3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Attitudes and practices of doctors in the private health care sector in Gauteng treating their own family members(2011-06-28) Fanaroff, Sheri PhilippaItem The impact of HIV on clinical-microbiologic features and mortality among patients with invasive nontyphoidal Salmonella infection in South Africa(2009-05-18T13:05:35Z) Mtandu, RugolaIntroduction: Nontyphoidal Salmonella (NTS) has been associated with HIV from the outset of the HIV pandemic. The few NTS studies done in Africa and America have not documented the impact of HIV on clinical-microbiologic features and mortality in patients with NTS infection. This study determined the association between HIV serostatus and mortality proportion, clinical presentation, length of hospital stay, frequency of invasive NTS infection recurrence, NTS serotypes and estimated the population attributable fraction of mortality due to HIV among patients with invasive NTS infection in South Africa. Methods: Secondary data from enteric diseases national surveillance in South Africa from 2003 to 2006 were analysed as a cross sectional study. A total of 1 398 subjects with known HIV serostatus were obtained after data cleaning. Data analysis was done in Stata using chi squared test for categorical variables and Wilcoxon rank sum test / Kruskal- Wallis test for continuous variables. Logistic regression models were used to quantify the associations, and adjust for confounders and effect modification. Population attributable fraction was calculated to quantify the impact of HIV on mortality. Results: Majority (82.26%) of patients were HIV positive. The frequency pattern of HIV positive serostatus in different age groups coincided with that of invasive NTS. The overall mortality was 32.00%. HIV positive patients had a higher proportion (35.79 %) of mortality than HIV negative patients (15.55 %) (P<0.001). Fifty five percent of deaths in this study population were attributed to HIV infection. In multivariate models, HIV positive patients were more likely than HIV negative patients to die (OR = 2.50, 95% CI 1.69- 3.70), to develop lower respiratory tract infection (LRTI) (OR = 1.89, 95% CI,1.34- 2.65), to have recurrence of invasive NTS (OR = 3.90, 95% CI 1.41-10.77), to stay less than 16 days in hospitals (OR = 1.61, 95% CI, 1.08-2.40) and to be infected with Salmonella serotype Typhimurium infection (OR = 2.59, 95% CI 1.91-3.51). There were no significant differences in temperature, cardiac arrest, meningitis and site of specimen isolation (p>0.05). Discussion: The major limitation to this study was poor data quality of the surveillance system, including missing HIV serostatus hence the findings cannot be generalized to patients with unknown HIV status. Conclusion: HIV infection is common among patients with invasive NTS and is associated with excess mortality, LRTI, fewer than 16 days of hospital stay, recurrent invasive NTS infection and Salmonella Typhimurium. It is important for clinicians to rule out HIV infection in patients with invasive NTS especially those presenting with LRTI and Salmonella Typhimurium infection in addition to recurrent NTS infection, which is a wellknown feature associated with HIV. Recommendation: Since these patients received antimicrobials and had considerable mortality, the first line treatment of invasive NTS should be reviewed especially to HIV positive patients by investigating resistance patterns and conducting a clinical trial of newer and effective antimicrobials.Item Patients seen at the university hospital in Johannesburg: their views on truth-telling(2009-04-29T09:11:46Z) Vangu, Mboyo Di Tamba Heb'En WillyTruth telling forms part of the contemporary debate in clinical bioethics and centers around the right of the patient to know honest information concerning his or her medical condition / illness and the duty of the doctor to inform the patient of such. Anecdotal evidence seems to imply that patients have concerns with the practice of truthtelling. Many often complain that they are not being informed and sometimes simply being ignored in matters that primarily concerns their health. On the other hand, there may be patients who do not to want a truthful answer to their health problems-they would in fact rather not know. The aim of this study was to explore my intuition that patients who attend the Johannesburg General Hospital are not given full information about their condition(s) and / or treatment(s) although they would like to know. The study explored the preferences of patients regarding the practice of truth telling and their attitudes toward truth telling in four out patient clinics of the Johannesburg General Hospital. Four hundred and sixty five participants completed and retuned the questionnaire from four different out patient clinics, namely oncology, surgical (general surgery and orthopedics), medical (gastro, renal and general internal medicine) and the nuclear medicine unit that represented the mixed out patient clinic. The majority of participants stated that the doctor had disclosed information about their condition (92.90%). Almost all participants were of the opinion that patients have the right to know about their condition (98.28%) and also that the doctor has the duty to inform them of their condition (98.02%). If they were suffering from a serious condition, a higher percentage of participants (86.28%) would prefer to know about their condition while a small but significant percentage (13.72%) would prefer not to know. The vast majority of participants (96.64%) also preferred to know about information relating to their treatment in detail while a high percentage (87.83%) supported disclosure to relatives. Variables such as gender, age and level of education did not seem to impact on the participants’ opinions of the truth telling process with significance with the exception of iv gender in relation with knowledge of one’s condition (p=0.0176) and education with regard to opinions on the right of patients to disclosure (p=0.0430). From the above results it can then be concluded that: 1. Participants in our study supported the right of patients to disclosure and the vast majority also felt that doctors have the duty to inform patients of their condition. 2. A significant percentage of participants felt that the level of information given to them was not satisfactory even when they have requested for more. This should be looked at and means for improvement should be sought. 3. A small but significant group did not support disclosure and must be respected as autonomous beings. 4. Gender seems to influence opinions of patients concerning their condition and education impacts on opinions relating to right of patients to disclosure of information. 5. To our appeasement, we found that patients attending the Johannesburg hospital are in fact given information about their condition. It is rather the quality and the quantity of information given that should be subject to scrutiny if we would like to move towards full disclosure in the process of truth telling in our institution. 6. Future studies should be considered to assess the attitudes of doctors towards disclosing, as well as further assess conflicting opinions in small group of patients by means of direct interviews.Item The role of mutations in uncomplicated Plasmodium falciparum malaria and sulfadoxine pyrimethamine efficacy in Mpumalanga Province, South Africa.(2006-11-17T07:55:38Z) Mngomezulu, Nicros MagangeniThe antifolate combination of sulfadoxine and pyrimethamine (SP) is one of few remaining affordable drug combinations available for wide-scale treatment of uncomplicated Plasmodium falciparum malaria in Africa. In vivo studies of SP efficacy conducted during 1998, 2000 and 2002 at the Naas sentinel site in Mpumalanga province, South Africa, demonstrated a gradual non-significant increase in late treatment failure (LTF) and early treatment failure (ETF) resistance to SP, while gametocyte carriage increased significantly between 1998 and 2002 (p < 0.0001). This study aimed to determined and compare the frequency of dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps) resistant haplotypes in P. falciparum parasites from patients treated with SP in three consecutive standardized in vivo therapeutic efficacy studies in Mpumalanga province, since implementation of SP as first line treatment in 1998, and to investigate associations between the presence of mutations and treatment outcomes after SP treatment. Four hundred-and-three samples were studied and 358 yielded polymerase chain reaction products. A novel high throughput sequence-specific oligonucleotide probe-based approach was used to examine the resistance status of the three in vivo P. falciparum populations. Screening for the presence of all known point mutations in dhfr and dhps genes revealed that only five dhfr and three dhps allelic haplotypes were present. In all the samples investigated, point mutations were identified only at codons 108, 51 and 59 of the dhfr gene and at codons 347 and 540 of the dhps gene. The prevalence of dhfr resistant haplotypes was 35.4% in 1998, 38.7% in 2000, and 41.0% in 2002, while the prevalence of dhps resistant haplotypes was 9.7% in 1998, 7.2% in 2000 and 41.6% in 2002, the latter representing a significant increase (p < 0.002). The prevalence in both dhfr and dhps gene resistant haplotypes were selected gradually during the three in vivo studies in Mpumalanga province. Infection with parasites having triple dhfr mutations and double dhps mutations, "the quintuple mutant", was associated with SP treatment failure (p < 0.001). Mutations at both dhfr and dhps loci may be important predictors of SP resistance in Mpumalanga province.