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This paper responds to Muller's notions of "knowing-that" and "knowing how". The paper addresses how educational interventions that are designed in line with targeted discipline-specific subjects can enhance the balance between professional practice and disciplinary knowledge in professionally accredited programmes at universities of technology. The context is a Dental Technology programme at a University of Technology in South Africa. Teaching through discipline-specific games, conceptualised from a game literacies perspective, is proposed as an engaging, interactive pedagogy for learning disciplinary knowledge that potentially encourages access to a particular affinity group. The authors use concepts from Bernstein and Maton to investigate whether epistemic relations or social relations are emphasised through board and digital games designed for two Dental Technology subjects. This paper offers valuable insight into alternative pedagogies that can be adopted into science, technology, engineering, and mathematics education with the aim of paving a pathway towards Muller's Scenario 3.

The introduction of outcomes-based education in South Africa placed many challenges on the transformation of science classrooms. The 2009 National Education Evaluation and Development Unit (NEEDU) Report concluded that South African rural and township schools are largely dysfunctional. This article examined some of the reasons for the "collapse" of rural schools as seen through the eyes of pre-service science teachers. It explored the reflections of 30 pre-service teachers in science classrooms in the Limpopo Province of South Africa where the majority of schools lack infrastructure such as libraries, laboratories and computer rooms. The reflections of pre-service science teachers revealed that the culture of teaching and learning has been negatively affected by lack of resources, poor training of science teachers, incompetent school management teams, overcrowding of science classrooms and a plethora of curriculum policies. Furthermore, teachers had not fully embraced all aspects of curriculum policy. This has resulted in the outcomes identified for science not being completely achieved. Pre-service teachers found it challenging to adapt to the "realities" of teaching science without science equipment or appropriate resources. Suggestions made by pre-service teachers to improve science teaching in schools are considered in the recommendations of this article. Some of the recommendations are: development of resource packs for teachers in rural schools; a module on improvisation and innovation in science in pre-service and in-service training; establishing science nodal hubs or science resource centres in rural areas; improving awareness of science through competitions, open days and science clubs; developing mobile libraries and science laboratories for rural teachers; and establishing science committees in schools or regions.

An inadequate number of suitably qualified and experienced supervisors, an increase in the number of students, uncertainty regarding the suitability of supervision and academic rigour in dissertations and theses make it difficult to produce quality graduates within the prescribed time-frame as stipulated by the Department of Education. By implication, a strategy is needed to help both students and supervisors overcome these difficulties and produce quality research within the minimum time-frames. In this article, an intervention to assist students with writing their postgraduate research is presented and the need, planning, validation and implementation thereof are described. Reflection, inductive reasoning and observation initiated the need for this study and formed part of the needs assessment for the intervention. A template was designed as the intervention and was used as a guideline for students to use, presenting the basic format pertinent to writing dissertations\theses. To evaluate the intervention, a questionnaire was applied to ascertain students' opinions about the intervention and was validated using face-validity. Responses were deemed reliable using the internal consistency for determining reliability. The study concluded that an intervention such as the template is beneficial and is an improvement from the traditional style of supervision and text-book teaching.

The school environment is a very dynamic sphere. Changes continually take place in educational policy, curriculum and in a school's physical and social environment. A teacher who wants to be effective in such an environment has to adapt to these changes. Continuous professional development of teachers is essential to addressing the gaps in training that arise through time and change. This article addresses the professional development of teachers at school level by examining the types of staff development practices that are implemented in thirty randomly selected schools. It also examines the staff development programmes of two schools in particular. The implementation process of these programmes, feedback from the staff members during the review of the programmes, and the personal development of the teachers is also examined. The results indicate that staff development in the 30 schools takes place sporadically and in an unstructured manner. The topics addressed during staff development do not focus adequately on the professional needs of the teachers. In the two structured programmes, teachers benefitted tremendously and were eager to continue. Finally, this article proposes a model for staff development in schools and discusses the implications this has for in-service training of teachers. (Contains 1 figure.)

Background. The Faculty of Health Sciences (FHS), University of Cape Town (UCT) adopted the primary healthcare (PHC) approach as its lead theme for teaching, research and clinical service in 1994. A PHC working group was set up in 2017 to build consensus on indicators to monitor and evaluate the PHC approach in health sciences education in the FHS, UCT. Objective. To develop a set of indicators through a Delphi technique for monitoring and evaluating the PHC approach in health sciences curricula in the FHS, UCT. Methods. A national multidisciplinary Delphi panel was presented with 61 indicators of social accountability from the international Training for Health Equity Network (THEnet) for scoring in round 1. Nineteen PHC indicators, derived from a mnemonic used in the FHS, UCT for teaching core PHC principles, were added in round 2 to the 20 highest ranked THEnet indicators from round 1, on recommendation of the panel. Scoring criteria used were relevance (in both rounds), feasibility/measurability (round 1 only) and application of the PHC indicators to undergraduate and postgraduate teaching and assessment (round 2 only). Results. Of the 39 indicators presented in the second round, 11 had an overall relevance score >85% based on the responses of 16 of 20 panellists (80% response rate). These 11 indicators have been grouped by learner needs (safety of learners - 88%, teaching is appropriate to learners' needs and context - 86%); healthcare user needs (continuity of care - 94%, holistic understanding of healthcare - 88%, respecting human rights - 88%, providing accessible care to all - 88%, providing care that is acceptable to users and their families - 87%, providing evidence-based care - 87%); and community needs (promoting health through health education - 88%, education programme reflects communities' needs - 86%, teaching embodies social accountability - 86%). Conclusion. The selected indicators reflect priorities relevant to the FHS, UCT and are measurable and applicable to undergraduate and postgraduate curricula. They provided the basis for a case study of teaching the PHC approach to our undergraduate students. [ABSTRACT FROM AUTHOR]

This study presents a comparative literature examination of the pharmaceutical industry in Japan, Europe, and the United States, focusing on quality culture, which historically has impacted operations in these regions. It aims to highlight generic pitfalls that result from cultural influences so that these can be avoided when designing a conceptual model of quality management practices for South African organisations. Simultaneously, the literature illuminates areas where culture promotes operational excellence (OpEx) in production. Quadrants of the organisational cultural analysis instrument (OCAI) are used to collect and examine research data from 72 literature sources. An activity theory research approach is adopted to perform a comparative study to ensure a consistent formal examination of the three geographical regions. During this analysis, industry traits presumed to be supported by culture types are highlighted and examined. Findings from this examination will be used in a future study to develop an OpEx model for South Africa, based on quality culture. [ABSTRACT FROM AUTHOR]

• Capacity building for research and implementation is key to operationalzing concerted and sustained strategies for addressing antimicrobial resistance. • Reciprocal and long-term partnerships between high-income and low- and middle-income countries can successfully develop robust, agile, and flexible antimicrobial stewardship research and implementation teams. • Capacity building in AMR, when supported by adequate funding to ensure investment in the workforce and infrastructure, can result in sustainable and resilient AMS programmes. Research, collaboration, and knowledge exchange are critical to global efforts to tackle antimicrobial resistance (AMR). Different healthcare economies are faced with different challenges in implementing effective strategies to address AMR. Building effective capacity for research to inform AMR-related strategies and policies is recognised as an important contributor to success. Interdisciplinary, intersector, as well as international collaborations are needed to span global to local efforts to tackle AMR. The development of reciprocal, long-term partnerships between collaborators in high-income and in low- and middle-income countries (LMICs) needs to be built on principles of capacity building. Using case studies spanning local and international research collaborations to codesign, implement, and evaluate strategies to tackle AMR, we have evaluated and build upon the ESSENCE criteria for capacity building in LMICs. The first case study describes the local codesign and implementation of antimicrobial stewardship (AMS) in the state of Kerala in India. The second case study describes an international research collaboration investigating AMR surgical patient pathways in India, the UK, and South Africa. We describe the steps undertaken to develop robust, agile, and flexible AMS research and implementation teams. Notably, investing in capacity building ensured that the programmes described in these case studies were sustained through the current severe acute respiratory syndrome coronavirus pandemic. Describing the strategies adopted by a local and an international collaboration to tackle AMR, we provide a model for capacity building in LMICs that can support sustainable and agile AMS programmes. [ABSTRACT FROM AUTHOR]

This article analyzes the significant role played by community safety structures in Msinga Local Municipality. The motivation behind this study was based on safety within the selected community, considering the increase in violent crimes there. It is rooted in the National Developmental Plan (NDP) of attempting to build safer communities by 2030, by building community participation in community safety. In ensuring that the aim of this study was achieved, a mixed method research design was used, which assisted the researcher to focus on both contesting the existence of community safety structures and exploring their significance in Msinga Local Municipality. Overall, the finding of this study revealed that community safety structures play a vital role in preventing crime within Msinga Local Municipality. [ABSTRACT FROM AUTHOR]

Calls for the decolonisation of higher education in the world and South Africa in particular, has gained momentum since the student protests in 2015 and 2016. This takes place after some efforts have been made to transform and democratise the higher education landscape. Efforts made include: National Commission on Higher Education, White Paper 3 1997, The Higher Education Act of 1997 and the South African Qualifications Authority (SAQA) Act of 1995 which led to the creation of National Qualification Framework (NQF). The policies had promises on issues of access, equity, equality, inclusivity and social justice. After 20 years of democracy, students started to question the progress or lack thereof in the transformation of higher education in South Africa. They started to make demands for access, free education, decolonisation of the curriculum, changes in the pedagogy and epistemic practices. They also demanded the removal of certain statues on some of the campuses. The protests jolted some academics to start debating and writing about the decolonisation of higher education in South Africa. This was done by picking up different aspects that were made points of focus in terms of decolonisation. Consequently, some academics focused on the decolonisation of the curriculum, some on the higher education system whilst others focussed on teacher education. In this article, we intend to contribute to the debate by focusing on Continuing Teacher Professional Development (CTPD) that is an aspect within teacher education. The focus on CTPD was prompted by the fact that not much has been done on the decolonisation of CTPD in South Africa. Furthermore, this is a critical area, because unless teachers are empowered and reskilled to drive the decolonisation process, they may resist and ultimately render the whole process unworkable. It is based on the study that was conducted, focusing on CTPD in the teaching of physical sciences in some of the rural schools in Limpopo Province. The choice of physical sciences was because physical sciences is a gateway subject and most physics sciences teachers in Limpopo Province are based in rural areas. Generally, these schools do not have the appropriate facilities and equipment to teach physical science. Physical sciences teachers also face many challenges such as negative perception about the subject, lack of resources, limited room for professional development, poor teacher training, and inadequate support from within the school and the Provincial Department of Education. This study focussed on creativity and teacher empowerment by enabling physical sciences teachers to reflect on their implementation of science inquiry. Physical sciences teachers were empowered to be creative in handling scientific inquiry especially in the absence of the necessary scientific equipment. The study was conduct at a Higher Education Institution (HEI) in Limpopo Province where teachers, from rural schools, are specifically invited to the university for the National Science Week, which included a component of ongoing Continuing Teacher Profession Development (CPTD). During the National Science Week physical sciences teachers attend an in-service workshop on Improvisation in Science. Ninety (90) physical sciences teachers participated in this study. Data were generated by using a questionnaire and unstructured interviews. The findings of the study revealed that the success of CTPD is not so much in spending more funds in CTPD programmes, but it is in the approach that is used to prepare teachers to respond appropriately to the needs and the demands of the classroom environment. The article argues that the decolonisation process should prioritise the CTPD programmes at universities. This is due to the fact that teachers as agents of change need to be empowered and reskilled, so that they can be in the forefront of the decolonisation process. This can be achieved by adopting a transformative approach that encourages improvisation in science teaching. This approach to CPTD demands that teachers' professional development should shift from the traditional approach to an approach that empowers teachers to be able to make a meaningful contribution to the classes that they teach. [ABSTRACT FROM AUTHOR]

Background. The statutory requirement for continuing professional development (CPD) for all health professionals registered with the Health Professions Council of South Africa (HPCSA) has been in place since 2007. The HPCSA intends to implement maintenance of licensure (MoL). Objectives. To determine practitioners’ perceptions and experiences of engaging with CPD to inform the development of the MoL system. Methods. A cross-sectional survey of practitioners registered with the HPCSA was conducted. The self-administered 30-item electronic questionnaire covered practitioner demographics and patterns of CPD practice and was completed by 11 307 respondents. Results. Methods used to determine learning needs included self-assessment (56.8%) and audit of own practice (53.2%). Selection of CPD activities was based on interest (80.2%) and expertise (72.8%) and less so on gaps in knowledge (66.1%) and skills (61.8%). The most frequent learning activities were primarily didactic (workshops (58%), lectures (53%) and conferences (51%)). Barriers included cost and location of CPD activities, especially for women and rural practitioners (p<0.001). Employer support for CPD was associated with adherence (p<0.001). There was strong support (88.7%) for continuing education as a component of MoL, but less support (<50%) for other elements, even though practitioners voluntarily engaged with these practices. Conclusion. Respondents engage in a range of activities that could be incorporated into a MoL system. The transition to MoL requires development of tools, including objective assessments, guidelines for individualised learning programmes and expanding the range of learning activities. Strategies to address barriers to CPD need to be considered. [ABSTRACT FROM AUTHOR]

Background. The current health system in South Africa (SA) struggles to meet the healthcare demands of its nation adequately, especially in KwaZulu- Natal (KZN) Province, South Africa. Local communities in KZN have long since recognised the need to supplement the public health system by means of community-driven initiatives of non-governmental organisations (NGOs) and the private sector. Projects by these sectors can also provide a platform for experiential learning for dental therapy students. Objective. To explore learning opportunities for dental therapy students through the community-driven health initiatives of NGOs and the private sector in KZN. Methods. This qualitative study used face-to-face interviews with key stakeholders organising community-based initiatives in the NGO and private sectors. The interviews were audio-recorded and analysed using thematic analysis. Ethical clearance was obtained from the University of KwaZulu-Natal, Durban, SA. Results. According to the participants, there were many innovative service delivery modes, ranging from a mobile health bus, a container turned into a clinic, to well-established clinics that provided meaningful learning opportunities for dental students. By participating in these projects, respondents believed that students could gain real-world experiences and a greater sense of social accountability. Conclusion. This study showed that there are many opportunities in the private and NGO sectors that could provide support for community-driven learning initiatives for undergraduate dental therapy students. [ABSTRACT FROM AUTHOR]

Abstract: Background: Community‐based education (CBE) is a learning strategy that provides meaningful opportunities for students to apply theory learnt in a larger social and cultural context in various community settings. Although the benefits of CBE to health professional students are well documented, to date, there is little evidence describing dental therapy students' experiences. Objectives: To describe the experience of CBE by undergraduate dental therapy students in the School of Health Sciences at the University of KwaZulu‐Natal. Methods: This descriptive study, conducted in 2016, gives insight into the experiences of community‐based education among dental therapy students using a self‐administered questionnaire eliciting qualitative data. Ethical clearance was obtained from the institution. Results: Students reported perceived benefits of improved professional and personal growth, and a deeper understanding of cultural, social and economic influences on oral health care. Some of the perceived challenges included language barrier, limited resources and adapting to new environments. Conclusion: The reported experiences of undergraduate dental therapy students involved in community‐based clinical training suggest that students gained awareness of the context‐specific challenges facing communities and health professionals in different oral health settings. [ABSTRACT FROM AUTHOR]

Background. Community-based education (CBE) is seen as a valuable tool in transforming health professions education by aligning clinical training with graduate competencies and needs of the health system. However, academics involved in the implementation have varied views. Objectives. To explore the experiences and views of academics involved in community-based training in the College of Health Sciences at the University of KwaZulu-Natal, Durban, South Africa. Methods. This qualitative study used interviews and focus group discussions consisting of a purposively selected sample of academics. The interviews were audio taped, transcribed and analysed using thematic analysis. Results. Three main themes emerged from the data analysis: the strengths of CBE, challenges experienced in implementation and academics' suggestions concerning challenges. The strengths included benefits to the institution, students, health system and communities. The main challenges experienced were insufficient support from the institution and the Department of Health (DoH). Suggestions were made by academics to overcome these challenges. Conclusion. The study indicates that CBE is perceived as an important pedagogical approach in transforming health professions education, as it can align clinical training with the business plan of the university and the needs of the health system. However, for the successful implementation of CBE, full support from the university and the DoH is required. [ABSTRACT FROM AUTHOR]

Introduction Student attitudes and behaviour towards their own oral health status could reflect their understanding of the importance of oral health promotive activities. Objectives This was a qualitative and exploratory study designed to gain a deeper understanding of the extent to which the undergraduate curriculum could act as an enabler for student oral health self-care practices. Methods Data collection comprised of document analysis (curriculum review) and in-depth face-to-face interviews with undergraduate dental therapy and oral health students and academic staff at the University of KwaZulu-Natal. Ten students volunteered to participate in the study while five academic staff were purposively selected. A separate interview schedule was developed for students and staff, respectively. The emergent themes from document analysis were compared to the analysed data from the interviews. Results The curriculum was underpinned by a strong foundation in prevention, and there was consensus among respondents that the curriculum met the needs for undergraduate training in preventive dentistry. The following themes emerged from data analysis: curriculum support for self-care practices; depth and scope of clinical training; role of clinical supervisors and challenges in clinical training. Respondents agreed that the curriculum could influence students' attitudes towards self-care practices such as toothbrushing and flossing but that academic responsibilities and clinical contact time placed constraints on these practices. Conclusion The undergraduate curriculum does provide support for enabling student knowledge acquisition and positive attitudes, but more effort is required to enable oral health behavioural modifications among students. [ABSTRACT FROM AUTHOR]

As an interdisciplinary team of researchers, we sought ways of encouraging discussion, reflexivity and generative thinking around HIV and AIDS integration in higher education curricula. We facilitated conversations in three higher education research settings through the medium of a digital animation based on a storyboard prepared in response to experiences of university educators who integrate HIV and AIDS-related issues in their teaching. We screened the digital animation and encouraged responses from the three audiences, then used these responses together with our own deliberations to explore the 'what' and 'how' of making public our work. Using digital animation for generative action, we found that the four conceptual and methodological features of generative processes (playfulness, passion, perspicacity and participation) that we identified through previous research may be extended to a fifth-that of publicising research, or 'going public', which played an important role in our innovative and responsive use of digital animation. [ABSTRACT FROM AUTHOR]

Highlights: [•] Novel co-fired South African coal/waste tyre and pure fired waste tyre ashes assessed. [•] Co-fired South African coal/waste tyre presents a low slagging/fouling hazard. [•] Volatile nature of ZnO–Zn derived from waste tyre will not influence slagging/fouling. [Copyright &y& Elsevier]

Objectives. To describe South African infants and children requiring gastrostomies in a tertiary hospital, including the indications, medical conditions and health services, during a 5-year period (2005 - 2009). Design. The research design was a retrospective descriptive survey of medical records. Setting. A tertiary paediatric state hospital in South Africa. Subjects. One hundred and forty-two patients between the ages of 0 and 17 years. Results. Dysphagia (N=80, 56%), aspiration (N=70, 49%) and need for nutritional support (N=63, 44%) were the most common indicators for gastrostomy placement. Most participants (N=85, 75% of the subset of 114 with feeding and swallowing difficulties) presented with multiple medical conditions, and neurological impairment (N=94, 82%) and gastro-intestinal problems (N=96, 84%) were the most prominent. Services were required from a variety of health care professionals for a period ranging from 6 to 103 months (mean 18 months). The speech-language therapist was consulted most frequently before gastrostomy placement (85%), while the stoma sister (97%) and dietician (97%) were consulted after placement. Conclusions. South African infants and children requiring gastrostomies frequently present with multiple medical conditions and dysphagia. These children are likely to benefit from extended services provided by a specialised team of health care professionals. [ABSTRACT FROM AUTHOR]

The article presents various national and regional researches related to plants belonging to the bryophyte group including Brachythecium rivulare, Bryum pallens, and Bucklandiella lamprocarpa. Brachythecium rivulare takes the usual form of mosses which grow in the full spray of a waterfall. Tropical Africa has the only previous record of the species which came from Mount Kenya. Bryum pallens which stem shows red coloration can be found in Zambesi, a fast flowing stream in the Northwestern province of Europe. Bucklandiella lamprocarpa is widely distributed in temperate regions of South Africa including Bolivia.

The GenoType CMdirect Ver 1.0 and GenoType Mycobacterium Common Mycobacteria Ver 2.0-line probe assays were utilized to identify nontuberculous mycobacteria (NTM) from decontaminated sputum in a GeneXpert MTB/RIF Ultra negative cohort. A preliminary NTM prevalence of 1.7 % was observed, with a 100 % specificity. The high specificity advocates the CMdirect as a possible rule-in test for NTM disease., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background:  The Central Chronic Medicines Dispensing and Distribution (CCMDD) programme facilitates clinically stable patients to collect their chronic medication from community-based pick-up points., Aim:  We determined baseline glycaemic control and rates and predictors of becoming sub-optimally controlled for type 2 diabetes mellitus (T2DM) CCMDD-enrolled patients., Setting:  The setting of the study was eThekwini, KwaZulu-Natal, South Africa., Methods:  We performed a cohort study (April 2018- December 2021). We linked T2DM CCMDD-enrolled patients to glycated haemoglobin (HbA1c) data from the National Health Laboratory Service. We selected patients optimally controlled at their baseline HbA1c, with ≥ 1 repeat-test available. We used Kaplan-Meier analysis to assess survival rates and extended Cox regression to determine associations between time to sub-optimal control (HbA1c 7%) and predictors. Adjusted hazard ratios (aHRs), 95% confidence interval (CI), and p-values are reported., Results:  Of the 41145 T2DM patients enrolled in the CCMDD programme, 7960 (19%) had a HbA1c result available. Twenty-seven percent (2147/7960) were optimally controlled at their baseline HbA1c. Of those controlled at baseline, 695 (32%) patients had a repeat test available, with 35% (242/695) changing to sub-optimal status. The HbA1c testing frequency as per national guidelines was associated with a lower hazard of sub-optimal glycaemic control (aHR: 0.46; 95% CI: 0.24-0.91; p-value = 0.024). Patients prescribed dual-therapy had a higher hazard of sub-optimal glycaemic control (aHR: 1.50; 95% CI: 1.16-1.95; p-value = 0.002) versus monotherapy., Conclusions:  The HbA1c monitoring, in-line with testing frequency guidelines, is needed to alert the CCMDD programme of patients who become ineligible for enrolment. Patients receiving dual-therapy require special consideration.Contribution: Addressing identified shortfalls can assist programme implementation.

Current evidence indicates that workplace health and wellness programmes provide numerous benefits concerning altering cardiovascular risk factor profiles. Implementing health programmes at workplaces provide an opportunity to engage adults towards positive and sustainable lifestyle choices. The first step in designing lifestyle interventions for the workplace is understanding the barriers and facilitators to implementing interventions in these settings. The barriers and facilitators to implementing lifestyle interventions in the workplace environment was qualitatively explored at two multinational consumer goods companies among seven workplaces in South Africa. Semi-structured in-depth interviews (IDIs) were conducted with ten workplace managers. Five focus group discussions (FGDs) were conducted among workplace employees. The IDI findings revealed that the main facilitators for participation in a lifestyle intervention programme were incentives and rewards, educational tools, workplace support, and engaging lessons. In contrast, the main facilitator of the FGDs was health and longevity. The main barriers from the IDIs included scheduling time for lifestyle interventions within production schedules at manufacturing sites, whereas time limitations, a lack of willpower and self-discipline were the main barriers identified from the FGDs. The findings of this study add to literature on the barriers and facilitators of implementing healthy lifestyle interventions at workplaces and suggest that there is a potential for successfully implementing intervention programmes to improve health outcomes, provided that such efforts are informed and guided through the engagement of workplace stakeholders, an assessment of the physical and food environment, and the availability of workplace resources.

Zooplankton plays an essential role in marine ecosystems as the link between primary producers (phytoplankton) and higher trophic levels in food webs, and as a dynamic pool of recruits for invertebrates and fish. Zooplankton communities are diverse with a patchy distribution at different spatial scales, influenced by oceanographic processes. The continental shelf of eastern South Africa is narrow and exposed to the western-boundary Agulhas Current, with some shelter against strong directional flow provided by the broader KwaZulu-Natal Bight, a coastal offset adjacent to an estuary. We compared zooplankton species richness, diversity and relative abundance of key taxa among sheltered and exposed shelf areas using metabarcoding and community analysis, to explore the ecological role of the bight in a highly dynamic ocean region. Metabarcoding recovered higher richness and diversity at a finer resolution than could previously be achieved with traditional microscopy. Of 271 operational taxonomic units (OTUs) recovered through metabarcoding, 63% could be matched with >95% sequence similarity to reference barcodes. OTUs were dominated by malacostracan crustaceans (161 spp.), ray-finned fishes (45 spp.) and copepods (28 spp.). Species richness, diversity and the relative abundance of key taxa differed between sheltered and exposed shelf areas. Lower species richness in the bight was partly attributed to structurally homogeneous benthic habitats, and an associated reduction of meroplanktonic species originating from local benthic-pelagic exchange. High relative abundance of a ray-finned fish in the bight, as observed based on fish eggs and read counts, confirmed that the bight is an important fish spawning area. Overall, zooplankton metabarcoding outputs were congruent with findings of previous ecological research using more traditional methods of observation., (© 2022 The Authors. Molecular Ecology published by John Wiley & Sons Ltd.)

The healthcare sector in South Africa has seen a rise in medical errors and negligence adversely affecting healthcare delivery. This study aimed to determine the nature and magnitude of Patient Safety Incidents at a tertiary hospital between April 2018 to March 2021 (the COVID-19 era). A retrospective review of Patient Safety Incidents forms and clinical records of inpatients above 12 years with a reported incident were included. The overall incidence of patient safety incidents was 4.40 PSIs per 10 000 patient-days. The majority of PSIs were harmful incidents (An incident that results in harm to a patient that is related to medical management, in contrast to disease complications or underlying disease) at 72.50% [145/200], followed by no harm incidents at 18.00% [36/200] and 9.50% [19/200] near-miss incidents. The five highest incident types were clinical process/procedure [83/200; 41.50%], behaviour [49/200; 24.50%], falls [28/200; 14%], complications [20/200; 10%], and pressure sores [11/200; 5.50%]. Incidents occurred more frequently within the week (83.50%) and during day shift (67.50%). Overall, the study showed low PSI reporting rates which is an inherent challenge with voluntary reporting. Notably, there has been an increasing trend in reporting. The results reflect a reporting culture more inclined to bring awareness to incidents that have negative outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Singh, Mahomed. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

High rates of gender violence in South Africa, including those in higher education institutions, have prompted considerable research into understanding its causes. Studies focusing on gender and sexual risk at universities have found alcohol to be a significant contributor to gender violence. In this study, I analyse alcohol-related gender violence against female drinkers from the perspectives of male students. In-depth individual interviews were conducted with ten undergraduate male students at a university residence. Findings reveal that alcohol is seen as a masculine privilege. Male students explain that men use alcohol to give them the courage to enact hegemonic heterosexual masculinities. While they see alcohol as a tool to enhance men's capacity to control women, they simultaneously attribute blame to alcohol for men's loss of control over their behaviour. Alcohol is also exploited as currency to coerce women into submission to sexual favours. When male students blame alcohol for any deviant behaviour, men's culpability in the violation of female students remains hidden. Violence prevention efforts in educational contexts must address the ways in which alcohol shapes students' experience of gender, sexuality and violence.

Objective: The irrational use of antibiotics is a leading contributor to antibiotic resistance. Antibiotic stewardship (AS) interventions predominantly focus on prescribers. This study investigated the influence and participation of inpatients in infection-related care, including antibiotic decision-making, within and across two tertiary hospitals in South Africa (Cape Town) and India (Kerala)., Methods: Through ethnographic enquiry of clinical practice in surgical pathways, including direct nonparticipant observation of clinical practices, healthcare worker (HCW), patient and carer interactions in surgical ward rounds and face-to-face interviews with participants (HCWs and patients), we sought to capture the implicit and explicit influence that patients and carers have in infection-related care. Field notes and interview transcripts were thematically coded, aided by NVivo 12® Pro software., Results: Whilst observational data revealed the nuanced roles that patients/carers play in antibiotic decision-making, HCWs did not recognize these roles. Patients and carers, though invested in patient care, are not routinely involved, nor are they aware of the opportunities for engagement in infection-related decision-making. Patients associated clinical improvement with antibiotic use and did not consider hospitalization to be associated with infection acquisition or transmission, highlighting a lack of understanding of the threat of infection and antibiotic resistance. Patients' economic and cultural positionalities may influence their infection-related behaviours. In the study site in India, cultural norms mean that carers play widespread but unrecognized roles in inpatient care, participating in infection prevention activities., Conclusion: For patients to have a valuable role in AS and make informed decisions regarding their infection-related care, a mutual understanding of their role in this process among HCWs and patients is crucial. The observed differences between the two study sites indicate the critical need for understanding and addressing the contextual drivers that impact effective patient-centred healthcare delivery., Patient or Public Contribution: Ethnographic observations and interviews conducted in this study involved patients as participants. Patients were recruited for interviews after obtaining signed informed consent forms. Patients' identities were completely anonymized when presenting the study findings., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: Lymphadenitis is the most common extrapulmonary tuberculosis (EPTB) manifestation. The microbiome is important to human health but uninvestigated in EPTB. We profiled the site-of-disease lymph node microbiome in tuberculosis lymphadenitis (TBL)., Methods: Fine-needle aspiration biopsies were collected from 158 pretreatment presumptive TBL patients in Cape Town, South Africa. 16S Illumina MiSeq rRNA gene sequencing was done., Results: We analysed 89 definite TBLs (dTBLs) and 61 non-TBLs (nTBLs), which had similar α- but different β-diversities (p= 0.001 ). Clustering identified five lymphotypes prior to TB status stratification: Mycobacterium- dominant , Prevotella- dominant and Streptococcus- dominant lymphotypes were more frequent in dTBLs whereas a Corynebacterium -dominant lymphotype and a fifth lymphotype (no dominant taxon) were more frequent in nTBLs. When restricted to dTBLs, clustering identified a Mycobacterium -dominant lymphotype with low α-diversity and non- Mycobacterium -dominated lymphotypes (termed Prevotella-Corynebacterium , Prevotella-Streptococcus ). The Mycobacterium dTBL lymphotype was associated with HIV-positivity and features characteristic of severe lymphadenitis (eg, larger nodes). dTBL microbial communities were enriched with potentially proinflammatory microbial short-chain fatty acid metabolic pathways (propanoate, butanoate) vs nTBLs. 11% (7/61) of nTBLs had Mycobacterium reads BLAST-confirmed as Mycobacterium tuberculosis complex., Conclusions: TBL at the site-of-disease is not microbially homogeneous. Distinct microbial community clusters exist that, in our setting, are associated with different clinical characteristics, and immunomodulatory potentials. Non- Mycobacterium -dominated dTBL lymphotypes, which contain taxa potentially targeted by TB treatment, were associated with milder, potentially earlier stage disease. These investigations lay foundations for studying the microbiome's role in lymphatic TB. The long-term clinical significance of these lymphotypes requires prospective validation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Biobanking practice continues to proliferate in South Africa, yet little is known about how stakeholders engage with social, cultural, and religious considerations in this area of research. This study was undertaken to establish the perspectives of South African stakeholders (researchers, biobankers, clinicians, and research committee members) on sociocultural considerations in biobanking research. Methods: This in-depth exploratory study used semistructured face-to-face or Skype interviews with 25 purposively selected stakeholders involved in the biobanking-related practice. The study sample comprised biobankers, clinicians, researchers, postgraduate students in biobanking research, and research ethics committee members in South Africa. The interview focused on social and cultural challenges facing the biobanking practice in the country. Further probes included stakeholder perspectives on ownership and custodianship of stored biosamples. Thematic analysis was used to analyze the collected data. Results and Discussion: Several themes arose from the data analysis. These included respondents' perceptions of poor understanding of biobanking among research participants and communities; inconsistency in defining ownership and custodianship of biosamples; variability in respondents' understanding of cultural, religious, and social implications of biobanking; the notion of distrust; and building trust in biobanking. There were also inconsistencies in respondents' recognition of social, cultural, and/or religious influences on participant decision-making in biobanking research. Respondents highlighted that a general climate of distrust existed in the biobanking practice in South Africa. Conclusion: There is a need for greater stakeholder awareness of sociocultural considerations in biobanking practice in South Africa. One possible way to achieve this could be through the availability of training programs aimed at improving stakeholder understanding of the sociocultural context for biobanking practice in addition to greater efforts at community engagement with respect to all biobanking activities and research.

Background: Multisystem inflammatory syndrome in children (MIS-C) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been infrequently described in Africa., Objective: To describe the clinical characteristics, outcomes and associations of severe disease in children hospitalized with MIS-C in KwaZulu-Natal., Methods: Retrospective multicenter study of children (0-13 years) who met the Centers for Disease Control and Prevention criteria for MIS-C. Children with shock were compared with children without shock to determine the characteristics of severe MIS-C., Results: Twenty-nine children with MIS-C were identified, the mean age was 55 (SD ±45) months, 25 (86%) were Black-African, and 8 (28%) had pre-existing comorbidities. The predominant presenting symptoms included fever 29 (100%), gastrointestinal symptoms 25 (83%), skin rash 19 (65%), and shock 17 (59%). Children with shock had significantly increased CRP (P = 0.01), ferritin (P < 0.001), troponin-T (P = 0.02), B-type natriuretic peptide (BNP) (P = 0.01), and lower platelets (P = 0.01). Acute kidney injury (P = 0.01), cardiac involvement (P = 0.02), and altered levels of consciousness (P = 0.03) were more common in children with shock. The median length of hospital stay was 11 (IQR 7-19) days, with a mortality of 20.6%. Children who did not survive had significantly higher ferritin levels 1593 (IQR 1069-1650) ng/mL versus 540 (IQR 181-1156) ng/mL; P = 0.03) and significantly more required mechanical ventilation (OR 18; confidence interval 1.7-191.5; P = 0.005)., Conclusions: Hospitalized children with MIS-C in KwaZulu-Natal had more aggressive disease and higher mortality than children in better-resourced settings. Markedly elevated biomarkers and critical organ involvement were associated with severe disease. Risk factors for poor outcomes include higher ferritin levels and the need for mechanical ventilation., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Previous studies have reported comorbid disease, including hypertension, diabetes mellitus, chronic cardiac and renal disease, malignancy, HIV, tuberculosis (TB) and obesity, to be associated with COVID‑19 mortality. National demographic surveys have reported a high proportion of undiagnosed and untreated comorbid disease in South Africa (SA)., Objectives: To determine the number of individuals with previously undiagnosed HIV, TB and non-communicable diseases (NCDs) among patients hospitalised with COVID‑19, and the level of medical control of these chronic diseases., Methods: We conducted a sentinel surveillance study to collect enhanced data on HIV, TB and NCDs among individuals with COVID‑19 admitted to 16 secondary-level public hospitals in six of the nine provinces of SA. Trained surveillance officers approached all patients who met the surveillance case definition for inclusion in the study, and consenting patients were enrolled. The data collection instrument included questions on past medical history to determine the self-reported presence of comorbidities. The results of clinical and laboratory testing introduced as part of routine clinical care for hospitalised COVID‑19 patients were collected for the study, to objectively determine the presence of hypertension, diabetes, HIV and TB and the levels of control of diabetes and HIV., Results: On self-reported history, the most prevalent comorbidities were hypertension (n=1 658; 51.5%), diabetes (n=855; 26.6%) and HIV (n=603; 18.7%). The prevalence of self-reported active TB was 3.1%, and that of previous TB 5.5%. There were 1 254 patients admitted with COVID‑19 (39.0%) who met the body mass index criteria for obesity. On clinical and laboratory testing, 87 patients were newly diagnosed with HIV, 29 with TB, 215 with diabetes and 40 with hypertension during their COVID‑19 admission. There were 151/521 patients living with HIV (29.0%) with a viral load >1 000 copies/mL and 309/570 (54.2%) with a CD4 count <200 cells/μL. Among 901 patients classified as having diabetes, 777 (86.2%) had a glycated haemoglobin (HbA1c) level ≥6.5%., Conclusion: The study revealed a high prevalence of comorbid conditions among individuals with COVID‑19 admitted to public hospitals in SA. In addition, a significant number of patients had previously undiagnosed hypertension, diabetes, HIV and active TB, and many and poorly controlled chronic disease, as evidenced by high HbA1c levels in patients with diabetes, and high viral loads and low CD4 levels in patients with HIV. The findings highlight the importance of strengthening health systems and care cascades for chronic disease management, which include prevention, screening for and effectively treating comorbidities, and ensuring secure and innovative supplies of medicines in primary healthcare during the COVID‑19 pandemic.

Introduction: The proliferation of biobanking activities demand a review of current training opportunities for service providers and researchers, specifically related to the ethical, legal, and social issues (ELSI) of biobanking research. Such information could be useful for planning and developing an educational course. However, it is equally important to explore the platform for offering such a course. Aim and Objectives: This study explored stakeholder perspectives on training needs in biobanking research and the use of an online training platform for such educational purposes. Methods: An exploratory study design using qualitative data was used. The study sample comprised selected stakeholders ( n  = 25) including biobankers, clinicians, researchers, postgraduate students, and research ethics committee members. Semi-structured in-person or Skype interviews were conducted and all ethical considerations were upheld. The interview focused on participants' perspectives on the accessibility and applicability of current available courses, and advantages and disadvantages of online biobanking courses. Data were analyzed using thematic analysis. Results and Discussion: The following themes arose from data analysis: inadequate availability of online courses, and advantages and disadvantages of online courses and opportunities for a successful training course. There was general consensus regarding the limited availability of context-specific training opportunities on the ELSI of biobanking. The majority of participants were previously self-taught and therefore relied on existing literature and collaborations with international biobanking groups for ongoing learning. Some respondents indicated that the costs of such available training courses were exorbitant. Some respondents also felt that available courses were not tailored to the specific needs of a diverse audience in biobanking. Apart from access, respondents reported possible challenges with internet connectivity and availability of data. Conclusion: Respondents expressed a need for affordable and focused online educational opportunities in biobanking, but highlighted that these courses need to be contextualized and integrated into other learning activities.

Background: Globally, long-term care facilities (LTCFs) experienced a large burden of deaths during the COVID-19 pandemic. The study aimed to describe the temporal trends as well as the characteristics and risk factors for mortality among residents and staff who tested positive for SARS-CoV-2 in selected LTCFs across South Africa., Method: We analysed data reported to the DATCOV sentinel surveillance system by 45 LTCFs. Outbreaks in LTCFs were defined as large if more than one-third of residents and staff had been infected or there were more than 20 epidemiologically linked cases. Multivariable logistic regression was used to assess risk factors for mortality amongst LTCF residents., Results: A total of 2324 SARS-CoV-2 cases were reported from 5 March 2020 through 31 July 2021; 1504 (65%) were residents and 820 (35%) staff. Among LTCFs, 6 reported sporadic cases and 39 experienced outbreaks. Of those reporting outbreaks, 10 (26%) reported one and 29 (74%) reported more than one outbreak. There were 48 (66.7%) small outbreaks and 24 (33.3%) large outbreaks reported. There were 30 outbreaks reported in the first wave, 21 in the second wave and 15 in the third wave, with 6 outbreaks reporting between waves. There were 1259 cases during the first COVID-19 wave, 362 during the second wave, and 299 during the current third wave. The case fatality ratio was 9% (138/1504) among residents and 0.5% (4/820) among staff. On multivariable analysis, factors associated with SARS-CoV-2 mortality among LTCF residents were age 40-59 years, 60-79 years and ≥ 80 years compared to < 40 years and being a resident in a LTCF in Free State or Northern Cape compared to Western Cape. Compared to pre-wave 1, there was a decreased risk of mortality in wave 1, post-wave 1, wave 2, post-wave 2 and wave 3., Conclusion: The analysis of SARS-CoV-2 cases in sentinel LTCFs in South Africa points to an encouraging trend of decreasing numbers of outbreaks, cases and risk for mortality since the first wave. LTCFs are likely to have learnt from international experience and adopted national protocols, which include improved measures to limit transmission and administer early and appropriate clinical care., (© 2022. The Author(s).)

Objectives: To investigate the drivers for infection management and antimicrobial stewardship (AMS) across high-infection-risk surgical pathways., Methods: A qualitative study-ethnographic observation of clinical practices, patient case studies, and face-to-face interviews with healthcare professionals (HCPs) and patients-was conducted across cardiovascular and thoracic and gastrointestinal surgical pathways in South Africa (SA) and India. Aided by Nvivo 11 software, data were coded and analysed until saturation was reached. The multiple modes of enquiry enabled cross-validation and triangulation of findings., Results: Between July 2018 and August 2019, data were gathered from 190 hours of non-participant observations (138 India, 72 SA), interviews with HCPs (44 India, 61 SA), patients (six India, eight SA), and case studies (four India, two SA). Across the surgical pathway, multiple barriers impede effective infection management and AMS. The existing implicit roles of HCPs (including nurses and senior surgeons) are overlooked as interventions target junior doctors, bypassing the opportunity for integrating infection-related care across the surgical team. Critically, the ownership of decisions remains with the operating surgeons, and entrenched hierarchies restrict the inclusion of other HCPs in decision-making. The structural foundations to enable staff to change their behaviours and participate in infection-related surgical care are lacking., Conclusions: Identifying the implicit existing HCP roles in infection management is critical and will facilitate the development of effective and transparent processes across the surgical team for optimized care. Applying a framework approach that includes nurse leadership, empowering pharmacists and engaging surgical leads, is essential for integrated AMS and infection-related care., (Copyright © 2021 European Society of Clinical Microbiology and Infectious Diseases. All rights reserved.)

Tuberculosis (TB) is an infectious disease that threatens >10 million people annually. Despite advances in TB diagnostics, patients continue to receive an insufficient diagnosis as TB symptoms are not specific. Many existing biodiagnostic tests are slow, have low clinical performance, and can be unsuitable for resource-limited settings. According to the World Health Organization (WHO), a rapid, sputum-free, and cost-effective triage test for real-time detection of TB is urgently needed. This article reports on a new diagnostic pathway enabling a noninvasive, fast, and highly accurate way of detecting TB. The approach relies on TB-specific volatile organic compounds (VOCs) that are detected and quantified from the skin headspace. A specifically designed nanomaterial-based sensors array translates these findings into a point-of-care diagnosis by discriminating between active pulmonary TB patients and controls with sensitivity above 90%. This fulfills the WHO's triage test requirements and poses the potential to become a TB triage test., (© 2021 The Authors. Advanced Science published by Wiley-VCH GmbH.)

Background: Biobanking provides exciting opportunities for research on stored biospecimens. However, these opportunities to advance medical science are fraught with challenges including ethical and legal dilemmas. This study was undertaken to establish perspectives of South African stakeholders on the ethico-legal dimensions of biobanking., Methods: An in-depth exploratory study was conducted with 25 purposively selected biobankers, clinicians, researchers, postgraduate students in biobanking research, and research ethics committee (REC) members in South Africa. Potential study participants were recruited through known hubs for biobanking in the country, online searches and the snowball sampling technique. A semi-structured face-to-face or Skype interview was arranged. Data was analysed using thematic analysis., Results: The emergent themes included: inconsistency in understanding consent models, disconnect between biobank researchers and biosample donors, inadequate processes to support re-consenting minors, inconsistent governance processes for biobanking research; challenges with sample and data sharing, and suboptimal strategies for benefit sharing and return of results. Biobanking practice in general appeared to be inconsistent and fragmented. While the need for consent in research is explicitly outlined in legislative documents, some respondents were unclear on the type of consent model to apply in biosample collection. They also reported inconsistencies in research participants' understanding of consent. Furthermore, these respondents' own understanding of consent and consent models were dependent on where they were positioned in biobanking practice (roles occupied). Respondents were unsure about the process to follow to re-consent child participants once the age of majority (≥ 18 years) was reached. It was not surprising that consent was identified as one of the major ethical challenges in biobanking practice. In certain settings, some respondents reported suboptimal governance processes for sample collection. Participants were generally unsure about how to operationalise benefit sharing and how to approach the idea of returning results to research participants and biobank donors., Conclusion: The study findings indicated inconsistencies in stakeholder understanding of ethico-legal considerations related to biobanking in South Africa. A need for ongoing ethics capacity development among stakeholders was identified. Improving understanding of the ethics of biobanking could be facilitated by acknowledging the disconnect created by biosamples in the relationship between biobank researchers and donors.

Background: Disparities in invasive cervical cancer (ICC) incidence exist globally, particularly in HIV positive women who are at elevated risk compared to HIV negative women. We aimed to determine the spatial, temporal, and spatiotemporal incidence of ICC and the potential risk factors among HIV positive women in South Africa., Methods: We included ICC cases in women diagnosed with HIV from the South African HIV cancer match study during 2004-2014. We used the Thembisa model, a mathematical model of the South African HIV epidemic to estimate women diagnosed with HIV per municipality, age group and calendar year. We fitted Bayesian hierarchical models, using a reparameterization of the Besag-York-Mollié to capture spatial autocorrelation, to estimate the spatiotemporal distribution of ICC incidence among women diagnosed with HIV. We also examined the association of deprivation, access to health (using the number of health facilities per municipality) and urbanicity with ICC incidence. We corrected our estimates to account for ICC case underascertainment, missing data and data errors., Results: We included 17,821 ICC cases and demonstrated a decreasing trend in ICC incidence, from 306 to 312 in 2004 and from 160 to 191 in 2014 per 100,000 person-years across all municipalities and corrections. The spatial relative rate (RR) ranged from 0.27 to 4.43 in the model without any covariates. In the model adjusting for covariates, the most affluent municipalities had a RR of 3.18 (95% Credible Interval 1.82, 5.57) compared to the least affluent ones, and municipalities with better access to health care had a RR of 1.52 (1.03, 2.27) compared to municipalities with worse access to health., Conclusions: The results show an increased incidence of cervical cancer in affluent municipalities and in those with more health facilities. This is likely driven by better access to health care in more affluent areas. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers, such as transportation to health centres and strengthening of screening programmes.

Background: The HPTN 071 (PopART) trial showed that a combination HIV prevention package including universal HIV testing and treatment (UTT) reduced population-level incidence of HIV compared with standard care. However, evidence is scarce on the costs and cost-effectiveness of such an intervention., Methods: Using an individual-based model, we simulated the PopART intervention and standard care with antiretroviral therapy (ART) provided according to national guidelines for the 21 trial communities in Zambia and South Africa (for all individuals aged >14 years), with model parameters and primary cost data collected during the PopART trial and from published sources. Two intervention scenarios were modelled: annual rounds of PopART from 2014 to 2030 (PopART 2014-30; as the UNAIDS Fast-Track target year) and three rounds of PopART throughout the trial intervention period (PopART 2014-17). For each country, we calculated incremental cost-effectiveness ratios (ICERs) as the cost per disability-adjusted life-year (DALY) and cost per HIV infection averted. Cost-effectiveness acceptability curves were used to indicate the probability of PopART being cost-effective compared with standard care at different thresholds of cost per DALY averted. We also assessed budget impact by projecting undiscounted costs of the intervention compared with standard care up to 2030., Findings: During 2014-17, the mean cost per person per year of delivering home-based HIV counselling and testing, linkage to care, promotion of ART adherence, and voluntary medical male circumcision via community HIV care providers for the simulated population was US$6·53 (SD 0·29) in Zambia and US$7·93 (0·16) in South Africa. In the PopART 2014-30 scenario, median ICERs for PopART delivered annually until 2030 were $2111 (95% credible interval [CrI] 1827-2462) per HIV infection averted in Zambia and $3248 (2472-3963) per HIV infection averted in South Africa; and $593 (95% CrI 526-674) per DALY averted in Zambia and $645 (538-757) per DALY averted in South Africa. In the PopART 2014-17 scenario, PopART averted one infection at a cost of $1318 (1098-1591) in Zambia and $2236 (1601-2916) in South Africa, and averted one DALY at $258 (225-298) in Zambia and $326 (266-391) in South Africa, when outcomes were projected until 2030. The intervention had almost 100% probability of being cost-effective at thresholds greater than $700 per DALY averted in Zambia, and greater than $800 per DALY averted in South Africa, in the PopART 2014-30 scenario. Incremental programme costs for annual rounds until 2030 were $46·12 million (for a mean of 341 323 people) in Zambia and $30·24 million (for a mean of 165 852 people) in South Africa., Interpretation: Combination prevention with universal home-based testing can be delivered at low annual cost per person but accumulates to a considerable amount when scaled for a growing population. Combination prevention including UTT is cost-effective at thresholds greater than $800 per DALY averted and can be an efficient strategy to reduce HIV incidence in high-prevalence settings., Funding: US National Institutes of Health, President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The quadruple burden of disease (BoD) and multimorbidity reflected in South Africa's public health sector challenges speech-language therapists (SLTs) to optimise patient management in this context. For planning and delivery of appropriate services, it is important to understand the profile of speech-language therapy (SLT) patients and the public healthcare services provided by SLTs., Objectives: This study aimed to describe the prevalence of inpatient adult speech, language and swallowing disorders associated with various medical conditions and South Africa's BoD, in addition to the target areas and duration of SLT interventions provided at a central public hospital., Method: A retrospective review was conducted on records of 2549 adult inpatients who received SLT services between January 2014 and December 2015 at Chris Hani Baragwanath Academic Hospital. Data, including demographics, medical and SLT diagnoses, and treatment recommendations, were analysed using descriptive and inferential statistics., Results: Non-communicable diseases (NCDs) were most prevalent (77.48%), with multimorbidity of BoD categories in 29.27% of patients. Cerebrovascular disease (CeVD) comprised 52.45% patients, with CeVD, traumatic brain injury, other neurological conditions, cancer and burns comprising 88.74% patients. More than a third of the patients with CeVD were 56 years (n = 486; 36.35%). Dysphagia (48.96%), aphasia (30.95%) and dysarthria (23.62%) were the most common, with 44.68% of patients having multiple SLT diagnoses. The number of SLT sessions significantly correlated with SLT comorbidity (rs = 0.4200; p = 0.0000), but not BoD comorbidity (rs = 0.0049; p = 0.8058)., Conclusion: Speech-language therapy patients reflected a heavy NCD burden and multimorbidity. Provision of SLT services should take into consideration a profile of increased complexity of medical conditions and SLT diagnoses.

As COVID-19 spreads rapidly across Africa, causing havoc to economies and disruption to already fragile healthcare systems, it is becoming clear that despite standardised global health strategies, national and local government responses must be tailored to their individual settings. Some African countries have adopted stringent measures such as national lockdown, quarantine or isolation, in combination with good hand hygiene, mandatory wearing of masks and physical distancing, to prevent an impending healthcare crisis. The impact of stringent measures in low- to middle-income African countries has bought time for healthcare facilities to prepare for the onslaught of COVID-19 cases, but some measures have been challenging to implement. In some settings, public health measures have been associated with serious violations of individual rights owing to abuse of power and gaps in implementation of well-intentioned policy. Collateral damage with regard to non-COVID-19 diseases that were suboptimally managed in pre-pandemic times may mean that lives lost from other diseases could exceed those saved from COVID-19. While individuals complying with lockdown regulations have embraced an acceptance of the concept of the common good, at a broad community level many are finding the transition from individualism to collective thinking required during a pandemic difficult to navigate. In this article, we look at government responses to the pandemic in six African countries (Malawi, South Africa, Uganda, Zambia, Zimbabwe and Botswana), and highlight ethical concerns arising in these contexts.

Purpose: To inform service provision, this study explored feeding and swallowing difficulties in children within the context of South Africa's quadruple burden of disease (BOD) (i.e. conditions characterised as communicable, non-communicable, maternal and/or perinatal and trauma). Method: A retrospective chart review of 1432 paediatric inpatients (under 12 years of age) who met the inclusion criteria of presenting with dysphagia and being referred for speech-language pathology services was conducted. Result: Participants with diagnoses within the maternal and/or perinatal BOD category were noted most frequently (61.2%), followed by non-communicable (59.7%), communicable (43.4%) and trauma (4.2%). The majority of participants were under 1 year of age (82.2%) and 56.2% presented with comorbidities in multiple BOD categories. Mortality was 5.9%, with a higher rate (67.7%) in more complex cases. Mortality was associated with non-communicable BOD ( p  = 0.001), and maternal and/or perinatal BOD ( p  = 0.003). Pharyngeal phase swallowing difficulties were a significant risk for mortality (OR = 2.96; 95% CI: 1.01-8.65, p  = 0.047). Conclusion: The majority of children with dysphagia presented with multiple comorbidities and were at high risk for mortality. Education and service delivery models should be designed to improve health outcomes and reduce mortality rates.

Field experiments were conducted on wheat to study the effects of foliar-applied iodine(I) alone, Zn (zinc) alone, and a micronutrient cocktail solution containing I, Zn, Se (selenium), and Fe (iron) on grain yield and grain concentrations of micronutrients. Plants were grown over 2 years in China, India, Mexico, Pakistan, South Africa, and Turkey. Grain-Zn was increased from 28.6 mg kg -1 to 46.0 mg -1 kg with Zn-spray and 47.1 mg -1 kg with micronutrient cocktail spray. Foliar-applied I and micronutrient cocktail increased grain I from 24 μg kg -1 to 361 μg kg -1 and 249 μg kg -1 , respectively. Micronutrient cocktail also increased grain-Se from 90 μg kg -1 to 338 μg kg -1 in all countries. Average increase in grain-Fe by micronutrient cocktail solution was about 12%. The results obtained demonstrated that foliar application of a cocktail micronutrient solution represents an effective strategy to biofortify wheat simultaneously with Zn, I, Se and partly with Fe without yield trade-off in wheat.

Background: With Universal Health Coverage and Integrated People-centred Health Care, streamlined health-systems and respectful care are necessary. South Africa has made great strides in prevention of mother-to-child transmission (PMTCT) but with the great burden of HIV, a minimum of birth and 10-week HIV-PCR testing are required for the estimated 360,000 HIV-exposed infants born annually which presents many challenges including delayed results and loss to follow-up. Point-of-care (POC) HIV testing of infants addresses these challenges well and facilitates initiation of HIV-infected infants rapidly after diagnosis for best clinical outcomes., Methods: Objectives were to determine accuracy, feasibility and acceptability of POC testing compared to standard-of-care (SOC) central-laboratory testing. HIV-exposed infants for birth PCR testing in hospital (n = 323) and follow-up at a primary health care clinic (n = 117) in Durban, South Africa were included. A baseline situational-analysis reviewed registers and phoned mothers of HIV-exposed infants prior to the intervention. An effectiveness-implementation study of the Alere™q HIV-1/2 Detect POC test (heel-prick specimen processed in 50 min) was compared with SOC with questionnaires to mothers and staff. Stata 14 was used for analysis., Results: At baseline 2% of birth HIV tests were missed; only 40% of mothers could be contacted; 17% did not receive birth test result; 19% did not have a 10-week test; 39% had not received the 10-week results. There were 5(1.5%) HIV-infected and 318(98.5%) HIV-negative infants detected in hospital with all clinic babies negative. All positive infants commenced ART before discharge. Ultimately POC and SOC had perfect concordance but for 10 SOC tests researchers actively tracked-down results or repeated tests. Turn around times for SOC tests were on average 8-days (IQR 6-10  days) and for POC testing was 0-days. The POC error-rate was 9,6% with all giving a result when repeated. The majority of mothers (92%) preferred POC testing with 7% having no preference. No staff preferred SOC testing with 79% preferring POC and 21% having no preference., Conclusions: Point-of-care HIV testing for EID is accurate, feasible and acceptable, with benefits of early ART for all positive infants at birth facilities. We recommend that it be considered best practice for EID., Trial Registration: ISRCTN38911104 registered 9 January 2018 - retrospectively registered.

Background: Echoing the sentiments of the Sixty-seventh World Health Assembly of May 2014, mandating the all-inclusive and synchronized efforts for the management of autism spectrum disorder (ASD), the aim of this current study was to investigate the oral health status of children with ASD aged between 7 to 14 years in KwaZulu-Natal, South Africa., Methods: An investigative cross-sectional quantitative design employing non-probability purposeful sampling was conducted on 149 children with ASD attending special needs schools in KwaZulu-Natal. An intra-oral examination to investigate decayed, missing and filled teeth (DMFT/dmft), gingival index (GI), and plaque index (PI), attrition and soft tissue trauma using the World Oral Health Survey Form for Children, (2013) was implemented during data collection., Results: Average DMFT/dmft scores of 3, 42 and 0, 97 were recorded respectively. Molars dominated the decayed component of the DMFT/dmft with an average caries prevalence of (51, 7% and 40, 8%) respectively. These results displayed zero fillings indicative of unmet treatment needs. The gingival index revealed mild gingival inflammation, (46, 3%) and the plaque index demonstrated visible plaque at (43, 6%).Attrition scores revealed mild loss of dental enamel (47%). The most prevalent soft tissue trauma recorded was lip biting (37, 25%)., Conclusion: Restorative or preventative treatment measures were not evident in this study. Unmet dental needs are therefore an important concern in this population. Health care planners should develop preventive programs targeted at high risk groups such as this study population.

This case report describes diagnosis and management of intussusception in an 8-month-old baby girl seen at the Ventersdorp District Hospital, South Africa. According to the vaccination card, the child had been immunized with rotavirus vaccine with the last dose given 6 months and 2 weeks before presentation to Ventersdorp Hospital. This case of intussusception was unlikely associated with rotavirus vaccination.

Immune restoration disease associated with Mycobacterium tuberculosis (TB IRD) is clinically important among HIV patients commencing antiretroviral therapy in countries where tuberculosis is endemic. Vitamin D affects dendritic cell and T cell function and the antimicrobial activity of monocytes. Plasma levels of vitamin D and polymorphisms in the vitamin D receptor may affect tuberculosis, and HIV infection associates with vitamin D deficiency. Here we assess whether plasma vitamin D levels may predict TB IRD. Samples were available from prospective studies of TB IRD in Cambodia (26 cases), India (19 cases), and South Africa (29 cases). IRD cases and controls from each site were similar in age and baseline CD4(+) T cell count. Plasma samples were assessed using 25(OH) vitamin D immunoassay plates. DNA samples were available from a subset of patients and were genotyped for the VDR FokI (F/f) [C/T, rs10735810] SNP. When data from each cohort were pooled to assess ethnic/geographic differences, 25(OH)D levels were higher in Cambodian than Indian or South African patients (p<0.0001) and higher in South African than Indian patients (p<0.0001). TB IRD was not associated with differences in levels of 25(OH)D in any cohort (p=0.36-0.82), irrespective of the patients' prior TB diagnoses/treatment. Carriage of the minor allele of VDR FokI (F/f) was marginally associated with TB IRD in Indian patients (p=0.06) with no association in Cambodians. Neither plasma levels of vitamin D nor the vitamin D allele will usefully predict TB IRD in diverse populations from TB endemic regions.