4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
Permanent URI for this communityhttps://hdl.handle.net/10539/37773
Browse
Search Results
Item Understanding SARS-CoV-2 vaccine hesitancy among pregnant women in Soweto, South Africa: A qualitative study(University of the Witwatersrand, Johannesburg, 2024) Zungu, Zwile; Myburgh, NellieThe study focused on understanding SARS-CoV-2 vaccine hesitancy among pregnant women in Soweto, South Africa. Pregnant women are at a greater risk of experiencing COVID-19 complications during pregnancy if infected with the SARS-CoV-2 virus. Vaccination uptake remains low in the population at large. This is a qualitative exploratory study approach using key-informant interviews. A total of sixteen key informant interviews with vaccinated pregnant women, unvaccinated pregnant women, healthcare workers and alternative healers were conducted. This study took place in Soweto townships, South Africa. Thematic qualitative analysis was used to construct themes in NVivo, where the gathered data was reviewed and analysed. The study found that pregnant women experience barriers and motivations that determine their decision to get vaccinated against COVID-19. Motivators to vaccinate health concerns, monetary benefit and structural motivators such as employment, travelling and education. Barriers included vaccine related fears were the main reason for poor vaccine uptake. The lack of knowledge, healthcare system barriers, misinformation, and lack of trust in the government were some reasons for vaccine hesitancy. The study's findings show that pregnant women's decisions to get vaccinated are significantly influenced by several barriers, perceptions and the motivators they haveItem The moral obligation to include pregnant women in clinical trials(University of the Witwatersrand, Johannesburg, 2024) Ramtahal, Kieara-Lee; Behrens, KevinMany pregnancies are complicated by serious medical conditions that require treatment, and despite the need to use medication during pregnancy, the majority of clinical trials do not include the pregnant population, which leaves pregnant women with limited “robust” data regarding the safety and effectiveness of medications that they may require during pregnancy (Little & Wickremsinhe, 2017, p.1). In this report, I examine the reasons provided for the exclusion of pregnant women from clinical trials and the ethical reasons for their inclusion. I argue that, 1. the exclusion of pregnant women as participants in clinical trials could potentially expose future pregnant women to significant harms, 2. the benefits arising out of the inclusion of pregnant women in clinical trials far exceeds the possible harms to the pregnant women trial participants and their fetuses and 3. pregnant women deserve fair access to research trials where their participation will involve access to potential benefits. I also discuss objections to my arguments and provide a response. In conclusion, I contend that pregnant women should be included in clinical trials unless there are compelling reasons for exclusion.Item Association between serum zinc level and dynamics of Group B Streptococcus colonisation among pregnant women in South Africa(University of the Witwatersrand, Johannesburg, 2024) Dhar, Nisha; Madhi, Shabir ABackground Maternal colonisation by Group B Streptococcus (GBS) is a major risk factor for early onset invasive GBS disease among newborns. Zinc micronutrient plays a critical role in several biological processes that are essential to prevent bacterial colonisation and/or invasion. The aim of this study was to investigate the association of serum zinc levels with GBS rectovaginal new acquisition and clearance from 20 to 37+ weeks gestation in pregnant women. Methods Vaginal and rectal GBS colonisation was determined at 20–25 weeks (visit-1), followed by 3 subsequent visits at 5–6 weeks intervals, until 37–40 weeks gestation (visit-4). Serum was collected at visit-1 and visit-4 and serum zinc was estimated by inductively coupled plasma mass spectrometry. “New acquisition” group was defined as participants for whom GBS culture was negative at visit-1 and acquired GBS in one of the subsequent visits. Participants not colonised with GBS at any visits were categorized as GBS “persistently uncolonised”. Participants who remained colonised throughout all study visits were defined as “persistently colonised” group. GBS “clearance group” included participants who were colonised at enrolment (visit-1) and in whom GBS colonisation cleared by last visit (visit-4). Results Participants in persistently un-colonised group had significantly higher zinc geometric mean concentration (GMC) at visit-1 compared with those who had new acquisition (20.18 µmol/L; 95%CI 17.99-22.64 vs 13.68 µmol/L; 95%CI 12.59-14.87, p=0.03). Higher zinc concentration in the persistently un-colonised group when compared with new acquisition group was significantly associated with lower odds of GBS rectovaginal acquisition [Odds ratio (OR) 0.15, p=0.001]. The lowest zinc threshold significantly associated with 45% lower odds of new acquisition was ≥15 umol/L (27.2% in new acquisition vs 40.5% in persistently un-colonised; OR 0.55; 95%CI 0.31- 0.96; p=0.03). Furthermore, zinc concentration was higher among women in clearance group compared with those in persistently colonised group (20.03 µmol/L; 95%CI 16.54-24.27 vs 16.45 µmol/L; 95%CI 13.32-20.31, p=0.04). Conclusion There was an inverse association between serum zinc levels in pregnant women and odds of GBS acquisition in those not initially colonised. Zinc supplementation in early pregnancy could reduce risk of invasive GBS disease in their newbornsItem Prevalence of Group B Streptococcus colonization and serotype distribution among pregnant women in South Asian and African countries(University of the Witwatersrand, Johannesburg, 2024) Kwatra, Gaurav; Madhi, Shabir A.Background: Recto-vaginal Group B Streptococcus (GBS) colonization in pregnant women at the time of labour is the major risk-factor for developing invasive GBS disease within 7 days of age (early onset disease; EOD). We investigated prevalence of GBS recto-vaginal colonization at the time of labour among pregnant women and vertical transmission to their newborns across six African and two south-Asian countries. Methods: This multi-country prospective, observational cross-sectional study was undertaken in six African [(Ethiopia (Adama city), Kenya (Kilifi), Mozambique (Manhica), Nigeria (Gwagwalada), Mali (Bamako) and South Africa (Johannesburg) and two Southeast Asian countries (Bangladesh (Mirzapur) and India (Vellore)]. Inclusion criteria included pregnant women 18 to 45 years of age, delivery at ≥37 weeks gestation and documented to be HIV-uninfected prior to study-enrolment. Lower vaginal swabs, rectal swabs and urine were collected from the mothers and separate skin surface swabs of the umbilicus, outer ear and axillary fold; and rectal and throat swabs were obtained from the newborn for GBS culture. Standardized sampling and culture using direct plating and selective broth media for detection of GBS colonization in the mother-newborn dyads was undertaken across the sites. Serotyping of GBS isolates was done in South Africa. Results: Overall, 6,922 pregnant women were enrolled from January 10th , 2016 to December 11th , 2018. Of 6922 women who were enrolled, 6514 (94.1%; 759 to 892 per site) were included in the analysis. Overall, the prevalence of maternal GBS colonization was 24.1% (95%CI 23.1- 25.2; 1572/6514) being highest in Mali (41.1%, 95%CI: 37.7-44.6; 314/764) and lowest in Ethiopia (11.6%, 95%CI:9.5-14.1; 88/759). The overall rate of vertical transmission of GBS was 72.3% (95%CI 70.0-74.4; 1132/1566); being highest in Mozambique (79.2%, 95%CI 73.3-84.2); 168/212) and lowest in Bangladesh (55.8%, 95%CI 47.5-63.8; 77/138). The five most common GBS colonizing serotypes were Ia (37.3%; 586/1572), V (28.5%; 448/1572), III (25.1%; 394/1572), II (9.2%; 144/1572) and Ib (6.5%; 102/1572). There was geographic variability in serotype proportion distribution. Serotype VII was the third most common serotype in India (8.5%, n=15/176) and serotype VI was mainly identified in Bangladesh (5.8%) and India (5.7%). Conclusion: Our study reported high prevalence of GBS colonization in most settings, with some geographic variability even within African countries. Our findings suggests that there is likely to be a significant burden of EOD across the study sites. Post-licensure vaccine effectiveness studies should also focus on maternal GBS serotype distribution as non-vaccine serotype replacement could occur due to vaccine immune pressureItem Routine laboratory and clinical monitoring of HIV-positive pregnant women on antiretroviral therapy(2024) Khulu, Kwano Mahlako KgweranoBackground Developments in South Africa’s prevention of mother-to-child transmission of HIV (PMTCT) programme show a decline in AIDS-related paediatric deaths. In 2015, PMTCT guidelines were updated, with revised protocols for clinical and laboratory monitoring for patients on antiretroviral therapy (ART). The aim of this study was to assess adherence to monitoring guidelines for HIV-positive pregnant women on ART. Methods This was a clinical audit of 185 HIV-positive pregnant women, on pre-pregnancy ART, or initiated during the index pregnancy and delivered at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in the period January to June 2017. Data were collected on timing of HIV diagnosis and ART initiation, clinical and laboratory monitoring, and initiation of prophylaxis for opportunistic infections. Results Of the 185 patients, 64.9% (120/185) were known with HIV infection prior to the index pregnancy, and 85.8% (103/120) were initiated on ART pre-pregnancy, with 64/103 (62.1%) virally suppressed (<50 copies/ml)d t baseline. Overall, 179/185 women accessed antenatal care. A total of 82 patients were initiated on ART in the index pregnancy, and of these 60/82 (73.2%) had a 3-month viral load done, and 22/82 (26.8%) were suppressed. A total of 153/185 (82.7%) patients had CD4 counts done, and of these, 63/153 (41.2%) were ≤350 cells/dl, with 7/63 (11.1%) patients receiving cotrimoxazole prophylaxis. Tuberculosis (TB) screening was documented for 35/179 (19.6%) patients, with 6/35 (17.1%) receiving TB preventative therapy. Birth HIV PCR tests were available for 175/185 (94.6%) neonates, and all were negative. Conclusion There were gaps identified in laboratory and clinical monitoring. ART initiation was however high, with no cases of MTCT reported.