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- Volume 29, Issue 2, 2014
Southern African Journal of Infectious Diseases - Volume 29, Issue 2, 2014
Volume 29, Issue 2, 2014
Author Hendrik KoornhofSource: Southern African Journal of Infectious Diseases 29 (2014)More Less
The journal has undergone a number of changes since its inception as The Southern African Journal of Epidemiology 28 years ago. At that time, it amalgamated with the newly initiated Southern African Journal of Sexually Transmitted Diseases, and was a joint venture of three societies, namely the Infectious Diseases Society of Southern Africa, the Sexually Transmitted Diseases Society of Southern Africa and the Epidemiological Society of Southern Africa. There have been four editors-in-chief since 1986. The two longest-serving editors were Prof Hendrik Koornhof, who still contributes substantially to the journal as Editor Emeritus, and the present Editor-in-Chief, Prof Charles Feldman. The other two editors were the late Prof Ray Smego, an infectious diseases physician, and the first editor, Dr Patrick Hessel, an epidemiologist. Associate editors during the 1990s and 2000s included Profs Ron Ballard, Barry Schoub, Shan Naidoo, Bernard Fourie, Carel Ijsselmuiden, Lucille Blumberg and John Frean.
Source: Southern African Journal of Infectious Diseases 29, pp 52 –55 (2014)More Less
Pregnancy drains the body physically, physiologically and immunologically. This burden is aggravated when combined with parasite infection. Intestinal parasitic infections in pregnancy have been associated with serious adverse outcomes, both for the mother and the unborn baby. In this article, we describe the prevalence and effects of these infections on pregnancy in women in Africa. There is a dearth of research on parasitic infections in pregnancy in South Africa. Most studies have focused on parasites in schoolchildren. This information gap needs urgent attention in a country with the added burden of human immunodeficiency virus (HIV) during pregnancy, as well as unacceptable levels of maternal mortality; and especially so in the light of growing evidence of a link between HIV and parasitic infections.
Factors affecting nonadherence to tuberculosis treatment in uMgungundlovu Health District in 2010 : original researchSource: Southern African Journal of Infectious Diseases 29, pp 56 –59 (2014)More Less
KwaZulu-Natal has a high burden of tuberculosis disease, and is currently not meeting national and international treatment outcome targets. The aim of this study was to investigate patient-related and socio-economic factors that affect treatment adherence in patients on tuberculosis treatment in uMgungundlovu Health District. A case-control study design was used. Three hundred cases (treatment interruption) and 300 controls (treatment completed) were interviewed by trained fieldworkers using a structured questionnaire. In bivariate analysis, lack of education, unemployment and other socio-economic indicators (low income, type of housing, sanitation and residential area) were associated with an increased risk of treatment interruption. Personal factors [smoking, drug and alcohol use, human immunodeficiency virus (HIV) co-infection and perceived severity of illness] were also risk factors for treatment interruption. In multivariate analysis, distance from the clinic was significantly associated with treatment interruption [adjusted odds ratio (OR) 1.3, 95% confidence interval (CI): 1.3-1.6, p-value < 0.005)], as well as residing in a rural area (adjusted OR 14, 95% CI: 1.1-18, p-value < 0.005). Patients co-infected with HIV were twice as likely to interrupt treatment (adjusted OR 2.3, 95% CI: 1.1-4.7, p-value < 0.005), and feeling very or fairly ill during tuberculosis treatment was also significantly associated with treatment interruption (adjusted OR 5.0, 95% CI: 2.1-11.9, p-value < 0.005). The results highlight the complex interaction between personal and socio-economic risk factors for treatment interruption.
Epidemiology of rubella disease in south-west Nigeria: trends and projection from measles case-based surveillance data : original researchSource: Southern African Journal of Infectious Diseases 29, pp 60 –64 (2014)More Less
Although surveillance for rubella does not exist in Nigeria, a measles case-based surveillance system was introduced in 2005 as one of the strategies for measles morbidity control, and included laboratory testing for confirmation of the disease. In this report, we provide the epidemiological distribution of rubella-confirmed cases reported from the south-west zone of the country, and predict the expected number of cases in the ensuing years. A descriptive analysis was carried out of rubella cases reported in the measles case-based surveillance data from the south-west zone of Nigeria for the period 2007-2012. Using an additive time series model, we predicted the expected number of cases until the year 2015. Four hundred and thirty-eight (5.4%) rubella cases were confirmed from 8 046 suspected measles cases. Cases were confirmed from all six states within the zone. The majority (87.3%) were individuals < 15 years of age and 40.9% were female. Seasonal variation existed, with peaks of infection in the first and third triannual periods of the year, while annual trends showed peaks in 2007 and 2010. Based on projections, there was a reduction in the number of expected cases. Rubella testing, in parallel with measles case-based surveillance, provides understanding of the epidemiology of rubella infection in south-west Nigeria.
Measures practised by healthcare workers to prevent tuberculosis transmission at rural hospitals in Vhembe district : original researchAuthor T.G. TshitanganoSource: Southern African Journal of Infectious Diseases 29, pp 65 –69 (2014)More Less
The risk of becoming infected with tuberculosis in healthcare settings is increasing daily. Of every 100 hospitalised patients at any given time, seven in developed, and 10 in developing, countries, will acquire at least one infection in a healthcare setting, including tuberculosis. This study assessed measures practised by healthcare workers (HCWs) to prevent tuberculosis transmission at rural hospitals of Vhembe district. A qualitative approach using a cross-sectional descriptive phenomenology design was adopted. Purposive sampling was used to select 57 participants for focus group discussions. The necessary approval, permission and clearance were obtained. Participants' rights were respected. The findings of this study revealed that the majority of tuberculosis infection control measures practised by HCWs were incorrect, and not aligned with national and international tuberculosis infection control standards. It was concluded that the incorrect measures that were practised might increase the risk of HCWs becoming infected with tuberculosis at rural hospitals in Vhembe district. The development and implementation of a tuberculosis infection control plan at hospital level would ensure that tuberculosis infection control measures practised by HCWs at hospitals in Vhembe district would reduce the chance of them acquiring tuberculosis at these hospitals.
The routine paediatric human immunodeficiency virus visit as an intervention opportunity for failed maternal care, and use of point-of-care CD4 testing as an adjunct in determining antiretroviral therapy eligibility : original researchSource: Southern African Journal of Infectious Diseases 29, pp 70 –74 (2014)More Less
South African women and children remain at the centre of the human immunodeficiency virus (HIV) pandemic, and maternal well-being plays a critical role in child health. In this study, we evaluated the impact of the paediatric visit on the determination of antiretroviral therapy (ART) eligibility in mothers using Alere Pima Analyser (Pima) testing as an adjunct to routine care. Fifty-two mothers who had failed to obtain routine CD4 screening were enrolled during the paediatric visit at Tygerberg Children's Hospital between November 2011 and May 2012. Clinical staging assessments and parallel standard CD4 cell count testing were performed. Finger-prick samples for the Pima, and simultaneous venous samples for reference flow cytometry, were obtained. The Pima identified 37% of mothers as meeting ART eligibility versus 35% using the reference flow cytometry method. An additional 4% of mothers were identified using World Health Organization clinical staging only. The sensitivity of the Pima was 89%, specificity 91%, and positive and negative predictive values 84% and 94%, respectively. These results indicate that the paediatric HIV care visit can provide a valuable additional intervention opportunity to identify mothers in need of ART, with point-of-care CD4 technologies being used as a meaningful adjunct in screening for ART eligibility.
Antifungal products dispensed by a group of community pharmacies in South Africa : original researchSource: Southern African Journal of Infectious Diseases 29, pp 75 –79 (2014)More Less
There is increasing evidence of Candida spp. becoming resistant to some antifungal agents, particularly the azole group. Few studies have investigated antifungal prescribing. The primary aim of the study was to determine the general prescribing patterns of antifungal products in South Africa. A retrospective, cross-sectional drug utilisation study was conducted on the prescription data of a national community pharmacy group in South Africa for 2010. A total of 1 576 593 antimicrobial products were prescribed, of which antifungal products constituted 7.42%. A total of 84 912 patients received 116 955 antifungal products during 2010 [average 1.38, standard deviation (SD) 1.05]. Diagnoses were not specific. The majority (70.86%) were prescription-only products. Fluconazole was the most frequently prescribed active ingredient (42.14%), followed by nystatin (28.83%) and itraconazole (15.33%). The average age of patients was 37.64 (SD 18.29) years, with patients aged 20-49 years receiving 49.44% of the products. Female patients were prescribed more antifungal products (69.67%) than antimicrobial agents (58.32%). Nystatin (53.07%) and griseofulvin (26.74%) were most frequently dispensed to the age group 16 years and younger. Fluconazole (44.26%) and nystatin (27.27%) were most often dispensed to the age group 65 years and older. The average cost per antifungal product was R123.19. Fluconazole was the most prescribed antifungal product in this study. The need for diagnoses of databases is of the utmost importance when determining the cost of treating different types of fungal infections.
Causes of death in patients treated at a tertiary hospital in the Limpopo province : a retrospective study from 2008-2010 : original researchSource: Southern African Journal of Infectious Diseases 29, pp 80 –86 (2014)More Less
The aim of this study was to determine mortality rates and identify associated causes at a tertiary hospital situated in the Limpopo province of South Africa. Death notification forms from Pietersburg Mankweng Hospital Complex were retrieved and reviewed for the period 1 January 2008-31 December 2010 in this cross-sectional study. Data were collected using a data collection form designed for the study. There were 5 232 deaths, on which there was complete information for 5 147, which was then analysed. The average death rate was 6.8 deaths per 1 000 patients, based on the number of patients admitted during the study period. The age of the deceased ranged from 15-104 years, with a mean of 49.1 ± 18.6 years. While only 2.4% of deaths occurred in teenagers, over two thirds occurred in people aged 20-59 years. Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), cancer, cardiovascular disease, trauma and tuberculosis were the top five most common causes of death, and were responsible for 61.2% of all recorded deaths. Trauma was the most common cause of death in teenagers, and HIV/AIDS the most common cause in young adults and adults. Cardiovascular disease was the main cause of death in the elderly. Overall, the triple burden of infectious diseases, noncommunicable diseases (NCDs) and injury remain the leading causes of death in patients at the study site. Innovative injury prevention strategies and interventions to control the spread of infectious diseases are urgently required. Cancer screening services and culturally appropriate lifestyle programmes are needed to address NCDs.
Factors associated with retreatment tuberculosis in Tshwane, South Africa : the role of tobacco smoking : brief reportSource: Southern African Journal of Infectious Diseases 29, pp 87 –90 (2014)More Less
There is evidence from international studies that tobacco smoking increases the risk of tuberculosis recurrence through its effects on the immunological and barrier functions of the airways. In this cross-sectional study, the association between current tobacco smoking and retreatment tuberculosis was studied in a population of 1 926 South African tuberculosis patients with high human immunodeficiency virus (HIV) co-infection rates. Retreatment tuberculosis was more common in male and among HIV-positive participants currently on antiretroviral treatment, or with unknown antiretroviral treatment status. However, we did not find an association between smoking and retreatment tuberculosis. A longitudinal study is needed to confirm these findings.
Source: Southern African Journal of Infectious Diseases 29, pp 91 –94 (2014)More Less
The World Health Organization and Centers for Disease Control and Prevention estimate that rotavirus-associated gastroenteritis is the third most common cause of death in young children, with approximately 453 000 deaths annually, and that more than 90% of these deaths occur in developing countries. An accurate diagnosis of rotavirus in stool samples is important to determine the rotavirus burden of disease, possible rotavirus vaccine failure, and to limit the inappropriate use of antibiotics. While enzyme immunoassay (EIA) is one of the most sensitive and specific testing methods to achieve this, it is relatively time consuming and expensive for laboratories that require short turnaround times. This study evaluated the sensitivity and specificity of the simpler and cheaper Combi® immunochromatographic test (ICT) strip (Coris BioConcepts, Gembloux, Belgium) routinely used by pathology practices to screen stool samples for rotaviruses. Of 6 050 stool samples collected in 2010 and 2011 from a private pathology practice in Pretoria and screened using the Combi® ICT strip, 752 (12%) were tested using a commercial, large-scale EIA detection method, e.g. ProSpecT® Rotavirus EIA kit (Oxoid Diagnostics, Basingstoke, UK). Results showed the sensitivity of the Combi® ICT strip to be 93.7% and the specificity of this assay to be 99.8%, when compared to the gold standard EIA. The study results support the use of the Combi® ICT strip as an appropriate detection assay, showing that it has a highly sensitive and specific reaction to rotavirus antigens.