Umbilical artery doppler abnormalities and associated factors in women with pre-eclampsia at Mulago Hospital- a cross sectional study

Background: Umbilical artery (UA) Doppler velocimetry detects foetuses at risk of asphyxia from IUGR before changes in the CTG and biophysical score are evident. This has made it a primary fetal surveillance tool in pre-eclampsia in developed countries with resultant reduction in perinatal mortality by 29%. Iatrogenic preterm deliveries related to pre-eclampsia are a key contributor to neonatal intensive care admissions at Mulago hospital due in part to limited use of UA Doppler velocimetry to optimize delivery because of high patient load.Objective: The objective was to determine the prevalence and factors associated with UA Doppler abnormalities in women with preeclampsia from 28 weeks of pregnancy so as to identify a subpopulation who would require routine UA Doppler velocimetry to improve perinatal outcomes in a resource limited context.Study design: This was a cross-sectional analytical study. Maternal age, Gestational age, Parity, and Blood pressure were recorded. Degree of proteinuria, Platelet count, serum creatinine and liver transaminases were analysed and UA Doppler sonography was performed to determine the RI, S/D ratio, AEDV and RF patterns. These data were entered into EPIDATA 3.1 and exported to STATA version 12 for analysis. Bivariate and Multivariate analysis were deployed to identify factors associated with Doppler abnormalities.Study Setting: The study was conducted on the labour and maternal-fetal medicine wards of Mulago National Referral hospital, Kampala Uganda between June and September 2014.Subjects: A total of 155 women with pre-eclampsia between 28 and 42 weeks of pregnancy were consented/assented and recruited for the study. Critically ill  patients and those in active phase of labour or premature rupture of membranes were excluded.Results: The overall prevalence of UA Doppler abnormalities was 31.6%. High RI, high S/D ratio, AEDV and RF were found in 25.8%, 31.6%, 7.7% and 4.5% of the population respectively. Key factors associated with UA Doppler abnormalities were gestational age below 35 weeks (AOR=8.1, 95% CI: 2.91- 22.76, P<0.001), severe pre-eclampsia with heavy proteinuria (AOR=7.3, 95% CI: 2.82-18.87, P<0.001), and multiparity (AOR=5.3, 95% CI: 1.52-18.53, P<0.001). Severe pre-eclampsia comprised 61% (n=95) of the study population. Maternal age and pre-eclampsia with light proteinuria had no association with UA Doppler abnormalities.Conclusion: UA Doppler abnormalities are very common in pre-eclampsia. Gestational age below 35 weeks and heavy proteinuria are the key associated factors of these abnormalities

Lack of effect of intermittent preventive treatment for malaria in pregnancy and intense drug resistance in western Uganda

Background Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine–pyrimethamine (SP) is widely implemented in sub-Saharan Africa for the prevention of malaria in pregnancy and adverse birth outcomes. However, in areas of intense SP resistance, the efficacy of IPTp may be compromised. Methods A cross-sectional study among 915 delivering women (728 analysable live singleton deliveries) was conducted in Fort Portal, western Uganda, to assess associations of reported IPTp use, Plasmodium falciparum infection, maternal anaemia, low birth weight, and preterm delivery, and to estimate the degree of SP resistance as reflected by pfdhfr/pfdhps mutations. Results Plasmodium falciparum infection was detected by PCR in 8.9 % and by microscopy of placental blood samples in 4.0 %. Infection was significantly associated with stillbirth, early neonatal death, anaemia, low birth weight, and pre-term delivery. Eighty percent of the women had taken at least one dose of IPTp, and more than half had taken two doses. As compared to women without chemoprophylaxis against malaria, IPTp had no significant influence on the presence of P. falciparum infection (13.8 vs. 9.6 %, P = 0.31). Nor was it associated with reductions in anaemia, low birth weight or preterm delivery. P. falciparum with intense SP resistance (pfdhfr/pfdhps quintuple or sextuple mutations) were observed in 93 % (pfdhps 581G, 36 %), and the additional high resistance allele pfhdr 164L in 36 %. Conclusions In Fort Portal, Uganda, reported use of IPTp with SP does not provide an observable benefit. The molecular markers of P. falciparum indicate high grade SP resistance reaching the threshold set by WHO for the discontinuation of IPTp with SP. Alternative approaches for the prevention of malaria in pregnancy are urgently needed

High prevalence of Schistosoma mansoni infection and stunting among school age children in communities along the Albert-Nile, Northern Uganda: A cross sectional study

BackgroundKnowing the prevalence of schistosomiasis is key to informing programmes to control and eliminate the disease as a public health problem. It is also important to understand the impact of infection on child growth and development in order to allocate appropriate resources and effort to the control of the disease.MethodsWe conducted a survey to estimate the prevalence of schistosomiasis among school aged children in villages along the Albert-Nile shore line in the district of Pakwach, North Western Uganda. A total of 914 children aged between 10-15 years were screened for Schistosoma mansoni using the POC-CCA and Kato Katz (KK) techniques. The infection intensities were assessed by POC-CCA and KK as well as CAA tests. The KK intensities were also correlated with POC-CCA and with CAA intensity. Anthropometric measurements were also taken and multivariate analysis was carried out to investigate their association with infection status.ResultsThe prevalence of schistosomiasis using the POC-CCA diagnostic test was estimated at 85% (95% CI: 83-87), being highest amongst children living closer to the Albert-Nile shoreline. Visual scoring of the POC-CCA results was more sensitive than the Kato Katz test and was positively correlated with the quantified infection intensities by the CAA test. The majority of the children were underweight (BMI< 18.5), and most notably, boys had significantly lower height for age (stunting) than girls in the same age range (p < 0.0001), but this was not directly associated with S. mansoni infection.ConclusionHigh prevalence of S. mansoni infection in the region calls for more frequent mass drug administration with praziquantel. We observed high levels of stunting which was not associated with schistosomiasis. There is a need for improved nutrition among the children in the area.Author summarySchistosomiasis is a neglected but frequent disease that is caused by schistosomes, with over 290 million people worldwide at risk of infection. The major mode of transmission is through contact with fresh water sources infested with infected snails (the intermediate host). In this study, using the point of care test (POC-CCA), we screened 914 school aged children (10-15 years) living in the rural communities along the Lake Albert- River Nile shores of Pakwach district in Northern Uganda. We observed a very high prevalence of S. mansoni infections (over 80%) although the prevalence dropped to 40% in communities that were further from the lake shores. This high prevalence was also coupled with Kato Katz light schistosome infection intensities as categorised by WHO guidelines. We further compared the POC-CCA and Kato Katz tests to the more sensitive CAA assay and this revealed that even though both tests gave good probability of positive prediction, the POC-CCA had higher sensitivity in screening for S. mansoni infections than Kato Katz assay. The study also revealed high levels of stunting within the children, more so amongst boys. Frequent screening and mass treatment of these communities with praziquantel will reduce on the infection rates. But in addition, improved hygiene and sanitation will be required for a sustainable reduction in the prevalence and morbidity of schistosomiasis in the Albert-Nile communities along with dietary intervention for optimal child health

Socioeconomic Gradients of Cardiovascular Risk Factors in China and India: Results from the China Health and Retirement Longitudinal Study and Longitudinal Aging Study in India

ObjectivesCardiovascular disease has become a major public health challenge in developing countries. The goal of this study is to compare socioeconomic status (SES) gradients of cardiovascular risk factors (CVRF) both within and between China and India.MethodsWe used multivariable logistic regression models to examine the associations between SES and CVRF, using data from the China health and retirement longitudinal study and the longitudinal aging study in India.ResultsThe results showed that, compared to illiteracy, the odds ratios of completing junior high school for high-risk waist circumference were 4.99 (95% confidence interval: 1.77-14.06) among Indian men, 3.42 (95% confidence interval: 1.66-7.05) among Indian women, but 0.74 (95% confidence interval: 0.59-0.92) among Chinese women. Similar patterns were observed between educational attainment and high-risk body mass index, and between education and hypertension, based on self-reported physician diagnosis and direct blood pressure measurements.ConclusionsSES is associated with CVRF in both China and India. However, this relationship showed opposite patterns across two countries, suggesting that this association is not fixed, but is subjective to underlying causal pathways, such as patterns of risky health behaviors and different social and health policies