Growth patterns of normo-nourished Afghan, Haitian and Congolese children aged 6-59 months: A comparative study.

OBJECTIVES: International growth charts have been used in the past decades to identify atypical growth and diagnose the nutritional status of individuals. The aim of this study was to construct and compare growth patterns of normo-nourished children between 6-59 months from Afghanistan, Haiti, and the Democratic Republic of the Congo, to assess if it would be worth developing growth charts at a national level. METHODS: We used an international sample of 46 466 subjects (53.7% female; 46.3% male) from the aforementioned regions. To create the growth charts, we used different statistical methodologies: the Lambda-Mu-Sigma (LMS), LMSP, and LMST models, and regression models based on fractional polynomials. The LMSP models were the ones that fitted our data best and were therefore the ones used to make comparisons between countries using percentiles (3rd, 50th, and 97th). RESULTS: We found that Haitian children were both, taller and heavier than their Afghan and Congolese equals of the same ages. Moreover, differences were bigger in the highest percentiles (i.e., 97th percentile). These differences might be the result of the influence that genetics and diverse social and environmental contexts have on growth rates. CONCLUSIONS: Using the same international reference standards for all populations could result in the overestimation or underestimation of the proportion of malnourished children. In light of our results, we recommend the future development of national and regional growth charts to provide health workers with more precise tools to evaluate the nutritional status in the child population.

Sarcoma de Kaposi en pacientes que viven con el VIH en Guinea Ecuatorial / Kaposi sarcoma in patients living with HIV in Equatorial Guinea

Introducción: El sarcoma de Kaposi es una neoplasia oportunista asociada a la inmunodepresión causada por VIH, que se relaciona con la infección por VHH tipo 8. Objetivo: Describir la presentación del sarcoma de Kaposi en personas que viven con VIH en Guinea Ecuatorial. Métodos: Se realizó un estudio descriptivo de carácter retrospectivo para identificar la prevalencia y las características epidemiológicas y clínicas del sarcoma de Kaposi en las personas que viven con VIH que acuden a las unidades de referencia para el manejo de casos en Guinea Ecuatorial. Se revisaron las historias clínicas de una muestra aleatoria y representativa de 338 pacientes del grupo que ha recibido tratamiento en las unidades de referencia para enfermedades infecciosas de Bata, desde enero de 2007 a febrero de 2012. Resultados: Se identificaron 40 pacientes diagnosticados de sarcoma de Kaposi (prevalencia del 11, 83 por ciento). La mediana de la edad al diagnóstico de sarcoma de Kaposi fue de 43 años, siendo la ratio del sexo de 1/1. La media de linfocitos CD4 al diagnóstico fue de 166 (rango 21-375) y la frecuencia de afectación oral fue de 45 por ciento. En la mayoría de los pacientes (94,6 por ciento) la observación del sarcoma de Kaposi fue anterior al inicio del tratamiento antirretroviral. Las cifras de linfocitos T CD4/mm3 inferiores a 100 aparecían sobre todo en pacientes menores de 30 años, y esto era especialmente frecuente en el grupo de mujeres (OR 11, p <0,04, Ic 95 por ciento 0,8-148). Conclusiones: El sarcoma de Kaposi es una neoplasia prevalente en personas que viven con VIH seguidas en las unidades de referencia en Guinea Ecuatorial. En mujeres menores de 30 años podría existir un diagnóstico tardío(AU)

Introduction: Kaposi sarcoma is an opportunistic neoplasm associated to the immunosuppression caused by HIV and related to infection by HHV-8. Objective: Describe the presentation of Kaposi sarcoma in people living with HIV in Equatorial Guinea. Methods: A retrospective descriptive study was conducted to identify the prevalence and the clinical and epidemiological characteristics of Kaposi sarcoma in people living with HIV attending reference units for the management of cases in Equatorial Guinea. A review was carried out of the medical records of a random sample representative of 338 patients from the group receiving treatment at Bata reference unit for infectious diseases from January 2007 to February 2012. Results: A total 40 patients diagnosed with Kaposi sarcoma were identified (prevalence of 11,83 percent). Mean age at Kaposi sarcoma diagnosis was 43 years, with a 1/1 sex ratio. The mean CD4 lymphocyte count at diagnosis was 166 (range 21-375), whereas the frequency of oral damage was 45 percent. In most patients (94.6 percent) detection of Kaposi sarcoma was prior to the start of antiretroviral therapy. CD4 T lymphocyte levels / mm3 below 100 were mainly found in patients aged under 30 years, a fact particularly frequent among women (OR 11, p< 0.04, CI 95% 0.8-148). Conclusions: Kaposi sarcoma is a neoplasm prevailing in people living with HIV who attend reference units in Equatorial Guinea. Late diagnosis could exist among women aged under 30 years(AU)

Female eco-stability and severe malnutrition in children: Evidence from humanitarian aid interventions of Action Against Hunger in African, Asian and Latin American countries / Ecoestabilidad femenina y malnutrición severa infantil: Evidencia a partir de intervenciones de ayuda humanitaria de Acción Contra el Hambre en países africanos, asiáticos y latinoamericanos

Introduction: Previous evidences reported sex differences in nutritional status between boys and girls of the same community, living under identical conditions of food deprivation. The aim of the present study is to analyze the sexual differences in the prevalence of severe malnutrition in children under 5 years of age, who were subjected to food crisis. Methods: Data from humanitarian aid interventions carried out by Action Against Hunger between 2002 and 2010 in 24 countries were analyzed. These surveys were carried out in populations in Africa, Latin America and Asia that were in a serious food crisis. The sample consists of a total of 367,258 children (186,156 boys and 181,102 girls) aged (A) 6 to 59 months. Weight (W) and height (H) were measured according to SMART methodology. Prevalence of severe underweight (W/A <-3SD), wasting (W/H <-3SD) and stunting (H/A <-3SD) were calculated based on WHO Standards. Results: On the whole sample, the proportion of boys with severe underweigh was 9.8% compared to 7.3% for girls (p< 0.001). Severe wasting affected 3.9% of boys versus 2.5% of girls (p< 0.001). Differences were also notable in chronic malnutrition: 19.5% of boys and 15% of girls (p < 0.001) suffered stunting. Conclusion: The results support the idea of so-called female eco-stability, according to which females would be less sensitive to external factors that modulate ontogenetic development, while males would be most negatively affected by environmental aggressions (AU)

Introducción: Evidencias previas han reportado diferencias en la condición nutricional de niños y niñas pertenecientes a la misma comunidad y sometidos a idénticas condiciones de privación alimentaria. El objetivo del presente trabajo es analizar las diferencias sexuales en prevalencia de malnutrición severa en menores de 5 años, sometidos a situación de crisis alimentaria. Métodos: Se analizaron datos recogidos en intervenciones de ayuda humanitaria llevadas a cabo por Acción Contra el Hambre entre 2002 y 2010 en 24 países. Dichas intervenciones se efectuaron en poblaciones de Africa, Latinoamérica y Asia que se encontraban en situación de grave crisis alimentaria. La muestra se compone de un total de 367.258 menores (186,156 niños y 181,102 niñas) con edad (E) entre 6 y 59 meses. Se midió el peso (P) y la talla (T) siguiendo la metodología SMART y se estimó la prevalencia de severo bajo peso (P/E <-3DE), desnutrición aguda severa (P/T <-3DE) y desnutrición crónica severa (T/E <-3DE) de acuerdo a los estándares de la OMS. Resultados: Para el total de la muestra, la proporción de niños con severo bajo peso fue de 9,8% en comparación al 7,3% de niñas (p < 0.001). La desnutrición aguda severa afectó al 3,9% de los niños frente al 2,5% de las niñas (p< 0.001). Las diferencias también fueron notables en la desnutrición crónica: el 19, 5% de los niños frente al 15% de las niñas (p< 0,001) presentaron crecimiento retardado. Conclusiones: Los resultados avalan la idea de la denominada eco-estabilidad femenina, de acuerdo a la cual, las mujeres serian menos sensibles a los factores externos que modulan el desarrollo ontogénico, mientras los varones se verían más negativamente afectados por las agresiones medioambientales (AU)

Evaluación inicial del programa de prevención de la transmisión materno-infantil de la infección por el virus de la inmunodeficiencia humana en Guinea Ecuatorial / Initial evaluation of a programme to prevent mother-to-child transmission of human immunodeficiency virus infection in Equatorial Guinea

INTRODUCCIÓN: La prevalencia de la infección por el virus de la inmunodeficiencia humana (VIH) en gestantes en Guinea Ecuatorial (GE) es alta (7,3%). En 2008 se actualizó el protocolo de prevención de transmisión vertical (PTMH) de VIH para adaptarlo a las guías de la OMS vigentes. El objetivo de nuestro trabajo es describir las características y la evolución de los niños expuestos al VIH tras la introducción del protocolo. MÉTODOS: Estudio descriptivo retrospectivo de los hijos de madres con infección por VIH, en el Hospital Regional y Centro de Salud María Rafols en Bata (GE) seguidos desde junio de 2008 hasta noviembre de 2011. El diagnóstico de infección por VIH en los niños se basó en el protocolo de test rápidos serológicos. RESULTADOS: Se incluyeron 103 niños, y de ellos 47 eran varones. Un total de 53 pacientes (51%) completaron el seguimiento. Catorce niños (26%) fueron diagnosticados de infección por VIH (11 por diagnóstico presuntivo, 3 por persistencia de anticuerpos después de los 18 meses de vida). Seis niños (12%) fallecieron antes de un diagnóstico definitivo. El 52% de las madres recibieron tratamiento antirretroviral (TAR) durante el embarazo. La transmisión vertical en los niños cuyas madres recibieron TAR fue del 16% (3/19), frente al 43% (10/23) en los niños cuyas madres no lo recibieron (p = 0,05), y del 8% (1/13) en los niños cuyas madres recibieron TAR y el niño profilaxis posnatal (p < 0,05). CONCLUSIONES: En nuestra cohorte el cumplimiento del protocolo de PTMH ha sido todavía muy bajo. El tratamiento antirretroviral en mujeres embarazadas disminuyó la tasa de transmisión vertical, pero esta aún sigue siendo muy alta. Una elevada proporción de niños se perdieron durante el seguimiento, así que es prioritario desarrollar estrategias para evitarlo, así como medidas de diagnóstico virológico precoz

Background: The prevalence of human immunodeficiency virus (HIV)-iBACKGROUND: The prevalence of human immunodeficiency virus (HIV)-infected pregnant women in Equatorial Guinea (EG) has been reported as 7.3%. In 2008 an updated version of the PMTCT protocol was accepted according to the current WHO guidelines. The aim of this study was to describe the characteristics and outcome of children exposed to HIV after the introduction of the protocol. METHODS: A retrospective review was conducted on the clinical characteristics of the infants born to HIV-infected mothers in the Hospital Regional de Bata and Primary Health Care Centre Maria Rafols in Bata (EG) between June 2008 and November 2011. The diagnosis of HIV infection in children was based on rapid serology tests. RESULTS: A total of 103 children were included, of which 47 were males. Fifty three patients (51%) completed the follow-up (51%). Fourteen children (26%) were diagnosed with HIV infection (11 presumptive diagnosis, 3 due to persistence of antibodies at 18 months). Six children (12%) died before a definitive diagnosis. Just over than half (52%) of mothers received antiretroviral therapy (ART) during pregnancy. The transmission rate in children whose mothers received ART was 16% (3/19), compared with 43% (10/23) in children whose mothers did not receive it. Only one child was infected (8%) when the mother received ART, and child received postnatal prophylaxis. CONCLUSIONS: The PMTCT protocol compliance was still very low. Antiretroviral therapy in pregnant women decreased the rate of vertical transmission, but the rate still remains very high. Many children were lost to follow-up. Strategies to prevent loss to follow-up and methods for earlier virological diagnostic are needed

[Initial evaluation of a programme to prevent mother-to-child transmission of human immunodeficiency virus infection in Equatorial Guinea]. / Evaluación inicial del programa de prevención de la transmisión materno-infantil de la infección por el virus de la inmunodeficiencia humana en Guinea Ecuatorial.

BACKGROUND: The prevalence of human immunodeficiency virus (HIV)-infected pregnant women in Equatorial Guinea (EG) has been reported as 7.3%. In 2008 an updated version of the PMTCT protocol was accepted according to the current WHO guidelines. The aim of this study was to describe the characteristics and outcome of children exposed to HIV after the introduction of the protocol. METHODS: A retrospective review was conducted on the clinical characteristics of the infants born to HIV-infected mothers in the Hospital Regional de Bata and Primary Health Care Centre Maria Rafols in Bata (EG) between June 2008 and November 2011. The diagnosis of HIV infection in children was based on rapid serology tests. RESULTS: A total of 103 children were included, of which 47 were males. Fifty three patients (51%) completed the follow-up (51%). Fourteen children (26%) were diagnosed with HIV infection (11 presumptive diagnosis, 3 due to persistence of antibodies at 18 months). Six children (12%) died before a definitive diagnosis. Just over than half (52%) of mothers received antiretroviral therapy (ART) during pregnancy. The transmission rate in children whose mothers received ART was 16% (3/19), compared with 43% (10/23) in children whose mothers did not receive it. Only one child was infected (8%) when the mother received ART, and child received postnatal prophylaxis. CONCLUSIONS: The PMTCT protocol compliance was still very low. Antiretroviral therapy in pregnant women decreased the rate of vertical transmission, but the rate still remains very high. Many children were lost to follow-up. Strategies to prevent loss to follow-up and methods for earlier virological diagnostic are needed.