Browsing by Author "Adetokunboh, Olatunji Oluseyi"

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    Understanding the relationship between vaccination, vaccine-preventable diseases, and HIV infection among sub-Saharan African children
    (Stellenbosch : Stellenbosch University, 2019-04) Adetokunboh, Olatunji Oluseyi; Wiysonge, Charles S.; Uthman, Olalekan A.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics.
    ENGLISH SUMMARY : Numerous care and treatment guidelines pinpoint vaccination as a crucial preventive strategy for HIV-infected patients, but data regarding these vaccines among children living with HIV are still very scanty. There are knowledge gaps concerning the understanding of the mediators of vaccine protection, adverse effects and fundamental aspects of the epidemiology of various vaccine-preventable diseases. Likewise, there is also limited information on the determinants of vaccine non-uptake within the HIV-infected population, and on the association between maternal HIV status and the vaccination status of her HIV-exposed child. Further synthesis of all available evidence is required to provide reliable and easily accessible information for decision-makers and healthcare workers. We completed evidence synthesis of existing studies and secondary analyses of existing data sets using different research methods such as systematic review, meta-analysis, meta-regression and multivariable logistic regression models. We found that the burden of vaccine-preventable diseases is still high among HIV-infected and HIV-exposed children in sub-Saharan Africa. Several routine vaccines show possibilities for direct and indirect protection against various vaccine-preventable diseases among HIV-infected and HIV-exposed children. However, HIV-infected children are less likely to be protected against vaccine-preventable diseases when compared to non-exposed children. There is no significant difference in the uptake of the full series of three doses of diphtheria-tetanus-pertussis containing vaccines (DTP3) among infants of HIV-infected mothers and those of uninfected mothers in sub-Saharan Africa. Vaccination coverage for both HIV-exposed children and non-exposed children is still sub-optimal. Furthermore, individual and contextual factors such as maternal age, educational level, unemployment, and adult literacy level contributed significantly to non-uptake of DTP3 among the children of HIV-infected women across sub-Saharan Africa. The symptoms of acute respiratory infections show no statistical difference in the overall estimates between the children of HIV-infected mothers who were vaccinated with DTP3 and the ones who were not vaccinated. The data for episodes of diarrhoea were pooled together with resultant nil significant difference in the overall estimates between the children of HIV-infected mothers who were vaccinated with DTP3 and those not vaccinated. Many African countries also recorded high rates of respiratory infections and diarrhoeal diseases among both HIV-exposed and unexposed children. Residency in communities with high unemployment was an independent predictor of acute respiratory infections among immunised and HIV-exposed children while those born to women aged 15-24 or 25-34 years old were significantly more likely to develop diarrhoeal diseases. There is a need to address sub-optimal uptake of vaccines among HIV-exposed and non-exposed children. Epidemiological studies on vaccine-preventable diseases and the development of more efficacious vaccines are required for vaccine-preventable diseases studies with respect to HIV-infected and HIV-exposed uninfected children. The findings of this research would be useful in advocating for a more equitable share of healthcare resources especially for preventive services such as vaccination of both HIV-exposed and non-exposed children with subsequent reduction in the burden of vaccine-preventable diseases.