Browsing by Author "Ehrlich, Rodney"

Now showing 1 - 20 of 49
  • Thumbnail Image
    Item
    Open Access
    The acceptability of rat trap use over pesticides for rodent control in two poor urban communities in South Africa
    (BioMed Central Ltd, 2012) Roomaney, Rifqah; Ehrlich, Rodney; Rother, Hanna-Andrea
    BACKGROUND: Rodent infestations are a public health problem in poor urban communities. The use of illegal street pesticides to control rodent infestations with resulting poisonings is an additional public health concern receiving limited attention in many developing countries, including South Africa. METHODS: Participants in a household intervention in two poor urban areas of Cape Town, South Africa, received two high quality rat traps. Reported in this article are the results of a follow-up survey conducted six months after distribution to assess community perceived acceptability of using rat traps instead of toxic pesticides (N=175). RESULTS: Of the 175 respondents that were followed up, 88% used the traps and only 35% continued using pesticides after the intervention. The analysis identified perceived effectiveness of the traps (prevalence odds ratio 18.00, 95% confidence interval 4.62 to 70.14), being male (prevalence odds ratio 8.86, 95% confidence interval 1.73 to 45.19), and the willingness to buy traps from an informal market (prevalence odds ratio 17.75, 95% confidence interval 4.22 to 74.57) as significantly associated with the acceptance of trap use. CONCLUSIONS: Rat traps, when introduced to poor urban communities, are acceptable as an alternative to toxic pesticides for rodent control. Sustainability of trap use, however, needs to be researched, especially cost and cost-benefit.
  • Thumbnail Image
    Item
    Open Access
    Alcohol and problem drinking as risk factors for tuberculosis
    (2009) Mkandawire, Tiwonge Jaranthowa; Ehrlich, Rodney
    [Background] Tuberculosis is a major public health concern for South Africa which has one of the highest recorded incidence rates in the world. Previous research [1998 South African Demographic and Health Survey (SADHS)] reported a crude association between alcohol use and tuberculosis. This study aimed to examine evidence for a relationship, and the size thereof, between alcohol consumption and previous tuberculosis in the 2003 SADHS as a means of informing tuberculosis prevention. [ Methods ] This study was a secondary analysis of cross sectional data collected as part of the 2003 SADHS. Tuberculosis lifetime risk was derived from respondent reports of past tuberculosis episodes based on being informed by a healthcare worker. Alcohol consumption, problem drinking as well as selected explanatory variables were generated from similar questions from the adult questionnaire of the SADHS. The CAGE questionnaire was used to measure symptoms of alcohol problems. Logistic regression was used to model the relationship between past tuberculosis and both alcohol consumption and CAGE. [ Results ] Current and previous alcohol consumption were found to be associated with an increase in odds of tuberculosis in both men and women, with odds ratios ranging iii from 1.1 (95% CI 0.9 - 2.5) to 2.8 (95% CI 1.4 - 5.7) after adjusting for potential confounding effects of socioeconomic factors, smoking, nutritional status and age. Having a CAGE score of either 1 to 2 or 3 to 4 was associated with a doubling [OR 2.2 (95% CI 1.0 - 4.8) and quadrupling [OR 4.4 (95% CI 1.4 - 13.4)] in the odds of tuberculosis respectively. [ Discussion ] and conclusion Behavioural and biological mechanisms of effect of alcohol on tuberculosis may explain the findings. Impairment of the immune system, both acute and long term, has been suggested as the mechanism of increased susceptibility to tuberculosis. On the other hand, high risk living conditions and behaviour associated with problem drinking provide potential for increased exposure and susceptibility to tuberculosis infection. The study was able to control for several potentially confounding socioeconomic predictor variables although not HIV infection. The results complement a body of research that has documented the adverse effects of alcohol consumption on health in general and tuberculosis specifically. The findings thus provide more evidence for public health practitioners to tackle the problem of tuberculosis via specific efforts to control alcohol use and abuse, in addition to other methods of tuberculosis control.
  • Thumbnail Image
    Item
    Open Access
    Analysing the socioeconomic determinants of hypertension in South Africa: A structural equation modelling approach
    (2012) Cois, Annibale; Ehrlich, Rodney
    Epidemiological research has long since observed that the prevalence of hypertension varies across populations' socioeconomic strata. Higher socioeconomic status (SES) has been consistently associated with lower levels of blood pressure in most studies from Europe and North America, while research in low- and middle-income countries at an earlier stage of the epidemiological transition revealed mixed patterns. The causal mechanisms underlying these varying relationships are largely unknown. Only in recent years the pathways through which SES impacts the cardiovascular system have been explored in large-scale studies, with results suggesting that body mass index, heart rate, and to a lesser extent physical exercise, alcohol use and smoking, may play a role in mediating these associations. However, these results refer to high-income countries, while similar research in low- and middle-income countries, and sub-Saharan Africa in particular, is lacking. In 2008, the National Income Dynamics Study (NIDS) collected a broad range of information on a representative sample of the population of South Africa, a medium-income country undergoing rapid epidemiological transition. Among other topics, information was gathered on blood pressure, biologic and behavioural risk factors, education, income and other indicators of socioeconomic position.
  • Thumbnail Image
    Item
    Open Access
    Analysing the socioeconomic determinants of hypertension in South Africa: a structural equation modelling approach
    (BioMed Central, 2014-05-01) Cois, Annibale; Ehrlich, Rodney
    Abstract Background Epidemiological research has long observed a varying prevalence of hypertension across socioeconomic strata. However, patterns of association and underlying causal mechanisms are poorly understood in sub-Saharan Africa. Using education and income as indicators, we investigated the extent to which socioeconomic status is linked to blood pressure in the first wave of the National Income Dynamics Study — a South African longitudinal study of more than 15000 adults – and whether bio-behavioural risk factors mediate the association. Methods In a cross-sectional analysis, structural equation modelling was employed to estimate the effect of socioeconomic status on systolic and diastolic blood pressure and to assess the role of a set of bio-behavioural risk factors in explaining the observed relationships. Results After adjustment for age, race and antihypertensive treatment, higher education and income were independently associated with higher diastolic blood pressure in men. In women higher education predicted lower values of both diastolic and systolic blood pressure while higher income predicted lower systolic blood pressure. In both genders, body mass index was a strong mediator of an adverse indirect effect of socioeconomic status on blood pressure. Together with physical exercise, alcohol use, smoking and resting heart rate, body mass index therefore contributed substantially to mediation of the observed relationships in men. By contrast, in women unmeasured factors played a greater role. Conclusion In countries undergoing epidemiological transition, effects of socioeconomic status on blood pressure may vary by gender. In women, factors other than those listed above may have substantial role in mediating the association and merit investigation.
  • Thumbnail Image
    Item
    Open Access
    An analysis of needle-stick and splash exposures among health care workers and students at Groote Schuur Hospital, 2001-2005
    (2008) Maiphetlho, Lerato; Ehrlich, Rodney
    Blood-borne diseases such as HIV, hepatitis B and C viruses have made health care institutions hazardous places of work. Health care workers (HCWs) and students are at risk of acquiring these infections and associated diseases in the workplace through needle-stick and splash exposures. Globally over the years, preventative measures such as universal precautions, safetey devices, Hepatitis B vaccination and post-exposure prophylaxis for HIV have been introduced so as to reduce the transmission of infection from patients to HCWs and students to prevent the associated diseases. Groote Schuur Hospital (GSH), a tertiary and teaching hospital, has these preventative measures in place. It also has a well-established staff health clinic which records all the reported needle-stick and splash exposures sustained by HCWs working there and by the students training there. The overall aim of this study was to analyse the data of the reported needle-stick and splash exposures among HCWs and students at GSH between 2001 and 2005.
  • Thumbnail Image
    Item
    Open Access
    An analysis of sociodemographic, dietary and environmental determinants of allergic rhinitis and atopic eczema symptoms among adolescents in Cape Town, South Africa : findings from the International Study of Asthma and Allergies in Childhood (ISAAC)
    (2011) Dearham, Astrid Chrisilda; Ehrlich, Rodney
    Most analyses of International Study of Asthma and Allergies in Childhood (ISAAC) data in developing countries have suggested an increase over time in 12-month prevalence of rhinitis and eczema symptoms amongst adolescents. The objective of this study is to measure the sociodemographic, dietary and environmental risk factors of allergic rhinitis and atopic eczema symptoms amongst adolescents of the Cape Town centre of the ISAAC Phase Three study.
  • Thumbnail Image
    Item
    Open Access
    The anthropometric nutritional status of children 0-18 years old in the Western Cape Province of South Africa : a systematic review
    (2011) Durao, Solange; Ehrlich, Rodney
    This review will employ systematic methods for study selection and quality assessment, which decrease the probability of bias. The integration of data from individual studies also increases the precision of the results. Thus, the review will aim to produce valid and reliable evidence for health-care decision-making and policy planning aimed at improving the nutritional status of children in the province.
  • Thumbnail Image
    Item
    Open Access
    Auditing healthcare facilities against the National Core Standards for occupational health and safety and infection prevention and control: compliance, reliability and impact
    (2016) Cloete, Brynt Lindsay; Ehrlich, Rodney; Yassi, annalee
    Auditing in health care has been recommended by many national organisations to improve patient safety and quality of care, despite inconclusive evidence to support its effectiveness. In South Africa, the National Core Standards for health establishments in South Africa (NCS) was published in 2011. The NCS recognises that staff are vital to ensuring that the health system delivers quality health care and therefore require protection against the risk of injury, infection and other occupational hazards, consistent with the South African Occupational Health and Safety act of 1993. The aim of this study was to determine: (a) the compliance of public sector primary healthcare (PHC) facilities with the NCS for occupational health and safety (OHS) and infection prevention and control (IPC), (b) the impact of the audits three years after baseline audits, at follow up self-assessment audits and (c) the reliability of self-assessment audits when compared to external audit results. This dissertation is divided in three parts. Part A is the study protocol which received ethics approval in March 2015. Part B is a structured literature review covering standards for health care, the impact and effectiveness of accreditation/certification/auditing in health care, interrater reliability and factors associated with OHS/IPC compliance. Previous studies have failed to address whether evaluating occupational health and safety or infection prevention and control standards using accreditation/certification in a primary healthcare, low and middle income setting is effective or reliable. Part C is the journal ready manuscript presenting the results of the study in the form of a manuscript for an article for a named peer reviewed journal. This was a cross-sectional study of NCS OHS/IPC audit data, with a longitudinal component, of a sample of public sector PHC facilities in the Western Cape province of South Africa between 2011 and 2015. Baseline PHC facility compliance with OHS/IPC measures was low. There was no significant improvement in compliance after three years. Poor inter-rater reliability indicates a large degree of measurement error. Practical implications of these results are the need to improve reliability of assessments and a process to convert low compliance scores into implemented improvement actions.
  • Thumbnail Image
    Item
    Open Access
    Dietary and environmental factors associated with symptoms or diagnosis of asthma in Cape Town school children : findings from the International Study of Asthma and Allergies in Childhood (ISAAC) phase three study
    (2007) Mahlati, Unati; Zar, Heather; Ehrlich, Rodney
    The prevalence of current wheeze and asthma in school children in Cape Town has been reported to be increasing. The multi centre International Study of Asthma and Allergies in Childhood Phase 3 (ISAAC 3) offered an opportunity to investigate the relationship between environmental or dietary risk factors and asthma symptoms or diagnosis.
  • No Thumbnail Available
    Item
    Open Access
    Disability in the Middle Ramu, Madang Province, Papua New Guinea: perceptions, prevalence and the role of community based rehabilitation
    (2002) Veenstra, Nina; Byford, Julia; Ehrlich, Rodney
    [pg 1,2,15,16,18-32,37-41,44,45 missing] Worldwide, disability is a major public health problem and the socio-economic impact of disability puts disabled individuals at risk of being amongst the poorest in society. Many disabilities in developing countries are preventable. Community Based Rehabilitation (CBR) is a rehabilitation model promoted by the World Health Organisation for addressing the problems of disability in developing countries. However, for this model to be effective accurate information is required about the socio-economic and cultural context prior to implementation. The purpose of this research was to gain a better understanding of disability in the remote Middle Ramu district, Madang Province, Papua New Guinea. Baseline data concerning the prevalence and types of disability, biomedical and culturally perceived causes of disability, and help-seeking behaviour was collected. A two-phase village screening was done, first to identify and register disabled individuals for the study. Following this in-depth interviews were conducted with selected key informants. The purpose of these interviews was to determine the participation of disabled individuals in community life, as well as the impact of cultural attitudes and perceptions on their lives. The overall prevalence of disability in the area studied was calculated at 3.2%, using the two-phase screening method. A high proportion of disabilities were found to be due to trauma and accidents, while disabilities affecting hearing were frequently associated with illness or infection. The onset of disability was most commonly attributed to social or supernatural causes. Western medicine was widely accepted and utilised. Most disabled individuals were physically well rehabilitated, and there was little or no stigma associated with disability. However, disabled individuals and their families identified a range of outstanding needs. Analysis of these needs suggests that any future CBR program in the area should focus on disability prevention, the construction of mobility aids out of local resources, the provision of accurate information concerning disability, social support for caregivers, and income generation for families with a disabled individual.
  • Thumbnail Image
    Item
    Open Access
    Does helminth treatment reduce the risk of active tuberculosis in a cohort of children from high tuberculosis risk population who have been vaccinated with BCG at birth?
    (2009) Workman, Lesley; Ehrlich, Rodney; Little, Francesca; Hatherill, Mark
    [Background] Research in adults and older children has shown an association between Mycobacterium tuberculosis and helminth infection, with those infected with helminths at greater risk of tuberculosis. This association is believed to be on the basis that chronic helminth infection can result in a functional impairment of the immune response that is necessary to clear or control infection by Mycobacterium tuberculosis (Elias et al. 2001; Rook et al. 2006; Fincham 2001). It is thus possible that the introduction of regular deworming programmes in a vulnerable population of children under the age of five years could assist their immune systems to ward off tuberculosis infection and reduce the risk of tuberculosis disease in such a population. A randomised controlled trial to compare two methods of administering bacille Camlette-Guerin (BCG) vaccination to newborns from a high tuberculosis risk population provided an opportunity to test this hypothesis in a sub-study. [Objective] The objective of this study is to determine if young children in a high-risk tuberculosis population who have been vaccinated with BCG at birth and have been treated for helminth infection are at lower risk of tuberculosis disease than children who have been vaccinated with BCG at birth but not treated for helminth infection. [Method] A case control study nested within a cohort recruited for a separate randomised control trial to compare two methods of administering BCG vaccination was carried out. Children who presented to their local clinic or hospital with symptoms of tuberculosis or a history of exposure to tuberculosis were admitted to a case verification (CV) ward for investigation of tuberculosis. Investigation of tuberculosis included a detailed history, including past helminth treatment, physical examination, tuberculin skin test, chest radiograph, gastric washing and induced sputum for culture of tuberculosis and clinical examination. A diagnostic algorithm was developed by specialist physicians and biostatisticians to classify the children into one of five tuberculosis categories. A total of 510 children (median age 18.13 months) were included in the primary analysis of this case control study. Those defined as cases were the 328 classified as "definite or probable TB" and 182, classified as "not TB", comprised the control group. Those classified as "possible TB" or "unlikely TB" were excluded. A secondary analysis was performed that included the 337 children who had been classified as "unlikely TB" with the controls resulting in a total of 847 children (median age 18.37 months). The 328 children classified as "definite or probable TB" were defined as cases and the 519 classified as "unlikely or not TB" comprised the control group. Univariate analysis was used to explore a possible relationship between tuberculosis and helminth treatment using all the variables in the sub-study (n=510 primary analysis; n=847 secondary analysis). For both the primary and secondary analysis a multivariate logistic regression model was built using a reduced sample that had a complete set of data for all the variables: primary analysis (n=435); secondary analysis (n=724). This final model was then fitted on a more complete sample as the final variables selected had fewer missing data for the observations: primary analysis (n=493); secondary analysis (n=822). [Result] A total of 35.69% of the study sample in the primary analysis had been treated for helminth infection. The proportion of children who had been treated for helminth infection was similar in the cases and controls (35.98% and 35.16% respectively). Univariate logistic regression showed no association between tuberculosis and treatment for helminth infection: [odds ratio (OR) 1.04; 95% confidence interval (CI) 0.71 - 1.51]. Multivariate analysis adjusted for the effect of nutritional status, recorded as height for age z score (haz), number of occupants sharing the same dwelling as the child, gender and birth site showed a similar result: (OR 1.03; 95% CI 0.69 " 1.53). The OR is very close to 1 with a 95% CI that includes 1, which indicates that there is not a statistically significant association between tuberculosis and helminth treatment. In the secondary analysis, a total of 38.61% of the study sample had been treated for helminth infection. In this analysis the proportion of children who had been treated for helminth infection showed a difference between the cases and controls (35.98% and 40.27% respectively). Univariate logistic regression showed a 17% relative reduction in tuberculosis odds but this was not a statistically significant result: (OR 0.83; 95% CI 0.63 " 1.11). Multivariate analysis adjusted for the effect of haz, number of children sharing the same dwelling as the child and gender, showed a similar result: (OR 0.85; 95% CI 0.63 " 1.15). [Conclusion] The primary analysis of this observational study does not support the hypothesis that helminth treatment reduces the risk of tuberculosis disease in young children in a high-risk tuberculosis population. Although the secondary analysis showed a 15% relative reduction in tuberculosis odds after adjusting for the effect of haz, number of occupants sharing the same dwelling as the child and gender, this was not a statistically significant result. [Final Conclusion] This study does not support the hypothesis that helminth treatment reduces the risk of tuberculosis disease in young children in a high-risk tuberculosis population.
  • Thumbnail Image
    Item
    Open Access
    Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial
    (BioMed Central Ltd, 2007) Zwarenstein, Merrick; Bheekie, Angeni; Lombard, Carl; Swingler, George; Ehrlich, Rodney; Eccles, Martin; Sladden, Michael; Pather, Sandra; Grimshaw, Jeremy; Oxman, Andrew
    BACKGROUND:Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice. METHODS: This is a cluster randomised trial with general practices as the unit of intervention, randomisation, and analysis. The setting is Mitchells Plain (population 300,000), a dormitory town near Cape Town. Solo general practitioners, without nurse support, operate from storefront practices. Caregiver-reported symptom data were collected for 318 eligible children (2 to 17 years) with moderate to severe asthma, who were attending general practitioners in Mitchells Plain. One year post-intervention follow-up data were collected for 271 (85%) of these children in all 43 practices.Practices randomised to intervention (21) received two 30-minute educational outreach visits by a trained pharmacist who left materials describing key interventions to improve asthma care. Intervention and control practices received the national childhood asthma guideline. Asthma severity was measured in a parent-completed survey administered through schools using a symptom frequency and severity scale. We compared intervention and control group children on the change in score from pre-to one-year post-intervention. RESULTS: Symptom scores declined an additional 0.84 points in the intervention vs. control group (on a nine-point scale. p = 0.03). For every 12 children with asthma exposed to a doctor allocated to the intervention, one extra child will have substantially reduced symptoms. CONCLUSION: Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting.
  • Thumbnail Image
    Item
    Open Access
    Effectiveness of control measures to prevent occupational tuberculosis infection in health care workers: a systematic review
    (BioMed Central, 2018-05-25) Schmidt, Bey-Marrié; Engel, Mark E; Abdullahi, Leila; Ehrlich, Rodney
    Background A number of guideline documents have been published over the past decades on preventing occupational transmission of tuberculosis (TB) infection in health care workers (HCWs). However, direct evidence for the effectiveness of these controls is limited particularly in low-and middle-income (LMIC) countries. Thus, we sought to evaluate whether recommended administrative, environmental and personal protective measures are effective in preventing tuberculin skin test conversion among HCWs, and whether there has been recent research appropriate to LMIC needs. Methods Using inclusion criteria that included tuberculin skin test (TST) conversion as the outcome and longitudinal study design, we searched a number of electronic databases, complemented by hand-searching of reference lists and contacting experts. Reviewers independently selected studies, extracted data and assessed study quality using recommended criteria and overall evidence quality using GRADE criteria. Results Ten before-after studies were found, including two from upper middle income countries. All reported a decline in TST conversion frequency after the intervention. Among five studies that provided rates, the size of the decline varied, ranging from 35 to 100%. Since all were observational studies assessed as having high or unclear risk of bias on at least some criteria, the overall quality of evidence was rated as low using GRADE criteria. Conclusion We found consistent but low quality of evidence for the effectiveness of combined control measures in reducing TB infection transmission in HCWs in both high-income and upper-middle income country settings. However, research is needed in low-income high TB burden, including non-hospital, settings, and on contextual factors determining implementation of recommended control measures. Explicit attention to the reporting of methodological quality is recommended. Trial registration This systematic review was registered with PROSPERO in 2014 and its registration number is CRD42014009087 .
  • Thumbnail Image
    Item
    Open Access
    The efficacy of intermittent directly observed isoniazid in preventing tuberculosis in HIV-infected adults with advanced disease
    (2008) Mohammed, Ashraf Allie; Maartens, Gary; Ehrlich, Rodney
    [Introduction] Meta-analysis of the treatment of latent tuberculosis infection (LTBI) in HIV-infected adults has shown significant reduction in the incidence of tuberculosis in participants with a positive tuberculin skin test (TST), but not in those with a negative TST. However, there are insufficient data on patients with advanced HIV disease from high tuberculosis incidence areas. It is important to exclude tuberculosis prior to such preventive therapy, but this can be difficult in patients with symptomatic HIV disease. A tuberculosis screening instrument is thus needed to ensure that patients placed on preventive therapy do not have tuberculosis. Furthermore, to ensure adherence and avoid drug resistance optimal supervision of the treatment administrations is required. [ Methods ] Patients with clinically advanced HIV disease were screened for active tuberculosis using a symptom questionnaire, measured weight loss, chest radiography, sputum microscopy and culture prior to receiving tuberculosis preventive therapy. Once tuberculosis was excluded, a randomized doubleblind trial was conducted comparing INH with placebo among TST negative status participants with WHO Stage 3 or 4 HIV disease. INH/placebo was administered for 12 months by patient-nominated supervisors. TST-positive participants were given open-label INH. Participants who did not have access to ART were followed up for 24 months with 6-monthly sputum culture and chest radiography. All those enrolled for the trial were required to visit a clinic on a monthly basis for 12 months during the period of weekly intermittent supervised administration of INH/placebo to assess for tuberculosis and adherence. [ Results ] A total of 118 participants were enrolled: TST was negative in 98. Tuberculosis was diagnosed in 11 of 129 patients screened. A simple screening instrument of two or more of the symptoms cough, night sweats or fever, (plus measured weight loss) had a sensitivity of 100% and specificity of 88.1% (against the gold standard of sputum culture) and positive and negative predictive values of 44% and 100%, respectively. In the randomized trial arms, the incidence of tuberculosis was 18/100 person-years (py) in the INH arm and 11.6/100 py in the placebo arm [hazard ratio 1.59, 95% confidence interval (CI) 0.57-49)]. There was no significant difference in mortality, hospitalization rate or CD4+ lymphocyte decline. Patient adherence for INH/placebo was 8 5% and was significantly higher among participants with work-based treatment supervisors than among those who were supervised by home-based or community-based treatment supervisors. The daily self-administered treatment (SAT) of cotrimoxazole (CTX) showed a good adherence especially among the TST positive participants, where a greater benefit in terms of survival among participants with good cotrimoxazole adherence was observed.
  • Thumbnail Image
    Item
    Open Access
    The epidemiology of asthma and wheeze in primary school children in Mitchell's Plain, Cape Town, with special reference to the role of environmental tobacco smoke
    (1999) Ehrlich, Rodney; Myers, Jonny; Burney, Peter
    This study was undertaken in the light of the increasing importance of childhood asthma worldwide, an apparently large burden of asthma morbidity disease in Cape Town, high local smoking rates and a lack of epidemiologic information on childhood asthma in South Africa. Two detailed literature reviews were undertaken. The first covered epidemiologic aspects of asthma and allergy in South Africa, as inferred from allergen and atopy studies, clinical series, and studies of prevalence and mortality. The second addressed the international literature on whether environmental tobacco smoke is associated with asthma, wheeze or bronchial hyperresponsiveness in general and asthmatic populations of children. This thesis is based on a self-administered questionnaire survey of the parents of 1 955 sub-8 pupils (90% response rate), aged 7 to 9 years, in Mitchell's Plain, a large, working class area of Cape Town Five empirical questions were asked: 1) is the prevalence of asthma and wheezing in primary school children? (2) What is the reliability (across two questionnaires) of questions about wheezing and asthma? 3) What are the household risk factors for wheezing and asthma; in particular, to what extent is household environmental tobacco smoke (ETS) a risk factor for asthma/wheeze? 4) Among children with asthma/wheeze, is there an association between ETS exposure and bronchial hyper-responsiveness (BHR), and 5) To what extent is asthma underrecognised and undertreated?
  • Thumbnail Image
    Item
    Open Access
    The Epidermiology of Hairstyle related african hair disdorders, in and Urban Township in South Africa
    (2007) Khumalo, Nonhlanhla P; Ehrlich, Rodney; Jessop, S
    The hair of indigenous people of Africa varies from the north to the south of the continent. Although the variation in hair colour from light brown to black occurs, the most significant difference is in the curls which are tightest, and spiral, in indigenous sub Saharan Africans. African hair for the purpose of this thesis refers to the latter hair phenotype. The unique morphology of this hair type is associated with specific responses to grooming. In addition hairstyle preferences may be influenced by politics and fashion. Specific scalp disorders have been anecdotally reported to be more prevalent in Africans. These are acne (folliculitis) keloidalis (AKN), central centrifugal cicatricial alopecia (CCCA) and traction alopecia (TA). For many years all these conditions have been suspected to have a causal association with hairstyles. However, preliminary investigation suggested a lack of population studies demonstrating the latter association. In addition the possible influence of the unique African hair follicle on disease pathogenesis had not been determined. The aims of this thesis were to: Present a systematic 1. literature review of published prevalence and incidence data on the above three conditions. 2. Conduct cross sectional studies to investigate the prevalence of AKN, CCCA and TA in a population of school children and adults and the prevalence of different hairstyles, and to describe any associations between hairstyles and disease. 3. Develop and test for reliability a new severity scoring system for TA the commonest of the above conditions [the marginal traction alopecia severity (M-TAS) scoring instrument]. 4. Evaluate the determinants of both TA presence and severity in African females using data from our cross sectional studies in school children and adults.
  • Thumbnail Image
    Item
    Open Access
    An evaluation of the clinical audit of diabetes management at community health centres in the metro district of the Western Cape Province
    (2011) Govender, Indira; Ehrlich, Rodney
    This study aimed to evaluate the long-term trend in quality improvement and determine whether there had been an increase in the performance of diabetic clinical processes.
  • Thumbnail Image
    Item
    Open Access
    Evaluation of the quality of informed consent in a vaccine field trial in a developing country setting
    (BioMed Central Ltd, 2008) Minnies, Deon; Hawkridge, Tony; Hanekom, Willem; Ehrlich, Rodney; London, Leslie; Hussey, Greg
    BACKGROUND:Informed consent is an ethical and legal requirement for research involving human participants. However, few studies have evaluated the process, particularly in Africa.Participants in a case control study designed to identify correlates of immune protection against tuberculosis (TB) in South Africa. This study was in turn nested in a large TB vaccine efficacy trial.The aim of the study was to evaluate the quality of consent in the case control study, and to identify factors that may influence the quality of consent.Cross-sectional study conducted over a 4 month period. METHODS: Consent was obtained from parents of trial participants. These parents were asked to complete a questionnaire that contained questions about the key elements of informed consent (voluntary participation, confidentiality, the main risks and benefits, etc.). The recall (success in selecting the correct answers) and understanding (correctness of interpretation of statements presented) were measured. RESULTS: The majority of the 192 subjects interviewed obtained scores greater than 75% for both the recall and understanding sections. The median score for recall was 66%; interquartile range (IQR) = 55%-77% and for understanding 75% (IQR = 50%-87%). Most (79%) were aware of the risks and 64% knew that they participated voluntarily. Participants who had completed Grade 7 at school and higher were more likely (OR = 4.94; 95% CI = 1.57 - 15.55) to obtain scores greater than 75% for recall than those who did not. Participants who were consented by professional nurses who had worked for more than two years in research were also more likely (OR = 2.62; 95% CI = 1.35-5.07) to obtain such scores for recall than those who were not. CONCLUSION: Notwithstanding the constraints in a developing country, in a population with low levels of literacy and education, the quality of informed consent found in this study could be considered as building blocks for establishing acceptable standards for public health research. Education level of respondents and experience of research staff taking the consent were associated with good quality informed consent.
  • Thumbnail Image
    Item
    Open Access
    Experience of Violence and Socioeconomic Position in South Africa: A National Study
    (Public Library of Science, 2007) Doolan, Katherine; Ehrlich, Rodney; Myer, Landon
    BACKGROUND: Violence is a leading cause of morbidity and mortality in South Africa and needs to be researched from a public health perspective. Typically in violence research, socioeconomic position is used in the analysis to control for confounding. Social epidemiology approaches this variable as a primary determinant of interest and is used in this research to better understand the aetiology of violence in South Africa. We hypothesised that measures of socioeconomic position (employment, education and household wealth) would be inversely related to violence at the individual and household levels. METHODOLOGY/PRINCIPAL FINDINGS: Data came from the1998 South African Demographic and Health Survey (SADHS). Measures of socioeconomic position used were employment, education and household wealth. Eighty-eight people (0.2%) received treatment for a violent injury in the previous 30 days and 103 households (0.9%) experienced a violent death in the previous year. Risk factors for violence at the individual level included employment (41% of those who experienced violence were employed vs. 27% of those who did not, p = 0.02), and education (those who experienced violence had on average, one year more education than those who did not, p = 0.04). Belonging to a household in the wealthiest quintile was protective against violence (OR: 0.32; 95% CI: 0.12-0.89). In contrast, at the household level all three measures of socioeconomic position were protective against the experience of a violent death. The only association to persist in the multivariate analysis was that between the wealth of the household and violence at the individual level. Conclusions/Significance Our hypothesis was supported if household wealth was used as the measure of socioeconomic position at the individual level. While more research is needed to inform the conflicting results observed between the individual and household levels, this analysis has begun to identify the disparities across the socioeconomic structure with respect to violent outcomes.
  • Thumbnail Image
    Item
    Open Access
    Gender-specific epidemiology of tuberculosis in a population with high HIV prevalence
    (2013) Racow, Kimberly; Ehrlich, Rodney; Wood, Robin
    We hypothesized that the increased burden of TB disease among young females in Cape Town is primarily due to HIV infection in this age group. During 2009, City of Cape Town TB clinics prospectively collected routine notification data on 29,478 new TB cases. The objectives of this analysis were to describe the 2009 Cape Town TB case population by gender, age, and HIV; explore associations between gender, clinical characteristics, and HIV in TB cases; and estimate age-specific TB notification rates by gender and HIV.