Seasonality of adverse birth outcomes in women with and without HIV in a representative birth outcomes surveillance study in Botswana

IntroductionSub-Saharan Africa has the largest number of people with HIV, one of the most severe burdens of adverse birth outcomes globally and particular vulnerability to climate change. We examined associations between seasonality and adverse birth outcomes among women with and without HIV in a large geographically representative birth outcomes surveillance study in Botswana from 2015 to 2018.MethodsWe evaluated stillbirth, preterm delivery, very preterm delivery, small for gestational age (SGA), very SGA, and combined endpoints of any adverse or severe birth outcome. We estimated the risk of each outcome by month and year of delivery, and adjusted risks ratios (ARRs) of outcomes during the early wet (1 November–15 January), late wet (16 January–31 March) and early dry (1 April–15 July) seasons, compared with the late dry (16 July–31 October) season. Analyses were conducted overall and separately by HIV status.ResultsAmong 73 178 women (24% with HIV), the risk of all adverse birth outcomes peaked in November–January and reached low points in September. Compared with the late dry season, the ARRs for any adverse birth outcome were 1.03 (95% CI 1.00 to 1.06) for the early dry season, 1.08 (95% CI 1.04 to 1.11) for the early wet season and 1.07 (95% CI 1.03 to 1.10) for the late wet season. Comparing the early wet season to the late dry season, we found that ARRs for stillbirth and very preterm delivery were higher in women with HIV (1.23, 95% CI 0.96 to 1.59, and 1.33, 95% CI 1.10 to 1.62, respectively) than in women without HIV (1.07, 95% CI 0.91 to 1.26, and 1.19, 95% CI 1.04 to 1.36, respectively).ConclusionsWe identified a modest association between seasonality and adverse birth outcomes in Botswana, which was greatest among women with HIV. Understanding seasonal patterns of adverse birth outcomes and the role of HIV status may allow for mitigation of their impact in the face of seasonal extremes related to climate change.

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The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab366 ◽

2021 ◽

Author(s):

Christina Fennell ◽

Modeigi Diseko ◽

Rebecca Zash ◽

Gloria Mayondi ◽

Judith Mabuta ◽

...

Keyword(s):

Pregnant Women ◽

Preterm Delivery ◽

Birth Outcomes ◽

Vaginal Discharge ◽

Adverse Birth Outcomes ◽

Infant Outcomes ◽

Syndromic Management ◽

Very Preterm ◽

Immortal Time Bias ◽

In Pregnancy

Abstract Background Vaginal discharge syndrome (VDS) is a common clinical diagnosis during pregnancy in Botswana, treated with broad spectrum antibiotics using a syndromic approach. We evaluated associations between the syndromic management of VDS and adverse birth outcomes. Methods The Tsepamo Study performs birth outcomes surveillance at government hospitals throughout Botswana. Obstetric record data collected from August 2014–March 2019 were analyzed. Chi-square tests were conducted to compare proportions of maternal characteristics and infant outcomes. To avoid immortal time bias, all analyses were conducted among women who presented to care prior to 24 weeks gestation, with VDS categorized as present or absent by 24 weeks gestation. Log-binomial regression models were generated to determine associations between treated VDS and infant outcomes. Results VDS was diagnosed in 36,731 (30.7%) pregnant women, of whom 33,328 (90.7%) received antibiotics. Adjusted analyses yielded a harmful association between treated VDS and very preterm delivery (aRR= 1.11; 95% CI, 1.02, 1.21). This association remained when restricting to women with VDS who received the recommended combined treatment regimen. Sensitivity analyses produced non-significant associations when women with treated VDS were compared to women without VDS who received antibiotics for other indications. Conclusions Syndromic treatment for VDS is common among pregnant women in Botswana, and the majority receive antibiotics in pregnancy. Although analyses of VDS occurring later in pregnancy are precluded by immortal time bias, a modest association between treated VDS and very preterm delivery was observed among women diagnosed with VDS by 24 weeks gestation.

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Adverse birth outcomes among women who gave births at Eastern Ethiopian Hospitals: a cross sectional study

10.21203/rs.3.rs-22703/v1 ◽

2020 ◽

Author(s):

Teshale Mulatu Dibisa ◽

Adera Debela Kebede ◽

Tilaye Feto Gelano ◽

Yadeta Dessie Bacha ◽

Kemal Jemal

Keyword(s):

Birth Outcomes ◽

Birth Outcome ◽

Multiple Pregnancy ◽

Neonatal Morbidity ◽

Cross Sectional Study ◽

Adverse Birth Outcome ◽

Adverse Birth Outcomes ◽

Cross Sectional ◽

Eastern Ethiopia ◽

History Of

Abstract Background Adverse births outcomes (ABO) such as preterm birth, low birth weight (LBW) and stillbirth are important determining of neonatal morbidity and mortality. It is the major public health problem in low resourced countries. Despite many efforts to reduce neonatal morbidity and mortality, adverse birth outcomes in hospitals has remained high. Therefore, this study aimed to assess the prevalence and factors associated with adverse birth outcomes among women who gave birth at selected public hospitals in Eastern Ethiopia. Methods Facility based cross-sectional study design was conducted in February 2017. Data were collected using a pretested and structured face to face interviewer-administered questionnaire. Binary logistic regression was used to analyze the association between the dependent and independent variables. Results A total of 555 women who give births were involved from four hospitals in Eastern Ethiopia. The prevalence of low birth weight, stillbirth and preterm births were 40(7.2%), 37(6.7%) and 28(5%) respectively. The overall prevalence of adverse birth outcomes was 76(13.7%). Four-ninth 247(44.5%) of mothers had high-risk pregnancies. Hypertension [AOR = 7.25; 95%, CI= (1.71, 30.64)], history of adverse birth outcome [AOR = 12.12; 95%, CI= (6.5, 22.6)], multiple pregnancy [AOR = 6.94; 95%, CI= (2.74, 17.53)] and spontaneous vaginal delivery [AOR = 0.11; 95%, CI= (0.44, 0.16)] were associated with adverse birth outcome. Conclusion In this study adverse birth outcomes were still found as public health problems. Hypertension, history of adverse birth outcome, multiple pregnancy and spontaneous vaginal delivery were significantly associated with ABO. Thus, developing strategies to prevent and treat complications during pregnancy and increasing maternal health utilization at ANC clinics are warranted.

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Paternal age and the risk of low birth weight and preterm delivery: a Finnish register-based study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2017-210170 ◽

2018 ◽

Vol 72 (12) ◽

pp. 1104-1109 ◽

Cited By ~ 6

Author(s):

Alice Goisis ◽

Hanna Remes ◽

Kieron Barclay ◽

Pekka Martikainen ◽

Mikko Myrskylä

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Delivery ◽

Birth Outcomes ◽

Conclusive Evidence ◽

Paternal Age ◽

Adverse Birth Outcomes ◽

Maternal Characteristics ◽

Parental Characteristics ◽

Increased Risk

BackgroundBased on existing studies, there is no conclusive evidence as to whether and why paternal age matters for birth outcomes.MethodsWe used Finnish population registers on 106 652 children born 1987–2000. We first document the unadjusted association between paternal age and the risk of low birth weight (LBW; <2500 g) and preterm birth (<37 weeks’ gestation). Second, we investigate whether the unadjusted association is attenuated on adjustment for child’s, maternal and parental socioeconomic characteristics. Third, by adopting a within-family design which involves comparing children born to the same father at different ages, we additionally adjust for unobserved parental characteristics shared between siblings.ResultsThe unadjusted results show that being born to a father aged 40+, as opposed to a father aged 30–34, is associated with an increased risk of LBW of 0.96% (95% CI 0.5% to 1.3%) and to a younger father (<25) with a 1% (95% CI 0.6% to 1.3%) increased risk. The increased risk at younger paternal ages is halved on adjustment for the child’s characteristics and fully attenuated on adjustment for child/parental characteristics. The increased risk at paternal ages 40+ is partially attenuated on adjustment for maternal characteristics (β=0.62%; 95% CI 0.13% to 1.1%). Adjustment for unobserved parental characteristics shared by siblings further attenuates the 40+ coefficient (β=0.4%; 95% CI −0.5% to −1.2%). Results for preterm delivery are similar.ConclusionsThe results underscore the importance of considering paternal age as a potential risk factor for adverse birth outcomes and of expanding research on its role and the mechanisms linking it to birth outcomes.

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Seasonal and successional dynamics of size-dependent plant demographic rates in a tropical dry forest

PeerJ ◽

10.7717/peerj.9636 ◽

2020 ◽

Vol 8 ◽

pp. e9636

Author(s):

Irving Saenz-Pedroza ◽

Richard Feldman ◽

Casandra Reyes-García ◽

Jorge A. Meave ◽

Luz Maria Calvo-Irabien ◽

...

Keyword(s):

Climate Change ◽

Tropical Forests ◽

Dry Season ◽

Dry Forest ◽

Species Density ◽

Wet Season ◽

Successional Stage ◽

Size Dependent ◽

Demographic Rates ◽

Successional Stages

Tropical forests are globally important for biodiversity conservation and climate change mitigation but are being converted to other land uses. Conversion of seasonally dry tropical forests (SDTF) is particularly high while their protection is low. Secondary succession allows forests to recover their structure, diversity and composition after conversion and subsequent abandonment and is influenced by demographic rates of the constituent species. However, how these rates vary between seasons for different plant sizes at different successional stages in SDTF is not known. The effect of seasonal drought may be more severe early in succession, when temperature and radiation are high, while competition and density-dependent processes may be more important at later stages, when vegetation is tall and dense. Besides, the effects of seasonality and successional stage may vary with plant size. Large plants can better compete with small plants for limiting resources and may also have a greater capacity to withstand stress. We asked how size-dependent density, species density, recruitment and mortality varied between seasons and successional stages in a SDTF. We monitored a chronosequence in Yucatan, Mexico, over six years in three 0.1 ha plots in each of three successional stages: early (3–5 years-old), intermediate (18–20 years-old) and advanced (>50 years-old). Recruitment, mortality and species gain and loss rates were calculated from wet and dry season censuses separately for large (diameter > 5 cm) and small (1–5 cm in diameter) plants. We used linear mixed-effects models to assess the effects of successional stage, seasonality and their changes through time on demographic rates and on plant and species density. Seasonality affected demographic rates and density of large plants, which exhibited high wet-season recruitment and species gain rates at the early stage and high wet-season mortality at the intermediate stage, resulting in an increase in plant and species density early in succession followed by a subsequent stabilization. Small plant density decreased steadily after only 5 years of land abandonment, whereas species density increased with successional stage. A decline in species dominance may be responsible for these contrasting patterns. Seasonality, successional stage and their changes through time had a stronger influence on large plants, likely because of large among-plot variation of small plants. Notwithstanding the short duration of our study, our results suggest that climate-change driven decreases in rainy season precipitation may have an influence on successional dynamics in our study forest as strong as, or even stronger than, prolonged or severe droughts during the dry season.

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Future Climate Change Renders Unsuitable Conditions for Paramo Ecosystems in Colombia

Sustainability ◽

10.3390/su12208373 ◽

2020 ◽

Vol 12 (20) ◽

pp. 8373

Author(s):

Matilda Cresso ◽

Nicola Clerici ◽

Adriana Sanchez ◽

Fernando Jaramillo

Keyword(s):

Climate Change ◽

Greenhouse Gas Emission ◽

Dry Season ◽

Capital City ◽

Maximum Temperature ◽

Future Climate Change ◽

Mountain Range ◽

Wet Season ◽

Temperature And Precipitation ◽

The Future

Paramo ecosystems are tropical alpine grasslands, located above 3000 m.a.s.l. in the Andean mountain range. Their unique vegetation and soil characteristics, in combination with low temperature and abundant precipitation, create the most advantageous conditions for regulating and storing surface and groundwater. However, increasing temperatures and changing patterns of precipitation due to greenhouse-gas-emission climate change are threatening these fragile environments. In this study, we used regional observations and downscaled data for precipitation and minimum and maximum temperature during the reference period 1960–1990 and simulations for the future period 2041–2060 to study the present and future extents of paramo ecosystems in the Chingaza National Park (CNP), nearby Colombia’s capital city, Bogotá. The historical data were used for establishing upper and lower precipitation and temperature boundaries to determine the locations where paramo ecosystems currently thrive. Our results found that increasing mean monthly temperatures and changing precipitation will render 39 to 52% of the current paramo extent in CNP unsuitable for these ecosystems during the dry season, and 13 to 34% during the wet season. The greatest loss of paramo area will occur during the dry season and for the representative concentration pathway (RCP) scenario 8.5, when both temperature and precipitation boundaries are more prone to be exceeded. Although our initial estimates show the future impact on paramos and the water security of Bogotá due to climate change, complex internal and external interactions in paramo ecosystems make it essential to study other influencing climatic parameters (e.g., soil, topography, wind, etc.) apart from temperature and precipitation.

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Adverse Birth Outcomes in Botswana Among Women With Vertically or Horizontally Acquired Human Immunodeficiency Virus

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa051 ◽

2020 ◽

Author(s):

Christina Fennell ◽

George R Seage ◽

Rebecca Zash ◽

Kelesitse Phiri ◽

Modiegi Diseko ◽

...

Keyword(s):

Birth Outcomes ◽

Neonatal Death ◽

Regression Models ◽

Antiretroviral Treatment ◽

Birth Outcome ◽

Adverse Birth Outcomes ◽

Binomial Regression ◽

Immunodeficiency Virus ◽

Risk Ratios ◽

In Pregnancy

Abstract Background Women with vertically acquired HIV (VHIV) may have a greater risk of adverse birth outcomes than women with horizontally acquired HIV (HHIV). Methods The Tsepamo study performed birth outcomes surveillance at 8 government delivery sites in Botswana from July 2014 through March 2019. Pregnant women diagnosed with HIV before their 11th birthday received VHIV status, and other women had HHIV. Small for gestational age (SGA), preterm delivery (PTD), stillbirth, and neonatal death were compared using χ2 and Fisher’s exact tests. Log-binomial regression models determined risk ratios (RRs). Results VHIV women (n = 402) aged 15–27 years were identified over 4 years of surveillance and compared with HHIV women (n = 8465) of the same age. VHIV women were more likely to use nevirapine (NVP)-based antiretroviral treatment (ART) in pregnancy and to have SGA and very SGA infants, but less likely to have very PTD infants. In unadjusted analyses, VHIV women had a higher risk of any adverse birth outcome combined (RR = 1.21, 95% confidence interval [CI], 1.08–1.36). After adjusting for potential confounders, particularly use of NVP-based regimens, the risk of adverse birth outcomes among VHIV and HHIV women was similar. Conclusions NVP-based ART is a primary and modifiable risk factor for adverse birth outcomes. Updating ART regimens could improve birth outcomes for women with HIV.

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Downscaled Climate Change Projections for Wa District in the Savanna Zone of Ghana

Journal of Disaster Research ◽

10.20965/jdr.2014.p0422 ◽

2014 ◽

Vol 9 (4) ◽

pp. 422-431 ◽

Cited By ~ 7

Author(s):

Emmanuel Tachie-Obeng ◽

◽

Bruce Hewitson ◽

Edwin Akonno Gyasi ◽

Mark Kofi Abekoe ◽

...

Keyword(s):

Climate Change ◽

Local Level ◽

Control Period ◽

Dry Season ◽

Future Climate ◽

Future Climate Change ◽

Wet Season ◽

Annual Variations ◽

Near Future ◽

Savanna Zone

The possibility of future climate change in Ghana has received much attention due to repeated droughts and floods over the last decades. The savanna zone which is described as the food basket of Ghana is highly susceptible to climate change impact. Scenarios from 20-year time slices of the near future – 2046-2065 – and the far future – 2081-2100 – climate change meant to help guide policy remain a challenge. Empirical downscaling performed at the local-scale of Wa District in the savanna zone of Ghana under the IPCC A2 SRES emissions scenario showed evidence of probable climate change with mean annual temperatures expected to increase over an estimated range of 1.5°C to 2.3°C in the near future, with number of cool nights becoming less frequent, especially during the Harmattan1 period. The dry season is expected to be warmer than the wet season, with high inter-annual variations projected in both maximum (Tmax) and minimum (Tmin) temperatures. Given an average of 1 day of Tmax > 40°C per month in the control period of 1961-2000, the number of hot days is expected to increase to 12 by 2046-2065. An increase in total rainfall is projected with possible shifts in distribution toward the end of the year, with a slight increase in rainfall during the dry season and an increase of rainfall at the onset and toward the end of the wet season. However, a decrease in June rainfall is projected in the wet season. The objective of this paper is to improve the understanding of future climate as a guide to local level medium-term development plans of effective adaptation options for Wa district in the savanna zone of Ghana.

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Future Changes in Wet and Dry Season Characteristics in CMIP5 and CMIP6 simulations

Journal of Hydrometeorology ◽

10.1175/jhm-d-21-0017.1 ◽

2021 ◽

Author(s):

Caroline M. Wainwright ◽

Emily Black ◽

Richard P. Allan

Keyword(s):

Climate Change ◽

South America ◽

West Africa ◽

Southern Africa ◽

Dry Season ◽

Maximum Temperature ◽

Wet Season ◽

Dry Spells ◽

Dry Spell ◽

Spell Length

AbstractClimate change will result in more dry days and longer dry spells, however, the resulting impacts on crop growth depend on the timing of these longer dry spells in the annual cycle. Using an ensemble of Coupled Model Intercomparison Project Phase 5 and Phase 6 (CMIP5 and CMIP6) simulations, and a range of emission scenarios, here we examine changes in wet and dry spell characteristics under future climate change across the extended tropics in wet and dry seasons separately. Delays in the wet seasons by up to two weeks are projected by 2070-2099 across South America, Southern Africa, West Africa and the Sahel. An increase in both mean and maximum dry spell length during the dry season is found across Central and South America, Southern Africa and Australia, with a reduction in dry season rainfall also found in these regions. Mean dry season dry spell lengths increase by 5-10 days over north-east South America and south-west Africa. However, changes in dry spell length during the wet season are much smaller across the tropics with limited model consensus. Mean dry season maximum temperature increases are found to be up to 3°C higher than mean wet season maximum temperature increases over South America, Southern Africa and parts of Asia. Longer dry spells, fewer wet days, and higher temperatures during the dry season may lead to increasing dry season aridity, and have detrimental consequences for perennial crops.

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Quantifying Factors Associated With Birth Outcomes and Their Implications on Evaluating the Success of a Maternal Respiratory Syncytial Virus (RSV) Vaccine Program in Kenya

10.21203/rs.3.rs-724011/v1 ◽

2021 ◽

Author(s):

Joyce U. Nyiro ◽

Elizabeth Bukusi ◽

Dufton Mwaengo ◽

David Walumbe ◽

Amek Nyaguara ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Birth Outcomes ◽

Birth Outcome ◽

Home Delivery ◽

Surveillance Systems ◽

Adverse Birth Outcomes ◽

Cross Sectional Survey ◽

Care Clinic ◽

Factors Associated ◽

Syncytial Virus

Abstract BackgroundMaternal immunisation to prevent respiratory syncytial virus (RSV) associated disease among infants is in focus. However, little is known about adverse birth outcomes and associated factors occurring in a setting with high morbidities of malaria, HIV infection and undernutrition. Quantifying these ahead of introduction of a maternal vaccine would assist in assessing an association between RSV vaccination and adverse birth outcomes. MethodsA cross-sectional survey was conducted to collect data on birth outcomes from women residents of the health and demographic surveillance systems (HDSS) of Siaya and Kilifi, Kenya and from the maternity wards of Siaya County referral hospital and Bondo sub-county hospital. Participants of the HDSS sites had pregnancies registered in the years 2017 to 2020 through census rounds and were traced at home for interview. All women had a birth outcome by the time of data collection. Multiple logistic regression was used to determine independent predictors of adverse birth outcomes. Results A total of 2219 women were interviewed. Median age during pregnancy was 27.7yrs (range: 22.7-32.4), 1857 (83.7%) attended antenatal care clinic (ANC), 1,979 (89.2%) delivered at a health facility and 2204 (99.3%) reported they would take up a new maternal vaccine. Adverse birth outcomes occurred in 781 (35%) of pregnancies; 490 (62.7%) were preterm, 247 (31.6%) low birth weight, 189 (24.2%) macrosomia and 42 (5.4%) still births. Predictors of adverse birth outcomes were, eclampsia (AOR 6.86 (1.40-33.60); p=0.017), gestational diabetes (AOR 3.01 (1.24-7.30; p=0.015), and home delivery (AOR 2.48 (1.20-5.13); p=0.014). Being multiparous (AOR 0.52 (0.33-0.81); p=0.004) was protective. Home delivery was significantly associated with older maternal age 40-49 years (p=0.001), multiparous >5 (p=0.001), level of formal education below primary (p=0.001) and Islamic religion (p=0.001). ConclusionsIn this maternal population, about a third of pregnancies have adverse birth outcomes. Recognizing this baseline prevalence will be important in validating safety of a new maternal vaccine. Monitoring of the actual safety outcomes of the maternal RSV vaccine, will require integrated initiatives to mitigate against factors affecting utilization of maternal healthcare services and individual factors associated with adverse birth outcomes.

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Analyzing Land Use Impacts on Streamflow Response in a Tropical Watershed: A Hydrometric and Geochemical Approach

10.5194/egusphere-egu2020-1211 ◽

2020 ◽

Author(s):

Nicola Mathura ◽

Kegan Farrick

Keyword(s):

Climate Change ◽

Land Use ◽

Critical Zone ◽

Dry Season ◽

Future Climate Change ◽

Wet Season ◽

Forested Catchment ◽

Streamflow Response ◽

The Caribbean ◽

Geochemical Approach

Climate change and unsustainable land use practices such as quarrying have the potential to negatively impact the hydrology and water resource availability in catchments. Throughout the Caribbean, hillside quarrying has become a common practice. While these activities remove large sections of the critical zone, very little work has been done on how hillside quarrying impacts storm response and catchment water storage. &#160;The study is particularly important given the expected changes to rainfall patterns in the Caribbean under future climate change. We hypothesised that the removal of the critical zone during quarrying will increase the magnitude of streamflow response to storm events due to its close proximity to the river, while also reducing the overall storage of the watershed. This study utilized a hydrometric and geochemical approach with direct measurements of rainfall and streamflow, and bi-weekly water sample collections for geochemistry and 18O and 2H stable isotopes between the 3.6 km2 Acono (forested) and the adjacent 3.6 km2 Don Juan (quarried) watersheds, located in Trinidad and Tobago. A total of 1207 mm of rainfall occurred, with 87.3% falling from August to November (wet season) and 12.7% from December to March (dry season). The &#948; 18O in rainfall ranged from -7.7 to 0.3 &#8240; across both seasons with an average &#948;18O of -3.5&#177;1.8&#8240; during the wet season and 0.1&#177;0.5&#8240; in the dry season. During the dry season the mean &#948; 18O of stream water showed a difference between the forested (-2.8&#177;0.3&#8240;) and quarried (-3.1&#177;0.3&#8240;) catchments whereas there was little differences in &#948;18O in the forested catchment (-3.3&#177;0.3 &#8240;) and quarried catchment&#8211;(-3.2&#177;0.27&#8240;) in the wet season. Our stream &#948;18O dry season results suggests that different sources of water or anthropogenic influences such as water from settling ponds in the quarry could have impacted the &#948;18O of the quarried stream as we expected the forested catchment to be more stable. Sample collection at these sites is ongoing and additional parameters such as soil water isotopes and rainfall, soil and stream ion chemistry are expected to improve our understanding of the translation from rainfall to streamflow. This research will allow us to gain a better insight of the current hydrological processes within this catchment and aid in the long term adaptive planning for factors such as climate change and further land use change.&#160;

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