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- Southern African Journal of Epidemiology and Infection
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- Volume 25, Issue 1, 2010
Southern African Journal of Epidemiology and Infection - Volume 25, Issue 1, 2010
Volume 25, Issue 1, 2010
Source: Southern African Journal of Epidemiology and Infection 25, pp 3 –4 (2010)More Less
In summary, World Cup fever is truly upon us and we can look forward to show-casing the wonders of this beautiful country and its diverse culture. Visitors to the World Cup should follow travel advice, in particularwith respect to vaccine-preventable diseases and strong messaging surrounding avoidance of STIs. Healthcare practitioners should be aware of the potential for communicable disease outbreaks and report any suspicious pathogens to their local health authority.
Source: Southern African Journal of Epidemiology and Infection 25, pp 7 –10 (2010)More Less
Sinusitis, is a significant and increasing health problem resulting in a large financial burden in South Africa and to society in general. Increasing antibiotic resistance is a major problem with no new antibiotics on the immediate horizon and poor and inappropriate antibiotic usage amplifying this burden. Correct dosages of antibiotics are often not covered in formularies whereas inappropriate formulations of antibiotics and other inappropriate medications often are. The 'Updated guideline for the management of upper respiratory tract infections in South Africa: 2008', clearly defines the treatment of the various forms of sinusitis, with appropriate antibiotics, where required, and their dosages clearly laid out. (See reprinted summary on pg 12). This guideline appears to be poorly applied in general. Inappropriate use of other non-antibiotics, especially over the counter treatments, adds considerably to these issues, especially costs. More important though is that accurate diagnosis is an absolute essential for treatment of the various forms of sinusitis. Rhinitis and sinusitis usually coexist and are concurrent in most; the correct terminology is now rhinosinusitis.
Author S. ParkerSource: Southern African Journal of Epidemiology and Infection 25, pp 14 –18 (2010)More Less
About 5,000 South Africans depart yearly for the Hajj, the largest annual congregation on earth, involving an estimated three million pilgrims all converging to perform set rituals within specified time-frames in relatively confined spaces. Though the actual Hajj only lasts for five days, most pilgrims spend about a month in Saudi Arabia, with a significant percentage being over 50 years old. The massive crowds, congestions, changing seasons (the Hajj follows the lunar calendar, which is about 10 days earlier each year in comparison to the Gregorian one), ongoing construction, and the older age group of pilgrims (often suffering from medical problems), and present winter season in which it occurs, makes the Hajj a potential site for epidemic events and pandemic spread. The recorded meningococcal epidemics highlight the above, and the 2009 pandemic novel H1N1 influenza strain has led to unprecedented concern.
Source: Southern African Journal of Epidemiology and Infection 25, pp 19 –21 (2010)More Less
The handling of healthcare waste (HCW) was investigated in 30 rural healthcare facilities in KwaZulu-Natal. Using a semi-structured questionnaire, interviews were carried out with the person in charge of the facility and observations were made to establish current practices in sorting, handling and disposal of HCW. It was found that improper sorting and management of HCW occurred on most sites with implications for cost, infection control and education. It is imperative therefore that improved HCW management measures be implemented and that healthcare facility staff receive appropriate and repeated training to ensure minimising risk.
Outcome of patients with severe abdominal sepsis in intensive care - experience at Charlotte Maxeke Johannesburg Academic Hospital : clinical case studySource: Southern African Journal of Epidemiology and Infection 25, pp 23 –27 (2010)More Less
Despite advances in diagnosis, surgery, antimicrobial therapy and intensive care support, the mortality rate associated with intra-abdominal sepsis remains unacceptably high. The aim of the present study was to identify prognostic factors in 54 consecutive cases with abdominal sepsis admitted to the intensive care unit (ICU) over a two-year period, from January 2001 to December 2002. This was a retrospective record review of cases with abdominal sepsis admitted to the ICU. Of 54 patients that were studied, only 14 survived. The mortality rate was 74.1%. Non-survivors had significantly longer ICU stay, had more relook laparotomies, more blood transfusions and a significantly higher APACHE II score on admission to the ICU. Other results revealed that non-survivors required significantly more inotropic support and corticosteroids, had a lower paO2/FiO2 ratio and had more total parenteral nutrition days. None of the patients who survived required dialysis. The number of relook laparotomies were higher in the non-survivors and the maximum number of relook laparotomies were four in the survivors and 13 in the non-survivors. The non-survivors were also more likely to have an open abdomen. We conclude that patients with abdominal sepsis have an extremely high mortality and utilise an enormous amount of limited intensive care resources. The length of ICU stay, APACHE II score on admission, number of relook laparotomies, whether the abdomen was left open or not, and requirement for inotropic support, dialysis, total parenteral nutrition and blood transfusions were predictive of adverse outcomes in these patients.
Prevalence and risks of asymptomatic bacteriuria among HIV-positive pregnant women : original researchSource: Southern African Journal of Epidemiology and Infection 25, pp 28 –32 (2010)More Less
The objective of the study was to determine whether the prevalence of asymptomatic bacteriuria (ASB) and subsequent complications are higher in HIV-positive than in HIV-negative pregnant women. A prospective controlled study of asymptomatic pregnant women was carried out. One hundred and twenty-five consecutive HIV-positive women and 247 HIV-negative controls were screened for asymptomatic bacteriuria. Treatment of positive cultures was by means of antibiotics as per protocol. Nine percent (n=11) of HIV-positive patients and 7.9% (n=19) of HIV-negative patients had positive urine cultures (p=0.68). Microorganisms were similar in both groups. The incidence of preterm labour was 6.7% in the HIV-positive cohort, versus 11.3% in HIV-negative control patients (p=0.17). The rate of prelabour rupture of membranes was significantly increased in HIV-positive patients compared to HIV-negative controls (17 HIV-positive versus 13 HIV-negative patients, 14.17% and 5.42%, respectively; RR 2.615, 95% CI, 1.314-5.204). CD4+ cell count level <200/mm3 or ≥200/mm3 did not influence the occurrence of ASB. The prevalence of ASB in HIV-positive study patients did not differ from HIV-negative controls.
The appropriateness of the South African Thoracic Society's guidelines for antibiotic treatment of patients with chronic obstructive pulmonary disease exacerbation in the Universitas Academic Hospital, Bloemfontein : original researchSource: Southern African Journal of Epidemiology and Infection 25, pp 33 –35 (2010)More Less
Chronic obstructive pulmonary disease (COPD) is a progressive disease predominantly associated with smoking. Exacerbation of COPD frequently results from respiratory infections. The South African Thoracic Society (SATS) recommends treatment with amoxicillin / clavulanate, cefuroxime or a fluoroquinolone. The study aimed to determine the appropriateness of these guidelines regarding organisms isolated from sputum of patients with COPD exacerbation at Universitas Academic Hospital, Bloemfontein. A descriptive study was performed. Seventeen hospitalised patients diagnosed with COPD exacerbation from July - October 2007, not treated with antibiotics or corticosteroids or having a respiratory infection four weeks prior to admission, were included. Demographic information (age, gender, area of residence, smoking history) was obtained from patients' files, as well as FEV1 values, FEV1 / FVC ratio, infection markers, microorganisms isolated from sputum and their antibiotic susceptibility profiles. Nine patients were male and eight female, with a median age of 72 years (range 53 - 82 years). Twelve (70.6%) patients resided in the Bloemfontein urban area. Three patients (18.8%) never smoked, 25% smoked previously and 56.3% were active smokers (median pack years 45 years, range 17 - 70 years). Eight patients had culture-positive sputum specimens. Haemophilus influenzae, H. parainfluenzae, Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens and Escherichia coli were isolated from sputa. With the exception of S. aureus, all isolates were susceptible to at least one antibiotic recommended by SATS. The guidelines proposed by SATS for treatment of COPD exacerbation were appropriate and would be effective in the management of these patients in the Free State region.
Source: Southern African Journal of Epidemiology and Infection 25, pp 36 –38 (2010)More Less
Dog bites are a poorly understood and complex public health problem. Children are most frequently the victims of dog bites and the face is often the favoured target. A review of dog bite wounds in small children presenting to the Red Cross War Memorial Children's Hospital was carried out over a period of 13.5 years (1991-2004). One thousand eight hundred and seventy-one dog bite wounds were admitted from a total of 125,677 patients treated. From 1,871 patients presenting with dog bite injuries, we identified 596 children who sustained injuries to the head, face or neck. Dog bites to the head, face or neck were responsible for 0.5% of all trauma unit presentations and 32% of all dog bite injuries. The mean age of the children was 5.1 years. Male children accounted for 68% of the patients. The peak incidence was noted in children aged 2 to 4 years old. One hundred and seventy-two (29%) bites occurred between the summer months of December and February. Two hundred and forty-nine (42%) patients presented to hospital between the hours of 12:00 and 18:00 hours and 275 (46%) children presented between 18:00 and 0:00 hours. A large proportion of all attacks occurred either inside or outside the victim's own home and at the home of friends or family. Superficial injuries were treated with wound cleaning, suturing and dressing. There were no fatalities. Dog bites are relatively common in small children, but do not represent a major cause of morbidity and mortality.