RESUMO
BACKGROUND: Maternal HIV infection remains a significant global health concern with potential repercussions on perinatal outcomes. Emphasis on early intervention to improve peri- and postnatal outcomes in infected mothers and infants is a valid therapeutic concern. OBJECTIVES: To comprehensively analyze perinatal outcomes associated with maternal HIV infection and evaluate adverse effects associated with the HIV infection in the existing literature. SEARCH STRATEGY: A comprehensive search of PubMed, MEDLINE, and Google Scholar was conducted from 2013 to September 2023, using relevant MeSH terms. SELECTION CRITERIA: The included studies encompassed original studies, cross-sectional, prospective, retrospective studies and observational studies focused on perinatal outcomes in the context of maternal HIV infection. DATA COLLECTION AND ANALYSIS: The selected studies underwent rigorous data collection and comprehensive quality checks and adhered to the PRISMA guidelines. MAIN RESULTS: Nine eligible studies from Brazil, China, India, Malawi, Nigeria, Tanzania, the USA, and Canada were included. These studies have consistently demonstrated that maternal HIV infection is associated with adverse perinatal outcomes. The analysis revealed a higher risk of preterm birth (OR 1.57, 95% CI: 1.39-1.78), low birth weight (OR 1.33, 95% CI: 1.18-1.49), and small for gestational age (OR 1.38, 95% CI: 1.24-1.53) among infants born to mothers living with HIV. Notably, the impact of antiretroviral treatment (ART) on these outcomes varied, but maternal HIV infection remained a significant risk factor regardless of income level and geographic region. CONCLUSION: Maternal HIV infection is consistently associated with adverse perinatal outcomes, emphasizing the need for targeted interventions and improved prenatal care in pregnant women with HIV infection.
Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Resultado da Gravidez , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/complicações , Gravidez , Feminino , Recém-Nascido , Nascimento Prematuro/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Recém-Nascido de Baixo Peso , Brasil/epidemiologia , Canadá , Recém-Nascido Pequeno para a Idade Gestacional , Índia/epidemiologia , China/epidemiologia , Nigéria/epidemiologia , Estados Unidos/epidemiologia , Tanzânia/epidemiologia , Malaui/epidemiologiaRESUMO
Viral metagenomics has been extensively applied for the identification of emerging or poorly characterized viruses. In this study, we applied metagenomics for the identification of viral infections among pediatric patients with acute respiratory disease, but who tested negative for SARS-CoV-2. Twelve pools composed of eight nasopharyngeal specimens were submitted to viral metagenomics. Surprisingly, in two of the pools, we identified reads belonging to the poorly characterized Malawi polyomavirus (MWPyV). Then, the samples composing the positive pools were individually tested using quantitative polymerase chain reaction for identification of the MWPyV index cases. MWPyV-positive samples were also submitted to respiratory virus panel testing due to the metagenomic identification of different clinically important viruses. Of note, MWPyV-positive samples tested also positive for respiratory syncytial virus types A and B. In this study, we retrieved two complete MWPyV genome sequences from the index samples that were submitted to phylogenetic inference to investigate their viral origin. Our study represents the first molecular and genomic characterization of MWPyV obtained from pediatric patients in South America. The detection of MWPyV in acutely infected infants suggests that this virus might participate (coparticipate) in cases of respiratory symptoms. Nevertheless, future studies based on testing of a larger number of clinical samples and MWPyV complete genomes appear to be necessary to elucidate if this emerging polyomavirus might be clinically important.
Assuntos
COVID-19 , Infecções por Polyomavirus , Polyomavirus , Infecções Respiratórias , Vírus , Lactente , Criança , Humanos , Metagenômica , Brasil/epidemiologia , Malaui/epidemiologia , Filogenia , SARS-CoV-2 , Infecções por Polyomavirus/epidemiologia , Polyomavirus/genética , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologiaRESUMO
OBJECTIVE: To examine changes in vaccination of children younger than 1 year during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-August 2021) in Haiti, Lesotho, Liberia and Malawi. METHODS: We used data from health management information systems on vaccination of children aged 12 months or younger in districts supported by Partners In Health. We used data from January 2016 to February 2020 and a linear model with negative binomial distribution to estimate the expected immunization counts for March 2020-August 2021 with 95% prediction intervals, assuming no pandemic. We compared these expected levels with observed values and estimated the immunization deficits or excesses during the pandemic months. FINDINGS: Baseline vaccination counts varied substantially by country, with Lesotho having the lowest count and Haiti the highest. We observed declines in vaccination administration early in the COVID-19 pandemic in Haiti, Lesotho and Liberia. Continued declines largely corresponded to high rates of COVID-19 infection and discrete stock-outs. By August 2021, vaccination levels had returned to close to or above expected levels in Haiti, Liberia and Lesotho; in Malawi levels remained below expected. CONCLUSION: Patterns of childhood immunization coverage varied by country over the course of the pandemic, with significantly lower than expected vaccination levels seen in one country during subsequent COVID-19 waves. Governments and health-care stakeholders should monitor vaccine coverage closely and consider interventions, such as community outreach, to avoid or combat the disruptions in childhood vaccination.
Assuntos
COVID-19 , Criança , Haiti/epidemiologia , Humanos , Imunização , Programas de Imunização , Lactente , Lesoto/epidemiologia , Libéria/epidemiologia , Malaui/epidemiologia , Pandemias , SARS-CoV-2 , VacinaçãoRESUMO
BACKGROUND: Acute kidney injury (AKI) is increasingly encountered in community settings and contributes to morbidity, mortality, and increased resource utilization worldwide. In low-resource settings, lack of awareness of and limited access to diagnostic and therapeutic interventions likely influence patient management. We evaluated the feasibility of the use of point-of-care (POC) serum creatinine and urine dipstick testing with an education and training program to optimize the identification and management of AKI in the community in 3 low-resource countries. METHODS AND FINDINGS: Patients presenting to healthcare centers (HCCs) from 1 October 2016 to 29 September 2017 in the cities Cochabamba, Bolivia; Dharan, Nepal; and Blantyre, Malawi, were assessed utilizing a symptom-based risk score to identify patients at moderate to high AKI risk. POC testing for serum creatinine and urine dipstick at enrollment were utilized to classify these patients as having chronic kidney disease (CKD), acute kidney disease (AKD), or no kidney disease (NKD). Patients were followed for a maximum of 6 months with repeat POC testing. AKI development was assessed at 7 days, kidney recovery at 1 month, and progression to CKD and mortality at 3 and 6 months. Following an observation phase to establish baseline data, care providers and physicians in the HCCs were trained with a standardized protocol utilizing POC tests to evaluate and manage patients, guided by physicians in referral hospitals connected via mobile digital technology. We evaluated 3,577 patients, and 2,101 were enrolled: 978 in the observation phase and 1,123 in the intervention phase. Due to the high number of patients attending the centers daily, it was not feasible to screen all patients to assess the actual incidence of AKI. Of enrolled patients, 1,825/2,101 (87%) were adults, 1,117/2,101 (53%) were females, 399/2,101 (19%) were from Bolivia, 813/2,101 (39%) were from Malawi, and 889/2,101 (42%) were from Nepal. The age of enrolled patients ranged from 1 month to 96 years, with a mean of 43 years (SD 21) and a median of 43 years (IQR 27-62). Hypertension was the most common comorbidity (418/2,101; 20%). At enrollment, 197/2,101 (9.4%) had CKD, and 1,199/2,101 (57%) had AKD. AKI developed in 30% within 7 days. By 1 month, 268/978 (27%) patients in the observation phase and 203/1,123 (18%) in the intervention phase were lost to follow-up. In the intervention phase, more patients received fluids (observation 714/978 [73%] versus intervention 874/1,123 [78%]; 95% CI 0.63, 0.94; p = 0.012), hospitalization was reduced (observation 578/978 [59%] versus intervention 548/1,123 [49%]; 95% CI 0.55, 0.79; p < 0.001), and admitted patients with severe AKI did not show a significantly lower mortality during follow-up (observation 27/135 [20%] versus intervention 21/178 [11.8%]; 95% CI 0.98, 3.52; p = 0.057). Of 504 patients with kidney function assessed during the 6-month follow-up, de novo CKD arose in 79/484 (16.3%), with no difference between the observation and intervention phase (95% CI 0.91, 2.47; p = 0.101). Overall mortality was 273/2,101 (13%) and was highest in those who had CKD (24/106; 23%), followed by those with AKD (128/760; 17%), AKI (85/628; 14%), and NKD (36/607; 6%). The main limitation of our study was the inability to determine the actual incidence of kidney dysfunction in the health centers as it was not feasible to screen all the patients due to the high numbers seen daily. CONCLUSIONS: This multicenter, non-randomized feasibility study in low-resource settings demonstrates that it is feasible to implement a comprehensive program utilizing POC testing and protocol-based management to improve the recognition and management of AKI and AKD in high-risk patients in primary care.
Assuntos
Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/terapia , Injúria Renal Aguda/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Bolívia/epidemiologia , Criança , Pré-Escolar , Creatinina/sangue , Países em Desenvolvimento , Progressão da Doença , Estudos de Viabilidade , Feminino , Humanos , Lactente , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Testes Imediatos , UrináliseRESUMO
Edematous severe acute childhood malnutrition (edematous SAM or ESAM), which includes kwashiorkor, presents with more overt multi-organ dysfunction than non-edematous SAM (NESAM). Reduced concentrations and methyl-flux of methionine in 1-carbon metabolism have been reported in acute, but not recovered, ESAM, suggesting downstream DNA methylation changes could be relevant to differences in SAM pathogenesis. Here, we assess genome-wide DNA methylation in buccal cells of 309 SAM children using the 450 K microarray. Relative to NESAM, ESAM is characterized by multiple significantly hypomethylated loci, which is not observed among SAM-recovered adults. Gene expression and methylation show both positive and negative correlation, suggesting a complex transcriptional response to SAM. Hypomethylated loci link to disorders of nutrition and metabolism, including fatty liver and diabetes, and appear to be influenced by genetic variation. Our epigenetic findings provide a potential molecular link to reported aberrant 1-carbon metabolism in ESAM and support consideration of methyl-group supplementation in ESAM.
Assuntos
Metilação de DNA , Epigenoma/genética , Desnutrição Aguda Grave/genética , Adolescente , Adulto , Estudos de Casos e Controles , Pré-Escolar , Ilhas de CpG/genética , Epigenômica/métodos , Feminino , Perfilação da Expressão Gênica , Humanos , Lactente , Jamaica/epidemiologia , Malaui/epidemiologia , Masculino , Mucosa Bucal , Estudos Prospectivos , Estudos Retrospectivos , Desnutrição Aguda Grave/mortalidade , Sobreviventes , Adulto JovemRESUMO
BACKGROUND: The persistence of preventable maternal and newborn deaths highlights the importance of quality of care as an essential element in coverage interventions. Moving beyond the conventional measurement of crude coverage, we estimated effective coverage of facility delivery by adjusting for facility preparedness to provide delivery services in Bangladesh, Haiti, Malawi, Nepal, Senegal, and Tanzania. METHODS: The study uses data from Demographic and Health Surveys (DHS) and Service Provision Assessments (SPA) in Bangladesh (2014 DHS and 2014 SPA), Haiti (2012 DHS and 2013 SPA), Malawi (2015-16 DHS and 2013-14 SPA), Nepal (2016 DHS and 2015 SPA), Senegal (2016 DHS and 2015 SPA), and Tanzania (2015-16 DHS and 2014-15 SPA). We defined effective coverage as the mathematical product of crude coverage and quality of care. The coverage of facility delivery was measured with DHS data and quality of care was measured with facility data from SPA. We estimated effective coverage at both the regional and the national level and accounted for type of facility where delivery care was sought. FINDINGS: The findings from the six countries indicate the effective coverage ranges from 24% in Haiti to 66% in Malawi, representing substantial reductions (20% to 39%) from crude coverage rates. Although Malawi has achieved almost universal coverage of facility delivery (93%), effective coverage was only 66%.vSuch gaps between the crude coverage and the effective coverage suggest that women delivered in health facility but did not necessarily receive an adequate quality of care. In all countries except Malawi, effective coverage differed substantially among the country's regions of the country, primarily due to regional variability in coverage. INTERPRETATION: Our findings reinforce the importance of quality of obstetric and newborn care to achieve further reduction of maternal and newborn mortality. Continued efforts are needed to increase the use of facility delivery service in countries or regions where coverage remains low.
Assuntos
Atenção à Saúde , Instalações de Saúde , Mortalidade Infantil , Cobertura do Seguro , Mortalidade Materna , Qualidade da Assistência à Saúde , Adulto , Bangladesh/epidemiologia , Feminino , Haiti/epidemiologia , Humanos , Lactente , Saúde do Lactente , Malaui/epidemiologia , Serviços de Saúde Materna , Nepal/epidemiologia , Gravidez , Senegal/epidemiologia , Tanzânia/epidemiologiaRESUMO
OBJECTIVE: To describe associations between childhood violence and forced sexual initiation in young Malawian females. STUDY DESIGN: We analyzed data from 595 women and girls who were 13-24 years old who ever had sex and participated in Malawi's 2013 Violence Against Children Survey, a nationally representative household survey. We estimated the overall prevalence of forced sexual initiation and identified subgroups with highest prevalences. Using logistic regression, we examined childhood violence and other independent predictors of forced sexual initiation. RESULTS: The overall prevalence of forced sexual initiation was 38.9% among Malawian girls and young women who ever had sex. More than one-half of those aged 13-17 years at time of survey (52.0%), unmarried (64.6%), or experiencing emotional violence in childhood (56.9%) reported forced sexual initiation. After adjustment, independent predictors of forced sexual initiation included being unmarried (aOR, 3.54; 95% CI, 1.22-10.27) and any emotional violence (aOR, 2.47; 95% CI, 1.45-4.24). Those experiencing emotional violence alone (aOR, 3.04; 95% CI: 1.01-9.12), emotional violence in combination with physical or nonpenetrative sexual violence (aOR, 2.50; 95% CI, 1.23-5.09), and emotional violence in combination with physical and nonpenetrative sexual violence (aOR, 2.61; 95% CI, 1.20-5.67) had an increased independent odds of forced sexual initiation. CONCLUSIONS: Experiences of forced sexual initiation are common among Malawian females. Emotional violence is strongly associated with forced sexual initiation, alone and in combination with other forms of childhood violence. The relationship between emotional violence and forced sexual initiation highlights the importance of comprehensive strategies to prevent childhood violence.
Assuntos
Delitos Sexuais/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Violência/estatística & dados numéricos , Adolescente , Estudos Transversais , Características da Família , Feminino , Humanos , Violência por Parceiro Íntimo/estatística & dados numéricos , Malaui/epidemiologia , Prevalência , Estupro/estatística & dados numéricos , Inquéritos e Questionários , Adulto JovemRESUMO
The growing burden of noncommunicable diseases (NCDs) may pose challenges for resource-limited health systems. This study used standardized, nationally representative data from Service Provision Assessments conducted in 2013-15 and the Service Availability and Readiness Assessment methodology to examine NCD service availability and readiness in Bangladesh, Haiti, Malawi, Nepal, and Tanzania. Both service availability and readiness were found to be very low: Very few facilities were fully "ready" to provide any one NCD service. Shortages of trained health workers and essential medicines were critical limitations to readiness. Rural and free facilities had lower availability and readiness, which may present access barriers. Policy makers should draw on decades of experience with global health initiatives to close these service gaps through the training of health workers on NCD screening and treatment, engaging the private sector on NCDs, and ensuring access to NCD medicines. Such efforts must be attentive to distributional equity and the multiple dimensions of care quality.
Assuntos
Recursos em Saúde/provisão & distribuição , Doenças não Transmissíveis/epidemiologia , Bangladesh/epidemiologia , Medicamentos Essenciais/provisão & distribuição , Haiti/epidemiologia , Acessibilidade aos Serviços de Saúde , Humanos , Malaui/epidemiologia , Nepal/epidemiologia , Doenças não Transmissíveis/tratamento farmacológico , Formulação de Políticas , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Tanzânia/epidemiologiaAssuntos
Cólera/epidemiologia , Cólera/prevenção & controle , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Criança , Pré-Escolar , Cólera/microbiologia , Vacinas contra Cólera/administração & dosagem , Confidencialidade , Haiti/epidemiologia , Humanos , Malaui/epidemiologia , Saneamento/normas , Somália/epidemiologia , Sudão do Sul/epidemiologia , Revelação da Verdade , Microbiologia da Água , Abastecimento de Água/normas , Organização Mundial da Saúde , Iêmen/epidemiologiaRESUMO
BACKGROUND: Faith-based organizations (FBOs) have a long history of providing health services in developing countries and are important contributors to healthcare systems. Support for the wellbeing of women, children, and families is evidenced through active participation in the field of family planning (FP). However, there is little quantitative evidence on the availability or quality of FP services by FBOs. METHODS: The descriptive analysis uses facility-level data collected through recent Service Provision Assessments in Malawi (2013-14), Kenya (2010), and Haiti (2012) to examine 11 indicators of FP service and method availability and nine indicators of comprehensive and quality counseling. The indicators include measures of FP service provision, method mix, method stock, the provision of accurate information, and the discussion of reproductive intentions, client's questions/concerns, prevention of sexually transmitted infections, and return visits, among others. Pearson's Chi-square test is used to assess the selected indicators by managing authority (FBO, public, and other private sector) to determine statistical equivalence. RESULTS: Results show that FBOs are less likely to offer FP services than other managing authorities (p < 0.05). For example, 69% of FBOs in Kenya offer FP services compared to 97% of public facilities and 83% of other private facilities. Offering long-acting or permanent methods in faith-based facilities is especially low (43% in Malawi, 29% in Kenya and 39% in Haiti). There were few statistically significant differences between the managing authorities in comprehensive and quality counseling indicators. Interestingly, Haitian FBOs often perform as well or better than public sector health facilities on counseling indicators, such as discussion of a return visit (79% of FBO providers vs. 68% of public sector providers) and discussion of client concerns/questions (52% vs. 49%, respectively). CONCLUSIONS: Results from this analysis indicate that there is room for improvement in the availability of FP services by FBOs in these countries. Quality of counseling should be improved by all managing authorities in the three countries, as indicated by low overall coverage for practices such as ensuring confidentiality (22% in Malawi, 47% in Kenya and 12% in Haiti), discussion of sexually transmitted infections (18%, 25%, 17%, respectively), and providing services to youth (53%, 27%, 32%, respectively).