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

Pancreatic cancer mortality in South Africa: A case-control study

Background. There are variations in the numbers of pancreatic cancer deaths reported annually in South Africa (SA). Since pancreatic cancer deaths occurred in SA from 1997 to 2016, the number of cases has hugely increased, and reached 23 581 in both sexes. Sex differences are likely to contribute to the variations in the strength of associations between the risk factors and pancreatic cancer mortality. Objective. To identify factors associated with an increased risk of pancreatic cancer mortality in SA. Methods. A matched case-control study with 1:1 matching was conducted using data collected by Statistics SA from 1997 to 2016. Controls were randomly selected to be as similar as possible to the cases, and matched by age, sex and year of death. Conditional logistic regression was used to identify factors associated with pancreatic cancer mortality. Results. This case-control study comprised a final selection of 23 581 cases (12 171 males and 11 410 females) and 23 581 controls (12 171 males and 11 410 females). A significantly increased risk of pancreatic cancer mortality was observed among males who were managers (odds ratio (OR) 2.99; 95% confidence interval (CI) 1.36 - 6.60; p=0.006) and craft and related trade workers (OR 1.89; 95% CI 1.14 - 3.14; p=0.013). Elevated risks of pancreatic cancer mortality were also found among females who were managers (OR 6.13; 95% CI 1.32 - 28.52; p=0.021), professionals (OR 2.12; 95% CI 1.24 - 3.63; p=0.006), clerical support workers (OR 3.78; 95% CI 1.79 - 7.98; p=0.001) and elementary occupation workers (OR 1.41; 95% CI 0.99 - 2.00; p=0.059). Smoking was significantly associated with pancreatic cancer mortality in females (OR 1.36; 95% CI 1.02 - 1.82; p=0.039). Working in several occupations was associated with an increased risk of pancreatic cancer mortality in males (OR 1.31; 95% CI 1.01 - 1.71; p=0.045) and females (OR 1.66; 95% CI 1.30 - 2.12; p<0.001). Conclusion. Smoking and certain occupations increased the risk of pancreatic cancer mortality. Further research is needed to evaluate the associations between other extrinsic and intrinsic factors and pancreatic cancer mortality

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

Antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus isolates from South Africa

Objective. Trends in the antibiotic susceptibility of methicillinresistantStaphylococcus aureus (MRSA) are regularlyinvestigated in many countries, but minimal countrywidedata are available for South Africa. The aim of this study wasto describe the antibiotic susceptibility patterns of MRSAisolates collected in South Africa.Design. Susceptibility testing of 248 MRSA isolates collectedfrom 15 National Health Laboratory Services (NHLS) and8 private laboratories against 17 antibiotics was performedusing the disc diffusion method. Demographic data werecollected and correlated with antibiotic resistance patterns.Results. Antibiotic resistance of MRSA to erythromycin,tetracycline, trimethoprim/sulfamethoxazole, gentamicinand ciprofloxacin ranged between 55% and 78%, while allisolates were susceptible to teicoplanin, linezolid, vancomycinand quinopristin/dalfopristin. A significant difference in theresistance pattern of the isolates towards certain antimicrobialagents was identified among adults and children, as wellas between isolates collected from the private and NHLSlaboratories.Conclusion. This is the first extensive report on theantimicrobial susceptibilities of South African MRSA isolates.These data can assist treatment decisions and form a baselinefor further surveillance

Common lower extremity injuries in female high school soccer players in Johannesburg east district

Objectives. Soccer is one of the sports in South Africa which hasseen an increase in the participation of youth and adult female players. The aim of this study was to determine point and 1-year prevalence, profile of injuries that affect female soccer players, associations between injuries and player position, age, use of equipment, frequency of play, and training duration. Methods. A retrospective questionnaire-based descriptive survey of 103 first team high school female soccer players in the Johannesburg east district was conducted.Results. The 1-year prevalence for the participants who reportedinjuries was 46% (N=47) and the point prevalence was 33% (N=34). From these, a total of 78 and 42 injuries for the 1-year and point prevalence respectively were reported. An extended duration of skills (p=0.0001) and fitness (p=0.02) training in this population reduced the likelihood of incurring an injury. The older the participants, the more chance there was of sustaining injuries (p=0.01). The participants who wore shin guards were less prone to shin/leg injuries (p=0.01), the relative odds being 0.35. Themidfielders had more foot and toe injuries than the other players(p=0.05). Starting age (p=0.78), frequency of play (p=0.83), wearing of shoes (p=0.54) and stretching had no influence on injury. The knee and ankle were the main locations of injury, with defenders and midfielders mostly being injured. Conclusion. A decrease in the duration of training for both skills and fitness and not wearing shin guards are risk factors for injury in female soccer players in high school. The profile of injuries andthe risk factors determined from this study do not differ from the studies done in male adolescent and adult soccer players

Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa.

Introduction: In low/middle-income countries with substantial HIV and tuberculosis epidemics, health services often neglect other highly prevalent chronic conditions, such as hypertension, which as a result are poorly managed. This paper reports on a study to assess the effect on hypertension management of lay health workers (LHW) working in South African rural primary healthcare clinics to support the provision of integrated chronic care. Methods: A pragmatic cluster randomised trial with a process evaluation in eight rural clinics assessed the effect of adding two LHWs supporting nurses in providing chronic disease care in each intervention clinic over 18 months. Control clinics continued with usual care. The main outcome measure was the change in the difference of percentage of clinic users who had elevated cardiovascular risk associated with high blood pressure (BP) before and after the intervention, as measured by two cross-sectional population surveys. Results: There was no improvement in BP control among users of intervention clinics as compared with control clinics. However, the LHWs improved clinic functioning, including overall attendance, and attendance on the correct day. All clinics faced numerous challenges, including rapidly increasing number of users of chronic care, unreliable BP machines and cuffs, intermittent drug shortages and insufficient space. Conclusion: LHWs improved the process of providing care but improved BP control required improved clinical care by nurses which was compromised by large and increasing numbers of patients, the dominance of the vertically funded HIV programme and the poor standards of equipment in clinics. Trial registration number: ISRCTN12128227.The Nkateko study was funded by the UK Medical Research Council under the Global Alliance for Chronic Diseases (GACD) Programme

Rheumatoid arthritis - clinical aspects: 134. Predictors of Joint Damage in South Africans with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) causes progressive joint damage and functional disability. Studies on factors affecting joint damage as clinical outcome are lacking in Africa. The aim of the present study was to identify predictors of joint damage in adult South Africans with established RA. Methods: A cross-sectional study of 100 black patients with RA of >5 years were assessed for joint damage using a validated clinical method, the RA articular damage (RAAD) score. Potential predictors of joint damage that were documented included socio-demographics, smoking, body mass index (BMI), disease duration, delay in disease modifying antirheumatic drug (DMARD) initiation, global disease activity as measured by the disease activity score (DAS28), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and autoantibody status. The predictive value of variables was assessed by univariate and stepwise multivariate regression analyses. A p value <0.05 was considered significant. Results: The mean (SD) age was 56 (9.8) years, disease duration 17.5 (8.5) years, educational level 7.5 (3.5) years and DMARD lag was 9 (8.8) years. Female to male ratio was 10:1. The mean (SD) DAS28 was 4.9 (1.5) and total RAAD score was 28.3 (12.8). The mean (SD) BMI was 27.2 kg/m2 (6.2) and 93% of patients were rheumatoid factor (RF) positive. More than 90% of patients received between 2 to 3 DMARDs. Significant univariate predictors of a poor RAAD score were increasing age (p = 0.001), lower education level (p = 0.019), longer disease duration (p < 0.001), longer DMARD lag (p = 0.014), lower BMI (p = 0.025), high RF titre (p < 0.001) and high ESR (p = 0.008). The multivariate regression analysis showed that the only independent significant predictors of a higher mean RAAD score were older age at disease onset (p = 0.04), disease duration (p < 0.001) and RF titre (p < 0.001). There was also a negative association between BMI and the mean total RAAD score (p = 0.049). Conclusions: Patients with longstanding established RA have more severe irreversible joint damage as measured by the clinical RAAD score, contrary to other studies in Africa. This is largely reflected by a delay in the initiation of early effective treatment. Independent of disease duration, older age at disease onset and a higher RF titre are strongly associated with more joint damage. The inverse association between BMI and articular damage in RA has been observed in several studies using radiographic damage scores. The mechanisms underlying this paradoxical association are still widely unknown but adipokines have recently been suggested to play a role. Disclosure statement: C.I. has received a research grant from the Connective Tissue Diseases Research Fund, University of the Witwatersrand. All other authors have declared no conflicts of interes