ObjectivesPreconception folic acid (PFA) taken at least 3 months before conception can decrease the incidence of neural tube defects (NTDs) by approximately 46%. NTDs contribute significantly to neonatal morbidity and mortality in migrant and refugee populations on the Thailand-Myanmar border (incidence 1.57/1000 live births). This audit aimed to assess uptake of PFA among migrant and refugee women, evaluate knowledge about PFA among local healthcare workers and implement a participatory community intervention to increase PFA uptake and decrease NTD incidence in this population.Study designA mixed-methods baseline evaluation was followed by an intervention involving health worker education and a community outreach program. A follow-up audit was performed 18 months post-intervention.MethodsData were gathered via surveys, short interviews and focus group discussions. The intervention program included community-based workshops, production and distribution of printed flyers and posters, and outreach to various local organisations.ResultsUptake of PFA was <2% both before and after the intervention. Despite a substantial increase in local healthcare worker knowledge of PFA, no significant improvement in PFA uptake after the intervention was detected. Most pregnancies in this local community sample were reported to be unplanned.ConclusionsHigh rates of NTDs with low PFA uptake remains a major public health challenge in this transient population. Results indicate that improved health worker knowledge alone is not sufficient to enhance PFA uptake in this population. Integration of PFA education within expanded family planning programs and broad-based food fortification may be more effective.
Objective: In this study, we aim to investigate the relationship between particulate matter, a common proxy indicator for air pollution, and markers of inflammation, monocyte activation, and subclinical vascular disease.Design: A cross-sectional study.Methods: Adolescents with perinatally acquired HIV (PHIV) and HIV-uninfected adolescents between 10 and 18years living near Kampala, Uganda were included. Daily ambient concentrations of particulate matter (PM 2.5 ) were measured from the Eastern Arica GEOHealth Hub. Outcome variables measured were carotid intimamedia thickness (IMT), as well as plasma markers of systemic inflammation, oxidized lipids, and gut integrity. Multivariable quantile regression models were used to explore the relationship between PM 2.5 and IMT.Results: One hundred and nineteen participants (69 PHIV, 50 HIV-uninfected) were included. The median (Q1, Q3) age was 12.7 (11.4,14.2) years, 55% were girls. Median daily PM 2.5 exposure was 29.08 mg/m 3 (23.40, 41.70). There was no significant difference in exposure of PM 2.5 between groups (P ¼ 0.073). PM 2.5 significantly correlated with intestinal permeability (zonulin; r ¼ 0.43, P < 0.001), monocyte activation (soluble CD163: r ¼ 0.25, P ¼ 0.053), and IMT (r ¼ 0.35, P ¼ 0.004) in PHIV but not in HIV-uninfected (P ! 0.05). In multivariable quantile regression, after adjusting for age, sex, poverty level, soluble CD163, and zonulin, daily PM 2.5 concentrations remained associated with IMT [b ¼ 0.005, 95% CI (0.0003-0.010), P ¼ 0.037] in adolescents with PHIV. Conclusion:Adolescents in urban Uganda are exposed to high levels of air pollution. Both PM 2.5 and HIV have independently been observed to contribute to atherosclerotic disease, and our findings suggest the combined effects of HIV and air pollution may amplify the development of cardiovascular disease.
Background Air pollution is known to induce systemic inflammation and contribute to cardiovascular disease. The effects of ambient air pollution on adolescents living with perinatally acquired HIV (PHIV) in Africa has been understudied. In this study, we aim to investigate the relationship between particulate matter, a common proxy indicator for air pollution, and markers of inflammation, monocyte activation, and cardiovascular disease risk. Methods We recruited a cohort of PHIV-positive and HIV-negative adolescents who were from around Kampala, aged 10-18 years, had no known active infections, and who lived within 40 km of an PM₂ • ₅ monitoring site. Adolescents with PHIV were on ART with HIV-1 RNA concentrations ≤400 copies/mL. Daily ambient concentrations of particulate matter (PM₂ • ₅), a proxy for air pollution, were measured with continuous central site monitoring using a Beta Attenuation Monitor or E-Samplers from the GeoHealth Hub. We measured carotid intima media thickness (IMT) using ultrasound, plasma concentrations of soluble CD14 and CD163 as markers of monocyte activation, plasma markers of systemic inflammation (hsCRP, IL6, sTNFRI), oxidised lipids, and intestinal permeability (zonulin). Findings One hundred and nineteen participants were included (69 with PHIV, 50 were HIV-negative). Median age was 12•7 years (IQR 11•4-14•2) years, 55% were female and 63% lived below the extreme poverty line (living with
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