South African Medical Journal (SAMJ)
Not a member yet
649 research outputs found
Sort by
Household transmission of SARS-CoV-2 in a rural area in South Africa
Get PDFBackground. Patterns of SARS‐CoV‐2 spread have varied by geolocation, with differences in seroprevalence between urban and rural areas, and between waves. Household spread of SARS‐CoV‐2 is a known source of new COVID‐19 infections, with rural areas in sub‐Saharan Africa being more prone than urban areas to COVID‐19 transmission because of limited access to water in some areas, delayed health‐ seeking behaviour and poor access to care.
Objectives. To explore SARS‐CoV‐2 infection incidence and transmission in rural households in South Africa (SA).
Methods. We conducted a prospective household cluster investigation between 13 April and 21 July 2021 in the Matjhabeng subdistrict, a rural area in Free State Province, SA. Adults with SARS‐CoV‐2 confirmed by polymerase chain reaction (PCR) tests (index cases, ICs) and their household contacts (HCs) were enrolled. Household visits conducted at enrolment and on days 7, 14 and 28 included interviewer‐ administered questionnaires and respiratory and blood sample collection for SARS‐CoV‐2 PCR and SARS‐CoV‐2 immunoglobulin G serological testing, respectively. Co‐primary cases were HCs with a positive SARS‐CoV‐2 PCR test at enrolment. The incidence rate (IR), using the Poisson distribution, was HCs with a new positive PCR and/or serological test per 1 000 person‐days. Associations between outcomes and HC characteristics were adjusted for intra‐cluster correlation using robust standard errors. The secondary infection rate (SIR) was the proportion of new COVID‐19 infections among susceptible HCs.
Results. Among 23 ICs and 83 HCs enrolled, 10 SARS‐CoV‐2 incident cases were identified, giving an IR of 5.8 per 1 000 person‐days (95% confidence interval (CI) 3.14 ‐ 11.95). Households with a co‐primary case had higher IRs than households without a co‐primary case (crude IR 14.16 v. 1.75, respectively; p=0.054). HIV infection, obesity and the presence of chronic conditions did not materially alter the crude IR. The SIR was 15.9% (95% CI 7.90 ‐ 29.32). Households with a lower household density (fewer household members per bedroom) had a higher IR (IR 9.58; 95% CI 4.67 ‐ 21.71) than households with a higher density (IR 3.06; 95% CI 1.00 ‐ 12.35).
Conclusion. We found a high SARS‐CoV‐2 infection rate among HCs in a rural setting, with 48% of households having a co‐primary case at the time of enrolment. Households with co‐primary cases were associated with a higher seroprevalence and incidence of SARS‐CoV‐2. Sociodemographic and health characteristics were not associated with SARS‐CoV‐2 transmission in this study, and we did not identify any transmission risks inherent to a rural setting
Pregnancy after kidney and liver transplantation
Get PDFPregnancy in kidney and liver transplant recipients presents unique challenges and risks for both maternal and fetal health. This article examines the management of pregnancy in kidney and liver transplant recipients, focusing on pre-pregnancy counselling, trimester-specific care, the teratogenic effects of immunosuppressive drugs, and the role of the multidisciplinary team. While South African (SA) data on this topic are limited, the Transplant Pregnancy Registry International has provided valuable insights. Despite the increased risk of maternal and fetal complications, the overall risk of graft loss during pregnancy is low. Graft survival rates are comparable between pregnant and non- pregnant transplant recipients, except for pregnancies occurring within 1 year of transplantation. By addressing the complexities of managing pregnant women with kidney or liver transplants, this article underscores the importance of tailored care and the involvement of various medical specialists. It also explores the safety of and potential complications associated with specific immunosuppressive therapies during pregnancy. Further research is needed to enhance our understanding and optimise the management of these high-risk pregnancies in SA
Community perceptions of community health worker effectiveness: Contributions to health behaviour change in an urban health district in South Africa
Get PDFBackground. Community health worker (CHW) programmes contribute towards strengthening adherence support, improving maternal and child health outcomes and providing support for social services. They play a valuable role in health behaviour change in vulnerable communities. Large-scale, comprehensive CHW programmes at health district level are part of a South African (SA) strategy to re-engineer primary healthcare and take health directly into communities and households, contributing to universal health coverage.
Objective. These CHW programmes across health districts were introduced in SA in 2010 - 11. Their overall purpose is to improve access to healthcare and encourage healthy behaviour in vulnerable communities, through community and family engagements, leading to less disease and better population health. Communities therefore need to accept and support these initiatives. There is, however, inadequate local evidence on community perceptions of the effectiveness of such programmes.
Methods. A cross-sectional descriptive study to determine community perceptions of the role and contributions of the CHW programme was conducted in the Ekurhuleni health district, an urban metropolis in SA. Members from 417 households supported by CHWs were interviewed in May 2019 by retired nurses used as fieldworkers. Frequencies and descriptive analyses were used to report on the main study outcomes of community acceptance and satisfaction.
Results. Nearly all the study households were poor and had at least one vulnerable member, either a child under 5, an elderly person, a pregnant woman or someone with a chronic condition. CHWs had supported these households for 2 years or longer. More than 90% of households were extremely satisfied with their CHW; they found it easy to talk to them within the privacy of their homes and to follow the health education and advice given by the CHWs. The community members highly rated care for chronic conditions (82%), indicated that children were healthier (41%) and had safer pregnancies (6%).
Conclusion. As important stakeholders in CHW programmes, exploring community acceptance, appreciation and support is critical in understanding the drivers of programme performance. Community acceptance of the CHWs in the Ekurhuleni health district was high. The perspective of the community was that the CHWs were quite effective. This was demonstrated when they reported changes in household behaviour with regard to improved access to care through early screening, referrals and improved management of chronic and other conditions
The role of new hepatitis B vaccines in South Africa
Get PDFVaccination is key to eliminating hepatitis B virus infection in South Africa (SA). Despite introducing immunisation in 1995, as part of the expanded programme of immunisation (EPI), hepatitis B virus infection remains endemic, and EPI vaccine coverage is incomplete. In addition to infants, non-immune adults at risk of infection through their occupation or with behavioural risk factors should receive vaccination. SA has many individuals with diabetes mellitus (a prevalence of almost 13%), obesity, HIV (8.45 million) or older age (5 million >60 years old), associated with a poorer vaccine response. Recently two new hepatitis B vaccines have been licensed: HEPLISAV-B includes an adjuvant that improves immunogenicity and has shown improved vaccine response in individuals with HIV, old age or diabetes mellitus. PreHevbrio, which includes three hepatitis B surface protein domains, instead of one, may also be more immunogenic, although clinical study data are still limited. These two novel vaccines have not yet been investigated in children and licensed in SA. Should HEPLISAV-B become available in SA, it may be particularly valuable to target high-risk groups in the country, such as people living with HIV, who show a poor response to the currently licensed vaccine
Towards developing new private sector obstetric care and contracting models in South Africa: Insights from public hospitals using private general practitioners to provide caesarean deliveries
Get PDFMaternal healthcare in South Africa faces huge private and public health systems challenges. A key challenge for policy makers is how to address the inappropriate patterns of obstetric care in the private sector and how to mobilise private sector resources to serve the broader population dependent on the public sector, without replicating those patterns of inappropriate care. Developing and implementing new obstetric care models that address these challenges and lend themselves to public private engagements could play a vital role in efforts to improve obstetric care in the country. Drawing on insights from research we carried out on the care and contracting models used by five rural district hospitals in the Western Cape Province to contract private general practitioners to provide caesarean delivery services, this article outlines a potential alternative private sector obstetric care model with the aim of stimulating discussion by all relevant stakeholders on the development of new obstetric models for improving obstetric care in the country
A decomposition analysis of sociodemographic factors and non-cigarette tobacco use as contributors to the change in smoking rates in South Africa between 2017/18 and 2021
Get PDFBackground. Trends data up to 2018 suggest that tobacco smoking was increasing in South Africa (SA), but only limited information is available on the impact of the COVID-19 pandemic on the current pattern of use of tobacco and nicotine products (TNPs).
Objectives. To assess trends in sociodemographic patterns in the use of TNPs and the extent to which sociodemographic factors and non-cigarette tobacco use may explain possible changes in rates of TNP use between 2017/18 and 2021.
Methods. Data from three waves (2017, 2018 and 2021) of the South African Social Attitudes Survey (total N=8 140) were analysed. The sociodemographic correlates of current daily and non-daily use of factory-manufactured cigarettes (FMCs), roll-your-own (RYO) cigarettes, waterpipe/hubbly, electronic cigarettes (ECigs), snuff (a smokeless tobacco) and any combination of FMCs, RYO cigarettes and waterpipe/hubbly (‘current smoking’) in 2017/18 (pre-pandemic) were compared with those for 2021 (during the pandemic). Chi-square analyses and generalised linear models were used to compare the prevalence of TNP use between the two periods. A Blinda-Oaxaca decomposition analysis was also used to explore the roles of various sociodemographic factors, including any differences in the use of TNPs, that may explain any observed differences in smoking rates between 2017/18 and 2021.
Results. Current smoking increased significantly from 22.4% (95% confidence interval (CI) 20.4 - 24.5) in 2017/18 to 27.6% (95% CI 24.3 - 31.1) in 2021 (p=0.009). Smoking of FMCs did not change significantly overall between these two periods (20.1% v. 22.1%; p=0.240), except for a significant increase among those who self-identified as black African and a decrease among those who self-identified as coloured and those currently employed. However, the use of waterpipe/hubbly, ECigs, RYO cigarettes and snuff increased significantly. Women, individuals aged <35 years and black Africans had the largest increase in waterpipe/hubbly and ECig use. A decomposition analysis showed that increased waterpipe/hubbly and RYO use explained 52% and 15%, respectively, of the increase in smoking rates, while lower employment during 2021 compared with 2017/18 explained 15% of the increase in smoking rates during 2021.
Conclusion. The use of all TNPs continued to increase in SA, particularly among women and unemployed people. These findings have policy and practice implications for addressing socioeconomic disparities in tobacco-related diseases
South African healthcare reforms towards universal healthcare – where to next?
Get PDFThe National Assembly approval of the National Health Insurance (NHI) Bill represents an important milestone, but there are many uncertainties concerning its implementation and timeline. The challenges faced by the South African healthcare system are huge, and we cannot afford to wait for NHI to address them all. It is critical that the process of strengthening the health system to advance universal healthcare (UHC) begins now, and there are several viable initiatives that can be implemented without delay. This article examines potential scenarios after the Bill is passed and ways in which UHC could be advanced. It begins with an overview of the trajectory of health system reform since 1994, then examines the scenarios that may emerge once the Bill is passed by Parliament and makes a case for finding ways in which UHC could be advanced within the country, regardless of any legal or financial barriers that may delay or limit NHI implementation