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BACKGROUND: Maternal HIV and antiretroviral therapy exposure in-utero may influence infant weight, but the contribution of maternal y body mass index (BMI) to early life overweight and obesity is not clear. OBJECTIVE: To estimate associations between maternal BMI at entry to antenatal care and infant weight through approximately 1 year of age and to evaluate if associations were modified by maternal HIV status, maternal HIV and viral load, breast feeding intensity through 6 months or timing of entry into antenatal care. METHODS: We followed HIV-uninfected and -infected pregnant women initiating efavirenz-based antiretroviral therapy from first antenatal visit through 12 months postpartum. Infant weight was assessed via World Health Organization BMI and weight-for-length (WL) z-scores at 6 weeks, 3, 6, 9, and 12 months. We used multivariable linear mixed effects models to estimate associations between maternal BMI and infant z-scores over time. RESULTS: In 861 HIV-uninfected infants (454 HIV-exposed; 407 HIV-unexposed), nearly 20% of infants were overweight or obese by 12 months of age, regardless of HIV-exposure status. In multivariable analyses, increasing maternal BMI category was positively associated with higher infant BMIZ and WLZ scores between 6 weeks and 12 months of age and did not differ by HIV exposure status. However, HIV-exposed infants had slightly lower BMIZ and WLZ trajectories through 12 months of age, compared to HIV-unexposed infants across all maternal BMI categories. Differences in BMIZ and WLZ scores by HIV exposure were not explained by timing of entry into antenatal or maternal viral load pre-antiretroviral therapy initiation, but z-scores were slightly higher for HIV-exposed infants who were predominantly or exclusively versus partially breast fed. CONCLUSIONS: These findings suggest maternal BMI influences early infant weight gain, regardless of infant HIV-exposure status. Intervention to reduce maternal BMI may help to address growing concerns about obesity among HIV-uninfected children.

In settings with a high burden of HIV, pregnant women often experience a cluster of risk factors, including alcohol use and intimate partner violence (IPV). These interrelated risks are poorly understood among pregnant women at risk of HIV in sub-Saharan Africa. We aim to determine cross-sectional associations between pregnant women's alcohol use and victimization due to IPV in the HIV-Unexposed-Uninfected Mother-Infant Cohort Study in Cape Town, South Africa. Women who tested HIV-negative at first antenatal care (ANC) visit were followed to delivery. Trained interviewers collected demographic and psychosocial information, including recent alcohol use and experiences of IPV victimization. We assess the prevalence of alcohol use and associations with IPV using multivariable logistic regression. In 406 HIV-uninfected pregnant women (mean age = 28 years; mean gestational age = 21 weeks), 41 (10%) reported alcohol consumption in the past 12 months; 30/41 (73%) of these at hazardous levels. Any and hazardous alcohol use were associated with greater odds of reporting past year IPV (adjusted odds ratio [aOR] for hazardous use: 3.24, 95% CI = 1.11, 7.56; aOR for any alcohol use: 2.97, 95% CI = 1.19, 7.45). These data suggest the occurrence of overlapping HIV risk factors among pregnant women and may help design improved health interventions in this population.

One-electron reductants (OER) photoproduced by chromophoric dissolved organic matter (CDOM) have been shown to be likely precursors for the formation of superoxide and subsequently hydrogen peroxide. An improved method that employs a nitroxide radical probe (3AP) has been developed and utilized to determine the photoproduction rates of OER from a diverse set of CDOM samples. 3AP reacts with OER to produce the hydroxylamine, which is then derivatized with fluorescamine and quantified spectrofluorometrically. Although less sensitive than traditional methods for measuring RO2•-, measuring RH provides a simpler and faster method of estimating RO2•- and is amenable to continuous measurement via flow injection analysis. Production rates of OER (RH), superoxide (RO2•-), and hydrogen peroxide (RH2O2) have a similar wavelength dependence, indicating a common origin. If all the OER react with molecular oxygen to produce superoxide, then the simplest mechanism predicts that RH/RH2O2 and RO2•-/RH2O2 should be equal to 2. However, our measurements reveal RH/RH2O2 values as high as 16 (5.7-16), consistent with prior results, and RO2•-/RH2O2 values as high as 8 (5.4-8.2). These results indicate that a substantial fraction of superoxide (65-88%) is not undergoing dismutation. A reasonable oxidative sink for superoxide is reaction with photoproduced phenoxy radicals within CDOM.

Mother-child pairs may separate during early life, yet the health impacts thereof are unclear. We explored the patterns and impact of separation among women living with HIV (WLHIV) and their children in South Africa.WLHIV who had initiated antiretroviral therapy (ART) during pregnancy received HIV viral load (VL) testing and completed a timeline questionnaire of mother-child separation since delivery at 3-5 years post-partum. Health care usage was abstracted from routine medical records. We examined associations between separation and (a) maternal health outcomes (engagement in HIV care and HIV viral suppression, [VS]) and (b) child health outcomes (post-breastfeeding HIV testing and immunisation completion), using logistic regression.Of 346 mother-child pairs (median maternal age at antenatal ART initiation, 28 years), 24% were ever separated (median time to first separation 20 months, interquartile range [IQR] 9, 31). Most separated children were living with their grandmothers (65/83, 78%). Mothers who ever separated were younger, and more likely to be employed, and to reside in informal housing than those who never separated. Any separation reduced the odds of VS ≤ 50 copies/mL at four years post-partum (odds ratio 0.57; 95% CI 0.34-0.93); associations were similar for VL ≤ 1000 copies/mL and maternal engagement in care. No association was found between separation and child confirmatory HIV testing or immunisation completion.In this setting, mother-child separation is common in the first four years of life and appears associated with suboptimal maternal outcomes. Further research is required to understand the drivers and implications of mother-child separation.Les couples mère-enfant peuvent être séparés au début de la vie, mais les effets sur la santé ne sont pas clairs. Nous avons exploré les modèles et l'impact de la séparation chez les femmes vivant avec le VIH (PVVIH) et leurs enfants en Afrique du Sud. MÉTHODES: Les PVVIH qui avaient initié un traitement antirétroviral (ART) pendant la grossesse ont subi un test de charge virale du VIH (CV) et ont rempli un questionnaire chronologique sur la séparation mère-enfant depuis l'accouchement à 3-5 ans post-partum. L'utilisation des soins de santé a été extraite des dossiers médicaux de routine. Nous avons examiné les associations entre la séparation et (a) les résultats pour la santé maternelle (engagement dans les soins du VIH et la suppression virale du VIH [SV]) et (b) les résultats pour la santé de l'enfant (dépistage du VIH après l'allaitement et achèvement de la vaccination), en utilisant la régression logistique. RÉSULTATS: Sur 346 couples mère-enfant (âge maternel médian au début de l’ART prénatal, 28 ans), 24% ont été séparés (délai médian jusqu'à la première séparation 20 mois, intervalle interquartile [IQR] 9 à 31). La plupart des enfants séparés vivaient avec leurs grands-mères (65/83, 78%). Les mères qui ont vécu une telle séparation étaient plus jeunes et plus susceptibles d'avoir un emploi et de vivre dans un logement informel que celles qui ne l’ont jamais vécue. Toute séparation réduisait les chances de SV ≤50 copies/mL à quatre ans après l'accouchement (odds ratio 0,57; IC95%: 0,34-0,93); les associations étaient similaires pour la CV ≤1000 copies/mL et l'engagement de la mère dans les soins. Aucune association n'a été trouvée entre la séparation et le test de confirmation du VIH chez l'enfant ou l'achèvement de la vaccination.Dans ce contexte, la séparation mère-enfant est courante au cours des quatre premières années de la vie et semble associée à des résultats maternels sous-optimaux. Des recherches supplémentaires sont nécessaires pour comprendre les facteurs et les implications de la séparation mère-enfant.

Home visiting by community health workers (CHW) improves child outcomes in efficacy trials, there is however limited evidence of impact evaluating CHW programmes when operating outside of a research project. A CHW programme, previously demonstrated efficacious in a peri-urban township, was evaluated in a deeply rural context in a non-randomised comparative cohort study. Two non-contiguous, rural areas in the Eastern Cape of South Africa of about equal size and density were identified and 1469 mother-infant pairs were recruited over 33 months. In one area, CHWs conducted perinatal home visits (intervention group). Mothers in the comparison group received standard clinic care. Maternal and child outcomes were compared between the groups at one year. Mothers in the intervention group had significantly fewer depressive symptoms than mothers in the comparison group. Children of intervention mothers attained a higher proportion of their developmental milestones, compared to children in the comparison group. There were no other significant differences between mothers and children in the two groups. It is important to establish key parameters for implementing efficacious CHW programmes, especially as the numbers of CHWs are rapidly increased and are becoming critical components of task-shifting strategies of health departments in low and middle income countries (LMIC).

Invasion by invasive alien trees is a major threat to the biodiversity of the fynbos biome in South Africa. The environmental factors influencing the intensity of invasion are, however, largely unknown. In particular, the effects of soil nutrients on the invasion of alien trees in the fynbos biome have not been investigated. The Catabolic Theory predicts that trees will be more competitive than shrubs and herbaceous plants where anabolic nutrients (e.g. Mg, Mn and B) are comparatively more abundant than catabolic nutrients (e.g. P, Cu and Zn). We tested this theory at seven study sites by comparing soil nutrient concentrations in non-invaded and adjacent invaded sub-sites. Soil samples from 275 plots across 17 sub-sites were analysed for pH, Na, Mg, K, Ca, P, S, C, B, Mn, Cu and Zn. The results corroborated the Catabolic Theory. An index of anabolic to catabolic nutrients was greater in all ten sub-sites invaded by invasive alien trees than in sub-sites without invasion. Nutrients strongly related to tree invasion included B and P. As per the Catabolic Theory, poverty of B at certain sites is likely to constrain anabolism and consequently tree establishment. Some non-invaded sites had B concentrations of 0.02 mg kg−1, which is an order of magnitude less than critical deficiency thresholds in an agronomic context. By contrast, richness of P (as a result of prior fertilization) in fallow agricultural fields would, as per the Catabolic Theory, promote catabolism and the competitive strength of shrubs and/or herbaceous plants relative to trees. Practical implications of these findings include: 1) the mapping of soil properties such as B and P to reveal the inherent propensity of landscapes in the Western Cape to be invaded by trees; and 2) the application of B-binding substances such as illite and vermiculite to constrain invasion of trees in fynbos.

In settings where access to paediatric intensive care unit (PICU) facilities is constrained and transfer capacity is limited, High Flow Nasal Cannulae (HFNC) might fill an important service gap. The aim of this study was to document the effect of HFNC on the outcomes of children admitted with severe respiratory disease at a regional hospital without a PICU in Cape Town, South Africa. It is a 4-year retrospective analysis documenting two periods of 2 years each, one before (2013–15) and one after (2016–18) the initiation of HFNC use. Patients were between the ages of 2 months and 13 years and had been admitted to a paediatric ward. Outcomes were defined by the need for transfer to a tertiary hospital, the need for invasive ventilation and death. There were 90 instances of HFNC use with a significant reduction in the number of children who were transferred (59 vs. 31), invasively ventilated (20 vs. 6, p ≤ 0.01) and who died (3 vs. 0, p = 0.02). Before HFNC implementation, there was also a significantly greater proportion of transferred children who remained on low flow nasal cannulae (15 vs. 2, p ≤ 0.001) at the tertiary hospital. Children who failed HFNC use tended to do this within a day of initiation (Median 11 vs. 60 h for success, p ≤ 0.001). There were no complications related to its use. We believe that in our setting the utilization of HFNC has helped to timeously and accurately identify children needing to be transferred and may mitigate against severe respiratory disease progression.

South Africa faces dual epidemics of HIV and obesity; however, little research has explored whether HIV status influences associations between pre-pregnancy body mass index (BMI) and adverse birth outcomes.To examine associations between pre-pregnancy body mass index (BMI) and adverse birth outcomes, and if they differ by HIV status.We followed HIV-uninfected and -infected pregnant women initiating antiretroviral therapy (ART) from first antenatal visit through delivery. HIV-infected women initiated ART (tenofovir-emtricitabine/lamivudine-efavirenz) in pregnancy. Estimated pre-pregnancy BMI (kg/mAmong 1116 women (53% HIV-infected), 44% of HIV-uninfected women and 36% of HIV-infected women were classified as obese; 4% of women were underweight. Overall, 12% of infants were delivered preterm (37 weeks), 10% small for gestational age (SGA,10th percentile), and 9% large for gestational age (LGA,90th percentile). Compared to HIV-uninfected women, HIV-infected women on ART had less LGA (5% vs 13%) but more SGA (12% vs 8%), and a similar proportion of preterm (13% vs 11%) infants. Pre-pregnancy BMI was not associated with preterm birth. Among HIV-uninfected women, obesity modestly increased the risk of LGA (RR 1.34, 95% confidence interval [CI] 0.82, 2.19), and underweight modestly elevated the risk of SGA (RR 1.66, 95% CI 0.79, 3.46). These associations were attenuated among HIV-infected women (RR 1.07, 95% CI 0.44, 2.64 for LGA, and RR 1.34, 95% CI 0.49, 3.64 for SGA).In this urban African setting of high HIV prevalence, pre-pregnancy obesity was common and did not vary by HIV status. In HIV-uninfected women, obesity increased the risk of LGA and being underweight the risk of SGA, compared with among HIV-uninfected women.

This paper investigates the air dense medium fluidized bed (ADMFB) as a suitable dry beneficiation technique to upgrade +5.6 mm-13.2 mm South African coal. The separation efficiency of the ADMFB was assessed by determining the effect, if any, of particle size range, medium to coal feed ratios, and the addition of vibration on the separation ability of the bed. The coal was upgraded to varying degrees, depending on the parameters of the applied methods. For example, when considering the bottom bed layer (one quarter of the total bed height) as discard, the cumulative ash yield of the clean coal fraction ranged between 13.0% and 17.6% with a corresponding yield of 82.21%–83.93%, respectively. A variation in feed coal PSD did not significantly influence the response of the bed pertaining to its ability to beneficiate the coal. This was quantified by the similarity in percentage ash yield for the feed, top and bottom layers. In addition, it was established that by feeding a coal and magnetite (+300 µm) mixture, in various mass ratios, did not significantly influence the separation efficiency of the bed, nor did the application of external vibration to the bed aid in the beneficiation of the coal. Although these factors did not influence the performance of the ADMFB, it was found that the minimum fluidization velocity and bed stability were largely improved by the introduction of these variables

Background In South Africa, breastfeeding promotion is a national health priority. Regular perinatal home visits by community health workers (CHWs) have helped promote exclusive breastfeeding (EBF) in underresourced settings. Innovative, digital approaches including mobile video content have also shown promise, especially as access to mobile technology increases among CHWs. We measured the effects of an animated, mobile video series, the Philani MObile Video Intervention for Exclusive breastfeeding (MOVIE), delivered by a cadre of CHWs (“mentor mothers”). Methods and findings We conducted a stratified, cluster-randomized controlled trial from November 2018 to March 2020 in Khayelitsha, South Africa. The trial was conducted in collaboration with the Philani Maternal Child Health and Nutrition Trust, a nongovernmental community health organization. We quantified the effect of the MOVIE intervention on EBF at 1 and 5 months (primary outcomes), and on other infant feeding practices and maternal knowledge (secondary outcomes). We randomized 1,502 pregnant women in 84 clusters 1:1 to 2 study arms. Participants’ median age was 26 years, 36.9% had completed secondary school, and 18.3% were employed. Mentor mothers in the video intervention arm provided standard-of-care counseling plus the MOVIE intervention; mentor mothers in the control arm provided standard of care only. Within the causal impact evaluation, we nested a mixed-methods performance evaluation measuring mentor mothers’ time use and eliciting their subjective experiences through in-depth interviews. At both points of follow-up, we observed no statistically significant differences between the video intervention and the control arm with regard to EBF rates and other infant feeding practices [EBF in the last 24 hours at 1 month: RR 0.93 (95% CI 0.86 to 1.01, P = 0.091); EBF in the last 24 hours at 5 months: RR 0.90 (95% CI 0.77 to 1.04, P = 0.152)]. We observed a small, but significant improvement in maternal knowledge at the 1-month follow-up, but not at the 5-month follow-up. The interpretation of the results from this causal impact evaluation changes when we consider the results of the nested mixed-methods performance evaluation. The mean time spent per home visit was similar across study arms, but the intervention group spent approximately 40% of their visit time viewing videos. The absence of difference in effects on primary and secondary endpoints implies that, for the same time investment, the video intervention was as effective as face-to-face counseling with a mentor mother. The videos were also highly valued by mentor mothers and participants. Study limitations include a high loss to follow-up at 5 months after premature termination of the trial due to the COVID-19 pandemic and changes in mentor mother service demarcations. Conclusions This trial measured the effect of a video-based, mobile health (mHealth) intervention, delivered by CHWs during home visits in an underresourced setting. The videos replaced about two-fifths of CHWs’ direct engagement time with participants in the intervention arm. The similar outcomes in the 2 study arms thus suggest that the videos were as effective as face-to-face counselling, when CHWs used them to replace a portion of that counselling. Where CHWs are scarce, mHealth video interventions could be a feasible and practical solution, supporting the delivery and scaling of community health promotion services. Trial registration The study and its outcomes were registered at clinicaltrials.gov (#NCT03688217) on September 27, 2018., Maya Adam and colleagues study a video intervention, delivered by community health workers, to promote breastfeeding in South Africa., Author summary Why was this study done? Perinatal home visits from trained community health workers (CHWs) have shown promise for increasing the prevalence of exclusive breastfeeding, a national health priority in South Africa. Video-based, mobile health interventions, incorporating narratives and entertainment–education (E–E), have demonstrated potential for engaging community members and improving health knowledge. Few studies have measured the effect of integrating health promotion videos into CHW workflows in underresourced settings. What did the researchers do and find? We developed a mobile, video breastfeeding intervention to be delivered by CHWs (“mentor mothers”) employed by an established community health program during their home visits with 1,502 pregnant participants. We randomized mentor mothers 1:1 to intervention and control arm. All participants served by the same mentor mother either received or did not receive the intervention. In addition to the causal impact evaluation using a randomized controlled trial, we performed a mixed-methods performance evaluation measuring mentor mothers’ time use and gaining insights into mentor mothers’ subjective experiences with the intervention through in-depth interviews. The randomized controlled trial showed no difference in effects between the intervention and control arms. The performance evaluation results showed that mentor mothers in the intervention arm spent approximately 40% of their visit time viewing videos with their participants. What do these findings mean? Instead of serving as a complement to the standard of care, mentor mothers in the video intervention group used it to replace two-fifths of their face-to-face counseling time with participants. The absence of difference between infant feeding outcomes in the 2 study arms implies that the video intervention was as effective as face-to-face counseling, when the CHWs used it to replace a portion of that counselling. Used in addition to face-to-face engagement, video interventions could boost the health promotion efforts of CHWs, and, where CHWs are not available or extremely scarce, mobile video health interventions could become an increasingly feasible and practical solution for the delivery and scaling of community health promotion services. Future research should explore alternative delivery channels for mobile video E–E health interventions and measure, across channels, the potential for these interventions to (a) increase access to health promotion in underresourced communities; (b) support existing CHW programs; and (c) improve health behaviors and outcomes.

Summary Background Without breastfeeding and maternal antiretroviral therapy (ART), HIV-exposed uninfected (HEU) infants have greater infectious morbidity than HIV-unexposed (HU) infants. We hypothesised that with the introduction of universal maternal ART, breastfed HEU and HU infants would have similar morbidity. Methods We prospectively studied a cohort of HIV-infected pregnant women initiating ART, and a parallel group of HIV-uninfected pregnant women, starting from their first antenatal care visit at the Gugulethu Midwife Obstetrics Unit in Cape Town, South Africa. All pregnant women attending their first antenatal care visit were eligible for enrolment if aged 18 years or older and planning to deliver in Cape Town, without gestational age restrictions. HIV-infected women were participants of the Maternal Child Health ART (MCH-ART) study, and HIV-uninfected women were participants of the HIV-Unexposed Uninfected (HU2) study. All enrolled women were followed up during pregnancy and through delivery. At the early neonatal visit (scheduled for the first week after birth), mother–infant pairs who practiced any breastfeeding in the first 7 days of life were eligible for further postnatal follow-up for at least 12 months post partum. HIV infection was excluded among HEU infants at ages 6 weeks and 12 months by PCR. We evaluated the effect of HIV exposure on two primary outcomes: hospitalisation (all-cause and infection-related admission to hospital) and longitudinal prevalence of child infectious illness (diarrhoea and presumed lower respiratory tract infection [LRTI]). Hospitalisation data were abstracted from routine health records. Crude and adjusted incidence rate ratios (aIRRs; with adjustment for maternal HIV disease severity, timing of ART initiation, breastfeeding, timely vaccination, and birth outcomes [gestational size and age]) for infection-related hospitalisations were calculated from Poisson regression models (with variance corrected for clustering). Prevalence of infant infectious illness was based on maternal self-report for the preceding 2 weeks of each visit, with questions based on Demographic and Health Survey (DHS) questionnaires. Infants who acquired HIV infection during follow-up were excluded from this analysis. MCH-ART is registered on ClinicalTrials.gov , NCT01933477 . Findings Pregnant women were recruited between March 20, 2013, and Aug 19, 2015. Mother–infant pairs (HEU, n=459; HU, n=410) were followed up for a median of 12 months until March 24, 2017. Compared with HU infants, HEU infants had more infection-related hospitalisations between the age of 8 days and 3 months (HEU, 34·2 admissions per 100 child-years [24·4–47·9] vs 9·8 per 100 child-years [95% CI 5·1–18·8]; IRR 3·50 [95% CI 1·68–7·30]), but rates were similar at other ages. In infants aged 8 days to 3 months, infection-related hospitalisations for HEU infants with healthier mothers (n=84; ART initiation at 350 cells per μL, HIV viral load Interpretation Despite ART in pregnancy, breastfed HEU infants versus breastfed HU infants had transiently increased infectious morbidity risks in early infancy. However, differences were driven by factors potentially amenable to intervention, including delayed diagnosis and ART initiation in HIV-positive mothers, and suboptimal breastfeeding and vaccination of their infants. Funding US National Institute of Child Health and Human Development, Elizabeth Glaser Pediatric AIDS Foundation, South African Medical Research Council, Fogarty Foundation and the Office of AIDS Research.

BACKGROUND: Perinatal HIV transmission has dramatically decreased with combination antiretroviral (ARV) regimens, but complications among children who are HIV-exposed but uninfected (HEU), such as microcephaly, warrant ongoing surveillance. The goal of our study was to evaluate whether individual in utero ARV exposures were associated with increased risk of microcephaly based on long-term follow up of HEU infants and children. METHODS: We evaluated HEU children enrolled in the Surveillance Monitoring for ART Toxicities (SMARTT) study, a prospective cohort study conducted by the PHACS network. Microcephaly was defined using 2000 CDC Growth z-scores for head circumference (HC) measurements obtained at 6–36 months of age (z-score

To compare short-term outcomes of very low birthweight (VBLW

Purpose This retrospective observational hospital-based study assessed the characteristics of children with epilepsy in a sub-Saharan African tertiary service over a 10-year period. Methods Children with a primary or secondary diagnosis of epilepsy seen during the study period were identified from the departmental database. Demographic and clinical data were collected from the database and available medical records. Results Of 4701 children managed in the neurology service, 2407 children (51%) had epilepsy. The 2017 International League Against Epilepsy Classification of the Epilepsies was used to ascribe seizure and epilepsy type, epilepsy syndrome diagnosis and aetiologic categories. Forty-three percent of children had seizure onset before age one year. Focal Epilepsy occurred in 48% of the cohort (n = 1145). Twenty-five percent had an epilepsy syndrome diagnosis. Most children (54%) had epilepsy of unknown aetiology. Among those with underlying non-genetic aetiologies (33%), sequelae of intracranial infections, perinatal insults and structural brain malformations were most prevalent. Motor disability was present in 24% of children. Seventy-four percent had at least one associated motor disability, intellectual or learning disability, developmental delay or psychiatric comorbidity. Conclusion Epilepsy is common in sub-Saharan Africa. Many affected children have avoidable aetiologies. Compared to data from similar hospital-based studies in poorly resourced and resource-equipped settings, our cohort had a higher proportion of seizure onset below the age of one year and a greater number of infectious aetiologies, which is similar to population-based studies reported in sub-Saharan Africa. The presence of comorbidities is significant and demands greater advocacy for services for these children.

Background Childhood lower respiratory tract infections (LRTIs) cause substantial morbidity and under-5 child mortality. The epidemiology of LRTI is changing in low- and middle-income countries with expanding access to conjugate vaccines, yet there are few data on the incidence and risk factors for LRTI in these settings. Methods A prospective birth cohort enrolled mother–infant pairs in 2 communities near Cape Town, South Africa. Active surveillance for LRTI was performed for the first 2 years of life over 4 respiratory seasons. Comprehensive data collection of risk factors was done through 2 years of life. World Health Organization definitions were used to classify clinical LRTI and chest radiographs. Results From March 2012 to February 2017, 1143 children were enrolled and followed until 2 years of age. Thirty-two percent of children were exposed to antenatal maternal smoking; 15% were born at low birth weights. Seven hundred ninety-five LRTI events occurred in 429 children by February 2017; incidence of LRTI was 0.51 and 0.25 episodes per child-year in the first and second years of life, respectively. Human immunodeficiency virus (HIV)–exposed, uninfected infants (vs HIV-unexposed infants) were at increased risk of hospitalized LRTI in the first 6 months of life. In regression models, male sex, low birth weight, and maternal smoking were independent risk factors for both ambulatory and hospitalized LRTI; delayed or incomplete vaccination was associated with hospitalized LRTI. Conclusions LRTI incidence was high in the first year of life, with substantial morbidity. Strategies to ameliorate harmful exposures are needed to reduce LRTI burden in vulnerable populations.

Aims To examine child outcomes over time among mothers with perinatally depressed mood in rural South Africa (SA). Methods A representative sample of consecutive births (470/493) in the OR Tambo District of the Eastern Cape of South Africa (SA) were recruited and were reassessed at five points over the course of the next two years: 85% were reassessed at 3 months, 92% at 6 months, 88% at 9 months, 91% at 12 months, and 88% at 2 years post-birth. Over time, the children of mothers with perinatally depressed mood (16%) were compared to children of mothers without depressed mood using multiple linear and logistic regressions. Results Mothers with perinatal depressed mood are significantly less likely to live with the child's father or their in-laws (23% vs 35%), have household incomes above 2000 ZAR (154 USD) (31% vs 51%), and significantly more likely to have experienced IPV prior (19% vs 9%) and during (32% vs 20%) pregnancy compared to mothers without depressed mood. There are no differences in age, education, primipara, HIV status (29% seropositive), or alcohol use. Growth and developmental delays and motor and speech milestones through 24 months post-birth are similar for mothers with and without perinatal depressed mood. Conclusions Despite increased economic and partner difficulties associated with perinatal depressed mood, infant outcomes are similar in mothers with and without depressed mood in rural South Africa.

Elevated HIV viral load (VL) in pregnancy has been linked to increased risk of mortality, immunologic abnormalities, infectious morbidity and restricted growth among HIV-exposed uninfected (HEU) children, but little is known about effects on child development.HIV-infected women initiating lifelong antiretroviral therapy (ART; tenofovir + emtricitabine + efavirenz) antenatally were followed from first antenatal visit through delivery and with their breastfed infants postpartum. Cognitive, motor and expressive language development (Bayley Scales of Infant and Toddler Development-Third Edition; delay defined as score85) were assessed on a subset of HEU infants. HIV VL was measured at ART initiation, in third trimester and around delivery. Cumulative viremia in pregnancy was expressed as log10 VL copies × year/mL [viremia copy-years (VCY)]. Relationships between VCY and development were examined after adjusting for socioeconomic, behavioral and psychosocial confounders.Women (median pre-ART log10 VL 4.1, CD4 349 cells/mm) commonly reported adverse social circumstances (44% informal housing, 63% unemployed, 29% risky drinking). Among 214 infants (median age, 13 months; 53% male; 13% born37 weeks' gestation), viremia predicted lower motor and expressive language, but not cognitive, scores in crude and adjusted analysis [per log10 VCY increase, αβ (95% confidence interval [CI]): motor, -2.94 (-5.77 to -0.11); language, -3.71 (-6.73 to -0.69) and cognitive -2.19 (-5.02 to 0.65)]. Increasing VCY also predicted higher relative odds of motor delay [adjusted odds ratio (aOR): 3.32; 95% CI: 1.36-8.14) and expressive language delay (aOR: 2.79; 95% CI: 1.57-4.94), but not cognitive delay (aOR: 1.68; 95% CI: 0.84-3.34).Cumulative maternal HIV viremia in pregnancy may have adverse implications for HEU child development.

Studies have shown that contact sorption drying is a feasible technique to dewater fine (+0.15mm–0.5mm) and ultra-fine (−0.15 mm) coal. The aim of this article is to further investigate the drying mechanism involved. It could be shown that moisture transfer occurred primarily in the liquid phase, requiring direct contact between the coal and sorbent particles to facilitate the movement of the water. Moisture transfer was enhanced by operating with a higher sorbent to coal mass ratio. When drying smaller coal particle size ranges, the resistance to liquid transport decreased, leading to better desorption results. These improvements were mainly as a result of a greater contact area between the sorbent and coal particles

This paper introduces contact sorption with ceramic sorbents as a method to reduce the moisture content of coal fines produced by coal processing plants. The proposed method was tested on laboratory scale where ceramic spheres with diameters of 3 mm and 5 mm were combined with wet coal fines of size fractions between 0.25 mm and 2 mm. The coal had an initial moisture content of 0.25 g(Water)/g(Coal and water), and was dewatered using contact sorption to an average moisture content of 0.13 g(Water)/g(Coal and water) after 2.5 minutes and 0.05 g(Water)/g(Coal and water) after 10 minutes, respectively. This paper focuses on identifying the solid phase conditions essential to improving the contact sorption drying technology, proving that contact between the coal and sorbent material is the main driving force behind this technology. Increasing the sorbent to coal mass ratio and using smaller sorbents with a larger surface area resulted in improved contact and consequently improved moisture mass transfer. The final coal moisture content that could be achieved was independent of coal particle size. Current studies show a reliance on thermal drying technologies to dry the saturated sorbent material, whereas this paper proves that drying with high airflow at low temperatures is sufficient to regenerate the sorbent material. The loaded sorbent material could easily be separated from the dried coal product by dry screening, and could be dried and regenerated afterwards in an air-blown packed bed within 10 minutes. The re-use of sorbent material showed no decrease in its dewatering efficiency, and it was shown to be possible to re-use the sorbents for a large number of cycles. Contact sorption can prove to be a cost-effective and efficient drying method to dewater coal fines in the industry

Non-target analysis (NTA) employing high-resolution mass spectrometry is a commonly applied approach for the detection of novel chemicals of emerging concern in complex environmental samples. NTA typically results in large and information-rich datasets that require computer aided (ideally automated) strategies for their processing and interpretation. Such strategies do however raise the challenge of reproducibility between and within different processing workflows. An effective strategy to mitigate such problems is the implementation of inter-laboratory studies (ILS) with the aim to evaluate different workflows and agree on harmonized/standardized quality control procedures. Here we present the data generated during such an ILS. This study was organized through the Norman Network and included 21 participants from 11 countries. A set of samples based on the passive sampling of drinking water pre and post treatment was shipped to all the participating laboratories for analysis, using one pre-defined method and one locally (i.e. in-house) developed method. The data generated represents a valuable resource (i.e. benchmark) for future developments of algorithms and workflows for NTA experiments. © 2021, The Author(s).

Introduction There are limited data on Tuberculosis (TB) in adolescents with perinatally acquired HIV (APHIV). We examined the incidence and determinants of TB infection and disease in the Cape Town Adolescent Antiretroviral Cohort (CTAAC). Methods Youth between nine and fourteen years on antiretroviral therapy (ART) for more than six months in public sector care, and age‐matched HIV‐negative adolescents, were enrolled between July 2013 through March 2015 and followed six‐monthly. Data were censored on 31 October 2018. Symptom screening, chest radiograph, viral load, CD4 count, QuantiFERON (QFT) and sputum for Xpert MTB/RIF, microscopy, culture and sensitivity were performed annually. TB infection was defined by a QFT of >0.35 IU/mL. TB diagnosis was defined as confirmed (culture or Xpert MTB/RIF positive) or unconfirmed (clinical diagnosis and started on TB treatment). Analyses examined the incidence and determinants of TB infection and disease. Results Overall 496 HIV+ and 103 HIV‐negative participants (median age at enrolment 12 years (interquartile range, IQR 10.6 to 13.3) were followed for a median of 3.1 years (IQR 3.0 to 3.4); 50% (298/599) were male. APHIV initiated ART at median age 4.4 years (IQR 2.1 to 7.6). At enrolment, 376/496 (76%) had HIV viral load

Background Fetal Alcohol Spectrum Disorders (FASD) are a global health concern. Early intervention mitigates deficits, yet early diagnosis remains challenging. We examined whether children can be screened and meet diagnoses for FASD at 1.5 years compared to 5 years post-birth. Methods A population cohort of pregnant women in 24 neighborhoods (N = 1258) was recruited and 84.5 %–96 % were reassessed at two weeks post-birth, 0.5 years, 1.5 years, 3 years, and 5 years later. A two-step process was followed to diagnose FASD; first, a paraprofessional screened the children and then a physician evaluated the child. We evaluated FASD symptoms at 1.5 vs. 5 years. We also examined maternal differences in children receiving a positive FASD screening (n = 160) with those who received a negative FASD screening. Results Screening positive for FASD more than doubled from 1.5 years to 5 years (from 6.8 % to 14.8 %). About one quarter of children who screened positive and were evaluated by a physician, were diagnosed as having a FASD. However, half did not complete the 2nd stage screening. Compared to mothers of children with a negative FASD screening, mothers of children with a positive FASD screening were less likely to have a high school education and more likely to have lower incomes, have experienced interpersonal partner violence, and have a depressed mood. Mothers of children who did not follow up for a 2nd stage physician evaluation were more like to live in informal housing compared to those who followed-up (81.3 % vs. 62.5 %, p = 0.014). Conclusions We found that children can be screened and diagnosed for FASD at 1.5 and 5 years. As FASD characteristics develop over time, repeated screenings are necessary to identify all affected children and launch preventive interventions. Referrals for children to see a physician to confirm diagnosis and link children to care remains a challenge. Integration with the primary healthcare system might mitigate some of those difficulties.

We investigated patterns and predictors of health service utilization (HSU) among children with autism spectrum disorder (ASD) and global developmental delays (GDD, non-ASD) attending tertiary services in a resource-constrained setting.Caregivers and children (diagnosed with either ASD or GDD) attending the developmental service were enrolled into a retrospective cohort study. Sociodemographic factors, clinical factors, and service use over the preceding year were collected using structured questionnaires and medical record reviews.We enrolled 240 households (116 ASD, 124 GDD; ages 3-8 years; male:female ratio 2:1). The majority (84%) had moderate-to-severe symptoms, and 42% were nonverbal. Children with GDD had higher levels of underlying syndromic diagnoses than those with ASD (46, 37.1%; 14, 9.5%); (p0.01) and more co-occurring comorbidities (51, 41.0%; 14, 12.1%; p = 0.0001). Those with GDD had higher mean total HSU visits (13.3; 11.5; p = 0.02), higher mean specialist visits (4.0:2.0; p = 0.001), and more hospitalizations than those with ASD (38, 31%; 16, 14%; p = 0.02). Other services were similarly attended by both groups: therapy 6.0 (2.0-10.0), emergency visits 1.0 (1.0-2.0), auxiliary services 0 (0-1.0), and primary care visits 0 (0-1.0). Having an employed parent was the strongest predictor of increased HSU (p = 0.05).Despite high functional impairment in this cohort, many households underutilized therapy services. There was skewed attendance of emergency and specialist services over primary care services. Children with GDD had greater HSU compared with those with ASD, primarily because of more specialist visits. HSU could be improved by caregiver education, household economic empowerment, and strengthening of primary care services.

SYNOPSIS The aim of this study was to determine the acid-generating potential of coal mine tailings located in the Middelburg area, South Africa, using conventional assessment techniques. Four coal-tailing samples were collected from different layers of a coal-tailing pile. The acid-base accounting (ABA), acid-buffering characteristic curve (ABCC), and net acid generation (NAG) methods were used in conjunction with a mineralogical investigation to assess the potential of acid mine drainage (AMD) formation from the tailings. The results showed that the top layer of the pile, which was exposed to the atmosphere, was most likely to form AMD, exhibiting the lowest paste pH (2.5) and ABA of zero kg H2SO4 per ton. The ABA results were compared to ABCC results and mineralogical calculations to confirm the findings. The results from the ABCC test and calculations based on mineralogy indicated that the ABA method overestimates the effective or readily available acid neutralization capacity (ANC) and the true MPA of each sample; only three of the four samples could therefore be classified as acid-forming, but with low acid-generating capacity. Although the findings show that the top layer of the coal tailings in the Middelburg area is most likely to form AMD, it is important for future studies to further investigate the kinetics of acid formation. Keywords: acid mine drainage, acid-base accounting, mineralogy, net acid generation, coal mine tailings.

Background Home visits by paraprofessional community health workers (CHWs) has been shown to improve maternal and child health outcomes in research studies in many countries. Yet, when these are scaled or replicated, efficacy disappears. An effective CHW home visiting program in peri-urban Cape Town found maternal and child health benefits over the 5 years point but this study examines if these benefits occur in deeply rural communities. Methods A non-randomized, two-group comparison study evaluated the impact of CHW in the rural Eastern Cape from August 2014 to May 2017, with 1310 mother-infant pairs recruited in pregnancy and 89% were reassessed at 6 months post-birth. Results Home visiting had limited, but important effects on child health, maternal wellbeing and health behaviors. Mothers reported fewer depressive symptoms, attended more antenatal visits and had better baby-feeding practices. Intervention mothers were significantly more likely to exclusively breastfeed for 6 months (OR: 1.8; 95% CI: 1.1, 2.9), had lower odds of mixing formula with baby porridge (regarded as detrimental) (OR: 0.4; 95% CI: 0.2, 0.8) and were less likely to consult traditional healers. Mothers living with HIV were more adherent with co-trimoxazole prophylaxis (p Conclusion The impact of CHWs in a rural area was less pronounced than in peri-urban areas. CHWs are likely to need enhanced support and supervision in the challenging rural context.

OBJECTIVE: To examine associations between high blood pressure (BP) when entering antenatal care (ANC) and birth outcomes in a cohort of pregnant HIV- and women living with HIV (WLHIV) initiating antiretroviral treatment (ART). STUDY DESIGN: Prospective cohort study. MAIN OUTCOME MEASURES: Cesarean delivery, preterm birth (10(th) percentile for GA). RESULTS: Of 1116 women (median GA 20 weeks; WLHIV 53%), 48% (53% WLHIV; 43% HIV-) entered ANC with high BP, defined as elevated (120–129 or 130–139 or 80–89) or stage 2 hypertension (≥140 / or ≥90). WLHIV were more likely to have high BP (RR 1.32; 95%CI 1.12-1.57), controlling for pre-pregnancy body mass index and additional confounders. In multivariable analysis, there was no evidence that high BP increased the risk of cesarean delivery (RR 1.10, 95% CI 0.92-1.30), preterm birth (RR 1.15, 95% CI 0.81-1.62), LBW (RR 1.16, 95% CI 0.84-1.60) or SGA (RR 1.02, 0.72-1.44), overall or when stratified by HIV-status. High BP was associated with an increased risk of LGA (RR 1.43; 95% CI 1.00-2.03). CONCLUSION: In this setting, half of women had high BP at entry into ANC, with WLHIV at increased risk of high BP. There was no strong evidence that high BP increased the risk of adverse birth outcomes overall, or by HIV-status, with the exception of LGA. WLHIV may be at high risk of high BP during pregnancy and should be monitored closely.

Background More than 50% of Africa’s population lives in rural areas, which have few professional health workers. South Africa has adopted task shifting health care to Community Health Workers (CHWs) to achieve the Sustainable Development Goals, but little is known about CHWs’ efficacy in rural areas. Methods In this longitudinal prospective cohort study, almost all mothers giving birth (N = 470) in the Zithulele Hospital catchment area of the OR Tambo District were recruited and repeatedly assessed for 2 years after birth with 84.7–96% follow-up rates. During the cohort assessment we found that some mothers had received standard antenatal and HIV care (SC) (n = 313 mothers), while others had received SC, supplemented with home-visiting by CHWs before and after birth (HV) (n = 157 mothers, 37 CHWs). These visits were unrelated to the cohort study. Multiple linear and logistic regressions evaluated maternal comorbidities, maternal caretaking, and child development outcomes over time. Results Compared to mothers receiving SC, mothers who also received home visits by CHWs were more likely to attend the recommended four antenatal care visits, to exclusively breastfeed at 3 months, and were less likely to consult traditional healers at 3 months. Mothers in both groups were equally likely to secure the child grant, and infant growth and achievement of developmental milestones were similar over the first 2 years of life. Conclusion CHW home visits resulted in better maternal caretaking, but did not have direct benefits for infants in the domains assessed. The South African Government is planning broad implementation of CHW programmes, and this study examines a comprehensive, home-visiting model in a rural region.

In South Africa, up to 40% of pregnant women are living with human immunodeficiency virus (HIV), and 30–45% are obese. However, little is known about the dual burden of HIV and obesity in the postpartum period. In a cohort of HIV‐uninfected and HIV‐infected pregnant women initiating antiretroviral therapy in Cape Town, South Africa, we examined maternal anthropometry (weight and body mass index [BMI]) from 6 weeks through 12 months postpartum. Using multinomial logistic regression, we estimated associations between baseline sociodemographic, clinical, behavioural, and HIV factors and being overweight–obese I (BMI 25 to 35), compared with being underweight or normal weight (BMI