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3.
Int J Environ Res Public Health ; 19(11)2022 May 30.
Article in English | MEDLINE | ID: covidwho-1869620

ABSTRACT

Vaccine hesitancy, long considered a global health threat, poses a major barrier to effective roll-out of COVID-19 vaccination. With less than half (45%) of adult South Africans currently fully vaccinated, we identified factors affecting non-uptake of vaccination and vaccine hesitancy in order to identify key groups to be targeted when embarking upon COVID-19 vaccine promotion campaigns. A cross-sectional, anonymous online survey was undertaken among the South African adult population in September 2021. Our research identified race, interactive-critical vaccine literacy, trust in the government's ability to roll out the COVID-19 vaccination programme, flu vaccination status and risk perception for COVID-19 infection as key factors influencing the uptake of COVID-19 vaccination. Respondents who did not trust in the government's ability to roll out vaccination were almost 13 times more likely to be vaccine-hesitant compared to those respondents who did trust the government. Reliable, easy-to-understand information regarding the safety of COVID-19 vaccines is needed, but it is also important that vaccination promotion and communication strategies include broader trust-building measures to enhance South Africans' trust in the government's ability to roll out vaccination effectively and safely. This may also be the case in other countries where distrust in governments' ability prevails.


Subject(s)
COVID-19 , Influenza Vaccines , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Cross-Sectional Studies , Humans , Pandemics/prevention & control , Patient Acceptance of Health Care , South Africa/epidemiology , Vaccination
4.
BMC Public Health ; 22(1): 1035, 2022 May 24.
Article in English | MEDLINE | ID: covidwho-1862121

ABSTRACT

BACKGROUND: Globally, long-term care facilities (LTCFs) experienced a large burden of deaths during the COVID-19 pandemic. The study aimed to describe the temporal trends as well as the characteristics and risk factors for mortality among residents and staff who tested positive for SARS-CoV-2 in selected LTCFs across South Africa. METHOD: We analysed data reported to the DATCOV sentinel surveillance system by 45 LTCFs. Outbreaks in LTCFs were defined as large if more than one-third of residents and staff had been infected or there were more than 20 epidemiologically linked cases. Multivariable logistic regression was used to assess risk factors for mortality amongst LTCF residents. RESULTS: A total of 2324 SARS-CoV-2 cases were reported from 5 March 2020 through 31 July 2021; 1504 (65%) were residents and 820 (35%) staff. Among LTCFs, 6 reported sporadic cases and 39 experienced outbreaks. Of those reporting outbreaks, 10 (26%) reported one and 29 (74%) reported more than one outbreak. There were 48 (66.7%) small outbreaks and 24 (33.3%) large outbreaks reported. There were 30 outbreaks reported in the first wave, 21 in the second wave and 15 in the third wave, with 6 outbreaks reporting between waves. There were 1259 cases during the first COVID-19 wave, 362 during the second wave, and 299 during the current third wave. The case fatality ratio was 9% (138/1504) among residents and 0.5% (4/820) among staff. On multivariable analysis, factors associated with SARS-CoV-2 mortality among LTCF residents were age 40-59 years, 60-79 years and ≥ 80 years compared to < 40 years and being a resident in a LTCF in Free State or Northern Cape compared to Western Cape. Compared to pre-wave 1, there was a decreased risk of mortality in wave 1, post-wave 1, wave 2, post-wave 2 and wave 3. CONCLUSION: The analysis of SARS-CoV-2 cases in sentinel LTCFs in South Africa points to an encouraging trend of decreasing numbers of outbreaks, cases and risk for mortality since the first wave. LTCFs are likely to have learnt from international experience and adopted national protocols, which include improved measures to limit transmission and administer early and appropriate clinical care.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , COVID-19/epidemiology , Disease Outbreaks , Humans , Long-Term Care , Middle Aged , Pandemics , Residential Facilities , Retrospective Studies , South Africa/epidemiology
5.
S Afr Med J ; 112(4): 279-287, 2022 04 04.
Article in English | MEDLINE | ID: covidwho-1857301

ABSTRACT

BACKGROUND: Major causes of under-5 child deaths in South Africa (SA) are well recognised, and child mortality rates are falling. The focus of child health is therefore shifting from survival to disease prevention and thriving, but local data on the non-fatal disease burden are limited. Furthermore, COVID-19 has affected children's health and wellbeing, both directly and indirectly. OBJECTIVES: To describe the pattern of disease on admission of children at different levels of care, and assess whether this has been affected by COVID-19. METHODS: Retrospective reviews of children's admission and discharge registers were conducted for all general hospitals in iLembe and uMgungundlovu districts in KwaZulu-Natal Province, SA, from January 2018 to September 2020. The Global Burden of Disease framework was adapted to create a data capture sheet with four broad diagnostic categories and 37 specific cause categories. Monthly admission numbers were recorded per cause category, and basic descriptive analysis was completed in Microsoft Excel. RESULTS: Overall, 36 288 admissions were recorded across 18 hospital wards, 32.0% at district, 49.8% at regional and 18.2% at tertiary level. Communicable diseases, perinatal conditions and nutritional deficiencies (CPNs) accounted for 37.4% of admissions, non-communicable diseases (NCDs) for 43.5% and injuries for 17.1%. The distribution of broad diagnostic categories varied across levels of care, with CPNs being more common at district level and NCDs more common at regional and tertiary levels. Unintentional injuries represented the most common cause category (16.6%), ahead of lower respiratory tract infections (16.1%), neurological conditions (13.6%) and diarrhoeal disease (8.4%). The start of the local COVID-19 outbreak coincided with a 43.1% decline in the mean number of monthly admissions. Admissions due to neonatal conditions and intentional injuries remained constant during the COVID-19 outbreak, while those due to other disease groups (particularly respiratory infections) declined. CONCLUSIONS: Our study confirms previous concerns around a high burden of childhood injuries in our context. Continued efforts are needed to prevent and treat traditional neonatal and childhood illnesses. Concurrently, the management of NCDs should be prioritised, and evidence-based strategies are sorely needed to address the high injury burden in SA.


Subject(s)
COVID-19 , Noncommunicable Diseases , COVID-19/epidemiology , Child , Disease Outbreaks , Female , Hospitals , Humans , Infant, Newborn , Noncommunicable Diseases/epidemiology , Pregnancy , Retrospective Studies , South Africa/epidemiology
6.
PLoS One ; 17(2): e0262442, 2022.
Article in English | MEDLINE | ID: covidwho-1854992

ABSTRACT

In late December 2019, pneumonia cases of unknown origin were reported in Wuhan, China. This virus was named SARS-CoV2 and the clinical syndrome was named coronavirus disease 19 (COVID-19). South Africa, despite strict and early lockdown has the highest infection rate in Africa. A key component of South Africa's response to SARSCoV2 was the rapid scale-up of diagnostic testing. The Abbott SARS-CoV2 assay detects IgG antibodies against the Nucleocapsid (N) protein of the SARS-CoV2 virus. This study undertook to validate and evaluate performance criteria of the Abbott assay and to establish whether this assay would show clinical utility in our population. Positive patients (n = 391) and negative controls (n = 139) were included. The Architect-i and Alinity-i systems were analyzers that were used to perform the SARS-CoV-2 IgG assay. In-house ELISA was incorporated into the study as a confirmatory serology test. A total of number of 530 participants was tested, 87% were symptomatic with infection and 13% were asymptomatic. When compared to RT-qPCR, the sensitivity of Architect and Alinity SARS-CoV2 assays was 69.5% and 64.8%, respectively. Specificity for Architect and Alinity assays was 95% and 90.3%, respectively. The Abbott assay was also compared to in house ELISA assay, with sensitivity for the Architect and Alinity assays of 94.7% and 92.5%, respectively. Specificity for Abbott Alinity assays was 91.7% higher than Abbott Architect 88.1%. Based on the current findings testing of IgG after 14 days is recommended in South Africa and supports other studies performed around the world.


Subject(s)
Antibodies, Viral/blood , COVID-19 Serological Testing/methods , COVID-19/diagnosis , Immunoglobulin G/blood , SARS-CoV-2/isolation & purification , Adult , Aged , Aged, 80 and over , Antibodies, Viral/immunology , COVID-19/blood , COVID-19/epidemiology , COVID-19/virology , Enzyme-Linked Immunosorbent Assay , Female , Follow-Up Studies , Humans , Immunoglobulin G/immunology , Male , Middle Aged , Prognosis , Retrospective Studies , South Africa/epidemiology , Young Adult
7.
BMC Public Health ; 22(1): 1029, 2022 May 21.
Article in English | MEDLINE | ID: covidwho-1854792

ABSTRACT

BACKGROUND: Evidence on the impact of COVID-19 and lockdown remains at an early stage. There is limited research about the impact of hard lockdown restrictions on families, specifically how these restrictions impact on women and children's experiences of domestic violence, including intimate partner violence (IPV) and child abuse in South Africa. We conducted research among men and women in Gauteng province, South Africa to understand their experiences of the COVID-19 national lockdown and its impact and link to women and children's experiences of domestic violence. METHODS: We conducted a qualitative study, using social media to recruit men and women who were 18 years and older, living with a spouse and/or children in Gauteng province, South Africa during the lockdown. To collect the data, we conducted telephone interviews, and analyzed data using the thematic approach. RESULTS: The lockdown had unprecedented negative economic impacts on families, and exacerbated some of the risk factors for violence against women and children in the home in South Africa. Some women reported experiences of emotional violence. Experiences of physical violence were mostly amongst children. The risk factors for women and children's experiences of violence in the home differed by socio-economic class. Job losses and reduction in earnings resulted to food insecurity which was a key driver of violence in most low socio-economic status (SES) families. Confinement in the home with spouses was an unfamiliar and difficult experience, associated with conflict and perpetration of violence by men in high SES families. Participants across socio-economic groups reported high levels of stress with limited psychosocial support available during the lockdown. CONCLUSIONS: Our finding showing a link between low-socio-economic status and increased risk for domestic violence during the lockdown in South Africa suggests the need for socio-economic interventions to mitigate these risks. Structural and social relief measures need to be strengthened to reduce the loss of jobs and income and to address food insecurity during pandemics. Psychosocial support should be provided to men and women to mitigate the mental health impacts of the pandemics and lockdown.


Subject(s)
COVID-19 , Intimate Partner Violence , COVID-19/epidemiology , COVID-19/prevention & control , Child , Communicable Disease Control , Female , Humans , Intimate Partner Violence/psychology , Male , Pandemics/prevention & control , South Africa/epidemiology
8.
Lancet Glob Health ; 10(7): e961-e969, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1852287

ABSTRACT

BACKGROUND: Up to the end of January, 2022, South Africa has had four recognisable COVID-19 pandemic waves, each predominantly dominated by one variant of concern: the ancestral strain with an Asp614Gly mutation during the first wave, the beta variant (B.1.351) during the second wave, the delta variant (B.1.617.2) during the third wave, and lastly, the omicron variant (B.1.1.529) during the fourth wave. We aimed to assess the clinical disease severity of patients admitted to hospital with SARS-CoV-2 infection during the omicron wave and compare the findings with those of the preceding three pandemic waves in South Africa. METHODS: We defined the start and end of each pandemic wave as the crossing of the threshold of weekly incidence of 30 laboratory-confirmed SARS-CoV-2 cases per 100 000 population. Hospital admission data were collected through an active national COVID-19-specific surveillance programme. We compared disease severity across waves by post-imputation random effect multivariable logistic regression models. Severe disease was defined as one or more of the following: acute respiratory distress, receipt of supplemental oxygen or mechanical ventilation, admission to intensive care, or death. FINDINGS: We analysed 335 219 laboratory-confirmed SARS-CoV-2 hospital admissions with a known outcome, constituting 10·4% of 3 216 179 cases recorded during the four waves. During the omicron wave, 52 038 (8·3%) of 629 617 cases were admitted to hospital, compared with 71 411 (12·9%) of 553 530 in the Asp614Gly wave, 91 843 (12·6%) of 726 772 in the beta wave, and 131 083 (10·0%) of 1 306 260 in the delta wave (p<0·0001). During the omicron wave, 15 421 (33·6%) of 45 927 patients admitted to hospital had severe disease, compared with 36 837 (52·3%) of 70 424 in the Asp614Gly wave, 57 247 (63·4%) of 90 310 in the beta wave, and 81 040 (63·0%) of 128 558 in the delta wave (p<0·0001). The in-hospital case-fatality ratio during the omicron wave was 10·7%, compared with 21·5% during the Asp614Gly wave, 28·8% during the beta wave, and 26·4% during the delta wave (p<0·0001). Compared with those admitted to hospital during the omicron wave, patients admitted during the other three waves had more severe clinical presentations (adjusted odds ratio 2·07 [95% CI 2·01-2·13] in the Asp614Gly wave, 3·59 [3·49-3·70] in the beta wave, and 3·47 [3·38-3·57] in the delta wave). INTERPRETATION: The trend of increasing cases and admissions across South Africa's first three waves shifted in the omicron wave, with a higher and quicker peak but fewer patients admitted to hospital, less clinically severe illness, and a lower case-fatality ratio compared with the preceding three waves. Omicron marked a change in the SARS-CoV-2 epidemic curve, clinical profile, and deaths in South Africa. Extrapolations to other populations should factor in differing vaccination and previous infection levels. FUNDING: National Institute for Communicable Diseases.


Subject(s)
COVID-19 , Influenza, Human , COVID-19/epidemiology , Hospitals , Humans , Influenza, Human/epidemiology , Pandemics , SARS-CoV-2 , South Africa/epidemiology
9.
J Affect Disord ; 308: 616-622, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-1851376

ABSTRACT

BACKGROUND: Studies worldwide have highlighted the acute and long-term depressive impacts of psychosocial stressors due to the 2019 coronavirus disease (COVID-19) pandemic, particularly in low- and middle-income countries. Among the wide range of risk factors for depression that transpired during pandemic, greater perceptions of individual vulnerability to the COVID-19 have emerged as a major predictor of increased depressive risk and severity in adults. METHODS: We estimated the extent to which COVID-19 risk perceptions affected adult depressive symptoms in a longitudinal, nationally representative sample in South Africa. We used covariate balanced propensity scores to minimize the bias from treatment assignment to estimate average causal effects of COVID-19 risk perceptions. RESULTS: The point prevalence of perceived COVID-19 infection risk increased between the third and fifth months of the pandemic, which corresponded with elevations in national COVID-19 infection rates. Approximately 33% of adults met or surpassed the PHQ-2 cut-off score of 2. An increase in perceived risk of COVID-19 infection predicted worse depressive symptoms in adults four months later. CONCLUSIONS: Our findings highlight the widespread mental health burdens of the COVID-19 pandemic and emphasize the importance of greater psychological resources and structural changes to promote equitable access to COVID-19 risk mitigation policies.


Subject(s)
COVID-19 , Pandemics , Adult , COVID-19/epidemiology , Depression/epidemiology , Disease Susceptibility , Humans , SARS-CoV-2 , South Africa/epidemiology
11.
S Afr Med J ; 112(5): 313-316, 2022 04 29.
Article in English | MEDLINE | ID: covidwho-1848616

ABSTRACT

SARS-CoV-2 was first identified in Wuhan City, China, in 2019. Initially it was associated with the development of pulmonary disease, but research over the past 2 years has identified effects on multiple systems. Neuropsychiatric manifestations of COVID-19 have been reported in countries around the world, including new-onset psychosis in patients with no personal or family psychiatric history. We present the first case series describing neuropsychiatric manifestations of patients in Johannesburg, South Africa (SA). All four patients presented with their index-episode psychosis, and evidence of COVID-19 infection. The patients had varied psychiatric presentations, from delirium and psychosis to mania, and all responded well to low doses of antipsychotics. One patient had newly diagnosed HIV in addition to COVID-19. Further research is needed to determine the prevalence of neuropsychiatric manifestations in acute SARS-CoV-2 infections in SA.


Subject(s)
Antipsychotic Agents , COVID-19 , Psychotic Disorders , Humans , Psychotic Disorders/psychology , SARS-CoV-2 , South Africa/epidemiology
12.
J Glob Health ; 12: 05013, 2022 May 14.
Article in English | MEDLINE | ID: covidwho-1847638

ABSTRACT

Background: To date, COVID-19 vaccine coverage in the African region falls far too short of global goals. Increasing vaccination rates requires understanding barriers to vaccination so that effective interventions that sensitively and effectively address barriers to vaccination can be implemented. Methods: To assess COVID-19 vaccination levels and identify major barriers to vaccine uptake we conducted a population-based, cross-sectional survey among 1662 adults 18 and older from August 25 to October 29 2021 in the Agincourt Health and Socio-Demographic Surveillance System (AHDSS) area, Mpumalanga, South Africa. Results: Half of participants reported receiving a COVID-19 vaccine (50.4%) with 41.1% being fully vaccinated and 9.3% being partially vaccinated; 49.6% were unvaccinated. More women than men were vaccinated (55.5% vs 42.8%, P < 0.001), and older age groups were more likely to be vaccinated than younger age groups (P < 0.001). Among the unvaccinated, 69.0% planned to get vaccinated as soon as possible, while 14.7% reported definitely not wanting the vaccine. Major barriers to vaccination included lacking information on eligibility (12.3%) or where to get vaccinated (13.0%), concerns about side effects (12.5%), and inconvenient hours and locations for vaccination (11.0%). Confidence in the safety and efficacy of COVID-19 vaccines was higher among those vaccinated than unvaccinated (75.3% vs 51.2%, 75.8% vs 51.0%, both P < 0.001, respectively). Conclusions: Increasing vaccination in South Africa beyond current levels will require a concerted effort to address concerns around vaccine safety and increase confidence in vaccine efficacy. Clarifying eligibility and ensuring access to vaccines at times and places that are convenient to younger populations, men, and other vulnerable groups is necessary.


Subject(s)
COVID-19 , Vaccines , Adult , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Cross-Sectional Studies , Female , Humans , Male , SARS-CoV-2 , South Africa/epidemiology
13.
Int J Infect Dis ; 118: 150-154, 2022 May.
Article in English | MEDLINE | ID: covidwho-1838855

ABSTRACT

BACKGROUND: At present, it is unclear whether the extent of reduced risk of severe disease seen with SARS-Cov-2 Omicron variant infection is caused by a decrease in variant virulence or by higher levels of population immunity. METHODS: RdRp target delay (RTD) in the Seegene AllplexTM 2019-nCoV PCR assay is a proxy marker for the Delta variant. The absence of this proxy marker in the transition period was used to identify suspected Omicron infections. Cox regression was performed for the outcome of hospital admission in those who tested positive for SARS-CoV-2 on the Seegene AllplexTM assay from November 1 to December 14, 2021 in the Western Cape Province, South Africa, in the public sector. Adjustments were made for vaccination status and prior diagnosis of infection. RESULTS: A total of 150 cases with RTD and 1486 cases without RTD were included. Cases without RTD had a lower hazard of admission (adjusted hazard ratio [aHR], 0.56; 95% confidence interval [CI], 0.34-0.91). Complete vaccination was protective against admission, with an aHR of 0.45 (95% CI, 0.26-0.77). CONCLUSION: Omicron has resulted in a lower risk of hospital admission compared with contemporaneous Delta infection, when using the proxy marker of RTD. Under-ascertainment of reinfections with an immune escape variant remains a challenge to accurately assessing variant virulence.


Subject(s)
COVID-19 , Hepatitis D , COVID-19/diagnosis , Humans , Polymerase Chain Reaction , RNA-Dependent RNA Polymerase , SARS-CoV-2/genetics , South Africa/epidemiology , Survival Analysis
14.
Int J Health Policy Manag ; 11(1): 5-8, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1836564

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has exposed the wide gaps in South Africa's formal social safety net, with the country's high levels of inequality, unemployment and poor public infrastructure combining to produce devastating consequences for a vast majority in the country living through lockdown. In Cape Town, a movement of self-organising, neighbourhood-level community action networks (CANs) has contributed significantly to the community-based response to COVID-19 and the ensuing epidemiological and social challenges it has wrought. This article describes and explains the organising principles that inform this community response, with the view to reflect on the possibilities and limits of such movements as they interface with the state and its top-down ways of working, often producing contradictions and complexities. This presents an opportunity for recognising and understanding the power of informal networks and collective action in community health systems in times of unprecedented crisis, and brings into focus the importance of finding ways to engage with the state and its formal health system response that do not jeopardise this potential.


Subject(s)
COVID-19 , COVID-19/epidemiology , Communicable Disease Control , Community Health Planning , Humans , SARS-CoV-2 , South Africa/epidemiology
15.
PLoS One ; 17(5): e0266008, 2022.
Article in English | MEDLINE | ID: covidwho-1822265

ABSTRACT

As a direct consequence of the Covid-19 pandemic, due to being exposed to chronic and multiple sources of psychological stress, healthcare workers constitute a vulnerable population. Despite the potential impact of Covid-19 on their psychological and physical health, insufficient attention has been given to their mental well-being. The primary objective of this study was to measure and understand this psychological impact on public sector doctors and nurses in KwaZulu-Natal Province, South Africa. The secondary objective was to ascertain their perceptions of psychosocial support, specific to Covid-19, within the workplace. This cross-sectional electronic survey was conducted from August to October 2020, following the first surge of the pandemic in the country, and included 312 participants. Depression, anxiety and stress symptoms were assessed with the Depression Anxiety and Stress Scale-21 item and post-traumatic stress was measured by the Impact of Events Scale-Revised version. Measures of employer support were assessed using an adapted closed-ended questionnaire. The participants' mean age was 36.6± 9.3 years with three quarters being male (n = 234, 75.0%) and predominantly (n = 214, 72.3%) medical doctors. Numbers of participants with depression, anxiety and stress were 121 (51.5%), 111 (47.2%) and 104 (44.3%) respectively, with 38 (16.2%), 50 (21.3%) and 38 (16.2%) in the combined severe/extremely severe range, respectively. On the Impact of Events Scale-Revised, 34 (13.7%) participants were in the severe range. Subjectively, 63.0% felt that their concerns were not 'heard', 75.1% did not feel 'cared for' and 81.1% and 74.0% did not feel 'physically' or 'psychologically' supported, respectively. High levels of depression, anxiety, stress and traumatic stress, combined with poor perceptions of employer support, highlight the need to identify and address the psychosocial support needs and expectations of healthcare workers for the duration of the pandemic, as well as for the mental health sequelae post-pandemic.


Subject(s)
COVID-19 , Adult , Anxiety/epidemiology , Anxiety/psychology , COVID-19/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Female , Health Personnel/psychology , Humans , Male , Mental Health , Middle Aged , Pandemics , SARS-CoV-2 , South Africa/epidemiology
16.
PLoS One ; 17(5): e0268025, 2022.
Article in English | MEDLINE | ID: covidwho-1822290

ABSTRACT

BACKGROUND: Evidence on the risk factors for COVID-19 hospitalization, mortality, hospital stay and cost of treatment in the African context is limited. This study aims to quantify the impact of known risk factors on these outcomes in a large South African private health insured population. METHODS AND FINDINGS: This is a cross sectional analytic study based on the analysis of the records of members belonging to health insurances administered by Discovery Health (PTY) Ltd. Demographic data for 188,292 members who tested COVID-19 positive over the period 1 March 2020-28 February 2021 and the hospitalization data for these members up until 30 June 2021 were extracted. Logistic regression models were used for hospitalization and death outcomes, while length of hospital stay and (log) cost per patient were modelled by negative binominal and linear regression models. We accounted for potential differences in the population served and the quality of care within different geographic health regions by including the health district as a random effect. Overall hospitalization and mortality risk was 18.8% and 3.3% respectively. Those aged 65+ years, those with 3 or more comorbidities and males had the highest hospitalization and mortality risks and the longest and costliest hospital stays. Hospitalization and mortality risks were higher in wave 2 than in wave 1. Hospital and mortality risk varied across provinces, even after controlling for important predictors. Hospitalization and mortality risks were the highest for diabetes alone or in combination with hypertension, hypercholesterolemia and ischemic heart disease. CONCLUSIONS: These findings can assist in developing better risk mitigation and management strategies. It can also allow for better resource allocation and prioritization planning as health systems struggle to meet the increased care demands resulting from the pandemic while having to deal with these in an ever-more resource constrained environment.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/therapy , Cross-Sectional Studies , Health Expenditures , Hospital Mortality , Hospitalization , Humans , Male , South Africa/epidemiology
17.
Sci Rep ; 12(1): 7158, 2022 05 03.
Article in English | MEDLINE | ID: covidwho-1821606

ABSTRACT

A major obstacle to tackling the growing burden of chronic disease in South Africa is lack of testing, particularly where individuals face multiple barriers to accessing health services. We conducted a pilot study to evaluate a cardiometabolic self-measurement kit, including assessment of blood pressure, obesity and urine analysis, amongst adults in Soweto, South Africa. Participants (N = 94) were recruited by researchers during community health screening and were provided with a home test kit including a tablet with self-measurement instructions. The participants entered their results on the tablet and, on completion, the researcher immediately repeated the measurements. We interviewed 10% of participants to understand their experience and views of the kits. Concordance correlation coefficients ranged from 0.78 for waist circumference to 0.93 for height, while the overall percentage agreement ranged from 80.5% for both urine protein and urine glucose testing to 91.4% for the identification of central obesity (ratio of waist circumference to height of ≥ 0.5). Participants saw the need for self-testing and found the process for the most part simple, though urine testing and height self-assessment presented some challenges. This pilot study suggests that self-assessment at home has the potential to facilitate the identification of individuals at risk for cardiometabolic disease in low-income settings, adding to a growing body of evidence on the use of self-testing in disease prevention and detection. However, we would not recommend self-testing for urine glucose and protein without further study.


Subject(s)
COVID-19 , Cardiovascular Diseases , Adult , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Glucose , Humans , Obesity/diagnosis , Obesity/epidemiology , Pandemics , Pilot Projects , Reproducibility of Results , Self-Assessment , South Africa/epidemiology
18.
Int J Environ Res Public Health ; 19(9)2022 05 02.
Article in English | MEDLINE | ID: covidwho-1820267

ABSTRACT

Healthcare workers (HCWs) are among the most vulnerable in regard to contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Comorbidities are reported to increase the risk for more severe COVID-19 outcomes, often requiring hospitalization. However, the evidence on disease severity and comorbidities among South African HCWs is lacking. This retrospective study analyzed the prevalence of comorbidities among HCW hospitalized with COVID-19 and its association with the severity of outcomes. Data from public and private hospitals in nine provinces of South Africa were extracted from the national hospital surveillance database for COVID-19 admissions. A total of 10,149 COVID-19 HCWs admissions were reported from 5 March 2020 to 31 December 2021. The risk of disease severity among HCWs increased with age, with those older (≥60 years) having seven times the odds of disease severity (aOR 7.0; 95% CI 4.2-11.8) compared to HCWs in the younger age (20-29 years) group. The most commonly reported comorbidity was hypertension (36.3%), followed by diabetes (23.3%) and obesity (16.7%). Hypertension (aOR 1.3; 95% CI 1.0-1.6), diabetes (aOR 1.6; 95% CI 1.3-2.0), and HIV (aOR 1.6; 95% CI 1.2-2.1) were significantly associated with disease severity. In conclusion, age, gender, and existing comorbidities were strong predictors of the prognosis of severe COVID-19 among HCWs in South Africa. The information is important in the development of occupational health policies and vulnerability risk assessments for HCWs in light of future COVID-19 waves or similar outbreaks.


Subject(s)
COVID-19 , Hypertension , Adult , COVID-19/epidemiology , Comorbidity , Health Personnel , Hospitalization , Humans , Hypertension/epidemiology , Middle Aged , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , South Africa/epidemiology , Young Adult
19.
Sci Rep ; 12(1): 5088, 2022 03 24.
Article in English | MEDLINE | ID: covidwho-1815588

ABSTRACT

Human pressures are pervasive in coastal ecosystems, but their effect magnitudes are masked by methodological limitations. Government lockdowns associated with the global COVID-19 pandemic can address this gap since lockdowns are effectively manipulations of human presence in ecosystems at scales unachievable otherwise. We illustrate this using a study on shorebirds in an urban South African sandy beach ecosystem. Data collected prior to (2019) and during the COVID-19 (2020) pandemic indicated an inverse relationship between shorebird and human numbers, but this was stronger in 2020. In 2020, human exclusion resulted in a six-fold increase in shorebird abundance relative to 2019. Following easing of lockdowns, shorebird abundance declined by 79.6% with a 34.1% increase in human density. Our findings highlight the sensitivity of shorebirds to recreational disturbance, the potential for current methodological approaches to underestimate repercussions of disturbance and the capacity for COVID-19 lockdowns to refine understanding of human-induced stress in ecosystems.


Subject(s)
COVID-19 , Ecosystem , COVID-19/epidemiology , Communicable Disease Control , Humans , Pandemics/prevention & control , South Africa/epidemiology
20.
BMC Pediatr ; 22(1): 241, 2022 05 02.
Article in English | MEDLINE | ID: covidwho-1813302

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome is a severe manifestation of SARS-CoV-2 in children. The incidence of MIS-C after infection is poorly understood. There are very few cohorts describing MIS-C in Africa despite MIS-C being more common in Black children worldwide. METHODS: A cohort of children with MIS-C and healthy children was recruited from May 2020 until May 2021 from the two main paediatric hospitals in Cape Town, South Africa. Clinical and demographic data were collected, and serum was tested for SARS-CoV-2 antibodies. The incidence of MIS-C was calculated using an estimation of population exposure from seroprevalence in the healthy group. Summary data, non-parametric comparisons and logistic regression analyses were performed. RESULTS: Sixty eight children with MIS-C were recruited with a median age of 7 years (3.6, 9.9). Ninety seven healthy children were recruited with a 30% seroprevalence. The estimated incidence of MIS-C was 22/100 000 exposures in the city in this time. Black children were over-represented in the MIS-C group (62% vs 37%, p = 0.002). The most common clinical features in MIS-C were fever (100%), tachycardia (98.5%), rash (85.3%), conjunctivitis (77.9%), abdominal pain (60.3%) and hypotension (60.3%). The median haemoglobin, sodium, neutrophil count, white cell count, CRP, ferritin, cardiac (pro-BNP, trop-T) and coagulation markers (D-dimer and fibrinogen) were markedly deranged in MIS-C. Cardiac, pulmonary, central nervous and renal organ systems were involved in 71%, 29.4%, 27.9% and 27.9% respectively. Ninety four percent received intravenous immune globulin, 64.7% received methylprednisolone and 61.7% received both. Forty percent required ICU admission, 38.2% required inotropic support, 38.2% required oxygen therapy, 11.8% required invasive ventilation and 6% required peritoneal dialysis. Older age was an independent predictor for the requirement for ionotropic support (OR = 1.523, CI 1.074, 2.16, p = 0.018). The median hospital stay duration was 7 days with no deaths. CONCLUSION: The lack of reports from Southern Africa does not reflect a lack of cases of MIS-C. MIS-C poses a significant burden to children in the region as long as the pandemic continues. MIS-C disproportionately affects black children. The clinical manifestations and outcomes of MIS-C in this region highlight the need for improved surveillance, reporting and data to inform diagnosis and treatment.


Subject(s)
COVID-19 , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Child , Humans , Incidence , SARS-CoV-2 , Seroepidemiologic Studies , South Africa/epidemiology , Systemic Inflammatory Response Syndrome
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