Triple-Antiretroviral Prophylaxis to Prevent Mother-To-Child HIV Transmission through Breastfeeding—The Kisumu Breastfeeding Study, Kenya: A Clinical Trial

Timothy Thomas and colleagues report the results of the Kisumu breastfeeding study (Kenya), a single-arm trial that assessed the feasibility and safety of a triple-antiretroviral regimen to suppress maternal HIV load in late pregnancy

Factors Associated with Tuberculosis Treatment Default in an Endemic Area of the Brazilian Amazon: A Case Control-Study

SETTING: Treatment default is a serious problem in tuberculosis control because it implies persistence of infection source, increased mortality, increased relapse rates and facilitates the development of resistant strains. OBJECTIVE: This study analyzed tuberculosis treatment default determinants in the Amazonas State to contribute in planning appropriate control interventions. DESIGN: Observational study with a retrospective cohort using Brazilian Disease Notification System data from 2005 to 2010. A nested case control study design was used. Patients defaulting from treatment were considered as 'cases' and those completing treatment as 'controls'. In the analysis, 11,312 tuberculosis patients were included, 1,584 cases and 9,728 controls. RESULTS: Treatment default was observed to be associated to previous default (aOR 3.20; p<0.001), HIV positivity (aOR 1.62; p<0.001), alcoholism (aOR 1.51; p<0.001), low education level (aOR 1.35; p<0.001) and other co-morbidities (aOR 1.31; p = 0.05). Older patients (aOR 0.98; p = 0.001) and DOT (aOR 0,72; p<0.01) were considered as protective factor for default. CONCLUSIONS: Associated factors should be considered in addressing care and policy actions to tuberculosis control. Information on disease and treatment should be intensified and appropriate to the level of education of the population, in order to promote adherence to treatment and counter the spread of multidrug resistance to anti-TB drugs

Intermittent preventive treatment for malaria in pregnancy in Africa: What's new, what's needed?

Falciparum malaria is an important cause of maternal, perinatal and neonatal morbidity in high transmission settings in Sub-Saharan Africa. Intermittent preventive treatment with sulphadoxine-pyrimethamine (SP-IPT) has proven efficacious in reducing the burden of pregnancy-associated malaria but increasing levels of parasite resistance mean that the benefits of national SP-IPT programmes may soon be seriously undermined in much of the region. Hence, there is an urgent need to develop alternative drug regimens for IPT in pregnancy. This paper reviews published safety and efficacy data on various antimalarials and proposes several candidate combination regimens for assessment in phase II/III clinical trials

Causes of injuries resulting in a visit to the emergency department of a Provincial General Hospital, Nyanza, western Kenya

Background: There is increasing importance of trauma not only as a major cause of surgical admissions, but also a significant cause of morbidity, mortality and disability. Objective: To document injury-related visits and hospitalization in a provincial hospital, western Kenya. Methods: On-site review of records of all patients who visited emergency department (ED) from January 2002 through December 2003, and admissions of year 2003. Results: A total of 15365 patients visited the ED, of which 41% (6319/15395) were injury cases. The leading causes of injury were assault (42%), road traffic crashes (RTC) (28%), unspecified soft tissue injury (STI) (11%). Cut-wounds, dog-bites, falls, burns and poisoning were infrequently reported (each <10%). The age group 15-44 years formed the largest proportion (75%). A total of 3253 patients were admitted in 2003, of which 1010 (31%) were due to injuries. RTC were leading cause of hospitalization (49%) followed by assault (16%). Men were more likely to be hospitalized due to assault (OR=2.22; CI = 1.45 - 3.41) and not burns or poisoning (p<0.01). There were 64 (6.3%) injury-related deaths, mainly resulting from RTC (41.9%), burns (19.4%) and assault (16.1%). Conclusions: This study provides considerable information on major causes of injuries, useful for epidemiological surveillance and injury prevention campaigns