Survey responses to questions regarding antibiotic use, sources of antibiotics and information on antibiotics.

<p>Survey responses to questions regarding antibiotic use, sources of antibiotics and information on antibiotics.</p

Total households (counts and proportions; n = 122) in which responses for knowledge, attitude and practice survey questions changed between entry and exit surveys, and the significance levels of the observed changes (Wilcoxon rank sum test, <i>P</i> < 0.05).

<p>Total households (counts and proportions; n = 122) in which responses for knowledge, attitude and practice survey questions changed between entry and exit surveys, and the significance levels of the observed changes (Wilcoxon rank sum test, <i>P</i> < 0.05).</p

Proportion of household respondents that mentioned an antibiotic* during the entry and exit surveys.

<p>Proportion of household respondents that mentioned an antibiotic* during the entry and exit surveys.</p

Proportion of responses for which respondents responded “FALSE” for a set of true-or-false questions regarding the use of antibiotics.

<p>Proportion of responses for which respondents responded “FALSE” for a set of true-or-false questions regarding the use of antibiotics.</p

Plot showing the direction of change (entry versus the exit survey) in household responses (n = 122).

<p>Twenty-nine knowledge, attitude and practices variables were analyzed. Dashed line depicts no change between entry and exit surveys, variables above the dashed line depict negative change while those below it depict positive change. Variables near the line depict little change while those far from the line depict greater change. Each point represents the proportion of households that changed their responses either negatively of positively during the exit survey compared to the entry survey. Details regarding the determination of the direction of change (positive or negative) are provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185827#pone.0185827.s002" target="_blank">S1 Table</a>.</p

Invasive Group B Streptococcal Disease in South Africa: Importance of Surveillance Methodology

<div><p>Data on neonatal group B streptococcal (GBS) invasive disease burden are needed to refine prevention policies. Differences in surveillance methods and investigating for cases can lead to varying disease burden estimates. We compared the findings of laboratory-based passive surveillance for GBS disease across South Africa, and for one of the provinces compared this to a real-time, systematic, clinical surveillance in a population-defined region in Johannesburg, Soweto. Passive surveillance identified a total of 799 early-onset disease (EOD, <7 days age) and 818 LOD (late onset disease, 7–89 days age) cases nationwide. The passive surveillance provincial incidence varied for EOD (range 0.00 to 1.23/1000 live births), and was 0.03 to 1.04/1000 live births for LOD. The passive surveillance rates for Soweto, were not significantly different compared to those from the systematic surveillance (EOD 1.23 [95%CI 1.06–1.43] vs. 1.50 [95%CI 1.30–1.71], respectively, rate ratio 0.82 [95%CI 0.67–1.01]; LOD 1.04 [95% CI 0.90–1.23] vs. 1.22 [95%CI 1.05–1.42], rate ratio 0.85 [95% CI 0.68–1.07]). A review of the few cases missed in the passive system in Soweto, suggested that missing key identifiers, such as date of birth, resulted in their omission during the electronic data extraction process. Our analysis suggests that passive surveillance provides a modestly lower estimate of invasive GBS rates compared to real time sentinel-site systematic surveillance, however, this is unlikely to be the reason for the provincial variability in incidence of invasive GBS disease in South Africa. This, possibly reflects that invasive GBS disease goes undiagnosed due to issues related to access to healthcare, poor laboratory capacity and varying diagnostic procedures or empiric antibiotic treatment of neonates with suspected sepsis in the absence of attempting to making a microbiological diagnosis. An efficacious GBS vaccine for pregnant women, when available, could be used as a probe to better quantify the burden of invasive GBS disease in low-middle resourced settings such as ours. From our study passive systems are important to monitor trends over time as long as they are interpreted with caution; active systems give better detailed information and will have greater representivity when expanded to other surveillance sites.</p></div

Estimates of incidence of early- and late-onset GBS disease and rate ratios and infant disease comparing rates using provincial and overall CDW reports to real-time clinical surveillance at CHBH, 2004–2008.

<p>Estimates of incidence of early- and late-onset GBS disease and rate ratios and infant disease comparing rates using provincial and overall CDW reports to real-time clinical surveillance at CHBH, 2004–2008.</p

Chloropleth map of South Africa demarcating provinces (and Soweto) and their respective rates of infant GBS disease, 2004–2008.

<p>Chloropleth map of South Africa demarcating provinces (and Soweto) and their respective rates of infant GBS disease, 2004–2008.</p

Hospitalized pneumococcal pneumonia incidence rates and proportion of acute respiratory infection (ARI) cases by age, Guatemala, 2008–2012.

<p>Incidence rates (bars) ranged from 2.75/100,000 (among 18–24 year-olds) to as high as 31.3 per 100,000 (among adults aged ≥65 years). Proportion of ARI positive for pneumococcus (line) was more stable than the incidence rate across age groups.</p

Characteristics of patients with pneumococcal pneumonia, n = 188.

<p>^ Includes asthma or lung disease</p><p>^^ Includes cardiovascular disease or hypertension</p><p>^† Oxygen saturation <90% in Santa Rosa and <88% in Quetzaltenango, adjusted for elevation</p><p>Characteristics of patients with pneumococcal pneumonia, n = 188.</p