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ObjectiveAntenatal anaemia is associated with increased peripartum transfusion requirement in South Africa. We studied whether HIV was associated with the response to treatment of iron-deficiency anaemia.DesignProspective cohort study.SettingHospital-based antenatal anaemia clinic in South Africa.SampleEqual-sized cohorts of pregnant women testing positive for HIV (HIV+) and testing negative for HIV (HIV-) with iron-deficiency anaemia.MethodsHaemoglobin trajectories of women with confirmed iron-deficiency anaemia (ferritin < 50 ng/ml) were estimated from the initiation of iron supplementation using mixed-effects modelling, adjusted for baseline HIV status, ferritin level, maternal and gestational ages and time-varying iron supplementation.Main outcome measuresHaemoglobin trajectories.ResultsOf 469 women enrolled, 51% were HIV+, 90% of whom were on antiretroviral therapy (with a mean CD4+ lymphocyte count of 403 cells/mm3 ). Anaemia diagnoses did not differ by HIV status. A total of 400 women with iron-deficiency anaemia were followed during treatment with oral or intravenous (6%) iron therapy. In multivariable analysis, haemoglobin recovery was 0.10 g/dl per week slower on average in women who were HIV+ versus women who were HIV- (P = 0.001), 0.01 g/dl per week slower in women with higher baseline ferritin (P < 0.001) and 0.06 g/dl per week faster in women who were compliant with oral iron therapy (P = 0.002).ConclusionsCompared with women who were HIV-, women who were HIV+ with iron-deficiency anaemia had slower but successful haemoglobin recovery with iron therapy. Earlier effective management of iron deficiency could reduce the incidence of peripartum blood transfusion.Tweetable abstractAmong pregnant women with iron-deficiency anaemia in South Africa, HIV slows haemoglobin recovery in response to oral iron therapy.

As fragmentation and oversize are critical to the economic viability of most mines, establishing the optimum size distribution is a high priority. Changes in geological conditions often mean that the optimum pattern and charge distribution for one bench will not suffice for subsequent benches, so it is necessary to develop processes which can deliver solutions as or before conditions become critical. At Ernest Henry copper-gold mine, in Queensland, which is affected by fracture-hosted groundwater and widely spaced, shallow-dipping joints, the establishment of these processes is well under way. Each key factor affecting fragmentation has been evaluated and measured, a benchmark established and trials and procedures implemented to identify the sources of oversize and reduce fragmentation. Preliminary modelling and observation indicated that trials should focus on drilling to design, improving explosives distribution, changing pattern orientation, improving initiation sequences and reducing the pre-conditioning of new faces., As fragmentation and oversize are critical to the economic viability of most mines, establishing the optimum size distribution is a high priority. Changes in geological conditions often mean that the optimum pattern and charge distribution for one bench will not suffice for subsequent benches, so it is necessary to develop processes which can deliver solutions as or before conditions become critical. At Ernest Henry copper-gold mine, in Queensland, which is affected by fracture-hosted groundwater and widely spaced, shallow-dipping joints, the establishment of these processes is well under way. Each key factor affecting fragmentation has been evaluated and measured, a benchmark established and trials and procedures implemented to identify the sources of oversize and reduce fragmentation. Preliminary modelling and observation indicated that trials should focus on drilling to design, improving explosives distribution, changing pattern orientation, improving initiation sequences and reducing the pre-conditioning of new faces.