Papers by Elizabeth Molyneux
Archives of Disease in Childhood, 2021
ObjectiveTo determine whether a national quality improvement programme implementing continuous po... more ObjectiveTo determine whether a national quality improvement programme implementing continuous positive airway pressure (CPAP) at government hospitals in Malawi improved outcomes for neonates prioritised by an algorithm recommending early CPAP for infants weighing 1.0–1.3 kg (the 50th percentile weight at 30 weeks’ gestation).DesignThe analysis includes neonates admitted with respiratory illness for 5.5 months before CPAP was introduced (baseline period) and for 15 months immediately after CPAP was implemented (implementation period). A follow-up data analysis was completed for neonates treated with CPAP for a further 11 months.Setting and patientsNeonates with admission weights of 1.0–1.3 kg before (106 neonates treated with nasal oxygen) and after implementation of CPAP (153 neonates treated with nasal oxygen, 103 neonates treated with CPAP) in the newborn wards at Malawi government district hospitals. Follow-up analysis included 87 neonates treated with CPAP.InterventionNeonatal ...
Oxford Textbook of Global Health of Women, Newborns, Children, and Adolescents
The focus is on the most common non-communicable diseases (NCDs) in low and middle-income countri... more The focus is on the most common non-communicable diseases (NCDs) in low and middle-income countries, including asthma, cancer, diabetes, rheumatic fever, and sickle cell disease. It reviews the burden of disease, the global targets, and the challenges in prevention, screening, diagnosis, and management, largely due to limited resources and their low priority relative to other conditions. The chapter proposes a life-course approach to the prevention of adult NCDs due to tobacco use, alcohol abuse, unhealthy diet, and lack of physical activity, as lifestyle habits are often established in childhood and adolescence. The importance of government policies to prioritise prevention of NCDs by limiting the sale of harmful products using tax policies and the use of the revenue generated to promote healthy lifestyle and to strengthen health systems is emphasised.
African Journal of Emergency Medicine, 2017
used to define shock, including the stringent definition used by WHO (presence of cold hands or f... more used to define shock, including the stringent definition used by WHO (presence of cold hands or feet with both capillary refill time of 4 or more seconds and a weak, fast pulse). Of the children in this category who received fluid boluses, 48% died, compared to 20% in the no bolus arm, an absolute risk difference of 28 percent (95% CI 3.4% - 52.5%) (Appendix Table 5)1. Table 5 also shows increased mortality among children with moderate hypotension (192 children) and those with any one of the WHO clinical criteria for shock who received bolus therapy (1890 children). Second, final clinical diagnoses are shown in Appendix Table 2, Professor Duke’s concern regarding children with oxygen saturation <90%, ‘many of whom probably had pneumonia’, is countered by the greater mortality associated with boluses among children without hypoxaemia than in those with hypoxaemia: risk ratio 1.91 vs 1.09 (p=0.04 for heterogeneity). Finally, Professor Duke expresses concern that the protocol amendm...
Journal of Cancer Policy, 2018
Developmental medicine and child neurology, Sep 7, 2018
British journal of haematology, Jun 1, 2017
Cancer is increasingly important in low and middle-income settings where infectious diseases are ... more Cancer is increasingly important in low and middle-income settings where infectious diseases are declining. Childhood cancers treated in well-resourced centres have excellent outcomes with more than 80% survival. This success is not reflected in low-income settings where challenges involve every step on the care pathway. Access to diagnosis, delayed presentation, advanced disease, co-morbidities and underlying malnutrition make treatment difficult. Treatments are costly for impoverished families. Yet, the common haematological malignancies (Burkitt lymphoma, Hodgkin lymphoma, non Hodgkin lymphoma) are relatively easy to diagnose and, when managed with simple chemotherapy protocols, give limited but good results. As funding becomes available for cancer research we must ensure that the care and cure of these children is top of the agenda. There is already evidence of improved outcomes in middle-income countries. For others there is a long journey ahead.
The Journal of antimicrobial chemotherapy, Jan 10, 2015
Current guidelines for dosing of anti-TB drugs in children advocate higher doses for rifampicin a... more Current guidelines for dosing of anti-TB drugs in children advocate higher doses for rifampicin and isoniazid despite limited availability of paediatric data on the pharmacokinetics of these drugs, especially from Africa, where the burden of childhood disease remains high. Thirty children aged 6 months to 15 years underwent intensive pharmacokinetic sampling for first-line anti-TB drugs at Queen Elizabeth Central Hospital, Blantyre, Malawi. Rifampicin, isoniazid, pyrazinamide and ethambutol were dosed at 10, 5, 25 and 20 mg/kg, respectively. Plasma drug concentrations were determined using sensitive, validated bioanalytical methods and summary pharmacokinetic parameters were estimated using non-compartmental analysis. The median (IQR) Cmax was 2.90 (2.08-3.43), 3.37 (2.55-4.59), 34.60 (32.30-40.90) and 1.20 (0.85-1.68) mg/L while the median (IQR) AUC0-∞ was 16.92 (11.10-22.74), 11.48 (7.35-18.93), 333.50 (279.50-487.2) and 8.65 (5.96-11.47) mg·h/L for rifampicin, isoniazid, pyrazina...
Emergency Medicine Australasia, 2009
BMC Medical Genomics, 2012
Background High throughput technologies offer insight into disease processes and heightens opport... more Background High throughput technologies offer insight into disease processes and heightens opportunities for improved diagnostics. Using transcriptomic analyses, we aimed to discover and to evaluate the clinical validity of a combination of reliable and functionally important biomarkers of serious bacterial infection (SBI). Methods We identified three previously reported biomarkers of infection (neutrophil gelatinase-associated lipocalin (NGAL), granulysin and resistin) and measured gene expression using quantitative real-time PCR. Protein products related to the three transcripts were measured by immunoassays. Results Relative gene expression values of NGAL and resistin were significantly increased, and expression of granulysin significantly decreased in cases compared to controls. Plasma concentrations of NGAL and resistin were significantly increased in children with confirmed SBI compared to children with no detectable bacterial infection (NBI), and to controls (287 versus 128 v...
Audiological Medicine, 2004
... HOPE FORSYTH1, FANNY KALUMBI3, ETHEL MPHAKA3, MADALITSO TEMBO2,3, JAMES MWENECHANYA2,3, KONDO... more ... HOPE FORSYTH1, FANNY KALUMBI3, ETHEL MPHAKA3, MADALITSO TEMBO2,3, JAMES MWENECHANYA2,3, KONDOWANI KAYIRA2,3, LOYD BWANAISA2,3, ALFRED NJOBVU2,3, AMANDA WALSH3 AND ELISABETH MOLYNEUX2 ... Fortnum et al. ...
Infectious Agents and Cancer, 2010
Pediatric Blood & Cancer, 2012
Clinical Rheumatology, 2011
Cancers, 2021
Background: Endemic Burkitt lymphoma (eBL) is the most common childhood cancer in Africa and is l... more Background: Endemic Burkitt lymphoma (eBL) is the most common childhood cancer in Africa and is linked to Plasmodium falciparum (Pf) malaria infection, one of the most common and deadly childhood infections in Africa; however, the role of Pf genetic diversity is unclear. A potential role of Pf genetic diversity in eBL has been suggested by a correlation of age-specific patterns of eBL with the complexity of Pf infection in Ghana, Uganda, and Tanzania, as well as a finding of significantly higher Pf genetic diversity, based on a sensitive molecular barcode assay, in eBL cases than matched controls in Malawi. We examined this hypothesis by measuring diversity in Pf-serine repeat antigen-5 (Pfsera5), an antigenic target of blood-stage immunity to malaria, among 200 eBL cases and 140 controls, all Pf polymerase chain reaction (PCR)-positive, in Malawi. Methods: We performed Pfsera5 PCR and sequencing (~3.3 kb over exons II–IV) to determine single or mixed PfSERA5 infection status. The p...
African Journal of Emergency Medicine, 2015
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Papers by Elizabeth Molyneux