1,721,002 research outputs found
Viraemia before, during and after pregnancy in HIV-infected women on antiretroviral therapy in rural KwaZulu-Natal-South Africa, 2010-2015
Get PDFObjectives: Pregnancy and postpartum viral load (VL) suppression is critical to prevent mother-to-child HIV transmission (MTCT) and ensure maternal health. We measured viraemia risk before, during and after pregnancy in HIV-infected women.Methods: Between 2010 and 2015, 1425 HIV-infected pregnant women on lifelong antiretroviral therapy (ART) for at least six months pre-pregnancy were enrolled in a cohort study in rural KwaZulu-Natal, South Africa. Odds ratios (OR) were estimated in multilevel logistic regression, with pregnancy period time varying.Results: Over half of 1425 women received tenofovir-based regimens (n=791). Median pre-pregnancy ART duration was 2.1 years. Of 988 women (69.3%) with pre-pregnancy VLs; 82.0%, 6.8% and 11.2% had VL <50, 50-999 and ≥1000 copies/ml, respectively. During pregnancy and at six, 12 and 24 months, VL was ≥1000 copies/ml in 15.2%, 15.7%, 17.8%, and 16.6% respectively; VL<50 was 76.9%, 77%, 75.5% and 75.8%, respectively. Adjusting for age, clinical and pregnancy factors, viraemia risk (VL ≥50 copies/ml) was not significantly associated with pregnancy [adjusted OR (aOR) 1.31; 95% confidence interval (CI) 0.90-1.92], six month (aOR 1.30; 95% CI 0.83-2.04), 12 month (aOR 0.96; 95% CI 0.58-1.58) and 24 month (aOR 1.40; 95% CI 0.89-2.22) postpartum period. Adjusting for ART duration-pregnancy period interaction, viraemia risk was 1.8 and two-fold higher during pregnancy and postpartum, respectively. Conclusions: While undetectable VL before pregnancy through postpartum was high, the UNAIDS goal to suppress 90% of women was not met. Women on preconception ART remain vulnerable to viraemia; additional support is required to prevent MTCT and maintain maternal health
Evaluation of an exclusive breastfeeding promotion programme in an informal settlement in Durban.
Get PDFMasters Degree. University of KwaZulu-Natal, Durban.Abstract available in PDF.Quality of scanned PDF has been compromised owing to poor condition of original document
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
A randomised double blind placebo controlled trial to determine the effect of soluble dietary fibre (inulin-type fructans) on disease progression and body composition of HIV positive ARV naive adults attending a wellness clinic in KZN South Africa.
No full textPh. D. University of KwaZulu-Natal, Pietermaritzburg 2015.Abstract available in PDF file
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
The accuracy, sensitivity and specificity of rapid point-of-care testing for CD4+ T cell count enumeration and TB diagnosis.
No full textM. Med. Sc. University of KwaZulu-Natal, Durban 2014.Objectives:
The PIMA CD4+ T cell count analyser has been favourably evaluated for use in point-of-care (POC) situations in Mozambique and Zimbabwe, has also been recommended by the World Health Organisation (WHO), however, there is limited information on its use in Primary Healthcare (PHC) settings in KwaZulu Natal (KZN) South Africa. The main aim of this study therefore assessed the accuracy, sensitivity and specificity of the Alere PIMA Point of Care (POC) analyser CD4+ T cell count enumeration compared to the South African National Health Laboratory Services (SA-NHLS) methodology, which uses Beckman Coulter with Panleucogating (PLG/CD4). The potential role of using the PIMA CD4 analyser as a predictor of antiretroviral therapy (ART) eligibility was also assessed.
Material and Methods:
The study took place at Lancers Road clinic, a busy primary health clinic (PHC) facility under the eThekwini Health Unit.
An extra two millilitres of venous blood was drawn from the same blood draw as for the routine CD4 NHLS test (Beckman Coulter) into another EDTA tube for the comparison of the enumeration of CD4+ T cells using the PIMA analyser during January – July 2013.
Results:
A total of 268 patients were recruited for the PIMA analyser comparison with NHLS PLG/CD4 while a sub-set of 100 blood samples were also analysed on the FACS calibur.
In the 100 samples the PIMA analyser results correlated better with the FACS calibur results (mean bias of 7.52, Bland Altman limits of agreement -111 to 126 and correlation of 0.970) than with the NHLS PLG/CD4 results (mean bias of -12.78, Bland Altman limits of agreement -226.041 to 200.481 and correlation of 0.90).
In the 268 samples the overall mean difference between the PIMA analyser – NHLS PLG/CD4 was 17.5 cells/μl (95% CI 6.2 to 28.8). The percentage similarity (SIM) between the two (Mean ± SD) was 106 ± 15.5; indicative of acceptable agreement between the two tests. When
categorised by the following CD4+ T cell counts of: ≤350 cells/μl; 351-500 cells/μl; ≤500 cells/μl and > 500 cells/μl , the mean difference of PIMA analysers – NHLS PLG/CD4 was 33 cells/μl (95% CI 23 to 42); 22 cells/μl (95% CI -3.5 to 47); 30 cells/μl (95%CI 21 to 39); and cells/μl (95% CI -78 to 6.1) respectively.
Under the current South African guidelines of ≤350 cells/μl CD4+ T cells, the sensitivity of the PIMA analyser was 83.5% and specificity 92%. At this threshold of ≤ 350 cells/μl there were 35 (13%) misclassifications, of which 27 were false negatives. This implies that 27 patients would have been falsely deemed ineligible for ART according to the PIMA analyser. The mean difference between the PIMA analyser and NHLS PLG/CD4 in this group of 27 patients was 112 cells/μl. The positive predictive value was high at 95% such that 95% of the patients eligible for treatment according to PIMA analysers would have also been deemed eligible for treatment on the NHLS PLG/CD4 test. Using future South African treatment guidelines threshold of CD4+ T cell counts ≤500 cells/μl , a high sensitivity of 94% was observed at the sacrifice of lower specificity of 78%.
According to the NHLS PLG/ CD4 test result, 164/268 (61%) of patients were eligible for ART (CD4+ T cell count ≤350 cells/μl) compared to 145/268 (54%) with the PIMA analyser POC CD4+ T cell test. Of those eligible for ART according to the ART register at Lancers Road PHC, 110/164 (only 67%) of these patients were initiated on ART. Of those who did not return for their results 35/268 (13%), twenty of 35 (57%) were eligible for ART according to the NHLS PLG/CD4 laboratory CD4 test result, all of whom were not initiated on ART.
Conclusion:
The overall agreement between the PIMA analyser POC and NHLS PLG/ CD4+ T cell count enumeration in adult HIV positive individuals was acceptable with clinically insignificant mean bias. Together with high positive predictive value, and sensitivity and acceptable specificity the PIMA analyser POC lends itself to an excellent facilitator of improved healthcare
Optimum timing for vitamin A supplementation in children with diarrhoea.
No full textThesis (M.Med.Sc.)-University of Natal, Durban, 2001.Vitamin A has well recognised benefits for the reduction in severity of
diarrhoeal episodes but the impact of therapeutic doses given during diarrhoea on
the biochemical and clinical outcomes is less clear. In this study these potential
therapeutic benefits were investigated to establish the optimum time for vitamin A
supplementation to improve vitamin A status. Establishing the optimum time for
vitamin A supplementation during an infectious stage would improve cost effectiveness
and clinical benefit.
Young children (174) between the ages of 3 and 60 months with severe
diarrhoea were randomised in a double - blinded placebo controlled trial into one
of 2 groups. The 1 st group received 60 mg of retinol as retinyl palmitate on
admission during the acute diarrhoeal stage. The 2nd group received the same
dose of vitamin A once symptoms had resolved, usually between 3 - 7 days. At
each of these two time points, children not receiving vitamin A were given an
identical placebo dose. Baseline (day 0) and day 3 serum samples were
collected for vitamin A, retinol binding protein (RBP) and other biochemical
markers. At four and eight weeks after discharge both morbidity and weight gain
were recorded. The modified dose response test (MRDR) was conducted at the
eight - week follow - up to estimate vitamin A liver stores.
Initially, most of the children presented with watery diarrhoea and
dehydration and were clinically very ill. At day 3 plasma retinol concentrations
improved in both groups viz. from 0.57umol/L to 0.97umol/L in the 1st group and
from 0.49umol/L to 0.90umol/L in the 2nd group. Similar improvements were
found in retinol binding protein viz. 21.28 mg/L to 31.06 mg/L in the 1st group and
17.05 mg/L to 24.80 mg/L in the 2nd group. At 8 weeks there was also no
significant difference between the two groups either for serum retinol (0.69umol/L
and 0.73umol/L respectively) nor for MRDR ratios (0.036 and 0.049 respectively).
The MRDR results at 8 weeks indicated that these children did not have
depleted vitamin A liver stores and that the low serum retinol levels seen at
baseline were probably due to the acute phase response during an infectious
episode.
The results of these analyses showed no significant difference between the
two treatment groups thus indicating that there was no benefit to giving vitamin A
on recovery from an infectious episode instead of on admission, as is currently
practised
Effect of infant feeding mode and maternal nutritional supplementation on the nutrition and health of HIV positive mothers and their infants.
No full textThesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.Background: Breastfeeding is known to have benefits both for maternal and child health. Some
questions around the benefits and risks of breastfeeding in the presence of HIV infection still remain
unclear.
Aims: To study the effects of infant feeding mode by HIV-positive mothers, on maternal and child
health. In addition, to assess the effect of nutritional supplementation to HIV-positive lactating
mothers on nutritional and health status of mothers and their infants and on the quality of breastmilk.
Methods: The study had 2 components; a prospective study to examine the impact of infant feeding
mode on nutritional and health indices in mothers and their infants and within it a nested
randomized controlled clinical trial to study the impact of a daily 50 g soya/peanut based
supplement during breastfeeding on the above parameters. The measurements included
anthropometry; body composition indicators (using both deuterium dilution and BIA); haematology
and biochemical markers; as well as incidence rates of opportunistic infections and clinical disease
progression. Breastmilk was analysed for both macro and micronutrients. Cervical screening was
offered to all the women.
Results: AFASS criteria were fulfilled by 38.7% of the formula feeding mothers. No significant
differences between the formula feeding and breastfeeding groups in terms of haematological,
immunological and body composition changes were seen. Breastfeeding mothers had significantly
lower events with high depression scores (p=0.043). Longer duration of breastfeeding was observed
to be significantly associated with a mean increase in CD4 count (74 cells/μL) and better health
outcomes. The supplement made no significant impact on any maternal or child outcomes except for
a limited effect on mothers with low BMI, where it was significantly associated with preventing loss
of lean body mass (p=0.026). Breastfeeding infants had a significantly lower risk of diarrhoea and
hospitalisation at 3 months (p=0.006 and 0.014 respectively). Both breastfeeding and longer
duration of breastfeeding was significantly associated with better development scores and growth
parameters. Supplementation made no impact on breastmilk composition. Of the 86 mothers who
agreed for cervical screening, 27.6% had human papilloma virus infection.
Conclusions: Breastfeeding is not harmful to the mother despite the presence of HIV infection. On
the contrary we observed both breastfeeding and longer breastfeeding duration to be associated with
better maternal and child outcomes. Mothers are still choosing formula feeding inappropriately
presumably because of the availability of free formula and/or sub-optimal counseling. The new
(2010) local PMTCT guidelines based on WHO recommendations should reverse this. Food
insecurity was prevalent amongst 32% of our study population, highlighting the need to include
sustainable and empowering solutions to encounter this problem. Less sustainable solutions such as
nutritional supplementation should be targeted to the malnourished and in emergency situations
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