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Biomedical subjects

L A Wagstaff

Publications and source records attributed to L A Wagstaff.

At least 19 recordsLinked to original sources
PubMed1998

Vitamin A status does not influence neopterin production during illness or health in South African children.

Excessive interferon-gamma (IFN-gamma) production appears to be a primary immunological lesion in vitamin A-deficient experimental animals but comparable data from humans is lacking. We investigated IFN-gamma production in South African children by measurement of urinary excretion of neopterin, a product of IFN-gamma-activated monocytes or macrophages. Preschool children were examined during an acute inflammatory illness resulting from accidental ingestion of kerosene and they and a neighbourhood control child were examined 3 months later when well. Vitamin A status was assessed by the modified relative dose response (MRDR) test at 3 months and serum retinol and acute phase proteins were measured at both time points. Urinary neopterin was measured for forty cases in hospital, forty-six cases after recovery, and forty-one controls. Significantly increased neopterin excretion was seen following kerosene ingestion and in association with raised serum acute phase protein concentrations. There was no relationship between neopterin excretion at either time point and vitamin A status as assessed by MRDR test. Urinary neopterin was negatively correlated with serum retinol but no significant relationship was observed when acute phase protein concentrations were included in a multiple regression, suggesting the correlation was secondary to illness-induced changes in serum retinol. The results indicate that, contrary to what is observed in rodents under experimental conditions, poor vitamin A status is not associated with altered regulation of IFN-gamma production in children.

Acute Disease↗
PubMed1998

Urban community health workers: selection, training, practice and outcomes.

The role, desirability and success of community health workers is debated. Conflicting reports have highlighted important concerns and provided guidelines. Particular issues identified are the necessity for both community and health professional input to determine needs and to ensure an acceptable selection process, training, support and accountability. Such steps were followed in the Greater Soweto Maternal Child Project. These are described together with the results achieved. Eight trained Soweto community health workers centered at Chiawelo Clinic and providing home based and neighbourhood health care undertake supervised Tuberculosis treatment, tracing of immunisation defaulters, and health education based on GOBI FFF (Grant JP, UNICEF:1985;94) and "Facts for Life" (UNICEF 1989-1993). They form a link between the community and government health care services and also other available resources. Over a period of 26 months, working from their own homes, they provided 14,254 health related services and in addition undertook 14,501 neighbourhood home visits. They were responsible for 8,710 referrals to the clinic or other relevant agencies for assistance. Incremental training has included HIV/AIDS counselling, advice on family planning with regular report back sessions and discussions. Participatory management involves all major role players. The community health workers have the approval and support of the Local Soweto Health Authority, the Civic Association and the communities they serve. On completion of the project, all were redeployed into local health service posts where it is intended that they form the nucleus of an expanding service. Delegation of selected tasks allows for cost effective functioning of more highly trained staff, an improved service and better use of available resources.

Adult↗
PubMed1997

Toxic damage to the respiratory epithelium induces acute phase changes in vitamin A metabolism without depleting retinol stores of South African children.

Whereas there is much information concerning the effects of vitamin A status on response to infectious challenge, the effects of infection or trauma on vitamin A metabolism and status are less well documented. These relationships need to be understood to optimize clinical and public health programs to improve vitamin A status and health of children in less-developed countries. We measured acute changes in retinol and retinol-binding protein in 57 young South African children hospitalized following respiratory epithelial damage resulting from accidental ingestion of kerosene. In addition, vitamin A status, as measured by the modified relative dose response test, of these children 3 mo later was compared with that of neighborhood control children to determine whether their illness had depleted retinol stores. Plasma retinol was already significantly below control levels when children were admitted [geometric mean (95% CI): 0.57 micromol/L (0.48-0.67) compared with 1.15 micromol/L (1.02-1.30) for controls] and decreased further the following morning [0.38 micromol/L (0.31-0.46)]. Significant differences in retinol-binding protein were not detected until the next morning [5.99 mg/L (4.70-7.63) compared with 14.0 mg/L (11.8-16.6) for controls] and were not as large as the relative differences in retinol. This dissociation between changes in retinol and its binding protein suggests that there may be increased retinol uptake by certain tissues during the acute phase response. The proportion of case children (37/46, 80%) with inadequate liver retinol stores 3 mo after the illness was slightly, but not significantly (chi2 = 2.16, P = 0.14), greater than the proportion of control children (28/42, 67%). Acute respiratory illness therefore did not further deplete retinol stores in this population in which stores were already frequently inadequate.

Acute-Phase Proteins↗
PubMed1990

Measles, mumps and rubella immunization at nine months in a developing country.

The antibody responses and reactogenicity of a measles, mumps and rubella vaccine in 9-month-old and 15-month-old black children in South Africa were compared. The antibody response to the measles component was marginally better in the older group, but no differences were observed in the response to the mumps and rubella components. Reactogenicity was similar in the two age groups. Therefore it is possible that a trivalent measles, mumps and rubella vaccine can safely and effectively replace routine measles immunization at 9 months of age in this population. Whether routine immunization policy should incorporate such a vaccine depends on the extent of acceptance of measles vaccination. In urban populations of developing countries with high rates of measles immunization, routine vaccination at 9 months might interrupt circulating wild type rubella and provide sufficient herd immunity to protect susceptible women of childbearing age. It also should decrease significantly the complications associated with wild type mumps infection. The replacement of measles vaccine by a trivalent vaccine may be very cost-effective.

Black or African American↗
PubMed1989

Infant diarrhoea in Soweto--how much oral rehydration therapy?

In Soweto, infant morbidity and mortality from gastro-enteritis have markedly declined. Nevertheless, there were 1514 admissions to the Baragwanath Infant Gastro-enteritis Unit in a 12-month period (1985/6). Oral rehydration therapy (ORT) could be implemented with advantage not only as a life-saving strategy but for self-help management of milder diarrhoea. Surveys conducted in Soweto and at Baragwanath showed that 84 (22%) of 382 mothers/minders of children knew formulas for acceptable salt-and-sugar oral hydration solutions (OHS), although 203 (53%) claimed to have knowledge of ORT. One hundred and ten interviewees (29%) were aware of the desirability of giving extra fluid to a child with diarrhoea. A need exists for health educators to explain and ensure understanding of the basic concept of adequate fluid replacement that is fundamental to ORT. This important message may have been overshadowed by emphasis on choice of containers and different formulas with consequent confusion.

Adolescent↗
PubMed1988

Whither school health services for lower primary schoolchildren in Soweto?

Over 1,000 clinical examinations and screening procedures in Soweto lower primary schoolchildren revealed few significant health problems which had not previously been identified. Information from parents and teachers was of limited value. The study revealed that only a small percentage of children referred for further medical attention attended for investigation or treatment as advised. Most of the health problems found could well have been managed at a school-based primary care level. It would thus be desirable to modify and extend the role and functions of the school nurse. However, the effectiveness of so doing would depend on adequate training, the availability of personnel and the organisational structure of health care services.

Black or African American↗
PubMed1985

Clinical competence of paediatric primary health care nurses in Soweto.

Primary health care (PHC) nurses provide care at polyclinics in Soweto. Our study assessed nurse competence in the clinical detection of important respiratory signs in 337 consecutive paediatric patients with respiratory complaints. The patients were then independently re-examined by two paediatricians, one of whom was arbitrarily chosen as a 'standard doctor'. The standard doctor found 95 patients with important respiratory signs; nurses detected the same signs in 45 and the other doctor in 44 patients. Therefore nurses detected important signs as well as could be expected, considering the inter-observer variation between doctors. The nurses did, however, significantly overdiagnose one condition, follicular tonsillitis. Our results suggest that the Soweto paediatric PHC nurses detect clinical signs with as much accuracy as doctors. This study adds to the available evidence that adequately trained and supervised nurse practitioners can provide high-quality health care.

Clinical Competence↗
PubMed1982

Comparisons in the therapeutic management of Black paediatric outpatients by primary health care nurses and doctors.

Studies were conducted in 1977 and again in 1980 comparing the knowledge and information escorts of paediatric outpatients had about the child's illness and treatment after completing primary care consultations of various kinds. Primary health care nurses achieved the best communication as judged by answers to a questionnaire administered to the escorts by a social worker. Understanding was greater when patients were seen initially by doctors in the Department of Paediatrics outpatient clinic rather than by doctors in the Soweto polyclinics. Some of the associated factors are discussed.

Humans↗
PubMed1978

The changing role of doctors in the Soweto clinics' health care teams.

Delegation of common health problems and their management to specially trained primary health care nurses allows the clinic doctor in a health care team to employ his own skills and time more effectively. He may become an expert in comprehensive community health care or develop related research interests, and thus help to promote optimal health services relevant to the local situation.

Humans↗
PubMed1977

The paediatric primary health care nurse project in Soweto.

The in-service training of paediatric primary health care nurses at Baragwanath Hospital, and the implementation of this project with health care teams in the Soweto clinics, is discussed. Appropriately trained members of the community can provide better comprehensive primary care, and optimal use is made of available manpower. Similar schemes in other parts of the world are briefly considered.

Education, Nursing↗
PubMed1976

Nutrition knowledge in urban Blacks.

A simple questionnaire has been presented to Blacks at Baragwanath Hospital and in Soweto to test their current knowledge of basic nutrition and some related attitudes. The survey of 400 persons included nurses, schoolchildren, and a group of others whose standard of general education was lower. The vast majority had received nutrition instruction, were aware of basic requirements, and, given a free choice, could select reasonable diets. Fatness is no longer considered a desirable attribute in these urban Blacks but reasons for this vary.

Adolescent↗