Perceived acceptability of progesterone to prevent preterm births and low birth weight among HIV-infected and HIV-uninfected Zambian pregnant women.

INTRODUCTION: Intramuscular and vaginal progesterone are recommended for prevention of preterm labor (PTL) in women with risk factors. Studies are emerging to indicate that HIV-infected women on combination antiretroviral therapy (cART) are at risk of PTL and low birth weight (LBW), and may benefit from supplemental progesterone. This study aims to determine the perceived acceptability of various modes of progesterone supplementation to prevent PTL and LBW in HIV-infected and HIV-uninfected women. METHODS: HIV-infected and HIV-uninfected women were recruited in Lusaka, Zambia. The participants completed a questionnaire to assess their willingness to take oral, vaginal, or intramuscular progesterone supplementation for preventing PTL and LBW, preferred modes of supplementation, and concern for PTL and LBW. RESULTS: The study questionnaire was completed by 147 participants. Of the participants, 98.6% would consider using a medication to help prevent PTL and LBW, of whom 97.9% would consider using an oral form of progesterone. In addition, 83.3% and 84.0% of women would consider intramuscular and vaginal (gel or tablet) administration of progesterone respectively. Between intramuscular and vaginal modes of progesterone, 60.5% of participants (n=147) preferred intramuscular progesterone, while 39.5% preferred vaginal progesterone. There was no difference in preference between HIV-infected (n=70) and HIV-uninfected (n=77) women. CONCLUSIONS/IMPLICATIONS: Pregnant Zambian women demonstrated a high degree of acceptance for all modes of progesterone supplementation for the prevention of PTL and LBW. Women preferred intramuscular over vaginal supplementation. Progesterone supplementation can be considered a feasible intervention for preventing PTL and LBW in both HIV-infected and HIV-uninfected pregnant Zambian women.

Mapping an HIV/STD prevention curriculum for Zambian in-school settings.

HIV/AIDS poses grave risk to human development in sub-Saharan Africa. Evidence-based interventions that are rooted in local culture could help efforts to prevent threats to human development from HIV/AIDS. We used concept mapping (Concept System, 2006 ) to construct the components and content of a locally developed HIV/AIDS curriculum for use by secondary schools in Lusaka, Zambia. Participants were school counsellors (n = 14), youth health program officers (n = 7), and regular education teachers (n = 3) from the education, health, and youth development agencies in Lusaka, Zambia (males = 11; females = 13; mean age 38; SD = 15 years). Concept mapping yielded six statement clusters defining preliminary components of a locally grounded in-school HIV/AIDS prevention curriculum and the content items that define these components: (1) life skills education (18 items), (2) sexuality and reproductive health (10 items), (3) treatment, care and support (13 items), (4) counselling (12 items), (5) basic facts about HIV/AIDS (11 items), and (6) dissemination of information about HIV/AIDS (11 items). Zambian locally constructed constructs for an HIV/STD prevention curriculum overlap those promoted by public health programs in the country and internationally.

Congenital trypanosomiasis.

The last successfully treated case of congenital trypanosomiasis in Zambia was in October 1978, with detailed analysis of immunoglobulins, illustrating the waning of blood and serum levels of IgA, IgG, and IgM during treatment, up to 99 days after treatment. Twenty-five years later, we report on a case of congenital trypanosomiasis. The disease is now rare and can be missed or dismissed as retroviral disease, particularly in adults. The main unusual symptoms were the prolonged intermittent convulsions in an otherwise well infant. Management of the disease is now more interdisciplinary, resources for laboratory support are fewer, lumbar puncture is more relevant, and antitrypanosomal drugs are more difficult to obtain. The mother died within one week of hospitalization and the infant initially responded to three doses of suramin and 3 weeks of melsopropol. Convulsions ceased during the second round of melsopropol. Unfortunately, the infant died of nosocomial infection.