Search

Objectives: The objectives of this study were to ascertain whether the nutrient requirements of 6–11-month-old infants can be met with a food-based approach, and to identify the nutrients of which it is difficult to achieve adequate intakes. Design, setting and subjects: A cross-sectional survey and interviews with mothers and caregivers from the KwaMashu Community Health Centre were conducted. One hundred and thirty-four interviews were completed. This information provided the food consumption input for the model using Optifood software. Results: The results revealed that with the current food pattern of infants from the study group in KwaMashu, iron, zinc and calcium are nutrients whose requirements are likely not to be met in the diet. The percentage RNI (recommended nutrient intake) for iron was 25.2%, zinc 51.3% and calcium 77%. Nutrient intakes for these nutrients of concern improved in the ‘No pattern’ diet but iron and zinc intakes remained below the RNI. According to the best diets modelled by Optifood, it appears that infants in KwaMashu would be able to achieve the recommended intakes of energy, protein, and 8 of the 11 micronutrients, as long as breastfeeding on demand continues during the complementary feeding phase. Conclusions: This study calls into question the continued food-based focus to ensure nutrient adequacy in infants. In conjunction with efforts to improve household food security and continued support and promotion of breastfeeding for the first 2 years of life, targeted micronutrient supplementation may be needed to ensure the optimal growth and development of infants in South Africa.&nbsp

Timely uptake of Antiretroviral therapy considerably improves the health of people living with the Human Immunodeficiency virus. We conducted a cross-sectional study of newly HIV diagnosed individuals in four clinics in eThekwini municipality, KwaZulu-Natal. Data was collected between June 2020 and December 2020. Participants completed an interviewer-administered questionnaire after HIV testing, on the day of HIV diagnosis. We evaluated factors influencing uptake of same-day ART initiation in eThekwini clinics, KwaZulu Natal, South Africa. Demographic information, health status, sexual behaviour, knowledge of universal test and treat (UTT), ART initiation uptake, and disclosure data was collected. Among the 403 participants, same-day initiation (SDI) was 69.2% (n = 279). We observed the number of sexual partners (aOR 0.35; 95% CI 0.15–0.81), HIV status of the partner (aOR 5.03; 95% CI 2.74–9.26) and knowledge of UTT (aOR 1.97; 95% CI 1.34–2.90) were identified as major factors influencing uptake of same-day ART initiation. More strategies are needed to achieve the SDI uptake within the framework of UTT.

Background Introduction of tenofovir (TDF) plus lamivudine (3TC) and dolutegravir (DTG) in first- and second-line HIV treatment regimens in South Africa warrants characterization of acquired HIV-1 drug resistance (ADR) mutations that could impact DTG-based antiretroviral therapy (ART). In this study, we sought to determine prevalence of ADR mutations and their potential impact on susceptibility to drugs used in combination with DTG among HIV-positive adults (≥ 18 years) accessing routine care at a selected ART facility in KwaZulu-Natal, South Africa. Methods We enrolled adult participants in a cross-sectional study between May and September 2019. Eligible participants had a most recent documented viral load (VL) ≥ 1000 copies/mL after at least 6 months on ART. We genotyped HIV-1 reverse transcriptase and protease genes by Sanger sequencing and assessed ADR. We characterized the effect of ADR mutations on the predicted susceptibility to drugs used in combination with DTG. Results From 143 participants enrolled, we obtained sequence data for 115 (80%), and 92.2% (95% CI 85.7–96.4) had ADR. The proportion with ADR was similar for participants on first-line ART (65/70, 92.9%, 95% CI 84.1–97.6) and those on second-line ART (40/44, 90.9%, 95% CI 78.3–97.5), and was present for the single participant on third-line ART. Approximately 89% (62/70) of those on first-line ART had dual class NRTI and NNRTI resistance and only six (13.6%) of those on second-line ART had major PI mutations. Most participants (82%) with first-line viraemia maintained susceptibility to Zidovudine (AZT), and the majority of them had lost susceptibility to TDF (71%) and 3TC (84%). Approximately two in every five TDF-treated individuals had thymidine analogue mutations (TAMs). Conclusions Susceptibility to AZT among most participants with first-line viraemia suggests that a new second-line regimen of AZT + 3TC + DTG could be effective. However, atypical occurrence of TAMs in TDF-treated individuals suggests a less effective AZT + 3TC + DTG regimen in a subpopulation of patients. As most patients with first-line viraemia had at least low-level resistance to TDF and 3TC, identifying viraemia before switch to TDF + 3TC + DTG is important to avoid DTG functional monotherapy. These findings highlight a need for close monitoring of outcomes on new standardized treatment regimens.

Background: Diabetes mellitus (DM) represents a major health-related problem in South Africa and throughout the world. The management goals of diabetes are first to maintain normal blood glucose levels and second to prevent the development of complications. Local guidelines developed by the Society for Endocrine Metabolism and Diabetes South Africa (SEMDSA) have shown that tight glycaemic control and appropriate monitoring can prevent or delay the development of diabetic complications. The demographic profile of patients with type 2 DM and the compliance of doctors to the guidelines were determined.Methods: Five hundred records of patients with type 2 DM were selected from the medical outpatients’ department (MOPD) by systematic sampling. Demographic information on age, sex and ethnicity was obtained. The performance and timing of recommended investigations were recorded and compared with the 2012 SEMDSA guidelines.Results: The mean age of patients was 61 years. Black and Indian patients formed the majority, comprising 44.4% and 43.0% respectively. Glycated haemoglobin was measured in 29.2% of patients once and 13.2% of patients twice in the past year. Lipid studies were done on 40.4% of patients. A serum creatinine (sCr), estimated glomerular filtration rate (eGFR) and serum potassium were done on 38.2% of patients. Eye examinations were done on 13.60% patients and examination of the foot was done on 7.8% of patients. Some 15% had a urine dipstick test done at least once in the past year and 10.4% had a urine albumin/creatinine ratio (ACR) requested. Only 21 patients (4.2%) were compliant with the SEMDSA guidelines. Measurements of blood pressure and blood glucose were 100% compliant. Anthropometric measurements (height, weight and body mass index), dietitian referral and foot examinations were the least compliant, being performed 4.2%, 5.0% and 7.8% of the time respectively.Conclusion: Black and Indian patients formed the majority of the study population. The screening for chronic complications of type 2 DM was poor in the majority of patients. Evaluation of selected records demonstrated compliance with the SEMDSA guidelines in only 4.2% of patients. There is an urgent need to review barriers to the implementation of guidelines in South Africa.

Background: Despite a substantial diabetes mellitus (DM) burden, there are few data regarding the relationship between DM and hyperglycaemia on COVID-19 severity and outcome in African populations. This study aimed to describe this relationship in the local context, and to determine whether our data correlated with observations made globally.Methods: Retrospective analysis of patients admitted to King Edward VIII Hospital with COVID-19 during June–September 2020 was undertaken. The sample was subdivided into three cohorts: DM; hyperglycaemia only (HO); and neither DM nor hyperglycaemia (NDNH). Patients living with DM (PLWD) were further subdivided into those with hyperglycaemia (PLWDH) versus normoglycaemia (PLWDN). Comparisons were made across groups.Results: The 236 participants enrolled comprised 79 with DM, 22 with HO, and 135 with NDNH. Half of patients with HO, 26.6% of PLWD and 15.6% of NDNH died. A log-rank test revealed significantly lower survival rates for those with HO compared with PLWDN (p = 0.001) and NDNH (p = 0.002). PLWDH also had significantly lower survival rates when compared with these two groups (p = 0.018 and p = 0.039 respectively). PLWD were significantly more likely to receive steroids (odds ratio [OR] 2.03) and oxygen therapy (OR 2.93). Patients with HO were significantly more likely to receive mechanical ventilation (MV) (OR 7.7) and die (OR 5.43). Compared with PLWDN, PLWDH were significantly more likely to receive MV (OR 10.83) and die (OR 4.24). When compared with PLWDN, patients with HO were significantly more likely to receive oxygen (100% vs. 70.4%), MV (63.6% vs. 3.7%) or die (50% vs. 11.1%).Conclusion: This study concurred with global findings, highlighting the importance of glycaemia as a prognostic marker in patients hospitalised with COVID-19. We recommend that all patients admitted with COVID-19 have a random glucose on admission and strict glycaemic control in those with hyperglycaemia to improve outcomes.

Climate change manifesting in inconsistent rainfall has affected subsistence agriculture, posing a threat to food security in South Africa. Women are central in food production, hence this study ex...

Climate change projections of increases in lightning activity are an added concern for lightning-prone countries such as South Africa. South Africa’s high levels of poverty, lack of education, and awareness, as well as a poorly developed infrastructure, increase the vulnerability of rural communities to the threat of lightning. Despite the existence of national lightning networks, lightning alerts and warnings are not disseminated well to such rural communities. We therefore developed a community-based early warning system (EWS) to detect and disseminate lightning threats and alerts in a timely and comprehensible manner within Swayimane, KwaZulu-Natal, South Africa. The system is composed of an electrical field meter and a lightning flash sensor with warnings disseminated via audible and visible alarms on site and with a remote server issuing short message services (SMSs) and email alerts. Twelve months of data (February 2018–February 2019) were utilized to evaluate the performance of the EWS’s detection and warning capabilities. Diurnal variations in lightning activity indicated the influence of solar radiation, causing convective conditions with peaks in lightning activity occurring during the late afternoon and early evening (between 1400 and 2100) coinciding with students being released from school and when most workers return home. In addition to detecting the threat of lightning, the EWS was beneficial in identifying periods that exhibited above-normal lightning activity, with two specific lightning events examined in detail. Poor network signals in rural communities presented an initial challenge, delaying data transmission to the central server until rectified using multiple network providers. Overall, the EWS was found to disseminate reliable warnings in a timely manner.

Dental amalgam has been used as a restorative material in dentistry for the past 150 years. This material has been used to restore posterior teeth throughout the world and is also used in South Africa. Dental amalgam has been the material of choice for patients presenting with large tooth decay areas, including the loss of cuspal areas. The reason for this is that dental amalgam was always considered strong and durable. Compared to alternate dental materials, this material could also withstand the significant forces associated with chewing and biting. Dental amalgam is also considered more cost-effective than alternate dental materials such as conventional glass ionomers, resin-modified glass ionomers, resin composite and ceramic restorations, making it more feasible and material of choice in lower economic countries, including South Africa.

The majority of patients living with diabetes mellitus (PLWD) are diagnosed and managed at primary care level. Much research has focused on diabetes mellitus, its complications and the need for ear...

Unintended pregnancy impacts many young women in South Africa, and rates of consistent contraceptive use among this population are suboptimal. Limited empirical work has investigated reasons for inconsistency between pregnancy intention and contraceptive use behaviour with data collected during pregnancy. We explored pregnancy intentions and discordance between intentions and contraceptive use prior to conception among young pregnant women in KwaZulu-Natal, South Africa. In-depth qualitative interviews were conducted with 35 women during pregnancy (mean age = 19.3; range = 18–21) in 2011 and 2012. Data were analysed using content analysis. All participants reported unintended pregnancies; almost half were not using contraception near conception. Reasons for not intending to become pregnant spanned personal, social, health, and economic domains. Participants living with HIV (n = 13) expressed specific concerns related to impacts of pregnancy on HIV disease management and fear of transmission of HIV to the infant. Discordance between pregnancy intentions and contraceptive use prior to conception was attributed to personal, social, health and structural domains. Findings indicate a need for interventions that address barriers to contraceptive use in order to minimise unintended pregnancy and support safe, desired pregnancies among young women.

Background South Africa is a middle-income country with major discrepancies in wealth and access to care. There is a significant burden of surgical disease and limited access to quality health care for a large proportion of the population. This article quantifies the burden of abdominal surgery over a 6-month period in KwaZulu-Natal (KZN) province and quantifies the emergency to elective (Ee) ratio for these operations. Methods This study describes the abdominal operations conducted at all regional and tertiary hospitals in the public health sector of KZN province for the period of 1 July to December 31, 2015. Operations performed were tabulated in a spreadsheet and categorized as elective, emergency, and trauma. They were further subdivided by anatomical region and by specific predetermined procedures. Uncertain criteria were clarified using a modified Delphi discussion. The Ee ratio was determined using the recently described technique. Results Between June, 1st and December 31, 2015, of 13,282 operations, there were 4580 (34.5%) elective operations, 7777 (58.6%) emergency operations, and 925 (6.9%) trauma-related operations. A total of 5630 abdominal operations were performed of which 2949 were emergency procedures. There were 660 trauma-related abdominal procedures and 2021 elective procedures. There was a heavy weighting toward emergency surgeries with an Ee ratio of 145 for abdominal surgery. The previous sub-Saharan African ratio was estimated to be 62.6. Conclusions An overview of abdominal surgery in KZN reveals a high ratio of emergency to elective surgery. This suggests that the current primary health care program is failing to detect and treat acute surgical disease timeously.

There are limited data on vertebral fractures (VFs) in South Africa (SA). Therefore a study was undertaken to compare the demographic profile, clinical risk factors and bone mineral density (BMD) i...

Unlocking on-farm entrepreneurship is said to be fundamental for employment creation in the smallholder sector and for rural poverty reduction. However, policy-relevant knowledge to enhance smallho...

South Africa’s adopted neoliberalism framework, since democracy, has spearheaded industrial development such as mining and has contributed to eroding civil society formations for environmental just...

Introduction: Knowledge, attitude and practices (KAP) of COVID-19 pandemic play a significant role in reducing the transmission of the virus. There is limited information available about HCWs KAP regarding COVID-19. Therefore, the objective of this study was to investigate the KAP of KCWs from a primary healthcare setting in South Africa. Method: This was a cross-sectional study conducted among all medical and nursing healthcare professionals of KwaDabeka Community Healthcare Center (KCHC) and seven PHC clinics. Selfadministered questionnaire was used to collect data. Student’s t-test and ANOVA test were carried out to compare the overall mean knowledge, attitude and practice scores between two or more groups. Pearson’s correlation test was undertaken to establish correlation between KAP scores. Results: Majority HCWs were female (82.8%), single or unmarried (56.6%) and nurses comprised the most (69.2%). Nearly half (44%) reported to have recognized vulnerable co-morbid illnesses for COVID-19. Only 24% of HCWs had good knowledge (scored > 60%), however, 81% had positive attitude (scored >60%) and 63% had good practice (>60% scores). Nursing practitioners had significantly lower mean knowledge and practice scores than medical officers and allied healthcare workers (p

Despite efforts to address HIV-infection, adolescents and young peoples’ (AYP) engagement in interventions remain suboptimal. Guided by a risk protection framework we describe factors that support positive and negative experiences of HIV and SRH interventions among AYP in rural KwaZulu-Natal, South Africa, using data from: community mapping; repeat semi-structured individual interviews (n = 58 in 2017, n = 50 in 2018, n = 37 in 2019–2020); and group discussions (n = 13). AYP who had appropriate and accurate HIV-and SRH-related information were reported to use health-care services. Responsive health-care workers, good family and peer relationships were seen to be protective through building close connections and improving self-efficacy to access care. In contrast to cross-generational relationships with men, alcohol and drug use and early pregnancy were seen to put AYP at risk. Policies and interventions are needed that promote stable and supportive relationships with caregivers and peers, positive social norms and non-judgemental behaviour within clinical services.

The primary objective of this research was to evaluate long-term user acceptability of menstrual cups in a student population in South Africa.A cohort of female students aged 18-24 years attending 10 further education institutions including 22 campus sites in KwaZulu-Natal, South Africa, were offered menstrual cups after receiving education and training in their use. The students were followed for up to 12 months to assess menstrual cup acceptability, user experiences and continuation.A total of 509 students were enrolled. Disposable pads were the primary menstrual hygiene product used in the 3 months prior to the baseline interview (95.5%,The menstrual cup was well accepted among this student population and should be considered as a cost-effective and environmentally sustainable option in menstrual health management initiatives in South Africa.

Background: The diabetes pandemic continues to cause both patient and economic burden. Globally, strategies to improve glycaemic control in patients with diabetes are highly sought after. One such ...

The ongoing spread of human immunodeficiency virus (HIV) has driven novel interventions, such as antiretrovirals, for pre-exposure prophylaxis. Interventions have overlooked a high-risk Sub-Saharan African population: adolescent girls and young women (AGYW), particularly those under 18. We apply the Balkus risk tool among rural South African AGYW (n = 971) in a hyper-endemic setting, identify limitations, and assess deficiencies with modern statistical techniques. We apply the “Ayton” tool, the first risk tool applicable to sub-Saharan African AGYW, and compare performance of Balkus and Ayton tools under varying conditions. The Ayton tool more effectively predicted HIV acquisition. In low and high-risk AGYW, the Ayton tool out-performed the Balkus tool, which did not distinguish between risk classes. The Ayton tool better captured HIV acquisition risk and risk heterogeneities due to its AGYW-focused design. Findings support use of the Ayton tool for AGYW and underscore the need for diverse prognostic tools considering epidemic severity, age, sex and transmission.Clinical Trial Number ClinicalTrials.gov (NCT01187979) and the South African National Clinical Trials Registry (SANCTR) (DOH-27-0812-3345).

The ranging behaviour of raptors in human-altered environments, such as agricultural and suburban landscapes, is becoming increasingly important for conservationists in the context of unprecedented high rates of anthropogenic land use change. We studied the movement ecology of adult Long-crested Eagles Lophaetus occipitalis fitted with geographic positioning system transmitters in an agricultural landscape in KwaZulu-Natal Province, South Africa. Mean home ranges (± SD) of males and females estimated using the autocorrelated kernel density estimator (AKDE) method were 608 ± 552 ha (n = 5) and 664 ± 844 ha (n = 4), respectively. Core areas (KDEhref 50%) were estimated as 80 ± 38 ha and 39 ± 20 ha for males and females, respectively. We also recorded exploratory behaviour (in the form of long excursions) in two of the birds, of up to 49 km from the centre of their home range. The relatively small home ranges reported in this study are suggestive of productive foraging habitats whereby Long-crested Eagles can meet their energy requirements without having to travel long distances to obtain resources. Consistent with predictions, non-breeding male and female Long-crested Eagles showed similar ranging behaviour, which includes occasional exploratory behaviour.

Cross infection in the dental clinical environment remains a low priority in conversations around oral health care despite the high risk of exposure to blood and airborne infections. The aim of this study was to determine the presence of selected pathogens after use of disinfectants on specific dental environmental surfaces at a public oral health facility in KwaZulu-Natal. This was a cross-sectional descriptive case study with a non-experimental design. The dental clinical environment was divided into four zones and 9 dental units were systematically selected. Swabs were collected from the 26 identified areas at specific time intervals (7.00, 9.00, 11.00, and 16.00) after the use of chlorine, ethanol (70% in water) and glutaraldehyde (2%) as surface disinfectants. The collected swab samples were cultured in nutrient agar media for two days at 37°C. The colony forming units were then examined and characterized using the MALDI-TOF spectrometer. Out of the 312 samples taken, 262 (84%) were shown to be bacterial culture positive. The most contaminated areas in the dental environment were around the chair area (86.53%) and the area away from the chair (92%). Glutaraldehyde was found to be more effective than chlorine and ethanol. The study suggests an association between the frequency of cleaning, the type of disinfectant used and the bacterial microbial count on the specified dental environmental surfaces at the identified oral health facility.

Background Recent analysis of drinking water in South Africa found the presence of ARVs, other pharmaceutical and personal care products. The environmental and human health risk that this presents is daunting. The increased use of ARVs with poor disposal practices could be the reason for these substances being present in drinking water. Therefore, this study aimed to determine the knowledge and practices of HIV infected patients, regarding medicine disposal. Method A descriptive, cross sectional, quantitative study that utilised a structured, self-administered, questionnaire was undertaken at 3 different public ARV clinics in the eThekwini Metro of KwaZulu Natal, SA. The variables included questions on demographics, knowledge and practices of medicine disposal of ARV and other medications. Data was captured using excel spreadsheets and analysed using SPSS version 25. Chi square tests were used to compare factors between correct and incorrect knowledge and practice groups. Results Four hundred and eighty four participants agreed to participate in this study, of which the majority (71.1%) were females. Over 87% of the participants knew that improper disposal of medicines were harmful to the environment with only 28.3% knowing that there were laws governing the way medicines should be disposed. Majority of participants that had unused and expired ARVs at home disposed of these medicines. The most common route of medicine disposal for ARVs was by throwing these medicines into the bin (56.4%). Only 24.2% of participants were informed by healthcare professionals about the proper method of medicine disposal. Participants who had secondary and tertiary level of education (p = 0.043) and the ability to speak English (p = 0.001) had appropriate knowledge on medicine disposal. Conclusion This study identified that poor medicine disposal practices and lack of adequate information about the proper methods of medicine disposal were evident among the participant population. There is a need for patient education and healthcare professional intervention to ensure patients are aware of standard proper medicine disposal practices.

Government policy in South Africa to promote agricultural entrepreneurship among smallholders has failed to recognise their heterogeneity and the factors that influence their entrepreneurial drive....

Background: Healthcare policy decisions are driven by many factors, including cost, hence the need to show costs of diabetes mellitus-related lower limb amputations (DMLLA) to inform amendments to ...

Background Radiographic imaging remains a cornerstone of orthopaedic practice. Traditional control X-Rays are routinely requested after procedures. These X-rays may add little value in post-op evaluation of trauma ICU patients, in light of intra-operative screening already performed and reviewed, but has high potential morbidity risk. Aim The aim is to determine if patients undergoing extra-articular fracture fixation, with fluoroscopic image guidance, require any management change due to immediate check x-rays findings. Method Electronic patient and imaging records from January 2015 to November 2019 at a Trauma-specific ICU at a Trauma Society of South Africa accredited, Level 1 Trauma Unit were reviewed retrospectively. All patients matching the inclusion criteria were evaluated to determine if there were any complications and changes in management after the check X-Rays. Results There were 103 ICU patients identified with a mean age of 32 years (3 to 94). Fifty-seven percent had fluoroscopy images as well as post-operative check x-rays and 51.5% had only check X-rays. Only two cases needed revision surgery based on the control x-ray findings. The post-operative x-ray did not alter the management of 98.1% of our patients. Conclusion In this study, routine post-op check x-rays did not add significant additional information to warrant early additional surgical intervention especially in ICU patients with adequate intra-operative fluoroscopy images. This investigation should be ordered for individual patients based on clinical grounds. This will help minimize patient exposure to avoidable radiation, labour intensive transfers to the radiology department, and decrease investigations that have financial implications but with limited benefits.

The effects of rainfall variability and droughts on food production are well established. However, in South Africa, the association between rainfall, droughts and household food insecurity is not w...

Background Myelomeningocoele (MMC) is common in the developing world. The purpose of this study was to investigate the clinical characteristics and management of myelomeningocoele and to identify factors contributing to outcomes. Methods This was a retrospective, observational study of consecutive children diagnosed with MMC managed in the Paediatric Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital. Multiple logistic regression analysis identified clinical characteristics, demographics and surgical variables that were associated with outcome. Results A total of 309 children were managed during this period (M:F 1.3:1). The most common sites were lumbar, lumbo-sacral and sacral. Mean age at surgical repair was 4.7 ± 15.6 months. Two hundred and eight children had ventriculomegaly, of whom 158 had symptomatic hydrocephalus, requiring CSF diversion. Fifty-eight (21%) patients developed wound sepsis, of whom 13 (22%) developed meningitis (p = 0.001). The time to wound sepsis was 9.5 ± 3.6 days. The commonest organism isolated was Staphylococcus aureus followed by MRSA. Thirty-two patients (23%) developed shunt malfunction and three (11%) developed ETV malfunction. Twenty children (9%) demised during the admission period. Death was associated with meningitis (p p p = 0.002) and meningitis (p Conclusion There was a slight male preponderance and hydrocephalus occurred in two thirds of cases. Wound sepsis and meningitis were associated poor outcomes.

Limited research on access and utilization of sexual health services by sexual minorities has disadvantaged improvements of health systems in terms of providing appropriate treatment and care. Stud...

The article gives 70 Pterophoridae species of nature reserves and national parks of KwaZulu Natal province, Republic of South Africa. New taxonomic combinations are revealed, new data on the distribution of Plume moths in the Republic of South Africa are indicated. New generic combinations were established for two species of Marasmarcha ammonias (Meyrick, 1909) and Sphenarches erythrodactylus (Fletcher, 1911). 7 species are recorded for the first time for the province of KwaZulu Natal.

Local indigenous knowledge (IK) informs decision-making about fundamental aspects of life. The inclusion of indigenous knowledge is increasingly becoming a topical subject to enhance livestock veterinary care. The objective of the current study was to explore the extent of utilisation of indigenous knowledge to control ticks in goats. There was an association (P < 0.05) between the use of IK and gender, with males using IK (76.58%) more than females. The association between age distribution and IK use was (P < 0.05); however, farmers above the age of 50 years were using IK more than all group ages. Farmers ranked the purposes of using IK differently (P < 0.05). Ectoparasites were ranked as the most important constraint limiting goat productivity. Ticks were ranked as the most important external parasites. Amblyomma tick species were ranked as the most important amongst the tick species, followed by Rhipicephalus evertsi evertsi ticks. A significant population of farmers (80.7%) are dependent on the use of tick sprays, whereas others used injections (3.3%). Cissus quadrangularis L. (Inhlashwana) was singled out as the most used ethno-veterinary plant to control ticks with a frequency of (64%), followed by Gomphocarpus physocarpus E. Mey (Uphehlacwathi) (55.9%). The probability of keeping goats in wet rangelands (P < 0.05) was 3.04 times more likely to influence the extent of IK use compared to their contemporaries in the dry rangeland. Male farmers keeping goats (P < 0.01) were 2.95 more likely to influence the extent of use of IK than females. The type of rangeland, gender, age, residing on farm and also having the herbalist in the locality were the most common factors that influenced the extent of IK utilisation.

Background: Brain metastases are relatively common and carry a poor prognosis. In a resource-constrained environment, the judicious use of radiotherapy must be considered in the context of its benefit. The Recursive Partitioning Analysis (RPA) scoring system is internationally validated to predict median survival in patients with brain metastases. It may be used to guide appropriate management of patients with brain metastases. Aim: To establish the relevance of applying the RPA prognostic scoring system to the local setting. Setting: The Department of Oncology, Greys Hospital, Pietermaritzburg, South Africa. Methods: A retrospective chart review of patients treated for brain metastases for the period 01 January 2014 to 31 December 2019 was performed. Data was collected to determine the RPA class for each patient. Multivariate analysis of potential factors which could impact survival was done, and the actual survival of each patient was calculated. Results: The commonest primary cancer in the study cohort was breast (67%), followed by lung (17%). Survival differences between RPA classes were statistically significant ( p < 0.001). Actual survival relative to that predicted by the RPA model was 4.5 versus 7–12 months, 3.6 versus 4–7 months, and 0.8 versus 2–4 months, for classes I, II and III, respectively. Conclusion: Results support the use of the RPA classification to risk stratify patients in this setting – and therefore may be used in treatment decision-making. However, it over-predicts the median survival for the local population. Larger studies are warranted in diagnostically homogenous patient groups with brain metastases, to determine survival more accurately.

The main aim of the study was to investigate the impact of recruitment policies and induction programmes on employee retention. The Durban Central Fire Station was used as a case study for this investigation. Relevant literature from periodicals, journals, textbooks, theses and dissertations was reviewed. A quantitative research design was adopted for this study through the administration of a pre-coded structured closed-ended questionnaire to the 126 employees at the Durban Central Fire Department. Only 110 of the 126 administered questionnaires were returned. However, of the returned questionnaires, 5 were discarded due to incomplete responses and the final questionnaire returns numbered 105, which resulted in an 83.3% response rate. The data collected from respondents were analysed using the Statistical Package for Social Sciences (SPSS) version 24.0 in order to conduct non-parametric tests for testing the generated hypotheses. In total, 13 hypotheses were formulated for this study’s empirical analysis. Furthermore, the Pearson’s Chi-square and Spearman correlation tests were carried out on the formulated hypotheses to ascertain whether a statistically significant relationship existed between the variables. The study’s notable findings showed that a positive relationship existed between recruitment policies and employee retention, hence recruitment policies do have an impact on employee retention. The findings also showed that a moderately significant relationship existed between induction programmes and employee retention at the Durban Central Fire Department. Based on the findings, the researcher then recommended that the Durban Central Fire department should clarify expectations to its employees, encourage socialisation and positive work relationships, increase the duration of the induction programme and conduct exit interviews. The researcher concluded the study with suggestions for future research.

Introduction: Unplanned pregnancy continues to be a global reproductive and public health concern among women. This study aimed to investigate whether factors associated with modern contraceptive use differ by age-group among young and older women of reproductive age. Methods: This was a cross-sectional study conducted among 433 women of reproductive age, with the median age of 25 years (interquartile range: 21–28), and aged between 18 and 49. Data were collected from 10 public health care clinics in Umlazi Township, KwaZulu-Natal, using a structured questionnaire. Data were coded, entered into Epi Data Manager and exported to Stata for analysis. A Pearson’s chi-square test and logistic regression models were employed to assess the level of the association between the predictor and outcome variables, and the p-value of 0.05 or lower was considered statistically significant. Results: Most women in the sample (n = 351, 81%) had obtained a secondary level of education, while 53% (n = 230) were unemployed and 89% (n = 387) were single. We found that women with secondary level of education (AOR: 2.89, 95% CI: 0.99–5.38) or a tertiary level of education (AOR 3.80, 95% CI: 1.07–3.53) were more likely to use contraceptive methods compared to women with lower education. Women who experienced unplanned pregnancy (AOR 0.51, 95% CI: 0.22–3.79) were more likely to use contraceptives. Women aged 25–49 years who experienced pregnancy, whether planned (AOR 3.87, 95% CI: 1.08–3.89) or unplanned (AOR 3.60, 95% CI: 2.15–4.19), were more likely to use a contraceptive method. Results showed that the level of education (p = 0.942) and whether one experienced unplanned pregnancy (p = 0.913) were not significant predictors of contraceptive use among women aged 18–24 years. Conclusion: Concerted educational efforts to addressing existing barriers deterring women from accessing contraception among young women are necessary. Different groups of women should be targeted with family planning interventions specific to their needs.

Background: The government’s inability to ensure that both the local and the national markets adequately accommodate smallholder producers is inhibiting the sector’s ability to grow and expand. Aim: This article explored the influence of the governmental administrative processes on agro-smallholders’ ability to access municipal markets. Setting: The study is based in KwaZulu-Natal (KZN), specifically in the eThekwini Municipality. The target population is agricultural (agro-) smallholder producers who are located within the traditional leadership and government officials (KZN Department of Agriculture and Rural Development and eThekwini Municipality). Methods: A qualitative exploratory research methodology using semi-structured interviews was adopted for this study. Results: The results showed that the government structures and municipal markets do not provide substantial support to agro-smallholder producers who are seeking access to markets. The results further showed that there is no integration or relationship between the government institutions on the issues related to the promotion and development of agro-smallholder producers. Conclusion: Through the application of administrative theory, the article posited the recommendations that the government institutions should incorporate stakeholders’ insights, lay a policy foundation for a whole-of-government approach to planning and set the direction for agro-smallholder’s planned future. It is also recommended that the government departments create a single planning and coordination structure or forum that will be beneficial to the smallholder sub-sector and avoid duplication and resource wastage directed to this sub-sector.

Background: The coronavirus disease 2019 (COVID-19) global pandemic led to the closure of the University of KwaZulu-Natal (UKZN) in March 2020 and the migration to online teaching for all students, with modules and assessments being modified to accommodate the new form of teaching. Aim: The aim of this research was to assess the 5th year students’ experience of emergency on-line learning during the Family Medicine module, which was adapted in response to the pandemic. Setting: The research was conducted among 5th year medical students at the University of KwaZulu-Natal in December 2020. Methods: A questionnaire was used to assess the experiences of the 5th year MBChB students of on-line learning. Results: Of the 256 students, 43.8% completed the questionnaire; 43 (38.4%) spent lockdown in an urban area; 30 (26.8%) in semi-urban and 39 (34.8%) in rural area; 34 (30.4%) always had internet connectivity; 41 (36.6%) mostly or often; and 28 (25%) sometimes or occassionally whilst 9 (8%) did not have any connectivity. Despite data bundles being provided by the UKZN, 47 did not have access to sufficient data for their academic needs. Only 35 students felt that their environment during lockdown was conducive to online learning and 71 students were not in a good headspace to engage with online learning. Conclusion: Whilst there are undoubted advantages of online teaching and learning in terms of access and reach, this potential is limited by structural and economic factors. These issues had a major impact on the ability of students to engage with this form of instruction.

Background: In South Africa, patients are meant to attend the clinic close to their place of residence. However, patients often choose which clinic to attend, which results in overcrowding. Aim: This study aimed to investigate the structural and process factors influencing patients’ choice to attend a community health centre (CHC) in KwaZulu-Natal, South Africa. Setting: The study was conducted at the Inanda C Community Health Centre (CHC). Methods: Systematic random sampling was used to select study participants. A structured questionnaire was used to collect socio-demographic data and assess the factors influencing patients’ choice to attend this CHC. Results: There were 400 patients who participated. The commonest structural indicator that patients agreed on as the reason they attend Inanda C CHC was because it has enough medication (126, 73.3%). There was a significant difference in the proportion of patients who agreed that seeing a doctor instead of nurse was a reason for attending this clinic with 118 (68.6%) patients from within the catchment area and 170 (74.6%) from outside the catchment area. The commonest process indicators that patients from within and outside the catchment area agreed on as reasons for attending Inanda C CHC were ‘the doctor or nurse explains my sickness and treatment to me’ and ‘I get good quality of care’. Conclusion: The structural and process indicators that influence patients’ choice of clinic may need to be improved at other clinics in this area in order to decrease the overcrowding at this clinic.

Background: Formal ultrasonography has advanced to point-of-care ultrasound (POCUS) in the emergency department (ED) for the purpose of acute critical care. While POCUS application expands, little is known about POCUS utilisation in public hospital EDs. This study aimed to describe the use of POCUS in an ED in KwaZulu-Natal. Methods: A retrospective chart review study was conducted on all patients who had POCUS exams performed in the ED at the General Justice Gizenga Mpanza Regional Hospital from 01 September 2019 to 31 March 2020. A data collection tool was used to extract the required data from the Mindray M6 ultrasound machine. The data were processed using the Statistical Package for Social Sciences (SPSS version 26) and descriptive statistics were used to summarise the data. Results: A total of 978 POCUS were performed on 784 patients. Point-of-care ultrasound was utilised more often for focused emergency echocardiography in resuscitation ( n = 383) and extended focused assessment with sonography for trauma ( n = 319). The findings were normal in 17% of exams, 31% were positive, 9% were unspecified and 43% of POCUS exams were inconclusive. Seven percent of POCUS exams were performed by accredited level 1 emergency POCUS providers and ultrasounds occurred more frequently during day-shift hours than after-hours. Conclusion: Point-of-care ultrasound core applications were utilised by ED doctors for various emergency care scenarios, mainly for trauma and cardiac assessments.

Background: This study aims to make use of a longitudinal data modelling approach to analyze data on the number of CD4+cell counts measured repeatedly in HIV-1 Subtype C infected women enrolled in the Acute Infection Study of the Centre for the AIDS Programme of Research in South Africa. Methodology: This study uses data from the CAPRISA 002 Acute Infection Study, which was conducted in South Africa. This cohort study observed N=235 incident HIV-1 positive women whose disease biomarkers were measured repeatedly at least four times on each participant. Results: From the findings of this study, post-HAART initiation, baseline viral load, and the prevalence of obese nutrition status were found to be major significant factors on the prognosis CD4+ count of HIV-infected patients. Conclusion: Effective HAART initiation immediately after HIV exposure is necessary to suppress the increase of viral loads to induce potential ART benefits that accrue over time. The data showed evidence of strong individual-specific effects on the evolution of CD4+ counts. Effective monitoring and modelling of disease biomarkers are essential to help inform methods that can be put in place to suppress viral loads for maximum ART benefits that can be accrued over time at an individual level. Keywords: Random-effects model; spatial covariance structure; CD4+ count; HAART; CAPRISA.

Background: The Ward Based Primary Health Care Outreach Team (WBPHCOT) policy framework states that community health workers (CHW)s should be distributed mainly according to poverty lines for each catchment population. We aimed to describe the spatial distribution of CHWs in relation to the HIV prevalence which has been associated with poverty in previous studies.Methods: We utilized geographic information system (GIS) method to visualize the distribution of CHWs in relation to HIV prevalence in KwaZulu-Natal (KZN) districts. Dot density mapping, was used to visualize the random distribution of CHWs in relation to HIV prevalence in the districts. The districts’ HIV prevalence, number of PLWH, CHW: PLWH ratio and poverty scores were mapped using choropleth mapping. MapInfo 17, a GIS software was used to map geospatial presentation of the data.Results: Ten out of 11 KZN districts had more than a required CHW:PLWH ratio of 1:160-267, which indicates a significant shortage of CHWs regardless of the HIV prevalence or poverty scores. Furthermore, our findings showed extensive geospatial heterogeneity with no clear pattern in the distribution CHWs in relation to the HIV prevalence and poverty scores in the districts Conclusion: This finding represents inequalities in the provision of HIV services by the CHWs. It is critical to strengthen response to the HIV epidemic through the well informed and justified distribution of CHWs especially to the poor districts.

BackgroundVoluntary Medical male circumcision (VMMC) has been identified as a cost-effective intervention for reducing the transmission of HIV. KwaZulu-Natal (KZN), the second most populous province in South Africa, has the highest HIV prevalence, estimated at 27%. VMMC reduces the transmission of HIV by up to 60%; at initiation of VMMC Program in 2010, the KZN VMMC target was 2.4 million, almost 50% of the national target, among males aged 15-49 years. This paper documents the prevalence of penile abnormalities and related factors among clients undergoing VMMC procedures in KwaZulu-Natal province. MethodsA retrospective review of files was conducted among VMMC clients at the Centre of Excellence (a referral centre in the KZN province) and data was captured from a standardized client form into an Excel database. The data was analysed using STATA 15.0. Univariate and multivariate analysis were done using Logistic regression was used to determine factors associated with penile abnormalities. ResultsDuring the review period, 6,650 males accessed VMMC services; the median age was 13 years (IQR 9 – 21). A total of 227 (3.4%) of the clients were HIV-Positive, about 80% of these aged ≥13 years. Upon physical examination, 5,366 (80.6%) of the VMMC clients had penile abnormalities (Mild 781, Moderate 2,282, Severe 2,303). Overall, 43% of these clients had severe penile abnormalities (SPA); two-thirds were aged below 13 years and 10% aged above 34 years. The three most common Penile Abnormalities (PA) were phimosis (3,686; 55.4%), tight ring (3,669; 55.2%) and overhanging foreskin (2,966; 44.6%). The odds of penile abnormality were significantly lower in older clients aged 13–18 years (AOR = 0.74; 95% CI = 0.59–0.87) and above 18 years (AOR = 0.15; 95% CI = 0.10–0.29) compared to younger clients aged below 13 years.ConclusionsA higher prevalence of Penile Abnormalities was observed among the younger clients except for balanitis / posthitis. Recommendations for VMMC program include the fact that all clients need to be examined thoroughly preoperatively to exclude any abnormalities. Any clients with severe abnormalities should be referred for specialist examination and surgery.

Introduction:the most reliable screening tool for colorectal cancer, colonoscopy, is not readily accessible in resource-deprived settings of KwaZulu-Natal. The aim of this study was to determine whether serum carcinoembryonic antigen (CEA) levels in patients symptomatic for lower gastrointestinal (GI) pathology correlates with the histological presence and severity of primary colorectal cancer in a large referral centre. Perhaps CEA may have a larger role as a marker for colorectal cancer (CRC) development in these resource deprived communities. Methods:this study was a retrospective analysis of prospectively collected clinical data of 380 pretreatment patients with colorectal cancer attending a tertiary referral centre in KwaZulu-Natal. Data were analyzed using descriptive statistics and findings were compared with those from the existing literature. Results:the mean CEA level of the study population was 170.0 ± 623.3 μg/l. The number of participants with a CEA level

Background: The increasing cancer burden remains a public health challenge. Quality and accurate population data is important to improve cancer control, screening, and treatment programmes for the sub-Saharan Africa region. Aim: The aim of this study was to establish hospital-based cancer surveillance system, thereby reporting the burden that cancer diagnosis and treatment place on 3 hospitals – an approach of health systems strengthening. Methods: A hospital-based cancer surveillance was established in 3 public health facilities that provide oncology services in KwaZulu-Natal. An active method was used for finding cancer cases. The cancer surveillance database was evaluated according to the criteria recommended for cancer registries. Analyses of data included descriptive and crude incidence rates. Results: A total of 2307 newly diagnosed cancer cases were reported in 2018, with a majority from Inkosi Albert Luthuli Central hospital (65.3%), followed by Greys hospital (30.8%) and then Addington hospital (3.94%). Most of the cancer cases were from the 2 major urban areas of the province (eThekwini and uMgungundlovu district). The most commonly diagnosed cancers from all combined 3 facilities for both sexes were breast, cervix, colorectal, Kaposi Sarcoma, and lung. Approximately half of the cancer cases had no staging, and 12.8% of the cases were diagnosed at stage 4. The mostly prescribed treatments for the patients were radiotherapy and chemotherapy. Conclusions: Based on our hospital-based surveillance, cancer burden is high in the 3 facilities. Strengthening cancer screening and diagnostic policies and procedures that will allow expansion of accurate cancer surveillance system is essential in KwaZulu-Natal and South Africa as a whole.

Background: We sought to provide a descriptive report of inpatient admissions for cerebrovascular disease (CVD) at a tertiary hospital in KwaZulu-Natal, South Africa. Methods: We conducted a retrospective, descriptive study involving 1 017 patients admitted to the Inkosi Albert Luthuli Central Hospital for treatment of CVD during 2005 - 2015. Patients were identified using the hospital’s electronic administrative system. Demographics, inpatient length of stay, surgical procedures, and survival status at discharge were also obtained for each patient. Descriptive statistics were used to analyse the data. Results: The median age of CVD patients was 50.0 years, and 50.4% were male. The median inpatient length of stay was 13.0 days. Surgery was performed in 38.8% of patients. The mortality rate was 22.5%. Conclusion: The resource burden that CVD places on tertiary healthcare services and the high mortality in afflicted patients highlights the need for effective primary and secondary prevention interventions in our setting.

Background: Community-acquired Gram-negative Enterobacteriaceae infections in malnourished and HIV-infected hospitalised children are not well documented and are of concern because of increasing antibiotic resistance and limited available treatment options. This study describes the clinical characteristics and outcomes of hospitalised children with positive Enterobacteriaceae cultures. Method: A retrospective chart review of children with Gram-negative Enterobacteriaceae infections was performed in King Edward VIII Hospital, a referral hospital in Durban, KwaZulu-Natal. Standard descriptive and analytical statistics, including regression analysis, were performed to determine the clinical characteristics associated with Enterobacteriaceae infections in children hospitalised in the study period. Results: Of all hospitalised children in the study period, 207 (3.5%) had positive cultures for Enterobacteriaceae isolates, with Escherichia coli 109 (44.5%) and Klebsiella spp. 59 (24.1%) making up most of the infections. Urine (126; 58%) followed by stool (34; 14.8%) and blood (35; 14.0%) were the commonest samples that yielded positive cultures. Diarrhoeal hospitalisations especially posed a higher risk for Enterobacteriaceae infections. Severe acutely malnourished and HIV-infected children were at higher risk. These comorbidities were independently associated with an increased risk of Enterobacteriaceae infection. Prolonged hospitalisation and increased risk of death were also associated with Enterobacteriaceae infection. Conclusion: Enterobacteriaceae infections were common in hospitalised children and posed an increased risk, especially in malnourished and HIV-infected children. Further studies investigating the relationships between diarrhoea, urinary tract infections and Enterobacteriaceae infections are needed.

Background: Despite progress in reducing child mortality, preventable child deaths remain a challenge in South Africa. Poor implementation of Integrated Management of Childhood Illness (IMCI) guide...