Browsing by Author "Ramokolo, Vundli"

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    Completeness of patient-held records: observations of the Road-to-Health Booklet from two national facility-based surveys at 6 weeks postpartum, South Africa
    (Edinburgh University Global Health Society, 2018) Ramraj, Trisha; Goga, Ameena E.; Larsen, Anna; Ramokolo, Vundli; Bhardwaj, Sanjana; Chirinda, Witness; Jackson, Debra; Nsibande, Duduzile; Ayalew, Kassahun; Pillay, Yogan; Lombard, Carl J.; Ngandu, Nobubelo K.
    BACKGROUND Continuity of care is important for child well-being in all settings where postnatal retention of mother-infant pairs in care remains a challenge. This analysis reports on completeness of patient-held infant Road to Health Booklets (RtHBs), amongst HIV exposed and unexposed infants during the first two years after the RtHB was launched country-wide in South Africa. METHODS Secondary data were analysed from two nationally representative, cross-sectional surveys, conducted in 2011-12 and 2012-13. These surveys aimed to measure early effectiveness of the national programme for preventing vertical HIV transmission. Participants were eligible for this analysis if they were 4-8 weeks old, receiving their six-week immunisation, not needing emergency care and had their RtHBs reviewed. Caregivers were interviewed and data abstracted from RtHBs. RtHB completeness across both surveys was defined as the proportion of RtHBs with any of the following indicators recorded: infant birth weight, BCG immunisation, maternal syphilis results and maternal HIV status. A partial proportional odds logistic regression model was used to identify factors associated with completeness. Survey sampling weights were included in all analyses. RESULTS Data from 10 415 (99.6%) participants in 2011-12 and 9529 (99.2%) in 2012-13 were analysed. Overall, recording of all four indicators increased from 23.1% (95% confidence interval (CI) = 22.2-24.0) in 2011-12 to 43.3% (95% CI = 42.3-44.4) in 2012-13. In multivariable models, expected RtHB completeness (ie, recording all four indicators vs recording of <4 indicators), was significantly (P<0.05) associated with survey year, marital status, socio-economic status, maternal antenatal TB screening, antenatal infant feeding counselling, delivery at a clinic or hospital and type of birth attendant. CONCLUSIONS Routine patient-held infant health RtHB, a critical tool for continuity of care in high HIV/TB prevalence settings, was poorly completed, with less than 50% of the RtHB showing expected completeness. However, government efforts for improved usage of the booklet were evidenced by the near doubling of completeness from 2011 to 2013. Education about its importance and interventions aiming at optimising its use without violating user privacy should be continued.
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    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, Jan
    After 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.
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    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, Debra
    BACKGROUND: 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.
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    In utero art exposure and birth and early growth outcomes among HIV-exposed uninfected infants attending immunization services: Results from national pmtct surveillance, South Africa
    (Oxford University Press, 2017) Ramokolo, Vundli; Goga, Ameena E.; Doherty, Tanya
    . Despite the recognized benefit of antiretroviral therapy (ART) for preventing and treating HIV, some studies have reported adverse birth outcomes with in utero ART exposure. We evaluated the effect of infant in utero HIV and ART exposure on preterm delivery (PTD), low birth weight (LBW), small for gestational age (SGA), and underweight for age (UFA) at 6 weeks.We surveyed 6179 HIV-unexposed-uninfected (HUU) and 2599 HIV-exposed-uninfected (HEU) infants. HEU infants were stratified into 3 groups: ART, Zidovudine alone, and no antiretrovirals (None). The ART group was further stratified to explore pre- or postconception exposure. Multivariable logistic regression evaluated effects of HIV and ARV exposure on the outcomes.
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    Strategies to improve male involvement in PMTCT Option B+ in four African countries: a qualitative rapid appraisal
    (Taylor & Francis Open, 2016) Besada, Donela; Rohde, Sarah; Goga, Ameena; Raphaely, Nika; Daviaud, Emmanuelle; Ramokolo, Vundli; Magasana, Vuyolwethu; Noveve, Nobuntu; Doherty, Tanya
    BACKGROUND: The World Health Organization recommends that antiretroviral therapy be started as soon as possible, irrespective of stage of HIV infection. This ‘test and treat’ approach highlights the need to ensure that men are involved in prevention of mother-to-child HIV transmission (PMTCT). This article presents findings from a rapid appraisal of strategies to increase male partner involvement in PMTCT services in Uganda, Democratic Republic of Congo, Malawi, and Coˆ te d’Ivoire in the context of scale-up of Option B protocol. DESIGN: Data were collected through qualitative rapid appraisal using focus groups and individual interviews during field visits to the four countries. Interviews were conducted in the capital city with Ministry of Health staff and implementing partners (IPs) and at district level with district management teams, facility-based health workers and community health cadres in each country. RESULTS: Common strategies were adopted across the countries to effect social change and engender greater participation of men in maternal, child and women’s health, and PMTCT services. Community-based strategies included engagement of community leaders through dialogue and social mobilization, involving community health workers and the creation and strengthening of male peer cadres. Facility-based strategies included provision of incentives such as shorter waiting time, facilitating access for men by altering clinic hours, and creation of family support groups. CONCLUSIONS: The approaches implemented at both community and facility levels were tailored to the local context, taking into account cultural norms and geographic regional variations. Although intentions behind such strategies aim to have positive impacts on families, unintended negative consequences do occur, and these need to be addressed and strategies adapted. A consistent definition of ‘male involvement’ in PMTCT services and a framework of indicators would be helpful to capture the impact of strategies on cultural and behavioral shifts. National policies around male involvement would be beneficial to streamline approaches across IPs and ensure wide-scale implementation, to achieve significant improvements in family health outcomes.
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    ‘To be a woman is to make a plan’: a qualitative study exploring mothers’ experiences of the Child Support Grant in supporting children’s diets and nutrition in South Africa
    (BMJ Publishing Group, 2018) Zembe-Mkabile, Wanga; Surender, Rebecca; Sanders, David; Swart, Rina; Ramokolo, Vundli; Wright, Gemma; Doherty, Tanya
    Food security and good nutrition are key determinants of child well-being. There is strong evidence that cash transfers such as South Africa’s Child Support Grant (CSG) have the potential to help address some of the underlying drivers of food insecurity and malnutrition by providing income to caregivers in poor households, but it is unclear how precisely they work to affect child well-being and nutrition. We present results from a qualitative study conducted to explore the role of the CSG in food security and child well-being in poor households in an urban and a rural setting in South Africa.
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    Undernutrition and its social determinants
    (Elsevier, 2017) Ramokolo, Vundli; Zembe-Mkabile, Wanga; Sanders, David
    Undernutrition, especially among young children in low- and middle-income countries (LMICs) remains widespread, particularly in sub-Saharan Africa and South Asia. Its effects include increased risk of morbidity and mortality from infection, impaired intellectual development, and a higher risk of developing obesity and chronic noncommunicable diseases in later life. The immediate determinants are intake of inadequate diets and increased disease. Underlying these are food insecurity, suboptimal social care (including breastfeeding), and inadequate health and environmental services. These, in turn, are underpinned by a combination of social and structural factors that include limited education of women, lack of financial and other resources at household level, and a food environment in an increasing number of countries that promotes consumption of a nutrient-poor diet.