Women attending Haitian slum-based antenatal clinics were evaluated for sexually transmitted diseases (STDs): 110 (11%) of 996 were syphilis seroreactive, 313 (35%) of 903 had trichomoniasis, 110 (12%) of 897 had gonococcal or chlamydial cervical infection (or both), and 418 (47%) of 891 had at least one STD. Syphilis seroreactivity was associated with illiteracy (P = .007), lower socioeconomic status (P < .001), and a history of spontaneous abortion (P = .02). Of 663 evaluated sera, 56 (8%) had human immunodeficiency virus (HIV) antibodies. In multivariate analysis, positive HIV serostatus was associated with syphilis seroreactivity (P = .006), partner's unemployment (P = .002), and history of a previous sex partner (P = .04). Risk factors for gonococcal or chlamydial cervical infection were evaluated. Clinical assessment of cervical discharge, a World Health Organization algorithm, and a decision model based on local risk factors were 64%, 77%, and 89% sensitive, respectively, and 44%, 38%, and 43% specific, respectively, for predicting cervical infection. Alternative treatment approaches should be validated while waiting for affordable, simple, rapid, and accurate laboratory diagnostic tests for gonococcal and chlamydial cervical infections.
Focus group discussions were held with women attending slum-based antenatal clinics and with male partners of pregnant women separately to evaluate knowledge and attitudes regarding sexually transmitted diseases (STDs) and acceptability of a proposed antenatal STD screening and treatment programme, including partner management. Subsequently, antenatal women found to have a STD were asked to refer their partner(s) for STD treatment. The institution's routine procedure of internal referral to the curative center was evaluated for loss to follow-up. Focus group participants described common STD syndromes, knew that a pregnant woman could transmit a STD to her child, and knew that all sex partners needed to be treated for STDs. Discussion participants disagreed on the possibility of asymptomatic STDs and mentioned other ways of contracting STDs beside sexual transmission. The response to the proposed programme was positive. Of 331 male partners named by antenatal women who were found to have at least one STD, 101 (30%) presented at the clinic through index referral, and an additional 38 (11.5%) presented because of health worker referral. Of the 59 men sent to the curative center for care, only 26 (44%) received treatment. The study demonstrated that in Haiti, partners of antenatal STD patients can be treated without apparent adverse effects. However, internal referrals to separate treatment centres should be avoided. Following this study, education efforts have emphasized the curable nature of STDs, the threat of vertical transmission, and frequent asymptomatic presentation of STDs to promote prevention and treat more partners of STD patients.
Objective. To compare the risk of complications following Bacillus Calmette-Guérin(BCG) vaccination among children by maternal and infant HIV-1 infection status as part of an investigation of an outbreak of BCG complications.
Methods. A nonconcurrent cohort study of BCG complications among 125 infants born to HIV-1 seropositive and 166 infants born to HIV-1 seronegative mothers was conducted in Cité Soleil, Haiti. Infants were examined at regular intervals until 15 months of age, and complications from BCG were documented. An investigation of BCG vaccination practices was conducted.
Results. Mild or moderate complications occurred among 16 of 166 (9.6%) infants born to HIV-1 seronegative mothers compared with 4 of 13 HIV-1-infected infants (30.8%, P = .04) and 10 of 75 (13.3%, P = .39) uninfected infants born to HIV-1-infected mothers. No serious complications were noted. The outbreak of complications was associated with administration of 2.0 to 2.5 times the recommended dose of BCG vaccine.
Conclusions. This and five other cohort studies indicate that there may be a small increased risk of complications following BCG vaccination among HIV-1-infected children, but the reactions are usually mild and the risk does not outweigh the benefits of BCG vaccination in populations at high risk of tuberculosis during infancy and childhood.
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