Browsing by Author "Mwenechanya M"

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Brain Imaging in New-Onset Seizure of Children Living With Human Immunodeficiency Virus in Zambia.
(2024-Oct) Mohajeri S; Potchen M; Sikazwe I; Kampondeni S; Hoffman C; Bearden D; Kalungwana L; Musonda N; Mathews M; Mwenechanya M; Dallah I; Johnson B; Bositis C; Huang J; Birbeck GL; Center for Infectious Diseases Research in Zambia (CIDRZ), Lusaka, Zambia.; Department of Imaging Sciences, University of Rochester, Rochester, New York. Electronic address: sarahmohajeri29@gmail.com.; Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California.; University Teaching Hospital-Children's Hospital, Lusaka, Zambia.; Department of Imaging Sciences, University of Rochester, Rochester, New York.; Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York.; University of Rochester School of Medicine, Rochester, New York.; Mpingwe Clinic, Blantyre, Malawi.; Department of Psychology, University of Zambia, Lusaka, Zambia.; Department of Neurology, Epilepsy, University of Rochester, Rochester, New York.; Department of Neurology, Pediatric, University of Rochester, Rochester, New York.; TrialSpark, New York, New York.; Department of Radiology, Michigan State University, East Lansing, Michigan.
BACKGROUND: There are an estimated 1.5 million children living with human immunodeficiency virus (CLHIV), most residing in sub-Saharan Africa. A common hospital presentation of CLHIV is new-onset seizure, for which imaging is helpful but not routinely performed due to scarce resources. We present imaging findings and their association with clinical risk factors and outcomes in a cohort of Zambian CLHIV presenting with new-onset seizure. METHODS: In this prospective cohort study, participants were recruited at the University Teaching Hospital in Lusaka, Zambia. Various clinical and demographic characteristics were obtained. Computed tomography (CT), magnetic resonance imaging (MRI), or both were obtained during admission or shortly after discharge. If both studies were available, MRI data was used. Two neuroradiologists interpreted images using REDCap-based NeuroInterp, a tool that quantifies brain imaging findings. Age-dependent neuropsychologic assessments were administered. RESULTS: Nineteen of 39 (49%) children had a brain MRI, 16 of 39 (41%) had CT, and four of 39 (10%) had both. Mean age was 6.8 years (S.D. = 4.8). Children with advanced HIV disease had higher odds of atrophy (odds ration [OR] 7.2, 95% confidence interval [CI] 1.1 to 48.3). Focal abnormalities were less likely in children receiving antiretroviral therapy (ART) (OR 0.22, 95% CI 0.05 to 1.0). Children with neurocognitive impairment were more likely to have atrophy (OR 8.4, 95% CI 1.3 to 55.4) and less likely to have focal abnormalities (OR 0.2, 95% CI 0.03 to 0.9). CONCLUSIONS: Focal brain abnormalities on MRI were less likely in CLHIV on ART. Brain atrophy was the most common imaging abnormality, which was linked to severe neurocognitive impairment.
Clinical characteristics and outcomes after new-onset seizure among Zambian children with HIV during the antiretroviral therapy era.
(2022-Jun) Ravishankar M; Dallah I; Mathews M; Bositis CM; Mwenechanya M; Kalungwana-Mambwe L; Bearden D; Navis A; Elafros MA; Gelbard H; Theodore WH; Koralnik IJ; Okulicz JF; Johnson BA; Belessiotis C; Ciccone O; Thornton N; Tsuboyama M; Siddiqi OK; Potchen MJ; Sikazwe I; Birbeck GL; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Weill Cornell Medicine, New York, New York, USA.; University of Michigan, Ann Arbor, Michigan, USA.; Tufts School of Medicine, Medford, Massachusetts, USA.; Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia.; National Institute of Health, Bethesda, Maryland, USA.; Icahn School of Medicine, New York, New York, USA.; University College London, London, UK.; University of Zambia, Lusaka, Zambia.; University Teaching Hospitals Children's Hospital, Lusaka, Zambia.; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Boston Children's Hospital, Boston, Massachusetts, USA.; Center for Infectious Disease Research in Zambia, Lusaka, Zambia.; Epilepsy Division, Department of Neurology, University of Rochester, Rochester, New York, USA.; Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA.; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.; Zambian College of Medicine & Surgery, Lusaka, Zambia.; US Army Brooke Army Medical Center, Fort Sam Houston, Texas, USA.; University of Rochester Medical Center, Rochester, New York, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVE: This study describes clinical profiles including human immunodeficiency virus (HIV) disease history and seizure etiology among children living with HIV presenting with new-onset seizure during the era of antiretroviral therapy (ART) in Zambia. 30-day mortality and cause of death are also reported. METHODS: Children living with HIV (CLWHIV) with new-onset seizures were prospectively evaluated at one large urban teaching hospital and two non-urban healthcare facilities. Interviews with family members, review of medical records, and where needed, verbal autopsies were undertaken. Two clinicians who were not responsible for the patients' care independently reviewed all records and assigned seizure etiology and cause of death with adjudication as needed. RESULTS: From April 2016 to June 2019, 73 children (49 urban, 24 rural) were identified. Median age was 6 years (IQR 2.2-10.0) and 39 (53%) were male children. Seizures were focal in 36 (49%) and were often severe, with 37% presenting with multiple recurrent seizures in the 24 hours before admission or in status epilepticus. Although 36 (49%) were on ART at enrollment, only 7 of 36 (19%) were virally suppressed. Seizure etiologies were infectious in over half (54%), with HIV encephalitis, bacterial meningitis, and tuberculous meningitis being the most common. Metabolic causes (19%) included renal failure and hypoglycemia. Structural lesions identified on imaging accounted for 10% of etiologies and included stroke and non-accidental trauma. No etiology could be identified in 12 (16%) children, most of whom died before the completion of clinical investigations. Twenty-two (30%) children died within 30 days of the index seizure. SIGNIFICANCE: Despite widespread ART roll out in Zambia, new-onset seizure in CLWHIV occurs in the setting of advanced, active HIV disease. Seizure severity/burden is high as is early mortality. Enhanced programs to assure early ART initiation, improve adherence, and address ART failure are needed to reduce the burden of neurological injury and premature death in CLWHIV.
Early Initiation of Antiretroviral Therapy is Protective Against Seizures in Children With HIV in Zambia: A Prospective Case-Control Study.
(2024-Mar-01) Bearden DR; Mwanza-Kabaghe S; Bositis CM; Dallah I; Johnson BA; Siddiqi OK; Elafros MA; Gelbard HA; Okulicz JF; Kalungwana L; Musonda N; Theodore WH; Mwenechanya M; Mathews M; Sikazwe IT; Birbeck GL; Greater Lawrence Family Health Center, Lawrence, MA.; Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.; Department of Neurology, University of Michigan, Ann Arbor, MI.; University of Rochester, Center for Health and Technology, Rochester, NY.; Department of Biostatistics, University of Rochester, Rochester, NY.; Department of Psychology, University of Zambia, Lusaka, Zambia.; University of Zambia School of Medicine, Lusaka, Zambia.; University of Zambia, University Teaching Hospitals, Lusaka, Zambia.; San Antonio Military Medical Center, Infectious Diseases Service, HIV Medical Evaluation Unit, San Antonio, TX.; Department of Neurology, University of Rochester, Rochester, NY.; Department of Educational Psychology, University of Zambia, Lusaka, Zambia.; Epilepsy Division, US National Institute of Health, Bethesda, MD; and.; Department of Neurology, Beth Israel Deaconess Medical Center, Global Neurology Program, Boston, MA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Seizures are relatively common among children with HIV in low- and middle-income countries and are associated with significant morbidity and mortality. Early treatment with antiretroviral therapy (ART) may reduce this risk by decreasing rates of central nervous system infections and HIV encephalopathy. METHODS: We conducted a prospective, unmatched case-control study. We enrolled children with new-onset seizure from University Teaching Hospital in Lusaka, Zambia and 2 regional hospitals in rural Zambia. Controls were children with HIV and no history of seizures. Recruitment took place from 2016 to 2019. Early treatment was defined as initiation of ART before 12 months of age, at a CD4 percentage >15% in children aged 12-60 months or a CD4 count >350 cells/mm 3 for children aged 60 months or older. Logistic regression models were used to evaluate the association between potential risk factors and seizures. RESULTS: We identified 73 children with new-onset seizure and compared them with 254 control children with HIV but no seizures. Early treatment with ART was associated with a significant reduction in the odds of seizures [odds ratio (OR) 0.04, 95% confidence interval: 0.02 to 0.09; P < 0.001]. Having an undetectable viral load at the time of enrollment was strongly protective against seizures (OR 0.03, P < 0.001), whereas history of World Health Organization Stage 4 disease (OR 2.2, P = 0.05) or CD4 count <200 cells/mm 3 (OR 3.6, P < 0.001) increased risk of seizures. CONCLUSIONS: Early initiation of ART and successful viral suppression would likely reduce much of the excess seizure burden in children with HIV.
Junk food use and neurodevelopmental and growth outcomes in infants in low-resource settings.
(2024) Chiwila MK; Krebs NF; Manasyan A; Chomba E; Mwenechanya M; Mazariegos M; Sami N; Pasha O; Tshefu A; Lokangaka A; Goldenberg RL; Bose CL; Koso-Thomas M; Goco N; Do BT; McClure EM; Hambidge KM; Westcott JE; Carlo WA; School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.; University of Colorado School of Medicine, Aurora, CO, United States.; Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States.; Department of Obstetrics and Gynecology, Columbia University, New York, NY, United States.; Department of Pediatrics, University of North Carolina, Chapel Hill, NC, United States.; Eunice Kennedy Shiver National Institute of Child Health and Human Development, Bethesda, MD, United States.; Global Network, University Teaching Hospital, Lusaka, Zambia.; Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.; Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala.; Research Triangle Institute International, Durham, NC, United States.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: Feeding infants a sub-optimal diet deprives them of critical nutrients for their physical and cognitive development. The objective of this study is to describe the intake of foods of low nutritional value (junk foods) and identify the association with growth and developmental outcomes in infants up to 18 months in low-resource settings. METHODS: This is a secondary analysis of data from an iron-rich complementary foods (meat versus fortified cereal) randomized clinical trial on nutrition conducted in low-resource settings in four low- and middle-income countries (Democratic Republic of the Congo, Guatemala, Pakistan, and Zambia). Mothers in both study arms received nutritional messages on the importance of exclusive breastfeeding up to 6 months with continued breastfeeding up to at least 12 months. This study was designed to identify the socio-demographic predictors of feeding infants' complementary foods of low nutritional value (junk foods) and to assess the associations between prevalence of junk food use with neurodevelopment (assessed with the Bayley Scales of Infant Development II) and growth at 18 months. RESULTS: 1,231 infants were enrolled, and 1,062 (86%) completed the study. Junk food feeding was more common in Guatemala, Pakistan, and Zambia than in the Democratic Republic of Congo. 7% of the infants were fed junk foods at 6 months which increased to 70% at 12 months. Non-exclusive breastfeeding at 6 months, higher maternal body mass index, more years of maternal and paternal education, and higher socioeconomic status were associated with feeding junk food. Prevalence of junk foods use was not associated with adverse neurodevelopmental or growth outcomes. CONCLUSION: The frequency of consumption of junk food was high in these low-resource settings but was not associated with adverse neurodevelopment or growth over the study period.
Kangaroo mother care for the prevention of neonatal hypothermia: a randomised controlled trial in term neonates.
(2018-May) Ramani M; Choe EA; Major M; Newton R; Mwenechanya M; Travers CP; Chomba E; Ambalavanan N; Carlo WA; Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVE: To test the hypothesis that kangaroo mother care (KMC) initiated either at birth or at 1 hour after birth reduces moderate or severe hypothermia in term neonates at (A) 1 hour after birth and (B) at discharge when compared with standard thermoregulation care. METHODS: Term neonates born at a tertiary delivery centre in Zambia were randomised in two phases (phase 1: birth to 1 hour, phase 2: 1 hour to discharge) to either as much KMC as possible in combination with standard thermoregulation care (KMC group) or to standard thermoregulation care (control group). The primary outcomes were moderate or severe hypothermia (axillary temperature <36.0°C) at (A) 1 hour after birth and (B) at discharge. RESULTS: The proportion of neonates with moderate or severe hypothermia did not differ between the KMC and control groups at 1 hour after birth (25% vs 27%, relative risk (RR)=0.93, 95% CI 0.59 to 1.4, P=0.78) or at discharge (7% vs 2%, RR=2.8, 95% CI 0.6 to 13.9, P=0.16). Hypothermia was not found among the infants who had KMC for at least 9 hours or 80% of the hospital stay. CONCLUSIONS: KMC practised as much as possible in combination with standard thermoregulation care initiated either at birth or at 1 hour after birth did not reduce moderate or severe hypothermia in term infants compared with standard thermoregulation care. The current study also shows that duration of KMC either for at least 80% of the time or at least 9 hours during the day of birth was effective in preventing hypothermia in term infants. CLINICAL TRIAL REGISTRATION: NCT02189759.
Long-term outcomes after new onset seizure in children living with HIV: A cohort study.
(2024-Apr) Birbeck GL; Mwenechanya M; Ume-Ezeoke I; Mathews M; Bositis CM; Kalungwana L; Bearden D; Elafros M; Gelbard HA; Theodore WH; Koralnik IJ; Okulicz JF; Johnson BA; Musonda N; Siddiqi OK; Potchen MJ; Sikazwe I; Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.; University Teaching Hospitals Neurology Research Office, Lusaka, Zambia.; Department of Biostatistics, University of Rochester, Rochester, New York, USA.; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Department of Neurology, University of Rochester, Rochester, New York, USA.; Department of Medicine, San Antonio Military Medical Center, San Antonio, Texas, USA.; Department of Psychology, University of Zambia, Lusaka, Zambia.; Zambian College of Medicine and Surgery, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Clinical Epilepsy Section, US National Institute of Health, Bethesda, Maryland, USA.; Department of Imaging Sciences, University of Rochester, Rochester, New York, USA.; University Teaching Hospitals Children's Hospital, Lusaka, Zambia.; Chikankata Epilepsy Care Team, Mazabuka, Zambia.; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVE: To determine the long-term outcomes, including mortality and recurrent seizures, among children living with HIV (CLWH) who present with new onset seizure. METHODS: Zambian CLWH and new onset seizure were enrolled prospectively to determine the risk of and risk factors for recurrent seizures. Demographic data, clinical profiles, index seizure etiology, and 30-day mortality outcomes were previously reported. After discharge, children were followed quarterly to identify recurrent seizures and death. Given the high risk of early death, risk factors for recurrent seizure were evaluated using a model that adjusted for mortality. RESULTS: Among 73 children enrolled, 28 died (38%), 22 within 30-days of the index seizure. Median follow-up was 533 days (IQR 18-957) with 5% (4/73) lost to follow-up. Seizure recurrence was 19% among the entire cohort. Among children surviving at least 30-days after the index seizure, 27% had a recurrent seizure. Median time from index seizure to recurrent seizure was 161 days (IQR 86-269). Central nervous system opportunistic infection (CNS OI), as the cause for the index seizure was protective against recurrent seizures and higher functional status was a risk factor for seizure recurrence. SIGNIFICANCE: Among CLWH presenting with new onset seizure, mortality risks remain elevated beyond the acute illness period. Recurrent seizures are common and are more likely in children with higher level of functioning even after adjusting for the outcome of death. Newer antiseizure medications appropriate for co-usage with antiretroviral therapies are needed for the care of these children. CNS OI may represent a potentially reversible provocation for the index seizure, while seizures in high functioning CLWH without a CNS OI may be the result of a prior brain injury or susceptibility to seizures unrelated to HIV and thus represent an ongoing predisposition to seizures. PLAIN LANGUAGE SUMMARY: This study followed CLWH who experienced a new onset seizure to find out how many go on to have more seizures and identify any patient characteristics associated with having more seizures. The study found that mortality rates continue to be high beyond the acute clinical presentation with new onset seizure. Children with a CNS OI causing the new onset seizure had a lower risk of later seizures, possibly because the trigger for the seizure can be treated. In contrast, high functioning children without a CNS OI were at higher risk of future seizures.