Environmental health practitioners potentially play a key role in helping communities adapt to climate change.

BACKGROUND: Vulnerable population groups in South Africa, especially those living in poverty, young children, women, the elderly and people with pre-existing diseases, are susceptible to new or exacerbated health threats resulting from climate change. Environmental Health Practitioners (EHPs) can play an important role in helping communities adapt to climate change health impacts, however, effective coordination of this requires further understanding of their roles in implementing climate change-related adaptation actions in communities. METHODS: A cross-sectional survey using convenience sampling was undertaken at the January 2017 conference for EHPs hosted by the South African Institute of Environmental Health in Cape Town. All EHPs who attended the conference were invited to complete a study questionnaire that requested information on participant demographics, as well as climate change related-knowledge, practices and perceptions. RESULTS: Majority of participating EHPs (n = 48; 72.8%) had received formal or informal training on climate change and health. Thirty-nine percent of EHPs indicated that they had a climate change and health-related committee / working group in their department, a policy or strategy (41.0%) and budget allocated for climate change and health-related work (51.5%). A total of 33.3% had participated in climate change-related projects. Majority (62.2%) of EHPs believed that they should play a supportive role in addressing climate change while 37.8% believed that EHPs should play a leading role. CONCLUSIONS: Recognising the need for raising awareness about climate change adaptation as well as implementing appropriate interventions to combat climate-related ill health effects, especially among vulnerable groups, EHPs are well-placed to adopt significant roles in helping communities to adapt to climate change.

Copper sulphate use in South African traditional medicine.

Copper (Cu) is an essential element to humans; however, exposure to elevated concentrations through occupational hazard and/or environmental means may be detrimental. This paper provides results of a cross-sectional study aimed to determine the prevalence of copper sulphate (CuSO4) use in South African traditional medicine by traditional health practitioners (THPs) and details the use thereof. A total of 201 THPs were enrolled from two main municipal areas of KwaZulu-Natal (South Africa). Information on demographic characteristics of THPs, reasons for using or not using CuSO4 as well as administration methods and age groups of recipients were collected. Of the 201 THPs interviewed, 145 (72 %) use CuSO4 for healing purposes. The use of CuSO4 was strongly associated with gender (p = 0.009) where the proportion of CuSO4 users was higher for female than male THPs. CuSO4 was reportedly administered to individuals of all ages, including infants and children. The main routes of administration were enema (n = 110; 76 %), oral (n = 40; 28 %) and use in bath (n = 40; 28 %). The reasons cited for use are diverse and included skin rashes (n = 43; 30 %), aches, pains and swelling (n = 38; 28 %) as well as sexually transmitted diseases (n = 28; 19 %). This study identified a high prevalence of THPs using CuSO4 for healing purposes. These findings support the need to regulate South African traditional medicine to safeguard the user.

Predictors of perceived male partner concurrency among women at risk for HIV and STI acquisition in Durban, South Africa.

BACKGROUND: Women in sub-Saharan Africa continue to be at greater risk for HIV acquisition than men. Concurrency, viz. multiple sexual partnerships that overlap over time, has been studied as a possible risk factor for HIV transmission. The aim of this study was to identify predictors of perceived male partner concurrency among sexually active, HIV negative women. METHODS: Socio-demographic and behavioural data from women enrolled in a biomedical HIV prevention clinical trial were assessed in relation to perceived male partner concurrency using the Chi squared test. Univariate and multivariate logistic regression was performed to assess the independent predictors of perceived male partner concurrency. Kaplan-Meier survival estimates were obtained for HIV and STI incidence in relation to male partner concurrency. A Cox Proportional Hazards model was used to assess the association between perceived male partner concurrency and HIV and STI incidence. RESULTS: The results revealed that 29 % of women reported their male partners to be in concurrent sexual relationships, 22 % reported partners that were not engaging in concurrency, whilst 49 % reported not knowing their partners concurrency status. Older women, having never married, experiencing economic abuse, and women reporting individual concurrency, were found to be significant predictors of perceived male partner concurrency in the studied population. Perceived male partner concurrency was not found to be a significantly associated with incident HIV and STI infections in this analysis. CONCLUSIONS: The study provides insight into predictors of perceived male partner concurrency among women at high risk for STI and HIV acquisition. These results may inform the design of behavioural and biomedical interventions, to address the role of multiple sexual partnerships in HIV prevention.

Metallic mercury use by South African traditional health practitioners: perceptions and practices.

BACKGROUND: Mercury is a toxic metal however its use in traditional healthcare systems remains widespread. The aim of this study was to determine the prevalence of mercury use by South African Traditional Health Practitioners (THP) and to document reasons for use and administration methods. METHODS: A cross-sectional study design was employed. A total of 201 THPs were enrolled from two main metropolitan areas of KwaZulu-Natal (South Africa), and 198 were included in the final analysis. Information on demographic characteristics, reasons for using or not using mercury as well as mercury administration methods were collected. RESULTS: Of the 198 THPs, 78 (39%) used mercury for healing purposes and 74 (95%) of the mercury users stated that they were taught to use it by another THP. The two main routes of administration were oral and sub-cutaneous implantations (ukugcaba) at 85% (n = 66) and 59% (n = 46), respectively. The most common responses for mercury administration were for child birth (n = 70; 90%) and protection against guns (n = 39; 50%). CONCLUSION: This is the first study to describe the prevalence and practice of mercury use in South African traditional medicine. Socio-cultural mercury use is a potential source of exposure to both THPs and their patients. In light of such findings, public education messages and regulatory measures need to be effected.

Respiratory outcomes among plant processing workers in Durban, South Africa.

Plant products used by informal traditional medicine traders go through various methods of manual processing to yield a final single or multi-concoction product; however, the prevalence of potentially associated respiratory outcomes has yet to be established. The aim of this study was to describe respiratory outcomes associated with processing plants among informal traditional medicine traders. Questionnaires related to the preparation of plant products and respiratory outcomes were administered to study participants by trained researchers. Of the 216 traders, nocturnal cough, nasal allergies and waking with a feeling of tightness in the chest were the most frequently cited respiratory outcomes (43, 35 and 22%, respectively). The study highlighted the burden of respiratory outcomes among traders who process plant products and the need for targeted workplace interventions.

Ergonomic Risk Assessment during an Informal Hand-Made Cookware Operation: Extending an Existing Model.

The work conducted in the informal sector is highly variable within and between days. Characterizing ergonomic exposures remains a challenge because of unstructured work settings and schedules. The existing ergonomic risk assessment tools have been widely used in formal work settings with a narrow range of exposure, and for predefined tasks that primarily constitute a daily routine. There is limited information in the literature on how they have been applied in informal workplaces. The aim of this study was to extend an existing risk assessment tool and to evaluate the applicability of the extended tool by assessing ergonomic exposure related to hand-made cookware operations. Eighteen hand-made cookware makers were recruited from six sites. A walkthrough risk assessment questionnaire was used to collect information on workers, tasks, work stations and workplace structures. The Rapid Upper Limb Assessment (RULA) screening tool was extended by including duration and vibration. An action priority matrix was used to guide intervention. According to the RULA action levels, the workers required investigation and changes soon, and immediate investigation and changes. The use of an action priority matrix was appropriate, and indicated that all the workers assessed were within the high to very high exposure domain and required immediate corrective measures. The methodology used proved to be an effective and reliable strategy for identifying ergonomic exposure among hand-made cookware makers.

Informal-sector occupational hazards: an observational workplace assessment of the traditional medicine trade in South Africa.

Informal traditional medicine markets are trading and processing hubs for a range of plant, animal and mineral materials; however, little is known regarding the occupational risks associated with the processing and handling of these products. The aim of this study was to identify the workplace hazards of the traditional medicine trade. A walk-through observation of the workplace was conducted by two independent observers with formal training in workplace risk evaluation. Ergonomic, physical, chemical, biological and environmental hazards were identified from the handling of plant, animal and/or mineral products. The study gives an insight into a unique and diverse sector.

Occupational Exposure to Fine Particulate Matter (PM4 and PM2.5) during Hand-Made Cookware Operation: Personal, Indoor and Outdoor Levels.

(1) Exposure of informal artisanal cookware makers to fine particles has not yet been characterized. The aim of this study was to characterize occupational exposure to fine particulate matter (PM4 and PM2.5) levels and fine particulate matter (PM2.5) elemental components; (2) Artisanal cookware makers were recruited from five cookware making sites. Exposure to fine particulate matter was measured for 17 male participants. SidePak personal aerosol monitors (AM520) were used to measure personal exposure to PM4, while a DustTrak monitor and an E-sampler were used to assess indoor and outdoor PM2.5 levels, respectively. A questionnaire was administered to capture information on demographic characteristics. The chemical characterization of indoor and outdoor PM2.5 filter mass was conducted using Wavelength Dispersive X-ray Fluorescence. Time series record of 15-min averages for indoor and outdoor PM2.5 levels were assessed; (3) The median (range) was 124 µg/m3 (23-100,000), 64 µg/m3 (1-6097) and 12 µg/m3 (4-1178), respectively, for personal PM4, indoor and outdoor PM2.5. The highest levels for many of the elemental components of PM2.5 were found in the outdoor PM2.5 filter mass and (4). The information generated during this study may assist in extending occupational health and safety strategies to artisanal cookware makers and developing targeted prevention initiatives.

Recycling of scrap metal into artisanal cookware in the informal sector: A public health threat from multi metal exposure in South Africa.

Recycling of scrap metal into artisanal cookware is widespread in poorly resourced countries. The aim of the study was to determine the risk of metal exposure from the use of artisanal cookware available in South Africa. Twenty cookware samples were purchased from local manufacturers and informal traders across South Africa. Aluminum and silicon concentrations were determined using XRF and the total content of 18 elements (Ag, As, Ba, Cd, Co, Cr, Cu, Fe, Hg, Mn, Mo, Ni, Pb, Sb, Se, Sn, V and Zn) were evaluated using ICPMS. Leaching of metals from cut pieces of cookware over a 2-h period of boiling in a 3% acetic acid solution was repeated 3 times and revealed multi-metal migration that was compared to EU maximum permissible levels. The mean Al migration of 509 mg L-1 was over 100 times the EU maximum permissible level allowed for cookware. Lead was detected in all samples with 11 (55%), 12 (60%) and 9 (45%) of samples being over the maximum EU permissible level (10 µg Pb L-1) for 1st, 2nd and 3rd migrations respectively. The mean As migration concentrations in the first leaching event ranged from 0.23 to 24.1 µg L-1 with four pots (20%) over the maximum EU permissible limit for As (2 µg L-1). Notably, all four pots were well below the maximum EU permissible As limit by the 3rd migration. Cadmium and mercury were detected in each pot across all three migrations however the levels were relatively low. Transmission electron microscopy revealed dramatic changes in surface structure after leaching of cookware.

Effect of cadmium accumulation on anti-inflammatory activity in two Eucomis species.

Eucomis species (Hyacinthaceae) are widely used in South Africa as traditional medicine. The bulbs are used to alleviate a variety of symptoms including pain and inflammation. High levels of cyclooxygenase-1 and -2 (COX-1 and COX-2) inhibitory activity have been associated with certain Eucomis species. The aim of this study was to quantify cadmium(Cd) accumulation and examine its effect on COX-1 and COX-2 anti-inflammatory activity in Eucomis autumnalis and Eucomis humilis. Cadmium application at 2 mg L(-1) over a 6 week period revealed a substantial difference in total Cd accumulation in E. autumnalis and E. humilis (40.2 and 15.3 mg Cd kg-1, respectively). When supplied with Cd at 2 mg L(-1), E. humilis bulbous extracts showed lower inhibitory activity than the control for both COX-1 and COX-2. E. autumnalis bulbous extracts had greater COX-1 activity compared to the control. While COX-2 activity was suppressed. Researchers should be aware of the effect of environmental contaminants when reporting on biological activity of crude plant extracts.

Anti-HIV activity of southern African plants: Current developments, phytochemistry and future research.

ETHNOPHARMACOLOGICAL RELEVANCE: The African continent is home to a large number of higher plant species used over centuries for many applications, which include treating and managing diseases such as HIV. Due to the overwhelming prevalence and incidence rates of HIV, especially in sub-Saharan Africa, it is necessary to develop new and affordable treatments. AIM OF THE STUDY: The article provides an extensive overview of the status on investigation of plants from the southern African region with ethnobotanical use for treating HIV or HIV-related symptoms, or the management of HIV. The review also provide an account of the in vitro assays, anti-viral activity and phytochemistry of these plants. MATERIALS AND METHODS: Peer-reviewed articles investigating plants with ethnobotanical information for the treatment or management of HIV or HIV-related symptoms from the southern African region were acquired from Science Direct, PubMed central and Google Scholar. The selection criteria was that (1) plants should have a record of traditional/popular use for infectious or viral diseases, HIV treatment or symptoms similar to HIV infection, (2) if not traditionally/popularly used, plants should be closely related to plants with popular use and HIV activity identified by means of in vitro assays, (3) plants should have been identified scientifically, (4) should be native to southern African region and (5) anti-HIV activity should be within acceptable ranges. RESULTS: Many plants in Africa and specifically the southern African region have been used for the treatment of HIV or HIV related symptoms and have been investigated suing various in vitro techniques. In vitro assays using HIV enzymes such as reverse transcriptase (RT), integrase (IN) and protease (PR), proteins or cell-based assays have been employed to validate the use of these plants with occasional indication of the selectivity index (SI) or therapeutic index (TI), with only one study, that progressed to in vivo testing. The compounds identified from plants from southern Africa is similar to compounds identified from other regions of the world, and the compounds have been divided into three groups namely (1) flavonoids and flavonoid glycosides, (2) terpenoids and terpenoid glycosides and (3) phenolic acids and their conjugated forms. CONCLUSIONS: An investigation of the plants from southern Africa with ethnobotanical use for the treatment of HIV, management of HIV or HIV-related symptoms, therefore provide a very good analysis of the major assays employed and the anti-viral compounds and compound groups identified. The similarity in identified anti-viral compounds worldwide should support the progression from in vitro studies to in vivo testing in development of affordable and effective anti-HIV agents for countries with high infection and mortality rates due to HIV/AIDS.

'These people who dig roots in the forests cannot treat HIV': Women and men in Durban, South Africa, reflect on traditional medicine and antiretroviral drugs.

Relatively few empirical investigations of the intersection of HIV biomedical and traditional medicine have been undertaken. As part of preliminary work for a longitudinal study investigating health-seeking behaviours among newly diagnosed individuals living with HIV, we conducted semi-structured interviews with 24 urban South Africans presenting for HIV testing or newly enrolled in HIV care; here we explored participants' views on African traditional medicine (TM) and biomedical HIV treatment. Notions of acceptance/non-acceptance were more nuanced than dichotomous, with participants expressing views ranging from favourable to reproachful, often referring to stories they had heard from others rather than drawing from personal experience. Respect for antiretrovirals and biomedicine was evident, but indigenous beliefs, particularly about the role of ancestors in healing, were common. Many endorsed the use of herbal remedies, which often were not considered TM. Given people's diverse health-seeking practices, biomedical providers need to recognise the cultural importance of traditional health practices and routinely initiate respectful discussion of TM use with patients.

Sun Exposure, Sun-Related Symptoms, and Sun Protection Practices in an African Informal Traditional Medicines Market.

Informal workers in African market trade have little formal protection against sun exposure. We aimed to examine sun exposure, sun-related symptoms, and sun protection practices in an informal occupational setting. Trained fieldworkers asked 236 workers in the Warwick Junction market about their workplace, skin and eye sensitivity and skin colour, symptoms faced at work during the summer due to heat, and preventive measures. Data were analyzed using univariate logistic regression to assess the effect of gender and the risk of experiencing symptoms to sun exposure in relation to pre-existing diseases and perception of sun exposure as a hazard. Of the 236 participants, 234 were Black African and 141 (59.7%) were female. Portable shade was the most commonly used form of sun protection (69.9%). Glare from the sun (59.7%) and excessive sweating (57.6%) were commonly reported sun-related health symptoms. The use of protective clothing was more prevalent among those who perceived sun exposure as a hazard (p = 0.003). In an informal occupational setting, sun exposure was high. Protective clothing and portable shade to eliminate heat and bright light were self-implemented. Action by local authorities to protect informal workers should consider sun exposure to support workers in their efforts to cope in hot weather.

Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing.

Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor) temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2-4 °C on average. Apparent temperature (AT) incorporating relative humidity readings made in the clinics showed 'realfeel' temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of 'stuffiness' and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat-health impact warning categories of 'caution' and 'extreme caution'.

The generational effect on age disparate partnerships and the risk for human immunodeficiency virus and sexually transmitted infections acquisition.

In South Africa, a large proportion of young women are in age disparate relationships, which is believed to be a risk factor for human immunodeficiency virus (HIV). The aim of this study was to determine the generational effect of age disparity on HIV and sexually transmitted infection (STI) incidence. Socio-demographic and behavioural data were collected from women, aged 16 and older, who were followed for up to 24 months. Women who reported having a steady sexual partner older than themselves were categorised into: (1) non-age disparate partnerships (age difference between partners was 0-4 years); (2) intra-generational age disparate partnerships (5-9 year age gap between sexual partners); and (3) inter-generational age disparate partnerships (age gap of 10 years or more between sexual partners). Of the 1355 women included in the analysis, 759, 429 and 167 were in non-age disparate, intra-generational age disparate and inter-generational age disparate partnerships, respectively. Strong predictors of inter-generational age disparate partnerships include age, marital status and concurrency of sexual partners. No significant relationship between age disparity and risk of HIV acquisition was found. The highest crude STI incidence was observed among those in intra-generational age disparate relationships followed by those in non-age disparate relationships (31.86 [26.41-38.44] and 25.60 [21.92-29.91] per 100 person-years, respectively). Reduction of multiple partnerships remains key to HIV prevention; however, in light of partner concurrency being more prevalent than individual concurrency partnerships, female-initiated HIV prevention options remain critical.

Effects of Cd and Al stress on secondary metabolites, antioxidant and antibacterial activity of Hypoxis hemerocallidea Fisch. & C.A. Mey.

This study investigated the effects of cadmium (Cd) and aluminium (Al) on the accumulation of phenolics, flavonoids and the bioactive compound hypoxoside in Hypoxis hemerocallidea. In addition, antioxidant scavenging and antibacterial activity were assessed to evaluate if Cd and Al stress affect the accumulation of bioactive compounds in H. hemerocallidea. In vitro grown plantlets of H. hemerocallidea were acclimatized for seven months in a greenhouse. Thereafter plants were exposed to various concentrations of Cd and Al both singularly and in combination in the form of Cd(NO3)2 (2, 5, 10 mg Cd/L); Al3(NO3)3 (500, 1000, 1500 mg Al/L) and combinations of Cd and Al (Cd 2:Al 500, Cd 5:Al 1000 and Cd 10:Al 1500 mg/L) for a further six weeks. The highest amounts of Cd and Al translocated to the shoot were 34 and 1608 mg/L respectively. Phytochemical screening showed significantly high amounts of total phenolics and flavonoids at the moderate Cd treatment (5 mg/L) compared to the controls. Exposure to Cd and Al significantly decreased the accumulation of hypoxoside. There was a significant increase in diphenylpicrylhydrazyl (DPPH) antioxidant scavenging activity in most of the metal-treated plants compared to the positive control ascorbic acid. Extracts from Cd 2 mg/L treatment exhibited moderate antibacterial activity against Staphylococcus aureus compared to the control. The results of the present study revealed that cultivating H. hemerocallidea on metal contaminated soils affects the accumulation of the bioactive compound, hypoxoside.

Cichorium intybus: Traditional Uses, Phytochemistry, Pharmacology, and Toxicology.

The genus Cichorium (Asteraceae) is made up of six species with major geographical presence in Europe and Asia. Cichorium intybus, commonly known as chicory, is well known as a coffee substitute but is also widely used medicinally to treat various ailments ranging from wounds to diabetes. Although this plant has a rich history of use in folklore, many of its constituents have not been explored for their pharmacological potential. Toxicological data on C. intybus is currently limited. This review focuses on the economic and culturally important medicinal uses of C. intybus. Traditional uses, scientific validation, and phytochemical composition are discussed in detail.