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Search Results: 1 - 10 of 246758 matches for " David N. Durrheim "
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The use of hospital-based nurses for the surveillance of potential disease outbreaks
Durrheim,David N.; Harris,Bernice N.; Speare,Rick; Billinghurst,Kelvin;
Bulletin of the World Health Organization , 2001, DOI: 10.1590/S0042-96862001000100006
Abstract: objective: to study a novel surveillance system introduced in mpumalanga province, a rural area in the north-east of south africa, in an attempt to address deficiences in the system of notification for infectious conditions that have the potential for causing outbreaks. methods: hospital-based infection control nurses in all of mpumalanga?s 32 public and private hospitals were trained to recognize, report, and respond to nine clinical syndromes that require immediate action. sustainability of the system was assured through a schedule of regular training and networking, and by providing feedback to the nurses. the system was evaluated by formal review of hospital records, evidence of the effective containment of a cholera outbreak, and assessment of the speed and appropriateness of responses to other syndromes. findings: rapid detection, reporting and response to six imported cholera cases resulted in effective containment, with only 19 proven secondary cholera cases, during the two-year review period. no secondary cases followed detection and prompt response to 14 patients with meningococcal disease. by the end of the first year of implementation, all facilities were providing weekly zero-reports on the nine syndromes before the designated time. formal hospital record review for cases of acute flaccid paralysis endorsed the value of the system. conclusion: the primary goal of an outbreak surveillance system is to ensure timely recognition of syndromes requiring an immediate response. infection control nurses in mpumalanga hospitals have excelled in timely weekly zero-reporting, participation at monthly training and feedback sessions, detection of priority clinical syndromes, and prompt appropriate response. this review provides support for the role of hospital-based nurses as valuable sentinel surveillance agents providing timely data for action.
The use of hospital-based nurses for the surveillance of potential disease outbreaks
Durrheim David N.,Harris Bernice N.,Speare Rick,Billinghurst Kelvin
Bulletin of the World Health Organization , 2001,
Abstract: OBJECTIVE: To study a novel surveillance system introduced in Mpumalanga Province, a rural area in the north-east of South Africa, in an attempt to address deficiences in the system of notification for infectious conditions that have the potential for causing outbreaks. METHODS: Hospital-based infection control nurses in all of Mpumalanga?s 32 public and private hospitals were trained to recognize, report, and respond to nine clinical syndromes that require immediate action. Sustainability of the system was assured through a schedule of regular training and networking, and by providing feedback to the nurses. The system was evaluated by formal review of hospital records, evidence of the effective containment of a cholera outbreak, and assessment of the speed and appropriateness of responses to other syndromes. FINDINGS: Rapid detection, reporting and response to six imported cholera cases resulted in effective containment, with only 19 proven secondary cholera cases, during the two-year review period. No secondary cases followed detection and prompt response to 14 patients with meningococcal disease. By the end of the first year of implementation, all facilities were providing weekly zero-reports on the nine syndromes before the designated time. Formal hospital record review for cases of acute flaccid paralysis endorsed the value of the system. CONCLUSION: The primary goal of an outbreak surveillance system is to ensure timely recognition of syndromes requiring an immediate response. Infection control nurses in Mpumalanga hospitals have excelled in timely weekly zero-reporting, participation at monthly training and feedback sessions, detection of priority clinical syndromes, and prompt appropriate response. This review provides support for the role of hospital-based nurses as valuable sentinel surveillance agents providing timely data for action.
Local level epidemiological analysis of TB in people from a high incidence country of birth
Peter D Massey, David N Durrheim, Nicola Stephens, Amanda Christensen
BMC Public Health , 2013, DOI: 10.1186/1471-2458-13-62
Abstract: TB notification data for the three year period 2006–2008 were analysed by grouping the population into those from a high-incidence country-of-birth and the remainder.During the study period there were 1401 notified TB cases in the state of NSW. Of these TB cases 76.5% were born in a high-incidence country. The annualised TB notification rate for the high-incidence country-of-birth group was 61.2/100,000 population and for the remainder of the population was 1.8/100,000. Of the 152 Local Government Areas (LGA) in NSW, nine had higher and four had lower TB notification rates in their high-incidence country-of-birth populations when compared with the high-incidence country-of-birth population for the rest of NSW. The nine areas had a higher proportion of the population with a country of birth where TB notification rates are >100/100,000. Those notified with TB in the nine areas also had a shorter length of stay in Australia than the rest of the state. The areas with higher TB notification rates were all in the capital city, Sydney. Among LGAs with higher TB notification rates, four had higher rates in both people with a high-incidence country of birth and people not born in a high-incidence country. The age distribution of the HIC population was similar across all areas, and the highest differential in TB rates across areas was in the 5–19 years age group.Analysing local area TB rates and possible explanatory variables can provide useful insights into the epidemiology of TB. TB notification rates that take country of birth in local areas into account could enable health services to strategically target TB control measures.In many low incidence countries such as Australia, Canada, New Zealand and the United Kingdom, higher rates of tuberculosis (TB) are reported in recent immigrants [1-4]. For example the increasing TB rate in the United Kingdom has been considered a result of increased notifications in migrants from countries with a high TB incidence [5]. In these sett
Research that influences policy and practice – characteristics of operational research to improve malaria control in Mpumalanga Province, South Africa
David N Durrheim, Richard Speare, Anthony D Harries
Malaria Journal , 2002, DOI: 10.1186/1475-2875-1-9
Abstract: A series of operational research studies were conducted to refine malaria diagnosis in Mpumalanga Province, South Africa between 1995 and 1999. The grounded theory approach was used with groups of experienced Masters of Public Health students in South Africa and Australia to analyse a compilation of these studies for determining positive and negative attributes of operational research that affect its ability to influence communicable disease control policy and practice.The principal positive attributes of the operational research studies were high local relevance, greater ability to convince local decision-makers, relatively short lag-time before implementation of findings, and the cost-effective nature of this form of research. Potential negative features elicited included opportunities forfeited by using scarce resources to conduct research and the need to adequately train local health staff in research methodology to ensure valid results and accurate interpretation of findings.Operational research effectively influenced disease control policy and practice in rural South Africa, by providing relevant answers to local questions and engaging policy-makers. This resulted in accelerated inclusion of appropriate measures into a local communicable disease control programme."We have at our disposal the tools necessary for achieving control – elimination – eradication of a particular disease", is a common refrain of public health bodies and practitioners. Vaccination programmes have had a major impact on a few key diseases, even in developing countries, but why are there relatively few examples of successful disease control programmes, particularly of non-vaccine preventable endemic diseases in developing settings? The inequitable global distribution of resources available for health care is certainly an important contributory factor. However, even interventions deemed cost-effective for developing environments often fail to perform as expected. Apology, justification or
Meeting measles elimination indicators: surveillance performance in a regional area of Australia
Julie K Kohlhagen,Peter D Massey,David N Durrheim
Western Pacific Surveillance and Response , 2011,
Abstract: The World Health Organization (WHO) Western Pacific Region has established specific measles elimination surveillance indicators. There has been concern in Australia that these indicators may be too stringent and that measles elimination can occur without all surveillance prerequisites being met, in particular the minimum fever and rash clinician-suspected measles reporting rate with subsequent laboratory exclusion of measles. A regional public health unit in northern New South Wales, Australia, prompted local general practitioners to report fever and rash presentations that met the measles case definition or that they considered to be clinical measles. These notifications from July 2006 to June 2008 were reviewed to determine whether measles indicators for monitoring progress towards measles elimination could be achieved in Australia. Results confirmed that the surveillance indicators of “>2 reported suspected measles cases per 100 000 population,” “at least 80% of suspected cases adequately investigated within 48 hours” and “greater than 80% of cases had adequate blood samples collected” could be met. Only half the cases had virology that would allow genotyping of measles virus. Special efforts to engage and convince Australian medical doctors about the public health value of reporting clinically suggestive measles cases and collecting confirmatory blood tests, resulted in the current WHO Western Pacific Region indicators for progress towards measles elimination being met in a regional area of Australia.
Pertussis vaccination in Child Care Workers: room for improvement in coverage, policy and practice
Kirsty Hope, Michelle Butler, Peter D Massey, Patrick Cashman, David N Durrheim, Jody Stephenson, April Worley
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-98
Abstract: A cross sectional survey of all child care centre directors in the Hunter New England (HNE) area of northern NSW was conducted in 2010 using a computer assisted telephone interviewing service.Ninety-eight percent (319/325) of child care centres identified within the HNE area participated in the survey. Thirty-five percent (113/319) of centres indicated that they had policies concerning respiratory illness in staff members. Sixty-three percent (202/319) of centres indicated that they kept a record of staff vaccination, however, of the 170 centre’s who indicated they updated their records, 74% (125/170) only updated records if a staff member notified them. Of centres with records, 58% indicated that fewer than half of their staff were vaccinated.Many childcare workers have not had a recent pertussis immunisation. This potentially places young children at risk at an age when they are most vulnerable to severe disease. With increasing use of child care, national accreditation and licensing requirements need to monitor the implementation of policies on child care worker vaccination. Higher levels of vaccination would assist in reducing the risk of pertussis cases and subsequent outbreaks in child care centres.The resurgence of pertussis (whooping cough) in Australia has attracted community concern, especially with recent deaths in two infants from the Australian state of New South Wales (NSW) [1,2]. Although pertussis incidence declined after the widespread use of whole cell pertussis vaccines in the mid-1940’s, this disease remains an important cause of morbidity in Australia, especially in young infants [3].This bacterial infection of the respiratory tract, caused by Bordetella pertussis, usually begins with coryza (nasal conjestion), fatigue and sometimes a mild fever. A cough then develops, which is often paroxysmal, may be followed by a deep gasp (or whoop). Pertussis affects people of all ages with infants being at greatest risk of severe disease, complications, ho
A structured framework for improving outbreak investigation audits
Craig B Dalton, Tony D Merritt, David N Durrheim, Sally A Munnoch, Martyn D Kirk
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-472
Abstract: A framework for prioritising which outbreak investigations to audit, an approach for conducting a successful audit, and a template for audit trigger questions was developed and trialled in four foodborne outbreaks and a respiratory disease outbreak in Australia.The following issues were identified across several structured audits: the need for clear definitions of roles and responsibilities both within and between agencies, improved communication between agencies and with external stakeholders involved in outbreaks, and the need for development of performance standards in outbreak investigations - particularly in relation to timeliness of response. Participants considered the audit process and methodology to be clear, useful, and non-threatening. Most audits can be conducted within two to three hours, however, some participants felt this limited the scope of the audit.The framework was acceptable to participants, provided an opportunity for clarifying perceptions and enhancing partnership approaches, and provided useful recommendations for approaching future outbreaks. Future challenges include incorporating feedback from broader stakeholder groups, for example those of affected cases, institutions and businesses; assessing the quality of a specific audit; developing training for both participants and facilitators; and building a central capacity to support jurisdictions embarking on an audit. The incorporation of measurable performance criteria or sharing of benchmark performance criteria will assist in the standardisation of outbreak investigation audit and further quality improvement.Outbreak investigation is a core function of public health agencies. Suboptimal outbreak investigation endangers both public health and agency reputations. Surprisingly, there is little guidance on enhancing the quality of outbreak investigation and control provided to public health agencies. Audits of clinical medical and nursing practice are conducted as part of continuous quality
Lessons from the Pacific programme to eliminate lymphatic filariasis: a case study of 5 countries
Clare Huppatz, Corinne Capuano, Kevin Palmer, Paul M Kelly, David N Durrheim
BMC Infectious Diseases , 2009, DOI: 10.1186/1471-2334-9-92
Abstract: Reported MDA coverage and results from initial surveys and post-MDA surveys of LF using the immunochromatographic test (ICT) from these five Pacific Island countries (Tonga, Niue, Vanuatu, Samoa and Cook Islands) were analysed to provide an understanding of their quality and programme progress towards LF elimination. Denominator data reported by each country programme for 2001 was compared to official sources to assess the accuracy of MDA coverage data.Initial survey results from these five countries revealed an ICT prevalence of between 2.7 and 8.6 percent in individuals tested prior to commencement of the programme. Country MDA coverage results varied depending on the source of denominator data. Of the five countries in this case study, three countries (Tonga, Niue and Vanuatu) reached the target prevalence of <1% antigenaemia following five rounds of MDA. However, endpoint data could not be reliably compared to baseline data as survey methodology varied.Accurate and representative baseline and post-campaign prevalence data is crucial for determining program effectiveness and the factors contributing to effectiveness. This is emphasised by the findings of this case study. While three of the five Pacific countries reported achieving the target prevalence of <1% antigenaemia, limitations in the data preclude identification of key determinants of this achievement.Lymphatic filariasis (LF), an infection caused by a mosquito borne parasite, is the second leading cause of disability worldwide, affecting more than 120 million people in 80 countries [1-3]. It is a major cause of physical and emotional suffering, as well as economic loss [4,5]. The three species of nematode worm that cause LF are Wuchereria bancrofti, Brugia malayi and Brugia timori [6]. Bancroftian filariasis accounts for 90% of cases worldwide [6], including all cases of LF in the Pacific [2].In 1997 the World Health Organization (WHO) declared LF one of six potentially eradicable diseases [2]. Subsequen
Using the SaTScan method to detect local malaria clusters for guiding malaria control programmes
Marlize Coleman, Michael Coleman, Aaron M Mabuza, Gerdalize Kok, Maureen Coetzee, David N Durrheim
Malaria Journal , 2009, DOI: 10.1186/1475-2875-8-68
Abstract: SaTScan? software using the Kulldorf method of retrospective space-time permutation and the Bernoulli purely spatial model was used to identify malaria clusters using definitively confirmed individual cases in seven towns over three malaria seasons. Following passive case reporting at health facilities during the 2002 to 2005 seasons, active case detection was carried out in the communities, this assisted with determining the probable source of infection. The distribution and statistical significance of the clusters were explored by means of Monte Carlo replication of data sets under the null hypothesis with replications greater than 999 to ensure adequate power for defining clusters.SaTScan detected five space-clusters and two space-time clusters during the study period. There was strong concordance between recognized local clustering of cases and outbreak declaration in specific towns. Both Albertsnek and Thambokulu reported malaria outbreaks in the same season as space-time clusters. This synergy may allow mutual validation of the two systems in confirming outbreaks demanding additional resources and cluster identification at local level to better target resources.Exploring the clustering of cases assisted with the planning of public health activities, including mobilizing health workers and resources. Where appropriate additional indoor residual spraying, focal larviciding and health promotion activities, were all also carried out.Malaria is the most important parasitic disease of humans. Over three billion people live in malarious areas and the disease causes over 500 million cases with one to three million deaths per year [1,2]. An estimated one hundred million people in Africa are at risk of malaria epidemics [3]. In common with most vector-borne infectious diseases, malaria is heterogeneous in its distribution in time and space [4-6], and incidence can vary greatly between districts, towns and villages. This heterogeneity is affected by patterns of malaria v
Evaluation of an operational malaria outbreak identification and response system in Mpumalanga Province, South Africa
Marlize Coleman, Michael Coleman, Aaron M Mabuza, Gerdalize Kok, Maureen Coetzee, David N Durrheim
Malaria Journal , 2008, DOI: 10.1186/1475-2875-7-69
Abstract: Using five years of historical notification data, two binomial thresholds were determined for each primary health care facility in the highest malaria risk area of Mpumalanga province. Whenever the thresholds were exceeded at health facility level (tier 1), primary health care staff notified the malaria control programme, which then confirmed adequate stocks of malaria treatment to manage potential increased cases. The cases were followed up at household level to verify the likely source of infection. The binomial thresholds were reviewed at village/town level (tier 2) to determine whether additional response measures were required. In addition, an automated electronic outbreak identification system at town/village level (tier 2) was integrated into the case notification database (tier 3) to ensure that unexpected increases in case notification were not missed.The performance of these binomial outbreak thresholds was evaluated against other currently recommended thresholds using retrospective data. The acceptability of the system at primary health care level was evaluated through structured interviews with health facility staff.Eighty four percent of health facilities reported outbreaks within 24 hours (n = 95), 92% (n = 104) within 48 hours and 100% (n = 113) within 72 hours. Appropriate response to all malaria outbreaks (n = 113, tier 1, n = 46, tier 2) were achieved within 24 hours. The system was positively viewed by all health facility staff. When compared to other epidemiological systems for a specified 12 month outbreak season (June 2003 to July 2004) the binomial exact thresholds produced one false weekly outbreak, the C-sum 12 weekly outbreaks and the mean + 2 SD nine false weekly outbreaks. Exceeding the binomial level 1 threshold triggered an alert four weeks prior to an outbreak, but exceeding the binomial level 2 threshold identified an outbreak as it occurred.The malaria outbreak surveillance system using binomial thresholds achieved its primary goal o
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