South African neonates with mild and moderate hypoxic-ischaemic encephalopathy

Background. Clear risk profiles of neonates with mild and moderate hypoxic-ischaemic encephalopathy (HIE) are lacking.Objective. To describe and compare factors associated with mild and moderate HIE in South African neonates. Methods.A prospective, comparative design was used to describe factors among South African neonates with mild (n=13) and moderate (n=33) HIE in an urban tertiary academic hospital. HIE diagnosis and encephalopathy grading were conducted using the modified Sarnat stages. Thompson scores were recorded. Participants' clinical records were reviewed to identify factors. Descriptive data were obtained. Chi-square and Fisher's exact tests were used to compare categorical data, and Mann-Whitney tests were used to compare continuous data between groups. Results. Significant differences were found between groups' admission (p<0.001) and highest Thompson scores (p<0.001). The mild group's APGAR scores were significantly higher than those of the moderate group at five (p=0.012) and ten minutes (p=0.022). Duration of resuscitation (p=0.011) and time to spontaneous respiration (p=0.012) also differed significantly between groups. Significantly more moderate than mild participants received therapeutic hypothermia(TH) (p<0.001).Conclusion. Clinical tests and management factors differed significantly between groups. The findings provided the multidisciplinary team with an increased understanding of the heterogeneous HIE population and add to existing evidence for identifying neonates eligible for TH in resource-limited settings

Improving survival of preterm babies in low- to middle-income countries ­ what can we do?

Surviving prematurity poses the greatest challenge in neonatal care in low- to middle-income countries (LMICs). South Africa has not made much progress in improving the survival of preterm babies. Neonatal survival of preterm infants has become a national priority since the serious failure to reach the Millennium Development Goal targets in 2015. High rates of prevention are particularly relevant in LMICs, where the neonatal mortality rate is at its highest owing to a lack of simple and effective measures. Preventing prematurity and related complications begins with a healthy pregnancy. Antenatal care and maternal corticosteroids are antenatal interventions that could improve the survival of preterm babies. Postnatal interventions include: the management of neonatal sepsis, meningitis and pneumonia;prevention of hypothermia after delivery, for example, the plastic bag/wrap and cap, which has been extensively researched and is found to be an effective, low-cost method for reducing hypothermia in preterm infants; the use of continuous positive airway pressure (CPAP),including the low-cost CPAP device, which is a cost-effective strategy for providing respiratory support for premature neonates with respiratory distress syndrome; exogenous surfactant; early feeding with breastmilk; and kangaroo mother care. The use of cost-effective,evidence-based interventions can be implemented in LMICs to reduce neonatal mortality

Pyrethroid Resistance in a Major African Malaria Vector Anopheles arabiensis from Mamfene; Northern KwaZulu-Natal; South Africa

A population of Anopheles arabiensis; a major malaria vector in South Africa; was collected during 2005 from inside sprayed houses in Mamfene; northern KwaZulu-Natal; South Africa; using window exit traps. None of these specimens (n = 300 females) was found to be infected with Plasmodium falciparum. Insecticide susceptibility assays on 2-3 day old F1 progeny usingWHOsusceptibility kits revealed 100susceptibility to bendiocarb; resistance to deltamethrin (95.91) was suspected; while resistance to permethrin (78.05) was confirmed. The knockdown resistant (kdr) genotype was not found in the surviving mosquitoes. Biochemical analysis using enzyme assays showed elevated levels of monooxygenase that correlated with the permethrin bioassay data. While elevated levels of non-specific esterase were found in some families (11/12 for a- and 6/12 for Beta-esterases); the data did not show any correlation with the permethrin bioassay. Analysis of permethrin and bendiocarb tolerant lines; selected in the laboratory to characterise biochemical resistance profiles; showed increased levels of non-specific esterase and monooxygenase activity in the case of the permethrin-selected cohorts; and elevated glutathione S-transferases and general esterases in that of the bendiocarb-selected line. Synergist assays; using piperonyl butoxide; confirmed the involvement of monooxygenase and glutathione S-transferase in pyrethroid and bendiocarb resistance. This study underlines the importance of routine surveillance for insecticide susceptibility in wild anopheline populations

Dynamics of knockdown pyrethroid insecticide resistance alleles in a field population of Anopheles gambiae s.s. in southwestern Nigeria.

BACKGROUND & OBJECTIVES: Pyrethroid insecticide resistance in the malaria vector Anopheles gambiae Giles is mainly associated with reduced target site sensitivity arising from a single point mutation in the sodium channel gene, often referred to as knockdown resistance (kdr). This resistance mechanism is widespread in West Africa and was reported for the first time in Nigeria in 2002. Here we present changes in the susceptibility/resistance status of the molecular 'M' and 'S' forms of An. gambiae and the frequency of the kdr alleles from 2002-05. METHODS: Adult anophelines were sampled quarterly inside human dwellings from January 2002 to December 2005 and adults reared from wild larvae were identified using morphological keys. Samples belonging to the An. gambiae complex were subjected to PCR assays for species identification and detection of molecular 'M' and 'S' forms. Insecticide susceptibility tests were carried out using standard WHO procedures and test kits only on 2-3 days old adult An. gambiae s.s. reared from larval collections. The kdr genotypes were determined in both live and dead specimens of An. gambiae s.s. using alleles-specific polymerase chain reaction diagnostic tests. RESULTS: The overall collection showed that the molecular 'S' form was predominant (> 60%) but the proportions of both forms in the mosquito populations from 2002-05 were not statistically different. Both forms also occurred throughout the period without apparent relationship to wet or dry season. Insecticide susceptibility tests did not show any significant increase in the resistance status recorded for either Permethrin or DDT from 2002-05, rather, an improvement in the susceptibility status of the mosquitoes to these insecticides was observed from 2004-05 relative to the tests performed in 2002-03. CONCLUSION: The proportion of the molecular 'M' and 'S' form of An. gambiae and the kdr frequencies have not increased significantly from 2002 when it was first reported in Nigeria. However, the findings on susceptible mosquitoes exhibiting the kdr gene need further investigation. Further monitoring of this may provide additional information on the ongoing debate on the possibility of restriction in gene flow and reproductive barriers in these sympatric taxa.

Report : the Student Health Services at University of Pretoria from 2000 to 2005

The University of Pretoria's Student Health Services provides free; voluntary; family-medicine-orientated health services with an emphasis on offering preventative medicine and health education to enrolled students. Students are examined and/or educated by skilled personnel familiar with the University's environment and demands. Apart from the family medicine services; the Student Health Services also educates students concerning contraception and sexually-transmitted diseases; carries out HIV/AIDS counselling and provides a comprehensive dietetic service. During the period 2000 to 2005 the percentage of students visiting the Student Health Services; of the total number of students enrolled at the University; remained almost constant at 12.5. A large percentage of the students making use of these services do belong to a medical aid and it is estimated that during the past six years the University of Pretoria has subsidised an amount of about R2.4 million towards the medical costs of students belonging to a medical aid

Malaria vectors and transmission dynamics in coastal south-western Cameroon

Background: Malaria is a major public health problem in Cameroon. Unlike in the southern forested areas where the epidemiology of malaria has been better studied prior to the implementation of control activities; little is known about the distribution and role of anophelines in malaria transmission in the coastal areas. Methods: A 12-month longitudinal entomological survey was conducted in Tiko; Limbe and Idenau from August 2001 to July 2002. Mosquitoes captured indoors on human volunteers were identified morphologically. Species of the Anopheles gambiae complex were identified using the polymerase chain reaction (PCR). Mosquito infectivity was detected by the enzyme-linked immunosorbent assay and PCR. Malariometric indices (plasmodic index; gametocytic index; parasite species prevalence) were determined in three age groups (5yrs; 5-15yrs; 15yrs) and followed-up once every three months. Results: In all; 2;773 malaria vectors comprising Anopheles gambiae (78.2); Anopheles funestus (17.4) and Anopheles nili (7.4) were captured. Anopheles melas was not anthropophagic. Anopheles gambiae had the highest infection rates. There were 287; 160 and 149 infective bites/person/year in Tiko; Limbe and Idenau; respectively. Anopheles gambiae accounted for 72.7; An. funestus for 23and An. nili for 4.3of the transmission. The prevalence of malaria parasitaemia was 41.5in children 5 years of age; 31.5in those 5-15years and 10.5in those 15years; and Plasmodium falciparum was the predominant parasite species.Conclusions: Malaria transmission is perennial; rainfall dependent and An. melas does not contribute to transmission. These findings are important in the planning and implementation of malaria control activities in coastal Cameroon and West Africa