Southern African Journal of Infectious Diseases最新文献

Background: The Expanded Program on Immunisation has made it possible to prevent more than 3 million deaths in children under 5 years. The objectives of this study were to estimate the vaccination coverage of children from 0 to 59 months and identify factors associated with incomplete vaccination coverage.

Methods: A cross-sectional study was carried out in a dispensary in Conakry, Guinea between January and February 2020. Sociodemographic and vaccination information was collected from mothers of 380 randomly select children aged 0 to 59 months. Information on immunisation coverage was gathered from records vaccination cards and maternal reports. Logistic regression was used to identify factors independently associated with incomplete immunisation coverage.

Results: Most (66.5%) children aged < 12 months were up-to-date with their vaccinations. Factors associated with incomplete vaccination in this age group included: unavailability of vaccination cards (adjusted odds ratio [aOR] 7.58; 95% confidence interval [CI]: 2.56-22.44) and lack of prenatal consultation attendance (aOR 2.93; 95% CI: 1.15-7.48). In contrast only 19.8% (95% CI: 13.9-26.7) of children aged 12-59 months were fully immunised. Factors associated with incomplete vaccination coverage in children aged 12-59 months included high birth order (aOR 10.23; 95% CI: 2.06-19.43), and lack of prenatal consultation attendance (aOR 5.34; 95% CI: 1.48-19.23).

Conclusion: Child immunisation coverage is low in Guinea. These results highlight the need to develop strategies based on an integrated approach to overcome obstacles to childhood immunisation in Guinea.

Background: Bone marrow examination is a useful diagnostic tool in human immunodeficiency virus (HIV)-positive patients presenting with cytopenias and fever. However, its role in the afebrile and asymptomatic patient presenting with an isolated cytopenia is not well established. This study was conducted to determine the indications for bone marrow examination and its diagnostic yield, in HIV-positive patients at Tygerberg Hospital.

Methods: A retrospective, cross-sectional descriptive study was performed over a 3-year period from 01 September 2015 to 31 August 2018. The bone marrow examination reports for the HIV-positive patients who had a bone marrow examination during the study period were retrieved. Clinical and laboratory information was captured.

Results: Altogether 374 bone marrow reports for HIV-positive patients were found. The indication of the bone marrow examination included investigation of unexplained cytopenias, suspected haematological malignancies, follow-up examination for patients with known haematological diseases, staging of haematological or non-haematological malignancies and investigation of suspected disseminated infection. The patients' median age was 43 years and the interquartile range was 27-60 years. There was a slight female predominance with females 51% and males 49%. The diagnostic yield was 33.7%. Acute leukaemia and lymphoma were the most common diagnoses. Haematinic deficiency and pure red cell aplasia were found in the majority of cases with isolated anaemia. All cases with isolated thrombocytopenia were due to immune thrombocytopenia.

Conclusion: Bone marrow examination is a useful investigation for HIV-positive patients with cytopenias, suspected haematological malignancy and lymphoma staging. However, its early use in patients with isolated anaemia and isolated thrombocytopenia is questionable.

Background: Generalised anxiety disorder (GAD) frequently occurs amongst patients with tuberculosis (TB) and contributes to poor quality of life and treatment outcomes. This study evaluated the construct validity and reliability of the GAD-7 scale in a sample of patients with TB in the Free State Province.

Methods: A pilot study was conducted amongst a convenience sample of 208 adult patients newly diagnosed with drug-susceptible TB attending primary healthcare (PHC) facilities in the Lejweleputswa District in the Free State. A structured interviewer-administered questionnaire comprising social demographic questions and the GAD-7 scale was used. Confirmatory factor analysis was used to investigate the construct validity of the GAD-7 scale. The reliability of the scale was assessed by calculating Cronbach's alpha.

Results: The analysis showed that a modified two-factor (somatic symptoms and cognitive -emotional symptoms) model, in which the items 'Not being able to stop or control worrying' and 'Worrying too much about different things' were allowed to covary (Comparative Fit Index: 0.996, Tucker-Lewis Index: 0.993, Root Mean Square Error of Approximation: 0.070, 90% confidence interval: 0.032-0.089), fitted the data better than a unidimensional (generalised anxiety) or an unmodified two-factor model. The indicators all showed significant positive factor loadings, with standardised coefficients ranging from 0.719 to 0.873. The Cronbach's alpha of the scale was 0.86.

Conclusion: The modified two-factor structure and high internal consistency respectively provide evidence for construct validity and reliability of the GAD-7 scale for assessing GAD amongst patients with TB. Studies are necessary to assess the performance of this brief scale under routine TB programme conditions in the Free State.

Toxigenic Vibrio cholerae O1/O139 is causative of cholera, which is a well characterised potentially epidemic gastrointestinal disease. Less is known about the pathogenesis and clinical presentation of non-toxigenic V. cholerae non-O1/non-O139, although they are increasingly implicated in human disease globally, have been isolated from various South African water sources and can contaminate the environment. The authors describe a case of pseudo-bacteraemia with non-toxigenic V. cholerae non-O1/non-O139 in a neonate.

Background: The use of the antibiotic colistin was increasing as a treatment option for multidrug-resistant (MDR) infections. Standardisation of colistin dosing and more appropriate record-keeping practices were required to fully assess the optimal usage of colistin. The aim of this study was to determine how and why colistin was used in the treatment of MDR infections in a tertiary care public hospital in South Africa (SA).

Methods: This cross-sectional retrospective record review described adult and paediatric patients who received colistin intravenously from 01 May 2016 to 31 April 2017. Information from patient records were captured on a data collection tool and analysed using descriptive statistics. Ethical approval was obtained from the Human Research Ethics Committee of the University of the Witwatersrand.

Results: A total of 43 patient records were reviewed. Acinetobacter baumannii was the most common organism isolated (85.2% adults and 62.5% paediatrics). Colistin was mostly prescribed for sepsis (18 adults and 15 paediatrics). Most adults (66.7%) received loading doses as recommended; however, there was a great variation in maintenance doses. Paediatric patients reviewed also showed varying dosing according to weight. The mean duration of colistin therapy was 10 days. Carbapenems were most commonly co-administered with colistin (58%).

Conclusion: The findings suggested that although colistin usage was restricted in the hospital, it was not adequately monitored or controlled. Doses prescribed were made at the discretion of prescribing doctors and differed to currently accepted guidelines. Improved record-keeping practices related to the monitoring of colistin use were required.

Background: Vaginal swabs have been traditionally used for the diagnosis of bacterial vaginosis (BV). Currently, there are limited studies that have investigated the use of other sample types other than vaginal swabs for the detection of BV from South African populations. This study investigated whether urine can be used for the detection of BV-associated microorganisms in South African pregnant women.

Methods: One-hundred self-collected vaginal swabs and urine samples were obtained from women presenting for antenatal care at King Edward VIII Hospital in Durban. The BD MAX™ vaginal panel assay was used for diagnosing BV and droplet digital polymerase chain reaction was used to quantify Gardnerella vaginalis, Prevotella bivia, Atopobium vaginae and Lactobacillus crispatus. The absolute counts were determined on the QX200 Droplet Reader (Bio-Rad) using the QuantaSoft Software. Data analysis was performed with statistical computing software called R, version 3.6.1.

Results: Median copy numbers obtained for G. vaginalis and P. bivia across urine and swabs in BV-positive samples were not significantly different (p = 0.134 and p = 0.652, respectively). This was confirmed by the correlation analysis that showed a good correlation between the two sample types (G. vaginalis [r = 0.63] and P. bivia [r = 0.50]). However, the data obtained for A. vaginae differed, and a weak correlation between urine and swabs was observed (r = 0.21). Bacterial vaginosis-negative samples had no significant difference in median copy numbers for L. crispatus across the urine and swabs (p = 0.062), and a good correlation between the sample types was noted (r = 0.71).

Conclusion: This study highlights the appropriateness of urine for the detection of microorganisms associated with BV.

Background: Trichomoniasis is the most common sexually transmitted infection (STI) with an estimated annual incidence of 276.4 million cases globally and about 30 million cases in sub-Saharan Africa. Trichomoniasis has been found to be associated with various health complications including pelvic inflammatory disease (PID), significant pregnancy complications, cervical cancer, prostatitis, infertility and the acquisition of human immunodeficiency virus (HIV).

Aim: Despite being a highly prevalent infection in the African continent, there is no review article published that solely focusses on Trichomonas vaginalis (T. vaginalis) infections in women from Africa. This review aims to fill this gap in the literature.

Method: An electronic search of online databases was used to identify and extract relevant research articles related to the epidemiology, health complications and treatment associated with T. vaginalis in women from Africa.

Results: Within the African continent, South Africa has reported the highest prevalence rate for this infection. A combination of sociodemographic, behavioural and biological factors has been shown to be associated with infection. Trichomonas vaginalis infection is associated with the acquisition of HIV, cervical cancer and PIDs in various female populations across the continent. Emerging patterns of resistance to metronidazole have been reported in women from South Africa. Currently, there is no effective vaccine against this pathogen despite efforts at vaccine development.

Conclusion: Based on the high prevalence and health consequences associated with T. vaginalis, there is a need for improved screening programmes that will lead to early diagnosis, detection of asymptomatic infections and effective treatment regimens.

Background: The role of Mycoplasma hominis (M. hominis) as a genital tract pathogen was still debatable. This study identified the risk factors associated with the prevalence of M. hominis in South African pregnant women.

Methods: This was a cross-sectional analysis of n = 221 prenatal patients attending a Durban hospital during November 2017 to April 2018. M. hominis was detected from urine samples using the quantitative polymerase chain reaction. The population characteristics were described using frequencies stratified by the infection status of M. hominis. In addition, a univariate analysis was used to assess the relationship between each risk factor and infection status. The analysis further considered logistic regression to assess the influence of these risk factors univariately and in the presence of other factors. The coinfection rate between M. hominis and bacterial vaginosis (BV), Trichomonas vaginalis (T. vaginalis), Mycoplasma genitalium (M. genitalium) and Candida species was also determined. All the tests were conducted at 5% level of significance.

Results: The prevalence of M. hominis in this study population was 48% (106/221). In the univariate analysis, factors significantly associated with M. hominis positivity included having past abnormal vaginal discharge (p = 0.037), having current abnormal vaginal discharge (p = 0.010) and a borderline significance (p = 0.052), which were noted for previous pre-term delivery. However, none of these factors were sustained in the multivariate analysis. There was a statistically significant association between M. hominis and BV positivity (p < 0.001). Similarly, M. hominis and M. genitalium positivity was significant (p = 0.006).

Conclusion: This study showed that M. hominis does not share common risk factors with known genital tract pathogens in a population of pregnant women and therefore cannot be considered a genital tract pathogen.

Background: Sustained injudicious and indiscriminate use of antimicrobials has exerted selection pressure for developing antimicrobial resistance (AMR), requiring behaviour change from healthcare professionals (HCPs) based on their knowledge, attitudes and practices (KAP) on antimicrobials, AMR and antimicrobial stewardship (AMS).

Methods: A cross-sectional online questionnaire-based survey was conducted nationally amongst doctors, pharmacists and nurses from November 2017 to January 2018. The questionnaire comprised demographic information and KAP questions.

Results: Respondents comprised of 1120 doctors, 744 pharmacists and 659 nurses. Antimicrobial resistance was considered a severe problem globally and nationally by majority of HCPs. Self-assessment of knowledge revealed gaps in understanding of antimicrobials, AMR and AMS. Confidence scores in prescribing by doctors, pharmacists and nurses were 57.82%, 32.88% and 45.28%, respectively. Doctors, 441 (45.2%) indicated no confidence in using combination therapy. Prescribing correctly showed a confidence level of 33.99% from 436 doctors, 41.88% from nine pharmacists and 35.23% from 107 nurses. Healthcare professionals (1600 [91.22%]) stated educational campaigns would combat AMR. Only 842 (40.13%) HCPs attended training on these topics and 1712 (81.60%) requesting more education and training.

Conclusion: This is the first comparative survey on KAP of practising doctors, pharmacists and nurses in South Africa. Doctors had the highest knowledge score followed by nurses and pharmacists. Practice scores did not corroborate knowledge and the higher attitude scores. Gaps in KAP were evident. Healthcare professionals indicated the need for more education and training, thus requiring a review of pre-service and in-service education and training in addition to continued professional development programmes for practising HCPs.