Browsing by Author "Naidoo, P."

Now showing 1 - 5 of 5
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    Closing the reporting gap for childhood tuberculosis in South Africa : improving hospital referrals and linkages
    (IUATLD -- International Union Against Tuberculosis and Lung Disease, 2020-03-21) Du Preez, K.; Schaaf, H. S.; Dunbar, R.; Swartz, A.; Naidoo, P.; Hesseling, A. C.
    Setting: A referral hospital in Cape Town, Western Cape Province, Republic of South Africa. Objective: To measure the impact of a hospital-based referral service (intervention) to reduce initial loss to follow-up among children with tuberculosis (TB) and ensure the completeness of routine TB surveillance data. Design: A dedicated TB referral service was established in the paediatric wards at Tygerberg Hospital, Cape Town, in 2012. Allocated personnel provided TB education and counselling, TB referral support and weekly telephonic follow-up after hospital discharge. All children identified with TB were matched to electronic TB treatment registers (ETR.Net/EDRWeb). Multivariable logistic regression was used to compare reporting of culture-confirmed and drug-susceptible TB cases before (2007–2009) and during (2012) the intervention. Results: Successful referral with linkage to care was confirmed in 267/272 (98%) and successful reporting in 227/272 (84%) children. Children with drug-susceptible, culture-confirmed TB were significantly more likely to be reported during the intervention period than in the pre-intervention period (OR 2.52, 95%CI 1.33–4.77). The intervention effect remained consistent in multivariable analysis (adjusted OR 2.62; 95%CI 1.31–5.25) after adjusting for age, sex, human immunodeficiency virus status and the presence of TB meningitis. Conclusions: A simple hospital-based TB referral service can reduce initial loss to follow-up and improve recording and reporting of childhood TB in settings with decentralised TB services.
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    Establishing a health promotion and development foundation in South Africa
    (Health and Medical Publishing Group (HMPG), 2013-03) Perez, A. M.; Ayo-Yusuf, O. A.; Hofman, K.; Kalideen, S.; Maker, A.; Mokonoto, D.; Morojele, N.; Naidoo, P.; Parry, C.; Rendall-Mkosi, K.; Saloojee, Y.
    South Africa has a ‘quadruple burden of disease’. One way to reduce this burden, and address the social determinants of health and social inequity, could be through health promotion interventions driven by an independent Health Promotion and Development Foundation (HPDF). This could provide a framework to integrate health promotion and social development into all government and civil society programmes. On priority issues, the HPDF would mobilise resources, allocate funding, develop capacity, and monitor and evaluate health promotion and development work. Emphasis would be on reducing the effects of poverty, inequity and unequal development on disease rates and wellbeing. The HPDF could also decrease the burden on the proposed National Health Insurance (NHI) system. We reflect on such foundations in other countries, and propose a structure for South Africa’s HPDF and a dedicated funding stream to support its activities. In particular, an additional 2% levy on alcohol and tobacco products is proposed to be utilised to fund the HPDF.
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    Health psychology in family practice : fulfilling a vital need
    (AOSIS, 2003) Kagee, S. A.; Naidoo, P.
    In the context of a busy family practise, medical practitioners often have little time to attend to the psychosocial concerns of patients. Nevertheless, psychological and behavioural factors play an important role in the trajectory of health problems. Health Psychology, a relatively new profession in South Africa, addresses the relationship between behaviour and health. This emerging field is concerned with the emotional problems associated with poor health, behavioural risk factors that contribute to the onset, exacerbation and maintenance of health problems, and co-morbid psychiatric conditions commonly seen in primary care settings. Among the various interventions dispensed by health psychologists are psychological interventions to manage chronic pain, counseling to help cancer patients manage distress or mood turbulence, self-care regimens for adolescents diagnosed with diabetes, and interventions to help AIDS patients manage stress. The role of the health psychologist is becoming increasingly important as part of a holistic approach to meeting the needs of patients in family practice settings.
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    Impact of Xpert MTB/RIF assay on multidrug-resistant tuberculosis treatment outcomes in a health district in South Africa
    (Health & Medical Publishing Group, 2019-04) Mahwire, T. C.; Zunza, M.; Marukutira, T. C.; Naidoo, P.
    Background. Xpert MTB/RIF assay rapidly diagnoses rifampicin resistance, enabling early initiation of second-line tuberculosis (TB) treatment. However, the impact of an earlier multidrug-resistant TB (MDR-TB) diagnosis on treatment outcomes is unknown. Objectives. To compare MDR-TB treatment outcomes in cases diagnosed with smear/culture and Xpert. Methods. This was a retrospective cohort study with cohorts defined by the diagnostic assay used in presumptive TB cases. Data were extracted from a drug-resistant (DR)-TB register including cases from January 2012 to June 2014. Treatment outcomes were assessed at recorded endpoints or after 2 years for those completing treatment. Results. A total of 718 cases were enrolled into the study. Cure rates were 43.4% (n=158) for the smear/culture cohort and 33.5% (n=118) for the Xpert cohort (p<0.01). Xpert diagnosis (adjusted risk ratio (aRR) 0.65; p=0.02) and male gender (aRR 0.66; p=0.04) were associated with cure outcome. Xpert diagnosis increased time to sputum culture conversion from 4 to 5 months (log-rank test p=0.01). Time to treatment initiation was not associated with treatment success in logistic regression analysis. Conclusions. Despite rapid treatment initiation, MDR-TB treatment outcomes were poorer in patients diagnosed with Xpert MTB/RIF assay than in the smear/culture cohort, and they were also poorer in men than in women. Additional studies are required to assess possible factors influencing DR-TB outcomes.
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    Optimizing mycobacterial culture in smear- negative, human immunodeficiency virus- infected tuberculosis cases
    (Public Library of Science, 2015) Ismail, N. A.; Said, H. M.; Pinini, Z.; Omar, S. V.; Beyers, Nulda; Naidoo, P.
    Introduction: Tuberculosis (TB) is a significant public health problem and the diagnosis in human immunodeficiency virus (HIV)—infected individuals is challenging. The use of mycobacterial culture remains an important complementary tool and optimizing it has important benefits. We sought to determine the effect of an increase in the number of specimens evaluated, addition of nutritional supplementation to the culture medium, sputum appearance and volume on diagnostic yield and time to detection of pulmonary TB among smear-negative, HIV-infected adults. Methods: In this prospective study conducted at the Tshwane District Hospital and Academic TB Laboratory, Pretoria, South Africa we collected three sputum specimens an hour apart from presumptive TB cases at an antiretroviral treatment site. We analysed specimens from 236 patients. Specimen appearance and volume were recorded. All specimens were processed for culture using both standard and supplemented media. Results: A single specimen identified 79% of PTB cases using standard media; the second and third specimens added 12.5% and 8.3% respectively. Media supplementation, sputum appearance and specimen volume had no effect on culture yield or contamination rates. The mean time to detection was reduced from 19.8 days in standard cultures to 11.8 days in nutrient supplemented cultures (p = 0.002). For every 1 ml increase in sputum volume, time to detection was decreased by a factor of 0.797 (p = 0.011). Conclusion: Use of an inexpensive culture supplement substantially reduced time to detection and could contribute to reducing treatment delay among HIV-infected cases.