Demographic correlates of low haemoglobin deferral among potential blood donors in South Africa

A research report submitted to the Faculty of Heath Sciences, University of Witwatersrand, Johannesburg in partial fulfilment of the requirements of the degree of Master of Science in Epidemiology (Epidemiology and Biostatistics) 19 October 2015Introduction Blood transfusion is important in the management of many diseases. Approximately 20% of all potential blood donors are deferred from giving blood for various reasons. Low haemoglobin potential donor deferral is the single major cause of donor deferral and it accounts for about 10% of all deferrals (1). Understanding factors associated with low haemoglobin potential donor deferral could help in reducing deferrals and increase blood supply. Literature on correlates of low haemoglobin deferral is sparse in South Africa. The aim of the study was to determine the prevalence of low haemoglobin deferral among potential donors, proportion of low haemoglobin deferral among deferred donors and to identify factors associated with low haemoglobin donor deferral in potential blood donors in eight provinces of South Africa in 2013. Methods The study was a cross sectional analysis of secondary data collected from eight South African provinces in 2013. There were a total of 996 060 attempted blood donations from 471 126 potential donors. Analysed sample consisted of 8056 random sampled donors (representing 2% of the potential blood donors aged 18 and above). Prevalence of low haemoglobin donor deferral among potential donors and proportion of low haemoglobin donor deferral among deferred donors were estimated. Binomial and multinomial logistic regression analyses were used to identify the factors associated with low haemoglobin donor deferral. Results Among the 8056 potential donors, 51.9% were females and the overall median age of all potential donors was 32 years (IQR: 23-45). About half (49.3%) of all the potential donors were repeat donors, 26.4% were re-join and 24.3% were first time donors. The potential donors of blood group O were 43.8% of the population, followed by blood group A (29.4%) while blood group B and AB were 14.9% and 4.4%, respectively. The overall prevalence of donor deferral was 22.7% (95% CI: 21.8-23.7), while the prevalence of deferral due to low haemoglobin was 6.7% (95% CI: 6.1-7.2). Potential donors of female gender, 18-25 age group, Black race, first time donors and those that donated in Kwa-Zulu Natal had the highest low haemoglobin prevalence. The proportion attributable to low haemoglobin among potential donors was 0.29. In adjusted analysis the factors associated with low haemoglobin deferral were sex (P<0.001), donor type (P<0.001), province (P<0.001) and race (P<0.001). Conclusion The prevalence of low haemoglobin donor deferral obtained was 6.7%. The proportion of deferral due to haemoglobin among deferred donors was 0.29 and the identified correlates are sex, donor type, province and race. The identified correlates could be used when deciding which potential donors to invite for a blood donation after each inter-donation interval has elapsed and blood supply could be increased

Risk factors for tuberculosis treatment failure among pulmonary tuberculosis patients in four health regions of Burkina Faso, 2009: case control study

Introduction: In Burkina Faso, the tuberculosis (TB) treatment failure rate increased from 2.5% in 2000 to 8.3% in 2006. The risk factors for TB treatment failure in the country are not well known. The study aims to determine the risk factors for treatment failure among pulmonary tuberculosis patients in four health region of Burkina Faso and to recommend appropriate interventions. Methods: A case control study was conducted among pulmonary TB patients who began TB treatment in 2009. A case was any patient who remained smear-positive at fifth month of TB treatment and a control was a patient who tested smear-negative at fifth month of treatment. A structured questionnaire was administered to one hundred cases and one hundred controls to collect information on exposure factors. Odds ratio were calculated using bivariate and multivariate analysis to determine the association between exposures and outcome. Results: Multivariate analysis showed that independent risk factors for TB treatment failure were fail to take TB drugs for more than 14 consecutive days (OR=18.53; 95% CI:4.56 - 75.22), sputum smearpositive at two months of treatment (OR=11.52; 95%CI:5.18-25.60), existence of comorbidity (OR=5.74; 95%CI:1.69-19.44), and use of traditional medicines or herbs (OR=2.97; 95%CI:1.12-7.85). Conclusion: Early identification of patients with the above risk factors for intense case management will improve TB treatment outcome. Patient with smear positive at 2ndnd month of treatment require more intense follow-up, and involving traditional healers who provide traditional medicines or herbs in the educational programme on TB are required. The national referral laboratory capacity needs to be strengthened to do drug susceptibility testing and routine drug monitoring on cases of non conversion at 2nd month of treatment

Evaluating the acute flaccid paralysis surveillance system in South Africa, 2005-2009 -an analysis of secondary data

Introduction: Acute Flaccid Paralysis (AFP) surveillance was adopted by World Health Organization (WHO) to monitor progress towards poliomyelitis eradication. South Africa Department of Health (DoH) routinely collects AFP surveillance data but has no documented evidence of its epidemiological use. The study discusses the epidemiology of AFP in South Africa from 2005-9, evaluates performance of the AFP surveillance system, and identifies components that require strengthening. Methods: A retrospective descriptive analysis was conducted on secondary AFP surveillance data for South Africa for the period 2005-2009, consisting of all children. Results: South Africa reported 1501 AFP cases between 2005 and 2009. Of these, 67.2% were &lt;5years of age, and 54.3% were male. None of the cases were confirmed poliomyelitis, and ten (0.7%) were classified as polio-compatible. The national annualized non-polio AFP detection rate increased from 1.6 in 2005 to 2.1 non-polio AFP cases/100,000 children &lt;15years in 2008-9. All performance indicators met the WHO-specified targets except two. Between 2007 and 2009, 51.5%, 55.3% and 65% of specimens, respectively, reached the laboratory within 72hours of being sent (WHO target is ≥80%). Proportion of stool specimens where non-polio enterovirus was isolated decreased from 22.5% in 2006 to &lt;1% in 2008 and 2009 (WHO target is ≥10%). Conclusion: The AFP surveillance system met most WHO-specified epidemiological and laboratory performance standards. The surveillance programme needs to address problems of delayed specimen arrival to the laboratory and incomplete documentation of laboratory findings in the national AFP surveillance database.Pan African Medical Journal 2013; 14: 8

Public health systems strengthening in Africa: The role of South Africa Field Epidemiology and Laboratory Training Programme

The South Africa Field Epidemiology and Laboratory Training Programme (SAFELTP) was created in 2006 after recognizing the need to build and sustain the country's human resource capacity in field (applied) epidemiology and public health practice. The programme was formed as a collaboration between the South Africa Department of Health (DoH), the National Institute for Communicable Diseases (NICD), the National Health Laboratory Services (NHLS), the US Centers for Disease Control and Prevention (CDC) and the University of Pretoria. The primary goal of the programme was to produce field-trained epidemiologists equipped with knowledge and practical skills to effectively and efficiently address the public health priorities of South Africa. SAFELTP is a 2-year full-time training, consisting of a combination of classroom-based instruction (30%) and mentored field work (70%). The training places emphasis on public health surveillance, investigation of disease epidemics, public health laboratory practice and communication of epidemiologic information, among other aspects of epidemiology research. At completion, residents are awarded a Master of Public Health (MPH) degree from the University of Pretoria. Since its inception in 2006, 48 residents have enrolled onto the programme and 30 (62%) of them have completed the training. Over the past 5 years, the residents have conducted more than 92 outbreak investigations, 47 surveillance evaluations, 19 planned studies, analyzed 37 large databases and presented more than 56 papers at local and international conferences. In recognition of the high-quality work, at least five SAFELTP residents have received awards at various international scientific conferences during the 5 years. In conclusion, the South Africa FELTP is now fully established and making valuable contributions to the country's public health system, albeit with innumerable challenges

Factors associated with repeat genital symptoms among sexually transmitted infection service attendees in South Africa, 2015 - 2016

Background. South African guidelines recommend a syndromic approach for the management of sexually transmitted infections (STIs), based on the presence of genital symptoms. However, the guidelines do not prescribe specific indications for microbiology testing for patients presenting with or without repeat genital symptoms.Objectives. To describe the prevalence of and factors associated with repeat genital symptoms among STI service attendees at primary care facilities.Methods. This was a cross-sectional study at 7 STI primary care facilities participating in the aetiological surveillance of STIs between January 2015 and December 2016. Demographic and clinical information and appropriate genital specimens were collected from participants presenting with vaginal discharge syndrome (VDS), male urethral syndrome (MUS) and/or genital ulcer syndrome (GUS). Repeat genital symptoms were defined as self-reported history of the same STI-related genital symptoms in the preceding 12 months. Multivariable logistic regression identified factors associated with repeat genital symptoms.Results. Of 1 822 eligible participants, 480 (30%) had repeat genital symptoms (25% and 75% in the preceding 3 months and 12 months, respectively). Of those with repeat genital symptoms, the median age was 28 (interquartile range (IQR) 24 - 32) years, and 54% were females. The most common aetiological agents among participants with VDS, MUS and GUS were bacterial vaginosis (n=132; 55%), Neisseria gonorrhoeae (n=172; 81%) and ulcers (n=67; 63%), respectively. One hundred and seven (20%) participants had no detectable common STI aetiology. In the multivariable analysis, repeat genital symptoms were associated with HIV co-infection (adjusted odds ratio (aOR) 1.43; 95% confidence interval (CI) 1.14 - 1.78), VDS diagnosis (aOR 1.39; 95% CI 1.10 - 1.76), self-reported condom use (aOR 1.56; 95% CI 1.20 - 2.03) and age 25 - 34 years (aOR 1.33; 95% CI 1.03 - 1.71).Conclusions. Our study found a high prevalence of repeat genital symptoms ‒ a significant proportion without STI aetiology. Identified factors of repeat genital symptoms highlight the need for improved integration of HIV and STI prevention and management. Further research is needed to determine the aetiology of repeat genital symptoms and the contribution of non-STI causes

Cervical cancer screening programme in Limpopo province : January 2007 to December 2010

OBJECTIVE: South Africa launched a cervical screening policy in 2001 and aimed to screen 70% of women aged 30 years and older by the year 2010. The current study describes the performance of the cervical cancer screening programme that was implemented in the Limpopo province between 2007 and 2010. DESIGN: A retrospective descriptive analysis of data on cervical smears that were collected and evaluated by the National Health Laboratory Services in the Limpopo province from 2007 to 2010. OUTCOME MEASURES: Screening coverage, smear adequacy, appropriate age for screening and prevalence of premalignancy were calculated. RESULTS: Overall, 202 251 cervical smears were submitted in the Limpopo province between 2007 and 2010. The number of smears increased from 39 029 in 2007 to 63 512 in 2010. Of the 202 251 women screened, 130 911 (72.7%) were within the recommended screening age (30 years and older). Annual screening coverage rates ranged from 2.9-4.2% of the population of women aged 30 years and older. The cumulative screening coverage during the four years was 13.7%. The mean smear adequacy rate during this time was 98.5%. Of the 202 251 smears, 5 237 (2.5%) reflected high-grade squamous intraepithelial lesions, while 238 (0.2%) contained malignant lesions. CONCLUSION: The cervical cancer screening programme in Limpopo improved during the study period, but still fell short of national goals. Key areas that require strengthening include low screening coverage and the screening of young women who are at less risk of acquiring cervical cancer.http://www.sajgo.co.za/index.php/sajgoam2013ay201

Dog bites and human rabies in the Uthungulu District of KwaZulu-Natal province, 2008-2010 : a review of surveillance data

The Uthungulu District in KwaZulu-Natal province is the area that is most affected by rabies in South Africa. Usually, the transmission of rabies to humans occurs through the bites of infected dogs. In 2008, Uthungulu commenced a programme to eliminate human rabies in the district. This paper describes the epidemiology of dog bites and human rabies in the Uthungulu District from 2008-2010, and the extent of adherence to rabies post-exposure prophylaxis (PEP). The method was a retrospective analysis of dog-bite and human rabies surveillance data that were collected in Uthungulu from January 2008-December 2010. Dog-bite injuries in Uthungulu increased from 1 176 in 2008 to 2 365 in 2009, and decreased to 1 598 in 2010. Of 2 601 patients who were offered rabies PEP in 2009 and 2010, 83.7% [95% confidence interval (CI): 82.4-85.2] completed the treatment. Logistic regression analysis found that investigation of the report by an environmental healthcare practitioner [odds ratio (OR) = 3.95; 95% CI: 2.43-6.43, p-value = 0 .0001], the availability of patient telephone contact details in the healthcare facility’s records (OR = 1.76; 95% CI: 1.02-3.03, p-value = 0.041), and bite wounds that were classified as Category 3 exposure injuries (OR = 2.96; 95% CI: 1.39-6.29, p-value = 0.004), were independently associated with completion of rabies PEP. Seven human rabies cases were reported (four in 2008, two in 2009 and one in 2010). Annualised human rabies incidence rates decreased from four cases per million in 2008 to one case per million in 2010. The findings suggest that the rabies elimination initiative is having an impact on the reduction of the incidence of human rabies in Uthungulu. The district should strengthen the follow-up of people who are exposed to rabies to ensure PEP completion.http://www.sajei.co.za/index.php/SAJEIam2013ay201

Outbreak of multi-drug resistant Pseudomonas aeruginosa bloodstream infection in the haematology unit of a South African academic hospital

Objective: To describe an outbreak of multi-resistant Pseudomonas aeruginosa bloodstream infections (MRPA-BSI) that occurred in the haematology ward of a tertiary academic hospital in Cape Town, South Africa, and determine risk factors for acquisition of MRPA-BSI. METHODS: The outbreak investigation included a search for additional cases, review of patient records, environmental and staff screening, molecular typing using pulsed-field gel electrophoresis (PFGE) and Multi-locus sequencing (MLST) and a retrospective case-control study. RESULTS: Ten MRPA-BSI cases occurred in the haematology ward between January 2010 and January 2011. The case fatality rate was 80%. Staff screening specimens were negative for MRPA and an environmental source was not identified. PFGE showed that 9/10 isolates were related. MLST showed that 3 of these 9 isolates belonged to Sequence type (ST) 233 while the unrelated isolate belonged to ST260. CONCLUSION: We have described an outbreak of MRPA-BSI occurring over an extended period of time among neutropenic haematology patients. Molecular typing confirms that the outbreak was predominantly due to a single strain. The source of the outbreak was not identified, but the outbreak appears to have been controlled following intensive infection control measures