3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Spatially adjusted determinants of Malaria and Anaemia Morbidity among children under age 5 years in Ghana, 2014(2018) Blam, Stephen NuerteyeBackground: Malaria and anaemia pose significant public health challenges to most developing countries. Sub-Saharan Africa continues to carry a disproportionately high share of the global malaria burden. Recent WHO (2015) global estimates on disease burden shows the African region accounted for 88% of the 214 million new malaria cases in 2015. This statistic further highlighted that the region accounted for 90% of malaria deaths in 2015. Similarly, anaemia, defined as low hemoglobin concentration, is estimated to globally affect 43% of children under five years of age. Anemia prevalence is very high among Ghanaian children under 5 years of age. The objectives of this study were to determine the prevalence and spatial distribution of malaria morbidity in children under age 5 years in Ghana in 2014, to ascertain the prevalence and spatial distribution of childhood anaemia morbidity in Ghanaian children under age 5 years in 2014, to determine the spatial distribution of factors associated with malaria morbidity in Ghana in 2014, and to determine the spatial distribution of factors associated with anaemia morbidity in Ghana in 2014. Objectives: The aim of the study is to determine spatial distribution and factors associated with malaria and anaemia morbidity among Ghanaian children under 5 years of age in 2014. Methods: This study analysed malaria and anaemia morbidity and prevalence using data from the Ghana 2014 Demographic and Health Survey. These data captured malaria related information on children under 5 years. Survey logistic and ordered logistic multivariable regression was done to determine associations between the singular outcomes malaria and anaemia and several explanatory variables. The regression models were employed and results thereof were used to produce maps illustrating the predicted risk of malaria and anaemia occurrence. The generalized linear mixed model was used to simultaneously identify the risk factors of malaria and anaemia of children under five years and how these are spatially distributed. Multilevel survey adjusted logistic and ordinal logistic regression models with non-spatial random effects were fitted for malaria and anaemia respectively. A Bayesian approach was employed to further adjust for spatial random effects on the convolution models for the two main outcomes. Results: The sample in this study was made up of 2727 children under age 5 years, of which 783 tested positive for malaria and 1873 had anaemia, resulting in an observed malaria and anaemia prevalence of 28.71% and 68.68% respectively. Spatially adjusted significant variables were: Child’s age; type of place of residence; mother’s highest education level, wealth index; child’s altitude adjusted haemoglobin level; cluster altitude; severe anaemia vomiting; severe anaemia extreme weakness. Children from the Western, Central, Greater Accra, Eastern, and Brong Ahafo regions were more likely to have malaria compared to northern region. Malaria was 1.46 times more likely to occur among children residing in rural than urban areas [OR=1.46, (95% CI: 1.02-2.16); p=0.05]. Vomiting as well as extreme weakness were 6.37 [OR=6.37 (95% CI: 2.16- 18.75); p<0.001] and 7.63 [OR=7.63 (95% CI: 3.02-19.22); p<0.001] times more likely to have anaemia than those without these symptoms. Children residing at higher altitude were 0.98 times less likely to have anaemia compared to those at lower altitude [OR=0.98 (95% CI: 0.97-0.99); p=0.01]. Conclusion: Recent reports in Ghana indicate that malaria and anaemia related deaths in children under age 5 years are on the ascendancy. In spite of this, there is a dearth of empirical research that establishes our understanding on the prevalence of malaria and anaemia in the endemic regions of Ghana. Understanding the prevalence of malaria and anaemia in terms of spatial risk factors, will provide more insight and practical guidelines to the formulation of policies aimed at fighting the spread of malaria and anaemia. Hence, directing health interventions to higher risk areas and ensuring nationwide coverage are promising strategies for promoting equity and reducing risk of malaria and anaemia. This study showed that Brong Ahafo, Eastern, Northern, Western, Volta and Upper East regions were the hotspot zones with greatest disease burden. Keywords: Ghana, Anaemia morbidity, Malaria morbidity, Malaria Indicator Survey (MIS), Demographic and Health Survey (DHS), spatial mapping, West Africa.Item Morbidity in women with placenta abruption: a descriptive prospective study(2017) Nkomo, Bongiwe PamellaPlacental abruption is one of the causes of obstetric haemorrhage that is associated with adverse maternal and neonatal outcomes. Knowledge of the risk factors and complications of placental abruption is important to reduce the maternal and perinatal morbidity and mortality associated with this condition. Objectives 1. To determine the frequency of abruptio placentae at Chris Hani Baragwanath Academic Hospital. 2. To assess maternal risk factors common in the patients admitted with placental abruption. 3. To determine the number of patients that had operative deliveries. 4. To assess maternal morbidity associated with placental abruption. 5. To assess perinatal outcomes of births in women with abruptio placentae. Methods This was a descriptive prospective study of morbidity in women with placental abruption. The study was carried out in the department of Obstetrics and Gynaecology at Chris Hani Baragwanath Hospital (CHBAH). Patients with placental abruption who gave informed consent to participate in the study were interviewed using a structured questionnaire. The study was conducted at Chris Hani Baragwanath Hospital. The study was carried out over a 6 month period and 60 subjects were recruited. All the women with the diagnoses of placental abruption and singleton pregnancies were included in the study. Results Of the 13734 delivered women 60 patients (0.4%) had placental abruption. Out of the 60 patients 53 (83%) were booked. The age group was between 18 – 42 years with the mean age of 28.2±6.8years. The mean gestational age on admission was 31.8±4.7. Forty six (71.6%) patients had parity of one and more. The risk factors that were identified in the study were previous history of placental abruption which occurred in 4 patients (6.7%),previous caesarean section in 7 (11.7%).The commonest medical disorder observed was hypertensive disease, pre-eclampsia was found in 24 patients(40%), gestational hypertension was found in 5 patients (8.3%) and chronic hypertension in 4(6.7%). The maternal complications that were identified were PPH in 15(44%) patients that had stillbirths compared to 1(3.8%) in the group that had live births, DIC was observed in 8 (23.5%),haemorrhagic shock occurred in 2 (5.9%) of the patients, acute kidney injury in 20(58.8%) in the group that had stillbirths compared to 3(11.5%) in the group that had live births, Couvelaire uterus in 9(26.4%) in the group that had still births, hysterectomy was performed in 2 (5.8%) and ICU admission was required for 5 (14.7%) of the patients. The neonatal out comes that were observed were stillbirths in 34 patients, birth asphyxia in 5(19.2%) and ICU admission was required in 11(42.3%). There were no maternal deaths. Conclusion In conclusion placental abruption is still a dangerous complication for both the mother and baby. In this study the patients that had stillbirths had worse outcomes compared to those that had live births. Therefore the conditions that are associated with this condition should be identified. Early recognition of this condition as well as proper referral of the patient can ensure better outcomes.Item Rotavirus vaccine and diarrhoeal morbidity in South Africa(2016-11-04) Groome, Michelle JenniferBackground Vaccination against rotavirus, the leading cause of diarrhoea in children under 5 years of age, has the potential to reduce diarrhoeal morbidity and mortality. Lower vaccine efficacy and immunogenicity were observed in clinical studies of oral rotavirus vaccines in low- and middleincome countries in Africa compared to high-income countries. The impact of routine vaccine use in African countries, where almost half of the global rotavirus deaths occur, is yet to be established. In addition, factors affecting immune responses to the rotavirus vaccine warrant further investigation. Objectives To assess the effectiveness and public health impact of introduction of the monovalent oral rotavirus vaccine into the national immunisation programme in South Africa, a setting with a high prevalence of human immunodeficiency virus infection; and to determine the effect of maternal rotavirus-specific antibodies and abstention from breastfeeding at the time of rotavirus vaccination on immune responses to the rotavirus vaccine. Methods A case-control study was used to estimate vaccine effectiveness in children under 2 years of age, with comparison of rotavirus vaccination status among rotavirus-positive diarrhoeal cases to rotavirus-negative and respiratory controls, respectively. The impact of routine rotavirus vaccination on all-cause diarrhoeal hospitalisations was assessed by comparing the incidence before and after vaccine introduction among HIV-infected and HIV-uninfected children under 5 years of age. HIV-uninfected mother-infant pairs were randomised to either abstention from breastfeeding or unrestricted breastfeeding at the time of rotavirus vaccination to assess the effect of breast milk on the immune response to the vaccine; in addition maternal rotavirus serum antibodies were measured. Results Two doses of rotavirus vaccine provided protection of 57% (95% CI 40–68) against hospitalisation for acute rotavirus diarrhoea. Protection extended through the first 2 years of life and the vaccine protected against different rotavirus strains. Routine vaccine introduction was temporally associated with a 34% to 57% decrease in the overall incidence of all-cause diarrhoeal hospitalisations in children under 5 years of age during 2010–2014 compared to prevaccination years (p<0.001).The greatest reductions were observed in children under 12 months of age. Reductions were maintained for 5 years post-vaccine introduction. Abstention from breastfeeding for 60 minutes before and after each rotavirus vaccine dose showed no significant improvement in infant immune responses to the vaccine. However, mothers of infants who seroconverted after the first vaccine dose had significantly lower anti-rotavirus immunoglobulin G titres at baseline than those whose infants did not seroconvert. Conclusion Rotavirus vaccination was an effective intervention against severe diarrhoea in South African children, preventing hospitalisations due to rotavirus while also reducing diarrhoeal hospitalisations for diarrhoea of any cause. These studies add to the growing body of evidence showing that rotavirus vaccines are reducing diarrhoeal disease in low- and middle-income countries and should form part of comprehensive diarrhoeal disease control and prevention. A change in breastfeeding practice at the time of rotavirus vaccination did not improve immune responses to the vaccine, yet maternal antibodies may play an important role. Continued research is needed to optimise the protection afforded by currently licenced vaccines and to develop novel rotavirus vaccines.Item Childhood drowning: morbidity and mortality from a Johannesburg paediatric ICU, 2003 to 2013(2016-11-04) Edwards, Tamsen PetaDrowning is a worldwide significant but preventable public health problem. South Africa has one of the highest rates in the world of unintentional drowning mortality in the under five year age group. The aim of this study was to describe the population of patients admitted to a Johannesburg PICU with the diagnosis of drowning and to investigate potential prognostic factors recorded within the first 12 hours after admission. A retrospective record review of all the children between zero and 14 years admitted to PICU between January 2003 and December 2013, with a diagnosis of “drowning” or “near-drowning” was conducted. Of the 215 children admitted into the unit in the 11 year period, 11 did not meet inclusion criteria. Seventy-two percent of the population were male and the mean age was two years and seven months, with the majority of patients under the age of three years (76.5%). There were 71.6% discharged with a good neurological outcome while 10.3% died in hospital and 24% were classified as having a poor outcome with neurological sequelae. These results, similar to those found in previous hospital based studies, showed that more boys are likely to drown than girls and that the largest number of victims fall in the one to four year age group. Univariate analysis found 15 physiological variables (all recorded in the first 12 hours after admission) to be significantly associated with outcome. When a forward stepwise multivariate discriminant analysis was used six variables were found to be significant predictors of outcome, GCS (≤6) and sodium (>148mmol/L) having the strongest association, but no one factor was found to accurately predict outcome. It is therefore recommended that every patient who has drowned be treated aggressively, no matter their presentation or history.Item Socio-demographic factors associated with morbidity in children under-five years in agincourt hdss in 2006.(2012-01-10) Matabane, Mosehle NoriahIntroduction: A large proportion of under-5 mortality in the world occurs in the sub- Saharan region and South East Asia and these deaths are mostly due to preventable diseases. Socio-economic status of the household, maternal education, maternal employment status, child‟s age and gender are said to be determinants of children‟s morbidity and mortality. An inverse relationship between illness, mortality and socioeconomic status has been observed with morbidity and mortality concentrated in children in the lower socio-economic class and substantial reductions occurring in higher socio-economic class. Objectives: To determine the prevalence of all-cause morbidity, proportional morbidity from common illnesses and the maternal, household and community socio-demographic risk factors associated with morbidity in children under-5 years of age in the Agincourt health and Socio-Demographic Surveillance System (AHDSS) site, Mpumalanga Province, in 2006. Methods: Secondary data analysis based on a child morbidity survey for children under-5 years was linked to the Agincourt Health and Socio-demographic Surveillance System site between August and December 2006. Caregivers of 6 404 children were administered a health care utilization questionnaire and 732 children were reported to have had an illness in the preceding 14 days. Stata version 10.0 was used for data handling, cleaning and statistical analysis. Results: Nine percent of the children in the AHDSS site had had an illness in the 14 days preceding the survey. Illnesses due to other infections contributed to over half of the proportion of morbidity in the children. This was followed by fever, acute respiratory infections, malnutrition, gastro intestinal disease and lastly injuries. The 12-23 months age group had the highest proportion of morbidity due to malnutrition and gastro intestinal diseases compared to the other age groups, although this relationship was not significant. A significant difference in proportion of morbidity between children living in households headed by Mozambicans and those living in households headed by South Africans was found. A younger age, higher birthweight, living in a household headed by an individual with only (primary) and living in a community without a clinic increased the likelihood of a child being reported ill. Conclusion: A younger age, higher birthweight, living with a household head with some education (primary and less) and poor access to a community health center in the village of residence increased the risk of a caregiver reporting a illness in a child. Confounding factors could have attributed to the observed association found between morbidity and high birthweight as well as that found between household head education status and morbidity. Further investigations as to why increase in household head education and higher birthweight is associated with morbidity is necessary. More research is needed to find out which factors at all levels (individual, household and community) unique to this region, contribute to making younger children more vulnerable to acquiring an illness.