ORCID Profile
0000-0001-9833-4882
Current Organisations
University Hospitals Birmingham NHS Foundation Trust
,
UK Health Security Agency
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2005
DOI: 10.1097/01.QAI.0000174251.35398.72
Abstract: South Africa is one of the countries most severely affected by the global HIV/AIDS pandemic. The effects of increased numbers of sick patients on rural district hospitals are not well documented. This study summarizes the changes in number and type of hospital admissions to the medical wards of a small rural district hospital in Northern KwaZulu/Natal, South Africa, between 1991 and 2002. For the same 2-month period, across the study period total admissions rose by 228 to 626 patients with no increase in hospital staff or capacity. Length of inpatient stay fell from 10.9 to 7.9 days, and inpatient mortality rose from 8% to 20%. The median age of female patients fell from 50 to 34 years, and the median male patient's age fell from 45 from 39 years over the study period. After 1991, tuberculosis became the most frequent diagnosis, and in 2002 it was the leading cause of death. The HIV epidemic has increased the number of medical hospital admissions, primarily infectious diseases such as tuberculosis, lower respiratory infection, and diarrheal illness. Comprehensive strategies are needed to reduce the community burden of disease and minimize the impact of HIV on the health services.
Publisher: European Respiratory Society (ERS)
Date: 07-06-2018
Publisher: Wiley
Date: 09-2008
DOI: 10.1002/JMV.21241
Publisher: BMJ
Date: 04-2019
DOI: 10.1136/BMJOPEN-2018-025192
Abstract: To compare health-related quality of life and prevalence of chronic diseases in housed and homeless populations. Cross-sectional survey with an age-matched and sex-matched housed comparison group. Hostels, day centres and soup runs in London and Birmingham, England. Homeless participants were either sleeping rough or living in hostels and had a history of sleeping rough. The comparison group was drawn from the Health Survey for England. The study included 1336 homeless and 13 360 housed participants. Chronic diseases were self-reported asthma, chronic obstructive pulmonary disease (COPD), epilepsy, heart problems, stroke and diabetes. Health-related quality of life was measured using EQ-5D-3L. Housed participants in more deprived neighbourhoods were more likely to report disease. Homeless participants were substantially more likely than housed participants in the most deprived quintile to report all diseases except diabetes (which had similar prevalence in homeless participants and the most deprived housed group). For ex le, the prevalence of chronic obstructive pulmonary disease was 1.1% (95% CI 0.7% to 1.6%) in the least deprived housed quintile 2.0% (95% CI 1.5% to 2.6%) in the most deprived housed quintile and 14.0% (95% CI 12.2% to 16.0%) in the homeless group. Social gradients were also seen for problems in each EQ-5D-3L domain in the housed population, but homeless participants had similar likelihood of reporting problems as the most deprived housed group. The exception was problems related to anxiety, which were substantially more common in homeless people than any of the housed groups. While differences in health between housed socioeconomic groups can be described as a ‘slope’, differences in health between housed and homeless people are better understood as a ‘cliff’.
Publisher: Oxford University Press (OUP)
Date: 15-09-2004
DOI: 10.1086/423326
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2003
DOI: 10.1097/01.INF.0000101188.95433.60
Abstract: Malaria and HIV are important pediatric problems in sub-Saharan Africa. It is uncertain how HIV-related immunosuppression and malaria interact in children. We aimed to describe associations among HIV status, presentation and outcome from malaria in children from Hlabisa district, KwaZulu-Natal, South Africa, a region of high HIV prevalence and unstable Plasmodium falciparum transmission. Consecutive febrile children were screened for malaria with a rapid antigen test. After consent was given, clinical data were recorded, and blood spots were obtained for HIV antibody testing. Cases were managed according to national guidelines. Malaria was diagnosed in 663 children, of whom 10.1% were HIV antibody-positive. Semiquantitative asexual and sexual stage parasitemia densities were unrelated to HIV status. Overall 161 children were hospitalized 19 (12%) were 1 year old with coma (P = 0.02) and hypoglycemia (P = 0.05). Receiving parenteral antibiotics was associated with severe disease (odds ratio, 3.0 95% confidence interval, 1.3 to 6.7) whereas a low white blood cell count (<4 x 10(6)/l) was associated with nonsevere disease (odds ratio, 0.4 95% confidence interval, 0.2 to 0.8). Seven children (4.3%) died. Coma, age <1 year and low white blood cell count were the clearest predictors of poor outcome. HIV infection was associated with severe/complicated malaria, although the magnitude of the effect may be relatively small. Given that both malaria and HIV are widespread in Africa, even small effects may generate significant morbidity and mortality and major public health consequences.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2004
DOI: 10.1097/00002030-200402200-00023
Abstract: Malaria and HIV are two of the most important diseases facing Africa. It remains uncertain whether HIV-related immunosuppression adversely affects the clinical outcome of malaria. To measure the association between HIV status and outcome from malarial infection in adults living in a region of unstable malaria transmission. Observational cohort study. Four community clinics and the Government hospital in Hlabisa district, KwaZulu-Natal, South Africa a region of high HIV prevalence. Consecutive febrile adults were screened for malaria with a rapid antigen test. Those with malaria provided blood spots for HIV testing, a thick blood film for confirmation of malaria and clinical data. Outcome was established following management according to South African government guidelines. Malaria was microscopically confirmed in 613. HIV prevalence was 29.9% (180/613) 110 (18%) had severe/complicated malaria and 28 (4.6%) died. HIV-infected patients were more likely to vomit or be confused and were more likely to be admitted to hospital (P = 0.05). In patients admitted to hospital, HIV infection was associated with severe/complicated malaria [adjusted odds ratio (OR) 2.3 95% confidence interval (CI), 1.4-3.9] and with death (OR 7.5 95% CI, 2.2-25.1). Acidosis and coma were also strong independent risk factors for death. HIV infection had an unexpectedly large association with the outcome of falciparum malaria in a region of unstable transmission. Both diseases are widespread in Africa and these results add to the body of knowledge suggesting an interaction of significant public health importance between HIV and malaria in Africa.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Martin Dedicoat.