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This paper evaluates the impact of a sudden and unexpected nationwide alcohol sales ban in South Africa. We find that this policy causally reduced injury-induced mortality in the country by at least 14%. We argue that this estimate constitutes a lower bound on the true impact of alcohol on injury-induced mortality. We also document a sharp drop in violent crimes, indicating a tight link between alcohol and aggressive behavior in society. Our results underscore the severe harm that alcohol can cause and point toward a role for policy measures that target the heaviest drinkers in society. [ABSTRACT FROM AUTHOR]

Purpose: Hypertension is a leading cause of cardiovascular-related morbidity and mortality worldwide, with a prevalence increasing at an alarming rate in both middle- and low-income countries. Various environmental and genetic factors have been attributed to play a significant role in the increasing prevalence of hypertension. Single nucleotide polymorphisms (SNPs) in the angiotensinogen (AGT) gene are reported to have a significant association with hypertension; however, there are limited studies done on South African populations. Therefore, this case–control study aimed to investigate the association between AGT SNPs (rs2004776, rs3789678, rs5051 and rs7079) with hypertension in a study population of isiXhosa-speaking participants from the Eastern Cape Province in South Africa. Materials and Methods: The SNPs were genotyped in 250 hypertensive cases and 237 normotensive controls, using TaqMan genotyping assays. Results: For the SNP rs2004776, the frequency of CC genotype (18.4%) and C allele (44%) in hypertensive cases showed no significant differences (p = 0.52, χ 2 = 1.32), when compared to the normotensive control group (CC: 19.8% and C allele: 43%). Similar results were obtained for the genotypic and allelic frequencies between hypertensive cases and normotensive controls for rs3789678 (p = 0.88, χ 2=0.26) and rs5051 (p = 0.57, χ 2=1.12), and rs7079 (p = 0.33, χ 2=2.23). These findings demonstrate that there were no significant associations between the SNPs rs2004776, rs3789678, rs7079, rs5051 with hypertension in our study population. Conclusion: These findings suggest that AGT gene polymorphisms are not associated with the development of hypertension in the studied population. The present study represents the first genetic report to investigate the AGT gene polymorphisms with hypertension in an isiXhosa-speaking South African population. [ABSTRACT FROM AUTHOR]

Homelessness is a global issue that is often associated with substance use. Research on this relationship in low- to middle-income countries (LMIC) is limited. We aimed to explore which factors are associated with substance use through secondary data analysis of a sample of 472 adults who attended services for homeless individuals in Cape Town, South Africa. Logistic regression was utilized to investigate if length of homelessness was associated with current alcohol and drug use respectively, after accounting for other factors. Current drug use (44.9%) was higher than current alcohol use (22.7%) and the most prevalent lifetime drug was methamphetamine (32.6%). After adjusting for lifetime substance use, and source of income, length of homelessness was not significantly associated with current alcohol use (less than on year: OR = 2.60; 95% CI: 0.78-8.66; one or more years: OR = 0.90; 95% CI: 0.32-2.57) or current drug use (less than one year: OR = 0.78; 95% CI: 0.41-1.47; one year or more: OR = 1.04; 95% CI: 0.56-1.93). These results highlight the need to further investigate other factors that may influence current alcohol or drug use among populations at risk of being homeless, and to utilize validated measures of substance and other mental health conditions. [ABSTRACT FROM AUTHOR]

Objective: Innovative public health approaches are required to improve human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) education and prevention among adolescents, one of the most vulnerable groups to HIV/AIDS. Consequently, elearning and classroom instruction was assessed for HIV/AIDS knowledge uptake and internalizing among South African and Irish pupils between the ages of 11 and 16 years. Method: An HIV/AIDS intervention was implemented based on a quasi-experimental design using experimental and control groups. Experimental group pupils underwent an elearning programme and the control group used the same material in workbooks in a classroom setting. The McNemar test assessed change in both groups' knowledge levels from baseline to post-intervention. A theoretical framework guided by the conflict theory and health belief model strengthened the learning material. Discussions took place in the classroom and in an eforum; the latter was qualitatively analysed using thematic content analysis. Results: A significant increase (P < 0.01) in HIV/AIDS knowledge uptake was experienced by the experimental group compared to a decline of 1.6% in the control group from baseline to post-intervention. Internalization of HIV/AIDS knowledge emerged in the eforum among experimental group pupils, while the classroom discussions faced structural barriers. Learning outcomes were demonstrated by higher marks achieved in the experimental than control group brochures, the outcome of the learning process. Conclusion: Elearning proved a superior technique to classroom instruction for HIV/AIDS knowledge uptake and internalizing and should be considered for wider implementation.

Objective To investigate injury-related mortality in South Africa using a nationally representative sample and compare the results with previous estimates. Methods We conducted a retrospective descriptive study of medico-legal postmortem investigation data from mortuaries using a multistage random sample, stratified by urban and non-urban areas and mortuary size. We calculated age-specific and age- standardized mortality rates for external causes of death. Findings Postmortem reports revealed 52493 Injury-related deaths in 2009 (95% confidence interval, CI: 46930-58057). Almost half (25499) were Intentionally inflicted. Age-standardized mortality rates per 100000 population vyere as follows: all injuries: 109.0 (95% CI: 97.1-121.0); homicide 38.4 (95% CI: 33.8-43.0; suicide 13.4 (95% CI: 11.6-15.2) and road-traffic injury 36.1 (95% CI: 30.9-41.3). Using postmortem reports, we found more than three times as many deaths from homicide and road-traffic injury than had been recorded by vital registration for this period. The homicide rate was similar to the estimate for South Africa from a global analysis, but road-traffic and suicide rates were almost fourfold higher. Conclusion This is the first nationally representative sample of injury-related mortality in South Africa. It provides more accurate estimates and cause-specific profiles that are not available from other sources. Objectif Enqueter sur la mortalite par traumatisme en Afrique du Sud a partir d'un echantlllon natlonalement representatlf et comparer les resultats avec les estimations anterieures. Methodes Nous avons realise une etude descriptive retrospective des donnees de rapports medico-legaux obtenus aupres de morgues, en utilisant une technique d'echantillonnage aleatoire a plusieurs degres, stratifie en fonction des criteres suivants: zone urbaine, zone non urbaine et taille de la morgue. Nous avons calcule les taux de mortalite par age et les taux de mortalite standardlses selon l'age, pour les differentes causes externes de deces. Resultats Les dossiers d'autopsie font etat de 52.493 deces par traumatisme en 2009 (intervalle de confiance de 95 %, IC: 46.930-58.057). Quasiment la moitle (25.499 deces) correspond a des blessures infligees intentionnellement. Taux de mortalite standardise selon l'age pour 100.000 personnes: Tous types de blessures: 109,0 (1C 95 %: 97,1-121,0); Homicides 38,4 (IC 95%: 33,8-43); Suicides 13,4 (IC 95%: 11,6-15,2); Blessures llees a des accidents de transport 36,1 (IC 95%: 30,9-41,3). Les rapports d'autopsie indiquent un nombre de deces par homicide et accident de la route plus de trols fois superleur aux chiffres recenses dans les registres d'etat civil pour la meme periode. Le taux d'homicide a confirme les estimations prealablement faites pour l'Afrlque du Sud dans une analyse internationale. En revanche, les taux correspondan aux accidents de la route et aux suicides se sont averes pres de quatre fois plus eleves. Conclusion Il s'agit du tout premier echantlllon nationalement representatif pour la mortalite par traumatisme en Afrique du Sud. Cette etude offre des estimations plus precises et des profils detailles par causes, qui ne sont disponibles dans aucune autre source. Objetivo Investigar la mortalidad relacionada con los traumatismos en Sudafrica utilizando una muestra representativa a nivel nacional y comparar los resultados con estimaciones anteriores. Metodos Se llevo a cabo un estudio retrospectivo y descriptivo de datos medico-legales de Investigaciones post mortem utilizando una muestra aleatoria en varias etapas, estratificado por zonas urbanas y zonas no urbanas y el tamano de la morgue. Se calcularon las tasas de mortalidad especificas y normalizadas por edades de causas de muerte externas. Resultados Los informes post mortem revelaron 52.493 muertes relacionadas con traumatismos en 2009 (intervalo de confianza, IC, del 95%: 46.930-58.057). Casi la mitad (25.499) fueron infligidas intencionadamente. Las tasas de mortalidad normalizadas por edades por 100.000 habitantes fueron las siguientes: todos los traumatismos: 109,0 (IC del 95%: 97,1-121,0); homicidio 38,4 (IC del 95%: 33,8-43); suicidio 13,4 (IC del 95%: 11,6-15,2) y traumatismos relacionados con el transporte 36,1 (IC del 95%: 30,9-41,3). Utilizando informes post mortem, se observaron tres veces mas casos de muertes por homicidio y traumatismos por accidentes de trafico que la cantidad registrada en el registro civil para este periodo. La tasa de homicidio fue similar a la estimacion para Sudafrica desde una perspectiva global, pero las tasas de accidentes de trafico y suicidios fueron casi cuatro veces superiores. Conclusion Esta es la primera muestra representativa a nivel nacional de mortalidad relacionada con los traumatismos en Sudafrica. Proporciona estimaciones mas precisas y perfiles por causas especificas que no pueden obtenerse de otras fuentes., Introduction In South Africa in the year 2000, injury-related mortality accounted for 12% of deaths and 16% of years of life lost. (1) This was primarily due to high mortality [...]

This study aimed to investigate the association between consumption of ultra-processed foods, whole foods and breast cancer risk in black women from Soweto, South Africa. A population-based case (n 396)–control (n 396) study matched on age and residence, using data from the South African Breast Cancer study. Dietary intake was assessed using a validated quantified FFQ. Food items were categorised using the NOVA system ((1) unprocessed/minimally processed foods, (2) culinary ingredients, (3) processed foods and (4) ultra-processed foods). Conditional logistic regression models were used to estimate OR and 95 % CI of dietary contributions from each NOVA food group (as a percentage of total energy intake (EI)) and adjusting for potential confounders. Considering contributions to total EI per day, ultra-processed food consumption contributed to 44·8 % in cases and 47·9 % in controls, while unprocessed/minimally processed foods contributed to 38·8 % in cases and 35·2 % in controls. Unprocessed/minimally processed food consumption showed an inverse association with breast cancer risk overall (OR = 0·52, 95 % CI 0·35, 0·78), as well as in pre- and postmenopausal women separately (OR = 0·52, 95 % CI 0·27, 0·95 and OR = 0·55, 95 % CI 0·35, 0·89, respectively) and in women with progesterone positive breast cancer (OR = 0·23, 95 % CI 0·06, 0·86). There was no heterogeneity in association with breast cancer when analyses were stratified according to BMI. No significant associations were observed for the consumption of other NOVA food groups. Intake of unprocessed/minimally processed foods may reduce the risk of developing breast cancer in black women from Soweto, South Africa. [ABSTRACT FROM AUTHOR]

Objective: To determine the level of adherence and to assess the association between higher adherence to the South African food based dietary guidelines (SAFBDG) and breast cancer risk. Design: Population-based, case–control study (the South African Breast Cancer study) matched on age and demographic settings. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to the SAFBDG, a nine-point adherence score (out of eleven guidelines) was developed, using suggested adherence cut-points for scoring each recommendation (0 and 1). When the association between higher adherence to the SAFBDG and breast cancer risk was assessed, data-driven tertiles among controls were used as cut-points for scoring each recommendation (0, 0·5 and 1). OR and 95 % CI were estimated using multivariate logistic regression models. Setting: Soweto, South Africa. Participants: Black urban women, 396 breast cancer cases and 396 controls. Results: After adjusting for potential confounders, higher adherence (>5·0) to the SAFBDG v. lower adherence (<3·5) was statistically significantly inversely associated with breast cancer risk overall (OR = 0·56, 95 % CI 0·38, 0·85), among postmenopausal women (OR = 0·64, 95 % CI 0·40, 0·97) as well as for oestrogen-positive breast cancers (OR = 0·51, 95 % CI 0·32, 0·89). Only 32·3 % of cases and 39·1 % of controls adhered to at least half (a score >4·5) of the SAFBDG. Conclusions: Higher adherence to the SAFBDG may reduce breast cancer risk in this population. The concerning low levels of adherence to the SAFBDG emphasise the need for education campaigns and to create healthy food environments in South Africa to increase adherence to the SAFBDG. [ABSTRACT FROM AUTHOR]

The fourth author's name is spelled incorrectly. The correct name is: Vundli Ramokolo. The correct citation is: Mwambenu B, Ramokolo V, Laubscher R, Feucht U (2022) Growth and the pubertal growth spurt in South African adolescents living with perinatally-acquired HIV infection. PLOS ONE 17(1): e0262816. https://doi.org/10.1371/journal.pone.0262816.By Bilema Mwambenu; Vundli Ramokolo; Ria Laubscher and Ute FeuchtReported by Author; Author; Author; Author [Extracted from the article]

Background: Real-world evaluation of the safety profile of vaccines after licensure is crucial to accurately characterise safety beyond clinical trials, support continued use, and thereby improve public confidence. The Sisonke study aimed to assess the safety and effectiveness of the Janssen Ad26.COV2.S vaccine among healthcare workers (HCWs) in South Africa. Here, we present the safety data. Methods and findings: In this open-label phase 3b implementation study among all eligible HCWs in South Africa registered in the national Electronic Vaccination Data System (EVDS), we monitored adverse events (AEs) at vaccination sites through self-reporting triggered by text messages after vaccination, healthcare provider reports, and active case finding. The frequency and incidence rate of non-serious and serious AEs were evaluated from the day of first vaccination (17 February 2021) until 28 days after the final vaccination in the study (15 June 2021). COVID-19 breakthrough infections, hospitalisations, and deaths were ascertained via linkage of the electronic vaccination register with existing national databases. Among 477,234 participants, 10,279 AEs were reported, of which 138 (1.3%) were serious AEs (SAEs) or AEs of special interest. Women reported more AEs than men (2.3% versus 1.6%). AE reports decreased with increasing age (3.2% for age 18–30 years, 2.1% for age 31–45 years, 1.8% for age 46–55 years, and 1.5% for age > 55 years). Participants with previous COVID-19 infection reported slightly more AEs (2.6% versus 2.1%). The most common reactogenicity events were headache (n = 4,923) and body aches (n = 4,483), followed by injection site pain (n = 2,767) and fever (n = 2,731), and most occurred within 48 hours of vaccination. Two cases of thrombosis with thrombocytopenia syndrome and 4 cases of Guillain-Barré Syndrome were reported post-vaccination. Most SAEs and AEs of special interest (n = 138) occurred at lower than the expected population rates. Vascular (n = 37; 39.1/100,000 person-years) and nervous system disorders (n = 31; 31.7/100,000 person-years), immune system disorders (n = 24; 24.3/100,000 person-years), and infections and infestations (n = 19; 20.1/100,000 person-years) were the most common reported SAE categories. A limitation of the study was the single-arm design, with limited routinely collected morbidity comparator data in the study setting. Conclusions: We observed similar patterns of AEs as in phase 3 trials. AEs were mostly expected reactogenicity signs and symptoms. Furthermore, most SAEs occurred below expected rates. The single-dose Ad26.COV2.S vaccine demonstrated an acceptable safety profile, supporting the continued use of this vaccine in this setting. Trial registration: ClinicalTrials.gov NCT04838795; Pan African Clinical Trials Registry PACTR202102855526180. Saimbarashe Takuva, Azwi Takalani, and colleagues investigate the frequency and incidence of adverse events reported after receipt of a single dose of the Ad26.COV2.S COVID-19 vaccine among health care workers in South Africa. Author summary: Why was this study done?: While the safety of the Ad26.COV2.S vaccine was established in phase 3 clinical trials, continuous evaluation of safety in expanded populations is crucial. The Sisonke phase 3b implementation study enrolled almost half a million healthcare workers, providing an opportunity to further evaluate the safety of the single-dose Ad26.COV2.S vaccine. What did the researchers do and find?: A total of 477,234 healthcare workers across all South African provinces received the Ad26.COV2.S vaccine between 17 February 2021 and 17 May 2021. Through self-reports and active case finding, adverse events, serious adverse events, and adverse events of special interest were identified. Overall occurrence of adverse events was low. The majority of adverse events reported were common reactogenicity signs and symptoms. Most serious adverse events and adverse events of special interest, including vascular events, immune system disorders, and deaths, occurred at lower than the expected population rates. What do these findings mean?: The single-dose Ad26.COV2.S vaccine had an acceptable safety profile. This supports continued use of this vaccine in large rollout programmes. [ABSTRACT FROM AUTHOR]

Breast cancer prevention is of great importance to reduce high incidence in South Africa. This study aimed to investigate adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations and the association with breast cancer risk in black urban women from Soweto, South Africa. A total of 396 breast cancer cases and 396 population-based controls from the South African Breast Cancer study (SABC) matched on age and demographic settings were included. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to these recommendations, an eight-point adherence score was developed, using tertiles among controls for scoring each recommendation (0, 0·5 and 1) with zero indicating the lowest adherence to the recommendations. OR and 95 % CI were estimated using multivariate logistic regression models to analyse associations between the WCRF/AICR score and breast cancer risk. Greater adherence (>4·5 v. <3·25) to the 2018 WCRF/AICR Cancer Prevention Recommendations was associated with a significant inverse association with breast cancer risk overall (OR = 0·54, 95 % CI 0·35, 0·91) and specifically in postmenopausal women (OR = 0·55, 95 % CI 0·34, 0·95), in cases with oestrogen positive and progesterone positive breast cancer subtypes (OR = 0·54, 95 % CI 0·39, 0·89 and OR = 0·68, 95 % CI 0·43, 0·89, respectively) and in obese women (OR = 0·52, 95 % CI 0·35, 0·81). No significant association with breast cancer risk was observed in premenopausal women. Greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations may reduce breast cancer risk in this black urban population of Soweto. Adherence thereof should be encouraged and form a part of cost-effective breast cancer prevention guidelines. [ABSTRACT FROM AUTHOR]

This study examined the prevalence of and risk factors for intimate partner physical violence against women. Interviews were conducted with a sample of 1,378 men working in Cape Town municipalities. An average of 42.3% (95% CI: 39.6, 44.8) reported physical violence against a partner of the last 10 years, and 8.8% (95% CI: 7.3, 10.3) reported physical violence in the past year. After adjustment for age, occupational group, and race, the factors associated with use of violence against partners of the last 10 years were having no post-school training (OR = 2.10), witnessing parental violence in childhood (OR = 1.87), involvement in fights at work (OR = 2.73) and in communities (OR = 1.54), drug use (OR = 1.99), problem alcohol use (OR = 1.98), perceiving hitting women to be acceptable (OR = 4.54), frequent conflict (OR = 2.40), women's alcohol use (OR = 2.25), conflict about sex (OR = 2.16), and conflict about his infidelity (OR = 2.81). The study shows that ideas supportive of gender inequality and normative use of violence in different settings are major underlying factors for men's violence against partners. Keywords: gender based violence; abuse; masculinities, male violence; South Africa

Objective: This study formed part of the 1998 South African Demographic and Health Survey, which included questions assessing the extent of alcohol use, risky drinking and alcohol problems among South Africans to obtain up-to-date baseline estimates of consumption and risky drinking and to inform intervention efforts. Method: A two-stage random sample of 13,826 persons ages 15 or older (59% women) was included in the survey. Alcohol use was assessed through eight questions, including the CAGE questionnaire. Frequency analyses for different age groups, geographic setting, education level, population group and gender were calculated, as were odds ratios for these variables in relation to symptoms of alcohol problems. Results: Current alcohol consumption was reported by 45% of the men and 17% of the women. White men (71%) were most likely and Asian women (9%) least likely to be current drinkers. Urban residents were more likely than nonurban dwellers to report current drinking. One third of the current drinkers reported risky drinking over weekends, and 28% of the men and 10% of the women scored above the cutoff level on the CAGE questionnaire. Symptoms of alcohol problems were significantly associated with lower socioeconomic status, no school education in women and being older than 25 years of age. Conclusions: A comprehensive strategy is required to address the high levels of risky drinking and reported symptoms of alcohol problems. (J. Stud. Alcohol 66: 91-97, 2005), IN MANY DEVELOPING countries, levels of alcohol consumption have increased in recent years as a result, in part, of a change in drinking patterns from traditional use of home-brews with [...]

Introduction: There is uncertainty regarding the completeness of death recording by civil registration and by health centres in South Africa. This paper aims to compare death recording by the two systems, in cohorts of South African patients receiving antiretroviral treatment (ART). Methods: Completeness of death recording was estimated using a capture-recapture approach. Six ART programmes linked their patient record systems to the vital registration system using civil identity document (ID) numbers and provided data comparing the outcomes recorded in patient files and in the vital registration. Patients were excluded if they had missing/invalid IDs or had transferred to other ART programmes. Results: After exclusions, 91,548 patient records were included. Of deaths recorded in patients files after 2003, 94.0% (95% CI: 93.3-94.6%) were recorded by civil registration, with completeness being significantly higher in urban areas, older adults and females. Of deaths recorded by civil registration after 2003, only 35.0% (95% CI: 34.2-35.8%) were recorded in patient files, with this proportion dropping from 60% in 2004-2005 to 30% in 2010 and subsequent years. Recording of deaths in patient files was significantly higher in children and in locations within 50 km of the health centre. When the information from the two systems was combined, an estimated 96.2% of all deaths were recorded (93.5% in children and 96.2% in adults). Conclusions: South Africa's civil registration system has achieved a high level of completeness in the recording of mortality. However, the fraction of deaths recorded by health centres is low and information from patient records is insufficient by itself to evaluate levels and predictors of ART patient mortality. Previously documented improvements in ART mortality over time may be biased if based only on data from patient records. Keywords: antiretroviral therapy; HIV; vital statistics registration; South Africa. To access the supplementary material to this article please see Supplementary Files under Article Tools online., Introduction Antiretroviral treatment (ART) has had a significant impact on AIDS mortality in developing countries [1-4]. However, most of what is known regarding mortality after ART initiation in developing countries [...]