The Association between Race and Crohn's Disease Phenotype in the Western Cape Population of South Africa, Defined by the Montreal Classification System

BACKGROUND: Inter-racial differences in disease characteristics and in the management of Crohn's disease (CD) have been described in African American and Asian subjects, however for the racial groups in South Africa, no such recent literature exists. METHODS: A cross sectional study of all consecutive CD patients seen at 2 large inflammatory bowel disease (IBD) referral centers in the Western Cape, South Africa between September 2011 and January 2013 was performed. Numerous demographic and clinical variables at diagnosis and date of study enrolment were identified using an investigator administered questionnaire as well as clinical examination and patient case notes. Using predefined definitions, disease behavior was stratified as ‘complicated’ or ‘uncomplicated’. RESULTS: One hundred and ninety four CD subjects were identified; 35 (18%) were white, 152 (78%) were Cape Coloured and 7(4%) were black. On multiple logistic regression analysis Cape Coloureds were significantly more likely to develop ‘complicated’ CD (60% vs. 9%, p = 0.023) during the disease course when compared to white subjects. In addition, significantly more white subjects had successfully discontinued cigarette smoking at study enrolment (31% vs. 7% reduction, p = 0.02). No additional inter-racial differences were found. A low proportion of IBD family history was observed among the non-white subjects. CONCLUSIONS: Cape Coloured patients were significantly more likely to develop ‘complicated’ CD over time when compared to whites

The association between childhood environmental exposures and the subsequent development of Crohn's Disease in the Western Cape, South Africa

BACKGROUND: Environmental factors during childhood are thought to play a role in the aetiolgy of Crohn's Disease (CD). However the association between age at time of exposure and the subsequent development of CD in South Africa is unknown. METHODS: A case control study of all consecutive CD patients seen at 2 large inflammatory bowel disease (IBD) referral centers in the Western Cape, South Africa between September 2011 and January 2013 was performed. Numerous environmental exposures during 3 age intervals; 0-5, 6-10 and 11-18 years were extracted using an investigator administered questionnaire. An agreement analysis was performed to determine the reliability of questionnaire data for all the relevant variables. RESULTS: This study included 194 CD patients and 213 controls. On multiple logistic regression analysis, a number of childhood environmental exposures during the 3 age interval were significantly associated with the risk of developing CD. During the age interval 6-10 years, never having had consumed unpasteurized milk (OR = 5.84; 95% CI, 2.73-13.53) and never having a donkey, horse, sheep or cow on the property (OR = 2.48; 95% CI, 1.09-5.98) significantly increased the risk of developing future CD. During the age interval 11-18 years, an independent risk-association was identified for; never having consumed unpasteurized milk (OR = 2.60; 95% CI, 1.17-6.10) and second-hand cigarette smoke exposure (OR = 1.93; 95% CI, 1.13-3.35). CONCLUSION: This study demonstrates that both limited microbial exposures and exposure to second-hand cigarette smoke during childhood is associated with future development of CD

Growth of a cohort of very low birth weight and preterm infants born at a single tertiary health care center in South Africa

BackgroundVery low birth weight (VLBW) and extremely low birth weight (ELBW) infants are known to be at high risk of growth failure and developmental delay later in life. The majority of those infants are born in low and middle income countries.AimGrowth monitoring in a cohort of infants born with a VLBW up to 18 months corrected age was conducted in a low resource setting tertiary hospital.MethodsIn this prospective cohort study, 173 infants with a birth weight below 1,501 g admitted within their first 24 h of life were recruited and the 115 surviving until discharged were asked to follow up at 1, 3, 6, 12 and 18 months. Weight, height and head circumferences were recorded and plotted on WHO Z-score growth charts.ResultsOf the 115 discharged infants 89 were followed up at any given follow-up point (1, 3, 6, 12 and/or 18 months). By 12 months of corrected age another 15 infants had demised (13.0%). The infants' trends in weight-for-age z-scores (WAZ) for corrected age was on average below the norm up to 12 months (average estimated z-score at 12 months = −0.44; 95% CI, −0.77 to −0.11), but had reached a normal range on average at 18 months = −0.24; 95% CI, −0.65 to 0.19) with no overall difference in WAZ scores weight between males and female' infants (p > 0.7). Similar results were seen for height at 12 months corrected age with height-for-age z-scores (HAZ) of the study subjects being within normal limits (−0.24; 95% CI, −0.63 to 0.14). The mean head circumference z-scores (HCZ) initially plotted below −1.5 standard deviations (S.D.), but after 6 months the z-scores were within normal limits (mean z-score at 7 months = −0.19; 95% CI, −0.45 to 0.06).ConclusionWeight gain, length and head circumferences in infants with VLBW discharged showed a catch-up growth within the first 6–18 months of corrected age, with head circumference recovering best. This confirms findings in other studies on a global scale, which may be reassuring for health systems such as those in South Africa with a high burden of children born with low birth weights

Using a mHealth system to recall and refer existing clients and refer community members with health concerns to primary healthcare facilities in South Africa: a feasibility study

Background: Lay health workers (LHWs) are critical in linking communities and primary healthcare (PHC) facilities. Effective communication between facilities and LHWs is key to this role. We implemented a mobile health (mHealth) system to improve communication and continuity of care for chronically ill clients. The system focused on requests from facility staff to LHWs to follow up clients and LHW referrals of people who needed care at a facility. We implemented the system in two rural and semi-rural sub-districts in South Africa. Objective: To assess the feasibility of the mHealth system in improving continuity of care for clients in PHC in South Africa. Method: We implemented the intervention in 15 PHC facilities. The clerks issued recalls to LHWs using a tablet computer. LHWs used smartphones to receive these requests, communicate with clerks and refer people to a facility. We undertook a mixed-methods evaluation to assess the feasibility of the mHealth system. We analysed recall and referral data using descriptive statistics. We used thematic content analysis to analyse qualitative data from semi-structured interviews with facility staff and a researcher fieldwork journal. Results: Across the sub-districts, 2,204 clients were recalled and 628 (28%) of these recalls were successful. LHWs made 1,085 referrals of which 485 (45%) were successful. The main client group referred and recalled were children under 5 years. Qualitative data showed the impacts of facility conditions and interpersonal relationships on the mHealth system. Conclusion: Using mHealth for recalls and referrals is probably feasible and can improve communication between LHWs and facility staff. However, the low success rates highlight the need to assess facility capacity beforehand and to integrate mHealth with existing health information systems. mHealth may improve communication between LHWs and facility staff, but its success depends on the health system capacity to incorporate these interventions

The association between environmental exposures during childhood and the subsequent development of Crohn's Disease: A score analysis approach

Background Environmental factors during childhood are thought to play a role in the aetiology of Crohn's Disease (CD). In South Africa, recently published work based on an investigation of 14 childhood environmental exposures during 3 age intervals (0-5, 6-10 and 11-18 years) has provided insight into the role of timing of exposure in the future development of CD. The 'overlapping' contribution of the investigated variables however, remains unclear. The aim of this study was to perform a post hoc analysis using this data and investigate the extent to which each variable contributes to the subsequent development of CD relative to each aforementioned age interval, based on a score analysis approach. Methods Three methods were used for the score analysis. Two methods employed the subgrouping of one or more (similar) variables (methods A and B), with each subgroup assigned a score value weighting equal to one. For comparison, the third approach (method 0) involved no grouping of the 14 variables. Thus, each variable held a score value of one. Results Results of the score analysis (Method 0) for the environmental exposures during 3 age intervals (0-5, 6-10 and 11-18 years) revealed no significant difference between the case and control groups. By contrast, results from Method A and Method B revealed a significant difference during all 3 age intervals between the case and control groups, with cases having significantly lower exposure scores (approximately 30% and 40% lower, respectively). Conclusion Results from the score analysis provide insight into the 'compound' effects from multiple environmental exposures in the aetiology of CD.IS

Die beraming van MIV behandeling-dekking in Suid Afrikaanse ART klinieke gebaseer op die tendens van CD4 telling verspreiding by ART inisiasie oor tyd en ’n dinamiese epidemiologiese model

Thesis (MSc)--Stellenbosch University, 2013.ENGLISH ABSTRACT: HIV treatment coverage is currently inferred by dividing the number of people alive and on antiretroviral treatment (ART) by the number of individuals eligible for treatment, and estimates of these numbers are often made using dynamical epidemiological model. However, this approach ignores data on the distribution of CD4 cell counts at the time of ART initiation, and hence the inferred treatment coverage may be inconsistent with these CD4 count data. Here, we present a more inclusive method to estimate treatment coverage by incorporating the time trend of the CD4 count distribution at ART initiation in the dynamic epidemiological model. Data analysis of a cohort of 61 398 HIV infected adult patients who initiated treatment at eight South African ART clinics between 2004-2009 was conducted. Next, we used the results of the statistical analysis to adjust the parameters in the epidemiological model that governs the rate at which people from different CD4 cell count levels initiate ART. Lastly, we calibrate the model to reproduce the number of people alive and on ART. More than 80% of individuals started treatment very late, with CD4 count <200 cells/ L. A maximum of three years were delayed treatment after being eligible in all clinics involved in this study. The treatment coverage reached 61% in the eight clinics in our study. Methods to estimate ART coverage should make maximal use of CD4 cell count data at ART initiation, which may help to improve accuracy of the coverage estimates.AFRIKAANSE OPSOMMING: Die dekking van HIV behandeling word huidiglik beraam deur die aantal mense op anti-retrovirale middels (ART) te deel deur die aantal mense wat die behandeling benodig, laasgenoemde beraam deur ’n dinamiese, epidemiologiese model. Hierdie benadering ignoreer egter data oor die verspreiding van CD4 tellings ten tyde van ART-inisiasie en dus kan die afgeleide behandeling dekking inkonsekwent wees met daardie CD4 telling data. Hier word ’n metode voorgestel wat behandeling dekking beraam deur die tendens van CD4 tellings ten tyde ART-inisiasie oor kalender tyd in die dinamiese model in te sluit.Data-analise van ’n groep van 61.398 MIV-besmette volwassenes pasiente wat behandeling begin by agt Suid-Afrikaanse kuns klinieke tussen 2004-2009 is uitgevoer. Volgende, ons gebruik die resultate van die statistiese analise die parameters in die epidemiologiese model wat bepaal die tempo waarteen mense van verskillende CD4 selle tel vlakke inisieer ART aan te pas. Ten slotte, ons kalibreer die model om voort te plant die berig aantal mense in die lewe en op die kuns. Meer as 80% individue behandeling begin baie laat, met ’n CD4-telling <200 selle L. ’N Maksimum van drie jaar vertraag behandeling nadat hy in aanmerking kom in alle klinieke betrokke in hierdie studie. Die behandeling dekking bereik 61% in die agt klinieke in ons studie. Metodes ART dekking te skat moet maksimale gebruik van CD4-telling data maak by ART-inisiasie, wat kan help om die akkuraatheid van die dekking skattings te verbeter

Prospective cohort study of mortality in very low birthweight infants in a single centre in the Eastern Cape province, South Africa

Background Neonatal mortality is a major contributor worldwide to the number of deaths in children under 5 years of age. The primary objective of this study was to assess the overall mortality rate of babies with a birth weight equal or below 1500 g in a neonatal unit at a tertiary hospital in the Eastern Cape Province, South Africa. Furthermore, different maternal-related and infant-related factors for higher mortality were analysed.Methods This is a prospective cohort study which included infants admitted to the neonatal wards of the hospital within their first 24 hours of life and with a birth weight equal to or below 1500 g. Mothers who consented answered a questionnaire to identify factors for mortality.Results 173 very low birth weight (VLBW) infants were recruited in the neonatal department between November 2017 and December 2018, of whom 55 died (overall mortality rate 32.0%). Twenty-three of the 44 infants (53,5%) with a birth weight below 1000 g died during the admission. One hundred and sixty-one mothers completed the questionnaire and 45 of their babies died.Main factors associated with mortality were lower gestational age and lower birth weight. Need for ventilator support and sepsis were associated with higher mortality, as were maternal factors such as HIV infection and age below 20 years.Conclusion This prospective study looked at survival of VLBW babies in an underprivileged part of the Eastern Cape of South Africa. Compared with other public urban hospitals in the country, the survival rate remains unacceptably low. Further research is required to find the associated causes and appropriate ways to address these

Environmental risk factors over three age intervals; 0–5 years, 6–10 years and 11–18 years. [4].

<p>Environmental risk factors over three age intervals; 0–5 years, 6–10 years and 11–18 years. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0171742#pone.0171742.ref004" target="_blank">4</a>].</p

Patient Medical and Surgical Management and Extraintestinal Manifestations (EIMs).

<p>*Statistical analysis excludes black patients.</p>†<p>Excludes 15 patients with insufficient records of medical management.</p>‡<p>Excludes 12 patients with incomplete records of surgical dates.</p>§<p>Other EIM disorders included; ankylosing spondylitis and primary biliary cirrhosis.</p

Montreal Classification Scheme.

<p>*Upper gastrointestinal (GI) modifier (L4) can be added to L1–L3 when concomitant upper GI disease present.</p>†<p>B1 category should be considered “interim” until a pre-specified time has elapsed from time of diagnosis. Suggested time period is between 5–10 years.</p>‡<p>“p” is added to B1–B3 when concomitant perianal disease is present.</p