Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Attrition amongst Emergency Medicine Registrars in the Western Cape: an exploration of contributing factors

Background. Attrition of registrars impedes the development of Emergency Medicine (EM) in South Africa and Africa, which negatively affects health systems strengthening. Factors relating to attrition of registrars in the EM training program in the Western Cape had not previously been explored. Understanding these factors will enable the development of a framework to be used to conduct formal exit interviews. This exit interview will allow the Division to continually document and address factors related to attrition. Objectives. To explore the factors contributing towards attrition amongst EM Registrars in the Western Cape, to enable a framework for a formal exit interview to be developed. Methods. An explorative qualitative study was conducted using semi-structured interviews. Data was analysed using NVivo software and thematic qualitative analysis. Results. Seven participants were interviewed (5 female and 2 male; ages 28-33). They joined the EM training program at different times (2005-2013) and their time spent in the program varied (8 months to 20 months). Despite their diverse histories, they voiced similar concerns regarding the training program (i.e. lack of support, unsociable hours), regarding relationships (i.e. motherhood, family time), and also with regards to self (i.e. burnout, work-life balance). Conclusion. This study highlights the need for a formal exit interview to address attrition in the Division of EM. The framework for the exit interview should encompass factors related to self, relationships and the training program