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- Volume 29, Issue 4, 2014
Southern African Journal of Infectious Diseases - Volume 29, Issue 4, 2014
Volume 29, Issue 4, 2014
Source: Southern African Journal of Infectious Diseases 29 (2014)More Less
High prevalence of mupirocin resistance associated with resistance to other antimicrobial agents in Staphylococcus aureus isolated from patients in private health care, Western Cape : original researchSource: Southern African Journal of Infectious Diseases 29, pp 126 –132 (2014)More Less
Staphylococcus aureus is an opportunistic pathogen which results in high morbidity and mortality. Decolonisation of the carriers by the intranasal administration of mupirocin is frequently prescribed in infection control practice. The aim of this study was to establish the prevalence of mupirocin resistance in our setting and to investigate the association between mupirocin resistance and resistance to other antimicrobial agents. We simultaneously evaluated laboratory procedures for the sensitivity testing of mupirocin. Standardised disc sensitivity testing for high-level resistance to mupirocin was performed on a prospective sample of 997 unique clinical isolates of S. aureus. The results were confirmed with molecular testing. We also evaluated the reliability of automated sensitivity testing by Vitek® 2. Statistical methods were used to estimate associations between high-level resistance to mupirocin and resistance to other antimicrobial agents. High-level mupirocin resistance prevalence was 23.37% [95% confidence interval (CI): 20.77-26.12]. The phenotypic results agreed with the molecular tests for the mupA gene. Raw agreement between standardised disc sensitivity and the automated method was 94.38%, with a weighted kappa of 0.8767 (95% CI: 0.83-0.90). We found statistically significant associations between high-level mupirocin resistance and resistance to cloxacillin, fusidic acid, fluoroquinolones, co-trimoxazole and macrolide-lincosamide-streptogramin B phenotypes. The high prevalence of mupirocin resistance in this setting necessitates sensitivity testing before decolonisation with mupirocin. The correlation between high-level mupirocin resistance and resistance to other antimicrobial agents implies selective pressure for more resistant strains, which should be considered in the practice of antimicrobial stewardship.
Profile of patients and referrals at a midwife obstetric unit in Tshwane North subdistrict, Gauteng province : original researchSource: Southern African Journal of Infectious Diseases 29, pp 133 –136 (2014)More Less
Midwife obstetric units (MOUs) are primary health level facilities at which antenatal care and delivery for low-risk patients are performed. They are important facilities because they are at the interface of the health system in South Africa and the population. One of their main functions is the identification and referral of high-risk patients. However, few recent published studies describe the profile of patients utilising the services of MOUs and their referral data in detail in South Africa. The study design was a cohort study. Three hundred and nineteen patients reporting their pregnancies at the MOU were enrolled in the study, and were monitored for the duration of their pregnancies. 20.1% of the women were classified as high risk at booking. Additionally, 18.2% were referred in labour. Of the high-risk patients, 21.2% of them delivered at the MOU. These women should have delivered at hospital and therefore presented a considerable risk for the MOU. 3.4% of women in the study delivered at home. This constitutes a significant risk for these women. Finally, the data showed the detailed distribution of risk factors, taken from history and examination, as well as important delivery information on the study patients. For example, 6.2% of the women had had a Caesarean section for a previous pregnancy, 2.8% had had pregnancy-induced hypertension, 1.5% tested positive for syphilis during their current pregnancy, and 1.8% developed severe anaemia.
Current status of urinary schistosomiasis in communities around the Erinle and Eko-Ende Dams and the implications for schistosomiasis control in Nigeria : original researchSource: Southern African Journal of Infectious Diseases 29, pp 137 –140 (2014)More Less
Schistosomiasis is an endemic disease in many parts of the world and the disease is associated with water resource development projects, such as dams, irrigation schemes, and rice and fish farming. The present study was designed to determine the prevalence and intensity of urinary schistosomiasis in five communities around the Erinle and Eko-Ende Dams in Osun State, Nigeria, using dipstick-haematuria, and parasitogical and molecular techniques. A total of 462 participants were screened, of whom 46.3%, 51.1% and 61.5% tested positive when using haematuria, microscopy and PCR respectively. The highest prevalence of the infection and intensity was in Illie (Erinle Dam), while Eko-Ajala (Eko-Ende Dam) had the least. Using analysis of variance and chi-square tests, the differences in the prevalence and intensity of the infection between the five communities was statistically significant (p-value < 0.05). The prevalence and the intensity of the infection was higher in communities around Erinle Dam when compared with those around Eko-Ende Dam, but the differences were not significant (p-value > 0.05). The high prevalence and intensity of the infection of schistosomiasis around the two dams underscores the need for urgent public health measures, such as appropriate treatment and the provision of motorised boreholes.
Knowledge and practices of residents in two north Namibian towns with regard to rabies and pet care : original researchSource: Southern African Journal of Infectious Diseases 29, pp 141 –146 (2014)More Less
Recent studies have highlighted the epidemiology of rabies in southern Africa and the unique nature of kudu rabies in Namibia. However, the serious effect on human populations in northern Namibia lacks focused attention. This study surveyed knowledge and awareness of rabies, including its prevention and pet care in two towns in the Oshana Region of Namibia. Of the 245 interviewed, two thirds owned at least one dog, while a third owned a cat. Eighty-one per cent allowed their animals to roam freely, while 14% reported having been bitten by a dog. The majority of those surveyed recognised that rabies is caused by a virus (53%), identified a dog bite as the main means of transmission (90.6%), cited wild animals as reservoirs (75.5%) and knew that dogs and jackals are significant reservoirs (96.3%). Only 35 (14.3%) identified the correct answers to all four questions. Most of the study participants (63.3%) received their information about rabies from the media. While 83% knew that free vaccines are available at government offices, only 37% had vaccinated their pets, and only 6% had been vaccinated themselves. The results indicate a general understanding of rabies, but focused education efforts are needed with respect to community members in order for specific points to be clarified. The high level of knowledge of vaccine availability, but low coverage, indicates the need for mobilisation with regard to at-risk populations. By building on what is already known, future programmes should successfully reach populations throughout northern Namibia and control rabies in the future.
Differences in the average Caesarean section rate across levels of hospital care in Gauteng, South Africa : original researchSource: Southern African Journal of Infectious Diseases 29, pp 147 –150 (2014)More Less
Caesarean section rate is expressed as a percentage, and is calculated by dividing the total number of Caesarean sections by the total number of deliveries within a specified period. This indicator is used to track obstetric performance. The objective of this study was to document and differentiate Caesarean section rates within the different levels of hospital care and four central hospitals in Gauteng. A retrospective cross-sectional review was carried out on secondary audited data from the Department of Health's Annual Performance Plans (2014/2015 to 2016/2017) for Gauteng province. All public sector hospitals in Gauteng were included. There are distinct differences with regard to the average Caesarean section rate across levels of hospital care in Gauteng province. There is a trend of a rising Caesarean section rate at the regional and tertiary hospitals, stabilisation thereof in the central hospitals and a decline in the rate at the district hospitals in Gauteng. Further research needs to be conducted to determine the norms for an acceptable Caesarean section rate across all levels of health care. In the interim, the average Caesarean section rate should continue to be monitored and evaluated, since it may be indicative of changes to the burden of disease profile, the complexity of maternal cases and access to maternal health care. When comparing the Caesarean section rates of hospitals in the same category, interpretation of the results must be contextualised through consideration of factors, such as the packages of services rendered, the supporting infrastructure in the hospital, differences pertaining to geographical service area, transportation routes and level of affluence within the population.
Source: Southern African Journal of Infectious Diseases 29, pp 151 –153 (2014)More Less
A previously well, human immunodeficiency virus (HIV)-positive boy, presented with features of chronic mastoiditis with no intracranial complications. Intraoperative findings revealed a chronic granulomatous infection. Culture of pus swabs grew Nocardia asteroides, sensitive to trimethoprim and sulphamethoxazole. The child completed 12 months of treatment. There are very few case reports on N. mastoiditis in the literature, and the incidence of this as a complication of otitis media is unknown. To the best of our knowledge, this is the first case report of N. mastoiditis from Africa.