Dissertations / Theses on the topic 'Prenatal transmission'

This thesis consists of four chapters on the role of prenatal health and fertility on the intergenerational transmission of disadvantage. The first two are related, and the third and fourth chapters are independent essays. The abstracts are provided in the following: Multigenerational effects of the 1918-19 influenza pandemic on educational attainment: Evidence from Sweden We use the 1918-19 influenza pandemic in Sweden as a natural experiment to estimate the effects of a prenatal health shock on the children of those who experienced the pandemic as a prenatal insult. We find that for women educational attainment decreases by 3-4 months of schooling if their mothers potentially experienced the Spanish flu as a prenatal insult. For men, educational attainment decreases by 4-7 months of schooling if their fathers were potentially prenatally exposed. We find no mother-son or father-daughter transmission. Second generation effects of prenatal health shocks: Disentangling social from biological pathways Second-generation effects of prenatal health shocks can represent direct biological effects and indirect effects via the parental household environment, but the relative importance of these two effects remains unknown. We combine an exogenous source of variation in fetal health with an adoption design and exploit the fact that adoptees do not inherit health conditions from their adoptive parents, which rules out direct effects. Adoptees are furthermore not exposed to the home environment of their biological parents, which rules out indirect post-birth effects. Our results are imprecisely estimated and need to be interpreted as suggestive at best, but seem to suggest that direct second generation effects may be positive, whereas indirect effects may be negative. Intergenerational income mobility and fertility patterns in Sweden & USA I contrast the USA and Sweden to shed light on the question if differences in fertility patterns can explain differences in intergenerational income mobility. I document substantial fertility differences between both countries and I quantify the importance of these differences using a simple decomposition of persistence metrics. I find that intergenerational persistence increases (decreases) in the number of children in Sweden (USA). A substantial part of the difference in intergenerational mobility estimates between Sweden and the USA originates from differences in the family size distribution. Low birth weight and parental investments in an intervention context Using data from a reading intervention targeted at disadvantaged households in Chicago, we investigate whether children’s initial health endowment affects parental behavior and their responsiveness to behavioral tools aimed at increasing parental investments. We find that parents with low birth weight children increase parental reading time twice as much than their normal birth weight counterparts after receiving a simple nudge to do so. These parents do not differ in their pre-intervention time investments, although there is some albeit weak evidence that their subjective beliefs about the returns to their time investments could be lower. There is no strong evidence for higher subjective costs of reading. Goal setting behavior is markedly different, though. While both groups of parents typically do not reach their reading goals, parents of normal birth weight children adjust their goals downwards in reaction to past failure of goal attainment.

At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Manuscript. Paper 2: Manuscript. Paper 3: Manuscript.

The hippocampus, which plays a crucial role in cognitive processes, is a brain region that has been repeatedly shown to be disrupted in schizophrenia, which likely contributes to some of the cognitive impairments associated with the disease. Although the aetiology of schizophrenia remains unknown, mounting evidence from epidemiological studies have implicated exposure to infection during pregnancy as a potent risk factor for schizophrenia in the offspring. Using rodent models to mimic maternal infection during gestation, we sought to examine in the offspring changes that may be occurring in the hippocampus. While anatomical and behavioural alterations have been reported in the hippocampus in rodent models of prenatal maternal infection, it remains unknown as to how hippocampal synaptic transmission is affected. Understanding what is occurring at the synaptic level will help to understand the consequences of maternal infection during pregnancy on hippocampal function in the offspring.Study 1 investigated synaptic transmission in the hippocampus of the juvenile offspring from rat mothers that were exposed to infection near-term. Lipopolysaccharide (LPS) was used to mimic bacterial infection and was administered to rats on embryonic days 15 and 16. A significantly attenuated presynaptic excitatory input and a compensatory increase in transmission postsynaptically were uncovered in the CA1 region after prenatal maternal infection. Although synaptic transmission was assessed in the dentate gyrus and CA3 areas, the marked changes were only found in CA1, an important hippocampal output region. In addition, prenatal maternal infection led to heightened excitability of CA1 pyramidal cells.Based on the findings from Study 1 and the existing reports suggesting that excitatory and inhibitory synaptic transmission may be affected by prenatal maternal infection, Study 2 examined whether network-generated activity in the hippocampus might also be disrupted. Using a mouse model of prenatal maternal infection with polyriboinosinic:polyribocytidilic acid (poly I:C), we measured spontaneously generated oscillations in areas CA3, CA1 and the subiculum from in vitro, whole hippocampal preparations of the juvenile offspring. Although no significant alterations in theta and gamma rhythms were found in the 3 hippocampal subfields, a greater contribution of NMDA (N-methyl D-aspartate) transmission to the generation of theta oscillations was uncovered exclusively in the subiculum, a major output of the hippocampus. Furthermore, the modulation of gamma amplitudes by the underlying theta was abnormally greater in the subiculum after prenatal maternal poly I:C treatment. Taken together, neurodevelopmental disruption triggered by prenatal maternal infection can have profound effects on hippocampal synaptic transmission and hippocampal networks that are already evident in early life. We revealed changes exclusively occurring in the CA1 and subiculum, suggesting that the outflow of information from the hippocampus is severely disrupted. These results strongly indicate that prenatal maternal infection leads to impaired information processing in the hippocampus that probably contributes to the cognitive deficits in schizophrenia.
L'hippocampe est une des structures clés du cerveau dans les processus de mémorisation. Les altérations du fonctionnement de cette structure chez les patients schizophrènes pourraient expliquer en partie les troubles cognitifs associés à la maladie. Même si les causes exactes de la schizophrénie font encore l'objet de nombreux débats, plusieurs études ont pu mettre en évidence une augmentation de l'incidence de cette maladie chez les enfants des mères exposées à une infection bactérienne ou virale durant la grossesse. Afin de mieux comprendre les changements intervenant au sein des réseaux hippocampiques lors de la schizophrénie, nous avons utilisé un modèle d'infection prénatale chez le rongeur. Ce modèle animal, largement validé, a permis de caractériser les changements anatomiques survenant dans l'hippocampe. Cependant, soulignons qu'aucune étude n'a pour le moment étudié les altérations possibles de l'activité électrophysiologique, tant au niveau de la synapse que du réseau, occasionnées dans l'hippocampe par une infection prénatale. La caractérisation de ces altérations nous permettra par conséquent de mieux saisir d'une part les changements d'activité observés dans l'hippocampe suite à une infection prénatale et de cerner d'autre part leurs rôles possibles dans les troubles comportementaux communément décrits dans la schizophrénie.La première partie de notre étude porte ainsi sur les altérations de la transmission synaptique dans l'hippocampe de jeunes rats provenant de mères exposées à une infection bactérienne (en utilisant le lipopolysacharide ou LPS comme modèle d'infection) vers la fin de la grossesse, soit le quinzième et seizième jours de gestation chez le rat. Dans ce modèle d'infection prénatale, nous avons observé une diminution de la transmission excitatrice vers l'aire CA1 de l'hippocampe (altérations présynaptique) accompagnée d'une augmentation compensatoire au niveau postsynaptique. Ces changements semblent spécifiques à l'aire CA1 puisqu'ils ne sont pas présents dans l'aire CA3 ou le gyrus dentelé. Finalement, nous avons également mis en évidence une augmentation de l'excitabilité des cellules pyramidales de l'aire CA1.Ces résultats couplés aux nombreuses études mettant en évidence une perturbation de la transmission excitatrice et inhibitrice dans l'hippocampe suite à une infection prénatale, suggèrent que l'activité de réseau de l'hippocampe pourrait être altérée. Afin de tester cette hypothèse, nous avons étudié l'effet d'une infection prénatale au poly I:C sur l'activité oscillatoire de l'hippocampe et ce en utilisant une nouvelle approche expérimentale récemment développée au laboratoire, l'hippocampe intact isolé in vitro. Bien qu'aucune altération des rythmes thêta et gamma nà été observée, nous avons mis en évidence une plus grande sensibilité du rythme thêta aux récepteurs NMDA (N-methyl D-aspartate) exclusivement dans le subiculum. Dans cette region de l'hippocampe nous avons de plus observé une augmentation du couplage des oscillations gamma et theta. En conclusion, l'infection prénatale induit des changements neurodéveloppementaux qui affectent profondément la transmission synaptique et l'activité de réseau de façon précoce dans l'hippocampe. Ces changements, spécifiques au subiculum et à l'aire CA1, pourraient fortement compromettre le transfert d'information entre l'hippocampe et différentes structures corticales et sous-corticales et pourraient de ce fait contribuer aux déficits cognitifs observés dans la schizophrénie.

In 2012, Tanzania, the prevalence of HIV infection among Tanzanian women was 6.3%; that same year, 18% of Tanzanian children were born already infected with HIV. The purpose of this study was to determine the importance of prenatal care attendance on comprehensive knowledge of HIV mother-to-child transmission (MTCT), and HIV testing and counseling, as well as awareness of HIV testing coverage services, in Tanzania. The study population was Tanzanian women of childbearing, aged 15 to 49 years old. Guided by the health belief model, this cross-sectional survey design used secondary data from the 2011-2012 Tanzania Demographic Health Survey. Independent variables were comprehensive knowledge of HIV MTCT, HIV testing and counseling, and awareness of HIV testing coverage services; the dependent variable was prenatal care visit (PNCV) attendance. Findings showed that 69% of women had their first PNCV in the second trimester, meaning that they attended less than 4 visits. Multinomial logistic regression modeling assessed the association between independent variables and PNCV attendance after controlling for sociodemographic factors. Findings denoted that comprehensive knowledge of HIV MTCT after controlling for married vs. never married, maternal age, and wealth was associated with PNVC. HIV testing and post counseling, and awareness of HIV testing coverage services were also significant for women who attended their first prenatal visit in the 2nd trimester. These findings have positive social change implications by informing efforts to identify at-risk pregnant women through systematic HIV testing and counseling for early medical intervention; such efforts may reduce MTCT and encourage them to start their PNCV in the first trimester.

The convergence of compelling evidence that transmission of HIV from a pregnant woman living with HIV to her foetus can be significantly interrupted due to advances in antiretroviral and obstetrical interventions, and worrisome epidemiologic data documenting a rise in HIV infection among Canadian women, spurred the development in Canada and world wide of policies and programmes aimed at increasing the number of pregnant women who are tested for HIV. Responding to innovative therapy reducing perinatal HIV transmission risk by increasing the number of pregnant women who agree to test for HIV is clearly an important prevention objective. However, the process must be accomplished in a way that is of most benefit to the pregnant woman herself and in a way that does not compromise a pregnant woman's rights to the established Canadian principles of HIV counselling and testing.
Working with pregnant women in Ontario, the province with the highest level of HIV infection among Canadian women, this thesis articulates and interprets their experiences of prenatal HIV counselling and testing and details their perspectives on best practices. The pregnant women's evidence-based recommendations for the re-design of prenatal HIV testing programmes are provided. These unique data have important utility for federal and provincial policy makers as HIV counselling and testing policies and programmes that encompass and are grounded in pregnant womens' experiences and perspectives are likely to be maximally acceptable and thereby increase the number of pregnant women who can be apprised of prophylactic treatment to take care of their own health needs as well as those of their unborn children.
In order for pregnant women to increase control over their own health and that of their unborn children, there is clear value in all pregnant women being afforded the opportunity to know their HIV status. However, the voices of the women in this study suggest that the autonomy rights of pregnant women may well be at risk in a programme in which the current emphasis is on potential HIV infection of the foetus rather than on potential or actual infection of the pregnant woman.

Les regroupements avec des congénères et les interactions avec l’humain sont deux sources de stress majeures pour les truies gestantes. Elles y répondent de manière variable. Cette variabilité de réponse, si elle est stable, permet d’aborder le concept de personnalité. Réaction au stress et personnalité pourraient avoir un impact sur la descendance. Si l’expérience prénatale peut impacter le comportement des jeunes, il en est de même pour des expériences précoces positives avec l’humain. L’interaction entre expérience pré- et péri-natale reste peu connue chez les porcs. Cette thèse a donc visé dans un premier temps à étudier l’existence d’une variabilité et d’une stabilité de réponse à un facteur de stress social chez les truies et les répercussions sur le stress induit. Le statut social étant susceptible de moduler l’impact de ce stress, nous avons au préalable caractérisé la structure hiérarchique de nos groupes. Puisque l’agressivité semblait être une variable pertinente pour qualifier la variabilité de réponse à un challenge social, nous avons étudié son impact sur le comportement des porcelets. Enfin, nous avons étudié les effets de la réaction à l’humain des truies et ses interactions avec un renforcement positif de la relation humain-animal sur le comportement de leurs porcelets. Nous avons montré que la hiérarchie des groupes de truies est linéaire, raide et stable ce qui a eu pour conséquences de limiter l’impact du stress social. Les truies les plus agressives étaient aussi les plus dominantes et les moins blessées, mais aucun effet de l’agressivité des truies sur leur niveau de stress ou le comportement de leurs porcelets n’a été trouvé. En revanche, la réaction à l’humain des truies, sans moduler leur stress, a impacté le comportement de leurs porcelets. Les porcelets de mères farouches ont eu des réponses comportementales à différents tests qui peuvent être interprétées directement ou indirectement comme étant en lien avec la peur de l’humain. Bien que le renforcement positif ait amélioré la relation humain-animal des porcelets, il n’a pas effacé les effets maternels. Les porcelets nés de mères farouches ont également eu des performances moindre dans un test de mémorisation spatiale, que l’ont peut attribuer à un état anxieux général. Cette étude soulève dans un premier temps l’intérêt de la conduite des truies gestantes en groupe stable pour limiter les effets d’un éventuel stress social, par résolution des conflits grâce à la hiérarchie. Aussi, elle soulève l’importance de la relation humain-animal dans les élevages de truies gestantes, non seulement pour leur propres bien être mais également celui de leurs porcelets
Mixing with conspecifics and interactions with humans are two of the major stress sources for pregnant sows. They may respond to it in different ways. This variability of response, if it is time stable, draws the concept of animal personality. Stress response and personality could have an impact on the offspring behaviour, as well as early positive experiences with human. This study thus first focused on the investigation of the individual response variability and stability to a social stressor, and its impact on the stress response. Social status can modulate the stressor impact ; we thus previously investigated the characteristics of the hierarchy inside our groups. Since the aggressiveness seemed to be a valuable indicator of the social stress response variability, we investigated its impact on piglets’ behaviour. Finally, we studied the effects of sows’ reaction to humans and their interactions with early positive human handling on piglets’ behaviour.We demonstrated that the hierarchy inside groups of sows is linear, steep and stable, which limited the impact of the social stress. The most aggressive sows were also the most dominant and least injured, but no effects of sows aggressiveness were described on their stress levels, neither on their piglets’ behaviour. Piglets born from fearful sows showed behavioural responses in various tests that could be directly or indirectly attributed to the fear of human. Positive experiences with humans improved human-piglets relation but didn’t erase the maternal effects. Piglets born from fearful sows had lower performances in a spatial memory task that could be attributed to a general anxious state. This study raises the importance of the breeding of sows in stable groups to lower the impact of a possible social stress thanks to the hierarchy. It also points out the importance of a good human-animal relation in sow breedings, not only for their own welfare but also for their piglets’

Le syndrome des ovaires polykystiques (SOPK) est la principale cause d’infertilité feminine à travers le monde, associé à un risqué élevé de comorbidités avec des conséquences économiques non négligeables. Ce syndrome est caractérisé par une oligo-anovulation, une hyperandrogénie, et un aspect échographique d’ovaires polykystiques. De plus, la plupart des femmes atteintes de SOPK présentent des concentrations élevées de LH suggérant une libération accrue de GnRH. De plus, les patientes SOPK ont habituellement des concentrations en Hormone Anti Müllerienne (AMH) 2 à 3 fois plus élevés que les femmes non atteintes.Alors que l’origine exacte du SOPK demeure inconnue, des études de clustering familial et portant sur des jumeaux ou des ascendants de femmes atteintes du SOPK ont mis en évidence une forte composante héréditaire. Cependant, les gènes candidats identifiés n’expliquent qu’à peine 10% des cas de SOPK suggérant qu’une origine développementale et que des facteurs environnementaux tels que des modifications hormonales durant la vie foetale pourrait être à l’origine du SOPK.Dans cette étude, nous avons d'abord comparé les concentrations d'AMH dans un groupe de femmes atteintes de SOPK et chez des femmes témoins pendant la grossesse. Les concentrations d’AMH se sont révélées significativement plus élevées chez les SOPK par rapport aux témoins. Nous avons ensuite utilisé ces résultats cliniques pour développer un modèle animal murin de SOPK en exposant les souris gestantes à une concentration élevée d’AMH au cours d'une fenêtre temporelle spécifique. Nous avons montré que cette exposition foetale conduisait à une cascade d'altérations affectant le cerveau maternel, les ovaires et le placenta, entrainant une reprogrammation du cerveau foetal et induisant l'acquisition des principaux critères diagnostiques retrouvés dans le SOPK, à savoir l'hyperandrogénie, l'augmentation de la pulsalitié de la LH et de l'oligo-anovulation, ainsi qu’une augmentation persistante de l'activité électrique de la GnRH à l'âge adulte. De plus, nos résultats montrent que les conséquences à long terme d'une exposition courte à des niveaux élevés d'AMH pendant la gestation s'étendent au-delà de la première génération exposée et que les manifestations de type SOPK semblent être transmises d’une génération à l’autre chez les femelles.De manière intéressante, en utilisant une approche pharmacologique, nous avons démontré que l’inhibition partielle de la voie de signalisation de la GnRH permettait de restaurer chez les animaux SOPK un phénotype neuroendocrinien normal, en rétablissant des concentrations hormonales normales, la cyclicité oestrale et leur morphologie ovarienne.Enfin, nous avons cherché à comprendre comment une exposition précoce à un excès d'AMH affecterait les caractéristiques neuroendocriennes et reproductives de la progéniture mâle. Ici, nous avons démontré que le traitement par AMH en période prénatale modifiait la fonction de l'axe hypothalamo-hypophyso-gonadique (HPG) chez les mâles, qui ne parviennent pas à engager le pic de testostérone néonatal normalement observé chez les nouveau-nés mâles témoins, conduisant à une féminisation des circuits sexuellement dimorphiques cérébraux, à une augmentation de la LH, et finalement à une diminution drastique des niveaux de testostérone à l’âge adulte, à des altérations sévères de la stéroïdogenèse et de la spermatogenèse ainsi qu'à un risque plus élevé de développer une cryptorchidie à l'âge adulte. Ainsi, il pourrait être intéressant de relier les résultats de cette étude au phénotype reproductif des garçons de femmes atteintes du SOPK, qui ont été exposés pendant la grossesse mais qui ne sont habituellement pas suivis plus tard à l'âge adulte [...]
Polycystic ovary syndrome (PCOS) is the main cause of female infertility worldwide with high comorbidity and economic burden. It is mainly characterized by hyperandrogenism, oligo/anovulation and polycystic appearing ovaries. Moreover, most women with PCOS exhibit higher levels of circulating luteinizing hormone (LH), suggestive of heightened gonadotropin-releasing hormone (GnRH) release. Additionally, PCOS patients also exhibit 2-3x higher levels of Anti-Müllerian Hormone (AMH) as compared to healthy controls.While the exact origin of PCOS is unknown, familiar clustering and twin studies of PCOS patients and their relatives suggest a strong heritable component in PCOS. However, the candidate genes identified account for only <10% of the estimated 70% heritability of PCOS, implying that it may originate during intrauterine development and that environmental factors, such as hormonal imbalances during fetal life, could be involved in the onset of PCOS.In this study, we first measured AMH levels in a cohort of pregnant women with PCOS and control women which revealed that AMH is significantly more elevated in the former group versus the latter, we then modelized our clinical findings by exposing pregnant mice to high concentration of AMH during a specific temporal window and showed that this fetal exposure leads to a cascade of alterations impacting the maternal brain, the ovaries, and the placenta, which consequently reprogram the fetal brain and induce the acquisition of the major PCOS cardinal neuroendocrine reproductive features, namely hyperandrogenism, elevation in LH pulse frequency and oligo-anovulation, and a persistent rise in the GnRH neuronal firing activity in adulthood. Moreover, our results show that the long-term consequences of a short exposure to elevated AMH levels during gestation expand beyond the first generation exposed and that PCOS-like manifestations seem to be transmitted across subsequent generations of females.Intrestingly, using a pharmacological approach, we demonstrate that tempering GnRH signaling pathway rescues the neuroendocrine phenotype of PCOS-like animals, restoring their normal hormonal levels, estrus cyclicity and ovarian morphology.Lastly, we sought to understand how early exposure to AMH excess would affect the neuroendocrine and reproductive features of the male offspring. Here, we demonstrate that prenatal AMH treatment profoundly impacts the Hypothalamic-Pituitary-Gonadal (HPG) axis function in males, which fail to engage the testosterone surge at birth observed in control newborns, leading to a feminization of sexually dimorphic circuitries of their brains, an increase in LH, a drastic decrease in testosterone levels, severe alterations in the testicular steroidogenesis and morphology as well as a higher risk of developing cryptorchidism in adulthood. Thus, it could be of clinical interest to relate findings from this study to the reproductive phenotype of sons of PCOS women, who are exposed during gestation but not systematically investigated in adulthood.Collectively, our results challenge the concept of PCOS originating in utero and appear to consolidate the role of AMH as a trigger of the pathogenesis, suggesting that an altered hormonal milieu during early life associated with PCOS may not only affect the female fetus but also the male fetus exposed and that these alterations could be transmitted across multiple generations.These findings point to PAMH mouse model as an excellent preclinical tool to investigate both neuroendocrine disturbances of PCOS and how developmental programming effects are transmitted, while offering a therapeutic avenue for the treatment of the disease

O objetivo do estudo foi avaliar a influência da implantação do projeto Pré-natal do parceiro (PNP) no município de Ribeirão Preto sobre: 1) as taxas das infecções pelo vírus da imunodeficiência humana (HIV), vírus das hepatites B e C (VHB, VHC) e pelo Treponema pallidum (TP) entre gestantes; 2) as taxas de transmissão vertical (TV) dos VHB, VHC, do HIV e do TP; 3) os indicadores de qualidade do pré-natal (número de consultas; idade gestacional (IG) na primeira consulta; desfecho gestacional); 4) os indicadores perinatais (peso ao nascer; prematuridade; índice de Apgar no 1º e 5º minutos) e 5) as taxas das infecções pelos VHB, VHC, do HIV e do TP nos parceiros que aderiram ao projeto. Estudo transversal do grupo de gestantes (G) e nascidos vivos (NV) que tiveram seus parceiros participantes do projeto PNP (denominados G1 e NV1) e do grupo de gestantes e NV que não tiveram seus parceiros participantes do projeto PNP (denominados G2 e NV2). Os grupos de gestantes e parceiros foram incluídos no estudo no período de 1º de Julho de 2013 a 30 de Junho de 2014 e os grupos de NV, entre 1º de Julho de 2013 a 31 de Dezembro de 2014. Foram selecionadas 5391 gestantes (1781 do G1 e 3610 do G2), 1781 parceiros e 4044 NV (1376 do NV1 e 2668 do NV2). Utilizado o teste Quiquadrado de Pearson com um nível de significância de 5%. Os resultados demonstraram prognósticos estatisticamente mais favoráveis no grupo onde houve a participação do parceiro no pré-natal (G1 e NV1). Encontraram-se menores taxas de TV (0,7% no NV1 e 1,5% no NV2 com p= 0,04); início mais precoce do PN (com até 120 dias de gestação 88,3% no G1 e 84,5% no G2 com p< 0,01); mais de sete consultas no PN (80,8% no G1 e 74,3% no G2 com p< 0,01); desfecho gestacional favorável (95,9% no G1 e 94,2% no G2 com p= 0,01); menores taxas de prematuridade (10,3% no NV1 e 12,9% no NV2 com p= 0,01), menor ocorrência de baixo peso ao nascer (8,7% no NV1 e 11,4% no NV2 com p< 0,01) e melhores índices de Apgar no 5º minuto (2,5% de Apgar <= 7 no NV1 e 3,8% no NV2 com p= 0,03). Frente a estes dados foi possível concluir que a estratégia de inclusão do parceiro no PN foi importante na identificação e tratamento da sífilis reduzindo significativamente a taxa de TV do TP. A adesão do parceiro ao PNP foi fundamental para a adesão da gestante ao PN associando-se também à melhora significativa dos indicadores de saúde perinatal
The goal of these study was to evaluate of the influence of the implementation of the project \"Male Partner in the Prenatal Care (MPPC)\" in Ribeirao Preto city on: 1) the rates of infection by the human immunodeficiency virus (HIV), hepatitis virus B and C (HBV, HCV), and Treponema pallidum (TP) among pregnant women; 2) the vertical transmission (VT) rates of HBV, HCV, HIV and TP; 3) the prenatal care quality indicators (number of visits, gestational age (GA) at the first visit, gestational outcome); 4) the perinatal indicators (birth weight, prematurity, Apgar score at 1 and 5 minutes) and 5) the rates of infection with HIV, HBV, HCV and TP in partners that have joined the project. It is a cross-sectional study of group of the pregnant women (G) and born alive (BA) who had their partners participating MPPC project (called G1 and NV1) and the group of pregnant women and BA who have not had their partners participants (called G2 and NV2). The pregnant women groups and the male partners group were surveyed in the period from July 1, 2013 to June 30, 2014 and the BA groups, between July 1, 2013 to December 31, 2014. Were selected 5391 pregnant women (1781 of the G1 and 3610 of the G2), 1781 partners and 4044 BA (1376 of the NV1 and 2668 of the NV2). Used the Chi-square test of Pearson with a 5% significance level. The results showed statistically more favorable prognosis in the group where there was the partner\'s participation in prenatal care (G1 and NV1). The lower VT rate was found (0.7% in NV 1 and 1.5% in NV2 p= 0.04); earlier initiation of PN (up to 120 days of gestation 88.3% in G1 and 74.3% in G2 with p< 0.01); more than seven consultations in PNC (80.8% in G1 and 74.3% in G2 with p< 0.01); favorable pregnancy outcome (95.9% in G1 and 94.2% in G2 with p= 0.01); lower prematurity rates (10.3% in the NV1 and 12.9% in the NV2 with p= 0.01); lower incidence of low birth weight (8.7% in NV1 and 11.4% in NV2 with p< 0.01) and better Apgar scores at five minutes (2.5% Apgar <= 7 in NV1 and 3.8% in NV2 with p= 0.03). Considering these data it was concluded that the male partner\'s inclusion strategy in prenatal care was important in the identification and treatment of syphilis reducing significantly the VT rate of the TP. The partner\'s adherence to MPPC project was essential to the mother\'s adherence to PNC and it was also associated with significant improvement in perinatal health indicators.

Introdução: O Protocol Aids Clinical Trial Group (PACTG 076), publicado em 1994, demonstrou que a utilização da zidovudina (ZDV) reduzia a taxa de transmissão materno-infantil do HIV (TMI HIV) de 25% para 8,3%. Atualmente a terapia antirretroviral (TARV) combinada associada a uma série de medidas pode reduzir a taxa de TMI HIV para menos de 2%. Embora o Ministério da Saúde preconize a adoção destas medidas, a TMI HIV ainda permanece acima dos níveis desejados, principalmente em nosso meio. De acordo com levantamento da Vigilância Epidemiológica do Município de Porto Alegre, no ano de 2012 a taxa TMI HIV foi de 2,9%. Objetivo: Avaliar os fatores que interferem na TMI HIV em um Hospital Universitário do Município de Porto Alegre/RS. Método: Trata-se de um estudo de coorte histórico, tendo como amostra 292 bebês nascidos de mulheres portadoras do HIV, cujos nascimentos ocorreram no Centro Obstétrico de um Hospital Universitário do Município de Porto Alegre/RS, entre 1º de janeiro de 2010 a 31 de dezembro de 2014. Resultados: Dos 292 bebês, cujas mães eram portadoras do HIV, 3,8% (n=11) foram contaminados. Destes 90,9% (n=10) nasceram por cesariana; 90,9% (n=10) tinham d37 semanas; 54,6% (n=6) receberam ZDV xarope isoladamente e 45,4% (n=5) receberam ZDV + nevirapina (NVP). Quatro gestantes cujos bebês foram contaminados apresentaram sífilis na gestação (36,4%). A má adesão a TARV (p<0,003), a carga viral d1.000 cópias/mL ou ignorada no 3º trimestre (p<0,001) e o CD4 <500 células/mm3 (p<0,046) no terceiro trimestre foram significativamente associados a maior TMI HIV. Conclusão: Os fatores associados significativamente a TMI HIV foram à má adesão a TARV, a presença de sífilis na gestação, a carga viral d1000 cópias e o CD4 <500 células/mm³ no terceiro trimestre.
Introduction: Protocol Aids Clinical Trial Group (PACTG 076), published in 1994, demonstrated that the use of zidovudine (ZDV) had reduced the rate of mother-tochild transmission (MTCT) of HIV from 25% to 8.3%. Currently, a combined antiretroviral therapy (HAART) associated with a number of measures can reduce the rate of MTCT to less than 2%. Although the Ministry of Health recommends the adoption of these measures, the MTCT still remains above desired levels, especially in our center. According to a survey of Epidemiological Surveillance of Porto Alegre, in 2012 the rate of MTCT was 2.9%. Objective: To evaluate the factors that interfere with MTCT from HIV-positive women who gave birth in a University Hospital of Porto Alegre/RS. Method: A historical cohort study, with a sample 292 babies from HIV infected mother whose delivery occurred at Obstetric Center of the University Hospital of Porto Alegre/RS, at period of January 2010 till December 2014. Results: Of 292 babies of women HIV positive, 3.8% (n=11) were infected. Of those 90.9% (n=10) was born by cesarean section; 90.9% (n=10) had d37 weeks; 54.6% (n=6) received only ZDV syrup and 45.4% (n=5) received ZDV+nevirapine (NVP). Four pregnant women whose babies were infected, mother had syphilis during pregnancy (36.4%). Poor adherence to HAART (p<0.003), viral load d1000 copies/mL or ignored in the third trimester (p<0.001) and CD4 <500 cells/mm3 (p<0.046) in the third trimester were significantly associated with higher MTCT. Conclusion: We conclude that the presence of syphilis in pregnancy, viral load d1000 copies/mL or ignored in the third trimester, the CD4 <500 cells/mm³ in the third trimester, poor adherence to HAART were significant factors for MTCT.

OBJETIVOS: Avaliar os efeitos da rubéola durante a gestação, sobre o feto, o recém-nascido e a criança. CASUÍSTICA E MÉTODO: Analisamos 35 gestantes com suspeita de rubéola que foram divididas em dois grupos. Grupo 1: 15 pacientes que apresentaram quadro clínico com comprovação sorológica. Grupo2: 20 pacientes com IgM positiva na rotina pré-natal, na ausência de quadro clínico. O seguimento ultrasonográfico mensal foi realizado em todas as pacientes e as do grupo 1 foram encaminhadas também para propedêutica invasiva. Foram também realizadas a ecocardiografia fetal e a Dopplervelocimetria. As placentas foram submetidas a exame anátomo-patológico. Os recém-nascidos vivos foram avaliados através de exame clínico e sorológico, além do potencial evocado auditivo, ultra-sonografia de crânio, fundo de olho e ecocardiografia pós-natal. RESULTADOS: No grupo 1: a infecção fetal ocorreu em 9 casos, sendo que o risco de transmissão vertical entre 2 a 14 semanas foi de 64,9%. A malformação ocorreu em 37,5% dos infectados. A ultrasonografia revelou crescimento intra-uterino retardado simétrico em todos os fetos infectados que atingiram o terceiro trimestre, tendo se iniciado, em média com 25,1 semanas. A cordocentese foi realizada em 9 pacientes e, todos os casos infectados, apresentavam IgM positiva e eritroblastose no sangue de cordão. A PCR no líquido amniótico foi positiva em todos os 3 casos em que ela foi realizada. 50% das placentas dos fetos infectados apresentava sinais sugestivos de infecção viral. A idade gestacional média do parto entre os infectados foi de 33,8 semanas e o peso médio ao nascimento foi 1365,6g.Todos os 6 nascidos-vivos infectados foram classificados como pequenos para a idade gestacional e apresentaram disacusia. A sobrevida entre os infectados, num seguimento pós-natal médio de 35,2 meses, foi de 62,5%. No grupo 2: a infecção não foi comprovada em nenhum dos recém-nascidos vivos, porém em um caso pudemos demonstrar a infecção congênita pelo vírus de Epstein-Barr. CONCLUSÕES: A transmissão vertical da rubéola no primeiro trimestre parece poder variar entre as populações, bem como a presença dos defeitos associados à infecção. Tanto o diagnóstico invasivo, como o ultrasonográfico apresentaram boa sensibilidade e especificidade. Pudemos estabelecer o padrão de crescimento fetal associado à infecção. A presença isolada de IgM positiva para rubéola na gestação não teve boa correlação com a presença de infecção neonatal, porém pode se associar à presença de outras infecções congênitas.
OBJECTIVES: Our aim was to analyse rubella effects on the fetus, new-born and child. MATERIAL AND METHODS: We analysed 35 patients with suspicious rubella during pregnancy. According to presence or absence of symptoms they were divided in two groups. Group 1: 15 patients presenting rash in which serology was positive. Grupo2: 20 symptomless patients found to have positive IgM during routine prenatal care. Monthly ultrasonographic evaluation was accomplished in all patients and in group 1 they were also offered prenatal invasive testing. Fetal echocardiography and Dopplers were performed. After birth, the placentas were submitted to pathological examination. The liveborn babies had clinical and serological examination. Auditory tests, brain scan, fundoscopy and postnatal echocardiography were also performed. RESULTS: In group 1: fetal infection occurred in 9 cases and vertical transmission between 2 to 14 weeks was 64,9%. Malformation was present in 37,5% of infected cases. Ultrasound revealed symmetrical intra-uterine growth retardation in all infected fetuses that reached the third trimester, and started around 25,1 weeks. Cordocentesis was accomplished in 9 cases and all the infected ones, presented positive IgM and erythroblastosis in cord blood. PCR in the amniotic fluid was positive in all 3 cases it was performed. 50% of the infected fetuses placentas presented signs of viral infection. The average gestacional age of delivery among infected cases was 33,8 weeks and medium birth weight was 1365,6g. All 6 liveborn infected babies were small for gestacional age and presented deafness. Survival among infected cases was 62,5%, medium follow-up was 35,2 months. In group 2: the infection was not demonstrated in any of neonates, although we could demonstrate a congenital infection caused by the Epstein-Barr virus. CONCLUSIONS: Vertical transmission of the rubella in the first trimester seems to vary among different populations, as well as the presence of the associated defects in the new-born. Invasive diagnosis and ultrasonographic follow-up presented good sensitivity and specificity. We could establish the pattern of fetal grown associated to the infection. The isolated presence of a positive rubella IgM in pregnancy did not correlated with congenital rubella, but it can be related to other congenital infections.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
The vertical transmission of infection from mother to child, and may increase morbidity and mortality of both mother and child, when not diagnosed and by suitably dealest, causing a serious public health problem. This study aimed to estimate the prevalence of antibodies to toxoplasmosis, rubella, cytomegalovirus, hepatitis B, syphilis and HIV among pregnant women in Caxias, Maranhão, Brazil and identify the main factors associated with seropositivity for Toxoplasma gondii infection in pregnant women attending two referral centers Caxias, MA. Descriptive, observational, cross-sectional study of 561 pregnant women who received prenatal care at two clinics reference to prenatal high risk in the period July 2011 to December 2012, the outpatient clinics of Maternity Carmosina Coutinho (MCC) and the Specialized Center for Maternal and Child Care (CEAMI). Serological tests for toxoplasmosis, rubella, cytomegalovirus, hepatitis B were performed by a laboratory conveniado to the municipality by the same trained technician, and for syphilis and HIV were performed in the Counseling and Testing Center (ATC) in the city laboratory. And a small sample of whole blood from five pregnant IGM reagent for Toxoplasma gondii and their respective newborns was processed at the Institute of Tropical Pathology and Public Health in the Department of Parasitology UFG for performing Polymerase Chain Reaction (PCR). Statistical analysis was performed using SPSS version 20.0 Windows, using the chi-square tests of association and Odds Ratio (95%CI), considering a significance level of 5%. It was found to be positive for HIV was 0.4%, 2.0% syphilis, rubella and cytomegalovirus IgG reactivity were 93.6% and 87.8% respectively without reactive IgM, HBsAg was negative for all pregnant women in the sample tested. Regarding toxoplasmosis in 437 (77%), 124 susceptibility (22.1%) and 5 (0.9%) women with active infection. Found no significant association between toxoplasmosis susceptibility and age, location, income, education, sewerage, number of pregnancies and gestational age. Variables with significant association (p≤0.05) were seropositive pregnant women who are multiparous (p=0.036), living with dogs stuck at home (p=0.001), and consumption of raw kibbeh (p=0.036). The frequency of seropositivity of these infectious diseases of vertical transmission in pregnant women seen at antenatal care in the city of Caxias-MA is considered high, but are similar to those described in other regions of Brazil. Pregnant women who are multiparous who perform consumption of raw kibbeh and live with dogs that do not wobble on the street, had more chance of becoming infected with Toxoplasma gondii, thus guidance on primary prevention measures and quarterly serological monitoring should be strengthened these infections of pregnant women, since it is important to identify and/or prevent congenital infection measured.
A transmissão vertical das infecções da mãe para o filho e pode aumentar a morbimortalidade do binômio mãe-filho. Quando não diagnosticadas e tratadas adequamente, e ocasionam um sério problema de saúde pública. Este estudo objetivou estimar a soroprevalência de anticorpos para toxoplasmose, rubéola, citomegalovírus, hepatite B, sífilis e HIV entre gestantes em Caxias, Maranhão, Brasil e identificar os principais fatores associados à soropositividade para o Toxoplasma gondii (T. gondii) em gestantes atendidas em dois centros de referência em Caxias–MA. Estudo descritivo, observacional, transversal, com 561 gestantes que realizaram a assistência pré-natal em dois ambulatórios de referência para pré-natal de alto risco, no período de julho de 2011 a dezembro de 2012, nos ambulatórios da Maternidade Carmosina Coutinho (MCC) e no Centro Especializado de Assistência Materno-Infantil (CEAMI). Os testes sorológicos de toxoplasmose, rubéola, citomegalovírus, hepatite B foram realizados por um laboratório conveniado ao município, e para sífilis e HIV foram realizadas no laboratório do Centro de Testagem e Aconselhamento (CTA) do município. Uma amostra de sangue total das cinco gestantes IGM reagente para o T. gondii e de seus respectivos recém-nascidos foi processada no Instituto de Patologia Tropical e Saúde Publica da UFG no Setor de Parasitologia para a realização de Reação em Cadeia da Polimerase (PCR). A análise estatística foi realizada com o programa SPSS versão 20.0 Windows, usando os testes de associação qui-quadrado e Odds Ratio (IC95%), considerando-se o nível de significância de 5%. Constatou-se que a soropositividade para HIV foi de 0,4%, sífilis 2,0%, rubéola e citomegalovírus a reatividade de IgG foram de 93,6% e 87,8% respectivamente sem IgM reativa, HBsAg foi não reagente para todas as gestantes da amostra. Em relação ao T. gondii 437 (77,9%) foram soropositivas, a susceptibilidade em 124 (22,1%) e 5 (0,9%) gestantes com infecção ativa. Não foi observada associação significativa entre soropositividade para toxoplasmose e idade, procedência, renda, escolaridade, rede de esgotos, número de gestações e idade gestacional. As variáveis com associação significativa (p≤0,05) para soropositividade foram gestantes que são multigestas (p=0,036), convívio com cães presos em casa (p=0,001), e consumo de quibe cru (p=0,036). A frequência de soropositividade dessas doenças infecciosas de transmissão vertical em gestantes atendidas no pré-natal, no município de Caxias-MA é considerada alta, mas encontram-se semelhantes aos descritos em outras regiões do Brasil. As gestantes que são multigestas que realizam consumo de quibe cru e convivem com cães presos em casa, apresentaram mais chance de se infectar com o Toxoplasma gondii, assim, deve ser reforçada orientações sobre medidas de prevenção primária e o monitoramento sorológico trimestral dessas infecções às gestantes, uma vez que são medidas importantes para identificar e/ou prevenir as infecções congênitas.

ObjeEste estudo teve como objetivo primário avaliar a estratégia de incluir o parceiro na assistência pré-natal no município de Franca-Brasil. Constituíram os objetivos secundários: 1) Detectar a prevalência de parceiros com dosagens alteradas de colesterol total, HDL-colesterol, LDL-colesterol e triglicérides; 2) Detectar a prevalência de parceiros com dosagens alteradas de glicemia de jejum; 3) Detectar a prevalência de parceiros com HAS; 4) Detectar a prevalência da sífilis, HIV, hepatites B e C entre gestantes; 5) Verificar a taxa de DMG e de DM entre as gestantes; 6) Detectar a prevalência da sífilis, HIV, hepatites B e C entre os parceiros das gestantes; 7) Avaliar a motivação da equipe de saúde em acolher a Estratégia Pré-natal do Parceiro; 8) Avaliar a aceitação materna e do parceiro sobre a estratégia de inclusão do parceiro na assistência PN. Estudo quantitativo, utilizado o teste \"t\" de Student para comparações das variáveis paramétricas e o teste Qui-quadrado para as variáveis não paramétricas, considerando significativo o valor de p< 0,05 em quaisquer dos testes. Os resultados identificaram quatro parceiros com hipertensão arterial (3,4%) e 51 (43,2%) com intolerância à glicose, verificando-se que em quatro casos, a glicemia possibilitou diagnosticar diabetes mellitus. Constatou-se que a prevalência de dislipidemias dos parceiros foi de 84,4%. No tocante às sorologias identificou-se um casal (1,5%) com sorologia discordante para sífilis (gestante com sífilis) e outro casal, no qual o parceiro foi diagnosticado como portador da infecção pelo vírus da imunodeficiência humana (HIV), cujo diagnóstico só foi possível por sua participação no PNP. Foi possível identificar que 57 parceiros (48,3%) qualificaram as equipes de saúde com não motivadoras para a adoção da estratégia PNP. No entanto, 58 (49,1%) participaram por motivação própria. A percepção paterna sobre o PNP foi referida como positiva por 77,9% dos parceiros e 93 gestantes/mães (78,8%) consideraram importante e positiva a inclusão do parceiro no PN. Foi identificado que a inclusão do parceiro no PN foi importante no diagnóstico e tratamento precoces de doenças de transmissão vertical e crônicas e que é necessário incentivar a equipe de saúde a difundir os benefícios dessa participação no PN, contribuindo com a saúde da tríade mãe, filho e parceiro.
This study\'s primary objective was to analyze the strategy of including the male partner in prenatal care in the city of Franca, Brazil. The secondary objectives were: 1) To detect the prevalence of male partners with abnormal levels of total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides; 2) To detect the prevalence of male partners with abnormal levels of fasting blood glucose; 3) To detect the prevalence of systemic hypertension among male partners; 4) To detect the prevalence of syphilis, HIV, hepatitis B and hepatitis C among pregnant women; 5) To find out the frequency of Gestational diabetes mellitus (GDM) and of Diabetes mellitus (DM) among pregnant women; 6) To detect the prevalence of syphilis, HIV, hepatitis B and hepatitis C among the pregnant women\'s male partners; 7) To gauge the health team\'s motivation to implement the strategy of male involvement in prenatal care; 8) To assess maternal acceptance and male partner acceptance of the strategy of including the male partner in prenatal care. This was a quantitative study, which used the Student\'s t-test to compare parametric variables and the Chi-squared test for the nonparametric variables and which considered a p-value < 0.05 as significant in both tests. The results identified 4 male partners with hypertension (3.4%) and 51 male partners (43.2%) with glucose intolerance, of which four had a diagnosis of Diabetes mellitus as a result of the blood glucose test. We found that the Anexos 100 prevalence of dyslipidemia among the male partners was 84.4%. Regarding serology tests, we identified a couple (1.5%) with discordant syphilis serology (pregnant woman with syphilis) and another couple in which the male partner was diagnosed with Human Immunodeficiency Virus (HIV) infection with such diagnosis only having been possible because of his participation in prenatal care. We could identify that 57 male partners (48.3%) classified the health teams as not encouraging of the male involvement in prenatal care. However, 58 male partners (49.1%) participated by selfmotivation. The fathers\' perception of their involvement in prenatal care was referred to as positive by 77.9% of the male partners and 93 pregnant women / mothers (78.8%) considered the inclusion of the male partner in prenatal care important and positive. We identified that the inclusion of the male partner in prenatal care was important in the early diagnosis and early treatment of vertical transmission diseases and chronic diseases as well as that it is crucial to encourage health teams to communicate the benefits of the inclusion of the male partner in prenatal care, thus contributing to the health of the father- mother-child triad.

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CNPq
FACEPE
A sífilis gestacional é uma doença infecciosa, transmitida verticalmente, e está associada a diversos desfechos negativos na gravidez que são evitáveis quando detectada e tratada de forma precoce. As recomendações atuais para o controle da sífilis reforçam a necessidade de priorizar intervenções globais em prevenção, diagnóstico e tratamento oportuno com atenção a grupos populacionais mais expostos. O objetivo desta tese foi estudar os fatores que influenciam a ocorrência e o tratamento para sífilis em mulheres atendidas em sete maternidades públicas do Recife – PE. O documento foi estruturado nos seguintes capítulos: revisão da literatura, método, resultados apresentado sob a forma de dois artigos originais, considerações finais e recomendações. O estudo foi desenvolvido a partir de uma pesquisa mais abrangente, do tipo caso-controle, que recrutou 1.206 mulheres a partir da admissão nas maternidades, conforme local de residência e resultado do exame de VDRL (Venereal Disease Research Laboratory). Para cada resultado de VDRL reagente sob qualquer titulação, buscavam-se, na sequência posterior de ordem de admissão, duas com resultados de VDRL não reagentes, durante os anos de 2013/2014. O primeiro artigo analisou os fatores de risco sociodemográficos, comportamentais e de assistência à saúde relacionados à ocorrência de sífilis em mulheres residentes e atendidas em maternidades públicas da cidade do Recife – PE. Utilizou-se um delineamento do tipo caso-controle que considerou o resultado da sorologia ELISA (Enzyme-Linked Immunosorbent Assay). A amostra foi constituída de 561 mulheres, das quais 239 eram reagentes (casos) e 322 eram não reagentes (controles) ao ELISA. Os resultados mostraram que os fatores de risco à sífilis gestacional estavam relacionados a menor escolaridade, ausência de acesso ao telefone, religião católica, ocorrência de quatro ou mais gestações, maior número de parceiros sexuais nos últimos doze meses, início do uso de drogas antes dos dezoito anos, assim como à utilização de drogas ilícitas pelo companheiro. Além destes, ao número insuficiente de consultas ao pré-natal e ao relato de história anterior de infecção sexualmente transmissível. O segundo artigo teve como objetivo caracterizar o perfil sociodemográfico, reprodutivo e assistencial segundo a situação do pré-natal, o registro do VDRL e o tratamento para sífilis em mulheres admitidas em maternidades públicas de uma capital do Nordeste do Brasil, entre 2013 e 2014. Trata-se de um estudo transversal, com uma amostra de 1.206 mulheres residentes em Pernambuco nos anos de 2013/2014. Os resultados evidenciaram entraves para o controle da transmissão vertical da sífilis. Do total, 91,3% das mulheres realizaram o pré-natal. O registro do VDRL no cartão de pré-natal estava ausente em 23,9% e destas, a maior parte iniciou o acompanhamento no último trimestre da gestação. O pré-natal não se mostrou efetivo na prevenção e rastreio da sífilis, uma vez que 34,1% apresentaram-se reagentes ao VDRL na admissão à maternidade. Entre as mulheres não tratadas para sífilis no pré-natal, apenas 57,7% e 46,2% cumpriram as recomendações de iniciar o acompanhamento no primeiro trimestre gestacional e realizar seis ou mais consultas, em contraste com as que receberam tratamento com valores de 70% para as duas situações, respectivamente. A ocorrência da sífilis na gestação está associada ao baixo nível de escolaridade, a piores condições socioeconômicas, a comportamentos de maior vulnerabilidade e acompanhamento pré-natal insatisfatório. Notou-se, também, obstáculos no diagnóstico e tratamento da sífilis durante o pré-natal, tornando ainda mais complexo o controle nessa população.
Gestational syphilis is an infectious disease transmitted vertically. It is associated with many negative outcomes during pregnancy, which can be avoided when the disease is detected and treated early. The current recommendations for controlling syphilis reinforce the need of prioritizing global preventive interventions, diagnosis, and timely treatment, paying special attention to more exposed groups. The objective of this thesis was to study the factors that influence the occurrence of syphilis and its treatment in women attending seven public maternity hospitals in Recife – PE. The document was structured into the following chapters: literature review, method, results presented in the form of two original articles, final considerations, and recommendations. The study was developed from a more comprehensive case-control study, which recruited 1,206 women during hospital admission according to their address and Venereal Disease Research Laboratory (VDRL) test. For every woman recruited with a positive VDRL test result regardless of titer, two consecutive women with negative VDRL test results were recruited by order of admission during 2013 and 2014. The first article analyzed the sociodemographic, behavioral, and health care risk factors related to the presence of syphilis in women from Recife/PE attending the city’s maternity hospitals. A case-control design took into account the result of the Enzyme-Linked Immunosorbent Assay test. The sample consisted of 561 women, of which 239 were ELISA positive (cases) and 322 were ELISA negative (controls). The results showed that the risk factors for gestational syphilis were related to lower education level, no access to a telephone, being Catholic, occurrence of four or more pregnancies, higher number of sexual partners in the last twelve months, illicit drug use before age 18 years, illicit drug use by partner, inadequate number of prenatal care visits, and a reported history of sexually transmitted diseases. The second article aimed to characterize the sociodemographic, reproductive, and health care profile according to prenatal care adequacy, VDRL records, and treatment for syphilis of women attending public maternity hospitals in a state capital in the Brazilian Northeast between 2013 and 2014. The cross-sectional study included 1,206 women from Pernambuco recruited between 2013 and 2014. The results evidenced obstacles for controlling vertical syphilis transmission. In total, 91.3% of the women received prenatal care. The VDRL test result was not recorded in 23.9% of the prenatal care cards and most of these women began prenatal care during the last trimester of pregnancy. Prenatal care did not effectively prevent and screen syphilis since 34.1% of the women had positive VDRL test result on hospital admission. Among women who did not receive treatment for syphilis during prenatal care, only 57.7% and 46.2% followed the recommendations to begin follow-up during the first trimester of pregnancy and to attend six or more visits. On the other hand, 70% of the women who received treatment began follow-up during the first trimester of pregnancy and attended six or more prenatal care visits. The occurrence of gestational syphilis is associated with low education level, low socioeconomic level, more vulnerable behaviors, and unsatisfactory prenatal care. Obstacles for controlling syphilis in this population were also present.

INTRODUÇÃO: A continuidade das elevadas taxas de sífilis congênita (SC) no Brasil é preocupante, apesar do fácil diagnóstico e tratamento. Os objetivos deste estudo foram: descrever características sociodemográficas, clínico-laboratoriais, assistência ao pré-natal e terapêutica específica das gestantes com sífilis; descrever características clínico-laboratoriais, terapêutica específica e desfecho dos recém-nascidos expostos à sífilis; estimar taxa de incidência anual de SC; estimar frequência de SC entre os recém-nascidos e conceptos expostos; identificar fatores associados à ocorrência de SC entre os conceptos e recém-nascidos expostos. MÉTODOS: Estudo transversal com 149 gestantes com sífilis e 152 recém-nascidos / conceptos expostos, no município de Itapeva (SP), de janeiro de 2010 a dezembro de 2014. Os casos foram identificados pela Vigilância Epidemiológica (VE) e por busca ativa nas Unidades Básicas de Saúde, Centro Materno Infantil, Serviço de Ambulatório Especializado em Infectologia e Santa Casa de Misericórdia. Foi realizada coleta de dados das fichas de notificação de sífilis em gestante (SG) e SC e de prontuários das gestantes e recém-nascidos. Para avaliar a associação de SC com variáveis de interesse, foram calculadas razões de prevalência (RP) e IC95%. Na análise multivariada foi utilizado modelo de regressão de Poisson com variância robusta com nível de significância de p < 0,05. RESULTADOS: A média de idade das gestantes foi 24,3 anos. Oito gestantes não fizeram pré-natal, maioria iniciou pré-natal com idade gestacional <= 13 semanas, realizou mais de seis consultas e 97,2% realizou teste não treponêmico; 57% com resultado VDRL > 1:4. O diagnóstico de sífilis foi feito no momento do parto/curetagem em 11,4% das gestantes; no segundo trimestre da gravidez em 20,8% e no terceiro trimestre em 8,7%. Entre as 132 mulheres diagnosticadas durante a gestação, 77,2% recebeu tratamento adequado >= 30 dias antes do parto; 31,7% fizeram o VDRL mensal para controle de cura. Quanto aos parceiros, 48,3% foi tratado inadequadamente ou não tratado. Ocorreram dois abortos e três natimortos. Em relação aos 147 recém-nascidos vivos, 29,9% foram prematuros, 35,4% teve baixo peso e 51% apresentou sinais de SC ao nascer. Somente 132 recém-nascidos realizaram pelo menos um exame VDRL, com resultado positivo em 65,3%; 55,1% dos recém-nascidos receberam tratamento para sífilis, e a maioria (91,4%) iniciou tratamento no dia do nascimento. Ocorreram cinco óbitos por SC. O pesquisador confirmou 101 casos de sífilis congênita, dos quais 62 foram notificados à VE. Dez crianças apresentaram sequelas. As taxas de incidência de SC foram: 15,1/1.000 NV (2010); 12,1/1.000 NV (2011); 15,6/1.000 NV (2012); 9,1/1.000 NV (2013) e 22,3/1000 NV (2014). Na análise bivariada, tabagismo, <6 consultas pré-natal e idade gestacional >=14 semanas ao diagnóstico de sífilis foram associados à ocorrência de SC. No primeiro modelo da análise multivariada, a idade gestacional ao diagnóstico e o tabagismo foram independentemente associados à SC. No segundo modelo, idade gestacional ao diagnóstico, número de consultas no pré-natal e resultado do primeiro VDRL foram independentemente associados à ocorrência de SC. CONCLUSÃO: As taxas de incidência de SC encontradas pelo pesquisado foram maiores que as informadas pela VE. Os resultados sugerem subnotificação de SG e SC
INTRODUCTION: The continuity of high rates of congenital syphilis (CS) in Brazil is worrying, despite simple diagnosis and treatment. This study had the following objectives: To describe socio-demographic characteristics, clinical laboratory results, prenatal assistance and specific therapy of pregnant women with syphilis; To describe clinical-laboratory characteristics, specific therapeutics and outcome of newborns exposed to syphilis; To estimate annual incidence rate of CS; To determine CS frequency among newborns and proved conceptus; and To identify factors associated with the occurrence of CS between the conceptus and exposed newly born. METHODS: A cross-sectional study was carried out with 149 pregnant women with syphilis and 152 newborns / proved conceptus, in Itapeva (SP), from January 2010 to December 2014. Cases were identified by Epidemiological Surveillance (ES) and by active Basic Health Units, Maternal and Child Center, Specialized Clinic in Infectious Diseases and Santa Casa de Misericórdia. All data were collected from the records of syphilis notification in pregnant women and CS and the records of pregnant women and newborns. To assess the association of CS with variables of interest, prevalence, and 95% confidence interval were calculated. In the multivariate analysis, we used a Poisson Regression Model with robust variance with a significance level of p < 0.05. RESULTS: The mean age of pregnant women was 24.3 years. Eight pregnant women did not get prenatal exams, most started prenatal with gestational age <= 13 weeks, performed more than six medical appointments and 97.2% showed the non-treponemal test; 57% with VDRL result > 1: 4. The diagnosis of syphilis made at the time of childbirth / endometrial curettage was 11.4% of pregnant women; by the second trimester of pregnancy 20.8% and by the third quarter 8.7%. Among the 132 women diagnosed during pregnancy, 77.2% received adequate treatment >= 30 days before delivery; 31.7% did the monthly VDRL for cure control. As for the partners, 48.3% were treated improperly or untreated. There were two miscarriage and three stillbirths. Regarding the 147 live births (LB), 29.9% were premature, 35.4% were underweight, and 51% presented signs of CS at birth. Only 132 newborns performed at least one VDRL test, with a positive result in 65.3%; 55.1% of the newly born received treatment for syphilis, and the majority (91.4%) started treatment on the day of birth. There were five deaths per CS. The investigator confirmed 101 cases of congenital syphilis, of which 62 were notified to the ES. Ten children had sequelae. The incidence rates of CS were: 15.1 / 1000 LB (2010); 12.1 / 1000 LB (2011); 15.6 / 1000 LB (2012); 9.1 / 1000 LB (2013) and 22.3 / 1000 LB (2014). In the bivariate analysis, smoking, = 14 weeks at diagnosis of syphilis was associated with the occurrence of CS. In the first model of multivariate analysis, gestational age at diagnosis and smoking were independently associated with CS. In the second model, gestational age at diagnosis, the number of prenatal appointments, and the outcome of the first VDRL were independently associated with the occurrence of SC. CONCLUSION: The incidence rates of CS found by the researcher were higher than those reported by the ES. The results suggest underreporting of syphilis in pregnant women and CS

Cette intervention a été construite par la méthode du « health belief model », en renforçant l’intervention de conseil post-test classiquement offerte au cours du dépistage prénatal du VIH, en prenant en compte le contexte conjugal de la femme. Une approche méthodologique en deux étapes a été adoptée. La première étape, encore appelée étape de preuve de concept, a consisté, à travers un essai d’intervention randomisé mené dans une structure de référence en zone urbaine (essai ANRS 12127- Prenahtest), à évaluer l’efficacité de la nouvelle intervention de COC pour améliorer le dépistage prénatal du VIH des partenaires, le conseil de couple de VIH, la communication conjugale autour du VIH. Outre les effets du COC, nous avons aussi documenté les autres facteurs associés à l’approche de couple de prévention du VIH. La deuxième étape a consisté en une phase de passage à l’échelle de la mise en oeuvre de l’intervention de COC, de façon à évaluer sa transférabilité dans la pratique des soins courants. A cet effet, une étude de type Avant/Après (le projet SIMECAM-FGSK) a été réalisée. Ce choix méthodologique a permis de prendre en compte l’architecture sanitaire du système de santé, en incluant le niveau périphérique qui comporte trois catégories de formations sanitaires (hôpital de district ; centre médical d’arrondissement ; centre de santé intégré). Il a aussi permis de prendre en compte les contraintes éthiques, liées à la connaissance de la supériorité de la nouvelle intervention de COC décrite en zone urbaine. Les résultats les plus importants de l’essai ANRS 12127/12236l en zone urbaine au Cameroun sont les suivants :- La réalisation d’un essai comparatif randomisé de puissance moyenne et sans biais majeur et qui a été bien mené jusqu’à la fin - La description de l’acceptabilité du conseil orienté vers le couple dans un contexte où la prévalence du VIH atteint les 12% ;- La description de l’efficacité du nouveau type de conseil orienté vers le couple pour améliorer en zone urbaine la fréquence du dépistage du VIH du partenaire jusqu’à atteindre 27% des femmes ayant reçu le COC (vs 16% pour les femmes du groupe classique) ; - La description de l’efficacité du nouveau type de conseil pour améliorer la fréquence du conseil et dépistage du VIH en couple autour de 13% des femmes ayant reçu le COC (vs 3% pour les femmes du groupe classique) ;- La description de l’efficacité du nouveau type de conseil pour améliorer la fréquence de la communication conjugale autour du VIH. En zone rurale, les principaux résultats préliminaires du projet SIMECAM-FGSK, après seulement six mois effectifs d’activités de passage à l’échelle sont : - Le taux de prévalence du VIH est de 20,5% ; - Le COC permet le dépistage du VIH de près de 18% des partenaires ; et ce dépistage est majoritairement effectué dans le cadre d’un conseil VIH en couple ; - Le taux de prévalence du VIH chez les partenaires est de 22% et 11,2% des couples sont sérodiscordants ; - Sur cinquante trois femmes dépistées positives pour le VIH, 94% ont bénéficié d’une prise en charge par les ARV pour la PTME, dont 28,3% suivant le protocole de l’option B+. Le travail réalisé dans le cadre de cette thèse a permis de montrer que les effets du COC sur l’approche de prévention du VIH en couple sont modestes mais réels. Les faibles proportions observées peuvent entre autres s’expliquer par un certain nombre de barrières individuelles (telles que la peur de découvrir son statut VIH en même temps que sa partenaire), de barrières programmatiques (telles que les délais d’attente et la qualité de l’accueil des hommes en prénatale), et des barrières culturelles (la considération de la prénatale comme un espace réservé aux femmes). Par ailleurs, il est important de relever un certain de limites au cours de ce travail de thèse. L’essai Prenahtest compte un taux de perdues de vue de près de 25%, ce qui ne permet pas d’exclure tous les biais
It is a little above 30 years that the first cases of AIDS resulting from HIV infection were described in the United States of America. This disease remains a public health problem worldwide, with a great social and economic impact. In 2012, it was reported that the disease had already caused over 25 million deaths, and yet every year, more than 70% of the 2.3 million new HIV infections occurred in Africa, where there are only 12% of the world’s population. In Africa, there is a peculiar evolution of this infection overtime. After nearly two decades of promoting the ABC programs (abstinence, be faithful, condoms); promotion of counseling and testing; or more recently, introduction of pre- and post-exposure prophylaxis, usage of antiretroviral therapy as treatment and prevention, the prevalence of HIV remained stable or decreased in the most at-risk populations but increased dramatically in the formerly low-risk populations. Recent data from South Africa, Botswana an Cameroon showed that the prevalence of HIV is twice as much in women as in men and was higher in the population age range of 30 to 45 years, which constitute the economic livelihood of the continent. Furthermore, in some countries like in Cameroon, HIV prevalence was reported to be higher in stable couples (married, prolonged cohabitation etc.). It therefore seems necessary to revise the actual strategies of HIV prevention to deal with the new facet of the HIV epidemic in the African context. This thesis, which is a reported experience from an operational research, presents the results of the evaluation of a new intervention so called couple-oriented HIV counseling (COC), built by using the health belief model. It is an enhanced HIV post-test counseling offered during prenatal HIV testing, in replacement of the classical HIV post-test counseling. The originality of this study was the quality of our study design with a good level of proof and the public health perspective of the new strategy. To realize the study, we adopted two methodological approaches. The first one, acting as a proof of concept, was a randomized trial, conducted in a reference structure in an urban area (ANRS 12127-Prenahtest trial), to evaluate the efficiency of the new COC intervention to improve prenatal HIV testing of male partners, couple counseling for HIV and spousal communication about. Besides the effects of the COC, we documented other conditions for the improvement of previously mentioned indicators. After the proof of concept phase, we realized a second stage which consisted of scaling-up of the new intervention, with implementation conditions very close to the field conditions to take into account the future needs of transferability in practical standard care conditions. The study design used for this phase was the before/ after study (SIMECAM – FGSK project). This type of study was chosen to take into account the organization of the health system with three categories of health facilities at the peripheral level (district hospitals, divisional medical centers and integrated health centers). It also took into account the ethical component resulting from the superiority of the new intervention of COC described in an urban area

Genetic and environmental factors, and their interactions, contribute to the etiology and pathophysiology of neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD). The clinical heterogeneity and phenotypic variability in patients with NDDs have made identification of causal mechanisms contributing to their onset difficult. Yet, unraveling the underlying causes of NDDs is essential to the development of appropriate preventive/therapeutic strategies. Maternal obesity is considered one of the main nongenetic risk factors for NDDs in progeny. We and others have found that high-fat (HF) obesogenic diets in both humans and animal models induce significant modifications in maternal gut microbiome composition (dysbiosis), which are causally related to detrimental health outcomes in offspring, including ASD-like social deficits. Given the increasing prevalence of obesity and overweight in women of childbearing age, further investigation into the mechanisms by which maternal obesity impacts offspring health is needed. Here, working in a mouse model, we aimed to determine in whether vertical transmission of maternal high-fat diet (MHFD)-induced obese-type gut microbiota could serve as the primary driver of cognitive and metabolic dysfunction in offspring, identify the underlying mechanisms, and test the efficacy of prenatal modulation of the maternal gut microbiome on preventing behavioral and metabolic dysfunction in offspring. In a second study, we tested the hypothesis that MHFD-induced dysbiosis of the gut microbiome and related social dysfunction persists across generations and are therefore propagated in generations beyond the first, even in the absence of direct exposure to MHFD. We anticipate that our studies have the potential to revolutionize antenatal care for women of overweight and obese status and could lead to the development of innovative preventative and therapeutic strategies, such as prenatal probiotic administration, to improve the health of children affected by maternal diet-induced obesity in utero.

La transmission prénatale du VIH de la mère à l’enfant est à l’origine de la majorité des infections à VIH/sida chez les nourrissons. En dépit du risque quasi omniprésent de faire naître des enfants infectés et de l’accès encore très limité aux thérapies antirétrovirales, le nombre des femmes séropositives menant leur grossesse à terme est en augmentation constante en Afrique subsaharienne. Motivée par ce constat empirique, l’étude aborde une gamme des questions juridiques et de bioéthique, pour certaines encore inédites, tiraillées entre désir légitime d’enfant (droit à l’enfant) et devoir de la société de mettre les futurs enfants à l’abri d’un handicap congénital prévisible reconnu comme incurable (droit de l’enfant). Fondamentalement, elle interroge le législateur sur la manière de saisir le risque biologique de transmission maternelle du VIH, sans rompre avec l’équilibre éthique nécessaire entre les droits et libertés fondamentaux de la femme ou mère séropositive et l’intérêt supérieur de l’enfant à naître. À partir de l’exemple du droit congolais et suivant la démarche d’information comparative, l’étude s’attache à démontrer systématiquement que face à la forte probabilité de naître avec le VIH, la protection que les droits africains actuels apportent à l’enfant est insuffisante et, à certains égards, incohérente. Pour y remédier, elle préconise un nouveau paradigme de normativité fondé sur la philosophie de la recherche d’une conciliation éthique, qui n’apparaisse pas manifestement disproportionnée, entre l’autonomie de soi de la femme ou mère séropositive sur son corps et la responsabilité de ses choix en matière de santé de la reproduction. Ainsi, grâce à ses nombreuses propositions innovantes de refonte du droit, cette étude est-elle parvenue à contribuer, significativement, à la recherche d’outils théoriques nécessaires à l’émergence de nouveaux droits africains en ordre de bataille pour des générations futures sans sida
Prenatal HIV transmission from mother to child is responsible for the majority of HIV / AIDS infections in infants. Despite the almost ubiquitous risk of infected children and still very limited access to antiretroviral therapy, the number of HIV-positive women who complete their pregnancies is increasing steadily in sub-Saharan Africa. Motivated by this empirical observation, the study tackles a range of legal and bioethical questions, some of which are still unpublished, torn between legitimate desire for children (right to the child) and society's obligation to protect future children against a predictable congenital disability recognized as incurable (right of the child). Fundamentally, it questions the legislator on how to capture the biological risk of maternal HIV transmission without breaking the necessary ethical balance between the fundamental rights and freedoms of the HIV-positive woman or mother and the best interests of the unborn child. Using the example of Congolese law and following the comparative information approach, the study seeks to systematically demonstrate that, in the face of the high probability of being born with HIV, the protection that the current African rights bring to the child is insufficient and, in some respects, incoherent. To remedy this, she advocates a new paradigm of normativity based on the philosophy of seeking an ethical reconciliation which does not appear to be manifestly disproportionate between the autonomy of the woman or mother who is HIV-positive on her body and the responsibility of its choices in reproductive health. Thus, thanks to its many innovative proposals for the revision of the law, has this study managed to contribute significantly to the search for theoretical tools necessary for the emergence of new African rights in order of battle for future generations without AIDS

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A Sífilis Congênita é um importante problema de saúde em vários países. No Brasil, em 2007, foi lançado o Plano Operacional para redução da transmissão vertical da Sífilis visando reduzir a ocorrência da Sífilis Congênita. Para avaliar a efetividade das ações para prevenção e controle da transmissão vertical da Sífilis em Cuiabá e Mato Grosso, realizou-se estudo de série temporal da incidência desta doença e avaliou-se a evolução de alguns indicadores de assistência à saúde das gestantes com Sífilis. SINAN e SINASC foram as fontes de dados. A efetividade das ações foi avaliada pela comparação da evolução de indicadores de resultados, 2001-2006 e 2007-2011, e pela Fração Prevenível. Não foram observadas melhorias dos indicadores de resultados referentes à assistência a saúde das gestantes. A Fração Prevenível pelas ações em Mato Grosso foi de 0,0950 (IC95% -0,3370; 0,3875) e em 0,4372 (IC95% -0,0018; 0,6839). A não efetividade das ações sugere que as mesmas não estão sendo desenvolvidas ou estão sendo implementadas de forma inadequada e/ou insuficiente.
Salvador

A thesis completed by published work, Submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the requirements for the degree of Doctor of Philosophy Johannesburg, South Africa 24 May 2017.
Introduction: Prevention of mother-to-child transmission (PMTCT) has potential to eliminate new HIV infections among infants. Yet, in many settings in sub-Saharan Africa, women are unable to adhere to PMTCT recommendations due to social constraints. One such factor may be intimate partner violence (IPV), or any actions taken by a relationship partner that cause physical, sexual, or psychological harm. Despite theoretical and empirical rationale for understanding the links between IPV and PMTCT adherence, few studies in the extant literature have explored this association. Methods: This thesis draws upon four distinct studies that interface using an overall mixed method study design. The first study is a systematic review of the literature around women’s experience of lifetime IPV and adherence to anti-retroviral treatment (ART). The second study is formative qualitative research with pregnant women, health workers, and other local stakeholders that explores how IPV may be related to PMTCT in the urban Johannesburg setting. The third study is a deeper qualitative examination of women living with both IPV and HIV, aiming to understand the mechanisms that link partner violence to PMTCT behaviors using a social constructionist lens. The final study is a quantitative cohort study nested within a randomized control trial testing an intervention for IPV in pregnancy. Using regression techniques and structural equation modeling, I aim to determine the association between IPV and ART adherence in pregnancy and postpartum and identify pathways that mediate the relationship between partner violence and PMTCT. Results: This doctoral research contributes several new findings to the extant literature around PMTCT. I find that IPV is related to ART adherence among HIV-positive women in extant literature, with meta-analysis showing significantly worse odds of ART uptake, self-reported adherence, and viral suppression among women reporting lifetime IPV. In one of first of studies among women in sub-Saharan Africa, I learn that impact of IPV on ART adherence in pregnancy and postpartum is marked. I identify several mechanisms through which IPV influences PMTCT adherence. Mental health emerges as a robust pathway linking IPV to worse adherence in both qualitative and quantitative papers. Partner non-disclosure due to IPV can impede adherence, or women can navigate this challenge through hiding their HIV status or medication. Women experiencing IPV may attend fewer antenatal clinic visits, leading to worsened adherence. An unexpected finding was that women in our qualitative and quantitative studies were resilient and used strategies to adhere despite IPV. Motherhood seems to be a central feature of women who are resilient to the effects of IPV on adherence. Conclusion: The findings of this research have implications for research, policy, and practice. Research should incorporate social factors, such as IPV, into future studies testing PMTCT adherence interventions. Clinical practice and HIV programs should recognize that partner-level dynamics such as IPV may drive persistent gaps in PMTCT coverage. HIV policy urgently needs to incorporate ethical and safety considerations for women who experience IPV around the time of pregnancy. Women living with recent or past IPV are highly resilient and often want to protect their own health and that of their children. Only by recognizing and addressing their experience within the context of HIV care can future PMTCT programs and studies ensure maternal and infant health.
MT2017

The study reports on the perceptions of the midwives and pregnant women of the PMTCT of HIV programme at the antenatal care and maternity ward at the Johan Heyns Community Health Centre. A qualitative approach was adopted to conduct the study. Purposive sampling was used to select participants and was informed by social behavioural theories. Data was collected using interviews and analysed using thematic categorisation. The findings show that at the first PMTCT encounter participants had little to no knowledge of the PMTCT programme, generally displayed a lack of interest, experienced emotional distress, and fear at the thought of having to disclosing their HIV-positive status to their partners/family and had certain trepidations about participating in the PMTCT programme. The participants’ perception on their roles was that their roles were interlinked, midwife needs the recipients (pregnant woman) and pregnant woman needs the provider (midwife) therefore one cannot do PMTCT without the other. The study recommends that the capacity building of pregnant women be optimised, that PMTCT awareness campaigns for women of childbearing age should be a priority and PMTCT skills to be prerequisite for midwives deployed to ANC clinics and maternity ward units.
Health Studies
M. A. (Social Behaviour Studies in HIV/AIDS)

This study sought to determine if ANC and PMTCT services are utilized within the first trimester of pregnancy by the women in East Ekurhuleni sub-district. Quantitative descriptive research was conducted on 390 eligible pregnant women and data collection was done using structured questionnaires. The results indicated that women start ANC late despite their knowledge of first trimester as the best time to start ANC. Actions that would motivate them to start ANC early were explored and barriers were identified.
Health Studies
MA (Public Health)

The importance of adequate completion of clinical records and data collection tools at a health care facility is widely acknowledged. This study was conducted in order to explore and describe the completion of the ante-natal care (ANC) register by midwives in Tshwane Metsweding District, Gauteng Province, South Africa. A sequential mixed method approach consisting of quantitative and qualitative phases was employed. To collect quantitative data, 155 entries of variables completed in the ANC register were assessed using a checklist. Subsequently, qualitative data were collected through two focus group discussions with midwives to understand their experience regarding the completion of the register. The findings revealed that the completion of the ANC register is generally poor. Midwives indicated that the register is a good data collection tool. Recommendations to improve record-keeping such as the implementation of an electronic ANC register were made.
Health Studies
M.A. (Health Studies)

In its efforts to reduce maternal mortality and prevent Mother-to-Child Transmission of HIV, the government of Swaziland developed and implemented several programmes including a special antenatal care package for HIV-positive pregnant women in line with the WHO (2009) guidelines. Since the implementation of this latest special ANC package for HIV-positive women, little is known about how these services are experienced by the intended recipients. The purpose of this study was to explore and describe the actual experiences of HIV-positive women with the antenatal care services provided at a regional referral hospital in Swaziland, with the view of providing more insight into the quality of ANC services from the users' perspectives. A qualitative descriptive, exploratory design was used to address the above purpose. The researcher used purposive sampling to select the participants who met the inclusion criteria for the study. Semi-structured individual interviews were used and saturation was reached after 18 individual face-to-face interviews. Thematic content analysis was used to analyse the collected data. Forteen themes related to the participants experiences with the ANC services and seven related to measures for improvement emerged from data. In general HIV positive pregnant women expressed positive views towards ANC services they received at the target institution. The results give an indication on the quality of the focussed ANC package provided at the hospital and specific recommendations for improvement are outlined.
Health Studies
M. A. (Nursing Science)

This study investigated the factors influencing the utilisation of PMTCT of HIV services and proposed measures to promote service utilisation by HIV positive pregnant women in the FCT, Abuja, Nigeria. Effective interventions exist that can reduce the transmission of HIV infection to the baby. The study is a quantitative descriptive one, with 190 HIV positive pregnant women from 20 health Centres in three area councils in Abuja, who were interviewed using structured questionnaire to get their opinion. The findings revealed that the majority (90.4%) of the respondents were aware of PMTCT and how HIV can be transmitted from mother-to-child. The respondents (95.9%) were of the opinion that all pregnant women should be tested. Notably, PMTCT services will be hindered by the following: permission from spouse before being tested, couple counselling not done, group post test counselling, non-incorporation of family planning and low support group enrolment. Recommendations made include emphasis on couple counselling, confidentiality and friendly environment
Health Studies
M.A. (Public Health)

This study investigated the factors influencing the utilisation of PMTCT of HIV services and proposed measures to promote service utilisation by HIV positive pregnant women in the FCT, Abuja, Nigeria. Effective interventions exist that can reduce the transmission of HIV infection to the baby. The study is a quantitative descriptive one, with 190 HIV positive pregnant women from 20 health Centres in three area councils in Abuja, who were interviewed using structured questionnaire to get their opinion. The findings revealed that the majority (90.4%) of the respondents were aware of PMTCT and how HIV can be transmitted from mother-to-child. The respondents (95.9%) were of the opinion that all pregnant women should be tested. Notably, PMTCT services will be hindered by the following: permission from spouse before being tested, couple counselling not done, group post test counselling, non-incorporation of family planning and low support group enrolment. Recommendations made include emphasis on couple counselling, confidentiality and friendly environment
Health Studies
M.A. (Public Health)