Résumé
Background: Concerns and misconceptions surrounding coronavirus disease 2019 (COVID-19) vaccines may account for vaccine hesitancy and low uptake. Aim: To determine prevalence of COVID-19 vaccine hesitancy, vaccine-related misconceptions, and predictors of vaccine hesitancy among South Africans. Setting: Community setting in five districts in KwaZulu- Natal province. Methods: Between August 20, 2021, and September 27, 2021, we conducted a cross-sectional survey, interviewing 300 unvaccinated adults amid the national vaccination campaign. Predictors of hesitancy were identified through multivariable logistic regression analysis. Results: Participants had a median age of 29 years (IQR: 2339), 86.7% were Black African, 63.2% were male, 53.3% resided in rural communities, and 59.3% (95% CI: 53.8% 64.9%) were classified as vaccine hesitant. The primary reason for not vaccinating was a lack of trust in the vaccine (62.1%). Factors associated with reduced vaccine hesitancy included age (participants aged 3549 years: OR: 0.28, 95% CI: 0.180.64, p = 0.003; participants over 50 years: OR: 0.18, 95% CI: 0.070.47, p = 0.0004), previous COVID-19 infection (OR: 0.31, 95% CI: 0.110.87, p = 0.03), and receiving vaccine information from healthcare workers (OR: 0.32, 95% CI: 0.101.0, p = 0.05). Unemployed (OR: 2.14, 95% CI: 1.14.2, p = 0.03) and self-employed individuals (OR: 2.98, 95% CI: 1.277.02, p = 0.01) were more likely to be vaccine hesitant. Conclusion: COVID-19 vaccine hesitancy rates are high in KwaZulu-Natal. Uptake could be enhanced by healthcare workers leading information campaigns with messages targeting younger individuals, the unemployed, and the self-employed. Contribution: This survey provides evidence to improve COVID-19 vaccination uptake in South Africa.
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COVID-19Résumé
Background: The COVID-19 pandemic has placed immense pressure on healthcare workers (HCWs). Objectives: This study sought to find the prevalence and factors associated with psychological distress among HCWs in South Africa during the beginning phases of COVID-19 and make relevant recommendations. Method: The survey was administered online through a data-free platform. Data were benchmarked to the national population of over 500 000 healthcare professionals in South Africa. Multiple logistic regressions were used to determine association between psychological distress and potential explanatory variables. Results: A total of 7607 healthcare professionals participated in the study (1760 nurses, 2843 medical practitioners and 3004 other healthcare professionals). Half of the nurses, 41% of medical practitioners and 47% of other healthcare professionals were classified as psychologically distressed. Those who were of older age, provided with well-being support services and having a positive outlook on the healthcare system were significantly less likely to be distressed. Being female medical practitioners and female other healthcare professions, requesting routine counselling, being concerned about not having enough leave and that their life insurance policy did not cover COVID-19 were more likely to be distressed. Conclusion: Psychological well-being of HCWs in South Africa is at risk. We recommend that psychological distress of HCWs be routinely assessed and that routine counselling, well-being support services, appropriate hazardous leave and insurance be provided to all HCWs. Contribution: This study adds to the literature on the psychological distress faced by HCWs in South Africa during COVID-19.
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Humains , Mâle , Femelle , Enquêtes et questionnaires , COVID-19 , PandémiesRésumé
Background: Competitive intelligence (CI) involves monitoring competitors and providing organizations with actionable and meaningful intelligence. Some studies have focused on the role of CI in other industries post-COVID-19 pandemic. Objectives: This article aims to examine the impact of COVID-19 on the South African insurance sector and how the integration of CI and related technologies can sustain the South African insurance sector post-COVID-19 epidemic. Method: Qualitative research with an exploratory-driven approach was used to examine the impact of the COVID-19 pandemic on the South African insurance sector. Qualitative secondary data analyses were conducted to measure insurance claims and death benefits paid during the COVID-19 pandemic. Results: The research findings showed that the COVID-19 pandemic significantly impacted the South African insurance industry, leading to a reassessment of pricing, products, and risk management. COVID-19 caused disparities in death benefits and claims between provinces; not everyone was insured. Despite challenges, South African insurers remained well-capitalised and attentive to policyholders. Integrating CI and analytical technologies could enhance the flexibility of prevention, risk management, and product design. Conclusion: COVID-19 requires digital transformation and CI for South African insurers' competitiveness. Integrating artificial intelligence (AI), big data (BD), and CI enhances value, efficiency, and risk assessments. Contribution: This study highlights the importance of integrating CI strategies and related technologies into South African insurance firms' operations to aid in their recovery from the COVID-19 crisis. It addresses a research gap and adds to academic knowledge in this area.
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Humains , Mâle , Femelle , Intelligence artificielle , COVID-19Résumé
Background: Burnout, resulting from chronic workplace stress that has been unsuccessfully managed, has previously been documented in doctors. The coronavirus disease 2019 (COVID-19) pandemic has increased occupational challenges faced by doctors, potentiating their risk for burnout. Aim: This study aimed to determine the prevalence and determinants of burnout among medical doctors during the COVID-19 pandemic. Setting: Three public sector hospitals in Gqeberha, South Africa. Methods: A cross-sectional study of 260 voluntary participants was conducted. Participants completed self-administered electronic questionnaires. Logistic regression analysis was performed to explore the determinants of burnout. Results: The prevalence of burnout in this study was 78%. Burnout was significantly associated with being a medical intern or community-service medical officer (adjusted odd ratio [AOR] = 6.72, 1.7126.40), being in the lowest income band (AOR = 10.78, 2.5545.49), and using alcohol to manage work-related stress (AOR = 3.01, 1.128.04). Job-related factors associated with burnout were experiencing high conflict at work (AOR = 5.04, 1.9213.20) and high role ambiguity and role conflict (AOR = 4.49, 1.9810.18). Low support at work (AOR = 9.99, 3.6627.23), medium job satisfaction (AOR = 5.38, 2.6510.93) and medium support at work (AOR = 3.39, 1.716.73) were positively associated with burnout. Participants with medium (AOR = 0.28, 0.100.80) and high levels of resilience (AOR = 0.08, 0.030.25) were protected against burnout. Coronavirus disease 2019-related factors were not significantly associated with burnout. Conclusion: The burnout prevalence among South African medical doctors at public hospitals during the COVID-19 pandemic was high and strongly associated with job stress factors. Contribution: Given the increased prevalence of burnout among doctors and the strong associations with job stress factors, mitigation of burnout requires targeted organisational interventions.
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COVID-19 , PandémiesRésumé
Background: South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment. Aim: The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system. Setting: The Public health sector, Gauteng province formed the setting for the study. Method: A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing. Results: General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals. Conclusion: In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended. Contribution: This study provides insight into service provision for MNS disorders.
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Santé mentale , Coûts et analyse des coûtsRésumé
Background: South African pharmacies face challenges like cost reduction, inventory management, and employee efficiency. Balancing dispensing error rates and customer satisfaction, along with ensuring accurate medication dispensing, is also crucial. An effective solution to these challenges is adopting automatic robotic dispensing systems, which enhance stock inventory management, integrated systems, and accurate dispensing capabilities. Objectives: The study delved into IT and robotic automation in South African pharmaceutical dispensing, assessing current methods and advocating for integrated IT and Automated Storage and Retrieval Systems in retail and hospital pharmacies. Method: The research used a quantitative approach to gather data from public and private hospital pharmacy employees, aiming to understand their requirements and expectations. It assessed the potential improvements that could result from adopting a new system. Results: The study found that most government and private pharmacies in South Africa prefer automated dispensing systems to reduce errors, lower costs, improve customer service, and enhance inventory management. Benefits also included minimising medication errors, improving operational efficiency, and ensuring patient safety. Conclusion: The study holds importance as it underscores the necessity of integrating Information Technology (IT) and Robotic Automation in the pharmaceutical sector to address prevailing issues. It identifies factors contributing to medication dispensing errors and demonstrates the potential of automated robotic systems in mitigating these errors. Contribution: South Africa's pharmaceutical sector must enhance efficiency and competitiveness by adopting integrated IT and Robotic Automation Systems. The study identified key factors for future implementation and emphasized the need for clear pre-implementation policies outlining functions and benefits.
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Background: International literature has evidenced that Deaf people have been disadvantaged during the COVID-19 pandemic; however, there is currently little research published within the South African context. Objectives: This study investigated the ways in which the COVID-19 pandemic and its consequent response measures impacted Deaf adults in Cape Town. Method: Using a descriptive approach, semi-structured, qualitative interviews were held with 15 Deaf adults in Cape Town, South Africa. Participants were purposively selected through a local Deaf organisation. Data were analysed using thematic analysis. Results: Data revealed the challenges experienced when accessing information, the impact of communication barriers on daily life, and how the response measures impacted access to healthcare. Conclusion: The findings of this study demonstrate how the needs of the Deaf community were overlooked and their voices disregarded during the planning of the national pandemic response, ultimately having detrimental consequences. Therefore, the authors argue for greater inclusion of Deaf representatives to ensure equal access to information and resources, especially during a crisis. Contribution: This study contributes to the growing body of knowledge on the consequences of the COVID-19 pandemic in the field of disability and insights can inform both future research and interventions to promote equity and inclusion for Deaf people.
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Rendez-vous et plannings , Prestations des soins de santé , Pandémies , COVID-19Résumé
Background:Present study total participants were 700 males and females included with different age group and different education level. Topics of discussion included typical drinking reasons- Daily Habitual, stress, emotions type/mood (happy/Sad), burden, and party and the drink type like only beer, only whisky/vodka/wine and both. Methods:The legal age of wine purchase in South Africa is 18 years and on. We have analysed the age groups 18-25, 26-45, and 45-65, with the interviews having the general questions regarding the reason of drinking. Preliminary bar visits were carried out in ten bars and restaurants to develop and identify any potential problems with the planned data collection protocols and to determine which specific reason were common in bar customers will emphasized during the main study. Bar and restaurant visits in the main study began in June 2021 and were completed in March 2022, bar visits were made from 3 p.m. to 10 p.m. on nights randomly. Results: The customers we studies having majority of males than female observed. In daily habitual is high in age of 26-45 41.57%, in stress high rate is in unemployed of 57.71%, in workload burden alcohol consumption is age group 26-45 of 51.71%, in Party criteria age group 57.85%, In Emotions type/mood (happy/Sad) alcohol consumption is in category unemployed of 83%. Conclusion: Support the need for additional research to develop effective prevention and intervention strategies to reduce high-risk alcohol
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Background. Regulation of antibiotic prescription and consumption remain a major public health burden in low- and middle-income country. This study aimed to describe the antibiotic consumption of patients who had a positive antibiotic culture in a reference laboratory. Methods. A retrospective descriptive study was conducted among 113 participants with positive antibiogram with a documented history of antibiotics intake at the Yaoundé University Teaching Hospital (YUTH) in Cameroon between January 2016 to June 2021. Data were stored and analyzed using the Census and Survey Processing System (CSPro) version 7.3 and Statistical Package for Social Science (SPSS) version 25.0. Descriptive statistic was used to estimate the indicators. Results. Of the 113 patients enrolled, 105 had a history of drug use; 56 participants (53, 3%) had taken at least 2 antibiotics prior to sampling. Cephalosporins were the most consumed antibiotics (41, 0%), followed by nitroimidazols (28, 6%) and penicillins (28,6%). According to the WHO classification, 55 (52, 4%) took the major priority antibiotics. Conclusion. We are on the alert and there is an urging need to raise awareness among clinicians and patients alike by providing them with good clinical practice guidelines.
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Qualité des soins de santé , Prestations des soins de santé , Sécurité des patientsRésumé
Background: Historically, in South Africa (SA), single motherhood has been part of the landscape and continues to increase. Disability in children is also increasing, yet it remains under-researched. Mothers are often left to raise their children with a disability alone, yet their voiced maternal experiences continue to largely be unheard, particularly in SA. Objectives: This study aimed to explore the lived experiences of single mothers raising a child with a disability in SA. Furthermore, the aim was to explore how these mothers navigate their complex realities and practice of mothering, and to amplify the voices of mothers. Finally, the study sought to shed light on the particular contextual factors that affect single maternal experiences in caring for a child with a disability. Method: Twelve South African single mothers raising a child with a disability between the ages of 7 years and 18 years were individually interviewed in this exploratory interpretivist study. Thematic analysis was utilised on the data. Results: The four themes highlight the complex, multi-level strain of raising a child with a disability, which has had a significant impact on the social, financial and emotional facets of single mothers' lives. Conclusion and contribution: The findings of the study are important for developing a thorough understanding of the needs of single mothers in this specific context as well as their daily experiences as mothers of children with disabilities. These needs include the necessity of psychosocial support and equipping single mothers with accurate knowledge about their child's disability so that they can make better accommodations for themselves and their child.
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Éducation , Activités de loisirsRésumé
Background: People with disabilities are a large, disadvantaged minority, comprising approximately 12% of the population. The South African government has ratified international and regional disability treaties but deals with disability rights within general anti-discrimination legislation. There are no specific frameworks to monitor justice for people with disabilities. The study aims to inform further development of disability inclusive mechanisms relating to crises including pandemics. Objectives: This study explored the perceptions of South Africans with disabilities, to understand their experiences during coronavirus disease 2019 (COVID-19), focussing on socioeconomic, well-being and human rights aspects. Method: An online survey tool generated quantitative and qualitative data. Widespread publicity and broad recruitment were achieved through project partners networks. Participants responded via mobile phone and/or online platforms. Results: Nearly 2000 people responded, representing different genders, impairments, races, socio-economic status, education and ages. Findings include: (1) negative economic and emotional impacts, (2) a lack of inclusive and accessible information, (3) reduced access to services, (4) uncertainty about government and non-government agencies' support and (5) exacerbation of pre-existing disadvantages. These findings echo international predictions of COVID-19 disproportionally impacting people with disabilities. Conclusion: The evidence reveals that people with disabilities in South Africa experienced many negative impacts of the pandemic. Strategies to control the virus largely ignored attending to human rights and socioeconomic well-being of this marginalised group. Contribution: The evidence will inform the development of the national monitoring framework, recognised by the South African Government and emphasised by the United Nations as necessary to ensure the realisation of the rights of people with disabilities during future crises including pandemics.
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Justice sociale , Stratégies de Santé Nationales , Personnes handicapées , Statut économique , COVID-19 , Droits de l'homme , Enquêtes et questionnaires , Téléphones portables , PandémiesRésumé
Background: Initiating newly diagnosed people living with human immunodeficiency virus (HIV) onto antiretroviral treatment (ART) and retaining patients on treatment are vital to South Africa's ART programme. In 2020, coronavirus disease 2019 (COVID-19) and its accompanying containment (lockdown) measures presented unprecedented challenges to achieving these objectives. Aim: This study describes the impact of COVID-19 and related restrictions on district-level numbers of newly diagnosed people living with HIV and defaulting ART patients. Setting: Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape of South Africa. Methods: Mixed-methods approach: Monthly aggregated electronic patient data (newly initiated and restarted on ART) from 113 public healthcare (PHC) facilities were analysed (December 2019 to November 2020) across varying levels of COVID-19 lockdown regulation periods; telephonic in-depth interviews at 10 rural BCMM PHC facilities were conducted with facility staff, community health workers (CHWs) and intervention personnel. Results: The number of newly initiated ART patients decreased dramatically compared with pre-COVID-19 levels. The overall number of restarted ART patients increased in response to fears of co-infection with COVID-19. Facility-level communications and community outreach promoting HIV testing and treatment were disrupted. Novel approaches to providing services to ART patients were developed. Conclusion: Programmes for identifying undiagnosed people living with HIV and services aimed at retaining ART patients in care were profoundly impacted by COVID-19. The value of CHWs was highlighted, as were communication innovations. Contribution: This study describes the impact of COVID-19 and related regulations on HIV testing, ART initiation and adherence to treatment in a District of the Eastern Cape of South Africa.
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Humains , Mâle , Femelle , Thérapeutique , Infections à VIH , Agents de santé communautaire , Co-infection , COVID-19 , Prestations des soins de santé , DiagnosticRésumé
Background: Little is known about the experiences and impact of coronavirus disease 2019 (COVID-19) on the mental health and wellbeing of healthcare workers (HCWs), particularly in Global South contexts. Aim: The authors aimed to explore the experiences of HCWs at different points during the COVID-19 pandemic in South Africa. Setting: This study's sample included 621 HCWs from various professions and health sectors who completed the survey during the pandemic peaks of waves I, II and III in South Africa. Methods: The authors used a qualitative survey design exploring participants' general work, life, mental health and wellbeing experiences, and their support mechanisms or strategies. Data were analysed using thematic analysis. Results: The authors identified three overarching themes in the data, namely stress, adjustment to work during COVID-19, and support experiences and needs. These themes were common across all three survey waves, with some minor differences noted across the waves. Conclusion: An overarching thread of uncertainty seems central to HCWs' experiences of working during COVID-19, related to pressures in the South African healthcare system that have been aggravated by the pandemic. Contribution: These findings have the potential to inform the development of contextually relevant approaches to support the mental health and wellbeing needs of HCWs during and after a pandemic. In particular, workplaces need to actively offer psychological support to all HCWs, not just to workers traditionally defined as frontline.
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Santé mentale , Personnel de santé , COVID-19 , Bien-être psychologique , PandémiesRésumé
Aims:To identify virtual healthcare services and digital health technologies deployed in South Africa during coronavirus disease 2019(COVID-19)and the challenges associated with their use.Methods:To determine the status of digital health utilization during COVID-19 in South Africa,the preferred reporting items for systematic reviews and meta-analyses model was used to perform a systematic and in-depth critical analysis of previously published studies in well-known and trusted online electronic databases using specific search keywords words that are relevant to this study.We selected published peer-reviewed articles available from the onset of COVID-19 to July 2021.Results:Total of 24 articles were included into this study.This study revealed that South Africa adopted digital technologies such as SMS-based solutions,mobile health applications,telemedicine and telehealth,WhatsApp-based systems,artificial intelligence and chatbots and robotics to provide healthcare services during COVID-19 pandemic.These innovative technologies have been used for various purposes including screening infectious and non-infectious diseases,disease surveillance and monitoring,medication and treatment compliance,creating awareness and communication.The study also revealed that teleconsultation and e-prescription,telelaboratory and telepharmacy,teleeducation and teletraining,teledermatology,teleradiology,telecardiology,teleophthal-mology,teleneurology,telerehabilitation,teleoncology and telepsychiatry are among virtual healthcare services delivered through digital health technologies during COVID-19 in South Africa.However,these smart digital health technologies face several impediments such as infrastructural and technological barriers,organization and financial barriers,policy and regulatory barriers as well as cultural barriers.Conclusion:Although COVID-19 has invigorated the use of digital health technologies,there are still some short-comings.The outbreak of pandemics like COVID-19 in the future is not inevitable.Therefore,we recommend increasing community networks in rural areas to bridge the digital divide and the modification of mHealth pol-icy to advocate for the effective use of innovative technologies in healthcare and the development of sustainable strategies for resources mobilization through private-public partnerships as well as joining available international initiatives advocating for smart digital health.
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This paper analyzes the registration regulations and guidelines of Traditional Chinese Medicine (TCM) products in South Africa, summarizes the registration path of TCM products in South Africa, analyzes the Common Technical Document (CTD) data required for registration from the aspects of quality control, safety and effectiveness, and discusses the registration strategy of TCM products in South Africa. This paper suggests that the strategies could include effective management and control of the registration risk of TCM and steady promotion of the products; TCM enterprises can first register low-risk TCM products, then open the South African TCM market, and promote the registration of high-risk TCM products after accumulating some experience; TCM enterprises need to have the awareness of promoting the inheritance, innovation and development of TCM, increase the investment in clinical trials of TCM products, and supplement the clinical effectiveness and safety data of TCM products; Strengthen the quality control of TCM and build an international brand of TCM.
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Depression is a major contributor to the overall global burden of disease, impacting social life, family life and occupational functioning if left untreated. Despite its high prevalence and morbidity, the evidence suggests that men are hesitant to seek help, with a large percentage remaining undiagnosed. This study aimed to determine the attitudes and perceptions related to depression and its treatment amongst black men in a rural district of South Africa.Methods: The design used was an exploratory descriptive qualitative design. Participants were selected by purposive sampling. Individual semistructured interviews were conducted, which were audio-recorded and transcribed verbatim. The data were subsequently analysed thematically to develop themes and subthemes.Results: Participants described depression as a psychological problem associated with lack of sleep, loneliness, feeling unwanted, increased stress, deep sadness, weight loss, forgetfulness, crying over small things and lack of concentration. Collectively, the interviews with participants showed a good understanding of the psychosocial determinants of depression but exposed a lack of awareness of its biological determinants. A large proportion (n = 13; 68.4%) of participants reported not having knowledge of available services in their area for people seeking treatment for depression. Barriers to help-seeking behaviours were fear of social stigma, fear of expressing their feelings, gender norms and stereotypes and lack of trust in others.Conclusion: Interventions such as support groups and mental health awareness programmes to counteract personal perceptions may help to improve and expand the effectiveness of depression treatment. The results highlight the future need to raise awareness of depressive symptoms and expand health outreach programmes.Keywords: depression; perceptions; attitudes; mental health; help-seeking; treatment; SouthAfrica.
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Perception , Santé mentale , Dépression , République d'Afrique du Sud , Comportement de recherche d'aideRésumé
Sextortion, a gendered form of corruption where sexual favours are the means of exchange, frequently occurs during migration.While the consequences of surviving sextortion are devastating, sextortion remains relatively understudied. Hence, this paper explores the experiences of sextortion of African migrants migrating to South Africa. Based on interviews with experts on migration, corruption, and gender in South Africa, this paper answers the research question: "What are the experiences of sextortion for African migrants migrating to South Africa and how are they gendered?". The results confirm irregular, female migrants are most vulnerable to experiencing sextortion both during their journeys and in South Africa. This is alarming as there are various psychical, mental, and sexual health consequences like trauma, STIs, pregnancies, and stigmatisation. These consequences have both short- and long-term consequences and will continue to exist without adjusted policy frameworks, improved support systems for survivors, and a broader discussion on gender norms. (Afr J Reprod Health 2022; 26[6]:45-54).
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Humains , Infractions sexuelles , Migration humaine , Sexe , République d'Afrique du Sud , CorruptionRésumé
Background: Different diagnostic tools could improve early detection of coronavirus disease 2019 (COVID-19). A number of antibody-based serological point-of-care tests have been developed to supplement real-time reverse transcriptase polymerase chain reaction (RT-PCR)-based diagnosis. This study describes the validity of an antibody test, namely the immunoglobulin G (IgG)/immunoglobulin M (IgM) Rapid Test Cassette® (BNCP 402 and BNCP402), manufactured by Spring Healthcare Services. Methods: A prospective cohort validation study was undertaken at Chris Hani Baragwanath Academic Hospital between 16 July 2020 and 12 August 2020. A total of 101 patients admitte as COVID-19 cases under investigation were included in the study. They were divided into two categories depending on time since symptom onset: testing performed within seven days (early cohort) and after seven days (late cohort). The rapid antibody test was compared to the RT-PCR. Results: Overall, the test has a sensitivity and specificity of 85.2% and 80.0%, respectively, for a combination of IgG and IgM. Sensitivity and specificity of IgG testing alone were 81.5% and 85%. Sensitivity improved for testing with increasing time from symptom onset; however, specifity was not significantly different. Conclusion: The study data adds to the body of evidence that because of relatively low sensitivity and specificity, there is a limited role for antibody-based point-of-care testing in the acute phase of COVID-19 infection, as was the case with this IgG/IgM Rapid Test Cassette (BNCP 402 and BNCP402). There may exist a role for such testing in patients recovered from prior COVID-19 infection or in seroprevalence studies; however, additional evaluations at later timepoints from symptom onset are required.
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Immunoglobuline M , Sensibilité et spécificité , Diagnostic précoce , Dépistage sérologique de la COVID-19 , COVID-19Résumé
Background: The coronavirus disease 2019 (COVID-19) has highlighted the scope of heroin dependence and need for evidence-based treatment amongst marginalised people in South Africa. Acute opioid withdrawal management without maintenance therapy carries risks of increased morbidity and mortality. Due to the high costs of methadone, Tshwane's Community Oriented Substance Use Programme (COSUP) used tramadol for opioid withdrawal management during the initial COVID-19 response. Aim: To describe demographics, route of heroin administration and medication-related experiences amongst people accessing tramadol for treatment of opioid withdrawal.Setting: Three community-based COSUP sites in Mamelodi (Tshwane, South Africa). Methods: A retrospective cross-sectional study was conducted. Data were collected using an interviewer-administered paper-based tool between April and August 2020. Descriptive statistics were used to analyse data. Results: Of the 220 service users initiated onto tramadol, almost half (n = 104, 47%) were not contactable. Fifty-eight (26%) people participated, amongst whom most were male (n = 55, 95%). Participants' median age was 32 years. Most participants injected heroin (n = 36, 62.1%). Most participants experienced at least one side effect (n = 47, 81%) with 37 (64%) experiencing two or more side effects from tramadol. Insomnia occurred most frequently (n = 26, 45%). One person without a history of seizures experienced a seizure. Opioid withdrawal symptoms were experienced by 54 participants (93%) whilst taking tramadol. Over half (n = 38, 66%) reported using less heroin whilst on tramadol. Conclusion: Tramadol reduced heroin use but was associated with withdrawal symptoms and unfavourable side effects. Findings point to the limitations of tramadol as opioid withdrawal management to retain people in care and the importance of access to first-line opioid agonists.
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Humains , Mâle , Femelle , Tramadol , Utilisations thérapeutiques , COVID-19 , Troubles liés aux opiacés , Signes et symptômes , Analgésiques morphiniquesRésumé
Objectives: The objectives of this study were to ascertain whether the nutrient requirements of 611-month-old infants can be met with a food-based approach, and to identify the nutrients of which it is difficult to achieve adequate intakes.Design, setting and subjects: A cross-sectional survey and interviews with mothers and caregivers from the KwaMashu Community Health Centre were conducted. One hundred and thirty-four interviews were completed. This information provided the food consumption input for the model using Optifood software. Results: The results revealed that with the current food pattern of infants from the study group in KwaMashu, iron, zinc and calcium are nutrients whose requirements are likely not to be met in the diet. The percentage RNI (recommended nutrient intake) for iron was 25.2%, zinc 51.3% and calcium 77%. Nutrient intakes for these nutrients of concern improved in the 'No pattern' diet but iron and zinc intakes remained below the RNI. According to the best diets modelled by Optifood, it appears that infants in KwaMashu would be able to achieve the recommended intakes of energy, protein, and 8 of the 11micronutrients, as long as breastfeeding on demand continues during the complementary feeding phase. Conclusions: This study calls into question the continued food-based focus to ensure nutrient adequacy in infants. In conjunction with efforts to improve household food security and continued support and promotion of breastfeeding for the first 2 years of life, targeted micronutrient supplementation may be needed to ensure the optimal growth and development of infants in South Africa.