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Objective To determine risk factors for poor birth outcome and their population attributable fractions. Methods 1688 women who attended for antenatal care were recruited into a prospective study of the effectiveness of syphilis screening and treatment. All women were screened and treated for syphilis and other reproductive tract infections (RTIs) during pregnancy and followed to delivery to measure the incidence of stillbirth, intrauterine growth retardation (IUGR), low birth weight (LBW) and preterm live birth. Findings At delivery, 2.7% of 1536 women experienced a stillbirth, 12% of live births were preterm and 8% were LBW. Stillbirth was independently associated with a past history of stillbirth, short maternal stature and anaemia. LBW was associated with short maternal stature, ethnicity, occupation, gravidity and maternal malaria whereas preterm birth was associated with occupation, age of sexual debut, untreated bacterial vaginosis and maternal malaria. IUGR was associated with gravidity, maternal malaria, short stature, and delivering a female infant. In the women who had been screened and treated for syphilis, in between 20 and 34% of women with each outcome was estimated to be attributable to malaria, and 63% of stillbirths were estimated as being attributable to maternal anaemia. Screening and treatment of RTIs was effective and no association was seen between treated RTIs and adverse pregnancy outcomes. Conclusion Maternal malaria and anaemia continue to be significant causes of adverse pregnancy outcome in sub-Saharan Africa. Providing reproductive health services that include treatment of RTts and prevention of malaria and maternal anaemia to reduce adverse birth outcomes remains a priority. Objectif Determiner les facteurs de risque pour diverses issues defavorables de l'accouchement et les fractions attribuables en population de ces issues. Methodes 1688 femmes beneficiant de soins antenataux ont ete incluses dans une etude prospective visant a evaluer l'efficacite du depistage de la syphilis et de son traitement. Pendant leur grossesse, ces femmes ont toutes ete soumises a un depistage de la syphilis et ont eventuellement ete traitees contre cette maladie ou d'autres infections de l'appareil reproducteur. Elles ont egalement fait l'objet d'un suivi jusqu'a l'accouchement, en vue de mesurer l'incidence des mortinaissances, des retards de developpement intra-uterins, des faibles poids a la naissance et des naissances avant terme. Resultats Parmi les 1536 accouchements, 2,7 % ont donne un enfantmort-ne, 12% unenfant premature vivant et 8 % un enfant de faible poids a la naissance. La mortinaissance etait associee de maniere independante aux facteurs suivants : antecedents d'accouchement d'un enfant mort-ne, et faible stature ou anemie maternelles. Le faible poids a la naissance pouvait etre associe a une petite stature de la mere, a son origine ethnique, a sa profession, au nombre de grossesses et a la presence du paludisme chez la mere, tandis que la naissance avant terme pouvait etre mise en relation avec la profession, l'age au debut de l'activite sexuelle et la presence d'une vaginite bacterienne non traitee ou d'un paludisme chez la mere. Le retard de croissance intra-uterin pouvait etre correle avec le nombre de grossesses, la presence d'un paludisme chez la mere, une faible stature maternelle et la mise au monde d'une fille. Parmi les femmes chez lesquelles on avait detecte et traite une syphilis, 20 a 24 % des issues defavorables de l'accouchement ont ete considerees comme imputables au paludisme et 63 % des mortinaissances a une anemie maternelle. Le depistage et le traitement des infections de l'appareil reproducteur se sont reveles efficaces et aucune association n'a ete relevee entre ces infections et des issues defavorables de la grossesse. Conclusion Le paludisme et l'anemie maternels restent des causes importantes d'issues defavorables de la grossesse en Afrique subsaharienne. L'apport de services de sante genesique comprenant le traitement des infections de l'appareil reproducteur et la prevention du paludisme et de l'anemie chez la mere demeure une priorite pour reduire les issues defavorables de l'accouchement. Objetivo Identificar los factores de riesgo de desenlace adverso del parto y sus fracciones poblacionales atribuibles. Metodos En un estudio prospectivo sobre la eficacia de la deteccion y tratamiento de la sifilis se incluyeron 1688 mujeres que esperaban recibir atencion prenatal. Todas ellas fueron sometidas a pruebas de deteccion y tratamiento de la sifilis y de otras infecciones del aparato reproductor durante el embarazo, y fueron observadas hasta el parto para determinar la incidencia de muerte fetal, retraso del crecimiento intrauterino, bajo peso al nacer y parto antes del termino. Resultados Entre las 1536 mujeres observadas hasta el parto hubo un 2,7% de muertes fetales, un 12% de nacidos vivos antes del termino y un 8% de recien nacidos con bajo peso al nacer. La muerte fetal se asocio de forma independiente a los antecedentes de muerte fetal y a la anemia y la baja estatura de la madre. El bajo peso al nacer se asocio a la baja estatura de la madre, su etnia y ocupacion, el numero de embarazos anteriores y los antecedentes de paludismo, mientras que el parto antes del termino se asocio con la ocupacion, la edad de inicio de las relaciones sexuales, la vaginosis bacteriana no tratada y los antecedentes de paludismo. El retraso del crecimiento intrauterino se asocio con el numero de embarazos anteriores, el paludismo, la baja estatura de la madre y el sexo femenino del recien nacido. En estas mujeres sometidas a pruebas de deteccion y tratamiento de la sifilis, entre un 20 y un 34% de cada uno de los desenlaces adversos fueron atribuibles al paludismo, mientras que el 63% de las muertes fetales fueron atribuibles a la anemia materna. La deteccion y tratamiento de las infecciones del aparato reproductor fue eficaz y no se observo ninguna asociacion entre las infecciones tratadas y los desenlaces adversos del embarazo. Conclusion El paludismo y la anemia materna siguen siendo causas importantes de desenlace adverso del embarazo en el Africa subsahariana. La prestacion de servicios de salud reproductiva que incluyan el tratamiento de las infecciones del aparato reproductor y la prevencion de la malaria y la anemia materna siguen siendo prioritarias para reducir los desenlaces adversos del embarazo. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction Adverse birth outcomes such as low birth weight (LBW) and prematurity are associated with increased infant morbidity and mortality. (1) Maternal risk factors that are likely to be particularly [...]

Background: Schistosomiasis affects 218 million people worldwide, with most infections in Africa. Prevalence studies suggest that people with chronic schistosomiasis may have higher risk of HIV-1 acquisition and impaired ability to control HIV-1 replication once infected. We hypothesized that: (1) pre-existing schistosome infection may increase the odds of HIV-1 acquisition and that the effects may differ between men and women, and (2) individuals with active schistosome infection at the time of HIV-1 acquisition may have impaired immune control of HIV-1, resulting in higher HIV-1 viral loads at HIV-1 seroconversion. Methology/Principal findings: We conducted a nested case-control study within a large population-based survey of HIV-1 transmission in Tanzania. A population of adults from seven villages was tested for HIV in 2007, 2010, and 2013 and dried blood spots were archived for future studies with participants’ consent. Approximately 40% of this population has Schistosoma mansoni infection, and 2% has S. haematobium. We tested for schistosome antigens in the pre- and post-HIV-1-seroconversion blood spots of people who acquired HIV-1. We also tested blood spots of matched controls who did not acquire HIV-1 and calculated the odds that a person with schistosomiasis would become HIV-1-infected compared to these matched controls. Analysis was stratified by gender. We compared 73 HIV-1 seroconverters with 265 controls. Women with schistosome infections had a higher odds of HIV-1 acquisition than those without (adjusted OR = 2.8 [1.2–6.6], p = 0.019). Schistosome-infected men did not have an increased odds of HIV-1 acquisition (adjusted OR = 0.7 [0.3–1.8], p = 0.42). We additionally compared HIV-1 RNA levels in the post-seroconversion blood spots in HIV-1 seroconverters with schistosomiasis versus those without who became HIV-infected in 2010, before antiretroviral therapy was widely available in the region. The median whole blood HIV-1 RNA level in the 15 HIV-1 seroconverters with schistosome infection was significantly higher than in the 22 without schistosomiasis: 4.4 [3.9–4.6] log10 copies/mL versus 3.7 [3.2–4.3], p = 0.017. Conclusions/Significance: We confirm, in an area with endemic S. mansoni, that pre-existing schistosome infection increases odds of HIV-1 acquisition in women and raises HIV-1 viral load at the time of HIV-1 seroconversion. This is the first study to demonstrate the effect of schistosome infection on HIV-1 susceptibility and viral control, and to differentiate effects by gender. Validation studies will be needed at additional sites. [ABSTRACT FROM AUTHOR]

In order to determine the status of malaria among schoolchildren on Kome Island (Lake Victoria), near Mwanza, Tanzania, a total of 244 schoolchildren in 10 primary schools were subjected to a blood survey using the fingerprick method. The subjected schoolchildren were 123 boys and 121 girls who were 6-8 years of age. Only 1 blood smear was prepared for each child. The overall prevalence of malaria was 38.1% (93 positives), and sex difference was not remarkable. However, the positive rate was the highest in Izindabo Primary School (51.4%) followed by Isenyi Primary School (48.3%) and Bugoro Primary School (46.7%). The lowest prevalence was found in Muungano Primary School (16.7%) and Nyamiswi Primary School (16.7%). These differences were highly correlated with the location of the school on the Island; those located in the peripheral area revealed higher prevalences while those located in the central area showed lower prevalences. Plasmodium falciparum was the predominant species (38.1%; 93/244), with a small proportion of them mixed-infected with Plasmodium vivax (1.6%; 4/244). The results revealed that malaria is highly prevalent among primary schoolchildren on Kome Island, Tanzania, and there is an urgent need to control malaria in this area. [ABSTRACT FROM AUTHOR]