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Introduction: With the scaling up of vertical HIV transmission prevention programmes, the HIV‐related population profile of children in South Africa has shifted. We described temporal changes in HIV‐related characteristics of children, aged ≤3 years (up to the third birthday), with infectious disease hospitalisations across the Western Cape province. Methods: We used routinely collected electronic data to identify children born in the Western Cape with infectious disease hospital records for lower respiratory tract infections, diarrhoea, meningitis and tuberculous meningitis, from 2008 to 2021. Linked maternal and child unique identifiers were used to extract pregnancy, HIV‐related, laboratory, pharmacy and hospitalisation data. We described temporal changes in child HIV exposure and acquisition status, timing of maternal HIV diagnosis and antiretroviral therapy (ART) start, infant exposure to maternal ART and timing thereof, and maternal CD4 and HIV viral load closest to delivery. We used logistic and multinomial regression to assess changes in characteristics between the Pre‐Option B+ (2008–2013), Option B+ (2013–2016) and Universal ART periods (2016–2021). Results: Among 52,811 children aged ≤3 years with hospitalisations, the proportion living with HIV dreased from 7.0% (2008) to 1.1% (2021), while those exposed to HIV and uninfected increased from 14.0% (2008) to 16.1% (2021) with a peak of 18.3% in 2017. Among mothers with HIV (n = 9873), the proportion diagnosed with HIV and starting ART before pregnancy increased from 20.2% to 69.2% and 5.8% to 59.0%, respectively, between 2008 and 2021. Children hospitalised during the Universal ART period had eight times higher odds (Odds Ratio: 8.41; 95% CI: 7.36–9.61) of exposure to maternal ART versus children admitted Pre‐Option B+. Among mothers of children exposed to HIV and uninfected with CD4 records (n = 7523), the proportion with CD4 <350 cells/μl decreased from 90.6% (2008) to 27.8% (2021). Conclusions: In recent years, among children hospitalised with infectious diseases, there were fewer children with perinatally acquired HIV, while an increased proportion of those without HIV acquisition are exposed to maternal HIV and ART. There is a need to look beyond paediatric HIV prevalence and consider child exposure to HIV and ART among children without HIV, when assessing the HIV epidemic's impact on child health services. [ABSTRACT FROM AUTHOR]

Many water sustainability and governance issues around the world can be viewed as wicked problems, whereby a solution, even if quite broad and comprehensive, may be contested because of high complexity, uncertainty, and diverging perspectives. These types of issues and their contestation thus create a complex landscape of possible solutions, which we term a water governance "solutionscape." We develop the concept of the solutionscape to identify different types of solutions that present themselves through the emphases placed upon four major dimensions: science, policy, practice, and participation. After first considering these four dimensions via a literature review, we then conceptualize the solutionscape's expressions comprising six different solution pathways. These are comprehensive solutions, where all four dimensions are equally supported and integrated; clumsy solutions, where multiple solutions are pursued separately without coordination (risking contradictions); two types of expedient solutions (high and low-cost), which involve attempts to pursue outcomes rapidly; solutionism, which refers to the over-emphasis of one dimension in an attempt to provide a quick-fix (leading to unintended consequences); and finally anti-solutions, whereby one or more dimensions are actively disputed or disregarded by policy makers. An example from South Africa is used to illustrate the framework's key components. We then discuss the allure of solutionism in solving wicked water problems, and how alternatives might be envisaged with the consideration of often-hidden institutional processes and power. Finally, we consider the value of the solutionscape as an integrative heuristic tool to discuss wicked water problems, recognizing issues such as plural perspectives and power asymmetries between stakeholders. [ABSTRACT FROM AUTHOR]

We aimed to quantify the contribution of excess mortality in HIV-exposed uninfected (HEU) infants to total mortality in HIV-uninfected infants in Botswana and South Africa in 2013. Population attributable fractions (PAFs) and excess infant deaths associated with HIV exposure in HIV-uninfected infants were estimated. Additionally, the Thembisa South African demographic model estimated the proportion of all infant mortality associated with excess mortality in HEU infants from 1990 to 2013. The PAF (lower bound; upper bound) of mortality associated with HIV exposure in HIV-uninfected infants was 16.8% (2.5; 31.2) in Botswana and 15.1% (2.2; 28.2) in South Africa. Excess infant deaths (lower bound; upper bound) associated with HIV exposure in 2013 were estimated to be 5.6 (0.5; 16.6)/1000 and 4.9 (0.6; 11.2)/1000 HIV-uninfected infants in Botswana and South Africa, respectively. In South Africa, the proportion of all infant (HIV-infected and HIV-uninfected) mortality associated with excess HEU infant mortality increased from 0.4% in 1990 to 13.8% in 2013. [ABSTRACT FROM AUTHOR]

Sirex noctilio is an economically important invasive pest of commercial pine forestry in the Southern Hemisphere. Newly established invasive populations of this woodwasp are characterized by highly male‐biased sex ratios that subsequently revert to those seen in the native range. This trend was not observed in the population of S. noctilio from the summer rainfall regions in South Africa, which remained highly male‐biased for almost a decade. The aim of this study was to determine the cause of this persistent male bias. As an explanation for this pattern, we test hypotheses related to mating success, female investment in male versus female offspring, and genetic diversity affecting diploid male production due to complementary sex determination. We found that 61% of females in a newly established S. noctilio population were mated. Microsatellite data analysis showed that populations of S. noctilio from the summer rainfall regions in South Africa are far less genetically diverse than those from the winter rainfall region, with mean Nei's unbiased gene diversity indexes of 0.056 and 0.273, respectively. These data also identified diploid males at low frequencies in both the winter (5%) and summer (2%) rainfall regions. The results suggest the presence of a complementary sex determination mechanism in S. noctilio, but imply that reduced genetic diversity is not the main driver of the male bias observed in the summer rainfall region. Among all the factors considered, selective investment in sons appears to have the most significant influence on male bias in S. noctilio populations. Why this investment remains different in frontier or early invasive populations is not clear but could be influenced by females laying unfertilized eggs to avoid diploid male production in populations with a high genetic relatedness. [ABSTRACT FROM AUTHOR]

Introduction: Co‐trimoxazole prophylaxis is recommended for children born to women with HIV to protect those who acquire HIV from opportunistic infections, severe bacterial infections and malaria. With scale‐up of maternal antiretroviral therapy, most children remain HIV‐exposed uninfected (HEU) and the benefits of universal co‐trimoxazole are uncertain. We assessed the effect of co‐trimoxazole on mortality and morbidity of children who are HEU. Methods: We performed a systematic review (PROSPERO number: CRD42021215059). We systematically searched MEDLINE, Embase, Cochrane CENTRAL, Global Health, CINAHL Plus, Africa‐Wide Information, SciELO and WHO Global Index Medicus for peer‐reviewed articles from inception to 4th January 2022 without limits. Ongoing randomized controlled trials (RCTs) were identified through registries. We included RCTs reporting mortality or morbidity in children who are HEU receiving co‐trimoxazole versus no prophylaxis/placebo. The risk of bias was assessed using the Cochrane 2.0 tool. Data were summarized using narrative synthesis and findings were stratified by malaria endemicity. Results: We screened 1257 records and included seven reports from four RCTs. Two trials from Botswana and South Africa of 4067 children who are HEU found no difference in mortality or infectious morbidity in children randomized to co‐trimoxazole prophylaxis started at 2–6 weeks of age compared to those randomized to placebo or no treatment, although event rates were low. Sub‐studies found that antimicrobial resistance was higher in infants receiving co‐trimoxazole. Two trials in Uganda investigating prolonged co‐trimoxazole after breastfeeding cessation showed protection against malaria but no other morbidity or mortality differences. All trials had some concerns or a high risk of bias, which limited the certainty of evidence. Discussion: Studies show no clinical benefit of co‐trimoxazole prophylaxis in children who are HEU, except to prevent malaria. Potential harms were identified for co‐trimoxazole prophylaxis leading to antimicrobial resistance. The trials in non‐malarial regions were conducted in populations with low mortality potentially reducing generalizability to other settings. Conclusions: In low‐mortality settings with few HIV transmissions and well‐performing early infant diagnosis and treatment programmes, universal co‐trimoxazole may not be required. [ABSTRACT FROM AUTHOR]

Along the >650 km long southern margin of the Karoo Basin in South Africa, we traversed four evenly spaced stratigraphic transects and collected 22 samples of volcanic, air-fall tuffs thought to be distal deposits derived from the Permian–Triassic Southern Gondwanan volcanic arc. We present 469 new U-Pb zircon ages determined by sensitive high-resolution ion microprobe reverse geometry (SHRIMP-RG) at the Stanford–USGS Microanalytical Center in order to constrain the maximum depositional ages for the southern Karoo Basin strata. Weighted means of these youngest coherent zircon populations were selected to maximize the number of analyses while minimizing the mean square weighted deviation (MSWD) to increase the robustness and decrease the influence of Pb-loss and inheritance in determining the maximum depositional age. Maximum depositional ages for the marine Ecca Group range from 250 to 274 Ma, whereas in the conformably overlying terrestrial Beaufort Group maximum depositional ages ranged from 257 to 452 Ma. Across the southern Karoo Basin, the Ecca Group tuffs produce maximum depositional ages that young upward; however, the Beaufort Group tuffs yield maximum depositional ages that are geochronologically out of sequence. Furthermore, maximum depositional ages of the Beaufort Group tuffs are consistently older than ash ages within the underlying marine strata. Our results are supported by previously published U-Pb tuff zircon geochronology in the Karoo Basin and demonstrate that the presence of out-of-sequence, older tuff ages are repeatable in Beaufort Group tuffs along the southern margin of the basin. We propose that tuffs in the Karoo Basin are correlative with tuffs in southern South America, and that the age spectra of these tuffs were influenced by magmatic crustal recycling. We use these data to highlight the complexity of U-Pb zircon datasets from tuffs, address the use of U-Pb zircon ages to provide absolute age controls, and discuss the implications of these new age controls on the Permian-Triassic Karoo strata. [ABSTRACT FROM AUTHOR]

Introduction: Risk perception is a core construct in many behaviour change theories in public health. Individuals who believe they are at risk of acquiring an illness may be more likely to engage in behaviours to reduce that risk; those who do not feel at risk may be unlikely to engage in risk reduction behaviours. Among participants who seroconverted in two FEM-PrEP sites - Bondo, Kenya, and Pretoria, South Africa - we explored perceived HIV risk and worry about acquiring HIV prior to HIV infection. Methods: FEM-PrEP was a phase III clinical trial of once-daily, oral emtricitabine and tenofovir disoproxil fumarate for HIV prevention among women in sub-Saharan Africa. We asked all participants about their perceived HIV risk in the next four weeks, prior to HIV testing, during a quantitative face-to-face interview at enrolment and at quarterly follow-up visits. Among participants who seroconverted, we calculated the frequencies of their responses from the visit conducted closest to, but before, HIV acquisition. Also among women who seroconverted, we conducted qualitative, semi-structured interviews (SSIs) at weeks 1, 4 and 8 after participants' HIV diagnosis visit to retrospectively explore feelings of HIV worry. Applied thematic analysis was used to analyse the SSI data. Results: Among participants who seroconverted in Bondo and Pretoria, 52% reported in the quantitative interview that they had no chance of acquiring HIV in the next four weeks. We identified four processes of risk rationalization from the SSI narratives. In "protective behaviour,'' participants described at least one risk reduction behaviour they used to reduce their HIV risk; these actions made them feel not vulnerable to HIV, and therefore they did not worry about acquiring the virus. In "protective reasoning,'' participants considered their HIV risk but rationalized, based on certain events or beliefs, that they were not vulnerable and therefore did not worry about getting HIV. In "recognition of vulnerability,'' participants described reasons for being worried about getting HIV but said no or limited action was taken to reduce their perceived vulnerability. Participants with "no rationalization or action'' did not describe any HIV worry or did not engage in HIV risk reduction behaviours. Conclusions: Women who are at substantial risk of acquiring HIV may underestimate their actual risk. Yet, others who accurately understand their HIV risk may be unable to act on their concerns. Perceived HIV risk and risk rationalization are important concepts to explore in risk reduction counselling to increase the use of HIV prevention strategies among women at risk of HIV. [ABSTRACT FROM AUTHOR]

Background: Children of foreign-born parents with vulnerable legal status, limited economic rights and exclusion from national social interventions may be at higher risk for severe acute malnutrition (SAM). We evaluated the relationship between parent status (foreign-born vs. South African) and outcomes for children with SAM admitted to a rural regional hospital in the Western Cape, South Africa.Methods: A retrospective cohort study was conducted including children <5 years admitted to Worcester Provincial Hospital during 2015-17 with SAM (WHO weight-for-height Z score <-3, presence of nutritional oedema, mid-upper-arm-circumference of <11.5 cm or visible severe wasting). Exposures, including parent status, and outcomes including in-hospital death were determined from hospital and regional dietician records.Results: Of 95 children included, 31 (33%) were of foreign-born and 64 (67%) of South African parents. Median (interquartile range) age at admission was 12 (8-18) vs. 10 (8-13) months in children of South African vs. foreign-born parents with no difference in preterm birth, concurrent illnesses or admission duration. Age, HIV status and breastfeeding practices were no different in foreign-born compared to South African mothers. In-hospital deaths occurred in 3/64 (5%) and 6/31 (19%) children of South African vs. foreign-born parents (p = 0.01). Children of foreign-born compared to South African parents had an odds ratio of 4.88 (95% CI 1.13-21.06) for in-hospital SAM-associated mortality.Conclusion: In this rural setting, 33% of children admitted with SAM were of foreign-born parents and experienced in-hospital SAM-associated mortality at least four times higher than children of South African parents. This illustrates the extreme vulnerability of these children. [ABSTRACT FROM AUTHOR]

A dearth of information obscures the true scale of the global illegal trade in wildlife. Herein, we introduce an automated web crawling surveillance system developed to monitor reports on illegally traded wildlife. A resource for enforcement officials as well as the general public, the freely available website, http://www.healthmap.org/wildlifetrade, provides a customizable visualization of worldwide reports on interceptions of illegally traded wildlife and wildlife products. From August 1, 2010 to July 31, 2011, publicly available English language illegal wildlife trade reports from official and unofficial sources were collected and categorized by location and species involved. During this interval, 858 illegal wildlife trade reports were collected from 89 countries. Countries with the highest number of reports included India (n = 146, 15.6%), the United States (n = 143, 15.3%), South Africa (n = 75, 8.0%), China (n = 41, 4.4%), and Vietnam (n = 37, 4.0%). Species reported as traded or poached included elephants (n = 107, 12.5%), rhinoceros (n = 103, 12.0%), tigers (n = 68, 7.9%), leopards (n = 54, 6.3%), and pangolins (n = 45, 5.2%). The use of unofficial data sources, such as online news sites and social networks, to collect information on international wildlife trade augments traditional approaches drawing on official reporting and presents a novel source of intelligence with which to monitor and collect news in support of enforcement against this threat to wildlife conservation worldwide. [ABSTRACT FROM AUTHOR]

The marine red alga Schimmelmannia cf. elegans was identified from samples collected from an aquaculture facility on the island of Hawai'i based on morphological and molecular data analyses. The genus has never before been reported from the Hawaiian Islands. Awareness of this species is raised given that it has been suspected as introduced in Cape Town, South Africa, and because Hawaiian coastal marine waters are already heavily impacted by introduced algae. [ABSTRACT FROM AUTHOR]

Abstract: The Western Cape region of South Africa is home to a unique type of mediterranean vegetation called fynbos, as well as some of the earliest sites of modern human occupation in southern Africa. Reconstructing the paleohabitats during occupations of these early anatomically modern Homo sapiens is important for understanding the availability of resources to the humans during the development of behaviors that are often considered advanced. These reconstructions are critical to understanding the nature of the changes in the environment and resources over time. Here we analyze the craniodental fossils of the larger mammals recovered from two Pleistocene assemblages in the Pinnacle Point complex, Mossel Bay, Western Cape Region, South Africa. We reconstruct the paleohabitats as revealed by multivariate analyses of the mammalian community structures. Pinnacle Point 30 is a carnivore assemblage and Pinnacle Point 13B includes early evidence of a suite of modern human behavior; together they present an opportunity to identify environmental change over time at a localized geographic scale. Further, this is the first such study to include dated Western Cape localities from Marine Isotope Stage 6, a time of environmental pressure that may have marginalized human populations. Results indicate that environmental change in the Western Cape was more complex than generalized C4 grassland expansions replacing fynbos habitats during glacial lowered sea levels, and thus, resources available to early modern humans in the region may not have been entirely predictable. [ABSTRACT FROM AUTHOR]

Abstract: Some of the earliest evidence for modern human behavior has been recovered from the Western Cape Province, South Africa. Archaeological and paleontological sites in the Western Cape are typically described as “glacial” or “interglacial” in aspect based on the numbers of grazers found in the faunal assemblage, as glacial periods are often thought to have been characterized by spreading C4 grasslands that replaced endemic C3 shrubland vegetation found in the Western Cape today. Here, we test the hypothesis that glacial and interglacial time periods were associated with a predictable change in large mammal trophic adaptations by analyzing the proportions of grazing larger mammals from 118 levels of 15 Western Cape fossil assemblages sampling marine isotope stage (MIS) 6 to the present time to determine whether there is a change in composition in these communities that might reflect a shift in ecology and habitat. Our results indicate that trophic proportions did not significantly change over time in the Western Cape as a whole, and thus the hypothesis for habitat changes affecting the subsistence ecology of modern humans during the development of modern behavior is not supported. However, our results show that the southwestern subregion of the Western Cape was characterized by the presence of more grazing species through time than the western subregion. Thus, if ecological and population isolation during glacial periods were integral to catalyzing the development of modern behaviors in the Western Cape region of South Africa, then a complex model including the development of possible mosaic habitats is needed. [Copyright &y& Elsevier]

Background: Infants born HIV-exposed yet remain uninfected (HEU) are at increased risk of poorer growth and health compared to infants born HIV-unexposed (HU). Whether maternal antiretroviral treatment (ART) in pregnancy ameliorates this risk of poorer growth is not well understood. Furthermore, whether risks are similar across high burden HIV settings has not been extensively explored.Methods: We harmonized data from two prospective observational studies conducted in Cape Town, South Africa, and Lusaka, Zambia, to compare weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) Z-scores between infants who were HEU and HU, converting infant anthropometric measures using World Health Organisation Growth Standards adjusted for age and sex. Linear mixed effects models were fit to identify risk factors for differences in anthropometrics at 6-10 weeks and 6 months by infant HIV exposures status and by timing of exposure to maternal ART, either from conception or later in gestation.Results: Overall 773 mother-infant pairs were included across two countries: women living with HIV (WLHIV), 51% (n = 395) with 65% on ART at conception and 35% initiating treatment in pregnancy. In linear mixed effects models, WAZ and WLZ at 6-10 weeks were lower among infants who were HEU vs HU [β = - 0.29 (95% CI: - 0.46, - 0.12) and [β = - 0.42 (95% CI: - 0.68, - 0.16)] respectively after adjusting for maternal characteristics and infant feeding with a random intercept for country. At 6 months, LAZ was lower [β = - 0.28 CI: - 0.50, - 0.06)] among infants who were HEU, adjusting for the same variables, with no differences in WAZ and WLZ. Within cohort evaluations identified different results with higher LAZ among infants who were HEU from Zambia at 6-10 weeks, [β = + 0.34 CI: + 0.01, + 0.68)] and lower LAZ among infants who were HEU from South Africa [β = - 0.30 CI: - 0.59, - 0.01)] at 6 months, without other anthropometric differences at either site.Conclusion: Infant growth trajectories differed by country, highlighting the importance of studying contextual influences on outcomes of infants who were HEU. [ABSTRACT FROM AUTHOR]

The Molteno Adapted Scale (MAS) is a developmental screening tool for children up to five years of age, used by medical practitioners in the Western Cape, South Africa. It generates subquotients for language, personal and social, fine and gross motor domains. The general quotient is the average of all four subquotients, with a score < 85 indicating risk for global developmental delay. The authors aimed to determine the concurrent validity of the MAS, using the Bayley Scales of Infant and Toddler Development-3rd edition (BSID) as a comprehensive assessment reference measure. A total of 103 (55 girls) participants were enrolled from a longitudinal cohort study, of which 90 (49 girls) were assessed on both the MAS and BSID at 11–14 months, 53 (27 girls) at 30–42 months of age and 44 (21 girls) at both timepoints. The low number of developmentally delayed children precluded estimation of diagnostic accuracy of the MAS. Therefore, the authors determined Pearson correlation coefficients (r) for the MAS and BSID across similar domains at 11–14 months (n = 90) and 30–42 months (n = 53) and used the Bland–Altman analysis to detect bias between the MAS and BSID domain scores. Correlation was moderate to high between MAS and BSID domains, except for fine motor in 1-year-olds (r = 0.23), but Bland–Altman analysis found discordance especially between the MAS and BSID language and motor scores at the upper and lower performance ranges. Future studies should aim to standardise the operational procedures of the MAS, validate it across a wider age-range, and include children with varying degrees of delay. [ABSTRACT FROM AUTHOR]

Background: Reasons for the variation in reported treatment outcomes from antiretroviral therapy (ART) programmes in developing countries are not clearly defined. Methods: Among ART-naïve individuals in a workplace ART programme in South Africa we determined virological outcomes at 12 months, and risk factors for suboptimal virological outcome, defined as plasma HIV-1 viral load >= 400 copies/ml. Results: Among 1760 individuals starting ART before July 2004, 1172 were in follow-up at 12 months of whom 953 (81%) had a viral load measurement (median age 41 yrs, 96% male, median baseline CD4 count 156 x 106/l). 71% (681/ 953) had viral load < 400 copies/ml at 12 months. In a multivariable analysis, independent predictors of suboptimal virological outcome at 12 months were <1 log decrease in viral load at six weeks (odds ratio [OR] 4.71, 95% confidence interval [CI] 2.56-8.68), viral load at baseline (OR 3.63 [95% CI 1.88-7.00] and OR 3.54 [95% CI 1.79-7.00] for 10,001-100,000 and >100,000 compared to <= 10,000 copies/ml, respectively), adherence at six weeks (OR 3.50 [95% CI 1.92-6.35]), WHO stage (OR 2.08 [95% CI 1.28-3.34] and OR 2.03 [95% CI 1.14-3.62] for stage 3 and 4 compared to stage 1-2, respectively) and site of ART delivery. Site of delivery remained an independent risk factor even after adjustment for individual level factors. At 6 weeks, of 719 patients with self-reported adherence and viral load, 72 (10%) reported 100% adherence but had <1 log decrease in viral load; conversely, 60 (8%) reported <100% adherence but had >= 1 log decrease in viral load. Conclusion: Virological response at six weeks after ART start was the strongest predictor of suboptimal virological outcome at 12 months, and may identify individuals who need interventions such as additional adherence support. Self reported adherence was less strongly associated but identified different patients compared with viral load at 6 weeks. Site of delivery had an important influence on virological outcomes; factors at the health system level which influence outcome need further investigation to guide development of effective ART programmes. [ABSTRACT FROM AUTHOR]

In both high- and low-income countries, HIV-negative children born to HIV-positive mothers (HIV exposed, uninfected [HEU]) are more susceptible to severe infection than HIV-unexposed, uninfected (HUU) children, with altered innate immunity hypothesized to be a cause. Both the gut microbiome and systemic innate immunity differ across biogeographically distinct settings, and the two are known to influence each other. And although the gut microbiome is influenced by HIV infection and may contribute to altered immunity, the biogeography of immune-microbiome correlations among HEU children have not been investigated. To address this, we compared the innate response and the stool microbiome of 2-y-old HEU and HUU children from Belgium, Canada, and South Africa to test the hypothesis that region-specific immune alterations directly correlate to differences in their stool microbiomes. We did not detect a universal immune or microbiome signature underlying differences between HEU versus HUU that was applicable to all children. But as hypothesized, population-specific differences in stool microbiomes were readily detected and included reduced abundances of short-chain fatty acid–producing bacteria in Canadian HEU children. Furthermore, we did not identify innate immune-microbiome associations that distinguished HEU from HUU children in any population. These findings suggest that maternal HIV infection is independently associated with differences in both innate immunity and the stool microbiome in a biogeographical population-specific way. [ABSTRACT FROM AUTHOR]