RESUMO
Distrust in science has been linked to scepticism over vaccines and climate change. Using data from nationally representative surveys administered in eight key countries for global efforts to mitigate climate change and COVID-19 (Australia, Brazil, China, India, Japan, South Africa, the UK and US), we find that distrust in scientists was an important predictor variable for most sceptics, who were sceptical of one issue but not both, in February 2021, when most countries had experienced their first wave of the pandemic. However, the association was significantly weaker among the segment of hardcore sceptics who were both climate sceptics and antivaxxers. We demonstrate that these individuals tended to possess many of the typical sceptic characteristics such as high distrust in social institutions and rightward political orientation, which are (collectively) suggestive of an underlying sceptic mindset rather than a specific distrust of scientists. Our results suggest that different types of sceptics necessitate different strategies to dispel scepticism.
Assuntos
COVID-19 , Mudança Climática , Opinião Pública , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Inquéritos e Questionários , Confiança/psicologia , Atitude , SARS-CoV-2/isolamento & purificação , China/epidemiologia , Austrália , Feminino , Masculino , Pandemias , Brasil , Índia/epidemiologia , Japão , África do Sul/epidemiologiaRESUMO
AIM: To assess the clinical utility of novel anthropometric indices and other traditional anthropometric indices in identifying the risk of type 2 diabetes mellitus (T2D) among South African adult females. METHODS: In the first South African National Health and Nutrition Examination Survey (SANHANES-1), traditional [body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)] and novel [a-body shape index (ABSI), abdominal volume index (AVI), body adiposity index (BAI), body roundness index (BRI), conicity index (CI), and Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE)] anthropometric indices were assessed. T2D was diagnosed using glycated haemoglobin (HbA1c) ≥ 6.5% among participants without known T2D. Basic statistics and multiple regression analyses were explored the association between anthropometric indices and newly diagnosed T2D. Receiver operating characteristic (ROC) curve analysis was used to measure the predictive ability of both traditional and novel indices. RESULTS: Among 2 623 participants, 384 (14.6%) had newly diagnosed T2D. All anthropometric indices mean values were significantly higher among participants with T2D (most p < 0.001). Higher mean values increased T2D odds e.g., in the model adjusted for age, employment, residence, and population group, odds ratio (OR) and 95% confidence interval (CI) for T2D with some of anthropometric indices were: 1.86 (1.60-2.15) for WC, 1.84 (1.59-2.13) for WHtR, 1.73 (1.51-1.99) for AVI, 1.71 (1.49-1.96) for BRI and 1.86 (1.57-2.20) for CUN-BAE. The top quartile for all indices had the highest T2D odds (p < 0.05). These outcomes were the highest for WC, AVI, and CUN-BAE and remained so even after removing the confounding effects of age, employment, population group, and residence. Based on the ROC analysis, none of the anthropometrical indices performed excellently (i.e., had an area under the curve [AUC] > 0.80). The WC, WHtR, AVI, BRI, and CUN-BAE, however, performed acceptably (AUCs 0.70-0.79), while also exhibiting corresponding cutoff values of 86.65 cm, 0.57, 15.52, 3.83, and 38.35, respectively. CONCLUSIONS: The data shows that traditional and novel anthropometric indices similarly identifying newly diagnosed T2D among adult South African females. We recommend the continuing the use of traditional indices, as they are affordable and easy to use in our setting.
Assuntos
Antropometria , Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , África do Sul/epidemiologia , Adulto , Antropometria/métodos , Pessoa de Meia-Idade , Inquéritos Nutricionais , Curva ROCRESUMO
BACKGROUND AND OBJECTIVES: Neonatal mortality due to severe bacterial infections is a pressing global issue, especially in low-middle-income countries (LMICs) with constrained healthcare resources. This study aims to validate the Neonatal Healthcare-associated infectiOn Prediction (NeoHoP) score, designed for LMICs, across diverse neonatal populations. METHODS: Prospective data from three South African neonatal units in the Neonatal Sepsis Observational (NeoOBS) study were analysed. The NeoHoP score, initially developed and validated internally in a South African hospital, was assessed using an external cohort of 573 sepsis episodes in 346 infants, focusing on different birth weight categories. Diagnostic metrics were evaluated, including sensitivity, specificity, positive predictive value and area under the receiver operating characteristic curve. RESULTS: The external validation cohort displayed higher median birth weight and gestational age compared with the internal validation cohort. A significant proportion were born before reaching healthcare facilities, resulting in increased sepsis evaluation, and diagnosed healthcare-associated infections (HAIs). Gram-negative infections predominated, with fungal infections more common in the external validation cohort.The NeoHoP score demonstrated robust diagnostic performance, with 92% specificity, 65% sensitivity and a positive likelihood ratio of 7.73. Subgroup analysis for very low birth weight infants produced similar results. The score's generalisability across diverse neonatal populations was evident, showing comparable performance across different birth weight categories. CONCLUSION: This multicentre validation confirms the NeoHoP score as a reliable 'rule-in' test for HAI in neonates, regardless of birth weight. Its potential as a valuable diagnostic tool in LMIC neonatal units addresses a critical gap in neonatal care in low-resource settings.
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Infecção Hospitalar , Humanos , Recém-Nascido , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Feminino , Estudos de Casos e Controles , Estudos Retrospectivos , Masculino , África do Sul/epidemiologia , Sepse Neonatal/diagnóstico , Sepse Neonatal/microbiologia , Sepse Neonatal/epidemiologia , Unidades de Terapia Intensiva Neonatal , Curva ROC , Peso ao Nascer , Sensibilidade e Especificidade , Idade Gestacional , Valor Preditivo dos Testes , Mortalidade InfantilRESUMO
BACKGROUND: South Africa faced challenges while implementing coronavirus disease 2019 (COVID-19) measures such as mass vaccination. Some people rejected or were hesitant to receive government-recommended vaccines. This study explored COVID-19 vaccination hesitancy among unvaccinated individuals in a primary care setting in Pretoria, South Africa. METHODS: This was an exploratory phenomenological study that included one-on-one interviews with 12 individuals at Temba Community Health Centre in Pretoria, South Africa. RESULTS: The research revealed five themes: perceptions of COVID-19 disease, perceptions of COVID-19 vaccine, factors related to non-vaccination, information sources about the COVID-19 vaccine, and long-term vaccination decisions. There were seven linked sub-themes. CONCLUSION: Overall, participants had a good understanding of COVID-19 disease, but limited knowledge about the vaccine, causing hesitancy to get vaccinated. Reasons for not getting vaccinated included health-related concerns, safety concerns, personal experiences, and social and political factors. Safety and health-related concerns were prevalent, with adverse vaccine outcomes being the most common concern. Most participants had experienced a historic encounter with a vaccine-related death or illness.Contribution: Vaccine hesitancy should be viewed as a powerful concern from the community, and a key source of worry for the health authorities over any vaccine-related doubt.
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Vacinas contra COVID-19 , COVID-19 , Atenção Primária à Saúde , Hesitação Vacinal , Humanos , África do Sul/epidemiologia , Hesitação Vacinal/psicologia , Vacinas contra COVID-19/administração & dosagem , Masculino , Feminino , COVID-19/prevenção & controle , Adulto , Pessoa de Meia-Idade , SARS-CoV-2 , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Vacinação/psicologia , Entrevistas como AssuntoRESUMO
BACKGROUND: Initiatives to reduce patient safety incidents (PSI) and support healthcare professionals who may experience psychological trauma as a result are becoming increasingly common. However, little is known about the quality of the support provided by Tshwane District Health Services. Therefore, it is necessary to assess their assistance for the second victims in order to evaluate their effectiveness. METHODS: A cross-sectional study was conducted, and 319 healthcare professionals from six primary health care institutions were invited to participate in the study. The sociodemographic information, work experience, emotional support, familiarity with the concept of the 'second victim' and involvement with PSIs were collected. RESULTS: The mean age was 39.8 years, ranging from 22 years to 66 years. The majority of participants were females (n = 249; 78.1%), nurses (n = 153; 49.2%), and those with 5-9 years of experience (n = 82; 25.8%). Most participants (n = 168; 52.7%) were aware of the possibilities of emotional support, while less than half (n = 142; 44.5%) were familiar with the term 'second victim'. The cumulative incidence of adverse events in the institutions was 19.4%, and the majority of second victims (n = 39; 62.9%) emotionally felt the need to speak with someone about it, preferably outside of the workplace. Less than 5% of individuals received support that was initiated by existing structures at their workplace. CONCLUSION: Frameworks exist to assist second victims, although they are only known to some healthcare professionals. However, their current use in Tshwane health facilities is ineffective. After experiencing PSIs, second victims often rely on psychological assistance outside of the workplace.Contribution: Authorities need to determine the causes behind some healthcare professionals' lack of awareness regarding the support framework for second victims, as well as their growing tendency to rely on psychologists outside of the workplace, and corrective measures should be implemented.
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Pessoal de Saúde , Humanos , África do Sul/epidemiologia , Feminino , Estudos Transversais , Masculino , Adulto , Pessoa de Meia-Idade , Pessoal de Saúde/psicologia , Idoso , Adulto Jovem , Segurança do Paciente , Atenção Primária à Saúde , Inquéritos e Questionários , Apoio Social , Trauma Psicológico/epidemiologiaRESUMO
BACKGROUND: Type 2 diabetes prevalence is steadily increasing worldwide, and South Africa is one of the countries in Africa with the highest prevalence of this disease, along with other non-communicable diseases. The adherence to treatment in male patients with type 2 diabetes is influenced by their attitudes towards medication and how they perceive their condition. To some extent, these factors impact the treatment outcomes for patients undergoing type 2 diabetes treatment. The purpose of this study was to investigate the perceptions of male patients with type 2 diabetes on their adherence to diabetic therapy. The study was conducted in the clinics of the City of Tshwane Metropolitan municipality in Gauteng. METHODS: This study followed a qualitative, exploratory design. Data were gathered from 15 male patients who were purposefully sampled through in-person, one-on-one interviews with the principal investigator. The eight steps outlined by Tesch were used to analyse the participant data. RESULTS: Emergent themes indicated that there were barriers to adherence to diabetic treatment and also factors that promoted adherence to diabetic treatment among the participants. Several factors were found to affect treatment uptake among the participants. CONCLUSION: Patients demonstrated various reactions to diabetic treatment, highlighting the need for reinforcing education at the time of diagnosis and treatment initiation. Additionally, regular patient follow-up may be essential to improve adherence among patients.Contribution: The study highlights the importance of health promotion and the need to develop materials for medication-specific counselling for patients receiving diabetic treatment, in order to promote adherence.
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Diabetes Mellitus Tipo 2 , Adesão à Medicação , Pesquisa Qualitativa , Humanos , Masculino , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/psicologia , Pessoa de Meia-Idade , África do Sul/epidemiologia , Adesão à Medicação/psicologia , Idoso , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Hipoglicemiantes/uso terapêutico , Entrevistas como AssuntoRESUMO
BACKGROUND: This is a study of service provider perceptions of the place, role and practices of CHWs in a four-year, large-scale private sector funded, public service ICT-enabled COPC intervention with rural and remote mining communities. Like all South African communities, apart from large mining house employees and some contractors, most people use available public healthcare services and private traditional as well as limited allopathic private sector providers. In addition to the limitations of facility centred primary healthcare and a fragmented health care system, the many negative health effects of mining on the communities, go unattended. METHODS: This is a rapid, qualitative pragmatic study. Using site and participation convenience sampling, 37 semi-structured individual or group interviews were conducted with 57 stakeholders from 38 of the 135 intervention PHC facilities. Using a data driven, inductive approach, the results were analysed thematically in terms of perceived changes in the role and place of CHWs. RESULTS: CHWs registered 42 490 households and captured the demographic and social profiles as well as the health status of over 154 910 individuals using AitaHealth™. These data provided healthcare professionals and managers with knowledge about community demographics, at-risk groups and vulnerable individuals. The intervention changed the locational focus of CHW practice and expanded their scope of work and competencies in household comprehensive health education, advice and care. It led to a growth in community and professional confidence in CHWs as trusted members of mining community PHC teams and to more focused and efficient clinic work. CONCLUSION: This ICT-enabled COPC intervention adopted a comprehensive approach to healthcare delivery that started by including CHWs in PHC teams and locating them in communities. Inclusive and systematic continuous learning, clinically-led CHW service support and ICT-enabled information technology engendered trust in CHWs as competent PHC members, and grew community confidence in them and the PHC system as a whole. Although health, care and other professionals and workers valued the changes the intervention brought to their work as well as people's lives in underserved and vulnerable mining communities, its sustainability is contingent on the vagaries of political will and financial commitment.
Assuntos
COVID-19 , Agentes Comunitários de Saúde , Atenção Primária à Saúde , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , África do Sul/epidemiologia , Mineração , Pesquisa Qualitativa , Feminino , Masculino , Papel Profissional , SARS-CoV-2 , Adulto , Atitude do Pessoal de SaúdeRESUMO
BACKGROUND: Coronavirus disease (COVID-19) negatively impacted tuberculosis (TB) programs which were already struggling to meet End-TB targets globally. We aimed to quantify and compare diagnosis, treatment initiation, treatment success, and losses along this TB care cascade for drug-susceptible TB in Cape Town, South Africa, prior to and during COVID-19. METHODS: This observational study used routine TB data within two predefined cohorts: pre-COVID-19 (1 October 2018-30 September 2019) and during-COVID-19 (1 April 2020-31 March 2021). The numbers of people diagnosed, treated for TB and successfully treated were received from the Western Cape Provincial Health Data Centre. Pre and post treatment loss to follow up and cascade success rates (proportion of individuals diagnosed with an outcome of treatment success) were calculated and compared across cohorts, disaggregated by sex, age, HIV status, TB treatment history and mode of diagnosis. RESULTS: There were 27,481 and 19,800 individuals diagnosed with drug-susceptible TB in the pre- and during-COVID-19 cohorts respectively, a relative reduction of 28% (95% CI [27.4% - 28.5%]). Initial loss to follow up increased from 13.4% to 15.2% (p<0.001), while post treatment loss increased from 25.2% to 26.1% (p < 0.033). The overall cascade success rate dropped by 2.1%, from 64.8% to 62.7% (p< 0.001). Pre- and during-COVID-19 cascade success rates were negatively associated with living with HIV and having recurrent TB. CONCLUSIONS: An already poorly performing TB program in Cape Town was negatively impacted by the COVID-19 pandemic. There was a substantial reduction in the number of individuals diagnosed with drug-susceptible. Increases in pre-and post-treatment losses resulted in a decline in TB cascade success rates. Strengthened implementation of TB recovery plans is vital, as health services now face an even greater gap between achievements and targets and will need to become more resilient to possible future public health disruptions.
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COVID-19 , Tuberculose , Humanos , África do Sul/epidemiologia , COVID-19/epidemiologia , COVID-19/diagnóstico , Masculino , Feminino , Adulto , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/tratamento farmacológico , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Pandemias , Resultado do Tratamento , Antituberculosos/uso terapêutico , Criança , SARS-CoV-2/isolamento & purificação , Idoso , Pré-Escolar , Infecções por HIV/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , LactenteRESUMO
BACKGROUND: Antiretroviral therapy (ART) use during pregnancy is essential to prevent vertical transmission of HIV, but it may also increase the risk of adverse birth outcomes. This study investigated the impact of both maternal HIV infection and the timing of ART initiation on birth outcomes in women living with HIV in South Africa. METHODS: This secondary data analysis examined the dataset from an earlier cohort study involving 1709 pregnant women living with HIV who delivered their babies at three major maternity centres in the Eastern Cape province of South Africa between September 2015 and May 2018. The associations between adverse birth outcomes (stillbirth, preterm birth, very preterm birth, and low birth weight) and the timing of maternal ART initiation, peripartum CD4 count, and HIV viral load were examined using logistic regression analysis. RESULTS: The observed rates of stillbirth, preterm birth, very preterm birth, and low birth weight were 1.4%, 33.5%, 5.4% and 18.0%, respectively. In the multivariable analysis, low birth weight was associated with ART initiated during the second trimester (adjusted odds ratio [aOR] 1.38; 95% confidence interval [CI], 1.03-1.85), low-level viraemia (21-999 copies/ml) (aOR, 1.62; 95% CI, 1.17-2.22), and high-level viraemia (≥1000 copies/ml) (aOR, 1.66; 95% CI, 1.66-2.38) during the peripartum period. Preterm birth was associated with low-level viraemia (aOR, 1.44; 95% CI, 1.16-1.79) and a CD4 count of less than 200 cells/mm3 (aOR, 1.35; 95% CI, 1.01-1.82). Very preterm birth was associated with detectable maternal viraemia. CONCLUSION: Adverse birth outcomes are common among pregnant women living with HIV, especially those with unsuppressed viraemia. Clinicians and programme managers should prioritise timeous ART initiation and virological suppression in all pregnant women living with HIV.
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Infecções por HIV , Complicações Infecciosas na Gravidez , Resultado da Gravidez , Carga Viral , Humanos , Feminino , Gravidez , África do Sul/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Adulto , Contagem de Linfócito CD4 , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Recém-Nascido , Nascimento Prematuro/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Adulto Jovem , Recém-Nascido de Baixo Peso , Fármacos Anti-HIV/uso terapêutico , Natimorto/epidemiologia , Análise de Dados SecundáriosRESUMO
BACKGROUND: COVID-19 vaccine effectiveness (VE) studies leveraging systematic surveillance in sub-Saharan Africa are limited. We assessed the effectiveness of two vaccines (Pfizer BNT162b2 and Johnson & Johnson Ad26.COV2.S) against SARS-CoV-2-associated hospitalization in South African adults aged ≥18 years. METHODS: We conducted a test-negative case-control study using pneumonia surveillance data in South Africa. Inpatients with physician-diagnosed lower respiratory tract infection or suspected COVID-19, testing SARS-CoV-2 positive or negative from June 2021-March 2022, were cases or controls, respectively. Fully vaccinated individuals received one Ad26.COV2.S dose or two BNT162b2 doses ≥14-days before enrollment. VE was estimated using multivariable logistic regression for Delta- and Omicron BA.1/BA.2-predominant periods, stratified by age and HIV status. RESULTS: The study included 925 cases and 1890 controls; 38 (4%) cases and 186 (10%) controls were fully vaccinated with BNT162b2, and 30 (3%) cases and 94 (5%) controls with Ad26.COV2.S. The vaccine effectiveness of BNT162b2 against SARS-CoV-2-associated hospitalization over Delta and Omicron BA.1/BA.2 periods was 91% (95% CI: 52%, 98%) and 33% (-16%, 86%), respectively. The vaccine effectiveness of Ad26.COV2.S against hospitalization over Delta and Omicron BA.1/BA.2 periods was 72% (-36% ,94%), and -19% (-130%, 39%), respectively. The vaccine effectiveness of BNT162b2 against hospitalization over the Delta period was 94% (50%, 99%) and 89% (27%, 98%) among adults aged ≥60 years and HIV-uninfected, respectively. CONCLUSIONS: The BNT162b2 vaccine was effective against SARS-CoV-2-associated hospitalization during the Delta period for adults aged ≥18 years, ≥60 years and those HIV-uninfected. VE for Ad26.COV2.S was inconclusive, potentially due to limited sample size or residual confounding. These findings highlight the utility of sentinel surveillance for estimating VE.
Assuntos
COVID-19 , Hospitalização , SARS-CoV-2 , Vigilância de Evento Sentinela , Eficácia de Vacinas , Humanos , África do Sul/epidemiologia , COVID-19/prevenção & controle , COVID-19/epidemiologia , Hospitalização/estatística & dados numéricos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estudos de Casos e Controles , SARS-CoV-2/imunologia , Adulto Jovem , Adolescente , Vacinas contra COVID-19/imunologia , Idoso , Vacina BNT162 , Ad26COVS1RESUMO
PURPOSE: The Rahima Moosa Mother and Child Hospital (RMMCH) maternal HIV cohort originated from data systems that were developed to support HIV-related birth care and track outcomes of a complete birth cohort of HIV-exposed infants at Rahima Moosa Hospital and their mothers living with HIV. PARTICIPANTS: Supported by the Empilweni Services and Research Unit, maternal and infant data from 13 654 pregnant women living with HIV who delivered their infants (and a subset also attended antenatal care) were collected at RMMCH in Johannesburg, South Africa since 2013. Maternal data were collected using counsellor-administered interviews and the 2013-2018 subset of this cohort was linked to the National Health Laboratory Services (NHLS) national HIV cohort-a longitudinal cohort of people living with HIV accessing care in the public sector antiretroviral therapy programme in South Africa that can observe national access to HIV care through laboratory testing data. FINDINGS TO DATE: Topics addressed by the cohort include antenatal care history, HIV treatment exposure, delivery/birth management, prophylaxis and maternal blood results relevant to HIV captured at delivery. The cohort was also one of the first to describe implementation of early infant diagnosis procedures in South Africa including evaluations of novel point-of-care testing strategies demonstrating improvements in uptake of HIV care among infants accessing point-of-care services. FUTURE PLANS: Annual linkage of infant delivery and testing data to longitudinal laboratory test data in the NHLS national HIV cohort is planned to allow for analysis of both infant continuity of care outcomes and as well as evaluation of maternal-infant pair treatment and mobility outcomes in the post partum and later period.
Assuntos
Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez , Humanos , África do Sul/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/tratamento farmacológico , Feminino , Gravidez , Adulto , Complicações Infecciosas na Gravidez/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Recém-Nascido , Lactente , Adulto Jovem , Cuidado Pré-Natal/estatística & dados numéricos , Estudos de Coortes , Estudos LongitudinaisRESUMO
BACKGROUND: Improving geographic access can aid in managing tuberculosis (TB) by enabling early diagnosis and treatment initiation. Although geospatial techniques have been used to map the transmission patterns of drug-resistant TB in South Africa, fewer studies have investigated the accessibility of TB diagnostic services. This study evaluated the accessibility of TB diagnostic services and disease distribution in the eThekwini district of South Africa. METHODS: In this cross-sectional study, population data for 2021 were disaggregated into smaller analysis units and then re-aggregated through the dasymetric mapping technique. Data on notified TB patients, including Global Positioning System coordinates of clinics, were obtained from the District of Health Information System, exported to ArcGIS 10.8.2 and used to calculate distances to the nearest clinics and hospitals. RESULTS: 92% of the population (3 730 494 people) in eThekwini could access TB diagnostic services within 5 km. Patients travelled an average distance of 4.7 km (range: 0.1-26.9 km). TB diagnostic services were highly accessible in the Northern and Central regions and moderately accessible in the predominately rural Western and Southern regions. The smallest population of eThekwini resides in rural areas; however, 40.7% of its residents live >5 km from a diagnosing facility, with patients in the South having to travel up to 44.5 km. TB incidence was higher in the predominately rural West and South regions compared with the Central and North regions which are mainly comprised of urban and suburban areas. Our findings also showed that 98.4% of the clinics in eThekwini were located within 30 km of a hospital at an average distance of 9.6 km within the district. However, the distribution of these hospitals does not demonstrate equitable access as the majority are located within the Central region, and fewer are found in the other three regions of eThekwini. CONCLUSIONS: Addressing the disparities in access to TB diagnostic services is required in the eThekwini district. Leveraging the existing mobile health clinics can assist with this, particularly, in rural areas with inadequate access. Additionally, active-case finding should be intensified in these regions since they had a higher TB burden per population. Prioritising interventions in these areas is crucial for reducing the impact of the disease on affected communities.
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Acessibilidade aos Serviços de Saúde , Atenção Primária à Saúde , Tuberculose , Humanos , África do Sul/epidemiologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Estudos Transversais , Feminino , Adulto , Masculino , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adolescente , Pessoa de Meia-Idade , Análise Espacial , Sistemas de Informação Geográfica , Adulto Jovem , Criança , Pré-Escolar , Lactente , Serviços de Diagnóstico/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricosRESUMO
INTRODUCTION: Courier delivery has become a popular antiretroviral therapy (ART) distribution method in some HIV care settings, yet data on ART courier delivery and how it relates to ART outcomes are scarce. We studied the differences in viral suppression rates between individuals from a South African private sector HIV programme receiving ART by courier delivery and those receiving ART through traditional retail dispensing. METHODS: Individuals aged 15 years or older who were actively enrolled in the Aid for AIDS programme between January 2011 and July 2022 were eligible for the analysis. The outcome of interest was viral suppression defined as a viral load (VL) <400 copies per ml. We calculated adjusted odds ratios (OR) for the association between the ART distribution method and viral suppression, comparing those receiving refills through courier pharmacies versus retail dispensing at the time of the VL testing. We used generalized estimating equations to account for repeated VL testing of the same individual. The models were adjusted for age, sex, calendar year, ART regimen, history of mental illness and medical insurance scheme. We computed adjusted ORs for the calendar periods 2011-2013, 2014-2016, 2017-2019, 2020-2022 and overall. RESULTS: We extracted 442,619 VL measurements from 68,720 eligible individuals, 39,406 (57.3%) were women. The median number of VL measurements per individual was 6 (IQR 3-10). VL suppression was detected in 398,901 (90.1%) tests, and 185,701 (42.0%) of the tests were taken while the individual was receiving ART by courier delivery. Overall, courier delivery was associated with 5% higher odds of viral suppression than retail dispensing (adjusted OR 1.05, 95% CI 1.02-1.08). The strength and direction of this association varied by calendar period, with an adjusted OR of 1.37 (95% CI 1.27-1.48) in 2011-2013 and 1.02 (95% CI 0.97-1.07) in 2020-2022. CONCLUSIONS: Courier delivery of ART is a viable alternative to retail dispensing in the South African private sector, as it was associated with higher viral suppression until 2016 and similar suppression rates in recent years. Further research is needed to investigate the potential benefits and drawbacks of courier delivery of ART in both private and public healthcare settings.
Assuntos
Infecções por HIV , Setor Privado , Humanos , Masculino , África do Sul/epidemiologia , Infecções por HIV/tratamento farmacológico , Feminino , Adulto , Estudos de Coortes , Adulto Jovem , Carga Viral , Pessoa de Meia-Idade , Fármacos Anti-HIV/uso terapêutico , Adolescente , Antirretrovirais/uso terapêuticoRESUMO
INTRODUCTION: Bacterial meningitis is a major cause of death, with an approximate case fatality rate of 37% across all age groups in South Africa. This study aimed to describe the demographic and pathogen characteristics of incident meningitis in children aged <1 year in South Africa from 2014 through 2018, during a period when Haemophilus influenzae type b vaccine and pneumococcal conjugate vaccines (PCV) were both included in the expanded program on immunization (EPI). METHODS: We conducted a cohort study of routine laboratory data in the National Health Laboratory Service Corporate Data Warehouse, which covers approximately 80% of the South African population. We defined a case of laboratory-confirmed bacterial meningitis as any person aged <1 year with meningitis diagnosed by culture and identification of a pathogen documented as being a common cause of meningitis in CSF. The cause-specific incidence risks were calculated by dividing the number of positive specimens in each age group and year by the corresponding mid-year population for children under 1 year old and those in the post-neonatal period (≥ 28 days to 365 days old). For children under 28 days old, the annual numbers of registered livebirths were used. We used Poisson regression to compare the incidence of meningitis by year. RESULTS: We identified 3575 (1.5%) cases of culture-confirmed bacterial meningitis from the 232,016 cerebrospinal fluid (CSF) specimens tested from 2014-2018. The highest number of cases were recorded in children aged <28 days (1873, 52.4%), male children (1800, 50.4%) as well as in the Gauteng Province (2014, 56.3%). Acinetobacter baumannii (14.9%), followed by Klebsiella pneumoniae (13.5%), and group B streptococcus (GBS) (10.7%), were the most common pathogens detected. Overall, A. baumannii had the highest incidence risk, occurring at 9.8 per 100,000 persons in children aged <1 year in 2018. Among neonates, A. baumannii peaked at 14.9 per 100,000 livebirths in 2018, while Streptococcus pneumoniae was most common in the post-neonatal period (≥ 28 days to 365 days old), peaking at 9.8 per 100,000 persons in 2014. There was an increase in the annual incidence of most pathogens over the study period. CONCLUSION: There was an increasing trend in the annual incidence of bacterial meningitis in infants caused by most pathogens, particularly A. baumannii, K. pneumoniae and GBS. In addition to increased uptake of vaccination, prevention measures to reduce nosocomial and mother-to-child transmission of bacteria could include antenatal screening for GBS in pregnant women, rigorous hygiene in the hospital environment as well as rational antibiotic use.
Assuntos
Meningites Bacterianas , Humanos , Lactente , África do Sul/epidemiologia , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/microbiologia , Feminino , Masculino , Incidência , Estudos de Coortes , Recém-Nascido , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/patogenicidade , Vacinas Pneumocócicas , Vacinas Anti-Haemophilus , Klebsiella pneumoniae/isolamento & purificação , Klebsiella pneumoniae/patogenicidade , Acinetobacter baumannii/patogenicidade , Acinetobacter baumannii/isolamento & purificaçãoRESUMO
Ticks are arachnid blood-feeding parasites, which infest livestock, wildlife, and humans, transmitting medically and veterinary significant pathogens. Their biodiversity and distribution in wild animals remains complex. This study analysed archived tick samples (n = 48) from the South African Biodiversity Institute (SANBI) Wildlife Biobank utilizing morphology and genetic analyses of the 16S rRNA and COI (DNA barcoding) mitochondrial genes to identify ticks collected among 13 vertebratesavian, reptilian, and mammalian host species. The specimens came from nine localities including nature reserves and captive facilities (zoological garden) in South Africa, Namibia, and Botswana. These ticks were also assessed for associated pathogens with the reverse line blot (RLB) hybridization assay. Seven tick genera, Amblyomma, Hyalomma, Haemaphysalis, Ixodes, Rhipicephalus, Rhipicentor, and Otobius were identified, with Amblyomma being the most prevalent (22.9 %) in our sample set. Obtained sequences were 95-100 % similar to published records of tick species collected from wild and domestic animals, as well as those collected from vegetation, from different southern African areas. However, tick specimens (n = 3) identified morphologically as Hyalomma truncatum, Rhipicephalus e. evertsi, and R. simus, were, on a molecularly level, more closely related to their sister taxa (H. glabrum, R. e. mimeticus, and R. gertrudae, respectively) suggesting a need for taxonomic verification. With the RLB hybridization assay, six samples reacted with the Ehrlichia/Anaplasma genus-specific probe, while two reacted with the Theileria/Babesia genus-specific probe. Sequencing of the RLB amplicons targeting the 18S rRNA gene (n = 2) indicated 100 % similarity to Hepatozoon fitzsimonsi, while one was closely related to He. ingwe with 99.39 % similarity. The results show that wildlife harbour different tick species, and pathogen detection identified novel genotypes, indicating wildlife as potential pathogens reservoirs. This study enhances our understanding of tick biodiversity, distribution and highlights wildlife's role in harbouring diverse tick species and novel pathogens.
Assuntos
Animais Selvagens , RNA Ribossômico 16S , Infestações por Carrapato , Doenças Transmitidas por Carrapatos , Carrapatos , Animais , África do Sul/epidemiologia , Animais Selvagens/parasitologia , Infestações por Carrapato/veterinária , Infestações por Carrapato/parasitologia , Infestações por Carrapato/epidemiologia , Doenças Transmitidas por Carrapatos/veterinária , Doenças Transmitidas por Carrapatos/parasitologia , Doenças Transmitidas por Carrapatos/epidemiologia , Doenças Transmitidas por Carrapatos/microbiologia , RNA Ribossômico 16S/análise , Carrapatos/parasitologia , Carrapatos/microbiologia , Filogenia , Feminino , Código de Barras de DNA Taxonômico/veterinária , Animais de Zoológico/parasitologiaRESUMO
BACKGROUND: Both efavirenz and dolutegravir have been associated with neuropsychiatric side-effects and cognitive impairment. Furthermore, cerebrospinal fluid (CSF) HIV RNA escape has not been comprehensively studied in African populations. We aimed to examine changes in cognition, neuropsychiatric symptoms, and CSF viral control associated with the widespread switch from efavirenz-based to dolutegravir-based antiretroviral therapy (ART). METHODS: This prospective cohort study of people with HIV and people without HIV recruited adults with HIV (aged 18-55 years) from the Gugulethu Community Health Centre in a low-income periurban area of Cape Town, South Africa. Eligible participants had been receiving efavirenz-based ART for at least 1 year and were identified by the clinic to switch to dolutegravir-based ART as part of the national programmatic switch. Participants were studied at baseline and followed up at 1 year after switch to dolutegravir. People without HIV were recruited from the same area, matched for age and gender, and followed up at the same time interval. People with HIV and people without HIV underwent comprehensive cognitive testing over seven domains and measures of functioning, mood, anxiety, and sleep. People with HIV had CSF sampling for HIV RNA quantification. FINDINGS: Between Aug 12, 2019, and Sept 16, 2022, we recruited 178 people with HIV and 95 people without HIV. 145 (81%) of 178 people with HIV and 40 (66%) of 60 people without HIV who were offered underwent follow-up. Global cognitive performance was 2·57 T score points lower in people with HIV than in people without HIV at baseline (p=0·0008). At follow-up, cognition in people with HIV improved more than practice effects observed in people without HIV (coefficient 1·40, 95% CI 0·48-2·32, p=0·0028) and no significant difference in cognitive performance between groups was apparent (51·43 vs 52·73; p=0·22). Sleep quality improved following the switch (risk ratio 0·90, 95% CI 0·84-0·95; p=0·0002), driven mainly by indicators of disturbed sleep. There were nine incident cases of depression, although baseline differences were present. There was one case (1%) of CSF escape at baseline and three cases (4%) at follow-up; all were at low levels or resolved with repeated sampling. INTERPRETATION: Improvements in cognition and sleep are probably related to switching from efavirenz. However, the possible increase in depression warrants further examination. Cognitive performance in virally supressed African people with HIV receiving dolutegravir-based therapy is similar to people without HIV. CSF escape is uncommon on both efavirenz-based and dolutegravir-based therapy. FUNDING: South African Medical Research Council and UK Medical Research Council, Newton Fund.
Assuntos
Alcinos , Benzoxazinas , Cognição , Ciclopropanos , Infecções por HIV , Compostos Heterocíclicos com 3 Anéis , Oxazinas , Piperazinas , Piridonas , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Adulto , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Benzoxazinas/uso terapêutico , Masculino , África do Sul/epidemiologia , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Cognição/efeitos dos fármacos , Adulto Jovem , Carga Viral , Fármacos Anti-HIV/uso terapêutico , Adolescente , RNA Viral/líquido cefalorraquidiano , Substituição de MedicamentosRESUMO
The available research findings suggest that non-suicidal self-injury (NSSI) constitutes an important public health issue, with identified risk factors for NSSI having been found to include exposure to adverse childhood experiences (ACEs) and comorbidity with various mental disorders. However, the available findings have, for the most part, been based on the experiences of individuals living in predominantly high-income countries located in the Global North, and it is not clear whether these findings can be confidently generalised to individuals living in low-resourced countries. As such, this cross-sectional study assessed risk factors for NSSI in a non-clinical sample of 636 South African adolescents (12-18 years old), with the data being analysed using a multi-mediation analysis. ACEs were assessed using a revised version of the ACEs Questionnaire, and NSSI was assessed using items adapted from the Self-Harm subscale of the Risk-Taking and Self-Harm Inventory for Adolescents, with emotion dysregulation, depression, and PTSD being considered as possible mediators. High prevalence rates for NSSI and exposure to five or more ACEs were reported by the participants, with the mediation analysis indicating that significant direct effects of adverse childhood experiences on NSSI were partially mediated by emotion dysregulation. These findings are discussed with respect to their implications for primary, secondary, and tertiary prevention.
Assuntos
Experiências Adversas da Infância , Comportamento Autodestrutivo , Humanos , Adolescente , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/psicologia , África do Sul/epidemiologia , Experiências Adversas da Infância/estatística & dados numéricos , Experiências Adversas da Infância/psicologia , Feminino , Masculino , Criança , Estudos Transversais , Fatores de Risco , Análise de Mediação , Prevalência , Inquéritos e QuestionáriosRESUMO
Cardiovascular disease (CVD) risk factors are frequently reported among firefighters, yet no studies have compared these factors between male and female firefighters, specifically from a low- to middle-income country (LMIC). This study aimed to determine the prevalence of CVD risk factors and their relationship with cardiorespiratory fitness (VO2max) in 254 active career firefighters (mean age: 42.6 ± 7.8 years). The assessments included anthropometry, blood pressure, blood glucose, cholesterol, triglycerides, and VO2max. The results indicated that 48.0% and 51.8% of females and males were pre-hypertensive, respectively. Hypertension was identified in 15.8% of the firefighters. According to body mass index (BMI), 37.3% of males and 25% of females were found to be overweight, while an additional 44.9% of males and 45.7% of females were classified as obese. Only 17.3% of males and 18.2% of females were found to be of normal weight. These findings were corroborated by categories of central obesity using waist circumference (WC), which were 47.7% for males and 41.6% for females. Low HDL-C was found in 95.2% of males and 86.4% of females, with 28.3% of males also having elevated triglyceride levels (TG). VO2max was "excellent" in 48.8% of males and 12.6% of females, though it had no significant association with most CVD risk factors. The only notable link was a small correlation between VO2max and triglycerides (r = -0.215; p = 0.001). These findings suggest that while cardiorespiratory fitness may have no impact, additional factors likely contribute to the cardiovascular health of firefighters, necessitating the need for comprehensive health and fitness programmes.
Assuntos
Aptidão Cardiorrespiratória , Doenças Cardiovasculares , Bombeiros , Humanos , Masculino , Feminino , Aptidão Cardiorrespiratória/fisiologia , Estudos Transversais , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Bombeiros/estatística & dados numéricos , Pessoa de Meia-Idade , África do Sul/epidemiologia , Fatores de Risco , Prevalência , Índice de Massa Corporal , Fatores de Risco de Doenças CardíacasRESUMO
OBJECTIVE: In Africa, the treatment outcomes of lupus nephritis (LN) are not well known. This is especially true in the current era where contemporary treatment options are more widely available. This retrospective study aimed to measure the outcomes of biopsy-proven LN treated at the Livingstone Tertiary Hospital (LTH) Renal Unit in Gqeberha (formerly Port Elizabeth), South Africa and to identify predictors of a poor outcome. METHODS: A retrospective cohort study of 131 patients with biopsy-proven LN who had a kidney biopsy between 01 January 2012 to 31 December 2021 as identified from the biopsy register. A sub-analysis of 107 patients with proliferative and/or membranous LN was performed. RESULTS: Mean age was 31.4 ± 12.7 years with a female predominance of 86.3%. At 6-month follow-up, 69.6% of patients had complete or partial response to treatment. This increased to 70.3% and 72.6% at 18 and 30 months, respectively. Twenty-seven patients were lost to follow-up, while 7 (5.3%) patients progressed to kidney failure (KF). There were 3 (2.3%) deaths. Predictors of poor response were an elevated baseline serum creatinine (OR = 2.53, 95% CI 0.99 - 6.52, p = .054), a decreased eGFR (OR = 2.92, 95% CI 0.94 - 9.09, p = .065) and an elevated blood pressure (OR = 6.06, 95% CI 1.11 - 33.33, p = .038) at the time of biopsy. Infections were the most common adverse event with 50 infections seen in 39 (29.8%) patients. Herpes viral infections were frequently noted (n = 12) accounting for 24.0% of all documented infections. CONCLUSION: Response rates were similar in this cohort when compared to other contemporary studies. Predictors of poor response were an elevated baseline serum creatinine, a decreased eGFR and an elevated blood pressure at time of the biopsy. Infections were the most common occurring adverse event, although the mortality rate remained low at 2.3%.