The Democratic Republic of Congo (DRC) is experiencing increasing human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in young adults. This is despite the government's widespread campaign on HIV/AIDS awareness. In this study, high-risk university students who engage in casual sex, but who have good literacy skills, were surveyed to ascertain whether the education campaigns in the country influenced their condom use practice. This study sought to determine Goman University students’ knowledge and attitudes about and practices of condom use for the purpose of reducing HIV infection. A descriptive cross-sectional quantitative study, using a self-administered questionnaire, was carried out. The ages of the students varied between 18 and 33. Most of them were men: 111 (80%), 129 (93%) were single, and most participants were Protestants (61, 44%) and Roman Catholics (57, 41%). The majority of participants (137, 99%) knew about condoms, while 132 (96%) were aware that condoms were available from and sold by pharmacies. Seventy-two (52 %) understood that condoms helped to prevent HIV, pregnancy and sexually transmitted infections (STIs). Ninety-four (68%) said that they knew how to use a condom, while 111 (80%) stated that the price of condoms was not a barrier to usage thereof. One hundred and two (74%) suggested that the university should supply students with condoms. Ninety-one (66%) were sexually active and 98 (71%) of participants reported that they had unprotected sex. Condom awareness was high and information was available from varying sources. Condoms were accepted as a means to prevent HIV/AIDS, STIs and pregnancy. Some ethnic groups disapproved of condom use because of religious and cultural beliefs. Consistent use of condoms was low in Goma University students.
In 2007, the World Health Organization Regional Committee for Africa officially noted the resurgence of cholera in the Africa subregion, 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 hig...
Oral lesions that are associated with human immunodeficiency virus (HIV) infection are often the first clinical signs of an underlying infection. This study aimed to test primary healthcare (PHC) nurses’ knowledge and practices before and after an educational intervention on the detection and management of oral diseases, and in particular, those associated with HIV infection. A crosssectional study was conducted among PHC nurses who were employed in a range of clinical settings within the public sector (hospitals, clinics and nurse training colleges) in urban and rural areas in the uMgungundlovu Health District of KwaZulu-Natal. The convenience sample comprised 121 nurses who completed a self-administered questionnaire, undertook pre-education testing, were provided with educational material and underwent post-education testing. The obtained results showed that most nurses (90%) had received little or no undergraduate or postgraduate training in the examination, diagnosis or treatment of oral lesions. Analysis of the pre-education test results that pertained to the identification of a number of oral lesions revealed a mean correct response rate of 38.5%. Post-education results revealed a statistically significant (p-value < .0001) (24%) improvement to 62.4%. The provision of a basic education intervention can have significant effects on knowledge, treatment and referral patterns, and can lead to early diagnosis, treatment and improved quality of life for persons who are infected with HIV.
This guideline provides a rational and cost-effective approach to patients with acute meningitis, which causes considerable morbidity and mortality, predominantly in children.There are many aetiologies, but a small number of bacteria and viruses account for the majority of cases. There should be a low threshold for suspecting acute meningitis, which is a medical emergency and antibiotics should not be delayed. Blood culture and cerebrospinal fluid (CSF) analysis are the most important diagnostic tests and should be performed whenever it is safe and practical. Contraindications to lumbar puncture are discussed and an algorithm is given regarding administering empiric antibiotics and antivirals, performing blood cultures, computer tomography brain scanning and cerebrospinal fluid analysis, depending on the clinical features and availability of resources. Administration of steroids is not recommended. Guidelines are provided for definitive therapy whenever a causative organism is identified. When no organism is identified, treatment and further investigation should be guided by laboratory results and clinical response. An approach to this process is outlined in a second algorithm. The epidemiology of resistance to common pathogens is described and advice given regarding special groups, including those with recurrent meningitis or base-of-skull fractures. Advice regarding infection control, post-exposure prophylaxis and vaccination is provided.
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 dififcult”) 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 intra-coder 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 refected 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% misclassifed 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.
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.
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 frst glycopeptide-intermediate S. aureus (GISA) isolate from a renal unit at a central academic hospital in Durban, KwaZulu-Natal. The rapid sequence of increasingly resistant profles 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.Keywords: GISAglycopeptidesMRSA sepsisKwaZulu-Natal
Climate change has resulted in water mismanagement, increased population, urbanisation, industrialisation, poor sanitation and other developmental activities in the desert of Rajasthan. As a consequence, malariagenic conditions have developed and malaria is now a major public health problem in this area. Malaria control efforts need to identify associated factors and to integrate these efforts with the information, education and communication campaigns and behaviour change communication campaigns that are targeting the community of this region. To this end, a community-based study of knowledge, treatment-seeking behaviour and the socio-economic impact of malaria was conducted in 18 villages of Ramgarh primary health centre in Jaisalmer district. Three hundred and sixty-five subjects who had contracted malaria at least once in the year before the interview were randomly selected. Data were collected through an interview process. More than two thirds of respondents (69.3%) stated that malaria was transmitted by mosquitoes. Nearly three quarters of respondents (73.7%) identified the symptoms of malaria as shivering, alternating fever and chills, and headaches and vomiting. Just over half the respondents (55.1%) believed that antimalarial drugs, such as chloroquine, could not be administered to pregnant women. 11.8% of subjects were aware of the use of preventative measures against mosquito bites. 7.2 days was the mean time taken by respondents to utilise health facilities for diagnosis and treatment. The treatment cost was significantly higher for those who used private health clinics (rupees 1 200) than it was for those who used government health facilities (Rs. 150/-) (p-value < 0.001). Literate respondents had better knowledge of malaria than illiterate respondents.
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 identifed 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 ciprofoxacin, norfoxacin 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 norfoxacin were also resistant to ciprofoxacin. 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.
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.
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. Amplifcation was performed using specifc 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 refux disease. This implies a signifcant 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 signifcant pathological role (82.6% PUD) than the other variants (p-value = 0.0142). The prevalence of vacA m1 was signifcantly higher in gastritis cases (p-value = 0.0253). vacA m2 was found to be signifcantly associated with gastritis (p-value = 0.0253). This fnding 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.
Acinetobacter baumannii is an important cause of hospital-acquired infections. The occurrence of carbapenem resistance that is caused by the carbapenem-hydrolysing class D β-lactamases and the metallo-β-lactamases (MBLs) limits the range of therapeutic alternatives in treating A. baumannii infections. In this study, two multiplex polymerase chain reactions were performed to screen for both carbapenem-hydrolysing class D β-lactamases and MBL genes in 97 clinical isolates of A. baumannii. Oxacillinase (OXA)-51 had a prevalence of 83% (81/97), and OXA-23 had a prevalence of 59% (57/97). One isolate was positive for an MBL [Verona integron-encoded metallo β-lactamases (VIM)]. Therefore, continuous surveillance and monitoring of A. baumannii is crucial because of the high prevalence of antibiotic resistance genes.
Click to increase image sizeClick to decrease image sizeKeywords: actinomycosisintrauterine devices
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 stratifed 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 signifcantly associated with private home ownership and family size (p-value < 0.05). There was no signifcant 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.
Tuberculosis is the leading cause of death from a single infectious disease, accounting for over a quarter of avoidable deaths in adults. The great majority of cases, and more than 95% of deaths, occur in the developing world.
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 fuctuations 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 signifcantly associated with age [-0.3 mmol/l per month of age, 95% confdence 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 fuctuations 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.
Lack of diagnostic methods to determine a specific aetiology can contribute to an increase in genital tract infections (GTIs) in women. We determined the aetiology of, and risk factors associated with, GTIs in women with genital symptoms. After obtaining informed consent, genital swabs to detect Neisseria gonorrhoeae, Trichomonas vaginalis, vaginal candidiasis, bacterial vaginosis and Chlamydia trachomatis, were collected from women who attended sexually transmitted infection (STI) clinics in Mwanza in 2010. Demographic data were also gathered. A total of 320 women, with a mean age 26.5 ± 6.9 years, were recruited for the study. The percentages of GTIs in women with genital discharge syndromes were 25.9% for bacterial vaginosis, 25.6% for vaginal candidiasis, 14% for C. trachomatis, 8.7% for T. vaginalis and 8.4% for N. gonorrhoeae. Gonococcal infections were detected more by N. gonorrhoeae PCR than by culture methods (p-value < 0.000). From a sample of 66 women, (24.2%), 14 were infected by > 2 infections of bacterial vaginosis, C. trachomatis and N. gonorrhoeae. Women who were reported to have engaged in sexual intercourse before the age of 18 years and those who had > 2 sexual partners were more likely to be infected by C. trachomatis vs. N. gonorrhoeae and T. vaginalis. Following a sensitivity test, 21 out of 27 (77.7%) of gonococcal isolates were quinolone-resistant N. gonorrhoeae. One isolate was resistant to ciprofloxacin, azithromycin and cefixime, but not ceftriaxone. A high prevalence of bacterial vaginosis, gonorrhoea, trichomoniasis, chlamydia and vaginal candidiasis in women who attended the STI clinics in Mwanza was observed. Drug resistance of N. gonorrhoeae to ciprofloxacin is very high. This calls for an immediate review of the guidelines on its use as a first-line treatment for STIs in Tanzania.
A human immunodeficiency virus-infected girl with previous cerebral tuberculosis presented with paraparesis and sphincter dysfunction after improvement in her CD4 count, following antiretroviral therapy. Magnetic resonance imaging of her spinal cord revealed a conus medullaris lesion, in keeping with a tuberculoma. Her neurological signs improved after initiating tuberculosis treatment and steroids. It is most likely that this case demonstrates an unusual central nervous system immune reconstitution inflammatory syndrome (IRIS) response and is probably the first reported case of conus medullaris tuberculoma IRIS in the literature.
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 classifcation; 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-fve 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 ffty-eight (78.2%) received occasional visitors. There were 121 (59.9%) smokers. The adverse outcomes for tuberculosis were signifcantly increased by an age < 37 years, human immunodefciency 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.
Pertussis is a highly contagious respiratory disease that can occur in all age groups. Over the past 15 years, an increase in the incidence of reported cases has been observed globally. Local surveillance data have also shown an increase in the number of laboratory-confrmed cases. This raises concerns about waning immunity in adolescents and adults. The aim of this study was to screen for seropositivity against pertussis infection by measuring immunoglobulin G (IgG) antibody titers of Bordetella pertussis in an adolescent population in the Western Cape, South Africa. Serum samples were collected from 182 adolescents aged 15-18 years from different racial groups. The SERION ELISA® classic B. pertussis IgG assay was used to detect human antibodies in serum. Twenty-seven subjects (15%) were seronegative and 135 (74%) seropositive for IgG antibodies. Racial breakdown showed that 84% of the black, 74% of the coloured, and 69% of the white subjects were seropositive, while the largest percentage (24%) of sero-negative individuals was in the white population group. This study demonstrated a high percentage of individuals in the adolescent age group with sero-positive antibody levels. However, it is unknown if these antibody levels are functionally protective. A more rigourous surveillance system would assist in defning and understanding the epidemiology of pertussis in South Africa, and could provide evidence of the need for booster vaccinations in adolescence and adulthood.
