3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item One year mortality following surgical intervention for neck of femur fractures in the elderly in a developing country.(2017) Pieterse, Barend HermanusBACKGROUND: Fractures of the neck of the femur are currently one of the most serious health care problems facing developed nations on account of their aging populations. The one-year mortality rate is in the region of 30%. Although less of burden in developing nations, the fractures still affect a significant proportion of the elderly population. Very little has been published on the subject in developing nations and outcomes in resource rich countries may not be applicable to the less developed world. We hypothesized that the one year mortality would be higher in our setting. AIM OF THE STUDY: To determine the one year mortality following operative treatment of neck of femur fractures in the elderly at Charlotte-Maxeke Johannesburg academic hospital. METHODS: We undertook a retrospective study of all patients admitted with a fractured neck of femur in a teaching hospital over a five year period. Males and females over the age of 65 who underwent surgical treatment for neck of femur fractures where included into the study. Excluded was open fractures of any nature, neck of femur fractures due to tumors or metastatic bone disease, hip fractures other than neck of femur fractures and hip fractures treated nonoperatively. The patient’s files were collected to identify their ID numbers. Home affairs records was used to determine if the ID numbers were registered as a death. The website http://www.dha.gov.za/status was used for this purpose. To determine the time of death of the deceased patients Home affairs was contacted using the Request for access to record of public body form. RESULTS: The study comprised of 66.2% females and 33.8% males with a age range of 65-93 and a mean age of 80. We found that females had a higher age at the time of surgery than males. Our one year mortality was 43% (p=0.00288781) and significance level of 99.7%. CONCLUSION: Our mortality rate was significant higher compared to international or local figures. This might be due to the higher age of patients that we are seeing or lack of proper treatment protocols for the elderly with neck of femur fractures. Further investigations are needed to determine the cause.Item Mesothelioma incidence and mortality in South Africa from 2003 to 2013(2018) Muteba, Kasongo MichelBackground The incidence of mesothelioma in South Africa was expected to increase until around 2022 because of the high production of asbestos in the 1990s and a latency period of 20 to 40 years. Not enough research has been done to determine the burden of mesothelioma and evaluate the impact of asbestos ban policies in South Africa since 2001. This study investigated the burden of mesothelioma among South African men and women from 2003 to 2013, and compared the trends in mesothelioma by province, using four different data repositories. Methods A review of records from Statistics South Africa (Stats SA), the National Cancer Registry (NCR), the Pathology Automation database of the National Institute for Occupational Health, and the Asbestos and Kgalagadi Relief Trusts (ART/KRT), were used to estimate the annual mesothelioma incidence and mortality by province of South Africa from 2003 to 2013. Age-standardized incidence and mortality rates using direct standardization, and the average annual percentage change were calculated using the mid-year populations of South Africa as reported by Stats SA for each province, using the World Health Organization World standard population. A negative binomial regression analysis was conducted to identify factors associated with mesothelioma deaths. Results The NCR reported 1 242 new cases of mesothelioma from 2003 to 2010. The average incidence rate per annum was 155 cases, with an age-standardized incidence rate of 0.619 cases per 100 000 world population in 2003, which gradually decreased to 0.399 by 2010. The official statistics from Stats SA reported an average of 194 mesothelioma deaths per annum between 2003 and 2013, or 2132 mesothelioma deaths in total. During the same period, 385 and 499 cases were recorded in the PATHAUT and the ART/KRT databases, respectively. The average age at diagnosis was 63 years in the NCR data, while the average age at death varied from 63 to 65 years in the StatSA and PATHAUT data, with a sex ratio of 5:1 in the PATHAUT data, and 3:1 in the other databases. The Northern Cape had the highest number of mesothelioma deaths across the years of study, with the age standardized mortality rates varying from 3 to 7 cases per 100 000 standard population. The average annual percent change was -1.65%, showing a decreasing trend over time. The annual age standardized mortality rates were higher than the age standardized incidence rates, decreasing from 0.63 to 0.57 mesothelioma deaths per 100 000 World standard population from 2003 to 2013. There was overwhelming evidence of associations of age, sex, race, and province of death with mesothelioma deaths (P<0.001). The adjusted mortality rate ratio was 1.3 times higher in males compared to females, 5 times higher in the Northern Cape compared to the Western Cape, 21 times higher in those older than 75 years compared to those younger than 40 years, and 3 times higher in Whites compared to Blacks. Conclusion The patterns of mesothelioma observed in this study suggest a decreasing trend in mesothelioma incidence and mortality in South Africa, contrary to previous predictions anticipating an increasing trend until 2022. It can therefore be assumed that the peak of mesothelioma has occurred earlier than expected. Record linkage of the different data repositories could be used to confirm under-reporting of the mesothelioma official statistics. Key words: age-standardized mortality rates, asbestos related diseases, negative binomial regression, average annual percent changeItem Modalities of prostate specific antigen testing in Gauteng clinics and hospitals, South Africa(2018) Maphayi, Mpho ReginahBackground: The use of prostate specific antigen (PSA) in screening for prostate cancer remains controversial. However, in developing countries mortality from prostate cancer remains high due to lack of screening facilities such as PSA testing. Prostate specific antigen testing could be beneficial in reducing advanced prostate cancer and mortality in developing countries like South Africa. The Prostate Cancer Foundation of South Africa has issued guidelines on the use of PSA in prostate cancer screening, diagnosis and management, but we do not know how this test is used in our healthcare facilities. Aims and objectives: To describe modalities of PSA testing in screening and diagnosis of prostate cancer in terms of number of PSA test requests, patient demographic characteristics, type of health care facility (clinic versus hospital), prostate biopsy uptake and PSA level. Methods: This was a descriptive retrospective study of PSA tests done at the National Health Laboratory Services laboratory at Charlotte Maxeke Johannesburg Academic Hospital from January 2013 to December 2013. Results: 17 498 subjects had PSA tests. Of these 13 795 (79%) were done in Black African men (BA) while 3703 (21%)) in other racial groups (Others). More requests (62%) were from clinics versus than from hospitals (38%). The mean age for Black Africans (55.5 years SD (±13.3 years) was significantly lower than that of Others (62.9 years (±12.6 years, p<0.005), and median PSA level was significantly higher in Black African men from age 60 and above compared to Others (1.79 versus 1.53 μg/L, p<0.001). More Black Africans aged 60 and above had PSA level above age specific reference interval than others of the same age category (33% versus 26%, p<0.001). Only 17% of all men had a PSA above 4.00 μg/L which is the cut-off used by the National Health Laboratory Services. Of the four hundred and twenty-three men who underwent prostate biopsy, 213 (50%) had cancer. Fewer prostate biopsies were done in Black Africans than Others (2% vs. 4 % p=0.01), although Black African men were more likely to be diagnosed with prostate cancer on biopsy than Others (54% vs. 43%, p=0.03). Conclusion: PSA testing is a common practice in our healthcare facilities. The numbers of PSA tests done differ by age and race of patients. Black African men had lower biopsy uptake even though they were likely to be diagnosed with prostate cancer on biopsy.Item Paediatric patients ventilated in a high care area in a low resource setting: their characteristics and mortality outcomes(2017) Cawood, Shannon KimBackground. The paediatric department at Chris Hani Baragwanath Academic Hospital (CHBAH) in South Africa is able to ventilate patients in a high care area (HCA). Studies have shown that this practice increases patient mortality. Objectives. To describe patients ventilated in the HCA and their outcomes. Methods. Retrospective descriptive record review of all children (0-16 years) receiving mechanical ventilation in the HCA of CHBAH between 01 February 2015 and 31 October 2015. Results. 214 patients were admitted to the HCA for mechanical ventilation. The majority of patients, 116 (54.2%) were infants with a median age of 2.35 months (IQR: 28 days - 8.6 months). Eight-point-nine percent of patients were HIV positive. 28.4% of patients were severely underweight, 29.6% severely stunted and 15.7% severely wasted. Acute lower respiratory tract infections were the most common cause for ventilation. In terms of intensive care unit (ICU) candidacy, there was no significant difference in terms of weight-for-age, height-for-age, weight-for-height or HIV status Of the 214 patients, 69% were ultimately accepted into an ICU. Reasons for ICU refusal included lack of beds or poor candidacy. Sixty-eight (31.8%) patients died, with 36 of these deaths (52.9%) occurring in HCA. The mortality rate in HCA was higher than ICU (45.57% vs. 23.70%). Conclusions. Mortality is increased when patients are ventilated outside of an ICU.Item A review of bacterial meningitis in paediatric patients admitted to the emergency department of Charlotte Maxeke Johannesburg academic hospital(2016) Harris, KimThe morbidity and mortality of paediatric patients with bacterial meningitis are significantly higher in developing countries than in developed countries. We do not know the outcome of bacterial meningitis in our setting of a developing country where HIV and poor socioeconomic factors may be significant confounding factors. Purpose of Study To assess the neurological sequelae and mortality rates of paediatric patients with bacterial meningitis and to evaluate the risk factors for morbidity and mortality within this population. Method This is a retrospective observational analysis of medical records of paediatric patients aged 1 month – 14 years, with bacterial meningitis admitted to the Emergency Department at Charlotte Maxeke Johannesburg Academic Hospital over a 3-year period (2011 - 2013). Results One hundred and seventy one patients were enrolled with only 48 (28%) patients having confirmed meningitis. Thirty seven (77%) were male, 11 (23%) were female and 30 (62.5%) were under 12 months of age. Thirty three (68.7%) were HIV negative and 7 (14.6%) were HIV positive. No deaths were recorded. In terms of Herson Todd Score (Appendix 1) where scores were >4.5, only 1 (2%) patient had a GCS <8/15, 18 (37.5%) had duration of illness longer than 3 days at the time of admission and 3 patients had body temperatures recorded below 36.6 degrees Celsius. Two (4.2%) presented in status epilepticus. 7 Within the meningitis group, neurological sequelae and hearing loss had high scores on the HTS. However, the HTS did not demonstrate a high predictor of morbidity in terms of visual disturbances or empyemas. Two (5.7%) patients had spastic quadriplegia, 9 (18.75%) had a hemiplegia and 1 (2.08%) had ataxia. Three (6.25%) children had cranial nerve palsies. Hydrocephalus was found in 2 (4.7%) patients, empyema / abscess in 3 (6.25%) and 3 (6.25%) had visual disturbances; one had diplopia. Hearing loss occurred in 3 (6.25%) children. The commonest organism cultured on blood and cerebrospinal fluid was Neisseria meningitidis, followed closely by Streptococcus pneumoniae. Conclusion There were no deaths recorded in patients diagnosed with meningitis. HIV status was positive in less than 15% of patients. Most patients were under one year of age. The main pathogen for meningitis was N. Meningitidis followed by S. Pneumoniae. A third of patients developed neurological sequelae. HTS showed a high predictor of morbidity in neurological sequelae, and hearing loss but not for visual disturbances nor empyema/ abscess. The acute complication rate was low compared to developing countries.Item Childhood drowning: morbidity and mortality from a Johannesburg paediatric ICU, 2003 to 2013(2016-11-04) Edwards, Tamsen PetaDrowning is a worldwide significant but preventable public health problem. South Africa has one of the highest rates in the world of unintentional drowning mortality in the under five year age group. The aim of this study was to describe the population of patients admitted to a Johannesburg PICU with the diagnosis of drowning and to investigate potential prognostic factors recorded within the first 12 hours after admission. A retrospective record review of all the children between zero and 14 years admitted to PICU between January 2003 and December 2013, with a diagnosis of “drowning” or “near-drowning” was conducted. Of the 215 children admitted into the unit in the 11 year period, 11 did not meet inclusion criteria. Seventy-two percent of the population were male and the mean age was two years and seven months, with the majority of patients under the age of three years (76.5%). There were 71.6% discharged with a good neurological outcome while 10.3% died in hospital and 24% were classified as having a poor outcome with neurological sequelae. These results, similar to those found in previous hospital based studies, showed that more boys are likely to drown than girls and that the largest number of victims fall in the one to four year age group. Univariate analysis found 15 physiological variables (all recorded in the first 12 hours after admission) to be significantly associated with outcome. When a forward stepwise multivariate discriminant analysis was used six variables were found to be significant predictors of outcome, GCS (≤6) and sodium (>148mmol/L) having the strongest association, but no one factor was found to accurately predict outcome. It is therefore recommended that every patient who has drowned be treated aggressively, no matter their presentation or history.Item Patterns and predictors of mortality in older people (50 years and above) in Kassena-Nankana District of Ghana, 2007-2010(2014-08-27) Abdul, RamadhaniBackground: The world population is aging at an increasing rate. One product of this increase is the shift in mortality patterns and causes as a result of change in the age structure of the general population. An understanding of patterns and predictors of mortality in older populations is essential for policy and planning.However, very little is known due to limited research targeting this older population. Objectives: To identify patterns and predictors of mortality in older people (50 years and above) in the Kassena-Nankana district of Northern Ghana from 2006-2010, and to investigate the association between self-rated health (SRH) and subsequent mortality of older adults. Methods: Longitudinal follow-up of 4584 older people aged 50 and above who participated in a SAGE cross-sectional survey conducted in the Kassena-Nankana District of Ghana in 2007. Mortality rates were estimated using person time (in years) as the denominator, and Kaplan-Meier curves were employed to compare survival between different exposure groups. Cox proportional hazards modeling was used to identify predictors of mortality. Results: Of the 4584 people followed up until the end of 2010, 601 (13.1%) died. Overall mortality rates were 37.5 (95% CI 34.5, 40.6) deaths per 1000 Persons Years (PY). Older males had consistently higher mortality rates than women and the pattern indicate that, the highest mortality rate of 43.3 (95% CI 37.3, 49.9) was observed in 2008. Being married, being female, and living in household with higher socio-economic status were associated with significant reduction of mortality. There was increased risk of mortality among participants who rated their health as bad (HR=2.36 (95%CI 1.57 , 3.54 ) as compared to those who rated their health as very good (P<0.05). Conclusions: Despite overall low level of older adult mortality, there were significant difference in mortality magnitudes for different subgroups such as sex, education level, wealth and marital status. The findings also support previous studies that show the ability of SRH to significantly predict subsequent older mortality.Item The causes of teenage maternal mortality at Chris Hani Baragwanath Hospital in Soweto. A review of cases from 1997 to 2011.(2014-03-28) Mokone, Nteboheleng Moleboheng PontshoIntroduction The most tragic outcome of a teenage pregnancy is a teenage maternal death. Research from African countries has shown that pregnant teenagers are at increased risk for maternal death when compared with older women, chiefly from complications of hypertension in pregnancy and pregnancy-related sepsis. The objectives of this study were to determine the proportion of maternal deaths accounted for by teenagers, and to describe associated obstetric factors, causes of death and avoidable factors. Setting and methods This was a descriptive retrospective study, using records of all maternal deaths at Chris Hani Baragwanath Hospital (CHBH) from 1997 to 2011. All maternal deaths at CHBH are notified to the national government, and complete patient records have been kept since 1997. All teenage (age less than 20 years) maternal deaths were found by hand-searching all maternal death files for the study period. Demographic and obstetric details were recorded, as well as the primary cause of death and avoidable factors in each case, using the methodology of the Confidential Enquiries into Maternal Deaths in South Africa. Results There were 33 teenage maternal deaths out of a total of 562 deaths (6.1%). Eighteen (54.5%) of the teenagers were 18 or 19 years old. Nine died without having booked for antenatal care.Twenty-six (78.8%) were 28 weeks or more pregnant or postpartum when they died. The most frequent causes of death were hypertensive disorders of pregnancy (n=10; 30.3%), including 9 cases of eclampsia, and non-pregnancy-related infections (n=10; 30.3%), including 6 cases of lower respiratory tract infection and 2 foreign nationals who died of malaria. Among the teenagers who died from non-pregnancy-related infections, 3 were HIV infected, 4 were HIV negative and 3 did not have HIV results. Infrequent causes of death included pregnancy-related sepsis (n=2; 6.1%), and postpartum haemorrhage (n=1; 3.0%). The most frequent avoidable factors were failure to book for antenatal clinic (n=5; 15.2%) and delay in seeking medical help (n=8; 24.2%). Conclusion Maternal deaths in teenagers were infrequent and occurred in a lower proportion of all maternal deaths (6.1%) than expected, based on data suggesting a 13% teenage pregnancy proportion from a study done in 1999 to 2001. This finding differs from those in other African countries. The high frequency of eclampsia is similar to data from other countries, but pregnancy-related sepsis was not frequent. Development and maintenance of adolescent community resources and health services, including improving access to foreign teenagers, may improve health care utilisation by teenagers. Utilisation indicators would include use of contraception, uptake of termination of pregnancy services, and antenatal care attendance for ongoing pregnancies.Item Peri-operative deaths in two major academic hospitals in Johannesburg, South Africa(2012-07-11) Lungren, Aina ChristinaBackground to and purpose of the study An adverse outcome during the administration of an anaesthetic may result in morbidity or mortality, the latter providing us with the most fundamental measure of the safety of anaesthesia for our patients. Peri-operative deaths due to anaesthesia have not been documented in the province of Gauteng, South Africa, since 1955. The purpose of this study was to document these deaths and compare the findings with previous South African studies, as well as some studies performed overseas. Aims and objectives This study aimed to investigate and determine the prevalence of anaesthesia associated deaths, particularly those that occurred as a direct result of anaesthesia (ACD), both general and regional in two major academic hospitals in the Johannesburg area. These were the Charlotte Maxeke Johannesburg Academic Hospital and the Chris Hani Baragwanath Maternity Hospital. The objectives included examining current legislation and the interpretation thereof with recommendations, as well as the causes or possible risk factors involved in the peri-operative deaths that were studied. vii Research methods and procedures This was a retrospective longitudinal descriptive study, in the form of a clinical audit. All peri-operative deaths during the period 2000 to 2004 were studied at both sites. Numerous data were collected from each death, and descriptive and analytical statistics performed using SAS for Windows to provide frequencies for all of the variables recorded, with subsequent categorical analysis. Results The Anaesthetic Contributory Death (ACD) rate at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) was 0.4 per 10,000, which is an improvement from the pilot study that was conducted in that hospital during 1999, but it is still higher per 10,000 than the figures from the United Kingdom. The Anaesthetic Contributory Maternal Death (ACDM) rate at the Chris Hani Baragwanath Hospital was similar to the ACD rate at the CMJAH, and similar to the rate in the United Kingdom. Conclusions The ACD rate in these two hospitals is low, and may well not improve any further, as human error cannot totally be eliminated from anaesthetic practice. The South African law does not specify a time period from the start of the anaesthetic during which a peri-operative death is classified as an ACD. This is poorly understood by the medical fraternity and general public.