Khanyisile Tshabalala - Academia.edu (original) (raw)
Uploads
Papers by Khanyisile Tshabalala
Diseases, May 24, 2024
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
South African Medical Journal, 2020
Rates of healthcare-associated infections (HAIs) among babies born in hospitals in developing cou... more Rates of healthcare-associated infections (HAIs) among babies born in hospitals in developing countries are 3-20 times higher than among those born in resource-rich countries. [1] While poor infection prevention and control (IPC) practices are most proximally associated with transmission of HAIs and high infection rates, contributing factors include ageing hospital infrastructure, overcrowded neonatal units, inappropriate use of antimicrobial agents and inadequate institutional support for IPC and antimicrobial stewardship programmes. [2] Klebsiella pneumoniae is a common pathogen causing invasive HAIs in neonates. [1] Factors that predispose neonates to K. pneumoniae infection include prematurity and low birth weight. [3] The emergence of carbapenem-resistant K. pneumoniae in neonatal units has rendered recommended first-line empirical regimens for neonatal sepsis ineffective. [4] OXA-48-producing K. pneumoniae strains, which may remain phenotypically susceptible to carbapenems, can be missed in routine laboratories if not confirmed with molecular testing. [5] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Background Leadership and governance are critical for achieving universal health coverage (UHC). ... more Background Leadership and governance are critical for achieving universal health coverage (UHC). In South Africa, aspirations for UHC are expressed through the National Health Insurance policy, which underscores the importance of primary health care, delivered through the district health system (DHS). In light of this, the aim of this study was to determine the existence of legislated District Health Councils (DHCs) in Gauteng Province, and the perceptions of members on the functioning and effectiveness of these structures. Methods The study was done in all five districts in Gauteng. The population of interest was members of existing governance structures. Members completed an electronic-self- administered questionnaire (SAQ), which collected perceptions on the functioning and effectiveness of the governance structures, using a seven-point Likert scale. STATA® 13 was used to analyze the survey data. In-depth interviews with the chairpersons of the DHCs and the District Health Counci...
Background: HIV is moderate risk factor for developing severe COVID-19 and is associated with inc... more Background: HIV is moderate risk factor for developing severe COVID-19 and is associated with increased risk of COVID-19 mortality. HIV infection causes immune dysregulation characterised by progressive lymphopenia, chronic immune activation, immunological senescence, and T cell exhaustion. These changes are partly reversed by effective antiretroviral therapy (ART), which reduces morbidity and mortality in people living with HIV (PWH). We investigated the associations among clinical phenotypes, laboratory biomarkers, and hospitalisation outcomes in a cohort of people hospitalised with COVID-19 in a high HIV prevalence area.Methods: We conducted a prospective observational cohort study in the Tshwane District Hospital complex in Pretoria, South Africa. We analysed data for patients admitted from April to November 2020, before the SARS-CoV-2 Beta variant-driven second wave. Respiratory disease severity was quantified using the respiratory oxygenation (ROX) score. Analysed biomarkers i...
The Lancet HIV, 2021
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
The Lancet HIV
Background The interaction between COVID-19, non-communicable diseases, and chronic infectious di... more Background The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis is unclear, particularly in low-income and middle-income countries in Africa. South Africa has a national HIV prevalence of 19% among people aged 15–49 years and a tuberculosis prevalence of 0·7% in people of all ages. Using a nationally representative hospital surveillance system in South Africa, we aimed to investigate the factors associated with in-hospital mortality among patients with COVID-19. Methods In this cohort study, we used data submitted to DATCOV, a national active hospital surveillance system for COVID-19 hospital admissions, for patients admitted to hospital with laboratory-confirmed SARS-CoV-2 infection between March 5, 2020, and March 27, 2021. Age, sex, race or ethnicity, and comorbidities (hypertension, diabetes, chronic cardiac disease, chronic pulmonary disease and asthma, chronic renal disease, malignancy in the past 5 years, HIV, and past and current tuberculosis) were considered as risk factors for COVID-19-related in-hospital mortality. COVID-19 in-hospital mortality, the main outcome, was defined as a death related to COVID-19 that occurred during the hospital stay and excluded deaths that occurred because of other causes or after discharge from hospital; therefore, only patients with a known in-hospital outcome (died or discharged alive) were included. Chained equation multiple imputation was used to account for missing data and random-effects multivariable logistic regression models were used to assess the role of HIV status and underlying comorbidities on COVID-19 in-hospital mortality. Findings Among the 219 265 individuals admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and known in-hospital outcome data, 51 037 (23·3%) died. Most commonly observed comorbidities among individuals with available data were hypertension in 61 098 (37·4%) of 163 350, diabetes in 43 885 (27·4%) of 159 932, and HIV in 13 793 (9·1%) of 151 779. Tuberculosis was reported in 5282 (3·6%) of 146 381 individuals. Increasing age was the strongest predictor of COVID-19 in-hospital mortality. Other factors associated were HIV infection (adjusted odds ratio 1·34, 95% CI 1·27–1·43), past tuberculosis (1·26, 1·15–1·38), current tuberculosis (1·42, 1·22–1·64), and both past and current tuberculosis (1·48, 1·32–1·67) compared with never tuberculosis, as well as other described risk factors for COVID-19, such as male sex; non-White race; underlying hypertension, diabetes, chronic cardiac disease, chronic renal disease, and malignancy in the past 5 years; and treatment in the public health sector. After adjusting for other factors, people with HIV not on antiretroviral therapy (ART; adjusted odds ratio 1·45, 95% CI 1·22–1·72) were more likely to die in hospital than were people with HIV on ART. Among people with HIV, the prevalence of other comorbidities was 29·2% compared with 30·8% among HIV-uninfected individuals. Increasing number of comorbidities was associated with increased COVID-19 in-hospital mortality risk in both people with HIV and HIV-uninfected individuals. Interpretation Individuals identified as being at high risk of COVID-19 in-hospital mortality (older individuals and those with chronic comorbidities and people with HIV, particularly those not on ART) would benefit from COVID-19 prevention programmes such as vaccine prioritisation as well as early referral and treatment. Funding South African National Government.
Diseases, May 24, 2024
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
South African Medical Journal, 2020
Rates of healthcare-associated infections (HAIs) among babies born in hospitals in developing cou... more Rates of healthcare-associated infections (HAIs) among babies born in hospitals in developing countries are 3-20 times higher than among those born in resource-rich countries. [1] While poor infection prevention and control (IPC) practices are most proximally associated with transmission of HAIs and high infection rates, contributing factors include ageing hospital infrastructure, overcrowded neonatal units, inappropriate use of antimicrobial agents and inadequate institutional support for IPC and antimicrobial stewardship programmes. [2] Klebsiella pneumoniae is a common pathogen causing invasive HAIs in neonates. [1] Factors that predispose neonates to K. pneumoniae infection include prematurity and low birth weight. [3] The emergence of carbapenem-resistant K. pneumoniae in neonatal units has rendered recommended first-line empirical regimens for neonatal sepsis ineffective. [4] OXA-48-producing K. pneumoniae strains, which may remain phenotypically susceptible to carbapenems, can be missed in routine laboratories if not confirmed with molecular testing. [5] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Background Leadership and governance are critical for achieving universal health coverage (UHC). ... more Background Leadership and governance are critical for achieving universal health coverage (UHC). In South Africa, aspirations for UHC are expressed through the National Health Insurance policy, which underscores the importance of primary health care, delivered through the district health system (DHS). In light of this, the aim of this study was to determine the existence of legislated District Health Councils (DHCs) in Gauteng Province, and the perceptions of members on the functioning and effectiveness of these structures. Methods The study was done in all five districts in Gauteng. The population of interest was members of existing governance structures. Members completed an electronic-self- administered questionnaire (SAQ), which collected perceptions on the functioning and effectiveness of the governance structures, using a seven-point Likert scale. STATA® 13 was used to analyze the survey data. In-depth interviews with the chairpersons of the DHCs and the District Health Counci...
Background: HIV is moderate risk factor for developing severe COVID-19 and is associated with inc... more Background: HIV is moderate risk factor for developing severe COVID-19 and is associated with increased risk of COVID-19 mortality. HIV infection causes immune dysregulation characterised by progressive lymphopenia, chronic immune activation, immunological senescence, and T cell exhaustion. These changes are partly reversed by effective antiretroviral therapy (ART), which reduces morbidity and mortality in people living with HIV (PWH). We investigated the associations among clinical phenotypes, laboratory biomarkers, and hospitalisation outcomes in a cohort of people hospitalised with COVID-19 in a high HIV prevalence area.Methods: We conducted a prospective observational cohort study in the Tshwane District Hospital complex in Pretoria, South Africa. We analysed data for patients admitted from April to November 2020, before the SARS-CoV-2 Beta variant-driven second wave. Respiratory disease severity was quantified using the respiratory oxygenation (ROX) score. Analysed biomarkers i...
The Lancet HIV, 2021
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
The Lancet HIV
Background The interaction between COVID-19, non-communicable diseases, and chronic infectious di... more Background The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis is unclear, particularly in low-income and middle-income countries in Africa. South Africa has a national HIV prevalence of 19% among people aged 15–49 years and a tuberculosis prevalence of 0·7% in people of all ages. Using a nationally representative hospital surveillance system in South Africa, we aimed to investigate the factors associated with in-hospital mortality among patients with COVID-19. Methods In this cohort study, we used data submitted to DATCOV, a national active hospital surveillance system for COVID-19 hospital admissions, for patients admitted to hospital with laboratory-confirmed SARS-CoV-2 infection between March 5, 2020, and March 27, 2021. Age, sex, race or ethnicity, and comorbidities (hypertension, diabetes, chronic cardiac disease, chronic pulmonary disease and asthma, chronic renal disease, malignancy in the past 5 years, HIV, and past and current tuberculosis) were considered as risk factors for COVID-19-related in-hospital mortality. COVID-19 in-hospital mortality, the main outcome, was defined as a death related to COVID-19 that occurred during the hospital stay and excluded deaths that occurred because of other causes or after discharge from hospital; therefore, only patients with a known in-hospital outcome (died or discharged alive) were included. Chained equation multiple imputation was used to account for missing data and random-effects multivariable logistic regression models were used to assess the role of HIV status and underlying comorbidities on COVID-19 in-hospital mortality. Findings Among the 219 265 individuals admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and known in-hospital outcome data, 51 037 (23·3%) died. Most commonly observed comorbidities among individuals with available data were hypertension in 61 098 (37·4%) of 163 350, diabetes in 43 885 (27·4%) of 159 932, and HIV in 13 793 (9·1%) of 151 779. Tuberculosis was reported in 5282 (3·6%) of 146 381 individuals. Increasing age was the strongest predictor of COVID-19 in-hospital mortality. Other factors associated were HIV infection (adjusted odds ratio 1·34, 95% CI 1·27–1·43), past tuberculosis (1·26, 1·15–1·38), current tuberculosis (1·42, 1·22–1·64), and both past and current tuberculosis (1·48, 1·32–1·67) compared with never tuberculosis, as well as other described risk factors for COVID-19, such as male sex; non-White race; underlying hypertension, diabetes, chronic cardiac disease, chronic renal disease, and malignancy in the past 5 years; and treatment in the public health sector. After adjusting for other factors, people with HIV not on antiretroviral therapy (ART; adjusted odds ratio 1·45, 95% CI 1·22–1·72) were more likely to die in hospital than were people with HIV on ART. Among people with HIV, the prevalence of other comorbidities was 29·2% compared with 30·8% among HIV-uninfected individuals. Increasing number of comorbidities was associated with increased COVID-19 in-hospital mortality risk in both people with HIV and HIV-uninfected individuals. Interpretation Individuals identified as being at high risk of COVID-19 in-hospital mortality (older individuals and those with chronic comorbidities and people with HIV, particularly those not on ART) would benefit from COVID-19 prevention programmes such as vaccine prioritisation as well as early referral and treatment. Funding South African National Government.