Trends in birth weight and gestational age for infants born to HIV-infected, antiretroviral treatment-naive women in Malawi

Prevalence and associated risk factors of preterm birth among neonates in referral hospitals of Amhara Region, Ethiopia

INTRODUCTION

Preterm birth (PTB) is the largest direct cause of neonatal mortality and the second leading cause of under-five mortality following pneumonia. Although there are studies conducted before, the magnitude of PTB remains a major issue in most developing countries including Ethiopia. Therefore, this study aims to assess the prevalence and associated factors of premature birth among newborns delivered in Amhara Region Referral Hospitals, Northern Ethiopia.

METHODS

A hospital-based cross-sectional study was undertaken from February to April 2020. A systematic sampling technique was used to select 482 mother-newborn pairs. The data were collected by interviewing the mothers and reviewing their charts using a structured and pretested questionnaire. The outcome variable was preterm birth. Data were entered using Epi-data version 4.6 and then analyzed using STATA software (version 14). Bivariable and multivariable logistic regression analyses were done to determine the risk factors associated with premature birth.

RESULTS

In this study, the prevalence of premature birth was 11.41% (95% CI: 8.9, 14.6%). In multivariable logistic regression model; maternal age < 20 years (Adjusted odds ratio (AOR) = 7.8: 95% CI 2.3-26), preeclampsia (AOR = 5: 95% CI 2.3-11), premature rupture of membrane (AOR = 3.9: 95%CI 1.6-9.0), chronic medical illness (AOR = 4.6:95% CI2.1-10), and history of stillbirth (AOR = 2.7: 95% CI 1.1-7.3) were significantly associated with preterm birth.

CONCLUSION

The study indicates preterm birth is a major public health problem among newborns delivered in Amhara region referral hospitals. The risk factors associated with preterm birth are maternal age <20 years, preeclampsia, premature rupture of membranes, chronic medical illness, and history of stillbirth. Therefore, public health interventions have to be made to reduce the burden of prematurity through early detection and management of preeclampsia, premature rupture of membranes, and chronic medical illness. Obstetric care providers should give due attention to women with an age of <20 years and a history of stillbirth.

Prevalence of low birth weight and its associated factor at birth in Sub-Saharan Africa: A generalized linear mixed model

Background

Low birth weight (LBW) is one of the major determinants of perinatal survival, infant morbidity, and mortality, as well as the risk of developmental disabilities and illnesses in future lives. Though studies were conducted to assess the magnitude and associated factors of low birth weight, most of the studies were at a single center and little information on the regional level. Hence, this study assessed the prevalence and associated factors of low birth weight in Sub-Saharan countries.

Method

This study was based on secondary data sources from 35 Sub-Saharan countries’ Demography and Health Survey (DHS). For this study, we used the Kids Record (KR file) data set. In the KR file, all under-five children who were born in the last five years preceding the survey in the selected enumeration area who had birth weight data were included for the study. To identify determinants of low birth weight multivariable mixed-effect logistic regression model fitted. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤0.05 in the multivariable model were used to declare significant factors associated with low birth weight at birth.

Result

The pooled prevalence of newborn babies’ low birth weight measured at birth in Sub-Saharan Africa was 9.76% with (95% CI: 9.63% to 9.89%). Female child, women not participated in healthcare decision making, and wider birth intervals, divorced/ separated women, and twin pregnancies associated with increased occurrences of low birth weight, while some level of woman and husband education, antenatal care visits, older maternal age, and multiparity associated with reduced occurrence low birth weight.

Conclusion

This study revealed that the magnitude of low birth weight was high in sub-Saharan Africa countries. Therefore, the finding suggests that more emphasis is important for women with a lack of support, multiples, and healthcare decision-making problems.

A stitch in time: narrative review of interventions to reduce preterm births in Malawi

Background

The rising rate of preterm births (PTBs) is a global concern, and Malawi has a high rate of PTBs (10.5%). The resulting neonatal and under-5 mortality, morbidity and lifelong disability represent a significant loss of human potential affecting individuals, families and society as a whole. This study aims to review the literature to determine the risk factors for PTB in Malawi and to identify effective interventions to prevent PTBs.

Methods

A literature search yielded 22 studies that were categorized according to risk factors implicated for PTBs and health interventions to reduce the risks.

Results

The study has shown that maternal pregnancy factors, infections, nutrition, anaemia and young maternal age are the main causes and risk factors of PTBs in Malawi. The literature revealed no evidence of community-based interventions for reducing the rates of PTBs in Malawi.

Conclusions

Any successful effort to reduce the rate of PTBs will require a multisector, multilevel strategy targeted at the community, homes and individuals as a package to improve the education, nutrition and reproductive health of girls and women as well as focus on improving the delivery of antenatal services in the community.

Determinants of preterm birth among mothers who gave birth in East Africa: systematic review and meta-analysis

BACKGROUND

Preterm birth (PTB) can be caused by different factors. The factors can be classified into different categories: socio demographic, obstetric, reproductive health, medical, behavioral and nutritional related. The objective of this review was identifying determinants of PTB among mothers who gave birth in East African countries.

METHODS

We have searched the following electronic bibliographic databases: PubMed, Google scholar, Cochrane library, AJOL (African journal online). Cross sectional, case control and cohort study published in English were included. There was no restriction on publication period. Studies with no abstracts and or full texts, editorials, and qualitative in design were excluded. Funnel plot was used to check publication bias. I-squared statistic was used to check heterogeneity. Pooled analysis was done by using fixed and random effect model. The Joanna Briggs Critical Appraisal Tools for review and meta-analysis was used to check the study quality.

RESULTS

A total of 58 studies with 134,801 participants were used to identify determinants of PTB. On pooled analysis, PTB was associated with age < 20 years (AOR 1.76, 95% CI: 1.33-2.32), birth interval less than 24 months (AOR 2.03, 95% CI 1.57-2.62), multiple pregnancy (AOR 3.44,95% CI: 3.02-3.91), < 4 antenatal care (ANC) visits (AOR 5.52, 95% CI: 4.32-7.05), and absence of ANC (AOR 5.77, 95% CI: 4.27-7.79). Other determinants of PTB included: Antepartum hemorrhage (APH) (AOR 4.90, 95% CI: 3.48-6.89), pregnancy induced hypertension (PIH) (AOR 3.10, 95% CI: 2.34-4.09), premature rupture of membrane (PROM) (AOR 5.90, 95% CI: 4.39-7.93), history of PTB (AOR 3.45, 95% CI: 2.72-4.38), and history of still birth/abortion (AOR 3.93, 95% CI: 2.70-5.70). Furthermore, Anemia (AOR 4.58, 95% CI: 2.63-7.96), HIV infection (AOR 2.59, 95% CI: 1.84-3.66), urinary tract infection (UTI) (AOR 5.27, 95% CI: 2.98-9.31), presence of vaginal discharge (AOR 5.33, 95% CI: 3.19-8.92), and malaria (AOR 3.08, 95% CI: 2.32-4.10) were significantly associated with PTB.

CONCLUSIONS

There are many determinants of PTB in East Africa. This review could provide policy makers, clinicians, and program officers to design intervention on preventing occurrence of PTB.

Weight gain of HIV-exposed, uninfected children born before and after introduction of the 'Option B+' programme in Malawi

OBJECTIVE

To compare birth weight and weight gain in HIV-exposed, uninfected (HEU) infants up to 24 months old, who enrolled in the Malawian national HIV care clinic (HCC) programme either before or after Option B+ (OB+) was implemented.

DESIGN, SETTING AND PARTICIPANTS

HIV-exposed infants enrol in the HCC programme as soon as possible after birth and are followed up to at least 24 months old. This analysis includes HEU infants with recorded birth weight, date of birth, gender and at least one follow-up weight measurement from 21 health facilities in central and southern Malawi (January 2010-December 2014). Weight-for-age z scores (WAZ) were derived and compared by birth period using linear regression at birth and mixed effects models for postnatal weight gain up to 24 months old.

RESULTS

Of 6845 HEU infants included in this study, 88.5% were born after OB+. The proportion of infants exposed in utero to combination antiretroviral therapy (ART) significantly increased after OB+ was implemented, and infants were exposed to ART for a longer time. There was no significant difference in WAZ at birth (P = 0.654) among HEU infants by birth period, but postnatal weight gain was faster among HEU infants born in the Option B+ period than infants born pre-Option B+.

CONCLUSION

Birth weight was not affected by longer exposure to ART during pregnancy after OB+ was introduced, when weight gain in HEU infants was faster, possibly because their mothers were in better health.

Using multilevel models to evaluate the influence of contextual factors on HIV/AIDS, sexually transmitted infections, and risky sexual behavior in sub-Saharan Africa: a systematic review

PURPOSE

To describe the use of multilevel models (MLMs) in evaluating the influence of contextual factors on HIV/AIDS, sexually transmitted infections (STIs), and risky sexual behavior (RSB) in sub-Saharan Africa.

METHODS

Ten databases were searched through May 29, 2016. Two reviewers completed screening and full-text review. Studies examining the influence of contextual factors on HIV/AIDS, STIs, and RSB and using MLMs for analysis were included. The Quality Assessment Tool for Quantitative Studies was used to evaluate study quality.

RESULTS

A total of 118 studies met inclusion criteria. Seventy-four studies focused on HIV/AIDS-related topics; 46 focused on RSB. No studies related to STIs other than HIV/AIDS met the eligibility criteria. Of five studies examining HIV serostatus and community socioeconomic factors, three found an association between poverty and measures of inequality and increased HIV prevalence. Among studies examining RSB, associations were found with numerous contextual factors, including poverty, education, and gender norms.

CONCLUSIONS

Studies using MLMs indicate that several contextual factors, including community measures of socioeconomic status and educational attainment, are associated with a number of outcomes related to HIV/AIDS and RSB. Future studies using MLMs should focus on contextual-level interventions to strengthen the evidence base for causality.

Pregnancy Outcomes in HIV-Infected Women: Experience from a Tertiary Care Center in India

BACKGROUND AND OBJECTIVES

There is conflicting data on the effect of HIV infection as well as antiretroviral therapy (ART) on pregnancy outcome. The objectives of this study were to compare pregnancy outcomes in women with and without HIV infection, and to evaluate the effect of HAART on pregnancy in HIV-infected women.

METHODS

This is a prospective case record analysis of 212 HIV-infected women delivering between 2002 and 2015, in a tertiary health care center in India. The pregnancy outcome in HIV-infected women was compared to 238 HIV-uninfected controls. Women received ART for prevention of mother to child transmission as per protocol which varied during the period of study. Effect of use of ART on preterm birth (PTB) and intrauterine growth restriction (IUGR) was analyzed.

RESULTS

HIV-infected women were more likely to have PTB, IUGR, and anemia (9.4%, 9.9%, 5.2%) compared to uninfected women (7.6%, 5%, 3.8%), this did not reach statistical significance (P-value = >0.05). The incidence of PIH, diabetes mellitus and intrahepatic cholestasis of pregnancy was similar in both groups. Mean birth weight was significantly lower in neonates of HIV-infected women (2593.60±499g) than HIV-uninfected women (2919±459g) [P-value=0.001]. neonatal intensive care unit admissions were also significantly higher in infants born to HIV-infected women (P-value=0.002). HIV-infected women on ART had decreased incidence of PTB and IUGR.

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Good antenatal care and multidisciplinary team approach can optimize pregnancy outcomes in HIV-infected women.

Increased morbidity in early childhood among HIV-exposed uninfected children in Uganda is associated with breastfeeding duration

Human immunodeficiency virus (HIV)-exposed uninfected children (HEU) have an increased risk of morbidity and mortality compared with HIV-unexposed uninfected children (HUU); however, prior studies have not fully accounted for the role of both breastfeeding and age on this association. In this cohort of HEU and HUU in Uganda, non-breastfeeding HEU, from 6-11 months compared with non-breastfeeding HUU had a higher risk of hospitalizations [relative risk (RR): 10.1, 95% confidence interval (CI): 3.70-27.6], severe febrile illness (RR: 3.84, 95% CI: 2.06-7.17), severe diarrhea (RR: 6.37, 95% CI: 2.32-17.4) and severe malnutrition (RR: 18.4, 95% CI: 4.68-72.0). There were no differences between morbidity outcomes between breastfeeding HEU and HUU children, aged 6-11 months. In the 12-24 month age group, the only difference in morbidity outcomes among non-breast feeding children was an increased risk of severe malnutrition for HEU. These data suggest that the increased risk of morbidity among HEU aged 6-11 years is partially explained by early cessation of breastfeeding.

Severity of maternal HIV-1 disease is associated with adverse birth outcomes in Malawian women: a cohort study

BACKGROUND

Compared with HIV-negative women, HIV-infected women have increased risk of low birthweight (LBW) and preterm delivery (PTD). We assessed whether severity of maternal HIV-1 disease was associated with LBW or PTD.

METHODS

Secondary analysis of The Malaria and HIV in Pregnancy prospective cohort, which enrolled HIV-positive, pregnant Malawian women from 2000 to 2004. Included participants (n = 809) were normotensive antiretroviral treatment-naive women who delivered a live singleton infant. Binomial regression models were used to assess the unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CI) of the effect of severity of HIV-1 disease, defined by viral load and CD4 T-cell counts, on prevalence of LBW and PTD.

RESULTS

In unadjusted analyses, among those with malaria (n = 198), there was no association between severity of HIV-1 infection and LBW, whereas among women without malaria (n = 611), we observed a harmful association between both increasing peripheral viral load and LBW (PR: 1.44 per 1-log10 increase, 95% CI: 1.12 to 1.86) and placental viral load and LBW (PR: 1.24 per 1-log10 increase, 95% CI: 1.00 to 1.53). We observed a similar association between increasing placental viral load and PTD (PR: 1.33 per one-log10 increase, 95% CI: 1.04 to 1.69). These associations persisted in multivariate models adjusted for residence, maternal education, primigravid status, and maternal anemia.

CONCLUSIONS

In malaria-negative women, maternal HIV-1 disease severity was significantly associated with increased prevalence of LBW and PTD. Such an association was not found in the malaria-infected women.