65 research outputs found
The relationship between urinary organophosphate pesticide residues and reproductive development among boys living in the rural Western Cape
No full textBackground: Many contemporary agricultural pesticides are hormonally active, but few previous studies have investigated their effect on the reproductive health and growth of pubertal boys. A previous analysis found significant differences in serum reproductive hormone levels and lower anthropometric measurements as well as non-significant lower sexual maturity ratings and testicular sizes in farm boys compared to non-farm boys from the rural Western Cape in South Africa. Methodology: This analysis included 183 out of 269 school boys residing on farms and neighbouring nonfarming areas who provided urine samples in a cross-sectional study. Measurements included a questionnaire, clinical assessment of sexual maturity development (SMD), anthropometric measurements (height, weight and body mass index (BMI)), serum reproductive hormones (including luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone and oestradiol (E2)) and urinary levels of 3 dialkyl phosphates (organophosphate pesticide metabolites) including di-ethyl, di-methyl and di-methyl triphosphate (DEP, DMP and DMTP). Results: The median (interquartile range) of age and sum dialkyl phosphates of the school boys was 12 years (9-13 years) and 68.3 ng/mL (27.9-129.5 ng/mL) respectively. There were consistent, mostly non-significant associations with some dose response relationships between urinary levels of dialkyl phosphates and adverse effects on outcomes including SMD, serum reproductive hormones and anthropometric development. The strongest results included a strong positive association and dose response found between serum oestradiol > the 50th percentile and quartiles DMTP (odd ratio and confidence interval for highest and lowest quartile: 7.4; 1.7-32.4) and between BMI <50th percentile and quartiles of DMTP (odd ratio and confidence interval for highest and lowest quartile: 3.2; 1.2-9.0). Conclusion: The results provide some preliminary evidence that organophosphate pesticides exposure could alter the reproductive hormone levels and adversely affect the body size of school boys. There was also lack of evidence of other adverse effects on reproductive development. These findings require further investigation in a larger longitudinal study with seasonal bio-monitoring for pesticides
HIV-associated Neuropathy and Autonomic Dysfunction in South Africans on established ART impacts daily living
No full textIntroduction A common complication of Human Immunodeficiency Virus (HIV) and anti-retroviral therapy (ART) is distal sensory polyneuropathy (DSP). Older age and previous TB are risk factors for DSP among HIVinfected Africans before and shortly after ART initiation. Little is known about autonomic dysfunction in Africans on long-term ART and the impact of DSP and autonomic impairment on their quality of life. Our aim was to describe the frequency, characteristics and functional consequences of DSP and autonomic dysfunction in a healthy HIV-infected community-based cohort after at least 5 years of ART. Methods HIV-infected South Africans on the government-sponsored ART program for at least 5 years were included in this cross-sectional analysis. Each consenting participant underwent a focussed neurological assessment using the Brief Peripheral Neuropathy Screen (BPNS) and a reduced version of the Total Neuropathy Score (rTNS). DSP was defined as the presence of at least 2 neuropathic signs in a distal and symmetrical distribution, and symptomatic DSP (SDSP) when accompanied by neuropathic symptoms. Heart rate variability and orthostatic hypotension were measured as described by the Ewing classic battery, and the Survey of Autonomic Symptoms (SAS) questionnaire assessed the presence and severity of autonomic symptoms. We used a modified version of the Lower Extremity Functional Scale (LEFS) to assess lower limb physical ability. Results The 67 participants had a median age of 41 years (interquartile range (IQR) 36-46) and 61 (91 %) were women. The median duration of ART was 7 years (IQR 6-10). DSP criteria were met in 54 (80.6%) and 24 (44.4%) had symptomatic DSP. Comparing participants with DSP to those without DSP, there was no difference in sex (P=0.39), age (P=0.79), current CD4 (P=0.69), viral suppression (P=0.34), ART duration (P=0.22) or previous tuberculosis (TB) (P=0.72) in those with DSP. Similar outcomes were obtained for SDSP. Abnormal autonomic tests were present in 60%. Those with SDSP had more severe autonomic symptoms than those with asymptomatic DSP (P=0.0008). We found that those with DSP and SDSP had significantly lower LEFS percentage scores than those without (P=0.039 and P=0.013 respectively). 5 Conclusion DSP remains a common complication of HIV in the modern era of ART and can lead to significant functional impairment. Autonomic dysfunction is prevalent in SDSP
A cross-sectional study of Ig-E mediated food sensitisation and food allergy in an unselected population of South African children aged 12-36 months
No full textIncludes bibliographical references.Background: Food allergy (FA) is a significant and often life-threatening health problem affecting about 4-6% of children and their families globally. In some developed countries FA prevalence has reached 10% and it is believed that developing economies may follow a similar trend since there is a reported rise in the global burden of other allergic diseases like asthma, allergic rhinitis and eczema. However, there is a dearth of population studies at global level documenting challenge-proven Ig-E mediated food allergy (FA) prevalence. As such, we studied an unselected population of children attending crèches in Cape Town, South Africa. Methodology All children aged 12-36 months attending the selected crèches between February 2013 and October 2013 were eligible for the study. Participants were assessed with an allergy questionnaire, had skin prick tests (SPTs) done and if they qualified, were invited for an oral food challenge (OFC) at the Red Cross Hospital Paediatric Allergy Clinic (RCHPAC). The SPT wheal size results were categorised into ≥1mm, ≥3mm and ≥7mm. We gave a general description of the study sample with respect to the demographic characteristics and compared participants and non-participants. We reported sensitisation pattern towards foods in the panel i.e. egg white extract, peanut, cow’s milk, wheat(flour), soy, hazelnut and fish (cod) according to the SPT categories. The effects of age, ethnicity, sex and concomitant allergy on sensitisation patterns were assessed. Associations between the potential predictor variables and sensitisation were assessed by Z-test for proportions and Chi-square/Fisher’s exact. PART I presents the study protocol with a brief motivation for the relevance of the study and the methodology used. PART II presents a structured literature review on FA and FS in large populations of selected and unselected cohorts. It provides an overview of empirical evidence on prevalence estimates from both the developed and developing world, and the potential risk factors causing Fav. PART III summarises the methodology, results and interpretation of the analysis conducted in a journal-ready manuscript according to Current Allergy and Clinical Immunology Journal requirements. Results The sample consisted of; 39% black African, 20% Caucasian and 41% mixed race participants, with a median age 26 months (IQR: 22-31). Amongst 121 participants (66% response rate, 92% participation rate and 94% completion rate), the prevalence of SPT≥1mm to any food was 16%, SPT≥3mm 12% and SPT≥7mm 4%. The prevalence of challenge-proven Ig-E mediated raw egg allergy was 1.7% and peanut allergy 0.8%. Black African participants had higher sensitisation rates (23%) of SPT≥1mm to any food, when compared to Caucasian (13%) and mixed race (10%) participants despite the difference not reaching statistical significance (p=0.17). Conclusions: This study was acceptable and feasible in this population that has a low prevalence of Ig-E mediated FA that is comparable to other studies from developed countries using objective measures in unselected cohorts. The prevalence of FS is appreciably high in this sample and there are ethnic differences that require further investigation. The findings seem to suggest an existing burden of Ig-E mediated FAs in the South African context that is un-diagnosed and therefore not manage
Infant and Childhood Infective Endocarditis in the Western Cape, South Africa: A Retrospective Review
No full textIntroduction Infective endocarditis is a microbial infection of the endothelial surface of the heart, predominantly the heart valves, that is associated with high mortality and morbidity. Few contemporary data exist regarding affected children in our context. Aims and Objectives: We aimed to describe the profile and treatment outcomes of infant and childhood endocarditis at our facilities. Methods: This is a retrospective review of infants and children with endocarditis at two public-sector hospitals in the Western Cape Province of South Africa over a 5-year period. Patients with “definite” and “possible” endocarditis according to Modified Duke Criteria were included in the review. Results: Forty-nine patients were identified for inclusion; 64% of patients met “definite” and 36% “possible” criteria. The in-hospital mortality rate was 20%; 53% of patients underwent surgery with a post-operative mortality rate of 7.7%. The median interval from diagnosis to surgery was 20 days (interquartile range 9-47 days). Valve replacement occurred in 28% and valve repair in 58%. There was a significant reduction in valvular dysfunction in patients undergoing surgery and only a marginal improvement in patients treated medically. Overall, 43% of patients had some degree of residual valvular dysfunction. Conclusion: Endocarditis is a serious disease with a high in-hospital mortality and presents challenges in making an accurate diagnosis. Despite a significant reduction in valvular dysfunction, a portion of patients had residual valvular dysfunction. Early surgery is associated with a lower mortality rate, but a higher rate of valve replacement when compared to delayed surgery
Tertiary hospitals physician’s knowledge and perceptions towards antibiotic use and antibiotic resistance in Cameroon
No full textAbstract Background Infections due to resistant bacteria are associated with severe illness, increased risk for complications, hospital admissions, and higher mortality. Inappropriate use of antibiotics, which contributes to increased antibiotic resistance (ABR), is common in healthcare settings across the globe. In Cameroon, antibiotics have been reported as high as 45–70% of prescriptions. We sought to investigate the knowledge, attitudes, and perceptions regarding appropriate antibiotic use and ABR of medical doctors practicing in tertiary hospitals in Yaoundé, Cameroon. Methods We conducted a cross-sectional survey using a 54-item self-administered questionnaire sent via email to medical doctors working in the four major tertiary hospitals of Yaoundé. The questionnaire recorded socio-demographics, perceptions on antibiotic use and ABR, sources and usefulness of education on ABR, and clinical scenarios to appraise knowledge. Results A total of 98/206 (48%) doctors responded. Years of experience ranged between 1 and 17 years. Most participants agreed that ABR is a problem nationwide (93%) and antibiotics are overused (96%), but only one third (32%) thought that ABR was a problem in their wards. Most respondents (65%) were confident that they use antibiotics appropriately. We found a mean knowledge score of 56% (± 14), with prescribers not influenced by patient-exerted pressure for antibiotic prescribing scoring better compared to those influenced by patients (67% vs 53%, p = 0.01). Overall, most participants (99%) expressed interest for further education on both appropriate antibiotic use and ABR. Conclusion Confidence of prescribers in their ability to appropriately use antibiotics conflicts with the low level of knowledge on antibiotic use in this group of doctors. Moreover, the opinion of the majority, that ABR is not a problem in their own backyard is in keeping with similar studies in other countries and is of significant concern. Introduction of formal antibiotic stewardship programmes in Cameroon may be a useful intervention
Barriers and facilitating factors to HIV treatment among men in a high-HIV burdened district in KwaZulu-Natal, South Africa: A qualitative study
No full textDespite enormous increases in the proportion of people living with HIV accessing treatment in sub-Saharan Africa, major gender disparities persist, with men experiencing lower rates of testing, linkage to treatment, and retention in care. In this study, we investigated the barriers and facilitating factors to HIV treatment among men in uThukela, a high-HIV-burdened district in KwaZulu-Natal province, South Africa. We conducted a qualitative study including nine Black African male participants who were recruited from 18 health care facilities in uThukela District, KwaZulu-Natal province. In-depth interviews were conducted with participants who linked to care and those who did not link to care at 3-month post HIV diagnosis. We used Atlas.ti for thematic analysis. Data were coded and linked to broader themes emerging across interviews. The median age was 40 years (interquartile range [IQR]: 31–41). This study identified the following key themes which emerged as barriers to HIV treatment among men in uThukela District: lack of emotional readiness, perceived medication side effects, fear of treatment non-adherence, perceived stigma and confidentiality concerns, and poor socioeconomic factors
Comparing PrEP initiation rates by service delivery models among high risk adolescent boys and young men in KwaZulu-Natal, South Africa: findings from a population-based prospective study
No full textAbstract Introduction Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy that can reduce the risk of HIV acquisition by more than 90% if taken consistently. Although South Africa has been implementing PrEP since 2016, initially for selected population groups before expanding access to more people, there is a dearth of research focused on PrEP among adolescent boys and young men (ABYM), despite them experiencing high rates of HIV infection. To address this gap, we compared PrEP initiation rates by service delivery points (SDPs) among ABYM in KwaZulu-Natal, South Africa. Methods We conducted a population-based prospective study in 22 SDPs from July 2021 to July 2022 in KwaZulu-Natal, South Africa. Sexually active ABYM aged 15–35 years who tested HIV negative were recruited at purposively selected PrEP SDPs (i.e., healthcare facilities, secondary schools and Technical Vocational Education and Training (TVET) colleges, and community-based youth zones). We collected baseline quantitative data from each participant using self-administered electronic questionnaires built into REDCap, including demographic information such as age, sex, employment status and level of education, as well as PrEP initiation outcomes. We extracted data from REDCap and exported it to Stata version 17.0 for analysis, and then eliminated discrepancies and removed duplicates. We described baseline characteristics using summary and descriptive statistics (median, interquartile range [IQR] and proportions) and reported PrEP initiation proportions overall and by SDPs. Results The study included 1104 ABYM, with a median age of 24 years (interquartile range (IQR): 21–28)). Almost all participants were black African (n = 1090, 99%), with more than half aged 15–24 years (n = 603, 55%) and 45% (n = 501) aged 25–35 years. The majority (n = 963; 87%) had attained a secondary level of education. Overall PREP initiation rate among adolescent boys and young men was low: among 1078 participants who were eligible for PrEP, 13% (n = 141) were started on PrEP. Among the participants who were initiated on PrEP, over three quarters (78%, n = 58) were initiated from high schools, compared with community-based youth zones (40%, n = 37), TVET colleges (26%, n = 16) and healthcare facilities (4%, n = 30). Conclusions This study provided evidence suggesting that expanding PrEP services to non-traditional settings, such as high schools, TVET colleges, and community-based organizations, may have a potential to increase PrEP access among ABYM in South Africa
Linkage to HIV care and early retention in care rates in the universal test-and-treat era: A population-based prospective study in Kwazulu- Natal, South Africa
No full textHIV linkage, and retention are key weaknesses in South Africa’s national antiretroviral therapy (ART) program, with the
greatest loss of patients in the HIV treatment pathway occurring before ART initiation. This study investigated linkage-to
and early-retention-in-care (LTRIC) rates among adults newly diagnosed with HIV in a high-HIV prevalent rural district.
We conducted an observational prospective cohort study to investigate LTRIC rates for adults with a new HIV diagnosis
in South Africa. Patient-level survey and clinical data were collected using a one-stage-cluster design from 18 healthcare
facilities and triangulated between HIV and laboratory databases and registered deaths from Department of Home Affairs.
We used Chi-square tests to assess associations between categorical variables, and results were stratified by HIV status,
sex, and age. Of the 5,637 participants recruited, 21.2% had confirmed HIV, of which 70.9% were women, and 46.5%
were aged 25–34 years. Although 82.7% of participants were linked-to-care within 3 months, only 46.1% remained-in-care
12 months after initiating ART and 5.2% were deceased
Exploring the Genesis, Nature, Etymology and Efficacy of Austerity Policies: Drawing Lessons for Austerity Policy Initiatives in Africa
No full textThis article presents a diagnosis of the concept of austerity and its evolution as a policy tool in public affairs in a bid to sniff out sustainable factors for the implementation of austerity policies in Africa and beyond. To this end, experiences in Greece, the three European Baltics, Portugal, Italy, Argentina and Spain were reviewed to draw lessons for Zimbabwe and Africa in general. The term austerity, whose intellectual roots lie in neo-classical school of economics, denotes economy, frugality, thriftiness, stinginess, prudence in the use of resources by an individual, corporate or nation. Austerity becomes a national policy where governments create restrictive and difficult economic conditions in order to revive economies in crises by cutting public expenditure, debt and deficits. In recent years, austerity policies have become the dominant global wisdom for solving economic and fiscal stress. Cuts in social welfare budgetary allocations, cuts and freezing of posts in the public service and state enterprises—generally characterise countries under austerity policies. For austerity policies to be effective, the article proposes an interplay of factors such as strong political will, buy-in and ownership of the policy by business, labour and civic society; bailouts to support the reform; strong regulatory frameworks for the supervision and surveillance of the banking and financial services sector towards market stability; institutional policy consistency and coherence, and embedded institutional fiscal discipline, among others
AIDS Behav
No full textHIV linkage, and retention are key weaknesses in South Africa's national antiretroviral therapy (ART) program, with the greatest loss of patients in the HIV treatment pathway occurring before ART initiation. This study investigated linkage-to and early-retention-in-care (LTRIC) rates among adults newly diagnosed with HIV in a high-HIV prevalent rural district. We conducted an observational prospective cohort study to investigate LTRIC rates for adults with a new HIV diagnosis in South Africa. Patient-level survey and clinical data were collected using a one-stage-cluster design from 18 healthcare facilities and triangulated between HIV and laboratory databases and registered deaths from Department of Home Affairs. We used Chi-square tests to assess associations between categorical variables, and results were stratified by HIV status, sex, and age. Of the 5,637 participants recruited, 21.2% had confirmed HIV, of which 70.9% were women, and 46.5% were aged 25-34 years. Although 82.7% of participants were linked-to-care within 3 months, only 46.1% remained-in-care 12 months after initiating ART and 5.2% were deceased. While a significantly higher proportion of men were linked-to-care at 3 months compared to women, a significant proportion of women (49.5%) remained-in-care at 12 months than men (38.0%). Post-secondary education and child support grants were significantly associated with retention. We found high linkage-to-care rates, but less than 50% of participants remained-in-care at 12 months. Significant effort is required to retain people living with HIV in care, especially during the first year after ART initiation. Our findings suggest that interventions could target men to encourage HIV testing.CC999999/ImCDC/Intramural CDC HHSUnited States/U2G GH001150/GH/CGH CDC HHSUnited States/1U2GGH001150/CC/CDC HHSUnited States
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