Association between birth outcomes and aflatoxin B1 biomarker blood levels in pregnant women in Kumasi,Ghana

Objective To investigate the association between birth outcomes and blood levels of aflatoxin B₁ (AFB1)‐lysine adduct in pregnant women in Kumasi, Ghana. Method A cross‐sectional study of 785 pregnant women attending antenatal clinic was conducted. Aflatoxin B₁ (AFB₁)‐lysine adduct levels were determined by high performance liquid chromatography (HPLC) on blood taken after delivery. The birth outcomes considered were small for gestation age, low birthweight, preterm delivery and stillbirth. Participants were divided into quartiles based on the distribution of aflatoxin B₁‐lysine adducts in pg/mg albumin (‘low’: ≤2.67, ‘moderate’: >2.67 to ≤4.97, ‘high’: >4.97 to ≤11.34, ‘very high’: >11.34). Statistical analysis involved models that included socio‐demographic variables and other potential confounders. Results The average AFB₁‐lysine adduct level in maternal serum was 10.9 ± 19.00 pg/mg albumin (range = 0.44–268.73 pg/mg). After adjusting for socio‐demographic variables and potential confounding factors, participants in the highest AFB₁‐lysine quartile with ‘very high’ AFB₁‐lysine level (>11.34 pg/mg) were more likely to have low birthweight babies (OR, 2.09; 95% CI, 1.19–3.68), and showed a trend of increasing risk for low birthweight (P_trend = 0.007) compared to participants in the lowest quartile. Conclusion This study adds to the growing body of evidence that aflatoxins may increase the risk of adverse birth outcomes. The findings have implications for targeted nutritional education of pregnant women in areas with high levels of aflatoxin contamination of foods.     

Hepatitis B infection and aflatoxin biomarker levels in Gambian children

OBJECTIVES: To examine the relationship between hepatitis B virus (HBV) infection and biomarkers of aflatoxin exposure in West African children. METHODS: Sera from 444 children aged 3-4 years who were selected to be representative of their communities were analysed for aflatoxin-albumin (AF-alb) adducts and markers of hepatitis B infection. RESULTS: There was large interindividual variation in adduct levels (range: 2.2 to 459 pg AF-lysine eq./mg albumin). Adduct level was strongly correlated with season, with an approximately twofold higher mean level in the dry season than the wet. Geometric mean adduct levels in uninfected children, chronic carriers and acutely infected children were 31.6 (n = 404), 44.9 (n = 34) and 96.9 (n = 6) pg/mg, respectively. The relationship of AF-alb level to ethnicity, month of sampling and HBV status was examined in a multiple regression model. Month of obtaining the blood sample (P = 0.0001) and HBV status (P = 0.0023) each made a highly significant contribution to the model; the high AF-alb levels were particularly associated with acute infection. Elevated serum transaminase levels were significantly (P < 0.002) associated with HBV status, with acutely infected children having the highest levels. Ethnicity was not significantly associated with AF-alb adduct levels in the model (P = 0.09). CONCLUSIONS: HBV infection and month of sampling both significantly influence AF-alb adduct levels. The effect of seasonality on adducts was also observed in a previous study of 347 Gambian adults, although there was no correlation between adduct level and HBV status in that population. This difference between children and adults may reflect a more severe effect of HBV infection, particularly acute infection, in childhood on hepatic AF metabolism.     

Higher prevalence of anemia among pregnant immigrant women compared to pregnant ethnic Danish women

The aim of the study was to investigate whether the well-known high anemia prevalence in pregnant women from the eastern Mediterranean and Asian regions decreased when the women immigrated to a low-frequency region (Denmark). During 70 months, 1,741 pregnant immigrant women referred from primary care to an obligatory hemoglobinopathy screening were eligible for the study, as their screening was negative. To compare this group with a cohort of 205 pregnant ethnic Danish women, the groups were matched by gestational age, and a total of 406 immigrant women were included. Hemoglobin (Hb) and iron status parameters were examined in the two groups. The prevalence of anemia was higher in the immigrant group (20.0%) compared to the Danish women (4.9%) (P < 0.0001). Blood Hb concentration was 119 ± 12 g/l (mean ± SD) in the immigrant group compared to 122 ± 9 g/l in the Danish group (P = 0.01). Erythrocyte mean corpuscular volume (MCV) was also lower in the immigrant group (87 ± 7 fl vs 96 ± 4 fl) (P < 0.0001). A total of 13.1% of the immigrant women had an MCV <80 fl (the lower reference limit) compared to 0.0% in the Danish group, and plasma iron, ferritin, and transferrin saturation values indicated iron deficiency. Conclusively, the pregnant immigrant women had significantly higher prevalence of anemia compared to pregnant women of Danish origin. It indicates the need for an alternative routine screening procedure for this population group, which should also include nutritional counselling.     

The risk of hepatitis B virus infection by transfusion in Kumasi,Ghana

The risk of hepatitis B virus (HBV) transmission by transfusion in sub-Saharan Africa is considered to be relatively low, and testing of blood donors is often not done or is done relatively poorly. To re-examine this attitude, we identified HBV chronically infected blood donors from a major hospital in Ghana with a range of hepatitis B surface antigen (HBsAg) assays. Test efficacy was estimated using HBV DNA as a gold standard, and the risk of HBV infection in blood recipients was estimated for different testing strategies. Particle agglutination, dipstick, and enzyme immunoassay (EIA) HBsAg screening detected 54%, 71%, and 97% of HBV infectious donors, respectively. The risk of HBV transmission to recipients less than 10 years old ranged between 1:11 and 1:326 with blood unscreened and screened by EIA, respectively. For older recipients, the risk decreased a further 4-fold because of the high frequency of natural exposure to HBV. A total of 98% of HBsAg-confirmed positive samples contained HBV DNA. HBV DNA load was less than 1 x 10(4) IU/mL in 75% of HBsAg-reactive samples, most of them anti-HBe reactive. Approximately 0.5% of HBsAg-negative but anti-HBc-positive samples contained HBV DNA. The use of sensitive HBsAg tests is critical to prevent transfusion transmission of HBV infection to young children in a population with a 15% prevalence of chronic HBV infection in blood donors. However, this will not have much effect on the prevalence of this infection unless other strategies to protect children from infection are also advanced in parallel.     

Sexual risk behavior and uptake of HIV counseling and testing among youth in Metropolitan Kumasi,Ghana

Research on HIV counselling and testing (HCT) has proliferated in Ghana but limited evidence exists about the uptake of HCT among a large population that has been shown to engage in HIV risk-related behavior in Metropolitan Kumasi. With retrospective cross-sectional data from a representative sample of sexually active young people, multivariate logistic regression models examine the variables associated with HCT uptake in Kumasi. Among 906 participants (male 51% and female 49%, with a mean age ±SD, 25?±?6), 22% had utilized HCT in the last six months despite the higher knowledge of HCT (84%) mainly through mass media (65%) and health providers (27%). Besides, less than 20% of the sample intended to undergo HCT services. Multivariate logistic regression analysis showed that female gender (adjusted odds ratio [aOR]?=?1.830; 95% CI: 1.280–47.831; p?p?=?0.040), having sexual intercourse with irregular partner (aOR?=?5.597; 95% CI: 1.776–17.638; p?=?0.018), practiced unprotected sex (aOR?=?2.614; 95% CI: 1.821–6.472; p?=?0.002), having multiple sex partners (aOR?=?2.902; 95% CI: 1.405–7.226; p?p?相似文献   

Serotypes and antibody levels of group B streptococci in pregnant women]

Group B streptococcus were isolated from 1404 pregnant out-patient women in the Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, from June 1, 1992 to May 31, 2001. Serotype of 187 (13.3%) fresh isolates of GBS was determined by using hemolytic streptococcus-typing immune sera (Denka Seiken, Tokyo, Japan). With these strains there were 59 (31.6%), 46 (26.6%), 19 (10.2%), 16 (8.6%), 16 (8.6%), 12 (6.4%) and 3 (1.6%) indicating that their types were VIII, VI, III, Ia, V, Ib and II respectively. Also, bacterial agglutination reaction was employed for detection of titer to GBS in pregnant women serum. Positive reaction showed in 31 (57.4%) samples but 23 (42.6%) samples were not seen in this essay. It is assumed that the high antibody levels in pregnant women serum plays an important role as an in vivo defence factor in neonatal infection by GBS.     

Prevalence,types and determinants of anemia among pregnant women in Sudan: a systematic review and meta-analysis

Background

Anemia during pregnancy is a public health problem especially in developing countries and it is associated with maternal and perinatal adverse outcomes. There is no meta-analysis on anemia during pregnancy in Sudan. The current systemic review and meta-analysis was conducted to assess the prevalence, types and determinant of anemia during pregnancy in Sudan.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. The databases (PubMed, Cochrane Library, Google Scholar, CINAHL, and African Journals Online) were searched using; anemia, pregnancy related anemia and Sudan. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and Modified Newcastle – Ottawa quality assessment scale were used for critical appraisal of studies. The pooled Meta logistic regression was computed using OpenMeta Analyst software.

Results

Sixteen cross-sectional studies included a total of 15, 688 pregnant women were analyzed. The pooled prevalence of anemia among pregnant women in Sudan was 53.0% (95%, CI?=?45.9–60.1). The meta-analysis showed no statistical significant between the age (mean difference?=?0.143, 95 CI?=???0.033???0.319, P?=?0.112), parity (mean difference?=?0.021, 95% CI?=???0.035???0.077, P?=?0.465) between the anemic and no anemic women. Malaria was investigated in six studies. Pregnant women who had malaria infection during pregnancy were 1.94 times more likely to develop anemia than women who had no malaria infection (OR?=?1.94, 95% CI =1.33–2.82). Six (37.5%) studies investigated type of anemia. The pooled prevalence of iron deficiency anemia (IDA) among pregnant women in Sudan was 13.6% (95% CI?=?8.9–18.2).

Conclusion

There is a high prevalence of anemia among pregnant in the different region of Sudan. While age and parity have no association with anemia, malaria infection was associated with anemia. Interventions to promote the strengthening of antenatal care, and access and adherence to nutrition, and malaria preventive measures are needed to reduce the high level of anemia among pregnant women in Sudan.

     

Factors influencing participation in national immunization days in Kumasi, Ghana

A study of the factors influencing participation in national immunization days (NID) in Kumasi, Ghana was carried out between the April and June of 1999. Polio-immunization coverage during NID was assessed among children aged < 5 years; > 90% of these children had received polio vaccinations on both of the two previous NID. The mothers who participated most in the NID tended to be those who were better educated and Ghanaian. Mothers who were salaried workers participated fully in NID. Radio and television played a major role in public education about NID, whereas the attitude of health workers was a strong factor that prevented many mothers/caregivers from bringing their children to be immunized. The coverage of the Expanded Programme on Immunization (EPI) was assessed in children aged 12-23 months; nearly 70% of these children were fully immunized. BCG had the highest coverage (97.0%) and measles the lowest (79%). Again, full coverage of the children of mothers who had been educated beyond primary level was higher than that of the other children (75.9% v. 65.2%), and coverage of the children of Ghanaian women was higher than that of the others (70.8%. v. 50.0%). Although the mothers/caregivers raised concerns about the costs of the routine immunizations, these charges apparently did not prevent them from taking their children to be immunized. NID complement the routine EPI-associated work in Ghana, increasing overall polio-immunization coverage. The results of this study will be used to improve the overall performance of immunization programmes, especially in the Kumasi metropolis. Hopefully, sustained, increased polio-immunization coverage will contribute positively towards polio eradication in Ghana.     

Synergistic interaction between aflatoxin B1 and hepatitis B virus in hepatocarcinogenesis

Abstract: Chronic hepatitis B virus (HBV) infection and dietary exposure to aflatoxin B₁ (AFB₁), two of the major risk factors in the multifactorial aetiology of hepatocellular carcinoma (HCC), co‐exist in those countries with the highest incidences of and the youngest patients with this tumour, raising the possibility of a synergistic carcinogenic interaction between the two agents. Experimental studies in HBV‐transgenic mice and woodchucks infected with woodchuck hepatitis virus were the first to show a synergistic hepatocarcinogenic effect between hepadnaviral infection and AFB₁ exposure. With the availability of urinary and serum biomarkers that more accurately reflect dietary exposure to AFB₁ than did the initially used food sampling and dietary questionnaires, cohort studies of patients with HCC in China and Taiwan have provided compelling evidence for a multiplicative or sub‐multiplicative interaction between HBV and AFB₁ in the genesis of human HCC. A number of possible mechanisms for the interaction have been suggested. Chronic HBV infection may induce the cytochrome P450s that metabolise inactive AFB₁ to the mutagenic AFB₁‐8,9‐epoxide. Hepatocyte necrosis and regeneration and the generation of oxygen and nitrogen reactive species resulting from chronic HBV infection increase the likelihood of the AFB₁‐induced p53 249^ser and other mutations and the subsequent clonal expansion of cells containing these mutations. Nuclear excision repair, which is normally responsible for removing AFB₁–DNA adducts, is inhibited by HBV×protein, favouring the persistence of existing mutations. This protein also increases the overall frequency of DNA mutations, including the p53 249^ser mutation, and may contribute to uncontrolled cell cycling when p53 is non‐functional.     

亚急性联合变性与维生素B12缺乏和巨幼红细胞贫血的研究

目的探讨亚急性联合变性(SCD )与维生素B12(VB12)缺乏和巨幼红细胞贫血(MA)的相关性.方法分析36例SCD的神经损害程度与贫血程度和血清VB12水平之间的相关性;对比MRI、神经电生理检查在SCD诊断中的敏感性和特异性.监测SCD脑脊液髓鞘碱性蛋白(MBP)浓度的动态变化.分析开始治疗时间对疗效和预后的影响.结果患者治疗前Hb平均含量(77.1±11.2 ) g/L ,表明SCD大都伴贫血,但其程度与SCD神经损害程度无直线相关关系(r=-0.1917、0.0926,P＞ 0.5).治疗前平均血清VB12水平(87.0±21.4) ng/L,异常率47.2 %, 治疗后很快恢复, 但神经体征改善较慢,二者无直线相关关系(r=0.207、0.101,P>0.5).诱发电位综合阳性率100%,并可在临床症状出现前或在SCD初期出现.MRI检查阳性率为71.4%,部分病灶治疗后缩小或消失.脑脊液MBP水平治疗前(3.96±1.66 ) ng/L.治后3个月有显著改善(2.25±1.66) ng/L.确诊6个月后开始治疗者,神经功能改善不显著.结论 SCD多由VB12缺乏引起,常伴MA,但血清VB12水平不能作为诊断或排除SCD的惟一标准.MRI可显示SCD的多数脊髓和脑部病灶,治疗后可缩小或消失.诱发电位为早期确诊和发现隐匿病灶提供帮助.脑脊液MBP水平可反映SCD神经髓鞘损害和修复的程度.早期诊断和治疗可降低永久神经功能损害的范围和程度.     

Prevalence and determinants of anemia among pregnant women in Ethiopia; a systematic review and meta-analysis

Background

Anemia during pregnancy is one of the most common indirect obstetric cause of maternal mortality in developing countries. It is responsible for poor maternal and fetal outcomes. A limited number of studies were conducted on anemia during pregnancy in Ethiopia, and they present inconsistent findings. Therefore, this review was undertaken to summarize the findings conducted in several parts of the country and present the national level of anemia among pregnant women in Ethiopia.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. The databases used were; PUBMED, Cochrane Library, Google Scholar, CINAHL, and African Journals Online. Search terms used were; anemia, pregnancy related anemia and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. The meta-analysis was conducted using STATA 14 software. The pooled Meta logistic regression was computed to present the pooled prevalence and relative risks (RRs) of the determinate factors with 95% confidence interval (CI).

Results

Twenty studies were included in the meta-analysis with a total of 10, 281 pregnant women. The pooled prevalence of anemia among pregnant women in Ethiopia was 31.66% (95% CI (26.20, 37.11)). Based on the pooled prevalence of the subgroup analysis result, the lowest prevalence of anemia among pregnant women was observed in Amhara region, 15.89% (95% CI (8.82, 22.96)) and the highest prevalence was in Somali region, 56.80% (95% CI (52.76, 60.84)). Primigravid (RR: 0.61 (95% CI: 0.53, 0.71)) and urban women (RR: 0.73 (95% CI: 0.60, 0.88)) were less likely to develop anemia. On the other hand, mothers with short pregnancy interval (RR: 2.14 (95% CI: 1.67, 2.74)) and malaria infection during pregnancy (RR: 1.94 (95% CI: 1.33, 2.82)) had higher risk to develop anemia.

Conclusions

Almost one-third of pregnant women in Ethiopia were anemic. Statistically significant association was observed between anemia during pregnancy and residence, gravidity, pregnancy interval, and malaria infection during pregnancy. Regions with higher anemia prevalence among pregnant women should be given due emphasis. The concerned body should intervene on the identified factors to reduce the high prevalence of anemia among pregnant women.

     

Correlation between measles-neutralizing antibody and HI antibody, between measles-neutralizing antibody and PA antibody among pregnant women, and protective levels of three titration types

When measles antibody levels among pregnant women were measured with measles hemagglutinin inhibition (HI), 31% of subjects had negative HI antibody titers. When the same blood samples were tested with measles gelatin particle agglutination (PA) and neutralizing (NT), the percentages of those with negative antibody levels were 1% and 3%. We conducted the correlation between antibody titers measured by the three types of titration. Correlation between NT and HI antibody titers higher than 1:8 and that between NT and PA antibody titers were good, but 81% of subjects whose HI antibody titer was below 1:8 and all women with HI antibody of 1:8 were found to have NT antibody titer higher than 1:4. NT antibody titer higher than 1:4 was found in 95% of women having PA antibody titer of 1:256 and in 99% of those with PA antibody titer of 1:512. Based on the relationships to measles NT antibody level, the majority of subjects with HI antibody titer higher than 1:8 or PA antibody level higher than 1:512 was reasonably assumed to be protected against clinical measles. PA seemed superior to HI in finding subjects with insufficient immunity against measles, because the former detects weak immunity more efficiently than the latter.     

Association among serum ferritin, alanine aminotransferase levels, and metabolic syndrome in Korean postmenopausal women

We examined the relationships among serum ferritin, alanine aminotransferase (ALT) levels, and cardiovascular risk factors of metabolic syndrome in Korean postmenopausal women. We conducted a cross-sectional study of 959 postmenopausal women without an apparent cause of liver disease. Metabolic syndrome was defined as the presence of at least 3 of the following: elevated blood pressure, low high-density lipoprotein cholesterol, elevated serum triglycerides, elevated plasma glucose, and abdominal obesity. Serum ferritin and ALT levels were found to be correlated (r=0.374, P<.001) and to be associated with the components of metabolic syndrome. Subjects with metabolic syndrome showed significantly higher serum ferritin (74.7+/- 2.0 vs 59.6+/- 2.0 ng/mL, P<.001) and ALT levels (21.3+/-1.6 vs 18.7+/-1.5 IU/L, P<.001). Moreover, the greater the number of metabolic syndrome components present, the higher were the serum ferritin and ALT levels (P<.001). Multiple regression analysis showed that serum ALT levels are significantly associated with serum ferritin levels, waist circumference, fasting blood glucose, age, and white blood cell count (adjusted R(2)=0.147). Elevated iron stores were positively associated with serum ALT levels and metabolic syndrome in Korean postmenopausal women.     

Relationship between dietary and plasma copper levels of pregnant Nigerian women

Dietary copper intake as well as plasma copper levels were assessed in a group of pregnant Nigerian women during the third trimester of pregnancy. Intake of zinc, protein and energy was also measured. Dietary intake was assessed by cumulative 24-hour recalls while plasma copper was assessed by atomic absorption spectrophotometry. Dietary copper levels were relatively lower than those documented in the literature for other physiological groups. The intake of other nutrients was below recommended dietary allowances. When corrected for the effect of gestation and maternal age, one-way analysis of variance showed that plasma copper varied with the level of dietary copper intake. Correlation analysis seems to suggest that the influence of dietary copper on plasma levels during pregnancy is partially dependent on the relative amounts of copper and zinc as represented by the copper:zinc ratio in the diets consumed.     

Biochemical and hematological changes among anemic and non-anemic pregnant women attending antenatal clinic at the Bolgatanga regional hospital,Ghana

Background

Anemia in pregnancy may not only be associated with maternal morbidity and mortality but can also be detrimental to the fetus. A definitive diagnosis of anemia is a pre-requisite to unravelling possible cause(s), to allow appropriate treatment intervention. It is hypothesised that measured hemoglobin (HGB), complemented by biochemical and other hematological parameters would enhance anemia diagnosis.

Methods

This was a cross-sectional study among 400 pregnant women comprising 253 anemic and 147 non-anemic pregnant women, attending an antenatal clinic at Bolgatanga Regional Hospital, Ghana. Venous blood was collected and hemoglobin genotype, complete blood count and biochemical parameters [ferritin, iron, total iron binding capacity (TIBC), transferrin saturation (TfS), C-reactive protein (CRP) and bilirubin] were determined. Thick blood films were prepared for malaria parasitemia, while early morning stool and midstream urine samples were examined for enteric and urogenital parasites, respectively.

Results

There were significantly reduced levels of HGB (p?<?0.0001), HCT (p?<?0.0001), MCV (p?<?0.0001), iron (0.0273), ferritin (p?=?0.018) and transferrin saturation (0.0391) and increased WBC (p?=?0.006), RDW (p?=?0.0480), TIBC (p?=?0.0438) and positivity of CRP in anemic, compared to non-anemic pregnant women. Anemic women were associated with increased proportion of hemoglobinopathies (AS, SS and SC), Plasmodium falciparum, Schistosoma hematobium and intestinal parasite infections.

Conclusion

Anemic pregnant women are associated with a significant derangement in hematological and iron indices that implicate iron deficiency. This was influenced by hemoglobinopathies and parasitic infections.

     

Rapid increase in the prevalence of sulfadoxine-pyrimethamine resistance among Plasmodium falciparum isolated from pregnant women in Ghana

Use of intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) during pregnancy (IPTp-SP) has become policy in much of sub-Saharan Africa but crucially depends on the efficacy of SP. We assessed the frequency of the dhfr triple mutation among Plasmodium falciparum isolates obtained from pregnant Ghanaian women in 1998, 2000, and 2006. The prevalence of the triple mutation, which confers resistance to SP, doubled from 36% to 73% during the study period (P<.001). In 2006, the prevalence was virtually identical among women of early gestation and delivering women with or without a history of IPTp-SP use, indicating that such treatment did not select for mutant parasites. Nevertheless, IPTp-SP may be outdated by drug resistance before it is fully implemented.