Browsing by Author "Hutton, Lauren"

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    Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa : descriptive observational study
    (BMJ Publishing Group, 2021) Mash, Robert James; Presence-Vollenhoven, Mellisa; Adeniji, Adeloye; Christoffels, Renaldo; Doubell, Karlien; Eksteen, Lawson; Hendrikse, Amee; Hutton, Lauren; Jenkins, Louis; Kapp, Paul; Lombard, Annie; Marais, Heleen; Rossouw, Liezel; Stuve, Katrin; Ugoagwu, Abi; Williams, Beverley
    ENGLISH ABSTRACT: Objectives To describe the characteristics, clinical management and outcomes of patients with COVID-19 at district hospitals. Design A descriptive observational cross-sectional study. Setting District hospitals (4 in metro and 4 in rural health services) in the Western Cape, South Africa. District hospitals were small (<150 beds) and led by family physicians. Participants All patients who presented to the hospitals’ emergency centre and who tested positive for COVID-19 between March and June 2020. Primary and secondary outcome measures Source of referral, presenting symptoms, demographics, comorbidities, clinical assessment and management, laboratory turnaround time, clinical outcomes, factors related to mortality, length of stay and location. Results 1376 patients (73.9% metro, 26.1% rural). Mean age 46.3 years (SD 16.3), 58.5% females. The majority were self-referred (71%) and had comorbidities (67%): hypertension (41%), type 2 diabetes (25%), HIV (14%) and overweight/obesity (19%). Assessment of COVID-19 was mild (49%), moderate (18%) and severe (24%). Test turnaround time (median 3.0 days (IQR 2.0–5.0 days)) was longer than length of stay (median 2.0 day (IQR 2.0–3.0)). The most common treatment was oxygen (41%) and only 0.8% were intubated and ventilated. Overall mortality was 11%. Most were discharged home (60%) and only 9% transferred to higher levels of care. Increasing age (OR 1.06 (95% CI 1.04 to 1.07)), male (OR 2.02 (95% CI 1.37 to 2.98)), overweight/obesity (OR 1.58 (95% CI 1.02 to 2.46)), type 2 diabetes (OR 1.84 (95% CI 1.24 to 2.73)), HIV (OR 3.41 (95% CI 2.06 to 5.65)), chronic kidney disease (OR 5.16 (95% CI 2.82 to 9.43)) were significantly linked with mortality (p<0.05). Pulmonary diseases (tuberculosis (TB), asthma, chronic obstructive pulmonary disease, post-TB structural lung disease) were not associated with increased mortality. Conclusion District hospitals supported primary care and shielded tertiary hospitals. Patients had high levels of comorbidities and similar clinical pictures to that reported elsewhere. Most patients were treated as people under investigation. Mortality was comparable to similar settings and risk factors identified.
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    The prevalence of and risk factors for perinatal depression among woman in the Knysna and Bitou sub-district : a cross sectional observational study
    (Stellenbosch : Stellenbosch University, 2019-12) Hutton, Lauren; Pather, Michael; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.
    ENGLISH SUMMARY : Background: Perinatal depressive symptoms occur in women during pregnancy, around childbirth and within one year after delivery. Women in low middle income countries (LMICs) are at risk, screening is poor and the prevalence in the Southern Cape region of South Africa is unknown. Aim and objectives: The aim of the study is to determine the prevalence of and risk factors associated with perinatal depressive symptoms among women in the Knysna and Bitou sub-districts. The objectives are to compare antenatal and postnatal depressive symptoms, to evaluate associated risk factors and compare the effect of multiple versus single risk factors. Methods: A descriptive cross sectional study design was used. Women aged 18 and above were sampled over a period of 10 months. Participation was voluntary and signed informed consent was obtained. Each participant completed the validated Edinburgh Postnatal Depression Scale (EPDS) and a risk factor assessment questionnaire. All documentation was available in Afrikaans, English and isiXhosa. A positive score for perinatal depressive symptoms was 13 or more. Referral for optional counselling or management was done as needed. Results: In this study, the prevalence of perinatal depressive symptoms was high at 40.6%. The prevalence was similar for antenatal and postnatal groups with 40% and 40.5% respectively. Significant risk factors present among both groups were: no social support, use of alcohol and tobacco, race and a known or previous diagnosis of depression. More than one of the identified risk factors were present in 28.8% of depressed participants. Conclusion: Perinatal depression risk in the Knysna/Bitou sub-districts, as found using the EPDS screening tool, is high. Both antenatal and postnatal groups showed similar prevalence. Risk factors in this population were lack of social support, substance use, race and a current or previous diagnosis of depression; with the majority of participants having one risk factor. Prevalence was similar for those with no risk factors and two or more risk factors. The results highlight the need for effective screening of all antenatal and postnatal women.