Screening for adulticidal activity against Anopheles arabiensis in ten plants used as mosquito repellent in South Africa.

BACKGROUND: Due to the development of resistance to synthetic insecticides, adverse effects to human health, non-target organisms and the environment, there is an urgent need to develop new insecticides, which are effective, safe, biodegrable and target-specific. This study was undertaken to evaluate the adulticidal activity of 10 plants used traditionally as mosquito repellents in South Africa. METHODS: The dried plant materials were extracted with dichloromethane (DCM) and ethanol (EtOH). The extracts were evaluated for adulticidal activity against Anopheles arabiensis mosquitoes, a potent malaria vector in South Africa. Adult mortality was observed after 24 hours of exposure. RESULTS: All the extracts showed adulticidal activity. The highest activity was observed in both DCM and EtOH extracts of Aloe ferox leaves with 98 and 86% mosquito mortality, respectively. The DCM extract of A. ferox leaves was then subjected to a dose-dependent bioassay to determine the EC50 value. The extract exhibited an EC50 value of 4.92 mg/ml. CONCLUSION: The results of the present study showed that the DCM extract of A. ferox leaves may have the potential to be used as an insecticide against An. arabiensis. Further studies to isolate and identify active compounds are in progress.

A Systematic Review of Factors That Influence Parents' Views and Practices around Routine Childhood Vaccination in Africa: A Qualitative Evidence Synthesis.

A Cochrane review which explored the factors that influence caregivers' views and practices around routine childhood vaccines worldwide was conducted by Cooper and colleagues. After sampling 154 studies that met their inclusion criteria, the authors included 27 studies in their synthesis, of which 6 were from Africa. The aim of the current review was to synthesise all 27 studies conducted in Africa. We wanted to determine if the inclusion of additional African studies will change any of the themes, concepts or theory generated in the Cochrane review. Our review found that parents' views and practices regarding childhood vaccination in Africa were influenced by various factors, which we categorised into five themes, namely, ideas and practices surrounding health and illness (Theme 1); social communities and networks (Theme 2); political events, relations, and processes (Theme 3); lack of information or knowledge (Theme 4); and access-supply-demand interactions (Theme 5). All of the themes identified in our review were also identified in the Cochrane review except for one theme, which was lack of information or knowledge. This finding will help to promote vaccine acceptance and uptake in Africa by developing and implementing interventions tailored to address lack of knowledge and information around vaccines.

The use of artificial intelligence for delivery of essential health services across WHO regions: a scoping review.

Background: Artificial intelligence (AI) is a broad outlet of computer science aimed at constructing machines capable of simulating and performing tasks usually done by human beings. The aim of this scoping review is to map existing evidence on the use of AI in the delivery of medical care. Methods: We searched PubMed and Scopus in March 2022, screened identified records for eligibility, assessed full texts of potentially eligible publications, and extracted data from included studies in duplicate, resolving differences through discussion, arbitration, and consensus. We then conducted a narrative synthesis of extracted data. Results: Several AI methods have been used to detect, diagnose, classify, manage, treat, and monitor the prognosis of various health issues. These AI models have been used in various health conditions, including communicable diseases, non-communicable diseases, and mental health. Conclusions: Presently available evidence shows that AI models, predominantly deep learning, and machine learning, can significantly advance medical care delivery regarding the detection, diagnosis, management, and monitoring the prognosis of different illnesses.

COVID-19 vaccine demand protest might have increased vaccine acceptance and uptake in South Africa.

Safe and efficacious COVID-19 vaccines exist, but their success against the disease depends on public willingness to receive them. Vaccine hesitancy is one major obstacle to the achievement of herd immunity. On 25 June 2021, about 2000 supporters of the Economic Freedom Fighters (EFF) (the third biggest political party in South Africa) marched to the offices of the national regulatory authority (NRA) supporting COVID-19 vaccination and demanding approval of two additional vaccines (Sputnik V and Sinovac) in South Africa. The march was led by EFF leader, Julius Malema. By then, only three COVID-19 vaccines had received emergency use authorization in the country-the Janssen, AstraZeneca and Pfizer-BioNtech vaccines. It is worth noting that NRAs should only approve a vaccine if they are satisfied that its benefits outweigh any potential risks and not through political pressure. Nevertheless, we believe that this march might have increased COVID-19 vaccine acceptance and uptake among EFF supporters. The endorsement of COVID-19 vaccines by Malema, an influential political figure in South Africa, probably convinced some vaccine hesitant South Africans that COVID-19 vaccination is important. Therefore, we suggest vaccine endorsement by influential individuals in South Africa as one of the strategies to increase COVID-19 vaccine uptake.

Predictors of COVID-19 Vaccine Hesitancy in South African Local Communities: The VaxScenes Study.

South Africa launched a mass COVID-19 vaccination campaign in May 2021, targeting 40 million adults. Understanding predictors of COVID-19 vaccine intentions was required to achieve this goal. We conducted a population-based survey in June-July 2021 using the WHO Behavioral and Social Drivers (BeSD) of COVID-19 Vaccination tool to determine predictors of vaccine hesitancy, defined as intention to refuse or uncertainty whether to accept COVID-19 vaccination. There were 1193 participants, mean age 39 (standard deviation 15) years, and 53% women, of whom 58% trusted information provided by healthcare workers and 32% were vaccine hesitant. Independent predictors of vaccine hesitancy included concerns about side effects (odds ratio (OR) 11.41; 95% confidence interval (CI) 3.5-50.80), lack of access to the online vaccine registration platform (OR 4.75; CI 2.15-10.37), distrust of government (OR 3.0; CI 1.33-6.77), belief in conspiracy theories (OR 3.01; CI 1.32-6.77), having no monthly income (OR 1.84; CI 1.12-3.07), and depending on someone else to make vaccination decision (OR 2.47; CI 1.06-5.77). We identified modifiable predictors of vaccine hesitancy at the start of South Africa's COVID-19 vaccination rollout. These factors should be addressed by different stakeholders involved in the national immunization program through tailored communication and other effective strategies that increase vaccine literacy, reach low-income households, and engender confidence in government.

Reflection: burden of cervical cancer in Sub-Saharan Africa and progress with HPV vaccination.

In Sub-Saharan (SSA) cervical cancer is the leading cause of cancer deaths amongst women. The region carries the greatest burden, with 24.55% of the global mortality from cervical cancer. Reports indicate an increasing challenge of cervical cancer in SSA. HPV vaccination with its well-established effectiveness provides hope for cancer control in SSA. Following an initial delay in HPV vaccine uptake in SSA, 18 countries mostly in Eastern and Southern Africa, had a national programme by 2020. Vaccination coverage data show that high populated countries have lower coverage figures. Furthermore, high coverage of demonstration projects may not be achieved in the national rollout. In conclusion, whilst there is significant progress with the rollout of HPV vaccination programme in SSA, some countries in West Africa should be prioritised. Experiences of early adopters should be reviewed to guide other countries to achieve and sustain high coverage.

A Systematic Review of Interventions to Improve HPV Vaccination Coverage.

Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. Although most HPV infections are transient and asymptomatic, persistent infection with high-risk HPV types may results in diseases. Although there are currently three effective and safe prophylactic HPV vaccines that are used across the world, HPV vaccination coverage remains low. This review evaluates the effects of the interventions to improve HPV vaccination coverage. We searched the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Scopus, and the World Health Organization International Clinical Trials Registry Platform and checked the reference lists of relevant articles for eligible studies. Thirty-five studies met inclusion criteria. Our review found that various evaluated interventions have improved HPV vaccination coverage, including narrative education, outreach plus reminders, reminders, financial incentives plus reminders, brief motivational behavioral interventions, provider prompts, training, training plus assessment and feedback, consultation, funding, and multicomponent interventions. However, the evaluation of these intervention was conducted in high-income countries, mainly the United States of America. There is, therefore, a need for studies to evaluate the effect of these interventions in low-and middle-income countries, where there is a high burden of HPV and limited HPV vaccination programs.

A systematic review of immunogenicity, clinical efficacy and safety of human papillomavirus vaccines in people living with the human immunodeficiency virus.

The human papillomavirus (HPV) is the most prevalent sexually transmitted infection worldwide. People living with the human immunodeficiency virus (HIV) are at high risk of HPV infection. This systematic review evaluates the immunogenicity, clinical efficacy, and safety of prophylactic HPV vaccines in people living with HIV. We registered the protocol for this review in the International Prospective Register of Systematic Reviews (CRD42018109898) and prepared the review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Five randomized trials with 1042 participants are included in this review. One trial with 120 participants compared the bivalent HPV vaccine to placebo, three trials with 830 participants compared the quadrivalent vaccine to placebo, and another trial with 92 participants compared the quadrivalent to the bivalent vaccine. There was low to moderate certainty evidence suggesting that seroconversion was higher among participants in the vaccine arms compared to the placebo arms for both vaccines. In one study with very low certainty evidence, participants who received the bivalent vaccine had higher anti-HPV-18 geometric mean titers (GMTs) compared to those who received the quadrivalent vaccine, despite little difference in anti-HPV-16 GMTs between the two vaccines. There were no differences in the incident and persistent HPV infections in both groups. None of the studies reported data on the incidence of precancerous lesions, or cancer. There were no reports of serious adverse events following vaccination in any of the trials. None of the included studies assessed the effects of HPV vaccines in adolescents living with HIV. Very limited evidence suggests lower immunogenicity of HPV vaccines in HIV positive compared to HIV-negative people. Finally, the long-term effect of the HPV vaccine in the incidence of cervical precancerous lesions and cervical cancer needs to be monitored. There is an urgent need for more high-quality randomized controlled trials that can address these gaps.

Systematic review protocol on Bacillus Calmette-Guerin (BCG) revaccination and protection against tuberculosis.

INTRODUCTION: Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis (M.TB) and other species of the Mycobacterium tuberculosis complex. Globally, TB is ranked as the ninth leading cause of death and the leading cause of death from a single infectious agent. The bacille Calmette-Guerin (BCG) vaccine has been used globally since 1921 for the prevention of TB in humans, and was derived from an attenuated strain of Mycobacterium bovis. Evidence from previous randomised trials show that the efficacy of primary BCG vaccination against pulmonary TB ranged from no protection to very high protection. In addition, some studies suggest a benefit of BCG revaccination. For example, a recent trial conducted in South Africa showed that BCG revaccination of adolescents could reduce the risk of TB infection by half. However, we are not aware of any recent systematic reviews of the effects of BCG revaccination. Thus, the need for this systematic review of the effects of BCG revaccination on protection against TB infection and disease. METHOD AND ANALYSIS: We will search PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, WHO International Clinical Trials Registry Platform and reference lists of relevant publications for potentially eligible studies. We will screen search outputs, select eligible studies, extract data and assess risk of bias in duplicate. Discrepancies will be resolved by discussion and consensus or arbitration. We will use the Grading of Recommendations Assessment, Development and Evaluation method to assess the certainty of the evidence. The planned systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in August 2018. ETHICS AND DISSEMINATION: Publicly available data will be used, hence no formal ethical approval will be required for this review. The findings of the review will be disseminated through conference presentations and publication in an open-access peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018105916.

Social media and HPV vaccination: Unsolicited public comments on a Facebook post by the Western Cape Department of Health provide insights into determinants of vaccine hesitancy in South Africa.

On the 4 February 2019, the Western Cape Department of Health's Facebook page announced the implementation of a school-based vaccination campaign aimed to administer the first doses of human papillomavirus (HPV) vaccine in public schools to Grade 4 girls who are nine years old. This announcement was met with a flurry of social media responses posted on the campaign's Facebook page. This study identifies determinants of vaccine hesitancy amongst responses provided by social media users to this post. On 8 March 2019, we conducted a qualitative study including all 157 comments to the Facebook post. The post had 659 'emotion' reactions: 574 "likes", 62 "loves", 21 "angry faces", 2 "laughs", 2 "wows" and 1 "sad face". An overwhelming majority (636/659 i.e. 97%) of reactions were favourable to the HPV vaccination campaign. Out of the 157 comments, we judged 52 (33%) of them to be 'hesitant', suggesting that people with negative reactions though few in number, were more likely to be vocal deniers. Concern around the safety of HPV vaccines including effects on reproductive health was the most common theme identified. Other emerging themes included: risk of cervical cancer perceived as being low, issues around consent, concerns that girls are being used for research, questionable vaccine effectiveness, use of the school-based strategy for the campaign, risk-benefits calculations of HPV vaccination and constraints such as stock-outs. Knowing someone who had been affected or being at risk of cervical cancer, having knowledge about the causes of cervical cancer, confidence in the effectiveness and safety of the vaccine, knowing the vaccine was being used in high income settings, and having strong recommendations from the World Health Organisation and key actors seemed to increase the willingness to accept the vaccine. The magnitude and causes of HPV vaccine hesitancy need to be investigated to ensure the success of this programme.

Vector-control personnel's knowledge, perceptions and practices towards insecticides used for indoor residual spraying in Limpopo Province, South Africa.

BACKGROUND: Contradictory arguments regarding the benefits and harm of insecticides, especially DDT, have caused concerns in different societal circles, threatening to undermine the achievements of the indoor residual spraying (IRS) programme in South Africa. These concerns were exacerbated by the screening of a documentary on South African Broadcasting Corporation (SABC) Television with anti-DDT sentiments. Consequently, Limpopo Malaria Control Programme (LMCP) Management advocated for an investigation to determine the potential effect of such campaigns on vector-control personnel's knowledge and perceived effects of insecticides on human health, with a view to improving the educational materials designed for use in training vector-control personnel. METHODS: The study was a cross-sectional descriptive survey using a structured field-piloted questionnaire, administered to 233 randomly selected vector-control personnel. Ethical clearance was granted by the University of KwaZulu-Natal. Approval for the study was granted by the Department of Health, Limpopo. Participation in the study was voluntary and all respondents signed informed consent. Descriptive statistics were used to analyse the collected data. RESULTS: Most respondents (96.6%) had a positive perception of IRS as a method to control malaria. Despite their positive perception, 93.6% viewed IRS insecticides to be potentially harmful to the users. DDT was perceived to cause long-term reproductive and respiratory effects, whereas alpha-cypermethrin and deltamethrin were largely associated with skin irritation/itchiness and skin burn. Study participants were more worried about DDT's potential effects on their reproductive system, including poor sexual performance, decline in libido, miscarriage and bearing children with genetic defects. However, none reported personal experience of bearing a child with genetic defects or miscarriage.Most anti-insecticide messages, especially relating to DDT, emanated from sources external to the LMCP, mainly through radio (62%) and television (33.9%) and about 70% believed such messages. While most respondents preferred to work with a moderately itchy deltamethrin, DDT was admittedly the most effective insecticide. CONCLUSION: Vector-control personnel faced health and ethical dilemmas, in that, while they perceived insecticides used for IRS in Limpopo to be potentially harmful to the health of users, as purported through media, they also viewed IRS using insecticides to be effective in controlling malaria.