43 research outputs found
Risk factors for pertussis among hospitalized children in a high HIV prevalence setting, South Africa
BACKGROUND : In low- and middle-income countries, including South Africa, the epidemiology of pertussis
in relation to immunization, nutritional, and HIV status is poorly described. This article reports on risk
factors in South African children hospitalized with pertussis.
METHODS : A prospective, hospital-based, sentinel surveillance programme for pertussis was conducted in
Gauteng Province, South Africa. Hospitalized children ( 10 years) meeting the surveillance criteria for
clinically suspected pertussis were screened and enrolled. Nasopharyngeal specimens were collected for
real-time multiplex PCR and culture of Bordetella species.
RESULTS : Bordetella pertussis was detected in 6.2% (61/992) of children. Pertussis was significantly more
prevalent in infants younger than 3 months (9.8%; 38/392) and in young children between the ages of 5
and 9 years (12%; 4/34) (p = 0.0013). Of the 61 confirmed pertussis cases, 17 were too young for
vaccination. Of the remaining 44 infants, vaccination DTP1 was administered in 73% (32/44) of pertussisconfirmed
patients who were eligible, DTP2 in 50% (16/32), DTP3 in 54% (14/26), and DTP4 in 56% (5/9) of
vaccine-eligible cases at 18 months of age. B. pertussis infection was less likely in children immunized at
least once (5%, 32/692) than in unvaccinated children (10%, 24/230) (p = 0.0001). HIV exposure and
infection status were determined in 978 (99%) patients: 69% (678/978) were HIV-unexposed and
uninfected and 31% (300/978) were HIV-exposed. Of these HIV-exposed patients, 218 (22%) were proven
HIV-exposed and uninfected and 82 patients were HIV-infected (8.4%, 82/978). HIV prevalence was
similar in pertussis-positive (6%, 5/82) and pertussis-negative (6%, 55/896) children (p = 0.90). B. pertussis
infection was unrelated to poor nutritional status.
CONCLUSIONS : In South Africa, B. pertussis poses a greater risk to infants who are too young for the
first
vaccine dose, those who are not vaccinated in a timely manner, and those who do not receive all three
primary doses. HIV infection and HIV exposure were not associated with pertussis infection.A research grant from Sanofi
Pasteur.http://www.elsevier.com/locate/ijidam2018Paediatrics and Child Healt
Completeness of the Road-to-Health Booklet and Road-to-Health Card : results of cross-sectional surveillance at a provincial tertiary hospital
BACKGROUND : Accurate record-keeping is important for continuity and quality of care.
Completing a child’s Road-to-Health Booklet (RTHB), or the older, less detailed, Road-to-
Health Card/Chart (RTHC), immediate interpretation thereof and appropriate action facilitates
comprehensive care, which could contribute to a decline in child morbidity and mortality.
OBJECTIVE : This study aimed to assess the extent to which healthcare personnel working
in catchment clinics of Kalafong Provincial Tertiary Hospital (KPTH), Tshwane district,
South Africa, complete HIV-related, sociodemographic, neonatal, growth and immunisation
information in the RTHC and/or RTHB.
METHODS : A cross-sectional, quantitative record review was conducted. Data were extracted
from 318 RTHCs and/or RTHBs of children attending KPTH for paediatric care. Data extraction
focused on six main areas, namely documentation of HIV-related, neonatal, sociodemographic,
anthropometric, immunisation and vitamin A-related information. During data analysis,
age-appropriate completeness scores were generated for each area and completeness of
documentation in the RTHB and RTHC was assessed.
RESULTS : Data demonstrate significantly less unrecorded HIV-related information (maternal
HIV status, timing of maternal HIV testing, timing of maternal antiretroviral therapy [ART]
initiation, current maternal ART use and infant feeding decisions) in RTHBs compared with
RTHCs (p < 001). Despite this, 24% of all RTHBs had no record of maternal HIV status and 67%
of RTHBs from documented HIV-exposed infants had no record of maternal ART duration.
Neonatal information completeness was similar between RTHBs and RTHCs, but sociodemographic
completeness was significantly better in RTHBs compared with RTHCs (p = 0.006). Growth (especially weight), immunisation and vitamin A completeness was > 80%
and similar between RTHBs and RTHCs. Length-for-age, weight-for-length and head
circumference were plotted in < 5% of RTHBs and none of the RTHCs.
CONCLUSION : Although completeness of key HIV-related information was better in RTHBs
compared with RTHCs, RTHB completeness was suboptimal. Healthcare personnel need
reminders to utilise the RTHB optimally to improve continuity and quality of child healthcare.The South African Medical Research Councilhttp://www.sajhivmed.org.zaam2018Paediatrics and Child Healt
Healthcare without borders : a cross-sectional study of immigrant and nonimmigrant children admitted to a large public sector hospital in the Gauteng province of South Africa
BACKGROUND: Human migration is a worldwide phenomenon that receives considerable attention from the
media and healthcare authorities alike. A significant proportion of children seen at public
sector health facilities in South Africa (SA) are immigrants, and gaps have previously been
METHODS AND FINDINGS: A cross-sectional study was conducted over a 4-month period during 2016 to 2017. Information was obtained through a structured questionnaire and health record review. The enrolled
study participants included 508 children divided into 2 groups, namely 271 general paediatric patients and 237 neonates. Twenty-five percent of children in the neonatal group and
22.5% in the general paediatric group were immigrants. The parents/caregivers of the immigrant group had a lower educational level (p < 0.0001 neonatal and paediatric), lower
income (neonatal p < 0.001; paediatric p = 0.024), difficulty communicating in English (p <
0.001 neonatal and paediatric), and were more likely residing in informal settlements (neonatal p = 0.001; paediatric p = 0.007) compared to the SA group. In the neonatal group,
there was no difference in the number of antenatal care (ANC) visits, type of delivery, gestational age, and birth weight. In the general paediatric group, there was no difference in
immunisation and vitamin A supplementation coverage, but when comparing growth, the
noted in their healthcare provision.
The objective of the study was to describe the characteristics and differences between
the immigrant and SA children admitted to Kalafong Provincial Tertiary Hospital (KPTH), a
large public sector hospital in the urban Gauteng Province of SA.immigrant group had more malnutrition compared to the SA group (p = 0.029 for wasting).
There was no difference in the prevalence of maternal human immunodeficiency virus (HIV)
infection, with equally good prevention of mother-to-child transmission (PMTCT) coverage.
There was also no difference in reported difficulties by immigrants in terms of access to
healthcare (neonatal p = 0.379; paediatric p = 0.246), although a large proportion (10%) of
the neonates of immigrant mothers were born outside a medical facility.
CONCLUSIONS: Although there were health-related differences between immigrant and SA children accessing in-hospital care, these were fewer than expected. Differences were found in parental
educational level and socioeconomic factors, but these did not significantly affect ANC
attendance, delivery outcomes, immunisation coverage, HIV prevalence, or PMTCT coverage. The immigrant population should be viewed as a high-risk group, with potential problems including suboptimal child growth. Health workers should advocate for all children in
the community they are serving and promote tolerance, respect, and equal healthcare
access.https://journals.plos.org/plosmedicinepm2022Paediatrics and Child Healt
Hepatitis A virus seroprevalence among children and adolescents in a high‑burden HIV setting in urban South Africa
Hepatitis A virus (HAV) infection is one of the most important global causes of viral hepatitis. Recent
reviews suggested that HAV endemicity in South Africa could shift from high to intermediate. A
hospital-based HAV seroprevalence study was conducted between February 2018 and December
2019 in Pretoria, South Africa. Systematic sampling was performed on children and adolescents
(1–15 years) who attended outpatient services. Participants with a known HIV status and valid HAV
serology results were included. Of the 1220 participants, the median age was 7 years (IQR: 4–11),
with 648 (53.11%) males and 572 (46.89%) females. Of 628 (51.48%) HIV-infected participants, most
(329, 71.83%) were both immunologically and virologically controlled or had low-level viremia (74,
16.16%). Almost three-quarters (894, 73.28%) were living in formal dwellings, and just over half
(688, 56.39%) had access to clean water sources inside the house. Increasing age was associated with
testing HAV IgG-positive (OR 1.25; 95% CI 1.20–1.30, p < 0.001), with 19.8% of participants one year
of age compared with 86.7% of participants 15 years of age. This study suggests that South Africa
has an intermediate HAV seroprevalence, with rates < 90% by 10 years of age (68.6%). Increased age
and informal dwellings are statistically associated with HAV seropositivity, while HIV status does not
significantly influence HAV seropositivity.DATA AVAILABILITY : Raw data were generated at Kalafong Provincial Tertiary Hospital and the University of Pretoria. Derived data
supporting the fndings of this study are available from the corresponding author [NdP] on request.A Research Grant by Sanofi Pasteur.http://www.nature.com/scientificreportsam2023Paediatrics and Child Healt
Loss of detectability and indeterminate results : challenges facing HIV infant diagnosis in South Africa's expanding ART programme
BACKGROUND. Early infant diagnosis with rapid access to treatment has been found to reduce HIV-associated infant mortality and morbidity
considerably. In line with international standards, current South African guidelines advocate routine HIV-1 polymerase chain reaction
(PCR) testing at 6 weeks of age for all HIV-exposed infants and ‘fast-track’ entry into the HIV treatment programme for those who test
positive. Importantly, testing occurs within the context of increasing efforts at prevention of mother-to-child transmission (PMTCT) by
means of maternal and infant antiretroviral therapy (ART). In addition, infants already initiated on combination ART (cART) may be
retested with PCR assays for ‘confirmatory’ purposes, including assessment prior to adoption. The potential for cART to compromise the
sensitivity of HIV-1 PCR assays has been described, although there are limited and conflicting data regarding the effect of PMTCT regimens
on HIV-1 PCR diagnostic sensitivity.
METHODS. We describe a case series of three infants with different ART exposures in whom HIV diagnosis, confirmation or the result of
retesting for adoption purposes were uncertain.
RESULTS. These cases demonstrate that ART can be associated with a loss of detectability of HIV, leading to ‘false-negative’ HIV-1 PCR
results in infants on cART. Furthermore, current PMTCT practices may lead to repeatedly indeterminate results with a subsequent delay
in initiation of cART.
CONCLUSION. The sensitivity of HIV-1 PCR assays needs to be re-evaluated within the context of different ART exposures, and diagnostic
algorithms should be reviewed accordingly.http://www.samj.org.zaam201
Recommendations for the medical evaluation of children prior to adoption in South Africa
The current legislative framework in South Africa (SA) supports adoption as the preferred form of care for children with inadequate or no parental or family support. There are an estimated 3.8 million orphans in SA, with approximately 1.5 - 2 million children considered adoptable. As a means of improving services, newly drafted adoption guidelines from the National Department of Social Development will in future require both non-profit and private sector adoption agencies to obtain a medical report on a child prior to placement. However, no local guidelines specify what an appropriate medical examination entails or how it should be reported. For the purposes of proposing and developing such guidelines, an open forum was convened at the Institute of Pathology, University of Pretoria, in March 2013. These ‘Recommendations for the medical evaluation of children prior to adoption in South Africa’ emanate from this meeting
Factors associated with the development of drug resistance mutations in HIV-1 infected children failing protease inhibitor-based antiretroviral therapy in South Africa
OBJECTIVE
Limited data are available from the developing world on antiretroviral drug resistance in
HIV-1 infected children failing protease inhibitor-based antiretroviral therapy, especially in
the context of a high tuberculosis burden. We describe the proportion of children with drug
resistance mutations after failed protease inhibitor-based antiretroviral therapy as well as
associated factors.
METHODS
Data from children initiated on protease inhibitor-based antiretroviral therapy with subsequent
virological failure referred for genotypic drug resistance testing between 2008 and
2012 were retrospectively analysed. Frequencies of drug resistance mutations were determined
and associations with these mutations identified through logistic regression analysis.
RESULTS
The study included 65 young children (median age 16.8 months [IQR 7.8; 23.3]) with mostly
advanced clinical disease (88.5% WHO stage 3 or 4 disease), severe malnutrition (median
weight-for-age Z-score -2.4 [IQR -3.7;-1.5]; median height-for-age Z-score -3.1 [IQR -4.3;-
2.4]), high baseline HIV viral load (median 6.04 log10, IQR 5.34;6.47) and frequent tuberculosis
co-infection (66%) at antiretroviral therapy initiation. Major protease inhibitor mutations
were found in 49% of children and associated with low weight-for-age and height-for-age
(p = 0.039; p = 0.05); longer duration of protease inhibitor regimens and virological failure
(p = 0.001; p = 0.005); unsuppressed HIV viral load at 12 months of antiretroviral therapy (p = 0.001); tuberculosis treatment at antiretroviral therapy initiation (p = 0.048) and use of ritonavir as single protease inhibitor (p = 0.038). On multivariate analysis, cumulative
months on protease inhibitor regimens and use of ritonavir as single protease inhibitor
remained significant (p = 0.008; p = 0.033).
CONCLUSION
Major protease inhibitor resistance mutations were common in this study of HIV-1-infected
children, with the timing of tuberculosis treatment and subsequent protease inhibitor dosing
strategy proving to be important associated factors. There is an urgent need for safe, effective,
and practicable HIV/tuberculosis co-treatment in young children and the optimal timing
of treatment, optimal dosing of antiretroviral therapy, and alternative tuberculosis treatment
strategies should be urgently addressed.All files are available
from the GenBank database under accession
numbers KT031999-KT032063.Ms LAW Hahne for the development of the electronic database for the Kalafong clinic. Mr T
Moto for the assistance with data collection. Drs G Malherbe and P Mahasha for assisting with
the development of the genotyping assay and the staff at the HIV clinics for their dedicated service
to patients and their assistance with data collection.Conceived and designed the experiments: TR UF. Performed the experiments: GVD. Analyzed
the data: GM. Contributed reagents/materials/analysis tools: TR GM. Wrote the paper: TR UF
GM GVD WT NDP TA.This research and selected researchers
(TR and GVD) were partially funded by a grant from
the Delegation of the European Union to South Africa:
"Drug Resistance Surveillance and Treatment
Monitoring Network for the Public Sector HIV
Antiretroviral Treatment Programme in the Free
State” - Sante 2007/147-790 - and National Research
Council of South Africa, Unlocking the Future 61509.http://www.plosone.orgam201
Nosocomial outbreak of hepatitis B virus infection in a pediatric hematology and oncology unit in South Africa : epidemiological investigation and measures to prevent further transmission
BACKGROUND : Hospital-acquired hepatitis B virus (HBV) infection has been well described and continues to occur worldwide. Recent nosocomial outbreaks have been linked to unsafe injection practices, use of multi-dose vials, and poor staff compliance with
standard precautions. This report describes a nosocomial outbreak that occurred in a
paediatric haematology and oncology unit of a large academic hospital, the epidemiological investigation of the outbreak, and preventive measures implemented
to limit further in-hospital transmission.
METHODS :Outbreak investigation including contact tracing and HBV screening were initiallycarried out on all patients seen by the unit during the same period as the first three
cases. Routine screening for the entire patient population of the unit was initiated in
February 2013 when it was realised that numerous patients may have been
exposed.
RESULTS : Forty-nine cases of HBV infection were confirmed in 408 patients tested between July 2011 and October 2013. Phylogenetic analysis of the HBV preC/C gene
nucleotide sequences revealed that all tested outbreak strains clustered together.
Most (67%) patients were HBeAg positive. The cause of transmission could not be
established. Preventive measures targeted three proposed routes. HBV screening
and vaccination protocols were started in the unit.
CONCLUSIONS : The high number of HBeAg positive patients, together with suspected lapses in infection prevention and control measures, are believed to have played a major role in the transmission. Measures implemented to prevent further in-hospital
transmission were successful. On-going HBV screening and vaccination
programmes in paediatric haematology and oncology units should become standard
of care.http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1545-50172016-11-30hb201
Recommendations for the medical evaluation of children prior to adoption in South Africa
The current legislative framework in South Africa (SA) supports adoption as the preferred form of care for children with inadequate or
no parental or family support. There are an estimated 3.8 million orphans in SA, with approximately 1.5 - 2 million children considered
adoptable. As a means of improving services, newly drafted adoption guidelines from the National Department of Social Development will
in future require both non-profit and private sector adoption agencies to obtain a medical report on a child prior to placement. However,
no local guidelines specify what an appropriate medical examination entails or how it should be reported. For the purposes of proposing
and developing such guidelines, an open forum was convened at the Institute of Pathology, University of Pretoria, in March 2013. These
‘Recommendations for the medical evaluation of children prior to adoption in South Africa’ emanate from this meeting.http://www.samj.org.zaam201
Epidemiology and aetiology of community-acquired pneumonia in children : South African Thoracic Society guidelines (part 1)
BACKGROUND. Pneumonia remains a major cause of morbidity and mortality among South African (SA) children. Improved immunisation
regimens, strengthening of HIV programmes, better socioeconomic conditions and new preventive strategies have influenced the epidemiology
of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis.
OBJECTIVES. To summarise current information on childhood community-acquired pneumonia (CAP) epidemiology and aetiology in
children as part of the revised South African Thoracic Society guidelines.
METHODS. The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases expert
subgroup on epidemiology and aetiology revised the existing SA guidelines.The subgroup reviewed the published evidence in their area; in
the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system, and
the relevant section underwent peer review.
RESULTS. Respiratory viruses, particularly respiratory syncytial virus, are the key pathogens associated with hospitalisation for radiologically
confirmed pneumonia in HIV-uninfected children. Opportunistic organisms, including Pneumocystis jirovecii, are important pathogens in
HIV-infected infants, while non-typable Haemophilus influenzae and Staphylococcus aureus are important in older HIV-infected children.
Co-infections with bacteria or other respiratory viruses are common in hospitalised children. Mycobacterium tuberculosis is common in
children hospitalised with CAP in SA.
CONCLUSIONS. Numerous public health measures, including changes in immunisation schedules and expansion of HIV prevention
and treatment programmes, have influenced the epidemiology and aetiology of CAP in SA children. These changes have
necessitated a revision of the South African Paediatric CAP guidelines, further sections of which will be published as part of a
CME series in SAMJ.The SA Medical Research Councilhttp://www.samj.org.zaam2021Paediatrics and Child Healt