Latex allergy and its clinical features among healthcare workers at Mankweng Hospital, Limpopo Province, South Africa

BACKGROUND AND OBJECTIVES. Latex allergy, caused by sensitisation in atopic individuals, is a common occupational disease among healthcare workers who use latex gloves. It may be present in non-atopic individuals as well. The main objective of this study was to document the prevalence and disease spectrum of latex allergy at Mankweng Hospital, Limpopo Province, South Africa. The secondary objective was to determine clinical presentation of the disease. METHODS. A cross-sectional descriptive study, with an analytical component, was conducted among healthcare workers who worked in high-risk areas for latex sensitisation. ImmunoCAP testing was performed and followed by a skin-prick test (SPT) in those who tested negative to the blood test. RESULTS. Two hundred screening questionnaires were distributed to healthcare workers at the hospital. Of these 158 (79.0%) were returned, with 59 participants meeting the inclusion criteria (experiencing symptoms due to wearing latex gloves). The mean age of the participants was 39.6 years (standard deviation 9.8 years, range 20 - 60 years). There were more females (98.1%) than males (1.9%). Glove-related symptoms were present in 59 subjects (37.1%), in 7 (11.9%) of whom the ImmunoCAP was positive to latex (95% confidence interval 4.2 - 22.9%). Fourteen participants were lost to follow-up before the SPT was performed. Thirty-eight of the participants with negative ImmunoCAP tests underwent SPT. Positive SPTs were reported in 5 of these 38 workers (13.2%), indicating that the ImmunoCAP test missed 11.1% (5/45) of latex-allergic individuals. The prevalence of latex allergy in this study was 8.3% (12/144). A denominator of 144 was used, as there is a possibility that some of the 14 individuals lost to follow-up could have tested positive to latex sensitisation by SPT. The symptoms experienced by latex-sensitised workers were rhinitis (100.0%), asthma (50.0%), dermatitis (25.0%), severe anaphylaxis (8.3%), abdominal pain (8.3%) and angio-oedema (8.3%). CONCLUSION. Our findings reveal that latex allergy is a problem at our hospital. The prevalence of 8.3% is comparable to findings in other South African centres. We recommend a latex-free protocol for high-risk areas and healthcare workers.http://www.samj.org.zaam2014ay201

Breastfeeding and Complementary Feeding Practices among Caregivers at Seshego Zone 4 Clinic in Limpopo Province, South Africa

Breastfeeding and complementary feeding are key components of infant and young child feeding that ensure healthy growth, survival, and development. Initiating breastfeeding within an hour after delivery, exclusively breastfeeding for six months, and introducing complementary feeding at six months while continuing breastfeeding up to 24 months or beyond, helps in the prevention of malnutrition, which is a public health problem. The aim of this study was to determine breastfeeding and complementary feeding practices among caregivers of children under 24 months in Seshego, Limpopo Province. A quantitative and cross-sectional design was applied to collect data from 86 caregivers using convenience sampling. A structured questionnaire was utilised to gather data and analysed through statistical software, using descriptive and inferential statistics. Chi-square tests were used to determine associations at a 95% confidence interval where a p-value of <0.05 was considered statistically significant. The findings show that 55% of participants had good breastfeeding and complementary feeding practices. Moreover, 94.2% of participants breastfeed within an hour after delivery at a healthcare facility. Only 43.6% of children were exclusively breastfed. Most participants (52.3%) gave children food before six months and 45.1% introduced complementary feeding at the appropriate age. Also, 69.7% of children across all age groups were not given infant formula. No statistical association was observed between feeding practices and sociodemographic. Breastfeeding was initiated within an hour after delivery at the healthcare facilities, however, post discharge exclusive breastfeeding maintenance remains a challenge. Few infants were introduced to complementary feeding at the appropriate age. A post discharge intervention to practice exclusive breastfeeding, continued breastfeeding, and introduction of appropriate complementary feeding is recommended

Notes on a remotely operated vehicle survey to describe reef ichthyofauna and habitats – Agulhas Bank, South Africa

Background: Despite their ecological and economic importance, reef habitats on the central Agulhas Bank, off the southern tip of Africa, remain poorly studied. The ichthyofauna of these habitats cannot be surveyed using trawl gear. Objective: Preliminary assessment of the use of a remotely operated vehicle (ROV) to investigate the ichthyofauna associated with deep reef habitats on the central Agulhas Bank. Method: Underwater visual surveys were carried out during ROV dives (maximum duration 60 minutes; area covered approximately 800 m2; maximum dive depth 100 m). Results & discussion: The number of detected fish species (36) compares well with that reported from fishing surveys and commercial fisher data. Most (68%) fishes appeared to be undisturbed by the ROV. Species saturation was reached after a maximum of 135 minutes survey time, but species numbers increased and saturation times shortened (34 minutes minimum) with the introduction of bait. Conclusion:  ROV surveys may represent a non-extractive alternative to assess demersal ichthyofaunal diversity in relation to habitat structure and benthic cover on temperate reefs around South Africa

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa