Efficacy of mobile phone intervention to increase male partner antenatal care attendance for HIV testing in Moshi municipal, Tanzania: a randomized controlled trial

BACKGROUND

HIV partner counselling and testing in antenatal care (ANC) is a crucial strategy to raise the number of males who know their HIV status. However, in many settings like Tanzania, male involvement in antenatal care remains low, and there is a definite need for innovative strategies to increase male partner involvement. This study was designed to evaluate the efficacy of mobile phone intervention increase male partner ANC attendance for HIV testing in Moshi municipal, Tanzania.

METHODS

Between April and July 2022, we enrolled pregnant women presenting to a first ANC visit at Majengo and St. Joseph reproductive health facilities without their male partners. Eligible pregnant women were randomly assigned to invitation of their male partners either via phone calls, text messages from clinic staff and verbal invites from pregnant partners (intervention arm) or verbal invites only from the pregnant partners (control arm). Neither healthcare provider nor participant were blinded. The primary outcome was the proportion of male partners who attended ANC with their pregnant partners during a follow-up period of two consecutive visits. The secondary outcome measure was HIV testing among male partners following the invitation. Participants were analyzed as originally assigned (intention to treat).

RESULTS

A total of 350 pregnant women presenting to ANC for the first time were enrolled, with 175 women enrolled in each arm. The efficacy of male attendance with their pregnant women following the invitations was 83.4% (147/175) in the intervention arm and 46.3% (81/175) in the control arm. Overall, the results suggest a positive and statistically significant average treatment effect among men who received mobile phone intervention on ANC attendance. For the secondary outcome, the percent of male partners who accepted HIV counselling and testing was 99.3% (146/147) in the intervention arm and 93.8% (76/81) in the control arm. Married men were having higher odds of ANC attendance compared with single men (aOR:6.40(3.26-12.56), Males with multigravida women were having lower odds of ANC attendance compared with primigravida women (aOR:0.17(0.09-0.33).

CONCLUSION

The study demonstrates that supplementing verbal invitations with mobile phone calls and text messages from clinic staff can significantly increase male partner ANC attendance and HIV testing. This combined approach is recommended in improving ANC attendance and HIV testing of male partners who do not accompany their pregnant partners to antenatal clinics in the first visits.

TRIAL REGISTRATION

PACTR202209769991162.

Validation of the Pediatric Resuscitation and Trauma Outcome (PRESTO) model in injury patients in Tanzania

INTRODUCTION

Sub-Saharan Africa has the highest rate of unintentional paediatric injury deaths. The Pediatric Resuscitation and Trauma Outcome (PRESTO) model predicts mortality using patient variables available in low-resource settings: age, systolic blood pressure (SBP), heart rate (HR), oxygen saturation, need for supplemental oxygen (SO) and neurologic status (Alert Verbal Painful Unresponsive (AVPU)). We sought to validate and assess the prognostic performance of PRESTO for paediatric injury patients at a tertiary referral hospital in Northern Tanzania.

METHODS

This is a cross-sectional study from a prospective trauma registry from November 2020 to April 2022. We performed exploratory analysis of sociodemographic variables and developed a logistic regression model to predict mortality using R (V.4.1). The logistic regression model was evaluated using area under the receiver operating curve (AUC).

RESULTS

499 patients were enrolled with a median age of 7 years (IQR 3.41-11.18). 65% were boys, and in-hospital mortality was 7.1%. Most were classified as alert on AVPU Scale (n=326, 86%) and had normal SBP (n=351, 98%). Median HR was 107 (IQR 88.5-124). The logistic regression model based on the original PRESTO model revealed that AVPU, HR and SO were statistically significant to predict in-hospital mortality. The model fit to our population revealed AUC=0.81, sensitivity=0.71 and specificity=0.79.

CONCLUSION

This is the first validation of a model to predict mortality for paediatric injury patients in Tanzania. Despite the low number of participants, our results show good predictive potential. Further research with a larger injury population should be done to improve the model for our population, such as through calibration.

Recurrence of post-term pregnancy and associated factors among women who delivered at Kilimanjaro Christian Medical Centre in northern Tanzania: A retrospective cohort study

BACKGROUND

Post-term pregnancy is a health problem of clinical importance and; tends to recur in subsequent pregnancies. Maternal age, height, and male fetal sex are risk factors associated with Post-term pregnancy. The study aimed to determine the recurrence risk of post-term pregnancy and associated factors among women delivered at KCMC referral hospital.

METHODOLOGY

This retrospective cohort study used KCMC zonal referral hospital medical birth registry cohort data for 43472 women delivered between 2000 and 2018. Data were analyzed using STATA version 15 software. Log-binomial regression with robust variance estimator determined the factors associated recurrence of post-term pregnancy adjusted for other factors.

RESULTS

A total of 43472 women were analyzed. The proportion of post-term pregnancy was 11.4%, and the recurrence was 14.8%. The recurrence risk of post-term pregnancy was increased when a woman had a history of previous post-term pregnancy (aRR: 1.75; 95%CI: 1.44, 2.11). Advanced maternal age, i.e., ≥35years (aRR: 0.80; 95%CI: 0.65, 0.99), having secondary and higher education (aRR: 0.8; 95%CI: 0.66, 0.97), and being employed (aRR: 0.68; 95%CI: 0.55, 0.84) decreased the recurrence risk of post-term pregnancy. Women with recurrence of post-term pregnancy had a higher risk of delivering newborns weighed ≥4000gm (aRR: 5.05; 95% CI: 2.80, 9.09).

CONCLUSION

Post-term pregnancy is associated with recurrence risk in subsequent pregnancies. A history of previous post-term pregnancy is associated risk factor and these women are at increased risk of delivering newborns weighed ≥4000gm. Clinical counselling of women at risk of post-term pregnancy and timely management is recommended to prevent adverse neonatal and maternal outcomes.

Analysis of glucose tolerance in twin gestations using an oral glucose load

The effect of twin gestation on carbohydrate metabolism was evaluated using a 75 g oral glucose tolerance test (75 g OGTT). A 75 g OGTT was performed in 63 twin gestations and 3 791 singleton gestations during the third trimester. Plasma glucose concentrations were measured in the pregnant women under fasting conditions as well as 30 min, 1 h, and 2 h after ingestion of glucose (75 g oral load), and serum insulin concentrations were measured in fasting and 30 min post-ingestion samples. Women with twin gestations showed significantly lower plasma glucose concentrations during fasting and 30 min after the glucose load in the samples taken than those with singleton gestations. No significant difference in serum glucose concentrations was found in the other specimens. There were no cases of gestational diabetes mellitus in our study. Although women with twin gestations demonstrated lower plasma glucose concentrations than women with singleton gestations, the difference observed was subtle. We could not find any significant differences in these plasma glucose values as used to define a pathologic OGTT between twin and singleton pregnancies, with the exception of the fasting value.

[Infection route of MRSA to pregnant women and to newborns]

It has been reported that newborn babies are compromised hosts, and to be MRSA carriers means that the danger of occurrence of MRSA infection is high. Our department has focused on improving the hospital environment to guard against hospital infections. Infection from the hospital environment was prevented by looking for staphylococcus bacteria in the nasal cavity during pregnancy, and isolating pregnant MRSA carriers from others. Such effects as MRSA infection of the body members and organs, the newborn babies, nasal cavities of their family members, and discharging MRSA into hospital environments were investigated. 1. The rate of MRSA carriers among pregnant women was 0.8% (3.7% of pregnant women engaged in medical services, and 0.5% of pregnant women engaged in non-medical services). In the former case it was suspected that their children became MRSA carriers for some reason and they became infected through their children. In the latter case, there are two possibilities; one was that MRSA was picked up at the place of work was not removed by sterilization, so that they became carriers and the other is infection through children similarly to non-medical workers. 2. A healthy carrier was observed to be spreading MRSA in to the environment. 3. In the environment where hospital infections were fully dealt with, MRSA infection of newborn babies was always from puerperal women who were carriers. 4. The rates for both MRSA carrying in the nasal cavities of newborn babies at the time of dehospitalization and 1-month-old babies were distinctly low, when the nasal MRSA of puerperal was removed by sterilization, compared to without sterilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Latent papillomavirus and recurring genital warts

After anogenital condylomata and intraepithelial neoplasms are removed, they frequently recur. Since these lesions are related to papillomaviruses, it has been suggested that latent papillomavirus infection is responsible for recurrence. We studied 20 cases of anogenital lesions that were treated by laser therapy and analyzed biopsy specimens of margins of normal skin adjacent to the lesions for papillomavirus sequences by Southern blot hybridization. In nine cases (45 per cent), papillomavirus sequences were detected in the normal skin margin; lesions recurred in 6 of the 9 patients (67 per cent), in contrast to only 1 of 11 patients (9 per cent) whose margins were negative for the presence of papillomavirus sequences. All but one recurrence developed within 15 mm of the treatment area. Our results demonstrate that clinically and histologically latent papillomavirus exists beyond the treatment area and that its presence influences subsequent recurrences.

Immunoperoxidase localization of chlamydial antigens in acute salpingitis

Seventy surgically excised fallopian tubes in which there was originally a diagnosis of acute salpingitis were reviewed histologically and screened for chlamydial antigens by the immunoperoxidase technique. Chlamydial antigens were localized within tubal epithelial cells in two of the 70 cases (3%). Endometrial specimens from these two patients were also positive for chlamydial antigens. There was no definite correlation between the histologic features of the salpingitis and chlamydial immunoperoxidase positivity.

Chlamydial endometritis. A histological and immunohistochemical analysis

A series of 90 endometrial biopsies and curettings originally diagnosed as chronic endometritis were reviewed and histological findings of plasma cells, lymphoid infiltrate, stromal necrosis, acute inflammation, lymphoid follicles, and epithelial atypia were correlated with the demonstration of chlamydial antigens by the immunoperoxidase technique. Chlamydial antigens were localized within endometrial epithelial cells in four cases. Although these four cases represented only 4% of the total number, chlamydial immunoperoxidase positivity was best discriminated by the severity of the inflammation and the presence of an acute inflammatory infiltrate. Among cases of severe endometritis 22% were chlamydia-positive, and in those cases with an associated acute inflammatory infiltrate, 57% were positive. A high index of suspicion of chlamydial infection should exist when severe endometritis is diagnosed in patients with clinical histories of post-abortal state, pelvic inflammatory disease, secondary infertility or menometrorrhagia, and chronic pelvic pain.

Chlamydial cervicitis and cervical intraepithelial neoplasia: an immunohistochemical analysis

Studies using serological and culture techniques indicate that chlamydial infection is frequently associated with cervical intraepithelial neoplasia (CIN). This relationship was investigated by examining a series of biopsies containing normal epithelium, non-neoplastic condylomatous epithelium, and neoplastic epithelium (CIN). In each case the degree of inflammation and the presence of reparative atypia were recorded from an examination of the hematoxylin and eosin stained sections and serial sections were stained for chlamydial antigens using a polyclonal antichlamydial antibody and the immunoperoxidase technique. Overall, staining for chlamydia was positive in 0, 2, and 16% of biopsies with mild, moderate, and severe inflammation, respectively. In cases of severe inflammation positive staining was present in 20, 25, and 8% of biopsies containing non-neoplastic, condylomatous, and neoplastic epithelium, respectively. In all positive cases the staining was most prevalent in areas of the most intense inflammation. A spectrum of squamous epithelial changes was found in the infected biopsies and their distinction from CIN is discussed. This study suggests that tissue staining for chlamydia is related more to the extent of the coexisting inflammation than the presence or absence of CIN. Chlamydial infection, however, was frequently associated with inflammation-related squamous atypia in the transformation zone, which may be confused histologically with CIN.

Localizing chlamydial infection in cervical biopsies with the immunoperoxidase technique

One hundred and two cervical biopsy specimens containing varying degrees of chronic inflammation were stained for chlamydial antigens with the immunoperoxidase technique. Seven cases (6.9%) were positive. Histologically, six (84%) of the Chlamydia-positive cases contained severe chronic inflammation, all contained reparative atypia, and two (28%), follicular cervicitis. When evaluated separately, 22% (six of 27) of the specimens with severe inflammation were positive in contrast to 0% (0 of 45) of cases with mild inflammation. Positively staining cells were located primarily in columnar epithelium and reparative atypia and occasionally in areas of immature squamous metaplasia. The cytological finding which correlated with positive staining was cytoplasmic vacuolation; however, cytoplasmic vacuoles were common in cells which did not stain positively, and it was impossible to predict on histological grounds which cells/specimens would stain positively by immunoperoxidase. Because of these findings, the presence of chlamydial infection should be strongly suspected whenever the cervical biopsy specimen contains severe inflammation and repair. Although tissue staining may not be as sensitive as culture for diagnostic purposes, it can be performed rapidly and simply and may be a useful special stain in cases where the diagnosis of chlamydial infection is not suspected clinically or cultures are not immediately available.

[Evaluation of postoperative radiotherapy by the moving strip technique for malignant ovarian tumor]

As a treatment for malignant ovarian tumor, whole abdominal irradiation including the upper abdomen is more useful. Between December, 1975 and November, 1980, we additionally applied whole abdominal irradiation by the moving strip technique (1,600 rad) after operation and whole pelvic irradiation (3,000 rad) to 43 cases of malignant ovarian tumor (serous cystadenocarcinoma-24, mucinous cystadenocarcinoma-7, mesodermal mixed tumor-3, clear cell carcinoma-2, endometrioid carcinoma-2, malignant granulosa cell tumor-1, malignant Brenner tumor-1 and metastatic tumor-3). Out of 10 cases with complete resection of the tumor, nine patients are surviving without recurrence, and also some advanced cases with incomplete operation have shown a remarkable reduction in the tumor size. As to complications, diarrhea during lower abdominal irradiation as well as nausea and vomiting during upper abdominal irradiation were observed, but no characteristic changes were observed upon checking peripheral blood, liver and renal function; thus most cases completed the whole therapy without interruption. Some cases that had appeared to respond favorably course showed a rapid recurrence after 1.5-2 years, so four cases were given repeated irradiation, but results were not so satisfactory. Further study of radiation and combinations with other therapies is now being tried.