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- Volume 21, Issue 3, 2006
Southern African Journal of Epidemiology and Infection - Volume 21, Issue 3, 2006
Volume 21, Issue 3, 2006
Author Shan NaidooSource: Southern African Journal of Epidemiology and Infection 21 (2006)More Less
The Public Health Association of South Africa (PHASA) successfully held its third Public Health Conference in May 2006. The theme of the conference was Making Health Systems Work and was deliberately chosen by the scientific committee to highlight the greatest challenge facing us in this country and indeed the continent.
Source: Southern African Journal of Epidemiology and Infection 21, pp 70 –147 (2006)More Less
Source: Southern African Journal of Epidemiology and Infection 21, pp 150 –151 (2006)More Less
Multidrug-resistant(MDR) tuberculosis (TB), defined as TB caused by strains resistant to both isoniazid and rifampicin, has for many years been a well recognised but poorly defined problem in South Africa and included an outbreak involving six patients infected with an MDR strain resistant to isoniazid and rifampicin : ethambutol and pyrazinamide, as well as ofloxacin and three other second-line drugs at Sizwe Hospital for Tropical Diseases as far back as 1997. Systematic surveillance of drug resistance of Mycobacterium tuberculosis isolates in South Africa conducted by the MRC in 2001 and 2002 according to criteria adopted by the Global Project on Anti-Tuberculosis Drug Resistance Surveillance (GPDRS) of the WHO and adopting a multistage cluster sampling strategy with samples representing entire provinces, showed relatively low percentages of 0.9% to 2.6% primary MDR cases in the various provinces with a small but significant increase of cases from 1.5% to 2.6% in Mpumalanga (the only province where the surveillance was repeated).
Source: Southern African Journal of Epidemiology and Infection 21, pp 152 –160 (2006)More Less
Objective : To write a guideline for the management and prevention of nosocomial infections in South Africa in view of the following : i) nosocomial infections are a common and increasing problem globally, including South Africa; ii) widely varying standards of prevention and management of these important infections; iii) increasing and emerging antimicrobial resistance among commonly isolated pathogens, and iv) the significant economic burden of these infections on the healthcare system as well as their impact on patient morbidity and mortality. The main aims of the guideline are to provide recommendations for the initial choice of antimicrobial agents and the appropriate management of these infections encompassing the following conditions : i) nosocomial pneumonia, healthcare-associated pneumonia and ventilator-associated pneumonia; (ii) nosocomial bloodstream infections; (iii) nosocomial intravascular infections; (iv) nosocomial urinary tract infections; (v) nsocomial intra-abdominal infections; and (vi) nosocomial surgical skin and soft-tissue infections.
Evidence : Working group of clinicians from relevant disciplines, following detailed literature review.
Recommendations : These include details of the likely pathogens, an appropriate diagnostic approach, antibiotic treatment options and appropriate preventive strategies.
Endorsement : The guideline document was endorsed by the South African Thoracic Society, the Critical Care Society of Southern Africa and the Federation of Infectious Diseases Societies of Southern Africa.
Guideline sponsor : The meeting of the Working Group and the guideline publication were sponsored by an unrestricted educational grant from Sanofi Aventis South Africa.
Antibiotic susceptibility patterns of anaerobic bacteria isolated in Pretoria, South Africa, during 2003-2004Source: Southern African Journal of Epidemiology and Infection 21, pp 161 –163 (2006)More Less
Antibiotic resistance amongst previously susceptible anaerobic bacteria has increased during the last decade, raising concerns about the choice of empirical therapy. In this study, Etest methodology and Clinical Laboratory Standards Institute guidelines were used for processing and interpretation of minimum inhibitory concentration values for anaerobic bacteria obtained over a one-year period from two teaching hospitals in Pretoria, South Africa. From the data obtained, the genera Bacteroides, Clostridium and Peptostreptococcus were most frequently isolated. The β-lactam/β-Iactamase inhibitor combination, piperacillin/tazobactam seems to be the superior choice as empiric therapy for suspected serious anaerobic infections in this setting. In addition, a definite increase in resistance against metronidazole was exhibited by isolates originating from invasive samples, making the drug an unlikely choice for future empiric therapy.
Immunisation coverage estimates by cluster sampling survey of children (aged 12-23 months) in Gauteng province, 2003Source: Southern African Journal of Epidemiology and Infection 21, pp 164 –169 (2006)More Less
Routine data using the district health information system indicated low immunisation coverage rates for Gauteng. The Guuteng Department of Health initiated a survey to verify coverage rates as immunisation and child health services are a priority for the province and immunisation is a corner stone of child health interventions. A standard Expanded Programme on immunisation (EPl) coverage survey with 30 randomly selected clusters with a minimum of seven children in each cluster was conducted in the province. The survey found that 79.1% (CI 71-87) of children were fully immunised. However, only just over 50% of children were immunised on time. Most children were taken to public sector facilities for immunisation services and there was no difference in coverage rates between the children who used the public sector compared to those who used the private sector. There were also no differences found by social class where housing type was used as a proxy for social class.
Author N. MalanguSource: Southern African Journal of Epidemiology and Infection 21, pp 170 –172 (2006)More Less
Community pharmacies in Pretoria were surveyed to determine the stocking of 19 antidotes in these pharmacies and to establish the reasons/or non-availability. A cross-sectional survey of community pharmacies located in Pretoria was conducted. These pharmacies were identified through a list provided by the South African Pharmacy Council. Questionnaires were sent to all 64 pharmacies listed. Thirty (47%) of 64 questionnaires were completed by pharmacists at these pharmacies. This study found a great variability in the stocking of antidotes. Twelve (40%) out of 30 pharmacies stocked no antidotes at all. None of the pharmacies kept all antidotes, although one kept 11 (57.9%) of the 19 antidotes listed. With regard to individual antidotes, the most stocked were sodium polystyrene (67%), sodium bicarbonate (56.7%), folinic acid (50%), activated charcoal (40%), IV-acetylcysteine (33.3%), ipecacuanha (33.3%), disulfiram (33.3%), citric acid (26. 7%) and atropine (26.7%). The reasons for the unavailability of antidotes at the time of the survey were that the stock was not ordered (43.3%), the stock was ordered but not delivered from suppliers (45.0%), the previous stock had expired unused (16. 7%), and that the pharmacies were too close to hospitals which kept antidotes (40%). In conclusion, the community pharmacies surveyed kept an insufficient and inappropriate range of antidotes. There is a need for these facilities to improve their upkeep of antidotes.
Source: Southern African Journal of Epidemiology and Infection 21, pp 173 –177 (2006)More Less
This cross-sectional study focused on the detection of nematode eggs in the sandpits of registered pre-school facilities in the Bloemfontein area. Schools were drawn from a list of registered pre-school facilities in the Bloemfontein urea. Each sampled pre-school completed a questionnaire concerning the maintenance and usage of their sandpit(s). Sand samples were taken from respective sandpits and a method for the processing and microscopic investigation of the sand samples was adapted from Düwel. No parasitic elements were found at eight of the 22 pre-schools tested for nematode contamination. Toxocara species proved to he the dominant parasite eggs found in the sandpits (present at 12 facilities). The most successful frequency of sand replacement was shown to be six-monthly and the most effective treatment was methods incorporating the use of chlorine, either alone or in combination with salt and/or a disinfectant. The frequency of sand treatment, as well as covering of the sand pit, appeared to have little bearing on the prevention of contamination of the sand. Of the fenced in sand pits, 42.9% tested negative for nematode contamination, whereas only 25% of the non-fenced in sand pits tested negative. There was no marked improvement found in parasite contamination of sandpits inspected by health officials. Nematode contamination of sand pits in Bloemfontein pre-schools is a relevant concern. A protocol should he developed with regards to inspection of the sand pits by health inspectors and methods of treatment of the sand by the various institutions.