RESUMO
INTRODUCTION: regular use of Antiretroviral Therapy (ART) in pregnancy and breastfeeding reduces the odds of Mother-to-Child HIV Transmission (MTCT). However, adherence to ART is critical for MTCT to be successful. The present study investigated factors that influence adherence to ART among HIV infected pregnant women in Zambia. METHODS: a cross-sectional study design was conducted involving 71 HIV infected pregnant women who were advised to join the Prevention of Mother-to-Child HIV Transmission (PMTCT) program during their routine Antenatal clinic (ANC) visit and were on ART for more than six months. We used the Medication Possession Ratio (MPR) to quantify adherence levels. We used logistic regression to establish factors that influence adherence to ART. RESULTS: a total of 71 HIV infected pregnant women with a median age of 27years (IQR, 25-30) were enrolled in the study. There was evidence of a difference in adherence levels between pregnant women above 30 years and ones between 15 years and 30 years (P<0.001). Median adherence levels in this group were found to be at 96%(IQR 89-97). The main predictor of adherence in this population was marital status (being on separation) and age. The women who were on separation were 0.14 times less likely to adhere to option B+ compared to married women. CONCLUSION: adherence to option B+ among pregnant women is low. Adherence was significantly influenced by marital status (being on separation) and age. Efforts to improve adherence should be directed towards women on separation and young adults (< 30 years of age).
Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Adesão à Medicação/estatística & dados numéricos , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Feminino , Infecções por HIV/prevenção & controle , Humanos , Estado Civil , Projetos Piloto , Gravidez , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal , Setor Público , Adulto Jovem , ZâmbiaRESUMO
Vitamin A (VA) deficiency is a serious public health problem, especially in preschool children who are at risk of increased mortality. In order to address this problem, the World Health Organization recommends periodic high-dose supplementation to children 6-59 months of age in areas of highest risk. Originally, supplementation was meant as a short-term solution until more sustainable interventions could be adopted. Currently, many countries are fortifying commercialized common staple and snack foods with retinyl palmitate. However, in some countries, overlapping programs may lead to excessive intakes. Our review uses case studies in the United States, Guatemala, Zambia, and South Africa to illustrate the potential for excessive intakes in some groups. For example, direct liver analysis from 27 U.S. adult cadavers revealed 33% prevalence of hypervitaminosis A (defined as ≥1 µmol/g liver). In 133 Zambian children, 59% were diagnosed with hypervitaminosis A using a retinol isotope dilution, and 16% had ≥5% total serum VA as retinyl esters, a measure of intoxication. In 40 South African children who frequently consumed liver, 72.5% had ≥5% total serum VA as retinyl esters. All four countries have mandatory fortified foods and a high percentage of supplement users or targeted supplementation to preschool children.
Assuntos
Vitamina A/administração & dosagem , Pré-Escolar , Suplementos Nutricionais , Feminino , Guatemala/epidemiologia , Humanos , Hipervitaminose A/epidemiologia , Lactente , Masculino , África do Sul/epidemiologia , Estados Unidos/epidemiologia , Deficiência de Vitamina A/epidemiologia , Zâmbia/epidemiologiaRESUMO
ABSTRACT Since many rural-poor Lozi people of Sesheke District (Western Province, Zambia) that suffer from sexually transmitted infections do not usually access public health facilities; they turn to traditional healers who administer remedies extracted from medicinal plants. However, the medicinal plants used for sexually transmitted infections and data on the usage of plants in Sesheke District in particular and Western Province in general have not been documented. In this study, an ethnobotanical survey was conducted to document the indigenous knowledge of medicinal plants that alleviate symptoms of sexually transmitted infections in Sesheke District, Western Province, Zambia. Using semi-structured interviews and questionnaires, ethnobotanical data were collected from twenty traditional healers that manage patients presenting with sexually transmitted infections. The results showed that 52 plant species in 25 families and 43 genera were used to treat gonorrhoea, syphilis, chancroid, chlamydia, genital herpes, and ano-genital warts. Sexually transmitted infections were frequently managed using the following plants: Terminalia sericea, Strychnos cocculoides, Ximenia caffra, Cassia abbreviata, Cassia occidentalis, Combretum hereroense, Combretum imberbe, Dichrostachys cinerea, Boscia albitrunca, Momordica balsamina and Peltophorum africanum. Many of these plants have putative antimicrobial activities which may justify their roles as natural remedies for sexually transmitted infections. Further studies are needed to determine the dosages, minimum inhibitory concentrations, biological activities and toxicities, and characterise the plants' chemical compounds.
RESUMO
Inadequate vitamin A (VA) nutrition continues to be a major problem worldwide, and many interventions being implemented to improve VA status in various populations need to be evaluated. The interpretation of results after an intervention depends greatly on the method selected to assess VA status. To evaluate the effect of an intervention on VA status, researchers in Cameroon, India, Indonesia, Mexico, Senegal and Zambia have used serum retinol as an indicator, and have not always found improvement in response to supplementation. One problem is that homeostatic control of serum retinol may mask positive effects of treatment in that changes in concentration are observed only when status is either moderately to severely depleted or excessive. Because VA is stored mainly in the liver, measurements of hepatic VA stores are the gold standard for assessing VA status. Dose response tests such as the relative dose response (RDR) and the modified relative dose response (MRDR), allow a qualitative assessment of VA liver stores. On the other hand, the use of the vitamin A-labeled isotope dilution (VALID) technique, (using 13C or 2H-labeled retinyl acetate) serves as an indirect method to quantitatively estimate total body and liver VA stores. Countries including Cameroon, China, Ghana, Mexico, Thailand and Zambia are now applying the VALID method to sensitively assess changes in VA status during interventions, or to estimate a populations dietary requirement for VA. Transition to the use of more sensitive biochemical indicators of VA status such as the VALID technique is needed to effectively assess interventions in populations where mild to moderate VA deficiency is more prevalent than severe deficiency.
Assuntos
Técnicas de Diluição do Indicador , Marcação por Isótopo , Vitamina A/metabolismo , Humanos , Fígado/metabolismo , Estado Nutricional , Deficiência de Vitamina A/epidemiologiaRESUMO
PIP: In 1996, the Joint Commission International (JCI), which is a partnership between the Joint Commission on Accreditation of Healthcare Organizations and Quality Healthcare Resources, Inc., became one of the contractors of the Quality Assurance Project (QAP). JCI recognizes the link between accreditation and quality, and uses a collaborative approach to help a country develop national quality standards that will improve patient care, satisfy patient-centered objectives, and serve the interest of all affected parties. The implementation of good standards provides support for the good performance of professionals, introduces new ideas for improvement, enhances the quality of patient care, reduces costs, increases efficiency, strengthens public confidence, improves management, and enhances the involvement of the medical staff. Such good standards are objective and measurable; achievable with current resources; adaptable to different institutions and cultures; and demonstrate autonomy, flexibility, and creativity. The QAP offers the opportunity to approach accreditation through research efforts, training programs, and regulatory processes. QAP work in the area of accreditation has been targeted for Zambia, where the goal is to provide equal access to cost-effective, quality health care; Jordan, where a consensus process for the development of standards, guidelines, and policies has been initiated; and Ecuador, where JCI has been asked to help plan an approach to the evaluation and monitoring of the health care delivery system.^ieng
Assuntos
Atenção à Saúde , Planejamento em Saúde , Qualidade da Assistência à Saúde , África , África Subsaariana , África Oriental , América , Ásia , Ásia Ocidental , Países em Desenvolvimento , Equador , Saúde , Pesquisa sobre Serviços de Saúde , Jordânia , América Latina , Oriente Médio , Organização e Administração , Avaliação de Programas e Projetos de Saúde , América do Sul , ZâmbiaRESUMO
The introduction of new contraceptive technologies has great potential for expanding contraceptive choice, but in practice, benefits have not always materialized as new methods have been added to public-sector programs. In response to lessons from the past, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP) has taken major steps to develop a new approach and to support governments interested in its implementation. After reviewing previous experience with contraceptive introduction, the article outlines the strategic approach and discusses lessons from eight countries. This new approach shifts attention from promotion of a particular technology to an emphasis on the method mix, the capacity to provide services with quality of care, reproductive choice, and users' perspectives and needs. It also suggests that technology choice should be undertaken through a participatory process that begins with an assessment of the need for contraceptive introduction and is followed by research and policy and program development. Initial results from Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Vietnam, and Zambia confirm the value of the new approach.
PIP: In response to difficulties associated with the introduction of new contraceptive technologies to public sector service systems, the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction has formulated a new model. The strategic approach to contraceptive introduction shifts the emphasis from the promotion of a particular technology to quality of care issues, a reproductive health focus, and users' perspectives and needs. It further entails a participatory approach with collaboration among governments, women's health groups, community groups, nongovernmental providers, researchers, international donors, and technical assistance agencies. The underlying philosophy is that method introduction should proceed only when a system's ability to provide high-quality services exists or can be generated. Since 1993, WHO has provided support for the implementation of this perspective in public sector programs in Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Viet Nam, and Zambia. Preliminary assessments in these countries revealed major structural, managerial, and philosophical barriers to high-quality family planning services. In cases where assessments have indicated the feasibility of new method introduction, this has been implemented through a carefully phased, research-based process intended to encourage the development of appropriate managerial capacity and to promote a humanistic philosophy of care.
Assuntos
Anticoncepção , Atenção à Saúde/métodos , Países em Desenvolvimento , Serviços de Planejamento Familiar/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Organização Mundial da Saúde , África , Sudeste Asiático , Participação da Comunidade , Anticoncepção/métodos , Anticoncepção/psicologia , Anticoncepção/normas , Atenção à Saúde/organização & administração , Serviços de Planejamento Familiar/organização & administração , Liberdade , Implementação de Plano de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Cooperação Internacional , Modelos Organizacionais , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Formulação de Políticas , Desenvolvimento de Programas , Qualidade da Assistência à Saúde , América do SulRESUMO
The efficacy and acceptability of two widely used oral contraceptive tablets, one containing 250 mg levonorgestrel and 50 micrograms ethinyl estradiol and the other containing 150 micrograms desogestrel and 30 micrograms ethinyl estradiol, administered by the vaginal route were compared in 1055 women studied over 12,630 woman-months of vaginal contraceptive pill use. This multicenter clinical trial was performed in nine countries of the developing world by the "South to South Cooperation in Reproductive Health," an organization founded by scientists from the Third World working in the area of reproductive health, and the study was developed and coordinated by one of these centers. The findings of this study confirm the efficacy of both these tablets when administered by the vaginal route. Involuntary pregnancy rates at 1 year of 2.78 for subjects in the levonorgestrel group and 4.54 for subjects the desogestrel group showed no statistically significant difference between the two groups. However, total discontinuation rates of 47.01 for subjects in the levonorgestrel group and 56.33 for subjects in the desogestrel group showed a statistically significant difference between the two groups, and discontinuation rates attributable to prolonged bleeding of 0.6 for subjects in the levonorgestrel group and 3.2 for subjects in the desogestrel group were also significantly higher in the group of subjects using the desogestrel vaginal contraceptive pill. Blood pressure remained at admission values throughout treatment. A statistically significant weight increase from admission values occurred in both groups of subjects.
PIP: Efficacy and acceptability of 2 combined oral contraceptive pills administered vaginally are summarized. This is the 1st collaborative trial published by the South to South Cooperation in Reproductive Health. 1055 women participated in 12,630 cycles, in 9 countries, from June 1988 to May 1991. The pills were commercially available tablets containing 50 mcg ethinyl estradiol and 250 mg levonorgestrel (Schering AG, Sao Paulo, Brazil), or 30 mcg ethinyl estradiol and 15 mcg desogestrel (Organon, Sao Paulo, Brazil). Subjects were aged 17-39 younger and of lower parity from Mexico and Dominican Republic and older from Egypt and China. All had at least 1 pregnancy. 675 participated for 6 months, 470 for 1 year, 364 for 18 months, and 210 for 2 years. The 1-year discontinuation rate averaged 47.01% for the levonorgestrel group and 56.33% for the desogestrel group (p = 0.0061); 2-year discontinuation rates were 48.01% and 69.36, respectively, explained in part by higher involuntary pregnancy rates and prolonged bleeding rates in the desogestrel group. The most common medical reasons for stopping contraception were unplanned pregnancy, vaginal or vulval irritation, nausea, vaginal discharge and headache. Vaginal irritation was reported by 1%, 9 in each group. There were 32 pregnancies, 14 in the levonorgestrel and 18 in the desogestrel group. 17 were in missed pill cycles and the rest were method failures, 6 in the levonorgestrel group and 9 in the desogestrel group. The Pearl index varied from 0 in Nigeria to 12.24 in Mexico, and was 2.45 for levonorgestrel vs. 3.74 for desogestrel. There was a wide variation in discontinuation rates by center: Brazil and China had few, while many women from Dominican Republic, Mexico and Zambia left the study. Bleeding problems were common complaints, more so in the desogestrel group. There were 363 women with intermenstrual bleeding (only once in 80%), 148 with spotting (only twice in 65%). Bleeding duration was significantly less in pill cycles than baseline, pressure. Women gained an average of 1 kg over 2 years, more in the desogestrel group. The pregnancy rate of 2.78 is within the range reported for levonorgestrel rings.
Assuntos
Desogestrel/administração & dosagem , Etinilestradiol/administração & dosagem , Levanogestrel/administração & dosagem , Administração Intravaginal , Adolescente , Adulto , Desogestrel/efeitos adversos , Países em Desenvolvimento , Combinação de Medicamentos , Etinilestradiol/efeitos adversos , Feminino , Humanos , Levanogestrel/efeitos adversos , Estudos Multicêntricos como Assunto , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Distribuição Aleatória , VaginaRESUMO
PIP: Community counseling is a process that supports the community to act assertively and confidently in its own interests to provide support for those affected by HIV/AIDS and to reduce the spread of HIV. Hope is fundamental in initiating this process and should begin by rendering care and support to individuals affected by HIV/AIDS. Care and support helps generate a sense of self worth and confidence which in turn motivates the recipients to take personal responsibility in preventing further spread of HIV. Moreover, care stimulates awareness and illustrates a commitment to non-discrimination against those infected, or at high risk. Another key aspect of community counseling is a commitment to monitoring changes in high-risk behavior. This process involves identifying high-risk behaviors, choosing strategies for prevention, and recognizing and recording ways of showing that these risk behaviors are changing. In conclusion, community counseling is facilitated by the skills and training from outside the community, and the community decides the content. This process allows monitoring of behavioral change and is a way of sustaining it.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida , Comportamento , Serviços de Saúde Comunitária , Participação da Comunidade , Aconselhamento , Infecções por HIV , Pesquisa , Características de Residência , África , África Subsaariana , África Oriental , Instituições de Assistência Ambulatorial , América , Ásia , Brasil , Atenção à Saúde , Demografia , Países em Desenvolvimento , Doença , Geografia , Saúde , Planejamento em Saúde , Serviços de Saúde , Índia , América Latina , Organização e Administração , População , Atenção Primária à Saúde , América do Sul , Viroses , ZâmbiaRESUMO
PIP: To evaluate the epidemiologic significance of breastfeeding to the transmission of human immunodeficiency virus (HIV) in a country with a high prevalence of HIV infection, the 1720 seronegative women who delivered at the University Teaching Hospital in Lusaka, Zambia, in a 3- month period in 1987 were enrolled in a longitudinal study. Only 634 (37%) of these women returned for testing at the 1-year follow-up point. Of these, 19 (3%) had become seropositive. The infection was asymptomatic in all 19 women at the time of the 1-year follow-up; however, 5 of these women soon developed generalized persistent adenopathy and 3 had spontaneous abortions during the year in which seroconversion occurred. 30 of the spouses of the women in the study sample were HIV-positive; the relative risk of seroconversion was 3.84 in women with HIV-infected spouses compared to those with HIV-negative spouses. Other significant risk factors for HIV seroconversion included: history of genital ulceration after delivery (relative risk, 15.51), use of a cloth to remove vaginal secretions during intercourse (dry sex) (relative risk, 37.95), and blood transfusion (relative risk, 10.89). 3 infants born to these 19 women also seroconverted; 2 years after seroconversion, only 1 of the 3 infected children was symptomatic (persistent, generalized lymphadenopathy). Other sources of HIV infection 9e.g., scarification, blood transfusions, use of contaminated needles during immunization) aside from breastfeeding were not recorded in these 3 infants. Although there is a high prevalence of HIV infection in Zambia, the health benefits of breastfeeding (in terms of the prevention of mortality from diarrheal disease) still outweigh the small risk of HIV transmission.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida/transmissão , Aleitamento Materno , HIV-1/isolamento & purificação , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/etiologia , Adulto , Métodos Epidemiológicos , Feminino , Sangue Fetal/microbiologia , Seguimentos , Humanos , Recém-Nascido , Gravidez , Fatores de Risco , Reação Transfusional , ZâmbiaAssuntos
Participação da Comunidade , Planejamento em Saúde , Habitação , Áreas de Pobreza , Política Pública , Características de Residência , Mudança Social , Seguridade Social , Urbanização , África , África Subsaariana , África Oriental , África Austral , Demografia , Países em Desenvolvimento , Economia , Geografia , Malásia , Marrocos , Organização e Administração , Peru , População , Densidade Demográfica , População Urbana , ZâmbiaRESUMO
PIP: Recent developments in the tobacco industry in several countries are described: 1) in the USSR the policy is not to encourage smoking but to produce pleasant cigarettes which are as harmless as possible; 2) in the US, a survey shows that in 1975 not more than 12.4% of men over age 21 smoked a pipe; 3) in Britain a new cigarette tax structure will cripple the cigarette industry's coupon scheme of which manufacturers make great use to secure brand loyalty; 4) in the Philippines a proposal to print a health warning on cigarette packets and in advertisements might affect cigarette and tobacco taxes, which contribute 47% of government income; 5) in the Netherlands health warnings will be printed on cigarette packs, 6) in Austria there has been an increase of 4.2% in cigarette smoking since late 1975; 7) in Poland anti-smoking officials have proposed that the name of the popular "Sport" cigarette be changed; 8) in Indonesia there has been a recovery in kretek sales; 9) in Denmark cigarette consumption increased 6% from 1974; and 10) in western Europe it has been shown that up to 99% of grocery stores in Ireland sell tobacco products, 91% in Britain, 30% in Austria, 17% in Spain, and 7% in Italy.^ieng
Assuntos
Fumar , África , África Subsaariana , África Oriental , África do Norte , África Ocidental , América , Ásia , Sudeste Asiático , Austrália , Áustria , Comportamento , Brasil , Canadá , República Centro-Africana , República Democrática do Congo , Dinamarca , Países Desenvolvidos , Países em Desenvolvimento , Europa (Continente) , Europa Oriental , Ásia Oriental , França , Alemanha Oriental , Alemanha Ocidental , Índia , Indonésia , Itália , Japão , América Latina , Países Baixos , Nigéria , América do Norte , Ilhas do Pacífico , Paquistão , Filipinas , Polônia , Portugal , Países Escandinavos e Nórdicos , América do Sul , Espanha , Suíça , Tailândia , U.R.S.S. , Reino Unido , Estados Unidos , Zâmbia , ZimbábueRESUMO
PIP: Responses to the second worldwide survey of 80 nations on their population policy can be divided into 3 categories. First are countries with large official programs of family planning in existence: Egypt, Kenya, Tunisia, Barbados, Colombia, Panama, Trinidad and Tobago, China, India, Iran, Japan, Nepal, Pakistan, Philippines, Republic of Viet-nam, Singapore, Sri Lanka, Thailand, Turkey, Denmark, Netherlands, United Kingdom, Yugoslavia, Canada, and Fiji. Madagascar and New Zealand are starting programs. The second category is countries that encourage private family planning programs: Tanzania, Mexico, Israel, Cambodia, Bahrain, Jordan, Laos, Syria, Austria, France, West Germany, Finland, and Norway. Third are listed countries that do not officially support, or that forbid contraception: Gabon, Malawi, Zambia, Greece, Italy, and Spain. Thus Asia and North Africa have the most ambitious programs, but Europe and North America practice contraception universally.^ieng