Surgical Capacity at District Hospitals in the Western Cape, South Africa

IntroductionLimited data exist on Clostridium difficile infection (CDI) in low-resource settings and settings with high prevalence of HIV. We aimed to determine baseline CDI patient characteristics and management and their contribution to mortality.MethodsWe reviewed adult patients hospitalised with diarrhoea and a C. difficile test result in 2015 from four public district hospitals in the Western Cape, South Africa. The primary outcome measures were risk factors for mortality. Secondary outcomes were C. difficile risk factors (positive vs negative) and CDI treatment.ResultsCharts of patients with diarrhoea tested for C. difficile (n=250; 112 C. difficile positive, 138 C. difficile negative) were reviewed. The study population included more women (65%). C. difficile-positive patients were older (46.5 vs 40.7 years, p<0.01). All-cause mortality was more common in the C. difficile-positive group (29% vs 8%, p<0.0001; HR 2.0, 95% CI 1.1 to 3.6). Tuberculosis (C. difficile positive 54% vs C. difficile negative 32%, p<0.001), 30-day prior antibiotic exposure (C. difficile positive 83% vs C. difficile negative 46%, p<0.001) and prior hospitalisation (C. difficile positive 55% vs C. difficile negative 22%, p<0.001) were also more common in the C. difficile-positive group. C. difficile positive test result (OR 4.7, 95% CI 2.0 to 11.2; p<0.001), male gender (OR 2.8, 95% CI 1.1 to 7.2; p=0.031) and tuberculosis (OR 2.3, 95% CI 1.0 to 5.0; p=0.038) were independently associated with mortality. Of patients starting treatment, metronidazole was the most common antimicrobial therapy initiated (70%, n=78); 32 C. difficile-positive (29%) patients were not treated.ConclusionPatients testing positive for C. difficile are at high risk of mortality at public district hospitals in South Africa. Tuberculosis should be considered an additional risk factor for CDI in populations with high tuberculosis and HIV comorbidity. Interventions for CDI prevention and management are urgently needed.

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A geospatial analysis of two-hour surgical access to district hospitals in South Africa

10.21203/rs.3.rs-20559/v3 ◽

2020 ◽

Author(s):

Kathryn Chu ◽

Angela J Dell ◽

Harry Moultrie ◽

Candy Day ◽

Megan Naidoo ◽

...

Keyword(s):

South Africa ◽

District Hospital ◽

Surgical Care ◽

Sub Saharan Africa ◽

Surgical Capacity ◽

Surgical Access ◽

District Hospitals ◽

Government Hospitals ◽

Sub Saharan ◽

Improve Access

Abstract Background: In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods: All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results: Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion: Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

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Two-hour surgical access in South Africa: a useful indicator in a middle-income country?

10.21203/rs.3.rs-16476/v1 ◽

2020 ◽

Author(s):

Kathryn Chu ◽

Angela J Dell ◽

Harry Moultrie ◽

Candy Day ◽

Megan Naidoo ◽

...

Keyword(s):

South Africa ◽

District Hospital ◽

Surgical Care ◽

Sub Saharan Africa ◽

Surgical Capacity ◽

Middle Income ◽

Surgical Access ◽

District Hospitals ◽

Government Hospitals ◽

Sub Saharan

Abstract Background In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. Conclusion Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

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Two-hour surgical access in South Africa: a useful indicator in a middle- income country?

10.21203/rs.3.rs-20559/v1 ◽

2020 ◽

Author(s):

Kathryn Chu ◽

Angela J Dell ◽

Harry Moultrie ◽

Candy Day ◽

Megan Naidoo ◽

...

Keyword(s):

South Africa ◽

District Hospital ◽

Surgical Care ◽

Sub Saharan Africa ◽

Surgical Capacity ◽

Middle Income ◽

Surgical Access ◽

District Hospitals ◽

Government Hospitals ◽

Sub Saharan

Abstract Background In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. Conclusion Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

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District hospital surgical capacity in Western Cape Province, South Africa: A cross-sectional survey

South African Medical Journal ◽

10.7196/samj.2021.v111i4.15281 ◽

2021 ◽

Vol 111 (4) ◽

pp. 343

Author(s):

P Naidu ◽

K M Chu

Keyword(s):

South Africa ◽

District Hospital ◽

Western Cape ◽

Surgical Capacity ◽

Western Cape Province ◽

Cross Sectional Survey ◽

Cross Sectional

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Occupational Risk of Airborne Mycobacterium tuberculosis Exposure: A Situational Analysis in a Three-Tier Public Healthcare System in South Africa

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910130 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10130

Author(s):

Dikeledi O. Matuka ◽

Thabang Duba ◽

Zethembiso Ngcobo ◽

Felix Made ◽

Lufuno Muleba ◽

...

Keyword(s):

Risk Factors ◽

South Africa ◽

Mycobacterium Tuberculosis ◽

Infection Prevention And Control ◽

Public Healthcare ◽

Situational Analysis ◽

Western Cape ◽

District Hospitals ◽

Risk Areas ◽

Medical Wards

This study aimed to detect airborne Mycobacterium tuberculosis (MTB) at nine public health facilities in three provinces of South Africa and determine possible risk factors that may contribute to airborne transmission. Personal samples (n = 264) and stationary samples (n = 327) were collected from perceived high-risk areas in district, primary health clinics (PHCs) and TB facilities. Quantitative real-time (RT) polymerase chain reaction (PCR) was used for TB analysis. Walkabout observations and work practices through the infection prevention and control (IPC) questionnaire were documented. Statistical analysis was carried out using Stata version 15.2 software. Airborne MTB was detected in 2.2% of samples (13/572), and 97.8% were negative. District hospitals and Western Cape province had the most TB-positive samples and identified risk areas included medical wards, casualty, and TB wards. MTB-positive samples were not detected in PHCs and during the summer season. All facilities reported training healthcare workers (HCWs) on TB IPC. The risk factors for airborne MTB included province, type of facility, area or section, season, lack of UVGI, and ineffective ventilation. Environmental monitoring, PCR, IPC questionnaire, and walkabout observations can estimate the risk of TB transmission in various settings. These findings can be used to inform management and staff to improve the TB IPC programmes.

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A geospatial analysis of two-hour surgical access to district hospitals in South Africa

10.21203/rs.3.rs-20559/v2 ◽

2020 ◽

Author(s):

Kathryn Chu ◽

Angela J Dell ◽

Harry Moultrie ◽

Candy Day ◽

Megan Naidoo ◽

...

Keyword(s):

South Africa ◽

District Hospital ◽

Surgical Care ◽

Sub Saharan Africa ◽

Surgical Capacity ◽

Surgical Access ◽

District Hospitals ◽

Government Hospitals ◽

Sub Saharan ◽

Improve Access

Abstract Background: In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods: All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods.Results: Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion: Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

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Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa: descriptive observational study

BMJ Open ◽

10.1136/bmjopen-2020-047016 ◽

2021 ◽

Vol 11 (1) ◽

pp. e047016

Author(s):

Robert James Mash ◽

Mellisa Presence-Vollenhoven ◽

Adeloye Adeniji ◽

Renaldo Christoffels ◽

Karlien Doubell ◽

...

Keyword(s):

South Africa ◽

Type 2 Diabetes ◽

Length Of Stay ◽

Turnaround Time ◽

Secondary Outcome ◽

Chronic Obstructive ◽

Western Cape ◽

Presenting Symptoms ◽

District Hospitals

ObjectivesTo describe the characteristics, clinical management and outcomes of patients with COVID-19 at district hospitals.DesignA descriptive observational cross-sectional study.SettingDistrict hospitals (4 in metro and 4 in rural health services) in the Western Cape, South Africa. District hospitals were small (<150 beds) and led by family physicians.ParticipantsAll patients who presented to the hospitals’ emergency centre and who tested positive for COVID-19 between March and June 2020.Primary and secondary outcome measuresSource of referral, presenting symptoms, demographics, comorbidities, clinical assessment and management, laboratory turnaround time, clinical outcomes, factors related to mortality, length of stay and location.Results1376 patients (73.9% metro, 26.1% rural). Mean age 46.3 years (SD 16.3), 58.5% females. The majority were self-referred (71%) and had comorbidities (67%): hypertension (41%), type 2 diabetes (25%), HIV (14%) and overweight/obesity (19%). Assessment of COVID-19 was mild (49%), moderate (18%) and severe (24%). Test turnaround time (median 3.0 days (IQR 2.0–5.0 days)) was longer than length of stay (median 2.0 day (IQR 2.0–3.0)). The most common treatment was oxygen (41%) and only 0.8% were intubated and ventilated. Overall mortality was 11%. Most were discharged home (60%) and only 9% transferred to higher levels of care. Increasing age (OR 1.06 (95% CI 1.04 to 1.07)), male (OR 2.02 (95% CI 1.37 to 2.98)), overweight/obesity (OR 1.58 (95% CI 1.02 to 2.46)), type 2 diabetes (OR 1.84 (95% CI 1.24 to 2.73)), HIV (OR 3.41 (95% CI 2.06 to 5.65)), chronic kidney disease (OR 5.16 (95% CI 2.82 to 9.43)) were significantly linked with mortality (p<0.05). Pulmonary diseases (tuberculosis (TB), asthma, chronic obstructive pulmonary disease, post-TB structural lung disease) were not associated with increased mortality.ConclusionDistrict hospitals supported primary care and shielded tertiary hospitals. Patients had high levels of comorbidities and similar clinical pictures to that reported elsewhere. Most patients were treated as people under investigation. Mortality was comparable to similar settings and risk factors identified.

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