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1.
Pan Afr Med J ; 33: 159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565121

RESUMO

Introduction: Hospital-based surveillance programs only capture people presenting to facilities and may underestimate disease burden. We conducted a healthcare utilisation survey to characterise healthcare-seeking behaviour among people with common infectious syndromes in the catchment areas of two sentinel surveillance hospitals in Johannesburg, South Africa. Methods: A cross-sectional survey was conducted within three regions of Johannesburg from August to November 2015. Premises were randomly selected from an enumerated list with data collected on household demographics and selected syndromes using a structured questionnaire. Fisher's exact or chi-square tests were used to determine association of characteristics among different regions. Results: Of 3650 selected coordinates, 3358 were eligible dwellings and 2930 (87%) households with 9850 individuals participated. Four percent of participants (431/9850) reported influenza-like illness (ILI) in the last 30 days; equal numbers of participants (0.2%, 20/9850) reported pneumonia or tuberculosis symptoms in the last year and <1% reported diarrhoea or meningitis symptoms. Sixty eight percent (295/431) of participants who reported ILI, 75% (6/8) of children with diarrhoea and all participants who reported pneumonia (20), tuberculosis (20) or meningitis (6) sought healthcare. For all syndromes most sought care at registered healthcare providers. Of these only 10% (24/237) attended sentinel hospitals, predominantly those that lived closer to the hospitals. In contrast, of patients with meningitis, 50% (3/6) sought care at sentinel hospitals. Conclusion: Patterns of seeking healthcare differed by syndrome and distance from facilities. Surveillance programs are still relevant in collecting information on infectious syndromes and reflect a proportion of the hospital's catchment area.


Assuntos
Doenças Transmissíveis/epidemiologia , Assistência à Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância de Evento Sentinela , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Doenças Transmissíveis/terapia , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , África do Sul/epidemiologia , Inquéritos e Questionários , Síndrome , Adulto Jovem
2.
J S Afr Vet Assoc ; 90(0): e1-e7, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31368316

RESUMO

The objective of this study was to gain better insight into factors associated with the capture-related mortality rate in cheetahs. A link to an online questionnaire was sent to zoo and wildlife veterinarians through the Species Survival Plan Programme and European Endangered Species Programme coordinators and via the 'Wildlife VetNet' Google group forum. The questionnaire consisted of 50 questions relating to the veterinarians' country of residence and experience, the medicine combinations used, standard monitoring procedures, capture-related complications and mortalities experienced in this species under different capture conditions. In addition, necropsy data from the national wildlife disease database of the National Zoological Gardens of South Africa were examined for cases where anaesthetic death was listed as the cause of death in cheetahs. A total of 75 veterinarians completed the survey, with 38 from African countries and a combined total of 37 from Europe, the United States (US) and Asia. Of these, 24% (n = 18/75) had experienced at least one capture-associated cheetah mortality, with almost all of the fatalities (29/30) reported by veterinarians working in Africa. A lack of anaesthetic monitoring and the absence of supplemental oxygen were shown to be significant risk factors for mortality. Hyperthermia, likely to be associated with capture stress, was the most common reported complication (35%). The results suggest that free-ranging rather than habituated captive cheetahs are particularly at risk of dying during immobilisation and transport. The capture-related fatalities in this species do not appear to be associated with either the veterinarian's level of clinical experience or the immobilisation agents used.


Assuntos
Acinonyx , Anestésicos Dissociativos/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Imobilização/veterinária , Mortalidade , Animais , Animais Selvagens , Animais de Zoológico , Autopsia/veterinária , Bases de Dados Factuais , Combinação de Medicamentos , Europa (Continente) , Imobilização/efeitos adversos , Imobilização/métodos , Ketamina/efeitos adversos , Modelos Logísticos , Medetomidina/efeitos adversos , Fatores de Risco , África do Sul/epidemiologia , Inquéritos e Questionários , Tranquilizantes/efeitos adversos , Médicos Veterinários
4.
J Glob Health ; 9(2): 020413, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31448114

RESUMO

Background: Past studies have demonstrated how single non-communicable diseases (NCDs) affect health care utilisation and quality of life (QoL), but not how different NCD combinations interact to affect these. Our study aims to investigate the prevalence of NCD dyad and triad combinations, and the implications of different NCD dyad combinations on health care utilisation and QoL. Methods: Our study utilised cross-sectional data from the WHO SAGE study to examine the most prevalent NCD combinations in six large middle-income countries (MICs). Subjects were mostly aged 50 years and above, with a smaller proportion aged 18 to 49 years. Multivariable linear regression was applied to investigate which NCD dyads increased or decreased health care utilisation and QoL, compared with subjects with only one NCD. Results: The study included 41 557 subjects. Most prevalent NCD combinations differed by subgroups, including age, gender, income, and residence (urban vs rural). Diabetes, stroke, and depression had the largest effect on increasing mean number of outpatient visits, increasing mean number of hospitalisation days, and decreasing mean QoL scores, respectively. Out of the 36 NCD dyads in our study, thirteen, four, and five dyad combinations were associated with higher or lower mean number of outpatient visits, mean number of hospitalisations, or mean QoL scores, respectively, compared with treating separate patients with one NCD each. Dyads of depression were associated with fewer mean outpatient visits, more hospitalisations, and lower mean QoL scores, compared to patients with one NCD. Dyads of hypertension and diabetes were also associated with a reduced mean number of outpatient visits. Conclusions: Certain NCD combinations increase or decrease health care utilisation and QoL substantially more than treating separate patients with one NCD each. Health systems should consider the needs of patients with different multimorbidity patterns to effectively respond to the demands on health care utilisation and to mitigate adverse effects on QoL.


Assuntos
Países em Desenvolvimento , Multimorbidade/tendências , Doenças não Transmissíveis/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida , Adolescente , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Índia/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Federação Russa/epidemiologia , África do Sul/epidemiologia , Adulto Jovem
5.
Pan Afr Med J ; 33: 42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384357

RESUMO

Introduction: We investigated an outbreak of influenza-like illness (ILI) at a boarding school in Eastern Cape Province, South Africa. We aimed to confirm the etiological agent, estimate attack rates and identify risk factors for illness. Methods: We conducted a retrospective cohort study including senior school boarders (n=308). Students with ILI (cough and fever) were identified through school medical records. We also conducted a questionnaire-based cross-sectional study among senior students including boarders (n=107) and day students (n=45). We collected respiratory specimens for respiratory pathogen testing by real-time polymerase chain reaction from a subset of symptomatic students. We calculated attack rates of medically attended ILI (medILI) and identified factors associated with medILI using logistic regression. We calculated seasonal influenza vaccine effectiveness (VE) against medILI. Results: Influenza A (H3N2) virus was detected in 61% (23/38) of specimens. Attack rate for medILI was 13% among boarders (39/308) in the cohort study and 20% in both day students (9/45) and boarders (21/107) in the cross-sectional study. Playing squash was associated with medILI (aOR 5.35, 95% confidence interval [95% CI]: 1.68-17.07). Of the boarders, 19% (57/308) were vaccinated before the outbreak. The adjusted VE against medILI was 18% (aOR 0.82, 95% CI 0.38-1.78). The outbreak led to cancellation of several events and the need for academic remedial sessions. Conclusion: We confirmed an influenza A (H3N2) virus outbreak with a high attack rate. The outbreak affected academic and sports activities. Participation in sports and social gatherings while experiencing ILI should be discouraged to reduce viral transmission and impact on school activities.


Assuntos
Surtos de Doenças , Vírus da Influenza A Subtipo H3N2/isolamento & purificação , Vacinas contra Influenza/administração & dosagem , Influenza Humana/epidemiologia , Adolescente , Criança , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Influenza Humana/virologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Instituições Acadêmicas , África do Sul/epidemiologia , Estudantes , Adulto Jovem
6.
Vet Parasitol ; 271: 22-30, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31303199

RESUMO

Babesia rossi causes the most severe clinical disease in dogs of all the babesia parasites. We included 320 naturally-infected dogs that presented for care at the Onderstepoort Veterinary Academic Hospital between 2006 and 2016. All dogs had mono-infections confirmed by multiplex PCR. The data allowed more accurate clinical classification of the disease and identified parameters that were associated with disease severity and death. Odds ratios for dying were significant (P < 0.05) for increased band neutrophil count, collapse at presentation; presence of cerebral signs; hypoglycaemia; hyperlactatemia; high urea, high creatinine; hyperbilirubinaemia; hypercortisolaemia; and hypothyroxinaemia. Joint component analysis confirmed that the variables with significant odds ratios grouped together with death. Yet, multivariate logistic regression was unable to identify a group of significant independent predictors of death. Receiver Operator Characteristic curves indicated that low total thyroid hormone, high bilirubin, high serum urea and high cortisol concentrations were the variables with the highest sensitivity and specificity for death. These data provide both the clinician and researcher with a set of easily-measured laboratory and clinical assessments to classify cases into those that are uncomplicated and those that are complicated. The disease is complex and multisystemic and probably involves mechanisms more proximal in the pathogenesis than those that have been evaluated.


Assuntos
Babesiose/patologia , Babesiose/parasitologia , Doenças do Cão/patologia , Doenças do Cão/parasitologia , Animais , Babesia , Babesiose/epidemiologia , Babesiose/mortalidade , Doenças do Cão/epidemiologia , Doenças do Cão/mortalidade , Cães , Razão de Chances , África do Sul/epidemiologia
7.
N Engl J Med ; 381(3): 207-218, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31314965

RESUMO

BACKGROUND: A universal testing and treatment strategy is a potential approach to reduce the incidence of human immunodeficiency virus (HIV) infection, yet previous trial results are inconsistent. METHODS: In the HPTN 071 (PopART) community-randomized trial conducted from 2013 through 2018, we randomly assigned 21 communities in Zambia and South Africa (total population, approximately 1 million) to group A (combination prevention intervention with universal antiretroviral therapy [ART]), group B (the prevention intervention with ART provided according to local guidelines [universal since 2016]), or group C (standard care). The prevention intervention included home-based HIV testing delivered by community workers, who also supported linkage to HIV care and ART adherence. The primary outcome, HIV incidence between months 12 and 36, was measured in a population cohort of approximately 2000 randomly sampled adults (18 to 44 years of age) per community. Viral suppression (<400 copies of HIV RNA per milliliter) was assessed in all HIV-positive participants at 24 months. RESULTS: The population cohort included 48,301 participants. Baseline HIV prevalence was 21% or 22% in each group. Between months 12 and 36, a total of 553 new HIV infections were observed during 39,702 person-years (1.4 per 100 person-years; women, 1.7; men, 0.8). The adjusted rate ratio for group A as compared with group C was 0.93 (95% confidence interval [CI], 0.74 to 1.18; P = 0.51) and for group B as compared with group C was 0.70 (95% CI, 0.55 to 0.88; P = 0.006). The percentage of HIV-positive participants with viral suppression at 24 months was 71.9% in group A, 67.5% in group B, and 60.2% in group C. The estimated percentage of HIV-positive adults in the community who were receiving ART at 36 months was 81% in group A and 80% in group B. CONCLUSIONS: A combination prevention intervention with ART provided according to local guidelines resulted in a 30% lower incidence of HIV infection than standard care. The lack of effect with universal ART was unanticipated and not consistent with the data on viral suppression. In this trial setting, universal testing and treatment reduced the population-level incidence of HIV infection. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 071 [PopArt] ClinicalTrials.gov number, NCT01900977.).


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Administração Massiva de Medicamentos , Programas de Rastreamento , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Incidência , Masculino , Prevalência , África do Sul/epidemiologia , Carga Viral , Adulto Jovem , Zâmbia/epidemiologia
8.
J Pediatr Ophthalmol Strabismus ; 56(4): 248-253, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31322716

RESUMO

PURPOSE: To describe the clinical features of Duane's retraction syndrome in a cohort of South African children and to analyze the differences between ethnic groups. METHODS: A retrospective case series of 120 patients seen between 1997 and 2017 at a tertiary referral center in Cape Town, South Africa. RESULTS: Type 2 Duane's retraction syndrome was most common in black children (54%), whereas type 1 was predominant in mixed race (68%) and white (94%) children. In this cohort, 63% of black children with Duane's retraction syndrome were boys, whereas 69% of white children and 59% of mixed race children were girls. Left eye involvement was the most common in all ethnic groups (44%), followed by right eye (41%) and bilateral (14%) involvement. The average age at presentation was 34.2 months (range: 1 to 144 months). Strabismus in primary position was present in 57 patients (46%), of whom 39% had esotropia and 61% had exotropia. A deviation in the primary position was more common in black (71%) children than in mixed race (39%) or white (41%) children. Ametropia was found in 94 patients (79%), amblyopia was present in 15 patients (13%), and 41 patients (34%) underwent surgery. CONCLUSIONS: This is the first study to provide robust data on the profile of pediatric Duane's retraction syndrome in the three main ethnic groups in South Africa, and it showed clear ethnic differences. Among black children, boys are affected more often, the proportion with type 2 Duane's retraction syndrome is more frequent, and surgery is required more often. Among white and mixed race children, girls are affected more often and type 1 Duane's retraction syndrome is predominant. [J Pediatr Ophthalmol Strabismus. 2019;56(4):248-253.].


Assuntos
Síndrome da Retração Ocular/etnologia , Grupos Étnicos , Previsões , Centros de Atenção Terciária/estatística & dados numéricos , Distribuição por Idade , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , África do Sul/epidemiologia
9.
Onderstepoort J Vet Res ; 86(1): e1-e11, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31291732

RESUMO

Fasciola spp. are the causative agents of fascioliasis in humans and livestock. Before the development of control and management measures, the geographical distribution of the species and patterns of infection must be considered. Because of difficulties in the phenotypic differentiation and morphometric classification of Fasciola spp., DNA molecular markers have become more useful for fluke differentiation and description of phylogenetic patterns. This study aimed to differentiate and describe the phylogenetic background of Fasciola spp. isolated from cattle slaughtered at three abattoirs in the Mpumalanga and KwaZulu-Natal provinces of South Africa. The cytochrome c oxidase I (COI) - FHCO1 (forward: 5'-TTGGTTTTTTGGGCATCCT-3') and FHCO1 (reverse: 5' -AGGCCACCACCAAATAAAAGA3') - marker was sequenced from 55 Fasciola flukes that were collected from abattoirs in catchment areas of the KwaZulu-Natal and Mpumalanga provinces. Fasciola hepatica was demonstrated to have 100% prevalence in KwaZulu-Natal and Mpumalanga (highveld), respectively, and 76% prevalence in the lowveld (Belfast area) of Mpumalanga. Two animals from the Belfast metapopulation were co-infected with both Fasciola gigantica and F. hepatica. DNA sequence analysis of all the isolates demonstrated a sequence conservation of 0.472, nucleotide diversity of 0.082 and Tajima's D of -1.100; however, it was not statistically significant (p > 0.05). Twenty-two haplotypes were identified, with 18 novel haplotypes being unique to the isolates from South Africa. Within the study samples, 12 haplotypes were isolated to a few individuals, with a haplotype diversity of 0.8957 indicating high genetic diversity. Principal coordinate analysis supported the clustering and distribution of the haplotypes, with 11.38% of the variation being attributed to coordinate 2 and 55.52% to coordinate 1. The distribution of Fasciola spp. has been demonstrated to be related to the distribution of the freshwater intermediate host snails, Lymnaea spp., as well as the relative altitude of the localities in South Africa. Information provided by this study serves as preliminary evidence for further studies on the mapping of the distribution of F. gigantica and F. hepatica in South Africa, which is key in designing control programmes for fascioliasis in humans and livestock.


Assuntos
Doenças dos Bovinos/epidemiologia , Complexo IV da Cadeia de Transporte de Elétrons/genética , Fasciola/isolamento & purificação , Fasciolíase/veterinária , Microbiologia de Alimentos , Matadouros , Animais , Bovinos , Doenças dos Bovinos/parasitologia , DNA de Helmintos/análise , Fasciola/classificação , Fasciola/genética , Fasciolíase/epidemiologia , Marcadores Genéticos , Filogenia , África do Sul/epidemiologia
10.
Onderstepoort J Vet Res ; 86(1): e1-e9, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291733

RESUMO

South Africa is a large country of approximately 1.22 million km2, made up of nine provinces with three climatic zones. Farming in the country is mostly defined by regional differences. Of the different organisms isolated from milk samples of dairy cows, Staphylococcus aureus poses a challenge to maintain udder health and wholesome dairy products for human consumption. Antibiotic resistant bacteria are therefore a potential health hazard. The objective of this study was to investigate the seasonal and regional relationships of antibiotic resistance of S. aureus, of which little is known. This study was undertaken to evaluate a data set of 3410 S. aureus isolates, taken from milk samples with a somatic cell count of > 400 000 cells/mL from commercial dairy herds. These isolates were tested for antimicrobial susceptibility using the Kirby Bauer method for ampicillin, cloxacillin, penicillin G, clindamycin, oxy-tetracycline, cephalexin, cefuroxime and tylosin. The samples were from 830 dairy herds, out of the estimated 2000 commercial dairy herds in South Africa. All the antibiotics tested, except for cephalosporins, showed a predicted prevalence of resistance of above 50% in most provinces, which is a concern. The lowest prevalence of resistance to the majority of the categories of antibiotics tested was present in KwaZulu-Natal during spring. The cephalosporins had the lowest levels of prevalence of bacterial resistance in Gauteng during winter. Resistance patterns of S. aureus to the eight antibiotics varied in the different seasons and provinces, possibly because of different weather conditions, and the action and spectrum of antibiotics.


Assuntos
Antibacterianos/farmacologia , Indústria de Laticínios , Mastite Bovina/epidemiologia , Leite/microbiologia , Infecções Estafilocócicas/veterinária , Staphylococcus aureus/efeitos dos fármacos , Animais , Bovinos , Clima , Demografia , Farmacorresistência Bacteriana , Feminino , Mastite Bovina/microbiologia , Testes de Sensibilidade Microbiana/veterinária , Prevalência , África do Sul/epidemiologia , Infecções Estafilocócicas/epidemiologia
11.
BMC Infect Dis ; 19(1): 651, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331281

RESUMO

BACKGROUND: Hepatitis A, caused by the hepatitis A virus (HAV), is a vaccine preventable disease. In Low and Middle-Income Countries (LMICs), poor hygiene and sanitation conditions are the main risk factors contributing to HAV infection. There have been, however, notable improvements in hygiene and sanitation conditions in many LMICs. As a result, there are studies showing a possible transition of some LMICs from high to intermediate HAV endemicity. The World Health Organization (WHO) recommends that countries should routinely collect, analyse and review local factors (including disease burden) to guide the development of hepatitis A vaccination programs. Up-to-date information on hepatitis A burden is, therefore, critical in aiding the development of country-specific recommendations on hepatitis A vaccination. METHODS: We conducted a systematic review to present an up-to-date, comprehensive synthesis of hepatitis A epidemiological data in Africa. RESULTS: The main results of this review include: 1) the reported HAV seroprevalence data suggests that Africa, as a whole, should not be considered as a high HAV endemic region; 2) the IgM anti-HAV seroprevalence data showed similar risk of acute hepatitis A infection among all age-groups; 3) South Africa could be experiencing a possible transition from high to intermediate HAV endemicity. The results of this review should be interpreted with caution as the reported data represents research work with significant sociocultural, economic and environmental diversity from 13 out of 54 African countries. CONCLUSIONS: Our findings show that priority should be given to collecting HAV seroprevalence data and re-assessing the current hepatitis A control strategies in Africa to prevent future disease outbreaks.


Assuntos
Hepatite A/epidemiologia , África/epidemiologia , Surtos de Doenças , Hepatite A/mortalidade , Anticorpos Anti-Hepatite A/sangue , Hospitalização/estatística & dados numéricos , Humanos , Imunoglobulina M/sangue , Pobreza , Fatores de Risco , Saneamento , Estudos Soroepidemiológicos , África do Sul/epidemiologia
12.
BMC Public Health ; 19(1): 898, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286953

RESUMO

BACKGROUND: HIV diagnosis is a critical step in linking HIV-infected individuals to care and treatment and linking HIV-uninfected persons to prevention services. However, the uptake of HIV testing remains low in many countries. HIV self-screening (HIVSS) is acceptable to adults, but there is limited data on HIVSS feasibility in community programmes. This study aimed to evaluate the feasibility of HIVSS in South Africa. METHODS: We conducted a prospective study that enrolled participants through mobile site, homebased, workplace and sex worker programmes in two townships from May to November 2017. Following an information session on HIVSS, interested participants were offered one of three methods of HIVSS testing: supervised, semi-supervised, and unsupervised. Participants who opted for unsupervised testing and those who tested HIV positive after semi- or supervised HIVSS were followed up telephonically or with a home visit one week after receipt of the test kit to confirm results and linkages to care. Follow-up visits were concluded when the participant indicated that they had used the kit or had accessed a confirmatory HIV test. RESULTS: Of the 2061 people approached, 88.2% (1818/2061) received HIV testing information. Of this group, 89% (1618/1818) were enrolled in the study and 70.0% (1133/1618) were tested for HIV with the kit. The median age was 28 (IQR:23-33) years with an even gender distribution. Of those enrolled, 43.0% (696/1618) were identified through homebased outreach, 42.5% (687/1618) through mobile sites, 7.3% (118/1618) at their workplace and 7.2% (117/1618) from sex worker programmes. A total of 68.7% (1110/1616) selected unsupervised HIVSS, whereas 6.3% (101/1616) opted for semi-supervised and 25.0% ((405/1616) chose supervised HIVSS. Overall, the HIV prevalence using the HIVSS test was 8.2% (93/1129). Of those newly diagnosed with HIV, 16% (12/75) were initiated on ART. Almost half (48.0%; 543/1131) of those tested were linked to a primary HIV test as follows: supervised (85.2%; 336/394); semi-supervised (93.8%; 91/97) and unsupervised (18.1%; 116/640). CONCLUSION: Unsupervised HIVSS was by far the most selected and utilised HIVSS method. Linkages to primary and confirmatory testing for the unsupervised HIVSS and further care were low, despite home visits and telephonic reminders.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autocuidado/métodos , Testes Sorológicos/métodos , Adulto , Estudos de Viabilidade , Feminino , HIV , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Programas de Rastreamento/psicologia , Prevalência , Estudos Prospectivos , Autocuidado/psicologia , Testes Sorológicos/psicologia , Profissionais do Sexo , África do Sul/epidemiologia , Adulto Jovem
13.
Lancet ; 394(10200): 757-779, 2019 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-31257127

RESUMO

BACKGROUND: Pneumonia is the leading cause of death among children younger than 5 years. In this study, we estimated causes of pneumonia in young African and Asian children, using novel analytical methods applied to clinical and microbiological findings. METHODS: We did a multi-site, international case-control study in nine study sites in seven countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. All sites enrolled in the study for 24 months. Cases were children aged 1-59 months admitted to hospital with severe pneumonia. Controls were age-group-matched children randomly selected from communities surrounding study sites. Nasopharyngeal and oropharyngeal (NP-OP), urine, blood, induced sputum, lung aspirate, pleural fluid, and gastric aspirates were tested with cultures, multiplex PCR, or both. Primary analyses were restricted to cases without HIV infection and with abnormal chest x-rays and to controls without HIV infection. We applied a Bayesian, partial latent class analysis to estimate probabilities of aetiological agents at the individual and population level, incorporating case and control data. FINDINGS: Between Aug 15, 2011, and Jan 30, 2014, we enrolled 4232 cases and 5119 community controls. The primary analysis group was comprised of 1769 (41·8% of 4232) cases without HIV infection and with positive chest x-rays and 5102 (99·7% of 5119) community controls without HIV infection. Wheezing was present in 555 (31·7%) of 1752 cases (range by site 10·6-97·3%). 30-day case-fatality ratio was 6·4% (114 of 1769 cases). Blood cultures were positive in 56 (3·2%) of 1749 cases, and Streptococcus pneumoniae was the most common bacteria isolated (19 [33·9%] of 56). Almost all cases (98·9%) and controls (98·0%) had at least one pathogen detected by PCR in the NP-OP specimen. The detection of respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus, influenza virus, S pneumoniae, Haemophilus influenzae type b (Hib), H influenzae non-type b, and Pneumocystis jirovecii in NP-OP specimens was associated with case status. The aetiology analysis estimated that viruses accounted for 61·4% (95% credible interval [CrI] 57·3-65·6) of causes, whereas bacteria accounted for 27·3% (23·3-31·6) and Mycobacterium tuberculosis for 5·9% (3·9-8·3). Viruses were less common (54·5%, 95% CrI 47·4-61·5 vs 68·0%, 62·7-72·7) and bacteria more common (33·7%, 27·2-40·8 vs 22·8%, 18·3-27·6) in very severe pneumonia cases than in severe cases. RSV had the greatest aetiological fraction (31·1%, 95% CrI 28·4-34·2) of all pathogens. Human rhinovirus, human metapneumovirus A or B, human parainfluenza virus, S pneumoniae, M tuberculosis, and H influenzae each accounted for 5% or more of the aetiological distribution. We observed differences in aetiological fraction by age for Bordetella pertussis, parainfluenza types 1 and 3, parechovirus-enterovirus, P jirovecii, RSV, rhinovirus, Staphylococcus aureus, and S pneumoniae, and differences by severity for RSV, S aureus, S pneumoniae, and parainfluenza type 3. The leading ten pathogens of each site accounted for 79% or more of the site's aetiological fraction. INTERPRETATION: In our study, a small set of pathogens accounted for most cases of pneumonia requiring hospital admission. Preventing and treating a subset of pathogens could substantially affect childhood pneumonia outcomes. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Hospitalização/estatística & dados numéricos , Pneumonia Bacteriana/epidemiologia , Pneumonia Viral/epidemiologia , Bangladesh/epidemiologia , Teorema de Bayes , Estudos de Casos e Controles , Pré-Escolar , Feminino , Gâmbia/epidemiologia , Infecções por HIV/epidemiologia , Haemophilus influenzae tipo b/isolamento & purificação , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Masculino , Mali/epidemiologia , Pneumonia , Vírus Sinciciais Respiratórios/isolamento & purificação , Índice de Gravidade de Doença , África do Sul/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Tailândia/epidemiologia , Zâmbia/epidemiologia
14.
BMC Public Health ; 19(1): 866, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269939

RESUMO

BACKGROUND: There is no population based occupational health surveillance system in South Africa, thus mortality data may be a cost effective means of monitoring trends and possible associations with occupation. The aim of this study was to use deaths due to pneumoconiosis (a known occupational disease) to determine if the South African mortality data are a valid data source for occupational health surveillance in South Africa. METHODS: Proportions of complete occupation and industry information for the years 2006-2015 were calculated for working age and retired adults. Deaths due to pneumoconiosis were identified in the data set and mortality odds ratios calculated for specific occupations and industry in reference to those who reported being unemployed using logistic regression. RESULTS: Only 16.1% of death notifications provided a usual occupation despite 43.1% of the population being employed in the year. The MORs for occupation provided significant increased odds of pneumoconiosis for miners (9.04), those involved in manufacturing (4.77), engineers and machinery mechanics (6.85). Along with these jobs the Mining (9.8), Manufacture (2.2) and Maintenance and repair industries (6.0) have significantly increased odds of pneumoconiosis deaths. The data can be said to provide a useful source of occupational disease information for surveillance where active surveillance systems do not exist. CONCLUSION: The findings indicate valid associations were found between occupational disease and expected jobs and industry. The most useful data are from 2013 onwards due to more detailed coding of occupation and industry.


Assuntos
Indústrias/estatística & dados numéricos , Doenças Profissionais/mortalidade , Ocupações/estatística & dados numéricos , Pneumoconiose/mortalidade , Vigilância da População , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Reprodutibilidade dos Testes , África do Sul/epidemiologia
15.
BMC Public Health ; 19(1): 867, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269950

RESUMO

BACKGROUND: Systematic household contact investigation (SHCI) is recommended as an active-case-finding (ACF) strategy to identify individuals at high risk of tuberculosis (TB) infection, in order to enable early detection and treatment. Reluctance to implement SHCI in sub-Saharan African and South African high-burden contexts may stem from uncertainty about the potential yield of this strategy when targeting specific categories of TB index cases. In order to inform and motivate scale-up, this pilot study investigated the effectiveness of SHCI when targeting the World Health Organization's (WHO) recommended categories of infectious index cases. METHOD: Data were gathered in September and October 2016. Household contacts of infectious TB cases who attended 40 primary health care facilities in Mangaung Metropolitan District were recruited. The categories of TB index cases included 1) children <5 years, 2) HIV co-infected pulmonary TB (PTB) cases (≥5 years), 3) HIV-negative PTB cases (≥5 years), and 4) multidrug-resistant (MDR) TB cases. Contacts were screened for TB symptoms and symptomatic individuals and all children <5 years were referred for clinical evaluation. Data were analysed to establish the yield and factors associated with new TB diagnosis. RESULTS: Of 259 contacts screened, just under half (47.1%) underwent TB clinical investigation, during which 17 (6.6%) new TB cases were diagnosed, which represents a prevalence rate of 6564 per 100,000 population. Fifteen contacts needed to be screened to detect one new TB case. The proportion of new TB cases was the highest among contacts of HIV-negative PTB index cases (47.9%). The likelihood of TB diagnosis was higher among male contacts (odds ratio [OR]: 4.8; 95% confidence interval [CI]: 1.54-14.97) and those reporting coughing (OR: 4.3; 95% CI: 1.11-16.43). CONCLUSION: The high yield of new TB observed in this pilot study demonstrates that targeted SHCI may be an effective ACF strategy in Mangaung and similar high-burden settings in South Africa. Targeting different index case categories produced variable yield - the highest among contacts of HIV-negative TB index cases. SHCI among household contacts of all four the WHO-recommended categories of infectious TB index cases - and male and coughing contacts, in particular - should be maximised.


Assuntos
Busca de Comunicante/métodos , Características da Família , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Tosse/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prevalência , África do Sul/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/epidemiologia , Organização Mundial da Saúde , Adulto Jovem
16.
Afr J AIDS Res ; 18(2): 158-167, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282301

RESUMO

The study explored constructions of sexuality among young people of Venda in Limpopo, South Africa, and cultural practices that can be used to develop context-specific HIV prevention programmes. HIV prevention can be promoted by including some cultural practices in prevention programmes and changing some aspects of culture that may contribute negatively to health. Six focus group discussions were held with school-going young people (Grades 10 to 12) in urban and rural areas to explore their constructions of sexuality and HIV risk. Four focus group discussions were held with community leaders in the same areas to explore their constructions of young people's sexuality and cultural practices relevant to HIV prevention. Through discourse analysis, the following dominant discourses that influence young people's sexual risk behaviour were identified: rite of passage, the male sexual drive discourse (sex is natural and unavoidable); discourse of hegemonic masculinity (sex to prove masculinity); sex as a commodity; non-adherence to cultural practices; and HIV is normalised (AIDS is like flu). Some alternative constructions and shifts in gender norms were noticed, especially among female participants. The constructions of young people were not culture-specific but similar to those identified in other South African cultures. Community leaders identified a few cultural practices that could be considered in HIV prevention, for example, reinstating the rite of passage to provide age-appropriate sex and HIV education (behavioural intervention), and promoting traditional male circumcision (biological intervention). Cultural practices that contribute negatively to health should be challenged such as current constructions of gender roles (masculinity and femininity) and the practice that parents do not talk to young people about sex (both structural interventions).


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Sexualidade , Adolescente , Circuncisão Masculina , Feminino , Feminilidade , Grupos Focais/estatística & dados numéricos , Infecções por HIV/epidemiologia , Humanos , Masculino , Masculinidade , Fatores de Risco , Assunção de Riscos , Instituições Acadêmicas , Comportamento Sexual , África do Sul/epidemiologia
17.
Onderstepoort J Vet Res ; 86(1): e1-e11, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31170780

RESUMO

Canine leishmaniasis is a vector-borne disease caused by protozoa of the genus Leishmania that affect dogs, humans and wildlife. Sandflies of the genera Phlebotomus and Lutzomyia are the primary vectors. Canine leishmaniasis is an exotic and controlled disease in South Africa. The main purpose of our risk assessment study was to evaluate the likelihood that this exotic disease could enter and be established in South Africa through importation of live dogs. Risk analysis to the spread of the disease follows the World Organization for Animal Health (OIE) formal method of quantitative risk assessment documented as a step-by-step process. We have identified and discussed 11 possible risk factors involved in three steps for final assessment. The annual average number of diagnostic tests performed on imported dogs from 44 countries for 2011-2015 was 1158. Leishmania is reported to occur in 21/44 (47.7%) exporting countries. A total of 71.1% of Leishmania positive dogs were imported from these endemic countries. The yearly percentage of Leishmania positive dogs ranged from 0.2% to 2%. Three confirmed clinical and fatal cases of leishmaniasis in dogs of unidentified origin have been reported by our laboratory and the state veterinarians. The disease has been reported in neighbouring countries as well as the putative sandfly vectors. This study concluded that the risk for the introduction and degree of uncertainty of Leishmania in imported dogs in South Africa are moderate. Risk mitigation and recommendations such as investigations into possible occurrence of autochthonous leishmaniasis in the country, surveillance in its wildlife reservoirs and systematic surveillance of sandfly populations are discussed.


Assuntos
Doenças do Cão/epidemiologia , Leishmaniose/veterinária , Quarentena/veterinária , Animais , Doenças do Cão/prevenção & controle , Doenças do Cão/transmissão , Cães , Leishmaniose/epidemiologia , Leishmaniose/prevenção & controle , Leishmaniose/transmissão , Fatores de Risco , África do Sul/epidemiologia
18.
Onderstepoort J Vet Res ; 86(1): e1-e6, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31170781

RESUMO

Reports on the occurrence of Campylobacter spp. in dogs in South Africa are non-existent. This study investigated the prevalence of Campylobacter spp. in 481 dogs visiting four rural community veterinary clinics in South Africa. Dogs were screened for Campylobacter spp. by culture and polymerase chain reaction (PCR), and logistic regression analysis was performed to assess the association between sex, clinic, breed and age and the occurrence of Campylobacter spp. in dogs. The prevalence of Campylobacter spp. was 41.50% (95% confidence interval [CI], 37.39% - 46.04%). Campylobacter jejuni, C. upsaliensis and C. coli were detected in 29.31% (95% CI, 25.42% - 33.54%), 13.10% (95% CI, 10.37% - 16.42%) and 5.41% (95% CI, 3.71% - 7.82%) of dogs, respectively. Dogs carrying more than one species of Campylobacter spp. accounted for 6.23% (95% CI, 4.40% - 8.78%). Campylobacter upsaliensis and C. jejuni were detected in 3.74% (95% CI, 2.37% - 5.86%), whereas C. coli and C. jejuni were found in 2.49% (95% CI, 1.42% - 4.34%) of dogs. Age and clinic were the risk factors significantly associated with Campylobacter spp. occurrence, while age, breed and clinic were predictors of C. jejuni carriage. Furthermore, age was the only risk factor associated with a higher likelihood of carrying C. upsaliensis. The prevalence of Campylobacter spp. C. jejuni and C. upsaliensis increased significantly as dogs grew older. In addition, the odds of carrying Campylobacter spp. were higher in the Staffordshire bull terrier breed compared to crossbreed dogs. In conclusion, this study shows that dogs visiting rural community veterinary clinics in South Africa are reservoirs of Campylobacter spp. and may be potential sources of Campylobacter spp. for humans living in close proximity of the dog populations under study.


Assuntos
Infecções por Campylobacter/veterinária , Campylobacter jejuni/isolamento & purificação , Campylobacter upsaliensis/isolamento & purificação , Doenças do Cão/epidemiologia , Animais , Infecções por Campylobacter/epidemiologia , Infecções por Campylobacter/etiologia , Infecções por Campylobacter/prevenção & controle , Campylobacter jejuni/genética , Campylobacter upsaliensis/genética , Estudos Transversais , Doenças do Cão/etiologia , Doenças do Cão/prevenção & controle , Cães , Feminino , Hospitais Veterinários , Masculino , Reação em Cadeia da Polimerase/veterinária , Prevalência , Fatores de Risco , População Rural , África do Sul/epidemiologia
19.
Onderstepoort J Vet Res ; 86(1): e1-e6, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31170783

RESUMO

African animal trypanosomosis (AAT) is caused by several species of the genus Trypanosoma, a parasitic protozoan infecting domestic and wild animals. One of the major effects of infection with pathogenic trypanosome is anaemia. Currently, the control policies for tsetse and trypanosomosis are less effective in South Africa. The only response was to block treat all infected herds and change the dip chemical to one which controls tsetse flies during severe outbreaks. This policy proved to be less effective as demonstrated by the current high level of trypanosome infections in cattle. Our objective was to study the impacts of AAT (nagana) on animal productivity by monitoring the health of cattle herds kept in tsetse and trypanosomosis endemic areas before and after an intervention that reduces the incidence of the disease. The study was conducted on a farm in northern KwaZulu-Natal which kept a commercial cattle herd. There was no history of any cattle treatment for trypanosome. All cattle were generally in poor health condition at the start of the study though the herd received regular anthelminthic treatment. A treatment strategy using two drugs, homidium bromide (ethidium) and homidium chloride (novidium), was implemented. Cattle were monitored regularly for 13 months for herd trypanosomosis prevalence (HP), herd average packed cell volume (H-PCV) and the percentage of the herd that was anaemic (HA). A total of six odour-baited H-traps were deployed where cattle grazed from January 2006 to August 2007 to monitor the tsetse population. Glossina brevipalpis Newstead and Glossina austeni Newstead were collected continuously for the entire study period. High trypanosomes HP (44%), low average H-PCV (29.5) and HA (24%) were rerecorded in the baseline survey. All cattle in the herd received their first treatment with ethidium bromide. Regular monthly sampling of cattle for the next 142 days showed a decline in HP of 2.2% - 2.8%. However, an HP of 20% was recorded by day 220 and the herd received the second treatment using novidium chloride. The HP dropped to 0.0% and HA to 0.0% by day 116 after the second treatment. The cow group was treated again by day 160 when the HP and HA were 27.3% and 11%, respectively. The same strategy was applied to the other two groups of weaners and the calves at the time when their HP reached 20%. Ethidium and novidium treatment protected cattle, that were under continuous tsetse and trypanosomosis challenge, for up to 6 months. Two to three treatments per year may be sufficient for extended protection. However, this strategy would need to be included into an integrated pest management approach combining vector control for it to be sustainable.


Assuntos
Criação de Animais Domésticos , Anti-Helmínticos/uso terapêutico , Doenças dos Bovinos/tratamento farmacológico , Controle de Insetos , Tripanossomíase Africana/veterinária , Animais , Anti-Helmínticos/administração & dosagem , Bovinos , Doenças dos Bovinos/epidemiologia , Esquema de Medicação/veterinária , Fazendas , Insetos Vetores , África do Sul/epidemiologia , Resultado do Tratamento , Tripanossomíase Africana/tratamento farmacológico , Tripanossomíase Bovina/tratamento farmacológico , Moscas Tsé-Tsé
20.
J S Afr Vet Assoc ; 90(0): e1-e5, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31170779

RESUMO

Equid herpesvirus type 1 is primarily a respiratory tract virus associated with poor athletic performance that can also cause late gestation abortion, neonatal foal death and encephalomyelopathy. Horizontal transmission is well described, whereas evidence of vertical transmission of equid herpesvirus type 1 associated with the birth of a healthy foal has not been demonstrated. This study sampled a population of Thoroughbred mares (n = 71), and their healthy neonatal foals and foetal membranes, to test for the presence of both equid herpesvirus types 1 and 4 using a quantitative polymerase chain reaction assay. Foetal membrane swabs and tissue samples were taken immediately post-partum, and venous blood samples and nasal swabs were obtained from both mare and foal 8 h after birth. Neither equid herpesvirus type 1 nor equid herpesvirus type 4 nucleic acid was detected in any sample, and it was concluded that there was no active shedding of equid herpesvirus types 1 and 4 at the time of sampling. Consequently, no evidence of vertical transmission of these viruses could be found on this stud farm during the sampling period.


Assuntos
Animais Recém-Nascidos/virologia , Infecções por Herpesviridae/veterinária , Herpesvirus Equídeo 1/isolamento & purificação , Herpesvirus Equídeo 4/isolamento & purificação , Doenças dos Cavalos/virologia , Animais , Sangue/virologia , Feminino , Infecções por Herpesviridae/transmissão , Doenças dos Cavalos/transmissão , Cavalos , Transmissão Vertical de Doença Infecciosa/veterinária , Mucosa Nasal/virologia , Placenta/virologia , Reação em Cadeia da Polimerase/veterinária , Gravidez , África do Sul/epidemiologia
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