Factors associated with non-attendance at scheduled infant follow-up visits in an observational cohort of HIV-exposed infants in South Africa, 2012–2014

Community-onset pneumonia (COP) is a combined concept of community acquired pneumonia and the previous classification of healthcare-associated pneumonia. Although ceftriaxone (CRO) is one of the treatment choices for COP, it is unclear whether 1 or 2 g CRO daily has better efficacy. We compared the effectiveness of 1 g with 2 g of CRO for COP treatment. We hypothesized that 1 g CRO would show non-inferiority over 2 g CRO. This study was an analysis of prospectively registered data of the patients with COP from four Japanese hospitals (the Adult Pneumonia Study Group-Japan: APSG-J). We included subjects who were initially treated solely with 1 or 2 g of CRO. The propensity score was estimated from the 33 pre-treatment variables, including age, sex, weight, pre-existing comorbidities, prescribed drugs, risk factors for aspiration pneumonia, vital signs, laboratory data, and a finding from chest xrays. The primary endpoint was the cure rate, for which a non-inferiority analysis was performed with a margin of 0.05. In addition, we performed three sensitivity analyses; using data limited to the group in which CRO solely was used until the completion of treatment, using data limited to inpatient cases, and performing a generalized linear mixed-effect logistic regression analysis to assess the primary outcome after adjusting for random hospital effects. Of the 3817 adult subjects with pneumonia who were registered in the APSG-J study, 290 and 216 were initially treated solely with 1 or 2 g of CRO, respectively. Propensity score matching was used to extract 175 subjects in each group. The cure rate was 94.6 and 93.1% in the 1 and 2 g CRO groups, respectively (risk difference 1.5%; 95% confidence interval − 3.1 to 6.0; p = 0.009 for non-inferiority). The results of the sensitivity analyses were consistent with the primary result. The propensity score-matched analysis of multicenter cohort data from Japan revealed that the cure rate for COP patients treated with 1 g daily CRO was non-inferior to that of patients treated with 2 g daily CRO.     

Moving from vertical to integrated child health programmes: experiences from a multi‐country assessment of the Child Health Days approach in Africa

Objectives To assess the effect of child health days (CHDs) on coverage of child survival interventions, to document country experiences with CHDs and to identify ways in which CHDs have strengthened or depleted primary health care (PHC) services. Methods Programme evaluation in six countries in sub‐Saharan Africa using both quantitative (review of routine child health indicators) and qualitative (key informant interviews) methods. Results We found that CHDs have raised the profile of child survival at different levels from central government to the community in all six countries. The approach has increased the coverage of vitamin A supplementation and immunizations, especially in previously poorly performing countries. However, similar improvements have not occurred in non‐CHD interventions, most notably exclusive breastfeeding. There were examples of duplication, especially in the capturing and use of health information. There was widespread evidence that PHC staff were being diverted from their usual PHC functions, and managers reported being distracted by the time required for the planning and execution of CHDs. Finally, there were examples of where the routine PHC system is becoming distorted through, for example, the payment of health worker incentives during CHD activities only. Conclusion Interventions such as CHDs can rapidly increase coverage of key child survival interventions; however, they need to do so in a manner that strengthens rather than depletes existing PHC services. Our findings suggest that stand alone child health day interventions may gradually need to be integrated with routine PHC through more general health system strengthening.     

Quality of primary care for sexually transmitted diseases in Durban, South Africa: influences of patient, nurse, organizational and socioeconomic characteristics

Quality of sexually transmitted disease (STD) primary care in South Africa varies widely but reasons for this are poorly understood. We investigated 37 randomly sampled clinics providing STD care, with simulated patients, and staff interviews and record review. Census data provided local socioeconomic indicators. Multiple regression identified independent predictors of quality. Of 271 simulated patient visits, 79% were correctly treated and 39% were correctly managed. Women received worse care, and care tended to be poorer in mainly African and mainly coloured (mixed race) areas. African and Indian nurses were more likely to provide correct treatment. Previous STD training was marginally associated with correct treatment. Quality assessments using simulated patients were not generally associated with assessments using staff interviews and record review. There were frequent missed opportunities for STD prevention and treatment, and evidence of racial but not socioeconomic inequalities.     

Effectiveness and cost effectiveness of syndromic sexually transmitted infection packages in South African primary care: cluster randomised trial

Objectives

To evaluate the effectiveness and cost effectiveness of syndromic sexually transmitted infection (STI) packages on appropriate treatment and preventive management during primary care consultations.

Methods

Cluster randomised trial of 37 Durban primary care clinics randomised to use syndromic packages (containing antibiotics, condoms, partner notification cards, and written information) or not. We assessed outcomes using simulated patients who reported STI symptoms and recorded how they were managed, before and after implementation (269 and 256 simulated patient consultations). We adjusted for baseline values and intra‐clinic correlation of outcomes statistically. We used health department information to estimate the extra resources needed to provide the packages to 20 clinics for 1 year and their costs.

Results

Simulated patients in intervention clinics were more likely to receive appropriate syndromic STI management (correct treatment plus condoms offered plus partner notification cards offered; prevalence rate ratio 2.3; 95% confidence intervals (CI) 1.6 to 3.0) and to receive more STI advice and information (odds ratio 1.5; 95% CI 1.01 to 2.1). Women were less likely to receive appropriate syndromic STI management. The intervention increased STI information provision in women more than in men. The extra cost per extra patient appropriately managed was $1.51.

Conclusions

Syndromic packages improved syndromic STI management at a reasonable cost and should be used more widely.     

Screening of Cyanobacterial Peptide Toxin,Microcystins in Hyperscum Water Samples from an Inland Sub Saharan Drinking Freshwater Reservoir

A study which probed the occurrence and quantitative variations hepatotoxic microcystin in a Sub Saharan drinking freshwater reservoir was carried out between November 2014 and March 2015. Results reveal the presence of MCYST-YR, MCYST-LR, MCYST-RR, MCYST-LA and MCYST-LF variants either in cells collected directly from bloom or toxic isolates cultured under laboratory conditions. Two minor microcystin congeners (MCYST-(H₄)YR) and (D-Asp³, Dha⁷) MCYST-RR) were identified, but not quantified. Variants dominance were in the order MCYST-LR?>?MCYST-RR?>?MCYST-YR?>?MCYST-LA?>?MCYST-LF across sampling sites. Maximum and minimum concentrations of quantified MCYSTs congeners were (489.25, 50.95 µg toxin/g DW), (98.92, 9.11 µg toxin/g DW), (140.25, 12.07 µg toxin/g DW), (56.99, 6.20 µg toxin/g DW) and (50.46, 3.65 µg toxin/g DW) for MCYST-LR, MCYST-YR, MCYST-RR, MCYST-LA and MCYST-LF, respectively. Analysis of variance (ANOVA) revealed there was a high significant difference between mean microcystin concentrations across sampling sites (p?<?0.05).     

Incidence and profile of spinal tuberculosis in patients at the only public hospital admitting such patients in KwaZulu-Natal

STUDY DESIGN: A retrospective chart review at the major provincial public hospital serving patients with spinal injuries/pathology. OBJECTIVES AND SETTING: To determine the incidence of spinal tuberculosis (Tb) and establish the profile of these patients treated at King George V Hospital (KGV) in KwaZulu-Natal, South Africa. METHODS: A total of 525 medical records for the period March 2005 to April 2006 were reviewed. Data from 104 files of Tb spine cases were categorized according to demographic details, medical conditions and length of stay in hospital. The South African mid-year 2006 census was used to calculate associations and risk rates for race, gender, adulthood, urbanization and employment and analyzed using the STATA version 9.0 statistical package. RESULTS: About 90% of the patients were African and 10% from other races. Females comprised 58% of the patients. The incidence of Tb spine is 1.02 per 100,000 and 3.13 per 100,000 for Africans and other races, respectively. The incidence rate is 1.17 per 100,000 females and 0.916 per 100,000 males. All the participants had a history of pulmonary Tb and 28% were human immunodeficiency virus positive. Thoracic spine was affected in 42% of the cases. About 32% presented with incomplete paraplegia. The average length of stay at this hospital for these patients was 41 days. CONCLUSIONS: About 20% of all patients seen for spinal conditions at KGV over the past year presented with Tb spine. A higher association between living in an urban area, adulthood (age 18+), being non-Black patients and the occurrence of spinal Tb was observed.     

Development of a turn-on graphene quantum dot-based fluorescent probe for sensing of pyrene in water

Polycyclic aromatic hydrocarbons (PAHs) are potentially harmful pollutants that are emitted into the environment from a range of sources largely due to incomplete combustion. The potential toxicity and carcinogenic effects of these compounds warrants the development of rapid and cost-effective methods for their detection. This work reports on the synthesis and use of graphene quantum dots (GQDs) as rapid fluorescence sensors for detecting PAHs in water. The GQDs were prepared from two sources, i.e. graphene oxide (GO) and citric acid (CA) – denoted GO-GQDs and CA-GQDs, respectively. Structural and optical properties of the GQDs were studied using TEM, Raman, and fluorescence and UV-vis spectroscopy. The GQDs were then applied for detection of pyrene in environmental water samples based on a “turn-off-on” mechanism where ferric ions were used for turn-off and pyrene for turn-on of fluorescence emission. The fluorescence intensity of both GQDs was switched on linearly within the 2–10 × 10⁻⁶ mol L⁻¹ range and the limits of detection were found to be 0.325 × 10⁻⁶ mol L⁻¹ and 0.242 × 10⁻⁶ mol L⁻¹ for GO-GQDs and CA-GQDs, respectively. Finally, the potential application of the sensor for environmental water samples was investigated using lake water and satisfactory recoveries (97–107%) were obtained. The promising results from this work demonstrate the feasibility of pursuing cheaper and greener environmental monitoring techniques.

Graphene quantum dots provide a more environmentally friendly fluorescence sensor for pyrene.     

Essential roles for imuA′- and imuB-encoded accessory factors in DnaE2-dependent mutagenesis in Mycobacterium tuberculosis

In Mycobacterium tuberculosis (Mtb), damage-induced mutagenesis is dependent on the C-family DNA polymerase, DnaE2. Included with dnaE2 in the Mtb SOS regulon is a putative operon comprising Rv3395c, which encodes a protein of unknown function restricted primarily to actinomycetes, and Rv3394c, which is predicted to encode a Y-family DNA polymerase. These genes were previously identified as components of an imuA-imuB-dnaE2–type mutagenic cassette widespread among bacterial genomes. Here, we confirm that Rv3395c (designated imuA′) and Rv3394c (imuB) are individually essential for induced mutagenesis and damage tolerance. Yeast two-hybrid analyses indicate that ImuB interacts with both ImuA′ and DnaE2, as well as with the β-clamp. Moreover, disruption of the ImuB-β clamp interaction significantly reduces induced mutagenesis and damage tolerance, phenocopying imuA′, imuB, and dnaE2 gene deletion mutants. Despite retaining structural features characteristic of Y-family members, ImuB homologs lack conserved active-site amino acids required for polymerase activity. In contrast, replacement of DnaE2 catalytic residues reproduces the dnaE2 gene deletion phenotype, strongly implying a direct role for the α-subunit in mutagenic lesion bypass. These data implicate differential protein interactions in specialist polymerase function and identify the split imuA′-imuB/dnaE2 cassette as a compelling target for compounds designed to limit mutagenesis in a pathogen increasingly associated with drug resistance.     

Improving the coverage of the PMTCT programme through a participatory quality improvement intervention in South Africa

Background  

Despite several years of implementation, prevention of mother-to-child transmission (PMTCT) programmes in many resource poor settings are failing to reach the majority of HIV positive women. We report on a data driven participatory quality improvement intervention implemented in a high HIV prevalence district in South Africa.