Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 9 de 9
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Influenza Other Respir Viruses ; 15(4): 446-456, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33452708

RESUMO

BACKGROUND: There are conflicting data concerning the impact of antenatal influenza vaccination on birth outcomes including low birthweight (LBW), preterm birth, small for gestational age (SGA), and stillbirth. METHODS: We conducted a retrospective observational cohort study of infants born to women residing in Mitchells Plain, Cape Town. Infants were born at 4 health facilities during May 28 - December 31, 2015 and April 15 - December 31, 2016. We performed crude and multivariable logistic regression, propensity score (PS) matching logistic regression, and inverse probability of treatment weighted (IPTW) regression to assess vaccine effectiveness (VE) against LBW, preterm birth, SGA, and stillbirth adjusting for measured confounders. RESULTS: Maternal vaccination status, antenatal history, and ≥1 birth outcome(s) were available for 4084/5333 (76.6%) pregnancies, 2109 (51.6%) vaccinated, and 1975 (48.4%) unvaccinated. The proportion LBW was lower in vaccinated (6.9%) vs. unvaccinated (12.5%) in multivariable [VE 0.27 (95% CI 0.07-0.42)], PS [VE 0.30 (95% CI 0.09-0.51)], and IPTW [VE 0.24 (95% CI 0.04-0.45)]. Preterm birth was less frequent in vaccinated (8.6%) than unvaccinated (16.4%) in multivariable [VE 0.26 (0.09-0.40)], PS [VE 0.25 (95% CI 0.09-0.41)], and IPTW [VE 0.34 (95% CI 0.18-0.51)]. The proportion SGA was lower in vaccinated (6.0%) than unvaccinated (8.8%) but not in adjusted models. There were few stillbirths in our study population, 30/4084 (0.7%). CONCLUSIONS: Using multiple analytic approaches, we found that influenza vaccination was associated with lower prevalence of LBW (24-30%) and preterm birth (25-34%) in Cape Town during 2015-2016.


Assuntos
Vacinas contra Influenza , Influenza Humana , Nascimento Prematuro , Feminino , Humanos , Lactente , Recém-Nascido , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Estudos Retrospectivos , África do Sul/epidemiologia , Vacinação
2.
Paediatr Int Child Health ; 35(1): 24-8, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25034798

RESUMO

BACKGROUND: A child's caregiver is key to the successful drug delivery and outcome of tuberculosis (TB) treatment. Understanding caregivers' practices and perceptions is important in the management of childhood TB. OBJECTIVE: To investigate caregivers' practices and perceptions regarding TB treatment of children. METHODS: A prospective, questionnaire-based study at Red Cross War Memorial Children's Hospital, Cape Town, South Africa of caregivers of children receiving TB treatment. During the children's follow-up visits at 1 (M1), 3 (M3) and 6 (M6) months after initiation of TB treatment, caregivers were interviewed face-to-face. RESULTS: Caregivers of 253 children being treated for TB were interviewed and 434 surveys were completed between May 2011 and April 2013. 168 (39%) questionnaires were completed at M1, 165 (39%) at M3 and 94 (22%) at M6. Median age of children was 41 months (IQR 20-81). TB drugs were generally obtained from clinics most commonly visited 1-3 times a week. Only 86/162 (53%) and 109/155 (70%) children had been weighed at the clinic at M1 and M3, respectively. Drugs were most commonly administered after meals (69%). Two-thirds of interviewees crushed, dissolved or mixed the tablets with beverages or food. Most (88%) respondents reported easy drug administration. Few adverse drug reactions were reported. In 54/427 (13%) of surveys, concomitant antiretroviral treatment was given, most commonly before TB medication. CONCLUSION: Administration of TB drugs was regarded as easy, but differed substantially from recommended practice. Children were not weighed so that dosage could be adjusted, most caregivers crushed, dissolved or mixed the tablets with beverages or food, and administered medication after meals, all potentially contributing to sub-therapeutic drug levels.


Assuntos
Antituberculosos/administração & dosagem , Cuidadores/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Tuberculose/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Masculino , Estudos Prospectivos , África do Sul , Inquéritos e Questionários
3.
Lancet Glob Health ; 2(5): e278-84, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24818083

RESUMO

BACKGROUND: Urine tests for mycobacterial lipoarabinomannan might be useful for point-of-care diagnosis of tuberculosis in adults with advanced HIV infection, but have not been assessed in children. We assessed the accuracy of urine lipoarabinomannan testing for the diagnosis of pulmonary tuberculosis in HIV-positive and HIV-negative children. METHODS: We prospectively recruited children (aged ≤ 15 years) who presented with suspected tuberculosis at a primary health-care clinic and paediatric referral hospital in South Africa, between March 1, 2009, and April 30, 2012. We assessed the diagnostic accuracy of urine lipoarabinomannan testing with lateral fl ow assay and ELISA, with mycobacterial culture of two induced sputum samples as the reference standard. Positive cultures were identified by acid-fast staining and tested to confirm Mycobacterium tuberculosis and establish susceptibility to rifampicin and isoniazid. FINDINGS: 535 children (median age 42.5 months, IQR 19.1 ­ 66.3) had urine and two induced specimens available for testing. 89 (17%) had culture-confirmed tuberculosis and 106 (20%) had HIV. The lateral fl ow lipoarabinomannan test showed poor accuracy against the reference standard, with sensitivity of 48.3% (95% CI 37.6 ­ 59.2), specificity of 60.8% (56.1 ­ 65.3), and an area under the receiver operating characteristic curve of 0.53 (0.46 ­ 0.60) for children without HIV and 0.64 (0.51 ­ 0.76) for children with HIV. ELISA had poor sensitivity in children without HIV (sensitivity 3.0%, 95% CI 0.4 ­ 10.5) and children with HIV (0%, 0.0 ­ 14.3); overall specificity was 95.7% (93.4 ­ 97.4). INTERPRETATION: Urine lipoarabinomannan tests have insufficient sensitivity and specificity to diagnose HIV-positive and HIV-negative children with tuberculosis and should not be used in this patient population.


Assuntos
Lipopolissacarídeos/urina , Tuberculose Pulmonar/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Prospectivos
4.
Clin Infect Dis ; 57(3): e18-21, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23580738

RESUMO

In a pilot accuracy study, stool Xpert testing from 115 children with suspected pulmonary tuberculosis (PTB) detected 8/17 (47%) culture-confirmed tuberculosis cases, including 4/5 (80%) HIV-infected and 4/12 (33%) HIV-uninfected children. Sputum Xpert detected 11/17 (65%) cases. Stool holds promise for PTB diagnosis in HIV-infected children.


Assuntos
Técnicas Bacteriológicas/métodos , Fezes/microbiologia , Técnicas de Diagnóstico Molecular/métodos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Projetos Piloto , Estudos Prospectivos
5.
Lancet Glob Health ; 1(2): e97-e104, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25104164

RESUMO

BACKGROUND: In children admitted to hospital, rapid, accurate diagnosis of pulmonary tuberculosis with the Xpert MTB/RIF assay is possible, but no paediatric studies have been done in the primary care setting, where most children are given care, and where microbiological diagnosis is rarely available. We assessed the diagnostic accuracy of Xpert MTB/RIF in children in primary care. METHODS: For this prospective study, we obtained repeat induced sputum and nasopharyngeal aspirate specimens from children (<15 years) with suspected pulmonary tuberculosis at a clinic in Khayeliwtsha, Cape Town, South Africa. We compared the diagnostic accuracy of Xpert MTB/RIF with a reference standard of culture and smear microscopy on induced sputum specimens. For the main analysis, specificity of Xpert MTB/RIF versus liquid culture, we included only children with two interpretable Xpert MTB/RIF and induced sputum culture results. FINDINGS: Between Aug 1, 2010, and July 30, 2012, we enrolled 384 children (median age 38·3 months, IQR 21·2-56·5) who had one paired induced sputum and nasopharyngeal specimen, 309 (81%) of whom had two paired specimens. Five children (1%) tested positive for tuberculosis by smear microscopy, 26 (7%) tested positive by Xpert MTB/RIF, and 30 (8%) tested positive by culture. Xpert MTB/RIF on two induced sputum specimens detected 16 of 28 culture-confirmed cases (sensitivity of 57·1%, 95% CI 39·1-73·5) and on two nasopharyngeal aspirates detected 11 of 28 culture-confirmed cases (sensitivity of 39·3, 23·6-57·6; p=0·18). The specificity of Xpert MTB/RIF on induced sputum was 98·9% (95% CI 96·9-99·6) and on nasopharyngeal aspirates was 99·3% (97·4-99·8). INTERPRETATION: Our findings suggest that Xpert MTB/RIF on respiratory secretions is a useful test for rapid diagnosis of paediatric pulmonary tuberculosis in primary care. FUNDING: National Institutes of Health, National Health Laboratory Services Research Trust, the Medical Research Council of South Africa, the National Research Foundation South Africa, the European and Developing Countries Clinical Trials Partnership.


Assuntos
DNA Bacteriano/análise , Mycobacterium tuberculosis/genética , Nasofaringe/microbiologia , Atenção Primária à Saúde , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Adolescente , Criança , Pré-Escolar , Coinfecção , Técnicas de Cultura , Farmacorresistência Bacteriana/genética , Feminino , Infecções por HIV/complicações , Humanos , Lactente , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico , Estudos Prospectivos , Sensibilidade e Especificidade , África do Sul , Fatores de Tempo , Tuberculose Pulmonar/complicações
6.
Clin Infect Dis ; 55(8): 1088-95, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22752518

RESUMO

BACKGROUND: A rapid diagnosis of pediatric pulmonary tuberculosis (PTB) using Xpert MTB/RIF (Mycobacterium tuberculosis/rifampicin) automated testing on induced sputum (IS) is possible, but the capacity for performing IS is limited. The diagnosis using a nasopharyngeal aspirate (NPA), which can be non-invasively obtained, is desirable. METHODS: Paired specimens (NPA and IS) were tested using smear, liquid culture and Xpert. The diagnostic accuracy of Xpert and smear was compared with culture for different specimens in children with suspected PTB. RESULTS: There were 535 children [median age 19 months, 117 (21·9%) HIV-infected] who had one IS and one NPA specimen; 396 had two paired specimens. A positive smear, Xpert test or culture occurred in 30 (5.6%), 81 (15.1%) and 87 children (16.3%), respectively. The culture yield was higher from IS (84/87, 96.6%) vs NPA (61/87, 70.1%, P < .001). Amongst children with two paired specimens, 63 culture-confirmed cases occurred [60 (95.2%) IS vs 48 (76.2%) NPA, P = .002]. The sensitivity of two Xpert tests was similar for IS and NPAs [(45/63) 71% vs (41/63) 65%, P = .444)]; the sensitivity of smear was lower for IS (21/63, 33%) and NPA (16/63, 25%). The incremental yield from a second IS was 9 cases (17.6%) by culture and 9 (25%) by Xpert testing; a second NPA increased the culture yield by 10 (26.3%) and Xpert by 11 (36.7%). Xpert specificity was 99.1% (98.1-100) for IS and 98.2% (96.8-99.6) for NPAs. Xpert testing provided faster results than culture (median 0 vs 15 days, P < .001). CONCLUSIONS: Xpert testing on 2 NPAs is useful in children with suspected PTB, particularly in settings where IS and culture are not feasible.


Assuntos
Técnicas Bacteriológicas/métodos , Técnicas de Diagnóstico Molecular/métodos , Nasofaringe/microbiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Sensibilidade e Especificidade , Escarro/microbiologia
7.
Lancet Infect Dis ; 11(11): 819-24, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21764384

RESUMO

BACKGROUND: WHO recommends that Xpert MTB/RIF replaces smear microscopy for initial diagnosis of suspected HIV-associated tuberculosis or multidrug-resistant pulmonary tuberculosis, but no data exist for its use in children. We aimed to assess the accuracy of the test for the diagnosis of pulmonary tuberculosis in children in an area with high tuberculosis and HIV prevalences. METHODS: In this prospective, descriptive study, we enrolled children aged 15 years or younger who had been admitted to one of two hospitals in Cape Town, South Africa, with suspected pulmonary tuberculosis between Feb 19, 2009, and Nov 30, 2010. We compared the diagnostic accuracy of MTB/RIF and concentrated, fluorescent acid-fast smear with a reference standard of liquid culture from two sequential induced sputum specimens (primary analysis). RESULTS: 452 children (median age 19·4 months, IQR 11·1-46·2) had at least one induced sputum specimen; 108 children (24%) had HIV infection. 27 children (6%) had a positive smear result, 70 (16%) had a positive culture result, and 58 (13%) had a positive MTB/RIF test result. With mycobacterial culture as the reference standard, MTB/RIF tests when done on two induced sputum samples detected twice as many cases (75·9%, 95% CI 64·5-87·2) as did smear microscopy (37·9%, 25·1-50·8), detecting all of 22 smear-positive cases and 22 of 36 (61·1%, 44·4-77·8) smear-negative cases. For smear-negative cases, the incremental increase in sensitivity from testing a second specimen was 27·8% for MTB/RIF, compared with 13·8% for culture. The specificity of MTB/RIF was 98·8% (97·6-99·9). MTB/RIF results were available in median 1 day (IQR 0-4) compared with median 12 days (9-17) for culture (p<0·0001). INTERPRETATION: MTB/RIF testing of two induced sputum specimens is warranted as the first-line diagnostic test for children with suspected pulmonary tuberculosis. FUNDING: National Institutes of Health, the National Health Laboratory Service Research Trust, the Medical Research Council of South Africa, and Wellcome Trust.


Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real/métodos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia , Pré-Escolar , DNA Bacteriano/química , DNA Bacteriano/genética , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade , África do Sul , Escarro/microbiologia , Estatísticas não Paramétricas , Tuberculose Pulmonar/genética
8.
J Nutr ; 135(4): 850-5, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15795446

RESUMO

The aim of this study was to determine whether iron deficiency anemia (IDA) in young South African mothers alters mother-infant interactions and the infant's development. The study was a prospective, randomized, controlled intervention trial with 3 groups of mothers: nonanemic controls and anemic mothers administered either placebo (25 mg ascorbic acid and 10 microg folate) or daily iron treatment (125 mg FeSO(4) plus ascorbate and folate). Mothers of full-term, normal birth weight infants (n = 81) were followed from 10 wk to 9 mo postpartum. Maternal iron status, socioeconomic level, mother-infant interaction [Parent/Caregiver Involvement Scale (PCIS scale)], and infant development (Griffiths scale) were assessed. At baseline, anemic mothers tended (P < 0.10) to be less responsive to, and more controlling of, their infants. Infants of anemic mothers were developmentally delayed at 10 wk in hand-eye movement and overall quotient. Despite normalization of maternal iron status with supplementation in some mothers, the developmental delays were not diminished at 9 mo. At 9 mo, anemic mothers were significantly more "negative" towards their babies, engaged less in goal setting, and were less "responsive" than control mothers. In contrast, the behavior of anemic mothers given iron treatment toward their children was similar to that of the control mothers on all 11 scales of the PCIS. In conclusion, IDA altered mother-child interactions at both 10 wk and 9 mo postpartum. Additionally, infants whose mothers were anemic in the early postpartum scored worse on developmental tests at 10 wk and 9 mo of age.


Assuntos
Anemia Ferropriva/psicologia , Desenvolvimento Infantil/fisiologia , Relações Mãe-Filho , Anemia Ferropriva/epidemiologia , Feminino , Audição , Humanos , Lactente , Atividade Motora , Desempenho Psicomotor , Comportamento Social , Fatores Socioeconômicos , África do Sul/epidemiologia , Fala , Gravação de Videoteipe
9.
J Nutr ; 135(2): 267-72, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15671224

RESUMO

The aim of this study was to determine whether iron deficiency anemia (IDA) in mothers alters their maternal cognitive and behavioral performance, the mother-infant interaction, and the infant's development. This article focuses on the relation between IDA and cognition as well as behavioral affect in the young mothers. This prospective, randomized, controlled, intervention trial was conducted in South Africa among 3 groups of mothers: nonanemic controls and anemic mothers receiving either placebo (10 microg folate and 25 mg vitamin C) or daily iron (125 mg FeS0(4), 10 microg folate, 25 mg vitamin C). Mothers of full-term normal birth weight babies were followed from 10 wk to 9 mo postpartum (n = 81). Maternal hematologic and iron status, socioeconomic, cognitive, and emotional status, mother-infant interaction, and the development of the infants were assessed at 10 wk and 9 mo postpartum. Behavioral and cognitive variables at baseline did not differ between iron-deficient anemic mothers and nonanemic mothers. However, iron treatment resulted in a 25% improvement (P < 0.05) in previously iron-deficient mothers' depression and stress scales as well as in the Raven's Progressive Matrices test. Anemic mothers administered placebo did not improve in behavioral measures. Multivariate analysis showed a strong association between iron status variables (hemoglobin, mean corpuscular volume, and transferrin saturation) and cognitive variables (Digit Symbol) as well as behavioral variables (anxiety, stress, depression). This study demonstrates that there is a strong relation between iron status and depression, stress, and cognitive functioning in poor African mothers during the postpartum period. There are likely ramifications of this poorer "functioning" on mother-child interactions and infant development, but the constraints around this relation will have to be defined in larger studies.


Assuntos
Anemia Ferropriva/psicologia , Cognição , Emoções , Complicações na Gravidez/psicologia , Transtornos Puerperais/prevenção & controle , Estresse Psicológico/prevenção & controle , Adulto , Ácido Ascórbico , Demografia , Depressão/prevenção & controle , Suplementos Nutricionais , Escolaridade , Feminino , Compostos Férricos , Humanos , Renda , Placebos , Gravidez , África do Sul
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...