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Kufa T, Jassat W, Cohen C, Tempia S, Masha M, Wolter N, Walaza S, von Gottburg A, Govender NP, Hunt G, Shonhiwa AM, Ebonwu J, Ntshoe G, Maruma W, Bapela P, Ndhlovu N, Mathema H, Modise M, Shuping L, Manana PN, Moore D, Dangor Z, Verwey C, Madhi SA, Saloojee H, Zar HJ, Blumberg L. Epidemiology of SARS-CoV-2 infection and SARS-CoV-2 positive hospital admissions among children in South Africa. Influenza Other Respir Viruses 2021; 16:34-47. [PMID: 34796674 PMCID: PMC9664941 DOI: 10.1111/irv.12916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction We describe epidemiology and outcomes of confirmed SARS‐CoV‐2 infection and positive admissions among children <18 years in South Africa, an upper‐middle income setting with high inequality. Methods Laboratory and hospital COVID‐19 surveillance data, 28 January ‐ 19 September 2020 was used. Testing rates were calculated as number of tested for SARS‐CoV‐2 divided by population at risk; test positivity rates were calculated as positive tests divided by total number of tests. In‐hospital case fatality ratio (CFR) was calculated based on hospitalized positive admissions with outcome data who died in‐hospital and whose death was judged SARS‐CoV‐2 related by attending physician. Findings 315 570 children aged <18 years were tested for SARS‐CoV‐2; representing 8.9% of all 3 548 738 tests and 1.6% of all children in the country. Of children tested, 46 137 (14.6%) were positive. Children made up 2.9% (n = 2007) of all SARS‐CoV‐2 positive admissions to sentinel hospitals. Among children, 47 died (2.6% case‐fatality). In‐hospital deaths were associated with male sex [adjusted odds ratio (aOR) 2.18 (95% confidence intervals [CI] 1.08–4.40)] vs female; age <1 year [aOR 4.11 (95% CI 1.08–15.54)], age 10–14 years [aOR 4.20 (95% CI1.07–16.44)], age 15–17 years [aOR 4.86 (95% 1.28–18.51)] vs age 1–4 years; admission to a public hospital [aOR 5.07(95% 2.01–12.76)] vs private hospital and ≥1 underlying conditions [aOR 12.09 (95% CI 4.19–34.89)] vs none. Conclusions Children with underlying conditions were at greater risk of severe SARS‐CoV‐2 outcomes. Children > 10 years, those in certain provinces and those with underlying conditions should be considered for increased testing and vaccination.
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Affiliation(s)
- Tendesayi Kufa
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Waasila Jassat
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Cheryl Cohen
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Stefano Tempia
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Influenza Division, National Center for Immunization and Respiratory DiseasesUS Centers for Disease Control and PreventionAtlantaGeorgiaUSA
- MassGenicsDuluthGeorgiaUSA
| | - Maureen Masha
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Nicole Wolter
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of PathologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sibongile Walaza
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Anne von Gottburg
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of PathologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Nelesh P. Govender
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of PathologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Gillian Hunt
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of PathologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Joy Ebonwu
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Genevie Ntshoe
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of Health Systems and Public Health, Faculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
| | - Wellington Maruma
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Poncho Bapela
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Nomathamsanqa Ndhlovu
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Hlengani Mathema
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Motshabi Modise
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Liliwe Shuping
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Pinky N. Manana
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of PathologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - David Moore
- Department of Pediatrics and Child HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Ziyaad Dangor
- Department of Pediatrics and Child HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Charl Verwey
- Department of Pediatrics and Child HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Shabir A. Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), Faculty of Health Science JohannesburgUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science JohannesburgUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Haroon Saloojee
- Department of Pediatrics and Child HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Heather J. Zar
- Dept of Paediatrics and Child Health, Red Cross Children's Hospital, and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Lucille Blumberg
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
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McCarthy KM, Tempia S, Kufa T, Kleynhans J, Wolter N, Jassat W, Ebonwu J, von Gottberg A, Erasmus L, Muchengeti M, Walaza S, Ntshoe G, Shonhiwa AM, Manana PN, Pillay Y, Moonasar D, Muthivhi T, Mngemane S, Mlisana K, Chetty K, Blumberg LH, Cohen C, Govender NP. The importation and establishment of community transmission of SARS-CoV-2 during the first eight weeks of the South African COVID-19 epidemic. EClinicalMedicine 2021; 39:101072. [PMID: 34405139 PMCID: PMC8360332 DOI: 10.1016/j.eclinm.2021.101072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We describe the epidemiology of COVID-19 in South Africa following importation and during implementation of stringent lockdown measures. METHODS Using national surveillance data including demographics, laboratory test data, clinical presentation, risk exposures (travel history, contacts and occupation) and outcomes of persons undergoing COVID-19 testing or hospitalised with COVID-19 at sentinel surveillance sites, we generated and interpreted descriptive statistics, epidemic curves, and initial reproductive numbers (Rt). FINDINGS From 4 March to 30 April 2020, 271,670 SARS-CoV-2 PCR tests were performed (462 tests/100,000 persons). Of these, 7,892 (2.9%) persons tested positive (median age 37 years (interquartile range 28-49 years), 4,568 (58%) male, cumulative incidence of 13.4 cases/100,000 persons). Hospitalization records were found for 1,271 patients (692 females (54%)) of whom 186 (14.6%) died. Amongst 2,819 cases with data, 489/2819 (17.3%) travelled internationally within 14 days prior to diagnosis, mostly during March 2020 (466 (95%)). Cases diagnosed in April compared with March were younger (median age, 37 vs. 40 years), less likely female (38% vs. 53%) and resident in a more populous province (98% vs. 91%). The national initial Rt was 2.08 (95% confidence interval (CI): 1.71-2.51). INTERPRETATION The first eight weeks following COVID-19 importation were characterised by early predominance of imported cases and relatively low mortality and transmission rates. Despite stringent lockdown measures, the second month following importation was characterised by community transmission and increasing disease burden in more populous provinces.
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Manana PN, Jewett S, Zikhali J, Dlamini D, Mabaso N, Mlambo Z, Ngobese R, Munhenga G. "Maskandi experience": exploring the use of a cultural song for community engagement in preparation for a pilot Sterile Insect Technique release programme for malaria vector control in KwaZulu-Natal Province, South Africa 2019. Malar J 2021; 20:204. [PMID: 33910575 PMCID: PMC8082840 DOI: 10.1186/s12936-021-03736-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/16/2021] [Indexed: 11/12/2022] Open
Abstract
Background An assessment of the Sterile Insect Technique (SIT) as a complementary malaria vector control tool, is at an advanced stage in South Africa. The technique involves the release of laboratory-reared sterilized male mosquitoes of the major malaria vector Anopheles arabiensis, raising social, ethical and regulatory concerns. Therefore, its implementation largely depends on community participation and acceptance. Against this background, it is critical that robust and effective community strategies are developed. This study describes the development of a cultural song to engage the community and increase awareness on SIT and malaria control in KwaZulu-Natal, South Africa. Methods An exploratory concurrent mixed-methods study was conducted to get opinions about the effectiveness of a cultural song developed to engage communities and increase acceptability of the SIT technology. Two self-administered surveys (expert and community) were conducted. Additionally, more in depth opinions of the song and its effectiveness in conveying the intended information were investigated through three community dialogue sessions with community members in the study area. Results A total of 40 experts and 54 community members participated in the survey. Four themes were identified in relation to the appropriateness and effectiveness of the song, with a fifth theme focused on recommendations for adaptations. Overall, the song was well received with the audience finding it entertaining and informative. Responses to unstructured questions posed after the song showed an increase in the knowledge on malaria transmission and SIT technology. In particular, the explanation that male mosquitoes do not bite allayed anxiety and fears about the SIT technology. Conclusion The song was deemed both culturally appropriate and informative in engaging community members about the SIT technology. It proved useful in promoting health messages and conveying SIT technology as a complementary malaria vector control tool. With minor adaptations, the song has potential as an area-wide community engagement tool in areas targeted for sterile male releases. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03736-9.
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Affiliation(s)
- Pinky N Manana
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases (NICD), Division of National Health Laboratory Services (NHLS), Johannesburg, South Africa. .,Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Sara Jewett
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jabulani Zikhali
- Clinton Health Access Initiative, Malaria, KwaZulu-Natal, South Africa.,Department of Health, Environmental Health, Malaria and Communicable Disease Control, KwaZulu-Natal, South Africa
| | - Dumsani Dlamini
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nondumiso Mabaso
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zothile Mlambo
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Roxanne Ngobese
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Givemore Munhenga
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases (NICD), Division of National Health Laboratory Services (NHLS), Johannesburg, South Africa.,Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Manana PN, Kuonza L, Musekiwa A, Koornhof H, Nanoo A, Ismail N. Feasibility of using postal and web-based surveys to estimate the prevalence of tuberculosis among health care workers in South Africa. PLoS One 2018; 13:e0197022. [PMID: 29746507 PMCID: PMC5945004 DOI: 10.1371/journal.pone.0197022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 04/25/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Health Care Workers (HCWs) are among the highest risk groups for contracting tuberculosis (TB), which is ranked the third most common occupational health disease in South Africa. Little is known about the true extent of the burden of TB among South African HCWs and current surveillance approaches are inadequate. The study aimed to determine the feasibility of using postal and web-based surveys accessed through registries of registered professionals to estimate the prevalence of TB among HCWs in South Africa. MATERIALS AND METHODS We conducted a cross sectional survey on a sample of professional nurses and doctors (general practitioners) registered on the Medpages database platform; a subscription based registry for practising health care professionals. The survey included professionals who were actively involved in the clinical management of patients, either in public or private health care facilities. The paper based survey, including pre-paid return envelopes, was distributed via the post office and web-based surveys were distributed via e-mail through a hyperlink. Descriptive statistics were used to summarize the data and the Chi-square test to determine associations between categorical variables. Active TB was defined as any history of TB. RESULTS Out of a total of 3,400 health care professionals contacted, 596 (18%) responses were received: 401 (67%) web-based and 195 (33%) postal. A significantly higher percentage of complete forms were from postal compared to web-based (97% [189/195] versus 87% [348/401], p<0.001). Younger (<60 years) professionals were more likely to use the web-based compared to postal (87% [236/270] versus 71% [134/189], p<0.001). Overall, the prevalence of active TB infection was 8.7%, (95%CI: 6.3%-11.7%) and there was no difference observed between doctors and nurses (10.8% [18/167] versus 7.5% [22/292], p = 0.236). CONCLUSION This novel approach demonstrated the feasibility of using an existing registry of professionals to conduct surveys to estimate the prevalence of TB. Our findings showed a high TB prevalence; however the estimate might have been biased by the low response rate. Further research to optimise our approach could lead to a viable option in improving surveillance among health care professionals.
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Affiliation(s)
- Pinky N. Manana
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- * E-mail:
| | - Lazarus Kuonza
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Alfred Musekiwa
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Hendrik Koornhof
- Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ananta Nanoo
- Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Nazir Ismail
- Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa
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Manana PN, Kuonza L, Musekiwa A, Mpangane HD, Koekemoer LL. Knowledge, attitudes and practices on malaria transmission in Mamfene, KwaZulu-Natal Province, South Africa 2015. BMC Public Health 2017; 18:41. [PMID: 28728572 PMCID: PMC5520288 DOI: 10.1186/s12889-017-4583-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 07/11/2017] [Indexed: 11/12/2022] Open
Abstract
Background In South Africa malaria is endemic in Mpumalanga, Limpopo and the north–eastern areas of KwaZulu-Natal provinces. South Africa has set targets to eliminate malaria by 2018 and research into complementary vector control tools such as the Sterile Insect Technique (SIT) is ongoing. It is important to understand community perceptions regarding malaria transmission and control interventions to enable development of community awareness campaign messages appropriate to the needs of the community. We aimed to assess knowledge, attitudes, and practices regarding malaria transmission to inform a public awareness campaign for SIT in Jozini Local Municipality, Mamfene in KwaZulu-Natal province. Methods We conducted a cross-sectional survey in three communities in Mamfene, KwaZulu-Natal during 2015. A structured field piloted questionnaire was administered to 400 randomly selected heads of households. Descriptive statistics were used to summarize data. Results Of the 400 participants interviewed, 99% had heard about malaria and correctly associated it with mosquito bites. The sources of malaria information were the local health facility (53%), radio (16%) and community meetings (7%). Approximately 63% of the participants were able to identify three or four symptoms of malaria. The majority (76%) were confident that indoor residual spraying (IRS) kills mosquitoes and prevents infection. Bed nets were used by 2% of the participants. SIT knowledge was poor (9%), however 63% of the participants were supportive of mosquito releases for research purposes. The remaining 37% raised concerns and fears, including fear of the unknown and lack of information on the SIT. Conclusion Appropriate knowledge, positive attitude and acceptable treatment-seeking behaviour for malaria were demonstrated by members of the community. Community involvement will be crucial in achieving success of the SIT and future studies should further investigate concerns raised by the community. The existing communication channels used by the malaria control program can be used; however additional channels should be investigated. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4583-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pinky N Manana
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa. .,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Johannesburg, South Africa.
| | - Lazarus Kuonza
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Johannesburg, South Africa
| | - Alfred Musekiwa
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa.,Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Hluphi D Mpangane
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Lizette L Koekemoer
- Wits Research Institute of Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Opportunistic, Tropical & Hospital Infections, National Institute for Communicable Diseases, Johannesburg, South Africa
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