BACKGROUND:Electronic data capture (EDC) in academic health care organizations provides an opportunity for the management, aggregation, and secondary use of research and clinical data. It is especially important in resource-constrained environments such as the South African public health care sector, where paper records are still the main form of clinical record keeping.OBJECTIVE:The aim of this study was to describe the strategies followed by the University of the Witwatersrand Faculty of Health Sciences (Wits FHS) during the period from 2013 to 2021 to overcome resistance to, and encourage the adoption of, the REDCap (Research Electronic Data Capture; Vanderbilt University) system by academic and clinical staff. REDCap has found wide use in varying domains, including clinical studies and research projects as well as administrative, financial, and human resource applications. Given REDCap's global footprint in >5000 institutions worldwide and potential for future growth, the strategies followed by the Wits FHS to support users and encourage adoption may be of importance to others using the system, particularly in resource-constrained settings.METHODS:The strategies to support users and encourage adoption included top-down organizational support; secure and reliable application, hosting infrastructure, and systems administration; an enabling and accessible REDCap support team; regular hands-on training workshops covering REDCap project setup and data collection instrument design techniques; annual local symposia to promote networking and awareness of all the latest software features and best practices for using them; participation in REDCap Consortium activities; and regular and ongoing mentorship from members of the Vanderbilt University Medical Center.RESULTS:During the period from 2013 to 2021, the use of the REDCap EDC system by individuals at the Wits FHS increased, respectively, from 129 active user accounts to 3447 active user accounts. The number of REDCap projects increased from 149 in 2013 to 12,865 in 2021. REDCap at Wits also supported various publications and research outputs, including journal articles and postgraduate monographs. As of 2020, a total of 233 journal articles and 87 postgraduate monographs acknowledged the use of the Wits REDCap system.CONCLUSIONS:By providing reliable infrastructure and accessible support resources, we were able to successfully implement and grow the REDCap EDC system at the Wits FHS and its associated academic medical centers. We believe that the increase in the use of REDCap was driven by offering a dependable, secure service with a strong end-user training and support model. This model may be applied by other academic and health care organizations in resource-constrained environments planning to implement EDC technology.

Electronic data capture (EDC) in academic healthcare organizations provides an opportunity for the management, aggregation and secondary use of research and clinical data. It is especially important in resource constrained environments such as the South African public healthcare sector, where paper records are still the main form of clinical record-keeping. We describe the strategies followed by the Faculty of Health Sciences, University of the Witwatersrand (Wits FHS), during the period of 2013-2021 to overcome resistance and encourage adoption of the Research Electronic Data Capture (REDCap) system by academic and clinical staff. REDCap has found wide use in varying domains including clinical studies, research projects and administrative, financial and human resource applications. Given REDCap’s global footprint in more than 5 000 institutions worldwide and potential for future growth, the strategies followed by the Wits FHS to support users and encourage adoption may be of interest to others utilizing the system, particularly in resource-constrained setting. The strategies to support users and encourage adoption included: 1) Top-down organizational support; 2) Secure and reliable hosting infrastructure and systems administration 3) An enabling and accessible REDCap support team 4) Regular hands-on training workshops covering data collection instrument design and use of REDCap; 5) Annual local symposia to promote networking and awareness of all the latest software features and best practices for using them 6) Participation in REDCap Consortium activities; and 7) Regular and ongoing mentorship from members of Vanderbilt University Medical Center. During the period 2013-2021, utilization of the REDCap EDC system by individuals in the Wits FHS increased from 129 active user accounts in 2013 to 3 447 active user accounts respectively in 2021. The number of REDCap projects numbered 149 in 2013 and increased to 12 865 in 2021. REDCap at Wits also supported various publications and research outputs including journal articles and postgraduate monographs. As of 2020, a total of 233 journal articles and 87 postgraduate monographs acknowledged the use of the Wits REDCap system. By providing reliable infrastructure and accessible support resources, we were able to successfully implement and grow the REDCap electronic data capture system at the Wits FHS and its associated academic medical centers. We believe that the increase in use of REDCap was driven by offering a dependable, secure service with a strong end-user training and support model. This model may be applied by other academic and healthcare organizations in resource-constrained environments planning to implement EDC technology.

BACKGROUND:Kidney transplants are the only curative therapeutic intervention for end-stage kidney disease (ESKD). The current organ shortage in South Africa makes recipient risk assessments and effective laboratory workup crucial to assist in better organ assignment and increase the likelihood of better transplant outcomes. HLA typing is a step in the pre-transplant workup for performing virtual crossmatches and matching donors and recipients. Sequence Specific Oligonucleotide (SSO) PCR is a relatively fast and inexpensive method for determining genotypic HLA types at a 2- to 4-digit resolution. This study aimed to validate the SSO technique for achieving a 4-digit resolution when determining HLA types to improve virtual crossmatches.METHODS:DNA was extracted from 33 samples. After PCR amplification, the samples were hybridized to oligonu-cleotide probes and the HLA A, B, C, DRB1, DQA1/B1, DRB3, DRB4, DRB5, and DPA1/B1 types were identified. These results were compared to results from external laboratories.RESULTS:The kappa coefficient calculated for the low-resolution comparison suggested a perfect agreement between the two results (p = 0.32).CONCLUSIONS:SSO was successfully validated for HLA typing in the Johannesburg kidney transplant setting. This will improve the specificity of virtual crossmatches on an automated system by matching the resolution of the HLA typing and the HLA antibody testing. Additionally, common HLA types were identified in this donor cohort. Future research into these common HLA types and haplotypes in a South African population will inform the feasibility of reintroducing HLA matching into the pretransplant workup.

Background: The World Health Organisation provides a standardised survey-based questionnaire for collecting cause of death data. This standardised tool is undergoing iterative changes almost every 3 to 5 years resulting in the redesign of in-use re-adapted questionnaires and their database schemes. Given the size of this questionnaire, its redesign process requiring a lot of time and resources does not allow research centres to update their questionnaire. In addition, the heaviness and the expensive cost of the Physician Certified Verbal Autopsy method used for collected data interpretation, led the emergence of new methods with which data are usually managed in ad hoc fashion by using spreadsheets and Comma Separated Value files. Therefore, these tools not allow preservation of the contextual metadata and also not support recovery and building relationship among data object. While the absence of data object relationships does not facilitate the use of relational database management systems and data preservation over time in longitudinal studies contexts such Health and Demographic surveillance systems.Results: This research used Microsoft Visual studio based on model-driven and metadata architectures associated with R.NET Package,R InterVA function, Google Maps API, eXtensible Mark-up Language and Microsoft SQL Server 2012 to develop a Verbal Autopsy data management platform. This platform assists INDEPTH Network HDSS fields sites to quickly follow the iterative changes of WHO questionnaire through questionnaire generation, data collection and entry, and a mapping layer that translates verbal autopsy CRF to ODK XML data dictionary enabling cause of death data collection in offline mode using handheld devices. In addition, being a R InterVA function aided tool for the interpretation of cause of death data, this web application has an interface for visualising cause of death patterns using Google Maps API.Conclusions: Verbal autopsy data management interpretation over time in the longitudinal studies context such Health and Demographic Surveillance System is feasible. Thereby, possibilities given by metadata-driven to build reliable software architecture for verbal autopsy data collection, interpretation and cause of death patterns visualisation and particularly compliance with regulatory relational database management requirements are achievable.

BACKGROUND:Health protocols need to be guided by current data on survival and benefits of interventions within the local context. Periodic clinical audits are required to inform and update health care protocols. This study aimed to review morbidity and mortality in very low birth weight (VLBW) infants in 2013 compared with similar data from 2006/2007. METHODS:We performed a retrospective review of patients' records from a neonatal computer database for 562 VLBW infants. These neonates weighed between 500 and 1500 g at birth, and were admitted within 48 hours after birth between 01 January 2013 and 31 December 2013. Patients' characteristics, complications of prematurity, and therapeutic interventions were compared with 2006/2007 data. Univariate analysis and multiple logistic regression were performed to establish significant associations of various factors with survival to discharge for 2013. RESULTS:Survival in 2013 was similar to that in 2006/2007 (73.4% vs 70.2%, p = 0.27). However, survival in neonates who weighed 750-900 g significantly improved from 20.4% in 2006/2007 to 52.4% in 2013 (p = 0.001). The use of nasal continuous positive airway pressure (NCPAP) increased from 20.3% to 62.9% and surfactant use increased from 19.2% to 65.5% between the two time periods (both p < 0.001). Antenatal care attendance improved from 54.4% to 70.6% (p = 0.001) and late onset sepsis (>72 hours after birth) increased from 12.5% to 19% (p = 0.006) between the two time periods. Other variables remained unchanged between 2006/2007 and 2013. The main determinants of survival to discharge in 2013 were birth weight (odds ratio 1.005, 95% confidence interval 1.003-1.0007, resuscitation at birth (2.673, 1.375-5.197), NCPAP (0.247, 0.109-0.560), necrotising enterocolitis (4.555, 1.659-12.51), and mode of delivery, including normal vaginal delivery (0.456, 0.231-0.903) and vaginal breech (0.069, 0.013-0.364). CONCLUSIONS:There was a marked improvement in the survival of neonates weighing between 750 and 900 g at birth, most likely due to provision of surfactant and NCPAP. Provision of NCPAP, prevention of necrotising enterocolitis, and control of infection need to be prioritised in VLBW infants to improve their outcome.

Aim . Investigate the clinical, economic, and cellular effects of the addition of oncothermia to standard treatment for HIV-positive and -negative locally advanced cervical cancer patients in public healthcare in South Africa. Objectives . Evaluate the effect that the addition of oncothermia has on local disease control, progression-free survival, overall survival at 2 years, treatment toxicity, quality of life, economic impact, and HIV status of participants. Radiobiology investigations will evaluate thermoradiosensitivity and the molecular markers for thermoradiosensitivity. Methodology . Phase III randomised clinical trial involving 236 HIV-negative and -positive stage IIb-III locally advanced cervical cancer patients. Treatment includes cisplatin, external beam radiation, and brachytherapy. The study group will receive oncothermia treatments. Participants will be monitored for two years after completion of treatment. Hypothesis . The addition of oncothermia to standard treatment protocols will result in improved clinical response without increasing treatment toxicity in HIV-positive patients or raising healthcare costs.