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Background A high prevalence of cardiac abnormalities has been reported in children with human immunodeficiency virus (HIV) taking antiretroviral therapy (ART) in sub-Saharan Africa. We investigated the incidence and progression of cardiac abnormalities among children taking ART in Zimbabwe. Methods A prospective cohort study was conducted at a pediatric HIV clinic from 2014 to 2017. Children with HIV aged between 6 and 16 years and taking ART ≥6 months were enrolled. Transthoracic echocardiography was performed at baseline and after 18 months. Results Of 197 participants recruited at baseline, 175 (89%; 48% female; median age 12 years, interquartile range 10–14 years) were followed up. The incidences of left and right heart abnormalities were 3.52 and 5.64 per 100 person-years, respectively. Stunting was associated with the development of any cardiac abnormality (adjusted odds ratio 2.59, 95% confidence interval 1.03–6.49; P = .043). Right ventricular (RV) dilatation persisted at follow-up in 92% of participants and left ventricular (LV) diastolic dysfunction in 88%. Cardiac abnormalities present at baseline reverted to normal over the follow-up period in 11 (6%). There was an overall increase in mean z scores for LV, left atrium (LA), RV, interventricular septum, and LV posterior wall diameters at 18 months (P < .001). Conclusions Despite ART, children with HIV have a high incidence of cardiac abnormalities, with only a minority being transient. Mean z scores for LV, LA, RV, interventricular septum, and LV posterior wall diameters increased over a relatively short follow-up period, suggesting the potential for progression of cardiac abnormalities. Longer follow-up is required to understand the clinical implications of these abnormalities., Older children and adolescents with human immunodeficiency virus (HIV) who are receiving antiretroviral therapy in sub-Saharan Africa have a high incidence of echocardiographic abnormalities, which are likely primary HIV-related heart muscle disease and have the potential for progression over time.

In a cross-sectional study of 296 children and adolescents from Zimbabwe living with perinatal human immunodeficiency virus, individuals with the top tertile of cytomegalovirus-specific immunoglobulin G titer had an increased odds of chronic lung disease (odds ratio, 3.33; 95% confidence interval, 1.37–8.85; P = .010).

Background Pregnancy outcomes are widely used indicators of population wellbeing varying both between and within countries. The aim of this study was to assess social variations in preterm births and term small-for-gestation-age (SGA) infants in the Northernmost provinces of Europe - the Murmansk region - using the data from the first Russian population-based birth registry. Methods A registry-based study of 52 806 births in the Murmansk region for a 5-year period was performed. We studied the prevalence and social determinants of moderate-to-late preterm births (MLPTB, 224-258 days of gestation), very preterm births (VPTB, 196-223 days) and extremely preterm births (EPTB, 154-195 days) and term SGA for both weight and length births (SGAWL). Associations between social factors and pregnancy outcomes were studied by multivariable logistic regression. Results The prevalence of PTB was 6.9 with EPTB, VPTB and MLPTB constituting 0.3%, 0.6% and 6.0%, respectively. A total of 4.1% of infants were SGAWL. Women with primary, secondary and vocational education were 1.59 (95%CI:1.22-1.85), 1.33 (95%CI:1.20-1.48), 1.19 (95%CI:1.22-1.85) times more likely to have MLPTB than women with higher education. Corresponding values for VPTB were 1.65 (95%CI:0.88-3.08), 1.41 (95%CI:1.02-1.95) and 1.27 (95%CI:0.92-1.75), respectively. Single and cohabiting women had significantly elevated risk for MLPTB (ORs=1.47 (95%CI:1.30-1.66) and 1.39 (95%CI:1.26-1.44)) and VLPTB (ORs=2.00, 95% CI: 1.42-2.81 and 1.32, 95% CI: 0.97-1.79) compared to married women. Unmarried mothers were more likely to have SGAWL boys (OR = 1.60, 95% CI: 1.38-1.86) and SGAWL girls (OR = 1.51, 95%CI:1.31-1.76) compared to married women. Conclusions We observed significant social variations in pregnancy outcomes by maternal education and marital status in the Murmansk region. Registry data can be used as an effective tool for monitoring inequalities in pregnancy outcomes as indicators of social inequalities. Key messages We found significant social variations in pregnancy outcomes in the Northernmost province of Europe - the Murmansk county (Russia). Birth registry data can be used for monitoring of health inequalities in Russia.

Background Tobacco smoking is a public health problem. Even though this habit is less common among women than men in Russia, it appears to be on the increase among women aged ≥15 years. Smoking during pregnancy leads to adverse pregnancy and birth outcomes. Compared to the number of studies on maternal smoking and birth weight, the influence of stop smoking on low birth weight is not well documented. The aim of the study was to assess an effect of quitting smoking during the first trimester on low birth weight. Methods The study is based on the Murmansk County Birth registry. Women who delivered a singleton pregnancy after 37 weeks of gestation were comprised to the study (N = 44,486). Smoking information was assessed at the first antenatal visit during pregnancy and self-reported and. Low birth weight was defined in according to the World Health Organization as Mean value minus 2 standard deviations for girls and boys separately. Using logistic regressions, we adjusted for maternal age, residence, ethnicity, education, marital status, alcohol abuse, year of delivery, body mass index, pregnancy diabetes, gestational age, and excessive weight gain. Results The prevalence of low birth weight was 1.1%. This adverse birth outcome was more prevalent in women who smoked during pregnancy (2.5%) in compared to those who stopped do it during pregnancy (0.8%) or did not smoke before and during pregnancy (0.9%) (p Conclusions We observed that women who stop smoking during the first trimester are at no greater risk of having a term baby with low birth weight. Our findings underline a continued need for actions against smoking during pregnancy. Key messages Women who stop smoking during the first trimester are at no greater risk of having a term baby with low birth weight. Our findings underline a continued need for actions against smoking during pregnancy.

Introduction Periconceptional use of folic acid supplementation is an evidence-based measure of birth defects prevention. The study was aimed to assess effect of periconceptual use of folic acid on birth defect prevalence in Arkhangelsk county and to investigate socio-demographic factors, which are associated with adherence to this preventive measure. Methods A registry-based study was conducted with data from the Arkhangelsk County Birth Registry for 2012-2015. The study population included 57084 pregnancies to calculate the proportion of women taking folic acid and 53340 pregnancy outcomes without missing data to analyze related socio-demographic characteristics. Results The proportion of women followed a folic acid supplementation before pregnancy was 1.3% (95% CI: 1.2-1.4), during pregnancy - 55.8% (95%CI: 54.6-56.4). Such women had less risk to deliver a newborn with any birth defects (OR = 0,84, 95%CI: 0,75 - 0,95). Considering birth defects prevalence of 38,6 per 1000 newborns in Arkhangelsk county, number needed to prevent one case of birth defect was 142,9. Based on multivariate analysis, nulliparous married women with higher education, aged 30 or more, had a higher chance to use folic acid before and during pregnancy. The history of spontaneous abortion in the mother's medical history and the first pregnancy were negatively associated with the probability of folic acid intake both before and during pregnancy. Conclusions The compliance to periconceptional intake of folic acid among women in the region was low. A level of compliance was associated with such socio-demographic factors as age, education, marital status, gravidity and parity. The findings have direct applications in improving prenatal care in Arkhangelsk county and establishing targets for prenatal counseling. Key messages A level of compliance to primary prevention of birth defects is associated with such socio-demographic factors as age, education, marital status, gravidity and parity. Prenatal counseling in terms of birth defects prevention should be based on socio-demographic characteristics of pregnant women.

A Norwegian-Russian cooperation in public health education in the Euro-Arctic Barents region started in the 1980s. In the 1990s it has been mostly limited to research- and student exchanges. In September 2006 seven universities including Northern State Medical University, Arkhangelsk (Russia), University of Tromsø (Norway), Nordic School of Public Health (Sweden), Umeå University (Sweden), Mid-Sweden University (Sundsvall, Sweden), Tampere University (Finland) and the National Institute of Public Health (Oslo, Norway), came together to found the International school of public health in Arkhangelsk, Russia (ISPHA). The mission of the ISPHA was to increase the level of knowledge in methods of research and practice in the field of public health, and to promote the implementation of this knowledge in Northwest Russia. Since 2007, ISPHA is providing public health education based on a 2-year MPH training. In 2007, ISPHA became the first full member of ASPHER. Forty-eight specialists got MPH degrees at ISPHA as a part of the program. In 2013 a PhD programme between NSMU and the University of Tromsø was established. In 2013-19, 6 PhD theses were defended, and totally 28 full-text papers were published in peer-reviewed journals. In 2017 two new PhD programs in public health between Norway and Russia were initiated. The programme in environmental health and registry epidemiology in Arctic and Sub-Arctic Russia is run in collaboration between two Russian and two Norwegian universities while the second programme on cardiovascular epidemiology is run by NSMU and the University of Tromsø. Both programmes have already recruited PhD students and teachers from both countries. Achievements, challenges, sustainability and future perspectives will be discussed. In spite of political perturbations, cooperation in public health education and research between Norway and Russia is contributing to better understanding of each other and strengthening public health workforce in Arctic Russia. Key messages Norwegian Russian cooperation evolved from exchanges to PhD programs. Most of the graduates strengthen public health capacity in their regions.

Background Smoking during pregnancy leads to adverse pregnancy and birth outcomes. Compared to the number of studies on low birth weight, the influence of maternal smoking on low head circumference at birth is not well documented. The aim of the study was to assess an effect of smoking behavior before and during pregnancy on low head circumference at birth. Methods The study is based on the Murmansk County Birth registry. Our study includes women who delivered a singleton pregnancy after 37 weeks of gestation (N = 44,486). Smoking information was self-reported and assessed at the first antenatal visit during pregnancy. Low head circumference was defined in according to the World Health Organization as Mean value minus 2 standard deviations for girls and boys separately. Using logistic regressions we adjusted for maternal age, residence, ethnicity, education, marital status, alcohol abuse, year of delivery, body mass index, pregnancy diabetes, gestational age, and excessive weight gain. Results A dose-response relationship was evident between the number of cigarettes smoked per day during pregnancy and the odds of low head circumference at birth (adjusted OR1-5 cig/day = 1.69 with 95% CI: 1.31-2.19; OR6-10 cig/day = 2.08 with 95% CI: 1.63-2.65; and OR ≥ 11 cig/day = 5.19 with 95% CI: 3.89-6.92). Compared to non-smokers, quitting smoking during the first trimester of pregnancy had no significant effect on low head circumference at birth (adjusted ORquitters = 1.04 with 95% CI: 0.80-1.34). Conclusions Despite dose-response relationship was observed between maternal smoking and low head circumference at birth, women who stopped smoking during the first trimester were at no higher risk of having a baby with the low head circumference as compared to non-smokers. Our findings underline a continued need for actions against maternal smoking. Key messages women who stopped smoking during the first trimester were at no higher risk of having a baby with the low head circumference as compared to non-smokers. A dose-response relationship was evident between the number of cigarettes smoked per day during pregnancy and the odds of low head circumference at birth.

Background Birth defects (BD) constitute an important public health issue as they are the main cause of infant death. Their prevalence in Europe for 2007-2011 is 25.7 per 1000 newborns. To date, there are no population-based studies for the Russian Federation. The aim of the present study is to estimate the prevalence, forms and changes in the prevalence of BD over time …