Background: Prematurity is a major risk factor for intraventricular haemorrhage (IVH). Premature infants often require respiratory support. There is little information on neonates with IVH who require respiratory support in low and middle income countries. Objective: To describe the characteristics and short-term outcomes of very low birth weight (VLBW) infants with IVH who required respiratory support in a tertiary neonatal unit with resource limitations. Methods: This was a matched retrospective observational study. The population included VLBW infants with IVH, who received positive pressure respiratory support between January 2014 and December 2016. Outcomes of infants with severe IVH was compared to those with mild IVH. Outcomes were further analysed according to mode of ventilation. Results: 150 infants were included in the study, 56 (37%) received continuous positive airway pressure (CPAP) only and 94 (63%) mechanical ventilation. Severe IVH was associated with surfactant therapy across both ventilation groups (p=0.03). Oxygen requirement at 28 days was more frequent in infants with severe IVH compared to mild IVH (79% vs 38%, p=0.01) (OR 6.11 (95% CI 1.19-31.34), p=0.03). Severe IVH and the presence of coagulopathy were the strongest predictors of death in both ventilation groups (p <0.0001). Pulmonary haemorrhage was the commonest cause of death in those with severe IVH and blood culture confirmed sepsis in those with mild IVH. Periventricular leukomalacia (PVL) was associated with severe IVH in those receiving invasive ventilation (OR 6.67 (95% CI 1.11-40.17)). Conclusion: Mechanical ventilation, coagulopathy and pulmonary haemorrhage were strongly associated with death in VLBW infants with severe IVH in a resource-limited setting. These prognostic factors may have a role in end of life decisions.

No description available.

Purpose: To describe behavior of children with periventricular brain injury (PBI) in a tethered-kicking intervention. Methods: Sixteen infants with PBI were randomly assigned to exercise or no-training in a longitudinal pilot study. Frequencies of leg movements and interlimb coordination were described from videos at 2 and 4 months' corrected age (CA). Results: Eight of the 13 children (62%) with longitudinal data increased the frequency of leg movements while tethered to a mobile between 2 and 4 months' CA. Movement frequency was correlated with scores on the Test of Infant Motor Performance, but no differences between experimental groups were found. Children with typical development at 12 months' CA increased the proportion of leg movements that were synchronous between 2 and 4 months, as did a child with cerebral palsy in the experimental group. Conclusions: The tethered-kicking intervention facilitates movement in infants with PBI, but effects on development remain to be demonstrated.

The name of William Harvey is imortal, and it is fitting that a quotation form his epoch-making 'De Motu Cordis et Sanguinis' should preface this thesis. the discoverer of the circulation did not fall to point out the difference between foetal and postnatal conditions of the heart and great vessels. Harvey, however, was not particularly concerned with the problems of the foetal circulation, and devoted only a passing glance to the subject, using foetal conditions to illustrate his general argument about the circulation of the blood. The subsequent progress of though on the subject of foetal circulation has been admirably set out in the first chapter of Barclay, Frankin, and Prichard's book 'The Foetal Circulation', published in 1944, but there is no doubt that the major advance since Harvey's time is represented by the cine-radiographic observations made by the authors of this book on the foetal lamb. They provided, for this species, a convincing and complete picture of the pattern of the foetal circulation, together with the change brought on by allowing the foetus to breathe and by severing the umbilical cord, thus simulating the event of birth.

Parents of premature infants have unique information and support needs regarding the caregiving of their premature infants after the initial discharge home from the hospital. These needs may only become evident after the discharge, which presents challenges that require additional social and professional support. Through my research I strived to determine the information and support needs of parents relating to the caregiving of their premature infants after the initial discharge home from the hospital. The main aim of my study was to inform a South African post-discharge parent support programme within the Developmental Systems Model theoretical framework. A four-phase qualitative descriptive design was employed. In Phase 1, an integrative literature review was conducted to determine the information and support needs of parents of premature infants following their initial discharge home from the hospital. Phase 2 explored the information and support needs of 25 South African parents regarding the caregiving of their premature infants by utilising a pilot study and four asynchronous online focus groups. In Phase 3 the data sources from Phases 1 and 2 were merged to develop and finalise ten recommendations that were utilised to develop the content of the parent support programme. Seven Early Childhood Intervention professionals were involved to ensure the recommendations were appropriate and contextual for South African parents. Fifteen South African parents were subsequently asked to validate and confirm the ten recommendations. The final phase (Phase 4) of the study comprised a parent validation survey with 17 South African parents, which ensured the appropriateness of the content for the South African post-discharge parent support programme. The contents, based on the findings of the four-phase study, will appropriately serve as the foundation for a South African parent support programme to be implemented as part of a future project. Keywords: caregiving, information needs, parents, post-discharge programme, premature infants, recommendations, support needs, South Africa. / Thesis (PhD (Augmentative and Alternative Communication))--University of Pretoria, 2021. / NRF / Centre for Augmentative and Alternative Communication (CAAC) / PhD (Augmentative and Alternative Communication) / Restricted

MSc., Faculty of Science, University of the Witwatersrand, 2011 / Background: Due to the high cost and limited serotype coverage of pneumococcal conjugate vaccines (PCV), surface proteins of Streptococcus pneumoniae are being investigated for their role as potential vaccine candidates. There are limited data on natural antibody kinetics against pneumococcal surface proteins arising through exposure to pneumococcal nasopharyngeal (NP) colonization in African populations. Objectives: To characterize the natural antibody kinetics and sero-prevalence to 15 pneumococcal proteins with respect to age, PCV vaccination and HIV status as well as to explore the association between antibody titers and pneumococcal nasopharyngeal colonization in infants, older children and adults. Methods: We established a 15-plex Luminex assay for the following proteins: PspA, PspC, LytB, IgA1-proteinase, SP 0082, PdB, PcsB, PsaA, SP 0609, SP 0749, PpmA, SlrA, StkP, SP 2027 and SP 2194, and also validated the Luminex assay comparing it to a standard ELISA method for PspA, PspC, PsaA and PdB. We used the Luminex method to characterize the prevalence and dynamics of serum IgG antibodies against the pneumococcal proteins. The study involved 2 166 human subjects which included: i. A longitudinal cohort of children less than 2 years of age, who were vaccinated with the seven-valent pneumococcal conjugate vaccine (PCV-7) and were either a) HIV-exposed infected, b) HIV-exposed uninfected or c) HIV-unexposed uninfected. ii. A longitudinal cohort of PCV-7 unvaccinated children less than 2 years of age who were either: a) HIV-unexposed uninfected or b) HIV-exposed uninfected. The PCV-7 vaccinated and unvaccinated children were followed up from approximately 4 to 24 months of age. In addition, samples were also analyzed from HIV-uninfected and HIV-infected children Project ID: Pneumococcal protein antigens Student: Zanele Ditse Date: 04 October 2011 - 5 - aged between 4 to 7 years who received either a primary series of PCV-9 or placebo during infancy. Lastly, we analyzed cross-sectional samples from HIV-uninfected and HIV-infected women. Results: The multiplex Luminex assay correlated well with singleplex ELISAs for all four analyzed proteins with correlation coefficients of 0.86, 0.90, 0.87 and 0.96 for PspA, PspC, PdB and PsaA respectively. Antibody titers to PspC, PdB, LytB, SP 0082, PcsB and StkP showed increases in titer with respect to increasing age. Prevailing nasopharyngeal pneumococcal colonization in young children was associated with higher antibody titers to PspA, PspC, PdB, SP 0082, LytB, IgA1-proteinase, PpmA, PcsB and StkP. Conversely higher antibody titers to PspC, PdB, LytB, SP 0082, PcsB and StkP were associated with lower prevalence of pneumococcal colonization in older children and adults. In children under two years of age, PCV vaccination was associated with lower antibody titers to PspA, PspC, LytB, PdB, IgA1-proteinase, PcsB and StkP as well as higher antibody titers against SP 0082 and PpmA at multiple time-points. In PCV-vaccinated children under two years of age, those who were HIV-unexposed , -uninfected had higher antibody titers to PspA, PspC, SP 0082, IgA1-proteinase, PpmA and StkP compared to HIV-exposed, uninfected children. Conclusion: There was an age-related increase in antibody titers to PspA, PspC, PdB, SP 0082, LytB, IgA1-proteinase, PpmA, PcsB, and StkP in children under two years of age. PCV immunization was, however, associated with lower antibody titers to PspA, PspC, LytB, PdB, IgA1-proteinase, PcsB and StkP in young children which was not attributed to differences in the prevalence of nasopharyngeal colonization. Furthermore, HIV-infection status in young children was associated with higher antibody responses to PspA, PspC, PdB, SP 0082, LytB, IgA1-proteinase, PpmA, PcsB and StkP proteins in HIV-unexposed uninfected children compared to HIV-exposed uninfected and HIV-exposed infected children. Higher antibody concentrations to Project ID: Pneumococcal protein antigens Student: Zanele Ditse Date: 04 October 2011 - 6 - PspC, PdB, LytB, SP 0082, PcsB and StkP was negatively associated with nasopharyngeal pneumococcal colonization in older children and adults; indicating a protective role against colonization and a potential role as vaccine candidates.

A dissertation presented in partial fulfilment of the requirements for the degree of Masters in Clinical Psychology in the Department of Psychology, University of Witwatersrand. March 2016. / Attachment theory is an extensive yet emerging body of research which emphasises the centrality of the mother-infant bond in healthy socio-emotional and cognitive development, particularly during infancy. The last two decades in particular have seen a proliferation of attachment research involving indigenous populations in the developing world. This has also seen our understanding of the concept of ‘mothering’ grow in breadth and depth. However, with the increased interest in these contexts, so questions are being raised by the scientific community as to the cross-cultural reliability and validity of the findings of such research. A central point of contention surrounds the measure’s suitability to the contextual and/or cultural idiosyncrasies of the sample’s characteristics. Related to this are issues of construct equivalence, item and/or methodological biases, as well as theoretical discordance between Western and non-Western principles which invariably underscore such research. Debate is particularly rife in situations where the measures have been imported and ‘imposed’ upon the sample under study without prior, appropriate adaptation. The mini Maternal Behaviour Q-Sort (MBQS-mini) was employed for the first time in a South African research initiative, the Ububele Mother-Baby Home Visiting Project (UMBHVP), to assess the maternal sensitivity scores of a group of mothers residing in Alexandra Township (Alex), Johannesburg. Maternal sensitivity is thought to be a key concept in the study of parent-infant interactions, and its influence on child development has been significantly correlated to the developmental outcomes of the infant. The MBQS-mini was designed and normed in Canada and is based on the notion of the ‘prototypically sensitive’, Canadian mother. This brings into focus some of the concerns raised above regarding the measure’s appropriateness for use in a distinctly high-risk context like Alex. This research aimed to explore the coders’ and trainer’s experiences of the first time use and application of the measure in the Ububele research initiative in Alex. A focus group and semi-structured interview elicited important information on the participants’ experiences of the training and reliability procedures and further highlighted some of the contextual/cultural constituents that were thought to have impacted the measure’s overall performance and thus also its suitability, utility and applicability to a South African setting. The analysis was inductive and exploratory in nature insofar as a prescribed theoretical interest did not necessarily inform the themes that were identified. The findings indicate that despite the significant impact of the context and the possibility of further adaptation to some items, the MBQS-mini is a suitable measure with utility for assessing maternal behaviours within South Africa. / GR2017

A Doctoral Thesis submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa; in fulfillment of the requirements for the award of PhD in Demography and Population Studies September 2013. / Background: Despite modest improvements in child health outcomes during the 20th century, infant and child mortality rates remain unacceptably high in Nigeria. With about 1 in 6 children dying before the age of five, Nigeria, like many other countries in sub-Saharan Africa, is not on track to achieve the Millennium Development Goal 4 (MDG 4) (i.e. reducing childhood mortality by 2015). Nigeria’s under-five mortality rate is among the highest in the world. Addressing poor infant and child health outcomes requires scientific evidence on how best to tackle its determinants. Literature shows that knowledge about the determinants of child mortality at the individual level is insufficient to address the problem. This is because the characteristics of the household and community context where a child is born or raised tend to modify individual-level factors and therefore affect child survival. However, there are gaps in evidence on the effects of characteristics of the community contexts on child survival in Nigeria. Hence, this study examined the contextual determinants of infant and child mortality in Nigeria with a focus on individual, household and community-level characteristics. The study addressed three specific objectives: (1) to examine the levels and magnitudes of infant and child mortality in Nigeria; (2) to identify the individual, household, and community-level factors associated with infant and child mortality in Nigeria; and (3) to determine the extent to which the contextual factors account for regional variations in infant and child mortality in Nigeria. Methodology: The study utilized data from 2003 and 2008 Nigeria Demographic and Health Survey (NDHS). The target population for this study (women aged 15-49 years who had at least a live birth in the five years preceding the survey) were extracted from the whole 2003 and 2008 NDHS datasets. Out of the survey’s total sample size of 7620 women contained in 2003 dataset, analysis was restricted to the live born children of 3775 women amounting to 6028 live births within the five years before the survey. Similarly, from a total of 33,385 women contained in 2008 dataset, analysis was restricted to the live born children of 18,028 women who were 28,647 children delivered in the five years before 2008 survey. In order to achieve the objectives of this study, analysis was restricted to births in the five years before the survey. All analyses were completely child-based. That is, child was the unit of analysis. The dependent variables in this study are: (i) infant mortality – defined as the risks of dying during the first year of life; (ii) child mortality – defined as the risk of dying between ages 12 and 59 months; and (iii) under-five mortality – defined as the risks of dying between birth and the fifth birthday. All the outcome variables were measured as the duration of survival since birth in months. Guided by the reviewed literature and the conceptual framework, relevant independent variables were selected at the individual-, household- and community-levels. Three levels of analysis – univariate, bivariate and multivariate – were conducted. At the multivariate level, Cox proportional hazards regression analysis was employed because of its suitability for analysing time-to-event data and censored observations. In addition, using generalized linear latent and mixed models (GLLAMM) implementable in Stata, multilevel survival analysis was employed to consider the hierarchical structure of the DHS mortality data; and to identify contextual factors influencing regional variations in infant and child mortality in Nigeria. Data were analyzed using Stata software (version 11.1). Indirect estimations were obtained using MortPak-Lite, Microsoft Excel, and Model Life Tables. Key findings addressing objective 1: Indirect techniques gave the levels of infant mortality for both sexes in 2002-2003 as 93 per 1000 live births (male: 95/1000, female: 91/1000), and 78 per 1000 live births (male: 80/1000, female: 75/1000) in 2007-2008. Probabilities of dying between ages 1 and 5 were estimated at 0.049 (male: 0.051, female: 0.047) in 2002-2003, and 0.036 (male: 0.038, females: 0.033) in 2007-2008. Indirectly computed estimates of infant/child mortality were not substantially different from the estimates obtained from direct techniques. Using INDEPTH life table, e0 (i.e. expectation of life at birth) in 2008 was estimated at 55.6 years for females and 51.6 years for males. This suggests that the data utilized in this study are of good quality. Bivariate results indicated a slight reduction in the proportion of infant and child death over the 1999-2003 and 2004-2008 periods. Key findings addressing objective 2: Using both 2003 and 2008 data, region of residence, place of residence, ethnic diversity, community education, community infrastructures, and community health contexts were identified as important contextual determinants of infant and child mortality in Nigeria during the periods under study. For instance, results from 2008 NDHS data showed that children of mothers residing in the North-east were having significantly higher risks of infant (hazard ratio - HR: 1.54, p<0.05) and child (HR: 3.19, p<0.05) mortality compared to children in the South-west. Residence in communities with high proportion of hospital delivery was associated with lower risks of infant (HR: 0.73, p<0.05) and child (HR: 0.62, p<0.05) mortality. In addition, residence in communities with high concentration of poor households was significantly associated with higher risks of death during childhood (HR: 1.40, p<0.05). Many of the selected variables remained significantly associated with infant and child mortality after adjusting for the effects of the selected important characteristics, although some to a lesser degree. Results also showed that demographic factors were more important in explaining infant mortality while socio-economic factors were more important for child mortality. Key findings addressing objective 3: Results from both 2003 and 2008 data indicated that substantial variations in the risks of infant and child mortality exist across regions in Nigeria, and that characteristics of the community contexts were important in explaining the observed regional variations. For instance, results from 2003 data indicated that the proportional change in variance (PCV) of 43.5% in the hazards of dying during infancy, and PCV of 44.4% in the risks of dying during childhood, could be attributed to community-level contextual determinants. Also, analysis of 2008 data showed that the PCV of 43.3% in the risks of dying before age one and PCV of 50.0% in the hazards of dying during childhood could be explained by community-level characteristics. Although, community factors appear to moderate the association between individual-level factors and death during infancy and childhood, adjusting for the effects of child-, mother- and community-levels characteristics in the final models indicated higher child mortality clustering at the community level relative to individual level. Conversely, higher infant mortality clustering was found at the individual level compared with the community level. This result suggests that community-level attributes appear to play more important role in child survival during childhood than in infancy. Plausible explanation for this is that children’s interaction with community environment or neighbourhood contexts is likely to be higher during age 12-59 months compared to the period under age one. Conclusion: The study’s findings showed that insufficient progress was made in infant and child mortality reduction over the 1999-2003 and 2004-2008 periods. Besides, increased variations in the risks of infant and child death were observed across the six regions of the country. Results demonstrated that characteristics of the community contexts tend to mitigate infant and child mortality risks in the South-west while community characteristics appear to exacerbate infant and child mortality risks in other regions, particularly in the North-east and North-west. Study’s findings suggest that policies that will ensure substantial reduction in infant and child mortality in Nigeria must include strategies and programmes that rectify characteristics of the community contexts which exacerbate infant and child mortality risks, particularly in the socially and economically disadvantaged communities and regions of Nigeria. Keywords: Infant, child, under-five, neighbourhood, community, context, mortality, demography and health survey, Nigeria

No description available.

No description available.