Aarti Kinikar
Maharashtra University 0f Health Science, Pedaitrics, Faculty Member
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In order to determine the efficacy of a new hepatitis B immune globulin (HBIG), a phase 3, vertical transmission (mother to child) clinical interventional trial of hepatitis B virus (HBV) post exposure prophylaxis (PEP) was conducted at... more
In order to determine the efficacy of a new hepatitis B immune globulin (HBIG), a phase 3, vertical transmission (mother to child) clinical interventional trial of hepatitis B virus (HBV) post exposure prophylaxis (PEP) was conducted at selected sites (n=15) throughout India. This required a large screening program for HBsAg positivity at prenatal clinics located in tertiary care hospitals. 36,379 pregnant women consented to be tested for Hepatitis B surface antigen (HBsAg) by Rapid Test and if positive-confirmed by ELISA. The weighted mean prevalence was 0.82% (95% CI, 0.72, 0.91). In conclusion, the prevalence of HBV carrier state during pregnancy in India in this study was low compared to previous reports.
Research Interests: Obstetrics, Medicine, India, Pregnancy, Hepatitis B, and 7 moreHumans, Female, Pubmed, Prevalence, Hepatitis B virus, Prenatal Care, and HBsAg
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Background- Of the 27 million babies born in India,3.5 million are preterm and 7.6 million with low birthweight, increasing the risk of mortality neonates.Human milk has the greatest impact on child survival.Everynewborn is unable to... more
Background- Of the 27 million babies born in India,3.5 million are preterm and 7.6 million with low birthweight, increasing the risk of mortality neonates.Human milk has the greatest impact on child survival.Everynewborn is unable to benefit from their mothers milk, because of maternal illness,death or lactational failure.Understanding donors experiences and attitude towards donation is important as it will help improve milk donation and motivate potential donors. Aim- The aim of this study is to describe the attitude and experiences of donor mothers in the Human Milk Bank(HMB). Methods- This is a descriptive study conducted in the HMB attached to a tertiary hospital with a time bound sample of 72 mothers who had donated milk atleast once. A validated questionnaire was used to collect data and appropriate tests of significance applied. Results- Mean age group of this study was 24.63 and the range was from 18 to 33 years.20% population was below 20 years of age.25% were primiparous and 75% were multiparous.55% mothers have completed their middle and high schooling.43% mothers belonged to Class 4 of the Modified KuppuswamyScale. Altruism was the main reason for milk donation followed by breast engorgement.There is significant correlation between education level of mother and knowledge about contraindications of donating HMB.Experiencing pain and discomfort during donation was more in primiparous women. Fear about affecting their own health due to frequently donating at HMB was more in primiparousmother. Inference- Educating mothers and creating awareness among them and their family members regarding HMB is important.Primiparous mothers are more apprehensive in donating milk and need more support and counseling.Establishment of collection centres in the communities will bridge the demand and supply gap in PDHM and ultimately reduce neonatal mortality and morbidity.
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Background: Inblood transfusion related thalassemia patients, high iron state is observed because of regular blood transfusion. Our body has limited mechanism to excrete iron, excess of iron gets deposited in various organs causing their... more
Background: Inblood transfusion related thalassemia patients, high iron state is observed because of regular blood transfusion. Our body has limited mechanism to excrete iron, excess of iron gets deposited in various organs causing their dysfunction. To prevent the complication associated with this iron overload use of iron chelators becomes important in management of such patients. Aims /Objectives: 1.To determine effectiveness of deferasirox, an oral iron chelator to decrease iron overload in reference to serum ferritin level in blood transfusion dependent pediatric thalassemia patients. 2.To determine effectiveness of deferasirox in reducing iron deposition induced organ damage. Methods: This is a hospital based retrospective observationalstudy conducted on 80 blood transfusion dependent thalassemia patients admitted in tertiary care hospital. Data was collected in pre-designed case record sheets after taking consent from parents. Results:in the present study the mean age was 7.12 years for females and 10.93 years for males. The mean of pre and post blood transfusion hemoglobin was significantly higher (7.07 and 10.76 respectively). The mean blood transfusion days are 26.33. Mean annual blood requirement is 198.99. Mean drop rate is 1.02. On comparing mean ferritin levels, there was a significant difference between baseline (711.81), start of deferasirox treatment (1271.71) and the end of 2nd dose increment of deferasirox (2076.11). The mean ferritin decreased significantly after starting deferasirox (from 1360.03 to 1271.71) by the end of1stdose increment (from 1832.41 to 1696.75) by the end of 2nd dose increment (from 2097.32 to 2076.11) , but when we compare mean ferritin after end of 2nddose increment of deferasirox (2076.11) with6 month back mean ferritin (2506) or current mean ferritin (2514.90) there is increase in ferritin.Mean blood transfusions at start of deferasirox is (11.025), at 1st dose increment is (26.13), at 2nd dose increment is (42.12).There were no organ complications seen with the present population at the end of the study Conclusion: from the results of our study, we state that using deferasirox as oral iron chelator in blood transfusion dependent pediatric thalassemia patients helps in reducing iron overload till we reach maximum dose of oral deferasirox but beyond that there is significant increase in serum ferritin level,thereby necessitating use of another iron chelator along with oral deferasirox(either deferoxamine, deferiprone or some new iron chelator),. Also in this study it is observed that there is no iron deposition related significant organ damage.
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OBJECTIVE: To assess Xpert® MTB/RIF (Xpert) and Xpert® MTB/RIF Ultra (Ultra) performance in diagnosing pediatric tuberculous meningitis (TBM).METHODS: We conducted a study among children with suspected meningoencephalitis in Pune, India.... more
OBJECTIVE: To assess Xpert® MTB/RIF (Xpert) and Xpert® MTB/RIF Ultra (Ultra) performance in diagnosing pediatric tuberculous meningitis (TBM).METHODS: We conducted a study among children with suspected meningoencephalitis in Pune, India. Clinical, radiological, laboratory, and treatment data were analyzed to classify disease as definite, probable, possible or no TBM, using microbiologic or composite reference standards. We tested cerebrospinal fluid (CSF) either using Xpert or Ultra and estimated test performance characteristics.RESULTS: Of 341 participants, 149 (43.7%) were tested using Ultra and 192 (56.3%) with Xpert. Ultra had higher sensitivity (50% vs. 18%), lower specificity (91% vs. 99%), poor positive predictive value (PPV) (13% vs. 75%), and higher negative predictive value (NPV) (99% vs. 93%) than Xpert using the composite reference standard, with similar results by the microbiologic reference standard. Of 10 participants with trace positivity on Ultra, none met clinical ...
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Background: Studies have shown that using hypotonic fluids may result in hyponatremia and the use of isotonic fluids is associated with lower incidence of electrolyte disturbances. Renal functions usually based on measurements of serum... more
Background: Studies have shown that using hypotonic fluids may result in hyponatremia and the use of isotonic fluids is associated with lower incidence of electrolyte disturbances. Renal functions usually based on measurements of serum urea and creatinine are dependent on the maintenance of appropriate intravascular volume in order to maintain adequate organ perfusion and functioning. Aims and Objectives: To analyze the short term effect of IV Fluids in PICU on serum electrolytes and renal function tests. Methods: This observational descriptive study was conducted in 125 children admitted PICU from April 2022 to September 2022 receiving IV fluids and kept nil by mouth. The levels of serum sodium, potassium, urea and creatinine done at day1 of admission were compared to the investigations done after 72hrs.The data was categorized based on the type of fluid received by the child. Hypotonic fluids (0.45% DNS, D10) and isotonic fluids (0.9% DNS). Results: Out of 125 children, 61(48.8%) received hypotonic fluids whereas 64(51.2%) received isotonic fluids. The average volume of hypotonic fluid given was 3.2±1.7 ml/kg/hr whereas of isotonic fluid given was 2.7±1.3 ml/kg/hr (p=0.11). Hyponatremia developed in 16 out of 42 baseline normal sodium patients in hypotonic group and 6 out of 46 in isotonic group(p=0.03). Serum creatinine was raised in 6(12%) patients out of 50 baseline normal patients in hypotonic group. Serum urea from baseline normal was raised in 7(21.9%) in hypotonic and in 5(17.9%) in isotonic group (p=0.4). Mortality was significantly higher in hypotonic group (13.1%) compared to isotonic group (3.1%) (p=0.04). Conclusions:For preventing positive fluid balance and also development of hyponatremia, isotonic fluids should be considered as routine maintenance fluids.
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Background: Thalassemia is considered as the most common single gene disorder worldwide. Preventive measures include identification of thalassemia carriers (traits) through screening, genetic counselling and prenatal diagnosis to reduce... more
Background: Thalassemia is considered as the most common single gene disorder worldwide. Preventive measures include identification of thalassemia carriers (traits) through screening, genetic counselling and prenatal diagnosis to reduce the incidence. This study aims at estimating the prevalence of carrier status detection among the extended family members of children having thalassemia major so as to use it as a screening prevention strategy with appropriate counselling. Methods: This cross-sectional study was conducted in thalassemia unit of Pediatric Department of a tertiary care teaching hospital over a period of 18 months. Blood samples were collected from 117 extended family members (EFM) of 23 children with thalassemia major to carry out investigations such as Complete Blood Counts (CBC), Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT), Reticulocyte count, High Performance Liquid Chromatography(HPLC) and serum ferritin. Reports were analysed to find out the prevalence of carriers. Results: Among 117 EFM, 62 (52.9%) were males while 55(47.1%) were females. Mean age distribution in this study was 16.49 years (8.5). Prevalence of thalassemia trait (carrier) was 35%. NESTROFT test was positive in 57(48.7%) participants. The binary logistic regression found only positive NESTROFT test as a predictor (adjusted OR=0.022, P=0.001) of having raised HbA2 (HbA2≥3.5 %). Conclusion: Screening of thalassemia carrier by targeting extended family members of thalassemia major children could yield more carrier cases and targeted counselling could help effectively in decreasing the number of children born with thalassemia major. This strategy could be included in future plan of national prevention programme for thalassemia.
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Background: Although extremely low gestational age newborns (ELGANs) or extremely low birth weight (ELBW)newborns are born they have their third-trimester intrauterine life pertaining to development. During this time, one of the... more
Background: Although extremely low gestational age newborns (ELGANs) or extremely low birth weight (ELBW)newborns are born they have their third-trimester intrauterine life pertaining to development. During this time, one of the objectives of the NICU staff is to feed the newborn with enough nourishment to reach a growth velocity (GV) comparable to intrauterine GV. Early parenteral & enteral nutrition to ELBW infants during the first twenty-four hrs of life leads to a quick recovery of weight loss, enhanced overall weight growth, and earlier accomplishment of complete enteral feeding. Early & substantial protein administration has also been linked to increased weight gain & brain growth. Aims/Objective: To identify determinants of shorter time taken to reach full feeds among ELBW admitted to level III NICU. Method: It was a retrospective hospital-based study conducted from April 2022 to September 2022 and included 55 ELBW newborns admitted to NICU satisfying the WHO definition of ELBW and categorizedinto group I(<28wks), group II (>28 wks. till 31 wks.). Various determinants like ventilatory support, surfactant therapy, NEC, gestational age (GA), etc. are used for analysis. Results: 55 ELBW analysed their mean gestational age (27±3.1) weeks, Range (25-31 weeks) Mean Birth weight (884±114 gram) Range (500-<1000 gm). There were 2 groups, Group 1 (< 28 weeks) included 28 ELBW who reached full feeding in 16.8±13.8 days whereas 27 ELBW were included in Group 2 who reached full feeding in 13.07±8.5 days. Most of the determinates have P VALUE-0.0 except birth weight(P-0.89) and metabolic factor (P-0.14). Overall, all determinates have an impact the on duration to reach full feed in ELBW. Conclusion: ELBW newborns who require minimal ventilatory support, no surfactant, less association with NEC, IVH, Sepsis, and average gestation age above 28 weeks attained early full feed regain birth weight also decreases hospital stay. Funding source: None. Ethics committee clearance submitted Conflict of interest: None.
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The WHO recommends the integration of routine HIV services within maternal and child health (MCH) services to reduce the fragmentation of and to promote retention in care for pregnant and postpartum women living with HIV (WWH) and their... more
The WHO recommends the integration of routine HIV services within maternal and child health (MCH) services to reduce the fragmentation of and to promote retention in care for pregnant and postpartum women living with HIV (WWH) and their infants and children exposed to HIV (ICEH). During 2020–2021, we surveyed 202 HIV treatment sites across 40 low- and middle-income countries within the global International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We determined the proportion of sites providing HIV services integrated within MCH clinics, defined as full [HIV care and antiretroviral treatment (ART) initiation in MCH clinic], partial (HIV care or ART initiation in MCH clinic), or no integration. Among sites serving pregnant WWH, 54% were fully and 21% partially integrated, with the highest proportions of fully integrated sites in Southern Africa (80%) and East Africa (76%) compared to 14%–40% in other regions (i.e., Asia-Pacific; the Caribbean, Central and South Amer...
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Background Drug-resistant gram-negative (GN) pathogens are a common cause of neonatal sepsis in low- and middle-income countries. Identifying GN transmission patterns is vital to inform preventive efforts. Methods We conducted a... more
Background Drug-resistant gram-negative (GN) pathogens are a common cause of neonatal sepsis in low- and middle-income countries. Identifying GN transmission patterns is vital to inform preventive efforts. Methods We conducted a prospective cohort study, 12 October 2018 to 31 October 2019 to describe the association of maternal and environmental GN colonization with bloodstream infection (BSI) among neonates admitted to a neonatal intensive care unit (NICU) in Western India. We assessed rectal and vaginal colonization in pregnant women presenting for delivery and colonization in neonates and the environment using culture-based methods. We also collected data on BSI for all NICU patients, including neonates born to unenrolled mothers. Organism identification, antibiotic susceptibility testing, and next-generation sequencing (NGS) were performed to compare BSI and related colonization isolates. Results Among 952 enrolled women who delivered, 257 neonates required NICU admission, and 2...
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Background: Low birth infants account for 27% of total live births in India. India has a large burden of very low birth weight (VLBW) babies, i.e. those who are <1500 g, account for about 5% of all live births(1) and their nutritional... more
Background: Low birth infants account for 27% of total live births in India. India has a large burden of very low birth weight (VLBW) babies, i.e. those who are <1500 g, account for about 5% of all live births(1) and their nutritional rehabilitation is major concern.But every infant is unable to benefit from mothers milk because of maternal illness, death or lactation failure. This is when donors milk help for these VLBW infants who are unable to get their own mothers milk. Hence, understanding the impact of donor milk on various clinical parameters affecting a VLBWinfant is important. Aim: To study impact of donor milk on various parameters studied among VLBWinfants of an NICU of a tertiary teaching hospital. Methods: Ours is a retrospective comparative study over a period of 10 months in an NICU of a tertiary teaching hospital. 119 infants were enrolled. The data was collected from case records of these infants. Appropriate test of significance was applied to get the results. R...
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IntroductionInterruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID‐19 pandemic's impact on HIV service delivery across diverse settings is not broadly... more
IntroductionInterruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID‐19 pandemic's impact on HIV service delivery across diverse settings is not broadly documented.MethodsFrom September 2020 to March 2021, the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium surveyed 238 HIV care sites across seven geographic regions to document constraints in HIV service delivery during the first year of the pandemic and strategies for ensuring care continuity for PWH. Descriptive statistics were stratified by national HIV prevalence (<1%, 1–4.9% and ≥5%) and country income levels.ResultsQuestions about pandemic‐related consequences for HIV care were completed by 225 (95%) sites in 42 countries with low (n = 82), medium (n = 86) and high (n = 57) HIV prevalence, including low‐ (n = 57), lower‐middle (n = 79), upper‐middle (n = 39) and high‐ (n = 50) income countries. Most sites report...
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BACKGROUND: Microbiologic screening of extrapulmonary TB (EPTB) patients could inform recommendations for aerosol precautions and close contact prophylaxis. However, this is currently not routinely recommended in India. Therefore, we... more
BACKGROUND: Microbiologic screening of extrapulmonary TB (EPTB) patients could inform recommendations for aerosol precautions and close contact prophylaxis. However, this is currently not routinely recommended in India. Therefore, we estimated the proportion of Indian patients with EPTB with microbiologic evidence of pulmonary TB (PTB).METHODS: We characterized baseline clinical, radiological and sputum microbiologic data of 885 adult and pediatric TB patients in Chennai and Pune, India, between March 2014 and November 2018.RESULTS: Of 277 patients with EPTB, enhanced screening led to the identification of 124 (45%) with concomitant PTB, including 53 (19%) who reported a cough >2 weeks; 158 (63%) had an abnormal CXR and 51 (19%) had a positive sputum for TB. Of 70 participants with a normal CXR and without any cough, 14 (20%) had a positive sputum for TB. Overall, the incremental yield of enhanced screening of patients with EPTB to identify concomitant PTB disease was 14% (95% CI...
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ObjectivesPediatric tuberculosis (TB) remains difficult to diagnose. The plasma kynurenine to tryptophan ratio (K/T ratio) is a potential biomarker for TB diagnosis and treatment response but has not been assessed in children.MethodsWe... more
ObjectivesPediatric tuberculosis (TB) remains difficult to diagnose. The plasma kynurenine to tryptophan ratio (K/T ratio) is a potential biomarker for TB diagnosis and treatment response but has not been assessed in children.MethodsWe performed a targeted diagnostic accuracy analysis of four biomarkers: kynurenine abundance, tryptophan abundance, the K/T ratio, and IDO-1 gene expression. Data were obtained from transcriptome and metabolome profiling of children with confirmed tuberculosis and age- and sex-matched uninfected household contacts of pulmonary tuberculosis patients. Each biomarker was assessed as a baseline diagnostic and in response to successful TB treatment.ResultsDespite non-significant between-group differences in unbiased analysis, the K/T ratio achieved an area under the receiver operator characteristic curve (AUC) of 0.667 and 81.5% sensitivity for TB diagnosis. Kynurenine, tryptophan, and IDO-1 demonstrated diagnostic AUCs of 0.667, 0.602, and 0.463, respective...
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Objective: To study the impact of lockdown during the corona virus disease 2019 pandemic, considering the limited healthcare and transport facilities while reaching the tertiary care hospital. It was a hospital based; observational study... more
Objective: To study the impact of lockdown during the corona virus disease 2019 pandemic, considering the limited healthcare and transport facilities while reaching the tertiary care hospital. It was a hospital based; observational study done over a period of 12 month consisting of pre lockdown period (December 2019 to March 2020), Lockdown (April 2020 to June 2020) and post lock-down (July 2020 to November 2020) period data of COVID-19 negative reported children admitted to pediatric intensive care unit (PICU). 0ut of 1019 enrolled children, total number of admissions prior lockdown was 534, during lockdown 240 and post lock down 243. Admissions from rural was signicantly less during lockdown i.e., urban =80% and rural=20% whereas prior lockdown 56% from urban and 44% from rural Pune. Percentage of male children admitted was signicantly more during lockdown compared to prelockdown (62.3% male and 37.7% females). The mortality rate was 6.7% and discharge against medical advice rat...
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INTRODUCTION: Testing for anti-TB drugs in small hair samples may serve as a non-invasive tool to measure cumulative drug exposure and/or adherence, as these determine treatment success. We aimed to assess how well hair assays of TB drugs... more
INTRODUCTION: Testing for anti-TB drugs in small hair samples may serve as a non-invasive tool to measure cumulative drug exposure and/or adherence, as these determine treatment success. We aimed to assess how well hair assays of TB drugs predict TB treatment outcomes.METHODS: A small thatch of hair, ~30 strands, was cut from the occipital region in adults and children from a prospective TB cohort in India. Isoniazid (INH), acetyl-INH and pyrazinamide (PZA) were extracted from the hair samples and quantified using liquid-chromatography-tandem mass spectrometry. The relationship between drug concentrations in hair and time to unfavourable outcomes was assessed using Cox-proportional hazards regression models.RESULTS: A two-fold increase in hair acetyl-INH concentrations in the 264 participants in our cohort with hair assays for TB drugs indicated a lower hazard of unfavourable TB treatment outcomes (aHR 0.67, 95%CI 0.44–1.02) and TB treatment failure (aHR 0.65, 95%CI 0.42–1.01). High...
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Background Children living with HIV (CLHIV) on prolonged antiretroviral therapy (ART) are at risk for lipid and glucose abnormalities. Prevalence and associated factors were assessed in a multicentre, Asian longitudinal paediatric cohort.... more
Background Children living with HIV (CLHIV) on prolonged antiretroviral therapy (ART) are at risk for lipid and glucose abnormalities. Prevalence and associated factors were assessed in a multicentre, Asian longitudinal paediatric cohort. Methods CLHIV were considered to have lipid or glucose abnormalities if they had total cholesterol ≥200 mg/dL, high-density lipoprotein (HDL) ≤35 mg/dL, low-density lipoprotein (LDL) ≥100 mg/dL, triglycerides (TG) ≥110 mg/dL, or fasting glucose >110 mg/dL. Factors associated with lipid and glucose abnormalities were assessed by logistic regression. Results Of 951 CLHIV, 52% were male with a median age of 8.0 (interquartile range [IQR] 5.0–12.0) years at ART start and 15.0 (IQR 12.0–18.0) years at their last clinic visit. 89% acquired HIV perinatally, and 30% had ever used protease inhibitors (PIs). Overall, 225 (24%) had hypercholesterolemia, 105 (27%) low HDL, 213 (58%) high LDL, 369 (54%) hypertriglyceridemia, and 130 (17%) hyperglycemia. Hype...
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Objective:Use a modified Delphi approach to develop competencies for neurologists completing>1 year of advanced global neurology training.Methods:An expert panel of 19 US-based neurologists involved in global health was recruited from... more
Objective:Use a modified Delphi approach to develop competencies for neurologists completing>1 year of advanced global neurology training.Methods:An expert panel of 19 US-based neurologists involved in global health was recruited from the American Academy of Neurology Global Health Section and the American Neurological Association International Outreach Committee. An extensive list of global health competencies was generated from review of global health curricula and adapted for global neurology training. Using a modified Delphi method, US-based neurologists participated in three rounds of voting on a survey with potential competencies rated on a 4-point Likert scale. A final group discussion was held to reach consensus. Proposed competencies were then subjected to a formal review from a group of seven neurologists from low- and middle-income countries (LMICs) with experience working with neurology trainees from high-income countries (HICs) who commented on potential gaps, feasib...
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Research Interests: Medicine and Overweight
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Schwachman Diamond Syndrome is an extremely rare genetic condition with autosomal recessive inheritance characterized by multisystem involvement with considerable phenotypic variation(1). Its epidemiology is not well studied in Asia. Only... more
Schwachman Diamond Syndrome is an extremely rare genetic condition with autosomal recessive inheritance characterized by multisystem involvement with considerable phenotypic variation(1). Its epidemiology is not well studied in Asia. Only 65cases have been reported from Asia most of them from Japan(1). Life span is usually 35 years but those with haematological complications have reduced life expectancy(2). We report to you a case of 14 month old boy with complaints of chronic diarrhoea and not gaining weight with previous history of multiple admissions for pneumonia, diarrhoea transfusions for severe anaemia since last 7- 8 months. Baseline investigations were suggestive of bicytopenia initially and later progressed to pancytopenia and hence bone marrow examination was done which was suggestive of bone marrow failure together with features of malabsorption lead to suspicion of Schwachman Diamond syndrome and hence genetic study was done which showed DNAJC21 gene mutation which is a...
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BackgroundSARS-CoV-2 was first reported in China in December 2019 and quickly spread across the world. Non-pharmaceutical interventions (NPIs) are the key to control the transmission of respiratory viruses. To stop the spread, NPI is... more
BackgroundSARS-CoV-2 was first reported in China in December 2019 and quickly spread across the world. Non-pharmaceutical interventions (NPIs) are the key to control the transmission of respiratory viruses. To stop the spread, NPI is widely recommended and is still followed by most countries.MethodsAt the National Influenza Center of the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), the surveillance of severe acute respiratory illness and acute respiratory illness cases for influenza and other respiratory viruses is in place. In this study, we analyzed surveillance data on respiratory viruses and/or SARS-CoV-2 testing from January 2017 to December 2021. Multiplex real-time PCR was used to detect the respiratory viruses.ResultsOur findings indicate that during the pandemic, the positivity for influenza A and B, metapneumovirus, parainfluenza virus, respiratory syncytial virus, and human coronavirus declined significantly.ConclusionThe annual distinct s...
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Introduction: Women play an essential role in health care delivery, and it is vital that they have equal representation in health leadership for equity, innovation, and the strengthening of health systems globally. Yet women remain vastly... more
Introduction: Women play an essential role in health care delivery, and it is vital that they have equal representation in health leadership for equity, innovation, and the strengthening of health systems globally. Yet women remain vastly underrepresented in global health leadership positions, providing a clear example of the deeply rooted power imbalances that are central to the calls to decolonize global health. We conducted a multi-country study in Haiti, Tanzania, India, and the USA to examine gender-based challenges to career advancement for women in the global health workforce. Quantitative data on the type and prevalence of gender-based challenges has been previously reported. In this study, we analyze qualitative data collected through focus group discussions and in-depth interviews to understand women’s experiences of gender-based obstacles to career advancement, their perceptions of underlying drivers, and perspectives on effective solutions. Guided by an adaptation of the...
BackgroundSuboptimal exposure to antituberculosis drugs has been associated with unfavourable treatment outcomes. We aimed to investigate estimates and determinants of first-line antituberculosis drug pharmacokinetics in children and... more
BackgroundSuboptimal exposure to antituberculosis drugs has been associated with unfavourable treatment outcomes. We aimed to investigate estimates and determinants of first-line antituberculosis drug pharmacokinetics in children and adolescents at a global level.MethodsWe systematically searched MEDLINE, Embase, and Web of Science (1990–2021) for pharmacokinetic studies of first-line antituberculosis drugs in children and adolescents. Individual patient data were obtained from authors of eligible studies. Summary estimates of total/extrapolated area under the plasma concentration-time curve (AUC0–24) and peak plasma concentration (Cmax) were assessed with random-effects models, normalised with current WHO-recommended paediatric doses. Determinants of AUC0–24and Cmaxwere assessed with linear mixed-effects models.ResultsOf 55 eligible studies, individual patient data were available for 39 (71%), including 1628 participants from 12 countries. Geometric means (95% CIs) of steady-state ...