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Background and objectivePopulation-appropriate lung function reference data are essential to accurately identify respiratory disease and measure response to interventions. There are currently no reference data in African infants. The aim was to describe normal lung function in healthy African infants.MethodsLung function was performed on healthy South African infants enrolled in a birth cohort study, the Drakenstein child health study. Infants were excluded if they were born preterm or had a history of neonatal respiratory distress or prior respiratory tract infection. Measurements, made during natural sleep, included the forced oscillation technique, tidal breathing, exhaled nitric oxide and multiple breath washout measures.ResultsThree hundred sixty-three infants were tested. Acceptable and repeatable measurements were obtained in 356 (98%) and 352 (97%) infants for tidal breathing analysis and exhaled nitric oxide outcomes, 345 (95%) infants for multiple breath washout and 293 of the 333 (88%) infants for the forced oscillation technique. Age, sex and weight-for-age z score were significantly associated with lung function measures.ConclusionsThis study provides reference data for unsedated infant lung function in African infants and highlights the importance of using population-specific data.

Background and objectiveNon-invasive techniques for measuring lung mechanics in infants are needed for a better understanding of lung growth and function, and to study the effects of prenatal factors on subsequent lung growth in healthy infants. The forced oscillation technique requires minimal cooperation from the individual but has rarely been used in infants. The study aims to assess the use of the forced oscillation technique to measure the influence of antenatal exposures on respiratory mechanics in unsedated infants enrolled in a birth cohort study in Cape Town, South Africa.MethodsHealthy term infants were studied at 6–10 weeks of age using the forced oscillation technique. Respiratory impedance was measured in the frequency range 8–48 Hz via a face mask during natural sleep. Respiratory system resistance, compliance and inertance were calculated from the impedance spectra.ResultsOf 177 infants tested, successful measurements were obtained in 164 (93%). Median (25–75%) values for resistance, compliance and inertance were 50.2 (39.5–60.6) cmH2O.s.L−1, 0.78 (0.61–0.99) mL.cmH2O−1 and 0.062 (0.050–0.086) cmH2O.s2.L−1, respectively. As a group, male infants had 16% higher resistance (P = 0.006) and 18% lower compliance (P = 0.02) than females. Infants whose mothers smoked during pregnancy had a 19% lower compliance than infants not exposed to tobacco smoke during pregnancy (P = 0.005). Neither maternal HIV infection nor ethnicity had a significant effect on respiratory mechanics.ConclusionsThe forced oscillation technique is sensitive enough to demonstrate the effects of tobacco smoke exposure and sex in respiratory mechanics in healthy infants. This technique will facilitate assessing perinatal influences of lung function in infancy.

Background. Despite the challenges facing healthcare in South Africa, empirical insights into the performance of healthcare services over time are scarce. Methods. We analysed first admissions of adult medical inpatients to Groote Schuur Hospital, Cape Town, from January 2002 to July 2009. Data included age, sex, medical specialty, and date of admission and discharge. We used population group and hospital billing codes as proxy measures for socio-economic status (SES). We calculated the duration of stay in days from the date of admission to discharge, and inpatient mortality rates per 1 000 patient days. Poisson regression was used to estimate mortality rate ratios (MRR) in unadjusted analysis and after adjusting for potential confounders. Annual increases in mortality rates were highest during the first 2 days following admission (increasing from 30.1 to 50.3 deaths per 1 000), and were associated with increasing age, non-paying patient status, black population group and male sex, and were greatest in the emergency ward (adjusted MRR 1.73, comparing 2009 with 2002; 95% CI 1.49 -2.01). Discussion. Increasing medical inpatient mortality rates at a large South African academic hospital were most marked during the first 2 days after admission and appeared greatest among emergency medical inpatients.

Methods: Between 2006 and2010, we enrolled Thai MSM, age ‡ 18 years, from the Bangkok metropolitan area. Participants completed sexual behavior questions using audio computerassisted self-interviews, and underwent physical examination, and rectal, urethral, and pharyngeal screening for CT and NG using nucleic acid amplification testing (NAAT). We calculated NNS as the reciprocal of the proportion of asymptomatic MSM with unrecognized infection detected by NAAT. Results: Of 1,744 participants enrolled, 1593 (91%) had no symptoms or signs of CT/NG at baseline. We detected CT infection in 216 (14%), NG infection in 99 (6%), and CT/NG co-infection in 40 (2.5%). The overall NNS to detect CT and/or NG at any sites was 5 (95% Confidence Interval [CI] 5-6). Among insertive-only MSM (n = 285), the chance of detecting urethral CT infection (NNS 11, 95% CI 8-19) was higher than detecting urethral NG infection (NNS 71, 95% CI 36-2646, p < 0.05). Among versatile MSM (n = 1284), the NNS for infection at any site was 7 (95% CI 6-8) for CT, and 14 (95% CI 12-18) for NG. Among receptive only MSM (n = 287), the NNS for infection at rectal was 6 (95% CI 5-9). Conclusions: Asymptomatic CT and NG infection in this population is high. Given that the NNS in asymptomatic sexually active MSM is low, annual screening using NAAT for all sites can diminish progression of diseases and disrupt transmission. In settings where screening all specimen sites is not available, the rectal swab test should be a priority. P49.13Withdrawn P49.14 HIV-1