Dissertations / Theses on the topic 'Newborn infants Diseases Prevention'

The incidence of Low Birth Weight (LBW) babies born in the Uitenhage Provincial Hospital would seem to be a cause of concern from a public health of view. The incidence of 21% recorded during 1999 is markedly higher than the 7% recorded in the United States of America in 1998 and the average of 17% noted for developing countries. Some health concerns related to LBW babies are Sudden Infant Death Syndrome, scholastic performances later in life, and several chronic diseases in adults associated with them having been born as LBW babies.

High frequencies of CTL recognizing laboratory strains of HIV-1 are present in HIV-1 infected adults as early as preseroconversion. The presence of HIV-1 specific CTL during primary infection has been correlated with better control of early viremia and a more delayed onset of CD4 lymphocyte loss. Previous experiments in our laboratory have demonstrated that, unlike HIV-1 infected adults, the majority of vertically infected infants lack CTL which recognize laboratory strains of HIV-1 within the first year of life. ADCC antibody responses against laboratory strains of HIV-1 env gene products are also delayed until at least two years of age. As a possible correlate, disease progression is also more rapid in vertically infected infants. We hypothesized that HIV-1-specific CTL are type-specific in early infancy and that the use of target cells expressing laboratory strain gene products might limit the detection of HIV-1-specific CTL. To address this hypothesis, HIV-1 env genes from early isolates of four infants were PCR amplified, cloned, and used to generate recombinant vaccinia vectors (vv). The frequencies of CTL precursors (CTLp) recognizing env gene products from autologous isolates and the IIIB strain of HIV-1 were measured at time points from early infancy to 19 months using limiting dilution analysis (LDA). ADCC titers were also measured against autologous and IIIB env gene products at 4 time points spanning 2 months to 2 years of age. CTL precursors from 3 of 4 of these patients were specific only for autologous HIV-1 env gene products during the first 6 to 12 months of age. A pattern of CTL responsiveness was observed in these 3 patients in which type-specific CTL precursors observed in early infancy were replaced by cross-reactive, group-specific CTL by 6 to 12 months of age. CTL precursors from a fourth patient at 12 months of age recognized IIIB env and 1 out of 2 envs derived from 2 autologous viral isolates. High titers titers of ADCC antibodies against autologous env were detected in two infants prior to the detection of ADCC antibodies to IIIB. In two other infants, group specific ADCC antibody responses were detected in late infancy. Our results demonstrate that young infants can mount HIV-1 specific CTL and ADCC responses. The ability of young infants to mount cellular immune responses to HIV-1 also provides support for the concept of perinatal vaccination to prevent HIV-1 transmission. Furthermore. the lack of broadly-reactive CTL in early infancy suggests that the use of vaccines based on laboratory strains of HIV-1 may not afford protection from vertical infection.

Made available in DSpace on 2014-06-11T19:29:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-08-23Bitstream added on 2014-06-13T19:59:17Z : No. of bitstreams: 1 000736008.pdf: 2094696 bytes, checksum: 7ab992c2bf8c7520fd68c3ad6ff612c6 (MD5)
A vigilância da mortalidade infantil e fetal é uma das prioridades do Ministério da Saúde. Contribui para o cumprimento dos compromissos assumidos pelo Governo Brasileiro em defesa da criança, tais como o Objetivo de Desenvolvimento do Milênio, o Pacto pela Redução da Mortalidade Neonatal; o Pacto pela Vida e, mais recentemente, o Programa Mais Saúde e Rede Cegonha. O objetivo geral deste estudo foi identificar as áreas do município de Botucatu/SP, com maior concentração de recém-nascidos classificados como com risco de adoecer ou morrer, considerando-se o ano de 2010 e utilizando técnicas de geoprocessamento. Para análise de dados, buscou-se identificar as ocorrências por setor censitário, relacionandoas a condições sociais e ambientais. Trata-se de estudo observacional de caráter analítico. Foram utilizados como fonte de dados: o Sistema de Informações de Nascidos Vivos e informações sobre condições sociais e ambientais obtidas do banco de dados do Censo Demográfico 2010 para o município de Botucatu. Como resultados do estudo foram identificados um agrupamento alto (Jardim Riviera e Jardim Santa Elisa) e outro baixo (Jardim Paraíso II e Jardim Altos do Paraíso), áreas com grande e pequeno número de casos, respectivamente. Nenhuma relação dos casos com condições ambientais foi identificada. Quanto às condições sociais, as análises encontraram associação entre renda e risco social. Ausência de companheiro e idade materna inferior a 19 anos foram importantes fatores de risco neonatal no município. Concluiu-se que o município de Botucatu é homogêneo para questões ambientais, não havendo associação entre estas e o risco do recém-nascido. A renda foi o único fator capaz de captar eventuais desigualdades existentes, influenciando indiretamente na classificação de risco do neonato ao nascer. Mostrou-se necessário o desenvolvimento de ações que incentivem a...
Surveillance on child and fetal mortality is one of the priorities of the Ministry of Health. It contributes to the fulfillment of commitments taken by the Brazilian Government for children’s defense, such as the Millennium’s Development Objective; Agreement for Reduction of Neonatal Mortality; Agreement for Life and, more recently, the Mais Saúde and Rede Cegonha Programs. The goal of this study is to identify areas in the city of Botucatu/SP with a higher concentration of newborns classified as at risk for falling ill or dying by considering the year of 2010 and using geoprocessing techniques. For data analysis, was sought to identify occurrences per census tract, relating them to the social and environmental conditions. This was an observational study of analytical character. Were used as the data source: the System of Information on Live Newborns and information of social and environmental conditions obtained from the database of the 2010 Demographic Census for the city of Botucatu. As results from the study, was identified a high cluster (Jardim Riviera e Jardim Santa Elisa) and a low one (Paraíso II e Jardim Altos do Paraíso), areas with large and small numbers of cases, respectively. No relationship of cases with environmental conditions has been identified. As social conditions, the analysis found an association between income and social risk. Lack of partner and maternal age less than 19 years were significant neonatal risk factors in municipality. It was concluded that Botucatu is homogeneous for environmental issues, there was no association between them and newborn risk. Income was the only factor capable of capturing any inequalities, indirectly influencing the risk rating of the neonate at birth. Proved necessary to develop actions that promote the inclusion of family planning in the context of life of young people, especially at the neighborhoods of the high cluster, where ...

Orientador: Cristina Maria Garcia de Lima Parada
Coorientador: Cassiano Victória
Banca: Maria Candida de Carvalho Furtado
Resumo: A vigilância da mortalidade infantil e fetal é uma das prioridades do Ministério da Saúde. Contribui para o cumprimento dos compromissos assumidos pelo Governo Brasileiro em defesa da criança, tais como o Objetivo de Desenvolvimento do Milênio, o Pacto pela Redução da Mortalidade Neonatal; o Pacto pela Vida e, mais recentemente, o Programa Mais Saúde e Rede Cegonha. O objetivo geral deste estudo foi identificar as áreas do município de Botucatu/SP, com maior concentração de recém-nascidos classificados como com risco de adoecer ou morrer, considerando-se o ano de 2010 e utilizando técnicas de geoprocessamento. Para análise de dados, buscou-se identificar as ocorrências por setor censitário, relacionandoas a condições sociais e ambientais. Trata-se de estudo observacional de caráter analítico. Foram utilizados como fonte de dados: o Sistema de Informações de Nascidos Vivos e informações sobre condições sociais e ambientais obtidas do banco de dados do Censo Demográfico 2010 para o município de Botucatu. Como resultados do estudo foram identificados um agrupamento alto (Jardim Riviera e Jardim Santa Elisa) e outro baixo (Jardim Paraíso II e Jardim Altos do Paraíso), áreas com grande e pequeno número de casos, respectivamente. Nenhuma relação dos casos com condições ambientais foi identificada. Quanto às condições sociais, as análises encontraram associação entre renda e risco social. Ausência de companheiro e idade materna inferior a 19 anos foram importantes fatores de risco neonatal no município. Concluiu-se que o município de Botucatu é homogêneo para questões ambientais, não havendo associação entre estas e o risco do recém-nascido. A renda foi o único fator capaz de captar eventuais desigualdades existentes, influenciando indiretamente na classificação de risco do neonato ao nascer. Mostrou-se necessário o desenvolvimento de ações que incentivem a ...
Abstract: Surveillance on child and fetal mortality is one of the priorities of the Ministry of Health. It contributes to the fulfillment of commitments taken by the Brazilian Government for children's defense, such as the Millennium's Development Objective; Agreement for Reduction of Neonatal Mortality; Agreement for Life and, more recently, the Mais Saúde and Rede Cegonha Programs. The goal of this study is to identify areas in the city of Botucatu/SP with a higher concentration of newborns classified as at risk for falling ill or dying by considering the year of 2010 and using geoprocessing techniques. For data analysis, was sought to identify occurrences per census tract, relating them to the social and environmental conditions. This was an observational study of analytical character. Were used as the data source: the System of Information on Live Newborns and information of social and environmental conditions obtained from the database of the 2010 Demographic Census for the city of Botucatu. As results from the study, was identified a high cluster (Jardim Riviera e Jardim Santa Elisa) and a low one (Paraíso II e Jardim Altos do Paraíso), areas with large and small numbers of cases, respectively. No relationship of cases with environmental conditions has been identified. As social conditions, the analysis found an association between income and social risk. Lack of partner and maternal age less than 19 years were significant neonatal risk factors in municipality. It was concluded that Botucatu is homogeneous for environmental issues, there was no association between them and newborn risk. Income was the only factor capable of capturing any inequalities, indirectly influencing the risk rating of the neonate at birth. Proved necessary to develop actions that promote the inclusion of family planning in the context of life of young people, especially at the neighborhoods of the high cluster, where ...
Mestre

Made available in DSpace on 2014-06-11T19:29:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2011Bitstream added on 2014-06-13T18:59:45Z : No. of bitstreams: 1 costa_el_me_botfm.pdf: 250558 bytes, checksum: 70bf179aa259c3c0b523630a00bdc8c1 (MD5)
Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS)
A análise da evolução e principais características dos nascimentos no Brasil no período de 2000 a 2007 evidencia que mulheres com idade de 15 a 19 anos, no momento do parto, respondem por 20% dos nascimentos no país. Estudos indicam que a gravidez na adolescência, etapa da vida de 10 a 19 anos, está associada a eventos adversos no recém- -nascido como baixo peso, prematuridade e comprometimento das condições de vitalidade ao nascimento. Dois objetivos foram definidos: 1.Revisar a ocorrência de partos prematuros e de baixo peso ao nascer com a gravidez em adolescentes e sua condição socioeconômica e cultural. Analisar os nascimentos, descrevendo-os segundo características da gestação, do parto e do recém-nascido. Dois trabalhos foram realizados para responder os objetivos. O primeiro compreende um artigo de revisão de um levantamento bibliográfico onde foram identificados textos que abordam assunto e o segundo um artigo original. Neste trabalho foram analisadas 24.800 declarações de nascidos vivos, correspondentes aos partos hospitalares ocorridos no Hospital Regional da Asa Sul (HRAS), no período de 1º de janeiro de 2006 a 31 de dezembro de 2009. As faixas etárias maternas foram estratificadas em: adolescente precoce, idade entre 10 a 14 anos; adolescente tardia, idade de 15 a 19 anos e adultas jovens, de 20 a 35 anos. Foi utilizando o programa estatístico SPSS versão 17.0 e aplicado o Qui-quadrado de Pearson com significância de 5 %. Rocha et al apuraram que a ocorrência de baixo peso logo após o nascimento no grupo de gestantes precoces foi muito maior (13,5%) em relação ao grupo de gestantes tardias (3,1%); identificaram no seu estudo que 91,3% das gestantes precoces possuíam somente o ensino fundamental, enquanto que as gestantes tardias representavam 55,5%. Ainda nessa pesquisa...
An analysis of the development and main characteristics of births in Brazil from 2000 to 2007 suggests that women aged 15 to 19 at childbearing represent 20% of births in this country. Studies have demonstrated that pregnancy among teenagers, a stage of life between the ages of 13 and 19, is associated with adverse birth outcomes such as low-birth weight, prematurity and compromised vitality conditions at birth. Two objectives were defined:To revise the incidence of preterm births and low-birth weight in teenage pregnant mothers and their socioeconomic and cultural condition. To analyse the births, describing them according to pregnancy, delivery and newborn infant characteristics. Two studies were carried out to meet the objectives. The first one is a review article based on reference materials in which article s related to the topic were identified, and the second one, the original article. In the present study, we analysed 24.8000 declarations of live births corresponding to hospital births at the Hospital Regional da Asa Sul (HRAS), from January 1, 2006, to December 31, 2009. The mother age groups were stratified in: precocious adolescent, aged between 10 to 14; late adolescent, between 15 to 19; and young adult, between 20 to 35. We used the statistical program SPSS version 17.0 and applied the Chi-square Pearson with 5% level of significance. Rocha et al concluded that the incidence of low-birth weight in the group of precocious pregnant adolescents was much higher (13.5%) if compared to the group of late pregnant adolescents (3.1%); it was also showed that 91.3% of precocious pregnant adolescents had just basic schooling while in the late pregnant adolescents, 55.5%. Still in this study it has been showed that 37.5% of precocious pregnant adolescents had poor prenatal care, having fewer than 07 visits... (Complete abstract click electronic access below)

Gestational diabetes mellitus (GDM) and infant macrosomia are important obstetric health concerns for Aboriginal populations in Canada. Previous research in non-Aboriginal populations has established that GDM and macrosomia are associated with increased risk of fetal morbidity. Specifically, GDM is a risk factor for infant macrosomia, hypoglycemia, polycythemia, hypocalcemia, and hyperbilirubinemia. Furthermore, macrosomia is an independent risk factor for shoulder dystocia, clavicular fracture, brachial plexus injury, birth asphyxia and operative delivery. The main objectives of this study were to determine prevalence rates of GDM and macrosomia related neonatal complications for the James Bay Cree population of northern Quebec, and to identify risk factors for specific birth trauma injuries and metabolic complications in the population. The prevalence of macrosomia (≥4500 g) was 10.4%, and the estimated prevalence of GDM was 16.6% (95% CI 14.6-18.6) (n = 229/1379). Shoulder dystocia was the most common birth trauma event among the Cree, affecting 2.5% (n = 42/1650) of all Cree births, and 9.3% (n = 16/172) of macrosomic deliveries ≥4500 g. The prevalence of neonatal hypoglycemia was also high, affecting 8.8% (n = 144/1650) of all Cree newborns, and 18.1% (n = 34/192) of GDM deliveries. Macrosomia (BW ≥ 4500 g) was a significant risk factor for shoulder dystocia, clavicular fracture, hypoglycemia, and caesarean section delivery. After adjusting for maternal age, parity, and gestational age, GDM was identified as a significant risk factor for macrosomia (≥4500 g), hypoglycemia, polycythemia, and hypocalcemia. In summary, this study identified a high incidence of neonatal complications among the James Bay Cree compared with rates in the general North American population. These outcomes can be explained, in part, by high prevalence rates of gestational diabetes and infant macrosomia. Further studies to investigate the long-term consequences of GDM and

A sustainable primary prevention strategy for infant iron deficiency anemia (IDA) was implemented and evaluated in a community with at-risk infants in northern Quebec, Canada. Communication strategies were used to promote iron-rich complementary food rather than iron-fortified formula, which can interfere with breastfeeding practice. This food-based approach has been successfully implemented in developing countries, but has not been applied in an industrialized country setting.
Mass media (i.e., radio dialogues, key messages, print material, point-of-purchase grocery store display) and interpersonal (i.e., homemade baby food cooking activity) communication strategies were developed in collaboration with community members and implemented in partnership with an existing community program. Reach and exposure of the strategies were measured using a questionnaire administered to a post-intervention sample (n = 45). Sales of promoted iron-rich infant food were examined pre- and post-intervention period. A repeat cross-sectional design was used for the impact evaluation. Two groups of mothers with infants, aged 7-10 months at Time 1 (n = 32) and Time 2 (n = 22) were interviewed. Outcome variables were infants' total iron and complementary food iron intakes measured by two 24-hour recalls. Secular trends in infants' hemoglobin values and milk type consumption were examined in the study community and two comparison communities.
Multiple communication channels increased awareness of IDA and influenced self-reported use of iron-rich infant food. Iron-rich infant food sales increased from pre- to post-intervention (p < 0.05). Complementary food intake iron increased between Time 1 (3.2 +/- 0.8 mg) and Time 2 (4.4 +/- 1.1 mg) (p < 0.05). The proportion of infants with anemia (hemoglobin < 110 g/L) significantly decreased from the period before (37.2%) to during (14.3%) the intervention (p < 0.05). No significant difference was found for this variable within the comparison communities. The proportion of infants receiving iron-fortified formula in the study community did not differ between Time 1 and Time 2, but increased from Time 1 (55%) to Time 2 (73%) (p < 0.05) in the comparison communities, indicating an erosion of breastfeeding practice.
These results suggest the effectiveness of communication strategies to improve infant iron nutrition in a community with good access to iron-rich infant food. The potential for this strategy in other communities warrants further investigation.

Orientador: Adriano Dias
Coorientador: Maria Cristina Ferreira Sena
Banca: Olímpio Barbosa de Moraes Filho
Banca: Adriano Bueno Tavares
Resumo: A análise da evolução e principais características dos nascimentos no Brasil no período de 2000 a 2007 evidencia que mulheres com idade de 15 a 19 anos, no momento do parto, respondem por 20% dos nascimentos no país. Estudos indicam que a gravidez na adolescência, etapa da vida de 10 a 19 anos, está associada a eventos adversos no recém- -nascido como baixo peso, prematuridade e comprometimento das condições de vitalidade ao nascimento. Dois objetivos foram definidos: 1.Revisar a ocorrência de partos prematuros e de baixo peso ao nascer com a gravidez em adolescentes e sua condição socioeconômica e cultural. Analisar os nascimentos, descrevendo-os segundo características da gestação, do parto e do recém-nascido. Dois trabalhos foram realizados para responder os objetivos. O primeiro compreende um artigo de revisão de um levantamento bibliográfico onde foram identificados textos que abordam assunto e o segundo um artigo original. Neste trabalho foram analisadas 24.800 declarações de nascidos vivos, correspondentes aos partos hospitalares ocorridos no Hospital Regional da Asa Sul (HRAS), no período de 1º de janeiro de 2006 a 31 de dezembro de 2009. As faixas etárias maternas foram estratificadas em: adolescente precoce, idade entre 10 a 14 anos; adolescente tardia, idade de 15 a 19 anos e adultas jovens, de 20 a 35 anos. Foi utilizando o programa estatístico SPSS versão 17.0 e aplicado o Qui-quadrado de Pearson com significância de 5 %. Rocha et al apuraram que a ocorrência de baixo peso logo após o nascimento no grupo de gestantes precoces foi muito maior (13,5%) em relação ao grupo de gestantes tardias (3,1%); identificaram no seu estudo que 91,3% das gestantes precoces possuíam somente o ensino fundamental, enquanto que as gestantes tardias representavam 55,5%. Ainda nessa pesquisa... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: An analysis of the development and main characteristics of births in Brazil from 2000 to 2007 suggests that women aged 15 to 19 at childbearing represent 20% of births in this country. Studies have demonstrated that pregnancy among teenagers, a stage of life between the ages of 13 and 19, is associated with adverse birth outcomes such as low-birth weight, prematurity and compromised vitality conditions at birth. Two objectives were defined:To revise the incidence of preterm births and low-birth weight in teenage pregnant mothers and their socioeconomic and cultural condition. To analyse the births, describing them according to pregnancy, delivery and newborn infant characteristics. Two studies were carried out to meet the objectives. The first one is a review article based on reference materials in which article s related to the topic were identified, and the second one, the original article. In the present study, we analysed 24.8000 declarations of live births corresponding to hospital births at the Hospital Regional da Asa Sul (HRAS), from January 1, 2006, to December 31, 2009. The mother age groups were stratified in: precocious adolescent, aged between 10 to 14; late adolescent, between 15 to 19; and young adult, between 20 to 35. We used the statistical program SPSS version 17.0 and applied the Chi-square Pearson with 5% level of significance. Rocha et al concluded that the incidence of low-birth weight in the group of precocious pregnant adolescents was much higher (13.5%) if compared to the group of late pregnant adolescents (3.1%); it was also showed that 91.3% of precocious pregnant adolescents had just basic schooling while in the late pregnant adolescents, 55.5%. Still in this study it has been showed that 37.5% of precocious pregnant adolescents had poor prenatal care, having fewer than 07 visits... (Complete abstract click electronic access below)
Mestre

Thesis (MCur)--Stellenbosch University, 2011.
ENGLISH ABSTRACT: The impact of infant feeding practices in the prevention of mother-to-childtransmission of HIV raised concerns in the field of health services. Breast feeding adds an additional 15-30% risk of HIV transmission to the infant; therefore, mothers who are HIV-positive are in need of information regarding safe infant feeding. A descriptive design for this particular study was applied with a primary quantitative approach. A convenient sample of sixty (n=60) participants between the ages of 15 – 37 were taken from subjects that enrolled in the prevention of mother-to-child transmission (PMTCT) programme in Onandjokwe district. The sample formed 85% of the target population (N=71). A structured questionnaire with closed and openended questions was used and completed by the researcher. Ethical approval for the study was obtained from the Ethics Committee at the Faculty of Health Sciences, University of Stellenbosch. Permission to conduct the research was obtained from the Ministry of Health and Social Services, Namibia, and the Onandjokwe district Hospital. A pilot study was conducted that constituted 25% of the sample. Validity and reliability was insured by the pilot study and the consultation of an expert in HIV research and an expert in nursing research. The presentation of results was mostly descriptive in nature by using frequency tables and a pie chart. The results showed that all participants (n=60/100%) were offered HIV counselling and testing during antenatal care. Mothers who were HIV positive knew that there is a possibility that the baby might be infected through breast milk. Furthermore, the study found that 70% (n=42) of participants used breast feeding exclusively, 20% (n=12) used replacement feeding and 10% (n=6) used mixed feeding practices. It was concluded that pregnant women and mothers known to be HIV-infected should be informed of the infant feeding practice recommended by the national or subnational authority to improve HIV-free survival of HIV-exposed infants. This includes information about the risks and benefits of various infant feeding options based on local assessments and guidance in selecting the most suitable option for their own situation.
AFRIKAANSE OPSOMMING: Die invloed van voedingspraktyke vir babas by die voorkoming van moeder-na-kindoordrag van die menslike immuungebrekvirus (MIV) het kommer op die gebied van gesondheidsdienste laat ontstaan. Borsvoeding dra ’n addisionele 15–30% risiko van MIV-oordrag tot die baba by en daarom benodig moeders wat MIV-positief is inligting ten opsigte van veilige voeding van hulle babas. 'n Beskrywende ontwerp vir hierdie besondere studie is gebruik tesame met 'n primêr kwantitatiewe benadering. 'n Gerieflikheidsteekproef van sestig (n=60) deelnemers tussen die ouderdomme 15–37 jaar is gekies uit persone wat ingeskryf het vir die voorkoming van moeder-na-kind-oordrag (VMNKO) program in Onandjokwe-distrik. Die steekproef het 85% van die teikenpopulasie (N=71) uitgemaak. 'n Gestruktureerde vraelys met geslote en oop vrae is gebruik en deur die navorser voltooi. Etiese goedkeuring vir die studie is verkry van die Etiese Kommitee van die Fakulteit Gesondheidswetenskappe, Universiteit Stellenbosch. Toestemming om die navorsing te doen, is verkry van die Ministerie van Gesondheid en Maatskaplike Dienste, Namibië, en die Onandjokwe Distrikshospitaal. 'n Loodsstudie is onderneem wat 25% van die steekproef behels het. Geldigheid en betroubaarheid is verseker deur die loodsstudie en oorlegpleging met 'n kundige op die gebied van MIV-navorsing en 'n kundige in verpleegnavorsing. Die aanbieding van resultate was meestal deskriptief van aard deur van frekwensietabelle en 'n sektordiagram gebruik te maak. Die resultate het getoon dat MIV-berading en -toetsing gedurende voorgeboortesorg aan alle deelnemers (n=60/100%) aangebied is. Moeders wat MIV-positief is, het geweet dat daar 'n moontlikheid bestaan dat die baba moontlik deur moedersmelk geïnfekteer kan word. Verder het die studie bevind dat 70% (n=42) van deelnemers uitsluitlik borsvoeding gebruik, 20% (n=12) gebruik ’n vervanging vir moedersmelk en 10% (n=6) gebruik gemengde voedingspraktyke. Daar is tot die slotsom gekom dat swanger vroue en moeders van wie bekend is dat hulle MIV-geïnfekteer is, ingelig behoort te word oor die babavoedingspraktyk aanbeveel deur die nasionale of subnasionale owerheid vir die verbetering van MIVvrye oorlewing van babas wat aan die MIV blootgestel is. Dit sluit in inligting oor die risiko’s en voordele van verskeie babavoedingsopsies gebaseer op plaaslike assesserings en leiding ten opsigte van die kies van die geskikste opsie vir hulle eie situasie.

A lesão nasal decorrente do uso da ventilação não invasiva (VNI) é um evento adverso cada vez mais comum nas unidades de terapia intensiva neonatais (UTIN) e apresenta consequências a curto e longo prazo. Esta lesão pode resultar em sequelas tanto de ordem estética quanto funcional, limitar o uso da VNI em RN que necessita desse suporte ventilatório, causar desconforto e septicemia; podendo aumentar, desta forma, o tempo de internamento na UTIN. Esta pesquisa tem por objetivo avaliar tecnológica e clinicamente os protetores nasais empregados na VNI de RN internados na UTIN. A metodologia consistiu primeiramente em levantar as possíveis causas da lesão nasal e avaliar os fatores de risco associados ao seu desenvolvimento. Em seguida, foi realizado um ensaio clínico randomizado para comparar os efeitos de três tipos de proteção nasal e das prongas novas e esterilizadas sobre a gravidade da lesão nasal. E por fim, foi realizada a caracterização térmica e estrutural dos protetores nasais após serem envelhecidas com temperatura e umidade no interior da incubadora neonatal. As principais causas da lesão foram relacionadas às características do material, a problemas no equipamento, a fatores assistenciais, neonatais e profissionais. Neste estudo, foram constatados como fatores de risco: a idade gestacional, a massa ao nascer, o tempo total de permanência na VNI, a reutilização deste suporte, o tempo da primeira utilização e da reutilização da VNI, bem como o tempo de internação na UTIN. Não foram observadas diferenças significativas na gravidade da lesão quando comparadas as três proteções estudadas, nem quando utilizadas prongas novas e esterilizadas. Quanto à análise dos materiais, foi constatado que a exposição à temperatura e à umidade alterou a percentagem de cristalinidade e a rugosidade das proteções nasais estudadas.
The nasal injury resulting from the use of non-invasive ventilation (NIV) is an adverse event increasingly common in the newborn intensive care unit (NICU) and shows the short and long term consequences. This lesion can result both aesthetic and functional sequelae, limit the use of NIV in newborns who need this ventilatory support, cause discomfort and septicemia, may thereby increase the length of stay in NICU. This research aims to evaluate technological and clinically nasal protectors used with NIV of newborns admitted to the NICU. The methodology consisted primarily in raising the possible causes of nasal injury and assess the risk factors associated with its development. Then, it was conducted a randomized clinical trial to compare the effects of three kind of nasal protector and new and sterilized prongs on the severity of nasal lesions. And finally, it was performed the thermal and structural characterization of nasal protection after being aged with temperature and humidity inside the neonatal incubator. The main causes of injury were related to characteristics of the material, equipment problems, assistive, neonatal and professional factors. In this study, it was found as risk factors: gestational age, weight at birth, the total time stay in the NIV, the reuse of this support, the time of first use and reuse of NIV and the length of stay in the NICU. They were not observed significant differences in lesion severity when compared the three protectors studied, nor when used new and sterilized prongs. The materials analysis indicated that exposure to temperature and humidity changed the percentage of crystallinity and the roughness of the nasal protections studied.

The dramatic improvement of neonatal intensive care has produced vexing ethical and legal questions. One of the most striking issues is to determine whether the most defective neonates should be provided with intensive care and to what extent they should be treated. This thesis demonstrates that an attempt to answer this question and an analysis of the demands and limitations of a duty to treat defective neonates cannot properly occur without first considering the legal concerns and ethical issues surrounding the notion of "person". The author examines germane ethical theories and North-American jurisprudence to see what approaches and standards commentators and courts have adopted in this respect. This thesis demonstrates that in the context of the cessation or non-initiation of intensive care, the legal and moral status of very defective neonates remain ambiguous. In particular, the author suggests that a legal best interests analysis that includes quality of life considerations may actually involve the use of criteria similar to those supported by the authors of the controversial moral theories that negate the personhood of seriously handicapped newborns. The author ultimately concludes that a clear divide between the legal definition of the "person" and the moral and social perceptions of that term is misleading.

Investigation of the relationship between iron deficiency, iron supplementation and susceptibility to infection, was suggested by the author's initial observations of an association of anaemia with serious bacterial infections in infancy in Papua New Guinea. The bulk of previous longitudinal clinical intervention studies in infancy showed beneficial effects of iron supplementation. However, defects of control and design and recording in these studies and contradictory anecdotal reports left the question unresolved. A prospective, placebo-controlled, randomised, double-blind trial of iron prophylaxis (3ml intramuscular iron dextran = 150mg Fe) to two month old infants was carried out on the North Coast of Papua New Guinea where there is high transmission of malaria. A literature review, pilot studies, protocol, demography, geography and laboratory methods developed are described. Findings indicate that the placebo control group became relatively iron deficient over the first year of life and that the iron dextran group had adequate, although not excessive iron stores and a higher mean haemoglobin; however, the prevalence and effects of malaria recorded in the field were higher in the iron dextran group. Analysis of field and hospital infectious morbidity in the trial indicated a deleterious association with iron dextran for all causes including respiratory infections (the main single reason for admission). Total duration of hospitalisation was significantly increased in the iron dextran group. Analysis of other factors showed (1) a higher admission rate associated with low weight-for-height recorded at the start of the trial; (2) a significant positive correlation between birth haemoglobin and hospital morbidity rates; (3) increased malaria rates in primiparous mothers of the cohort infants who received iron infusion during pregnancy; (4) lower relative risk of malaria associated with iron prophylaxis in individuals with alpha thalassaemia, which was found to be highly prevalent in this region. In conclusion, it is suggested that policies of iron supplementation, total dose iron injection and routine presumptive iron therapy for anaemia which are widely in practice in malaria endemic areas should be closely reviewed.

225 leaves printed on single pages, preliminary pages i- xxiii and numbered pages 1-203. Includes bibliography, list of abbreviations, list of definitions, list of tables and figures and list of appendices.
Digitized at 330 dpi color PDF format (OCR), using KODAK i 1220 PLUS scanner.
Thesis (MNutr (Interdisciplinary Health Sciences))--University of Stellenbosch, 2005.
ENGLISH ABSTRACT: "A comprehensive package of care for the Prevention of Mother- To-Child Transmission (PMTCT) of HIV" states that all mothers participating in the PMTCT Programme should receive education that will enable them to make informed decisions about infant feeding options. Rapid, same-day HIV testing and results that are available immediately, enable health care workers to be responsible for providing pre- and post-test counselling (which includes infant feeding options) on the same day. This could place a tremendous workload and time pressure on the health care workers. The aim of this study was to determine how "informed" is the literate mother's decision regarding infant feeding options, who participated in the PMTCT Programme, in the Gert Sibande District, Mpumalanga, South Africa. Method: Data was collected from health care workers and mothers on the PMTCT Programme at 23 PMTCT sites in the Gert Sibande District, with the help of 6 field workers and the PMTCT site manager at each PMTCT site, by means of once-off, self-administered questionnaires, which had been previously tested and validated. Results: Health care workers' attitude towards the PMTCT Programme was positive, although some (14%) indicated that what was expected of them was not achievable in their working environment. The most prominent change relating to the personal preferences of health care workers regarding infant feeding options for HIV-infected mothers, after attending the 5-day PMTCT course, was from formula-feeding to breast-feeding. Most (65%) indicated it was possible to stay neutral in a counselling session regardless of personal preference for infant feeding and 60% of those who could not stay neutral, still thought it was in the mother's best interest to be counselled by them. Most (98%) agreed mothers had the right to make informed decisions and 80% agreed mothers were able to make such a decision. Most (67%) health care workers indicated that not enough staff was stationed at PMTCT sites, only 53% used the feeding option cards when counselling mothers and indicated that more educational material was needed. Sixty one percent of the health care workers demonstrated the preparation of the formula to the mothers and allowed the mothers to demonstrate back to them. Between 49-82% and 37-56% of the health care workers knew the correct answers to knowledge questions relating to breastfeeding and formula-feeding, respectively. Not one health care worker, nor mother, knew all the steps in preparing a formula feed. Most (80%) mothers made decisions based on information provided to them by health care workers and only a small (13%) percentage were influenced by the community to practise a different feeding option than what they had chosen. Conclusions: The attitude, personal preferences, knowledge of and resources available to health care workers, influenced the decision made by mothers regarding infant feeding options and seeing that most mothers made their decision, based on information provided by health care workers, it is concluded that mothers can only make an informed decision about infant feeding options if they are advised appropriately by well trained, equipped and informed health care workers.
AFRIKAANSE OPSOMMING: "A comprehensive package of care for the Prevention of Mother-To-Child Transmission of HIV", vermeld dat moeders, wat deelneem aan die Voorkoming van Moeder-Tot-Kind Oordrag (VMTKO) progam, voorligting behoort te ontvang ten opsigte van voedingsopsies vir hul babas, sodat hulle in staat sal wees om 'n ingeligte keuse te maak. Gesondheidswerkers is verantwoordelik om voorligting voor en na die HIV toets te gee, wat die voedingsopsies vir babas insluit, op dieselfde dag. Dit kan 'n ontsaglike werkslading op die gesondheidswerkers plaas. Die doel van die studie was om te bepaal hoe "ingelig" is die geletterde moeder se keuse ten opsigte van voedingsopsies, wat deelneem aan die VMTKO program, in die Gert Sibande distrik, Mpumalanga, Suid-Afrika. Metode: Die data is ingesamel by 23 VMTKO-klinieke en -hospitale in die Gert Sibande distrik onder gesondheidswerkers en moeders op die VMTKO-program, met behulp van 6 veldwerkers en VMTKO-bestuurders, deur middel van eenmalige, selfvoltooide vraelyste, wat van tevore getoets en gevalideer was. Resultate: Die gesondheidswerkers se houding teenoor die VMTKO-program was positief, alhoewel 14% aangedui het dat wat van hulle verwag word nie prakties of moontlik is in hul werksomgewing nie. Die prominentste verandering rakende die persoonlike voorkeure van die gesonheidswerkers teenoor voedingsopsies vir HIV -geinfekteerde moeders, na die 5-dag VMTKO kursus, was van formulevoeding na borsvoeding. Meeste (65%) het aangedui dit is moontlik om neutraal te bly gedurende 'n voorligtingssessie, ten spyte van persoonlike voorkeure vir voedingsopsies en 60% van die wat nie neutraal kon bly nie, het steeds gedink dit is in die beste belang van die moeder om deur hulle voorgelig te word. Meeste (98%) het saamgestem dat dit die moeder se reg is om 'n ingeligte keuse te maak en 80% het saamgestem dat die moeder wel in staat is om so 'n besluit te neem. Meeste (67%) gesondheidswerkers het aangedui dat personeel tekorte bestaan by die VMTKO klinieke en hospitale. Slegs 53% gebruik die voedingsopsie kaarte gedurende 'n voorligtingsessie met die moeder en het aangedui dat meer voorligtingsmateriaal benodig word. Een en sestig persent van die gesondheidswerkers het die voorbereiding van die formulevoeding aan die moeders gedemonstreer en het moeders toegelaat om ook die demonstrasie te doen. Nege en veertig tot twee en tagtig persent en 37-56% van die gesondheidswerkers kon die korrekte antwoorde verskaf vir vrae oor borsvoeding en formulevoeding, afsonderlik. Nie een gesondheidswerker of moeder kon al die stappe vir die voorbereiding van die formulevoeding noem nie. Meeste (80%) moeders maak keuses gebaseer op inligting wat aan hulle verskaf word deur die gesondheidswerkers en slegs 'n klein persentasie (13%) word beinvloed deur familielede om die teenoorgestelde voedingsopsie te praktiseer as wat hulle gekies het. Gevolgtrekking: Die houding, persoonlike voorkeure, kennis van en hulpbronne beskikbaar aan die gesongheidswerkers, beinvloed die besluit wat moeders neem ten op sigte van voedingsopsies en aangesien die moeders hulle besluit baseer op inligting wat deur die gesondheidswerkers aan hulle gegee word, word die gevolgtrekking gemaak dat moeders slegs 'n ingeligte keuse aangaande voedingsopsies kan maak indien hulle voorligting ontvang deur goed opgeleide en ingeligte gesondheidswerkers.

Thesis (MScMedSc)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Background: Sudden infant death syndrome (SIDS) is considered the second most frequent cause of infant mortality worldwide. Research specifically pertaining to SIDS is limited in the South African setting. Identifiable causes for sudden infant death remain challenging despite full medico-legal investigations inclusive of autopsy, scene visit and ancillary studies. Viral infections could contribute to some sudden unexpected death in infancy (SUDI) cases, especially since a multitude of respiratory viruses have been detected from autopsy specimens. The specific contribution of viruses in the events preceding death, including the subsequent involvement of the immature immune response in infants, still warrants deciphering. Infancy is characterised by marked vulnerability to infections due to immaturities of their immune systems that may only resolve as infants grow older when these sudden deaths rarely still occur. In South Africa there is a lack of a standard protocol for investigations into the causes of SIDS, including the lack of standard guidelines as to which specimens should be taken, which viruses should be investigated and which laboratory assays should be utilised. Objectives: In this prospective descriptive study we aimed to investigate the prevalence of viruses in SUDI and SIDS cases at Tygerberg Forensic Pathology Service (FPS) Mortuary over a one year period. The primary aim was to explore possible respiratory viral infections in SUDI and SIDS cases and to determine the usefulness of molecular techniques to detect viruses from SUDI cases. To determine the significance of viruses, we assessed signs of infection from lung histology. The secondary objectives included collecting demographic data to investigate possible risk factors for SUDI and to look for possible similarities between viruses confirmed in living hospitalised infants at Tygerberg, during the study period compared to viruses detected from SUDI cases. Methods: Between May 2012 and May 2013 samples were collected from 148 SUDI cases presenting at Tygerberg FPS Mortuary. As part of the mandatory routine investigations into SUDI, shell vial culture (SVC) results were collected from lung and liver tissue specimens and bacterial culture results were collected from left and right lung and heart swabs at autopsy. To investigate the possibility of viruses implicated in some of the infant deaths we used the Seeplex® RV15 Ace detection multiplex polymerase chain reaction (PCR) assay to establish the frequency of 13 ribonucleic acid (RNA) respiratory viruses (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus) from RNA extracted from tracheal and lower left and right lung lobe swabs. Tissue from the lower left and right lung lobes were also assessed for histology signs of infection. Results: During our study we confirmed multiple known demographic risk factors for SIDS, such as the age peak around 1-3 months, the male predominance, bed-sharing, sleeping in the prone position, heavy wrapping in warm blankets, prenatal smoke exposure, and socio-economic factors. With the Seeplex® RV15 Ace detection assay between one and three viruses were detected in 59.5% (88/148) of cases. Of the 88 cases that had viruses detected, 75% (66/88) had one virus and 25% (22/88) had co-detections of two to three viruses. The most common viruses detected were HRV in 77% (68/88) of cases, RSV in 18% (16/88) of cases and HCoV in 14% (12/88) of cases. Many of the viruses we detected from our cases are included in the SVC test that forms part of the medico-legal laboratory investigation for all SUDI cases at Tygerberg FPS Mortuary. SVCs were positive in 9.5% (14/148) of all cases only. We showed that the SVC method is potentially missing most of the 13 respiratory viruses we investigated that could contribute to death in some of the SUDI cases. Conclusion: In some cases that had a Cause of Death Classification - SIDS, the PCR viruses detected cannot be ignored, especially when it is supported by histological evidence of infection. We thus propose that the use of PCR could alter a Cause of Death Classification from SIDS to Infection in some of these cases. Further research is needed to determine the significance of detecting viruses from SUDI cases wherein no significant histological evidence of infection was observed. This questions whether PCR may be too sensitive and is detecting past and latent viral infections that do not play any role in the cause of death. The histological picture also requires further characterisation to determine if it accurately predicts infections or lethal events and can truly support virology findings, especially in young infants whose immune systems are still maturing. Without determining the true prevalence of viruses in SUDI cases and the viral-specific immune response, the contribution of virus-specific infections to this syndrome will remain largely undetermined.
AFRIKAANSE OPSOMMING: Agtergrond: Wiegiedood (“SIDS/SUDI”) word beskou as die tweede mees algemene oorsaak van sterftes in kinders jonger as een jaar wêreldwyd. Toegewyde SIDS-spesifieke navorsing in die Suid-Afrikaanse samelewing is beperk. Dit bly steeds „n uitdaging om oorsake te probeer identifiseer vir hierdie onverwagte sterftes in kinders (SUDI) ten spyte van volledige medies-geregtelike ondersoeke, insluitende die lykskouing, ondersoek van die doodstoneel en aanvullende ondersoeke. Virusinfeksies kan aansienlik bydra tot sommige onverwagte sterftes in kinders, aangesien verskeie respiratoriese virusse alreeds aangetoon is in monsters verkry tydens outopsies. Die spesifieke rol wat virusse speel in die prosesse wat die dood voorafgaan, asook die bydraende rol van „n onder-ontwikkelde immuunrespons in babas, regverdig verdere ondersoek. Die eerste jaar van lewe word gekenmerk deur verhoogde vatbaarheid vir infeksies weens die ontwikkelende immuunstelsels soos wat babas ouer word, en die voorkoms van SUDI neem stelselmatig af met „n toename in ouderdom. In Suid-Afrika bestaan daar tans geen standaard protokol vir die ondersoek van wiegiedood nie en daar is ook nie standaard riglyne oor die tipe monsters wat geneem moet word, watter virusse ondersoek moet word en watter laboratorium toetse uitgevoer moet word nie. Doelstellings: In hierdie prospektiewe beskrywende studie is gepoog om die virusse wat in gevalle van wiegiedood of SUDI voorkom te ondersoek. Die studie is uitgevoer by die Tygerberg Geregtelike Patologie Dienste lykshuis oor 'n tydperk van een jaar. Molekulêre tegnieke om virusse aan te toon in hierdie gevalle is gebruik om spesifieke virusinfeksies te ondersoek. Die resultate is met histologiese tekens van infeksie in longweefsel gekorreleer. Demografiese data is verder versamel om moontlike risikofaktore vir wiegiedood te ondersoek. Dit is verder vergelyk met virusse wat met dieselfde diagnostiese tegnieke in babas geïdentifiseer is wat tydens die studieperiode in Tygerberg Hospitaal opgeneem was met lugweginfeksies. Metodes: Monsters van 148 SUDI gevalle wat by die Tygerberg lykshuis opgeneem is, is versamel tussen Mei 2012 en Mei 2013. As deel van die roetine ondersoeke in SUDI gevalle, was selkultuur resultate verkry van long en lewer weefsel, asook bakteriële kulture van deppers wat van beide longe en hart geneem was tydens die lykskouings. „n Seeplex® RV15 Ace polimerase kettingreaksie (PKR) toets is gebruik om die teenwoordigheid van virusse te ondersoek wat moontlik by die babasterftes betrokke kon wees. Trageale- en longdeppers wat tydens die lykskouings versamel was, was getoets vir 13 ribonukleïensure (RNS) respiratoriese virusse (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus). Resultate: Ons studie het verskeie bekende demografiese risikofaktore vir SUDI bevestig, byvoorbeeld „n ouderdomspiek tussen een en drie maande ouderdom, manlike predominansie, deel van „n bed met ander persone, slaap posisie op die maag, styf toedraai in warm komberse, blootstelling aan sigaretrook voor geboorte en sosio-ekonomiese faktore. Die Seeplex® RV15 Ace toets het tussen een en drie virusse geïdentifiseer in 59.5% (88/148) van die gevalle. Uit die 88 gevalle waarin virusse opgespoor was, was selgs een virus in 75% (66/88) van gevalle gevind en twee en drie virusse in 25% (22/88). Die mees algemene virusse was HRV in 77% (68/88) van gevalle, RSV in 18% (16/88) van gevalle en HCoV in 14% (12/88) van gevalle. Baie van die virusse wat tydens hierdie studie ondersoek was, was ingesluit in die roetine selkultuur toets wat deel vorm van die standaard medies-geregtelike laboratoriumondersoeke in alle SUDI gevalle by die Tygerberg lykshuis, alhoewel die selkulture positief was in slegs 9.5% (14/148) van gevalle. Ons het gevind dat baie respiratoriese virusse potensieel gemisdiagnoseer word wat „n rol kon speel in of bydra tot die dood van sommige SUDI gevalle. Gevolgtrekking: In sommige gevalle waarin SIDS geklassifiseer is as die oorsaak van dood, kan die virusse wat met PKR toetse opgespoor is nie geïgnoreer word nie, veral waar die bevinding ondersteun word deur histologiese bewyse van infeksie. Ons stel dus voor dat die gebruik van PKR toetse die oorsaak van dood klassifikasie kan verander van SIDS na Infeksie in sommige van hierdie gevalle. Verdere navorsing is nodig om die waarde van gelyktydige opsporing van virusse in SUDI gevalle te bepaal wanneer daar geen noemenswaardige histologiese bewyse van infeksie gevind word nie. Dit bevraagteken of die PKR toets dalk te sensitief is en gevolglik vorige en latente virusinfeksies identifiseer wat nie noodwendig 'n rol in die oorsaak van dood speel nie. Die diagnostiese en kliniese waarde van die histologiese beeld in terme van die rol van virusinfeksies as bydraende oorsaak van dood moet verder ondersoek word, veral in jong kinders wie se immuunstelsels nog nie volledig ontwikkel is nie. Indien die werklike voorkoms van virusse in SUDI gevalle en die virus-spesifieke immuunrespons nie bepaal word nie, sal die rol van virus-spesifieke infeksies in hierdie sindroom grootliks onbekend bly.
Harry Crossley Foundation
Poliomyelitis Research Foundation (PRF)
National Health Laboratory Services Research Trust

Infant and child mortality have played a crucial role in health transition patterns and both have been considered as good indicators of development and demographic modernization. The establishment of the Millennium Development Goals (MDGs) meant a significant injection of funds and resources for health, and a national and international commitment to child health, which led to an unprecedented progress in the reduction of child mortality worldwide. In terms of neonatal infections, neonatal sepsis and meningitis are well- known leading causes of mortality and severe sequelae in term and preterm babies in industrialized countries but information about them and their burden in LIC is more limited. Early-onset disease (EOD, 0-6 days), is usually vertically transmitted, and mainly caused by Group B streptococcus (GBS) and Escherichia coli (E. coli). Late-onset disease (LOD, 7-89 days) is generally due to horizontal infections (either community-acquired or hospital-acquired) and most frequently associated pathogens include E. coli, Klebsiella spp, GBS and other Gram-positive organisms (Staphylococcus aureus and Coagulase-negative staphylococci). Maternal colonization by these pathogens is crucial for transmission from mother to child to occur, presenting in such cases generally as EOD. Prevalence of maternal colonization may be affected by Human Immunodeficiency Virus (HIV), maternal nutritional status and other maternal risk factors. Prevention strategies such as maternal screening of GBS at the end of the pregnancy and intrapartum antibiotic prophylaxis (IAP) for those mothers found to be carriers have demonstrated their efficacy in dramatically reducing EOD. However, IAP as we know it is not currently reaching all women in need in poor settings, possibly in relation to the fragility of health systems, precariousness of laboratory infrastructures, or more simply because a significant proportion of deliveries in these settings still occurs at home. In addition, other preventive strategies against E. coli or those bacterial causing LOD have yet to be developed. Other infectious diseases also considered as important contributors to neonatal, infant and even child morbidity and mortality include infections encompassed under the TORCH syndrome. The HIV pandemic and the Zika virus outbreak have raised great concern across the world and have highlighted the importance of other pathogens for infants, including viruses, parasites or fungi. Screening of some of these diseases such as syphilis or HIV is routinely offered to women attending antenatal care (ANC) clinics of LIC. However, further screening of other potential vertically transmitted pathogens, such as cytomegalovirus (CMV), rubella, toxoplasma gondii (T. gondii), enterovirus (EV), parvovirus B19 (B19V), herpes simplex virus (HSV) or hepatitis B virus (HBV), among others is not offered. Congenital CMV infection (cCMV) is the most prevalent and principal cause of deafness in developed countries. However, and similarly to other congenital infections, it remains fundamentally unnoticed and therefore largely neglected in resource-constrained settings, thus also hindering the characterization of its real burden and impact in these settings. An interesting approach to prevent many of these congenital and neonatal infections now includes maternal vaccination during pregnancy under the assumption that maternal transfer of antibodies to the newborn will be more feasible, effective and rapidly protective than waiting for the generation of neonatal immune responses to vaccines administered directly to them. This “vertical vaccination” strategy has already been successfully implemented for tetanus and pertussis control, and is being explored against other pathogens. There are other well-known causes of severe disease and mortality in children, although not usually listed as direct CoD and therefore often forgotten in global estimates. Malnourished children, neonates born with a low weight or small for their gestational age, may be prone to suffering life-threating conditions or developing significant sequelae. In many cases, the fatal outcome is determined by the underlying condition rather than the acute disease. On the other hand, the emergence of certain complications such as for instance hypoglycaemia, relatively common in the evolution of many different diseases or conditions (malaria, sepsis, diarrhoea cases, malnutrition or neonates in general), may also adversely determine the prognosis of these cases, although the real incidence and significance of such complications remains to be described and addressed as part of their management strategies. In many LMIC, at least half the child deaths occur at home, often without having been seen by a clinician. In some cases, though, deaths occur also at home, but soon after a contact with the health system. Inpatient mortality is a well-understood portion of the global overall child mortality estimates, and interventions to reduce it have been developed and successfully implemented. However, post-discharge mortality (PDM) could be as high as inpatient mortality in those constrained-resource settings, but is clearly a neglected and understudied phenomenon. Indeed, no guidelines, recommendations or further strategies have been developed to address the care of patients during the days immediately following discharge, a critical period for child survival. The fragility of the health systems and scarcity of the health force in LIC, the unaffordable high costs to provide care for acute illness and the generalised lack of awareness about the burden and implications of PDM by health workers and policy makers partly explain this neglect. This thesis aims to address issues related with those severe diseases that cause the majority of morbidity and deaths among neonates, infants and children under five and for which no specific interventions have yet been implemented. Most of the studies conforming this thesis have been conducted in Manhiça, a semi-rural area in Southern Mozambique, and a paradigmatic example of a resource-constrained setting.
La mortalidad de lactantes y niños ha jugado un papel crucial en los patrones de transición de la salud y es considerado un buen indicador de desarrollo y modernización demográfica a lo largo del tiempo. El establecimiento de los Objetivos de Desarrollo del Milenio (MDGs) supuso una importante inyección de fondos y recursos para la mejora de la salud y un compromiso nacional e internacional con la salud infantil, que condujo a un progreso sin precedentes en la reducción de la mortalidad infantil en todo el mundo. En términos de infecciones neonatales, la sepsis neonatal y la meningitis son bien conocidas causas de muerte y enfermedades que pueden producir secuelas graves tanto en los bebés prematuros y como aquello a término en países industrializados. Sin embargo, la información sobre estas enfermedades y su impacto en los países empobrecidos del África subsahariana es más limitada. Otras enfermedades infecciosas también consideradas como contribuyentes importantes a la morbi-mortalidad neonatal, del lactante e incluso de niños más mayores son las infecciones englobadas en el síndrome TORCH. La pandemia del VIH y el brote del virus del Zika han suscitado gran preocupación en todo el mundo y han destacado la importancia de otros patógenos que afectan a los niños incluyendo virus, parásitos y hongos. La detección de algunas de estas enfermedades, como la sífilis o el VIH, se ofrece de forma rutinaria a las mujeres atendidas en las consultas prenatales (ANC) de países empobrecidos. Sin embargo, no ocurre lo mismo con la detección de otros posibles patógenos potencialmente transmisibles al feto durante el embarazo y parto, como citomegalovirus (CMV), rubéola, toxoplasma, enterovirus (EV), parvovirus B19 (B19V), virus del herpes simple (HSV) o hepatitis B (HBV), entre otros. La infección congénita por CMV (cCMV) es la más frecuente y la principal causa de sordera en los países desarrollados. Sin embargo, como sucede con la mayoría de las infecciones congénitas, permanece olvidada en entornos con recursos limitados, y se desconoce en gran parte su carga real y su impacto. En muchos países de renta media o baja, al menos la mitad de las muertes de niños se producen en casa, a menudo sin haber sido visitados por un clínico. Sin embargo, en algunos casos, los niños mueren en casa justo después de haber sido atendidos en un centro sanitario. La mortalidad hospitalaria es un contribuyente bien conocido de la mortalidad infantil y se han desarrollado e implementado con éxito guías e intervenciones para reducirla. Aunque la mortalidad posterior al alta hospitalaria (PDM) puede ser tan alta como la mortalidad hospitalaria en entornos con recursos limitados, es un fenómeno olvidado y poco estudiado. De hecho no se han desarrollado guías, recomendaciones o estrategias adicionales para abordar los días inmediatamente posteriores a alta hospitalaria, el cual es un período crítico para la supervivencia infantil. La fragilidad de los sistemas de salud en LIC, los altos costos inasequibles para atender enfermedades agudas y la falta generalizada de conciencia sobre la carga y las implicaciones del PDM por parte de los trabajadores de salud y los responsables políticos explican en parte que la mortalidad durante el periodo inmediato al alta hospitalaria permanezca relegada al olvido. Para alcanzar el nuevo objetivo de mortalidad infantil establecido por los Objetivos de Desarrollo Sostenible (SDGs) para 2030, es necesario mejorar el conocimiento en enfermedades graves en aquellos países con mayor morbi-mortalidad y desarrollar e implementar intervenciones para abordar las enfermedades que causan el mayor número de muertes entre los niños menores de 5 años. Esta tesis pretende abordar cuestiones relacionadas con las enfermedades graves que causan la mayoría de las muertes en lactantes y niños menores de cinco años y para las cuales no se han implementado intervenciones específicas en Manhiça, un área semirural en el sur de Mozambique.

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout.
Health Studies
M.A. (Health Studies)

Thesis in English, Annexure E: Consent form (leaf 81) as well as KABP Survey Questionnaire (leaves 87-91) in English and SiSwati.
The purpose of the study was to assess knowledge, explore attitudes and determine practices of breastfeeding mothers living with HIV regarding post-natal PMTCT interventions and services. The study was quantitative and descriptive in nature, utilising a retrospective cohort design. The study sample included breastfeeding mothers living with HIV, who attended the King Sobhuza II public health unit in the Manzini region of Swaziland. A written questionnaire was administered to a non-random sample of 90 consecutively selected mothers living with HIV attending the above-cited public health unit for post-natal health purposes. The overall study results revealed that the majority of breastfeeding mothers living with HIV in the afore-mentioned region (77.8%) presented high levels of knowledge on PMTCT, and 90% demonstrated a positive attitude; while a further 90% also demonstrated positive behaviour towards PMTCT. However, stigma and discrimination among family members, non-disclosure of HIV status to sexual partners; as well as poverty and fear of future drug-resistance are the cause of non-adherence to ARV prophylaxis. Furthermore, inconsistent condom use, mixed-feeding methods and wet-nursing also emerged as other contributing factors to the increase of post-natal mother-to-child transmission of HIV among breastfeeding mothers living with HIV.
Health Studies
M.A. (Nursing Science)

Text in English
This qualitative descriptive phenomenological study explored the experiences of HIV positive women utilising PMTCT services at a central hospital in Zimbabwe. Data was collected using in-depth interviews of fifteen participants. The interviews were audio recorded and transcribed verbatim. Using the Interpretive Phenomenological Analysis framework for data analysis, two super-ordinate themes emerged, namely resources for provision of PMTCT services and approaches and nature of PMTCT care. The study revealed challenges experienced by HIV positive women emanating from material, financial and human resource related constraints in the PMTCT setting. The resource challenges negatively affected access and utilisation of PMTCT services. A practice model, whose purpose is to enhance the quality and utilisation of PMTCT services, was developed and described. The model was evaluated using Chin and Krammer (2011) criteria plus a modified form of the Delphi technique. These findings have implications for effective PMTCT service provision. The key lessons learnt for programmatic improvement were that in order to provide quality and accessible PMTCT services the health care system will need to be well resourced. There is need to strengthen the health care system in line with HIV related programmatic changes.
Health Studies
D. L.itt. et Phil. (Health Studies)

Leung, Wan Lun Fiona.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2011.
Includes bibliographical references (leaves 179-204).
Abstracts in English and Chinese.
Abstract --- p.i
中文摘要 --- p.v
Acknowledgement --- p.viii
List of Abbreviations and Symbols x --- p.vi
List of Tables --- p.xx
List of Figures --- p.xxi
Chapter CHAPTER ONE --- Introduction --- p.1
Chapter 1.1 --- General Overview --- p.1
Chapter 1.2 --- Necrotizing Enterocolitis (NEC) --- p.3
Chapter 1.2.1 --- Epidemiology of NEC --- p.3
Chapter 1.2.2 --- "Clinical Presentation, Diagnosis and Management of NEC" --- p.5
Chapter 1.2.3 --- Pathophysiology of NEC --- p.9
Chapter 1.2.3.1 --- Prematurity --- p.9
Chapter 1.2.3.2 --- Bacterial Colonization --- p.12
Chapter 1.2.3.3 --- Enteral Feeding --- p.15
Chapter 1.2.3.4 --- Hypoxia and Ischemia --- p.16
Chapter 1.2.3.5 --- Genetic Polymorphism --- p.17
Chapter 1.2.3.6 --- Inflammatory Mediators --- p.20
Chapter 1.3 --- Spontaneous Intestinal Perforation (SIP) --- p.24
Chapter 1.3.1 --- Epidemiology of SIP --- p.24
Chapter 1.3.2 --- "Clinical Presentation, Diagnosis and Management of SIP" --- p.26
Chapter 1.3.3 --- Risk Factors of SIP --- p.28
Chapter 1.3.3.1 --- Prematurity --- p.29
Chapter 1.3.3.2 --- Use of Drugs --- p.30
Chapter 1.4 --- Comparison between NEC and SIP --- p.32
Chapter 1.5 --- Role of Cytokines in Pathogenesis of NEC and SIP --- p.38
Chapter 1.6 --- Immunoregulatory Molecules of Interest in This Study --- p.46
Chapter 1.6.1 --- Angiopoietin-2 (Ang-2) --- p.46
Chapter 1.6.2 --- v-erb-b2 Erythroblastic Leukemia Viral Oncogene Homolog 2 (avian) (ErbB3) --- p.48
Chapter 1.6.3 --- Type II Interleukin-1 Receptor (IL-1RII) --- p.52
Chapter 1.6.4 --- Urokinase Plasminogen Activator Receptor (uPAR) --- p.54
Chapter CHAPTER TWO --- Objectives --- p.57
Chapter CHAPTER THREE --- Materials and Methodology --- p.58
Chapter 3.1 --- Overview of the Experimental Procedures --- p.58
Chapter 3.1.1 --- Investigation on the Profile of Circulatory Immunoregulatory Proteins in Plasma of NEC and SIP High Risk Neonates --- p.58
Chapter 3.1.2 --- Investigation on the mRNA Expression Level of Targeted Immunoregulatory Molecules on Resected Intestinal Tissues in NEC and SIP Neonates --- p.58
Chapter 3.1.3 --- Investigation on the mRNA and Protein Expression Levels of Targeted Immunoregulatory Molecules in Human Intestinal Cell Lines --- p.60
Chapter 3.2 --- Reagents and Lab-wares with Their Sources --- p.61
Chapter 3.3 --- Study Population --- p.63
Chapter 3.4 --- Collection of Neonatal Whole Blood Samples --- p.65
Chapter 3.5 --- Cytokine Antibody Array Analyses --- p.67
Chapter 3.6 --- Enzyme-linked Immunosorbant Assays (ELISA) --- p.69
Chapter 3.6.1 --- Angiopoietin-2 --- p.69
Chapter 3.6.2 --- sErbB3 --- p.71
Chapter 3.6.3 --- sIL-lRII --- p.72
Chapter 3.6.4 --- suPAR --- p.74
Chapter 3.7 --- Collection of Neonatal Resected Intestinal Tissues --- p.76
Chapter 3.8 --- Resected Intestinal Tissue RNA Isolation --- p.78
Chapter 3.9 --- Purity Assessment of the Purified Tissue RNA Samples --- p.80
Chapter 3.10 --- Integrity Assessment of the Purified Tissue RNA Samples --- p.81
Chapter 3.11 --- In vitro Stimulation of Human Enterocytes by Lipopolysaccharides (LPS) and/or Platelet Activating Factor (PAF) --- p.84
Chapter 3.12 --- mRNA Expression Level Assessment of Selected Target Genes in Resected Intestinal Tissues and Human Intestinal Cell Lines --- p.86
Chapter 3.12.1 --- Synthesis of First Strand cDNA --- p.86
Chapter 3.12.2 --- Quantitative Polymerase Chain Reaction (qPCR) --- p.87
Chapter 3.13 --- Statistical Analysis --- p.89
Chapter CHAPTER FOUR --- Screening of Immunoregulatory Target Protein Molecules in Plasma of NEC and SIP Patients by Cytokine Array Analyses --- p.104
Chapter 4.1 --- Results --- p.104
Chapter 4.1.1 --- Screening of Detectable Immunoregulatory Target Molecules --- p.104
Chapter 4.1.2 --- Selection of Target Molecules Based on the Fold Change in NEC or SIP Compared with Control Samples --- p.105
Chapter 4.1.2.1 --- Similar Regulation of Target Molecules in Both NEC and SIP patients --- p.105
Chapter 4.1.2.2 --- Differential regulation of Target Molecules in NEC and SIP Patients --- p.106
Chapter 4.1.2.3 --- "Relative Normalized Expressions of Selected Circulatory Immunoregulatory Protein Molecules in NEC, SIP and Control Neonates" --- p.108
Chapter 4.1.2.3.1 --- Anti-inflammation --- p.108
Chapter 4.1.2.3.2 --- Pro-inflammation --- p.109
Chapter 4.1.2.3.3 --- Cell Growth --- p.110
Chapter 4.1.2.3.4 --- Wound Healing --- p.110
Chapter 4.1.2.3.5 --- Angiogenesis --- p.111
Chapter 4.1.2.3.6 --- "Anti-apoptosis, Cell Adhesion and Extracellular Matrix Organization" --- p.112
Chapter 4.1.3 --- Further Selection of Novel Target Molecules Based on Statistical Significance and Fold Change of NEC versus SIP --- p.113
Chapter 4.2 --- Discussion --- p.115
Chapter CHAPTER FIVE --- Validation of Target Proteins in Plasma of NEC and SIP Patients by Enzyme-linked Immunosorbant Assay --- p.132
Chapter 5.1 --- Results --- p.133
Chapter 5.1.1 --- Demographic Data of the Study Group --- p.133
Chapter 5.1.2 --- "Comparison of Plasma Levels of Target Proteins between NEC, SIP and Respective Controls" --- p.134
Chapter 5.1.3 --- Longitudinal Study of the Pre- and Post-operative Target Proteins Levels in Plasma --- p.136
Chapter 5.2 --- Discussion --- p.138
Chapter CHAPTER SIX --- Investigation on mRNA Expression Levels of Target Immunoregulatory Protein Molecules in Intestinal Tissue and Intestinal Cell Lines --- p.151
Chapter 6.1 --- Results --- p.152
Chapter 6.1.1 --- mRNA Expression Levels of Target Molecules in the Diseased Margin of Resected Intestinal Tissues of NEC and SIP patients --- p.152
Chapter 6.1.2 --- mRNA Expression Levels of Target Molecules in the Macroscopically Normal and Diseased Margin of Resected Intestinal Tissues of NEC and SIP patients --- p.154
Chapter 6.1.3 --- mRNA Expression Levels of Target Molecules in Human Intestinal Cell Lines upon LPS and PAF Challenge --- p.156
Chapter 6.1.3.1 --- FHs-74 Int Cell Line --- p.156
Chapter 6.1.3.2 --- Caco-2 Cell Line --- p.157
Chapter 6.2 --- Discussion --- p.158
Chapter CHAPTER SEVEN --- General Discussion --- p.171
Chapter 7.1 --- Overall Findings --- p.171
Chapter 7.2 --- Limitations of Study --- p.174
Chapter 7.3 --- Future Investigations --- p.177
References --- p.179

Background: Neonatal mortality is a major burden in developing countries. Most neonatal deaths in Bangladesh can be prevented by simple interventions or by preventive measures before birth, better delivery practices or basic treatments after birth. Researchers over the years have focused on upgrading health care options to combat particular causes of disease but simple preventive measures before birth are often ignored. The outcome of neonatal illnesses depends on how it is managed and when. An illness that is addressed before the actual occurrence will have a better outcome especially when it involves newly-born neonates who have limited immunity. Thus, understanding the neonatal causes of deaths is an effective way to improve neonatal outcomes at low cost. Study Design: This study used primary data from two ICDDR,B surveillance sites, Abhoynagar and Mirsarai from the period 1997-2006 and analysed the major 'preventable causes' that can be prevented before the birth of the baby. It also identified the 'treatable causes' that are not amenable to prevention before the birth of the baby. This categorization is based on context of a developing country as Bangladesh where advanced techniques to treat severe conditions is unavailable or expensive. A particular cause of death can potentially be prevented or treated but consideration needs to be given to what is feasible in terms of available resources. The study compares deaths between the two surveillance sites and observes some of the biological, social and health care variables associated with preventable and treatable causes of deaths. Result of Neonatal death causes: Preventable causes of neonatal deaths comprised 75 percent of all neonatal deaths signifying the importance of targeted interventions before birth .Major identified preventable causes were prematurity (48.9%), birth asphyxia(30.2%), maternal and pregnancy-related complications (16.5%)),and neonatal tetanus (4.4%). Pneumonia (66.4%) and sepsis (33.6%) were the two treatable causes identified. Preventable deaths comprised 79.5% (163/205) of deaths in Abhoynagar and 69.2% (144/208) of deaths in Mirsarai. Result of Post-neonatal causes of death: The study grouped preventable (Diarrhoea and malnutrition, composed 30%) and treatable (Pneumonia, sepsis and SIDS, comprise 70%) causes of post-neonatal deaths. Except for sepsis, all causes of deaths were found in greater proportion in Mirsarai. Conclusion: The study found that preventable causes constitute the majority of neonatal deaths in Bangladesh. To address the majority of causes of neonatal deaths, interventions are needed to focus on the period before birth of the baby.

This study was undertaken to investigate the relationship between Natural Killer cells and HLA-G at the placental barrier in HIV-I infected pregnant women and to establish the significance, if any, to in utero infection. Fifty-five HIV -I infected pregnant women were recruited into the study after consent was obtained. Blood samples were collected from both mothers and babies for viral loads and CD4+ cell counts. Placental samples were obtained from pregnancies at delivery and examined by immunoperoxidase immunohistochemistry methods using monoclonal antibodies to p24 antigens and Natural Killer (CD56+) cells. HLA-G expression was quantified using real-time polymerase chain reaction. Analysis of viral loads and CD4+ cell counts were undertaken in categories. No significant association was observed between the viral load of mothers and their CD4+ cell counts. Eighteen percent of the women in this study population had 5 log viral loads with a transmission rate of 0.27(95% Cl, 0.15 - O. 39). Maternal viraemia was significantly associated with transmission of infection to babies (p = 0.047). The odds ratio indicated that for every 1 log increase in maternal viral load the babies were 3.1 times more likely to acquire the infection (Exp (B) = 3.137 (95%CI, 1.015-9.696). Furthermore, the study found that a higher number of female babies were infected than males. Although not statistically significant the odds ratio indicated that female babies were 3.1 times more likely to become infected than males (Exp (B) = 3.110 (95%CI, 0.819-11.808). We report here the results of immunohistochemistry for p24 antigens and NK (CD56+) cells and compare them to the immunological responses of both mothers and babies at birth. HIV-1 antigens were detected in 94.5% of all placentas by immunohistochemistry. Infiltration of CD56+ was found in 98% of placental tissue. The analysis revealed that the presence of p24 antigens in placental tissue was not influenced by maternal viral load or CD4+ cell counts. Lower median NK cell values were observed in placentas of mothers with infected babies as compared with the uninfected cluster. Although not statistically significant, the risk of vertical transmission was increased 3.4 times more in placentas which had lower NK cell values. According to the odds ratio, babies CD4+ counts were affected by every 1 log increase in mother's viral load. Overall, maternal viral load emerged as a strong predictor for risk of infection from infected mothers to their infants. Our analysis indicated that female babies were 3.7 times more likely to acquire the infection than males. Using data obtained from real-time PCR we investigated the relationship between maternal viral load and the quantity of HLA-G expression (p = 0.045; 95%CI 1.029- 11.499). Logistic regression models revealed that mother's viral load was the strongest risk factor for vertical transmission. No statistically significant correlation was noted with HLA-G and viral transmission. However, the odds ratio indicated that the risk of infection increased by 1.3 with every 1 fold increase in HLA-G expression. An analysis of mother-to-child transmission rates by gender revealed that the odds ratio for transmission was 3.4 times more in female babies than in males. We then investigated the relationship between maternal viraemia and HLA-G expression. A positive correlation between maternal viral load and placental HLA-G was observed (p = 0.038). When gender susceptibility to HLA-G expression was explored a statistically significant association was observed in placental tissue of mothers with infected and uninfected male babies and HLA-G expression (p = 0.013). To conclude, the analysis found that HLA-G was up regulated 3.95 times more in placental tissue of mothers with infected babies than in mothers with uninfected babies.
Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

Ethiopia is one of the five nations that bear the global burden of nearly 50% maternal mortalities and newborn deaths. Cause-specific maternal mortality and newborn death information are vitally important for prevention, but little is known about the causes of deaths. Many maternal mortalities and newborn deaths occur at home, outside the formal health sector, and few are attended by qualified medical professionals. Despite the fact that, non-medical factors are often more important in determining whether a woman/newborn lives or dies than the medical cause of death itself. This study determines and explores factors contributing to maternal mortalities and newborn deaths in Ethiopia with the aim of developing a community-based model for averting maternal mortalities and newborn deaths in Ethiopia. The study was organised in three phases. In Phase 1, a community-based-retrospective approach using explorative, descriptive and contextual study design, combining both qualitative and quantitative methods (mixed methods) were used to make an in-depth investigation and analysis of the circumstances and events surrounding individual cases of maternal mortality and newborn deaths. The result of the study revealed various direct and indirect as well as possible contributing factors to maternal mortalities and newborn deaths which outlined bases for forwarding Phase 2 of the study called concept analysis. In Phase 3, a prototype model was developed according to Chinn and Kramer’s approach to theory generation: initially, based on the empirical perspectives of the study, concept analysis was conducted. The structure and process of a model to avert maternal mortality and newborn death were described; and, six survey list; namely, agent, recipient, context, procedure, dynamic and terminus of Dickoff, James and Wiedenbach (1968) form the basis for development and description of a model for averting maternal mortality and newborn deaths in Ethiopia. Impediment in receiving prompt, adequate and appropriate care were common problems encountered even after reaching an appropriate medical facility. For any attempt to attain a significant reduction in maternal mortality and newborn death, the health care system in Ethiopia must assume its tasks to institute critical changes in both the structure and process of health care delivery services.
Health Studies
D. Litt. et Phil. (Health Studies)

Thesis (M.Med. (Paediatrics and Child Health)) -- University of Limpopo, 2019
Objectives To determine the prevalence and survival rate; and to assess the maternal risk factors as well as complications of prematurity, associated with the mortality of very low and extremely low birth weight infants in the Neonatal Intensive Care Unit (NICU) of Mankweng Hospital. Materials and Methods A retrospective descriptive study was conducted at the NICU of Mankweng Hospital for a 7-month period from 1st January to 31st July 2015. The patient medical records and the Perinatal Problem Identification Programme (PPIP) data were used for the study. Results Prevalence of prematurity was 23%, Infants weighing between 500g-1499g represented 6.3% of the total live births and 25% of the admissions to the NICU; of which 4.9% were classified as extremely low birth weight (ELBW). Overall 77% of the study population survived until discharge. From the medical records, the survival to discharge of infants with weight 500g - 999g was 52%; and 84% for those with weight 1000g-1499g. Multivariable analysis found that improved survival was associated with an increase in gestational age (p <0.001), as well as birth weight (p <0.001) and prolonged length of stay. Variables associated with poor survival were spontaneous preterm labour (p = 0.031), low Apgar score at 1 and 5 minutes (p <0.001), sepsis (p = 0.001), respiratory distress syndrome (p <0.001), pulmonary hemorrhage (p <0.001), hypothermia (P = 0.005), resuscitation at birth (p = 0.002) and necrotising enterocolitis (p =0.044). Antenatal steroids were not associated with survival (p =0.111), however this was not documented in 53%(134/252) of the records, so the non-significance to outcome in this study may not be a true reflection. The use of NCPAP or SiPAP only was associated with improved survival of up to 69% and high mortality rates were recorded in babies who required invasive ventilator support. Multi-organ immaturity was found to be the most common cause of death, followed by sepsis. Conclusion: The prevalence and survival rates of very low and extremely low birth weight, found in this study are comparable to those found in other tertiary hospitals in South Africa. The survival rate of ELBW babies is low and must be improved. Reliable data and further research should address effective steps to prevent preterm labour, extreme prematurity and hypothermia. The documentation and provision of antenatal steroids is encouraged. KEY CONCEPTS: Prematurity, Extremely low and Very low birth weight, Risk factors, Prevalence, Survival, Neonatal mortality rate.

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.

Submitted in fulfilment of the requirements of the Degree of Master of Technology: Biomedical Technology, Durban University of Technology, 2013.
The purpose of the study was to evaluate knowledge and effects of Haemolytic Disease of the Newborn (HDN) in postnatal women from the Umgungundlovu District. Although the prevalence of HDN has declined because of prophylaxis from 45 cases per 10,000 births to 10.2 cases per 10,000 births but it is still a cause of infant and neonatal morbidity and mortality. The effects of the disease range from jaundice, kernicterus and in severe cases death. Methodology : An interviewer-administered questionnaire was used to obtain information about the knowledge and effects of HDN amongst postnatal women. The incidence rate was calculated using the number of cases that were found divided by the total number of deliveries during the study period. A total of 300 women were interviewed. SPSS version 19.0 was used to analyse data. Findings : Fifteen (15) of the 300 women had babies with confirmed HDN and only four of the 15 (26%) women had knowledge of HDN. Two hundred and eighty five women had babies with jaundice but were not affected by HDN and, of these women, 12 (4.2%) of them knew what HDN was. Overall, only 16 (5.3%) knew what HDN was. All 15 women who had babies with HDN indicated financial and emotional effects because of HDN. The total incidence was 0.09% for the first 12 months of the study period. Conclusion : Postnatal women with jaundiced babies lack knowledge of HDN and HDN has financial and emotional effects on these women. Although the incidence rate of HDN was found to be even smaller than previously reported, it still exists and threatens the lives of infants and neonates.

BACKGROUND AND OBJECTIVES: Streptococcus agalactiae (Group B Streptococcus, GBS) is the leading cause of neonatal infections and deaths in human. It can also cause infections in pregnant women and non-pregnant adults. Penicillin and ampicillin are antibiotics of choice for the treatment of GBS infections. Erythromycin and clindamycin are used as alternative therapy in penicillin allergic patients, however resistance to these agents has been increasingly observed. This present study was undertaken to determine the colonization rate of GBS, susceptibility profile and the mechanism of antibiotic resistance in pregnant women and their babies at Dr. George Mukhari Academic Hospital in Pretoria. METHODS: Rectal and vaginal swabs were collected from pregnant women; ear and umbilical swabs from newborns over an 11 month period. Samples were cultured on selective media (CNA agar and Todd-Hewitt broth) and GBS positively identified using morphological and biochemical tests including Gram staining, hemolytic activity, catalase test, bile esculin, CAMP test and Latex agglutination test. The susceptibility testing was done using the Kirby-Bauer and E-test methods. The D-test method was used to determine the inducible clindamycin resistance. Multiplex PCR with were used to detect different genes coding for resistance. RESULTS: Out of the 413 patients evaluated, 128 (30.9%) were positive with GBS. All isolates were sensitive to penicillin and ampicillin. Erythromycin and clindamycin resistance was 21.1% and 17.2% respectively; of which 69% harbouring constitutive MLBB, 17.4% inducible MLSB. The alteration of ribosomal target encoded by ermB genes was the commonest mechanism of resistance observed in 55% of isolates, 38% of isolates had both ermB and linB genes and efflux pump mediated by mefA genes was detected in one of isolates. Conclusion: This study reaffirms the appropriateness of penicillin as the antibiotic of choice for treating GBS infection. However it raises the challenges of resistance to the macrolides and lincosamides. More GBS treatment options for penicillin allergic patients need to be researched.
Health Studies
M.Sc. (Life Sciences (Microbiology))

Background: Group B streptococcus (GBS) is regarded as one of the most important causes of maternal and neonatal morbidity and mortality in many parts of the world. GBS recto-vaginal colonization is important in the health of a mother and her neonate, especially in developing countries. Maternal vaginal colonization with GBS at the time of delivery can cause vertical transmission to the neonate. Multilocus sequence typing (MLST) is a technique used to characterize microbial isolates by means of sequencing internal fragments of housekeeping genes and has the advantage of reproducibility and has been shown to correlate with the other typing techniques and thus has emerged as the standard for delineating the clonal population of GBS. The study aimed to investigate the epidemiology of GBS colonization among pregnant women and their neonates, and to characterize the isolates by multilocus sequence typing technique at Dr George Mukhari Academic Hospital, Pretoria. Methodology: A total of 413 pregnant women who visited the antenatal clinic were recruited and screened. Participants were interviewed using a questionnaire to gather demographic and other relevant information such as history of current pregnancy, previous miscarriages and still births. Samples from maternal rectum and vagina as well as neonate ear and umbilical cord were taken for culture using colistin and nalidixic acid (CNA) blood agar and incubated for 24-48 hours. If negative after 48 hours, Todd-Hewitt broth was subcultured after 18-48 hours onto sheep blood agar. Multilocus sequence typing (MLST) was used to characterize seven group B streptococcus isolates collected at Dr George Mukhari academic hospital. Fragments of seven housekeeping genes were amplified by polymerase chain reaction (PCR) for each strain and sequenced. CLC bio software (Inqaba biotech, South Africa; Pretoria) was used to analyse sequenced loci and UPGMA dendrogram was constructed. Results: The colonization rate for GBS in pregnant women and their neonates was 30.9% and 0%, respectively. A higher proportion of GBS were isolated from the rectum (37.9%) as compared to the vagina (20.6%). Most socio-economic, demographic and obstetric factors analysed were not significantly associated with.GBS colonization. On 128 positive samples, the results of Todd-Hewitt enrichment broth and direct plating method using CNA were compared. A total of 45.3% of colonised were positive on direct selective agar (CNA); an additional 54.7% samples were recovered from Todd-Hewitt broth. Three genes (adhP, glnA and tkt) were sequenced successfully for six samples (1, 2. 4,6,12 and 65). The UPGMA tree with 1000 bootstrap showing the relationship between six samples was drawn.Conclusion: This study revealed that pregnant women of all ages are at risk of group B streptococcus colonization. Group B streptococcus was common among pregnant women at Dr George Mukhari Academic Hospital. No socio-economic risk factor was associated with group B streptococcus colonization. Results confirm that the combination of Todd-Hewitt broth and CNA agar plate is a time saving and sensitive method. The allelic profile, characteristics such as G+C (guanine+cytosine) content and dN/dS ratio were not analysed because of the smaller sample size used in this study, which shows that the MLST method was unsuccessful in this study. The UPGMA tree based on differences in consensus of the isolates showed that all group B streptococcus isolates are clustered and descend from a single node.
Life & Consumer Sciences
Life Sciences
M.Sc. (Life Sciences)