An Evaluation of Risk Factors Associated with Pregnancy Related Acute Kidney Injury in Women Admitted to the High Dependency Care Unit at Women and Newborn Hospital, Lusaka-Zambia

Objective:To evaluate factors associated with Pregnancy-related KidneyInjury(PRAKI) inwomen admitted to high dependency care unit at Women and Newborn Hospital in Lusaka, ZambiaMethodology:This was an unmatched case-control study conducted in the high-dependency care unit at Women and Newborn Hospital in Lusaka. Study participantswererecruitedconsecutivelybyconveniencesampling.Participants'medicalrecords were reviewed to capture serum creatinine levels;whileastructuredquestionnairewasadministeredto eligible andconsentedstudy participants to capture data on sociodemographic, obstetric, and medical factors. Serum creatinine levels above 84µmol/l were used as criteria for classifying PRAKI. Excel was used for data cleaningandStatav13usedforanalysis.Descriptive statistics were done for all variables followed by univariate and multivariable logistic regression to determine association. 95% CI was usedand p value of<0.05 was consideredsignificant.Results:Thestudy comprised of185 study participants, split into 85 women with PRAKI (cases) and 100 women without PRAKI (controls). The median age was 29 years with 11years interquartile range. 75.3%of the study participants wereinmarriagerelationships.Pre-existinghypertension was the most prevalent medical condition in both the cases (51.8%) and the controls (38%). Sickle celldisease was much less common at 1.2% in cases and 8% in controls. Among the obstetric conditions, preeclampsia was the most common condition at 77.6% and 60% in cases and controls respectively. Eclampsia was found in 38.8% of cases and 11% of controls. Sepsis was least common at 4.7% of cases. This study found that obstetricfactorssuch as eclampsia (AOR = 5.12, 95% CI [2.14 ­ 12.23]; p≤0.0001), preeclampsia (AOR = 2.46, 95% CI [1.12 ­ 5.39]; p = 0.025), and postpartum haemorrhage were associated with the development of PRAKI. Medical conditions were not associated with PRAKI.

Association of socioeconomic status with adverse birth outcomes at the Women and Newborn Hospital of the University Teaching Hospitals in Lusaka, Zambia

Background: Low socioeconomic status has generally been associated with adverse birth outcomes worldwide. Adverse birth outcomes significantly contribute to perinatal morbidity and mortality worldwide with some literatures showing conflicting results. At Women and New-born Hospital in Zambia, this relationship had remained unclear among women who experienced poor neonatal outcome; hence the study was done to explore this association between socioeconomic status and adverse birth outcomes. Methods: A retrospective cohort study was conducted. Secondary data from ZAPPS study that had been collected prospectively between August 2015 and September 201 7 was retrieved. Altogether, 1,450 participants' information was retrieved, out of which 1,084 data records were set out for analysis after excluding those not meeting eligibility criteria. Socioeconomic status was an explanatory variable which was estimated using the standardized wealth score derived from principal component analysis of 14 variables. The wealth quintiles were further categorised into poor and not poor. Response variables were low birth weight, preterm birth and small for gestation age. SPSS version 21 was used for data analysis and p value< 0.05 was significant Results: This study found the incidences of SGA, LBW and preterm births to be 164, 124 and 13 5 per 1000 live births respectively. In survival analysis, the proportion of babies who survived LBW among mothers who were poor was lower (82.9%) compared to babies born to rich mothers (87.5%) (p-value = 0.189). Furthermore, the proportion of babies who survived SGA for the poor was lower (79 .1 % ) compared to babies born to none poor mothers (85.8%) (p-value = 0.032) and preterm birth for the poor (78.4%) compared to babies born to mothers who were rich (83 .6%) (p-value = 0.022). In multiple Cox regression analysis socioeconomic status was not a significant risk factor for SGA ( aHR = 1.08; 95% CI; p=0.099), LBW and preterm birth (aHR = 1.17; 95% CI; p= l.41). However, male babies (aHR = 1.80; 95% CI; p=0.012), domestic violence or abuse during pregnancy (aHR = 3.48; 95% CI [1.59 - 7.34]; p = 0.002) and maternal anaemia (aHR = 2.1; 95% CI; p = 0.019) were risk factors for SGA while prior preterm birth ( aHR = 2.02; 95% CI; p = 0.002), HIV infection (aHR = 1.22; 95% CI; p = 0.040) and anaemia (aHR = 1.37; 95% CI; p = 0.009) were predictors of preterm delivery. Conclusion: There was no statistically significant association between low socioeconomic status and adverse birth outcomes although being pregnant with a male baby, HIV infection, anaemia and prior preterm birth were significantly associated with SGAand preterm

Nutritional status is the major factor affecting grip strength of African HIV patients before and during antiretroviral treatment.

OBJECTIVES: Low grip strength is a marker of frailty and a risk factor for mortality among HIV patients and other populations. We investigated factors associated with grip strength in malnourished HIV patients at referral to ART, and at 12 weeks and 2-3 years after starting ART. METHODS: The study involved HIV-infected Zambian and Tanzanian participants recruited to the NUSTART trial when malnourished (body mass index <18.5 kg/m2 ) and requiring ART. The relationship of grip strength to nutritional, infectious and demographic factors was assessed by multivariable linear regression at referral for ART (n = 1742) and after 12 weeks (n = 778) and 2-3 years of ART (n = 273). RESULTS: In analyses controlled only for sex, age and height, most nutrition and infection-related variables were associated with grip strength. However, in multivariable analyses, consistent associations were seen for fat-free mass index, mid-upper arm circumference, haemoglobin and systolic blood pressure, and a variable association with fat mass index in men. C-reactive protein and CD4 count had limited independent effects on grip strength, while receiving tuberculosis treatment was associated with weaker grip strength. CONCLUSIONS: In this population of originally malnourished HIV patients, poor grip strength was more strongly and independently associated with nutritional than with infection and inflammation variables. Programmes to improve health and survival of HIV patients should incorporate nutritional assessment and management and could use grip strength as a functional indicator of improving nutrition.

Effect of multiple micronutrient-fortified food on mild morbidity and clinical symptoms in Zambian infants: results from a randomised controlled trial.

BACKGROUND/OBJECTIVES: We aimed to assess the effects on mild morbidity of a richly micronutrient-fortified complementary/replacement food given to Zambian infants aged 6-18 months. Previous results (The Chilenje Infant Growth, Nutrition and Infection Study Team, 2010) showed an increase in the rate of hospital referral for pneumonia in the same cohort. SUBJECT/METHODS: A total of 743 six-month-old healthy Zambian infants were randomised to receive either a richly or a basal micronutrient-fortified porridge for 12 months. Mild morbidity was defined as an illness that did not cause death or require hospitalisation and was diagnosed on clinical examination at scheduled visits. RESULTS: There was no evidence of an effect of trial arm on overall mild morbidity during the study (odds ratio (OR)=1.04, 95% confidence interval (CI)=0.90, 1.20, P=0.62). Infants in the richly fortified arm had significantly more visits in which they were diagnosed with lower respiratory tract infections/pneumonia (OR=1.65, 95% CI=1.06, 2.59, P=0.03) and fewer visits in which a diagnosis of urinary tract infection was made (OR=0.43, 95% CI=0.21, 0.87, P=0.02). Maternally reported symptoms were similar between trial arms. CONCLUSION: Compared with the basal diet, the richly micronutrient-fortified food was associated with more episodes of lower respiratory infections/pneumonia diagnosed at scheduled visits, which reinforces our previously reported findings of a higher incidence in hospital referral for pneumonia.

Early growth of infants of HIV-infected and uninfected Zambian women.

OBJECTIVE: Parental HIV infection may affect even those exposed children who remain uninfected. We investigated early growth, an indicator of overall health, of infants born to Zambian mothers recruited for a study of breastfeeding and postpartum health. METHODS: HIV-infected and uninfected women in Lusaka were followed regularly from late pregnancy to 16 weeks postpartum. Infant weight and length were measured at birth, 6 and 16 weeks. Infant HIV status could not be specifically determined in this cohort so comparisons were between all infants of HIV-uninfected mothers (n = 184) and those infants of HIV-infected mothers who were known to be alive and showed no clinical evidence of HIV infection at age 2-4 years (n = 85). RESULTS: Most infants were exclusively or predominantly breastfed until 16 weeks. At all time points infants of HIV-infected mothers tended to have lower weight and length standard deviation (Z) scores (significant for weight at 6 weeks; P = 0.04), even after adjustment for their lower gestational age at birth, compared with infants of uninfected mothers. In multivariate analyses the major factors affecting weight or length at 6 or 16 weeks of age were birth weight or length, and maternal subclinical mastitis, primiparity and weight during pregnancy. CONCLUSIONS: Early growth of infants of HIV-infected mothers is less than that of uninfected mothers, in part associated with subclinical mastitis, and this effect cannot be overcome with intensive support of mothers to follow international recommendations regarding exclusive breastfeeding.

Factors associated with postpartum physical and mental morbidity among women with known HIV status in Lusaka, Zambia.

The objective of our study was to investigate factors associated with postpartum physical and mental morbidity among women in Lusaka, Zambia with particular reference to known HIV status. Our study was part of the Breastfeeding and Postpartum Health (BFPH) longitudinal cohort study conducted between June 2001 and July 2003. Women were recruited at 34 weeks gestation and followed up to 16 weeks postpartum. Data on maternal health were collected at 3, 7, 10, and 14 days and at 3, 4, 5, 6, 9, 12, and 16 weeks postpartum. Maternal mental health data were collected from April 2002 onwards at recruitment and at seven days and six weeks postpartum. Data on physical morbidity were collected for 429 women (218 HIV-negative, 211 HIV-positive) and data on mental morbidity were collected for 272 women (134 HIV-negative, 138 HIV-positive). Multivariate logistic regression was used to examine factors associated with postpartum physical or mental morbidity. Postpartum physical morbidity was associated with HIV status, parity > or =5 and age < 20 years. Neither antenatal nor postpartum mental morbidity, as indicated by a self-reporting questionnaire 20-item (SRQ-20) score > or =7, were associated with HIV status or with postpartum physical morbidity in this population. Larger comparative studies are required to corroborate or contest these findings.

Maternal micronutrient status and decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African drought of 2001-2002.

OBJECTIVE: To investigate the effects on maternal micronutrient status and infant growth of the increased maize prices that resulted from the southern African drought of 2001-2002. DESIGN: Longitudinal cohort study. SETTING: A maternal and child health clinic in Lusaka, Zambia. SUBJECTS: Maternal and infant health and nutrition data and maternal plasma were being collected for a study of breast-feeding and postpartum health. Samples and data were analysed according to whether they were collected before (June to December 2001), during (January 2002 to April 2003) or after (May 2003 to January 2004) the period of increased maize price. Season and maternal HIV status were controlled for in analyses. RESULTS: Maize price increases were associated with decreased maternal plasma vitamin A during pregnancy (P = 0.028) and vitamin E postpartum (P = 0.042), with the lowest values among samples collected after May 2003 (vitamin A: 0.96 micromol l(-1), 95% confidence interval (CI) 0.84-1.09, n = 38; vitamin E: 30.8 micromol mmol(-1) triglycerides, 95% CI 27.2-34.8, n = 64) compared with before January 2002 (vitamin A: 1.03 micromol l(-1), 95% CI 0.93-1.12, n = 104; vitamin E: 38.9 micromol mmol(-1) triglycerides, 95% CI 34.5-43.8, n = 47). There were no significant effects of sampling date on maternal weight, haemoglobin or acute-phase proteins and only marginal effects on infant weight. Infant length at 6 and 16 weeks of age decreased progressively throughout the study (P-values for time of data collection were 0.51 at birth, 0.051 at 6 weeks and 0.026 at 16 weeks). CONCLUSIONS: The results show modest effects of the maize price increases on maternal micronutrient status. The most serious consequence of the price increases is likely to be the increased stunting among infants whose mothers experienced high maize prices while pregnant. During periods of food shortages it might be advisable to provide micronutrient supplements even to those who are less food-insecure.

Barriers to accessing safe motherhood and reproductive health services: the situation of women with disabilities in Lusaka, Zambia.

PURPOSE: To ascertain how well health services in Lusaka, Zambia currently meet the safe motherhood and reproductive health care needs of women who have physical impairment leading to disability. METHODS: A qualitative study was conducted in Lusaka, Zambia. In-depth tape-recorded interviews were conducted with 24 purposively selected women with disabilities and with 25 safe motherhood/reproductive public sector health service providers. Qualitative analysis was conducted using NVivo software. RESULTS: Women with disabilities encounter various social, attitudinal and physical barriers to accessing safe motherhood and reproductive health (RH) services in this particular setting. The strong desire for children and affection can increase vulnerability to sexual exploitation. At the same time, a generalized assumption among reproductive health service providers that women with disabilities will not be sexually active, and not require RH services, leads to increased vulnerability to sexually transmitted infection including HIV. Once pregnant, traditional beliefs about transmission of disabilities can create barriers to integration in ante-natal clinics. Nurse-midwives' fear of delivery complications in women with physical impairments can also result in routine over-referral to a tertiary maternity facility which is outside the locality and harder for women with mobility limitations to get to. CONCLUSION: Greater understanding of the influences underpinning societal attitudes towards sexuality and disability in this setting, and more extensive communication between health care staff and women with disabilities would facilitate positive action towards improving safe motherhood and reproductive health services for women with disabilities.