Investigation into changes in inflammatory and immune cell markers in pre-diabetic patients from Durban, South Africa

The prevalence of pre-diabetes is increasing in rapidly urbanizing cities, especially in individuals aged 25 - 45 years old. Studies also indicate that this condition is associated with aberrant immune responses that are also influenced by environmental factors. This study sought to investigate changes in the concentration of immune cells and select inflammatory markers in patients with pre-diabetes in Durban, South Africa. Blood samples collected from King Edward Hospital, after obtaining ethics approval, were divided into non-diabetic (ND), pre-diabetic (PD) and type 2 diabetic (T2D) using ADA criteria. In each sample, the concentration of immune cells and select inflammatory markers were determined. The results showed a significant increase in eosinophil and basophil levels in the PD group as compared to the ND group. Compared to ND, the PD and T2D groups had significant increases in serum TNFα, CD40L and fibrinogen concentrations. Additionally, there were decreases in serum CRP, IL-6, and P-selectin in the PD group while these markers increased in the T2D group. These findings were indicative of immune activation and highlight the impact of pre-diabetes in this population. More studies are recommended with a higher number of samples that are stratified by gender and represent the gender ratio in the city.

Patients' experiences in the use of mobile health clinics in KwaMachi rural area of KwaZulu-Natal, South Africa

Background

A study was conducted to evaluate the role of mobile health clinics (MHCs) in providing healthcare services in rural areas, focusing on the population of KwaMachi in KwaZulu Natal, South Africa. The objective of the study was to explore the level of health promotion and health-seeking behaviour in KwaMachi, understand the services provided by the MHCs, and assess the experiences of individuals accessing healthcare through these clinics.

Methods

The study used qualitative research methods, including face-to-face interviews and focused group discussions. A sample of 20 patients, with equal representation of males and females across different age groups, was selected using purposive and convenience sampling methods. Two themes were developed: positive experiences and negative experiences. The collected data was analyzed using manual thematic analysis.

Findings

The findings of the study revealed that MHCs serve as the main entry point to the national healthcare system in rural areas, but they offer limited services, which contributes to the ongoing struggle of rural communities to access primary healthcare. While respondents generally had positive experiences with MHCs, some negative aspects need to be addressed. These included concerns about privacy during consultations, the unavailability of essential medications, limited services offered, lack of doctors, and inadequate management of clinical records leading to diagnostic inaccuracies.

Conclusion

The study highlights the challenges faced by rural communities in accessing healthcare services and the role of MHCs in addressing these challenges Based on these findings, the study concludes that there is a need for sustainable MHC programs that address the specific needs and preferences of the local population.

Recommendations

These insights are of value to policymakers seeking to enhance the impact of MHCs in improving healthcare access and outcomes in rural areas. By looking at areas of improvement in the services provided by MHCs, including addressing privacy concerns, ensuring the availability of essential medications, and improving the management of clinical records. The study provides valuable insights for policymakers to enhance the effectiveness of MHC programs in rural areas.

Development and validation of an intervention for childhood trauma and exposure to violence in Vhembe District, South Africa

Most strategies are implemented; however, South Africa needs to evaluate and develop trauma interventions. The study aims to develop, test and validate childhood trauma exposure intervention in the Vhembe district, Limpopo province. Donabedian's structure-process-outcome model will guide the study. The study will employ multiphase mixed methods with five phases. Phase 1 will be a thorough systematic evaluation of literature on childhood trauma and exposure to violence interventions to describe existing interventions. Phase 2, stage 1: Will explore the experiences of children exposed to trauma and violence regarding their experiences of the treatment they received, using semi-structured qualitative interviews. Non-probability purposeful sampling techniques will be used to select participants. The Thoyondou Victim Empowerment's database will select participants. The researchers will conduct semi-structured and unstructured interviews with youngsters exposed to violence and trauma. Stage 2 will be a qualitative study of trauma centre managers and personnel sampled from the contact record. IPA will analyze data. Phase 3 will conceptualize Phase 1 and the empirical phase into Donabedian's SPO framework for Phase 4. Phase 4 develops the intervention using Phase 3's conceptual framework and tests and validates it.

Preventing Stunting in South African Children Under 5: Evaluating the Combined Impacts of Maternal Characteristics and Low Socioeconomic Conditions

More than 140 million children under five suffered from stunting in 2020. This highlights the ongoing challenge of addressing childhood malnutrition globally. We utilized data from a nationally representative sample of children under five years of age (n = 14,151) who participated in five cycles of the South African National Income Dynamics Study (SA-NIDS) (2008-2017). We estimated the proportion of stunted children attributed to the mothers' anthropometric characteristics and socioeconomic conditions. We also quantified the population-level burden of low-socioeconomic conditions on hunger/food insecurity among pregnant women (n = 22,814) who participated in the nine rounds of the South African General Household Surveys (GHS) (2008-2021). Results from weighted-multivariate logistic regression were incorporated into the population-level impacts of correlates of stunting and low-socioeconomic conditions. The prevalence of stunting declined from 25% in 2008 to 23% in 2017. Mothers' anthropometric measures (underweight/height < 160 cm), marital status, low education, absence of medical insurance and low-socioeconomic conditions were all identified as the most influential risk factors for stunting. Their population-level impacts on stunting increased substantially from 34% (in 2008) to 65% (in 2017). Comprehensive strategies emphasizing enhanced food security, extended breastfeeding, appropriate nutrition, and access to adequate healthcare and education are urgently needed to reduce the burden of food insecurity low-socioeconomic, malnutrition, and its long-term consequences.

Family functioning and problematic usage of the internet in youth: A cross-sectional investigation

BACKGROUND

Problematic usage of the internet (PUI) refers to maladaptive use of the Internet linked to functional impairment as a growing concern in many countries. Youths are often considered more vulnerable to PUI than other age groups. The relationship between PUI and family dynamics is likely bidirectional and complex, warranting further research. Using a cross-sectional study design, we aimed to determine the rate of PUI and the association between PUI and family functioning in a South African sample between the ages of 18 and 30 years.

METHODS

South African youths were recruited via email and social media. Respondents completed an online survey as part of a cross-sectional study to assess the extent and the types of activities for which they use the internet, as well as the quality of their family relationships and functioning, employing standardised questionnaires (including the IAT-10) and the General Functioning Scale of the Family Assessment Device (GF-FAD). The sample included 814 participants (65% female; aged 21 years; SD 3 years).

RESULTS

15.5% of our sample presented with PUI. There was a significant, moderate positive correlation between totals on the IAT-10 and GF-FAD (r = 0.33, p < .001). An independent samples t-test found that individuals with self-reported PUI (GF-FAD: M = 2.57, SD = 0.51) had significantly poorer quality family functioning than individuals without PUI (GF-FAD: M = 2.13, SD = 0.61; t (812) = -7.52, p < .001; Cohen's d = -0.73, 95% CI [-0.92, -0.54]). Correlations were found between increased time spent on various online activities, including pornography (r = 0.20, p < 0.001), cyberbullying (r = 0.17, p < 0.001), social networking (r = 0.11, p = 0.003), and streaming media (r = 0.11, p = 0.003), and poorer quality family functioning.

CONCLUSION

PUI is common in South African youth. Presence of PUI and increased PUI severity were associated with worse family functioning in this sample. We recommend using family-based approaches in promoting a healthy family environment, and in the prevention of PUI and mitigation of its effects, with the goal of striking a balance between the benefits of the internet and its potential role in compromising aspects of family relationships.

Prevalence and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa

INTRODUCTION

Between 10 and 20% of children and adolescents globally experience common mental health conditions such as depression or anxiety. Given the dearth of mental health services in low- and middle-income countries, most mental health conditions among adolescents remain undiagnosed and untreated. In South Africa, few studies have explored the prevalence of depression and anxiety among young adolescents aged 10-14 years. This study examined the prevalence of, and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa.

METHODS

A cross-sectional study was conducted in 10 schools in the Western Cape Province from February to July 2022. Data were collected using a tablet-based survey and included sociodemographic items, the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire for Adolescents (PHQ-A) and other psychosocial measures. The prevalence of depression and anxiety was estimated based on cut-off scores for the GAD-7 and PHQ-A. Multivariable logistic regression models were used to investigate the associations between sociodemographic and psychosocial factors, and depression and anxiety.

RESULTS

Of the 621 adolescents, 33.5% (n = 208) reported experiencing symptoms of depression and 20.9% (n = 130) symptoms of anxiety potentially indicative of a diagnosis. The results of the multivariable logistic regression model indicate that being in a higher grade in school (AOR = 1.65, CI:1.43-1.92), any lifetime alcohol use (AOR = 1.62, CI:1.04-2.64), other drug use (AOR = 2.07, CI:1.06-4.04), and witnessing violence among adults at home (AOR = 2.12, CI:1.07-1.41) were significantly associated with experiencing depressive symptoms. Being in a higher grade in school (AOR = 1.69, CI: 1.42-2.01), poor emotional regulation skills (AOR = 1.03, CI: 1.00-1.07), and the use of cannabis (AOR = 1.03, CI: 1.00-1.07) were significantly associated with experiencing anxiety symptoms.

CONCLUSION

These findings add to our understanding of school-going adolescents' pressing mental health needs and suggest that mental health adolescent and caregiver interventions may be required to address mental health symptoms and associated risk factors.

Biomonitoring of bisphenol A (BPA) and bisphenol analogues in human milk from South Africa and Canada using a modified QuEChERS extraction method

A sensitive modified QuEChERS extraction method was developed to assess the levels of free and conjugated bisphenols (BPs) in human milk collected between 2018 and 2019 from two regions of South Africa (the Limpopo Province Vhembe district, n = 194; Pretoria, n = 193) and Canada (Montreal, n = 207). Total BPA (free and conjugated) and BPS were the predominant bisphenols detected in samples from Vhembe and Pretoria, whereas total BPS was the predominant bisphenol detected in Montreal samples. The levels of total BPA in samples from Vhembe and Pretoria ranged between < MDL-18.61 and Collapse

Key Words

• Biomonitoring
• Bisphenols
• Canada
• Human milk
• Liquid chromatography–mass spectrometry
• South Africa

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MESH Headings

• Humans
• South Africa
• Biological Monitoring
• Milk, Human/chemistry
• Benzhydryl Compounds/analysis
• Canada
• Phenols

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Affiliation(s)

Zhi Hao Chi Department of Food Science and Agricultural Chemistry, McGill University, Montreal, QC, Canada
Lan Liu Department of Food Science and Agricultural Chemistry, McGill University, Montreal, QC, Canada
Jingyun Zheng Department of Food Science and Agricultural Chemistry, McGill University, Montreal, QC, Canada
Lei Tian Department of Food Science and Agricultural Chemistry, McGill University, Montreal, QC, Canada
Jonathan Chevrier Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
Riana Bornman University of Pretoria, Pretoria, South Africa
Muvhulawa Obida University of Pretoria, Pretoria, South Africa
Cynthia Gates Goodyer McGill University Health Centre Research Institute, Montreal, QC, Canada
Barbara F Hales Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
Stéphane Bayen Department of Food Science and Agricultural Chemistry, McGill University, Montreal, QC, Canada.

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Longitudinal Correlates of Grandparenting with Depressive Symptoms and Poor Sleep Quality Among Middle-Aged and Older Women and Men in South Africa

OBJECTIVES

The study aimed to assess the impact of grandparenting on incident depressive symptoms and incident poor sleep quality among aging women and men in rural South Africa.

METHODS

This longitudinal community study enrolled 3,237 adults (≥40 years) from the "Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)."

MEASUREMENTS

Grandparenting was assessed by self-report at wave 1, and depressive symptoms and poor sleep quality at waves 1 and 2. Outcomes were incident depressive symptoms and incident poor sleep quality at wave 2. Logistic regression was utilized to estimate the associations between grandparenting and incident depressive symptoms and incident poor sleep quality.

RESULTS

Almost half of the grandfathers (44.6%) and 68.4% of the grandmothers were parenting 7/days/week. In the final adjusted models, among grandmothers, compared to 0 days/week grandparenting, 7 days/week grandparenting reduced the odds of incident depressive symptoms (AOR: 0.71, 95% CI: 0.55 to 0.91) and reduced the odds of incident poor sleep quality (AOR: 0.58, 95% CI: 0.40 to 0.82).

CONCLUSION

Grandparenting significantly reduced poor mental health among grandmothers but not among grandfathers.

CLINICAL IMPLICATIONS

Practitioners may encourage grandparent caregiving, among grandmothers, to reduce poor mental health in South Africa.

First Report of Rust Caused by Phakopsora nishidana on Creeping Fig, Ficus pumila, in South Africa

Phakopsora nishidana has recently been reported as the causal organism of rust on edible fig, Ficus carica in South Africa (SA) (Boshoff et al. 2022). This contradicted reports by Doidge (1927, 1950) and Verwoerd (1929) who listed Cerotelium fici as the causal organism of the disease in SA. Similarities in urediniospore morphology and differing taxonomic interpretations most likely contributed to the use of both pathogen names as the causal agents for fig rust (Boshoff et al. 2022; Padamsee and McKenzie 2024). In January 2023 rust was commonly observed on nursery specimens of creeping fig, Ficus pumila, a popular evergreen and fast-growing garden plant in SA. Ficus pumila is native to southern China, Indochina, and eastern Asia but has been introduced to many countries worldwide (https://powo.science.kew.org/ accessed 20 March 2024). The F. pumila rust isolate collected in Somerset West (34°07'00.70"S, 18°52'41.75"E; Western Cape (WC) province) was identified using the sequenced 5.8S rRNA-ITS2-28S rRNA locus. When used in a BLAST analysis, this F. pumila isolate (GenBank accession number OR835538) shared the best homology with the Vermont P. nishidana isolate (34°24'33.37"S, 19°08'59.24"E) (MZ047090; e-value 0.0, 99.7% identity, 1400/1404 bp) reported on edible fig by Boshoff et al. (2022). Other P. nishidana isolates with excellent homology were KY764080 (e-value 0.0, 99.8% identity, 1012/1014 bp), KY764081 (e-value 0.0, 99% identity, 882/885 bp) and MF580676 (e-value 0.0, 99.3% identity, 981/988 bp). Accessions were used in a phylogenetic study that included four other rust samples collected from F. carica trees in Somerset West, WC (OR835534; 34°03'37.26"S, 18°51'02.18"E), Onrus River, WC (OR835535; 34°24'43.10"S, 19°09'57.99"E), Elgin, WC (OR835536; 34°14'31.37"S, 19°03'05.38"E), and Bloemfontein, Free State province (OR835537; 29°05'05.1"S 26°09'09.5"E). Reference sequences were as described in Boshoff et al. (2022). Despite limited variation, all six South African isolates, including the F. pumila isolate, grouped with the three P. nishidana reference isolates, but separate from the three P. myrtacearum isolates collected from eucalyptus trees (Maier et al. 2016). Uredinia on F. pumila leaves were mostly hypophyllous and surrounded by a halo of brown, necrotic tissue. On the upper leaf surface, the lesions appeared as small, dark leaf spots with infrequent sporulation. Urediniospores were echinulate, mostly obovoid or elliptical and their cell walls pale-yellow to yellowish-brown. The mean width and length of urediniospores were 16.7 x 21.3 µm. No telia were observed. Applying standard rust inoculation and incubation procedures (Boshoff et al. 2022), F. pumila plants inoculated with P. nishidana isolate PREM63073 produced sporulating uredinia on the abaxial surface of leaves. Likewise, inoculation of F. carica cv. Kadota leaves with the F. pumila isolate OR835538 yielded sporulating lesions containing urediniospores typical of P. nishidana, on the lower surface. Based on both the DNA sequence data and controlled infection studies, our study confirmed the host status of F. pumila for P. nishidana. The occurrence of rust on creeping fig plants in nurseries, the evergreen status of the creeper, and thus the potential to harbor the pathogen during winter, are likely to contribute to the spread of fig rust in SA.

Integrating 'undetectable equals untransmittable' into HIV counselling in South Africa: the development of locally acceptable communication tools using intervention mapping

BACKGROUND

The global campaign for "Undetectable equals Untransmittable" (U = U) seeks to spread awareness of HIV treatment as prevention, aiming to enhance psychological well-being and diminish stigma. Despite its potential benefits, U = U faces challenges in Sub-Saharan Africa, with low awareness and hesitancy to endorse it. We sought to develop a U = U communications intervention to support HIV counselling in primary healthcare settings in South Africa.

METHODS

We used Intervention Mapping (IM), a theory-based framework to develop the "Undetectable and You" intervention for the South African context. The six steps of the IM protocol were systematically applied to develop the intervention including a needs assessment consisting of a systematic review and qualitative research including focus group discussions (FGD) and key informant (KI) interviews. Program objectives and target population were determined before designing the intervention components and implementation plan.

RESULTS

The needs assessment indicated low global U = U awareness, especially in Africa, and scepticism about its effectiveness. Lay counsellors and clinic managers stressed the need for a simple and standardized presentation of U = U addressing both patients' needs for encouragement and modelling of U = U success but also clear guidance toward ART adherence behaviour. Findings from each step of the process informed successive steps. Our final intervention consisted of personal testimonials of PLHIV role models and their partners, organized as an App to deliver U = U information to patients in primary healthcare settings.

CONCLUSIONS

We outline an intervention development strategy, currently in evaluation stage, utilizing IM with formative research and input from key U = U stakeholders and people living with HIV (PLHIV).

Analysis of sociodemographic characteristics of learners

The outbreak of COVID-19 had resulted in the complete closure of schools in nearly all countries across the globe. However, reopening after prolonged closure may adversely affect the school attendance of learners, with long-term implications for life outcomes. Given the limited studies on the subject, this study aims at examining the impact of COVID-19 on the school attendance of learners in South Africa and how this outcome is exacerbated by underlying socioeconomic factors using National Income Dynamics Study-Coronavirus Rapid Mobile Survey data (NIDS-CRAM). The findings reveal that COVID-19 has led to a sharp drop of 48.2% in the school attendance of learners following the reopening of schools after the state of national disaster-based lockdown. The study has demonstrated that the impact of COVID-19 on the school attendance of learners varies according to socioeconomic factors such as gender, race, geographical area, family size, and the economic status of the learners' parents and provincial location. Sociodemographic characteristics such as African race, coloured race, Asian race, female gender, rural location, large household size, and Eastern Cape are associated with lower school attendance among learners. Based on these findings, educational-based policy needs to include these sociodemographic factors to promote a high school attendance rate among learners. This may include a shift from a blanket approach to geographical, racial, family, and gender-based interventions.

Advocacy Coalitions, Policy Entrepreneurs, and Windows of Opportunity: Tobacco Control in South Africa, 1948-2018

This article examines the political history of tobacco control policy in South Africa from 1948 to 2018 by drawing on available historical documents, media reports, published books and articles, the grey literature, and face-to-face interviews with key policy actors. Tracing the historical evolution of tobacco control policies in South Africa reveals how embedded opposition from vested interest groups at every stage of the policy process complicates responses to the tobacco issue. This case study demonstrates how, despite such embedded difficulties, a confluence of regime change, evidence-based messaging, political will, policy entrepreneurs, and advocacy coalitions have led to the gradual transformation of tobacco control policy in South Africa over time. Understanding the historical evolution of tobacco control policy in South Africa opens up space for an in-depth inquiry that allows researchers to trace the policy-making process over the last seven decades, and to understand how those processes have facilitated a shift in the orientation of policy makers over time.

Health-Related Quality of Life of Adolescent and Young Adult-Aged Childhood Cancer Survivors in a South African Cohort: A Pilot Study Using the Minneapolis-Manchester Quality of Life Instrument

Purpose: We investigated the health-related quality of life (HRQoL) of an adolescent and young adult (AYA)-aged South African childhood cancer survivor (CCS) cohort. Methods: Participants completed the Minneapolis-Manchester Quality of Life adolescent and adult forms. The overall Cronbach's alpha coefficients were 0.81 (adolescent form) and 0.92 (adult form). The scale-level content validity indexes were acceptable (0.88 and 0.89 for the adolescent and adult forms, respectively). The total domain and overall HRQoL scores were calculated. Results: Sixty-two survivors completed the adolescent form and 30 completed the adult form. The median age was 17.5 years (range 13-34 years), and the median time from diagnosis was 12 years (male:female ratio 1:1.2). Risk factors for poor physical functioning included age at study visit (p = 0.015), solid tumor diagnosis (p = 0.012), radiotherapy (p = 0.021), and surgery (p = 0.006). Six or more late effects impacted most domains negatively; severe late effects (p = 0.020) decreased physical functioning. Lower socioeconomic status was associated with poorer physical (p = 0.006) and cognitive (p = 0.047) functioning. The adult form cohort had poorer psychological (p = 0.014) and social functioning (p = 0.005) and body image (p = 0.016) than the adolescent form cohort. Conclusion: Older age, radiotherapy, surgery, solid tumor diagnosis, and the number and severity of late effects negatively influenced HRQoL in AYA-aged CCSs. A long-term follow-up (LTFU) risk stratification system should include HRQoL status to assist with holistic LTFU care.

Draft genome sequences of two β-glucuronidase positive strains of Salmonella enterica subspecies salamae isolated from reptile feces in KwaZulu-Natal, South Africa

Two Salmonella enterica isolates obtained from reptile feces displayed β-glucuronidase activity. Nearly complete genome sequences were obtained after shotgun sequencing and de novo genome assembly. By comparison to reference genomes, both isolates were identified as Salmonella enterica subspecies salamae with the sequence type identified as 1208 and the serotype as 42:r:-.

Unravelling the maternal evolutionary history of the African leopard (Panthera pardus pardus)

The African leopard (Panthera pardus pardus) has lost a significant proportion of its historical range, notably in north-western Africa and South Africa. Recent studies have explored the genetic diversity and population structure of African leopards across the continent. A notable genetic observation is the presence of two divergent mitochondrial lineages, PAR-I and PAR-II. Both lineages appeared to be distributed widely, with PAR-II frequently found in southern Africa. Until now, no study has attempted to date the emergence of either lineage, assess haplotype distribution, or explore their evolutionary histories in any detail. To investigate these underappreciated questions, we compiled the largest and most geographically representative leopard data set of the mitochondrial NADH-5 gene to date. We combined samples (n = 33) collected in an altitudinal transect across the Mpumalanga province of South Africa, where two populations of leopard are known to be in genetic contact, with previously published sequences of African leopard (n = 211). We estimate that the maternal PAR-I and PAR-II lineages diverged approximately 0.7051 (0.4477-0.9632) million years ago (Ma). Through spatial and demographic analyses, we show that while PAR-I underwent a mid-Pleistocene population expansion resulting in several closely related haplotypes with little geographic structure across much of its range, PAR-II remained at constant size and may even have declined slightly in the last 0.1 Ma. The higher genetic drift experienced within PAR-II drove a greater degree of structure with little haplotype sharing and unique haplotypes in central Africa, the Cape, KwaZulu-Natal and the South African Highveld. The phylogeographic structure of PAR-II, with its increasing frequency southward and its exclusive occurrence in south-eastern South Africa, suggests that this lineage may have been isolated in South Africa during the mid-Pleistocene. This hypothesis is supported by historical changes in paleoclimate that promoted intense aridification around the Limpopo Basin between 1.0-0.6 Ma, potentially reducing gene flow and promoting genetic drift. Interestingly, we ascertained that the two nuclear DNA populations identified by a previous study as East and West Mpumalanga correspond to PAR-I and PAR-II, respectively, and that they have come into secondary contact in the Lowveld region of South Africa. Our results suggest a subdivision of African leopard mtDNA into two clades, with one occurring almost exclusively in South Africa, and we identify the potential environmental drivers of this observed structure. We caution that our results are based on a single mtDNA locus, but it nevertheless provides a hypothesis that can be further tested with a dense sample of nuclear DNA data, preferably whole genomes. If our interpretation holds true, it would provide the first genetic explanation for the smaller observed size of leopards at the southernmost end of their range in Africa.

Longitudinal Associations Between Food Insecurity and Mental Health in Aging Adults in South Africa

OBJECTIVES

The aim of this study was to assess the longitudinal unidirectional and bidirectional associations between food insecurity and mental health among aging adults in South Africa.

METHODS

The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa (HAALSI) study.

RESULTS

The proportion of food insecurity was 20.2% in 2015, 24.1% in 2019 and 18.4% in 2021/2022. Food insecurity was positively associated depressive symptoms, poor life satisfaction, poor sleep quality, PTSD, loneliness, impaired cognition, and current tobacco use. Compared to without food insecurity in all three study waves, having food insecurity in one wave and/or two to three waves was positively associated with incident depressive symptoms, incident poor life satisfaction, incident poor sleep quality, incident PTSD, incident loneliness, incident current tobacco use, and incident current heavy alcohol use. PTSD, impaired cognition, current tobacco use and current heavy alcohol use were positively associated with incident food insecurity.

CONCLUSION

We found that food insecurity was unidirectionally associated with depressive symptoms, poor life satisfaction, poor sleep quality and loneliness, and bidirectionally associated with PTSD, impaired cognition, current tobacco use and current heavy alcohol use.

CLINICAL IMPLICATIONS

Enhanced screening and management of food insecurity may reduce mental ill-health in South Africa.

The Challenges of Implementing a Health Referral System in South Africa: A Qualitative Study

Introduction

Health system strengthening efforts also entails streamlining an existing referral system in a particular context to improve quality of health care offered to people. Conceptually, the referral system in South Africa, is seemingly sound. Nevertheless, gaps exist in its implementation. The aim of this study was to explore health care professionals' perceptions of referral system implementation in the Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape Province of South Africa.

Methods

This qualitative study included 12 health care professionals as participants. Each participant was interviewed using a semi-structured interview guide; with their consent, the interviews were audio recorded and transcribed verbatim. For data analysis, a thematic content analysis was used.

Results

The participants identified many impediments to the effective implementation of the referral system in BCCM. The main obstacles were deteriorating infrastructure, inadequate staffing, lack of transportation, and inadequate medical supplies and medications.

Conclusion

In mitigation, the participants proposed suggestions such as increasing the capacity of the health workforce, allocating personnel appropriately, increasing the availability of transportation, and providing essential medications to all levels of care. They also suggested involving all stakeholders in the referral process, providing education and training to health professionals on the referral system, and enhancing communication and feedback between the various levels of care. These challenges emphasised in this study highlight the need for targeted interventions to improve the referral system in this setting.

Assessment of the performance of the plasma separation card for HIV-1 viral load monitoring in South Africa

Scaling up of newer innovations that address the limitations of the dried blood spot and the logistics of plasma monitoring is needed. We employed a multi-site, cross-sectional assessment of the plasma separation card (PSC) on blood specimens collected from all consenting adults, assenting young and pediatric patients living with HIV from 10 primary healthcare clinics in South Africa. Venous blood for EDTA-plasma samples was collected and analyzed according to the standard of care assay, while collected capillary blood for the PSC samples was analyzed using the Roche COBAS AmpliPrep/Cobas TaqMan (CAP/CTM) HIV-1 Test at the National Reference laboratories. McNemar tests assessed the differences in concordance between the centrifuged plasma and dried plasma spots. The usability of PSC by blood spotting, PSC preparation, and pre-analytical work was assessed by collecting seven-point Likert-scale data from healthcare and laboratory workers. We enrolled 538 patients, mostly adults [n = 515, 95.7% (95% CI: 93.7%-97.1%)] and females [n = 322, 64.2% (95% CI: 60.0%-68.1%)]. Overall, 536 paired samples were collected using both PSC- and EDTA-plasma diagnostics, and 502 paired PSC- and EDTA-plasma samples assessed. Concordance between the paired samples was obtained for 446 samples. Analysis of these 446 paired samples at 1,000 copies per milliliter threshold yielded an overall sensitivity of 87.5% [95% CI: 73.2%-95.8%] and specificity of 99.3% [95% CI: 97.9%-99.8%]. Laboratory staff reported technical difficulties in most tasks. The usability of the PSC by healthcare workers was favorable. For policymakers to consider PSC scale-up for viral load monitoring, technical challenges around using PSC at the clinic and laboratory level need to be addressed.

IMPORTANCE

Findings from this manuscript emphasize the reliability of the plasma separation card (PSC), a novel diagnostic method that can be implemented in healthcare facilities in resource-constrained settings. The agreement of the PSC with the standard of care EDTA plasma for viral load monitoring is high. Since the findings showed that these tests were highly specific, we recommend a scale-up of PSC in South Africa for diagnosis of treatment failure.

Colonial-driven extinction of the blue antelope despite genomic adaptation to low population size

Low genomic diversity is generally indicative of small population size and is considered detrimental by decreasing long-term adaptability.1,2,3,4,5,6 Moreover, small population size may promote gene flow with congeners and outbreeding depression.7,8,9,10,11,12,13 Here, we examine the connection between habitat availability, effective population size (Ne), and extinction by generating a 40× nuclear genome from the extinct blue antelope (Hippotragus leucophaeus). Historically endemic to the relatively small Cape Floristic Region in southernmost Africa,14,15 populations were thought to have expanded and contracted across glacial-interglacial cycles, tracking suitable habitat.16,17,18 However, we found long-term low Ne, unaffected by glacial cycles, suggesting persistence with low genomic diversity for many millennia prior to extinction in ∼AD 1800. A lack of inbreeding, alongside high levels of genetic purging, suggests adaptation to this long-term low Ne and that human impacts during the colonial era (e.g., hunting and landscape transformation), rather than longer-term ecological processes, were central to its extinction. Phylogenomic analyses uncovered gene flow between roan (H. equinus) and blue antelope, as well as between roan and sable antelope (H. niger), approximately at the time of divergence of blue and sable antelope (∼1.9 Ma). Finally, we identified the LYST and ASIP genes as candidates for the eponymous bluish pelt color of the blue antelope. Our results revise numerous aspects of our understanding of the interplay between genomic diversity and evolutionary history and provide the resources for uncovering the genetic basis of this extinct species' unique traits.

Leading the transition to ethical human body sourcing in Africa: The South African experience

BACKGROUND

The use of human bodies for anatomy education and research forms an integral part of the training of health professionals around the world. However, the ethical acquisition of human remains for this purpose has been a challenge in many countries, particularly for those on the African continent. South African institutions have however, been able to progressively transition to a more ethical approach to human body acquisition. The aim of the current study was to investigate the provenance of human bodies and the number used in South African health sciences institutions during the period 2017-2021.

METHODS

an online self-administered anonymised questionnaire was circulated to all health sciences institutions in South Africa. Questions were focused on establishing the provenance and the associated number of bodies and body donor programmes.

RESULTS

responses were received from thirteen of the fourteen South African institutions. All thirteen institutions use human bodies for teaching and research, with the majority of the institutions being reliant on bequests (77%) and family donations (62%), and less on unclaimed remains (46%). Most institutions have established body donor programmes. Four institutions were negatively affected by the effects of the pandemic. Memorial services, which continued during the pandemic, were conducted by eight of the thirteen institutions.

CONCLUSION

South Africa is leading the transition to the ethical acquisition of human remains on the African continent. It is hoped that South African institutions will soon transform to the exclusive sourcing of bodies through willed donation and provide guidance and support for the other countries on the continent.

Olfactory tract/bulb metal concentration in Manganese-exposed mineworkers

BACKGROUND

Manganese (Mn) is an essential micronutrient as well as a well-established neurotoxicant. Occupational and environmental exposures may bypass homeostatic regulation and lead to increased systemic Mn levels. Translocation of ultrafine ambient airborne particles via nasal neuronal pathway to olfactory bulb and tract may be an important pathway by which Mn enters the central nervous system.

OBJECTIVE

To measure olfactory tract/bulb tissue metal concentrations in Mn-exposed and non-exposed mineworkers.

METHODS

Using inductively coupled plasma-mass spectrometry (ICP-MS), we measured and compared tissue metal concentrations in unilateral olfactory tracts/bulbs of 24 Mn-exposed and 17 non-exposed South African mineworkers. We used linear regression to investigate the association between cumulative Mn exposures and olfactory tract/bulb Mn concentration.

RESULTS

The difference in mean olfactory tract/bulb Mn concentrations between Mn-exposed and non-Mn exposed mineworkers was 0.16 µg/g (95% CI -0.11, 0.42); but decreased to 0.09 µg/g (95% CI 0.004, 0.18) after exclusion of one influential observation. Olfactory tract/bulb metal concentration and cumulative Mn exposure suggested there may be a positive association; for each mg Mn/m3-year there was a 0.05 µg/g (95% CI 0.01, 0.08) greater olfactory tract/bulb Mn concentration overall, but -0.003 (95% CI -0.02, 0.02) when excluding the three influential observations. Recency of Mn exposure was not associated with olfactory tract/bulb Mn concentration.

CONCLUSIONS

Our findings suggest that Mn-exposed mineworkers might have higher olfactory tract/bulb tissue Mn concentrations than non-Mn exposed mineworkers, and that concentrations might depend more on cumulative dose than recency of exposure.

Detection and characterisation of microplastics in tap water from Gauteng, South Africa

This study reports the presence, concentration, and characteristics of microplastics (MPs) in tap water in three suburbs in Gauteng Province in South Africa. Physical characterisation was conducted using stereomicroscopy and scanning electron microscopy following staining of MPs with the Rose Bengal dye. The concentrations of MPs in all samples ranged from 4.7 to 31 particles/L, with a mean of 14 ± 5.6 particles/L. Small-sized (<1 mm) and fibrous-shaped MPs were most abundant in all samples. Fibers accounted for 83.1% of MPs in samples from all the three areas, followed by fragments (12.4%), pellets/beads (3.1%), and films (1.5%), with a minor variation in the distribution of shapes and sizes in samples from each area. Raman microspectroscopy was used for chemical analysis, and five polymers were identified, namely: high-density polyethylene, polyurethane, polyethylene terephthalate, poly(hexamethylene terephtalamide), and poly(acrylamide-co-acrylic acid). C.I Pigment Red 1, C.I. Solvent Yellow 4, Potassium indigotetrasulphonate, and C.I Pigment Black 7 were the colourants detected. These colourants are carcinogenic and mutagenic and are potentially toxic to humans. The prevalence of MPs in tap water implies their inadequate removal during water treatment. For instance, the presence of poly(AM-co-AA) suggests that drinking water treatment plants may be a potential source of MPs in tap water. Other polymers, e.g., high-density polyethylene may be released from pipes during the transportation of drinking water. The estimated daily consumption of MPs from tap water was 1.2, 0.71, and 0.50 particles/kg.day for children, men, and women, respectively. The findings of this study provide evidence of the presence of MPs in drinking water in South Africa, thus giving some insights into the performance of treatment plants in removing these contaminants and a benchmark for the formulation of standard limits for the amount of MPs in drinking water.

Linkage to HIV care and early retention in HIV care among men in the 'universal test-and-treat' era in a high HIV-burdened district, KwaZulu-Natal, South Africa

INTRODUCTION

Despite the numerous efforts and initiatives, males with HIV are still less likely than women to receive HIV treatment. Across Sub-Saharan Africa, men are tested, linked, and retained in HIV care at lower rates than women, and South Africa is no exception. This is despite the introduction of the universal test-and-treat (UTT) prevention strategy anticipated to improve the uptake of HIV services. The aim of this study was to investigate linkage to and retention in care rates of an HIV-positive cohort of men in a high HIV prevalence rural district in KwaZulu-Natal province, South Africa.

METHODS

From January 2018 to July 2019, we conducted an observational cohort study in 18 primary health care institutions in the uThukela district. Patient-level survey and clinical data were collected at baseline, 4-months and 12-months, using isiZulu and English REDCap-based questionnaires. We verified data through TIER.Net, Rapid mortality survey (RMS), and the National Health Laboratory Service (NHLS) databases. Data were analyzed using STATA version 15.1, with confidence intervals and p-value of ≤0.05 considered statistically significant.

RESULTS

The study sample consisted of 343 male participants diagnosed with HIV and who reside in uThukela District. The median age was 33 years (interquartile range (IQR): 29-40), and more than half (56%; n = 193) were aged 18-34 years. Almost all participants (99.7%; n = 342) were Black African, with 84.5% (n = 290) being in a romantic relationship. The majority of participants (85%; n = 292) were linked to care within three months of follow-up. Short-term retention in care (≤ 12 months) was 46% (n = 132) among men who were linked to care within three months.

CONCLUSION

While the implementation of the UTT strategy has had positive influence on improving linkage to care, men's access of HIV treatment remains inconsistent and may require additional innovative strategies.

Trajectories of intimate partner violence and their relationship to stress among young women in South Africa: An HPTN 068 study

BACKGROUND

One in four South African women will experience intimate partner violence (IPV) in their lifetime, potentially increasing their biological stress. In South Africa, limited IPV and stress research has utilized multiple timepoints or examined modifying factors. Cash transfers (CTs) are associated with reduced IPV and stress and may be an intervention target.

AIMS

We used data-driven methods to identify longitudinal IPV trajectory groups among South African adolescent girls and young women (AGYW), estimate each group's association with stress, and assess modification by a CT.

METHODS

A total of 2,183 South African AGYW ages 13 to 24 years from the HIV Prevention Trials Network 068 study were randomized to a CT or control group. Physical IPV was measured five times (2011-2017), and stress was captured once (2018-2019). Stress measures included the Cohen Stress Scale and stress biomarkers (C-reactive protein (CRP), cytomegalovirus (CMV), herpes simplex virus type-1 (HSV-1)). Group-based trajectory modeling identified IPV trajectories; ordinal logistic regression estimated the association between trajectory group and stress.

RESULTS

A two-group quadratic trajectory model was identified (higher trajectory group = 26.7% of AGYW; lower trajectory group = 73.3%). In both groups, the probability of IPV increased from ages 13 to 17 years before declining in early adulthood. However, the higher group's probability peaked later and declined gradually. The higher trajectory group was associated with an increased odds of elevated CRP (OR: 1.41, 95% CI [1.11, 1.80]), but not with other stress measures. The CT modified the relationship with CMV: a positive association was observed among the usual care arm (OR: 1.59, 95% CI [1.11, 2.28]) but not the CT arm (OR: 0.85, 95% CI [0.61, 1.19]).

CONCLUSIONS

Sustained IPV risk during adolescence was associated with elevated CRP in young adulthood. The relationship between IPV and elevated CMV was attenuated among those receiving a CT, suggesting that CTs could possibly reduce biological stress due to IPV.

Field and laboratory microplastics uptake by a freshwater shrimp

Microplastics are widespread pollutants, but few studies have linked field prevalence in organisms to laboratory uptakes. Aquatic filter feeders may be particularly susceptible to microplastic uptake, with the potential for trophic transfer to higher levels, including humans. Here, we surveyed microplastics from a model freshwater shrimp, common caraidina (Caridina nilotica) inhabiting the Crocodile River in South Africa to better understand microplastic uptake rates per individual. We then use functional response analysis (feeding rate as a function of resource density) to quantify uptake rates by shrimps in the laboratory. We found that microplastics were widespread in C. nilotica, with no significant differences in microplastic abundances among sampled sites under varying land uses, with an average abundance of 6.2 particles per individual. The vast majority of microplastics found was fibres (86.1%). Shrimp microplastic accumulation patterns were slightly higher in the laboratory than the field, where shrimp exhibited a hyperbolic Type II functional response model under varying exposure concentrations. Maximum feeding rates of 20 particles were found over a 6 h feeding period, and uptake evidenced at even the lowest laboratory concentrations (~10 particles per mL). These results highlight that microplastic uptake is widespread in field populations and partly density dependent, with field concentrations corroborating uptake rates recorded in the laboratory. Further research is required to elucidate trophic transfer from these taxa and to understand potential physiological impacts.

Genomic epidemiology and molecular characteristics of blaNDM-1-positive carbapenem-resistant Pseudomonas aeruginosa belonging to international high-risk clone ST773 in the Gauteng region, South Africa

PURPOSE

The emergence of carbapenem-resistant P. aeruginosa (CRPA) harbouring acquired carbapenemase genes (blaVIM, blaIMP and blaNDM) has become a global public health threat. Three CRPA isolates included in the study had an extensively drug-resistant phenotype with susceptibility to colistin only and were positive for the blaNDM-1 gene. The current study aimed to investigate the genomic epidemiology and molecular characteristics of the blaNDM-1-positive CRPA isolates collected from the Gauteng region, South Africa.

METHODS

Short read whole genome sequencing (WGS) was performed to determine sequence types (STs), genetic relatedness, resistome, virulome and the genetic environment of the blaNDM-1 gene.

RESULTS

The WGS and phylogenetic analyses revealed that the study isolates belonged to an international high-risk clone ST773 and belonged to the same clade with eight blaNDM-1-positive ST773 isolates from Hungary, India, Nigeria, South Korea and USA. The study isolates harboured a wide repertoire of intrinsic and acquired antibiotic resistance genes (ARGs) related with mobile genetic elements, porins and efflux pumps, as well as virulence factor genes. The clade-specific ARGs (blaNDM-1, floR2/cmlA9, rmtB4, tetG) were found in a putative integrative and conjugative element (ICE) region similar to ICE6660-like.

CONCLUSION

As ICE carrying the blaNDM-1 gene can easily spread to other P. aeruginosa isolates and other Gram-negative bacteria, the findings in this study highlight the need for appropriate management strategies and active surveillance of CRPA isolates in the Gauteng region, South Africa.

ART history prior to conception: trends and association with postpartum disengagement from HIV care in Khayelitsha, South Africa (2013-2019): a retrospective cohort study

INTRODUCTION

In recent years, the expansion of HIV treatment eligibility has resulted in an increase in people with antiretroviral therapy (ART) experience prior to pregnancy but little is known about postpartum engagement in care in this population. We examined differences in disengagement from HIV care after delivery by maternal ART history before conception.

METHODS

We analysed data from people living with HIV (aged 15-49) in Khayelitsha, South Africa, with ≥1 live birth between April 2013 and March 2019. We described trends over time in ART history prior to estimated conception, classifying ART history groups as: (A) on ART with no disengagement (>270 days with no evidence of HIV care); (B) returned before pregnancy following disengagement; (C) restarted ART in pregnancy after disengagement; and (D) ART new start in pregnancy. We used Kaplan-Meier curves and proportional-hazards models (adjusted for maternal age, number of pregnancy records and year of delivery) to examine the time to disengagement from delivery to 2 years postpartum.

RESULTS

Among 7309 pregnancies (in 6680 individuals), the proportion on ART (A) increased from 19% in 2013 to 41% in 2019. The proportions of those who returned (B) and restarted (C) increased from 2% to 13% and from 2% to 10%, respectively. There was a corresponding decline in the proportion of new starts (D) from 77% in 2013 to 36% in 2019. In the first recorded pregnancy per person in the study period, 26% (95% CI 25-27%) had disengaged from care by 1 year and 34% (95% CI 33-36%) by 2 years postpartum. Individuals who returned (B: aHR 2.10, 95% CI 1.70-2.60), restarted (C: aHR 3.32, 95% CI 2.70-4.09) and newly started ART (D: aHR 2.41, 95% CI 2.12-2.74) had increased hazards of postpartum disengagement compared to those on ART (A).

CONCLUSIONS

There is a growing population of people with ART experience prior to conception and postpartum disengagement varies substantially by ART history. Antenatal care presents an important opportunity to understand prior ART experiences and an entry into interventions for strengthened engagement in HIV care.

Acceptability and perceived feasibility of the KaziKidz health promotion intervention among educators and caregivers in schools from South Africa: a qualitative descriptive study

BACKGROUND

Despite the uncontested benefits of physical activity, its promotion lags behind in the public health agenda of low- and middle-income countries (LMICs). School-based interventions are promising strategies to foster health during childhood, but evidence of their effectiveness is limited and inconclusive for LMICs. Thus, further investigation is needed on contextual factors associated with intervention implementation in low-resource settings. We studied the acceptability and feasibility of the KaziKidz health promotion intervention and its implementation and make recommendations to improve future adoption and sustainability.

METHODS

KaziKidz was implemented in four primary schools from low-income communities in South Africa in 2019. Semi-structured interviews with four school principals, three focus group interviews with 16 educators, and another three with 16 caregivers were conducted between October and November 2021. Participants were purposively recruited. Interview transcripts were analyzed via thematic analysis using a deductive and reflexive approach.

RESULTS

Three main themes influencing intervention implementation and adoption were identified: (1) prioritizing teachers' needs (2), integrating the program into the school structure, and (3) creating opportunities in the community. Supporting recommendations included: (theme 1) adopting intervention approaches that are inclusive of educators' health and providing them with capacity development and external support; (theme 2) fostering a feeling of ownership and belonging among school stakeholders to adapt interventions to specific resources and needs; and (theme 3) raising community awareness to encourage individuals to claim power over and actively engage with the program.

CONCLUSIONS

Comprehensive interventions comprising health support, adequate training, and ongoing assistance for educators combined with school-wide and community outreach actions seeking to strengthen program ownership, accountability, and engagement can enhance uptake of school-based interventions and long-term maintenance.

TRIAL REGISTRATION

ISRCTN15648510, registered on 17/04/2020.

Case Report of Nasal Rhinosporidiosis in South Africa

We describe a classic case of nasal rhinosporidiosis in a woman who resided in Johannesburg, South Africa, but originated from a rural area in Eastern Cape Province. We confirmed histologic diagnosis using PCR testing and compared details with those from records on 17 other cases from South Africa.

Renewable energy investments in South Africa: Potentials and challenges for a sustainable transition - a review

The Republic of South Africa is one of the leading investors in renewable energy in Africa, despite the widespread perception that the country is trapped in the carbon age due to its high dependence on fossil fuels. Renewable energy, rooted in sustainable development, requires the creation of an appropriate framework and environmentally friendly technologies to support growth. Renewable energy sources are considered more environmentally friendly than fossil fuels, which most energy processes rely on. For this reason, the scope of this article has been narrowed to focus on the motivation for renewable energy and its potential in South Africa. Furthermore, the current developments in the South African renewable energy sector, as well as the challenges and prospects for a sustainable transition to a bioeconomy, were discussed. This study shows that a sustainable energy system can only promote the integration of renewable energy into the energy mix with the help of technology, policy, and infrastructure.

Tracing beach litter sources: Drink lids tell a different story from their bottles

Water and soft drink bottles made from polyethylene terephthalate (PET) sink at sea unless they contain trapped air, whereas their lids are made from polymers that float and can drift long distances. We sampled loose lids and bottles at 21 South African beaches to compare their origins. The proportions of foreign-made bottles and lids were correlated, and increased away from urban centres, indicating that much land-based litter strands close to source areas. Over 80 % of foreign-made drink bottles and 90 % of lids came from Asia, but most bottles were manufactured in China, Malaysia-Singapore and the UAE, and were dumped from ships. By comparison, most loose lids were in poor condition after being carried across the Indian Ocean from Indonesia by the South Equatorial Current. Reducing PET drink bottles at sea requires enforcement of regulations banning dumping at sea, whereas reducing their lids requires better control of littering in source countries.

Religious and Medical Pluralism Among Traditional Healers in Johannesburg, South Africa

Religion and spirituality are powerful social forces in contemporary South Africa. Traditional Health Practitioners (THPs) are commonly consulted for both spiritual and medical ailments as a first line of care. Many studies have assessed African traditional health seeking behaviors but few have examined beliefs, practices, and behaviors of THPs themselves. This study sought to explore spiritual worldviews among South African THPs. Semi-structured in-depth interviews were conducted with 18 THPs in Johannesburg, South Africa between January and May, 2022. Interviews were transcribed and translated into English. Data were managed using NVivo 12 software and thematically analyzed. The majority of THPs interviewed indicated that initiation as a THP was almost always preceded by a sickness accompanied by dreams/visions that represented an "ancestral calling" to become a healer. Most THPs also trained as both sangomas-who healed according to traditional beliefs-and prophets-who healed according to Christian beliefs. This reflects a syncretic relationship between traditional African beliefs and Christianity. However, not all churches are accepting of traditional beliefs and subsequently these THPs are members only at non-Pentecostal AIC churches who blend both African and Christian practices. Similar to these forms of religious pluralism melding Christianity and traditional beliefs, many THPs also often practice medical pluralism, mixing Western treatments with traditional practices/medicines. THPs are able to adapt elements of Western and African beliefs into healing practices that span multiple religious and medical fields. Thus, collaborative and decentralized healthcare services may be highly acceptable among such a pluralistic community.

Applying the HIV Prevention Cascade to an Evaluation of a Large-Scale Combination HIV Prevention Programme for Adolescent Girls and Young Women in South Africa

Adolescent girls and young women (AGYW) in South Africa are at a three times higher risk of acquiring HIV than their male counterparts. The HIV prevention cascade is a tool which can be used to measure coverage of HIV prevention services, although there is limited empirical evidence to demonstrate its application in low-resourced settings. The unifying framework is a conceptualisation of the HIV prevention cascade which theorises that both motivation and access are required for an individual to effectively use an HIV prevention method. We applied this framework to data from a random sample of 127,951 beneficiaries of a combination HIV prevention programme for AGYW aged 15-24 in South Africa to measure the steps to, and identify key barriers to, effective use of male condoms and oral pre-exposure prophylaxis (PrEP) among this vulnerable population. Barriers to each step were analysed using univariate and multivariable logistic regression. Among self-reported HIV-negative AGYW who had sex in the past 6 months, effective use of condoms (15.2%), access to PrEP (39.1%) and use of PrEP (3.8%) were low. AGYW were: less likely to be motivated to use condoms if they believed that they had a faithful partner (aOR 0.44, 95% CI 0.22-0.90) or disliked condoms (aOR 0.26, 95% CI 0.11-0.57), less likely to access condoms if the place where AGYW accessed them was far away (aOR 0.25, 95% CI 0.10-0.64), more likely to effectively use condoms if they received counselling on how to use them (aOR 2.24, 95% CI 1.05-4.76), less likely to be motivated to use PrEP if they did not believe PrEP was efficacious (aOR 0.35, 95% CI 0.17-0.72), more likely to be motivated if they felt confident that they could use PrEP, and more likely to have access to PrEP if they had ever been offered PrEP (aOR 2.94, 95% CI 1.19-7.22). This combination HIV prevention programme and similar programmes should focus on risk-reduction counselling interventions for AGYW and their male partners to improve effective use of condoms and ensure easy access to condoms and PrEP by making them available in youth-friendly spaces. Our findings demonstrate that the application of HIV prevention cascades can inform AGYW HIV prevention programming in low-resourced settings.

High study participation but diverging adherence levels: qualitatively unpacking PrEP use among adolescent girls and young women over two years in Eastern Cape, South Africa

In Southern and Eastern Africa, initiation of daily oral pre-exposure prophylaxis (PrEP) for HIV prevention has been high among adolescent girls and young women (AGYW) offered PrEP. However, persistence and prevention-effective use of PrEP among this critical group continues to be a challenge. We conducted a qualitative sub-study of AGYW from the Community PrEP Study in Eastern Cape Province, South Africa who had high rates of pick up for monthly PrEP refills over two years, but differing levels of PrEP adherence based on tenofovir-diphosphate (TFV-DP) measurements in dried blood spots (DBS). Contrasting 22 AGYW with low versus high levels of TFV-DP in DBS, we qualitatively explored factors which influenced PrEP persistence vs. non-persistence, unique patterns of PrEP use (e.g., discarding or stockpiling), and participant recommendations for improving AGYW prevention-effective use of PrEP in the future. Results showed that PrEP misconceptions and mistrust among participants' social networks negatively influenced adherence. In comparison, supportive families and/or partners and personal trust that PrEP works positively influenced adherence. Those with low adherence described being motivated to come to the site for other study benefits (e.g., reimbursement money, snacks, sanitary pads) and discarding PrEP to avoid stigma associated with being seen with pills. Future PrEP implementation strategies should focus on involving families and partners in PrEP support for AGYW and minimizing PrEP stigma at a community level.Trial registration NCT03977181. Retrospectively registered on June 6, 2019.

Estimating the mortality risk correcting for high loss to follow-up among female sex workers with HIV in Durban, South Africa, 2018-2021

PURPOSE

This study assesses risk factors of loss to follow-up (LTFU) and estimates mortality risk among female sex workers (FSW) with HIV in Durban, South Africa, in 2018-2021.

METHODS

We used data from the Siyaphambili trial, which evaluated strategies for improved viral suppression. FSW with HIV aged ≥ 18 years with viral load ≥ 50 copies/mL were followed up for 18 months. LTFU was defined as absence from study or intervention visits for 6 months. We traced LTFU participants by calling/in-person visit attempts to ascertain their vital status. We used Cox regression to determine risk factors of LTFU and inverse probability of tracing weights to correct mortality risk.

RESULTS

Of 777 participants, 10 (1.3%) had died and 578 (74.4%) were initially LTFU. Among those LTFU, 36.3% (210/578) were traced successfully, with 6 additional deaths ascertained. Recent physical and sexual violence, and non-viral suppression were associated with increased LTFU. The unweighted and weighted 18-month mortality risks were 2.4% (95% CI: 0.8%-3.9%) and 3.7% (95% CI: 1.8%-5.9%), respectively.

CONCLUSIONS

LTFU is common among FSW with HIV in South Africa with additional investigation of vital status demonstrating under-ascertained mortality. These data suggest the need for comprehensively addressing risks for mortality among FSW.

Analysis of a 5-year, evidenced-based, rational blood utilisation project in a South African regional hospital

BACKGROUND

Blood products are a lifesaving but limited resource, particularly in resource-limited settings. Evidence-based transfusion criteria tailored to local hospitals have shown great promise in reducing costs, minimising shortages, and ameliorating the morbidity and mortality associated with liberal blood product usage. We implemented the "Saving Blood, Saving Lives" project to: promote responsible blood product use and reduce blood product ordering inefficiencies and expenditure.

METHODS

A comprehensive change management programme, preceded by 3 months of clinical department consultation and training, was implemented. A new evidence-based protocol for blood product utilisation was developed, together with an accountability form. This form was used in monthly audit meetings to refine policies, identify new problems, improve communication, and to drive hospital staff accountability and training. The primary measure of the programme's success was the change in the number of red cell concentrate units ordered.

RESULTS

Project implementation required minimal time and no additional budget or staff. Annual red cell concentrate usage reduced from 7211 units in year one to 4077 units in year 5 (p < 0.001). Similar reductions were seen in freeze-dried plasma and platelet usage, as well as administrative costs. Total project saving, adjusted to baseline admission numbers, amounted to over R46 million ($2.5 million).

CONCLUSIONS

As a change management programme centred the "Saving Blood, Saving Lives" project, was able to significantly reduce blood product-related administration and expenditure by implementing evidence-based transfusion criteria. The programme is simple, replicable and cost effective, making it ideally suited for use in resource-constrained environments.

Quantification and Potential Viability of Human Noroviruses in Final Effluent from Wastewater Treatment Works in Pretoria, South Africa

Growing global concerns over water scarcity, worsened by climate change, drive wastewater reclamation efforts. Inadequately treated wastewater presents significant public health risks. Previous studies in South Africa (SA) have reported high norovirus levels in final effluent and sewage-polluted surface water, indicating pathogen removal inefficiency. However, the viability of these virions was not explored. This study assessed human norovirus viability in final effluent from wastewater treatment works (WWTWs) in Pretoria, SA. Between June 2018 and August 2020, 200 samples were collected from two WWTWs, including raw sewage and final effluent. Norovirus concentrations were determined using in-house RNA standards. Viability of noroviruses in final effluent was assessed using viability RT-qPCR (vPCR) with PMAxx™-Triton X-100. There was no significant difference in GI concentrations between raw sewage (p = 0.5663) and final effluent (p = 0.4035) samples at WWTW1 and WWTW2. WWTW1 had significantly higher GII concentrations in raw sewage (p < 0.001) compared to WWTW2. No clear seasonal pattern was observed in norovirus concentrations. At WWTW1, 50% (7/14) of GI- and 64.9% (24/37) of GII-positive final effluent samples had no quantifiable RNA after vPCR. At WWTW2, the majority (92.6%, 25/27) of GII-positive final effluent samples showed a 100% RNA reduction post vPCR. PMAxx™-Triton X-100 vPCR provides a more accurate reflection of discharge of potentially viable noroviruses in the environment than standard RT-qPCR. Despite significant reductions in potentially viable noroviruses after wastewater treatment, the levels of potentially viable viruses in final effluent are still of concern due to the high initial load and low infectious dose of noroviruses.

Mental health services in Gauteng, South Africa: A proxy evaluation using pharmaceutical data

Background

South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment.

Aim

The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system.

Setting

The Public health sector, Gauteng province formed the setting for the study.

Method

A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing.

Results

General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals.

Conclusion

In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended.

Contribution

This study provides insight into service provision for MNS disorders.

The gendered context of women charged with violent offences in the forensic psychiatric setting

Background

Women charged with violent offences may be referred by courts for forensic psychiatric assessment to determine whether mental disorder or intellectual disability impacts their fitness to stand trial and/or criminal responsibility. The profile of these women is a poorly researched area in South Africa.

Aim

This study examined the socio-demographic, offence-related, and clinical profile of South African women charged with violent offences referred for forensic assessment.

Setting

Fort England Hospital (FEH), a forensic psychiatric institution in the Eastern Cape.

Methods

The clinical records of 173 women referred by courts for forensic psychiatric evaluation over a 24-year period (1993-2017) to FEH were systematically reviewed.

Results

Most women were single, black mothers with dependent children, who were unemployed and socio-economically impoverished. Many had backgrounds of pre-offence mental illness, alcohol use and alleged abuse. The majority were first-time offenders whose victims were known to them. Most child victims were biological children killed by their mothers. Likely primary motives for violence were related to psychopathology in half of cases, and interpersonal conflict in a third. Forensic assessment most frequently confirmed psychotic disorders and dual diagnoses. Half the cases were fit to stand trial and under half were criminally responsible.

Conclusion

Violent female offending occurs within a gendered context, with high rates of prior trauma, alcohol use and psychosocial distress in perpetrators. An emphasis on gender-sensitive psychosocial interventions is required.

Contribution

This study highlights the nature and context of violent offending by women referred for forensic psychiatric assessment in South Africa.

Empirical analysis of drought-induced cattle destocking in South Africa

Destocking as a drought mitigation strategy exposes smallholder cattle farmers to adverse effects, including the distortion of farm planning and income loss, as cattle are sold off regardless of the market price. Factors influencing destocking as a drought mitigation strategy for smallholder cattle farmers have received less attention in the literature. The study assessed the relationship between drought and cattle destocking as well as factors that affect farmers' destocking decision. The relationship between drought and cattle destocking was assessed using correlation analysis, while determinants of destocking were identified through the zero-inflated Poisson (ZIP) regression model, which controlled for structural zeros. The research covered the period 2008-2017 using secondary data from the National Income Dynamics Study (NIDS), the South Africa Weather Service and the Food and Agriculture Organisation (FAO). The study found that drought has direct correlation with the quantity of beef produced in South Africa at -0.67, with a 1% significance level. Farmers' socioeconomic characteristics such as cattle herd size, income, secondary occupation, fodder purchase and ownership of land positively influenced cattle destocking decision while household size and cattle loss during drought influenced destocking decision negatively.

Contribution

The study estimated the determinants of smallholder cattle farmers' decision to destock during drought, using a count model and accounted for socioeconomic and farmer-specific factors.

Proximity to public green spaces and depressive symptoms among South African residents: a population-based study

BACKGROUND

Exposure to green spaces has been suggested to improve mental health and may reduce the risk of depression. However, there is generally limited evidence on the association between green spaces and depression originating from low-and middle-income countries and Africa in particular. Here, we investigate the association between proximity to public green spaces and depressive symptoms among residents of Gauteng Province, South Africa.

METHODS

We used data from the 2017/2018 Gauteng quality of life survey. We included all individuals aged 18 years or older residing in the nine municipalities of Gauteng Province that completed the survey (n = 24,341). Depressive symptoms were assessed using the Patient Health Questionnaire-2. Proximity to public green spaces was defined as self-reported walking time (either less or greater than 15 min) from individuals' homes to the nearest public green space. To assess the association between access to public green spaces and depressive symptoms, we used mixed-effects models, adjusted for age, sex, population group (African, Indian/Asian, Coloured (mixed race), and White), educational attainment, and municipality. We additionally performed stratified analyses by age, sex, educational attainment, and population group to evaluate whether associations differed within subgroups. Associations are expressed as prevalence ratios (PR) and their 95% confidence intervals (95% CI).

RESULTS

We observed a 6% (PR = 0.94, 95%CI = 0.92-0.96) prevalence reduction in depressive symptoms for individuals who reported that the nearest public green space was less than 15 min from their homes as compared to those who reported > 15 min. After stratification, this inverse association was stronger among females, individuals aged 35-59 years,those with higher levels of educational attainment, and Coloured individuals as compared to their counterparts.

CONCLUSION

Our findings suggest that public green spaces close to residential homes may be associated with a reduction in the occurrence of depressive symptoms among urban populations in resource-constrained settings like South Africa.

Development of entrustable professional activities for family medicine in South Africa

South Africa is undergoing a significant shift towards implementing enhanced workplace-based assessment methodologies across various specialist training programmes, including family medicine. This paradigm involves the evaluation of Entrustable Professional Activities (EPAs) through comprehensive portfolios of evidence, which a local and national clinical competency committee then assesses. The initial phase of this transformative journey entails the meticulous development of EPAs rooted in discrete units of work. Each EPA delineates the registrar's level of entrustment for autonomous practice, along with the specific supervision requirements. This concise report details the collaborative effort within the discipline of family medicine in South Africa, culminating in the consensus formation of 22 meticulously crafted EPAs for postgraduate family medicine training. The article intricately outlines the systematic structuring and rationale behind the EPAs, elucidating the iterative process employed in their development. Notably, this marks a groundbreaking milestone as the first comprehensive documentation of EPAs nationally for family medicine training in Africa.

Student nurse perceptions of family nursing practices in South Africa: A descriptive survey

Background

Family nursing practices (FNPs) are gaining momentum in global literature, but the available research has targeted qualified nursing professionals. There are limited studies exploring this phenomenon in undergraduate student nurses in South Africa.

Aim

The study aimed at exploring the undergraduate student nurse perceptions of FNPs.

Setting

The study was conducted at a selected university in KwaZulu-Natal, South Africa.

Methods

A descriptive survey design was used to purposively select undergraduate nursing students. The Family Nursing Practice Scale (FNPS) was used to collect data online. Descriptive and inferential statistics were used to analyse quantitative data. Open ended questions were analysed using content analysis.

Results

Out of 154 participants, 77 responded to the questionnaire, translating to a response rate of 50%. Compared with other studies in literature, student nurses rated their overall FNP as being low (M = 3.43, s.d. = 0.99). A further descriptive analysis revealed better FNPs (2.97) for 3rd year compared to 2nd year (3.90) nursing students with significance differences in the means (p < 0.0001). While family conflict, maintaining confidentiality, ill prepared and absent family were challenges experienced in FNP, advantages included obtaining detailed information, ability to plan individualised care and enhanced student nurse-family relationship.

Conclusion

A lower critical practice appraisal and lower perceptions of interaction and reciprocity in the nurse-family relationship were identified. There is need for an inclusive curriculum that promotes and advocates for family nursing within the undergraduate programme.

Contribution

This study highlights the importance of teaching family nursing to undergraduate student nurses.

Absorbent hygiene products disposal behaviour in informal settlements: identifying determinants and underlying mechanisms in Durban, South Africa

BACKGROUND

Within South Africa, many low-income communities lack reliable waste management services. Within these contexts, absorbent hygiene product (AHP) waste, including nappies (diapers), are not recycled, and are often dumped, ending up in watercourses and polluting the local environment. The structural barriers to collection which have been well explored, however the behavioural determinants of safe disposal for AHPs remains poorly understood. The purpose of this study is to determine the psycho-social factors driving AHP disposal behaviour for caregivers, while identifying potential underlying mechanisms (such as mental health), which may be influencing disposal behaviour, with the intention of informing a future, contextually appropriate and sustainable, collection system.

METHODS

The cross-sectional study was conducted within three low-income communities located within eThekwini Municipality (Durban), South Africa. The study included a pre-study and a quantitative survey of 452 caregivers, utilising the RANAS approach of behaviour change. The quantitative questionnaire was based on the RANAS model to measure psycho-social factors underlying sanitary disposal of AHPs. Mental health was assessed using the Self-Reporting Questionnaire (SRQ-20). Statistical analysis involved regressing psycho-social factors onto disposal behaviour and exploring their interaction with mental health through a moderation model.

RESULTS

Our findings suggest that one third of caregivers do not dispose of nappies sanitarily, despite intent (86.9%). Regression analysis revealed ten psycho-social factors which significantly predict the desired behavioural outcome, the sanitary disposal of AHPs. Caregivers with poor mental health were less likely to dispose of AHP sanitarily, which reflects previous research linking poor mental health and the impairment of health-related daily activities, particularly within vulnerable groups. Specifically, several psycho-social factors underlying were moderated by poor mental health, the prevalence of sanitary disposal of AHPs depended on mental condition of caregiver.

CONCLUSIONS

Our findings confirmed the link between poor mental health and unsanitary AHPs disposal. This is especially relevant because poor mental health is common within South Africa. Addressing mental health problems within these communities is an essential step to providing sustainable waste management services. The findings informed an intervention strategy to implement a future collection system for these communities, and similar low-income or informal contexts within South Africa.

A case of babesiosis in a returning traveller

Human babesiosis data in Africa is scarce. The clinical presentation and parasite morphology mimics falciparum malaria infection. Diagnostic confirmation is informed by adequate history and communication with the laboratory to activate appropriate testing. This case report describes the course of a returning traveller with persisting symptoms that resolved on tailored antimicrobial therapy following prompt collaborative diagnosis.

Contribution

Case highlighting overlapping characteristics of Babesia and malaria infection, necessitating close clinical and laboratory correlation to confirm diagnosis.

Processed food consumption and risk of non-communicable diseases (NCDs) in South Africa: evidence from Demographic and Health Survey (DHS) VII

We aimed to analyse the association between processed food consumption and the risk of non-communicable diseases (NCDs) in South Africa. In this empirical study, we analysed nationally representative secondary data obtained from the South African Demographic and Health Survey (SADHS) VII. The survey included 13,288 occupied households, of which 11,083 were interviewed. In the interviewed households, 12,717 eligible adults aged 15 and older were identified and 10,336 were successfully interviewed. The study included four processed food groups (i.e. fried foods, takeaway foods/fast foods, salty snacks/packed chips, and processed meats) and eight NCDs (i.e. hypertension, cardiac arrest, cancer, stroke, hypercholesterolaemia, diabetes, chronic bronchitis, and asthma). As per the logistic regression results following adjustment, none of the disease states showed association with all four processed food groups. However, at least three processed food groups showed a significant positive association with hypertension, cardiac arrest, and diabetes. Two processed food groups showed significant positive association with stroke, and chronic bronchitis; one with hypercholesterolaemia and asthma; and cancer was not associated with any food groups. Processed meat and salted snacks/packed chips were each associated with five chronic conditions. In summary, we found that the consumption of any of the processed food groups increased the risk of NCDs in the South African population. Enabling policy and regulatory efforts in the production and distribution of processed foods, combined with improved awareness among the population need to be prioritised for immediate action. Facilitating the populations to choose traditional healthy diets would be a sustainable strategy for the prevention of NCDs.

Diamond Gymnura natalensis and duckbill Aetomylaeus bovinus rays undertake nationwide coastal migrations

Migration is a critical aspect of ocean ecosystems, and understanding this phenomenon answers ecological and management questions. Given the difficulty in tracking ocean animals across large distances, the extent to which different ray species perform long-distance movements, such as migrations, remains unknown. This study used passive acoustic telemetry to track the movements of endemic diamond Gymnura natalensis and critically endangered duckbill Aetomylaeus bovinus rays along the South African coastline using a collaborative nationwide network of coastal acoustic receivers for up to 7 years. Duckbill rays were detected significantly more frequently than diamond rays, but both species moved between the south and east coasts of South Africa (traveling up to 1167 km). Tagged individuals were detected significantly more often in their tagging locations during summer months but traveled significantly further distances during winter months. Furthermore, movement models fitted to individual duckbill rays' annual net-squared displacement identified most individual annual movements as migratory. This evidence suggests that both diamond and duckbill rays make eastward winter migrations and return to specific areas along the coastline during the summer months. The exceptions to this were diamond rays tagged on the east coast that were not found to migrate seasonally, which supports previous research that there is intraspecific variability in migrations for ray species. These findings have implications for understanding ray migration not only on a global scale but also locally for spatial management interventions and population delineation.

Seroprevalence and risk factors of Toxoplasma gondii in sheep and goats of North West Province, South Africa

BACKGROUND

The protozoan parasite Toxoplasma gondii causes toxoplasmosis, one of the most prevalent parasitic zoonotic diseases with significant economic and public health implications worldwide. Infection with the parasite has a significant adverse effect on sheep and goat production and can frequently go undetected in the herd, resulting in abortions and weak or dead offspring. Although there are few studies on seroprevalence and risk factors associated with T. gondii infections in livestock in other provinces of South Africa, there is no data in the North West province. Therefore, a cross-sectional study was conducted to investigate the seroprevalence of T. gondii and risk factors associated with exposure in sheep and goats of the North West province of South Africa. Sera from 439 livestock (164 sheep and 285 goats) were collected and analysed for the presence of T. gondii IgG antibodies using indirect ELISA (Enzyme-linked immunosorbent assay). An assessment of potential risk factors in farms associated with seropositivity was also conducted using a structured questionnaire.

RESULTS

Out of the 439 tested sheep and goats, 13.9% (61/439) were positive for IgG antibodies against T. gondii. Sheep and goats had seroprevalences of 19.5% (32/164) and 10.5% (29/275) respectively. In the multivariable logistic regression model, the risk of acquiring T. gondii was significantly higher in the mixed breed [Odds ratio (OR) = 71.07; 95% confidence interval (CI): 266.8-1893.1; p < 0.011)] animals than white dorper sheep and in farms that burn or bury aborted material (OR = 42.04; CI: 179.9-982.5; p = 0.020) compared to those that only burn aborted material. The risk was lower for the farms in Kagisano-Molopo (OR = 0.00; CI: 0.0-25.4; p = 0.015) and Mahikeng (OR = 0.00; CI: 0.0-4.9; p < 0.001) local municipalities than Greater Taung local municipality, and for the animals that drink water from dams (OR = 0.03; CI: 0.2-58.8; p = 0.021) than those that drink from boreholes.

CONCLUSION

The seroprevalence and risk factors associated with transmission observed show that T. gondii infection is widespread in sheep and goats of the North West province.

Influence of organisational climate on public service employee physical health

Background

The working conditions in the South African public service, notably its challenging environment, pose significant threats to the physical health of employees. Calls exist in understanding how this can be addressed.

Aim

The study investigated the predictors of physical health, accounting for the role of organisational climate and decent work.

Setting

The study was conducted in Bisho in the Eastern Cape province of South Africa.

Methods

An instrument was administered through a survey using a sample of 289 respondents. Descriptive and inferential statistics were used to test the hypothesised relationships.

Results

No significant direct effect existed to show that the sounder an organisational climate, the better the physical health of employees will be (β = -0.014, t = -0.199, p = 0.843, 95% confidence interval [CI] [-0.153 to 0.125]). However, statistically significant evidence existed to show that the more focus on promoting decent work, the better the physical health of employees will be (β = 0.463, p = < 0.001, 95% CI [0.258 to 0.668]). Finally, decent work has a full mediating effect on the relationship between organisational climate and employee physical health (β = 0.105, 95% CI [0.054 to 0.167]).

Conclusion

Public service organisations need to pay attention to the role of its climate and decent working conditions in promoting employee physical health.

Contribution

Interventions are needed centered on improving decent work and the organisational climate as identified predictors of employee physical health.