Browsing by Author "Pillay, Victoria"

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    International collaboration, funding and association with burden of disease in randomized controlled trials in Africa
    (2005) Swingler, George H; Pillay, Victoria; Pienaar, Elizabeth D; Ioannidis, John P A
    OBJECTIVE: This study aimed to assess whether randomized controlled trials conducted in Africa with collaborators from outside Africa were more closely associated with health conditions that have a burden of disease that is of specific importance to Africa than with conditions of more general global importance or with conditions important to developed countries. We also assessed whether the source of funding influenced a study's relevance to Africa. METHODS: We compared randomized controlled trials performed in Africa that looked at diseases specifically relevant to Africa (as determined by burden of disease criteria) with trials classified as looking at diseases of global importance or diseases important to developed countries in order to assess differences in collaboration and funding. FINDINGS: Of 520 trials assessed, 347 studied diseases that are specifically important to Africa; 99 studied globally important diseases and 74 studied diseases that are important to developed countries. The strongest independent predictor of whether a study was of specifically African or global importance was the corresponding author's country of origin: African importance was negatively associated with a corresponding author being from South Africa (odds ratio (OR) = 0.04; 95% confidence interval (CI) = 0.02–0.10) but there was little difference between corresponding authors from other African countries and corresponding authors from countries outside Africa. The importance of a study to Africa was independently associated with having more non-African authors (OR per author = 1.31; 95% CI = 1.08–1.58), fewer trial sites (OR per site = 0.69; 95% CI = 0.50–0.96), and reporting of funding (OR = 2.14; 95% CI = 1.15–4.00). Similar patterns were present in the comparisons of trials studying diseases important to Africa versus those studying diseases important to developed countries with stronger associations overall. When funding was reported, private industry funding was negatively associated with African importance compared with global importance (OR = 0.31, P = 0.008 for African importance and OR = 0.51, P = 0.57 for importance for developed countries). CONCLUSION: The relevance to Africa of trials conducted in Africa was not adversely affected by collaboration with non-African researchers but funding from private industry was associated with a decreased emphasis on diseases relevant to Africa
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    Sodium and potassium disturbances in childhood diarrhoea
    (2006) Pillay, Victoria
    Includes bibliographical references.
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    A systematic review of the symptomatic treatment of the cough in whooping cough
    (2002) Pillay, Victoria; Swingler, George H
    Background: There are between 20 - 40 million cases of whooping cough annually world-wide, 90% of which occur in developing countries, resulting in an estimated 200 - 300 O00 fatalities each year. Much of the morbidity is due to the paroxysmal cough. Corticosteroids, salbutamol (a β₂- adrenergic stimulant), and pertussis-specific immunoglobulin have been proposed as standard treatment for the cough. Antihistamines have also been administered. No systematic review of the effectiveness of any of these interventions or others has been performed. Objective: in this systematic review we aim to assess the effectiveness of interventions used to reduce the severity of the coughing paroxysms in whooping cough in children and adults. Selection criteria: Randomised and quasi randomised controlled trials of any intervention that reduced the severity of the coughing paroxysms in whooping cough; excluding antibiotics and vaccines. Study selection: All interventions aimed at reducing the severity of the coughing paroxysms in children or adults with whooping cough with any of the following outcome measures met inclusion criteria for the review; i) frequency of paroxysms of coughing (primary outcome), ii) frequency of vomiting, iii) frequency of whoop, iv) frequency of cyanotic spells, v) development of serious complications, vi) mortality from any cause, vii) side effects due to medication, viii) admission to hospital, and ix) duration of hospital stay. Search strategy: We searched the Cochrane Controlled Trials register, Acute Respiratory infectious Disease Group Specialised Trials register, MEDLINE, LILACS, scanned reference lists of identified trials, contacted authors of identified trials and the relevant pharmaceutical companies. Data collection and analysis: Studies were selected, quality assessed and data extracted by two reviewers independently. Results: Nine studies satisfied the inclusion criteria but four had insufficient data for further meta-analysis of our pre-specified outcomes. Studies were old and poorly reported. The largest study had a total sample size of 49 and the smallest study nine. All studies were performed in industrialised settings. Eligible studies assessed diphenhyramine, pertussis immunoglobulin, dexamethasone and salbutamol. No statistically significant benefit was found for any of the interventions. Diphenhydramine was associated with a mean increase of 1.90 coughing spells per 24 hours [95%Cl - 4.66; 8.46] and pertussis immunoglobulin a mean decrease in hospital stay of 0.70 days [95% Cl -3.79; 2.39]. and a mean reduction of 3.10 whoops per 24 hours [95% CI - 6.22; 0.02]. Dexamethasone resulted in a mean decrease in hospital stay of 3.45 days [95% Cl - 15.34; 8.44] and salbutamol in a weighted mean decrease in coughing paroxysms of 0.95 per 24 hours [95% Cl - 6.21; 4.31]. Reviewers' conclusion: Although assessments have been performed on a whole range of interventions, including diphenhyramine, pertussis immunoglobulin, dexamethasone and salbutamol, insufficient evidence exists to draw conclusions about the effects of any of them.