Biomarkers of Growth Faltering and Neurodevelopmental Delay in Children who are HIV-Exposed but Uninfected: A Systematic Review.

INTRODUCTION: Children who are HIV-exposed but uninfected (CHEU) are at risk of linear growth faltering and neurodevelopmental delay. Circulating biomarkers associated with these adverse outcomes may elucidate pathways of injury. OBJECTIVE: To identify biomarkers associated with growth faltering and neurodevelopmental delay in CHEU. METHODS: We performed a systematic review of electronic databases MEDLINE (1946-April 2021), EMBASE (1974-April 2021), Scopus (2004-April 2021), and PubMed (1985-April 2021), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42021238363). RESULTS: We found seven studies associating biomarker abnormalities and growth outcomes in CHEUs and two studies on biomarker abnormalities and neurodevelopmental delay. Biomarker abnormalities associated with growth restriction were: C-reactive protein (CRP), tumour necrosis factor (TNF), interferon-gamma (IFN-γ), interleukin (IL)-12p70, IFN-γ-induced protein-10 (CXCL10/IP-10), lipopolysaccharide binding protein (LBP), insulin-like growth factor-1 (IGF-1), and IGF-binding protein-1 (IGFBP-1). Biomarkers associated with motor, language, and cognitive delay were CRP, IFN-γ, IL-1ß, -2, -4, -6, -10, -12p70, neutrophil gelatinase-associated lipocalin (NGAL), granulocyte-macrophage colony-stimulating factor (GM-CSF), and matrix metalloproteinase- 9 (MMP-9). CONCLUSION: Elevated markers of inflammation (acute phase reactants, pro-inflammatory cytokines, chemokines) and intestinal microbial translocation are associated with growth faltering. Elevated markers of inflammation are associated with adverse neurodevelopment.

Impact of the COVID-19 pandemic on Muslim older immigrants in Edmonton, Alberta: A community-based participatory research project with a local mosque.

OBJECTIVE: Older Muslim immigrants experience multiple vulnerabilities living in Canada. This study explores the experiences of Muslim older adults during the COVID-19 pandemic to identify ways to build community resilience as part of a community-based participatory research partnership with a mosque in Edmonton, Alberta. METHODS: Using a mixed-methods approach, check-in surveys (n = 88) followed by semi-structured interviews (n = 16) were conducted to assess the impact of COVID-19 on older adults from the mosque congregation. Quantitative findings were reported through descriptive statistics, and thematic analysis guided the identification of key findings from the interviews using the socio-ecological model. RESULTS: Three major themes were identified in consultation with a Muslim community advisory committee: (a) triple jeopardy leading to loneliness, (b) decreased access to resources for connectivity, and (c) organizational struggles to provide support during the pandemic. The findings from the survey and interviews highlight various supports that were missing during the pandemic for this population. CONCLUSION: The COVID-19 pandemic exacerbated the challenges associated with aging in the Muslim population and contributed to further marginalization, with mosques being sites of support during times of crises. Policymakers and service providers must explore ways of engaging mosque-based support systems in meeting the needs of older Muslim adults during pandemics.

RéSUMé: OBJECTIF: Les immigrants musulmans âgés vivant au Canada sont confrontés à des vulnérabilités multiples. Cette étude explore les expériences des personnes âgées musulmanes durant la pandémie de COVID-19 afin d'identifier des moyens pour renforcer la résilience communautaire dans le cadre d'un partenariat de recherche participative communautaire (CBPR) avec une mosquée à Edmonton, en Alberta. MéTHODES: À l'aide d'une approche à méthodes mixtes, des enquêtes de contrôle (n = 88) suivies d'entretiens semi-dirigés (n = 16) ont été menés pour évaluer l'impact du COVID-19 sur les personnes âgées de la congrégation de la mosquée. Les résultats quantitatifs ont été rapportés au moyen de statistiques descriptives, tandis que l'analyse thématique a guidé l'identification des principaux résultats des entretiens à l'aide du modèle socio-écologique. RéSULTATS: Trois thèmes majeurs ont été identifiés en concertation avec un comité consultatif de la communauté musulmane : a) triple péril menant à la solitude, b) accès réduit aux ressources pour la connectivité, et c) luttes organisationnelles pour fournir un soutien pendant la pandémie. Les résultats de l'enquête et des entretiens mettent en évidence le manque d'aides diverses à cette population durant la pandémie. CONCLUSION: La pandémie de COVID-19 a exacerbé les défis associés au vieillissement de cette population et a contribué à une marginalisation supplémentaire, les mosquées étant des sites de soutien en temps de crise. Les décideurs politiques et les prestataires de services doivent explorer les moyens d'engager les systèmes d'aide basés dans les mosquées pour répondre aux besoins des adultes musulmans âgés pendant les pandémies.

Growth Faltering and Developmental Delay in HIV-Exposed Uninfected Ugandan Infants: A Prospective Cohort Study.

BACKGROUND: HIV-exposed but uninfected (HEU) infants are at increased risk of impaired early linear growth and cognitive development. We examined associations between prenatal and postnatal growth and subsequent neurodevelopment in Ugandan HEU infants, hypothesizing that early insults may explain alterations in both somatic growth and brain development. METHODS: We prospectively followed a cohort of HEU infants from birth to 18 months of age, and measured length/height, weight, head, and arm circumference longitudinally. The Malawi Development Assessment Tool (MDAT, 12 and 18 months) and the Color Object Association Test (18 months) were used for developmental assessments. RESULTS: Among 170 HEU infants, the prevalence of low-birth weight and failure to thrive was 7.6% and 37%, respectively. HEU infants had MDAT scores that were similar to the reference population. The mean (SD) score on the Color Object Association Test was 5.5 (3.1) compared with 6.9 (5.3) in developmentally normal children. Developmental ability at age 18 months showed strong cross-sectional correlation with weight-for-age (ρ = 0.36, P < 0.0001), length/height-for-age (ρ = 0.41, P < 0.0001), head circumference-for-age (ρ = 0.26, P = 0.0011), and mid-upper arm circumference-for-age (ρ = 0.34, P = 0.0014). There was a statistically significant correlation between birth weight and MDAT z-score at 18 months (ρ = 0.20, P = 0.010). Failure to thrive was associated with lower MDAT z-score [median -0.13 (IQR -0.75 to +0.14) versus +0.14 (IQR -0.44 to +0.63), P = 0.042]. CONCLUSION: Growth faltering in HEU infants was associated with lower attainment of developmental milestones at age 18 months. Our findings point to a simple screening method for identifying HEU infants at risk for developmental intervention.

Reproductive healthcare for women in IDP camps in Nigeria: An analysis of structural gaps.

Health and health service access for women displaced by terrorism from Northeast Nigeria is a serious problem. Existing government and humanitarian initiatives in Northeast Nigeria focus on food, security, housing, water and sanitation to the neglect of health access needs, especially access to reproductive health. With no policy in place and very little existing research, the systemic influences surrounding IDP women's health in Nigeria are not well understood. This study aimed to identify structural gaps influencing access to reproductive health care for women displaced by terrorism in Nigeria. The findings highlight important factors that undermine reproductive health access for internally displaced women: poor governance of the primary health care sector in Nigeria and insufficient co-ordination between the federal government and implementing agencies. Results have implications for policy and administrative restructuring in the primary health sector, as well as for improved funding allocation for the provision of reproductive health services. The Federal Government and all institutions managing healthcare funds should implement strategies to ensure strong leadership and accountability in health development assistance and practices. Specifically, a special taskforce should be established to co-ordinate and harmonise the development activities targeting improvements in the health and wellbeing of IDPs.

A Scoping Review of the Health of Conflict-Induced Internally Displaced Women in Africa.

Armed conflict and internal displacement of persons create new health challenges for women in Africa. To outline the research literature on this population, we conducted a review of studies exploring the health of internally displaced persons (IDP) women in Africa. In collaboration with a health research librarian and a review team, a search strategy was designed that identified 31 primary research studies with relevant evidence. Studies on the health of displaced women have been conducted in South- Central Africa, including Democratic Republic of Congo (DRC); and in Eastern, East central Africa, and Western Africa, including Eritrea, Uganda, and Sudan, Côte d'Ivoire, and Nigeria. We identified violence, mental health, sexual and reproductive health, and malaria and as key health areas to explore, and observed that socioeconomic power shifts play a crucial role in predisposing women to challenges in all four categories. Access to reproductive health services was influenced by knowledge, geographical proximity to health services, spousal consent, and affordability of care. As well, numerous factors affect the mental health of internally displaced women in Africa: excessive care-giving responsibilities, lack of financial and family support to help them cope, sustained experiences of violence, psychological distress, family dysfunction, and men's chronic alcoholism. National and regional governments must recommit to institutional restructuring and improved funding allocation to culturally appropriate health interventions for displaced women.

Obstetric fistula policy in Nigeria: a critical discourse analysis.

BACKGROUND: In 2012, Nigeria's Federal Ministry of Health published its National Strategic Framework for the Elimination of Obstetric Fistula (NSFEOF), 2011-2015. The framework has since lapsed and there is no tangible evidence that the goal of eliminating obstetric fistula was met. To further inform future policy directions on obstetric fistula in Nigeria, this paper explores how the NSFEOF conceptualized obstetric fistula and its related issues, including child marriage and early childbearing. METHODS: A critical discourse analysis of the policy was performed. We examined four policies in addition to the strategic framework: the Nigerian constitution; the Marriage Act; the Matrimonial Causes Act; and the National Reproductive Health Policy. We used the three phases of critical discourse analysis: textual analysis, analysis of discourse practice, and analysis of discursive events as instances of sociocultural practice. RESULTS: The analysis demonstrates that, despite its title, the policy document focuses on reduction rather than elimination of obstetric fistula. The overall orientation of the policy is downstream, with minimal focus on prevention. The policy language suggests victim blaming. Furthermore, the extent to which subnational stakeholders in government and civil society were engaged in decision-making process for developing this policy is ambiguous. Although the policy is ostensibly based on principles of social justice and equity, several rhetorical positions suggest that the Nigerian constitutional environment and justice systems make no real provisions to protect the reproductive rights of girls in accordance with the United Nations' "2030 Agenda for Sustainable Development." CONCLUSION: This analysis establishes that the Nigerian constitution, justice environment and the obstetric fistula policy itself do not demonstrate clear commitment to eradicating obstetric fistula. Specifically, a clear commitment to eradicating obstetric fistula would see the constitution and Marriage Act of Nigeria specify an age of consent that is consistent with the agenda to prevent obstetric fistula. Additionally, a policy to end obstetric fistulas in Nigeria must purposefully address the factors creating barrier to women's access to quality maternal healthcare services. Future policies and programs to eliminate obstetric fistulas should include perspectives of nurses, midwives, researchers and, women's interest groups.