Biomedical subjects
B Brabin
Publications and source records attributed to B Brabin.
The effects of smoking on birthweight-for-gestational-age curves in teenage and adult primigravidae.
OBJECTIVE: To compare the effect of smoking on the birthweight-for-gestational-age curves of teenage and adult primigravidae. METHODS: A retrospective analysis of the perinatal database at the Liverpool Women's Hospital for the years 1997-1999 for teenage and adult primigravidae. RESULTS: Records on 1157 primigravidae were available. There were no significant differences between the mean birthweight (3220 g +/- 666 vs 3244 g +/- 680, P = 0.43) and the proportion with low birthweight (LBW) babies (8.9% vs 10.6%, P = 0.39) between teenage and adult primigravidae, respectively. The percentage of women who smoked increased from the middle class (Townsend score -6- - 3) to the working class group (Townsend score +4- + 12) for both teenagers (33.3-51.3%) and adults (6.9-29.6%). The mean birthweight of babies of smoking mothers was significantly lower than for non-smoking mothers (3112 g +/- 639 vs 3327 g +/- 663, P = 0.00002). The birthweight-for-gestational-age pattern was lower at all gestational ages for smoking mothers in both the teenage and adult groups. Risk of LBW was significantly increased in teenagers who smoked (10.8% vs 3.9%, P < 0.01), but not in adult smokers. CONCLUSION: Lower birthweights at all gestational ages were observed in babies of teenage and adult mothers who smoked.
Breast-feeding knowledge and attitudes of teenage mothers in Liverpool.
OBJECTIVES: To determine the knowledge and attitudes of teenage mothers towards breast-feeding. DESIGN: A questionnaire of teenage (< 20 years) and non-teenage (> or = 20 years) primigravidae attending the antenatal care services at the Liverpool Women's Hospital, during the period April-May 2000. RESULTS: Forty teenage primigravidae and 40 non-teenage primigravidae registered for the survey. Teenagers had poorer knowledge about breast-feeding than the non-teenagers, and fewer teenagers considered breast milk the best food for their baby. More teenagers than non-teenagers planned to bottle feed [23 (57.5%) vs. 9 (22.5%), P=0.002]. Only one teenager had knowledge about colostrum. Teenagers were more often single, had a lower level of education, higher unemployment, higher smoking frequency and less contact with a person who had previously breast-fed. CONCLUSION: Teenage primigravidae have poor knowledge regarding breast-feeding compared with non-teenage primigravidae. A greater proportion of teenagers opted not to breast-feed compared with non-teenagers. Health education classes stressing the importance of breast-feeding should be emphasized in antenatal teenage clinics. More research is needed to understand how to improve the knowledge and motivation of adolescent girls to breast feed.
Hepatitis B prevalence among Somali households in Liverpool.
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Lack of protection against vertical transmission of HIV-1 by interferons produced during pregnancy in a cohort from East African republic of Malawi.
Interferons (IFNs) associated with pregnancy were studied for their possible role in inhibition of vertical transmission of the human immunodeficiency virus type 1 (HIV-1). A study group was composed of 43 HIV-1-positive mothers, of whom 15 transmitted the virus to the offspring and 28 did not. The control group included 48 HIV-1-negative mother-infant pairs. The IFN-alpha was detected only sporadically in the maternal sera from the groups of transmitters (27%), nontransmitters (21%), and controls (19%). The average levels of IFN-alpha were low, 16.3 +/- 2.5 pg/ml, 21.4 +/- 9.9 pg/ml, and 21.3 +/- 9.4 pg/ml among the transmitters, nontransmitters, and control subjects, respectively. In the cord blood, IFN-alpha was detected only on two occasions among transmitters, and on a single occasion in the control group. IFN-beta was absent from both maternal and cord blood in the study group, and found to be present in one case in the control group simultaneously in the maternal and fetal sera. In the placentas, on the other hand, both type I and II IFNs were expressed universally in the villous trophoblast, and IFN-alpha and -beta in the stromal macrophages as well. In one case among transmitters, no IFNs were detected; nevertheless, no significant difference with respect to nontransmitters could be confirmed. Our data suggest that although the placental IFNs have an antiviral potential, they are not sufficient to suppress transmission of HIV from mother to infant.
Developing country twinning programmes in paediatric oncology.
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Iron pots for cooking: wishful thinking or traditional common sense?
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Are orphans at increased risk of malnutrition in Malawi?
The objective of this study was to compare the nutritional status and health problems of village orphans, non-orphans and orphanage children, and to identify factors associated with undernutrition. A cross-sectional study was conducted in three orphanages and two villages near Blantyre, Malawi. Seventy-six orphanage children, 137 village orphans and 80 village non-orphans were recruited. Anthropometric measurement was done and guardians were interviewed. In the group of children aged < 5 years, the prevalence of undernutrition in orphanage children was 54.8% compared with 33.3% and 30% of village orphans and non-orphans, respectively. Sixty-four per cent of young orphanage children were stunted compared with 50% of village orphans and 46.4% of non-orphans. The mean (SD) Z-score of height/age was significantly lower in the orphanage group, -2.75 (1.29) compared with -2.20 (1.51) and -1.61 (1.57) in the village orphan and non-orphan groups (p < 0.05). Conversely, older orphanage children (> or = 5 years) were less stunted and wasted than orphans and non-orphans in villages. Illness of children in the last month was reported to be higher in the non-orphan group, especially diarrhoeal disease, which occurred in 30% compared with 10.8% of village orphans and 6.6% of orphanage children. More than three children in a family being cared for by guardians was significantly associated with undernutrition. Orphanage girls were more likely to be malnourished than orphanage boys. Children who had been admitted to an orphanage for more than a year were less malnourished. In village orphans, there was no association between undernutrition and duration of stay in extended families. Age and education of guardians were not associated with the nutritional status of children. We conclude that young orphanage children are more likely to be undernourished and more stunted than village children. Older orphanage children seem to have better nutrition than village orphans. There was no significant difference in nutritional status between village orphans and non-orphans.
A community based study of vitamin A and vitamin E status of adolescent girls living in the Shire Valley, Southern Malawi.
OBJECTIVE: To assess vitamin A and E status and anaemia in non-pregnant Malawian adolescent girls. DESIGN: A cross-sectional study in rural village communities in the Shire Valley, Southern Malawi. SUBJECTS: Adolescent girls, n = 118, aged between 10 and 19 y, 112 of whom were unmarried. METHODS: Socio-demographic information was collected by questionnaire, heights and weights were measured. Vitamin A was assessed by the Modified Relative Dose Response (MRDR) test, in addition to serum retinol values. Blood samples were collected 4-5 h after administration of 3,4-didehydroretinyl acetate. Retinol and alpha-tocopherol levels were measured by HPLC. Serum retinol results for non-pregnant girls were compared with values for 43 adolescent pregnant girls which were available from a previous study. RESULTS: 26.6% of non-pregnant girls had serum retinol values < 0.70 micromol/L; 40.2% had an MRDR ratio > 0.060. In 59.3%, serum tocopherol levels were < 11.5 micromol/L and the tocopherol/cholesterol ratio was < 2.2 in 23.9%. 11.3% had a haemoglobin > or = 12 g/dl. Vitamin A levels were significantly related to age, and younger girls were more likely to be deficient. Significant correlations were found between serum retinol, MRDR values and serum tocopherol. Girls with a low body mass index for age had tocopherol cholesterol ratios < 2.2. Low serum retinol values occurred significantly more often in stunted girls (P=0.01). Serum retinol values of adolescent pregnant girls were significantly lower than those of non-pregnant adolescents (P=0.002). CONCLUSIONS: Vitamin A and E deficiency and anaemia were common in adolescent non-pregnant girls, and thought to partly result from increased growth requirements. Girls who become pregnant at an early age are at risk of depletion of their nutritional reserves. Measures to reduce nutritional deficiencies before the first pregnancy are needed.
Malaria-related maternal mortality in urban Mozambique.
All pregnancy-related maternal deaths that occurred at the central hospital of Maputo during the 5 years between 1989 and 1993 were reviewed. The 239 maternal deaths recorded represented a maternal mortality ratio of 320/100,000 live births. Overall, 15.5% of the deaths were directly attributable to malaria, and 19.7% of the women who died were found to be parasitaemic (with Plasmodium falciparum) prior to death. Autopsies on 161 of the women who died showed histological evidence of malarial infection in the spleens of 44 (27.3%). Many (37.8%) of the malaria-related deaths occurred in adolescent primigravidae, and most were associated with severe anaemia. Pregnancy outcome was generally poor. Unbooked deliveries, and poor antenatal care were identified as risk factors for maternal death from malaria. The current policy of prescribing antimalarials in pregnancy based on symptomatic malaria alone should be reviewed. Improved primary prevention is required in order to reduce the high risk of malaria-related mortality in all pregnant women in the urban study area, especially among adolescents.
Randomised placebo-controlled trial of iron supplementation and malaria chemoprophylaxis for prevention of severe anaemia and malaria in Tanzanian infants.
BACKGROUND: Malaria and anaemia, especially that due to iron deficiency, are two leading causes of morbidity worldwide. Little is known about the relative contribution of Plasmodium falciparum infection and iron deficiency to the aetiology of anaemia in malaria-endemic areas. We undertook a randomised comparison of different strategies for control of anaemia and malaria in infants, including an assessment of the effect of iron supplementation on malaria susceptibility. METHODS: 832 infants born at one hospital in a malaria-hyperendemic area of Tanzania between January and October, 1995, were randomly assigned to group DI, receiving daily oral iron (2 mg/kg daily) plus weekly Deltaprim (3.125 mg pyrimethamine plus 25 mg dapsone); group IP, receiving iron plus weekly placebo; group DP, receiving daily placebo plus weekly Deltaprim; or group PP. supplementation was given from 8 to 24 weeks of age, and the weekly chemoprophylaxis from 8 to 48 weeks. The frequency of severe anaemia (packed-cell volume < 25%) and malaria episodes was assessed through a combination of passive case detection and cross-sectional surveys. FINDINGS: The groups that received iron supplementation had a lower frequency of severe anaemia than those that did not receive iron (0.62 vs 0.87 cases per person-year; protective efficacy 28.8% [95% CI 6.3-45.8). Iron supplementation had no effect on the frequency of malaria (0.87 vs 1.00 cases per person-year; protective efficacy 12.8% [-12.8 to 32.5]). The groups that received malaria prophylaxis had lower frequencies of both severe anaemia (0.45 vs 1.04 episodes per person-year; protective efficacy 57.3% [43.0-67.9]) and malaria (0.53 vs 1.34 episodes per person-year; protective efficacy 60.5% [48.2-69.9]) than the groups that did not receive prophylaxis. After the end of the intervention period, children who had received malaria chemoprophylaxis had higher rates of severe anaemia and malaria than non-chemoprophylaxis groups (relative risks 2.2 [1.3-3.7] and 1.8 [1.3-2.6]). INTERPRETATION: Malaria chemoprophylaxis during the first year of life was effective in prevention of malaria and anaemia but apparently impaired the development of natural immunity. Iron supplementation was effective in preventing severe anaemia without increasing susceptibility to malaria. Our findings support iron supplementation of infants to prevent iron-deficiency anaemia, even in malaria-endemic areas.
Informed consent. British institutions collaborating in projects overseas may face dilemma.
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Pneumocystis carinii pneumonia in Malawian children.
Sixty children aged between 1 and 23 months admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi for diagnosis of acute lower respiratory tract infections (ALRI) were investigated for laboratory diagnosis of Pneumocystis carinii pneumonia (PCP) by indirect immunofluorescence assay on nasopharyngeal secretions. P. carinii was found in five of the 60 children. Three PCP cases had AIDS. The clinical presentation of children with PCP was of little diagnostic value and all the children were infants. Arterial oxygen saturation was significantly lower in PCP cases. Of the five PCP cases, four died, indicating that the marked hypoxaemia was associated with poor prognosis. These results indicate that an immunofluorescence assay on nasopharyngeal secretions could be used for first-line diagnosis of PCP in Africa.
Malaria in pregnancy: current issues.
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Pneumocystis carinii pneumonia in Africa.
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Respiratory morbidity in Merseyside schoolchildren exposed to coal dust and air pollution.
A cross sectional study was carried out to determine whether schoolchildren in a specific locality exposed to pollution from steam coal dust have an excess of respiratory symptoms compared with children in control areas. A total of 1872 primary schoolchildren (aged 5-11 years) from five primary schools in the Bootle dock area of Liverpool (exposed area), five primary schools in South Sefton (control area), and five primary schools in Wallasey (control area) were studied. A questionnaire was distributed through the schools and was completed by the parents of the children. The questionnaire inquired about respiratory symptoms (cough, wheezing, and shortness of breath), allergy, atopy, smoking, and socioeconomic factors. Height, weight, and peak expiratory flow were measured. Compliance was good (92%) and similar in the three study areas. The children in the three areas were of similar mean age (7.5 years), height (1.24 m), sex ratio, and had a similar prevalence of paternal (6.2%) and maternal (7%) asthma. The exposed zone contained more unemployed parents (41, 29, and 29% respectively), more rented housing (64, 45, 34%), and more smoking parents (71, 60, 59%) than the control areas. Respiratory symptoms were significantly more common in the exposed area, including wheeze (25.0, 20.6, and 17.5%), excess cough (40.0, 23.4, and 25.1%), and school absences for respiratory symptoms (47.5, 35.9, and 34.9%). These differences remained significant even if the groups were subdivided according to whether or not parents smoked or were employed. Multiple logistic regression analysis confirmed the exposed zone as a significant risk factor for absenteeism from school due to respiratory symptoms (odds ratio 1.55, 95% confidence interval 1.17 to 2.06) after adjusting for confounding factors. Standard dust deposit gauges on three schools confirmed a significantly higher dust burden in the exposed zone. An increased prevalence of respiratory symptoms in primary schoolchildren exposed to coal dust is confirmed. Although the association with known coal dust pollution is suggestive a cross sectional study cannot confirm a casual relation and further studies are needed.
The consequences of malaria infection in pregnant women and their infants.
Preliminary results are presented from this study which indicate that 84.8% of pregnant women present at first antenatal visit with anemia (Hb 11g/dl) an 8.7% of their infants (n = 230) have a hemoglobin at birth below 14g/dl. There is an association between pregnancy anemia and malaria. A case control study in pregnant women and an infant cohort study to 18 months of age, are employed to study the cause and effects of anemia and malaria on women and their infants health.
A review of randomized controlled trials of routine antimalarial drug prophylaxis during pregnancy in endemic malarious areas.
Current global recommendations for routine malaria chemoprophylaxis in pregnant women living in endemic malarious areas are not clear. To assist in policy formulation, the evidence from randomized controlled trials was reviewed. The literature was extensively searched, and studies identified were systematically analysed in relation to outcomes in the mother and the baby. Routine chemoprophylaxis appears to have an effect on antenatal morbid episodes and packed cell volume. There is a trend towards higher birth-weight values in chemoprophylaxis groups, which reached statistical significance in some studies. Evidence of an effect on gestation was only examined in one study. The effects on perinatal and neonatal mortality have only been examined in a few studies, with small sample sizes. The analysis questions whether routine malaria chemoprophylaxis is the best use of scarce resources in developing countries, and suggests that chemoprophylaxis might be targeted at anaemic women and primigravidae. Large controlled trials, with treatment available to placebo groups, are required to test whether routine chemoprophylaxis has advantages over early, effective treatment of clinical malaria.