The Enhancement of East African Universities’ Contribution towards the Attainment of Millennium Development Goal 5-Improving Maternal Health

Improving maternal health was recognized by the international community as a key component of the United Nations 2000 Millennium Summit initiative to reduce worldwide hunger, poverty and disease.Improving maternal health was recognized by the international community as a key component of the United Nations 2000 Millennium Summit initiative to reduce worldwide hunger, poverty and disease. All participating countries agreed to work toward the eight Millennium Development Goals (MDGs) and Millennium Development Goal 5 (MDG-5) in particular, which focuses on reducing the global maternal mortality ratio by 75 percent by 2015 compared to 1990 rates. According to recent estimates, exciting progress towards reducing maternal mortality has been made in many developing regions, including sub-Saharan Africa and Southern Asia where the majority of maternal deaths occur. Despite this important progress however, an estimated 358,000 maternal deaths occurred worldwide in 2008. Worse still, developing countries account for 99 percent, or 355,000, of all deaths. Sub-Saharan Africa and Southern Asia account for 87 percent of global maternal deaths, (313,000 deaths). It has also been estimated that, in sub-Saharan Africa, a woman’s risk of dying from preventable or treatable complications of pregnancy and childbirth over the course of her life time is 1 in 31, compared to only 1 in 4300 in developed regions (United Nations, 2010).1 Sub-Saharan African countries have much to gain from the realization and achievement of the MDGs. This takes the involvement of different stakeholders including universities. However, what role(s) are the universities in Sub-Saharan Africa playing in educating students about MDGs and, especially, MDG-5? Given that current and future Sub-Saharan Africa University students are considered to be the elites in their countries and will become decision makers and activists, a study on the Enhancement of East African Universities’ Contribution towards the Attainment of MDG 5 reveals that universities can, and should play a pivotal role in accelerating progress

A case for vaccinating adolescent girls for protection against COVID-19 during pregnancy and childbirth in resource-limited settings

The coronavirus disease 2019 (COVID-19) pandemic has had severe implications worldwide, including increased adverse maternal and neonatal health outcomes. Vaccination is one way of protecting against these adverse health outcomes. However, in some low-resource settings, vaccine inequity has led to poor uptake of COVID-19 vaccination. There are very high rates of adolescent pregnancy in low-resource settings, which are likely to become even higher as we begin to see the full effects of COVID-19 lockdown measures, including school closures. Although the benefits of COVID-19 vaccination in adolescents are debated, we propose that adolescent girls should be prioritised in COVID vaccination roll out in low-resource settings. This is to provide protection from severe COVID-19 disease in pregnancy, preventing adverse maternal and neonatal health outcomes

Relative impact of pre-eclampsia on birth weight in a low resource setting: A prospective cohort study.

OBJECTIVES: Low birth-weight is a major risk factor for perinatal death in sub-Saharan Africa, but the relative contribution of determinants of birth-weight are difficult to disentangle in low resource settings. We sought to delineate the relationship between birth-weight and maternal pre-eclampsia across gestation in a low-resource obstetric setting. STUDY DESIGN: Prospective cohort study in a tertiary referral centre in urban Uganda, including 971 pre-eclampsia cases and 1461 control pregnancies between 28 and 42 weeks gestation. MAIN OUTCOME MEASURES: Nonlinear modeling of birth-weight versus maternal pre-eclampsia status across gestation. Models were adjusted for maternal-fetal characteristics including maternal age, parity, HIV status, and socio-economic status. Propensity score matching was used to control for the severity of pre-eclampsia at different gestational ages. RESULTS: Mean birth-weight for pre-eclampsia cases was 2.48 kg (±0.81SD) compared to 3.06 kg (±0.46SD) for controls (p < 0.001). At 28 weeks, the mean birth-weight difference between pre-eclampsia cases and controls was 0.58 kg (p < 0.05), narrowing to 0.17 kg at 39 weeks (p < 0.01). Controlling for pre-eclampsia severity only partially explained this gestational difference in mean birth-weight between pre-eclampsia cases and controls. Holding gestational age constant, pre-eclampsia status predicted 7.1-10.5% of total variation in birth-weight, compared to 0.05-0.7% for all other maternal-fetal characteristics combined. CONCLUSIONS: Pre-eclampsia is the dominant predictor of birth-weight in low-resource settings and hence likely to heavily influence perinatal survival. The impact of pre-eclampsia on birth-weight is smaller with advancing gestational age, a difference that is not fully explained by controlling for pre-eclampsia severity.CA is supported by an Isaac Newton Trust[12.21(a)]/Wellcome Trust ISSF [105602/Z/14/Z]/ University of Cambridge Joint Research Grant. This work was funded by the Wellcome Trust (094073/Z/10/B), and a Wellcome Trust Uganda Postdoctoral Fellowship in Infection and Immunity held by AN, funded by a Wellcome Trust Strategic Award, grant number 084344. Supported by NURTURE fellowship to AN, grant number D43TW010132. This work was also supported through the DELTAS Africa Initiative (grant number 107743/Z/15/Z). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (grant number 107743/Z/15/Z) and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government. JES acknowledges the support of a T32 fellowship from the U.S. National Institutes of Health

Experiences of Using the Toll Free Telephone Line to Access Maternal and Newborn Health Services in Central Uganda: A Qualitative Study

<p>Maternal mortality remains a significant public health challenge in Sub-Saharan Africa. Most of these deaths are preventable and can be addressed with low cost, effective interventions with an understanding of the <i>three delays</i> associated with maternal morbidity and mortality. This qualitative study used Focused Group Discussions (FGDs) to collect data in four health facilities. A total of 10 FGDs were conducted; two with health workers, four with women, and another four with both men and women. Each session lasted 45-60 minutes and had a moderator, observer and note taker. All discussions were audio recorded after obtaining consent from the participants. Interviews were transcribed verbatim and translated to English from audio recordings. Data analysis was performed using the thematic analysis with major themes determined appriori while sub themes emerge using QDA DATA Miner software. This data comprises of 10 full text transcripts from the group discussion sessions</p><p><br></p><p><br></p><p><br></p><p><br></p

Antibody and B-cell Immune Responses Against Bordetella Pertussis Following Infection and Immunization

Neither immunization nor recovery from natural infection provides life-long protection against Bordetella pertussis. Replacement of a whole-cell pertussis (wP) vaccine with an acellular pertussis (aP) vaccine, mutations in B. pertussis strains, and better diagnostic techniques, contribute to resurgence of number of cases especially in young infants. Development of new immunization strategies relies on a comprehensive understanding of immune system responses to infection and immunization and how triggering these immune components would ensure protective immunity. In this review, we assess how B cells, and their secretory products, antibodies, respond to B. pertussis infection, current and novel vaccines and highlight similarities and differences in these responses. We first focus on antibody-mediated immunity. We discuss antibody (sub)classes, elaborate on antibody avidity, ability to neutralize pertussis toxin, and summarize different effector functions, i.e. ability to activate complement, promote phagocytosis and activate NK cells. We then discuss challenges and opportunities in studying B-cell immunity. We highlight shared and unique aspects of B-cell and plasma cell responses to infection and immunization, and discuss how responses to novel immunization strategies better resemble those triggered by a natural infection (i.e., by triggering responses in mucosa and production of IgA). With this comprehensive review, we aim to shed some new light on the role of B cells and antibodies in the pertussis immunity to guide new vaccine development