Dissertations / Theses on the topic 'AIDS (Disease) – Mortality – Australia'

Although the under-five mortality rate in Malawi has been declining since 1960, it still remains one of the highest in the world. In order to appropriately target interventions to achieve substantial reductions in deaths among children under the age of five years in Malawi, there is an ongoing need for better knowledge of the proportion of cause-specific under-five mortality in the country. The aim of this study was to estimate the direct contribution of HIV/AIDS to the observed level of under-five mortality in Malawi during the period 2000 to 2004.

The Australian HIV Observational Database (AHOD) is a collaboration of hospitals, sexual health clinics and specialist general practices throughout Australia, established in April 1999. Core data variables collected include demographic data, immunological and virological markers, AIDS diagnosis, antiretroviral and prophylactic treatment and cause of death. The first electronic data transfer occurred in September 1999 followed by six monthly data transfers thereafter. All analyses included in this thesis are based on patients recruited to AHOD by March 2004. By March 2004, 2329 patients had been recruited to AHOD from 27 sites throughout Australia. Of these, 352 (15%) patients were recruited from non-metropolitan clinics. The majority of patients were male (94%), and infected with HIV through male homosexual contact (73%). Almost 90% of AHOD patients are antiretroviral treatment experience, and the majority of patients are receiving triple therapy as mandated by standard of care guidelines in Australia. Antiretroviral treatment use has changed in Australia reflecting changes in the availability of new treatment strategies and agents. The crude mortality rate was 1.58 per 100 person years, and of the 105 deaths, more than half died from HIV-unrelated deaths. The prevalence of HBV and HCV in AHOD was 4.8% and 10.9%, respectively. HIV disease progression in the era of highly active antiretroviral treatment (HAART) among AHOD patients is consistent with what has been reported in developed countries. Common factors associated with HIV disease progression were low CD4 cell count, high viral load and prior treatment with mono or double therapy at the time of commencing HAART. This was demonstrated in AHOD in terms of long-term CD4 cell response, the rate of changing combination antiretroviral therapy and factors predicting death. HBV and HCV coinfection is also relatively common in AHOD, similar to other developed country cohorts. Coinfection does not appear to be serious impediments to the treatment of HIV infected patients. However, HIV disease outcome following HAART does appear to be adversely affected by HIV/HCV coinfection but not in terms of HIV/HBV coinfection. Patients attending non-metropolitan sites were found to be similar to those attending metropolitan sites in terms of both immunological response and survival.

Thesis (M. Ed.)--University of South Australia, 1993.
"Report of a thesis submitted for a masters in Education, Human Resource Studies August 1993"--Cover. Includes bibliographical references (leaf 178-188).

The first two official AIDS cases were diagnosed in South Africa in 1982. During the same period of the 1980s, the black/African population was experiencing an accelerated fertility decline, following a period of accelerated mortality decline. Demographers invoked the demographic transition theory to explain the observed mortality and fertility decline. According to the demographic transition theory, mortality and fertility rates would continue declining to low, post transitional levels with increasing modernization. The relatively higher prevalence of HIV/AIDS estimated among black/African South Africans is expected to alter their demographic transition. This research investigated the impact of HIV/AIDS on the demographic transition of black/Africans by 2021.

Air pollution is ranked by the World Health Organisation as one of the top ten contributors to the global burden of disease and injury. Epidemiological studies have shown that exposure to air pollution is associated with cardiorespiratory diseases. However, most of the previous studies have looked at this issue using air pollution data from a single monitoring site or average values from a few monitoring sites in a city. There is increasing concern that the relationships between air pollution and mortality may vary with geographical area, particularly for a big city. This thesis consisted of three interlinked studies that aimed to examine the spatial variation in the relationship between long-term exposure to air pollution and cardiorespiratory mortality in Brisbane, Australia. The first study evaluated the long-term air pollution trends in Brisbane, Australia. Air pollution data used in this study were provided by the Queensland Environmental Protection Agency (QEPA). The data comprised the daily average concentrations of particulate matter less then 10 µm in aerodynamic diameter (PM10), nitrogen dioxide (NO2), ozone (O3) and sulphur dioxide (SO2) between 1 January 1980 and 31 December 2004 in two monitoring sites (i.e. Eagle farm and Rocklea), and in other available monitoring sites between 1 January 1996 and 31 December 2004. Computerised data files of daily mortality between 1 January 1996 and 31 December 2004 in Brisbane city were provided by the Office of Economic and Statistical Research of the Queensland Treasury. Population data and the Socio-Economic Indexes for Areas (SEIFA) data in 2001 were obtained from the Australian Bureau of Statistics (ABS) for each statistical local area (SLA) of the Brisbane city. The long-term air pollution (the daily maximum 1-hour average or daily 24-hour average concentrations of NO2, O3 and PM10) trends were evaluated using a polynomial regression model in two monitoring sites (Eagle Farm and Rocklea) in Brisbane, Australia, between 1980 and 2003. The study found that there were significant up-and-down features for air pollution concentrations in both monitoring sites in Brisbane. Rocklea recorded a substantially higher number of days with concentrations above the relevant daily maximum 1-hour or 24-hour standards than that in Eagle Farm. Additionally, there was a significant spatial variation in air pollution concentrations between these areas. Therefore, the results indicated a need to examine the spatial variation in the relationship between long-term exposure to air pollution and cardiorespiratory mortality in Brisbane. The second study examined the spatial variation of SO2 concentrations and cardiorespiratory mortality in Brisbane between 1999 and 2001. Air pollutant concentrations were estimated using geographical information systems (GIS) techniques at a SLA level. Spatial distribution analysis and a multivariable logistic regression model were employed to investigate the impact of gaseous air pollution on cardiorespiratory mortality after adjusting for potential confounding effects of age, sex, calendar year and SEIFA. The results of this study indicate that for every 1 ppb increase in annual average SO2 concentration, there was an estimated increase of 4.4 % (95 % confidence interval (CI): 1.4 - 7.6 %) and 4.8 % (95 % CI: 2.0 - 7.7 %) in cardiovascular and cardiorespiratory mortality, respectively. We estimated that the excess number of cardiorespiratory deaths attributable to SO2 was 312 (3.4% of total cardiorespiratory deaths) in Brisbane during the study period. Our results suggest that long-term exposure to SO2, even at low levels, is a significant hazard to population health. The final study examined the association of long-term exposure to gaseous air pollution (including NO2, O3 and SO2) with cardiorespiratory mortality in Brisbane, Australia, 1996 - 2004. The pollutant concentrations were estimated using GIS techniques at a SLA level. Logistic regression was used to investigate the impact of NO2, O3 and SO2 on cardiorespiratory mortality after adjusting for potential confounding effects of age, sex, calendar year and SEIFA. The study found that there was an estimated 3.1% (95% CI: 0.4 - 5.8%) and 0.5% (95% CI: -0.03 - 1.3 %) increase in cardiorespiratory mortality for 1 ppb increment in annual average concentration of SO2 and O3, respectively. However there was no significant relationship between NO2 and cardiorespiratory mortality observed in the multiple gaseous pollutants model. The results also indicated that long-term exposure to gaseous air pollutants in Brisbane, even at the levels lower than most cities in the world (especially SO2), were associated with cardiorespiratory mortality. Therefore, spatial patterns of gaseous air pollutants and their impact on health outcomes need to be assessed for an evaluation of long-term effects of air pollution on population health in metropolitan areas. This study examined the relationship between air pollution and health outcomes. GIS and relevant mapping technologies were used to display the spatial patterns of air pollution and cardiorespiratory mortality at a SLA level. The results of this study show that long-term exposure to gaseous air pollution was associated with cardiorespiratory mortality in Brisbane and this association appeared to vary with geographic area. These findings may have important public health implications in the control and prevention of air pollution-related health effects, since now many countries and governments have paid more attention to control wide spread air pollution and to protect our environment and human health.

[Truncated abstract] The main objective of this study was to develop and validate a demographic/epidemiologic Markov model for population modelling/forecasting of CARPs as well as CHD deaths and incidence in Western Australia using population, linked hospital morbidity and mortality data for WA over the period 1980 to 2000. A key feature of the model was the ability to count events as individuals moved from one state to another and an important aspect of model development and implementation was the method for estimation of model transition probabilities from available population data. The model was validated through comparison of model predictions with actual event numbers and through demonstration of its use in producing forecasts under standard extrapolation methods for transition probabilities as well as improving the forecasts by taking into account various possible changes to the management of CHD via surgical treatment changes. The final major objective was to demonstrate the use of model for performing sensitivity analysis of some scenarios. In particular, to explore the possible impact on future numbers of CARPs due to improvements in surgical procedures, particularly the introduction of drug eluting stents, and to explore the possible impact of change in trend of CHD incidence as might be caused by the obesity epidemic. ... When the effectiveness of PCI due to introduction of DES was increased by reducing Pr(CABG given PCI) and Pr(a repeat PCI), there was a small decline in the requirements for PCIs and the effect seemed to have a lag. Finally, in addition to these changes when other changes were incorporated which captured that a PCI was used more than a CABG due to a change in health policy after the introduction of DES, there was a small increase in the requirements for PCIs with a lag in the effect. Four incidence scenarios were developed for assessing the effect of change in secular trends of CHD incidence as might be caused by the obesity epidemic in such a way that they gradually represented an increasing effect of obesity epidemic (assuming that other risk factors changed favourably) on CHD incidence. The strategy adopted for developing the scenarios was that based on past trends the most dominant component of CHD incidence was first gradually altered and finally the remaining components were altered. iv The results showed that if the most dominant component of CHD incidence, eg, Pr(CHD - no history of CHD) levelled off and the trends in all other transition probabilities continued into future, then the projected numbers of CABGs and PCIs for 2001-2005 were insensitive to these changes. Even increasing this probability by as much as 20 percent did not alter the results much. These results implied that the short-term effect on projected numbers of CARPs caused by an increase in the most dominant component of CHD incidence, possibly due to an ?obesity epidemic, is small. In the final incidence scenario, two of the remaining CHD incidence components-Pr(CABG - no history of CHD) and Pr(CHD death - no CHD and no history of CHD) were projected to level off over 2001-2005 because these probabilities were declining over the baseline period of 1998-2000. The projected numbers of CABGs were more sensitive (compared to the previous scenarios) to these changes but PCIs were not.

This thesis argues that the work of the artist David McDiarmid is to be read as an enactment of late twentieth century gay male and queer politics. It will analyse how both the idea and the cultural specificity of ???America??? impacted on the work of this Australian artist resident in New York from 1979 to 1987. The thesis examines how African American music, The Beats, notions of ???hip??? and ???cool???, street art and graffiti, the underground dance club Paradise Garage, street cruising and gay male urban culture influenced the sensibility and the materiality of the artist???s work. McDiarmid???s cultural practice of dress and adornment, it is proposed, forms an essential part of his creative oeuvre and of the ???queer worldmaking??? which is the driver of his creative achievements. The thesis proposes that McDiarmid was a Proto-queer artist before the politics of queer emerged in the 1980s and that his work, including his own life-as-art practices of dress and adornment, enact a mobile rather than fixed gay male identity.

To obtain more complete mortality data following HIV and AIDS diagnosis in Australia, HIV/AIDS diagnoses between 1980 and 2003 were linked to the National Death Index. Based on 6900 known deaths, and 1455 known non-deaths, sensitivity and specificity of the linkage was estimated to be 82% and 92% respectively. Mortality rates were compared by calendar period, pre-ART (<1990), pre- and early-HAART (1990-1996) and late-HAART (1997-2003). Mortality following AIDS decreased from 590.2/1000 person years pre-ART to 77.4 during the late-HAART period. Mortality following HIV diagnosis prior to AIDS increased from 9.7 to 20.2/1000 person years. The total number living with diagnosed HIV infection in Australia was estimated to have increased from 7873 at the end of 1989 to 12828 in 2003. Risk factors for survival following HIV and AIDS diagnosis were assessed using Cox regression. Age >40 years and certain HIV exposure results were associated with poorer survival following HIV. Predictors of poorer survival following AIDS were age >40 years, females exposed to HIV through receipt of blood, CD4 count <20 and certain AIDS illnesses. Parametric models of survival following HIV and AIDS diagnosis were assessed using likelihood based criteria. Goodness of fit was assessed by comparing observed with model predicted numbers of deaths. Weibull models were found to fit best to both survival following HIV and AIDS. Parametric survival models were used to project deaths after HIV and AIDS across three scenarios of HAART usage. Deaths following HIV were projected to remain low, but to increase from 223 in 2005 to 288, 292 and 282 in 2010 if the HAART usage remains stable at 2005 levels, increases to 70% of all people with diagnosed HIV by 2010 and decreases to 39% of all people with diagnosed HIV respectively. Deaths after AIDS diagnosis were projected to increase unless if HAART usage increases to 100% of AIDS diagnoses by 2010.

"As a partial requirement for Master of Arts (Animation & Interactive Media) by Research Project 25th March 2002, studied at Centre for Animation and Interactive Media, School of Creative Media, Faculty of Art, Design and Communication" Typescript (photocopy) Bibliography: leaves 66-67. Internet access at: http://www.hivaids.webcentral.com.au/

AIDS mortality, its linkages as a determinant and consequence of food security and its impact on natural resource utilisation by mainly rural populations, has not been well researched, especially their effects on rural livelihoods. With the high epidemic prevalence and persistent food insecurity, natural resources are and will continue to play a key role as a buffer against stresses and shocks in rural livelihoods. Determining linkages between household food security, adult AIDS mortality, and how these affect natural resource utilisation at the village level was the objective of this research. The overarching goal of sustainable natural resource utilisation in Agincourt Demographic Surveillance Site (DSS) was determined through three research questions outlined as follows; What is the status of food security, AIDS mortality and Natural resource utilisation in Agincourt?; What is the relationship between dependence on natural resources as a source of food and or livelihood to resource degradation?; and What are the household and community drivers of household food security? Statistical analysis was used to evaluate the prevalence of food insecurity and the reliance on natural resources while remote sensing was used to assess resource availability and identification of possible natural resource degradation hotspots. More than half of the population in the DSS is food-secure, in 2004, with an even smaller hungry population in 2007. HIV/AIDS and non-HIV/AIDS adult mortality, analysed at village level are underlying drivers and determinants, affecting availability of income which is a direct driver of food insecurity. Availability of income, through social grants, remittances or wages, and delay or non-receipt of this income results in food insecurity in some households. Food production, affected and constrained by climate variability, is a less stable and less popular means of attaining food. More than half of the Agincourt population utilises natural resources to supplement dietary diversity and household income, although there is a significant reduction in households using natural resources in 2007 compared to 2004. Resource degradation is noted in the village commons especially between the highly food-insecure villages and are identified as environmental degradation hot spots. The identification of synergies among these factors in policy design and for interventions is essential for poverty alleviation, improved health and sustainable utilisation of natural resources and rural livelihoods. Glory be to GOD for making this work possible “Commit your work to the Lord and then your plans will succeed” (Proverbs 16:3) “Material poverty doesn‟t necessarily lead to a lack of capacity for creativeness and Inventiveness. Poor people survival by their wits and have much more to contribute to address complex problems than we tend to credit them with.” Dr. Maphela Ramphele (Destiny Magazine, 2010)

The HIV and AIDS epidemic has remained one of the leading causes of death in the world and has been destructive in Africa with Sub-Saharan Africa remaining the epidemiological locus of the epidemic. HIV and AIDS hinders development by erasing decades of health, economic and social progress, reducing life expectancy by years and deepening poverty [57].The most urgent public-health problem globally is to devise effective strategies to minimize the destruction caused by the HIV and AIDS epidemic. Due to the problems caused by HIV and AIDS, well defined endpoints to evaluate treatment benefits are needed. The surrogate and true endpoints for a disease need to be specified. The purpose of a surrogate endpoint is to draw conclusions about the effect of intervention on true endpoint without having to observe the true endpoint. It is of great importance to understand the surrogate validation methods. At present the question remains as to whether CD4 count and viral load are good surrogate markers for death in HIV or there are some better surrogate markers. This dissertation was undertaken to obtain some clarity on this question by adopting a mathematical model for HIV at immune system level and the impact of treatment in the form of reverse transcriptase inhibitors (RTIs). For an understanding of HIV, the dissertation begins with the description of the human immune system, HIV virion structure, HIV disease progression and HIV drugs. Then a review of an existing mathematical model follows, analyses and simulations of this model are done. These gave an insight into the dynamics of the CD4 count, viral load and HIV therapy. Thereafter surrogate marker validation methods followed. Finally generalized estimating equations (GEEs) approach was used to analyse real data for HIV positive individuals, from the Centre for the AIDS Programme of Research in South Africa (CAPRISA). Numerical simulations for the HIV dynamic model with treatment suggest that the higher the treatment efficacy, the lower the infected cells are left in the body. The infected cells are suppressed to a lower threshold value but they do not completely disappear, as long as the treatment is not 100% efficacious. Further numerical simulations suggest that it is advantageous to have a low proportion of infectious virions (ω) at an individual level because the individual would produce few infectious virions to infect healthy cells. Statistical analysis model using GEEs suggest that CD4 count< 200 and viral load are highly associated with death, meaning that they are good surrogate markers for death. An interesting finding from the analysis of this particular data from CAPRISA was that low CD4 count and high viral loads as surrogates for HIV survival act independently/additively. The interaction effect was found to be insignificant. Individual characteristics or factors that were found to be significantly associated with HIV related death are weight, CD4 count< 200 and viral load.
Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

Given the increasing number of deaths associated with the HIV/AIDS epidemic in South Africa, funerals have become a heavy financial burden on lower-income families, each costing the equivalent of several months' income or more. Three main choices are available to families to assist with the payment of funerals: burial societies, burial schemes provided by funeral homes, and formal insurers. This thesis will seek to discover how burial societies and funeral homes offering burial schemes are coping with the increased mortality. Initial thoughts about the industry would equate the increasing deaths and subsequent funerals with an increase in business and profits. However, that might not be the case. This study conducted personal interviews with the managers of burial societies, funeral homes, and others within the funeral industry to ascertain a better understanding of the issues and problems. Families invest in a burial society to provide assistance with a funeral because they trust the burial society to deliver their services when needed. This study has shown that burial societies are hindered by a lack of managerial skills and are hesitant to change their business structure (such as increasing fees or limiting beneficiaries) to offset the increase in money spent on funerals, which is rapidly outpacing their income. Funeral homes offer burial schemes in addition to their funeral services to attract and maintain business. These burial schemes are better managed than their burial society counterparts, but an increase in competition, especially from illegal establishments, is drawing away an increasing amount of customers and profits.
Thesis (M.A.)-University of KwaZulu-Natal, 2006.

Uganda has experienced 1.6 million deaths to HIV/AIDS related illness. Introduction of free-ART in rural hospitals that bear the burden od AIDS reduces adults morbidity and mortality. The study design was a quantitative, retrospective and descriptive design through data mining of medical records. In the six years, hospital admissions decreased by 16.7% and the median age at death increased by seven years. Hospital admissions decreased from three to seven deaths per 100 admissions per month. Male and female mortality was 1:1.6 and females in the 15-34 age group had a 37% higher likeliness of dying in hospital compared to males. Deaths from sub-countries with an ART site reduced by 4% to 8.6%. The data revealed that despite ART coverage of 60%, mortality rates showed a rising trend. Free access to ART's over three years did not make any observable changes to overall mortality. Therefore, ART access contributed to a decline in overall hospital admissions, an increase in median age at time of death and a reduction in deaths from sub-counties with an ART site. There was no reduction in overall hospital mortality rate.
M.A. (Public Health)
Health Studies

A thesis submitted to the Faculty of Humanities, University of Witwatersrand, Johannesburg, South Africa in fulfilment of the requirements of the Degree of Doctor of Philosophy in the field of Demography and Population Studies.
Background: In exploring the relationship between migration and HIV/AIDS, a focus of earlier studies was on the role of the mobile population in the geographical spread of the disease. There has been a shift in this perception and the focus now is on the implications of being a migrant. A body of literature has developed on the risk of migrants contracting HIV, but only a few studies have examined the AIDS/TB mortality risk as a consequence of migration, with the results showing that migrants have higher chance of dying of AIDS/TB compared to their non-migrant counterparts. However, these studies mainly looked at the impact of migration on mortality due to AIDS/TB and did not make provision for the presence of other causes of death. Therefore, this study is geared towards investigating migration as it relates to death caused by AIDS/TB, longitudinally, and in the presence of other causes such as non communicable diseases, other infectious diseases, and external causes of death, in rural South Africa. Specifically, the study addressed the following questions: (i) What is the risk of dying from AIDS/TB among migrants in rural South Africa in the presence of other causes of death? (ii) How does this relationship compare with the relationship between migration and other causes of death? (3) What are possible predictors of the relationship between migration and AIDS/TB in the presence of other causes of death? Method: This research project is part of a longitudinal study of the inhabitants of the Agincourt sub-district, situated in the rural north-eastern part of South Africa. The study utilises the Agincourt Health and Demographic Surveillance System data spanning 12 years, starting from 1st January, 2000 to 31st December, 2011. The main target group for the study is individuals aged 20 to 69 years at the date of analysis. The selected individuals are divided into the following categories: (i) the return migrants who returned after spending a period of time outside the study area; (ii) the in-migrants who moved into the study location for the first time, and (iii) the permanent residents (non migrants). A six month residence threshold period is used to distinguish participants from ordinary visitors. The migration status categorical variable was further expanded from three to five categories with in-migrant and return migrant categories being split to accommodate short and long-term durations of exposure. In the year 2000, the baseline year, a total of 25,621 individuals who met the entry criteria were recruited into the study. For data analysis, a Fine and Gray model is used, which is a variant of a Cox proportional hazard model, to estimate the competing risk of dying among the selected participants by sex. The causes of death (CoD) variable was categorised into the following broad categories: “AIDS/TB”, “Non Communicable Disease”, “External cause” and “Other infectious disease”, with indeterminate causes coded as missing. The five categories of migration serve as the independent variable, with permanent residence acting as the reference group, while the broad Cause of Death categories are the main dependent variables. Other dependent variables are: period, nationality, education and socio-economic status. Results: This first set of results aims to address the question on the risk of AIDS/TB mortality among migrants in rural South Africa in the presence of other causes of death. The findings are that male and female short-term return migrants have significantly higher relative risk of dying of AIDS/TB death when compared to their non-migrants counterparts with sub-hazard ratio (SHR) of 4.87 (95% CI 4.17-5.72; P<0.001) and 5.44 (95% CI 4.64-6.38; P<0.001)) reported for both gender group respectively. For male and female long-term return migrants, their SHR was 1.80 (95% CI 1.43-2.26; P<0.001) and 2.06 (95% CI 1.57-2.70; P<0.001) respectively. The results did not reveal significant results for the in-migrants. The second set of results aims to address the second research question, which is, how does the relationship between migration and mortality caused by AIDS/TB in rural South Africa in the context of other causes of death compare with the relationship between migration and causes different from AIDS/TB. The results show that Short-term return migrants have higher mortality than non-migrants, whatever the four causes of mortality. For instance, the competing risk of death due to AIDS/TB for short-term return migrants compared to non-migrants showed a lower SHR for external cause of death, namely 8.78 (95% CI 5.86-13.16; P<0.05) vis-à-vis non-migrants. This implies that the difference in the relative risk of mortality between migrants and non migrants is even higher for external causes than for AIDS/TB. The same is applicable to the risk of death from other infectious diseases for females, which has a SHR of 4.97 (95% CI 2.50-9.89; P<0.05) in the competing risk model. The relative risk of death due to AIDS/TB for male is 4.87 (95% CI 4.14-5.72 P<0.001) while that of female is 5.44 (95% CI 4.64-6.38; P<0.001); respectively. With regards to the question on the possible predictors of the relationship between migration and AIDS/TB in the presence of other causes of death, it is shown that period is one of the predictors of the relationship between migration and AIDS/TB mortality. And, it is relevant to the study participants who died as a result of AIDS/TB, NCDs and other infectious diseases. In general, the risk dwindles in the latter period when the antiretroviral drugs become available for AIDS/TB. Nationality is also a determinant of the relationship and it is applicable to those who lost their lives due AIDS/TB (female only), NCDs and other infections (female). In all, the Mozambican nationals are less likely to die in comparison with the South Africans. Educational status is a predictor and it relevance cuts across virtually all the causes of death. The dominant pattern that is revealed in this context is that the higher the level of education, the lower the risk of death due to any of the causes. The predictive impact of SES can only be felt among the respondents whose death was due to AIDS/TB and NCDs (female only). Conclusion: With circular labour migration in South Africa showing no evidence of declining and with the attendant mortality risks due to AIDS/TB and other causes, and needs to be carefully considered - in policies aiming to control mortality in South Africa. Disease-induced migration creates burdens not only for the left-behind families in terms of their means of livelihood through loss of remittances, but also for the burden on health care facilities in the rural area. With short-term labour migrants being a high risk group, the success of intervention programmes addressing the problem of HIV infection and the resultant mortality implication, such as ‘treatment as prevention’ programmes, can only be guaranteed by recognising the risks incumbent on this group of people and the influence of the larger communities.
XL2018

Purpose of the study - Identify predictors of mortality and develop a related care plan for patients who are on antiretroviral therapy (ART) in Gondar, Ethiopia. Design - A quantitative, retrospective cohort study was conducted analysing medical records of HIV patients who presented to Gondar University Hospital (GUH), Gondar, and started ART between 1 January 2007 and 30 June 2010. Results - In defining the predictors of mortality, the findings in bivariate analysis revealed: female sex, CD4 cell count ≤ 50/μl, CD4 cell count 51-199/μl, a haemoglobin concentration ≤8g/dl, a history of oral candidiasis, tuberculosis and Cryptococcus meningitis were all statistically significant. A female sex, CD4 cell count ≤ 50/μl and CD4 cell count 51-199/μl maintain their significance level in the multivariate analysis. Conclusions - The study therefore recommends that clinicians and case managers be vigilant of these predictors of mortality while managing HIV patients who are on ART. Key Concepts- ART, AIDS, HIV, predictors of mortality
Health Studies
(M.A. (Public Health))

Introduction. Previous studies have established that infants born to mothers with advanced HIV disease and co-infections are smaller, premature and have rapidly progressive HIV disease and an early death. King Edward VIIIth Hospital, in Durban, admits many sick mothers and manages a large proportion of low birth weight and ill newborns. On discharge and follow-up, the mortality and morbidity of these infants are known to be high and are related to the prematurity. How much is related to being HIV exposed is still uncertain. Aim. To determine the perinatal transmission rate of HIV-1 and mortality at 12 months in HIV exposed infants that were admitted to and discharged from the Neonatal Unit, in Durban, South Africa. Methods. In this observational study, data from the outpatient charts of HIV exposed infants that required specialised neonatal care and subsequent follow up, between the period November 2007 and December 2009, were collected. Perinatal transmission rates and mortality of these infants were compared with maternal and infant risk factors. Results. Data on 463 HIV exposed, predominantly low birth weight infants are presented. The median maternal CD4 count was 309cells/mm3 with 16.8% of mothers commenced on HAART. Maternal co-infection with TB was found in 19.2% of the cohort. Early HIV transmission occurred in 11.5% of infants and was influenced by the type of ARV exposure (None, 20%; single dose NVP, 14.3%; dual therapy, 10.6%; maternal HAART, 8.5%). The dual therapy regimen for 7 days was more protective than that for 28 days (p=0.045). HIV infection was associated with higher risk of neonatal sepsis (RR 1.6; 95% CI, 1.1-2.3; p=0.015). The mortality for the cohort at 12 months was 10%. Maternal HAART was associated with a lower mortality: 2.95% vs.10.2% (RR 3.0; 95% CI, 0.4-20.5). There was a higher mortality rate in those that were low birth weight (RR 4.2; 95% CI, 1.02-18.8; p=0.037); those that were HIV infected (RR 4.8; 95% CI, 1.9-11.6; p=0.002) and those that were breastfeeding compared to formula feeding (RR 2.7; 95% CI, 1.1-6.8; p=0.038). Discussion. Rates of HIV transmission within the PMTCT programme were similar to that reported by the Department of Health. Early maternal ARVs for PMTCT prophylaxis, prevents HIV transmission. The coverage of maternal HAART was sub-optimal. Breastfeeding was associated with a higher HIV transmission rate and was most likely associated with non-exclusive breastfeeding during neonatal admission. Recommendations. Maternal HAART or ARV prophylaxis should be commenced early in the pregnancy for the best benefits. Meticulous attention should be paid to the feeding practices of high risk HIV exposed infants admitted for specialised neonatal care.
Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2012.

Background: Although the prevalence of pneumonia in pregnancy is reported to be less than 1%, the pregnant state and risk factors associated with the development of pneumonia adversely influence the outcome of pregnancy. KwaZulu-Natal is at the epicenter of the dual epidemics of tuberculosis and HIV-1 and the impact of these diseases occurring concurrently in pregnant women at King Edward VIII hospital (KEH), South Africa have been described previously. The impact of antenatal pneumonia in HIV-1 infected and uninfected women however has not been described in the study population and was investigated. Methods: Pregnant women with clinical and radiological evidence of pneumonia were recruited from the antenatal clinic and labour ward at KEH. The study was conducted prospectively between January and December 2000. The clinical profile of these women and the causative organisms were determined. In addition the impact of HIV-1 infection, maternal immunosuppression and maternal pneumonia on obstetric and perinatal outcomes were evaluated. Mothers diagnosed with tuberculosis and multi drug resistant tuberculosis were hospitalised at King George V hospital until delivery. Results: Twenty nine women were diagnosed with antenatal pneumonia (study arm) with Mycobacterium tuberculosis the only causative organism isolated. A control arm of 112 pregnant women was also studied. Maternal and perinatal mortality was restricted to the study arm with a maternal mortality ratio of 99 per 100 000 live births and a perinatal mortality rate of 240 per 1000 births. Pneumonia was significantly associated with a negative overall obstetric outcome in the presence of HIV- l infection, antenatal care, anaemia and second trimester booking status. In addition, the presence of pneumonia was significantly associated with maternal mortality. There was a highly significant association between exposure to pneumonia and poor neonatal outcome. Maternal pneumonia, maternal HIV infection and the presence of medical and obstetric conditions were significantly associated with low birth weight and neonatal pneumonia. Further, maternal pneumonia (p <0.001) and concurrent HIV infection (p=0.002) was significantly associated with neonatal death. Conclusion: The presence of pneumonia in the antenatal period impacts negatively on maternal and neonatal morbidity and mortality. Health care providers must maintain a high degree of suspicion when managing a pregnant woman with unresolving upper respiratory tract symptoms and refer timeously for further investigation. Pneumonia and in particular pulmonary tuberculosis associated with HIV co- infection in pregnancy is a threat to mother and baby. Therefore in areas endemic for TB and HIV infection, it may be prudent to screen HIV positive pregnant women for symptoms suggestive of pneumonia and thereby identify women requiring further investigations such as sputummicroscopy and cultures, and a screening chest radiograph.
Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2007.

Introduction. The Human Immunodeficiency Virus (HIV) is the main contributor to rising child mortality in South Africa. Although prevention of mother-to-child transmission programmes have been implemented in the country, little is known about the clinical and loss to follow-up outcomes of infants born to HIV-infected women attending these programmes. Purpose. The purpose of the study was to describe the clinical and loss to follow-up outcomes of HIV-exposed infants whose mothers had received antiretroviral therapy or prophylaxis during their pregnancy at the Prevention of Mother-to-Child Transmission programme at McCord Hospital. Furthermore, maternal socio-demographic characteristics associated with these outcomes were determined. Methods. An observational retrospective cohort study design was used. The study population consisted of infants whose mothers had received antiretroviral prophylaxis or therapy at McCord Hospital, and were delivered at McCord Hospital, and/or were brought back to McCord Hospital, following delivery from 1 May 2008 to 31 May 2009. Results. Data on 265 infants was analysed. Of the 220 infants who were tested, the HIV transmission risk was 2.7% (n=6; 95% Cl: 1.0% to 5.8%) at 6 weeks of age. Overall, 40.4% of infants in the cohort were lost to follow-up (n=105, 95% Cl: 34.4 to 46.6). In the multivariable model (n=253), late booking for first antenatal visit at or after 28 weeks of gestation (adjusted hazard ratio (AHR) 2.3; 95% Cl: 1.0 to 5.1, p=0.044) was a risk factor for loss to follow-up. Compared to having an emergency caesarean section, having an elective caesarean section (AHR 1.9; 95% Cl: 1.1 to 3.5) or normal vaginal delivery (AHR 2.5; 95% Cl: 1.4 to 4.5) was significantly associated with loss to follow-up of infants. Discussion. The substantial attrition of infants born to HIV-infected mothers in the Prevention of Mother-to-Child Transmission programme at McCord Hospital undermined the goals of the programme, and underestimated the effect of infectious disease morbidity, mortality and HIV transmission risk associated with these infants. Recommendations. Counselling mothers on the health benefits to their HIV-exposed infants of attending the follow-up clinic and tracing of infants who have been lost to follow-up is vital to the operational effectiveness of the Prevention of Mother-to-Child Transmission programme at McCord Hospital.
Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.