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Universities have been stricken by gender-based violence (GBV). The high prevalence of GBV within universities is clear evidence of attacks on educational settings. To address GBV, universities have adopted policies that focus on deterring its occurrence. Shockingly, GBV incidents continue to manifest within universities despite these policies. This study aims to explore stakeholders' and survivors’ perceptions of the effectiveness of the adopted university policy in managing GBV at the University of Fort Hare. The rational choice theory (RCT) underpins this study, informing how university policies should be implemented to effectively manage GBV. A qualitative approach, supported by an exploratory design, was employed to gain nuanced insights from participants’ perspectives. In gathering data, ten purposefully sampled participants (two survivors of GBV, staff members from the GBV unit, counselling unit, HIV unit, and South African Police Service (SAPS) members) were interviewed one-on-one through semi-structured interviews. Data was analysed thematically. Findings based on participants’ perceptions revealed that the UFH harassment, sexual harassment, and GBV policy fails to effectively manage and avert GBV at the UFH, there is poor policy implementation regarding the reporting of GBV cases, a failure to execute justice in GBV cases, and inadequate support for survivors of GBV. Based on the research findings, we recommend strengthening university policies, establishing confidential and accessible reporting channels, conducting ongoing policy evaluations, and adopting multi-sectoral approaches to better manage GBV within university campuses. Such measures would help create a more supportive and accountable environment free from GBV.

Abstract Background Hybrid immunity provides better protection against COVID-19 than vaccination or prior natural infection alone. It induces high magnitude and broadly cross-reactive neutralising anti-Spike IgG antibodies. However, it is not clear how long these potent antibodies last, especially in the context of adenovirus-based COVID-19 vaccines. Methods We conducted a longitudinal cohort study and enrolled 20 adults who had received an adenovirus-based COVID-19 vaccine before a laboratory-confirmed SARS-CoV-2 infection. We followed up the study participants for 390 days post the initial breakthrough infection. We assessed the longevity and cross-reactive breadth of serum antibodies against SARS-CoV-2 variants of concern (VOCs), including Omicron. Results The binding anti-Spike IgG antibodies remained within the reported putative levels for at least 360 days and were cross-neutralising against Beta, Gamma, Delta, and Omicron. During the follow up period, a median of one SARS-CoV-2 re-infection event was observed across the cohort, but none resulted in severe COVID-19. Moreover, the re-exposure events were associated with augmented anti-Spike and anti-RBD IgG antibody titres. Conclusions This study confirms that hybrid immunity provides durable broadly cross-reactive antibody immunity against SARS-CoV-2 variants of concern for at least a year (360 days), and that it is further augment by SARS-CoV-2 re-exposure.

Abstract We present metagenomes of 16 samples of water and sediment from two lakes, collected from eutrophic and non-eutrophic areas, including pooled samples enriched with phosphate and nitrate. Additionally, we assembled 167 bacterial metagenome-assembled genomes (MAGs). These MAGs were de-replicated into 83 unique genomes representing different species found in the lakes. All the MAGs exhibited >70% completeness and 90%), while 54 falling within 80–90% range and 34 between 75–80% complete. The most abundant MAGs identified across all samples were Proteobacteria (n = 80), Firmicutes_A (n = 35), Firmicutes (n = 13), and Bacteriodota (n = 22). Other groups included Desulfobacteria_I (n = 2), Verrucomicrobiota (n = 4), Campylobacterota (n = 4) and Actinobacteriota (n = 6). Importantly, phylogenomic analysis identified that approximately 50.3% of the MAGs could not be classified to known species, suggesting the presence of potentially new and unknown bacteria in these lakes, warranting further in-depth investigation. This study provides valuable new dataset on the diverse and often unique microbial communities living in polluted lakes, useful in developing effective strategies to manage pollution.

PURPOSEWomen living with HIV (WLWH) experience decreased breast cancer survival. We sought to determine whether WLWH surviving breast cancer also experienced different quality of life (QOL) gain.METHODSWomen who enrolled in the Thabatse Cancer Cohort across oncology centers in Botswana for the initial treatment of stage I-III breast cancer from October 2010 to February 2022 were included. Exclusion criteria were no documented definitive therapy and incomplete data at treatment end or 24 ± 3 months after treatment. QOL was measured quarterly using the SF-8 questionnaire. G methods using weighted exposure and outcome modules were used to mitigate potential bias from imbalances in demographic and cancer characteristics by HIV status. Primary analysis was change in physical component summary (PCS) and mental component summary (MCS) from treatment end to 24 months after treatment for WLWH compared with women without HIV.RESULTSOf 603 women enrolled, the final analysis included 298, comprising 85 WLWH and 213 women without HIV. Most common reasons for exclusion were no documented definitive treatment (n = 114) and death before 21 months after treatment (n = 137). WLWH were younger, were less wealthy, and had more estrogen receptor/progesterone receptor positive tumors. Overall, PCS and MCS significantly increased from treatment end to 24 months after treatment, from 50.8 to 52.8 and 51.8 to 53.7, respectively. There was no difference in the change of the PCS or MCS with HIV infection, 2.2 (95% CI, –0.4 to 4.9) and 0.6 (95% CI, –1.7 to 2.9), respectively.CONCLUSIONHIV infection did not impede QOL gain at 24 months after treatment in women surviving breast cancer. Further work is needed to clarify the role of HIV on specific treatment-related morbidities and in other malignancies.

The study presents for the first time complex spinel NiFe2O4 nanoparticles supported on nitrogen and phosphorus co-doped carbon nanosheets (NPCNS) prepared using sol gel and the carbonization of graphitic carbon nitride with lecithin as a highly active and durable electrocatalyst for oxygen reduction reaction. The physicochemical properties of complex spinel NiFe2O4 on NPCNS and subsequent nanomaterials were investigated using techniques such as X-ray diffraction, Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, and transmission electron microscopy. The electrochemical activity of the electrocatalysts was evaluated using hydrodynamic linear sweep voltammetry, cyclic voltammetry, electrochemical impedance spectroscopy, and chronoamperometry. The electrocatalytic performance of the NiFe2O4/NPCNS nanohybrid electrocatalyst is dominated by the 4e− transfer mechanism, with an onset potential of 0.92 V vs. RHE, which is closer to that of the Pt/C, and a current density of 7.81 mA/cm2 that far exceeds that of the Pt/C. The nanohybrid demonstrated the best stability after 14 400 s, outstanding durability after 521 cycles, and the best ability to oxidize methanol and remove CO from its active sites during CO tolerance studies. This improved catalytic activity can be attributed to small nanoparticle sizes of the unique complex spinel nickel ferrite structure, N-Fe/Ni coordination of nanocomposite, high dispersion, substantial ECSA of 47.03 mF/cm2, and synergy caused by strong metal-support and electronic coupling interactions.

Background Men who have sex with men (MSM) in Kenya continue to face barriers to HIV testing, which leads to delays in HIV prevention and care. An HIV self-testing (HIVST) intervention was implemented in three Kenyan counties to increase coverage and frequency of HIV testing among MSM communities with high HIV prevalence. The evaluation study examined how HIVST can increase testing among MSM who are unaware of their status by increasing coverage, frequency, and early uptake of testing and support linkages to prevention and treatment. We share results from the process evaluation of the intervention implemented in partnership with MSM-led organizations. Methods For a 12-month period between August 2019 and July 2020, the project team conducted in-depth interviews with HIVST users, monthly meetings with programme implementation teams, and monthly monitoring data reviews. Polling booth surveys were also conducted with participants. The process evaluation explored the fidelity, feasibility, coverage, acceptability, quality, and effectiveness of the HIVST intervention. Results An average of 793 MSM received 1,041 HIVST kits on a monthly basis through different distribution channels. Of those who received HIVST kits, 67% were distributed to infrequent testers and non-testers. Testing frequency among users increased to 82% for those who had a recent test during the previous three months, compared to 58% of HIVST non-users. There was a high linkage to care and treatment services (84%) among those who tested reactive for HIV at endline. MSM shared preferring HIVST kits because of its convenience and privacy. During the COVID-19 pandemic, adaptations to the intervention were made to support ongoing HIV testing and linkages to services. Conclusion The introduction of HIVST in MSM-led HIV prevention programmes was feasible with high acceptability. The involvement of the MSM community in the design, implementation and evaluation of the intervention was a key factor to intervention success.

Summary: Background: Treatment-simplification strategies are important tools for patient-centred management. We evaluated long-term outcomes from a PI monotherapy switch strategy. Methods: Eligible participants attending 43 UK treatment centres had a viral load (VL) below 50 copies/ml for at least 24 weeks on combination ART. Participants were randomised to maintain ongoing triple therapy (OT) or switch to a strategy of physician-selected PI monotherapy (PI-mono) with prompt return to combination therapy if VL rebounded. The primary outcome, previously reported, was loss of future drug options after 3 years, defined as new intermediate/high level resistance to at least one drug to which the participant's virus was considered sensitive at trial entry. Here we report resistance and disease outcomes after further extended follow-up in routine care. The study was registered as ISRCTN04857074. Findings: We randomised 587 participants to OT (291) or PI-mono (296) between Nov 4, 2008, and July 28, 2010 and followed them for a median of more than 8 years (100 months) until 2018. At the end of this follow-up time, one or more future drug options had been lost in 7 participants in the OT group and 6 in the PI-mono group; estimated cumulative risk by 8 years of 2.7% and 2.1% respectively (difference −0.6%, 95% CI −3.2% to 2.0%). Only one PI-mono participant developed resistance to the protease inhibitor they were taking (atazanavir). Serious clinical events (death, serious AIDS, and serious non-AIDS) were infrequent; reported in a total of 12 (4.1%) participants in the OT group and 23 (7.8%) in the PI-mono group (P = 0.08) over the entire follow-up period. Interpretation: A strategy of PI monotherapy, with regular VL monitoring and prompt reintroduction of combination treatment following rebound, preserved future treatment options. Findings confirm the high genetic barrier to resistance of the PI drug class that makes them well suited for creative, patient-centred, treatment-simplification approaches. The possibility of a small excess risk of serious clinical events with the PI monotherapy strategy cannot be excluded. Funding: The National Institute for Health Research Health Technology Assessment programme.

Abstract Background There is limited data on client preferences for different HIV self-testing (HIVST) and provider-delivered testing options and associated factors. We explored client preferences for oral-fluid-based self-testing (OFBST), blood-based self-testing (BBST) and provider-delivered blood-based testing (PDBBT) among different populations. Methods At clinics providing HIV testing services to general populations (1 urban, 1 rural clinic), men seeking voluntary medical male circumcision (VMMC, 1 clinic), and female sex workers (FSW, 1 clinic), clients had the option to test using OFBST, BBST or PDBBT. A pre-test questionnaire collected information on demographics and testing history. Two weeks after collecting a self-test kit, participants responded to a questionnaire. We used logistic regression to determine predictors of choices. We also conducted 20 in-depth interviews to contextualise quantitative findings. Results May to June 2019, we recruited 1244 participants of whom 249 (20%), 251 (20%), 244 (20%) and 500 (40%) were attending urban general, rural, VMMC and FSW clinics, respectively. Half (n = 619, 50%) chose OFBST, 440 (35%) and 185 (15%) chose BBST and PDBBT, respectively. In multivariable analysis comparing those choosing HIVST (OFBST and BBST combined) versus not, those who had never married aOR 0.57 (95% CI 0.34–0.93) and those previously married aOR0.56 (0.34–0.93) were less likely versus married participants to choose HIVST. HIVST preference increased with education, aOR 2.00 (1.28–3.13), 2.55 (1.28–5.07), 2.76 (1.48–5.14) for ordinary, advanced and tertiary education, respectively versus none/primary education. HIVST preference decreased with age aOR 0.97 (0.96–0.99). Urban participants were more likely than rural ones to choose HIVST, aOR 9.77 (5.47–17.41), 3.38 (2.03–5.62) and 2.23 (1.38–3.61) for FSW, urban general and VMMC clients, respectively. Comparing those choosing OFBST with those choosing BBST, less literate participants were less likely to choose oral fluid tests, aOR 0.29 (0.09–0.92). Conclusions Most testing clients opted for OFBST, followed by BBST and lastly, PDBBT. Those who self-assessed as less healthy were more likely to opt for PDBBT which likely facilitated linkage. Results show importance of continued provision of all strategies in order to meet needs of different populations, and may be useful to inform both HIVST kit stock projections and tailoring of HIVST programs to meet the needs of different populations.

Abstract Student engagement is critical for meaningful learning and can be impacted by teaching methods, tools, and course content. Online student engagement continues to be challenging because online classes offer fewer ways to engage with professors, peers, and the university than in-person classes. PlayPosit is a video teaching tool that incorporates questions to check for understanding. Our study aimed to evaluate how a PlayPosit guided group project impacted engagement in a structured online learning environment. For this qualitative study, a PlayPosit guided group project was implemented in an online undergraduate course taught via Canvas learning management system. Engagement was evaluated using online course analytics and student’s written feedback. Canvas reports were analyzed using descriptive statistics, and students’ written feedback was analyzed using directed content analysis. All 29 students enrolled in the course completed the course successfully. They completed 99.3% of the PlayPosit activities with accuracy 87.6–100% and completed the course project with scores 89–100%. Student comments were grouped into themes related to PlayPosit, group project, and engagement. Students found PlayPosit activities helpful/beneficial, aligned with deliverables, a great learning resource, and enjoyable. Students recognized the group project for its importance in teaching them collaboration, expressed that it enabled them to learn more from each-other, was an enjoyable networking experience, and was challenging. Engagement themes included knowledge gained was applicable to the real world, the course stimulated higher-order thinking, and the course was enjoyable and kept students wanting more. This study suggested that a PlayPosit guided group project was well-received by students and contributed to high engagement with the content, peers, and the professor.

Access to water is a universal human right for every individual and a key instrument in meeting the United Nations’ sustainable development goal SDG 6, namely, to ensure safe drinking water and sanitation for all by 2030. Water is also intrinsically linked to any society or country's social, economic and political development. Nevertheless, many communities and households, predominantly rural and underprivileged in the Nelson Mandela Metropolitan Municipality, continue to experience persistent water shortages. This means entrenched poverty, ill health, hunger, stress, and social and economic challenges for the population. Using data collection tools inspired by traditional methods of qualitative and quantitative approaches, this paper scrutinised the social and economic factors contributing to severe inequality in water access in the municipality. Our findings established that water shortage is portrayed as a stand-alone issue without linking it to social and economic challenges. Furthermore, both government and municipalities fail to contextualise a multidimensional problem-solving approach to the water provision challenges in the municipality. This paper, therefore, recommends a multidimensional approach to tackling the problem of accessibility, taking into consideration the social and economic needs of the population. HIGHLIGHTS This paper highlights the inequalities of water provision in Nelson Mandela Metropolitan Municipality.; While some households enjoy uninterrupted access to a reliable water supply, other marginalised communities face regular water shortages or lack access altogether.; The uneven distribution of water resources exacerbates social and economic inequalities within the municipality.;

Progesterone (P4) and cortisol production increase in luteinized granulosa cells (LGCs) during the periovulatory period, but their interaction is not well established. Therefore, we investigated their interaction in cultured bovine LGCs. Granulosa cells were collected from follicles of 2–5 mm in diameter and cultured in DMEM/F-12 supplemented with 10% fetal calf serum for up to 14 days. P4 production and the expression of steroidogenic acute regulatory protein (STAR), cholesterol side-chain cleavage enzyme (CYP11A1), and 3β-hydroxysteroid dehydrogenase type 1 (HSD3B1) rapidly increased until day 10 and remained high thereafter. No de novo production of cortisol from P4 was detected during the culture period. The expression of 11β-hydroxysteroid dehydrogenase type 1 (HSD11B1), which converts cortisone to cortisol, increased dramatically on day two, decreased until day 8, and remained relatively constant. To investigate how P4 and cortisol influence each other’s production, LGCs were treated with trilostane (a P4 synthesis inhibitor), nomegestrol acetate (NA, a synthetic progestogen), P4, and/or cortisol for 24 h on days 6 and 12 of culture. Trilostane suppressed P4 and STAR expression while elevating HSD11B1 and HSD3B1 expression and cortisol production. Concomitant treatment with NA or P4 dose-dependently decreased cortisol production and HSD11B1 and HSD3B1 expression but elevated STAR expression in both days 6 and 12. Conversely, cortisol treatment increased HSD11B1 and HSD3B1 expression and decreased STAR expression without influencing P4 production. These results indicate that progestogens suppress cortisol production by modulating HSD11B1 expression and that progestogens and cortisol differentially regulate STAR, HSD3B1, and HSD11B1 expression in bovine LGCs.

Different stages of drinking water treatment plants (DWTPs) play specific roles in diverse contaminants’ removal present in natural water sources. Although the stages are recorded to promote adequate treatment of water, the occurrence of pathogenic bacteria (PB) and antibiotic-resistant bacteria (ARB) in the treated water and the changes in their diversity and abundance as it passed down to the end users through the drinking water distribution systems (DWDSs), is a great concern, especially to human health. This could imply that the different stages and the distribution system provide a good microenvironment for their growth. Hence, it becomes pertinent to constantly monitor and document the diversity of PB and ARB present at each stage of the treatment and distribution system. This review aimed at documenting the occurrence of PB and ARB at different stages of treatment and distribution systems as well as the implication of their occurrence globally. An exhaustive literature search from Web of Science, Science-Direct database, Google Scholar, Academic Research Databases like the National Center for Biotechnology Information, Scopus, and SpringerLink was done. The obtained information showed that the different treatment stages and distribution systems influence the PB and ARB that proliferate. To minimize the human health risks associated with the occurrence of these PB, the present review, suggests the development of advanced technologies that can promote quick monitoring of PB/ARB at each treatment stage and distribution system as well as reduction of the cost of environomics analysis to promote better microbial analysis.

BackgroundUnderstanding how HIV affects SARS-CoV-2 immunity is crucial for managing COVID-19 in sub-Saharan populations due to frequent coinfections. Our previous research showed that unsuppressed HIV is associated with weaker immune responses to SARS-CoV-2, but the underlying mechanisms are unclear. We investigated how pre-existing T cell immunity against an endemic human coronavirus HCoV-NL63 impacts SARS-CoV-2 T cell responses in people living with HIV (PLWH) compared to uninfected individuals, and how HIV-related T cell dysfunction influences responses to SARS-CoV-2 variants.MethodsWe used flow cytometry to measure T cell responses following PBMC stimulation with peptide pools representing beta, delta, wild-type, and HCoV-NL63 spike proteins. Luminex bead assay was used to measure circulating plasma chemokine and cytokine levels. ELISA and MSD V-PLEX COVID-19 Serology and ACE2 Neutralization assays were used to measure humoral responses.ResultsRegardless of HIV status, we found a strong positive correlation between responses to HCoV-NL63 and SARS-CoV-2. However, PLWH exhibited weaker CD4+ T cell responses to both HCoV-NL63 and SARS-CoV-2 than HIV-uninfected individuals. PLWH also had higher proportions of functionally exhausted (PD-1high) CD4+ T cells producing fewer proinflammatory cytokines (IFNγ and TNFα) and had elevated plasma IL-2 and IL-12(p70) levels compared to HIV-uninfected individuals. HIV status didn’t significantly affect IgG antibody levels against SARS-CoV-2 antigens or ACE2 binding inhibition activity.ConclusionOur results indicate that the decrease in SARS-CoV-2 specific T cell responses in PLWH may be attributable to reduced frequencies of pre-existing cross-reactive responses. However, HIV infection minimally affected the quality and magnitude of humoral responses, and this could explain why the risk of severe COVID-19 in PLWH is highly heterogeneous.

The last decades have seen a shift towards activation policies in welfare states, such as the introduction programme for refugees in Norway, a qualification programme that seeks to prepare refugees for the labour market. In the last decade, the programme has placed further focus on refugees’ duties rather than their rights, as it had previously done. This article examines the strategies that work counsellors in the introduction programme use to ‘activate’ and assist newly arrived refugees as they prepare to enter the Norwegian labour market. We focus on how work counsellors guide and motivate refugees in this process. We draw on 10 semi-structured interviews with work counsellors in various municipalities in southwestern Norway. We suggest that the activating strategies used by the work counsellors may be seen as a form of aspirations management to get the refugees to shift their aspirations toward those the work counsellors see as more achievable within a shorter period, to get them more quickly into the labour market. We suggest that unchecked power dynamics, together with increasing time-pressure on work counsellors, may be at play leading them to exert too much influence, and leading to user involvement practice not being properly implemented.

Abstract Background Adolescent girls and young women (AGYW) are at high risk of contracting HIV and exchanging sex for financial or material support heightens their risk. In Zimbabwe, the DREAMS initiative integrated education and employment opportunities within HIV health promotion and clinical services for vulnerable young women, including those who sell sex. While most participants accessed health services, fewer than 10% participated in any social programmes. Methods We conducted semi-structured qualitative interviews with 43 young women aged 18–24 to understand their experiences of engaging with the DREAMS programme. We purposively sampled participants for diversity in level of education, type and location of selling sex. We analysed the data by applying the Theoretical Domains Framework to explore facilitators and barriers to engaging with DREAMS. Results Eligible women were motivated by hopes of escaping poverty, and their longer-term engagement was sustained through exposure to new social networks, including friendships with less vulnerable peers. Barriers included opportunity costs and expenses such as transport or equipment required for job placements. Participants also described pervasive stigma and discrimination related to their involvement in selling sex. Interviews highlighted the young women’s struggles in a context of entrenched social and material deprivation and structural discrimination that hindered their ability to take up most of the social services offered. Conclusions This study demonstrates that while poverty was a key driver of participation in an integrated package of support, it also constrained the ability of highly vulnerable young women to benefit fully from the DREAMS initiative. Multi-layered HIV prevention approaches such as DREAMS that seek to alter complex and longstanding social and economic deprivation address many of the challenges faced by YWSS but will only succeed if the underlying drivers of HIV risk among YWSS are also addressed.

Malawi, as a low-income country in southeastern Africa, severely lacks early identification, diagnosis and intervention measures for hearing loss. Due to its constrained resources, an educational awareness campaign targeted at professionals can be a cost-effective instrument in promoting good health care through awareness, prevention, and early identification of hearing loss. The aim of this study is to assess school teachers’ knowledge of hearing health, audiology services, identification, and management of hearing issues before and after an educational intervention. Methods: A Pre-Survey, followed by an educational intervention, and a Post-Survey were completed by teacher participants. A similar World Health Organization-derived survey was also administered to compare to our locally adapted survey. Trends related to efficacy, performance, and survey improvement were evaluated. Results: A total of 387 teachers participated. The average score on the Post-Survey was significantly improved compared to the Pre-Survey (71% to 97% correct responses) with the educational intervention. The only predictive variable related to performance was the location of the school within the capital of Lilongwe compared to rural sites outside of the capital. Our locally adapted survey compared favorably to the WHO survey. Conclusions: The results suggest that there is a statistically significant improvement in the implementation of an educational program to increase the knowledge and awareness of hearing health care among teachers. Some topics were more poorly understood than others, suggesting the need for targeted awareness interventions. Location within the capital city had some effect on performance but a high rate of correct responses was achievable across the participants independent of age, teaching experience, or gender. Our data support the idea that hearing health awareness interventions can be an effective and low-cost option to equip teachers to effectively serve as an advocate for improved identification, early diagnosis and appropriate referral of students with hearing loss.

Anaerobic digestion as a treatment option for waste produced in high throughput red meat abattoirs in South Africa is now gaining interest in both private and government sectors. The resultant digested slurry (digestate) is currently being regarded as waste despite its nutritional value for soil and plants which can be harnessed if digestate is utilized as biofertilizer to ensure nutrient cycling. The study investigated the physicochemical and microbial characteristics of digestate emanating from anaerobic digestion of red meat abattoir waste in South Africa, as well as evaluating its potential use as biofertilizer. The pH, total solids, volatile solids, chemical oxygen demand, electrical conductivity, total volatile fatty acids and chemical composition were determined using standard methods. Microbial analyses were determined according to the serial dilution method (101- 1010). The results were benchmarked with Public Available Specifications (PAS) 110 standards for quality control of digestate intended to be used as biofertilizer for agricultural purposes. Results for pH, total solids, electrical conductivity, chemical oxygen demand, and total volatile fatty acids fell within the required PAS110 standard which requires standard limits of 6.5–9, 30 %–50 %,

Purpose: Endometrial and ovarian cancers are leading causes of cancer death among women. However, there is little data on these patients from low- and middle-income countries including Botswana, a country in sub-Saharan Africa. This study reports data on demographics, treatment, and outcomes for patients with endometrial and ovarian cancer in Botswana. Methods: This prospective cohort study included all prospectively enrolled patients with endometrial or ovarian cancer who presented to Princess Marina or Gaborone Private Hospital between May 2015 and May 2021. Demographic, treatment, and survival data were analyzed. Results: 99 patients with endometrial and 38 patients with ovarian cancer were included. Median age at diagnosis was 64 for patients with endometrial cancer and 57 for patients with ovarian cancer. Just over half of patients with endometrial cancer (52.6%) presented with FIGO stages I and II, whereas most patients with ovarian cancer (65.8%) presented with stages III and IV. 24.2% of patients with endometrial cancer received chemotherapy, 32.3% received radiotherapy, 74.7% received surgical treatment, and 16.2% received no treatment; of patients with ovarian cancer, 42.1% received chemotherapy, 2.6% received radiotherapy, 52.6% received surgical treatment, and 31.6% of patients received no treatment. 1-and 2-year overall survival probabilities were 76.9% and 59.7% for patients with endometrial cancer and 62.8% and 43.7% for patients with ovarian cancer, respectively. Conclusion: This study demonstrates that a large proportion of patients with ovarian and endometrial cancer in Botswana are diagnosed at an advanced stage, and many do not receive standard-of-care treatment. Further inquiry is required to characterize challenges to diagnosis and treatment of ovarian and endometrial cancers in Botswana.

Orientation: Among the numerous factors affecting small and medium enterprises’ (SMEs) ability to access funding, financial literacy or the lack thereof continues to rank high. The below-average levels of financial literacy among entrepreneurs inevitably restrict their access to finance, thereby adding to the already soaring rate of small business failure. Research purpose: The main research objective of this article is to determine the underlying financial literacy-financial access relationship among SMEs in the Ekurhuleni Metropolitan Municipality in South Africa. Motivation of the study: Understanding the relationship between financial literacy and financial access among small businesses is imperative as they are key players in economic development. Empirical literature outlining this relationship is sparse. Therefore, the study made an original empirical contribution to the financial literacy-financial access nexus in the metropolitan. Research design, approach and method: A quantitative descriptive research design was followed. The survey method was used to gather data, where structured questionnaires were distributed to the respondents. The study considered a targeted population of 5609 registered SMEs in Ekurhuleni with a sample size of 384 prospective participants. A total of 310 responses were obtained from the owners and managers of SMEs in the municipality. The Statistical Package for Social Sciences was used to compute all statitical analyses for the study. Descriptive statistics were used to establish the SMEs’ financial literacy and financial access relationship. Data were analysed using factor analysis, regression analysis and correlation analysis. Main findings: Entrepreneurs in Ekurhuleni were found to have a limited understanding of basic financial concepts implying low levels of financial knowledge. Additionally, the study established that financial access was significantly challenging for most SMEs. The findings further revealed a positive relationship between financial literacy and financial access. Practical managerial/ implications: The knowledge from this article may assist entrepreneurs and financial institutions in bridging the financial literacy gap, thereby increasing the likelihood of accessing funding by SMEs. It may also assist in influencing the development and implementation of micro and macroeconomics policies to raise financial literacy levels and leniency from financing sources towards SMEs.

Delays in care for patients with cervical cancer in Botswana can be benchmarked using a multidisciplinary clinic model.

Objectives It is estimated that NHS staff consist of over 200 different nationalities, with a reported 30.7% of doctors holding a nationality other than British. Despite this, international medical students represent 7.5% of all medical students studying in the UK and pay on average, 4–6 times more in tuition fees when compared with the £9250 per annum (Great British Pounds (£) in 2021) paid by home students. This study’s aim and objective are to evaluate the perception of the financial cost and value of the UK medical degree for international students and their motivations for pursuing such a degree.Methods This is a cross-sectional observational study enquiring about international premedical, medical and medical school graduates’ perception of the value of the UK medical degree and factors influencing their decision to study in the UK.A questionnaire was developed and distributed to 24 medical schools and 64 secondary schools both internationally and across the UK.Results A total of 352 responses from 56 nationalities were recorded. 96% of international students identified clinical and academic opportunities as the most important factors to study medicine in the UK, closely followed by quality of life (88%). The least important factor was family reasons, with 39% of individuals identifying this factor. Only 4.82% of graduates in our study considered leaving the UK after training. Overall, 54% of students felt the UK degree was value for money. This belief was significantly higher in premedical students compared with existing students and graduates (71% vs 52% and 20%, p

Background: Older people continue to be disproportionately affected by late HIV diagnosis, which results in increased morbidity and mortality. Despite high acceptance of HIV testing generally, older people are less likely to undergo testing than younger people. Two previous studies have been conducted, one focussing on patient-related and one focussing on clinician-related factors associated with HIV testing in older age (⩾50 years) Objective: This study is an integrated analysis from two linked studies – one focussed on patients, and one focussed on clinicians – to understand overlap in views and experiences of HIV testing in older age, to outline the clinical implications of the findings, and to highlight potential interventions to improve testing in this group. Methods: This qualitative study utilised semi-structured interviews conducted with 20 clinicians who were not HIV care specialists, but who had recently seen an older person prior to their HIV diagnosis, and 20 people who had been diagnosed late with HIV aged 50+. Interviews were audio recorded, transcribed verbatim and thematically analysed. The combined synthesis reported here was planned a priori as part of a sequential design. Results: Seven clinician- and seven patient-related themes were associated with undergoing HIV testing in older age. This article discusses the four themes that were common to both groups: poor knowledge, incorrect symptom attribution, inaccurate perception of risk, and stigma. Conclusion: Both clinician and patient factors associated with testing will have to be addressed in order to increase HIV testing in older people, and reduce the likelihood of late diagnosis. Findings from overlapping themes suggest several areas for intervention: (1) routine screening as part of existing clinical contacts aimed at older people to eliminate the need to attribute symptoms to HIV or assess risk; (2) specific and tailored education materials for clinicians and older people which utilise appropriate modalities; (3) tailored HIV testing services: either specific clinics for older people at existing sexual health services, or dedicated services in primary care.

IntroductionForest resources are an important source of products on which rural communities depend for survival. Mpanga Central Forest Reserve (CFR) is a valuable resource to adjacent communities through provision of different goods and serves for subsistence and income generation. It also serves as an important eco-tourist site. However, there is scanty information regarding the products obtained from Mpanga CFR and their contribution to livelihoods of adjacent communities.MethodsThe study explored the provisioning services obtained from the CFR, assessed the contribution of the CFR to the surrounding communities and explored the challenges faced while obtaining these services from the forest reserve. Provisioning services are the material benefits supplied by the ecosystem. A total of 118 respondents were randomly selected from 11 villages in Kamengo sub-county Mpigi District and interviewed using semi-structured questionnaires.Results and discussionThe residents obtained wild foods, medicinal herbs, fuelwood, construction and carving materials. Most of the respondents used obtained products for subsistence (51%) while the rest sold them. Regression analysis revealed that 76.5% of the variability in cash income from the CFR is significantly explained by age of respondents, period of stay and education level. Increase in age and educational level of respondents reduced ability to obtain cash income from the forest by (β = −0.19) and (β = −0.625), respectively but increase in period of stay acted in the reverse (β = 0.22). Despite the importance of provisioning services in improving the livelihood of communities adjacent the forest, some challenges in accessing the forest were reported. The quantities of some extracted species had declined over a 5-year period resulting in reduction of household income. This negatively impacts on the livelihoods of the young and uneducated that depend on forest activities for income generation. It is pertinent that alternative livelihood options are sought to address this trend. Also, forest management strategies should provide a win-win situation to forest managers and communities adjacent to the forest. This will not only preserve the forest resource but will also ensure a sustainable livelihood to forest dependent communities.

The fast-growing pace of the world's population and the increasing pressure exerted on global life supporting natural systems due to amplified natural resource use and consumption coupled with the impacts of climate change necessitates the development of innovative technologies and comprehensive policy frameworks to address the looming crisis in the water, energy and food nexus. As the 30th driest country globally, South Africa has embarked on and enacted a pro-water-energy and food nexus policy which aims to create an understanding of the interdependencies of the three components and their influence on socio-economic growth and national development in the face of climate change-induced environmental changes. While these policies and programmes appear to have a sound theoretical basis, their implementation has been hindered by a number of structural and systemic challenges. Using methods inspired by the tradition of participatory research, this paper discusses the strengths and weaknesses of the water-energy-food policy framework in South Africa within the context of its implementation in order to achieve water, energy and food security. The findings of this paper revealed that while some level of progress has been attained to improve the livelihoods of the population using the nexus ecosystem, the broader goal of the concept has failed to materialise due to poor execution of the programme, which is exacerbated by lack of synergies, and establishment of collaborations and partnerships among the relevant actors mandated with the management of the three components and inadequate investment. This paper recommends a broader and coordinated approach to implementing the water-energy-food nexus programme with a broader objective of sustainable development goals (SDGs) framework. HIGHLIGHTS Analysed policies and implementation challenges of water-energy-food nexus programmes.; Lack of awareness, understanding and applicability of the nexus ecosystem.; Systemic and structural challenges to the nexus trade offs.; Alternative strategies to enhance the programmes.; The role of stakeholders to improve the nexus concept.;

When pandemics hit communities, women are bound to suffer as most of the responsibilities of ensuring food security lie on them. This article assesses the impact of the COVID-19 pandemic on the role that church-going women play in food provision. The qualitative study used interviews and focus group discussions to examine the toll of the pandemic-induced restrictions, especially with regard to their disruption of activities that ensure the provision of food for the family. They sought to identify how an environment as restrictive as the one that was imposed during the COVID-19 pandemic affects those largely responsible for food provision in urban Marondera – the women, in this case. The focus was extended to factor in how disasters and pandemics affect women and detract from their normative food procurement and provision roles in marginal societies and how these effects can be mitigated to allow women to carry on with their roles even in restrictive environments. This research was motivated by the recent COVID-19-imposed regulations that restricted the movement of people, restrictions that have only recently been relaxed and (in some cases) removed. We also sought to establish how gender roles are played out, together with whether they are exacerbated by pandemics, and in what ways these pandemics result in higher workloads on women. By utilising the Africana womanist theory, the study analysed women roles in food provision and food security in their societies within the restrictive environments of the pandemics. Contribution: This study concluded that there are gender inequalities that are exacerbated by these pandemics that result in higher workloads for women. It foregrounded how existing gender inequalities were exacerbated by the pandemic, resulting in higher workloads on women. It therefore recommended that women should form empowerment groups to help focus attention on food provision to mitigate challenges women face in this role. Finally, we averred that there ought to be consultation and participation of women on issues to do with pandemics to allow for their full and productive participation in critical roles of providing food.

Contamination of different ecological spheres with acid mine drainage (AMD) has raised numerous concerns in countries with well-developed mining industries, thus calling for urgent intervention measures to redress the prevailing water pollution challenges. Due to its chemical composition and (eco)-toxicological nature, AMD can pose severe environmental damage if not properly managed. Herein, the performance of subsurface horizontally flow constructed wetland (SSHF-CW) equipped with Vetiveria zizanioides for the treatment of AMD was explicitly assessed. To fulfill the goals of this phytoremediation study, the experiments were administered for a period of 30 days using authentic AMD from an active gold mine; and the quality of the feed and product water was monitored daily. The results showed a slight increase in pH from 2.4 to 4.01 and a net reduction in electrical conductivity, total dissolved solids, and sulphate, registering ≥ 47.20%, ≥ 46.00%, and ≥ 33.04%, respectively. Thenceforth, there was a net removal of metal in the following order; Zn (77.75%) ≥ Fe (75.36%) ≥ Mn (67.48%) ≥ Al (55.05%) ≥ Ni (44.01%) ≥ Cu (11.36%). Interestingly, the obtained results demonstrated that Vetiveria zizanioides was tolerant to AMD with a tolerance index of 1.23 after 30 days, while the removed metals were partitioned amongst the substrate, plant matrices, and external factors. Chemical species accumulated by the plants were more concentrated in the roots except for Mn, which was more concentrated in the shoots. The X-ray fluorescence and X-ray diffractometers analyses revealed the presence of chemical species in the substrate, while Fourier transform infrared and scanning electron microscopy-energy dispersive spectroscopy analysis revealed the presence of chemical species in plants roots, confirming that substrate and plants play a huge role in pollutants removal. As such, it can be concluded that SSHF-CW equipped with Vetiveria zizanioides plays a major role in the removal of contaminants from AMD and could be employed in derelict mines or small operations as a passive treatment technique to phyto-remediate mine effluents.

Abstract Background Childhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the annual national childhood 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu. Methods We conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes, and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7™ to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge. Results The majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW’s negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair knowledge of childhood TB notification. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400 mg was out of stock and adult 800 mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions. Conclusion The childhood TB program failed to meet its targets due to inadequate inputs, HW suboptimal knowledge and COVID-19 lockdown measures. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.

Seiring dengan meningkatnya permintaan dunia terhadap komoditas getah pinus, maka salah satu upaya yang dapat dilakukan untuk meningkatkan produksi getah pinus yaitu menggunakan zat perangsang getah/stimulansia. Selama ini, dalam kegiatan penyadapan getah pinus digunakan stimulansia anorganik yang tetapi komponen utamanya adalah asam sulfat dan asam nitrat atau campurannya yang bersifat sebagai oksidator kuat yang dapat merusak kulit manusia, kayu dan lingkungan jika digunakan dalam jangka panjang dan secara berlebihan. Alternatif penggunaan stimulansia dari bahan alami yang aman, harga relatif murah, dan mudah didapat seperti lengkuas (Alpinia galanga) dan jahe (Zingiber officinale). Penelitian ini dilakukan untuk mengetahui pengaruh pemberian stimulansia ekstrak lengkuas dan jahe terhadap peningkatan produktivitas getah pinus. Hasil penelitian ini menunjukkan produktivitas getah yang paling tinggi dihasilkan oleh pohon pinus menggunakan stimulansia organik jahe konsentrasi 50% yaitu sebesar 11,15 g/koakan/hari. Kualitas getah pinus yang memiliki mutu terbaik dihasilkan oleh stimulansia jahe, sedangkan pada penggunaan stimulansia lengkuas memiliki mutu II berdasarkan SNI 7837:2016. Stimulansia organik lengkuas dan jahe bersifat aman bagi kesehatan pekerja, pohon, dan lingkungan sehingga keuntungan yang diperoleh akan lebih besar. Berdasarkan hal tersebut perlu dilakukan penelitian lanjutan untuk mengetahui analisis biaya penggunaan stimulansia organik terhadap stimulansia anorganik dalam upaya meningkatkan produktivitas getah pinus.

Abstract Background HIV self-testing (HIVST) has emerged as a way of reaching individuals who may be less likely to access testing, including men who have sex with men (MSM). Understanding the social networks of MSM is key to tailoring interventions, such as HIVST, for particular locations. Methods We undertook a socio-sexual network study to characterize and identify patterns of connection among MSM and inform an HIVST intervention in three sites in Kenya. Community researchers in each site selected eight seeds to complete a demographic form and network surveys for 15 each of their sexual and social network members. Seeds recruited three respondents, including two regular service users and one MSM who was “unreached” by the program, who then each identified three respondents, resulting with data on 290 individuals. Results Findings illustrate the interconnectedness of community-based organization (CBO) members and non-members. In networks where a majority of members had a CBO membership, members had better contacts with programs and were more likely to have accessed health services. Larger networks had more HIV testing and seeds with frequent testing had a positive influence on their network members also being tested frequently. HIVST was tried in very few networks. Almost all network members were willing to use HIVST. Conclusion Willingness to use HIVST was nearly universal and points to the importance of networks for reaching individuals not enrolled in programs. Network analysis can help in understanding which type of networks had higher testing and how network-based approaches can be useful to promote HIVST in certain contexts.

Cycads are the most threatened group in the plant kingdom. Fire is identified as one of the major factors heightening cycad extinction risk. However, compared to South American cycads, we know little about how fire negatively affects the demography of African cycads. Here, we collected a snapshot of demographic data on the largest known population of South Africa’s cycad species, Encephalartos lanatus, in unburnt and regularly burnt habitats. We fitted several statistical models to investigate the effects of fire on the population structure of E. lanatus. First, we found that the population follows a ‘J’ structure with more adults than any other life stage. Contrary to popular belief, this ‘J’ structure may not necessarily imply the future of the population is at risk, given that E. lanatus is a long-lived species. Second, we found that the abundance of adults explains 25% of the abundance of seedlings but does not predict the abundance of suckers, perhaps suggesting the adults ensure preferential seedling rather than clonal recruitment. Third, irrespective of life stages, the subpopulation in fire-prone habitats is, in term of size, proportionately lower than the subpopulation in unburnt areas, suggesting that fire may negatively affect the dynamic of the population. However, fire is not linked to differences in sex ratio across the population; not only do fire-prone subpopulations have more cones, but they also tend to have more damaged cones than unburnt populations. Overall, although we raised some limitations of the present study, we also inferred that fire may shape the observed ‘J’ structure of the population of E. lanatus, but, contrary to traditional belief, the ‘J’ structure is not enough to raise concern about the future of the population. A population dynamics study is required to determine if the future of the population is at risk.

Introduction: As people living with HIV age, the increasing burden of multimorbidity poses a significant health challenge. The aims of this study were to identify common patterns of multimorbidity and examine changes in their burden, as well as their associations with risk factors, over a 3–5 year period in people with HIV, enrolled in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study.Methods: Common multimorbidity patterns were identified in POPPY participants with HIV using principal component analysis, based on Somers’ D statistic. Multimorbidity burden scores were calculated for each participant/pattern at study entry/follow-up and were standardised relative to the mean in the sample at baseline (scores >0 thus reflect a greater number of comorbidities relative to the mean). Two multivariable linear regression models were fitted to examine the associations between risk factors and burden z-scores at baseline and change in z-scores over a 3–5 year period.Results: Five patterns were identified among the 1073 POPPY participants with HIV {median age [interquartile range (IQR)], 52 (47–59) years; 85% male and 84% white}: Cardiovascular diseases (CVDs), Sexually transmitted diseases (STDs), Neurometabolic, Cancer and Mental-gastro-joint. The multivariable linear regression showed that older age, behavioural factors (i.e., body mass index (BMI), history of injection drug use, current recreational drug use and sex between men), and HIV-specific factors (i.e., duration since HIV diagnosis and a prior AIDS diagnosis) were associated with higher multimorbidity burden at baseline. However, only three of the factors (age, BMI and duration since HIV diagnosis) were significantly associated with an increase in burden across specific patterns over time.Discussion: Key modifiable and non-modifiable factors contributing to an increase in burden of multimorbidity were identified. Our findings may inform the development of more targeted interventions and guidelines to effectively prevent and manage the rising burden of multimorbidity in people with HIV.

Summary: Background: The B.1.1.529 (Omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the fourth COVID-19 pandemic wave across the southern African region, including Malawi. The seroprevalence of SARS-CoV-2 antibodies and their association with epidemiological trends of hospitalisations and deaths are needed to aid locally relevant public health policy decisions. Methods: We conducted a population-based serosurvey from December 27, 2021 to January 17, 2022, in 7 districts across Malawi to determine the seroprevalence of SARS-CoV-2 antibodies. Serum samples were tested for antibodies against SARS-CoV-2 receptor binding domain using WANTAI SARS-CoV-2 Receptor Binding Domain total antibody commercial enzyme-linked immunosorbent assay (ELISA). We also evaluated COVID-19 epidemiologic trends in Malawi, including cases, hospitalisations and deaths from April 1, 2021 through April 30, 2022, collected using the routine national COVID-19 reporting system. A multivariable logistic regression model was developed to investigate the factors associated with SARS-CoV-2 seropositivity. Findings: Serum samples were analysed from 4619 participants (57% female; 60% aged 18–50 years), of whom 878/3794 (23%) of vaccine eligible adults had received a single dose of any COVID-19 vaccine. The overall assay-adjusted seroprevalence was 83.7% (95% confidence interval (CI), 79.3%–93.4%). Seroprevalence was lowest among children

Men who have sex with men (MSM) bear a disproportionate burden of new HIV infections in Kenya, while experiencing discrimination, leading to suboptimal levels of HIV care. HIV self-testing (HIVST) is a tool to increase HIV screening and earlier diagnosis; however, questions remain regarding how best to scale-up HIVST to MSM in Kenya. The main objective of this study was to examine changes in knowledge and use of HIVST after implementation of a community-led HIVST project. Participants were MSM recruited from Kisumu, Mombasa, and Kiambu counties. Data were collected from two rounds (Round 1: 2019; Round 2: 2020) of serial cross-sectional integrated biological and behavioural assessments (IBBA), pre-, and post-project implementation. Two main outcomes were measured: 1) whether the respondent had ever heard of HIVST; and 2) whether they had ever used HIVST kits. Changes in outcomes between IBBA rounds were examined using modified multivariable Poisson regression models; adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) are reported. A total of 2,328 respondents were included in main analyses. The proportion of respondents who had heard of HIVST increased from 75% in Round 1 to 94% in Round 2 (aPR: 1.2, 95% CI: 1.2-1.3), while those reporting using an HIVST kit increased from 20% to 53% (aPR: 2.3, 95% CI: 2.0-2.6). Higher levels of education and HIV programme awareness were associated with both outcomes. Awareness and use of HIVST kits increased after implementation of a community-led HIVST implementation project, demonstrating the importance of integration with existing community groups.

PURPOSEUnderdeveloped nations carry the burden of most cervical cancer, yet access to adequate treatment can be challenging. This report assesses the current management of cervical cancer in sub-Saharan Africa to better understand the needs of underdeveloped nations in managing cervical cancer.METHODSA pre- and postsurvey was sent to all centers participating in the Cervical Cancer Research Network's 4th annual symposium. The pre- and postsurvey evaluated human papillomavirus and HIV screening, resources available for workup and/or treatment, treatment logistics, outcomes, and enrollment on clinical trials. Descriptive analyses were performed on survey responses.RESULTSTwenty-nine centers from 12 sub-Saharan countries saw approximately 300 new cases of cervical cancer yearly. Of the countries surveyed, 55% of countries had a human papillomavirus vaccination program and 30% (range, 0%-65%) of women in each region were estimated to have participated in a cervical cancer screening program. In the workup of patients, 43% of centers had the ability to obtain a positron emission tomography and computed tomography scan and 79% had magnetic resonance imaging capabilities. When performing surgery, 88% of those centers had a surgeon with an expertise in performing oncological surgeries. Radiation therapy was available at 96% of the centers surveyed, and chemotherapy was available in 86% of centers. Clinical trials were open at 4% of centers.CONCLUSIONThere have been significant advancements being made in screening, workup, and management of patients with cervical cancer in sub-Saharan Africa; yet, improvement is still needed. Enrollment in clinical trials remains a struggle. Participants would like to enroll patients on clinical trials with Cervical Cancer Research Network's continuous support.

Objective: To present the stage distribution, patterns of care, and outcomes of patients from Botswana with invasive cervical cancer, living with or without HIV. Methods: Between 2013 and 2020, women with cervical cancer were prospectively enrolled in an observational cohort study. Results: A total of 1,043 patients were enrolled; 69% were women living with HIV. The median age of the cohort was 47 years (interquartile range [IQR] 40–58 years), with women living with HIV presenting at a younger age compared to women without HIV (44 versus 61 years, p 10 g/dL (HR 0.51, p

In dealing with adolescent mental health, teachers and school institutions have a critical role in minimizing the challenges of mental health. However, the success of such a measure is dependent on teachers’ attitudes and perceptions of mental health literacy. Adolescent mental health disorders have become a major global concern with heightened increases and prevalence in secondary schools. In Zimbabwe, a dearth of knowledge exists in understanding the perceptions and attitudes of teachers in maximizing student mental health and positive educational outcomes. The aim of the research was to understand the attitudes and perceptions of teachers toward mental health literacy. Using a qualitative approach to understanding attitudes and perceptions, a case study was carried out at Odzi High School. A total of 12 teachers were purposively sampled for data generation on knowledge, attitudes, perceptions, and strategies that can be used to inform adolescent mental health. Data were collected using semi-structured interview(s). Emergent themes of the study were knowledge, stigma, training, and development. Using thematic analysis, the data showed that there was generalized knowledge of mental health and there were disparities in effective and efficient responses to gender sensitivity issues. Additionally, this knowledge was not put into practice because of attitudes and perceptions toward mental health. Recommendations from the study include developing of mental health training for teachers, equipping teachers with skills in psychosocial support in schools’ mental health, and enabling teachers to be able to link adolescents to appropriate care within the school and community-based settings. Teachers have the responsibility of promoting the wellbeing of the students, thus minimizing the adverse effects. Outcomes for positive mental health may be the result of teachers’ informed perceptions and positive attitudes on mental health literacy.

Abstract Purpose To compare updated prospective 5-year survival outcomes of cervical cancer patients living with and without human immunodeficiency virus (HIV) infection who initiated curative chemoradiation therapy (CRT) in a resource-limited setting. Methods & Materials Women in Botswana with locally advanced cervical cancer were enrolled in a prospective, observational, cohort study from July 2013 through January 2015. Survival outcomes were analyzed after 5 years of follow-up. Results This cohort included 143 women initiating curative CRT. Sixty-seven percent (n = 96) of cohort were women living with HIV (WLWH), all of whom were receiving antiretroviral therapy (ART) at the time of treatment initiation and boasted a median CD4 count of 481 cells/μL (IQR, 351-579 μL). The 5-year overall survival (OS) rates were 56.8% (95% CI, 40.0–70.5%) for patients without HIV infection and 55.1% (95% CI, 44.2–64.7%) for WLWH (p = 0.732). Factors associated with superior 5-year OS on multivariate analyses included baseline hemoglobin > 10 g/dL (hazard ratio (HR) 0.90, 95% CI, 0.83–0.98, p = 0.015), lower stage at diagnosis (stage I and II vs. III and IV) (HR 1.39, 95% CI 1.09–1.76, p = 0.007), and higher EQD2 (HR 0.98, 95% CI 0.97–0.99, p = 0.001). Conclusions Five-year OS was not impacted by HIV status in this population of WLWH with well-managed infection who initiated curative treatment for cervical cancer in Botswana. Regardless of HIV status, hemoglobin levels and stage at diagnosis were associated with survival. These findings suggest that treatment for cervical cancer in WLWH with well-controlled infection need not be altered solely due to HIV status.

Refugee, asylum seekers, and migrant (displaced) children are at protracted vulnerability levels, and COVID-19 has exacerbated the situation. Zimbabwe accepts refugees but enforces an encampment policy, and displaced populations are encamped at Tongogara Refugee Camp (TRC). The research gap is that there is very little literature on refugees in Zimbabwe. The research objectives for the study were to explore the challenges that refugees, asylum seekers, and displaced children at TRC face, ascertain how COVID-19 has affected children at TRC, and propose solutions to these challenges. This research relied upon a mixed method of quantitative and qualitative approach considering the immediacy of the COVID-19 pandemic. Secondary data is referred from published articles and organizational reports. The population size of 2,304 children aged 12 to 17 was obtained through the United Nations refugee agency (UNHCR)’s January 2021 population statistics for TRC. A 10% sample of 230 respondents was selected. Non-probability sampling techniques were used in administering a questionnaire through individual and focus group interviews, which were fed into KoBo Toolbox. Data cleaning and analysis were conducted, with SPSS and NViVo for quantitative and qualitative data analysis, respectively. Ethical considerations of consent, confidentiality, do no harm, and statements to withdraw from the study were employed. The process involved strict observance of World Health Organization (WHO) guidelines on COVID-19. The research was conducted between April 2020 and February 2021. Results showed that displaced children suffered a spectrum of challenges before COVID-19. During the COVID-19 period, respondents had limited access to child protection services, experienced increased conflicts at home, and limited access to formal learning and entertainment: their already dire situation was exacerbated by COVID-19. The study recommends the upgrade of the local secondary school to advanced level status, adoption of educational innovations in lieu of the COVID-19 pandemic, including radio, television, and virtual learning platforms; improved child protection mechanisms; accommodation; dietary diversity; access to water and sanitation hygiene; provision of electricity; adequate street lighting; activities for entertainment; and increasing awareness against child abuse and gender-based violence (GBV).

Abstract Background Cervical cancer is the leading cause of female cancer mortality in Botswana with the majority of cervical cancer patients presenting with late-stage disease. The identification of factors associated with late-stage disease could reduce the cervical cancer burden. This study aims to identify potential patient level clinical and sociodemographic factors associated with a late-stage diagnosis of cervical cancer in Botswana in order to help inform future interventions at the community and individual levels to decrease cervical cancer morbidity and mortality. Results There were 984 women diagnosed with cervical cancer from January 2015 to March 2020 at two tertiary hospitals in Gaborone, Botswana. Four hundred forty women (44.7%) presented with late-stage cervical cancer, and 674 women (69.7%) were living with HIV. The mean age at diagnosis was 50.5 years. The association between late-stage (III/IV) cervical cancer at diagnosis and patient clinical and sociodemographic factors was evaluated using multivariable logistic regression with multiple imputation. Women who reported undergoing cervical cancer screening had lower odds of late-stage disease at diagnosis (OR: 0.63, 95% CI 0.47–0.84) compared to those who did not report screening. Women who had never been married had increased odds of late-stage disease at diagnosis (OR: 1.35, 95% CI 1.02–1.86) compared to women who had been married. Women with abnormal vaginal bleeding had higher odds of late-stage disease at diagnosis (OR: 2.32, 95% CI 1.70–3.16) compared to those without abnormal vaginal bleeding. HIV was not associated with a diagnosis of late-stage cervical cancer. Rural women who consulted a traditional healer had increased odds of late-stage disease at diagnosis compared to rural women who had never consulted a traditional healer (OR: 1.61, 95% CI 1.02–2.55). Conclusion Increasing education and awareness among women, regardless of their HIV status, and among providers, including traditional healers, about the benefits of cervical cancer screening and about the importance of seeking prompt medical care for abnormal vaginal bleeding, while also developing support systems for unmarried women, may help reduce cervical cancer morbidity and mortality in Botswana.

Pavettamine, a plant toxin first isolated from Pavetta harborii in 1995, was previously identified as a polyamine with C2 symmetry and a 1,3-syn-diol moiety on a C10 carbon backbone – one of very few substituted polyamines to be isolated from nature. Its absolute configuration was later established by our first reported total synthesis in 2010. Herein we report the first total synthesis of the enantiomer of pavettamine, ent-pavettamine. The symmetrical structure of the molecule allows for the synthesis of a common C5 fragment that can be divergently transformed into two synthons for later convergent coupling to furnish the target carbon framework. Based on the success of the protocol we employed for the synthesis of the naturally occurring pavettamine, (S)-malic acid was again the starting material of choice for the synthesis of the two individual C5 fragments, with strategic differences in terminal-group manipulation allowing for the synthesis of ent-pavettamine rather than pavettamine. Chain extension and stereoselective ketone reduction were achieved using the (R)-methyl p-tolyl sulfoxide chiral auxiliary to give the desired 1,3-syn-diol C5 unit. A protecting-group strategy was also developed for the orthogonal protection of the alcohol and amine functional groups as they were unveiled. The functionalized C5 fragments were coupled via reductive amination revealing the C10 carbon backbone. Deprotection of the alcohol and amine functional groups successfully provided ent-pavettamine as a TFA salt.

Herein, the catchment-wide temporal dynamics and potential ecotoxicological risk of phthalic acid esters (PAEs) in aquatic ecosystems were assessed. Specifically, water samples were collected for a period of six consecutive months from seven selected sites, i.e., covering both dry and wet seasons for seasonal variabilities. The appraised PAEs comprised dimethyl phthalate (DMP), diethyl phthalate (DEP), di-n-butyl phthalate (DBP), benzylbutyl phthalate (BBP), diphenyl phthalate (DPP), di-n-hexyl phthalate (DHP), bis(2-ethylhexyl) phthalate (DEHP), di-n-octyl phthalate (DOP), diisodecyl phthalate (DiDP) and diisononyl phthalate (DiNP)) in municipal wastewater effluents, rivers and dam. Their concentrations were quantified using a gas chromatography–flame ionisation detector (GC–FID) via the liquid–liquid extraction mode. The appraised PAEs were ubiquitous in the selected sampling points, with DBP being the most abundant PAE homologue throughout the assessed localities. In particular, quantifiable concentrations were 18.9, 37.9 and 11.5 μg/L for DBP in wastewater effluents, rivers and the dam catchment, respectively, and for overall Σ10PAEs of minimum, mean and maximum of 0.492, 3.6 ± 9.82 and 63.2 μg/L, respectively. In addition, PAE concentrations in the effluents, rivers, and dam samples showed no significant differences with p < 0.05. The overall prominent sequence for ∑PAEs registered: 53.3 > 10.1 > 10.0 > 9.8 > 4.3 > 2.5 > 1.8 > 1.7 > 1.1 > 0.9% for DBP > DEHP > DiDP > DOP > DHP > DPP > BBP > DMP > DEP > DiNP, respectively. The ecotoxicological risk assessment (risk quotient method) showed that DBP and DiDP posed high risk (RQ ≥ 1), and DOP, DEHP, DHP, DiNP and BBP posed median risk to aquatic organisms (0.1 ≤ RQ < 1), while the risk from DMP and DEP was minimal (RQ < 0.1). Additionally, DBP, DEHP, DOP, DPP and DiDP were higher than the water criterion (3 μg/L) of PAEs recommended by the United States Environmental Protection Agency (USEPA) for the protection of aquatic life. Findings from this study should go a long way in guiding regulators, custodians and catchment management forums, along with interested and affected parties, regarding the status and potential ecotoxicological effects of PAEs in the receiving environment.

Climate change and ozone depletion are topics challenging the world over and are both attributed mainly to human activities, particularly emissions of ozone depleting substances. One such substance is chlorodifluoromethane (HCFC-22), a cheap, widely used refrigerant with a high global warming potential and a chemical target for phase-out under the Montreal protocol. Botswana like all signatory countries to the Montreal Protocol is required to develop and implement a country-level Hydrochlorofluorocarbon Phase-out Management Plan (HPMP). This study focused on evaluating the environmental and socioeconomic implications of phasing out HCFC-22 in Botswana. A census of nine HCFC-22-importing companies was conducted and probability sampling proportional to company size was used to select a sample of 159 respondents from the Department of Meteorological Services, Customs officers and HCFC-22 Industrial consumers. Annual HCFC-22 importation figures for Botswana in 2009–2017 from the National Ozone Unit were analysed. It emerged that HCFC-22 phase-out had reduced HCFC-22 consumption by approximately 510,400 kg in 2011–2017, translating to 28,072 ozone depleting potential (ODP) saved. Also, the HCFC-22 phase-out plan saved the country 128 kW h of electricity for 2009–2017. While decreasing demand for HCFC-22, the HPMP had correspondingly occasioned the higher replacement and servicing costs of HCFC-22-compliant equipment, as HCFC-22 substitutes cost more. To deter use of HCFC-22 and promote phase-out, the price of substitute refrigerants can be made less expensive than HCFC-22. Participating stakeholders attest that HCFC-22 phase-out has positive social benefits such as raising community awareness of the ozone depleting phase-out. As a recommendation, the government of Botswana could offer a number of incentives towards HCFC-22 substitutes uptake in order to give impetus to technology transfer.

Unlike sex steroids, mineralocorticoids have attracted limited attention in ovarian physiology. Recent studies on primates have indicated possible local synthesis and action of mineralocorticoids in the ovary. Here, we examined developmental changes in the levels of mineralocorticoids and expression of genes encoding their biosynthetic enzymes and receptor in the bovine ovary. The follicles and corpora lutea (CL) were collected from F1 heifers. Expression levels of 21α-hydroxylase (CYP21A2), 11β-hydroxylase-1 (CYP11B1), and the mineralocorticoid receptor (NR3C2) in granulosa cells (GC), thecal layers (TL), and CL tissues were quantified by real-time PCR, whereas mineralocorticoids in the follicular fluid were measured by enzyme immunoassay (EIA). TL and GC expressed CYP21A2 and NR3C2, whereas CYP11B1 was expressed at very low or undetectable levels. The expression levels of these genes were not significantly different among small/large and healthy/atretic follicles but were higher in TL than in GC. CYP21A2 and NR3C2 were expressed in all CL stages with higher expression observed in the mid-stage. CYP11B1 expression was only apparent in the mid-stage CL. Aldosterone was detected in all follicles, and its concentration was not significantly different among the follicular groups. In paired large-healthy/atretic follicles, the concentration of deoxycorticosterone, a precursor of aldosterone, was approximately ten-fold higher than that of aldosterone and not significantly different between healthy and atretic follicles. In conclusion, the presence of mineralocorticoids and expression of NR3C2 in the bovine follicle together with the developmental change in the expression of CYP21A2, CYP11B1, and NR3C2 in the CL suggest possible endocrine/paracrine/autocrine roles of mineralocorticoids in the bovine ovary.

Abstract Malawi is midway through its current Malaria Strategic Plan 2017–2022, which aims to reduce malaria incidence and deaths by at least 50% by 2022. Malariometric data are available with health surveillance data housed in District Health Information Software 2 (DHIS2) and household survey data from two recent Malaria Indicator Surveys (MIS) and a Demographic and Health Survey (DHS). Strengths and weaknesses of the data were discussed during a consultative meeting in Lilongwe, Malawi in July 2019. The first 3 days included in-depth exploration and analysis of surveillance and survey data by 13 participants from the National Malaria Control Programme, district health offices, and partner organizations. Key indicators derived from both DHIS2 and MIS/DHS sources were analysed with three case studies, and presented to stakeholders on the fourth day of the meeting. Applications of the findings to programmatic decision-making and strategic plan evaluation were critiqued and discussed.

Variability in temperature and precipitation due to climate change is predicted to significantly impact on Southern African countries' resources. These variations have the potential to affect the energy sector due to a heavy reliance on hydropower for electricity in the region. Energy insecurity is largely felt in cities as they are large consumers of the resource. This negatively impacts on urban livelihoods reliant on electricity like those in the informal sector. A survey of electricity dependent home-based informal businesses operated by women was conducted, to generate information on the vulnerability of urban livelihoods to energy insecurity in Harare, Zimbabwe. Households across all socio-economic backgrounds performed informal businesses to supplement household income and were heavily depended on the irregular electricity supply. Women from poor households managing informal businesses were disproportionately affected by the unstable electricity supply, as they could not afford alternative energy sources to continue business operations during power cuts. This accentuated their low adaptive capacity and vulnerability to climate change induced stresses. This paper brings to light the importance of improving the resilience and adaptive capacity of urban livelihoods to climate change related challenges like energy insecurity, whilst exploring climate-resilient energy options to sufficiently mitigate against the impacts of climate change on energy security.

Astroviruses are human pathogens with emerging disease associations, including the recent recognition of their capacity to cause meningoencephalitis. Astrovirus VA1 is the most commonly identified astrovirus genotype from cases of human encephalitis, but it is unknown what percentage of the human population has neutralizing antibodies to VA1.

The dissolution profile is of great importance in drug delivery and is affected by the manufacturing method. Thus, it is important to study the influence of the thermal process on drug release in emerging technologies such as 3D printing-fused deposition modeling (FDM). For this purpose, the characteristics of 3D printed tablets were compared to those of tablets prepared by other thermal methods such as hot-melt extrusion (HME) and non-thermal methods such as physical mixture (PM). Theophylline was used as a drug model and blends of ethyl cellulose (EC) and hydroxypropyl cellulose (HPC) were used as a matrix former. The solid state of the drug in all formulations was investigated by differential scanning calorimetry, X-ray powder diffraction, and Fourier-transformed infrared spectroscopy. All studied tablets had the same weight and surface area/volume (SA/V). Dissolution data showed that, for some formulations, printed tablets interestingly had a faster release profile despite having the highest hardness values (>550 N) compared to HME and PM tablets. Porosity investigations showed that 100% infill printed tablets had the highest porosity (~20%) compared to HME (3) compared to tablets made from both HME and PM methods (~1.26 g/m3), reflecting the possible increase in polymer specific volume while printing. This increase in the volume of polymer network may accelerate water and drug diffusion from/within the matrix. Thus, it is a misconception that the 3D printing process will always retard drug release based on increased tablet hardness. Hardness, porosity, density, solid-state of the drug, SA/V, weight, and formulation components are all factors contributing to the release profile where the total balance can either slow down or accelerate the release profile.

Carbon nanofibers (CNFs) supported by Pd and Pd-Sn electro-catalysts were prepared by the chemical reduction method using ethylene glycol as the reducing agent. Their physicochemical characteristics were studied using high resolution-transmission electron microscopy (HR-TEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), thermogravimetric analysis (TGA) and Bruanaer-Emmett-Teller (BET) analysis. FTIR revealed that oxygen, hydroxyl, carboxylic and carbonyl functional groups facilitated the dispersion of Pd and Sn nanoparticles. The doping of Pd with Sn to generate PdSn alloy was also confirmed by XPS data. The amorphous nature of CNFs was confirmed by XRD patterns which exhibited the Pd diffraction peaks. When Sn was added to Pd/CNFs, the diffraction peaks moved to lower angles. HRTEM images revealed that the CNFs with cylindrical shape-like morphology and also Pd-Sn nanoparticles dispersed on carbon support. The catalytic activity and stability towards alcohol electro-oxidation in alkaline medium at room temperature was evaluated using cyclic voltammetry (CV), chronoamperometry (CA) and electrochemical impedance spectroscopy (EIS). The obtained Pd-Sn/CNFs electro-catalyst exhibited a better electro-catalytic activity than Pd/CNFs and Pd/C electro-catalysts for both methanol and ethanol oxidation. The improvement of the electrochemical performance was associated with the synergistic effect via the addition of Sn which modified the Pd atom arrangement, thereby promoting oxidation through a dehydrogenation pathway. Furthermore, SnO2 generates abundant OH species which helps with increasing the rate of the oxidative removal of carbon monoxide (CO) intermediates from Pd sites.