Showing papers by "Deborah Watson-Jones published in 2007"

Adverse birth outcomes in United Republic of Tanzania: impact and prevention of maternal risk factors

Abstract: OBJECTIVE: To determine risk factors for poor birth outcome and their population attributable fractions. METHODS: 1688 women who attended for antenatal care were recruited into a prospective study of the effectiveness of syphilis screening and treatment. All women were screened and treated for syphilis and other reproductive tract infections (RTIs) during pregnancy and followed to delivery to measure the incidence of stillbirth, intrauterine growth retardation (IUGR), low birth weight (LBW) and preterm live birth. FINDINGS: At delivery, 2.7% of 1536 women experienced a stillbirth, 12% of live births were preterm and 8% were LBW. Stillbirth was independently associated with a past history of stillbirth, short maternal stature and anaemia. LBW was associated with short maternal stature, ethnicity, occupation, gravidity and maternal malaria whereas preterm birth was associated with occupation, age of sexual debut, untreated bacterial vaginosis and maternal malaria. IUGR was associated with gravidity, maternal malaria, short stature, and delivering a female infant. In the women who had been screened and treated for syphilis, in between 20 and 34% of women with each outcome was estimated to be attributable to malaria, and 63% of stillbirths were estimated as being attributable to maternal anaemia. Screening and treatment of RTIs was effective and no association was seen between treated RTIs and adverse pregnancy outcomes. CONCLUSION: Maternal malaria and anaemia continue to be significant causes of adverse pregnancy outcome in sub-Saharan Africa. Providing reproductive health services that include treatment of RTIs and prevention of malaria and maternal anaemia to reduce adverse birth outcomes remains a priority.

Adverse Birth Outcomes in United Republic of Tanzania-Impact and Prevention of Maternal Risk factors/Issues Defavorables De L'accouchement En Tanzanie-Influence et Prevention Des Facteurs De Risque maternels/Desenlaces Adversos del Parto En la Republica Unida De Tanzania: Impacto Y Prevencion De Los Factores De Riesgo Maternos

Abstract: Introduction Adverse birth outcomes such as low birth weight (LBW) and prematurity are associated with increased infant morbidity and mortality. (1) Maternal risk factors that are likely to be particularly important in sub-Saharan Africa include reproductive tract infections (RTIs), malaria and human immunodeficiency virus (HIV) infection. (2-5) The impact of these infections is likely to be high because they are so prevalent. Up to 50% of stillbirths, for example, have been attributed to untreated maternal syphilis. (6,7) Other RTIs associated with adverse birth outcomes include bacterial vaginosis (BV), gonorrhoea, and Chlamydia trachomatis and Trichomonas vaginalis infections. (8-12) A few studies have documented other maternal factors associated with adverse pregnancy outcomes in sub-Saharan Africa. (13-20) However, there are few data on the examination of multiple determinants of birth outcome and the proportion of adverse birth events attributable to these factors from the study region, partly because of a lack of simple, inexpensive diagnostic methods. We conducted a study to determine the effectiveness of syphilis screening and treatment in preventing adverse pregnancy outcomes in women in Mwanza city, north-west United Republic of Tanzania. (21) This study allowed the concomitant measurement of the importance and impact of other maternal factors in this population. Methods Study design and participants The study methods have been described in detail elsewhere. (21) In summary, a prospective cohort of 1688 women attending an antenatal clinic (ANC) was recruited from the main ANC in Mwanza city from 1997 to 2000 to examine the effectiveness of antenatal screening and treatment of syphilis. Women were screened at the ANC for syphilis by the rapid plasma reagin assay (RPR). RPR-positive women were treated with a stat dose of benzathine penicillin G, 2.4 MU, by intramuscular injection. Inclusion criteria for enrolment included informed consent, residence in Mwanza city for at least 1 month and a viable pregnancy confirmed by ultrasound. Exclusion criteria included more than one fetus or congenital fetal abnormality seen on ultrasound, maternal diabetes, hypertension or a history of vaginal bleeding in the current pregnancy. For each RPR-positive woman consecutively enrolled, the next two RPR-negative eligible women were recruited. Women were interviewed about their sociodemographic characteristics, obstetric history, RTI symptoms and recent antibiotic treatment. On examination, vaginal and cervical specimens were collected. Women diagnosed with T. vaginalis and/or Candida albicans on vaginal wet preparations were offered immediate treatment. ANC attendees were provided with iron and folate supplements and chloroquine 300-mg base following the Tanzanian national guidelines at that time. At a follow-up visit 2 weeks later, participants were treated for any RTIs identified in reference laboratory tests done following national guidelines. Syphilis testing was repeated at the STD reference laboratory in Mwanza. Women who were RPR-negative following the initial ANC screening, but who were found to be RPR-reactive at the reference laboratory were treated with benzathine penicillin G, 2.4 MU, by intramuscular injection. A second RTI screen and treatment and an ultrasound examination were offered to women recruited before 32 weeks gestation. Free treatment was offered to the sexual partners of women with RTIs. Participants were followed to delivery. As soon as possible after admission, a 10-ml venous blood sample and a finger-prick sample for a malaria thick film and haematocrit were collected. A placental blood smear and a 10 [mm.sup.3] placental biopsy from the maternal placental surface were taken after delivery. Data were collected on birth outcomes and signs of congenital syphilis. Stillbirth was defined as a fetal death after 22 weeks gestation, intrauterine fetal death (IUFD) as fetal death at or before 22 weeks gestation, LBW as birth weight less than 2500 g, prematurity as delivery before 37 weeks gestation and intrauterine growth retardation (IUGR) as an LBW infant born at or after 37 weeks gestation. …

Risk factors for herpes simplex virus type 2 and HIV among women at high risk in northwestern Tanzania: preparing for an HSV-2 intervention trial.

Abstract: The objectives were to determine prevalence of and risk factors for herpes simplex virus type 2 (HSV-2) and HIV among women being screened for a randomized controlled trial of HSV suppressive therapy in northwestern Tanzania. Two thousand seven hundred nineteen female facility workers aged 16 to 35 were interviewed and underwent serological testing for HIV and HSV-2. Factors associated with HSV-2 and HIV in women aged 16 to 24 were examined using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). HSV-2 seroprevalence was 80% and HIV seroprevalence was 30%. Among women aged 16 to 24 both infections were significantly and independently associated with older age being a bar worker working at a truck stop and having more lifetime sexual partners. HSV-2 infection was also associated with lower socioeconomic status increased alcohol intake younger age at first sex inconsistent condom use and vaginal douching. There was a strong association between the 2 infections after adjustment for other factors (OR = 4.22 95% CI: 2.6 to 6.9). Female facility workers in northwestern Tanzania are vulnerable to HSV-2 and HIV infections. Programs designed to increase safer sexual behavior and reduce alcohol use could be effective in reducing HSV-2 incidence and in turn HIV infection. This is a suitable population for an HSV suppressive therapy trial. (authors)

Microbicides Development Program, Tanzania-Baseline Characteristics of an Occupational Cohort and Reattendance at 3 Months.

Abstract: bjectives: To determine baseline characteristics of an occupational cohort of women in Mwanza City, Tanzania, and factors associated with reattendance at 3 months, in preparation for a microbicide trial. Study Design: One thousand five hundred seventy-three women aged 16-54 years working in food outlets and recreational facilities were enrolled, interviewed, and examined at community-based reproductive health clinics, provided specimens for HIV/STI and pregnancy testing, and attended 3 monthly clinical follow-up. Results: Baseline prevalence of HIV was 25.5%; pregnancy 9.7%; herpes simplex virus type-2 74.6%; active syphilis 10.2%, bacterial vaginosis 52.6%; gonorrhea 5.5%; chlamydia 5.9%; and trichomoniasis 12.3%. Reattendance at 3 months was 74.1% and was higher in older women, less mobile women, and in those who received an HIV-negative result at enrollment. Conclusions: Baseline characteristics of this occupational group suggest their suitability for microbicide trials. A screening round, locally appropriate informed consent procedures, and effective community tracing may help reduce losses to follow-up in such settings. © Copyright 2007 American Sexually Transmitted Diseases Association

Low specificity of the Murex fourth-generation HIV enzyme immunoassay in Tanzanian adolescents.

Abstract: OBJECTIVE To determine the specificity of the Abbott Murex HIV antigen/antibody combination enzyme immunoassay (EIA) for the diagnosis of HIV infection in Tanzania. METHODS A cross-sectional survey of 7333 Tanzanian adolescents and young adults was carried out. Sera testing positive by the Murex assay were further evaluated using a battery of other EIA which detect either antibody to HIV-1 or p24 antigen, and by PCR using pol primers. RESULTS Of the 674 sera testing positive by the Murex assay, only 53 (7.9%) were confirmed. The specificity of the Murex assay was 91.5%. CONCLUSIONS Serological tests for HIV may perform differently in different populations. New diagnostic tests should not be introduced into populations in which they have not been evaluated.