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Peter Nyasulu,1,3 Susan Kambale,2 Tobias Chirwa,3 Teye Umanah,3 Isaac Singini,4 Simon Sikwese,5 Hastings T Banda,6 Rhoda P Banda,7 Henry Chimbali,8 Bagrey Ngwira,9 Alister Munthali10 1Department of Public Health, School of Health Sciences, Monash University, Johannesburg, South Africa; 2World Health Organization, Country Office, Lilongwe, Malawi; 3School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 4Johns Hopkins Research Project, College of Medicine, University of Malawi, 5Pakachere Institute of Health and Development Communication, Blantyre, 6Research for Equity and Community Health (REACH) Trust, Lilongwe, 7National Tuberculosis Control Program, Community Health Sciences Unit, Ministry of Health, Lilongwe, 8Health Promotion Section, Ministry of Health, Lilongwe, 9Department of Community Health, College of Medicine, University of Malawi, Blantyre, 10Centre for Social Research, University of Malawi, Zomba, Malawi Background: Knowledge and perceptions about tuberculosis (TB) can influence care-seeking behavior and adherence to treatment. Previous studies in Malawi were conducted to assess knowledge and attitudes regarding TB in adults, with limited data on knowledge in children. Objectives: This study assessed knowledge and perceptions about TB in children aged 10–14 years attending primary school in Ntcheu District, Malawi. Design: A cross-sectional study was conducted in four primary schools in Ntcheu District. Data on knowledge and perception of TB were collected using a structured questionnaire. Pearson chi-square test was used to determine the association between socioeconomic factors and TB knowledge and perception. A P0.05). Conclusion: Lack of knowledge regarding TB and gaps identified, may be due to a deficiency in the content of the school curriculum or the availability of information, education, and communication materials. This is the first study to report on knowledge and perceptions of TB among primary school learners in Malawi. These results will inform the development of relevant information, education, and communication materials to enhance awareness about TB among school going children. Keywords: tuberculosis, knowledge, perceptions, health seeking, adherence, Malawi

The aim of this article is to outline the factors that prohibit the reduction of Policeable crimes in Gauteng Province, South Africa. Statistical evidence shows that policeable crimes have increased in South Africa, nationally, by 22 percent in the 2008/09 financial year whereas aggravated robberies rose by 8 per cent during 2015/16 and 2016/17 financial years, notwithstanding police efforts and emphasis on containment of business and house robberies, and car hijacking. This article frames the question thus: What inhibits the reduction of policeable crime in Gauteng? Accordingly, the article develops an interpretive conceptual framework and reports on empirical evidence on factors that inhibit the reduction of policeable crime in Gauteng Province. The research results and findings show that South African Police Service (SAPS) leadership in Gauteng Province still rely on traditional forms of policing that has not kept up with the evolution of strategies used by crime perpetrators. This article shows that the SAPS in Gauteng Province has not aligned its policing strategies with the evolving crime environment, resulting into a general lack of credibility and gaping management inefficiency, except for a few police clusters whose commanders have adopted area-specific strategies. The status quo is, as this article argues, attributable to wanting provincial, if not national, leadership. This article's conclusion corroborates the generally held hypothesis that the absence of public credibility and ineffectiveness of the SAPS are a function of the perennial top management and leadership crises. To this extent, the article recommends that successful reduction and prevention of policeable crime in Gauteng Province, and in the rest of South Africa, has to be preceded by redress of SAPS for visionary leadership. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV) infected individuals in South Africa. Despite the implementation of HIV/TB integration services at primary healthcare facility level, the effect of HIV on TB treatment outcomes has not been well investigated. To provide evidence base for TB treatment outcome improvement to meet End TB Strategy goal, we assessed the effect of HIV status on treatment outcomes of TB patients at a rural clinic in the Ugu Health District, South Africa., Methods: We reviewed medical records involving a cohort of 508 TB patients registered for treatment between 1 January 2013 and 31 December 2015 at rural public sector clinic in KwaZulu-Natal province, South Africa. Data were extracted from National TB Programme clinic cards and the TB case registers routinely maintained at study sites. The effect of HIV status on TB treatment outcomes was determined by using multinomial logistic regression. Estimates used were relative risk ratio (RRR) at 95% confidence intervals (95%CI)., Results: A total of 506 patients were included in the analysis. Majority of the patients (88%) were new TB cases, 70% had pulmonary TB and 59% were co-infected with HIV. Most of HIV positive patients were on antiretroviral therapy (ART) (90% (n = 268)). About 82% had successful treatment outcome (cured 39.1% (n = 198) and completed treatment (42.9% (n = 217)), 7% (n = 39) died 0.6% (n = 3) failed treatment, 3.9% (n = 20) defaulted treatment and the rest (6.6% (n = 33)) were transferred out of the facility. Furthermore, HIV positive patients had a higher mortality rate (9.67%) than HIV negative patients (2.91%)". Using completed treatment as reference, HIV positive patients not on ART relative to negative patients were more likely to have unsuccessful outcomes [RRR, 5.41; 95%CI, 2.11-13.86]., Conclusions: When compared between HIV status, HIV positive TB patients were more likely to have unsuccessful treatment outcome in rural primary care. Antiretroviral treatment seems to have had no effect on the likelihood of TB treatment success in rural primary care. The TB mortality rate in HIV positive patients, on the other hand, was higher than in HIV negative patients emphasizing the need for enhanced integrated management of HIV/TB in rural South Africa through active screening of TB among HIV positive individuals and early access to ART among HIV positive TB cases., Competing Interests: The authors have declared that no competing interests exist.

Background: Multidrug resistant-tuberculosis (MDR-TB) is a threat to global tuberculosis control which is worsened by human immune-deficiency virus (HIV) co-infection. There is however paucity of data on the effects of antiretroviral treatment (ART) before or after starting MDR-TB treatment. This study determined predictors of mortality and treatment failure among HIV co-infected MDR-TB patients on ART., Methods: A retrospective medical record review of 1200 HIV co-infected MDR-TB patients admitted at Sizwe Tropical Disease Hospital, Johannesburg from 2007 to 2010 was performed. Chi-square test was used to determine treatment outcomes in HIV co-infected MDR-TB patients on ART. Multivariable logistic regression and Poisson models were used to determine predictors of mortality and treatment failure respectively., Results: Mortality was higher (21.8% vs. 15.4%) among patients who started ART before initiating MDR-TB treatment compared with patients initiated on ART after commencing MDR-TB treatment (p = 0.013). Factors significantly associated with mortality included: the use of ART before starting MDR-TB treatment (OR 1.65, 95% CI 1.02-2.73), severely-underweight (OR 3.71, 95% CI 1.89-7.29) and underweight (OR 2.35, 95% CI 1.30-4.26), cavities on chest x-rays at baseline (OR 1.76, 95% CI 1.08-2.94), presence of other opportunistic infections (OR 1.80, 95% CI 1.10-2.94) and presence of other co-morbidities (OR 2.26, 95% CI 1.20-4.21). Factors predicting failure were severe anaemia (IRR (OR 4.72, 95% CI 1.47-15), other co-morbidities (OR 2.39, 95% CI 1.05-5.43) and modified individualised regimen at baseline (OR 2.15, 95% CI 0.98-4.71)., Conclusions: High mortality among patients already on ART before initiating MDR-TB treatment is a worrisome development. Management of adverse-events, opportunistic infections and co-morbidities in these patients is important if the protective benefits of being on ART are to be maximized. There is the need to intensify intervention programmes targeted at early identification of MDR-TB, treatment initiation, drug monitoring and increasing adherence among HIV co-infected MDR-TB patients.

Introduction. Correctional facilities house large number of inmates who are at high risk of developing tuberculosis (TB); however factors associated with TB among inmates at Mangaung Correctional Centre have not been studied. Study Population and Methods. We undertook a case control study and reviewed a total of 1140 medical records of inmates treated for TB between 2009 and 2010. Cases were selected randomly from the medical records of inmates who were treated. Data collected were analysed using STATA version 12.0 and determinants of TB were evaluated using multiple logistic regression analyses. Factors with P < 0.05 were considered significant. Results. Prevalence of TB was 8.8% and 52% of inmates with TB were aged 31-40 years; 58% of the TB cases were HIV positive and 34% of them had CD4 cell count 350 cells/mm(3). Factors associated with TB among inmates were HIV coinfection (OR: 4.2; 95% CI: 2.64-7.00); previous history of TB disease (OR: 3.58; 95% CI: 2.25-5.70); and smoking (OR: 2.1; 95% CI: 1.16-3.81). Conclusion. Interventions to improve TB detection such as regular screening of inmates with such factors need to be reinforced to control transmission of TB among inmates and the community.