Student Number : 0110645G - MSc research report - School of Public Health - Faculty of Health Sciences / South Africa is one of the countries in sub-Saharan Africa that are severely affected by the HIV/AIDS pandemic. This epidemic has led to high mortality rates, decreased life expectancies, increasing poverty, and overburdened health systems. Objective: To quantify the disease burden related to HIV/AIDS in Leratong Hospital, a level 2 public sector hospital in Gauteng Province of South Africa. In the context of the recent introduction of anti-retroviral therapy programme in the hospital, it is hoped that this study will assist in defining a baseline to which future evaluation of the programme will be compared. Methods: This was a retrospective descriptive study on routinely collected hospital data. The records of all patients admitted into the four medical wards of the hospital in 2001 and 2004 (n=21,029) were analyzed. Data on their socio-demographic characteristics, discharge diagnoses, HIV status, clinical outcome and length of stay in the hospital were extracted and analyzed. Results: More than half (52%) of the patients were aged between 21 and 40 years. Between the two years, the annual total number of admissions to the medical wards decreased by 6.6%, and this was more pronounced in the female wards where the decline was more than 10%. HIV-related diseases accounted for four out of the top five diseases in all patients. The proportion of chronic diseases, such as hypertension, diabetes, congestive cardiac failure and cerebrovascular diseases, decreased from 15.3% in 2001 to 14.3% in 2004. The average length of stay (ALOS) increased from 3.7 days in 2001 to 4.1 days in 2004. Only 14% of all patients consented to HIV testing in the review period. Of these more than 90% were reactive to HIV. Although the proportion who had HIV tests decreased significantly from 16.9% in 2001 to 11% in 2004 (p<0.001), the HIV positive rate increased significantly from 89.1% in 2001 to 92.4% in 2004 (p<0.001). The proportion of patients admitted due to HIVrelated diseases increased significantly from 52% in 2001 to 58% in 2004 (p<0.001). The crude mortality rate for all patients during the two years studied was 13.6%. This increased significantly from 12% in 2001 to 15% in 2004 (p<0.001). Mortality was significantly higher in those patients with documented HIV results and those admitted with HIV-related diseases irrespective of their HIV status. While cause-specific mortality rate due to HIV-associated diseases either increased or remained very high, that due to diabetes mellitus decreased significantly between the two years studied (p=0.02). Patients’ length of stay in the hospital and mortality were both found to be associated with their age group, HIV status, diagnosis and year of admission. The study has demonstrated some changes in the clinical profile of the patients towards a preponderance of HIV-related diseases and crowding out of other chronic non-infectious diseases. Based on these results, it is therefore recommended that all patients should have access to voluntary counseling and testing (VCT) and emphasis should be placed on those diseases with high admission and mortality rates to improve patient care and outcome. Measures should be developed to ensure that patients with chronic noninfectious diseases are not crowded out.

A research report is submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Sciences in Child Health Johannesburg, 2016 / Background: Leratong Hospital is a regional hospital in the West Rand of Johannesburg, South Africa. Statistics from maternity in 2008 showed high utilisation rates for delivery services at Leratong but a study on neonatal mortality was not yet done. It was therefore essential to measure and analyse the causes of new-born deaths so as to have policies to advance neonatal care. Objectives: To determine the neonatal mortality rate (NMR), the major neonatal causes of death and the occurrence of avoidable health factors. Methods: This was a prospective review of the clinical records of the 46 neonates who died within the 3 month period (15th April 2013 to the 15th July 2013). Data was obtained from neonatal admission and death registers. Information on the number oflive births was obtained from labour ward registers. Delegation books for nurses were checked to determine the number of nursing staff per shift as well as their allocation in different rooms. Neonate's age, birth weight, gender, race, place of origin, reason for admission and cause of death, were analysed. Health factors examined were access to high care services and to the neonatal ICU, number of staff on duty and the use of treatment guidelines. Questionnaires were used to collect information, and the consent to use clinical records was obtained from the mothers. Descriptive statistics were used to describe the frequencies and percentages of variables. Logistic regression of variables was applied to predict mortality. Results: The overall neonatal mortality rate at Leratong Hospital was lower than the rates found in South Africa and other studies in sub-Saharan Africa. Almost 37% of neonates died within 24 hours of admission. The three most common causes of death were: prematurity (39%), perinatal asphyxia (26%) and infection (20%). More than sixty per cent of deaths occurred in the admission room. Three-quarters of neonates who died (74%) were low birth weight neonates. A critical staff shortage (nurse: neonate rati02.: 1:10) was the most common modifiable factor (63% of deaths). Thirty seven per cent of neonates were denied access to ICU. The significant predictors of neonatal death were being born preterm (OR: 3.1, 95% CI 1.7-6.0), extremely low birth weight (OR: 27.5,95% CI 8.2-92.6), very low birth weight (OR: 5.0, 95% CI 2.1-12.3) and birth by caesarean section (OR: 3.2, 95% CI 1.6-6.2). Conclusions: The study found the neonatal mortality rate at Leratong Hospital in 2013 to be lower than rates recorded in South Africa. Our results showed that the most common causes of neonatal mortality were similar to those in other hospitals in sub-Saharan Africa and in South Africa. A high number of neonatal deaths were avoidable by providing high care services (including NCP AP and surfactant) and adequate number of nurses trained in newborn care in the admission room, improving access to neonatal ICU, early detection of perinatal asphyxia and improved neonatal resuscitation, and the supervision of medical doctors. / AC2016