BACKGROUND
Since 2016, the World Health Organization (WHO) has recommended a minimum of eight antenatal care (ANC) contacts during pregnancy, replacing the previous recommendation of four focused ANC visits. In Mali and Burkina Faso, the four ANC visits are still recommended and their coverage remains low or insufficient. To anticipate possible obstacles to the implementation of the new recommendations, this study aimed to identify the individual determinants of ANC attendance in two study districts, with a representative sample of women recruited from the community.
METHODS
Data were collected in June 2022 through a three-stage household survey with a representative sample of women who delivered in the previous 12 months in the health districts of Kangaba (Mali) and Boussé (Burkina Faso). Country-specific analyses were performed using self-reported data. Women’s sociodemographic and clinical characteristics, as well as attitudes towards ANC attendance, were described to account for clustering. Multivariable logistic regression models using generalized estimating equations were used to identify the determinants of four or more ANC uptakes. A p-value < 0.05 was considered statistically significant in the adjusted model.
RESULTS
Overall, 1590 women participated (780 in Mali; 810 in Burkina Faso) in the study. Women in Burkina Faso were older and less educated than women in Mali. The proportions of women with at least four ANC visits were 80% and 54%, and that of ANC in the first trimester was 38.7% and 43.8% in Burkina Faso and Mali respectively. Factors significantly associated with a greater probability of women attending ANC4 + visits were found only in Mali: a history of stillbirth and time spent at ANC. Factors reducing the use of ANC4 + were the lack of transportation/distance in Burkina Faso, travel time of less than 1 h to reach the maternity clinic, women’s nonrecognition of the importance of ANC visits, and the perceived high cost of the ANC visit in both countries.
CONCLUSION
ANC was lower in Mali than in Burkina Faso. Health policies aimed at achieving the WHO recommendation of 8 ANC contacts should prioritize health information and sensitization of pregnant women to improve their knowledge of the importance of attending ANC several times.
TRIAL REGISTRATION
Retrospectively registered on August 11th, 2022 registration # PACTR202208844472053. Protocol v4.0 dated September 04, 2023.
Insulin-like growth factor 1 (IGF-1) is an important growth factor in childhood. We aimed to investigate the impact of food supplements for the treatment of moderate acute malnutrition (MAM) on serum IGF-1 (sIGF-1). Secondary analysis of a randomised 2 × 2 × 3 factorial nutrition trial was performed. Children aged 6–23 months with MAM received 2093 kJ/d as lipid-based nutrient supplement (LNS) or corn soy blend (CSB), containing either dehulled soya or soya isolate and different quantities of dried skimmed milk (0 %, 20 % or 50 % of total protein) for 12 weeks. The trial was double-blind with regard to soya and milk but not to matrix (LNS v. CSB). sIGF-1 was measured at inclusion and after 12 weeks of supplementation. Of 1609 children enrolled, 1455 (90 %) had sIGF-1 measured at both time points. During supplementation, sIGF-1 increased 6·7 (95 % CI 6·1, 7·3) ng/ml compared with an expected age-dependent decrease of 0·3 (95 % CI 0·2, 0·4) ng/ml. Children who received LNS v. CSB had a lower increase in sIGF-1 (–8 %, 95 % CI − 12, −3). The effect of LNS was partly attenuated when sIGF-1 was corrected for inflammation. Children who received soya isolate compared with dehulled soya had a higher increase in sIGF-1 (6 %, 95 % CI 1, 12). Milk content did not affect sIGF-1. Overall, sIGF-1 increased during supplementation. The lower increase with LNS v. CSB was only partly explained by increased inflammation with LNS and needs further investigation. Isolate v. dehulled soya led to a higher increase which may be due to antinutrients in dehulled soya.
Insulin-like growth factor 1 (IGF-1) is an important growth factor in childhood. We aimed to investigate the impact of food supplements for treatment of moderate acute malnutrition (MAM) on serum IGF-1 (sIGF-1). Secondary analysis of a randomized 2×2×3 factorial nutrition trial was performed. Children aged 6-23 months with MAM received 2093 kJ/day as lipid-based nutrient supplement (LNS) or corn-soy blend (CSB), containing either dehulled soy or soy isolate and different quantities of dried skimmed milk (0%, 20% or 50% of total protein) for 12 weeks. The trial was double-blind with regard to soy and milk, but not to matrix (LNS vs. CSB). sIGF-1 was measured at inclusion and after 12 weeks supplementation. Of 1609 children enrolled, 1455 (90%) had sIGF-1 measured at both time points. During supplementation sIGF-1 increased 6.7 (95%CI 6.1; 7.3) ng/ml compared with an expected age-dependent decrease of 0.3 (95%CI 0.2; 0.4) ng/ml. Children who received LNS vs. CSB had lower increase in sIGF-1 (-8%, 95%CI -12; -3). The effect of LNS was partly attenuated when sIGF-1 was corrected for inflammation. Children who received soy isolate compared with dehulled soy had higher increase in sIGF-1 (6%, 95%CI 1; 12). Milk content did not affect sIGF-1. Overall, sIGF-1 increased during supplementation. The lower increase with LNS vs. CSB was only partly explained by increased inflammation with LNS, and needs further investigation. Isolate vs. dehulled soy led to a higher increase which may be due to antinutrients in dehulled soy.
The burden of antimicrobial resistance (AMR) has been estimated to be the highest in sub-Saharan Africa (SSA). The current study estimated the proportion of drug-resistant Enterobacterales causing infections in SSA children.
METHODS
We searched MEDLINE/PubMed, Embase and the Cochrane Library to identify retrospective and prospective studies published from 01/01/2005 to 01/06/2022 reporting AMR of Enterobacterales causing infections in sub-Saharan children (0-18 years old). Studies were excluded if they had unclear documentation of antimicrobial susceptibility testing methods or fewer than ten observations per bacteria. Data extraction and quality appraisal were conducted by two authors independently. The primary outcome was the proportion of Enterobacterales resistant to antibiotics commonly used in paediatrics. Proportions were combined across studies using mixed-effects logistic regression models per bacteria and per antibiotic. Between-study heterogeneity was assessed using the I2 statistic. The protocol was registered with PROSPERO (CRD42021260157).
FINDINGS
After screening 1111 records, 122 relevant studies were included, providing data on more than 30,000 blood, urine and stool isolates. Escherichia coli and Klebsiella spp. were the predominant species, both presenting high proportions of resistance to third-generation cephalosporins, especially in blood cultures: 40.6% (95% CI: 27.7%-55%; I2: 85.7%, number of isolates (n): 1032) and 84.9% (72.8%-92.2%; I2: 94.1%, n: 2067), respectively. High proportions of resistance to other commonly used antibiotics were also observed. E. coli had high proportions of resistance, especially for ampicillin (92.5%; 95% CI: 76.4%-97.9%; I2: 89.8%, n: 888) and gentamicin (42.7%; 95% CI: 30%-56.5%; I2: 71.9%, n: 968). Gentamicin-resistant Klebsiella spp. were also frequently reported (77.6%; 95% CI: 65.5%-86.3%; I2: 91.6%, n: 1886).
INTERPRETATION
High proportions of resistance to antibiotics commonly used for empirical treatment of infectious syndromes were found for Enterobacterales in sub-Saharan children. There is a critical need to better identify local patterns of AMR to inform and update clinical guidelines for better treatment outcomes.
Efforts to control the COVID-19 pandemic have potentially compromised the availability and/or quality of HIV services. We aimed to assess the pandemic’s impact on ART initiation and HIV viral load (VL) monitoring in three West African countries.
METHODS
We used routinely collected data from five clinics contributing to the IeDEA collaboration in Burkina Faso, Côte d'Ivoire and Nigeria. We included ART-naïve adults living with HIV (ALWH) initiating ART from 01/01/2018. We conducted regression discontinuity analysis to estimate changes in the number of ART initiations and VL measures per week, before and during the pandemic period in each country.
RESULTS
In clinics in Burkina Faso and Côte d’Ivoire, ART initiations per week remained constant throughout the studied periods (-0.24 points (p) of ART initiations/week 95%CI -5.5, 5.9, -0.9 p 95%CI -8.5,8.6, respectively), whereas in Nigeria’s clinic, they decreased significantly (-6.3 p, 95% CI -10.8, -1.7) after the beginning of the pandemic. The volume of VL tests performed decreased significantly in all three countries (-17.0 p 95%CI -25.3, -8.6 in Burkina Faso, -118.4 p 95%CI -171.1, -65.8 in Côte d’Ivoire and -169.1p 95%CI-282.6, -55.6 in Nigeria).
CONCLUSIONS
Access to ART was maintained for newly diagnosed ALWH despite pandemic-related physical/social distancing measures. However, VL monitoring was severely disrupted and did not return to pre-pandemic levels approximately one year after the beginning of the pandemic. While HIV services in West Africa appear rather resilient, the impact of disruptions in VL monitoring on virological and clinical outcomes should continue to be monitored.