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BMJ No 7111 Volume 315 Papers - Abstracts Saturday 27 September 1997
Mortality associated with HIV-1 infection over five years in a
rural Ugandan population: cohort study
Mortality associated with HIV-1 infection over five years in a rural Ugandan population: cohort studyAndrew J Nunn, Daan W Mulder, Anatoli Kamali, Anthony Ruberantwari, Jane-Frances Kengeya-Kayondo, Jimmy Whitworth AbstractObjective: To assess the impact of HIV-1 infection on mortality over five years in a rural Ugandan population.Design: Longitudinal cohort study followed up annually by a house to house census and medical survey. Setting: Rural population in south west Uganda. Subjects: About 10,000 people from 15 villages who were enrolled in 1989-90 or later. Main outcome measures: Number of deaths from all causes, death rates, mortality fraction attributable to HIV-1 infection. Results: Of 9,777 people resident in the
study area in 1989-90, 8833 (90%) had an unambiguous result on testing
for HIV-1 antibody; throughout the period of follow up adult
seroprevalence was about 8%. During 35,083 person years of follow up,
459 deaths occurred, 273 in seronegative subjects and 186 in
seropositive subjects, corresponding to standardised death rates of 8.1
and 129.3 per 1,000 person years. Standardised death rates for adults
were 10.4 (95% confidence interval 9.0 to 11.8) and 114.0 (93.2 to
134.8) per 1,000 person years respectively. The mortality fraction
attributable to HIV-1 infection was 41% for adults and was in excess
of 70% for men aged 25-44 and women aged 20-44 years. Median survival
from time of enrolment was less than three years in subjects aged 55
years or more who were infected with HIV-1. Life expectancy from birth
in the total population resident at any time was estimated to be 42.5
years (41.4 years in men; 43.5 years in women), which compares with
58.3 years (56.5 years in men; 60.5 years in women) in people known to
be seronegative.
Medical Research Programme on AIDS in
Uganda, Institute of Social Medicine, Correspondence to: Mr A J Nunn
MRC HIV Clinical
Trials Centre, Epidemiology and clinical management of meningococcal disease in west Gloucestershire: retrospective, population based studyPhilip AL Wylie, David Stevens, William Drake III, James Stuart, Keith Cartwright See Editorial by Cartwright, p 757 AbstractObjective: To study changes in the epidemiology and management of meningococcal disease in one health district during a period of high local incidence of disease.Design: Prospective case ascertainment and data collection over 14 years, with retrospective analysis of cases. Setting: West Gloucestershire (population 320,000). Subjects: Residents developing meningococcal disease between 1 January 1982 and 31 December 1995. Results: 252 cases of invasive
meningococcal disease were identified, of which 102 (40%) were
officially notified and 191 (76%) were confirmed by culture from a
deep site. The observed disease incidence of 5.6/100,000/year was
about 2.7 times the national incidence (as measured by either statutory
notifications or reference laboratory reports). The period 1983-90 was
characterised by a prolonged localised outbreak due to serogroup B
serotype 15 sulphonamide resistant (B15R) strains. General
practitioners gave benzylpenicillin before hospital admission to 18%
of patients who presented with meningococcal disease in the first half
of the study period and to 40% who presented in the second half. The
overall case fatality rate was 6.7% (17/252). Four deaths were
directly or indirectly related to lumbar puncture. Of 120 patients
whose lumbar puncture yielded meningococci, nine (8%) showed no
abnormality on initial examination.
Paediatric Department, Public Health
Laboratory, Correspondence to: Dr Cartwright Audit of prenatal diagnosis for haemoglobin disorders in the United Kingdom: the first 20 yearsB Modell, M Petrou, M Layton, L Varnavides, C Slater, R H T Ward, C Rodeck, K Nicolaides, S Gibbons, A Fitches, J Old
AbstractObjectives: To audit services for prenatal diagnosis for haemoglobin disorders in the United Kingdom.Design: Comparison of the annual number of cases recorded in a United Kingdom register of prenatal diagnoses for haemoglobin disorders, with the annual number of pregnancies at risk of these disorders, by ethnic group and regional health authority. The number of pregnancies at risk was estimated using data on ethnic group from the 1991 census and data from the United Kingdom thalassaemia register, which records the number of babies born with thalassaemia. Setting: The three national prenatal diagnosis centres for haemoglobin disorders. Subjects: 2,068 cases of prenatal diagnosis for haemoglobin disorders in the United Kingdom from 1974 to 1994. Main outcome measures: Utilisation of prenatal diagnosis by risk, ethnic group, and regional health authority. Proportion of referrals in the first trimester and before the birth of any affected child. Results: National utilisation of prenatal diagnosis
for haemoglobin disorders was around 20%. During the past 10 years it
has remained steady at about 50% for thalassaemias and risen from 7%
to 13% for sickle cell disorders. Utilisation for sickle cell
disorders varies regionally from 2% to 20%. Utilisation for
thalassaemias varies by ethnic group. It is almost 90% for Cypriots
and ranges regionally for British Pakistanis from 0% to over 60%.
About 60% of first prenatal diagnoses are done for couples without an
affected child. Less than 50% of first referrals are in the first
trimester.
Department of Obstetrics and Gynaecology, Department of Haematological
Medicine, Department of
Obstetrics and Gynaecology, Department of Primary Care and Population
Sciences, Institute of
Molecular Medicine, Correspondence to: Professor B Modell
Department of Primary Care and Population Sciences, Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trialSana M Ceesay, Andrew M Prentice, Timothy J Cole, Frances Foord, Lawrence T Weaver, Elizabeth M E Poskitt, Roger G Whitehead AbstractObjective: To test the efficacy in terms of birth weight and infant survival of a diet supplement programme in pregnant African women through a primary healthcare system.Design: 5 year controlled trial of all pregnant women in 28 villages randomised to daily supplementation with high energy groundnut biscuits (4.3MJ/day) for about 20 weeks before delivery (intervention) or after delivery (control). Setting: Rural Gambia. Subjects: Chronically undernourished women (twin bearers excluded), yielding 2,047 singleton live births and 35 stillbirths. Main outcome measures: Birth weight; prevalence of low birth weight (<2500 g); head circumference; birth length; gestational age; prevalence of stillbirths; neonatal and postneonatal mortality. Results: Supplementation increased weight gain in
pregnancy and significantly increased birth weight, particularly during
the nutritionally debilitating hungry season (June to October). Weight
gain increased by 201 g (P<0.001) in the hungry season, by 94 g
(P<0.01) in the harvest season (November to May), and by 136 g
(P<0.001) over the whole year. The odds ratio for low birthweight
babies in supplemented women was 0.61 (95% confidence interval 0.47 to
0.79, P<0.001). Head circumference was significantly increased
(P<0.01), but by only 3.1 mm. Birth length and duration of gestation
were not affected. Supplementation significantly reduced perinatal
mortality: the odds ratio was 0.47 (0.23 to 0.99, P<0.05) for
stillbirths and 0.54 (0.35 to 0.85, P<0.01) for all deaths in first
week of life. Mortality after 7 days was unaffected.
MRC Dunn Nutrition Unit, MRC Dunn
Clinical Nutrition Centre,
Correspondence to: Dr Prentice
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