Ai Koyanagi

Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey

BACKGROUND Macrosomia is a risk factor for adverse delivery outcomes. We investigated the prevalence, risk factors, and delivery outcomes of babies with macrosomia in 23 developing countries in Africa, Asia, and Latin America. METHODS We analysed data from WHOs Global Survey on Maternal and Perinatal Health, which was a facility-based cross-sectional study that obtained data for women giving birth in 373 health facilities in 24 countries in Africa and Latin America in 2004-05, and in Asia in 2007-08. Facilities were selected by stratified multistage cluster sampling and women were recruited at admission for delivery. We extracted data from the medical records with a standardised questionnaire. We used logistic regression with random effects to assess the risk factors for macrosomia and the risks for caesarean section and adverse maternal and perinatal outcomes (assessed by a composite score) in babies with the disorder. FINDINGS Of 290,610 deliveries, we analysed data for 276,436 singleton livebirths or fresh stillbirths. Higher maternal age (20-34 years), height, parity, body-mass index, and presence of diabetes, post-term pregnancy, and male fetal sex were associated with a significantly increased risk of macrosomia. Macrosomia was associated with an increased risk of caesarean section because of obstructed labour and post-term pregnancy in all regions. Additionally, macrosomia was associated with an increased risk of adverse maternal birth outcomes in all regions, and of adverse perinatal outcomes only in Africa. INTERPRETATION Increasing prevalence of diabetes and obesity in women of reproductive age in developing countries could be associated with a parallel increase in macrosomic births. The effect and feasibility of control of diabetes and preconception weight on macrosomia should be investigated in these settings. Furthermore, increased institutional delivery in countries where rates are low could be crucial to reduce macrosomia-associated morbidity and mortality. FUNDING None.

Morbidity among human immunodeficiency virus-exposed but uninfected, human immunodeficiency virus-infected, and human immunodeficiency virus-unexposed infants in Zimbabwe before availability of highly active antiretroviral therapy.

Background: Human immunodeficiency virus (HIV) remains a major cause of pediatric morbidity in Africa. In addition, HIV-exposed, but uninfected (HEU) infants can comprise a substantial proportion of all infants born in high prevalence countries and may also be a vulnerable group with special health problems. Methods: A total of 14,110 infants were recruited within 96 hours of birth between November 1996 and January 2000. Rates and causes of sick clinic visits and hospitalizations during infancy were investigated according to infant HIV infection group: infected-intrauterine, infected-intrapartum, postnatally-infected, HEU, and not-exposed (born to HIV-negative mother). Results: A total of 382 infected-intrauterine, 499 infected-intrapartum, 188 postnatally-infected, 2849 HEU, and 9207 not-exposed infants were included in the analysis. Compared with not-exposed infants, HIV-infected infants made 2.8 times more all-cause sick clinic visits and required 13.3 times more hospitalizations; they had 7.2 times more clinic visits and 23.5 times more hospitalizations for lower respiratory tract infection after the neonatal period and were 159.9 times more likely to be hospitalized for malnutrition during the second half of infancy. Compared with not-exposed infants, sick clinic visits were 1.2 times more common among HEU infants, were inversely associated with maternal CD4 cell count, and were significantly higher for all HEU infants except those whose mothers had a CD4 count ≥800 cells/&mgr;L, which was the mean value of HIV-negative women enrolled in the trial. Conclusions: Morbidity is extremely high among HIV-infected infants. Compared with not-exposed infants, morbidity is higher among HEU infants and increases with severity of maternal disease, but is significantly higher for all mothers with CD4 cell count <800 cells/&mgr;L.

Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015

Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides an up-to-date analysis of the burden of diarrhoeal diseases. This study assesses cases, deaths, and aetiologies spanning the past 25 years and informs the changing picture of diarrhoeal disease worldwide. Methods We estimated diarrhoeal mortality by age, sex, geography, and year using the Cause of Death Ensemble Model (CODEm), a modelling platform shared across most causes of death in the GBD 2015 study. We modelled diarrhoeal morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for diarrhoeal diseases using a counterfactual approach that incorporates the aetiology-specific risk of diarrhoeal disease and the prevalence of the aetiology in diarrhoea episodes. We used the Socio-demographic Index, a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in diarrhoeal mortality. The two leading risk factors for diarrhoea—childhood malnutrition and unsafe water, sanitation, and hygiene—were used in a decomposition analysis to establish the relative contribution of changes in diarrhoea disability-adjusted life-years (DALYs). Findings Globally, in 2015, we estimate that diarrhoea was a leading cause of death among all ages (1·31 million deaths, 95% uncertainty interval [95% UI] 1·23 million to 1·39 million), as well as a leading cause of DALYs because of its disproportionate impact on young children (71·59 million DALYs, 66·44 million to 77·21 million). Diarrhoea was a common cause of death among children under 5 years old (499 000 deaths, 95% UI 447 000–558 000). The number of deaths due to diarrhoea decreased by an estimated 20·8% (95% UI 15·4–26·1) from 2005 to 2015. Rotavirus was the leading cause of diarrhoea deaths (199 000, 95% UI 165 000–241 000), followed by Shigella spp (164 300, 85 000–278 700) and Salmonella spp (90 300, 95% UI 34 100–183 100). Among children under 5 years old, the three aetiologies responsible for the most deaths were rotavirus, Cryptosporidium spp, and Shigella spp. Improvements in safe water and sanitation have decreased diarrhoeal DALYs by 13·4%, and reductions in childhood undernutrition have decreased diarrhoeal DALYs by 10·0% between 2005 and 2015. Interpretation At the global level, deaths due to diarrhoeal diseases have decreased substantially in the past 25 years, although progress has been faster in some countries than others. Diarrhoea remains a largely preventable disease and cause of death, and continued efforts to improve access to safe water, sanitation, and childhood nutrition will be important in reducing the global burden of diarrhoea. Funding Bill & Melinda Gates Foundation.

Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study

Please cite this paper as: Hirayama F, Koyanagi A, Mori R, Zhang J, Souza J, Gülmezoglu A. Prevalence and risk factors for third‐ and fourth‐degree perineal lacerations during vaginal delivery: a multi‐country study. BJOG 2012;119:340–347.

Relationships between serum concentrations of C-reactive protein and micronutrients, in patients with tuberculosis

Abstract Studies on the serum concentrations of micronutrients in tuberculosis (TB), and their relationship to the acute-phase response (APR), are scarce. The serum concentrations of zinc, copper, selenium and vitamins A and E in 46 smear-positive cases of pulmonary TB (PTB) from Ecuador were therefore compared with those in 10 healthy Ecuadorian volunteers, and the correlations between these concentrations and the serum concentration of C-reactive protein (CRP) were evaluated. Compared with the healthy volunteers, the PTB cases had significantly lower serum concentrations of zinc, retinol and selenium and significantly higher serum concentrations of copper. Both groups had moderately high concentrations of selenium in their sera. The PTB cases who had >50 mg CRP/ litre (a concentration indicative of an APR) had lower serum concentrations of retinol and zinc than the cases with lower CRP concentrations. In patients with PTB, hypozincaemia and hyporetinolaemia are strongly associated with the APR. It is therefore necessary to consider the extent of activation of the APR when interpreting serum micronutrient concentrations in patients with TB.

Zinc and infection: a review

Abstract Dietary zinc deficiency is widespread in developing countries and is often aggravated by intercurrent acute and chronic infections. Recent studies have demonstrated that zinc supplementation can significantly reduce the morbidity and mortality of apparently well-nourished children and shorten the time to recovery from acute infectious diseases. This review summarises current knowledge of the role of zinc in childhood diarrhoea, acute respiratory infections and malaria, and its potential role in diseases associated with impaired cellular immunity, namely tuberculosis, lepromatous leprosy and leishmaniasis, and explores avenues for future research.

The Association between Sleep Problems and Psychotic Symptoms in the General Population : A Global Perspective

STUDY OBJECTIVES To assess the prevalence of sleep problems and their association with psychotic symptoms using a global database. DESIGN Community-based cross-sectional study. SETTING Data were analyzed from the World Health Organizations World Health Survey (WHS), a population-based survey conducted in 70 countries between 2002 and 2004. PATIENTS OR PARTICIPANTS 261,547 individuals aged ≥ 18 years from 56 countries. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS The presence of psychotic symptoms in the past 12 months was established using 4 questions pertaining to positive symptoms from the psychosis screening module of the Composite International Diagnostic Interview. Sleep problems referred to severe or extreme sleep problems in the past 30 days. Multivariable logistic regression was used to estimate the associations. The overall prevalence of sleep problems was 7.6% and ranged from 1.6% (China) to 18.6% (Morocco). Sleep problems were associated with significantly higher odds for at least one psychotic symptom in the vast majority of countries. In the pooled sample, after adjusting for demographic factors, alcohol consumption, smoking, and chronic medical conditions, having sleep problems resulted in an odds ratio (OR) for at least one psychotic symptom of 2.41 (95% confidence interval [CI] 2.18-2.65). This OR was 1.59 (1.40-1.81) when further adjusted for anxiety and depression. CONCLUSIONS A strong association between sleep problems and psychotic symptoms was observed globally. These results have clinical implications and serve as a basis for future studies to elucidate the causal association between psychotic symptoms and sleep problems.

Loneliness and health risk behaviours among Russian and U.S. adolescents: a cross-sectional study

BackgroundFor some adolescents feeling lonely can be a protracted and painful experience. It has been suggested that engaging in health risk behaviours such as substance use and sexual behaviour may be a way of coping with the distress arising from loneliness during adolescence. However, the association between loneliness and health risk behaviour has been little studied to date. To address this research gap, the current study examined this relation among Russian and U.S. adolescents.MethodsData were used from the Social and Health Assessment (SAHA), a school-based survey conducted in 2003. A total of 1995 Russian and 2050 U.S. students aged 13–15 years old were included in the analysis. Logistic regression was used to examine the association between loneliness and substance use, sexual risk behaviour, and violence.ResultsAfter adjusting for demographic characteristics and depressive symptoms, loneliness was associated with a significantly increased risk of adolescent substance use in both Russia and the United States. Lonely Russian girls were significantly more likely to have used marijuana (odds ratio [OR]: 2.28; confidence interval [CI]: 1.17–4.45), while lonely Russian boys had higher odds for past 30-day smoking (OR, 1.87; CI, 1.08–3.24). In the U.S. loneliness was associated with the lifetime use of illicit drugs (excepting marijuana) among boys (OR, 3.09; CI, 1.41–6.77) and with lifetime marijuana use (OR, 1.79; CI, 1.26–2.55), past 30-day alcohol consumption (OR, 1.80; CI, 1.18–2.75) and past 30-day binge drinking (OR, 2.40; CI, 1.56–3.70) among girls. The only relation between loneliness and sexual risk behaviour was among Russian girls, where loneliness was associated with significantly higher odds for ever having been pregnant (OR, 1.69; CI: 1.12–2.54). Loneliness was not associated with violent behaviour among boys or girls in either country.ConclusionLoneliness is associated with adolescent health risk behaviour among boys and girls in both Russia and the United States. Further research is now needed in both settings using quantitative and qualitative methods to better understand the association between loneliness and health risk behaviours so that effective interventions can be designed and implemented to mitigate loneliness and its effects on adolescent well-being.

Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi-continent study

The aim of this study was to evaluate the factors associated with low skeletal muscle mass (SMM), sarcopenia, and sarcopenic obesity using nationally representative samples of people aged ≥65 years from diverse geographical regions of the world.

Chronic Conditions and Sleep Problems among Adults Aged 50 years or over in Nine Countries: A Multi-Country Study

Background Data on the association between chronic conditions or the number of chronic conditions and sleep problems in low- or middle-income countries is scarce, and global comparisons of these associations with high-income countries have not been conducted. Methods Data on 42116 individuals 50 years and older from nationally-representative samples of the Collaborative Research on Ageing in Europe (Finland, Poland, Spain) and the World Health Organizations Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) conducted between 2011–2012 and 2007–2010 respectively were analyzed. Results The association between nine chronic conditions (angina, arthritis, asthma, chronic lung disease, depression, diabetes, hypertension, obesity, and stroke) and self-reported severe/extreme sleep problems in the past 30 days was estimated by logistic regression with multiple variables. The age-adjusted prevalence of sleep problems ranged from 2.8% (China) to 17.0% (Poland). After adjustment for confounders, angina (OR 1.75–2.78), arthritis (OR 1.39–2.46), and depression (OR 1.75–5.12) were significantly associated with sleep problems in the majority or all of the countries. Sleep problems were also significantly associated with: asthma in Finland, Spain, and India; chronic lung disease in Poland, Spain, Ghana, and South Africa; diabetes in India; and stroke in China, Ghana, and India. A linear dose-dependent relationship between the number of chronic conditions and sleep problems was observed in all countries. Compared to no chronic conditions, the OR (95%CI) for 1,2,3, and≥4 chronic conditions was 1.41 (1.09–1.82), 2.55 (1.99–3.27), 3.22 (2.52–4.11), and 7.62 (5.88–9.87) respectively in the overall sample. Conclusions Identifying co-existing sleep problems among patients with chronic conditions and treating them simultaneously may lead to better treatment outcome. Clinicians should be aware of the high risk for sleep problems among patients with multimorbidity. Future studies are needed to elucidate the best treatment options for comorbid sleep problems especially in developing country settings.