Understanding first year university students' perception of poster and television health communication messages on HIV/AIDS.

Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2006.No abstract available

Surgical site infections at a quaternary South African Hospital: epidemiology and impact on healthcare resources.

Doctoral Degree. University of KwaZulu-Natal, Durban.ABSTRACT Background: Studies focused on the epidemiology of surgical site infection (SSI) and its impact on healthcare resource utilisation in resource-constrained African settings are rare. This information is important for two reasons: 1) It facilitates the development of setting-specific risk stratification tools for identifying patients who might benefit fro m additional preventative interventions, and 2) It can guide public health specialists’ decisions around resource and budget allocations to surgical units and the degree to which this can be optimised through SSI prevention. The research comprising this PhD thesis sought to address these gaps in the knowledge. Methodology: This research is comprised of five stand-alone analyses involving surgical patient dataobtained from a South African quaternary hospital. The data was collected through patient medical chart review, as well as accessing the hospital’s and service laboratory’s administrative systems. Study designs used in this research include cohort, trend analysis, geospatial analysis, case-control, and prognostic study designs. Results: The incidence of SSI in high-risk laparotomy patients was 16.6%. Risk factors for SSI in this group included infectious indication for surgery, preoperative non-steroidal anti-inflammatory use, preoperative hypoalbuminemia, Bogota bag use, and perioperative blood transfusion. A 10-year trend analysis of all surgeries performed at the hospital found no change in admissions for post-discharge SSI. Mortality in elderly SSI admissions declined. The geospatial analysis found that most postdischarge SSI admissions originated from urban areas. Analysis of the laparotomy dataset showed that SSI resulted in an additional 1.06 days of hospitalisation (additional cost of ZAR8900/ $1180), but only in patients who already had short hospital stays. While preoperative hypoalbuminemia demonstrates a similar prognostic performance to the more complex SENIC/NNIS risk stratification methods (Cstatistic 0.677 versus 0.652/0.634), preoperative serum sodium is unlikely to have the same prognostic utility. Conclusions: SSI is common among South African patients undergoing high-risk surgery. A settingspecific, multifactorial risk stratification tool might be of benefit in this population. Inpatient and postdischarge SSIs contribute to unnecessary healthcare utilisation a expenditure in this resource constrained setting. There is also great potential for certain routine preoperative laboratory tests to be used as simple, cost-effective SSI risk stratification tools in African settings. Isizinda: Ucwaningo lugxile ekwakhiwenisimo sendawo ehlinziwe yokutheleleka (SSI) nomthelela wakho wokusetshenziswa komthombo wokunakekela ngokokwelapha ezizindeni esivaleleke e-Afrika nokungavamile. Lolu lwazi lubalulekile ngezizathu ezimbili: 1) Kusebenzisa intuthuko yamathuluzi okuchaza ingcuphe egxile esizindeni esiqondile sokuhlonza iziguli ezingazuza emizamweni eyongeziwe yokuvimbela, nokuthi 2) ingahola izinqumo zongoti bezempilo yomphakathi ngomthombo nokwabiwa kwezimali kuya ezikhungweni zokuhlinzwa kanye nezinga lapho enganyuswa khona ngokuvimbela nge-SSI. Ucwaningo okusekelwe kuyo le PhD kuhloswe ngalo ukubhekana nalezi zikhala olwazini. Indlelakwenza: Lolu cwaningo lunohlaziyo oluyisihlanu oluzimele olufaka imininingo yesigulo esihlinziwe olutholakele esibhedlela esisezingeni lesine. Imininingo iqoqwe ngokubuyekeza ishathi lokwelapha lesiguli, kanjalo nokufinyelela ezinhlelweni zesibhedlela kanjalo nezinsiza zaselabhorethri. Uhlelosakhiwo locwaningo olusetshenziswe kulolu cwaningo lufaka ikhohothi, ukuhlaziya okwenziwa kuleso sikhathi, ukuhlaziya umumomhlaba, ukulawula ucwaningonto, nohlelosakhiwo locwaningo oluyinhlonzasifo. Imiphumela: Ukwenzeka kwe-SSI ezigulini ezisengcupheni yelapharathomi ingama-16.6zengcuphe ze-SSI kuleli qembu elifakwe izinkomba zokutheleleka, isidambisikuvuvukala okunganasteroydi angesikhathi sokuhlinzwa. Ukuhlaziya okwenzeka eminyakeni eyi-10 kokuhlinza okwenziwa esibhedlela akutholanga shintsho ekungenisweni esibhedlela emva kokukhishwa. Ukufa kwabadala ekufakweni esibhedlela nge-SSI kusukela ezindaweni zasemadolobheni. Ukuhlaziya kwedathasethi yelapharothomi ikhombise ukuthi i-SSI inomphumela wezinsuku ezi-1.06 ezongeziwe zokulaliswa esibhedlela (izindleko ezongeziwe zama-ZAR8900/$1180), kodwa yiziguli esezike zahlala kafushane esibhedlela. Ngesikhathi i-hypoalbuminemia ngaphambi kokuhlinzwa ikhombisa ukusebenza kokuhlonzwa kwesifo ezindlelenikwenza zokuchaza ingcuphe eyinkimbi ye-SENIC/NNIS (istathistikhi i-C0677 uma siqhathaniswa ne-0.652/0.634), isiramu yesodiyamu yangaphambi kokuhlinzwa okungenzeka ibe nenhlonzasifo efanayo. Iziphetho: I-SSI ivamile ezigulini zaseNingizimu Afrika ezisezingcupheni ezinkulu. Isizinda esiqondile, ithuluzi lokucacisa ingcuphe enezizathu eziningi zokuzuza eqoqwenibantu. Iziguli ezelashelwa esibhedlela nama-SSI emva kokukhishwa esibhedlela kufaka ukusetshenziswa kokunakekelwa ngokwezempilo nokusetshenziswa kulesi sizinda esincishelwe yimithombo. Kuphinde kube nokukwazi okusezingeni ngokwezivivinyo ezilungiswe ngaphambi kwesikhathi elabhorethri ukuba zisetshenziswe, njengamathuluzi alula, nashibhile okuchaza ingcuphe yama-SSI ezizindeni zase-Afrika.Zulu language title not available

The wrong and wounding road: Paediatric polytrauma admitted to a level 1 trauma intensive care unit over a 5-year period

Background. Injury in childhood is a major cause of potentially preventable morbidity and mortality. In order to implement effective preventive strategies, epidemiological data on mechanisms of injury and outcome are essential.Objectives. To assess the causation, severity of injury, morbidity and mortality of paediatric trauma admitted to a level 1 trauma intensive care unit (TICU).Methods. Children were defined as being <16 years of age. The study covered the 5-year period January 2008 - December 2012. Eligible patients were identified from a prospective database maintained in the level 1 TICU at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Data extracted were referral source, mechanism of injury, age and gender distribution, injury severity score (ISS), anatomical distribution of injury and mortality.Results. A total of 181 patients admitted during the study period accounted for 15.9% of all admissions. There were 84 females (46.4%) and 97 males (53.6%), with a median age of 7 years (interquartile range (IQR) 4 - 10). Sources of admission were directly from the scene in 38 cases (21.0%), from a primary healthcare facility in 47 (26.0%), from a regional hospital in 56 (31.0%) and from a tertiary facility in 40 (22.0%). Mortality rates according to location of transfer were regional hospital 8 deaths (30.8%), tertiary facility 7 (26.9%), primary health clinic 7 (26.9%), and from the scene 4 (15.4%). Mechanisms of injury were pedestrian-motor vehicle collision (PMVC) in 105 cases (58.0%), motor vehicle passenger in 38 (21.0%), non-vehicular blunt trauma in 18 (10.0%), gunshot wounds (GSWs) in 12 (6.6%), stab wounds in 6 (3.3%), bull goring in 1 (0.5%) and bicycle accident 1 (0.5%). The median ISS for all admissions was 25 (IQR 16 - 38). ISSs were >25 in 98 patients (54.1%), 16 - 25 in 51 (28.2%), 9 - 15 in 9 (4.9%) and <9 in 13 (7.2%); 61.9% of patients had head injuries, 48.1% injuries to the extremities, 41.4% abdominal trauma, 40.3% thoracic trauma, 20.4% external soft-tissue trauma, 9.9% cervical injury and 9.4% facial trauma. There were 26 deaths (14.4%), of which PMVCs accounted for 16 (61.5%), motor vehicle passengers for 7 (26.9%), blunt trauma for 2 (7.7%) and GSWs for 1 (3.8%). The majority of deaths (92%) were of patients with an ISS >25. Of the 26 patients who died, 88.4% had a head injury, 46.2% an extremity injury, 38.5% an external injury, 34.6% abdominal or chest injuries, 19.2% neck injury and 11.5% facial injury.Conclusions. Motor vehicle-related injuries, especially PMVCs, dominate severe paediatric trauma and there is an urgent need for more road traffic education and stringent measures to decrease the incidence and associated morbidity and mortality

Incidence And Risk Factors For Surgical Site Infection Following Laparotomy At A South African Quaternary Hospital

Published ArticleBackground: A published report of surgical site infection (SSI) incidence and risk factors following laparotomy in a South African (SA) setting is lacking. This information would have important implications for SSI clinical prediction rules in SA patients undergoing this common surgical procedure. This study sought to determine the incidence and associated risk factors for SSI following laparotomy in a SA setting. Methods: This was a retrospective chart review study of 439 patients who underwent laparotomy at a SA quaternary hospital over a 5-year period. Demographic information, comorbidities, medication use, and surgery-related variables were collected for each patient. The Centers for Disease Control definition of SSI was used in this study. The incidence of SSI was determined using conventional epidemiological methods. Logistic regression was used to identify risk factors for SSI. Results: The incidence of SSI was 16.6% (CI: 13.4-20.4%). Risk factors for SSI included infectious indication for surgery (Odds Ratio, OR: 3.32, CI: 1.16-9.47; p=0.003), preoperative non-steroidal anti-inflammatory use (OR: 2.82, CI: 1.33-5.95; p=0.007), preoperative hypoalbuminemia (OR: 2.47, CI: 1.12-5.42; p=0.025), Bogota bag use (OR: 2.23, CI: 1.05-4.74; p=0.036), and perioperative blood transfusion (OR: 2.51, CI: 1.33-4.75; p=0.004). Conclusion: The incidence of SSI in SA patients undergoing laparotomy is higher than that reported for mixed surgical populations. Several risk factors for SSI were identified. The prognostic relevance of these risk factors, and the reduction in SSI risk when these factors are addressed requires further investigation

Establishing a baseline of published air pollution and health research studies in the Waterberg-Bojanala Priority Area

An umbrella review study was conducted to establish a baseline of published air pollution and health research studies in the Waterberg-Bojanala Priority Area (WBPA). Forty peer-reviewed research studies were included based on the systematic search criteria. Less than ten studies considered air quality and health in the WBPA (as opposed to only air quality) and of these studies, only a few collected human health data in relation to air pollution exposure. Identified studies together showed that air quality is a problem in the WBPA, with ambient air quality levels often exceeding national ambient air quality standards. Based on the findings, we recommend that more focused health studies be conducted in the WBPA to better understand the air pollution-related health burden at the population and the individual level. Such studies will help bolster the baseline evidence of the impacts of air pollution on human health and wellbeing in the WBPA and support decision-making in the future

Establishing a baseline of published air pollution and health research studies in the Waterberg- Bojanala Priority Area

Though originally the Waterberg-Bojanala Priority Area (WBPA) was strategically declared as an air quality priority area due to potential future air pollution risks, it is now a confirmed air pollution hotspot. More research is needed to assess the health impacts of air pollution in the WBPA. The aim of this study was to conduct an umbrella review to establish a baseline of the peer-reviewed research which has been conducted and published to assess the health outcomes associated with air pollution exposure, specifically in the WBPA. Just over seventy peer-reviewed research studies were included, based on the systematic search criteria. Fewer than ten studies considered air quality and health in the WBPA (as opposed to only air quality) and of these studies, only a few collected human health data in relation to air pollution exposure. Identified studies together showed that poor air quality is a problem in the WBPA, with ambient air quality levels often exceeding national ambient air quality standards. Based on the findings, we recommend that more focused health studies be conducted in the WBPA to advance our understanding of the air pollution-related health burden at the population and the individual level. Such studies will help bolster the baseline evidence of the impacts of air pollution on human health and wellbeing in the WBPA and support decision-making in the future.The South Africa Medical Research Council and the National Research Foundation.https://cleanairjournal.org.za/article/view/14887am2024Geography, Geoinformatics and MeteorologySDG-11:Sustainable cities and communitie

Evaluation of a synthetic peptide for the detection of anti-Mycobacterium tuberculosis curli pili IgG antibodies in patients with pulmonary tuberculosis.

CAPRISA, 2018.Abstract available in pdf

Co-enrollment in multiple HIV prevention trials — Experiences from the CAPRISA 004 Tenofovir gel trial

Background: In settings where multiple HIV prevention trials are conducted in close proximity, trial participants may attempt to enroll in more than one trial simultaneously. Co-enrollment impacts on participant's safety and validity of trial results. We describe our experience, remedial action taken, inter-organizational collaboration and lessons learnt following the identification of co-enrolled participants. Experiences: Between February and April 2008, we identified 185 of the 398 enrolled participants as ineligible. In violation of the study protocol exclusion criteria, there was simultaneous enrollment in another HIV prevention trial (ineligible co-enrolled, n = 135), and enrollment of women who had participated in a microbicide trial within the past 12 months (ineligible not co-enrolled, n = 50). Following a complete audit of all enrolled participants, ineligible participants were discontinued via study exit visits from trial follow-up. Custom-designed education program on co-enrollment impacting on participants' safety and validity of the trial results was implemented. Shared electronic database between research units was established to enable verification of each volunteer's trial participation and to prevent future co-enrollments. Lessons learnt: Interviews with ineligible enrolled women revealed that high-quality care, financial incentives, altruistic motives, preference for sex with gel, wanting to increase their likelihood of receiving active gel, perceived low risk of discovery and peer pressure are the reasons for their enrollment in the CAPRISA 004 trial. Conclusion: Instituting education programs based on the reasons reported by women for seeking enrollment in more than one trial and using a shared central database system to identify co-enrollments have effectively prevented further co-enrollments

Exploring the association between ambient temperature and daily hospital admissions for diarrhea in Mopani district, Limpopo province, South Africa

DATA AVAILABILITY STATEMENT: Data are available upon request from the corresponding author.Please read abstract in article.Sustainable Development (SATREPS) Program of JAPAN International Cooperation Agency (JICA)/Japan Agency; Climate and Earth Systems Science (ACCESS) program of National Research Foundation (NRF); Department of Science and Technology in South Africa (DST).https://www.mdpi.com/journal/healthcareGeography, Geoinformatics and Meteorolog