A cross-sectional study to ascertain the prognostic factors and symptoms associated with cryptococcal meningitis cases treated at the East London Hospital complex
- Authors: Okorie, Ikechukwu Obinna
- Date: 2012
- Subjects: Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11782 , http://hdl.handle.net/10353/d1016194 , Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Description: The focus of this study is to identify the potential prognostic factors and symptoms that are associated with Cryptococcal Meningitis and to establish a statistical model for the prediction of outcomes (survival and mortality) among in-hospital patients. Materials and Method: The hospital admission books in the medical wards and pharmacy of the East London Hospital Complex were searched to identify the folder numbers of all the patients that were admitted, diagnosed and or treated for Cryptococcal Meningitis at the hospital between the 1st of January 2009 and the 31st of August 2012. 237 folders out of 519 folders reviewed had confirmed cases of Cryptococcal Meningitis. Data on patients’ demographics, In-hospital care, and Concurrent infection/health condition were collected and analysed in a cross-sectional study, using the univariable and multiple logistic regression. Analysis of data was done with SAS version 9.1.3 and NCSS version 2007 software. Results: In a multivariable logistic analysis of variables found to be significantly associated with Cryptococcal Meningitis in a univariable logistic regression, Being Conscious (i.e. a Glasgow Coma score of 15) (OR= 5.34,CI=2.85-9.99 p =<0.000); Having no history of TB infection (OR=28.91, CI= 3.68-226.89, p = <0.001); No Fits (OR = 2.59, CI= 1.18-5.68 p = 0.017); Being a non-smoker (OR =2.22,CI=1.13-4.34 p = 0.020); and Adhering to treatment instruction and guidelines (OR = 2.38, 1.15-4.89, p = 0.019) were the variables found to be significantly associated with the survival of a Cryptococcal Meningitis patient. The uninterrupted use of Amphotericin B (OR=3.04, CI=1.06-8.72, P=0.038) as a first line regimen was also found to be significantly associated with survival.On the other hand, being unconscious (i.e. Glasgow Coma score <15) (OR =5.34, CI=2.85-9.99, p = < 0.000), Currently having a TB infection (OR = 9.20, CI=2.77-30.57, p = < 0.000), Not adhering to treatment guidelines (OR=2.38, CI=1.15-4.89, p=0.019 ); Being a smoker (OR = 2.22, CI=1.13-4.34, p = 0.020) and having Fits (OR=2.59 CI=1.18-5.68 p=0.017 ) were found to be significantly associated with mortality. Headache (p= 0.505) was found not to be a significant predictor of survival contrary to the findings in many publications on Cryptococcal Meningitis. Owing to time constraint, testing data was not collected to validate the prognostic models. However, model diagnostics was done and the relevant statistics confirmed the goodness of fit and the predictive ability of the model Conclusion: It has been established in this study that certain baseline variables can be helpful in the prognosis of Cryptococcal Meningitis infection. It is therefore believed that these variables will help in improving the prognosis of the infection especially at the East London Hospital Complex. Though the statistical models will work well in predicting the outcome of Cryptococcal Meningitis infection for patients admitted at the East London Hospital Complex, adequate precaution must be exercised while attempting to apply it in other geographical areas.
- Full Text:
- Authors: Okorie, Ikechukwu Obinna
- Date: 2012
- Subjects: Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11782 , http://hdl.handle.net/10353/d1016194 , Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Description: The focus of this study is to identify the potential prognostic factors and symptoms that are associated with Cryptococcal Meningitis and to establish a statistical model for the prediction of outcomes (survival and mortality) among in-hospital patients. Materials and Method: The hospital admission books in the medical wards and pharmacy of the East London Hospital Complex were searched to identify the folder numbers of all the patients that were admitted, diagnosed and or treated for Cryptococcal Meningitis at the hospital between the 1st of January 2009 and the 31st of August 2012. 237 folders out of 519 folders reviewed had confirmed cases of Cryptococcal Meningitis. Data on patients’ demographics, In-hospital care, and Concurrent infection/health condition were collected and analysed in a cross-sectional study, using the univariable and multiple logistic regression. Analysis of data was done with SAS version 9.1.3 and NCSS version 2007 software. Results: In a multivariable logistic analysis of variables found to be significantly associated with Cryptococcal Meningitis in a univariable logistic regression, Being Conscious (i.e. a Glasgow Coma score of 15) (OR= 5.34,CI=2.85-9.99 p =<0.000); Having no history of TB infection (OR=28.91, CI= 3.68-226.89, p = <0.001); No Fits (OR = 2.59, CI= 1.18-5.68 p = 0.017); Being a non-smoker (OR =2.22,CI=1.13-4.34 p = 0.020); and Adhering to treatment instruction and guidelines (OR = 2.38, 1.15-4.89, p = 0.019) were the variables found to be significantly associated with the survival of a Cryptococcal Meningitis patient. The uninterrupted use of Amphotericin B (OR=3.04, CI=1.06-8.72, P=0.038) as a first line regimen was also found to be significantly associated with survival.On the other hand, being unconscious (i.e. Glasgow Coma score <15) (OR =5.34, CI=2.85-9.99, p = < 0.000), Currently having a TB infection (OR = 9.20, CI=2.77-30.57, p = < 0.000), Not adhering to treatment guidelines (OR=2.38, CI=1.15-4.89, p=0.019 ); Being a smoker (OR = 2.22, CI=1.13-4.34, p = 0.020) and having Fits (OR=2.59 CI=1.18-5.68 p=0.017 ) were found to be significantly associated with mortality. Headache (p= 0.505) was found not to be a significant predictor of survival contrary to the findings in many publications on Cryptococcal Meningitis. Owing to time constraint, testing data was not collected to validate the prognostic models. However, model diagnostics was done and the relevant statistics confirmed the goodness of fit and the predictive ability of the model Conclusion: It has been established in this study that certain baseline variables can be helpful in the prognosis of Cryptococcal Meningitis infection. It is therefore believed that these variables will help in improving the prognosis of the infection especially at the East London Hospital Complex. Though the statistical models will work well in predicting the outcome of Cryptococcal Meningitis infection for patients admitted at the East London Hospital Complex, adequate precaution must be exercised while attempting to apply it in other geographical areas.
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Comparison of the prevalence of HIV infection in circumcised and uncircumcised men from Salima District in Malawi
- Authors: Kankuwe, Hector Master
- Date: 2012
- Subjects: HIV infections -- Malawi , Initiation rites -- Malawi
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11778 , http://hdl.handle.net/10353/462 , HIV infections -- Malawi , Initiation rites -- Malawi
- Description: The overall objective of the study was to investigate the relationship between male circumcision status and HIV infection in men from Salima district in Malawi. A cross-sectional survey-based study of men aged 15 years or more was conducted at three sites in Salima district, each of which targeted 90 participants, half of whom were circumcised and the other half uncircumcised. These participants had already decided on their own to visit HIV Testing and Counseling centres at these sites to know their HIV serostatus. Consenting men were drawn into the study using quota sampling, interviewed through a structured questionnaire in local language and tested for HIV during January and March 2011. Measures of association were performed using analysis of contingency tables and Pearson’s chi-square tests or Fisher’s exact tests for comparison of proportions in STATA version 11.0 and PASW Statistics 18.0 software. Unadjusted odds ratios were used to approximate the direction and strength of association. Further, a multivariable logistic regression model was fit to determine which other variables were significantly associated with HIV infection. The study was approved by University of Fort Hare Interim Research Ethics Committee and National Health Sciences Research Committee in Malawi. The overall prevalence of HIV infection was 11.5 percent. However, it was less than half in circumcised males (7.4 percent) compared with uncircumcised counterparts (15.6 vi percent). While Fisher’s exact test revealed a borderline statistically significant association between male circumcision status and HIV infection (p 0.055), Pearson’s chi-square test showed a stronger significant association between the two variables ( p 0.036). The strength of the association was manifested by the odds of HIV infection being roughly 0.43 times lower for circumcised males than their uncircumcised counterparts with a 95 percent confidence interval of (0.20 0.96). Although the association was maintained after controlling for some variables, it lost statistical significance when adjusted for other variables. A multivariable logistic regression revealed that three other variables had significant associations with HIV infection and these were: falling in the age group of 25 years or more (OR 4.69; p 0.020), having had sex with an HIV positive partner (OR 12.15; p 0.000) and having contracted a sexually transmitted infection (OR 3.25; p 0.032). Male circumcision status is significantly related to HIV infection. Although the study involved a small sample size and undertaken in one district in Malawi, the finding is consistent with existing clinic-based findings in literature that indicate a lower risk of HIV infection in circumcised males than in uncircumcised males. Consequently, male circumcision could be considered if it can prove to be a public health intervention in the Malawi context aimed at reducing the risk of uncircumcised males becoming infected by HIV.
- Full Text:
- Authors: Kankuwe, Hector Master
- Date: 2012
- Subjects: HIV infections -- Malawi , Initiation rites -- Malawi
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11778 , http://hdl.handle.net/10353/462 , HIV infections -- Malawi , Initiation rites -- Malawi
- Description: The overall objective of the study was to investigate the relationship between male circumcision status and HIV infection in men from Salima district in Malawi. A cross-sectional survey-based study of men aged 15 years or more was conducted at three sites in Salima district, each of which targeted 90 participants, half of whom were circumcised and the other half uncircumcised. These participants had already decided on their own to visit HIV Testing and Counseling centres at these sites to know their HIV serostatus. Consenting men were drawn into the study using quota sampling, interviewed through a structured questionnaire in local language and tested for HIV during January and March 2011. Measures of association were performed using analysis of contingency tables and Pearson’s chi-square tests or Fisher’s exact tests for comparison of proportions in STATA version 11.0 and PASW Statistics 18.0 software. Unadjusted odds ratios were used to approximate the direction and strength of association. Further, a multivariable logistic regression model was fit to determine which other variables were significantly associated with HIV infection. The study was approved by University of Fort Hare Interim Research Ethics Committee and National Health Sciences Research Committee in Malawi. The overall prevalence of HIV infection was 11.5 percent. However, it was less than half in circumcised males (7.4 percent) compared with uncircumcised counterparts (15.6 vi percent). While Fisher’s exact test revealed a borderline statistically significant association between male circumcision status and HIV infection (p 0.055), Pearson’s chi-square test showed a stronger significant association between the two variables ( p 0.036). The strength of the association was manifested by the odds of HIV infection being roughly 0.43 times lower for circumcised males than their uncircumcised counterparts with a 95 percent confidence interval of (0.20 0.96). Although the association was maintained after controlling for some variables, it lost statistical significance when adjusted for other variables. A multivariable logistic regression revealed that three other variables had significant associations with HIV infection and these were: falling in the age group of 25 years or more (OR 4.69; p 0.020), having had sex with an HIV positive partner (OR 12.15; p 0.000) and having contracted a sexually transmitted infection (OR 3.25; p 0.032). Male circumcision status is significantly related to HIV infection. Although the study involved a small sample size and undertaken in one district in Malawi, the finding is consistent with existing clinic-based findings in literature that indicate a lower risk of HIV infection in circumcised males than in uncircumcised males. Consequently, male circumcision could be considered if it can prove to be a public health intervention in the Malawi context aimed at reducing the risk of uncircumcised males becoming infected by HIV.
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Prevalence, seasonal trends and incidences of cattle tuberculosis and brucellosis in the Cacadu municipality, Eastern Cape, South Africa
- Authors: Nombebe, Thobeka
- Date: 2012
- Subjects: Tuberculosis in cattle -- South Africa -- Eastern Cape , Brucellosis in animals -- South Africa -- Eastern Cape , Dairy farms -- South Africa -- Eastern Cape , Mycobacterium tuberculosis -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11783 , http://hdl.handle.net/10353/d1016200 , Tuberculosis in cattle -- South Africa -- Eastern Cape , Brucellosis in animals -- South Africa -- Eastern Cape , Dairy farms -- South Africa -- Eastern Cape , Mycobacterium tuberculosis -- South Africa -- Eastern Cape
- Description: A cross-sectional study was conducted from February 2011 to August 2012 to investigate the status and identify risk factors for Bovine Tuberculosis (BTB) and cattle Brucellosis. A total of 1277 cattle from 6 selected dairy farms were tested. The farms were purposively selected on suspected risk. Samples were analysed using Rose Bengal Test (RBPT) and Complement Fixation Test (CFT) for Brucellosis and Comparative Intradermal Tuberculin Test (CITT) for BTB. The results revealed the overall prevalence of 1.6% for Brucellosis and no BTB was found. Logistic regression analysis revealed that age of cattle, herd size and number of calves a cow has had significant association with Brucellosis with p-values 0.0071, 0.0490 and 0.000 respectively. The role of location (p>0.05), gender (p>0.05) and breed (p>0.05) in the occurrence of the disease was not statistically significant at α=0.05, although higher rates were obtained in females and Jersey breed. Questionnaires were also administered to 47 individuals a total of 12 females and 35 males. Most respondents were not aware about cattle brucellosis and cattle tuberculosis. Consumption of raw or unpasteurized milk still occurs with 74.75% of respondents revealed.
- Full Text:
- Authors: Nombebe, Thobeka
- Date: 2012
- Subjects: Tuberculosis in cattle -- South Africa -- Eastern Cape , Brucellosis in animals -- South Africa -- Eastern Cape , Dairy farms -- South Africa -- Eastern Cape , Mycobacterium tuberculosis -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11783 , http://hdl.handle.net/10353/d1016200 , Tuberculosis in cattle -- South Africa -- Eastern Cape , Brucellosis in animals -- South Africa -- Eastern Cape , Dairy farms -- South Africa -- Eastern Cape , Mycobacterium tuberculosis -- South Africa -- Eastern Cape
- Description: A cross-sectional study was conducted from February 2011 to August 2012 to investigate the status and identify risk factors for Bovine Tuberculosis (BTB) and cattle Brucellosis. A total of 1277 cattle from 6 selected dairy farms were tested. The farms were purposively selected on suspected risk. Samples were analysed using Rose Bengal Test (RBPT) and Complement Fixation Test (CFT) for Brucellosis and Comparative Intradermal Tuberculin Test (CITT) for BTB. The results revealed the overall prevalence of 1.6% for Brucellosis and no BTB was found. Logistic regression analysis revealed that age of cattle, herd size and number of calves a cow has had significant association with Brucellosis with p-values 0.0071, 0.0490 and 0.000 respectively. The role of location (p>0.05), gender (p>0.05) and breed (p>0.05) in the occurrence of the disease was not statistically significant at α=0.05, although higher rates were obtained in females and Jersey breed. Questionnaires were also administered to 47 individuals a total of 12 females and 35 males. Most respondents were not aware about cattle brucellosis and cattle tuberculosis. Consumption of raw or unpasteurized milk still occurs with 74.75% of respondents revealed.
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