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- Volume 28, Issue 3, 2013
Southern African Journal of Epidemiology and Infection - Volume 28, Issue 3, 2013
Volume 28, Issue 3, 2013
Author Marc MendelsonSource: Southern African Journal of Epidemiology and Infection 28 (2013)More Less
The infectious diseases landscape in Southern Africa is subtly changing. Although human immunodeficiency virus (HIV) and tuberculosis continue to dominate, the response to these major epidemics is maturing. With respect to HIV, we are making the transition from the desperate situation of the pre-antiretroviral therapy (ART) and "Manto" years, to having nearly two million South Africans on ART, and as the bar descends in terms of CD4 count starting levels, the numbers will only increase. Treatment as prevention could make a major impact on transmission. How long will it be before persons living with HIV are offered ART, irrespective of stage or CD4 count? However, continued challenges present themselves with this shift, no more so than sustaining adherence to drugs, whether or not one pill or multiple, and the quality-of-life issues associated with any chronic disease. However, the sense of learned helplessness with respect to HIV is gone and has been replaced with optimism for the future.
Author C. SimangoSource: Southern African Journal of Epidemiology and Infection 28, pp 139 –142 (2013)More Less
Thermophilic Campylobacter spp. are important causative agents of diarrhoeal disease in humans. Antimicrobial-resistant Campylobacter spp. that originate from poultry can enter the human food chain and result in resistant Campylobacter spp. In human infections. Campylobacter spp. were isolated from chicken faeces collected from chicken farms near Harare. Human isolates of Campylobacter spp. were obtained from clinical laboratories in Harare. The Campylobacter isolates were identified by biochemical tests and tested for their susceptibility to antimicrobial drugs using the disc-diffusion method. A total of 77 human and 83 chicken isolates were characterised. C. jejuni was the most common in both humans (75.3%) and chickens (60.2%), followed by C. coli, which was detected in 19.5% of human and 28.9% of chicken isolates, and then C. lari, detected in 5.2% of human and 10.8% of chicken isolates. All the Campylobacter spp. from humans and chickens were susceptible to erythromycin and all isolates from the chickens were also susceptible to chloramphenicol and gentamicin. Over 85% of the isolates from humans and chickens were susceptible to ciprofloxacin, norfloxacin and tetracycline. Approximately 50% of the isolates from humans and 82% of those from chickens were resistant to co-trimoxazole. All the human and chicken Campylobacter isolates that were resistant to norfloxacin were also resistant to ciprofloxacin. The present study has shown low levels of resistance of Campylobacter spp. from humans and chickens to most of the antimicrobial drugs tested, with the exception of co-trimoxazole.
Source: Southern African Journal of Epidemiology and Infection 28, pp 143 –146 (2013)More Less
In 2007, the World Health Organization Regional Committee for Africa officially noted the resurgence of cholera in the Africa sub-region, and called for strengthening of policies on water supply and sanitation. We study the mortality profile of patients admitted for cholera and factors associated with adverse outcomes. Records of patients admitted with cholera between 1 November 2010 and 31 October 2011 were studied. Patients' age, sex, duration of symptoms before hospitalisation, duration of hospitalisation, and outcome after hospitalisation, were noted. One thousand, two hundred and twenty cholera cases were admitted during the study period, accounting for 39.3% of 3 108 admissions to the medical wards. Of the 1 220 managed cases of cholera, 38 died, providing a case fatality of 3.1%. The mean age of the non-survivors (42.3 ± 16.2) was higher (p-value = 0.01) than that of the survivors (34.9 ± 15.1). Similarly, the mean duration of symptoms before hospitalisation, and duration of hospitalisation, was higher in non-survivors than it was in survivors (p-value 0.001, 0.001 respectively). The mortality profile in women was better than it was in men (p-value = 0.02). Case fatality was high in managed patients with cholera because of their late presentation to the hospital. There is a need to increase personal hygiene and environmental sanitation campaigns in urban and rural areas.
Source: Southern African Journal of Epidemiology and Infection 28, pp 147 –152 (2013)More Less
An important risk factor for congenital malaria is cord blood malaria parasitaemia. We report on the effect of malaria prevention methods [intermittent preventive treatment (IPT) and insecticide-treated nets (ITNs)] on cord blood malaria parasitaemia, as well as the effect of cord blood malaria parasitaemia on the anthropometry of term normal birthweight Nigerian babies. Thin and thick film smears were made from cord blood and peripheral maternal blood samples from mother-infant pairs at delivery. Babies who were included were those who were born at term and who had a normal birthweight. Information on the use of IPT and ITNs was obtained. Of the 231 mother-infant pairs, malaria parasitaemia was found in 60 (26%) mothers and 39 (16.9%) infants' cord blood. Maternal parasitaemia was a significant predictor of cord blood parasitaemia (p-value < 0.006). The mothers of all the babies with cord parasitaemia were infected. The mean length of the babies who had cord parasitaemia (48.84 ± 2.2 cm) was significantly less than that of the babies who did not have parasitaemia (49.70 ± 1.85 cm, p-value < 0.01). Continuous use of ITNs significantly reduced maternal parasite density. Babies who were born to mothers with parasitaemia should be screened for malaria and followed-up. Such babies may already have compromised growth, even when their birthweight is normal as they may be at risk of further growth compromise if nutrition during infancy is suboptimal. Mothers should be encouraged to use ITNs all of the time.
A sero-survey to identify the window of vulnerability to measles in infants in north-eastern Nigeria : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 153 –155 (2013)More Less
As infants lose maternal measles antibodies (MMAs), they experience periods when their antibody levels are insufficient to protect them against measles. A prospective study was carried out at the University of Maiduguri Teaching Hospital. Sera collected from neonates at birth, and at six weeks, three months, six months and nine months of age, were analysed for MMAs by enzyme-linked immunosorbent assay. Seventy-seven neonates were enrolled. Of these, 73 (94.8%) had protective MMAs at birth. This figure declined to 36 (46.8%), 28 (36.4%), 13 (16.9%) and 4 (5.2%) at six weeks, three months, six months and nine months of age (χ2 = 154.264, p-value = 0.000). Protective MMAs at birth waned rapidly, resulting in an early window of vulnerability to measles by the age of six months. Protecting infants with early measles immunisation with potent, safe vaccines are recommended.
Repeatability of manual coding of cancer reports in the South African National Cancer Registry, 2010 : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 157 –165 (2013)More Less
Data validity is a very important aspect of cancer registries in ensuring data quality for research and interventions. This study focused on evaluating the repeatability of manual coding of cancer reports in the South African National Cancer Registry (NCR). This cross-sectional study used the Delphi technique to classify 48 generic tumour sites into sites that would be most likely ("difficult") and least likely ("not difficult") to give rise to discordant results among coders. Reports received from the Charlotte Maxeke Academic Hospital were manually recoded by five coders (2 301 reports, e.g. approximately 400 reports each) for intracoder agreement; and by four coders (400 reports) for inter-coder agreement. Unweighted kappa statistics were calculated and interpreted using Byrts' criteria. After four rounds of the Delphi technique, consensus was reached on the classification of 91.7% (44/48) of the sites. The remaining four sites were classified according to modal expert opinion. The overall kappa was higher for intra-coder agreement (0.92) than for inter-coder agreement (0.89). "Not difficult" tumour sites reflected better agreement than "difficult" tumour sites. Ten sites (skin other, basal cell carcinoma of the skin, connective tissue, other specified, lung, colorectal, prostate, oesophagus, naso-oropharynx and primary site unknown) were among the top 80% misclassified sites. The repeatability of manual coding at the NCR was rated as "good" according to Byrts' criteria. Misclassified sites should be prioritised for coder training and the strengthening of the quality assurance system.
Cross-cultural adaptation of the 12-Item Short-Form survey instrument in a Moroccan representative survey : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 166 –171 (2013)More Less
The health survey, the 12-Item Short-Form (SF-12) survey instrument, was developed as a shorter alternative to the SF-36 for use in scale studies. The aim of our study was to adapt this instrument into Moroccan Arabic and to examine its psychometric properties. The SF-12 was translated from English to dialectical Moroccan Arabic following the International Quality of Life Assessment translation procedure. The psychometric properties were tested in September 2007. Testing involved a sample of families and friends of patients (≥ 16 years old) in the diagnostic centre of the Fez University hospital, Morocco. The SF-12 was assessed by examining item-level characteristics, estimates of scale reliability (internal consistency) and construct validity. The study was conducted on 141 subjects. The physical component summary (PCS-12) and the mental health component Summary (MCS-12) of the SF-12 demonstrated good internal consistency reliability, with alpha coefficients of 0.80 and 0.79, respectively. Multitrait analysis showed that the subscales of the SF-12 had good convergent and discriminant validity. Construct validity, assessed by the method of extreme groups, determined that the SF-12 summary scores varied for individuals who differed according to age and medical conditions. The Moroccan Arabic version of the SF-12 appears to be a valid tool with which to for assess the health status of the general Moroccan population. On the other hand, issues such as test-retest reliability, longitudinal construct validity and responsiveness were not addressed in this study and should be considered in future ones.
Contraceptive use and prevalence of sexually transmitted infections among women seeking termination of pregnancy at a district hospital in KwaZulu-Natal : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 172 –176 (2013)More Less
Termination of pregnancy (TOP) is one of the components of female reproductive health and rights that are freely available in South Africa within the public health system, and yet unwanted pregnancies still remain a challenge. The objectives of this study were to determine the level of knowledge and use of contraceptive methods among women seeking TOP services and to evaluate the prevalence of human immunodeficiency virus (HIV) and other sexually transmitted infections in this group of women. This population-based study was conducted at Northdale Hospital in KwaZulu-Natal. Four hundred and ninety-seven women seeking TOP were interviewed over a period of six months, using a structured questionnaire. The mean age of the women was 25 years. The majority of the participants were black Africans (n = 424, 85.3%,) and single (n = 423, 85%), respectively. Most participants (n = 354, 71%) were unemployed, having obtained a secondary school education level. The majority (n = 420, 84.5%) indicated that they had previously used some form of contraception. However, condom use was used by only 18% (n = 78). The HIV prevalence among women requesting TOP was 39%. Nearly half of the participants (45.9%) had abnormal vaginal discharge and 50% of those who had tested for syphilis received an abnormal result. This study reinforces the need to intensify sexual and reproductive health programmes among women seeking TOP.
Source: Southern African Journal of Epidemiology and Infection 28, pp 177 –179 (2013)More Less
Neisseria meningitidis is a rare cause of meningitis and septicaemia in the neonatal population. Meningococcal septicaemia in neonates is divided into early-onset infection (symptoms within seven days of life) and late-onset infection (8-30 days of life). Early-onset meningococcal infection is extremely rare. We report on a case of early-onset meningitis with septicaemia in a term male infant and provide a review of the literature. This case report highlights the importance of maintaining a high index of suspicion of sepsis in the neonate.
Author A. RevelasSource: Southern African Journal of Epidemiology and Infection 28, pp 181 –185 (2013)More Less
Mabey's Principles of Medicine in Africa, David Mabey, Geoff Gill, Chris Whitty, Eldryd Parry & Martin Weber (Eds.) : book reviewAuthor Hendrik KoornhofSource: Southern African Journal of Epidemiology and Infection 28 (2013)More Less
This medical textbook is written for medical doctors, medical students and other health professionals working in sub-Saharan Africa by authors with many years of experience of medical practice in different parts of Africa. The authors are renowned for their expertise in clinical and epidemiological aspects of diseases occurring in Africa and their experience and knowledge of diseases of Africa through personal encounter with patients in their clinical, social and cultural settings across the continent.
5th FIDSSA Conference 2013
Champagne Sports Resort Drakensberg, KwaZulu-Natal, South Africa
Oral Presentations : congress abstractsSource: Southern African Journal of Epidemiology and Infection 28, pp 189 –201 (2013)More Less
Antibiotic Stewardship/ SAAPS
Session: STIs & HIV Risk
Session: Resistant organisms
Session: Challenges in Therapeutics
Session: Vibrant Virile Viruses
Session: Top 5 session
Session: Hospital acquired infections
Session: Management of drug resistant Tuberculosis
Session: Developments in Vaccinology 2013
Conference Poster Abstracts
5th FIDSSA Congress 2013
Champagne Sports Resort Drakensberg, KwaZulu Natal, South Africa
Poster Presentations : congress abstractsSource: Southern African Journal of Epidemiology and Infection 28, pp 202 –257 (2013)More Less