International Journal of MCH and AIDS最新文献

Background and objective: Above 90% of childhood HIV infections result from mother-to-child transmission (MTCT). This study examined the MTCT rates of HIV-exposed infants enrolled in the infant follow-up arm of the prevention of mother-to-child transmission (PMTCT) program in a teaching hospital in Southeast Nigeria.

Methods: This was a 14-year review of outcomes of infants enrolled in the infant follow-up arm of the PMTCT program of Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. The majority of subjects were enrolled within 72 hours of birth and were followed up until 18 months of age according to the National Guidelines on HIV prevention and treatment. At enrollment, relevant data were collected prospectively, and each scheduled follow-up visit was recorded both electronically and in physical copy in the client's folders. Data were analyzed using SPSS version 20. The major outcome variable was final MTCT status.

Results: Out of 3,784 mother-infant dyads studied 3,049 (80.6%) received both maternal and infant Antiretroviral (ARV) prophylaxis while 447 (11.8%) received none. The MTCT rates were 1.4%, 9.3%, 24.1%, and 52.1% for both mother and infant, mother only, infant only, and none received ARV prophylaxis respectively. There was no gender-based difference in outcomes. The MTCT rate was significantly higher among mixed-fed infants (p<0.001) and among those who did not receive any form of ARVs (p<0.001). Among dyads who received no ARVs, breastfed infants significantly had a higher MTCT rate compared to never-breastfed infants (57.9% vs. 34.8%; p<0.001). The MTCT rate was comparable among breastfed (2.5%) and never-breastfed (2.1%) dyads who had received ARVs. After logistic regression, maternal (p<0.001, OR: 7.00) and infant (p<0.001, OR: 4.00) ARV prophylaxis for PMTCT remained significantly associated with being HIV-negative.

Conclusion and global health implications: Appropriate use of ARVs and avoidance of mixed feeding in the first six months of life are vital to the success of PMTCT programs in developing countries. PMTCT promotes exclusive breastfeeding and reduces the burden of pediatric HIV infection, thereby enhancing child survival.

Background: Clubfoot or Congenital Talipes Equinovarus (CTEV) treatment in newborn infants involves simple, non-invasive manipulation and is primarily managed non-surgically if identified early. In low- and middle-income countries (LMICs), less than 15% of patients with CTEV access treatment. This cross-sectional questionnaire study conducted descriptive and regression analysis of institutional reasons for CTEV management in LMICs.

Methods: A cross-sectional study was undertaken of 1,489 medical institutions in 62 LMICs. Data were evaluated from the "World Health Organization Situation Analysis tool" database. We analyzed characteristics of institutions that manage and did not manage CTEV. With the use of a multivariate linear regression model, we identified a set of factors linked to referral for non-management of CTEV.

Results: A total of 72.7% (1,083/1,395) of institutions surveyed did not manage CTEV. The most common reason cited for not managing CTEV was a lack of sufficient skills, 92.1% (668/725, P<0.001). A total of 39.4% (286/725) of institutions also cited a lack of functioning equipment as a reason. Multivariate linear regression analysis showed lack of training, lack of supplies, and lack of functioning equipment were most closely related to non-management of CTEV.

Conclusion and global health implications: We identified that failure to manage CTEV may result from a lack of skills and medical equipment. Increasing the capacity of sustainable training programs may reduce the presently available skill deficit in treating CTEV in LMICs and provide improved health outcomes for those with CTEV. While considerable progress has been made in building capacity for the treatment and management of CTEV in LMICs, structured training programs that support conservative manipulative methods to manage CTEV should be initiated globally.

Genital Chlamydia trachomatis (CT) has adverse health outcomes for women and children. In pregnant women, the infection causes adverse obstetric outcomes including pelvic inflammation, ectopic pregnancy, and miscarriage. In children, it causes adverse birth outcomes such as skin rash, lesions, limb abnormalities, conjunctivitis, neurological damage, and even death. This article discusses genital CT prevalence, risk factors, and adverse pregnancy and birth outcomes among women and children in sub-Saharan Africa as well as challenges associated with the mitigation of the disease. A comprehensive search of databases including PubMed, ResearchGate, and Google Scholar was conducted using keywords such as genital chlamydia trachomatis, adverse pregnancy outcomes, adverse birth outcomes, and sub-Saharan African. We found that genital CT prevalence rates in some sub-Saharan Africa countries were higher than others and that risk factors such as the lack of condom use, having multiple sexual partners, and low educational levels contribute to the transmission of the infection. We also found that negative cultural practices, illiteracy among women, and the lack of access to screening services during pregnancy are some of the challenges associated with CT mitigation in sub-Saharan Africa. To reduce genital CT transmission in sub-Saharan Africa, efforts must be made by country governments to eliminate negative cultural practices, promote female literacy, and provide access to screening services for pregnant women.

Background and objective: Obstetric fistula affects approximately 2 million women worldwide, predominantly in places with a high Human Immunodeficiency Virus (HIV) burden. In Malawi, where thousands of women live with fistulas, HIV prevalence is 11-13%. Although repair is usually successful, surgical outcomes among immunocompromised women are poorly understood. Inconsistent guidelines regarding the Cluster of Differentiation 4 (CD4) threshold necessary for repair make it difficult for surgeons to make informed decisions. This study compares the postoperative outcomes of women undergoing obstetric fistula repair with and without HIV, stratified by CD4 count.

Methods: This is a retrospective case-control study using a database of women who underwent vesicovaginal fistula repair at the Fistula Care Center from 2010-2018. HIV-positive participants, stratified by CD4<350 and CD4>350, were matched to HIV-negative controls by age within 5 years and Goh classification. Controls were matched to cases in a 3:1 ratio. Bivariate analysis and logistic regression were conducted on indicators based on HIV status and CD4 count stratification. Outcomes included dye test results, pad weights, and continence status at 2 weeks post-repair.

Results: 54 seropositive women were matched to 135 seronegative women. Of the 54 HIV positive women, 22.2% (n=12) had a CD4 count < 350. We found no statistically significant difference in surgical outcomes between HIV-positive and negative patients. 93.5% of HIV positive and 90% of HIV negative women healed completely. In our sub-analysis of 12 seropositive women with CD4<350, we found a statically significant difference in successful closure, with 25% of women with CD4<350 having a positive dye test indicating incomplete closure, compared to 2.8% of women with CD4>350 (p=0.024).

Conclusion and global health implications: Our analysis confirms previous research indicating that seropositive women with a CD4>350 can safely undergo obstetric fistula repair. Further research is needed to evaluate postoperative outcomes among women with CD4<350.

Background: Human Immunodeficiency Virus (HIV)-exposed and HIV-infected infants are at increased risk of vaccine-preventable diseases. However, little is known about health care workers' knowledge and immunization counseling practices in this population. We determined the predictors of health care workers' knowledge of vertical transmission risks, HIV exposed/infected infant immunization, and counseling practices in a tertiary center in Northern Nigeria.

Methods: A cross-section of 297 health workers were interviewed using a structured, validated questionnaire. Knowledge and HIV-exposed infant immunization counseling practices were analyzed, and adjusted odds ratios for predictors were derived from logistic regression models.

Results: Of the 297 participating health care workers, (32.3%, n=96) had adequate knowledge of HIV-exposed/infected infant immunization. Two-thirds (67%, n=199) of the participants appropriately identified the timing of infant diagnosis, while (73%, n=217) and (56.2%, n=167) correctly categorized infants as HIV-exposed and HIV-infected, respectively. Only (19.5%, n=58) participants had ever counselled a HIV-positive mother on infant immunization. Knowledge was predicted by work unit (HIV clinic vs. Obstetrics & Gynecology clinic), (Adjusted Odds Ratio (AOR) =3.78, 95% CI: 1.27-5.54), age (30-39 vs. <30 years), (AOR=2.24, 95% CI:1.19-5.67), years of experience (≥10 vs. <5), (AOR=1.76, 95% CI: 1.15-6.04), number of children (1 vs. 0), (AOR=1.73, 95% CI:1.14-4.23), infant immunization training (yes vs. no), (AOR=1.57, 95% CI:1.12-5.43), female sex (AOR = 1.17, 95% CI:1.06-2.21), profession (nurse/midwife vs. physician), (AOR=0.44, 95% CI:0.21-0.94) and previous HIV test (no vs. yes), (AOR=0.67, 95% CI:0.21-0.83).

Conclusion and global health implications: Knowledge of HIV-exposed infant immunization was low and counseling practices were sub-optimal. Both immunization knowledge and counseling practices were predicted by demographic, professional, and training variables. Our findings indicate the need for educating health care workers on HIV exposed/infected infant immunization policy and improving counseling skills through capacity-building programs.

Background or objectives: Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is widespread in sub-Saharan Africa with similarity in geographical distribution of major pathogens of public health interest. The aim of this study was to assess the effect of malaria and helminths on CD4 count, hematocrit values and viral load among HIV-infected pregnant women.

Methods: One hundred and ninety-seven HIV-infected pregnant women aged 18-45 years were recruited from a registered HIV clinic and questionnaires were administered for socio-demographic details. Screening for malaria parasites in blood was through microscopy while helminths were identified in stool using Kato-Katz method. Hematocrit levels were determined through centrifugation of blood collected in capillary tubes. At the time of recruitment, most recent CD4 count and viral load was obtained from the patients' case notes.

Results: About three-quarters (73.6%) of the women had above primary school level of education while more than half (60.2%) were petty traders. The prevalence of malaria parasites in the blood samples was 24.9%, while 3% were infected with helminths. There was only a single case of malaria, helminths and HIV co-infection in the study group. Prevalence of anemia was 75.6% with eight cases (4.1%) of severe anemia. About 86.6% of the women with anemia had low CD4 count (χ²= 8.801, p=0.032). The mean CD4 count was significantly lower among those with co-infection of malaria and HIV.

Conclusion and global health implications: Malaria or helminth infection among HIV-infected women lowers the CD4 count and increases the viral load with little changes in hematocrit values. Routine screening of HIV-infected women for probable multiple infections will aid in improving their overall health and well-being.

Background and objective: Periodic tracking of the trends and the levels of HIV prevalence at regional and district levels helps to strengthen a state's HIV/AIDS response. HIV prevalence among pregnant women is crucial for the HIV prevalence estimation of the general population. Karnataka is one of the high HIV prevalence states in India. Probing regional and district levels and trends of HIV prevalence provides critical insights into district-level epidemic patterns. This paper analyzes the region- and district-wise levels and trends of HIV prevalence among pregnant women attending the antenatal clinics (ANC) from 2003 to 2019 in Karnataka, South India.

Methods: HIV prevalence data collected from pregnant women in Karnataka during HIV Sentinel Surveillance (HSS) between 2003 and 2019 was used for trend analysis. The consistent sites were grouped into four zones (Bangalore, Belgaum, Gulbarga and Mysore regions), totaling 60 sites, including 30 urban and 30 rural sites. Regional and district-level HIV prevalence was calculated; trend analysis using Chi-square trend test and spatial analysis using QGIS software was done. For the last three HSS rounds, HIV prevalence based on sociodemographic variables was calculated to understand the factors contributing to HIV positivity in each region.

Results: In total, 254,563 pregnant women were recruited. HIV prevalence in Karnataka was 0.22 (OR: 0.15 95% CI: 0.16 - 0.28) in 2019. The prevalence was 0.24, 0.32, 0.17 and 0.14 in Bangalore, Belgaum, Gulbarga, and Mysore regions, respectively. HIV prevalence had significantly (P< 0.05) declined in 26 districts.

Conclusion and global health implications: HIV prevalence among pregnant women was comparatively higher in Bangalore and Belgaum regions. Analysis of contextual factors associated with the transmission risk and evidence-based targeted interventions will strengthen HIV management in Karnataka. Regionalized, disaggregated, sub-national analyses will help identify emerging pockets of infections, concentrated epidemic zones and contextual factors driving the disease transmission.

Background and objective: Antiretroviral therapy (ART) has transformed human immune deficiency virus (HIV) infection from a death sentence to a chronic syndrome, allowing infected individuals to lead near-normal lives, including achieving pregnancy and bearing children. Notwithstanding, concerns remain about the effects of ART in pregnancy. Previous studies suggested contradictory associations between ART and pregnancy. This study determined birth outcomes in pregnant women who accessed ART between 2004 and 2017 at a major tertiary hospital in North Central Nigeria.

Methods: This was a retrospective study of 5,080 participants. Ethical clearance was obtained from the Institutional Review Board of the Harvard T. H. Chan School of Public Health Boston. A pro forma for data abstraction was designed and used to collect data. Abstracted data were sorted and managed using SPSS® version 22. The Chi-square test was used to calculate the proportions of pregnancy outcomes. One-way analysis of variance was used to test the effect of antiretroviral drug regimens on mean birth weight and gestational age at delivery. All levels of significance were set at p 0.05.

Results: Pregnancy outcomes were recorded as live birth (99.8%), stillbirth (0.2%), preterm delivery (6.6%), and low birth weight (23%). There was a statistically significant association between ART in pregnancy and low birth weight {χ² [(5, n = 3439) = 11.99, p = 0.04]}. The highest mean birth weights were recorded in participants who received drug combinations with protease inhibitors or efavirenz, in contrast to participants who received Nevirapine, stavudine and Emtricitabine/Tenofovirbased regimens. However, there was no significant difference in the gestational age of babies at birth for the six ART regimens in the study.

Conclusion and global health implications: Findings support the benefits of ART in pregnancy, which is in line with the testing and treatment policies of the 90-90-90 targets for ending HIV by the year 2030.

The emergence of novel virus SARS-CoV-2 that causes COVID-19 has complicated Africa's public health challenges, especially with the pre-existing epidemics such as HIV/AIDS. We highlight the known evidence related to COVID-19 infections among people with HIV (PWH) with specific reference to Africa. The knowledge gaps, level of public health preparedness and the potential research priorities are also outlined. Although the epidemiology and clinical course of COVID-19 in HIV patients are evolving, existing evidence indicate that the disease outcomes are comparable to that of the general population. However, PWH with low CD4 cell counts may have worse outcomes than individuals with restored immunity, whereas old age and co-morbidities such as obesity, hypertension and diabetes can further increase their overall risk. While there may be slight disruption of HIV service delivery in selected African countries, the resilience and resourcefulness of others have helped to sustain HIV service delivery and enhanced the level of public health preparedness and fight against the pandemic. The paucity of data and research studies on HIV-COVID-19 coinfection in Africa, call for concerted efforts to address these limitations.

Background and objective: Studies among COVID positive pregnant women are limited. Previous studies reported high rate of symptoms, comorbidities and poor fetal/neonatal outcome among women of different ethnicity. To date, no study was reported among pregnant African women. This study was conducted to determine the clinical features and outcomes of COVID-19 positive pregnant women in Ekurhuleni District in South Africa.

Methods: Retrospective record review of 103 COVID-19 infected pregnant women during the period of April to September 2020 was done. Clinical features, symptoms, comorbidities, laboratory results, maternal and neonatal outcomes were analyzed. Descriptive statistics (mean + standard deviation, number and percentages) and inferential statistics (Chi-square test) were calculated. Ethical clearance was obtained from the Human Research Ethics Committee of the University of Witwatersrand, South Africa.

Results: Majority (90%) were of African ethnicity and symptomatic (53%). The commonest symptom, comorbidity and laboratory abnormality was cough (62%), hypertension (23%) and high LDH (20%), respectively. Thrombocytopenia and lymphocytopenia occurred among 9% and 15% of the women, respectively. Although association was not significant, symptoms were more common among comorbid, HIV positive and women with abnormal results. Commonest complications were preterm labor (8%) and macerated stillbirths (6%). Six (6%) mothers died.

Conclusion and global health implications: COVID positive pregnant South African women were commonly symptomatic but incidence of adverse fetal outcomes was low. High rate of preterm labor, macerated stillbirths and maternal deaths was a concern. This study has several strengths. It included all COVID positive women over a 6 months' period at all level of healthcare facilities such as clinics, community health centers/midwifery units, and district, regional and tertiary hospitals, conducted in an African country. Previous studies included mainly hospitals raising a high probability of including mainly severely ill women. The study might benefit the health care workers in other African countries.