Evaluation of tuberculosis treatment outcomes and the determinants of treatment failures in the Eastern Cape Province, 2003-2005

Background: This paper describes the performance of the Tuberculosis (TB) control programme in the Eastern Cape Province. The aim of the study was to evaluate the tuberculosis treatment outcomes as well as to identify factors that contribute to treatment failures in health districts of the Eastern Cape Province from 2003 to 2005. TB can only be controlled and eventually eliminated in the context of a National Tuberculosis Control Program (NTCP). Such a program must operate within the general health service of each country. Although considerable progress has been made with TB control efforts in South Africa since 2000, there is still little sign that the epidemic is abating in the Eastern Cape Province. Method: The study was a descriptive study and the methodology employed in this evaluative study took cognizance of the main approaches used globally (World Health Organization and the International Union Against Tuberculosis and Lung Disease) to assess the performance and quality of Tuberculosis Control Programs. 152 336 records from the Electronic TB Register for the period 2003 – 2005 were systematically reviewed and a random sample design of 252 primary health care facilities with probability proportional to size was used to collect information on health system related factors that contribute to treatment failures with emphasis to input, process and output indicators for the TB Control programme including proper implementation of DOTS strategy. Results: Overall TB treatment outcomes in Eastern Cape Province did not reach the national targets for the period 2003 – 2005. A cure rate of 39.7% for new smear positive patients in 2005 was reported. Only Chris Hani district reached a national target of 70% for smear conversion rate in 2005. The successful treatment outcomes were below 85% threshold suggested by the World Health Organization. Cure rates never reached 50% for the three-year study period. Defaulting from treatment remained a challenge for the TB control programme in the Eastern Cape Province. There has been an increasing number of patients with treatment outcome not evaluated in 2005 from 20.1% to 24.7% in new smear positive cases and in re-treatment smear positive cases, this increased from 21.2% to 27.3%. Conclusion: The findings of the study reveal that, despite considerable efforts made by the NTCP, little change was noted in treatment outcomes. Efforts to provide effective TB treatment using DOTS at district and facility level in the province are constrained by failure of most districts to reach a 100% DOTS coverage. Patients are accurately diagnosed, recorded into the register, drug supply is regular and uninterrupted but there has been a slow increase in the proportion of patients cured and there are an increase number of defaulter rates and patients with treatment outcomes which are not evaluated. An improved base of information is needed to assess the TB morbidity impact more accurately. Human resources were among the most important resources, which were found lacking and health system managers have the responsibility and challenge of ensuring that maximum benefit is derived from these to maintain and expand health services.Dissertation (MSc)--University of Pretoria, 2009.School of Health Systems and Public Health (SHSPH)Unrestricte

Ketolide agents HMR 3004 and HMR 3647 (telithromycin) inhibit the growth of Plasmodium falciparum in vitro

Background: Malaria is on the increase due to emergence of parasite drug resistance and there is thus an urgent need for the development of new antiparasitic drugs effective at low concentrations. Ketolides antibiotics are used for treatment of various ailments and are relevant candidates to establish antiparasitic activity.Objectives: The present study investigates the activity of ketolide compounds HMR 3004 and HMR 3647 (telithromycin) (0.025-12.5 μM) for activity against chloroquine-sensitive and resistant strains of Plasmodium falciparum in vitro.Methods: The antiplasmodial activity of the two ketolide agents were determined using microscopic and colorimetric [lactate dehydrogenase assay] procedures.Results: Both HMR 3004 and HMR 3647 caused a dose-dependent inhibition of growth of both parasite strains with IC50 values 3 and 15 nM, respectively. Suppression of parasite growth was evident after 8 hours of exposure to both agents at 12.5 μM with total parasite clearance achieved at 40 hours.Conclusion: The results indicate lack of cross-resistance between the ketolide compounds and chloroquine, implying presence of a drug target different from that of chloroquine. The particular drug target has still to be investigated but the stage-specific results indicate that it is expressed in all parasite growth phases. These observations demonstrate the anti-malarial potential of the ketolide antimicrobial agents.Key words: Chloroquine, ketolides, macrolides, malaria, Plasmodium falciparum

Barriers and enablers to exclusive breastfeeding by mothers in Polokwane, South Africa

BackgroundExclusive breastfeeding (EBF) for six months, with the introduction of appropriate complementary feeding thereafter, and breastfeeding continuing for up to 2 years and beyond, is highly recommended. This could save the lives of up to 1.4 million children each year worldwide. Despite this, breastfeeding rates in South Africa remain sub-optimal, with the recommended target of 50% by the World Health Assembly (WHA) not being achieved. The study aimed to investigate the reasons influencing mothers' practice of exclusive breastfeeding in the Polokwane municipality of Limpopo province in South Africa.MethodologyA cross-sectional health facility-based quantitative and descriptive survey was conducted using a validated-structured questionnaire administered to 146 mothers. The data was analyzed using STATA. Chi-square tests were used to determine the relationship between selected demographic variables and their reasons not to breastfeed exclusively.ResultsAlthough 94% of the mothers had initiated breastfeeding, at the time of data collection 8% had stopped. Of those who had stopped breastfeeding, 5% did so within one month of starting. Thirty- nine percent of mothers' breastfed exclusively, while 61% practiced mixed feeding. A positive association between exclusive breastfeeding practices and the age of the mother were observed, with older mothers more likely to breastfeed. The reasons mothers stopped breastfeeding were: the mother was ill (45%) or they returned to school or work (27%). Reasons for not breastfeeding were cited as: medical conditions, not enough milk, and infant refusal to breastfeed (33%). Mothers believe that HIV-positive women should breastfeed their infants (57%), and health workers were found to be the main source of HIV information to mothers (77%).DiscussionExclusive breastfeeding during the first six months was less practiced. Infant formula and solid foods were introduced at an early age, usually within the first month of breastfeeding. This study sheds light on factors influencing the early initiation of breastfeeding and the practice of EBF as practiced in Polokwane

Ketolide agents HMR 3004 and HMR 3647 (telithromycin) inhibit the growth of Plasmodium falciparum in vitro

Background: Malaria is on the increase due to emergence of parasite drug resistance and there is thus an urgent need for the development of new antiparasitic drugs effective at low concentrations. Ketolides antibiotics are used for treatment of various ailments and are relevant candidates to establish antiparasitic activity. Objectives: The present study investigates the activity of ketolide compounds HMR 3004 and HMR 3647 (telithromycin) (0.025-12.5 \u3bcM) for activity against chloroquine-sensitive and resistant strains of Plasmodium falciparum in vitro. Methods: The antiplasmodial activity of the two ketolide agents were determined using microscopic and colorimetric [lactate dehydrogenase assay] procedures. Results: Both HMR 3004 and HMR 3647 caused a dose-dependent inhibition of growth of both parasite strains with IC50 values 3 and 15 nM, respectively. Suppression of parasite growth was evident after 8 hours of exposure to both agents at 12.5 \u3bcM with total parasite clearance achieved at 40 hours. Conclusion: The results indicate lack of cross-resistance between the ketolide compounds and chloroquine, implying presence of a drug target different from that of chloroquine. The particular drug target has still to be investigated but the stage-specific results indicate that it is expressed in all parasite growth phases. These observations demonstrate the anti-malarial potential of the ketolide antimicrobial agents

Profiling the mental health of diabetic patients: a cross-sectional survey of Zimbabwean patients

Objective The burden of diabetes mellitus has exponentially increased in low resource settings. Patients with diabetes are more likely to exhibit poor mental health which negatively affects treatment outcomes. However, patients with high levels of social support (SS) are likely to report optimal mental health. We sought to determine how SS affects the report of psychiatric morbidity and health-related quality of life (HRQoL) in 108 diabetic patients in Harare, Zimbabwe. Results The average age of participants was 54.1 (SD 18.6) years. Most of the participants were; females (69.4%), married (51.9%), and were of low level of income (43.5%). 37.1% of the participants exhibited signs of psychiatric morbidity [mean Shona Symptoms Questionnaire score—6.7 (SD 3.2)]. Further, patients also reported lower HRQoL [mean EQ-5D-VAS score—64.1 (SD 15.3)] and high levels of SS [mean Multidimensional Scale of Perceived Social Support score—43.7 (SD 11.5)]. Patients who received greater amount of SS had optimal mental health. Being female, unmarried, lower education attainment, having more comorbid conditions, being diagnosed with type 2 diabetes and having been diagnosed of diabetes for a longer duration were associated with poorer mental health. It is important to develop context-specific interventions to improve diabetic patients’ mental health

Knowledge, attitude and preventative practice of tuberculosis in rural communities of Dikgale, Mamabolo and Mothiba health and demographic surveillance system in Limpopo province, South Africa

Abstract Background Tuberculosis continues to be a serious public health issue. To reduce the transmission of the disease, it is imperative to address the major obstacle of inadequate understanding regarding the causes, risk factors, treatments, and prevention of pulmonary TB. The study assessed knowledge, attitude, and preventative practices of tuberculosis among community members in Dikgale, Mamabolo and Mothiba (DIMAMO) Health Demographic Surveillance system, Limpopo Province South Africa. Methods A cross-sectional clinic-based survey involving 360 participants was conducted at clinics at Dikgale, Mamabolo and Mothiba (DIMAMO) Health and Demographic Surveillance System. A standardised questionnaire on socio-demographic, knowledge, attitude and preventative practices towards tuberculosis based on (WHO) KAP-TB template guidelines was used to collect data. Descriptive statistics on Statistical Package for Social Sciences (SPSS) version 27.0 was used to analyse data. Results The results of the cross-sectional survey on KAP-TB illustrated that the participants have good knowledge, attitude, and perception of TB. Majority of the participants (n = 270, 75%) had good general knowledge, while (n = 90, 25%) had poor knowledge about TB. However, the study reports (n = 57, 15.6%) having knowledge of causative agents of TB. Participants showed a favourable attitude toward people who are infected with TB. 87% showed a favourable attitude while only 12.46% showed an unfavourable attitude towards TB. Participants showed a good practice of (71.7%) while (28.3%) of participants had poor practice towards TB. Conclusion Health education interventions programme on TB needs to be intensified among the community members to improve TB awareness and reduce transmission. Focused educational interventions on TB aetiology and mode of transmission are required to increase TB preventative practices and improve health-seeking behaviour among community members

Towards the elimination of malaria in South Africa: a review of surveillance data in Mutale Municipality, Limpopo Province, 2005 to 2010

<p>Abstract</p> <p>Background</p> <p>South Africa has targeted to eliminate malaria by the year 2018. Constant monitoring of malaria morbidity and mortality trends in affected subpopulations is therefore crucial in guiding and refining control interventions. Mutale Municipality in Limpopo Province is one of the areas with the highest risk of malaria in the country. This paper describes trends in malaria incidence, case fatality and household indoor residual spraying (IRS) coverage in Mutale Municipality, during the period 2005 to 2010.</p> <p>Methods</p> <p>A retrospective descriptive analysis was conducted on malaria data routinely collected through the Limpopo provincial malaria information system between July 2005 and June 2010. Five malaria seasons were defined. Annualized malaria incidence rates, case fatality rates (CFR) and IRS coverage rates were calculated.</p> <p>Results</p> <p>Cumulatively, 4,663 malaria cases and 21 malaria deaths were reported in Mutale between July 2005 and June 2010. Investigation of likely origin of the malaria in 3,517 patients revealed that 6.6% were imported cases, mostly from neighbouring Zimbabwe (222/231). Malaria incidence rates fell from 13.6 cases per 1,000 person-years in the 2005–2006 season to 2.7 cases per 1,000 person-years in the 2009–2010 season. The mean malaria CFR was stable between 0.3 and 0.6% during the first four seasons, and increased sharply to 2.1% in the 2009–2010 season. The median age of the 21 malaria deaths was 34 years (range: 16 to 60 years). CFRs were 0% in children below 15 years and above 0.5% in patients more than 24 years old. Regular IRS achieved coverage above 80% in all five seasons.</p> <p>Conclusion</p> <p>Malaria control interventions implemented in Mutale significantly reduced the incidence of malaria in the population. In order to accurately monitor progress towards the elimination goal, the malaria control programme should strengthen the reporting and capturing of the data in the provincial malaria information system; all patients diagnosed with malaria should be investigated to determine the likely source of the malaria, and malaria related deaths should be audited to improve case detection and management. Furthermore, the country should strengthen cross border malaria control collaborations in order to minimize malaria importation.</p