The Prevalence of Intraventricular Haemorrhage and Associated Risk Factors in Preterm Neonates in the Neonatal Intensive Care Unit at the University Teaching Hospital, Lusaka, Zambia

Objectives: The study was undertaken with the aims of determining the prevalence and most frequent grade of IVH as well as associated risk factors in preterm neonates with birth weight 1.5kg or less admitted to the neonatal intensive care unit at the UTH in Lusaka, ZambiaDesign: This was a cross sectional study where 298 preterm neonates meeting the study's inclusion criteria had cranial ultrasound done in the first three days of life and on the seventh postnatal day. Data on the risk factors was obtained from the neonatal referral form, maternal records and direct interview with the neonate's mother.Main outcomes and Measures: The main outcomes were the prevalence of IVH and the most frequent grade of IVH. The variable any-IVH generated at the time of analysis was used in determining the prevalence of IVH and also as the dependent variable in multivariate logistic regression. Any-IVH was the highest grade of IVH obtained on either the first 3 days or day 7 on cranial ultrasound.Results: In this study, the prevalence of intraventricular haemorrhage in preterm infants with birth weight 1.5kg and less was 34.2% in the first seven days of postnatal life. Grade 1 (mild) IVH was the most frequent (54.9%) followed by severe IVH (grade 3 and 4) at 27.5%. The case fatality rate was 85.7% for those with grade 4 in the first three days of life. Grade 2 was the least prevalent at 17.7%. Risk factors significantly associated with IVH were birth weight [p=0.04, OR= 0.25(0.06-0.98) 95% C.I.] and gestational age [p=0.02, OR= 0.82 (0.69-0.97) 95%C.I.]Conclusions: The study found a similar or even lower overall prevalence to that reported in studies in Africa and globally, while the frequency of severe IVH was relatively very high with a high case fatality rate (85.7%) in the first seven days of postnatal life in respect of grade 4 IVH. Risk factors significantly associated with IVH were birth weight and gestational age while the former was also significantly associated with severe IVH as in otherstudies internationally

Neurological & Psychiatric Society of Zambia's Evidence-Based Guidelines for EEG Utilization at the University Teaching Hospital

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A mixed-methods assessment of understanding (AoU) tool for AIDS vaccine trials in sub-Saharan Africa: results from a pilot study

Assessments of understanding (AoUs) in clinical trials are often composed of true/false multiple choice questions, however, these tools can be difficult for volunteers with limited education or without prior testing experience

Dietary diversity of women from soybean and non-soybean farming households in rural Zambia

IntroductionSoybean farming in Zambia is promoted to increase farm productivity and diversification away from maize, and improve cash income and livelihoods for farmers. However, the impact of soybean farming on women's dietary intake is not clear. This study compares the dietary diversity of women from soybean (S) and non-soybean (NS) farming households as a pathway to understanding policy efficacy.MethodsA cross-sectional survey involving 268 women of reproductive age from 401 rural households was conducted in two soybean-producing districts of Central Province, Zambia. Data from a qualitative 7-day food frequency questionnaire (FFQ) was used to calculate dietary diversity scores (DDS), women's dietary diversity scores (WDDS-10) and assess dietary patterns. Information on household sociodemographic and agricultural characteristics was used to explore determinants of dietary diversity.ResultsResults show there were no significant differences in the mean DDS (S: 10.3 ± 2.4; NS:10.3 ± 2.6) and WDDS-10 (S:6.27 ± 1.55; NS:6.27 ± 1.57) of women from soybean and non-soybean farming households. Both cohorts had similar dietary patterns, plant-based food groups with additional fats and oils. Agricultural diversity was not associated with dietary diversity. Household wealth status was the most important determinant of dietary diversity, as women from wealthier households were more likely to have higher DDS (β = 0.262, 95% CI = 0.26 to 0.70, P < 0.001) and WDDS-10 (β = 0.222, 95% CI = 0.08 to 0.37, P < 0.003) compared to those from poorer households. Women from households that spent more on food had a higher DDS (β = 0.182, 95% CI = 0.002 to 0.07), but not WDDS-10 (β = 0.120, 95% CI = −0.01 to 0.03); for every additional dollar spent on food in the past 7 days, the DDS increased by 0.18. Meanwhile, soyabean farming was not statistically associated with higher wealth.ConclusionsPolicymakers and promoters of agricultural diversification and nutrition-sensitive agriculture need to consider how women can benefit directly or indirectly from soybean farming or other interventions aimed at smallholder farmers

Trends in the incidence of possible severe bacterial infection and case fatality rates in rural communities in Sub-Saharan Africa, South Asia and Latin America, 2010-2013: a multicenter prospective cohort study

Background Possible severe bacterial infections (pSBI) continue to be a leading cause of global neonatal mortality annually. With the recent publications of simplified antibiotic regimens for treatment of pSBI where referral is not possible, it is important to know how and where to target these regimens, but data on the incidence and outcomes of pSBI are limited. Methods We used data prospectively collected at 7 rural community-based sites in 6 low and middle income countries participating in the NICHD Global Network’s Maternal and Newborn Health Registry, between January 1, 2010 and December 31, 2013. Participants included pregnant women and their live born neonates followed for 6 weeks after delivery and assessed for maternal and infant outcomes. Results In a cohort of 248,539 infants born alive between 2010 and 2013, 32,088 (13 %) neonates met symptomatic criteria for pSBI. The incidence of pSBI during the first 6 weeks of life varied 10 fold from 3 % (Zambia) to 36 % (Pakistan), and overall case fatality rates varied 8 fold from 5 % (Kenya) to 42 % (Zambia). Significant variations in incidence of pSBI during the study period, with proportions decreasing in 3 sites (Argentina, Kenya and Nagpur, India), remaining stable in 3 sites (Zambia, Guatemala, Belgaum, India) and increasing in 1 site (Pakistan), cannot be explained solely by changing rates of facility deliveries. Case fatality rates did not vary over time. Conclusions In a prospective population based registry with trained data collectors, there were wide variations in the incidence and case fatality of pSBI in rural communities and in trends over time. Regardless of these variations, the burden of pSBI is still high and strategies to implement timely diagnosis and treatment are still urgently needed to reduce neonatal mortality

Fifteen essential science advances needed for effective restoration of the world's forest landscapes

There has never been a more pressing and opportune time for science and practice to collaborate towards restoration of the world's forests. Multiple uncertainties remain for achieving successful, long-term forest landscape restoration (FLR). In this article, we use expert knowledge and literature review to identify knowledge gaps that need closing to advance restoration practice, as an introduction to a landmark theme issue on FLR and the UN Decade on Ecosystem Restoration. Aligned with an Adaptive Management Cycle for FLR, we identify 15 essential science advances required to facilitate FLR success for nature and people. They highlight that the greatest science challenges lie in the conceptualization, planning and assessment stages of restoration, which require an evidence base for why, where and how to restore, at realistic scales. FLR and underlying sciences are complex, requiring spatially explicit approaches across disciplines and sectors, considering multiple objectives, drivers and trade-offs critical for decision-making and financing. The developing tropics are a priority region, where scientists must work with stakeholders across the Adaptive Management Cycle. Clearly communicated scientific evidence for action at the outset of restoration planning will enable donors, decision makers and implementers to develop informed objectives, realistic targets and processes for accountability. This article paves the way for 19 further articles in this theme issue, with author contributions from across the world. This introduction article is part of the theme issue ‘Understanding forest landscape restoration: reinforcing scientific foundations for the UN Decade on Ecosystem Restoration’

Predictors of HIV Serostatus Disclosure to Partners among HIV-Positive Pregnant women in Morogoro, Tanzania.

Prevention of mother to child transmission of HIV (PMTCT) has been scaled, to more than 90% of health facilities in Tanzania. Disclosure of HIV results to partners and their participation is encouraged in the program. This study aimed to determine the prevalence, patterns and predictors of HIV sero-status disclosure to partners among HIV positive pregnant women in Morogoro municipality, Tanzania. A cross sectional study was conducted in March to May 2010 among HIV-positive pregnant women who were attending for routine antenatal care in primary health care facilities of the municipality and had been tested for HIV at least one month prior to the study. Questionnaires were used to collect information on possible predictors of HIV disclosure to partners. A total of 250 HIV-positive pregnant women were enrolled. Forty one percent (102) had disclosed their HIV sero-status to their partners. HIV-disclosure to partners was more likely among pregnant women who were < 25 years old [Adjusted odds ratio (AOR) = 2.2; 95% CI: 1.2--4.1], who knew their HIV status before the current pregnancy [AOR = 3.7; 95% CI: 1.7--8.3], and discussed with their partner before testing [AOR = 6.9; 95% CI: 2.4--20.1]. Dependency on the partner for food/rent/school fees, led to lower odds of disclosure to partners [AOR = 0.4; 95% CI: 0.1--0.7]. Nine out of ten women reported to have been counseled on importance of disclosure and partner participation. Six in ten HIV positive pregnant women in this setting had not disclosed their results of the HIV test to their partners. Empowering pregnant women to have an individualized HIV-disclosure plan, strengthening of the HIV provider initiated counseling and testing and addressing economic development, may be some of the strategies in improving HIV disclosure and partner involvement in this setting

Essential Care for Every Baby: Neonatal Clinical Decision Support Tool

Unacceptably high rates of neonatal mortality are an urgent global health challenge. Consistent application of Essential Newborn Care (ENC) interventions reduce newborn mortality. However, ENC has failed to scale-up in low-middle income countries, where the bulk of neonatal deaths occur. The American Academy of Pediatrics designed an evidence-based, simplified training and educational curriculum called Essential Care for Every Baby (ECEB), which includes a clinical practice guideline for the time of delivery through 24 h after birth. However, the scale-up of ECEB has been hampered by the need to provide a wide variety of time-sensitive ECEB interventions to numerous mother-baby pairs. This incurs significant cognitive load among providers who perform varied tasks every few minutes for each baby. In this high-load, stressful situation, there are often profound gaps in the delivery of crucial ECEB strategies. We propose an innovative, scalable, clinical decision support mobile app which prioritizes recognition over recall and addresses existing challenges