Sub-optimal influenza vaccine uptake amongst student healthcare workers in South Africa

Background: Influenza vaccination is recommended for healthcare workers (HCWs), including student HCWs, due to increased risk of exposure to influenza in their work and learning environments. However, there are concerns with costs. Data on influenza vaccine uptake among student HCWs is limited. Objectives: To investigate influenza vaccine uptake and reasons for vaccination decisions amongst student HCWs. Methods: Descriptive study using an electronic self-administered structured questionnaire amongst final year health sciences students at a South African university. Data were captured using Microsoft Excel® and imported to IBM SPSS® Statistics for descriptive statistical analysis. Results: Most respondents were female (61.9% [140/226]), Black African (94.7% [214/226]), from the School of Medicine (41.2% [93/226]), with mean age 23.9±3.7 years. Although 75.2% (170/226) of students knew that vaccination is the most effective strategy to prevent influenza, uptake was low (21.7% [49/226]; 2020 season). The main reason for accepting influenza vaccination was to protect themselves (67.3% [33/49]). Reasons for non-vaccination included: ‘Influenza is a mild disease and no need to be vaccinated’ (28.8% [51/177]) and ‘Do not believe in the influenza vaccine’ (8.5% (15/177); lack of access: ’Did not get a chance to get the influenza vaccine’ (25.4% [45/177]) and no information: ‘Never heard of the influenza vaccine’ (14.1% [25/177]). Conclusions: Influenza vaccine uptake by student HCWs was low due to reasons related to vaccine hesitancy, lack of access and no information. Education about, and access to influenza vaccination for student HCWs must be strengthened

South African Paediatric Surgical Outcomes Study : a 14-day prospective, observational cohort study of paediatric surgical patients

BACKGROUND : Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). METHODS : We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. RESULTS : We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4–11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2–8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6–1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. CONCLUSIONS : The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. CLINICAL TRIAL REGISTRATION : NCT03367832.Jan Pretorius Research Fund; Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town; Department of Anaesthesia, University of the Witwatersrand; and the Paediatric Anaesthesia Community of South Africa (PACSA).https://bjanaesthesia.org2020-02-01gl2019Anaesthesiolog

The association between preoperative anemia and postoperative morbidity in pediatric surgical patients: A secondary analysis of a prospective observational cohort study

BACKGROUND : The prevalence of anemia in the South African pediatric surgical population is unknown. Anemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low- and middle-income countries (LMICs). AIM : The primary aim of this study was to describe the association between preoperative anemia and 26 defined postoperative complications, in noncardiac pediatric surgical patients. Secondary aims included describing the prevalence of anemia and risk factors for intraoperative blood transfusion. METHOD : This was a secondary analysis of the South African Paediatric Surgical Outcomes Study, a prospective, observational surgical outcomes study. Inclusion criteria were all consecutive patients aged between 6 months and <16 years, presenting to participating centers during the study period who underwent elective and nonelective noncardiac surgery and had a preoperative hemoglobin recorded. Exclusion criteria were patients aged <6 months, undergoing cardiac surgery, or without a preoperative Hb recorded. To determine whether an independent association existed between preoperative anemia and postoperative complications, a hierarchical stepwise logistic regression was conducted. RESULTS : There were 1094 eligible patients. In children in whom a preoperative Hb was recorded 46.2% had preoperative anemia. Preoperative anemia was independently associated with an increased risk of any postoperative complication (odds ratio 2.0, 95% confidence interval: 1.3-3.1, P = .002). Preoperative anemia (odds ratio 3.6, 95% confidence interval: 1.8-7.1, P < .001) was an independent predictor of intraoperative blood transfusion. CONCLUSION : Preoperative anemia had a high prevalence in a LMIC and was associated with increased postoperative complications. The main limitation of our study is the ability to generalize the results to the wider pediatric surgical population, as these findings only relate to children in whom a preoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anemia reduces morbidity and mortality in children undergoing noncardiac surgery.http://wileyonlinelibrary.com/journal/panhj2021Anaesthesiolog