After action review of the COVID-19 pandemic response in North West province, South Africa

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused coronavirus disease 2019 (COVID-19) pandemic with major disruptions globally. Northwest Province Department of Health (NWDoH) in South Africa set up comprehensive epidemiological emergency response plans for preventing, finding, containing and stopping the spread of COVID-19 in accordance with the National Disaster Management Act. Objectives: This After-Action Report (AAR) describes the provincial response to the pandemic from September 2020 to October 2022. Method: The AAR was conducted using the World Health Organization AAR methodology. Focus groups discussed five items: coordination, leadership and governance; epidemiology, surveillance and laboratory; case management and continuity of essential services; risk communication and community engagement and COVID-19 vaccination. Results: The timely establishment and activation of provincial intergovernmental and intersectoral coordinating structures led to effective coordination, resource mobilisation, leadership, decision-making and intervention. The effective communication in the department and other stakeholders resulted in improved surveillance data quality, timelier response and increased ownership of data. Dissemination, training and implementation of case management protocols ensured standardised case management. The multi-channel information dissemination targeting different audiences empowered people with real-time knowledge on the infection and encouraged health-seeking behaviours. Conclusion: The AAR demonstrated the importance of coordinated epidemiological, laboratory and communication response that requires significant public health reserve capacity in peacetime for rapid expansion in an emergency. Contribution: This review contributes to the body of knowledge emerging from the COVID-19 pandemic and provides guidance on enhanced public health response to future emergencies.

Adherence of doctors to a clinical guideline for hypertension in Bojanala district, North-West Province, South Africa

Background: Clinical guidelines are systematically developed statements that assist practitioners and patients to make healthcare decisions for specific clinical circumstances. Non-adherence of doctors to guidelines is thought to contribute significantly to poor delivery of clinical care; resulting in poor clinical outcomes. Aim: To investigate adherence of doctors in rural district hospitals to clinical guidelines using the South African Hypertension Guideline 2006 as an example.Setting: Four district hospitals in Bojanala district of North-West Province; South Africa.Methods:A cross-sectional study determined adherence practices of doctors from records of patients with established hypertension seen at the four district hospitals.Results: Of the 490 total records documented by 29 doctors; screening for co-morbidity or associated factors was carried out as follows: diabetes mellitus 99.2%; obesity 6.1%; smoking 53.5%; dyslipidaemia 36.9%; abdominal circumference 3.3%; organ damage: eye 0; kidney 82%; heart 43.5%; chronic kidney disease 38.2%; stroke/transient ischaemic attack 15.9%; heart failure 23.5%; advanced retinopathy 0.2%; coronary heart disease 23.7%; peripheral arterial disease 13.9%. Critical tests/measurements were documented in the following proportions: blood pressure 99.8%; weight 85.3%; height 65.7%; body mass index 3.1%; urinalysis 74.5%; lipogram 76.1%; urea/creatinine 80.4%; electrocardiogram 42.9%; blood glucose 100%; risk determination and grading: diagnosis by hypertension severity 19%; low added risk 57.1%; moderate added risk 64.7%; high added risk 89.6%; very high added risk 89.2%. Adherence to therapies was as follows: first-line guideline drugs 69.4%; second line 84.7%; third line 87.8% and fourth-line 89.6%.Conclusion: Overall adherence of doctors to treatment guidelines for hypertension was found to be low (51.9%). Low adherence rates were related to age (older doctors) and less clinical experience; and differed with regard to various aspects of the guidelines

Factors Associated with Pulmonary Tuberculosis Outcomes among Inmates in Potchefstroom Prison in North West Province

Tuberculosis is the leading cause of death among the world's prison populations. Prisons are reservoirs of tuberculosis and threaten inmates; prison staff; visitors and the surrounding community. This study was carried out to explore the associated factors with pulmonary tuberculosis treatment outcomes at Potchefstroom Prison. A retrospective record review of 202 inmates with tuberculosis; whose treatment outcomes as of March 2010 were known; was conducted. Data on sex; racial group; level of education; weight; smoking habits; existence and type of co-morbidity; diagnostic classification; treatment regimen; initiation date; completion date and outcome; use of directly observed treatment; allergy and hospitalisation were captured. The majority of the inmates (142; 70.3) were aged 21-37 years; while 48 (23.8) were aged 38-53 years. There were 198 (98) male and 4 (2) female inmates. Fifty-five inmates (27.3) had attained Grade 6 and lower; 71 (35.1) grade 7-9; 68 (33.7) Grade 10-12; and 8 (3.9) above grade 12. One hundred and fifty-eight (78.2) received occasional visitors. There were 121 (59.9) smokers. The adverse outcomes for tuberculosis were significantly increased by an age 37 years; human immunodeficiency virus co-infection; smoking; a lack of support and an absence of directly observed treatment. Inmates who received fewer visits and less social support must be supported by community volunteers; counsellors and psychologists in order to motivate them and enhance favourable treatment outcomes. Smokers need to stop smoking. Younger inmates require peer support groups

Multidrug-Resistant Nosocomial Infections among Private Hospital Patients in the North West Province

"This article reports on severe clinical cases of nosocomial infections that were caused by multidrug-resistant (MDR) isolates of Acinetobacter baumannii and Pseudomonas aeruginosa in an intensive care unit (ICU). Globally; patients in ICUs have encountered an increasing emergence and spread of MDR pathogens. A retrospective case study was conducted to investigate the possible causes and occurrence of nosocomial infections linked to reported cases thereof in a private hospital in the North West province between December 2009 and August 2010. This followed an enquiry from a concerned community member about two patient deaths and a patient who was in the hospital's ICU between July and August 2010 with an infection by an unknown ""superbug"". Of the 24 adult patients who were admitted to the ICU in the study period; 22 presented with isolates of A. baumannii; one with P. aeruginosa; and one with presumed A. baumannii for which there was no laboratory test confirmation. Of those who were infected with A. baumannii; nine of the 22 died (a case fatality rate of 41). The patient with no laboratory test confirmation also died within seven days; while the patient who was infected with P. aeruginosa was still in hospital at the end of the study period (August 2010). The average length of stay in the hospital was 21.3 days. Six of the 24 patients (25) stayed longer than 30 days. A patient who was infected with P. aeruginosa stayed even longer. The most common cause of death among the ICU patients; notwithstanding other underlying conditions; was A. baumannii strain; which may have directly or indirectly contributed to the prolonged length of stay in hospital. It is possible that P. aeruginosa is a recent introduction to this ICU."