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Introduction: This study aimed to explore the views and perceptions of Advanced Life Support (ALS) practitioners in two South African provinces on initiating, withholding, and terminating resuscitation in OHCA. Methodology: Semi-structured one-on-one interviews were conducted with operational ALS practitioners working within the prehospital setting in the Western Cape and Free State provinces. Recorded interviews were transcribed and subjected to inductive-dominant, manifest content analysis. After familiarisation with the data, meaning units were condensed, codes were applied and collated into categories that were then assessed, reviewed, and refined repeatedly. Results: A total of 18 ALS providers were interviewed. Five main categories were developed from the data analysis: 1) assessment of prognosis, 2) internal factors affecting decision-making, 3) external factors affecting decision-making, 4) system challenges, and 5) ideas for improvement. Factors influencing the assessment of prognosis were history, clinical presentation, and response to resuscitation. Internal factors affecting decision-making were driven by emotion and contemplation. External factors affecting decision-making included family, safety, and disposition. System challenges relating to bystander response and resources were identified. Ideas for improvement in training and support were brought forward. Conclusion: Many factors influence OHCA decision-making in the Western Cape and Free State provinces, and numerous system challenges have been identified. The findings of this study can be used as a frame of reference for prehospital emergency care personnel and contribute to the development of context-specific guidelines.
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BACKGROUND: Prolonged obstructive jaundice (OJ), associated with resectable pancreatic pathology, has many deleterious effects that are potentially rectifiable by preoperative biliary drainage (POBD) at the cost of increased postoperative infective complications. The aim of this study is to assess the impact of POBD on intraoperative biliary cultures (IBCs) and surgical outcomes in patients undergoing pancreatic resection. METHODS: Data from patients at Groote Schuur Hospital, Cape Town, between October 2008 and May 2019 were analysed. Demographic, clinical, and outcome variables were evaluated, including perioperative morbidity, mortality, and 5-year survival. RESULTS: Among 128 patients, 69.5% underwent POBD. The overall perioperative mortality in this study was 8.8%. The POBD group had a significantly lower perioperative mortality rate compared to the non-drainage group (5.6% vs. 25.6%). POBD patients had a higher incidence of surgical site infections (55.1% vs. 23.1%), polymicrobial growth from IBCs and were more likely to culture resistant organisms. Five-year survival was similar in the two groups. CONCLUSION: POBD was associated with a high incidence of resistant organisms on the IBCs, a high incidence of surgical site infections and a high correlation between cultures from the surgical site infection and the IBCs.
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Drenagem , Icterícia Obstrutiva , Pancreatectomia , Cuidados Pré-Operatórios , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Icterícia Obstrutiva/cirurgia , Icterícia Obstrutiva/microbiologia , Icterícia Obstrutiva/etiologia , Idoso , Pancreatectomia/métodos , Pancreatectomia/efeitos adversos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , África do Sul , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Resultado do TratamentoRESUMO
Background: High-flow nasal oxygen (HFNO) is an accepted treatment for severe COVID-19-related acute hypoxaemic respiratory failure (AHRF). Objectives: To determine whether treatment outcomes at Groote Schuur Hospital, Cape Town, South Africa, during the third COVID-19 wave would be affected by increased institutional experience and capacity for HNFO and more restrictive admission criteria for respiratory high-care wards and intensive care units. Methods: We included consecutive patients with COVID-19-related AHRF treated with HFNO during the first and third COVID-19 waves. The primary endpoint was comparison of HFNO failure (composite of the need for intubation or death while on HFNO) between waves. Results: A total of 744 patients were included: 343 in the first COVID-19 wave and 401 in the third. Patients treated with HFNO in the first wave were older (median (interquartile range) age 53 (46 - 61) years v. 47 (40 - 56) years; p<0.001), and had higher prevalences of diabetes (46.9% v. 36.9%; p=0.006), hypertension (51.0% v. 35.2%; p<0.001), obesity (33.5% v. 26.2%; p=0.029) and HIV infection (12.5% v. 5.5%; p<0.001). The partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2 /FiO2 ) ratio at HFNO initiation and the ratio of oxygen saturation/FiO2 to respiratory rate within 6 hours (ROX-6 score) after HFNO commencement were lower in the first wave compared with the third (median 57.9 (47.3 - 74.3) mmHg v. 64.3 (51.2 - 79.0) mmHg; p=0.005 and 3.19 (2.37 - 3.77) v. 3.43 (2.93 - 4.00); p<0.001, respectively). The likelihood of HFNO failure (57.1% v. 59.6%; p=0.498) and mortality (46.9% v. 52.1%; p=0.159) did not differ significantly between the first and third waves. Conclusion: Despite differences in patient characteristics, circulating viral variant and institutional experience with HFNO, treatment outcomes were very similar in the first and third COVID-19 waves. We conclude that once AHRF is established in COVID-19 pneumonia, the comorbidity profile and HFNO provider experience do not appear to affect outcome. Study synopsis: What the study adds. This study adds to the body of evidence demonstrating the utility of high-flow nasal oxygen (HFNO) in avoiding invasive mechanical ventilation (IMV) in patients with severe COVID-19 hypoxaemic respiratory failure, and shows that this utility remained consistent across different waves of the COVID-19 pandemic.Implications of the study. In resource-constrained settings, HFNO is a feasible non-invasive alternative to IMV and can be employed with favourable and consistent outcomes outside traditional critical care wards. It also confirms that the degree of gas exchange abnormality, and not pre-existing patient-related factors, circulating wave variant or provider experience, is the main predictor of HFNO failure.
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A cross-sectional survey of Schistosoma haematobium prevalence was conducted among senior primary school pupils of Siphofaneni area, Eswatini. This area is devoid of potable water, with a newly constructed Lubovane dam and an LUSIP irrigation scheme. The objective of the study was to investigate the distribution of urinary schistosomiasis among Siphofaneni senior primary school pupils. Using simple random sampling, 200 partcipants were enroled from four of six schools in the area. Ten millimetres (10 ml) of urine samples were obtained from each participant and examined for S. haematobium eggs. The intensity of the infection was estimated by calculating the total number of S. haematobium eggs present in 10 ml urine. Out of 200 participants, 45% (n = 91) were males, and 55% (n = 109) were females. The mean age for participants was 13 years, and almost half (47%, n = 94) were in Grade 5. Overall, the prevalence of S. haematobium infection was 16% (32/200). More than half (59%, 19/32) of the Schistosomiasis cases were from females. Positive and significant associations were observed between the number of eggs (χ2=170.9) and the presence of red blood cells (χ2=49.2) at p = 0.001. In conclusion, the prevalence of Schistosomiasis is high among pupils enrolled in Siphofaneni area primary schools that needs comprehensive treatment and education to prevent from S. haematobium infection.
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Background: Treatment-limiting severe cutaneous adverse reactions (SCAR) occur more commonly amongst persons with HIV-associated tuberculosis (TB). The impact of SCAR on long-term HIV/TB outcomes is unknown. Methods: Patients with TB and/or HIV admitted to Groote Schuur Hospital, Cape Town, South Africa with SCAR between 1/10/2018 and 30/09/2021 were eligible. Follow-up data was collected for 6- and 12-month outcomes: mortality, TB and antiretroviral therapy (ART) regimen changes, TB treatment completion, and CD4 count recovery. Results: Forty-eight SCAR admissions included: 34, 11, and 3 HIV-associated TB, HIV-only and TB-only patients with 32, 13 and 3 cases of drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome/toxic epidermal necrolysis and generalised bullous fixed-drug eruption respectively. Nine (19%), all HIV-positive (eight co-infected with TB), were deceased at 12-months, and 12(25%) were lost to follow-up. Amongst TB-SCAR patients, seven (21%) were discharged on all four first-line anti-TB drugs (FLTD), while 12(33%) had regimens with no FLTDs; 24/37(65%) completed TB treatment. Amongst HIV-SCAR patients, 10/31(32%) changed ART regimen. If retained in care (24/36), median (IQR) CD4 counts increased at 12-months post-SCAR (115(62-175) vs. 319(134-439) cells/uL). Conclusion: SCAR admission amongst patients with HIV-associated TB results in substantial mortality, and considerable treatment complexity. However, if retained in care, TB regimens are successfully completed, and immune recovery is good despite SCAR.
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BACKGROUND: Up to a quarter of inpatients in high-income countries (HICs) self-report beta-lactam allergy (BLA), which if incorrect,increases the use of alternative antibiotics, worsening individual health outcomes and driving bacterial resistance. In HICs, up to 95% ofself-reported BLAs are incorrect. The epidemiology of BLA in low- and middle-income African countries is unknown. OBJECTIVES: To describe the epidemiology and de-labelling outcomes of self-reported BLA in hospitalised South African (SA) patients. METHODS: Point-prevalence surveys were conducted at seven hospitals (adult, paediatric, government and privately funded, district andtertiary level) in Cape Town, SA, between April 2019 and June 2021. Ward prescription records and in-person interviews were conductedto identify and risk-stratify BLA patients using the validated PEN-FAST tool. De-labelling was attempted at the tertiary allergy clinic atGroote Schuur Hospital. RESULTS: A total of 1 486 hospital inpatients were surveyed (1 166 adults and 320 children). Only 48 patients (3.2%) self-reported a BLA,with a higher rate in private than in government-funded hospitals (6.3% v. 2.8%; p=0.014). Using the PEN-FAST tool, only 10.4% (n=5/48)of self-reported BLA patients were classified as high risk for true penicillin hypersensitivity. Antibiotics were prescribed to 70.8% (n=34/48)of self-reported BLA patients, with 64.7% (n=22/34) receiving a beta-lactam. Despite three attempts to contact patients for de-labelling atthe allergy clinic, only 3/36 underwent in vivo testing, with no positive results, and 1 patient proceeded to a negative oral challenge. CONCLUSION: Unlike HICs, self-reported BLA is low among inpatients in SA. The majority of those who self-reported BLA were low risk fortype 1 hypersensitivity, but outpatient de-labelling efforts were largely unsuccessful.
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Hipersensibilidade a Drogas , Hipersensibilidade , Adulto , Humanos , Criança , beta-Lactamas/efeitos adversos , Autorrelato , África do Sul/epidemiologia , Testes Cutâneos/métodos , Antibacterianos/efeitos adversos , Penicilinas , Hipersensibilidade a Drogas/epidemiologia , Hospitais Públicos , Hospitais Privados , GovernoRESUMO
Background: Lung cancer remains the number one cause of cancer mortality estimated at 1.8 million deaths. There are limited studies in resource poor countries regarding knowledge, attitudes and practices towards lung cancer. Objective: This study aimed to describe the knowledge, attitudes and practices regarding lung cancer in selected communities in KwaZulu- Natal, South Africa. Methods: An observational, analytic cross-sectional study design was conducted using a standardized questionnaire. A stratified random cluster sampling method was applied across five communities. A regression model was developed to identify the predictors of the level of knowledge. Results: About 59.9% (95% CI 52.0-67.3) of the participants reported to have heard of lung cancer. The mean knowledge score was 41.8% (95% CI 35.7-47.9%). Coughing blood was the most recognized symptom (61.0%, 95% CI 52.1-69.1). About 17% (95% CI 14.7-21.5) of participants reported to be smokers. Many respondents reported that they would go to a health centre or clinic in case they were coughing blood (72.4%, 95% CI 93.9-79.5). Less than 10% (95% CI 3.9-8.1) of participants was screened for lung cancer at the time. Gender, history of working in the chemicals industry, screening for lung cancer, and time taken to seek health care when sick were significant predictors of lung cancer knowledge. Conclusions: Public health interventions should be explored to increase the levels of community awareness regarding lung cancer, particularly focusing on the importance of screening, early diagnosis and treatment. Keywords: Lung cancer, community awareness, screening, prevention.
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The World Health Organization (WHO) has urged countries to conduct tuberculosis (TB) prevalence surveys to better understand the burden of TB and to enable the WHO to conduct global estimates. Until the report from the first-ever prevalence survey in South Africa (SA), the country had to rely on WHO estimates. The recently published report on the SA TB prevalence survey provides important estimates of the burden of TB disease as well as information on health-seeking behaviour. This review notes the key findings of the 2018 prevalence survey. The high prevalence of TB in SA continues to be a major cause for concern, and calls for a significantly improved response to reach the End TB targets set by the WHO.
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Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , África do Sul/epidemiologia , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/prevenção & controle , Adulto JovemRESUMO
BACKGROUND: Estimates of prevalence of anti-SARS-CoV-2 antibody positivity (seroprevalence) for tracking the COVID-19 epidemic are lacking for most African countries. OBJECTIVES: To determine the prevalence of antibodies against SARS-CoV-2 in a sentinel cohort of patient samples received for routine testing at tertiary laboratories in Johannesburg, South Africa. METHODS: This sentinel study was conducted using remnant serum samples received at three National Health Laboratory Service laboratories in the City of Johannesburg (CoJ) district. Collection was from 1 August to 31 October 2020. We extracted accompanying laboratory results for glycated haemoglobin (HbA1c), creatinine, HIV, viral load and CD4 T-cell count. An anti-SARS-CoV-2 targeting the nucleocapsid (N) protein of the coronavirus with higher affinity for IgM and IgG antibodies was used. We reported crude as well as population-weighted and test-adjusted seroprevalence. Multivariate logistic regression analysis was used to determine whether age, sex, HIV and diabetic status were associated with increased risk for seropositivity. RESULTS: A total of 6 477 samples were analysed, the majority (n=5 290) from the CoJ region. After excluding samples with no age or sex stated, the model population-weighted and test-adjusted seroprevalence for the CoJ (n=4 393) was 27.0% (95% confidence interval (CI) 25.4 - 28.6). Seroprevalence was highest in those aged 45 - 49 years (29.8%; 95% CI 25.5 - 35.0) and in those from the most densely populated areas of the CoJ. Risk for seropositivity was highest in those aged 18 - 49 years (adjusted odds ratio (aOR) 1.52; 95% CI 1.13 - 2.13; p=0.0005) and in samples from diabetics (aOR 1.36; 95% CI 1.13 - 1.63; p=0.001). CONCLUSIONS: Our study conducted between the first and second waves of the pandemic shows high levels of current infection among patients attending public health facilities in Gauteng Province.
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Anticorpos Antivirais/imunologia , COVID-19/epidemiologia , SARS-CoV-2/isolamento & purificação , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , COVID-19/imunologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , SARS-CoV-2/imunologia , Vigilância de Evento Sentinela , Estudos Soroepidemiológicos , África do Sul/epidemiologia , Adulto JovemRESUMO
The SARS-CoV-2 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves.
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Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Hospitais Universitários/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Centros de Atenção Terciária/organização & administração , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Registros Eletrônicos de Saúde/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Humanos , Unidades de Terapia Intensiva/organização & administração , Administração de Materiais no Hospital , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Centros de Cuidados de Saúde Secundários , África do Sul/epidemiologiaRESUMO
The SARS-CoV-2 pandemic has presented clinicians with an enormous challenge in managing a respiratory virus that is not only capable of causing severe pneumonia and acute respiratory distress syndrome, but also multisystem disease. The extraordinary pace of clinical research, and particularly the surge in adaptive trials of new and repurposed treatments, have provided rapid answers to questions of whether such treatments work, and has resulted in corticosteroids taking centre stage in the management of hospitalised patients requiring oxygen support. Some treatment modalities, such as the role of anticoagulation to prevent and treat potential thromboembolic complications, remain controversial, as does the use of high-level oxygen support, outside of an intensive care unit setting. In this paper, we describe the clinical management of COVID-19 patients admitted to Groote Schuur Hospital, a major tertiary level hospital at the epicentre of South Africa's SARS-CoV-2 epidemic during its first 4 months.
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Infecções por Coronavirus/terapia , Hospitais Universitários/organização & administração , Pneumonia Viral/terapia , Centros de Atenção Terciária/organização & administração , Corticosteroides/uso terapêutico , Anticoagulantes/uso terapêutico , Gestão de Antimicrobianos , Betacoronavirus , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Cuidados Críticos/organização & administração , Complicações do Diabetes , Humanos , Intubação Intratraqueal , Corpo Clínico Hospitalar/psicologia , Oxigenoterapia , Cuidados Paliativos , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Respiração Artificial , Fatores de Risco , SARS-CoV-2 , Apoio Social , África do Sul/epidemiologiaRESUMO
The COVID-19 pandemic has placed significant strain on the oxygen delivery infrastructure of health facilities in resource-constrained health systems. In this case report, we describe a patient with severe COVID-19 pneumonia who was managed with high-flow nasal oxygen for 40 days, with an eventual successful outcome. We discuss the oxygen delivery infrastructure needed to offer this intervention, as well as the psychosocial impact on those undergoing treatment.
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Anticoagulantes/uso terapêutico , COVID-19/terapia , Glucocorticoides/uso terapêutico , Hipóxia/terapia , Oxigenoterapia/métodos , Oxigênio/provisão & distribuição , Posicionamento do Paciente/métodos , Sistemas de Apoio Psicossocial , Antibacterianos/uso terapêutico , Ansiedade/psicologia , Ansiedade/terapia , Gasometria , COVID-19/sangue , COVID-19/fisiopatologia , COVID-19/psicologia , Cânula , Citalopram/uso terapêutico , Aconselhamento , Dexametasona/uso terapêutico , Progressão da Doença , Enoxaparina/uso terapêutico , Inibidores do Fator Xa/sangue , Feminino , Pneumonia Associada a Assistência à Saúde/complicações , Pneumonia Associada a Assistência à Saúde/diagnóstico , Pneumonia Associada a Assistência à Saúde/tratamento farmacológico , Hematoma/induzido quimicamente , Humanos , Hipóxia/sangue , Hipóxia/fisiopatologia , Pessoa de Meia-Idade , Oxigenoterapia/psicologia , Equipe de Assistência ao Paciente , Posicionamento do Paciente/psicologia , Combinação Piperacilina e Tazobactam/uso terapêutico , Decúbito Ventral , Psiquiatria , Resiliência Psicológica , SARS-CoV-2 , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Índice de Gravidade de Doença , Serviço Hospitalar de Assistência Social , Coxa da Perna , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate the extent to which relapse and other previously treated tuberculosis (TB) contribute to the notified TB burden in South Africa.DESIGN: We conducted an ecological analysis at the level of the 52 South African health districts using national electronic TB register data. We included all bacteriologically confirmed TB cases treated for presumed drug-susceptible TB in 2011. Treatment history information was based on recorded patient categories (new vs. retreatment).RESULTS: Relapse and other previously treated TB cases constituted between 7.6% and 40% (median 17%, interquartile range 12-22) of all bacteriologically confirmed TB cases in the 52 South African districts. Multivariable analysis suggested that districts with higher proportions of previously treated TB cases had higher TB case notification rates (P < 0.001), lower estimates of antenatal human immunodeficiency virus (HIV) prevalence in the district population (P < 0.001) as well as lower HIV co-infection rates (P < 0.001) among new TB cases.CONCLUSION: Relapse and other previously treated TB cases contributed substantially to the notified TB burden in several South African health districts, particularly those with high case notification rates and lower antenatal HIV prevalence. Additional efforts to prevent TB among previously treated people, such as strengthening treatment monitoring and/or secondary preventive therapy, should be considered.
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Efeitos Psicossociais da Doença , Notificação de Doenças/estatística & dados numéricos , Infecções por HIV/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Antituberculosos/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Recidiva , Retratamento/estatística & dados numéricos , África do Sul/epidemiologia , Tuberculose/tratamento farmacológico , Adulto JovemRESUMO
OBJECTIVES: The aim of the study was to estimate rates of linkage to HIV care and antiretroviral treatment (ART) initiation after the introduction of home-based HIV counselling and testing (HBHCT) and telephone-facilitated support for linkage in rural South Africa. METHODS: A population-based prospective cohort study was carried out in KwaZulu Natal, South Africa. All residents aged ≥ 15 years were eligible for HBHCT. Those who tested positive and were not in care were referred for ART at one of 11 public-sector clinics. Individuals who did not attend the clinic within 2 weeks were sent a short message service (SMS) reminder; those who had not attended after a further 2 weeks were telephoned by a nurse counsellor, to discuss concerns and encourage linkage. Kaplan-Meier methods were used to estimate the proportion of newly diagnosed individuals linking to care and initiating ART. RESULTS: Among 38 827 individuals visited, 26% accepted HBHCT. Uptake was higher in women than in men (30% versus 20%, respectively), but similar in people aged < 30 years and ≥ 30 years (28% versus 26%, respectively). A total of 784 (8%) tested HIV positive, of whom 427 (54%) were newly diagnosed. Within 6 months, 31% of women and 18% of men < 30 years old had linked to care, and 29% and 16%, respectively, had started ART. Among those ≥ 30 years, 41% of women and 38% of men had linked to care within 6 months, and 41% and 35%, respectively, had started ART. CONCLUSIONS: Despite facilitated linkage, rates of timely linkage to care and ART initiation after HBHCT were very low, particularly among young men. Innovations are needed to provide effective HIV care and prevention interventions to young people, and thus maximize the benefits of universal test and treat.
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Fármacos Anti-HIV/uso terapêutico , Infecções por HIV , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Aconselhamento/métodos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta/estatística & dados numéricos , População Rural/estatística & dados numéricos , África do Sul , Adulto JovemRESUMO
BACKGROUND: Many patients with previous pulmonary tuberculosis (PTB) continue to experience respiratory symptoms long after completion of tuberculosis (TB) therapy, often resulting in numerous hospital visits and admissions. OBJECTIVES: To describe the profile of patients with chronic lung disease (CLD) with or without a history of PTB, and their in-hospital outcomes. METHODS: We conducted a retrospective review of patients with CLD admitted with respiratory symptoms to Dora Nginza Hospital, Port Elizabeth, South Africa, from 1 April 2016 to 31 October 2016. These patients were divided into two groups: CLD with a history of PTB (CLD-TB) and CLD without a history of PTB. Patients with current culture-positive TB were excluded. Baseline characteristics and clinical outcomes (duration of hospitalisation and in-hospital mortality) were compared between the two groups. RESULTS: During the study period, a total of 4 884 patients were admitted and 242 patients received a diagnosis of CLD. In the CLD patient group, 173 had CLD-TB and 69 had no history of PTB. Patients with CLD-TB presented with respiratory symptoms a median of 41 months (interquartile range (IQR) 101) after completion of TB therapy. CLD-TB patients were predominantly male (59.5%), and compared with patients with no history of PTB were more likely to be HIV-positive (49.7% v. 8.7%; p=0.001) and had had more frequent hospital admissions before the current admission (median 2.0 (IQR 2.0) v. 0; p=0.001) and longer hospital stays (median 5 days (IQR 7) v. 2 (4); p=0.002). However, there was no statistically significant difference in in-hospital mortality between the two groups (17.3% v. 10.1%; p=0.165). CONCLUSIONS: In patients with CLD, a history of PTB is associated with numerous hospital admissions and longer hospital stays but not with increased in-hospital mortality. TB therefore continues to be a public health burden long after cure of active disease.
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Tuberculose Pulmonar/fisiopatologia , Adulto , Idoso , Doença Crônica , Coinfecção/epidemiologia , Comorbidade , Efeitos Psicossociais da Doença , Progressão da Doença , Feminino , Seguimentos , Infecções por HIV/epidemiologia , Recursos em Saúde , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , África do Sul/epidemiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/terapiaRESUMO
Objective: To assess adherence to malaria diagnosis and treatment guidelines (2010 and 2014) in all health care facilities in Swaziland between 2011 and 2015. Methods: This was a cross-sectional descriptive study involving all health care facilities that diagnosed and managed malaria cases in Swaziland. Patients' age, sex, diagnosis method and type of treatment were analysed. Results: Of 1981 records for severe and uncomplicated malaria analysed, 56% of cases were uncomplicated and 14% had severe malaria. The type of malaria was not recorded for 30% of cases. Approximately 71% of cases were confirmed by rapid diagnostic tests (RDT) alone, 3% by microscopy alone and 26% by both RDT and microscopy. Of the uncomplicated cases, 93% were treated with artemether-lumefantrine (AL) alone, 5% with quinine alone and 2% with AL and quinine. Amongst the severe cases, 11% were treated with AL alone, 44% with quinine alone and 45% with AL and quinine. For severe malaria, clinics and health centres prescribed AL alone more often than hospitals (respectively 13%, 12% and 4%, P = 0.03). Conclusion: RDTs and/or microscopy results are used at all facilities to inform treatment. Poor recording of malaria type causes difficulties in assessing the prescription of antimalarial drugs.
Objectif : Evaluer l'adhérence aux directives de diagnostic et de traitement du paludisme (2010 et 2014) dans toutes les structures de santé du Swaziland entre 2011 et 2015.Méthodes : Une étude transversale descriptive impliquant toutes les structures de santé qui ont diagnostiqué et pris en charge des cas de paludisme au Swaziland, a été réalisée. On a analysé l'âge des patients, leur sexe, la méthode de diagnostic et le type de traitement.Résultats: De 1981 dossiers de paludisme grave et non compliqué analysés, 56% de ces cas ont été non compliqués et 14% ont été graves. Le type de paludisme n'a pas été enregistré dans 30% des cas. Près de 71% des cas ont été confirmés par des tests de diagnostic rapide (RDT) seuls, 3% par microscopie seule et 26% par RDT et microscopie à la fois. Parmi les cas non compliqués, 93% ont été traités par l'artéméther-luméfantrine (AL) seul, 5% par quinine seule et 2% par AL et quinine. Parmi les cas graves, 11% ont été traités par AL seul, 44% par quinine seule et 45% par AL et quinine. Les dispensaires et les centres de santé prescrivent plus souvent l'AL seul en cas de paludisme grave, comparés aux hôpitaux (respectivement 13%, 12% et 4% ; P = 0,03).Conclusion : Les résultats de RDT et/ou de microscopie sont utilisés dans toutes les structures pour guider le traitement. Un enregistrement médiocre du type de paludisme crée des difficultés pour évaluer la prescription des médicaments antipaludéens.
Objetivo: Evaluar el cumplimiento de las orientaciones en materia de diagnóstico y tratamiento del paludismo (2010 y 2014) en todos los establecimientos de salud de Swazilandia del 2011 al 2015.Métodos: Un estudio transversal descriptivo de todos los centros de atención de salud que diagnostican y tratan casos de paludismo en el país. Se analizó la edad de los pacientes, el sexo, el método diagnóstico y el tipo de tratamiento antipalúdico.Resultados: Se analizaron 1981 historias clínicas de casos de paludismo grave y sin complicaciones; el 56% de estos casos no presentó complicaciones y el 14% correspondió a casos de paludismo grave. El tipo de paludismo no se registró en el 30% de los casos. Alrededor del 71% de casos se confirmó solo mediante pruebas diagnósticas rápidas (RDT), el 3% solo por microscopia y el 26% por ambos métodos. El 93% de los casos no complicados se trató exclusivamente con la combinación artemetero + lumefantrina (AL), el 5% con quinina exclusiva y el 2% con AL y quinina. De los casos graves, el 11% se trató solo con AL, el 44% solo con quinina y el 45% con AL y quinina. En los casos de paludismo grave se receta de manera exclusiva AL, con mayor frecuencia en los consultorios y los centros de salud que en los hospitales (13%, 12% y 4% respectivamente; P = 0,03).Conclusión: Los resultados de las RDTs o de la microscopia se utilizan en todos los establecimientos con el fin de fundamentar el tratamiento. Un registro deficiente del tipo de paludismo dificulta la evaluación de las prácticas de recetas de fármacos antipalúdicos.
RESUMO
Settings: Swaziland is striving to achieve sustainable malaria elimination. Three preventive interventions are vital for reaching this goal: 1) effective household utilisation of long-lasting insecticide nets (LLINs), 2) indoor residual spraying (IRS), and 3) provision of chemoprophylaxis for those travelling to malaria-endemic areas. Objectives: To assess the uptake of preventive intervention among confirmed malaria cases. Design: A longitudinal study using nation-wide programme data from 2010 to 2015. Data on malaria cases from health facilities were sourced from the Malaria Surveillance Database System. Results: Of a total 2568 confirmed malaria cases in Swaziland, 2034 (79%) had complete data on case investigations and were included in the analysis. Of 341 (17%) individuals who owned LLINs, 169 (8%) used them; 338 (17%) had IRS and 314 (15%) slept in sprayed structures. Of 1403 travellers to areas at high malaria risk, 59 (4%) used any form of malaria prevention, including chemoprophylaxis. Conclusion: The uptake of all three key malaria prevention interventions is low, and could threaten the progress made thus far toward malaria elimination. Efforts to improve this situation, including qualitative research to understand the reasons for low uptake, are urgently needed.
Contextes : Le Swaziland s'efforce de parvenir à l'élimination pérenne du paludisme. Trois interventions préventives sont vitales pour atteindre ce but : l'utilisation efficace de moustiquaires imprégnées d'insecticide rémanent (LLIN) ; la pulvérisation d'insecticide à effet rémanent (IRS) ; et la fourniture de chimioprophylaxie pour les personnes voyageant en zone d'endémie palustre.Objectifs : Evaluer la couverture des interventions préventives parmi les cas confirmés de paludisme.Schéma : Une étude longitudinale basée sur les données du programme national de 2010 à 2015. Les données des cas de paludisme des structures de santé proviennent de la base de données du système de surveillance du paludisme.Résultats : Il y a eu un total de 2568 cas confirmés de paludisme au Swaziland, dont 2034 (79%) ont eu une investigation complète et ont été inclus dans l'analyse. Parmi eux, 341 (17%) disposaient de LLIN et 169 (8%) les utilisaient; 338 (17%) avaient bénéficié d'une IRS et 314 (15%) dormaient dans des structures vaporisées. Il y a eu 1403 voyageurs dans des zones à risque de paludisme, dont 59 (4%) ont utilisé une forme de prévention du paludisme incluant la chimioprophylaxie.Conclusion : La couverture des trois interventions clés de prévention du paludisme est faible et peut menacer les progrès réalisés à ce jour vers l'élimination du paludisme. Les efforts visant à améliorer cette situation, notamment l'utilisation de recherche qualitative pour comprendre les raisons de cette faible couverture, sont requises d'urgence.
Marco de referencia: Swazilandia se esfuerza por alcanzar una eliminación sostenible del paludismo. Existen tres intervenciones preventivas esenciales con miras a cumplir esta meta, a saber: 1) la utilización efectiva de mosquiteros impregnados de insecticidas de larga duración (LLIN); 2) la fumigación de interiores con insecticidas de efecto residual (IRS); y 3) la provisión de quimioprofilaxis a las personas que se desplazan hacia las zonas donde el paludismo es endémico.Objetivos: Apreciar la aceptación de la intervención preventiva en los casos confirmados de paludismo.Método: Un estudio longitudinal a partir de los datos del programa nacional del 2010 al 2015. Los datos sobre los casos de paludismo de los centros de atención de salud se obtuvieron de la Base de Datos del Sistema de Vigilancia del Paludismo.Resultados: Ocurrieron 2568 casos confirmados de paludismo en Swazilandia, de los cuales 2034 (79%) contaban con datos completos sobre las investigaciones del caso y se incluyeron en el análisis. De estas personas, 341 poseían LLIN (17%) y 169 lo utilizaban (8%); el domicilio de 338 personas había sido fumigado con un IRS (17%) y 314 dormían en estructuras fumigadas (15%). Se contabilizaron 1403 viajeros a zonas con riesgo de transmisión del paludismo, de los cuales 59 utilizaron alguna forma de prevención, incluida la quimioprofilaxis (4%).Conclusión: La utilización de las tres intervenciones esenciales de prevención del paludismo es muy baja y podría poner en peligro los logros alcanzados hasta ahora, en materia de eliminación de la enfermedad. Es urgente ejecutar medidas que mejoren esta situación, entre otras, la realización de investigaciones cualitativas que ayuden a comprender las razones de la baja utilización.
RESUMO
Antiretroviral therapy (ART) has fundamentally altered the natural history of HIV/AIDS, sharply reducing HIV-related morbidity and prolonging longevity. However, there seems to be a resurgence in HIV infection rates in some parts of the world that has prompted consideration of pre-exposure prophylaxis (pre-EP) and vaccination. Despite their good viral suppression profiles, most drugs used as part of ART also have unwanted adverse drug reactions/effects (ADRs). In this article we acknowledge the utility of pre-EP in combating HIV transmission, but we also highlight the need to prepare for management of other unexpected outcomes such as ADRs and viral resistance, to ensure the success of the programme.