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An experiment was conducted to evaluate the reproductive performance and offspring quality of Macrobrachium vollenhovenii broodstock fed four diets: commercial maturation feed (control, T0), maggot (T1), fresh mackerel (T2) and locally formulated feed (T3). Spent broodstock of M. vollenhovenii fed experimental diets and their reproductive performances were evaluated in phase one experimentation. In phase two their offspring quality in a recirculation system with three replicates per treatment (TL0, TL1, TL2 and TL3) were evaluated for 30 days. The duration of gonadal development was significantly different among all the treatments, 28.67 ± 0.58 days and 16.33 ± 1.15 days for T0 and T1, respectively. T1 recorded the best GSI (16.08 ± 0.2%). Larval development in TL1 and TL3 were significantly faster than TL0 and TL2. However, survival rate was the best in TL3 (32.17 ± 0.57%) followed by TL0 (29.63 ± 0.33%). The results of this study are evidence of the possibility of successfully re-maturing and breeding this prawn in captivity. [ABSTRACT FROM AUTHOR]

Macrobrachium vollenhovenii (Herklots, 1857), the largest of the indigenous West African Palaemonidae prawns, has a high potential for aquaculture. This work was carried out to assess the effect of temperature on embryonic development and offspring quality of this species. In the phase one experiment, females at stage V of gonadal development incubated their eggs at three experimental temperatures and their embryonic development was evaluated. Seven embryonic developmental stages were observed: fertilisation, mitosis, morula, blastula, gastrula, nauplius and larvae. The incubation periods were 19, 14 and 13 days at 26 °C, 28 °C and 30 °C, respectively. A temperature of 30 °C resulted in higher broodstock mortality (33.33%). In phase two, larvae were reared at the respective temperatures for 30 days at a stocking density of 30 larvae per litre of water. Offspring quality was significantly different between treatments from day five onwards, with the fastest development at 30 °C followed by 28 °C. However, larval survival rate was significantly higher at 26 °C (31.7%) followed by 28 °C (27.6%). A temperature of 28 °C could therefore be recommended as the most favourable for embryonic development and larviculture of M. vollenhovenii. These findings will help bridge the knowledge gap with respect to captive breeding and hatchery technology for M. vollenhovenii. [ABSTRACT FROM AUTHOR]

Net community production (NCP), an analog of carbon export out of the surface ocean, is often estimated using budgets of dissolved oxygen. Accurate estimates of oxygen‐based NCP, especially in dynamic coastal regions, require constraints on vertical transport of water with O2 out of equilibrium with the atmosphere, nonsteady state change in the oxygen inventory, heating/cooling‐driven O2 disequilibrium, and the rate of bubble injection from wave activity. The latter two are typically evaluated by using discrete measurements of the O2/Ar ratio in lieu of O2 only. Because sophisticated sampling and measurement techniques are required to make these measurements, they are often limited in spatiotemporal resolution. However, high‐resolution estimates of NCP may be useful in determining small‐scale patchiness in export. In this study, we calculated high‐resolution NCP in coastal Southern California using dissolved oxygen measurements made by an autonomous buoyancy‐driven Slocum glider and an empirical relationship derived using discrete measurements of O2/Ar in the surface mixed layer to remove the influence of bubble injection, which accounted for approximately one fourth of the O2 supersaturation observed. Using estimates of vertical transport from wind speed‐based parameterizations, previously validated using a 7Be budget, we were able to correct for the physical biases to the signal, which are known to significantly influence dissolved oxygen budgets in this region. Our results agree well with previously published NCP estimates for the study area but also reveal higher‐frequency variability that discrete sampling was unable to resolve, suggesting that this approach may be useful in other regions with well‐constrained vertical transport rates. Plain Language Summary: The ocean takes up carbon dioxide from the atmosphere through a process referred to as "the biological pump." "Carbon export" refers to the amount of carbon removed by this process and is therefore an important quantity in determining the ocean's role as a sink for atmospheric carbon dioxide and significantly influences ocean chemistry. Carbon export is often estimated using budgets of oxygen in the surface ocean because oxygen is affected by the same processes. However, bubbles introduced through wave activity can bias oxygen budgets if not accounted for using precise measurements, which are often made in low spatiotemporal resolution and thus can miss patchy, high‐productivity events believed to contribute significantly to carbon export. In this study, we use an autonomous underwater vehicle to estimate carbon export with high resolution in coastal California. The results agree with more precise but lower‐resolution measurements, implying that the vehicle‐based approach may be useful for estimating carbon export in similar regions that may be dominated by undersampled, high‐productivity events. Key Points: A glider‐mounted oxygen sensor shows the oxygen inventory varies across the San Pedro Channel and is not reflected in surface concentrationUsing an empirical relationship between oxygen supersaturation and {Delta}O2/Ar, we make high‐resolution estimates of NCP, an analog of carbon exportThis approach removes the effect of bubble injection and may be useful for detecting patchy, high‐productivity events in similar regions [ABSTRACT FROM AUTHOR]

Abstract Background There is a high burden of depression globally, including in South Africa. Maternal depression is associated with poverty, unstable income, food insecurity, and lack of partner support, and may lead to poor outcomes for mothers and children. In South Africa one-third of working women are in informal work, which is associated with socioeconomic vulnerability. Methods A cross sectional survey explored work setting and conditions, food security and risk of depression among informal working women with young children (0–3 years). Depression risk was assessed using the Edinburgh Postnatal Depression Score (EPDS) and Whooley score. Food insecurity was evaluated using Household Food Insecurity Access Scale. Data was analysed using SPSS and Stata. Results Interviews were conducted with 265 informal women workers. Types of work included domestic work, home-based work, informal employees and own account workers, most of whom were informal traders. Most participants (149/265; 56.2%) earned between US$70–200 per month, but some participants (79/265; 29.8%) earned US$200 per month (37/265; 14.0%). Many participants experienced mild (38/267; 14.3%), moderate (72/265; 27.2%) or severe (43/265; 16%) food insecurity. Severe food insecurity was significantly higher among participants with the lowest income compared to those with the highest income (p = 0.027). Women who received financial support from the baby’s father were less likely to be food insecure (p = 0.03). Using EPDS scores, 22/265 (8.3%) women were designated as being at risk of depression. This was similar among postnatal women and women with older children. Household food insecurity was significantly associated with depression risk (p

The article discusses the Africa Centre Vertical Transmission Study which aims to identify the impact of infant feeding practices on HIV infection rates of infants at 6 and 22 weeks of age. Conducted in the rural Umkhanyakude district of northern KwaZulu Natal in August 2001, the study analyzed a group of 3,445 pregnant women. Researchers found that HIV positive women are at a significantly increased risk of pregnancy complications.

Background. Breast problems, including mastitis, can interfere with the duration and exclusivity of breast-feeding. However, there are no large prospective studies documenting the prevalence, duration, and timing of such problems in breast-feeding women, particularly those who are infected with human immunodeficiency virus (HIV). Methods. Women enrolled prenatally underwent a breast-feeding counseling intervention until 6 months after delivery. Breast health problems were documented per breast for 180 days after delivery, with 14-day recall histories. Results. Breast health problems were rare, and there were no significant differences between HIV-infected and HIV-uninfected women for any of the following conditions: engorgement, 39 HIV-infected women (3.5%) versus 33 HIV-uninfected women (2.7%; P = .30); breast thrush, 17 (1.5%) versus 12 (1.0%; P = .25); bleeding nipple, 6 (0.5%) versus 4 (0.3%; P = .45); and mastitis/abscess, 11 (1.0%) versus 6 (0.5%; P = .17). Most problems occurred during the first month after birth, with few additional mothers experiencing problems after this point: at 1 and 6 months, 13% and 17% of all mothers, respectively, had experienced a minor or major breast health problem, including sore nipples. Women who had not exclusively breast-fed their infants were more likely to experience any of the breast health problems than were women who had exclusively breast-fed their infants (time-dependent variable; adjusted odds ratio, 1.46; 95% confidence interval, 1.13-1.87; P = .003). HIV-infected women who experienced any serious breast health problem (i.e., bleeding nipple, pus oozing from a nipple or breast, or mastitis/abscess) were 3.55 times (95% confidence interval, 0.86-14.78 times; P = .08) more likely to transmit HIV postnatally to their infant. Conclusions. With encouragement to exclusively breast-feed, women experienced few breast health problems. When those problems did occur, HIV-infected women with bleeding nipple, pus oozing from a nipple or breast, or mastitis/abscess were more likely to transmit HIV to their infants. [ABSTRACT FROM AUTHOR]

Objective To examine infant feeding intentions of HIV-infected and uninfected women and the appropriateness of their choices according to their home resources; and to determine their adherence to their intentions in the first postnatal week. Methods Feeding intentions of pregnant women were compared against four resources that facilitate replacement feeding: clean water, adequate fuel, access to a refrigerator and regular maternal income. First-week feeding practices were documented. Findings The antenatal feeding intentions of 1253 HIV-infected women were: exclusive breastfeeding 73%; replacement feeding 9%; undecided 18%. Three percent had access to all four resources, of whom 23% chose replacement feeding. Of those choosing replacement feeding, 8% had access to all four resources. A clean water supply and regular maternal income were independently associated with intention to replacement feed (adjusted odds ratio (AOR) 1.94, 95% confidence interval (CI) 1.2–3.2; AOR 2.1, 95% CI: 1.2–3.5, respectively). Significantly more HIV-infected women intending to exclusively breastfeed, rather than replacement feed, adhered to their intention in week one (exclusive breastfeeding 78%; replacement feeding 42%; P<0.001). Of 1238 HIV-uninfected women, 82% intended to exclusively breastfeed; 2% to replacement feed; and 16% were undecided. Seventy-five percent who intended to exclusively breastfeed adhered to this intention postnatally, and only 11 infants (<1%) received no breast milk. The number of antenatal home visits significantly influenced adherence to feeding intention. Conclusion Most HIV-infected women did not have the resources for safe replacement feeding, instead choosing appropriately to exclusively breastfeed. Adherence to feeding intention among HIV-infected women was higher in those who chose to exclusively breastfeed than to replacement feed. With appropriate counselling and support, spillover of suboptimal feeding practices to HIV-negative women is minimal. [ABSTRACT FROM AUTHOR]

Pediatric wards in South Africa are largely occupied by children with AIDS-related illnesses. This study uses qualitative inquiry involving focus groups with nurses into the needs of children, caregivers, and healthcare providers. The findings indicate changes to the nature of nursing practice, knowledge of nursing, and ethics of nursing care. [ABSTRACT FROM AUTHOR]

Unlabelled: Exclusive breastfeeding (EBF) from 0 to 6 mo of age is recommended by the World Health Organization as the optimal feeding method for infants, including infants of human immunodeficiency virus (HIV)-infected women from developing countries who choose to breastfeed. EBF may be associated with less risk of postnatal HIV transmission than mixed feeding, but is still uncommonly practised for reasons that are poorly understood. This study aimed to assess EBF rates and the impediments to EBF in a South African rural area of high HIV prevalence where most mothers are unaware of their status. In a longitudinal study, 130 women attending 3 clinics, chosen for their disparate socioeconomic characteristics, were interviewed at weekly postnatal intervals. Follow-up to 16 wk was completed on 119 infants. In an additional cross-sectional survey mothers of 445 infants, aged 0-12 mo, attending immunization clinics were interviewed. In the longitudinal study 46% of infants received non-breast-milk fluids or feeds within 48 h of birth; only 10% were exclusively breastfed for 6 wk and 6% for 16 wk. Supplements, most commonly formula milk, were introduced for perceived milk insufficiency. Feeding choices were mainly self-determined (43% of women), but health staff (22%) and grandmothers (16%) were cited as sources of advice. In the cross-sectional survey caregivers reported that 47% of infants aged 2 wk, 40% aged 6 wk and 33% aged 12 wk had been exclusively breastfed since birth.Conclusion: EBF is uncommon in this area in spite of a baby-friendly hospital initiative in the district. Strategies to promote exclusive breastfeeding in developing countries where HIV and infant feeding policies are being formulated must strongly address local perceptions on the need for supplements and sources of feeding advice. [ABSTRACT FROM AUTHOR]

Purpose: To report our experience with inferior vena cava (IVC) filters in pediatric patients.Methods: Over a 19-month period, eight low-profile percutaneously introducible IVC filters were placed in four male and four female patients aged 6-16 years (mean 11 years). Indications were contraindication to heparin in six patients, anticoagulation failure in one, and idiopathic infrarenal IVC thrombosis in one. Six of the eight devices placed were titanium Greenfield filters. One LGM and one Bird's Nest filter were also placed. Two of the filters were introduced via the right internal jugular vein by cutdown, and the remainder were placed percutaneously via the right internal jugular vein or the right common femoral vein. Patients received follow-up abdominal radiographs from 2 to 13 months after IVC filter placement.Results: All filters were inserted successfully without complication. Three of the patients died during the follow-up period: two due to underlying brain tumors at 2 and 12 months and a third at 6 weeks due to progressive idiopathic renal vein and IVC thrombosis. The remaining five patients were all alive and well at follow-up without evidence of IVC thrombosis, pulmonary emboli, or filter migration.Conclusion: IVC filter placement using available devices for percutaneous delivery is technically feasible, safe, and effective in children. [ABSTRACT FROM AUTHOR]

We present a case of extracranial craniopharyngioma simulating a sphenoid sinus mucocele in a 12‐year‐old female who presented with progressive subacute left‐sided visual disturbance. Although infrasellar craniopharyngioma is a rare entity, the presence of foci of calcification within the lesion is a useful finding for diagnosis. [ABSTRACT FROM AUTHOR]

Reports on the surgical problems and lessons encountered with an epidemic of Shigella dysenteriae type I in Africa. Signs and symptoms of the disease; Similarities with other endemic diseases; Difficulties in diagnosing the disease; Referral of patients to surgeons due to abdominal tenderness, distension, peritonitis or perforation; Performance of laparotomy due to evidence of perforation.

OBJECTIVE: Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/UNAIDS/UNICEF. The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks. METHODS: Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and best available liquid paediatric supplement found in local pharmacies) were compared. Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months. Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers. Time needed to prepare one feed of replacement milk was simulated. FINDINGS: When mixed with water, sugar, and each micronutrient supplement, PM and FM provided

Two cases of smooth muscle tumor developing in immunocompromised children are described. Both children presented after transplant surgery, one with a hepatic leiomyoma and the other with a hepatic leiomyosarcoma. [ABSTRACT FROM AUTHOR]

Simple, robust approaches are needed to monitor prevalence, incidence, and mother-to-child transmission of HIV-1 in rural Africa. We have designed a method that uses antibody and viral RNA testing of dried blood spots obtained from mother-infant pairs attending routine immunisation clinics. In our study, prevalence and incidence of HIV-1 was highest in young women in their late teens and early twenties. In children born to infected mothers, prevalence increased from 14% in infants younger than 6 weeks of age to 24% at 3-6 months. The blood-spot approach is an effective method for surveillance of HIV-1 in women and children, and for early identification of incidence of this infection in women of child-bearing age. [ABSTRACT FROM AUTHOR]

Abstract Background Integrated Management of Childhood Illness (IMCI) is a strategy to reduce mortality and morbidity in children under-5 years by improving management of common illnesses at primary level. IMCI has been shown to improve health worker performance, but constraints have been identified in achieving sufficient coverage to improve child survival, and implementation remains sub-optimal. At the core of the IMCI strategy is a clinical guideline whereby health workers use a series of algorithms to assess and manage a sick child, and give counselling to carers. IMCI is taught using a structured 11-day training course that combines classroom work with clinical practise; a variety of training techniques are used, supported by comprehensive training materials and detailed instructions for facilitators. Methods We conducted focus group discussions with IMCI trained health workers to explore their experiences of the methodology and content of the IMCI training course, whether they thought they gained the skills required for implementation, and their experiences of follow-up visits. Results Health workers found the training interesting, informative and empowering, and there was consensus that it improved their skills in managing sick children. They appreciated the variety of learning methods employed, and felt that repetition was important to reinforce knowledge and skills. Facilitators were rated highly for their knowledge and commitment, as well as their ability to identify problems and help participants as required. However, health workers felt strongly that the training time was too short to acquire skills in all areas of IMCI. Their increased confidence in managing sick children was identified by health workers as an enabling factor for IMCI implementation in the workplace, but additional time required for IMCI consultations was expressed as a major barrier. Although follow-up visits were described as very helpful, these were often delayed and there was no ongoing clinical supervision. Conclusion The IMCI training course was reported to be an effective method of acquiring skills, but more time is required, either during the course, or with follow-up, to improve IMCI implementation. Innovative solutions may be required to ensure that adequate skills are acquired and maintained.

Abstract Background Integrated Management of Childhood Illness (IMCI) is a WHO/UNICEF strategy to improve child survival in resource poor settings. South Africa adopted IMCI in 1997, and IMCI guidelines were adapted to include identification and management of HIV infected and exposed children. This study describes the validity of the IMCI/HIV algorithm when used by IMCI experts, the use of IMCI/HIV guidelines by IMCI trained health workers in routine clinical practice, and the burden of HIV among children under 5 years attending first level health facilities. Methods Seventy seven randomly selected IMCI trained health workers were observed in 74 health facilities in two provinces of South Africa. Consultations were observed with 1357 sick children; each child was reassessed by an IMCI expert to confirm the correct findings. Consent was requested for HIV testing of all children who attended with a parent or legal guardian. Positive rapid HIV tests were confirmed with HIV PCR in children aged less than 18 months. HIV positive children had a CD4 count and HIV clinical staging done. Results Of 1064 children with HIV results available, 76 (7.1% CI: 5.7% - 8.9%) children were confirmed HIV positive. IMCI experts using the HIV algorithm classified 54/76 (71.1% CI: 59.5%-80.9%) HIV positive children as suspected symptomatic HIV, and 15/22 remaining HIV positive children were identified as HIV exposed. Therefore, 69/76 (90.8% CI: 81.9-96.2) HIV infected children were identified by IMCI experts. No classification was made for HIV by observed health workers in 899/1357(66.2%) children. 906/1243(72.9%) mothers had been tested previously for HIV, of whom 221(24.4%) reported testing positive. Of 221 children therefore identified as HIV exposed, only 78(35.3%) had been tested for HIV within routine services. Conclusion The HIV algorithm is a valid tool for identifying HIV infected and exposed children when correctly and comprehensively implemented. However, it is not being used by IMCI trained health workers in routine practise, leading to a failure to implement life saving interventions.

Abstract Background Few studies address the use of paediatric highly active antiretroviral therapy (HAART) in Africa. Methods We performed a retrospective cohort study to investigate preliminary outcomes of all children eligible for HAART at Sinikithemba HIV/AIDS clinic in KwaZulu-Natal, South Africa. Immunologic, virologic, clinical, mortality, primary caregiver, and psychosocial variables were collected and analyzed. Results From August 31, 2003 until October 31, 2005, 151 children initiated HAART. The median age at HAART initiation was 5.7 years (range 0.3–15.4). Median follow-up time of the cohort after HAART initiation was 8 months (IQR 3.5–13.5). The median change in CD4% from baseline (p < 0.001) was 10.2 (IQR 5.0–13.8) at 6 months (n = 90), and 16.2 (IQR 9.6–20.3) at 12 months (n = 59). Viral loads (VLs) were available for 100 children at 6 months of which 84% had HIV-1 RNA levels ≤ 50 copies/mL. At 12 months, 80.3% (n = 61) had undetectable VLs. Sixty-five out of 88 children (73.8%) reported a significant increase (p < 0.001) in weight after the first month. Eighty-nine percent of the cohort (n = 132) reported ≤ 2 missed doses during any given treatment month (> 95%adherence). Seventeen patients (11.3%) had a regimen change; two (1.3%) were due to antiretroviral toxicity. The Kaplan-Meier one year survival estimate was 90.9% (95%confidence interval (CI) 84.8–94.6). Thirteen children died during follow-up (8.6%), one changed service provider, and no children were lost to follow-up. All 13 deaths occurred in children with advanced HIV disease within 5 months of treatment initiation. In multivariate analysis of baseline variables against mortality using Cox proportional-hazards model, chronic gastroenteritis was associated with death [hazard ratio (HR), 12.34; 95%CI, 1.27–119.71) and an HIV-positive primary caregiver was found to be protective against mortality [HR, 0.12; 95%CI, 0.02–0.88). Age, orphanhood, baseline CD4%, and hemoglobin were not predicators of mortality in our cohort. Fifty-two percent of the cohort had at least one HIV-positive primary caregiver, and 38.4% had at least one primary caregiver also on HAART at Sinikithemba clinic. Conclusion This report suggests that paediatric HAART can be effective despite the challenges of a resource-limited setting.

Background: Integrated Management of Childhood Illness (IMCI) is a strategy to reduce mortality and morbidity in children under-5 years by improving management of common illnesses at primary level. IMCI has been shown to improve health worker performance, but constraints have been identified in achieving sufficient coverage to improve child survival, and implementation remains sub-optimal. At the core of the IMCI strategy is a clinical guideline whereby health workers use a series of algorithms to assess and manage a sick child, and give counselling to carers. IMCI is taught using a structured 11-day training course that combines classroom work with clinical practise; a variety of training techniques are used, supported by comprehensive training materials and detailed instructions for facilitators.Methods: We conducted focus group discussions with IMCI trained health workers to explore their experiences of the methodology and content of the IMCI training course, whether they thought they gained the skills required for implementation, and their experiences of follow-up visits.Results: Health workers found the training interesting, informative and empowering, and there was consensus that it improved their skills in managing sick children. They appreciated the variety of learning methods employed, and felt that repetition was important to reinforce knowledge and skills. Facilitators were rated highly for their knowledge and commitment, as well as their ability to identify problems and help participants as required. However, health workers felt strongly that the training time was too short to acquire skills in all areas of IMCI. Their increased confidence in managing sick children was identified by health workers as an enabling factor for IMCI implementation in the workplace, but additional time required for IMCI consultations was expressed as a major barrier. Although follow-up visits were described as very helpful, these were often delayed and there was no ongoing clinical supervision.Conclusion: The IMCI training course was reported to be an effective method of acquiring skills, but more time is required, either during the course, or with follow-up, to improve IMCI implementation. Innovative solutions may be required to ensure that adequate skills are acquired and maintained. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of an intervention to improve the quality of data used to monitor the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus in South Africa. Methods The study involved 58 antenatal clinics and 20 delivery wards (37 urban, 21 rural and 20 semi-urban) in KwaZulu-Natal province that provided PMTCT services and reported data to the District Health Information System. The data improvement intervention, which was implemented between May 2008 and March 2009, involved training on data collection and feedback for health information personnel and programme managers, monthly data reviews and data audits at health-care facilities. Data on six data elements used to monitor PMTCT services and recorded in the information system were compared with source data from health facility registers before, during and after the intervention. Data completeness (i.e. their presence in the system) and accuracy (i.e. being within 10% of their true value) were evaluated. Findings The level of data completeness increased from 26% before to 64% after the intervention. Similarly, the proportion of data in the information system considered accurate increased from 37% to 65% (P < 0.0001). Moreover, the correlation between data in the information system and those from facility registers rose from 0.54 to 0.92. Conclusion A simple, practical data improvement intervention significantly increased the completeness and accuracy of the data used to monitor PMTCT services in South Africa. [ABSTRACT FROM AUTHOR]