Exploring pregnancy-related stigma experiences among adolescents in rural Uganda.

INTRODUCTION: Pregnant adolescents face multiple adverse experiences that vary by context due to pregnancy-related stigma. We explored experiences of pregnancy-related stigma and psychosocial issues among adolescents living in rural eastern Uganda. METHODS: We conducted in-depth semi-structured interviews with 15 adolescents (15-19 years old) who were pregnant (>3 months) or had recently given birth (<3 months) at Tororo District Hospital in Uganda. All interviews were translated from Dhopadhola to English. Thematic analysis was conducted to identify major themes, which were interpreted using the Health Stigma and Discrimination Framework. RESULTS: Six key themes were identified and were organized under the Health Stigma and Discrimination Framework. Social and gender norms for adolescent women and their lack of autonomy were identified as drivers and facilitators of pregnancy-related stigma. Results show how stigma is experienced by adolescents through the lack of social support, multiple forms of abuse, and negative judgement. Such manifested stigma negatively impacted their psychosocial wellbeing and resulted in limited access to socioeconomic resources and educational opportunities. CONCLUSION: This study acknowledges the multilevel nature of pregnancy-related stigma among adolescents in the context of existing policy and programming. Recognizing the impact of pregnancy-related stigma on the health and wellbeing of adolescent girls necessitates prioritizing comprehensive stigma reduction interventions that address main drivers and facilitators, and that are rooted in the communities to harness support.

Evaluación del parámetro BACT-info del citómetro de flujo UF-5000 (Sysmex) para la clasificación gram en infección del tracto urinario / Evaluation of Sysmex UF-5000 flow cytometer flag BACT-info for Gram discrimination in urinary tract infection

Introducción: El urocultivo como gold standard para diagnóstico de infección del tracto urinario (ITU) supone una carga de trabajo considerable en los Servicios de Microbiología Clínica, debido al elevado número de muestras recibidas que finalmente serán negativas. Por ello, utilizar sistemas de cribado que además reduzcan el tiempo de respuesta del diagnóstico de ITU es necesario. El nuevo citómetro de flujo UF-5000 (Sysmex Corporation) es capaz de diferenciar entre bacterias gramnegativas y grampositivas mediante el parámetro BACT-info según el fabricante. El objetivo de nuestro estudio fue evaluar la capacidad de discriminación gram del citómetro UF-5000. Métodos: Estudio prospectivo de 449 orinas recogidas de forma consecutiva, en el período 7/3/2022-27/5/2022, en las que se comparó el flag BACT-info con el urocultivo como método de referencia. Resultados: La sensibilidad obtenida tanto para bacterias gramnegativas como positivas fue superior al 95%. Sin embargo, en el caso de bacterias grampositivas, el índice Kappa moderado (0,49) y el valor predictivo positivo bajo (37,1%) indicó que la correlación entre el flag BACT-info y el urocultivo no era aceptable, por lo que no sería recomendable informarlo al clínico peticionario. Conclusión: El uso del citómetro UF-5000 supone un adelanto en la orientación etiológica de las ITUs causadas por bacterias gramnegativas. Informar la morfología gram en la muestra de orina reduce el tiempo de respuesta en el diagnóstico microbiológico de ITU, lo que tendría un impacto en la disminución y optimización del tratamiento empírico, y, por ende, en la generación de resistencias antimicrobianas. (AU)

Introduction. Urine culture as a gold standard for the diagnosis of urinary tract infection (UTI) involves a considerable workload in Clinical Microbiology Departments, due to the high number of samples received that will ultimately be negative. Therefore, it is necessary to use screening systems that also reduce the turnaround time for UTI diagnosis. The new flow cytometer UF-5000 (Sysmex Corporation) is able to differentiate between Gram-negative and Gram-positive bacteria using the BACT-info parameter according to manufacturer. The aim of our study was to evaluate the gram discrimination ability of the UF-5000 cytometer. Methods. A prospective study with 449 urine samples collected consecutively was conducted, in the period 7/3/2022- 27/5/2022, in which the BACT-info flag was compared with urine culture as the reference method. Results. The sensitivity obtained for both Gram-negative and Gram-positive bacteria was above 95%. However, for Gram-positive bacteria, the moderate Kappa index (0.49) and the low positive predictive value (37.1%) indicated that the correlation between BACT-info flag and urine culture was not acceptable and should not be reported to the requesting clinician. Conclusion. Implementation of the third generation UF5000 cytometer represents a significant advance in the aetiological orientation of UTIs caused by Gram-negative bacteria. Reporting the Gram morphology in the urine samples reduces the response time in the microbiological diagnosis of UTI, which would have an impact on the reduction and optimisation of empirical treatment, and thus on the generation of antimicrobial resistance. (AU)

In utero/peripartum antiretroviral therapy exposure and mental health outcomes at 8-18 years old: A longitudinal comparative study of children with perinatally acquired HIV, children perinatally HIV exposed but uninfected, and children unexposed uninfected from Uganda.

In utero/peripartum antiretroviral therapy (IPA) exposure type was examined in relationship to mental health symptoms among 577 children with perinatally acquired HIV (CPHIV), children perinatally HIV exposed but uninfected (CHEU), and children HIV unexposed uninfected (CHUU). IPA exposure was categorized for CPHIV and CHEU as none, single-dose nevirapine with or without zidovudine (sdNVP±AZT), sdNVP+AZT+lamivudine (3TC), or combination antiretroviral therapy (cART). Anxiety and depressive symptoms were reported at baseline, 6-, and 12-month follow-up per behavioral assessment system for children. Multivariable linear mixed models were used to estimate differences (b) with 95% confidence intervals (95% CI) for IPA exposure types versus CHEU without IPA exposure. Depressive and anxiety symptoms were lower in CHUU relative to CHEU and CPHIV but did not differ between CPHIV and CHEU. CHEU with sdNVP±AZT exposure had greater anxiety (b = 0.51, 95% CI: [0.06, 0.96]) and depressive symptoms (b = 0.48, 95% CI: [0.07, 0.89]) than CHEU without IPA exposure. CHEU with sdNVP+AZT+3TC exposure had higher anxiety (b = 0.0.45, 95% CI: [0.03, 0.86]) and depressive symptoms (b = 0.72, 95% CI: [0.27, 1.17]) versus CHEU without IPA exposure. Depressive and anxiety symptoms were not different for CHEU and CPHIV exposed to cART (b = 0.12-0.60, 95% CI: [-0.41, 1.30]) and CHEU and CHUU (b = -0.04 to 0.08, 95% CI: [-0.24, 0.29]) without IPA exposure. Among CHEU, peripartum sdNVP±AZT and sdNVP+AZT+3TC but not cART compared to no IPA exposure was associated with clinically important elevations in anxiety and depressive symptoms. Monitoring of mental health trajectory of HIV-affected children considering IPA is needed to inform mental health interventions. Patient Contribution: Caregivers and their dependents provided consent for participation and collaborated with study team to identify mutually convenient times for protocol implementation.

Correlates of maternal depression, anxiety and functioning across an urban-rural gradient in northern Ecuador.

Maternal depression remains under characterised in many low- and middle-income countries, especially in rural settings. We aimed to describe maternal depression and anxiety symptoms in rural and urban communities in northern Ecuador and to identify socioeconomic and demographic factors associated with these symptoms. Data from 508 mothers participating in a longitudinal cohort study were included. Depression and anxiety symptoms were assessed using the Hopkins Symptom Checklist (HSCL-25), and maternal psychological functioning was assessed using a checklist of daily activities. Tobit regression models were used to examine associations with sociodemographic variables and urbanicity. The median HSCL-25 score was 1.2 (IQR: 0.4) and 14% of women scored above the threshold for clinically relevant symptoms. Rural women reported similar food insecurity, less education, younger age of first pregnancy, and lower socio-economic status compared to their urban counterparts. After adjusting for these factors, rural women reported lower HSCL-25 scores compared to women lin urban areas (ß = -0.48, 95%CI:0.65, -0.31). Rural residence was also associated with lower depression and anxiety HSCL-25 sub-scale scores, and similar levels of maternal functioning, compared to urban residence. Our results suggest that both household and community-level factors are risk factors for maternal depression and anxiety in this context.

Attention Test Assessment from a Cluster Randomized Controlled Trial of Caregiver Training for Ugandan Preschool Children Living with Perinatal HIV.

Fifty-six Ugandan mothers/caregivers received Mediational Intervention for Sensitizing Caregivers (MISC) biweekly for one year; 46 mothers received treatment-as-usual. Preschool PHIV child attention was measured by proportion of time viewing a 7-min animation (early childhood vigilance test or ECVT) at enrollment, 6 and 12 months. Analysis of covariance compared ECVT outcomes for the two intervention groups, controlling for baseline ECVT performance, age and weight-for-age z scores. Differences by trial arm were not significant at any of the three time points. MISC trial-arm children on combination ART during the study period displayed more stable ECVT scores across time points compared to controls.

Description of eight human infections caused by Bacteroides pyogenes in a tertiary hospital of northern Spain.

Bacteroides pyogenes is a Gram-negative obligate anaerobe, saccharolytic, non-motile, non-pigment-producing and non-spore-forming rod. Reports of human infections caused by B. pyogenes are scarce, with approximately 30 cases documented in scientific literature. The aim of this study was to describe the clinical characteristics of 8 different patients and to study the in vitro antibiotic susceptibility of the strains, as well as to evaluate the in vivo activity of the prescribed treatments. We conducted a descriptive retrospective study by searching all B. pyogenes isolates from January 2010 to March 2023 at the Basurto University Hospital. This included all cases, both in monomicrobial or polymicrobial cultures. Among the eight patients, three experienced severe infections such as bacteremia and osteomyelitis. All the strains were susceptible to amoxicillin/clavulanic acid, piperacillin/tazobactam, imipenem, meropenem, clindamycin, metronidazole and moxifloxacin.

Predictive validation of Ugandan infant eye-tracking test for memory of human faces.

We provide initial evidence that an eye-tracking based measure of infant attention and working memory (gaze preference for novel human faces) can predict aspects of neurocognitive performance years later among Ugandan children. 49 HIV-exposed/uninfected Ugandan children (22 boys, 27 girls) 6-12 months old were tested with the Mullen Scales of Early Learning and a modified Fagan Test of Infant Intelligence (FTII). Modified FTII measures pertaining to attention are correlated to the KABC-II Mental Processing Index (MPI) (rp = -0.40), p Cognitive assessments adapted to eye-tracking instrumentation can be useful to evaluate attention and working memory in HIV-affected children living in low- and middle-income countries.

Antiretroviral choice and severe disease predict poorer neuropsychological outcomes in HIV+ children from Africa.

Background: The International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) P1104s study evaluated neuropsychological outcomes over 96 weeks in children living with HIV (CLHIV) aged 5-11 years at 6 Sub-Saharan African sites to explore associations between HIV-illness related biomarkers and neuropsychological outcomes. Methods: Children living with HIV had participated in IMPAACT P1060, which compared efficacy of nevirapine versus lopinavir/ritonavir in children initiating ART at <3 years of age. At age 5-11, neuropsychological evaluations of KABC cognitive ability, TOVA attention-impulsivity and BOT-2 motor domains were assessed and repeated after 48 and 96 weeks. Clinical, antiretroviral therapy (ART) and laboratory (immunological and virological) parameters were used to predict neuropsychological outcomes using linear mixed-effects multivariable regression models, controlling for child and caregiver characteristics. Results: 246 CLHIV (45% male, mean age at initial neuropsychological evaluation 7.1 yrs [SD 1.2]) began ART at a median age 14.9 months (IQR 8.2, 25.2). Nadir CD4 percentage was 14.7% (IQR 11.0, 19.5); the median peak viral load (VL) was 750 000 copies/ml (IQR 366 000, 750 000) and 63% had ≥WHO stage 3 clinical disease; 164 (67%) were on lopinavir/ritonavir, 71 (29%) were on nevirapine and 7 (3%) were on efavirenz. Other antiretrovirals were similar. Nevirapine at P1104s study start or later was associated with poorer neuropsychological scores across all domains except Global Executive Composite, even when controlling for nadir CD4 percent and time-varying HIV VL. Other predictors of poorer scores in KABC domains included low birth weight, WHO stage 4 disease and serious illness history and elevated VL was associated with worse BOT-2 scores. Conclusion: Children receiving nevirapine had poorer neuropsychological scores than those on lopinavir/ritonavir. Antiretroviral choice might adversely impact neuropsychological performance. In addition, low birth weight and markers of severe HIV disease: advanced WHO clinical HIV disease, history of serious illness and an elevated VL, were associated with lower neuropsychological scores.

A case of septic arthritis caused by Capnocytophaga canimorsus in an HIV patient.

Invasive infections caused by Capnocytophaga canimorsus , a Gram-negative rod found in the oral cavity of healthy dogs and cats, are rare but they are increasing worldwide. We report a case of septic arthritis in a native knee joint due to this micro-organism. A 57-year-old man, with a well-controlled chronic HIV infection, attended the Emergency Department because of left knee pain and shivering without measured fever. A knee arthrocentesis and a computed tomography scan were performed, revealing septic arthritis with collections in the left leg posterior musculature. He was admitted to the Infectious Diseases Department for antibiotic treatment. Initial synovial fluid was inoculated in blood culture bottles, and the anaerobic one was positive after 63 h. Gram stain revealed fusiform Gram-negative rods, identified as C. canimorsus by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) directly from the bottle. Identification was confirmed by 16S rRNA sequencing and serotyping was performed by PCR, with serovar A as the outcome. Due to an unfavourable clinical course, the patient required two surgical cleanings and after appropriate antibiotic treatment he was discharged 2 months later.

Association of pregnancy-related stigma and intimate partner violence with anxiety and depression among adolescents.

INTRODUCTION: We explored the association between pregnancy-related stigma and intimate partner violence (IPV) with depression and anxiety among adolescents in Uganda. METHODS: We interviewed a convenience sample of 100 adolescents (>18 years) who were pregnant (>3 months) or recently gave birth (<3 months) at Tororo District Hospital, Uganda. Symptoms of depression and anxiety were evaluated using the Hopkins Symptom Checklist (HSCL-25), physical and sexual IPV were assessed using the WHO violence against women instrument, and pregnancy-related stigma was captured with a questionnaire. Regression models were used to evaluate associations of pregnancy stigma and IPV with depression and anxiety. RESULTS: Mean age was 18 years, 84% were primiparous, 66% were married and 57% had only primary school-level education. About 48% women had clinically meaningful distress levels; 45% reported sexual IPV, 32% physical IPV, and 86% reported experiencing pregnancy-related stigma. Adjusted models showed that higher levels of depression and anxiety were associated with higher report of pregnancy-related stigma (ß = .27, p = .03), physical IPV, (ß = -.24, p < .01), or sexual IPV (ß = -.19, p = .05), compared to those who did not. Unemployment (ß = -.24, p = .01) and lower educational level (ß = -.21, p = .05) were also independent predictors of depression and anxiety. CONCLUSION: Findings suggest that IPV is common among adolescents in Uganda, as is pregnancy-related stigma, and both are independent predictors of depression and anxiety. The implications of these findings and the need for clinical interventions for IPV among adolescents are discussed.

Daily Training efficiency during computerized cognitive rehabilitation training (CCRT): an analysis from a randomized trial in Ugandan children with and without severe malaria.

Children in Uganda are at risk for significant cognitive sequelae from severe malaria. Computerized cognitive rehabilitation training (CCRT) represents a potential method to improve working memory, behavior, and executive functioning, cognitive domains most at risk following severe malaria. The primary aim of this study was to complete a secondary analysis of data from a concluded CCRT randomized control trial in order to compare the training efficiency of a commonly used CCRT program under conditions of titrated (adaptive) or non-titrated (non-adaptive) training and with children with increasing malaria severity to determine how various factors may affect potential CCRT improvement. A total of 201 school-aged children (66.2% boys) who were either healthy (n = 102) or previously diagnosed with severe or cerebral malaria (n = 99) were randomized into two active treatment arms (titrated and non-titrated learning). Each child received 24 one-hour sessions of training over 8 weeks using Captain's Log® CCRT by BrainTrain, which includes a comprehensive set of CCRT tasks. Children generally benefited from CCRT over the 24 training sessions, but titrated CCRT showed a clear advantage over non-titrated. Severity of illness or factors such as BMI, did not moderate CCRT performance indicators. These findings support our hypothesis that titrated CCRT would result in steeper improvement in learning, but do not support our hypothesis that history of recent significant illness would affect learning proficiency. Findings were evident across all CCRT performance scores, even given that children were from generally rural, low-resource settings and were generally unfamiliar with computers.ABBREVIATIONS:Computerized Cognitive Rehabilitation Training (CCRT); Mental Processing Index (MPI); Home Observation for the Measurement of the Environment (HOME); Socioeconomic Status (SES); least square means (LSM).

Global estimates of the attributable risk of alcohol consumption on road injuries.

BACKGROUND: Alcohol consumption is one of the main risk factors for death by road injuries, but little is known about the global distribution of the population-attributable risk (PAR) of alcohol use for death by road injuries. METHODS: We used publicly available data from the 2019 Global Burden of Disease Study (GBD) to estimate the PAR of alcohol use for 5 types of road injury, globally and individually for available countries, by socio-demographic index (SDI), and by age, sex, and year from 1990 to 2019. RESULTS: 6.6% of all road injuries in 2019 were attributable to alcohol consumption, with large variations worldwide; the highest burden was in Europe and among countries classified in the high-middle SDI. PAR was higher in men than in women, and among younger individuals. Important variations in PAR of alcohol were also observed by road injury type, with motorcyclist road injuries having the highest PAR. Overall, PAR showed a small increase during 1990-2019; younger (<39 years old) men showed an increasing trend during this period, while older women had a decreasing trend in PAR. CONCLUSIONS: PAR for alcohol and road injuries is not homogenous. Large PAR for alcohol and road deaths was found in Europe, among men, young adults, and motorcyclists. These results could help public health agencies, law enforcement, and the public guide efforts to reduce these deaths.

Attention Test Improvements from a Cluster Randomized Controlled Trial of Caregiver Training for HIV-Exposed/Uninfected Ugandan Preschool Children.

OBJECTIVE: To report vigilance attention outcomes from a cluster randomized controlled trial of early childhood development caregiver training for perinatally HIV-exposed/uninfected preschool-age children in rural Uganda. The Early Childhood Vigilance Test (ECVT) provides a webcam recording of proportion of time a child views an animation periodically moving across a computer screen. STUDY DESIGN: Sixty mothers/caregivers received biweekly year-long training sessions of the Mediational Intervention for Sensitizing Caregivers (MISC), and 59 mothers received biweekly training about nutrition, hygiene, and health care. Children were tested for attention at baseline, 6 months, and 12 months with the ECVT, in terms of proportion of time spent viewing a 6-minute animation of animals greeting the child and moving across the computer monitor screen. Time viewing the animation were scored by trained observers using ProCoder program for webcam scoring of proportion of time the child faced the animation. Mixed-effects modeling was used to compare ECVT outcomes for the 2 intervention groups. RESULTS: Unadjusted and adjusted (for age, sex, height, and ECVT at baseline) group differences on ECVT significantly favored the MISC arm at 6 months (P = .03; 95% CI (0.01, 0.11), effect size = 0.46) but not at 12 months. Both groups made significant gains in sustained attention across the year-long intervention (P = .021) with no significant interaction effects between time and treatment arms or sex. CONCLUSIONS: Caregiver early childhood development training enhanced attention in at-risk Ugandan children, which can be foundational to improved working memory and learning, and perhaps related to previous language benefits reported for this cohort. TRIAL REGISTRATION: Clinicaltrials.gov: NCT00889395.