Association between multivitamin supplementation and mortality among patients with Ebola virus disease: an international multisite cohort study

Introduction: Micronutrient supplementation is recommended in Ebola Virus Disease (EVD) care; however, there is limited data on its therapeutic effects. Methods: This retrospective cohort study included patients with EVD admitted to five Ebola Treatment Units (ETU) in Sierra Leone and Liberia during September 2014 to December 2015. A uniform protocol was used to guide ETU care, however, due to supply limitations, only a subset of patients received multivitamins. Data on demographics, clinical characteristics, and laboratory testing was collected. The outcome of interest was facility based mortality and the primary predictor was multivitamin supplementation initiated within 48 h of admission. The multivitamin formulations included: thiamine, riboflavin, niacin and vitamins A, C, and D3. Propensity score models (PSM) were used to match patients based on covariates associated with multivitamin administration and mortality. Mortality between cases treated and untreated within 48 h of admission were compared using generalized estimating equations to calculate relative risk with bootstrap methods employed to assess statistical significance. Results: There were 424 patients with EVD who had sufficient treatment data for analysis, of which 261 (61.6%) had daily multivitamins initiated within 48 h of admission. The mean age of the cohort was 30.5 years and 59.4% were female. In the propensity score matched analysis, mortality was 53.5% among patients receiving multivitamins and 66.2% among patients not receiving multivitamins, resulting in a relative risk for mortality of 0.81 (p=0.03) for patients receiving multivitamins. Conclusion: Early multivitamin supplementation was associated with lower overall mortality. Further research on the impact of micronutrient supplementation in EVD is warranted

Transactional Sex among Youths in Post-conflict Liberia.

This paper presents findings on sexual risk behaviours of Liberian youths based on five focus-group discussions conducted with 6th and 7th graders (n=36) attending an elementary/middle school in Monrovia, Liberia. The purpose of the focus-group discussions was to gain an understanding of the sexual behaviours of in-school Liberian adolescents. The focus-group discussions were part of a larger study to adapt an evidence- based HIV-prevention intervention—Making Proud Choices!—for in-school youths. Post-conflict conditions were discussed as a contributor to the emergence of high-risk sexual behaviours, including transactional sex, sexual violence, and lack of condom-use. Transactional sex was often described by the focus-group participants as occurring between young females and older, more financially-secure males to obtain cash, food, clothing, western commodities, and school-fees and was often encouraged by parents and promoted by peers. The findings also indicate that female adolescents make choices to engage in transactional sex to gain access to a continuum of material and consumer needs. These findings suggest that individual risk-taking behaviours are nested within complex sexual economies and that HIV-prevention interventions should be considered that leverage females’ agency and control.

HIV-associated tuberculosis among a cohort of heterosexual discordant couples in Lusaka, Zambia.

The purpose of this study was to determine the association between human immunodeficiency virus (HIV) infection and tuberculosis (TB) among a cohort of heterosexual discordant couples (one partner HIV-positive and the other HIV-negative) enrolled at an HIV prevention and research centre in Lusaka, Zambia. All medical records identified from January 1994 to July 1998 were extensively reviewed. In addition, follow-up visits to local health department and chest clinics and to sputum analyses laboratories were conducted to validate the extracted medical data. The study used a nested approach based on a retrospective study design. The participants with HIV-associated tuberculosis (HAT), when compared with HIV-negative subjects with diagnosis of presumptive tuberculosis, were more likely to have presented with negative sputum analyses, to have been diagnosed with pulmonary tuberculous lesion, to have experienced relapse from tuberculosis, to have never been hospitalized for tuberculosis-related complications, and to have died due to tuberculosis. In addition, 9% of the urban heterosexual discordant couples enrolled in the primary cohort study were positive for presumptive tuberculosis. This study reports the first major impact of HIV infections on the outcomes of tuberculosis among heterosexual discordant couples. However, further research using vigorous methodological criteria is recommended to confirm the above findings.