First social impact bond for the SAMRC: A novel financing strategy to address the health and social challenges facing adolescent girls and young women in South Africa.

A social impact bond (SIB) is an innovative financing mechanism to attract investors to social programmes traditionally funded by governments. In this article, in celebration of the 50th anniversary of the South African Medical Research Council (SAMRC), the authors describe the SAMRC's first foray into this new world of financing through a SIB to improve the health and quality of life of adolescent girls and young women (AGYW). The AGYW SIB is in its preparatory phase and is scheduled for implementation in 2020. The authors describe the mechanism, including financial flows and the process of customising the SIB to meet the needs of AGYW, focusing on HIV prevention and treatment and the prevention and management of unintended pregnancies in schoolgoing AGYW. The authors outline an approach to designing the package of interventions, the metrics associated with such a programme and the business model. It is hypothesised that the proposed approach will lead to an improvement in programmatic outcomes, monitoring and evaluation tools and cost-effectiveness, and will develop key learning data for the future use of SIBs in health service delivery.

Preoperative serum sodium measurements and postoperative inpatient mortality: A case-control analysis of data from the South African Surgical Outcomes Study.

BACKGROUND: Abnormal preoperative serum sodium measurements have been shown to be associated with increased postoperative mortality in US and European surgical populations. It is possible that such measurements are also associated with increased postoperative mortality in a South African (SA) setting, but this is yet to be confirmed. Establishing whether preoperative serum sodium measurements are associated with postoperative mortality could have implications for perioperative risk stratification in SA settings. OBJECTIVES: To determine whether preoperative serum sodium measurements are associated with postoperative mortality in SA surgical patients. METHODS: This was an unmatched case-control study of patient data (demographics, comorbidities, procedure-related variables, and preoperative serum sodium measurements) collected during the South African Surgical Outcomes Study. Data were analysed using recommended statistical methods for unmatched case-control studies. RESULTS: The study population comprised 103 patients and 410 controls. Cases were defined as patients who suffered postoperative inpatient mortality, while controls were defined as patients who did not suffer postoperative inpatient mortality. Preoperative hypernatraemia (i.e. a preoperative serum sodium measurement >144 mEq/L) was independently associated with a four-fold higher risk of postoperative inpatient mortality compared with a normal preoperative serum sodium measurement of 135 - 144 mEq/L (odds ratio (OR) 4.21, 95% confidence interval (CI) 1.19 - 14.83, p=0.025). Preoperative hyponatraemia (i.e. a preoperative serum sodium measurement <135 mEq/L) was not independently associated with a higher or lower risk of postoperative inpatient mortality compared with a normal preoperative serum sodium measurement (OR 1.39, 95% CI 0.70 - 2.76, p=0.346). CONCLUSIONS: Preoperative hypernatraemia, but not preoperative hyponatraemia, is a risk factor for postoperative inpatient mortality in SA surgical patients.

Preoperative serum sodium measurements and postoperative inpatient mortality: A case-control analysis of data from the South African Surgical Outcomes Study

Background. Abnormal preoperative serum sodium measurements have been shown to be associated with increased postoperative mortality in US and European surgical populations. It is possible that such measurements are also associated with increased postoperative mortality in a South African (SA) setting, but this is yet to be confirmed. Establishing whether preoperative serum sodium measurements are associated with postoperative mortality could have implications for perioperative risk stratification in SA settings.Objectives. To determine whether preoperative serum sodium measurements are associated with postoperative mortality in SA surgical patients.Methods. This was an unmatched case-control study of patient data (demographics, comorbidities, procedure-related variables, and preoperative serum sodium measurements) collected during the South African Surgical Outcomes Study. Data were analysed using recommended statistical methods for unmatched case-control studies.Results. The study population comprised 103 patients and 410 controls. Cases were defined as patients who suffered postoperative inpatient mortality, while controls were defined as patients who did not suffer postoperative inpatient mortality. Preoperative hypernatraemia (i.e. a preoperative serum sodium measurement >144 mEq/L) was independently associated with a four-fold higher risk of postoperative inpatient mortality compared with a normal preoperative serum sodium measurement of 135 - 144 mEq/L (odds ratio (OR) 4.21, 95% confidence interval (CI) 1.19 - 14.83, p=0.025). Preoperative hyponatraemia (i.e. a preoperative serum sodium measurement <135 mEq/L) was not independently associated with a higher or lower risk of postoperative inpatient mortality compared with a normal preoperative serum sodium measurement (OR 1.39, 95% CI 0.70 - 2.76, p=0.346).Conclusions. Preoperative hypernatraemia, but not preoperative hyponatraemia, is a risk factor for postoperative inpatient mortality in SA surgical patients

Factors associated with poor adherence to anti-retroviral therapy in patients attending a rural health centre in South Africa.

South Africa has a very high HIV disease burden and proper patient adherence to anti-retroviral therapy (ART) is crucial in achieving optimal treatment outcomes. Factors influencing adherence include demographic and psychosocial factors, medication-related issues and other patient-related matters. This study was carried out in order to determine factors associated with poor compliance to anti-retroviral (ARV) medications in a rural setting. This interview-based descriptive and analytical study was carried out in a health centre where 168 patients who received ARVs were interviewed with pre-structured questionnaires, which covered various important compliance-related aspects. The results showed that 37.5% of the patients were non-adherent. Amongst men, poor adherence was seen in those who were single (48.9%), with tertiary education (60%), in those who consumed alcohol regularly (47.1%) and in those who were unemployed (56.1%). Higher rates of non-adherence in women was associated with being single (36.5%) and in those who used alcohol (60.7%). Medication-related adverse effects were reported in 47% of patients, notably, neuropathy, headache, nausea, loss of memory, diarrhoea and fatigue. Common reasons for missing doses were: being away from home (57.1%), simply forgot (41.3%), side effects (50.8%) and being too busy (49.2%). Poor adherence to ART is an important concern relating to HIV management in our setting and needs to be addressed with more patient-oriented interventions.