Research Articles (Paediatrics and Child Health)

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An epigenetic perspective on neonatal encephalopathy with suspected hypoxic ischaemic encephalopathy
Mistry, Priyal; Mellet, Juanita; Durandt, Chrisna; Smuts, Izelle; Pepper, Michael Sean (BioMed Central, 2025-12-08)
Neonatal encephalopathy with suspected hypoxic ischaemic encephalopathy (NESHIE) is a neurological disorder caused by oxygen deprivation and limited blood flow to a neonate's brain. Although various antenatal and perinatal factors have been identified, their precise role in NESHIE pathogenesis remains unclear. The pathophysiology involves multiple molecular pathways that can be explored using a multi-omics approach, including epigenetics. Epigenetics involves heritable changes in gene expression without altering the DNA sequence, encompassing chemical modifications to DNA and histone proteins, as well as changes mediated by non-coding RNAs (ncRNAs). These epigenetic changes regulate gene expression and can be influenced by environmental factors, offering crucial insights into gene regulation and disease mechanisms. This review examines the role of epigenetic mechanisms in NESHIE, focusing on the modulation of hypoxia-inducible factor-1 alpha (HIF-1α) and ncRNA during hypoxic conditions. Additionally, epigenetic-mediated foetal programming may shed light on how maternal and antenatal risk factors contribute to NESHIE susceptibility. Understanding these epigenetic signatures could advance biomarker discovery and the development of novel therapeutic strategies for NESHIE.
Bridging gaps in mitochondrial disease diagnosis : the role of advanced biomarker discovery
Makwikwi, Tendai; Schoonen, Maryke; Smuts, Izelle; Van der Westhuizen, Francois H. (Springer, 2026-01)
Mitochondrial disease (MD) is associated with dysfunction of the oxidative phosphorylation (OXPHOS) system and represents one of the most frequently occurring inherited neuromuscular diseases. Like many rare diseases, MD is characterised by striking clinical heterogeneity, resulting from its unique bi-genomic aetiology and multi-system involvement of energy-dependent tissues. Despite four decades of genetic discoveries and the advent of omics-driven insights into genes, mutations, and phenotypes, achieving an early and accurate diagnosis remains challenging—even within advanced diagnostic settings. A reliable genetic diagnosis for MD requires specialised clinical expertise capable of recognising population-specific phenotypes, providing access to genomic diagnostic services, and interpreting local genotype–phenotype correlations. However, these resources remain unevenly distributed, limiting diagnostic yield and equity. Research output and diagnostic infrastructure for MD are disproportionately concentrated in high-income countries. This imbalance persists even though ~ 84% of the global population resides in low- and middle-income countries (LMICs), where access to MD diagnostics, research infrastructure, and specialised care remains limited. Recent World Health Organisation (WHO) and International Classification of Diseases (ICD-11) initiatives have acknowledged these disparities, emphasising the need for improved diagnostic access, laboratory capacity, and data-sharing mechanisms [4,5,6,7]. Nevertheless, the diagnostic capacity divide remains substantial. A major contributor to the diagnostic gap in MD is the absence of reliable biomarkers that enable early detection, disease monitoring, and assessment of therapeutic efficacy. The lack of validated biomarkers restricts both diagnostic precision and therapeutic development.
Maternal phenotype, infant size and breast milk composition in women living with HIV
Gilfillan, Marlene; Wenhold, Friedeburg Anna Maria; Mulol, Helen; Feucht, Ute Dagmar (Wiley, 2025-07)
The impact of maternal factors on the size of HIV‐exposed‐uninfected (HEU) infants and breast milk composition is poorly understood. Anthropometry, bio‐electrical impedance, haemoglobin and HIV viral load data of women living with HIV (WLWH) and without HIV (WLWOH) were compared and related to their infants' anthropometric Z‐scores and breast milk macronutrients 6 weeks and 6 months postnatally. At both time points, WLWH (6‐week: n = 83; 6‐month: n = 63) had lower reactance (measure of body cell mass) (6‐week: p = 0.016; 6‐month: p < 0.001), phase angle (PhA) (measure of cell health) (6‐week: p = 0.001; 6‐month: p = 0.002) and haemoglobin (6‐week: p = 0.002; 6‐month: p = 0.004) than WLWOH (6‐week: n = 90; 6‐month: n = 73). HEU infants had lower weight‐for‐age Z‐scores (WAZ) (6‐week: p = 0.010; 6‐month: p = 0.005). Breast milk composition did not differ between groups. At 6 weeks, HEU infants had lower head circumference‐for‐age Z‐scores (HCAZ) (p = 0.014). Bivariate regression demonstrated maternal HIV predicted lower infant WAZ (ß = −0.442; p = 0.011) and HCAZ (ß = −0.445; p = 0.014). Maternal body mass index (BMI) and mid‐upper arm circumference were positively associated with breast milk protein content (ß = 0.018; p = 0.014 and ß = 0.025; p = 0.002, respectively). At 6 months (bivariate regression) maternal HIV predicted lower infant WAZ (ß = −0.609; p = 0.005) and length‐for‐age Z‐scores (ß = −0.741; p = 0.018). Higher maternal BMI and PhA were associated with higher infant WAZ (ß = 0.622; p = 0.015 and ß = 0.055; p = 0.017, respectively). On multivariable analysis, maternal HIV remained a predictor of lower WAZ (ß = −0.568; p = 0.024). In conclusion, maternal HIV infection and phenotype predict the size of infants and breast milk composition up to 6 months postnatally.
Exploring infant size and body composition at 18 months : an ambidirectional peri‐urban South African cohort study
Mulol, Helen; Nel, Sanja; Wenhold, Friedeburg Anna Maria; Feucht, Ute Dagmar (Wiley, 2025-04)
The first 1000 days of life lay the foundations for subsequent growth. This ambidirectional study, including prenatal, perinatal and postnatal factors, aimed to identify exposure variables affecting body size and composition and corresponding Z‐score outcomes at age 18 months in infants born to women at low risk of adverse pregnancy outcomes in a peri‐urban area of South Africa. Prenatal factors (maternal age, HIV status, anthropometry, parity, food insecurity and umbilical artery resistance index Z‐score (UmA‐RIAZ) as a measure of placental function, with higher UmA‐RIAZ indicating poorer placental function); perinatal factors (infant sex, gestational age and birth anthropometry) and postnatal factors (infant feeding) were included as exposure variables, with infant anthropometry and body composition at 18 months as outcomes. Simple linear regression analysis was used to investigate associations between exposure variables and infant outcomes, and variables with p < 0.10 were included in the subsequent multiple regression analyses. Multiple regression analysis showed that higher UmA‐RIAZ predicted lower birthweight [−0.11 kg (95% CI: −0.17, −0.04 kg)], birthweight‐for‐age Z‐score [−0.24 (95% CI: −0.39, −0.09)] and 18‐month infant length [−0.9 cm (95% CI: −1.4, −0.4 cm)] and length‐for‐age Z‐score [−0.28 (95% CI: −0.45, −0.11)]. Maternal HIV infection predicted reduced 18‐month infant length‐for‐age Z‐score [−0.46 (95% CI: −0.83, −0.09)]. Household food insecurity predicted reduced fat‐free mass‐for‐age Z‐score at 18 months [−0.27 (95% CI: −0.51, −0.03)]. Infant anthropometry and body composition outcomes, therefore, are greatly affected by pre‐ and postnatal nutrition‐related factors, such as placental insufficiency in utero and household food insecurity, with long‐term consequences including stunting, which impact the individual, future generations and society.
Perspective : radiotherapy and body composition: unmet meeds in low- and middle-income countries
Murphy-Alford, Alexia J.; Grossberg, Aaron J.; Baracos, Vickie E.; Barbar, Maha; Bauer, Judy; Bennett, Jonathan P.; Fidarova, Elena; Fuller, Clifton D.; Loser, Anastassia; Moreno, Amy C.; Patra, Anurima; Puttaswamy, Deepa; Rosenthal, David, I.; Schoeman, Judy; Anacak, Yavuz (Elsevier, 2026-01)
Radiotherapy plays a vital role in cancer treatment, yet its effects on patients’ nutritional status can precipitate muscle loss, with significant implications for treatment tolerance and outcomes. Evidence from high-income countries increasingly links radiation-induced muscle loss to adverse clinical outcomes. In contrast, low- and middle-income countries face a stark evidence gap, despite the heightened vulnerability of cancer patients in these settings due to delayed diagnosis, limited access to care, and high rates of co-morbidities. This paper highlights the critical gaps in nutritional care for radiotherapy patients in low- and middle-income countries. STATEMENTS OF SIGNIFICANCE : Radiotherapy can affect body composition and consequently clinical outcomes, yet evidence from low- and middle-income countries remains limited despite heightened risks from delayed care and comorbidities. This perspective argues that generating context-specific body composition data and building evidence for integrating nutrition into radiotherapy services are critical steps to optimize treatment and improve survivorship in resource-limited settings.
Increasing access to pediatric allogeneic hematopoietic stem cell transplantation in South Africa
Hendricks, Candice Laverne; Brittain, David; Davidson, Alan; Novitzky, Nicolas; Du Toit, Justin Rudolph; Thomson, Jackie; Reynders, David; Geel, Jennifer Ann; Naidu, Gita; Mellet, Juanita; Durandt, Chrisna; West, Erna; Ingram, Charlotte; Verburgh, Estelle; Pepper, Michael Sean (Wiley, 2026)
Current pediatric allogeneic hematopoietic stem cell transplantation (HSCT) services in South Africa do not meet the substantial demand in the country. The factors leading to this paucity are multifactorial, including a limited number of appropriate donors on our local registries, inadequate identification and referral of appropriate patients, long distances to travel to health facilities, socioeconomic inequality, and inadequate infrastructure and clinical expertise for the number of transplants required. We describe a model for a large HSCT unit that caters to insured and uninsured patients in order to ensure equitable access, and which is in line with the WHO health system building blocks. The scale at which transplantation will be achieved will allow for the development of local skills and expertise, which can be decentralized in the future to further improve HSCT access.
Feeding profit : how the food and drinks industry (FDI) is one of the key drivers of the global epidemic of childhood overweight and obesity
Spencer, Nick; Mercer, Raul Gerardo; Rajmil, Luis; Lake, Lori; Kraus De Camargo, Olaf; Ezeonu, Thecla; Olatunya, Oladele Simeon; Oguda, Lulu; Tsitsika, Artemis; Iwamoto, Azusa; Rohloff, Peter (BMJ Publishing Group, 2026-01)
No abstract available.
Guest editorial
Van Niekerk, Andre (Allergy Society of South Africa, 2025-03)
Many short courses (bursts) of oral corticosteroids (OCS) are commonly prescribed for indicated and non-indicated conditions. These bursts are perceived to be safe and are usually given by prescription for less than 14 days at a time. The global corticosteroid market was USD 5.7 billion in 2023, and with a projected annual growth rate of 4.6% across all regions, reflects its widespread use. Published data of OCS use in South Africa are difficult to find, yet parents of children attending a clinic for immune deficiencies frequently report repetitive prescriptions.
Signal monitoring for adverse events following immunisation with COVID-19 vaccines during the SARS-CoV-2 pandemic : an evaluation of the South African Surveillance System
Sankar, Chenoa; Evans, Stephen; Meyer, Johanna Catharina; Gunter, Hannah May; Sekiti, Victoria; McCarthy, Kerrigan (Springer, 2025-08)
INTRODUCTION : Monitoring of adverse events following immunisation (AEFI) is recommended for post-licensure surveillance. We investigated whether the South African surveillance system could detect signals of disproportionate reporting and whether these signals aligned with globally identified AEFI and adverse events of special interest (AESI) post-coronavirus disease-2019 (COVID-19) vaccination. METHODS : This retrospective pharmacovigilance study undertook disproportionality analysis of the National Department of Health AEFI database from the start of the COVID-19 vaccine rollout on 17 May 2021 to 31 December 2022. We complemented this with AEFI reports for vaccines not on the routine Expanded Programme on Immunisation schedule, to address potential masking of signals due to the high reporting rate of COVID-19 vaccine AEFI. RESULTS : During the study period, 3846 AEFI were reported for 37,537,009 doses of COVID-19 vaccines (BNT162b2 and Ad26.COV2.S) administered. The overall reporting rate was 10.2 per 100,000 doses, 18.1/100,000 and 7.9/100,000 for Ad26.COV2.S and BNT162b2, respectively. Comparison with other countries suggests underreporting. Disproportionate reporting signals were obtained for three and seven AEFI following BNT162b2 and Ad26.COV2.S vaccines, respectively. An additional three AEFI signals from Ad26.COV2.S emerged in the augmented dataset, indicating masking. All Ad26.COV2.S signals, and one BNT162b2 signal, appear in the vaccines’ product information. Among nine AESI evaluated, myocarditis/pericarditis presented as a signal of disproportionate reporting following BNT162b2 vaccination. CONCLUSIONS : This study is one of the first from a lower-middle-income country, using a spontaneous reporting system for signal detection post-COVID-19 vaccination. Signals aligned with those reported globally. The study highlights the need to further investigate underreporting, masking, and system attributes for system strengthening.
All corticosteroids in any formulation are not innocuous and beg to be handled with care
Van Niekerk, Andre (Allergy Society of South Africa, 2025-03)
Many short courses (bursts) of oral corticosteroids (OCS) are commonly prescribed for indicated and non-indicated conditions. These bursts are perceived to be safe and are usually given by prescription for less than 14 days at a time. The global corticosteroid market was USD 5.7 billion in 2023, and with a projected annual growth rate of 4.6% across all regions, reflects its widespread use. Published data of OCS use in South Africa are difficult to find, yet parents of children attending a clinic for immune deficiencies frequently report repetitive prescriptions.
Dr Spur’s mystery case : the case of asthma, autoimmunity and an unexpected diagnosis
Van den Berg, Sylvia; Brauer, Marieke; Van Niekerk, Andre (Allergy Society of South Africa, 2025-06)
Thank you for seeing this 27-year-old woman referred from my practice for recurrent lower respiratory tract infections, chronic sinusitis and worsening eczema. Her main complaints are fatigue, weight loss and joint stiffness over the past year. She was previously diagnosed with asthma (due to persistent wheeze since adolescence), autoimmune thyroiditis and a psoriasis/eczema overlap. Her family history is notable for the death of a sibling in early childhood from pneumonia.
Dr Spur’s mystery case : a case of fragile defences
Swanepoel, Petri; Van den Berg, Sylvia; Van Niekerk, Andre (Allergy Society of South Africa, 2025-09)
I am treating a ten-month-old boy diagnosed with di George syndrome. He has a history of failure to thrive, which was mostly attributed to his cardiac anomalies (more specifically, a ventricular septal defect which has since been repaired). I am concerned about his infection history. Over the past four months he has experienced multiple episodes of upper respiratory tract infections characterised by nasal congestion, clear to mucopurulent rhinorrhoea, intermittent low-grade fever, cough (initially dry, progressing to a productive cough with occasional wheezing), feeding dif昀椀culties and refusal of feeds during episodes. He does not have any palatal anomalies. Despite symptomatic treatment with nasal saline irrigation, antipyretics and antibiotics on at least two occasions, the symptoms would resolve slowly over 10–14 days, only to recur within another week or two. Between infections, he never seems to return to baseline, exhibiting a persistent nasal discharge and a ‘wheezy chest’.
A laissez-faire approach to short bursts of corticosteroids may lead to over- exposure in the fetus and the young child
Delport, Suzanne D. (Allergy Society of South Africa, 2025-03)
Corticosteroids, in whichever form they occur, are potent drugs with serious short- and long-term side effects. Their indications for use encompass many diseases and all age groups, even extending to the fetus. In view of the potency and dangers of corticosteroids though, those who prescribe them must do so only for evidence-based indications and with informed consent. Documenting all exposures reflects corticosteroid stewardship and an awareness of a cumulative end point which determines toxicity rather than the dose and duration of therapy.
Dr Spur's mystery case : the case of the chicken or is it the egg?
Van den Berg, Sylvia; Van Niekerk, Andre (Allergy Society of South Africa, 2025-03)
Re: Advice on recurrent airway infections in a three-year-old patient. I am writing to ask your advice on Michael, a three-year-old patient, whose mother is concerned about the possibility of an underlying immune deficiency. She reports that he is frequently unwell, presenting with airway infections almost every month since she discontinued breastfeeding him at nine months so that she could return to work. He started attending daycare at that point.
Growth, neurodevelopmental outcomes and micronutrient intake in 18-month-old children with exposure to maternal human immunodeficiency virus and placental insufficiency : the UmbiGodisa cross-sectional study
Nyofane, Mothusi; Hoffman, Marinel; Mulol, Helen; Botha, Tanita; Pattinson, Robert Clive; Feucht, Ute Dagmar (Elsevier, 2025-08)
BACKGROUND AND AIM : Maternal human immunodeficiency virus (HIV) and intrauterine growth restriction (IUGR) are both associated with suboptimal childhood growth and neurodevelopment. This study assessed growth and neurodevelopmental outcomes and micronutrient intakes in children who are HIV-exposed-uninfected (CHEU), compared to HIV-unexposed-uninfected children (CHUU), stratified based on evidence of placental insufficiency. METHODS : Placental insufficiency, as proxy for IUGR, was identified using abnormal umbilical artery resistance indices (UmA-RI) on pregnancy Doppler ultrasound. At 18-months postpartum, 264 mother–child pairs were evaluated and categorized into four subgroups: CHUU with normal UmA-RI (control group), CHEU with normal UmA-RI (HIV exposure only), CHUU with abnormal UmA-RI (placental insufficiency only) and CHEU with abnormal UmA-RI (double-exposure). Dietary intake was assessed using a single 24-h dietary recall, and dietary intake of iron, zinc, and iodine was quantified by meal analysis on FoodFinder™ 3.0. Anthropometric data were collected and converted into z-scores. The Bayley Scales of Infant and Toddler Development (Bayley-III) assessed cognitive, language, and motor function. Statistical comparisons used t-test or Mann–Whitney U-tests; associations were analyzed with Spearman's correlation. RESULTS : Children with dual exposure (CHEU/AbN-RI) had significantly lower z-scores compared to the control group, including length-for-age z-score (1.4 ± 1.4 vs 0.0 ± 1.3; p = 0.001), weight-for-age zscore (0.6 ± 1.0 vs 0.0 ± 1.2; p = 0.024) and head circumference-for-age z-score (0.4 ± 0.7 vs 0.9 ± 1.2; p = 0.035). Mean cognitive scores were also lower in this group (93.9 ± 12.9 vs 100.1 ± 10.8; p = 0.042). Language composite scores were low across all groups. Higher zinc intake was positively associated with language scores (r = 0.10; p = 0.042) and weight-for-age z-scores were associated with motor outcomes (r = 0.10; p = 0.028). Among CHEU, better growth parameters were positively associated with cognitive and motor developmental domains.
Paediatric haematology/oncology workforce and training programmes for Africa
Fufa, Diriba; Attia, Asmaa; Salifu, Nihad; Reddy, Kershinee; Rashad, Hanna; Abdelaziz, Riham; Adam, Haileyesus; Amoda, Faizana; Bhattachyya, Arpita; Chirande, Lulu; Du Plessis, Jan; Geel, Jennifer; Kaspers, Gertjan; Maciel, Kaline; Dinkiye, Ali Mamude; Moulik, Roy; Naidu, Gita; Namazi, Ruth; Neethling, Beverley G.; Njuguna, Festus; Renner, Lorna; Reynders, David; Scanlan, Trish; Thomas, Karla; Van Zyl, Anel; Vik, Terry; Yimer, Mulugeta Ayalew; Hessissen, Laila; Omotola, Ayo; Fox Irwin, Leeanna; Mikkelsen, Margit; Naradasu, Srikanth; Balagadde-Kambugu, Joyce; Davidson, Alan; Bhakta, Nickhill; Van Heerden, Jaques; Moreira, Daniel C. (BMJ Publishing Group, 2025-07)
Graduate medical education programmes in paediatric haematology/oncology (PHO) are necessary to train specialists to provide high-quality care for children and adolescents with cancer and haematologic diseases. In this study, we used the Education Program Assessment Tool (EPAT). The study consisted of three components: (1) mapping the PHO workforce and training programmes in Africa; (2) using the EPAT to evaluate the current PHO programmes in Africa and (3) using a design-thinking approach to develop priority interventions to expand PHO training capacity in Africa through a collaborative co-design process. There were 236 fellowship-trained paediatric haematologists/oncologists in 37 countries in Africa. 17 countries (32%), with a total population of 42 million under 14 years of age, had no paediatric haematologists/oncologists. The continent has an average of 205 new paediatric cancer cases per specialist. 22 PHO training programmes completed the EPAT. The average score was 72% (SD 9%). Programmes showed varying strengths in the elements of comprehensive training, with the highest EPAT scores in experiential learning domains. A priority-setting exercise established interventions to strengthen PHO training in Africa, including a PHO curriculum, a leadership skill development process and a path for the creation of exchange opportunities. The PHO workforce and training capacity are highly variable in Africa. Through international collaboration and a systematic evaluation of workforce density and training programme strengths, alignment on key regional priorities and the creation of a shared model of cooperation to enhance training programmes for Africa can be achieved.
Paediatric colistin prescribing practices in South Africa : a clinician survey
Pillay-Fuentes Lorente, Veshni; Nana, Trusha; Black, Marianne; Reubenson, Gary; Thomas, Reenu; Dramowski, Angela; Bekker, Adrie; Du Plessis, Nicolette Marie; Demopoulos, Despina; Chibabhai, Vindana (AOSIS, 2025-08-05)
BACKGROUND : Increasing multidrug-resistant bacterial infections are a global health challenge. Colistin, a polymyxin antimicrobial, has activity against some resistant strains, and despite its adverse effects, it presents a last-line option to treat resistant Gram-negative pathogens. However, paediatric colistin prescribing guidelines are lacking. OBJECTIVES : To determine paediatric colistin prescribing practices and challenges in South Africa (SA) to aid the development of a paediatric colistin guideline. METHOD : We conducted an anonymous online survey of registered medical practitioners in SA who prescribed colistin to patients aged ≤ 14 years in the past 12 months. RESULTS : Of 196 participants, 71.9% (n = 141/196) completed the survey. Eighty-six respondents (n = 86/146; 58.9%) reported prescribing loading doses (LD), with the median LD and maintenance doses of 150 000 IU/kg/dose (interquartile range (IQR), 75 000–150 000) and 50 000 IU/kg/dose (IQR, 40 000–50 000), respectively. Empiric colistin use was reported by 47.2% (n = 69/146), of whom 46.3% (n = 32/69) continued empiric colistin for ≥ 72 h. Using the Likert scale, respondents highly perceived that therapeutic drug monitoring should be readily available (mean = 3.97). The perception that prescribing colistin should be advised by a microbiologist or infectious disease specialist had a mean score of 2.97, indicating moderate agreement. CONCLUSION : This survey demonstrated varied paediatric colistin prescribing practices. Recently, a new evidence-based paediatric guideline for colistin use in SA has been published. A follow-up survey will be conducted to assess the impact of the guideline on paediatric colistin prescribing practices in SA. CONTRIBUTION : This study highlighted paediatric colistin dosing practices in the absence of a paediatric colistin guideline in South Africa.
Cost-effectiveness of broadly neutralizing antibodies for HIV prophylaxis for infants born in settings with high HIV burdens
Alba, Christopher; Malhotra, Shelly; Horsfall, Stephanie; Barnhart, Matthew E.; Bekker, Adrie; Chapman, Katerina; Cunningham, Coleen K.; Fast, Patricia E.; Fouda, Genevieve G.; Freedberg, Kenneth A.; Goga, Ameena Ebrahim; Ghazaryan, Lusine R.; Leroy, Valeriane; Mann, Carlyn; McCluskey, Margaret M.; McFarland, Elizabeth J.; Muturi-Kioi, Vincent; Permar, Sallie R.; Shapiro, Roger; Sok, Devin; Stranix-Chibanda, Lynda; Weinstein, Milton C.; Ciaranello, Andrea L.; Dugdale, Caitlin M. (Public Library of Science, 2025-03)
BACKGROUND : Approximately 130 000 infants acquire HIV annually despite global maternal antiretroviral therapy scale-up. We evaluated the potential clinical impact and cost-effectiveness of offering long-acting, anti-HIV broadly neutralizing antibody (bNAb) prophylaxis to infants in three distinct settings. METHODS : We simulated infants in Côte d’Ivoire, South Africa, and Zimbabwe using the Cost-Effectiveness of Preventing AIDS Complications-Pediatric (CEPAC-P) model. We modeled strategies offering a three-bNAb combination in addition to WHO-recommended standard-of-care oral prophylaxis to infants: a) with known, WHO-defined high-risk HIV exposure at birth (HR-HIVE); b) with known HIV exposure at birth (HIVE); or c) with or without known HIV exposure (ALL). Modeled infants received 1-dose, 2-doses, or Extended (every 3 months through 18 months) bNAb dosing. Base case model inputs included 70% bNAb efficacy (sensitivity analysis range: 10–100%), 3-month efficacy duration/dosing interval (1–6 months), and $20/dose cost ($5–$100/dose). Outcomes included pediatric HIV infections, life expectancy, lifetime HIV-related costs, and incremental cost-effectiveness ratios (ICERs, in US$/year-of-life-saved [YLS], assuming a ≤ 50% GDP per capita cost-effectiveness threshold). FINDINGS : The base case model projects that bNAb strategies targeting HIVE and ALL infants would prevent 7–26% and 10–42% additional pediatric HIV infections, respectively, compared to standard-of-care alone, ranging by dosing approach. HIVE-Extended would be cost-effective (cost-saving compared to standard-of-care) in Côte d’Ivoire and Zimbabwe; ALL-Extended would be cost-effective in South Africa (ICER: $882/YLS). BNAb strategies targeting HR-HIVE infants would result in greater lifetime costs and smaller life expectancy gains than HIVE-Extended. Throughout most bNAb efficacies and costs evaluated in sensitivity analyses, targeting HIVE infants would be cost-effective in Côte d’Ivoire and Zimbabwe, and targeting ALL infants would be cost-effective in South Africa. INTERPRETATION : Adding long-acting bNAbs to current standard-of-care prophylaxis would be cost-effective, assuming plausible efficacies and costs. The cost-effective target population would vary by setting, largely driven by maternal antenatal HIV prevalence and postpartum incidence.
Dr Spur’s mystery solved : Dots connected. Please do screen for lymphoma and other cancers in IEI patients
Teixeira, Miguel Jose; Nagel, Lizelle; Van den Berg, Sylvia (Allergy Society of South Africa, 2024-09)
Thank you for the consultation. CVID is one of the most common inborn errors of immunity (IEI) encountered in practice, and these patients get infections, as well as noninfectious comorbidities like allergic disease, autoimmunity, lymphoproliferation and malignancies.
Comparison of infant feeding practices by maternal HIV status, and associated factors, in a rural district, South Africa 2019
Mukhula, Victoria Temwanani; Zunza, Moleen; Mbira, Thandiwe Elsie; Ramokolo, Vundli; Prendergast, Andrew J.; Tylleskar, Thorkild; Van de Perre, Phillippe; Goga, Ameena Ebrahim; Ngandu, Nobubelo K. (BioMed Central, 2025-04)
BACKGROUND : The prevalence of exclusive breastfeeding (EBF) during the first 6 months and breastfeeding up to 24 months in all mothers, regardless of HIV status, in high HIV prevalence settings of South Africa is not frequently evaluated. This study aimed to describe practices of EBF and breastfeeding beyond 12 months, compare these between HIV exposed (HE(s)) and unexposed infants (HU(s)), and determine associated factors. METHODS : A secondary objective analysis of data from a cross-sectional study conducted during September-December-2019 in a rural South African district, was performed. Mothers living with HIV (MLHIV) paired with their infants in the following age groups: 0 to 3, > 3 to 6, > 6 to 12, and > 12 to 24 months; and mother-infant pairs without HIV with infants aged > 3 to 6 months and > 12 to 24 months, were enrolled. Descriptive statistics and bivariate and multivariable binomial regression were used for analyses. RESULTS : A total of 771 mother-infant pairs, 62% being MLHIV, were enrolled. Among HEs (including 10 living with HIV), the prevalence of EBF was 41.0% and 16.7% in 0–3, and, 3–6 months age-groups, respectively, and breastfeeding prevalence was 19% in 12–24 months age-group. Among HUs, the prevalence of EBF was 7.9% among 3–6 months old and breastfeeding prevalence was 38.0% among > 12–24 months old. Overall, 79.8% and 45.5% HUs and HEs aged 3–6 months were still breastfeeding, respectively. HEs were more likely to exclusively breastfeed at 3–6 months age compared to HUs (adjusted prevalence ratio [aPR] 3.84; 95% confidence interval (CI) 1.55, 9.53). Breastfeeding practice at 12–24 months age was significantly less likely among HEs (versus HUs) and in infants with unmarried/non-cohabiting mothers (versus married/co-habiting) (aPR 0.42; 95% CI 0.27, 0.63 and aPR 0.66; 95% CI 0.47, 0.92), respectively). Among HEs, breastfeeding beyond 6 months was more likely among MLHIV with known HIV-negative male partners (versus known HIV concordant relationships). CONCLUSION : In this study population, EBF was comparably more likely among HEs while breastfeeding beyond 12 months was more likely among HUs. Maternal marital status, frequency of antenatal care attendance and male partner’s HIV status also influenced breastfeeding practice. Overall, there is still room for improvement regardless of infant HIV status, requiring continued client-sensitive strengthening of the implementation of the recommended breastfeeding practices.

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