Sithembiso Velaphi

University of Colorado, Denver, Colorado, United States

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Publications (28)250.98 Total impact

  • Susan Niermeyer, Sithembiso Velaphi
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    ABSTRACT: Delayed clamping of the umbilical cord is recommended for term and preterm infants who do not require resuscitation. However, the approach to the newly born infant with signs of fetal compromise, prematurity and extremely low birthweight, or prolonged apnea is less clear. Human and experimental animal data show that delaying the clamping of the umbilical cord until after the onset of respirations promotes cardiovascular stability in the minutes immediately after birth. Rather than regarding delayed cord clamping as a fixed time period before resuscitation begins, a more physiologic concept of transition at birth should encompass the relative timing of onset of respirations and cord occlusion. Further research to explore the potential benefits of resuscitation with the cord intact is needed.
    Seminars in Fetal and Neonatal Medicine 09/2013; · 3.51 Impact Factor
  • Sithembiso Velaphi, Jeffrey Perlman
    The Lancet 07/2013; · 39.06 Impact Factor
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    ABSTRACT: Background Babies with low birthweight (<2500 g) are at increased risk of early mortality. However, low birthweight includes babies born preterm and with fetal growth restriction, and not all these infants have a birthweight less than 2500 g. We estimated the neonatal and infant mortality associated with these two characteristics in low-income and middle-income countries. Methods For this pooled analysis, we searched all available studies and identifi ed 20 cohorts (providing data for 2 015 019 livebirths) from Asia, Africa, and Latin America that recorded data for birthweight, gestational age, and vital statistics through 28 days of life. Study dates ranged from 1982 through to 2010. We calculated relative risks (RR) and risk diff erences (RD) for mortality associated with preterm birth (<32 weeks, 32 weeks to <34 weeks, 34 weeks to <37 weeks), small-for-gestational-age (SGA; babies with birthweight in the lowest third percentile and between the third and tenth percentile of a US reference population), and preterm and SGA combinations. Findings Pooled overall RRs for preterm were 6·82 (95% CI 3·56–13·07) for neonatal mortality and 2·50 (1·48–4·22) for post-neonatal mortality. Pooled RRs for babies who were SGA (with birthweight in the lowest tenth percentile of the reference population) were 1·83 (95% CI 1·34–2·50) for neonatal mortality and 1·90 (1·32–2·73) for post-neonatal mortality. The neonatal mortality risk of babies who were both preterm and SGA was higher than that of babies with either characteristic alone (15·42; 9·11–26·12). Interpretation Many babies in low-income and middle-income countries are SGA. Preterm birth aff ects a smaller number of neonates than does SGA, but is associated with a higher mortality risk. The mortality risks associated with both characteristics extend beyond the neonatal period. Diff erentiation of the burden and risk of babies born preterm and SGA rather than with low birthweight could guide prevention and management strategies to speed progress towards Millennium Development Goal 4—the reduction of child mortality.
    The Lancet 06/2013; 382:417–25. · 39.06 Impact Factor
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    ABSTRACT: 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. We performed a secondary analysis of a study (clinicaltrials.gov, number NCT00136370) 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). 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). 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.
    PEDIATRICS 08/2012; 130(3):e581-90. · 4.47 Impact Factor
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    ABSTRACT: 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 Perinatal Sepsis Trial (NCT00136370 at ClinicalTrials.gov), Soweto, South Africa. Secondary analysis of 8011 enrolled mothers and their neonates. Prenatal and labor records were abstracted and neonatal wards were monitored for hospitalized Prevention of Perinatal Sepsis-enrolled neonates. Endpoint definitions required clinical and laboratory signs. All univariate factors associated with endpoints at P < 0.15 were evaluated using multivariable logistic regression. About 10.5% (837/8011) of women received intrapartum antibiotic prophylaxis; 3.8% of enrolled versus 15% of hospital births were preterm. Among 8129 infants, 289 had early-onset sepsis, 34 had late-onset sepsis, 49 had culture-confirmed neonatal sepsis and 71 died in the perinatal period. Factors associated with early-onset sepsis included preterm delivery [adjusted relative risk (aRR) = 2.6; 95% confidence interval (CI): 1.4-4.8]; low birth weight (<1500 g: aRR = 6.5, 95% CI: 2.4-17.3); meconium-stained amniotic fluid (MSAF) (aRR = 2.8, 95% CI: 2.2-3.7) and first birth (aRR = 1.8; 95% CI: 1.4-2.3). Preterm, low birth weight, MSAF and first birth were similarly associated with perinatal death and culture-confirmed sepsis. MSAF (aRR = 2.4, 95% CI: 1.1-5.0) was associated with late-onset sepsis. Preterm and low birth weight were important sepsis risk factors. MSAF and first birth were also associated with sepsis and death, warranting further exploration. Intrapartum antibiotic prophylaxis did not protect against all-cause sepsis or death, underscoring the need for alternate prevention strategies.
    The Pediatric Infectious Disease Journal 05/2012; 31(8):821-6. · 3.57 Impact Factor
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    ABSTRACT: Guidelines for the techniques of resuscitating newly born infants have undergone major revisions over the past 25 years. The International Liaison Committee on Resuscitation (ILCOR) is committed to "periodically developing and publishing a consensus on resuscitation science" every five years with the most recent Consensus on Science and Treatment Recommendations (CoSTR) statement published in 2010. The CoSTR document is used as a basis for developing specific resuscitation guidelines felt to be appropriate for implementation in respective countries. A "gaps in knowledge" summary is created at the conclusion of a cycle. It is a goal that identification of these knowledge gaps will stimulate investigators to pursue more targeted studies to help close the gaps. The current document is based on the "gaps in knowledge" summary for neonatal resuscitation that was created at the conclusion of the 2005-2010 ILCOR cycle.
    Resuscitation 01/2012; 83(5):545-50. · 4.10 Impact Factor
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    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 Perinatal Sepsis Trial (NCT00136370 at ClinicalTrials.gov), Soweto, South Africa. METHODS: Secondary analysis of 8011 enrolled mothers and their neonates. Prenatal and labor records were abstracted and neonatal wards were monitored for hospitalized Prevention of Perinatal Sepsis-enrolled neonates. Endpoint definitions required clinical and laboratory signs. All univariate factors associated with endpoints at P < 0.15 were evaluated using multivariable logistic regression. RESULTS: About 10.5% (837/8011) of women received intrapartum antibiotic prophylaxis; 3.8% of enrolled versus 15% of hospital births were preterm. Among 8129 infants, 289 had early-onset sepsis, 34 had late-onset sepsis, 49 had culture-confirmed neonatal sepsis and 71 died in the perinatal period. Factors associated with early-onset sepsis included preterm delivery [adjusted relative risk (aRR) = 2.6; 95% confidence interval (CI): 1.4-4.8]; low birth weight (<1500 g: aRR = 6.5, 95% CI: 2.4-17.3); meconium-stained amniotic fluid (MSAF) (aRR = 2.8, 95% CI: 2.2-3.7) and first birth (aRR = 1.8; 95% CI: 1.4-2.3). Preterm, low birth weight, MSAF and first birth were similarly associated with perinatal death and culture-confirmed sepsis. MSAF (aRR = 2.4, 95% CI: 1.1-5.0) was associated with late-onset sepsis. CONCLUSIONS: Preterm and low birth weight were important sepsis risk factors. MSAF and first birth were also associated with sepsis and death, warranting further exploration. Intrapartum antibiotic prophylaxis did not protect against all-cause sepsis or death, underscoring the need for alternate prevention strategies.
    The Pediatric Infectious Disease Journal 01/2012; 31(8):821-6. · 3.57 Impact Factor
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    ABSTRACT: 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. To validate a bedside C-reactive protein (CRP) test against the currently available laboratory CRP test in neonates with suspected sepsis. 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. 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 were 84%, 80%, 30% and 97%, respectively. Adjusting the cut-off value from 8.0 to 15.0 mg/L improved the specificity to 88%. The sensitivity, specificity and positive and negative predictive values were not different between early-onset and late-onset sepsis. The receiver operating characteristic curve had an area below the curve of 0.84 for the cut-off at 16.2 mg/L on the beside CRP test. The bedside CRP test may be used as a screening test to aid decisions to either commence or discontinue antibiotics in circumstances where the clinical diagnosis of sepsis is in doubt. By using a cut-off of 16.0 mg/L for the bedside CRP test, the possibility of a false negative result is minimised.
    Paediatrics and international child health. 01/2012; 32(1):35-42.
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    Dharmapuri Vidyasagar, Sithembiso Velaphi, Vishnu B Bhat
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    ABSTRACT: Since the first successful report of surfactant replacement therapy (SRT) in infants with respiratory distress syndrome (RDS), numerous randomized clinical trials have shown that SRT reduces mortality and morbidity in RDS. Surfactant is now a standard therapy for RDS. However, the use of SRT in the developing world has been extremely slow. The objective of this paper is to review the published information regarding the usage and barriers encountered in the use of SRT in developing countries. We reviewed the available literature and also gathered information from countries with a high burden of prematurity and high infant mortality rate regarding replacement therapy and the barriers to use of SRT. We reviewed the available literature and found that developing countries bear a high burden of prematurity and RDS that contribute to high neonatal and infant mortality rates. Based on the effectiveness of SRT in RDS, surfactant preparations were included in the Essential Drug List of WHO in 2008. However, the use of SRT in developing countries is still limited because of (1) high cost, (2) lack of skilled personnel to administer SRT, and (3) lack of support systems after the SRT. The cost of SRT may exceed the per-capita GNP (300-500 USD) in some countries. Data from India and South Africa suggests that SRT is limited to rescue therapy in babies with potential for better survival, usually >28 weeks' gestation. Recent studies show that infants with RDS respond well to initial continuous positive airway pressure (CPAP) followed by SRT for those who do not respond. In developing countries, CPAP may be used as the primary mode of management of RDS. SRT may be reserved for non-responders to CPAP. Alternate simpler methods of delivery of surfactant (aerosol technique) are also being explored. There is a need for further studies to develop and assess efficient and less expensive methods of application of CPAP and SRT in developing countries.
    Neonatology 01/2011; 99(4):355-66. · 2.57 Impact Factor
  • Resuscitation 10/2010; 81 Suppl 1:e260-87. · 4.10 Impact Factor
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    ABSTRACT: Nearly 1 million sepsis-related deaths per year occur in developing countries, primarily in the first week of life. In 2 nonrandomized studies in Africa, intravaginal washes during labor with cotton wipes soaked in chlorhexidine, a commonly available wide-spectrum antibiotic, were associated with reductions of 50% to 75% in neonatal sepsis-related morbidity and mortality. The lack of a definitive randomized, controlled trial has impeded widespread acceptance and use of chlorhexidine wipes. The results of a meta-analysis including randomized or quasi-randomized trials showed that chlorhexidine significantly reduced vertical transmission of group B streptococcus, but not early-onset neonatal infection caused by this bacterium or other neonatal pathogens. This randomized controlled trial investigated the efficacy of intravaginal chlorhexidine in reducing early-onset neonatal sepsis (the first 3 days of life) and vertical transmission of group B streptococcus. The study was conducted between 2004 and 2007 at a hospital in Soweto, South Africa. A total of 8011 pregnant women (age, 12–51 years) in active labor, were randomly assigned to intravaginal washes with either chlorhexidine wipes (interventional group) or external genitalia water wipes (control group); their 8129 newborn babies were assigned to either full-body (intervention group, n = 4072) or foot (control group, n = 4057) washes at birth, respectively. After delivery, swabs of the maternal lower vagina and neonatal skin were obtained from a maternal subset (n = 5144) to assess colonization with potentially pathogenic bacteria. The analysis was according to intention to treat. A total of 289 cases of early-onset sepsis occurred, with no difference in rates of neonatal sepsis between the chlorhexidine (34.6 per 1000 births) and control groups (36.5 per 1000 births). Similarly, the rates of colonization with group B streptococcus in neonates born to mothers in the chlorhexidine (54%, 217/401) and control groups (55%, 234/429) did not differ and there was no substantial reduction in vertical transmission. These findings demonstrate that the use of maternal and neonatal chlorhexidine wipes does not prevent the occurrence of early-onset sepsis or affect vertical transmission of one of the main sepsis-causing pathogens.
    Obstetrical and Gynecological Survey 03/2010; 65(4):215-216. · 2.51 Impact Factor
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    H Diar, S Velaphi
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    ABSTRACT: The diagnosis of congenital tuberculosis (TB) is often difficult as clinical signs are nonspecific. The maternal history of TB therefore remains an important tool in the diagnosis of congenital TB. In this case report, we present a patient with congenital TB, whose diagnosis was delayed because the mother was asymptomatic and there was a delay in eliciting a family history of TB. This highlights the importance of obtaining a detailed history on admission.
    Journal of perinatology: official journal of the California Perinatal Association 10/2009; 29(10):709-11. · 1.59 Impact Factor
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    ABSTRACT: About 500,000 sepsis-related deaths per year arise in the first 3 days of life. On the basis of results from non-randomised studies, use of vaginal chlorhexidine wipes during labour has been proposed as an intervention for the prevention of early-onset neonatal sepsis in developing countries. We therefore assessed the efficacy of chlorhexidine in early-onset neonatal sepsis and vertical transmission of group B streptococcus. In a trial in Soweto, South Africa, 8011 women (aged 12-51 years) were randomly assigned in a 1:1 ratio to chlorhexidine vaginal wipes or external genitalia water wipes during active labour, and their 8129 newborn babies were assigned to full-body (intervention group) or foot (control group) washes with chlorhexidine at birth, respectively. In a subset of mothers (n=5144), we gathered maternal lower vaginal swabs and neonatal skin swabs after delivery to assess colonisation with potentially pathogenic bacteria. Primary outcomes were neonatal sepsis in the first 3 days of life and vertical transmission of group B streptococcus. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00136370. Rates of neonatal sepsis did not differ between the groups (chlorhexidine 141 [3%] of 4072 vs control 148 [4%] of 4057; p=0.6518). Rates of colonisation with group B streptococcus in newborn babies born to mothers in the chlorhexidine (217 [54%] of 401) and control groups (234 [55%] of 429] did not differ (efficacy -0.05%, 95% CI -9.5 to 7.9). Because chlorhexidine intravaginal and neonatal wipes did not prevent neonatal sepsis or the vertical acquisition of potentially pathogenic bacteria among neonates, we need other interventions to reduce childhood mortality. US Agency for International Development, National Vaccine Program Office and Centers for Disease Control's Antimicrobial Resistance Working Group, and Bill & Melinda Gates Foundation.
    The Lancet 10/2009; 374(9705):1909-16. · 39.06 Impact Factor
  • Eckhart J Buchmann, Sithembiso C Velaphi
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    ABSTRACT: Hypoxic ischaemic encephalopathy (HIE) may be regarded as a near miss marker for perinatal death resulting from intrapartum hypoxia. Considering the serious long-term consequences of HIE and issues of blame and liability for clinicians, regional or national audit of HIE might best be done using confidential enquiries. These are conducted by independent multidisciplinary panels, and should identify weaknesses in delivery of health care. A confidential enquiry into HIE may determine intrapartum factors that could have caused the poor outcome. It should also consider the role of associated preconceptual and antepartum factors, which may predispose the fetus to intrapartum damage. The enquiry should also assess avoidable factors and suboptimal care. These may involve patient- and family-related problems, administration-related suboptimal care, and health worker-related suboptimal care. The dissemination of the results of confidential enquiries should result in an improvement in quality of health care, including better allocation of health resources and health worker education.
    Best practice & research. Clinical obstetrics & gynaecology 07/2009; 23(3):357-68. · 1.87 Impact Factor
  • S Velaphi, J Wadula, F Nakwa
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    ABSTRACT: Infection with resistant gram-negative bacteria is a growing threat to hospitalised patients. To determine factors associated with mortality among infants infected by extended-spectrum beta-lactamase-producing Klebsiella species (Klebs-ESBL) and to assess whether selective empirical use of meropenem (MERO) is associated with high mortality. Medical records of neonates admitted from January 2002 to December 2003 who had positive blood and/or cerebrospinal fluid (CSF) culture with Klebs-ESBL were reviewed for clinical, management and outcome information. Univariate and multivariate logistic regression analyses were performed to determine factors associated with mortality among infants with culture-proven Klebs-ESBL. A hundred patients had positive blood (n=97) and/or CSF cultures (n=9) owing to Klebs-ESBL. Overall mortality rate was 30%. The mortality rates among those who were empirically started on a combination of piperacillin-tazobactam and amikacin (Pip-Taz+Amik) (n=48), meropenem (MERO) (n=40) and in those not started on MERO or Pip-Taz+Amik) (n=12) were 25%, 32% and 42%, respectively. Non-survivors were younger (p=0.01), had cardio-respiratory compromise or required assisted ventilation at presentation (p<0.001), and were not started on antibiotics, MERO or Pip-Taz+Amik (p<0.001). On multivariate analysis, factors associated with mortality were vaginal delivery (OR -7.07, 95% CI 2.14-23.39), a need for assisted ventilation at onset of illness (OR -4.94, 95% CI 1.12-21.86) and not starting empirical MERO or Pip-Taz+Amik (OR -17.01, 95% CI 2.41-120.23). While empirical use of carbapenems for nosocomial sepsis might be appropriate in areas where Klebs-ESBL is prevalent, their use can be restricted to those with cardio-respiratory compromise or severe sepsis without an increase in mortality.
    Annals of Tropical Paediatrics International Child Health 06/2009; 29(2):101-10. · 0.92 Impact Factor
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    S Velaphi, A Van Kwawegen
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    ABSTRACT: To determine characteristics, management, complications and outcome of neonates with meconium aspiration syndrome (MAS) requiring mechanical ventilation (MV). A retrospective review of clinical data of neonates with MAS who were admitted to a public hospital for MV between January 2004 and December 2006. Eighty-eight neonates were ventilated for MAS. Thirty-one percent were postdates and 51% had no electronic fetal monitoring. Postnatal suctioning of meconium was not performed according to protocol in 47% of nonvigorous infants. High-frequency ventilation and surfactant were used in 32 and 14% of cases, respectively. Persistent pulmonary hypertension of the newborn (PPHN) and pneumothorax occurred in 57 and 24% of cases, respectively. Overall mortality rate was 33%. Neonates suffering from MAS with PPHN had higher mortality rate of 48% compared with 13% in those suffering from MAS without PPHN. Factors associated with mortality were peak inspiratory pressure (P<0.001), pneumothorax (P<0.001) and PPHN (P=0.001). Postdates, inadequate intrapartum monitoring and limited use of adjunct respiratory therapies were common. Severe MAS is associated with adverse outcome.
    Journal of perinatology: official journal of the California Perinatal Association 12/2008; 28 Suppl 3:S36-42. · 1.59 Impact Factor
  • Sithembiso Velaphi, Dharmapuri Vidyasagar
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    ABSTRACT: Routine oronasopharyngeal suctioning (ONPS) of the infant at delivery is a common practice in the delivery room. ONPS is performed to remove lung fluid, meconium, or other secretions from the airway, thereby improving oxygenation and/or preventing aspiration. However, there are controversies regarding this practice, as it seems to be associated with complications. In the presence of clear amniotic fluid, routine ONPS in infants born vaginally and by cesarean section is associated with bradycardia, apnea, and delays in achieving normal oxygen saturations, with no benefit. Intrapartum ONPS and post-natal endotracheal suctioning of vigorous infants born through meconium-stained amniotic fluid (MSAF) does not prevent meconium aspiration syndrome (MAS). Although depressed infants born through MSAF are at risk of developing MAS, there is no evidence that endotracheal suctioning of these infants reduces MAS.
    Seminars in Fetal and Neonatal Medicine 06/2008; 13(6):375-82. · 3.51 Impact Factor
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    ABSTRACT: South Africa is one of the few developing countries with a national confidential inquiry into maternal deaths. 164 health facilities obtain audit data for stillbirths and neonatal deaths, and a new audit network does so for child deaths. Three separate reports have been published, providing valuable information about avoidable causes of death for mothers, babies, and children. These reports make health-system recommendations, many of which overlap and are intertwined with the scarcity of progress in addressing HIV/AIDS. The leaders of these three reports have united to prioritise actions to save the lives of South Africa's mothers, babies, and children. The country is off-track for the health-related Millennium Development Goals. Mortality in children younger than 5 years has increased, whereas maternal and neonatal mortality remain constant. This situation indicates the challenge of strengthening the health system because of high inequity and HIV/AIDS. Coverage of services is fairly high, but addressing the gaps in quality and equity is essential to increasing the number of lives saved. Consistent leadership and accountability to address crosscutting health system and equity issues, and to prevent mother-to-child transmission of HIV, would save tens of thousands of lives every year. Audit is powerful, but only if the data lead to action.
    The Lancet 05/2008; 371(9620):1294-304. · 39.06 Impact Factor
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    ABSTRACT: To compare the effects of a biologically and chemically acidified formula with or without probiotics with a standard formula on growth of infants negative for human immunodeficiency virus (HIV). This was a double-masked, randomized, clinical trial. Infants born to consenting HIV-positive women who had decided not to breast-feed before being approached for participating in the study were randomized to receive one of four milk formulas: a chemically acidified formula with or without probiotics (Bifidobacterium lactis), a biologically acidified formula, or a standard whey formula. Infants who subsequently became HIV-positive according to polymerase chain reaction at 6 wk were excluded. Their growth and biochemical status were monitored for 4-6 mo. The z scores at the last visit of infants in each of the four formula groups were compared using analysis of covariance correcting for the z scores at baseline. Blood gases and pH were analyzed using a two-way analysis of variance corrected for center. One hundred thirty-two HIV-negative infants were monitored for growth and biochemical parameters for 4-6 mo. There was an improvement of z scores for all formulas, and there were no differences in weight for age (P = 0.22), length for age (P = 0.56), head circumference for age (P = 0.66), or weight for length (P = 0.13). There were no differences in blood pH and biochemical parameters among the formula groups. The growth of infants fed one of the three acidified formulas was not inferior to the standard formula. Growth and metabolism in HIV-negative infants fed the acidified formulas were not affected by the method of milk acidification.
    Nutrition 04/2008; 24(3):203-11. · 2.86 Impact Factor
  • International Journal of Infectious Diseases - INT J INFECT DIS. 01/2008; 12.

Publication Stats

431 Citations
250.98 Total Impact Points

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Institutions

  • 2013
    • University of Colorado
      Denver, Colorado, United States
  • 2006–2013
    • University of the Witwatersrand
      • • Faculty of Health Sciences
      • • Department of Obstetrics and Gynaecology
      • • Division of Community Paediatrics
      Johannesburg, Gauteng, South Africa
  • 2002–2013
    • Chris Hani Baragwanath Hospital
      Johannesburg, Gauteng, South Africa
  • 2012
    • American Academy of Pediatrics
      Elk Grove Village, Illinois, United States
  • 2010
    • Nottinghamshire Healthcare NHS Trust
      Nottigham, England, United Kingdom
  • 2005
    • University of Pretoria
      • Department of Obstetrics & Gynaecology
      Pretoria, Gauteng, South Africa