Breastfeeding cessation in the era of Elimination of Mother to Child Transmission of HIV in Uganda: a retrospective cohort study

Abstract Background: Among human immunodeficiency (HIV) infected mothers, the World Health Organization (WHO) recommends cessation of breastfeeding at one year to prevent HIV transmission but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at one year among HIV infected postpartum mothers at Ndejje Health Center IV, a large peri-urban health facility in Uganda. Methods: This retrospective cohort study involved all HIV infected postpartum mothers enrolled in HIV care for at least 12 months between June 2014 and June 2018. We abstracted data from registers, held focused group discussions with HIV infected postpartum mothers, and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of HIV infected postpartum mothers who had stopped breastfeeding at one year. We summarized quantitative data descriptively, tested differences in outcome with the Chi-square and t-tests, and established independently associated factors using the modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results. Results: Of 235 HIV infected postpartum mothers, 150 (63.8%) ceased breastfeeding at one year and this was independently associated with the HIV exposed infant (HEI) being female than male (Adjusted risk ratio (aRR): 1.25, 95% confidence interval (CI), 1.04, 1.50), the mother being multiparous than primparous (aRR, 1.26; 95% CI, 1.04-1.53), and breastfeeding initiation on same-day as birth (aRR, 0.06; 95% CI, 0.01-0.41). Qualitative results showed that partner reminders about breastfeeding adequacy of BF knowledge and maternal literacy facilitated continued breastfeeding until one year. Inadequate breastfeeding knowledge, casual and formal work demands, in addition to increased breastfeeding demand among boys led to cessation of breastfeeding before one year.Conclusion. Cessation of breastfeeding at one year among HIV infected postpartum mothers was suboptimal and this might increase risk of mother to child transmissions of HIV. Cessation of breastfeeding was more likely among female HEIs and multiparous mothers, and less likely when breastfeeding is initiated on same-day as birth. Interventions to enhance cessation of breastfeeding at one year should target groups of women with lower rates.

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Breastfeeding cessation in the era of Elimination of Mother to Child Transmission of HIV in Uganda: a retrospective cohort study

10.21203/rs.3.rs-19025/v1 ◽

2020 ◽

Author(s):

Jackslina Gaaniri Ngbapai ◽

Jonathan Izudi ◽

Stephen Okoboi

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

World Health ◽

Mother To Child Transmission ◽

Child Transmission ◽

Breastfeeding Cessation ◽

One Year ◽

Postpartum Mothers ◽

Mother To Child

Abstract Background To eliminate mother to child transmission of HIV (EMTCT), the World Health Organization (WHO) recommends that breastfeeding should cease at one year for infants born to HIV infected mothers but data are limited. We examined the magnitude and factors associated with breastfeeding cessation at one year among HIV infected postpartum mothers at Ndejje Health Center IV, a large peri-urban health facility in Uganda. Methods We conducted a retrospective cohort study involving all HIV infected postpartum mothers enrolled on EMTCT program for at least 12 months, between June 2014 and June 2018, abstracted data from EMTCT registers, held four focused group discussions with HIV infected postpartum mothers and four key informant interviews with healthcare providers. Breastfeeding cessation was defined as the proportion of HIV infected postpartum mothers who stopped breastfeeding an HIV exposed infant (HEI) at one year. We summarized quantitative data descriptively, tested differences in outcome with the Chi-square and t-tests, and established factors independently associated with breastfeeding cessation using modified Poisson regression analysis at 5% statistical significance level, and thematically analyzed qualitative data to enrich and triangulate the quantitative results. Results Of 235 HIV infected postpartum mothers, 150 (63.8%) ceased breastfeeding at one year and this was independently associated with the HEI being female than male (Adjusted risk ratio (aRR): 1.25, 95% confidence interval (CI), 1.04, 1.50), the mother being multiparous than primparous (aRR, 1.26; 95% CI, 1.04-1.53), and breastfeeding initiation on same day as birth (aRR, 0.06; 95% CI, 0.01-0.41). Qualitative results showed that maternal demands of work, high demand for breastfeeding among male HEIs, and low breastfeeding interest among primarous mothers were reasons for cessation of breastfeeding before one year. Conclusion Breastfeeding cessation at one year among HIV infected postpartum mothers was suboptimal. This might increase the risk of mother to child transmissions of HIV. Breastfeeding cessation at one year was more likely when the HEI was female than male and when the HIV infected postpartum mother was multiparous than primparous, but less likely when breastfeeding was initiated on same-day as birth. Interventions to enhance breastfeeding cessation at one year should target these areas.

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Breastfeeding cessation in the era of Elimination of Mother to Child Transmission of HIV in Uganda: a retrospective cohort study

10.21203/rs.3.rs-19025/v3 ◽

2020 ◽

Author(s):

Jackslina Gaaniri Ngbapai ◽

Jonathan Izudi ◽

Stephen Okoboi

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hiv Care ◽

Mother To Child Transmission ◽

Child Transmission ◽

Risk Of Death ◽

One Year ◽

Living With Hiv ◽

Mother To Child

Abstract Background: Breastfeeding an infant exposed to HIV carries the risk of HIV acquisition whilst not breastfeeding poses higher risk of death from malnutrition, diarrhea, and pneumonia. In Uganda, mothers living with HIV are encouraged to discontinue breastfeeding at 12 months but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at one year among mothers living with HIV at Ndejje Health Center IV, a large peri-urban health facility in Uganda.Methods: This retrospective cohort study involved all mothers living with HIV enrolled in HIV care for ≥12 months between June 2014 and June 2018. We abstracted data from registers, held focus group discussions with mothers living with HIV and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of mothers living with HIV who had discontinued breastfeeding at one year. We summarized quantitative data descriptively, tested differences in outcome using Chi-square and t-tests, and established independently associated factors using modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results. Results: Of 235 participants, 150 (63.8%) had ceased breastfeeding at one year and this was independently associated with the infant being female (Adjusted risk ratio (aRR): 1.25, 95% confidence interval (CI), 1.04, 1.50), the mother being multiparous (aRR, 1.26; 95%CI, 1.04-1.53), and the initiation of breastfeeding being on the same-day as birth (aRR, 0.06; 95%CI, 0.01-0.41).The reasons for ceasing breastfeeding included male infants over breastfeed than females, maternal literacy and knowledge adequacy about breastfeeding, support and reminders from the partner, and boys can bite once they get teeth. Conversely, the reasons for not ceasing to breastfeed encompassed insufficient knowledge about breastfeeding and girls feed a bit less.Conclusion: Suboptimal proportion of infants were ceased from breastfeeding at one year and this might increase the risk of mother to child transmission of HIV. Cessation of breastfeeding was more likely among female infants and multiparous mothers but less likely when breastfeeding was initiated on same-day as birth. Interventions to enhance cessation of breastfeeding should target groups of mothers with lower rates.

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Temporary disengagement and re-engagement in human immunodeficiency virus care in a rural county serving pastoralist communities in Kenya: a retrospective cohort study

International Health ◽

10.1093/inthealth/ihz049 ◽

2019 ◽

Vol 12 (2) ◽

pp. 95-100

Author(s):

Paul Yonga ◽

Stephen Kalya ◽

Lutgarde Lynen ◽

Tom Decroo

Keyword(s):

Human Immunodeficiency Virus ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Retention In Care ◽

Virologic Response ◽

World Health ◽

Hiv Care ◽

Pastoralist Communities ◽

Immunodeficiency Virus

Abstract Background Pastoralist communities are known to be hard to reach. The magnitude of temporary disengagement from human immunodeficiency virus (HIV) care is understudied. Methods We conducted a retrospective cohort study of temporary disengagement (2 weeks late for a next appointment), virologic response, lost to follow-up (6 months late) and re-engagement in care among patients who started antiretroviral therapy between 2014 and 2016 in Baringo County, Kenya. Predictors of re-engagement after disengagement were estimated using logistic regression. Results Of 342 patients, 76.9% disengaged at least once (range 0–7). Of 218 patients with a viral load (VL), 78.0% had a suppressed VL. Those with a history of temporary disengagement from care were less likely to suppress their VL (p=0.002). Six patients had treatment failure (two consecutive VLs >1000 copies/mm3) and all had disengaged at least once. After disengagement from care, male patients (adjusted odds ratio [aOR] 0.3 [95% confidence interval {CI} 0.2 to 0.6]; p<0.001) and patients with World Health Organization stage III–IV (aOR 0.3 [95% CI 0.1 to 0.5; p<0.001) were less likely to re-engage in care. Conclusions Temporary disengagement was frequent in this pastoralist setting. This indicator is often overlooked, as most studies only report binary outcomes, such as retention in care. Innovative strategies are required to achieve HIV control in rural settings like this pastoralist setting.

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Cessation of breastfeeding and associated factors in the era of elimination of mother to child transmission of HIV at Ndejje Health Center, Uganda: a retrospective cohort study

10.21203/rs.3.rs-19025/v4 ◽

2020 ◽

Author(s):

Jackslina Gaaniri Ngbapai ◽

Jonathan Izudi ◽

Stephen Okoboi

Keyword(s):

Cohort Study ◽

Health Center ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Associated Factors ◽

Mother To Child Transmission ◽

Child Transmission ◽

One Year ◽

Living With Hiv ◽

Mother To Child

Abstract BackgroundBreastfeeding an infant exposed to Human Immunodeficiency Virus (HIV) carries the risk of HIV acquisition whilst not breastfeeding poses a higher risk of death from malnutrition, diarrhea, and pneumonia. In Uganda, mothers living with HIV are encouraged to discontinue breastfeeding at 12 months but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at one year among mothers living with HIV at Ndejje Health Center IV, a large peri-urban health facility in Uganda.MethodsThis retrospective cohort study involved all mothers living with HIV and enrolled in HIV care for ≥ 12 months between June 2014 and June 2018. We abstracted data from registers, held focus group discussions with mothers living with HIV and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of mothers living with HIV who had discontinued breastfeeding at one year. We summarized quantitative data descriptively, tested differences in outcome using Chi-square and t - tests, and established independently associated factors using modified Poisson regression analysis at 5 % statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results. ResultsOf 235 participants, 150 (63.8 %) had ceased breastfeeding at one year and this was independently associated with the infant being male (Adjusted Risk Ratio [aRR] 1.25, 95 % confidence interval [CI] 1.04, 1.50), the mother being multiparous (aRR 1.26, 95 % CI 1.04-1.53), and the initiation of breastfeeding being on the same-day as birth (aRR 0.06, 95 % CI 0.01-0.41). The reasons for ceasing breastfeeding included male infants over breastfeed than females, maternal literacy and knowledge adequacy about breastfeeding, support and reminders from the partner, and boys can bite once they get teeth. ConclusionSuboptimal proportion of infants were ceased from breastfeeding at one year and this might increase the risk of mother to child transmission of HIV. Cessation of breastfeeding was more likely among male infants and multiparous mothers but less likely when breastfeeding was initiated on the same-day as birth. Interventions to enhance cessation of breastfeeding should target none multiparous mothers and those with female infants.

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Cessation of breastfeeding and associated factors in the era of elimination of mother to child transmission of HIV at Ndejje health center, Uganda: a retrospective cohort study

International Breastfeeding Journal ◽

10.1186/s13006-020-00323-7 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Jackslina Gaaniri Ngbapai ◽

Jonathan Izudi ◽

Stephen Okoboi

Keyword(s):

Cohort Study ◽

Health Center ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Associated Factors ◽

Hiv Care ◽

Mother To Child Transmission ◽

Child Transmission ◽

Living With Hiv ◽

Mother To Child

Abstract Background Breastfeeding an infant exposed to Human Immunodeficiency Virus (HIV) carries the risk of HIV acquisition whilst not breastfeeding poses a higher risk of death from malnutrition, diarrhea, and pneumonia. In Uganda, mothers living with HIV are encouraged to discontinue breastfeeding at 12 months but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at 1 year among mothers living with HIV at Ndejje Health Center IV, a large peri-urban health facility in Uganda. Methods This retrospective cohort study involved all mothers living with HIV and enrolled in HIV care for ≥12 months between June 2014 and June 2018. We abstracted data from registers, held focus group discussions with mothers living with HIV and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of mothers living with HIV who had discontinued breastfeeding at 1 year. We summarized quantitative data descriptively, tested differences in outcome using Chi-square and t - tests, and established independently associated factors using modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results. Results Of 235 participants, 150 (63.8%) had ceased breastfeeding at 1 year and this was independently associated with the infant being male (Adjusted Risk Ratio [aRR] 1.25, 95% confidence interval [CI] 1.04, 1.50), the mother being multiparous (aRR 1.26, 95% CI 1.04–1.53), and the initiation of breastfeeding being on the same-day as birth (aRR 0.06, 95% CI 0.01–0.41). The reasons for ceasing breastfeeding included male infants over breastfeed than females, maternal literacy and knowledge adequacy about breastfeeding, support and reminders from the partner, and boys can bite once they get teeth. Conclusion Suboptimal proportion of infants were ceased from breastfeeding at 1 year and this might increase the risk of mother to child transmission of HIV. Cessation of breastfeeding was more likely among male infants and multiparous mothers but less likely when breastfeeding was initiated on the same-day as birth. Interventions to enhance cessation of breastfeeding should target none multiparous mothers and those with female infants.

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General versus regional anaesthesia for caesarean section indicated for acute foetal distress: a retrospective cohort study

BMC Anesthesiology ◽

10.1186/s12871-021-01289-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Junette Arlette Mbengono Metogo ◽

Theophile Njamen Nana ◽

Brian Ajong Ngongheh ◽

Emelinda Berinyuy Nyuydzefon ◽

Christoph Akazong Adjahoung ◽

...

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Retrospective Cohort Study ◽

Medical Records ◽

Regional Anaesthesia ◽

Retrospective Cohort ◽

Statistical Significance ◽

Neonatal Resuscitation ◽

Maternal Outcomes ◽

Foetal Distress

Abstract Background Acute foetal distress (AFD) is a life-threatening foetal condition complicating 2% of all pregnancies and accounting for 8.9% of caesarean sections (CS) especially in developing nations. Despite the severity of the problem, no evidence exists as to the safest anaesthetic technique for the mother and foetus couple undergoing CS for AFD. We aimed to compare general anaesthesia (GA) versus regional (spinal and epidural) anaesthesia in terms of their perioperative maternal and foetal outcomes. Methods We carried out a retrospective cohort study by reviewing the medical records of all women who underwent CS indicated for AFD between 2015 to 2018 at the Douala General Hospital, Cameroon. Medical records of neonates were also reviewed. We sought to investigate the association between GA, and regional anaesthesia administered during CS for AFD and foetal and maternal outcomes. The threshold of statistical significance was set at 0.05. Results We enrolled the medical records of 117 pregnant women who underwent CS indicated for AFD. Their mean age and mean gestational age were 30.5 ± 4.8 years and 40 weeks respectively. Eighty-three (70.9%), 29 (24.8%) and 05 (4.3%) pregnant women underwent CS under SA, GA and EA respectively. Neonates delivered by CS under GA were more likely to have a significantly low APGAR score at both the 1st (RR = 1.93, p = 0.014) and third-minute (RR = 2.52, p = 0.012) and to be resuscitated at birth (RR = 2.15, p = 0.015). Past CS, FHR pattern on CTG didn’t affect these results in multivariate analysis. Adverse maternal outcomes are shown to be higher following SA when compared to GA. Conclusion The study infers an association between CS performed for AFD under GA and foetal morbidity. This, however, failed to translate into a difference in perinatal mortality when comparing GA vs RA. This finding does not discount the role of GA, but we emphasize the need for specific precautions like adequate anticipation for neonatal resuscitation to reduce neonatal complications associated with CS performed for AFD under GA.

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Outcomes of salvage radiation for recurrent world health organization grade II meningiomas: a retrospective cohort study

Journal of Neuro-Oncology ◽

10.1007/s11060-021-03711-z ◽

2021 ◽

Author(s):

Arbaz A. Momin ◽

Jianning Shao ◽

Pranay Soni ◽

João Paulo Almeida ◽

John H. Suh ◽

...

Keyword(s):

Cohort Study ◽

World Health Organization ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

World Health ◽

Grade Ii ◽

Health Organization

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Incidence of Secondary Microorganism Infections Following Utilization of Tocilizumab for the Treatment of COVID‑19 - A Matched Retrospective Cohort Study

10.54137/ijiid1782 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Joanna L. Moore ◽

Stephanie J. Stroever ◽

Patricia E. Rondain ◽

Robyn N. Scatena

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Secondary Infection ◽

World Health ◽

Quantitative Relation ◽

Secondary Outcome ◽

Healthcare Associated Infection ◽

Kaplan Meier ◽

Healthcare Associated

Introduction: immunological disorder agent’s area unit theorized to focus on the protein storm syndrome in COVID‑19. However, the downstream effects concerning susceptibilities to secondary infection risk stay unknown. This study seeks to work out risk variations for secondary infections among COVID‑19 patients World Health Organization did and failed to receive tocilizumab. Methods: we have a tendency to conducted a matched retrospective cohort study from 2 giants, acute care hospitals in Western Connecticut from March 1 to May 31, 2020. we have a tendency to collected variables exploitation manual case history abstraction. the first exposure variable was any dose of tocilizumab. the first outcome was any healthcare‑associated microorganism or mycosis as outlined by the National Care Safety Network. we have a tendency to performed a Kaplan–Meier analysis to assess the crude distinction within the additive likelihood of healthcare‑associated infection (HAI) across exposure teams. we have a tendency to conjointly performed a multivariable Cox multivariate analysis to work out the hazard quantitative relation for HAI by exposure group whereas dominant for potential confounders. Results: The Kaplan–Meier analysis incontestable no distinction within the additive likelihood of HAI across teams. The adjusted hazard of HAI for patients given tocilizumab was zero.85 times that of patients not given tocilizumab (95% confidence interval = zero.29, 2.52, P = 0.780) once dominant for relevant confounders. Conclusions: Tocilizumab failed to increase the incidence of secondary infection among COVID‑19 patients. Larger, irregular trials ought to valuate infection as a secondary outcome to validate this finding.

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