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Title: The long wait: reproductive health care in Haiti.
Author: John Snow [JSI]. Research and Training Institute, Inc.
Source: Arlington, Virginia, JSI, Research and Training Institute, Inc., 2009. 22 p.
Abstract: The reproductive health status of Haiti's communities contributes to a life expectancy of 62.8 years for women in comparison to 75.5 years in neighboring Dominican Republic or 80.8 years for women in the U.S. According to Haiti's 2005-2006 Demography Health Survey, 37.5% of women have unmet family planning needs. Additionally, youth and rural area residents report greater unmet needs for family planning than the national average. Unmet family planning contributes to a high total fertility rate of 4.79 (5 in rural versus 2.8 in urban areas), a high infant morality (57 deaths per 1000 live births) and the highest maternal mortality rate in the western world-630 deaths per 100,000 live births. These alarming RH indicators prompted a team from JSI Research & Training Institute, Inc. (JSI) to visit Haiti in January 2009. The objectives of the study were: 1) to identify gaps in the availability and accessibility of comprehensive RH services including: Safer motherhood and emergency obstetric care (EmOC), Family planning, HIV/AIDS and sexually transmitted infections (STI) prevention, care and support, Gender-based violence (GBV) prevention, care and support, and Adolescent-focused RH programming for each of the above RH components. 2) to identify community-level responses and opportunities for strengthening the quality and availability of comprehensive RH services. This report presents the findings of this assessment.
Language: English
Keywords:
HAITI | SUMMARY REPORT | MOTHERS | SAFE MOTHERHOOD | REPRODUCTIVE HEALTH | HIV PREVENTION | AIDS PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | VIOLENCE AGAINST WOMEN | PREVENTION AND CONTROL | FAMILY PLANNING | HEALTH SERVICES | DELIVERY OF HEALTH CARE | PROGRAM ACCESSIBILITY | Developing Countries | Caribbean | Americas | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Maternal Health | Health | HIV Infections | Viral Diseases | Diseases | AIDS | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Domestic Violence | Crime | Social Problems | Program Evaluation | Programs | Organization and Administration
Document Number: 341307

Title: Sexual and reproductive health and HIV linkages: evidence review and recommendations.
Author: World Health Organization [WHO]; United Nations Population Fund [UNFPA]; International Planned Parenthood Federation [IPPF]; Joint United Nations Programme on HIV / AIDS [UNAIDS]; University of California, San Francisco. Global Health Sciences
Source: Geneva, Switzerland, WHO, 2009 Apr. [8] p.
Abstract: The importance of linking sexual and reproductive health (SRH) and HIV is widely recognized. The international community agrees that the Millennium Development Goals will not be achieved without ensuring universal access to SRH and HIV prevention, treatment, care and support. In order to gain a clearer understanding of the effectiveness, optimal circumstances, and best practices for strengthening SRH and HIV linkages, a systematic review of the literature was conducted. The findings corroborate the many benefits gained from linking SRH and HIV policies, systems and services. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | CLIENTS | HIV TESTING | COUNSELING | HIV PREVENTION | FAMILY PLANNING | MATERNAL HEALTH | SEXUALLY TRANSMITTED DISEASE PREVENTION | CHILD HEALTH | MANAGEMENT | KNOWLEDGE | ATTITUDES | STIGMA | BEHAVIOR | FEES | HIV/FP INTEGRATION | INTERVENTIONS | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | HIV Infections | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Sociocultural Factors | Psychological Factors | Social Problems | Financial Activities | Economic Factors
Document Number: 331466

Title: Promoting health and equity: Evidence, policy and action: Cases from the Western Pacific Region.
Author: World Health Organization [WHO]. Regional Office for the Western Pacific
Source: Manila, Philippines, WHO, Regional Office for the Western Pacific, 2009 Mar. [173] p.
Abstract: Recent years have seen a growth in the evidence base on policies and actions to promote health equity. Despite efforts, however, the evidence shows that inequalities are increasing rather than decreasing in many countries. This may partly be due to faulty policy decisions. There is clearly need for a better evidence-based approach on health policies to achieve equity. At the same time, understanding is inadequate on how policy-makers can best make use of the growing evidence base on promoting equity in health. There is a need for stronger links between evidence and health policy-making and implementation. To respond in part to this need, the WHO Western Pacific Regional Office convened the High Level Meeting on Promoting Health Equity: Evidence, Policy and Action from 16-18 October 2007 in Phnom Penh, hosted by the Royal Government of Cambodia, to provide an opportunity to exchange experiences and identify ways to promote the more systematic use of equity research in health policy and action. Health ministers and other stake holders engaged in the evidence-to-policy process were invited to submit case studies that illustrate the process. This book compiles the nine cases presented at the meeting. An introductory chapter comprises a synthesis of the cases and the lessons learned from them.
Language: English
Keywords:
CAMBODIA | CHINA | VIETNAM | NEW ZEALAND | MALAYSIA | MONGOLIA | SUMMARY REPORT | CASE STUDIES | DELIVERY OF HEALTH CARE | PRIMARY HEALTH CARE | TREATMENT | HEALTH POLICY | HEALTH SERVICES | TUBERCULOSIS | CAPACITY BUILDING | PREVENTION AND CONTROL | PROGRAM ACCESSIBILITY | Developing Countries | Asia, Southeastern | Asia | Asia, Eastern | Oceania | Developed Countries | Asia, Northern | Studies | Research Methodology | Health | Medical Procedures | Medicine | Policy | Political Factors | Sociocultural Factors | Infections | Diseases | Program Sustainability | Programs | Organization and Administration | Program Evaluation
Document Number: 331453

Peer Reviewed

Title: Assessment of childhood immunisation coverage [letter]
Author: Aaby P; Benn CS
Source: Lancet. 2009 Apr 25;373(9673):1428.
Abstract: Stephen Lim and colleagues scrutinise coverage with the third dose of diphtheria-tetanus-pertussis vaccine (DTP3) in 193 countries. With donor emphasis on DTP3 coverage, it is not surprising that the national estimates might be inflated. Still, there is little doubt that DTP3 coverage has increased in recent decades. But maybe we should be more concerned about the health implications of this trend than about the accuracy of the estimate. From a public health perspective, the fact that DTP3 coverage is now higher than measles vaccine coverage in most African countries is of questionable value. Numerous studies have shown that measles vaccine is beneficial for child survival, but there are conflicting data about the effect of DTP. DTP has frequently been associated with increased mortality in situations with herd immunity. Furthermore, as a result of the drive to increase the DTP3 coverage, more children receive DTP simultaneously with or after measles vaccine. We have found consistently that DTP given simultaneously with measles vaccine (table) or after it is associated with increased mortality compared with having measles vaccine alone as the most recent vaccine. In a study from Bangladesh, children who received DTP/BCG after the age of measles vaccine administration had around threefold higher mortality than unvaccinated children. These observations have not been contradicted. If they are true, the drive to boost the DTP3 coverage could lead to increased child mortality. Current policy is based on the assumption that receiving three DTP vaccines is associated with decreased child mortality. It should be a major priority to determine whether this assumption is correct. (full-text)
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | CROSS-CULTURAL COMPARISONS | EPIDEMIOLOGIC METHODS | CHILDREN | IMMUNIZATION | PERTUSSIS | TETANUS | DIPHTHERIA | Comparative Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Primary Health Care | Health Services | Delivery of Health Care | Health | Bacterial and Fungal Diseases | Infections | Diseases
Document Number: 341150

Peer Reviewed

Title: HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response.
Author: Abdool Karim SS; Churchyard GJ; Abdool Karim Q; Lawn SD
Source: Lancet. 2009 Sep 12;374(9693):921-33.
Abstract: One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0.7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government's response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | TUBERCULOSIS | ANTIRETROVIRAL THERAPY | DRUG RESISTANCE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | MANAGEMENT | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Infections | HIV | Medical Procedures | Medicine | Health
Document Number: 342870

10.

Title: Risk factors associated with low CD4+ lymphocyte count among HIV-positive pregnant women in Nigeria.
Author: Abimiku A; Villalba-Diebold P; Dadik J; Okolo F; Mang E; Charurat M
Source: International Journal of Gynaecology and Obstetrics. 2009 May 20;
Abstract: OBJECTIVE: To determine the risk factors for CD4+ lymphocyte counts of 200 cells/mm(3) or lower in HIV-positive pregnant women in Nigeria. METHOD: A cross-sectional data analysis from a prospective cohort of 515 HIV-positive women attending a prenatal clinic. Risk of a low CD4+ count was estimated using logistic regression analysis. RESULTS: CD4+ lymphocyte counts of 200 cells/mm(3) or lower (280+/-182 cells/mm(3)) were recorded in 187 (36.3%) out of 515 HIV-positive pregnant women included in the study. Low CD4+ count was associated with older age (adjusted odds ratio [aOR] 10.71; 95% confidence interval [CI], 1.20-95.53), lack of condom use (aOR, 5.16; 95% CI, 1.12-23.8), history of genital ulcers (aOR, 1.78; 95% CI, 1.12-2.82), and history of vaginal discharge (aOR; 1.62; 1.06-2.48). CONCLUSIONS: Over 35% of the HIV-positive pregnant women had low CD4+ counts, indicating the need for treatment. The findings underscore the need to integrate prevention of mother-to-child transmission with HIV treatment and care, particularly services for sexually transmitted infections.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREGNANT WOMEN | HEMATOLOGICAL EFFECTS | RISK FACTORS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | CONDOM USE | SEXUALLY TRANSMITTED DISEASES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Hemic System | Physiology | Biology | Health | Disease Transmission Control | Prevention and Control | Risk Reduction Behavior | Behavior | Reproductive Tract Infections | Infections
Document Number: 341452

11.

Title: Building laboratory infrastructure to support scale-up of HIV/AIDS treatment, care, and prevention: in-country experience.
Author: Abimiku AG
Author: Institute of Human Virology, University of Maryland School of Medicine PEPFAR
Source: American Journal of Clinical Pathology. 2009 Jun;131(6):875-86.
Abstract: An unprecedented influx of funds and support through large programs such as the Global Fund for AIDS, Malaria and Tuberculosis and the World Health Organization's and President's Emergency Plan for AIDS Relief (PEPFAR) has made it possible for more than 1 million persons in resource-limited settings to access AIDS treatment and several million more to be in care and prevention programs. Nevertheless, there remain major challenges that prevent AIDS drugs and care from reaching many more in need, especially in rural settings. The roll-out of a high-quality treatment, care, and prevention program depends on an effective and reliable laboratory infrastructure. This article presents a strategy used by the Institute of Human Virology (IHV)-University of Maryland and its affiliate IHV-Nigeria to establish a multifaceted, integrated tier laboratory program to support a PEPFAR-funded scale-up of its AIDS Care Treatment in Nigeria program, in collaboration with the Centers for Disease Control and Prevention and the Nigerian government, as a possible model for overcoming a key challenge that faces several resource-limited countries trying to roll out and scale-up their HIV/AIDS treatment, care, and prevention program.
Language: English
Keywords:
NIGERIA | CRITIQUE | HIV INFECTIONS | CARE AND SUPPORT | TREATMENT | HIV PREVENTION | LABORATORY | EQUIPMENT AND SUPPLIES | LABORATORY EXAMINATIONS AND DIAGNOSES | TESTING | TUBERCULOSIS | INTEGRATED PROGRAMS | TRAINING ACTIVITIES | STANDARDS | QUALITY CONTROL | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Viral Diseases | Diseases | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine | Examinations and Diagnoses | Measurement | Research Methodology | Infections | Programs | Organization and Administration | Training Programs | Education
Document Number: 341766

12.

Title: Spontaneous vesicovaginal fistula caused by genitourinary aspergillosis.
Author: Agarwal N; Seth A; Kulshrestha V; Kochar S; Kriplani A
Source: International Journal of Gynaecology and Obstetrics. 2009 Apr;105(1):63-4.
Abstract: Genitourinary aspergillosis is rare in patients who are not immunocompromised. A 39-year-old woman presented with vaginal urinary leakage with no history of previous trauma, procedure, or fever. The patient's last delivery had been by cesarean 12 years previously and she had no history of difficult labor. Six months prior to presenting, the patient had been scheduled to undergo abdominal hysterectomy for menorrhagia along with repair of a surgical hernia; only the hernia was repaired at that time as dense adhesions prevented the hysterectomy. The patient had been amenorrheic since that surgery and her incontinence began 6 days prior to presentation. (excerpt)
Language: English
Keywords:
INDIA | SUMMARY REPORT | CASE HISTORIES | CLIENTS | FISTULA | AMENORRHEA | VAGINAL ABNORMALITIES | SURGERY | BACTERIAL AND FUNGAL DISEASES | UROGENITAL EFFECTS | Asia, Southern | Asia | Developing Countries | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Diseases | Menstruation Disorders | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Urogenital System | Physiology | Biology
Document Number: 341383

13.

Title: Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India.
Author: Ahmad A; Khan AU
Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2009 May;144(1):68-71.
Abstract: OBJECTIVES: The objectives were to determine the frequency of Candida species in women of different age groups as well as to suggest the criteria for the diagnosis of vulvovaginal candidiasis (VVC). STUDY DESIGN: A prospective study of vulvovaginal candidiasis was carried out using laboratory diagnosis, with the estimation of vaginal pH and the direct microscopic and biochemical examination of vaginal discharge/secretions. Vaginal cultures for Candida species were collected from 1050 women with vulvovaginal symptoms. RESULTS: Out of 1050 women, 215 (20.47%) were positive for Candida species. Of 215 women, 172 (80%) had pH within the normal range and 167 (77.67%) were showing yeast cells and mycelia on direct microscopic examination. Candida albicans accounted for 46.9% of cases, Candida glabrata 36.7%, Candida parapsilosis 10.2%, Candida tropicalis 2.8%, Candida krusei 1.4%, and Candida kiefer 1.9%. The frequency of culture positivity was related to pregnancy (P<0.001), an increase in parity (P<0.001), and use of oral contraceptives (P<0.001) and antibiotics (P<0.001). The most common signs and symptoms in 215 women with positive cultures were pruritus with or without vaginal discharge and vaginal erythema. CONCLUSION: Our study suggests that vulvovaginal candidiasis can only be diagnosed by using clinical criteria in correlation with vulvovaginal symptoms and Candida cultures.
Language: English
Keywords:
INDIA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | CANDIDIASIS | RISK FACTORS | PREVALENCE | LABORATORY EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | PRURITUS | VAGINITIS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Bacterial and Fungal Diseases | Infections | Diseases | Health | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Dermatitis | Vaginal Abnormalities
Document Number: 342002

14.

Peer Reviewed

Title: Enhanced immunogenicity of an oral inactivated cholera vaccine in infants in Bangladesh obtained by zinc supplementation and by temporary withholding breast-feeding.
Author: Ahmed T; Svennerholm AM; Al Tarique A; Sultana GN; Qadri F
Source: Vaccine. 2009 Feb 25;27(9):1433-9.
Abstract: The killed oral cholera vaccine Dukoral is recommended for adults and only children over 2 years of age, although cholera is seen frequently in younger children and there is an urgent need for a vaccine for them. Since decreased immunogenicity of oral vaccines in children in developing countries is a critical problem, we tested interventions to enhance responses to Dukoral. We evaluated the effect on the immune responses by temporarily withholding breast-feeding or by giving zinc supplementation. Two doses of Dukoral consisting of killed cholera vibrios and cholera B subunit were given to 6-18 months old Bangladeshi children (n=340) and safety and immunogenicity studied. Our results showed that two doses of the vaccine were safe and induced antibacterial (vibriocidal) antibody responses in 57% and antitoxin responses in 85% of the children. Immune responses were comparable after intake of one and two doses. Temporary withholding breast-feeding for 3 h before immunization or supplementation with 20 mg of zinc per day for 42 days resulted in increased magnitude of vibriocidal antibodies (77% and 79% responders, respectively). Administration of vaccines without buffer or in water did not result in reduction of vibriocidal responses. This study demonstrates that the vaccine is safe and immunogenic in children under 2 years of age and that simple interventions can enhance immune responses in young children.
Language: English
Keywords:
BANGLADESH | RESEARCH REPORT | INFANT | CHOLERA | ZINC | HUMAN MILK | VACCINES | ADMINISTRATION AND DOSAGE | CONTRACEPTIVE USE-EFFECTIVENESS | AUTOIMMUNE RESPONSE | SAFETY | Developing Countries | Asia, Southern | Asia | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Bacterial and Fungal Diseases | Infections | Diseases | Metals | Vitamins and Minerals | Physiology | Biology | Lactation | Maternal Physiology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment | Contraceptive Effectiveness | Contraception | Family Planning | Antibodies | Immunologic Factors | Immunity | Immune System | Public Health
Document Number: 341051

15.

Peer Reviewed

Title: Biological Validation of Self-Reported Condom Use Among Sex Workers in Guinea.
Author: Aho J; Koushik A; Diakite SL; Loua KM; Nguyen VK; Rashed S
Source: AIDS and Behavior. 2009 Aug 13;
Abstract: Self-reported condom use may be prone to social desirability bias. Our aim was to assess the validity of self-reported condom use in a population of female sex workers using prostate specific antigen (PSA) as a gold standard biomarker of recent unprotected vaginal intercourse. We collected data on 223 sex-workers in Conakry, Guinea in order to assess the sensitivity and specificity of self-reported condom use as well as to examine the predictors of discordance between self-report and PSA presence. PSA was detected in 38.4% of samples. Sensitivity of self-reported condom use was 14.6% and its specificity was 94.7%. Self-perceived high risk of HIV infection was the only significant independent predictor of misreported condom use. PSA could be useful to validate self-reported condom use in surveys and to allow a better understanding of factors associated with social desirability in sexual behaviour reporting.
Language: English
Keywords:
GUINEA | RESEARCH REPORT | STATISTICAL REGRESSION | SEX WORKERS | CONDOM USE | BIAS | DATA REPORTING | VALIDITY | VAGINA | SEMEN | ANTIGENS | SEXUALLY TRANSMITTED DISEASES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Data Analysis | Research Methodology | Sex Behavior | Behavior | Risk Reduction Behavior | Error Sources | Measurement | Data Collection | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Seminal Vesicles | Genitalia, Male | Immunologic Factors | Immunity | Immune System | Reproductive Tract Infections | Infections | Diseases
Document Number: 342486

16.

Peer Reviewed

Title: Diarrhoeagenic Escherichia coli are not a significant cause of diarrhoea in hospitalised children in Kuwait.
Author: Albert MJ; Rotimi VO; Dhar R; Silpikurian S; Pacsa AS; Molla AM; Szucs G
Source: BMC Microbiology. 2009;9:62.
Abstract: BACKGROUND: The importance of diarrhoeagenic Escherichia coli (DEC) infections in the Arabian Gulf including Kuwait is not known. The prevalence of DEC (enterotoxigenic [ETEC], enteropathogenic [EPEC], enteroinvasive [EIEC], enterohemorrhagic [EHEC] and enteroaggregative [EAEC]) was studied in 537 children < or = 5 years old hospitalised with acute diarrhoea and 113 matched controls from two hospitals during 2005-07 by PCR assays using E. coli colony pools. RESULTS: The prevalence of DEC varied from 0.75% for EHEC to 8.4% for EPEC (mostly atypical variety) in diarrhoeal children with no significant differences compared to that in control children (P values 0.15 to 1.00). Twenty-seven EPEC isolates studied mostly belonged to non-traditional serotypes and possessed beta and theta intimin subtypes. A total of 54 DEC isolates from diarrhoeal children and 4 from controls studied for antimicrobial susceptibility showed resistance for older antimicrobials, ampicillin (0 to 100%), tetracycline (33 to 100%) and trimethoprim (22.2 to 100%); 43.1% of the isolates were multidrug-resistant (resistant to 3 or more agents). Six (10.4%) DEC isolates produced extended spectrum beta-lactamases and possessed genetic elements (blaCTX-M, blaTEM and ISEcp1) associated with them. CONCLUSION: We speculate that the lack of significant association of DEC with diarrhoea in children in Kuwait compared to countries surrounding the Arabian Gulf Region may be attributable to high environmental and food hygiene due to high disposable income in Kuwait.
Language: English
Keywords:
KUWAIT | RESEARCH REPORT | CONTROL GROUPS | CHILDREN | BACTERIAL AND FUNGAL DISEASES | DIARRHEA | DIARRHEA, INFANTILE | PREVALENCE | ANTIBIOTICS | DRUG RESISTANCE | Middle East | Developed Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Measurement | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341689

17.

Peer Reviewed

Title: Seroreversion in children born to HIV-positive and AIDS mothers from Central West Brazil.
Author: Alcantara KC; Pereira GA; Albuquerque M; Stefani MM
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):620-6.
Abstract: The spread of HIV-1 infection among women of childbearing age has led to increasing numbers of children at risk of vertical transmission. This study aimed to assess child outcomes among HIV-positive (n=19) and AIDS (n=22) mothers from Central West Brazil. CD4(+) T-cell counts (FACScount, BD) and viral loads (HIV-1 RT-PCR, Amplicor HIV-1 Monitor Roche) were assessed at delivery and during the first 6 months of life. Heteroduplex mobility assay identified env and gag HIV-1 subtypes. Frequencies and medians were calculated. HIV-positive and AIDS mothers did not differ with regard to age, antiretroviral prophylaxis, parity and viral load. AIDS mothers had lower CD4(+) T-cell counts. One vertical transmission and a neonatal death were observed. Gestational age, gender and oral zidovudine prophylaxis were similar regardless of maternal clinical status. Infants born to AIDS mothers had lower birthweight and shorter time to seroreversion. Eight infants were lost to follow-up, and two were breastfed due to delayed maternal diagnosis. HIV-1 B(env)/B(gag) subtype were 75.6%; discordant B(env)/F(gag) were 12.2%. Exposed uninfected infants born to AIDS mothers with lower CD4(+) T-cell counts seroreverted earlier than infants born to asymptomatic HIV-positive mothers. It is possible that maternal immunological status may impact on the time to seroreversion.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | MOTHERS | PERSONS LIVING WITH HIV/AIDS | MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING | LABORATORY PROCEDURES | AIDS | HIV INFECTIONS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Viral Diseases | Diseases | Transmission | Infections | Infant Nutrition | Nutrition | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 342742

18.

Peer Reviewed

Title: High-risk behaviours among juvenile prison inmates in Pakistan.
Author: Altaf A; Janjua NZ; Kristensen S; Zaidi NA; Memon A; Hook EW 3rd; Vermund SH; Shah SA
Source: Public Health. 2009 Jul 15;
Abstract: OBJECTIVES: To assess the sexual- and drug-use-related risk behaviours of male juvenile detainees in Karachi, Pakistan. DESIGN: Cross-sectional study. METHODS: A cross-sectional study was conducted of prison inmates aged 15-21 years in Karachi Juvenile Prison in 2002. In total, 321 inmates were interviewed about sexual orientation and behaviours, and knowledge about human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). Urine specimens were collected and tested for Chlamydia trachomatis and Neisseria gonorrhoeae using ligase chain reaction. RESULTS: A substantial proportion (n=111, 34.6%) of the participants were sexually active. Sixty-two (19%) and 67 (21%) had had sex with a male or female before incarceration, respectively. Twenty-seven (8.4%) participants had an STI, and 50% of the 109 sexually active participants had had multiple sexual partners. Use of addictive substances was associated with sexual activity. The mean knowledge score computed from the sum of 16 items was 4.7, with a median of 2.9. A large proportion (40%) of participants knew about condoms, but very few (3.4%) had ever used one. The mean+/-standard deviation risk score from nine items was 2.4+/-1.7. On the basis of behavioural and biological markers, 117 (36.4%) participants had high-risk behaviour. In multivariate logistic regression analysis, knowledge, risk perception and age were predictive of higher risk. CONCLUSIONS: HIV risk behaviours are common among adolescent inmates. Although inmates do have knowledge about modes of transmission and condom use, the use of condoms is significantly low. Interventions are needed for behavioural change among this group.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | YOUTH | PRISONERS | SEX BEHAVIOR | DRUG USE AND ABUSE | ALCOHOL USE AND ABUSE | KNOWLEDGE | SEXUALLY TRANSMITTED DISEASES | HIV INFECTIONS | AIDS | Developing Countries | Asia, Southern | Asia | Age Factors | Population Characteristics | Demographic Factors | Population | Crime | Social Problems | Sociocultural Factors | Behavior | Reproductive Tract Infections | Infections | Diseases | Viral Diseases
Document Number: 342285

19.

Peer Reviewed

Title: HIV prevalence and associated risk factors among individuals aged 13-34 years in rural western Kenya.
Author: Amornkul PN; Vandenhoudt H; Nasokho P; Odhiambo F; Mwaengo D
Source: Plos One. 2009 Jul;4(7):e6470.
Abstract: From a demographic surveillance system, the authors selected a random sample of Asembo, Kenya residents ages 13�34 years, who were contacted at home and invited to a nearby mobile study site. From October 2003 to April 2004, consenting participants were interviewed on risk behavior and tested for HIV and HSV-2. HIV voluntary counseling and testing was offered. Of 2,606 eligible residents, 1,822 (70%) enrolled. Primary reasons for refusal included not wanting blood taken, not wanting to learn HIV status, and partner or parental objection. Females comprised 53% of 1,762 participants providing blood. Adjusted HIV prevalence was 15.4% overall: 20.5% among females and 10.2% among males. HIV prevalence was highest in women ages 25-29 years (36.5%) and men ages 30-34 years (41.1%). HSV-2 prevalence was 40.0% overall: 53% among females, 25.8% among males. In multivariate models stratified by gender and marital status, HIV infection was strongly associated with age, higher number of sex partners, widowhood, and HSV-2 seropositivity.
Language: English
Keywords:
KENYA | RURAL AREAS | RESEARCH REPORT | SAMPLING STUDIES | HIV INFECTIONS | HERPES GENITALIS | PREVALENCE | RISK FACTORS | AGE FACTORS | SEX FACTORS | MIGRATION | VOLUNTARY COUNSELING AND TESTING | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Geographic Factors | Population | Studies | Research Methodology | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Measurement | Health | Population Characteristics | Demographic Factors | Population Dynamics | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 339909

20.

Title: Efficacy and acceptability of rapid, point-of-care HIV testing in two clinical settings in Ghana.
Author: Appiah LT; Havers F; Gibson J; Kay M; Sarfo F; Chadwick D
Source: AIDS Patient Care and STDs. 2009 May;23(5):365-9.
Abstract: This study assessed the efficacy and acceptability of two rapid point-of-care HIV assays used in a voluntary counseling and testing (VCT) and a tuberculosis (TB) clinic in Kumasi, Ghana. Over a 4-week period in 2007, 95 individuals attending the VCT clinic and 35 patients with newly diagnosed TB were offered a rapid HIV test. Rates of return for positive results and attendance at the HIV clinic were compared with 471 individuals (395 attending the VCT clinic and 76 patients with TB), tested during an 8-week period 6 months earlier using standard testing procedures. All patients offered a rapid test in each clinic underwent testing, compared to 93% of VCT clients and 40% of TB patients offered a test 6 months earlier. In the rapid testing period, 37%, 60%, and 3% of the VCT clients and 26%, 74% and 0% of the TB patients had positive, negative, or indeterminate serology, respectively. There were no discordant results following retesting of patients with a positive test. All patients attending either the VCT or TB clinics who tested positive for HIV with the point-of-care test returned to the HIV clinic for care, while only 64% and 95%, respectively, of the patients previously testing positive had returned for follow-up. Both clients and staff showed high levels of satisfaction with the rapid testing procedure. In conclusion, rapid point-of-care testing in both of these settings was successful in improving diagnosis of HIV infection and engaging those testing positive in a clinical care program.
Language: English
Keywords:
GHANA | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | HIV TESTING | PROGRAM ACCEPTABILITY | CLINIC ACTIVITIES | VOLUNTARY COUNSELING AND TESTING | TUBERCULOSIS | SATISFACTION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Evaluation | Infections | Diseases | Psychological Factors | Behavior
Document Number: 342184

21.

22.

Peer Reviewed

Title: Prevalence of tuberculosis, HIV and respiratory symptoms in two Zambian communities: implications for tuberculosis control in the era of HIV.
Author: Ayles H; Schaap A; Nota A; Sismanidis C; Tembwe R; De Haas P; Muyoyeta M; Beyers N
Author: Peter Godfrey-Faussett for the ZAMSTAR Study Team
Source: PloS One. 2009;4(5):e5602.
Abstract: BACKGROUND: The Stop TB Partnership target for tuberculosis is to have reduced the prevalence of tuberculosis by 50% comparing 2015 to 1990. This target is challenging as few prevalence surveys have been conducted, especially in high burden tuberculosis and HIV countries. Current tuberculosis control strategies in high HIV prevalent settings are therefore based on limited epidemiological evidence and more evidence is needed from community-based surveys to inform improved policy formulation. METHODS AND FINDINGS: 8044 adults were sampled from 2 sub-districts (wards) in Lusaka province, Zambia. Questionnaires were used to screen for symptoms, respiratory samples were obtained for culture and oral secretions collected for HIV testing. 79 individuals were found to have Mycobacterium tuberculosis in their sputum, giving an adjusted overall prevalence of tuberculosis of 870/100,000 (95% CI 570-1160/100,000). The adjusted overall prevalence of HIV was 28.61% (95% CI 26.04-31.19). HIV- infection was significantly associated with prevalent tuberculosis (Adj OR 2.3, 95% CI 1.42-3.74) and the population attributable fraction of HIV for prevalent tuberculosis was 36%. Symptoms such as prolonged cough (adj OR 12.72, 95% CI 7.05-22.94) and fever (Adj OR 2.04, 95%CI 1.23-3.39), were associated with prevalent tuberculosis, but 8 (10%) individuals with prevalent tuberculosis denied having any symptoms at all and only 34 (43%) would have been classified as a TB suspect by current guidelines. CONCLUSIONS: Undiagnosed tuberculosis is a challenge for tuberculosis control and new approaches are needed if we are to reach international targets. Epidemiological studies can inform screening algorithms for both detection and prevention of active tuberculosis.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | SAMPLING STUDIES | ADULTS | TUBERCULOSIS | HIV INFECTIONS | RESPIRATORY INSUFFICIENCY | PREVALENCE | SCREENING | SIGNS AND SYMPTOMS | LABORATORY EXAMINATIONS AND DIAGNOSES | PREVENTION AND CONTROL | ANTIBIOTICS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Viral Diseases | Pulmonary Effects | Physiology | Biology | Measurement | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment
Document Number: 342445

23.

24.
Title: Circumcision's place in the vicious cycle involving herpes simplex virus type 2 and HIV [editorial]
Author: Bailey RC; Mehta SD
Source: Journal of Infectious Diseases. 2009 Apr 1;199(7):923-5.
Abstract: HSV-2 as a biological cofactor in HIV acquisition and transmission has likely contributed substantially to the HIV epidemic. Although it remains possible that HSV-2 suppressive therapy will be efficacious in reducing HIV transmission, it is not clear how and whether a twice daily regimen of acyclovir will be manageable and effective at a population level. Research is needed to develop and test a prophylactic vaccine that, even if only partially protective against HSV-2 acquisition, is likely to be effective in both concentrated epidemics and in generalized epidemics in which a large proportion of HIV transmission occurs in stable partnerships. (excerpt)
Language: English
Keywords:
AFRICA | EUROPE | SUMMARY REPORT | INCIDENCE | HERPES GENITALIS | HIV INFECTIONS | MALE CIRCUMCISION | SEX BEHAVIOR | HIV TESTING | LABORATORY PROCEDURES | Developing Countries | Developed Countries | Measurement | Research Methodology | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 341208

25.

Title: Minimally invasive surgery for children with HIV/AIDS.
Author: Banieghbal B
Source: Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A. 2009 Feb;19(1):97-101.
Abstract: AIM: Human deficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) have resulted in millions of deaths in Sub-Saharan Africa from opportunist infections. Children are not spared and are similarly affected. Minimally invasive surgery (MIS) can be used, in a selected number of children, as a mean to establish diagnosis or render a treatment. MATERIALS AND METHODS: This study was comprised of a 7-year retrospective analysis of a single pediatric surgeon's experience in South Africa. Forty-eight children, with ages 3 months to 14 years, with HIV/AIDS underwent laparoscopic/thoracoscopic exploration and treatment. RESULTS: Diagnostic laparoscopy and biopsy were the most common procedures (29 cases) indicated for nonspecific abdominal pain or rectal bleeding. The second most common procedure was laparoscopic antireflux fundoplication (10 cases) for damaged lower esophageal sphincter secondary to chronic candidal infection. The remaining procedures were for other rare surgical conditions, seen often in AIDS patients. No significant procedure-related complications occurred, but there were 2 mortalities from the underlying pathology in this cohort. CONCLUSIONS: This is the largest report on MIS for children with HIV/AIDS in the medical literature. It is shown that laparoscopic/thoracoscopic exploration and treatment in children with HIV/AIDS is safe and indicated for establishing the diagnosis and treatment of these unfortunate children.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | SURGERY | LAPAROSCOPY | PHYSICAL EXAMINATIONS AND DIAGNOSES | PAIN | BLEEDING | CANDIDIASIS | GASTROINTESTINAL EFFECTS | COMPLICATIONS | AIDS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Examinations and Diagnoses | Signs and Symptoms | Bacterial and Fungal Diseases | Infections | Physiology | Biology
Document Number: 330998

26.

Title: Condom use for preventing STI/HIV and unintended pregnancy among young men in sub-saharan Africa.
Author: Bankhole A; Singh S; Hussain R; Oestreicher G
Source: American Journal of Men's Health. 2009 Mar;3(1):60-78.
Abstract: The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | KAP SURVEYS | DEMOGRAPHIC AND HEALTH SURVEYS | CROSS-CULTURAL COMPARISONS | YOUTH | MEN | CONDOM USE | SEXUALLY TRANSMITTED DISEASE PREVENTION | HIV PREVENTION | PREGNANCY, UNPLANNED | KNOWLEDGE | CONTRACEPTIVE PREVALENCE | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Comparative Studies | Age Factors | Population Characteristics | Risk Reduction Behavior | Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | HIV Infections | Viral Diseases | Reproductive Behavior | Fertility | Sociocultural Factors | Contraceptive Usage | Contraception | Family Planning
Document Number: 329249

27.
Title: Integrating syndromic case management of sexually transmitted diseases into primary healthcare services in Nigeria.
Author: Banwat EB; Egah DZ; Peter J; Barau C; Majang Y; Mafuyai S; Imade GE; Bukbuk DN
Source: Nigerian Journal of Medicine. 2009 Apr-Jun;18(2):215-8.
Abstract: BACKGROUND: Sexually transmitted diseases (STDs) are a huge public health problem; both the aetiological and clinical approaches to management have limitations. WHO has therefore developed an alternative strategy--the syndromic case management approach. This paper reports a training of healthcare providers at the Primary Health Centers aimed at integrating STD care into other services in the PHCs to improve management at the community level. METHODS: Sixteen nurses, from eight PHCs were trained on this new strategy. The training included: identification of STDs, use of flow charts, patient education and counseling, clinic management issues and record keeping and reporting. RESULTS: Over a period of eight weeks post training, about 731 clients were attended to, 451 (61.7%) had signs and symptoms of various STDs (genital discharge, genital ulcer, genital warts and lower abdominal pains). They were treated using the syndromic case approach. About 18.6% (84/451) were males and 81.4% (367/451) were Females. Singles (never married) constituted 32.8% (148/451) while 28.6% were married. About 26.6% and 12.0% were divorced and separated respectively. Age group 20-35 years was at highest risk of infection CONCLUSION: Syndromic case management of STDs can be conveniently integrated into the primary health care delivery system in Nigeria.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | CLINICAL RESEARCH | NURSES AND NURSING | SEXUALLY TRANSMITTED DISEASES | SIGNS AND SYMPTOMS | TREATMENT | PRIMARY HEALTH CARE | INTEGRATED PROGRAMS | TRAINING ACTIVITIES | EXAMINATIONS AND DIAGNOSES | COUNSELING | PRE-POST TESTS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Health Personnel | Delivery of Health Care | Health | Reproductive Tract Infections | Infections | Diseases | Medical Procedures | Medicine | Health Services | Programs | Organization and Administration | Training Programs | Education | Clinic Activities | Program Activities | Program Evaluation
Document Number: 342684

28.

Peer Reviewed

Title: Social and environmental malaria risk factors in urban areas of Ouagadougou, Burkina Faso.
Author: Baragatti M; Fournet F; Henry MC; Assi S; Ouedraogo H; Rogier C; Salem G
Source: Malaria Journal. 2009;8:13.
Abstract: BACKGROUND: Despite low endemicity, malaria remains a major health problem in urban areas where a high proportion of fevers are presumptively treated using anti-malarial drugs. Low acquired malaria immunity, behaviour of city-dwellers, access to health care and preventive interventions, and heterogenic suitability of urban ecosystems for malaria transmission contribute to the complexity of the malaria epidemiology in urban areas. METHODS: The study was designed to identify the determinants of malaria transmission estimated by the prevalence of anti-circumsporozoite (CSP) antibodies, the prevalence and density of Plasmodium falciparum infection, and the prevalence of malarial disease in areas of Ouagadougou, Burkina-Faso. Thick blood smears, dried blood spots and clinical status have been collected from 3,354 randomly chosen children aged 6 months to 12 years using two cross-sectional surveys (during the dry and rainy seasons) in eight areas from four ecological strata defined according to building density and land tenure (regular versus irregular). Demographic characteristics, socio-economic information, and sanitary and environmental data concerning the children or their households were simultaneously collected. Dependent variables were analysed using mixed multivariable models with random effects, taking into account the clustering of participants within compounds and areas. RESULTS: Overall prevalences of CSP-antibodies and P. falciparum infections were 7.7% and 16.6% during the dry season, and 12.4% and 26.1% during the rainy season, respectively, with significant differences according to ecological strata. Malaria risk was significantly higher among children who i) lived in households with lower economic or education levels, iii) near the hydrographic network, iv) in sparsely built-up areas, v) in irregularly built areas, vi) who did not use a bed net, vii) were sampled during the rainy season or ii) had traveled outside of Ouagadougou. CONCLUSION: Malaria control should be focused in areas which are irregularly or sparsely built-up or near the hydrographic network. Furthermore, urban children would benefit from preventive interventions (e.g. anti-vectorial devices or chemoprophylaxis) aimed at reducing malaria risk during and after travel in rural areas.
Language: English
Keywords:
BURKINA FASO | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | URBAN AREAS | RURAL AREAS | CHILDREN | MALARIA | TRANSMISSION | ANTIBODIES | RISK FACTORS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Geographic Factors | Population | Youth | Age Factors | Population Characteristics | Demographic Factors | Parasitic Diseases | Diseases | Infections | Immunologic Factors | Immunity | Immune System | Physiology | Biology | Health
Document Number: 330546

29.

30.
Title: Primary and secondary tuberculosis preventive treatment in HIV clinics: simulating alternative strategies.
Author: Basu S; Maru D; Poolman E; Galvani A
Source: International Journal of Tuberculosis and Lung Disease. 2009 May;13(5):652-8.
Abstract: BACKGROUND: Isoniazid preventive treatment (IPT) has been recommended for human immunodeficiency virus (HIV) infected individuals. OBJECTIVE/DESIGN: We used a mathematical model to simulate the benefits and risks of preventive treatment delivered through antiretroviral (ARV) clinics using clinical data from Botswana. RESULTS: Preventive treatment was found to reduce the incidence of tuberculosis (TB) by at least 12 cases per 100000 population per year versus the scenario without such treatment over a 50-year simulation. Isoniazid (INH) resistant TB was observed to increase by <1% per year, even when using pessimistic assumptions about resistance emergence. The use of tuberculin skin testing had little impact as a screening procedure, while secondary treatment was observed to nearly double the impact of a preventive treatment program. Regardless of whether or not preventive treatment was implemented, INH-resistant TB rose in the context of increasing HIV prevalence, but was minimally amplified by preventive treatment itself. CONCLUSIONS: IPT programs implemented through ARV clinics may be effective at reducing TB incidence. The resistance contribution of IPT appears unlikely to supersede its overall incidence and mortality benefits.
Language: English
Keywords:
BOTSWANA | RESEARCH REPORT | MATHEMATICAL MODEL | PERSONS LIVING WITH HIV/AIDS | CLIENTS | TUBERCULOSIS | DRUGS | TESTING | ANTIRETROVIRAL DRUGS | DRUG RESISTANCE | INCIDENCE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Theoretical Models | Research Methodology | HIV Infections |