- A-Z Publications
- Southern African Journal of Infectious Diseases
- Previous Issues
- Volume 29, Issue 1, 2014
Southern African Journal of Infectious Diseases - Volume 29, Issue 1, 2014
Volume 29, Issue 1, 2014
Patient empowerment as a driver of hand hygiene practice : time for patients in South Africa to have their say : editorialSource: Southern African Journal of Infectious Diseases 29, pp 3 –4 (2014)More Less
"Patient-centered care" presumes the active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment. An extension of this concept would be for patients and their families to play an active role in policing potentially harmful practices that are ongoing in our healthcare facilities. One of the greatest direct threats to patient safety is the rise of antibiotic resistant bacterial infections. Antibiotics play a vital role in the treatment of bacterial infection, and when used correctly, have a profound impact on morbidity and mortality. However, decades of inappropriate antibiotic use have driven the emergence of drug-resistant bacteria, by selecting out those with resistance. Today, multidrug-resistant bacterial infections are encountered in public and private hospitals across South Africa. Pan-resistant Gram-negative infections have already been identified, and the number of these untreatable infections will only increase. The true burden of healthcare-associated infections in South Africa is unknown, but globally, hundreds of millions of patients are affected each year.
The SASCM CRE-WG : consensus statement and working guidelines for the screening and laboratory detection of carbapenemase-producing Enterobacteriaceae : guidelinesSource: Southern African Journal of Infectious Diseases 29, pp 5 –11 (2014)More Less
The threat of multi-drug resistance is a global one. Recently, this threat was exacerbated by the meteoric rise of carbapenemase-producing Enterobacteriaceae (CPE). South Africa is no exception, with well-documented reports of New Delhi metallo-β-lactamase (NDM), Klebsiella pneumoniae carbapenemase (KPC) and active on oxacillin-48-like (OXA-48-like) CPE.
Anal human papillomavirus and anal squamous cell cancer in people living with HIV/AIDS : implications for southern Africa : reviewAuthor S. ChirkutSource: Southern African Journal of Infectious Diseases 29, pp 12 –18 (2014)More Less
Southern Africa has the largest burden of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in the world. Highly active antiretroviral therapy (HAART) is increasingly being made available in the region. The disease has shifted from being a death sentence to that of a chronic disorder with the availability of HAART. The morbidity and mortality in people living with HIV/AIDS (PLWHA) in the developed world seems to be shifting from that of opportunistic infection to malignancy, particularly non-AIDS-defining cancer. A similar trend may be imminent in the developing world owing to the availability of HAART. Squamous cell cancer of the anus is a cancer with a seemingly increasing incidence in PLWHA. This review explores the possible impact that a rise in the incidence of squamous cell cancer of the anus would have on the region, and strategies that may be employed to identify and counteract this escalation.
Human immunodeficiency virus and hepatitis B or C co-infection in KwaZulu-Natal : a retrospective analysis of a laboratory database : original researchSource: Southern African Journal of Infectious Diseases 29, pp 19 –22 (2014)More Less
Hepatitis B or C virus infection has an important influence on treatment and outcomes in human immunodeficiency virus (HIV)-infected individuals. HIV worsens the prognosis in hepatitis B- or C virus-infected patients, and patients on antiretroviral therapy are more likely to experience hepatotoxicity if they are co-infected with a hepatotropic virus. There is a paucity of data on the epidemiology of hepatotropic viruses in relation to each other and to HIV in KwaZulu-Natal. The aim of this study was to describe the seroprevalence of hepatitis B and C virus in HIV-positive and -negative individuals in KwaZulu-Natal from 2002-2010, using a large laboratory database of routine serological results. Patients who had an HIV or hepatitis B or C test performed at the National Health Laboratory Service Department of Virology in Durban from 2002-2010 were included in the study. The study revealed that the overall seropositivity of hepatitis B surface antigen (HBsAg) was 12.05%, and that of hepatitis C immunoglobulin G (IgG), 4.13%. Individuals who were seropositive for HIV had 3.19-fold increased odds of being positive for HBsAg, 2.06-fold increased odds of being hepatitis B virus e antigen-positive, and 2.91-fold increased odds of being hepatitis C virus IgG-positive. Of those individuals who were tested for HBsAg and hepatitis C virus IgG (irrespective of HIV status), 15.76% were seropositive for both markers. HIV-positive individuals are at increased odds of having markers for hepatitis B and C infection.
Source: Southern African Journal of Infectious Diseases 29, pp 23 –26 (2014)More Less
Patients with pulmonary tuberculosis commonly have additional pathogens cultured in sputum, i.e. so-called potentially pathogenic bacteria. The significance of these organisms is uncertain. Previously, we demonstrated that the presence of potentially pathogenic bacteria in the sputum of a group of mainly human immunodeficiency virus (HIV)-seronegative tuberculosis patients was relatively uncommon. We wished to determine whether or not this was the same in a group of mainly HIV-seropositive patients. Patients admitted to Charlotte Maxeke Johannesburg Academic Hospital with sputum-positive tuberculosis and sputum for microscopy and culture were recruited between July 2011 and April 2012. Patient demographics, clinical investigations, sputum microbiological results and discharge data were reviewed. Twenty-five patients were recruited, 14 of whom were female. The median age was 30 years (a range of 19-63). Eighteen (72%) patients were HIV-infected, four HIV-uninfected and three of unknown HIV status. The median white cell count was 7.59 x 109/l (a range of 1.79-17.61), the median C-reactive protein was 167 mg/l (a range of 27-292), and the median CD4 81 cells/µl (a range of 14-369). The median albumin in the potentially pathogenic bacteria-positive group was 26 g/l versus 28 g/l in the potentially pathogenic bacteria-negative group (p-value 0.5229). Nine (36%) of the patients had potentially pathogenic bacteria on sputum culture. 38.9% and 28.6% in the HIV-infected, and HIV-uninfected, groups, respectively, grew potentially pathogenic bacteria. Seven patients (77.7%) in the potentially pathogenic bacteria-positive group survived to hospital discharge, compared with 14 (87.5%) of the potentially pathogenic bacteria-negative group (p-value 0.6016). This study showed that a mainly HIV-infected group had a similar rate of potentially pathogenic bacteria in the sputum, when compared with a previous mainly HIV-uninfected group. This study suggests that secondary bacterial infection may be relatively uncommon in both HIV-infected and -uninfected patients with active pulmonary tuberculosis.
Predictors of tuberculosis treatment defaulting in informal dwellers within the eThekwini Municipality, KwaZulu-Natal : original researchSource: Southern African Journal of Infectious Diseases 29, pp 27 –32 (2014)More Less
Globally, tuberculosis causes more than 2-million deaths annually. Despite the implementation of the directly observed treatment strategy (DOTS) in South Africa, cure and defaulter rates have not reached World Health Organization (WHO) target rates. This causes concern as it may increase the risks of the development of multiple drug-resistant tuberculosis. Prior to commencement of this study, the eThekwini Municipality reported a defaulter rate of 18.9% in 2007 and 29% in 2009, which is higher than the WHO guideline of 5%. In 2011, eThekwini reported a defaulter rate of 24.3%. Given these statistics and the impact that these high rates may have on susceptible populations and an already overburdened health system, this study aimed to investigate predictors of defaulting in informal dwellers of eThekwini Municipality, KwaZulu-Natal. The study population comprised 102 defaulters and 102 non-defaulters from informal settlements within eThekwini. It was a cross-sectional descriptive study. The Prince Cyril Zulu Communicable Disease Centre electronic tuberculosis register was used to trace defaulters who were interviewed from informal settlements. Demographic data for non-defaulters were matched from the Prince Cyril Zulu Communicable Disease Centre electronic tuberculosis register, but were not physically traced. A questionnaire was administered to all defaulters and retrospective data were obtained from the Prince Cyril Zulu Communicable Disease Centre register for non-defaulters. Multivariate logistic analysis found smoking, alcohol use and having a family member with tuberculosis to be statistically significant predictors of defaulting. Smoking [odds ratio (OR): 2.79, 95% confidence interval (CI): 1.15, 6.77, p-value ≤ 0.005], alcohol consumption (OR: 7.04, 95% CI: 2.96, 16.71, p-value ≤ 0.005), and having a family history of tuberculosis (OR: 4.60, 95% CI: 2.34, 9.04, p-value = 0.01), were all significantly associated with defaulting in informal dwellers. Smoking, alcohol use and having a family member with tuberculosis were predictors that informal dwellers would default from their treatment. These factors should be included in tuberculosis management programmes.
A retrospective review of group B streptococcal infection in the Metro East area of the Western Cape province : 2010 to 2011 : original researchSource: Southern African Journal of Infectious Diseases 29, pp 33 –36 (2014)More Less
Effective strategies to prevent infant death rely on knowledge of prevalent pathogens. Recent publications have drawn attention to limited data on the contribution of group B streptococcal infection to neonatal and infant mortality in resource-restricted settings. The aim was to describe all cases of group B streptococcal infection isolated from the blood culture of infants up to 90 days of age in two South African hospitals over a two-year period. A retrospective record review took place of infants in whom group B streptococcus was isolated from blood culture or cerebrospinal fluid from January 2010 and December 2011. The maternal records of infants were also reviewed. Data were analysed using Stata® version 1.1. Forty-one cases of group B streptococcal infection were identified, for which 33 records were available for analysis. There was early-onset disease in 14 (42.4%) and late-onset disease in 19 (57.6%) of the infants. Eight (24%) infants were human immunodeficiency virus (HIV)-exposed. There was a confirmed positive HIV PCR test for one infant only. Six infants had pneumonia, 11 meningitis and two died. Serotyping was not performed. All isolates were sensitive to penicillin. The crude incidence rate was calculated as 0.67/1 000 live births. The incidence rate of group B streptococcal disease was less than that in other African studies. Further data are needed for relevant prevention strategies to be established.
A cross-sectional study on knowledge of, attitudes towards and practice of malaria prevention and control measures in central Nigeria : original researchSource: Southern African Journal of Infectious Diseases 29, pp 37 –42 (2014)More Less
There is limited evidence of a decrease in malaria-related mortality and morbidity with the expiration of the 2010 Roll Back Malaria (RBM) Partnership target deadline. Thus, there is a need to evaluate the knowledge of, attitudes towards and practice of malaria control and prevention measures by the risk population, i.e. children and pregnant women in endemic communities. This was a cross-sectional study using a questionnaire on 640 children aged 0-18 years attending Jos University Teaching Hospital and three primary healthcare centres in malaria holoendemic communities in Plateau State, Nigeria. Of 640 children, 312 (48.8%) and 328 (51.2%) were male and female, respectively. Most respondents (78.8%) were aware that malaria is caused by a mosquito bite. There were mosquito breeding sites in the majority of respondents' homes and in the community. Five hundred and twenty (81.2%) subjects received the distributed insecticide-treated bed nets (ITNs). Fifty-six (8.8%) of the recipients had not started using the ITN because they held various incorrect beliefs about it. Three hundred and twenty-nine children (78.5%) aged five years and younger slept under ITNs. Some participants used mosquito coils, insecticide paper, insecticide spray, antimalaria therapy, and environmental hygiene and herbal leaves as malaria prevention and control measures. The results of this study demonstrated that there was increased ownership and use of ITNs at community level. However, the level of environmental and personal hygiene was low, and the existence of mosquitoes breeding sites was high. Thus, efforts need to be intensified with regard to malaria control strategies to ensure that adequate information relating to the importance of environmental and personal hygiene, the elimination of mosquito-breeding sources and the safety of ITNs is more made more available and accessible at community level. This will help RBM Partnership goals, both in Plateau State and Nigeria, to be achieved and sustained.
Source: Southern African Journal of Infectious Diseases 29, pp 43 –47 (2014)More Less
We investigated whether or not differences existed between black and white patients in Johannesburg with regard to the demographic and histological features of lung cancer. This was a retrospective case record review of patients with lung cancer, seen over seven years in the pulmonology units of three hospitals attached to the University of the Witwatersrand. Seven hundred and seventy-eight black and white patients were enrolled. Six hundred and thirty-two (77.4%) of these patients were known to have smoked. The white patients were older than the black patients [median age of 66 years (range of 32-92) vs. 57 years (range of 26-86), p-value < 0.001], and had significantly greater mean pack years of smoking (52.7 ± 21.7 vs. 21.7 ± 14.3, p-value < 0.001). [Pack years is the numerical value of lifetime exposure to cigarettes, calculated as follows: the number of cigarette smoked x years of exposure/20 (a pack of cigarettes usually has 20 cigarettes)]. Histological cell types of lung cancer were squamous cell carcinoma in 341 (43.8%), adenocarcinoma in 167 (21.5%), small cell carcinoma in 129 (16.6%) and large cell carcinoma in 68 (8.7%) of the cases. More white than black patients had small cell carcinoma (p-value 0.01). More black than white patients had large cell carcinoma (p-value 0.04). There were also differences between the genders within the two racial groups. There were significant differences in the demographics and histological features when lung cancer in black versus white patients was compared. Black patients were younger and smoked fewer cigarettes. Squamous cell carcinoma was the most common cancer in all patients, except black females, in whom small cell carcinoma was more common.
The benefits of using a community-engaged research approach to promote a healthy lifestyle in three Nigerian urban slums : brief reportSource: Southern African Journal of Infectious Diseases 29, pp 48 –50 (2014)More Less
Slums are a wide range of low-income settlements with poor living conditions. The quality of the dwellings varies from simple shacks to permanent structures, while access to water, electricity, sanitation and other basic services and infrastructure tends to be limited. Noncommunicable diseases (NCDs) exist in slums as the inhabitants adopt an urbanised lifestyle which places them at high risk. Lack of knowledge about the complications of NCDs and how to control them contributes to a large percentage of undetected and untreated cases. Therefore, our recently concluded study aimed to reduce the prevalence of NCDs by promoting a healthy lifestyle in three Nigerian urban slums using a community-engaged research approach. We decided to adopt this approach since community-engaged research takes place in real-world conditions, thus increasing the applicability of findings to practical applications that improve human health. Literature has shown that meaningful community involvement can improve the research process itself, as well as the ultimate findings. Research questions about health issues that concern the community are developed, and people are more likely to give their support when they understand the purpose of the research, and how the results may positively affect them. Thus, this helps when recruiting participants. In addition, research questions help to identify the health risks that are revealed through people's participation, and helps with the development of appropriate ways to protect participants in this regard. Research questions also assist with improving study and instrument design by producing user-friendly, culturally sensitive, accurate and valid practices and measures. Furthermore, community involvement in analysis and interpretation can provide an important explanation of the results, and provide ideas that the researchers had not even considered. A community-engaged research approach provides an opportunity for greater trust and respect to be built between academic researchers and communities. This can lead to future research collaborations, as well as an improvement in community health.