International Journal of MCH and AIDS最新文献

Background and objective: The continuum of care (CoC) is an important approach that should be prioritized for improving maternal health. The World Health Organization recommends working with individuals, families, and communities to ensure continuous care throughout pregnancy, childbirth, and the postpartum period. The purpose of this study was to assess the impact of an intervention on the awareness of the CoC among main caregivers and the completion of CoC among pregnant women.

Methods: During the COVID-19 pandemic, a community-based quasi-experimental study was conducted in two townships of the Yangon Region, including 200 pairs of pregnant women and their caregivers. The intervention focused on providing health education sessions and distributing pamphlets to caregivers in the intervention group. The study aimed to assess the awareness of main caregivers about CoC and completion of CoC among pregnant women. A key predictor variable for evaluating the outcome was receiving an intervention package by the main caregivers in the intervention. The analysis used logistic regression, including the propensity score model, and was conducted using STATA vs 15.1.

Results: The final analysis included 193 pairs. Most main caregivers were husbands: 47 were husbands in the intervention and 59 in the control group, while 24 mothers were included in both groups. The awareness of CoC for maternal health among main caregivers from the intervention group was 9.97 times higher than those from the control group (AOR = 9.97, 95% CI: 5.12 to 19.43, p < 0.001). The completion of CoC among women from the intervention group was 2.17 times higher than those from the controls (AOR = 2.17, 95% CI 1.08 to 4.37, p < 0.05). The awareness of main caregivers was found to be a significant predictor for completion of CoC.

Conclusion and global health implications: Health education intervention for main caregivers could improve CoC completion among pregnant women. It provided baseline information for further interventions at the family level for improving CoC among pregnant women in the future.

Background and objective: Although male partners are eager to support the implementation of prevention of mother-to-child transmission (PMTCT) of HIV programs, several obstacles prevent them from participating. The purpose of this study was to explore the support of male partners of HIV-positive women in sustaining the implementation of PMTCT interventions.

Methods: This study adopted a qualitative approach. The case study research design was used to generate an in-depth understanding of the factors that hinder male participation in PMTCT interventions. Non-probability purposive sampling was used to 20 sample participants. Data was collected from two focus group discussions and analyzed using open coding. Trustworthiness was achieved by credibility, transferability, and confirmability. Adherence to ethical principles was upheld.

Results: Findings revealed two themes, perceived practices that hinder the provision of support and perceived support provided to sustain PMTCT intervention during childbirth. Sustaining PMTCT interventions included how the male partner adheres to interventions that prevent the transmission of the virus, like consistent condom use, especially during breastfeeding, support in exclusive breastfeeding, adherence to ART, and limiting the use of cultural practices.

Conclusion and global health implications: The involvement of males in the interventions of PMTCT has been found to improve the sustainability of eliminating transmission of the virus to the baby. All clinics were recommended to be men user-friendly to encourage men to accompany their partners. Men are to be actively involved during decision-making and physical examination, where possible. Workshops and information-sharing sessions for men forums and community members on PMTCT interventions to be conducted.

Background and objective: HIV-infected and HIV-exposed children are known to have a lower immunization coverage. However, the current immunization coverage for this group of children in India is unknown. The present study assessed the immunization status, service-utilization issues, and factors associated with immunization status among them.

Methods: A descriptive, cross-sectional, and multisite study was conducted in four districts (Nadia, Murshidabad, South and North 24 Parganas) of West Bengal, a state in the Eastern part of India. Children aged between 12 and 59 months were included in the study. A sample size of 131 was calculated using Cochrane's formula. Onsite data was collected using an interviewer-administered predesigned, pre-tested, face-validated, semi-structured schedule. Immunization status was the outcome variable. The unadjusted association of the outcome variable with other variables was tested by the Chi-square test and the adjusted association was tested by regression analysis.

Results: The mean age of the children was 35.5 months (±15.7) and 50.4% were male. There were 18 (13.7%) HIV-infected children. Eighty-four percent of children were adequately immunized, but when considered along with the birth dose of the Hepatitis-B (Hep-B) vaccine, this reduced to 58.8%. Murshidabad district had the lowest proportion of fully immunized children (50%), while South 24 Parganas district had the lowest proportion of completely immunized children (60%). More than 95% of vaccinations were done in government facilities. Service utilization issues identified were lack of awareness of vaccine due dates and facing stigma from providers. Immunization status was associated with experience of stigma, mode and place of delivery by Chi-square test, it was only associated with stigma by regression analysis.

Conclusion and global health implications: Relatively lower immunization coverage among children born of HIV-infected women can be attributed to parents' unawareness about vaccination due dates and facing stigma while accessing service. Measures like documenting vaccine due dates and training healthcare providers on non-discriminatory, respectful care may improve vaccination coverage.

Background and objective: Highly active antiretroviral therapy (HAART) has reduced morbidity related to HIV infection, but HIV infection remains a public health in the era of HAART. The aim of this study was to investigate the oral manifestations of children living with HIV in the city of Bafoussam, Cameroon.

Methods: A cross-sectional study was carried out between February and April 2022 on children living with HIV/AIDS. A pretested questionnaire and data capture sheet were used to collect participants' data after an interview and clinical examination.

Results: We recruited 163 children, including 89 (54.6%) boys and 74 (45.4%) girls aged 1-18 years. All participants presented with HIV-1 serology, 143 (88%) at WHO stage 1, all were on HAART, 62 (38%) had been on treatment for six years, 144 (89%) had a viral load of less than 1000 copies/ml, none of the children had an infection opportunistic and only 31.3% were taking cotrimoxazole as prophylaxis, 3 (1.8%) had dermatosis and 20 (12.3%) adenopathies. A third 49 (30%) had mucosal pathologies, 30 (19%) gingivitis, 15 (9%) candidiasis oral, and 40 (24.5%) caries pathology. There was a statistically significant association between viral load and caries pathology. Oral hygiene was poor and 151 (92.6%) of the children had never consulted a dental surgeon.

Conclusion and global health implications: This study reveals that irrespective of compliance with HAART, some oral pathology related to HIV still persists. Therefore, early initiation to HAART and improvement of oral hygiene can further reduce these pathologies.

Adverse maternal health outcomes and high rates of maternal mortality continue to disproportionately affect low- and middle-income countries (LMICs). With limited access to health facility care, many women in LMICs rely on traditional birth attendants (TBAs) to meet their maternal health needs. While some studies consider the use of TBAs to be problematic, others suggest the integration of TBAs into maternal healthcare to improve health outcomes. The aim of this study is to utilize extant research to provide recommendations for optimizing the role of TBAs in maternal healthcare in Haiti, a LMIC. Each recommendation builds upon previous global health research, programmatic work, and a series of research studies conducted in Haiti to better understand and improve maternal healthcare in low-resource settings. Recommendations for integrating TBAs in maternal health include: (1) Integrate TBAs throughout prenatal, perinatal, and postpartum care to provide culturally relevant physical and emotional support to mothers; (2) Build capacity among TBAs to identify high-risk situations and link patients to care; (3) create TBA-led efforts to improve coordination and care; (4) Establish a collaborative pipeline from TBAs to facility-based care; and (5) create inclusive facility environments for TBAs to help reduce medical mistrust among patients. TBAs occupy an important role in the maternal health of women in LMICs and have the potential to contribute toward improved maternal health outcomes. The recommendations provided herein can be used to aid practitioners and researchers in reducing maternal morbidity and mortality globally.

Background and objective: The ablative and excision treatment procedures are effective, accessible, and affordable in resource-constrained settings, but the rollout and posttreatment follow-up are not remarkable. The outcomes of treatment procedures among women treated for precancerous lesions of the cervix have not been adequately studied in Cameroon. This study assessed the outcome of ablative and excisional treatment procedures.

Methods: This was a cross-sectional study that assessed the clinical outcome of 170 women treated for cervical precancers using ablative and excisional procedures in 2019 and 2020. Demographic and clinical data (treatment and posttreatment follow-up) were abstracted from the program registry. The data was analyzed to assess the clinical outcomes of cervical precancer treatment. The association between each independent variable and the dependent variable was examined in a simple logistic regression. All variables with p < 0.2 in the bivariate logistic regression model were subjected to a multivariable logistic model to get rid of cofounders and obtained adjustable odds ratios. The data was summarized using odds ratios, with p-value < 0.05 considered significant. All statistical analyses were performed using STATA version 17.

Results: The cervical precancer treatment effectiveness of 93.55% was disaggregated into 94.37% and 88.23% for ablative and excisional procedures, respectively, with less severe adverse clinical effects. Despite the high awareness of women on the importance and timing of posttreatment follow-up, its uptake was 54.71%. Most of the women who got pregnant after the procedures delivered live and healthy babies. Women who were HIV positive were 89% (0.89 times) [aOR = 0.11, 95%CI (0.01 0.85), p = 0.034] less likely to have effective treatment for cervical precancer when compared to HIV-negative women. Those with low-grade lesions were eight times [aOR = 8.39, 95%CI (1.10 64.06), p = 0.04] more likely to have effective treatment for cervical precancer treatment compared to those with high-grade lesions.

Conclusion and global health implications: Ablative and excisional treatment procedures for cervical precancer were effective with limited adverse effects in Cameroon. Women living with HIV and those with large lesions experienced lower treatment effectiveness. Most of the women who got pregnant after the procedures delivered live and healthy babies. Posttreatment follow-up which is highly recommended because of recurrent/persistent lesions was barely above average.

Background and objective: The discovery of innovative pharmacological preventative measures in Human Immunodeficiency Virus transmission has boosted optimism in the successful control of HIV/AIDS with the objective of eradication and the end of the epidemic. Hence, assessing the effect of pre-exposure prophylaxis (PrEP) on HIV prevention among key populations (KPs) is imperative in advancing the conversation on ending HIV/AIDs.

Methods: This was a cross-sectional study using data from KPs (female sex workers (FSWs), men who have sex with men (MSM), and people who inject drugs (PWIDs) enrolled in Heartland Alliance Ltd/GTE One Stop Shops (OSS) between May 2019 and April 2023 in the six selected Nigerian states (Lagos, Bayelsa, Cross River, Akwa Ibom, Jigawa, and Niger). Data were cleaned in a spreadsheet and analyzed using IBM-SPSS version 28.0. Descriptive statistics, including frequency and percentage calculations, were conducted to analyze the dataset. Additionally, cross-tabulation analysis was performed, with a significance level set at 0.05, to explore relationships between variables.

Results: The study population comprised 13,580 participants, with 56.1% female. In all, 43.9% were aged 18-35 and 97.3% were single. Among the three KPs examined, FSW was the largest subgroup (50.8%), followed by MSM (28.1%) and PWID (21.1%). Most participants had been on PrEP for 0-3 months (87.8%), and PrEP was initiated for 81.6% due to high-risk sexual behaviors and 9.9% for serodiscordant relationship reasons. Most of them were enrolled in community healthcare settings (97.0%). The results showed that 99.9% remained HIV negative, while only two (0.01%) were seroconverted while on PrEP. The HIV-positive cases did not complete one-month PreP treatment, comprising an FSW and a PWID. Recent HIV contact or poor compliance with PrEP medication are two possible causes of seroconversion.

Conclusion and global health implications: The findings underscore the significance of integrating PrEP into a comprehensive HIV prevention approach, including newer molecules that will improve adherence and the necessity of ongoing monitoring and support for PrEP users. With these insights, there can be an advocacy for promoting PrEP among the KPs as a vital component of Nigeria's HIV prevention strategy.

Background and objective: Pulmonary injuries resulting from urinary tract infections (UTIs) during pregnancy are rare. Prompt detection of pulmonary complications in pregnant patients with UTIs is crucial to prevent adverse outcomes in both the mother and the fetus. These complications may include respiratory issues, pulmonary edema, and exacerbation of preexisting conditions, such as asthma. We aimed to detect reported cases of pulmonary injury after UTIs among pregnancies.

Methods: We retrospectively reviewed the reported cases and articles in the PubMed database up to September 2023 on pulmonary injury after UTIs among pregnancies through a detailed search strategy. The titles and abstracts of the selected 15 articles were assessed, and ultimately, 7 articles were chosen based on adherence to our inclusion and exclusion criteria.

Results: Approximately 1-2% of women may develop acute pyelonephritis due to persistent UTIs, which has been associated with an increased risk of pulmonary edema in certain cases. UTIs can affect pulmonary health. Uremia, a consequence of UTIs, can lead to alterations in the respiratory drive, mechanics, muscle function, and gas exchange. Furthermore, urinary infection-induced inflammation activates neutrophils and promotes their recruitment to the lungs, compromising lung function and damaging the surrounding tissue.

Conclusion and global health implications: Although systematic research on this topic is limited, there may be a link between UTIs and pulmonary damage. However, it remains unclear whether pregnancy exacerbates this association. For maternal health, child health, and the whole public health, it is important to raise awareness of physicians and gynecologists, as well as the different specialties like emergency and intensive care units, with more information about pulmonary injury after UTI in pregnancy; it is important to note that UTIs may not directly cause pulmonary complications, but physiological changes associated with pregnancy can increase this risk, so more care, observation, early detection, and treatment are critical for treating these complications and achieving best outcome in pregnant women with UTIs. More research is needed in this area, as the mechanism underlying the existence of pulmonary damage post-UTI in pregnancy is unclear.

Background and objective: Hypertension is one of the most common medical complications during pregnancy and a leading cause of maternal mortality and morbidity. Severe preeclampsia is defined as blood pressure (BP) >160/110 mmHg with warning signs such as headache, blurring of vision, and epigastric pain. Nifedipine (C₁₇H₁₈N₂O₆), labetalol (C₁₉H₂₄N₂O₃), and hydralazine (C₈H₈N₄) are commonly used drugs, and all are recommended as first-line agents. Hydralazine is associated with a higher incidence of adverse outcomes, so oral nifedipine has been proposed as a first-line alternative to intravenous labetalol. Consequently, this study aims to compare the efficacy and safety of oral nifedipine with that of intravenous labetalol. The objective is to compare the ability/effectiveness of oral nifedipine and intravenous labetalol to normalize acute hypertension in severe preeclampsia and to assess the birth outcome. Relations between different factors were established by appropriate statistical tests. The p-value <0.05 was considered statistically significant.

Methods: The study was conducted on 120 antenatal women with blood pressure ≥160/110 mmHg admitted to our hospital, a tertiary care center, from January 1st, 2020 to June 30th, 2021. Patients were randomized by a single blinding method to receive intravenous labetalol and oral nifedipine. The primary outcome measures were the time taken to control the blood pressure and the number of doses of drugs required. The secondary outcome measures were the birth outcome like a method of delivery, side effect profile, and the number of admissions in the neonatal intensive care unit.

Results: A total of 120 patients were included with 60 patients in each group. The labetalol group took 48.67 ± 17.80 minutes and the nifedipine group took 64.33 ± 9.81 minutes to achieve a target BP of <=140/90 mmHg (p < 0.05). No side effects were seen in 70% of patients in the labetalol group and 71.67% in the nifedipine group (p > 0.05).

Conclusion and global health implications: Intravenous labetalol is faster in restoring blood pressure in pregnant women with preeclampsia than oral nifedipine and may be used as a first-line drug in the acute control of blood pressure in a hypertensive emergency during pregnancy. More studies are needed in order to evaluate the findings from this pilot study in a large sample of patients.