high at the end of therapy. Suppressor cells normalized faster, whereas helper cell levels remained abnormally low for a long period. Most children became nonimmune to polio, whereas the majority had antibodies to measles, mumps, and rubella. Despite depressed immunity, serious infections were not documented. SUPPRESSION OF THE OLIVOCOCHLEAR REFLEX: A NEUROTOXIC ADVERSE EFFECT OF VINCRISTINE Submitted by Helen Kosmidis OBJECTIVE:The purpose of this study was to examine the effects of a known neurotoxic regimen, such as the acute lymphocytic leukemia (ALL) Berlin-Frankfurt-Mü nster 95 (ALL-BFM-95) protocol, on the function of the medial olivocochlear bundle, which was assessed by recording suppression of the amplitudes of distortionproduct otoacoustic emissions (DPOAEs) when white noise was applied simultaneously to the contralateral ear. METHODS: Our population consisted of 3 groups of children with ALL. A baseline examination was performed before the beginning of therapy. DPOAE-suppression measurements were repeated after 4 weekly doses of vincristine in the first group (n ϭ 12), after 8 weekly doses in the second group (n ϭ 12), and 3 years after completion of the protocol in the third group (n ϭ 23). In the third group, a subgroup of 12 children who were exposed to low-dose gentamicin (Ͻ13 days) and another 11 children who were exposed to high gentamicin doses (Ͼ23 days) were evaluated. RESULTS: At baseline examination, all groups presented significant suppression at all frequencies. Efferent mediated DPOAE suppression was still present after 4 sessions of vincristine. However, after 8 vincristine sessions, instead of suppression, an increase of amplitudes was noted at 5 (of 12) frequencies. In the subgroups examined 3 years after ALL-BFM-95, the olivocochlear reflex had recovered. CONCLUSIONS: Enhancement or no significant suppression of OAEs by contralateral noise indicates a probable vincristine-induced insult to the efferent cochlear innervation. This adverse effect seems to take place early in the course of chemotherapy and is slowly reversed a few years after chemotherapy. The clinical implications of these findings may need additional investigation. SCREENING NEWBORNS FOR SICKLE CELL INTRODUCTION:Screening of newborns for sickle cell disease (SCD) allows early initiation of prophylactic therapy, parental education, and comprehensive management, which results in reduced mortality. Since April 1993, a demonstration project to develop and implement a program of newborn screening for SCD has been conducted in Kumasi, Ghana, by the Comprehensive Sickle Cell Center at the Children's Hospital of Philadelphia in collaboration with the Ministry of Health and other institutions in Ghana. OBJECTIVE: Our goal was to assess the program of screening and follow-up of children with SCD in Ghana. METHODS: Infants are screened at birth or at wellinfant visits within days or a few weeks after birth. Mothers are asked to come for results within 4 weeks, and failing that, an extensive tracking system is used to deliver r...

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Background: There is scanty data on the usage and safety of herbal medicines in pregnancy and breast feeding. Though they may be efficacious on account of their long experience of usage, effects of these herbal preparations and the extent of usage in pregnancy and breastfeeding are not known. There were anecdotal claims of herbal medicine usage in pregnancy in Offinso North District. Objective: To determine the prevalence and the pattern of herbal medicine usage among pregnant women attending ANC in all the health facilities in Offinso North District and to determine the level of awareness of healthcare givers about these herbal medicines. Design: Cross-sectional study. Method: A standardized structured questionnaire was administered to pregnant women attending antenatal clinics in the Offinso North district. Results: Age of respondents ranged from 15-49 years among which 25 (6.5%) took herbal medicines through varying routes of administration. High usage was found amongst those married and also with no formal and basic education and a median age of 25 years. Awareness of orthodox health practitioners about these herbal medicines was scanty. Conclusions: The study emphasized the use of herbal medicines particularly through some unconventional mode of preparations by pregnant women in Offinso North. Orthodox practitioners' awareness of their usage was found to be inadequate, highlighting an urgent need for health care practitioners and other health care givers to be aware of this practice and make efforts in obtaining information about herb use during antenatal care.

Background The probability of not breastfeeding within the first hour after delivery (timely initiation of breastfeeding) is particularly pronounced in sub-Saharan Africa. In this study, we examined the maternal and child factors associated with timely initiation of breastfeeding in sub-Saharan Africa. Methods We pooled data from 29 sub-Saharan African countries’ Demographic and Health Surveys conducted from 2010 to 2018. A total of 60,038 childbearing women were included. Frequencies, percentages, and binary logistic regression analyses were carried out. Binary logistic regression was used to examine the maternal and child factors associated with timely initiation of breastfeeding and the results were presented as adjusted odds ratios (aOR) at 95% confidence interval (CI).  Results We found a prevalence of 55.81% of timely initiation of breastfeeding in the sub-region. The country with the highest prevalence of timely initiation of breastfeeding was Burundi (86.19%), whereas Guinea had the lowest prevalence (15.17%). The likelihood of timely initiation of breastfeeding was lower among married women, compared to never married women (aOR 0.91; 95% CI 0.85, 0.98); working women compared to non-working women (aOR 0.90; 95% CI 0.87, 0.93); women who watched television at least once a week, compared to those who never watched television (aOR 0.74; 95% CI 0.70, 0.78); women who delivered through caesarean section, compared to vaginal birth (aOR 0.30; 95% CI 0.27, 0.32); and those with multiple births, compared to those with single births (aOR 0.67; 95% CI 0.59, 0.76). Women who lived in Central Africa were less likely to initiate breastfeeding timely compared to those who lived in West Africa (aOR 0.80; 95% CI 0.75, 0.84). Conclusions The findings call for the need for a behavioural change communication programmes, targeted at timely initiation of breastfeeding, to reverse and close the timely initiation of breastfeeding gaps stratified by the maternal and child factors. Prioritising policies to enhance timely initiation of breastfeeding is needed, particularly among Cental African countries where timely initiation of breastfeeding remains a challenge. Sufficient supportive care, especially for mothers with multiple births and those who undergo caesarean section, is needed to resolve timely initiation of breastfeeding inequalities.

Background Global commitment to stop Human Immunodeficiency Virus (HIV) and ensure access to HIV treatment calls for women empowerment, as these efforts play major roles in mother-to-child transmission. We examined the association between women’s healthcare decision-making capacity and uptake of HIV testing in sub-Saharan Africa. Methods We used data from the current Demographic and Health Surveys (DHS) of 28 countries in sub-Saharan Africa, conducted between January 1, 2010 and December 31, 2018. At the descriptive level, we calculated the prevalence of HIV testing in each of the countries. This was followed by the distribution of HIV testing across the socio-demographic characteristics of women. Finally, we used binary logistic regression assess the likelihood of HIV testing uptake by women’s health care decision-making capacity and socio-demographic characteristics. The results were presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals signifying precision. Statistical significance was set at p-value < 0.05. Results We found that prevalence of HIV testing uptake in the 28 sub-Saharan African countries was 64.4%, with Congo DR having the least (20.2%) and the highest occurred in Rwanda (97.4%). Women who took healthcare decisions alone [COR = 3.183, CI = 2.880–3.519] or with their partners [COR = 2.577, CI = 2.335–2.844] were more likely to test for HIV, compared to those whose healthcare decisions were taken by others, and this persisted after controlling for significant covariates: [AOR = 1.507, CI = 1.321–1.720] and [AOR = 1.518, CI = 1.334–1.728] respectively. Conclusion Sub-Saharan African countries intending to improve HIV testing need to incorporate women’s healthcare decision-making capacity strategies. These strategies can include education and counselling. This is essential because our study indicates that the capacity of women to make healthcare decisions has an association with decision to test for their HIV status.