The forgotten girls: the state of evidence for health interventions for pregnant adolescents and their newborns in low-income and middle-income countries.

Every year, an estimated 21 million girls aged 15-19 years become pregnant in low-income and middle-income countries (LMICs). Policy responses have focused on reducing the adolescent birth rate whereas efforts to support pregnant adolescents have developed more slowly. We did a systematic review of interventions addressing any health-related outcome for pregnant adolescents and their newborn babies in LMICs and mapped its results to a framework describing high-quality health systems for pregnant adolescents. Although we identified some promising interventions, such as micronutrient supplementation, conditional cash transfers, and well facilitated group care, most studies were at high risk of bias and there were substantial gaps in evidence. These included major gaps in delivery, abortion, and postnatal care, and mental health, violence, and substance misuse-related outcomes. We recommend that the fields of adolescent, maternal, and sexual and reproductive health collaborate to develop more adolescent-inclusive maternal health care and research, and specific interventions for pregnant adolescents. We outline steps to develop high-quality, evidence-based care for the millions of pregnant adolescents and their newborns who currently do not receive this.

Suicidality among pregnant women in Brazil: prevalence and risk factors.

Suicide is one of the major causes of preventable death. We evaluated suicidality among pregnant women who participated in prenatal care in Brazil. A total of 255 patients were assessed using semi-structured interviews as well as the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), and Mini-International Neuropsychiatric Interview (MINI) Plus. Thereafter, Stata 12 was used to identify the significant predictors of current suicide risk (CSR) among participants using univariate and multivariate analyses (p < 0.05). According to MINI Plus module C, the lifetime suicide attempt rate was 12.55%. The overall CSR was 23.53%, distributed across risk levels of low (12.55%), moderate (1.18%), and high (9.80%). Our rates approximate those found in another Brazilian study (18.4%). Antenatal depression (AD), lifetime bipolar disorder, and any current anxiety disorder (as measured using the MINI) as well as BDI scores ≥15 and EPDS scores ≥11 were identified as positive risk factors in a univariate analysis (p < 0.001). These factors changed after a multivariate analysis was employed, and only years of education [odds ratio (OR) = 0.45; 95% confidence intervals (CIs) = 0.21-0.99], AD (OR = 3.42; 95% CIs = 1.37-8.53), and EPDS scores ≥11 (OR = 4.44; 95% CIs = 1.97-9.97) remained independent risk factors. AD and other psychiatric disorders were the primary risk factors for suicidality, although only the former remained an independent factor after a multivariate analysis. More than 10 years of education and EPDS scores ≥11 were also independent factors; the latter can be used as a screening tool for suicide risk.

AIDS incidence and mortality in injecting drug users: the AjUDE-Brasil II Project.

This paper presents AIDS incidence and mortality among injecting drug users (IDUs) reached by the AjUDE-Brasil II Project. From a cross-sectional survey, 478 IDUs were interviewed in three Brazilian cities: Porto Alegre, São José do Rio Preto, and Itajaí. The cohort was followed up in the Brazilian surveillance database for AIDS and mortality during 2000 and 2001. AIDS incidence was 1.1 cases per 100 person-years, and the mortality rate was 2.8 deaths per 100 person-years. AIDS cases only occurred in IDUs who reported ever having shared injecting equipment. Female gender (RR = 5.30), homelessness (RR = 6.16), and report of previous sexual relations with same-sex partners (RR = 6.21) were associated with AIDS. Deaths occurred only among males. Homelessness (RR = 3.00), lack of income (RR = 2.65), HIV seropositive status (RR = 4.52), and no history of incarceration (RR = 3.71) were also associated with death. These findings support evidence that gender and socioeconomic conditions are both determinants of morbidity and mortality in Brazilian IDUs.

AIDS incidence and mortality in injecting drug users: the AjUDE-Brasil II Project

Este estudo apresenta a incidência de AIDS e a mortalidade em usuários de drogas injetáveis (UDIs) participantes do Projeto AjUDE-Brasil II. Uma coorte de 478 indivíduos entrevistados nas cidades de Porto Alegre ¡ Rio Grande do Sul ¡, São José do Rio Preto ¡ São Paulo ¡ e Itajaí ¡ Santa Catarina ¡ foi acompanhada nos sistemas de vigilância brasileiros entre 2000 e 2001. Encontrou-se incidência de AIDS de 1,1 caso por 100 pessoas/ano e taxa de mortalidade de 2,8 óbitos por 100 pessoas/ano. Casos de AIDS ocorreram somente em UDI que relataram compartilhar seringas. Sexo feminino (RR = 5,30), relato de ausência de local para morar (RR = 6,16) e de relacões sexuais com pessoas do mesmo sexo (RR = 6,21) estiveram associados à ocorrência de AIDS. Relato de ausência de local para morar (RR = 3,00) e de fonte de renda (RR = 2,65), ser HIV soropositivo (RR = 4,52) e nunca ter sido encarcerado (RR = 3,71) se associaram aos óbitos, que ocorreram somente em homens. Esses achados parecem confirmar que diferencas de gênero e condicões econômicas são determinantes para a morbi-mortalidade de UDIs brasileiros.