IntroductionAdolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour.MethodsWe conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included “adherence,” “compliance,” “antiretroviral use” and “antiretroviral adherence,” in combination with “adolescents,” “youth,” “HIV,” “Africa,” “interventions” and the MeSH term “Africa South of the Sahara.” Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed.DiscussionAdolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV.ConclusionsAlthough higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population.

We investigated associations between aspects of childbirth and elevated postpartum symptoms of depression and anxiety. We employed secondary analysis of perinatal data (N=4657–4946) from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. Multivariable logistic regression models (adjusted for covariates) examined predictors of elevated symptoms of postpartum depression and anxiety. Predictors included the following: type of delivery (normal physiological vs. interventive non-physiological), immediate postpartum complications, and maternal perception of the recent birth experience. The Edinburgh Postnatal Depression Scale assessed elevated symptoms of depression (score≥13), and the Crown-Crisp Experiential Index assessed elevated symptoms of anxiety (score≥9) at 2 and 8 months after delivery. A more negative perception of the recent birth experience was associated with elevated symptoms of anxiety at 2 months [odds ratio (OR) 1.52, 95 % confidence interval (CI) 1.25–1.85] and 8 months (OR 1.30, 95 % CI 1.06–1.60) postpartum but was not associated with elevated symptoms of depression at either time point. Type of delivery (physiological vs. non-physiological) and immediate postpartum complications were not associated with elevated symptoms of depression or anxiety. Our findings suggest that improving women's childbirth experience may decrease the likelihood of postpartum anxiety, but not postpartum depression.

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Context:Traditional medicine, which is more available and affordable for the poor uses medicinal plants for the treatment and management of various ailments, including the sickle cell disease (SCD). About 24 million Nigerians are carriers of this sickled cell gene, while approximately 2.4 million are SCD patients. Moringa oleifera Lam. (Moringaceae) possesses high nutritional value and has been used in folklore medicine to treat various ailments related to pain and inflammation. Chemical, pharmacological and pharmacognostical applications of Moringa oleifera have been reported.Objective:This study investigated the antisickling potential of polar and non-polar extracts of the seed, flower and leaf of Moringa oleifera for the first time.Materials and Methods:Using crude methanol extract, aqueous extract, ethyl acetate and butanol, the in vitro antisickling activities of Moringa oleifera fractions, were evaluated using erythrocyte cells deoxygenated with 2% sodium metabisulphite. p-Hydroxybenzoic acid and normal saline were employed as positive and negative controls.Results:Phytochemical screening revealed the presence of saponins, free anthraquinones, and alkaloids. Extracts of the seed and flower demonstrated a higher (P<0.05) antisickling activity in comparison to the leaf extract. The leaf extract, as well as those of the seed and flower, equally demonstrated a (P<0.05) reversal of sickled erythrocytes.Discussions and Conclusions:These findings suggest that Moringa oleifera may play a role in the management of SCD, by incorporation of its fractions into recipes. More extensive biological evaluations and further studies will be necessary for the chemical characterization of the antisickling principles.

assessing the birth experience within the first few days after birth; control for potential covariates; and conduct multivariate analyses with adequate statistical power.We examined whether the birth experience is associated with maternal caregiving throughout the first postnatal year using secondary analysis of a large population database. Given that feeling supported in labor has a salient effect on women's birth experience, we hypothesized that women who felt less support in labor would demonstrate less positive maternal attitudes and behavior postnatally compared to women who felt well supported in labor. Methods Design and PopulationWe conducted secondary data analysis of the Avon Longitudinal Study of Parents and Children (ALSPAC), an ongoing, UK population, birth cohort study investigating psychological, social, environmental, and biological influences on children's health (Boyd et al. 2013). Women were enrolled if they expected to give birth between April 1 st 1991 and December 31 st 1992 in the Avon region. Demographic characteristics were comparable to the UK population (Fraser et al. 2013). ALSPAC methodology is published and readily available (http://www.bristol.ac.uk/alspac/researchers/access/) (Golding et al. 2001). ALSPAC Law and Ethics Committee and local research ethics committees provided ethical approval before study enrollment.The initial number of pregnancies enrolled was 14,541. Of these initial pregnancies, there was a total of 14,676 fetuses, resulting in 14,062 live births and 13,988 children who were alive at 1 year of age. Birth data were available from 8295 medical records. We excluded multiple pregnancies (n=184), infants <34 or >42 gestational weeks (n=214), and neonatal deaths (n=21), resulting in 7876 potential participants. Analysis was further restricted to participants with complete data on self-reported maternal caregiving attitudes at one (97.4%) and eight (81.5%) postnatal months; and feelings about labor support (81.8%). Our final sample with self-reported maternal caregiving attitudes at one postnatal month was 4389 and at eight postnatal months was 4580, representing 55.7─58.2% of the overall study population with birth data. Additionally, within ALSPAC there were 1000 mother-infant pairs with video-recorded maternal caregiving behavior at one year, from participants randomly selected for a sub-study called "Children in Focus". Of these participants, 842 women with complete data were included in analysis. MeasuresThe birth experience was measured at two postnatal months. Women were asked "How did you feel while you were having the baby?" Ratings were on a scale of neglected, just-okay, or warmly supported. Women were also asked a