Impact of educational intervention regarding oral rehydration solution and zinc for management of diarrhoea among mothers of urban slums of Ahmedabad city, Gujarat, India: an interventional study

Background: Diarrhoea is one of the leading causes of morbidity and mortality among under-five children. Timely management of the children with oral rehydration solution (ORS) has substantially declined the mortality and morbidity from acute infectious diarrhea. The use of ORS largely depends on the level of knowledge and attitude of mothers. Mothers’ knowledge about diarrhoea can be improved through educational interventions. The objective of the study was to assess knowledge of mothers of urban slums of Ahmedabad city of Gujarat regarding ORS and Zinc for management of diarrhoea before and after training.Methods: This Interventional study was conducted among purposively selected 100 mothers of under five children of urban slums of Ahmedabad city of Gujarat, India during June to August 2011. After taking verbal consent, baseline knowledge of mothers regarding ORS and Zinc for management of diarrhoea was assessed by pre-designed, pre-tested and semi structured questionnaire. Single educational interventional training for 45 minutes was given to selected mothers Pre and post training assessment was done by scoring method and also mean, standard deviation, Wilcoxon sign rank test were applied.Results: Almost 83% of the mothers could define diarrhoea as the passage of watery stools three or more times a day, this knowledge was significantly increased to 100% after the training. Baseline knowledge of the mothers regarding causes of diarrhoea in children, signs and symptoms of dehydration in children, Correct method of preparation of ORS and importance of zinc therapy along with ORS was 4%, 22%, 39% and 26% respectively which was significantly increased to 73%, 90%, 89% and 76% respectively after the intervention.Conclusions: Knowledge of the mothers of under-five children regarding causes of diarrhoea, signs and symptoms of diarrhoea, correct method of preparation of ORS and importance of zinc therapy along with ORS has been significantly increased after intervention

Maternal micronutrient status and decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African drought of 2001-2002.

OBJECTIVE: To investigate the effects on maternal micronutrient status and infant growth of the increased maize prices that resulted from the southern African drought of 2001-2002. DESIGN: Longitudinal cohort study. SETTING: A maternal and child health clinic in Lusaka, Zambia. SUBJECTS: Maternal and infant health and nutrition data and maternal plasma were being collected for a study of breast-feeding and postpartum health. Samples and data were analysed according to whether they were collected before (June to December 2001), during (January 2002 to April 2003) or after (May 2003 to January 2004) the period of increased maize price. Season and maternal HIV status were controlled for in analyses. RESULTS: Maize price increases were associated with decreased maternal plasma vitamin A during pregnancy (P = 0.028) and vitamin E postpartum (P = 0.042), with the lowest values among samples collected after May 2003 (vitamin A: 0.96 micromol l(-1), 95% confidence interval (CI) 0.84-1.09, n = 38; vitamin E: 30.8 micromol mmol(-1) triglycerides, 95% CI 27.2-34.8, n = 64) compared with before January 2002 (vitamin A: 1.03 micromol l(-1), 95% CI 0.93-1.12, n = 104; vitamin E: 38.9 micromol mmol(-1) triglycerides, 95% CI 34.5-43.8, n = 47). There were no significant effects of sampling date on maternal weight, haemoglobin or acute-phase proteins and only marginal effects on infant weight. Infant length at 6 and 16 weeks of age decreased progressively throughout the study (P-values for time of data collection were 0.51 at birth, 0.051 at 6 weeks and 0.026 at 16 weeks). CONCLUSIONS: The results show modest effects of the maize price increases on maternal micronutrient status. The most serious consequence of the price increases is likely to be the increased stunting among infants whose mothers experienced high maize prices while pregnant. During periods of food shortages it might be advisable to provide micronutrient supplements even to those who are less food-insecure

The relentless spread of tuberculosis in Zambia - trends over the past 37 years (1964- 2000)

Objective. To review trends in the rates of tuberculosis (TB) case notifications over a 37-year period.Design. A retrospective study of Ministry of Health records on TB notifications between 1 January 1964 and 31 December 2000.Setting. Zambia, sub-Saharan Africa.Methods. Retrospective analysis of case-notification data for TB of the Zambia Ministry of Health annual returns.Outcome measures. Annual TB case-notification rates and trends over the past 37 years.Results. TB case-notification data from 1964 to 2000 show a 12-fold increase over the past two decades, and apparent gains in controlling TB seen in the 1960s and 1970s have been reversed over the past two decades. A stable situation during the period 1964 - 1984 (case-notification rate remained around 100 per 100 000 population) was followed by an exponential increase since the mid-1980s. The absolute number of new TBcases increased from 8 246 in 1985 (124/100 000) to 38 863 (409/100 000) in 1996 and 52 000 (512/100 000) in 2000. Comparison of case-notification rates over the past 2 decades with neighbouring countries (Zimbabwe, Malawi and Tanzania) show that Zambia has one of the highest case notification rates in the region.Conclusions. Zambia, like many countries in Africa, is in the midst of a serious TB epidemic and there are no signs that it is abating. This increase was most likely due to the impact of the HIV / AIDS epidemic and subsequent breakdown of TB services. Concerted donor-government efforts should invest appropriately in long-term plans for TB control

On-Farm Evaluation of Pearl Millet Varieties in Malawi for Farmer Preferences, Grain Yield, and Food Quality Traits

Dunng the 3993194 season two rypes ofon.fann rnah (research-managed and fanner.ma~ged], were conducred in 66 janners' fields tn the Shtre Vallq to veniy crop perfonnance and to expose new uanerles to the farming community Both inair were lmplemenred by farmers Three new pearl miller varieties (SDMV 89004, SDMV 89005, and ICMV 88908j and rwo controls (N~genan Compostre-rail [NC rail], and farmers' local landrace vaneties [LLl'jj were e~,aluatedjorplanta nd gram traits preferred by farmers, yield porenrral, andfor thetr acceptablltty as food. Varrerv SDM 1'89004 had the hia-herr n-raln v.~elds I 95 r ha ' when research. managedand I 47 f ha ' whenjarmer.ma~ged Under research-management rhe three test vanerier and NC-tall 'aer,ion ned szmilarlv and were suoerior ro the LLV used, whereas, under jarmer.managed ma&, rhr rhrer terr wnerles produced s~milar~ieldthsa t were supenor to both NC.ral1 and the LLV Ofthe 164 farmers who evaluated the pearl millet on.fann trraLforplant and groin rraits, the malonty preferred iCMV 88908 as rhe~rfavonref,o llowed by SDMV 89004, and SDMV 89005 based on field obsen,ations All the tmriprtes uer? ranked berrer than the LLVfor <ram rrairs (grain size, dehulltng, grtnding ease) However, far food taste NC-tall was the most preferred, followed by SDMV 89W5, SDMV 89004, and ICMV 88908. These results, and those from previous years, tnd~care rhat farmers prefer the new vanetres because of their h~gh grain yeld, good grain traits, and acceptabiliry as jood (taste) These varietter wll therefore be recomvnended soon for release tn Mala

QuantiFERON®-TB gold in-tube performance for diagnosing active tuberculosis in children and adults in a high burden setting.

To determine whether QuantiFERON®-TB Gold In-Tube (QFT) can contribute to the diagnosis of active tuberculosis (TB) in children in a high-burden setting and to assess the performance of QFT and tuberculin skin test (TST) in a prospective cohort of TB suspect children compared to adults with confirmed TB in Tanzania. Sensitivity and specificity of QFT and TST for diagnosing active TB as well as indeterminate QFT rates and IFN-γ levels were assessed in 211 TB suspect children in a Tanzanian district hospital and contrasted in 90 adults with confirmed pulmonary TB. Sensitivity of QFT and TST in children with confirmed TB was 19% (5/27) and 6% (2/31) respectively. In adults sensitivity of QFT and TST was 84% (73/87) and 85% (63/74). The QFT indeterminate rate in children and adults was 27% and 3%. Median levels of IFN-γ were lower in children than adults, particularly children <2 years and HIV infected. An indeterminate result was associated with age <2 years but not malnutrition or HIV status. Overall childhood mortality was 19% and associated with an indeterminate QFT result at baseline. QFT and TST showed poor performance and a surprisingly low sensitivity in children. In contrast the performance in Tanzanian adults was good and comparable to performance in high-income countries. Indeterminate results in children were associated with young age and increased mortality. Neither test can be recommended for diagnosing active TB in children with immature or impaired immunity in a high-burden setting

Abacavir, zidovudine, or stavudine as paediatric tablets for African HIV-infected children (CHAPAS-3): an open-label, parallel-group, randomised controlled trial

BACKGROUND: WHO 2013 guidelines recommend universal treatment for HIV-infected children younger than 5 years. No paediatric trials have compared nucleoside reverse-transcriptase inhibitors (NRTIs) in first-line antiretroviral therapy (ART) in Africa, where most HIV-infected children live. We aimed to compare stavudine, zidovudine, or abacavir as dual or triple fixed-dose-combination paediatric tablets with lamivudine and nevirapine or efavirenz. METHODS: In this open-label, parallel-group, randomised trial (CHAPAS-3), we enrolled children from one centre in Zambia and three in Uganda who were previously untreated (ART naive) or on stavudine for more than 2 years with viral load less than 50 copies per mL (ART experienced). Computer-generated randomisation tables were incorporated securely within the database. The primary endpoint was grade 2-4 clinical or grade 3/4 laboratory adverse events. Analysis was intention to treat. This trial is registered with the ISRCTN Registry number, 69078957. FINDINGS: Between Nov 8, 2010, and Dec 28, 2011, 480 children were randomised: 156 to stavudine, 159 to zidovudine, and 165 to abacavir. After two were excluded due to randomisation error, 156 children were analysed in the stavudine group, 158 in the zidovudine group, and 164 in the abacavir group, and followed for median 2·3 years (5% lost to follow-up). 365 (76%) were ART naive (median age 2·6 years vs 6·2 years in ART experienced). 917 grade 2-4 clinical or grade 3/4 laboratory adverse events (835 clinical [634 grade 2]; 40 laboratory) occurred in 104 (67%) children on stavudine, 103 (65%) on zidovudine, and 105 (64%), on abacavir (p=0·63; zidovudine vs stavudine: hazard ratio [HR] 0·99 [95% CI 0·75-1·29]; abacavir vs stavudine: HR 0·88 [0·67-1·15]). At 48 weeks, 98 (85%), 81 (80%) and 95 (81%) ART-naive children in the stavudine, zidovudine, and abacavir groups, respectively, had viral load less than 400 copies per mL (p=0·58); most ART-experienced children maintained suppression (p=1·00). INTERPRETATION: All NRTIs had low toxicity and good clinical, immunological, and virological responses. Clinical and subclinical lipodystrophy was not noted in those younger than 5 years and anaemia was no more frequent with zidovudine than with the other drugs. Absence of hypersensitivity reactions, superior resistance profile and once-daily dosing favours abacavir for African children, supporting WHO 2013 guidelines. FUNDING: European Developing Countries Clinical Trials Partnership

The impact of HIV and antiretroviral therapy on TB risk in children: a systematic review and meta-analysis.

BACKGROUND: Children (<15 years) are vulnerable to TB disease following infection, but no systematic review or meta-analysis has quantified the effects of HIV-related immunosuppression or antiretroviral therapy (ART) on their TB incidence. OBJECTIVES: Determine the impact of HIV infection and ART on risk of incident TB disease in children. METHODS: We searched MEDLINE and Embase for studies measuring HIV prevalence in paediatric TB cases ('TB cohorts') and paediatric HIV cohorts reporting TB incidence ('HIV cohorts'). Study quality was assessed using the Newcastle-Ottawa tool. TB cohorts with controls were meta-analysed to determine the incidence rate ratio (IRR) for TB given HIV. HIV cohort data were meta-analysed to estimate the trend in log-IRR versus CD4%, relative incidence by immunological stage and ART-associated protection from TB. RESULTS: 42 TB cohorts and 22 HIV cohorts were included. In the eight TB cohorts with controls, the IRR for TB was 7.9 (95% CI 4.5 to 13.7). HIV-infected children exhibited a reduction in IRR of 0.94 (95% credible interval: 0.83-1.07) per percentage point increase in CD4%. TB incidence was 5.0 (95% CI 4.0 to 6.0) times higher in children with severe compared with non-significant immunosuppression. TB incidence was lower in HIV-infected children on ART (HR: 0.30; 95% CI 0.21 to 0.39). Following initiation of ART, TB incidence declined rapidly over 12 months towards a HR of 0.10 (95% CI 0.04 to 0.25). CONCLUSIONS: HIV is a potent risk factor for paediatric TB, and ART is strongly protective. In HIV-infected children, early diagnosis and ART initiation reduces TB risk. TRIAL REGISTRATION NUMBER: CRD42014014276

Operational research in Malawi: making a difference with cotrimoxazole preventive therapy in patients with tuberculosis and HIV.

BACKGROUND: In Malawi, high case fatality rates in patients with tuberculosis, who were also co-infected with HIV, and high early death rates in people living with HIV during the initiation of antiretroviral treatment (ART) adversely impacted on treatment outcomes for the national tuberculosis and ART programmes respectively. This article i) discusses the operational research that was conducted in the country on cotrimoxazole preventive therapy, ii) outlines the steps that were taken to translate these findings into national policy and practice, iii) shows how the implementation of cotrimoxazole preventive therapy for both TB patients and HIV-infected patients starting ART was associated with reduced death rates, and iv) highlights lessons that can be learnt for other settings and interventions. DISCUSSION: District and facility-based operational research was undertaken between 1999 and 2005 to assess the effectiveness of cotrimoxazole preventive therapy in reducing death rates in TB patients and subsequently in patients starting ART under routine programme conditions. Studies demonstrated significant reductions in case fatality in HIV-infected TB patients receiving cotrimoxazole and in HIV-infected patients about to start ART. Following the completion of research, the findings were rapidly disseminated nationally at stakeholder meetings convened by the Ministry of Health and internationally through conferences and peer-reviewed scientific publications. The Ministry of Health made policy changes based on the available evidence, following which there was countrywide distribution of the updated policy and guidelines. Policy was rapidly moved to practice with the development of monitoring tools, drug procurement and training packages. National programme performance improved which showed a significant decrease in case fatality rates in TB patients as well as a reduction in early death in people with HIV starting ART. SUMMARY: Key lessons for moving this research endeavour through to policy and practice were the importance of placing operational research within the programme, defining relevant questions, obtaining "buy-in" from national programme staff at the beginning of projects and having key actors or "policy entrepreneurs" to push forward the policy-making process. Ultimately, any change in policy and practice has to benefit patients, and the ultimate judge of success is whether treatment outcomes improve or not