OpenUCT :: Browsing by Subject "mortality"

Browsing by Subject "mortality"

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Open Access
Collapse of an iconic conifer: long-term changes in the demography of Widdringtonia cedarbergensis using repeat photography
(2016) White, J D M; Jack, S L; Hoffman, M T; Puttick, J; Bonora, D; Visser, V; February, E C
BACKGROUND: Conifer populations appear disproportionately threatened by global change. Most examples are, however, drawn from the northern hemisphere and long-term rates of population decline are not well documented as historical data are often lacking. We use a large and long-term (1931-2013) repeat photography dataset together with environmental data and fire records to account for the decline of the critically endangered Widdringtonia cedarbergensis. Eighty-seven historical and repeat photo-pairs were analysed to establish 20th century changes in W. cedarbergensis demography. A generalized linear mixed-effects model was fitted to determine the relative importance of environmental factors and fire-return interval on mortality for the species. RESULTS: From an initial total of 1313 live trees in historical photographs, 74% had died and only 44 (3.4%) had recruited in the repeat photographs, leaving 387 live individuals. Juveniles (mature adults) had decreased (increased) from 27% (73%) to 8% (92%) over the intervening period. Our model demonstrates that mortality is related to greater fire frequency, higher temperatures, lower elevations, less rocky habitats and aspect (i.e. east-facing slopes had the least mortality). CONCLUSIONS: Our results show that W. cedarbergensis populations have declined significantly over the recorded period, with a pronounced decline in the last 30 years. Individuals that established in open habitats at lower, hotter elevations and experienced a greater fire frequency appear to be more vulnerable to mortality than individuals growing within protected, rocky environments at higher, cooler locations with less frequent fires. Climate models predict increasing temperatures for our study area (and likely increases in wildfires). If these predictions are realised, further declines in the species can be expected. Urgent management interventions, including seedling out-planting in fire-protected high elevation sites, reducing fire frequency in higher elevation populations, and assisted migration, should be considered.
Open Access
Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby
(BioMed Central Ltd, 2015) Kerber, Katherine J; Mathai, Matthews; Lewis, Gwyneth; Flenady, Vicki; Erwich, Jan Jaap; Segun, Tunde; Aliganyira, Patrick; Abdelmegeid, Ali; Allanson, Emma; Roos, Nathalie; Rhoda, Natasha; Lawn, Joy; Pattinson, Robert
BACKGROUND: While there is widespread acknowledgment of the need for improved quality and quantity of information on births and deaths, there has been less movement towards systematically capturing and reviewing the causes and avoidable factors linked to deaths, in order to affect change. This is particularly true for stillbirths and neonatal deaths which can fall between different health care providers and departments. Maternal and perinatal mortality audit applies to two of the five objectives in the Every Newborn Action Plan but data on successful approaches to overcome bottlenecks to scaling up audit are lacking. METHODS: We reviewed the current evidence for facility-based perinatal mortality audit with a focus on low- and middle-income countries and assessed the status of mortality audit policy and implementation. Based on challenges identified in the literature, key challenges to completing the audit cycle and affecting change were identified across the WHO health system building blocks, along with solutions, in order to inform the process of scaling up this strategy with attention to quality. RESULTS: Maternal death surveillance and review is moving rapidly with many countries enacting and implementing policies and with accountability beyond the single facility conducting the audits. While 51 priority countries report having a policy on maternal death notification in 2014, only 17 countries have a policy for reporting and reviewing stillbirths and neonatal deaths. The existing evidence demonstrates the potential for audit to improve birth outcomes, only if the audit cycle is completed. The primary challenges within the health system building blocks are in the area of leadership and health information. Examples of successful implementation exist from high income countries and select low- and middle-income countries provide valuable learning, especially on the need for leadership for effective audit systems and on the development and the use of clear guidelines and protocols in order to ensure that the audit cycle is completed. CONCLUSIONS: Health workers have the power to change health care routines in daily practice, but this must be accompanied by concrete inputs at every level of the health system. The system requires data systems including consistent cause of death classification and use of best practice guidelines to monitor performance, as well as leaders to champion the process, especially to ensure a no-blame environment, and to access change agents at other levels to address larger, systemic challenges.
Open Access
Emergence of a peak in early infant mortality due to HIV/AIDS in South Africa
(2009) Bourne, David E; Thompson, MaryLou; Brodya, Linnea L; Cotton, Mark; Draper, Beverly; Laubscher, Ria; Abdullah, M Fareed; Myers, Jonny E
Objectives: South Africa has among the highest levels of HIV prevalence in the world. Our objectives are to describe the distribution of South African infant and child mortality by age at fine resolution, to identify any trends over recent time and to examine these trends for HIV-associated and non HIV-associated causes of mortality. Methods: A retrospective review of vital registration data was conducted. All registered postneonatal deaths under 1 year of age in South Africa for the period 1997–2002 were analysed by age in months using a generalized linear model with a log link and Poisson family. Results: Postneonatal mortality increased each year over the period 1997–2002. A peak in HIV-related deaths was observed, centred at 2–3 months of age, rising monotonically over time. Conclusion: We interpret the peak in mortality at 2–3 months as an indicator for paediatric AIDS in a South African population with high HIV prevalence and where other causes of death are not sufficiently high to mask HIV effects. Intrauterine and intrapartum infection may contribute to this peak. It is potentially a useful surveillance tool, not requiring an exact cause of death. The findings also illustrate the need for early treatment of mother and child in settings with very high HIV prevalence.
Open Access
Hunting as a management tool? Cougar-human conflict is positively related to trophy hunting
(2016) Teichman, Kristine J; Cristescu, Bogdan; Darimont, Chris T
BACKGROUND: Overexploitation and persecution of large carnivores resulting from conflict with humans comprise major causes of declines worldwide. Although little is known about the interplay between these mortality types, hunting of predators remains a common management strategy aimed at reducing predator-human conflict. Emerging theory and data, however, caution that such policy can alter the age structure of populations, triggering increased conflict in which conflict-prone juveniles are involved. RESULTS: Using a 30-year dataset on human-caused cougar (Puma concolor) kills in British Columbia (BC), Canada, we examined relationships between hunter-caused and conflict-associated mortality. Individuals that were killed via conflict with humans were younger than hunted cougars. Accounting for human density and habitat productivity, human hunting pressure during or before the year of conflict comprised the most important variables. Both were associated with increased male cougar-human conflict. Moreover, in each of five regions assessed, conflict was higher with increased human hunting pressure for at least one cougar sex. CONCLUSION: Although only providing correlative evidence, such patterns over large geographic and temporal scales suggest that alternative approaches to conflict mitigation might yield more effective outcomes for humans as well as cougar populations and the individuals within populations.
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The influences of AIDS-related morbidity and mortality on change in urban households: An ethnographic study
(2008) Bray, Rachel
Drawing on qualitative panel data collected in a poor township on the edge of Cape Town, this paper provides a fine-grained analysis of the residential decision-making of five HIV positive women and some of their children. HIV status and illness are found to add to the pressures exerted by income and asset poverty in ways that further incline women to seek residential security for themselves and their children. The presence of HIV intensifies the mental health implications of pre-existing socio-economic burdens and efforts to respond to these. Much of the resultant mobility cannot therefore be considered AIDS specific. At the same time, being HIV positive and unwell (or anticipating illhealth) prompts women to organise particular domestic arrangements for themselves and their children. Previously non-resident children are moved from distant relatives to join the urban household, incurring financial and social strain on the domestic group and on infected women in particular. Infected mothers want to live with all their children so that they can nurture them, have opportunity to disclose and familiarise their children with the everyday implications of being positive and on treatment, and to ensure they have the skills to survive on their own should they themselves die. Such moves can be made without raising suspicion of HIV within the family because there is a well established pattern of moving teenagers from the Eastern Cape to schools in Masiphumelele for reasons of improving education.
Open Access
Initial burden of disease estimates for South Africa, 2000
(2003) Bradshaw, Debbie; Groenewald, Pam; Laubscher, Ria; Nannan, Nadine; Nojilana, Beatrice; Rosana, Norman; Pieterse, Desiréé; Schneider, Michelle; Bourne, David E; Timæus, Ian M; Dorrington, Rob; Johnson, Leigh
Background. This paper describes the first national burden of disease study for South Africa. The main focus is the burden due to premature mortality, i.e. years of life lost (YLLs). In addition, estimates of the burden contributed by morbidity, i.e. the years lived with disability (YLDs), are obtained to calculate disability-adjusted life years (DALYs); and the impact of AIDS on premature mortality in the year 2010 is assessed. Method. Owing to the rapid mortality transition and the lack of timely data, a modelling approach has been adopted. The total mortality for the year 2000 is estimated using a demographic and AIDS model. The non-AIDS cause-of-death profile is estimated using three sources of data: Statistics South Africa, the National Department of Home Affairs, and the National Injury Mortality Surveillance System. A ratio method is used to estimate the YLDs from the YLLestimates. Results. The top single cause of mortality burden was HIV/AIDS followed by homicide, tuberculosis, road traffic accidents and diarrhoea. HIV/AIDS accounted for 38% of total YLLs, which is proportionately higher for females (47%) than for males (33%). Pre-transitional diseases, usually associated with poverty and underdevelopment, accounted for 25%, non-communicable diseases 21% and injuries 16% of YLLs. The DALY estimates highlight the fact that mortality alone underestimates the burden of disease, especially with regard to unintentional injuries, respiratory disease, and nervous system, mental and sense organ disorders. The impact of HIV/AIDS is expected to more than double the burden of premature mortality by the year 2010. Conclusion. This study has drawn together data from a range of sources to develop coherent estimates of premature mortality by cause. South Africa is experiencing a quadruple burden of disease comprising the pre-transitional diseases, the emerging chronic diseases, injuries, and HIV/AIDS. Unless interventions that reduce morbidity and delay morbidity become widely available, the burden due to HIV/AIDS can be expected to grow very rapidly in the next few years. An improved base of information is needed to assess the morbidity impact more accurate.
Open Access
The mortality of members of group schemes in South Africa
(Acturial Society of South Africa, 2013) Schriek, K A; Lewis, P L; Clur, J C; Dorrington, R E
In this paper, the mortality of members of group schemes underwritten by South African life insurance companies is investigated. The research provides some indication of the level or mortality of this population as a whole, which apart from being useful for costing group schemes in future could be used, to the extent that these data represent the mortality of those in formal employment, in the costing of a national retirement scheme. Rates of mortality are investigated by several demographic factors such as age, sex, salary and industry of employment.
Open Access
Outcomes of patients admitted with acute coronary syndrome to a district level hospital in a lower to middle income country
(2025) Govender, Kamini; Van Der Schyff, Nasief; Engel, Mark
Background: Acute coronary syndrome (ACS) has become a leading cause of death in low-and middle-income countries. There is a lack of data regarding the outcomes of ACS in Africa. This study aims to assess the outcomes of ACS patients admitted to a resource-limited district hospital in Cape Town, South Africa. Methods: We conducted a retrospective observational study of patients admitted with ACS to the Department of Medicine at Victoria Hospital, Cape Town, from the 1 st September 2020 to 30 November 2020. Results: Eighty eight patients with a diagnosis of ACS was admitted, of who 52 had NSTEMI/UAP and 36 patients had STEMI. The median age was 60 years, with a male predominance of 61.36%. The major risk factors for CAD were hypertension and smoking. The overall 1-month, 6-month, and 12-month mortality rates for our cohort were 4%, 17%, and 19%, respectively. Patients that received coronary intervention (thrombolytics/PCI/CABG) had better outcomes than in those who were managed conservatively. Conclusion: This study describes the experience of ACS management in a resource-limited public hospital in Cape Town, South Africa. Our patients had multiple cardiovascular risk factors with a higher mortality than published data. The lack of receiving coronary intervention was associated with worse outcomes.
Open Access
Patterns of mortality in children presenting to a tertiary paediatric emergency unit in Sub-Saharan Africa: a cross sectional study
(2020) Josephs, Tracey; Buys, Heloise; Masu, Adelaide; Muloiwa, Rudzani
Background Pneumonia, diarrhoea and perinatal factors are the foremost killers of South African children as in other low- and middle-income countries. Poverty, poor access to care and pre-hospital care are reported major pre-hospital factors and lack of triage, poor skills, delays, poor adherence to treatment protocols and inadequate emergency care determining mortality have been reported to increase in-hospital mortality. Objectives To describe the clinical presentation and management of children admitted via the medical emergency unit (MEU) of the Red Cross War Memorial Children's Hospital (RCWMCH) who subsequently died. Methods We did a retrospective study undertaking a cross-sectional review of children who died following admission via RCWMCH MEU in 2008. Demographic information, clinical data, time factors and mortality data were reviewed and summarised by descriptive and inferential statistics. The unit utilised the WHO Emergency Triage Assessment and Treatment (ETAT) triage tool, categorising children into Red (emergency), orange (priority) and Green (non-urgent). Patient management was assessed by means of ETAT and the Integrated Management of Childhood Illness (IMCI) tools, which is used to identify severity of illness and strategize treatment plans accordingly. Results A total of 135 children met the inclusion criteria. The crude mortality rate was of 6.25 per 1000 admissions. Of the 135 children who died, 119 (88%) were under five years of age, 33(24%) were HIV-infected, of whom (88%) were under 5 years old. In 67 (50%), a chronic medical condition could be identified while 67 (50 %) were moderately or severely malnourished. There were 29 (22%) deaths within 24 hours of arrival at the MEU. Fifty-five (41%) presented after hours. Community health centres referred 65 (48%) patients, general practitioners referred 20 (15%) and 38 (28%) were self-referred. Ambulance services provided pre-hospital transport to 69 (51%). The two top presenting illnesses in 88 (65%) of the children were acute respiratory illness and acute gastroenteritis. Prior to referral, oxygen was not provided in 57 (59%) children, 35 (71%) with suspected sepsis did not receive antibiotics and glucose was not checked in 39 (80%) with depressed level of consciousness. The median time to ward transfer was 3.23 (IQR: 2.12-4.92) hours. Twelve deaths (9%) occurred in the MEU, 57 (42%) in PICU, 56 (42%) in medical wards and 10 (7%) in specialist wards. The five most common causes of death were acute respiratory infections in 45 (33%), acute gastroenteritis in 27 (20%), septicaemia 22 (16%), meningitis in 13 (10%) and cardiac conditions in 12 (9%) children. Conclusion The top causes of mortality in this hospital cohort in 2008 were pneumonia, acute gastroenteritis, and septicaemia. Using the IMCI and ETAT standard of care, suboptimal management was identified in pre-hospital management, as well as MEU management. Appropriate training and protocol implementation to improve morbidity and mortality should be undertaken.
Open Access
Perinatal mortality : the causes of stillbirth and early neonatal death as occurring in the obstetrical units of the University of Cape Town during the years 1952-1955 inclusive, with a statistical analysis of 1933 perinatal deaths, with special reference to the part played by antenatal supervision and prematurity in the white and non-white patient
(1961) Resnick, Louis
It is only within the last 2 decades that much attention has been focused on foetal mortality, what with the spectacular fall in the maternal morbidity consequent on the vast improvements in antenatal care, the consequences of the discovery of the antibiotics, and the liberal transfusions.
Open Access
Physical activity levels, perceived barriers, and facilitators among office-based workers in Grootfontein, Namibia
(2024) Nyazika, Blessing; Maart, Soraya; Gradidge, Philippe
Introduction Physical activity is known to reduce the risk of non-communicable diseases (NCDs), mortality, and healthcare costs. However, physical inactivity remains high worldwide, increasing the NCD disease burden risk. Office workers have reported high physical inactivity levels during and after working hours. Previous studies have investigated the efficacy of various physical activity interventions to break sedentary behaviour in this population. There is limited data on physical activity among office-based workers in Namibia. Understanding their perceptions of physical activity will help inform interventions and policies to enhance participation. Aim The aim of this study was to assess physical activity levels, barriers, and facilitators among office-based workers in Grootfontein, Namibia. Methods A An explanatory-sequential mixed-methods study was conducted, and 217 office workers were surveyed using the Global Physical Activity Questionnaire to assess their physical activity levels. The questionnaire included sections on demographic details, work, travel, leisure-based physical activity, and daily sitting time. Semi structured interviews were carried out with 26 participants from the surveyed sample to understand their barriers and facilitators of physical activity. Results The mean age of the participants was 38 years. Female participants made up 63% of the surveyed sample. The majority of the participants had over five years of employment experience, and the average daily sitting time was 8 hours. Sixty-four percent of office workers were physically active, and 65% of them were either overweight or obese. The mean BMI of the participants was 28.2 kg/m². Four themes were generated from the thematic analysis of qualitative data. Office workers were aware of what physical activity entails but had varied opinions on the recommended guidelines. Time constraints were cited as the main barrier while they were motivated to participate in physical activity for health and self-care reasons. Office workers suggested the provision of more facilities and support in the workplace and community for increased participation in physical activity. Conclusion The majority of participants in the study were physically active, but they were either overweight or obese. A multi-factorial approach to a healthy lifestyle is necessary in addition to physical activity.
Open Access
Physical activity, change in blood pressure and predictors of mortality in older coloured South Africans: a 24-month prospective study
(1997) Charlton, Karen Elizabeth; Steyn, Krisela
An historical cohort study was undertaken in a representative sample of the older coloured population in Cape Town to (1) investigate the prevalence of hypertension and identify associated risk factors; (2) to validate a questionnaire to assess habitual physical activity patterns; (3) to characterize the current physical activity patterns of subjects who were still alive using the validated instrument at 24-month follow-up; (4) to assess the association between physical activity, blood pressure and body composition, as well as changes in these parameters over 24 months, and (5) to identify predictive risk factors for 24-month mortality in the baseline sample. In 1993, a random sample of 200 free-living subjects aged ~ 65 years of age, resident in urban Cape Town, was drawn using a two-stage cluster design. The survey procedure included a dietary assessment using a quantified food frequency questionnaire method, anthropometric measurements and the drawing of blood for plasma lipid, haematological and biochemical analyses and a 2-hour glucose tolerance test. Blood pressure was determined according to the American Heart Association's recommendations. The prevalence of hypertension (systolic pressure ~ 160 mmHg and/or diastolic ~ 95 mm Hg) was 66, 7 % (95 % Cl: 57,3 - 76, 1 %) for men and 76,5 % (95 % Cl: 68,3 - 84, 7 %) for women. Isolated systolic hypertension ( ~ 160/ < 95 mm Hg) was identified in 33,8 % (95 % Cl: 18,2 - 30,2 %) of the hypertensive subjects. Over a third of hypertensive subjects (37 ,3 %) were previously undiagnosed. Only half of the hypertensives were being treated for the condition, 72 % of whom still had blood pressure levels .::: 160/95 mmHg. No association was found between either systolic or diastolic pressure and plasma lipids, salt intake, or alcohol intake. The prevalence of diabetes found in this study is amongst the highest in elderly populations worldwide and was of a similar order as that found in older South African Indians and Mauritian Creoles. The prevalence of anaemia (13 %) is of the same order of magnitude as that previously reported in this population. Over half (54 %) of the anaemic subjects had haemopoeitic nutrient deficiencies, with folate and vitamin B, 2 being more common than iron deficiency. An analysis of biochemical parameters related to liver function suggests that the high prevalence of hyperferritinamia found in the men (11 %) was related to an excessive alcohol intake. Obesity prevalence was found to be high in the women (47,5 %), according to age-adjusted body mass index (BMI: weight/height2) values, whereas over half of the men were classified as underweight. The results of the baseline study suggest an inadequate diagnosis and poor management of hypertension, diabetes and anaemia in the elderly coloured population. Improved medical care and preventive strategies regarding the early diagnosis, treatment and monitoring of these conditions requires special attention in this age group. There is a paucity of data on energy expenditure, habitual physical activity patterns and the association between activity and health status in free-living older South Africans. To date, no survey instruments used to assess physical activity have been validated in this population. The instrument used to assess physical activity levels in the baseline survey lacked sensitivity to detect participation in activities of low intensity, such as household chores (food preparation, dish-washing, laundry, etc.), time spent sitting or standing during the day, as well as activities of daily living (dressing, bathing, shopping, etc.), care-taking activities and yardwork. The information collected using this crude assessment instrument was limited to a narrow range of responses. In order to develop an instrument to accurately assess physical activity levels of subjects at follow-up, a sub-study was undertaken six months after the baseline survey to assess the construct validity of the questionnaire used in the Yale Physical Activity Survey for Older Persons (YPAS) in estimating energy expenditure associated with physical activity. A convenient sub-sample of 21 subjects from the baseline survey was drawn for a validation sub-study (10 men; 11 women; mean age = 76 (SD = 6) years). Resting metabolic rate (RMR) was measured in fasting subjects and individualized regression equations were calculated to assess the heart rate:oxygen consumption association. Heartrate monitoring was conducted over a 24-hour period and total daily energy expenditure (TDEE) was calculated from resting data and the regression equations. The YPAS was administered by trained interviewers and two composite indices of physical activity were estimated: weekly energy expenditure (PAR, kcal/day) and a Summary Index score (units/month). Both indices were significantly associated with total daily energy expenditure (r = 0,82, p < 0,0005 and r = 0,68, p < 0,01, respectively) and with the energy expenditure associated with physical activity (PAEE) (r=0,86, p<0,0001 and r=0,56, p<0,05, respectively). YPAS scores were approximately 37 % lower than those of a sample of North Americans of the same age, the population for whom the questionnaire was originally developed. The findings suggest that the Yale Physical Activity Survey provides a valid measure of energy expenditure associated with physical activity for use in a sample of older South Africans. Two years following the baseline survey, subjects were revisited in their homes. The validated YPAS questionnaire was administered to all subjects who were traced, and blood pressure and anthropometrical measurements were repeated by trained standardized fieldworkers. At follow-up, 142 of the subjects (Men (N = 66); Women (N = 76)) were traced and measurements collected. Thirty-two subjects were reported, by relatives living in the same household, to have died during the interim period (Men (N = 22); Women (N = 10)). The mortality rate was 16 % (95 % Cl: 10,9 - 21,2 %). More men than women had died (P < 0,05). The remaining twenty-six subjects had either moved out of the area, were unavailable on three occasions, or refused to participate in the follow-up study and were therefore classified as being lost to follow-up. Reported levels of habitual energy expenditure associated with physical activity were about two-thirds lower than that reported in a sample of North Americans of the same age (2 583 (3 027) kcal/week vs 7 613 (4 506) kcal/week, respectively). Both systolic and diastolic BP decreased over time, by about 8 mm Hg. BMI and waist:hip ratio also decreased over time in both men and women. An inverse association between age and total weekly energy expenditure (TWEE) (r =-0,31; P< 0,001) was found, and a positive association between BMI and TWEE (r =0,29; P< 0,005) was found in both men and women. The lack of an association between physical activity and either systolic or diastolic pressure at follow-up is inconsistent with findings from other studies. This may be explained by a number of reasons: ( 1) homogeneity of physical activity levels, (2) activity levels were not of sufficient intensity to have a physiological effect on blood pressure levels, (3) the measures of either activity or blood pressure lacked validity, or (4) the association was confounded by unmeasured variables. Potential sources of bias in the study may include a healthy survivor selection bias at baseline; observer bias which may have influenced the comparability of the repeat blood pressure measurements taken at baseline and follow-up (the measurements were not repeated by the same observer); and diurnal variation and intra-individual variability in blood pressure measurements which questions the reliability of an average measurement taken at one occasion only, at each visit. The use of antihypertensive medications or other medications which may affect blood pressure measurements, together with the presence of other conditions which may influence blood pressure (co-morbidity), are potential sources of confounding. Further, the duration of hypertension was not considered. It is possible that subjects with the highest blood pressure levels may have decreased their activity levels due to ill health. Conversely, known hypertensive subjects who were receiving treatment may have increased activity levels as a result of patient education regarding lifestyle modification. This is, however, unlikely since control of blood pressure in known hypertensives at baseline was poor. Regarding risk factors for mortality during the 24-month follow-up period, in men, systolic BP at baseline tended to be lower in those subjects who had died at follow-up compared to those still alive (difference approaching significance; P = 0 ,063), however in women no such trend was seen. In men, a trend for a greater proportion of subjects in the lowest BMI tertile at baseline to have died was seen (difference approaching significance; P=0,069), whereas in women, a greater proportion of subjects in the upper waist:hip ratio tertile had died at follow-up (p<0,05). Variables, collected at baseline, which were entered into forward stepwise logistic regression models to investigate the predictive factors for mortality at 24 months included: (i) continuous variables: age, systolic BP, diastolic BP, self-perceived health score, BMI, serum albumin, serum ferritin, fasting plasma glucose, haemoglobin, triglycerides, total cholesterol, HDL-C, LDL-C; and (ii) categorical variables: sex, presence of diabetes, tertiles of waist:hip ratio. The outcome (dependent) variable was mortality status at follow-up (dead or alive/lost-to-follow-up). Neither age, blood pressure (systolic or diastolic), nor BMI at baseline differed between men and women who were traced and those lost to follow-up, therefore the two groups were combined for the purpose of the regression analyses. For the total sample, low serum albumin, being male, having diabetes and a raised serum ferritin concentration were found to be independent risk factors for mortality during the 24month follow-up. When stratified according to sex, and including age and smoking in the models as possible confounders, in men higher serum albumin levels were associated with a reduced risk of mortality (OR = 0,85 (P< 0,05), whereas serum ferritin was positively associated with increased risk of death. For every 100 µg increase in ferritin, risk of death increased by 15 % (OR = 1, 15; 95 % Cl = 1,01 - 1,32). In women, being diabetic (OR = 4,27; P=0,056) and having a waist:hip ratio in the upper tertile (OR = 3,26; P=0,058) appeared to be associated with mortality. Although a high prevalence of hypertension was identified in the sample at baseline, no association was found between mortality after 24 months of follow-up and either systolic or diastolic blood pressure. Potential sources of bias which may have influenced the association between the variables of interest and mortality at 24-month follow-up may be an assumption that the subjects lost-to-follow-up were still alive and a lack of validation of mortality status through death certification records. The presence of underlying conditions associated with weight loss which may not have manifested at the time of the survey would further confound the analyses. Similarly, a reliable measure of functional disability is required in such studies of older adults; in this regard, the use of self-reported health status as a proxy for functional status in the present study may not have been an indicator of sufficient sensitivity. Nevertheless, this three-part study has yielded some important information which may be incorporated into the planning and provision of health services, particularly health promotion activities, for the elderly. The findings suggest a need for health education on behaviour modification in this age group, particularly with regard to the high prevalence of hypertension, diabetes and obesity (in women) identified in the baseline survey. The findings of the validation sub-study have shown that the adapted Yale Physical Activity Survey provides a valid measure of energy expenditure associated with physical activity for use in samples of older coloured South Africans and may be used to assess activity levels either in screening those subjects who are most in need of intervention (i.e. physical activity programmes) or for epidemiological research. The identification of predictors for mortality allows the screening of subjects at high risk, for whom medical intervention may be appropriate. In men, low serum albumin, raised serum ferritin, and a low BMI appear to be the best predictive factors of mortality during a 24-month follow-up period, whereas in women, the presence of diabetes and a high waist:hip ratio appear to be associated with increased risk of death. Simple anthropometric assessments, together with serum albumin determinations, may be useful to screen the general health risk of older adults at primary care level and may provide a tool to identify those to whom medical or social welfare intervention should be targeted. The findings suggest that strategies for the early detection and effective management of diabetes, particularly in women, may reduce premature mortality. Finally, the high prevalence of raised serum ferritin concentrations in men in this population and an apparent association with increased mortality risk warrant further investigation into the underlying causes of hyperferritinaemia.
Open Access
Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa
(BioMed Central Ltd, 2012) Nglazi, Mweete; Kranzer, Katharina; Holele, Pearl; Kaplan, Richard; Mark, Daniella; Jaspan, Heather; Lawn, Stephen; Wood, Robin; Bekker, Linda-Gail
BACKGROUND: Very few data are available on treatment outcomes of adolescents living with HIV infection (whether perinatally acquired or sexually acquired) in sub-Saharan Africa. The present study therefore compared the treatment outcomes in adolescents with those of young adults at a public sector community-based ART programme in Cape Town, South Africa. METHODS: Treatment outcomes of adolescents (9-19 years) were compared with those of young adults (20-28 years), enrolled in a prospective cohort between September 2002 and June 2009. Kaplan-Meier estimates and Cox proportional hazard models were used to assess outcomes and determine associations with age, while adjusting for potential confounders. The treatment outcomes were mortality, loss to follow-up (LTFU), immunological response, virological suppression and virological failure. RESULTS: 883 patients, including 65 adolescents (47 perinatally infected and 17 sexually infected) and 818 young adults, received ART. There was no difference in median baseline CD4 cell count between adolescents and young adults (133.5 vs 116 cells/muL; p = 0.31). Overall mortality rates in adolescents and young adults were 1.2 (0.3-4.8) and 3.1 (2.4-3.9) deaths per 100 person-years, respectively. Adolescents had lower rates of virological suppression (< 400 copies/mL) at 48 weeks (27.3% vs 63.1%; p < 0.001). Despite this, however, the median change in CD4 count from baseline at 48 weeks of ART was significantly greater for adolescents than young adults (373 vs 187 cells/muL; p = 0.0001). Treatment failure rates were 8.2 (4.6-14.4) and 5.0 (4.1-6.1) per 100 person-years in the two groups. In multivariate analyses, there was no significant difference in LTFU and mortality between age groups but increased risk in virological failure [AHR 2.06 (95% CI 1.11-3.81; p = 0.002)] in adolescents. CONCLUSIONS: Despite lower virological suppression rates and higher rates of virological failure, immunological responses were nevertheless greater in adolescents than young adults whereas rates of mortality and LTFU were similar. Further studies to determine the reasons for poorer virological outcomes are needed.
Open Access
Twelve-year mortality in adults initiating antiretroviral therapy in South Africa
(2017) Egger, Matthias; Davies, Mary-Ann; Boulle, Andrew
Introduction: South Africa has the largest number of individuals living with HIV and the largest antiretroviral therapy (ART) programme worldwide. In September 2016, ART eligibility was extended to all 7.1 million HIV-positive South Africans. To ensure that further expansion of services does not compromise quality of care, long-term outcomes must be monitored. Few studies have reported long-term mortality in resource-constrained settings, where mortality ascertainment is challenging. Combining site records with data linked to the national vital registration system, sites in the International Epidemiology Databases to Evaluate AIDS Southern Africa collaboration can identify >95% of deaths in patients with civil identification numbers (IDs). This study used linked data to explore long-term mortality and viral suppression among adults starting ART in South Africa.
Open Access
Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa?
(2020) Wege, Martha Helena; Morrow, Brenda; Rossouw, Beyra; Argent, Andrew
Objectives: To describe the characteristics of children who died and their modes of dying in a South African Paediatric Intensive Care Unit (PICU). Design: Retrospective review of data extracted from the Child Healthcare Problem Identification Programme (Child PIP)and the PICU summary system (admission and death records) on children of any age who died in the PICU between 01 January 2013 and 31 December 2017. Setting: Single-centre tertiary institution. Patients: All children who died during PICU admission were included. Measurements and Main Results: Four-hundred and fifty-one (54% male; median (IQR) age 7 (1-30) months) patients died in PICU on median (IQR) 3 (1-7) days after PICU admission; 103 (22.8%) had a cardiac arrest prior to PICU admission. Mode of death in 23.7% (n=107) was withdrawal of life sustaining therapies; 36.1% (n=163) died after limitation of life sustaining therapies; 22.0% (n=99) died after failed resuscitation and 17.3% (n=78) were diagnosed brain dead. Ultimately, 270 (60%) children died after the decision to limit or withdraw life sustaining therapies. There was no difference in the number of deaths during office and after-hours periods (45.5% vs. 54%; p = 0.07). Severe sepsis (21.9%) was the most common condition associated with death, followed by cardiac disease (18.6%).Ninety-four (20.8%) patients were readmitted to the PICU within the same year; 278 (61.6%) had complex chronic disorders. During the last phase of life, 75.0% (n=342) were on inotropes, 95.9% (n=428) were ventilated, 12.0% (n=45) received inhaled nitric oxide and 10.8% (n=46) renal replacement therapy. Only 1.5% (n=7) of children became organ donors and postmortems were done in 47.2% (n=213) of the patients. Conclusions: Most PICU deaths occurred after a decision to limit or withdraw life-sustaining therapy. Severe sepsis was the most common condition associated with death. Referral for organ donation was extremely rare.

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