16 research outputs found
Mental health is integral to public health: a call to scale up evidence-based services and develop mental health research
The Global Burden of Disease studies documented the challenges posed by mental illness. Mental illness comprised an estimated 12% of the global burden of disease in 2000, and is predicted to rise to 15% by 2020. Mental disorders comprise 5 of the 10 leading causes of health disability; it is predicted that, by 2030, unipolar depression will be the world's second most disabling health condition
Baseline Predictors of Sputum Culture Conversion in Pulmonary Tuberculosis: Importance of Cavities, Smoking, Time to Detection and W-Beijing Genotype
Background: Time to detection (TTD) on automated liquid mycobacterial cultures is an emerging biomarker of tuberculosis
outcomes. The M. tuberculosis W-Beijing genotype is spreading globally, indicating a selective advantage. There is a paucity
of data on the association between baseline TTD and W-Beijing genotype and tuberculosis outcomes.
Aim: To assess baseline predictors of failure of sputum culture conversion, within the first 2 months of antitubercular
therapy, in participants with pulmonary tuberculosis.
Design: Between May 2005 and August 2008 we conducted a prospective cohort study of time to sputum culture
conversion in ambulatory participants with first episodes of smear and culture positive pulmonary tuberculosis attending
two primary care clinics in Cape Town, South Africa. Rifampicin resistance (diagnosed on phenotypic susceptibility testing)
was an exclusion criterion. Sputum was collected weekly for 8 weeks for mycobacterial culture on liquid media (BACTEC
MGIT 960). Due to missing data, multiple imputation was performed. Time to sputum culture conversion was analysed using
a Cox-proportional hazards model. Bayesian model averaging determined the posterior effect probability for each variable.
Results: 113 participants were enrolled (30.1% female, 10.5% HIV-infected, 44.2% W-Beijing genotype, and 89% cavities). On
Kaplan Meier analysis 50.4% of participants underwent sputum culture conversion by 8 weeks. The following baseline
factors were associated with slower sputum culture conversion: TTD (adjusted hazard ratio (aHR) = 1.11, 95% CI 1.02; 1.2),
lung cavities (aHR = 0.13, 95% CI 0.02; 0.95), ever smoking (aHR = 0.32, 95% CI 0.1; 1.02) and the W-Beijing genotype
(aHR = 0.51, 95% CI 0.25; 1.07). On Bayesian model averaging, posterior probability effects were strong for TTD, lung
cavitation and smoking and moderate for W-Beijing genotype.
Conclusion: We found that baseline TTD, smoking, cavities and W-Beijing genotype were associated with delayed 2 month
sputum culture. Larger studies are needed to confirm the relationship between the W-Beijing genotype and sputum culture
conversion.Publisher's versio
The acceptability of three vaccine injections given to infants during a single clinic visit in South Africa
BACKGROUND: The Expanded Programme on Immunisation (EPI) has increased the number of antigens and injections
administered at one visit. There are concerns that more injections at a single immunisation visit could decrease
vaccination coverage. We assessed the acceptability and acceptance of three vaccine injections at a single immunisation
visit by caregivers and vaccinators in South Africa.
METHODS: A mixed methods exploratory study of caregivers and vaccinators at clinics in two provinces of South
Africa was conducted. Quantitative and qualitative data were collected using questionnaires as well as observations
of the administration of three-injection vaccination sessions.
RESULTS: The sample comprised 229 caregivers and 98 vaccinators. Caregivers were satisfied with the vaccinators’ care
(97 %) and their infants receiving immunisation injections (93 %). However, many caregivers, (86 %) also felt that
three or more injections were excessive at one visit. Caregivers had limited knowledge of actual vaccines provided,
and reasons for three injections. Although vaccinators recognised the importance of informing caregivers about
vaccination, they only did this sometimes. Overall, acceptance of three injections was high, with 97 % of caregivers
expressing willingness to bring their infant for three injections again in future visits despite concerns about the
pain and discomfort that the infant experienced. Many (55 %) vaccinators expressed concern about giving three
injections in one immunisation visit. However, in 122 (95 %) observed three-injection vaccination sessions, the
vaccinators administered all required vaccinations for that visit. The remaining seven vaccinations were not completed
because of vaccine stock-outs.
CONCLUSIONS: We found high acceptance by caregivers and vaccinators of three injections. Caregivers’ poor
understanding of reasons for three injections resulted from limited information sharing by vaccinators for caregivers.
Acceptability of three injections may be improved through enhanced vaccinator-caregiver communication, and
improved management of infants’ pain. Vaccinator training should include evidence-informed ways of communicating
with caregivers and reducing injection pain. Strategies to improve acceptance and acceptability of three injections
should be rigorously evaluated as part of EPI’s expansion in resource-limited countries.IS