a b s t r a c t a r t i c l e i n f oKeywords: Antenatal care Congenital syphilis Penicillin Rapid syphilis tests Objective: To evaluate the impact of rapid syphilis tests (RSTs) on syphilis testing and treatment in pregnant women in Kalomo District, Zambia. Methods: In March 2012, health workers at all 35 health facilities in Kalomo Distract were trained in RST use and penicillin treatment. In March 2013, data were retrospectively abstracted from 18 randomly selected health facilities and stratified into three time intervals: baseline (6 months prior to RST introduction), midline (0-6 months after RST introduction), and endline (7-12 months after RST introduction). Results: Data collected on 4154 pregnant women showed a syphilis-reactive seroprevalence of 2.7%. The proportion of women screened improved from baseline (140/1365, 10.6%) to midline (976/1446, 67.5%), finally decreasing at endline (752/1337, 56.3%) (P b 0.001). There was no significant difference in the proportion of syphilis-seroreactive pregnant women who received 1 dose of penicillin before (1/2, 50%) or after (5/48, 10.4%; P = 0.199) RST introduction with low treatment rates throughout. Conclusion: With RST scale-up in Zambia and other resource-limited settings, same-day test and treatment with penicillin should be prioritized to achieve the goal of eliminating congenital syphilis. © 2015 World Health Organization; licensee Elsevier. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). BackgroundGlobally, it is estimated that approximately 1.4 million annual cases of syphilis occur during pregnancy [1]. A recent meta-analysis demonstrated that, among asymptomatic, untreated pregnant women with syphilis, fetal loss and stillbirth, neonatal deaths, and prematurity/low birth weight were 21%, 9.3%, and 5.8%, respectively, more frequent when compared with women without syphilis [2]. Treatment of syphilis-seroreactive pregnant women with 1 dose of intramuscular penicillin at least 30 days prior to delivery reduces the risk of adverse pregnancy outcomes to that of a non-infected mother, although full treatment of latent maternal syphilis requires three doses of intramuscular penicillin [3][4][5]. However, modeling data suggest that less than 10% of women with syphilis during pregnancy are screened and appropriately treated [1], despite the 2007 World Health Organization's Global Elimination of Congenital Syphilis initiative goals of testing more than 90% of pregnant women and of treating more than 90% of those who are seroreactive by 2015 [6].Recently-developed rapid syphilis tests (RST; BIOLINE, Korea) have a high sensitivity (85.7% to 100%) and specificity (96% to 100%), and do not require the traditional laboratory infrastructure used for rapid plasma reagin (RPR) tests [7][8][9]. Previous studies have suggested increased syphilis screening post-RST implementation, but longerterm evaluation of screening rates after initial training is needed [10]. In March 2012, the Elizabeth Glaser Pediat...
We analyzed the association of age at antiretroviral therapy (ART) initiation with CD4(+) T cell count recovery, death, and loss to follow-up (LTFU) among HIV-infected adults in Zambia. We compared baseline characteristics of patients by sex and age at ART initiation [categorized as 16-29 years, 30-39 years, 40-49 years, 50-59 years, and 60 years and older]. We used the medication possession ratio to assess adherence and analysis of covariance to measure the adjusted change in CD4(+) T cell count during ART. Using Cox proportional hazard regression, we examined the association of age with death and LTFU. In a secondary analysis, we repeated models with age as a continuous variable. Among 92,130 HIV-infected adults who initiated ART, the median age was 34 years and 6,281 (6.8%) were aged ≥50 years. Compared with 16-29 year olds, 40-49 year olds (-46 cells/mm(3)), 50-59 year olds (-53 cells/mm(3)), and 60+ year olds (-60 cells/mm(3)) had reduced CD4(+) T cell gains during ART. The adjusted hazard ratio (AHR) for death was increased for individuals aged ≥40 years (AHR 1.25 for 40-49 year olds, 1.56 for 50-59 year olds, and 2.97 for 60+ year olds). Adherence and retention in care were poorest among 16-29 year olds but similar in other groups. As a continuous variable, a 5-year increase in age predicted reduced CD4(+) T cell count recovery and increased risk of death. Increased age at ART initiation was associated with poorer clinical outcomes, while age <30 years was associated with a higher likelihood of being lost to follow-up. HIV treatment guidelines should consider age-specific recommendations.
A weaning practices and foods study was conducted to provide guidelines for a concurrent project on development of computer-optimized weaning blend formulations from indigenous Zambian food commodities. The study sample was selected from mothers and their children in 5 high populationdensity areas of Lusaka, the capital city of Zambia, to represent children in similar urban communities in Lusaka for whom improved weaning mixtures are to be designed. The investigation included a nutritional evaluation of children's dietary intake; a survey of cultural, social and economic practices which could influence nutritional status; and responses from mothers as to which foods they would use or avoid in weaning their children.The results suggest the mothers are considerably more knowledgeable about the principles of child nutrition than their practices indicate. The information obtained will be helpful in nutritional design and selection of most likely acceptable ingredients for low-cost, blended food weaning mixtures.
Integration of HIV care into ANC and community-based support improved uptake of CD4 counts, proportion of cART-eligible women initiated on cART, and infants tested.
Composite quality of RMNH services did not vary by district wealth, but was slightly higher in urban districts. The availability data suggest that the higher population in richer districts outpaces health infrastructure.
This computerized linear programming study was performed to formulate low-cost, commercially processed, blended weaning foods, and even less expensive, homeprepared, blended wearing foods, with excellent energy and protein value for use in areas of Lusaka, Zambia, where the risk of malnutrition is high. Ingredient input information included proximate and essential amino acid analyses, intothe-blend costs, and factors for gastrointestinal absorption of proteins and total energy. For most computed mixtures, the minimum cost at selected levels of absorbed protein quality was optimized. Formulations were determined, with calculated cost and nutritional parameters, using only mother-favoured ingredients or, alternatively, selections from among all listed market ingredients; fat versus fat plus sugar as concentrated energy; for different seasons (home-prepared); and, for commercial blends, both with and without puridies amino acid(s) that do or do not include vitamin-antioxidant-mineral mix. The methodology should be widely applicable elsewhere.
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