Umbilical cord interleukin-6 predicts outcome in very low birthweight infants in a high HIV-burden setting: a prospective cohort study
- Mackay , Cheryl Anne, Smit, James Stephanus, Khan, Farhaad, Dessai, Fazana, Connolly, Catherine, Masekela, Refiloe
- Authors: Mackay , Cheryl Anne , Smit, James Stephanus , Khan, Farhaad , Dessai, Fazana , Connolly, Catherine , Masekela, Refiloe
- Date: 2020
- Language: English
- Type: Journal Article
- Identifier: http://hdl.handle.net/11260/6376 , vital:45384
- Description: Objectives South Africa has a double burden of high neonatal mortality and maternal HIV prevalence. Common to both is a proinflammatory in utero and perinatal milieu. The aim of this study was to determine cytokine profiles in HIV exposed (HE) and HIV unexposed (HU) very low birthweight (VLBW) infants and to determine whether these were associated with predischarge outcomes. Design Single-centre, prospective cohort study conducted from 1 June 2017 to 31 January 2019. Patients Inborn infants with birth weight of <1500 g were enrolled and cord blood was collected for interleukin (IL)-6 and tumour necrosis factor alpha (TNF-α) assays. Participants provided informed consent and ethics approval was obtained. Outcome measures The primary outcome was umbilical cord cytokine levels according to maternal HIV status. Secondary outcomes included death and/or serious neonatal infection, necrotising enterocolitis, intraventricular haemorrhage, periventricular leucomalacia, chronic lung disease and haemodynamically significant patent ductus arteriosus before discharge. Results A total of 279 cases were included with 269 cytokine assays performed on 122 HEs and 147 HUs. Median IL-6 levels were 53.0 pg/mL in HEs and 21.0 pg/ mL in HUs (p=0.07). Median TNF-α levels were 7.2 pg/ mL in HEs and 6.5 pg/mL in HUs (p=0.6). There was significantly more late-onset sepsis in the HE group compared with the HU group (41.2% vs 27.9%) (p=0.03). IL-6 levels were significantly higher for those with any adverse outcome (p=0.006) and death and/or any adverse outcome (p=0.0001). TNF-α levels did not differ according to predischarge outcomes. Conclusion There is no significant difference in IL-6 and TNF-α levels in cord blood of HE compared with HU VLBWs. However, IL-6 levels are significantly higher in VLBWs with adverse predischarge outcomes, and VLBW HEs are at increased risk of adverse predischarge outcomes compared with HUs, particularly late-onset sepsis.
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- Authors: Mackay , Cheryl Anne , Smit, James Stephanus , Khan, Farhaad , Dessai, Fazana , Connolly, Catherine , Masekela, Refiloe
- Date: 2020
- Language: English
- Type: Journal Article
- Identifier: http://hdl.handle.net/11260/6376 , vital:45384
- Description: Objectives South Africa has a double burden of high neonatal mortality and maternal HIV prevalence. Common to both is a proinflammatory in utero and perinatal milieu. The aim of this study was to determine cytokine profiles in HIV exposed (HE) and HIV unexposed (HU) very low birthweight (VLBW) infants and to determine whether these were associated with predischarge outcomes. Design Single-centre, prospective cohort study conducted from 1 June 2017 to 31 January 2019. Patients Inborn infants with birth weight of <1500 g were enrolled and cord blood was collected for interleukin (IL)-6 and tumour necrosis factor alpha (TNF-α) assays. Participants provided informed consent and ethics approval was obtained. Outcome measures The primary outcome was umbilical cord cytokine levels according to maternal HIV status. Secondary outcomes included death and/or serious neonatal infection, necrotising enterocolitis, intraventricular haemorrhage, periventricular leucomalacia, chronic lung disease and haemodynamically significant patent ductus arteriosus before discharge. Results A total of 279 cases were included with 269 cytokine assays performed on 122 HEs and 147 HUs. Median IL-6 levels were 53.0 pg/mL in HEs and 21.0 pg/ mL in HUs (p=0.07). Median TNF-α levels were 7.2 pg/ mL in HEs and 6.5 pg/mL in HUs (p=0.6). There was significantly more late-onset sepsis in the HE group compared with the HU group (41.2% vs 27.9%) (p=0.03). IL-6 levels were significantly higher for those with any adverse outcome (p=0.006) and death and/or any adverse outcome (p=0.0001). TNF-α levels did not differ according to predischarge outcomes. Conclusion There is no significant difference in IL-6 and TNF-α levels in cord blood of HE compared with HU VLBWs. However, IL-6 levels are significantly higher in VLBWs with adverse predischarge outcomes, and VLBW HEs are at increased risk of adverse predischarge outcomes compared with HUs, particularly late-onset sepsis.
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Competencies of Qualified Primary Health Care professional nurses in Assessing, Diagnosing and Managing clients in health facilities in Buffalo City Metro”
- Authors: Falati, Patience Yoliswa
- Date: 2019
- Subjects: Primary health care
- Language: English
- Type: Thesis , Masters/Doctoral , MPH
- Identifier: http://hdl.handle.net/10353/16716 , vital:40766
- Description: The study investigated the competencies of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities. Aim: The study aimed to explain the competences of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities. The research study followed a descriptive and qualitative design. Data was collected from qualified PHC professional nurses in 79 clinics (both urban and rural), 4CHC’s and 4 hospital casualties. A structured questionnaire with closed ended questions was used. Data analysis was done by means of descriptive statistics. The study showed that the overall percentage of 90% denotes that these PHC professional nurses are competent in all the aspects of competences. Assessing competences of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities is of vital importance for quality health care/ improving service delivery and client satisfaction. Recommendation were made to influence the implementation of policies and guidelines for quality service delivery
- Full Text:
- Date Issued: 2019
- Authors: Falati, Patience Yoliswa
- Date: 2019
- Subjects: Primary health care
- Language: English
- Type: Thesis , Masters/Doctoral , MPH
- Identifier: http://hdl.handle.net/10353/16716 , vital:40766
- Description: The study investigated the competencies of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities. Aim: The study aimed to explain the competences of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities. The research study followed a descriptive and qualitative design. Data was collected from qualified PHC professional nurses in 79 clinics (both urban and rural), 4CHC’s and 4 hospital casualties. A structured questionnaire with closed ended questions was used. Data analysis was done by means of descriptive statistics. The study showed that the overall percentage of 90% denotes that these PHC professional nurses are competent in all the aspects of competences. Assessing competences of qualified PHC professional nurses in assessing, diagnosing and managing clients in the facilities is of vital importance for quality health care/ improving service delivery and client satisfaction. Recommendation were made to influence the implementation of policies and guidelines for quality service delivery
- Full Text:
- Date Issued: 2019
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