Dyspnée récidivante révélatrice d'un syndrome de Kartagener: à propos d'un cas / Recurrent dyspnea revealing a Kartagener Syndrome: About one case

La triade bronchectasies, sinusites et situs inversus caractérisent le syndrome de Kartagener. Sa transmission est autosomique récessive. Le cas de cette jeune fille de 19 ans que nous rapportons permet de déterminer la place de l'imagerie dans la démarche diagnostique de cette pathologie. La patiente présentait un syndrome clinique respiratoire récidivant depuis sa naissance. Le diagnostic a été posé par l'examen scannographique. L'évolution de la maladie dépend de la précocité du diagnostic.

Early detection and risk factors of congenital hip dislocation in Morocco

Background and Objective: Congenital dislocation of the hip is a malformation of the lower limbs that could be complicated by a disabling physical handicap with long-term psychological and social repercussions if detected late. This study aims to describe the screening for congenital hip dislocation and to investigate the association between the occurrence of this anomaly and possible risk factors in Morocco. Methods: The study was based on the exploitation of the records of children treated at the trauma and orthopedics department of the Mohammed VI University Hospital in Marrakech, Morocco. It concerned 160 cases with a 5-year follow-up from January 2016 to March 2021. Results: The results of the study showed that 56.7% of the affected children had a bilateral dislocation and 25.8% of the cases had a left-sided dislocation. The malformation occurred more frequently in females 69.2%. A familial disposition to the malformation was found in about 22% of the cases. The diagnosis was late (at walking age) in 61% of children following the onset of lameness with or without pain in 91% of children. In 41.87% of the hips, the reduction was surgical, with 28% failure dominated by acetabular dysplasia in 11%. Conclusion: The risk factors for congenital hip dislocation identified in our setting were dominated by sex, primiparity, consanguineous marriage, and the presence of a family history of dislocation. Communication of risk factors specific to our setting to healthcare personnel will allow them to guide the diagnosis and increase vigilance in the at-risk population for management that prevents the development of complications.

Delays in HIV-1 infant polymerase chain reaction testing may leave children without confirmed diagnoses in the Western Cape province, South Africa

Background: Early diagnosis and confirmation of HIV infection in newborns is crucial for expedited initiation of antiretroviral therapy. Confirmatory testing must be done for all children with a reactive HIV PCR result. There is no comprehensive data on confirmatory testing and HIV PCR test request rejections at National Health Laboratory Service laboratories in South Africa.Objective: This study assessed the metrics of routine infant HIV PCR testing at the Tygerberg Hospital Virology Laboratory, Cape Town, Western Cape, South Africa, including the proportion of rejected test requests, turn-around time (TAT), and rate of confirmatory testing.Methods: We retrospectively reviewed laboratory-based data on all HIV PCR tests performed on children ≤ 24 months old (n = 43346) and data on rejected HIV PCR requests (n = 1479) at the Tygerberg virology laboratory over two years (2017­2019). Data from sample collection to release of results were analysed to assess the TAT and follow-up patterns.Results: The proportion of rejected HIV PCR requests was 3.3%; 83.9% of these were rejected for various pre-analytical reasons. Most of the test results (89.2%) met the required 96-h TAT. Of the reactive initial test results, 53.5% had a follow-up sample tested, of which 93.1% were positive. Of the initial indeterminate results, 74.7% were negative on follow-up testing.Conclusion: A high proportion of HIV PCR requests were rejected for pre-analytical reasons. The high number of initial reactive tests without evidence of follow-up suggests that a shorter TAT is required to allow confirmatory testing before children are discharged.

Early detection of acute renal lesions by serum cystatin C in children at hospital and university Centre of Brazzaville

Acute Kidney Injury (AKI) is considered one of the main public health problems. The effective management of these alterations is based on the early detection of renal lesions. The objective of this study was to evaluate the contribution of the Cystatin C (CysC) assay in the early diagnosis of acute kidney injury (AKI) in children hospitalized in pediatric intensive care units in Brazzaville. MATERIALS AND METHODS Sixty children at high risk of developing AKI were included. Consent form signed was obtained from parents, socio-demographic data, weight and height of children recorded. Creatinine (Cr), CysC and urea were assayed in serum 24 hours after admission. Glomerular filtration clearance was estimated using serum creatinine and CysC. Glomerular filtration rate (GFR) was calculated from CysC and Cr. The diagnostic accuracy was determined by comparing the results of CysC to those of Cr (considered as a reference biomarker). RESULTS The median age was 5 years (with extremes ranging from 1 month to 17 years). Cr, CysC, urea, and GFR/Cr (mean ± standard deviation [range]) were 0.94±1.17 (0.2­ 1.4 mg/dl), 0.14 ± 0.062 (0.053-0.095 mg/l), 46.65±47.75 (15.0­45.0 mg/dl), 81.85±31.90 (≥190 ml/min per 1.73 m2 , respectively. The level of CysC in patients with ARL was significantly higher than that of children with normal renal function (p<0.001). Our results show that the performance of serum CysC in detecting AKI early was superior to that of serum Cr in children hospitalized in pediatric intensive care units in Brazzaville

Early removal of etonogestrel subcutaneous contraceptive implant at a community health centre in Pretoria

The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01January 2020 to 30 June 2020.Methods: A cross-sectional study using a piloted and researcher assistant-administered questionnaire.Results: Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30­39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12­23 months. From participants' responses, it seems that Etonogestrel implants may be offered from as early as 15­20 years of age. Conclusion: Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.Keywords: early removal; etonogestrel; subcutaneous contraceptive; implant; Pretoria; community health centre; weight gain; vaginal bleeding.

Validation of the COVID-19 IgG/IgM Rapid Test Cassette (BNCP ­ 402 and BNCP402) in a South African setting

Background: Different diagnostic tools could improve early detection of coronavirus disease 2019 (COVID-19). A number of antibody-based serological point-of-care tests have been developed to supplement real-time reverse transcriptase polymerase chain reaction (RT-PCR)-based diagnosis. This study describes the validity of an antibody test, namely the immunoglobulin G (IgG)/immunoglobulin M (IgM) Rapid Test Cassette® (BNCP ­ 402 and BNCP402), manufactured by Spring Healthcare Services. Methods: A prospective cohort validation study was undertaken at Chris Hani Baragwanath Academic Hospital between 16 July 2020 and 12 August 2020. A total of 101 patients admitte as COVID-19 cases under investigation were included in the study. They were divided into two categories depending on time since symptom onset: testing performed within seven days (early cohort) and after seven days (late cohort). The rapid antibody test was compared to the RT-PCR. Results: Overall, the test has a sensitivity and specificity of 85.2% and 80.0%, respectively, for a combination of IgG and IgM. Sensitivity and specificity of IgG testing alone were 81.5% and 85%. Sensitivity improved for testing with increasing time from symptom onset; however, specifity was not significantly different. Conclusion: The study data adds to the body of evidence that because of relatively low sensitivity and specificity, there is a limited role for antibody-based point-of-care testing in the acute phase of COVID-19 infection, as was the case with this IgG/IgM Rapid Test Cassette (BNCP ­ 402 and BNCP402). There may exist a role for such testing in patients recovered from prior COVID-19 infection or in seroprevalence studies; however, additional evaluations at later timepoints from symptom onset are required.

Reversal in infant mortality in Kenya based on type of place of residence

Context: In the recent past, infant mortality has declined more rapidly in rural Kenya than urban Kenya. This paper sought to ascertain the factors responsible for the observed reversal in infant mortality in Kenya based on type of place of residence, defined as either urban or rural. Data source and methods: The study used data obtained from 2014 Kenya demographic and health survey. Survival analysis was employed on child-recoded data set to estimate the riskofa neonate, post-neonate or an infant dying in urban or rural areas based on selected study variables. Results: The study found early childhood mortalities to be significantly related to educational qualification of the mother, household wealth index, maternal age, size at birth, and place of delivery in both urban and rural Kenya. In urban Kenya, the study further found early childhood mortalities to be significantly related sex of the birth and the preceding birth interval. Conclusion: The study suggests the need to check on lifestyle especially among the urbanites and to delay entry into childbearing as some of the measures to make infant mortality reduction mission a success

Burning issues in blood pressure control

Globally more than 1 billion people have hypertension and it is predicted that because of ageing populations and increasing sedentary lifestyles, this figure will rise to about 1.5 billion by 2025. Elevated blood pressure (BP) is the leading cause of premature death and morbidity due to stroke and ischemic heart disease. Hypertension is also a major risk factor for heart failure, atrial fibrillation, chronic kidney disease, peripheral arterial disease and cognitive decline. This article discusses the current evidencebased treatment guidelines and pressing temporal issues in optimal blood pressure control

Predictors of time to sputum culture conversion in multi-drug-resistant tuberculosis and extensively drug-resistant tuberculosis in patients at Tshepong-Klerksdorp Hospital

Setting: Klerksdorp-Tshepong Hospital Complex MDR-TB Unit, North-West Province, South Africa.Background: To determine the time to sputum culture conversion (TTSCC) and factors predictive of TTSCC in patients with multi-drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in the North-West Province.Methods: A retrospective cohort study, abstracting patient demographic and clinical data, laboratory results, dates of sputum testing and sputum culture conversion results, from medical records of 526 MDR-TB and 47 XDR-TB patients started on TB treatment between 01 January 2012 and 31 December 2014. Predictors of TTSCC were determined by Cox proportional hazards regression.Results: The median age was 38 years (interquartile range 31­47) with 64% being male. Overall, 79% (449) were Human Immunodeficiency Virus (HIV)-infected. The median TTSCC was 56.5 days and 162.5 days for MDR-TB and XDR-TB patients, respectively. In the multivariate analysis, age [hazard ratio (HR): 0.89, 95% confidence interval (CI): 0.96­0.99], being underweight (HR: 0.631.61, 95% CI: 0.451.03­0.882.51), Acid Fast Bacilli (AFB) positivity (HR: 0.72, 95% CI: 0.51­1.01) and having XDR-TB (HR: 0.36. 95% CI: 0.19­0.69) were predictive of longer TTSCC.Conclusion: Predictors of TTSC allow for MDR-TB- and XDR-TB-diagnosed patients to be identified early for effective management. Those with risk factors for delayed sputum culture conversion which are being underweight and having XDR-TB should be monitored carefully during treatment so that they can achieve sputum culture conversion early

One-stop haematuria clinic: first experience in South Africa

Background. Haematuria is the most common symptom of urological cancers, specifically bladder cancer, and timely diagnosis can prevent disease from progressing to a more advanced or incurable stage. One-stop haematuria clinics (OSHCs) have become commonplace in urological services in developed countries during the past three decades.Objectives. To assess the efficacy of this specialised clinic, aimed at providing an investigative service for patients with haematuria, in decreasing morbidity and mortality by earlier diagnosis of urological malignancy. We also report on the outcomes of this study.Methods. A total of 275 patients who attended the weekly OSHC at Groote Schuur Hospital, Cape Town, South Africa (SA), between January 2012 and October 2015 were retrospectively included in the study (out of 477 folders reviewed). Only patients with visible haematuria (275/477) were included, and characteristics such as gender, age, self-identified ethnicity, and outcomes following OSHC attendance (diagnoses and stage/grade/type of cancers) were recorded.Results. While the majority of cases were classified as indeterminate following investigation, one-fifth (55/275) of the patients were diagnosed with urological neoplasms, mainly bladder cancer (87.2%, n=48). The 50 - 69-year age group was the most common window for diagnosis of a neoplasm. Forty-six patients (46/55) with urothelial cancers were diagnosed at a relatively early stage and were therefore offered curative management; 5 patients presented with late-stage disease and risked poor outcomes after management. The remaining 4 identified cases were adenocarcinomas and squamous cell carcinomas. Most patients presented with high-grade cancers (43.2%). A small subset of patients were diagnosed with renal cell carcinoma (11.6%) and upper-tract transitional cell carcinoma (1.6%).Conclusions. This audit revealed that an OSHC can streamline diagnosis of urological malignancies in the SA setting, and highlights the fact that the patients most at risk for developing malignant conditions were the ones frequently diagnosed at a later stage and hence potentially facing a poorer prognosis. These findings support the setting up of such clinics in other SA hospitals to improve ease of early access to the urological service

HIV testing at birth: Are we getting it right?

Background: Birth polymerase chain reaction (PCR) testing improves early detection of HIV and allows for early treatment initiation. National guidelines exist, but it is unknown whether these are being implemented correctly.Objectives: To determine whether HIV-exposed infants at the Mangaung University Community Partnership Programme Community Health Centre (MUCPP CHC) received PCR tests at birth, if HIV-positive infants were initiated on treatment, if follow-up dates were scheduled and the percentage of mothers or caregivers who returned to collect the results.Methods: The study was a retrospective descriptive file audit (1304 files) of births from 01 January to 31 December 2016 at MUCPP CHC. The study sample was 428 infants born to HIV-positive mothers. The birth register was used to collect the infants' HIV PCR test barcodes. The birth and 10-week PCR results were retrieved from an electronic database at the Virology Department, University of the Free State.Results: In total, 375 infants received a birth PCR test (87.6%) of which 4 (1.1%) tested HIV positive and 327 (87.2%) negative. Follow-up tests were not scheduled. However, 145 (44.3%) HIV-negative infants returned for a 10-week test. Irrespective of the PCR birth result, 157 (36.7%) infants were brought for a 10-week follow-up test at which time 3 (1.9%) tested positive and 151 (96.2%) negative.Conclusion: The majority of HIV-exposed infants received a PCR test at birth; however, the clinic is below the national target (90%) for HIV testing. A record-keeping system of infants' visits does not exist at MUCPP CHC, making it impossible to determine whether HIV-positive infants were started on antiretroviral treatment

Role of breast magnetic resonance imaging in early stage breast cancer

Background: globally, breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in women. The surgical management of patients with early stage operable breast cancer is the main step of treatment and addresses both the primary tumor and regional lymphatics. Objectives: this study aims at highlighting the role of preoperative dynamic contrast enhanced breast MRI in early stage breast cancer and its impact on surgical management. Patients and Methods: this study was carried out over the period from March 2015 to October 2017 in Radiodiagnosis Department of Mansoura University Hospitals and Nasser Institute. The study was conducted on 29 female their ages ranging from 30 to 59 years old the study was approved by our Institution's Ethics Committee, and all patients gave their informed consent before inclusion in the study. Results: in our study, MRI was requested for different causes varying between dense breast which may obscure lesions (51.7%), multifocal lobular carcinoma (13.7%), exclude multicentric lesion (10. 3%) and in (24%) of patients MRI was requested as preoperative routine check. In our study, we found that in 10 patients (34.5%), MRI revealed additional lesions that were not seen on conventional imaging by mammography and ultrasound.Six lesions (20.7%) of those additional occult lesions were identified as malignant and all were ipsilateral. Our study reported that six patients (20. 7%) who had unsuspected abnormalities identified on MRI had changes in treatment based on MRI findings. Conclusion: the results of this study confirm previous reports that preoperative MRI of the breast alters clinical management and detects otherwise occult carcinoma in a substantial number of patients with early breast cancer

Barriers to healthcare for sickle cell disease patients in Democratic Republic of Congo

Introduction: The World Health Organization estimates that up to 70% of sickle cell deaths in sub-Saharan Africa are preventable by implementing measures that include early diagnosis, information, education and prophylaxis of infections. In the city of Kisangani, in the Tshopo province of the Democratic Republic of the Congo, identifying difficulties in access to care will help guide interventions to fight sickle cell anemia. The aim of this study was to identify the barriers preventing sickle cell patients from accessing care in the Democratic Republic of Congo.Methods: This cross-sectional study involved 158 sickle cell patients who consulted at least once in one of the general hospitals in Kisangani in 2010. The interview guide included questions about social representations and knowledge about the disease, perceptions and knowledge of the provision of health services and financial accessibility to health facilities.Results: For 44.9% of the study participants attribute sickle cell disease to demonic origin or divine curse. The cost of care associated with sickle cell anemia is unaffordable for 93.6% of participants. The 77.8% and 44.9% indicated that it is in the church and in traditional healer's places respectively that the care is more prompt than in formal health system. However, only 22.8% patients in health facilities felt that they waited a long time before commencing treatment.Conclusion: Sickle cell control in Kisangani should focus on raising awareness, information and education of the population, sickle cell anemia patients and their families. In addition, centers for the comprehensive management of sickle cell disease supported by the state should be developed. Similarly, research on medicinal plants used by healers is necessary

Knowledge of tuberculosis and factors responsible for low case detection in the Amansie Central District, Ghana

Background:Tuberculosis (TB) case detection rate has remained consistently low in the Amansie Central District despite the implementation of the National TB Programme (NTP).Objective:To assess the factors influencing this low case detection of TB.Method:Information was collected from 120 individuals and 40 health workers were randomly selected from four health facilities that provided TB treatment. Results:All patients had a good knowledge of TB. There was no statistical association between patients knowledge and educational level (p>0.05). However, knowledge on the causes of TB was strongly associated with occupation (p<0.05). 53% of patients indicated health facilities as the first place of visit when sick and how they are received was dependent on education (p=0.005) and marital status (p<0.05); 60% of health workers were not trained on the NTP despite 93% being aware of the programme, and 62.5% reported not initiating contact tracing after disease confirmation. Only 34 of the 120 patients reported health workers visiting them regarding TB. Conclusion: Development of interventions such as HCW training on TB treatment and care, and establishing referral networks that bring TB information and services closer to community members can contribute to improved TB case notification

Malaria morbidity among under 5 children years of age: Epidemic Districts, Northern Uganda, July 2012 to June 2015

Introduction: a malaria epidemic has been confirmed in ten former IRS districts. Given the recent malaria control interventions, a sustained decline in the malaria cases would have been expected. Thus the need for a descriptive analysis on the trends in malaria morbidity in these districts among under 5yr olds for the past 3 financial years to help inform the Ministry of Health and predict future malaria epidemics. The objective of the analysis was to describe annual seasonal trends and peaks in prevalence in malaria morbidity among under 5yr olds over the past three financial years in former IRS districts. Describe the difference in incidence of malaria for the under 5yr olds among all the districts under study for the given period.Methods: a desk review of all under 5yr old malaria cases and malaria control interventions for the past three financial years in the given districts were conducted.Results: there are two malaria seasons each year from April to July and September to November which coincides with the rainy seasons. The peaks in prevalence for all the districts were in June 2015. For the past three financial years, 7/9 districts each had a higher malaria incidence than Lamwo district which has 100% coverage of iCCM (P < 0.001). Conclusion: the rainy seasons present an opportunity for malaria epidemics, iCCM seems to have an effect in reducing the incidence of malaria among under 5yr olds at health facilities. We recommended surveillance and monitoring of trends in malaria cases especially during the rainy season for early detection of epidemics; and assessment of the actual impact of iCCM on the reduction of malaria incidence

Chronic kidney disease screening: Results of the 2013 World Kidney Day activities conducted at the Jos University Teaching Hospital

Background: Chronic kidney disease (CKD) is on the rise globally due to the increase in prevalence of common risk factors. Screening for CKD risk factors is important for early detection and institution of measures to retard its progression. This study aimed to determine the markers of CKD and its risk factors in a selected population.Methods: A cross sectional study of 510 individuals who were recruited during the 2013 world kidney day activities. History, clinical examination as well as the collection of urine and blood samples was performed on each participant to determine the presence of CKD and its risk factors. CKD markers were defined as the presence of proteinuria and or an estimated glomerular filtration rate (eGFR) of < 60ml/min.Results: The mean age of the participants was 39±11 years with majority of them being females (64.7%). Hypertension was present in 256 (50.2%) while diabetes mellitus was seen in 27 (5.29%). Forty three individuals (8.4%) had proteinuria while the prevalence of CKD markers was 10.5%. Only age, (OR =1.03; 95% CI: 1.01-1.06) was found to be a factor independently associated with the development of CKD. Conclusion: Though the prevalence of the traditional risk factors for CKD was high, only age was found to be independently associated with CKD markers.Screening exercise is encouraged for the early detection of CKD markers with a view to mitigating their impact

Relationship between quality of life and postpartum depression among women in North-Central, Nigeria

Background: Postpartum depression is a problem of public health interest and impacts negatively on the perception of quality of lifer of sufferers. Quality of life' (QoL) as an outcome measure, is scantly used on women with postpartum depression in Nigeria. The current study was designed to assess the QoL of women with postpartum depression (PPD) in a tertiary hospital in North-Central, Nigeria.Method: A two-stage cross sectional procedure was used to recruit 550 participants 6 to 8 weeks postpartum in Jos, Northcentral, Nigeria. The Edinburgh Postnatal Depression Scale (EPDS), the World Health Organization Quality of Life-BREF-26 (WHOQoL-BREF-26) questionnaire and the Depression Module of the Structured Clinical Interview for DSM-IV axis I Diagnosis (SCID) were used.Results: The studied participants were 531 out which 21.8% with postpartum depression had significantly poor perception in all the four domains of the WHOQoL-BREF-26 i.e., in the physical health (p<0.001), psychological (p<0.001), social relationships (p<0.001) and environmental (p<0.001) domains. On the whole, the overall rating of quality of life (p=0.002) and satisfaction with general health (p<0.001) were also perceived to be poor when compared to those without depression. However, regression model analysis showed that the presence of postpartum depression in a participant predicts a significant negative perception on physical and environmental domains of quality of life, but a positive prediction on the general satisfaction with health. Conclusion: Postpartum depression as a disorder of public health importance impacts on the perception of quality of life of women who suffer from it. Early detection and treatment will improve the quality of life of women with postpartum depression

Infant hearing screening from a developing country context: status from two South African provinces

Background: New-born hearing screening (NHS) programmes are an important step toward early detection of hearing loss and require careful examination and planning within each context. The Health Professions Council of South Africa (HPCSA) has recommended specific contexts in which to actualise early hearing detection and intervention (EHDI) application. It is imperative therefore to explore if and how the current experience measures up to these recommendations.Objective: to explore the feasibility of and the current status of the implementation of NHS at various levels of health care within the South African context.Methods: A non-experimental, descriptive, cross-sectional survey research design was employed, using a combination of questionnaires and face-to-face semi-structured interviews. Participants comprised 30 primary health care (PHC) nursing managers across two provinces (Gauteng and North West) and 24 speech-language therapists and/or audiologists directly involved with NHS in secondary and tertiary levels of care within Gauteng.Results: Current findings indicated lack of formal, standardised, and systematic EHDI implementation at all three levels of health care (primary, secondary and tertiary) with valuable reasons such as insufficient knowledge, lack of equipment, budgetary constraints, and human resource challenges being provided for this. Regardless of the level of care and their varied resource allocations and levels of specialisation; EHDI implementation as advocated by the HPCSA (2007) position statement currently does not seem feasible, unless the number of barriers identified are addressed, and NHS becomes mandated.Conclusion: Current findings have highlighted the need for ensuring that context specific studies in EHDI are conducted to ensure that national position statements are sensitive to contextual challenges and therefore allow for evidence-based practice, particularly in developing countries where resource constraints dictate success and/or failure of any well-intentioned programme

Barriers; Facilitators and Recommendations for the Early Infant Diagnosis and Treatment (EIDT) Cascade: A Qualitative Study in Malawi

Background. Identifying and testing all HIV-exposed infants (HEIs) by 2 months of age with rapid antiretroviral therapy (ART) initiation for those infected is critical to survival. Yet in 2009 only 29% of HEIs in need of ART received treatment in Malawi.Objectives. To understand barriers; facilitators and recommendations for five key steps in the early infant diagnosis and treatment (EIDT) cascade: (1) identification of HEIs; (2) infant testing; (3) sample processing and transport; (4) reporting results to mothers; (5) ART initiation for HEI.Methods. Semistructured interviews were conducted through convenience sampling with mothers of infants eligible for EIDT (n=47) and with healthcare workers (HCWs) providing EIDT (n=20) in five facilities; in April 2013. Results. (1) Reliance on the health passport to identify HEIs is both barrier; as women may not attend appointments with their passports; and facilitator; for documentation of HIV-exposure status. Use of trained health surveillance assistants in EIDT enhances cascade steps 1 and 2; but requires increased supervision. (2) Women struggle to accept their own HIV status; yet test results for an HEI is a motivator. Sensitisation through local leadership facilitates EIDT. (3) A reliable transport system is needed. (4) Maintaining appointments to report results to women motivates them. (5) Mothers were reluctant to give ART to young; apparently healthy infants. Conclusion. Both women and healthcare workers are motivated by test results for HEIs. The inclusion of community education can improve all steps in the EIDT cascade; including information that HEIs need ART