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There is a dearth of research on primary school Geography in South Africa. With no Annual National Assessments (ANAs) being done in the subject, little is known about the quality of geographical learning and teaching in South African primary schools. This article begins to address this shortcoming. More specifically, it responds to the need for empirical research on Geography in primary schooling in the developing-world context of South Africa, where large scale education transformation has taken place since 1994. An overview of the national school system is given followed by a discussion of the major inefficiency characterising the South African school system, namely the low quality of learning and teaching in many schools. Our main contention is that the focus of research has been on understanding and addressing systemic factors associated with low learning outcomes in literacy and numeracy, with little attention being paid to Geography. Drawing on the findings of an exploratory qualitative study using semi-structured interviews, we provide tentative insights into primary Geography from the perspective of teachers. We conclude with some propositions for a future research agenda.

The genus Neotherevella Lyneborg, 1978 is revised. Two new species are described from Morocco (Neotherevella maroccanus sp. nov.) and South Africa (Neotherevella londti sp. nov.), the latter named in honour of the South African Dipterist, Jason G.H. Londt. [ABSTRACT FROM AUTHOR]

This paper describes an evaluation of a web-based consultation space (a dynamic frequently asked questions environment--DFAQ) in which learners consult one another using questions, and in which both the flow of interaction and its artefacts become a resource available to a community of learners. The DFAQ is a special form of a Computer-Mediated-Communication tool specifically developed to facilitate question-based interaction. We argue that education is too complex a social structure to be evaluated using deterministic positivist quantitative approaches. Given the volatility of determining what constitutes value, costs, inputs and outputs and the complexity of dynamics of socialization, a non-deterministic qualitative approach, utilisation-focused evaluation approach is used. Our conclusion is that the DFAQ does contribute to students' academic performance and frees the lecturer-learner consultation time. (Contains 3 figures.)

Background: Although tuberculosis (TB) symptoms have limited sensitivity they remain an important entry point into the TB care cascade. Objectives: To investigate self-reported healthcare seeking for TB symptoms in participants in a community-based survey. Methods: We compared reasons for not seeking care in participants reporting ≥1 of four TB screening symptoms (cough, weight loss, night sweats, fever) in the first South African national TB prevalence survey (2017–2019). We used logistic regression analyses to identify sociodemographic and clinical characteristics associated with healthcare seeking. Results: 5,168/35,191 (14.7%) survey participants reported TB symptoms and 3,442/5168 had not sought healthcare. 2,064/3,442(60.0%) participants intended to seek care, 912 (26.5%) regarded symptoms as benign, 399 (11.6%) reported access barriers(distance and cost), 36 (1.0%) took other medications and 20(0.6%) reported health system barriers. Of the 57/98 symptomatic participants diagnosed with bacteriologically confirmed TB who had not sought care: 38(66.7%) intended to do so, 8(14.0%) regarded symptoms as benign, and 6(10.5%) reported access barriers. Among these 98, those with unknown HIV status(OR 0.16 95% CI 0.03–0.82), p = 0.03 and those who smoked tobacco products(OR 0.39, 95% CI 0.17–0.89, p = 0.03) were significantly less likely to seek care. Conclusions: People with TB symptoms delayed seeking healthcare, many regarded symptoms as benign while others faced access barriers. Those with unknown HIV status were significantly less likely to seek care. Strengthening community-based TB awareness and screening programmes together with self-screening models could increase awareness of the significance of TB symptoms and contribute to improving healthcare seeking and enable many people with TB to enter the TB care cascade. [ABSTRACT FROM AUTHOR]

This article considers the case of the NM Cherry Blossom, a bulk carrier that docked in South Africa loaded with phosphate cargo from Western Sahara. The Sahrawi Arab Democratic Republic argued that the phosphate cargo was pillaged from the non-self-governing territory, and a South African court set out to determine ownership. This article analyses South Africa's recognition of the Sahrawi state's sovereignty as it pertains to determining the ownership of the phosphate in question. This recognition subsequently creates legal and political possibilities based on sovereignty that is not mediated through or reliant upon the United Nations. I argue that we must attend to jurisdictional histories and contexts in order to consider the scope of new political possibilities for decolonisation struggles. [ABSTRACT FROM AUTHOR]

• Rapid tests in resource-scarce settings are a promising tool in COVID-19 diagnosis • Antibody testing was conducted on people with previous COVID-19 diagnoses, using five rapid assays • Overall sensitivity to SARS-CoV-2-specific antibodies was below 70% in all assays • Sensitivity was reduced for those under 40 compared with those over 40 years of age • Gender, disease severity, and time since test did not have an effect on sensitivity Point-of-care serological assays are a promising tool in COVID-19 diagnostics but do have limitations. Our study evaluated the sensitivity of five rapid antibody assays and explored factors influencing their sensitivity in detecting SARS-CoV-2-specific IgG and IgM antibodies. Finger-prick blood samples from 102 participants, within 2–6 weeks of PCR-confirmed COVID-19 diagnosis, were tested for IgG and IgM using five rapid serological assays. The assay sensitivities were compared, and patient factors evaluated in order to investigate potential associations with assay sensitivity. Sensitivity ranged from 36% to 69% for IgG and 13% to 67% for IgM. Age was the only factor significantly influencing the likelihood of a detectable IgG or IgM response. Individuals aged 40 years and older had an increased likelihood of a detectable IgG or IgM antibody response by rapid antibody assay. Rapid serological assays demonstrate significant variability when used in a real-world clinical context. There may be limitations in their use for COVID-19 diagnosis among the young. [ABSTRACT FROM AUTHOR]

Background: Ambulatory blood pressure monitoring is a valuable tool that helps in providing an insight into the diagnosis and management of hypertension; however, no evidence exists of its acceptance in the diverse South African population. Aim: We assessed the acceptance of an ambulatory blood pressure monitor in patients attending public sector primary health care (PHC) clinics. Setting: Five PHC clinics in the Makana subdistrict in the Eastern Cape. Method: A cross-sectional study was conducted with 70 hypertensive patients. Eligible patients were between 40 and 75 years old, taking either enalapril and hydrochlorothiazide or enalapril, hydrochlorothiazide and amlodipine. Socio-demographic, clinical and acceptance data were collected. The monitor cuff remained in place for 24 h. Acceptance was assessed after the monitor was removed. An overall acceptance score was generated to classify acceptance as either good or poor. Results: The mean years of schooling was 5.9 years, with 22 reporting no school attendance. Generally, acceptance was good, with 70% of the population rating the technique as 'acceptable' (acceptance score of > 23/30). Most participants reported minimal discomfort with only 13.3% reporting that it hindered normal daily activities. Night readings interrupted sleep in 43%, with extreme sleep disturbance (≥ 3 awakenings) reported in just over half the patients. Increased years of schooling was the only variable associated with acceptance score (r = --0.243, p = 0.042). Conclusion: Ambulatory blood pressure monitoring was generally well-accepted, with few adverse effects being reported. Use of this technique at PHC facilities could reduce the incidence of misdiagnosis and uncontrolled hypertension. [ABSTRACT FROM AUTHOR]

Recent literature on organisational strategy has called for greater emphasis on individuals (stakeholders) and what they do in the process of strategizing. Public sector organisations have to engage with an array of heterogeneous stakeholders in fulfilling their mandate. The public health sector in particular needs to engage with a diversity of stakeholders at local, regional and national levels when strategising. The purpose of this study is to investigate the influence of stakeholder relations on the implementation of Information Systems (IS) strategy in public hospitals in South Africa. An interpretive approach using two provinces was employed. The Activity Analysis and Development (ActAD) framework, an enhanced form of activity theory, was used as the theoretical framework. Data was collected using semi-structured interviews, meetings, documents analysis, physical artefacts and observation. The collected data was analysed using thematic analysis. Findings reveal that IS strategy implementation in public hospitals involves a large and complex network of stakeholder groups at different levels, and over different time periods. These stakeholder groups act in accordance with formal and informal roles, rules and modalities. Various contextual conditions together with the actions of, and interactions between stakeholder groups give rise to the situationality of stakeholder relations dynamics and strategy implementation. The multiple actions and interactions over time lead to the realisation of some aspects of the IS strategy in public hospitals. Given the complexity and dynamism of the context there are also certain unplanned implementations as well. These relationships are captured in a Stakeholder Relations Influence (SRI) framework. The SRI framework can be assistive in the assessment and mapping of stakeholders and stakeholder relations, and the assessment of the implications of these relations for effective IS strategy implementation in public hospitals. The framework can also provide the basis for the development of appropriate corrective measures in the implementation of strategies and policies in public institutions such as public hospitals. [ABSTRACT FROM AUTHOR]

In 2011 South African short term insurer Santam (Santam Ltd.) put in place an advertising initiative that illustrates the power of a humorous brand narrative effected in conjunction with another brand. In this case, it is the South African arm of Nando's (Nando's Chickenland Ltd.), a fast food restaurant chain specialising in Portuguese-themed chicken dishes that rely heavily on peri-peri spices. The two well-known brands aired a series of five commercials on television and the Internet, trading good-humoured jibes centred around the value proposition of each company's offering. The resultant rise in social media viewership and consumer engagement was notable and illustrates the efficacy of a cobranded narrative run over numerous media platforms; in this case radio, television, social media, print and the Internet. [ABSTRACT FROM AUTHOR]

Background: Poverty undermines adherence to tuberculosis treatment. Economic support may both encourage and enable patients to complete treatment. In South Africa, which carries a high burden of tuberculosis, such support may improve the currently poor outcomes of patients on tuberculosis treatment. The aim of this study was to test the feasibility and effectiveness of delivering economic support to patients with pulmonary tuberculosis in a high-burden province of South Africa. Methods: This was a pragmatic, unblinded, two-arm cluster-randomized controlled trial, where 20 public sector clinics acted as clusters. Patients with pulmonary tuberculosis in intervention clinics (n = 2,107) were offered a monthly voucher of ZAR120.00 (approximately US$15) until the completion of their treatment. Vouchers were redeemed at local shops for foodstuffs. Patients in control clinics (n = 1,984) received usual tuberculosis care. Results: Intention to treat analysis showed a small but non-significant improvement in treatment success rates in intervention clinics (intervention 76.2%; control 70.7%; risk difference 5.6% (95% confidence interval: -1.2%, 12.3%), P = 0.107). Low fidelity to the intervention meant that 36.2% of eligible patients did not receive a voucher at all, 32.3% received a voucher for between one and three months and 31.5% received a voucher for four to eight months of treatment. There was a strong dose-response relationship between frequency of receipt of the voucher and treatment success (P <0.001). Conclusions: Our pragmatic trial has shown that, in the real world setting of public sector clinics in South Africa, economic support to patients with tuberculosis does not significantly improve outcomes on treatment. However, the low fidelity to the delivery of our voucher meant that a third of eligible patients did not receive it. Among patients in intervention clinics who received the voucher at least once, treatment success rates were significantly improved. Further operational research is needed to explore how best to ensure the consistent and appropriate delivery of such support to those eligible to receive it. [ABSTRACT FROM AUTHOR]

Home and community-based care (HCBC) has emerged as a way to provide cost-effective and compassionate care to people living with HIV (PLHIV) and those affected by the epidemic. HCBC organisations provide integrated services which address the basic needs of those infected and affected such as food, shelter, healthcare, protection from abuse and malnutrition. The main objective of this study was to conduct an audit of HCBC organisations in South Africa in order to provide the Government with empirical information on their existence, distribution, services and challenges. The primary approach to this task was to conduct a telephonic audit of organisations rendering HCBC services. Of the 2001 HCBC organisations that participated in the audit, the majority were situated in Limpopo and KwaZulu-Natal Provinces. More than half of all the organisations were located in the rural areas. The audited HCBC organisations targeted orphans and vulnerable children, PLHIV and vulnerable households and provided services such as conducting home visits, providing material and psychosocial support and running support groups. Most of the organisations were, however, faced with challenges such as lack of access to water, electricity and computer equipment and a formal office space. In addition, some organisations were in need of funds for stipends for their community caregivers. Non-availability of funds for stipends and necessary assets might affect the quality of HCBC services rendered. The findings of the study therefore suggest the need for more financial assistance from the Government and other stakeholders for organisations rendering HCBC services, in order for them to afford necessary assets and provide sustainable, high-quality services that can help in reducing HIV impacts in South Africa. [ABSTRACT FROM PUBLISHER]

An essay is presented which focuses on the themes of statehood, international order and nationalism relating to Third World countries, and the relationship between the United Nations and these countries from the mid-1940s to the early 1960s. The author explores the subject of apartheid as a framework for the research. The author discusses India's goal in 1946 to put South African government policy on the United Nations General Assembly agenda, as well as African decolonization in the 1960s.

In the past decade, the use of the World Wide Web (WWW) as a tool for job-seeking and recruitment has increased globally, changing the dynamics for job-seekers and recruitment organisations. The purpose of this study was to gain greater insight into the factors that influence the adoption of the Internet (WWW) for job-seeking within a South African context. The impact of the Internet (WWW) and newspaper-reading habits on the adoption process was of specific interest. Data was gathered by survey through telephonic interviews with 228 job seekers applying for information technology (IT) work in Cape Town, South Africa. The findings show that the income of a jobseeker influences the favourability of internet facilitating conditions they encounter. Facilitating conditions in turn influence Internet (WWW) usage habits. Such habits influence performance expectancy, effort expectancy and intentions to use the Internet (WWW) for job-seeking. The actual extent of Internet (WWW) usage for job-seeking is positively influenced by these usage intentions and negatively influenced by newspaper-reading habits. These and other findings are discussed and implications drawn. [ABSTRACT FROM AUTHOR]

In Internet banking and Internet-related transactions, security and privacy are of great concern. To alleviate these concerns, the South African government has promulgated the Electronic Communications and Transactions (ECT) Act No. 25 of 2002. The Act regulates all electronic communication transactions in South Africa. Business organisations implement the Act by, for example, posting a privacy policy statement on their websites, which, in accordance with the requirements of the ECT Act, states how the organisation will use any personal identifiable information provided by the client. This study investigates whether South African banks that subscribe to the ECT Act comply with the principles relating to the protection of a consumer's personal information. The study employed the research methods of content analysis and interviews. The findings indicate that some banks only complied with a few of the ECT Act principles, which, according to the interview respondents, undermines the levels of trust which are in play between their banks and themselves. The respondents themselves were not fully aware of all the ECT Act requirements. This lack of awareness results in consumers failing to assess the comprehensiveness of their bank's policy statements and to what extent such banks comply with the ECT Act. [ABSTRACT FROM AUTHOR]

Since the advent of the Internet, B2C e-Commerce has grown substantially across the globe. Whilst much research has examined factors influencing adoption of e-commerce, not as many studies have investigated the post-adoption phenomenon of success. Those studies that have investigated IS success and the extensions required to accommodate e-commerce have mainly been conceptual. Few have attempted to test and validate the models empirically. The purpose of this study was to fill this gap. By drawing from the technology acceptance model, expectation-confirmation theory and IS success theory, a revised conceptual model was derived. The model and relationships were tested and validated using data gathered from 166 online consumers in South Africa. 7 interrelated dimensions of B2C e-commerce success were confirmed, namely service quality, system quality, information quality, trust, perceived usefulness, user satisfaction and continuance intentions. Direct relationships between dimensions were identified. These showed that user intentions to continue using an online retail site are directly influenced by perceived usefulness, user satisfaction and system quality. User satisfaction is directly influenced by service quality and perceived usefulness, whilst perceived usefulness is directly influenced by trust and information quality. Trust in the online retailer is directly influenced by service quality and system quality. The implications of these and other findings are discussed. [ABSTRACT FROM AUTHOR]

The article discusses relations between the United States and South Africa in the early 1960s as representative of the intersection of two important developments in world affairs: decolonization and the Cold War. In particular, the heated debate in the United Nations over apartheid, the policy of racial segregation enforced by the white-dominated South African government, is discussed, including the international opposition led by the "African bloc," and U.S. support for South Africa. The efforts of developing countries to refocus international attention on postcolonial issues of universal human rights and opposition to racism, rather than superpower politics, is a particular focus.

This article examines the biographies of the four Noble Peace Prize laureates - Albert Luthuli, Desmond Tutu, Nelson Mandela, and Frederik Willem de Klerk - who stood for justice during the apartheid regime in South Africa. Of interest to the Nobel Committee were these leaders' accomplishments and efforts in the ending of apartheid. Chief Luthuli was a Christian minister and President of the African National Congress in the 1950s and 1960s. Bishop Tutu is a revered religious leader of the Anglican Church in South Africa. Nelson Mandela and Frederik Willem de Klerk were awarded the Nobel Peace Prize for their work towards the peaceful termination of the apartheid regime, and for laying the foundations for a new democratic South Africa. The telling of these Nobel laureates' stories through the text of their Nobel speeches illustrates the accelerated changes in the lives of black South Africans. Remarkable new justice institutions and court processes such as the Truth and Reconciliation Commission emerged shortly after the demise of apartheid. In its choice of Nobel laureates, the Nobel Peace Prize committee supported social justice for black South African leadership. The prize also recognizes de Klerk's reconciliation with an integrated South Africa that replaced the former discredited regime. [ABSTRACT FROM AUTHOR]

Describes the background, aims, and contents of courses offered in environmental education at the University of Bophuthatswana. Comments on the evaluation and potential value of courses. (RT)

The widespread diffusion of the Internet globally has prompted most retail banks to offer Internet banking services. A recent study in Singapore identified attitudinal and perceived behavioral control factors as having an influence on consumer adoption of Internet banking. It is expected that the national environment will also impact this process. The aim of this study therefore was to replicate the Singapore study in South Africa, compare the results between the two countries and explain differences in adoption process in terms of the national environment. The results confirm that attitudinal and perceived behavioral control factors influence adoption in South Africa as in Singapore, but with differences in the number of determinants, and the degree of influence of certain determinants. These differences were explained in terms of three environmental dimensions-socio-economic conditions, the state of Internet diffusion and government ICT policies respectively. [ABSTRACT FROM AUTHOR]

Theories of technology adoption and usage behaviour have generally been crafted and tested in developed countries. This study therefore aimed to extend knowledge by examining Internet adoption and usage behaviour in a developing country (South Africa). Differences in Internet adoption between those from a group previously advantaged by apartheid and those J?om a group previously disadvantaged were specifically examined. For the previously advantaged, Perceived Usefulness, Perceived Enjoyment, and Long-term Consequences of Use were found to influence Internet adoption. For the previously disadvantaged, the main influence was Perceived Usefulness, with Perceived Ease of Use having an indirect effect through Perceived Usefulness. Differences in Internet experience and exposure to technology largely explained the observed results as a result of varying socio-economic backgrounds between the majorities in the two groups. The implications of these findings in respect of the digital divide are discussed. [ABSTRACT FROM AUTHOR]

South African brand managers are discovering that the savvy use of corporate social investment (CSI) policies is making them more competitive and giving their brands high local profile. Savvy CSI programmes on the part of banks, game lodges, small businesses and even multi-nationals like Anglo American and De Beers have already proven to be an excellent means of promoting brand loyalty in a country where increasingly more consumers are looking to businesses to help solve the myriad economic and social inequalities the country has been bequeathed by the previous government. The author contends that businesses that hope to flourish in South Africa have learned that it is in their interests for their brands to stand for these values and beliefs with regard to society's transformation and to embrace a policy of transparency in their corporate dealings and social upliftment programmes. Brands that have successfully melded corporate social responsiblity (CSR) initiatives with traditional brand management have created what the author refers to as a policy of values-led branding that is catching on across the country and becoming de rigueur for modern South African brand management. The initiatives that South African companies have promoted in this politically and culturally hypersensitive microcosm of first and third world branding concerns may became emblematic for companies across the world which hope to utilise CSI and CSR programmes to build their brand image against powerful competitors struggling against the brunt of global activism. [ABSTRACT FROM AUTHOR]

• New IS theory that provides a better explanation of organisational social media use. • High quality social media content fuel a successful collective storytelling process. • A supportive social media strategy standardises organisational social media use. • A co-creation process collectively generates valued social media services. • Being consistently responsive lead to a more engaged and satisfied online community. The organisational implementation and use of social media for online community engagement is plagued with many challenges. The result is managers being frustrated at not achieving their desired results. Despite an increase in social media research, it is evident that some critical aspects of social media use by organisations are left unexplained by existing theories. The purpose of this research study is to investigate how social media is used within organisations to engage with its online community. The grounded theory method (GTM) was used to develop a substantive theory that increases understanding of this phenomenon. Two organisations were selected as the case studies. Both are industry leaders in South Africa, with one being a prominent retailer with a visible social media presence and the other, being a leading university in South Africa, which is actively growing its social media presence. The results show that organisations enter a collective storytelling process with their online community. The need to reduce risk to reputation and improve on the levels of online community engagement are identified as reasons for this. The strategic alignment of the social media function and the organisational social media use characteristics set the backdrop for the collective storytelling process, while content quality influences the richness of this process. Challenges associated with the collective storytelling process lead to the development and refinement of the organisational social media strategy, which in turn helps to reduce risk to reputation and improve online community engagement. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the most common malignancy affecting South African women aged 15–44 years, with a higher prevalence among women living with HIV (WLWH). Despite recommendations for a screening target of 70%, the reported rate of cervical cancer screening in South Africa is 19.3%. Objectives: To investigate the adherence of healthcare workers to cervical cancer screening guidelines in a tertiary-level HIV clinic. Method: A retrospective cross-sectional record audit of women attending the Charlotte Maxeke Johannesburg Academic Hospital HIV Clinic over a 1-month period. Results: Out of 403 WLWH who attended the clinic, 180 (44.7%) were screened for cervical cancer in the 3 years prior to the index consultation. Only 115 (51.6%) of those women with no record of prior screening were subsequently referred for screening. Women who had undergone screening in the previous 3 years were significantly older (47 years vs 44 years, P = 0.046) and had a longer time since diagnosis of their HIV (12 years vs 10 years, P = 0.001) compared to women who had not undergone screening. There was no significant difference in CD4 count or viral suppression between women who had and had not undergone screening. Conclusion: The rate of cervical cancer screening in our institution is below that recommended by the World Health Organization and the South African National Department of Health. [ABSTRACT FROM AUTHOR]

The creation of the independent black state of Transkei, under the apartheid regime, resulted in inadequate allocation of resources to the region. These inequalities were translated into health care. Despite these limitations, over the last five years an innovative community-based educational programme involving medical students, nurses and health educators is evolving at the relatively new medical school in this region. This programme, however, has not been free of difficulties. There is an urgent need to address these issues using a combination of administrative, educational and research approaches. This would provide a strong basis for the further development of this educational programme that could serve as a unique South African example of medical education in the community. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis remains an important clinical and public health issue in South Africa, which has one of the highest tuberculosis burdens in the world. We aimed to estimate the burden of bacteriologically confirmed pulmonary tuberculosis among people aged 15 years or older in South Africa.Methods: This multistage, cluster-based, cross-sectional survey included eligible residents (age ≥15 years, who had slept in a house for ≥10 nights in the preceding 2 weeks) in 110 clusters nationally (cluster size of 500 people; selected by probability proportional-to-population size sampling). Participants completed face-to-face symptom questionnaires (for cough, weight loss, fever, and night sweats) and manually read digital chest X-ray screening. Screening was recorded as positive if participants had at least one symptom or an abnormal chest X-ray suggestive of tuberculosis, or a combination thereof. Sputum samples from participants who were screen-positive were tested by the Xpert MTB/RIF Ultra assay (first sample) and Mycobacteria Growth Indicator Tube culture (second sample), with optional HIV testing. Participants with a positive Mycobacterium tuberculosis complex culture were considered positive for bacteriologically confirmed pulmonary tuberculosis; when culture was not positive, participants with a positive Xpert MTB/RIF Ultra result with an abnormal chest X-ray suggestive of active tuberculosis and without current or previous tuberculosis were considered positive for bacteriologically confirmed pulmonary tuberculosis.Findings: Between Aug 15, 2017, and July 28, 2019, 68 771 people were enumerated from 110 clusters, with 53 250 eligible to participate in the survey, of whom 35 191 (66·1%) participated. 9066 (25·8%) of 35 191 participants were screen-positive and 234 (0·7%) were identified as having bacteriologically confirmed pulmonary tuberculosis. Overall, the estimated prevalence of bacteriologically confirmed pulmonary tuberculosis was 852 cases (95% CI 679-1026) per 100 000 population; the prevalence was highest in people aged 35-44 years (1107 cases [95% CI 703-1511] per 100 000 population) and those aged 65 years or older (1104 cases [680-1528] per 100 000 population). The estimated prevalence was approximately 1·6 times higher in men than in women (1094 cases [95% CI 835-1352] per 100 000 population vs 675 cases [494-855] per 100 000 population). 135 (57·7%) of 234 participants with tuberculosis screened positive by chest X-ray only, 16 (6·8%) by symptoms only, and 82 (35·9%) by both. 55 (28·8%) of 191 participants with tuberculosis with known HIV status were HIV-positive.Interpretation: Pulmonary tuberculosis prevalence in this survey was high, especially in men. Despite the ongoing burden of HIV, many participants with tuberculosis in this survey did not have HIV. As more than half of the participants with tuberculosis had an abnormal chest X-ray without symptoms, prioritising chest X-ray screening could substantially increase case finding.Funding: Global Fund, Bill & Melinda Gates Foundation, USAID. [ABSTRACT FROM AUTHOR]

Background: Colonoscopy is a valuable tool for diagnosing various colonic pathologies. There is little recent research regarding the use of colonoscopy in South Africa. Objective: To describe the findings of the audit done on the practice of colonoscopy in a specialised gastroenterology unit (GEU) of a tertiary teaching hospital. Design: A retrospective audit of colonoscopies performed between the 01 January 2008 and 31 March 2010 in a single gastroenterology unit at Charlotte Maxeke Johannesburg Academic Hospital(CMJAH) was conducted. Details of colonoscopy records were obtained from an administrative database of patient files. No patient specific inclusion or exclusion criteria were applied. Results: In total 1143 colonoscopies were performed during the study period, and 989 were analysed. The mean age was 63.04 years (10 - 93), 61.58% female, 61.48% were Caucasians and 25.88% were of black ethnicity. The indications for colonoscopies were; screening for colorectal cancer (22.95%), case findings (14.16%) and surveillance (14.96%). Caecal intubation rate (CIR) was 80.08%. Findings included macroscopically normal colons (38.12%), polyps (28.18%) and diverticular disease (23.15%). Of the biopsies obtained during colonoscopy procedures 30.50% were reported as normal colonic mucosa, 10.40% revealed adenocarcinoma and 55.37% were tubular adenomas. Conclusions: The audit identified a number of shortfalls, which include: poor colonoscopy performance quality as reflected by the low CIR, non standardised colonoscopy reporting format resulting in paucity of information on scope reports, underrepresentation of the black community, to mention a few. It therefore would appear, based on the findings from this study that there is room for improvement in a number of areas in the practice of colonoscopy in this unit. Further studies may be of value to identify reasons behind these shortfalls. [ABSTRACT FROM AUTHOR]

Introduction: Dolutegravir (DTG)-based antiretroviral therapy is the World Health Organization's preferred first-line regimen for all persons with HIV, including pregnant women. While DTG has been implicated as an obesogen associated with greater weight gain compared to other antiretrovirals, there is a paucity of data in pregnant women and their children. The Obesogenic oRigins of maternal and Child metabolic health Involving Dolutegravir (ORCHID) study is investigating associations between DTG, weight gain, and metabolic outcomes in the context of HIV., Materials & Methods: ORCHID is a prospective observational study taking place in Cape Town, South Africa (NCT04991402). A total of 1920 pregnant women with and without HIV infection are being followed from ≤18 weeks gestational age to 24 months postpartum with their children. Participants attend eleven study visits: 3 antenatal, delivery, and 7 postnatal visits. Several embedded sub-studies address specific scientific aims. Primary outcome measurements in mothers include anthropometry, blood pressure, body composition, dysglycemia, insulin resistance (IR), and dyslipidemia. Other maternal measures include demographics, resting energy expenditure, viral load, physical activity, dietary intake, hepatic steatosis, and repository specimens. Sub-study measurements include markers of adipose inflammation, gut integrity, and satiety/hunger, subcutaneous adipose tissue morphology and mitochondrial function, and metabolomics. Primary outcome measurements in children include anthropometry, adipose tissue mass, dysglycemia, IR, and dyslipidemia. Other variables include fetal growth, birth outcomes, medical/breastfeeding history, caloric intake, neurodevelopment, and repository specimens. Sub-study measurements include metabolites/lipid subspecies in umbilical cord blood, as well as breast milk composition and DTG exposure., Discussion: ORCHID will play a pivotal role in defining obesogenic mechanisms and clinical consequences of DTG use in pregnancy in women with HIV and their children. It will provide insights into metabolic disease risk reduction in the context of HIV/DTG, identify intervention targets, and inform public health approaches to diminish chronic metabolic co-morbidities for women and children., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Abrams et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: In high-income countries, myosteatosis, sarcopenia, and obesity with sarcopenia (sarcopenic obesity) are associated with adverse outcomes after liver transplantation. In South Africa, an upper-middleincome country, we investigated the prevalence and impact of these muscle abnormalities on posttransplant outcomes in adult liver transplant recipients., Materials and Methods: We reviewed 106 liver transplant recipients and measured muscle abnormalities on computed tomography using segmentation software. The parameters evaluated were myosteatosis by mean muscle attenuation, sarcopenia by skeletal muscle index at the third lumbar vertebra using validated cutoffs, and sarcopenic obesity as sarcopenia and a body mass index of ≥25 kg/m². The effects of these abnormalities on 1-year patient and graft survival (primary endpoint) and length of hospital and intensive care unit stay, costs, and 90-day and overall postoperative complications (secondary endpoints) were assessed., Results: Most liver transplant recipients were male (n = 64, 60%). Alcoholic and/or nonalcoholic steatohepatitis were the most frequent indications for transplant (n = 38, 36%). Myosteatosis occurred in 76 patients (72%), 69 patients (65%) had sarcopenia, and 36 patients (34%) had sarcopenic obesity. One year after transplant, myosteatosis was associated with higher mortality (hazard ratio of 3.3; 95% confidence interval, 1.00-11.13; P = .049), greater risk of allograft failure (hazard ratio of 4.1; 95% confidence interval, 1.2-13.5; P = .021), and longer hospital and intensive care unit stays compared with those without myosteatosis. All patients with no body composition abnormalities were alive at 1 year compared with 69% with coexisting myosteatosis and sarcopenia., Conclusions: In our setting, liver transplant recipients with myosteatosis had a higher risk of death and allograft failure at 1 year compared with patients without body composition abnormalities.

During the 2017-2018 listeriosis outbreak in South Africa (SA), the total number of cases reached 1,060. In this study, the disaster management response to the 2017-2018 South Africa listeriosis outbreak is analyzed. The hazard was in part the contamination of a brand of a ready-to-eat (RTE) "polony" with a strain of Listeria monocytogenes ST6. The initial phase of the 2017-2018 listeriosis outbreak was characterized by a rapid increase in the number of detected human cases. The listeriosis outbreak was officially proclaimed in December 2017, resulting in listeriosis being added to the list of notifiable diseases in SA. The delay between onset and proclamation was a result of the difficulty in identifica-tion of the actual number of cases of listeriosis in the country. The response to the disaster included the coordination of the National Department of Health, the National Institute of Communicable Diseases (NICD), businesses/producers of the contaminated brand of RTE products, and the public. Some of these activities led to the removal of the contami-nated products from the retail sector in March 2018, resulting in a decrease in the number of cases found in SA. In re-sponse to the outbreak, the National Department of Health formed a multisector incidence response team and imple-mented the Emergency Response Plan. Impacts of future listeriosis outbreaks could be mitigated by the adoption of international listeriosis guidelines such as the WHO/FAO and FDA. Practical steps in this context should include setting a limit of L. monocytogenes in RTE products. WHO/FAO and FDA listeriosis policies which are described "zero toler-ance" where a limit of < 100 L. monocytogenes cells/g at the moment of consumption is acceptable can be adopted. Additional resources must be provided for research into infectious doses and the various routes of human exposure.

Objectives: The Transnet-Phelophepa Health Care Trains provide primary healthcare services to patients in under-resourced rural communities across South Africa. Selected final-year pharmacy students work on the trains for 1 week. The aim of the study was to determine the experiences and document the work-based activities of pharmacy students engaged in., Methods: A hyperlink to an online questionnaire was sent to 106 pharmacy students from five Pharmacy Schools (70.75% response rate). Both closed- and open-ended questions were included. Data were captured in Excel., Key Findings: Respondents expressed that their motivation to volunteer to work on the train was threefold: they wanted to help the community, experience this unparalleled work environment, as well as having heard positive responses from previous volunteers. Students were exposed to a variety of pharmacy-related activities; however, the majority of their time was spent dispensing. Although less than half (n = 33) found it difficult to communicate with patients, almost all responded that the translator helped them communicate with patients. A few saw this as an opportunity to learn a new language. The pharmacy staff was described as approachable, knowledgeable and willing to teach. Most respondents agreed that they were able to apply their knowledge and skills whilst working on the train (mean 4.52 ± 0.93; n = 75)., Conclusions: Pharmacy students felt valued by the community and found it to be a rewarding experience while reporting to apply knowledge and information, improve their communication skills and work as part of a team., (© 2018 Royal Pharmaceutical Society.)

Background: In an attempt to address a complex disease burden, including improving progress towards MDGs 4 and 5, South Africa recently introduced a re-engineered Primary Health Care (PHC) strategy, which has led to the development of a national community health worker (CHW) programme. The present study explored the development of a cell phone-based and paper-based monitoring and evaluation (M&E) system to support the work of the CHWs., Methods: One sub-district in the North West province was identified for the evaluation. One outreach team comprising ten CHWs maintained both the paper forms and mHealth system to record household data on community-based services. A comparative analysis was done to calculate the correspondence between the paper and phone records. A focus group discussion was conducted with the CHWs. Clinical referrals, data accuracy and supervised visits were compared and analysed for the paper and phone systems., Results: Compared to the mHealth system where data accuracy was assured, 40% of the CHWs showed a consistently high level (>90% correspondence) of data transfer accuracy on paper. Overall, there was an improvement over time, and by the fifth month, all CHWs achieved a correspondence of 90% or above between phone and paper data. The most common error that occurred was summing the total number of visits and/or activities across the five household activity indicators. Few supervised home visits were recorded in either system and there was no evidence of the team leader following up on the automatic notifications received on their cell phones., Conclusions: The evaluation emphasizes the need for regular supervision for both systems and rigorous and ongoing assessments of data quality for the paper system. Formalization of a mHealth M&E system for PHC outreach teams delivering community based services could offer greater accuracy of M&E and enhance supervision systems for CHWs.

The Mexico (2004), Bamako (2008) and Algiers (2008) declarations committed the South African (SA) Ministry of Health to allocate 2% of the national health budget to research, while the National Health Research Policy (2001) proposed that the country budget for health research should be 2% of total public sector health expenditure. The National Health Research Committee has performed an audit to determine whether these goals have been met, judged by: (i) health research expenditure as proportions of gross expenditure on research and development (GERD) and the gross domestic product (GDP); and (ii) the proportion of the national health and Department of Health budgets apportioned to research. We found that total expenditure on health research in SA, aggregated across the public and private sectors, was R3.5 billion in 2009/10, equating to 16.7% of GERD. However, the total government plus science council spend on health research that year was only R729 million, equating to 3.5% of GERD (0.03% of the GDP) or 0.80% of the R91.4 billion consolidated government expenditure on health. We further found that R418 million was spent through the 2009/2010 Health Vote on health research, equating to 0.46% of the consolidated government expenditure on health or 0.9% of the R45.2 billion Health Vote. Data from other recent years were similar. Current SA public sector health research allocations therefore remain well below the aspirational goal of 2% of the national health budget. We recommend that new, realistic, clearly defined targets be adopted and an efficient monitoring mechanism be developed to track future health research expenditure.

Background: Primary health care in rural South Africa is predominantly provided by remote clinics and health centres. In 1994, health centres were upgraded and new health centres developed to serve as a health care filter between community clinics and district hospitals., Aim: To describe the spectrum of clinical problems encountered at a new health centre in an area of high economic deprivation and compare this with an adjacent community clinic and district hospital., Design: Cross-sectional survey., Setting: A rural clinic, health centre and district hospital in Eastern Cape Province, South Africa., Methods: The International Classification of Primary Care-2 (ICPC-2) was used to code data collected over a 13-week period from patients presenting at a community clinic, health centre and district hospital., Results: Altogether, 4 383 patient encounters were recorded across all three sites in 2001. Most contacts at the clinic (97%) and the health centre (80%) were with a nurse. Females over 15 years of age comprised over half of all contacts at health facilities (53%). The most common diagnosis category was respiratory (23%). Cough was the most common symptom. Thirty per cent of children up to 5 years of age were seen for immunisations. Most childhood immunisations (79%) were carried out at the health centre., Conclusion: Of all the health care facilities surveyed, the health centre had the highest throughput of patients, indicating that the health centre is an efficient filter between the community and hospital. The ICPC-2 can be successfully used to monitor encounters at similar African health care facilities.

Objectives: To describe the demographic, environmental and health characteristics of the rural Eastern Cape and to explore demographic and environmental predictors of health., Design: Cross-sectional study., Setting: Engcobo and Umtata in the Eastern Cape, South Africa., Subjects: 12,049 people from 4608 households., Outcome Measures: (i) Children: immunisation history and being breastfed; (ii) women aged 15-45 years: use of contraception; (iii) women aged 20-25 years: total numbers of dead children; and (iv) all adults: smoking status, body mass index and blood pressure., Results: 2741 houses (59.5%) were structurally adequate, 1795 (39.0%) had access to clean water, and 1174 (25.6%) had access to gas or electric energy. Of children up to 5 years of age 1436 (44.2%) were fully immunised and 2472 (76.1%) were breastfed in their first year of life. Among women aged 15-45 years, 903 (37.8%) used contraceptives, and among women aged 20-25 years, 56 (11.8%) had lost at least 1 child. Self-report of chronic illness and disability was low. Current smokers include 264 men (12.7%) and 325 women (6.0%), and 315 men (15.2%) and 1439 women (26.7%) had a body mass index > 30. Adequate housing (odds ratio (OR) 1.31, 95% confidence interval (CI): 1.12-1.53) and access to refuse disposal (OR 1.65, 95% CI: 1.36-2.00) were predictive of complete immunisation in children. Children living in houses with access to clean water (OR 0.8, 95% CI: 0.64-0.99) and a fitted toilet (OR 0.56, 95% CI: 0.38-0.83) were less likely to be breastfed in the first year of their life. Women aged 15-45 years were likely to use contraception if they were well educated (OR 2.75, 95% CI: 1.76-4.28) and lived in houses with access to refuse disposal (OR 1.46, 95% CI: 1.20-1.78). Better education was associated with a reduced likelihood of loss of a child (OR 0.11, 95% CI: 0.02-0.51) and being a smoker (OR 0.52, 95% CI: 0.38-0.73). Obesity was associated with being female (OR 1.88, 95% CI: 1.62-2.18) and living in a house with electricity (OR 1.46, 95% CI: 1.26-1.68). High blood pressure was associated with living in a house with electricity (OR 1.36, 95% CI: 1.10-1.70) and with monthly household income exceeding R2 000 (OR 1.38, 95% CI: 1.07-1.78)., Conclusions: High socio-economic deprivation in the Eastern Cape is associated with health status comparable to that of poorer regions in sub-Saharan Africa. The educational level of the population, access to electricity, clean water and refuse disposal facilities are important predictors of child, maternal and adult health.

Lipoid proteinosis (LP), also known as hyalinosis cutis et mucosae or Urbach-Wiethe disease (OMIM 247100) is a rare, autosomal recessive disorder typified by generalized thickening of skin, mucosae and certain viscera. Classical features include beaded eyelid papules and laryngeal infiltration leading to hoarseness. Histologically, there is widespread deposition of hyaline (glycoprotein) material and disruption/reduplication of basement membrane. The aetiology of LP is currently unknown. Using DNA from three affected siblings in a consanguineous Saudi Arabian family we performed genome-wide linkage and mapped the disorder to 1q21 (marker D1S498) with a two-point LOD score of 3.45 at theta = 0. A further 28 affected individuals from five other unrelated consanguineous family groups from different geographical regions also showed complete linkage and resulted in a maximum two-point LOD score of 21.85 at theta = 0. Using available markers in the interval between D1S442 and D1S305, the observed recombinants placed the gene in a 2.3 cM critical interval between D1S2344 and D1S2343 (Marshfield genetic map) corresponding to an approximately 6.5 Mb region on the UCSC physical map. Using a candidate gene approach (comparison of control versus LP gene expression in cultured fibroblasts) and subsequent direct sequencing of genomic DNA, we identified six different homozygous loss-of-function mutations in the extracellular matrix protein 1 gene (ECM1). Although the precise function of ECM1 is not known, our findings provide the first clinical indication of its relevance to skin adhesion, epidermal differentiation, wound healing, scarring, angiogenesis/angiopathy and basement membrane physiology, as well as defining the molecular basis of this inherited disorder.

The recognition of the child abuse syndrome in the Republic of Sout Africa is briefly mentioned. The aims of setting up a Child Abuse Unit in a children's hospital are detailed; the procedure for the education of staff, details of training and the establishment of a programme are outlined, and the outcome is considered. The co-operation of the medical profession is sought in setting up programmes for the prevention of child abuse.