Sepsis in two hospitals in Rwanda: A retrospective cohort study of presentation, management, outcomes, and predictors of mortality

Purpose Few studies have assessed the presentation, management, and outcomes of sepsis in low-income countries (LICs). We sought to characterize these aspects of sepsis and to assess mortality predictors in sepsis in two referral hospitals in Rwanda. Materials and methods This was a retrospective cohort study in two public academic referral hospitals in Rwanda. Data was abstracted from paper medical records of adult patients who met our criteria for sepsis. Results Of the 181 subjects who met eligibility criteria, 111 (61.3%) met our criteria for sepsis without shock and 70 (38.7%) met our criteria for septic shock. Thirty-five subjects (19.3%) were known to be HIV positive. The vast majority of septic patients (92.7%) received intravenous fluid therapy (median = 1.0 L within 8 hours), and 94.0% received antimicrobials. Vasopressors were administered to 32.0% of the cohort and 46.4% received mechanical ventilation. In-hospital mortality for all patients with sepsis was 51.4%, and it was 82.9% for those with septic shock. Baseline characteristic mortality predictors were respiratory rate, Glasgow Coma Scale score, and known HIV seropositivity. Conclusions Septic patients in two public tertiary referral hospitals in Rwanda are young (median age = 40, IQR = 29, 59) and experience high rates of mortality. Predictors of mortality included baseline clinical characteristics and HIV seropositivity status. The majority of subjects were treated with intravenous fluids and antimicrobials. Further work is needed to understand clinical and management factors that may help improve mortality in septic patients in LICs.

TO STUDY HIV SEROPOSITIVITY IN PATIENTS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AT NATIONAL INSTITUTE OF TUBERCULOSIS AND RESPIRATORY DISEASES

Background: HIV (Human Immunodeficiency Virus) attacks the immune system and thereby weaken bodys natural defence mechanism against various diseases. Several pulmonary complications have been documented in HIV infected people among which Chronic Obstructive Pulmonary Disease (COPD) carries special importance. It has been postulated that COPD occurs more frequently in HIV infected people and occurs in younger aged HIV infected people than non HIV population. Methods: It was a cross sectional observational study, and convenience sampling method was adopted. COPD cases were selected from out-patient department. HIV testing was done as per national guideline with the HIV kits supplied by NATIONAL AIDS CONTROL ORGANIZATION (NACO). Objective: To study the occurrence of HIV seropositivity in the adult (older than 18 years of age) patients of COPD attending National Institute of Tuberculosis and Respiratory Diseases(NITRD). Results: HIV positivity was foundin 4% of COPD patients. COPD developed at an earlier age in HIV positive patients. Median age was 37.5 years in HIV positive patients compared to median age of 50 years in HIV negative patients. Smoking and nutritional status of the patients did not show any significant relationship with HIV. Final conclusion: Keeping in mind the limitations of this study we concluded that HIV testing may be helpful in young aged, uncontrolled COPD patients.But further studies are required with larger sample sizes to confirm these observations.

HIV infection, seasonality and younger age predicting incident Bell’s palsy among black South Africans

Background Although South Africa (SA) is facing a high prevalence of HIV infection, there is no literature from this region on a link between Bell’s palsy and HIV. The aim of this study was to identify the occurrence of Bell’s palsy in relation to demographics, seasons and HIV status among black South Africans. Methods This retrospective cohort was conducted among adult black patients, without Bell’s palsy in 2003, presenting to the neurology outpatients department at Dr. George Mukhari Academic hospital, Pretoria, South Africa, between 2004 (study baseline) and 2012 (end test). Gender, age, HIV status, and seasons were potential predictors of Bell’s palsy using Cox regression model and Kaplan Meier curves. Results From the baseline of 1487 patients, 20.9% (n = 311) experienced Bell’s palsy onset by the end of the study. In univariate analysis, male gender (RR = 2.1 95% CI 1.7–2.5; P < 0.0001), age less than 30 years (RR = 2.9 95% CI 2.4–3.6; P < 0.0001), HIV seropositivity (RR =2.9 95% CI 2.3–4.9; P < 0.0001). The highest incidence in winter (30.3% n = 136/450) vs. incidences during other seasons with Intermediate values during Summer (25.3% n = 136/450) and Autumn (20.7% n = 64/308) and the lowest incidence in Spring (23.7% n = 16/353) P < 0.0001) were predictors of Bell’s palsy. In multivariate analysis at adjusting for gender, the most significant and independent predictors of incident Bell’s palsy were HIV seropositivity (HR = 6.3 95% CI 4.8–8.3; P < 0.0001), winter (HR = 1.6 95% CI 1.2–2.1; P < 0.0001) vs. other seasons, and younger age < 30 years (HR = 7.1 95% CI 5.6–9.1; P < 0.0001) vs. older age groups. Conclusion Seasonality, younger age and HIV positivity are important and independent risk factors of Bell’s palsy. Education and awareness programs on the possible effects of HIV and seasons on the development of Bell’s palsy are necessary. This would lead to a better understanding and even a possible development of avoidance measures for this condition amongst young black South Africans.

Spatial patterns and associated factors of HIV Seropositivity among adults in Ethiopia from EDHS 2016: a spatial and multilevel analysis

Background HIV is a major public health issue, especially in developing countries. It is important to track and design successful intervention programs to explore the spatial pattern, distribution, and associated factors of HIV Seropositivity. This study therefore showed the spatial variation of HIV Seropositivity and related factors in Ethiopia. Methods A total sample of 25,774 individual data collected from the 2016 EDHS data were primarily HIV biomarkers, IR, MR, and GPS. Spatial heterogeneity analysis was used with methods such as Morans I, Interpolation, and Kulldorff ‘s scan statistic. Spatial analysis was conducted using open source tools (QGIS, GeoDa, SaTScan). Multilevel logistic regression analysis was performed using Stata14 to identify HIV-associated factors. Finally, the AOR with a 95% confidence interval was used to report the mixed-effect logistic regression result in the full model. Result The prevalence of HIV / AIDS at national level was 0.93%. The highest prevalence regions were Gambela, Addis Abeba, Harari and Diredawa, accounting for 4.79, 3.36, 2.65 and 2.6%, respectively. Higher HIV seropositive spatial clusters have been established in the Gambela and Addis Ababa regions. Multilevel analysis at the individual level being married [AOR = 2.19 95% CI: (1.11–4.31)] and previously married [AOR = 6.45, 95% CI: (3.06–13.59)], female [AOR = 1.8, 95% CI: (1.19–2.72)], first-sex at age ≤15 [AOR = 4.39, 95% CI: (1.70–11.34)], 18—19 [AOR = 2.67 95% CI: (1.05–6.8)], middle age group (25-34) [AOR = 6.53, 95% CI: (3.67–11.75)], older age group (>34) [AOR = 2.67 95% CI: (1.05–6.8)], primary school [AOR = 3.03, 95% CI: (1.92–4.79)], secondary school [AOR = 3.37, 95% CI: (1.92–5.92) were significantly associated with serropositivity. Regarding household level, place of residence [urban: AOR = 6.13 CI: (3.12, 12.06)], female-headed households (AOR = 2.24 95% CI: (1.57–3.73), media exposure [low exposure (AOR = 0.53 95% CI: (0.33–0.86), no exposure AOR = 0.39 95% CI: (0.23–0.65)] and increased household size [AOR = 0.72 95% CI: (0.65–0.8)] were associated with HIV Seropositivity. Conclusion High cluster HIV cases were found in Gambela, Addis Abeba, Harari, and Diredawa. Having a history of married, start sex at a younger age, female-headed household, urban residence, and lower household size is more affected by HIV/AIDS. So any concerned body work around this risk group and area can be effective in the reduction of transmission.

Influence of Social Cultural Factors on HIV Seropositivity Disclosure to Sexual Partners in Kenya

The purpose of the study was to assess whether sociocultural factors have an influence on the self-disclosure of HIV serostatus to intimate partners among People Living with HIV and AIDS (PLWHA). A survey was conducted among 232 randomly selected respondents who were HIV seropositive and were members of a registered community-based support group for PLWHA in Nairobi, Kenya. Data was gathered by means of semi-structured interviews and focus group discussions. Results revealed that the marital status of the respondents varied from never married (13.4%), married (27.6%), separated (26.3%), divorced (4.3%) and widowed (28.4%). Approximately half of the respondents (50.4%) had disclosed their HIV serostatus to their intimate partners while 49.6% had not. The binary logistic regression results established that some socio-cultural factors fostered HIV seropositivity disclosure while others did not. The positive predictors of HIV serostatus disclosure were gender inequalities in the sexual relationship (AOR=4.129; p=0.011), the role of females as dependent housewives (AOR=1.322; P=0.004), anticipated divorce following HIV disclosure (AOR=2.578; p=0.014) and the cultural belief that HIV was a curse (AOR=2.444; p=0.005). However, sexual behaviour such as homosexuality, rape, incest, sex with minors and extramarital sex (AOR=0.225; p=0.001), intimate partner violence (AOR=0.220; p=0.001), the subordination of females by their male partners (AOR=0.351; p=0.002) and the fear of exclusion from the cultural rite of wife inheritance during widowhood (AOR=0.410; p=0.002) were negative predictors of disclosure of HIV serostatus. This implies that there was no likelihood of HIV disclosure, thereby putting intimate partners at risk of HIV infection. It was recommended that there was the need to promote community discourse on HIV and AIDS in order to reduce the socio-cultural barriers to self-disclosure of HIV seropositive status and to increase the community acceptance of people living with HIV and AIDS.