Showing papers by "Sithembiso Velaphi published in 2012"

Risk factors for neonatal sepsis and perinatal death among infants enrolled in the prevention of perinatal sepsis trial, Soweto, South Africa.

Abstract: Background:Factors associated with neonatal sepsis, an important cause of child mortality, are poorly described in Africa. We characterized factors associated with early-onset (days 0–2 of life) and late-onset (days 3–28) ­sepsis and perinatal death among infants enrolled in the Prevention of Perina

Maternal HIV Infection and Vertical Transmission of Pathogenic Bacteria

Abstract: BACKGROUND: HIV-exposed newborns may be at higher risk of sepsis because of immune system aberrations, impaired maternal antibody transfer and altered exposure to pathogenic bacteria. METHODS: We performed a secondary analysis of a study (clinicaltrials.gov, number [NCT00136370][1]) conducted between April 2004 and October 2007 in South Africa. We used propensity score matching to evaluate the association between maternal HIV infection and (1) vaginal colonization with bacterial pathogens; (2) vertical transmission of pathogens to the newborn; and (3) sepsis within 3 days of birth (EOS) or between 4–28 days of life (LOS). RESULTS: Colonization with group B Streptococcus (17% vs 23%, P = .0002), Escherichia coli (47% vs 45%, P = .374), and Klebsiella pneumoniae (7% vs 10%, P = .008) differed modestly between HIV-infected and uninfected women, as did vertical transmission rates. Maternal HIV infection was not associated with increased risk of neonatal EOS or LOS, although culture-confirmed EOS was >3 times higher among HIV-exposed infants ( P = .05). When compared with HIV-unexposed, neonates, HIV-exposed, uninfected neonates (HEU) had a lower risk of EOS (20.6 vs 33.7 per 1000 births; P = .046) and similar rate of LOS (5.8 vs 4.1; P = .563). HIV-infected newborns had a higher risk than HEU of EOS (134 vs 21.5; P < .0001) and LOS (26.8 vs 5.6; P = .042). CONCLUSIONS: Maternal HIV infection was not associated with increased risk of maternal bacterial colonization, vertical transmission, EOS, or LOS. HIV-infected neonates, however, were at increased risk of EOS and LOS. * Abbreviations: EOS — : early-onset sepsis GBS — : group B Streptococcus HEU — : HIV-exposed uninfected HUU — : HIV-unexposed uninfected LOS — : late-onset sepsis PCR — : polymerase chain reaction PoPS — : Prevention of Perinatal Sepsis ROM — : rupture of membranes UTI — : urinary tract infection [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00136370&atom=%2Fpediatrics%2F130%2F3%2Fe581.atom

Reducing neonatal deaths in South Africa – are we there yet, and what can be done?

Abstract: In the year 2000, 189 member countries of the United Nations committed themselves to eight goals towards the development and well-being of their nations. These goals are called Millenium Development Goals (MDGs). The fourth goal (MDG4) aims to reduce the mortality rate in children under the age of 5 years (U5MR) by two thirds between 1990 and 2015. Infants less than 1 month old account for about 40% of deaths of children under the age of 5 years globally. Achieving MDG4 will therefore need to include reducing deaths during the neonatal period. The goal of reducing U5MR by two thirds for neonatal deaths in South Africa meant reducing the neonatal mortality rate (NMR) from 21/1 000 live births in 1998 to 7/1 000 by 2015. In order to achieve this, all neonatal deaths need to be scrutinsed by focusing on mortality rates and pathological and health system causes of neonatal deaths. Of paramount importance, however, would be looking at interventions that could impact significantly on reducing these deaths. In this article we discuss the mortality rates in South Africa, the rest of the world and Africa, and discuss causes and interventions that can be implemented to reduce these deaths in South Africa.

Evaluating the QuikRead® C-reactive protein test as a point-of-care test

Abstract: Background: Available tests to diagnose infection in neonates often provide results after 12–24 hours. A bedside test that is reliable will facilitate earlier exclusion or diagnosis of infection.Objective: To validate a bedside C-reactive protein (CRP) test against the currently available laboratory CRP test in neonates with suspected sepsis.Methods: This was a prospective observational study where a bedside CRP was done concurrently with and validated against a laboratory CRP in neonates with suspected sepsis. The sensitivities, specificities and predictive values for the bedside CRP tests were calculated using the laboratory CRPs as the reference test.Results: There were 209 measured CRP-sample pairs. Seventy per cent of these had suspected early-onset neonatal sepsis and 30% had suspected late-onset neonatal sepsis. Twelve per cent had culture-proven sepsis. At the recommended cut-off of 8·0 mg/L for the bedside CRP test, the sensitivity, specificity, positive and negative predictive values wer...