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Background: Echogenic Intracardiac Foci (EIF) are non-structural markers identified during the routine 18–20-week foetal anomaly ultrasound scan yet their clinical significance on future outcomes for the infant is unclear. Objective: To examine the association between EIF and risk of preterm birth, chromosomal abnormalities, and cardiac abnormalities. Design: A review across four databases to identify English language journal articles of EIF using a cohort study design. All studies were reviewed for quality using the Critical Appraisal Skills Programme (CASP) checklist and data extracted for comparison and analysis. Results: 19 papers from 9 different countries were included. Combining these studies showed 4.6% (95% CI = 4.55–4.65%) of all pregnancies had EIF which was on the left in 86% of cases, on the right in 3% of cases and bilaterally in 10%. There was no evidence that EIF was associated with higher rates of preterm birth. However, it is possible that infants with EIF were more likely to be terminated rather than be born preterm as there was a 2.1% (range 0.3–4.2%) rate of termination or death of the foetus after week 20 among those with EIF. There was no evidence that EIF alone is highly predictive of chromosomal abnormalities. There was evidence that EIF is associated with higher rates of minor cardiac abnormalities (e.g. ventricular septal defect, tricuspid regurgitation or mitral regurgitation)) with 5.1% (224 of 4385) of those with EIF showing cardiac abnormalities (3.08% in retrospective studies and 17.85% in prospective studies). However, the risk of cardiac defects was only higher with right-sided EIF and where the EIF persisted into the third trimester. However, this is a rare event and would be seen in an estimated 4 per 10,000 pregnancies. Conclusion: EIF alone was not associated with adverse outcomes for the infant. Only persistent EIF on the right side showed evidence of carrying a higher risk of cardiac abnormality and would warrant further follow-up. [ABSTRACT FROM AUTHOR]

Background Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa. Methods and findings This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman's self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes. Conclusions Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths. Trial registration The study is not a clinical trial., Author(s): Fahad Aftab 1, Imran Ahmed 2, Salahuddin Ahmed 3, Said Mohammed Ali 4, Seeba Amenga-Etego 5, Shabina Ariff 2, Rajiv Bahl 6,*, Abdullah H. Baqui 7, Nazma Begum 3, [...]

Objective To estimate neonatal mortality, particularly within 24 hours of birth, In six low- and lower-middle-income countries. Methods We analysed epidemiological data on a total of 149 570 live births collected between 2007 and 2013 In six prospective randomized trials and a cohort study from predominantly rural areas of Bangladesh, Ghana, India, Pakistan, the United Republic of Tanzania and Zambia. The neonatal mortality rate and mortality within 24 hours of birth were estimated for all countries and mortality within 6 hours was estimated for four countries with available data. The findings were compared with published model-based estimates of neonatal mortality. Findings Overall, the neonatal mortality rate observed at study sites in the six countries was 30.5 per 1000 live births (range: 13.6 in Zambia to 47.4 in Pakistan). Mortality within 24 hours was 14.1 per 1000 live births overall (range: 5.1 in Zambia to 20.1 in India) and 46.3% of all neonatal deaths occurred within 24 hours (range: 36.2% in Pakistan to 65.5% in the United Republic of Tanzania). Mortality in the first 6 hours was 8.3 per 1000 live births, i.e. 31.9% of neonatal mortality. Conclusion Neonatal mortality within 24 hours of birth in predominantly rural areas of six low-and lower-middle-income countries was higher than model-based estimates for these countries. A little under half of all neonatal deaths occurred within 24 hours of birth and around one third occurred within 6 hours. Implementation of high-quality, effective obstetric and early newborn care should be a priority in these settings. Methodes Nous avons analyse des donnees epidemiologiques portant sur un total de 149 570 naissances vivantes qui avaient ete recueillies entre 2007 et 2013 lors de six essais prospectifs randomises et d'une etude de cohorte realises dans des zones majoritairement rurales du Bangladesh, du Ghana, d'Inde, du Pakistan, de Tanzanie et de Zambie. Le taux de mortalite neonatale ainsi que la mortalite dans les 24 heures suivant la naissance ont ete estimes pour tous ces pays; la mortalite dans les 6 heures suivant la naissance a ete estimee pour quatre pays sur lesquels nous avions des donnees. Les resultats ont ete compares aux estimations de la mortalite neonatale publiees, qui ont ete etablies d'apres des modeles. Resultats Globalement, le taux de mortalite neonatale observe sur les sites etudies dans les six pays etait de 30,5 pour 1000 naissances vivantes (de 13,6 en Zambie a 47,4 au Pakistan). La mortalite globale dans les 24 heures suivant la naissance etait de 14,1 pour 1000 naissances vivantes (de 5,1 en Zambie a 20,1 en Inde) et 46,3% de l'ensemble des deces neonataux etaient survenus dans les 24 heures (de 36,2% au Pakistan a 65,5% en Tanzanie). Le taux de mortalite dans les 6 heures suivant la naissance etait de 8,3 pour 1000 naissances vivantes, soit 31,9% de la mortalite neonatale totale. Conclusion La mortalite neonatale dans les 24 heures suivant la naissance dans des zones majoritairement rurales de six pays a revenu faible et intermediaire-tranche inferieure etait superieure aux estimations etablies d'apres des modeles pour ces pays. Un peu moins de la moitie des deces neonataux etaient survenus dans les 24 heures suivant la naissance et environ un tiers dans les 6 heures. La mise en place de soins obstetriques et neonataux efficaces et de haute qualite devrait etre une priorite dans ces pays. Mortalidad neonatal durante las 24 horas posteriores al nacimiento en paises con ingresos bajos y paises con ingresos medios mas bajos Objetivo Calcular la mortalidad neonatal, especialmente durante las 24 horas posteriores al nacimiento, en paises con ingresos bajos y paises con ingresos medios mas bajos. Metodos Se analizaron datos epidemiologicos de un total de 149 570 nacidos vivos recopilados entre 2007 y 2013 en seis ensayos a leatorizados prospectivos y un estudio de cohortes de zonas principalmente rurales de Bangladesh, Ghana, india, Pakistan, la Republica Unida de Tanzania y Zambia. Se calculo la tasa de mortalidad neonatal y la mortalidad durante las 24 horas posteriores al nacimiento en todos los paises y se estimo la tasa de mortalidad en 6 horas en cuatro paises con informacion disponible. Los resultados se compararon con estimaciones publicadas basadas en modelos de mortalidad neonatal. Resultados En general, la tasa de mortalidad neonatal observada en los lugares de' estudio de los seis paises fue de 30,5 por cada 1 000 nacidos vivos (alcance: 13,6 en Zambia a 47,4en Pakistan). En conjunto, la mortalidad durante las primeras 24 horas fue de 14,1 porcada 1 000 nacidos vivos (alcance: 5,1 en Zambia a 20,1 en India) y el 46,3% de todas las muertes neonatales se produjo durante las primeras 24 horas (alcance: 36,2% en Pakistan a 65,5% en la Republica Unida deTanzania). La mortalidad en las primeras 6 horas fue de 8,3 porcada 1 000 nacidos vivos, es decir, un 31,9% de mortalidad neonatal. Conclusion La mortalidad neonatal durante las 24 horas posteriores al nacimiento en zonas principalmente rurales de seis paises con ingresos bajos y paises con ingresos medios mas bajos fue superior a las estimaciones basadas en modelos realizadas para estos paises. Algo menos de la mitad de todas las muertes neonatales se produjeron durante las 24 horas posteriores al nacimiento y cerca de un tercio durante las primeras 6 horas de vida. En estos lugares, la implementadon de obstetricia eficaz y de alta calidad y la atencion a recien nacidos deberia ser una prioridad., Introduction Neonatal mortality remains unacceptably high and the risk is greatest on the first day of life--these were the conclusions of the 14th annual State of the World's Mothers report, [...]

Objective To investigate delays in first and third dose diphtheria-tetanus-pertussis (DTP1 and DTP3) vaccination in low-birth-weight infants in Ghana, and the associated determinants. Methods We used data from a large, population-based vitamin A trial in 2010-2013, with 22 955 enrolled infants. We measured vaccination rate and maternal and infant characteristics and compared three categories of low-birth-weight infants (2.0-2.4 kg; 1.5-1.9 kg; and < 1.5 kg) with infants weighing ≥ 2.5 kg. Poisson regression was used to calculate vaccination rate ratios for DTP1 at 10, Hand 18 weeks after birth, and for DTP3 at 18, 22 and 24 weeks (equivalent to 1, 2 and 3 months after the respective vaccination due dates of 6 and 14 weeks). Findings Compared with non-low-birth-weight infants (n = 18979), those with low birth weight (n = 3382) had an almost 40% lower DTP1 vaccination rate at age 10 weeks (adjusted rate ratio, aRR: 0.58; 95% confidence interval, 0:0.43-0.77) and at age 18 weeks (aRR: 0.63; 95% CI: 0.50-0.80). Infants weighing 1.5-1.9 kg (n = 386) had vaccination rates approximately 25% lower than infants weighing ≥ 2.5 kg at these time points. Similar results were observed for DTP3. Lower maternal age, educational attainment and longer distance to the nearest health facility were associated with lower DTP1 and DTP3 vaccination rates. Conclusion Low-birth-weight infants are a high-risk group for delayed vaccination in Ghana. Efforts to improve the vaccination of these infants are warranted, alongside further research to understand the reasons for the delays. Objectif Examiner les retards d'administration de la premiere et de la troisieme dose de vacan diphterie-tetanos-coqueluche (DTP1 et DTP3) chez les nourrissons au faible poids de naissance au Ghana, ainsi que les determinants associes. Methodes Nous avons utilise les donnees issues d'un vaste essai sur la vitamine A, mene dans la population en 2010-2013, et qui portait sur 22 955 nourrissons. Nous avons determine le taux de vaccination ainsi que les caracteristiques des meres et des enfants et avons compare trois categories de nourrissons au faible poids de naissance (2,0-2,4 kg; 1,5-1,9 kg; et < 1,5 kg) avec des nourrissons pesant ≥ 2,5 kg. Une regression de Poisson nous a permis de calculer les ratios des taux de vaccination pour le DTP1 a 10,14 et 18 semaines apres la naissance et, pour le DTP3, a 18, 22 et 24 semaines (ce qui equivaut respectivement a 1, 2 et 3 mois apres l'age normal de vaccination qui est de 6 et 14 semaines). Resultats Compares aux nourrissons n'ayant pas un faible poids de naissance (n = 18 979), ceuxau faible poids de naissance (n=3382) avaient un taux de vaccination DTP1 presque 40% plus faible a l'age de 10 semaines (ratio des taux ajuste, RTa: 0,58; IC 95%: 0,43-0,77) et a l'age de 18 semaines (RTa: 0,63; IC 95%: 0,50-0,80). Les nourrissons pesant de 1,5 a 1,9 kg (n=386) avaient un taux de vaccination a ces ages environ 25% plus faible que ceux pesant ≥ 2,5 kg. Des resultats similalres ont ete observes pour le DTP3. Le plus jeune age des meres, leur niveau d'instruction et les distances plus longuesjusqu'a l'etablissement de soins le plus proche etaient associes a de plus faibles taux de vaccination DTP1 et DTP3. Conclusion Les nourrissons au faible poids de naissance sont un groupe a haut risque en matiere de retard de vaccination au Ghana. Des efforts devraient etre entrepris pour ameliorer la vaccination de ces enfants, parallelement a d'autres recherches permettant de comprendre les raisons de ce retard. Objetivo Investigar los retrasos de la primera y tercera dosis de la vacuna contra la difteria, el tetanos y la tos ferina (DTP1 y DTP3) en recien nacidos con insuficiencia ponderal en Ghana, asi como los determinantes relacionados con las mismas. Metodos En 2010-2013, se utilizaron datos de un ensayo poblacional de vitamina A a gran escala basado en la poblacion con 22 955 recien nacidos Inscritos. Se midio la tasa de vacunacion y las caracteristicas tanto de las madres como de los' recien nacidos, y se compararon tres categorias de recien nacidos con insuficiencia ponderal (2,0-2,4 kg; 1,5-1,9 kg; y < 1,5 kg) con recien nacidos con un peso de ≥ 2,5 kg. Se utilizaron modelos de regresion de Poisson para calcular los coeficientes de la tasa de vacunacion para DTP1 las semanas 10,14 y 18 despues del nacimiento, y para DTP3 las semanas 18,22 y 24 (lo que equivale a 1, 2 y 3 meses tras las fechas de vencimiento de las vacunaciones correspondiente de las semanas 6 y 14). Resultados En comparacion con los recien nacidos sin insuficiencia ponderal (n=18 979), los que nacieron con bajo peso [n=3 382) tenian una tasa de inmunizacion sistematica de DTP1 casi un 40% Inferior a la edad de 10 semanas (razon de tasa ajustada, aRR: 0,58; 1C del 95%: 0,43-0,77) y a la edad de 18 semanas (aRR: 0,63; 1C del 95%: 0,50-0,80). Los recien nacidos con un peso de 1,5-1,9 kg (n=386) tenian unas tasas de vacunacion de alrededor de un 25% Inferior ajos que pesaban ≥ 2,5 kg a la misma edad. Para DTP3 se observaron los mismos resultados. Se asociaron la juventud maternal, el bajo nivel educativo y la larga distancia hasta la instalacion sanitaria mas cercana con las bajas tasas de vacunacion de DTP1 y DTP3. Conclusion Los recien nacidos con Insuficiencia ponderal se encuentran en un grupo de alto riesgo para sufrir un retraso de la vacunacion en Ghana. Se han garantizado esfuerzos para mejorar la vacunacion de estos recien nacidos, junto con una investigacion mas profunda para comprender las razones de dichos retrasos., Introduction Approximately 14% of infants born in low- and middleincome countries have a low birth weight (weighing < 2.50 kg at birth). (1) It has been reported that in high-income [...]

Background Chronic kidney disease (CKD) is a growing contributor to the global burden of noncommunicable diseases. Early diagnosis and treatment can reduce the severity of kidney damage and the need for dialysis or transplantation. It is not known whether mild-to-moderate renal pelvis dilatation (RPD) identified at 18-20 weeks gestation is an early indicator of renal pathology. The aim of this follow-up to the Welsh Study of Mothers and Babies was to assess the risk of hospital admission in children with mild-to-moderate antenatal RPD compared with children without this finding. We also examined how the natural history of the RPD (whether the dilatation persists in later pregnancy or postpartum) or its characteristics (unilateral versus bilateral) changed the risk of hospital admission. Methods/Findings This population-based cohort study included singleton babies born in Wales between January 1, 2009, and December 31, 2011 (n = 22,045). We linked ultrasound scan data to routinely available data on hospital admissions from the Patient Episode Database for Wales (PEDW). The outcome was a hospital admission for urinary tract causes (defined by an expert study steering group) in the first three years of life. We used Cox regression to model time to first hospital admission, according to whether there was evidence of RPD at the fetal anomaly scan (FAS) and/or evidence of dilatation in later investigations, adjusting for other predictors of admission. We used multiple imputation with chained equations to impute values for missing data. We included 21,239 children in the analysis. The risk of at least one hospital admission was seven times greater in those with RPD (n = 138) compared with those without (n = 21,101, conditional hazard ratio [cHR] 7.23, 95% confidence interval [CI] 4.31-12.15, p < 0.001). The risk of hospital admission was higher in children with RPD at the FAS and later dilatation (cHR 25.13, 95% CI 13.26-47.64, p < 0.001) and in children without RPD at the FAS who had later dilatation (cHR 62.06, 95% CI 41.10-93.71, p < 0.001) than in children without RPD (n = 21,057). Among children with RPD at the FAS but no dilatation in later pregnancy or postpartum, we did not find an association with hospital admissions (cHR 2.16, 95% CI 0.69-6.75, p = 0.185), except when the initial dilatation was bilateral (cHR 4.77, 95% CI 1.17-19.47, p = 0.029). Limitations of the study include small numbers in subgroups (meaning that these results should be interpreted with caution), that less severe outcomes (such as urinary tract infections [UTIs] managed in the community or in outpatients) could not be included in our analysis, and that obtaining records of radiological investigations later in pregnancy and postpartum was challenging. Our conclusions were consistent after conducting sensitivity analyses to account for some of these limitations. Conclusions In this large population-based study, children with RPD at the FAS had higher rates of hospital admissions when there was persistent dilatation in later pregnancy or postpartum. Our results can be used to improve counselling of parents and develop care pathways for antenatal screening programmes, including protocols for reporting and further investigation of RPD., Author(s): Lisa Hurt 1, Melissa Wright 2, Joanne Demmler 3, Judith VanDerVoort 4, Susan Morris 4, Fiona Brook 5, David Tucker 6, Maria Chapman 7, Nick A. Francis 1, Rhian [...]

Objective To investigate the clinical characteristics of children who died from diarrhoea in low- and middle-income countries, such as the duration of diarrhoea, comorbid conditions, care-seeking behaviour and oral rehydration therapy use. Methods The study included verbal autopsy data on children who died from diarrhoea between 2000 and 2012 at seven sites in Bangladesh, Ethiopia, Ghana, India, Pakistan, Uganda and the United Republic of Tanzania, respectively. Data came from demographic surveillance sites, randomized trials and an extended Demographic and Health Survey. The type of diarrhoea was classified as acute watery, acute bloody or persistent and risk factors were identified. Deaths In children aged 1 to 11 months and 1 to 4 years were analysed separately. Findings The proportion of childhood deaths due to diarrhoea varied considerably across the seven sites from less than 3% to 30%. Among children aged 1-4 years, acute watery diarrhoea accounted for 31-69% of diarrhoeal deaths, acute bloody diarrhoea for 12-28%, and persistent diarrhoea for 12-56%. Among infants aged 1-11 months, persistent diarrhoea accounted for over 30% of diarrhoeal deaths in Ethiopia, India, Pakistan, Uganda and the United Republic of Tanzania. At most sites, more than 40% of children who died from persistent diarrhoea were malnourished. Conclusion Persistent diarrhoea remains an important cause of diarrhoeal death In young children in low- and middle- income countries. Research is needed on the public health burden of persistent diarrhoea and current treatment practices to understand why children are still dying from the condition. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Etudier les caracteristiques cliniques des enfants qui sont morts de maladies diarrheiques dans des pays a revenu faible et intermediaire, telles que la duree de la diarrhee, les conditions de comorbldite, le comportement en matiere de sollicitatlon des soins et l'utilisation de therapie de rehydratatlon orale. Methodes L'etude a inclus les donnees des autopsies verbales sur des enfants decedes de maladies diarrheiques entre 2000 et 2012 dans 7 sites du Bangladesh, de l'Ethiopie, du Ghana, de Unde, du Pakistan, de l'Ouganda etde la Tanzanle, respectivement. Les donnees provenaient des sites de surveillance demographique, des essais randomises et d'une enquete demographique et sanitaire etendue. Les diarrhees ont ete classees par type, en tant que diarrhee aqueuse aigue, diarrhee sanglante aigue ou diarrhee persistante, et les facteurs de risque ont ete identifies. Les deces chez les enfants ages de 1 a 11 mois et de 1 a 4 ans ont ete analyses separement. Resultats Le pourcentage de la mortalite infantile liee aux maladies diarrheiques varie considerablement entre les 7 sites, de moins de 3% a 30%. Chez les enfants ages de 1 a 4 ans, les diarrhees aqueuses aigues representaient 31% a 69% des deces lles aux maladies diarrheiques, les diarrhees sanglantes aigues 12% a 28% et les diarrhees persistantes 12% a 56%. Chez les enfants ages de 1 mois, les diarrhees persistantes representaient plus de 30% des deces lies aux maladies diarrheiques en Ethiopie, en Inde, en Ouganda et en Tanzanie. Dans la plupart des sites, plus de 40% des enfants qui sont morts de diarrhee persistante souffraient de malnutrition. Conclusion La diarrhee persistante reste une cause importante de deces lies aux maladies diarrheiques chez les jeunes enfants dans les pays a revenu faible et intermediaire. II est necessaire de mener des recherches sur la charge de la diarrhee persistante pour la sante publique et sur les pratiques actuelles de traitement afin de comprendre pourquoi des enfants meurent encore de cette maladie. [TEXT NOT REPRODUCIBLE IN ASCII] Objetivo Investigar las caracteristicas clinicas de los ninos que murieron de diarrea en paises de ingresos medios y bajos, tales como la duracion de la diarrea, las afecciones comorbidas, el comportamiento de busqueda de atencion y el uso de la terapia de rehidratacion oral. Metodos El estudio incluyo datos verbales de autopsias de ninos que murieron de diarrea entre los anos 2000 y 2012 en siete emplazamientos en Bangladesh, Etiopia, Ghana, India, Pakistan, Uganda y la Republica Unida deTanzania, respectivamente. Los datos provinieron de centros de vigilancia demografica, ensayos aleatorios y una encuesta demografica y de salud ampliada. El tipo de diarrea se clasifico como acuosa aguda, sanguinolenta aguda o persistente, y se identificaron los factores de riesgo. Se analizaron por separado las muertes en ninos de 1 a 11 meses y de 1 a 4 anos. Resultados La proporcion de muertes infantiles por diarrea vario considerablemente entre los siete emplazamientos, de menos del 3 % hasta el 30 %. Entre los ninos de entre 1 y 4 anos, la diarrea acuosa aguda represento del 31 % al 69 % de las muertes por diarrea, la diarrea sanguinolenta aguda, del 12 % al 28 %, y la diarrea persistente, del 12 % al 56 %. Entre los ninos de 1 a 11 meses, la diarrea persistente supuso mas del 30 % de las muertes por diarrea en Etiopia, India, Pakistan, Uganda y la Republica Unida deTanzania. En la mayoria de los emplazamientos, mas del 40 % de los ninos que murieron por diarrea persistente estaban malnutrldos. Conclusion La diarrea persistente sigue siendo una causa importante de muerte diarreica en ninos pequenos en paises de ingresos medios y bajos. Es necesario realizar investigaciones sobre la carga de salud publica de la diarrea persistente y las practicas de tratamiento actuales para entender por que los ninos siguen muriendo por esta afeccion., Introduction In the 1980s, five million children worldwide died every year because of diarrhoea, essentially because there was no readily available treatment. (1) In the intervening 30 years, improved management [...]

Effect of vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana: a secondary analysis from the Obaapa VitA trial/Effet de la supplementation en vitamine A sur la mortalite relative chez les femmes en age de procreer au Ghana: une analyse secondaire de l'etude Obaapa VitA/El efecto de los suplementos de vitamina A en la mortalidad por causas especificas de mujeres en edad reproductiva en Ghana: un analisis secundario del ensayo Obaapa VITA. Objective To determine the effect of weekly low-dose vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana. Methods A cluster-randomized, triple-blind, placebo-controlled trial was conducted in seven districts of the Brong Ahafo region of Ghana. Women aged 15-45 years who were capable of giving informed consent and intended to live in the trial area for at least 3 months were enrolled and randomly assigned, according to their cluster of residence, to receive oral vitamin A (7500 |jg) or placebo once a week. Randomization was blocked, with two clusters in each fieldwork area allocated to vitamin A and two to placebo. Every 4 weeks, fieldworkers distributed capsules and collected data during home visits. Verbal autopsies were conducted by field supervisors and reviewed by physicians, who assigned a cause of death. Cause-specific mortality rates in both arms were compared by means of random-effects Poisson regression models to allow for the cluster randomization. Analysis was by intention-to-treat, based on cluster of residence, with women eligible for inclusion once they had consistently received the supplement or placebo capsules for 6 months. Findings The analysis was based on 581 870 woman-years and 2624 deaths. Cause-specific mortality rates were found to be similar in the two study arms. Conclusion Low-dose vitamin A supplements administered weekly are of no benefit in programmes to reduce mortality in women of childbearing age. Objectif Determiner l'effet de la supplementation hebdomadaire en vitamine A a faible dose sur la mortalite specifique des femmes en age de procreer au Ghana. Methodes Une etude randomisee, en triple aveugle, controlee contre placebo, a ete menee dans sept districts de la region de Brong Ahafo au Ghana. Les femmes agees de 15 a 45 ans, capables de donner un consentement eclaire et amenees a vivre dans la region de l'etude pendant au moins 3 mois, ont ete incluses et il a ete determine qu'elles recevraient une fois par semaine, au hasard selon leur groupe de residence, de la vitamine A par voie orale (7 500 ug) ou un placebo. La randomisation a ete fixee par deux groupes dans chaque zone recevant la vitamine A et deux groupes recevant le placebo. Toutes les 4 semaines, les agents de terrain distribuaient les capsules et recueillaient les donnees lors de visites a domicile. Des autopsies orales ont ete effectuees par les superviseurs sur le terrain et analysees par des medecins, qui determinaient la cause du deces. Les taux de mortalite specifique dans les deux groupes ont ete compares a l'aide d'une regression de Poisson pour valider la randomisation des groupes. L'analyse, basee sur l'intention de traiter, etait basee sur le groupe de residence, pour des femmes eligibles a l'etude ayant recu les capsules de supplement ou de placebo de maniere constante pendant 6 mois. Resultats L'analyse s'est basee sur 581 870 annees-femmes et 2624 deces. Les taux de mortalite specifique ont ete juges similaires dans les deux groupes de l'etude. Conclusion Les supplements en vitamine A a faible dose administres hebdomadairement ne sont d'aucune utilite dans les programmes visant a reduire la mortalite chez les femmes en age de procreer. Objetivo Determinar el efecto de la administracion semanal de dosis bajas de vitamina A en la mortalidad por causas especificas de mujeres en edad reproductiva en Ghana. Metodos Se realizo un ensayo aleatorio de grupos, triple ciego y controlado por placebo en siete distritos de la region de Brong Ahafo, en Ghana. Se inscribieron mujeres de entre 15 y 45 anos de edad capaces de dar su consentimiento informado y que tuvieran previsto vivir en el area de ensayo durante al menos tres meses. De acuerdo con el grupo de residencia al que habian sido asignadas de forma aleatoria, recibieron semanalmente vitamina A por via oral (7500 ug) o placebo. La distribucion aleatoria se limito en cada area de trabajo a dos grupos a los que se les administro vitamina A y dos grupos que recibieron placebo. Cada cuatro semanas, los investigadores de campo distribuyeron capsulas y recogieron datos durante las visitas a los hogares. Las autopsias verbales realizadas por los supervisores de campo fueron revisadas por medicos, quienes determinaron la causa de la muerte. Se compararon las tasas de mortalidad por causas especificas de ambos brazos mediante los modelos de regresion de Poisson con efectos aleatorios para facilitar la distribucion aleatoria de los grupos. El analisis fue por intencion de tratar, segun el grupo de residencia y con mujeres que cumplieron las condiciones de inclusion una vez habian recibido de forma constante las capsulas de suplemento o placebo durante seis meses. Resultados El analisis se baso en 581 870 anos-mujer y 2624 muertes. Se descubrio que las tasas de mortalidad por causas especificas fueron similares en ambos brazos del estudio. Conclusion Los suplementos de dosis bajas de vitamina A administrados semanalmente no presentan ninguna ventaja en los programas para reducir la mortalidad de las mujeres en edad reproductiva., Introduction Vitamin A deficiency is an important problem in low- and middle-income countries. (1) Although in these countries all-cause mortality among young children (i.e. children aged from 6 months to [...]

Malaria-schistosomiasis coinfections are common in sub-Saharan Africa but studies present equivocal results regarding the interspecific relationships between these parasites. Through mixed-model analyses of a dataset of Ugandan preschool children, we explore how current coinfection and prior infection with either Schistosoma mansoni or Plasmodium species alter subsequent Plasmodium intensity, Plasmodium risk, and S mansoni risk. Coinfection and prior infections with S mansoni were associated with reduced Plasmodium intensity, moderated by prior Plasmodium infections, wealth, and host age. Future work should assess whether these interactions impact host health and parasite control efficacy in this vulnerable age group. [ABSTRACT FROM AUTHOR]