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- Volume 25, Issue 2, 2010
Southern African Journal of Epidemiology and Infection - Volume 25, Issue 2, 2010
Volume 25, Issue 2, 2010
Author Barry D. SchoubSource: Southern African Journal of Epidemiology and Infection 25, pp 3 –4 (2010)More Less
The 2009 influenza season has been characterised by alternating alarm, complacency, curiosity and, eventually, confusion and scepticism. Does pandemic influenza A (H1N1)v indeed pose a serious public health threat, or as the Council of Europe has put forward, has the WHO been over-hasty in declaring a public health emergency because of pressure from multinational pharma?
Acute viral bronchiolitis : aetiology and treatment implications in a population that may be HIV co-infected : original researchSource: Southern African Journal of Epidemiology and Infection 25, pp 06 –08 (2010)More Less
Bronchiolitis remains a viral disease. In our study, CRP does not correlate with white cell count or bacterial blood culture. It is therefore, no more useful than those tests in predicting bacterial co-infection. Routine use of antibiotics should be discouraged since their use is no longer a benign intervention. Serious sequelae of both adverse events and emerging microbiological resistance, both in targeted organisms and those not targeted for therapy (collateral damage), are potential areas of concern.
The antibiotic susceptibility of bacteria isolated from blood cultures during episodes of neutropenic fever in patients with acute myeloid leukaemia : original researchSource: Southern African Journal of Epidemiology and Infection 25, pp 09 –11 (2010)More Less
The aim of this study was to determine the spectrum of bacteraemic microorganisms isolated during episodes of NF (NFEs) in AML patients in the Haematology Unit of the Universitas Academic Complex (UAC), as well as antibiotic susceptibility profiles of these organisms. Duration of NF, the time-span between chemotherapy and onset of NF, and the efficacy of antibiotics administered to patients, were also investigated.
Validation of a rapid tuberculosis PCR assay for detection of MDR-TB patients in Gauteng, South Africa : original researchSource: Southern African Journal of Epidemiology and Infection 25, pp 12 –15 (2010)More Less
Nucleic acid amplification tests offer shorter turnaround times for diagnosis of tuberculosis (TB) and drug resistance of isolates compared to conventional culture methods. The rapid molecular-based multidrug-resistant (MDR)-TB assay, GenoType® MTBDRplus (Hain Lifescience) was evaluated in Gauteng, South Africa, as a pilot investigation to assess its performance for detection of MDR-TB in patients who were at high risk of drug-resistant TB. A total of 945 sputum specimens sequentially received within a period of six weeks from seven hospitals were assessed by MTBDRplus and compared to liquid culture drug susceptibility tests (DST) using the MGIT 960 system (BD Diagnostic Systems) as the 'gold standard'. Of the 945 specimens processed, 731 had interpretable results from both tests and therefore were included in the analysis. The overall sensitivities of the MTBDRplus in detecting individual resistance to rifampicin (RMP) and isoniazid (INH), as well as MDR were 95.0%, 93.4% and 100%, respectively. The specificities were 99.7% for RMP, and 100% for INH and MDR. The Genotype® MTBDRplus assay showed excellent concordance with the conventional 'gold standard' MGIT DST, and it detected all the MDR-TB cases analysed.
Perceived susceptibility of cervical cancer screening among women attending Mahalapye District Hospital, Botswana : original researchSource: Southern African Journal of Epidemiology and Infection 25, pp 16 –21 (2010)More Less
Cervical cancer is a significant cause of morbidity and mortality in Botswana. Papanicolaou (Pap) cervical cytology screening has helped to reduce cervical cancer rates dramatically through early detection of premalignant lesions in countries with screening programmes that have been well implemented. The objectives of this cross-sectional study were to describe the women's perceived susceptibility to cervical cancer and the association between socio-demographic characteristics. A total of 300 participants were selected by convenience sampling techniques. Participants' mean age was 37 years (SD=11). Results indicated that cervical cancer screening rates were 39%. Most of those that had ever been screened for cervical cancer (64%), had been screened in the previous three years. Most of the participants (75%) were aware of their perceived susceptibility to cervical cancer. There was a significant association between perceived susceptibility and screening for cervical cancer (X2=20.86; p<0.001). Among those with low perceived susceptibility to cervical cancer, 31% had screened for cervical cancer as compared to 59% screening rates among those with high perceived susceptibility to cervical cancer. Those with high perceived susceptibility were 3.2 times more likely to screen for cervical cancer (OR=3.24; 95% CI:1.937-5.43) than those with low perceived susceptibility. High susceptibility rates significantly associated with being married (X2=9.44; p=0.051), employed (X2 = 13.077; p < 0.001), monthly income more than $411 (X2 = 15.457; p < 0.004) and peri-urban residential status (X2 = 14.280; p = 0.001). Perceived susceptibility was significantly associated with cervical cancer screening. Education programmes geared towards increasing perceived susceptibility can significantly improve uptake of cervical cancer screening in Botswana as well as address issues of barriers and misconceptions.
Using lot quality assurance sampling methodology to evaluate the uThukela District Child Survival Project of KwaZulu-Natal : original researchSource: Southern African Journal of Epidemiology and Infection 25, pp 22 –27 (2010)More Less
Health services programmes and interventions require objective measures on coverage and quality to ensure that managers have the evidence to adopt and expand health interventions effectively and efficiently. Over the past 15 years, the uThukela District Child Survival Project of South Africa achieved this through regular two- to three-year project evaluations using cluster sampling. Results of these surveys have improved the ability of Child Survival Projects to identify priorities, define objectives based on data, and measure progress towards these objectives. However, the inability to disaggregate information to composite Supervision Areas (SAs) was a limitation. Lot quality assurance sampling (LQAS) was adopted as an improved method based on its ability to assess performance in disaggregated units within a study population and to reliably compare coverage and health status indicators for routine monitoring of child survival activities. This study assessed the feasibility and reliability of LQAS to evaluate the Child Survival Project and compare the results of a rapid manual analysis with a secondary electronic analysis of the same data. The accuracy of the manual analysis was comparable and provides evidence that LQAS and rapid manual analysis can be used to evaluate intervention programmes, particularly in settings of limited electronic technology and expertise.
CIKPLA: cryptogenic invasive Klebsiella pneumoniae liver abscess (and meningitis) - an emerging disease in South Africa? : clinical case studySource: Southern African Journal of Epidemiology and Infection 25, pp 28 –29 (2010)More Less
Disseminated Klebsiella bacteraemic syndrome and cryptogenic invasive Klebsiella pneumoniae-associated liver abscess (CIKPLA) have been well described in Taiwan. However, CIKPLA has never been described in patients in South Africa. The main aim of this case report is to describe the occurrence of this syndrome in a South African man, not of Asian descent, in order to highlight to clinicians the possibility of its occurrence in South Africa.
Source: Southern African Journal of Epidemiology and Infection 25, pp 30 –32 (2010)More Less
We report a case of rapidly progressive miliary tuberculosis in a 21-month-old HIV-infected girl exposed to tuberculosis, despite early access to highly active antiretroviral therapy and proven adherence to isoniazid chemoprophylaxis. Post mortem revealed multidrug-resistant tuberculosis. This case report illustrates three important points: a) the consequences of inadequate programmatic management of children exposed to an adult case of sputum smear-positive multidrug-resistant tuberculosis, b) multiple exposures to source cases over time and c) the difficulty in diagnosing childhood tuberculosis in the setting of close supervision. Drug susceptibility testing of the adult source case should become standard of care for all children who have been in close contact with a case of sputum smear-positive tuberculosis, and the choice of chemoprophylactic agents should be based on the sensitivities of the source case organism. Regular inquiry for new exposure to source cases should also be made. New tests are urgently needed for childhood tuberculosis.
Author Y. MoodleySource: Southern African Journal of Epidemiology and Infection 25, pp 33 –34 (2010)More Less
The HIV / AIDS pandemic poses a number of medical and logistical problems in South Africa. There are locations within the country with high HIV prevalence. The identification of these 'hotspots' can be problematic, but the use of geographical information system (GIS) and global positioning system (GPS) technologies has offered a method by which communities who are severely affected by the pandemic can be identified, thereby allowing for the targeted delivery of interventions. This report aims to outline the use of GIS / GPS technologies in HIV / AIDS research.
Author E. PrenticeSource: Southern African Journal of Epidemiology and Infection 25, pp 35 –36 (2010)More Less
''I am sorry to hear this'' said he. ''I only know Mr Holmes through some business dealings which we have had, but I have every respect for his talents and his character. He is an amateur of crime, as I am of disease. For him the villain, for me the microbe. There are my prisons,'' he continued, pointing to a row of bottles and jars which stood upon his side table. ''Amongst those gelatine cultivations some of the very worst offenders in the world are now doing time.''
Source: Southern African Journal of Epidemiology and Infection 25, pp 39 –41 (2010)More Less
Source: Southern African Journal of Epidemiology and Infection 25, pp 43 –44 (2010)More Less