Pregnant women cannot perform the analysis for Hepatitis B and HIV / AIDS at health centers. Doctors of maternity blame for this situation gynecologists of primary care. Health centers: The fault is not ours, but it is state’s fault that does not provide reagents to perform these examinations.
By Sonila Mesareja
Maternity health personnel are at risk from infectious diseases that undiagnosed women carry during pregnancy. The concern is raised by the leaders of the two maternity hospitals in Tirana, according to whom, pregnant women, who due to lack of information or even of income during the first three months of pregnancy do not perform tests to discover if they carry any infectious diseases such as hepatitis or HIV/AIDS etc. Everything starts from the health center, which is the first link in the health system where pregnant women go to take medical examinations and tests. In many cases the lack of reagents brings women to not perform tests for the detection of infectious diseases at these centers.
A few of pregnant women who have the economic means, address themselves to private clinics to perform analysis for infectious diseases. But a considerable number of them, due to the expensive price of examinations in private laboratories do not perform this test, becoming thus a potential risk for the spread of infectious diseases, especially to the white shirts that follow their pregnancy. But there is another category of women that do not address themselves to health centers during the 9 months of pregnancy and go straight to the maternity without performing any examinations of their condition or that of their babies. The alert to this problem came out in the maternity of “Queen Geraldine”, but also in the “Koço Gliozheni” maternity, by pointing the finger to gynecologists of health centers as being guilty for this serious problem.
“We are at risk. We receive at the hospital women who are carriers of hepatitis B, women that during pregnancy have not done the examinations, some due to lack of income and some others due to lack of information. If we are not informed earlier that they are carriers, we risk to get infected as staff. Those who know this fact inform us that they are carriers only when they are ready to deliver their babies and asking us to pay attention to not risk their baby to become a carrier and to have the hepatitis examination that actually costs”, says head midwife of maternity “Queen Geraldine”, Dhurata Boka . Further, she adds that “there are very few cases where women come to us knowing that they carry infectious diseases. They come urgently and undergo immediately the delivery of their babies. When they inform us of being carriers we take measures, but the risk is greater when even they do not have such information.”
Head midwife points her finger at the gynecologists of polyclinics as being somewhat guilty for this situation. “Who are to blame? Of course that during the months of pregnancy the woman is followed by health center doctors and they are checked step by step during their pregnancy. Since the first three months of pregnancy, the woman makes the analysis to discover if she is a carrier of hepatitis or HIV / AIDS. These tests are checked by health center doctors. We are the last phase of the 9 month pregnancy. It is exactly us that are endangered from undeclared intentional and unintentional carriers” says head midwife Boka. The same concern is also raised at the other maternity of the capital, “Koço Gliozheni”, appealing to take measures to not endanger staff or others too.
But what do gynecologists of health centers say about these direct charges coming from maternities. “In fact it is not good that white shirts accuse each other. They have all rights to raise the alarm when they feel threatened, but the fault is not ours but of the state. It’s not us that do not provide examinations of hepatitis B or HIV / AIDS. All women who come to us in the center to open the file of pregnancy are oriented by us for examinations according to the protocol every three months. The examinations for infectious diseases are to be performed the first trimester. This is handed in a written form to all women. Then, to the fact if they do carry out or not these examinations we don’t know what to say. There may be women avoiding these examinations because of the price”, say gynecologists of some health centers in the capital.
They refused to speak with names because of the fear of losing their job or because they have not been mentioned nominally, while they direct charges elsewhere, not towards maternity but towards state that is to say the Ministry of Health. “Examinations should be carried out in health centers or at the Department of Hygiene. But what happens is that the reagents for performing these examinations always lack, directing thus unintentionally or intentionally pregnant women to private clinics which never experience lack of reagent for carrying out an examination of hepatitis B and HIV / AIDS. The state should not allow such a thing as long as insurances are paid and they have the right to receive this service.
The cost of these two very important tests compels many women not to perform it and therefore go on maternity knowingly or unknowingly of the fact that they are carriers of this disease, jeopardizing the medical staff or maternity sanitary. But we assure you that is not our fault. The culprit is to the state that forces them deliberately to go towards the private clinics given that in most cases our health centers have a lack for performing these examinations”, say the gynecologists, adding that the state should intervene to control the delivery of this very important laboratory, as well as hepatitis B, HIV / AIDS is a very dangerous virus, and almost at the same level is Hepatitis C as well.
But how much dangerous is the virus of hepatitis B. According to doctors, the hepatitis B virus is transmitted by contact with infected blood and other bodily fluids such as saliva, sweat, tears, nasal secretions, sperm and vaginal discharge. Infection is also transmitted from infected mother to fetus. Most vulnerable to infection from hepatitis B virus are health workers, patients performing transfusions, dialysis patients, those who perform acupuncture, tattoos and those who share needles, shaving machine or tooth brush with an infected person. However, hepatitis B virus cannot be spread over touching, embracing, while kissing, coughing, and sneezing and breastfeeding. It is worth noting that hepatitis B virus is 50 to 100 times more infectious than HIV.
Doctors say acute infection with hepatitis B virus begins with general signs of infection, such as: loss of appetite, nausea, vomiting, body aches, fever and dark colored urination. Later the disease progresses with the development of jaundice or skin coloring in yellow. The disease lasts for several weeks and then gradually improves in most affected people. To 1-10% of people infected with hepatitis B virus are developed necrotizing vasculitis, glomerulonephritis membrane and aplastic anemia. There are rare cases where there is developed fulminating hepatitis ending with death.
All carriers of hepatitis B should be subject to an examination in the first quarter of pregnancy so that the child does not become carrier of this virus. Laboratory diagnosis of hepatitis B is mainly done through serological tests, where there is performed the determination of delineators hepatic or otherwise called hepatitis markers. Markers of hepatitis B are viral antigens (proteins that wrap the outside of the virus) and antibodies produced by the body against these antigens. The interpretation of these tests is difficult to be understood not only from the patients but also from doctors working in infections and laboratory departments.
Besides serological tests in the diagnosis of hepatitis B, the determination of other biochemical analysis, such as enzymes ALT, AST, GGT and Bilirubin in blood and urine is also helpful. By PCR test is determined the viral DNA in the serum of patients infected with VHB also called viral load. Although viral load results increased since before the appearance of HBsAg in circulation this test is almost never used in the diagnosis of acute infection with VHB, but to assess the state of infected patients and to monitor treatment.
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