Browsing by Author "Mehtar, Shaheen"
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- ItemCosts and process of in-patient tuberculosis management at a central academic hospital, Cape Town, South Africa(IUATLD -- International Union Against Tuberculosis and Lung Disease, 2012-09) Janson, J.; Marais, Frederick; Mehtar, Shaheen; Baltussen, R. M. P. M.Setting: South Africa reports more cases of tuberculosis (TB) than any other country, but an up-to-date, precise estimate of the costs associated with diagnosing, treating and preventing TB at the in-patient level is not available. Objective: To determine the costs associated with TB management among in-patients and to study the use of personal protective equipment (PPE) at a central academic hospital in Cape Town. Design: Retrospective and partly prospective cost analysis of TB cases diagnosed between May 2008 and October 2009. Results: The average daily in-patient costs were US$238; the average length of stay was 9.7 days. Mean laboratory and medication costs per stay were respectively US$26.82 and US$8.68. PPE use per day cost US$0.99. The average total TB management costs were US$2373 per patient. PPE was not always properly used. Discussion: The costs of in-patient TB management are high compared to community-based treatment; the main reason for the high costs is the high number of in-patient days. An efficiency assessment is needed to reduce costs. Cost reduction per TB case prevented was approximately US$2373 per case. PPE use accounted for the lowest costs. Training is needed to improve PPE use.
- ItemDeliberate exposure of humans to chlorine-the aftermath of Ebola in West Africa(BioMed Central, 2016-11-14) Mehtar, Shaheen; Bulabula, Andre N. H.; Nyandemoh, Haurace; Jambawai, SteveBackground: During the recent Ebola outbreak, spraying of the environment and humans, including healthcare workers, with chlorine was wide spread in affected African countries; adverse clinical effects are reported here. Methods: A cross sectional survey by interview of 1550 volunteers consisting of 500 healthcare workers (HCW), 550 Ebola survivors (EVD) and 500 quarantined asymptomatic Ebola contacts (NEVD) was conducted. Demographics, frequency of exposure to chlorine, clinical condition after chlorine exposure particularly eye, respiratory and skin conditions were noted. The length of time HCWs worked in Ebola Treatment Units (ETU), and use of personal protective equipment was recorded. Verbal consent was obtained from all participants and all responses remained anonymous. Permission and assistance from the guardian or parent was sought for those below 18 years of age. Results: 493/500 HCW, 550/550 EVD and 477/500 NEVD were sprayed at least once with 0 · 5 % chlorine. Following even a single exposure, an increase in the number of eye (all three groups) and respiratory symptoms (in HCW & EVD) was reported (p < 0 · 001); after multiple exposure, respiratory and skin symptoms increased. In HCW, multiple vs single exposure was associated with an increase in respiratory (OR = 32 (95 % CI 22 –49) p < 0.001), eyes (OR = 30 (95 % CI 21 –43) p < 0.001) and skin conditions (OR = 22 (95 % CI 15–32) p < 0.001). The available personal protective equipment neither reduced nor prevented the adverse effects of chlorine. Conclusion: Reported exposure to chlorine has usually been accidental. Despite the lack of evidence as a recognised outbreak control measure, deliberate exposure of humans to chlorine spray was wide spread in Africa during the Ebola epidemic resulting in serious detrimental health effects on humans. We strongly recommend that this practice be banned and that alternative safer methods be used.
- ItemDoes undergraduate teaching of infection prevention and control adequately equip graduates for medical practice?(Health and Medical Publishing Group, 2015) Dramowski, Angela; Marais, Frederick; Willems, B.; Mehtar, Shaheen; SURMEPI curriculum review working groupBackground. Knowledge, skills and desirable clinical practices in infection prevention and control (IPC) should be acquired during undergraduate medical training. Although knowledge and skills are learnt in the formal curriculum, attitudes and practices are assimilated by observation and modelling. We investigated whether undergraduate teaching and learning of IPC at Stellenbosch University adequately prepared graduates for medical practice. Methods. A situational analysis of IPC teaching was conducted, including development of IPC competencies, a curriculum review, an email survey of MB,ChB graduates and semistructured focus group or personal interviews with teaching faculty. Qualitative data were assessed using a framework analysis approach. Results. All graduate survey respondents who completed the IPC-related questions (n=180) agreed that teaching of IPC was important and most (156; 87.8%) felt that IPC teaching had adequately prepared them for practice. Despite this perception, graduates encountered difficulty implementing IPC best practice owing to lack of management support for IPC and resource constraints. Faculty members disagreed regarding the adequacy of IPC teaching and some were concerned that the curriculum failed to prepare graduates for medical practice. Graduates and faculty felt strongly that undergraduate IPC teaching and learning could be improved by addressing suboptimal IPC practices and lack of clinician role models for IPC at training institutions. Conclusion. IPC knowledge transfer appears adequate in most competency areas. However graduates struggled to implement IPC best practice in the clinical field. Undergraduate IPC teaching and learning could be enhanced by development of clinician role models for IPC and strengthened IPC practices in training institutions.
- ItemThe epidemiology of tuberculosis in health care workers in South Africa : a systematic review(BioMed Central, 2016-08-20) Grobler, Liesl; Mehtar, Shaheen; Dheda, Keertan; Adams, Shahieda; Babatunde, Sanni; Van der Walt, Martie; Osman, MuhammadENGLISH SUMMARY : Background: In South Africa, workplace acquired tuberculosis (TB) is a significant occupational problem among health care workers. In order to manage the problem effectively it is important to know the burden of TB in health care workers. This systematic review describes the epidemiology of TB in South African health care workers. Methods: A comprehensive search of electronic databases [MEDLINE, EMBASE, Web of Science (Social Sciences Citation Index/Science Citation Index), Cochrane Library (including CENTRAL register of Controlled Trials), CINAHL and WHO International Clinical Trials Registry Platform (ICTRP)] was conducted up to April 2015 for studies reporting on any aspect of TB epidemiology in health care workers in South Africa. Results: Of the 16 studies included in the review, ten studies reported on incidence of active TB disease in health care workers, two report on the prevalence of active TB disease, two report on the incidence of latent TB infection, three report on the prevalence of latent TB infection and four studies report on the number of TB cases in health care workers in various health care facilities in South Africa. Five studies provide information on risk factors for TB in health care workers. All of the included studies were conducted in publicly funded health care facilities; predominately located in KwaZulu-Natal and Western Cape provinces. The majority of the studies reflect a higher incidence and prevalence of active TB disease in health care workers, including drug-resistant TB, compared to the surrounding community or general population. Conclusions: There is relatively little research on the epidemiology of TB in health care workers in South Africa, despite the importance of the issue. To determine the true extent of the TB epidemic in health care workers, regular screening for TB disease should be conducted on all health care workers in all health care facilities, but future research is required to investigate the optimal approach to TB screening in health care workers in South Africa. The evidence base shows a high burden of both active and latent TB in health care workers in South Africa necessitating an urgent need to improve existing TB infection, prevention and control measures in South African.
- ItemFit for purpose? a review of a medical curriculum and its contribution to strengthening health systems in South Africa(Health and Medical Publishing Group, 2015) Dudley, Lilian; Young, T. N.; Rohwer, A. C.; Willems, B.; Dramowski, Angela; Goliath, C.; Mukinda, Fidele K.; Marais, Frederick; Mehtar, Shaheen; Cameron, N. A.ENGLISH SUMMARY : Background: Medical education in the 21st century needs to produce health professionals who can respond to health systems challenges and population health needs. Although research on medical education is increasing, insufficient attention is paid to the outcomes of medical training, in particular graduates’ competencies and the effects of their training on healthcare and population health in Africa. Method: This baseline study assessed whether the current Stellenbosch University medical curriculum enabled graduates to acquire health systems strengthening competencies. The teaching of competencies in public health, evidence-based healthcare, health systems and services research, and infection prevention and control was assessed through a document review of study guides and a survey of recent medical graduates. Results: We found that teaching of most competencies was included in the curriculum, but appeared fragmented with a lack of continuity across phases of the curriculum. Health systems and health leadership and management teaching was weak, and important public health competencies in human rights and health advocacy received little attention. Recent graduates said their training was ‘adequate’, but were unable to apply knowledge and skills to address health systems challenges within working environments. They wanted more integrated, practical, problem-based teaching in environments in which they would one day work, and their teachers to be role models for the competencies students were expected to acquire. This study is contributing to improvements to the medical curriculum at Stellenbosch University.
- ItemGlobal infection prevention gaps, needs, and utilization of educational resources: A cross-sectional assessment by the International Society for Infectious Diseases(Elsevier, 2019) Desai, Angel N.; Ramatowski, John W.; Lassmann, Britta; Holmesa, Alison; Mehtar, Shaheen; Bearman, GonzaloObjective: The Guide to Infection Control in the Hospital (Guide) is an open access resource produced by the International Society for Infectious Diseases (ISID) to assist in the prevention of infection acquisition and transmission worldwide. A survey was distributed to 8055 current Guide users to understand their needs. Methods: The survey consisted of 48-questions regarding infection prevention and control (IPC) availability and needs. Dichotomous questions, Likert scale-type questions, and open-and closed-ended questions were used. Results: Respondents (n = 1121) from 194 countries and six WHO regions participated in the survey. 43% (488) identified as physicians. Personal protective equipment (PPE) availability, training, and antimicrobial susceptibility testing varied between regions. Only 11% of respondents from low-income countries reported consistent access to respiratory equipment, 12% to isolation gowns, 4% to negative pressure rooms or personnel trained in IPC, and 20% to antimicrobial resistance testing. This differed significantly to high and upper middle-income resource settings (p < 0.05). 80% of all respondents used smartphones or tablets at the workplace. Conclusions: This survey demonstrates varied access to IPC equipment and training between high and low- income settings worldwide. Our results demonstrated many respondents across all regions utilize mobile technology, providing opportunities for rapid distribution of resource specific, up-to-date IPC content.
- ItemImpact of a quality improvement project to strengthen infection prevention and control training at rural healthcare facilities(Health and Medical Publishing Group, 2015) Dramowski, Angela; Marais, Frederick; Goliath, C.; Mehtar, ShaheenBackground: South Africa (SA) has a dire shortage of skilled infection prevention and control (IPC) practitioners with limited opportunities for IPC training, especially in rural areas. Methods: This quality improvement research-based case study surveyed healthcare workers’ IPC training needs and measured the impact of a targeted IPC training intervention at four healthcare facilities in a rural sub-district in the Western Cape Province of SA. Transfer and implementation of IPC knowledge and best practice were evaluated at the participating facilities, both pre and post intervention. Results: Most survey respondents (239/271; 88.2%) practised in rural districts and reportedly received infrequent (either annual or no) in-service training in IPC (138/271; 51%). The IPC education intervention (five short courses) was attended by almost one-third of clinical staff (129/422; 30.6%) at the four rural healthcare facilities. The pre-intervention IPC assessment identified the following: poor knowledge and implementation of tuberculosis-IPC measures; limited knowledge of medical device decontamination; high rates of needle-stick injuries; low hand-hygiene compliance rates and poor compliance with personal protective equipment use. At the post-intervention assessment, IPC knowledge scores and hand-hygiene compliance rates improved significantly but some IPC practices were unchanged. Conclusion: A structured IPC training programme in rural healthcare facilities can improve healthcare workers’ IPC knowledge, but has limited impact on clinical practice.
- ItemInfectious disease exposures and outbreaks at a South African neonatal unit with review of neonatal outbreak epidemiology in Africa(Elsevier, 2017) Dramowski, Angela; Aucamp, M.; Bekker, A.; Mehtar, ShaheenBackground: Hospitalized neonates are vulnerable to infection, with pathogen exposures occurring in utero, intrapartum, and postnatally. African neonatal units are at high risk of outbreaks owing to overcrowding, understaffing, and shared equipment. Methods: Neonatal outbreaks attended by the paediatric infectious diseases and infection prevention (IP) teams at Tygerberg Children’s Hospital, Cape Town (May 1, 2008 to April 30, 2016) are described, pathogens, outbreak size, mortality, source, and outbreak control measures. Neonatal outbreaks reported from Africa (January 1, 1996 to January 1, 2016) were reviewed to contextualize the authors’ experience within the published literature from the region. Results: Thirteen outbreaks affecting 148 babies (11 deaths; 7% mortality) over an 8-year period were documented, with pathogens including rotavirus, influenza virus, measles virus, and multidrug-resistant bacteria (Serratia marcescens, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci). Although the infection source was seldom identified, most outbreaks were associated with breaches in IP practices. Stringent transmission-based precautions, staff/parent education, and changes to clinical practices contained the outbreaks. From the African neonatal literature, 20 outbreaks affecting 524 babies (177 deaths; 34% mortality) were identified; 50% of outbreaks were caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae. Conclusions: Outbreaks in hospitalized African neonates are frequent but under-reported, with high mortality and a predominance of Gram-negative bacteria. Breaches in IP practice are commonly implicated, with the outbreak source confirmed in less than 50% of cases. Programmes to improve IP practice and address antimicrobial resistance in African neonatal units are urgently required.
- ItemLimiting the spread of COVID-19 in Africa : one size mitigation strategies do not fit all countries(Elsevier, 2020) Mehtar, Shaheen; Preiser, Wolfgang; Lakhe, Ndeye Aissatou; Bousso, Abdoulaye; TamFum, Jean-Jacques Muyembe; Kallay, Oscar; Seydi, Moussa; Zumla, Alimuddin; Nachega, Jean B.On March 11, 2020, when coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by WHO, there were comparatively few cases reported from Africa. Our Comment draws on early imported COVID-19 cases in South Africa, Senegal, Democratic Republic of the Congo, and Egypt as case studies to discuss important mitigation strategies of COVID-19 in Africa.
- ItemManaging and preventing vascular catheter infections : a position paper of the international society for infectious diseases(Elsevier, 2019) Lutwick, Larry; Saif Al-Maani, Amal; Mehtar, Shaheen; Memish, Ziad; Rosenthal, Victor Daniel; Dramowski, Angela; Lui, Grace; Osman, Tamer; Bulabula, Andre; Bearman, GonzaloENGLISH ABSTRACT: A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview recommendations on managing and preventing vascular catheter infections, specifically for the prevention and management of central line-associated bloodstream infections. These recommendations are intended to provide insight for healthcare professionals regarding the prevention of infection in the placement and maintenance of the catheter and diagnosis as well as treatment of catheter infection. Aspects of this area in pediatrics and in limited-resource situations and a discussion regarding the selection of empiric or targeted antimicrobial therapy are particular strengths of this position paper.
- ItemMaternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa : a systematic review and meta-analysis(Published by Elsevier on behalf of International Society for Infectious Diseases, 2017) Bulabula, Andre N.H.; Dramowski, Angela; Mehtar, ShaheenObjective: To summarize published studies on the prevalence of and risk factors for maternal bacterial colonization and/or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) in pregnant and/or post-partum women in Africa. Methods: A systematic review was conducted using the PubMed, Scopus, and Google Scholar databases. Bibliographies of included eligible studies were manually searched to identify additional relevant articles. No language restriction was applied. The timeframe of the search included all records from electronic database inception to July 15, 2017. A random-effects meta-analysis was performed to summarize the prevalence and the 95% confidence intervals (CI) of ESBL-E colonization or infection in pregnant or post-partum women in Africa. The meta-analysis was conducted using STATA IC 13.1 software and the metaprop function/plugin. Results: Ten studies (seven on pregnant women and three on post-partum women) were included, documenting a 17% prevalence of maternal colonization with ESBL-E in Africa (95% CI 10–23%). The prevalence of ESBL-E in community isolates exceeded that in isolates from the hospital setting (22% vs. 14%). The most frequently reported ESBL-encoding gene was CTX-M (cefotaxime hydrolyzing capabilities). Data on risk factors for maternal ESBL-E colonization and infection are very limited. Conclusions: The prevalence of colonization and/or infection with ESBL-E in pregnant and post-partum women in Africa exceeds that reported from high- and middle-income settings, representing a risk for subsequent neonatal colonization and/or infection with ESBL-E.
- ItemPreparedness of institutions around the world for managing patients with Ebola virus disease: an infection control readiness checklist(BioMed Central, 2015-06-08) Tartari, Ermira; Allegranzi, Benedetta; Ang, Brenda; Calleja, Neville; Collignon, Peter; Hopman, Joost; Lang, Lily; Lee, Lai Chee; Ling, Moi Lin; Mehtar, Shaheen; Tambyah, Paul A.; Widmer, Andreas; Voss, AndreasBackground: In response to global concerns about the largest Ebola virus disease (EVD), outbreak to-date in West Africa documented healthcare associated transmission and the risk of global spread, the International Society of Chemotherapy (ISC) Infection Control Working Group created an Ebola Infection Control Readiness Checklist to assess the preparedness of institutions around the globe. We report data from the electronic checklist that was disseminated to medical professionals from October to December 2014 and identify action needed towards better preparedness levels. Findings: Data from 192 medical professionals (one third from Africa) representing 125 hospitals in 45 countries around the globe were obtained through a specifically developed electronic survey. The survey contained 76 specific questions in 7 major sections: Administrative/operational support; Communications; Education and audit; Human resources, Supplies, Infection Prevention and Control practices and Clinical management of patients. The majority of respondents were infectious disease specialists/infection control consultants/clinical microbiologists (75; 39 %), followed by infection control professionals (59; 31 %) and medical doctors of other specialties (17; 9 %). Nearly all (149; 92 %) were directly involved in Ebola preparedness activities. Whilst, 54 % indicated that their hospital would need to handle suspected and proven Ebola cases, the others would subsequently transfer suspected cases to a specialized centre. Conclusion: The results from our survey reveal that the general preparedness levels for management of potentially suspected cases of Ebola virus disease is only partially adequate in hospitals. Hospitals designated for admitting EVD suspected and proven patients had more frequently implemented Infection Control preparedness activities than hospitals that would subsequently transfer potential EVD cases to other centres. Results from this first international survey provide a framework for future efforts to improve hospital preparedness worldwide.
- ItemTB infection prevention and control experiences of South African nurses : a phenomenological study(BioMed Central, 2011-04) Sissolak, Dagmar; Marais, Frederick; Mehtar, ShaheenAbstract. Background. The tuberculosis (TB) epidemic in South Africa is characterised by one of the highest levels of TB/HIV co-infection and growing multidrug-resistant TB worldwide. Hospitals play a central role in the management of TB. We investigated nurses' experiences of factors influencing TB infection prevention and control (IPC) practices to identify risks associated with potential nosocomial transmission. Methods. The qualitative study employed a phenomenological approach, using semi-structured interviews with a quota sample of 20 nurses in a large tertiary academic hospital in Cape Town, South Africa. The data was subjected to thematic analysis. Results. Nurses expressed concerns about the possible risk of TB transmission to both patients and staff. Factors influencing TB-IPC, and increasing the potential risk of nosocomial transmission, emerged in interconnected overarching themes. Influences related to the healthcare system included suboptimal IPC provision such as the lack of isolation facilities and personal protective equipment, and the lack of a TB-IPC policy. Further influences included inadequate TB training for staff and patients, communication barriers owing to cultural and linguistic differences between staff and patients, the excessive workload of nurses, and a sense of duty of care. Influences related to wider contextual conditions included TB concerns and stigma, and the role of traditional healers. Influences related to patient behaviour included late uptake of hospital care owing to poverty and the use of traditional medicine, and poor adherence to IPC measures by patients, family members and carers. Conclusions. Several interconnected influences related to the healthcare system, wider contextual conditions and patient behavior could increase the potential risk of nosocomial TB transmission at hospital level. There is an urgent need for the implementation and evaluation of a comprehensive contextually appropriate TB IPC policy with the setting and auditing of standards for IPC provision and practice, adequate TB training for both staff and patients, and the establishment of a cross-cultural communication strategy, including rapid access to interpreters.
- ItemUnexplained HIV-1 infection in children : documenting cases and assessing for possible risk factors(Health and Medical Publishing Group (HMPG), 2004-03) Hiemstra, R.; Rabie, H.; Schaaf, H. Simon; Eley, B.; Cameron, N.; Mehtar, Shaheen; Janse van Rensburg, A.; Cotton, M. F.Background. In the year 2000 we reported possible horizontal transmission of HIV-1 infection between two siblings. An investigation of three families, each with an HIV-infected child but seronegative parents, permitted this finding. Sexual abuse and surrogate breast-feeding were though unlikely. The children had overlapping hospitalisation in a regional hospital. Since then several cases of unexplained HIV infection in children have been reported. A registry was established at Tygerberg Children's Hospital for collection of data on the extent of horizontal or unexplained transmission of HIV in children. Study design. Retrospective chart review. Results. Fourteen children were identified, 12 from the Western Cape and 1 each from the Eastern Cape and KwaZulu-Natal. Thirteen (92%) had been hospitalised previously. In the Western Cape, children had been hospitalised in 8 hospitals. Ten of 13 (77%) were admitted as neonates and 9 of 13 (69%0 had 2 or more admissions. Intravascular cannulation and intravenous drug administration occurred in all but 2 children before HIV diagnosis. Conclusion. We have confirmed HIV infection in a number of cases where the source of infection has been inadequately explained. Circumstantial evidence supports but does not prove nosocomial transmission. Further studies and identification of medical procedures conducive to the spread of HIV are urgently needed.