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Sexuality, sexually transmitted infections and contraception among health sciences students in university of Lome, Togo.
BMC Research Notes. 2018 Nov 14; 11(1):808.OBJECTIVES: Evaluate the practice of sexuality, contraception and the risk of sexually transmitted infections among students in the Faculty of Health Sciences, University of Lome, Togo. RESULTS: Three hundred and sixteen (316) students were interviewed, with a response rate of 43.3%. The average age of students completing the form was 21.4 +/- 2.7 years and their sex ratio was 2.2. Of this number of students who completed the form, 51.8% have already had sex. The mean age of first intercourse was 17.9 +/- 3.2 years; 70.3% were heterosexual. Regarding the number of sexual partners, 48.5% of students had more than one partner, of whom 15.9% had at least 5 sexual partners. 21.5% of these students had only one sexual intercourse per month. Regarding contraception among students with the card, 67.5% of students used a method of contraception. Among those using contraceptives, it was a 55.3% condom, followed by the Ogino method at 14.1%. Some of our respondents used more than one method of contraception and 28.5% of respondents indicated that their partners used a method of contraception. For STIs, 10.8% of students completing the form were already infected. Gonorrhea was reported in 30.4% of cases, candidiasis in 26.1% of cases.
International Journal of Community Medicine and Public Health. 2018 Aug; 5(8):3298-3303.Background: Infectious disease such as urinary tract infection was found very commonly during all pregnancies. Chronic renal failure, pyelonephritis, preeclampsia, anemia, fetal mortality and premature delivery are the common complication associated with UTI in pregnancy. Hence the management and prevention of UTI in pregnancy is the crucial factor for the sustained pregnant period. It is more important for a clinician to recognize the pathogenic factor for UTI and its sensitivity profile for planning an effective treatment for infected patients. Hence the present study was designed to identify the pathogenic agents of UTI among pregnant women and to find out the drug susceptibility patterns of the isolated organism against commonly prescribed antibiotics Methods: A prospective analysis was carried out by collecting urine from the 210 patients, the sample was also processed for antimicrobial drug susceptibility testing. Results: A positive report was seen in 26 cases with 13.4% of incident rate. Escherichia coli 14 (53.8%), Klebsiella species 23.07%, Enterococcus species 7.69%, Staphylococcus aureus 3.84%, Proteus 3.84%, Pseudomonas aeroginosa 3.84%, Streptococcus pyogenes 3.84% were the most common isolate found in the present population. The isolated pathogens were sensitive to Ceftazidime, Cefotaxime, Ciprofloxacin, Gentamicin, and Amikacin. Conclusions: It is there for recommended that routine microbiological analysis and antibiotic sensitivity test of urine samples of pregnant women must be carried out before the administration of drugs for better treatments and managements of urinary tract infection.
Lancet. HIV. 2017 Jun; 4(6):e231.Add to my documents.
Lancet. Infectious Diseases. 2017 Jul; 17(7):700-701.Add to my documents.
Health Economics (United Kingdom). 2018; 27(8):1218-1229.We study the causal effect of maternal education on childhood immunization rates. We use the Compulsory Education Law of 1997, and the differentiation in its implementation across regions, as instruments for schooling of young mothers in Turkey. The Compulsory Education Law increased the compulsory years of schooling of those born after 1986 from 5 to 8 years. We find that education of mothers increases the probability of completing the full course of diphtheria, pertussis, and tetanus and Hepatitis B vaccinations for their children. The results are robust to variations in regression specification and including various individual and community variables. © 2018 The Authors. Health Economics published by John Wiley & Sons Ltd.
Vaccine. 2017 Apr 25; 35(18):2288-2290.Add to my documents.
Caregivers’ knowledge of pneumonia and uptake of vaccination in under-five children in Kaduna State, Nigeria.
Journal of Medical and Biomedical Sciences. 2018; 7(1):40-48.Pneumonia, though very much a preventable disease, still remains a tangible threat to the lives of under-5 children. Caregivers’ knowledge of pneumonia is important in effective management. The study determined the reported proportion of childhood pneumonia in Kaduna State and assessed caregivers’ knowledge of pneumonia and uptake of pneumococcal vaccine among under-5 children. The mixed method research ap-proach used 500 caregivers of under-five children in urban and rural communities in Kaduna state. Ethical approval and informed consent of participants was obtained before data collection using a pre-tested semi-structured questionnaire and a focus group discussion guide. Chi-square statistical test was used to test for association between variables, while data from the focus group discussion was analyzed using thematic cod-ing process. Most respondents were aware of pneumonia, they had local names for it but majority 340 (68%) had poor knowledge of pneumonia. The overall occurrence of pneumonia as reported by respond-ents among under-five children was 33 (6.6%). The rate of child pneumococcal vaccine uptake as reported by respondents was 105 (21%), the uptake was significantly more among the urban dwellers (p<0.01). The knowledge of pneumonia and uptake of pneumococcal vaccination was poor. Routine and constant health education of the community members on pneumonia is very necessary to preserve lives of under-5 children in our communities.
The case for routine Gram stain following invasive prenatal procedures with retained intrauterine device.
Journal of Obstetrics and Gynaecology. 2018 Jun 8; 1-2.Despite a high colonisation rate of 38% in the female lower genital tract (DiGiulio 2012), Candida seldom causes chorioamnionitis in pregnancy. The candida species (including albicans, glabrata and parapsilosis) is an opportunistic pathogen. A recent review found that most reported cases had underlying risk factors, such as conception by in vitro fertilisation, presence of a retained intrauterine device (IUD) or cervical cerclage (Garcia-Flores et al. 2016). It called for consideration of this entity when an intra-amniotic infection is suspected in the at-risk cases (Garcia-Flores et al. 2016). The reported outcome of candida chorioamnionitis is poor, particularly in the cases with an extremely low-birth weight (Barton et al. 2017). In this report, the authors describe a case of pregnancy loss following a second-trimester amniocentesis and highlight the need to actively exclude this possibility when performing invasive prenatal procedures for the at-risk cases, particularly those with IUD.
A randomised trial of a contraceptive vaginal ring in women at risk of HIV infection in Rwanda: Safety of intermittent and continuous use.
PloS One. 2018; 13(6):e0197572.BACKGROUND: Contraceptive vaginal rings could play a role in expanding the contraceptive method mix and in preparing communities for the introduction of HIV prevention and multipurpose rings. METHODS: We conducted an open label single-centre randomised clinical trial of intermittent versus continuous use of NuvaRing(R) in Kigali, Rwanda, in 2013-2014. We randomised 120 HIV-negative women 1:1 to intermittent use (three rings with a ring-free week in between rings) or continuous use (four rings without ring-free weeks). Women underwent an interview, counselling, and a speculum examination, and were tested for pregnancy, bacterial vaginosis (BV) by Nugent scoring, yeasts and trichomonads on wet mount, and sexually transmitted infections. FINDINGS: Only one woman withdrew early. Deliberate ring removals were rare, but spontaneous ring expulsions occurred during 14% of ring use periods. There were no incident pregnancies, serious adverse events, serious social harms, or early discontinuations for safety reasons. Systemic side effects were uncommon, and local side effects were not significantly differently distributed between groups except for lower abdominal pain (P = 0.013). The incidence of vaginal yeasts during ring use was high: 22% of intermittent users and 27% of continuous users had incident vaginal yeasts at one or multiple ring removal visits (P = 0.666), and symptomatic vaginal yeast cases were more common in the continuous than intermittent users (P = 0.031). In contrast, mean Nugent scores improved over time in both groups. CONCLUSIONS: Intermittent and continuous NuvaRing(R) use were safe in Rwandan women and improved Nugent scores over time. However, attention should be paid to ring expulsions and to a potential increased risk of vaginal candidiasis.
Prevalence of asymptomatic urethritis by Chlamydia trachomatis and Neisseria gonorrhoeae and associated risk factors among males living with HIV-1.
Revista Do Instituto De Medicina Tropical De Sao Paulo. 2018 Mar 8; 60:e11.OBJECTIVES: The increase in HIV transmissibility in non-ulcerative sexually transmitted infection is already well-established. It is estimated that symptomatic carriers of N. gonorrhoeae and C. trachomatis have a relative risk of 4.8-fold and 3.6-fold, respectively, for the sexual acquisition of HIV. This type of evaluation for asymptomatic urethritis is necessary to reinforce strategies to combat HIV transmission. This study aims to assess the prevalence of patients with asymptomatic urethritis among men diagnosed with HIV-1 and determine the risk factors associated with this infection. METHODS: We enrolled a total of 115 male patients aged 18 years or older who have been diagnosed with HIV infection and have no symptoms of urethritis or other sexually transmitted infections and who have been evaluated between May and August 2015 in a follow-up visit at the Immunology Outpatient Clinic of a Brazilian University Hospital. RESULTS: Four asymptomatic patients were positive for C. trachomatis and were considered asymptomatic carriers of urethritis. Prevalence was 3.47%. Patients who were positive for C. trachomatis urethritis had a lower mean age (p = 0.015). CONCLUSION: The presence of asymptomatic sexually transmitted infection is a challenge in clinical practice. We recommend that, in outpatient practice, the habit of inquiring on previous sexual behavior to obtain more information about risks and associations with asymptomatic sexually transmitted infection, a routine physical examination and complementary tests to detect STI pathogens should be performed to discard these conditions. The development of rapid tests for this purpose should also be encouraged.
A PRISMA systematic review and meta-analysis on Chlamydia trachomatis infections in Iranian women (1986-2015).
Medicine. 2018 Apr; 97(16):e0335.BACKGROUND: Chlamydia trachomatis (CT) is the cause of genital tract infections in women. Some evidence has shown the role of this infection with CT in spontaneous abortions. The purpose of this study is to study the frequency of CT infection in Iranian women. METHODS: This study was performed based on PRISMA guidelines. A total of 75 articles published in Google Scholar, PubMed, ISI Web of Science, Biological abs, Iranmedex, SID, and Scopus databases were found (1986-2015) using the following keywords: CT in women, CT and Iranian women, CT and infection in Iran, CT and pregnancy in Iran, CT and preterm delivery in Iran, CT and preterm labor in Iran, CT and fertility in Iran, CT and infertility in Iran, and CT and abortion in Iran. Finally, 40 studies from different regions of Iran were included. Statistical analyses were performed using R3 and STATA 12. RESULTS: From 1986 to 2015, the lowest rate of prevalence was from 2010 to 2011 (3.9%) and the highest prevalence rate was in 2009 (69.39%) in northern Iran. Fixed effects for different parts of Iran (North, South, East, and West) were Pooled proportion: 0.13 (95% confidence interval [CI] = 0.12-0.14) and for samples (cervical, vaginal, urine, and blood) the pooled proportion was = 0.14 (95% CI = 0.12-0.14). CONCLUSION: CT infection in this study was prevalent in urine samples and the rate of CT was observed from culture methods in comparison to other methods. Because women with CT play an important role because of sexual activity for transmission and untreated women are at risk of developing sequels. Also, most studies in Iran use sensitive polymerase chain reaction tests for the detection of genital CT infections.
Bacterial vaginosis and associated risk factors in pregnant women attending Ante Natal Clinic at Pumwani Maternity Hospital – Kenya.
African Journal of Health Sciences. 2018 Jan-Mar; 31(1):13-30.Introduction: Bacterial vaginosis (BV) is a syndrome characterized by a shift in vaginal flora. It is a strong independent risk factor for adverse pregnancy outcomes, found in 9% to 23% of pregnant women. Not many studies on BV have been conducted among the pregnant women attending Pumwani Maternity Hospital in Kenya. This study defined the prevalence and factors for prevalence of BV in pregnant women attending Pumwani Maternity Hospital in Nairobi, Kenya. Methods: One hundred and fifty women who attended the Pumwani Maternity Hospital Ante natal clinic formed the basis of the study. This study received ethical approval from the Pumwani Maternity Hospital ante natal department and KEMRI ethics committee. Vaginal swabs were obtained from all the 150 women who consented and detailed demographic, sexual and genital hygiene interviews were collected. BV was tested using both the Amsel and Nugent’s criteria. Results: Of 150 participants, the mean age was 26.02 years, [range 22 (16 -38) years], 72.7% were aged 21-30 years. Sixty eight percent were unemployed, 72.6% married, 20.7% reported previous STI including HIV, 74%, the age of sexual debut was less than 16 years; 78% had a regular sexual partner, 87.3% of them were circumcised male partners, 24% reported douching and 47.3% reported genital washing after sex. Twenty point seven percent had BV by Nugent’s criteria. Bacterial vaginosis was associated with having given birth only once (20.3% vs. 19.1%; p=0.03), more than one previous birth (19.2% vs. 19.1%; p=0.026), previous STI (50% vs. 19.4%; p=0.042) and non-circumcised male partners (18.3% vs. 36.8%; p=0.033). Bacterial vaginosis is prevalent among pregnant women. The factors associated with BV include partners not being circumcised, primiparous and a history of previous STI infections Conclusion: Bacterial vaginosis is prevalent among pregnant women. The factors associated with BV include partners not being circumcised, primiparous and a history of previous STI infections.
Accuracy of syndromic management in targeting vaginal and cervical infections among symptomatic women of reproductive age attending primary care clinics in Dakar, Senegal.
Tropical Medicine and International Health. 2018 May; 23(5):541-548.Objective: To assess the effectiveness of the WHO syndromic algorithm in the management of vaginal discharge among women of reproductive age in Dakar. Methods: Cross-sectional study of consecutive female patients (aged 18–49 years) presenting with vaginal symptoms at six selected study sites in Dakar; of these, 276 patients were included in the analysis. Vaginal and cervical swab samples were collected and analysed to establish an aetiological diagnosis of any infection. Syndrome-based diagnosis was compared with the laboratory results to evaluate its accuracy based on sensitivity, specificity and positive and negative predictive values. The degree of agreement between the two approaches was assessed using the Cohen's kappa concordance analysis. Results: Overall prevalence of vaginal infections was 56.9% (157/276); 5.4% (15/276) of the patients had cervical infection. Using the syndromic approach, 51% of patients were correctly managed for Trichomonas vaginalis (TV)/Gardnerella vaginalis (GV); 61% for Candida albicans (CA) and 54% for Chlamydia trachomatis (CT)/Neisseria gonorrhoea (NG) infections. Consequently, 31% of patients with TV/GV, 51% with CA and 53% with CT/NG infections would have missed treatment. Further, the kappa value was <0.20, indicating that there was no agreement or only slight agreement between the syndromic approach and laboratory-based diagnosis. Conclusion: This study highlights the limitations of the applicability of the WHO syndromic approach in settings with low prevalence of sexually transmitted infections (STIs) and calls for affordable and accurate rapid tests for STIs.
Bulletin of the World Health Organization. 2017 Apr 1; 95(4):250-260.OBJECTIVE: To investigate, in Amhara, Ethiopia, the association between prevalence of active trachoma among children aged 1-9 years and community sanitation usage. METHODS: Between 2011 and 2014, prevalence of trachoma and household pit latrine usage were measured in five population-based cross-sectional surveys. Data on observed indicators of latrine use were aggregated into a measure of community sanitation usage calculated as the proportion of households with a latrine in use. All household members were examined for clinical signs, i.e. trachomatous inflammation, follicular and/or intense, indicative of active trachoma. Multilevel logistic regression was used to estimate prevalence odds ratios (OR) and 95% confidence intervals (CI), adjusting for community, household and individual factors, and to evaluate modification by household latrine use and water access. FINDINGS: In surveyed areas, prevalence of active trachoma among children was estimated to be 29% (95% CI: 28-30) and mean community sanitation usage was 47% (95% CI: 45-48). Despite significant modification (p < 0.0001), no pattern in stratified ORs was detected. Summarizing across strata, community sanitation usage values of 60 to < 80% and >/= 80% were associated with lower prevalence odds of active trachoma, compared with community sanitation usage of < 20% (OR: 0.76; 95% CI: 0.57-1.03 and OR: 0.67; 95% CI: 0.48-0.95, respectively). CONCLUSION: In Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level.
Bulletin of the World Health Organization. 2017 Apr 1; 95(4):261-269.OBJECTIVE: To compare immunization coverage and equity distribution of coverage between 2001 and 2014 in Nepal. METHODS: We used data from the Demographic and Health Surveys carried out in 2001, 2006 and 2011 together with data from the 2014 Multiple Indicator Cluster Survey. We calculated the proportion, in mean percentage, of children who had received bacille Calmette-Guerin (BCG) vaccine, three doses of polio vaccine, three doses of diphtheria-pertussis-tetanus (DPT) vaccine and measles vaccine. To measure inequities between wealth quintiles, we calculated the slope index of inequality (SII) and relative index of inequality (RII) for all surveys. FINDINGS: From 2001 to 2014, the proportion of children who received all vaccines at the age of 12 months increased from 68.8% (95% confidence interval, CI: 67.5-70.1) to 82.4% (95% CI: 80.7-84.0). While coverage of BCG, DPT and measles immunization statistically increased during the study period, the proportion of children who received the third dose of polio vaccine decreased from 93.3% (95% CI: 92.7-93.9) to 88.1% (95% CI: 86.8-89.3). The poorest wealth quintile showed the greatest improvement in immunization coverage, from 58% to 77.9%, while the wealthiest quintile only improved from 84.8% to 86.0%. The SII for children who received all vaccines improved from 0.070 (95% CI: 0.061-0.078) to 0.026 (95% CI: 0.013-0.039) and RII improved from 1.13 to 1.03. CONCLUSION: The improvement in immunization coverage between 2001 and 2014 in Nepal can mainly be attributed to the interventions targeting the disadvantaged populations.
Use of copper intrauterine device is not associated with higher bacterial vaginosis prevalence in Thai HIV-positive women.
AIDS Care. 2018 Nov; 30(11):1351-1355.The study assessed and compared bacterial vaginosis (BV) prevalence in Thai women in reproductive age in four study groups - group 1, HIV-positive with copper intrauterine device (Cu-IUD); group 2, HIV-positive without Cu-IUD; group 3, HIV-negative with Cu-IUD; and group 4, HIV-negative without Cu-IUD. We conducted a cross-sectional study. BV prevalence was assessed by Nugent score and Amsel criteria. Descriptive statistics was used to present baseline characteristics; kwallis rank test - to compare variables between the four groups; logistic regression - to assess factors, related to BV prevalence. The analysis included 137 women in the four study groups with a median age of 39 years. Median BV prevalence by Nugent score was 45%, intermediate vaginal flora - 7% and normal vaginal flora - 48%. There was no statistically significant difference in the BV prevalence between the four study groups, p = 0.711. Threefold lower BV prevalence was found, assessed by Amsel criteria compared to Nugent score. Women with body mass index (BMI) < 20 had higher probability to have BV or intermediate vaginal flora, OR = 3.11, 95% CI (1.2-8.6), p = 0.025. The study found a high BV prevalence in the four study groups, related neither to HIV status, nor to Cu-IUD use. BV prevalence was associated only with low BMI. Thus, Cu-IUD could be a good contraceptive choice for HIV-positive women. Research in defining normal vaginal microbiota and improve diagnostic methods for BV should continue.
Impact of targeted counseling on reported vaginal hygiene practices and bacterial vaginosis: the HIV Prevention Trials Network 035 study.
International Journal of STD and AIDS. 2017 Apr; 28(5):467-475.The objective of this study was to describe the impact of intense counseling to reduce vaginal hygiene practices and its effect on bacterial vaginosis. A secondary data analysis of the HIV Prevention Trials Network 035 study was undertaken, focusing on HIV-negative, nonpregnant women who were at least 18 years old, in seven African sites and one US site. At enrollment and during follow-up quarterly visits, vaginal hygiene practices were determined by face-to-face administration of a behavioral assessment questionnaire. Vaginal hygiene practices were categorized as insertion into the vagina of (1) nothing, (2) water only, and (3) other substances with or without water. Each practice was quantified by frequency and type/combination of inserted substances. At quarterly visits, diagnosis of bacterial vaginosis was made using the Nugent score. Trends for vaginal hygiene practices and bacterial vaginosis were evaluated using generalized estimating equation models. A total of 3087 participants from the HIV Prevention Trials Network 035 study were eligible for this analysis. At enrollment, 1859 (60%) reported recent vaginal hygiene practices. By one year, this figure had decreased to 1019 (33%) with counseling. However, bacterial vaginosis prevalence remained consistent across the study observation period, with 36%-38% of women testing positive for the condition ( p for trend = 0.27). Overall, those who reported douching with water only (AOR = 1.03, 95%CI: 0.94-1.13) and those who reported inserting other substances (AOR= 0.98, 95%CI: 0.88-1.09) in the past quarter were not more likely to have bacterial vaginosis compared to those who reported no insertions. However, in South Africa, an increase in bacterial vaginosis was seen among those who reported inserting other substances (AOR: 1.48, 95%CI: 1.17, 1.88). In conclusion, targeted counseling against vaginal hygiene practices resulted in change in self-reported behavior but did not have an impact on bacterial vaginosis diagnosis in all but one site.
Vaccine. 2017 Sep 25; 35(40):5352-5359.BACKGROUND: Maternal immunization against pertussis is a potential strategy to protect young infants from severe disease. We assessed factors associated with intention to accept pertussis vaccination among pregnant women in Karachi, Pakistan. METHODS: We conducted a cross-sectional survey between May and August 2013 in pregnant women who visited healthcare centers in urban slums of Karachi city. Women completed a survey examining socio-demographic factors, vaccination history, knowledge on pertussis disease, perception of vaccine recommendation sources, and potential influences on vaccine decision-making. RESULTS: Of the 283 participants, 259 (92%) provided their intention to either accept or decline pertussis vaccination. Eighty-three percent women were willing to accept the pertussis vaccine if offered during pregnancy. About half (53%) of the participants had ever heard of pertussis disease. Perceptions of pertussis vaccine efficacy, safety, and disease susceptibility were strongly associated with intention to accept pertussis vaccine (p<0.01). Healthcare providers, Ministry of Health, and mass media were considered as highly reliable sources of vaccine recommendation and associated with intention to accept antenatal pertussis vaccination (p<0.001). Healthcare provider recommendation was a common reason cited by respondents for pregnant women to accept antenatal pertussis vaccination (p=0.0005). However, opinion of primary decision-makers in the family (husbands and in-laws) was a crucial reason cited by respondents for pregnant women to reject pertussis vaccination in pregnancy (p=0.003). CONCLUSION: Antenatal pertussis vaccination initiatives in South Asia should strongly consider inclusion of family members, healthcare providers, national health ministries, and mass media to help implement new vaccination programs. Copyright (c) 2017 Elsevier Ltd. All rights reserved.
Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18 HIV prevention studies.
PLoS Medicine. 2018 Feb; 15(2):e1002511.BACKGROUND: Estimates of sexually transmitted infection (STI) prevalence are essential for efforts to prevent and control STIs. Few large STI prevalence studies exist, especially for low- and middle-income countries (LMICs). Our primary objective was to estimate the prevalence of chlamydia, gonorrhea, trichomoniasis, syphilis, herpes simplex virus type 2 (HSV-2), and bacterial vaginosis (BV) among women in sub-Saharan Africa by age, region, and population type. METHODS AND FINDINGS: We analyzed individual-level data from 18 HIV prevention studies (cohort studies and randomized controlled trials; conducted during 1993-2011), representing >37,000 women, that tested participants for >/=1 selected STIs or BV at baseline. We used a 2-stage meta-analysis to combine data. After calculating the proportion of participants with each infection and standard error by study, we used a random-effects model to obtain a summary mean prevalence of each infection and 95% confidence interval (CI) across ages, regions, and population types. Despite substantial study heterogeneity for some STIs/populations, several patterns emerged. Across the three primary region/population groups (South Africa community-based, Southern/Eastern Africa community-based, and Eastern Africa higher-risk), prevalence was higher among 15-24-year-old than 25-49-year-old women for all STIs except HSV-2. In general, higher-risk populations had greater prevalence of gonorrhea and syphilis than clinic/community-based populations. For chlamydia, prevalence among 15-24-year-olds was 10.3% (95% CI: 7.4%, 14.1%; I2 = 75.7%) among women specifically recruited from higher-risk settings for HIV in Eastern Africa and was 15.1% (95% CI: 12.7%, 17.8%; I2 = 82.3%) in South African clinic/community-based populations. Among clinic/community-based populations, prevalence was generally greater in South Africa than in Southern/Eastern Africa for most STIs; for gonorrhea, prevalence among 15-24-year-olds was 4.6% (95% CI: 3.3%, 6.4%; I2 = 82.8%) in South Africa and was 1.7% (95% CI: 1.2%, 2.6%; I2 = 55.2%) in Southern/Eastern Africa. Across the three primary region/population groups, HSV-2 and BV prevalence was high among 25-49-year-olds (ranging from 70% to 83% and 33% to 44%, respectively). The main study limitation is that the data are not from random samples of the target populations. CONCLUSIONS: Combining data from 18 HIV prevention studies, our findings highlight important features of STI/BV epidemiology among sub-Saharan African women. This methodology can be used where routine STI surveillance is limited and offers a new approach to obtaining critical information on STI and BV prevalence in LMICs.
Prevalence and antimicrobial susceptibility profile of Group B Streptococcus in pregnant women of Yaounde. Colonisation Génitale et Profil de Sensibilité du Streptocoque du Groupe B chez les Femmes Enceintes dans deux Hôpitaux de Yaoundé.
Health Sciences and Diseases. 2017 Oct-Dec; 18(4):21-25.Introduction. Early neonatal death remains a concern in sub-Saharan Africa. Vaginal colonization of streptococcus agalactia in pregnant women probably related to HIV status is the leading cause of neonatal infections. Prophylactic antibiotics protocols have not been adopted so far in our context. The objective of this study was to evaluate the prevalence of GBS in pregnant women, and its antimicrobial susceptibility profile. Methods. This was a cross sectional prospective study, conducted in two hospitals of Yaoundé. Pregnant women of a gestational age = to 31 completed weeks were included, for culture and identification of streptococcus B in cervico-vaginal secretions, and then tested for antimicrobial susceptibility to 14 antibiotics on three strains, according to 2013 CASFM recommendations. Results. 150 pregnant women were included. GBS prevalence was 21.3%. The highest frequency was found in women aged 25 to 30 years. GBS colonization rate was not related to gestational age or HIV status. The three strains were resistant to penicillin and ampicillin and sensitive to vancomycin and pristamycine only. Conclusion. GBS colonization rate is high in pregnant women in Yaounde city. It is related to age but not to gestational age or HIV status. All the strains of GBS are resistant to recommended antibiotics for per partum antibioprophylaxis.
Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study.
BMJ Open. 2016 Aug 26; 6(8):e013015.OBJECTIVES: Aggregate data on childhood immunisation from urban settings may not reflect the coverage among the urban poor. This study provides information on complete childhood immunisation coverage among the urban poor, and explores its household and neighbourhood-level determinants. SETTING: Urban poor community in the Southeast district of Delhi, India. PARTICIPANTS: We randomly sampled 1849 children aged 1-3.5 years from 13 451 households in 39 clusters (cluster defined as area covered by a community health worker) in 2 large urban poor settlements. Of these, 1343 completed the survey. We collected information regarding childhood immunisation (BCG, oral polio vaccine, diphtheria-pertussis-tetanus vaccine, hepatitis B and measles) from vaccination cards or mothers' recall. We used random intercept logistic regression to explore the sociodemographic determinants of complete immunisation. RESULTS: Complete immunisation coverage was 46.7% and 7.5% were not immunised. The odds of complete vaccination (OR, 95% CI) were lower in female children (0.70 (0.55 to 0.89)) and Muslim households (0.65 (0.45 to 0.94)). The odds of complete vaccination were higher if the mother was literate (1.6 (1.15 to 2.16)), if the child was born within the city (2.7 (1.97 to 3.65)), in a health facility ( 1.5 (1.19 to 2.02)), belonged to the highest wealth quintile (compared with the poorest; 2.46 (1.5 to 4.02)) or possessed a birth certificate (1.40 (1.03 to 1.91)). Cluster effect due to unmeasured neighbourhood factors expressed as median OR was 1.32. CONCLUSIONS: Immunisation coverage in this urban poor area was much lower than that of regional surveys reporting overall urban data. Socioeconomic status of the household, female illiteracy, health awareness and gender inequality were important determinants of coverage in this population. Hence, in addition to enhancing the infrastructure for providing mother and child services, efforts are also needed to address these issues in order to improve immunisation coverage in deprived urban communities. TRIAL REGISTRATION NUMBER: CTRI/2011/091/000095. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Assessing the Evidence for Maternal Pertussis Immunization: A Report From the Bill & Melinda Gates Foundation Symposium on Pertussis Infant Disease Burden in Low- and Lower-Middle-Income Countries.
Clinical Infectious Diseases. 2016 Dec 1; 63(suppl 4):S123-S133.Implementation of effective interventions has halved maternal and child mortality over the past 2 decades, but less progress has been made in reducing neonatal mortality. Almost 45% of under-5 global mortality now occurs in infants <1 month of age, with approximately 86% of neonatal deaths occurring in low- and lower-middle-income countries (LMICs). As an estimated 23% of neonatal deaths globally are due to infectious causes, maternal immunization (MI) is one intervention that may reduce mortality in the first few months of life, when direct protection often relies on passively transmitted maternal antibodies. Despite all countries including pertussis-containing vaccines in their routine childhood immunization schedules, supported through the Expanded Programme on Immunization, pertussis continues to circulate globally. Although based on limited robust epidemiologic data, current estimates derived from modeling implicate pertussis in 1% of under-5 mortality, with infants too young to be vaccinated at highest risk of death. Pertussis MI programs have proven effective in reducing infant pertussis mortality in high-income countries using tetanus-diphtheria-acellular pertussis (Tdap) vaccines in their maternal and infant programs; however, these vaccines are cost-prohibitive for routine use in LMICs. The reach of antenatal care programs to deliver maternal pertussis vaccines, particularly with respect to infants at greatest risk of pertussis, needs to be further evaluated. Recognizing that decisions on the potential impact of pertussis MI in LMICs need, as a first step, robust contemporary mortality data for early infant pertussis, a symposium of global key experts was held. The symposium reviewed current evidence and identified knowledge gaps with respect to the infant pertussis disease burden in LMICs, and discussed proposed strategies to assess the potential impact of pertussis MI. (c) The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.
What Pertussis Mortality Rates Make Maternal Acellular Pertussis Immunization Cost-Effective in Low- and Middle-Income Countries? A Decision Analysis.
Clinical Infectious Diseases. 2016 Dec 1; 63(suppl 4):S227-S235.BACKGROUND: Despite longstanding infant vaccination programs in low- and middle-income countries (LMICs), pertussis continues to cause deaths in the youngest infants. A maternal monovalent acellular pertussis (aP) vaccine, in development, could prevent many of these deaths. We estimated infant pertussis mortality rates at which maternal vaccination would be a cost-effective use of public health resources in LMICs. METHODS: We developed a decision model to evaluate the cost-effectiveness of maternal aP immunization plus routine infant vaccination vs routine infant vaccination alone in Bangladesh, Nigeria, and Brazil. For a range of maternal aP vaccine prices, one-way sensitivity analyses identified the infant pertussis mortality rates required to make maternal immunization cost-effective by alternative benchmarks ($100, 0.5 gross domestic product [GDP] per capita, and GDP per capita per disability-adjusted life-year [DALY]). Probabilistic sensitivity analysis provided uncertainty intervals for these mortality rates. RESULTS: Infant pertussis mortality rates necessary to make maternal aP immunization cost-effective exceed the rates suggested by current evidence except at low vaccine prices and/or cost-effectiveness benchmarks at the high end of those considered in this report. For example, at a vaccine price of $0.50/dose, pertussis mortality would need to be 0.051 per 1000 infants in Bangladesh, and 0.018 per 1000 in Nigeria, to cost 0.5 per capita GDP per DALY. In Brazil, a middle-income country, at a vaccine price of $4/dose, infant pertussis mortality would need to be 0.043 per 1000 to cost 0.5 per capita GDP per DALY. CONCLUSIONS: For commonly used cost-effectiveness benchmarks, maternal aP immunization would be cost-effective in many LMICs only if the vaccine were offered at less than $1-$2/dose. (c) The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.
Costs of introducing pneumococcal, rotavirus and a second dose of measles vaccine into the Zambian immunisation programme: Are expansions sustainable?
Vaccine. 2016 Jul 29; 34(35):4213-4220.BACKGROUND: Introduction of new vaccines in low- and lower middle-income countries has accelerated since Gavi, the Vaccine Alliance was established in 2000. This study sought to (i) estimate the costs of introducing pneumococcal conjugate vaccine, rotavirus vaccine and a second dose of measles vaccine in Zambia; and (ii) assess affordability of the new vaccines in relation to Gavi's co-financing and eligibility policies. METHODS: Data on 'one-time' costs of cold storage expansions, training and social mobilisation were collected from the government and development partners. A detailed economic cost study of routine immunisation based on a representative sample of 51 health facilities provided information on labour and vaccine transport costs. Gavi co-financing payments and immunisation programme costs were projected until 2022 when Zambia is expected to transition from Gavi support. The ability of Zambia to self-finance both new and traditional vaccines was assessed by comparing these with projected government health expenditures. RESULTS: 'One-time' costs of introducing the three vaccines amounted to US$ 0.28 per capita. The new vaccines increased annual immunisation programme costs by 38%, resulting in economic cost per fully immunised child of US$ 102. Co-financing payments on average increased by 10% during 2008-2017, but must increase 49% annually between 2017 and 2022. In 2014, the government spent approximately 6% of its health expenditures on immunisation. Assuming no real budget increases, immunisation would account for around 10% in 2022. Vaccines represented 1% of government, non-personnel expenditures for health in 2014, and would be 6% in 2022, assuming no real budget increases. CONCLUSION: While the introduction of new vaccines is justified by expected positive health impacts, long-term affordability will be challenging in light of the current economic climate in Zambia. The government needs to both allocate more resources to the health sector and seek efficiency gains within service provision. Copyright (c) 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Expansion of Vaccination Services and Strengthening Vaccine-Preventable Diseases Surveillance in Haiti, 2010-2016.
American Journal of Tropical Medicine and Hygiene. 2017 Oct; 97(4_Suppl):28-36.Following the 2010 earthquake, Haiti was at heightened risk for vaccine-preventable diseases (VPDs) outbreaks due to the exacerbation of long-standing gaps in the vaccination program and subsequent risk of VPD importation from other countries. Therefore, partners supported the Haitian Ministry of Health and Population to improve vaccination services and VPD surveillance. During 2010-2016, three polio, measles, and rubella vaccination campaigns were implemented, achieving a coverage > 90% among children and maintaining Haiti free of those VPDs. Furthermore, Haiti is on course to eliminate maternal and neonatal tetanus, with 70% of communes achieving tetanus vaccine two-dose coverage > 80% among women of childbearing age. In addition, the vaccine cold chain storage capacity increased by 91% at the central level and 285% at the department level, enabling the introduction of three new vaccines (pentavalent, rotavirus, and pneumococcal conjugate vaccines) that could prevent an estimated 5,227 deaths annually. Haiti moved from the fourth worst performing country in the Americas in 2012 to the sixth best performing country in 2015 for adequate investigation of suspected measles/rubella cases. Sentinel surveillance sites for rotavirus diarrhea and meningococcal meningitis were established to estimate baseline rates of those diseases prior to vaccine introduction and to evaluate the impact of vaccination in the future. In conclusion, Haiti significantly improved vaccination services and VPD surveillance. However, high dependence on external funding and competing vaccination program priorities are potential threats to sustaining the improvements achieved thus far. Political commitment and favorable economic and legal environments are needed to maintain these gains.