Browsing by Author "Malaba, Thokozile"

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    A cross-sectional analysis on the association between pain and making tradeoffs for survival using a multidimensional health assessment tool among older adults living in low-to middle-income areas in Cape Town, South Africa
    (2021) Steyn, Simone; Malaba, Thokozile; Geffen, Leon
    Introduction Globally, the population of older adults is ageing rapidly, due to increased longevity and decreasing fertility rates. With the rapidly accelerating growth of this ageing population in low-to-middle income countries, the health systems are not well resourced to manage this rapid growth that are required to accommodate older multimorbid populations. Multimorbidity presents as an elevated risk for the health and wellbeing of older populations and occurs when more than one chronic condition is present. Globally pain is a common symptom among older adults that impairs health with severe consequences especially when multimorbidity is present. Some evidence has shown that living under poverty-stricken conditions is associated with increased pain, particularly among vulnerable populations such as older adults. There is limited evidence in Cape Town on the relationship between living in low-to middle income areas and poverty indicators such as making financial trade-offs for survival with increased reports of pain in older adults. Methods In this cross-sectional analysis, adults aged 60 years and above seeking care from four selected primary health care clinics and health clubs were enrolled in an ongoing longitudinal study (Wellbeing Study). Data was used from an existing study that commenced in March 2018. Data were collected using a multidimensional geriatric instrument called the Check-Up Self-Report (interRAI). The researcher assessed the relationship between financial trade-offs made for survival (as a proxy for poverty) and pain in the last three days (as a proxy for pain) overall, and according to study sites. Permission for the parent study was sought and granted by the University of Cape Town's Health Research Ethics Committee (UCT-HREC, Ref: 790/2017) as well as by the Western Cape Department of Health. Results The results highlighted that overall and by site, no associations were observed between pain and financial trade-offs after adjusting for various health-related variables (aOR: 1.17, 95% CI: 0.97 – 1.42). Of the 1813 older adults included in this analysis (64% female, median age 68 years (IQR: 64-74)) 51% reported making financial trade-offs and 46% reported experiencing pain in the last three days. Overall, a moderate proportion of participants (27%) reported daily pain, which was categorised as not severe (11%), severe (12%) and excruciating (4%). When assessed by site a significantly higher proportion of participants reported daily pain in Khayelitsha (43%) and Woodstock (40%). Conclusion In this study the need to make financial trade-offs for survival and pain were prevalent in this population. Although an association was not found between making financial trade-offs and recent pain, the results provided valuable information that can drive future research studies and policy. The use of this multidimensional tool which collects information from various health categories and provides broad and less in-depth data may have played a role in the nullified results. Further research is needed to evaluate the association of poverty indicators on pain in this population using more detailed pain and poverty assessment tools.
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    Clinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa
    (Public Library of Science, 2016) Constant, Deborah; Harries, Jane; Malaba, Thokozile; Myer, Landon; Patel, Malika; Petro, Gregory; Grossman, Daniel
    Objective To document clinical outcomes and women's experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only. METHODS: Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2-4 weeks after discharge for the 2014 cohort. RESULTS: The 2014 cohort received 200 mg mifepristone, which was self-administered 24-48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3-4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0.001), but side effects of medication were similar or more common for the mifepristone cohort. Overall satisfaction remained unchanged (95% vs. 91%), while other acceptability measures were higher (p<0.001) for the mifepristone compared to the misoprostol-only cohorts. CONCLUSION: The introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has been successful with shorter time-to-abortion events, less extreme pain and greater acceptability for women. High rates of uterine evacuation for placental tissue need to be addressed.
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    Intrauterine growth restriction (IUGR) and birth outcomes in a cohort of HIV-infected pregnant women in Cape Town, South Africa
    (2023) Sankar, Chenoa; Malaba, Thokozile
    Background: Intrauterine growth restriction (IUGR) is a major contributory factor of perinatal morbidity and mortality. This suboptimal growth is associated with infants being small-for-gestational age. In addition to genetic and placental factors, maternal factors such as infection are also responsible for IUGR. Numerous studies have shown that HIV infection could increase the risk of IUGR. Given the consequences of IUGR, determining the incidence of IUGR in a high HIV prevalence setting is essential. Screening for foetal growth abnormalities is an essential component of antenatal care, with foetal ultrasound playing a key role. Improving antenatal detection of IUGR in resource limited settings could improve perinatal outcomes. Methods: This research is a secondary analysis of a large prospective observational study conducted among pregnant women, seeking antenatal care at the Gugulethu MOU in South Africa. Pregnancy dating and foetal size was determined by research ultrasound in women ≤24 weeks' gestation. Women from the overall cohort were included if they had a singleton pregnancy, at least one ultrasound and a recorded estimated foetal weight. A subset of HIV-infected women enrolled in a longitudinal component were included for additional analyses. Growth restriction was determined using INTERGROWTH-21ST Project Standards. The incidence of IUGR was compared by HIV status in the overall cohort; while the relationship between estimated foetal weight and birthweight and size for gestational age was explored through regression modelling. Results: 1391 women were included in the overall cohort, and had an ultrasound at a median gestational age of 19 (16-23). The incidence of IUGR was very low (1.3%); with an unexpected difference observed by HIV status. In the nested cohort (n=453), using the ultrasound conducted at median gestational age of 28 weeks (27-28), an association between estimated foetal weight and birthweight was observed (β = 1.16, p <0.01). However, no association observed between estimated foetal weight and size for gestational age. Conclusions: While an unexpected difference was detected in IUGR by HIV status, further research is needed, into the incidence of IUGR in populations with HIV, taking into consideration ART status. Further exploration of the ability of foetal biometry to independently and accurately identify IUGR cases antenatally in resource limited settings is essential.
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    Maternal body mass index and proinflammatory immune markers in HIV-infected pregnant woman on antiretroviral treatment in Cape Town, South Africa
    (2023) More, Jessica; Malaba, Thokozile
    Background. High maternal body mass index (BMI) and the timing of antiretroviral (ART) initiation in pregnant women living with human immunodeficiency virus (HIV) (WLWH) may affect the controlled systemic inflammation during pregnancy. Proinflammatory immune markers during pregnancy and the impact of maternal BMI in WLWH initiating ART in pregnancy or preconception will be evaluated. Methods. In this mini-dissertation is a protocol (Part A), journal formatted manuscript (Part B) and Appendices (Part C) for a study on maternal BMI and inflammation in WLWH. A subset cohort from the Prematurity Immunology in HIV-infected Mothers and their infants Study (PIMS) study had three plasma immune markers (c-reactive protein (CRP), interferon-gamma inducible protein-10 (IP-10) and serum amyloid A (SAA)) and maternal weight measured from April 2015 to October 2016, at four antenatal care visits (visit 1, 2 (two weeks post-ART initiation in those initiating in pregnancy), 3 and 4). The association with maternal BMI by ART initiation (on ART preconception or initiated during current pregnancy) was assessed. Results. Among 526 pregnant WLWH, those on preconception ART had CRP and IP-10 levels lower compared to those who initiated ART in pregnancy. CRP was higher in obese WLWH (irrespective of timing of ART initiation) than those with a normal or overweight BMI. IP-10 was elevated in the 2nd trimester and SAA levels were highest in WLWH with a normal BMI. Conclusion. Immune marker level elevation is dependent on timing of ART exposure and pregnancy trimester. The timing of ART initiation and maternal BMI may adversely impact systemic inflammation in pregnant WLWH.