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Introduction: The treatment gap for mental health disorders persists in low- and middle-income countries despite overwhelming evidence of the efficacy of tasksharing mental health interventions. Key barriers in the uptake of these innovations include the absence of policy to support implementation and diverting of staff from usual routines in health systems that are already overstretched. South Africa enjoys a conducive policy environment; however, strategies for operationalizing the policy ideals are lacking. This paper describes the Mental health INTegration Programme (MhINT), which adopted a health system strengthening approach to embed an evidence-based task-sharing care package for depression to integrate mental health care into chronic care at primary health care (PHC). Methods: The MhINT care package consisting of psycho-education talks, nurse-led mental health assessment, and a structured psychosocial counselling intervention provided by lay counsellors was implemented in Amajuba district in KwaZulu-Natal over a 2-year period. A learning health systems approach was adopted, using continuous quality improvement (CQI) strategies to facilitate embedding of the intervention. MhINT was implemented along five phases: the project phase wherein teams to drive implementation were formed; the diagnostic phase where routinely collected data were used to identify system barriers to integrated mental health care; the intervention phase consisting of capacity building and using Plan-Do-Study-Act cycles to address implementation barriers and the impact and sustaining improvement phases entailed assessing the impact of the program and initiation of system-level interventions to sustain and institutionalize successful change ideas. Results: Integrated planning and monitoring were enabled by including key mental health service indicators in weekly meetings designed to track the performance of noncommunicable diseases and human immunovirus clinical programmes. Lack of standardization in mental health screening prompted the validation of a mental health screening tool and testing feasibility of its use in centralized screening stations. A culture of collaborative problem-solving was promoted through CQI data-driven learning sessions. The province-level screening rate increased by 10%, whilst the district screening rate increased by 7% and new patients initiated to mental health treatment increased by 16%. Conclusions: The CQI approach holds promise in facilitating the attainment of integrated mental health care in resource-scarce contexts. A collaborative relationship between researchers and health system stakeholders is an important strategy for facilitating the uptake of evidence-based innovations. However, the lack of interventions to address healthcare workers' own mental health poses a threat to integrated mental health care at PHC. [ABSTRACT FROM AUTHOR]

Background: Electronic clinical decision-making support systems (eCDSS) aim to assist clinicians making complex patient management decisions and improve adherence to evidence-based guidelines. Integrated management of Childhood Illness (IMCI) provides guidelines for management of sick children attending primary health care clinics and is widely implemented globally. An electronic version of IMCI (eIMCI) was developed in South Africa. Methods: We conducted a cluster randomized controlled trial comparing management of sick children with eIMCI to the management when using paper-based IMCI (pIMCI) in one district in KwaZulu-Natal. From 31 clinics in the district, 15 were randomly assigned to intervention (eIMCI) or control (pIMCI) groups. Computers were deployed in eIMCI clinics, and one IMCI trained nurse was randomly selected to participate from each clinic. eIMCI participants received a one-day computer training, and all participants received a similar three-day IMCI update and two mentoring visits. A quantitative survey was conducted among mothers and sick children attending participating clinics to assess the quality of care provided by IMCI practitioners. Sick child assessments by participants in eIMCI and pIMCI groups were compared to assessment by an IMCI expert. Results: Self-reported computer skills were poor among all nurse participants. IMCI knowledge was similar in both groups. Among 291 enrolled children: 152 were in the eIMCI group; 139 in the pIMCI group. The mean number of enrolled children was 9.7 per clinic (range 7-12). IMCI implementation was sub-optimal in both eIMCI and pIMCI groups. eIMCI consultations took longer than pIMCI consultations (median duration 28 minutes vs 25 minutes; p = 0.02). eIMCI participants were less likely than pIMCI participants to correctly classify children for presenting symptoms, but were more likely to correctly classify for screening conditions, particularly malnutrition. eIMCI participants were less likely to provide all required medications (124/152; 81.6% vs 126/139; 91.6%, p= 0.026), and more likely to prescribe unnecessary medication (48/152; 31.6% vs 20/139; 14.4%, p = 0.004) compared to pIMCI participants. Conclusions: Implementation of eIMCI failed to improve management of sick children, with poor IMCI implementation in both groups. Further research is needed to understand barriers to comprehensive implementation of both pIMCI and eIMCI. (349) Clinical trials registration: Clinicaltrials.gov ID: BFC157/19, August 2019. [ABSTRACT FROM AUTHOR]

South Africa is experiencing a rapidly growing diabetes epidemic that threatens its healthcare system. Research on the determinants of diabetes in South Africa receives considerable attention due to the lifestyle changes accompanying South Africa's rapid urbanization since the fall of Apartheid. However, few studies have investigated how segments of the Black South African population, who continue to endure Apartheid's institutional discriminatory legacy, experience this transition. This paper explores the association between individual and area-level socioeconomic status and diabetes prevalence, awareness, treatment, and control within a sample of Black South Africans aged 45 years or older in three municipalities in KwaZulu-Natal. Cross-sectional data were collected on 3,685 participants from February 2017 to February 2018. Individual-level socioeconomic status was assessed with employment status and educational attainment. Area-level deprivation was measured using the most recent South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and hypertension diagnosis. The prevalence of diabetes was 23% (n = 830). Of those, 769 were aware of their diagnosis, 629 were receiving treatment, and 404 had their diabetes controlled. Compared to those with no formal education, Black South Africans with some high school education had increased diabetes prevalence, and those who had completed high school had lower prevalence of treatment receipt. Employment status was negatively associated with diabetes prevalence. Black South Africans living in more deprived wards had lower diabetes prevalence, and those residing in wards that became more deprived from 2001 to 2011 had a higher prevalence diabetes, as well as diabetic control. Results from this study can assist policymakers and practitioners in identifying modifiable risk factors for diabetes among Black South Africans to intervene on. Potential community-based interventions include those focused on patient empowerment and linkages to care. Such interventions should act in concert with policy changes, such as expanding the existing sugar-sweetened beverage tax. [ABSTRACT FROM AUTHOR]

Grade 12 learners, in many instances, have early and late classes unlike the rest of the learners in the school. Sometimes their classes run over weekends and during school holidays. The aim of this study was to establish whether there was value in subjecting learners to extra classes over and above their normal class periods. We used the qualitative approach and purposive sampling to select the sample. The teaching of only 1 subject, accounting, was studied and the value of extra classes evaluated. Schools in the KwaZulu-Natal province, South Africa, that have consistently produced a 100% pass rate over a period of 3 years were selected to participate in the study. Data were collected using an interview schedule. The analysis of the data confirms that there is value in subjecting learners to more teaching because there is a direct relationship between teaching and learner performance. The worked example effect, as recommended through the cognitive load theory, was found to be dominant among the teaching strategies that accounting teachers used in extra classes. [ABSTRACT FROM AUTHOR]

In this paper, we explored how vulnerable, immunocompromised groups and caregivers of the elderly experienced and perceived the onset of the Covid-19 pandemic in South Africa. Semi-structured interviews were conducted remotely between the 5th andthe 18th of April 2020 in the three South African provinces hardest hit by Covid-19, namely Gauteng, KwaZulu-Natal and the Western Cape. In total, 60 qualitative key informant interviews and one focus group discussion were conducted. Study participants expressed concerns for elderly people and people with underlying health conditions because of their increased vulnerability to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). People living with HIV expressed an increased fear of infection following the advent of the Covid-19 pandemic in South Africa. The sidelining of healthcare services and stock-outs of medication proved to be an added concern in particular for vulnerable and immunocompromised groups. Overall, the data suggest that the fear of infection is ubiquitous for people who live in unstable environments such as overcrowded townships and informal settlements. Given the increased fears of infection brought on by the Covid-19 pandemic, the mental health of vulnerable communities and those caring for them becomes an added burden for people living in unstable environments. [ABSTRACT FROM AUTHOR]

Introduction: Object detection in remotely sensed satellite images is critical to socio-economic, bio-physical, and environmental monitoring, necessary for the prevention of natural disasters such as flooding and fires, socio-economic service delivery, and general urban and rural planning and management. Whereas deep learning approaches have recently gained popularity in remotely sensed image analysis, they have been unable to efficiently detect image objects due to complex landscape heterogeneity, high inter-class similarity and intra-class diversity, and difficulty in acquiring suitable training data that represents the complexities, among others. Methods: To address these challenges, this study employed multi-object detection deep learning algorithms with a transfer learning approach on remotely sensed satellite imagery captured on a heterogeneous landscape. In the study, a new dataset of diverse features with five object classes collected from Google Earth Engine in various locations in southern KwaZulu-Natal province in South Africa was used to evaluate the models. The dataset images were characterized with objects that have varying sizes and resolutions. Five (5) object detection methods based on R-CNN and YOLO architectures were investigated via experiments on our newly created dataset. Conclusions: This paper provides a comprehensive performance evaluation and analysis of the recent deep learning-based object detection methods for detecting objects in high-resolution remote sensing satellite images. The models were also evaluated on two publicly available datasets: Visdron and PASCAL VOC2007. Results showed that the highest detection accuracy of the vegetation and swimming pool instances was more than 90%, and the fastest detection speed 0.2 ms was observed in YOLOv8. [ABSTRACT FROM AUTHOR]

A strategy in this paper was viewed as a plan of action for achieving the mission and vision of an organisation. This paper presents preliminary findings of the larger study which aimed to determine the strategies for research data management (RDM) at selected universities in KwaZulu-Natal. The current study used the community capability maturity model framework (CCMF) and the digital curation centre (DCC) lifecycle model as theoretical support to determine the strategies for RDM service provision with specific reference to the University of Zululand. The interpretive paradigm, following the qualitative research approach through a single case study, was used. Primary data was gathered through online interviews using Zoom and Teams with Librarians, Technicians, HODs, and DVC Research due to the Covid-19 pandemic and availability of technologies. The findings of the study revealed the University of Zululand does not have an RDM policy; however, research activities are practiced. The University lacks the infrastructure and investment to support RDM services and activities. The study is significant for providing the background for developing RDM in the public university through RDM strategy and policy. The findings also sought to inform the university's RDM agenda. [ABSTRACT FROM AUTHOR]

he fourth industrial revolution has brought about plenty of changes in the educational landscape. As a result, the implementation of online education is now a necessity for any higher education institution that seeks recognition in the 21st century. Furthermore, online education has become a well-established global practice that enables active, individual, and flexible learning. While online education is growing at a tremendous rate in higher education, in South Africa, its use in Nursing Education is a relatively new phenomenon. This explorative, descriptive, qualitative research design paper aimed to report the results of a whole study whose purpose was to explore and describe the perceptions nurse educators have towards online education at the Nursing Education Institution in the province of KwaZulu-Natal, South Africa. Three themes emerged: the perceived advantages of online education, the perceived disadvantages of online education, and the perceived measures that can be used to promote the use of online education. The study concludes that online education has both advantages and disadvantages. [ABSTRACT FROM AUTHOR]

South Africa is gripped by protests which have usually taken the form of service delivery protests that have become more manifest during election periods. However, each election cycle has different types of protests with varying degrees of intensity. Thus, the aim of this paper is to analyse the link between elections and service delivery protests in South Africa with a focus on the 2016 and 2021 local government elections in Gauteng and KwaZulu-Natal provinces. This qualitative study relies on relative deprivation theory to tease out socio-economic issues driving these protests and rational choice theory to explore the rationale behind the timing of protests. Findings are that, in both provinces, although protests were linked to poor service provision, other factors like intra-party tension were notable. This article recommends a re-visit of cadre deployment policy, because the lack of capacitated and skilled cadres has fuelled service delivery especially in local municipality. [ABSTRACT FROM AUTHOR]

The devastating civil unrest experienced in July 2021 in especially KwaZulu-Natal, South Africa, not only affected more than 40,000 businesses, but also had a direct impact on the collection and administration of the recurrent property tax (called “property rates”). This paper considers policy recommendations for supplementary valuations and rates relief for affected property owners and debates the implementation options available to municipalities. [ABSTRACT FROM AUTHOR]

In South Africa, with highly variable and intense land-use practices, coupled with limited soil fertility and water resources, there has been a long history of encroachment of arable lands (sugarcane and timber plantations) into surrounding wetlands. Although wetland delineation within the timber and sugar sectors is well-defined in policy, and existing and proposed legislation, there are significant areas of non-compliance. The spatiallyexplicit Soil Water Assessment Tool (SWAT) was adopted to investigate the interactions of climate, landuse and soil on the water-use of natural and encroached wetlands. This paper documents the calibration, validation and application of the SWAT model on Quaternary Catchment (QC) U20G, which is a 498 km2 catchment that forms part of the uMngeni River basin. The SWAT-CUP parameter sensitivity and optimization model was tested with daily observed streamflow data for this catchment. Parameters were modified using the sequential uncertainty fitting (SUFI-2) analysis routine to calibrate the model. The simulated flow had a close fit to the observed flow with a regression coefficient (r2) of 0.87 and a Nash-Sutcliffe (NS) coefficient of 0.8. Through the buffer scenario analysis, the model showed that if the wetland and a 20-m buffer were to be returned to a natural state, there could be a 16% increase in the annual streamflow contribution, with an upper limit of a 60% increase in some hydrologic response units (HRUs). Thus there would be a hydrological gain if wetlands and sensitive buffer areas were to be cleared of commercial timber species and sugarcane. [ABSTRACT FROM AUTHOR]

Background: Combination prevention interventions, when integrated with community-based support, have been shown to be particularly beneficial to adolescent and young peoples' sexual and reproductive health. Between 2020 and 2022, the Africa Health Research Institute in rural South Africa conducted a 2 × 2 randomised factorial trial among young people aged 16–29 years old (Isisekelo Sempilo) to evaluate whether integrated HIV and sexual and reproductive health (HIV/SRH) with or without peer support will optimise delivery of HIV prevention and care. Using mixed methods, we conducted a process evaluation to provide insights to and describe the implementation of a community-based peer-led HIV care and prevention intervention targeting adolescents and young people. Methods: The process evaluation was conducted in accordance with the Medical Research Council guidelines using quantitative and qualitative approaches. Self-completed surveys and clinic and programmatic data were used to quantify the uptake of each component of the intervention and to understand intervention fidelity and reach. In-depth individual interviews were used to understand intervention experiences. Baseline sociodemographic factors were summarised for each trial arm, and proportions of participants who accepted and actively engaged in various components of the intervention as well as those who successfully linked to care were calculated. Qualitative data were thematically analysed. Results: The intervention was feasible and acceptable to young people and intervention implementing teams. In particular, the STI testing and SRH components of the intervention were popular. The main challenges with the peer support implementation were due to fidelity, mainly because of the COVID-19 pandemic. The study found that it was important to incorporate familial support into interventions for young people's sexual health. Moreover, it was found that psychological and social support was an essential component to combination HIV prevention packages for young people. Conclusion: The results demonstrated that peer-led community-based care that integrates SRH services with HIV is a versatile model to decentralise health and social care. The family could be a platform to target restrictive gender and sexual norms, by challenging not only attitudes and behaviours related to gender among young people but also the gendered structures that surround them. [ABSTRACT FROM AUTHOR]

Simple Summary: The present study addresses the lack of research on Staphylococcus spp. among dogs in South Africa. The study characterises isolates from retrospective data from a veterinary diagnostic laboratory in terms of time, place, and animal factors. Using data collected from 2012 to 2017, the study analysed 1627 positive Staphylococcus isolates and identified 10 species, the majority (92.0%) of which were classified as coagulase-positive, while a few were coagulase-negative (6.0%) and coagulase-variable (3.0%). Male dogs contributed just over half (53.2%) of the isolates. Dogs aged ≥9 years contributed the most isolates (23.2%). KwaZulu-Natal Province contributed the majority (45.0%) of the isolates, while Northern Cape Province contributed the least (0.1%). Almost half (46.0%) of the isolates came from skin specimens. The study demonstrated a limited variation in the number of Staphylococcus isolates across seasons and the occurrence of a diversity of Staphylococcus species among dogs in South Africa. There is a need for research to improve our understanding of factors that influence the observed disparities in Staphylococcus spp. Proportions observed in this study. There is a scarcity of published studies on the occurrence of Staphylococcus spp. Among dogs in South Africa. The objective of the study was to characterise the Staphylococcus spp. Isolated from dog samples submitted to a veterinary diagnostic laboratory in South Africa in terms of time, place, and person. This study utilised a dataset of 1627 positive Staphylococcus isolates obtained from a veterinary diagnostic laboratory in South Africa from 2012 to 2017. Out of the 1627 confirmed isolates, 10 different species of Staphylococcus were identified. Among these, 92.0% were classified as coagulase-positive staphylococci (CoPS), 6.0% were coagulase-negative staphylococci (CoNS), and 3.0% were coagulase-variable. Male dogs contributed just over half (53.2%) of the Staphylococcus isolates, while female dogs contributed the remaining 46.8%. The largest proportion of isolates (23.2%) were obtained from dogs aged ≥ 9 years, with the highest number of isolates originating from KwaZulu-Natal Province (45.0%) and the least from Northern Cape Province (0.1%). Out of the total samples included in the records, the majority (46.0%) were skin specimens. The number of Staphylococcus isolates recorded showed limited variation between the seasons (24.3% in autumn, 26.3% in winter, 26.0% in spring, and 24.0% in summer). This study highlighted the diversity of Staphylococcus spp. isolated from dogs, and the burden of staphylococcal carriage among dogs in South Africa. Further research is required to examine the factors that contribute to the observed discrepancies in the proportions of Staphylococcus spp. between the provinces. [ABSTRACT FROM AUTHOR]

Introduction: Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy that can reduce the risk of HIV acquisition by more than 90% if taken consistently. Although South Africa has been implementing PrEP since 2016, initially for selected population groups before expanding access to more people, there is a dearth of research focused on PrEP among adolescent boys and young men (ABYM), despite them experiencing high rates of HIV infection. To address this gap, we compared PrEP initiation rates by service delivery points (SDPs) among ABYM in KwaZulu-Natal, South Africa. Methods: We conducted a population-based prospective study in 22 SDPs from July 2021 to July 2022 in KwaZulu-Natal, South Africa. Sexually active ABYM aged 15–35 years who tested HIV negative were recruited at purposively selected PrEP SDPs (i.e., healthcare facilities, secondary schools and Technical Vocational Education and Training (TVET) colleges, and community-based youth zones). We collected baseline quantitative data from each participant using self-administered electronic questionnaires built into REDCap, including demographic information such as age, sex, employment status and level of education, as well as PrEP initiation outcomes. We extracted data from REDCap and exported it to Stata version 17.0 for analysis, and then eliminated discrepancies and removed duplicates. We described baseline characteristics using summary and descriptive statistics (median, interquartile range [IQR] and proportions) and reported PrEP initiation proportions overall and by SDPs. Results: The study included 1104 ABYM, with a median age of 24 years (interquartile range (IQR): 21–28)). Almost all participants were black African (n = 1090, 99%), with more than half aged 15–24 years (n = 603, 55%) and 45% (n = 501) aged 25–35 years. The majority (n = 963; 87%) had attained a secondary level of education. Overall PREP initiation rate among adolescent boys and young men was low: among 1078 participants who were eligible for PrEP, 13% (n = 141) were started on PrEP. Among the participants who were initiated on PrEP, over three quarters (78%, n = 58) were initiated from high schools, compared with community-based youth zones (40%, n = 37), TVET colleges (26%, n = 16) and healthcare facilities (4%, n = 30). Conclusions: This study provided evidence suggesting that expanding PrEP services to non-traditional settings, such as high schools, TVET colleges, and community-based organizations, may have a potential to increase PrEP access among ABYM in South Africa. [ABSTRACT FROM AUTHOR]

Introduction: Despite the numerous efforts and initiatives, males with HIV are still less likely than women to receive HIV treatment. Across Sub-Saharan Africa, men are tested, linked, and retained in HIV care at lower rates than women, and South Africa is no exception. This is despite the introduction of the universal test-and-treat (UTT) prevention strategy anticipated to improve the uptake of HIV services. The aim of this study was to investigate linkage to and retention in care rates of an HIV-positive cohort of men in a high HIV prevalence rural district in KwaZulu-Natal province, South Africa. Methods: From January 2018 to July 2019, we conducted an observational cohort study in 18 primary health care institutions in the uThukela district. Patient-level survey and clinical data were collected at baseline, 4-months and 12-months, using isiZulu and English REDCap-based questionnaires. We verified data through TIER.Net, Rapid mortality survey (RMS), and the National Health Laboratory Service (NHLS) databases. Data were analyzed using STATA version 15.1, with confidence intervals and p-value of ≤0.05 considered statistically significant. Results: The study sample consisted of 343 male participants diagnosed with HIV and who reside in uThukela District. The median age was 33 years (interquartile range (IQR): 29–40), and more than half (56%; n = 193) were aged 18–34 years. Almost all participants (99.7%; n = 342) were Black African, with 84.5% (n = 290) being in a romantic relationship. The majority of participants (85%; n = 292) were linked to care within three months of follow-up. Short-term retention in care (≤ 12 months) was 46% (n = 132) among men who were linked to care within three months. Conclusion: While the implementation of the UTT strategy has had positive influence on improving linkage to care, men's access of HIV treatment remains inconsistent and may require additional innovative strategies. [ABSTRACT FROM AUTHOR]

Objective: Female Genital Schistosomiasis (FGS) causes intravaginal lesions and symptoms that could be mistaken for sexually transmitted diseases or cancer. In adults, FGS lesions [grainy sandy patches (GSP), homogenous yellow patches (HYP), abnormal blood vessels and rubbery papules] are refractory to treatment. The effect of treatment has never been explored in young women; it is unclear if gynaecological investigation will be possible in this young age group (16–23 years). We explored the predictors for accepting anti-schistosomal treatment and/or gynaecological reinvestigation in young women, and the effects of anti-schistosomal mass-treatment (praziquantel) on the clinical manifestations of FGS at an adolescent age. Method: The study was conducted between 2011 and 2013 in randomly selected, rural, high schools in Ilembe, uThungulu and Ugu Districts, KwaZulu-Natal Province, East Coast of South Africa. At baseline, gynaecological investigations were conducted in female learners in grades 8 to 12, aged 16–23 years (n = 2293). Mass-treatment was offered in the low-transmission season between May and August (a few in September, n = 48), in accordance with WHO recommendations. Reinvestigation was offered after a median of 9 months (range 5–14 months). Univariate, multivariable and logistic regression analysis were used to measure the association between variables. Results: Prevalence: Of the 2293 learners who came for baseline gynaecological investigations, 1045 (46%) had FGS lesions and/or schistosomiasis, 209/1045 (20%) had GSP; 208/1045 (20%) HYP; 772/1045 (74%) had abnormal blood vessels; and 404/1045 (39%) were urine positive. Overall participation rate for mass treatment and gynaecological investigation: Only 26% (587/2293) learners participated in the mass treatment and 17% (401/2293) participated in the follow up gynaecological reinvestigations. Loss to follow-up among those with FGS: More than 70% of learners with FGS lesions at baseline were lost to follow-up for gynaecological investigations: 156/209 (75%) GSP; 154/208 (74%) HYP; 539/722 (75%) abnormal blood vessels; 238/404 (59%) urine positive. The grade 12 pupil had left school and did not participate in the reinvestigations (n = 375; 16%). Follow-up findings: Amongst those with lesions who came for both treatment and reinvestigation, 12/19 still had GSP, 8/28 had HYP, and 54/90 had abnormal blood vessels. Only 3/55 remained positive for S. haematobium ova. Factors influencing treatment and follow-up gynaecological investigation: HIV, current water contact, water contact as a toddler and urinary schistosomiasis influenced participation in mass treatment. Grainy sandy patches, abnormal blood vessels, HYP, previous pregnancy, current water contact, water contact as a toddler and father present in the family were strongly associated with coming back for follow-up gynaecological investigation. Challenges in sample size for follow-up analysis of the effect of treatment: The low mass treatment uptake and loss to follow up among those who had baseline FGS reduced the chances of a larger sample size at follow up investigation. However, multivariable analysis showed that treatment had effect on the abnormal blood vessels (adjusted odds ratio = 2.1, 95% CI 1.1–3.9 and p 0.018). Conclusion: Compliance to treatment and gynaecological reinvestigation was very low. There is need to embark on large scale awareness and advocacy in schools and communities before implementing mass-treatment and investigation studies. Despite challenges in sample size and significant loss to follow-up, limiting the ability to fully understand the treatment's effect, multivariable analysis demonstrated a significant treatment effect on abnormal blood vessels. Author summary: Female genital schistosomiasis (FGS) is a neglected tropical disease and it affects many women and young girls in schistosomiasis endemic areas. A lot of research is still needed to understand the characteristics of FGS, its prevention, as well as the timing for treatment. As a result of the limited information, some women who suffer from FGS end up being misdiagnosed with diseases such as human papilloma virus or other sexually transmitted diseases. The study highlights issues that need to be taken into considerations when providing treatment or conducting mass treatment for schistosomiasis and FGS or planning gynaecological investigations to inform FGS control programmes. In this study of adolescent girls and young women of KwaZulu-Natal Province of South Africa, we sought to explore the factors that influence participation in mass treatment and gynaecological investigation, and investigating the effect of praziquantel treatment on FGS. Factors that influenced participation in mass treatment included HIV, current water contact, water contact as a toddler and urinary schistosomiasis. Factors that influenced participation in follow up gynaecological investigation included grainy sandy patches, abnormal blood vessels, homogenous yellow patches, previous pregnancy, current water contact, water contact as a toddler and father present in the family. There was low uptake and loss to follow up for mass treatment, and this contributed to small sample size for follow up gynaecological investigations to understand the effect of treatment. However, multivariable analysis showed that treatment had effect on the abnormal blood vessels and not on grainy sandy patches and homogenous yellow patches. [ABSTRACT FROM AUTHOR]

Abortion in South Africa is a complex topic, rife with augmenting and limiting political, social, religious, and cultural factors. This study explores multiple age groups within Cato Manor and whether the attitudes towards abortion and factors impacting the choice of where and whether to receive an abortion differ. The study employs a general qualitative approach with inserted narratives highlighting individual perspectives and stories. The sample cohort was identified using purposive sampling of women, obtained via convenience through the gatekeeper in the community. The participants are from two generations, and two expert interviews were conducted to gain various perspectives. The sample population is from the greater Cato Manor community, and the interviews were conducted in a semi-structured format. The main goal of this study is to understand how socio-cultural factors impact abortion attitudes within each generation in Cato Manor and if community attitudes impact women's decisions on how and where to obtain medical abortions. The findings show that negative attitudes towards abortion persist in Cato Manor due to religious and cultural rationale. Greater acceptance occurs among younger generations following abortion legalization in South Africa, yet prejudice remains. The research reveals a range of factors that may pressure women to obtain illegal abortion options to avoid community shame. [ABSTRACT FROM AUTHOR]

In South Africa, freshwater habitats are among the most threatened ecosystems, and freshwater fishes are the most threatened species group. Understanding patterns in freshwater fish diversity, threat, invasion, and protection status are vital for their management. However, few studies have undertaken such analyses at ecologically and politically appropriate spatial scales, largely because of limited access to comprehensive biodiversity data sets. Access to freshwater fish data for South Africa has recently improved through the advent of the Freshwater Biodiversity Information System (FBIS). We used occurrence records downloaded from the FBIS to evaluate spatial patterns in distribution, diversity, threat, invasion, and protection status of freshwater fishes in South Africa. Results show that record density varies spatially, at both primary catchment and provincial scales. The diversity of freshwater fishes also varied spatially: native species hotspots were identified at a provincial level in the Limpopo, Mpumalanga, and KwaZulu-Natal provinces; endemic species hotspots were identified in the Western Cape; and threatened species hotspots in the Western Cape, Mpumalanga, Eastern Cape, and KwaZulu-Natal. Non-native species distributions mirrored threatened species hotspots in the Western Cape, Mpumalanga, Eastern Cape, and KwaZulu-Natal. Some 47% of threatened species records fell outside of protected areas, and 38% of non-native species records fell within protected areas. Concerningly, 58% of the distribution ranges of threatened species were invaded by non-native species. [ABSTRACT FROM AUTHOR]

The frequent failures of government-funded broiler enterprises raise concerns about the viability and wisdom of government funding for smallholders. This study therefore investigates the scope for the profitability of the small-scale broiler production and the range of socio-demographic and production issues that are implicated. The study area was the Northern KwaZulu-Natal (KZN) Province of South Africa, where smallholder broiler production is popular. A total of 75 randomly selected, small-scale broiler producers from three districts in Northern KZN, namely, King Cetshwayo, uMkhanyakude, and Zululand, participated in the survey out of the 134 small-scale broiler producers supported by the government. The analyses employed diverse descriptive analysis and included the calculation of the gross margin to proxy broiler chicken profitability. Three models were fitted for the empirical analysis, namely, the OLS, the Two-Stage Least Squares, and the Stochastic Frontier models, to determine the factors influencing profitability, correcting for endogeneity, and computing the technical efficiency and inefficiency of the small-scale broiler production system. The results show that the primary production and marketing challenges were the lack of infrastructure (abattoirs and refrigeration) and the lack of formal markets, including the lack of market information and high transport costs. On average, the sampled government-funded small-scale broiler enterprises achieved a positive gross profit margin of 31 percent, which is relatively low when compared to the small-scale farmers that work for a large-scale enterprise—the Commercial Chicken Farm, near Pietermaritzburg. It was revealed that the profits are significantly influenced by gender, farmgate price, access to market information, and access to extension services. The production system was also shown to be operating at a reasonably high technical efficiency, which is strongly influenced by flock size, feeds, and labour input, while age, gender, and educational level contributed to technical inefficiency. The recent crisis that was experienced by the poultry industry in South Africa linked to the outbreak of the Avian Flu and its devastating consequences point up the urgency for more investment in infrastructure to enhance bird safety at affordable costs. Although the government-funded small-scale broiler enterprises in Northern KZN were found to be viable, it is evident that they can be better, possibly through more capacity building and collective action to take full advantage of the economies of scale. [ABSTRACT FROM AUTHOR]

Species of Corymbia are increasingly being tested for plantation establishment in South Africa. During disease surveys in KwaZulu-Natal plantations in 2020, a serious canker disease was found on Corymbia henryi. The cankers were seemingly caused by a fungus belonging to the family Cryphonectriaceae. The aims of the study were to identify the fungus causing the disease, to test its pathogenicity and to determine the genetic diversity of a population of isolates from infected trees. Phylogenetic analyses using sequence data for the internal transcribed spacer, β-tubulin 1 and β-tubulin 2 gene regions showed that the causal agent of the cankers was Chrysoporthe austroafricana. This is the first record of C. austroafricana causing cankers on a Corymbia species. A pathogenicity trial demonstrated that the fungus could infect C. henryi and cause cankers. Fifteen isolates of C. austroafricana were subjected to population genetic analyses using microsatellite markers. Eleven multilocus genotypes (MLGs) were detected. Mating-type distribution was approximately equal (MAT1-1:MAT1-2 = 8:7). The results indicate that a wide diversity of genotypes of C. austroafricana have undergone a host shift to infect C. henryi. This is a similar situation to that observed for Eucalyptus in South Africa and suggests that research efforts will be required to reduce the risk of Cryphonectria canker limiting afforestation using Corymbia species in the future. [ABSTRACT FROM AUTHOR]

Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the 'Universal Test and Treat' (UTT) strategy – initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients' perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV-positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had been linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors that facilitated or inhibited linkage-to-care were found at individual, family, community, as well as health systems levels. Enablers included a positive HIV testing experience, and assistance from the fieldwork team. Support from family, and friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identified. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experiences with counselling and health systems inefficiency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system-level interventions would need to focus on clinic readiness in providing patients with necessary and effective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training healthcare providers, community outreach and the provision of psychological, social, and financial support. [ABSTRACT FROM AUTHOR]

Background and aims – Despite the fact that the orchid flora of South Africa is well documented, new species are still being discovered. The identity of an Eulophia subpopulation from near Port Edward in KwaZulu-Natal has been ambiguous. Some thought that it belongs to Eulophia schnelliae, currently considered a synonym of Eulophia macowanii, whereas others were of the opinion that it was potentially a new species. Both hypotheses are investigated here. Material and methods – Plants were studied in the field and herbarium specimens, including types, were consulted. The relevant published literature was revised. Key results – Eulophia schnelliae is confirmed as a synonym of Eulophia macowanii. The Port Edward subpopulation does not match any known Eulophia taxon and is newly described as Eulophia edwardii, endemic to the Pondoland Centre of Endemism. It is only known from one subpopulation of about 200 individuals, which is threatened by urban development. It is, therefore, assessed as Critically Endangered according to Criterion B2ab(i,ii,iii). Conclusion – The newly described species increases the number of Eulophia species in South Africa to 29 and the number of endemic Eulophia species to 10. This discovery underlines the need for continued botanical inventories and protection of sensitive grasslands. [ABSTRACT FROM AUTHOR]

Background: Language discordance occurs in healthcare when staff and service users do not share proficiency in the same language. It is a global phenomenon impacting on the quality of health services, as person-centred practice requires communication to establish partnerships and rapport. In a country as linguistically diverse as South Africa, effective ways to navigate language discordance in health care are urgently required, yet there is limited research. This study aimed to describe how occupational therapists navigated language discordance when working in the public health sector in KwaZulu-Natal. Methods: A qualitative descriptive design involved using purposive sampling to recruit occupational therapists as participants (n = 8) for 15 semi-structured interviews. Thematic analysis was used to analyse the data, which included reflective journal entries from all participants. Results: The four emergent themes were: (1) concurrent use of strategies, (2) I'm doing as much I can, what more can I do? (3) Language definitely impacts that therapy process and lastly, (4) systemic oppression perpetuating language discordance. Conclusion: Language discordance is a complex context-specific phenomenon, therefore insight into concurrent use of strategies is important to practitioners to enable them to navigate language discordance and ensure provision of quality services. These insights are significant for healthcare professionals and resource allocators as they shed light on the shortcomings of advocating for a single strategy such as providing trained interpreters. Successful navigation is characterised by determination, being kind to oneself, willingness to learn and use of pragmatic and flexible approaches. To prepare to navigate language discordance in a low-resource context, education should extend in time and scope, to include multiple strategies, culture and relevant languages. [ABSTRACT FROM AUTHOR]

Cassava (Manihot esculenta Crantz) is an important root crop worldwide. It is adapted to a wide range of environmental conditions, exhibiting differential genotypic responses to varying environmental conditions. The objectives of this study were: (1) to examine the effect of genotype, environment and genotype × environment interaction (GEI) on fresh root yield (FRY) and dry matter content (DMC); and (2) to identify superior genotypes that exhibit high performance for the traits of interest using the genetic tools of additive main effects and multiplicative interaction (AMMI) and genotype stability index (GSI) analysis. Eleven cassava genotypes were evaluated in a randomized complete block design at six trial sites in South Africa. The combined analysis of variance based on AMMI revealed significant genotype, environment and GEI for the traits. The percentage variation due to GEI was higher than the percentage variation due to genotype for FRY, reflecting differential genotypic responses across the experimental sites. The proportion of variance due to genotype variation was larger for DMC. Genotype stability index (GSI) showed that UKF3 (G6), 98/0002 (G2) and P4/10 (G5) were the highest yielding and most stable genotypes for FRY, and 98/0002 (G1), UKF3 (G6) and UKF9 (G11) were the highest yielding and most stable genotypes for DMC. Cultivars 98/0002 and UKF3 were identified as providing high stability with superior fresh root yield and DMC. These genotypes could be recommended to farmers for food, feed and industrial applications without the need for further breeding. The AMMI-2 model clustered the testing environments into three mega-environments based on the winning genotypes for FRY and DMC. Mabuyeni (KwaZulu-Natal), Shatale (Mpumalanga) and Mandlakazi (Limpopo) would be the best testing sites in future cassava-genotype evaluation and breeding programs. This study provides a baseline for a future study on the GEI of cassava varieties, using a larger set of genotypes, factoring in seasonal variation. [ABSTRACT FROM AUTHOR]

Background: To date, there are over 320 variants identified in the IRF6 gene that cause Van der Woude syndrome or popliteal pterygium syndrome. We sequenced this gene in a South African orofacial cleft cohort to identify the causal IRF6 variants in our population. Method: Saliva samples from 100 patients with syndromic and non‐syndromic CL ± P were collected. Patients were recruited from the cleft clinics at two public, tertiary hospitals in Durban, South Africa (SA), namely Inkosi Albert Luthuli Central Hospital (IALCH) and KwaZulu‐Natal Children's Hospital (KZNCH). We prospectively sequenced the exons of IRF6 in 100 orofacial cleft cases, and where possible, we also sequenced the parents of the individuals to determine the segregation pattern. Results: Two variants were identified; one novel (p.Cys114Tyr) and one known (p.Arg84His) missense variant in IRF6 gene were identified. The patient with the p.Cys114Tyr variant was non‐syndromic with no clinical VWS phenotype expected of individuals with IRF6 coding variants, and the patient with the p.Arg84His had phenotypic features of popliteal pterygium syndrome. The p.Arg84His variant segregated in the family, with the father also being affected. Conclusions: This study provides evidence that IRF6 variants are found in the South African population. Genetic counselling is essential for affected families, particularly in the absence of a known clinical phenotype since it helps with the plans for future pregnancies. [ABSTRACT FROM AUTHOR]

Drifting fish eggs and larvae (ichthyoplankton) can be identified to species using DNA metabarcoding, thus allowing for post hoc community analyses at a high taxonomic resolution. We undertook a regional-scale study of ichthyoplankton distribution along the east coast of South Africa, focused on the contrasting environments of the tropical Delagoa and subtropical Natal Ecoregions, and on exposed and sheltered shelf areas. Zooplankton samples were collected with tow nets at discrete stations along cross-shelf transects (20–200 m depth) spaced along a latitudinal gradient that incorporates a known biogeographical boundary. Metabarcoding detected 67 fish species, of which 64 matched prior distribution records of fishes from South Africa, with the remaining three known from the Western Indian Ocean. Coastal, neritic and oceanic species were present, from epi- and mesopelagic to benthopelagic and benthic adult habitats. By family, Myctophidae (10 species), Carangidae, Clupeidae, Labridae (each with 4 species) and Haemulidae (3 species) were most speciose. Ichthyoplankton community composition varied significantly with latitude, distance to coast, and distance to the shelf edge. Small pelagic fishes had the highest frequency of occurrence: Engraulis capensis, Emmelichthys nitidus and Benthosema pterotum increased in frequency towards the north, whereas Etrumeus whiteheadi increased towards the south. Chub mackerel Scomber japonicus accounted for most variability related to distance from the coast, whilst African scad Trachurus delagoa correlated with distance to the shelf edge. Dissimilarity between communities in the Delagoa and Natal Ecoregions was 98–100%, whereas neighbouring transects located within the sheltered KwaZulu-Natal Bight had lower dissimilarity (56–86%). Onshore transport of ichthyoplankton by Agulhas Current intrusions plausibly explained the abundance of mesopelagic species over the shelf. Metabarcoding followed by community analysis revealed a latitudinal gradient in the ichthyoplankton, associations with coastal and shelf-edge processes, and evidence of a spawning area in the sheltered KwaZulu-Natal Bight. [ABSTRACT FROM AUTHOR]

Objectives: The adverse effects of the COVID‐19 pandemic on tuberculosis (TB) detection have been well documented. Despite shared symptoms, guidance for integrated screening for TBand COVID‐19 are limited, and opportunities for health systems strengthening curtailed by lockdowns. We partnered with a high TB burden district in KwaZulu‐Natal, South Africa, to co‐develop an integrated approach to assessing COVID‐19 and TB, delivered using online learning and quality improvement, and evaluated its performance on TB testing and detection. Methods: We conducted a mixed methods study incorporating a quasi‐experimental design and process evaluation in 10 intervention and 18 control clinics. Nurses in all 28 clinics were all provided access to a four‐session online course to integrate TB and COVID‐19 screening and testing, which was augmented with some webinar and in‐person support at the 10 intervention clinics. We estimated the effects of exposure to this additional support using interrupted time series Poisson regression mixed models. Process evaluation data comprised interviews before and after the intervention. Thematic coding was employed to provide explanations for effects of the intervention. Results: Clinic‐level support at intervention clinics was associated with a markedly higher uptake (177 nurses from 10 intervention clinics vs. 19 from 18 control clinics). Lack of familiarity with online learning, and a preference for group learning hindered the transition from face‐to‐face to online learning. Even so, any exposure to training was initially associated with higher rates of GeneXpert testing (adjusted incidence ratio [IRR] 1.11, 95% confidence interval 1.07–1.15) and higher positive TB diagnosis (IRR 1.38, 1.11–1.71). Conclusions: These results add to the knowledge base regarding the effectiveness of interventions to strengthen TB case detection during the COVID‐19 pandemic. The findings support the feasibility of a shift to online learning approaches in low‐resource settings with appropriate support and suggest that even low‐intensity interventions are capable of activating nurses to integrate existing disease control priorities during pandemic conditions. [ABSTRACT FROM AUTHOR]

Large-bodied temnospondyl amphibians were the dominant predators in non-marine aquatic ecosystems from the Carboniferous to the Middle Triassic. In the Permian-aged lower Beaufort Group of the main Karoo Basin, South Africa, temnospondyls are represented exclusively by the family Rhinesuchidae and are well represented by body fossils, whereas trace fossils are scarce. Accordingly, most interpretations of the behaviour of this family are based on skeletal morphology and histological data. Here we document the sedimentology and palaeontology of a late Permian palaeosurface situated immediately below the palaeoshoreline of the Ecca Sea (transition from the Ecca Group to the Beaufort Group) near the town of Estcourt in KwaZulu-Natal Province. The surface preserves numerous ichnofossils, including tetrapod footprints and fish swim-trails, but most striking are seven body impressions and associated swim trails that we attribute to a medium-sized (~1.9 m long) rhinesuchid temnospondyl. These provide valuable insight into the behaviour of these animals. The sinuous shape of some of the traces suggest that the tracemaker swam with continuous sub-undulatory propulsion of the tail. [ABSTRACT FROM AUTHOR]

Background: South Africa had an estimated 7.5 million people living with HIV (PLHIV), accounting for approximately 20% of the 38.4 million PLHIV globally in 2021. In 2015, the World Health Organization recommended the universal test and treat (UTT) intervention which was implemented in South Africa in September 2016. Evidence shows that UTT implementation faces challenges in terms of human resources capacity or infrastructure. We aim to explore healthcare providers (HCPs)' perspectives on the implementation of the UTT strategy in uThukela District Municipality in KwaZulu-Natal province. Methods: A qualitative study was conducted with one hundred and sixty-one (161) healthcare providers (HCPs) within 18 healthcare facilities in three subdistricts, comprising of Managers, Nurses, and Lay workers. HCPs were interviewed using an open ended-survey questions to explore their perceptions providing HIV care under the UTT strategy. All interviews were thematically analysed using both inductive and deductive approaches. Results: Of the 161 participants (142 female and 19 male), 158 (98%) worked at the facility level, of which 82 (51%) were nurses, and 20 (12.5%) were managers (facility managers and PHC manager/supervisors). Despite a general acceptance of the UTT policy implementation, HCPs expressed challenges such as increased patient defaulter rates, increased work overload, caused by the increased number of service users, and physiological and psychological impacts. The surge in the workload under conditions of inadequate systems' capacity and human resources, gave rise to a greater burden on HCPs in this study. However, increased life expectancy, good quality of life, and immediate treatment initiation were identified as perceived positive outcomes of UTT on service users. Perceived influence of UTT on the health system included, increased number of patients initiated, decreased burden on the system, meeting the 90-90-90 targets, and financial aspects. Conclusion: Health system strengthening such as providing more systems' capacity for expected increase in workload, proper training and retraining of HCPs with new policies in the management of patient readiness for lifelong ART journey, and ensuring availability of medicines, may reduce strain on HCPs, thus improving the delivery of the comprehensive UTT services to PLHIV. [ABSTRACT FROM AUTHOR]

Background: Hypertension is the second leading risk factor for death in South Africa, and rates have steadily increased since the end of Apartheid. Research on the determinants of hypertension in South Africa has received considerable attention due to South Africa's rapid urbanization and epidemiological transition. However, scant work has been conducted to investigate how various segments of the Black South African population experience this transition. Identifying the correlates of hypertension in this population is critical to the development of policies and targeted interventions to strengthen equitable public health efforts. Methods: This analysis explores the relationship between individual and area-level socioeconomic status and hypertension prevalence, awareness, treatment, and control within a sample of 7,303 Black South Africans in three municipalities of the uMgungundlovu district in KwaZulu-Natal province: the Msunduzi, uMshwathi, and Mkhambathini. Cross-sectional data were collected on participants from February 2017 to February 2018. Individual-level socioeconomic status was measured by employment status and educational attainment. Ward-level area deprivation was operationalized by the most recent (2011 and 2001) South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and diabetes diagnosis. Results: The prevalence of hypertension in the sample was 44.4% (n = 3,240). Of those, 2,324 were aware of their diagnosis, 1,928 were receiving treatment, and 1,051 had their hypertension controlled. Educational attainment was negatively associated with hypertension prevalence and positively associated with its control. Employment status was negatively associated with hypertension control. Black South Africans living in more deprived wards had higher odds of being hypertensive and lower odds of having their hypertension controlled. Those residing in wards that became more deprived from 2001 to 2011 had higher odds of being aware of their hypertension, yet lower odds of receiving treatment for it. Conclusions: Results from this study can assist policymakers and practitioners in identifying groups within the Black South African population that should be prioritized for public health interventions. Black South Africans who have and continue to face barriers to care, including those with low educational attainment or living in deprived wards had worse hypertension outcomes. Potential interventions include community-based programs that deliver medication to households, workplaces, or community centers. [ABSTRACT FROM AUTHOR]

Background: Timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa. Methods: In the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012–2016, resident individuals ≥16 years were offered home-based HIV testing every six months. Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to "re-refer" people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up. Results: Among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47–2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07–7.48). Conclusions: Phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets. [ABSTRACT FROM AUTHOR]

Background: Of the 8 million people in South Africa living with HIV, 74% of persons living with HIV are on antiretroviral therapy (ART) and 65% are virally suppressed. Detectable viral load results in HIV-associated morbidity and mortality and HIV transmission. Patient barriers to care, such as missed wages, transport costs, and long wait times for clinic visits and ART refills, are associated with detectable viral load. HIV differentiated service delivery (DSD) has simplified ART delivery for clients who achieve viral suppression and engage in care. However, DSD needs adaptation to serve clients who are not engaged in care. Methods: A Sequential Multiple Assignment Randomized Trial will be undertaken in KwaZulu-Natal, South Africa, to test adaptive ART delivery for persons with detectable viral load and/or who are not engaged in care. The types of differentiated service delivery (DSD) which will be examined in this study are clinic-based incentives, community-based smart lockers, and home delivery. The study plans to enroll up to 900 participants-people living with HIV, eligible for ART, and who are not engaged in care. The study aims to assess the proportion of ART-eligible persons living with HIV who achieve viral suppression at 18 months. The study will also evaluate the preferences of clients and providers for differentiated service delivery and evaluate the cost-effectiveness of adaptive HIV treatment for those who are not engaged in care. Discussion: To increase population-level viral suppression, persons with detectable viral load need responsive DSD interventions. A Sequential Multiple Assignment Randomized Trial (SMART) design facilitates the evaluation of a stepped, adaptive approach to achieving viral suppression with "right-sized" interventions for patients most in need of effective and efficient HIV care delivery strategies. Trial registration: ClinicalTrials.gov NCT05090150. Registered on October 22, 2021 [ABSTRACT FROM AUTHOR]

Extreme rainfall occurred over the South African east coast during 10–12 April 2022, leading to over 500 deaths and massive damage. This study seeks to understand a key feature, namely the progression of the rainfall maxima from the northern KwaZulu-Natal (KZN) coast during the night of 10–11 April by ~550 km to the Eastern Cape coast about 48 h later. The large-scale circulation was dominated by a cut-off low over the South African interior with a strong ridging anticyclone southeast of the country in the South Indian Ocean. Satellite, rain gauge, and ERA5 reanalysis are used to show that the timing and location of the heaviest rainfall are closely tied to, firstly, the formation of a Mesoscale Convective System (MCS) at ~0300UTC April 11 on the northern KZN coast which tracked south and then offshore, and secondly, a meso-trough which formed a coastal meso-low by ~2100 UTC April 11. The meso-low tracked south over the warm waters of the Agulhas Current before strengthening into Subtropical Depression Issa. Mesoscale interaction between the MCS and coastal meso-low determined the positioning and timing of the strongest onshore low-level jet, moisture convergence and uplift, and hence the progression of the heavy rainfall down the coast. Such mesoscale interaction has not previously been documented in southern Africa or the Southern Hemisphere. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the usefulness or quality of annual reports formulated by the municipalities in the context of decision-making and accountability in the KwaZulu-Natal province in South Africa. Methodology: In this study, we employ a 21-index research tool designed by Beest, Braam, and Boelens (2009). Findings: The results of the study indicate that the quality of the KwaZulu-Natal municipalities' annual reports is quite satisfactory. However, there is scope for enhancement as far as the quality of the annual reports is concerned Originality/Value: This study contributes to the current body of knowledge and further contributes to the enhancement in the usefulness and quality of financial reporting in public sector and belyond. This study has also provided a very robust plan for future researchers. [ABSTRACT FROM AUTHOR]

Cassava is an important starchy root crop grown globally in tropical and subtropical regions. The ability of cassava to withstand difficult growing conditions and long-term storability underground makes it a resilient crop, contributing to food and nutrient security. This study was conducted to evaluate the performance and adaptability of exotic cassava cultivars across different environments in South Africa and to recommend genotypes for cultivation. A total of 11 cassava cultivars were evaluated at six on-farm sites, using a randomized complete block design with three replications. There were highly significant (p < 0.001) variations between genotypes, environments, and their interaction for all yield and yield-related traits studied. This indicates the need to test the genotypes in multiple environments before effective selection and commercialization can be undertaken. MSAF2 and UKF4 showed the overall best performances for most of the traits, whilst UKF9 (49.5%) and P1/19 (48.5%) had the highest dry matter yield. UKF4 (102.7 t ha−1) had the highest yield and greatest root yield stability across environments. MSAF2 did not perform consistently across environments because it was highly susceptible to cassava mosaic disease (CMD). MSAF2 could be used as a donor parent to generate novel clones with large numbers of marketable roots, and high fresh root yields, if the other parent can provide effective resistance to CMD. Based on genotype and environmental mean, Mabuyeni (KwaZulu-Natal), Mandlakazi (Limpopo), and Shatale (Mpumalanga) were found to be better environments for cassava cultivation and testing. This study is a pioneer in cassava research using multiple environments in South Africa. It provides baseline information on the performance of currently available cassava clones, their adaptation to multiple sites, the identification of suitable test sites, and information on current genetic resources for a future breeding program. [ABSTRACT FROM AUTHOR]

The production of nutritious food amongst rural farmers has been a challenge for m Cany years. Challenges can be attributed to many factors, including poor access to water, use of old planting methods, financial challenges, etc. Therefore, new climate-smart technologies (CSTs) were introduced to the farmers. The CSTs implemented in the study were in-field rainwater harvesting (IRWH) techniques compared with conventional production (CON). These technologies were applied in combination with sound agronomic management practices, such as mulching and fertilizer application, to produce cabbage, beetroot, spinach and orange-fleshed sweet potato. The vegetables produced were harvested and their nutritional composition analysed to assess whether or not agronomic treatments, water-use technology and season affected their micronutrient levels, with a particular focus on provitamin A and mineral levels. The main finding of the study was that the nutrient levels of the vegetables can be enhanced by adopting IRWH technology combined with different agronomic treatments, especially including mulching as one of the treatment combinations. Limitations: Farmer research participants did not always adhere to research agreements, particularly regarding reserving vegetable samples for analyses. As a result, some experiment replicates are missing. Value: The study findings are of socio-economic significance as they demonstrate that rural, small-scale farmers can apply local, accessible and appropriate agronomic treatments and water-use technologies to achieve economically viable yields of nutritive vegetables to enhance food and nutrition security and household livelihoods of the farmers. [ABSTRACT FROM AUTHOR]

Introduction. Treatment of gonorrhoea infection is limited by the increasing prevalence of multidrug-resistant strains. Cost-effective molecular diagnostic tests can guide effective antimicrobial stewardship. The aim of this study was to correlate mRNA expression levels in Neisseria gonorrhoeae antibiotic target genes and efflux pump genes to antibiotic resistance in our population. Methods. This study investigated the expression profile of antibiotic resistance-associated genes (penA, ponA, pilQ, mtrR, mtrA, mtrF, gyrA, parC, parE, rpsJ, 16S rRNA, and 23S rRNA) and efflux pump genes (macAB, norM, and mtrCDE), by quantitative real-time PCR, in clinical isolates from KwaZulu-Natal, South Africa. Whole-genome sequencing was used to determine the presence or absence of mutations. Results. N. gonorrhoeae isolates, from female and male patients presenting for care at clinics in KwaZulu-Natal, South Africa, were analysed. As determined by binomial regression and ROC analysis, the most significant (p ≤ 0.05) markers for resistance prediction in this population, and their cutoff values, were determined to be mtrC (p = 0.024 ; cutoff <0.089), gyrA (p = 0.027 ; cutoff <0.0518), parE (p = 0.036 ; cutoff <0.0033), rpsJ (p = 0.047 ; cutoff <0.0012), and 23S rRNA (p = 0.042 ; cutoff >7.754). Conclusion. Antimicrobial stewardship includes exploring options to conserve currently available drugs for gonorrhoea treatment. There is the potential to predict an isolate as either susceptible or nonsusceptible based on the mRNA expression level of specific candidate markers, to inform patient management. This real-time qPCR approach, with few targets, can be further investigated for use as a potentially cost-effective diagnostic tool to detect resistance. [ABSTRACT FROM AUTHOR]

Despite enormous increases in the proportion of people living with HIV accessing treatment in sub-Saharan Africa, major gender disparities persist, with men experiencing lower rates of testing, linkage to treatment, and retention in care. In this study, we investigated the barriers and facilitating factors to HIV treatment among men in uThukela, a high-HIV-burdened district in KwaZulu-Natal province, South Africa. We conducted a qualitative study including nine Black African male participants who were recruited from 18 health care facilities in uThukela District, KwaZulu-Natal province. In-depth interviews were conducted with participants who linked to care and those who did not link to care at 3-month post HIV diagnosis. We used Atlas.ti for thematic analysis. Data were coded and linked to broader themes emerging across interviews. The median age was 40 years (interquartile range [IQR]: 31–41). This study identified the following key themes which emerged as barriers to HIV treatment among men in uThukela District: lack of emotional readiness, perceived medication side effects, fear of treatment non-adherence, perceived stigma and confidentiality concerns, and poor socioeconomic factors. We identified the following enabling factors to HIV treatment among men: fear of HIV progressing, acceptance of status, disclosure, support from family and friends, positive testing experience, and accessibility of antiretroviral treatment. This study revealed barriers and enabling factors to HIV treatment among men. These factors are important to inform the design of targeted intervention strategies aimed at improving linkage and retention to HIV treatment among men. [ABSTRACT FROM AUTHOR]

The fungal genus Basidiobolus is typically associated with ectothermic animals such as amphibians and reptiles. In rare cases, it can cause infections in humans, which are often misdiagnosed. Although usually restricted to tropical and subtropical countries, infections have recently been more frequently reported in hot-dry regions such as Arizona and Saudi Arabia. Reptiles such as geckos are known to shed Basidiobolus spp. via feces and frequently live in close proximity to humans. To establish the frequency and burden of Basidiobolus spp. released by geckos in a suburban location, we regularly quantified viable Basidiobolus units per gram of feces from indoors and outdoors over 3.5 years between 2018 and 2022 using a selective medium. Geckos were shedding Basidiobolus spp. in all seasons, with most counts established ranging between 5.0 and 6.5 log10 cfu per gram. Statistically significant seasonal differences per location were only observed for the outside winter counts and, apparently, correlated to lower temperatures, while inside counts showed no seasonal difference. Overall, counts for droppings collected outdoors were significantly higher than counts for droppings collected indoors. Our data confirm that geckos, which frequently enter homes and are global invaders, are a regular source of this fungus. [ABSTRACT FROM AUTHOR]

Background: Due to the high prevalence of HIV, HIV-associated lymphoma (HAL) is a common malignancy in South Africa. However, there is a paucity of literature on HAL from this region. The objective of this study was to profile the clinical characteristics and outcome of CD20-positive HAL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), with or without rituximab (R), from a single center in KwaZulu -Natal, South Africa. Methods: Retrospective chart review of adult patients treated from 2006 to 2018 for HIV-associated CD20-positive lymphoma. The clinical characteristics, complete response (CR), and 2-year overall survival (OS) are described. Results: The analysis included 102 patients, 54% females, median age of 39 years, and median CD4 cell count of 196 cells/μL. Bone marrow involvement was noted in 5%. Eighty-six percent of the cohort received concomitant antiretroviral therapy and chemotherapy, 76% of the CHOP group, and 92% of the R-CHOP group. Overall, a CR was seen in 55% (95% CI 45%; 65%), with a 2-year OS of 59% (95% CI 50%, 69%). A CR was attained in 46% on CHOP and 64% on R-CHOP, with a 2-year disease-free survival (DFS) for CHOP of 42% and 50% for R-CHOP. Conclusion: Although the clinical characteristics and laboratory findings are similar to other higher-income cohorts, there was a difference in gender and incidence of marrow involvement. The low incidence of marrow involvement has prompted more routine use of immunohistochemistry and flow cytometry in staging marrows of HAL locally. Further randomized studies are required for the establishment of locally validated, cost-effective treatment guidelines. [ABSTRACT FROM AUTHOR]

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

Community engagement (CE) has been identified as an important pillar alongside teaching and research in higher education. Despite this it has emerged slowly within the South African landscape due to a lack of understanding regarding engagement. Drawing on in-depth interviews, this study sought to explore how academics (N=14), at a University of Technology in KwaZulu-Natal, South Africa understood CE and the processes involved in engagement. The study found that CE was a symbiotic relationship that involved collaboration with communities in order to understand community needs, nurture community partnerships, and ensure sustainable engagement initiatives. Finally, the data reflected that in order to enable social change, the community should be honoured as a source of knowledge and the university should recognise the benefits of engagement. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Bioethics / Revue canadienne de bioéthique is the property of Ecole de Sante Publique de l'Universite de Montreal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This qualitative exploratory study closely look at the evidential value of carcass traces in combating stock theft in South Africa. It was confined to the selected areas of KwaZulu-Natal (KZN) Province of South Africa. The Deoxyribonucleic Acid (DNA) technology, DNA testing, DNA profiling or Genetic fingerprinting refers to a technique adopted to identify and distinguish livestock by their DNA samples, focusing on patterns uniqueness of DNA sources (Carcass, fingerprints, footprints, hair, skin cells, blood, bodily fluids, pieces of clothing and fibres, alike). About 49 participants were purposively sampled, all from the KZN Province. The data was collected through Key Informant Interviews (KII) and Focus Group Discussions (FGDs). The inductive thematic methods was employed for data analysis. This study established that crime scenes involving livestock should be investigated using the same principles as any other crime scenes. It is also confirmed that every time contact is made with another person, place, or object, it results in an exchange of physical materials, carcass includes. Summarily, no matter where a stock thieve criminal go or do, by coming into contact with carcass, they can leave evidence behind, including the mentioned various DNA sources, which could positively lead to the scientific reconstruction of events, interpretation of observations and measurements from the stock theft scenes to collect physical evidence. For recommendations, the Anti-Stock theft structures should avoid mistakes in the recovering of stock theft scenes, sample collections or test procedures. They should ensure that the results are accurate by following all procedural measures, lay down guidelines for maintaining the chain of custody to ensure that the DNA tests become conclusive, and they should further provide detailed information about discovered carcass, while placing more emphasis on this type of evidence. [ABSTRACT FROM AUTHOR]

Background: Innovative models to distribute oral HIV self-tests (HIVST) provide an opportunity to increase access to HIV testing, especially for hard-to-reach populations. This study aimed to describe the acceptability of unsupervised peer-distribution of HIVST as a method to scale-up HIV testing. Methods: In this study, lay counsellors or community health workers provided HIVST kits to primary recipients (PRs) for distribution to their sexual partners, anyone in their social network (termed secondary recipients) or for self-testing, from September 2018 to March 2020. The study was conducted in Eshowe and Mbongolwane areas in KwaZulu-Natal, South Africa. A structured questionnaire was administered during the recruitment and passive follow-up, when people came for confirmatory HIV testing. Electronic records were retrospectively examined to determine initiation of antiretroviral treatment (ART) for all HIVST users and non-users. Results: Among 36,708 people approached to be primary recipients, 9,891 (26.9%) accepted; 31,341 HIVST kits were distributed with a median of three (IQR: 2–4) per peer. PRs were predominately recruited at primary health clinics (PHCs). However, acceptability of HIVST was thrice as high at community-based testing sites compared to PHCs (64.5% vs. 21.0%; p<0.001). During the study period, 34,715 adults were tested for HIV at both PHCs and community-based testing sites; of these, 1,089 individuals reported HIVST use. Among HIVST users, 893 (82.0%) returned to the clinic for confirmatory testing after testing negative on HIVST; 196 (17.9%) were confirmed HIV positive following a positive HIVST. After excluding 36/196 (18.4%) participants for whom clinical records could not be found in electronic register and 25/160 (15.6%) who were already on ART before receiving HIVST, 129/135 (95.5%) initiated ART, whereas 2,362/2685 (88%) of HIV positive HIVST non-users-initiated ART. Conclusion: Unsupervised peer-distribution of HIVST was feasible and acceptable, with more than 25% accepting to be peer-distributors. Acceptability of HIVST was thrice as high in community sites compared to clinics. [ABSTRACT FROM AUTHOR]

Introduction: Pre-exposure prophylaxis (PrEP) is an effective prevention intervention that can be used to control HIV incidence especially among people who are at increased risk for HIV such as adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM). In South Africa, various approaches of delivering PrEP have been adopted at different service delivery points (facility-based only, school-based only, community-based only and hybrid school-facility and community-facility models) to overcome challenges associated with individual, structural, and health systems related barriers that may hinder access to and uptake of PrEP among these populations. However, little is known about how to optimize PrEP implementation and operational strategies to achieve high sustained uptake of good quality services for AGYW and ABYM. This study aims to identify effective and feasible PrEP models of care for improving PrEP uptake, continuation, and adherence among AGYW and ABYM. Methods and analysis: A sequential explanatory mixed-methods study will be conducted in 22 service delivery points (SDPs) in uMgungundlovu district, KwaZulu-Natal, South Africa. We will recruit 600 HIV negative, sexually active, high risk, AGYW (aged 15–24 years) and ABYM (aged 15–35 years). Enrolled participants will be followed up at 1-, 4- and 7-months to determine continuation and adherence to PrEP. We will conduct two focus group discussions (with 8 participants in each group) across four groups (i. Initiated PrEP within 1 month, ii. Did not initiate PrEP within 1 month, iii. Continued PrEP at 4/7 months and iv. Did not continue PrEP at 4/7 months) and 48 in-depth interviews from each of the four groups (12 per group). Twelve key informant interviews with stakeholders working in HIV programs will also be conducted. Associations between demographic characteristics stratified by PrEP initiation and by various service-delivery models will be assessed using Chi-square/Fishers exact tests or t-test/Mann Whitney test. A general inductive approach will be used to analyze the qualitative data. Ethics and dissemination: The protocol was approved by the South African Medical Research Council Health Research Ethics Committee (EC051-11/2020). Findings from the study will be communicated to the study population and results will be presented to stakeholders and at appropriate local and international conferences. Outputs will also include a policy brief, peer-reviewed journal articles and research capacity building through research degrees. [ABSTRACT FROM AUTHOR]

Background: Recent evidence highlighting high HIV incidence and prevalence in informal settlements suggests that they are environments that foster HIV risk. Given growing urbanization in sub-Saharan Africa, there is a critical need to assess the successes and challenges of implementing HIV testing, prevention and treatment interventions in these contexts. Methods: We randomly selected a household-based sample of 1528 adult men (18–35) and women (18–24) living in 18 randomly selected communities in KZN, South Africa. After the baseline interview, communities were randomized to one of three intervention rollout arms in a stepped wedge design. At approximately 8-month intervals, the Asibonisane Community Responses Program (and in particular the implementation of Stepping Stones, a participatory HIV prevention program focused on strengthening relationships and communication) was rolled at by intervention phase. Using data from this evaluation, we describe levels and trends in HIV testing and treatment during follow-up, and we use fixed effects models to estimate the effects of participation in the program on testing. Results: Study respondents reported high levels of economic insecurity and mobility, and men report various HIV risk behaviors including about 50% reporting multiple partnerships. About two-thirds of respondents (73% of women, 63% of men) had been tested for HIV in the last six months. Among those living with HIV, treatment levels were high at baseline, and almost universal by endline in 2019. Program participation led to a 17% increase in the probability of testing for women (p<0.05) but had no effect on testing for men due, in part, to the fact that the program did not reach men who were least likely to be tested, including those who had migrated recently, and those who had never been tested at baseline. Conclusions: Near universal HIV treatment use demonstrates positive trends in access to some HIV services (including treatment as prevention) in these communities. Stepping Stones had positive effects on HIV testing for women, yet barriers to HIV testing remain, especially for men. Redoubled efforts to reach men with testing are vital for improving HIV outcomes for both men and their partners. [ABSTRACT FROM AUTHOR]

Health system constraints are increasingly recognized as an important addition to model-based analyses of disease control interventions, as they affect achievable impact and scale. Enabling activities implemented alongside interventions to relax constraints and reach the intended coverage may incur additional costs, which should be considered in priority setting decisions. We explore the use of group model building, a participatory system dynamics modelling technique, for eliciting information from key stakeholders on the constraints that apply to tuberculosis infection prevention and control processes within primary healthcare clinics in South Africa. This information was used to design feasible interventions, including the necessary enablers to relax existing constraints. Intervention and enabler costs were then calculated at two clinics in KwaZulu-Natal using input prices and quantities from the published literature and local suppliers. Among the proposed interventions, the most inexpensive was retrofitting buildings to improve ventilation (US$1644 per year), followed by maximizing the use of community sites for medication collection among stable patients on antiretroviral therapy (ART; US$3753) and introducing appointments systems to reduce crowding (US$9302). Enablers identified included enhanced staff training, supervision and patient engagement activities to support behaviour change and local ownership. Several of the enablers identified by the stakeholders, such as obtaining building permissions or improving information flow between levels of the health systems, were not amenable to costing. Despite this limitation, an approach to costing rooted in system dynamics modelling can be successfully applied in economic evaluations to more accurately estimate the 'real world' opportunity cost of intervention options. Further empirical research applying this approach to different intervention types (e.g. new preventive technologies or diagnostics) may identify interventions that are not cost-effective in specific contexts based on the size of the required investment in enablers. [ABSTRACT FROM AUTHOR]

Background: Continued efforts are required to reduce preventable child deaths. User-friendly Integrated Management of Childhood Illness (IMCI) implementation tools and supervision systems are needed to strengthen the quality of child health services in South Africa. A 2018 pilot implementation of electronic IMCI case management algorithms in KwaZulu-Natal demonstrated good uptake and acceptance at primary care clinics. We aimed to investigate whether ongoing electronic IMCI implementation is feasible within the existing Department of Health infrastructure and resources.Methods: In a mixed methods descriptive study, the electronic IMCI (eIMCI) implementation was extended to 22 health facilities in uMgungundlovu district from November 2019 to February 2021. Training, mentoring, supervision and IT support were provided by a dedicated project team. Programme use was tracked, quarterly assessments of the service delivery platform were undertaken and in-depth interviews were conducted with facility managers.Results: From December 2019 - January 2021, 9 684 eIMCI records were completed across 20 facilities, with a median uptake of 29 records per clinic per month and a mean (range) proportion of child consultations using eIMCI of 15% (1-46%). The local COVID-19-related movement restrictions and epidemic peaks coincided with declines in the monthly eIMCI uptake. Substantial inter- and intra-facility variations in use were observed, with the use being positively associated with the allocation of an eIMCI trained nurse (p < 0.001) and the clinician workload (p = 0.032).Conclusion: The ongoing eIMCI uptake was sporadic and the implementation undermined by barriers such as low post-training deployment of nurses; poor capacity in the DoH for IT support; and COVID-19-related disruptions in service delivery. Scaling eIMCI in South Africa would rely on resolving these challenges. [ABSTRACT FROM AUTHOR]

The evolution of internet and the widespread adoption of technology in academic libraries brings about new roles and responsibilities for subject librarians. Digital literacy instruction remains the indispensable service in academic libraries in the 21st century. This emphasises the necessity for subject librarians to possess relevant digital literacy skills. This article reports on the quantitative findings emanating from the explanatory sequential mixed methods study (2022) that investigated digital literacy instruction in academic libraries in the KwaZulu-Natal (KZN) region in South Africa. The quantitative findings were used to achieve the study's objective that sought to find out if subject librarians possess digital literacy skills necessary for digital literacy instruction in academic libraries in KwaZulu-Natal region, South Africa. The study adopted a census method and collected data from a total of 58 subject librarians from traditional universities and universities of technology in KZN region through an online survey. The findings revealed that subject librarians in academic librarians (KwaZulu-Natal region, South Africa) are competent in various digital literacy namely e-mailing skills, Word processing, PowerPoint, information retrieval and blended learning. Further, the study revealed a significant lack of digital literacy skills related to library management system, knowledge of statistical software packages, Microsoft Publisher, Microsoft Access, Website design and copyright licensing. [ABSTRACT FROM AUTHOR]