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Objective: To compare the performance of mid upper arm circumference (MUAC) and body mass index (BMI) for prediction of small for gestational age (SGA) in Zambia. Methods: This is a secondary analysis of an ongoing clinical cohort that included women with a single gestation and MUAC measured before 24 weeks of pregnancy. We assessed relationships between maternal MUAC and birth weight centile using regression. The performance of MUAC and BMI to predict SGA was compared using receiver operating characteristic curves and the effect of maternal HIV was investigated in sub‐group analyses. Results: Of 1117 participants, 847 (75%) were HIV‐negative (HIV−) and 270 (24%) were HIV‐positive (HIV+). Seventy‐four (7%) delivered severe SGA infants (<3rd centile), of whom 56 (76%) were HIV− and 18 (24%) were HIV+ (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.58–1.75). MUAC was associated with higher birth weight centile (+1.2 centile points, 95% CI 0.7–1.6; P < 0.001); this relationship was stronger among HIV+ women (+1.7 centile points, 95% CI 0.8–2.6; P < 0.001) than HIV− women (+0.9 centile points, 95% CI 0.4–1.4; P = 0.001). The discriminatory power was similar, albeit poor (area under the curve [AUC] < 0.7), between MUAC and BMI for the prediction of SGA. In stratified analysis, MUAC and BMI showed excellent discrimination predicting severe SGA among HIV+ (AUC 0.83 and 0.81, respectively) but not among HIV− women (AUC 0.64 and 0.63, respectively). Conclusion: Maternal HIV infection increased the discrimination of both early pregnancy MUAC and BMI for prediction of severe SGA in Zambia. Clinical Trial Number: ClinicalTrials.gov (NCT02738892). Synopsis: Maternal mid‐upper arm circumference measured early in pregnancy is associated with small for gestational age with predictive performance similar to body mass index. [ABSTRACT FROM AUTHOR]

Objective To assess the impact on the duration of latency to delivery when a single oral dose of azithromycin is substituted for erythromycin in the standard antibiotic regimen used in pregnancies complicated by preterm premature rupture of membranes (PPROM). Study Design A retrospective cohort study of singleton pregnancies complicated by PPROM between 23 and 33 6/7 weeks of gestation from January 2012 to June 2016. Patients prior to June 2014 received a standard antibiotic regimen of 7 days of erythromycin and ampicillin/amoxicillin. After this period, patients received a single oral dose of azithromycin 1 g substituted for erythromycin in this regimen. Primary outcome was latency from PPROM to delivery. Results One hundred sixty-two women met the inclusion criteria, 84 in the erythromycin group and 78 in the azithromycin group. There was no difference in the median latency from PPROM to delivery between the groups (erythromycin: 6.37 days, interquartile range [IQR]: 3.59-10.93 vs. azithromycin: 5.86 days, IQR: 3.12-12.05, p = 0.75). There was a higher rate of cesarean delivery (48.8 vs. 29.5%, p = 0.01) and positive neonatal blood cultures (13.6 vs. 4.1%, p = 0.05) in the erythromycin group. Conclusion There is no difference in latency to delivery when a single oral dose of azithromycin 1 g is substituted for erythromycin in the standard antibiotic regimen used in singleton pregnancies complicated by PPROM. [ABSTRACT FROM AUTHOR]

Objective To assess the impact on the duration of latency to delivery when a single oral dose of azithromycin is substituted for erythromycin in the standard antibiotic regimen used in pregnancies complicated by preterm premature rupture of membranes (PPROM). Study Design A retrospective cohort study of singleton pregnancies complicated by PPROM between 23 and 33 6/7 weeks of gestation from January 2012 to June 2016. Patients prior to June 2014 received a standard antibiotic regimen of 7 days of erythromycin and ampicillin/amoxicillin. After this period, patients received a single oral dose of azithromycin 1 g substituted for erythromycin in this regimen. Primary outcome was latency from PPROM to delivery. Results One hundred sixty-two women met the inclusion criteria, 84 in the erythromycin group and 78 in the azithromycin group. There was no difference in the median latency from PPROM to delivery between the groups (erythromycin: 6.37 days, interquartile range [IQRJ: 3.59-10.93 vs. azithromycin: 5.86 days, IQR: 3.12-12.05, p = 0.75). There was a higher rate of cesarean delivery (48.8 vs. 29.5%, p = 0.01) and positive neonatal blood cultures (13.6 vs. 4.1%, p = 0.05) in the erythromycin group. Conclusion There is no difference in latency to delivery when a single oral dose of azithromycin 1 g is substituted for erythromycin in the standard antibiotic regimen used in singleton pregnancies complicated by PPROM. [ABSTRACT FROM AUTHOR]

An abstract of the article "Impact of South-to-South Technical Assistance from Rwanda & Zambia in Couples Voluntary HIV Counseling and Testing (CVCT) Achievements in 19 Countries" by Ashley Appiagyei, Annie Mwaanga and Cortney Robinson is presented.

Background: Given the global nursing shortage and investments to scale-up the workforce, this study evaluated trends in annual student nurse enrolment, pre-service attrition between enrolment and registration, and factors that influence nurse production in Kenya.Methods: This study used a mixed methods approach with data from the Regulatory Human Resources Information System (tracks initial student enrolment through registration) and the Kenya Health Workforce Information System (tracks deployment and demographic information on licensed nurses) for the quantitative analyses and qualitative data from key informant interviews with nurse training institution educators and/or administrators. Trends in annual student nurse enrolment from 1999 to 2010 were analyzed using regulatory and demographic data. To assess pre-service attrition between training enrolment and registration with the nursing council, data for a cohort that enrolled in training from 1999 to 2004 and completed training by 2010 was analyzed. Multivariate logistic regression was used to test for factors that significantly affected attrition. To assess the capacity of nurse training institutions for scale-up, qualitative data was obtained through key informant interviews.Results: From 1999 to 2010, 23,350 students enrolled in nurse training in Kenya. While annual new student enrolment doubled between 1999 (1,493) and 2010 (3,030), training institutions reported challenges in their capacity to accommodate the increased numbers. Key factors identified by the nursing faculty included congestion at clinical placement sites, limited clinical mentorship by qualified nurses, challenges with faculty recruitment and retention, and inadequate student housing, transportation and classroom space. Pre-service attrition among the cohort that enrolled between 1999 and 2004 and completed training by 2010 was found to be low (6%).Conclusion: To scale-up the nursing workforce in Kenya, concurrent investments in expanding the number of student nurse clinical placement sites, utilizing alternate forms of skills training, hiring more faculty and clinical instructors, and expanding the dormitory and classroom space to accommodate new students are needed to ensure that increases in student enrolment are not at the cost of quality nursing education. Student attrition does not appear to be a concern in Kenya compared to other African countries (10 to 40%). [ABSTRACT FROM AUTHOR]