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- Southern African Journal of Epidemiology and Infection
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- Volume 26, Issue 4, 2011
Southern African Journal of Epidemiology and Infection - Volume 26, Issue 4, 2011
Volume 26, Issue 4, 2011
The potential impact of the 13-valent conjugate pneumococcal vaccine on antibiotic resistance in pneumococci : reviewSource: Southern African Journal of Epidemiology and Infection 26, pp 253 –258 (2011)More Less
The emergence of antibiotic-resistant Streptococcus pneumoniae strains is primarily due to a selection of resistant strains by antibiotic use. The majority of antibiotic-resistant pneumococcal strains exist as a limited number of serotypes, many of which are already included in a 7-valent pneumococcal conjugate vaccine (PCV7).
Additional non-PCV7 serotypes associated with antibiotic resistance include serotypes that were associated with antibiotic-resistance prior to the use of PCV7. These include an increase in nasopharyngeal colonisation and disease due to serotype 19A, both following, and in the absence of, PCV immunisation. Although transmission and disease from serotype 19A are likely to decline following immunisation with PCV13, pneumococcal disease associated with antibiotic-resistance due to serotypes not included in 13-valent PCV (PCV13) is likely to persist, albeit at lower rates. The non-PCV13 serotypes already identified to be associated with antibiotic-resistant strains of pneumococci in the pre-PCV13 era will possibly undergo selective expansion, and emerge as the new dominant serotypes associated with antibiotic non-susceptibility in the PCV13 era. Comprehensive control of disease from antibiotic non-susceptible pneumococci is likely to require a pneumococcal vaccine that will be effective in preventing nasopharyngeal colonisation from the vast majority of disease-causing serotypes, coupled with the judicious use of antibiotics.
Author S. SinghSource: Southern African Journal of Epidemiology and Infection 26, pp 259 –261 (2011)More Less
Despite the availability of epidemiological data on caries prevalence rates in children, there is little evidence that the issue of childhood caries is adequately addressed through policy and service provision efforts in South Africa. Given the underlying multifactorial determinants of dental caries, namely access to and availability and utilisation of oral health services, socioeconomic status and dietary intake, oral health planning efforts need to address issues of policy and programmatic integration, additional fluoride uptake and the availability of primary preventive programmes.
Source: Southern African Journal of Epidemiology and Infection 26, pp 262 –265 (2011)More Less
Although male circumcision is regarded as an efficacious and cost-effective public health strategy for combating human immunodificiency virus (HIV) in heterosexual men in high-prevalence areas, some experts suggest a more cautious approach to the implementation of circumcision for HIV prevention because of practical difficulties. This review addresses the practicality and ethics of implementing circumcision as a preventative strategy in under-resourced settings. A literature survey was carried out using the key terms "male circumcision" and "HIV prevention" in a number of databases. There is generally high acceptability of circumcision as a preventative strategy for HIV. Some experts, albeit a minority, raise questions regarding costs, timing, and integration of religious and cultural forms of circumcision in the fight against the spread of HIV. Geographical, cultural, religious and socio-economic factors should be considered prior to instituting circumcision as public health measure for the prevention of female-to-male HIV transmission.
Source: Southern African Journal of Epidemiology and Infection 26, pp 267 –270 (2011)More Less
An outbreak of invasive candidiasis in the neonatal intensive care unit (NICU) of the Dr George Mukhari Academic Hospital in Ga-Rankuwa necessitated evaluation of the antibiotic prescribing practices in the unit. A selective randomised sample of 100 patients was followed up over a nine-month period to evaluate prescribing patterns. The existing antibiotic policy was used to compare the prescription practices and use of antibiotics. The frequency of use, number of antibiotics per patient and duration of use were documented. Of the 100 patients followed, 95 were prescribed intravenous antibiotics. All prescribed antibiotics for 77 patients are listed in the antibiotic policy. Nineteen different antibiotics were prescribed, and 11 of the 19 prescribed antibiotics appear in the antibiotic policy. Most patients received more than two antibiotics during their stay, as the average number of antibiotics used per patient during the study period was 3.4. The average duration of use for all antibiotics, except cefepime and ceftriaxone, was for longer than seven days. Although antibiotics were used according to the ward protocol in the majority of patients, deviations from the protocol were associated with patients' clinical condition and / or results from blood cultures. The duration of antibiotic use needs to be monitored to prevent unnecessary prolonged use, as in this investigation. An antibiotic policy may be useful to guide and measure rational antibiotic therapy in a NICU.
Oral lesions in HIV-infected patients, before and after antiretroviral treatment : original researchSource: Southern African Journal of Epidemiology and Infection 26, pp 271 –273 (2011)More Less
Oral lesions cause considerable morbidity in HIV-infected patients. Antiretroviral therapy (ART) reconstitutes the immune system and reduces the incidence of opportunistic infections and malignancies. The aim of the present study was to determine the prevalence and range of oral lesions in patients before and after starting ART in Harare, Zimbabwe. A longitudinal, prospective study of oral lesions presenting in HIV-infected patients at baseline and three and six months after the initiation of ART was conducted. The study was undertaken at three hospitals in Harare. Two hundred and ten patients were enrolled; 96 (46%) and 49 (23%) patients presented for follow-up at three and six months, respectively. Two-thirds of the patients who completed follow-up were female; median age was 36 years. At six months of ART, the overall prevalence of oral lesions declined significantly (p<0.05). Oral candidiasis was the most common finding and showed the most significant reduction on ART. In contrast, the incidence of facial warts increased from baseline to three and six months. ART was effective in reducing the overall prevalence of oral lesions in HIV-infected patients, although incidence was variable depending on the type of lesion. Unmasking immune reconstitution inflammatory syndrome to human papillomavirus (HPV) is the likely cause for the increase in facial warts.
Compliance with infant formula feeding by HIV-positive women one week after delivery in Khayelitsha, South Africa : original researchSource: Southern African Journal of Epidemiology and Infection 26, pp 274 –279 (2011)More Less
When mixed feeding occurs a few days following delivery, the risk of HIV transmission is likely high. The study aim was to assess infant feeding practices, one week following delivery of HIV-positive mothers who intended to formula feed their infants. A consecutive sample of 95 HIV-positive mother-infant pairs was recruited soon after delivery from a midwife obstetric unit in Khayelitsha. Face-to-face interviews were conducted one week after delivery at the clinic to determine the actual infant feeding practices. Sixty-four HIV-positive mother-infant pairs completed the study. The response rate was 67%. The median interview day was day 8. Sixty-two mothers (97%) (95% CI: 95% to 99%) exclusively formula fed their infants. Fifty (78%) (95% CI: 73% to 83%) mothers gave their infants formula milk only. Two mothers breast-fed their babies. Twelve (19%) gave their babies other fluids or food. Eleven gave water, glucose water or gripe water and one gave cereal or porridge. Breast engorgement occurred in 51 (80%) mothers. Only five (8%) mothers had received advice about breast engorgement from the facility health providers. Compliance with formula feeding of HIV-positive mothers one week following delivery is at an acceptable level. Levels of breast engorgement and lack of counselling on breast engorgement were high. Advice about non-pharmacological methods of managing breast engorgement must be given to women choosing to formula feed their babies. Mothers must be informed about the dangers of mixed feeding during the first week after delivery.
Self-reported hypertension in eMbalenhle, Mpumalanga, South Africa : findings from a vulnerability to air pollution assessment : original researchSource: Southern African Journal of Epidemiology and Infection 26, pp 280 –284 (2011)More Less
The study determined the prevalence of self-reported hypertension and evaluated the relationship between self-reported hypertension and associated risk factors among adults who participated in the 2006 vulnerability to air pollution study in eMbalenhle, Mpumalanga, South Africa. Face-to-face interviews were conducted in September 2006 with the heads of 377 randomly selected households to obtain information on the household status of health and disease risk factors. eMbalenhle data were compared to the published provincial data on variables of interest. Logistic regression analysis was employed to determine associations between self-reported hypertension and individual risk factors. The prevalence of self-reported hypertension (7.0%), arthritis (3.9%), diabetes (3.8%) and asthma (2.2%) were comparable to provincial self-reported disease figures of 9.0%, 3.5%, 2.3% and 3.4%, respectively. self reporting of hypertension increased significantly with age (OR: 1.07; 95% CI: 1.05-1.09; p<0.001), being female (OR: 3.35; 95% CI: 1.84-6.01; p<0.001), and having doctor-diagnosed arthritis (OR: 2.42; 95% CI: 1.12-5.23; p<0.01) and diabetes (OR: 6.00, 95% CI: 2.08-17.26; p<0.01). The study demonstrates that self-reported hypertension and other chronic diseases in eMbalenhle mirrored the general provincial chronic diseases' patterns despite the poor socio-economic status of this community relative to the province. Self-reported hypertension was strongly related to age, gender, and self-reported arthritis and diabetes.
Source: Southern African Journal of Epidemiology and Infection 26, pp 285 –287 (2011)More Less
Patients with advanced HIV-1 disease can present with a vast array of opportunistic infections. Not only is the spectrum of disease more diverse, but the spectrum of presentation can vary significantly from what is expected. In this case report we describe a patient with advanced HIV-1 disease presenting disseminated skin lesions and haematological abnormalities. Upon further investigation, a probable diagnosis of disseminated histoplasmosis was established. The patient was subsequently treated with oral itraconazole and showed marked haematological and clinical improvement within six weeks of therapy. Histoplasmosis is an opportunistic infection endemic to South Africa and, like most opportunistic infections, can present with a myriad of clinical features which can complicate early diagnosis. Although not as prevalent as in other parts of the world, it should always be considered as part of the differential diagnosis, especially among severely immunocompromised individuals.
Author Elizabeth PrenticeSource: Southern African Journal of Epidemiology and Infection 26, pp 288 –289 (2011)More Less
I am really amused that, although said centuries apart and by men with such differing tastes, on this topic at least, both Mick and Samuel seemingly agree and make commentary on a subject very dear to my heart. Tea indeed amuses me when idle, at three or really any time of day or night. It dilutes, or so I hope, some of the very full meals from which I just cannot abstain or exercise away. And, perhaps most importantly, it relaxes me when studious.