Mphele Mulaudzi | University of Witwatersrand, Johannesburg, South Africa (original) (raw)
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Papers by Mphele Mulaudzi
Department of Health South Africa, 2014
The Committee on Morbidity and Mortality in Children under-five years (CoMMiC) is one of three na... more The Committee on Morbidity and Mortality in Children under-five
years (CoMMiC) is one of three national ministerial committees
continuously reviewing maternal, perinatal and childhood deaths
in South Africa. CoMMiC’s primary objective is the monitoring of
mortality and morbidity data in children younger than five years
in an effort to reduce deaths and improve the health of young
children. The committee is also tasked with improving clinical
governance and assisting in the development of appropriate
standards of health care for South African children. This is the
committee’s second comprehensive report and covers the
triennium 2011 to 2013.
This report is being presented recognising that there is just over
a year left for countries to achieve the United Nations Millennium
Development Goals (MDGs). Four of the MDGs are directly
relevant to children, with MDG 4 specifically calling for a two-third
reduction in the under-five mortality rate between 1990 and
2015. This report provides an opportunity to reflect on the
country’s past and recent child health related achievements and
performance, and to deliberate on, and recommend an
appropriate post-2015 agenda.
The number of under-five deaths has declined from approximately
60 000 in 2008 to 38 000 in 2012. Although this translates into
about 60 fewer child deaths per day in 2012 than in 2008, it still
means that more than 100 under five children died each day in
2012.
Acta Paediatrica, 2019
It is of critical importance to have internationally constructed tools to address early childhood... more It is of critical importance to have internationally constructed tools to address early childhood development. The aim of this second phase of a two-phase study was to examine the sensitivity and specificity of the Guide for Monitoring Child Development (GMCD) in identifying developmental delay in four diverse countries. The first phase of this 2011-2015 back-to-back study included 4949 children up to 42 months of age from primary healthcare centres in Argentina, India, South Africa and Turkey. Distribution curves were generated to show the ages when the children attained GMCD milestones and those that could be used across sexes and countries were placed in age ranges corresponding to the 85th and 97th percentile point estimates. Phase two examined a separately recruited sample of children in those countries to determine sensitivity and specificity of the GMCD. The validation phase of the 85 milestones in the GMCD identified delayed development in 30% of the 1731 children in the four countries. The sensitivity and specificity ranged from 0.71-0.94 and 0.69-0.82, respectively, for the total sample and the different age groups. The GMCD standardised in four diverse countries has appropriate accuracy for identification of children with developmental delay. Format: Abstract 1 2 3 4 1 2 1 1 5 5 5 6 6
South African Journal of Child Health, 2008
Introduction: Child health care Problem Identification Programme (Child PIP) aims to improve qual... more Introduction: Child health care Problem Identification Programme (Child
PIP) aims to improve quality of care in the health system of South Africa
by death auditing.
Methods: An audit of death of children less than 18 yrs from January 2005 to Dec 2006 was done at 26 hospitals in South Africa using Child PIP. This report focuses on the impact of HIV. Data have been analysed using the Child PIP software
Results: There were 3848 death audited from 56 146 admissions with In-hospital case fatality rate of 6.2%. Regarding the ages 60% were less than a year, 29% were underweight for age and 35% had severe malnutrition. The major causes of death were pneumonia (18%), septicaemia (15%) diarrhoea (12%), tuberculosis (9.2%) and pnuemocystis jeroveci pnuemonia (8.3%). Only 12% received single dose nevirapine at birth and in 52% it was unknown. Co-trimoxazole prophylaxis was given to only 22% and in 39% it was unknown. There were 33% with HIV World Health Organization clinical stage IV and 16% stage III. Only 4% were on HAART at the time of death.
Conclusion: The data show that half of the children dying in hospitals have
symptomatic HIV disease while less than 20% had documented proof
of benefit from the PMTCT and Comprehensive Care Management
and Treatment (CCMT) programme for HIV. We, therefore, recommend
documentation on the Road To Health Card for better health care provision of children and for the data to be used to advocate for more resources for PMTCT and paediatric ARV programme. The data also show that Child PIP can be used to assist in monitoring PMTCT and CCMT programme
South African health review, 2015
Child mortality is generally credited as a surrogate marker for the quality of care within a heal... more Child mortality is generally credited as a surrogate marker for the quality of care within a health service. However, if mortality rates are to be used as an indicator of quality of care, or to monitor and evaluate the effectiveness of programmes aimed at improving child health and the quality of health care, it is critical that this data is accurate. The quality of data routinely collected in the South African health system
is extremely variable. While data from primary health care clinics are generally good, that from hospitals is poor and data from the vital registration process is often incomplete.
This chapter describes five data sources currently in use in South Africa that assist in the monitoring of child mortality rates. In order to facilitate an improvement in the quality of these datasets, the available data has been used to present a profile of child mortality in 2007.
The year 2007 has been selected as this is the most recent year for which data from the death registration programme are available and is therefore the only year for which data are available from all five data sources. It is accepted that these data are incomplete and that some datasets have improved in subsequent years. However, by using these data the authors hope to stimulate reflection on the data as well as to
precipitate improved data collection.
Diabetes, 2017
Neonatal diabetes is frequently part of a complex syndrome with extrapancreatic features: 18 gene... more Neonatal diabetes is frequently part of a complex
syndrome with extrapancreatic features: 18 genes
causing syndromic neonatal diabetes have been identified
to date. There are still patients with neonatal diabetes
who have novel genetic syndromes. We performed exome
sequencing in a patient and his unrelated, unaffected
parents to identify the genetic etiology of a syndrome
characterized by neonatal diabetes, sensorineural deafness,
and congenital cataracts. Further testing was performed
in 311 patients with diabetes diagnosed before
1 year of age in whom all known genetic causes had been
excluded.We identified 5 patients, including the initial case,
with three heterozygous missense mutations in WFS1 (4/5
confirmed de novo). They had diabetes diagnosed before
12 months (2 before 6 months) (5/5), sensorineural deafness
diagnosed soon after birth (5/5), congenital cataracts
(4/5), and hypotonia (4/5). In vitro studies showed that
these WFS1 mutations are functionally different from the
known recessive Wolfram syndrome–causing mutations,
as they tend to aggregate and induce robust endoplasmic
reticulum stress. Our results establish specific dominant
WFS1 mutations as a cause of a novel syndrome including
neonatal/infancy-onset diabetes, congenital cataracts,
and sensorineural deafness. This syndrome has a discrete
pathophysiology and differs genetically and clinically from
recessive Wolfram syndrome.
J Pediatr Perinatol Child Health, 2019
South Africa is one of the countries in which neonatal mortality has remained the same or decreas... more South Africa is one of the countries in which neonatal mortality has remained the same or decreased slowly over the past 20 years. Many newborns are discharged after birth and readmitted within a few days. The Integrated management of childhood and neonate illness (IMCNI) guidelines uses seven danger signs to identify sick young infants. Aim: The aim of the study was to determine the profile and outcome of neonates admitted to the general paediatric wards at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methodology: Audit of all newborns (<28days) admitted to the general wards from 1 Results: A total of 75 neonates were admitted with a mean weight of 3.2 kg (SD 0.65). The majority of neonates 41/75 (54.6%) were male and 21/75 (28%) were Human Immunodeficiency Virus (HIV)-exposed. In the HIV-exposed group only 16/21 (76%) were on HIV prophylaxis. The most important clinical signs were tachypnoea (RR>60) 34 (46.6%) and jaundice 30 (41.1%). Most neonates, 45 (61%) were referred from the local clinic. The most common diagnoses were bronchopneumonia (BRPN) 22 (29.3%), neonatal sepsis (NNS) 27 (36%) and jaundice 20 (26.7%). Two patients died (2.7%) from NNS and BRPN. Conclusions: A proportion of the neonates are admitted from home to the general paediatric ward with mostly NNS, Journal of Pediatrics, Perinatology and Child Health 50 BRPN and jaundice. Although the mortality is low, admission to a neonatal ward may be more appropriate. IMCNI guidelines remain the most sensitive indicator of the need for admission, and "routine" investigations are often a non-contributor.
Lancet Global health, 2018
Background Knowledge about typical development is of fundamental importance for understanding and... more Background Knowledge about typical development is of fundamental importance for understanding and promoting child health and development. We aimed to ascertain when healthy children in four culturally and linguistically different countries attain developmental milestones and to identify similarities and differences across sexes and countries.
Lancet Global Health, 2008
Lancet Global health, 2018
Background The Sustainable Development Goals (SDGs) mandate systematic monitoring of the health a... more Background The Sustainable Development Goals (SDGs) mandate systematic monitoring of the health and wellbeing of all children to achieve optimal early childhood development. However, global epidemiological data on children with developmental disabilities are scarce. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 provides a comprehensive assessment of prevalence and years lived with disability (YLDs) for development disabilities among children younger than 5 years in 195 countries and territories from 1990 to 2016.
Books by Mphele Mulaudzi
Department of Health South Africa, 2014
The Committee on Morbidity and Mortality in Children under-five years (CoMMiC) is one of three na... more The Committee on Morbidity and Mortality in Children under-five
years (CoMMiC) is one of three national ministerial committees
continuously reviewing maternal, perinatal and childhood deaths
in South Africa. CoMMiC’s primary objective is the monitoring of
mortality and morbidity data in children younger than five years
in an effort to reduce deaths and improve the health of young
children. The committee is also tasked with improving clinical
governance and assisting in the development of appropriate
standards of health care for South African children. This is the
committee’s second comprehensive report and covers the
triennium 2011 to 2013.
This report is being presented recognising that there is just over
a year left for countries to achieve the United Nations Millennium
Development Goals (MDGs). Four of the MDGs are directly
relevant to children, with MDG 4 specifically calling for a two-third
reduction in the under-five mortality rate between 1990 and
2015. This report provides an opportunity to reflect on the
country’s past and recent child health related achievements and
performance, and to deliberate on, and recommend an
appropriate post-2015 agenda.
The number of under-five deaths has declined from approximately
60 000 in 2008 to 38 000 in 2012. Although this translates into
about 60 fewer child deaths per day in 2012 than in 2008, it still
means that more than 100 under five children died each day in
2012.
Acta Paediatrica, 2019
It is of critical importance to have internationally constructed tools to address early childhood... more It is of critical importance to have internationally constructed tools to address early childhood development. The aim of this second phase of a two-phase study was to examine the sensitivity and specificity of the Guide for Monitoring Child Development (GMCD) in identifying developmental delay in four diverse countries. The first phase of this 2011-2015 back-to-back study included 4949 children up to 42 months of age from primary healthcare centres in Argentina, India, South Africa and Turkey. Distribution curves were generated to show the ages when the children attained GMCD milestones and those that could be used across sexes and countries were placed in age ranges corresponding to the 85th and 97th percentile point estimates. Phase two examined a separately recruited sample of children in those countries to determine sensitivity and specificity of the GMCD. The validation phase of the 85 milestones in the GMCD identified delayed development in 30% of the 1731 children in the four countries. The sensitivity and specificity ranged from 0.71-0.94 and 0.69-0.82, respectively, for the total sample and the different age groups. The GMCD standardised in four diverse countries has appropriate accuracy for identification of children with developmental delay. Format: Abstract 1 2 3 4 1 2 1 1 5 5 5 6 6
South African Journal of Child Health, 2008
Introduction: Child health care Problem Identification Programme (Child PIP) aims to improve qual... more Introduction: Child health care Problem Identification Programme (Child
PIP) aims to improve quality of care in the health system of South Africa
by death auditing.
Methods: An audit of death of children less than 18 yrs from January 2005 to Dec 2006 was done at 26 hospitals in South Africa using Child PIP. This report focuses on the impact of HIV. Data have been analysed using the Child PIP software
Results: There were 3848 death audited from 56 146 admissions with In-hospital case fatality rate of 6.2%. Regarding the ages 60% were less than a year, 29% were underweight for age and 35% had severe malnutrition. The major causes of death were pneumonia (18%), septicaemia (15%) diarrhoea (12%), tuberculosis (9.2%) and pnuemocystis jeroveci pnuemonia (8.3%). Only 12% received single dose nevirapine at birth and in 52% it was unknown. Co-trimoxazole prophylaxis was given to only 22% and in 39% it was unknown. There were 33% with HIV World Health Organization clinical stage IV and 16% stage III. Only 4% were on HAART at the time of death.
Conclusion: The data show that half of the children dying in hospitals have
symptomatic HIV disease while less than 20% had documented proof
of benefit from the PMTCT and Comprehensive Care Management
and Treatment (CCMT) programme for HIV. We, therefore, recommend
documentation on the Road To Health Card for better health care provision of children and for the data to be used to advocate for more resources for PMTCT and paediatric ARV programme. The data also show that Child PIP can be used to assist in monitoring PMTCT and CCMT programme
South African health review, 2015
Child mortality is generally credited as a surrogate marker for the quality of care within a heal... more Child mortality is generally credited as a surrogate marker for the quality of care within a health service. However, if mortality rates are to be used as an indicator of quality of care, or to monitor and evaluate the effectiveness of programmes aimed at improving child health and the quality of health care, it is critical that this data is accurate. The quality of data routinely collected in the South African health system
is extremely variable. While data from primary health care clinics are generally good, that from hospitals is poor and data from the vital registration process is often incomplete.
This chapter describes five data sources currently in use in South Africa that assist in the monitoring of child mortality rates. In order to facilitate an improvement in the quality of these datasets, the available data has been used to present a profile of child mortality in 2007.
The year 2007 has been selected as this is the most recent year for which data from the death registration programme are available and is therefore the only year for which data are available from all five data sources. It is accepted that these data are incomplete and that some datasets have improved in subsequent years. However, by using these data the authors hope to stimulate reflection on the data as well as to
precipitate improved data collection.
Diabetes, 2017
Neonatal diabetes is frequently part of a complex syndrome with extrapancreatic features: 18 gene... more Neonatal diabetes is frequently part of a complex
syndrome with extrapancreatic features: 18 genes
causing syndromic neonatal diabetes have been identified
to date. There are still patients with neonatal diabetes
who have novel genetic syndromes. We performed exome
sequencing in a patient and his unrelated, unaffected
parents to identify the genetic etiology of a syndrome
characterized by neonatal diabetes, sensorineural deafness,
and congenital cataracts. Further testing was performed
in 311 patients with diabetes diagnosed before
1 year of age in whom all known genetic causes had been
excluded.We identified 5 patients, including the initial case,
with three heterozygous missense mutations in WFS1 (4/5
confirmed de novo). They had diabetes diagnosed before
12 months (2 before 6 months) (5/5), sensorineural deafness
diagnosed soon after birth (5/5), congenital cataracts
(4/5), and hypotonia (4/5). In vitro studies showed that
these WFS1 mutations are functionally different from the
known recessive Wolfram syndrome–causing mutations,
as they tend to aggregate and induce robust endoplasmic
reticulum stress. Our results establish specific dominant
WFS1 mutations as a cause of a novel syndrome including
neonatal/infancy-onset diabetes, congenital cataracts,
and sensorineural deafness. This syndrome has a discrete
pathophysiology and differs genetically and clinically from
recessive Wolfram syndrome.
J Pediatr Perinatol Child Health, 2019
South Africa is one of the countries in which neonatal mortality has remained the same or decreas... more South Africa is one of the countries in which neonatal mortality has remained the same or decreased slowly over the past 20 years. Many newborns are discharged after birth and readmitted within a few days. The Integrated management of childhood and neonate illness (IMCNI) guidelines uses seven danger signs to identify sick young infants. Aim: The aim of the study was to determine the profile and outcome of neonates admitted to the general paediatric wards at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methodology: Audit of all newborns (<28days) admitted to the general wards from 1 Results: A total of 75 neonates were admitted with a mean weight of 3.2 kg (SD 0.65). The majority of neonates 41/75 (54.6%) were male and 21/75 (28%) were Human Immunodeficiency Virus (HIV)-exposed. In the HIV-exposed group only 16/21 (76%) were on HIV prophylaxis. The most important clinical signs were tachypnoea (RR>60) 34 (46.6%) and jaundice 30 (41.1%). Most neonates, 45 (61%) were referred from the local clinic. The most common diagnoses were bronchopneumonia (BRPN) 22 (29.3%), neonatal sepsis (NNS) 27 (36%) and jaundice 20 (26.7%). Two patients died (2.7%) from NNS and BRPN. Conclusions: A proportion of the neonates are admitted from home to the general paediatric ward with mostly NNS, Journal of Pediatrics, Perinatology and Child Health 50 BRPN and jaundice. Although the mortality is low, admission to a neonatal ward may be more appropriate. IMCNI guidelines remain the most sensitive indicator of the need for admission, and "routine" investigations are often a non-contributor.
Lancet Global health, 2018
Background Knowledge about typical development is of fundamental importance for understanding and... more Background Knowledge about typical development is of fundamental importance for understanding and promoting child health and development. We aimed to ascertain when healthy children in four culturally and linguistically different countries attain developmental milestones and to identify similarities and differences across sexes and countries.
Lancet Global Health, 2008
Lancet Global health, 2018
Background The Sustainable Development Goals (SDGs) mandate systematic monitoring of the health a... more Background The Sustainable Development Goals (SDGs) mandate systematic monitoring of the health and wellbeing of all children to achieve optimal early childhood development. However, global epidemiological data on children with developmental disabilities are scarce. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 provides a comprehensive assessment of prevalence and years lived with disability (YLDs) for development disabilities among children younger than 5 years in 195 countries and territories from 1990 to 2016.