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Among the commonly studied organic fillers for PLA, cellulose is the most promising. It is available in various particle sizes and sources, providing numerous options for finding a suitable match for PLA matrices. In this study, cellulose was extracted from the leaves of E. autumnalis to create a novel PLA/cellulose composite. Based on a distinguished cellulose spectrum, EA cellulose was incorporated into a PLA matrix. According to SEM results, adding 3.0 wt% EA cellulose to PLA resulted in no fiber pull‐outs. Below this content, fiber pull‐outs were observed. FTIR and TGA results indicated no significant changes in chemical structure and thermal stability of the composites. XRD, DSC, and Tensile testing results revealed an increase in the crystallinity and modulus for the 3.0 wt% composites, below this content, the crystallinity and modulus of the samples were low. Therefore, in order to obtain the composition of the composite with the desired functional properties, the ratio of the PLA to EA cellulose plays a vital role, and these have to be controlled for more effective functional properties. This study has shown that blending PLA with EA cellulose can give improved properties at 3.0 wt% EA cellulose although not optimized. [ABSTRACT FROM AUTHOR]

Reading ability is important in education, as it transcends all forms of learning. Poor reading ability usually means that a learner will encounter academic challenges and perform poorly at school. Grade 9 (form 2) learners in Zimbabwe were thought to have been disadvantaged during Zimbabwe's economic turmoil from 2006 to 2008. There were so many disruptions and instances of absenteeism in government schools during that period that these learners, who were in grade R at the time, may not have received adequate reading instruction. The aim of the study was to investigate the reading comprehension levels of grade 9 (form 2) learners in Bulawayo Central District high schools in Zimbabwe to determine whether they were disadvantaged by the disruptions, and to what extent. Quantitative and qualitative methods were used to collect data to establish the learners' reading proficiency and to determine what factors influenced their reading proficiency. Forty-eight learners from government schools and 22 from private schools voluntarily wrote a reading comprehension test and provided narratives on their reading development. The test results were analysed using ANOVA and the narratives were analysed using content analysis. The test results showed that the reading comprehension level of the cohort of grade 9 (form 2) learners in government schools was below that expected for grade 4. The narratives of the government school learners were also fraught with errors, whereas private school learners wrote better narratives. The study therefore showed that the reading proficiency of the government school learners who were in grade R in 2008 was below the required level. The learners' reading development seems to have been adversely affected by the national disruptions. Recommendations are made for interventions to improve the reading proficiency of grade 9 learners in government schools before they pursue tertiary education. [ABSTRACT FROM AUTHOR]

Abstract Background There is an increasing burden of chronic illness in low and middle income countries, driven by TB/HIV, as well as non-communicable diseases. Few health systems are organized to meet the needs of chronically ill patients, and patients' perspectives on the difficulties of accessing care need to be better understood, particularly in poor resourced settings, to achieve this end. This paper describes the experience of poor households attempting to access chronic care in a rural area of South Africa. Methods A household survey (n = 1446 individuals) was combined with qualitative longitudinal research that followed 30 case study households over 10 months. Illness narratives and diaries provided descriptive textual data of household interactions with the health system. Results In the survey 74% of reported health problems were 'chronic', 48% of which had no treatment action taken in the previous month. Amongst the case study households, of the 34 cases of chronic illness, only 21 (62%) cases had an allopathic diagnosis and only 12 (35%) were receiving regular treatment. Livelihoods exhausted from previous illness and death, low income, and limited social networks, prevented consultation with monthly expenditure for repeated consultations as high as 60% of income. Interrupted drug supplies, insufficient clinical services at the clinic level necessitating referral, and a lack of ambulances further hampered access to care. Poor provider-patient interaction led to inadequate understanding of illness, inappropriate treatment action, 'healer shopping', and at times a break down in cooperation, with the patient 'giving up' on the public health system. However, productive patient-provider interactions not only facilitated appropriate treatment action but enabled patients to justify their need for financial assistance to family and neighbours, and so access care. In addition, patients and their families with understanding of a disease became a community resource drawn on to assist others. Conclusion In strengthening the public sector it is important not only to improve drug supply chains, ambulance services, referral systems and clinical capacity at public clinics, and to address the financial constraints faced by the socially disadvantaged, but also to think through how providers can engage with patients in a way that strengthens the therapeutic alliance.

This study describes ceftazidime-avibactam use in 17 young children from a resource-constrained country, where intra-abdominal infection was common. All-cause mortality was 53%. Earlier initiation, dose optimization, recording infusion times, and reviewing the need for additional antibiotics were identified as easy-to-implement-antimicrobial-stewardship interventions., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: To measure the direct cost burdens (health care expenditure as a percent of total household expenditure) for households in rural South Africa, and examine the expenditure and use patterns driving those burdens, in a setting with free public primary health care and hospital exemptions for the poor., Methods: Data on illness events, treatment patterns and health expenditure in the previous month were assessed from a cross-sectional survey of 280 households conducted in the Agincourt Health and Demographic Surveillance site, South Africa., Results: On average, a household experiencing illness incurred a direct cost burden of 4.5% of total household expenditure. A visit to a public clinic generated a mean burden of 1.3%. Complex sequences of treatments led 20% of households to incur a burden over 10%, with transport costs generating 42% of this burden. An outpatient public hospital visit generated a burden of 8.2%, as only 58% of those eligible obtained an exemption; inpatient stays incurred a burden of 45%. Consultations with private providers incurred a mean burden of 9.5%. About 38% of individuals who reported illness did not take any treatment action, 55% of whom identified financial and perceived supply-side barriers as reasons., Conclusion: The low overall mean cost burden of 4.5% suggests that free primary care and hospital exemptions provided financial protection. However, transport costs, the difficulty of obtaining hospital exemptions, use of private providers, and complex treatment patterns meant state-provided protection had limitations. The significant non-use of care shows the need for other measures such as more outreach services and more exemptions in rural areas. The findings also imply that fee removal anywhere must be accompanied by wider measures to ensure improved access.

Over the last 10-15 years, poor African households have had to cope with the burden of increased levels of chronic illness such as HIV/AIDS. How do these households cope with the cost burdens of ill health and healthcare, and has this burden further impoverished them? What policy responses might better support these households? This is a report from the field of the South African Costs and Coping study (SACOCO) - a longitudinal investigation of household experiences in the Agincourt health and demographic surveillance site.

Despite good intentions and commitment from providers, prevention-of-mother-to-child-transmission of HIV (PMTCT) services can be difficult for pregnant women to access, despite the provision of free health services for women and children. We examined the introduction of PMTCT services in a very poor rural area of the Eastern Cape, South Africa, to assess the context's impact on the provision of this service. Our approach involved 13 individual in-depth interviews and 26 focus group discussions, spread over six clinics in a single district, supplemented by situational observations. Our goal was to suggest how access to PMTCT services at the clinics may be improved. Poor roads, an underdeveloped transport system and poor telecommunications typify the pervasive poverty in the study area. Families have few resources for travel and most live a long distance from a clinic. Accessing emergency transport is especially difficult and expensive. Poor infrastructure also means that many families do not have access to clean water, which complicates the use of infant formula. PMTCT services had been recently added to several clinics that provide general services to the local population, but that were already understaffed and over-pressured. Since the PMTCT services were new, some elements of the intervention and staff training were delayed, thus inhibiting full implementation. New staff had not been added to ease accumulated pressures. Thus, socio-economic context can present a formidable barrier to the provision of PMTCT services. Improvement in services to rural areas will require creative thinking, perhaps including the use of mobile services and the development of community structures, such as contributions to community health education by traditional birth attendants and local volunteer groups.

Objective: To explore why South African women still abort outside designated services where there is substantial legal service provision., Design: Descriptive study., Setting: Three hospitals in Gauteng Province in South Africa. Sample Forty-six women attending hospital with incomplete abortion who had abortions induced outside of designated facilities., Methods: An interviewer-administered questionnaire with open and closed questions was completed. Induction status was determined from answers to a set of closed questions. Open-ended questions explored the circumstances of induction. Main focus of interviews Methods of induction used, barriers to legal service use., Results: Nearly two-thirds of women (n= 38) had self-induced or had consulted a traditional healer. A minority of these women (n= 11) indicated that they did this because they experienced barriers to legal service use. For others it was presented as a 'natural' response to a health problem (unwanted pregnancy). Several women (n= 10) were given misoprostol by a doctor, nurse, or pharmacist. Fifty-four percent of the women had not used legal services because they did not know about the law, while 15% knew of their legal rights, but did not know of a legal facility. Others did know where to access legal services but feared rude staff (17%) or breaches of confidentiality (6.5%). Others (6.5%) had been unable to get a legal abortion early enough in pregnancy to comply with the law., Conclusions: Lack of information on abortion rights under the Act and perceived poor quality of designated facilities were the most important barriers to access and should be addressed by policymakers and health service management. The willingness of women to self-medicate and visit traditional healers in these circumstances may influence the overall ability of the new legislation to reduce abortion morbidity.

Improving the quality of life of all South Africans has become a major concern to health care practitioners, organisations and politicians. However, the paucity of local information on health-related quality of life (HRQOL) does not allow us to address this public health challenge. In order to rectify this deficiency and complement international research, we undertook a study with 281 Type 2 Black diabetic patients and 437 controls, with no self-reported chronic conditions, to ascertain HRQOL. We used the SF-20 to measure functioning, general health, well-being and bodily pain (HRQOL). It was hypothesised that diabetes mellitus significantly affects functioning, general health and well-being. Multiple analyses of covariance controlled for age, schooling, marital status, employment status and commodity ownership (a socio-economic measure). Patients were significantly more likely to report poorer role functioning, poorer general health and more pain than controls, providing partial support for the hypothesis. Reliability (internal consistency) coefficients on the four multi-item SF-20 sub-scales ranged between 0.79 (well-being), 0.81 (general health), 0.83 (physical functioning) and 0.94 (role functioning) for patients: for controls these coefficients ranged between 0.70 (well-being), 0.78 (general health), 0.80 (physical functioning) and 0.90 (role functioning). Inter-correlations among the sub-scales were significant for patients and controls (p = 0.01). It was concluded that the SF-20 is a reliable instrument for measuring HRQOL in both patient and control samples, and diabetes mellitus has more impact on general health and level of pain than on well-being.