"What will my child think of me if he hears I gave him HIV?": a sequential, explanatory, mixed-methods approach on the predictors and experience of caregivers on disclosure of HIV status to infected children in Gombe, Northeast Nigeria.

BACKGROUND: With increasing access to effective Anti-Retroviral Therapy (ART), the proportion of children who survive into later childhood with HIV has increased. Consequently, caregivers are constantly being confronted with the dilemma of 'if', 'when', and 'how' to tell their children living with HIV their status. We aimed to determine the prevalence and predictors of disclosure and explore the barriers caregivers face in disclosing HIV status to children living with HIV in Gombe, northeast Nigeria. METHODS: We conducted a sequential, explanatory, mixed-methods study at the specialist Paediatric HIV clinic of the Federal Teaching Hospital Gombe, northeast Nigeria. The quantitative component was a cross sectional, questionnaire-based study that consecutively recruited 120 eligible primary caregivers of children (6-17 years) living with HIV. The qualitative component adopted an in-depth one-on-one interview approach with 17 primary caregivers. Primary caregivers were purposively selected to include views of those who had made disclosure and those who have not done so to gain an enhanced understanding of the quantitative findings. We examined the predictors of HIV status disclosure to infected children using binary logistic regression. The qualitative data was analysed using a combined deductive and inductive thematic analysis approach. RESULTS: The mean age of the index child living with HIV was 12.2 ± 3.2 years. The prevalence of disclosure to children living with HIV was 35.8%. Children living with HIV were 10 times more likely to have been told their status if their caregivers believed that disclosure had benefits [AOR = 9.9 (95% CI = 3.2-15.1)], while HIV-negative compared to HIV-positive caregivers were twice more likely to make disclosures [AOR = 1.8 (95%CI = 0.7-4.9)]. Girls were 1.45 times more likely than boys to have been disclosed their HIV positive status even after adjusting for other variables [AOR = 1.45 (95% CI = 0.6-3.5)]. Caregivers expressed deep-seated feeling of guilt and self-blame, HIV-related stigma, cultural sensitivity around HIV, and fears that the child might not cope as barriers to non-disclosure. These feeling were more prominent among HIV-positive caregivers. CONCLUSION: The process of disclosure is a complex one and caregivers of HIV positive children should be supported emotionally and psychologically to facilitate disclosure of HIV status to their children. This study further emphasises the need to address HIV-related stigma in resource constrained settings

La forma de la lactancia de la curva afecta el ajuste de modelos empíricos y mecanicistas aplicados a las lactancias de ovinos lecheros en México

The ability of mathematical models to represent the lactation process varies according with their mathematical structure and database characteristics. The aim of the current study was evaluated the goodness of fit of empirical and mechanistic models applied to dairy sheep lactation curves with different shapes. A total of 4,494 weekly test day records were analyzed. All lactations were individually fitted using two empirical (Wood and Wilmink) and two mechanistic (Dijkstra, and Pollott) models. The Dijkstra model showed the best performance to typical curves and Wood model to atypical curves (without peak lactation). Therefore, the selection of the mathematical model to fit sheep lactation curves must consider the specific patter of milk production.A capacidade dos modelos matemáticos em representar o processo de lactação varia de acordo com sua estrutura matemática e características do banco de dados. O objetivo do presente estudo foi avaliar a qualidade do ajuste de modelos empíricos e mecanísticos aplicados a curvas de lactação de ovelhas leiteiras com diferentes formas. Um total de 4.494 registros de dia de teste semanais foram analisados. Todas as lactações foram ajustadas individualmente usando dois modelos empíricos (Wood e Wilmink) e dois modelos mecanísticos (Dijkstra e Pollott). O modelo de Dijkstra apresentou melhor desempenho para curvas típicas e o modelo de Wood para curvas atípicas (sem pico de lactação). Portanto, a seleção do modelo matemático para ajustar as curvas de lactação de ovelhas deve considerar o padrão específico de produção de leiteLa capacidad de los modelos matemáticos para representar el proceso de lactancia varía según su estructura matemática y las características de la base de datos. El objetivo del presente estudio fue evaluar la bondad de ajuste de modelos empíricos y mecanísticos aplicados a curvas de lactancion de ovejas lecheras con diferentes formas. Se analizaron un total de 4.494 registros de días de prueba semanales. Todas las lactancias se ajustaron individualmente utilizando dos modelos empíricos (Wood y Wilmink) y dos mecanísticos (Dijkstra y Pollott). El modelo de Dijkstra mostró el mejor desempeño a las curvas típicas y el modelo de Wood a las curvas atípicas (sin pico de lactancia). Por lo tanto, la selección del modelo matemático para ajustar las curvas de lactancia de las ovejas debe considerar el patrón específico de producción de leche

Pneumonia hospitalizations and mortality in children 3 – 24-month-old in Nigeria from 2013 to 2020: Impact of pneumococcal conjugate vaccine ten valent (PHiD-CV-10)

Pneumococcal conjugate vaccine ten valent (PCV 10) was introduced into Nigeria in three phases. Phase 3 introduction started in August 2016. However, its impact on pneumonia admissions and mortality among vaccinated Nigerian children has not been determined. Data in the period before PCV-10 introduction (3 August 2013–2 August 2016), and after (3 August 2017–2 August 2020) were retrospectively extracted from the medical charts of eligible patients aged 3–24 months with hospitalized radiological pneumonia at the University College Hospital (UCH), Ibadan; National Hospital (NH), Abuja; and Federal Teaching Hospital (FTH), Gombe, allowing for an intervening period of 1 year. Proportions of the patients with hospitalized pneumonia and case fatality rates were determined during both periods. The results were compared using z-test, multiple logistic regression analysis and p < .05 was considered significant. Adjusted pneumonia hospitalization rates between the two periods increased at the NH Abuja (10.7% vs 14.6%); decreased at the UCH, Ibadan (8.7% vs 6.9%); and decreased at the FTH, Gombe (28.5% vs 18.9%). Case fatality rates decreased across all the sites during the post-PCV introduction period: NH Abuja, from 6.6% to 4.4% (p = .106); FTH, Gombe, 11.7% to 7.7% (p = .477); and UCH, Ibadan, 2.0% to 0% (p = .045); but only significant at Ibadan. Overall, proportion of hospitalized pneumonia cases decreased after 3 years of PCV 10 introduction into the National Immunization Programme in Nigeria. The case fatality rate during post-PCV 10 introduction decreased at all the three sites, but this difference was significant at the UCH, Ibadan