Cape Town, is the largest and only clinically based medicine information centre in South Africa.In collaboration with the Foundation for Professional Development and USAID/PEPFAR, the MIC provides a toll-free national HIV and TB hotline to all health care workers in South Africa for patient treatment-related enquiries.

SUMMARY Setting: Gauteng, South AfricaObjective: To determine treatment uptake among newly diagnosed multi-drug resistant tuberculosis (MDR-TB) patients and risk markers for non-initiation of treatment. Design:A cross-sectional study was conducted including all newly diagnosed MDR-TB patients in Gauteng province of South Africa in 2011. Socio-demographic and clinical characteristics of those that attended Sizwe hospital, the designated MDR-TB hospital, were extracted from their medical records. District health offices provided data on patients not seen at Sizwe hospital. Univariate and multivariate analysis were used to determine risk markers for non-initiation of treatment.Results: Of the 942 newly diagnosed MDR-TB patients in Gauteng, only 593 (63%) initiated treatment. Of these, 70 (11.8%) did not maintain treatment up to the fourth month. Among the 349 (37%) who did not initiate treatment, 31.2% died and 46.4% 2 could not be accounted for. Referral for laboratory diagnosis from hospitals, health district of laboratory diagnosis, HIV infection and place of residence were independently associated with non-initiation of MDR-TB treatment. Conclusion:Untreated patients continue the transmission of MDR-TB in communities. The study findings highlight the need to identify and target the causes of non-initiation of treatment in specific settings.

BackgroundIn 2004, Togo adopted a regional strategy for malaria control that made use of insecticide-treated nets (ITNs), followed by the use of rapid diagnostic tests (RDTs), artemisinin-based combination therapy (ACT). Community health workers (CHWs) became involved in 2007. In 2010, the impact of the implementation of these new malaria control strategies had not yet been evaluated. This study sought to assess the trends of malaria incidence and mortality due to malaria in Est Mono district from 2005 to 2010.MethodsSecondary data on confirmed and suspected malaria cases reported by health facilities from 2005 to 2010 were obtained from the district health information system. Rainfall and temperature data were provided by the national Department of Meteorology. Chi square test or independent student’s t-test were used to compare trends of variables at a 95% confidence interval. An interrupted time series analysis was performed to assess the effect of meteorological factors and the use of ACT and CHWs on morbidity and mortality due to malaria.ResultsFrom January 2005 to December 2010, 114,654 malaria cases (annual mean 19,109 ± 6,622) were reported with an increase of all malaria cases from 10,299 in 2005 to 26,678 cases in 2010 (p<0.001). Of the 114,654 malaria cases 52,539 (45.8%) were confirmed cases. The prevalence of confirmed malaria cases increased from 23.1 per 1,000 in 2005 to 257.5 per 1,000 population in 2010 (p <0.001). The mortality rate decreased from 7.2 per 10,000 in 2005 to 3.6 per 10,000 in 2010 (p <0.001), with a significant reduction of 43.9% of annual number of death due to malaria. Rainfall (β-coefficient = 1.6; p = 0.05) and number of CHWs trained (β-coefficient = 6.8; p = 0.002) were found to be positively correlated with malaria prevalence.ConclusionThis study showed an increase of malaria prevalence despite the implementation of the use of ACT and CHW strategies. Multicentre data analysis over longer periods should be carried out in similar settings to assess the impact of malaria control strategies on the burden of the disease. Integrated malaria vector control management should be implemented in Togo to reduce malaria transmission.