Nutritional status is the major factor affecting grip strength of African HIV patients before and during antiretroviral treatment.

: Low grip strength is a marker of frailty and a risk factor for mortality among HIV patients and other populations. We investigated factors associated with grip strength in malnourished HIV patients at referral to ART, and at 12 weeks and 2-3 years after starting ART. : The study involved HIV-infected Zambian and Tanzanian participants recruited to the NUSTART trial when malnourished (body mass index &lt;18.5 kg/m(2) ) and requiring ART. The relationship of grip strength to nutritional, infectious and demographic factors was assessed by multivariable linear regression at referral for ART (n=1742) and after 12 weeks (n=778) and 2-3 years of ART (n=273). : In analyses controlled only for sex, age and height, most nutrition and infection-related variables were associated with grip strength. However, in multivariable analyses, consistent associations were seen for fat-free mass index, mid-upper arm circumference, haemoglobin and systolic blood pressure, and a variable association with fat mass index in men. C-reactive protein and CD4 count had limited independent effects on grip strength, while receiving tuberculosis treatment was associated with weaker grip strength. : In this population of originally malnourished HIV patients, poor grip strength was more strongly and independently associated with nutritional than with infection and inflammation variables. Programmes to improve health and survival of HIV patients should incorporate nutritional assessment and management and could use grip strength as a functional indicator of improving nutrition. This article is protected by copyright. All rights reserved.<br/

Behavioural Determinants of Hand Washing and Glove Recontamination before Aseptic Procedures at Birth: A Time-and-Motion Study and Survey in Zanzibar Labour Wards

© 2020 by the authors. Recent research calls for distinguishing whether the failure to comply with World Health Organisation hand hygiene guidelines is driven by omitting to rub/wash hands, or subsequently recontamination of clean hands or gloves prior to a procedure. This study examined the determinants of these two behaviours. Across the 10 highest-volume labour wards in Zanzibar, we observed 103 birth attendants across 779 hand hygiene opportunities before aseptic procedures (time-and-motion methods). They were then interviewed using a structured cross-sectional survey. We used mixed-effect multivariable logistic regressions to investigate the independent association of candidate determinants with hand rubbing/washing and avoiding glove recontamination. After controlling for confounders, we found that availability of single-use material to dry hands (OR:2.9; CI:1.58–5.14), a higher workload (OR:29.4; CI:12.9–67.0), more knowledge about hand hygiene (OR:1.89; CI:1.02–3.49), and an environment with more reminders from colleagues (OR:1.20; CI:0.98–1.46) were associated with more hand rubbing/washing. Only the length of time elapsed since donning gloves (OR:4.5; CI:2.5–8.0) was associated with avoiding glove recontamination. We identified multiple determinants of hand washing/rubbing. Only time elapsed since washing/rubbing was reliably associated with avoiding glove recontamination. In this setting, these two behaviours require different interventions. Future studies should measure them separately.The project was funded by the Medical Research Council–PHIND scheme. Award number MR/N015975/1. The Soapbox Collaborative also contributed by funding staff involved in this project. This award is jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and is also part of the EDCTP2 programme supported by the European Union. The writing up of this paper provided part of the background needed for the CLEAN Study funded by the UK Joint Global Health Trials (Wellcome, MRC, DFID and DOH). Award number: MR/R019274/1. SN is supported by an award jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement, which is also part of the EDCTP2 programme supported by the European Union. Award number: MR/R010161/

Taxonomic Distinctness of Demersal Fishes of the California Current: Moving Beyond Simple Measures of Diversity for Marine Ecosystem-Based Management

BACKGROUND: Large-scale patterns or trends in species diversity have long interested ecologists. The classic pattern is for diversity (e.g., species richness) to decrease with increasing latitude. Taxonomic distinctness is a diversity measure based on the relatedness of the species within a sample. Here we examined patterns of taxonomic distinctness in relation to latitude (ca. 32-48 degrees N) and depth (ca. 50-1220 m) for demersal fishes on the continental shelf and slope of the US Pacific coast. METHODOLOGY/PRINCIPAL FINDINGS: Both average taxonomic distinctness (AvTD) and variation in taxonomic distinctness (VarTD) changed with latitude and depth. AvTD was highest at approximately 500 m and lowest at around 200 m bottom depth. Latitudinal trends in AvTD were somewhat weaker and were depth-specific. AvTD increased with latitude on the shelf (50-150 m) but tended to decrease with latitude at deeper depths. Variation in taxonomic distinctness (VarTD) was highest around 300 m. As with AvTD, latitudinal trends in VarTD were depth-specific. On the shelf (50-150 m), VarTD increased with latitude, while in deeper areas the patterns were more complex. Closer inspection of the data showed that the number and distribution of species within the class Chondrichthyes were the primary drivers of the overall patterns seen in AvTD and VarTD, while the relatedness and distribution of species in the order Scorpaeniformes appeared to cause the relatively low observed values of AvTD at around 200 m. CONCLUSIONS/SIGNIFICANCE: These trends contrast to some extent the patterns seen in earlier studies for species richness and evenness in demersal fishes along this coast and add to our understanding of diversity of the demersal fishes of the California Current

Measurement, incidence and risk factors of maternal peripartum infection

INTRODUCTION: Pregnancy-related infection causes an estimated 11% of maternal deaths and increases the risk of stillbirth and neonatal mortality. However, definitions vary, measurement methods are inconsistent, and the incidence remains poorly described. This thesis aims to improve understanding of the measurement, incidence and risk factors of maternal peripartum infection. METHODS: I conducted a systematic literature review of global incidence of maternal peripartum infection; I explored infection definitions and data collection methods. I conducted a literature review of postnatal follow-up methods. Applying learning from the reviews, I designed a telephone-surveillance cohort study to measure incidence and risk factors of postnatal infection in Tanzania. RESULTS: No existing study met the full WHO criteria for maternal peripartum infection. In highquality studies, pooled infection incidence per 1000 women was 39 for chorioamnionitis, 16 for endometritis, 12 for wound infection and 0.5 for sepsis. Only 19% of studies met all quality criteria and 41% used a standard definition for infection. Less than half of studies followed women after hospital discharge. In the literature review of postnatal follow-up, telephone surveillance studies reached 63-91% of women. We recruited 879 women and interviewed 791 (90%) by telephone in Tanzania. Age, delivery mode and hospital did not affect the chance of reaching women, but 29% of interviews required over one call attempt. At day-28 postnatal, infection incidence per 1000 was 49 for maternal peripartum infection; 27 for endometritis, 28 for wound infection and with no cases of chorioamnionitis. The infection rate was higher in women with caesarean childbirth. CONCLUSION: Maternal peripartum infection remains an important complication of pregnancy and prevention strategies need increased attention. Improved measurement requires validated, standard definitions for constituent infections, applicable to low-resource settings, plus active postnatal follow-up. Telephone surveillance should be considered for follow-up; in Tanzania it achieved good coverage, and infection estimates were consistent with other studies