Durban Metropolitan Area Research Articles

Exploring Black African women's experiences of vulnerability and adaptation to flood impacts in the eThekwini metropolitan municipality, KwaZulu-Natal, South Africa

This article explores the experiences of local Black African women in adapting to flood impacts within the Durban metropolitan area. The article is premised on the realisation that women and men experience climate change differently, as persisting gendered inequities affect women's adaptive capacity to climate change impacts. The study adopted a qualitative approach to research. Twenty-five local Black African women from four localities in Durban and five key informants from eThekwini municipality participated in the study through semi-structured interviews and focus group discussions. A qualitative content analysis approach was employed to elicit analytical themes and interpretations from the interview manuscripts in light of the research questions and the study's contexts. Findings from the study show that despite the experiences of poverty, lack of access to information, and persistent gender inequity in the study's contexts, the women's situated knowledge and agency have transformed lives and livelihoods and increased climate resilience and overall well-being. We conclude that a much more appropriate and intentional approach to local Black women's adaptation needs can yield much more effective, successful, equitable, and long-term climate change adaptation.

Characterizing Informal Settlement Dynamics Using Google Earth Engine and Intensity Analysis in Durban Metropolitan Area, South Africa: Linking Pattern to Process

The growing population in informal settlements expedites alterations in land use and land cover (LULC) over time. Understanding the patterns and processes of landscape transitions associated with informal settlement dynamics in rapidly urbanizing cities is critical for better understanding of consequences, especially in environmentally vulnerable areas. The study sought to map and systematically analyze informal settlement growth patterns, dynamics and processes, as well as associated LULC transitions in Durban Metropolitan area, from 2015 to 2021. The study applied an object-based image classification on PlanetScope imagery within the Google Earth Engine (GEE) platform. Further, intensity analysis approach was utilized to quantitatively investigate inter-category transitions at category and transition levels. Thus far, no study of land conversion to and from informal settlement areas in South Africa has exploited both GEE and intensity analysis approaches. The results suggest spatial growth of informal settlements with a total net gain of 3%. Intensity analysis results at category level revealed that informal settlements were actively losing and gaining land area within the period, with yearly gain and loss intensity of 72% and 54%, correspondingly, compared to the uniform intensity of 26%. While the growth of informal settlements avoided water bodies over the studied period, there was an observed systematic process of transition between informal settlements and other urban land. Government policy initiatives toward upgrading informal housing could be attributed to the transitions between informal and other urban settlements. This study illustrates the efficacy of intensity analysis in enhancing comprehension of the patterns and processes in land changes, which aids decision making for suitable urban land upgrading plans in the Durban Metropolitan area.

Thirteen-year audit of the management of anorectal fistulae in a tertiary colorectal unit

Persistent anorectal fistulae are referred for assessment in the Durban Metropolitan area to the colorectal unit at the tertiary hospital. This audit aimed to report the assessment and management of these fistulae to benchmark the outcomes from these approaches at a South African tertiary colorectal unit. Retrospective analysis of prospectively collected data of patients with anorectal fistulae over a 13-year period at a tertiary referral centre. Data analysed included demographics, clinical presentation, comorbidity, management and outcome. Study outcomes measures were healing time and secondary outcome measures were complications of surgery. One hundred and thirty-three patients (median age 44 and M:F ratio 2.8:1) with 206 fistulae were accrued. The initial assessment and diagnostic procedures included insertion of seton (126), fistulectomy (14), and fistulotomy (65). Definitive procedures included two-stage seton fistulotomy (43), ligation of the inter-sphincteric fistula tract (LIFT) procedure (39), modified Hanley procedure (17), and mucosal advancement flap (5). One patient had no surgery and nine did not undergo a definitive procedure. Additional procedures included anal sphincter reconstruction (2) and repair of rectovaginal fistula (2). Residual anal incontinence occurred in 13.5%. The failure rate was 6% and healing occurred in 94%. The median healing time was 8 months after the initial surgery and 4 months following the definitive procedure. The fistula healing rate overall was 94% and was associated with an incontinence rate of 13.5%.

GOD IN CONTEXT: THE SYMBOLIC CONSTRUCTION OF A RELIGIOUS UNIVERSE IN A BASE CHRISTIAN COMMUNITY

‘We have depended,’ says Teresa Okure, ‘either on expatriates … or on African men to speak for us theologically and otherwise. Has the time now come to speak for ourselves? Okure’s question is asked as an African woman, but in South Africa at least, it can also be asked for marginalized and oppressed black groups as a whole. The concern of this essay is to reflect on the speaking of a small base Christian community in a large informal peri-urban settlement, similar to the favellas of Latin America, outside the Durban metropolitan area. The first step is ‘listening to’ what they have to say.

Heat stress risk and vulnerability under climate change in Durban metropolitan, South Africa—identifying urban planning priorities for adaptation

There is an urgent need to map the geographic location of climate change risks and vulnerability, especially for cities in sub-Saharan Africa, which are experiencing the greatest urban development challenges and vulnerability to climate change impacts. The aim of this study is to investigate current and projected future heat risk, expressed as a heat stress exposure index using high-resolution climate change projections, and a social vulnerability index, to identify areas of potential future heat stress risk in the Durban (eThekwini) metropolitan area, South Africa. Additionally, this is the first study to use high-resolution downscaled climate change projections under Representative Concentration (RCP) 8.5, to construct the heat exposure index using apparent temperature and increases in minimum temperature and a social vulnerability index, using demographic and socio-economic census and land use data to, derived from principal component analysis (PCA) to spatially characterize heat stress within a South African city. Results show that while heat stress is not a current concern, it is projected to increase and become a future concern, mainly as a function of social vulnerability due to household demographic and infrastructural characteristics, and will be experienced in both the rural and inner-city areas of the metro. This study contributes a heat risk framework to identify locations for specific research and adaptation activities on heat stress risk and for urban planning in sub-Saharan African cities, which are characterized by both rural and urban contexts, to address climate change adaptation targeting and priority setting.

A hybrid methodology to map informal settlements in Durban, South Africa

Currently, given the rapid growth and implementation of inadequate planning policies in African cities, the gap between formal and informal urbanisation is becoming increasingly evident. Spontaneous and unplanned settlements are home to more than half the urban population in Africa, where lost and forgotten spaces within cities are claimed by the urban poor as their ‘right to the city’. This study proposes an innovative research methodology of spatial mapping to analyse informal settlements, thus giving them a new ‘lived’ identity. The research has two key objectives: understanding how lived space can be effectively captured and interpreted and using spatial mapping as a key methodological approach to reinterpreting and adapting spontaneous settlements to existing challenges, hazards and risks. The proposed hybrid methodology, which combines drone photography and qualitative research methods (e.g. interviews, collaborative mapping), was tested in two pilot studies in the Durban metropolitan area, South Africa, to reveal the real attributes and vulnerabilities of such human settlements and to understand how they can be reorganised and adapted. The outcomes of this study allow for a more accurate (lived four-dimensional) mapping of scenarios affecting cities today.

Harbor and Intra-City Drivers of Air Pollution: Findings from a Land Use Regression Model, Durban, South Africa.

Multiple land use regression models (LUR) were developed for different air pollutants to characterize exposure, in the Durban metropolitan area, South Africa. Based on the European Study of Cohorts for Air Pollution Effects (ESCAPE) methodology, concentrations of particulate matter (PM10 and PM2.5), sulphur dioxide (SO2), and nitrogen dioxide (NO2) were measured over a 1-year period, at 41 sites, with Ogawa Badges and 21 sites with PM Monitors. Sampling was undertaken in two regions of the city of Durban, South Africa, one with high levels of heavy industry as well as a harbor, and the other small-scale business activity. Air pollution concentrations showed a clear seasonal trend with higher concentrations being measured during winter (25.8, 4.2, 50.4, and 20.9 µg/m3 for NO2, SO2, PM10, and PM2.5, respectively) as compared to summer (10.5, 2.8, 20.5, and 8.5 µg/m3 for NO2, SO2, PM10, and PM2.5, respectively). Furthermore, higher levels of NO2 and SO2 were measured in south Durban as compared to north Durban as these are industrial related pollutants, while higher levels of PM were measured in north Durban as compared to south Durban and can be attributed to either traffic or domestic fuel burning. The LUR NO2 models for annual, summer, and winter explained 56%, 41%, and 63% of the variance with elevation, traffic, population, and Harbor being identified as important predictors. The SO2 models were less robust with lower R2 annual (37%), summer (46%), and winter (46%) with industrial and traffic variables being important predictors. The R2 for PM10 models ranged from 52% to 80% while for PM2.5 models this range was 61–76% with traffic, elevation, population, and urban land use type emerging as predictor variables. While these results demonstrate the influence of industrial and traffic emissions on air pollution concentrations, our study highlighted the importance of a Harbor variable, which may serve as a proxy for NO2 concentrations suggesting the presence of not only ship emissions, but also other sources such as heavy duty motor vehicles associated with the port activities.

Effects of habitat-patch size and patch isolation on the diversity of forest birds in the urban-forest mosaic of Durban, South Africa

Loss of habitat area and structural heterogeneity through anthropogenic fragmentation poses a threat to the survival of wildlife, which may be exacerbated by urban pressures. Understanding the underlying ecological processes that influence species’ persistence in fragmented landscapes is vital for conservation. We described the effects of forest fragmentation via measures of patch size and isolation on the taxonomic richness and functional richness of forest bird communities in five Protected Areas within the urban-forest mosaic of the Durban Metropolitan Area, South Africa. We conducted 137 fixed-radius point-count surveys across 41 distinct forest patches during the austral breeding season. We quantified the avian taxonomic, guild and functional richness and measured at each survey patch. We measured the influence of patch size, Euclidean isolation distance, patch shape and habitat configuration (i.e. habitat amount) on each diversity measure. We then conducted a series of General Linear Models to determine how fragmentation and patch configuration influenced the diversity of forest birds. The explanatory variables in the top models had a significant effect on all avian diversity measures but habitat amount did not. The amount of habitat surrounding a patch was not significant for measures of bird diversity but based on the Akaike’s weight it was important for specialist species. Isolation distance did not have a significant effect on the measures of bird diversity. An increase in patch shape index increased species richness. These results show the importance of large forest fragments/patches for the conservation of forest birds and for maintaining ecosystem functioning and services of forests in increasingly urbanising landscapes, to the benefit of the environment and its human population.

Multivariate analysis of the dominant and sub-dominant epipelic diatoms and water quality data from South African rivers

Data are presented on the distribution of the dominant and sub-dominant epipelic diatoms found in South African rivers from different regions of the country. A multivariate analysis identified 36 diatom species that were associated with different levels ofTDS, PO 4 , NH 4 and SiO 2 . Three groups of rivers were identified. Group I consisted of sites with high PO 4 and SiO 2 which corresponded to Durban Metropolitan Area sites, Kruger National Park rivers, the rivers in the Johannesburg Metropolitan Area and the Orange River. In these rivers 12 diatom species were identified that might indicate those water quality characteristics. Group II included stations where the water quality had high TDS and NH 4 values which were associated with most stations in the Swartkops River in the Eastern Cape. The indicators in this group comprised 12 diatom species. Group III were from sampling stations where the water had low levels of minerals, i.e. the upper reaches of the Gamtoos River and the Swartkops River in the Eastern Cape, the Olifants River in the Northern Cape, rivers sampled in KwaZulu-Natal and the Northern Cape. At these sites, 13 diatom species were found as dominants in this better water quality. Water quality data collected during this study showed that over 50% of the river systems display some degree of eutrophication and thus efforts should be made to reduce inputs of nutrients and pollutants to those rivers.

Modelling urban land change processes and patterns for climate change planning in the Durban metropolitan area, South Africa

ABSTRACTUrbanization is one of the most significant and irreversible forms of land change, but we lack empirical evidence of these changes in the Global South. This is the first study to quantify past and explore future land change for the Durban metropolitan, using Land Change Modeler (LCM) software. Results show between 1994–2016, the total changed area was 118,403 ha (47% of landscape) and eleven transition categories were responsible for these changes. Three scenarios were explored: Scenario 1: business as usual (BAU), Scenario 2: green space protection (GSP), and Scenario 3: integrated rapid public transport network (IRPTN), up to the year 2076. BAU and IRPTN show similar projected spatial change concentrated in the west and north. GSP shares temporal change trends with BAU, but projects spatial change concentrated in the north and south. We discuss the utility of this modelling approach to understand land change processes useful for climate change planning.

Genetic characterisation of virulence genes associated with adherence, invasion and cytotoxicity in Campylobacter spp. isolated from commercial chickens and human clinical cases.

Virulence-associated genes have been recognised and detected in Campylobacter species. The majority of them have been proven to be associated with pathogenicity. This study aimed to detect the presence of virulence genes associated with pathogenicity and responsible for invasion, expression of adherence, colonisation and production of the cytolethal distending toxin (cdt) in Campylobacter jejuni and Campylobacter coli. Commercial chicken faecal samples were randomly sampled from chicken farms within the Durban metropolitan area in South Africa. Furthermore, human clinical Campylobacter spp. isolates were randomly sampled from a private pathology laboratory in South Africa. Out of a total of 100 chicken faecal samples, 78% (n = 78) were positive for Campylobacter growth on modified charcoal cefoperazone deoxycholate and from the random laboratory collection of 100 human clinical isolates, 83% (n = 83) demonstrated positive Campylobacter spp. growth following culturing methods. These samples were screened for the presence of the following virulence genes: cadF, hipO, asp, ciaB, dnaJ, pldA, cdtA, cdtB and cdtC. As expected, the cadF gene was present in 100% of poultry (n = 78) and human clinical isolates (n = 83). Campylobacter jejuni was the main species detected in both poultry and human clinical isolates, whilst C. coli were detected at a significantly lower percentage (p < 0.05). Eight per cent of the C. jejuni from human clinical isolates had all virulence genes that were investigated. Only one C. coli isolate demonstrated the presence of all the virulence genes investigated; however, the pldA virulence gene was detected in 100% of the C. coli isolates in poultry and a high percentage (71%) in human clinical C. coli isolates as well. The detection of cdt genes was found at higher frequency in poultry than human clinical isolates. The high prevalence rates of virulence genes detected in poultry and human clinical isolates demonstrate their significance in the pathogenicity of Campylobacter species.

Spatial distribution of extensively drug-resistant tuberculosis (XDR TB) patients in KwaZulu-Natal, South Africa.

BackgroundKwaZulu-Natal province, South Africa, has among the highest burden of XDR TB worldwide with the majority of cases occurring due to transmission. Poor access to health facilities can be a barrier to timely diagnosis and treatment of TB, which can contribute to ongoing transmission. We sought to determine the geographic distribution of XDR TB patients and proximity to health facilities in KwaZulu-Natal.MethodsWe recruited adults and children with XDR TB diagnosed in KwaZulu-Natal. We calculated distance and time from participants’ home to the closest hospital or clinic, as well as to the actual facility that diagnosed XDR TB, using tools within ArcGIS Network analyst. Speed of travel was assigned to road classes based on Department of Transport regulations. Results were compared to guidelines for the provision of social facilities in South Africa: 5km to a clinic and 30km to a hospital.ResultsDuring 2011–2014, 1027 new XDR TB cases were diagnosed throughout all 11 districts of KwaZulu-Natal, of whom 404 (39%) were enrolled and had geospatial data collected. Participants would have had to travel a mean distance of 2.9 km (CI 95%: 1.8–4.1) to the nearest clinic and 17.6 km (CI 95%: 11.4–23.8) to the nearest hospital. Actual distances that participants travelled to the health facility that diagnosed XDR TB ranged from <10 km (n = 143, 36%) to >50 km (n = 109, 27%), with a mean of 69 km. The majority (77%) of participants travelled farther than the recommended distance to a clinic (5 km) and 39% travelled farther than the recommended distance to a hospital (30 km). Nearly half (46%) of participants were diagnosed at a health facility in eThekwini district, of whom, 36% resided outside the Durban metropolitan area.ConclusionsXDR TB cases are widely distributed throughout KwaZulu-Natal province with a denser focus in eThekwini district. Patients travelled long distances to the health facility where they were diagnosed with XDR TB, suggesting a potential role for migration or transportation in the XDR TB epidemic.

Greenhouse gas emissions profiles of neighbourhoods in Durban, South Africa – an initial investigation

Because current emissions accounting approaches focus on an entire city, cities are often considered to be large emitters of greenhouse gas (GHG) emissions, with no attention to the variation within them. This makes it more difficult to identify climate change mitigation strategies that can simultaneously reduce emissions and address place-specific development challenges. In response to this gap, a bottom-up emissions inventory study was undertaken to identify high emission zones and development goals for the Durban metropolitan area (eThekwini Municipality). The study is the first attempt at creating a spatially disaggregated emissions inventory for key sectors in Durban. The results indicate that particular groups and economic activities are responsible for more emissions, and socio-spatial development and emission inequalities are found both within the city and within the high emission zone. This is valuable information for the municipality in tailoring mitigation efforts to reduce emissions and address development gaps for low-carbon spatial planning whilst contributing to objectives for social justice.

Endo-parasites of public-health importance recovered from rodents in the Durban metropolitan area, South Africa

Background: Parasite infections of public health importance carried by Rattus spp. on the African continent (excluding toxoplasmosis) have not been adequately researched. The aim of this study was to investigate endoparasites of public health importance, particularly those associated with R. norvegicus, at different locations and seasons within the port-city, Durban.Methods: Four hundred rodents (379 R. norvegicus, 10 R. rattus and 11 Mastomys natalensis) were live-trapped at 60 sites in four locations, during wet and dry seasons in 2009. Rats were humanely euthanased, cardiac blood drawn (for blood smears and serology), ectoparasites removed and dissected. Each organ was separately processed to collect parasites. Binary logistic regression and four-way ANOVAs were used to test for the effects of location, season, rodent age and gender on parasite prevalence, richness and abundance.Results: Eight parasites of public health importance were detected: Gongylonema sp. (25.3%), Trypanosoma lewisi (22.8%), Hymenolepis diminuta (17.2%), Angiostrongylus cantonensis (15.3%), Toxoplasma gondii (11.2%), Moniliformis moniliformis (9.5%), Calodium hepaticum (2.6%) and H. nana (0.8%). Ascaris spp. (probably A. lumbricoides) ova, assumed to have been acquired from consuming infected human faeces were found in rat faeces (4.8%). Parasite species richness was positively associated with location, season and rodent age. Location, season, rat age and gender differentially affected prevalence and worm abundance of parasite species.Conclusions: These occurrence data of parasites of public health importance provide valuable information to local and provincial organisations and medical practitioners for diagnoses of possible zoonoses, and a reference point for further studies in metropolitan areas of Africa.

Genetic characterisation of antimicrobial resistance and virulence genes in Staphylococcus aureus isolated from commercial broiler chickens in the Durban metropolitan area, South Africa.

Antimicrobial resistance of Staphylococcus aureus in human and veterinary medicine is a serious worldwide problem. The aim of this study was to investigate the prevalence of S. aureus in commercial broiler chickens as well as to establish antimicrobial susceptibility and the distribution of genetic determinants conferring resistance and virulence. One hundred and ninety-four samples were aseptically collected from broiler chicken slaughterhouses and retail outlets around the Durban metropolitan area in South Africa. Microbiological and molecular methods were used to detect the presence of S. aureus as well as its resistance- and virulence-associated genes. Polymerase chain reaction (PCR) was used to confirm the presence of S. aureus by amplifying the nuc gene. Approximately 54% of 194 samples were positive for S. aureus. The disc diffusion technique was used to investigate antimicrobial susceptibility profiles of the S. aureus isolates to a battery of 10 antimicrobial agents, namely ampicillin, chloramphenicol, gentamicin, erythromycin, cefoxitin, kanamycin, streptomycin, tetracycline, vancomycin and trimethoprim. The results demonstrated that S. aureus isolates of abattoir origin had a high level (79.4%) of resistance to tetracycline, followed by ampicillin, vancomycin, cefoxitin, trimethoprim, erythromycin and streptomycin with resistance rates of 65.1%, 61.9%, 60.3%, 58.7%, 57.1% and 46.0%, respectively. Staphylococcus aureus isolates of retail origin exhibited higher antimicrobial resistance prevalence rates than those of abattoir origin. Tetracycline had the highest resistance rate (100%), followed by cefoxitin (91.7%), erythromycin (83.3%), streptomycin (83.3%) and kanamycin (66.7%). All isolates were resistant to two or more antimicrobial agents. Out of the four virulence genes that were screened, only two were detected (coagulase and protein A); however, their prevalence rates were very low. All antimicrobial resistance genes screened were detected (mecA, BlaZ and tetK), although their prevalence did not correspond with antimicrobial susceptibility testing.

An estimation of land surface temperatures from landsat ETM+ images for Durban, South Africa

Population increase within urban environments especially in the developing countries, has posed a need to understand the urban climates. While the importance of urban climates cannot be overemphasized, acquiring knowledge about contributing factors to urban climates can be challenging. Measuring land surface temperatures is one of the ways to acquire such knowledge which could be an uphill task if done manually. However, satellite remote sensing data could be applied to spatially estimate such factors. Land surface temperatures (LST) were estimated from the thermal bands of the Landsat Enhanced Thermal Mapper Plus (ETM+) using remote sensing and geographic information system (GIS) techniques. In addition, meteorological data which included air temperature and relative humidity for the same satellite image dates were used in the analysis. Results showed that Durban metropolitan area is experiencing a major heat island over the city centre with some micro ones around the metro. Comparing the LST results to the landuse/cover of the city showed the UHI phenomenon is a reality with a 3°C and 4°C LST increase over the city centre of Durban for winter and summer seasons respectively in 2012 and being attributed greatly to the human activities within the area that has led to increase thermal radiation from land surface over highly dense and paved areas.Keywords: Urban growth, urban heat Island, land surface temperatures, satellite remote sensing

The spectrum of gastric cancer as seen in a large quaternary hospital in KwaZulu-Natal, South Africa.

Gastric cancer (GC) is the fifth most commonly diagnosed cancer in the world, with the third-highest associated mortality. It has a varying geographical, ethnic and socioeconomic distribution. To assess the presentation and management of GC in the Durban metropolitan area, South Africa. A retrospective review of 131 patients treated at the quaternary Inkosi Albert Luthuli Central Hospital in Durban from 2009 to 2014 was performed. The 131 patients were predominantly black African (n=59, 45.0%) and Indian (n=63, 48.1%). Gender was evenly distributed, with 72 males (55.0%) and 59 females (45.0%). The average age of the patients was 60 years (standard deviation 13.3). More than 70% were in advanced stages of cancer and were treated conservatively. There was no significant relationship between body mass index (BMI) and the position of the tumour (p=0.175). Creatinine and albumin levels differed significantly between the genders (p&lt;0.001 and p=0.01, respectively). GC appears to have a disproportionately high prevalence among Indians in Durban, and the prevalence of GC appears to be slightly higher among males. Both these observations may simply reflect referral patterns and warrant further investigation. More than 70% of patients presented with advanced-stage disease, and anaemia was common. No relationship was found between BMI and the location of the tumour, although most of the cancers were in the body and distal part of the stomach.

Endo-parasites of public-health importance recovered from rodents in the Durban metropolitan area, South Africa

Background: Parasite infections of public health importance carried by Rattus spp. on the African continent (excluding toxoplasmosis) have not been adequately researched. The aim of this study was to investigate endoparasites of public health importance, particularly those associated with R. norvegicus, at different locations and seasons within the port-city, Durban.Methods: Four hundred rodents (379 R. norvegicus, 10 R. rattus and 11 Mastomys natalensis) were live-trapped at 60 sites in four locations, during wet and dry seasons in 2009. Rats were humanely euthanased, cardiac blood drawn (for blood smears and serology), ectoparasites removed and dissected. Each organ was separately processed to collect parasites. Binary logistic regression and four-way ANOVAs were used to test for the effects of location, season, rodent age and gender on parasite prevalence, richness and abundance.Results: Eight parasites of public health importance were detected: Gongylonema sp. (25.3%), Trypanosoma lewisi (22.8%), Hyme...

Incidence and outcome of ventilator-associated pneumonia in Inkosi Albert Luthuli and King Edward VIII Hospital surgical intensive care units

Background. Ventilator-associated pneumonia (VAP) is one of the most common causes of hospital morbidity and mortality, but has been poorly studied in the South African context. Objective. To evaluate the incidence and outcome of VAP in the intensive care units (ICUs) of two major centres in the Durban metropolitan area. Methods. The study was conducted over a period of 6 months with all intubated and mechanically ventilated patients who were screened on admission to ICU. A questionnaire was prepared to note patients’ age, gender, date and time of intubation or reintubation. Patients were monitored from date of admission to the date of discharge from ICU or death. A diagnosis of VAP was made on a clinical pulmonary infection score (CPIS) of ≥6. Results. Of 32 patients evaluated, eight patients (25%) were diagnosed with VAP. Median duration of ventilation in the VAP group was 249 hours v. 65.5 hours in the non-VAP group ( p =0.0002). We found no statistically significant association between age or gender with the development of VAP ( p =0.28 and p =0.59, respectively). The most common organism isolated was Acinetobacter baumannii , followed by Pseudomonas aeruginosa . Three of the eight (37.5%) patients diagnosed with VAP died in the ICU. Conclusion. VAP is common in critically ill patients, possibly associated with poor outcome. These results highlight the need for strict adherence to evidence-based preventive measures.

Incidence and outcome of ventilator-associated pneumonia in Inkosi Albert Luthuli and King Edward VIII Hospital surgical intensive care units

Background. Ventilator-associated pneumonia (VAP) is one of the most common causes of hospital morbidity and mortality, but has been poorly studied in the South African context. Objective. To evaluate the incidence and outcome of VAP in the intensive care units (ICUs) of two major centres in the Durban metropolitan area. Methods. The study was conducted over a period of 6 months with all intubated and mechanically ventilated patients who were screened on admission to ICU. A questionnaire was prepared to note patients’ age, gender, date and time of intubation or reintubation. Patients were monitored from date of admission to the date of discharge from ICU or death. A diagnosis of VAP was made on a clinical pulmonary infection score (CPIS) of ≥6. Results. Of 32 patients evaluated, eight patients (25%) were diagnosed with VAP. Median duration of ventilation in the VAP group was 249 hours v. 65.5 hours in the non-VAP group ( p =0.0002). We found no statistically significant association between age or gender with the development of VAP ( p =0.28 and p =0.59, respectively). The most common organism isolated was Acinetobacter baumannii , followed by Pseudomonas aeruginosa . Three of the eight (37.5%) patients diagnosed with VAP died in the ICU. Conclusion. VAP is common in critically ill patients, possibly associated with poor outcome. These results highlight the need for strict adherence to evidence-based preventive measures.