[show abstract][hide abstract] ABSTRACT: Compared with other middle-income countries, child health in South Africa is in a poor state, and should be addressed by focusing on the health care needs of all children across a system or region. Paediatricians have had little effect on this situation, partly because their training is not aligned with South African needs. The proposed re-engineering of primary health care will be limited by the skewed distribution of staff and the lack of suitable skills. A 'community' placement during specialist training, and the creation of a sub-specialty in Community Paediatrics and Child Health, could address the skills shortage and possibly attract health personnel to under-served areas through creating an appropriate career path. This proposal would also support the Department of Health's encouraging plans to re-engineer primary health care.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 09/2012; 102(9):738-9. · 1.70 Impact Factor
[show abstract][hide abstract] ABSTRACT: To investigate the effect of an exercise program, including specific stabilizing exercises, on pain intensity and functional ability in women with pregnancy-related low back pain.
Fifty women between 16 and 24 weeks of pregnancy were recruited at Tygerberg and Paarl Hospitals, Western Cape, South Africa. Twenty-six women were randomized to a 10-week exercise program and 24 were randomized as controls.
Overall, the most frequent type of back pain experienced was lumbar pain (36 [72.0%]). Pain intensity (P=0.76) and functional ability (P=0.29) were comparable between the groups on study entry. In the study group, there was a significant improvement in pain intensity (P<0.01) and an improvement in functional ability (P=0.06) at the end of the study. In the control group, there were no significant changes in pain intensity (P=0.89) or functional ability (P=0.70) at the end of the study.
A specific exercise program decreased back pain intensity and increased functional ability during pregnancy in South African women with lumbar and pelvic girdle pain.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 03/2011; 113(3):187-91. · 1.41 Impact Factor
[show abstract][hide abstract] ABSTRACT: No pharmacokinetic data exist for premature infants receiving single-dose nevirapine (sd NVP) for prevention of mother-to-child transmission (MTCT) of HIV.
To describe NVP decay pharmacokinetics in two groups of premature infants - those whose mothers either received or did not receive NVP during labour.
Infants less than 37 weeks' gestation were prospectively enrolled. Mothers received sd NVP during labour. Infants received sd NVP and zidovudine. Blood was collected on specified days after birth and NVP concentrations were determined by liquid chromatography-mass spectrometry.
Data were obtained from 81 infants, 58 born to mothers who received sd NVP during labour (group I) and 23 to mothers who did not receive NVP (group II). Of the infants 29.6% were small for gestational age (SGA). Median (range) maximum concentration (Cmax), time to reach maximum concentration (Tmax), area under the plasma concentration-time curve (AUC) and half-life (T½) were 1 438 (350 - 3 832) ng/ml, 25h50 (9h40 - 83h45), 174 134 (22 308 - 546 408) ng/h/ml and 59.0 (15.4 - 532.6) hours for group I and 1 535 (635 - 4 218) ng/ml, 17h35 (7h40 - 29h), 168 576 (20 268 - 476 712) ng/h/ml and 69.0 (22.12 - 172.3) hours for group II. For group II, the median (range) volume of distribution (Vd) and body clearance (Cl) were 1 702.6 (623.7 - 6 189.8) ml and 34.9 (6.2 - 163.8) ml/h. The AUC was higher (p=0.006) and Cl lower (p<0.0001) in SGA infants. Plasma concentrations exceeding 100ng/ml were achieved over 8 days in 78% infants in group I and 70.0% in group II. The MTCT rate was 4.8%.
Women in preterm labour often deliver with little advance warning. Our study suggests that NVP dosing of preterm infants as soon as possible after birth without maternal intrapartum dosing may be as effective as combined maternal and infant dosing.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 01/2011; 101(9):655-8. · 1.70 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine the leading causes of perinatal deaths and to evaluate any changes, with the inclusion of placental histology.
At perinatal mortality meetings, primary and final causes of death were assigned for the period 1 July 2006 - 30 June 2007. All singleton babies born to women residing in the metropolitan area serviced by Tygerberg Hospital were included in the prospective descriptive study.
The total number of singleton births was 10 396. The total of perinatally related losses (TPRL) rate was 26.2 per 1,000 births. The leading primary obstetric causes of death were: infections (47 - 17.3%), spontaneous preterm labour (PTL) (41 - 15.1%), antepartum haemorrhage (APH) (40 - 14.7%), intra-uterine growth restriction (IUGR) (40 - 14.7%), fetal abnormality (31 - 11.4%), hypertensive disorders (25 - 9.2%), unexplained intra-uterine deaths (IUD) (20 - 7.4%), intrapartum hypoxia (12 - 4.4%) and maternal disease (9 - 3.3%). A total of 162 placentas were sent for histology; 58 reports changed the primary cause of death.
The TPRL rate for singleton pregnancies was 26.2 per 1,000 births for the study period. The TPRL rates in 1986 and 1993 were 36.7 and 30.5 per 1,000 deliveries. Infection is now the leading primary cause of death, followed by spontaneous PTL, APH and IUGR. During the previous two study periods, APH was the leading primary cause of death, followed by spontaneous PTL. Unexplained IUDs ranked third in 1986, fourth in 1993 and seventh in this study because of the availability of placental histology. Placental histology reports changed 21.3% of the primary causes of death.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 04/2010; 100(4):250-3. · 1.70 Impact Factor
[show abstract][hide abstract] ABSTRACT: Studies have shown poor knowledge of oral contraceptives among women attending government health clinics and women in rural areas. Little is known about the level of contraceptive knowledge in educated, affluent, career-orientated women, although it could be expected that access to information would be greater. The study objective was to describe the profile, knowledge and understanding of oral contraceptive users in a private general practice in Johannesburg, South Africa.
Over a period of 3 months, all women attending a private general practice who were using an oral contraceptive were asked to complete an anonymous questionnaire. Informed written consent was obtained in all cases.
Fifty-one women participated in the study. Most women were nulliparous (71%), held a tertiary educational qualification (80%), were employed (84%) and were not concerned about the cost of their pill (65%). Most respondents (86%) obtained their information from a doctor. However, only 12% of women were aware of the danger of extending the active pill-free interval. Less than half (49%) were aware that their pill was less effective if taken more than 12 hours late and only 31% of women knew that their pill was effective again after taking seven active tablets.
Educated, affluent women attending a private general practice lacked basic knowledge of the oral contraceptive pill. Consultations by practitioners need to be improved.
Journal of Family Planning and Reproductive Health Care 11/2005; 31(4):307-9. · 2.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study measured the decision to delivery time intervals in non-elective caesarean sections and compared them to the 30-min interval suggested by international literature. It also evaluated fetal outcome. A 3-month prospective evaluation of all (n=178) non-elective caesarean sections was performed, using a structured time and data sheet, in a tertiary centre. Operations were divided into 'emergency', most pressing and 'urgent' where maternal or fetal compromise were not immediately life-threatening. The median interval for the 100 emergency cases was 48 min, and 59 min for the 78 urgent cases. Only 28 (15.7 per cent) of decision to delivery intervals were within 30 min. Twenty-two babies (12.4 per cent) had Apgar scores of below 7 at 5 min. Most decision to delivery intervals exceeded 30 min. It may be wiser to train staff to recognize and respond appropriately to emergencies than insisting on rigid decision to delivery intervals.
Journal of Tropical Pediatrics 05/2005; 51(2):78-81. · 1.01 Impact Factor
[show abstract][hide abstract] ABSTRACT: Early onset severe pre-eclampsia is ideally managed in a tertiary setting. We investigated the possibility of safe management at secondary level, in close co-operation with the tertiary centre.
Prospective case series over 39 months.
Secondary referral centre.
All women (n= 131) between 24 and 34 weeks of gestation with severe pre-eclampsia, where both mother and fetus were otherwise stable.
After admission, frequent intensive but non-invasive monitoring of mother and fetus was performed. Women were delivered on achieving 34 weeks, or if fetal distress or major maternal complications developed. Transfer to the tertiary centre was individualised.
Prolongation of gestation, maternal complications, perinatal outcome and number of tertiary referrals.
Most women [n= 116 (88.5%)] were managed entirely at the secondary hospital. Major maternal complications occurred in 44 (33.6%) cases with placental abruption (22.9%) the most common. One maternal death occurred and two women required intensive care admission. A mean of 11.6 days was gained before delivery with the mean delivery gestation being 31.8 weeks. The most frequent reason for delivery was fetal distress (55.2%). There were four intrauterine deaths. The perinatal mortality rate (> or =1000 g) was 44.4/1000, and the early neonatal mortality rate (> or =500 g) was 30.5/1000.
The maternal and perinatal outcomes are comparable to those achieved by other tertiary units. This model of expectant management of early onset, severe pre-eclampsia is encouraging but requires close co-operation between secondary and tertiary institutions. Referrals to the tertiary centre were optimised, reducing their workload and costs, and patients were managed closer to their communities.
BJOG An International Journal of Obstetrics & Gynaecology 02/2005; 112(1):84-8. · 3.76 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study was to compare the neonatal outcomes of babies with birthweights < 10th centile to those with birthweights > or = 10th centile with a gestational age of 28-34 weeks. This retrospective hospital-based study was performed at a tertiary referral centre. All women with early, severe pre-eclampsia, managed expectantly and who delivered a liveborn infant, over a 5-year period were included. The main outcome measures were birthweight within gestational age category, neonatal and infant deaths before discharge as well as neonatal intensive care. There were 136 and 190 babies in the < 10th and > or = 10th centile groups, respectively. No significant differences in outcome were noted in any of the gestational age categories. Thus within gestational age categories, birthweights < 10th centile did not predict a worse outcome in preterm deliveries for severe pre-eclampsia.
Journal of Tropical Pediatrics 07/2003; 49(3):178-80. · 1.01 Impact Factor