Browsing by Author "Khan, Munira."

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The impact of pneumonia in human immunodeficiency virus (HIV-1) infected pregnant women on perinatal and early infant mortality.
(2007) Khan, Munira.; Moodley, Jagidesa.
Background: Although the prevalence of pneumonia in pregnancy is reported to be less than 1%, the pregnant state and risk factors associated with the development of pneumonia adversely influence the outcome of pregnancy. KwaZulu-Natal is at the epicenter of the dual epidemics of tuberculosis and HIV-1 and the impact of these diseases occurring concurrently in pregnant women at King Edward VIII hospital (KEH), South Africa have been described previously. The impact of antenatal pneumonia in HIV-1 infected and uninfected women however has not been described in the study population and was investigated. Methods: Pregnant women with clinical and radiological evidence of pneumonia were recruited from the antenatal clinic and labour ward at KEH. The study was conducted prospectively between January and December 2000. The clinical profile of these women and the causative organisms were determined. In addition the impact of HIV-1 infection, maternal immunosuppression and maternal pneumonia on obstetric and perinatal outcomes were evaluated. Mothers diagnosed with tuberculosis and multi drug resistant tuberculosis were hospitalised at King George V hospital until delivery. Results: Twenty nine women were diagnosed with antenatal pneumonia (study arm) with Mycobacterium tuberculosis the only causative organism isolated. A control arm of 112 pregnant women was also studied. Maternal and perinatal mortality was restricted to the study arm with a maternal mortality ratio of 99 per 100 000 live births and a perinatal mortality rate of 240 per 1000 births. Pneumonia was significantly associated with a negative overall obstetric outcome in the presence of HIV- l infection, antenatal care, anaemia and second trimester booking status. In addition, the presence of pneumonia was significantly associated with maternal mortality. There was a highly significant association between exposure to pneumonia and poor neonatal outcome. Maternal pneumonia, maternal HIV infection and the presence of medical and obstetric conditions were significantly associated with low birth weight and neonatal pneumonia. Further, maternal pneumonia (p <0.001) and concurrent HIV infection (p=0.002) was significantly associated with neonatal death. Conclusion: The presence of pneumonia in the antenatal period impacts negatively on maternal and neonatal morbidity and mortality. Health care providers must maintain a high degree of suspicion when managing a pregnant woman with unresolving upper respiratory tract symptoms and refer timeously for further investigation. Pneumonia and in particular pulmonary tuberculosis associated with HIV co- infection in pregnancy is a threat to mother and baby. Therefore in areas endemic for TB and HIV infection, it may be prudent to screen HIV positive pregnant women for symptoms suggestive of pneumonia and thereby identify women requiring further investigations such as sputummicroscopy and cultures, and a screening chest radiograph.
Pregnancies complicated by multidrug-resistant tuberculosis and HIV co-infection in Durban, South Africa.
(International Union against Tuberculosis and Lung Disease., 2006) Khan, Munira.; Moodley, Jagidesa.; Pillay, T.; Ramjee, A.; Padayatchi, Nesri.
SETTING: Tertiary hospitals in KwaZulu Natal, South Africa. OBJECTIVE: To study the impact of multidrug-resistant tuberculosis (MDR-TB) and human immunodeficiency virus-1 (HIV-1) co-infection during pregnancy on maternal and perinatal outcome. DESIGN: Prospective study performed between 1996 and 2001. Symptomatic pregnant women were investigated for TB. Those with confirmed MDR-TB were reported on. RESULTS: Three of five pregnant women with MDR-TB were HIV-1 co-infected. One woman decided to terminate the pregnancy and one experienced pre-term labour. Two neonates had features of growth restriction. CONCLUSION: Management of pregnant women with MDR-TB in an HIV-endemic area is possible in developing countries.
A situation analysis of the PMTCT programme between 2013 and 2014 in the eThekwini Municipality.
(2015) Khan, Munira.; Voce, Anna Silvia.
Background The contribution of the human immunodeficiency virus (HIV) epidemic to morbidity and mortality in pregnancy has been well documented. Effective antiretroviral treatment (ART) improves maternal and newborn health as well as preventing mother-to-child transmission (PMTCT); yet access to ART for PMTCT in low and middle income countries only reached 62% (66-85%) in 2012. Of the pregnant women who required ART for their own health, 58% accessed treatment. Provider initiated HIV counseling and testing in a number of health care facilities including antenatal clinics, was recommended in an attempt to improve health outcomes within the expanding HIV epidemic. Further, screening for tuberculosis and initiation of isoniazid prophylaxis is advised in high risk groups. The main aim of the study was to explore the implementation of guidelines for the management of both seropositive and seronegative pregnant women as limited information is available in three key areas in the continuum of care for pregnant women: firstly, time to initiation of ART in women living with HIV; secondly, the implementation of the TB screening processes during pregnancy; and thirdly, follow-up (HIV) testing in uninfected pregnant women. Methods An exploratory, observational, cross sectional study design presenting both descriptive and analytic statistics was used. A two stage cluster sampling using a 30X7 strategy was applied in the selection of antenatal clinics within the metropolitan district. Data from records of eligible women between 32 and 36 weeks gestation was captured onto a data collection sheet. Demographic data and details of ART initiation, TB screening and repeat HIV testing practices were collected. All data was then entered onto a Microsoft Excel spreadsheet for importing into SPSS for processing and analysis. Measures of central tendency were used and chi squared tests and the Mann Whitney tests were applied for the analytic component of the study. Results Data was collected from records of 420 women, 210 were recorded seropositive and 210 were recorded seronegative at initial presentation. Overall, records show 202 women (48%) presented before 20 weeks gestation. Nurse initiation of ART occurred upon diagnosis of HIV infection was documented in 97% of women; TB screening practices however did not appear to be consistent and differed statistically according to administrative authority. The offer of a repeat HIV test to those women who initially tested uninfected was recorded to be offered at a standard rather than an individualised time point. Acute seroconversion was recorded in eight women. Statistically significant associations between HIV status and both median gestational age at first antenatal contact and age (in years) as well as between administrative authority and TB screening practices were found. Discussion, conclusion and recommendations Implementation of national guidelines for the management of pregnant women does not appear to be consistent within or across sampled clinics. Successful integration of HIV services was documented; however TB screening processes and feedback mechanisms following referral require strengthening. Deferment and delays in repeat testing in women who initially test seronegative are particularly concerning. Training and support of health care workers on the value of complete medical records for the overall management and continuity of care of a pregnant female is essential. Further, the benefit in implementation of national guidelines in relation to PMTCT must be highlighted.
Timing of initiation of antiretroviral drugs during tuberculosis therapy.
(Massachusetts Medical Society., 2010) Abdool Karim, Salim Safurdeen.; Naidoo, Kogieleum.; Grobler, Anna Christina.; Padayatchi, Nesri.; Baxter, Cheryl.; Gray, Andrew Lofts.; Gengiah, Tanuja Narayansamy.; Nair, Gonasagrie.; Bamber, Sheila.; Singh, Aarthi.; Khan, Munira.; Pienaar, Jacqueline C.; El-Sadr, Wafaa M.; Friedland, Gerald H.; Abdool Karim, Quarraisha.
Background. The rates of death are high among patients with coinfection with tuberculosis and the human immunodeficiency virus (HIV). The optimal timing for the initiation of antiretroviral therapy in relation to tuberculosis therapy remains controversial. Methods. In an open-label, randomized, controlled trial in Durban, South Africa, we assigned 642 patients with both tuberculosis and HIV infection to start antiretroviral therapy either during tuberculosis therapy (in two integrated-therapy groups) or after the completion of such treatment (in one sequential-therapy group). The diagnosis of tuberculosis was based on a positive sputum smear for acid-fast bacilli. Only patients with HIV infection and a CD4+ cell count of less than 500 per cubic millimeter were included. All patients received standard tuberculosis therapy, prophylaxis with trimethoprim–sulfamethoxazole, and a once-daily antiretroviral regimen of didanosine, lamivudine, and efavirenz. The primary end point was death from any cause. Results. This analysis compares data from the sequential-therapy group and the combined integrated-therapy groups up to September 1, 2008, when the data and safety monitoring committee recommended that all patients receive integrated antiretroviral therapy. There was a reduction in the rate of death among the 429 patients in the combined integrated-therapy groups (5.4 deaths per 100 person-years, or 25 deaths), as compared with the 213 patients in the sequential-therapy group (12.1 per 100 person-years, or 27 deaths); a relative reduction of 56% (hazard ratio in the combined integrated-therapy groups, 0.44; 95% confidence interval, 0.25 to 0.79; P = 0.003). Mortality was lower in the combined integrated-therapy groups in all CD4+ count strata. Rates of adverse events during follow-up were similar in the two study groups. Conclusions. The initiation of antiretroviral therapy during tuberculosis therapy significantly improved survival and provides further impetus for the integration of tuberculosis and HIV services. (Clinical Trials.gov number, NCT00398996.)
Unusual presentation of extrapulmonary tuberculosis: a case report on mammary tuberculosis.
(South African Medical Association., 2011) Khan, Munira.; Naidoo, Kogieleum.
This case study highlights an unusual manifestation of extrapulmonary tuberculosis (TB) in a person living with HIV, namely mammary TB. Clinicians practising in settings where HIV and TB are endemic need to be aware of the clinical presentation, diagnosis and management of mammary TB.