Global Genetic Structure and Molecular Epidemiology of Encapsulated Haemophilus influenzae

A collection of 2,209 isolates of six polysaccharide capsule types of Haemophilus influenzoe, including 1,975 serotype b isolates recovered in 30 countries was characterized for electrophoretically demonstrable allele profiles at 17 metabolic enzyme loci. Two hundred eighty distinct multilocus genotypes were distinguished, and cluster analysis revealed two primary phylogenetic divisions. The population structure of encapsulated H. influenzae is clonal. Currently, most of the invasive disease worldwide is caused by serotype b strains of nine clones, Strains producing serotype c, e, and f capsules belong to single divisions and have no close genetic relationships to strains of other serotypes, Serotype a and b strains occur in both primary phylogenetic divisions, probably as a result of transfer and recombination of serotype-specific sequences of the cap region between clonal lineages. A close genetic relatedness between serotype d isolates and some strains of serotypes a and b was identified, There are strong patterns of geographic variation, on an intercontinental scale, in both the extent of genetic diversity and the clonal composition of populations of encapsulated strains, The analysis suggests that the present distribution of clones is, in part, related to patterns of racial or ethnic differentiation and historical demographic movements of the human host population

Students’ experiences of inter-professional education through International classification of functioning-based activities at a community-based rehabilitation centre

CITATION: Kloppers, M., et al. 2015. Students’ experiences of inter-professional education through International classification of functioning-based activities at a community-based rehabilitation centre. African Journal of Health Professions Education, 7(1):22-25, doi:10.7196/AJHPE.289.The original publication is available at http://www.ajhpe.org.zaENGLISH SUMMARY : Introduction. The training of healthcare professionals is faced with many challenges. To ultimately strengthen the health system, training has to respond to new health challenges, health science developments and societal needs. The Bishop Lavis Primary Health Care Project was established in 1993 and led to the establishment of the Bishop Lavis Rehabilitation Centre (BLRC). The current inter-professional service delivery at the Centre is based on the World Health Organization’s International Classification of Functioning (ICF) model for holistic client-centred care. The objective of this article is to describe the students’ experiences of inter-professional education (IPE) through ICF-based activities at BLRC. Methods. Data were gathered from a retrospective review of student feedback forms from 2010 to 2012. Content analysis was employed to identify key themes regarding IPE. Results. Inter-professional learning was found to occur spontaneously between the four allied health professions as a result of the ICF model-driven activities at BLRC. Conclusion. Feedback at the end of the students’ clinical placement was open ended and no information was asked specifically about IPE. More than half of the students spontaneously mentioned that learning about working in an inter-professional team as one of the highlights of their placement at BLRC, has prompted the sharing of this information. This article offers a potential framework (ICF) that fosters and supports the IPE philosophy in a clinical setting.http://www.ajhpe.org.za/index.php/ajhpe/article/view/289Publisher's versio

Knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at the Vanguard Community Health Centre, Western Cape – a pilot Study

Objective. The aim of the study was to determine the knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at a community health centre (CHC). Method. A descriptive study was conducted using an administered, structured questionnaire. Subjects and setting. Thirty-six educated women aged 18 - 39 years and attending the clinic took part. Participants were from informal settlements and mostly unemployed, receiving government grants. Results. The majority (88.9%) scored 80% or more with regard to general HIV knowledge. Although the majority (78%) were formula feeding, primarily owing to their HIV status and convenience while working, 24% would not be able to sustain this feeding method after the initial 6 months' free supply provided by the provincial health services. The majority could not define the terms exclusive breastfeeding (89%), mixed feeding (81%) or cup feeding (94%) correctly. Attitudes were found to be positive with regard to both breastfeeding and formula feeding, but HIV status influenced it significantly (p < 0.1). Conclusion. In conclusion, certain aspects of the PMTCT programme appear to have been effective at the CHC included in this study. The women were knowledgeable about HIV transmission and mother-to-child transmission (MTCT), but they were uninformed about certain essential aspects, i.e. prevention, cure and infant feeding. Attitudes were similar towards breastmilk or formula milk as a feeding choice but were influenced by HIV status. It was indicated that an informed decision-making process was not followed, rather that the women were advised to formula feed. Sustainability of formula feeding after 6 months and training of health workers specifically regarding feeding options need to be addressed

Implementation of the Road-to-Health-Booklet health promotion messages at primary health care facilities, Western Cape Province, South Africa

CITATION: Du Plessis, L. M., et al. 2017. Implementation of the Road-to-Health-Booklet health promotion messages at primary health care facilities, Western Cape Province, South Africa. South African Journal of Child Health, 11(4):164-169, doi:10.7196/SAJCH.2017.v11i4.1414The original publication is available at http://www.sajch.org.zaBackground: Age-specific health promotion messages appear in the Road-to-Health-Booklet, an assessment and monitoring tool for child health in South Africa. Healthcare workers should communicate health promotion messages to caregivers at each clinic visit. Objective: This investigation, part of a larger Road-to-Health-Booklet survey, assessed the implementation of health promotion messages and identified barriers to its successful implementation. Methods: A cross-sectional descriptive study with analytical components was conducted in the Western Cape Province. Knowledge and practices of caregivers and healthcare workers were assessed at 143 randomly selected primary health care facilities. Information was obtained through questionnaires; direct observation of consultations and recording of health promotion material in facilities. Results: In total, 2442 children (0-36 months; mean age 6.26 ± 6.24 months.); 2481 caregivers and 270 healthcare workers were included. Caregivers' educational level varied, with only 24.3% completing Grade 12. Healthcare workers had a median of five years (0.5 - 37.0 years) work experience in primary health care. All healthcare workers indicated that health promotion messages are important, however, messages were only conveyed in 51% of consultations observed. If communicated, health promotion messages were age-appropriate in 97% of cases. Barriers to the implementation of health promotion messages hinged on time and staff constraints, workload and language barriers. Various forms of health promotion material were available in facilities. Conclusions: Sub-optimal implementation of the health promotion messages in the Road-to-Health-Booklet are apparent despite healthcare workers realising the importance of health promotion. Barriers to optimal implementation must be urgently addressed by the National Department of Health and healthcare workers in partnership with caregivers and supported by society to promote child health and care.http://www.sajch.org.za/index.php/SAJCH/article/view/1404Publisher's versio

Health-promoting schools as a service learning platform for teaching health-promotion skills

CITATION: Du Plessis, L.M., Koornhof, H.E., Daniels, L.C., Sowden, M. & Adams, R. 2014. Health-promoting schools as a service learning platform for teaching health-promotion skills. African Journal of Health Professions Education, 6(1):48-51,, doi:10.7196/AJHPE.250.The original publication is available at http://www.ajhpe.org.zaBackground. Health sciences students have traditionally been taught their practical skills in community health facilities. However, clinics and hospitals are not necessarily ideal settings for teaching students health-promotion skills. Objective. To explore health-promoting schools (HPSs) to teach Stellenbosch University (SU) undergraduate dietetic students health-promotion skills. Methods. In this descriptive, cross-sectional study, students completed structured reflective journals and conducted interviews with teachers. The chief professional nurse interviewed the school principals. Results. The students were positive about HPSs, but only fully understood its implementation and practice after entering the school setting. They felt that they could play a role in increasing its efficacy. The teachers were positive about the initiative and thought that they had adequate knowledge to take it further, but were open to gaining more knowledge and insight. Teachers and students had similar views on the role that students could play in HPSs, including educating learners, parents and teachers on health and nutrition, assisting with growth monitoring and promotion, developing educational tools, obtaining various resources for schools, planning menus, budgeting for meals, and growing vegetables. Resources required by the schools could best be addressed by a team of healthcare professionals in collaboration with government departments and with community support. Conclusion. HPSs offer extensive opportunities where SU undergraduate dietetic students, and possibly other healthcare profession students, could serve the needs of communities while learning and practising health-promotion skills.http://www.ajhpe.org.za/index.php/ajhpe/article/view/250Publisher's versio

Tuberculosis culture testing at a tertiary care hospital: options for improved management and use for treatment decisions

Chris Hani Baragwanath Hospital, a tertiary care hospital in Johannesburg, South Africa. To determine the proportion of patients with positive Mycobacterium tuberculosis cultures and whether those who were positive were on treatment. Tuberculosis (TB) culture results were obtained from the laboratory for a 3-month period. Positive results were checked against registrations at the hospital TB Care Centre (TBCC). The treatment status of non-registered patients was obtained from various records at the hospital, district clinics and from home visits. Overall, 3909 patients had 5404 samples sent for culture. Of these, 708 patients (18%) had at least one positive culture. The positive yield from 2749 adult sputum samples was 33% and ranged from 6% to 40% for different extra-pulmonary specimens. Among 1160 children, the yield varied from 0% to 12%, with 12% in sputum and gastric washing specimens. Of the 708 culture-positive patients, 429 (61%) patients were registered at the TBCC and were known to have started TB treatment. Of the 279 subjects not registered (39% overall), 100 (36%) died. Only 67 of the 179 survivors were confirmed on treatment, 40 were not on treatment and 72 could not be traced. Large numbers of TB culture tests were performed, some inappropriately. Study findings highlight inadequacies in the management of culture-confirmed TB at this hospita

Breastfeeding policies and practices in health care facilities in the Western Cape Province, South Africa

The Baby-Friendly Hospital Initiative (BFHI) is a global effort to improve the role of maternity services and to enable mothers to breastfeed their infants, thus ensuring the best start in life for their infants. The foundation for the BFHI is the Ten Steps to Successful Breastfeeding (BF). It has been shown, however, that the selective implementation of only some of the steps may be ineffective and discouraging to successful BF practices. An initial study was therefore conducted to assess the extent of the implementation of the Ten Steps in both public and private maternity facilities. Poor performance for some steps led to a follow-up study to investigate the knowledge and attitudes of health care workers (HCWs) and mothers alike and to evaluate the exclusive BF (EBF) practices of mothers attending private BF clinics. Both studies followed descriptive, cross-sectional designs and were set in the Cape Metropole in the Western Cape. Twenty-six maternity facilities participated in the initial study, for which observation lists were completed and verified by interviewer-administered questionnaires to both HCWs and mothers. Eighteen private BF clinics participated in the follow-up study, which included observations and interviewer-administered questionnaires to 25 HCWs and 64 mothers. During the initial study, lower mean scores were noted for Steps 1, 2, 6 and 10. The overall implementation of the Ten Steps was average. The findings highlighted the importance of the establishment and implementation of BF policies, of appropriate and continuous BF training and better referral systems to ensure initiation and establishment of early BF, EBF practices and support on an ongoing basis to ensure the best start in life for infants