Since the earliest reported cases of HIV/AIDS probably in 1959 in Africa, there has been a consistent progression in the new HIV/AIDS infection cases. In South Africa, Gauteng, records one of the highest HIV/AIDS prevalence rates in the country. The Department of Health (DOH) South Africa conducts ongoing studies on HIV/AIDS at provincial levels; these studies monitor the prevalence of HIV/AIDS amongst pregnant women attending antenatal clinics, as a tool for determining and monitoring the prevalence, trends, patterns and spread of the disease in the general population. This study analyses sentinel and spatial data collected from the (DOH) and Statistics South Africa (StatsSA) respectively, and depicts them in the form of spatial maps, and then critically analyses the spatial patterns that occur. The research findings would hopefully contribute to the overall knowledge of HIV/AIDS and provide framework and relevant literature for further investigation. / Geography / M.Sc. (Geography)

Since the earliest reported cases of HIV/AIDS probably in 1959 in Africa, there has been a consistent progression in the new HIV/AIDS infection cases. In South Africa, Gauteng, records one of the highest HIV/AIDS prevalence rates in the country. The Department of Health (DOH) South Africa conducts ongoing studies on HIV/AIDS at provincial levels; these studies monitor the prevalence of HIV/AIDS amongst pregnant women attending antenatal clinics, as a tool for determining and monitoring the prevalence, trends, patterns and spread of the disease in the general population. This study analyses sentinel and spatial data collected from the (DOH) and Statistics South Africa (StatsSA) respectively, and depicts them in the form of spatial maps, and then critically analyses the spatial patterns that occur. The research findings would hopefully contribute to the overall knowledge of HIV/AIDS and provide framework and relevant literature for further investigation. / Geography / M.Sc. (Geography)

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M.A. (Health Studies)

Thesis (PhD)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: The emergence and re-emergence of viral human pathogens from wildlife sources in the recent past has led to increased studies and surveillance of wildlife for potentially zoonotic agents in order to gain a better understanding of the pathogens, their sources as well as events that may lead to viral emergence. Of the >1407 known human pathogens, 13% are classified as emerging or re-emerging, and 58% as zoonotic; 37% of the (re-)emerging and 19% of the zoonotic pathogens are RNA viruses, accounting for the majority of recently emerged infectious diseases with a zoonotic origin, such as HIV, Ebola, Hendra, Nipah, Influenza and SARS. This study focusses on potentially zoonotic viruses hosted by rodents (Muridae family), shrews (order previously known as Insectivora/Soricomorpha, now reclassified as Eulipotyphla) and bats (order Chiroptera). Rodents and bats represent the largest (~40%) and second largest (~25%) mammalian orders and both occur on every continent except Antarctica. Together, the three mammalian orders investigated represent the most relevant potential sources of new zoonoses. In this study I investigated the occurrence of astroviruses, arenaviruses, coronaviruses and hantaviruses in South African small mammal species belonging to the orders mentioned above. These viruses have either been implicated in recent emerging zoonotic events or are considered to have the potential to cause cross-species transmissions resulting in a zoonotic event. In the first part of the study specimens collected from various bat, rodent and shrew species were screened for viral sequences by broadly reactive PCRs; positive samples were characterised by sequencing and sequence analysis. A separate part of the study focussed on hantavirus disease in humans: a seroprevalance survey was conducted to determine the presence of hantavirus antibodies in the local population. Additionally, acutely ill patients with potential hantavirus disease were tested in an attempt to identify possible acute infections and define clinical hantavirus disease in South Africa. Screening of rodent and shrew specimens resulted in the identification of eight novel arenavirus sequences. Seven of the sequences are related to Merino Walk virus, a recently identified South African arenavirus, and the eighth sequence represents a novel lineage of Old World arenaviruses. Screening of bat specimens resulted in the identification of highly diverse novel astrovirus and coronavirus sequences in various South African bat species, including the identification of a viral sequence closely related to the recently emerged Middle East Respiratory Syndrome coronavirus. While the study did not identify hantavirus infections in any of the acutely ill patients, it found seroprevalences similar to those observed in Europe and West Africa. The results obtained highlight the importance of small mammals in the emergence of potential zoonoses and further reinforce the importance of viral surveillance of relevant wildlife species. Further in-depth studies of naturally infected reservoir host populations are required in order to gain a better understanding of virus-host dynamics and the events that lead to virus emergence. / German Research Foundation (DFG) (project number: KR1293/9-1/13-1) / The Polio Research Foundation and the NHLS Research / Harry Crossley Foundation, the Polio Research Foundation and Stellenbosch University for granting scholarships and bursaries for PhD.

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M. A. (Health Studies)

INTRODUÇÃO: No Brasil, os doadores de sangue são submetidos à triagem clinica antes da doação através de um questionário padronizado que segue recomendações do Ministério da Saúde. Apesar de não ser obrigatório, os serviços de hemoterapia brasileiros costumam perguntar aos candidatos sobre o número de parceiros sexuais nos doze meses que precederam aquela doação de sangue. Os candidatos que referem um número de parceiros acima do limite permitido em cada hemocentro são recusados na triagem clínica pré-doação. Este estudo analisa as características demográficas, o número de parceiros heterossexuais e marcadores sorológicos em 689.868 doações de três hemocentros brasileiros, participantes do REDS-II, entre 1 de julho de 2007 a 31 de dezembro de 2009. MÉTODOS: Os doadores foram classificados de acordo com o número máximo declarado de parceiros sexuais nos últimos doze meses permitidos em cada hemocentro. Os valores de corte para Belo Horizonte, Recife e São Paulo são dois, três e seis parceiros, respectivamente. Foram realizados os testes de qui-quadrado e regressão logística a fim de examinar associações entre características demográficas, número de parceiros sexuais em doze meses e taxas de marcadores sorológicos individuais e globais positivas para o vírus da imunodeficiência adquirida (HIV), vírus linfotrópico humano (HTLV) tipo 1 e 2, hepatite B, hepatite C e sífilis. RESULTADOS: Doadores de primeira vez, jovens e com maior nível educacional foram associados a maior número de parceiros sexuais recentes, assim como o gênero em São Paulo e Recife (p < 0, 001). Marcadores sorológicos globais, para HIV e sífilis foram associados com maior número de parceiros em São Paulo e Recife (p < 0, 001), mas não em Belo Horizonte. Na análise de regressão logística, o número de parceiros sexuais foi associado com marcadores sorológicos positivos [razão de chance ajustada (AOR) 1,2-1,5], especialmente no HIV (AOR 1,9-4,4). Em conclusão, o número de parceiros sexuais nos doze meses antes da doação de sangue, foi associado com positividade para HIV e taxas globais de marcadores sorológicos para doenças transmissíveis por transfusão. A associação não foi consistente entre os centros, tornando difícil definir um valor de corte uniforme para todos os hemocentros brasileiros. Estes achados corroboram que o uso da informação dos contatos heterossexuais recentes é um importante critério de inaptidão e de melhora na segurança transfusional no Brasil / INTRODUCTION: In Brazil, blood donors undergo medical screening before donation through a standardized questionnaire that follows recommendations from the Ministry of Health. Although not required, most of the Brazilian blood centers routinely ask candidates about the number of sexual partners in the twelve months preceding that blood donation. Candidates who refer a number of partners over the limit allowed in each blood center are refused at the predonation clinic screening. This study analyzes the demographic characteristics, the number of heterosexual partners and serological markers in 689,868 donations from three Brazilian blood center, participants in the REDS-II, from 1 July 2007 to December 31, 2009. METHODS: Donors were classified according to the stated maximum of the number of sexual partners in the last twelve months, allowed at each blood center. The cutoff values for Belo Horizonte, Recife and Sao Paulo are two, three and six partners, respectively. We conducted the chi-square and logistic regression to examine associations between demographic characteristics, number of sexual partners in twelve months and rates of individual and global serological markers positive for human immunodeficiency virus (HIV), human lymphotropic virus (HTLV) type 1 and 2, hepatitis B, hepatitis C and syphilis. RESULTS: First time donors, young and better educated were associated with increased number of recent sexual partners, as well as gender in São Paulo and Recife (p < 0.001). Global serological markers for HIV and syphilis were associated with greater number of partners in Sao Paulo and Recife (p < 0.001), but not in Belo Horizonte. In logistic regression analysis, the number of sexual partners was associated with positive serological markers [adjusted odds ratio (AOR) 1.2 to 1.5], especially HIV (AOR 1.9 to 4.4). In conclusion, the number of sexual partners in the twelve months before blood donation was associated with HIV positivity and overall rates of serologic markers for transfusion-transmissible diseases. The association was not consistent among the Brazilian blood centers, making it difficult to set a uniform cut off value for all blood banks in Brazil. These findings confirm that, the use of information from recent heterosexual contacts is an important criterion of disability and improvement in transfusion safety in Brazil

INTRODUÇÃO: No Brasil, os doadores de sangue são submetidos à triagem clinica antes da doação através de um questionário padronizado que segue recomendações do Ministério da Saúde. Apesar de não ser obrigatório, os serviços de hemoterapia brasileiros costumam perguntar aos candidatos sobre o número de parceiros sexuais nos doze meses que precederam aquela doação de sangue. Os candidatos que referem um número de parceiros acima do limite permitido em cada hemocentro são recusados na triagem clínica pré-doação. Este estudo analisa as características demográficas, o número de parceiros heterossexuais e marcadores sorológicos em 689.868 doações de três hemocentros brasileiros, participantes do REDS-II, entre 1 de julho de 2007 a 31 de dezembro de 2009. MÉTODOS: Os doadores foram classificados de acordo com o número máximo declarado de parceiros sexuais nos últimos doze meses permitidos em cada hemocentro. Os valores de corte para Belo Horizonte, Recife e São Paulo são dois, três e seis parceiros, respectivamente. Foram realizados os testes de qui-quadrado e regressão logística a fim de examinar associações entre características demográficas, número de parceiros sexuais em doze meses e taxas de marcadores sorológicos individuais e globais positivas para o vírus da imunodeficiência adquirida (HIV), vírus linfotrópico humano (HTLV) tipo 1 e 2, hepatite B, hepatite C e sífilis. RESULTADOS: Doadores de primeira vez, jovens e com maior nível educacional foram associados a maior número de parceiros sexuais recentes, assim como o gênero em São Paulo e Recife (p < 0, 001). Marcadores sorológicos globais, para HIV e sífilis foram associados com maior número de parceiros em São Paulo e Recife (p < 0, 001), mas não em Belo Horizonte. Na análise de regressão logística, o número de parceiros sexuais foi associado com marcadores sorológicos positivos [razão de chance ajustada (AOR) 1,2-1,5], especialmente no HIV (AOR 1,9-4,4). Em conclusão, o número de parceiros sexuais nos doze meses antes da doação de sangue, foi associado com positividade para HIV e taxas globais de marcadores sorológicos para doenças transmissíveis por transfusão. A associação não foi consistente entre os centros, tornando difícil definir um valor de corte uniforme para todos os hemocentros brasileiros. Estes achados corroboram que o uso da informação dos contatos heterossexuais recentes é um importante critério de inaptidão e de melhora na segurança transfusional no Brasil / INTRODUCTION: In Brazil, blood donors undergo medical screening before donation through a standardized questionnaire that follows recommendations from the Ministry of Health. Although not required, most of the Brazilian blood centers routinely ask candidates about the number of sexual partners in the twelve months preceding that blood donation. Candidates who refer a number of partners over the limit allowed in each blood center are refused at the predonation clinic screening. This study analyzes the demographic characteristics, the number of heterosexual partners and serological markers in 689,868 donations from three Brazilian blood center, participants in the REDS-II, from 1 July 2007 to December 31, 2009. METHODS: Donors were classified according to the stated maximum of the number of sexual partners in the last twelve months, allowed at each blood center. The cutoff values for Belo Horizonte, Recife and Sao Paulo are two, three and six partners, respectively. We conducted the chi-square and logistic regression to examine associations between demographic characteristics, number of sexual partners in twelve months and rates of individual and global serological markers positive for human immunodeficiency virus (HIV), human lymphotropic virus (HTLV) type 1 and 2, hepatitis B, hepatitis C and syphilis. RESULTS: First time donors, young and better educated were associated with increased number of recent sexual partners, as well as gender in São Paulo and Recife (p < 0.001). Global serological markers for HIV and syphilis were associated with greater number of partners in Sao Paulo and Recife (p < 0.001), but not in Belo Horizonte. In logistic regression analysis, the number of sexual partners was associated with positive serological markers [adjusted odds ratio (AOR) 1.2 to 1.5], especially HIV (AOR 1.9 to 4.4). In conclusion, the number of sexual partners in the twelve months before blood donation was associated with HIV positivity and overall rates of serologic markers for transfusion-transmissible diseases. The association was not consistent among the Brazilian blood centers, making it difficult to set a uniform cut off value for all blood banks in Brazil. These findings confirm that, the use of information from recent heterosexual contacts is an important criterion of disability and improvement in transfusion safety in Brazil

<p>Serum amyloid A protein (SAA) is an acute phase protein that has recently gained increasing interest as a potential marker for disease and treatment monitoring. We investigated SAA and CRP levels in (a) patients with various common infectious diseases (n=98), (b) patients with pyelonephritis (n=37) versus patients with cystitis (n=32), (c) healthy individuals of varying ages (n=231), (d) very immature newborn infants with or without nosocomial infections (NIs) (n=72) and (e) patients with bacterial infections treated with cefuroxime (n=81). </p><p>SAA significantly correlated with CRP in viral as well as in bacterial infections (for the total group: r²=0.757, p<0.0001) and showed a systemic inflammatory response in 90% of the patients with cystitis as compared with 23% for CRP. Equally high efficiencies (0.96 and 0.94 for SAA and CRP, respectively) were observed in discriminating between pyelonephritis and cystitis. SAA and high sensitive (hs) CRP were lower in umbilical cords (p<0.0001) and higher in elderly adults (p<0.0001-0.03) than in the other age groups; higher in immature newborn infants than in term infants; and higher in the NI group than in the non-NI group. Interindividual variabilities of the time course of the biomarkers SAA and CRP were considerable. Because of the smoothed distribution of SAA and CRP (i.e. elevations were both essentially unchanged during the first 3 days of cefuroxime treatment), these markers were not useful when deciding parenteral-oral switch of therapy, which occurred within this time period in most cases.</p><p>SAA is a sensitive systemic marker in cystitis. SAA and hsCRP in umbilical cord blood are close to the detection limit and increase with age. They increase in relation to NI in very immature newborn infants and might therefore be used in diagnosis and monitoring. Finally, SAA and CRP in adults with bacterial infections could not predict an early parenteral-oral switch of antimicrobial therapy.</p>

Serum amyloid A protein (SAA) is an acute phase protein that has recently gained increasing interest as a potential marker for disease and treatment monitoring. We investigated SAA and CRP levels in (a) patients with various common infectious diseases (n=98), (b) patients with pyelonephritis (n=37) versus patients with cystitis (n=32), (c) healthy individuals of varying ages (n=231), (d) very immature newborn infants with or without nosocomial infections (NIs) (n=72) and (e) patients with bacterial infections treated with cefuroxime (n=81). SAA significantly correlated with CRP in viral as well as in bacterial infections (for the total group: r2=0.757, p&lt;0.0001) and showed a systemic inflammatory response in 90% of the patients with cystitis as compared with 23% for CRP. Equally high efficiencies (0.96 and 0.94 for SAA and CRP, respectively) were observed in discriminating between pyelonephritis and cystitis. SAA and high sensitive (hs) CRP were lower in umbilical cords (p&lt;0.0001) and higher in elderly adults (p&lt;0.0001-0.03) than in the other age groups; higher in immature newborn infants than in term infants; and higher in the NI group than in the non-NI group. Interindividual variabilities of the time course of the biomarkers SAA and CRP were considerable. Because of the smoothed distribution of SAA and CRP (i.e. elevations were both essentially unchanged during the first 3 days of cefuroxime treatment), these markers were not useful when deciding parenteral-oral switch of therapy, which occurred within this time period in most cases. SAA is a sensitive systemic marker in cystitis. SAA and hsCRP in umbilical cord blood are close to the detection limit and increase with age. They increase in relation to NI in very immature newborn infants and might therefore be used in diagnosis and monitoring. Finally, SAA and CRP in adults with bacterial infections could not predict an early parenteral-oral switch of antimicrobial therapy.

Twice during the first half of the twentieth century, on two separate and distinctly unique wartime campaigns in Europe, the survival of Canadian overseas armies was badly threatened not by enemy guns, but by the menace and ravages of an unseen enemy: infectious disease. Between the spring of 1915 and the fall of 1918, hundreds of thousands of Canadian soldiers lived and fought in the trenches of the Western Front. The Canadian Expeditionary Force (CEF) faced many tactical challenges in fighting this radical and unknown style of war in the trenches. There were also many medical challenges faced by the Canadian forces during this new era when they soon discovered that the trench environment was highly conducive to the rapid development and spread of infectious disease. In particular, pathogen carrying pests, such as body lice and rats, and “mysterious” emerging diseases, such as trench fever, would become the bane of existence for many Canadian soldiers. Life in the trenches would prove to be inherently dangerous for reasons other than enemy fire. Just two and one half decades later, during the Second World War, the Canadian First Division, recently victorious in occupying Sicily, was decimated, not by its German or Italian foes but by an epidemic of the mosquito transmitted infectious disease of malaria. Anti-malaria measures and precautions were well known, but the Canadians would discover that both the application of these practices and the compliance of the rank and file could not be taken for granted. This work examines the important influence disease vectors and infectious disease had upon the lives and experiences of our soldiers, as well as the conduct and outcomes of two important twentieth century military campaigns conducted by Canada’s army between 1914 and 1945. In essence, this study will explore and analyze Canadian attempts, both individual and corporate, to control, possibly defeat or at least come to terms with, its most elusive and silent enemies on the field of battle – infectious diseases.