Post cardiac surgery sternal wound sepsis burden, risk factors and outcomes at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa: A five-year experience

Purpose: Sternal wound infection (SWI) is associated with significant morbidity and mortality in post-operative cardiac patients. We aimed to describe the burden, risk factors and outcomes of SWI in post-operative paediatric cardiac patients at a tertiary children’s hospital.Methods: We conducted a retrospective record review of cardiac surgeries via median sternotomy over a 5-year period to identify cases of SWI.Results: Between 2011 and 2016, 1 319 patients underwent median sternotomy. Thirty four (2.6%) patients developed SWI; 18 (13%) patients developed deep sternal wound infection (DSWI), and 16 (12%) developed superficial sternal wound infections (SSWI). Twenty two (16%) of SWIs were apparent within a week postsurgery before discharge, and the remaining were readmitted post-discharge. Seven (0.5%) patients died from complications.Conclusion: Significant morbidity was associated with SWI. Furthermore, with a mortality rate of 20% in the case of DSWI, we strongly support quality improvement procedures such as the Sternal Wound Prevention Bundle (SWPB) that was introduced in late 2014. However, the rate of SWI implies that ongoing monitoring and evaluation of the SWPB is necessary and more stringent adherence to the protocol may result in better outcomes

International normalised ratio control in a non-metropolitan setting in Western Cape Province, South Africa

Background. The quality of international normalised ratio (INR) control determines the effectiveness and safety of warfarin therapy. Data on INR control in non-metropolitan settings of South Africa (SA) are sparse.Objectives. To examine the time in therapeutic range (TTR) and its potential predictors in a sample of Garden Route District Municipality primary healthcare clinics (PHCs).Methods. INR records from eight PHCs were reviewed. The TTR and percentage of patients with a TTR >65% were determined. A host of variables were analysed for association with TTR.Results. The median (interquartile range (IQR)) age of the cohort (N=191) was 56 (44 - 69) years. The median (IQR) TTR was 37.2% (20.2 - 58.8); only 17.8% of patients had a TTR ≥65%. Compared with patients aged >50 years, those aged <50 had worse INR control (median (IQR) TTR 26.6% (16.1 - 53.0) v. 43.5% (23.5 - 60.1); p=0.01). Patients hospitalised for any reason during the study period had worse INR control than patients not hospitalised (median (IQR) TTR 26.2% (16.2 - 50.2) v. 42.9% (23.5 - 62.0); p=0.02). On multivariable regression analysis, participants on warfarin for atrial fibrillation/flutter had better INR control than those with other indications for warfarin (odds ratio 2.21; 95% confidence interval 1.02 - 4.77; p=0.04), but the control was still very poor.Conclusions. INR control, as determined by TTR and proportion of TTR ≥65%, in these non-metropolitan clinics was poor. Age and hospitalisation as a marker of illness predicted poor control. There was a difference in control between groups, depending on the indication for warfarin. Evidence-based measures to improve the quality of INR control in patients on warfarin therapy need to be instituted as a matter of urgency

Association of activities related to pesticide exposure on headache severity and neurodevelopment of school-children in the rural agricultural farmlands of the Western Cape of South Africa

OBJECTIVE: Children and adolescents living in agricultural areas are likely to be exposed to mixtures of pesticides during their daily activities, which may impair their neurodevelopment. We investigated various such activities in relation to headache severity and neurodevelopment of school-children living in rural agricultural areas in the Western Cape of South Africa. METHOD: We used baseline date from 1001 school-children of the Child Health Agricultural Pesticide Cohort Study in South Africa (CapSA) aged 9-16 from seven schools and three agriculture areas in the Western Cape. Questionnaires were administrated to assess activities related to pesticide exposure and health symptoms addressing four types of activities: 1) child farm activities related to pesticide handling, 2) eating crops directly from the field, 3) contact with surface water around the field, and 4) seen and smelt pesticide spraying activities. Neurocognitive performance across three domains of attention, memory and processing speed were assessed by means of an iPad-based cognitive assessment tool, Cambridge Automated NeuroPsychological Battery (CANTAB). Headache severity was enquired using a standard Headache Impact Test (HIT-6) tool. Cross-sectional regression analysis was performed. RESULTS: About 50% of the cohort report to have ever been engaged in activities related to pesticide exposure including farm activities, eating crops directly from the field and leisure activities. Headache severity score was consistently increased in relation to pesticide-related farm activities (score increase of 1.99; 95% CI: 0.86, 3.12), eating crops (1.52; 0.41, 2.67) and leisure activities of playing, swimming or bathing in nearby water (1.25; 0.18, 2.33). For neurocognitive outcomes, an overall negative trend with pesticide exposure-related activities was observed. Among others, involvement in pesticide-related farm activities was associated with a lower multi-tasking accuracy score (-2.74; -5.19, -0.29), while lower strategy in spatial working memory (-0.29; -0.56; -0.03) and lower paired associated learning (-0.88; -1.60, -0.17) was observed for those who pick crops off the field compared to those who do not pick crops off the field. Eating fruits directly from the vineyard or orchard was associated with a lower motor screening speed (-0.06; -0.11, -0.01) and lower rapid visual processing accuracy score (-0.02; -0.03, 0.00). CONCLUSIONS: Children who indicate activities related to pesticide exposure may be at higher risk for developing headaches and lower cognitive performance in the domains of attention, memory and processing speed. However, self-reported data and cross-sectional design are a limitation. Future research in CapSA will consider pesticide exposure estimations via urinary biomarkers and longitudinal assessment of cognitive functions

Relation between organophosphate pesticide metabolite concentrations with pesticide exposures, socio-economic factors and lifestyles: a cross-sectional study among school boys in the rural Western Cape, South Africa

Evidence on the relationship between lifestyle, socio-economic factors and pesticide exposure and urinary concentrations of organophosphate (OP) pesticide metabolites among children is generally incomplete. This study investigated the relationship between socio-economic factors and reported pesticide exposures and the sum of three urinary concentrations of dialkyl phosphate metabolites (DAP) among boys living in the rural areas of the Western Cape, South Africa. Data was collected during a cross-sectional study of 183 boys from three agricultural intense areas. Measurements included a questionnaire on socio-economic and pesticide exposures and urinary DAP concentrations. Most boys (70%) lived on farms with a median age of 12 years (range: 5.0-19.5 years). Children aged >14 years had lower DAP urine concentrations (median = 39.9 ng/ml; beta = -68.1 ng/ml; 95% CI: -136.8, 0.6) than children aged 9 years and younger (median = 107.0 ng/ml). DAP concentrations also varied significantly with area, with concentrations in the grape farming area, Hex River Valley (median = 61.8 ng/ml; beta = -52.1; 95% CI: -97.9, -6.3 ng/ml) and the wheat farming area, Piketberg (median = 72.4 ng/ml; beta = -54.2; 95% CI: 98.8, -9.7 ng/ml) lower than those in the pome farming area, Grabouw (median = 79.9 ng/ml). Other weaker and non-significant associations with increased DAP levels were found with increased household income, member of household working with pesticides, living on a farm, drinking water from an open water source and eating crops from the vineyard and or garden. The study found younger age and living in and around apple and grape farms to be associated with increased urinary DAP concentrations. Additionally, there were other pesticide exposures and socio-economic and lifestyle factors that were weakly associated with elevated urinary DAP levels requiring further study. The study provided more evidence on factors associated to urinary DAP concentrations especially in developing country settings

Molecular IgE sensitization profiles of urban and rural children in South Africa

Item does not contain fulltextBACKGROUND: Allergens can act as disease-triggering factors in atopic dermatitis (AD) patients. The aim of the study was to elucidate the molecular IgE sensitization profile in children with and without AD living in urban and rural areas of South Africa. METHODS: Specific IgE reactivity was assessed in 166 Black South African children aged 9-38 months using a comprehensive panel of microarrayed allergens. According to clinical characterization children fell in four groups, urban AD cases (n = 32), urban controls (non-AD, n = 40), rural cases (n = 49) and rural controls (non-AD, n = 45). RESULTS: IgE reactivity to at least one of the allergens was detected in 94% of urban and 86% of rural AD children. House dust mite (HDM; 81% urban, 74% rural AD) and animal-derived allergens (50% urban, 31% rural AD) were the most frequently recognized respiratory allergens, whereas IgE to pollen allergens was almost absent. Urban AD children showed significantly higher frequency of IgE reactivity (50%) to mouse lipocalin, Mus m 1, than rural AD children (12%). The most frequently recognized food allergens were from egg (63% urban, 43% rural AD), peanut (31% vs 41%), and soybean (22% vs 27%), whereas milk sensitization was rare. α-gal-specific IgE almost exclusively occurred in rural children (AD: 14%, non-AD: 49%). CONCLUSION: Molecular allergy diagnosis detects frequent IgE sensitization to HDM, animal but not pollen allergens and to egg, peanut, and soy, but not milk allergens in African AD children. Urban AD children reacted more often to Mus m 1, whereas α-gal sensitization is more common in rural children likely due to parasite exposure

Nutrition and allergic diseases in urban and rural communities from the South African Food Allergy cohort

This study describes and compares allergic diseases and sensitization in urban and rural children in the SAFFA study cohort as well as infant feeding patterns and nutritional status. We assessed the relationship between nutritional status, breastfeeding, complementary feeding patterns, and atopic diseases including aeroallergen and food allergen sensitization, self-reported atopic dermatitis, allergic rhinitis, asthma, and challenge-proven food allergy (FA). Methodology: A total of 1185 urban and 398 rural toddlers aged 12-36 months were screened for food sensitization (FS) and FA using skin prick testing and oral food challenges. Of these, 535 and 347, respectively, were additionally screened for aeroallergen sensitization. Information was collected on infant feeding practices, and anthropometric measurements and clinical signs for atopy were documented. Results: Markedly higher rates of allergy (asthma 9.0% vs 1.0%, eczema 25.6% vs 2.0%, rhinitis 25.3% vs 3.3%, and FA 2.5% vs 0.5%) exist in urban vs rural children. 13.1% unselected urban South African children were sensitized to aeroallergens compared to 3.8% of their rural counterparts and 9.0% to any food compared to 0.5%. Exclusive breastfeeding duration was longer, and there was a later introduction of allergenic foods in rural communities. Obesity rates were similar between the two groups, but rural children were more likely to be stunted. Being overweight was associated with asthma in urban but not rural settings. In the urban cohort, children with FS and allergy were thinner than their peers. Conclusion: Allergy and sensitization rates are significantly higher in unselected urban South African toddlers than their rural counterparts. Risk and protective factors for allergy and atopy may differ between urban and rural settings