubMed2002

Pneumococcal disease in HIV-infected Malawian adults: acute mortality and long-term survival.

OBJECTIVE: HIV-infected patients in Africa are vulnerable to severe recurrent infection with Streptococcus pneumoniae, but no effective preventive strategy has been developed. We set out to determine which factors influence in-hospital mortality and long-term survival of Malawians with invasive pneumococcal disease. DESIGN, SETTING AND PATIENTS: Acute clinical features, inpatient mortality and long-term survival were described among consecutively admitted hospital patients with S. pneumoniae in the blood or cerebrospinal fluid. Factors associated with inpatient mortality were determined, and patients surviving to discharge were followed to determine their long-term outcome. RESULTS: A total of 217 patients with pneumococcal disease were studied over an 18-month period. Among these, 158 out of 167 consenting to testing (95%) were HIV positive. Inpatient mortality was 65% for pneumococcal meningitis (n = 64), 20% for pneumococcaemic pneumonia (n = 92), 26% for patients with pneumococcaemia without localizing signs (n = 43), and 76% in patients with probable meningitis (n = 17). Lowered consciousness level, hypotension, and age exceeding 55 years at presentation were associated with inpatient death, but not long-term outcome in survivors. Hospital survivors were followed for a median of 414 days; 39% died in the community during the study period. Outpatient death was associated with multilobar chest signs, oral candidiasis, and severe anaemia as an inpatient. CONCLUSION: Most patients with pneumococcal disease in Malawi have HIV co-infection. They have severe disease with a high mortality rate. At discharge, all HIV-infected adults have a poor prognosis but patients with multilobar chest signs or anaemia are at particular risk.

Age Factors↗