HIV and/or AIDS-related deaths and modifiable risk factors: a descriptive study of medical admissions at Oshakati Intermediate Hospital in Northern Namibia

Background: High rates of HIV infection have decreased life expectancy in many African countries. Regardless of worldwide efforts to escalate treatment; care and prevention strategies; the number of deaths due to AIDS-related disorders is still high. Local healthcare workers suspect that there are modifiable factors in the care of HIV and/or AIDS patients which can be identified and improved. Aim: To describe the HIV and/or AIDS-related causes of adult mortality and identify modifiable factors amongst patients admitted to Oshakati Intermediate Hospital; northern Namibia. Methods: Data was extracted retrospectively and coded using the modified CoDe protocol for AIDS. Modifiable factors relating to the patient; health system or clinical care were identified using a standardised data collection tool.Results: A total of 177 HIV and/or AIDS patients were identified; 94 (53.1%) were male and 120 (68%) had a CD4 count of less than 200 cells/mL. The common HIV-related causes of death were tuberculosis (25.9%); renal failure (15.8%); Pneumocystis jirovecii pneumonia (11.3%); cryptococcal meningitis (9%); HIV wasting syndrome (7.9%) and AIDS-defining malignancy (7.9%). The analysis revealed 281 modifiable factors; patient-related factors were the most common (153 [54.4%]); followed by health system factors (97 [34.5%]) and healthcare personnel factors (31 [11%]).Conclusion: Our findings have highlighted the challenges in overall HIV and/or AIDS inpatient care and surrounding primary care facilities. The identification of specific modifiable factors can be used to reduce mortality by providing training as well as rational monitoring; planning and resource allocation

Youth Mortality Due to HIV/AIDS in South Africa; 2001-2009: An Analysis of the Levels of Mortality Using Life Table Techniques

South Africa has one of the highest HIV/AIDS prevalence rates in the world. It is estimated that 5.38 million South Africans are living with HIV/AIDS. In addition; new infections among adults aged 15+ were reportedly 316 900 in 2011. New infections among children (0-14 years old) was also high in 2011 at 63 600. This paper examines South Africa's mortality due to HIV/AIDS among the youth (15-34 years old). This age group is of fundamental importance to the economic and social development of the country. However; the challenges of youth development remain vast and incomparable. One of these challenges is the impact of HIV/AIDS on mortality. Life table techniques are used to estimate among others; sex differentials in death rates for the youth population; probability of dying from HIV/AIDS before the age of 35 and life expectancy should HIV/AIDS be eradicated from the population. The study used data from the National Registry of Deaths; as collated by Statistics South Africa from 2001 to 2009. Results show that youth mortality due to HIV/AIDS has remained consistently higher among older youths than in younger ones. By sex; mortality due to this cause has also remained consistent over the period; with mortality due to HIV/AIDS being higher among females than males. Cause-specific mortality rates and proportional mortality ratios reflect the increased mortality of older youth (especially 30-34 years old) and females within the South African population. Probability of dying from HIV/AIDS shows that over the period; fluctuations in likelihood of mortality have occurred; but for both males and females (of all age groups) the chances of dying from this cause decreased in 2007-2009

The Experiences of AIDS Orphans Living in a Township

An overwhelming challenge to health-care professionals today; is the rendering of care services to AIDS orphans. This article is based on a study that explored and described the lived experiences of AIDS orphans in a township in order to understand their 'life world' as AIDS orphans. A further purpose was to provide information to primary health-care nurses (PHCNs); related professionals and partners involved in the care of these children; so that they could plan a care response to meet the orphans' unique needs. A qualitative research design that used an explorative; descriptive; contextual and phenomenological strategy of inquiry was employed. Data were collected by means of in-depth interviews from a purposively selected sample; and were analysed according to the steps of qualitative data analysis proposed by Tesch (Creswell 1994). Guba's model was used to ensure the trustworthiness of the qualitative data. Two main themes and their sub-themes were identified. The first theme was that children experience devastating changes in their life circumstances when they become AIDS orphans. The second theme highlighted how the participants rediscovered hope to persevere. Recommendations directed at nursing practice; education and research; were made based upon the findings

HIV and AIDS Knowledge and Sexual Behaviours amongst Secondary School Learners in Harare; Zimbabwe

Efforts to stem the tide of the Human immunodeficiency virus (HIV) and Acquired immune deficiency syndrome (AIDS) pandemic in Africa emphasise the necessity that learners should be able to make informed decisions. Although learners in Zimbabwe's schools are taught about HIV and AIDS; the extent of their knowledge needed to be determined. The major objective was to assess the knowledge of secondary school learners in Harare; Zimbabwe; about HIV and AIDS. Structured interviews were conducted with 75 Grade 8 (Form 1) secondary school learners from four schools in Harare. Most learners had obtained their HIV and AIDS knowledge from schools; but some did so from their parents; community activities; the radio or television. No learner had commenced with sexual activities and all had heard about HIV; but not all knew what HIV was; and even fewer could define AIDS. Less than one-third of the learners could mention the three most important HIV preventive measures. Most learners were willing to undergo voluntary counselling and testing (VCT); but few had done so. As no learner had commenced sexual activities; opportunities existed to empower Grade 8 (Form 1) learners with adequate HIV and AIDS knowledge. Generally the learners' HIV and AIDS knowledge levels were high but some misconceptions existed. Schools should engage with radio and television programmes to address misconceptions about HIV and AIDS. Learners should be enabled to access VCT services. More effective HIV prevention education in Zimbabwe's schools; could enable more youth to remain HIV negative

Mortality Decreases among Young Adults in Southern Central Ethiopia

Background: Despite the anticipated high impact of HIV and AIDS among young people; AIDS related mortality is not well documented because of the lack of death registration systems in Ethiopia. The objective of this analysis was to investigate the trends in mortality among young adults (aged 10-24 years) in the era of the AIDS epidemic. Methods: We analyzed data for young adults aged between 10-24 years using the Butajira Rural Health Programme (BRHP) open cohort database. The study covers 1 urban and 9 rural communities; which were initially randomly selected from the Butajira district. The BHRP database covers the period 1987-2004; recording vital events and migration at the household level after an initial baseline census in 1987; using village-based data collectors. The data included 34;150 young people who contributed a total of 248;154 person years. Results: In the 18-year follow-up period; 1;030 young adults died; giving an age-specific crude mortality rate of 4.2 per 1;000 person-years. The trends of mortality in this population declined from 6 per 1;000 person-years in 1987- 1989 to less than 2 per 1;000 person-years in 2002-2004. Deaths due to HIV were recorded at a rate of only 0.02 per 1;000 person-years; according to causes of death reported by family care givers. A multivariate regression model showed that young adults from the rural highlands and lowlands had a higher risk of death (adjusted rate ratios 1.99 [1.40-2.83] and 2.58 [1.82-3.66] respectively) than young urban adults; even after adjusting for water source; literacy and housing type. The earlier cohorts (1987-1989 and 1990-1994) had higher risks of mortality than the latest cohort (1999-2004) - (adjusted rate ratios 1.91 [1.59-2.29] 2.03 [1.75-2.35] respectively). Conclusion: A remarkable decline in mortality was observed in this population with little sign of excessive HIV/AIDS-related mortality appearing during this 18-year period. However; the occurrence of AIDS-related deaths in the latter part of the study period suggests appropriate interventions to counter the developing HIV epidemic are justified

Low rate of reporting of confirmed AIDS-related deaths using BI-1663 forms by private medical practitioners in the Mafikeng, North West Province

The aim of the study was to investigate the experiences and perceptions of medical practitioners about the implementation of the current death notification form (BI-1663) in cases of confirmed AIDS-related deaths. The study focused on reporting patterns by private medical practitioners of the deceased's underlying causes of death in BI-1663; together with reasons advanced for the reporting patterns. Using self-administered questionnaires; data were collected from 31 medical practitioners in the Mafikeng area of the North West Province. The findings revealed that the majority of medical practitioners either did not disclose; did omit or mis-report information that HIV/AIDS-related disease was the underlying cause of death in BI-1663 during notification of confirmed AIDS-related death. Reasons advanced for the phenomenon were fears of unauthorised breach of the deceased's confidential information by unintended parties that often led to invalidation of the deceased's insurance and funeral benefits; as well as stigmatisation and social discrimination of the relatives of the deceased. The study recommends that third parties (informants) should be relieved of the duties of conveying the deceased's confidential medical information to the state during death notification processes. Medical practitioners themselves should submit part 2 of BI-1663 that contains the deceased's confidential information directly to public health officials. The study also recommends that the Department of Health should provide formal training to the medical practitioners with respect to death certification to enable them to certify causes of death in a manner that is useful for epidemiological analysis and public policy

Impact of HIV/AIDS Mortality on South Africa's life Expectancy and Implications for the Elderly Population

The study seeks to raise awareness and expand knowledge about the deleterious effect of HIV/AIDS mortality on South Africa's life expectancy; a country with a relatively high HIV/AIDS prevalence rate (19. percent). Using the multiple and associated single decrement life table techniques; the study estimates the total number of South Africans who would die from HIV/AIDS by the time they reach age 75 from a hypothetical cohort of 100;000 live births; assuming that the mortality conditions of 1996 for South Africa prevailed. The findings indicate that 5.7 percent of babies will eventually die of HIV/AIDS. Furthermore; 7.7 percent and 11.5 percent of those aged 60 years; and 75 years and above respectively will die of HIV/AIDS. Overwhelming majority of deaths will come from persons within the reproductive and productive age groups. A tremendous gain in life expectancy to the tune of about 26 years would result in the absence of HIV/AIDS. The elderly persons; who are the grandmothers and grandfathers; are likely to manage family affairs following the death of their adult children. This condition is likely to impoverish the elderly population. Everything should be done to reduce HIV/AIDS mortality in order to increase life expectancy in the country

The effect of AIDS on manpower resource development in Uganda

A restrospective investigation of mortality among Uganda's highly trained manpower was carried out in 1990. It was found that the mortality rate in this category had increased from 0.4per year during the pre-AIDS period to 2.5per year by 1990. This increase was largely attributable to AIDS. These findings show that AIDS is causing big losses in training investment in Uganda

Mortality and geographical distribution of AIDS patients in Mangochi: an indication of the impact on Mangochi Hospital

In an attempt to determine a possible impact of the AIDS epidemic on Mangochi Hospital; basic information such as drug use; admission days and date and place of death of 971 patients presenting at Mangochi Hospital between 1986-1990 was prospectively studied. The study shows that; despite the rural characteristics of the district; AIDS/HIV infection is strongly related in urban and rural settings to a high economic activity

Orphans as a window on the AIDS epidemic in Sub-Saharan Africa: initial results and implications of a study in Uganda

Provisional estimates from a Save the Children Fund enumeration study in four Ugandan districts indicate that the total number of orphans (one or both parents missing) ranges between 620;000 and 1;200;000. Needs assessments with guardians and local administrators show that although extended family networks are absorbing these children according to traditional rules; they may be vulnerable to increased mortality due to economic and health stresses on their caretakers; many of whom are elderly persons. The orphan burden will increase in Uganda and other Sub-Saharan African countries over the next few years. Allocation of additional national and international resources must be considered to avert breakdowns in community and familial support systems and consequent increases in under 5 mortality. The orphan burden is a window on the potential for massive social breakdown and dislocation in Sub-Saharan Africa resulting from high AIDS-related mortality. Methodologies for data collection and planning that use indigenous political systems must be built quickly to avert disaster