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1. Characteristics, risk factors, and outcomes related to Zika virus infection during pregnancy in Northeastern Thailand: A prospective pregnancy cohort study, 2018-2020.

Author

Jurai Wongsawat, Somsak Thamthitiwat, Victoria J Hicks, Sumonmal Uttayamakul, Phanthaneeya Teepruksa, Pongpun Sawatwong, Beth Skaggs, Philip A Mock, John R MacArthur, Inthira Suya, Patranuch Sapchookul, Paul Kitsutani, Terrence Q Lo, Apichart Vachiraphan, Ekachai Kovavisarach, Chulwoo Rhee, Pamorn Darun, Kamol Saepueng, Chamnan Waisaen, Doungporn Jampan, Pravit Sriboonrat, Buncha Palanuwong, Punchawee Sukbut, Darin Areechokchai, Chakrarat Pittayawonganon, Sopon Iamsirithaworn, Emily Bloss, and Carol Y Rao

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

BackgroundIn response to the 2015-2016 Zika virus (ZIKV) outbreak and the causal relationship established between maternal ZIKV infection and adverse infant outcomes, we conducted a cohort study to estimate the incidence of ZIKV infection in pregnancy and assess its impacts in women and infants.Methodology/principal findingsFrom May 2018-January 2020, we prospectively followed pregnant women recruited from 134 participating hospitals in two non-adjacent provinces in northeastern Thailand. We collected demographic, clinical, and epidemiologic data and blood and urine at routine antenatal care visits until delivery. ZIKV infections were confirmed by real-time reverse transcriptase polymerase chain reaction (rRT-PCR). Specimens with confirmed ZIKV underwent whole genome sequencing. Among 3,312 women enrolled, 12 (0.36%) had ZIKV infections, of which two (17%) were detected at enrollment. Ten (83%, 3 in 2nd and 7 in 3rd trimester) ZIKV infections were detected during study follow-up, resulting in an infection rate of 0.15 per 1,000 person-weeks (95% CI: 0.07-0.28). The majority (11/12, 91.7%) of infections occurred in one province. Persistent ZIKV viremia (42 days) was found in only one woman. Six women with confirmed ZIKV infections were asymptomatic until delivery. Sequencing of 8 ZIKV isolates revealed all were of Asian lineage. All 12 ZIKV infected women gave birth to live, full-term infants; the only observed adverse birth outcome was low birth weight in one (8%) infant. Pregnancies in 3,300 ZIKV-rRT-PCR-negative women were complicated by 101 (3%) fetal deaths, of which 67 (66%) had miscarriages and 34 (34%) had stillbirths. There were no differences between adverse fetal or birth outcomes of live infants born to ZIKV-rRT-PCR-positive mothers compared to live infants born to ZIKV-rRT-PCR-negative mothers.Conclusions/significanceConfirmed ZIKV infections occurred infrequently in this large pregnancy cohort and observed adverse maternal and birth outcomes did not differ between mothers with and without confirmed infections.

Published
2024
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2. Cervical cancer screening using visual inspection with acetic acid: operational experiences from Ghana and Thailand

Author

Maria Plotkin, Enriquito Lu, Elaine Charurat, Amy N. Kleine, Harshad Sanghvi, Buncha Palanuwong, Wachara Eamratsameekool, and Khunying Kobchitt Limpaphayom

Subjects
Quality Assurance, Health Care, Trainer, Uterine Cervical Neoplasms, Ghana, Nursing, Medicine, Humans, Mass Screening, Competence (human resources), Reproductive health, Acetic Acid, Colposcopy, Cervical cancer, medicine.diagnostic_test, Peer feedback, business.industry, Obstetrics and Gynecology, medicine.disease, Thailand, Visual inspection, Primary Prevention, Reproductive Medicine, Cryotherapy, Female, Indicators and Reagents, business, Quality assurance
Abstract

Thailand in 2000 and Ghana in 2001 initiated cervical cancer prevention programmes using a single-visit approach with visual inspection with acetic acid (VIA) with cryotherapy for pre-cancerous lesions. This service was integrated into existing reproductive health services, provided by trained nurses. The providers maintained a high level of competence and performance, including after the withdrawal of external funding. In Ghana, independent co-assessments revealed a high level of agreement in diagnosis between providers and a Master Trainer. In Thailand, high quality performance was associated with quality assurance mechanisms such as peer feedback and review of charts and service statistics. Provider performance was maintained at a high level in both countries: an average of 74% of providers from both countries met 85% or more of performance standards. The successful transition from a demonstration project to a national programme in Thailand was dependent on a strong commitment from government health bodies and health professionals. In contrast, the lack of health infrastructure and political will has prevented scale-up to a national programme in Ghana. However, this study shows that a single-visit approach with VIA and cryotherapy is programmatically feasible and sustainable and should be considered in national investments to control cervical cancer.

Published
2008

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