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Recent Submissions

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HIV Viral Load Rebound at Delivery in Women on Art with Previously Suppressed Viral Loads During the Same Pregnancy
(University of the Witwatersrand, Johannesburg, 2025) Mzendana, Siseko
Background HIV viral load (VL) non-suppression can lead to adverse pregnancy outcomes, including vertical transmission (VT). Therefore, it is crucial to achieve and maintain viral suppression during pregnancy. Objectives The objectives of this study were to investigate the prevalence of HIV VL rebound at delivery in women with previously suppressed VLs in the same pregnancy, and also evaluate adherence to the 2019 PMTCT guidelines on VL testing. Methods This was a retrospective record review of pregnant women living with HIV (PWLHIV) and on antiretroviral therapy (ART) who delivered at Chris Hani Baragwanath Academic Hospital during the period 01 January to 31 December 2021. Patient files were randomly selected and data on demographics, timing and history of HIV diagnosis and treatment, VL testing during pregnancy and delivery, and infant outcomes were extracted. Results A total of 362 PWLHIV were included in the study and the majority (85.5%) were diagnosed with HIV prior to the index pregnancy and almost all were on ART at the first antenatal visit. HIV VL rebound was diagnosed in 11 women (3.6%), and of these, nine (82%) had a VL VIII between 50 and 1000 copies per ml, and two (18%) had a VL >1000 copies per ml. Overall, 56 (15.5%) women had no VLs done at delivery. Age was the only variable significantly associated with VL rebound at the time of delivery. No cases of VT were identified. Conclusion The low rate of HIV VL rebound at delivery is reassuring. While there was evidence of adherence to PMTCT guidelines in terms of ART initiation and monitoring, there are still gaps with regards to VL monitoring.
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Awareness Factors Affecting Contraceptive Uptake in women attending the Gynaecology Out-Patients Department, at a Tertiary Hospital
(University of the Witwatersrand, Johannesburg, 2023) Ndlovu, Sinegugu; Shimange-Matsose, Lusanda; Mpehle, Chileshe
Objectives: The objectives of the study were to assess the knowledge and awareness of contraception in the women seen at Chris Hani Baragwanath Academic Hospital Gynaecology Out- patient department. We also looked at the efficiency of contraceptive counselling from the health care providers and assessed patient satisfaction. Study design: We conducted a prospective, descriptive, cross-sectional study. A survey of 100 women, of reproductive age attending the gynaecology outpatient department was conducted using a questionnaire over a period of 3 months. Sample size was determined by use of The Survey System, Sample Size Calculator. The survey assessed the women’s knowledge regarding barrier methods as well as hormonal methods (in the form of combined oral contraceptives, injectables, the implant, the intrauterine device, emergency contraception) and permanent forms of contraception. Independent variables were age, level of education, employment, parity. Dependant variables were prevalence of contraceptive uptake, knowledge of available contraception. The association between the prevalence of contraceptive uptake and the knowledge regarding the available methods of contraception was assessed using the Chi square test, as well as the Mann Whitney U test. A p- value of 0.05 was decided upon for statistical significance an odds ratio and 95% confidence intervals were reported. Results: Overall Our study found that the total percentage of women using a form of contraception was 39.79 % while those that were not on any form of contraception was 60.20%. Our study found that the rates of contraception discontinuation were high. There was poor contraceptive awareness and knowledge. There was more awareness than there was intricate knowledge regarding the different forms available of contraception. Contraceptive counselling increased the rate of contraceptive uptake; of the women that were initially counselled, and then offered contraception, 82.9% of them were agreeable. Conclusion: Awareness does not equal knowledge. All gynaecology outpatient visits should be seen as an opportunity for contraceptive counselling, regardless of the main complaint. The high rate of discontinuation of hormonal contraception should be further assessed, women should be re- counselled prior to discontinuation, and preferably placed on another form of contraception which suits their needs. vi ACKNOWLEDGEMENTS I wish to express my deepest gratitude to my supervisors, Dr Chileshe Mpehle and Dr Lusanda Shimange-Matsose without whom this study would not have been possible. Their guidance, encouragement and knowledg
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A descriptive study of meningeal pathogens cultured from the general paediatric wards in Chris Hani Baragwanath Hospital, 2012 to 2020
(University of the Witwatersrand, Johannesburg, 2024) Dlamini, Sindiswa Charmaine
Background Meningitis is a leading cause of childhood morbidity and mortality, with an incidence of 7/100,000 children aged 1-4 years and 40/100,000 in infants in South Africa. Since the incorporation of protein-polysaccharide vaccines to prevent infections due to Haemophilus influenzae type b and pneumococcus into the South African immunisation programme, the epidemiology of meningitis in South Africa is changing. Methods We reviewed the clinical and laboratory characteristics, and clinical outcomes of children aged 0 to 14 years of age that were hospitalised with meningitis in the general paediatric wards at a public sector teaching hospital in South Africa from 01 January 2012 through 31 December 2020. Results During the study period, 1,617 episodes of meningitis were diagnosed in 1,597 children. Me- dian age at hospitalisation was 6.0 months (interquartile range (IQR), 1.2 to 38.6 months). Most (1,243/1,617, 78.9%) of the episodes occurred in HIV-uninfected children, 182 (11.2%) in HIV-infected children and 192 (11.8%) in children with undetermined HIV infection status. Two hundred, fifty-four (15.7%) episodes were microbiologically confirmed, and 1,268 (78.4%) were clinically diagnosed with no microbiological confirmation. Coagulase negative staphy- lococci (n=77), Streptococcus pyogenes (n=76) and pneumococcus (n=54) were the most frequently isolated organisms. The crude mortality rate was 8.5% (137/1,617). Using three multivariable logistic regression modelling approaches, HIV infection was consistently associ- ated with mortality (adjusted odds ratios ranging from 3.658 (95% confidence interval (CI), 1.645-8.133) to 4.070 (95% CI, 1.474-11.235)). A composite measure of low cerebrospinal fluid (CSF) to plasma glucose ratio, raised CSF protein and raised C-reactive protein was iv independently associated with a 3.413 (95% CI, 1.88-6.196) increased adjusted odds of death. Conclusions Most cases of meningitis are clinically diagnosed, and when microbiologically confirmed are caused predominantly by Gram positive organisms. HIV infection is consistently associated with worse outcomes. Biochemical parameters may be useful to prognosticate in children diagnosed with meningitis.
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The use of thyroid stimulating hormone testing in pregnancy and post-partum at Rahima Moosa Mother and Child Hospital
(University of the Witwatersrand, Johannesburg, 2025) Buhobe, Seele; Bayat, Zaheer; Daya, Reyna
Background: Thyroid disease is an uncommon but important cause of pregnancy and postpartum complications. Early diagnosis aids in preventing these complications. This study aimed to review the indications for TSH testing during pregnancy and evaluate the results and pregnancy outcomes of those tested at the Rahima Moosa Mother and Child Hospital. Methods: This retrospective descriptive study was conducted at Rahima Moosa Mother and Child Hospital in Coronationville, Johannesburg. Medical records of pregnant women and women in the postpartum period who had their TSH tested between the 01st October and 31st December 2019 were retrieved and reviewed. The indication for investigating a TSH level, the TSH result, and pregnancy outcomes were evaluated. Results: A total of 746 TSH samples were collected during the study period. Out of these, only 122 files were found and retrieved from the records department and reviewed. Only 82 (67.2%) of the patients had indications in line with American Thyroid Association (ATA) recommendations. Data showed that 106 (86.9%) of patients were euthyroid, 11 (9.0%) hypothyroid, and five (4.1%) were hyperthyroid. There was one low birth-weight baby born to a patient with hyperthyroidism, one low birth-weight baby, and one intrauterine fetal demise born to a patient with hypothyroidism. There were no maternal complications in patients found to be hyperthyroid, and only one pregnancy was complicated by sepsis in those patients found to be hypothyroid. Conclusion: Thyroid disease screening during pregnancy and postpartum at Rahima Moosa Mother and Child Hospital did not adhere to ATA recommendations. This study has a higher prevalence of thyroid disease than the world-reported prevalence.
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An Analysis of Circulating Invasive Pneumococcal Disease Serotypes in South Africa and the Potential of New and Existing Pneumococcal Vaccines to Prevent Disease and Death, 2012–2021
(University of the Witwatersrand, Johannesburg, 2024) Pillay, Sayuri
In recent years, various new pneumococcal conjugate vaccines (PCVs) (PCV10-SII, PCV15 and PCV20) containing different serotypes entered the global market to prevent invasive pneumococcal disease (IPD). This study aimed to assess the potential of these vaccines in preventing IPD within different populations in South Africa (SA) compared to current vaccines in use (PCV13 and the 23-valent pneumococcal polysaccharide vaccine (PPSV23)). A retrospective, descriptive, secondary analysis of primary data collected by GERMS-SA between 2012-2021 was performed. IPD incidence, serotype distribution and proportions of serotypes within pneumococcal vaccines were calculated. The association between case fatality rates and IPD serotypes, age group, province, HIV status, multidrug resistance and comorbidities were calculated through logistic regression. Between 2012 and 2021, 23 789 episodes of IPD were reported to GERMS-SA across South Africa. IPD incidence followed a decreasing trend, with an average annual incidence rate of 4.22 cases per 100 000 persons. was Absolute numbers of IPD cases were highest in persons between the ages of 25-44 years old. Common serotypes noted to cause IPD across the population were serotypes 8 (11%), 19A (8%) and 12F (8%). Across the vaccines assessed, PPSV23 (68%) contained the highest percentage of serotypes causing IPD in SA, followed by PCV20 (63%), PCV15 (40%), PCV13 (37%) and lastly, PCV10-SII (26%). PCV10-SII contained the highest proportion (> 50%) of serotypes causing penicillin and ceftriaxone antimicrobial resistance in IPD cases compared to the other vaccines. The case fatality rate across IPD cases between 2012-2021 was 32%. Children less than one years old (aOR:1.074 ; 95% CI (1.015-1.137)), adults aged 45-65 years old (aOR: 1.155; 95% CI (1.095-1.219)) and those older than 65 years (aOR: 1.208; 95% CI (1.120-1.304)), as well as people living with HIV (aOR: 1.044; 95% CI (1.013-1.076)) were all noted to have a significantly higher odds of death. Interestingly, no other comorbidities were significantly associated with higher odds of mortality when controlling for age, province, the presence of other comorbidities and risk factors. Next-generation higher-valent PCVs contain a moderate to high proportion of IPD serotypes circulating in SA and vulnerable populations including the extremes of ages, persons with comorbidities and the immunocompromised should be continuously targeted. These findings convey important implications for future pneumococcal vaccine use and policy in SA.