Browsing by Author "Obihara, C. C."

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    The prevalence of symptoms associated with pulmonary tuberculosis in randomly selected children from a high burden community
    (BMJ Publishing Group, 2005-11) Marais, B. J.; Obihara, C. C.; Gie, R. P.; Schaaf, H. Simon; Hesseling, A. C.; Lombard, C.; Enarson, D.; Bateman, E.; Beyers, Nulda
    Background: Diagnosis of childhood tuberculosis is problematic and symptom based diagnostic approaches are often promoted in high burden settings. This study aimed (i) to document the prevalence of symptoms associated with tuberculosis among randomly selected children living in a high burden community, and (ii) to compare the prevalence of these symptoms in children without tuberculosis to those in children with newly diagnosed tuberculosis. Methods: A cross sectional, community based survey was performed on a 15% random sample of residential addresses. A symptom based questionnaire and tuberculin skin test (TST) were completed in all children. Chest radiographs were performed according to South African National Tuberculosis Control Program guidelines. Results: Results were available in 1415 children of whom 451 (31.9%) were TST positive. Tuberculosis was diagnosed in 18 (1.3%) children. Of the 1397 children without tuberculosis, 253 (26.4%) reported a cough during the preceding 3 months. Comparison of individual symptoms (cough, dyspnoea, chest pain, haemoptysis, anorexia, weight loss, fatigue, fever, night sweats) in children with and without tuberculosis revealed that only weight loss differed significantly (OR = 4.5, 95% CI 1.5 to 12.3), while the combination of cough and weight loss was most significant (OR = 5.4, 95% CI 1.7 to 16.9). Children with newly diagnosed tuberculosis reported no symptoms in 50% of cases. Conclusion: Children from this high burden community frequently reported symptoms associated with tuberculosis. These symptoms had limited value to differentiate children diagnosed with tuberculosis from those without tuberculosis. Improved case definitions and symptom characterisation are required when evaluating the diagnostic value of symptoms.
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    Synchronized and regular deworming of children and women in South Africa : Policy and practice
    (Academy of Science of South Africa, 2005) Fincham, J. E.; Markus, M. B.; Ngobeni, J. T.; Mayosi, B. N.; Adams, V. J.; Kwitshana, Z. L.; Obihara, C. C.; Dhansay, M. A.; Jackson, T. F. H. G.
    SOUTH AFRICA IS A SIGNATORY TO WORLD Health Assembly (WHA) resolution 54.19 (May 2001), which calls for regular, synchronized treatment of helminthiasis in developing countries, particularly where the prevalence of worm infestation exceeds 50%. Helminthic infection is usually a hallmark of poverty and reasons why it should be controlled in disadvantaged communities are compelling. However, existing South African legislation regulating the procurement and use of anthelmintic medicines effectively renders group-based deworming as agreed to by WHA member states, and endorsed by the South African minister of health, non-implementable in practice. In order to make deworming sustainable, low-cost, unregistered anthelmintics must be imported from international procurement agencies. At present, this is not permitted. Another problem is that both medical and non-medical personnel are confused by out-of-date information in package-inserts regarding safety for young children and pregnant women. Albendazole and praziquantel should be de-scheduled and ivermectin, levamisole and possibly nitazoxanide should be registered in a way that permits treatment by non-medical personnel. Rational alternation of medication is important because reliance on mebendazole will lead to resistance. All batches of anthelmintics ought to comply with pharmacological quality specifications and testing should be routine. Facilities for doing this are available in South Africa.