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It is no longer a myth that climate change‐related disasters are on the rise globally, with severe and devastating consequences in developing countries, particularly in Sub‐Saharan Africa, where many of the world's poor people reside. Thus, the emphasis on adaptation to climate change is no longer a choice or a deferred problem into the future, but rather an urgent matter of concern which must be considered a policy priority. As a response to retrogressive climate change challenges on social‐economic development and environmental degradation, the government of South Africa has in the last two and half decades, embarked on the progressive formulation of different policy instruments and strategic frameworks to curb and minimize the impacts of climate change on all sub‐sectors of the economy. Although much remains to be achieved, some level of success has been realized, particularly in the space of policy formulation, albeit the poor record of implementation. Using research methods inspired by the tradition of qualitative research and an appraisal of existing literature, this paper discusses the complexities of climate change adaptation governance at a local government level in South Africa, focusing on the Eastern Cape Province. It is argued in the paper that one of the major challenges for climate change governance at local municipality levels in South Africa emanates from the gap between aspirations and actions across the entire national governance system. The absence of an integrated climate change governance system has posed significant systemic challenges, and these have tended to constrain decision‐making and implementation processes. These issues have been discussed within the broader discourse of the sustainable development goals, particularly goals number 13, 16 and 17. [ABSTRACT FROM AUTHOR]

Background: Achieving universal health coverage (UHC) in the context of limited resources will require prioritising the most vulnerable and ensuring health policies and services are responsive to their needs. One way of addressing this is through the engagement of marginalised voices in the priority setting process. Public engagement approaches that enable group level deliberation as well as individual level preference capturing might be valuable in this regard, but there are limited examples of their practical application, and gaps in understanding their outcomes, especially with rural populations. Objective: To address this gap, we implemented a modified priority setting tool (Choosing All Together—CHAT) that enables individuals and groups to make trade‐offs to demonstrate the type of health services packages that may be acceptable to a rural population. The paper presents the findings from the individual choices as compared to the group choices, as well as the differences among the individual choices using this tool. Methods: Participants worked in groups and as individuals to allocate stickers representing the available budget to different health topics and interventions using the CHAT tool. The allocations were recorded at each stage of the study. We calculated the median and interquartile range across study participants for the topic totals. To examine differences in individual choices, we performed Wilcoxon rank sum tests. Results: The results show that individual interests were mostly aligned with societal ones, and there were no statistically significant differences between the individual and group choices. However, there were some statistically significant differences between individual priorities based on demographic characteristics like age. Discussion: The study demonstrates that giving individuals greater control and agency in designing health services packages can increase their participation in the priority setting process, align individual and community priorities, and potentially enhance the legitimacy and acceptability of priority setting. Methods that enable group level deliberation and individual level priority setting may be necessary to reconcile plurality. The paper also highlights the importance of capturing the details of public engagement processes and transparently reporting on these details to ensure valuable outcomes. Public Contribution: The facilitator of the CHAT groups was a member from the community and underwent training from the research team. The fieldworkers were also from the community and were trained and paid to capture the data. The participants were all members of the rural community‐ the study represents their priorities. [ABSTRACT FROM AUTHOR]

The contamination of feed and food by heavy metals represents a significant concern for the health of both animals and humans. This study investigates the impact of geographical location on heavy metal distribution in dairy cattle feeds sourced from Free State and Limpopo, South Africa (SA). A total of 70 feed samples (40 from Free State and 30 from Limpopo) were collected from 2018 to 2019 and analyzed for heavy metals, including cadmium (Cd), arsenic (As), copper (Cu), zinc (Zn), lead (Pb), and chromium (Cr), using inductively coupled plasma mass spectrometry (ICP‐MS). Our findings revealed the presence of Cr, Cu, and Zn in the feeds, but at levels below the FAO/WHO permissible limits. Additionally, As, Cd, and Pb concentrations in the feeds were below the Limit of Detections (LODs). Generally, Cr concentrations (0.032–0.454 mg/kg) identified in the Free State samples were lower than those found in Limpopo (0.038–1.459 mg/kg), while the levels of Cu (0.092–4.898 mg/kg) and Zn (0.39–13.871 mg/kg) recorded in the Free State samples were higher than those from Limpopo [(0.126–3.467 mg/kg) and (0.244–13.767 mg/kg), respectively]. According to independent sample t‐tests, Cu and Zn levels were substantially higher (p ≤.05) in Free State feeds compared to Limpopo, while Limpopo feeds exhibited significantly higher (p ≤.05) Cr concentrations than Free State feeds. Despite the low recorded heavy metal levels, regular monitoring of these elements in cow diets across all SA provinces is essential for ensuring the well‐being of animals and humans. [ABSTRACT FROM AUTHOR]

Introduction: South Africa has one of the highest rates of internal migration on the continent, largely comprised of men seeking labour in urban centres. South African men who move within the country (internal migrants) are at higher risk than non‐migrant men of acquiring HIV yet are less likely to test or use pre‐exposure prophylaxis (PrEP). However, little is known about the mechanisms that link internal migration and challenges engaging in HIV services. Methods: We recruited 30 internal migrant men (born outside Gauteng Province) during August 2022 for in‐depth qualitative interviews at two sites in Johannesburg (Gauteng) where migrants may gather, a factories workplace and a homeless shelter. Interviewers used open‐ended questions, based in the Theory of Triadic Influence, to explore experiences and challenges with HIV testing and/or PrEP. A mixed deductive inductive content analytic approach was used to review data and explain why participants may or may not use these services. Results: Migrant men come to Johannesburg to find work, but unreliable income, daily stress and time constraints limit their availability to seek health services. While awareness of HIV testing is high, the fear of a positive diagnosis often overshadows the benefits. In addition, many men lack knowledge about the opportunity for PrEP should they test negative, though they express interest in the medication after learning about it. Additionally, these men struggle with adjusting to urban life, lack of social support and fear of potential stigma. Finally, the necessity to prioritize work combined with long wait times at clinics further restricts their access to HIV services. Despite these challenges, Johannesburg also presents opportunities for HIV services for migrant men, such as greater anonymity and availability of HIV information and services in the city as compared to their rural homes of origin. Conclusions: Bringing HIV services to migrant men at community sites may ease the burden of accessing these services. Including PrEP counselling and services alongside HIV testing may further encourage men to test, particularly if integrated into counselling for livelihood and coping strategies, as well as support for navigating health services in Johannesburg. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent girls and young women (AGYW) living with HIV experience poor HIV outcomes and high rates of unintended pregnancy. Little is known about which healthcare provisions can optimize their HIV‐related outcomes, particularly among AGYW mothers. Methods: Eligible 12‐ to 24‐year‐old AGYW living with HIV from 61 health facilities in a South African district completed a survey in 2018–2019 (90% recruited). Analysing surveys and medical records from n = 774 participants, we investigated associations of multiple HIV‐related outcomes (past‐week adherence, consistent clinic attendance, uninterrupted treatment, no tuberculosis [TB] and viral suppression) with seven healthcare provisions: no antiretroviral therapy (ART) stockouts, kind and respectful providers, support groups, short travel time, short waiting time, confidentiality, and safe and affordable facilities. Further, we compared HIV‐related outcomes and healthcare provisions between mothers (n = 336) and nulliparous participants (n = 438). Analyses used multivariable regression models, accounting for multiple outcomes. Results: HIV‐related outcomes were poor, especially among mothers. In multivariable analyses, two healthcare provisions were "accelerators," associated with multiple improved outcomes, with similar results among mothers. Safe and affordable facilities, and kind and respectful staff were associated with higher predicted probabilities of HIV‐related outcomes (p<0.001): past‐week adherence (62% when neither accelerator was reported to 87% with both accelerators reported), clinic attendance (71%−89%), uninterrupted ART treatment (57%−85%), no TB symptoms (49%−70%) and viral suppression (60%−77%). Conclusions: Accessible and adolescent‐responsive healthcare is critical to improving HIV‐related outcomes, reducing morbidity, mortality and onward HIV transmission among AGYW. Combining these provisions can maximize benefits, especially for AGYW mothers. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance (AMR) is a global health problem largely due to the overuse of antimicrobials. In recognition of this, the World Health Assembly in 2015 agreed on a global action plan to tackle AMR. Following the global emergence of the mcr‐1‐associated colistin resistance gene in the livestock industry in 2016, several countries including South Africa restricted the veterinary use of colistin as the gene threatens the clinical utility of the drug. This study is a follow‐up to the restriction in place in order to evaluate the impact of such policy adoption. Objective: To assess the prevalence of antibacterial resistance (ABR), and the mcr‐1 colistin resistance gene in broiler chicken over a 2‐year period, as a follow‐up to the veterinary ban on colistin use in South Africa. Methods: A total of 520 swab samples were obtained during 2019 (March–April) and 2020 (February–March), from healthy broiler chicken carcasses (n = 20) and chicken droppings in transport crates (n = 20) at various poultry abattoirs (N = 7) in the Gauteng province of South Africa. Escherichia coli organisms were isolated and subjected to a panel of 24 antibacterials using the MicroScan machine. Screening for mcr‐1 colistin resistance gene was undertaken using PCR. Result: Four hundred and thirty‐eight (438) E. coli strains were recovered and none demonstrated phenotypic resistance towards colistin, amikacin, carbapenems, tigecycline and piperacillin/tazobactam. The mcr‐1 gene was not detected in any of the isolates tested. Resistances to the aminoglycosides (0%–9.8%) and fluoroquinolones (0%–18.9%) were generally low. Resistances to ampicillin (32%–39.3%) and trimethoprim/sulphamethoxazole (30.6%–3.6%) were fairly high. A significant (p < 0.05) increase in cephalosporins and cephamycin resistance was noted in the year 2020 (February–March) when compared with the year 2019 (March–April). Conclusion: The absence of mcr‐1 gene and colistin resistance suggests that mitigation strategies adopted were effective and clearly demonstrated the significance of regulatory interventions in reducing resistance to critical drugs. Despite the drawback in regulatory framework such as free farmers access to antimicrobials OTC and a dual registration system in place, there is a general decline in the prevalence of ABR when the present data are compared with the last national veterinary surveillance on AMR (SANVAD 2007). To further drive resistance down, mitigation strategies should focus on strengthening regulatory framework, the withdrawal of OTC dispensing of antimicrobials, capping volumes of antimicrobials, banning growth promoters and investing on routine surveillance/monitoring of AMR and antimicrobial consumption. [ABSTRACT FROM AUTHOR]

The probabilistic forecast skill level of statistically downscaled European Centre for Medium‐Range Weather Forecasts (ECMWF) subseasonal‐to‐seasonal (S2S) forecasts is determined in predicting maximum and minimum temperatures for weeks 1–4 lead times during 20‐year December–January–February (DJF) seasons from 2001 to 2020 over South Africa. Skilful S2S forecasts are vital in assisting decision‐makers in the development of contingency planning for any eventualities that may arise because of weather and climate phenomena. Extreme high‐ and low‐temperature events over a prolonged period can lead to hyperthermia and hypothermia, respectively, and can lead to loss of life. The results from the relative operating characteristic (ROC) and reliability diagrams indicate that the ECMWF S2S model has skill in predicting maximum temperature up to week 3 ahead, particularly over the central and eastern parts of South Africa. The ROC scores indicate that the model has skill in predicting minimum temperature up to week 4 ahead for the above‐normal category, particularly over the central and eastern parts of South Africa. Reliability diagrams indicate that the model has a tendency of overestimating the below‐normal category when predicting both maximum and minimum temperatures for weeks 1–4 lead times over South Africa. Furthermore, canonical correlation analysis (CCA) pattern analysis suggests that when there are anomalously positive and negative predicted 850‐hPa geopotential heights located over South Africa, there are anomalously hot and cold conditions during the DJF seasons over most parts of South Africa, respectively. These results suggests that statistical downscaling of model forecasts can improve forecast skill. Moreover, the results suggest that there is potential for S2S predictions in South Africa, and as such, S2S prediction system for maximum and minimum temperatures can be developed. [ABSTRACT FROM AUTHOR]

Freshwater ecosystems are the most threatened on Earth, with many species facing extinction. The Clanwilliam sandfish (Labeo seeberi) is South Africa's most threatened migratory freshwater fish and is endemic to the Olifants–Doring River system in the Cape Fold Ecoregion. Non‐native fish predation and river desiccation have caused a recruitment bottleneck, severely compromising juvenile survival and resulting in a declining population of aging sandfish. The Saving Sandfish Project launched an emergency head‐start intervention in 2020 to reduce extinction risk. We (1) rescued juvenile sandfish from drying pools in a key spawning tributary (the Biedouw River); (2) relocated them to 6 off‐stream reservoirs; and (3) released reservoir‐reared sandfish back into their natal river once large enough to evade non‐native fish predation. Here, we estimate survival in the reservoir environment, evaluate return rates relative to wild run size, and assess the probability of return based on conditions at release. Between 2020 and 2022, we stocked 33,391 juvenile sandfish into the 6 reservoirs. After 1 year, the estimated survival rate at one reservoir was 0.679 (range based on 95% CI: 0.385–0.973). Release and return results are presented only for the first (2020) rescue cohort. In 2021, we released 1277 sandfish from 2 reservoirs into the Biedouw River, comprising 16.6% of the 2020 rescue cohort. Mean size at release was 169 mm (SE 0.6) total length. Of those released, 994 were PIT‐tagged. A total of 77 PIT‐tagged sandfish were recorded during the 2022 spawning migration—a return rate of 7.7% of tagged releases in the first year of returns. Size of fish and distance from the Doring River at release were significant predictors of return probability, with larger fish released further from the Doring experiencing a higher probability of return. This program serves as a model for the conservation of freshwater fish where there is an imminent and high risk of extinction. [ABSTRACT FROM AUTHOR]