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The association of puerperal sepsis with HIV infection at two tertiary hospitals in Zimbabwe.

ABSTRACT: OBJECTIVE:To evaluate the association between HIV infection and puerperal sepsis among women in Zimbabwe. METHODS:A subanalysis was performed using data from a prospective cohort study conducted between September 2, 2014, and July 1, 2015, at two tertiary hospitals in Zimbabwe. Eligible participants were consecutive women who met the WHO criteria for puerperal sepsis. Variables assessed included HIV-infection status and the use of antiretroviral therapy. Severity of immunosuppression was defined by the number of T cells that expressed cluster of differentiation 4 (CD4). Endocervical swabs and blood samples were collected for microbial culture and susceptibility testing. RESULTS:In all, 33 (21.9%) of the 151 women included in the present analysis had HIV. Among women with HIV, severe immunosuppression (CD4-positive T cell count <200/mm3 ) was associated with a mean hospital stay of 19.0 days versus 10.2 days for mild-advanced immunosuppression (CD4-positive T cell count 200-500/mm3 ) and insignificant immunosuppression (CD4-positive T cell count >500/mm3 ; P=0.030). Use of antiretroviral therapy did not independently influence clinical outcomes. Furthermore, infection with HIV did not influence the microorganisms isolated from blood or endocervical samples. CONCLUSION:Severe immunosuppression was associated with increased length of hospitalization among women with HIV who had puerperal sepsis.

SUBMITTER: Majangara R

PROVIDER: S-EPMC6283678 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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The association of puerperal sepsis with HIV infection at two tertiary hospitals in Zimbabwe.

Majangara Rumbidzai R Chirenje Zvavahera M ZM Gidiri Muchabaiwa F MF

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 20181108 1

<h4>Objective</h4>To evaluate the association between HIV infection and puerperal sepsis among women in Zimbabwe.<h4>Methods</h4>A subanalysis was performed using data from a prospective cohort study conducted between September 2, 2014, and July 1, 2015, at two tertiary hospitals in Zimbabwe. Eligible participants were consecutive women who met the WHO criteria for puerperal sepsis. Variables assessed included HIV-infection status and the use of antiretroviral therapy. Severity of immunosuppress ...[more]

PMID: 30343490

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Project description:BACKGROUND:Renal abnormalities in HIV infected children may be due to the HIV infection or treatment among other factors. Tenofovir disoproxil fumarate (TDF) is associated with proximal renal tubular dysfunction, proteinuria and decrease in glomerular function. Studies in developed countries have shown variable prevalence of proximal renal tubular dysfunction in children on TDF. There are no known studies in developing countries, including Zimbabwe, documenting the proximal tubular function in HIV infected children on TDF. The aim of this study was to assess renal and proximal renal tubular function in HIV infected children receiving TDF and determine factors associated with proximal tubular dysfunction. METHODS:A descriptive cross-sectional study was conducted in HIV infected patients below 18 years of age attending outpatient clinics at two tertiary hospitals in Harare, who received a TDF-containing antiretroviral regimen for at least six months. Dipstick protein and glucose, serum and urine phosphate and creatinine levels were measured. Fractional excretion of phosphate was calculated. Estimated glomerular filtration rate (eGFR) was calculated using the Schwartz formula. Tubular dysfunction was defined by at least two of the following characteristics: normoglycaemic glycosuria, hypophosphatemia and fractional excretion of phosphate > 18%. FINDINGS:One hundred and ninety-eight children below 18 years of age were recruited over a period of six months. The prevalence of tubular dysfunction was 0.5%. Normoglycaemic glycosuria occurred in 1 (0.5%), fractional excretion of phosphate >18% in 4 (2%), and hypophosphatemia in 22 [11.1%] patients. Severe stunting was associated with increased risk of hypophosphatemia (OR 9.31 CI (1.18, 80.68) p = 0.03). Reduction in estimated glomerular filtration rate (eGFR) < 90ml/min/1.73m2 and proteinuria was evident in 35.9% and 32.8% of children, respectively. Concurrent TDF and HIV-1 protease inhibitor-based regimen was the only independent factor associated with reduction in GFR (OR 4.43 CI (1.32; 4.89) p = 0.016). CONCLUSION:Tubular dysfunction was uncommon in Zimbabwean children on a TDF-based ART regimen. Hypophosphatemia, proteinuria and reduction in eGFR were common. Reassessing renal function using more sensitive biomarkers is needed to examine the long-term tolerance of TDF.

Project description:BackgroundThe relationship between the risk of acquiring human immunodeficiency virus (HIV) infection and people's choices about life course events describing the transition to parenthood-sexual debut, union (in the form of marriage, cohabitation, or long-term relationship), and parenthood-is still unclear. A crucial role in shaping this relationship may be played by the sequence of these events and by their timing. This suggests the opportunity to focus on the life courses in their entirety rather than on the specific events, thus adopting a holistic approach that regards each individual's life course trajectory as a whole.MethodsWe summarise the individual life courses describing the transition to parenthood using ordered sequences of the three considered events. We aim to (i) investigate the association between the sequences and HIV infection, and (ii) understand how these sequences interact with known mechanisms for HIV transmission, such as the length of sexual exposure and the experience of non-regular sexual partnerships. For this purpose, we use data from a general population cohort study run in Manicaland (Zimbabwe), a Sub-Saharan African area characterised by high HIV prevalence.ResultsFor both genders, individuals who experienced either premarital or delayed childbearing have higher HIV risk compared to individuals following more standard transitions. This can be explained by the interplay of the sequences with known HIV proximate determinants, e.g., a longer exposure to sexual activity and higher rates of premarital sex. Moreover, we found that people in the younger birth cohorts experience more normative and safer sequences.ConclusionsThe shift of younger generations towards more normative transitions to parenthood is a sign of behaviour change that might have contributed to the observed reduction in HIV prevalence in the area. On the other hand, for people with less normative transitions, targeted strategies are essential for HIV prevention.

Project description:BACKGROUND:Puerperal sepsis is an infection of the genital tract, which occurs from rupture of amniotic sacs and within 42ndday after delivery. It happens mainly after discharge in the 1st 24?h of parturition. It is the third leading cause of direct maternal mortality in developing nations. It is also among preventable conditions. Even though multiple interventions were done to overcome these health problems, maternal mortality and morbidities were still significant. Mainly, in Ethiopia lack of clearly identified causes of maternal mortality and morbidity makes the problem unsolved. METHODS:Case-control study was conducted at public Hospitals in west shoa zone Oromia regional state, Ethiopia from February 01 to April 30/2018.women with puerperal sepsis (n?=?67) were selected by convenience method. Controls (n?=?213) were selected by systematic random sampling. Controls to cases ratio was 3:1 and structured questionnaire was used to interviewafter verbal consent was obtained. Data was entered in to epi -info 7.2 then exported to SPSS version 20.0 for analysis. A logistic regression model was used for data analysis. Those variables which have p-value <?0.05 were accepted that they are independent determinants of puerperal sepsis. RESULT:Rural residence (AOR [95%CI]?=?2.5(1.029-6.054),Mothers with no formal education (AOR [95%CI]?=?6.74([1.210-37.541]), up to primary level of education(AOR [95%CI]?=?6.72(1.323-34.086), total monthly income of the mother or family<=500 ETB and 501-1500 ETB(AOR [95%CI]?=?5.94(1.471-23.93) and (AOR [95%CI] =6.57 (1.338-32.265) respectively, Mothers having 1-2 times antenatal care(ANC)visit (AOR [95%CI]?=?6.57([1.338-32.265]), Duration of Labor12-24?h (AOR [95%CI]?=?3.12 (1.805-12.115),>?=?25?h (AOR [95%CI]?=?4.71([1.257-17.687]),vaginal examinations >?=?5times (AOR [95%CI]?=?4.00([1.330-12.029]), Delivery by C/S (AOR [95%CI]?=?3.85 ([1.425-10.413]), Rupture of membrane >?24?h (AOR [95%CI]?=?3.73([1.365-10.208]) and those Referred from other health institutions (AOR [95%CI]?=?2.53([1.087-5.884],were independent determinants of puerperal sepsis in this study. CONCLUSION:Majority of determinants of puerperal sepsis were related with pregnancy and childbirth. Therefore, to tackle a problem of puerperal sepsis all concerning bodies should take measures during prenatal, natal and postnatal period.

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The association of puerperal sepsis with HIV infection at two tertiary hospitals in Zimbabwe.

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The association of puerperal sepsis with HIV infection at two tertiary hospitals in Zimbabwe.

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