South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Sexual and reproductive health (SRH) services for adolescent girls and young women (AGYW) remain inadequate - both globally and in South Africa (SA). We systematically scoped the available policies and guidelines for SRH-related policy for AGYW in SA. ⋯ Our policy review and analysis identified issues for researchers and policymakers to consider when developing and implementing programmes to improve SRH services. We suggest that considering national policies alongside evidence of what is effective, as well as contextual barriers to and enablers of strategies to address AGYW needs for SRH, are among the key steps to addressing the policy-to-implementation gap.
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An HIV-positive mother infected her daughter with extensively drug-resistant Mycobacterium tuberculosis. Despite adhering to the then current guidelines for prevention, the infant was diagnosed with extensively drug-resistant pulmonary tuberculosis at the age of 4 months and developed tuberculous meningitis. After a short delay, appropriate treatment was initiated, followed by an inhospital stay at a specialised hospital. ⋯ Secondary hydrocephalus due to tuberculous meningitis required a ventriculoperitoneal shunt. After 2 years of microbiologically and clinically effective tuberculosis treatment and several shunt complications, the HIV-negative child died at the age of 28 months ‒ with radiological signs of a shunt infection. The reason for the fatal outcome was probably related to inadequate risk reduction of airborne mother-to-child transmission, inappropriate chemoprophylaxis and delayed initiation of adequate treatment.
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Comparative Study
Comparison of adherence measures using claims data in the South African private health sector.
Medication adherence measurement is becoming increasingly important. Biological assays and markers, directly observed therapy, self-reports, pill counts and surveys have been successfully used to assess adherence under various circumstances, but may be limited by cost, ethical concerns and self-reported bias. Administrative claims data, in addition to offering a solution to these limitations, provide access to large study populations under real clinical practice situations, and in a timely and effective manner. With the wide range of adherence measures determined from claims data available - some of which have been found to be mathematically equivalent - researchers are often faced with the decision of choosing which is appropriate. An assessment of the various measures is therefore important for better understanding and to facilitate future adherence studies using administrative data. ⋯ The MPR is considered the most widely used metric to measure adherence using administrative data, but it may not always be applicable owing to the type of data available. Adherence computed using the CR, CMOS and PDC capped was found to be comparable to the MPR, and they may therefore be used as alternatives.
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Hepatitis C is a viral infection that leads to chronic liver disease, resulting in significant morbidity and mortality. ⋯ Compared with other genotypes, genotype 5 was predominant in our cohort, particularly in older age groups. Moreover, APRI and FIB-4 scores correlated significantly with advanced fibrosis in HCV patients. Finally, EVR during therapy was found to determine SVR.
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Urinary tract infection (UTI) is one of the most common infections during pregnancy, which can lead to significant maternal and perinatal morbidity and mortality if left untreated. Challenges when treating UTIs in pregnancy include fetal protection and resistance development of uropathogens. Currently, the Essential Medicines List recommends nitrofurantoin to treat cystitis and ceftriaxone to treat pyelonephritis in pregnant women. ⋯ E. coli is unsurprisingly the most common cause of UTI in pregnancy in KwaZulu-Natal. Susceptibility to ceftriaxone and nitrofurantoin remains good. Among Gram positives, GBS is prevalent and susceptible to penicillin, while E. faecalis is susceptible to ampicillin. As antimicrobial resistance evolves, routine surveillance is necessary to modify recommended empirical antibiotic use.