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This paper aims to provide surveillance information about the extent and consequences of alcohol and other drug (AOD) use by adolescents for three sentinel sites in South Africa (Cape Town, Durban and Gauteng province). From 1997 to 2001, data were gathered from multiple sources, including specialist treatment centres, trauma units, school students, rave party attenders, and arrestees. Since the start of surveillance, an increasing proportion of South African adolescents are using AODs. Surveys point to high levels of alcohol misuse among high school students, with alcohol being the most common substance of abuse. Cannabis is the most frequently reported illicit drug of abuse among adolescents. This is reflected in the large proportion of adolescents receiving treatment for cannabis, cannabis-positive arrestees, and cannabis-positive trauma patients. Cannabis smoked together with methaqualone is the second most common primary drug of abuse in Cape Town. Arrestee data highlights the potentially negative effect of adolescent methaqualone use. Cocaine and heroin are emerging as problem drugs of abuse among adolescents in large metropolitan centres. Ecstasy (MDMA) use occurs mainly among adolescents who attend rave parties and clubs. The study points to the need for AOD intervention programmes that target young people and the need for continued monitoring of adolescent AOD use in the future.

This study presents a systematic review and meta-analysis approach of Cryptosporidium species prevalence studies in animal and human hosts published between 1980 and 2020 in South Africa. Extensive searches were conducted on three electronic databases including PubMed, ScienceDirect and Google Scholar. The findings indicated an overall pooled prevalence estimate (PPE) of Cryptosporidium spp. infections in animals and humans at 21.5% and 18.1%, respectively. The PCR–RFLP appeared to be the most sensitive diagnostic method with a PPE of 77.8% for the detection of Cryptosporidium spp. infections followed by ELISA (66.7%); LAMP (45.4%); PCR (25.3%); qPCR (20.7%); microscopy (10.1%); IFAT (8.4%); and RDT (7.9%). In animal hosts, C. parvum had the highest PPE of 3.7%, followed by C. andersoni (1.5%), C. ubiquitum (1.4%) and C. bovis (1.0%), while in humans, C. parvum also had the highest PPE of 18.3% followed by C. meleagridis at 0.4%. The data generated in this study indicated that Cryptosporidium spp. infections were highly prevalent in both animals and humans in South Africa, especially in the KwaZulu-Natal and North West provinces. However, we further observed that there was a lack of prevalence studies for both animals and humans in some of the provinces. This study highlights the necessity for a "One Health" strategic approach promoting public hygiene, animal husbandry and regular screening for Cryptosporidium spp. infections in both animals and humans. [ABSTRACT FROM AUTHOR]

In South Africa (SA) more than 25.7 million people are at risk of infection and over four million people are expected to be infected with the disease. Using secondary data, the prevalence of urinary schistosomiasis was determined retrospectively in KwaNobuhle between 2014 and 2018. Data were obtained from the National Health Laboratory Service (NHLS) of Nelson Mandela Bay Health District (NMBHD). The findings revealed that there was no significant difference between prevalence and year (p=0.092). The prevalence of urinary schistosomiasis in 2014 was 14 (13%), which increased to 18 (17%), 24 (22%), and 31 (29%) in 2015, 2016, and 2017, respectively; however, it declined to 20 (19%) in 2018. It was further observed that there was a significant (p=<0.0005, V= 0.33 medium) difference found in the prevalence of urinary schistosomiasis infection among males and females from KwaNobuhle. Urinary schistosomiasis infection was higher among males 99 (93%) than females 6 (6%). Furthermore, the highest rate of disease infection was found in individuals between the ages of 10 and 19 years (p<0.0005, V=0.43 medium). There was no significant difference (p=0.156) in the prevalence of urinary schistosomiasis relative to the season over the five years. The results revealed that the rate of urinary schistosomiasis infections within the study area, although not statistically significant, showed an increase from 2014 to 2017 but declined in 2018. It was further found that males had a higher percentage of infections than females, and the highest rate of infections was found in individuals between the ages of 10 and 19 years. Therefore, effective prevention, control, and intervention programs are urgently needed to eliminate schistosomiasis from the study area and avoid possible resurgence. [ABSTRACT FROM AUTHOR]

Background: South Africa has the highest adolescent asthma prevalence in Africa. Previous studies have found that the prevalence, risk factors and outcomes of asthma in adolescents vary with location and socio-economic factors. Methods: A narrative review of the literature was carried out on the prevalence, risk factors and outcomes of asthmatic adolescents in South Africa, with a focus on research gaps and priorities. Results: A variety of epidemiological asthma research has been conducted in South Africa; however, generalisable and comparable data have been generated by studies using the Global Asthma Network (GAN) survey and these show a high prevalence of asthma in adolescents (ranging from 13.7% in Durban to 20.3% in Cape Town). As in other sub-Saharan countries, a large proportion of adolescents have severe asthma without a diagnosis and no access to appropriate medication in the form of inhaled corticosteroids. Risk factors for asthma in South African adolescents are modifiable and related mainly to lifestyle and environmental exposures. Research on indoor and outdoor air pollution shows that these risk factors play a significant role in asthma outcomes, although there are only a few of these studies. Barriers to asthma control are patient-, healthcare- and disease-related, and qualitative research highlighting the perceptions and attitudes of those affected by asthma may assist in the co-development of tailored interventions to improve outcomes. Conclusion: Reducing the burden of asthma in South Africa will require a concerted effort towards prevention through a reduction in exposure, education about asthma, improved access to diagnosis and quality-assured medicines, and improved capacity in asthma diagnostics and clinical trials in children. [ABSTRACT FROM AUTHOR]

Bovine brucellosis is a neglected zoonotic disease in developing countries, endemic, and a growing challenge to public health. The development of cost-effective control measures for the disease can only be affirmed by knowledge of the disease epidemiology and the ability to define its risk profiles. This study aimed to document the trend of bovine brucellosis and the control measures adopted following reported cases from 2014 to 2019 in South Africa. The data on confirmed cases of bovine brucellosis was retrieved from the website of the World Organization for Animal Health (WOAH). Descriptive analysis and the analysis of variance (ANOVA) were utilized for significance (p<0.05). The data retrieved revealed an overall average bovine brucellosis prevalence rate of 8.48%. There were significant differences in bovine brucellosis prevalence across the provinces in 2014, 2015, 2017, 2018, and 2019 (p<0.05). Provinces with generally lower annual temperatures, namely KwaZulu Natal, Western Cape, and Free State, had higher prevalences of bovine brucellosis, while disease trends for Gauteng, Northern Cape, and Eastern Cape provinces were not easy to establish due to missing data for some of the years falling within the study period. The study identified gaps in the reporting of bovine brucellosis and documentation of disease control measures in the country. The present study not only identified these gaps but also proposed the need for future studies that detect the prevalence of cattle brucellosis at the animal/herd level. This recommendation, if implemented, can provide further insights into the disease situation in South Africa and pave the way for more effective control measures. [ABSTRACT FROM AUTHOR]

Background: South Africa has the highest reported prevalence of fetal alcohol spectrum disorders (FASD) globally. The most recent study reported a weighted, estimated FASD prevalence of 310 per 1000 in a community in the Western Cape Province. Because there is as yet no reliable estimate of the national burden of FASD in South Africa, further epidemiological studies are needed in diverse settings. This paper reports on a multiyear, multisite FASD epidemiological study that took place from 2015 to 2022 at eight study sites in four provinces. Methods: The cross‐sectional epidemiological study used an active case‐ascertainment method, specifically in primary schools. All children were recruited when they were enrolled in Grade 1 at a participating school. All consented participants progressed through a tiered‐screening recruitment and diagnostic process. Results: Overall, 3033 children were included in the study. A total of 3001 children were screened for FASD in the first tier, with 1086 progressing to the second and 495 to the third tier. Of the 495 children referred, 475 were discussed during the final case conference. A total of 309 participants were diagnosed with FAS across the eight study sites. The highest reported prevalence was in the Northern Cape Province, with a rate of 199.3/1000 (95% CI, 147.6–251) using all eligible participants as the denominator. The lowest prevalence was in the Eastern Cape Province, with a rate of 57.4/1000 (95% CI, 36.5–78.3). The pooled FAS prevalence for the eight study sites was 80.2/1000 (95% CI, 70.4–89.9). Conclusions: As with previous studies, we found a concerningly high prevalence of FASD in South Africa. Given the scope of the problem it should be a high priority for health and welfare services to address. [ABSTRACT FROM AUTHOR]

Background: In South Africa, sexually transmitted infections (STIs) represent a significant public health issue. Sexually transmitted infections contribute significantly to the burden of disease in South Africa and are recognised as one of the main causes of the human immunodeficiency virus (HIV) epidemic. The aim of this study was to investigate the potential causes of the high prevalence of STIs in the Du Noon population. Methods: A mixed methodology study involving 40 participants between the ages of 18 years and 45 years was conducted at Du Noon community health centre from 01 May 2021 to 15 May 2021. Both structured questionnaires and one-on-one patient interviews with open-ended questions were utilised to collect data. Results: Cultural beliefs, having multiple partners, a lack of partner notification, alcohol consumption, and a lack of condom usage were found to be the main contributing factors to the high incidence of STIs. Sex education appears to be lacking. Our findings reflected the other well-known cultural and socioeconomic issues confronting South African communities, for example, poverty, age-disparate relationships, and polygamous relationships. Conclusion: The cultural perspectives and understandings of sexual interactions of older men appear to have an impact on younger generations; as do peer pressure, social media and other socio-economic factors. There is an urgent need to shift cultural ideologies and norms among the youth. More research is needed to understand the views and misconceptions of the general public about STIs. Contribution: This study highlighted how health education challenges, interpersonal relationships, and socioeconomic barriers are still important factors in STI transmission. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Limited research exists on the sleep profiles of South African Para athletes. The aims of this study are to describe sleep quality, day-time sleepiness, and chronotype of South African Para athletes and to compare the relationship between sleep-related outcomes and demographic factors to athletes from a higher-resource country. Design: A descriptive, cross-sectional survey was conducted. Sleep-related characteristics were assessed with the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Morningness-Eveningness Questionnaire. Multiple regression models were run with and without country as independent variable. Results: One hundred twenty-four South African athletes and 52 Israeli athletes were included. Thirty percent of South African athletes presented with excessive daytime sleepiness, 35% slept 6 hrs or less per night, and 52% reported poor sleep quality. Thirty-three percent of Israeli athletes reported excessive daytime sleepiness, 29% slept 6 hrs or less, and 56% reported poor sleep quality. Chronotype was the only variable that differed significantly between countries (overrepresentation of morning types in South African athletes, and intermediate types in Israeli athletes). Intermediate chronotypes had significantly greater odds of excessive daytime sleepiness (P = 0.007) and poor sleep quality (P = 0.002) than morning types, irrespective of country. Conclusions: The high prevalence of poor sleep among both South African and Israeli Para athletes warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: HIV has become a manageable chronic condition due to the success and scale-up of antiretroviral therapy (ART). Globally, South Africa has the highest number of people living with HIV (PLHIV) and research evidence indicates that countries with the highest burden of PLHIV have a substantial burden of obesity, hypertension (HPT) and type 2 diabetes (T2D). We sought to summarize the burden of these three common NCDs among PLHIV in South Africa. Methods: In this systematic review, multiple databases were searched for articles reporting on the prevalence of obesity, HPT, and T2D among PLHIV in South Africa published since journal inception until March 2022. A meta-analysis was conducted using random-effects models to obtain pooled prevalence estimates of the three NCDs. Heterogeneity was assessed using X2 test on Cochran's Q statistic. Results: We included 32 studies, with 19, 22 and 18 studies reporting the prevalence of obesity, HPT, and T2D among PLHIV, respectively. The overall prevalence of obesity, HPT, and T2D was 23.2% [95% CI 17.6; 29.9], 25.5% [95% CI 15.6; 38.7], and 6.1% [95% CI 3.8; 9.7] respectively. The prevalence of obesity was significantly higher among women (P = 0.034) compared to men, however the prevalence of HPT and T2D did not differ by sex. The prevalence of each of the three NCDs did not differ significantly between rural, urban, and peri-urban areas. The prevalence of obesity and T2D was higher in studies conducted between 2013 and 2022 compared to studies conducted between 2000 and 2012, while the prevalence of HPT was higher between 2000 and 2012 compared to between 2013 and 2022. Conclusions: These findings suggest that South Africa is experiencing a syndemic of NCDs among people PLHIV highlighting the need to increase cost-effective interventions and management strategies that involve integrated HIV and NCD care in the South African setting. [ABSTRACT FROM AUTHOR]

Background: While the global incidence of breast cancer is increasing, there is also an increase in the numbers of breast cancer survivors and in survival duration, as early detection programs are implemented, and treatments are optimized. Breast cancer survivors in several countries commonly struggle with a range of symptoms (fatigue, insomnia, depression) with 25–80% of survivors suffering from chronic pain. There is a paucity of literature reporting on breast cancer survivors in South Africa. In this pilot study we aimed to determine the prevalence of chronic pain in female breast cancer survivors attending the breast oncology clinic. Methods: A cross-sectional survey was conducted of all breast cancer survivors attending the Groote Schuur Hospital Breast Unit during one month in 2019. 44 female breast cancer survivors (median age 60.5y) completed a sociodemographic questionnaire, the Brief Pain Inventory, Pain Catastrophizing Scale and measures for neuropathic pain (DN4), health related quality of life (HRQoL; EQ-5d-3 L), physical activity (IPAQ), depression and anxiety (PHQ4), and screening questions to evaluate sleep, happiness and perceived discrimination in the language of their choice. Results: The prevalence of chronic pain (pain on most days for more than three months) was 59% (95%CI 44–72), a significantly higher number than the 18,3% prevalence of chronic pain reported by South African adults. 39% of the women were classified as having neuropathic pain. The median pain severity score was 3.75 (IQR = 2.75-5) and the median pain interference with function score was 4 (IQR = 2.9–5.4). The women were experiencing pain in a median of 2 different body sites (IQR = 1–3). The women with pain were more likely to be unemployed or receiving a disability grant, had significantly worse HRQoL, and significantly worse scores for risk of depression and anxiety. Conclusion: The results of this pilot study suggest that chronic pain may be a significant burden for South African breast cancer survivors. Routine screening for chronic pain in breast cancer survivors is recommended with a larger study indicated to explore this issue further. [ABSTRACT FROM AUTHOR]

Keratoconus (KC) is a progressive, asymmetrical corneal disease, characterized by stromal thinning that leads to distortion, causing vision loss. The visual loss is secondary to corneal scarring, irregular astigmatism, and myopia. The prevalence of KC has been reported to differ in different parts of the world. The study aimed to determine the prevalence and profile of patients with KC presenting to a provincial hospital in KwaZulu-Natal, South Africa. A retrospective study design was used to review 412 clinical records of patients attending the McCord Provincial Eye Hospital (MPEH) during a five-year period (2016-2020). Data on age, race, refraction, clinical profile, treatment plan, and diagnosis were ascertained. The prevalence of KC in MPEH was found to be 13.7% with a mean age of 24.7±7.94 years. Black African and females had a higher frequency of KC compared to males and other ethnic groups. Most of the patients presented with a severe stage of KC and referral was the most common management. Central corneal thinning and Munson's sign were the most prevalent clinical signs. There was no statistically significant difference between the worse and better eye when comparing the clinical signs. The prevalence and clinical profile of patients with KC in this study was similar to that reported by previous studies and more in Blacks and females. Population based epidemiological studies are needed to determine the prevalence of KC in South Africa to enable early clinical interventions. [ABSTRACT FROM AUTHOR]

Coronaviruses, re-emerging in human populations, cause mild or severe acute respiratory diseases, and occasionally epidemics. This study systematically reviewed human coronavirus (HCoVs) infections in Africa prior to the SARS-CoV-2 outbreak. Forty studies on the prevalence or molecular epidemiology of HCoVs were available from 13/54 African countries (24%). The first published data on HCoV was from South Africa in 2008. Eight studies (20%) reported on HCoV molecular epidemiology. Endemic HCoV prevalence ranged from 0.0% to 18.2%. The prevalence of zoonotic MERS-CoV ranged from 0.0% to 83.5%. Two studies investigated SARS-CoV infection, for which a prevalence of 0.0% was reported. There was heterogeneity in the type of tests used in determining HCoV prevalence. Two studies reported that risk factors for HCoV include exposure to infected animals or humans. The quantity of virologic investigations on HCoV on the African continent was scant, and Africa was not prepared for SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Prevalence studies of avian haemosporidian parasites frequently use microscopy and the nested polymerase chain reaction (PCR) protocols for detecting infections. Newer PCR protocols to detect parasites are being developed, with the distinct advantage of reducing screening cost and time, as well as increasing efficiency and sensitivity. The detection ability of microscopy and nested PCR was compared against a real-time PCR (qPCR) protocol using genomic DNA extracted from 240 bird blood samples collected from three starling species (Cape Starling, the Greater Blue-eared Starling, and the Wattled Starling; family Sturnidae) in the Kruger national park, South Africa. All three protocols successfully detected avian haemosporidian parasites with the qPCR having a considerable edge against the other two methods. Fifteen unique cytochrome b lineages were identified of which seven were new lineages. Microscopy and nested PCR recorded similar prevalence (32.92% and 35.42% respectively). The qPCR protocol used here, although more sensitive (52.92% prevalence), is not able to differentiate between parasite genera but provides the opportunity to screen a large number of samples in large-scale studies within a specific region. This study recommends the development and adoption of new molecular protocols with increased sensitivity and accuracy in prevalence studies. Nevertheless, microscopy remains essential for the morphological description of parasites and for distinguishing between abortive and successful chronic infections. The PCR-based method displays the detection of the parasitic genome but does not reveal whether parasites have or will develop into a successful infection. [ABSTRACT FROM AUTHOR]

Transporting and driving long distances might be associated with an increased risk of contracting HIV in truck drivers, which is recognized as a link to network transmission of HIV among this population. The present study aims to systematically review the prevalence and risk factors of HIV infection in truck drivers globally. A comprehensive search of the databases of Embase, PubMed, Scopus, and Web of Science was carried out. The original papers reporting statistics on the prevalence and risk factors of HIV infection among truck drivers were included. In this study, 23 original articles that met the eligibility criteria were reviewed. All articles were crosssectional studies in which a total number of 16,315 truck drivers were studied to estimate the prevalence and risk factors of HIV infection. Findings indicated high HIV seroprevalence among truck drivers, with the highest prevalence of 56% in South Africa. HIV/AIDS awareness and condom use among truckers were reported low. Having sex with other men, circumcision status, time away from home, marital status, years working as a truck driver, education, income, and drug/alcohol use are the most important risk factors for HIV in truck drivers. Longer time on the road can increase the risk of infection by creating conditions for unsafe sex, in particular, having sex with other men. Low socioeconomic status exacerbates the condition. HIV risk-reduction interventions for long-distance truck drivers are necessary to enhance the awareness of sexually transmitted infections and introduce protective measures such as condoms. [ABSTRACT FROM AUTHOR]

Fetal alcohol spectrum disorder (FASD) remains one of the leading sources of non-genetic intellectual and developmental disabilities globally. South Africa (SA) could be considered to bear the greatest burden of FASD globally with the recorded prevalence of FASD ranging from 29 to 290 per 1000 live births. Despite several efforts to reduce the incidence and prevalence of FASD in SA, its incidence and prevalence remain high. In this study, we examined the factors behind the sustained high incidence and prevalence of FASD in SA. Using an exploratory qualitative design, we explored the perspectives and experiences of 10 policymakers and 65 service providers on why FASD remains unabated despite various efforts to address the problem in SA. Ten in-depth interviews were conducted with policymakers and nine focus group discussions were conducted with the service providers in the Western Cape Province of SA. Data were analyzed inductively using the thematic analysis approach and emerging themes were deductively classified using the ecological model. Our findings revealed several reasons for the sustained high prevalence and increasing incidence of FASD in SA. At the individual level, late antenatal booking, alcohol consumption during pregnancy, and socio-economic conditions of individuals were identified as relevant factors driving the FASD prevalence in SA. Inadequate support groups for women were reported at the interpersonal level. The widespread availability of illegal liquor stores and inadequate specialized prevention programs were reported as community-level challenges. At the institutional level, the reasons included inadequate training of professionals and inadequate collaboration between government departments. At the policy level, the absence of a specific policy addressing FASD constitutes a significant barrier to the unabated FASD. The study findings suggest a cascade effect within the different levels of the ecological model highlighting the need for a holistic and systemic approach to preventing FASD in SA. The design and implementation of holistic, human rights-based, and inter-department policies and programs addressing the social determinants of FASD should be considered. [ABSTRACT FROM AUTHOR]

Parietal foramina of the human skull act as a passageway for emissary veins, connecting the superior sagittal sinus to the veins of the scalp. This passageway can lead to the spread of infection from the scalp to the dural venous sinuses, but may also assist in relieving intracranial pressure. However, variation in the prevalence of parietal foramina has been noted among population groups. This observational and descriptive study aimed to determine the incidence, size and location of parietal foramina by using osteological specimens of 252 African skulls from the Sefako Makgatho Health Sciences University, South Africa and 95 European skulls from the University of Leipzig, Germany. Parietal foramina were significantly more common in the African sample (61.9 %) compared to the European sample (55.8 %). Moreover, the Central European sample displayed more unilateral foramina (29.5 %), while the African sample exhibited more bilateral foramina (40.8 %). The diameter of the parietal foramen average 1.98 mm and 1.88 mm for the European and African samples, respectively. In this study, a median foramen on the sagittal suture was observed in 14 of the overall skull caps (4 %). This study demonstrated that parietal foramina are more prevalent than anticipated in both population groups. Findings of this study, indicating an increased prevalence, and the subsequent possibility of more emissary veins encountered, can be used to improve the understanding of the variations in the prevalence and clinical implications of the parietal foramen among various population groups located world-wide. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The available evidence indicates a correlation between owning consumer electronics, such as cellphones and televisions, and a higher risk of obesity and increased adiposity. However, such studies are sparse in South Africa. Thus, the aim of this study is to examine the dietary and sociodemographic factors associated with various BMI categories, including the possession of consumer electronics, among women of reproductive age in South Africa. This is a secondary study of a population registry that includes dietary, BMI, and digital use items among women of reproductive age. The data is from the South Africa Demographic Health Survey (SADHS, 2016). Of the 3363 participants included in the analysis, women of normal weight were (35.5%), pre-obese (34.5%), obese (27.1%) and underweight (2.9%). Age was found to be significantly associated with pre-obesity at a <0.05 confidence interval. Owning a cellphone was significantly associated with being underweight and had 55% increased odds (1–0.45) (OR = 0.45; 95% CI 0.26–0.77, p = 0.004). Using internet almost daily was statistically significant with being underweight and had 55% (1–0.45) increased odds of being underweight (OR = 0.45; 95% CI 0.20–1.01, p = 0.054). Owning a cellphone and internet use was found to be significantly associated with being underweight. More research is needed to understand why cellphone ownership and using internet almost daily are significantly associated with being underweight. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic continuously highlights the need for occupational health and safety among healthcare professionals. Physical and mental health safety resulting from needle prick injuries, stress, infections, and chemical hazards are priority work-related musculoskeletal disorders for nurses, including those working in the intellectual disability unit. The intellectual disability unit provides basic nursing care to patients with known mental disabilities, such as learning, problem-solving, and judgment problems, which demand diverse physical activities. Nevertheless, the safety of nurses within the unit receives little attention. Thus, we adopted a quantitative cross-sectional epidemiological survey design to determine the prevalence of work-related musculoskeletal disorders amongst nurses working in the intellectual disability unit at the selected hospital in Limpopo Province, South Africa. A self-administered questionnaire collected data from 69 randomly selected nurses from the intellectual disability unit. Data were extracted, coded, and captured in MS Excel format (2016) and imported into the IBM Statistical Package for the Social Sciences (SPSS), software version 25.0, for analysis. The study reported a low (38%) prevalence of musculoskeletal disorders in the intellectual disability unit, with significant effects on nursing care and staffing. The effects of these WMSDs included missing work, interference with the daily routine, disturbance with sleeping patterns after work, and absenteeism from work. Since intellectually disabled patients depend entirely on nurses for the basic activities of daily living, this paper recommends the incorporation of physiotherapy among nurses in the intellectual disability unit to treat the incidence of lower back pain while mitigating nurses missing work or absenteeism. [ABSTRACT FROM AUTHOR]

Background: Globally, the World Health Organization ranks chronic kidney disease (CKD) as one of the top 10 causes of mortality. In South Africa, where noncommunicable diseases have become leading causes of mortality, the true population prevalence of CKD is unknown and associated risk factors remain understudied. This study aimed to describe the prevalence of kidney dysfunction and associated risk factors in a community from the North West province of South Africa. Methods: This cross-sectional study included 1999 participants older than 30 years. Kidney dysfunction was defined as (i) estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73m2, or (ii) urine albuminuria-to-creatinine ratio (uACR) ≥ 3.0 mg/mmol, or a combination (i and ii). Risk factors included age, sex, urban/rural locality, body mass index (BMI), blood pressure (BP), lipid profile, haemoglobin A1c (HbA1C), C-reactive protein (CRP), gamma-glutamyl transferase (GGT), tobacco use, and HIV status. Results: Mean age of participants was 48 (42;56) years, and 655/1999 (33%) had eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol. Compared to those with normal kidney function, participants with eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol were older, female, had higher measures of adiposity, systolic, diastolic, and mean arterial blood pressure, serum lipids and C-reactive protein (CRP) (all p ≤ 0.024). In multiple regression analyses eGFR was associated with systolic BP (β = 0.11) and HIV infection (β = -0.09), and albuminuria was associated with elevated CRP (β = 0.12) and HIV infection (β = 0.11) (all p < 0.026). In both groups (individuals with and without kidney dysfunction respectively), eGFR was associated with age (β = -0.29, β = -0.49), male sex (β = 0.35, β = 0.28), BMI (β = -0.12, β = -0.09), low-density/high-density lipoprotein cholesterol ratio (β = -0.17, β = -0.09) and CRP (β = 0.10, β = 0.09) (all p < 0.005); and uACR was associated with female sex (β = 0.10, β = -0.14), urban locality (β = -0.11, β = -0.08), BMI (β = -0.11, β-0.11), and systolic BP (β = 0.27, β = 0.14) (all p < 0.017). Conclusion: In this study from the North West province, South Africa, eGFR < 90 ml/min/1.73m2 and/or uACR ≥ 3.0 mg/mmol was prevalent and associated with modifiable risk factors. The findings may inform screening strategies for kidney disease prevention, focusing on women, obesity, blood pressure control, dyslipidaemia, identifying and treating inflammation, and HIV diagnosis and treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: The increasing prevalence of substance abuse in rural areas of Limpopo Province is a concern for most stakeholders including the families, South Africa Police Service, and social workers. Combating Substance Abuse requires the active roles of various stakeholders in the rural community, due to limited resources for prevention, treatment, and recovery. PURPOSE: To report on the roles of stakeholders in tackling Substance Abuse during the awareness campaign conducted in the deep rural community of Limpopo Province, DIMAMO surveillance area. METHODS: Qualitative narrative design was adopted to explore the roles of stakeholders in combating Substance Abuse during the awareness campaign conducted in the deep rural community. The population consisted of different stakeholders who play an active role in reducing Substance Abuse. The triangulation method was used for data collection (interviews, observations, and taking field notes during presentations). Purposive sampling was used to select all the available stakeholders who actively combat substance abuse in the communities. Thematic narrative analysis was used to analyze the interviews conducted with and content presented by the stakeholders to generate the themes. RESULTS: The prevalence of Substance Abuse among the youth in the Dikgale community is high with a growing trend of Crystal Meth, "nyaope," and Cannabis(marijuana). The prevalence is worsened by the diverse challenges experienced by the families and stakeholders which impact the strategies targeted to combat Substance Abuse. CONCLUSION: The findings indicated the need for strong collaborations among the stakeholders (including school leadership) to successfully combat Substance Abuse in rural areas. The findings demonstrated a need for a well-capacitated healthcare services with adequate rehabilitation centers and well-trained healthcare providers for combating Substance Abuse to minimize victim stigmatization. [ABSTRACT FROM AUTHOR]

Background: Burnout impacts patient care and staff well-being. Emergency department (ED) staff are at an elevated risk for burnout. Despite an acceleration in burnout research due to the coronavirus disease 2019 (COVID-19) pandemic, there is limited data on the nature and prevalence of burnout in the South African emergency medicine setting. Aim: This study determined the prevalence of burnout in ED staff (doctors, nurses and non-clinical staff) at Tygerberg Hospital and explored staff awareness and utilisation of interventions. Setting: The study was conducted at Tygerberg Hospital, South Africa. Methods: This cross-sectional study used the Maslach Burnout Inventory to assess burnout via a self-administered electronic survey in a convenience sample of 109 ED staff. Quantitative data were analysed with descriptive and inferential statistics. Qualitative data were analysed using thematic analysis. Results: A total of 46 participants (45.10%) experienced burnout, with 73 participants (71.57%) at high risk for emotional exhaustion or depersonalisation. The prevalence of burnout in doctors was 57.89%, non-clinical staff was 25.93%, and nursing staff was 50.00%. Burnout was higher in doctors and nursing staff compared to non-clinical staff, with high emotional exhaustion and depersonalisation found in interns and specialist professional nurses. The level of intervention awareness was 41.8% and the level of intervention utilisation was 8.82%. Thematic analysis identified awareness, accessibility and reactive utilisation as barriers to utilisation with opportunities to reduce burnout and enhance resilience. Conclusion: Coordinated health system and organisational efforts are required to optimise intervention strategies to reduce burnout. Contribution: Guidance on the design and planning of intervention strategies considering at risk groups, intervention-related factors, and non-clinical staff. [ABSTRACT FROM AUTHOR]

Background: Human immunodeficiency virus (HIV) and psychosis share a complex bidirectional relationship, with people living with HIV being at increased risk of psychosis and those with psychosis at increased risk of HIV. However, people living with severe mental illness often have limited or reduced access to HIV testing and care. Aim: This study aimed to determine the prevalence of HIV and describe the access to HIV testing and care among adult patients with recent-onset psychosis who were admitted to a psychiatric hospital in KwaZulu-Natal (KZN) province, South Africa. Setting: A psychiatric hospital in Pietermaritzburg, KZN province, South Africa. Method: A retrospective chart review of 294 patients with recent-onset psychosis admitted between May 2018 and November 2020. Results: A total of 291 (99%) patients had access to HIV testing during the study period, with the HIV seroprevalence rate being 21.5% among the 294 patients; HIV seropositivity was associated with the 25-49 age category (adjusted odds ratio [aOR] = 3.09, 95% confidence interval [CI] 1.27-7.50), female gender (aOR = 9.55, 95% CI 4.40-20.74), current alcohol and cannabis use (aOR = 3.43, 95% CI 1.01-11.62), family history of psychosis (aOR = 3.22, 95% CI 1.03-10.02) and no tertiary education (aOR = 3.7, 95% CI 0.14-0.99). All those living with HIV were on antiretroviral treatment. Conclusion: This study showed that HIV testing and care was accessible at a psychiatric hospital but the prevalence of HIV in people living with recent onset psychosis remains high. Contribution: The study findings suggest the importance of integrating mental health and HIV management. [ABSTRACT FROM AUTHOR]

There is limited information on the development of helminth burdens of wild ungulates. This study examined the development of helminth burdens of impalas from birth to adulthood in the southern Kruger National Park, South Africa, based on systematic monthly collections of helminths from lambs, yearling and adult impalas at two sites over the course of a year. Eighteen species of nematodes, two trematode taxa and three species of cestodes were collected. Six species, Cooperia hungi, Cooperioides hamiltoni, Impalaia tuberculata, Strongyloides papillosus, Trichostrongylus deflexus and Trichostrongylus thomasi, each collected from > 75% of the impalas, accounted for > 90% of adult gastrointestinal nematodes. Infection with adult nematodes occurred in the first month of life and all lambs were infected with adults and L4 larvae by the second month. Intensities of infection of adult nematodes and larvae in lambs increased until November when they were similar to those of yearlings and adults. Adult female impalas had a lower intensity of infection of adult nematodes than males from April to July, and a higher intensity of infection from October to December. Intensity of infection of L4 larvae was higher in adult females than adult males throughout the year. These patterns were seen in the most common nematodes, but were more variable for the less common nematodes, trematodes and cestodes. The ratio of L4 larvae to adult nematodes was lowest in lambs and highest in adult impalas. Our results emphasised the importance of age, sex and season as potential sources of variation in specific parasite burdens. [ABSTRACT FROM AUTHOR]

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Background: Cancellations of elective surgeries adversely affect the patient, hospital staff, facility, and health system. Cancellations potentially result in hospital financial losses, theatre inefficiency, and substandard patient care. A common benchmark for the cancellation rate of elective surgeries is less than five percent, and most operating rooms fall short of this standard. There is a paucity of data on the rates and causes of elective surgical cancellations in rural, resource-limited settings. This study aimed to determine the prevalence of elective surgery cancellations, the causes for such cancellations, and the surgical disciplines most affected at Nelson Mandela Academic Hospital (NMAH). Methodology: This was an observational, descriptive, cross-sectional review of operating theatre records from January 2019 to July 2019. The prevalence and main causes of elective case cancellations were determined. The causes were classified, and the most affected surgical departments and patient characteristics were identified. Results: The prevalence of elective surgical case cancellations was 14.4% in our hospital, higher than the international benchmark of 5%. Patient-, facility-, and surgical-related factors were the leading causes of cancellations, and avoidable cancellations were mostly surgical- and anaesthetic-related. Ophthalmology was the most affected, followed by gynaecology and general surgery, with plastic surgery being the least affected. The most common patient-related factors were nonattendance and uncontrolled medical conditions, while overbooking was the most common surgical reason. Abnormal investigatory results and unfit status were the most common anaesthetic reasons. Facility-related issues included the lack of theatre time, equipment scarcity or malfunction, and staff unavailability. Most cancellations were unavoidable, but with careful planning, could be avoided. Conclusion and recommendations: This study identified challenges with theatre efficiency in a rural, resource-limited setting that call for the cooperation of multidisciplinary teams of surgeons, anaesthetists, nursing staff, and health care policymakers. [ABSTRACT FROM AUTHOR]

Background: Substance use is an important public health concern in many countries across the globe. Among the general public, institutions of higher learning have developed a reputation for inducing new substance use among students. In addition to socio-demographic factors, substance use and abuse among university students often appear to be related to psychological stressors typically related to the demand to adapt to the new environment and the pressures associated with academia. The purpose of this study was to identify the prevalence of, and factors associated with substance use among university students. Methods: This quantitative study employed convenience sampling to recruit university students who were 18 years and older from a university in the Western Cape. The study made use of self-administered online questionnaires, which participants completed via SurveyMonkey. The sample consisted of 2915 students. Descriptive statistics were used to describe and provide the prevalence and overview of the demographic characteristics of the respondents. Associations between variables were explored using Chi-square and Mann–Whitney U tests. Results: The main findings revealed a substance use prevalence rate of 62.7%. The most prominent substances used by students were alcohol (80.6%), cannabis (46%), and ecstasy (5.3%). The study further revealed clear associations between students' substance use and mental health. Students who reported substance use at university reported higher depression and anxiety scores than those who did not. However, findings reveal no significant association (p = 0.233) between being a substance user and a nonsubstance user and students' respective self-perceived stress scores. Conclusion: Results show the majority of sampled students had started using substances (both alcohol and other substances) only after entering university. The results call into question seminal findings relating to substance use and the university environment. The novel findings of this study could serve as a baseline input to inform policymakers, programme developers, service providers, parents, and other stakeholders who are involved in the design and implementation of more effective awareness, prevention and, needs-based intervention services. [ABSTRACT FROM AUTHOR]

Severe acute malnutrition (SAM) is an important global and national public health concern. It contributes to under-five mortality but is also largely a preventable disease. This study aimed to assess the prevalence of and mortality associated with SAM. A retrospective review of hospital files was conducted. Dora Nginza Hospital, Eastern Cape, South Africa was the site of the study. The study included children from 6 to 59 months of age admitted to the paediatric ward between January 1, 2018 and December 31, 2018. Children with chronic disease were excluded. Ethics approval was granted by Walter Sisulu University (053/2019). Anthropometric, co-morbid and outcomes data were retrieved and analysed. A total of 1 296 children were included in the study, 93 with SAM. The prevalence of SAM was 7.2%. Children with SAM had a median age of 16 months (IQR 11–25). Gender distribution was 52 (56%) females and 41 (44%) males. The inpatient mortality rate for children with SAM was 6.5%. Children with SAM were at significantly increased risk of mortality (RR 5.97, 95% CI 3.1–11.6, p-value < 0.0005). Three factors were significantly associated with mortality: nutritional oedema, sepsis, and hypokalaemia. The prevalence of SAM at Dora Nginza Hospital is high, and children with SAM are at significantly increased risk of mortality. Specific risk factors for mortality include sepsis, urinary tract infection, nutritional oedema and hypokalaemia. Modifiable factors associated with SAM and SAM-related mortality need to be targeted urgently to improve outcomes. [ABSTRACT FROM AUTHOR]

Background Undiagnosed asymptomatic subclinical tuberculosis (TB) remains a significant threat to global TB control, accounting for a substantial proportion of cases among people living with human immunodeficiency virus (HIV)/AIDS (PLWHA). We determined incidence, progression, and outcomes of subclinical TB in antiretroviral therapy (ART)–accessing PLWHA with known previous TB in South Africa. Methods A total of 402 adult PLWHA previously treated for TB were enrolled in the prospective Centre for the AIDS Programme of Research in South Africa TRuTH (TB Recurrence Upon TB and HIV treatment) Study. Participants were screened for TB with quarterly clinical and bacteriologic evaluation and biannual chest radiographs over 36 months. Those with suspected or confirmed TB were referred to the National TB Programme. Participants received HIV services, including ART. Incidence rate of TB was estimated using Poisson regression and descriptive statistical analyses summarized data. Results A total of 48 of 402 (11.9%) bacteriologically confirmed incident recurrent TB cases were identified, comprising 17 of 48 (35.4%) subclinical TB cases and 31 of 48 (64.5%) clinical TB cases. Age, sex, and body mass index were similar among subclinical, clinical, and no TB groups. Incidence rates (95% Confidence Interval [CI]) of recurrent TB overall, in clinical and subclinical TB groups were 2.3 (1.7-3.0), 1.5 (1.1-2.2), and 0.9 (0.5-1.4) per 100 person-years, respectively. In the subclinical TB group, 14 of 17 (82.4%) were diagnosed by TB culture only, 11 of 17 (64.7%) received TB treatment, and 6 of 17 (35.3%) resolved TB spontaneously. Conclusions High incidence rates of recurrent subclinical TB in PLWHA highlight inadequacies of symptom-based TB screening in high TB–HIV burden settings. [ABSTRACT FROM AUTHOR]

Background: Early detection and initiation of care is crucial to the survival and long-term well-being of children living with HIV (CLHIV). However, there remain challenges regarding early testing and linking of CLHIV for early treatment. This study examines the progress made towards achieving the 95-95-95 HIV indicators and associated factors among CLHIV < 15 years in South Africa., Methods: The data was collected as part of the 2017 cross-sectional, multistage cluster randomized population-based household National HIV survey. Age-appropriate structured questionnaires were utilized to gather sociodemographic data, HIV-related knowledge, risk behaviours, and health-related information. Blood samples were collected to test for HIV serology, viral load suppression, and antiretroviral usage. Backward stepwise multivariable generalized linear regression models were fitted to identify factors associated with the 95-95-95 HIV indicators. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) are shown, and p < 0.05 indicates statistical significance., Results: A total of 12,237 CLHIV < 15 years were included (median 8 years, interquartile range 4-11 years). HIV prevalence was 2.8% (95% CI: 2.4-3.3). Overall, 40.0% of the CLHIV were tested and knew their status (first 95%), and among these, 72.6% (95% CI: 61.7-81.3) were on antiretroviral therapy (ART) (second 95%), and 95.0% (95% CI: 88.4-97.9) of these were virally suppressed (third 95%). Among CLHIV, the odds of testing and knowing the HIV-positive status were significantly higher among children whose health was rated as fair/poor than excellent/good [AOR = 1.32 (95%CI: 1.05-1.67), p = 0.022], and were significantly lower among females than males [AOR = 0.82 (95% CI: 0.71-0.95), p = 0.009], and were significantly lower among those attending private healthcare facilities than public health facilities [AOR = 0.64 (95% CI:0.57-0.74), p < 0.001]. Among those who knew their HIV-positive status, the odds of being on ART were significantly higher among children residing in farm areas than urban areas [AOR = 1.40 (95% CI:1.05-1.86), p = 0.017], and were significantly lower among children attending private healthcare facilities [AOR = 0.44 (95% CI:0.36-0.54), p < 0.001]., Conclusions: Awareness of HIV status and initiation of treatment in children was low. The findings highlight the need to improve HIV status awareness and disclosure to children. The findings underscore the need for targeted interventions and programs tailored for CLHIV in urban areas., Competing Interests: Declarations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The COVID-19 pandemic led to a rapid shift to remote working, which affected ergonomic conditions and increased the risk of upper body musculoskeletal pain (MSP). This study assessed the prevalence and impact of upper body MSP (affecting the head, neck, shoulders, and back) among academic staff at a University of Technology during the pandemic. Data were collected from 110 participants through an online, descriptive, cross-sectional survey adapted from the Dutch Musculoskeletal Questionnaire, the Standardized Nordic Questionnaire, and the McCaffrey Initial Pain Assessment Tool. The survey examined demographics, ergonomic practices, MSP, and psychological well-being before and during the pandemic. The sample included 59.1% female participants, with most being middle-aged. Persistent MSP was common, with 54.5% reporting neck pain and 59.1% experiencing back pain during the pandemic, alongside a significant decline in wrists in neutral position ergonomics ( p = 0.012). Psychological well-being also worsened, as participants reported lower levels of cheerfulness, calmness, and energy than before the pandemic. While 81.9% of 90.9% participants with pre-existing MSP continued to experience pain, a small (9%) but notable proportion saw a decline in MSP during this period. These findings highlight a strong relationship between remote working conditions and MSP, with poor ergonomics and psychological distress contributing significantly to persistent pain. The results emphasise the need for institutions to provide ergonomic support, such as appropriate equipment and workstation adjustments, alongside mental health resources to mitigate the long-term impacts of remote working on physical and mental health.

Background: This study assessed prostate cancer burden and trends in major BRICS countries (Brazil, Russia, India, China, and South Africa) from 1990 to 2019., Methods: Utilizing Global Burden of Disease Study 2019 data, we calculated age-standardized rates for prostate cancer incidence, prevalence, mortality, and disability-adjusted life years (DALYs) with 95% uncertainty intervals (UIs). Joinpoint regression analysis determined the average annual percentage change (AAPC) for trend characterization., Results: Prostate cancer ranked highest in China for incidence, prevalence, mortality, and DALYs. In 2019, Brazil had the highest age-standardized incidence rate (ASIR) [55.029 (95% UI: 47.744-81.831)] and age-standardized prevalence rate (ASPR) [372.511 (95% UI: 327.549-549.128)], while South Africa recorded the highest age-standardized mortality rate (ASMR) [42.241 (95% UI: 32.146-47.933)], and age-standardized DALY rate (ASDR) [666.085 (95% UI: 522.626-764.612)]. ASIR and ASPR increased significantly over three decades (AAPC > 0), with varying ASMR and ASDR trends., Conclusion: Prostate cancer poses a significant public health challenge. While incidence and prevalence rise, mortality declines in China, India, and Brazil. Tailored health policies are crucial to address diverse disease burden characteristics., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To determine if any gradual onset running-related injury (GORRI) was associated with any allergies, multiple allergies (allergies to animals, plants, medication), and allergy medication use., Design: Cross-sectional descriptive study., Setting: Two Oceans Marathons (56 km, 21.1 km), South Africa., Participants: A total of 76 654 race entrants (2012-2015)., Independent Variables: The prevalence (%) and prevalence ratios (PR; 95% confidence intervals) for history of (1) any allergies, (2) multiple allergies to broad categories of allergens (animal material, plant material, allergies to medication, and other allergies), and (3) allergy medication use., Main Outcome Measures: Using a compulsory online screening questionnaire, the outcome was a history of any GORRIs, and subcategories of GORRIs (muscle, tendon) in the past 12 months and history of GORRIs (and subtypes of GORRIs) were reported., Results: In 68 258 records with injury and allergy data, the following were significantly associated with reporting any GORRIs: a history of any allergy (PR = 2.2; P < 0.0001), a history of allergies to broad categories of allergens (animal, plant, medication allergy, other) ( P < 0.0001), and the use of allergy medication ( P < 0.0001). A history of any allergies (PR = 2.4; P < 0.0001), all broad categories of allergies, and allergy medication use were significantly associated with muscle ( P < 0.0001) and tendon injuries ( P < 0.0001). The risk of reporting a GORRI increased as the number of reported categories of allergies increased ( P < 0.0001)., Conclusions: A novel finding was the cumulative risk effect with a history of multiple allergies. Further studies should aim to determine the underlying mechanism relating allergies and GORRIs., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Adolescent mothers face heightened economic and social vulnerabilities, which can place them at increased risk of intimate partner violence (IPV), prepandemic, and during COVID-19. However, few studies examine this population, and even less disaggregate findings by HIV status., Methods: We analyzed data from 834 South African adolescent mothers, 35% living with HIV (LHIV), who reported on physical, psychological, and sexual IPV exposure at two interviews: 2018-2019 (prepandemic) and 2021-2022 (during COVID-19). We estimated lifetime prevalence of IPV, disaggregating by HIV status. We used inverse weighted probability multivariate mixed-effects logistic regression to examine changes in IPV between the two periods and if changes in IPV differed by HIV status., Results: A quarter of adolescent mothers had experienced any IPV during COVID-19, quadruple prepandemic levels (24.7% vs. 6.0%). The increase was driven by surges in physical (+15.7%) and psychological (+11.2%) IPV. In both periods, psychosocial and physical IPV were the most prevalent forms and the most common combination among those who had experienced multiple forms of IPV. Exposure to any IPV was significantly more prevalent among those LHIV compared to those without HIV, prepandemic (9.5% vs. 4.1%, p = .026) and during COVID-19 (31.8% vs. 20.6%, p < .001). Adjusted models revealed an 18.2% significant increase in the average predicted probability of reporting IPV during COVID-19 compared to prepandemic, with no differential effect by HIV status., Discussion: Adolescent mothers experienced a significantly higher burden of IPV during COVID-19 than prepandemic, with those LHIV experiencing the highest level. Initiatives to reduce IPV need to reach adolescent mothers, particularly those living with HIV., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

This systematic review and meta-analysis evaluate human papillomavirus (HPV) prevalence, genotype distribution, and associations with cervicovaginal microbiota and cytokine profiles among South African women, where cervical cancer ranks as the second most common cancer. PubMed, SCOPUS, and Web of Science were searched for studies on HPV infection up to 21 September 2024. The pooled prevalence was estimated using a random-effects model, with subgroup analyses by province, sample type, and HIV status. Publication bias was evaluated using funnel plots and Egger's test. Of the 19,765 studies screened, 120 met the inclusion criteria, comprising 83,266 participants. Results indicate a high HPV burden, with a pooled prevalence of 58% (95% CI: 52-64%), varying regionally from 53% (95% CI: 41-65%) to 64% (95% CI: 55-73%), with some regions under-researched. Cervical samples had the highest HPV prevalence (60% (95% CI: 54-66%)), while non-genital samples were less studied. High-risk (HR) HPV types, notably HPV 16 (7.5%), HPV 35 (4.1%), and HPV 18 (3.9%), were prominent, with HPV 35 emphasizing the need for expanded vaccine coverage. HIV-positive women had a higher pooled HPV prevalence (63% (95% CI: 55-71%)). Funnel plot analysis and Egger's test suggested a potential publication bias ( p = 0.047). HPV-positive women exhibited lower Lactobacillus levels and an increase in Bacterial Vaginosis (BV)-associated species like Gardnerella , potentially supporting HPV persistence. Cytokine analysis showed elevated MIP-1α and MIP-1β in HPV infections, though cytokine profiles may depend on HPV genotypes. These findings underscore the need for research on HPV-microbiome-immune interactions and call for comprehensive HPV-prevention strategies, including vaccines targeting regional HPV types and tailored interventions for HIV-positive populations.

Meat inspection is the routine method used to identify cattle infected with Taenia saginata; however, the sensitivity of this method is low. We investigated the prevalence of T. saginata infection in cattle slaughtered in low throughput abattoirs (LTs) in Gauteng province, South Africa, based on meat inspection and serology. A total of 188 cattle carcasses from three abattoirs underwent meat inspection for the presence of T. saginata cysticerci, while serum was tested for the occurrence of antigens using antigen enzyme-linked immunosorbent assay (Ag-ELISA). Polymerase chain reaction (PCR)-sequencing was performed to confirm T. saginata cysts identified during enhanced inspection and incision of 10 randomly selected hearts. Apparent and true prevalence were calculated, and a logistic regression model was fit to evaluate associations between abattoir, sex, animal origin, age and T. saginata serological status. Out of the 188 carcasses, no positive cases (0%) were identified during routine meat inspection, yet three cysticerci-like lesions were identified from three hearts following additional incisions, of which one was confirmed as T. saginata. Fifty-four of the sampled cattle carcasses tested positive using Ag-ELISA (apparent and true prevalence: 29.0%, 71.8%). Feedlot cattle were less likely (odds ratios [OR]: 0.33, p = 0.043) to have a positive serological test result for T. saginata compared to non-feedlot cattle, and the odds of a positive result differed between abattoirs (p  0.05).Contribution: Our results confirmed the low sensitivity of routine meat inspection in LTs, which may pose a public health risk, and therefore other diagnostic methods need to be included in the surveillance system for T. saginata.

Introduction: In 2014, South Africa implemented a national two-dose HPV vaccination programme using the bivalent vaccine for girls aged 9 years and older attending Grade 4 at public schools. We assessed HPV prevalence and risk factors among South African adolescent girls and young women (AGYW) aged 17-18 years who were ineligible for vaccination., Methods: From June to December 2019, we surveyed AGYW aged 17-18 years attending primary care clinics in four South African provinces. Consenting participants completed a questionnaire, underwent HIV counselling and testing, and self-collected a vaginal swab for HPV testing. Samples were tested by Seegene AnyPlex™ II HPV28. We used summary statistics to describe the population characteristics and logistic regression to examine the association between risk factors and high-risk HPV detection., Results: 910 participants were screened, 900 enrolled, 896 had valid HPV results, and 819 were unvaccinated and included in this study. Of these, 248 (30.3 %) were living with HIV and 597 (72.9 %) reported ever having vaginal sex. Overall, 463 (56.5 %) had at least one high-risk HPV detected, and 177 (21.6 %) had HPV16/18 detected. AGYW living with HIV had a higher prevalence of any high-risk HPV (65.3 % vs 52.7 %, p < 0.001) and HPV 16/18 (29.4 % vs 18.2 %, p < 0.001) compared to those without HIV. Multiple infections were also more common in participants living with HIV, with three or more high-risk HPV types detected in 32.3 % compared with 15.4 % of those without HIV (p < 0.001). In multivariate analyses, HIV status (p < 0.001) and higher number of lifetime sexual partners (p-trend<0.001) were associated with high-risk HPV detection., Conclusions: High-risk HPV was very common in unvaccinated South Africa AGYW, especially among those living with HIV, highlighting the importance of HPV vaccination in settings with high HIV prevalence., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dorothy Machalek reports a relationship with MSD Merck Sharp & Dohme AG that includes: speaking and lecture fees and travel reimbursement. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Violence against women continues to be a challenge in many countries. Many women suffer physical violence at the hands of their intimate partners and sometimes this leads to their deaths. This study aimed to examine the multilevel determinants of physical violence among ever-partnered women in South Africa., Methods: We used data from the 2016 South Africa Demographic and Health Survey. The study has a weighted sample size of 4169 ever-partnered women aged 18-49 years, based on the domestic violence module. We included univariate, bivariate and multilevel logistic regression analysis. We included a two-level model to measure the relationship between the selected background characteristics and physical violence., Results: The prevalence of physical violence among ever-partnered women was 20.6%. The bivariate findings showed that educational status, employment status, witness to inter-parental violence, partner's drinking habits, household wealth, educational difference, and province were statistically associated with physical violence. The multilevel analysis showed some evidence of between-cluster variation in physical violence. We found that age, education, employment status, witness to inter-parental violence, partner's drinking habits, household wealth, education difference, place of residence, and province were key predictors of physical violence. The odds of physical violence were more than two-fold in the Eastern Cape and Mpumalanga compared to Gauteng., Conclusion: The study highlighted various key factors explaining physical violence. The findings suggest the need for targeted interventions aimed at specific communities of women, such as those from the Eastern Cape and Mpumalanga, as well as interventions that will empower women and address gender inequalities., Competing Interests: Declarations. Ethical consideration: We sought and were granted permission to use the 2016 SADHS data for this study by the DHSProgram. Ethical approval for the 2016 SADHS was received from the SAMRC Ethics Committee and the ICF Institutional Review Board (National Department of Health et al., 2019). Further information about the DHSProgram ethics processes can be found here: https://dhsprogram.com/Methodology/Protecting-the-Privacy-of-DHS-Survey-Respondents.cfm . Conflicting interests: The author(s) declared no potential conflicts of interest concerning the research, authorship, as well as the publication of this article., (© 2024. The Author(s).)

Background: Dementia is a leading cause of global death and disability. High-quality data describing dementia prevalence and burden remain scarce in sub-Saharan Africa. Health and Aging in Africa: A Longitudinal Study in South Africa (HAALSI) fills evidence gaps with longitudinal data on cognition, biomarkers, and everyday function in a population-based cohort of Black South Africans, aged 40 years and older, in a rural subdistrict. This study uses consensus diagnoses and prediction algorithms to estimate dementia prevalence., Methods: Data were from eligible HAALSI Wave 2 respondents aged 50 years or older (n=3662) and were collected between September, 2019, and January, 2020. An enriched sub-cohort (ie, including a high proportion of individuals with cognitive impairment; n=632) completed a battery of rigorous neuropsychological and clinical assessments and received expert classification of cognitively unimpaired, mild cognitive impairment, or dementia. Logistic regression was used to predict dementia status within the sub-cohort using predictor variables from the parent HAALSI wave. Coefficients were applied to the parent cohort to obtain dementia probability scores and calculate dementia prevalence. Optimal probability cut points to classify individual cases were selected for each model., Findings: When the sub-cohort was reweighted to reflect the full HAALSI population, the estimated prevalence of dementia was 18% (95% CI 15-22), with steep age gradients. Four models of increasing complexity showed good discrimination between dementia and non-dementia (area under receiver operating characteristic curves 0·78-0·84; classification accuracy 74-81%). Model-based dementia prevalence estimates aligned closely with weighted prevalence; model performance was consistent in cross-validated datasets., Interpretation: HAALSI is among the first studies to use algorithmic methods to describe dementia prevalence in a population-based sample in South Africa. These efforts could provide a foundation to expand understanding of dementia epidemiology in a region of the world experiencing rapid population ageing., Funding: National Institute on Aging., Competing Interests: Declaration of interests MTF reports employment at IQVIA. AMB reports consulting fees from Cogstate, Cognito Therapeutics, Cognition Therapeutics, and IQVIA; payment or honoraria for presentation or writing from Cedara; travel support from the International Neuropsychological Society; an editorial role at Alzheimer's & Dementia; patents or pending patents (#9867566 and #20230298170); and participation in advisory boards at the University of Illinois, Urbana-Champaign (Chicago, IL). KML reports consulting fees from National Institutes of Health-funded projects at Harvard University (Boston, MA), University of Pennsylvania (Philadelphia, PA), University of Minnesota (Minneapolis, MN), University of Colorado (Boulder, CO), Dartmouth College (Hanover, NH), University of Southern California (Los Angeles, CA); payment for expert testimony for a legal case related to decisional capacity in a person with dementia; and participation in a data safety monitoring board for a clinical trial at Indiana University (Bloomington, IN). JJM reports consulting fees from University of Mississippi (University, MS) and support for meeting attendance from the Alzheimer's Associations International Conference. RGW reports grants from the Bill & Melinda Gates Foundation. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

The GenoType CMdirect Ver 1.0 and GenoType Mycobacterium Common Mycobacteria Ver 2.0-line probe assays were utilized to identify nontuberculous mycobacteria (NTM) from decontaminated sputum in a GeneXpert MTB/RIF Ultra negative cohort. A preliminary NTM prevalence of 1.7 % was observed, with a 100 % specificity. The high specificity advocates the CMdirect as a possible rule-in test for NTM disease., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Psychotic symptoms are of increasing interest in mental health due to their predictive value for future psychotic disorders. While these symptoms are prevalent in the general population, their occurrence varies globally. This study aimed to explore the prevalence and factors associated with psychotic symptoms among individuals identified as substance-naïve and recent abstainers without a history of psychosis. A cross-sectional analysis was conducted on 11,686 participants who reported no lifetime substance use, no substance use in the previous three months, and did not have a diagnosis of psychosis. The study utilized the Psychosis Screening Questionnaire to estimate the one-year prevalence of psychotic symptoms and their associations with demographic and clinical attributes. Results revealed a 3.5 % overall prevalence of psychotic symptoms with 2.9 % prevalence among substance naïve and 4.3 % among recent abstainers. Factors associated with psychotic symptoms were age, being female, having chronic medical conditions, encountering traumatic life events being divorced or separated and lower education levels which positively correlated with symptom scores. There is a need for future investigations and longitudinal studies to uncover the underlying mechanisms and impacts of psychotic symptoms., Competing Interests: Declaration of competing interest We the authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Objective: To assess the relationship between metabolic syndrome (MetS) and physical fitness in firefighters., Methods: Firefighters (n = 309) were systematically recruited to participate in this study. A questionnaire and physical measures were used to collect data on firefighters' cardiometabolic health and physical fitness levels. Data were analyzed using binary and multinomial logistic regressions., Results: The prevalence of MetS was 23.0%, which was most prevalent in station and platoon commanders. Multivariable analysis showed that age (P < 0.001), lean body mass (P < 0.001), absolute aerobic capacity (P < 0.001), and leg strength (P < 0.001) was significantly associated with MetS. In addition, relative aerobic capacity (P < 0.001), push-ups (P = 0.016), and sit-ups (P < 0.001) were inversely associated with MetS., Conclusions: Firefighters with MetS had a higher absolute aerobic capacity and strength, and healthier fighters had a higher relative aerobic capacity, muscular endurance capacity, and flexibility., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

This study investigated the characteristics and outcomes of drug-resistant tuberculosis patients in selected rural healthcare facilities in the Eastern Cape, South Africa. A retrospective review of clinical records from 456 patients, covering the period from January 2018 to December 2020, revealed a statistically significant relationship between DR-TB types and age groups (Chi-square statistic: 30.74, p -value: 0.015). Younger adults (19-35 years) and middle-aged adults (36-50 years) are more frequently affected by RR-TB and MDR-TB, which are the most prevalent forms of DR-TB. Less common types, including Pre-XDR, XDR, and INH TB, were observed in smaller numbers. The study suggests that DR-TB imposes a heavy burden on the working age population. Gender analysis shows that while the frequency of DR-TB differs between males and females, the percentage distribution of DR-TB types is relatively equal. Both genders are predominantly affected by RR-TB and MDR-TB, which together account for nearly 90% of cases. Pre-XDR, XDR, and INH-resistant TB are much less common, comprising only a small percentage of cases in both males and females. High-risk behaviors such as smoking and drinking are linked to a wider diversity of DR-TB types, while occupations like mining and prison work show higher rates of RR-TB and MDR-TB. In HIV-positive individuals, DR-TB is more common, but the distribution of DR-TB types between HIV-positive and negative groups shows no statistically significant difference. However, HIV-positive individuals have a 20% lower survival rate (65%) compared to HIV-negative patients (85%). Financial stability and comorbidities also significantly influence outcomes, with patients having stable income and fewer high-risk comorbidities experiencing better survival and treatment outcomes. The findings underscore the importance of addressing socioeconomic disparities and strengthening healthcare infrastructure to improve DR-TB treatment outcomes in rural Eastern Cape.

Objective: Neural tube defects (NTD) are serious, life-threatening birth defects. Staple food fortification with folic acid (vitamin B 9 ) is a proven, effective intervention to reduce NTD birth prevalence. Mandatory food fortification with folic acid was implemented in South Africa (SA) in 2003. This article provides an overview of NTD birth prevalence in SA, pre- and post-fortification, and evaluates current folic acid fortification regulations., Design: Fortification effectiveness data in SA were reviewed using published studies and national reports on NTD birth prevalence pre- and post-folic acid fortification. Current folic acid fortification regulations in SA were evaluated by experts., Setting: Regulations were assessed using national health guidelines, legislation and regulations. NTD birth prevalence data were sourced from the published literature., Participants: None., Results: Significant reductions in the birth prevalence of spina bifida and anencephaly and improved maternal folate levels have been achieved following the introduction of folic acid fortification in SA. However, there is poor overall regulatory compliance in some instances and a gap in current regulations that excludes the fortification of cake flour in SA., Conclusions: While the SA NTD birth prevalence has decreased by 30% post-fortification, the regulatory exclusion of cake flour fortification is a significant and growing issue. Proposed 2016 regulatory amendments to address this gap urgently require finalisation and enactment by government to prevent negating benefits achieved to date and to ensure continued improvement. Fortification monitoring requires strengthening to ensure widespread compliance with policies, particularly in underserved areas.

Background: South Africa is facing a convergence of communicable diseases (CDs) and non-communicable diseases (NCDs). There are limited data about how tobacco use contributes to the burden of these conditions, especially in rural populations., Methods: We analyzed the associations between current tobacco smoking and four important CDs and NCDs in Vukuzazi, a cross-sectional study of individuals aged 15 years and older conducted between 2018-2020 in a demographic surveillance area in KwaZulu-Natal, South Africa. Data on HIV, active tuberculosis (TB), hypertension and diabetes mellitus were collected via direct measurement from participants., Results: Of 18,024 participants (68% female, median age 37 years [interquartile range 23-56 years]), 1,301 (7.2%) reported current smoking. Prevalence of HIV infection was similarly high among people who currently smoked (34.6%) and people who had never smoked (33.9%). However, among people living with HIV (PLWH), there was a higher prevalence of detectable viremia in people reporting current smoking compared to people who reported never smoking (28.8% vs. 16.6%; p-value < 0.001). Active TB was more prevalent in people who currently smoked than in people who never smoked (3.1% vs 1.3%, p < 0.001). In contrast, the prevalence of hypertension and diabetes mellitus were lower in people reporting current smoking than in people reporting never smoking (17.1% vs 26.0% (p < 0.001), and 2.5% vs 10.2% (p < 0.001), respectively). In sex-stratified multiple logistic regression analyses that were adjusted for potential confounding factors (including body mass index for the NCDs), the magnitude of differences in CD prevalence between people who currently smoked and people who never smoked decreased, whereas the lower prevalence of NCDs among people reporting current smoking persisted., Conclusions: In rural South Africa, smoking is associated with higher prevalence of active TB, and people with HIV who smoke have worse disease control. In contrast, hypertension and diabetes mellitus are less common in those who smoke. Interventions to screen for TB among those who smoke and to address smoking among people with HIV may be particularly impactful., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval for the study was obtained from the Biomedical Research Ethics Committee at the University of KwaZulu-Natal (BE560/17), the Observational / Interventions Research Ethics Committee at London School of Hygiene & Tropical Medicine (14722), Mass General Brigham Human Research Committee at the Mass General Brigham (2018P001802), and the University of Alabama at Birmingham (UAB)’s Institutional Review Board for Human Use (300007237). All methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from adult participants and assent from minors whose parent/guardian had provided consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Diabetes mellitus is one of the leading causes of morbidity and mortality worldwide. Type 2 diabetes mellitus is the most prevalent type of diabetes mellitus, and it is associated with both hereditary and lifestyle risk factors. South Africa is not exempt from this pandemic; hence, this paper aims to assess the prevalence and determinants of household self-reported diabetes mellitus in Gauteng, South Africa. Data were sourced from the Gauteng City-Region Observatory (GCRO) quality of life survey (2020/2021). Bivariate and multivariate logistic regressions were applied. The prevalence of household self-reported diabetes mellitus in Gauteng was 11.1%. The 'other population' group (which included Whites, Coloureds and Indians), as well as older respondents, higher household monthly food expenditure, poor self-perceived health status and household self-reported hypertension were factors that increased the odds of household self-reported diabetes mellitus. Only informal housing decreased the odds of household self-reported diabetes mellitus. Screening of diabetes mellitus among those with poor living conditions, no medical aid and lack of access to healthcare facilities such as Gauteng township and informal settlement residents should be intensified. This secondary disease prevention intervention is crucial, as it will enhance the appropriate referrals and timeous chronic treatment for those with diabetes mellitus.

This study investigated the prevalence of childhood asthma and respiratory symptoms with their associated air pollution sources among adolescents aged 13-14 years residing in a Malaria-endemic region., Methods: A cross-sectional survey was conducted with 2855 adolescents from fourteen (14) selected schools in communities exposed to high levels of air pollution from indoor residual spraying (IRS) that is used for malaria vector control in the Vhembe region. Data were collected using a self-administered standardized International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Statistical software STATA version 17 was used to analyze the data. Binary logistic regression was used to determine the relationship between air pollution sources and childhood asthma/symptoms., Results: The prevalences of asthma, 'wheeze ever' and 'wheeze in the past' were 18.91%, 37.69% and 24.69%, respectively. The results from the adjusted binary logistic regression model indicated that exposure to tobacco smoke (OR = 1.84; 95% CI: 1.08-3.16), smoking a water pipe (OR = 1.65; 95% CI: 1.16-2.36) and the use of paraffin as fuel for heating (OR = 1.70; 95% CI: 0.97-2.88) and cooking (OR = 0.48; 95% CI: 0.29-1.00) were significant risk factors for asthma. Trucks passing through the streets, having a cat at home and using open fires were significantly associated with 'wheeze in the past'. Finally, using gas for cooking (OR = 0.72; 95% CI: 0.53-0.99), open fires for heating (OR = 0.53; 95% CI: 0.35-0.80) and smoking a water pipe (OR = 2.47; 95% CI: 1.78-3.44) were associated with 'wheeze ever'., Conclusions: School children living in these communities had an increased risk of developing asthma and presenting with wheezing due to exposure to environmental air pollution sources.

Background: The International Society of Nephrology proposes an acute kidney disease (AKD) management strategy that includes a risk score to aid AKD identification in low- and low-middle-income countries (LLMICs). We investigated the performance of the risk score and determined kidney and patient outcomes from AKD at multiple LLMIC sites., Methods and Findings: Adult patients presenting to healthcare facilities in Bolivia, Brazil, South Africa, and Nepal were screened using a symptom-based risk score and clinical judgment. Those at AKD risk underwent serum creatinine testing, predominantly with a point-of-care (POC) device. Clinical data were collected prospectively between September 2018 and November 2020. We analyzed risk score performance and determined AKD outcomes at discharge and over follow-up of 90 days. A total of 4,311 patients were at increased risk of AKD, and 2,922 (67.8%) had AKD confirmed. AKD prevalence was 80.2% in patients enrolled based on the risk score and 32.5% when enrolled on clinical judgment alone (p < 0.0001). The area under the receiver operating characteristic curve was 0.73 for the risk score to detect AKD. Death during admission occurred in 84 (2.9%) patients with AKD and 3 (0.2%) patients without kidney disease (p < 0.0001). Death after discharge occurred in 206 (9.7%) AKD patients, and 1865 AKD patients underwent reassessment of kidney function after discharge; 902 (48.4%) patients had persistent kidney disease including 740 (39.7%) patients reclassified with de novo or previously undiagnosed chronic kidney disease (CKD). The study was pragmatically designed to assess outcomes as part of routine healthcare, and there was heterogeneity in clinical practice and outcomes between sites, in addition to selection bias during cohort identification., Conclusions: The use of a risk score can aid AKD identification in LLMICs. High rates of persistent kidney disease and mortality after discharge highlight the importance of AKD follow-up in low-resource settings., Competing Interests: RE has received honoraria from Therakos. EB has received honoraria from Baxter and AstraZeneca. Other authors have no conflicts to declare., (Copyright: © 2024 Evans 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.)

Background: Intimate partner violence in pregnancy (IPVP) is a serious and ubiquitous problem with cultural roots that have severe consequences on both the mother and the unborn child, and affects the general population's well-being. Understanding the dynamics of disclosure and coping strategies employed by pregnant women facing IPV is crucial for developing effective interventions and facilitating positive maternal and foetal outcomes., Objective: The study investigated the disclosure pattern and coping strategies of Antenatal attendees who experienced IPVP., Methods: The study was descriptive cross-sectional with mixed method data collection conducted among 400 antenatal attendees at the Ante-Natal clinics of the Nnamdi Azikiwe University Teaching Hospital. In-depth interviews were conducted among 20 antenatal attendees that experienced IPVP., Results: The overall prevalence of IPV in pregnancy was 27.3%. Among the respondents who experienced IPV, 53.4% did not report it to anybody. Among those that reported, 29.3% reported to health workers, 20.0% reported to their parents/siblings 19.0% committed their spouse to God by praying; 74.3% said they are coping fine; 13.3% said they are managing to cope and 5.7% find it stressful coping with IPVP. Among the 20 respondents in the in-depth interviews, 25% of respondents reported to their parents, sibling, and pastors; 3% reported to in-laws and 60% did not disclose to anybody but prayed to God., Conclusion: Awareness creation, screening of pregnant women for IPVP, the political will and effective interventions will ameliorate IPVP. This cannot be achieved without proper reporting or disclosure for intervention., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 by West African Journal of Medicine.)