Self-reported prevalence of chronic non-communicable diseases and associated factors among older adults in South Africa.

INTRODUCTION: Little is known about the prevalence and predictors of chronic non-communicable diseases (NCDs) of older adults in South Africa. This study aims to investigate the self-reported prevalences of major chronic NCDs and their predictors among older South Africans. METHODS: We conducted a national population-based cross-sectional survey with a sample of 3,840 individuals aged 50 years or above in South Africa in 2008. The outcome variable was the self-reported presence of chronic NCDs suffered, namely, arthritis, stroke, angina, diabetes, chronic lung disease, asthma, depression, and hypertension. The exposure variables were sociodemographic characteristics: age, gender, education, wealth status, race, marital status, and residence. Multivariate logistic regression was used to determine sociodemographic factors predictive of the presence of chronic NCDs. RESULTS: The prevalence of chronic NCDs was 51.8%. The prevalence of multimorbidity (≥2 chronic conditions) was 22.5%. Multivariate logistic regression analysis showed that being female, being in age groups 60-79 and 70-79, being Coloured or Asian, having no schooling, having greater wealth, and residing in an urban area were associated with the presence of NCDs. CONCLUSION: The rising burden of chronic NCDs affecting older people places a heavy burden on the healthcare system as a result of increased demand and access to healthcare services. Concerted effort is needed to develop strategies for the prevention and management of NCDs, especially among economically disadvantaged individuals who need these services the most.

Emergence and spread of extensively and totally drug-resistant tuberculosis, South Africa.

Factors driving the increase in drug-resistant tuberculosis (TB) in the Eastern Cape Province, South Africa, are not understood. A convenience sample of 309 drug-susceptible and 342 multidrug-resistant (MDR) TB isolates, collected July 2008-July 2009, were characterized by spoligotyping, DNA fingerprinting, insertion site mapping, and targeted DNA sequencing. Analysis of molecular-based data showed diverse genetic backgrounds among drug-sensitive and MDR TB sensu stricto isolates in contrast to restricted genetic backgrounds among pre-extensively drug-resistant (pre-XDR) TB and XDR TB isolates. Second-line drug resistance was significantly associated with the atypical Beijing genotype. DNA fingerprinting and sequencing demonstrated that the pre-XDR and XDR atypical Beijing isolates evolved from a common progenitor; 85% and 92%, respectively, were clustered, indicating transmission. Ninety-three percent of atypical XDR Beijing isolates had mutations that confer resistance to 10 anti-TB drugs, and some isolates also were resistant to para-aminosalicylic acid. These findings suggest the emergence of totally drug-resistant TB.

Self-rated health and associated factors among older South Africans: evidence from the study on global ageing and adult health.

BACKGROUND: Population ageing has become significant in South African society, increasing the need to improve understandings of health and well-being among the aged. OBJECTIVE: To describe the self-reported ratings of overall health and functioning, and to identify factors associated with self-rated health among older South Africans. DESIGN: A national population-based cross-sectional survey, with a sample of 3,840 individuals aged 50 years and older, was completed in South Africa in 2008. Self-reported ratings of overall health and functioning were measured using a single self-reported health state covering nine health domains (used to generate the Study on Global Ageing and Adult Health (SAGE) composite health state score). Disability was measured using the World Health Organization Disability Assessment Schedule II (WHODAS-II) activities of daily living (ADLs), instrumental activities of daily living (IADLs), perceptions of well-being, and the World Health Organization Quality of Life index/metric (WHOQoL). RESULTS: Overall, more than three quarters (76.8%) of adults rated their health as moderate or good. On balance, men reported very good or good health more often than women (p<0.001). Older people (aged 70 years and above) reported significantly poorer health status than those aged 50-59 (adjusted odds ratio (AOR) 1.52; 95% confidence interval (CI) 1.00-2.30). Indians and Blacks were significantly more likely to report poorer health status at (AOR = 4.01; 95% CI 1.27-12.70) and (AOR = 0.42; 95% CI 0.18_0.98; 30 p < 0.045), respectively, compared to Whites. Respondents with primary education (AOR = 1.83; 95% CI 1.19-2.80) and less than primary education (AOR = 1.94; 95% CI 1.37-2.76) were more likely to report poorer health compared to those with secondary education. In terms of wealth status, those in low wealth quintile (AOR = 2.02; 95% CI 1.14-3.57) and medium wealth quintile (AOR = 1.47; 95% CI 1.01-2.13) were more likely to report poorer health status than those in high wealth quintile. Overall, the mean WHODAS-II score was 20%, suggesting a low level of disability. The mean WHOQoL score for females (Mean = 51.5; SD = 12.2) was comparable to that of males (Mean = 49.1; SD = 12.6). CONCLUSION: The depreciation in health and daily functioning with increasing age is likely to increase demand for health care and other services as people grow older. There is a need for regular monitoring of the health status of older people to provide public health agencies with the data they need to assess, protect, and promote the health and well-being of older people.

Mutations in the rrs A1401G gene and phenotypic resistance to amikacin and capreomycin in Mycobacterium tuberculosis.

The aminoglycosides amikacin (AMK)/kanamycin (KAN) and the cyclic polypeptide capreomycin (CAP) are important injectable drugs in the treatment of multidrug-resistant tuberculosis. Cross-resistance among these drug classes occurs and information on the minimum inhibitory concentrations (MICs), above the normal wild-type distribution, may be useful in identifying isolates that are still accessible to drug treatment. Isolates from the Eastern Cape Province of South Africa were subjected to DNA sequencing of the rrs (1400-1500 region) and tlyA genes. Sequencing data were compared with (i) conventional susceptibility testing at standard critical concentrations (CCs) on Middlebrook 7H11 agar and (ii) MGIT 960-based MIC determinations to assess the presence of AMK- and CAP-resistant mutants. Isolates with an rrs A1401G mutation showed high-level resistance to AMK (>20 mg/L) and decreased phenotypic susceptibility to CAP (MICs 10-15 mg/L). The MICs of CAP were below the bioavailability of the drug, which suggests that it may still be effective against multi- or extensively drug resistant tuberculosis [M(X)DR-TB]. Agar-based CC testing was found to be unreliable for resistance recognition of CAP in particular.

South African TB nurses' experiences of provider-initiated HIV counseling and testing in the Eastern Cape Province: a qualitative study.

This study addressed factors that played a role in the limited but effective implementation of provider-initiated HIV counseling in tuberculosis (TB) clinics in the Eastern Cape Province, South Africa, as part of a clinical trial. The Eastern Cape is a region with some of the highest TB and HIV rates in the world. The parent study was a pragmatic, cluster-randomized trial designed to measure the impact of provider-initiated ("opt-out") counseling on the uptake of HIV counseling and testing in newly registered TB patients. Key informants were interviewed and clinic nurses who participated in the study were invited to participate in focus group discussions (FGDs). Thematic content analysis of transcriptions was conducted on data collected during interviews and FGDs. Three major themes regarding nurse experiences were derived from analysis, indicating that multiple structural and personal factors influence the success of provider-initiated HIV counseling of TB patients in primary care settings: (1) chronic frustration with knowing what TB tasks need to be accomplished but not having the resources, including staff, to accomplish them; (2) conflict between the appreciation of the need and importance of HIV counseling and testing and the health system's recognition of their difficulties implementing it; and (3) ambivalence in their roles as care providers and educators in the context of HIV counseling and testing. Innovative and coordinated strategies are needed in this environment to facilitate greater number of patients receiving HIV counseling and testing services.

A cluster-randomized trial of provider-initiated (opt-out) HIV counseling and testing of tuberculosis patients in South Africa.

OBJECTIVE: To determine whether implementation of provider-initiated human immunodeficiency virus (HIV) counseling would increase the proportion of tuberculosis (TB) patients who received HIV counseling and testing. DESIGN: Cluster-randomized trial with clinic as the unit of randomization. SETTING: Twenty, medium-sized primary care TB clinics in the Nelson Mandela Metropolitan Municipality, Port Elizabeth, Eastern Cape Province, South Africa. SUBJECTS: A total of 754 adults (18 years and older) newly registered as TB patients in the 20 study clinics. INTERVENTION: Implementation of provider-initiated HIV counseling and testing. MAIN OUTCOME MEASURES: Percentage of TB patients HIV counseled and tested. SECONDARY: Percentage of patients with HIV test positive, and percentage of those who received cotrimoxazole and who were referred for HIV care. RESULTS: : A total of 754 adults newly registered as TB patients were enrolled. In clinics randomly assigned to implement provider-initiated HIV counseling and testing, 20.7% (73/352) patients were counseled versus 7.7% (31/402) in the control clinics (P = 0.011), and 20.2% (n = 71) versus 6.5% (n = 26) underwent HIV testing (P = 0.009). Of those patients counseled, 97% in the intervention clinics accepted testing versus 79% in control clinics (P = 0.12). The proportion of patients identified as HIV infected in intervention clinics was 8.5% versus 2.5% in control clinics (P = 0.044). Fewer than 40% of patients with a positive HIV test were prescribed cotrimoxazole or referred for HIV care in either study arm. CONCLUSIONS: Provider-initiated HIV counseling significantly increased the proportion of adult TB patients who received HIV counseling and testing, but the magnitude of the effect was small. Additional interventions to optimize HIV testing for TB patients urgently need to be evaluated.