Perinatal audit has been tested and proved an important tool for reduction of perinatal mortality and assessment of quality of perinatal care. At Muhimbili National Hospital (MNH), a tertiary hospital in Dar es salaam, Tanzania we performed a retrospective cross-sectional study using data from an obstetrics database to classify all perinatal deaths during 1999-2003. We also determined the prevalence of anaemia in pregnancy and its impact on perinatal outcome. Furthermore, we conducted a perinatal audit to study potential determinants and causes of perinatal and neonatal deaths and their avoidability. We also assessed the quality of care of patients admitted with eclampsia using a criteria based audit. Stillbirth, early neonatal and perinatal mortality rates (PMR) were 96, 27 and 124 respectively. A large proportion of foetuses (38%) had no audible foetal heart beat on admission at MNH labour ward and the majority of the neonatal deaths were asphyxiated at delivery. The PMR for multiples and singletons were 269 and 118 respectively resulting in a rate ratio of 2.4 (95%CI: 2.1-2.4). The prevalence of anaemia and severe anaemia was 68% and 5.8%, respectively. Severity of anaemia increased the risk of preterm delivery with ORs of 1.4, 1.4 and 4.1 for women with mild, moderate and severe anaemia as compared to women with normal haemoglobin levels. The corresponding risks for LBW and VLBW were 1.2, 1.7 and 3.8, and 1.5, 1.9 and 4.2 respectively. The prevalence of preterm delivery and LBW was 17% and 14% respectively. The hospital-based incidence of eclampsia was 504 per 10,000 women or 5.1 % of all mothers admitted. Suboptimal care were identified on criteria regarding management plan by senior staff, review of the plans by specialist obstetrician, delay on caesarean section, monitoring patients on magnesium sulphate and inadequate use of the laboratory. Two out of three patients requiring operation were not operated within set standards. Birth asphyxia was the main cause of intrapartum fresh stillbirth (47%) and early neonatal deaths (51%), whereas eclampsia (25%) and preeclampsia (8.3%) were main maternal medical conditions. The majority of stillbirths were fresh, indicating foetal demise during labour or just before delivery. The audit study identified suboptimal care in about 80% of audited cases out of which about 50% were found to be the likely cause of the adverse perinatal outcome. Inadequate maternal and foetal monitoring during labour were the main suboptimal factors, though delay in referral and operative interventions were also prominent. Based on these studies, we conclude that: The perinatal mortality (PMR) in this study was higher than the national average. About one in four perinatal deaths at MNH can be attributed to avoidable factors linked to obstetric care Main causes of perinatal and neonatal deaths were intrapartum birth asphyxia, immaturity related and infections            Management of patients in labour needs to be improved Suboptimal care that is essentially avoidable included: inadequate monitoring of patients during labour, delay of care,    e.g. long decision to surgery interval, and delayed referral of patients fromprimary hospitals The prevalence of anaemia in pregnancy was very high; and low birth weight and preterm delivery was independently associated with severity of anaemia The prevalence of eclampsia at MNH was high and the case management needs to be improved

Childhood micronutrient deficiencies have negative effects on cognition. Little is known about the effects of combined consumption of micronutrients and sugar on growth and cognitive function. The aim of this thesis was to 1) investigate the effects of micronutrients and sugar, alone and in combination, in a beverage, on growth and cognition in South African children and 2) review recent evidence on iron status and anaemia prevalence in South African children since the National Food Consumption Survey-Fortification Baseline-2005 (NFCS-FB-2005). Children (n = 408, 6−11 years) were randomly allocated to a beverage containing 1) micronutrients with sugar, 2) micronutrients with non-nutritive sweetener, 3) no micronutrients with sugar, or 4) no micronutrients with non-nutritive sweetener for 8.5 months. Cognition was assessed using sub-tests from the Kaufman Assessment Battery for Children-II. Growth was assessed as weight-for-age (WAZ), height-for-age and body-mass-index-for-age z-scores. Relevant internet search engines identified studies reporting iron status of South African children after 2005. Secondary analysis was conducted on NFCS-FB-2005 provincial data for children 7−9 years old. Positive intervention effects were observed for micronutrients (0.76; 95% CI: 0.10, 1.42) and sugar (0.71; 95% CI: 0.05, 1.37) on Atlantis (measure learning ability), and sugar on Rover (measure simultaneous processing) (0.72; 96% CI: 0.08, 1.35) test scores. Attenuating micronutrient x sugar interactions were observed on Atlantis, Number Recall (measure sequential processing) and Rover test performance. Micronutrients or sugar alone lowered WAZ. In combination, this effect was attenuated (significant micronutrient x sugar interaction). Four studies from four different provinces were identified. All reported lower anaemia prevalence than the NFCS-FB-2005 (KwaZulu-Natal (11.5% vs 14.4%), North West (6.9% vs 27%) Western Cape (17.2% vs 18.8%) and Northern Cape (5.4% vs 22.2%). A beverage fortified with micronutrients or added sugar had beneficial effects on cognition, but a lowering effect on WAZ in the children. Unexpectedly, the combination of micronutrients and sugar attenuated these effects. In the identified studies, anaemia prevalence in school-aged children was lower than reported in the NFCS-FB-2005. / Thesis (PhD (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Childhood micronutrient deficiencies have negative effects on cognition. Little is known about the effects of combined consumption of micronutrients and sugar on growth and cognitive function. The aim of this thesis was to 1) investigate the effects of micronutrients and sugar, alone and in combination, in a beverage, on growth and cognition in South African children and 2) review recent evidence on iron status and anaemia prevalence in South African children since the National Food Consumption Survey-Fortification Baseline-2005 (NFCS-FB-2005). Children (n = 408, 6−11 years) were randomly allocated to a beverage containing 1) micronutrients with sugar, 2) micronutrients with non-nutritive sweetener, 3) no micronutrients with sugar, or 4) no micronutrients with non-nutritive sweetener for 8.5 months. Cognition was assessed using sub-tests from the Kaufman Assessment Battery for Children-II. Growth was assessed as weight-for-age (WAZ), height-for-age and body-mass-index-for-age z-scores. Relevant internet search engines identified studies reporting iron status of South African children after 2005. Secondary analysis was conducted on NFCS-FB-2005 provincial data for children 7−9 years old. Positive intervention effects were observed for micronutrients (0.76; 95% CI: 0.10, 1.42) and sugar (0.71; 95% CI: 0.05, 1.37) on Atlantis (measure learning ability), and sugar on Rover (measure simultaneous processing) (0.72; 96% CI: 0.08, 1.35) test scores. Attenuating micronutrient x sugar interactions were observed on Atlantis, Number Recall (measure sequential processing) and Rover test performance. Micronutrients or sugar alone lowered WAZ. In combination, this effect was attenuated (significant micronutrient x sugar interaction). Four studies from four different provinces were identified. All reported lower anaemia prevalence than the NFCS-FB-2005 (KwaZulu-Natal (11.5% vs 14.4%), North West (6.9% vs 27%) Western Cape (17.2% vs 18.8%) and Northern Cape (5.4% vs 22.2%). A beverage fortified with micronutrients or added sugar had beneficial effects on cognition, but a lowering effect on WAZ in the children. Unexpectedly, the combination of micronutrients and sugar attenuated these effects. In the identified studies, anaemia prevalence in school-aged children was lower than reported in the NFCS-FB-2005. / Thesis (PhD (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Motivation: A variety of factors including food shortage, poor hygiene and low education levels affects the nutritional status of black women. Women also have a high risk for the development of iron deficiency because they lose iron through menstruation, the birth process and a low intake of iron containing foods. All of these factors contribute to an increased risk for the development of iron deficiency anaemia in women. Objectives: The primary purpose of the study was to investigate the association between tea consumption and iron status of African females in the North West Province. To reach this purpose the specific aims were to (1) assess the iron status of women, (2) determine tea intake, and (3) determine the relationship between tea consumption and iron status, taking into account inhibiting and enhancing factors of iron absorption. Methods: A cross-sectional sample of apparently healthy females was taken from five different strata of urbanisation. The subjects were then further divided into two groups, namely younger women (younger than 45.9 years) and older women (older than 46 years). A sample of 920 subjects was used. Data were obtained from dietary, demographic and additional questionnaires, as well as from the taking of blood samples. This study was a sub-study of the THUSA study. Results: A total of 920 subjects participated of which 69.24% were younger women and 30.76% were older women. Due to missing data, the number of subjects for each parameter differed. The mean serum ferritin as well as haemoglobin concentrations were within normal ranges for both groups. The mean dietary iron intake for both groups was below recommendations. No significant correlations were found between serum ferritin or haemoglobin and total tea intake as well as a variety of other dietary factors. The low haemoglobin concentration group of the younger and older women combined had a slightly higher intake of animal protein and ascorbic acid than the high haemoglobin concentration group. On the other hand, the high serum ferritin concentration group had a significantly higher intake of animal protein than the low serum ferritin concentration group. Conclusion: The results of this study indicated that tea does not have an inhibitory effect on the iron status of the female population of the North West Province. However, the investigation of other studies conducted on the same topic had mixed results. Two of seven studies investigated and this study indicated that tea had no inhibitory effect on iron absorption. These two studies, as well as this study were not done in a controlled environment where certain factors can be controlled for, for example, time of tea intake and milk consumption with tea. The other five studies were, however, conducted in an environment where subjects were given test meals, time of tea consumption was regulated and milk consumption with tea was recorded. The conclusion can, therefore, be made that further studies on the South African population in a controlled environment are necessary to give accurate recommendations to the population. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2005.

The overall aims of this thesis were to investigate the incidence of inflammatory bowel disease in the Uppsala Region of Sweden, to study the clinical course and the impact of the disease with regards to complications. Patients in Uppsala County were included in the study from the 1st of January 2005 and patients in Falun, Eskilstuna and Åland counties from the 1st of January 2007. The study was closed for all centres on the 31st of December 2009. Mean population in the study region was 305,381 in 2005–2006 and 642,117 in 2007–2009. The mean incidence for ulcerative colitis (UC) during the time period 2005-2009 was 20.0 /100,000/year (95% CI: 16.1-23.9) and for Crohn’s disease (CD) it was 9.9/100,000/year (95% CI: 7.1-12.6). The combined incidence for UC or CD in the area was thus 29.9/100,000/year (95% CI: 25.1-34.7). Half of the UC patients relapsed during the first year. Risk factors for relapse were female gender and young age. Colectomy during the first year was uncommon (2.5%). CD patients with complicated disease had longer symptom duration before diagnosis and less often diarrhoea and blood in stools compared to patients with non-complicated disease. The risk for surgery during the first year was 12%. The prevalence of anaemia at the time of diagnosis was 30% and after one year 18%. Anaemia was more common among newly diagnosed patients with CD compared with UC. 13% of the UC patients developed an acute severe episode. During the first 90 days 22% of these patients were subjected to colectomy. There was a significant difference between University and County hospitals in colectomy frequency (7.5% vs. 41%). The cumulative prevalence of treatment complications was 12% at the hospital with low colectomy rate versus 41% at the hospitals with high colectomy rate. In conclusion, the incidence of UC and CD in Sweden was high compared to international studies. Colectomy frequency for UC during the first year was low. Patients with complicated CD at the time of diagnosis had longer symptom duration and less alarming symptoms compared to uncomplicated disease. Anaemia was a common trait among patients with newly diagnosed IBD and more effort is needed to treat anaemia in these patients. Severe UC can be treated safely with prolonged medical therapy instead of colectomy.

Introduction The last national micronutrient survey of Iran showed that, in spite of a national supplementation program, the prevalence of anaemia, and zinc deficiency were 37.8% and 20% among 15-23 months old infants, respectively. Data show that more than 60% of infants do not consume supplements regular. Moreover, the current supplementation program does not provide a zinc supplement. Home fortification has been promoted as an alternative approach, where families are able to add micronutrients to home-made food for infants. The majority of efficacy trials of multiple micronutrient containing ‘Sprinkles’ powder and crushable ‘Foodlets’ tablets have been conducted in areas where maize-based complementary food is common. The potential effects of home fortification supplement in Iran are uncertain as the staple food is different (wheat and rice vs. maize in other trials) and acceptability of the Sprinkles and Foodlets is unknown. This thesis aim to assess efficacy, adherence, and acceptability of Sprinkles and Foodlets as compared with current supplement (Drops) on micronutrient status (iron, zinc, vitamin A and vitamin D) and growth in Iranian infants aged 6-18 month. Methods A total of 405 infants were recruited from Hashtgerd, 80 km west of Tehran, Iran; 43 were excluded due to not meeting the inclusion criteria. The infants were randomly assigned to receive daily supplementation of Sprinkles (n=120), Foodlets (n=121) or Drops (n=121) for four months. Sprinkles and Foodlets contain iron, zinc, vitamin A, vitamin D, folate, and multiple B vitamins similar except that levels of iron are higher in the Sprinkles group. Drops do not contain zinc, vitamin B12, or folate. The persons responsible for the laboratory test and data entry were blinded to randomization. Haemoglobin, serum ferritin, serum retinol, serum zinc, 25(OH)D concentration and anthropometric measures were assessed at baseline and four months. At each monthly phase of the follow-up, adherence to supplements and side-effects related to supplements were reported by mothers. Six focus group discussions assessed mother’s perceptions about the supplements. Within group change in means over 4 months intervention was examined by Student’s paired t-test. The within group changes in proportions were assessed using McNemar’s test. Change across the three treatment groups were compared using analysis of covariance. Ethical clearance was obtained from the ethics committee of both the University of Queensland in Australia and the Ministry of Health in Iran. Results Of the total 362 infants included in the study, 313 (86%) had complete anthropometric and haemoglobin data, and 301 infants (83%) also had both initial and final serum samples. There were no significant differences between the three groups for baseline data. Baseline data showed approximately one fourth of anaemic children had iron deficiency anaemia and 38% of infants were zinc deficient. The children had a relatively good baseline status for vitamin A, vitamin D and growth. After four months intervention mean haemoglobin increased significantly in the three groups. Serum ferritin concentration increased in the Drops group (p<0.001) and Sprinkles group (p<0.05). A significant improvement was seen in zinc status for the Sprinkles and Foodlets but not the Drops group. Mean percentage of adherence to Sprinkles, Foodlets, and Drops (total amount of supplement used divided by total amount expected to be used) was (90.4±17.25), (80.7±25.01), and (88.5±16.85) respectively. Vomiting was higher in the Foodlets compared to other groups (p<0.001). Staining of the teeth was higher in Drops than the other groups (P<0.001). Most mothers in the Sprinkles group (97.3%) preferred this supplement over current supplement whereas 87.2% of mothers in the Foodlet group preferred Foodlets over the current supplement. In the focus group discussions, mothers stated that the new supplements were more acceptable and easier to use compared to current supplement. However, they had some issues about the new supplements; for example, lack of appropriate food to add the Sprinkles or Foodlets. Conclusion The combination of multivitamins plus iron and zinc when added to wheat or rice-based complementary foods improved iron and zinc status. Combining iron and zinc in Sprinkles and Foodlets did not show negative effects on iron or zinc status. No differences were seen in efficacy of the Sprinkles and Foodlets on outcomes except a little higher improvement of iron status in Sprinkles and a slight higher weight gain of infants in the Foodlets group. According to this efficacy trial and formative study, Sprinkles had a higher acceptability in the study population and there are factors to encourage its use (easy to use, tasteless, containing all required vitamins and minerals, shape, easy to transfer, and stimulates appetite). The trial identified trade-offs in combining multiple micronutrients into a single delivery mechanism, with no benefit from addition of vitamins A and D on nutritional status in this sample of infants. We might consider different acceptability to Sprinkles in some regions by different cultural practices but in summary Sprinkles is likely to be the best option as an alternative choice to the current supplementation (Drops).

Os comportamentos espectroeletroquímicos do ácido acetilsalicílico (AAS) e seu produto de hidrólise, o ácido salicílico (AS), foram estudados em soluções aquosas nas regiões de pH ácido, neutro e alcalino. Resultados para experimentos de voltametria cíclica sugeriram possíveis processos de eletro-oxidação e eletro-redução dos fármacos. O monitoramento do espectro de absorbância na região do UV-vis, simultâneo à medida de carga envolvida na eletrólise, permitiu a identificação de processos redox e o cálculo do número de elétrons envolvidos, aplicando a Lei de Faraday. O fármaco mostrou-se estável em pH ácido, reduziu em pH neutro e oxidou em pH alcalino. Tanto no processo de eletro-redução como na eletro-oxidação, os mecanismos propostos estabelecem o envolvimento de 1 elétron para a identificação de mudanças no nível molecular. Estas foram observadas pelas alterações de espectros de absorbância na região do UV-vis. Técnicas complementares, ressonância paramagnética eletrônica (RPE) e espectroscopia de transmitância FT-IR, foram usadas para a caracterização dos produtos obtidos em experimentos de eletrólise. As respostas espectrofotométricas associadas à processos eletroquímicos permitiram o desenvolvimento de método espectroeletroquímico para a detecção do fármaco em amostras reais contidas em soluções com pH neutro, utilizando a técnica de voltabsormetria derivada linear (DLVA). A interação entre os fármacos e íons de ferro no ambiente do estômago, foi simulada em experimentos in vitro, empregando eletroquímica e espectrofotometria. Na presença do AAS ocorreram interações fracas sem a interferência para a absorção de ferro pelo organismo. Em contrapartida, o AS interagiu formando um complexo estável com o Fe3+, podendo ser apontado como um potencial interferente para a absorção de ferro provocando anemia em indivíduos vegetarianos que fazem uso contínuo deste fármaco. / The spectroelectrochemical behavior of acetylsalicylic acid (ASA) and its spin off hydrolysis, salicylic acid (SA), were studied in aqueous solutions in the acid, neutral and alkaline pH regions. Results for cyclic voltammetry experiments suggested a possible electro-oxidation and electro-reduction of the drugs. The monitoring of the absorbance spectra in the region of the UV-vis, simultaneously with the measurement of the charge involved in the electrolysis, allowed the identification of redox processes and the calculation of the number of electrons involved applying Faraday\'s Law. The drug was stable in acid solutions, reduced in neutral and oxidized in alkaline ones. In electro-reduction and electro-oxidation processes, the proposed mechanisms establish the involvement of 1 electron to identify changes at the molecular level. These were observed by changes in absorbance spectra in the UV-vis region. Complementary techniques, electronic paramagnetic resonance (EPR) and FT-IR transmittance spectroscopy were used to characterize the products obtained in electrolysis experiments. The spectrophotometric responses associated to the electrochemical processes allowed the development of a spectroelectrochemical method for the detection of the drug in real samples contained in solutions with neutral pH, using the technique of derivative linear voltabsorptometry (DLVA). The interaction between drugs and iron ions in the stomach environment was simulated in in vitro experiments using electrochemistry and spectrophotometry. In the presence of ASA, weak interactions occurred without interference for the absorption of iron by the organism. On the other hand, AS interacted to form a stable complex with Fe3+ and could be considered as a potential interfering agent for the iron absorption, causing anemia in vegetarian individuals who make continuous use of this drug.

>Magister Scientiae - MSc / Adverse effects are a significant factor that determine how long patients will tolerate a given antiretroviral drug regimen. They also influence treatment options, and play an important role in the much needed adherence to treatment by patients on Highly Active Antiretroviral Therapy (HAART). This study is aimed at understanding adverse effects experienced by patients on the first line antiretroviral therapy at Keetmanshoop Hospital in Namibia. Methods : A retrospective quantitative method was used to review records of patients on first line antiretroviral treatment who started treatment between November 1st 2007 and December 1st, 2008 and followed up until they reached 36 – 48 months on treatment. Records of 94 patients were found eligible to be included in the study. Data was analysed using Stata 12 data analysis software. Results : The most reported adverse effect was musculoskeletal disorders (25%) whereas headache (16%) was the least reported. Low haemoglobin (78%) was the most common recorded hematologic adverse effect whereas low red cell distribution width and low mean platelet volume were the least recorded adverse effects (0%). A Male patient was more likely to experience a low haemoglobin levels compared to a female patient (adjusted OR: 3.29, 95% CI: 1.3 – 8.3). A male patient was found to be 64% times less likely to experience a higher mean cell haemoglobin compared to a female patient (adjusted OR. 0.31, 95% CI: 0.11 – 0.87). A patient on nevirapine was more likely to experience an elevated creatinine level compared to a patient on efavirenz (adjusted OR; 36.0, 95%CI: 2.02 – 62.5). At baseline, a patient who had prior exposure to ART had an 81 times (adjusted OR: 81.4, 95%CI: 5.3 – 119, p-value=0.00) increased odds of experiencing a high mean cell volume (MCV) compared to a patient with no ART exposure. A patient with a higher CD4 count was also less likely to experience a low hemoglobin compared to a patient with low CD4 count (adjusted OR; 0.31, 95% CI: 0.12 – 0.77). The author recommends further studies with higher sample size to confirm whether higher creatinine levels are more prevalent in patients on nevirapine compared to patients on efavirenz; this will have clinical implications especially in patients with impaired renal system. Antiretroviral treatment increases chances of developing macrocytosis anaemia; clinical implication of this condition may need to be investigated.

Magister Public Health - MPH / Background: Point of Care Testing (POCT) refers to qualitative or quantitative tests done in health facilities where the patient is being attended to (on-site), and not in the conventional hospital laboratory setting. As a consequence of many developing countries not having access to conventional laboratory services (with trained laboratory personnel), diagnostic testing often relies on the availability of valid POC tests. All pregnant women attending antenatal care clinics in the Sedibeng District Primary Health Care (PHC) centres should be screened for syphilis, anaemia and HIV. This can be done by means of POC testing, which is easy to perform. These POC tests provide results promptly allowing treatment to be commenced immediately, if required. Despite this highly desirable benefit of POCT, there is circumstantial evidence which suggests that staff is choosing to send specimens to the laboratory for testing, instead of doing POCT themselves. The extent to which this happens and the factors contributing to this practice are not clear. Aim: The aim of this study was to assess the prevalence of screening for syphilis, anaemia, and HIV amongst pregnant women during their first antenatal care visit to PHC facilities in the Sedibeng District, and to establish the factors affecting the prevalence of appropriately using POCT for screening tests. Methodology: Study design: A quantitative, analytical, cross-sectional study was conducted. Study Population and Sample: Patient registers, staff expected to perform POCT and facility managers. 33 District’s health care workers expected to perform POCT on pregnant women during the first ANC visit and 30 facility managers from these facilities; 360 patient records (these were collected from a total of 7 200 patients’ records). The data was collected over a six month period (from 1st July 2012 to 31st December 2012). Data collection: Data was collected from 360 patient records to determine the rate, appropriateness and mechanism of screening for syphilis, anaemia and, HIV in pregnant women on their first antenatal visit. Interviewer-administered closed-ended questions was asked from 30 antenatal care clinic staff tasked with performing POC tests and from 30 PHC facility managers to determine the factors affecting the rate of conducting POCT. Data analysis: Data was analysed using univariate, bivariate and multivariate analyses. Ethical considerations: No harm was anticipated to anyone participating in the study or from the findings of the study. A major benefit of the study was that clarity on the factors affecting the rate of screening and the use of POCT was gained. This will hopefully facilitate the implementation of evidence–based interventions to improve POCT uptake if required.

Objective: The objective of this retrospective cohort study is to assess whether demographic and anthropometric parameters, laboratory tests, co-morbidity, co-infection, treatment regimen, IRIS and adherence predict response to HAART as measured by CD4 count, weight gain and functional status in a cohort of patients in Roma, the Kingdom of Lesotho. Method: Data were collected from a computerised database of the Antiretroviral Centre of the hospital. A cohort of 300 subjects was identified from hospital records from January 2007. Each of these subjects was followed up over a period of 12 months with data obtained for at least two visits within the 12-month span. Data were obtained on weight and CD4 at baseline, three months and also at six and 12 months, and data for haemoglobin were obtained only at 12 months. Variables that may be potential confounders were identified and univariate and multivariate logistic regression analyses were carried out to establish differences independent of confounding factors for the combined endpoints, as well as for each endpoint separately. Results: Three-hundred patient records were analysed. Approximately 70% of the patients had a CD4 increase of at least 150 cells over baseline values at the end of the review period and in 52.3% of the patients an increase in weight of 10% over baseline measurements was seen. Seventy-nine patients (26.3%) had a haemoglobin level of at least 14g/dL at 12 months, regardless of baseline values or gender. The inclusion of Zidovudine (AZT) in treatment regimens was found in 73% of the patients and in multivariate analysis AZT was associated with not having anaemia at the end of the review period. However there was a slight reduction in haemoglobin level in the first two to three months of therapy in comparison with both Stavudine (d4T) and Tenofovir (TDF) but not significant enough to result in clinical anaemia. Baseline CD4 values were similar for all treatments options but dissimilar in other outcome variables and continued to vary significantly throughout the review period. The outcomes of multivariate analyses suggest that the male gender appears to have better response to HAART as seen in each of the multivariate models. The most important determinant of haemoglobin response was baseline haemoglobin values. In the haemoglobin-associated multivariate model, HAART is associated with an increase in haemoglobin over baseline values. A history of TB prior to HAART was a major factor in weight response and it is thought to be as a result of IRIS, which is the unmasking of latent infections as the immune system reconstitutes. CD4 values have no direct influence on weight however, but an increase in weight was observed in all therapy groups. Conclusion: Clinical and immunological parameters can be used to monitor response to HAART and predict treatment outcomes. These parameters can be organised into monitoring tools that will be useful in resource-limited areas. This study suggests that AZT-containing regimens appear not to result in anaemia and that symptomatic anaemia might need additional investigation. Treatment with TDF appeared to have shown the best possible response pattern more but patients on TDF therapy will have to be included in the study to justify this observation. / Dissertation (MSc)--University of Pretoria, 2012. / Clinical Epidemiology / unrestricted