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A study of intrahepatic blood flow by polyhepatography and evaluation of endothelial function by peripheral arterial tonometry in patients with essential hypertension and coronary heart disease was conducted. The study included 105 people. The subjects were divided into three groups: patients with hypertension, coronary heart disease in combination with hypertension, and a group of healthy people. In all observed cases, except for the healthy group, hemodynamic changes were detected. The features of impaired intrahepatic blood flow in patients with cardiovascular pathology were revealed. The nature of blood flow disorders largely depended on the etiologic factor. The endothelial dysfunction revealed in patients with cardiovascular disease. In patients with arterial hypertension in combination with or without coronary heart disease, a relationship was found between endothelial dysfunction and intrahepatic hemodynamic disorders. The relationship of endothelial dysfunction and intrahepatic hemodynamic disorders was established, in patients with hypertension in combination with coronary heart disease or without it. Therefore, the liver is involved in the pathological process, regardless of the form of myocardial damage in cardiovascular pathology. It is accompanied by varying degrees of severity of intrahepatic microcirculation disorders and endothelial dysfunction of the peripheral vascular bed. This may be a consequence of the universal reaction of the endothelium due to realized effect of risk factors for the development of cardiovascular diseases. In this regard, the liver can be considered as one of the target organs in patients with cardiovascular pathology.

Background Pregnancy among adolescents, whether intended or not, is a public health concern as it is generally considered high risk for both mothers and their newborns. In Zambia, where many women engage in early sexual behaviour or marry at a young age, 28.5% of girls aged 15–19 years were pregnant with their first child in the year 2013–2014. This study sought to explore associations between maternal age and neonatal outcomes among pregnant women in Lusaka, Zambia. Methods This was a secondary analysis of data nested within a larger population-based prospective cohort study which was implemented in three government health facilities-two first level hospitals and one clinic in Lusaka, Zambia. Women presenting to the study sites for antenatal care were enrolled into the study and followed up for collection of maternal and neonatal outcomes at 7, 28 and 42 days postpartum. The study’s primary outcomes were the incidence of maternal and newborn complications and factors associated with adverse neonatal outcomes. Statistical significance was evaluated at a significance level of P Results The study included 11,501 women, 15.6% of whom were adolescents aged 10–19 years. Generally, adolescence did not have statistically significant associations with poor maternal health outcomes. However, the risk of experiencing obstructed labour, premature rupture of membranes and postpartum hemorrhage was higher among adolescents than women aged 20–24 years while the risk of severe infection was lower and non-significant. Adolescents also had 1.36 times the odds of having a low birthweight baby (95% CI 1.12, 1.66) and were at risk of preterm birth (aOR = 1.40, 95% CI 1.06, 1.84). Their newborns were in need of bag and mask resuscitation at birth (aOR = 0.62, 95% CI 0.41, 0.93). Advanced maternal age was significantly associated with increased odds of hypertension/ pre-eclampsia (95% CI 1.54, 5.89) and preterm labour (aOR = 2.78, 95% CI 1.24, 6.21). Conclusions Adolescence is a risk factor for selected pregnancy outcomes in urban health facilities in Lusaka, Zambia. Health care workers should intensify the provision of targeted services to improve neonatal health outcomes. Trial registration Clinical trial number and URL: NCT03923023 (Retrospectively registered). Clinical trial registration date: April 22, 2019.

Summary Background Globally, cervical cancer is the fourth leading cause of cancer-related death among women. Poor uptake of screening services contributes to the high mortality. We aimed to examine screening frequency, predictors of screening results, and patterns of sensitisation strategies by age group in a large, programmatic cohort. Methods We did a cohort study including 11 government health facilities in Lusaka, Zambia, in which we reviewed routine programmatic data collected through the Cervical Cancer Prevention Program in Zambia (CCPPZ). Participants who underwent cervical cancer screening in one of the participating study sites were considered for study inclusion if they had a screening result. Follow-up was accomplished per national guidelines. We did descriptive analyses and mixed-effects logistic regression for cervical cancer screening results allowing random effects at the individual and clinic level. Findings Between Jan 1, 2010, and July 31, 2019, we included 183 165 women with 204 225 results for visual inspection with acetic acid and digital cervicography (VIAC) in the analysis. Of all those screened, 21 326 (10·4%) were VIAC-positive, of whom 16 244 (76·2%) received treatment. Of 204 225 screenings, 92 838 (45·5%) were in women who were HIV-negative, 76 607 (37·5%) were in women who were HIV-positive, and 34 780 (17·0%) had an unknown HIV status. Screening frequency increased 65·7% between 2010 and 2019 with most appointments being first-time screenings (n=158 940 [77·8%]). Women with HIV were more likely to test VIAC-positive than women who were HIV-negative (adjusted odds ratio 3·60, 95% CI 2·14–6·08). Younger women (≤29 years) with HIV had the highest predictive probability (18·6%, 95% CI 14·2–22·9) of screening positive. Interpretation CCPPZ has effectively increased women's engagement in screening since its inception in 2006. Customised sensitisation strategies relevant to different age groups could increase uptake and adherence to screening. The high proportion of screen positivity in women younger than 20 years with HIV requires further consideration. Our data are not able to discern if women with HIV have earlier disease onset or whether this difference reflects misclassification of disease in an age group with a higher sexually transmitted infection prevalence. These data inform scale-up efforts required to achieve WHO elimination targets. Funding US President's Emergency Plan for AIDS Relief.

Maternal death is the greatest health disparity globally, with postpartum hemorrhage the most common cause. As senior leaders in obstetrics and maternal health from Bolivia, Canada, Colombia, Côte d'Ivoire, Honduras, India, Kenya, Nepal, Niger, Norway, Peru, Tanzania, the UK, the USA, and Zambia, we are deeply disturbed by recent calls for randomized controlled trials (RCTs) of uterine balloon tamponade (UBT) in women with uncontrolled postpartum hemorrhage (PPH). Our collective experience, in combination with mounting evidence, unequivocally supports the effectiveness of commercial and condom UBTs in averting death and disability from PPH associated with atonic uterus. We believe it would be highly unethical to embark on an RCT of UBT, now or in the future, unless compared with a proven equivalent intervention. This article is protected by copyright. All rights reserved.

A new approach to evaluating of the state of cardiovascular system for patients with verified diagnosis of coronary heart disease (CHd), cardiac syndrome X (COAG) and hypertension (GB) by modification of known techniques of the PAT (peripheral arterial tonometry) is represented in the article. The results of studies by the method of us PAT patients with various cardiovascular disease indicate a particular clinical significance is not only the assessment of local «endothelial dysfunction» (the known value of reactive hyperemia index RHI), but also assess the nature of the Central system response regulation of blood circulation. In the article it is shown that more convenient for this relatively simpleCtrlmeasure R(relative change in the amplitude of pulsations in case of occlusion of the blood supplyto the sample identified on the hand are not subjected to occlusion). For patients without evidenceCtrlof cardiovascular disease the index value Rwas close to unity. The hypertensive patients, as a rule,observed values of R1. The differences associated, pre-CtrlCtrlsumably, with the changing balance between the degree of disturbance of peripheral blood circulationand degree of preservation of the reserves of the pumping function of the heart. This allows to consider the index RCtrl as an additional feature, an essential for individual selection of therapy in patients with cardiovascular pathology.

Objective. To investigate the efficacy of Cortexin in the treatment of cognitive and affective disorders in cerebral ischemia (AI) developing on the background of arterial hypertension or atherosclerosis. Materials and methods. We present an analysis of the all-Russian screening program for the efficacy of Cortexin, “Cognitive and Affective Disorders in the Treatment of Cerebral Ischemia with Cortexin” (KarKaDE), in 50,000 patients with AI developing on the background of arterial hypertension and/or atherosclerosis in 2013 in 70 Russian cities. Results. All patients received Cortexin at a dose of 10 mg/day for 10 days and were investigated before treatment and on days 11 and 30 after the first dose. More extensive analysis was applied to results from the treatment of 500 patients with stage II AI, mean age 63.7 ± 10.23 years. Treatment efficacy was evaluated using a five-point rating scale for subjective and objective neurological symptoms, the five-word memory test, the Schulte test, the MMSE, the Hamilton scales for evaluation of anxiety, and the short form of the Geriatric Depression Scale. Conclusions. Treatment decreased or completely eliminated focal neurological symptomatology and produced positive changes in measures of cognitive impairments, these changes being accompanied by normalization of patients’ emotional status and decreases in the level of depression.

A review contains a description of the most common methods of evaluation and monitoring of "endothelial dysfunction" that are assessed in terms of their information content and applicability in the practice of medicine. The term "endothelial function" is interpreted primarily as a function of the regulation of capillary blood flow, carried out by the expense of the dynamic change of the phase of vasoconstriction and vasodilatation in vessels of resistive type (in accordance with the changing needs of cellular metabolism). Assessment of endothelial dysfunction is understood as a generalized indicator of the extent and nature of violations of the regulation of peripheral circulation. It includes an assessment of imbalances between endotheliumdependent vasoconstrictor and vasodilating factors or mismatch of the local and central regulation of capillary blood flow in response to various functional tests or other effects (eg, cold test, or test with local ischemia). All methods of endothelial dysfunction assessment in the survey are divided into invasive and non-invasive. The main feature of invasive methods lies in the direct effect on the endothelium of the coronary or other vessels by introducing into these vessels vasoactive substances such as acetylcholine. Response to the test (vasoconstriction or vasodilation) is evaluated by coronary angiography or by ultrasound. Non-invasive methods of the assessment of endothelial dysfunction or functions of regulation of the peripheral circulation are regarded as the most promising for widespread use. There are two basic methods that underlie functional tests: methods PAT (peripheral arterial tone) and PHG (polyhepatography). Assessment of endothelial dysfunction in many modern scientific researches is important. They are regarded as the causative factors of many different diseases. Such assessments can be useful in everyday medical practice. Assessment of endothelial function provides the clinician with critical information essential for a personalized selection of therapy. In particular, for taking into account the individual characteristics of the local and central regulatory system response of peripheral blood circulation in the various functional tests, or other effects.

Background Antenatal corticosteroids for pregnant women at risk of preterm birth are among the most effective hospital-based interventions to reduce neonatal mortality. We aimed to assess the feasibility, effectiveness, and safety of a multifaceted intervention designed to increase the use of antenatal corticosteroids at all levels of health care in low-income and middle-income countries. Methods In this 18-month, cluster-randomised trial, we randomly assigned (1:1) rural and semi-urban clusters within six countries (Argentina, Guatemala, India, Kenya, Pakistan, and Zambia) to standard care or a multifaceted intervention including components to improve identification of women at risk of preterm birth and to facilitate appropriate use of antenatal corticosteroids. The primary outcome was 28-day neonatal mortality among infants less than the 5th percentile for birthweight (a proxy for preterm birth) across the clusters. Use of antenatal corticosteroids and suspected maternal infection were additional main outcomes. This trial is registered with ClinicalTrials.gov, number NCT01084096. Findings The ACT trial took place between October, 2011, and March, 2014 (start dates varied by site). 51 intervention clusters with 47 394 livebirths (2520 [5%] less than 5th percentile for birthweight) and 50 control clusters with 50 743 livebirths (2258 [4%] less than 5th percentile) completed follow-up. 1052 (45%) of 2327 women in intervention clusters who delivered less-than-5th-percentile infants received antenatal corticosteroids, compared with 215 (10%) of 2062 in control clusters (p

Objective To determine population-based neonatal mortality rates in low- and middle-income countries and to examine gestational age, birth weight, and timing of death to assess the potentially preventable neonatal deaths. Methods A prospective observational study was conducted in communities in five low-income countries (Kenya, Zambia, Guatemala, India, and Pakistan) and one middle-income country (Argentina). Over a 2-year period, all pregnant women in the study communities were enrolled by trained study staff and their infants followed to 28 days of age. Results Between October 2009 and March 2011, 153,728 babies were delivered and followed through day 28. Neonatal death rates ranged from 41 per 1000 births in Pakistan to 8 per 1000 in Argentina; 54% of the neonatal deaths were >37 weeks and 46% weighed 2500 g or more. Half the deaths occurred within 24 hours of delivery. Conclusion In our population-based low- and middle-income country registries, the majority of neonatal deaths occurred in babies >37 weeks' gestation and almost half weighed at least 2500 g. Most deaths occurred shortly after birth. With access to better medical care and hospitalization, especially in the intrapartum and early neonatal period, many of these neonatal deaths might be prevented.

Background: Cervical cancer is a highly preventable disease and the major cause of cancer related illness and deaths in Africa. Cervical cancer screening to find precancers before becoming invasive cancer is a well-proven way to prevent cervical cancer. In Zambia alone, over 2000 cervical cancer cases are diagnosed each year accounting for over 30% of new cancer cases with a mortality of above 35%. Women access screening services regardless of HIV status as long as they are sexually active. Cervical cancer screening for HIV-positive women in Zambia remains low despite the high burden of the disease among this population. Aim: We aimed to determine the trends of incidence of cervical precancer lesions among women who ever presented for screening in Lusaka. Methods: We conducted a retrospective cohort study of 95,520 women who presented for cervical cancer screening between 2007 and 2017 at 11 Lusaka district clinics that provide cervical cancer screening. Data were merged from these clinics and cleaned. Descriptive analyses and Logistic regression for data analysis was conducted. Results: The study showed that the mean age of screening among women that were HIV negative and HIV-positive was 34 years. About 12% of the women that screened had a positive VIA result from which 59% were HIV-positive. Results also showed the odds of 4 to be VIA positive when one is HIV-positive. Conclusion: We have data to show that there is an increased risk among HIV-positive women to be VIA positive in Zambia. HIV infected women should be targeted as priority for cervical cancer screening especially in the resource limited countries. Resources directed to HIV care programs in these settings should be leveraged and include cervical cancer screening.

Background Because large, prospective, population-based data sets describing maternal outcomes are typically not available in low- and middle-income countries, it is difficult to monitor maternal mortality rates over time and to identify factors associated with maternal mortality. Early identification of risk factors is essential to develop comprehensive intervention strategies preventing pregnancy-related complications. Our objective was to describe maternal mortality rates in a large, multi-country dataset and to determine maternal, pregnancy-related, delivery and postpartum characteristics that are associated with maternal mortality. Methods We collected data describing all pregnancies from 2010 to 2013 among women enrolled in the multi-national Global Network for Women’s and Children’s Health Research Maternal and Neonatal Health Registry (MNHR). We reported the proportion of mothers who died per pregnancy and the maternal mortality ratio (MMR). Generalized linear models were used to evaluate the relationship of potential medical and social factors and maternal mortality and to develop point and interval estimates of relative risk associated with these factors. Generalized estimating equations were used to account for the correlation of outcomes within cluster to develop appropriate confidence intervals. Results We recorded 277,736 pregnancies and 402 maternal deaths for an MMR of 153/100,000 live births. We observed an improvement in the total MMR from 166 in 2010 to 126 in 2013. The MMR in Latin American sites (91) was lower than the MMR in Asian (178) and African sites (125). When adjusted for study site and the other variables, no formal education (RR 3.2 [1.5, 6.9]), primary education only (RR 3.4 [1.6, 7.5]), secondary education only (RR 2.5 [1.1, 5.7]), lack of antenatal care (RR 1.8 [1.2, 2.5]), caesarean section delivery (RR 1.9 [1.3, 2.8]), hemorrhage (RR 3.3 [2.2, 5.1]), and hypertensive disorders (RR 7.4 [5.2, 10.4]) were associated with higher risks of death. Conclusions The MNHR identified preventable causes of maternal mortality in diverse settings in low- and middle-income countries. The MNHR can be used to monitor public health strategies and determine their association with reducing maternal mortality. Trial Registration clinicaltrials.gov NCT01073475

Introduction: Neonatal mortality associated with preterm birth can be reduced with antenatal corticosteroids (ACS), yet 36.0 weeks GA. In phase 1, UH measurements were collected prospectively in the Democratic Republic of Congo, India and Pakistan, using distinct tapes to address variation across regions and ethnicities. In phase 2, we tested accuracy in 250 pregnant women with known GA from early ultrasound enrolled at prenatal clinics in Argentina, India, Pakistan and Zambia. Providers masked to the ultrasound GA measured UH. Receiver operating characteristics (ROC) analysis was conducted. Results: 1,029 pregnant women were enrolled. In all countries the tapes were most effective identifying pregnancies between 20.0-35.6 weeks, compared to the other GAs. The ROC areas under the curves and 95% confidence intervals were: Argentina 0.69 (0.63, 0.74); Zambia 0.72 (0.66, 0.78), India 0.84 (0.80, 0.89), and Pakistan 0.83 (0.78, 0.87). The sensitivity and specificity (and 95% confidence intervals) for identifying pregnancies between 20.0-35.6 weeks, respectively, were: Argentina 87% (82%-92%) and 51% (42%-61%); Zambia 91% (86%-95%) and 50% (40%-60%); India 78% (71%-85%) and 89% (83%-94%); Pakistan 63% (55%-70%) and 94% (89% -99%). Conclusions: We observed moderate-good accuracy identifying pregnancies ≤35.6 weeks gestation, with potential usefulness at the community level in low-middle income countries to facilitate the preterm identification and interventions to reduce preterm neonatal mortality. Further research is needed to validate these findings on a population basis. Fil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Berrueta, Amanda Mabel. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Hemingway Foday, Jennifer. Rti International; Estados Unidos Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Bonorino, Carolina Astoul. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Gowdak, Andrea. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Bellad, M. B.. Jawaharlal Nehru Medical College Belgaum; India Fil: Metgud, M. C.. Jawaharlal Nehru Medical College Belgaum; India Fil: Goudar, Shivaprasad. Jawaharlal Nehru Medical College Belgaum; India Fil: Kodkany, Bhalchandra S.. Jawaharlal Nehru Medical College Belgaum; India Fil: Derman, Richard J.. Christiana Care Health System; Estados Unidos Fil: Saleem, Sarah. The Aga Khan University; Pakistán Fil: Iqbal, Samina. Sobhraj Maternity Hospital; Pakistán Fil: Ala, Syed Hasan. Sindh Government Qatar Hospital; Pakistán Fil: Goldenberg, Robert L.. Columbia University; Estados Unidos Fil: Chomba, Elwyn. University Teaching Hospital Lusaka; Zambia Fil: Manasyan, Albert. University of North Carolina; Estados Unidos. Centre For Infectious Disease Research In Zambia; Zambia Fil: Chiwila, Melody. University Teaching Hospital Lusaka; Zambia Fil: Imenda, Edna. University Teaching Hospital Lusaka; Zambia Fil: Mbewe, Florence. University Teaching Hospital Lusaka; Zambia Fil: Tshefu, Antoinette. Kinshasa School Of Public Health; República Democrática del Congo Fil: Lokomba, Victor. Kinshasa School Of Public Health; República Democrática del Congo Fil: Bose, Carl L.. University of North Carolina; Estados Unidos Fil: Moore, Janet. Rti International; Estados Unidos Fil: Meleth, Sreelatha. Rti International; Estados Unidos Fil: McClure, Elizabeth M.. Rti International; Estados Unidos Fil: Koso Thomas, Marion. Eunice Kennedy Shriver NICHD; Estados Unidos Fil: Buekens, Pierre. University of Tulane; Estados Unidos Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

A comparative study of the power spectra of short-latency auditory evoked potentials (SLAEPs) was made in norm and pathological states (neurinoma of the acoustic nerve, concussion of the brain, and epilepsy). Rather specific pattern of changes in the power of the medium- and high-frequency components along with the appearance of subcomponents was revealed. It is supposed that spectral analysis of SLAEP is highly informative and may be useful for neurophysiological clinical diagnostics.

Background Fetal and neonatal mortality rates in low-income countries are at least 10-fold greater than in high-income countries. These differences have been related to poor access to and poor quality of obstetric and neonatal care. Methods This trial tested the hypothesis that teams of health care providers, administrators and local residents can address the problem of limited access to quality obstetric and neonatal care and lead to a reduction in perinatal mortality in intervention compared to control locations. In seven geographic areas in five low-income and one middle-income country, most with high perinatal mortality rates and substantial numbers of home deliveries, we performed a cluster randomized non-masked trial of a package of interventions that included community mobilization focusing on birth planning and hospital transport, community birth attendant training in problem recognition, and facility staff training in the management of obstetric and neonatal emergencies. The primary outcome was perinatal mortality at ≥28 weeks gestation or birth weight ≥1000 g. Results Despite extensive effort in all sites in each of the three intervention areas, no differences emerged in the primary or any secondary outcome between the intervention and control clusters. In both groups, the mean perinatal mortality was 40.1/1,000 births (P = 0.9996). Neither were there differences between the two groups in outcomes in the last six months of the project, in the year following intervention cessation, nor in the clusters that best implemented the intervention. Conclusions This cluster randomized comprehensive, large-scale, multi-sector intervention did not result in detectable impact on the proposed outcomes. While this does not negate the importance of these interventions, we expect that achieving improvement in pregnancy outcomes in these settings will require substantially more obstetric and neonatal care infrastructure than was available at the sites during this trial, and without them provider training and community mobilization will not be sufficient. Our results highlight the critical importance of evaluating outcomes in randomized trials, as interventions that should be effective may not be. Trial registration ClinicalTrials.gov NCT01073488

OBJECTIVE: To describe the staffing and availability of medical equipment and medications and the performance of procedures at health facilities providing maternal and neonatal care at African, Asian, and Latin American sites participating in a multicenter trial to improve emergency obstetric/neonatal care in communities with high maternal and perinatal mortality. STUDY DESIGN: In 2009, prior to intervention, we surveyed 136 hospitals and 228 clinics in 7 sites in Africa, Asia, and Latin America regarding staffing, availability of equipment/medications, and procedures including cesarean section. RESULTS: The coverage of physicians and nurses/midwives was poor in Africa and Latin America. In Africa, only 20% of hospitals had full-time physicians. Only 70% of hospitals in Africa and Asia had performed cesarean sections in the last 6 months. Oxygen was unavailable in 40% of African hospitals and 17% of Asian hospitals. Blood was unavailable in 80% of African and Asian hospitals. CONCLUSIONS: Assuming that adequate facility services are necessary to improve pregnancy outcomes, it is not surprising that maternal and perinatal mortality rates in the areas surveyed are high. The data presented emphasize that to reduce mortality in these areas, resources that result in improved staffing and sufficient equipment, supplies, and medication, along with training, are required. Fil: Manasyan, Albert. Centre for Infectious Disease Zambia; Zambia. University of Alabama at Birmingahm; Estados Unidos Fil: Saleem, Sarah. Aga Khan University; Pakistán Fil: Koso Thomas, Marion. Eunice Kennedy Shriver National Institute of Child Health and Human Development; Estados Unidos Fil: Althabe, Fernando. Instituto de Efectividad Clínica y Política de Salud. Departamento de Investigación en Salud Madre e Infantil. Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Pasha, Omrana. Aga Khan University; Pakistán Fil: Chomba, Elwyn. Centre for Infectious Disease Zambia; Zambia. University of Alabama at Birmingahm; Estados Unidos. University of Zambia; Zambia Fil: Goudar, Shivaprasad S.. KLE; India Fil: Patel, Archana. Indira Gandhi Government Medical College; India Fil: Esamai, Fabian. Moi University; Kenia Fil: Garces, Ana. Francisco Marroquin University; Guatemala Fil: Kodkany, Bhala. KLE; India Fil: Belizan, Jose. Instituto de Efectividad Clínica y Política de Salud. Departamento de Investigación en Salud Madre e Infantil. Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: McClure, Elizabeth M.. Research Triangle Institute; Estados Unidos Fil: Derman, Richard J.. Christiana Health Care; Estados Unidos Fil: Hibberd, Patricia. Indiana University; Estados Unidos Fil: Liechty, Edward A.. Massachusetts General Hospital for Children; Estados Unidos Fil: Hambidge, K. Michael. State University of Colorado Boulder; Estados Unidos Fil: Carlo, Waldemar A.. Centre for Infectious Disease Zambia; Zambia Fil: Buekens, Pierre. Tulane School of Public Health and Tropical Medicine; Estados Unidos Fil: Moore, janet. Research Triangle Institute; Estados Unidos Fil: Wright, Linda L.. Eunice Kennedy Shriver National Institute of Child Health and Human Development; Estados Unidos Fil: Goldenberg, Robert L.. Columbia University; Estados Unidos

Background: Improved complementary feeding is cited as a critical factor for reducing stunting. Consumption of meats has been advocated, but its efficacy in low-resource settings has not been tested. Objective: The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal. Design: This was a cluster randomized efficacy trial conducted in the Democratic Republic of Congo, Zambia, Guatemala, and Pakistan. Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants. Blood tests were obtained at trial completion. Results: A total of 532 (86.1%) and 530 (85.8%) participants from the meat and cereal arms, respectively, completed the study. Linear growth velocity did not differ between treatment groups: 1.00 (95% CI: 0.99, 1.02) and 1.02 (95% CI: 1.00, 1.04) cm/mo for the meat and cereal groups, respectively (P = 0.39). From baseline to 18 mo, stunting [length-for-age z score (LAZ)

Background and aims:In western countries, the majority of depressed patients are treated in primary care, and in developing countries, the majority of such population is not revealed. The main objective of this study was to find out the structure and prevalence of mental disorders at the mental health and multidisciplinary diagnostic Centers.Methods:We work out appropriate documents to collect the clinical and epidemiological data. The mental disorders diagnosed according to ICD-10. There were investigated 148 patients at the Center “Stress” and 122–Center “Diagnostica”. The first group we conditionally named “psychiatric”, and the second one “diagnostic”. Baseline data on diagnosis, symptomatology and other independent variables was collected.Results:Of the 148 “psychiatric” patients the highest was the number of patients with depressive disorders (F 32, 33, 34) – 45 (27.6%), then the mental disorders due to brain damage, dysfunction and physical disease (F06,07) – 15.6%, and dissociative (conversion) disorders (F44) – 14.7%. Among 122 “diagnostic” patient the most frequent diagnosis was Neurasthenia (F48.0) – 24.6%, then depression (F32,33,34) – 24.5%, and mental disorders due to brain damage, dysfunction and physical disease” (F06,07) – 19.7%. So the rate of depressive disturbances was high in both groups. It was common for depressed people to present with somatic rather than psychological complaints.Conclusions:Of people with a need for depression treatment, great majority reject it. Results of this study will contribute to a better understanding of depressive disorders in primary health care settings in Armenia.

Background Approximately 3 million neonatal deaths occur each year worldwide. Simple interventions have been tested and found to be effective in reducing the neonatal mortality. In order to effectively implement public health interventions, it is important to know the rates of neonatal mortality and understand the contributing risk factors. Hence, this prospective, population-based, observational study was carried out to inform these needs. Methods The Global Network’s Maternal Newborn Health Registry was initiated in the seven sites in 2008. Registry administrators (RAs) attempt to identify and enroll all eligible women by 20 weeks gestation and collect basic health data, and outcomes after delivery and at 6 weeks post-partum. All study data were collected, reviewed, and edited by staff at each study site. The study was reviewed and approved by each sites’ ethics review committee. Results Overall, the 7-day neonatal mortality rate (NMR) was 20.6 per 1000 live births and the 28-day NMR was 25.7 per 1000 live births. Higher neonatal mortality was associated with maternal age > 35 and

Background Stillbirth rates remain nearly ten times higher in low-middle income countries (LMIC) than high income countries. In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented characteristics or care for mothers with stillbirths. Non-macerated stillbirths, those occurring around delivery, are generally considered preventable with appropriate obstetric care. Methods We undertook a prospective, population-based observational study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Results From 2010 through 2013, 269,614 enrolled women had 272,089 births, including 7,865 stillbirths. The overall stillbirth rate was 28.9/1000 births, ranging from 13.6/1000 births in Argentina to 56.5/1000 births in Pakistan. Stillbirth rates were stable or declined in 6 of the 7 sites from 2010-2013, only increasing in Pakistan. Less educated, older and women with less access to antenatal care were at increased risk of stillbirth. Furthermore, women not delivered by a skilled attendant were more likely to have a stillbirth (RR 2.8, 95% CI 2.2, 3.5). Compared to live births, stillbirths were more likely to be preterm (RR 12.4, 95% CI 11.2, 13.6). Infants with major congenital anomalies were at increased risk of stillbirth (RR 9.1, 95% CI 7.3, 11.4), as were multiple gestations (RR 2.8, 95% CI 2.4, 3.2) and breech (RR 3.0, 95% CI 2.6, 3.5). Altogether, 67.4% of the stillbirths were non-macerated. 7.6% of women with stillbirths had cesarean sections, with obstructed labor the primary indication (36.9%). Conclusions Stillbirth rates were high, but with reductions in most sites during the study period. Disadvantaged women, those with less antenatal care and those delivered without a skilled birth attendant were at increased risk of delivering a stillbirth. More than two-thirds of all stillbirths were non-macerated, suggesting potentially preventable stillbirth. Additionally, 8% of women with stillbirths were delivered by cesarean section. The relatively high rate of cesarean section among those with stillbirths suggested that this care was too late or not of quality to prevent the stillbirth; however, further research is needed to evaluate the quality of obstetric care, including cesarean section, on stillbirth in these low resource settings. Study registration Clinicaltrials.gov (ID# NCT01073475)