Limits...
Different factors associated with loss to follow-up of infants born to HIV-infected or uninfected mothers: observations from the ANRS 12140-PEDIACAM study in Cameroon.

Sidze LK, Faye A, Tetang SN, Penda I, Guemkam G, Ateba FN, Ndongo JA, Nguefack F, Texier G, Tchendjou P, Kfutwah A, Warszawski J, Tejiokem MC - BMC Public Health (2015)

Bottom Line: Differing LTFU between study groups may affect internal validity and generalizability of the results.Factors associated with this type of LTFU included maternal characteristics, socio-economic status, quality of antenatal care and obstetrical context of delivery.Enhanced counselling in antenatal and intrapartum services is required for mothers at high risk of failure to return for follow-up visits.

View Article: PubMed Central - PubMed

Affiliation: Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun. lsidze@gmail.com.

ABSTRACT

Background: Loss to follow-up (LTFU) is a cause of potential bias in clinical studies. Differing LTFU between study groups may affect internal validity and generalizability of the results. Understanding reasons for LTFU could help improve follow-up in clinical studies and thereby contribute to goals for prevention, treatment, or research being achieved. We explored factors associated with LTFU of mother-child pairs after inclusion in the ANRS 12140-Pediacam study.

Methods: From November 2007 to October 2010, 4104 infants including 2053 born to HIV-infected mothers and 2051 born to HIV-uninfected mothers matched individually on gender and study site were enrolled during the first week of life in three referral hospitals in Cameroon and scheduled for visits at 6, 10 and 14 weeks of age. Visits were designated 1, 2 and 3, in chronological order, irrespective of the child's age at the time of the visit. Mother-child pairs were considered lost to follow-up if they never returned for a clinical visit within the first six months after inclusion. Uni- and multivariable logistic regression were adjusted on matching variables to identify factors associated with LTFU according to maternal HIV status.

Results: LTFU among HIV-unexposed infants was four times higher than among HIV-exposed infants (36.7% vs 9.8%, p < 0.001). Emergency caesarean section (adjusted Odds Ratio (aOR) = 2.46 95% Confidence Interval (CI) [1.47-4.13]), young maternal age (aOR = 2.29, 95% CI [1.18-4.46]), and absence of antiretroviral treatment for prophylaxis (aOR = 3.45, 95% CI [2.30-5.19]) were independently associated with LTFU among HIV-exposed infants. Factors associated with LTFU among HIV-unexposed infants included young maternal age (aOR = 1.96, 95% CI [1.36-2.81]), low maternal education level (aOR = 2.77, 95% CI [1.95-3.95]) and housewife/unemployed mothers (aOR = 1.56, 95% CI [1.16-2.11]).

Conclusion: Failure to return for at least one scheduled clinical visit is a problem especially among HIV-unexposed infants included in studies involving HIV-exposed infants. Factors associated with this type of LTFU included maternal characteristics, socio-economic status, quality of antenatal care and obstetrical context of delivery. Enhanced counselling in antenatal and intrapartum services is required for mothers at high risk of failure to return for follow-up visits.

Show MeSH

Related in: MedlinePlus

Flow diagram of mother-child pairs from the enrolment through each follow-up visit for the ANRS 12140- Pediacam survey. Cameroon. 2007–2010. *1st, 2nd, and 3rd visits were planned at 6, 10, 14 weeks respectively after delivery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4358721&req=5

Fig1: Flow diagram of mother-child pairs from the enrolment through each follow-up visit for the ANRS 12140- Pediacam survey. Cameroon. 2007–2010. *1st, 2nd, and 3rd visits were planned at 6, 10, 14 weeks respectively after delivery.

Mentions: Figure 1 illustrates the flow of mother-child pairs from the enrolment and at each scheduled clinical visit. Overall, 23.1% (903/3913) of mother-child pairs never returned for a clinical visit and 0.1% (4/3913) only returned for visits more than 6 months after enrolment: these two groups of pairs (n = 907; 23.2%) were considered as lost to follow-up (LTFU). LTFU was significantly lower for HIV-infected mother-infant pairs than HIV-uninfected mother-infant pairs (9.8% vs 36.7%, p < .001). Among the 188 HIV-infected mother-infant pairs LTFU, only 67 could be contacted by phone. Among them, 41 infants were alive and 26 (38.8%) deceased. The median infant age at death was 4 weeks [IQR 1.7-6.1]. Seventy-six of the 715 HIV-uninfected mother-infant pairs LTFU could be contacted by phone, and all the infants were alive.Figure 1


Different factors associated with loss to follow-up of infants born to HIV-infected or uninfected mothers: observations from the ANRS 12140-PEDIACAM study in Cameroon.

Sidze LK, Faye A, Tetang SN, Penda I, Guemkam G, Ateba FN, Ndongo JA, Nguefack F, Texier G, Tchendjou P, Kfutwah A, Warszawski J, Tejiokem MC - BMC Public Health (2015)

Flow diagram of mother-child pairs from the enrolment through each follow-up visit for the ANRS 12140- Pediacam survey. Cameroon. 2007–2010. *1st, 2nd, and 3rd visits were planned at 6, 10, 14 weeks respectively after delivery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4358721&req=5

Fig1: Flow diagram of mother-child pairs from the enrolment through each follow-up visit for the ANRS 12140- Pediacam survey. Cameroon. 2007–2010. *1st, 2nd, and 3rd visits were planned at 6, 10, 14 weeks respectively after delivery.
Mentions: Figure 1 illustrates the flow of mother-child pairs from the enrolment and at each scheduled clinical visit. Overall, 23.1% (903/3913) of mother-child pairs never returned for a clinical visit and 0.1% (4/3913) only returned for visits more than 6 months after enrolment: these two groups of pairs (n = 907; 23.2%) were considered as lost to follow-up (LTFU). LTFU was significantly lower for HIV-infected mother-infant pairs than HIV-uninfected mother-infant pairs (9.8% vs 36.7%, p < .001). Among the 188 HIV-infected mother-infant pairs LTFU, only 67 could be contacted by phone. Among them, 41 infants were alive and 26 (38.8%) deceased. The median infant age at death was 4 weeks [IQR 1.7-6.1]. Seventy-six of the 715 HIV-uninfected mother-infant pairs LTFU could be contacted by phone, and all the infants were alive.Figure 1

Bottom Line: Differing LTFU between study groups may affect internal validity and generalizability of the results.Factors associated with this type of LTFU included maternal characteristics, socio-economic status, quality of antenatal care and obstetrical context of delivery.Enhanced counselling in antenatal and intrapartum services is required for mothers at high risk of failure to return for follow-up visits.

View Article: PubMed Central - PubMed

Affiliation: Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun. lsidze@gmail.com.

ABSTRACT

Background: Loss to follow-up (LTFU) is a cause of potential bias in clinical studies. Differing LTFU between study groups may affect internal validity and generalizability of the results. Understanding reasons for LTFU could help improve follow-up in clinical studies and thereby contribute to goals for prevention, treatment, or research being achieved. We explored factors associated with LTFU of mother-child pairs after inclusion in the ANRS 12140-Pediacam study.

Methods: From November 2007 to October 2010, 4104 infants including 2053 born to HIV-infected mothers and 2051 born to HIV-uninfected mothers matched individually on gender and study site were enrolled during the first week of life in three referral hospitals in Cameroon and scheduled for visits at 6, 10 and 14 weeks of age. Visits were designated 1, 2 and 3, in chronological order, irrespective of the child's age at the time of the visit. Mother-child pairs were considered lost to follow-up if they never returned for a clinical visit within the first six months after inclusion. Uni- and multivariable logistic regression were adjusted on matching variables to identify factors associated with LTFU according to maternal HIV status.

Results: LTFU among HIV-unexposed infants was four times higher than among HIV-exposed infants (36.7% vs 9.8%, p < 0.001). Emergency caesarean section (adjusted Odds Ratio (aOR) = 2.46 95% Confidence Interval (CI) [1.47-4.13]), young maternal age (aOR = 2.29, 95% CI [1.18-4.46]), and absence of antiretroviral treatment for prophylaxis (aOR = 3.45, 95% CI [2.30-5.19]) were independently associated with LTFU among HIV-exposed infants. Factors associated with LTFU among HIV-unexposed infants included young maternal age (aOR = 1.96, 95% CI [1.36-2.81]), low maternal education level (aOR = 2.77, 95% CI [1.95-3.95]) and housewife/unemployed mothers (aOR = 1.56, 95% CI [1.16-2.11]).

Conclusion: Failure to return for at least one scheduled clinical visit is a problem especially among HIV-unexposed infants included in studies involving HIV-exposed infants. Factors associated with this type of LTFU included maternal characteristics, socio-economic status, quality of antenatal care and obstetrical context of delivery. Enhanced counselling in antenatal and intrapartum services is required for mothers at high risk of failure to return for follow-up visits.

Show MeSH
Related in: MedlinePlus