Browsing by Author "Esser, Monika M."

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    Feeding practices and nutritional status of HIV-exposed and HIV-unexposed infants in the Western Cape
    (AOSIS Publishing, 2016-05-13) Rossouw, Magdel E.; Cornell, Morna; Cotton, Mark F.; Esser, Monika M.
    Background: Optimal infant- and young child–feeding practices are crucial for nutritional status, growth, development, health and, ultimately, survival. Human breast milk is optimal nutrition for all infants. Complementary food introduced at the correct age is part of optimal feeding practices. In South Africa, widespread access to antiretrovirals and a programme to prevent mother-to-child transmission of HIV have reduced HIV infection in infants and increased the number of HIV-exposed uninfected (HEU) infants. However, little is known about the feeding practices and nutritional status of HEU and HIV-unexposed (HU) infants. Objective: To assess the feeding practices and nutritional status of HIV-exposed and HIV-unexposed (HU) infants in the Western Cape. Design: Prospective substudy on feeding practices nested in a pilot study investigating the innate immune abnormalities in HEU infants compared to HU infants. The main study commenced at week 2 of life with the nutrition component added from 6 months. Information on children’s dietary intake was obtained at each visit from the caregiver, mainly the mother. Head circumference, weight and length were recorded at each visit. Data were obtained from 6-, 12- and 18-month visits. World Health Organization feeding practice indicators and nutrition indicators were utilised. Setting: Tygerberg Academic Hospital, Western Cape. Mothers were recruited from the postnatal wards. Subjects: Forty-seven mother–infant pairs, 25 HEU and 22 HU infants, participated in this nutritional substudy. Eight (17%) infants, one HU and seven HEU, were lost to follow-up over the next 12 months. The HEU children were mainly Xhosa (76%) and HU were mainly mixed race (77%). Results: The participants were from poor socio-economic backgrounds. In both groups, adherence to breastfeeding recommendations was low with suboptimal dietary diversity. We noted a high rate of sugar- and salt-containing snacks given from a young age. The HU group had poorer anthropometric and nutritional indicators not explained by nutritional factors alone. However, alcohol and tobacco use was much higher amongst the HU mothers. Conclusion: Adherence to breastfeeding recommendations was low. Ethnicity and cultural milieu may have influenced feeding choices and growth. Further research is needed to understand possible reasons for the poorer nutritional and anthropometric indicators in the HU group.
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    Identification of a novel WAS mutation in a South African patient presenting with atypical Wiskott-Aldrich syndrome : a case report
    (BioMed Central, 2020-06-05) Glanzmann, Brigitte; Möller, Marlo; Schoeman, Mardelle; Urban, Michael; Van Helden, Paul D.; Frigati, Lisa; Grewal, Ravnit; Pieters, Hermanus; Loos, Ben; Hoal, Eileen G.; Glashoff, Richard H.; Cornelissen, Helena; Rabie, Helena; Esser, Monika M.; Kinnear, Craig J.
    Background: The X-linked recessive primary immunodeficiency disease (PIDD) Wiskott-Aldrich syndrome (WAS) is identified by an extreme susceptibility to infections, eczema and thrombocytopenia with microplatelets. The syndrome, the result of mutations in the WAS gene which encodes the Wiskott-Aldrich protein (WASp), has wide clinical phenotype variation, ranging from classical WAS to X-linked thrombocytopaenia and X-linked neutropaenia. In many cases, the diagnosis of WAS in first affected males is delayed, because patients may not present with the classic signs and symptoms, which may intersect with other thrombocytopenia causes. Case presentation: Here, we describe a three-year-old HIV negative boy presenting with recurrent infections, skin rashes, features of autoimmunity and atopy. However, platelets were initially reported as normal in numbers and morphology as were baseline immune investigations. An older male sibling had died in infancy from suspected immunodeficiency. Uncertainty of diagnosis and suspected severe PIDD prompted urgent further molecular investigation. Whole exome sequencing identified c. 397 G > A as a novel hemizygous missense mutation located in exon 4 of WAS. Conclusion: With definitive molecular diagnosis, we could target treatment and offer genetic counselling and prenatal diagnostic testing to the family. The identification of novel variants is important to confirm phenotype variations of a syndrome.
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    The routine paediatric human immunodeficiency virus visit as an intervention opportunity for failed maternal care, and use of point-of-care CD4 testing as an adjunct in determining antiretroviral therapy eligibility
    (Medpharm Publications, 2014) Picken, Sandra Claire; Williams, Sadeeka; Harvey, Justin; Esser, Monika M.
    South African women and children remain at the centre of the human immunodeficiency virus (HIV) pandemic, and maternal well-being plays a critical role in child health. In this study, we evaluated the impact of the paediatric visit on the determination of antiretroviral therapy (ART) eligibility in mothers using Alere Pima™ Analyser (Pima™) testing as an adjunct to routine care. Fifty-two mothers who had failed to obtain routine CD4 screening were enrolled during the paediatric visit at Tygerberg Children’s Hospital between November 2011 and May 2012. Clinical staging assessments and parallel standard CD4 cell count testing were performed. Finger-prick samples for the Pima™, and simultaneous venous samples for reference flow cytometry, were obtained. The Pima™ identified 37% of mothers as meeting ART eligibility versus 35% using the reference flow cytometry method. An additional 4% of mothers were identified using World Health Organization clinical staging only. The sensitivity of the Pima™ was 89%, specificity 91%, and positive and negative predictive values 84% and 94%, respectively. These results indicate that the paediatric HIV care visit can provide a valuable additional intervention opportunity to identify mothers in need of ART, with point-of-care CD4 technologies being used as a meaningful adjunct in screening for ART eligibility.