South African Medical Journal - February 2023 Vol 113 No 2

Introduction

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.