Browsing by Author "Coetzee, David"

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    High yield of culture-based diagnosis in a TB-endemic setting
    (BioMed Central, 2012-09) Demers, Anne-Marie; Verver, Suzanne; Boulle, Andrew; Warren, Robin; Van Helden, Paul; Behr, Marcel A.; Coetzee, David
    Abstract Background In most of the world, microbiologic diagnosis of tuberculosis (TB) is limited to microscopy. Recent guidelines recommend culture-based diagnosis where feasible. Methods In order to evaluate the relative and absolute incremental diagnostic yield of culture-based diagnosis in a high-incidence community in Cape Town, South Africa, subjects evaluated for suspected TB had their samples processed for microscopy and culture over a 21 month period. Results For 2537 suspect episodes with 2 smears and 2 cultures done, 20.0% (508) had at least one positive smear and 29.9% (760) had at least one positive culture. One culture yielded 1.8 times more cases as 1 smear (relative yield), or an increase of 12.0% (absolute yield). Based on the latter value, the number of cultures needed to diagnose (NND) one extra case of TB was 8, compared to 19 if second specimens were submitted for microscopy. Conclusion In a high-burden setting, the introduction of culture can markedly increase TB diagnosis over microscopy. The concept of number needed to diagnose can help in comparing incremental yield of diagnosis methods. Although new promising diagnostic molecular methods are being implemented, TB culture is still the gold standard.
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    Is the Western Cape at risk of an outbreak of preventable childhood diseases? : lessons from an evaluation of routine immunisation coverage
    (Health and Medical Publishing Group (HMPG), 2008) Corrigall, Joanne; Coetzee, David; Cameron, Neil
    Objective. To determine the routine immunisation coverage rates in children aged 12-23 months in the Western Cape. Design. Cross-sectional Household Survey using an adaptation of the '30 by 7' cluster survey technique. Setting. Households across the Western Cape. Subjects. A total of 3 705 caregivers of children aged 12-23 months who had been living in the Western Cape for at least 6 months. Outcome measures. Vaccination status (1 = fully vaccinated; 0 = partially vaccinated) as recorded on a Road-to-Health card or by history. Reasons for not vaccinating were established from a questionnaire. Results. The immunisation coverage was 76.8% for vaccines due by 9 months and 53.2% for those due by 18 months. The reasons given for not being immunised were clinic-related factors (47%), lack of information (27%), caregiver being unable to attend the clinic (23%), and lack of motivation (14%). Of the clinic factors cited, the two commonest ones were missed opportunities (34%) and being told by clinic staff to return another time (20%). Conclusion. While the coverage indicates that a great deal of good work is being done, the coverage is insufficient to prevent outbreaks of measles and other common childhood conditions, including polio. The coverage is too low to consider not running periodic mass campaigns for measles and polio. It will need to be sustainably improved before introducing rubella vaccine as part of the Expanded Programme on Immunisations (EPI) schedule. The reasons given by caregivers for their children not being immunised are valuable pointers as to where interventions should be focused.
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    Missed opportunities for retention in pre-ART care in Cape Town, South Africa
    (Public Library of Science -- PLoS, 2014-05) Du Toit, Elizabeth; Van Schalkwyk, Cari; Dunbar, Rory; Jennings, Karen; Yang, Blia; Coetzee, David; Beyers, Nulda; Fox, Matthew
    Background: Few studies have evaluated access to and retention in pre-ART care. Objectives: To evaluate the proportion of People Living With HIV (PLWH) in pre-ART and ART care and factors associated with retention in pre-ART and ART care from a community cohort. Methods: A cross sectional survey was conducted from February – April 2011. Self reported HIV positive, negative or participants of unknown status completed a questionnaire on their HIV testing history, access to pre-ART and retention in pre-ART and ART care. Results: 872 randomly selected adults who reported being HIV positive in the ZAMSTAR 2010 prevalence survey were included and revisited. 579 (66%) reconfirmed their positive status and were included in this analysis. 380 (66%) had initiated ART with 357 of these (94%) retained in ART care. 199 (34%) had never initiated ART of whom 186 (93%) accessed pre-ART care, and 86 (43%) were retained in pre-ART care. In a univariable analysis none of the factors analysed were significantly associated with retention in care in the pre-ART group. Due to the high retention in ART care, factors associated with retention in ART care, were not analysed further. Conclusion: Retention in ART care was high; however it was low in pre-ART care. The opportunity exists, if care is better integrated, to engage with clients in primary health care facilities to bring them back to, and retain them in, pre-ART care.