Poverty dynamics and vulnerability to poverty: An empirical analysis using general household surveys

Background: This study analysed determinants of vulnerability to poverty in South Africa utilising the General Household Surveys from 2012 to 2015.Data source and methods: The Foster Greere Thorbecke poverty index by groups and income components using the Shapley Value was used to identify household vulnerability status. A multinomial logit model was used to investigate factors that contribute to vulnerability to poverty.Results: The study findings pointed out that high-income variability contributes to vulnerability and poverty among urban and rural areas.Additionally, the findings of the study demonstrated that only a few households fall in the middle (lower bound) poverty lines. Conclusions: Race and location are strong predictors of poverty in South Africa

The utility of hyperlactataemia in the definition of septic shock: evaluating the Sepsis-3 definitions in a sub-Saharan African intensive care unit

Background. Sepsis-3 definitions were published in 2016 and included hyperlactataemia (serum lactate >2.0 mmol/L) as a mandatory component of the new definition of septic shock. These data were collected mainly from high-income countries and lack adequate validation in scenarios outside these countries.Objectives. To evaluate admission serum lactate as a predictor of intensive care unit (ICU) mortality in patients with infection and hypotension requiring inotropic support.Methods. This was a retrospective observational study of 170 patients with infection and hypotension requiring inotropic support admitted to the ICU at King Edward VIII Hospital in Durban, South Africa. Admission serum lactate was evaluated as a predictor of ICU mortality in this cohort.Results. The study population had a median age of only 42 years. The ICU mortality rate for the cohort was 49.4%. Most patients were surgical (71.8%), with the most common source of sepsis being abdominal (55.9%). The ICU mortality rate was 40.9% in patients with a lactate level ≤2.0 mmol/L and 52.4% in those with a level >2.0 mmol/L; this did not reach statistical significance. The optimal cut-off was 4.5 mmol/L, at which there was a clear, statistically significant difference in mortality between patients without (39.3%) and with hyperlactataemia (59.3%)(p=0.009).Conclusions. Hyperlactataemia was associated with increased mortality. However, a lactate level >2.0 mmol/l, as proposed in Sepsis-3, did not reach statistical significance, and a higher cut-off of >4.5 mmol/L was more appropriate

Improving survival of preterm babies in low- to middle-income countries ­ what can we do?

Surviving prematurity poses the greatest challenge in neonatal care in low- to middle-income countries (LMICs). South Africa has not made much progress in improving the survival of preterm babies. Neonatal survival of preterm infants has become a national priority since the serious failure to reach the Millennium Development Goal targets in 2015. High rates of prevention are particularly relevant in LMICs, where the neonatal mortality rate is at its highest owing to a lack of simple and effective measures. Preventing prematurity and related complications begins with a healthy pregnancy. Antenatal care and maternal corticosteroids are antenatal interventions that could improve the survival of preterm babies. Postnatal interventions include: the management of neonatal sepsis, meningitis and pneumonia;prevention of hypothermia after delivery, for example, the plastic bag/wrap and cap, which has been extensively researched and is found to be an effective, low-cost method for reducing hypothermia in preterm infants; the use of continuous positive airway pressure (CPAP),including the low-cost CPAP device, which is a cost-effective strategy for providing respiratory support for premature neonates with respiratory distress syndrome; exogenous surfactant; early feeding with breastmilk; and kangaroo mother care. The use of cost-effective,evidence-based interventions can be implemented in LMICs to reduce neonatal mortality

The Effects of Household Assets Inequality and Conflict on Population Health in Sudan

We explored the effects on health of both household asset inequality and political armed conflict in Sudan. Using the 2010 Sudan household survey; we evaluated the role of both household asset distribution (measured by the Gini coefficient) and armed conflict status at the state level. We measured associations with six health-related outcomes: life expectancy; infant mortality; height-for-age (stunting); adequacy of food consumption; teenage birth rates and vaccination coverage for young children. For each of six measures of health in Sudan; outcomes were significantly worse in the states with more unequal asset distribution; with correlation coefficients ranging between -0.56 (stunting) and -0.80 (life expectancy). Conflict status predicted worse outcomes. Wealth redistribution in the more unequal states; as well as a political resolution of conflict; may improve population health

The Impact of Income on the Echocardiographic Pattern of Heart Diseases in Kano; Nigeria

Background:The aims of the present study were to assess the echocardiographic pattern of heart diseases; and to compare the pattern seen in a private echocardiography centre patronized by high income earners (group 1); with that in Murtala Mohammed Specialist Hospital patronized by low income earners (group 2); in Kano; Nigeria.Methods: the study was retrospective in design.The records of patients aged =15 years for a one year period (July 2006-June 2007) were reviewed. Results: Hypertensive heart disease (in 56.7) was the most common heart disease; more common among group 1 patients (p=0.027). Dilated cardiomyopathy was the 2nd most common heart disease (in 15.2); more common among group 2 patients (p=0.037). Ischemic Heart Disease (IHD) was the 3rd most common (in 8.7) heart disease in the study; more common than rheumatic heart disease (in 8.3). Peripartum cardiomyopathy was exclusively found among group 2 patients (4.3). Conclusion:The pattern of heart diseases in Kano differs between low and higher income earners. HHD was the commonest heart disease among both low income and higher income earners.The relatively high frequency of IHD might be a demonstration of the advanced stage of epidemiologic transition in Kano Nigeria

The Impact of Income on the Echocardiographic Pattern of Heart Diseases in Kano; Nigeria

Background:The aims of the present study were to assess the echocardiographic pattern of heart diseases; and to compare the pattern seen in a private echocardiography centre patronized by high income earners (group 1); with that in Murtala Mohammed Specialist Hospital patronized by low income earners (group 2); in Kano; Nigeria.Methods: the study was retrospective in design.The records of patients aged =15 years for a one year period (July 2006-June 2007) were reviewed. Results: Hypertensive heart disease (in 56.7) was the most common heart disease; more common among group 1 patients (p=0.027). Dilated cardiomyopathy was the 2nd most common heart disease (in 15.2); more common among group 2 patients (p=0.037). Ischemic Heart Disease (IHD) was the 3rd most common (in 8.7) heart disease in the study; more common than rheumatic heart disease (in 8.3). Peripartum cardiomyopathy was exclusively found among group 2 patients (4.3). Conclusion:The pattern of heart diseases in Kano differs between low and higher income earners. HHD was the commonest heart disease among both low income and higher income earners.The relatively high frequency of IHD might be a demonstration of the advanced stage of epidemiologic transition in Kano Nigeria