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- Volume 24, Issue 1, 2009
Southern African Journal of Epidemiology and Infection - Volume 24, Issue 1, 2009
Volume 24, Issue 1, 2009
Author Lucille BlumbergSource: Southern African Journal of Epidemiology and Infection 24 (2009)More Less
The media need to be recognised as critical partners in outbreak response and management. They, in turn, should recognise their responsibilities. Mistrust, sensational headlines, incorrect information, information taken out of context, agendas to find fault with health authorities, searching for the 'story behind the story' and very often a journalist's inexperience in the health arena all influence the sharing of information and its public value.
Staphylococcus aureus from public hospitals in KwaZulu-Natal, South Africa - infection detection and strain-typing : original researchSource: Southern African Journal of Epidemiology and Infection 24, pp 4 –7 (2009)More Less
The objectives of the study were: 1) to determine the range of infections caused by Staphylococcus aureus, 2) to establish one / more rapid, reliable, reproducible and cost-effective methods for the detection of methicillin-resistant S. aureus (MRSA) in resource-constrained healthcare settings, and 3) to compare South African strains with those found globally using multi-locus strain typing (MLST). A total of 241 S. aureus isolates collected from 16 hospitals in KwaZulu-Natal were subjected to antibiotic susceptibility testing using the CLSI disc sensitivity testing method. A random selection of 24 putative MRSA and a matched control group of methicillin-sensitive S. aureus isolates were subjected to agar-based methods, the Etest and screen latex agglutination methods for MRSA detection using polymerase chain reaction as the gold standard. Strain typing was undertaken by MLST. S. aureus was implicated in a range of infections. Sensitivity, specificity, positive predictive values, negative predictive values and costs of the various detection tests showed that the use of oxacillin disc agar diffusion and oxacillin screening salt agar was appropriate for routine laboratory testing for the identification of MRSA. MLST identified the ST8- SCCmec type IV (67%), ST239-SCCmec type III (13%), ST8- SCCmec type II (8%), ST5- SCCmec type IV (8%) and ST45- SCCmec type IV (1%) clones confirming the mobility of SCCmec type IV (79%). Infections by S. aureus are a public health concern in South Africa as they are worldwide. Antibiotic prescribing trends may account for the de novo evolution of strains identified globally. Routine surveillance for MRSA is thus advocated.
Increasing the risk of nosocomial transmission of HIV : pitfalls and practices at a busy secondary level hospital with a high burden of HIV : original researchSource: Southern African Journal of Epidemiology and Infection 24, pp 8 –11 (2009)More Less
Healthcare professionals working in high HIV prevalence settings are at continuous risk of nosocomial acquisition of HIV. Risk factors for percutaneous injuries include recapping or manipulation of needles following venesection and improper disposal of sharps. Prompt risk assessment and access to antiretroviral post-exposure prophylaxis (PEP) is essential to reduce the risk of HIV seroconversion. This study audits the practice of doctors involved in high risk procedures for acquisition of blood-borne viruses. Forty-two doctors working at GF Jooste Hospital, Cape Town, were polled by anonymous questionnaire as to their venesection practice, sharps disposal, history of at-risk exposures and access to PEP. An observational study of sharps bin use was undertaken concurrently. Thirty-six doctors responded, 92% of whom were misusing blood-taking equipment. Five times the number of sharps bins were available in medical wards compared to surgical. Twenty-four doctors sustained a total of 67 blood risk exposures since qualification. Less than half of exposures were reported and only 35% of those who reported their incident received post-exposure counselling and appropriate management. Twenty-five exposures led to a course of PEP. Median delay to PEP was two hours and median duration of PEP was 21 days. Incorrect venesection practice, improper sharps disposal and inadequate post-exposure management are directly increasing the risk of nosocomial transmission of HIV. We believe that these practices are widespread within the South African health service and need to be addressed to adequately protect our doctors and nurses.
The influence of health education on the prevalence, intensity and morbidity of Schistosoma haematobium infections in children over a two-year period in the Limpopo Province, South Africa : original researchSource: Southern African Journal of Epidemiology and Infection 24, pp 13 –17 (2009)More Less
The influence of health education on the prevalence and intensity of Schistosoma haematobium infections, as well as on the related morbidity, was studied in schoolchildren between the ages of 4 and 14. Three groups of children were selected for this investigation. The 67 children in the experimental group received chemotherapy before health education was implemented, as well as when they got re-infected during the study. Health education was presented in mother tongue by means of a puppet show. The 99 children in one of the control groups received treatment only after the study while the 80 children in the remaining control group were treated as those in the experimental group, except that no intervention by means of education was applied. Health education, parasitological screens and snail surveys were done during the rainy, cold-dry and hot-dry seasons between 2004 and 2006. The prevalence and intensity of infection, as well as the morbidity (degree of haematuria) due to the infections, were determined after the urine samples, collected from each child, were screened. Significant differences (p<0.05) were found between the initial prevalence of infection (100%) and all the values recorded from survey 2 to survey 7. With regard to the intensity of infection, significant differences were found in all cases between the experimental and the treated control groups except in the heavy category (p=0.84). Statistical comparisons between the mean percentages calculated for corresponding categories of haematuria between the different groups revealed significant differences in all cases except between the experimental and treated control groups in the heavy category (3+) of haematuria.
Knowledge of and attitude towards cervical cancer among female university students in South Africa : original researchSource: Southern African Journal of Epidemiology and Infection 24, pp 21 –24 (2009)More Less
The objectives of this descriptive cross-sectional study were to assess the knowledge of the risk factors associated with, and detection methods of cervical cancer among female undergraduate students at Mangosuthu University of Technology. A total of 389 students were selected by stratified random sampling techniques. Participants' mean age was 20 years (SD=2). Results indicated that 51.2% students were currently involved in a sexual relationship, with 19.2% reporting two or more sexual partners in the past year. Less than half (42.9%) of the participants had heard of cervical cancer and of these, 26 (15.6%) did not know any risk factors for cervical cancer, while 96 (58.6%) of 164 participants who knew of risk factors, did not know that cervical cancer is preventable. One-hundred and sixty-three (41.9%) participants had heard about the Pap smear test. That the Pap smear test is used for detection or prevention of cervical cancer, was known to 62 (38%) of the respondents. Only 16 (9.8%) participants had had a Pap smear test. Among those who knew about the Pap smear test (n=136), 86 respondents did not have the test done mainly because of personal factors such as fear of the procedure, cultural or religious reasons, and were not ill (61.1%). Findings suggest low level of knowledge on cervical cancer and its risk factors and detection method among these female university students. The university should thus concentrate on developing policies on health education and promotion, particularly targeting preventable health conditions, eg. cervical cancer and strategies to prevent transmission of the human papillomavirus.
Diagnosis and management of community-acquired pneumonia in childhood - South African Thoracic Society guidelines : clinical guidelineSource: Southern African Journal of Epidemiology and Infection 24, pp 25 –36 (2009)More Less
Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in South African children. The incidence, severity and spectrum of childhood pneumonia have changed owing to the HIV epidemic. Increasing emergence of antimicrobial resistance necessitates a rational approach to the use of antibiotics in pneumonia management.
Objective: To develop guidelines for the diagnosis, management and prevention of CAP in South African children.
Methods: The Paediatric Assembly of the South African Thoracic Society established five expert subgroups to address: (i) epidemiology and aetiology; (ii) diagnosis; (iii) antibiotic treatment; (iv) supportive therapy; and (v) prevention of CAP. Each subgroup developed a position paper based on the available published evidence; in the absence of evidence, expert opinion was accepted. After peer review and revision, the position papers were synthesised into an overall guideline which was further reviewed and revised.
Recommendations: Recommendations based on epidemiological factors include a diagnostic approach, investigations, supportive therapy, appropriate antibiotic treatment and preventive strategies. Specific recommendations for HIV-infected children are provided.
Validation: These guidelines are based on the available evidence supplemented by the consensus opinion of South African experts in paediatrics, paediatric pulmonology, radiology, infectious diseases and microbiology. Published international guidelines have also been consulted.
Author S. BudhavariSource: Southern African Journal of Epidemiology and Infection 24, pp 37 –38 (2009)More Less
Author E. PrenticeSource: Southern African Journal of Epidemiology and Infection 24, pp 39 –40 (2009)More Less
The Hidden Paw, or an account of a cat scratch and its contemplative repercussions, with sincere apologies and thanks to TS Elliot, whose 'rifled' and 'stifled' lines, rhymes, words and ideas litter the following lines.
''Macavity's a Mystery Cat: he's called the Hidden Paw - For he's the master criminal who can defy the Law. He's the bafflement of Scotland Yard, the Flying Squad's despair: For when they reach the scene of crime - Macavity's not there!'' TS Elliot "Old Possum's Book of Practical Cats''