South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
-
Observational Study
Burn injuries in KwaZulu-Natal Province, South Africa: Quantifying the healthcare burden.
Most burn injuries occur in low- and middle-income countries (LMICs) and affect those of lower socioeconomic status disproportionally. A multifaceted approach is needed to improve burn outcomes. Healthcare strategies and reform should be data driven, but South Africa (SA) currently lacks sufficient baseline data related to burn injuries. The absence of local data is compounded by a global lack of published data from LMIC settings. The Pietermaritzburg Burn Service Registry (PBSR) is the only established registry for burn injuries in SA. ⋯ There is a significant, unquantified burden of burn injury in KZN, highlighting the urgent need for development of specialised surgical services for burns. Collection of more robust national data to verify our projections is required to confirm the need and guide required healthcare reform.
-
Pelonomi Tertiary Hospital is the only hospital in the Free State Province with a burns unit. We do not have official data to assess our performance in the management of burns. ⋯ The epidemiology of burn patients and working conditions at Pelonomi Tertiary Hospital are similar to other burn units in the country; however, our mortality rate is higher than at most centres. The LA50 is low, but in keeping with the rest of Africa, and our predictors of mortality are in keeping with those found in other studies in other parts of the world.
-
The first vertical transmission of HIV prevention (VTP) programme in South Africa was launched in 1999 in Khayelitsha, Western Cape Province (WC). Since then, VTP guidelines have expanded in complexity and scope. ⋯ Although most women presented to care already knowing their HIV status, ART initiation was suboptimal prior to the first antenatal visit but improved over the course of pregnancy. The VT rate based on laboratory HIV-PCR testing alone underestimated HIV transmission: linked data from multiple sources suggested higher VT than programme-reported rates based on HIV-PCR testing alone.
-
The pattern of HIV-associated eye disease has changed with ongoing advancements in highly active antiretroviral therapy (HAART). HIV-infected individuals now live longer, enabling us to observe the long-term effects of HIV and HAART on the eye. There are few recent studies on HIV-related ocular disease in sub-Saharan Africa. ⋯ With the advent of HAART, ocular manifestations of HIV are changing and the incidence of severe ocular opportunistic infections and HIV retinopathy has decreased precipitously. Although this study has shown that patients with a CD4 count <200 cells/μL are at increased risk of developing anterior ocular manifestations of HIV, including cataracts, these diseases are relatively innocuous or easily treatable. Routine ocular screening of HIV patients seems to be substantially less important now than it was in the pre-HAART era.
-
Point-of-care (POC) rapid recency testing can be used as a cost-effective tool to identify recently infected individuals (i.e. infected within the last 12 months) in near-real time, support epidemic control and identify hotspots for transmission as part of recent infection surveillance. ⋯ The Asanté HIV-1 rapid recency assay test results demonstrated high accuracy (>90%) compared with the HIV ELISA and rapid assays for determining established infection and the Maxim HIV-1 LAg avidity assay for classifying recent HIV-1 infections. The assay's sensitivity for established infections was below the World Health Organization criteria (<99%) for POC devices. The Asanté HIV-1 rapid recency assay can be used to distinguish between recent and long-term infections, but may not be considered a POC test for determining HIV infection.