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Perinatal Exposure to HIV Infection: The Experience of Craiova Regional Centre, Romania. Healthcare (Basel) 2022; 10:healthcare10020308. [PMID: 35206923 PMCID: PMC8871740 DOI: 10.3390/healthcare10020308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 02/05/2023] Open
Abstract
Background and objectives: HIV infection in pregnant women can be responsible for a number of consequences during pregnancy, such as: maternal anaemia, miscarriage, low birth weight, and preterm birth. The objectives of this study were to determine the maternal–foetal transmission rate of HIV among pregnant women living with HIV from Craiova Regional Centre in order to assess the risk factors for mother-to-child transmission of HIV and to identify the characteristics of newborns perinatally exposed to HIV. Materials and methods: A retrospective study was conducted between 1 January 2011 and 31 December 2020, including children born to HIV-positive mothers. Results: The studied group included 138 newborns and was divided into two subgroups: group A, which included 10 HIV-infected infants; and group B, which included 128 uninfected infants. The mother-to-child transmission rate was 3.5% for women to whom all prophylaxis standards were applied. We found a statistically significant correlation between the level of maternal HIV viremia and perinatal HIV transmission (p = 0.01). Preterm birth and low birth weight were associated with perinatal transmission of the infection. Conclusions: Perinatal transmission of HIV infection during our study was associated with inconsistent application of screening for HIV infection among pregnant women, lack of antiretroviral therapy, poor adherence to treatment, and detectable HIV viral load during pregnancy.
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Ekali GL, Jesson J, Enok PB, Leroy V. Effect of in utero exposure to HIV and antiretroviral drugs on growth in HIV-exposed uninfected children: a systematic review and meta-analysis protocol. BMJ Open 2019; 9:e023937. [PMID: 31229997 PMCID: PMC6596996 DOI: 10.1136/bmjopen-2018-023937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION HIV-exposed uninfected (HEU) children have higher morbidity and mortality compared with HIV unexposed uninfected children. Despite the fact that malnutrition contributes to about half of all infant deaths below 5 years of age in low-income and middle-income countries and that growth impairment has been reported in the HEU population, the spectrum of growth disorders associated with HIV and antiretroviral therapy (ART) exposure during the in utero and perinatal periods is yet to comprehensively summarised among the global HEU population. This protocol for a systematic review and meta-analysis aims to critically synthesise data concerning the prevalence of underweight, stunting and wasting at different ages in the global HEU population. METHODS AND ANALYSIS Medline, EMBASE, Cochrane Library, TOXLINE, WHO Global Index Medicus and the Web of Science will be searched for relevant articles published between 1 January 1989 and 1 December 2017 without language restriction. In addition, conference abstracts and reference lists of eligible papers and relevant review articles will be screened. Authors will screen and select studies, extract data, assess the risk of bias as well as studies individually for heterogeneity. Study-specific estimates will be pooled through a random-effects meta-analysis model for studies that are clinically homogeneous while funnel plots and Egger's test will be used to detect publication bias. Results will be presented by ART availability period, country income levels and mode of breastfeeding. ETHICS AND DISSEMINATION Ethical approval will not be required for this study because it will be based on published data. The final report of this study will be published in a peer-reviewed journal and presented at scientific conferences. This review will summarise the evidence and quantify the problem of growth impairment in HEU infants and so shed more light on our understanding of the higher morbidity and mortality in this growing population. PROSPERO REGISTRATION NUMBER CRD42018091762.
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Affiliation(s)
- Gabriel L Ekali
- Biotechnology Center, Universite de Yaounde I, Yaounde, Cameroon
- National AIDS Control Committee, Cameroon
- Inserm UMR 1027, Universite Toulouse III Paul Sabatier, Toulouse, France
| | - Julie Jesson
- Inserm UMR 1027, Universite Toulouse III Paul Sabatier, Toulouse, France
| | - Pascal B Enok
- Department of Preventive Medicine, University of Montreal, Montreal, Canada
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Tenthani L, van Oosterhout JJ, Haas AD, Msukwa M, Phiri N, Chimbwandira F, Tal K, Aebi-Popp K, Estill J, Keiser O. Patterns of caesarean section in HIV infected and non-infected women in Malawi: is caesarean section used for PMTCT? BMC Pregnancy Childbirth 2018; 18:95. [PMID: 29649980 PMCID: PMC5897999 DOI: 10.1186/s12884-018-1722-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/28/2018] [Indexed: 11/15/2022] Open
Abstract
Background Caesarean section (CS) is not recommended for PMTCT in Malawi HIV Guidelines, contrary to most high-income countries where CS is indicated if viral suppression is sub-optimal pre-delivery. We describe patterns of CS in HIV-infected and uninfected women in Malawi and explored if insight into the use of Elective CS (ECS) for PMTCT could be obtained. Methods We used routinely collected data from individual medical records from 17 large health facilities in the central and southern regions of Malawi, from January 2010 to December 2013. We included data from maternity registers from all HIV-positive women, and randomly selected around every fourth woman with negative or unknown HIV status. We used multivariable logistic regressions and cluster-based robust standard errors to examine independent associations of patient- and facility characteristics with CS and ECS. Results We included 62,033 women in the analysis. The weighted percentage of women who had a spontaneous vaginal delivery was 80.0% (CI 95% 79.5–80.4%); 2.4% (95% CI 2.3–2.6%) had a vacuum extraction; 2.3% (95% CI 2.2–2.5%) had a vaginal breech delivery; 14.0% (95% CI 13.6–14.4%) had a CS while for 1.3% (95% CI 1.2–1.4%) the mode of delivery was not recorded. Prevalence of CS without recorded medical or obstetric indication (ECS) was 5.1%, (n = 3152). Presence of maternal and infant complications and older age were independently associated with CS delivery. HIV-positive women were less likely to have ECS than HIV negative women (aOR 0.65; 95%-CI 0.57–0.74). Among HIV-positive women, those on antiretrovirals (ARV’s) for ≥4 weeks prior to delivery were less likely to have ECS than HIV-positive women who had not received ARVs during pregnancy (aOR 0.81; 95% CI 0.68–0.96). Conclusions The pattern of CS’s in Malawi is largely determined by maternal and infant complications. Positive HIV status was negatively associated with CS delivery, possibly because health care workers were concerned about the risk of occupational HIV transmission and the known increased risk of post-operative complications. Our results leave open the possibility that CS is practiced to prevent MTCT given that ECS was more common among women at high risk of MTCT due to no or short exposure to ARV’s. Electronic supplementary material The online version of this article (10.1186/s12884-018-1722-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lyson Tenthani
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi. .,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. .,International Training and Education Center for Health, P.O Box 30369, Lilongwe 3, Malawi.
| | - Joep J van Oosterhout
- Dignitas International, Zomba, Malawi.,Department of Medicine, College of Medicine, Blantyre, Malawi
| | - Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Malango Msukwa
- The Baobab Health Trust, Lilongwe, Malawi.,Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Nozgechi Phiri
- The Baobab Health Trust, Lilongwe, Malawi.,Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - Kali Tal
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
| | - Janne Estill
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Olivia Keiser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Institute of Global Health, University of Geneva, Geneva, Switzerland
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Nyandat J, van Rensburg G. Non-disclosure of HIV-positive status to a partner and mother-to-child transmission of HIV: Evidence from a case-control study conducted in a rural county in Kenya. South Afr J HIV Med 2017; 18:691. [PMID: 29568627 PMCID: PMC5843143 DOI: 10.4102/sajhivmed.v18i1.691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 07/14/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Many factors contribute to an enhanced risk of infant HIV acquisition, two of which may include failure of a mother to disclose her HIV-positive status to her partner and exclusion of male partners in preventing mother-to-child transmission of HIV (PMTCT) interventions. To justify why HIV programmes need to integrate male partner involvement and partner disclosure, we need to establish an association between the two factors and infant HIV acquisition. OBJECTIVE To determine whether failure to disclose an HIV-positive status to a male partner is associated with increased risk of infant HIV acquisition, and whether part of the association is explained by exclusion of male partner in PMTCT programmes. METHODS Using a case-control study design, we identified a total of 180 mother-baby pairs with HIV-exposed infants. Thirty-six pairs with HIV-positive babies (cases) were compared to 144 pairs with HIV-negative babies (controls) on whether the mothers had disclosed their HIV status to their partner in order to determine whether a disclosure or lack of it contributed to increased risk of mother-to-child transmission of HIV (MTCT). Each case pair was matched to four control pairs from the same facility. RESULTS Overall, 16.7% of mothers had not disclosed their HIV status to their partners, the proportion being significantly more among cases (52.8% vs. 7.6%, p < 0.001). Non-disclosure was significantly associated with infant HIV acquisition (aOR 9.8 (3.0-26.3); p < 0.001) and male partner involvement partially mediated the effect of non-disclosure on infant HIV acquisition (indirect coefficient = 0.17, p < 0.005). CONCLUSIONS Failure of an HIV-positive woman to disclose her status to her male partner and exclusion of male partners in PMTCT programmes are two social factors that may curtail success of interventions towards the goal of eliminating MTCT.
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Affiliation(s)
- Joram Nyandat
- Department of Health Studies, University of South Africa, South Africa
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Wariki WMV, Ota E, Mori R, Wiysonge CS, Horvath H, Read JS. Interventions for preventing mother-to-child HIV transmission: protocol of an overview of systematic reviews. BMJ Open 2017; 7:e014332. [PMID: 28637726 PMCID: PMC5623404 DOI: 10.1136/bmjopen-2016-014332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/29/2017] [Accepted: 04/07/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Various interventions to prevent mother-to-child-transmission (MTCT) of HIV have been investigated and implemented. A number of systematic reviews assessing the efficacy of interventions for the prevention of MTCT of HIV reported antiretroviral prophylaxis, caesarean section before labour and before ruptured membranes, and complete avoidance of breastfeeding were efficacious for preventing MTCT of HIV. Recent WHO guidelines recommend lifelong antiretroviral therapy for all pregnant women for treatment of the woman's own HIV infection and for prevention of MTCT of HIV. Therefore, the objective of this overview is to evaluate the currently available systematic reviews of interventions for preventing MTCT of HIV, and to identify the current best evidence-based interventions for reducing the risk of MTCT of HIV. METHODS AND ANALYSIS We will include only peer-reviewed systematic reviews of randomised or quasi-randomised controlled trials assessing the effects of interventions for preventing MTCT of HIV that target both HIV-infected women and children aged 2 years and younger born to HIV-infected women. We will search the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effectiveness, Ovid MEDLINE and EMBASE. We will assess review eligibility, the methodological quality of included systematic reviews using A Measurement Tool to Assess The Systematic Reviews and will extract data, comparing our results and resolving discrepancies by consensus. Finally, we will independently assess the certainty of the evidence using Grades of Recommendation, Assessment, Development and Evaluation. ETHICS AND DISSEMINATION Ethics approval is not required. We will publish the results in a peer-reviewed journal and present at conferences, which will inform future research and will be useful for healthcare managers, administrators and policymakers to guide resource allocation decisions and optimisation of interventions to prevent the MTCT of HIV.
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Affiliation(s)
| | - Erika Ota
- Graduate School of Nursing Science, Global Health Nursing, St. Luke’s International University, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Hacsi Horvath
- Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jennifer S Read
- Global Health Sciences, University of California San Francisco, San Francisco, California, USA
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Timely antiretroviral prophylaxis during pregnancy effectively reduces HIV mother-to-child transmission in eight counties in China: a prospective study during 2004-2011. Sci Rep 2016; 6:34526. [PMID: 27721453 PMCID: PMC5056360 DOI: 10.1038/srep34526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 09/15/2016] [Indexed: 11/09/2022] Open
Abstract
This study investigates the improvement of the prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in China during 2004-2011. A clinic-based prospective study was conducted among HIV-positive pregnant women and their children in eight counties across China. Associated factors of mother-to-child transmission were analyzed using regression analysis. A total of 1,387 HIV+ pregnant women and 1,377 HIV-exposed infants were enrolled. The proportion of pregnant women who received HIV testing increased significantly from 45.1% to 98.9% during 2004-2011. Among whom, the proportion that received antiretroviral (ARV) prophylaxis increased from 61% to 96%, and the corresponding coverage in children increased from 85% to 97% during the same period. In contrast, single-dose nevirapine treatment during delivery declined substantially from 97.9% to 12.7%. Vertical transmission of HIV declined from 11.1% (95% confidence interval [CI]: 5.7-23.3%) in 2004 to 1.2% (95% CI: 0.1-5.8%) in 2011. Women who had a vaginal delivery (compared to emergency caesarian section (odds ratio [OR] = 0.46; 0.23-0.96)) and mothers on multi-ARVs (OR = 0.11; 0.04-0.29) were less likely to transmit HIV to their newborns. Increasing HIV screening enabled timely HIV care and prophylaxis to reduce vertical transmission of HIV. Early and consistent treatment with multi-ARVs during pregnancy is vital for PMTCT.
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Li B, Zhao Q, Zhang X, Wu L, Chen T, Liang Z, Xu L, Yu S. Effectiveness of a prevention of mother-to-child HIV transmission program in Guangdong province from 2007 to 2010. BMC Public Health 2013; 13:591. [PMID: 23773623 PMCID: PMC3726283 DOI: 10.1186/1471-2458-13-591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/26/2013] [Indexed: 11/12/2022] Open
Abstract
Background To achieve the goal of United Nations of elimination of new HIV infections, a program of prevention of mother-to-child transmission (PMTCT) was launched in Guangdong province. The objective of this study is to evaluate the effectiveness of the PMTCT program. Methods The retrospective cross-section analysis was conducted using the data of case reported cards of HIV positive mothers and their infants from 2007 to 2010 in Guangdong province, and 108 pairs of eligible subjects were obtained. We described the data and compared the rates of MTCT by various PMTCT interventions respectively. Results The overall rate of HIV MTCT was 13.89% (15) among 108 pairs of HIV positive mothers and their infants; 60.19% (65) of the mothers ever received ARVs, 80.56% (87) of infants born to HIV positive mothers ever received ARVs, but 16.67% (18) of the mothers and infants neither received ARVs. Among all the mothers and infants, who both received ARVs, received triple ARVs, mother received ARVs during pregnancy, and both received ARVs and formula feeding showed the lower rates of HIV MTCT, and the rates were 8.06%, 2.50%, 5.77%, and 6.67% respectively. In infants born to HIV positive mother, who received mixed feeding had a higher HIV MTCT up to 60.00%. Delivery mode might not relative to HIV MTCT. Conclusions The interventions of PMTCT program in Guangdong could effectively reduce the rate of HIV MTCT, but the effectiveness of the PMTCT program were heavily cut down by the lower availability of the PMTCT interventions.
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Affiliation(s)
- Bing Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou North Road 1838, Guangzhou 510515, China
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de Ruiter A, Mercey D, Anderson J, Chakraborty R, Clayden P, Foster G, Gilling-Smith C, Hawkins D, Low-Beer N, Lyall H, O'Shea S, Penn Z, Short J, Smith R, Sonecha S, Tookey P, Wood C, Taylor G. British HIV Association and Children's HIV Association guidelines for the management of HIV infection in pregnant women 2008. HIV Med 2009; 9:452-502. [PMID: 18840151 DOI: 10.1111/j.1468-1293.2008.00619.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A de Ruiter
- Guy's & St Thomas' NHS Foundation Trust, London, UK.
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Holmes C, Preko P, Bolds R, Baidoo J, Jolly P. Acceptance of Voluntary Counselling, Testing and Treatment for HIV Among Pregnant Women in Kumasi, Ghana. Ghana Med J 2008; 42:8-15. [PMID: 18560557 PMCID: PMC2423339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
SUMMARY BACKGROUND Voluntary counselling and testing (VCT) for human immunodeficiency virus (HIV) and treatment of positive pregnant women can reduce mother to child transmission (MTCT) of HIV. OBJECTIVE This study was conducted to assess acceptance of HIV VCT and antiretroviral therapy (ART) by pregnant women in Kumasi, Ghana, before and after VCT and ART were available. METHODS Two cross-sectional studies were conducted among women in antenatal clinics. The first, in 2003 among 501 women, before VCT and ART were available in Kumasi. Women who were willing were counselled and tested for HIV. In 2005, after the introduction of VCT and ART by the Ghana Health Service, 675 pregnant women were surveyed regarding HIV/VCT acceptance and uptake. RESULTS In 2003, 98% of women accepted counselling and 97% accepted testing; 3.3% tested HIV positive. Multivariate analysis showed that women with secondary education were 88% less likely than those with no/primary education to accept testing (OR=0.12, CI=0.03-0.54,p=0.006). Women who had prior HIV testing were 95% less likely to accept testing (OR=0.05, CI=0.01-0.19, p=0.0001). Women who reported two sexual partners in the past year were 6 times as likely to be HIV positive than those reporting one sexual partner (OR=5.76. CI=1.53 - 21.69, p=>0.05). In 2005, 76% of women reported no prior HIV counselling and 78% no testing. CONCLUSIONS In 2003, there was wide uptake of VCT by prenatal women. However, in 2005 the majority of pregnant women were not accessing the available VCT services.
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Affiliation(s)
- Cn Holmes
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, 1665 University Boulevard, Birmingham, Alabama, USA
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Abstract
BACKGROUND Rates of caesarean section (CS) have been rising globally. It is important to use the most effective and safe technique. OBJECTIVES To compare the effects of complete methods of caesarean section; and to summarise the findings of reviews of individual aspects of caesarean section technique. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3) and reference lists of identified papers. SELECTION CRITERIA Randomised controlled trials of intention to perform caesarean section using different techniques. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies and extracted data. MAIN RESULTS 'Joel-Cohen based' compared with Pfannenstiel CS was associated with: less blood loss, (five trials, 481 women; weighted mean difference (WMD) -64.45 ml; 95% confidence interval (CI) -91.34 to -37.56 ml); shorter operating time (five trials, 581 women; WMD -18.65; 95% CI -24.84 to -12.45 minutes); postoperatively, reduced time to oral intake (five trials, 481 women; WMD -3.92; 95% CI -7.13 to -0.71 hours); less fever (eight trials, 1412 women; relative risk (RR) 0.47; 95% CI 0.28 to 0.81); shorter duration of postoperative pain (two comparisons from one trial, 172 women; WMD -14.18 hours; 95% CI -18.31 to -10.04 hours); fewer analgesic injections (two trials, 151 women; WMD -0.92; 95% CI -1.20 to -0.63); and shorter time from skin incision to birth of the baby (five trials, 575 women; WMD -3.84 minutes; 95% CI -5.41 to -2.27 minutes). Serious complications and blood transfusions were too few for analysis.Misgav-Ladach compared with the traditional method (lower midline abdominal incision) was associated with reduced: blood loss (339 women; WMD -93.00; 95% CI -132.72 to -53.28 ml); operating time (339 women; WMD-7.30; 95% CI -8.32 to -6.28 minutes); time to mobilisation (339 women; WMD -16.06; 95% CI -18.22 to -13.90 hours); and length of postoperative stay for the mother (339 women; WMD -0.82; 95% CI -1.08 to -0.56 days). Misgav-Ladach compared with modified Misgav-Ladach methods was associated with a longer time from skin incision to birth of the baby (116 women; WMD 2.10; 95% CI 1.10 to 3.10 minutes). AUTHORS' CONCLUSIONS 'Joel-Cohen based' methods have advantages compared to Pfannenstiel and to traditional (lower midline) CS techniques, which could translate to savings for the health system. However, these trials do not provide information on mortality and serious or long-term morbidity such as morbidly adherent placenta and scar rupture.
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Affiliation(s)
- G J Hofmeyr
- University of the Witwatersrand, Department of Obstetrics and Gynaecology, East London Hospital Complex, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200.
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Henderson-Smart DJ, Lumbiganon P, Festin MR, Ho JJ, Mohammad H, McDonald SJ, Green S, Crowther CA. Optimising reproductive and child health outcomes by building evidence-based research and practice in South East Asia (SEA-ORCHID): study protocol. BMC Med Res Methodol 2007; 7:43. [PMID: 17892586 PMCID: PMC2194765 DOI: 10.1186/1471-2288-7-43] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 09/24/2007] [Indexed: 11/10/2022] Open
Abstract
Background Disorders related to pregnancy and childbirth are a major health issue in South East Asia. They represent one of the biggest health risk differentials between the developed and developing world. Our broad research question is: Can the health of mothers and babies in Thailand, Indonesia, the Philippines and Malaysia be improved by increasing the local capacity for the synthesis of research, implementation of effective interventions, and identification of gaps in knowledge needing further research? Methods/Design The project is a before-after study which planned to benefit from and extend existing regional and international networks. Over five years the project was designed to comprise five phases; pre-study, pre-intervention, intervention, outcome assessment and reporting/dissemination. The study was proposed to be conducted across seven project nodes: four in South East Asia and three in Australia. Each South East Asian study node was planned to be established within an existing department of obstetrics and gynaecology or neonatology and was intended to form the project coordinating centre and focus for evidence-based practice activities within that region. Nine hospitals in South East Asia planned to participate, representing a range of clinical settings. The three project nodes in Australia were intended to provide project support. The intervention was planned to consist of capacity-strengthening activities targeted at three groups: generators of evidence, users of evidence and teachers of evidence. The primary outcome was established as changes in adherence to recommended clinical practices from baseline to completion of the project and impact on health outcomes. Discussion The SEA-ORCHID project was intended to improve care during pregnancy and the perinatal period of mothers and their babies in South East Asia. The possible benefits extend beyond this however, as at the end of this project there is hoped to be an existing network of South East Asian researchers and health care providers with the capacity to generalise this model to other health priority areas. It is anticipated that this project facilitate ongoing development of evidence-based practice and policy in South East Asia through attracting long-term funding, expansion into other hospitals and community-based care and the establishment of nodes in other countries.
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Affiliation(s)
- David J Henderson-Smart
- NSW Centre for Perinatal Health Services Research, Queen Elizabeth ll Research Institute, University of Sydney, NSW 2006, Australia
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Mario R Festin
- Department of Obstetrics and Gynecology, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Jacqueline J Ho
- Department of Paediatrics, Penang Medical College, Penang 10450, Malaysia
| | - Hakimi Mohammad
- Department of Obstetrics and Gynecology, Gadjah Mada University, Yogyakarta 55281, Indonesia
| | - Steve J McDonald
- Australasian Cochrane Centre, Monash University, Melbourne, VIC 3168, Australia
| | - Sally Green
- Australasian Cochrane Centre, Monash University, Melbourne, VIC 3168, Australia
| | - Caroline A Crowther
- Discipline of Obstetrics and Gynaecology, University of Adelaide, SA 5006, Australia
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Abstract
OBJECTIVE To assess the uptake of HIV screening in pregnant women attending a tertiary hospital antenatal clinic. METHODS An audit was undertaken in an antenatal clinic where HIV screening was routinely offered to all women following counselling. For the women offered HIV testing, note was taken whether the woman agreed to testing or refused, and if so, the reason for refusal. RESULTS Sixty eight percent of women who were offered testing opted to have the test performed. Thirty two percent of women decided against testing, with half of these reporting a recent (negative) HIV test result. CONCLUSIONS Over 80% of pregnant women were willing to have HIV testing. IMPLICATIONS With the introduction of recommendations that all pregnant women be given the opportunity for HIV screening, a high participation rate can be expected from women who are offered testing, with the potential for minimisation of vertical transmission by identification of HIV positive women.
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Mills EJ, Wu P, Seely D, Guyatt GH. Vitamin supplementation for prevention of mother-to-child transmission of HIV and pre-term delivery: a systematic review of randomized trial including more than 2800 women. AIDS Res Ther 2005; 2:4. [PMID: 15877818 PMCID: PMC1131887 DOI: 10.1186/1742-6405-2-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 05/06/2005] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Observational studies have suggested that low serum vitamin levels are associated with increased mother-to-child transmission (MTCT) of HIV and increased preterm delivery. We aimed to determine the efficacy of vitamins on the prevention of MTCT and preterm delivery by systematically reviewing the available randomized controlled trials [RCTs]. We conducted systematic searches of 7 electronic databases. We extracted data from the RCTs independently, in duplicate. RESULTS: We included 4 trials in our review. Of the three trials on Vitamin A, two suggested no difference in MTCT, while the third and largest trial (n = 1078) suggested an increased risk of MTCT (Relative Risk 1.35, 95% Confidence Interval [CI], 1.11-1.66, P = 0.009). Two of the vitamin A trials addressed the impact of supplementation on pre-term delivery; one suggested a benefit (RR 0.65, 95% CI, 0.44-0.94) and the other no difference. All three vitamin A trials found no significant effect on infant mortality at 1 year. Of the two trials that looked at multivitamin use, only one addressed the prevention of MTCT, and found a non-significant RR of 1.04 (95% CI, 0.82-1.32). Two of the multivitamin trials found no significant effects on pre-term delivery. The single multivitamin trial examining children's mortality at 1 year yielded a non-significant RR of 0.91 (95% CI, 0.17-1.17). CONCLUSION: Randomized trials of vitamins to prevent MTCT have yielded conflicting results without strong evidence of benefit and have failed to exclude the possibility of harm.
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Affiliation(s)
- Edward J Mills
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - Ping Wu
- London School of Hygiene & Tropical Medicine, London, UK
- Division of Clinical Epidemiology, Canadian College Of Naturopathic Medicine, Toronto, Canada
| | - Dugald Seely
- Division of Clinical Epidemiology, Canadian College Of Naturopathic Medicine, Toronto, Canada
- Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
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Katz A. Neonatal HIV infection. Neonatal Netw 2004; 23:15-20. [PMID: 14974766 DOI: 10.1891/0730-0832.23.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this article is to describe the pertinent issues related to mother-to-child transmission of HIV infection. Significant succcss has been achieved in developed countries to reduce the incidence of this devastating disease in neonates through screening of pregnant women, maternal antiretroviral therapy to reduce transmission, and cesarean section for delivery. Prophylaxis continues for the first six weeks of the newborn's life with antiretroviral therapy and careful monitoring of clinical well-being. Antiretroviral therapy offers significant reduction in the rate of mother-to child transmission, and this is presently the cornerstone of therapy for the HIV-infected pregnant woman. Clinical studies of treatment modalities continue to offer new hope to prevent transmission of the virus to the fetus. Care for the HIV infected newborn is highly complex and constantly evolving. All neonatal nurses should be aware of these issues so that they can be partners in the identification of new cases and the ongoing treatment of babies who are infected.
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Affiliation(s)
- Anne Katz
- Faculty of Nursing, University of Manitoba, Winnipeg, Canada.
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15
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Ramos F, García-Fructuoso MT, Almeda J, Casabona J, Coll O, Fortuny C. [Determinants of HIV mother-to-child transmission in Catalonia, Spain [1997-2001]: is it possible to eliminate it?]. GACETA SANITARIA 2003; 17:275-82. [PMID: 12975050 DOI: 10.1016/s0213-9111(03)71747-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify and describe the factors that have led to new cases of HIV infection through mother-to-child transmission since the introduction of antiretroviral therapy in HIV-seropositive pregnant women (1997-2001) in Catalonia. METHODS Systematic review of cases identified in the pediatric services of all the hospitals in Catalonia. RESULTS Twenty-eight cases of pediatric HIV infection were identified: 9, 9, 8, 2 and 0 per year of birth from 1997 to 2001, respectively. Of 16 mothers with a diagnosis of known HIV infection before or during pregnancy, nine underwent antiretroviral prophylaxis during pregnancy (compliance was good in five, unknown in one and poor in one) and seven did not undergo prophylaxis (six refused it and no information was available in one). Of 12 mothers diagnosed after delivery, pregnancy was not monitored in five and was little or well-monitored in the remaining seven. Of mothers with well-monitored pregnancy, a serological HIV test was not performed in six and was negative in the first trimester in one. CONCLUSIONS Mother-to-child transmission of HIV has decreased in the last few years in Catalonia, but infections have sometimes occurred through poor implementation of preventive measures. Pregnant women should be offered an HIV diagnostic test not only in the first trimester but also at the end of pregnancy if HIV exposure is suspected. In women with unmonitored pregnancies, rapid diagnostic tests for HIV should be used in the delivery room.
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Affiliation(s)
- F Ramos
- CEESCAT. Hospital Universitari Germans Trias i Pujol. Badalona. Barcelona. Spain
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Abstract
Advances in preconception and prenatal care have been successful in reducing risk in a number of areas. Folic acid supplementation, abstinence from alcohol, tight glycemic control in pre-gestational diabetics, and the administration of rhogham all have been successful in reducing individual risks. Unfortunately, overall perinatal morbidity and mortality has not decreased in the past two decades. In light of this, clinicians must remain abreast of the latest research and technological advances, and adopt those practices that improve outcomes. Continued critical appraisal of persistent racial and ethnic disparities may be useful in understanding and reversing current trends. Additionally we must continue to creatively develop instruments of quantifying those aspects of high quality prenatal care, which are unmeasurable. Furthermore, we must advocate on a local, state, and national level for improved services for our prenatal patients not just in the office and the hospital, but in their homes and communities.
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Affiliation(s)
- Joshua H Barash
- Department of Family Medicine, Thomas Jefferson University, 833 Chestnut Street, Suite 301, Philadelphia, PA 19107, USA.
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