Department of Global Health

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The 17th International Congress on Infectious Diseases workshop on developing infection prevention and control resources for low - and middle-income countries
(Published by Elsevier on behalf of International Society for Infectious Diseases, 2017) Sastry, Sangeeta; Masroor, Nadia; Bearman, Gonzalo; Hajjeh, Rana; Holmes, Alison; Memish, Ziad; Lassmann, Britta; Pittet, Didier; Macnab, Fiona; Kamau, Rachel; Wesangula, Evelyn; Pokhare, Paras; Brown, Paul; Daily, Frances; Amer, Fatma; Torres, Jaime; O’Ryan, Miguel; Gunturu, Revathi; Bulabula, Andre; Mehtarp, Shaheen
Hospital-acquired infections (HAIs) are a major concern to healthcare systems around the world. They are associated with significant morbidity and mortality, in addition to increased hospitalization costs. Recent outbreaks, including those caused by the Middle East respiratory syndrome coronavirus and Ebola virus, have highlighted the importance of infection control. Moreover, HAIs, especially those caused by multidrug-resistant Gram-negative rods, have become a top global priority. Although adequate approaches and guidelines have been in existence for many years and have often proven effective in some countries, the implementation of such approaches in low- and middle-income countries (LMICs) is often restricted due to limited resources and underdeveloped infrastructure. While evidence-based infection prevention and control (IPC) principles and practices are universal, studies are needed to evaluate simplified approaches that can be better adapted to LMIC needs, in order to guide IPC in practice. A group of experts from around the world attended a workshop held at the 17th International Congress on Infectious Diseases in Hyderabad, India in March 2016, to discuss the existing IPC practices in LMICs, and how best these can be improved within the local context.
Abnormal eating attitudes and weight loss behaviours of girls attending a "traditional" Jewish high school in Johannesburg : an examination of teachers' awareness
(Stellenbosch : University of Stellenbosch, 2011-03) Notelovitz, Talia; Visser, J.; Szabo, C. P.; Fredericks, N.; Harvey, J.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
ENGLISH ABSTRACT: Background: Eating disorders are an important cause of morbidity and mortality in adolescent and young adult women. There is some evidence that Eating disorders may be more common in Jewish females than in their non-Jewish counterparts. Individuals with abnormal attitudes as defined by the Eating Attitudes Test (26-Item version) (EAT-26) are at increased risk of developing an eating disorder. School teachers are required to take an active role in the currently favoured ecological approach to the prevention of eating disorders. Objectives: The current study sought to determine the prevalence of abnormal eating attitudes and weight loss behaviours in a Jewish female adolescent sample and to investigate school teachers’ awareness of these factors and their attitudes towards a school programme to address these. Methods: A cross-sectional study of girls in grades 8 to 11 and teachers of both genders was undertaken at a “traditional” Jewish high school in Johannesburg, South Africa. A questionnaire consisting of the EAT-26 and a modified section of the United States Youth Risk Behaviour Survey (YRBS) was completed by pupils. A questionnaire developed by the researcher for the study was completed by teachers. Results: Two hundred and twenty pupils (response rate 84.3%) and 38 teachers (52.1%) participated. Twenty percent of pupils (n=43) had EAT-26 scores greater than or equal to 20 and 30.2% were found to require clinical evaluation for a potential eating disorder Thirty two point seven percent (n=72) of girls considered themselves to be overweight. Sixty four percent (n=139) were trying to lose weight at the time of the study and 19.1% (n=42) had engaged in one or more extreme methods of weight loss (fasting, purging or non-prescribed medication) in the past 12 months. Most teachers (81.6%, n=29) underestimated the proportion of girls requiring clinical evaluation and 71.1% (n=27) underestimated the extent of current weight loss attempts. Almost all (97.3%, n=37) the teachers recognised the need to address disordered eating attitudes and patterns in the school but only 34.2% (n=13) viewed the school as the appropriate place, would be prepared to participate and would give up class time. Conclusions: This is the first study to document the presence of abnormal eating attitudes among Jewish adolescent females in South Africa. The prevalence fell within the upper end of the range of rates reported in studies of adolescent girls in South Africa and abroad. Dieting and attempts at weight loss are common in this population and are also in keeping with the findings from international studies. This is the first study to measure teachers’ awareness of the eating attitudes and weight loss behaviours of girls attending the school at which they teach. The teachers participating in this study were not fully aware of the extent to which eating-related issues affect female pupils. Over and above this, there appears to be a resistance to facilitating and participating in a school programme addressing these issues. A qualitative exploration of this could yield valuable insights.
Abnormal eating attitudes and weight-loss behaviour of adolescent girls attending a “traditional” Jewish high school in Johannesburg, South Africa
(MedPharm Publications, 2014-07) Visser, Janicke; Notelovitz, Talia; Szabo, Christopher P.; Fredericks, Nicolette
Objectives: This study aimed to determine the prevalence of abnormal eating attitudes and weight-loss behaviour in female Jewish adolescents. Teachers’ awareness of these factors and their attitudes towards a school programme to address these were also investigated. Design: A cross-sectional study was conducted. Subjects and setting: Female learners in grades 8-11 (n = 220), attending a “traditional” Jewish high school in Johannesburg were included. Teachers (n = 38) at the relevant school were also recruited. Outcome measures: A questionnaire consisting of the 26-item version of the Eating Attitudes Test (EAT-26) and a modified section of the USA Youth Risk Behavior Survey was completed by learners. Teachers completed a questionnaire designed by the researchers. Results: Twenty per cent of the learners (n = 43) achieved EAT-26 scores ≥ 20, suggestive of a possible eating disorder, while 30.2% (n = 65) required clinical evaluation for a potential eating disorder. Thirty-three per cent (n = 72) of the adolescent girls considered themselves to be overweight, while 64% (n = 139) were trying to lose weight at the time of the study. 19.1% (n = 42) had engaged in one or more extreme methods of weight loss in the past 12 months. Most teachers (81.6%, n = 29) underestimated the proportion of adolescent girls requiring clinical evaluation and 71.1% (n = 27) underestimated the extent of current weight-loss attempts. Almost all of the teachers (97.3%, n = 37) recognised the need to address disordered eating attitudes. However, only 34.2% of the teachers (n = 13) viewed the school as the appropriate place in which to do this, and were also prepared to participate in the programme and sacrifice class time. Conclusion: To date, no published South African literature documents the presence of abnormal eating attitudes in Jewish adolescent females in South Africa. The prevalence fell within the upper end of rates reported in studies on adolescent girls in South Africa and abroad. Teachers who participated in this study were not fully aware of the extent to which eating-related issues affected female learners. A qualitative exploration thereof could yield valuable insights.
Acceptability and accessibility of pre-exposure prophylaxis modalities for HIV prevention (oral daily PrEP, dapivirine vaginal ring and long-acting cabotegravir injectable) among female sex workers in Salt River, Cape Town : a cross-sectional study
(Stellenbosch : Stellenbosch University, 2022-12) Mbuyamba, Rachel; Cois, Annibale; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
ENGLISH SUMMARY: Background: Female sex workers (FSWs) are at high risk of contracting HIV and have poor access to health care. Evidence is being collected in real world settings on the acceptability and accessibility of pre-exposure prophylaxis (PrEP) amongst FSWs. We explored oral PrEP accessibility, associated factors and acceptability of alternative PrEP modalities. Methods: This cross-sectional study involved 100 HIV-negative FSWs aged >18 years receiving services at the Wits RHI Sex Worker Clinic in Salt River. We tested the association between oral PrEP uptake status and independent variables using logistic regression models. Poisson regression models were used to identify factors associated with oral PrEP accessibility levels. Linear regression was used to identify factors associated with acceptability of alternative PrEP modalities. Results: FSWs with median age 32.6 years (interquartile range 11.7 years) participated in this study, with 97% indicating that they were at risk for HIV infection. Oral PrEP uptake was 33%. Condom use with the main partner (OR = 0.2, 95% CI: 0.0-0.9, sometimes vs. never) was negatively associated with oral PrEP uptake and no previous experience with long-acting drugs (OR = 5.4, 95% CI: 2.2-13.4) was positively associated with oral PrEP uptake. Accessibility of oral PrEP was lower among FSWs for whom sex work was their secondary source of income compared to those for whom sex work was a primary source of income (aIRR for accessibility score = 0.8, 95% CI: 0.7 – 0.9). Acceptability of alternative PrEP modalities was lower among FSWs with previous treatment for sexually transmitted diseases (differences in acceptability scores -5.1, 95% CI: -14.9– 4.6). Long waiting times (72% of participants), PrEP unavailability (27%), PrEP side effects (38%), limited privacy (31%) and nurse unavailability were the main barriers to PrEP uptake. The perceived risk of HIV infection, and the availability (43%) and cost (71%) of PrEP uptake were PrEP uptake facilitators. Conclusions: Oral PrEP uptake among FSWs is currently low. Limited privacy and side effects were the main barriers to PrEP uptake. FSWs were willing to use the new PrEP modalities when available. This study provides valuable lessons for a successful introduction of new PrEP modalities.
The acceptability of three vaccine injections given to infants during a single clinic visit in South Africa
(BioMed Central, 2016) Tabana, Hanani; Dudley, Lilian; Knight, Stephen; Cameron, Neil; Mahomed, Hassan; Goliath, Charlyn; Eggers, Rudolf; Wiysonge, Charles S.
ENGLISH SUMMARY : Background: The Expanded Programme on Immunisation (EPI) has increased the number of antigens and injections administered at one visit. There are concerns that more injections at a single immunisation visit could decrease vaccination coverage. We assessed the acceptability and acceptance of three vaccine injections at a single immunisation visit by caregivers and vaccinators in South Africa. Methods: A mixed methods exploratory study of caregivers and vaccinators at clinics in two provinces of South Africa was conducted. Quantitative and qualitative data were collected using questionnaires as well as observations of the administration of three-injection vaccination sessions. Results: The sample comprised 229 caregivers and 98 vaccinators. Caregivers were satisfied with the vaccinators’ care (97 %) and their infants receiving immunisation injections (93 %). However, many caregivers, (86 %) also felt that three or more injections were excessive at one visit. Caregivers had limited knowledge of actual vaccines provided, and reasons for three injections. Although vaccinators recognised the importance of informing caregivers about vaccination, they only did this sometimes. Overall, acceptance of three injections was high, with 97 % of caregivers expressing willingness to bring their infant for three injections again in future visits despite concerns about the pain and discomfort that the infant experienced. Many (55 %) vaccinators expressed concern about giving three injections in one immunisation visit. However, in 122 (95 %) observed three-injection vaccination sessions, the vaccinators administered all required vaccinations for that visit. The remaining seven vaccinations were not completed because of vaccine stock-outs. Conclusions: We found high acceptance by caregivers and vaccinators of three injections. Caregivers’ poor understanding of reasons for three injections resulted from limited information sharing by vaccinators for caregivers. Acceptability of three injections may be improved through enhanced vaccinator-caregiver communication, and improved management of infants’ pain. Vaccinator training should include evidence-informed ways of communicating with caregivers and reducing injection pain. Strategies to improve acceptance and acceptability of three injections should be rigorously evaluated as part of EPI’s expansion in resource-limited countries.
Accommodation of accessibility survey in primary care clinics of a rural Alberta community
(Stellenbosch : Stellenbosch University, 2014-12) Van der Linde, Erich; Pather, Michael; Stellenbosch University. Faculty of Health Sciences. Department of Interdisciplinary Health Sciences.
ABSTRACT Introduction: According to the Society of Rural Physicians of Canada’s National Rural Health Strategy, 21% of Canadian residents are rural but only 9.4% of Canadian physicians live in rural areas.1,2 Aim: To evaluate patient experience and the accommodation of accessibility to four primary care clinics in Brooks, Alberta. Objectives were to: • measure and compare the actual versus expected waiting times in the physician’s office. • assess patient satisfaction with the current organization of access and quality of care. • elicit ideas from patients on how to improve the accommodation of access. • elicit feedback from patients regarding the employment of alternative practitioners in the clinics. Methods: Design: cross-sectional survey. Setting: Four primary care clinics in the city of Brooks. Subjects: The study sample (n=391) included registered patients including emergency walk-in consultations, consultations for office procedures, short visits for prescription refills as well as annual physical examinations. Results: The mean perceived waiting room time was 12.35 minutes versus 5-15 minutes actual waiting room time for 60.5% of the participants. The mean perceived exam room waiting time was 10.58 minutes versus 5-15 minutes actual exam room waiting times for 81.4 % of the participants. Mean perceived time spent with the physician was 11.65 minutes versus 5-15 minutes actual time spent with the physician for 67.1 % of the participants. Patients who felt that they can get a timely appointment were 8.4 times more likely to be happy with the quality of care received. Patients who got prompt return of their calls are 10.4 times more likely to be happy with access to primary care clinics. Patients who felt that the clinic hours of operation were acceptable were 15.6 times more likely to agree that they received adequate health care. Patients who felt that the waiting time for an appointment at the clinic were acceptable to them were 8.1 times happier with the quality of care. Conclusion No major differences exist between perceived and actual waiting times in the physician’s offices. The waiting time for scheduled appointments is generally too long. The most satisfied patient appears to be someone whom waits no longer than 5-15 minutes in the waiting room, then no longer than 5-15 minutes in exam room for a 5 -15 minute consultation. The shorter the waiting times for an appointment and the shorter the different waiting times during a consultation in the clinic the more satisfied the patient.
Accuracy and completeness of notification of tuberculosis in two high incident communities in Cape Town, South Africa
(Stellenbosch : Stellenbosch University, 2011-12) Dunbar, Rory; Barnes, J. M.; Beyers, Nulda; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Community Health.
ENGLISH ABSTRACT: Introduction: Tuberculosis (TB) treatment registers and laboratory records are essential recording and reporting tools in TB control programmes. Reliable data are essential for any TB control programme but under-registration of TB cases has been well documented internationally, due to under-reporting of patients on treatment or failure to initiate treatment. The accuracy and completeness of routinely collected data are seldom monitored. Aim: This study used record linking to assess the accuracy and completeness of TB treatment register data and the feasibility of estimating the completeness of bacteriological confirmed pulmonary TB registration in two high incident communities in South Africa with capturerecapture methods. Methods: All cases of bacteriologically confirmed TB defined as 2 smear-positive results and/or at least one culture-positive result were included. Record linking was performed between three data sources: (1) TB treatment registers; and (2) all smear and culture results from (a) the nearest central laboratory, and (b) the referral hospital laboratory. To estimate the completeness of TB treatment recording three-source log-linear capture-recapture models were used, with internal validity analysis. Results: The TB treatment registers had 435 TB cases recorded of which 204 (47%) were bacteriologically confirmed cases. An additional 39 cases that were recorded as nonbacteriological cases in the TB treatment register, were reclassified as bacteriologically confirmed. In addition, there were 63 bacteriologically confirmed cases identified from the laboratory databases which were not recorded in the TB treatment register. The final total number of bacteriologically confirmed TB cases across all 3 databases was 306, an increase of 50% over what had initially been recorded in the TB treatment register. The log-linear capture-recapture model estimated the number of bacteriologically confirmed TB cases not found in any of the data sources at 20, resulting in a total number of bacteriologically confirmed TB cases of 326 (95% CI 314-355). The completeness of registration of bacteriologically confirmed pulmonary TB cases was 79% after record linking and 75% after the capture-recapture estimate. Conclusions: The results presented in this thesis highlighted the concern regarding the accuracy and completeness of routinely collected TB recording and reporting data. A high percentage of bacteriologically confirmed cases from both laboratories were not recorded in the TB treatment registers. Capture-recapture can be useful, but not essential, for evaluation of TB control programmes, also in resource-limited settings, but methodology and results should be carefully assessed. The present study estimated the extent of the problem of underreporting of TB in South Africa and identified challenges in the process. Interventions to reduce underreporting of TB are urgently needed.
Achieving the millennium development goals in sub-Saharan Africa
(Health and Medical Publishing Group (HMPG), 2007-09) Wiysonge, Charles S.; Young, T.; Volmink, J.
To the Editor: The UN has released a mid-term report on progress towards achieving the Millennium Development Goals (MDG), eight pro-poor goals contained in the Millennium Declaration of 2000, to be achieved by 2015. It paints a gloomy picture of health in sub-Saharan Africa. Child mortality rates declined globally, but the improvement was uneven, with sub-Saharan Africa recording the highest rate and the slowest pace of progress. In 1990 and 2005 in sub-Saharan Africa, 185 and 166 children respectively died, mainly from preventable causes, before their 5th birthday for every 1 000 live births, a mere 10% reduction in 16 years.
Acidified infant formula explained
(Medpharm Publications, 2013) Labuschagne, Irene; Van Niekerk, Evette; Lombard, Martani J.
The development of effective methods to prevent acute gastroenteritis is an important goal for infant health. Exclusive breastfeeding and postponement of complementary foods until the age of six months is recommended for healthy infants. However, at times, infant formula is required. Various types are commercially available. Acidified cow’s milk formula has been found to prevent the growth of pathogenic bacteria and concurring diarrhoeal disease.
Acute pain in the African prehospital setting : a scoping review
(Hindawi, 2019) Lourens, Andrit; McCaul, Michael; Parker, Romy; Hodkinson, Peter
Background. Acute pain is a common reason for seeking prehospital emergency care. Regrettably, acute pain is often underestimated and poorly managed in this setting. The scoping review was conducted to gain insight into existing research on the topic and to make recommendations for future work. Objectives. To identify all available evidence related to acute pain assessment and management in the African prehospital setting, describe the extent of the evidence, encapsulate findings, and identify research gaps. Methods. The scoping review considered primary and secondary research related to acute pain assessment and management of both medical and traumatic origins in all age groups in the African prehospital setting. The search strategy aimed to identify published, unpublished, and ongoing research which met the inclusion criteria. Potentially eligible studies were identified by a comprehensive search of electronic databases, trial registers, dissertation/thesis databases, grey literature databases, and conference proceedings. Screening and data extraction were conducted independently and in duplicate. Results. The comprehensive search identified 3823 potential studies, duplicate titles were removed, and 3358 titles/abstracts were screened. Full text of 66 potentially eligible titles was screened, 60 were excluded, and six publications met the inclusion criteria. Despite recommendations for pain assessment during general patient care, most studies reported no/limited pain assessment. In general, pain management was concluded to be insufficient and not conforming to best practice. Conclusions. Only six publications addressing prehospital acute pain care in Africa could be identified, possibly indicative of a knowledge gap. Future research is indicated to enable a better understanding of the epidemiology of acute pain and barriers and enablers of acute pain care and to develop evidence-based clinical practice guidelines (CPGs) catering for all EMS systems in Africa. Additionally, educational initiatives should be implemented to improve the quality of acute pain care and to monitor quality through continuous quality improvement (CQI) programs.
The adaptation of an appropriate screening tool for the early detection of malnutrition in individuals with intellectual disability (ID) in a psychiatric hospital in North West Province (South Africa)
(Stellenbosch : Stellenbosch University, 2012-12) Nel, Maretha; Marais, Maritha; Potgieter, Sunita; Nel, D. G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nutrition.
ENGLISH ABSTRACT: Background: Considering the myriad of risk factors causing nutritional deficiency, as well as the prevalence of malnutrition and feeding problems experienced by individuals with intellectual disability (ID), early detection and diagnosis of malnutrition in this population group is essential. Objectives: The main aim and objectives of the study were to determine the degree of malnutrition and body composition in individuals with ID living in a psychiatric hospital (North West Province, South Africa), to determine which degree of ID was more prone to malnutrition, to investigate the different risk factors for malnutrition in this group of individuals, and to use this data to adapt an existing screening tool used to facilitate the easier identification of malnutrition. Methodology: An observational descriptive cross-sectional study, with an analytical component, was conducted. The study consisted of two phases. During the first phase, measurements were taken of individuals with ID to determine body composition and nutritional status. During the second phase, said data, as well as other factors influencing the nutritional status of individuals with ID, were used to adapt an existing screening tool to allow for easier identification of malnutrition in the study population. The adapted screening tool was tested by nursing staff. Results: The anthropometric measurements of 244 individuals with ID were determined. The overall anthropometrical status indicated that half of the study population (52,1%, n=127) had a normal nutritional status, that 38,1% (n=93) was undernourished or at risk of becoming undernourished, and that 10,0% (n=24) was either at risk of becoming or was overnourished . Men were more prone to being undernourished or at risk of becoming undernourished (48,0%, n=73), compared to women (21,7%, n=20). Although no significant difference was found in anthropometrical status across the four severities of ID (Pearson Chi-square test (ρ=0,15)), individuals with mild ID were more likely to become obese (19,4%, n=6), and individuals with profound ID were more prone to being underweight (57,1%, n=8). It was found that 41,8% (n=102) of the total study population had a waist circumference (WC) above the normal values. A significant difference was found between increased WC and severity of ID (Pearson Chi-square test (ρ=0,00)). Other risk factors that can influence nutritional status in said population included medical conditions such as hypertension (13,0%, n=32) and epilepsy (EP) (46,0%, n=112), as well as polypharmacy (71,7%, n=175). An existing malnutrition screening tool for the population with ID was adapted by means of the addition of prevalent factors (WC measurements, presence of EP and use of medications), as well as through adaptation of the scoring system. Conclusion: Using anthropometric measurements and indices for body composition, a high prevalence of malnutrition was identified in the study population of individuals with ID. The adapted screening tool was more sensitive than the original tool in identifying individuals who were at risk of malnutrition, or who were already malnourished in this study population. The research undertaken in this respect can help health care professionals to be more aware of the interaction between the severity of ID and malnutrition.
Adaptation of the RenalSmart web-based application for the dietary management of patients with diabetic nephropathy
(Medpharm Publications, 2013) Esau, Nazeema; Koen, Nelene; Herselman, Marietjie G.
ENGLISH SUMMARY : Objectives: The aim of this study was to develop and test a web-based application for the dietary management of patients with diabetic nephropathy. Design: Observational descriptive study. Settings and subjects: RenalSmart® is a web-based application used to assist dietitians in clinical practice, from tertiary to primary care, to manage patients with chronic renal failure. The application was adapted and enhanced to include functions for the nutritional assessment of a patient with diabetic nephropathy, the formulation of a dietary prescription and the development of a meal plan and sample menu. It includes a graphical display of anthropometric and biochemical measurements. Quality assurance testing was undertaken throughout the development process by the project team in a pilot study involving generalist dietitians and dietitians who specialise in diabetic and renal nutrition. Nonrandom purposive sampling, including snowball sampling, was used to recruit them. Outcome measures: The application was finally tested for accuracy and acceptability by registered dietitians in South Africa. Results: Thirty-seven dietitians completed the final testing of the application. The mean age of the respondents was 33 years. Thirty-five per cent resided in the Western Cape. The overall acceptability of the application was rated as good to excellent by 81% of respondents. There was a significant difference between dietitians who usually consulted renal patients, compared to those who did not, in their rating of the accuracy of the data-saving function (p-value = 0.02) and the fluid requirements (p-value = 0.03). In this regard, the former group of dietitians was dissatisfied with these functions. Conclusion: The web-based application developed in this study was rated as accurate and acceptable by the majority of respondents. Identified problem areas were addressed in the final version.
The adherence to effective vaccine stock management protocols in the government facilities, the availability of vaccines, and the effectiveness of the stock visibility system in OR Tambo District of the Eastern Cape Province of South Africa
(Stellenbosch : Stellenbosch University, 2019-12) Iwu, Chinwe Juliana; Wiysonge, Charles S.; Chikte, Usuf; Ngcobo, Ntombenhle Judith; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems & Public Health.
ENGLISH SUMMARY : Effective vaccine stock management is one of the criteria for a functional vaccine supply chain. It ensures that the quality of vaccines is maintained and that vaccines are continuously available at service delivery points. The continuous availability of vaccines is a vital component of the health system which is required to achieve public health goals such as improved immunisation coverage, and universal health coverage. Reports on vaccine availability and stock management of vaccines in OR Tambo district of the Eastern Cape Province are scarce. Also, since the implementation of the mobile device for stock reporting, stock visibility solution (SVS), no study has explored the experiences of the health care workers in order to identify potential barriers and facilitators to the implementation of the system. This study was therefore aimed at assessing the vaccine stock management status as well as availability of vaccines in the OR Tambo district, in Eastern Cape Province, South Africa. As part of the literature review, we firstly gathered evidence on occurrence of vaccine stock -outs at different levels of the supply chain; the national, district, health facility level in the WHO African region. A systematic search of the literature was conducted to identify studies reporting on vaccine stock-outs at these levels. Furthermore, a cross-sectional study was conducted to assess the occurrence of vaccine stock-outs and vaccine stock management practices in primary health care settings in the Eastern Cape province, South Africa. Data was collected from a total of 64 PHC facilities using a researcher administered questionnaire, record checks and direct observation. This was followed by a qualitative study to explore the perceptions and experiences of the SVS system amongst healthcare workers (HCWs) who are involved with managing stock levels of medicines in primary health care facilities in the Eastern Cape Province. Consequently, a scoping review was conducted to summarise currently available information on interventions for vaccine stock management. Quantitative data was managed using an electronic data capturing tool, REDCap, and descriptive statistics, and Pearson’s chi-squared test, were conducted using STATA® Version 14. The qualitative data was analysed using thematic analysis. Based on the JRF data, approximately 50% of the countries in Africa reported stock-outs of at least one vaccine for at least one month at national and district levels, in 2017. Fourteen (30%) countries reported vaccine stock-outs in 2017 at the national level. BCG vaccine is the most affected vaccine, with an increase from five countries in 2010 to 16 counties in 2015. There is an 86% chance of stock-out at the district level is caused by stock-out at the national level being linked to national level stock-outs and a 62% chance of this leading to interruption of immunisation services at the facility level. At the facility level stock-outs reports from Africa were few. We found a total of eight studies that reported vaccine stock-outs across Africa; South Africa (5); Nigeria (1); Guinea (1) and Kenya (1) and Ethiopia (1). Poor stock management, disease outbreaks, poor supply chain structure, delays in deliveries and lack of trained health personnel are possible causes of facility level stock-outs. Both stock cards and the stock visibility solution (SVS) device were used in all the facilities for vaccine stock management. However, the health care workers were reluctant to fill in the stock cards. Less than half of the facilities visited 27 (44%) filled their stock cards regularly. The ordering system was weak; as only about half 31(49%) of the respondents understood the concept of maximum and minimum stock levels, which are needed for proper quantification of needs. Delays in receiving supplies from the pharmaceutical depot were commonly reported by facilities, which could have contributed to stock-outs. Common reasons for delays from the depot include staff shortages at the pharmaceutical depot causing a backlog of orders, delay from the suppliers, procurement delays and possibly lack of proper communication between the depot and the facilities. A total of 49 (77%) health facilities had at least one stockout for at least one vaccine on the day of the visit. Furthermore, BCG and OPV were the most commonly affected vaccines in 37 (58%) and 28 (44%) facilities, respectively. Within the last two years (between February 2017- February 2019), BCG and OPV had the most prolonged median duration of 167 and 103 days, respectively. PCV experienced the most prolonged duration of stock-outs amongst the newer vaccines with a median duration of stock-outs of 85 days. Four studies met our inclusion criteria (three before-after studies and one randomised trial). Three studies were conducted in low- and middle-income countries, while one was conducted in Canada. All the studies had various limitations and were classified as having a high risk of bias. Study findings suggest that use of digital information systems to improve information and stock visibility, coupled with other interventions (such as training of health care workers on the use of innovative tools and redesign of the supply chain to tackle specific bottlenecks) have the potential to increase vaccine availability, reduce response times, and improve the quality of vaccine records. Although more of well-designed studies are needed to strengthen the evidence base. The SVS system was well understood by most HCWs, as a system for reporting stock levels to managers. They also displayed high commitment to ensuring the systems works. However, some factors were identified as potential barriers for efficient usage of the system. This includes staff shortages and high staff turnover, lack of responses from the managers, the extra workload that comes with the system, amongst others. The HCWs made various suggestions for how the system might be improved, most pertinently the need for more pharmacists and pharmacy assistants and for these cadres to be primarily in-charge of stock management and the use of the SVS. The OR Tambo district of South Africa, just like in other countries, suffers from vaccine stock-outs especially BCG, and OPV. Similarly, the lack of proper stock management linked to the use of manual stock cards, long response time from the pharmaceutical depot and inadequate fridge capacity may be responsible for stock-outs in the primary health care facilities in OR Tambo district. Interventions for improving vaccine availability should be considered, especially those focused on the factors highlighted above.
Adherence to isoniazid preventive therapy among child contacts in Rwanda : a mixed-methods study
(Public Library of Science, 2019-02-11) Birungi, Francine Mwayuma; Graham, Stephen Michael; Uwimana, Jeannine; Musabimana, Angele; Van Wyk, Brian
Background: The World Health Organization recommends isoniazid preventive therapy (IPT) for six months for child contacts without tuberculosis (TB), who are exposed to an adult with active TB. The effectiveness of IPT depends on 80% or greater adherence to medication. In the current study, we assessed IPT adherence and explored barriers to and facilitators of adherence among eligible child contacts in Kigali, Rwanda. Methods: A mixed method study design was used to prospectively assess adherence to IPT among eligible child contacts and its associated factors through a quantitative, observational cohort study, and to explore barriers to and facilitators of adherence to IPT through a descriptive qualitative study. Results: Of the 84 child contacts who started IPT, 74 (88%) had complete adherence and ten (12%) had incomplete adherence. There were no factors (individual characteristics of index cases, households and or health facility characteristics) found to be significantly associated with IPT adherence in the bivariate and multivariate analysis. In the qualitative analysis, we identified factors relating to parents/caregivers, disease, household and health-care providers as major themes determining IPT adherence. Conclusion: There was a high rate of IPT completion in this cohort of eligible child contacts living in Kigali. However, structural factors (poverty and relocation) were found to be the main barriers to IPT adherence that could be addressed by health-care providers.
Adolescent mothers affected by HIV and their children : a scoping review of evidence and experiences from sub-Saharan Africa
(Taylor & Francis, 2020-06-06) Toska, Elona; Laurenzi, Christina A.; Roberts, Kathryn J.; Cluver, Lucie; Sherr, Lorraine
While adolescents have received increasing attention in the global HIV response and international strategies and commitments, adolescent mothers and their children remain largely overlooked in research, funding and, programming for health-related outcomes. We conducted an extensive scoping review of current evidence on the experiences of adolescent mothers affected by HIV and their children in this region. We included published literature and conference abstracts, complemented by consultations with key stakeholders, and a review of documents through grey literature searching. First, we summarise the experiences of adolescent mothers and their children related to HIV and key health and development indicators. The syndemic of early motherhood and HIV in sub-Saharan Africa increases the vulnerability of adolescent mothers and their children. We then highlight lessons from a series of promising programmes focused on supporting adolescent mothers through novel approaches. In sub-Saharan Africa, supporting adolescent mothers living in high HIV-risk communities is critical not only to eliminate HIV/AIDS, but also to attain the Sustainable Development Goals. While research on and programming for adolescent mothers and their children is growing, the complex needs for this vulnerable group remain unmet. We conclude with evidence gaps and programming priorities for adolescent mothers affected by HIV and their children.
African HIV/AIDS trials are more likely to report adequate allocation concealment and random generation than North American trials
(Public Library of Science (PLOS), 2008-10) Siegfried, Nandi; Clarke, Michael; Volmink, Jimmy; Van der Merwe, Lize
Background: Adherence to good methodological quality is necessary to minimise bias in randomised conrolled trials (RCTs). Specific trial characteristics are associated with better trial quality, but no studies to date are specific to HIV/AIDS or African trials. We postulated that location may negatively impact on trial quality in regions where resources are scarce. Methods: 1) To compare the methodological quality of all HIV/AIDS RCTs conducted in Africa with a random sample of similar trials conducted in North America; 2) To assess whether location is predictive of trial quality. We searched MEDLINE, EMBASE, CENTRAL and LILACS. Eligible trials were 1) randomized, 2) evaluations of preventive or treatment interventions for HIV/AIDS, 3) reported before 2004, and 4) conducted wholly or partly (if multi-centred) in Africa or North America. We assessed adequacy of random generation, allocation concealment and masking of assessors. Using univariate and multivariate logistic regression analyses we evaluated the association between location (Africa versus North America) and these domains. Findings: The African search yielded 12,815 records, from which 80 trials were identified. The North American search yielded 13,158 records from which 785 trials were identified and a random sample of 114 selected for analysis. African trials were three times more likely than North American trials to report adequate allocation concealment (OR = 3.24; 95%CI: 1.59 to 6.59; p<0.01) and twice as likely to report adequate generation of the sequence (OR = 2.36; 95%CI: 1.20 to 4.67; p = 0.01), after adjusting for other confounding factors. Additional significant factors positively associated with quality were an a priori sample size power calculation, restricted randomization and inclusion of a flow diagram detailing attrition. We did not detect an association between location and outcome assessor masking. Conclusions: The higher quality of reporting of methodology in African trials is noteworthy. Most African trials are externally funded, and it is possible that stricter agency requirements when leading trials in other countries and greater experience and training of principal investigators of an international stature, may account for this difference. © 2008 Siegfried et al.
Alcohol marketing and adolescent alcohol consumption : results from the International Alcohol Control study (South Africa)
(Health & Medical Publishing Group, 2018-08-28) Morojele, N. K.; Lombard, C.; Harker Burnhams, N.; Petersen Williams, P.; Nel, E.; Parry, C. D. H.
Background. A complete ban on alcohol advertisements has been proposed for South Africa (SA), but there has been limited local research on the association between exposure to alcohol advertisements and alcohol consumption. Objectives. To examine the role of demographic factors, exposure to alcohol marketing and liking of alcohol advertisements in predicting use of alcohol in the past 6 months among older adolescents in Tshwane, Gauteng Province, SA. Methods. Participants comprised the adolescent sub-sample (N=869) of the International Alcohol Control study survey that was conducted in SA. They consisted of 408 males and 461 females aged 16 and 17 years who took part in structured interviews on their alcohol consumption and various alcohol-related attitudes and behaviours. A multiple survey logistic regression analysis of the dependent variable alcohol use in the past 6 months on the independent variables age, gender, educational status, socioeconomic status, exposure to alcohol brand marketing and liking of alcohol advertisements was used. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Results. The prevalence of drinking in the past 6 months was 10.6% (95% CI 5.9 - 18.3). The number of modes of alcohol brand/product advertising to which the adolescents were exposed was positively associated with alcohol use in the past 6 months. An additional mode of alcohol brand/product advertising exposure led to a relative increase of 1.13 (95% CI 1.01 - 1.28) in the odds of alcohol use in the past 6 months (e.g. a participant who was exposed to advertisements via seven different channels was 2.08 times more likely to have used alcohol in the past 6 months than a participant with exposure via a single channel). Having a strong dislike of alcohol advertisements was associated negatively (protective) with alcohol use in the past 6 months, with the odds ratio being 0.35 (95% CI 0.19 - 0.64). Having only a moderate dislike or a liking of alcohol advertisements was positively associated with alcohol use in the past 6 months among the study participants (OR 2.90 and 2.84, respectively). Age, gender, educational status and socioeconomic status were not independently associated with alcohol consumption. Conclusions. Exposure to alcohol marketing and not being strongly averse to advertisements of alcohol brands and products were associated with alcohol use among adolescents. The results have implications for policies on alcohol marketing in SA.
Ambient air pollution and health in Sub-Saharan Africa : current evidence, perspectives and a call to action
(Elsevier, 2019) Katoto, Patrick D. M. C.; Byamungu, Liliane; Brand, Amanda S.; Mokaya, Jolynne; Strijdom, Hans; Goswami, Nandu; De Boever, Patrick; Nawrot, Tim S.; Nemery, Benoit
Background: People from low- and middle-income countries are disproportionately affected by the global burden of adverse health effects caused by ambient air pollution (AAP). However, data from Sub-Saharan Africa (SSA) are still scarce. We systematically reviewed the literature to describe the existing knowledge on AAP and health outcomes in SSA. Methods: We searched PubMed, Medline-OVID, EMBASE and Scopus databases to identify studies of AAP and health outcomes published up to November 15, 2017. We used a systematic review approach to critically analyze and summarize levels of outdoor air pollutants, and data on health effects associated with AAP. We excluded occupational and indoor exposure studies. Results: We identified 60 articles, with 37 only describing levels of AAP and 23 assessing the association between air pollution and health outcomes. Most studies (75%) addressing the relation between AAP and disease were cross-sectional. In general, exposure data were only obtained for selected cities in the framework of temporary international collaborative research initiatives without structural long-term continuation. Measurements of AAP revealed 10–20 fold higher levels than WHO standards. Of the 23 studies reporting health effects, 14 originated from South Africa, and most countries within SSA contributed no data at all. No studies, except from South Africa, were based on reliable morbidity or mortality statistics at regional or country level. The majority of studies investigated self-reported respiratory symptoms. Children and the elderly were found to be more susceptible to AAP. Conclusion: AAP and its negative health effects have been understudied in SSA compared with other continents. The limited direct measurements of air pollutants indicate that AAP in SAA cities is high compared with international standards. Efforts are needed to monitor AAP in African cities, to identify its main sources, and to reduce adverse health effects by enforcing legislation.
An analysis of DTP-associated reactions by manufacturer, batch, vaccinator, series number and infant weight
(Health & Medical Publishing Group, 1996-10) Benade, J. G.
Objectives. To determine whether two commonly used DTP batches manufactured by Rhone-Poulenc Rorer were more reactogenic than two commonly used batches manufactured by the South African Institute of Medical Research. Design. Prospective study. Setting. Six community clinics. Patients. Infants routinely scheduled for their first three DTP immunisations. Main outcome measures. Local and systemic adverse reactions following immunisation with DTP. Results. Local reactions were significantly more common with both Rhone-Poulenc Rorer products. Conclusion. All adverse reaction rates compared favourably with those reported by the Centers for Disease Control.
Analytical methods used in estimating the prevalence of HIV/AIDS from demographic and cross-sectional surveys with missing data : a systematic review
(BMC (part of Springer Nature), 2020-03-14) Mosha, Neema R.; Aluko, Omololu S.; Todd, Jim; Machekano, Rhoderick; Young, Taryn
Background: Sero- prevalence studies often have a problem of missing data. Few studies report the proportion of missing data and even fewer describe the methods used to adjust the results for missing data. The objective of this review was to determine the analytical methods used for analysis in HIV surveys with missing data. Methods: We searched for population, demographic and cross-sectional surveys of HIV published from January 2000 to April 2018 in Pub Med/Medline, Web of Science core collection, Latin American and Caribbean Sciences Literature, Africa-Wide Information and Scopus, and by reviewing references of included articles. All potential abstracts were imported into Covidence and abstracts screened by two independent reviewers using pre-specified criteria. Disagreements were resolved through discussion. A piloted data extraction tool was used to extract data and assess the risk of bias of the eligible studies. Data were analysed through a quantitative approach; variables were presented and summarised using figures and tables. Results: A total of 3426 citations where identified, 194 duplicates removed, 3232 screened and 69 full articles were obtained. Twenty-four studies were included. The response rate for an HIV test of the included studies ranged from 32 to 96% with the major reason for the missing data being refusal to consent for an HIV test. Complete case analysis was the primary method of analysis used, multiple imputations 11(46%) was the most advanced method used, followed by the Heckman’s selection model 9(38%). Single Imputation and Instrumental variables method were used in only two studies each, with 13(54%) other different methods used in several studies. Forty-two percent of the studies applied more than two methods in the analysis, with a maximum of 4 methods per study. Only 6(25%) studies conducted a sensitivity analysis, while 11(46%) studies had a significant change of estimates after adjusting for missing data. Conclusion: Missing data in survey studies is still a problem in disease estimation. Our review outlined a number of methods that can be used to adjust for missing data on HIV studies; however, more information and awareness are needed to allow informed choices on which method to be applied for the estimates to be more reliable and representative.

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