10 research outputs found
A process evaluation for the HIV/AIDS project for the Mbekweni Area Development Programme
No full textIncludes bibliographical references (leaves 56-59).This dissertation is a process evaluation of Mbekweni Area Development Programme (MADP)'s HIV/AIDS project. The MADP is a programme that is implemented by World Vision South Africa. The aim of the process evaluation was to assess whether the HIV/AIDS project was implemented as intended. HIV/AIDS is a global problem, particularly prominent in South Africa. It has negatively affected families and communities resulting in increased social and economic burdens. The HIV/AIDS project at MADP uses prevention and care programmes to mitigate the impact of HIV/AIDS in targeted areas of Mbekweni. In order to achieve this aim, the project uses the following programme activities: home visitation, home-based care, life skills, material support and awareness campaigns. To conduct the process evaluation, programme records, interviews with three key informants and questionnaires with 35 programme staff were used to assess the programme?s implementation. Findings from the evaluation show that the programme activities are largely being implemented as intended by the organisation. The HIV/AIDS project is being delivered to the intended beneficiaries and all the activities are being implemented as intended by the organisation. However, to improve the effectiveness of the project a structure
Publisher Correction: Computer-aided interpretation of chest radiography reveals the spectrum of tuberculosis in rural South Africa.
No full textThe original version of this Article contained errors in the affiliations of members of the Vukuzazi Team. Anand Ramnanan, Anele Mkhwanazi, Antony Rapulana, Anupa Singh, Ashentha Govender, Ayanda Zungu, Bongani Magwaza, Bongumenzi Ndlovu, Clive Mavimbela, Costa Criticos, Day Munatsi, Dilip Kalyan, Doctar Mlambo, Fezeka Mfeka, Freddy Mabetlela, Gregory Ording-Jespersen, Hannah Keal, Hlengiwe Dlamini, Hlengiwe Khathi, Hlobisile Chonco, Hlobisile Gumede, Hlolisile Khumalo, Hloniphile Ngubane, Hollis Shen, Innocentia Mpofana, Jaco Dreyer, Jade Cousins, Kandaseelan Chetty, Kayleen Brien, Khadija Khan, Khanyisani Buthelezi, Kimeshree Perumal, Kobus Herbst, Lindani Mthembu, Logan Pillay, Mandisi Dlamini, Mandlakayise Zikhali, Mbali Mbuyisa, Mbuti Mofokeng, Melusi Sibiya, Mlungisi Dube, Mpumelelo Steto, Mzamo Buthelezi, Nagavelli Padayachi, Nceba Gqaleni, Ngcebo Mhlongo, Nokukhanya Ntshakala, Nomathamsanqa Majozi, Nombuyiselo Zondi, Nomfundo Luthuli, Nomfundo Ngema, Nompilo Buthelezi, Nonceba Mfeka, Nondumiso Khuluse, Nondumiso Mabaso, Nondumiso Zitha, Nonhlanhla Mfekayi, Nonhlanhla Mzimela, Nozipho Mbonambi, Ntombiyenhlanhla Mkhwanazi, Ntombiyenkosi Ntombela, Pamela Ramkalawon, Phakamani Mkhwanazi, Philippa Mathews, Phumelele Mthethwa, Phumla Ngcobo, Raynold Zondo, Rochelle Singh, Rose Myeni, Sanah Bucibo, Sandile Mthembu, Sashin Harilall, Senamile Makhari, Seneme Mchunu, Senzeni Mkhwanazi, Sibahle Gumbi, Siboniso Nene, Sibusiso Mhlongo, Sibusiso Mkhwanazi, Sibusiso Nsibande, Simphiwe Ntshangase, Siphephelo Dlamini, Sithembile Ngcobo, Siyabonga Nsibande, Siyabonga Nxumalo, Sizwe Ndlela, Skhumbuzo Mthombeni, Smangaliso Zulu, Sphiwe Clement Mthembu, Sphiwe Ntuli, Talente Ntimbane, Thabile Zondi, Thandeka Khoza, Thengokwakhe Nkosi, Thokozani Bhengu, Thokozani Simelane, Tshwaraganang Modise, Tumi Madolo, Welcome Petros Mthembu, Xolani Mkhize, Zamashandu Mbatha, Zinhle Buthelezi, Zinhle Mthembu and Zizile Sikhosana were incorrectly associated with “Digital Health & Machine Learning, Hasso Plattner Institute for Digital Engineering, Berlin, Germany” and the affiliation “Africa Health Research Institute, KwaZulu-Natal, South Africa” was inadvertently omitted. This has now been corrected in both the PDF and HTML versions of the Article
Responses of gut morphology, serum biochemistry and quality of breast meat to water deprivation in broilers
No full textResponses of growth performance, gut morphology, blood biochemistry, and quality of breast meat to varying lengths of water deprivation were assessed. Ninety broilers were randomly allocated to water deprivation treatments, where water was either supplied ad libitum (0 h) or for 30 min at intervals of 6, 12, 18, and 24 h. Average daily feed intake (ADFI) and gain (ADG) were estimated weekly. Six birds from each treatment were randomly slaughtered. The duodenum, jejunum, and ileum were sectioned to determine gut morphology. Breast meat muscles (pectoralis major) were sampled to determine its physicochemical properties. There were linear decreases in ADG (P < 0.01) and ADFI (P < 0.05), crypt depth (P < 0.01) and crypt width (P < 0.05) in the jejunum, villus height (VH) (P < 0.01) and total mucosa thickness (P < 0.05) in the ileum, crude fat (P < 0.05), b*0 (yellowness at 0 h), a*24 (redness at 24 h), and L*24 (lightness at 24 h) (P < 0.01), and aspartate aminotransferase enzyme (P < 0.05) with increases in length of water deprivation. Positive quadratic responses of VH in the duodenum (P < 0.01) and jejunum (P < 0.05) were observed after 7.6 and 19.4 h of water deprivation, respectively. Severe water deprivation periods reduced growth performance, but induced positive growth of VH, suggesting that broilers may adapt to water stress. The appropriate length of water deprivation was 7.64 h.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author
Expansion of HIV testing in Eswatini: stakeholder perspectives on reaching the first 90.
No full textAchieving the United Nations' 90-90-90 goals has proven challenging in most settings and the ambitious 95-95-95 goals seem even more elusive. However, in Eswatini - a lower-middle-income country in sub-Saharan Africa with the highest HIV prevalence in the world - an estimated 92% of people living with HIV know their status. We conducted 26 in-depth interviews with stakeholders from policy, implementation, donor, local advocacy and academic sectors to elicit the facilitators and inhibitors to HIV testing uptake in Eswatini. Background data and related reports and policy documents (n = 57) were also reviewed. Essential facilitators included good governance via institutional and national budgetary commitments, which often led to swift adoption of globally recommended programs and standards. The integration of HIV testing into all points of care fostered a sense that testing was part of routine care, which reduced stigma. Challenges, however, centred on social norms that disadvantage certain groups with high ongoing HIV risk (such as key populations, adolescent girls and young women), a heavy reliance on external donor funding, and stigma that had subsided but nevertheless persisted. Amid concerns about whether the 90-90-90 targets could be achieved by 2020, the experience of Eswatini provides tangible insights into factors that have successfully influenced HIV testing uptake and may thus prove informative for other countries
Rethinking North–South Research Partnerships Amidst Global Uncertainties: Leveraging Lessons Learned from UK GCRF Projects during COVID-19
No full textInternational research and development projects (or grand challenge projects) consist of multicultural, multi-country, multi-sectoral, and multi-stakeholder initiatives aimed at poverty reduction. They are usually conceived as partnerships between actors in the global north–south. The COVID-19 pandemic was a major unexpected disruption to ongoing projects and challenged their already complex management. The aim of this paper is to present evidence on how international development projects were impacted by COVID-19 with a particular focus on the relationship between research institutions in the north and south. We conducted a mixed-methods research study, combining a reflective exercise with the co-author team and a survey with principal investigators, project managers, and capacity development leads drawn from 31 Global Challenges Research Fund (GCRF) projects funded through the UK government’s Official Development Assistance (ODA) and focused on social–ecological system research. The survey contained closed- and open-ended questions in order to (i) demonstrate how those involved in managing projects adapted to risks, including both threats and opportunities, presented by the COVID-19 pandemic, and (ii) consider the implications for tailoring adaptive management approaches in international research projects amidst uncertainties, with a special focus on enhancing equities in global north–south partnerships. The paper offers the following recommendations on designing, planning, and implementing international research and development projects: (i) devolve project management in order to enhance project resilience and improve north–south equities; (ii) allocate dedicated resources to enable equitable north–south research partnerships; (iii) rely more on hybrid and agile approaches for managing a project’s life cycle; and (iv) improve resource flexibility, transparency, and communication through enhanced funder–implementer collaboration
Stakeholder-driven transformative adaptation is needed for climate-smart nutrition security in sub-Saharan Africa.
No full textImproving nutrition security in sub-Saharan Africa under increasing climate risks and population growth requires a strong and contextualized evidence base. Yet, to date, few studies have assessed climate-smart agriculture and nutrition security simultaneously. Here we use an integrated assessment framework (iFEED) to explore stakeholder-driven scenarios of food system transformation towards climate-smart nutrition security in Malawi, South Africa, Tanzania and Zambia. iFEED translates climate-food-emissions modelling into policy-relevant information using model output implication statements. Results show that diversifying agricultural production towards more micronutrient-rich foods is necessary to achieve an adequate population-level nutrient supply by mid-century. Agricultural areas must expand unless unprecedented rapid yield improvements are achieved. While these transformations are challenging to accomplish and often associated with increased greenhouse gas emissions, the alternative for a nutrition-secure future is to rely increasingly on imports, which would outsource emissions and be economically and politically challenging given the large import increases required. [Abstract copyright: © 2024. The Author(s).
Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study
No full textBackgroundThere has been remarkable progress in the treatment of HIV throughout sub-Saharan Africa, but there are few data on the prevalence and overlap of other significant causes of disease in HIV endemic populations. Our aim was to identify the prevalence and overlap of infectious and non-communicable diseases in such a population in rural South Africa.MethodsWe did a cross-sectional study of eligible adolescents and adults from the Africa Health Research Institute demographic surveillance area in the uMkhanyakude district of KwaZulu-Natal, South Africa. The participants, who were 15 years or older, were invited to participate at a mobile health camp. Medical history for HIV, tuberculosis, hypertension, and diabetes was established through a questionnaire. Blood pressure measurements, chest x-rays, and tests of blood and sputum were taken to estimate the population prevalence and geospatial distribution of HIV, active and lifetime tuberculosis, elevated blood glucose, elevated blood pressure, and combinations of these.Findings17?118 adolescents and adults were recruited from May 25, 2018, to Nov 28, 2019, and assessed. Overall, 52·1% (95% CI 51·3–52·9) had at least one active disease. 34·2% (33·5–34·9) had HIV, 1·4% (1·2–1·6) had active tuberculosis, 21·8% (21·2–22·4) had lifetime tuberculosis, 8·5% (8·1–8·9) had elevated blood glucose, and 23·0% (22·4–23·6) had elevated blood pressure. Appropriate treatment and optimal disease control was highest for HIV (78·1%), and lower for elevated blood pressure (42·5%), active tuberculosis (29·6%), and elevated blood glucose (7·1%). Disease prevalence differed notably by sex, across age groups, and geospatially: men had a higher prevalence of active and lifetime tuberculosis, whereas women had a substantially high prevalence of HIV at 30–49 years and an increasing prevalence of multiple and poorly controlled non-communicable diseases when older than 50 years.InterpretationWe found a convergence of infectious and non-communicable disease epidemics in a rural South African population, with HIV well treated relative to all other diseases, but tuberculosis, elevated blood glucose, and elevated blood pressure poorly diagnosed and treated. A public health response that expands the successes of the HIV testing and treatment programme to provide multidisease care targeted to specific populations is required to optimise health in such settings in sub-Saharan Africa.FundingWellcome Trust, Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, South African Medical Research Council, and South African Population Research Infrastructure Network.</p
Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study
No full textBackgroundThere has been remarkable progress in the treatment of HIV throughout sub-Saharan Africa, but there are few data on the prevalence and overlap of other significant causes of disease in HIV endemic populations. Our aim was to identify the prevalence and overlap of infectious and non-communicable diseases in such a population in rural South Africa.MethodsWe did a cross-sectional study of eligible adolescents and adults from the Africa Health Research Institute demographic surveillance area in the uMkhanyakude district of KwaZulu-Natal, South Africa. The participants, who were 15 years or older, were invited to participate at a mobile health camp. Medical history for HIV, tuberculosis, hypertension, and diabetes was established through a questionnaire. Blood pressure measurements, chest x-rays, and tests of blood and sputum were taken to estimate the population prevalence and geospatial distribution of HIV, active and lifetime tuberculosis, elevated blood glucose, elevated blood pressure, and combinations of these.Findings17?118 adolescents and adults were recruited from May 25, 2018, to Nov 28, 2019, and assessed. Overall, 52·1% (95% CI 51·3–52·9) had at least one active disease. 34·2% (33·5–34·9) had HIV, 1·4% (1·2–1·6) had active tuberculosis, 21·8% (21·2–22·4) had lifetime tuberculosis, 8·5% (8·1–8·9) had elevated blood glucose, and 23·0% (22·4–23·6) had elevated blood pressure. Appropriate treatment and optimal disease control was highest for HIV (78·1%), and lower for elevated blood pressure (42·5%), active tuberculosis (29·6%), and elevated blood glucose (7·1%). Disease prevalence differed notably by sex, across age groups, and geospatially: men had a higher prevalence of active and lifetime tuberculosis, whereas women had a substantially high prevalence of HIV at 30–49 years and an increasing prevalence of multiple and poorly controlled non-communicable diseases when older than 50 years.InterpretationWe found a convergence of infectious and non-communicable disease epidemics in a rural South African population, with HIV well treated relative to all other diseases, but tuberculosis, elevated blood glucose, and elevated blood pressure poorly diagnosed and treated. A public health response that expands the successes of the HIV testing and treatment programme to provide multidisease care targeted to specific populations is required to optimise health in such settings in sub-Saharan Africa.FundingWellcome Trust, Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, South African Medical Research Council, and South African Population Research Infrastructure Network.</p
Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.
No full textBACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)
