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In Paraguay, incomplete surveillance data resulted in the burden of congenital syphilis being underestimated, which, in turn, led to missed opportunities for infant diagnosis and treatment.The prevalence of congenital syphilis, as defined by the World Health Organization (WHO), was estimated for Paraguay using the WHO congenital syphilis estimation tool. This tool was also used to monitor progress towards the elimination of mother-to-child transmission of syphilis.The burden of syphilis in Paraguay has historically been high: its prevalence in pregnant women was estimated to be 3% in 2018.The incidence rate of congenital syphilis estimated using the WHO tool was around nine times the reported prevalence. Subsequently, Paraguay: (i) provided training to improve diagnosis and case reporting; (ii) strengthened information systems for case monitoring and reporting; and (iii) procured additional rapid dual HIV-syphilis and rapid plasma reagin tests to increase syphilis testing capacity. In addition, the Ministry of Health prepared a new national plan for eliminating mother-to-child transmission of syphilis, with clear monitoring milestones.Health-care providers' reporting and surveillance procedures for congenital syphilis may not adequately reflect national and international case definitions. Use of the WHO congenital syphilis estimation tool in Paraguay drew attention to congenital syphilis as a national public health problem and highlighted the importance of comprehensive national surveillance systems and accurate data. Ongoing use of the WHO tool can track progress towards the elimination of mother-to-child transmission of syphilis by helping improve syphilis service coverage and national surveillance.Au Paraguay, l'insuffisance de données de surveillance entraîne une sous-estimation du fardeau causé par la syphilis congénitale, ce qui aboutit à des occasions manquées de diagnostiquer et traiter les nourrissons.Le taux d'incidence de la syphilis congénitale, telle que définie par l'Organisation mondiale de la Santé (OMS), a été calculée au Paraguay à l'aide de l'outil d'évaluation de l'OMS. Cet outil a également servi à suivre les progrès dans l'élimination de la transmission de la syphilis de la mère à l'enfant.Le fardeau de la syphilis au Paraguay a toujours été lourd: la prévalence de la maladie chez les femmes enceintes était estimée à 3% en 2018.Le taux de prévalence de la syphilis congénitale calculé avec l'outil de l'OMS était environ neuf fois plus élevé que celui enregistré. Par conséquent, le Paraguay a: (i) proposé des formations afin d'améliorer le diagnostic et le signalement des cas; (ii) renforcé les systèmes d'information pour le suivi et la notification des cas; et enfin, (iii) fourni des doubles tests rapides VIH/syphilis et des tests rapides de la réagine plasmatique supplémentaires en vue d'accroître les capacités de dépistage de la syphilis. En outre, le ministère de la Santé a élaboré un nouveau plan national destiné à éliminer la transmission de la syphilis de la mère à l'enfant, comprenant une série d'étapes de suivi.Les procédures des prestataires de soins de santé en matière de notification et de surveillance de la syphilis congénitale pourraient différer de la définition des cas aux niveaux national et international. L'utilisation de l'outil d'évaluation mis au point par l'OMS pour la syphilis congénitale au Paraguay a attiré l'attention sur cette maladie qui représente un problème de santé publique nationale, et souligné l'importance des systèmes de surveillance complets et des données précises. Continuer à employer cet outil peut permettre de mesurer les progrès accomplis dans l'élimination de la transmission de la syphilis de la mère à l'enfant, en contribuant à améliorer la couverture des services et la surveillance nationale.En Paraguay, los datos de vigilancia incompletos ocasionaron que se subestimara la carga de sífilis congénita, lo que, a su vez, hizo que se perdieran las oportunidades de diagnóstico y tratamiento de los lactantes.La prevalencia de la sífilis congénita, según la definición de la Organización Mundial de la Salud (OMS), se estimó para Paraguay utilizando la herramienta de estimación de la sífilis congénita de la OMS. Esta herramienta también se utilizó para monitorear el progreso hacia la eliminación de la transmisión maternofilial de la sífilis.La carga de sífilis en Paraguay ha sido históricamente alta: su prevalencia en embarazadas se estimó en un 3 % en 2018.La tasa de incidencia de sífilis congénita estimada con la herramienta de la OMS era aproximadamente nueve veces superior a la notificada. En consecuencia, Paraguay: i) impartió formación para mejorar el diagnóstico y la notificación de los casos; ii) reforzó los sistemas de información para el monitoreo y la notificación de los casos; y iii) adquirió más pruebas rápidas duales de VIH-sífilis y de inmunoglobulina E plasmática rápida para aumentar la capacidad de realizar pruebas de sífilis. Además, el Ministerio de Salud Pública preparó un nuevo plan nacional para eliminar la transmisión maternofilial de la sífilis, con claros hitos de monitoreo.Es posible que los procedimientos de notificación y vigilancia de la sífilis congénita que aplican los profesionales sanitarios no reflejen de manera adecuada las definiciones nacionales e internacionales de los casos. El uso de la herramienta de estimación de la sífilis congénita de la OMS en Paraguay llamó la atención sobre la sífilis congénita como un problema nacional de salud pública y destacó la importancia de contar con sistemas nacionales de vigilancia integrales y datos precisos. El uso constante de la herramienta de la OMS puede hacer un seguimiento de los avances hacia la eliminación de la transmisión maternofilial de la sífilis al ayudar a mejorar la cobertura de los servicios relacionados con la sífilis y la vigilancia nacional.أدت بيانات المراقبة غير المكتملة في باراغواي إلى الحد من عبء تقييم الزهري الخلقي، مما أدى بدوره إلى ضياع فرص تشخيص الرضع وعلاجهم.تم تقييم انتشار مرض الزهري الخلقي، وفقًا لتعريف منظمة الصحة العالمية (WHO)، في باراغواي باستخدام أداة تقييم الزهري الخلقي التابعة لمنظمة الصحة العالمية. تم استخدام هذه الأداة أيضًا لرصد التقدم نحو القضاء على انتقال مرض الزهري من الأم إلى الطفل.كان عبء مرض الزهري في باراغواي مرتفعًا على مدى تاريخها، فقد تم تقدير انتشاره بين النساء الحوامل بنسبة 3% في عام 2018.在巴拉圭，不完整的监测数据导致先天性梅毒的负担被低估，由此导致错过婴儿诊断和治疗的机会。.根据世界卫生组织的 (WHO) 定义，采用世界卫生组织先天性梅毒评估工具来估算先天性梅毒的患病率。该工具还可用来监测梅毒母婴传播评估领域的进展情况。.巴拉圭的梅毒负担历来很高：2018 年的孕妇患病率估计占到 3%。.使用世界卫生组织工具评估的先天性梅毒患病率大约是所报告的患病率的九倍。随后，巴拉圭：(I) 开展了培训以提升诊断和病例报告；(ii) 加强了病例监测和报告的信息系统，并且 (iii) 采购了额外的快速双重 HIV-梅毒检测和快速血浆反应素试验以增强梅毒检测能力。除此以外，卫生部还制定了一项新的全国性计划，通过明确的监测里程碑来评估梅毒的母婴传播。.医疗护理机构的先天性梅毒报告和监测程序可能无法充分反映全国性和国际性的病例定义。在巴拉圭采用世界卫生组织先天性梅毒评估工具提高了对先天性梅毒作为全国性公共卫生问题的关注度，强调了综合的全国性监测系统和准确数据的重要性。持续使用世界卫生组织工具可以有助于提高梅毒卫生服务覆盖面和全国性监测的普及，从而追赶梅毒母婴传播评估领域的进展。.В Парагвае неполные данные наблюдений привели к недооценке бремени врожденного сифилиса, что в свою очередь привело к упущенным возможностям в диагностике и лечении младенцев.В Парагвае распространенность врожденного сифилиса, по определению Всемирной организации здравоохранения (ВОЗ), оценивалась с использованием инструмента ВОЗ для оценки врожденного сифилиса. Этот инструмент также использовали для мониторинга прогресса в борьбе с передачей сифилиса от матери к ребенку.В Парагвае бремя сифилиса достигло рекордных показателей: его распространенность среди беременных женщин в 2018 году составила 3%.Распространенность врожденного сифилиса, оцененная с помощью инструмента ВОЗ, примерно в девять раз превышала зарегистрированную распространенность. В результате Парагвай: (i) организовал обучение для улучшения диагностики и отчетности о случаях заболевания; (ii) укрепил информационные системы для мониторинга случаев заболевания и отчетности; (iii) закупил дополнительные двойные экспресс-тесты на ВИЧ/сифилис и реакцию быстрого определения реагинов плазмы, чтобы расширить возможности тестирования на сифилис. Кроме того, Министерство здравоохранения подготовило новый национальный план по борьбе с передачей сифилиса от матери к ребенку с четкими этапами мониторинга.Процедуры отчетности и наблюдения медицинских работников за врожденным сифилисом могут неадекватно отражать определения случаев заболевания на национальном и международном уровне. Использование инструмента ВОЗ для оценки врожденного сифилиса в Парагвае привлекло внимание к врожденному сифилису как национальной проблеме в сфере общественного здравоохранения и подчеркнуло важность комплексных национальных систем наблюдения и точных данных. Постоянное использование инструмента ВОЗ поможет отслеживать прогресс в борьбе с передачей сифилиса от матери к ребенку, способствуя большему охвату услугами по борьбе с сифилисом и наблюдению на национальном уровне.

Pregnant women in Vietnam have a high prevalence of hepatitis B virus (HBV) and low prevalence of human immunodeficiency virus (HIV) and syphilis. This study aims to assess the feasibility and benefit of universal testing for HIV, HBV and syphilis in antenatal care (ANC) services. A pilot project was conducted in the Thai Nguyen province of Vietnam between 2012 and 2014. HIV, HBV and syphilis testing were offered to pregnant women. Interventions to eliminate mother-to child-transmission (MTCT) of the three pathogens were provided to infected mothers and their infants. Descriptive analysis was conducted, and the number of infections averted from integrating hepatitis B tests into ANC was estimated. Testing coverage for HIV, HBV and syphilis for the cohort of pregnant women during the pilot project was 98%. Prevalence of HIV, HBV and syphilis infections in this cohort was 0.14%, 7.8%, and 0.03%, respectively. No infant was infected with HIV or syphilis, while HBV infection was diagnosed in 27 infants (13.9%). An estimated 23 mother to child HBV infections were prevented by integrated interventions. The triple prevention of mother-to-child transmission of HIV, HBV and syphilis is feasible. Investment in the expansion of the integrated approach is required to achieve the goal of eliminating MTCT.

Hepatitis B vaccine (HepB), which has been available since 1982, provides lifelong protection against hepatitis B virus (HBV) infection and the associated 20%-30% increased lifetime risk for developing cirrhosis or hepatocellular carcinoma among >95% of vaccine recipients (1). Before HepB introduction into national childhood immunization schedules, the estimated hepatitis B surface antigen (HBsAg) prevalence in the World Health Organization (WHO) Western Pacific Region (WPR)* was >8% in 1990 (2). In 2005, the WPR was the first WHO region to establish a hepatitis B control goal, with an initial target of reducing HBsAg prevalence to

We conducted a nationwide retrospective study in Japan to evaluate the effectiveness of oral amoxicillin or ampicillin as alternatives to injectable benzathine penicillin G for treating pregnant women with syphilis and preventing congenital syphilis (CS). We investigated 80 pregnant women with active syphilis treated with amoxicillin or ampicillin during 2010–2018. Overall, 21% (15/71) had pregnancies resulting in CS cases, and 3.8% (3/80) changed therapies because of side effects. Among 26 patients with early syphilis, no CS cases occurred, but among 45 with late syphilis, 15 (33%) CS cases occurred. Among 57 patients who started treatment >60 days before delivery, 8 (14%) had CS pregnancy outcomes. We found oral amoxicillin potentially ineffective for preventing CS cases among pregnant women with late syphilis but potentially effective in those with early syphilis. Prospective studies are needed to definitively evaluate the efficacy of amoxicillin for the treatment of pregnant women with syphilis to prevent CS.

Every year, an estimated 180 000 babies in the Western Pacific Region are infected by hepatitis B, 13 000 by syphilis and 1400 by HIV through mother-to-child transmission. (1) These infections can be largely prevented by antenatal screening, treatment and timely vaccination for newborns. Despite challenges in controlling each disease, major achievements have been made. National immunization programmes have reduced the regional hepatitis B prevalence from over 8% in 1990 to 0.93% among children born in 2012. In addition, HIV testing and treatment have helped keep the regional prevalence of HIV infections at 0.1%. In contrast, the number of maternal syphilis cases is still high in the Western Pacific Region, with an estimated 45 million cases in 2012. Elimination of mother-to-child transmission of these infections cannot be achieved through vertically applied programming and require using and augmenting to the shared Maternal, Newborn and Child Health platform to coordinate, integrate and enable cost efficiencies for these elimination efforts. The Regional Framework for Triple Elimination of Mother-to-Child Transmission of HIV, Hepatitis B and Syphilis in Asia and the Pacific 2018-2030 offers such a coordinated approach towards achieving the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis and provides guidance for decision-makers, managers and health professionals working in programmes addressing maternal, newborn and child health, HIV, hepatitis, sexually transmitted infections and immunization.

In 2007 the World Health Organization (WHO) launched the global initiative to eliminate mother-to-child transmission of syphilis (congenital syphilis, or CS). To assess progress towards the goal of50 CS cases per 100,000 live births, we generated regional and global estimates of maternal and congenital syphilis for 2016 and updated the 2012 estimates.Maternal syphilis estimates were generated using the Spectrum-STI model, fitted to sentinel surveys and routine testing of pregnant women during antenatal care (ANC) and other representative population data. Global and regional estimates of CS used the same approach as previous WHO estimates.The estimated global maternal syphilis prevalence in 2016 was 0.69% (95% confidence interval: 0.57-0.81%) resulting in a global CS rate of 473 (385-561) per 100,000 live births and 661,000 (538,000-784,000) total CS cases, including 355,000 (290,000-419,000) adverse birth outcomes (ABO) and 306,000 (249,000-363,000) non-clinical CS cases (infants without clinical signs born to un-treated mothers). The ABOs included 143,000 early fetal deaths and stillbirths, 61,000 neonatal deaths, 41,000 preterm or low-birth weight births, and 109,000 infants with clinical CS. Of these ABOs- 203,000 (57%) occurred in pregnant women attending ANC but not screened for syphilis; 74,000 (21%) in mothers not enrolled in ANC, 55,000 (16%) in mothers screened but not treated, and 23,000 (6%) in mothers enrolled, screened and treated. The revised 2012 estimates were 0.70% (95% CI: 0.63-0.77%) maternal prevalence, and 748,000 CS cases (539 per 100,000 live births) including 397,000 (361,000-432,000) ABOs. The estimated decrease in CS case rates between 2012 and 2016 reflected increased access to ANC and to syphilis screening and treatment.Congenital syphilis decreased worldwide between 2012 and 2016, although maternal prevalence was stable. Achieving global CS elimination, however, will require improving access to early syphilis screening and treatment in ANC, clinically monitoring all women diagnosed with syphilis and their infants, improving partner management, and reducing syphilis prevalence in the general population by expanding testing, treatment and partner referral beyond ANC.

Background The Regional Framework for Triple Elimination of Mother-to-Child Transmission (EMTCT) of HIV, Hepatitis B (HBV) and Syphilis in Asia and the Pacific 2018-30 was endorsed by the Regional Committee of WHO Western Pacific in October 2017, proposing an integrated and coordinated approach to achieve elimination in an efficient, coordinated and sustainable manner. This study aims to assess the population impacts and cost-effectiveness of this integrated approach in the Cambodian context. Methods Based on existing frameworks for the EMTCT for each individual infection, an integrated framework that combines infection prevention procedures with routine antenatal care was constructed. Using decision tree analyses, population impacts, cost-effectiveness and the potential reduction in required resources of the integrated approach as a result of resource pooling and improvements in service coverage and coordination, were evaluated. The tool was assessed using simulated epidemiological data from Cambodia. Results The current prevention programme for 370,000 Cambodian pregnant women was estimated at USD$2.3 ($2.0–$2.5) million per year, including the duration of pregnancy and up to 18 months after delivery. A model estimate of current MTCT rates in Cambodia was 6.6% (6.2–7.1%) for HIV, 14.1% (13.1–15.2%) for HBV and 9.4% (9.0–9.8%) for syphilis. Integrating HIV and syphilis prevention into the existing antenatal care framework will reduce the total time required to provide this integrated care by 19% for health care workers and by 32% for pregnant women, resulting in a net saving of $380,000 per year for the EMTCT programme. This integrated approach reduces HIV and HBV MTCT to 6.1% (5.7–6.5%) and 13.0% (12.1–14.0%), respectively, and substantially reduces syphilis MCTC to 4.6% (4.3–5.0%). Further introduction of either antiviral treatment for pregnant women with high viral load of HBV, or hepatitis B immunoglobulin (HBIG) to exposed newborns, will increase the total cost of EMTCT to $4.4 ($3.6–$5.2) million and $3.3 ($2.7–$4.0) million per year, respectively, but substantially reduce HBV MTCT to 3.5% (3.2–3.8%) and 5.0% (4.6–5.5%), respectively. Combining both antiviral and HBIG treatments will further reduce HBV MTCT to 3.4% (3.1–3.7%) at an increased total cost of EMTCT of $4.5 ($3.7–$5.4) million per year. All these HBV intervention scenarios are highly cost–effective ($64–$114 per disability-adjusted life years averted) when the life benefits of these prevention measures are considered. Conclusions The integrated approach, using antenatal, perinatal and postnatal care as a platform in Cambodia for triple EMTCT of HIV, HBV and syphilis, is highly cost-effective and efficient.

Melanie Taylor and colleagues discuss progress towards eliminating vertical transmission of HIV and syphilis.

Aim Postnatal depression has demonstrated long-term consequences on child cognitive and emotional development; however, the link between maternal and child pathology has not been clearly identified. We conducted a prospective study using self-rating questionnaires to clarify the association between bonding disorder and maternal mood during pregnancy and after childbirth. Methods A total of 389 women participated in this study and completed questionnaires. Participants were asked to complete the Edinburgh Postnatal Depression Scale (EPDS) and the Mother-to-Infant Bonding Scale four times during pregnancy and the postpartum period. Results We found statistically significant weak to moderate correlations (r = 0.14–0.39) between the EPDS and Mother-to-Infant Bonding Scale scores at each testing period. Women who experienced low mood tended to have stronger bonding disorder. Furthermore, the effectiveness of attachment between the mother and child was closely related to the mood of the mother as measured by the EPDS. Conclusion We observed different patterns of bonding and maternal mood. Distinct subtypes regarding maternal mood and formation of mother-to-infant attachment suggests that analysis of bonding disorder should be performed considering the course of maternal depressive symptoms.

BackgroundIn 2007 the World Health Organization (WHO) launched the global initiative to eliminate mother-to-child transmission of syphilis (congenital syphilis, or CS). To assess progress towards the goal of MethodsMaternal syphilis estimates were generated using the Spectrum-STI model, fitted to sentinel surveys and routine testing of pregnant women during antenatal care (ANC) and other representative population data. Global and regional estimates of CS used the same approach as previous WHO estimates.ResultsThe estimated global maternal syphilis prevalence in 2016 was 0.69% (95% confidence interval: 0.57-0.81%) resulting in a global CS rate of 473 (385-561) per 100,000 live births and 661,000 (538,000-784,000) total CS cases, including 355,000 (290,000-419,000) adverse birth outcomes (ABO) and 306,000 (249,000-363,000) non-clinical CS cases (infants without clinical signs born to un-treated mothers). The ABOs included 143,000 early fetal deaths and stillbirths, 61,000 neonatal deaths, 41,000 preterm or low-birth weight births, and 109,000 infants with clinical CS. Of these ABOs- 203,000 (57%) occurred in pregnant women attending ANC but not screened for syphilis; 74,000 (21%) in mothers not enrolled in ANC, 55,000 (16%) in mothers screened but not treated, and 23,000 (6%) in mothers enrolled, screened and treated. The revised 2012 estimates were 0.70% (95% CI: 0.63-0.77%) maternal prevalence, and 748,000 CS cases (539 per 100,000 live births) including 397,000 (361,000-432,000) ABOs. The estimated decrease in CS case rates between 2012 and 2016 reflected increased access to ANC and to syphilis screening and treatment.ConclusionsCongenital syphilis decreased worldwide between 2012 and 2016, although maternal prevalence was stable. Achieving global CS elimination, however, will require improving access to early syphilis screening and treatment in ANC, clinically monitoring all women diagnosed with syphilis and their infants, improving partner management, and reducing syphilis prevalence in the general population by expanding testing, treatment and partner referral beyond ANC.

Background Adherence to antiretroviral (ARV) drugs is essential for eliminating new pediatric infections of human immunodeficiency virus (HIV). Since the Zambian government revised the national guidelines based on option A (i.e., maternal zidovudine and infant ARV prophylaxis) of the World Health Organization’s 2010 guidelines, no studies have assessed adherence to ARVs during pregnancy up to the postpartum period. This study aimed to examine adherence to ARVs and identify the associated risk factors. Methods A prospective cohort study was conducted in the Chongwe district from June 2011 to January 2014. Self-reported adherence to ARVs was examined during pregnancy and at one week, six weeks, and 24 weeks postpartum among 321 HIV-positive women. The probability of remaining adherent to ARVs was estimated using the Kaplan-Meier method, and the risk factors for non-adherence were identified using the Cox proportional hazard regressions—treating loss to follow-up as non-adherence. The statuses of HIV in HIV-exposed infants were assessed in January 2014. Results During the study period, 326 infants were born to HIV-positive women, 262 (80.4 %) underwent HIV testing, and 11 (3.4 %) had their HIV infection detected at the time that they had the latest HIV testing as of January 2014. The ARV adherence rate was 82.5 % during pregnancy, 84.2 % at one week postpartum, 81.5 % at six weeks postpartum, and 70.5 % at 24 weeks postpartum. The probability of remaining adherent to ARVs was 0.61 at day 50, 0.35 at day 100, 0.18 at day 200, and 0.06 at day 300. Attending a referral health center (HC) was a risk factor for non-adherence compared with attending rural HCs that provided HIV care/treatment (adjusted hazard ratio [aHR] 0.71, 95 % confidence interval [CI] 0.57–0.88) and those that did not provide HIV care/treatment (aHR 0.58, 95 % CI 0.46–0.74). A new diagnosis of HIV infection compared to a known HIV-positive status before pregnancy was another risk factor for non-adherence (aHR 1.24, 95 % CI 1.03–1.50). Conclusions Maintaining adherence to ARVs through pregnancy to the postpartum period remains a crucial challenge in Zambia. To maximize the treatment benefits, adherence to ARVs and retention in care should be improved at all health facilities.

Although the association between social support and postpartum depression has been previously investigated, its causal relationship remains unclear. Therefore, we examined prospectively whether social support during pregnancy affected postpartum depression. Social support and depressive symptoms were assessed by Japanese version of Social Support Questionnaire (J-SSQ) and Edinburgh Postnatal Depression Scale (EPDS), among 877 pregnant women in early pregnancy and at one month postpartum. First, J-SSQ was standardized among peripartum women. The J-SSQ was found to have a two-factor structure, with Number and Satisfaction subscales, by exploratory and confirmatory factor analyses. Analysis of covariance was performed to examine how EPDS and J-SSQ scores during pregnancy affected the EPDS score at postpartum. Significant associations were found between postpartum EPDS score and both EPDS and total scores on the Number subscales during pregnancy (β = 0.488 and -0.054, ps

BackgroundCountries are currently progressing towards the elimination of new paediatric HIV infections by 2015. WHO published new consolidated guidelines in June 2013, which now recommend either 'Antiretroviral drugs (ARVs) for women living with HIV during pregnancy and breastfeeding (Option B)' or 'Lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (Option B+)', while de facto phasing out Option A. This study examined health outcomes and cost impact of the shift to WHO 2013 recommendations in Zambia.MethodsA decision analytic model was developed based on the national health system perspective. Estimated risk and number of cases of HIV transmission to infants and to serodiscordant partners, and proportions of HIV-infected pregnant women with CD4 count of ≤350 cells/mm3 to initiate ART were compared between 2010 Option A and the 2013 recommendations. Total costs of prevention of mother-to-child transmission of HIV (PMTCT) services per annual cohort of pregnant women, incremental cost-effectiveness ratio (ICER) per infection averted and quality-adjusted life-year (QALY) gained were examined.ResultsOur analysis suggested that the shift from 2010 Option A to the 2013 guidelines would result in a 33% reduction of the risk of HIV transmission among exposed infants. The risk of transmission to serodiscordant partners for a period of 24 months would be reduced by 72% with 'ARVs during pregnancy and breastfeeding' and further reduced by 15% with 'Lifelong ART'. The probability of HIV-infected pregnant women to initiate ART would increase by 80%. It was also suggested that while the shift would generate higher PMTCT costs, it would be cost-saving in the long term as it spares future treatment costs by preventing infections in infants and partners.ConclusionThe shift to the WHO 2013 guidelines in Zambia would positively impact health of family and save future costs related to care and treatment.

Postnatal depression has demonstrated long-term consequences on child cognitive and emotional development; however, the link between maternal and child pathology has not been clearly identified. We conducted a prospective study using self-rating questionnaires to clarify the association between bonding disorder and maternal mood during pregnancy and after childbirth.A total of 389 women participated in this study and completed questionnaires. Participants were asked to complete the Edinburgh Postnatal Depression Scale (EPDS) and the Mother-to-Infant Bonding Scale four times during pregnancy and the postpartum period.We found statistically significant weak to moderate correlations (r = 0.14-0.39) between the EPDS and Mother-to-Infant Bonding Scale scores at each testing period. Women who experienced low mood tended to have stronger bonding disorder. Furthermore, the effectiveness of attachment between the mother and child was closely related to the mood of the mother as measured by the EPDS.We observed different patterns of bonding and maternal mood. Distinct subtypes regarding maternal mood and formation of mother-to-infant attachment suggests that analysis of bonding disorder should be performed considering the course of maternal depressive symptoms.

BackgroundRecent studies have displayed increased interest in examining the relationship between personality traits and the onset, treatment response patterns, and relapse of depression. This study aimed to examine whether or not harm avoidance (HA) was a risk factor for postpartum depression measured by the Edinburgh Postnatal Depression Scale (EPDS) and the state dependency of HA.MethodsPregnant women (n=460; mean age 31.9±4.2 years) who participated in a prenatal program completed the EPDS as a measure of depressive state and the Temperament and Character Inventory (TCI) as a measure of HA during three periods: early pregnancy (T1), late pregnancy (around 36 weeks), and 1 month postpartum (T2). Changes in EPDS and HA scores from T1 to T2 were compared between the non depressive (ND) group and the postpartum depressive (PD) group.ResultsThere was no significant difference in the level of HA between the ND and PD groups at T1. In the ND group, EPDS and HA scores did not change significantly from T1 to T2. In the PD group, both scores increased significantly from T1 to T2 (EPDS, pConclusionsThese results suggest that HA cannot be considered a risk factor for the development of postpartum depression measured by EPDS. Furthermore, HA may be state dependent.

BackgroundThe relationship between perceived rearing and the postpartum depressive state remains unclear. We aimed to examine whether perceived rearing is a risk factor for postpartum depression as measured by the Edinburgh Postnatal Depression Scale (EPDS), and whether the score of perceived rearing is affected by depressive mood (the state dependency of perceived rearing).MethodsPregnant women (n = 448, mean age 31.8 ± 4.2 years) completed the EPDS as a measure of depressive state in early pregnancy (T1), late pregnancy (around 36 weeks), and at 1 month postpartum (T2), and the Parental Bonding Instrument (PBI) at T1 as a measure of perceived rearing. Changes in the EPDS and the PBI scores from T1 to T2 were compared between the non depressive (ND) group and the postpartum depressive (PD) group.ResultsThere were no significant differences in any PBI category for perceived rearing between the ND and PD groups at T1. EPDS scores did not change significantly from T1 to T2 in the ND group but increased significantly in the PD group. The PBI maternal care score increased significantly in the ND group (pConclusionsThe present study suggests that perceived rearing is not a strong risk factor for postpartum depression as measured by the EPDS. Furthermore, the results indicated the state dependency of the PBI maternal care score.

Background The primary objective of this study was to analyze the pattern of depressive moods related to pregnancy and postpartum in a dataset collected prospectively. A secondary objective was to assess the association between (1) low moods during pregnancy and postpartum depressive symptoms, and (2) maternity blues and postpartum depressive symptom. Method Three hundred eighty-seven women completed self-administered questionnaires. The participants were asked to respond to Stein's Maternity Blues Scale (Stein's Scale) on five consecutive days after delivery and to the Edinburgh Postnatal Depression Scale (EPDS) during both pregnancy and postpartum. Results 32.0% of the women were identified as having a score of more than 9 on EPDS during pregnancy and postpartum. 21.6% of the women scored above the Stein's Scale cut-off point for at least 1 day during the 5-day period following delivery. The odds ratio (95% CI) for postpartum low mood if the women experienced low mood during pregnancy was 4.46 (2.48–8.04), while the odds ratio for postpartum depressive symptoms if the women experienced symptoms of maternity blues was 5.48 (2.74–10.98). In logistic regression analysis, the number of days in which women scored over the cut-off point by Stein's Scale proved to be the more significant predictor of scoring over the EPDS cutoff (8/9) [OR (95% CI)=2.74 (1.89–3.96)]. Conclusion The rate of maternity blues in our findings was similar to the rates previously reported in Japan, but lower than the rates observed in Western countries. Furthermore, our longitudinal study confirms the likelihood of subsequent postpartum depressive symptoms if low moods during pregnancy and/or maternity blues are present.

This study examines the psychosocial needs of the children affected by AIDS. Eight primary school children aged 10-13 years who lost parents to AIDS or whose parents were living with HIV were closely followed for a period of one year and qualitative data on the psychosocial challenges they faced were collected using semi-structured interviews, observation, drawings and diaries. Data were also collected from their caregivers and classroom teachers using semi-structured interviews, as well as data from their classmates using a self-completion questionnaire. The findings strongly suggested that adults were creating a "wall of silence" around children affected by AIDS by hiding the parents' HIV status from them and avoid talking to them about HIV and AIDS. The silence was intended to protect the children from sadness, embarrassment, bullying and discrimination. In reality, however, the silence was found to have isolated them and increased their psychosocial vulnerability by blocking open communication with family members, peers and teachers, and left them to cope with their problems on their own. It is argued that to support the psychosocial health of these children, it is necessary for the adults to recognise the negative impact of silence and for the families and the school to be involved in a process of participatory learning and action to find culturally appropriate ways to break down the wall of silence, and promote more open communication.

Introduction : HIV testing is the entry point for the elimination of mother-to-child transmission of HIV. Decreasing external funding for the HIV response in some low- and middle-income countries has triggered the question of whether a focused approach to HIV testing targeting pregnant women in high-burden areas should be considered. This study aimed at determining and comparing the cost-effectiveness of universal and focused HIV testing approaches for pregnant women across high to very low HIV prevalence settings. Methods : We conducted a modelling analysis on health and cost outcomes of HIV testing for pregnant women using four country-based case scenarios (Namibia, Kenya, Haiti and Viet Nam) to illustrate high, intermediate, low and very low HIV prevalence settings. We used subnational prevalence data to divide each country into high-, medium- and low-burden areas, and modelled different antenatal and testing coverage in each. Results : When HIV testing services were only focused in high-burden areas within a country, mother-to-child transmission rates remained high ranging from 18 to 23%, resulting in a 25 to 69% increase in new paediatric HIV infections and increased future treatment costs for children. Universal HIV testing was found to be dominant (i.e. more QALYs gained with less cost) compared to focused approaches in the Namibia, Kenya and Haiti scenarios. The universal approach was also very cost-effective compared to focused approaches, with $ 125 per quality-adjusted life years gained in the Viet Nam-based scenario of very low HIV prevalence. Sensitivity analysis further supported the findings. Conclusions : Universal approach to antenatal HIV testing achieves the best health outcomes and is cost-saving or cost-effective in the long term across the range of HIV prevalence settings. It is further a prerequisite for quality maternal and child healthcare and for the elimination of mother-to-child transmission of HIV. Keywords: HIV; mother-to-child transmission; HIV testing; cost-effectiveness; universal approach; focused approach. To access the supplementary material to this article please see Supplementary Files in the column to the right (under Article Tools). (Published: 14 December 2016) Citation: Ishikawa N et al. Journal of the International AIDS Society 2016, 19 :21212 http://www.jiasociety.org/index.php/jias/article/view/21212 | http://dx.doi.org/10.7448/IAS.19.1.21212