Southern African Journal of Epidemiology and Infection - Volume 26, Issue 1, January 2011

Health care-associated infections (HAIs) are among the most common and serious adverse events in hospitals globally, occurring in about one in 10 admissions overall. A recent meta-analysis shows that HAIs are a much bigger problem in the hospitals of developing countries, than in those in the industrialised world. HAI prevalence is 15.5 per 100 patients, at least double the overall rate in Europe, while the incidence of HAIs acquired in intensive care units (ICUs) is 34.2 per 1 000 patient days, triple the rate in the USA.

Identification and prioritisation of candidate antigens on which novel vaccines can be based, or the efficacy of existing vaccines improved, are critically dependent on characterising the strategies utilised by microbial pathogens to evade host defences, and, in particular, the key virulence factors involved. In this review, we have focused on the immune evasion strategies utilised by two important bacterial respiratory pathogens, viz Streptococcus pneumoniae and non-typeable Haemophilus influenzae, with particular emphasis on key virulence factors and their potential to serve as candidate immunogens.

Rhinosinusitis is a significant and increasing health problem, resulting in a large financial burden on society. It is multifactorial in origin. With age, several predisposing factors change and rhinosinusitis manifests differently. Management thereof is evolving and controversial. Usually, rhinitis and sinusitis appear concurrently in most individuals, therefore the correct terminology is rhinosinusitis. The case definition has been stratified into a technical description that is useful for ear, nose and throat specialists, and a clinical definition that is pertinent for other health care professionals.

Candida species are responsible for a wide range of systemic as well as superficial opportunistic infections, which are of particular importance among debilitated and immunocompromised patients. Species of the genus Candida comprise part of the oral commensal microflora of healthy individuals, with Candida albicans being the most common pathogen of the genus. A diverse array of host factors has been implicated in the pathogenesis of oral candidiasis. This paper describes the local, systemic and iatrogenic factors affecting oral candidiasis.

An estimated 4.5 million South Africans, mainly in settings of rural poverty, are in need of treatment for urogenital schistosomiasis. In spite of severe morbidity and mortality, schistosomiasis remains a neglected disease with an important gender impact. The World Health Organization recommends regular mass treatment of all school-aged children. In areas endemic for schistosomiasis children are treated with a single dose of praziquantel, used for almost 30 years as the drug of choice. If administered in childhood, praziquantel has been proven to effectively prevent schistosomiasis-related morbidity, as well as reduce the socio-economic impact of the disease. Moreover, preventing urogenital schistosomiasis may also reduce HIV transmission in sexually active females. In this paper we examine the impact of the disease, the use of generic praziquantel and the need for a change in health and drug policy in order to make generic praziquantel available for mass treatment campaigns in South Africa. Generic praziquantel has been on the market for almost 30 years. Although elsewhere available free of charge, or at low cost, affordable generic versions of praziquantel are not obtainable in South Africa.

One of the Millennium Development Goals (MDG-4) is to reduce child mortality by up to two-thirds by 2015. In most developing countries, a higher proportion of neonatal deaths are observed. We quantify the causes of neonatal morbidity and mortality at a rural hospital. A retrospective review of consecutive neonatal admissions to Empangeni Hospital, between January and December 2005, was conducted. Of 1,573 admissions, male babies made up 57.8% of admissions and 63% of the deaths. The most common causes of admission were birth asphyxia (38.2%), prematurity (23.5%), and infection (21%). The average length of stay was 9.2 days (SD 12 days). The overall mortality rate was 13.8% but higher (23.4%) among the referred babies. Admission and death rates of low birthweight babies (<2,500g) were 53% and 84%, respectively. Two-thirds (67.7%) of those babies who died were born preterm. Over half (56.6%) of the deaths took place within the first three days of life. Logistic regression showed that extremely low birthweight (OR=13.923, 95% CI:5.759; 33.656), male sex of the babies (OR=1.633, 95% CI:1.132; 2.356), and preterm delivery (OR=2.975, 95% CI: 1.296; 6.836) were significant predictors of neonatal death. A substantial proportion of neonatal mortality occurs in the hospital neonatal unit. Asphyxia, prematurity, low birthweight and neonatal infection are the leading cause of neonatal hospitalisation and deaths. Several simple and effective interventions exist to minimise neonatal admissions and deaths in South Africa.

The average length of hospital stay is regarded as a key determinant of greater hospital costs. The objectives of this quantitative, retrospective, descriptive study were to determine the health status and medical conditions of patients with increased length of stay at a district hospital in Limpopo Province. A total of 609 patients' records with longer than average length of stay, from January to December 2007, were selected by stratified random sampling. The most prevalent diseases for staying longer were infectious and parasitic diseases, symptoms, signs etc, and injury, poisoning and consequences of causes yielding more than a third (36% and 12%, respectively, for each classification). Neoplasm-related admissions, in which cancer was identified as the most prevalent, stayed in hospital for an average of 14.6 days. The average length of stay for all disease classifications ranged from 7.1 days to 14.6 days. The length of stay at Elim Hospital is mostly influenced by the type of health conditions which are diagnosed. Further research is needed to find influential factors that might contribute to patients staying longer than normal.

The objective of the study was to determine changes in frequency of sexual activity during pregnancy. A prospective study was conducted using a structured questionnaire to interview 611 healthy pregnant women at a regional hospital in KwaZulu-Natal. Data were analysed using descriptive statistics. Five hundred and fifty-six (91.0 %) of the 611 women were sexually active during pregnancy. Sexual desire was increased in 102 (18%), decreased in 299 (40%) and was unchanged in 210 (34%). Four hundred and twenty-two (69%) engaged in sexual activity until the third trimester of pregnancy. Three hundred and seventy-nine (62%) used condoms. The majority (63%) found it easier to discuss the topic of sexual activity with midwives rather than with doctors. One hundred and thirty-eight (23%) experienced adverse events attributed to sexual intercourse during pregnancy. Religious and traditional practices played a minor role in guiding the practice of sexual activity during pregnancy. Twenty-eight (5%) of the 611 women were guided by religious rules while 27 (4%) were guided by traditional rules. Our findings confirm that sexual activity is commonly practised in pregnancy. Given the high HIV rates and sexually transmitted infections in the local population, this has important implications for information provided during antenatal care.

An investigation was conducted to determine the prevalence of the new variant of Chlamydia trachomatis (nvCT) in South Africa (SA). Four hundred and fifty-nine C. trachomatis-positive clinical specimens, tested by in-house multiplex polymerase chain reaction (PCR), were screened for the presence of the 377 bp deletion in the ORF1 of the cryptic plasmid, documented in nvCT, by means of nested PCR. All specimens generated a 630 bp amplicon in the nested PCR, indicative of wild-type CT, and no nvCT strains were identified. Even though there was no evidence of the presence of nvCT in South Africa, continuous screening for emerging mutant strains is of epidemiological importance.

Travellers' diarrhoea (TD) is the most common affliction encountered by travellers, and is associated with the ingestion of contaminated food and/or water. It can be most disruptive, and empiric self-therapy has been advocated by many practitioners to reduce disruption to the travel itinerary. TD can occur in up to 80% of travellers and is more likely to manifest in those travelling from developed to developing countries, where standards of hygiene are not optimal. It also depends on the food risk-taking behaviour of the traveller. However, there appears to be a decrease in faecal-orally transmitted diseases among travellers at the travel destination due to better hygienic standards.

Forgoing the mouth-watering pleasure of waxing endlessly on the virtues of a well-made stock, consommé or aspic, for the moment, I shall turn away from the kitchen towards the laboratory to wax rather less than endlessly and with only slightly less pleasure on the virtues of well-made microbiological culture media and more importantly to their creators. I stand in awe of these pioneers. In the laboratory we name them daily, but seldom stop to consider why. Not only does their inspiration and dogged hard work continue to save lives, but their endeavours to isolate pathogens in pure culture provided proof for a then-new paradigm of disease causation, namely the germ theory.

Childhood HIV: a learning programme for professionals is one of a series of books aimed at assisting health care professionals to learn about various aspects of the human immunodeficiency virus (HIV).