Background. The Foundation for Professional Development (FPD) collects information annually on HIV/AIDS service provision and estimates service needs in the City of Tshwane Metropolitan Municipality (CTMM).
Methods. Antiretroviral therapy (ART) data from the Department of Health and Statistics South Africa (SSA) mid-year population estimates were used to approximate the ART need among adults in the CTMM.
Results.According to SSA data, ART need decreased dramatically from 2010 to 2011 and was lower than the number of adults receiving ART. Although the noted difference was probably due to changes in the calculations by SSA, no detailed or confirmed explanation could be offered.
Conclusions. We provide a constructive contribution to the discussion regarding the use of model-derived estimates of ART need.
Background. Many patients present to an emergency centre (EC) with problems that could be managed at primary healthcare (PHC) level. This has been noted at George Provincial Hospital in the Western Cape province of South Africa.
Aim. In order to improve service delivery, we aimed to determine the patient-specific reasons for accessing the hospital EC with PHC problems.
Methods. A descriptive study using a validated questionnaire to determine reasons for accessing the EC was conducted among 277 patients who were triaged as green (routine care), using the South African Triage Score. The duration of the complaint, referral source and appropriateness of referral were recorded.
Results. Of the cases 88.2% were self-referred and 30.2% had complaints persisting for more than a month. Only 4.7% of self-referred green cases were appropriate for the EC. The three most common reasons for attending the EC were that the clinic medicine was not helping (27.5%), a perception that the treatment at the hospital is superior (23.7%), and that there was no PHC service after-hours (22%).
Conclusions. Increased acceptability of the PHC services is needed. The current triage system must be adapted to allow channelling of PHC patients to the appropriate level of care. Strict referral guidelines are needed.
Background. Potent immunosuppressive therapy is standard treatment for inflammatory bowel disease (IBD) but carries a risk of reactivating latent tuberculosis (TB). No data exist on the burden of TB in South African patients with IBD.
Objective. To evaluate the burden of TB in IBD patients attending a large tertiary IBD clinic.
Methods. Data pertaining to patients attending the Groote Schuur Hospital IBD clinic were retrospectively analysed. Data were extracted from an existing IBD database, patient notes, the National Health Laboratory Services database and chest X-ray analysis.
Results. Of 614 patients, 72 (11.7%) were diagnosed with TB; 40 (55.6%) developed TB prior to the diagnosis of IBD. On regression analysis, coloured IBD patients were at increased risk for TB development (p=0.004, odds ratio (OR) 3.57, 95% confidence interval (CI) 1.49 - 8.56), as were patients with extensive Crohn's disease (CD) compared with those with less extensive disease (p=0.001, OR 2.84, 95% CI 1.27 - 6.33). No other risk factors, including the use of immunosuppressive agents, were identified for the development of TB.
Conclusions. Of over 600 patients, 12% had TB either before or after IBD diagnosis. The high rate of previous TB and positive association with ethnicity probably reflect the high burden of TB in a socio-economically disadvantaged community. We recommend that IBD patients should be screened actively and monitored for TB when immunosuppressive medications are used.
Xpert MTB/RIF (Xpert) offers rapid detection of Mycobacterium tuberculosis and rifampicin resistance. However, little is known about routine point-of-care (POC) use in high TB/HIV burden settings. We describe our experiences of launching Xpert as the POC, initial diagnostic for all TB suspects at a primary healthcare clinic in Johannesburg, South Africa. Noted important benefits of POC Xpert were fewer clinic visits, rapid detection of TB and rifampicin resistance, real-time assessment of accompanying household members of new TB cases, and increased staff motivation for TB screening.
While Xpert results are available within 2 hours, actual turnaround time was longer for most patients because of sample preparation time and clinic congestion. Consequently, a GX4 instrument did not result in a 16-test capacity during an 8-hour working day, and some patients did not receive same-day results. Loss to follow-up was an unforeseen challenge, overcome by clinic flow changes, marking of clinic files, documenting patientsâ?? physical description and locating patients in the clinic by cell phone. Staff with high school education successfully performed the assay after minimal training.
Human resource requirements were considerable, with a minimum of 2 staff needed to supervise sputum collection, process sputum, perform assays, and document results for an average of 15 TB suspects daily. POC placement of the instrument transferred logistical responsibilities to the clinic, including quality assurance, maintenance, stock control and cartridge disposal.
POC use of Xpert is feasible at the primary healthcare level but must be accompanied by financial, operational and logistical support.
Background. Severe anaemia (haemoglobin concentration < 50 g/l) is a major cause of paediatric hospital admissions and deaths in the tropics.
Objectives.To examine the pattern and predictors of mortality among severely anaemic children.
Methods. A prospective cross-sectional study was conducted among children with severe anaemia at the Children's Emergency Room of the University Teaching Hospital, Ado-Ekiti, Nigeria. Sociodemographic characteristics, clinical features, laboratory findings and co-morbidities of the survivors and those who died were compared by logistic regression analysis.
Results. Of the 1 735 children admitted, 311 (17.9%) had severe anaemia, with a case-fatality rate of 9.3%. The presence of respiratory distress (95% confidence interval (CI) 2.1 - 3.6, p=0.031); acidosis (95% CI 1.8 - 2.7, p=0.010); coma (95% CI 0.1 - 0.3, p=0.001); hypotension (95% CI 2.0 - 4.2, p=0.020); and bacteraemia (95% CI 3.1 - 3.9; p=0.008) were the significant independent predictors of death with regression analysis.
Conclusion. Early recognition with prompt and appropriate anticipatory intervention is essential to reduce mortality from severe anaemia.