Browsing by Author "Nyemba, Dorothy"

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    Open Access
    A comparative analysis of the medicine use and exposures in infants who are HIV exposed uninfected and HIV unexposed uninfected in the first year in Cape Town, South Africa
    (2025) Mlunga, Hilkka; Mehta, Ushma; Honwana, Frissiano; Nyemba, Dorothy
    Background: Despite several studies investigating medicine exposures in infants, the administration and monitoring of medications in infants who are HIV-exposed uninfected (HEU), a growing population, remains poorly studied. This study aimed to describe and compare medication consumption patterns, including immunization coverage, between infants who are HEU and HIV-unexposed uninfected (HUU) during their first year of life. Methods: This was a secondary analysis of a birth cohort study of pregnant women living with and without HIV and their infants between 2017 and 2019 in Cape Town, South Africa. Interviewer- administered questionnaires captured sociodemographic factors, self-reported medication use, infant feeding practices, and vaccine use over four postnatal visits (<7 days, 10 weeks, 6 and 12 months). Data was manually classified and coded by a clinical pharmacist and student. Logistic regression models were employed to compare patterns of use among infants who are HEU and HUU, as well as identify other maternal and infant factors associated with medication use and vaccine coverage. Findings: A total of 772 mother-infant pairs were analyzed. Compared to infants who are HUU, HEU infants were preterm (64/393 vs. 39/379; p = 0.02), less often breastfed (314/393 vs. 322/379; p <0.001), and weighed less (median, 3288g vs. 3405 g; p = 0.03). HEU infants were found to take at least one medication at a significantly higher rate 388/393 (98.7%) vs 345/379 (91.0%) than infants who are HUU (p <0.001). HEU infants reported lower use of over-the-counter (OTC) medicine (69.2% vs. 80.2%; p <0.01) and traditional, complementary, and alternative medicine (TCAM) (16.8% vs. 26.1%; p <0.001) compared to HUU infants. Mothers of HEU infants were less likely to forget a medicine's name (29.3% vs. 36.9%, p<0.001) than HUU mothers. Prescription medicine use, excluding antiretroviral (ARV) prophylaxis medicines routinely administered to infants who are HEU at birth, was significantly higher among infants who are HEU compared to HUU (65.4%. vs. 23.0%; p <0.01). Vaccine coverage showed no significant difference between infants who are HEU and HUU but steadily declined over the year (95.0% coverage with birth immunizations, vs 70.0% at 9 months) across the entire cohort. Only 293 infants (38.0%) had complete immunization coverage at 1 year. In the adjusted models, being a HEU infant was a protective factor against self-medication. (aOR 0.45; 95% CI 0.31 –0.65; p <0.001). Conversely, being breastfed (aOR 2.46; 95% CI 1.56 –3.83; p <0.001) was a significant risk factor for self-medication infants. Prescription medicine use (excluding ARV prophylaxis medicines) was significantly associated with increased maternal age (aOR 1.06; 95% CI 1.03 – 1.08; p <0.001) and infants who are HEU (aOR 6.52; 95% CI 4.66 – 9.21; p <0.001). No significant associations were found between maternal and infant characteristics and full vaccine coverage. Interpretation: The study revealed that infants who are HEU were more exposed to prescribed medicine (excluding ARV prophylaxis medicines) compared to their HUU counterparts, however, mothers of HUU infants, generally reported higher usage of both TCAM and OTC compared to HEU infants. The study also revealed drops in vaccine coverage rates among infants over the first year of life, indicating a gap in protection against vaccine-preventable diseases. Further research is needed to study medication patterns in different settings. Medication literacy efforts need to be prioritized in pregnant women and mothers of newborns to support rational and safe medicine (including vaccine) usage and subsequently improve the health outcomes for all infants, irrespective of HIV status.
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    Open Access
    Association between food intake and obesity in pregnant women living with and without HIV in Cape Town, South Africa: a prospective cohort study
    (2021-08-04) Madlala, Hlengiwe P.; Steyn, Nelia P.; Kalk, Emma; Davies, Mary-Anne; Nyemba, Dorothy; Malaba, Thokozile R.; Mehta, Ushma; Petro, Gregory; Boulle, Andrew; Myer, Landon
    Background Although global nutrition/dietary transition resulting from industrialisation and urbanisation has been identified as a major contributor to widespread trends of obesity, there is limited data in pregnant women, including those living with HIV in South Africa. We examined food-based dietary intake in pregnant women with and without HIV at first antenatal care (ANC) visit, and associations with maternal overweight/obesity and gestational weight gain (GWG). Methods In an urban South African community, consecutive women living with (n = 479) and without (n = 510) HIV were enrolled and prospectively followed to delivery. Interviewer-administered non-quantitative food frequency questionnaire was used to assess dietary intake (starch, protein, dairy, fruits, vegetables, legumes, oils/fats) at enrolment. Associations with maternal body mass index (BMI) and GWG were examined using logistic regression models. Results Among women (median age 29 years, IQR 25–34), the prevalence of obesity (BMI ≥ 30 kg/m2) at first ANC was 43% and that of excessive GWG (per IOM guidelines) was 37% overall; HIV prevalence was 48%. In women without HIV, consumption of potato (any preparation) (aOR 1.98, 95% CI 1.02–3.84) and pumpkin/butternut (aOR 2.13, 95% CI 1.29–3.49) for 1–3 days a week increased the odds of overweight/obesity compared to not consuming any; milk in tea/coffee (aOR 6.04, 95% CI 1.37–26.50) increased the odds of excessive GWG. Consumption of eggs (any) (aOR 0.52, 95% CI 0.32–0.86) for 1–3 days a week reduced the odds of overweight/obesity while peanut and nuts consumption for 4–7 days a week reduced the odds (aOR 0.34, 95% CI 0.14–0.80) of excessive GWG. In women with HIV, consumption of milk/yoghurt/maas to drink/on cereals (aOR 0.35, 95% CI 0.18–0.68), tomato (raw/cooked) (aOR 0.50, 95% CI 0.30–0.84), green beans (aOR 0.41, 95% CI 0.20–0.86), mixed vegetables (aOR 0.49, 95% CI 0.29–0.84) and legumes e.g. baked beans, lentils (aOR 0.50, 95% CI 0.28–0.86) for 4–7 days a week reduced the odds of overweight/obesity; tomato (raw/cooked) (aOR 0.48, 95% CI 0.24–0.96) and mixed vegetables (aOR 0.38, 95% CI 0.18–0.78) also reduced the odds of excessive GWG. Conclusions Diet modification may promote healthy weight in pregnant women living with and without HIV.