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Background Child and youth care workers (CYCWs) are a crucial and growing component of South Africa’s national response to HIV and AIDS and other issues affecting children and families. CYCWs use the community-centred Isibindi model of care to reach the most vulnerable with key services including psychosocial, health, economic and education support. Like others in similar professions, they may be at risk for occupational challenges affecting retention. Methods This study uses data from the first nationally representative survey of CYCWs in South Africa to identify factors associated with workers’ retention intentions. Data were collected in 2015 as part of a formative evaluation conducted around the mid-point of a nationwide Isibindi programme expansion. A total of 1158 CYCWs from 78 sites participated. The response rate for the sample was 87%. Questions addressed demographics, work history, retention intentions, training, mentorship and supervision experiences, workload and remuneration. Mixed effects regression models with random intercepts for project site and mentor were used to estimate factors associated with retention intentions. Results High-quality mentorship and frequent supervision support retention intentions among CYCWs. Respondents who indicated that wanting to help children or the community was their primary motivator for seeking work as a CYCW were also more likely to report intending to continue working as a CYCW. High perceived workloads and feeling threatened or unsafe on the job were negatively associated with retention intentions. As CYCWs gained experience, they were also less likely to intend to stay. Conclusions Understanding the factors affecting retention in the CYCW workforce is vital to helping vulnerable children and families across South Africa access key social and health services. Findings highlight the importance of mentoring and supervision as part of the Isibindi model and the value of support for manageable workloads, workplace safety, and career advancement opportunities for promoting worker retention.

Systems’ thinking places high value on understanding the context. This study focused on the collection of disaggregated data in order to understand the context, to facilitate improvement of health ...

Background Schistosomiasis, a neglected tropical disease caused by parasites that infest open water sources such as rivers and dams may increase susceptibility to HIV. Mass-treatment with praziquantel tablets, recommended by the World Health Organization reduces the prevalence of schistosomiasis. The goal in endemic areas is 75% treatment participation in every treatment round (e.g. yearly). However, in rural Ugu district, KwaZulu-Natal, South-Africa there was low participation among pupils in a Department of Health Mass-Treatment Campaign for schistosomiasis. Methods Nested in a large study on schistosomiasis the study was conducted in 2012 over 4 months using qualitative methods with the Health Belief Model as the conceptual framework. Purposive sampling was done. Focus Group Discussions were undertaken at six schools in grades 10–12. Individual in-depth interviews were held with one teacher and two pupils at each school. In addition three traditional healers and a community health worker were interviewed. Results The severity of schistosomiasis was not recognised and neither was the pupils’ susceptibility. Barriers to treatment included confusing S, haematobium symptoms with sexually transmitted infections, teasing and stigma. Conclusions Increased knowledge, health literacy for treatment, and correct understanding about the severity of schistosomiasis may provide cues to action. The study indicates that comprehensive information may increase pupil participation in mass-treatment and decrease schistosomiasis prevalence. Trial registration This study was registered with clinicaltrials.gov registry database and the registration number is NCT01154907 30 June 2011.

Sexual violence, a global concern, has far reaching consequences for individuals and communities. This survey of South African high school students, reported baseline prevalence and factors associated with forced sex. Data collected among 434 adolescents (54.4% boys; 45.6% girls) used a questionnaire developed using the I-Change Model conceptual framework. Forced sex prevalence was 14.2% (95% CI 9.1, 21.5) with a non-significant difference between females (15.0%) and males (13.6%) (p = 0.781). After multivariable adjustment, urban location (39%), low socio-economic status (15%) and discordant mother/father vital status (20%) remained significant risk factors for forced sex. South African high school students are still at risk of experiencing forced sex with a higher prevalence in females. Interventions to address socio-economic and structural constructs contributing to the forced sex prevalence in this population are required.

Schistosoma haematobium infection is reported to facilitate the development of urogenital diseases. Its symptoms include haematuria, dysuria and tiredness, and it may cause cognitive decline in chi...

Background: High-risk human papillomavirus (hr-HPV) infections and low-grade squamous intraepithelial lesions occur frequently in young women. The available vaccines cover up to seven hr-HPV genotypes (HPV16, HPV18, HPV31, HPV33, HPV45, HPV52 and HPV58) and two low-risk HPV types (HPV6 and HPV11). The objective of this study was to describe the hr-HPV genotypes present among HIV-uninfected and HIV-infected young women in rural high schools. Methods: Cervicovaginal lavages were obtained from sexually active young women recruited from high schools in KwaZulu-Natal (n=1223). HPV testing was done by the polymerase chain reaction using GP5+/GP6+primers and enzyme immunoassay. HIV testing was done using rapid test kits. Results: Of the 1223 cervicovaginal lavages, 301 (25%) were positive for hr-HPV. The HPV prevalence was higher in HIV infected (32.20%, 95% CI: 0.27-0.38) than in HIV-uninfected women (22.50%, 95% CI: 0.21-0.26), (p=.001). Similarly, multiple infections were slightly more common in HIV infected (59.32%) than in HIV-uninfected women (53.51%), (p=.37). The nine predominant genotypes in descending order were HPV types 16 (n=99, 22.10%), 51 (n=58, 12.91%), 18 (n=56, 12.50%), 35 (n=50, 11.10%), 33 (n=47, 10.82%), 56 (n=42, 9.31%), 45 (n=34, 7.60%), 52 (n=32, 7.14%) and 59 (n=31, 6.91%). HPV 35, 51, 56 and 59 (40.62%), which are not covered by any vaccine, were among the most prevalent in the schools of KwaZulu-Natal. Conclusion: Four of the most predominant high-risk HPV types in this region are not covered by the new nine-valent HPV vaccine.

While it is well-accepted that mothers play a key role in child health outcomes, the role of the father is less well understood. This study, the first of two investigations of the relationship between the social environment and child health, growth and development, was nested in a child nutrition programme carried out in Kwale County. At present child health services are largely administered through government Mother and Child Health programmes. Previous community consultations have raised the need to include all family members, particularly fathers, in the process of addressing child health and development issues. To provide a background to planning for inclusion of the wider family this study investigated local attitudes and beliefs towards parenting and how these may influence child health outcomes. In this study, we used qualitative in-depth interviews of 61 co-habiting couples with fathers and mothers interviewed separately, analysed using NVivo 10 software, to look for patterns of responses with regards to attitudes and behaviours relevant to child health. The study findings suggested that both mothers and fathers overall valued their status as parents and were willing to be involved in promoting the well-being of their children. Fathers and mothers saw that they carried out a different role, and drew on different influences in their decision making and role definition. The main barrier to direct paternal involvement in the health care of their children was reported to be the cost of attendance at clinics, both in terms of time and money. Innovation in how medical services engage with families is required to increase the supportive role that fathers can provide by using opportunities such as community meetings where men gather to explain child health risks and preventative measures.

Background and objectivesThe aim of the current study was to establish the relative prevalences of Female Genital Schistosomiasis (FGS) and sexually transmitted infections (STIs). We hypothesised that due to the use of syndromic management for STIs it is possible that FGS is being misdiagnosed and mismanaged as an STI. We therefore wanted to examine the relationship between FGS and the individual STIs in schistosomiasis endemic areas.MethodsBetween 2011 and 2013, a cross-sectional study was performed in 32 randomly selected secondary schools in rural KwaZulu-Natal, South Africa, where each school had at least 300 pupils. In a research clinic, FGS diagnosis, STI testing, and face-to-face interviews were performed in sexually active, young women aged 16 – 22 years.ResultsFGS was the second most prevalent current genital infection (23%). There were significantly more women who had presented FGS among those who had detectable urinary schistosomiasis (35%), compared to those without (19%, p< 0.001). In the FGS positive group 35% were positive for HPV infection, compared to 24 % in the FGS negative group (p=0.010). In the FGS positive group 37% were sero-positive for HSV infection, compared to 30% in the FGS negative group (p=0.079). There were significantly fewer chlamydia infections amongst women with FGS (20%, p=0.018) compared with those who did not have FGS (28%).ConclusionsFGS was the second most common genital infection after HSV but the two were not significantly associated. HPV infection was significantly associated with FGS. Surprisingly Chlamydia infection were negatively associated with FGS. The results show the importance of the inclusion of FGS in the management protocols for genital infections in areas endemic for urinary schistosomiasis, and highlight the importance for more research on suitable differential diagnostic tools and disease management.Key messages boxFGS was the second most common genital infection in this rural population after HSV.FGS was positively associated with HPV.FGS was negatively associated with genital chlamydia infections.FGS should be included in the syndromic management of genital infections.

Background HIV testing contributes to the prevention and control of the HIV epidemic in the general population. South Africa has made strides to improve HIV testing towards reaching the first of the UNAIDS 90–90–90 targets by 2020. However, to date no nationally representative analysis has examined temporal trends and factors associated with HIV testing among youth and adults in the country. Aim This study aimed to examine the trends and associations with ever having tested for HIV among youth and adults aged 15 years and older in South Africa using the 2005, 2008, 2012 and 2017 nationally representative population-based household surveys. Methods The analysis of the data collected used multi-stage stratified cluster randomised cross-sectional design. P-trend chi-squared test was used to identify any significant changes over the four study periods. Bivariate and multivariate logistic regression analysis was conducted to determine factors associated with HIV testing in each of the survey periods. Results Ever having tested for HIV increased substantially from 2005 (30.6%, n = 16 112), 2008 (50.4%, n = 13 084), 2012 (65.5%, n = 26 381), to 2017 (75.2%, n = 23 190). Those aged 50 years and older were significantly less likely to ever have tested for HIV than those aged 25–49 years. Those residing in rural areas were significantly less likely to have tested for HIV as compared to people from urban areas. There was a change in HIV testing among race groups with Whites, Coloureds and Indian/Asians testing more in 2005 and 2008 and Black Africans in 2017. Marriage, education and employment were significantly associated with increased likelihood of ever testing for HIV. Those who provided a blood specimen for laboratory HIV testing in the survey rounds and were found to have tested positive were more likely to have ever tested for HIV previously. Conclusion The results show that overall there has been an increase in ever having an HIV test in the South African population over time. The findings also suggest that for South Africa to close the testing gap and reach the first of the UNAIDS 90–90–90 targets by 2020, targeted programmes aimed at increasing access and utilization of HIV testing in young people, males, those not married, the less educated, unemployed and those residing in rural areas of South Africa should be prioritised.

Background Adolescent pregnancy and motherhood has been a controversial and much disputed subject within the field of public health. Early childbearing is not only characterized as a physical body experience but also embodies the experiences and perceptions of the social norms, discourses, conflict and moral judgement. There is an increasing concern that the psychosocial challenges facing adolescent mothers remains in the background since research in this field has mainly focused on the medical and physical complications of early childbearing. The aim of this qualitative study was to explore adolescent pregnancy and motherhood in order to understand this phenomenon from the perspective of adolescent mothers and to gain insight into their future aspirations. Methods This descriptive qualitative study was based on data from four focus group discussions with adolescent mothers utilising healthcare services at a district hospital in Ugu district, KwaZulu Natal, South Africa. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis. Results Some adolescent mothers’ partners were in denial and rejected them and the child while others’ partners were happy and supported them during their pregnancy. Families’ reactions to the pregnancies ranged between anger and disappointment to abandonment, the silent treatment, and acceptance and forgiveness. The psychological issues experienced by some of the adolescent mothers included suicidal ideation, guilt, loneliness, anxiety, and stress. They also experienced financial constraints, difficulty in returning to school, and stigmatisation in society. The participants envisioned completing their education, focusing on their dream careers, and contributing positively to society. Conclusion Experiences of adolescent pregnancy and parenting are multifaceted and the healthcare needs of pregnant and parenting adolescents extend beyond information and knowledge. A multidisciplinary approach is required in the care of adolescent mothers. A key policy priority should encompass the collaboration of different professionals from various healthcare sectors to assist adolescent mothers in achieving better health and psychosocial and socio-economic outcomes as steps to securing a better future for them.

IntroductionAmong women living with HIV, intimate partner violence (IPV) is increasingly recognised worldwide as a serious public health concern. The understanding of the link between IPV and HIV is currently inconclusive and information concerning the IPV experiences of HIV-infected women is insufficient. This protocol aims to map evidence of IPV against women living with HIV/AIDS in Africa.Methods and analysisWe will search and review peer-reviewed and review articles. The comprehensive search will include the electronic databases PubMed, MEDLINE with full text via EBSCO host, Google Scholar, Science Direct and Scopus. The advanced search will use MeSH terms. Grey literature will also be included. The titles of the studies from the database searches will be screened, and duplicates will be removed. The abstract screening will be done independently by two reviewers, followed by the full-text screening which will be based on the eligibility criteria. The six methodological stages in this review will be to: identify the research questions; identify relevant studies; select the studies; chart the data; collate, summarise and report the results; and thereafter undertake consultations. The quality of studies included in the review will be determined by the Mixed Methods Appraisal Tool. NVIVO software V.11 will be used to undertake a thematic analysis of each of the studies and to extract the relevant outcomes.DisseminationThe results of this study will be disseminated through publication, and presented at conferences related to IPV.Scoping review registrationCurrently, a scoping review is not eligible for registration on the International Prospective Register of Systematic Reviews.

In the era of HIV/AIDS, repeat pregnancies among adolescents indicate the growing problem of high-risk sexual behavior and the status of reproductive health services. A cross sectional survey was conducted to establish the prevalence and risk factors of repeat pregnancies among South African adolescents. A total of 326 adolescents participated in this study at a district hospital in, KwaZulu-Natal, South Africa from June 2017 to November 2017. Data was analysed using R Software. Out of the 326 adolescents, 19.9% had experienced a repeat pregnancy. The risk factors associated with adolescent repeat pregnancy included a history of spontaneous abortion (p0.001) and previous contraceptive use (p0.001). A higher level of education (p0.001) and emotional support from family (p=0.007) were found to be significant protective factors against adolescent repeat pregnancy. These findings have implications for future interventions aimed at reducing repeat pregnancy among adolescents.

Background: Adolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes. Aim: The aim of this study was to explore nurses’ perceptions of the MDT approach in the continuum of care for adolescent mothers and their children. Setting: The study was conducted in a local district hospital in Ugu, KwaZulu-Natal. Methods: An explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses’ perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis. Results: Six overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses’ reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers. Conclusion: In the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention.

Female Genital Schistosomiasis (FGS) is a neglected disease affecting millions, however challenging to diagnose. This explorative descriptive study compares Schistosoma real-time PCR analysis of cervico-vaginal lavages (CVL) with corresponding urine and stool samples of 933 women from five different previously described study populations. Sampling included 310 women from an S. mansoni endemic region in Mwanza, Tanzania and 112 women from a nearby S. haematobium endemic region. Findings were compared with samples collected from S. haematobium endemic regions in South Africa from 394 women and from 117 women from Madagascar of which 79 were urine pre-selected microscopy positive cases from highly-endemic communities and 38 were urine microscopy negatives from a low-endemic community. As anticipated, urine and stool microscopy and gynecological investigations varied substantially between study populations; however, the same Schistosoma real-time PCR was performed in one reference laboratory. Schistosoma DNA was detected in 13% (120/933) of the CVL, ranging from 3% in the S. mansoni Tanzanian endemic region to 61% in the pre-selected Malagasy urine microscopy positive cases. Detectable Schistosoma DNA in CVL was associated with Schistosoma DNA in urine but not with microscopic detection of eggs in urine or by cytological examination. This study confirmed real-time PCR for the detection of Schistosoma DNA in gynecological samples to be a valuable diagnostic tool to study the distribution of FGS within schistosomiasis endemic areas.

The research study that informed this article’s discussion, critically interrogates an HIV-infected research team’s positionality whilst conducting a mixed-methods’ study on HIV-positive patients’ experiences of the public ART programme at four ARV clinics in KwaZulu-Natal, South Africa. It primarily utilises the principal investigator’s (PI) narrative to explore insider/outsider positionality, reflexivity, bracketing and participatory action research through exposure of feelings, emotions, challenges, engagements, relationships and observations. The fluid positionality of the HIV-positive research team presented both challenges and opportunities. However, the opportunities for more HIV-infected researchers to engage in HIV-related research to assist with destigmatising HIV, close research gaps and the creation of a trustworthy research environment to achieve an ethical and reliable health science study, far outweigh the challenges. Further, such research can improve patients’ support and healthcare, healthcare workers’ perceptions of patients, and provide a guide for policymakers to better understand the recipients of HIV policies. Lastly, the term ‘HIV reflexivity’ is coined as a result.

The university period provides a critical developmental transition from adolescence to adulthood. During this period, young people establish patterns of behaviors and make lifestyle choices that affect their current and future health. Using the social constructionist paradigm that examines the development of masculinities as a mutual construct of individual, social, cultural, and historical context, this article explores the interactions between masculinities and sexual behaviors of young men at the University of KwaZulu-Natal, South Africa. The study used a qualitative approach and employed purposive sampling to recruit 36 young Black male students aged between 18 and 30 years. Four focus group discussions consisting of 8 to 10 participants were conducted according to the current year of study of male students. Data were transcribed, coded, and analyzed thematically. Our results show that the freedom and independence acquired from being away from home enabled students to enact their masculinities freely. Our findings further reveal that an individual has multiple masculinities which are often exerted to suit the present discourse they are in at any given point.

ObjectivesThe present study undertakes a scoping review aimed to map the evidence of intimate partner violence (IPV) against women living with HIV/AIDS in Africa.DesignWe used the online database to identify papers published from 1 January 2009 to 1 April 2019, from which we selected 21 articles from Uganda, Nigeria, Kenya, South Africa, Zambia, Ethiopia, Cameroon, Tanzania and Swaziland that used IPV as an outcome variable among women living with HIV/AIDS.Data sourcesPubMed, MEDLINE, EBSCO host, Google Scholar.Eligibility criteriaWe included women who were aged 15 years and above, living with HIV/AIDS in sub-Saharan Africa.Data extraction and synthesisWe conducted the abstract screening with two independent reviewers. We also performed full-text screening. We used the six methodological frameworks proposed by Arksey and O'Malley. The Mixed Method Appraisal Tool was used to determine the quality of the studies. We used NVIVO software V.12 to undertake a thematic analysis.ResultsOf the studies, the majority, 57.1%, reported cross-sectional results. In comparison, 23.8% examined qualitative studies, 9.5% were clinical trials, 4.8% were cohort studies and the remaining 4.8% covered grey literature. This review revealed evidence of IPV experience among women with HIV/AIDS, evidence of how HIV status disclosure influences IPV, proof of the association of sociodemographic characteristics with IPV and implications for practice. Moreover, the review revealed that following the serostatus disclosure, there is evidence of heightened risk for IPV.ConclusionsThis study found evidence of IPV among women living with HIV/AIDS. The HIV-positive women were at considerable risk of IPV after disclosure of their serostatus to a male partner. Therefore, further research is needed to promote action to reduce IPV among HIV-positive and HIV-negative women and to determine healthcare workers’ IPV screening experience.

Background and Objectives Alcohol abuse, a significant health problem in South Africa, affects the ability of adults to care for children. Little is known regarding risky alcohol use among child caregivers there. A large population-based study examined the prevalence of, and factors associated with, risky drinking among caregivers of young children in KwaZulu-Natal, South Africa comparing the use of the Alcohol Use Disorders Identification Test (AUDIT) and the AUDIT-C screens for hazardous or harmful drinking (referred to here as risky drinking). Methods 83 % of child caregivers from five tribal areas were interviewed using the 10-question AUDIT to screen for risky drinking. The AUDIT-C screen, a subset of AUDIT questions, targets alcohol consumption and binge drinking. Factors associated with risky drinking were investigated using logistic regression. Results 1434 caregivers participated, 98 % female. Sixteen percent reported ever drinking alcohol. Based on AUDIT criteria for risky drinking, 13 % of the sample scored as moderate drinkers, 2 % as hazardous users, and 1 % as harmful or dependent users (identifying 3 % as risky drinkers). Using AUDIT-C criteria to identify risky drinking significantly increased the proportion of caregivers identified as risky drinkers to 9 %. In multivariate analyses, factors associated with risky drinking were similar in both screens: partner violence, smoking, HIV-infection, caring for a child with disabilities. Conclusions for Practice Since the AUDIT-C identified risky alcohol use not otherwise detected with the full AUDIT, and since resources for screening in health care settings is limited, the AUDIT-C may be a more appropriate screen in populations where binge drinking is common.

Background: Stunting continues to affect young children as a global nutritional disorder. The aim of our study was to assess the prevalence, associated risk factors and spatial clustering for stunting in a disadvantaged South African District. Methods: A community-based cross-sectional weighted survey of households was conducted in the iLembe district, KwaZulu-Natal in 2014. Children aged 0–59 months were included in the study sample. Height for age Z scores were calculated for the children and the spatial clustering was assessed. Results: Of the 572 children included in the weighted analyses, 21.1% (95% confidence intervals (CI) 18.0–24.5) were classified as stunted and of these 7.5% (95% CI 5.3–10.4) were severely stunted. Conclusion: Stunting is a major public health burden in SA that requires intervention at a community level. A multi-sectoral approach is required to reduce stunting prevalence, focusing on child growth and development monitoring, nutrition education and household food security.

Background In many countries, there is evidence that intimate partner violence is prevalent among young women. This study aimed to determine the prevalence and the factors associated with intimate partner violence in young women (aged 15–24 years) attending secondary schools in Maputo, Mozambique. Method Using a probability proportional sampling strategy, 431 participants were recruited, and the data were collected using a self-administered questionnaire. Binary and multivariate logistic regression analyses were performed to assess the association between IPV and sociodemographic and sociocultural factors. Odds ratio (OR) and 95% confidence intervals (CI) are reported. Results Of the 413 participants, 248 (60%) (95% CI: 55.15–64.61) had experienced at least one form of IPV in their lifetime. Then, of the 293 participants who had a partner in the previous 12 months prior to the data collection, 186 (63.4%) (95% CI: 57.68–69.00) reported IPV in the 12 months prior to data collection. The psychological violence was the predominant type of violence, lifetime prevalence 230 (55.7%), and over the previous 12 months 164 (55.9%). The risk of IPV was associated with young women lacking religious commitment (AOR, 1.596, 95% CI: 1.009–2.525, p = 0.046) and if the head of the young women’s household was unemployed (AOR, 1.642 95% CI: 1.044–2.584, p = 0.032). In the bivariate analysis the odds of being abused remained lower among the younger teenage women (OR, 0.458 95% CI: 0.237–0.888, p = 0.021), and higher, among young women if the partner was employed (OR, 2.247 95% CI: 1.187–4.256, p = 0.013) and among the young women believing that males are superior to females (OR, 2.298 95% CI:1.014–5.210. p = 0.046). Conclusion These findings reveal a high prevalence of IPV among young women. Comprehensive programs should incorporate socioeconomic empowerment strategies to increase women’s autonomy. There is a need to address religious beliefs through cultural perspectives, to improve social interactions that promote violence free relationships, gender egalitarian norms, and physical and emotional wellbeing for young women.

Background Knowledge and practices of sexual and reproductive healthcare is pivotal to the Safe Motherhood Initiative; however, only a few studies have investigated adolescent mothers’ knowledge of sexual and reproductive health in light of the above initiative. Research should thus focus on the knowledge and attitudes of adolescent girls as well as peer influences related to pregnancy and sexual and reproductive health among adolescents, as the findings may highlight vital health interventions that should be introduced. The aim of this study was thus to determine the knowledge, personal attitudes and peer influences related to pregnancy, sexual and reproductive health among adolescents who attended maternal health services in a district hospital in Ugu, KwaZulu-Natal, South Africa. Methods A cross sectional study was conducted. Data were collected from 326 adolescents who accessed maternal health services in a peri-urban district hospital during June 2017 and November 2017. The questionnaire surveyed the knowledge, personal attitudes and peer influences related to pregnancy, sexual and reproductive health. The questionnaire was administered by fieldworkers using mobile devices powered by the Mobenzi Researcher® technology. The completed surveys were uploaded to the Mobenzi server where it was stored and aggregated. The data was analysed using R software. Results Of the 326 participants, 65 (19.9%) experienced repeat pregnancies in adolescence. Overall, only 143 (43.9%) of the participants answered 50% or more of the knowledge questions on pregnancy and HIV/AIDS and STIs correctly, while 183 (56.1%) answered less than 50% of the knowledge questions correctly. There was no relationship between knowledge of pregnancy and HIV/STIs and repeat adolescent pregnancies. Conclusion Adolescents’ knowledge of pregnancy and sexual and reproductive health was deficient as, even with repeat pregnancies, these adolescents were evidently no better informed about pregnancy and sexual and reproductive health. This suggests that social determinants, modes and platforms regarding the delivery of adolescent sexual and reproductive health education are important. An innovative mode to the delivery of sexual and reproductive health education includes the emerging digital platform. The digital platform encompasses social media, multimedia and mobile phones which is growing popular among young people. Electronic supplementary material The online version of this article (10.1186/s12889-019-7242-y) contains supplementary material, which is available to authorized users.

Background: Patients play a major role in the success of any antiretroviral treatment (ART) programme. Hence, their needs should be articulated on a regular basis for interventional processes to promote adherence, retention and quality care. Aim: This study investigated whether patients’ needs were being met, described which needs were met, which were not and how such needs could be met. Setting: The study took place at four ART clinics in eThekwini district public hospitals. Methods: This study formed part of a larger study that utilised a sequential mixed-methods design. However, only the qualitative component is documented herein. Twelve HIV-infected patients engaged in in-depth interviews (three patients from each of the four hospitals). A socio-ecological framework divided responses into four categories, namely, the individual, interpersonal, institutional and policy. Each category presented (1) patients’ needs that are being met, (2) needs that are not being met, (3) recommendations on how they can be met and (4) researchers’ observations. Results: All 12 patients reported that all their needs were not being met. They further shared their met needs, unmet needs and made recommendations for meeting their unmet needs. These needs varied per antiretroviral clinic because of unique processes at each institution. Conclusion: To adequately address the needs of HIV-infected patients, it is imperative for all stakeholders involved in the public ART programme to gain an understanding of what constitutes ‘patients’ needs’. The results reflect patients’ willingness to be involved in their care, treatment and interventional strategies to adequately meet their needs.

ObjectivesThis study aimed to measure the prevalence and associated factors of Intimate Partner Violence (IPV) among women living with and without HIV in Wolaita Zone, Southern Ethiopia.MethodsA comparative cross-sectional study design was used to interview the 816 women between 18-49 years of age (408 = HIV positive, 408 = HIV negative). Using a multistage sampling technique, participants were recruited from nine health facilities based on probability proportional to the number of clients. After data entry (EpiData version 4.4.2.0) the data were exported to STATA/SE 15 software. Binary and multivariable logistic regression analysis were undertaken and the odds ratio (OR) and 95% confidence interval (CI) are presented.ResultsThe lifetime prevalence of IPV among all women was 59.7%, [95% CI: 56.31%-63.05%]. IPV was slightly higher among women living with HIV, 250(61.3%), than those who were HIV negative, 238(58.1%). Lifetime prevalence of emotional violence 413(50.6%), physical violence 349(42.8%), sexual violence 219(26.8%), and controlling behaviours by husbands/partners 489(59.9%) were reported. Associations were found between IPV and controlling behaviour of husband/partner [AOR = 8.13; 95% CI: 4.93-13.42],income [AOR = 3.97; 95% CI:1.81-8.72], bride price payment [AOR = 3.46; 95% CI:1.74-6.87], women's decision to refuse sex [AOR = 2.99; 95% CI: 1.39-6.41],age group of women [AOR = 2.86; 95% CI:1.67-4.90], partner's family choosing wife [AOR = 2.83; 95% CI:1.70-4.69], alcohol consumption by partner [AOR = 2.36;95% CI:1.36-4.10], number of sexual partners [AOR = 2.35; 95% CI:1.36-4.09], and if partner ever physically fought with another man [AOR = 1.83; 95% CI:1.05-3.19].ConclusionsThere is a high prevalence of IPV against women both living with and without HIV. Policy priorities should therefore involve males in programs of gender-based violence prevention in order to change their violent behaviour, and interventions are required to improve the economic status of women. Both sexes should be advised to have a single partner and marriage arrangements should be by mutual consent rather than being made by parents.

Background: Sexually transmitted infections (STIs) remain a major public health problem globally, with men being the main transmitters of infections. A high prevalence of curable STIs is reported in adults aged between 15 and 49 years, and the delay in seeking treatment has adverse consequences for both the individual and population.Objective: A study was undertaken to assess the factors associated with the health seeking and sexual behaviour of men presenting with STIs at the two primary health care sites in eThekwini metropolitan area.Method: A cross-sectional study design with systematic random sampling was used. Data were collected using an intervieweradministered questionnaire and analysed using STATA.Results: Some 23% of the 134 participants delayed coming to the clinic after noticing the signs and symptoms of an STI. Participants were 5.89 (95% CI 1.49–23.32) times more likely to delay seeking treatment if they sought medical help only when perceiving an illness to be severe, and three times more likely to delay (borderline result) if they only used a condom when sober (OR 3.16; 95% CI 0.99–10.06). Staff stigma and the bad attitude of nurses were factors that delayed men visiting the clinic for STI treatment and this was reported by 76 (56.7%) of the participants.Conclusion: Delayed health seeking behaviour amongst men with STIs remains a major challenge. Appropriate interventions are required to deal with factors associated with delayed health seeking behaviour amongst men with STIs.

Background. Worldwide, suicide affects the most vulnerable populations, including adolescents and young adults. It is estimated that suicide will contribute more than 2% to the global burden of disease by 2020. Information about the prevalence of suicidal behaviour and the sociodemographic characteristics and risk factors associated with suicide in the South African (SA) rural context is important for local and national policy and contributes to global understanding of the phenomenon. Objective. To investigate key demographic factors and behaviours associated with planning and attempting suicide among high-school learners. Methods. In a cross-sectional study, we used stratified random sampling to select 16 schools in uMgungundlovu District, KwaZulu-Natal Province, SA. All grade 10 learners ( N =1 759) at these schools completed a self-administered questionnaire (Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Surveillance System). Data analysis was carried out with Stata 13 statistical software using generalised estimating equations. Results. In total, 222 learners (12.6% of the 1 759) had made plans to attempt suicide during the previous 12 months, 261 (14.8%) had actually attempted suicide, and 218 attempts had resulted in the learner being treated by a doctor or nurse (12.4%). The risk of planning suicide increased with age. For male learners, being threatened with a weapon on school property (adjusted odds ratio (AOR) 3.7, 95% confidence interval (CI) 1.9 - 7.1; p

Background: Prevention of youth sexual risk behaviour among the youth in uMgungundlovu District Municipality continues to be a primary challenge for public health and health promotion. Current prevention interventions are targeted at an individual level, whilst youth behaviour is influenced by many social and environmental factors.Aim: The aim of the study was to explore the factors influencing sexual risk behaviours of the youth at different socio-ecological levels in uMgungundlovu District Municipality.Methods: An explorative and descriptive qualitative study design was used, using in-depth interviews and focus group discussions for data collection. A framework analysis was used to develop themes derived from the socio-ecological theory.Results: Four themes were identified that influence youth to engage in sexual risk behaviours: (1) individual factors, related to role modelling behaviour, gender and negative stereotypes towards females; (2) the microsystem in which youth function including the influence of family and peers; (3) the exo-system comprising the disadvantaged socio-economic status of the communities where the youth live; and (4) the macrosystem where negative social norms were reported to influence youth health outcomes.Conclusion: Sexual risk behaviour among youth in uMgungundlovu is influenced by many factors at multiple social levels. Interventions directed at these multiple levels are needed urgently.

Background Cervical cancer is a major problem in women and it is important to find a suitable and acceptable screening method, especially among young in low-resource areas for future human papillomavirus (HPV) vaccine follow-up investigations. The study sought to test the acceptability of self-sampling as well as the suitability of the specimen collecting devices. Methods Ninety-eight young women from rural KwaZulu-Natal were enrolled between March and July 2014. Collected genital specimens were transferred to colour indicator cards for HPV detection. Participants answered a questionnaire where they described their experiences with self-sampling. Samples were tested for high-risk HPV using GP5/6+ PCR. Results Of the enrolled participants, 91 answered questionnaires and indicated that self-sampling was preferred by 51/91 (56%) women while 40/91 (44%) indicated preference for sampling by a doctor (p = 0.023). The majority, 64% were comfortable using a swab, 22% preferred a brush while 11% were comfortable with both devices. Of the 98 self-sampled specimens 61 were negative for HPV in both specimens while 37 were HPV-positive in either brush or swab. Of the 37, 26 (70%) were HPV-positive in both brush and swab (kappa = 0.743) and 11 (30%) were discordant. Conclusions Self-sampling was acceptable to the majority of participants in this rural area. The Dacron swab was the preferred device, and can be used in combination with colour indicator cards for comfortable self-sampling, easy storage and transport of specimens plus detection.

Schistosoma haematobium eggs can induce lesions in the urinary and genital tract epithelia, as eggs pass through or get trapped in the tissue. Local inflammatory reactions induced by S. haematobium eggs might affect the ability of bacteria to establish mucosal super-infection foci. S. haematobium infection and asymptomatic bacteriuria can both portray haematuria, proteinuria and leukocyturia. This shared set of proxy diagnostic markers could fuel routine misdiagnosis in S. haematobium endemic areas. Furthermore, S. haematobium infected individuals might be at a higher risk of contracting bacterial urinary tract infections, which could manifest either as symptomatic or asymptomatic bacteriuria. The aim of the current study was to explore whether schistosomal lesions are susceptible to super-infection by bacteria measured as asymptomatic bacteriuria. S. haematobium infection was determined by microscopy of urine samples. Furthermore, urine samples were tested with dipslides for asymptomatic bacteriuria and with dipsticks for haematuria, proteinuria and leukocytes. We found no association between asymptomatic bacteriuria and S. haematobium infection in a sample of 1040 female primary and high school students from a schistosomiasis endemic area in KwaZulu-Natal, South Africa. Furthermore, it was demonstrated that asymptomatic bacteriuria is not a bias for use of micro-haematuria as a proxy diagnostic measure for S. haematobium infection in this population.

Female genital schistosomiasis (FGS) is a highly prevalent waterborne disease in some of the poorest areas of sub-Saharan Africa. Reliable and affordable diagnostics are unavailable. We explored colourimetric image analysis to identify the characteristic, yellow lesions caused by FGS. We found that the method may yield a sensitivity of 83% and a specificity of 73% in colposcopic images. The accuracy was also explored in images of simulated inferior quality, to assess the possibility of implementing such a method in simple, electronic devices. This represents the first step towards developing a safe and affordable aid in clinical diagnosis, allowing for a point-of-care approach.

Background: It has been estimated that 700 million people worldwide and 5.2 million people in South Africa are in need of annual treatment for schistosomiasis. In accordance with the current policy the Department of Health (DoH) in KwaZulu-Natal province, South Africa, aimed to reach 75% treatment coverage in a mass treatment campaign (MTC) of schools in a schistosomiasis-endemic area.Methods: A cross-sectional study was designed to explore the implementation, coverage, challenges and limitations of a DoH MTC in a middle-income country. The study was conducted by exploring nurses’ and research team records, school enrolment lists and parental consent forms.Results: Slightly more than 10 000 learners in 43 primary and high schools were treated, achieving treatment coverage of 44.3%. A median of two schools per day were visited over the course of 39 days. We found that older learners, being male and attending a large school were independent significant predictors for low treatment coverage.Conclusion: Our r...

Background. A predominant feature of Schistosoma haematobium infection is urinary egg excretion, and microscopic egg detection remains the accepted standard field diagnostic tool. Praziquantel is the drug of choice for schistosomiasis, and the World Health Organization recommends that it should be administered to all children >4 years of age living in schistosomiasis-endemic areas. The frequency of mass drug administration depends on the prevalence rate in the community. Urinary schistosome egg output has a day-to-day and hour-to-hour intrasubject variation. Therefore, it is important to assess possible seasonal variations in egg excretion to improve the planning of drug treatment. Objectives. To assess the influence of seasonality on urinary schistosome egg excretion in South Africa (SA). Methods. We performed a prospective cohort study, exploring seasonal variations of S. haematobium egg excretion in 184 girls aged 10 - 12 years from randomly selected schools in a rural area of KwaZulu-Natal Province, SA. The area has a subtropical climate characterised by a cool dry season and a hot humid season. For children, water contact is higher in the latter season. At baseline, 108 girls were examined in the hot season, and 76 in the cold season. In the next year’s cold season the untreated patients were re-investigated before treatment. Results. There was a decrease in infection in the group initially tested in the hot season compared with the group tested in the cold season at both time points when adjusted for age and water contact (adjusted odds ratio 3.61 (95% confidence interval 1.14 - 11.44); p =0.03). Conclusions. This unique study shows that schistosomiasis prevalence determined by microscopy exhibits seasonal variation, with a higher prevalence in the hot rainy season. Precise community prevalence estimations are key in decisions to treat communities. There was significantly lower egg output in the cold season, and sampling in that season may therefore underestimate the prevalence of urinary schistosomiasis. The study indicates that sampling in SA should be done in the hot season.

Background: Youth behaviour in South Africa continues to be a public health concern. Primary prevention interventions remain a pre-requisite for promotion of improved social and health outcomes. Aim: The aim of the study was to assess the impact of a behavioural youth risk reduction intervention among grade 10 learners. Setting: The Study was conducted in KwaZulu-Natal high schools, at UMgungundlovu District Municipality. Methods: We conducted a cluster randomised controlled trial at 16 KwaZulu-Natal high schools where learners completed a self- administered questionnaire assessing youth risk behaviours. Schools were divided into two arms, intervention and a control arms. Results: The intervention reduced learners’ reports of carrying of a weapon to school in the past 30 days, but did not significantly reduce other assessed risk behaviours. Although the intervention appeared more likely to reduce learners’ risk behaviours when compared to the control group, such as carrying weapons, risky sexual behaviour and alcohol and drug abuse. Conclusion: This study was unable to show statistical significance for these outcomes.

Background: Adolescent repeat pregnancy is of importance in public health because the birth of a second child to an adolescent mother compounds the adverse medical, educational, socioeconomic and parenting outcomes. Repeat pregnancy in adolescence is not only an international phenomenon but also a local concern as it also occurs in South Africa. The prevalence of adolescent repeat pregnancy in Durban, KwaZulu-Natal, was reported as 17.6% in 2013. Aim: This review aimed to gather relevant information from national and international sources to inform practice and to provide an understanding of what is known about the risk factors of and the interventions for adolescent repeat pregnancy. Methods: A scoping review was undertaken using the Arksey and O’Malley framework. An electronic search was conducted using PubMed, Medline, Science Direct, Ebscohost, Sage and Wiley Online and Google Scholar. Results: The search identified 3032 citations. After a review of the full text articles, 26 articles met the inclusion criteria. Risk factors pertaining to adolescent repeat pregnancy are categorised according to individual factors, partner relationship factors, family factors, peer factors, and social and community factors. Interventions to reduce adolescent repeat pregnancy have been largely influenced by the ecological framework. Across studies, adolescent mothers who received medical, psychosocial, educational, and family planning support experienced lower rates of repeat pregnancy. Conclusion: A single ‘one-size-fits-all’ intervention for adolescent repeat pregnancy prevention is unlikely as different strategies were employed by the intervention programmes in this scoping review.

Background Anaemia is one of the world’s most prevalent child health problems. Its control in Africa and other developing nations has been hindered by uncertainty regarding its cause. Anaemia control has been particularly problematic in regions where the non-iron deficiency causes of anaemia, are projected to be substantial. The implementation of effective interventions to reduce the anaemia prevalence, requires improved documentation on iron status and other causes of anaemia for target populations. Methods This cross-sectional study enrolled n = 184 children, aged 6–8 years from Kwazulu-Natal, South Africa. Tests of haemoglobin, serum ferritin, soluble transferrin receptor and C-reactive protein were performed. These conventional measures of iron status were used to calculate body iron and to categorize the children into different groups of anaemia profiles. Results Anaemia prevalence was high, 43/184 (23.4%). Iron deficiency anaemia contributed 7/43 (16.3%) to the anaemia prevalence compared to non-iron deficiency anaemia 34/43 (79.1%) and mixed anaemia 2/43 (4.7%). In total 47/184 (25.5%) of the sampled children had either iron deficiency or anaemia. Information about the presence of inflammation was used to adjust serum ferritin concentrations, resulting in improved diagnosis of iron deficiency. Conclusion Appropriate investigations for iron status and inflammation/infection screening, need to be integral in the evaluation of anaemia and its causes before anaemia control interventions are implemented. Interventions that target the multifactorial nature of anaemia in school-aged children need to be strengthened. Additionally, regular screening of anaemia in school-aged children from disadvantaged communities is recommended.

Objective To investigate 6-year-old to 8-year-old children's health, nutritional status and cognitive development in a predominantly rural area of KwaZulu-Natal, South Africa. Methods Cohort study of 1383 children investigating the association of demographic variables (area of residence, sex, pre-school education, HIV status, height for age and haemoglobin level) and family variables (socioeconomic status, maternal and paternal level of education), with children's cognitive performance. The latter was measured using the Grover-Counter Scale of Cognitive Development and subtests of the Kaufman Assessment Battery for Children, second edition (KABC-II). General linear models were used to determine the effect of these predictors. Results Area of residence and height-for-age were the statistically significant factors affecting cognitive test scores, regardless of attending pre-school. Paternal level of education was also significantly associated with the cognitive test scores of the children for all three cognitive test results, whereas HIV status, sex and their socioeconomic status were not. Conclusion Children with low cognitive scores tended to be stunted (low height-for-age scores), lacked pre-school education and were younger. Area of residence and their parents' educational level also influenced their cognition.

BACKGROUND: Research in high-income countries has repeatedly demonstrated that intimate partner violence (IPV) experienced by women negatively affects the health and behavior of children in their care. However, there is little research on the topic in lower- and middle-income countries. The population-based Asenze Study gathered data on children and their caregivers in KwaZulu-Natal, South Africa. This data analysis explores the association of caregiver IPV on child behavior outcomes in children METHODS: This population-based study was set in 5 Zulu tribal areas characterized by poverty, food insecurity, unemployment, and a high HIV prevalence. The Asenze Study interviewed caregivers via validated measures of IPV, alcohol use, caregiver mental health difficulties, and child behavior disorders in their preschool children. RESULTS: Among the 980 caregivers assessed, 37% had experienced IPV from their current partner. Experience of partner violence (any, physical, or sexual) remained strongly associated with overall child behavior problems (odds ratio range: 2.46–3.10) even after age, HIV status, cohabitation with the partner, alcohol use, and posttraumatic stress disorder were accounted for. CONCLUSIONS: Childhood behavioral difficulties are associated with their caregiver’s experience of IPV in this population, even after other expected causes of child behavior difficulties are adjusted for. There is a need to investigate the longer-term impact of caregiver partner violence, particularly sexual IPV, on the health and well-being of vulnerable children in lower- and middle-income countries. Studies should also investigate whether preventing IPV reduces the occurrence of childhood behavior difficulties.

Gender-based violence has serious consequences for the psychological, physical, and sexual well-being of both men and women. Various gender roles, attitudes, and practices in South Africa create an environment that fosters submission and silence in females and hegemony and coercion in males. One of the expressions of this power inequity is a high prevalence of forced sex, which in its turn is associated with higher risk of HIV infection. This study therefore assessed potential gender differences in beliefs about forced sex and in prevalence of reported forced sex among high school students (N = 764) in KwaZulu-Natal. Results showed that significantly more boys were sexually active (26 %) than girls (12 %) and that boys experienced earlier sexual debut by over a year. Boys also held a more positive view about forced sex than girls since they associated it more often with signs of love, as an appropriate way to satisfy sexual urges, and as acceptable if the girl was financially dependent on the boy. The perception that peers and friends considered forced sex to be an effective way to punish a female partner was also more common among boys. On the other hand, boys were less knowledgeable about the health and legal consequences of forced sex, but no significant differences were found for other sociocognitive items, such as self-efficacy and behavioral intention items. Consequently, health education programs are needed to inform both boys and girls about the risks of forced sex, to convince boys and their friends about its inappropriateness and girls to empower themselves to avoid forced sex.

Despite its popularity, few studies have assessed the temporal stability and cross-lagged effects of the Theory of Planned Behavior factors: Attitude, subjective norms and self-efficacy. For this study, 298 adolescent learners from KwaZulu-Natal, South Africa, filled out a Theory of Planned Behavior questionnaire on teenage pregnancy at baseline and after 6 months. Structural equation modeling showed that there were considerable cross-lagged effects between attitude and subjective norms. Temporal stability was moderate with test–retest correlations ranging from 0.37 to 0.51 and the model was able to predict intentions to have safe sex ( R2 = 0.69) Implications for practice and future research are discussed.

A study was done in the Durban Area, South Africa amongst residents (n = 300) of four lower socio-economic housing typologies: Reconstruction and Development Programme (RDP) houses, informal settlements (IS), traditional rural houses (TR) and inner-city apartments (IC). Respondents living in IC were most satisfied with their dwellings, those living in RDP houses and in IS were the least satisfied. People living in the IC perceived their health best, while those living in IS perceived it as worst. Major reasons for dissatisfaction with housing were pest infestation in their dwelling in the past 12 months, inadequate toilet facilities, high temperature, unclean neighbourhood, poor ventilation and dust. Pest infestation and poor ventilation were mentioned most frequently by flat dwellers whilst RDP, IS and TR households complained about inadequate toilet facilities. For many people living in low socio-economic housing, both housing and service provision remain inadequate.

Background. Young people grow up in homes and communities where many are exposed daily to crime and antisocial behaviours. Objective. To investigate the prevalence of violence and the demographic factors associated with such violence among South African (SA)high school learners in the uMgungundlovu District, KwaZulu-Natal, SA. Methods. In a cross-sectional study, we used stratified random sampling to select 16 schools in uMgungundlovu District. All Grade 10 high school learners (N=1 741) completed a self-administered questionnaire (Centers for Disease Control Youth Risk Behavior Survey). Data analysis was carried out using STATA 13 statistical software (Statacorp, USA). Results. Of the participants in this study, 420 (23.9%) had been bullied, 379 (21.7%) had missed school because of feeling unsafe, 468 (15.4%) had been involved in physical fights and 41 (2.4%) had carried weapons to school. There was a significant association between being in a physical fight and missing school (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.9 - 3.3; p

Background Cervical cancer is a major problem in women and it is important to find a suitable and acceptable screening method, especially among young in low-resource areas for future human papillomavirus (HPV) vaccine follow-up investigations. The study sought to test the acceptability of self-sampling as well as the suitability of the specimen collecting devices. Methods Ninety-eight young women from rural KwaZulu-Natal were enrolled between March and July 2014. Collected genital specimens were transferred to colour indicator cards for HPV detection. Participants answered a questionnaire where they described their experiences with self-sampling. Samples were tested for high-risk HPV using GP5/6+ PCR. Results Of the enrolled participants, 91 answered questionnaires and indicated that self-sampling was preferred by 51/91 (56%) women while 40/91 (44%) indicated preference for sampling by a doctor (p = 0.023). The majority, 64% were comfortable using a swab, 22% preferred a brush while 11% were comfortable with both devices. Of the 98 self-sampled specimens 61 were negative for HPV in both specimens while 37 were HPV-positive in either brush or swab. Of the 37, 26 (70%) were HPV-positive in both brush and swab (kappa = 0.743) and 11 (30%) were discordant. Conclusions Self-sampling was acceptable to the majority of participants in this rural area. The Dacron swab was the preferred device, and can be used in combination with colour indicator cards for comfortable self-sampling, easy storage and transport of specimens plus detection.

Objective. To investigate whether targeted chemotherapy can reduce parasite prevalence rates in rural black preschool children.Design. The study consisted of a before/after trial. Stool and urine samples were analysed on four occasions over a 21-week period.Setting. Creches in two rural areas of southern _ Kwazulu/Natal (coastal and inland). Patients. Two hundred children of 4 - 6 years of age attending 19 creches in the area. Intervention. Targeted chemotherapy using albendazole for nematode infestations, praziquantel for trematode and cestode infestations and metronidazole for protozoal infections was administered twice at an interval of 14 weeks.Main outcome measure. Prevalence rates.Results. The prevalences of Ascaris lumbricoides, Trichuris trichiura and Necator americanus infestation decreased significantly after treatment. Reinfestation rates 12 weeks after treatment were 16% for A lumbricoides, 33% for T. trichiura, 24% for Giardia lamblia and 3% for N. americanus. No reinfestation was noted for Schistosoma haematobium, Hymenolepsis or Taenia species.Conclusion. The study suggests that parasite prevalence rates in children can be reduced by the administration of appropriate chemotherapy at regular intervals. However, the provision of clean water and adequate sewerage facilities remains a high priority for black communities living in rural areas of South Africa.

This document is one important step in a process for improving access to quality of care in family planning by reviewing the medical eligibility criteria for selecting methods of contraception. It updates the third edition of Medical eligibility criteria for contraceptive use published in 2004 and summarizes the main recommendations of an expert Working Group meeting held at the World Health Organization Geneva 1-4 April 2008. (Please see Annex 2 for the list of participants.) The Working Group brought together 43 participants from 23 countries including nine agency representatives. The document provides recommendations for appropriate medical eligibility criteria based on the latest clinical and epidemiological data and is intended to be used by policy-makers family planning programme managers and the scientific community. It aims to provide guidance to national family planning/reproductive health programmes in the preparation of guidelines for service delivery of contraceptives. It should not be seen or used as the actual guidelines but rather as a reference. The document covers the following family planning methods: low-dose combined oral contraceptives (COCs) combined patch (P) combined vaginal ring (R) combined injectable contraceptives (CICs) progestogen-only pills (POPs) depot medroxyprogesterone acetate (DMPA) norethisterone enantate (NET-EN) levonorgestrel (LNG) and etonogestrel (ETG) implants emergency contraceptive pills (ECPs) copper-bearing intrauterine devices (Cu-IUDs) levonorgestrel-releasing IUDs (LNG-IUDs) copper-IUD for emergency contraception (E-IUD) barrier methods (BARR) fertility awareness-based methods (FAB) lactational amenorrhoea method (LAM) coitus interruptus (CI) and female and male sterilization (STER). WHO will update and add to the recommendations in this document at appropriate intervals through expert Working Group meetings every three to four years and through input from its family planning Guidelines Steering Group on an as-needed basis. These recommendations will be made available on the WHO web site (www.who.int/reproductivehealth). The web site will also provide additional information determined by WHO to be relevant to these recommendations pending the next formal consensus Working Group meeting. Such updates may be particularly warranted for issues where the evidence base may change rapidly. WHO encourages research to address key unresolved issues for establishing medical eligibility criteria for contraceptive use. WHO also invites comments and suggestions for improving this guidance.

Background Dichlorodiphenyltrichloroethane (DDT) has been the centre of debate for several decades with a global call for a ban on its use, while organophosphates (OP) and pyrethroids are used extensively in agriculture. Both DDT, OPs and pyrethroids are being used extensively in South Africa in malaria control and small-scale agriculture. There is limited information from Africa on the adverse associations between DDT, OPs, pyrethroids and reproductive and neurobehavioural health outcomes. Aim The aim of this study is to identify the impact of DDT, OP and pyrethroid exposure on the reproductive health of pregnant women and the neurobehavioural health outcomes of their offspring. Method This longitudinal study with a 3 year follow-up period is being conducted in the uMkanyakude (exposed population) and uMgungundlovu (unexposed population) districts of KwaZulu-Natal, South Africa. A total of 350 pregnant women attending antenatal clinics at the district hospital and respective primary health clinics will be recruited (February – December 2016) and followed for 3 years. Maternal interviews (demographic, exposure and health data), and biomonitoring of exposure to pesticide (urine and blood) will take place at recruitment and annually for the duration of the study. Infant clinical and neurobehavioural assessments together with direct home observations to assess child development will take place. Biomonitoring of exposure to DDT, OPs and pyrethroids will take place at birth and annually for the duration of the study. Results and discussion Data is currently being collected and information from the baseline recruitment interviews will be presented for the available women. Demographic, occupational and environmental pesticide exposure together with reproductive histories will be presented for the recruited cohort. This study will contribute knowledge on the relationship between DDT, OPs, pyrethroids and reproductive and neurobehavioural health outcomes in an African population.

The HIV prevalence among young South African adults makes it important to understand their HIV knowledge, sexual behaviour and HIV counselling and testing (HCT) behaviour in this group. This paper presents the demographics, knowledge, sexual behaviour and cues to action as reported by sexually active students’ who had HCT. A cross-sectional study conducted in 10 high schools in the eThekwini and Ugu districts, KwaZulu-Natal, surveyed students’ HIV knowledge, sexual behaviour and HCT behaviour. Complete information was available from 1 114 (97.9%) students who participated in the survey. Of these, 378 (33.9%) were sexually active and were included in this analysis. Logistic regression models tested for significant associations between the independent and the dependent variables under study, nesting the students within schools and controlling for age, sex, grade and school location (urban/rural).The median age of students was 17 years (range: 14–23 years) with most being male (n = 287; 75.9%). The lifetime median number of sexual partners of students was 3 (range: 1–27). Students who used condoms with their regular partners were more likely to have had counselling for HIV (OR :1.79; 95% CI: 1.06–3.01). Those students who were more likely to have been tested for HIV were female (OR: 44.90; 95% CI: 7.77–259.38), those who had always used a condom with their non-regular partner (OR: 2.75; 95% CI: 1.01–7.47), and those who knew a person who had tested for HIV (OR: 15.28; 95% CI: 5.16–45.23). Targeting students, especially males early in adolescence and reinforcing safe sex behaviour messages through their high school years, can encourage HCT among students.Keywords: HCT, pregancy, regular partner, voluntary

This study aimed to investigate the health related quality of life (HRQoL) of people living in lower socio-economic areas comparing HIV positive on anti-retroviral treatment (ART) and HIV negative respondents and investigating the factors associated with their HRQoL. In total 600 respondents in eThekwini, KwaZulu-Natal were included from both phase one (household sample) and phase two (clinic sample). The Euro Quality of life (EQ 5D) instrument and the Visual Analogue Score (EQ-VAS) were used. The majority of the respondents (79.0 %) were females, and those who were HIV positive on ART were younger than those who were HIV negative, mean age [34.8 years (8.85 SD) vs. 37.1 years (14.65 SD; HIV negative females; p = 0.02)]. Males with a higher perceived quality of health-score > 50 % were two and a half times more likely to have attended high school and to experience no pain/discomfort when compared to those reporting pain/discomfort (OR 0.32, 95 % CI 0.16, 0.64). The odds of females reporting problems with their mobility and usual activities compared to no such problems, were associated with lower EQ VAS scores [OR 2.10 (1.20, 3.67) and OR 2.22 (1.21, 4.08)], respectively. For both HIV positive respondents on ART and HIV negative respondents living in lower socio economic housing, interventions are needed to reduce the prevalence of pain/discomfort, and increase their mobility and ability to engage in their usual activities in order to improve their HRQol. Further, more longitudinal studies are required.

Background More than 260 million people live with schistosomiasis and regular mass-treatment should be implemented to prevent morbidity. Praziquantel, dosed at 40 milligrams per kilogram bodyweight, is the drug of choice. During the last decades the WHO Tablet Pole–which estimates tablet need by height as representing weight–has been used as a practical and cheap tool in mass treatment. In South Africa this method could be inaccurate given the prevalence of overweight and obesity. In this study in female pupils in KwaZulu-Natal, South Africa, we explored the accuracy of the WHO Tablet Pole and the recently developed Modified Dose Pole for adults with two additional intervals and correction for body mass index (BMI). Methodology In randomly selected primary and secondary schools of schistosomiasis-endemic areas, height and weight of female pupils were measured. The WHO Tablet Pole and Modified Dose Pole were used to indicate the amount of praziquantel according to height and the dose in milligrams per kilogram bodyweight was calculated. The BMI correction was performed by adding 600 milligrams (1 tablet) to the indicated dose if a person was overweight/obese. Principal Findings 3157 female students were investigated and 35% were found to be overweight/obese. Using the WHO Tablet Pole, 73% would have received an adequate dose (range 30–60 mg/kg). When correcting for BMI, this would have been 94%. Using the Modified Dose Pole with BMI correction, 97% would have been adequately treated. Conclusions This study shows that the WHO Tablet Pole will be inaccurate in estimating the dose of praziquantel in South African girls due to high prevalence of overweight/obesity. Under-dosing of individuals who appear overweight/obese could be largely prevented by adding an extra praziquantel tablet to the recommended dose. Further research must be done to explore if subjective weight estimates are reliable., Author Summary Schistosomiasis is an acute and chronic parasitic disease caused by Schistosoma worms, contributing to morbidity and mortality in 261 million people, mainly in poor, rural communities. In an effort to control schistosomiasis, the World Health Organization advocates for regular mass treatment to at-risk populations, administering free praziquantel (40mg/kg). The WHO Tablet Pole, which estimates the number of tablets for each individual by height, is recommended for the dosing of praziquantel. A Modified Dose Pole with two additional height intervals has been developed for adults. In addition, the developers of the Modified Dose Pole suggest to add an extra tablet to the indicated dose if the person appears to be overweight/obese (“correction for body mass index (BMI)”). This study explored the accuracy of these dose pole programmes in 3157 school-girls in schistosomiasis-endemic KwaZulu-Natal, South Africa. Overweight or obesity was found in 35% of the study population. With the WHO Tablet Pole, only 73% would have received an acceptable dose (30-60mg/kg), whereas when correcting for overweight/obesity almost all the girls would have been adequately treated. We suggest adding one tablet to the dose recommended by the WHO Tablet Pole if a person appears to be overweight/obese to prevent under-dosing of these individuals.

Objectives. To investigate prevalence and the factors influencing substance use among rural high school pupils in KwaZulu-Natal in order to develop and implement intervention programmes.Design. Cross-sectional study.Setting. Twenty-eight high schools in southern KwaZulu-Natal.Subjects. One thousand three hundred and eighteen grade 10 pupils.Outcome measures. An anonymous self-reporting questionnaire was used to investigate the use of alcohol, tobacco (cigarettes), cannabis and solvents.Results. Of the male scholars, 52.9% (95% confidence interval (CI): 45.4- 60.3) reported ever using alcohol, 16.9% (CI: 11.5 - 24.0) reported using cannabis, and 13.1% (CI: 7.2 - 22.5) had smoked more than one cigarette daily. Among male pupils 45.5% (CI: 38.6- 52.6) had inhaled benzine and 34.6% (CI: 28.0- 41.8), thinners; 7.4% (CI: 3.4 - 15.2) had used cocaine and 4.1% (CI: 1.0 - 10.6), crack. Female pupils reported significantly less use of alcohol (25.5%, CI: 17.6 - 35.3), cannabis (2.3%, CI: 1.3 - 4.1), cigarettes (more than one daily) (2.0%, CI: 1.0 - 4.1), and inhalation of benzine (18.8%, CI: 13.8 - 25.2) and thinners (10.8%, CI: 7.2 - 16). Logistical regression indicated that the odds of smoking cigarettes increased significantly (p < 0.0005) with use of the other substances.Conclusion. The results of this study confirm the prevalence of multi-substance use among pupils at the majority of rural high schools in this district and the need for targeted interventions to reduce/prevent this.

The South African National School Health Policy was launched in 2003 to improve pupils' health by linking school visits by nurses and other health providers with the intersectoral collaboration required for health promoting schools. In KwaZulu-Natal, the policy required that various parties collaborate in order to ensure the successful implementation of the policy. This study examines the status of provincial departments and district level groups and their capacity to contribute to this partnership. It is a situational analysis that includes interviews, a questionnaire and focus group discussions. The results reveal issues that need addressing before the policy can be successfully implemented, including staffing, transport for the School Health Teams and further training of these teams and the teachers. Given the health issues faced by South Africans, especially the quadruple burden of disease, it is imperative that the School Health Policy be comprehensively implemented in KwaZulu-Natal.