Lactic Acidosis; Risk Factors and Predictive Laboratory Markers: a Nested Case Control Study in South Africa

Background: The incidence of antiretroviral therapy (ART)-induced lactic acidosis and its associated mortality may be reduced by appropriate dosing; risk stratification and early detection. Objectives: To describe the epidemiology of lactic acidosis; define the risk factors and identify predictive laboratory markers in the context of the roll-out of ART in South Africa. Design: A nested case control study. Risk factor analysis was adjusted for the established risk factors of weight and gender.Setting and subjects: Persons commenced on stavudine-containing therapy between 2004 and 2007 at Port Shepstone Hospital in KwaZulu-Natal were included. Persons with a body weight above 60 kg received Stavudine 40 mg twice daily; and those with a body weight below 60 kg; 30 mg twice daily.Outcome measures: Assessed risk factors included weight; gender; age; alanine transaminase (ALT); urea; creatinine; albumin; cholesterol; triglyceride (TG) levels; CD4 counts and viral loads.Results: Lactic acidosis occurred in 79 (17 per 1 000 person-years) of 1 762 people living with HIV on ART. Significant factors were being female [adjusted odds ratio (AOR) of 5.4] and increased body weight (adjusted OR of 1.1 per kg). The risk of lactic acidosis increased 6.6; 6.9 and 95 times (adjusted ORs) as weight increased from a baseline weight of 60 kg to 60-69 kg; 70-79 kg or 80 kg; respectively. Six months into therapy; predictors of developing lactic acidosis were an ALT 50 IU/l (adjusted OR of 11.1) and a higher TG (adjusted OR of 8.8 per mmol/l). No associations were found with regard to age; CD4 count; viral load; and creatinine or albumin levels.Conclusion: Obese females are at greatest risk of lactic acidosis; with an exponential increase in risk above 80 kg. The 30-mg dose may be preferable; given that a sharp increase in risk occurred at 60 kg; was most likely dose related; and that 30 mg has been shown to provide adequate virological suppression. Additional risk factors for lactic acidosis include a high ALT and TG levels at treatment

Prevalence Patterns and Predictors of Alcohol Use and Abuse among Secondary School Students in Southern KwaZulu-Natal; South Africa: Demographic Factors and the Influence of Parents and Peers

Used alcohol and 32Background: The prevalence and predictors of alcohol use and abuse among school students were investigated with the aim of gaining insight to guide prevention interventions.Method: A cross-sectional; self-administered survey pertaining to a one-month period was conducted among students in grades 11 and 12 in purposively selected schools with mixed-race groups. Frequencies and ?2 analyses were conducted and forward stepwise; conditional entry logistic regression models were fitted to determine the significant demographic predictors and influence of peers and parents on students' alcohol use and binge drinking.Results: About 54 of students had used alcohol before; while 14.5 had had their first drink before the age of 13. In the relevant month; 41 engaged in binge drinking. Students who were more likely to have used alcohol in the preceding month were older [odds ratio (OR) = 1.44; P = 0.006]; male (OR = 2.1; P 0.001); white (OR

Healthcare Waste Management in Clinics in a Rural Health District in Kwazulu-Natal

The handling of healthcare waste (HCW) was investigated in 30 rural healthcare facilities in KwaZulu-Natal. Using a semi-structured questionnaire; interviews were carried out with the person in charge of the facility and observations were made to establish current practices in sorting; handling and disposal of HCW. It was found that improper sorting and management of HCW occurred on most sites with implications for cost; infection control and education. It is imperative therefore that improved HCW management measures be implemented and that healthcare facility staff receive appropriate and repeated training to ensure minimising risk

Using Lot Quality Assurance Sampling Methodology to Evaluate the Uthukela District Child Survival Project of Kwazulu-Natal

Abstract:Health services programmes and interventions require objective measures on coverage and quality to ensure that managers have the evidence to adopt and expand health interventions effectively and efficiently. Over the past 15 years; the uThukela District Child Survival Project of South Africa achieved this through regular two- to three-year project evaluations using cluster sampling. Results of these surveys have improved the ability of Child Survival Projects to identify priorities; define objectives based on data; and measure progress towards these objectives. However; the inability to disaggregate information to composite Supervision Areas (SAs) was a limitation. Lot quality assurance sampling (LQAS) was adopted as an improved method based on its ability to assess performance in disaggregated units within a study population and to reliably compare coverage and health status indicators for routine monitoring of child survival activities. This study assessed the feasibility and reliability of LQAS to evaluate the Child Survival Project and compare the results of a rapid manual analysis with a secondary electronic analysis of the same data. The accuracy of the manual analysis was comparable and provides evidence that LQAS and rapid manual analysis can be used to evaluate intervention programmes; particularly in settings of limited electronic technology and expertise