Browsing by Author "Madhi, Shabir A."

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Advances in childhood immunisation in South Africa: where to now? Programme managers’ views and evidence from systematic reviews.
(BioMed Central., 2012) Wiysonge, Charles Shey.; Ngcobo, Nthombenhle J.; Jeena, Prakash M.; Madhi, Shabir A.; Schoub, Barry D.; Hawkridge, Anthony.; Shey, Muki Shehu.; Hussey, Gregory D.
Background: The Expanded Programme on Immunisation (EPI) is one of the most powerful and cost-effective public health programmes to improve child survival. We assessed challenges and enablers for the programme in South Africa, as we approach the 2015 deadline for the Millennium Development Goals. Methods: Between September 2009 and September 2010 we requested national and provincial EPI managers in South Africa to identify key challenges facing EPI, and to propose appropriate solutions. We collated their responses and searched for systematic reviews on the effectiveness of the proposed solutions; in the Health Systems Evidence, Cochrane Library, and PubMed electronic databases. We screened the search outputs, selected systematic reviews, extracted data, and assessed the quality of included reviews (using AMSTAR) and the quality of the evidence (using GRADE) in duplicate; resolving disagreements by discussion and consensus. Results: Challenges identified by EPI managers were linked to healthcare workers (insufficient knowledge of vaccines and immunisation), the public (anti-immunisation rumours and reluctance from parents), and health system (insufficient financial and human resources). Strategies proposed by managers to overcome the challenges include training, supervision, and audit and feedback; strengthening advocacy and social mobilisation; and sustainable EPI funding schemes, respectively. The findings from reliable systematic reviews indicate that interactive educational meetings, audit and feedback, and supportive supervision improve healthcare worker performance. Structured and interactive communication tools probably increase parents’ understanding of immunisation; and reminders and recall, use of community health workers, conditional cash transfers, and mass media interventions probably increase immunisation coverage. Finally, a national social health insurance scheme is a potential EPI financing mechanism; however, given the absence of high-quality evidence of effects, its implementation should be pilot-tested and the impacts and costs rigorously monitored. Conclusion: In line with the Millennium Development Goals, we have to ensure that our children’s right to health, development and survival is respected, protected and promoted. EPI is central to this vision. We found numerous promising strategies for improving EPI performance in South Africa. However, their implementation would need to be tailored to local circumstances and accompanied by high-quality monitoring and evaluation. The strength of our approach comes from having a strong framework for interventions before looking for systematic reviews. Without a framework, we would have been driven by what reviews have been done and what is easily researchable; rather than the values and preferences of key immunisation stakeholders.
The association between the ratio of monocytes: lymphocytes at age 3 months and risk of tuberculosis (TB) in the first two years of life.
(BioMed Central., 2014) Naranbhai, Vivek.; Kim, Soyeon.; Fletcher, Helen.; Cotton, Mark F.; Violari, Avy.; Mitchell, Charles.; Nachman, Sharon.; McSherry, George.; McShane, Helen.; Hill, Adrian V. S.; Madhi, Shabir A.
Background: Recent transcriptomic studies revived a hypothesis suggested by historical studies in rabbits that the ratio of peripheral blood monocytes to lymphocytes (ML) is associated with risk of tuberculosis (TB) disease. Recent data confirmed the hypothesis in cattle and in adults infected with HIV. Methods: We tested this hypothesis in 1,336 infants (540 HIV-infected, 796 HIV-exposed, uninfected (HEU)) prospectively followed in a randomized controlled trial of isoniazid prophylaxis in Southern Africa, the IMPAACT P1041 study. We modeled the relationship between ML ratio at enrollment (91 to 120 days after birth) and TB disease or death in HIV-infected children and latent Mycobacterium tuberculosis (MTB) infection, TB disease or death in HEU children within 96 weeks (with 12 week window) of randomization. Infants were followed-up prospectively and routinely assessed for MTB exposure and outcomes. Cox proportional hazards models allowing for non-linear associations were used; in all cases linear models were the most parsimonious. Results: Increasing ML ratio at baseline was significantly associated with TB disease/death within two years (adjusted hazard ratio (HR) 1.17 per unit increase in ML ratio; 95% confidence interval (CI) 1.01 to 1.34; P = 0.03). Neither monocyte count nor lymphocyte counts alone were associated with TB disease. The association was not statistically dissimilar between HIV infected and HEU children. Baseline ML ratio was associated with composite endpoints of TB disease and death and/or TB infection. It was strongest when restricted to probable and definite TB disease (HR 1.50; 95% CI 1.19 to 1.89; P = 0.006). Therefore, per 0.1 unit increase in the ML ratio at three to four months of age, the hazard of probable or definite TB disease before two years was increased by roughly 4% (95% CI 1.7% to 6.6%). Conclusion: Elevated ML ratio at three- to four-months old is associated with increased hazards of TB disease before two years among children in Southern Africa. While significant, the modest effect size suggests that the ML ratio plays a modest role in predicting TB disease-free survival; its utility may, therefore, be limited to combination with existing tools to stratify TB risk, or to inform underlying pathophysiologic determinants of TB disease.
Treatment and outcomes in children with multidrug-resistant tuberculosis: a systematic review and individual patient data meta-analysis.
(Public Library of Science., 2018) Harausz, Elizabeth P.; Garcia-Prats, Anthony J.; Law, Stephanie.; Schaaf, H. Simon.; Kredo, Tamara.; Seddon, James A.; Menzies, Dick.; Turkova, Anna.; Achar, Jay.; Amanullah, Farhana.; Barry, Pennan.; Becerra, Mercedes.; Chan, Edward D.; Chan, Pei Chun.; Ioana Chiotan, Domnica.; Crossa, Aldo.; Drobac, Peter C.; Lee, Fairlie.; Falzon, Dennis.; Flood, Jennifer.; Gegia, Medea.; Hicks, Robert M.; Isaakidis, Petros.; Kadri, S. M.; Kampmann, Beate.; Madhi, Shabir A.; Marais, Else.; Mariandyshev, Andrei.; Méndez-Echevarría, Ana.; Moore, Brittany Kathryn.; Nargiza, Parpieva.; Ozere, Iveta.; Padayatchi, Nesri.; Ur-Rehman, Saleem.; Rybak, Natasha.; Santiago-Garcia, Begoña.; Shah, N. Sarita.; Sharma, Sangeeta.; Shim, Tae Sun.; Skrahina, Alena.; Soriano-Arandes, Antoni.; Van den Boom, Martin.; Van der Werf, Marieke J.; Van der Werf, Tjip S.; Williams, Bhanu.; Yablokova, Elena.; Yim, Jae-Joon.; Furin, Jennifer.; Hesseling, Anneke C.
Abstract available in pdf.