Infant morbidity and mortality are indicators used globally as measures of a country’s health status. Among the 8 millennium development goals (MDGs), this study aimed to address goal four (MDG 4) on the reduction of child mortality and six (MDG 6) on combating HIV and other diseases. We assessed different health conditions caused by bacterial vaginosis (BV) that could have life-long effects among infants. We aimed to address the time effects of BV on the long-term cause of infants' morbidities when asymmetry is assumed. We analyzed infant data from HIV-positive mothers with known BV status from a randomized controlled trial study conducted in Nairobi, Kenya. We aimed to investigate the effect of BV on infant morbidity with time from birth up to the age of 6 months. We derived a score for morbidity incidences depending on illnesses reported in the register during scheduled visits only. By adjusting for the mother’s BV status, child’s HIV status, sex, feeding status, and weight for age, we used two approaches for analysis. We considered and fitted the traditional generalized estimating (GEE) equations and our proposed skewed generalized estimating equations (SGEE). Overall, we included information on 327 infants. One thousand nine hundred sixty-two repeated measurements were available for analysis. Among the 327 mothers, 148 (45%) tested positive for BV, while 179 (55%) tested negative. We found that BV, gender, and time were associated with multiple health conditions in infants. Infants of women who tested positive for BV, at month 1, had 4.46 higher odds of various health conditions compared to infants of mothers who tested negative. The effects of BV tended to decrease with time, and at 5 months of age, children in the BV group had 1.10 times the odds of experiencing morbidity incidence. In the SGEE model, BV was statistically significant at the 0.05 level with a positive coefficient, indicating that children in the BV group had a higher probability of experiencing multiple morbidities. BV is a significant predictor of infant morbidity because its effects on exposed infants could persist over time. In contrast, the traditional GEE results showed an insignificant positive coefficient. The results indicate the need to factor in the skewness during analysis in case of data transformation, especially when converting from continuous to binary data for parsimony and straightforward interpretation of the effects of covariates. Maternal BV status was positively associated with morbidity incidences, which highlights the need for early intervention for infected women. Accelerated programs promoting access to BV treatment with proper infant handling practices that better deal with emerging multiple health conditions in infants may prove useful in reducing the incidence of infant morbidity in Kenya. Emphasis on care to promote better health for infants during growth is necessary to achieve the MDGs.

Background: The lactobacillus-rich microbiome forms a defense system against infections. Babies are born sterile and acquire their microbiome from exposure to the mothers' vaginal and rectal microbiota. Bacterial vaginosis (BV), which is characterized by a deficit of the Lactobacilli genera, may predispose women and their babies to an increased frequency of illness.Objective: To determine the effect of BV on HIV-infected women's post-delivery health as well as the morbidity and mortality of the exposed infant at birth, 6 months, and at 12 months of life.Study Design: A retrospective cohort study was conducted using previously collected data to investigate whether there was an association between BV-HIV-1 infected mothers and subsequent infant morbidity and mortality over a 12-month period.Methods: Data for this analysis were extracted from the original data set. Women were categorized into two groups according to whether they had a positive or negative laboratory-based diagnosis of BV using the Nugent method. The two groups were compared for socio-demographic characteristics, prior to the pregnancy experience in their current pregnancy outcome and at post-delivery morbidity, and for the duration of hospital stay. BV-exposed and unexposed infants were compared in terms of morbidity and mortality at birth, and in the periods between birth and 6 months, and between 6 and 12 months, respectively, based on prospectively collected data of the mother's past and present illness, and clinical examination at scheduled and unscheduled visits during the follow-up period of the original study. The generalized estimating equation (GEE) was used to analyze the longitudinally collected data. We used the Kaplan-Meier (KM) method to generate the cumulative hazard curve and compared the mortality in the first year of life between the two groups.Results: In total, 365 patients were included in the study. Exposure to BV was associated with an adverse maternal condition (Relative Risk [RR], 2.45; 95% confidence interval [CI], 1.04–5.81, P = 0.04) and maternal hospital admission (RR, 1.99; 95% CI, 1.14–3.48, P = 0.02) but was not linked to any neonatal morbidity at birth. There was a higher frequency of gastro-intestinal morbidity among BV-exposed infants. At 6 months, infants of BV-exposed mothers had higher odds of bloody stool (Odds Ratio [OR], 3.08; 95% CI, 1.11–10.00, P = 0.04), dehydration (OR, 2.94; 95% CI, 1.44–6.37, P = 0.01), vomiting (OR, 1.64; 95% CI, 1.06–2.56, P = 0.03), and mouth ulcers (OR, 12.8; 95% CI, 2.27–241.21, P = 0.02). At 12 months, exposure to BV was associated with dehydration (OR, 1.81; 95% CI, 1.05–3.19, P = 0.03) and vomiting (OR, 1.39; 95% CI, 1.01–1.92, P = 0.04). KM survival analysis showed non-significant higher trends of deaths among BV-exposed infants (P = 0.65).Conclusion: This study demonstrates differences in maternal and infant morbidity outcomes associated with exposure to BV. Further research is required to determine whether treatment for maternal BV mitigates maternal and infant morbidity.

Background: This study aimed to assess the effects of maternal bacterial vaginosis (BV) on the morbidity and mortality of HIV-exposed infants of women enrolled in a randomized controlled trial (pre-dating antiretroviral therapy) at birth, 6 months, and 12 months. Methods: Four hundred and twenty-five HIV-positive pregnant women were enrolled in this trial and were categorized as exposed if they had a laboratory-based diagnosis of BV (Nugent method). We compared the morbidity and mortality of infants of the mothers at birth, 6 months, and 12 months. We assessed morbidities from the mother’s history and clinical examination during scheduled and non-scheduled visits. The data that were collected longitudinally were then analyzed via multiple logistic regression with the generalized estimating equation. An independent correlation structure was assumed to evaluate the specific morbidity risks to infants associated with exposure to BV. We used the Kaplan–Meier method to generate the cumulative hazard curve, to determine mortalities at different stages between the two groups. Overall, only data for 328 infants were complete and used in the analysis.Results: Data were available for 159 and 171 BV exposed and non-exposed mothers, respectively. Exposure to BV was not associated with any neonatal morbidity at birth, but was associated with adverse maternal condition (unadjusted odds ratio [OR], 2.93; 95% confidence interval [CI], 1.19–7.20, P=0.02) and maternal hospital admissions (unadjusted OR, 1.95; 95% CI, 1.08–3.51, P=0.02). At 6 months, infants of BV exposed mothers had higher odds of bloody stool (adjusted OR, 3.08; 95% CI, 1.11–10.00, P=0.04), dehydration (adjusted OR, 2.94; 95% CI, 1.44–6.37, P=0.01), vomiting (adjusted OR, 1.64; 95% CI, 1.06–2.56, P=0.03), and mouth ulcers (adjusted OR, 12.8; 95% CI, 2.27–241.21, P=0.02). At 12 months, exposure to BV was associated with dehydration (adjusted OR, 1.81; 95% CI, 1.05–3.19, P=0.03) and vomiting (adjusted OR, 1.39; 95% CI, 1.01–1.92, P=0.04). Kaplan­–Meier survival analysis showed no association of BV with infant mortality (P=0.65); however, the cumulative hazard curve showed a higher trend toward deaths among BV exposed infants.Conclusion: Our findings demonstrate that BV is a good predictor of maternal and infant morbidities. Infants of both HIV and BV exposed mothers can manifest these symptoms at any stage within a year of growth. Adverse maternal condition and hospitalization of mothers after birth could indicate exposure to BV. Bloody stool, dehydration, vomiting, and mouth ulcers could indicate exposure to BV among infants.

Background: Distance to a health facility for inpatient care in developing countries has been a huge hindrance towards the achievement of the Sustainable Development Goal three. The United Nation encourages countries to research on access to inpatient care, so as to form health policies based on data. Methods: Data on four hundred and eighty-one participants of all ages from forty-seven counties in Kenya who sought inpatient care in Kenya in 2018 were analyzed. Distance to a health facility was captured as a continuous variable and was self-reported by the respondent. The response exhibited a discrete mass at zero and continuous characteristic, therefore a Tweedie distribution was adopted for modelling. Due to the correlation nature of clustered data, we embraced the Generalized Estimating Equations approach with an exchangeable correlation. Since no standard software was available to analyze this problem, we developed an R functions. We assessed the best model fit using the QICu and criteria, in which the lowest value for the former and the highest for the later are preferred.Findings: Differences in employment, ability to pay for the service and household size are associated with the distance covered to access government facilities. Interpretation: Poor people tend to have large households and are more likely to live in rural areas and slums, thus are forced to travel for long distance to access inpatient care. Compared to unemployed, the employed could have better socio-economic status and possibly live within reach of the inpatient health facilities, therefore travel less distances to access. Longer distances are associated with high payments, signifying some form of specialized treatment care due to the complexity of the medical cases, that are expensive to treat.