The HIV paradox: Perinatal mortality is lower in HIV-positive mothers-A field case-control study in Ethiopia.

OBJECTIVE: Sub-Saharan African countries have the highest perinatal mortality rates. Although HIV is a risk factor for perinatal death, antioretroviral therapy (ART) programs have been associated with better outcomes. We aimed to investigate how maternal HIV affects perinatal mortality. METHODS: The authors performed a nested case-control study at Saint Luke Hospital, Wolisso, Ethiopia. Data on sociodemographic characteristics, current maternal conditions, obstetric history, and antenatal care (ANC) services utilization were collected. The association between perinatal mortality and HIV was assessed with logistic regression adjusting for potential confounders. RESULTS: A total of 3525 birthing women were enrolled, including 1175 cases and 2350 controls. Perinatal mortality was lower among HIV-positive women (18.3% vs. 33.6%, P = 0.007). Crude analysis showed a protective effect of HIV (odds ratio, 0.442 [95% confidence interval, 0.241-0.810]), which remained after adjustment (adjusted odds ratio, 0.483 [95% confidence interval, 0.246-0.947]). Among HIV-negative women, access to ANC for women from rural areas was almost half (18.8% vs. 36.2%; P < 0.001), whereas in HIV-positive women, no differences were noted (P = 0.795). CONCLUSION: Among HIV-positive mothers, perinatal mortality was halved and differences in access to ANC services by area were eliminated. These data highlight the benefits of integrating ANC and HIV services in promoting access to the health care system, reducing inequalities and improving neonatal mortality.

Evaluation of training of trainers courses for Oromia (Ethiopia) health professional schools' tutors.

BACKGROUND: In Ethiopia training tutors in the health system are part of a major health programme. A previous study disclosed that tutors felt they lacked sufficient teaching skills. AIM: The Teaching Methodology Course (TMC) described here was designed to correct these deficiencies. The aim of the study was firstly to evaluate the usefulness of questionnaires in terms of TMC quality control and secondly to evaluate whether the subcourses differed in terms of self-progress evaluation and course evaluation. CONTENT: The TMC consists of eight subcourses and is evaluated according to a quality circle described previously. METHODS: Two questionnaires were used as part of the TMC quality control, one to assess tutors' self-progress and the other to examine tutors' opinion about the course instructors' pre-defined teaching skills. RESULTS: In the questionnaires a distinction was made between 'good' and 'bad' subcourses. Moreover, the quantitative evaluation of subcourses was in accord with the tutors' written qualitative comments. CONCLUSION: The questionnaires can be used for TMC quality control in order to improve at least some subcourses.

Community-wide outbreak of hemolytic-uremic syndrome associated with non-O157 verocytotoxin-producing Escherichia coli.

From 20 April through 13 May 1992, 9 children were hospitalized with hemolytic-uremic syndrome in Lombardia, Italy, where only 14 cases of this syndrome had occurred in the preceding 4 years. Cases were scattered in a large area encompassing five provinces, and the source of the outbreak was not identified. Eight patients needed dialysis, and there was 1 death. Seven of the 9 cases were examined for evidence of infection by Vero cytotoxin (VT)-producing Escherichia coli (VTEC). Six children had serum antibodies to the lipopolysaccharide of E. coli O111, and a VT-producing E. coli O111:NM was isolated from stool in 1 case. This is the first outbreak of VTEC infection recognized in Italy and the first associated with an E. coli serotype other than O157:H7.

Infertility clinic at Consolata Hospital, Nkubu Kenya (1987).

Data regarding 266 cases of couple infertility were reviewed in the Infertility Clinic of Consolata Hospital, Nkubu, Meru, between January and December 1987. Of these, 132 were cases of primary infertility and 134 of secondary infertility. 218 women with primary and secondary infertility were investigated with tubal insufflation with the result that 163 (74.8%) presented tubal occlusion. Besides more than 68% of primary infertility cases had a positive smear for gonorrhoea.