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

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 <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 <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 <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.Table 1: Background characteristics of AFP cases reported in South Africa between January 2005 and December 2009Table 2: Final diagnoses given for AFP cases reported in South Africa between 2005 and 2009Table 3: AFP surveillance performance indicators for South Africa, 2005-2009Figure 1: Flow chart showing the virological classification of AFP cases reported in South Africa between 2005 and 2009Figure 2: Annualized non-polio AFP rates by year for each province in South Africa, 2005-2009Figure 3: Proportion of AFP cases with adequate stool specimens per year, by province, South Africa 2005-2009The authors would like to thank all the staff from South African Field Epidemiology and Laboratory Training Programme (SAFELTP), the South Africa National Department of Health Expanded Programme on Immunization (EPI-SA) and the School of Health System and Public Health (SHSPH) at University of Pretoria, who provided valuable technical contributions to this study.http://www.panafrican-med-journal.com/content/article/14/86/full/am201

Cognitive and behavioural determinants of multiple sexual partnerships and condom use in South Africa: results of a national survey

BACKGROUND: Human immunodeficiency virus (HIV) risky behaviours including multiple sexual partnership (MSP) and non-condom use (nCU) are known to be drivers of the spread of HIV; cognitive factors including perceived susceptibility of HIV, self-efficacy and attitudes play a significant role in influencing risky sexual behaviours. OBJECTIVES: We sought to investigate personal beliefs, perceptions, thoughts and actions that are associated with MSP and nCU in South Africa. METHODS: We analysed nationally representative data from the 2012 National HIV Communication Survey (NCS) that included about 10 000 participants aged 16–55 years. Five constructs were created to measure psychosocial and cognitive determinants. Cronbach’s alpha coefficient for internal consistency reliability was calculated. Multivariable logistic regression was used to determine factors associated with MSP and nCU. RESULTS: Of the 6061 sexually active respondents, 13% (95% CI: 11.47–13.12) reported MSP and 52.7% (n = 3158 of 6039) (95% CI: 51.0–53.55) nCU at last sex. Factors associated with MSP included perceived benefits, adjusted odds ratio (aOR) = 2.16 (95% CI: 1.80–2.58), perceived susceptibility to HIV, aOR = 2.22 (95% CI: 1.83–2.69) and engaging in intergenerational sex, aOR = 2.14 (95% CI: 1.78–2.56). Predictors of nCU were perceived benefits, aOR = 1.25 (95% CI: 1.09–1.43); perceived susceptibility to HIV, aOR = 1.6 (95% CI: 1.39–1.83); and personal beliefs, aOR = 1.35 (95% CI: 1.13–1.62). CONCLUSION: Cognitive and behavioural factors were found to be predictors of risky sexual behaviours for HIV. This highlights the importance of considering personal perception and reasoning when attempting to understand and influence an individual’s sexual behaviour. This could be done through enhancing awareness of HIV risk in the general population and by influencing cognitive behaviour change through community mobilisation, advocacy and creating activities to improve self-esteem.https://sajhivmed.org.zapm2020School of Health Systems and Public Health (SHSPH

Knowledge, attitudes and practices of oral HIV pre-exposure prophylaxis (PrEP) among healthcare workers in the Ekurhuleni District, South Africa

This research article formed part of the requirements for fulfillment of an MSc in Epidemiology and Biostatistics namely "Knowledge, attitudes, and practices of oral HIV pre-exposure prophylaxis (PREP) among healthcare workers in the Ekurhuleni District, Gauteng Province" by Mahlare, Edna. URI: https://repository.up.ac.za/handle/2263/89525BACKGROUND : Prevention of new HIV infections is crucial for controlling the HIV epidemic. Despite HIV pre-exposure prophylaxis (PrEP) being one of the highly effective approaches to preventing HIV, and being freely available through primary healthcare clinics (PHCs), the uptake of HIV PrEP in South Africa (SA) is low. OBJECTIVE : To understand knowledge, attitudes and practices (KAPs) of healthcare workers responsible for generating demand for HIV PrEP services, or identifying clients eligible for HIV PrEP services in PHCs in Ekurhuleni District, South Africa. METHODS : We conducted a cross-sectional interviewer-administered survey among healthcare workers from 45 randomly selected PHCs in Ekurhuleni District. We collected information on participant characteristics and their KAPs regarding HIV PrEP service delivery. KAP scores were developed using a priori cut-off points and participants were categorised into binary levels of KAPs. We performed descriptive and multivariable logistic regression analysis in line with the study objectives. RESULTS : We enrolled 160 study participants from 1 May to 30 June 2022. About two-thirds of the participants (64.4%) were highly knowledgeable about HIV PrEP, and 58.1% self-reported practices that were considered to be good. Notably, 73.1% of participants had negative attitudes toward HIV PrEP delivery. Participants who were aged >50 years had poor HIV PrEP knowledge (adjusted odds ratio (aOR) 0.1; 95% confidence interval (CI) 0.0 - 0.4; p=0.01) compared with participants <30 years old. Participants aged 30 - 40 years had poor HIV knowledge although their association is not statistically significant. Nurses had higher HIV PrEP knowledge (aOR 11.1; 95% CI 3.8 - 32.4, p<0.001) compared with health promoters. Both nurses (aOR=0.2, 95% CI 0.1 - 0.6; p<0.001) and HIV testing service counsellors (aOR 0.3; 95% CI 0.1 - 0.9; p=0.02) had negative attitudes toward HIV PrEP, compared with health promoters. Nurses had better practices in HIV PrEP delivery compared with health promoters (aOR 2.5; 95% CI 1.0 - 5.9; p=0.04). CONCLUSI0ON : Among the healthcare workers tasked with generating demand and identifying clients eligible for HIV PrEP services, low knowledge of HIV PrEP and negative attitudes towards HIV PrEP may be barriers to the uptake of HIV PrEP. Training healthcare workers on HIV PrEP is recommended.http://www.samj.org.zahj2024School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

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.The SA National Department of Health through a core surveillance funding grant to the National Institute for Communicable Diseases (NICD).http://www.samj.org.zaam2021School of Health Systems and Public Health (SHSPH

Conducting a secondary data analysis to estimate the incidence of congenital syphilis in South Africa, 2010–2016

Analysis of existing health data is often used as a cost-effective and time-efficient means to provide evidence to inform important public health decisions. However, the accuracy of the resultant decisions largely depends on the quality of the accessible data, and how the data are processed, analyzed, interpreted and reported. This case study, based on an actual secondary data analysis that was conducted by a trainee of the South African Field Epidemiology Training Programme during April 2017, was designed to provide a classroom simulation of practical considerations that should be taken into account when planning an analysis of a secondary dataset. The case study is ideally suited to reinforce principles already covered in lectures or in background reading assignments.http://www.panafrican-med-journal.comam2019School of Health Systems and Public Health (SHSPH

Determinants of loss to follow-up in patients on antiretroviral treatment, South Africa, 2004–2012 : a cohort study

BACKGROUND : The number of Human Immunodeficiency Virus (HIV) infected people eligible for initiation on antiretroviral Therapy (ART) is increasing. ART programmatic success requires that patients who are taking ART remain on treatment and are followed up regularly. This study investigated factors associated with being lost to follow-up, in a cohort of patients enrolled in a pharmacovigilance study in South Africa. METHODS : This was a retrospective observational cohort study performed at one of the Medunsa National Pharmacovigilance Centre’s (MNPC) ART sentinel surveillance sites. Loss to Follow-up (LTFU) was defined as “a patient who had been followed up at the sentinel site, who had not had contact with the health facility for 180 days or more since their last recorded expected date of return or if there were 180 days or more between the expected date of return and the next clinic visit”. RESULTS : Out of 595 patients, 65.5 % (n = 390) were female and 23.4 % (n = 139) were LTFU. The median time on ART before LTFU was 21.5 months (interquartile range: 12.9 – 34.7 months). The incidence rate of LTFU was 103 per 1000 person-years in the first year on ART and increased to 405 per 1000 person-years in the eighth year of taking ART. Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95 % Confidence Interval (CI):1.19-6.97, p = 0.019), being self-employed (aHR: 13.9, 95 % CI:2.81 - 69.06, p = 0.001), baseline CD4 count > 200 cells/ml (aHR: 3.8, 95 % CI: 1.85-7.85, p < 0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95 % CI:1.98 - 6.52, p < 0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95 % CI:1.22-3.27, p = 0.006). Patients that previously had an ART adverse event had a lower risk (aHR: 0.6, 95 % CI: 0.38 - 0.99, p = 0.044) of becoming LTFU than those that had not. CONCLUSION : The incidence rate of LTFU increases with additional years on ART. Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.The University of Pretoria School of Health systems and Public Health and the South African Field Epidemiology and Laboratory training program.http://www.biomedcentral.com/bmchealthservresam201

Determinants of sub-optimal glycemic control among patients enrolled in a medicine dispensing programme in KwaZulu-Natal : a cohort study, 2018–2021

DATA AVAILABITY STATEMENT: Permissions to publish were granted by the NDoH, the NHLS and the CCMDD Programme. The data that support the findings of this study are available from third parties, namely, the CCMDD and NHLS. Restrictions apply to the availability of these data, which were used under licence for this study. Data are available from the authors with the permission of the CCMDD and NHLS.BACKGROUND: The Central Chronic Medicines Dispensing and Distribution (CCMDD) programme facilitates clinically stable patients to collect their chronic medication from community-based pick-up points. AIM: We determined baseline glycaemic control and rates and predictors of becoming suboptimally controlled for type 2 diabetes mellitus (T2DM) CCMDD-enrolled patients. SETTING: The setting of the study was eThekwini, KwaZulu-Natal, South Africa. METHODS: We performed a cohort study (April 2018- December 2021). We linked T2DM CCMDD-enrolled patients to glycated haemoglobin (HbA1c) data from the National Health Laboratory Service. We selected patients optimally controlled at their baseline HbA1c, with ≥ 1 repeat-test available. We used Kaplan–Meier analysis to assess survival rates and extended Cox regression to determine associations between time to sub-optimal control (HbA1c > 7%) and predictors. Adjusted hazard ratios (aHRs), 95% confidence interval (CI), and p-values are reported. RESULTS: Of the 41145 T2DM patients enrolled in the CCMDD programme, 7960 (19%) had a HbA1c result available. Twenty-seven percent (2147/7960) were optimally controlled at their baseline HbA1c. Of those controlled at baseline, 695 (32%) patients had a repeat test available, with 35% (242/695) changing to sub-optimal status. The HbA1c testing frequency as per national guidelines was associated with a lower hazard of sub-optimal glycaemic control (aHR: 0.46; 95% CI: 0.24–0.91; p-value = 0.024). Patients prescribed dual-therapy had a higher hazard of sub-optimal glycaemic control (aHR: 1.50; 95% CI: 1.16–1.95; p-value = 0.002) versus monotherapy. CONCLUSIONS: The HbA1c monitoring, in-line with testing frequency guidelines, is needed to alert the CCMDD programme of patients who become ineligible for enrolment. Patients receiving dual-therapy require special consideration. CONTRIBUTION: Addressing identified shortfalls can assist programme implementation.The South African Field Epidemiology Programme.https://phcfm.org/index.php/phcfmSchool of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-beingSDG-09: Industry, innovation and infrastructur

The performance of different case definitions for severe influenza surveillance among HIV-infected and HIV-uninfected children aged <5 years in South Africa, 2011–2015

In 2014, the World Health Organization (WHO) proposed a new severe influenza surveillance case definition, which has not been evaluated in a high human immunodeficiency virus (HIV) prevalence setting. Our study aimed to assess the performance of this proposed case definition in identifying influenza among HIV-uninfected and HIV-infected children aged <5 years in South Africa. We prospectively enrolled children aged <5 years hospitalised with physician-diagnosed lower respiratory tract infection (LRTI) at two surveillance sites from January 2011 to December 2015. Epidemiologic and clinical data were collected. We tested nasopharyngeal aspirates for influenza using reverse transcription polymerase chain reaction. We used logistic regression to assess factors associated with influenza positivity among HIV-infected and HIV-uninfected children. We calculated sensitivity and specificity for different signs and symptoms and combinations of these for laboratory-confirmed influenza. We enrolled 2,582 children <5 years of age with LRTI of whom 87% (2,257) had influenza and HIV results, of these 14% (318) were HIV-infected. The influenza detection rate was 5% (104/1,939) in HIV-uninfected and 5% (16/318) in HIV-infected children. Children with measured fever (≥38°C) were two times more likely to test positive for influenza than those without measured fever among the HIV-uninfected (OR 2.2, 95% Confidence Interval (CI) 1.5–3.4; p<0.001). No significant association was observed between fever and influenza infection among HIV-infected children. Cough alone had sensitivity of 95% (95% CI 89–98%) in HIV-uninfected and of 100% (95% CI 79–100%) in HIV-infected children but low specificity: 7% (95% CI 6–8%) and 6% (95% CI 3–9%) in HIV-uninfected and HIV-infected children, respectively. The WHO post-2014 case definition for severe acute respiratory illness (SARI—an acute respiratory infection with history of fever or measured fever of ≥ 38°C and cough; with onset within the last ten days and requires hospitalization), had a sensitivity of 66% (95% CI 56–76%) and specificity of 46% (95% CI 44–48%) among HIV-uninfected and a sensitivity of 63% (95% CI 35–84%) and a specificity of 42% (95% CI 36–48%) among HIV-infected children. The sensitivity and specificity of the WHO post-2014 case definition for SARI were similar among HIV-uninfected and HIV-infected children. Our findings support the adoption of the 2014 WHO case definition for children aged <5 years irrespective of HIV infection status.MassGenicshttps://journals.plos.org/plosonehj2020School of Health Systems and Public Health (SHSPH