Research Articles (Paediatrics and Child Health)

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Change in the prevalence of extra-uterine growth restriction in very low birthweight infants, following the introduction of a written nutrition protocol, in a tertiary neonatal unit
(Taylor and Francis, 2024-09-11) Mosidi, L.N.D.; Van Niekerk, A.; Coetzee, Melantha; mel.coetzee@up.ac.za
BACKGROUND : Advances in neonatal medicine, resulting in improved survival, have brought the concept of extra-uterine growth restriction (EUGR), defined as postnatal growth failure secondary to protein and energy deficits, to the forefront as an important cause of morbidity, particularly in very low birthweight (VLBW) neonates. OBJECTIVES : This study’s main objective was to determine the prevalence of EUGR in Steve Biko Academic Hospital in VLBW infants. METHODS : This was a pre- (epoch 1) and post- (epoch 2) intervention study. The intervention was the introduction of a written nutritional protocol in the neonatal unit in mid-November 2017. Three definitions were used to identify EUGR, namely: (1)discharge weight < 10th percentile, (2) a change by −1.28 z-score in weight at discharge, and (3) the discharge weight percentile below the nadir percentile. RESULTS : The prevalence of EUGR in epoch 1 was 85.7%, 63.5%, and 88.0% using the above definitions, respectively. The prevalence of EUGR in epoch 2 was 73.9%, 65.8%, and 89.4% using the above definitions, respectively. EUGR using the three definitions combined was present in 95.2% and 92.8% of infants in epochs 1 and 2, respectively. None of the differences in EUGR prevalence between the two epochs were significant. CONCLUSION : The prevalence of EUGR was not significantly different between the two epochs, although it had been proposed that the introduction of a written nutritional protocol would have decreased the prevalence of EUGR in epoch 2. One of the reasons proposed for this finding was poor adherence to the nutritional protocol during epoch 2.
Hepatocardiopulmonary hydatid cysts : a rare paediatric case
(South African Medical Association, 2024) Mfingwana, Lunga; Goussard, P.; Van Wyk, L.; Andronikou, S.
Echinococcus granulosus (CE) is a worldwide public health problem causing considerable human morbidity and mortality. We report on a case of complicated paediatric echinococcosis as evidenced by pulmonary, hepatic and cardiac cysts. Combined surgery and chemotherapy represent an appropriate strategy for managing cardiac and cardiopulmonary echinococcosis. However, there is a pressing need for developing a prevention strategy, collaborative research efforts and establishing a registry for information sharing, particularly in SA and other endemic regions.
Comparison of specific IgE against allergen components measured on the ALEX2® Allergy Xplorer and the ImmunoCAP™ ISAC multiplex assays
(South African Medical Association, 2024-12) Murray, L.; Van Heerden, C.; Ranchod, H.; De Beer, C.; Van den Berg, Sharon; Teixeira, M.J.; Swanepoel, P.; Van Rooyen, Cathy; Van Niekerk, A.
BACKGROUND : Allergic disease, mediated by immunoglobulin E (IgE), is common worldwide and its incidence is on the rise. OBJECTIVES : To compare common food, inhalant and cross-reactive molecular components detected by the ImmunoCAP Immuno Solid-phase Allergen Chip (ISAC™) and the Allergy Xplorer (ALEX2®) multiplex IgE assays. METHODS : The study analysed serum samples from 100 patients with suspected allergies. Allergen-specific IgE (sIgE) molecular component measurements were performed using the ImmunoCAP™ ISAC E112i assay (ISAC™) (Thermo Fisher Scientific, Sweden). Subsequently, sIgE molecular component measurements were performed using the Allergy Xplorer 2® (ALEX2®) (Macro Array Diagnostics, Austria). The ISAC™ method tests 112 molecular allergen components. The ALEX2® method offers 295 reportable molecular allergen components and whole allergen extracts. RESULTS : The overall Kappa analysis showed very good agreement in 58.33% (n=28/48) of components, good agreement in 33.33% (n=16/48) of components, moderate agreement in 8.33% (n=4/48) of components and no fair or poor agreements seen among the analysed components. The four components with a moderate agreement were Gly m 4 (PR-10, soy), Ara h 8 (PR-10, peanut), Gly m 5 (storage protein, soy) and Tri aA/TI (alpha amylase/TI, wheat), with K values of 0.52, 0.51, 0.48 and 0.44, respectively. Tri-AA/TI exhibited the lowest agreement. CONCLUSIONS : The study findings demonstrated a good correlation between the ALEX2® and ISAC™ assays for the detection of sIgE against molecular allergen components. ALEX2® offers the benefit of testing 295 molecular allergen components and extracts, as well as cross-reactive carbohydrate determinants (CCD) inhibition.
A survey of the optimal oxygen saturation targets in premature infants in the neonatal intensive care units of three tertiary care hospitals in Tshwane, South Africa
(South African Medical Association, 2024-09) Thomas, J.G.; Coetzee, Melantha
BACKGROUND : An optimal oxygen saturation target for premature infants receiving supplemental oxygen, that aims to decrease morbidity and mortality, has been the aim of many studies worldwide. Recently, a saturation target of 91 - 95% was recommended by the NeOProM collaboration. OBJECTIVE : To identify current practice and healthcare-worker knowledge regarding target oxygen saturation in preterm infants. METHOD : This cross-sectional descriptive study was conducted at three tertiary hospital neonatal units in Tshwane, South Africa. A web-based survey was administered to staff caring for premature infants. To confirm the reliability of the survey, a snapshot was conducted to assess actual practice in the neonatal units. RESULTS : A total of 190 responses from the three neonatal units were analysed for the web-based survey. Overall, 56.3% of respondents indicated that a written standard operating procedure (SOP) for targeting oxygen saturation was in place. However, data analysis revealed that 43 different saturation target ranges were reported, with 90 - 95% being the most common. Approximately three-quarters of respondents indicated that supplemental oxygen may have harmful effects. Knowledge-based questions assessing the benefits and risks of targeting lower saturations (85 - 89%) were answered poorly. Snapshot data analysis revealed that 70.2% of infants were receiving oxygen, of which 81.2% received blended oxygen. The majority (61.2%) of these premature infants had saturations above 95%, with only 27.1% of infants’ snapshot saturations falling within the recommended range (91 - 95%). CONCLUSION : The large number of saturation target range responses that deviated from the SOP stipulated target, indicates that staff are not following an SOP for targeting oxygen saturation in premature infants. To ensure standardised care, we recommend that all three units ensure the availability of a written SOP and perform ongoing staff training.
A case of congenital diaphragmatic hernia, limb‑reduction defects and other abnormalities
(South African Medical Association, 2024-12) Coetzee, Melantha
Congenital diaphragmatic hernias are usually an isolated finding, though other malformations and syndromes may also be present, including limb-reduction defects in up to 13.1% of infants. These defects often occur in the upper limb and on the ipsilateral side of the hernia. This association between congenital diaphragmatic hernias and limb-reduction defects suggests a developmental relationship, where both organs are either affected during the same embryological period or by the same factor/s (genetic and environmental/teratogenic).
Primary ciliary dyskinesia : meeting the challenges of diagnosis in South Africa
(South African Medical Association, 2024-08) Dangor, Z.; Birkhead, M.; Verwey, C.; Gray, D.M.; Vanker, A.; Githingi, L.; Goga, Ameena Ebrahim; Masekela, R.; Zampoli, M.
Primary ciliary dyskinesia (PCD) is an inherited ciliopathy that results in impaired mucous clearance and affects primarily the respiratory tract, causing upper airway disease, bronchial inflammation and bronchiectasis. The prevalence of PCD in low- and middle-income settings, including South Africa (SA), is unknown, largely owing to challenges with diagnosis, and identifying children or adults with PCD is challenging in a setting with a high prevalence of other infectious diseases, including lower respiratory tract infections and tuberculosis. No single test is diagnostic of PCD, and while some tests are costly, others are labour intensive and require highly specialised laboratory expertise. In the SA setting, awareness and opportunities for the diagnosis of PCD need to be created. In this commentary, we provide a pragmatic approach to identifying which children and adults require further investigations for PCD using a range of diagnostic tests or tools that are available. Furthermore, we recommend that designated centres of expertise for PCD diagnosis are created in SA. This would be an important step towards improving accessibility of diagnostic tests and developing local expertise to improving PCD diagnosis, especially in early childhood, to prevent long-term irreversible respiratory sequelae.
Policy brief : optimising antimicrobial usage in paediatric inpatient hospital settings
(South African Medical Association, 2024-04) Cloete, Jeane; Karsas, Maria; Chetty, T.; Pillay, A.; Archary, M.; Moore, D.; Reddy, T.; Balakrishna, Y.; Nakwa, F.; Lancaster, R.; Goga, A.; Jeena, P.; jeane.cloete@up.ac.za
This policy brief document utilised an original published study from three academic hospitals in South Africa (SA) and all relevant published literature to develop recommendations on several strategies, summarised by the acronym ‘PRACTICE’, to optimise antimicrobial prescribing practices. These include implementing standardised policies for empirical antimicrobial use, routine review of antimicrobial therapy, age-specific antimicrobial stewardship programmes and continued collaborative efforts and research. Individualised treatment plans, improved infection prevention and control measures, ongoing surveillance and exploring electronic technology for antimicrobial stewardship are also crucial in combating the growing threat of antimicrobial resistance and improving patient outcomes in low- and middle-income countries (LMICs) such as SA.
Exploring the role of district clinical specialist teams in maternal health outcomes in a South African district : a mixed method study from 2012 to 2020
(South African Medical Association, 2024-12) Basu, Jayati Kusari; Stewart, A.; Basu, Debashis; Wing, J.; Feucht, Ute Dagmar
BACKGROUND : High maternal and child mortality in South Africa (SA) necessitated the establishment of district clinical specialist teams (DCSTs) in all health districts in 2012, mandated to work in collaboration with district managers and health professionals to achieve joint goals of improved maternal and child health services and outcomes. OBJECTIVE : Within the context of SA district health services, to explore the various obstetric intervention measures undertaken by a DCST over an 8-year period (July 2012 - February 2020), as aligned to the national DCST policy framework, and to document the knowledge and perceptions among managers and health professionals on the work done by the DCST in the district health service. METHODS : A review of DCST reports and documents was conducted along with in-person structured interviews among health professionals and district health managers in the Ekurhuleni Health District in SA. Health professionals who had a working relationship with the DCST and relevant managers of health, including CEOs, clinical managers, community health centre managers, maternal and child health co-ordinators and municipal managers were selected for the interview. Interviews were conducted by the interviewer using a data collection tool focused on the scope of work and acceptance of the DCST in improving maternal health services in a geographically defined district health system. Data collection tools were completed by the interviewer upon questioning the participants. Data were analysed by documenting the activities of the DCST, and thematic analysis was performed for the interviews. RESULTS : Analysis of DCST reports and documents revealed the broad range of activities, including clinical training and mentoring, clinical work, supervision, audit, research, monitoring and evaluation and clinical risk management. Thematic analysis extracted seven themes, namely clinical effectiveness, clinical risk management, professional development, accountability for maternal and child health, clinical work, monitoring and evaluation, and leadership and governance. All (n=20) participants acknowledged the positive impact of the DCST on the improvement in maternal health services. CONCLUSION : The DCST was perceived by local peers as a successful strategy to improve maternal health services in a district health service. This success is likely rooted in its focused intervention measures, within a supportive environment of district managers and health professionals. Such district-based clinical teams are a potential strategy to improve maternal health services within primary healthcare services.
Biallelic variants in RYR1 and STAC3 are predominant causes of King-Denborough syndrome in an African cohort
(Springer Nature, 2025-04) Schoonen, Maryke; Fassad, Mahmoud; Patel, Krutik; Bisschoff, Michelle; Vorster, Armand; Makwikwi, Tendai; Human, Ronel; Lubbe, Elsabeth (Elsa); Nonyane, Malebo; Vorster, Barend C.; Vandrovcova, Jana; Hanna, Michael G.; Taylor, Robert W.; Mcfarland, Robert; Wilson, Lindsay A.; Van der Westhuizen, Francois H.; Smuts, Izelle
King-Denborough Syndrome (KDS) is a congenital myopathy (CM) characterised by myopathy, dysmorphic features and susceptibility to malignant hyperthermia. The objective of this study was to investigate the genotype-phenotype correlation in Black African patients presenting with CM, specifically those with KDS-like phenotypes, who remained undiagnosed for over 25 years. A cohort of 67 Black African patients with CM was studied, of whom 44 were clinically evaluated and diagnosed with KDS. Whole-exome sequencing (WES) was performed as part of an international genomics study (ICGNMD) to identify potential pathogenic mutations. Genomic assessments focused on identifying relevant genes, including RYR1 and STAC3, and establishing genotype-phenotype correlations. The study identified RYR1 and STAC3 mutations as the predominant genetic causes of KDS in this cohort, with mutations in both genes exhibiting autosomal recessive inheritance. While RYR1 has previously been linked to autosomal dominant mutations, STAC3, which was formerly associated exclusively with Native American Myopathy/Bailey-Bloch Myopathy, congenital hypotonia, and susceptibility to malignant hyperthermia, is now newly associated with CM-KDS in this study. This establishes the first genotype-phenotype correlation for 44 Black African individuals with KDS. This study marks a significant milestone in research on understudied African populations with CM, emphasising the lengthy diagnostic journey these patients endured. The findings highlight the pressing need for improved access to genomic medicine in underserved regions and underscore the importance of expanding research and diagnostic capabilities in Africa. This work contributes to the advancement of genetic medicine in underrepresented populations, facilitating better diagnostic and therapeutic outcomes.
Safety, effectiveness and immunogenicity of heterologous mRNA-1273 boost after prime with Ad26.COV2.S among healthcare workers in South Africa : the single-arm, open-label, phase 3 SHERPA study
(Public Library of Science, 2024-12-05) Garrett, Nigel; Reddy, Tarylee; Yende-Zuma, Nonhlanhla; Takalani, Azwidhwi; Woeber, Kubashni; Bodenstein, Annie; Jonas, Phumeza; Engelbrecht, Imke; Jassat, Waasila; Moultrie, Harry; Bradshaw, Debbie; Seocharan, Ishen; Odhiambo, Jackline; Khuto, Kentse; Richardson, Simone I.; Omondi, Millicent A.; Nesamari, Rofhiwa; Keeton, Roanne S.; Riou, Catherine; Moyo-Gwete, Thandeka; Innes, Craig; Zwane, Zwelethu; Mngadi, Kathy; Brumskine, William; Naicker, Nivashnee; Potloane, Disebo; Badal-Faesen, Sharlaa; Innes, Steve; Barnabas, Shaun; Lombaard, Johan; Gill, Katherine; Nchabeleng, Maphoshane; Snyman, Elizma; Petrick, Friedrich; Spooner, Elizabeth; Naidoo, Logashvari; Kalonji, Dishiki; Naicker, Vimla; Singh, Nishanta; Maboa, Rebone; Mda, Pamela; Malan, Daniel; Nana, Anusha; Malahleha, Mookho; Kotze, Philip; Allagappen, Jon J.; Diacon, Andreas H.; Kruger, Gertruida M.; Patel, Faeezah; Moore, Penny L.; Burgers, Wendy A.; Anteyi, Kate; Leav, Brett; Bekker, Linda-Gail; Gray, Glenda E.; Goga, Ameena Ebrahim; The SHERPA study team
Limited studies have been conducted on the safety and effectiveness of heterologous COVID-19 vaccine boosting in lower income settings, especially those with high-HIV prevalence., The Sisonke Heterologous mRNA-1273 boost after prime with Ad26.COV2.S (SHERPA) trial evaluated a mRNA-1273 boost after Ad26.COV2.S priming in South Africa. SHERPA was a single-arm, open-label, phase 3 study nested in the Sisonke implementation trial of 500000 healthcare workers (HCWs). Sisonke participants were offered mRNA-1273 boosters between May and November 2022, when Omicron sub-lineages were circulating. Adverse events (AE) were self-reported, and co-primary endpoints (SARS-CoV-2 infections and COVID-19 hospitalizations or deaths) were collected through national databases. We used Cox regression models with booster status as a time-varying covariate to determine the relative vaccine effectiveness (rVE) of the mRNA-1273 booster among SHERPA versus unboosted Sisonke participants. Of 11248 SHERPA participants in the rVE analysis cohort (79.3% female, median age 41), 45.4% had received one and 54.6% two Ad26.COV2.S doses. Self-reported comorbidities included HIV (18.7%), hypertension (12.9%) and diabetes (4.6%). In multivariable analysis including 413161 unboosted Sisonke participants, rVE of the booster was 59% (95%CI 29-76%) against SARS-CoV-2 infection: 77% (95%CI 9-94%) in the one-Ad26.COV2.S dose group and 52% (95%CI 13-73%) in the two-dose group. Severe COVID-19 was identified in 148 unboosted Sisonke participants, and only one SHERPA participant with severe HIV-related immunosuppression. Of 11798 participants in the safety analysis, 228 (1.9%) participants reported 575 reactogenicity events within 7 days of the booster (most commonly injection site pain, malaise, myalgia, swelling, induration and fever). More reactogenicity events were reported among those with prior SARS-CoV-2 infections (adjusted odds ratio [aOR] 2.03, 95%CI 1.59-2.59) and less among people living with HIV (PLWH) (aOR 0.49, 95%CI 0.34-0.69). There were 115 unsolicited adverse events (AEs) within 28 days of vaccination. No related serious AEs were reported. In an immunogenicity sub-study, mRNA-1273 increased binding and neutralizing antibody titres and spike-specific T-cell responses 4 weeks after boosting regardless of the number of prior Ad26.COV2.S doses, or HIV status, and generated Omicron spike-specific cross-reactive responses. mRNA-1273 boosters after one or two Ad26.COV2.S doses were well-tolerated, safe and effective against Omicron SARS-CoV-2 infections among HCWs and PLWH. TRIAL REGISTRATION : The SHERPA study is registered in the Pan African Clinical Trials Registry (PACTR): PACTR202310615330649 and the South African National Clinical Trial Registry (SANCTR): DOH-27-052022-5778.
“If we work as a team, there are success stories.” Unpacking team members’ perceptions and experiences of what impacts team performance in a maternal and neonatal quality improvement programme in South Africa, before, and during COVID-19
(Public Library of Science, 2024-12-23) Odendaal, Willem; Goga, Ameena Ebrahim; Tomlinson, Mark; Singh, Yages; Schneider, Helen; Mianda, Solange; Kauchali, Shuaib; Marshall, Carol; Chetty, Terusha; Hunt, Xanthe
Many maternal and neonatal deaths and stillbirths can be avoided if quality of care is improved. The South African National Department of Health implemented a multi-partner quality improvement (QI) programme between 2018 and 2022, in 21 facilities, with the aim to reduce maternal and perinatal mortality. We conducted a qualitative evaluation to explore QI team members’ perceptions of the factors shaping variation in team performance. The evaluation was conducted in 15 purposively selected facilities. We interviewed 47 team members from the 14 facilities consenting to participate in the evaluation, over three time points. We conducted 21 individual interviews and 18 group interviews. Data were thematically analysed using ATLAS.ti 8. Based on a preliminary assessment, six teams were rated as well-performing and eight, less well-performing. Patterns of divergence between well-performing and less well-performing teams were then examined through in-depth analysis of the full data set. Well-performing teams had a core team of members with a good understanding of the programme aims and QI methodology; a second in-charge member to ensure leader continuity; and leader stability throughout the implementation period. Well-performing teams were recruited from existing facility service teams who had a positive prevailing work culture. Team leaders’ enthusiasm for QI and their ability to mobilise member buy-in, and how well teams worked together, further affected teams’ performance. Existing facility contexts, how teams are set up, leadership—and member buy-in into the methodology, affect QI teams’ performance. Focusing on these as well as supporting leaders to foster a shared vision and culture of excellence; mitigating contextual and implementation barriers; and strengthening team members’ technical QI skills, has the potential to improve QI teams’ performance.
SARS-CoV-2 seroprevalence among learners in grades 1-7, their parents and teachers in KwaZulu-Natal, South Africa : a cross-sectional study
(Frontiers Media, 2025-05) Dassaye, Reshmi; Chetty, Terusha; Daniels, Brodie; Ramraj, Trisha; Gaffoor, Zakir; Spooner, Elizabeth; Mthethwa, Ncengani; Nsibande, Duduzile Faith; Magasana, Vuyolwethu; Mohlabi, Khanya; Singini, Isaac; Gwebushe, Nomonde; Woeber, Kubashni; Goga, Ameena Ebrahim
INTRODUCTION : There is limited information on SARS-CoV-2 seroprevalence among children and adolescents in LMIC school settings. We aimed to assess (1) the seroprevalence of SARS-CoV-2 antibodies, (2) prevalence of self-reported or confirmed SARS-CoV-2 prior infections and, (3) COVID-19 symptoms (including long-COVID) among a cohort of primary school learners, their parents and teachers in a semi-rural school setting approximately 3-years into the COVID-19 pandemic. METHODS : Learners in grades 1-7 attending two pre-selected schools in close proximity in the Ndwedwe area, iLembe district, KwaZulu-Natal, South Africa, their parents and teachers were invited to enroll into the COVID Kids Schools Study (CoKiDSS) - a cross-sectional survey conducted between May-August 2023. All participants provided informed consent, completed a questionnaire and provided a fingerprick of blood for SARS-CoV-2 antibody testing using the COVID-19 IgG/IgM Rapid Test. Statistical methods included descriptive analysis, jackknife-estimated seroprevalence and incidence (unadjusted and sensitivity-adjusted), and logistic regression using generalized linear models. RESULTS : A total of 645 participants (i.e., 456 learners, 147 parents and 42 teachers) were enrolled into the survey. Overall SARS-CoV-2 IgG seroprevalence was 78% unadjusted to 81% adjusted with an increasing seropositivity trend, from learners to teachers (76% unadjusted to 79% adjusted in learners, 79% unadjusted to 82% adjusted in parents and 93% unadjusted to 97% adjusted in teachers). About 2.6% of learners tested IgM seropositive. Interestingly, 17% of the participants, including 20% learners, tested negative for SARS-CoV-2 antibodies. While only 16 participants (2.5% - 2 learners, 10 parents, and four teachers) self-reported a prior confirmed SARS-CoV-2 infection. Of these 2 learners (100%), eight parents (80%) and 4 teachers (100%) reported COVID-19 like symptoms that persisted for ≥28-days. CONCLUSION : We reported high SARS-CoV-2 IgG seroprevalence among learners in grades 1-7, their parents and teacher approximately 3 years into the COVID-19 pandemic which may be attributed to the snowball effect of multiple waves of infection in South Africa. However, only a small proportion of participants self-reported prior COVID-19 infection. This may be due to (1) recall bias and participants' perception of low susceptibility to and severity of COVID-19, (2) limited access to SARS-CoV-2 testing, and/or (3) a high prevalence of asymptomatic infections.
Insights into bloodstream infections in South African paediatric burn patients : implications for antimicrobial stewardship
(BioMed Central, 2025-03) Christie, Michael; Avenant, Theunis; Nembudani, Masindi; Mnqandi, Anelisa; Muller, Chris; De Villiers, Mariza; Bhikhoo, Zeenat; michael.christie@up.ac.za
INTRODUCTION : Bloodstream infections (BSIs) significantly contribute to the morbidity and mortality in paediatric burn patients from low- and middle-income countries; with common pathogens like Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa frequently being multidrug resistant (MDR). Due to the growing prevalence of MDR BSIs, antimicrobial stewardship needs to be improved with perhaps more targeted initial antimicrobial use. The study describes the aetiology, and timing of burn-associated BSIs and MDR infections in paediatric burn patients admitted to two paediatric surgery units in Tshwane District, South Africa. METHODS : This multi-centre retrospective review analysed paediatric burn patients (ages 0–12 years) admitted between January 2020 and December 2022 to two public hospitals in Tshwane District, South Africa. Collected data was from patient records and the National Health Laboratory System TrakCare database. BSIs were defined according to the CDC criteria. RESULTS : Of 245 burn patients admitted, 18.8% (n = 46) developed BSIs. From 63 positive blood cultures, the most common isolates were S. aureus (n = 19; 30%), Acinetobacter baumannii (n = 18; 29%), and P. aeruginosa (n = 10; 16%). Collectively, gram negative bacteria were responsible for most BSIs (n = 41; 65%). Candida spp accounted for 9% (n = 5). Thirty-five pathogens (56%) were MDR; this included methicillin-resistant S. aureus (MRSA) (n = 7; 11%), carbapenem-resistant A. baumannii (n = 16; 25%), and P. aeruginosa (n = 6; 10%). The median time to the first positive blood culture was 5 days (IQR: 3–12) (gram positive organisms: median: 5 days [IQR: 3–15}); gram negative organisms: median: 8 days [IQR: 4–20]; Fungal: median: 9 days [IQR: 8–27]; p-value 0.37). In the first week, S. aureus caused 32% of infections, including five MRSA cases. Gram negative bacteria dominated weeks two and three, with fungal and polymicrobial infections mainly in weeks two and four. CONCLUSION : Our findings show that as gram positive and gram negative infections predominantly occurred early in the admission period, while polymicrobial infections are more frequently observed later. Consequently, initial targeted narrow-spectrum antimicrobial use is not possible. Instead, antimicrobial de-escalation should be prioritized once culture results are available. Efforts should shift from a focus on treating BSIs to preventing them through wound care and infection control measures. Broad-spectrum antibiotics should be used judiciously and quickly de-escalated to minimise antimicrobial resistance development.
The challenging road to sustainable kangaroo mother care practice and service : reflections from a South African health district
(BioMed Central, 2025-03) Bergh, Anne-Marie; Van Rooyen, Elise; Kritzinger, Alta M. (Aletta Margaretha); Skhosana, Maria Rinah; Tshukudu, Mphailele; Feucht, Ute Dagmar; anne-marie.bergh@up.ac.za
BACKGROUND : Kangaroo mother care (KMC) was introduced in the Tshwane Health District in South Africa in 1999. After more than two decades of the expansion of KMC services, we describe the KMC implementation trajectory in the district. METHODS : A group of district clinical specialists, clinicians and academics involved in KMC implementation wrote a reflection on the status of KMC in Tshwane District and lessons for sustaining KMC services and practice. RESULTS : The KMC implementation trajectory is described according to three phases: (1) a slow start (1999–2012); (2) consolidation (2012–2023); and (3) sustaining KMC beyond the COVID-19 pandemic. The Tshwane KMC programme activities are interpreted using a 10-component model for scaling up care for small and/or sick newborns at the district level. Major lessons for the sustainability of KMC practice and service include embedding system-wide supportive supervision in the health system’s budget, encouraging multidisciplinary teamwork, conducting regular KMC refresher activities, and working on improving data to enable meaningful action. CONCLUSION : Despite great strides in KMC implementation and ongoing services in the Tshwane Health District, the road to continued sustainability remains challenging.
Dr Spur's mystery case : Is the answer in the gut?
(Allergy Society of South Africa, 2024-06-01) Van den Berg, Sylvia; Brauer, Marieke; Van Niekerk, Andre; andre.vanniekerk@up.ac.za
I have been treating a delightful young 16-year-old lady for a couple of years now in my practice. She has been diagnosed with selective IgA deficiency when she was six years old, after suffering from more than the usual amount of upper respiratory infections in comparison with her peers. She is also atopic suffering from allergic rhinitis and is sensitised to grasses. Unfortunately, she also developed type 1 Diabetes Mellitus when she was eight years old. Despite all her afflictions, she has a sunny disposition and is a very brave girl. I have come across articles where it is stated that IgA is particularly important in maintaining microbiome homeostasis. Can all her symptoms be contributed to a microbial dysbiosis? How can I manage her more optimally? Your opinion and guidance in this matter will be highly appreciated.
Good practices to optimise the performance of maternal and neonatal quality improvement teams : results from a longitudinal qualitative evaluation in South Africa, before, and during COVID-19
(Public Library of Science, 2024-11-19) Odendaal, Willem; Tomlinson, Mark; Goga, Ameena Ebrahim; Singh, Yages; Kauchli, Shuaib; Marshall, Carol; Pillay, Yogan; Makua, Manala; Chetty, Terusha; Hunt, Xanthe
Many maternal and neonatal deaths can be avoided if quality healthcare is provided. To this end, the South African National Department of Health implemented a quality improvement (QI) programme (2018-2022) to improve maternal and neonatal health services in 21 public health facilities. This study sought to identify good practices aimed at improving QI teams' performance by identifying optimal facility-level contextual factors and implementation processes. We purposively selected 14 facilities of the 21 facilities for a longitudinal qualitative process evaluation. We interviewed 17 team leaders, 47 members, and five QI advisors who provided technical support to the teams. The data were analysed using framework analysis. We choose the Consolidated Framework for Implementation Research as framework given that it explicates contexts and processes that shape programme implementation. Six quality improvement teams were assessed as well-performing, and eight as less well-performing. This research conceptualises a 'life course lens' for setting up and managing a QI team. We identified eight good practices, six related to implementation processes, and two contextual variables that will optimise team performance. The two most impactful practices to improve the performance of a QI team were (i) selecting healthcare workers with quality improvement-specific characteristics, and (ii) appointing advisors whose interpersonal skills match their technical quality improvement competencies.
Detection of the epidemic Pseudomonas aeruginosa AUST-03 (ST242) strain in people with cystic fibrosis in South Africa
(Wiley, 2024-12) Hamiwe, Thabo; White, Debbie A.; Kwenda, Stanford; Ismail, Arshad; Klugman, Susan; Van Bruwaene, Lore; Goga, Ameena Ebrahim; Kock, Marleen M.; Smith, Anthony Marius; Ehlers, Marthie Magdaleen; marthie.ehlers@up.ac.za
INTRODUCTION: Pseudomonas aeruginosa AUST-03 (ST242) has been reported to cause epidemics in people with CF (pwCF) from Australia and has been associated with multidrug resistance and increased morbidity and mortality. Here, we report an epidemic P. aeruginosa (AUST-03) strain in South African pwCF detected at a public hospital and characterize the genomic antibiotic resistance determinants. METHODS: The P. aeruginosa AUST-03 (ST242) study isolates were analysed with whole genome sequencing using the Illumina NextSeq2000 platform. Raw sequencing reads were processed using the Jekesa pipeline and multilocus sequence typing and genomic antibiotic resistance characterization was performed using public databases. Genetic relatedness between the study isolates and global P. aeruginosa ST242 from public databases was determined using a maximum-likelihood phylogenetic tree. Antibiotic susceptibility testing was performed using the disk diffusion and broth microdilution techniques. RESULTS: A total of 11 P. aeruginosa AUST-03 isolates were isolated from two children with CF. The majority (8/11) of these isolates were multidrug-resistant (MDR) or extensively drug resistant; and the multidrug efflux pumps MexAB-OprM, MexCD-OprJ, MexEF-OprN, and MexXY-OprM were the most clinically relevant antibiotic resistance determinants and were detected in all of the isolates. The study isolates were the most closely related to a 2020 P. aeruginosa AUST-03 (ST242) CF isolate from Russia. CONCLUSION: Epidemic MDR P. aeruginosa strains are present at South African public CF clinics and need to be considered when implementing segregation and infection control strategies to prevent possible spread and outbreaks.
SARS-CoV-2 infections in a triad of primary school learners (Grades 1-7), their parents, and teachers in KwaZulu-Natal, South Africa : protocol for a cross-sectional and nested case-cohort study
(JMIR Publications, 2024-12) Dassaye, Reshmi; Chetty, Terusha; Daniels, Brodie; Gaffoor, Zakir; Spooner, Elizabeth; Ramraj, Trisha; Mthethwa, Ncengani; Nsibande, Duduzile Faith; Pillay, Saresha; Bhana, Arvin; Magasana, Vuyolwethu; Reddy, Tarylee; Mohlabi, Khanya; Moore, Penelope Linda; Burgers, Wendy A.; De Oliveira, Tulio; Msomi, Nokukhanya; Goga, Ameena Ebrahim
BACKGROUND : In low- and middle-income countries (LMICs) such as South Africa, there is paucity of data on SARS-CoV-2 infections among children attending school, including seroprevalence and transmission dynamics. OBJECTIVE : This pilot study aims to assess (1) the prevalence of self-reported or confirmed SARS-CoV-2 prior infections, COVID-19 symptoms (including long COVID), seroprevalence of SARS-CoV-2 antibodies, and general/mental health, (2) longitudinal changes in SARS-CoV-2 seroprevalence, and (3) SARS-CoV-2 acute infections, immune responses, transmission dynamics, and symptomatic versus asymptomatic contacts in a unique cohort of unvaccinated primary school learners, their parents, teachers, and close contacts in semirural primary school settings. METHODS : Learners (grades 1-7) from primary schools in KwaZulu-Natal, South Africa, their parents, and teachers will be invited to enroll into the COVID kids school study (CoKiDSS). CoKiDSS comprises 3 parts: a cross-sectional survey (N=640), a follow-up survey (n=300), and a nested case-cohort substudy. Finger-prick blood and saliva samples will be collected for serological and future testing, respectively, in the cross-sectional (451 learners:147 parents:42 teachers) and follow-up (210 learners:70 parents:20 teachers) surveys. The nested case-cohort substudy will include cases from the cross-sectional survey with confirmed current SARS-CoV-2 infection (n=30) and their close contacts (n=up to 10 per infected participant). Finger-prick blood (from all substudy participants), venous blood (from cases), and nasal swabs (from cases and contacts) will be collected for serological testing, immunological testing, and viral genome sequencing, respectively. Questionnaires covering sociodemographic and general and mental health information, prior and current SARS-CoV-2 symptoms and testing information, vaccination status, preventative behavior, and lifestyle will be administered. Statistical methods will include generalized linear mixed models, intracluster correlation, descriptive analysis, and graphical techniques. RESULTS : A total of 645 participants were enrolled into the cross-sectional survey between May and August 2023. A subset of 300 participants were followed up in the follow-up survey in October 2023. Screening of the participants into the nested case-cohort substudy is planned between November 2023 and September 2024. Data cleanup and analysis for the cross-sectional survey is complete, while those for the follow-up survey and nested case substudy will be completed by the third quarter of 2024. The dissemination and publication of results is anticipated for the fourth quarter of 2024. CONCLUSIONS : This study provides data from an LMIC setting on the impact of SARS-CoV-2 on school-attending learners, their parents, and teachers 3 years after the SARS-CoV-2 pandemic was declared and 21-24 months after resumption of normal school attendance. In particular, this study will provide data on the prevalence of self-reported or confirmed SARS-CoV-2 prior infection, prior and current symptoms, seroprevalence, changes in seroprevalence, SARS-CoV-2 transmission, SARS-CoV-2 adaptive immune responses, and symptoms of long COVID and mental health among a triad of learners, their parents, and teachers. International Registered Report Identifier (IRRID): DERR1-10.2196/52713
Safety of a second homologous Ad26.COV2.S vaccine among healthcare workers in the phase 3b implementation Sisonke study in South Africa
(Elsevier, 2024-02) Takalani, Azwidihwi; Robinson, Michelle; Jonas, Phumeza; Bodenstein, Annie; Sambo, Vuyelo; Jacobson, Barry; Louw, Vernon; Opie, Jessica; Peter, Jonny G.; Rowji, Pradeep; Seocharan, Ishen; Reddy, Tarylee; Yende-Zuma, Nonhlanhla; Khutho, Kentse; Sanne, Ian; Bekker, Linda-Gail; Gray, Glenda; Garrett, N.; Goga, Ameena Ebrahim
The Sisonke 2 study provided a homologous boost at least 6 months after administration of the priming dose of Ad26.COV2.S for healthcare workers enrolled on the Sisonke phase 3b implementation study. Safety monitoring was via five reporting sources: (i.) self-report through a web-link; (ii.) paper-based case report forms; (iii.) a toll-free telephonic reporting line; (iv.) healthcare professionals-initiated reports; and (v.) active linkage with National Disease Databases. A total of 2350 adverse events were reported by 2117 of the 240 888 (0.88%) participants enrolled; 1625 of the 2350 reported events are reactogenicity events and 28 adverse events met seriousness criteria. No cases of thrombosis with thrombocytopaenia syndrome were reported; all adverse events including thromboembolic disorders occurred at a rate below the expected population rates apart from one case of Guillain Barre Syndrome and one case of portal vein thrombosis. The Sisonke 2 study demonstrates that two doses of Ad26.COV2.S is safe and well tolerated; and provides a feasible model for national pharmacovigilance strategies for low- and middle-income settings.
Machine learning to predict interim response in pediatric classical Hodgkin lymphoma using affordable blood tests
(American Society of Clinical Oncology, 2024-10-24) Geel, Jennifer A.; Hramyka, Artsiom; Du Plessis, Jan; Goga, Yasmin; Van Zyl, Anel; Hendricks, Marc G.; Naidoo, Thanushree; Mathew, Rema; Louw, Lizette; Neethling, Beverley; Schickerling, Tanya M.; Omar, Fareed E.; Du Plessis, Liezl; Madzhia, Elelwani; Netshituni, Vhutshilo; Eyal, Katherine; Ngcana, Thandeka V.Z.; Kelsey, Tom; Ballott, Daynia E.; Metzger, Monika L.
PURPOSE : Response assessment of classical Hodgkin lymphoma (cHL) with positron emission tomography-computerized tomography (PET-CT) is standard of care in well-resourced settings but unavailable in most African countries. We aimed to investigate correlations between changes in PET-CT findings at interim analysis with changes in blood test results in pediatric patients with cHL in 17 South African centers. METHODS : Changes in ferritin, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), albumin, total white cell count (TWC), absolute lymphocyte count (ALC), and absolute eosinophil count were compared with PET-CT Deauville scores (DS) after two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine in 84 pediatric patients with cHL. DS 1-3 denoted rapid early response (RER) while DS 4-5 denoted slow early response (SER). Missing values were imputed using the k-nearest neighbor algorithm. Baseline and follow-up blood test values were combined into a single difference variable. Data were split into training and testing sets for analysis using Python scikit-learn 1.2.2 with logistic regression, random forests, na¨ıve Bayes, and support vector machine classifiers. RESULTS : Random forest analysis achieved the best validated test accuracy of 73% when predicting RER or SER from blood samples. When applied to the full data set, the optimal model had a predictive accuracy of 80% and a receiver operating characteristic AUC of 89%. The most predictive variable was the differences in ALC, contributing 21% to the model. Differences in ferritin, LDH, and TWC contributed 15%-16%. Differences in ESR, hemoglobin, and albumin contributed 11%-12%. CONCLUSION : Changes in low-cost, widely available blood tests may predict chemosensitivity for pediatric cHL without access to PET-CT, identifying patients who may not require radiotherapy. Changes in these nonspecific blood tests should be assessed in combination with clinical findings and available imaging to avoid undertreatment.

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