African Hospital Research Articles

Predictive value of different body segments to estimate height in a South African adult hospital population.

Height measurement is a vital component for assessing nutritional risk, and calculating dietary requirements in a clinical setting where indirect calorimetry is not available. In many patients, height cannot be measured accurately, and equations based on body segments are relied on to predict height. This study aimed to evaluate if specific body segments are better associated with height than others in a South African public hospital setting. A descriptive cross-sectional study was conducted in three public hospitals in Bloemfontein, South Africa, on patients, 20-50 years of age, and able to stand upright without assistance to be measured by stadiometer. Spearman correlations were assessed between stadiometer height and arm-span, demi-span, ulna length, knee height, tibia length, fibula length and foot length (measured by standardised techniques). Multiple regression analysis was performed to identify the segment that is most closely associated with stadiometer height in the study population. The sample included 141 participants (61.7% male, median age 38.8 years; IQR: 10.1 years). All measured body segment were statistically significantly correlated with stadiometer height, the strongest association being with knee height in both males (R2:0.77) and females (R2:0.86). Foot length and ulna length had the weakest correlation with stadiometer height in males and females, respectively. Multiple regression analysis identified knee height as having the best predictive value in determining stadiometer height. Overall, measurements of lower leg segments, particularly knee height, predicted measured height better than upper body segments. When choosing height-prediction equations in clinical settings in populations with a high prevalence of stunting, such as South Africa, the fact that stunting affects the growth of long bones in the lower body more than in the upper body, should be considered.

Clinical and laboratory features of patients with Candida auris cultures, compared to other Candida, at a South African Hospital.

Multidrug resistant Candida auris is an emerging threat worldwide. It has been identified in Africa, however, there is minimal data available comparing C. auris to other Candida species in Africa. Retrospective, case control study at a tertiary South African Hospital. Clinical and laboratory features of patients with positive C. auris clinical cultures from 1 January 2015 to 31 August 2018 were compared to patients who cultured C. albicans and C. glabrata. Forty-five clinical cases with C. auris cultures were identified. The median age was 32 years (IQR = 26-46). The median duration of hospital stay was 64 days (IQR = 39-88) and median time from admission to diagnosis 35 days (IQR = 21-53). Indwelling devices and previous antibiotic exposure were found to be significant risk factors. All C. auris isolates were susceptible to amphotericin B and micafungin. Patients treated with amphotericin B alone, had a higher mortality (73.33%, n = 11/15) than patients treated with an echinocandin (54.55%, n = 6/11), however this was not statistically significant. All C. auris isolates were healthcare associated with 80% (n = 36/45) acquired in ICU. The 30-day all-cause in-patient mortality was 42% (n = 19/45) for C. auris, 36% (n = 16/45) for C. albicans and 53% (n = 24/45) for C. glabrata. C. auris is an emerging multi drug resistant threat in South Africa. Improved access to echinocandins and improvement of infection prevention and control strategies are imperative to prevent further morbidity and mortality due to this pathogen.

Chest radiography evaluation in patients admitted with confirmed COVID-19 infection, in a resource limited South African isolation hospital.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the subsequent global outbreak (coronavirus disease 2019 [COVID-19]) was declared a public health emergency in January 2020. Recent radiologic literature regarding COVID-19 has primarily focused on Computed Tomography (CT) chest findings, with chest radiography lacking in comparison.ObjectivesTo describe the demographic profile of adult patients with COVID-19 pneumonia requiring hospital admission. To describe and quantify the imaging spectrum on chest radiography using a severity index, and to correlate the severity of disease with prognosis.MethodRetrospective review of chest radiographs and laboratory records in patients admitted to a South African tertiary hospital with confirmed COVID-19 infection. The chest X-rays were systematically reviewed for several radiographic features, which were then quantified using the Brixia scoring system, and correlated to the patient’s outcome.ResultsA total of 175 patients (mean age: 53.34 years) admitted with COVID-19 were included. Ground glass opacification (98.9%), consolidation (86.3%), and pleural effusion (29.1%) was commonly found. Involvement of bilateral lung fields (96.6%) with no zonal predominance (61.7%), was most prevalent. Correlation between the Brixia score and outcome was found between severe disease and death (odds ratio [OR]: 12.86; 95% confidence interval [CI]: 1.58–104.61). Many patients had unknown TB (71.4%) and HIV (72.6%) statuses.ConclusionIn this study population, ground glass opacification, consolidation, and pleural effusions, with bilateral lung involvement and no zonal predominance were the most prevalent findings in proven COVID-19 infection. Quantification using the Brixia scoring system may assist with timeous assessment of disease severity in COVID-19 positive patients, as an overall predicator of clinical outcome.

The burden of road traffic accident-related trauma to orthopaedic healthcare and resource utilisation at a South African tertiary hospital: a cost analysis study

BACKGROUND: Road traffic accidents (RTAs), the second commonest cause of trauma in South Africa (SA), are on the rise. It is therefore important to study and understand the burden of RTA-related injuries on our orthopaedic healthcare and healthcare in general, in order to devise new prevention strategies to minimise the number of RTAs METHODS: A retrospective analysis of data from orthopaedic trauma intake records was done for patients admitted with RTA-related injuries to the orthopaedic department at a South African tertiary hospital between February 2019 and January 2020. Hospital records and the PAC (picture archiving and communication) system were analysed for radiological studies done. The Uniform Patient Fee Schedule (UPFS) was analysed for individual costing of all variables being studied RESULTS: There were 642 patients seen and managed with RTA-related injuries included in this study. Seventy-one per cent of them were males, with an average age of 35 years. The majority (76.2%) were motor vehicle occupants, whereas 17% were pedestrians. Seventeen per cent of them had polytrauma. Four hundred and sixty-two (76%) patients required some form of surgical intervention and spent an average of 171 minutes in theatre per procedure. Ten per cent of these patients required ICU/HCU admission for an average of 13 days. The total length of hospital stay was an average of 21.8 days. The majority of patients (67%) had some form of orthopaedic implant inserted, with an average of 1.3 implants per patient. The average cost per patient was R92 737.39. The major cost drivers were hospital stay, ICU/HCU stay, implant cost, radiological studies and theatre utilisation, respectively CONCLUSION: Management of RTA-related trauma puts a significant burden on orthopaedic healthcare management and resource utilisation. While we may not be able to directly influence other contributing factors to high costs, reducing the use of temporary external fixators may help reduce the cost of managing RTA victims These findings provide scientific data which will help support the implementation of preventative measures aimed at minimising the numbers of RTAs we see on our roads, thereby minimising the burden this puts on our healthcare system. Level of evidence: Level 3

A clinician-run 3D-printing laboratory for orthopaedic preoperative planning: an illustrative case series

BACKGROUND: Orthopaedic surgery often benefits from innovation in biomedical engineering, with 3D printing being one of the latest examples. Proving cost-effectiveness and improved clinical outcomes remains challenging. Because of the reduced cost and increased accessibility, it has been possible to start an orthopaedic 3D-printing laboratory in a South African tertiary hospital, exploring the place for this emergent technology in orthopaedic practice. This case series aims to illustrate the clinical use of 3D-printed anatomical models and investigate the time and cost involved in their manufacture METHODS: The design and manufacturing process is discussed, and a retrospective descriptive case series is presented of all models manufactured from January 2020 to April 2021. Using three illustrative cases, we elaborate on two main usage situations: intraoperative reference models (haptic maps) or rehearsal and templating (simulation models RESULTS: In the study, 3D-printed anatomical models were manufactured for 16 patients. For 12 patients, these were simulation models, and for the other four patients, haptic maps were made. The mean time for manufacture was 33 hours (range 8-62), and the median cost per patient was ZAR 3 257.62 (range ZAR 927.17 to ZAR 7 177.09 CONCLUSION: Considering the decreasing cost and ease of using 3D-printing technology, starting a clinician-run orthopaedic 3D-printing laboratory at a South African training hospital has become possible. In this series we illustrate how 3D printing has been used at our unit for planning and rehearsal of a wide range of orthopaedic cases, and we establish a baseline of time and cost expenditure. The cost-effectiveness of implementing 3D-printing technology in everyday orthopaedic practice warrants further investigation Level of evidence: Level 5

Orthopaedic surgical training exposure at a South African academic hospital - is the experience diverse and in depth?

ABSTRACT BACKGROUND: With increasing pressure on our training hospitals, we undertook to ascertain whether our clinical orthopaedic surgery training platform is providing adequate surgical exposure, both in diversity and the level of trainee participation METHODS: The orthopaedic surgery database was interrogated for theatre procedures logged for the 12-month period 1 January to 31 December 2018. Each theatre case was assessed as to the level of trainee participation, whether it was performed during or after hours, and categorised as being elective or trauma in nature, as well as the orthopaedic subdiscipline RESULTS: A total of 3 147 orthopaedic surgical procedures were logged with an even split of elective (51.1%) and trauma (49.9%) cases. Adults predominated in the trauma group while the paediatric service contributed most to the elective cases, followed by arthroplasty and spine. Overall, 25.5% of procedures were performed by consultants and 74.5% by registrars. Registrars were more frequently the primary surgeon in trauma cases (90%) compared to elective procedures (59%) (p < 0.001). Of the elective cases, 37% were performed by registrars as supervised unscrubbed and 22% as supervised scrubbed operations. In total, 17.5% of cases were performed after hours, with 31.7% of trauma surgeries and only 2.9% of elective surgeries occurring after hours. Registrars were the primary surgeon in 98.7% of after-hours trauma cases and 58% of after-hours elective cases under unscrubbed supervision CONCLUSION: Our study presents the surgical experience and level of participation available to orthopaedic surgical trainees in a South African training hospital where their exposure was an equal number of elective and trauma cases. The vast majority of the cases were performed by the registrars in their supervised unscrubbed capacity although the more complex, elective cases were performed by consultants. Almost all after-hours trauma cases were performed by registrars. This suggests the platform allows for a high level of registrar surgical participation and training despite the challenges. Further review is required to assess achievement of trainee competency and whether in fact the current experience is adequate Level of evidence: Level 4 Keywords: orthopaedic registrar surgical experience, South African orthopaedic training exposure, orthopaedic case exposure

Audiologists' Perceptions of Hearing Healthcare Resources and Services in South Africa's Public Healthcare System.

Hearing loss poses a significant burden globally. Its prevalence is exceptionally high in countries across the African region, where healthcare resources and services remain inaccessible. This study aimed to describe audiologists' perceptions regarding hearing healthcare resources and services within South Africa's public healthcare system. A national self-developed telephonic survey was conducted with audiologists in public healthcare system hospitals across South Africa, with the final sample comprising 100 audiologists. Most (82%) audiologists indicated that their hospitals did not have adequate hearing healthcare resources to render efficient audiology services to patients. Binaural amplification devices (invasive and non-invasive) for adults with bilateral hearing loss who adhered to the criteria for these devices were perceived to be unavailable in most hospitals. Audiologists also perceived that universal newborn hearing screening services, adult aural rehabilitation services, and follow-up care for all hearing devices post-warranty expiration were limited. Efforts should be made to upsurge hearing healthcare resources, including increasing the financial budgets allocated to audiology resources so that increased diagnostic and screening audiology equipment and hearing devices can be procured where required, and additional audiologists can be employed within the South African public sector hospitals where needed.

Five-year epidemiological study of surgical valvular heart diseases in a north African tertiary referral hospital

The etiology of valvular heart disease (VHD) has changed dramatically in the last decades. In middle-income countries, the incidence of rheumatic heart disease (RHD) is still high, yet the prevalence of other valve disorders may be on the rise as the population's life expectancy is increasing. The aim of this study was to assess the epidemiological profile of the patients undergoing valvular surgery in a north African center of cardiology. A retrospective study involving patients hospitalized in our department and proposed for valvular surgery between January 2012 and May 2021. During the study period, 400 patients were referred for valvular surgery. The mean age was 57 ± 13 years. Two hundred and nine patients were male (52,3%) with a sex ratio of 1,1. Rheumatic etiology was the most important (53,8%). Arterial hypertension and diabetes mellitus are respectively present in 33.3% and 22% of the patients. Before surgery mean LVEF was 58.55 ± 11%. Thirty-nine patients (9.8%) were operated with (left ventricular dysfunction (LVEF ≤ 40%). A preoperative coronary angiography was performed in 69.5% of the patients and coronary artery disease was associated with the valvular heart disease in 127 patients (31.7%). Mitral valve replacement, aortic valve replacement, and double valve replacement were respectively performed in 43.6%, 33.9% and 17,7% of the cases. Bioprothesis were implanted in 5.67% of the cases. Forty-nine patients (12,3%) underwent coronary artery bypass graft in addition to the valvular surgery. In 15.9 of the cases, it was a redosurgery. Contemporary epidemiological data shows a rise of the degenerative etiology and associated coronary artery disease. Yet VHD is still high. Further investment in planning and resources for secondary prophylaxis would be a cost and life-saving strategy for in developing and emerging economy nations.

A retrospective comparative study of complications after total knee replacement in rheumatoid arthritis and osteoarthritis patients

BACKGROUND: Total knee arthroplasty (TKA) rates have significantly increased over the past few decades; consequently, so too have the absolute number of complications. International literature expounds on complications in the rheumatoid arthritis (RA) and osteoarthritis (OA) subgroups from the developed context, but these findings cannot be generalised to the developing world, where access to medication, medical facilities and patient characteristics may differ. The purpose of this study was to determine the comparative rates and nature of complications that occur post total knee arthroplasty in RA and OA patients at a single South African quaternary hospital. METHODS: This was a retrospective comparative study of complication rates in two groups following TKA at Inkosi Albert Luthuli Central Hospital (IALCH) arthroplasty unit, between 1 January 2014 and 29 February 2020. The data was collected retrospectively, utilising the digitised patient management system at the hospital. Data extraction included patient demographics, time to surgery, indication for surgery and early complication rates. Descriptive analysis was performed to quantify complications, comparing the two groups. RESULTS: The chart review yielded 332 cases, comprising 41 RA and 291 OA patients. The mean age of the combined participant group was 65 years (standard deviation [SD] 8). Most cases were female (87%, 289 of 332), with males comprising 13% (43 of 332). Concomitant human immunodeficiency virus (HIV) was present in 6% of patients (20 of 332), and 24% (80 of 332) had diabetes mellitus (DM). The absolute number of complications was greater in the OA group, where revision surgery was performed in 3% (8 of 291) of cases, infection occurred in 1% (3 of 291), mechanical complications in 3% (10 of 291), and deep vein thrombosis (DVT) in 1% (2 of 291) of cases. There was one complication, a DVT, in the RA group (2%, 1 of 41). CONCLUSION: In the current study, complications after TKA occurred predominantly in the OA group, 8% (23 of 291) as compared to the RA group, 2% (1 of 41). Complications included DVT, revision surgery, infection and mechanical complications. The study was underpowered to detect significant differences between the groups. Further large-scale investigation will be required to determine if differences in complication rate are significant when low complication incidence is anticipated. Level of evidence: Level 4.

The epidemiological profile of meningitis among adults in a South African district hospital.

Introductionunderstanding the epidemiological profile of a disease in a particular region allows for proper planning of public health resources for prevention, early diagnosis and treatment. In this present study, we describe the epidemiological profile of viral, fungal, tuberculous and bacterial meningitis among adults at National District Hospital (NDH), Free State province, over three years period (January 2017 to December 2019).Methodsa retrospective, observational study of all adult meningitis cases, managed at the National District Hospital (NDH) Bloemfontein, Free State Province, South Africa between January 2017 and December 2019.Resultsof the 236 case files reviewed, majority (93.2%; n=220) of the patients managed for meningitis were black, as well as males (55.5%; n = 131). Higher incidence was found between the ages 20 to 49 (81.7%). Of those who died, the majority (n = 14; 63.6%) were males, in the age group 40-49 (n = 7; 31.8%), had TB meningitis (n = 12; 54.5%), were HIV positive (n = 20; 90.9%), and had cell count <100 cells/mm3 (n = 10; 45.5%).Conclusionour study suggests that combining information on patient demography, co-morbidities, clinical presentation, and examination findings can substantially contribute to raising clinical suspicion, leading to swift identification, diagnosis, and treatment of patients.

Hospital Information Systems Shortage in Sub-Saharan African Hospitals: Opportunities and Challenges

The HIS is recognised as an essential tool for optimising the management of a health establishment in particular and the health system in general. But it is still very little implemented in hospitals in the South. Open source HIS software, available on the Internet, can be a solution for starting a (HIS) project in these hospitals. A search on the Internet for open source HIS software allowed us to choose MedBoard, the second most popular open source software out of 381, to start an HIS project called PERFORMANCE at the Kara University Hospital in northern Togo. A questionnaire allowed us to assess the level of knowledge of health actors on hospital information systems. The results of this evaluation allowed us to strengthen our proposal. The analysis of the current computer park of the CHU Kara does not allow whatever the functionalities of MedBoard to implement PERFORMANCE at the CHU Kara. Logistics are needed to make PERFORMANCE work. The real difficulty to start and perpetuate HIS project is linked to the human factor.

Profiling Hepatitis B Viral Load: Treatment and Epidemiological Implications in a West African Hospital

Background: Chronic hepatitis B virus (HBV) infection is one of the largest public health problems with nearly 350 million chronic carriers and 500,000 deaths each year. These deaths are most often associated with disease progression to cirrhosis or hepatocellular carcinoma, which some studies have shown is associated with long-term viral replication in chronic carriers. Viral load quantification, a key element of disease management, is expensive and difficult to access. Viral load plays a crucial role in patient classification and treatment initiation. Four years after the implementation of viral load platform, the objective of this study was to assess viral load profile in HBs chronic carriers in a sub-Saharan Hospital and to determine the potential impact of this distribution on preventive and therapeutic strategies against hepatitis B infection. Materials and Method: The study was carried out between April 2016 and October 2020 in the laboratory of the PRINCIPAL Hospital in Dakar. All patients referred for HBV DNA viral load testing following a positive AgHBs test were included. Incomplete medical records were excluded from the study. Only the first quantification test performed on each patient is recorded. DNA extraction was performed with COBAS AmpliPrep (Roche Molecular Systems, Inc., Branchburg, NJ, USA). Amplification was performed using COBAS TaqMan48 (Roche Molecular Systems, Inc., Branchburg, NJ, USA). Data were collected from the laboratory’s computer system and entered into Microsoft Excel (2007). Statistical analyzes were performed using Epi-Info 7 software. Results: A total of 3002 patients, 76.1% (2285/3002) men and 33.9% (717/3002) women, were included in the study. Young adults were most represented among the subjects (23.2%) and (20.1%) in the age groups 25 - 30 and 30 - 35. The majority (52.7%) of patients had viral loads between 20 and 2000 IU. Patients with undetectable viral loads and patients with viral loads below 20 IU comprised 14.6% and 7.53% of the study population, respectively. Patients with viral loads between 2000 and 20,000 IU/ml and those with viral loads greater than 20,000 IU/ml represented 16.3% and 8.89% of the study population, respectively. Viral load was higher in males than females, with corresponding median and interquartile ranges of 2.7 log IU (2.2, 2.75) and 2.23 log IU (2.1, 2.4) (p < 0.001). This viral load also decreases with age. There were more patients with an undetectable viral load over 30 years than those under 30 years, with a ratio of 1.62 (IC95% = 1.29 - 2.05) (p = 0.009). Conclusion: This study shows a successful implementation of virus quantification in the context of resource-constrained countries. The second finding of this study is the high prevalence of adolescents with high plasma viral loads, indicating the need for additional investigations to initiate therapy. The large population with a low HBV replication rate points to the problem of financing follow-up care for chronically infected people. Studying this population in the context of an unknown genomic profile indicates the need to deepen virological laboratory testing through a sequencing platform. Finally, regular viral load reporting in major hospital cities could be a powerful and accessible management tool for hepatitis B programs in resource-constrained countries.

FACTORS AFFECTING THE SUSTAINABILITY OF LEAN IN HEALTHCARE: A SYSTEMATIC LITERATURE REVIEW

The application of Lean in healthcare has been steadily climbing since 2000. However, Lean implementation in healthcare environments has experienced high failure rates that could be attributed to a lack of sustainable implementation. A knowledge gap has therefore been identified, in both practice and research, to understand the reason for failure and the impact of Lean sustainability on Lean success. The aim of the main study is to explore the factors that affect the sustainability of Lean healthcare in South African hospitals. This paper reports on the first part of the study, a systematic literature review (SLR) that identifies the factors that affect the sustainability of Lean healthcare in hospitals. Through the SLR, 50 factors affecting Lean sustainability in hospitals were identified and grouped into 12 themes. These themes were then tested against Lean principles. The results showed that the adaptation of Lean so that it makes sense to healthcare staff and is compatible with a hospital context is important for sustainability. Staff and organisational readiness during Lean implementation is also critical for long-term sustainability. The SLR results will be used to develop an interview protocol for the second part of the main study, which will involve interviews with South African-based practitioners, consultants, and academics who are directly involved in Lean implementation in South African hospitals. Keywords Lean; Lean healthcare; Lean principles; factors; systematic literature review; hospital

Placental Heterogeneity in Stillbirth and Its Relations to Maternal Exogenous Characteristics

Heterogeneous patterns of placental lesions in stillbirth signal important variations in placental histopathology that may be diagnostic in stillbirth. We explore placental heterogeneity and its associations with maternal characteristics (including HIV) using latent class analysis. Placental and maternal data and slides were assessed retrospectively for 122 confirmed stillbirths (gestational age ≥ 28weeks) delivered at a major South African academic hospital between January 2016-July 2018. The slides were reviewed by 2 pathologists and classified using the Amsterdam Consensus Classification System. Latent class analyses were conducted on raw data. We identify 5 latent placental classes in stillbirth based on similarity in patterns of observed diagnostic criteria and their associations with maternal characteristics. Three classes bear similarity to generalized patterns of placental injury identified previously. Our study shows that intrauterine infection was the commonest histopathological condition associated with stillbirth in our setting. Novel findings include 2 classes, distinguished by high placental RPH and maternal HIV, respectively, and the non-emergence of a class distinguished by VUE. The size and content of the latent classes and their similarity/dissimilarity to the more generalized patterns identified previously suggest potential new avenues for investigation and theory development concerning the role of the placenta in stillbirth and the impact of HIV.

Rationalising empirical antibiotics for bloodstream infections: A retrospective study at a South African district-level hospital

Background. Incorrect empirical antibiotic therapy is one of the factors that contribute to poor clinical outcomes and the development of antimicrobial resistance. Knowledge of the local infectious disease burden and antibiotic resistance patterns can assist with development of strategies, updating of guidelines and subsequent improvement in initial empirical therapy. Objectives. To determine whether the empirical antibiotic choice for treatment of septic episodes at a district-level hospital was appropriate according to national guidelines, and to describe the epidemiological features of the septic episode population being studied and depict their antibiotic susceptibility profile. Methods. This was a retrospective, descriptive study of adult inpatients with bloodstream infections at Karl Bremer Hospital, Cape Town, South Africa. Laboratory and clinical data were obtained and analysed for the period 1 July 2017 - 30 June 2018. Septic episodes were subdivided into community-acquired bloodstream infection (CABSI) and hospital-acquired bloodstream infection (HABSI) study populations, and empirical antibiotics for both groups were assessed and compared with the adult Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level Care, 2015 edition (STG and EML). Results. Our study sample consisted of 184 septic episodes, isolated from 176 patients. Nearly half of the septic episodes (49.5%) were hospital acquired. Overall guideline adherence in the CABSI population was 88%, compared with 58% in the HABSI population. The reasons for guideline non-adherence in the CABSI population were lack of source-appropriate empirical antibiotics (n=7) and septic episodes where empirical antibiotics were indicated but not prescribed (n=4), while in the HABSI group the main reason was that the patients were treated by community-acquired standards (n=30; 33.0%). The in-hospital mortality rate for a septic episode in this study was 38%. Considering the typical first-line antibiotics used, 77.3% of CABSIs were found to be susceptible to co-amoxiclav (n=75) and 59.8% to ceftriaxone (n=58). With the exclusion of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii isolates as confounders, HABSIs had a susceptibility of 86% to the piperacillin/tazobactam plus amikacin combination, 81% to ertapenem, 90% to imipenem and 93% to meropenem. Conclusions. This study demonstrates poor guideline adherence in HABSIs, emphasising the importance of distinguishing between CABSIs and HABSIs. The empirical antibiotics advised by the STG and EML were found to be appropriate in the majority of septic episodes. Future revision and improvement of prescribing practices can assist in rationalising empirical antibiotic decisions.

Stroke: A retrospective review of the incidence and epidemiology in a South African academic hospital emergency department.

Stroke is a leading cause of morbidity and mortality. Most deaths occur in low- and middle-income countries, with the incidence predicted to increase as populations undergo socioeconomic and epidemiological changes. Knowledge of contributing factors in a South African (SA) population can be used to drive healthcare initiatives to modify this burden of disease. To analyse epidemiological data on patients with stroke presenting to an emergency department in Johannesburg, SA. The study was a 12-month descriptive, retrospective review of medical records, undertaken at a tertiary-level hospital. Patients' records were selected based on the presumptive diagnosis of stroke. Data collected included ethnicity, age, gender, risk factors, signs and symptoms at presentation, and computed tomography (CT) brain scan findings. Of 312 records reviewed, 160 were eligible for inclusion. The mean age of the patients included was 57.7 years, and 64 patients (40%) had CT-confirmed haemorrhagic strokes. Hypertension was the most common comorbidity/risk factor identified, in the sample as a whole (n=93; 58%) and in both patients with haemorrhagic (n=33; 52%) and ischaemic strokes (n=56; 61%). Diabetes was the second most common comorbidity/risk factor (n=23; 14%), and was three times more likely in patients with ischaemic strokes (n=19; 20%) compared with haemorrhagic strokes (n=4; 6%). Stroke is an important healthcare concern for SA. Our study demonstrated a lower mean age of patients presenting with stroke compared with high- and upper middle-income countries, and a higher proportion of haemorrhagic strokes. Several modifiable risk factors such as hypertension and diabetes were identified. Data collection on a regional and national level is important to drive targeted healthcare initiatives.

Positive Postoperative Blood Cultures in Major Abdominal Surgery Patients Attending a Tertiary Hospital in Durban, South Africa

Background : Evidence from high-income countries suggests that bloodstream infection is an essential complication following major surgery. However, studies of bloodstream infections following major surgery in lower-income settings, particularly in Africa, are rare. This study aimed to determine the incidence of postoperative bloodstream infection and to explore any association with mortality in high-risk laparotomy patients in South Africa. Methods : This study was a retrospective study, reviewing 435 consecutive adults who underwent laparotomy at a South African tertiary hospital over a five-year period. Incident postoperative bloodstream infection, defined as a positive blood culture following surgery, was determined from laboratory reports in the patient’s medical chart. Source infections and the causative microorganisms were established from laboratory reports. Inpatient mortality was determined from the patient’s hospital discharge summary. Data were summarized using descriptive statistics. Potential associations between bloodstream infection and mortality were tested using the chi-square test. Results : The incidence of postoperative bloodstream infection was 7.4%. Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus were isolated from 21.9%, 18.7%, and 15.6% of blood cultures. Mortality in patients with bloodstream infection was 46.9% vs. 16.1% in patients without bloodstream infection (p&lt;0.001). Conclusions : Postoperative bloodstream infection is an essential complication following major abdominal surgery with K. pneumoniae, E. coli, and S. aureus being the most common causative agents. Bloodstream infection is associated with a higher risk of postoperative mortality. Further studies are recommended to confirm the findings and improve patient management.

Refeeding syndrome in children 0 – 59 months diagnosed with severe acute malnutrition in a South African setting

Rationale: Refeeding syndrome (RFS) is life-threatening, but an under-researched complication in the treatment of severe acute malnutrition (SAM). This study aimed to determine the incidence and onset of RFS, characterised by hypophosphataemia, and identify biochemical abnormalities, clinical signs and complications that may be associated with the development of refeeding syndrome in children aged 0 – 59 months diagnosed with SAM in a South African public hospital setting.

The spectrum, prevalence and in-hospital outcomes of cardiovascular diseases in a South African district hospital: a retrospective study

The increasing prevalence of cardiovascular risk factors in South African rural communities is well reported. However, the prevalence of cardiovascular disease (CVD) leading to hospital admission and related in-hospital mortality in rural and semi-rural hospitals is unknown. We conducted a retrospective review of hospital records for patients admitted to the Department of Internal Medicine at Dora Nginza Hospital in Port Elisabeth, South Africa between 1 April and 31 October 2016. The study focused on patients who received a primary diagnosis of CVD. During the seven-month study period, 4 884 patients were admitted to the unit, 1 325 of whom received a primary diagnosis of CVD, giving a prevalence of 27%. Patients with CVD had a mean (standard deviation) age of 60 (± 15) years, 32% of this patient population was younger than 55 years and 65% were female. Furthermore, 94% had a background medical history of systemic hypertension and 30% of diabetes mellitus. The three leading cardiovascular causes of hospital admission were stroke (38%), hypertensive heart disease plus heart failure (33%), and hypertensive emergency/urgency (18%). In-hospital outcome: 12.4% of patients admitted for CVD died during the index hospitalisation and strokes were responsible for 70% of the deaths. The prevalence of CVD in this cohort was high and accounted for significant morbidity and mortality. Systemic hypertension was a leading risk factor in our cohort and we need to intensify efforts to diagnose and treat systemic hypertension.

Predicting mortality in trauma patients - A retrospective comparison of the performance of six scoring systems applied to polytrauma patients from the emergency centre of a South African central hospital.

IntroductionOver 90% of trauma-related deaths worldwide, ensue in low- and middle-income countries. Multiple useful trauma scoring systems have been devised. Although validated in high-income countries, they cannot always be replicated in resource-limited countries. This study compares six trauma scores to identify the best-suited system to use for polytrauma patients in a hospital in Pretoria, South Africa.MethodsThis is an observational retrospective analysis of polytrauma admissions from 1 July 2016 to 31 December 2016. Data collected from patients' records from the EC of Steve Biko Academic Hospital, was analysed using Stata Release 14. Outcomes were recorded as 30-day survival, ICU– and overall hospital LOS. Scores pertaining to patient mortality, were compared in terms of sensitivity, specificity, and cut-off points based on ROC curve. Finally, for LOS Pearson correlation analysis was used.ResultsAt the best calculated mortality prediction cut-points for the scores, the sensitivities and specificities were respectively 87% and 68% for TRISS, 81% and 61% for ISS, RTS yielded 81% and 60%, while for REMS it was 61% and 69%. The SI and RSI (cut-points used in agreement with the literature) produced sensitivities 58% and only 48%, and specificities of 73% and 83%, respectively.45(41,7%) patients required ICU admission. Though the ICU LOS best correlated with ISS(r = 0.2710), the ICU LOS correlation coefficient was weak for all trauma scores. None of the scores had a significant p value for hospital LOS.DiscussionAmong the scores compared, TRISS had the highest sensitivity and NPV for mortality prediction in this South African polytrauma population. ISS correlated best with ICU LOS. However, compared to developed countries, ROC analyses & predictability of these scores fare relatively worse, and no correlation was found with hospital LOS. Therefore, we conclude that further studies are needed to ascertain a more suitable system for resource-limited settings.