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- Volume 27, Issue 3, 2012
Southern African Journal of Epidemiology and Infection - Volume 27, Issue 3, 2012
Volume 27, Issue 3, 2012
Source: Southern African Journal of Epidemiology and Infection 27, pp 91 –92 (2012)More Less
Tuberculosis (TB) continues to be one of the biggest public health challenges of our time, and as epidemiology of the disease evolves in an era of high HIV prevalence in South Africa, so must the response. With exciting developments in diagnostics, treatment options and vaccine candidates at various stages of development, South Africa needs a centre that can synthesise all these options and advise government on preventing TB transmission and caring for those infected. The new Centre for Tuberculosis (CTB) of the National Institute for Communicable Diseases (NICD) is well placed to provide this service for the South African government and people.
Author Wamda AbuelhassanSource: Southern African Journal of Epidemiology and Infection 27, pp 93 –97 (2012)More Less
Hepatitis C virus infection is estimated to affect 150 million people worldwide. A large number of individuals are chronically infected and are at risk of developing chronic liver disease, cirrhosis and hepatocellular carcinoma. Chronic hepatitis C infection causes significant morbidity and mortality. It is the leading indication for liver transplantation in the USA and Europe, and accounts for 30-50% of liver transplants in those countries. The introduction of blood and blood product screening protocols in 1992 led to a decline in new infections, but intravenous drug abuse still remains a major risk factor for acquiring the disease. Since no vaccine is available to prevent infection with this virus, research has been ongoing to find a cure. Treatment of hepatitis C has continuously evolved since the introduction of interferon monotherapy in the early 1990s, with very low response rates. In 2002, the use of pegylated interferon and ribavirin significantly improved sustained virological response rates to 50-80%. The management of patients who do not respond to standard care remains challenging. The US FDA approved directly acting antivirals in May 2011. This introduced a new era with regard to management of this condition.
Source: Southern African Journal of Epidemiology and Infection 27, pp 98 –103 (2012)More Less
With the advent of antimicrobials during World War II, and a natural decline that began before then, dread diseases began to assume a less important role, especially in industrialised countries. By the 1970s, acute rheumatic fever and acute glomerulonephritis were rarely seen, even though acute streptococcal infections continued to occur with their usual frequency and severity. In the 1980s, attention was once again focused on infections caused by group A streptococcus and its sequelae. The most common infections caused by group A streptococcus are pharyngitis and pyoderma, which occur in children particularly.
Observations on dust mites (Acari: Pyroglyphidae) in coastal hospitals in South Africa : original researchSource: Southern African Journal of Epidemiology and Infection 27, pp 104 –110 (2012)More Less
Surveys of houses in South Africa have shown that dust mites and mite-derived antigens are more common along the eastern and southern coastal lowlands than on the central Highveld plateau. The present study extended this research to hospitals in the three major coastal cities, to determine whether or not dust mites were present in ward furnishings and on floors, and if so, at what densities. Sampling, over 22 months, in provincial and private hospitals in Durban, Port Elizabeth and Cape Town recovered 10 mite species, including the cosmopolitan pyroglyphids, Dermatophagoides farinae, D. pteronyssinus, Euroglyphus maynei and Malayoglyphus intermedius. Mites were found in all sampled habitats without any apparent preferences, but mean densities were mostly below 10/m2, lower than found previously in houses along the coast. To characterise mite habitats in these coastal hospitals, preliminary environmental data were collected in wards and from inside mattresses. These showed nearly constant environments, with moderate temperatures and relative humidity and narrow annual ranges. Temperature and relative humidity levels decreased with increasing latitude from Durban to Cape Town.
Multidrug-resistant nosocomial infections among private hospital patients in the North West province : original researchSource: Southern African Journal of Epidemiology and Infection 27, pp 111 –115 (2012)More Less
This article reports on severe clinical cases of nosocomial infections that were caused by multidrug-resistant (MDR) isolates of Acinetobacter baumannii and Pseudomonas aeruginosa in an intensive care unit (ICU). Globally, patients in ICUs have encountered an increasing emergence and spread of MDR pathogens. A retrospective case study was conducted to investigate the possible causes and occurrence of nosocomial infections linked to reported cases thereof in a private hospital in the North West province between December 2009 and August 2010. This followed an enquiry from a concerned community member about two patient deaths and a patient who was in the hospital's ICU between July and August 2010 with an infection by an unknown "superbug". Of the 24 adult patients who were admitted to the ICU in the study period, 22 presented with isolates of A. baumannii, one with P. aeruginosa, and one with presumed A. baumannii for which there was no laboratory test confirmation. Of those who were infected with A. baumannii, nine of the 22 died (a case fatality rate of 41%). The patient with no laboratory test confirmation also died within seven days, while the patient who was infected with P. aeruginosa was still in hospital at the end of the study period (August 2010). The average length of stay in the hospital was 21.3 days. Six of the 24 patients (25%) stayed longer than 30 days. A patient who was infected with P. aeruginosa stayed even longer. The most common cause of death among the ICU patients, notwithstanding other underlying conditions, was A. baumannii strain, which may have directly or indirectly contributed to the prolonged length of stay in hospital. It is possible that P. aeruginosa is a recent introduction to this ICU.
Community knowledge variation, bed-net coverage and the role of a district healthcare system, and their implications for malaria control in southern Malawi : original researchSource: Southern African Journal of Epidemiology and Infection 27, pp 116 –125 (2012)More Less
This paper presents data on the pattern of knowledge of caregivers, bed-net coverage and the role of a rural district healthcare system, and their implications for malaria transmission, treatment, prevention and control in Chikhwawa, southern Malawi, using multi-level logistic regression modelling with Bayesian estimation. The majority of caregivers could identify the main symptoms of malaria, that the mosquito was the vector, and that insecticide-treated nets (ITN) could be used to cover beds as an effective preventative measure, although cost was a prohibitive factor. Use of bed nets displayed significant variation between communities. Groups that were more knowledgeable on malaria prevention and symptoms included young mothers, people who had attended school, wealthy individuals, those residing closest to government hospitals and health posts, and communities that had access to a health surveillance assistant (HSA). HSAs should be trained on malaria intervention programmes, and tasked with the responsibility of working with village health committees to develop community-based malaria intervention programmes. These programmes should include appropriate and affordable household improvement methods, identification of high-risk groups, distribution of ITNs and the incorporation of larval control measures, to reduce exposure to the vector and parasite. This would reduce the transmission and prevalence of malaria at community level.
Knowledge and utilisation of expanded functions of oral hygiene and barriers to successful implementation in public healthcare services in Gauteng : original researchSource: Southern African Journal of Epidemiology and Infection 27, pp 126 –129 (2012)More Less
Dental hygiene continues to evolve as a profession. It needs greater regulation and autonomy. Since the burden of disease and demand for treatment is increasing, there is a great need for existing oral hygiene services to be utilised effectively and efficiently. The purpose of this study was to assess the knowledge and utilisation of the expanded functions of oral hygiene, and also to gauge the barriers to successful implementation of these functions among dentists and dental therapists in public healthcare services in Gauteng province. The study was cross-sectional, and 51 selected dentists completed a self-administered questionnaire. More than a third (n = 19, 37%) of the dentists did not know anything about the expanded functions of oral hygiene. Among dentists who did have knowledge of these functions, 66% (n = 19) identified restorative procedures as the scope of the expanded functions. Almost three-quarters (n = 37, 72%) worked with oral hygienists, but only 14% delegated some of the expanded functions. Regarding non-delegation, 70% (n = 22) mentioned that the oral hygienists were too busy to carry out these functions. Seventy per cent (n = 22) of dentists indicated that the expanded functions were never used in their workplace, and 50% (n = 16) reported the lack of patient need as a barrier to utilisation of the functions in the workplace. Oral hygiene services in South Africa need to be brought in line with international expanded function standards. The full use of oral hygienists in applying these functions should be encouraged and supported.
Demographic profile of lung cancer patients at the Universitas Academic Hospital Bronchoscopy Unit in Bloemfontein : brief reportSource: Southern African Journal of Epidemiology and Infection 27, pp 130 –132 (2012)More Less
The prevalence of lung cancers with epidermal growth factor receptor (EGFR) mutations in South Africa is not known. In the absence of the routine availability of laboratory assays to test for the presence of EGFR mutations, certain demographic and clinical features might be used to predict a response to treatment with a tyrosine kinase inhibitor in patients with lung cancer. These features include East-Asian ethnicity, female gender, non-smokers, and those with adenocarcinoma.
Source: Southern African Journal of Epidemiology and Infection 27, pp 133 –136 (2012)More Less
Neurocysticercosis (NCC) is a relatively common disease in South Africa. It occurs in the rural areas surrounding Bloemfontein in the Free State province, as well as in neighbouring Lesotho. We report on a 46-year-old female admitted with vertebral and spinal NCC, who was newly diagnosed with human immunodeficiency virus (HIV), and had a CD4 count of 46 x 106 cells/l. She presented with severe pain, associated with spasms and weakness of the lower limbs. She had similar prior episodes and underwent spinal surgery to evacuate cysts. Magnetic resonance imaging revealed a spinal lesion at T12, causing vertebral collapse. During subsequent surgery, cysts were extracted from the subarachnoid space and spinal medulla. Yamshidi needle biopsy of the vertebral body was performed and sent with the cysts for histological examination. A diagnosis of spinal NCC was made on the basis of histological findings. The patient had a recurrence of a former disease, leading to the question of whether or not this recurrence was as a result of a weakened immunity, due to her HIV status. The patient was treated with albendazole, steroids, analgesics, and amitriptyline. Her condition improved after surgery, and she was subsequently admitted to a regular ward. To our knowledge, this is the first case in the Free State of spinal NCC that extended into the adjacent vertebral body. The occurrence of cysticercosis is escalating due to factors such as HIV/AIDS, and poor socio-economic conditions. Its widespread distribution poses a research challenge with regard to the true extent of the disease.