Determinants of serum 25-hydroxyvitamin d levels in healthy young adults living in the Western Cape, South Africa

Background: Vitamin D deficiency is fast emerging as a global pandemic. In South Africa few studies have been conducted to determine the vitamin D status of the healthy population.Methods: This prospective study with an analytical component investigated vitamin D status of healthy undergraduate students at two time points (winter and summer) at Stellenbosch University. Serum 25(OH)D was determined, anthropometric measurements taken and dietary vitamin D intake estimated (food-frequency questionnaire). Skin tone was determined (Fitzpatrick skin type classification), and a skin reflectometry device used to measure dermal melanin content.Results: Results of 242 students indicated a mean serum 25(OH)D of 63.80 ± 41.35 ng/ml and a high prevalence of vitamin D sufficiency (88%). Significantly more females experienced suboptimal vitamin D levels than males (18 vs. 5%; p < 0.01). Participants with lighter skin tones had higher levels of 25(OH)D than those with darker skin tones (chi-square = 24.02; p = 0.02). The majority (60.74%) had a normal BMI, although there was no significant relationship between BMI and serum 25 (OH)D (Spearman's r=­0.11; p = 0.09). Total mean dietary vitamin D intake was 7.99 ± 13.81 mcg, with 87.2% having inadequate intake (< 15 mcg). The relationship between total vitamin D intake and serum 25(OH)D was found to be significant in winter (p < 0.001) and summer (p = 0.01). Serum vitamin D levels were significantly higher in the winter phase (p < 0.001).Conclusions: A low prevalence of vitamin D deficiency was found amongst healthy young adults, despite low dietary vitamin D intakes. Significant relationships were found between serum 25(OH)D and gender, skin tone and vitamin D intake. Further studies need to be conducted, especially in high-risk groups, before results are applied to the greater South African public

Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa

Background. Venous thromboembolism (VTE) is a common complication during and after hospitalisation, and is regarded as the most common cause of preventable death in hospitalised patients worldwide. Despite its importance, there are few data on VTE risk and adherence to prophylaxis prescription guidelines in surgical patients from the South African (SA) public sector, especially from low-resource environments such as Eastern Cape Province.Objectives. To evaluate the risk and prescription of VTE prophylaxis to surgical patients at a tertiary government hospital in the Eastern Cape.Methods. A cross-sectional clinical audit of general surgical inpatients was performed on two dates during July and August 2017. Patients' VTE risk was calculated by using the Caprini risk assessment model (RAM) and thromboprophylaxis prescription evaluated accordingly. Results. A total of 179 patients were included in the study, of whom 56% were male and 44% female. The average age was 45 (range 18 - 83) years. Of the total number of participants, 33% were elective cases and 67% were emergency admissions. With application of RAM, 77% of patients were at risk of VTE (Caprini score ≥2), with 81% of elective and 74% of emergency patients being at risk. The most prevalent risk factors for VTE were major surgery (34%), age 41 - 60 years (30%), age 61 - 74 years (20%) and sepsis during the previous month (27%). A contraindication to chemoprophylaxis was recorded in 30% of patients, with the most prevalent being renal dysfunction (40%), peptic ulcer disease (34%), active bleeding (17%), liver dysfunction (17%), coagulopathy (6%) and recent cerebral haemorrhage (6%). With regard to VTE risk profile and contraindications to chemoprophylaxis, the correct thromboprophylactic treatment was prescribed to 26% of at-risk patients, with 21% of elective and 27% of emergency admission patients receiving the correct therapy.Conclusions. Despite a high proportion of patients being at risk of VTE, the rate of adequate thromboprophylaxis prescription for surgical inpatients at Frere Hospital, East London, SA is very low. Increased availability of mechanical prophylaxis, as well as interventions to improve the rate of adequate prophylaxis prescription, needs to be evaluated for feasibility and effect in this hospital and other SA public hospitals

Preoperative anaemia and clinical outcomes in the South African surgical outcomes study

Background.In high-income countries, preoperative anaemia has been associated with poor postoperative outcomes. To date, no large study has investigated this association in South Africa (SA). The demographics of SA surgical patients differ from those of surgical patients in the European and Northern American settings from which the preoperative anaemia data were derived. These associations between preoperative anaemia and postoperative outcomes are therefore not necessarily transferable to SA surgical patients.Objectives. The primary objective was to determine the association between preoperative anaemia and in-hospital mortality in SA adult non-cardiac, non-obstetric patients. The secondary objectives were to describe the association between preoperative anaemia and (i) critical care admission and (ii) length of hospital stay, and the prevalence of preoperative anaemia in adult SA surgical patients.Methods. We performed a secondary analysis of the South African Surgical Outcomes Study (SASOS), a large prospective observational study of patients undergoing inpatient non-cardiac, non-obstetric surgery at 50 hospitals across SA over a 1-week period. To determine whether preoperative anaemia is independently associated with mortality or admission to critical care following surgery, we conducted a multivariate logistic regression analysis that included all the independent predictors of mortality and admission to critical care identified in the original SASOS model.Results. The prevalence of preoperative anaemia was 1 727/3 610 (47.8%). Preoperative anaemia was independently associated with in-hospital mortality (odds ratio (OR) 1.657, 95% confidence interval (CI) 1.055 - 2.602; p=0.028) and admission to critical care (OR 1.487, 95% CI 1.081 - 2.046; p=0.015).Conclusions. Almost 50% of patients undergoing surgery at government-funded hospitals in SA had preoperative anaemia, which was independently associated with postoperative mortality and critical care admission. These numbers indicate a significant perioperative risk, with a clear need for quality improvement programmes that may improve surgical outcomes. Long waiting lists for elective surgery allow time for assessment and correction of anaemia preoperatively. With a high proportion of patients presenting for urgent or emergency surgery, perioperative clinicians in all specialties should educate themselves in the principles of patient blood management

The barriers that women face when choosing food for their primary school children: A case study in the Western Cape Province, South Africa

Background. Unhealthy food choices made by mothers can impact negatively on child health and may lead to unhealthy eating behaviours that persist into adulthood. Choosing food is a complex process influenced by many factors. Objectives. To determine the factors that influence mothers' food choices and to investigate barriers to purchasing healthy food.Methods. A cross-sectional, descriptive study, with an analytical component, was conducted. Mothers (N=476) were recruited from three randomly selected primary schools, from a low, middle and high quintile. A self-administered questionnaire was used to collect data on demographics, knowledge, attitude and practices of mothers. Six focus groups (FG) (two per school) were conducted to investigate the factors that prevent mothers from making healthy dietary decisions.Results. The mean nutrition knowledge score for the group was 68.6%. Nutrition knowledge was significantly lower (p<0.01) in mothers from the lower quintile school (64.0%). Primary factors influencing food purchases were cost (60%), nutritional value (37%) and time constraints (29%). Primary sources of nutrition information included magazines and health professionals at 62% and 44%, respectively. Time constraints resulted in mothers purchasing convenience foods more often (p=0.001). The main barriers identified were mixed media messages, the school environments and supermarket layouts.Conclusion. Nutrition education campaigns should include practical advice, e.g. the preparation of economical, wholesome meals. Policymakers should monitor increasing prices of healthy foods. School and supermarket environments, as well as the food industry, can play a pivotal role in facilitating mothers to make healthy food choices

Nosocomial Infections in HIV-Infected and HIV-Uninfected children Hospitalized for Tuberculosis

Background : The interaction between tuberculosis and human immunodeficiency virus (HIV) infection is well known and is responsible for the increase in the incidence of tuberculosis (TB) in sub-Saharan Africa over the last decade. This places a considerable extra burden on health services. The Brooklyn Hospital for Chest Diseases (BCH) is a non-acute TB hospital for the City of Cape Town; South Africa. The hospital has 60 children's beds and approximately 140 paediatric admissions annually. This study; undertaken before the availability of antiretroviral drugs in the public sector in South Africa; documents the occurrence of nosocomial infections in HIV-infected and HIV-uninfected children at BCH. Methods : This retrospective case-control study evaluated the occurrence of nosocomial infections in human immunodeficiency virus (HIV)-infected children and age- and time of admission-matched HIV-uninfected children admitted to the BCH; Cape Town; South Africa between July 1999 and December 2001 for the treatment of tuberculosis (TB). Results : Forty-seven HIV-infected children (mean age 40 months) and 47 HIV-uninfected children (mean age 41 months) were studied. The HIV-infected children; who were not receiving antiretroviral therapy because it was not yet available in the public sector; experienced 109 episodes of nosocomial infections compared to 22 episodes amongst those not infected with HIV (p = 0.001). Twenty-five nosocomial infections (23)among the HIV-infected children; but only two (9) among the HIV-uninfected children; were serious enough to require transfer to a tertiary care hospital for management. Pneumonia was the commonest nosocomial infection and occurred in 26 (56) HIV-infected patients; of whom three died; but in only four (9 HIV-uninfected children; none of whom died. An outbreak of varicella affected 10 HIV-infected (21) and 9 HIV-uninfected children (19). One HIV-infected child died of varicella pneumonia. Other common nosocomial infections encountered in HIV-infected and HIV-uninfected children respectively were upper respiratory tract infections (pharyngitis; tonsillitis or rhinitis) affecting 21 and four; otitis media in five and one; oral candidiasis in seven and 0; urinary tract infection in four and one and acute gastroenteritis in five and zero children. Five HIV-infected children (11) died and four of the deaths were known to be due to nosocomial infection; only one HIV-uninfected child died from severe miliary TB. Conclusion : Nosocomial infections occurring in HIV-infected children are a serious cause of morbidity and mortality in children hospitalised for the treatment of tuberculosis. Their impact could be reduced by the earlier introduction of antiretroviral treatment and by immunisation against certain of the infecting agents. Post-exposure prophylaxis for varicella could prevent or alleviate disease