Browsing by Author "Loveday, M."
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- ItemClinical perspectives on treatment of rifampicin-resistant/multidrug-resistant TB(International Union Against Tuberculosis and Lung Disease, 2020-11) Cox, V.; McKenna, L.; Acquah, R.; Reuter, A.; Wasserman, S.; Vambe, D.; Ustero, P.; Udwadia, Z.; Trivino-Duran, L.; Tommasi, M.; Skrahina, A.; Seddon, J. A.; Rodolfo, R.; Rich, M.; Padanilam, X.; Oyewusi, L.; Ohler, L.; Lungu, P.; Loveday, M.; Khan, U.; Khan, P.; Hughes, J.; Hewison, C.; Guglielmetti, L.; Furin, J.Rapid diagnostics, newer drugs, repurposed medications, and shorter regimens have radically altered the landscape for treating rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB). There are multiple ongoing clinical trials aiming to build a robust evidence base to guide RR/MDR-TB treatment, and both observational studies and programmatic data have contributed to advancing the treatment field. In December 2019, the WHO issued their second ‘Rapid Communication´ related to RR-TB management. This reiterated their prior recommendation that a majority of people with RR/MDR-TB receive all-oral treatment regimens, and now allow for specific shorter duration regimens to be used programmatically as well. Many TB programs need clinical advice as they seek to roll out such regimens in their specific setting. In this Perspective, we highlight our early experiences and lessons learned from working with National TB Programs, adult and pediatric clinicians and civil society, in optimizing treatment of RR/MDR-TB, using shorter, highly-effective, oral regimens for the majority of people with RR/MDR-TB.
- ItemNeonatal, infant and child health in South Africa : reflecting on the past towards a better future(Health & Medical Publishing Group, 2019-12-05) Goga, A.; Feucht, U.; Zar, H. J.; Vanker, A.; Wiysonge, C. S.; McKerrow, N.; Wright, C. Y.; Loveday, M.; Odendaal, W.; Ramokolo, V.; Ramraj, T.; Bamford, L.; Green, R. J.; Pillay, Y.; Nannan, N.Although the neonatal mortality rate in South Africa (SA) has remained stagnant at 12 deaths per 1 000 live births, the infant and under-5 mortality rates have significantly declined since peaking in 2003. Policy changes that have influenced this decline include policies to prevent vertical HIV transmission, earlier treatment of children living with HIV, expanded immunisation policies, strengthening breastfeeding practices, and health policies to contain tobacco and sugar use. The Sustainable Development Goals (2016 - 2030) have shifted the focus from keeping children alive, as expressed in the Millennium Development Goals (1990 - 2015), to achieving optimal health through the ‘Survive, thrive and transform’ global agenda. This paper focuses on important remaining causes of childhood mortality and morbidity in SA, specifically respiratory illness, environmental pollution, tuberculosis, malnutrition and vaccine-preventable conditions. The monitoring of maternal and child health (MCH) outcomes is crucial, and has improved in SA through both the District Health Information and Civil Registration and Vital Statistics systems, although gaps remain. Intermittent surveys and research augment the routinely collected data. However, availability and use of local data to inform quality and effectiveness of care is critical, and this requires ownership at the collection point to facilitate local redress. Potential game changers to improve MCH outcomes include mobile health and community-based interventions. In SA, improved MCH remains a crucial factor for human capital development. There is a pressing need to focus beyond childhood mortality and to ensure that each child thrives.