Browsing by Author "Coetzee, Nicol"

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    The chemoprophylaxis of meningococcal disease in the Cape Town City Council area : an evaluation of programme efficacy
    (1994) Girdler-Brown, Brendan Vaughan; Coetzee, Nicol; Coetzee, Gerrit
    This dissertation reports the findings of a study which was carried out in the Cape Town City Council area, in order to establish whether the offering of rifampicin to household contacts, of patients with meningococcal disease, resulted in protection of those contacts against developing the disease during a 32 week follow up period. The study took the form of a retrospective follow up of 3 350 household contacts of 412 cases notified over a 4-year period (mid 1988-mid 1992). It was found that the offering of rifampicin to the household contacts resulted in an odds ratio of not developing meningococcal disease over the 32-week follow up period of 14, 17 (SD = 12, 34). Although there was a tendency for contacts who were not offered rifampicin to have been younger, and of male gender, when compared to those who were offered prophylaxis, these demographic differences were not statistically significant at the 0,05 level. Furthermore, three out of the four male second cases, all in the younger age group, were in fact offered prophylaxis. It seems desirable that prophylaxis should be given as soon as possible. It is concluded, therefore, that the offering of rifampicin to household contacts of patients with meningococcal disease, living under the prevailing social circumstances in the Western Cape, has protective benefit for those contacts. It is likely that the chemoprophylaxis programme prevented up to 88 cases of meningococcal disease over the study period of four years, as well as preventing 8 deaths from this disease, in the CCC population.
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    Passive smoking and meningococcal disease
    (1997) Moodley, Jennifer R; Coetzee, Nicol; Hussey, Gregory D
    Neiserria meningitidis remains an important cause of morbidity and mortality in South Africa (SA). It is the sixth commonest cause of notified disease with a case fatality rate of 11% for the period 1990 1994. Identification of preventable risk factors is critical as no effective vaccine exists for serogroup B, the most prevalent serogroup in SA. A case control study was undertaken to determine the risk factors associated with meningococcal disease. The study population consisted of all children under the age of 14 years who were residents of the Cape Town City Council and Cape Metropolitan Council areas of jurisdiction. Cases were identified from weekly notification reports and from admissions to the City Hospital for Infectious Diseases. Controls were selected from the trauma wards at Red Cross War Memorial Children's Hospital. Data was analyzed using EPI INFO and SAS statistical software. During the period October 1993 to January 1995 70 cases and 210 controls were interviewed. Cases were significantly younger than controls (p = 0.0001). On univariate analysis significant risk factors for meningococcal disease included: a household where 2 or more members smoked (odds ratio (OR) =1.8), recent upper respiratory tract infection (OR= 1.8), poor nutritional status (OR= 3.6), being breastfed for less than 3 months (OR= 2.7) and overcrowding (OR= 2.8). After adjusting for confounders, the main force of passive smoking as a risk factor for meningococcal disease appeared to be in the presence of a recent upper respiratory tract infection. Other factors that remained significant after adjusting for confounders included: being breastfed for less than three months (adjusted OR= 2.4) and being less than 4 years old (adjusted OR= 2.3). This is the first case control study in South Africa examining risk factors associated with meningococcal disease. The study provides further evidence for the reduction of smoking, reduction of overcrowding and the promotion of breast-feeding as important public health measures. It also identifies children under the age of 4 years as an important target group should an effective vaccine become available.
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    Strategies for sexually transmitted infection partner notification
    (2002) Mathews, Catherine; Coetzee, Nicol; Myers, Jonny
    South Africa's HIV epidemic has increased rapidly over the last 10 years, and developing effective strategies to curb it is a priority. The presence of other sexually transmitted infections (STIs) facilitates the sexual transmission of HIV, and the control of STIs has been shown to be an effective way of reducing HIV incidence. One component of the process of STI control is partner notification: a process whereby the sexual partners of patients who have been diagnosed with an STI are informed of their exposure to infection and of the importance of obtaining effective treatment. Partner notification is one of the two strategies to reach and treat asymptomatic and unrecognised STIs, which are highly prevalent in South Africa. Unfortunately, current partner notification strategies are not very effective, and there is a need to improve their effectiveness. This thesis investigates strategies to improve partner notification in South Africa. This aim is achieved through three separate studies. The first is a systematic review of published and unpublished randomized controlled trials (RCTs) conducted around the world, comparing the effects various partner notification strategies, in an attempt to uncover evidence of effective strategies. The review uses methods advocated by the Cochrane Collaboration. Eleven RCTs were found, including 8014 participants, only two of which were conducted in developing countries. The review found moderately strong evidence that either provider referral alone, or the choice between patient and provider referral, or contract referral, when compared with patient referral, improved partner notification. This evidence is of limited value in South Africa, where public health services have not been able to implement provider or contract referral due to the prohibitive staffing costs involved. The review also found that verbal, nurse-given health education together with intense patient-centred counselling by lay workers, when compared with standard care results in small increases in the rate of partners treated. The review concludes that there is a need for evaluations of patient education interventions (including audiovisual presentations), of interventions combining provider training and patient education, and for evaluations to be conducted in developing countries. Further, there is a need to measure potential harmful effects, such as domestic violence, to ensure that partner notification does more good than harm.