Case fatality of patients with stroke over a 12-month period post stroke

Introduction. Stroke is among the top 4 causes of death in SouthAfrica and the top 10 leading causes of disability worldwide. There is a dearth of literature on stroke incidence, prevalence and outcome in sub-Saharan Africa. We aimed to establish the case fatality of stroke patients over a 12-month period post discharge from hospital.Methods. A total of 200 patients with first-time ischaemic stroke were recruited from Chris Hani Baragwanath Academic Hospital and followed up for 12 months. The Barthel Index (BI) and Rivermead Mobility Index (RMI) were used to establish patient functional ability and, by inference, stroke severity. Follow-up assessments were performed at 3, 6 and 12 months post discharge. Data analysis was largely descriptive in nature.Results. Thirty-eight per cent of patients died within the 12 month follow-up period; 25.5% within 3 months of discharge. The average length of hospital stay was 6 days. Low BI scores at discharge were observed in the majority of patients who died.Conclusion. The 12-month cumulative mortality was high (highest at the 3-month follow-up). The short hospital stay and poor functional ability of the patients post stroke possibly left them vulnerable to bed-rest complications, such as chest infections and pressure sores

Incidence estimation and calibration from cross-sectional data of acute infection HIV-1 seroconvertors

ABSTRACT Incidence estimation and calibration from cross-sectional data of acute infection HIV-1 seroconvertors. May 2007 Eustasius Musenge Masters in Medicine in the Field of Biostatistics and Epidemiology Supervised by: Mr E Marinda and Dr A Welte Background: The HIV-1 incidence (a very important measure used as a proxy for disease burden) can be estimated from a cross-sectional study. This incidence estimate has the advantage of reducing on costs and time, thus enabling more timely intervention; it is also ideal for developing nations. A common procedure used in making this estimate utilizes two antibody tests (Sensitive/Less sensitive tests). Due to the long window period of such tests (at least three months), persons classified as recently infected would have been infected more than three months prior to the test date. Detecting acute HIV-1 infection is very important since this is the most infectious stage of the disease. This research report explores a method of estimating incidence using an antibody test and a virological test, Polymerase Chain Reaction Ribonucleic Acid (PCR-RNA).The cross-sectional data used are from the Centre for the AIDS Programme of Research in South Africa (CAPRISA). Methods: Actual follow-up cohort data from CAPRISA acute infection cohort (AIC), comprised of 245 sex workers, were used to estimate the incidence of HIV-1 using a PCR-RNA ,virology test based, incidence formula. The result obtained was compared to the incidence estimate obtained by the classical method of estimating incidence the AIDS Programme of Research in South Africa (CAPRISA). Methods: Actual follow-up cohort data from CAPRISA acute infection cohort (AIC), comprised of 245 sex workers, were used to estimate the incidence of HIV-1 using a PCR-RNA ,virology test based, incidence formula. The result obtained was compared to the incidence estimate obtained by the classical method of estimating incidence (prospective cohort follow-up). As a measure to reduce costs inherent in virological tests (PCR-RNA), multistage pooling was discussed and several pooling strategies simulations were proposed with their uncertainties. Point estimates and interval estimates of the window period, window period prevalence and incidence from crosssectional study of the AIC cohort were computed. Findings: The mean window period was 6.6 days 95% CI: (2.7 – 13.0). The monthly window period prevalence was 0.09423 percent 95 % CI: (0.0193 – 0.1865)%. The incidence from the prospective cohort follow-up was 5.43 percent 95% CI: (3.9 – 9.2) %. The incidence estimate from cross-sectional formulae was 5.21 percent 95% CI: (4.1– 4.6). It was also shown by use of simulations that an optimum pool sample size is obtained when at least half the samples are removed on every run. Interpretation and recommendations: The PCR-RNA test is very sensitive at detecting acute HIV-1 infected persons. The incidence estimate from the crosssectional study formulae was very similar to that obtained from a follow-up study. The number of tests needed can be reduced and a good estimate of the incidence can still be obtained. The calibration was not accurate since the samples used were small and the window period duration was too short, hence, it was difficult to extrapolate to the whole population. Further work still needs to be done on the calibration of the proposed incidence formulae as it could be a very useful public health tool

The outcome of Mental Health Care Users admitted under Section 40 of the South African Mental Health Care Act (No 17 of 2002)

Objective: To determine the outcomes of mental health care users (MHCU’s) admitted in terms of Section 40 of the South African Mental Health Care Act (No 17 of 2002) (MHCA) and the factors, if any, that are associated with these outcomes. Method: The study was a retrospective record review of MHCU’s, 18 years and older, referred by the South African Police Service (SAPS) to Chris Hani Baragwanath Hospital (CHBH). All mental health care users handed over to CHBH by SAPS with completed MHCA form 22’s during the period July 2007 to December 2007 were included in the study. The outcomes, demographics and clinical characteristics of these referrals were obtained from hospital records. Results: During the six-month study period, 718 MHCU’s were referred by members of SAPS to the CHBH Emergency Department. Associations were found between discharged MHCU’s and i) being male, ii) being less than 35 years of age, iii) being unemployed, iv) having a lower level of education, v) having a past history of substance abuse and/or vi) a past psychiatric illness. Females were twice as likely to be unemployed and admitted to hospital (either to a psychiatric or general medical ward). MHCU’s diagnosed with delirium were more likely to be admitted intoa medical ward as compared to a psychiatric ward. Conclusion: As has been the case in most countries where police services have been incorporated into mental health acts, South Africa’s new Mental Health Care Act (No 17 of 2002) has resulted in a large number of referrals by the police to mental health services. However, many of these referrals may not be necessary as most MHCU’s end up not being admitted. The characteristics of police referrals suggest that the receiving facility should have thecapacity to identify factors that favour outpatient care (especially substance abuse problems) and divert MHCU’s presenting with such factors to appropriate treatment facilities without admitting them to the hospital.Keywords: Mental Health Care Act; Outcome; Police services; Mental illness, South Afric

Relationship between glycated haemoglobin and fasting plasma glucose among diabetic out-patients at the University Teaching Hospital, Lusaka, Zambia

Background: Glycated haemoglobin (HbA1c) measurement provides an accurate result of glycaemic levels from blood drawn at any time of day without reference to prandial state. We established the relationship between HbA1c and fasting plasma glucose (FPG) in diabetic out-patients among diabetic outpatients in Lusaka, Zambia.Methods: This cross-sectional study was carried out at the University Teaching Hospital diabetic clinic, Lusaka, Zambia. A total sample of 198 consenting participants was selected randomly from diabetic out-patients between September and December 2013. A structured interview schedule was used to capture data on socio-demographics and laboratory examination results. The Pearson’s correlation coefficient, Student’s t-test and Paired Samples t-test were used for data analysis.Results: A total of 198 patients (mean age+SD= 53.19±13.32 years) were involved in the study. Majority (60.10%) of the patients were females while 39.90 per cent were males. The mean±SD of FPG of the patients slightly increased from the previous 10.75±7.78 mmo/L to the current 11.09±6.23 mmo/L (p = 0.592). The mean±SD of HbA1c of the patients was 54.77±17.12 mmol/mol. There was a statistically significant weak and moderate positive correlation between HbA1c and the previous and current FPG (r = 0.282, P = 0.001 and (r = 0.385, p = 0.001), respectively. However, there was a statistically significant but weak negative correlation between HbA1c and age (r = -0.163, p = 0.023).Conclusion: We found evidence of an association between HbA1c and FPG proposing that as the FPG levels increase, the HbA1c levels also increase in a predictable way. There is need to sensitise more especially the major stakeholders in the management of diabetes mellitus to consider FPG as an alternative in glycaemic control monitoring in the absence of HbA1c

Monitoring good governance in South African local government and its implications for institutional development and service delivery. A case study of the sub-councills and councillor support department.

Masters in Public Administration - MPAThe empowering of local governments in South Africa as engines of national development has been plagued with problems and imbalance related to the ethic and the functioning of the local government machinery itself. The said imbalances are being reinforced by a lack of understanding and consensus as to what democracy is and how it should work. The consequences are widespread corruption and distortions of government priorities; both of which undermine the ability of governments to improve broad-based economic growth and social well-being. The central problem addressed in this study investigates the extent to what the City of Cape Town’s accountability mechanism support good governance and develop institutional development and service deliver. The researcher is of the opinion that municipalities in their daily endeavours should now be at the sustainable phase which would mean that all policies, systems and procedures are in place for good governance. The researcher further assumes that municipalities should be at this stage capacitated and therefore, are able to fulfil basic institutional mandate of providing basic services and facilitating economic development. This is a wide subject that different researchers will undertake and provide potential solutions. But for the purpose of this research the following are posited to prevent some developmental issues: Firstly, a wall-to-wall local government, i.e., a constitutional guarantee that there shall be local government through the jurisdiction of the country. This suggestion has waken up the importance to emphasize the distinction and independence of each local government. The only challenge within and between local government, is seen by a politico-administration dichotomy which historically has always been an issue in public administration. As a matter of facts, there is interpenetration between the role of political and the one of administrative leadership as one can’t separate them in practice since officials also play important role in policy development. The effectiveness of Ward Committees for institutional development in reflecting on the best practice at the operational level rests on the need to capacitate the said formed ward committees in terms of skills equipping to maintain a world class service standard. The author posits that, this will do away with incompetence at local level and will promote efficiency and effectiveness in the fulfillment of daily tasks. Furthermore the following should be considered: 1.There should be a provision of adequate resources; this will enable officials to perform their tasks. 2. There should be a display of less politics or noninterference from politicians in the administration; this will avoid encroachment and mismanagement while enhancing proper accountability principles. Secondly, local government should maintain democratic elections, i.e., an electoral system that mixes proportional representation with ward representation as the best basis for local government councils. A wide array of information collected on this level from respondents posited that local government should only have ward representation although full time councillors found it difficult to perform both functions because of high demand from the community and from their job. This should maybe be rated at 90% to 10% rather than 50%.Finally, emphasis should be on financial decision-making power i.e., municipalities should be creatures of the Constitution rather than creatures of statue. The formal local government only entrusted service delivery powers to local government. Municipalities were not developmental in nature. However, the current local government is expected to be developmental. This turns its focus on top of its daily routine, to economic development. It is only then that one can maintain that local government powers are relevant to the development mandate

Glycaemic control in diabetic patients in Zambia

Introduction: the glycaemic control status of diabetic patients affects the management of their disorder. We examined the glycaemic control and clinical factors that may influence the achievement of the glycaemic control targets among diabetic out-patients. Methods: this was a hospital based cross-sectional study carried out at the University Teaching Hospital diabetic clinic in Lusaka, Zambia. A simple random sample of 198 consenting participants was selected from diabetic out-patients between September and December 2013. A structured interview schedule was used to capture socio-demographic data as well as needed clinical data from clients’ medical records and laboratory results. Multivariate binary logistic regression analysis was carried out to examine factors that may be associated with the glycaemic control status of these diabetic patients. Results: overall (n=198), mean (SD) age was 53.19±13.32 years. Majority (61.3%) of the patients had poor glycaemic control status (HbA1c≥49 mmol/mol). Insulin treatment (OR 0.13, 95% CI: 0.01 - 1.41), systolic blood pressure (OR 1.04, CI: 1.00 - 1.08) and fasting plasma glucose (previous; OR 0.81, CI: 0.72 - 0.90 and current; OR 0.85, CI: 0.78 - 0.93) were statistically significantly associated with glycaemic control. The poor glycaemic control observed in this study is similar to that reported in other published studies. Conclusion: we found evidence of poor glycaemic control in the study population suggesting need to explore the reasons for this. Association of Insulin, systolic blood pressure and fasting plasma glucose with glycaemic control further suggests the efficiency of traditional basic monitoring parameters which should be exploited in sharpening primary preventive strategies especially those that support lifestyle modification. Such efforts should also be integrated in all information, education and communication strategies that target but not limited to hospital based patients too

HIV Disease Progression Among Antiretroviral Therapy Patients in Zimbabwe: A Multistate Markov Model.

Background: Antiretroviral therapy (ART) impact has prolonged survival of people living with HIV. We evaluated HIV disease progression among ART patients using routinely collected patient-level data between 2004 and 2017 in Zimbabwe. Methods: We partitioned HIV disease progression into four transient CD4 cell counts states: state 1 (CD4 ≥ 500 cells/μl), state 2 (350 cells/μl ≤ CD4 < 500 cells/μl), state 3 (200 cells/μl ≤ CD4 < 350 cells/μl), state 4 (CD4 < 200 cells/μl), and the absorbing state death (state 5). We proposed a semiparametric time-homogenous multistate Markov model to estimate bidirectional transition rates. Covariate effects (age, gender, ART initiation period, and health facility level) on the transition rates were assessed. Results: We analyzed 204,289 clinic visits by 63,422 patients. There were 24,325 (38.4%) patients in state 4 (CD4 < 200) at ART initiation, and 7,995 (12.6%) deaths occurred by December 2017. The overall mortality rate was 3.9 per 100 person-years. The highest mortality rate of 5.7 per 100 person-years (4,541 deaths) was from state 4 (CD4 < 200) compared to other states. Mortality rates decreased with increase in time since ART initiation. Health facility type was the strongest predictor for immune recovery. Provincial or central hospital patients showed a diminishing dose-response effect on immune recovery by state from a hazard ratio (HR) of 8.30 [95% confidence interval (95% CI), 6.64-10.36] (state 4 to 3) to HR of 3.12 (95% CI, 2.54-4.36) (state 2 to 1) compared to primary healthcare facilities. Immune system for male patients was more likely to deteriorate, and they had a 32% increased mortality risk (HR, 1.32; 95% CI, 1.23-1.42) compared to female patients. Elderly patients (45+ years) were more likely to immune deteriorate compared to 25-34 years age group: HR, 1.35; 95% CI, 1.18-1.54; HR, 1.56; 95% CI, 1.34-1.81 and HR, 1.53; 95% CI, 1.32-1.79 for states 1 to 2, state 2 to 3, and states 3 to 4, respectively. Conclusion: Immune recovery was pronounced among provincial or central hospitals. Male patients with lower CD4 cell counts were at a higher risk of immune deterioration and mortality, while elderly patients were more likely to immune deteriorate. Early therapeutic interventions when the immune system is relatively stable across gender and age may contain mortality and increase survival outcomes. Interventions which strengthen ART services in primary healthcare facilities are essential

Prevalence and determinants of malnutrition among under-five children in Lusaka urban, Zambia

Background: Malnutrition is a severe and persisting cause of morbidity and mortality among under-five children in Zambia. We assessed malnutrition and its determinants among under-five children in Lusaka urban, Zambia. &nbsp;Methods: This cross-sectional study was conducted at Chawama, Kabwata, Chilenje and Mtendere urban clinics in Lusaka. A simple random sample of 384 under-five children were selected between February and March 2015. A structured interview schedule was used to collect data on demographic characteristics, determinants of malnutrition and anthropometric measurements. Multivariate binary logistic regression analysis was carried out using IBM® SPSS® Statistics for Windows Version 20.0 to identify determinants of malnutrition while adjusting for confounders. &nbsp;Results: Of the 384 under-five children, most (51.8%) of them were male and the mean (SD) age was 13.83±10.17 months. The zH/A; zW/H; and zW/A was 68.5% and 31.5%; 95.6% and 4.4%; and 86.2% and 13.8% for normal and stunted; normal and wasted; and normal and underweight respectively. Majority (77.1%) of the children had MUAC &gt; 12.5 cm, 16.9% had 11.5 – 12.5 cm and 6.0% had &lt; 11.5 cm. Mother’s good nutritional practices (OR 0.50, 95% CI: 0.27 – 0.95) and MUAC &gt; 12.5 cm (OR 0.10, 95% CI: 0.01 – 0.94; OR 0.01, 0.00 – 0.10; and OR 0.4, 0.01 – 0.19) were statistically significantly associated with stunting, wasting and underweight respectively. &nbsp;Conclusion: We established varied levels of stunting, wasting and underweight and mother’s nutritional practices and MUAC predicted these levels. More information, education and communication messages to the mothers and caretakers with regard to nutritional practices are needed so that under-nutrition can be improved, to ensure healthy living for mothers, care takers and under-five children. &nbsp; &nbsp