Epidemiological, animal, and in vitro investigations suggest that Chlamydia trachomatis infection engenders acquired immunity, the basis for which is incompletely defined, especially in humans. In a prospective cohort study of women at high risk for C. trachomatis infection, we found that, at baseline and after adjustment for age and other potential confounding variables, production of interferon- gamma by peripheral-blood mononuclear cells (PBMCs) stimulated with chlamydia heat-shock protein 60 strongly correlated with protection against incident C. trachomatis infection. This investigation supports a direct role for C. trachomatis-specific immune responses in altering the risk of infection and suggests immune correlates of protection that are potentially useful in vaccine development.

Use of cesarean delivery is limited in the African health facilities surveyed. Emergency cesareans, when performed, are often too late to reduce perinatal deaths.

I n areas without adequate medical facilities and resources, cesarean delivery (CD) can increase maternal and newborn risks and raise medical costs. It is also a marker for the availability and use of obstetric services in resource-poor countries. This survey studied the mode of delivery and maternal and perinatal outcomes in African health facilities and the association of institutional CD rates with maternal and perinatal morbidity and mortality. Data from 7 of 46 African countries who are surveyed by the World Health Organization for maternal and perinatal health were randomly selected for inclusion. The data from each country were divided and recombined into 21 geographic units, covering the capital city of each country, and 2 randomly selected provinces in every participating country (Algeria, Angola, Democratic Republic of Cong, Niger, Nigeria, Kenya, and Uganda). From 699 health facilities in the geographic areas, 133 were randomly selected (2 facilities declined to participate). Among these 131 facilities, 83,439 deliveries were recorded during the study period. Maternal data included risk indicators, the mode of delivery, and maternal and newborn outcomes until discharge or during hospital stay up until 7 days postpartum. Institutional outcomes included adequacy of laboratory tests, amount of anesthesia resources, measures of intrapartum care including emergency obstetric care, and the amount of human resources. A health facility classification score (HFCS) was determined based on basic services, general medical services, availability of screening tests, emergency obstetric care, intrapartum care, and human resources. Each domain was scored as basic, comprehensive, or advanced, and the sum of the scores comprised the HFCS.Most births (81.7%) occurred in governmental facilities. Thirty facilities overall had low HFCS; 54 and 47 facilities had medium and high scores, respectively, and 1% charged fees for delivery. The median CD rate was 8.8% but such deliveries were performed in only 95 (72.5%) of the facilities. Among facilities doing CDs, the median rate for CD was 13.4% of deliveries (range, 2.3%-27.3%). Facilities with higher percentages of women with previous CD, preeclampsia, induced labor, referrals, and higher HFCS had higher CD rates. Midwives did 75% of the normal deliveries and specialist and trainee obstetricians, general physicians, and nonphysicians performed 60%, 33%, and 6% of CDs, respectively. Nearly 50% of operative vaginal deliveries (3% of all deliveries) were performed by midwives, nurses, or other paramedical personnel. CDs were performed for cephalopelvic disproportion, dystocia, or failure to progress in 30.9% of patients, for fetal indications in 25%, for previous CD in 21.5%, and malpresentation in 13% of patients. Socio-demographic characteristics, past reproductive history, variables in the current pregnancy and during childbirth, and facility characteristics accounted for 64%, 41%, 35%, and 44% of the variation in CD rates among the institutions, respectively. The overall mate...

In HIV-1-infected, antiretroviral-naive women without symptoms of pelvic inflammatory disease infection, abnormal vaginal flora and inflammatory cells in the endometrium affected HIV-1 shedding from the lower genital tract. These data suggest that both the upper and lower genital tracts contribute to female HIV-1 genital shedding.

Background: The objectives are to compare the effectiveness of cell phone-supported SMS messaging to standard care on adherence, quality of life, retention, and mortality in a population receiving antiretroviral therapy (ART) in Nairobi, Kenya.