Ugandan Mothers Research Articles

POC viral load testing in an antenatal clinic setting for Ugandan pregnant women living with HIV: a qualitative implementation process analysis

IntroductionPoint of care viral load (POC VL) testing improves viral suppression and retention in HIV care, and is increasingly being integrated into routine health services for African pregnant women living with HIV. We examined processes of implementing POC VL testing in antenatal care and at delivery for Ugandan mothers living with HIV as part of a pilot randomized trial (Clinical Trial Number: NCT05092997).MethodsWe conducted individual qualitative interviews with 12 clinical and research staff who implemented POC VL testing and 22 mothers who received POC VL testing using the Xpert® HIV-1 Viral Load Assay (Cepheid Inc., Sunnyvale, CA, USA). An inductive, content analytic approach was used to examine the interview transcripts. The analysis addressed the question: How did a group of Ugandan health care providers approach the process of implementing POC VL testing in antenatal care and at delivery for mothers living with HIV?ResultsThe analysis yielded three themes. (1) Staff created an efficient system of communication and then relied on that system to coordinate testing procedures. (2) They also found ways of increasing the speed and efficiency of the testing process. (3) They adopted a “mother-centered” approach to implementation, prioritizing the needs, preferences, and well-being of women in planning and carrying out testing procedures.ConclusionAs POC VL testing becomes more widely used across high HIV burden settings, understanding how implementers approach the implementation process and what they do to make an intervention successful will be an important part of evaluating feasibility.Clinical Trial Number: NCT05092997.

Performance of Different Glucose Testing Methods Amongst Patients of Gestational Diabetes Mellitus in St. Francis Hospital Nsambya, Kampala, Uganda: A CrossSectional and Descriptive Study

Background: Medical examination detects illness or disease risk factors in individuals otherwise well to treat early on and minimize morbidity and death. In spite of recommended GDM screening during prenatal care worldwide and local standards, it has been shown that the procedure has not been properly implemented. A further difficulty might be the lack of consensus worldwide and on local consistence on GDM screening and diagnosis guidelines. Methods: The study was a hospital based cross-sectional and descriptive study that employed both quantitative and qualitative methods of data collection. A descriptive study was concerned with describing the characteristics of a particular individual, or of a group in a given situation. The study was guided by the primary objective of assessing the extent of GDM monitoring among women receiving antenatal care at St. Francis Hospital Nsambya in Kampala, Uganda. Both Capillary and venous blood samples in which plasma/serum was taken from pregnant mothers and their glucose levels estimated using a One touch (Roche Diagnostics) code 298 and plasma calibrated glucometer and Roche Cobas C311fully automated Chemistry Analyser respectively. Both whole blood glucose and plasma/serum glucose was determined as per the principle of enzyme hexokinase (HK) catalyzes the reaction between glucose and adenosine triphosphate (ATP) to form glucose-6-phosphate (G-6-P) and adenosine diphosphate (ADP). In the presence of nicotinamide adenine dinucleotide (NAD), G-6-P is oxidized by the enzyme glucose-6-phosphate Dehydrogenase (G-6-PD) to 6-phosphogluconate and reduced nicotinamide adenine dinucleotide (NADH). The increase in NADH concentration was directly proportional to the glucose concentration and was measured spectrophotometrically at 340 nm. The data was analysed using the McNemar's test to determine the sensitivity, specificity and the direct cost for performing capillary glucose. Receiver operator characteristic and Area under curve analyses to analyze the predictive power of the constructed equation Sensitivity, specificity, false positive rate and false negative rate was computed to validate the capillary method in testing/detecting Gestational Diabetes Mellitus. Data analysis was performed using the SPSS package Results: The results presented below for both capillary and Venous Blood Glucose were based on the principle of glucose oxidase test. Cutoff for the different blood sugar level were as follows; Normal A1C test being < 5.4% and Diabetes being >5.4%. Based on the Venous Blood Glucose tests method, 89.0% (154/173) respondents tested normal, while 11.0% (19/173) had diabetes. However, capillary blood glucose testing method identified 78.6% (136/173)5 respondents as being normal compared 21.4% (37/173) having diabetes. Results obtained from the process indicate capillary glucose blood test for gestation diabetes having very low sensitivity i.e. 30% for gestation diabetes. The findings of the study will help to create public awareness on disease burden, improved diagnosis, classification, management and health policies by the Ministry of Health about Gestational diabetes among Ugandan mothers. Conclusion: Most of the procedures employed to detect and trace for GDM was found to be painful and stressful. The healthcare providers and managers some lacked required skills and knowledge concerning GDM among women and procedural handling was found to be wanting in one case or another. The GDM prevalence was discovered to be slowly increasing even though it was detected to be at low levels at Nsambya hospital but the situation elsewhere might be different. Most of the GDM risk factors were majorly originating from family background, maternal ages discrepancies, and abuse of alcohol. Most GDM challenges were found to be fueled by lack of proper counseling and screening since it wasn’t routine among health care professionals hence lack of expertise and inconsistencies in handling GDM women. Preparing women for GDM screening and diagnosis would have reduced the risks and health challenges faced by pregnant women if they are well prepared and trained before subjecting them to the GDM testing.

Maternal attitudes and behaviours differentially shape infant early life experience: A cross cultural study.

Early life environments afford infants a variety of learning opportunities, and caregivers play a fundamental role in shaping infant early life experience. Variation in maternal attitudes and parenting practices is likely to be greater between than within cultures. However, there is limited cross-cultural work characterising how early life environment differs across populations. We examined the early life environment of infants from two cultural contexts where attitudes towards parenting and infant development were expected to differ: in a group of 53 mother-infant dyads in the UK and 44 mother-infant dyads in Uganda. Participants were studied longitudinally from when infants were 3- to 15-months-old. Questionnaire data revealed the Ugandan mothers had more relational attitudes towards parenting than the mothers from the UK, who had more autonomous parenting attitudes. Using questionnaires and observational methods, we examined whether infant development and experience aligned with maternal attitudes. We found the Ugandan infants experienced a more relational upbringing than the UK infants, with Ugandan infants receiving more distributed caregiving, more body contact with their mothers, and more proximity to mothers at night. Ugandan infants also showed earlier physical development compared to UK infants. Contrary to our expectations, however, Ugandan infants were not in closer proximity to their mothers during the day, did not have more people in proximity or more partners for social interaction compared to UK infants. In addition, when we examined attitudes towards specific behaviours, mothers' attitudes rarely predicted infant experience in related contexts. Taken together our findings highlight the importance of measuring behaviour, rather than extrapolating expected behaviour based on attitudes alone. We found infants' early life environment varies cross-culturally in many important ways and future research should investigate the consequences of these differences for later development.

Differential pre-pandemic breast milk IgA reactivity against SARS-CoV-2 and circulating human coronaviruses in Ugandan and American mothers

ObjectiveUganda has registered fewer coronavirus disease 2019 (COVID-19) cases and deaths per capita than Western countries. The lower numbers of cases and deaths might be due to pre-existing cross-immunity induced by circulating common cold human coronaviruses (HCoVs) before the COVID-19 pandemic. To investigate pre-existing mucosal antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, a comparison was performed of IgA reactivity to SARS-CoV-2 and HCoVs in milk from mothers collected in 2018. MethodsUgandan and United States milk samples were run on an ELISA to measure specific IgA to SARS-CoV-2 and HCoVs NL63, OC43, HKU1, and 229E spike proteins. Pooled plasma from United States SARS-CoV-2-positive and negative cases were positive and negative controls, respectively. ResultsOne Ugandan mother had high milk IgA reactivity against all HCoVs and SARS-CoV-2 spike proteins. Ugandan mothers had significantly higher IgA reactivity against the betacoronavirus HCoV-OC43 than United States mothers (P = 0.018). By contrast, United States mothers had significantly higher IgA reactivity against the alphacoronaviruses HCoV-229E and HCoV-NL63 than Ugandan mothers (P < 0.0001 and P = 0.035, respectively). ConclusionSome Ugandan mothers have pre-existing HCoV-induced IgA antibodies against SARS-CoV-2, which may be passed to infants via breastfeeding.

The prevalence and socio-behavioural and clinical covariates of oral health related quality of life in Ugandan mothers with and without HIV-1

BackgroundThere is limited evidence regarding oral health related quality of life of HIV positive populations in sub-Saharan Africa. Focusing HIV positive- and HIV negative Ugandan mothers, this study assessed the influence of HIV status on oral health related quality of life in terms of oral impacts on daily performances, whilst adjusting for clinical- and socio-behavioural factors. We also examined whether any association of clinical and socio-behavioural factors with oral impacts on daily performances vary according to mothers’ HIV status.MethodsThis cross-sectional study used data from a trial (n = 164) and a comparison group (n = 181). The trial comprised of mothers with HIV-1 participating in the ANRS 121741-PROMISE-PEP-trial (NCT00640263) conducted between 2009 and 2013 and from the ANRS 12341-PROMISE-PEP-M&S follow-up study conducted in 2017. The comparison group comprised of HIV negative mothers recruited in 2017. Interviews and clinical oral examinations were performed. The oral health related quality of life was assessed using the oral impacts on daily performances frequency scale. Caries experience and gingival bleeding were assessed using the World Health Organization’s Decayed, Missed and Filled teeth indices and community periodontal index. Logistic and negative binomial regression analyses were performed.Results29% of HIV-1 positive and 32% among the comparison reported any oral impact on daily performance. In adjusted logistic regression analysis, HIV status was not significantly associated with oral impacts on daily performances. Mother’s self-reported oral health, caries experience, gingival bleeding and oral health related quality of life of their children were independently associated with oral impacts on daily performances. Corresponding prevalence ratios and 95% confidence intervals were: 0.3 (0.2–0.6), 1.8 (1.0–3.2), 1.1 (1.0–1.1), and 2.1 (1.1–4.3). No significant interaction between HIV status and covariates were observed.ConclusionsOral health related quality of life was substantially impaired in Ugandan mothers but did not discriminate between HIV positive and negative participants. Mothers with impaired oral health related quality of life were more likely to have dental caries and children with impaired oral health related quality of life. HIV positive and negative mothers in Uganda deserve special attention regarding their oral disease and quality of life status.

Caries experience by socio-behavioural characteristics in HIV-1-infected and uninfected Ugandan mothers – a multilevel analysis

Objectives To assess caries experience in Ugandan mothers according to HIV status, socio-behavioural-characteristics, gingival bleeding status and to examine whether HIV status impacts the association of socio-behavioural characteristics with caries experience. Third, using multilevel analysis, this study assessed to what extent surface-specific caries experience varied between and within individuals. Materials and methods Caries experience was recorded using the World Health Organization’s Decayed, Missed and Filled Teeth/Surfaces indices from a cohort of 164 HIV-1-infected Ugandan mothers and a cross sectional comparison group of 181 negative controls. Mixed-effects logistic regression was conducted with surface-specific caries experience as the outcome variable. Results The prevalence of caries in HIV-1-infected and uninfected mothers was 81% and 71%, respectively. Significant associations occurred between caries experience at surface level and women’s increasing age (odds ratio [OR] = 1.8, 95% confidence interval [CI]: 1.1–2.8) and presence of gingival bleeding (OR = 2.0, 95% CI: 1.2–3.2). Intra-class correlation (ICC) coefficient amounted to 0.54 (95% CI 0.48‒0.59). Conclusions Caries prevalence was higher in HIV-1 infected than in uninfected mothers and increased with age and gingival bleeding. ICC indicated that 54% of the variance was attributable to variation between individuals. Socio-demographic differences in dental caries did not vary by HIV-1 status.

Comparative analysis of perinatal outcomes and birth defects amongst adolescent and older Ugandan mothers: evidence from a hospital-based surveillance database

BackgroundUganda has one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes between adolescents (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals.MethodsMaternal demographics, HIV status, and birth outcomes of all live births, stillbirths, and spontaneous abortions delivered from August 2015 to December 2018 were extracted from a hospital-based birth defects surveillance database. Differences in the distributions of maternal and infant characteristics by maternal age groups were tested with Pearson’s chi-square. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated using logistic regression to compare the prevalence of adverse birth outcomes among adolescents to mothers 20–34 years.ResultsA total of 100,189 births were analyzed, with 11.1% among adolescent mothers and 89.0% among older mothers. Adolescent mothers had an increased risk of preterm delivery (aOR: 1.14; CI 1.06–1.23), low birth weight (aOR: 1.46; CI 1.34–1.59), and early neonatal deaths (aOR: 1.58; CI 1.23–2.02). Newborns of adolescent mothers had an increased risk of major external birth defects (aOR: 1.33; CI 1.02–1.76), specifically, gastroschisis (aOR: 3.20; CI 1.12–9.13) compared to mothers 20–34 years. The difference between the prevalence of gastroschisis among adolescent mothers (7.3 per 10,000 births; 95% CI 3.7–14.3) was statistically significant when compared to mothers 20–34 years (1.6 per 10,000 births; 95% CI 0.9–2.6).ConclusionsThis study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years, similar to findings in the region and globally. Interventions are needed to improve birth outcomes in this vulnerable population.

Iron and Vitamin a Biomarkers in Mothers and Infants in Rural Uganda: Using the BRINDA Approach to Adjust for Inflammation (P10-108-19)

ObjectivesWe aimed to assess prevalence of iron and vitamin A deficiencies in Ugandan mothers and infants using the BRINDA (Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia) adjustment and to ascertain any differences by prevalence of malaria. MethodsFrom a prospective birth cohort (N = 5000) conducted in rural Uganda (2014–2016), samples from mothers (n = 1652, at birth) and infants (n = 695, 5–7 m/o) were analyzed for ferritin (FER), soluble transferrin receptor (sTFR), retinol binding protein (RBP), CRP, AGP, hemoglobin (Hb) and malaria. FER, sTFR and RBP were adjusted for inflammation using CRP and AGP. Depleted iron stores were defined as: FER <12 μg/L and <15 μg/L in children and mothers respectively; sTFR >8.3 mg/L for Fe-deficient erythropoiesis; RBP <1.05 μmol/L for vitamin A deficiency; and Hb <110 g/L for anemia. Prevalence estimates were stratified by malaria status. ResultsAdjustment for inflammation in mothers increased depleted iron stores (FER) from 7 to 12%, and decreased iron-deficient erythropoiesis (sTFR) from 27 to 22%. For children, adjustment increased depleted Fe stores from 17 to 40%, and iron-deficient erythropoiesis from 76 to 64%. Vitamin A deficiency in mothers was 9% and in infants decreased after adjustment (15% vs 4%). The prevalence of altitude adjusted anemia was 18% in mothers and 72% in infants. The prevalence of tissue iron deficiency (BIS <0 mg/kg) using adjusted sTFR and FER was 10% for mothers and 50% for infants compared to 8% and 34% using unadjusted markers respectively (Tables 1,2). Almost 14% of children (n = 75) were diagnosed with malaria. Malaria prevalence in mothers was low (5%), possibly due to the high (82%) prevalence of IPT prophylaxis reported during pregnancy. No significant differences were found in adjusted versus unadjusted estimates for Fe markers stratifying by malaria. ConclusionsFe deficiency adjusted estimates varied by biomarker and were not correlated with malaria in line with BRINDA recommendations. For mothers and children, the prevalence of Fe deficiency (sTFR) and anemia (Hb) were similar, suggesting that a big part of anemia in Uganda could be due to Fe deficiency as opposed to other micronutrients. Funding SourcesSupport provided by Feed the Future Innovation Lab for Nutrition, funded by the United States Agency for International Development (USAID). Supporting Tables, Images and/or Graphs▪▪

\u201cI beg you\u2026breastfeed the baby, things changed\u201d: infant feeding experiences among Ugandan mothers living with HIV in the context of evolving guidelines to prevent postnatal transmission

BackgroundFor women living with HIV (WLWH) in low- and middle-income countries, World Health Organization (WHO) infant feeding guidelines now recommend exclusive breastfeeding until six months followed by mixed feeding until 24 months, alongside lifelong maternal antiretroviral therapy (ART). These recommendations represent the sixth major revision to WHO infant feeding guidelines since 1992. We explored how WLWH in rural Uganda make infant feeding decisions in light of evolving recommendations.MethodsWe conducted semi-structured interviews with 20 postpartum Ugandan WLWH accessing ART, who reported pregnancy < 2 years prior to recruitment. Interviews were conducted between February–August 2014 with babies born between March 2012–October 2013, over which time, the regional HIV treatment clinic recommended lifelong ART for all pregnant and breastfeeding women (Option B+). Content analysis was used to identify major themes. Infant feeding experiences was an emergent theme. NVivo 10 software was used to organize analyses.ResultsAmong 20 women, median age was 33 years [IQR: 28–35], number of livebirths was 3 [IQR: 2–5], years on ART was 2.3 [IQR: 1.5–5.1], and 95% were virally suppressed. Data revealed that women valued opportunities to reduce postnatal transmission. However, women made infant feeding choices that differed from recommendations due to: (1) perception of conflicting recommendations regarding infant feeding; (2) fear of prolonged infant HIV exposure through breastfeeding; and (3) social and structural constraints shaping infant feeding decision-making.ConclusionsWLWH face layered challenges navigating evolving infant feeding recommendations. Further research is needed to examine guidance and decision-making on infant feeding choices to improve postpartum experiences and outcomes. Improved communication about changes to recommendations is needed for WLWH, their partners, community members, and healthcare providers.

Influence of maternal pelvis height and other anthropometric measurements on the duration of normal childbirth in Ugandan mothers

In low resource settings, maternal anthropometry may complicate time based monitoring of childbirth. We set out to determine the effect of maternal anthropometry and foetal birth weight on the duration of childbirth. Birth related secondary data from 987 mothers with pregnancies of ≥ 37 weeks, singleton baby and a normal childbirth were obtained. This data was analysed for regression coefficients and Interclass correlations coefficients (ICCs). The mean duration of childbirth was 7.63hours. Each centimetre increase in maternal pelvis height led to a 0.56hours increase for the first stage (P&lt;0.01), 0.05hours reduction for second stage (P&lt;0.01), and 0.46hours increase in total duration of childbirth (p&lt;0.01). For each centimeter increase in maternal height there was a 0.04hours reduction in the first stage (P=0.01) and a 0.005hours increase in second stage (P=0.03). The ICCs with respect to geographical site were 0.40 for stage 1, 0.27 for stage 2 and 0.21 for stage 3. Additional modeling with tribe of mother did not change the ICCs. Maternal pelvis height and maternal height were found to have a significant effect on the duration of the different stages of normal childbirth. Additional study is needed into the public health value of the above measurements in relation to childbirth in these settings.Key words: Humans; anthropometry; childbirth; pelvis height;

Understanding the meaning and role of gifts given to Ugandan mothers in maternity care settings: 'The help they give when they've seen how different you are'.

The provision of gifts to new mothers in Uganda is laden with significance that varies by the social location of the giver and receiver and the context and conditions under which the gift is made available. Here, we examine the act of gift giving and receiving within a Ugandan maternity care setting, describing the connections between these material objects and social relations. A study investigating the social organisation of maternity care in post-conflict northern Uganda found that gift-giving to new mothers functioned to create a material and discursive context wherein women's desire to access these goods was leveraged to create an incentive to attend formal maternity care during pregnancy and for delivery. In this article we describe the material and discursive processes surrounding gift-giving to new mothers in this global South health care setting. This article contributes critical analyses of the function of gifts in healthcare settings as constructing shared identities, social differences and normative values about health citizenship, and an incentive politic that affects equitable access to maternity care. Drawing on intersectional theory and analysis of how specific practices function ideologically to reward or incentivise pregnant women, we integrate material culture studies into the sociology of women's reproductive health.

Association between Maternal Pelvis Height and Intrapartum Foetal Head Moulding in Ugandan Mothers with Spontaneous Vertex Deliveries.

Introduction. In Sub-Saharan Africa, excessive foetal head moulding is commonly associated with cephalopelvic disproportion and obstructed labour. This study set out to determine the associations of maternal pelvis height and maternal height with intrapartum foetal head moulding. Methods. This was a multisite secondary analysis of maternal birth records of mothers with singleton pregnancies ending in a spontaneous vertex delivery. A summary of the details of the pregnancy and delivery records were reviewed and analysed using multilevel logistic regression respect to foetal head moulding. The alpha level was set at P < 0.05. Results. 412 records were obtained, of which 108/385 (28%) observed foetal head moulding. There was a significant reduction in risk of foetal head moulding with increasing maternal height (Adj. IRR 0.97, P = 0.05), maternal pelvis height (Adj. IRR 0.88, P < 0.01), and raptured membranes (Adj. IRR 0.10, P < 0.01). There was a significant increased risk of foetal head moulding with increasing birth weight (Adj. IRR 1.90, P < 0.01) and duration of monitored active labour (Adj. IRR 1.21, P < 0.01) in the final model. Conclusion. This study showed that increasing maternal height and maternal pelvis height were associated with a significant reduction in intrapartum foetal head moulding.

Relationship between maternal pelvis height and other anthropometric measurements in a multisite cohort of Ugandan mothers.

IntroductionIn sub Saharan Africa, childbirth remains a challenge that creates the need for additional screening tools. Maternal pelvis height, which is currently in use by automotive engineers has previously been shown to have significant associations with various childbirth related outcomes and events. This study set out to determine the associations between maternal: Age, height, weight and number of pregnancies with maternal pelvis height in Ugandan mothers.MethodsThis was a secondary analysis of maternal birth records from nine Ugandan hospitals, of mothers with singleton pregnancies. Data was analyzed using multilevel regression with respect to maternal pelvis height and additional analysis for tribe and site of childbirth intraclass correlations (ICCs).ResultsThe mean maternal pelvis height was 7.30cm for the 2068 records. Maternal pelvis height was associated with: a 0.01cm reduction per centimeter of maternal height (P=0.02), 0.01cm increase per kg of maternal weight (P<0.01), 0.04cm increase for each additional pregnancy (P=0.03) and 0.03cm increase with respect to tribe of mother (P=0.27), for a constant of 7.97cm (P<0.01). The ICC for tribe was 0.20 (SE=0.08) and 0.37 (SE=0.11) for site.ConclusionMaternal pelvis height was associated with maternal height, maternal weight and number of pregnancies. The site of childbirth had a moderate effect on the above associations with maternal pelvis height. More study on the public health screening value of these measurements in these settings is required.

A cross sectional study evaluating screening using maternal anthropometric measurements for outcomes of childbirth in Ugandan mothers at term.

BackgroundBirth related newborn and maternal mortality/morbidity remains high in most of sub-Saharan Africa compared to the rest of the world. In this low income region there is a need for valid, low cost, easy to use mass screening tests. This study looked at the screening value of maternal: height, weight and pelvis height, for assessing the outcomes of parturition in Ugandan mothers at term.MethodsThis was a multi site cross-sectional study on mothers with singleton pregnancies in labour at various hospitals in different parts of Uganda. A summary of the details of the pregnancy, maternal height, weight and the delivery record were captured and analysed to generate descriptive and inferential (multilevel logistic regression analysis) and diagnostic (Receiver Operator Curve analysis) statistics.ResultsWe recruited 1146 mothers from all the study sites during the study period of whom 987 (86.13%) had normal deliveries and healthy babies. Mothers with adverse outcomes included 107 mothers that had caesarean section and 52 mothers who had vaginal deliveries with foetal Apgar score of ≤7 at 5 min of whom 11 had fresh still births. Maternal height (Adj OR 0.97, 95% CI 0.94–1.00) and maternal pelvis height (Adj OR 0.73, 95% CI 0.61–0.86) were significantly associated with adverse pregnancy outcomes. The combination of maternal: height (<150 cm), weight (>55.7 kg) and pelvis height (>8.95 cm) had the best diagnostic value with a combined area under the curve of 0.60.ConclusionsIt was observed that an increase in either maternal pelvis height or maternal height was associated with a significant reduction in adverse pregnancy outcomes. The cut off values of all three evaluated maternal anthropometric measurements were of low test accuracy as screening tests even when used together. Further research is needed to develop low cost screening tools for use in low income settings.

Association between malaria exposure and Kaposi's sarcoma-associated herpes virus seropositivity in Uganda.

ObjectiveUnlike other herpes viruses, Kaposi's sarcoma-associated herpes virus (KSHV) is not ubiquitous worldwide and is most prevalent in sub-Saharan Africa. The reasons for this are unclear. As part of a wider investigation of factors that facilitate transmission in Uganda, a high prevalence country, we examined the association between antimalaria antibodies and seropositivity against KSHV.MethodsAntibodies against P. falciparum merozoite surface protein (PfMSP)-1, P. falciparum apical membrane antigen (PfAMA)-1 and KSHV antigens (ORF73 and K8.1) were measured in samples from 1164 mothers and 1227 children.ResultsKaposi's sarcoma-associated herpes virus seroprevalence was 69% among mothers and 15% children. Among mothers, KSHV seroprevalence increased with malaria antibody titres: from 60% to 82% and from 54% to 77%, comparing those with the lowest and highest titres for PfMSP-1 and PfAMA-1, respectively (P < 0.0001). Among children, only antibodies to PfAMA-1 were significantly associated with KSHV seropositivity, (P < 0.0001). In both mothers and children, anti-ORF73 antibodies were more strongly associated with malaria antibodies than anti-K8.1 antibodies.ConclusionThe association between malaria exposure and KSHV seropositivity suggests that malaria is a cofactor for KSHV infection or reactivation.

Using survival analysis to determine association between maternal pelvis height and antenatal fetal head descent in ugandan mothers

IntroductionFetal head descent is used to demonstrate the maternal pelvis capacity to accommodate the fetal head. This is especially important in low resource settings that have high rates of childbirth related maternal deaths and morbidity. This study looked at maternal height and an additional measure, maternal pelvis height, from automotive engineering. The objective of the study was to determine the associations between maternal: height and pelvis height with the rate of fetal head descent in expectant Ugandan mothers.MethodsThis was a cross sectional study on 1265 singleton mothers attending antenatal clinics at five hospitals in various parts of Uganda. In addition to the routine antenatal examination, each mother had their pelvis height recorded following informed consent. Survival analysis was done using STATA 12.ResultsIt was found that 27% of mothers had fetal head descent with an incident rate of 0.028 per week after the 25th week of pregnancy. Significant associations were observed between the rate of fetal head descent with: maternal height (Adj Haz ratio 0.93 P < 0.01) and maternal pelvis height (Adj Haz ratio 1.15 P < 0.01).ConclusionThe significant associations observed between maternal: height and pelvis height with rate of fetal head descent, demonstrate a need for further study of maternal pelvis height as an additional decision support tool for screening mothers in low resource settings.

Hair and plasma data show that lopinavir, ritonavir, and efavirenz all transfer from mother to infant in utero, but only efavirenz transfers via breastfeeding.

As efforts intensify to eliminate perinatal HIV transmission, understanding kinetics of maternal-to-child transfer of antiretrovirals during pregnancy and breastfeeding is critical. Antiretroviral levels in plasma, cord blood, and breastmilk reflect exposure over short intervals. Hair concentrations reflect cumulative exposure and can uniquely quantify in utero transfer of maternal medications to infants. We measured plasma and hair antiretroviral levels in HIV-infected Ugandan mothers and their infants at delivery and during breastfeeding to assess transfer. HIV-infected pregnant women were randomized to lopinavir/ritonavir- or efavirenz-based therapy in a larger trial (the Prevention of Malaria and HIV disease in Tororo, PROMOTE). At 0, 8, and 12 weeks postpartum, plasma antiretroviral levels were measured in 117 mother-infant pairs; hair levels were assayed at 12 weeks. Ratios and correlations of infant:maternal concentrations were calculated. By 12 weeks, 90.4% of mothers reported exclusive breastfeeding. Hair and plasma levels over time suggest moderate (47%) to extensive (87%) in utero transfer of lopinavir and ritonavir, respectively, but negligible transfer of either via breastfeeding. Moderate transfer of efavirenz occurs during pregnancy and breastfeeding (40% cumulative; 15% during breastfeeding). Despite differences in exposure, no infant seroconversions or correlations between infant hair/plasma antiretroviral levels and adverse effects were observed. Using a unique approach combining hair and plasma data, we found that different antiretrovirals have distinct kinetics of mother-to-infant transfer. Efavirenz transfers during both pregnancy and breastfeeding, whereas lopinavir and ritonavir transfer only in utero. Further study of the degree and timing of maternal-to-child transfer by antiretroviral will help optimize strategies that protect infants and minimize toxicities during periods of risk.

The Impact of HIV on Maternal Morbidity in the Pre-HAART Era in Uganda

Objective. To compare maternal morbidity in HIV-infected and uninfected pregnant women. Methods. Major maternal morbidity (severe febrile illness, illnesses requiring hospital admissions, surgical revisions, or illnesses resulting in death) was measured prospectively in a cohort of HIV-infected and uninfected women followed from 36 weeks of pregnancy to 6 weeks after delivery. Odds ratios of major morbidity and associated factors were examined using logistic regression. Results. Major morbidity was observed in 46/129 (36%) and 104/390 (27%) of the HIV-infected and HIV-uninfected women, respectively, who remained in followup. In the multivariable analysis, major morbidity was independently associated with HIV infection, adjusted odds ratio (AOR) 1.7 (1.1 to 2.7), nulliparity (AOR 2.0 (1.3 to 3.0)), and lack of, or minimal, formal education (AOR 2.1 (1.1 to 3.8)). Conclusions. HIV was associated with a 70% increase in the odds of major maternal morbidity in these Ugandan mothers.

Sensitive Oligonucleotide Ligation Assay for Low-Level Detection of Nevirapine Resistance Mutations in Human Immunodeficiency Virus Type 1 Quasispecies

This study has adapted the oligonucleotide ligation assay (OLA) to probe for low-level nevirapine (NVP) resistance mutations K103N and Y181C in the human immunodeficiency virus type 1 (HIV-1) population of infected mother-infant pairs from Uganda. When NVP is used to prevent perinatal transmission, NVP-resistant HIV-1 clones may be rapidly selected due to a low barrier for mutation and a relatively high level of fitness (compared to that of other drug-resistant HIV-1 clones). Monitoring for even a low frequency of NVP resistance mutations may help predict the success of subsequent treatment or warrant the use of another regimen to prevent transmission in a subsequent pregnancy. The standard OLA was optimized by using nonstandard bases in oligonucleotides to allow promiscuous base pairing and accommodate significant HIV-1 heterogeneity. Radiolabeled as opposed to fluorescently tagged oligonucleotides increased the sensitivity, whereas alteration of the template, oligonucleotides, salt, and thermostable DNA ligase concentrations increased the specificity for the detection of minority codons. This modified OLA is now capable of detecting mutants with the K103N or the Y181C mutation present in an HIV-1 population at a frequency of approximately 0.4% and is at least 10- to 30-fold more sensitive than the original protocol. A cohort of 19 Ugandan mothers who received NVP treatment perinatally were sampled 6 weeks postdelivery. Ten of 19 HIV-1 DNA samples extracted from peripheral blood mononuclear cells had a detectable K103N (0.5 to 44%) or Y181C (0.8 to 92.5%) mutation, but only one plasma HIV-1 RNA sample had a viral population with the Y181C mutation. These findings suggest that OLA is a robust, sensitive, and specific method for the detection of low-frequency drug resistance mutations in an intrapatient HIV-1 population.

Immediate maternal thermal response to skin‐to‐skin care of newborn

To elucidate the immediate maternal thermal skin response when placing the neonate on the mothers' chest, skin-to-skin (STS). Ugandan mothers with non-asphyxiated newborns after vaginal delivery (n = 39) were studied. Maternal skin and axillary temperatures were measured immediately before STS contact, then every 2 min for 20 min and finally 10 min after removing the neonate. Neonatal axillary/forehead temperatures were measured immediately before STS contact, and twice after initiating STS, followed by a measurement 10 min after the newborn had been removed. A rapid thermal response was demonstrated in maternal breast skin immediately after STS contact. It rose by 0.5 degrees C (p < 0.0001) on average the first 2 min after STS contact and fell by 0.5 degrees C 10 min after we had removed the neonate (p < 0.0001). Maternal axillary temperature also rose 2 min after initiation of STS (p < 0.0001) but stayed constant 10 min after removal of the newborn from the STS position. The findings indicate that there is a rapid maternal, thermal response to the positioning of the newborn STS. The tactile contact may elicit a maternal adaptation enhancing the warming of the newborn. Possible mechanisms include maternal autonomic nerve-mediated skin vasodilatation.