First Trimester Use of Artemisinin-Based Combination Therapy and Risk of Low Birth Weight

Thesis (Master's)--University of Washington, 2017-02Introduction: There is a lack of sufficient evidence on the safety of use of artemisinin-based combination therapies (ACT) among pregnant women, especially during early pregnancy. We determined the association between exposure to ACT during the first trimester of pregnancy and occurrence of low birth weight (LBW), and small for gestational age (SGA) among the offspring of pregnant women. Methods: We performed a secondary analysis of data from a prospective cohort study of pregnant women recruited at three health and demographic surveillance system (HDSS) sites in the sub-Saharan African countries of Mozambique, Burkina Faso and Kenya. Data from the HDSS allowed earlier pregnancy identification and linkage and tracking of pregnancy outcomes to determine birth weight and gestational age at delivery. Exposure to any antimalarials was ascertained through a combination of data collected from clinic registers, prescription records and self-reported usage by the women. Results: There was no difference in the pooled prevalence of LBW among children born to pregnant women who were exposed to quinine, ACT and had no exposure to antimalarials, 21.0%, 11.3% and 10.2%, respectively. Children whose mothers had exposure to ACTs during the first trimester had 21% lower occurrence of LBW when compared to children born to mothers exposed to ACTs in second or third trimester, this difference was not statistical significant (95%CI: -7-49%). Conclusion: ACT exposure during the first trimester was not associated with an increased risk of LBW. Our findings support the use of ACT for treatment of malaria during the first trimester of pregnancy

Radiological findings in young children investigated for tuberculosis in Mozambique.

Chest radiography remains a critical tool for diagnosing intrathoracic tuberculosis (TB) in young children who are unable to expectorate. We describe the radiological findings in children under 3 years of age investigated for TB in the district of Manhiça, southern Mozambique, an area with a high prevalence of TB and HIV.Digital antero-posterior and lateral projections were performed and reviewed by two independent readers, using a standardized template. Readers included a local pediatrician and a pediatric radiologist blinded to all clinical information. International consensus case definitions for intra-thoracic TB in children were applied.A total of 766 children were evaluated of whom 43 (5.6%) had TB. The most frequent lesion found in TB cases was air space consolidation (65.1%), followed by suggestive hilar lymphadenopathy (17.1%) and pleural effusion (7.0%). Air space consolidation was significantly more common in TB cases than in non-TB cases (odds ratio 8.9; 95% CI: 1.6-50.5), as were hilar lymphadenopathy (OR 17.2; 95% CI: 5.7-52.1). The only case with miliary infiltrates and 3 with pleural effusions occurred in HIV-infected children.Frequent air space consolidation complicates radiological distinction between TB and bacterial pneumonia in young children, underscoring the need for epidemiological contextualization and consideration of all relevant signs and symptoms

Caretakers' perspectives of paediatric TB and implications for care-seeking behaviours in Southern Mozambique.

Tuberculosis (TB) remains an important public health concern, especially in poorly resourced settings. TB diagnosis is challenging, particularly for children, who are the most vulnerable to its' impacts. Lack of knowledge and awareness of the disease compromises prompt diagnosis and treatment compliance.To gain insights regarding caretakers' knowledge of the aetiology and prevention of paediatric TB in southern Mozambique, to describe their care-seeking behaviours and to assess the acceptability of diagnostic procedures.A total of 35 caretakers were interviewed, all of which had children with TB compatible symptoms. Eleven were caretakers of children diagnosed with TB at the health facility, 11 of children for whom TB was excluded as a diagnosis at the health facility and 13 of children with TB compatible symptoms identified in the community. The first two groups took part in a TB incidence study, while the third group did not. All underwent the same semi-structured interviews, the results of which were analysed and compared using content analysis.Even when confronted with signs suggestive of TB, most caretakers never suspected it or misinterpreted the signs, even among caretakers with TB and TB contacts. There was limited knowledge of TB, except among those undergoing treatment. The transgression of social norms was often presented as an explanation for TB in parallel to medically sound causes. The use of traditional care for prevention is widespread, but it varied for treatment purposes. TB diagnostic procedures were considered painful but were unanimously tolerated.Misconceptions of paediatric TB, associated complex care-seeking itineraries and negative feelings of the diagnostic procedures may result in delays, low adherence and lost to follow-up, which needs to be addressed by adequately framed health promotion approaches

Airway compression and displacement of the left main bronchus with some consolidation in the left inferior lobe in a 17 month old HIV negative female.

<p>Airway compression and displacement of the left main bronchus with some consolidation in the left inferior lobe in a 17 month old HIV negative female.</p

Bilateral bronchoneumonia with perihilial lymph node enlargement and possible left bronchius compression in an 5 month old male HIV infected TB case.

<p>Lateral View.</p