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- Volume 28, Issue 2, 2013
Southern African Journal of Epidemiology and Infection - Volume 28, Issue 2, 2013
Volume 28, Issue 2, 2013
Gonorrhoea resistance among men who have sex with men : what's oral sex got to do with it? : editorialSource: Southern African Journal of Epidemiology and Infection 28 (2013)More Less
The term "men who have sex with men" (MSM) refers to men who engage in sexual activity with other men, but who may also have sex with women. Relevant to healthcare delivery and sexual history-taking, many MSM do not consider themselves to be "homosexual" or "gay", so it is important that appropriate language is used during clinical consultations. MSM are an important group of individuals from the public health perspective as they may act as a bridging population for sexually transmitted infections (STIs), including human immunodeficiency virus, to pass from high-risk MSM sexual networks into the general population, and vice versa. Research conducted on 1783 men in the Eastern Cape and KwaZulu-Natal provinces showed that more than one in 20 South African men engage in consensual sexual activity with other men.
Enteropathogens associated with the seasonal fluctuations in plasma sodium and potassium levels in childhood diarrhoea : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 79 –89 (2013)More Less
This paper aims to assess the clinical, nutritional, microbiological, environmental and socio-economic determinants that have a seasonal distribution, or are potential confounders of a seasonal association of previously described seasonal fluctuations in plasma sodium and potassium concentrations in children with dehydrating diarrhoea. A cross-sectional analytical study was conducted from 15 April 2002 to 14 April 2003 of 350 children aged six weeks to two years admitted to the diarrhoea rehydration unit of a children's hospital in Cape Town. Multiple linear regression analysis showed the plasma sodium levels to be statistically significantly associated with age [-0.3 mmol/l per month of age, 95% confidence interval (CI): -0.2, -0.4], enterotoxigenic Escherichia coli infection [-2.1 mmol/l, 95% CI: -4, -0.2], enteropathogenic E. coli infection [-5.1 mmol/l, 95% CI: -7.1, -3.1], being breastfed [1.9 mmol/l, 95% CI: 0.4, 3.4] and living in a brick house [2.7 mmol/l, 95% CI: 0.8, 4.5]. Plasma potassium levels were associated with duration of diarrhoea before admission [-0.02 mmol/l per day of diarrhoea, 95% CI: -0.01, -0.04], cryptosporidium infection [-0.3 mmol/l, 95% CI: -0.1, -0.6] and parental education [0.04 mmol/l per year of education; 95% CI: 0.1, 0.01]. Of these, enterotoxigenic and enteropathogenic E. coli and cryptosporidium infections followed seasonal distributions that were similar to those of the electrolyte concentrations. Seasonal fluctuations in plasma sodium and potassium levels are at least partly explained by both enterotoxigenic E. coli and cryptosporidium infections working together. Enterotoxigenic E. coli infection has a larger effect on plasma sodium levels and cryptosporidium infection has a larger effect on plasma potassium levels.
Disintegrating perineal disease in patients with urethral stricture and HIV infection : a review of 12 cases : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 91 –95 (2013)More Less
The aim of this study was to define disintegrating perineal disease (DPD) and to determine whether the fulminating nature of the condition could be explained by urine and perineal swab microbiology or perineal histology. A retrospective study that included 12 male patients with urethral strictures and DPD was performed. DPD was defined as a chronic, destructive, purulent perineal inflammation with multiple fistulae or sinuses of the perineum, scrotum or penoscrotal area, which continued for more than six weeks despite a patent urethra after direct vision internal urethrotomy (DVIU) or urinary diversion by means of suprapubic cystostomy. The median patient age was 43.5 years (range of 22-68 years). The patients all tested positive for human immunodeficiency virus (HIV) infection. Their mean CD4 count was 340 cells/mm3 (range of 244-1 252 cells/mm3). Histology of the fistula tracts showed non-specific inflammation in 8 patients (66.7%), tuberculosis in 2 (16.7%), hydradenitis suppurativa in one (8.3), and squamous cell carcinoma in situ with condylomata acuminata in one patient (8.3%). DVIU was performed in 10 patients. Patency of the urethra could be achieved in only three patients for more than six weeks. Perineal urethrostomy was completed in three patients after failed DVIU. Ileal conduit urinary diversion and simple cystectomy was carried out in three patients and curing the DPD was accomplished in two. DPD relates to urethral stricture disease in HIV-positive men with secondary infection as the initiating cause, but no predominant microorganism is responsible for the condition. Simple cystectomy with urinary diversion may be the only solution to treating this debilitating disease.
Factors associated with pulmonary tuberculosis outcomes among inmates in Potchefstroom Prison in North West province : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 96 –101 (2013)More Less
Tuberculosis is the leading cause of death among the world's prison populations. Prisons are reservoirs of tuberculosis and threaten inmates, prison staff, visitors and the surrounding community. This study was carried out to explore the associated factors with pulmonary tuberculosis treatment outcomes at Potchefstroom Prison. A retrospective record review of 202 inmates with tuberculosis, whose treatment outcomes as of March 2010 were known, was conducted. Data on sex; racial group; level of education; weight; smoking habits; existence and type of co-morbidity, diagnostic classification; treatment regimen, initiation date, completion date and outcome; use of directly observed treatment; allergy and hospitalisation were captured. The majority of the inmates (142, 70.3%) were aged 21-37 years, while 48 (23.8%) were aged 38-53 years. There were 198 (98%) male and 4 (2%) female inmates. Fifty-five inmates (27.3%) had attained Grade 6 and lower, 71 (35.1%) grade 7-9, 68 (33.7%) Grade 10-12, and 8 (3.9%) above grade 12. One hundred and fifty-eight (78.2%) received occasional visitors. There were 121 (59.9%) smokers. The adverse outcomes for tuberculosis were significantly increased by an age < 37 years, human immunodeficiency virus co-infection, smoking, a lack of support and an absence of directly observed treatment. Inmates who received fewer visits and less social support must be supported by community volunteers, counsellors and psychologists in order to motivate them and enhance favourable treatment outcomes. Smokers need to stop smoking. Younger inmates require peer support groups.
Characteristics of women having first-trimester termination of pregnancy at a district hospital in KwaZulu-Natal : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 102 –105 (2013)More Less
Termination of pregnancy (TOP) is requested by some women for a variety of reasons and it is plausible that profiling their characteristics might help to target selected groups for counselling. This study aimed to determine the characteristics of women having a legal first-trimester TOP at a regional hospital in KwaZulu-Natal. The medical records of 254 women were retrospectively sampled and analysed from a total of 758 women who had a first-trimester TOP between January and December 2008. The women were aged 14-45 years (the most common age group was 20-29 years, a mean age of 25.3 years and a standard deviation of 5.9). The majority (75.6%) reported that they had at least one child who was alive, 1.6% had previously had a TOP, 93.3% were single and 28.4% resided outside the health district in which the hospital was situated. Eighty-nine per cent had not used contraception before the index pregnancy. Fifty-eight per cent requested a TOP between 9 and 12 weeks of gestation (a mean of 8 weeks). Ninety-six per cent had a TOP because of socio-economic reasons. All of the women received counselling prior to undergoing TOP. In our patient population, women who had a legal TOP in the first trimester were in their twenties, single, parous, sexually active, not on a contraceptive and of poor socio-economic status. Women with these characteristics should be targeted for appropriate counselling on reproductive health matters.
Wastewater and solid waste disposal patterns of Dukem town households in Ethiopia : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 106 –111 (2013)More Less
The objective of this descriptive, cross-sectional study was to assess wastewater and solid waste management by the households of Dukem, a town in Ethiopia. A total of 391 households were selected using stratified random sampling techniques. Face-to-face interviews were carried out with respondents by asking questions about wastewater and solid waste management in the households. A majority (75.1%) of households used unsafe wastewater disposal methods. Approximately two thirds (67.7%) of households had a temporary storage container in their compound in which to store solid waste. 53.3% of households used a safe solid waste disposal method. Only 4.9% of the households used waste as manure (compost) for home gardening. More than a quarter (28.1%) of households practised burning waste on their premises. The availability of safe wastewater disposal facilities was significantly associated with private home ownership and family size (p-value < 0.05). There was no significant association between the availability of safe solid waste disposal facilities and owning a private home or family size (p-value > 0.05). Generally, there were inadequate domestic wastewater and solid waste disposal facilities in the studied households. Thus, there is a need for improved waste management in the households. Environmental health and health education programmes should be emphasised in order to improve practices of household waste management.
Prevalence of Helicobacter pylori cagA and vacA allelic variants and associated disease outcomes in Kenyan patients with dyspepsia : original researchAuthor A.N. Kimang'aSource: Southern African Journal of Epidemiology and Infection 28, pp 112 –116 (2013)More Less
Although Helicobacter pylori has been linked to various gastric disorders in Western countries and Asia, its aetiopathological role in African populations is controversial. The aim of this study was to investigate the role of H. pylori and its virulence genotypes in gastrointestinal diseases in Kenyan patients with dyspepsia. Gastric biopsy specimens were obtained for DNA isolation and histopathological analysis. Amplification was performed using specific oligonucleotide primers. H. pylori positivity was determined by H. pylori stool antigen test, rapid urease test, and histology and molecular diagnostic tools. H. pylori was detected with high frequency in patients with gastritis, peptic ulcer disease (PUD) and gastro-oesophageal reflux disease. This implies a significant risk of the development of these pathologies (p-value = 0.0000 in all cases). H. pylori strains with cagA occurred more frequently in PUD (65.2%). vacA s1a genotype appeared to play a more significant pathological role (82.6% PUD) than the other variants (p-value = 0.0142). The prevalence of vacA m1 was significantly higher in gastritis cases (p-value = 0.0253). vacA m2 was found to be significantly associated with gastritis (p-value = 0.0253). This finding may point to the fact that H. pylori vacA m1 and vacA m2 are independently associated with an increased risk for gastritis. Indications are that H. pylori prevalence in Kenya may be declining. The independently occurring H. pylori genotypes, as opposed to simultaneous carriage, could be the reason for the low distribution of H. pylori pathologies.
An evaluation of the diagnostic adequacy and immunocytochemistry of manual liquid-based smears in breast aspirates : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 117 –121 (2013)More Less
The aim of this study was to determine if the Syner-Med®/Cell-Solutions® liquid-based cytology (LBC) technique would provide adequate diagnostic material when applied to breast fine-needle aspiration biopsy (FNAB) specimens and to determine its suitability for immunocytochemistry. A prospective study was undertaken of 38 consecutive patients who underwent FNAB of breast masses in the Fine Needle Aspiration Clinic at Tygerberg Hospital, Cape Town, over a period of six months. Conventional smear cytology slides (CSC) were formulated and the material that remained in the needle was used to prepare the LBC Syner-Med®/Cell-Solutions® slides. The CSC and LBC slides were evaluated by two pathologists. The assessed parameters were cellularity, background and representative diagnostic material. Immunocytochemical stains for pancytokeratin (MNF-116) and oestrogen receptor were performed in each case. In 33 cases (87%), LBC compared favourably with CSC. Adequacy rates of 84.2% for CSC and 76.3% for LBC were found. A diagnosis was made in 78.9% of the CSC cases and in 71% of the LBC cases. The LBC slides showed excellent results, with immunocytochemical staining for MNF-116 and oestrogen receptor. The Syner-Med®/Cell-Solutions® LBC fixative and preparation method provides an alternative technique for obtaining well fixed and prepared slides that are suitable for diagnostic cytology and immunocytochemistry.
An observational study of influenza A(H1N1)pdm09 viral shedding and resistance under standard-duration oseltamivir treatment : brief reportSource: Southern African Journal of Epidemiology and Infection 28, pp 122 –125 (2013)More Less
An observational study was established in South Africa in 2009, early in the influenza A(H1N1)pdm09 outbreak, to provide information on the virological response of the new virus to oseltamivir and the potential for resistance. Patients (n = 54) aged 1-64 years who were treated with standard five-day courses of oseltamivir, starting within two days of onset of the symptoms, showed rapid reductions in viral load or shedding and clinical signs and symptoms. Oseltamivir was well tolerated, with no serious adverse events. Signs of treatment-emergent phenotypic and genotypic resistance were noted in one patient.
First detected isolate of glycopeptide-intermediate resistant Staphylococcus aureus in a renal unit at a central academic hospital in KwaZulu-Natal : brief reportSource: Southern African Journal of Epidemiology and Infection 28, pp 126 –129 (2013)More Less
Staphylococcus aureus is an important and common cause of healthcare and community-associated infections. Reduced susceptibility to glycopeptides in methicillin-resistant S. aureus is well documented. We report on the first glycopeptideintermediate S. aureus (GISA) isolate from a renal unit at a central academic hospital in Durban, KwaZulu-Natal. The rapid sequence of increasingly resistant profiles in a single patient highlights the capacity of S. aureus to evolve to overt resistance with clinical vancomycin use. This case emphasises the critical need for reliable detection methods of GISA strains in clinical laboratories to ensure timeous initiation of the appropriate therapy.
Source: Southern African Journal of Epidemiology and Infection 28, pp 130 –133 (2013)More Less
Actinomycosis is very often misdiagnosed as typically, the associated laboratory and radiological findings are nonspecific. Therefore, clinicians should always have a high index of suspicion in cases in which there is a chronic, indolent development of a mass lesion with sinus tracts, that progresses through the tissue planes, and which relapses following short courses of antibiotics. Early diagnosis may prevent invasive investigations and radical surgical procedures as the patient can then simply be treated with oral penicillin.