Self-reported beta-lactam allergy in government and private hospitals in Cape Town, South Africa
Beta-lactams are the commonest antibiotic class reported to cause allergy, yet globally there is a large burden of patients mislabelled as having a beta-lactam allergy (BLA). In high-income countries (HICs), 6 - 25% of the population are labelled as having a BLA, but only 1 - 10% of the population have a true BLA. In keeping with this low prevalence, the prevalence of life-threatening anaphylaxis caused by beta-lactams is estimated to be 0.02 - 0.04%, a rate unchanged in the past 60 years. While the epidemiology of BLA in HICs is well described, there are no published epidemiological data available on BLA in Africa or other low- and middle-income countries (LMICs). An HIC is defined by the World Bank as a nation with a gross national income (GNI) per capita of ≥USD12 696 in 2020, whereas an LMIC is defined as one with a GNI of USD1 046 - 4 095. South Africa (SA) is classed as an upper middle-income economy, with a GNI per capita of USD4 096 - 12 695.
Risk stratification of hospital admissions for COVID-19 pneumonia by chest radiographic scoring in a Johannesburg tertiary hospital
SARS-CoV-2 is the novel viral pathogen responsible for the potentially serious pulmonary infection known as COVID-19 pneumonia, now a global pandemic. The clinical disease progression varies from asymptomatic to severe pneumonia with multiorgan dysfunction that may result in death. The benchmark test for COVID-19 is a nucleic acid amplification test (NAAT) using reverse transcriptase polymerase chain reaction (RT-PCR) to detect SARS-CoV-2 in respiratory samples. However, it has limitations, including false negative rates of up to 58%, difficulties associated with large-scale testing in low- and middle-income countries and lengthy turnaround times during the height of the pandemic. Thus various radiological imaging modalities have proven to be integral ancillary tools in the triage and management of COVID-19.
Implementation of self-monitoring of blood glucose for patients with insulin-dependent diabetes at a rural non-communicable disease clinic in Neno, Malawi
Diabetes is a chronic non-communicable disease (NCD) of growing public health concern and with an increasing incidence worldwide. Africa has the fastest-growing prevalence of diabetes, with estimates predicting a 47.5% increase by 2030 to 28.6 million people. Furthermore, the rural poor bear a disproportionate burden of NCDs without typical risk factors associated with urbanisation, such as obesity. While it is unclear whether the aetiology of diabetes in the sub-Saharan African (SSA) setting differs from that in North America and Europe, cases are still typically classified as type 1 and type 2 diabetes. In Malawi, 84% of the population lives in rural settings and 65% survive on less than USD1 per day. While the national burden of diabetes in adults is estimated to be 1.4 - 3.0%, a recent population-based study found that 41% of participants with diabetes were undiagnosed, suggesting that the actual burden may be much higher. Human insulin is procured by the Malawian government and provided free of charge to patients through public facilities, although availability can be limited. Home glucometers and test strips must be purchased privately and are inaccessible and unaffordable to most patients living in rural communities.
Factors associated with partner notification intentions among symptomatic sexually transmitted infection service attendees in South Africa
South Africa (SA) has a high burden of sexually transmitted infections (STIs), with an estimated incidence of 4.5 million cases of gonorrhoea and 5.8 million cases of chlamydia among adults aged 15 - 49 years in 2017. In the public health sector alone during 2020, 288 778 new cases of male urethritis syndrome (MUS) were reported. Partner notification (PN), the process of an index case informing sexual partners of their possible exposure to STIs and their need to seek treatment, is an integral component of STI management. Effective PN and the promotion of healthcare seeking for sexual contacts are critical in preventing reinfection of the index case as well as reducing community transmission. In SA, STIs are managed using a syndromic approach, as routine STI testing (point of care or laboratory based) is not readily available at primary healthcare (PHC) facilities. In such settings, PN would contribute to a reduction in the community burden of STIs through the treatment of undiagnosed infections in asymptomatic sexual contacts.
Peritoneal dialysis outcomes in a tertiary-level state hospital in Johannesburg, South Africa: Ethnicity and HIV co-infection do not increase risk of peritonitis or discontinuation
Reduced costs, lower staff requirements, and independence from in-centre treatment render peritoneal dialysis (PD) a valuable kidney replacement therapy (KRT) for low- to middle-income countries such as South Africa (SA). PD is therefore more likely than haemodialysis (HD) to be prescribed in the resource-limited public healthcare sector in this country, which serves a historically socioeconomically disadvantaged population of predominantly black African ethnicity with a high prevalence of HIV infection and diabetes.
Health Professions Council of South Africa
Attempts allowed: 2
70% pass rate
South African Medical Journal - February 2023 Vol 113 No 2