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South Africa is the epicentre of the HIV pandemic. Although there have been health promotion education campaigns to reduce HIV incidence, these have not achieved the desired outcomes. When exploring the effectiveness of these campaigns, it is useful not only to examine HIV knowledge, but also to explore the relationship between that knowledge and health-related behaviour. This study aimed to determine the (1) level of knowledge of HIV prevention, (2) relationship between the level of knowledge and the adoption of these behaviours and (3) barriers to sexual behaviour change of vulnerable women in Durban's city centre, KwaZulu-Natal, South Africa. A mixed methods approach was used to collect information from a marginalised population of women (n = 109) attending a non-governmental organisation, which provides for the needs of people from low socio-economic strata. Data were collected during September 2018 at a wellness day programme at the centre. A total of 109 women, over the age of 18 years answered the questionnaire. Knowledge of HIV transmission was high, with majority of participants correctly identifying modes of transmission. Almost all the participants (91.2%) had been tested for HIV, with 68.8% tested a minimum of three times. Despite this, sexual risk behaviour was high. Despite the high level of knowledge of HIV transmission, there was no relationship between HIV knowledge and adoption of behaviours for the prevention of HIV transmission (p =.457). However, bivariate analysis showed an association between transactional sex and living in informal housing (OR = 31.94, 95% CI: 5.65–180.63, p <.001). Living in informal housing was also associated with having multiple current sexual partners (OR = 6.30, 95% CI: 1.39–28.42, p =.02). Multivariate analysis, after adjusting for all other factors, indicated that the odds of having transactional sex was increased by 23 times in those who did not have formal housing (OR = 23.306, 95% CI: 3.97–144.59, p =.001). Qualitative responses showed that women perceived poverty as the overarching factor determining the lifestyle choices which impacted their health. They indicated a need for employment opportunities and provision of housing to alleviate both poverty as well as transactional sex. Although, participants from this study understood the benefits of the protective behaviours to prevent HIV transmission, economic and social factors do not afford this vulnerable group the opportunity nor the motivation to adopt such behaviours. In the current climate of increasing unemployment and escalating GBV, urgent interventions are needed in terms of employment opportunities and empowerment drives to prevent an increase in HIV transmission. [ABSTRACT FROM AUTHOR]

Globally, burnout in medical doctors (MDs) is concerning, with higher rates reported in studies conducted in South Africa (SA). This psychological syndrome leads to serious health consequences, and jeopardises patient care. Despite this, there is no data pertaining to these potential adverse mental health outcomes in KwaZulu-Natal (KZN) Province, SA, where it is overshadowed by the fight against priorities such as HIV and AIDS/TB. This study therefore aimed to establish the nature and extent of burnout, anxiety and depressive symptoms and their associations among public sector MDs in KZN. A cross sectional study was conducted among MDs at five KZN public sector training hospitals to investigate their associations with practitioner (individual) and organisational factors using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS), the Generalised Anxiety Disorder-7 (GAD-7) questionnaire and the Patient Health Questionnaire-9 (PHQ-9). Of the 150 participants, 88 (59.0%) screened positive for burnout, as indicated by high scores on the emotional exhaustion or depersonalisation subscales in the MBI-HSS. One fifth screened positive for anxiety (n = 30) and depressive symptoms (n = 32). Burnout was significantly associated with individual factors of anxiety (p<0.01) and depressive (p<0.01) symptoms based on adjusted logistic regression models. Organisational factors, such as lack of clinical supervisor support (p<0.01) and hospital resources (p<0.01), were significantly associated with burnout based on the bivariate analyses. Burnout, anxiety and depressive symptoms in MDs are highly prevalent and intertwined in resource constrained KZN public training hospitals. Addressing burnout at individual and organisational levels is important to mitigate its adverse effects. [ABSTRACT FROM AUTHOR]

Background: Long-term retention of adolescents aged 10 -19 years on antiretroviral therapy (ART) is crucial to achieve viral load suppression. However, it is reported globally that adolescents have lower retention in care (RiC) on ART, compared with children and adults. Objectives: To determine the prevalence and predictors of RiC of adolescents over 2 years following initiation onto ART in public health facilities in the Metropole District Health Services of the Western Cape province in 2013. Methods: Data of 220 adolescent patients who were newly initiated on ART in 2013 were extracted from the provincial electronic database, and subjected to univariate and bivariate analyses using SPSS. Results: The rate of RiC post-initiation was low throughout the study period, that is, 68.6%, 50.5% and 36.4% at 4, 12 and 24 months, respectively. The corresponding post-initiation viral load suppression levels on ART of those remaining in care and who had viral loads monitored were 84.1%, 77.4% and 68.8% at 4, 12 and 24 months, respectively. Retention in care after initiation on ART was higher amongst younger adolescents (10-14 years), compared with older adolescents (15-19 years). Male adolescents were significantly more likely to be retained, compared with females. Pregnant adolescents were significantly less likely to be retained compared with those who were not pregnant. Conclusion: Key interventions are needed to motivate adolescents to remain in care, and to adhere to their treatment regimen to achieve the target of 90% viral load suppression, with specific emphasis on older and pregnant adolescents. [ABSTRACT FROM AUTHOR]

Background. The KwaZulu-Natal (KZN) Province remains one of the provinces mostly affected by under-5 mortality in South Africa, despite the many programmes and policies implemented to prevent under-5 children from dying. Objective. To examine the association between socioeconomic and demographic factors and under-5 mortality in KZN. Methods. The study was cross-sectional and based on a secondary data set from the 2011 national census, conducted by Statistics South Africa. From the 10% sample, 1 474 under-5-year-olds had died in the province during the period of data collection. Statistical analysis was performed in Stata 12.0 and involved univariate, bivariate and multivariate analysis. Results. The results showed that maternal variables such as age, education level and race, as well as annual household income were predictors of under-5 mortality. Male children were also found to have a higher likelihood of dying before the age of 5 years than female children. Conclusion. The study identified several socioeconomic and demographic factors as predictors of under-5 mortality in KZN. The findings suggest the importance of up-scaling and strengthening interventions aimed at reducing under-5 mortality in the province, with specific focus on addressing the needs of young black women, those with limited education and women from poor households. [ABSTRACT FROM AUTHOR]

Background: There are limited studies assessing rural–urban disparities among older adults in Africa including South Africa. Aim: This study explores rural–urban health disparities among older adults in a population-based survey in South Africa. Setting: Data for this study emanated from the 2008 study on 'Global Ageing and Adult Health (SAGE) wave 1' (N = 3280) aged 50 years or older in South Africa. Methods: Associations between exposure variables and outcome variables (health status variables and chronic conditions) were examined through bivariate analyses and multivariable logistic regression. Results: Rural dwellers were more likely to be older, black African and had lower education and wealth than urban dwellers. Rural and urban dwellers reported a similar prevalence of self-rated health status, quality of life, severe functional disability, arthritis, asthma, lung disease, hypertension, obesity, underweight, stroke and/or angina, low vision, depression, anxiety and nocturnal sleep problems. Adjusting for socio-demographic and health risk behaviour variables, urban dwellers had a higher prevalence of diabetes (OR: 2.36, 95% CI: 1.37, 4.04), edentulism (OR: 2.79, 95% CI: 1.27, 6.09) and cognitive functioning (OR: 1.91, 95% CI: 1.27, 2.85) than rural dwellers. Conclusion: There are some rural–urban health disparities in South Africa, that is, urban dwellers had a higher prevalence of diabetes, edentulism and cognitive functioning than rural ones. Understanding these rural–urban health variations may help in developing better strategies to improve health across geolocality in South Africa. [ABSTRACT FROM AUTHOR]

Background: Combined pancreaticoduodenal injuries (CPDI) are complex and result in significant morbidity and mortality. Survival in CPDI after initial damage-control laparotomy (DCL) and pancreaticoduodenectomy was evaluated in a large cohort treated in a Level I trauma center. We hypothesized that bivariate analyses would accurately identify factors influencing morbidity and mortality.Study Design: The records from a prospective database of 453 consecutive patients treated for pancreatic injuries between January 1990 and April 2015 were reviewed to identify those with CPDI. Primary and secondary end points assessed were death and morbidity.Results: Seventy-five patients (69 men, median age 27 years, range 14 to 56 years) with CPDI, underwent 161 operations (range 1 to 9 operations). Twenty-nine patients with complex CPDI underwent a DCL and 46 had definitive treatment during the initial operation. Nineteen had a pancreaticoduodenectomy, either during the initial operation (n = 13) or after the DCL (n = 6). Postoperative complications occurred in 63 (84%) patients. Twenty-one (28%) patients died, including 15 (43%) of 35 patients with associated vascular injuries. Sixteen (84%) of the 19 patients who had a pancreaticoduodenectomy survived. Significantly more complications related to bleeding, disseminated intravascular coagulation, and hypovolemic shock occurred in those patients who eventually died and significantly more abdominal sepsis and fistulas occurred in patients who survived. Mortality was related to associated vascular injuries overall (p < 0.01), major visceral venous injuries (p < 0.011), and the combination of vascular plus the total number of associated organs injured (p < 0.046).Conclusions: Despite using DCL in CPDIs, morbidity (84%) and mortality (28%) remain substantial. Careful selection of patients undergoing pancreaticoduodenectomy resulted in 84% survival. Associated vascular injuries, major visceral venous injuries, and combined vascular and associated organs injured influenced outcomes and mortality. [ABSTRACT FROM AUTHOR]

• More recombinant than classic strains were detected. • Astrovirus surveillance in non-human sources will identify reservoirs for recombination. • Challenges in classifying recombinant strains exist in the current characterisation system. • The Vesikari severity scale must be used with caution when rating the severity of astrovirus-associated diarrhoea. • Genotype HAstV-5 requires further in-depth investigation. Astroviruses (AstVs) are associated with diarrhoeal and extra-intestinal infections in human, animal and avian species. A prevalence of 7% was reported in selected regions in SA while AstVs detected from clinical stool specimens were almost identical phylogenetically to strains identified in environmental and water samples. This study investigated the molecular diversity of astroviruses circulating between 2009 and 2014 in South Africa (SA). Astroviruses detected in stool specimens collected from hospitalised children were investigated retrospectively. Astroviruses were characterised using type-specific RT-PCR, partial nucleotide sequence analyses in ORF1 and ORF2 and whole genome sequencing. Different genotypes were compared with clinical features to investigate genotype-related associations. The Vesikari severity scale (VSS) was evaluated for scoring astrovirus diarrhoeal infections. Of 405 astroviruses detected, 49.9 % (202/405) were characterised into 32 genotypes comprising 66.3 % (134/202) putative-recombinants and 33.7 % (68/202) classic strains. No trends by year of collection, age or site were observed. Whole genome analysis in eight strains revealed that genotypes assigned by partial nucleotide sequence analyses to five astroviruses were incorrect. Bivariate analyses showed there were no significant associations between genotypes and clinical symptoms or severity of infection. A comparison of Vesikari parameters with astrovirus-positive proxy values demonstrated that Vesikari scores for duration of diarrhoea and admission temperatures would result in a milder infection rating in astrovirus-positive cases. Diverse genotypes co-circulated with putative-recombinants predominating. Astrovirus classification was complicated by the lack of a consistent characterisation system and reliable reference database. The VSS should be used cautiously to rate astrovirus diarrhoea. While surveillance in communities and out-patient clinics must be continued, screening for human astroviruses in alternate hosts is needed to determine the reservoir species. [ABSTRACT FROM AUTHOR]

• A breakdown of the location accuracy of the SALDN and ALDIS per year, indicating that rare large location errors still occur even as performance improves. • A methodology to fit statistical models to geographical lightning data and evaluate the quality of the fit. • The methodology is applied to lightning location system data time-correlated with ground-truth lightning events - tall tower lightning in both South Africa and Austria. • It is shown that the bivariate Students' t-distribution is a better statistical model for lightning location system errors than the bivariate Gaussian distribution. Lightning location systems geolocate lightning strokes. Given assumptions made in the geolocation models, errors in the reported locations can occur. Modelling these errors as a bivariate Gaussian distribution of historic stroke detections has found success in the form of confidence ellipses. However, the presence of outliers - strokes with large location errors - indicate that there is a better model for these errors. The Students' t-distribution is a "heavier" tailed distribution. This paper investigates whether the bivariate Students' t-distribution is a better model for such errors. A methodology for modelling and evaluating the distribution of location errors using maximum likelihood estimation, expectation-maximization and a Mahalanobis distance quality-of-fit test is described. This method is applied to stroke reports from the South African Lightning Detection Network and the Austrian Lightning Detection and Information System time-correlated with photographed lightning events to the Brixton Tower, South Africa and current measurements to the Gaisberg Tower, Austria respectively. In both cases, we find outliers in the distribution of location errors - even as the performance of the networks increase. Using the Mahalanobis test, we find the bivariate Students' t-distribution to be a better statistical model for both the South African and the Austrian events. [ABSTRACT FROM AUTHOR]

Background Chronic substance use (CSU) is associated with health problems, including self-harm, placing a significant burden on health care resources and emergency departments (EDs). This is problematic in low- and middle-income countries like South Africa (SA), where primary care facilitates and emergency departments (EDs) are often poorly resourced. Aim To investigate the epidemiology of CSU and self-harm and to consider the implications for primary health care service delivery and suicide prevention in SA. Methods Data were collected from 238 consecutive self-harm patients treated at the emergency department (ED) of an urban hospital in SA. The data were analysed using bivariate and multivariate analyses. Results Approximately 37% of self-harm patients reported CSU. The patients in the CSU subgroup, compared to other self-harm patients, were more likely to be men (odds ratio [OR] = 8.33, 95% confidence interval [CI] = 3.19–20.9, p < 0.001), to have self-harmed by inflicting damage to their body tissue OR = 4.45, 95% CI = 1.77–11.2, p < 0.01) and to have a history of self-harm (OR = 3.71, 95% CI = 1.44–9.54, p = 0.007). A significantly smaller proportion of CSU patients, compared to other self-harm patients, were referred for psychiatric assessment (OR = 8.05, 95% CI = 4.16–15.7, p < 0.001). Conclusion The findings of this study confirm that CSU is associated with greater service utilisation and repetition of self-harm among patients in primary health care settings. Treating self-harm as the presenting problem within primary care settings does not necessarily ensure that patients receive the care that they need. It might be helpful to include psychiatric assessments and screening for CSU as an integral component of care for self-harm patients who present in primary health care settings. [ABSTRACT FROM AUTHOR]

Background Sexual and reproductive decision-making has emerged as an important health indicator in family reproductive health issues. While there is evidence of male dominance in sexual and reproductive health decisions, the role of socio-demographic factors on women's decision to use contraception is not well understood. Aim This study aimed at exploring the socio-demographic factors associated with married women's decision-making to use contraception. Setting The study was conducted in Mahikeng local municipality in the Modiri Molema District Municipality. Methods Data were generated in Mahikeng from married and cohabiting women, aged 18–49 years, from a survey comprising 568 participants. Data were collected on women's demographic characteristics and contraceptive behaviour. Descriptive, bivariate and multivariate analyses were used to examine factors related to decision-making on contraceptive use. Results The result revealed that 57% of the participants were currently using contraception and 45% stated jointly-made decision regarding the use of contraception. Decisions on use of contraceptives were associated with education, occupation, religion, duration of union and home language. Other factors associated with decision-making on contraceptive use were perception on husband's right to sex, use of force for sex and spousal communication about sex. Conclusion Empowering women to use contraception to meet their fertility desire should aim at improving their socio-economic status and spousal communication. Family planning providers should recognise socio-cultural barriers under which the relationships exist and how women can navigate these contextual factors. [ABSTRACT FROM AUTHOR]