Tag: public health

Categories : HospitalsTags :

Charlotte Maxeke Repairs Make Progress, but Doubts Remain

On By ModernMedia
A fire broke out on 16 April 2021 at Charlotte Maxeke Hospital in Johannesburg. Credit: Gauteng Health

By Ufrieda Ho for Spotlight

2023 is the crunch year to complete the restoration of the fire-damaged sections of Charlotte Maxeke Johannesburg Academic Hospital, but one month in, it has not been plain sailing.

There are doubts over timeframes, the quality of workmanship, compliance, and effective project management. Added to this are deepening concerns that theft and suspected sabotage continue and that HR red tape and inefficiencies are standing in the way of getting the right people into 774 vacant posts that need to be filled to meet the high demand for healthcare services.

According to Gauteng Department of Health’s head of communication, Motalatale Modiba, the province is on track to meet its December 2023 deadline to complete repair work. There is a separate deadline for 2026 to complete fire safety compliance throughout the hospital.

Scramble for parking persists

January kicked off with what should have been the reopening of parking bays on the hospital campus. The parking levels were among the worst affected areas in the fire that broke out on 16 April 2021. Delays in getting parking areas reopened have had dire knock-on effects on the efficient running of the hospital. Staff and visitors have had to scramble to find parking on the streets around the hospital. This adds to traffic congestion and jammed-up appointment schedules even as the hospital is trying to play catch-up after healthcare services were disrupted by COVID and the fire. Added to this, there have been reports of theft from motor vehicles as well as muggings and assaults of doctors and nurses having to make their way to and from their cars.

Before the fire, the hospital had 1700 parking bays. Since the fire, only 229 have been accessible on the hospital campus and another 400 in sites around the hospital – it’s a shortfall of about 1000 parking bays.

Modiba told Spotlight at the beginning of February, “The construction of the temporary access ramp to level P3 is 100% complete. The only outstanding thing is the enrolment of the traffic management system to ensure a greater flow of vehicles into the parking, manage different parking zones, and vehicle access. The P3 parking bays will be available for usage soon.”

‘Criminal syndicates’

But DA spokesperson for health in the province, Jack Bloom says after his own site visit in January that continued delays to reopen this section is “gross incompetence that is causing misery as staff and patients hunt for parking every day and some sick people have to walk a long way from where they’ve found parking”.

“It’s not a great start for the year,” says Bloom. He says delays are being made worse by the higher stages of rolling blackouts that have hit the country, even though the hospital campus is exempt from loadshedding.

“Another issue is that we still haven’t been able to crack down on criminal syndicates operating at our hospitals. I believe what we’re seeing in the media now is only skimming the surface of widespread corruption in the system,” he says.

Insiders at Charlotte Maxeke have again raised alarms over ongoing theft that they say smacks of sabotage. According to them, the current situation is that cables and piping that run in-between hospital floors have been stolen or destroyed, resulting in disrupted oxygen flow that is fed to wards in Block 5 of the hospital. Block 5, houses, among others, the transplant unit.

Last year, the National Department of Health confirmed to Spotlight that vandalism and theft were rife. Investigations resulted in three officials in the Department of Infrastructure and Development being arrested in connection with these crimes.

Modiba did not respond to follow-up questions on how theft, vandalism, and sabotage are being dealt with by the provincial health department.

Repair work “on track”

Still, Modiba insists that the province is on track to meet both its 2023 and 2026 deadlines. Modiba however, also didn’t respond to a follow-up question on what compliance protocols will be followed in the three-year gap till fire safety compliance is expected to be completed.

It was fire safety compliance being flouted (including non-functioning fire doors, hose couplings that were stolen or broken, and no floor plan available for firefighters when they arrived on site) that led to the April 21 fire spreading and causing the extensive damage it did.

The repair bill now carries a price tag of R1.16 billion. According to Modiba, just over a billion of this will come from National Treasury, with around R146 million from donors making up the remainder.

The restoration work plan has also had to be adjusted in the past few months. An initial approach to work on fire compliance in multiple hospital blocks at a time was rejected by clinicians because it would be too disruptive for patient care.

“Decanting will now happen on a block-by-block basis with compliance work estimated to be between six to eight months per block. Services will keep rotating within the facility while contractors work from one area to another,” Modiba says.

He also tells Spotlight that the emergency unit which only reopened in May last year – and at the time only for referral patients – is now fully functioning. “All specialities are now present at the facility; there are no longer services that are being remotely rendered at other facilities,” he adds.

Modiba says that the hospital currently runs 1024 beds compared to the pre-fire status of 1138 beds. This comprises 1068 public beds and 70 Folateng beds. Folateng is the private ward within the hospital. There are 108 ICU and high-care beds and between 60 000 and 70 000 outpatients per month.

Meeting demands amid HR issues

Professor Adam Mahomed, head of the Department of Internal Medicine at the hospital, says meeting these massive demands when whole units and blocks have been out of commission has been a feat of adapting by doctors and nurses who have optimised ward space and found ways to repurpose parts of the hospital.

“Wards that used to fit 20 to 24 beds, we now have turned into wards that fit 32 beds,” he says.

Mahomed says it’s not optimal and amounts to trying to function in an overburdened state, especially with gross staff shortages. He says they expect the healthcare need to increase from the current numbers to having to run 1 400 beds in the hospital.

“We are seeing more people and sicker people coming through the doors because, during the COVID years, many people were not coming for healthcare or taking their chronic meds. We are also still playing catch up in oncology and surgery.”

Mahomed singles out inefficiencies in the hospital’s human resources department as the biggest stumbling block. He is calling for an independent audit and investigation into how human resources at Charlotte Maxeke is being run.

According to him, there are mounting questions around irregularities of why positions are not being filled timeously, or seemingly deliberately delayed and not just as a tactic to wait for budgets to refresh with the new financial year in April.

Some examples of “silly paperwork”, he says, are sessional doctors who have worked in the public sector previously being asked to produce matric certificates from 40 years ago. Other doctors have been asked to produce police clearance certificates, while others are asked to have proof of citizenship issued by the Department of Home Affairs.

According to Modiba, Charlotte Maxeke Hospital has 5334 approved posts and 774 vacancies currently. Of the 774 vacant positions, 253 vacancies are in administration and support, 40 for allied workers, 124 in medical, and 357 in nursing.

Mahomed says, “We need to have staff that will be able to accommodate 1400 beds and we need to have increased resources allocated for a hospital that is already over-burdened. We need to get HR to stop with the red tape, silly paperwork, and bureaucracies. “Bureaucracy is hampering us from getting actual resources to the people – HR bureaucracy is killing people. Politicians and management are still running healthcare when they should be taking input from those who are on the ground.”

Republished from Spotlight under a Creative Commons 4.0 Licence.

Source: Spotlight

Categories : COVIDTags :

Prof Madhi Addresses Omicron Subvariant Concerns

On By ModernMedia
SARS-CoV-2 virus
SARS-CoV-2 virus. Source: Fusion Medical Animation on Unsplash

In an interview about new Omicron subvariants, leading vaccinologist Prof Shabir Madhi said that “we don’t need to be concerned” about any current threat they may pose to South Africa. However, he stressed that it can still be lethal, particularly in those without underlying T cell immunity. He also noted that boosters are also important for high-risk populations, while some sort of seasonality needs to be observed for COVID for it to make boosters worthwhile for those at low risk due to the way vaccination protection wanes.

The XBB 1.5 SARS-CoV-2 subvariant, nicknamed ‘Kraken’ by researchers, is now accounting for more than half of cases in the United States, and appears much more transmissible and antibody-evasive than the original Omicron variant which evolved in Southern Africa. Prof Pravin Manga, editor of the Wits Journal of Clicnical Medicine interviewed Prof Madhi and asked him what the emergence of Omicron subvariants meant for South Africa.

Prof Madhi, who is the Dean of the Faculty of Health Sciences at Wits University, noted that before this new XBB.1.5 variant, there were BA4 and BA5, which created a “mini surge” in the middle of last year when they arrived in SA. There were concerns that these strains seemed more antibody-resistant than previous ones, stoking fears that they would result in increased hospitalisations and deaths.

In light of the current situation, he says that “the short answer is that we don’t need to be concerned.”

One important aspect of immunity which was becoming apparent was that, although neutralising antibodies were important in protecting against contracting and transmitting the virus, “what seems to be playing a greater role in protecting against severe disease is the T cell immunity, the Natural Killer cell immunity.” This immunity is much more diverse than that from antibodies, instead of merely targeting the Spike protein is rather “multi-epitopic”, targeting the N-protein as well.

“Now this T cell immunity appears to be holding strong. It appears to be less affected by all these mutations. In fact, close to 75 to 80% of vaccine-induced T cell immunity is conserved despite the multiple mutations have arisen in Omicron and its subvariants.”

Differing impacts across countries

With regard to the impact of the virus, Prof Madhi noted that China had pursued its ‘zero COVID’ policy, along with “suboptimal” coverage of vaccines (especially among ages 60+) that were “probably not the best”, meaning that large portions of the population were essentially naïve to the virus.

SA meanwhile, had 90% of the population infected at least once with COVID, and coupled with vaccination, meant that many will have highly robust immunity, which appears to last for 9–12 months compared to vaccine-only immunity where protection starts wanes after 4–6 months.

“What is unlikely to materialise in a country such as South Africa is large numbers of hospitalisations,” he says.

Protecting at-risk populations and the need for new vaccines

At present, he says there is not a strong case for boosters, but people at greater risk, such as those over 60, people with underlying medical conditions, and compromised immune systems, hybrid immunity is likely not enough protection. In these cases probably at least four doses of vaccination. From a public health standpoint, the population under 45 without underlying conditions would require a huge effort for only a nominal benefit as they are no longer at high risk of severe disease.

Timing is also important, due to the waning of vaccine protection, as the best time to get a booster is “probably around two or three weeks before the start of the next resurgence.” Otherwise, it’s useless to get a booster now if the next resurgence is in six months and antibodies will have waned – an obvious logistical challenge for little benefit. Therefore, in order for boosters to be useful, the virus will have to settle into some sort of predictable seasonality such as with influenza.

As for people who are at risk, at least four doses are probably required, though the case for a fifth is thin. Annual boosters are a likely option, and there is a need for a second generation of vaccines. These vaccines would need to be resilient against further mutations that may arise.

Novavax, monoclonal antibodies and Paxlovid

Regarding Novavax, Prof Madhi said that it had been licensed for use in South Africa, but their bivalent vaccine was not yet available. It would not be procured by government but rather by a private company – a situation which needs to change in terms of who is allowed to bring in vaccines. Another issue is whether the no fault compensation used by the government for public sector vaccinations would be used in the private sector as well.

Prof Manga also asked about whether there had been any success with monoclonal antibody treatment, to which Prof Madhi answered that there had been some limited use in the country but overall, monoclonal antibodies were “spectacularly unsuccessful” as they were highly specific and generally unable to keep up with mutations.

In general, antivirals hold much better promise, particularly Paxlovid which is unfortunately not available in South Africa. It was disappointing that it was not available in the country,

Benefits to both pregnant mothers and babies

Regarding pregnant women and children, Prof Madhi said that their own study shows that a substantial amount of transmission takes place between mothers and children. Infants with COVID under six months are often hospitalised, especially in the first month of life. Vaccination reduces the risk of hospitalisation and protects the baby as well, with research showing that babies born to vaccinated mothers were 80% less likely to develop COVID, “which is really a huge benefit,” he noted. This is likely a little reduced with Omicron because the only thing that babies get from the mother is antibodies, not T cell immunity.

Vaccination also reduces the risk of adverse pregnancy outcomes such as stillbirth, and safety “is simply not an issue” as supported by the data. He says there is case for vaccinating pregnant women, even under 45, in the second trimester of the pregnancy so that more antibodies are transferred to the foetus.

Categories : COVIDTags :

Hybrid Immunity Offers Greatest Protection against COVID

On By ModernMedia
Image of a syring for vaccination
Photo by Mika Baumeister on Unsplash

Analysing data from controlled studies throughout the world, researchers discovered that people with hybrid immunity – from both full vaccination and prior infection – are the most protected against severe illness and reinfection. The study, published in The Lancet Infectious Diseases, will aid public policy-makers in planning the optimal timing of vaccinations.

Researchers from University of Calgary teamed up with World Health Organization (WHO) experts to answer the question of how well protected people are from combinations of vaccinations, boosters and prior infection.

“The results reinforce the global imperative for vaccination,” says Dr Niklas Bobrovitz, first author on the study. “A common question throughout the pandemic was whether previously infected people should also get vaccinated. Our results clearly indicate the need for vaccination, even among people that have had COVID.”

The global emergence and rapid spread of the Omicron variant required scientists and policy-makers to reassess population protection against Omicron infection and severe disease. In the study, investigators were able to look at immune protection against Omicron after a prior SARS-CoV-2 infection, vaccination or hybrid immunity.

“Protection against hospitalisation and severe disease remained above 95 per cent for 12 months for individuals with hybrid immunity,” says Dr Lorenzo Subissi, PhD, a technical officer with WHO and senior author on the study. “We know more variants are going to emerge. The study shows, to reduce infection waves, vaccinations could be timed for rollout just prior to expected periods of higher infection spread, such as the winter season.”

The systematic review and meta-analysis found that protection against Omicron infection declines substantially by 12 months, regardless of prior infection, vaccinations or both, which means vaccination is the best way to periodically boost protection and to keep down levels of infection in the population. In total, 4268 articles were screened and 895 underwent full-text review – a difficult task before the assistance of experts in health informatics.

“This study demonstrates the power of machine translation. We were able to break through language barriers; most of the time, systematic reviews aren’t done in every language, they are limited to one or two,” says Dr Tyler Williamson “These former BHSc classmates, along with the large diverse team they brought together, have emerged as global leaders in SARS-CoV-2 research and delivered decision-grade evidence to the world.”

While the findings demonstrate that vaccination along with a prior infection carries the most protection, the scientists warn against intentional exposure to the virus.

“You should never try to get COVID,” says Bobrovitz. “The virus is unpredictable in how it will affect your system. For some, it can be fatal or send you to hospital. Even if you have a mild infection, you risk developing long COVID.”

The group says the next phase of this research would be to investigate how the bivalent vaccine performs against severe disease.

Findings from the study complement data on the SeroTracker dashboard which monitors studies and news reports to track seroprevalence data – the percentage of people in a population who have antibodies against the novel coronavirus. The website aggregates serology data from studies and news reports in different populations, and built-in filters allow users to compare seroprevalence levels between countries, occupations, and demographic groups.

Source: University of Calgary

Categories : COVIDTags :

Getting a COVID Booster Shot is not as Easy as it Should be

On By ModernMedia
Photo by Spencer Davis on Unsplash

By Daniel Steyn for GroundUp

As COVID cases rise again around the world and the more infectious XBB.1.5 variant spreads rapidly, health minister Joe Paahla has emphasised the importance of getting vaccinated and boosted.

About 19 million people in South Africa (just over 30% of the population) are fully vaccinated and four million booster shots have been administered. The country is administering just over 40 000 jabs a week.

At the moment only people over 50 are eligible for a second booster. But according to Dr Nicholas Crisp, Deputy Director-General for the National Department of Health, all adults will be eligible in February. “As soon as the systems are all in place and staff orientated, the department will announce,” Crisp told GroundUp.

But finding a booster shot has become difficult. Privately-owned facilities have mostly discontinued their rollout of the vaccine, although a handful of Dis-Chem pharmacies still do vaccinations. Public sector health facilities are the only alternative.

Active vaccination sites can be found on the government’s Find My Jab website. Some are “visiting” sites only, open once or twice a week, and others are permanently open, but it is advised to call ahead to confirm availability.

“The department is trying to find a more efficient way of updating which vaccination sites are active and those are being reflected and changed weekly on Find My Jab,” says Crisp.

The Western Cape Health Department makes weekly updates to this list of vaccination sites in the province.

One concerned reader from Pennington in KwaZulu-Natal, who is over the age of 50 and HIV-positive (meaning COVID poses a higher risk for him) told GroundUp that his local clinic no longer offered vaccines. It had been ten months since his previous booster. He went to the nearest hospital but was refused a jab and told to wait for an SMS.

He called the vaccination hotline and was told to send a copy of his ID and vaccination card to be registered on the system and receive an SMS, despite already having received jabs in the past.

Without a device to send the documents, and 60km of flood-damaged road between him and and his nearest PostNet, he has still not received his booster shot.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : COVID VaccinesTags :

Increase in Global Willingness to Accept COVID Vaccines

On By ModernMedia
Vaccine injection
Image source: NCI on Unsplash

Global COVID vaccine acceptance increased from 75.2% in 2021 to 79.1% in 2022, according to a new survey of 23 countries accounting for more than 60% of the world’s population, published today in Nature Medicine. It was not all good news, though: vaccine hesitancy increased in eight countries including South Africa, and nearly one in eight vaccinated respondents were hesitant about receiving a booster dose.

This third annual study reveals a wide variability between countries and suggests a need to tailor communication strategies to effectively address vaccine hesitancy.

“The pandemic is not over, and authorities must urgently address vaccine hesitancy and resistance as part of their COVID prevention and mitigation strategy,” says CUNY Graduate School of Public Health and Health Policy (CUNY SPH) Senior Scholar Jeffrey V. Lazarus. “But to do so effectively, policymakers need solid data on vaccine hesitancy trends and drivers.”

To provide these data, an international collaboration led by Lazarus and CUNY SPH Dean Ayman El-Mohandes performed a series of surveys starting in 2020 in 23 countries which were impacted significantly by the pandemic, including the United States as well as South Africa and Brazil.

Of the 23 000 respondents (1000 per country surveyed), 79.1% were willing to accept vaccination, up 5.2% from June 2021. The willingness of parents to vaccinate their children also increased slightly, from 67.6% in 2021 to 69.5% in 2022. However, eight countries saw an increase in hesitancy (from 1.0% in the UK to 21.1% in South Africa). Worryingly, almost one in eight (12.1%) vaccinated respondents were hesitant about booster doses, and booster hesitancy was higher among the 18–29 age groups.

“We must remain vigilant in tracking this data, containing COVID variants and addressing hesitancy, which may challenge future routine COVID immunisation programs,” says Dean El-Mohandes, the study’s senior author.

The survey also provides new information on COVID treatments received. Globally, ivermectin was used as frequently as other approved medications, despite the fact that it is not recommended by the WHO or other agencies to prevent or treat COVID  

Also of note, almost 40% of respondents reported paying less attention to new COVID information than before, and there was less support for vaccine mandates. 

In some countries, vaccine hesitancy was associated with being female (for example in China, Poland, Russia), having no university degree (in France, Poland, South Africa, Sweden, or the US), or lower income (in Canada, Germany, Turkey or the UK). Also, the profile of people paying less attention to the pandemic varied between countries.

“Our results show that public health strategies to enhance booster coverage will need to be more sophisticated and adaptable for each setting and target population,” says Lazarus, also head of the Health Systems Research Group at ISGlobal. “Strategies to enhance vaccine acceptance should include messages that emphasise compassion over fear and use trusted messengers, particularly healthcare workers.”

The data provided by these surveys may offer insight to policymakers and public health officials in addressing COVID vaccine hesitancy. The study follows on the heels of a global consensus statement on ending COVID as a public health threat that Lazarus, El-Mohandes and 364 co-authors from 112 countries published in Nature in November.

Source: CUNY SPH

Categories : AntibioticsTags :

In-depth: ‘Access not Excess’ Key to Reducing Antibiotic Resistance in SA

On By ModernMedia

By Tiyese Jeranji

Source: Danilo Alvesd on Unsplash

Antibiotics play a vital role in the management of bacterial infections, reducing morbidity, and preventing mortality. A 2011 report from the United Kingdom estimated that they have increased life expectancy by 20 years. However, the extensive use of antibiotics has resulted in drug resistance that threatens to reverse their life-saving power and if the situation is not reversed, it has been estimated that by 2050, 10 million people will die annually of drug-resistant infections.

Such estimates of future deaths are obviously uncertain, but there is strong evidence the problem is already very serious. A major study published earlier this year in the Lancet estimated that globally around 1.27 million deaths in 2019 were directly due to antibiotic resistance. The study identified sub-Saharan Africa as the hardest-hit region.

What is AMR?

Sham Moodley, a community pharmacist from Durban and the vice chairperson of the Independent Community Pharmacy Association (ICPA) explains that antimicrobial resistance (AMR) is the ability of microorganisms (bacteria, viruses, fungi, and protozoa) to withstand treatment with antimicrobial drugs. “It is vitally important as it directly impacts our ability to treat and cure common infectious diseases, including pneumonia, urinary tract infections, gonorrhoea and tuberculosis,” he says.

According to Professor Olga Perovic, Principal Pathologist at the National Institute of Communicable Diseases’ Centre for Healthcare-associated Infections, Antimicrobial Resistance and Mycoses (CHARM), there are six factors fuelling the AMR crisis. These are over-prescribing and dispensing of antibiotics by health workers, patients not finishing their full treatment course of antibiotics, poor infection control in hospitals and clinics, lack of hygiene and poor sanitisation in the community, lack of new antibiotics being developed, and the overuse of antibiotics in livestock and fish farming.

Under overuse, she stresses the misuse of antibiotics to treat upper respiratory tract infections, which are typically viral rather than bacterial. Antibiotics are powerless against viruses. Another driver of inappropriate or overprescribing of antibiotics, she says, may be the lack of testing of specimens for the presence of bacteria and their susceptibility to treatment.

How can we prevent AMR?

Dr Marc Mendelson, Professor of Infectious Diseases and Head of the Division of Infectious Diseases and HIV Medicine at Groote Schuur Hospital, the University of Cape Town as well as chairperson of the Ministerial Advisory Committee on Antimicrobial Resistance, says reducing the use of antibiotics is about preventing the need for prescription in the first place. (Mendelson’s recent SAMJ article provides excellent further reading on AMR in South Africa.)

“So, reducing the burden of infections through the provision of clean water and safe sanitation (reduces diarrhoeal diseases) and vaccination programmes (reduces diarrhoea and pneumonia for instance),” he says. “Education and awareness raising of the public and (sadly) healthcare professionals as to the correct use of antibiotics is also critical.”

Broadly speaking, all the experts we interviewed agreed that we should use far fewer antibiotics and only use them when they are absolutely necessary. But actually making this happen is surprisingly complex.

Part of the complexity, for example, is that resistance profiles and disease profiles are different in different places. Geraldine Turner, a pharmacist at Knysna Hospital in the Western Cape, says there is a need for guidelines tailored to the South African context or linked to the local epidemiology. This, she says, can play an important role in determining the correct antibiotics to be used.

It is also not just an issue of what antibiotics are prescribed for humans.

“A big driver of antimicrobial resistance is overuse in agriculture and collaboration with stakeholders in this regard is required,” says Turner. She says we need policies that facilitate improved integration among environmental, animal, and human sector interventions.

Moodley agrees that a multidisciplinary, One Health approach is needed at every level of care and in both human and animal health sectors.

“It is important we reinforce the principle that antimicrobial medicines for human use are only supplied on the authority of a healthcare professional and that antimicrobial medicines for either human or animal use are only supplied in accordance with country legislation and regulations,” he says.

The role of stewardship programmes

One response to the AMR crisis is antimicrobial stewardship programmes or ASPs. Moodley describes ASPs as a systematic approach used “to optimise appropriate use of all antimicrobials to improve patient outcome and limit the emergence of resistant pathogens whilst ensuring patient safety.”

Perovic says, “In healthcare institutions, resistant bacteria can spread easily within and from patient to patient. That is why there are guidelines, which we call ASPs in the medical and veterinary fields, on how and when antibiotics are prescribed as well as how to implement infection prevention and control measures, particularly for patients with health risks such as diabetes, high blood pressure, and cancer.”

“In hospitals,” explains Mendelson, “ASPs will consist of a governance body such as an AS Committee that directs a work programme of stewardship, often with AS teams as the implementers of policy. AS teams can involve anything from single pharmacists or physicians, through one to two dedicated individuals, through to all-singing all-dancing multi-disciplinary teams in academic teaching hospitals, comprising infectious diseases specialists, microbiologists, pharmacists, [and] infection prevention and control nurses.”

ASPs are not only important at institutional levels, adds Moodley, but imperative for every individual prescriber/practitioner to implement to reduce AMR in our population.

Critical role for pharmacists

Mendelson stresses that pharmacists are integral to antibiotic stewardship in South Africa and globally. “Community pharmacists give advice to patients seeking symptomatic relief and reduce doctors’ visits, which can result in antibiotic prescriptions when not needed,” he says. In hospitals, dispensing pharmacists help optimise the antibiotics prescribed to patients by checking indication for the antibiotic, dose, dosing frequency, and duration. “Some hospitals have pharmacists on the wards, again, checking and helping to optimise the use of antibiotics,” he says.

“Pharmacists play an important role in recommending symptomatic treatments for non-specific symptoms and particularly, the common cold, which is a major cause of inappropriate antibiotic prescribing, requiring simple paracetamol with or without decongestants. Unfortunately, a recent pilot study suggests that a small number of community pharmacies are dispensing antibiotics without a prescription, which is not allowed in South Africa,” says Mendelson.

Turner concurs that pharmacists play a crucial role in ensuring that the correct antibiotics are used appropriately and only if indicated. She says pharmacists are also in a good position to counsel and advise patients on the correct use of antibiotics.

Strategy framework

The key policy document setting out South Africa’s response to AMR is the South Africa Antimicrobial Resistance Strategy Framework of 2018-2024. The framework outlines nine strategic objectives – they include improving the appropriate use of diagnostic investigations to identify pathogens, guiding patient and animal management and ensuring good quality laboratory, enhancing infection prevention and control, promoting appropriate use of antimicrobials in humans and animals as well as legislative and policy reform for health systems strengthening.

Mendelson is positive about what has been achieved so far. “There have been major improvements to the surveillance and reporting of antibiotic resistance and antibiotic use in humans and animals, development of a greater one health (human, animal, and environmental health) response. There was a formation of national training centres for antibiotic stewardship and empowerment of under-resourced provinces to train and develop Antimicrobial Stewardship programmes and there have been improvements in governance and delivery of infection prevention and control measures in hospitals and development of education programmes for healthcare workers in South Africa,” he says.

But Mendelson also says that challenges remain in promoting prescribing behaviour change amongst the health workforce in SA and the expectations and social position that antibiotics hold in society.

As with several other health policies, there are questions on whether the plan has been backed up with funding.

“The national strategic framework remains largely unfunded (shared by most low- and middle-income countries) but this does hamper progress in developing programmes of interventions,” says Mendelson. “In food production, reducing [the] use of antibiotics is an important goal but will require investment in reducing drivers of infection in the animals that produce food. Legislation to bring all antibiotic prescribing in food production under veterinarian control will be an important intervention,” says Mendelson.

Source: Spotlight

Categories : General InterestTags :

Looking Back at 2022: Pandemic Fades but Other Challenges Remain

On By ModernMedia
Photo by Joshua Hoehne on Unsplash

The year 2022 finally saw the COVID pandemic petering out, largely through the less-lethal but still highly contagious Omicron variant. Significant strides were made in cancer and Alzheimer’s research, although not without controversy. Amid growing public healthcare challenges in South Africa, the NHI Bill advanced closer to reality.

As Omicron displayed greatly reduced severity compared to prior strains, South African medical experts were some of the first to justify no longer being at ‘code red’. This brought an end to the cycles of lockdowns and travel restrictions characterised by the two previous years.

It even saw the lifting of some aspects of China’s ultra-strict ‘zero-COVID’ policy, with citizens paying online tribute to the memory of the heroic doctor who defied government censorship to warn the world. However, the pandemic’s true cost became apparent as the World Health Organization put global excess deaths for the pandemic at almost 15 million.

A number of key medical advances were made during the year for a variety of conditions. Studies showed that administering steroids after COVID hospitalisation with severe inflammation reduced mortality up to one year post-infection.

COVID was found to be linked to a spate of new-onset Type 1 diabetes, but this may just have been due to medical checkups as a result of developing COVID. The rheumatoid arthritis drug auranofin was found to relieve diabetes symptoms. And research suggested a possible way to deliver insulin and cancer drugs orally, by adding a ‘tag’ that lets them enter the bloodstream through the intestines.

The fields of cancer and Alzheimer’s research was rocked by findings of numerous red flags. This controversy did not stop real progress: the first new drug that had any real effectiveness against Alzheimer’s disease was confirmed in a historic trial. Fortunately, the flu jab also seems to protect against developing the disease. Indeed, serious infections appear to increase the risk of both Alzheimer’s and Parkinson’s.

In advanced ER-positive, HER-2 negative breast cancers, the new drug capivasertib halved the rate of progression.

It was also revealed that humans are paying through the nose for common medications compared to those that animals receive. Antimicrobial resistance also remains a growing problem, causing an estimated 1.2 million deaths in 2019.

A major South African Medical Research Council (SMARC) study told a familiar story: unsafe sex, interpersonal violence, obesity, hypertension, and alcohol consumption are the top risk factors for disease and death in South Africa.

Despite lessons learned in the COVID pandemic, South Africa saw the progression of systemic problems in healthcare such as a critical shortage of nurses. Dr Tim de Maayer’s open letter on appalling conditions at Rahima Moosa exposed deep-seated problems in Gauteng’s public healthcare system. This was followed by the shock resignation of top cancer surgeon Professor Carol-Ann Benn. The appointment of Nomantu Nkomo-Ralehoko as Gauteng Health MEC should hopefully change the province’s situation.

As for the National Health Insurance (NHI) Bill, medical aids have aimed to reposition themselves in the new uncertain paradigm while the threat of a mass exodus of healthcare professionals from the country still hangs in the air. A slew of legal challenges now await the Bill, which still has no details on how it will be financed.

Categories : HIVTags :

Some in Free State only Given ARVs for Two Weeks at a Time

On By ModernMedia

Both health minister Dr Joe Phaahla and health authorities in the Free State last week denied claims from activists that there are shortages of antiretroviral medicines at health facilities in the province. Authorities did however confirm that some people living with HIV are only given a two-week supply of medicines at a time.

“I can confidently say that there are no stockouts or shortages of ARVs in the Free State,” Phaahla told Spotlight at the World AIDS Day commemoration event in Mangaung.

This was reiterated by spokesperson for the Free State Department of Health, Mondli Mvambi saying, “We do not have shortages of HIV medicines in the province.”

He says allegations of patients not receiving their medication are very serious and cannot be taken lightly. He says should the department hear from patients who are not receiving their HIV medicine, they will investigate.

But Makhosazana Mkhatshwa, a research officer at the Treatment Action Campaign (TAC), says in the past three months, nine clinics in the province indicated that patients have left their facility without the medicine that they needed and of these nine clinics, three of them had sent people home because there was a stockout of HIV medication. She says impacted clinics include Poly Clinic and MUCPP in Mangaung, and Namahadi Clinic in Thabo Mofutsanyana District.

According to community-led monitoring group Ritshidze’s latest report on clinic services in the Free State, there were 40 patient reports this year of shortages of HIV medication compared to 13 patient reports last year. The report states that the most commonly reported medicine shortages by public healthcare users were contraceptives, HIV, and TB medicines. The report was based on monitoring at 28 clinics. TAC is a Ritshidze partner organisation.

Only 7 or 14-day supply for some

One woman Spotlight spoke to at the World AIDS Day commemoration event held in Mangaung last week says she is a patient at Pule Sefatsa Clinic in Botshabelo, Mangaung. “I am forced to go to clinic every week because they only give me a supply for eight days. This is an inconvenience for me because I have to skip work every week just to get my medication.”

Another public healthcare user from Bloemfontein tells Spotlight that for two weeks in October he was stranded without ARVs. He says that he is usually given a 14-day supply at a time. When he requested a full month’s supply to last him through a work-related trip to Cape Town he says his request was declined at the Poly Clinic at Pelenomi Hospital. He says he ended up going without medication.

Aron Malete, District Health Manager for Mangaung, told Spotlight there are no ARV shortages in the district, but asked for details of the above cases so that he could investigate.

The problem is not stockouts per se, but a shortage of medication, says Sello Mokhalipi, Secretary General of Positive Action Campaign.  “You will find that there is a shortage of ARVs for seven days, then the next week it will be available,” he says.

Mokhalipi, like other activists Spotlight spoke to, is opposed to giving people only a seven or 14-day supply of medication at a time. He says people should be given enough for three to six months.

When Spotlight put the concerns and calls for multi-month dispensing to Mvambi he says, “We have identified people who are clinic hoppers who steal medicine. They get three months and thereafter run to another clinic to get another three months’ supply. To curb this practice,” Mvambi says, “we keep people on seven and 14 days’ supply The idea is to give them a few days because they claim to have forgotten their clinic cards.”

According to him, people get three months’ supply when they have their clinic card because clinic staff can verify who they are and what medicine they have been receiving.

Doing ‘exceptionally well’ but there are concerns

According to Phaahla who delivered a speech at the World AIDS Day commemoration event, the province has done “exceptionally well in terms of testing, having already surpassed the 94 percent threshold”. Phaahla said 94 percent of people who are living with HIV in the province know their status, 86 percent of those who know their status are on antiretroviral treatment, and 92 percent of those who are on treatment are virally suppressed.

He, however, singled out some districts such as Xhariep and Lejweleputswa where he says the “number of people with HIV and on treatment fare poorly on the target of being virally suppressed”. “This,” Phaahla says, “is very concerning and we must urgently intervene to create a balance among the targets in order to achieve zero new infections by 2030. This includes ensuring that services are brought closer to the people and that our health facilities are adequately resourced with medicine and related necessities.”

“Results for each of the sub-populations vary with adult females at 95 – 91 – 93, adult males at 93 – 77 – 93, and children at 82 – 65 – 68,” says Mvambi. “To achieve the 95 – 95 -95 targets the Free State must increase the number of adult men on ART by 25 745, adult women on ART by 9 744, and children on ART by 5 138.”

“As you can see,” says Mvambi, “the women are more likely to get tested, be initiated on ART, and have their viral load suppressed than their counterparts.”

According to the Free State Department of Health’s latest annual report for the financial year 2021/2022, the number of patients initiated on ARV treatment dropped from 36 776 in 2019/2020 to 26 364 in 2021/2022. In the report, the department states that it failed to meet its target for retaining adults on ART in care. The ART adult remain-in-care rate in 2019/20 was 68%. In 2020/21, it dropped to 52.8% and picked up in 2020/21 at 67.3%. Among the reasons the department cites are the high number of loss to follow-up of clients and “poor tracing by community healthcare workers due to poor supervision”.

NOTE: An employee of the TAC is quoted in this article. Spotlight is published by SECTION27 and the TAC, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

Republished from Spotlight under a Creative Commons 4.0 Licence.

Source: Spotlight

Categories : General InterestTags :

Very Few South Africans can Swim, Says the NSRI. It Aims to Change this

On By ModernMedia

With summer and the holidays approaching, soon thousands of adults and children will flock to the country’s shorelines and public pools. But many who live inland and in poor communities do not have access to safe water bodies and have not learned how to swim. Children play unsupervised in rivers and farm dams.

In Riebeek Kasteel last year, a grade six learner found his way into a dam within walking distance of his school, Meiring Primary. Just 12 years old, he drowned.

Now a bright red container stands at the school. It is one of the National Sea Rescue Institute’s (NSRI) “survival swimming centres”.

Andrew Ingram, NSRI drowning prevention manager, says swimming is an “essential skill”.

The first of its kind, the 12-metre shipping container contains a six-metre heated swimming pool, a changing room, an office and a camera monitored by the NSRI. The water is one metre deep, making it possible for the learners’ feet to touch the ground. The facility can also be locked up to avoid children accessing it unsupervised.

The design is inspired by previous work done with lifeguard containers. Almost everything is donated – the container, the pool’s fibreglass and resin, pumps and the filtration systems. The cost would otherwise be about R650 000.

After the Riebeek Kasteel installation in March, a second centre was set up in Tombo Village, Eastern Cape. Two more are expected next year – in KZN and the Northern Cape.

“We don’t teach the children how to swim, we teach them how to survive,” says Petro Meyer, an NSRI Instructor in Riebeek Kasteel. She said the valley gets very hot in summer and parents are away working. Children then “go to the dams and to the rivers and they swim alone without supervision”.

Meyer says they teach students four things: breath control, orientation, floating and moving through water. Children should be able to swim at least five metres once training is complete. Since the survival school opened, she says that they’ve given about 1,400 lessons.

A 2021 study on drowning prevention by the World Health Organisation found drowning to be the third most common accidental death in the world.

Brenton Cupido, principal at Meiring Primary, said there are no other public pools. The closest public one is 20 minutes by bus to Malmesbury and costs R30.

Riebeek Kasteel has many poor families and many parents at his school are farm workers and the majority depend on social grants.

“The farmers try to stop the learners [from using the farm dams] but they can’t be everywhere,” he says.

Cupido said the government should see that “there is a need for swimming pools in the rural areas with proper supervision”, and this would “prevent further tragedy”. “I don’t want to go through another … drowning again,” said Cupido.

“We have that peace of mind, that if our children … fall in the water, they know how to survive,” he said.

Another NSRI project is the over 1300 pink buoys across South Africa used as assisted floating devices in case of emergencies. These can be found in dams, rivers and the seaside. The NSRI also runs free swimming lessons at various municipal pools in the Western Cape.

According to the NSRI, only 15% of South Africans can swim (we cannot verify this statistic but it is highly likely that most South Africans cannot swim – editor). “If your parents can’t swim, it’s very likely that you won’t learn to swim,” said Ingram. “It’s expensive to learn to swim”.

With the survival centres, the NSRI hopes to “instil a culture of swimming in poor communities where it wouldn’t have been possible previously”.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : COVIDTags :

GroundUp: Vaccine drive is Running out of Steam

On By ModernMedia
Covid vaccines
Photo by Mat Napo on Unsplash

By Daniel Steyn

Daily COVID vaccinations have more or less plateaued since July. At the peak of the vaccination drive, South Africa was administering up to 240 000 vaccine doses a day. But this number has dropped to just over 5000 a day. Less than half of these are first doses and a third are booster shots.

The government still hasn’t reached its target of 67% adult vaccination, which it wanted to achieve by the end of 2021. Half of the adult population in South Africa is currently vaccinated. Among adults 60 years or older, nearly 73% have been fully vaccinated.

GroundUp visited the District Six Community Day Centre, a government clinic, in Cape Town. We asked for a COVID vaccine and were directed to a small room on the first floor, where one of us waited over 1.5 hours to get a vaccine (though two of us were vaccinated considerably quicker – about 30 minutes). This wasn’t because there was a long queue.

The nurse administering the vaccines was busy treating patients elsewhere in the clinic. The person logging the vaccines on the computer system told GroundUp that on average, 12 people a day come to the clinic for vaccines.

GroundUp visited a Clicks store in Cape Town where, three months ago, vaccines were still being administered. But they no longer do COVID vaccines.

The government’s dedicated Coronavirus website has a list of “active vaccination sites”, many of which are no longer active, and the “Find My Jab” page has completely different information.

Meanwhile, people are still getting ill from the virus. About 2000 new cases are reported each week, but according to the National Institute for Communicable Diseases (NICD) only 16% of cases are being detected. Testing sites are also few and far between.

Professor Glenda Gray says that the vaccine has done a good job at reducing deaths, serious illness and hospitalisations. Official daily deaths and hospitalisation rates are low in relation to previous waves. In the past four weeks, 125 deaths from COVID were reported.

The real number of deaths is likely much more than this. A weekly report published by the Medical Research Council and the University of Cape Town calculates the number of excess deaths – the deaths above the historical average before COVID: there have been close to 50 000 excess deaths so far this year. While in earlier waves the researchers were able to estimate that 85% to 95% of these excess deaths were due to COVID, the changing nature of the epidemic has made it much harder to estimate how many of this year’s excess deaths are due to COVID.

More than 85% of COVID infections in the country are from the Omicron BA.5 variant, which is widespread and infectious but usually causes very mild illness.

To prevent serious illness and death, getting the vaccine and booster shots are still recommended. Gray says that it is especially important for immunocompromised people, such as people living with HIV, to get vaccinated.

“Sadly, the virus has done a far better job of generating immunity than our government, which continues to be maddeningly slow at getting the vaccine out,” says Professor Francois Venter, infectious diseases clinician and head of Ezintsha at Wits University.

Although being infected by and recovering from the virus does provide a level of immunity, getting a vaccine still greatly improves one’s protection against the virus.

“I think we were all hoping once we had immunity from either infection or a vaccine or two, it would be enough. But from what we are seeing internationally, new waves of COVID, while not killing people in the numbers we saw in 2020 and 2021, are still making people very sick,” Venter says.

Dr Nicholas Crisp, Deputy Director-General of the National Department of Health, is the coordinator of the national vaccination drive. He agrees the current status of the vaccination drive is “very disappointing”.

He says the vaccination program is being integrated into primary health care, targeting areas geographically where communities or segments of a community are not vaccinated.

To monitor and manage the pandemic, Crisp says the government is continuing with daily testing, gene sequencing and wastewater sampling. Crisp says that the government is preparing for the future of COVID as well as other potential pandemics.

Future variants of the virus could be more dangerous. “As long as there is transmission, there is going to be mutation,” Gray told GroundUp. How the virus mutates in the future is yet to be seen.

In the US, new bivalent vaccines designed to target the Omicron variant are already available. But, Gray says, there is not yet sufficient evidence that these work better than the current vaccines.

According to Crisp, the government is not considering any new vaccines. “We are not buying vaccines this year and may not buy vaccines next year,” he says.

South Africa still has 8 million doses of the Pfizer vaccine and 10 million doses of the Johnson and Johnson vaccine. He says paediatric Pfizer vaccines will be purchased with some of the credit that South Africa has with the Covax facility. These will be given to children who are immunocompromised.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp