Browsing by Author "Lombard, Carl"
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Item Adolescent access to care and risk of early mother-to-child HIV transmission(Elsevier, 2017) Ramraj, Trisha; Jackson, Debra; Dinh, Thu-Ha; Olorunju, Steve; Lombard, Carl; Sherman, GaylePURPOSE: Adolescent females aged 15–19 account for 62% of new HIV infections and give birth to 16 million infants annually. We quantify the risk of early mother-to-child transmission (MTCT) of HIV among adolescents enrolled in nationally representative MTCT surveillance studies in South Africa. METHODS: Data from 4,814 adolescent (≤19 years) and 25,453 adult (≥20 years) mothers and their infants aged 4–8 weeks were analyzed. These data were gathered during three nationally representative, cross-sectional, facility-based surveys, conducted in 2010, 2011–2012, and 2012– 2013. All infants were tested for HIV antibody (enzyme immunoassay), to determine HIV exposure. Enzyme immunoassay-positive infants or those born to self-reported HIV-positive mothers were tested for HIV infection (total nucleic acid polymerase chain reaction). Maternal HIV positivity was inferred from infant HIV antibody positivity. All analyses were weighted for sample realization and population live births. RESULTS: Adolescent mothers, compared with adult mothers, have almost three times less planned pregnancies 14.4% (95% confidence interval [CI]: 12.5–16.5) versus 43.9% (95% CI: 42.0–45.9) in 2010 and 15.2% (95% CI: 13.0–17.9) versus 42.8% (95% CI: 40.9–44.6) in 2012–2013 (p < .0001), less prevention of MTCT uptake (odds ratio [OR] in favor of adult mothers = 3.36, 95% CI: 2.95– 3.83), and higher early MTCT (adjusted OR = 3.0, 95% CI: 1.1–8.0), respectively. Gestational age at first antenatal care booking was the only significant predictor of early MTCT among adolescents. CONCLUSIONS: Interventions that appeal to adolescents and initiate sexual and reproductive health care early should be tested in low- and middle-income settings to reduce differential service uptake and infant outcomes between adolescent and adult mothers.Item Correction to: Effects of early feeding on growth velocity and overweight/obesity in a cohort of HIV unexposed South African infants and children(BioMed Central, 2017) Ramokolo, Vundli; Lombard, Carl; Chhagan, Meera; Engebretsen, Ingunn M.S.; Doherty, Tanya; Goga, Ameena; Fadnes, Lars Thore; Zembe, Wanga; Jackson, Debra; Van den Broeck, JanAfter publication of this article [1] it was brought to our attention that there were errors in the text under the heading ‘Data cleaning’, and in Table 3. The corrected text and updated Table 3 are given in this erratum.Item Effect of home based HIV counselling and testing intervention in rural South Africa: cluster randomised trial(BMJ Publishing Group Ltd, 2013) Doherty, Tanya; Tabana, Hanani; Jackson, Debra; Naik, Reshma; Zembe, Wanga; Lombard, Carl; Swanevelder, Sonja; Fox, Matthew P.; Thorson, Anna; Ekström, Anna Mia; Chopra, MickeyOBJECTIVE: To assess the effect of home based HIV counselling and testing on the prevalence of HIV testing and reported behavioural changes in a rural subdistrict of South Africa. DESIGN: Cluster randomised controlled trial. SETTING: 16 communities (clusters) in uMzimkhulu subdistrict, KwaZulu-Natal province, South Africa. PARTICIPANTS: 4154 people aged 14 years or more who participated in a community survey. INTERVENTION: Lay counsellors conducted door to door outreach and offered home based HIV counselling and testing to all consenting adults and adolescents aged 14-17 years with guardian consent. Control clusters received standard care, which consisted of HIV counselling and testing services at local clinics. MAIN OUTCOME MEASURES: Primary outcome measure was prevalence of testing for HIV. Other outcomes were HIV awareness, stigma, sexual behaviour, vulnerability to violence, and access to care. RESULTS: Overall, 69% of participants in the home based HIV counselling and testing arm versus 47% in the control arm were tested for HIV during the study period (prevalence ratio 1.54, 95% confidence interval 1.32 to 1.81). More couples in the intervention arm had counselling and testing together than in the control arm (2.24, 1.49 to 3.03). The intervention had broader effects beyond HIV testing, with a 55% reduction in multiple partners (0.45, 0.33 to 0.62) and a stronger effect among those who had an HIV test (0.37, 0.24 to 0.58) and a 45% reduction in casual sexual partners (0.55, 0.42 to 0.73). Conclusions Home based HIV counselling and testing increased the prevalence of HIV testing in a rural setting with high levels of stigma. Benefits also included higher uptake of couple counselling and testing and reduced sexual risk behaviour.Item Effects of early feeding on growth velocity and overweight/obesity in a cohort of HIV unexposed South African infants and children(BioMed Central, 2015) Ramokolo, Vundli; Lombard, Carl; Chhagan, Meera; Engebretsen, Ingunn M.S.; Doherty, Tanya; Jackson, DebraBACKGROUND: South Africa has the highest prevalence of overweight/obesity in Sub-Saharan Africa. Assessing the effect of modifiable factors such as early infant feeding on growth velocity and overweight/obesity is therefore important. This paper aimed to assess the effect of infant feeding in the transitional period (12 weeks) on 12–24 week growth velocity amongst HIV unexposed children using WHO growth velocity standards and on the age and sex adjusted body mass index (BMI) Z-score distribution at 2 years. METHODS: Data were from 3 sites in South Africa participating in the PROMISE-EBF trial. We calculated growth velocity Z-scores using the WHO growth standards and assessed feeding practices using 24-hour and 7-day recall data. We used quantile regression to study the associations between 12 week infant feeding and 12–24 week weight velocity (WVZ) with BMI-for-age Z-score at 2 years. We included the internal sample quantiles (70th and 90th centiles) that approximated the reference cut-offs of +2 (corresponding to overweight) and +3 (corresponding to obesity) of the 2 year BMI-for-age Z-scores. RESULTS: At the 2-year visit, 641 children were analysed (median age 22 months, IQR: 17–26 months). Thirty percent were overweight while 8.7% were obese. Children not breastfed at 12 weeks had higher 12–24 week mean WVZ and were more overweight and obese at 2 years. In the quantile regression, children not breastfed at 12 weeks had a 0.37 (95% CI 0.07, 0.66) increment in BMI-for-age Z-score at the 50th sample quantile compared to breast-fed children. This difference in BMI-for-age Z-score increased to 0.46 (95% CI 0.18, 0.74) at the 70th quantile and 0.68 (95% CI 0.41, 0.94) at the 90th quantile . The 12–24 week WVZ had a uniform independent effect across the same quantiles. CONCLUSIONS: This study demonstrates that the first 6 months of life is a critical period in the development of childhood overweight and obesity. Interventions targeted at modifiable factors such as early infant feeding practices may reduce the risks of rapid weight gain and subsequent childhood overweight/obesity.Item Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial(Elsevier, 2011) Tylleskar, Thorkild; Jackson, Debra; Meda, Nicolas; Ingrebetsen, Ingunn Marie S; Chopra, Mickey; Diallo, Abdoulaye Hama; Doherty, Tanya; Ekström, Eva-Charlotte; Fadnes, Lars Thore; Goga, Ameena; Kankasa, Chipepo; Klungsøyr, Jørn I; Lombard, Carl; Nankabirwa, Victoria; Nankunda, Jolly K; Van de Perre, Philippe; Sanders, David; Shanmugam, Rebecca; Sommerfelt, Halvor; Wamani, Henry; Tumwine, James K; PROMISE-EBF Study GroupBackground: Exclusive breastfeeding (EBF) is reported to be a life-saving intervention in low-income settings. The effect of breastfeeding counselling by peer counsellors was assessed in Africa. Methods:24 communities in Burkina Faso, 24 in Uganda, and 34 in South Africa were assigned in a 1:1 ratio, by use of a computer-generated randomisation sequence, to the control or intervention clusters. In the intervention group, we scheduled one antenatal breastfeeding peer counselling visit and four post-delivery visits by trained peers. The data gathering team were masked to the intervention allocation. The primary outcomes were prevalance of EBF and diarrhoea reported by mothers for infants aged 12 weeks and 24 weeks. Country-specific prevalence ratios were adjusted for cluster effects and sites. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00397150. Findings 2579 mother–infant pairs were assigned to the intervention or control clusters in Burkina Faso (n=392 and n=402, respectively), Uganda (n=396 and n=369, respectively), and South Africa (n=535 and 485, respectively). The EBF prevalences based on 24-h recall at 12 weeks in the intervention and control clusters were 310 (79%) of 392 and 139 (35%) of 402, respectively, in Burkina Faso (prevalence ratio 2·29, 95% CI 1·33–3·92); 323 (82%) of 396 and 161 (44%) of 369, respectively, in Uganda (1·89, 1·70–2·11); and 56 (10%) of 535 and 30 (6%) of 485, respectively, in South Africa (1·72, 1·12–2·63). The EBF prevalences based on 7-day recall in the intervention and control clusters were 300 (77%) and 94 (23%), respectively, in Burkina Faso (3·27, 2·13–5·03); 305 (77%) and 125 (34%), respectively, in Uganda (2·30, 2·00–2·65); and 41 (8%) and 19 (4%), respectively, in South Africa (1·98, 1·30–3·02). At 24 weeks, the prevalences based on 24-h recall were 286 (73%) in the intervention cluster and 88 (22%) in the control cluster in Burkina Faso (3·33, 1·74–6·38); 232 (59%) and 57 (15%), respectively, in Uganda (3·83, 2·97–4·95); and 12 (2%) and two (<1%), respectively, in South Africa (5·70, 1·33–24·26). The prevalences based on 7-day recall were 279 (71%) in the intervention cluster and 38 (9%) in the control cluster in Burkina Faso (7·53, 4·42–12·82); 203 (51%) and 41 (11%), respectively, in Uganda (4·66, 3·35–6·49); and ten (2%) and one (<1%), respectively, in South Africa (9·83, 1·40–69·14). Diarrhoea prevalence at age 12 weeks in the intervention and control clusters was 20 (5%) and 36 (9%), respectively, in Burkina Faso (0·57, 0·27–1·22); 39 (10%) and 32 (9%), respectively, in Uganda (1·13, 0·81–1·59); and 45 (8%) and 33 (7%), respectively, in South Africa (1·16, 0·78–1·75). The prevalence at age 24 weeks in the intervention and control clusters was 26 (7%) and 32 (8%), respectively, in Burkina Faso (0·83, 0·45–1·54); 52 (13%) and 59 (16%), respectively, in Uganda (0·82, 0·58–1·15); and 54 (10%) and 33 (7%), respectively, in South Africa (1·31, 0·89–1·93). Interpretation: Low-intensity individual breastfeeding peer counselling is achievable and, although it does not affect the diarrhoea prevalence, can be used to effectively increase EBF prevalence in many sub-Saharan African settings.Item Impact of antenatal antiretroviral drug exposure on the growth of children who are HIV-exposed uninfected: The national South African prevention of mother to child evaluation cohort study(BMC, 2022) Vundli, Ramakolo; Kuhn, Louise; Lombard, CarlBackground: The relationship between in-utero antiretroviral (ARV) drug exposure and child growth needs further study as current data provide mixed messages. We compared postnatal growth in the first 18-months of life between children who are HIV-exposed uninfected (CHEU) with fetal exposure to ARV drugs (prophylaxis or triple-drug therapy (ART)) and CHEU not exposed to ARVs. We also examined other independent predictors of postnatal growth.Item Impact of maternal ART on mother-to-child transmission (MTCT) of HIV at six weeks postpartum in Rwanda(BMC, 2018) Mugwaneza, Placidie; Lyambabaje, Alexandre; Umubyeyi, Aline; Humuza, James; Tsague, Landry; Mwanyumba, Fabian; Mutabazi, Vincent; Nsanzimana, Sabin; Ribakare, Muhayimpundu; Irakoze, Ange; Mutaganzwa, Emmanuel; Lombard, Carl; Jackson, DebraBACKGROUND: In 2010, Rwanda adopted ART for prevention of mother to child transmission of HIV from pregnant women living with HIV during pregnancy and breasfeeding period. This study examines rates of mother-to-childtransmission of HIV at 6–10 weeks postpartum and risk factors for mother-to-child transmission of HIV (MTCT) among HIV infected women on ART during pregnancy and breastfeeding. METHODS: A cross-sectional survey study was conducted between July 2011–June 2012 among HIV-exposed infants aged 6–10 weeks and their mothers/caregivers. Stratified multi-stage, probability proportional to size and systematic sampling to select a national representative sample of clients. Consenting mothers/caregivers were interviewed on demographic and program interventions. Dry blood spots from HIV-exposed infants were collected for HIV testing using DNA PCR technique. Results are weighted for sample realization. Univariable analysis of socio-demographic and programmatic determinants of early mother-to-child transmission of HIV was conducted. Variables were retained for final multivariable models if they were either at least of marginal significance (p-value < 0.10) or played a confounding role (the variable had a noticeable impact > 10% change on the effect estimate). RESULTS: The study sample was 1639 infants with HIV test results. Twenty-six infants were diagnosed HIV-positive translating to a weighted MTCT estimate of 1.58% (95% CI 1.05–2.37%). Coverage of most elimination of MTCT (EMTCT) program interventions, was above 80, and 90.4% of mother-infant pairs received antiretroviral treatment or prophylaxis. Maternal ART and infant antiretroviral prophylaxis (OR 0.01; 95%CI 0.001–0.17) and maternal age older than 25 years were significantly protective (OR 0.33; 95%CI 0.14–0.78). No disclosure of HIV status, not testing for syphilis during pregnancy and preterm birth were significant risk factors for MTCT. Factors suggesting higher sociodemographic status (flush toilet, mother self-employed) were borderline risk factors for MTCT. CONCLUSION: ART for all women during pregnancy and breastfeeding was associated with the estimated low MTCT rate of 1.58%. Mothers who did not receive a full package of anti-retroviral therapy according to the Rwanda EMTCT protocol, and young and single mothers were at higher risk of MTCT and should be targeted for support in preventing HIV infection.Item Leisure boredom and high school dropout in Cape Town, South Africa(Elsevier, 2008) Wegner, Lisa; Flisher, Alan J.; Chikobvu, Perpetual; Lombard, Carl; King, GaryThis prospective cohort study investigated whether leisure boredom predicts high school dropout. Leisure boredom is the perception that leisure experiences do not satisfy the need for optimal arousal. Participants completed a self-report questionnaire which included the Leisure Boredom Scale. The original cohort of grade 8 students (n ¼ 303) was followed up twice at 2-yearly intervals. Of the 281 students at the second follow-up, 149 (53.0%) students had dropped out of school. The effect of leisure boredom on dropout was investigated using logistic regression taking into account the clustering effect of the schools in the sampling strategy, and adjusting for age, gender and racially classified social group. Leisure boredom was a significant predictor of dropout (OR ¼ 1.08; 95% CI: 1.01–1.15) in students 14 years and older, but not so in younger students (OR ¼ 1.0; 95% CI: 0.95–1.05). The study has shown that measuring leisure boredom in grade 8 students can help identify students who are more likely to drop out of school. Further research is needed to investigate the longitudinal association between leisure boredom and school dropout.Item Uptake and predictors of early postnatal follow–up care amongst mother–baby pairs in South Africa: Results from three population–based surveys, 2010–2013(Edinburgh University Global Health Society, 2017) Larsen, Anna; Cheyip, Mireille; Aynalem, Getahun; Dinh, Thu–ha; Jackson, Debra; Ngandu, Nobubelo Kwanele; Chirinda, Witness; Mogashoa, Mary; Kindra, Gupreet; Lombard, Carl; Goga, AmeenaBACKGROUND Achieving World Health Organization (WHO) recommendations for postnatal care (PNC) within the first few weeks of life is vital to eliminating early mother–to–child transmission of HIV (MTCT) and improving infant health. Almost half of the annual global deaths among children under five occur during the first six weeks of life. This study aims to identify uptake of three PNC visits within the first six weeks of life as recommended by WHO among South African mother–infant pairs, and factors associated with uptake. METHODS We analyzed data from three facility–based, nationally representative surveys (2010, 2011/12 and 2012/13) primarily designed to determine the effectiveness of the South African program to prevent MTCT. This analysis describes the proportion of infants achieving the WHO recommendation of at least 3 PNC visits. Interviews from 27 699 HIV–negative and HIV–positive mothers of infants aged 4–8 weeks receiving their six week immunization were included in analysis. Data were analyzed using STATA 13.0 and weighted for sample ascertainment and South African live births. We fitted a multivariable logistic regression model to estimate factors associated with early PNC uptake. RESULTS Over half (59.6%, 95% confidence interval (CI) = 59.0–60.3) of mother–infant pairs received the recommended three PNC visits during the first 6 weeks; uptake was 63.1% (95% CI = 61.9–64.3) amongst HIV exposed infants and 58.1% (95% CI = 57.3–58.9) amongst HIV unexposed infants. Uptake of early PNC improved significantly with each survey, but varied significantly by province. Multivariable analysis of the pooled data, controlling for survey year, demonstrated that number of antenatal visits (4+ vs <4 Adjusted odds ratio (aOR) = 1.13, 95% CI = 1.04–1.23), timing of initial antenatal visits (≤12 weeks vs >12 weeks, aOR = 1.13, 95% CI = 1.04–1.23), place of delivery (clinic vs hospital aOR = 1.5, 1.3–1.6), and infant HIV exposure (exposed vs unexposed aOR = 1.2, 95% CI = 1.1–1.2) were the key factors associated with receiving recommended PNC visits. CONCLUSIONS Approximately 40% of neonates did not receive three or more postnatal care visits in the first 6 weeks of life from 2010–2013. To improve uptake of early PNC, early antenatal booking, more frequent antenatal care attendance, and attention to HIV negative women is needed.