Mortality Among Children Aged <5 Years Living with HIV Who Are Receiving Antiretroviral Treatment - U.S. President's Emergency Plan for AIDS Relief, 28 Supported Countries and Regions, October 2020-September 2022.

Globally, children aged <5 years, including those living with HIV who are not receiving antiretroviral treatment (ART), experience disproportionately high mortality. Global mortality among children living with HIV aged <5 years receiving ART is not well described. This report compares mortality and related clinical measures among infants aged <1 year and children aged 1-4 years living with HIV with those among older persons aged 5-14, 15-49, and ≥50 years living with HIV receiving ART services at all clinical sites supported by the U.S. President's Emergency Plan for AIDS Relief. During October 2020-September 2022, an average of 11,980 infants aged <1 year and 105,510 children aged 1-4 years were receiving ART each quarter; among these infants and children receiving ART, 586 (4.9%) and 2,684 (2.5%), respectively, were reported to have died annually. These proportions of infants and children who died ranged from four to nine times higher in infants aged <1 year, and two to five times higher in children aged 1-4 years, than the proportions of older persons aged ≥5 years receiving ART. Compared with persons aged ≥5 years living with HIV, the proportions of children aged <5 years living with HIV who experienced interruptions in treatment were also higher, and the proportions who had a documented HIV viral load result or a suppressed viral load were lower. Prioritizing and optimizing HIV and general health services for children aged <5 years living with HIV receiving ART, including those recommended in the WHO STOP AIDS Package, might help address these disproportionately poorer outcomes.

A cross-sectional survey on gender-based violence and mental health among female urban refugees and asylum seekers in Kampala, Uganda.

OBJECTIVE: To assess gender-based violence and mental health outcomes among a population of female urban refugees and asylum seekers. METHODS: In a questionnaire-based, cross-sectional study conducted in 2010 in Kampala, Uganda, a study team interviewed a stratified random sample of female refugees and asylum seekers aged 15-59 years from the Democratic Republic of Congo and Somalia. Questionnaires were used to collect information about recent and lifetime exposure to sexual and physical violence, and symptoms of depression and post-traumatic stress disorder (PTSD). RESULTS: Among the 500 women selected, 117 (23.4%) completed interviews. The weighted lifetime prevalences of experiencing any (physical and/or sexual) violence, physical violence, and sexual violence were 77.5% (95% CI 66.6-88.4), 76.2% (95% CI 65.2-87.2), and 63.3% (95% CI 51.2-75.4), respectively. Lifetime history of physical violence was associated with PTSD symptoms (P<0.001), as was lifetime history of sexual violence (P=0.014). Overall, 112 women had symptoms of depression (weighted prevalence 92.0; 95% CI 83.9-100) and 83 had PTSD symptoms (weighted prevalence 71.1; 95% CI 59.9-82.4). CONCLUSION: Prevalences of violence, depression, and PTSD symptoms among female urban refugees in Kampala are high. Additional services and increased availability of psychosocial programs for refugees are needed.

Neonatal survival in complex humanitarian emergencies: setting an evidence-based research agenda.

BACKGROUND: Over 40% of all deaths among children under 5 are neonatal deaths (0-28 days), and this proportion is increasing. In 2012, 2.9 million newborns died, with 99% occurring in low- and middle-income countries. Many of the countries with the highest neonatal mortality rates globally are currently or have recently been affected by complex humanitarian emergencies. Despite the global burden of neonatal morbidity and mortality and risks inherent in complex emergency situations, research investments are not commensurate to burden and little is known about the epidemiology or best practices for neonatal survival in these settings. METHODS: We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritize research questions on neonatal health in complex humanitarian emergencies. Experts evaluated 35 questions using four criteria (answerability, feasibility, relevance, equity) with three subcomponents per criterion. Using SAS 9.2, a research prioritization score (RPS) and average expert agreement score (AEA) were calculated for each question. RESULTS: Twenty-eight experts evaluated all 35 questions. RPS ranged from 0.846 to 0.679 and the AEA ranged from 0.667 to 0.411. The top ten research priorities covered a range of issues but generally fell into two categories- epidemiologic and programmatic components of neonatal health. The highest ranked question in this survey was "What strategies are effective in increasing demand for, and use of skilled attendance?" CONCLUSIONS: In this study, a diverse group of experts used the CHRNI methodology to systematically identify and determine research priorities for neonatal health and survival in complex humanitarian emergencies. The priorities included the need to better understand the magnitude of the disease burden and interventions to improve neonatal health in complex humanitarian emergencies. The findings from this study will provide guidance to researchers and program implementers in neonatal and complex humanitarian fields to engage on the research priorities needed to save lives most at risk.

An Evaluation of an Early Warning Alert and Response Network (EWARN) in Darfur, Sudan.

Objective: To conduct a field-based evaluation of an Early Warning Alert and Response Network (EWARN) in Darfur, Sudan. Methods: Using adapted surveillance evaluation guidelines, evaluators reviewed EWARN documents and conducted semi-structured in-depth interviews and group discussions with key informantsat national, state, and local levels. Evaluators conducted visits at 18 purposively sampled clinics in all Darfur states. Observers examined morbidity reporting, laboratory functions, and disease controland nutrition data. Qualitative and quantitative analysis identified common themes and examinedkey variable frequencies. Results: All clinicians described EWARN as useful; most indicated that its primary usefulness was early outbreak detection. Between January and October 2009, there were a total of 30 alerts with 10 confirmed outbreaks, 16 negative results, and four results with pending laboratory tests. Of the 26 alerts with investigation results, 10 were confirmed (positive predictive value [PPV] = 38%). The sensitivity of the outbreak detection system could not be determined on the basis of available data. Lack of clarity and variations in the application of case definitions and laboratory testing led to differences in reporting of specific conditions and rendered trend data less reliable. Collecting data on non-epidemicprone diseases at every site was burdensome. Few deaths were reported at the clinic level. Conclusions: EWARN is a useful system for outbreak detection. Refining, standardizing, and increasing training frequency on case definitions, expanding laboratory capacity, and focusing data collection on epidemic-prone diseases would greatly improve the system's outbreak and surveillance capacity. Mortality reporting from outpatient clinic data should be eliminated.