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Your search found 6 Results

  1. 1

    Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa: A systematic literature review.

    Gumede-Moyo S; Filteau S; Munthali T; Todd J; Musonda P

    Medicine. 2017 Oct; 96(40):e8055.

    BACKGROUND: To synthesize and evaluate the impact of implementing post-2010 World Health Organization (WHO) prevention of mother-to-child transmission (PMTCT) guidelines on attainment of PMTCT targets. METHODS: Retrospective and prospective cohort study designs that utilized routinely collected data with a focus on provision and utilization of the cascade of PMTCT services were included. The outcomes included the proportion of pregnant women who were tested during their antenatal clinic (ANC) visits; mother-to-child transmission (MTCT) rate; adherence; retention rate; and loss to follow-up (LTFU). RESULTS: Of the 1210 references screened, 45 met the inclusion criteria. The studies originated from 14 countries in sub-Saharan Africa. The highest number of studies originated from Malawi (10) followed by Nigeria and South Africa with 7 studies each. More than half of the studies were on option A while the majority of option B+ studies were conducted in Malawi. These studies indicated a high uptake of human immunodeficiency virus (HIV) testing ranging from 75% in Nigeria to over 96% in Zimbabwe and South Africa. High proportions of CD4 count testing were reported in studies only from South Africa despite that in most of the countries CD4 testing was a prerequisite to access treatment. MTCT rate ranged from 1.1% to 15.1% and it was higher in studies where data were collected in the early days of the WHO 2010 PMTCT guidelines. During the postpartum period, adherence and retention rate decreased, and LTFU increased for both HIV-positive mothers and exposed infants. CONCLUSION: Irrespective of which option was followed, uptake of antenatal HIV testing was high but there was a large drop off along later points in the PMTCT cascade. More research is needed on how to improve later components of the PMTCT cascade, especially of option B+ which is now the norm throughout sub-Saharan Africa.
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  2. 2
    Peer Reviewed

    Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh.

    Saha KK; Frongillo EA; Alam DS; Arifeen SE; Persson LA; Rasmussen KM

    American Journal of Clinical Nutrition. 2008 Jun; 87(6):1852-1859.

    The World Health Organization and the United Nations International Children's Emergency Fund recommend a global strategy for feeding infants and young children for proper nutrition and health. We evaluated the effects of following current infant feeding recommendations on the growth of infants and young children in rural Bangladesh. The prospective cohort study involved 1343 infants with monthly measurements on infant feeding practices (IFPs) and anthropometry at 17 occasions from birth to 24 mo of age to assess the main outcomes of weight, length, anthropometric indexes, and undernutrition. We created infant feeding scales relative to the infant feeding recommendations and modeled growth trajectories with the use of multilevel models for change. Mean (+or- SD) birth weight was 2697 +or- 401 g; 30%weighed less than 2500 g. Mean body weight at 12 and 24 mo was 7.9 +or- 1.1 kg and 9.7 +or- 1.3 kg, respectively. More appropriate IFPs were associated (P less than 0.001) with greater gain in weight andlength during infancy. Prior IFPs were also positively associated (P less than 0.005) with subsequent growth in weight during infancy. Children who were in the 75th percentile of the infant feeding scales had greater (P less than 0.05) attained weight and weight-for-age z scores and lower proportions of underweight compared with children who were in the 25th percentile of these scales. Our results provide strong evidence for the positive effects of following the current infant feeding recommendations on growth of infants and young children. Intervention programs should strive to improve conditions for enhancing current infant feeding recommendations, particularly in low-income countries. (author's)
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  3. 3

    School-age children: their nutrition and health.

    Drake L; Maier C; Jukes M; Patrikios A; Bundy D

    SCN News. 2002 Dec; (25):4-30.

    This paper addresses the most common nutrition and health problems in turn, assessing the extent of the problem; the impact of the condition on overall development, and what programmatic responses can be taken to remedy the problem through the school sys- tern. The paper also acknowledges that an estimated 113m children of school-age are not in school, the majority of these children living in Sub-Saharan Africa and South-East Asia. Poor health and nutrition that differentially affects this population is also discussed. (excerpt)
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  4. 4
    Peer Reviewed

    The prognostic value of the World Health Organisation staging system for HIV infection and disease in rural Uganda.

    Malamba SS; Morgan D; Clayton T; Mayanja B; Okongo M

    AIDS. 1999; 13(18):2555-62.

    The objective was to assess whether the WHO staging classification for HIV provides prognostically valuable and applicable information in rural Uganda. Data were obtained from a population-based cohort of 232 HIV-infected individuals. Clinical information was obtained using a detailed questionnaire and ascertained by physical examination. Participants were seen routinely every 3 months and when they were sick. A computer algorithm based on clinical history, examination and laboratory findings was used to stage HIV-positive participants at each routine visit. Kaplan-Meier survival estimates and the Cox proportional hazard model were used to assess the prognostic strength of the clinical and laboratory categories of the system. An attendance rate of 81% and 799 person-years of follow-up were achieved. Survival probability estimates at 6 years from being seen in clinical stages 1, 2, 3, and 4 were 63%, 46%, 24%, and 6%, respectively. When staging was revised to incorporate lymphocyte categories, the survival probabilities were 73%, 62%, 39%, and 6%, respectively. Unexplained prolonged fever and severe bacterial infection had survival probabilities closer to stage 2 conditions, mucocutaneous herpes simplex virus infection for more than 1 month and cryptosporidiosis with diarrhea for more than 1 month closer to stage 3 and oral candidiasis closer to stage 4 conditions. Even without the laboratory markers, the clinical category of the WHO staging system is useful for predicting survival in individuals with HIV disease. This is important for areas with limited access to laboratory markers. A simple rearrangement of a few clinical conditions could improve the prognostic significance of the WHO system. (author's)
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  5. 5
    Peer Reviewed

    Classification of HIV infection and disease in women from Rwanda. Evaluation of the World Health Organization HIV staging system and recommended modifications.

    Lifson AR; Allen S; Wolf W; Serufilira A; Kantarama G; Lindan CP; Hudes ES; Nsengumuremyi F; Taelman H; Batungwanayo J

    ANNALS OF INTERNAL MEDICINE. 1995 Feb 15; 122(4):262-70.

    In Rwanda, health workers followed 412 HIV infected women attending prenatal and pediatric outpatient clinics in Kigali for 4 years. Researchers used these findings to evaluate WHO's HIV Staging System and predictors of mortality and to produce an HIV staging system for sub-Saharan Africa. The 36-month cumulative mortality was 9% for women originally in stage I, 15% for those in stage II, and 25% for those in stage III, and 27% for those in stage IV (p = 0.001). Significant predictors of mortality at 36 months were oral candidiasis, a low body mass index (=or< 19 kg/sq. m), a history of oral or genital ulcers (especially chronic ulcers), a low hematocrit (<0.38), and a high erythrocyte sedimentation rate (>65 mm/h) (p < 0.001). 12 of the 96 women who died by 36 months had developed pulmonary or extrapulmonary tuberculosis (TB). The researchers revised the WHO system by adding oral candidiasis, chronic oral or genital ulcers, and pulmonary TB to clinical stage IV (severe HIV disease). In the laboratory axis of the system, they replaced lymphocyte count with hematocrit and erythrocyte sedimentation rate. Using the modified laboratory axis, the 36-month mortality rate was 10% for women with normal laboratory results (stage A) and 33% for those with low hematocrit and a high erythrocyte sedimentation rate (stage B). Based on the proposed single staging system, the 36-month mortality rate was 7% for women in stage I, 10% for those in stage II, 29% for those in stage III, and 62% for those in stage IV (p < 0.001). The researchers used these results to propose a staging system that is relevant for sub-Saharan Africa, considers the extent of HIV-related outcomes, requires only inexpensive and available laboratory tests, and has clear prognostic significance. Both clinicians and researchers can use this modified staging system.
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  6. 6
    Peer Reviewed

    Validation of the proposed World Health Organization staging system for HIV disease and infection in a cohort of intravenous drug users.

    Aylward RB; Vlahov D; Munoz A; Rapiti E

    AIDS. 1994 Aug; 8(8):1129-33.

    In Maryland, researchers aimed to determine whether clinical staging using the World Health Organization (WHO) proposed system would predict progression from HIV seropositivity to AIDS. They used product-limit estimates with right censoring to compare time of progression to AIDS among 694 intravenous drug users (IVDUs) in Baltimore who were HIV-positive by January, 1992, from each of the WHO proposed system's 1st 3 clinical stages. The researchers used Cox proportional hazard methods to examine the effect of race, sex, age, and baseline injection status on the risk of progression by clinical stage. Most of the participants were Black (95%), poor (legal income of <$5000/year, 78%), and male (75.8%). Many (35%) were homeless. At the time of the index visit, the proportion of IVDUs at WHO stages 1, 2, and 3 were 49%, 10%, and 41%, respectively. At the end of the study period, 67 (9.7%) of all IVDUs had progressed to AIDS. The product-limit estimates for progression to AIDS over a 3-year period indicate that the risk of progression to AIDS increases as the stages advance (6.5% for stage 1, 10.4% for stage 2, and 17.1% for stage 3; logrank p = .003). Age, race, sex, and baseline injection status did not affect the association between initial clinical stage and progression. The hazard for progression to AIDS relative to stage 1 was 1.51 for stage 2 and 2.39 for stage 3. These findings suggest that WHO'S proposed staging system for HIV infection and AIDS may predict progression from HIV seropositivity to AIDS using clinical criteria alone. This system would be most useful in areas with limited routine access to laboratory markers (e.g., CD4 counts), such as in many developing countries.
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