The document summarizes a study that assessed midwives' perceptions of services for preventing mother-to-child transmission of HIV in public antenatal clinics in Blantyre, Malawi. Key findings included:
1) Midwives reported routinely providing HIV prevention messages but few clinics offered condoms or STI screening.
2) While most midwives advised exclusive breastfeeding, some were unsure how to advise HIV-positive women.
3) Facilities often lacked appropriate space, counselors, and supplies to properly provide maternity services and HIV testing.
4) Additional training and support are needed for midwives to adequately care for antenatal women regarding HIV prevention.
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
Sorry this presentation is not great, because all the animations just stockpiled. If you want to see a better version, please go to http://tinyurl.com/pat48ks
Thanks!
This is a plenary lecture given during the CVCHRD Research and Innovation Conference at CIT-U in Cebu City with the theme "Research innovations for Improved Health and Wellness"
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
Sorry this presentation is not great, because all the animations just stockpiled. If you want to see a better version, please go to http://tinyurl.com/pat48ks
Thanks!
This is a plenary lecture given during the CVCHRD Research and Innovation Conference at CIT-U in Cebu City with the theme "Research innovations for Improved Health and Wellness"
Over the past decade, Kenya has made tremendous efforts to enhance maternal and child health. Secure maternity policies such as free maternity care are one of the initiatives that have enhanced maternal and child health in all public health facilities. Despite these attempts, public health facilities for maternal and child health are still underused. This study employed a cross-sectional descriptive study design to identify determinants of free maternal health services by evaluating factors determining perceptions and health-seeking behavior of 384 pregnant mothers in Malava Sub-County, Kakamega County. The study used a mixed-method (quantitative and qualitative approaches). Questionnaires were administered to pregnant mothers selected for the study. The study employed a purposive sampling of research participants. Quantitative data were collected using the questionnaire administered by the research assistants whereas qualitative data were collected by the researcher through interview schedules. Quantitative data analysis was carried out using SPSS 23. However, qualitative data were analyzed through content analysis. Quantitative data representation was done in terms of frequency and percentages. Analysis of chi-square testing was used to assess the association between the variables of socio-economic and health facilities and the provision of free maternity facilities (p<0.05). The study established that the uptake of free maternal service by pregnant mothers was influenced by their level of primitivism and religious beliefs. In addition, this study found out that 53.8% and 77.7% of the pregnant mothers could not attend antenatal and post-natal care because government facilities were located far away from their residences and they also had less access to some information about free maternal health care. The results of this research would be disseminated to the hospital management team, Sub-Country health management team, County health management team, and other stakeholders, thereby demonstrating reasons for low uptake of free maternity services and helping to strategize for better service delivery. Based on the finding, the study recommends that to improve access to free maternal health care, the county government ought to place health services as close as possible to the community where people live. Secondly, there is a need to embrace the usage of the existing media network to sensitize pregnant mothers to the danger signs and the need to have decision-making powers over their safety. Lastly, hospital management ought to increase the awareness of free maternal health care and to include it among the community priorities during dialog days, action days, and other group discussions.
I was in a Capstone Community Psychology Class at the University of Cincinnati. In conjunction with this course, we worked alongside the Cincinnati Health Department to try to aid in their Sexual Health and Awareness Toolkit that they presented to local communities in the Cincinnati area.
Background: With the widespread use of highly active antiretroviral therapy, the epidemic of HIV has evolved into a chronic disease. HIV is extremely stigmatizing, resulting in highly emotionally charged responses to disclosure. World Health Organization (WHO) recommends that children should be informed of their HIV status at ages of 6 to 12 years and full disclosure at about 8 to 10 years. Disclosure process is much more difficult when the person being disclosed to is an adolescent. However, disclosure of HIV to a child should be an ongoing process that may last several years depending on the cognitive development of the child.
Methods: This study investigated the determinants of HIV status disclosure among HIV infected adolescents. A total of 209 HIV infected adolescents (10-19 years) who have been on treatment for at least six months, and are taking lifelong anti-retroviral therapy from Bondo County Hospital, Got Agulu and Uyawi Sub County Hospital in Bondo Sub County were enrolled. Simple random sampling was employed in selecting the adolescents. Data was collected using a structured questionnaire. Quantitative data was analysed using both descriptive and inferential statistics while statistical tests including Pearson Correlation analysis and multiple linear regression were used to test the hypotheses.
Results: Findings on the overall parental perceptions regarding risks and benefits of disclosure and disclosure of HIV status to adolescents show that 180 (86.12%) of the respondents had a negative attitude compared to 29 (13.88%) who held a positive attitude. 122 (58.37%) of the respondents believed that overall availability and quality of counselling was moderate. 10 (4.78%) of the respondents believed that the overall availability and quality of counselling was high. Quality services and perception of the parents have been found to be good predictors of disclosure of HIV status among the newly diagnosed adolescents in Bondo sub-County, p-value<0.05.
Conclusion and recommendation: This study identified quality of service and perception of the parents as the two factors determining the disclosure of HIV status. There is a correlation between the parental perceptions regarding risks and benefits of disclosure and the quality of counselling to parental disclosure of HIV status to adolescents. Therefore the study recommends deliberate efforts to ensure quality service delivery and age specific disclosure counselling to caregivers to equip them with adequate knowledge on disclosure.
This is a lecture given to medical students of Cebu Institute of Medicine under the reproductive module. It contains a discussion of principles of HIV infection screening, diagnosis, staging and management, especially during pregnancy.
Emily Chambers Sharpe of the Office of the Global AIDS Coordinator discusses the importance of nutrition and the relationship between ARVs and breastfeeding in preventing mother to child transmission of HIV.
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
Sugbuanong Pundok Aron sugpuon and Child Abuse (SUPACA) is a group of youth advocates who promote the four inherent rights of a child: survival, protection, development and participation. Due to the explosion of the Philippine HIV Epidemic especially in Cebu, the SUPACA youth advocates go from barangay to barangay to organize children and youth to talk about HIV/AIDS to improve awareness. With understanding comes compassion and with compassion, stigma and discrimination is reduced.
Awareness and attitude of HIV-positive lactating mothers towards breast feed...PUBLISHERJOURNAL
The controversy between the risk of HIV transmission through breast milk and the lifesaving benefits of breastfeeding remains to be a dilemma faced by HIV-positive mothers. In developing countries, 30-45% of infants born to HIV-positive mothers become infected during pregnancy, childbirth, and breastfeeding. This study explored the knowledge and attitude of HIV-positive lactating mothers attending the Young Child Clinic (YCC) at Kabwohe Health Center IV, Sheema district towards breastfeeding their babies. A descriptive cross-sectional quantitative approach to data collection was used to collect data from HIV-positive lactating mothers attending Young Child Clinic at Kabwohe Health Center IV, Sheema district. Forty-four interviewed HIV-positive lactating mothers were age group of 20 to 29 (48%), 27% age group 30 to 39, 14% were age group 40 to 49, the least 7% age group 19 or lesser, and 4% were aged 50 years or more. 77% of HIV-positive mothers knew that HIV can be transmitted to their child, 18% did not know and 5% were not sure. 72.7% were aware that MTCT can be prevented by ARVs during pregnancy and breastfeeding; modified infant feeding; avoid sharing sharp objects and only 27.3% were not aware. The reproductive age needs to be empowered with knowledge regarding HIV infection, risks of transmission to their baby, and services available to reduce the risk. Follow-up and sensitization of HIV-positive lactating mothers for replacement feeding when it is acceptable, feasible, affordable, sustainable, and safe (AFASS).
Keywords: HIV-positive mothers, Breastfeeding, Childbirth, Pregnancy, Lactating mothers
Over the past decade, Kenya has made tremendous efforts to enhance maternal and child health. Secure maternity policies such as free maternity care are one of the initiatives that have enhanced maternal and child health in all public health facilities. Despite these attempts, public health facilities for maternal and child health are still underused. This study employed a cross-sectional descriptive study design to identify determinants of free maternal health services by evaluating factors determining perceptions and health-seeking behavior of 384 pregnant mothers in Malava Sub-County, Kakamega County. The study used a mixed-method (quantitative and qualitative approaches). Questionnaires were administered to pregnant mothers selected for the study. The study employed a purposive sampling of research participants. Quantitative data were collected using the questionnaire administered by the research assistants whereas qualitative data were collected by the researcher through interview schedules. Quantitative data analysis was carried out using SPSS 23. However, qualitative data were analyzed through content analysis. Quantitative data representation was done in terms of frequency and percentages. Analysis of chi-square testing was used to assess the association between the variables of socio-economic and health facilities and the provision of free maternity facilities (p<0.05). The study established that the uptake of free maternal service by pregnant mothers was influenced by their level of primitivism and religious beliefs. In addition, this study found out that 53.8% and 77.7% of the pregnant mothers could not attend antenatal and post-natal care because government facilities were located far away from their residences and they also had less access to some information about free maternal health care. The results of this research would be disseminated to the hospital management team, Sub-Country health management team, County health management team, and other stakeholders, thereby demonstrating reasons for low uptake of free maternity services and helping to strategize for better service delivery. Based on the finding, the study recommends that to improve access to free maternal health care, the county government ought to place health services as close as possible to the community where people live. Secondly, there is a need to embrace the usage of the existing media network to sensitize pregnant mothers to the danger signs and the need to have decision-making powers over their safety. Lastly, hospital management ought to increase the awareness of free maternal health care and to include it among the community priorities during dialog days, action days, and other group discussions.
I was in a Capstone Community Psychology Class at the University of Cincinnati. In conjunction with this course, we worked alongside the Cincinnati Health Department to try to aid in their Sexual Health and Awareness Toolkit that they presented to local communities in the Cincinnati area.
Background: With the widespread use of highly active antiretroviral therapy, the epidemic of HIV has evolved into a chronic disease. HIV is extremely stigmatizing, resulting in highly emotionally charged responses to disclosure. World Health Organization (WHO) recommends that children should be informed of their HIV status at ages of 6 to 12 years and full disclosure at about 8 to 10 years. Disclosure process is much more difficult when the person being disclosed to is an adolescent. However, disclosure of HIV to a child should be an ongoing process that may last several years depending on the cognitive development of the child.
Methods: This study investigated the determinants of HIV status disclosure among HIV infected adolescents. A total of 209 HIV infected adolescents (10-19 years) who have been on treatment for at least six months, and are taking lifelong anti-retroviral therapy from Bondo County Hospital, Got Agulu and Uyawi Sub County Hospital in Bondo Sub County were enrolled. Simple random sampling was employed in selecting the adolescents. Data was collected using a structured questionnaire. Quantitative data was analysed using both descriptive and inferential statistics while statistical tests including Pearson Correlation analysis and multiple linear regression were used to test the hypotheses.
Results: Findings on the overall parental perceptions regarding risks and benefits of disclosure and disclosure of HIV status to adolescents show that 180 (86.12%) of the respondents had a negative attitude compared to 29 (13.88%) who held a positive attitude. 122 (58.37%) of the respondents believed that overall availability and quality of counselling was moderate. 10 (4.78%) of the respondents believed that the overall availability and quality of counselling was high. Quality services and perception of the parents have been found to be good predictors of disclosure of HIV status among the newly diagnosed adolescents in Bondo sub-County, p-value<0.05.
Conclusion and recommendation: This study identified quality of service and perception of the parents as the two factors determining the disclosure of HIV status. There is a correlation between the parental perceptions regarding risks and benefits of disclosure and the quality of counselling to parental disclosure of HIV status to adolescents. Therefore the study recommends deliberate efforts to ensure quality service delivery and age specific disclosure counselling to caregivers to equip them with adequate knowledge on disclosure.
This is a lecture given to medical students of Cebu Institute of Medicine under the reproductive module. It contains a discussion of principles of HIV infection screening, diagnosis, staging and management, especially during pregnancy.
Emily Chambers Sharpe of the Office of the Global AIDS Coordinator discusses the importance of nutrition and the relationship between ARVs and breastfeeding in preventing mother to child transmission of HIV.
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
Sugbuanong Pundok Aron sugpuon and Child Abuse (SUPACA) is a group of youth advocates who promote the four inherent rights of a child: survival, protection, development and participation. Due to the explosion of the Philippine HIV Epidemic especially in Cebu, the SUPACA youth advocates go from barangay to barangay to organize children and youth to talk about HIV/AIDS to improve awareness. With understanding comes compassion and with compassion, stigma and discrimination is reduced.
Awareness and attitude of HIV-positive lactating mothers towards breast feed...PUBLISHERJOURNAL
The controversy between the risk of HIV transmission through breast milk and the lifesaving benefits of breastfeeding remains to be a dilemma faced by HIV-positive mothers. In developing countries, 30-45% of infants born to HIV-positive mothers become infected during pregnancy, childbirth, and breastfeeding. This study explored the knowledge and attitude of HIV-positive lactating mothers attending the Young Child Clinic (YCC) at Kabwohe Health Center IV, Sheema district towards breastfeeding their babies. A descriptive cross-sectional quantitative approach to data collection was used to collect data from HIV-positive lactating mothers attending Young Child Clinic at Kabwohe Health Center IV, Sheema district. Forty-four interviewed HIV-positive lactating mothers were age group of 20 to 29 (48%), 27% age group 30 to 39, 14% were age group 40 to 49, the least 7% age group 19 or lesser, and 4% were aged 50 years or more. 77% of HIV-positive mothers knew that HIV can be transmitted to their child, 18% did not know and 5% were not sure. 72.7% were aware that MTCT can be prevented by ARVs during pregnancy and breastfeeding; modified infant feeding; avoid sharing sharp objects and only 27.3% were not aware. The reproductive age needs to be empowered with knowledge regarding HIV infection, risks of transmission to their baby, and services available to reduce the risk. Follow-up and sensitization of HIV-positive lactating mothers for replacement feeding when it is acceptable, feasible, affordable, sustainable, and safe (AFASS).
Keywords: HIV-positive mothers, Breastfeeding, Childbirth, Pregnancy, Lactating mothers
[[INOSR ES 11(2)108-121, 2023.Evaluation of Male partner participation in pre...PUBLISHERJOURNAL
Evaluation of Male partner participation in prevention of mother to child transmission of HIV/AIDs at Hoima Referral hospital
Sebwami Richard
School of Allied Health Sciences, Kampala International University Uganda.
________________________________________
ABSTRACT
The purpose of the study was to assess the knowledge and attitude, the level of male involvement and factors associated with male involvement in the prevention of mother-to-child transmission of HIV in Hoima municipality. This study was a descriptive cross section in which quantitative method of data collection was employed in collection of data from respondents. Questionnaires were distributed to participants to assess the knowledge and attitude, the level of male involvement and factors associated with male involvement in prevention of mother-to-child transmission of HIV (PMTCT) in Hoima municipality. Sample size of 200 participants were used, this included the Male partners who hard escorted their pregnant partners to the antenatal clinic aged between 20-50years.The predominant religion were Catholics 59% and seventh day Adventists. Regarding educational levels, majority of respondents had completed secondary level and above (61%) and the predominant ages were between 20-29 years. The study revealed that very few males partner were involved in the PMTCT program especially during HIV counseling and testing (HCT) because of being at old age group above 30years couples, couples not living together, high number of wife’s pregnancies four and above, having no knowledge on methods of MTCT, and husbands failure to discuss HCT with their wives. From the findings, majority of the respondents have ever had about the male involvement in the PMTCT but there was still low male involvement in PMTCT programs at antenatal clinics. There is a need to do an in-depth assessment of women’s experiences when tested HIV-positive in the presence of their partners at the ANC, as well as to develop strategies to improve male involvement. The study again recommends formative research on the use of incentives to promote male involvement in the PMTCT program and the government should train more of the health promoters and the Village Health Teams in order to reach even those that are deep in the village that are not having easy access to the health facility.
Keywords: HIV, Hoima municipality, Male partner, counseling
This was a lecture given during the CME activitiy for POGS Region 7 by the Philippine Infectious Disease Society for Obstetrics and Gynecology (PIDSOG) at Casino Espanyol in Cebu City.
Physician and public health researcher Mitchell Besser visited the School of Public Affairs on Oct. 4, delivering a presentation on the prevention of mother-to-child transmission of HIV in Africa. Besser is the founder of Mothers2mothers, an organization that trains mothers with HIV to work in health centers to educate and support pregnant women who are HIV-positive.
Besser talked about "task shifting" some of the responsibilities of health care education from nurses and doctors (that are always in short supply and high demand) to the mothers, and utilizing new technologies such as mobile phones to expand the scope of care.
As an obstetrician and gynecologist, Dr. Besser professional career has been dedicated to the public health needs of women. In 1999, Dr. Besser joined the University of Cape Town's Department of Obstetrics and Gynecology, assisting with the development of services to meet the needs of pregnant women living with HIV and to prevent the transmission of HIV from mothers to their children (PMTCT). Dr. Besser recognized the need for an education and psychosocial support program that would contribute to PMTCT services achieving the best medical and social outcomes. Hoping to fill this void, he founded mothers2mothers in which mothers with HIV are employed to work in health centers, educating and supporting pregnant women and new mothers with HIV; reducing the workload of doctors and nurses and increasing the effectiveness of interventions that reduce the number of babies born with HIV and keep mothers healthy and alive to raise their children. Since its inception in 2001, the program has grown to provide services in more than 680 health care facilities in nine countries in Africa, with more than 3 million contacts with woman each year, reaching 20% of the HIV-positive pregnant women in the world. Dr. Besser has received Global Health Council’s Best Practice Award, Skoll Award for Social Entrepreneurship, Presidential Citizens Award of the United States Government and is an Ashoka and Schwab Fellow. He has presented at TED, appeared on BBC’s Forum and has given a Friday Evening Discourse at the Royal Institution of Great Britain.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Are Public Antenatal Clinics in Blantyre, Malawi, Ready to Offer Services for the Prevention of Vertical Transmission of HIV?
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African Journal of Reproductive Health
WOMEN'S HEALTH AND ACTION RESEARCH CENTRE
ISSN: 1118-4841
VOL. 8, NUM. 2, 2004,
PP .
64-70
African Journal of Reproductive Health, Vol. 8, No. 2, Aug, 2004 pp. 64-70
Are Public Antenatal Clinics in Blantyre, Malawi, Ready to Offer Services
for the Prevention of Vertical Transmission of HIV?
Humphreys E Misiri1, Eyob Tadesse2 and Adamson S Muula1
1
Department of Community Health, University of Malawi College of Medicine and 2Department of Obstetrics and
Gynaecology, College of Medicine and Queen Elizabeth Central Hospital, Blantyre, Malawi.
Correspondence: Dr Adamson S. Muula, Department of Community Health, University of Malawi College of
Medicine, Private Bag 360, Blantyre 3, Malawi. E-mail: amuula@medcol.mw; Fax: 265-1-674 700
Code Number: rh04027
Abstract
At least 10% of the adult population in Malawi is infected with HIV and vertical transmission is a major mode of
transmission. Currently, there are plans to provide widespread antiretroviral therapy to prevent mother to child
transmission of HIV. This study was conducted to describe the perceptions of midwives towards selected issues
regarding prevention of mother to child transmission of HIV in eleven public health centres in Blantyre, Malawi. A
cross-sectional study using a self-administered questionnaire incorporating both open-ended and closed-ended
questions was used. Twenty seven midwives participated in the study. Less than half (40.7%), of them reported
working at a baby friendly hospital initiative health facility, while 96.3% reported that they would advise an HIV
infected woman to breastfeed her infant. HIV prevention messages were reportedly offered routinely by 77.8%
of the respondents, but only 22.2% reported that their clinics offered condoms to pregnant women. Also, only
37.0% reported offering routine STI screening, while 37.0% of the midwives would support antenatal women
being accompanied by their male partners. Majority (81.2%) said that women who know they are HIV infected
should not become pregnant, while 37.0% reported that they would be uncomfortable to assist in the delivery of
an HIV infected woman. There was lack of appropriate clinic space and sterile gloves for the proper delivery of
maternity services. Midwives in Malawi need training, supervision and other support to provide adequate health
care services to antenatal women. (Afr J Reprod Health 2004; 8[2]: 64-70 )
Key Words: Malawi, vertical transmission, mother-to-child transmission, HIV
Résumé
Les cliniques prénatales publiques à Blantyre, Malawi, sont-elles prêtes à assurer des services pour la
prévention de la transmission verticale du VIH? Dix pourcent de la population adulte au Malawi sont infectés
par le VIH. La transmission verticale est un moyen important de transmission. A l'heure actuelle, il y a des
tentatives pour assurer la thérapie anti-retrovirale bien répandue pour prévenir la transmission du VIH de la mère
à l'enfant. Cette étude a été menée pour décrire les perceptions des sages-femmes envers des problèmes
sélectionnés concernant la prévention de la transmission du VIH de la mère à l'enfant dans onze centres de
santé publique à Blantyre, Malawi. Nous avons effectué une étude transversale à l'aide d'un questionnaire
auto-administré qui incorporait à la fois les questions sans limite et celles qui sont limitées. Vingt-sept sagesfemmes ont participé à l'étude. Moins d'une moitié (40,7%) ont déclaré qu'elles travaillaient dans les hôpitaux
adoptés aux besoins des enfants alors que 96,3% ont déclaré qu'elles conseilleront à une femme infectée par le
VIH d'allaiter son enfant. Des messages pour la prévention du VIH, selon 77,8% des interviewées, ont été
diffusés régulièrement, mais, seuls 22,2% ont déclaré que leurs cliniques donnaient des préservatifs aux
femmes enceintes. De plus, il n'y avait seules que 37,0% ont déclaré qu'elles assuraient le dépistage de routine
des MSTs, alors que 37,0% des sages-femmes soutiendraient que les femmes prénatales soient
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accompagnées par leurs partenaires hommes. La majorité (81,2%) ont dit que les femmes qui savent qu'elles
sont infectées par le VIH ne doivent pas devenir enceintes, alors que 37,0% ont déclaré qu'elles ne seriont pas
à l'aise à assister à l'accouchement d'une femme infectée par le VIH. Il manquait d'espace approprié dans la
clinique ainsi que de gants stériles pour la présentation des services de maternité. Les sages-femmes
malawiennes ont besoin de formation de surveillance et tout autre appui afin qu'elles puissent rendre des
services de soins de santé adéquate aux femmes prénatales. (Rev Afr Santé Reprod 2004; 8[2]: 64-70 )
Introduction
Africa, and especially southern Africa, has been significantly affected by HIV/AIDS. Malawi's HIV infection rate is
1
estimated to be at least 10% among the adult population. High infection rates have been reported in Blantyre,
the major commercial city of Malawi, among women attending antenatal care, where up to 30% are reported to
be infected.2
There has been increasing global interest towards the prevention of vertical or mother to child transmission of
HIV (MTCT). Initially, at least in the developed world, caesarian section deliveries were instituted to prevent
vertical HIV transmission.3 Such an intervention was deemed inappropriate for the majority of women in Africa.
Various antiretroviral therapy regimes have been tried and have brought new hope in the prevention of vertical
HIV transmission even in Africa. This has been possible because of simplified drug regimens and reduction in
prices of antiretrovirals (ARVs).
HIV is mainly spread heterosexually in Africa.4 The other major mode of transmission is vertical transmission,
when a baby or child acquires HIV from the mother in-utero, intrapartum and through breastfeeding. The
following maternal and infant factors facilitate vertical HIV transmission: advanced maternal disease, reduced
5,6
CD4 counts, mastitis, high viral load, genital tract infection and oral sores in the infant. Prevalence of genital
infections among antenatal women has been described as high in several locations in Africa, with over 60%
7,8
infection rates in some settings. Mastitis is potentially preventable through improvement of the micronutrient
9
status of nursing women. HIV transmission is also efficient with colostrum and early milk, as they have higher
viral load than mature milk.10 Studies to determine whether vitamin A supplementation could reduce vertical
11
transmission have shown no positive effect.
12
Prenatal HIV testing was reported to be acceptable to the majority of women studied, where 92.5%
suggested that it is a good idea in Ireland. In Rwanda, HIV testing was acceptable to the majority of women with
13
14
high maternal age and high socio-economic status of spouse. A multi-centre study reported HIV acceptance
rates averaging 69% among pregnant women.
It is therefore expected that with such high level of HIV testing acceptance, prevention of mother to child
transmission (PMTCT) programmes would be implemented in many sites in Africa. While acceptability of HIV
testing reported is high, some women decide not to inform their spouses when tested in the absence of the male
spouse.
In Malawi, midwives receive training in HIV during both pre-service and in-service trainings. Most of the trainings
concentrate on counselling and education on the prevention of HIV infection and not on ARV therapy.
In early 2004, Malawi provided ART for the prevention of vertical HIV transmission in a few mission hospitals,
two central hospitals and three private hospitals using nevirapine as pilot initiatives. Expansion of the
programmes has been planned using resources from the Global Fund for the prevention of tuberculosis, malaria
and HIV/AIDS.15
Midwives are at the forefront in the provision of care to pregnant women and nursing mothers. However, the
perceptions and experience of this cadre of healthcare workers has not been studied. We therefore undertook
this study to describe the perceptions and experiences of nurse-midwives towards efforts to prevent mother to
child transmission of HIV in Blantyre, Malawi.
Materials and Methods
This cross-sectional descriptive study carried out in 2003 utilised a self-administered questionnaire. The survey
instrument contained questions on demographic characteristics of respondents, perceptions and advice towards
breastfeeding support, availability of infrastructure for HIV testing, knowledge about use of ARVs to reduce
PMTCT of HIV and perceptions towards HIV infected women and babies. Both open-ended and closed-ended
questions were used. All midwives currently in public practice within the Blantyre District health office were
eligible for recruitment. Eleven public health centres, five rural and six urban in Blantyre participated, two of
which offered HIV testing on site while the rest offered counselling and advised clients to obtain testing
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elsewhere. Syndromic STI management is practiced in all the clinics. Respondents were interviewed during
antenatal clinic (ANC) visits. Midwives who were on leave or had travelled were excluded from the study. Data
was analysed using Microsoft Excel 6.0 to obtain proportions. Explanations obtained from open-ended questions
were analysed based on themes and, in some cases, particularly interesting answers presented as written by
the respondent.
Results
Twenty seven midwives participated in the study. The number of years they had practiced mid-wifery ranged
from 2 to 32 years (mean 15.5 years).
Attitudes Towards Breastfeeding
Of the 27 respondents, 21 (77.78%) reported training women on how to properly position baby during
breastfeeding, while 3 (11.11%) did not and 2 (7.40%) were not sure. Eleven (40.74%) of them worked at
baby-friendly health facilities, 9 (33.33%) did not work there, while 6 (22.22%) did not know about the
16-18
baby-friendly hospital initiative.
The advice given by midwives to ANC attendees on exclusive breastfeeding was determined. Almost all
(96.30%) the midwives reported encouraging all women to practice exclusive breastfeeding, while only one
reported otherwise. Interestingly also 96.30% reported that they would advise HIV-infected women to
exclusively breastfeed, while only one respondent reported that she would not do so. Regarding whether to
provide exclusive breastfeeding or not, one respondent said:
Previously, people said there was no problem but now some people say you should not because HIV can be
transmitted to the child. It's like you don't know what to do really.
Another respondent who said she would encourage breastfeeding reported advice on cessation during teething.
The reason given was:
Because during teething the baby tends to have sores around the erupting tooth, which can allow HIV into the
baby.
One respondent reported that there is no conclusive evidence that breastfeeding could be a vehicle of vertical
HIV transmission.
As mastitis is identified to facilitate HIV transmission during breastfeeding, respondents were asked what advice
they would give to a nursing mother with the condition. The responses are presented in Table 1.
Sexuality Advice
In order to determine whether antenatal attendees were advised to abstain from sex at any time by midwives,
respondents were asked whether they would advise abstinence from sexual intercourse at anytime. Two
respondents each said they would advise a woman to abstain from sex if she has antepartum haemorrhage, or if
she has reached term. Two respondents said they would advise sexual abstinence during the whole puerperium.
Perceptions and Practices towards HIV Testing
HIV/AIDS prevention messages were reported to be routinely provided by 21 (80.76%) of the midwives.
However, only 6 (22.22%) reported that their clinics would offer condoms to pregnant women, 16 (59.26%)
would not, and 5 (18.51%) were not sure. It was reported that condoms are not usually offered as pregnant
women would not feel the need for them.
In order to determine the capacity for HIV counselling and testing, respondents were asked whether their health
facilities had at least one trained HIV counsellor. About half (51.85%) reported having such a counsellor, 10
(37.03%) had no counsellor and 3 (11.11%) were not sure of the existence of a counsellor within their facility.
Only 9 (33.33%) midwives reported conducting routine screening of sexually transmitted infections (STIs). At
one health centre, antenatal clinics were being conducted in the corridors and respondents expressed
unsuitability of such a site for either HIV/AIDS counselling or STI screening. However, 21 (77.78%) reported
teaching ANC attendees about HIV/AIDS.
We also aimed to determine midwives' perceptions about the reasons antenatal women sometimes either do not
accept HIV testing or accept testing without wanting to know the results. The responses were that women were
afraid of a positive result, feared losing hope and dying prematurely if they are confirmed to be HIV infected.
The lack of adequate HIV counselling services was mentioned as one of the reasons women would not fully
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accept testing or would not wish to know their test result.
In practice sometimes, women who accept HIV testing decide not to inform their spouses. Midwives'
perceptions of this practice were sought. Midwives thought that women are reluctant to inform their spouses
about HIV testing and seropositive results for the following reason: fear of blame that it was the woman who
acquired the infection from extramarital sexual relations, fear of divorce, and fear of accusation of being
unfaithful in marriage. It was reported that there is a common perception that those who go for test do so after
realising their high risk sexual behaviours. A woman who decides to have an HIV test:
is therefore telling others that she has been unfaithful.
Spousal Support in Antenatal Clinics
It has been suggested that successful PMTCT programme should endeavour to involve men. Midwives were
therefore asked whether they would allow men to attend antenatal clinics with their spouses. Only 10 (37.03%)
reported that they would allow men to accompany spouses, 8 (29.62%) would not and 9 (33.33%) were not
sure if they would accept. The reasons provided for not involving male spouses in antenatal care services were
that ANC services have traditionally been tailored for pregnant women and not men, midwives have never
thought or discussed about involving men, and that men are usually busy at work at the period ANCs are
conducted. For those respondents who wished that men would come to ANC, the reasons provided for such
intentions were that: if men were to come to ANC they would help in ensuring that their spouses understood
health information better and that midwives would cease being accused in the event of adverse neonatal and
maternal outcomes.
Midwives' Attitudes towards HIV-Infected Women and Babies
Respondents were asked whether they thought women who know they are HIV-infected should become
pregnant if they so wished. Only 3 (11.11%) thought they should, 22 (81.48%) said HIV-infected women should
never become pregnant, while 2 (7.41%) were not sure. Sixteen (59.26%) indicated that they would not mind
assisting in the delivery of a woman known to be HIV-infected, 10 (37.04%) reported that they would be
uncomfortable assisting and 1 (3.70%) was not sure. Relating this to the availability of sterile gloves to use in
assisting deliveries, only 11 (40.74%) midwives reported working in health centres with adequate stocks of
gloves. However, only 9 (33.33%) always have gloves appropriate to their hand sizes.
Only 2 (7.41%) reported that women should have access to ARVs even when not tested for HIV, two were not
sure, while 23 (85.19%) reported that access to ARVs should only be to those who have had a positive HIV
testing result. With regard to the baby, 40.74% reported that they would go ahead to give BCG to a day-old
infant whose mother is known to be HIV-infected, 48.15% would not give the vaccine, while 11.1% were not
sure.
Discussion
Midwives in Blantyre, Malawi, generally have a positive attitude towards the use of ARVs to prevent vertical HIV
transmission. However, there still exist important potential impediments to preventing HIV infections among
pregnant women and infants.
This study reports that only 22.22% of midwives provide condoms within their facilities. As consistent and
correct use of condoms during sexual intercourse is an important HIV preventative tool, lack of promotion of
such intervention is a matter of concern. Bauni and Jarabi reported lack of acceptance of condom use within
19
stable relationship. Use of condoms was associated with perceived lack of trust in the relationship.
Perceptions that pregnant women may not need condoms should be challenged and corrected.
There are general beliefs in some parts of Malawi about sexual intercourse among pregnant women; some
cultures promote it, others advice abstinence, while yet others advice abstinence under particular circumstances.
Only 37% of the midwives reported conducting routine STI screening, yet genital infections facilitate HIV
transmission. Lack of STIs screening should be perceived as lost opportunity at ANC where some vertical HIV
20
transmission and maternal HIV acquisition could be prevented if treatment for STIs were routine. Of course, it
ought to be recognised that many women with STIs are asymptomatic and, therefore, will not present with
21,22
23
symptoms.
However, Wilkinson et al, in their study among 189 rural South African women showed that 74
(39%) of them who had not presented with symptoms to a family planning clinic admitted having genital
symptoms on direct questioning.
It is interesting to note, however, that just about 59% reported that they would be comfortable to assist in the
delivery of a known HIV-infected woman. This certainly has implications on widespread access and use of ARV
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to prevent vertical HIV transmission in labour. It is possible that HIV-infected women would be stigmatised and
discriminated by their professional carers. Programmes that provide ARVs for prevention of vertical HIV
transmission should seriously consider this finding.
In general, midwives reported high acceptance and promotion of exclusive breastfeeding even for HIV-infected
women. As breast milk can spread HIV from mother to infant, any advice given whether to encourage or
24
discourage must be as much as possible evidence-based. Nduati et al reported both high maternal and infant
mortality in a randomised study associated with breastfeeding among HIV-infected women. The attributable risk
of maternal mortality as a result of breastfeeding was 69% as compared to formula feeding. The opinions of the
woman and her family must always be respected.
This study reveals that sometimes advice on this subject has been confusing and conflicting. This disempowers
midwives as to what advice to give to ANC attendees. Also, although exclusive breastfeeding is known to have a
25
lower risk of vertical HIV transmission, the practice is a rarity in many developing countries.
It is also of particular interest that about half (48.15%) of the midwives reported that they would not provide
BCG vaccine to a day-old infant whose mother is HIV-infected. This is obviously in contrast to the
recommendation that BCG should be given to all infants regardless of their HIV status. Only when the child has
clinical AIDS can BCG be withheld.
Midwives had negative attitudes towards involvement of men in ANC services. This can be explained by the
belief that ANC services are for women. However, the observation that men are busy at work during ANC clinic
periods is quite important. The majority of women in Malawi are housewives.26 Changing attitudes towards men
attending ANC with their spouses should be viewed as just the first step. In order to ensure sustained
participation of men, there is need to introduce flexible clinic schedules, make allowance for their presence and
27
probably include male health professionals.
The continued and significant braindrain of nurses and midwives from the country to other countries is also a
28
significant challenge towards wide implementation of PMTCT programmes. In the study health centres, each
of the facilities had just between two and five midwives. The reasons for the braindrain and lack of interest in
29
midwifery in Malawi have been described by Ostergaard.
Unwillingness to disclose one's HIV status to the spouse remains a formidable challenge towards effective
30
implementation of a comprehensive PMTCT programme. Twahir et al reported that women attending STI
services in Mombasa, Kenya, were unwilling to disclose their diagnosis to their spouses for fear of being
accused of bringing the infection into the home. Even though ARVs could be administered intrapartum without the
knowledge of the male spouse, the subsequent decision to either breastfeed or not, have further children, and
the need for behavioural change, will most likely require a spouse who is knowledgeable of the HIV status.
Although most Malawian women attend antenatal services at least once during their pregnancy, delivery is
31
usually outside a modern health facility. Therefore, programmes aimed at preventing vertical HIV transmission
must consider this important fact. Despite its attendant formidable challenges, some programme planners have
suggested the use of traditional birth attendants. 32
Acknowledgements
We are greatly indebted to the nurses who accepted to participate in the study. Permission to conduct the study
was obtained from the District Health Officer for Blantyre, Dr Atupele Kapito. We also thank the following
research assistants: Malangizo Mbewe, Francis Kachali, Sandress Msuku, Lumbani Munthali, Staphael Kalengo
and Amos Nyaka. This study was funded through a research grant from the National Research Council of Malawi
(NRCM) of the Government of the Republic of Malawi.
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