An Analysis of Pregnancy-Related Mortality in the KEMRI/CDC Health and Demographic Surveillance System in Western Kenya

Background

Pregnancy-related (PR) deaths are often a result of direct obstetric complications occurring at childbirth.

Methods and Findings

To estimate the burden of and characterize risk factors for PR mortality, we evaluated deaths that occurred between 2003 and 2008 among women of childbearing age (15 to 49 years) using Health and Demographic Surveillance System data in rural western Kenya. WHO ICD definition of PR mortality was used: “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death”. In addition, symptoms and events at the time of death were examined using the WHO verbal autopsy methodology. Deaths were categorized as either (i) directly PR: main cause of death was ascribed as obstetric, or (ii) indirectly PR: main cause of death was non-obstetric. Of 3,223 deaths in women 15 to 49 years, 249 (7.7%) were PR. One-third (34%) of these were due to direct obstetric causes, predominantly postpartum hemorrhage, abortion complications and puerperal sepsis. Two-thirds were indirect; three-quarters were attributable to human immunodeficiency virus (HIV/AIDS), malaria and tuberculosis. Significantly more women who died in lower socio-economic groups sought care from traditional birth attendants (p = 0.034), while less impoverished women were more likely to seek hospital care (p = 0.001). The PR mortality ratio over the six years was 740 (95% CI 651–838) per 100,000 live births, with no evidence of reduction over time (χ² linear trend = 1.07; p = 0.3).

Conclusions

These data supplement current scanty information on the relationship between infectious diseases and poor maternal outcomes in Africa. They indicate low uptake of maternal health interventions in women dying during pregnancy and postpartum, suggesting improved access to and increased uptake of skilled obstetric care, as well as preventive measures against HIV/AIDS, malaria and tuberculosis among all women of childbearing age may help to reduce pregnancy-related mortality.     

Efficacy and Safety of Pafuramidine versus Pentamidine Maleate for Treatment of First Stage Sleeping Sickness in a Randomized,Comparator-Controlled,International Phase 3 Clinical Trial

Background

Sleeping sickness (human African trypanosomiasis [HAT]) is a neglected tropical disease with limited treatment options that currently require parenteral administration. In previous studies, orally administered pafuramidine was well tolerated in healthy patients (for up to 21 days) and stage 1 HAT patients (for up to 10 days), and demonstrated efficacy comparable to pentamidine.

Methods

This was a Phase 3, multi-center, randomized, open-label, parallel-group, active control study where 273 male and female patients with first stage Trypanosoma brucei gambiense HAT were treated at six sites: one trypanosomiasis reference center in Angola, one hospital in South Sudan, and four hospitals in the Democratic Republic of the Congo between August 2005 and September 2009 to support the registration of pafuramidine for treatment of first stage HAT in collaboration with the United States Food and Drug Administration. Patients were treated with either 100 mg of pafuramidine orally twice a day for 10 days or 4 mg/kg pentamidine intramuscularly once daily for 7 days to assess the efficacy and safety of pafuramidine versus pentamidine. Pregnant and lactating women as well as adolescents were included.The primary efficacy endpoint was the combined rate of clinical and parasitological cure at 12 months. The primary safety outcome was the frequency and severity of adverse events. The study was registered on the International Clinical Trials Registry Platform at www.clinicaltrials.gov with the number ISRCTN85534673.

Findings/Conclusions

The overall cure rate at 12 months was 89% in the pafuramidine group and 95% in the pentamidine group; pafuramidine was non-inferior to pentamidine as the upper bound of the 95% confidence interval did not exceed 15%. The safety profile of pafuramidine was superior to pentamidine; however, 3 patients in the pafuramidine group had glomerulonephritis or nephropathy approximately 8 weeks post-treatment. Two of these events were judged as possibly related to pafuramidine. Despite good tolerability observed in preceding studies, the development program for pafuramidine was discontinued due to delayed post-treatment toxicity.     

Composition and distribution of indigenous trees and shrubs as possible criteria for indicating adapted species in semi‐arid rangelands

This study assessed the composition and natural distribution of indigenous trees and shrubs as possible criteria for selecting suitable species for rehabilitation of degraded sites in semi‐arid rangelands. Study sites were identified at Nthangu, Kathonzweni and Kibwezi forests of Makueni County, Kenya using existing vegetation, agro‐climatic maps and Landsat imageries. The sites had mean annual rainfalls of 974 mm, 700 mm and 616 mm, respectively, and moisture indices of 49%, 35% and 32%. Data were collected by establishing sample plots and assessing species counts and diameters at breast height (DBH). Basal area, relative dominance, relative abundance, relative frequency and important value indices (IVIs) were computed for individual families and species at each site. The number of families, genera and species declined from Nthangu (33, 60, 77) through Kibwezi (30, 48, 70) to Kathonzweni (28, 42, 69). Corresponding mean basal areas were 16.7 m² ha^?1, 76.8 m² ha^?1 and 19.3 m² ha^?1. The families Combretaceae, Burseraceae and Mimosaceae were the most important and widely distributed. Based on ecological importance values, candidate species for rehabilitation of degraded sites at Nthangu, Kathonzweni and Kibwezi were Combretum molle and Acacia hockii; Combretum collinum, Commiphora campestris and Acacia tortilis; and Commiphora africana and A. tortilis, respectively.     

Comparison between observed and DeNitrification-DeComposition model-based nitrous oxide fluxes and maize yields under selected soil fertility management technologies in Kenya

Plant and Soil - Process-based biogeochemical models can be used to simulate soil nitrous oxide (N2O) fluxes and maize yields and draw insights on yields improvement and climate change mitigation...