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 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.
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.
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.
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.
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.
Anaemia in South Africa: the past, the present and the future
(Health and Medical Publishing Group, 2013) Visser, Janicke; Herselman, Marietjie
Despite some modest improvements described recently, anaemia remains a significant global public health concern affecting both developed and developing countries. It affects a quarter of the global population, including 293-million (47%) children who are younger than five years of age. A prevalence of 42% and 30% has been described in pregnant and non-pregnant women, respectively. Children and women of reproductive age are at high risk, partly because of physiological vulnerability, followed by the elderly. Africa and Asia are the most heavily affected regions, accounting for 85% of the absolute anaemia burden in high-risk groups. According to the World Health Organization global database on anaemia (1993-2005), this haematological disorder was considered to be a moderate public health problem at the time in South African preschool children, pregnant women and non-pregnant women of reproductive age.
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.
An anti-inflammatory approach to the dietary management of multiple sclerosis : a condensed review
(Co-published by Medpharm Publications and Taylor & Francis, 2017) Labuschagne, I. L.; Blaauw, Renee
Multiple sclerosis (MS) is a chronic, inflammatory, neurodegenerative demyelinating disease of the central nervous system (CNS). Inflammation is increased by high-energy Western-style diets, typically high in salt, animal fat, red meat, sugar-sweetened drinks and fried food, and low in fibre, as well as lack of physical exercise. An anti-inflammatory dietary regimen, with or without administration of dietary supplements, supporting the general trend towards an amelioration of inflammatory status, should be considered. Understanding the role of gut microbiota in health and disease can lay the foundation to treat chronic diseases by modifying the composition of gut microbiota through lifestyle choices, including dietary habits and possibly probiotic supplementation. Evidence from experimental, epidemiologic and clinical studies supports the potential association between poor vitamin D status and the risk of developing MS, as well as an adverse disease course. Correcting vitamin D status seems plausible in patients with MS
Antibiotic prescribing practice and adherence to guidelines in primary care in the Cape Town Metro District, South Africa
(Health & Medical Publishing Group, 2018) Gasson, J.; Blockman, M.; Willems, B.
Background. Knowledge of antibiotic prescribing practice in primary care in South Africa is limited. As 80% of human antibiotic use is in primary care, this knowledge is important in view of the global problem of antibiotic resistance. Objectives. To assess antibiotic prescribing in primary care facilities in the Cape Town Metro District and compare it with current national guidelines, and to assess the reasons why prescriptions were not adherent to guidelines. Methods. A retrospective medical record review was performed in April/May 2016. Records of all patients seen over 2 days in each of eight representative primary care facilities in the Cape Town Metro District were reviewed. The treatment of any patient who raised a new complaint on either of those days was recorded. Prophylactic antibiotic courses, tuberculosis treatment and patients with a non-infection diagnosis were excluded. Treatment was compared with the Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2014 edition. Results. Of 654 records included, 68.7% indicated that an antibiotic had been prescribed. Overall guideline adherence was 45.1%. Adherence differed significantly between facilities and according to the physiological system being treated, whether the prescription was for an adult or paediatric patient, and the antibiotic prescribed. Healthcare professional type and patient gender had no significant effect on adherence. The main reasons for non-adherence were an undocumented diagnosis (30.5%), antibiotic not required (21.6%), incorrect dose (12.9%), incorrect drug (11.5%), and incorrect duration of therapy (9.5%). Conclusions. This study demonstrates poor adherence to guidelines. Irrational use of antibiotics is associated with increased antibiotic resistance. There is an urgent need to improve antibiotic prescribing practice in primary care in the Cape Town Metro District.
Application of evidence on probiotics, prebiotics and synbiotics by food industry : a descriptive study
(London : Biomed Central, 2014-10) Mugambi, Mary N.; Young, Taryn; Blaauw, Renee; Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
ENGLISH ABSTRACT: This study assessed how the food industry applies the knowledge and evidence gained from synbiotics, probiotics or prebiotics research in infants, on the general paediatric population. This study also explored: what happens after the clinical trials using infant formula are completed, data is published or remains unpublished; the effectiveness and type of medium the formula manufacturers use to educate consumers on probiotic, prebiotic or synbiotic infant formula. Findings: This was a descriptive study (a survey) that used a structured questionnaire. All listed companies that manufacture and / or market food products with added probiotics, prebiotics or synbiotics for infants were identified and invited to participate. People responsible for research and development were invited to participate in the survey. A letter of invitation was sent to selected participants and if they expressed willingness to take part in the study, a questionnaire with a written consent form was sent. Descriptive statistics and associations between categorical variables were to be tested using a Chi-square test, a p < 0.05 was statistically significant. A total of 25 major infant formulas, baby food manufacturers were identified, invited to participate in the survey. No company was willing to participate in the survey for different reasons: failure to take any action 5 (20%), decision to participate indefinitely delayed 2 (8%), sensitivity of requested information 3 (12%), company does not conduct clinical trials 1 (4%), company declined without further information 4 (16%), erroneous contact information 6 (24%), refusal by receptionists to forward telephone calls to appropriate staff 3 (12%), language barrier 3 (12%), company no longer agrees to market research 1 (4%). Conclusion: Due to a poor response rate in this study, no conclusion could be drawn on how the food industry applies evidence gained through probiotics, prebiotics or synbiotics research on infants for the benefit of the general paediatric population. More information and greater transparency is needed from the infant formula manufacturers on how they apply the evidence gained from the research on probiotics, prebiotics and synbiotics on infants
Are central hospitals ready for national health insurance? ICD coding quality from an electronic patient discharge record for clinicians
(Health & Medical Publishing Group, 2016-02) Dyers, Robin E.; Evans, Juliet; Ward, Grant Alex; Du Plooy, Shane; Mahomed, Hassan
ENGLISH SUMMARY : Background. South Africa (SA)’s planned National Health Insurance reforms require the use of International Statistical Classification of Diseases (ICD) codes for hospitals to purchase services from the proposed National Health Authority. However, compliance with coding at public hospitals in the Western Cape Province has been challenging. A computer application was developed to aid clinicians in integrating ICD coding into the patient hospital discharge process.Objective. To evaluate the quality of ICD codes captured using the application and predictors thereof in a single hospital department.Methods. After 6 months, the quality of ICD codes was determined by comparing ICD code descriptors with medical concepts in a random sample of original patient records selected over a 6-week period. Patient and personnel characteristics influencing quality of coding, derived from a theoretical framework, were collected.Results. Of 223 patient records, 45.3% (95% confidence interval (CI) 38.8 - 51.9) had complete ICD codes. Primary ICD code accuracy was 74.0% (95% CI 67.8 - 79.5). Patient characteristics such as female gender, younger age group and fewer comorbidities, as well as seniority of clinician rank, were significantly associated with ICD coding being complete on adjusted analysis.Conclusion. The results of this study describe ICD coding quality at a central hospital in SA supported by a computer application and the factors influencing this. More interventions are required to achieve reliable coding data, such as additional ICD coding validation tools, training and oversight of junior clinicians.
Are the attitudes and practices of foodservice managers, catering personnel and students contributing to excessive food wastage at Stellenbosch University?
(Co-published by Medpharm Publications, NISC (Pty) Ltd and Taylor & Francis Group, 2017) Marais, M. L.; Smit, Y.; Koen, N.; Lotze, E.
Objective: The aim was to investigate factors contributing to food wastage by Stellenbosch University (SU) students in selected residences, and to determine the attitudes and practices of students and catering personnel impacting on food waste and a sustainable environment. Design: Cross-sectional, descriptive study. Setting: Stellenbosch University, Western Cape. Subjects: Six foodservice managers, 63 catering personnel and 517 students participated in the study. Outcome measures: A weighed-food wastage study was conducted at seven selected residences during lunch and supper on three non-consecutive weekdays. Food service managers (FSMs) and catering personnel completed interviewer-administered questionnaires, while SU students completed an electronic survey. Results: Ninety percent of students preferred the standard menu options, despite a relatively high average plate waste of 16.9%. More production waste was generated during lunch than supper. The male residence generated more plate waste. Even though students requested larger servings of vegetables, the wastage of these items was high. Factors contributing to wastage were the booking system, menus and serving style, meal plan stipulating the serving of dessert and serving of a large starch portion. All FSMs and 88.5% catering personnel considered it important to reduce food wastage to a minimum. Conclusion: Education of catering personnel and students regarding food waste reduction measures is crucial. A representative forum including students, catering companies and faculty management should be involved when seeking solutions to reduce food wastage and improve communication. By implementing these strategies, a university-wide culture of sustainability with a focus on food waste reduction can be developed and nurtured.

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