Pediatric Infection-Induced SARS-CoV-2 Seroprevalence Increases and Seroprevalence by Type of Clinical CareSeptember 2021 to February 2022.

Wasting is a severe threat to children's survival and development. Attaining optimal breastfeeding practices for infants under six months of age remains a significant challenge in low-income countries. This study assessed the association between wasting and breastfeeding practices among infants under six months of age in the SNNPR and Somali regions of Ethiopia. The study used data from a large feasibility study conducted in the SNNPR and Somali regions of Ethiopia, from August-September 2021. This study involved 895 infants under six months of age with their mothers. The Poisson regression model with robust variance estimation was used to produce adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs). The prevalence of wasting was 16.5% (95% CI: 14.2, 19.2) among infants under six months of age. Non-exclusive breastfeeding (APR = 1.50; 95% CI:1.02, 2.21), delayed initiation of breastfeeding (APR = 1.52; CI:1.00, 2.30), being male infants (APR = 1.50; 95% CI:1.09, 2.07), and mothers who attained primary level (APR = 0.62; 95% CI: 0.40, 0.95) or secondary level education (APR = 0.30; 95% CI: 0.09, 0.99) were independently associated with wasting in the multivariable analysis. This study indicates a high prevalence of wasting among infants under six months of age. Non-exclusive breastfeeding and delayed initiation of breastfeeding were the modifiable factors significantly linked to infant wasting. Strengthening breastfeeding promotion and support may help reduce wasting in infants under six months.

SeroTracker: a global SARS-CoV-2 seroprevalence dashboard

Lyantonde District, Uganda, is a recognized hotspot for Peste des Petits Ruminants (PPR) outbreaks. However, the magnitude and risk factors of PPR in this area remain poorly characterized. This study aimed to determine the prevalence of PPR antibodies in goats and sheep and to identify associated risk factors in selected sub-counties of Lyantonde District. A cross-sectional serosurvey was conducted in July 2024 in three purposively selected sub-counties (Lyantonde, Lyakajula, and Kinuuka), chosen for their large small ruminant populations, high livestock trade activity, and active animal movement. Farms without a history of PPR vaccination were randomly selected, and simple random sampling was used to select study animals. Whole blood samples were collected from the jugular vein and analyzed using the ID Screen® PPR competitive ELISA kit to detect virus-specific IgG antibodies. Multivariate analysis was performed using Modified Poisson regression to identify risk factors associated with PPR seroprevalence. Adjusted prevalence ratios (aPRs), 95% confidence intervals (CIs), and p-values were reported. A total of 351 goats and sheep were sampled, with an overall apparent seroprevalence of 42.17% (n = 148). The Rogan-Gladen estimator gave a true prevalence of 44.27%, with goats showing a significantly (p = 0.046) higher prevalence (46.27%) compared to sheep (33.62%). Age was significantly associated with seropositivity. Animals aged > 1-3 years (aPR = 1.86; 95% CI: 1.16-2.97, p = 0.009), and > 3-5 years (aPR = 2.56; 95% CI: 1.54-4.24, p < 0.0001) had higher prevalence ratios compared to those < 1 year. Goats also had higher prevalence ratios than sheep (aPR = 1.59; 95% CI: 1.01-2.53, p = 0.046). Farms reporting wildlife interactions had a 43% higher prevalence ratio (aPR = 1.43; 95% CI: 1.07-1.91, p = 0.015), and acquisition of new animals from other farmers was similarly associated with higher prevalence ratios (aPR = 1.32; 95% CI: 1.02-1.71, p = 0.029). This study shows the high burden of PPR among small ruminants in Lyantonde district, with higher prevalence in goats than sheep and identification of risk factors associated with seropositivity. The study provides baseline evidence of PPR exposure and documents differences by species, age group, animal acquisition practices, and reported wildlife interactions. These findings contribute to improved characterization of PPR epidemiology in Lyantonde district and may inform the design of future surveillance and control activities aimed at reducing PPR burden.

Intimate partner violence (IPV) is associated with increased risk of HIV infection among women, however, whether IPV affects outcomes after HIV infection is uncertain. We assess the impact of IPV on HIV-positive women. All HIV-positive women who received outpatient HIV care in southern Alberta between March 2009 and January 2012 were screened for IPV. The associations with IPV of sociodemographic factors, health-related quality of life, clinical status, and hospitalizations were obtained from a regional database and evaluated with multivariable regression analysis. Of 339 women screened, 137 (40.4%) reported experiencing IPV. Those disclosing IPV had higher rates of smoking [adjusted prevalence ratio (APR) = 5.07; 95% confidence interval (CI): 2.72 to 9.43]; illicit drug use (APR = 7.58; CI: 2.45 to 23.26); a history of incarceration (APR = 4.84, CI: 1.85 to 12.68); depression (APR = 2.50, CI: 1.15 to 5.46); and anxiety disorders (APR = 5.75, CI: 2.10 to 15.63). Health-related quality of life was diminished with IPV (APR = 2.94, CI: 1.40 to 6.16) for poor/fair versus very good/excellent. IPV-exposed women were hospitalized 256 times per 1000 patient-years compared to 166/1000 patient-years among IPV-unexposed (P < 0.001) women. The relative risk was increased for HIV-unrelated hospitalizations (APR = 1.42, CI: 1.16 to 1.73) and for HIV-related hospitalizations after outpatient HIV care was initiated (APR = 2.19, CI: 1.01 to 4.85). Modifiable contributors to the poor outcomes included decreased use of antiretroviral therapy (APR = 0.55, CI: 0.34 to 0.91) and additional interruptions in care longer than 1 year (APR = 1.90, CI: 1.07 to 3.39). IPV is associated with deleterious HIV-related and HIV-unrelated health outcomes, of which, suboptimal engagement in care is a contributor. To improve outcomes, practitioners should aim to increase engagement in care of these women in particular.

Background: Previous work on adult specimens have demonstrated some differential thickness of the iliotibial band (ITB) tissue in different areas. The purpose of this study was twofold: 1) to quantitatively and qualitatively describe the relevant surgical anatomy of the ITB, at the level of the knee, in pediatric cadaveric specimens in which either an iliotibial band tenodesis or extraphyseal reconstruction would be considered, and 2) to provide recommendations that allow the surgeon to obtain the ideal graft in terms of tissue width and location on the larger ITB structure. Methods: Pediatric cadaveric specimens (n=24) were dissected by a group of fellowship trained pediatric orthopaedic surgeons. Digital photography of each specimen was obtained prior to collecting quantitative data of the ITB and its three main divisions using digital calipers and a coordinated measurement device (Hexagon Romer Absolute V3 CMM). Measurements included thickness, surface area, length, and width of each branch; surface area and length of each insertion; and distance of insertion in relation to other pertinent anatomical landmarks. Specimens were grouped into four age groups (Group 1: 2 year olds, Group 2: 3 and 4 year olds, Group 3: 5-7 year olds, and Group 4: 9-11 year olds). The four age groups were compared utilizing ANOVA and nonparametric Kruskal-Wallis tests with post-hoc analysis using the Tukey method. In order to correlate measurements and age, a Spearman’s correlation was used. Results: All specimens (mean age 4.7 years; range 2-11) contained a visible ITB with a direct primary arm to Gerdy’s tubercle. Sixteen specimens (66.6%) had a visible trifurcation point, in which the aggregate of ITB fibers diverge into three distinct branches: a direct arm, the iliopatellar branch, and the iliotendinous branch (Figure 1). Fibers from the central third of the iliotibial band, as described as the primary site for harvest, do not terminate on Gerdy’s tubercle, but diverge to the patella, patellar tendon and a portion of Gerdy’s tubercle. The length from the trifurcation point to the insertion of the direct arm at Gerdy’s tubercle increased with each age group (21.3 mm, 29.9 mm, 31.5 mm, and 41.8 mm, respectively) with a significant difference seen between Group 1 and 4 (p&lt;0.01) and Group 2 and 4 (p=0.03), indicating migration of this point with longitudinal growth. The mean thicknesses of the direct arm (0.55 mm), the iliopatellar branch (0.74 mm), and iliotendinous branch (0.42 mm) were not statistically different between age groups. Length, width, and surface area were also not statistically different between age groups. Conclusion: The ITB is a consistent, well-defined structure in pediatric specimens. While some longitudinal changes in the ITB and its insertions were seen with increasing age, the thickness and width of the direct arm of the ITB, typically harvested for extra-physeal ACL reconstruction, does not appear to differ between age groups and does not represent the thickest distal branch of the ITB. The location of ITB harvest may influence the impact that the extra-articular “capsular tightening” has on joint mechanics, including altering the compression across the joint, and/or the impact on the Pivot-Shift/rational laxity of the knee undergoing ITB reconstructions. Further study of the graft location/harvest and its impact on knee biomechanics is warranted. [Figure: see text]

BackgroundTeenage pregnancy is a global issue raising concerns for all who are interested in the health and well-being of young women and their children. It carries major health and social issues with unique medical and psychosocial consequences for both adolescents and society in general. This study aimed at assessing the prevalence and factors associated with teenage pregnancy in eastern Ethiopia.MethodsA community-based cross-sectional study was conducted. Multi-stage simple random sampling procedure was used to select 2258 female teenagers. Interviewer-administered questionnaire was used for data collection. Data were entered into EpiData and analyzed using stata software. The Poisson regression model with robust variance estimation was used to examine the association of the independent variable with teenage pregnancy. An adjusted prevalence ratio (APR) with 95% confidence intervals (CI) was reported.ResultsThe prevalence of teenage pregnancy was 30.2% (95% CI: 28.3, 32.1). Age 16–17 years old (APR=7.05; 95% CI: 4.15,11.96), 17–18 years old (APR=9.85; 95% CI: 5.72,16.98), not being in school (APR=2.83; 95% CI: 1.93,4.16), lack of formal education (APR=1.11; 95% CI: 1.03,1.19), being married (APR=3.59; 95% CI: 2.83,4.56), parental divorce (APR=1.24; 95% CI: 1.08,1.42), having elder sister who had a history of teenage pregnancy (APR=1.11; 95% CI: 1.02,1.21), and not knowing fertile period in menstrual cycle (APR=1.31; 95% CI: 1.16,1.47) were independently associated with teenage pregnancy.ConclusionOne in three teenagers had been pregnant. Age, not being in school, lack of formal education, being married, parental divorce, having an elder sister who had a history of teenage pregnancy, and not knowing fertile period during the menstrual cycles were the factors associated with teenage pregnancy. In Ethiopia, further efforts are required in the prevention of teenage pregnancy, keeping girls in school and strengthening the policy of delaying child marriage, particularly in rural areas.

Access to primary healthcare (PHC) is essential for achieving universal health coverage (UHC), particularly in fragile and resource-limited settings such as Somalia. Urban slum populations often face multiple barriers that limit timely use of essential health services. This study assessed factors associated with household access to PHC among residents of Wadajir District in Mogadishu. A community-based cross-sectional study was conducted between October and November 2023 among 300 households selected using purposive sampling to capture underserved areas with limited health service availability. One adult household representative (≥ 18 years) was interviewed using a structured questionnaire. Descriptive and bivariate analyses were conducted using SPSS, while multivariable analysis was performed using modified Poisson regression with robust variance estimation in R to identify factors independently associated with access to PHC. Results were reported as adjusted prevalence ratios (APR) with 95% confidence intervals (CI). Overall, 30% of households reported easy access to primary healthcare services. Most respondents were female (65.7%), and a large proportion reported that healthcare services were unaffordable (79.7%). In the multivariable model, respondents aged 60 years and above were significantly more likely to report easy access to PHC compared with those aged 18–29 years (APR = 2.31; 95% CI: 1.06–5.04; p = 0.035). Additionally, households reporting comfort with healthcare providers had significantly higher prevalence of easy access to PHC compared with those who did not feel comfortable with their providers (APR = 8.11; 95% CI: 5.33–12.33; p < 0.001). Other factors including sex, type of healthcare facility, waiting time, affordability of healthcare services, availability of services, and perceived quality of care were not significantly associated with access to PHC after adjustment. Access to primary healthcare in Wadajir District remains limited, with only one-third of households reporting easy access to services. The findings highlight the critical role of patient–provider relationships in shaping perceived access to healthcare. Interventions aimed at improving respectful communication, trust, and patient-centered care within healthcare facilities may enhance access to PHC in urban slum settings. Strengthening these interpersonal dimensions of care, alongside broader health system improvements, may help improve equitable access to healthcare.

Subthreshold syndromes (STS) frequently precede the onset of full-threshold syndromes (FTS) of the corresponding mental disorder (homotypic continuity). This study examines whether subthreshold conditions are comorbid and whether there is heterotypic continuity also between STS and FTS. Data were extracted from the Brisbane "19Up" cohort study of twins and siblings (N = 1838; 56% female) on individuals who (i) completed self-report ratings of depression-like (DLE), hypomanic-like (HMLE) and psychotic-like experiences (PLE) and (ii) were assessed for mood and psychotic FTS using the Composite International Diagnostic Interview (CIDI). Associations between STS and FTS were estimated using adjusted prevalence ratios (APR) and 95% confidence intervals (CI). STS are prevalent, with 22% reporting DLE, 14% HMLE and 5% PLE; 7% reported >1 STS, with PLE most likely to demonstrate comorbidity. Individuals with DLE were likely to meet CIDI criteria for depression (APR: 3.71, 95% CI: 2.83, 4.89), hypo/mania (APR: 3.62, 95% CI: 2.21, 5.94) and psychotic disorders (APR: 1.74, 95% CI 1.08, 2.83). Individuals with HMLE were likely to meet CIDI criteria for depression (APR: 2.29, 95% CI: 1.58, 3.31) and hypo/mania (APR: 2.51, 95% CI: 1.29, 4.91); those with PLE were likely to meet criteria for hypo/mania (APR: 5.8, 95% CI: 1.90, 17.70) and psychotic disorders (APR: 17.27, 95% CI: 7.54, 39.65). The findings suggest that STS are common among young adults and show heterotypic as well as homotypic continuity with FTS and support the need for more trans-diagnostic research on the evolution of major mental disorders.

HIV controllers demonstrate high rates of spontaneous clearance of hepatitis C virus (HCV) infection. The objective of this study was to evaluate the role of human leukocyte antigen (HLA) B*57 and other genetic polymorphisms on HCV clearance in HIV controllers. This is a prospective cohort study. Patients in the Study of the Consequences of Protease Inhibitor Era (SCOPE) were tested for anti-HCV using enzyme immunoassay (EIA3) and HCV RNA using discriminatory HCV transcription-mediated amplification assay (Norvatis). We compared the proportion of HIV controllers and noncontrollers demonstrating HCV clearance and fitted multivariable Poisson regression models with robust standard errors to estimate adjusted prevalence ratios (APRs) and assessed genetic and immunologic predictors of HCV clearance. Of 279 HIV/HCV seropositive individuals, 48 were HIV controllers. HIV controllers compared to HIV noncontrollers, were significantly more likely to have HLA B*57 (33 vs. 10%, P < 0.01). In multivariate analyses, adjusting for HLAB57, IL28B genotype, age, sex and race/ethnicity, HCV clearance was significantly more likely in HIV controllers than HIV noncontrollers [APR 1.78; 95% confidence interval (CI) 1.06-3.0; P = 0.03]. HLA B*57 did not explain the increased proportion of HCV clearance in HIV controllers, but IL28B CC genotype was independently associated with spontaneous HCV clearance (APR 2.76; 95% CI 1.85-4.11; P < 0.001). Although enriched in HIV controllers, HLA B*57 does not explain the increased HCV clearance. Further identification of host immunologic or genetic factors that contribute to control of HIV and HCV may support the development of novel treatments for and effective vaccines against both viruses.

Incidence of Clostridium difficile Infection in Inflammatory Bowel Disease

BackgroundBreastfeeding initiation within the first hour of birth is beneficial in reducing the risk of maternal and neonatal mortality. However, a significant proportion of mothers delay initiating breastfeeding within an hour of birth, but the association with age has not been rigorously studied. We examined the association between maternal age and delayed initiation of breastfeeding in a large urban referral hospital in central Uganda.MethodsThis analytic cross-sectional study was conducted at the Entebbe Regional Referral Hospital in Central Uganda. Data were collected using a researcher-administered questionnaire between October 1, 2019, and December 20, 2019. Delayed initiation of breastfeeding was the primary outcome, defined as putting the newborn to the breast after one hour of birth. The primary exposure was maternal age categorized as 15–24, 25–34, and 35–45 years. We performed a modified Poisson regression analysis to determine the independent association between maternal age and delayed initiation of breastfeeding, adjusting for other confounders. We stated the findings as an adjusted prevalence ratio (aPR) and 95% confidence interval (CI).ResultsWe studied 384 participants with a mean age of 27.5 ± 5.5 years. Of the 384 participants studied, 275 (71.6%) had delayed initiating breastfeeding, with the majority aged 15–24 years. In a multivariable analysis, delayed initiation of breastfeeding was significantly associated with maternal age groups of 15–24 years (aPR 1.28, 95% CI 1.01,1.63) and 25–34 years (aPR 1.28, 95% CI 1.01–1.60) compared to the reference group of 35–45 years. Additionally, delivery through cesarean section compared to spontaneous vaginal delivery was associated with delayed initiation of breastfeeding (aPR 1.93, 95% CI 1.49–2.49).ConclusionDelayed initiation of breastfeeding is common and is associated with maternal age (15–24 and 25–34 years) as well as delivery through cesarean section. Routine health education and staff mentoring are needed to enhance early initiation of breastfeeding to prevent maternal and neonatal morbidity and mortality.

BackgroundStudies in various countries including Uganda and Kenya have shown a much lower incidence of the human immunodeficiency virus (HIV) among men that underwent voluntary medical male circumcision (VMMC) compared to uncircumcised men. Wakiso district, the district with the highest prevalence of HIV in Uganda (7%), has a very low estimated proportion of men who have undergone VMMC (30.5%). Within the district, various public health facilities provide free VMMC services. This study examined the prevalence and factors associated with the uptake of VMMC among men attending the outpatient department (OPD) of a public facility offering VMMC services.MethodsWe conducted a cross-sectional study between July to August 2021 using a sample of men attending the OPD at Kira Health Centre IV. We defined VMMC uptake as the removal of all or part of the foreskin of the penis by a trained healthcare professional. We determined factors independently associated with VMMC uptake using a modified Poisson regression analysis with robust standard errors at a 5% statistical significance level. Adjusted prevalence risk ratios (APRR) were reported as the measure of outcome.ResultsOverall, 389 participants were enrolled in the study. The mean age of the participants was 27.2 (standard deviation ± 9.02) years. The prevalence of VMMC uptake was 31.4% (95% Confidence Interval [CI] 26.8–36.2). In the adjusted analysis, the uptake of VMMC among men attending the OPD of Kira HC IV was less likely among married participants compared to unmarried participants (APRR 0.64, 95% CI 0.48–0.88), among participants from Western tribes (APRR 0.50, 95% CI 0.41–0.86) or Eastern tribes (APPR 0.31, 95% CI 0.13–0.72) compared to participants from the Central tribes and among participants who didn’t disclose their sexual partner number compared to those that had one or no sexual partner (APRR 0.62, 95% CI 0.40–0.97). On the other hand, the prevalence of uptake of VMMC was 7 times among participants who were aware of VMMC compared to those who were not aware of VMMC (APRR 7.85 95% CI 1.07–9.80) and 2.7 times among participants who knew their HIV status compared to those that didn’t know (APRR 2.75, 95% CI 1.85–4.0). Also, the uptake of VMMC was 85% more among participants who knew that Kira HC IV provided free VMMC services compared to those that didn’t (APRR 1.85, 95% CI 1.85–4.08).ConclusionVMMC among men attending the OPD at the largest public healthcare facility proving free VMMC services in Kira Municipality was low. The OPD may provide a quick win for improving VMMC uptake. Collaborative efforts among the administration of Kira HC IV, the Ministry of Health and VMMC implementation partners could work towards developing health-facility-based strategies that can improve VMMC awareness and uptake with emphasis on the OPD.

Neutrophil-to-lymphocyte ratio on admission is an independent risk factor for the severity and mortality in patients with coronavirus disease 2019

Objective: To determine the perception of possible infection caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) and associated complications according to the labor sector in Peru. Methods: We performed an observational, cross sectional, and secondary data analysis. The study had three dependent variables that were obtained from a locally validated questionnaire, in which it is asked whether the professionals had the perception that they could be infected with SARS-CoV-2 at work, or could transmit the virus to their family/friends, and regarding the possibility of complications related to the infection. Results: Of the 2843 workers participating in the study, those in the health sector perceived that they were more likely to be infected at work. In the multivariate analysis, adjusted for four variables, health sector workers also perceived that they could be infected more frequently at work (adjusted prevalence ratio (aPR): 1.74; 95% confidence interval (CI): 1.40-2.15; p <0.001). These professionals, moreover, perceived that they could transmit the virus to their family/friends (aPR: 0.76; 95% CI: 0.63-0.92; p = 0.005) or that there would be complications resulting from the infection (aPR: 0.59; 95% CI: 0.48-0.73; p <0.001). On the other hand, engineering sector workers were the ones who had a greater perception that they could infect their family/friends (aPR: 1.95; 95% CI: 1.20-3.20; p = 0.007), while workers from other sectors perceived that they could have more chances of complications from the infection (aPR: 1.17; 95% CI: 1.05-1.30; p = 0.006). Conclusion: The health sector may be the most vulnerable in this context, which is why occupational health teams should develop and implement specific surveillance plans to prevent and reduce the number of coronavirus disease 2019 (COVID-19) cases among healthcare workers.

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