Global Consensus Recommendations on Prevention and Management of Nutritional Rickets

"BACKGROUND: Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. EVIDENCE: A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describes the strength of the recommendation and the quality of supporting evidence. PROCESS: Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. RESULTS: This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. CONCLUSION: Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required."

HIV risk factors among pregnant women in a Rural Nigerian Hospital / Factores de riesgo de VIH entre las mujeres embarazadas en un Hospital Rural Nigeriano

OBJECTIVE: Specific risk behaviours and practices promote the spread of HIV/AIDS. Identification of those at risk of the Human Immunodeficiency Virus (HIV) infection is an important step toward prevention of both vertical and horizontal transmission of HIV. This study sought to identify risk factors for HIV infection in pregnant women attending a rural antenatal clinic in Northern Nigerian. METHODS: A cross-sectional descriptive study of pregnant women attending antenatal clinic at a rural mission hospital in Northern Nigeria between June and October 2005 was conducted. Data were collected with a structured questionnaire. HIV screening and confirmation were done for the pregnant women after voluntary counselling. RESULTS: The study enrolled 350 pregnant women with a mean (± SD) age of 26.8 ±6.4 years. HIV infection was not associated with smoking habits in women, alcohol intake in the women or their partners, prior blood transfusion, history of sexually transmitted infection or history ofscarification. In multiple logistic regression, HIV infection was independently associated with suspecting their partner of extramarital sex (adjusted odds ratio 3.8, 95% CI 1.6, 9.0), post-primary education (AOR 2.4, 95% CI 1.1, 5.3), multiple sexual partners (AOR 2.4, 95% CI 0.97, 6.2) and cigarette smoking by a partner (AOR 3.0, 95% CI 0.95, 9.4). CONCLUSION: Multiple partners and extramarital sex remain a hindrance to the fight against HIV infection. Promoting the ABC approach (abstinence, be faithful, condom) may reduce risky behaviour as it has in other parts of Africa.

OBJETIVO: Las prácticas y los comportamientos de riesgo específicos promueven la propagación del VIH/SIDA. La identificación de quienes se encuentran en riesgo de infección por el virus de la inmunodeficiencia humana (VIH) es un paso importante hacia la prevención de la transmisión vertical y horizontal del VIH. Este estudio buscó identificar los factores de riesgo de infección de VIH en las mujeres embarazadas que asisten a una clínica prenatal rural en el norte de Nigeria. MÉTODOS: Se llevó a cabo un estudio descriptivo transversal de mujeres embarazadas que asisten a la clínica prenatal en un hospital rural misionero en Nigeria Norte, entre junio y octubre de 2005. Los datos fueron recogidos mediante un cuestionario estructurado. El pesquisaje y confirmación del virus de la inmunodeficiencia humana fueron realizados para las mujeres embarazadas tras recibir aconsejamiento voluntario. RESULTADOS: El estudio enroló a 350 mujeres embarazadas con una edadpromedio (± SD) de 26.8 ± 6.4 anos. La infección por VIH no estuvo asociada con el hábito defumar entre las mujeres, la ingestión de alcohol por las mujeres o sus companeros, las transfusiones de sangre previas, una historia de infecciones de transmisión sexual, o una historia de escarificación. En la regresión logística múltiple, la infección por VIH estuvo independientemente asociada con sospechas de relaciones sexuales extramaritales por parte de sus companeros (odds ratio ajustado 3.8, 95% CI 1.6, 9.0), educación postprimaria (AOR 2.4, 95% CI 1.1, 5.3), parejas sexuales múltiples (AOR 2.4, 95% CI0.97, 6.2) y el hábito defumar cigarrillos por parte del companero (AOR 3.0, 95% CI 0.95, 9.4). CONCLUSIÓN: Las parejas múltiples y el sexo extramarital siguen siendo un estorbo para la lucha contra la infección por VIH. Promover el enfoque ABC puede reducir el comportamiento riesgoso, como ha ocurrido en otras partes de Africa.