Sero-epidemiology ofhepatitis A in black South African children

A cOIDInunity-based sero-epidemiological survey was undertaken to determine the age-specific prevalence rates of hepatitis A virus (HAV) infection in a representative sample of 782 urban black children aged from newborn to 13 years. Among children aged °-5 months, the prevalence ofantiHAV was 68,8% (95% confidence interval (Cl) 60,6 - 77,0%); this fell to a low of2,5% (Cl 0,1 - 4,9%) in those aged 6 - 11 months, implying the presence of maternal antibody in the first few months of life. By the age of2 years, 51,2% (Cl 45,7 - 56,7%) had anti-HAV, by age 4 the prevalence had risen to 81,4% (Cl 75,5 - 87,3%) and by age 6, the prevalence of anti-HAV was almost 100% (Cl 90,5 96,7%), reflecting the poor socio-economic and environmental conditions these children live in. The lowest prevalence of HAV infection among urban black South African children was during infancy, before the age at which the incidence rate rose sharply; e.g. lout of 5 children was already infected with HAV by its 2nd birthday. Vaccination in infancy will therefore have the biggest impact on the spread of HAV. However, before HAV vaccination in infancy is advocated, vaccine immunogenicity in infancy and the possible detrimental effect of maternal antibodies on the immunogenicity ofthe vaccine need clarification

An investigation into the challenges and limitations of implementing universal pulse oximetry screening for critical congenital heart disease in asymptomatic newborns

Neonatal pulse oximetry has been identified as an important screening tool for critical congenital heart disease. This oximetry screening, although mandatory in many developed countries, is not routinely implemented in South African hospitals.The objective of this study was therefore to determine the feasibility of implementing pulse oximetry in a typical level 2 hospital in the province of KwaZulu-Natal. Challenges and limitations experienced in implementing the screening were documented.The study was an observational analytical descriptive study which was conducted in the postnatal ward of Addington Hospital, Durban. Nursing staff were educated regarding the importance of pulse oximetry screening and were subsequently trained to perform the procedure.A total of 2 453 newborns were admitted to the hospital from January to August 2016 with 599 of these being eligible for enrolment in the study. Consent and screening were initially performed by participating nursing staff. During the last 4 months, consent was obtained by a dedicated research assistant. Of the 599 eligible newborns, 22 were excluded resulting in 577 being available for analysis. There were 29 newborns who fulfilled criteria for a second screening, however, in 21 of these newborns, the protocol was not appropriately followed.This study suggests that while routine neonatal saturation monitoring appears to be a simple, cost-effective tool to detect critical congenital heart disease, several barriers to its implementation were detected. The main barriers were inadequate staffing and infrastructure. This, in turn, highlighted the need for appropriate human resource provision and training as well as adequate infrastructure. These may not be easily achievable in a resource constrained environment

Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa

BACKGROUND: The evidence on the effect of pregnancy on acquiring HIV is conflicting, with studies reporting both higher and lower HIV acquisition risk during pregnancy when prolonged antiretroviral therapy was accessible. The aim of this study was to assess the pregnancy effect on HIV acquisition where antiretroviral therapy was widely available in a high HIV prevalence setting. METHODS: This is a retrospective cohort study nested within a population-based surveillance to determine HIV incidence in HIV-uninfected women from 15 to 49 years from 2010 through 2015 in rural KwaZulu-Natal. HIV incidence per 100 person-years according to pregnancy status (not pregnant, pregnant, to eight weeks postpartum) were measured in 5260 HIV-uninfected women. Hazard ratios (HR) were estimated by Cox proportional hazards regression with pregnancy included as a time varying variable. RESULTS: Overall, pregnancy HIV incidence was 4.5 per 100 person-years (95% CI 3.4-5.8), higher than non-pregnancy (4.0; 95% CI 3.7-4.3) and postpartum incidences (4.2 per 100 person-years; 95% CI 2.3-7.6). However, adjusting for age, and demographic factors, pregnant women had a lower risk of acquiring HIV (HR 0.4; 95% CI 0.2-0.9, P = 0.032) than non-pregnant women; there were no differences between postpartum and non-pregnant women (HR 1.2; 95% CI 0.4-3.2; P = 0.744). In models adjusting for the interaction of age and gravidity, pregnant women under 25 years with two or more pregnancies had a 2.3 times greater risk of acquiring HIV than their older counterparts (95% CI 1.3-4.3; P = 0.008). CONCLUSIONS: Pregnancy had a protective effect on HIV acquisition. Elevated HIV incidence in younger women appeared to be driven by those with higher gravidity. The sexual and biological factors in younger women should be explored further in order to design appropriate HIV prevention interventions

Rapid testing may not improve uptake of HIV testing and same day results in a rural South African community: a cohort study of 12,000 women

<p>Background: Rapid testing of pregnant women aims to increase uptake of HIV testing and results and thus optimize care. We report on the acceptability of HIV counselling and testing, and uptake of results, before and after the introduction of rapid testing in this area.</p> <p>Methods and Principal Findings: HIV counsellors offered counselling and testing to women attending 8 antenatal clinics, prior to enrolment into a study examining infant feeding and postnatal HIV transmission. From August 2001 to April 2003, blood was sent for HIV ELISA testing in line with the Prevention of Mother-to-Child Transmission (PMTCT) programme in the district. From May 2003 to September 2004 women were offered a rapid HIV test as part of the PMTCT programme, but also continued to have ELISA testing for study purposes. Of 12,323 women counselled, 5,879 attended clinic prior to May 2003, and 6,444 after May 2003 when rapid testing was introduced; of whom 4,324 (74.6%) and 4,810 (74.6%) agreed to have an HIV test respectively. Of the 4,810 women who had a rapid HIV test, only 166 (3.4%) requested to receive their results on the same day as testing, the remainder opted to return for results at a later appointment. Women with secondary school education were less likely to agree to testing than those with no education (AOR 0.648, p<0.001), as were women aged 21–35 (AOR 0.762, p<0.001) and >35 years (AOR 0.756, p<0.01) compared to those <20 years.</p> <p>Conclusions: Contrary to other reports, few women who had rapid tests accepted their HIV results the same day. Finding strategies to increase the proportion of pregnant women knowing their HIV results is critical so that appropriate care can be given.</p&gt

Changes in body composition and other anthropometric measures of female subjects on highly active antiretroviral therapy (HAART): A pilot study in KwaZulu-Natal, South Africa

Background and objectives. An understanding of the effect of highly active antiretroviral therapy (HAART) on various aspects of health, including nutritional status, is needed to ensure that population-specific guidelines can be developed for South Africa. This study aimed to investigate the changes in body composition and other anthropometric measures that occur in HIV-infected women after the initiation of HAART and to explore the relationship between these measures and CD4 lymphocyte count. Design and setting. A longitudinal study was carried out at the Umkhumbane Community Health Centre, KwaZulu-Natal. Subjects. 30 HIV-infected adult women who started HAART between March 2007 and October 2007. Methods. Anthropometric measurements and bioelectrical impedance analysis were performed at baseline and 24 weeks after commencing HAART. CD4 lymphocyte counts were done at baseline and at the 24-week visit. Results. There was a statistically significant increase in all anthropometric measures except waist-hip ratio and lean body mass. The mean weight change (± standard deviation) was 3.4±5.8 kg (p=0.006). Mean body mass index (BMI) (kg/m2) increased from 25.6±5.7 to 27.3±5.6 (p=0.007). Seventy per cent of subjects gained weight, 18.5% had a stable weight and 11.1% lost weight. Subjects with lower CD4 lymphocyte counts experienced greater increases in weight, BMI, fat mass and body fat percentage. No significant association was found between anthropometric changes and change in CD4 count between baseline and the 24-week visit. Conclusions. The findings demonstrate the value of including circumference measurements and body composition techniques as part of nutritional status assessment. Research is needed to determine the best methods of bringing about favourable anthropometric changes to enhance the health of patients on HAART. Southern African Journal of HIV Medicine Vol. 9 (4) 2008: pp. 36-4

Prevention is better than cure – the art of avoiding non-adherence to antiretroviral treatment

The much-used phrase ‘prevention is better than cure’ is applicable to many circumstances, including human mmunodeficiency virus (HIV) infection. In recent years suggestions have been made for a move towards treatment strategies that emphasise prevention of foreseeable adherence problems on a patient-by-patient basis, through focused patient preparation before commencing antiretroviral therapy (ART). This is well elucidated in a statement made in 2004 by Coetzee et al.:1 ‘As it is difficult to ascertain robust predictors of adherence, there has been a move to concentrate on patient preparation before the initiation of ART rather than the use of nonclinical predictors of adherence or selection criteria. A paradigm focused on preparation rather than selection is better suited to the aggressive targets for the scaling up of ART in countries with large epidemics (such as in South Africa), where the view of ART as a very expensive rationed intervention is rapidly changing.&rsquo

Determining appropriate nutritional interventions for South African children living in informal urban settlements

Rapid urbanisation in South Africa has led to the creation of infonnal shack settlements where the health status of children is in jeopardy; it needs to be monitored so that appropriate intervention strategies can be formulated.Accordingly, the nutritional status of 190 children (3 - 6 years of age) living in Besters, a typical urban shack settlement north of Durban, was assessed anthropometrically. In addition the following biochemical values were determined: vitamins A and E, calcium, magnesium, phosphorus, albumin, haemoglobin, serum iron and ferritin and percentage of transferrin saturation.Malnutrition was evident in 13% of the children who were underweight (below the National Center for Health Statistics (NCHS) third weight-for-age percentile) and 27% who were stunted (below the NCHS third height-for-age percentile). Concentrations of albumin, calcium, magnesium, phosphorus arid vitamin E were close to normal, with no more than 10% of the sample having values outside the normal range. However, 44% of the children had low serum retinol levels < 20 μg/dl) and 21 % of the children had anaemia (haemoglobin < 11 μg/dl). Significant positive correlations were found between serum retinol and all biochemical indicators of iron status except serum ferritin.This study highlights the fact that nutrient deficiencies are interrelated, particularly protein energy malnutrition and poor vitamin A and iron status. A broad multifaceted comprehensive health intervention programme is therefore required

Infant feeding practices of teenage mothers attending a well-baby clinic in a public hospital in Umlazi, KwaZulu-Natal, South Africa

Objective: This study aimed to determine the breastfeeding practices of urban, predominantly isiZulu speaking, South African teenage mothers, and to examine factors associated with breastfeeding.Study Design and Methods: A cross-sectional study was conducted with 73 mothers (aged 15 to 19 years) who were attending a well-baby clinic for their infant’s scheduled 14-week immunisation visit. A face-to-face interview was conducted with each mother in isiZulu (n = 66) or English (n = 7) by a trained research assistant. Close ended questions included; socio-demographic characteristics; obstetric history; and, breastfeeding practices while open-ended questions explored reasons for early cessation of breastfeeding, and perceptions of how the family, health care workers, and the school could support teenage mothers with breastfeeding.Results: All 73 mothers had initiated breastfeeding; however, by the time of the interview, 31.5% had stopped breastfeeding. A multivariate logistic regression model was used to predict the likelihood of early breastfeeding cessation. The odds ratio of early breastfeeding cessation for teenage mothers below the age of ≤ 17 years was 17.3% higher compared to teenage mothers older than 17 years (OR 1.17, 95% CI:0.617–2.269); 8.6% higher for teenage mothers who completed their grade 11 and above compared those who did not complete grade 11 and above (OR 1.17, 95% CI:0.617–2.269); and, 79.5% (OR 1.795, 95% CI:0.565– 5.739) higher for teenage mothers who experienced breastfeeding problems compared to mothers without breastfeeding problems. However, since the 95% CI for these odds ratios spanned the null value (1.0), the increased odds were not statistically significant.Conclusion: The elevated odds of early breastfeeding cessation were associated with a young maternal age (≤ 17 years) and experiencing breastfeeding problems. This highlights the importance of targeting adolescent mothers for support and promotion of breastfeeding, noting the influence of society and peer pressure. It is also clear that the healthcare workers, schools and communities have an important role to play in supporting breastfeeding teenage mothers, especially in providing accurate information and support for the prevention of breastfeeding problems.Keywords: infant feeding practices, teenage mothers, well-baby clini

Cohort Profile: Mamanengane or the Africa Centre Vertical Transmission Study

How did the study come about? From the mid-1990s, the success of antiretroviral prophylaxis to reduce HIV RNA viral load in plasma and avoidance of breastfeeding provided the real possibility that mother-to-child transmission (MTCT) of HIV-1 could be markedly reduced, 1 with an implicit understanding that these measures could be effectively applied to all HIV-infected women in developing countries. 2,3 The latter constitute the overwhelming majority of HIV-positive pregnancies resulting in approximately half a million new infant infections annually. 4 However, the inappropriate use of formula milks amongst impoverished populations resulted in major adverse effects; without the nutritiona