Causes of preventable death among children of female sex worker mothers in low- and middle-income countries: A community knowledge approach investigation.

Background: Female sex workers (FSW) in low- and middle-income countries (LMIC) are disproportionately vulnerable to poor health, social, and economic outcomes. The children of female sex workers (CFSW) experience health risks based on these challenging circumstances and the unique conditions to which they are exposed. Although country child mortality data exist, little is known about the causes of death among CFSW specifically, thereby severely limiting an effective public health response to the needs of this high-risk group of children. Methods: The Community Knowledge Approach (CKA) was employed between January and October 2019 to survey a criterion sample of 1280 FSW participants across 24 cities in eight LMIC countries. Participants meeting pre-determined criteria provided detailed reports of deaths among the CFSW within their community of peers. Newborn deaths were gleaned from FSW maternal death reports where the infants also died following birth. Results: Of the 668 child deaths reported, 589 were included in the analysis. Nutritional deficiencies comprised the leading cause of mortality accounting for 20.7% of deaths, followed closely by accidents (20.0%), particularly house fires, overdoses (19.4%), communicable diseases (18.5%), and homicides (9.8%). Other reported causes of death included neonatal conditions, respiratory illnesses, and suicides. Conclusions: The causes of CFSW death in these eight countries are preventable with improved protections. Governments, intergovernmental organisations like the United Nations, nongovernmental stakeholder organisations (e.g. sex worker organisations), and funders can implement targeted policies and programmes to protect CFSW and assist vulnerable FSW who are pregnant and raising children. Further research is needed to identify effective child welfare safeguards for CFSW.

The preventable burden of mortality from unsafe abortion among female sex workers: a Community Knowledge Approach survey among peer networks in eight countries.

Previous studies have found high levels of unintended pregnancy among female sex workers (FSW), but less attention has been paid to their abortion practices and outcomes. This study is the first to investigate abortion-related mortality among FSW across eight countries: Angola, Brazil, Democratic Republic of Congo (DRC), India, Indonesia, Kenya, Nigeria, and South Africa. The Community Knowledge Approach (CKA) was used to survey a convenience sample of FSW (n = 1280). Participants reported on the deaths of peer FSW in their social networks during group meetings convened by non-governmental organisations (n = 165 groups, conducted across 24 cities in 2019). Details on any peer FSW deaths in the preceding five years were recorded. The circumstances of abortion-related deaths are reported here. Of the 1320 maternal deaths reported, 750 (56.8%) were due to unsafe abortion. The number of abortion-related deaths reported was highest in DRC (304 deaths reported by 270 participants), Kenya (188 deaths reported by 175 participants), and Nigeria (216 deaths reported by 312 participants). Among the abortion-related deaths, mean gestational age was 4.6 months and 75% occurred outside hospital. Unsafe abortion methods varied by country, but consumption of traditional or unknown medicines was most common (37.9% and 29.9%, respectively). The 750 abortion-related deaths led to 1207 children being left motherless. The CKA successfully recorded a stigmatised practice among a marginalised population, identifying very high levels of abortion-related mortality. Urgent action is now needed to deliver comprehensive sexual and reproductive healthcare to this vulnerable population, including contraption, safe abortion, and post-abortion care.

Causes of mortality among female sex workers: Results of a multi-country study.

Background: The vast majority of studies on female sex workers (FSW) focus on causes of morbidity while data on causes of mortality are scarce. In low- and middle-income countries, where civil registry and vital statistics data are often incomplete and FSW may not be identified as such in official registries, identifying causes of mortality among FSW has proven challenging. Methods: As part of a larger investigation on the maternal health of FSW, the current study used the Community Knowledge Approach (CKA) to identify causes of mortality among FSW in LMIC across three global regions in 2019. The CKA, validated to identify maternal, neonatal, and jaundice-associated deaths among women living in a community, was employed to identify deaths of any cause among communities of FSW. Study participants, recruited by in-country partner non-governmental organizations (NGOs) working with local FSW, provided detailed information about FSW deaths in their communities. Findings: 1280 FSW participated in 165 group meetings through which 2112 FSW deaths were identified. Of these reported deaths, 57·9% occurred in 2019 and 57·2% were among women aged 20-29. Causes of death included abortion (35·5%), other maternal causes (16·6%), suicide (13·6%), murder (12·5%), unclassified causes (11·6%), HIV/AIDS (7·9%), and accidents (3·2%). A total of 3659 children lost their mothers. Interpretation: Maternal death comprised the leading cause of FSW mortality in our sample. This methodology can be used by local governments and NGOs to identify unrecognized patterns and clusters of FSW deaths in near-real time and urgently steer targeted preventative strategies. Funding: New Venture Fund.

Controlled nucleation of lipid nanoparticles.

PURPOSE: We describe a nucleation-based method which allows for the generation of monodisperse lipid nanoparticles over a range of diameters. Using a set of novel zwitterionic lipids and inverse phosphocholine lipids with pKas ranging from 2 to 5, we showed how the hydrodynamic diameter of lipid nanoparticles can be systematically manipulated over a 60 nm to 500 nm size range. METHOD: Lipid nanoparticles were prepared by adding an anti-solvent, such as water, to the organic phase containing the lipid components. This led to super-saturation and the spontaneous formation of particles. RESULTS: The growth and final particle size was controlled by the ratio of the components in the ternary system: lipid, organic solvent and aqueous phase. Particles with diameter below 125 nm were formed under conditions where the super-saturation coefficient was between 2.3 and 20. PEG-lipid served as an efficient growth inhibitor except at very high and low lipid concentrations. Encapsulation efficiency of siRNA into lipid nanoparticles was shown to be pH-dependent and requires the protonation of the anionic carboxylate groups of the zwitterionic lipids, emphasizing the importance of electrostatic forces. CONCLUSION: This process enables high encapsulation efficiency of nucleic acids and allows the size of lipid nanoparticles to be controlled.

Inverse-phosphocholine lipids: a remix of a common phospholipid.

Zwitterionic inverse-phosphocholine (iPC) lipids contain headgroups with an inverted charge orientation relative to phosphocholine (PC) lipids. The iPC lipid headgroup has a quaternary amine adjacent to the bilayer interface and a phosphate that extends into the aqueous phase. Neutral iPC lipids with ethylated phosphate groups (CPe) and anionic iPC lipids nonethylated phosphate groups (CP) were synthesized. The surface potential of CPe liposomes remains negative across a broad pH range and in the presence of up to 10 mM Ca(2+). CP liposomes aggregate in the presence of Ca(2+), but at a slower rate than other anionic lipids. Hydrolysis of CP lipids by alkaline phosphatases generates a cationic lipid. CPe liposomes release encapsulated anionic carboxyfluorescein (CF) 20 times faster than PC liposomes and release uncharged glucose twice as fast as PC liposomes. As such, iPC lipids afford a unique opportunity to investigate the biophysical and bioactivity-related ramifications of a charge inversion at the bilayer surface.

Zwitterionic sulfobetaine lipids that form vesicles with salt-dependent thermotropic properties.

We describe a class of zwitterionic sulfobetaine (SB) lipids with fascinating salt-dependent properties. SB lipids are zwitter-neutral across a broad pH range; however they have negative surface potentials in the presence of anions and two salt-dependent transition temperatures. These new SB lipids provide insight on the role of charge orientation at the membrane interface and may be useful components in drug delivery systems.

Hetero-arylboroxines: the first rational synthesis, X-ray crystallographic and computational analysis.

A novel series of hetero-arylboroxines were synthesized and structurally characterized by X-ray diffraction, NMR and computational analysis. The solid-state structures of the hetero-arylboroxines represent the first report of AB(2)-type hetero-arylboroxines.