THE RISE OF DRUG-RESISTANT TUBERCULOSIS IN SOUTHERN AFRICA: ARE WE LEARNING FROM HISTORY OR REPEATING IT?

Background and Objective The tuberculosis epidemic has reached astronomic and emergency proportions, particularly in Southern Africa, despite efforts by key stakeholders in implementing necessary control strategies. The diagnosis of TB is still based on smear microscopy in many parts of Africa while the emergence of drug-resistant TB is increasing. We are reporting on the outcomes of samples received in a TB reference laboratory in Swaziland and results from an assessment of non-clinical staff’s knowledge, attitudes, and beliefs towards TB and IPC related issues in public health facilities in South Africa. Methods A self-administered close-ended questionnaire was used to collect cross-sectional data among non-clinical staff in 5 public hospitals in KwaZulu-Natal between April 2011 and November 2011. In a TB reference laboratory in Swaziland, using   MGIT automated instrument, sputum samples were screened for TB from June 2011 to December 2011. Positive cultures were confirmed as MTB complex using ZN smears and TB Ag MPT64 and then, the drug susceptibility testing was done on RIF, INH, Streptomycin, and Ethambutol using the 1% proportion method. Results Of the 79 non-clinical staff, 67.4% were of the opinion that a surgical face mask protects the wearer from contracting TB while 44.3% did not understand the rationale behind triage and fast-tracking of patients in the TB control program. Of great concern, 25% of non-clinical respondents perceived no risk of contracting TB in the hospital environment and believed that TB was caused by drinking and smoking. Whilst 10% of these respondents desperately felt that there is no means of protection against TB; they also expressed that there is no need to implement a screening program for staff. Samples were obtained from 6163 patients of which 22.3% were culture positive and of these culture positives, 90% were MTB complex and 10% were NTM.  Among patients diagnosed with TB, 52% were smear-positive and 48% were smeared negative. Sixty-six percent of these cases were MDR follow up cases with 3.4% relapse cases, and 4.5% failure to convert. Conclusion While knowledge of staff about TB Infection Control is still very low, DR-TB cases are increasing. The study underlines the need to prevent DR-TB by bridging knowledge gaps among HCWs and the necessity to improve laboratory capacity to support TB control efforts

Postoperative infections: Aetiology, incidence and risk factors among neurosurgical patients in Mthatha, South Africa

Background. Despite progress in hospital care, infections continue to represent one of the major complications among hospitalised patients.Objectives. To determine the aetiology and incidence of hospital-acquired infections and their associated risk factors following neurosurgical procedures.Methods. A retrospective study was conducted from October 2013 to September 2014. Data including demographics, hospitalisation period, type of operation and primary diagnosis were collected. Post-surgical infections were confirmed microbiologically. SPSS (Statistical Package for the Social Sciences) version 23 was used for statistical analysis.Results. Among a total of 1 688 patients who underwent neurosurgical operations, the incidence of post-surgical infections was 4.2% per year. Post-surgical infections were significantly associated with craniotomy (p<0.0001), prolonged stay in hospital (≥30 days) (p=0.008), and patient age ≥35 years (p=0.05). Staphylococcus aureus was the most frequently isolated pathogen (19.7%), followed by Klebsiella pneumoniae (12.7%). A total of 42.9% of S. aureus isolates were methicillin-resistant S. aureus (MRSA), but all these isolates were susceptible to vancomycin; 44.4% of K. pneumoniae isolates were extended-spectrum beta-lactamase (ESBL)-positive, but were susceptible to carbapenems, piperacillin-tazobactam and amikacin.Conclusions. Post-surgical infections remain an important problem in neurosurgery. Increased resistance to causative pathogens is a major concern.

Prevalence of hypertension and its associated risk factors in a rural black population of Mthatha town,South Africa

The occurrence of hypertension has been increasing alarmingly in both low and middle-income countries. Despite acknowledging hypertension as the most common life-threatening risk factor for cardiovascular disease (CVD), a dearth of data is available on the prevalence, awareness, and determinants of hypertension in rural parts of South Africa. The principal aim of the current study is to determine the prevalence and associated risk factors of hypertension among a black rural African population from the Mtatha town of Eastern Cape Province. Methods: This was a cross-sectional study, and individuals over 18 years of age were randomly screened using a World Health Organization stepwise questionnaire. Sociodemographic information, anthropometric measurements, fasting blood glucose levels, and three independent blood pressure (BP) readings were measured. Blood pressure measurements were classified according to the American Heart Association guidelines. Univariate and multivariate analyses were performed to determine the significant predictors of hypertension. Results: Of the total participants (n = 556), 71% of individuals had BP scores in the hypertensive range. In univariate analysis, age, westernized diet, education, income, and diabetic status, as well as overweight/obese status were positively associated with the prevalence of hypertension

Species distribution and antifungal susceptibility patterns of Candida isolates from a public tertiary teaching hospital in the Eastern Cape Province, South Africa

vital:49389Candida species are the leading cause of invasive fungal infections, and over the past decade there has been an increased isolation of drug resistant Candida species. This study aimed to identify the species distribution of Candida isolates and to determine their unique antifungal susceptibility and resistance patterns. During a cross-sectional study, 209 Candida isolates (recovered from 206 clinical samples) were collected and their species distribution was determined using ChromAgar Candida. The Vitek-2 system (Biomerieux, South Africa) was used to determine minimum inhibitory concentrations (MICs) to azoles (fluconazole, voriconazole), echinocandins (caspofungin, micafungin), polyenes (amphotericin B) and flucytosine. Four species of Candida were isolated, of which C. albicans was the most frequent, isolated in 45.4 percent (95/209) of the isolates, followed by C. glabrata: 31.1 percent (65/209). The MICs of the different antifungal drugs varied amongst the species of Candida. From the 130 isolates tested for MICs, 90.77 percent (112/130) were susceptible to all antifungal drugs and 6.9 percent (9/130) of the isolates were multi-drug resistant. C. dubliniensis (n=2) isolates were susceptible to all the above mentioned antifungal drugs. There was no significant difference in species distribution amongst clinical specimens and between patients’ genders (P40.05). An increase in MIC values for fluconazole and flucytosine towards the resistance range was observed. To our knowledge, this is the first report on surveillance of Candida species distribution and antifungal susceptibility at a public tertiary teaching hospital in Eastern Cape, South Africa. Key words: Candida species; Distribution; Antifungal susceptibility; Identification; South Afric

Prevalence of depression among HIV positive adults on antiretroviral therapy in O.R. Tambo District, Eastern Cape, South Africa: A descriptive cross-sectional study

Living with HIV/AIDS is associated with negative emotional as well as bodily symptoms; however, there is a paucity of data on the prevalence and associated factors of depression among this population. This study examined the prevalence and factors contributing to depression among HIV-positive adults on antiretroviral therapy (ART) in O.R. Tambo district of the Eastern Cape, South Africa. This descriptive cross-sectional study involved 334 adults receiving ART in the two Community Health Centers in O.R. Tambo district. Beck’s Depression Inventory (BDI-II) and a semi-structured questionnaire on coping mechanisms and challenges in seeking help with depressive symptoms, were used to collect data. Multiple logistic regression analysis was used to assess the factors associated with depression among the HIV-positive adults. The prevalence of depression among the HIV-positive adults on ART was 44%, and this fell within the borderline and moderate threshold for the majority of the patients. The prevalence of depression was significantly higher among females (71.0%; p < 0.0003) and unemployed (73.0%; p < 0.0014) patients, with participants not benefiting from any form of social grant exhibiting highest prevalence of depression (79%). Participants’ race (p=0.590), age (p=0.338) and marital status (p=0.511) showed no statistically significant associations with depression. The unadjusted logistic regression model showed that being female (OR = 1.99, 95% CI: 1.23-3.23; p < 0.003) and unemployed (OR =1.73, 95% CI: 1.08-2.77; p < 0.014) were significantly associated with a likelihood of depression. Most of the participants who could express their feelings about HIV disease and challenges faced in accessing ART were more depressed (85%) than those who were conservative about their feelings. The high rate of depression among HIV/AIDS patients on ART warrants the need for its early detection, not only to ease the challenges associated with accessing treatment and improving compliance, but also to promote overall quality of life. Keywords: Depression, HIV positive adults, anti-retroviral therapy, O.R. Tambo District, South Africa

Prevalence of Intestinal Parasites in HIV/AIDS-Infected Patients Attending Clinics in Selected Areas of the Eastern Cape

Introduction: Intestinal parasites in HIV and AIDS patients increase the risk of gastroenteritis, adding to the complexity of the virus. According to the literature, their interactions are one of the factors leading to HIV replication and progression of AIDS in Africa. Chronic immunosuppression caused by HIV infection makes people vulnerable to parasitic infections, and this is associated with a CD4+ cell count of less than 100. The study describes the prevalence of intestinal parasites in patients attending HIV/AIDS clinics in certain areas of the Eastern Cape. Methods: A cross-sectional study was conducted among 600 patients from HIV/AIDS clinics in the Eastern Cape. Tambo Municipality and Amatole Municipality were the municipalities covered. These included the Ngangalizwe Community Clinic, Tsolo Gateway Clinic, Idutywa Health Centre, and Nqamakwe Health Centre. The stools of 600 participants were examined using direct wet saline/iodine embedding, formal ether concentration technique, and modified Ziehl–Neelsen methods. Results: The mean age of the study participants was 28.2 years. They were predominantly female (79.9%), mostly single (63.6%), and lived in rural (65.2%) and urban areas (34.8%). The prevalence of intestinal parasites was determined to be 30% (180/600) after screening 600 stool samples. The most frequently detected parasites were Ascaris lumbricoides (55.9%), Balantidium coli (15.1%), Entamoeba coli (11.3%), Diphyllobothrium latum (4.3%), Taenia species (3.8%), Schistosoma mansoni (1.6%), and Cryptosporidium spp. (1.6%). Males were affected more frequently (39.2%) than females (27.9%). The difference was statistically significant (p = 0.017). Among the identified intestinal parasites, A. lumbricoides, B. coli, and Taenia spp. were found at all four sites. Conclusion: This study has shed light on the high burden of intestinal parasites in HIV/AIDS patients in the Eastern Cape. Medication adherence, deworming, and sanitary hygiene practices are needed to enhance the control of infection in the affected communities and hence contribute to the control of the HIV pandemic

Prevalence of Intestinal Parasites in HIV/AIDS-Infected Patients Attending Clinics in Selected Areas of the Eastern Cape

Introduction: Intestinal parasites in HIV and AIDS patients increase the risk of gastroenteritis, adding to the complexity of the virus. According to the literature, their interactions are one of the factors leading to HIV replication and progression of AIDS in Africa. Chronic immunosuppression caused by HIV infection makes people vulnerable to parasitic infections, and this is associated with a CD4+ cell count of less than 100. The study describes the prevalence of intestinal parasites in patients attending HIV/AIDS clinics in certain areas of the Eastern Cape. Methods: A cross-sectional study was conducted among 600 patients from HIV/AIDS clinics in the Eastern Cape. Tambo Municipality and Amatole Municipality were the municipalities covered. These included the Ngangalizwe Community Clinic, Tsolo Gateway Clinic, Idutywa Health Centre, and Nqamakwe Health Centre. The stools of 600 participants were examined using direct wet saline/iodine embedding, formal ether concentration technique, and modified Ziehl–Neelsen methods. Results: The mean age of the study participants was 28.2 years. They were predominantly female (79.9%), mostly single (63.6%), and lived in rural (65.2%) and urban areas (34.8%). The prevalence of intestinal parasites was determined to be 30% (180/600) after screening 600 stool samples. The most frequently detected parasites were Ascaris lumbricoides (55.9%), Balantidium coli (15.1%), Entamoeba coli (11.3%), Diphyllobothrium latum (4.3%), Taenia species (3.8%), Schistosoma mansoni (1.6%), and Cryptosporidium spp. (1.6%). Males were affected more frequently (39.2%) than females (27.9%). The difference was statistically significant (p = 0.017). Among the identified intestinal parasites, A. lumbricoides, B. coli, and Taenia spp. were found at all four sites. Conclusion: This study has shed light on the high burden of intestinal parasites in HIV/AIDS patients in the Eastern Cape. Medication adherence, deworming, and sanitary hygiene practices are needed to enhance the control of infection in the affected communities and hence contribute to the control of the HIV pandemic

Part VII : Interventions

Antimicrobial resistance (AMR) surveillance activities in South Africa have been described in Part V of this report. Surveillance – knowing the levels of resistance and the trends around the country and in different types of institutions – is essential, but is only useful to the extent that the data influence practice. That link is not made automatically, nor is it always easy. Choices must be made among the available interventions based on what will work best in a given situation, and taking into consideration feasibility, cost, likely impact, acceptability to patients and providers, political will, etc. Clearly, surveillance and recent studies can inform revisions of the essential drugs list (EDL) and standard treatment guidelines (STGs). What is more difficult but still possible is that these data can influence and change antibiotic prescribing practices and result in policy formulation geared to limit inappropriate antibiotic use and, consequently, AMR and its spread. However, so far the efficacy and clinical outcomes of both EDLs and STGs have, since their implementation, not been adequately evaluated. Reducing the burden of infectious diseases also reduces the need for antibiotics but, primarily, prevents illness. Vaccination and infection prevention and control in hospitals and other health care facilities are the two critical interventions in this category. In this section, the status and challenges of all these interventions in South Africa are reviewed.http://www.samj.org.z