Evaluation of the national clinical sentinel surveillance system for sexually transmitted infections in South Africa: Analysis of provincial and district-level data.

BACKGROUND: Globally, >1 million new cases of curable sexually transmitted infections (STIs) are estimated to occur daily, an alarming rate that has prevailed for over a decade. Modelled STI prevalence estimates for South Africa (SA) are among the highest globally. Robust STI surveillance systems have implications for policy and planning, antimicrobial stewardship and prevention strategies, and are critical in stemming the tide of STIs. OBJECTIVES: To evaluate the STI clinical sentinel surveillance system (STI CSSS) in SA, to describe the population incidence of four designated STI syndromes in males and females ≥15 years, and to provide recommendations for strengthening the STI CSSS. METHODS: This was a retrospective analysis of the STI CSSS in SA. Distribution of the primary healthcare facilities designated as STI CSSS sites was described, taking into account provincial population distribution and headcount coverage of STI CSSS facilities. Reporting compliance was evaluated to determine completion of data reporting. Further analysis was undertaken for those provinces that had good reporting compliance over a 12-month period. Population-level and demographic STI syndrome incidence were estimated from CSSS data using case reports of male urethritis syndrome (MUS) as a proxy for data extrapolation. RESULTS: Reporting compliance exceeded 70% for seven of the nine provinces. STI syndromes with the highest incidence were MUS and vaginal discharge syndrome (VDS). The 20 - 24 years age group had the highest STI incidence, at least double the incidence estimated in the other two age groups. Overall STI incidence in females was higher than among males in all provinces, except Limpopo and Western Cape. The 15 - 19 years age group had the most prominent gender disparity, with the national STI incidence in females 70% higher than in males. District-level analysis revealed high regional STI incidence even in provinces with lower overall incidence. CONCLUSION: The STI CSSS is pivotal to epidemiological monitoring and proactive management of STIs, especially in view of the high HIV prevalence in SA. CSSS processes and facility selection should be reviewed and revised to be representative and responsive to the current STI needs of the country, with biennial analysis and reporting to support evidence-based policy development and targeted implementation.

Laboratory parameters associated with prolonged hospital length of stay in COVID-19 patients in Johannesburg, South Africa.

BACKGROUND: Coronavirus disease (COVID-19) has imposed unprecedented stressors on South Africa (SA)'s healthcare system. Superimposed on the country's quadruple burden of disease, pandemic-related care further exposes existing inequities. Some of these inequities are specific to hospital-based inpatient services, such as the geographical maldistribution of hospital beds, lack of oxygen supplies and assisted ventilation, and scarcity of trained healthcare workers. Certain high-risk groups, such as individuals with cardiometabolic comorbidity, are likely to develop severe COVID-19 disease requiring hospitalisation with potential for a prolonged length of stay (LoS). It may be helpful for health authorities to identify those at risk for prolonged LoS to facilitate appropriate health systems planning. OBJECTIVES: To identify hospital admission laboratory parameters associated with a hospital stay >14 days in patients with COVID-19 pneumonia. METHODS: A retrospective observational study design was used. Laboratory data were obtained from an SA private laboratory for 642 inpatients with suspected or confirmed COVID-19 pneumonia, comprising 7 months of admission laboratory data from six private hospitals in Johannesburg, Gauteng Province. RESULTS: Of 642 hospital admissions for pneumonia, 497 were confirmed to have COVID-19 infection (reverse transcription-polymerase chain reaction test positive). In the COVID-19-positive group, hospital LoS was prolonged in 35.4% of admissions. Univariate analysis demonstrated an association with the following risk factors for prolonged LoS: older age; male sex; high serum creatinine, sodium (Na), chloride, potassium and urea levels and low estimated glomerular filtration rate; raised white blood cell count, lymphopenia, neutrophilia and an elevated neutrophil-to-lymphocyte ratio (NLR); and elevated levels of D-dimers, interleukin-6 (IL-6), and procalcitonin (PCT). The strongest univariate associations (relative risk (RR) ≥2.0) with a hospital stay >14 days were high Na levels, NRL >18, high PCT levels and IL-6 >40 pg/mL. On multivariable analysis, the following factors remained significantly associated with prolonged LoS: older age (RR 1.015 per year of age; 95% confidence interval (CI) 1.005 - 1.024); hypernatraemia (RR 1.80; 95% CI 1.25 - 2.60); hyperkalaemia (RR 1.61; 95% CI 1.18 - 2.20); and neutrophilia (RR 1.47; 95% CI 1.15 - 1.88). CONCLUSIONS: COVID-19 pandemic preparedness requires hospital-based inpatient care to be prioritised in resource-limited settings, and availability of beds and prompt admissions are essential to ensure good clinical outcomes. In this study of COVID-19 patients admitted with pneumonia, multivariable analysis showed older age, hypernatraemia, hyperkalaemia and neutrophilia to be associated with LoS >14 days. This may assist with healthcare systems planning.

Assessment of knowledge and attitudes about HIV/AIDS among inmates of Quthing Prison, Lesotho.

OBJECTIVE: To assess the knowledge of and attitudes towards HIV/AIDS among the inmates in Quthing Prison, Lesotho. METHOD: A semi-structured questionnaire was used to interview the prisoners. Of the 138 prisoners, 123 inmates were successfully interviewed The data were collated and analyzed quantitatively using the SPSS computer software programme. RESULTS: Ninety-two per cent of the respondents were in the age group 20-44 years, while 57. 7% were single and had never married. Knowledge about HIV/AIDS was found to be high, as 95.5% of the inmates knew the cause of the disease and over 70% of the inmates knew how it could be transmitted or prevented A majority of the respondents (68.1%) agreed that people with the disease should be isolated (evidence of unfavourable attitudes); 31.2% believed that there were holes and worms in the condoms (misconception) and 41.5% would not use condom (prevent full sexual enjoyment) despite the risk associated with non-use. CONCLUSION: Knowledge about HIV/AIDS was found to be high and prisoners had misconceptions about HIV/AIDS and use of condoms.

Assessment of knowledge and attitudes about HIV/AIDS among inmates of Quthing Prison, Lesotho / Evaluación del conocimiento y la actitud hacia el vih/sida entre los reclusos de la prisión de quthing, en lesotho

OBJECTIVE: To assess the knowledge of and attitudes towards HIV/AIDS among the inmates in Quthing Prison, Lesotho. METHOD: A semi-structured questionnaire was used to interview the prisoners. Of the 138 prisoners, 123 inmates were successfully interviewed The data were collated and analyzed quantitatively using the SPSS computer software programme. RESULTS: Ninety-two per cent of the respondents were in the age group 20-44 years, while 57. 7were single and had never married. Knowledge about HIV/AIDS was found to be high, as 95.5of the inmates knew the cause of the disease and over 70of the inmates knew how it could be transmitted or prevented A majority of the respondents (68.1) agreed that people with the disease should be isolated (evidence of unfavourable attitudes); 31.2believed that there were holes and worms in the condoms (misconception) and 41.5would not use condom (prevent full sexual enjoyment) despite the risk associated with non-use. CONCLUSION: Knowledge about HIV/AIDS was found to be high and prisoners had misconceptions about HIV/AIDS and use of condoms.

Objetivo. Evaluar el conocimiento y actitud hacia el VIH/SIDA entre los reclusos de la prisión de Quthing, en Lesotho. Método. Se aplicó un cuestionario semiestructurado para entrevistar a los prisioneros. De los 138 prisioneros, 123 fueron entrevistados con éxito. Los datos fueron recopilados y analizados cuantitativamente usando el programa SPSS. Resultados. Noventa y dos de los encuestados estaban en el grupo etario de 20 a 44 años, mientras que el 57.7% eran solteros y no habían estado casados nunca. Se halló que el conocimiento sobre el VIH/SIDA era alto, ya que 95.5% de los reclusos conocía la causa de la enfermedad, y más del 70% de ellos sabía como podía trasmitirse y prevenirse. Una mayoría de encuestados (68.1%) estuvo de acuerdo en que las personas con esa enfermedad debían ser aisladas (evidencia de actitudes desfavorables); el 31.2% creia que habían huecos y gusanos en los condones (concepción errónea); y 41.5% no usaría condones (alegando que impiden el pleno goce sexual), a pesar del riesgo asociado con el abandono de su uso. Conclusión. Se hallo que el; conocimiento sobre el VIH/SIDA era alto, y que los prisioneras tenían concepciones erróneas sobre el VIH/SIDA, y el uso de los condones