Browsing by Author "le Roux, David"

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    Open Access
    Adherence to isoniazid prophylaxis among HIV-infected children: a randomized controlled trial comparing two dosing schedules
    (BioMed Central Ltd, 2009) le Roux, Stanzi; Cotton, Mark; Golub, Jonathan; le Roux, David; Workman, Lesley; Zar, Heather
    BACKGROUND:Tuberculosis contributes significantly to morbidity and mortality among HIV-infected children in sub-Saharan Africa. Isoniazid prophylaxis can reduce tuberculosis incidence in this population. However, for the treatment to be effective, adherence to the medication must be optimized. We investigated adherence to isoniazid prophylaxis administered daily, compared to three times a week, and predictors of adherence amongst HIV-infected children. METHODS: We investigated adherence to study medication in a two centre, randomized trial comparing daily to three times a week dosing of isoniazid. The study was conducted at two tertiary paediatric care centres in Cape Town, South Africa. Over a 5 year period, we followed 324 HIV-infected children aged [greater than or equal to] 8 weeks. Adherence information based on pill counts was available for 276 children. Percentage adherence was calculated by counting the number of pills returned. Adherence [greater than or equal to] 90% was considered to be optimal. Analysis was done using summary and repeated measures, comparing adherence to the two dosing schedules. Mean percentage adherence (per child during follow-up time) was used to compare the mean of each group as well as the proportion of children achieving an adherence of [greater than or equal to] 90% in each group. For repeated measures, percentage adherence (per child per visit) was dichotomized at 90%. A logistic regression model with generalized estimating equations, to account for within-individual correlation, was used to evaluate the impact of the dosing schedule. Adjustments were made for potential confounders and we assessed potential baseline and time-varying adherence determinants. RESULTS: The overall adherence to isoniazid was excellent, with a mean adherence of 94.7% (95% confidence interval [CI] 93.5-95.9); similar mean adherence was achieved by the group taking daily medication (93.8%; 95% CI 92.1-95.6) and by the three times a week group (95.5%; 95% CI 93.8-97.2). Two-hundred and seventeen (78.6%) children achieved a mean adherence of [greater than or equal to] 90%. Adherence was similar for daily and three times a week dosing schedules in univariate (odds ratio [OR] 0.88; 95% CI 0.66-1.17; P = 0.38) and multivariate (adjusted OR 0.85; 95% CI 0.64-1.11; P = 0.23) models. Children from overcrowded homes were less adherent (adjusted OR 0.71; 95% CI 0.54-0.95; P = 0.02). Age at study visit was predictive of adherence, with better adherence achieved in children older than 4 years (adjusted OR 1.96; 95% CI 1.16-3.32; P = 0.01). CONCLUSION: Adherence to isoniazid was excellent regardless of the dosing schedule used. Intermittent dosing of isoniazid prophylaxis can be considered as an alternative to daily dosing, without compromising adherence or efficacy.TRIAL REGISTRATION:Clinical Trials NCT00330304
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    Open Access
    In-hospital neonatal mortality in a level-two hospital in Cape Town, South Africa
    (2022) Gabriels, Cindi; le Roux, David
    Background Neonatal mortality (deaths in the first 28 days of life) is a major contributor to under-5 mortality in South Africa. Many advances in neonatal care have been introduced, but the impact of these interventions has not been studied outside of tertiary academic centers. Objectives To describe neonatal mortality in the neonatal high care unit at New Somerset Hospital in Cape Town, South Africa, over an 8 year period. Methods Neonatal deaths were captured and entered into a database; deaths were coded according to Perinatal Problem Identification Program categories. Results Neonatal deaths from 2011 to 2018 were analyzed, excluding 2014. There were 296 neonatal deaths; median birthweight of neonatal deaths was 1140g (interquartile range (IQR) 790 – 2420g); median gestation was 29 weeks (IQR 25 – 38). Immaturity (132/296, 45%) was the most common cause of death, followed by hypoxia (67/296, 23%) and infections (61/296, 21%). There were 250 (84%) neonatal deaths in the first week of life; there was a trend towards decreasing number of neonatal deaths (from 48 in 2011 to 34 in 2018), and rate of deaths (from 45.2 per 1000 admissions to 28.2 per 1000 admissions). This was driven by decreased deaths due to immaturity; number of deaths due to other causes remained approximately constant. Conclusions We observed decreasing number of neonatal deaths and rate of deaths per 1000 admissions, with the largest decrease due to prematurity. Advances in respiratory care for preterm neonates may have contributed to decreased mortality due to immaturity. Upstream obstetric interventions will be required to address hypoxia-related causes of neonatal mortality.