scholarly journals Epidemiology and outcomes of Clostridium difficile infection among hospitalised patients: results of a multicentre retrospective study in South Africa

2018 ◽  
Vol 3 (4) ◽  
pp. e000889 ◽  
Author(s):  
Laurel Legenza ◽  
Susanne Barnett ◽  
Warren Rose ◽  
Monica Bianchini ◽  
Nasia Safdar ◽  
...  
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Clostridium Difficile ◽  
Patient Characteristics ◽  
Additional Risk Factor ◽  
Western Cape ◽  
Positive Group ◽  
Hospitalised Patients ◽  
District Hospitals ◽  
Test Result

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.

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

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.

scholarly journals Knowledge and perceptions of risk for cardiovascular disease: Findings of a qualitative investigation from a low-income peri-urban community in the Western Cape, South Africa

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Sam Surka ◽  
Krisela Steyn ◽  
Katherine Everett-Murphy ◽  
Thomas A. Gaziano ◽  
Naomi Levitt
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Cardiovascular Disease ◽  
Low Income ◽  
Urban Community ◽  
Visual Methods ◽  
Western Cape ◽  
Community Screening ◽  
Perceptions Of Risk ◽  
Low Health Literacy

Background: South Africa currently faces an increasing burden of cardiovascular disease. Although referred to clinics after community screening initiatives, few individuals who are identified to be at high risk for developing cardiovascular disease attend. Low health literacy and risk perception have been identified as possible causes. We investigated the knowledge and perceptions about risk for cardiovascular disease in a community.Method: We conducted a series of focus group discussions with individuals from a low incomeperi-urban community in the Western Cape, South Africa. Different methods of presenting risk were explored. The data were organised into themes and analysed to find associations between themes to provide explanations for our findings.Results: Respondents’ knowledge of cardiovascular disease and its risk factors varied, but most were familiar with the terms used to describe cardiovascular disease. In contrast, understanding of the concept of risk was poor. Risk was perceived as a binary concept and evaluation of different narrative and visual methods of presenting risk was not possible.Conclusion: Understanding cardiovascular disease and its risk factors requires a different set of skills from that needed to understand uncertainty and risk. The former requires knowledge of facts, whereas understanding of risk requires numerical and computational skills. Without a better understanding of risk, risk assessments for cardiovascular disease may fail in this community.

scholarly journals Diabetes mellitus in Zambia and the Western Cape province of South Africa: Prevalence, risk factors, diagnosis and management

2016 ◽  
Vol 118 ◽  
pp. 1-11 ◽  
Author(s):  
Sarah Lou Bailey ◽  
Helen Ayles ◽  
Nulda Beyers ◽  
Peter Godfrey-Faussett ◽  
Monde Muyoyeta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
South Africa ◽  
Western Cape ◽  
Western Cape Province ◽  
Diagnosis And Management

scholarly journals Incidence and risk factors of C. trachomatis and N. gonorrhoeae among young women from the Western Cape, South Africa: The EVRI study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250871
Author(s):  
Vita W. Jongen ◽  
Maarten F. Schim van der Loeff ◽  
Matthys H. Botha ◽  
Staci L. Sudenga ◽  
Martha E. Abrahamsen ◽  
...  
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Young Women ◽  
Vaccine Trial ◽  
Incidence Rates ◽  
Sexual History ◽  
Treatment Programs ◽  
Western Cape ◽  
Sex Partners ◽  
Sexually Transmitted

Objective Young women in South Africa are highly affected by sexually transmitted infections (STI), like C. trachomatis (CT) and N. gonorrhoeae (NG). We aimed to estimate the incidence of CT and NG, and its determinants, among young women from the Western Cape, South Africa, participating in an HPV vaccine trial (the EVRI study). Methods HIV-negative women aged 16–24 years were enrolled between October 2012 and July 2013. At enrolment and month 6 participants were screened for CT and NG (Anyplex CT/NG real-time detection method). A questionnaire on demographic and sexual history characteristics was completed at enrolment and month 7. Treatment for CT and/or NG was offered to infected participants. Incidence rates (IR) of CT and NG were estimated. Determinants of incident CT and NG infections were assessed using Poisson regression. Results 365 women were tested for CT and/or NG at least twice. Prevalence of CT and NG at baseline was 33.7% and 10.4%, respectively. Prevalence of co-infection with CT and NG was 7.1%. During 113.3 person-years (py), 48 incident CT infections were diagnosed (IR = 42.4 per 100 py, 95% confidence interval (CI) 31.9–56.2). Twenty-nine incident NG were diagnosed during 139.3 py (IR = 20.8 per 100 py, 95%CI 14.5–29.9). Prevalent CT infection at baseline was associated with incident CT (adjusted incidence rate ratio (aIRR) 5.8, 95%CI 3.0–11.23. More than three lifetime sex partners increased the risk for incident NG (3–4 partners aIRR = 7.3, 95%CI 2.1–26.0; ≥5 partners aIRR = 4.3, 95%CI 1.1–17.5). Conclusions The IR of bacterial STIs among young women in the Western Cape is very high. Besides being previously infected and a higher lifetime number of sex partners, no other risk factors were found for CT and NG, suggesting that the majority of these women were at risk. This indicates the need for intensified prevention of STIs as well as screening and treatment programs to increase sexual health in this region.

scholarly journals Maternal Risk Factors for Fetal Alcohol Syndrome in the Western Cape Province of South Africa: A Population-Based Study

2005 ◽  
Vol 95 (7) ◽  
pp. 1190-1199 ◽  
Author(s):  
Philip A. May ◽  
J. Phillip Gossage ◽  
Lesley E. Brooke ◽  
Cudore L. Snell ◽  
Anna-Susan Marais ◽  
...  
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Fetal Alcohol Syndrome ◽  
Population Based ◽  
Western Cape ◽  
Maternal Risk Factors ◽  
Fetal Alcohol ◽  
Western Cape Province ◽  
Population Based Study ◽  
Maternal Risk

Risk Factors for Cervical Human Papillomavirus Infection and High-Grade Intraepithelial Lesion in Women Aged 20 to 31 Years in Germany

2013 ◽  
Vol 23 (3) ◽  
pp. 519-526 ◽  
Author(s):  
Cornelius Remschmidt ◽  
Andreas M. Kaufmann ◽  
Ingke Hagemann ◽  
Elena Vartazarova ◽  
Ole Wichmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Genital Warts ◽  
Hpv Infection ◽  
Older Age ◽  
High Grade ◽  
Negative Group ◽  
Positive Group ◽  
Hpv Test ◽  
Intraepithelial Lesion ◽  
Test Result

BackgroundPersistent infection with high-risk human papillomaviruses (HPVs) can lead to cervical intraepithelial lesion and cervical cancer. Sexual behavior and smoking have been identified as risk factors for HPV infection. However, it is unclear which factors account for the persistence of HPV infection and for high-grade squamous intraepithelial lesions (HSIL). Therefore, we conducted a study to identify epidemiological risk factors for the following: (1) the presence of HPV among women without a recent diagnosis of HSIL and (2) HSIL.Materials and MethodsParticipants aged 20 to 31 years were recruited at 2 study sites. All women received a cervical Papanicolaou test, were tested for HPV, and categorized into 1 of 3 different groups: The women of the first group had negative cytological test results and a negative HPV test result (HPV-negative group), and the women of the second group had negative cytological test result but positive HPV test result (HPV-positive group). The third group consisted of women with a diagnosis of HSIL (HSIL group). We first compared the HPV-negative group with the HPV-positive group, and then the HPV-positive group with the HSIL group.ResultsOne hundred forty-seven women were included: 53 women in the HPV-negative group, 46 women in the HPV-positive group, and 48 women in the HSIL group. Comparing the HPV-negative with the HPV-positive group, we found that more than 5 sexual partners during a lifetime were independently associated with cervical HPV infection, whereas the chance of being infected decreased with older age. Irregular condom use during one-night stands or smoking was associated with HPV infection only in univariable but not multivariable analysis. In contrast, older age and having had genital warts were independently associated with an HSIL diagnosis when comparing the HPV-positive group with the HSIL group.DiscussionAlthough the study was hampered by its relatively small sample size, our data suggest that main risk factors for the acquisition of HPV infection are a higher number of sexual partners and younger age, whereas older age and genital warts may be epidemiological cofactors in the development of HSIL.

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