Association between experienced stigma, anxiety, depression and loneliness among people with drug-resistant tuberculosis in Lagos Nigeria: The moderating role of social support.

BACKGROUND: This study assessed the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness among people with drug-resistant tuberculosis. METHODS: A descriptive cross-sectional study was conducted among 203 adults on treatment for drug-resistant tuberculosis for at least 8 weeks. Validated scales were used to assess experienced stigma, anxiety, depression, loneliness and social support. Partial correlations and hierarchical multiple regression were used to determine the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness. The interaction was visualised using slope analysis. RESULTS: Anxiety, loneliness and depression were reported by 148 (72.9%), 114 (56.2%) and 128 (63.1%) of the 203 participants, respectively. Experienced stigma was positively associated with depression (B = 0.428, p < 0.001), anxiety (B = 0.374, p < 0.001) and loneliness (B = 0.285, p = 0.001). Social support was negatively associated with depression (B = -0.255, p < 0.001), anxiety (B = -0.406, p < 0.001) and loneliness (B = -0.270, p = 0.001). The impact of experienced stigma on depression was different at low (B = 0.567, SE = 0.115, p < 0.001) and high (B = 0.275, SE = 0.253, p = 0.024) groups of social support. Similarly, at low social support, the effect of experienced stigma on loneliness (B = 0.491, SE = 0.250, p < 0.001) and anxiety (B = 0.254, SE = 0.060, p = 0.044) was different compared to the effect of experienced stigma on loneliness (B = 0.275, SE = 0.253, p = 0.024) and anxiety (B = 0.127, SE = 0.094, p = 0.307) at high group of social support. CONCLUSION: In this study, social support reduced the effects of experienced stigma on anxiety, depression and loneliness suggesting that improving social support among people with drug-resistant tuberculosis is crucial in reducing the negative effects of stigma on anxiety, depression and loneliness.

Motivators for oral PrEP uptake and adherence in the eThekwini municipality, KwaZulu-Natal.

Pre-exposure prophylaxis (PrEP) is a single daily pill that prevents a seropositive HIV status. Since 2016, South Africa has staggered PrEP roll-out, with uptake levels not reaching optimal goals. The aim of this study was to determine motivation behind PrEP initiation and adherence among South African users. A phenomenological qualitative study (n = 15) was used. Participants were purposively recruited from two primary healthcare clinics in eThekwini, KwaZulu-Natal. Thematic analysis was used to analyse the data. Three themes were identified: motivation for PrEP uptake, PrEP adherence and PrEP awareness. Initiation was influenced by healthcare professionals. Responsibility for one's well-being, serodiscordant relationships and sexual partner's behavioural patterns contributed toward initiation. Most were fully compliant, using reminders to negate medication forgetfulness. The internet and healthcare professionals served as information sources, however, few were aware of PrEP prior to this. Innovative ways are required to increase awareness levels and increase uptake.

Four years later: Do South Africans know what pre-exposure prophylaxis for HIV is?

HIV incidence remains high among South Africans, with low uptake of preventative measures such as condom use. Pre-exposure prophylaxis (PrEP), which protects HIV-negative individuals from infection, was first introduced in SA in 2016. This study determined the knowledge of PrEP among university students (n = 282) and primary health care clinic users (n = 358) in KwaZulu-Natal, South Africa. Data were collected using a cross-sectional survey. The study population was at high-risk of HIV infection, with early age of sexual debut, multiple concurrent sexual partners and inconsistent condom usage. Only 12.3% (n = 79) stated that they had a full understanding of PrEP, which was higher among university students (9.8%; n = 63) than clinic users (2.5%; n = 16; p < 0.001). Specific PrEP knowledge was, however, low. Health Science students did not have a better knowledge than students from other faculties. Neither did users of clinics offering PrEP have a better knowledge than users of clinics not offering PrEP. Moreover, few participants (15%; n = 96) were aware of the availability of PrEP at their local clinic. Interventions to address the low level of PrEP knowledge within the population are required, to reduce the high HIV incidence.

The use of photovoice to transform health science students into critical thinkers.

BACKGROUND: Students are often inadequately prepared for higher education, particularly concerning independent learning and critical thinking. These attributes are essential, especially in health science students as health care needs are complex. Innovative methods of teaching that promote these attributes are thus required. One such method, which has been included previously in other disciplines is photovoice, a participatory method, in which students become co-creators of knowledge. The aim of the study was to determine whether photovoice would promote critical thinking in students enrolled for a module in Public Health. The study also aimed to analyze the experiences of students using this methodology, as part of their learning. METHODS: Photovoice was introduced to a class of 56 chiropractic and homeopathy students registered for a module on Epidemiology: Public Health in 2019. Students working in self-selected groups were required to take photographs of environmental factors, involved in causing disease. After engaging in a group dialogue, one photograph was selected for presentation in class, with a discussion of how environmental factors visible in the photograph affect the health of individuals. Presentations were assessed based on the picture, presentation quality and ability to answer questions. Focus group discussions were subsequently held to understand the experience of students with this new teaching method. Data was analyzed using thematic analysis. RESULTS: Students established that it was a positive experience. They recognized the lived realities, within the community, that cause disease. The assignment demonstrated how learning can occur beyond the lecture room and extend into communities. Students offered realistic solutions to health problems that were confronted by communities. In addition, students participated in unintended community engagement. CONCLUSIONS: The incorporation of photovoice into undergraduate teaching in the health science module promoted higher order learning such as problem solving and critical-thinking. Students transformed from rote learners to critical thinkers who reflected upon what they were taught and how this related to the lived realities of the community. Student communication improved as they disseminated knowledge to others. Teaching using this alternative pedagogy has the potential to produce graduates who are responsive to the local needs of the community.

Exploring male condom use among women in South Africa: a review of the literature.

The male condom is the most cost-effective method for prevention of HIV and other sexually transmitted infections (STIs), yet in high-burden countries, promotion of its use remains difficult to achieve, especially among high-risk individuals. This review reports on women's perspectives of male condom use and identifies outcome measures that will assist in understanding barriers to male condom use in a South African setting. The Boolean search method was used to retrieve literature, from which 18 studies met the inclusion criteria. The use of the male condom was generally low and inconsistent. Use was higher among women who engaged in transactional sex. Most women had difficulty in negotiating condom use with their partners, particularly if they were in male-dominated relationships or were financially dependent on their partner. Women with higher education levels were able to negotiate use more easily. Interventions for assertive negotiation skills were useful. However, the stigma of infidelity and HIV infection are barriers to condom use. Incorrect use further reduces protection. This review emphasises that women are a vulnerable group who are not always able to control their own protection. Further implementation of the health policies promoting interventions for condom use are required to assist women in taking control of their own protection. Intervention measures should be adapted to include the male population so that they understand and accept condom use. Education to address unequal gender dynamics within relationships is also essential. Much work is required to make women feel less vulnerable in their relationships.

Understanding the risk factors for HIV acquisition among refugee women in South Africa.

The prevalence of HIV in South Africa is among the highest in the world. This study provides an in-depth understanding of the risks for HIV transmission among refugee women residing in Durban, KwaZulu-Natal, South Africa. Qualitative interviews were conducted among refugee women originally from Sub-Saharan African countries. They reported sexual abuse by their intimate partners who were also having extramarital affairs with the local women. Condom use was low, with the women unable to negotiate use, due to fear of violence and religious beliefs, making them vulnerable to contracting HIV. Women were unable to leave their relationship due to financial constraints and dependence on their spouses. These dire circumstances also led to transactional sex. Uptake of HIV testing was high among the women. They were, however, uncertain of their partners' HIV status. We conclude that the higher risk for HIV transmission among refugee women is associated with increased engagement in sexual risk behavior. Behavioral change is required within this population and we recommend counselling in line with the religious and cultural beliefs of the population. The acceptability of condom use requires promotion. Increasing employment opportunities will empower women and decrease the social and structural determinants of sexual risk behavior.

The Relationship Between Body Image Perceptions and Condom Use Outcomes in a Sample of South African Emerging Adults.

HIV continues to be a health priority in South Africa. Consistent condom use helps prevent HIV, yet less than half of South African emerging adults use condoms consistently. Cultural beliefs about illnesses (e.g., being thin is perceived to be a sign of HIV infection) suggest that body image perceptions may play a role in emerging adults' condom use outcomes. We explored the relationships between body image perceptions (i.e., body dissatisfaction, body consciousness) and condom use outcomes (e.g., attitudes, negotiation efficacy, past use) in a sample of South African emerging adults. Participants (n = 379) recruited from university residences completed an anonymous survey. Participants' mean age was 21.79 years, 54.6% were female, 96.1% identified as Black African, and 73.5% reported primarily speaking IsiZulu. For women, the relationship between body dissatisfaction and condom negotiation efficacy was mediated by body consciousness and condom use attitudes after controlling for BMI, relationship status, and mental health symptoms. Further, the relationship between body dissatisfaction and past condom use was mediated by body consciousness. These results were not significant for men. Findings from this study suggest that integrating messages about body image perceptions into HIV prevention efforts targeting South African emerging adult women may be warranted.

Male circumcision for HIV prevention: female risk compensatory behaviour in South Africa.

South Africa promotes male circumcision (MC) as an HIV prevention method and implemented a national plan to scale-up MC in the country from 2012 to 2016. Literature has suggested that female risk compensatory behaviours (RCBs) are occurring in countries where these programmes have been implemented. Behaviours such as decreased condom use, concurrent sexual partners and sexual activity during the circumcision wound-healing period have the potential to jeopardise the campaigns' objectives. Literature has shown that directly providing women with MC information results in correct knowledge however, previous studies have not directly sought women's views and ideas on engagement with the information. This study aims to identify and explore female RCBs in relation to MC campaigns in South Africa, and to identify interventions that would result in greater female involvement in the campaigns. Snowball sampling was used to conduct twelve qualitative vignette-facilitated semi-structured interviews with women residing in a municipal housing estate in Durban, Kwa-Zulu Natal, South Africa. Interviews were audio-recorded, verbatim transcribed and analysed using framework analysis. MC knowledge and understanding varied, with some participants mistaking MC as direct HIV protection for females. Despite a lack in knowledge, the majority of women did not report signs of RCBs. Even with a lack of evidence of RCBs, misinterpretation of the MC protective effect has the potential to lead to RCBs; a concept acknowledged in the literature. Several women expressed that MC campaigns are directed to males only and expressed a keenness to be more involved. Suggested interventions include couple counselling and female information sessions in community clinics. Exploring women's attitude towards involvement in MC campaigns fills in a research knowledge gap that is important to international health, as women have a vital role to play in reducing the transmission of HIV.

Is the HIV epidemic changing views on marriage aspirations? Perspectives of university students in Durban, South Africa.

Marriage rates in South Africa have dropped to approximately 37% in recent years. This is particularly marked in the Black African population compared to other race groups. In tandem, the prevalence of HIV in this country has risen to 12.7%, with the highest prevalence among Black Africans. However, no data associates marriage decline with high HIV prevalence. We bridge this gap in knowledge by investigating young students' aspirations to marry in the context of high national HIV rates. A cross-sectional study was conducted among university students (n = 384) in KwaZulu-Natal, South Africa, between October and November 2014. Quantitative data were collected through self-administered questionnaires. Data was analysed by Likert scale analysis, Chi square test, Fisher's exact test, multivariate regression modelling and calculation of odds ratios. Majority of respondents (85.8%, n = 331) indicated that they wished to get married but more than half (53%, n = 205, p < 0.001) indicated that the high prevalence of HIV has had a negative impact on their marriage aspirations. Students indicated that considering a partner's HIV status prior to marriage was important (p < 0.001), marriage did not offer protection from HIV (p < 0.001), and testing for HIV prior to marriage was imperative (p < 0.001). Considering a partner's HIV status before marriage is important and associated with increased odds (OR = 5.62, 95%CI: 1.57-20.05) of wanting to get married. There was a significant relationship between respondents wanting to get married and the future marriage partner being HIV negative (p = 0.003). Furthermore, the HIV epidemic has decreased the odds of wanting to get married (OR = 0.21; 95%CI: 0.08-0.58). We conclude that while the majority of young students have marriage aspirations, the high prevalence of HIV has resulted in a negative perception of marriage. Although HIV testing prior to marriage is considered important, students recognize that they may not be protected from infection during marriage.

Perceived HIV-related stigma among university students in South Africa: implications for HIV testing.

HIV-related stigma, and particularly perceived stigma, has a negative impact across the HIV care continuum. This study adds to our understanding of stigma by assessing how perceived stigma varies from one context to another and how such differences are associated with the location where individuals would prefer an HIV test. We used self-administered questionnaire data (n = 378) obtained from a convenience sample of students (18 years and older) attending a tertiary education institution in Durban, South Africa. Perceived stigma in the university environment was compared to perceived stigma in the home community environment. Multiple logistic regression analysis tested whether a higher level of perceived stigma in one setting was associated with a preference for HIV testing in the other setting. While levels of symbolic stigma and discrimination were low, a large proportion of the sample perceived that people living with HIV experience some form of stigmatisation in the home community and university environments (47% vs 41%, p = 0.09). A total of 31% reported less perceived stigma in the university environment. Students who perceived less stigma in the university environment were significantly more likely to report a preference for HIV testing at the university clinic rather than at a clinic in their community (aOR: 2.03; p < 0.01). Perceptions common across settings that people living with HIV experience stigmatisation are of great concern, especially for efforts to increase demand for HIV testing among young people. Results suggest that HIV-testing services in environments perceived to be less stigmatising than home communities could provide preferred alternatives for HIV testing.

Placental leptin mRNA expression and serum leptin levels in pre-eclampsia associated with HIV infection.

Leptin, primarily produced by adipocytes, is implicated in the development of pre-eclampsia. This study examines placental leptin production and serum leptin levels in HIV infected and uninfected normotensive and pre-eclamptic pregnancies. Placental leptin production was analysed by RT-PCR and serum leptin levels by ELISA in normotensive (n = 90) and pre-eclamptic (n = 90) pregnancies which were further stratified by HIV status. Placental leptin production was higher in pre-eclampsia compared to normotensive pregnancies irrespective of HIV status (p = .04). Serum leptin was non-significantly raised in HIV uninfected (p = .42) but lower in HIV-infected (p = .03) pre-eclampsia. The latter had lower BMI (p = .007) and triceps skin-fold thickness (p < .001) than the HIV uninfected groups with a significant correlation between serum leptin and triceps skin-fold thickness (p < .001), indicative of less adipose tissue in HIV-infected women with consequently lower serum leptin. Thus, serum leptin levels are not indicative of increased placental production when pre-eclampsia is associated with HIV infection.

Experiences of schizophrenia patients with treatment buddy support during the COVID-19 pandemic.

Background: Schizophrenia is a major psychiatric disorder affecting physical, psychosocial, and cognitive functioning. Treatment includes pharmacological and psychotherapeutic interventions. Adherence to prescribed medication is critical but reportedly low, because of side effects, failure to understand instructions, a lack of insight about the condition, cognitive deficits, and financial difficulties. Interventions to promote adherence to medication are required. This study introduced a treatment buddy to provide the patient with virtual support in adherence to medication. Aim: The aim of this study was to explore the participants' lived experiences of a treatment buddy support. Setting: A specialised psychiatric clinic in a resource-constrained district of KwaZulu-Natal, South Africa. Methods: A qualitative study design, using semi-structured one-on-one interviews, was used to collect in-depth data from 24 participants, suffering from schizophrenia and who had been offered virtual treatment buddy support for 6 months. Data were analysed using thematic analysis. Results: The intervention improved adherence to medication. Participants indicated that the text messages served as reminders to take their medication daily. An alleviation of associated problems such as sleeping difficulties was observed. Participants were willing to encourage other patients suffering from schizophrenia to join 'treatment buddy services'. Conclusion: The virtual treatment buddy support increased awareness of the importance to adhere to antipsychotic medications among patients suffering from schizophrenia and helped to resolve other schizophrenia-related problems experienced by the participants. Contribution: The study has provided a supportive intervention that can be utilised by mental health institutions to address poor adherence to medication by patients suffering from schizophrenia.

Provision of HIV testing services and its impact on the HIV positivity rate in the public health sector in KwaZulu-Natal: a ten-year review.

South Africa has been rated as having the most severe HIV epidemic in the world since it has one of the largest populations of people living with HIV (PLHIV). KwaZulu-Natal (KZN) is the epicentre of the HIV epidemic. The HIV test and treat services in the public health sector are critical to managing the epidemic and responding to the increase in HIV infections. The KwaZulu-Natal Department of Health (DOH) commissioned a review of the provision of HIV testing services in the province and aimed to investigate its impact on the HIV positivity rate over a ten-year period. The study was an ecological study design using data extracted from the Department's District Health Information System (DHIS). Descriptive analysis was conducted in addition to ANOVA and multiple regression analysis. The results of this study have shown that the total number of HIV tests conducted over the ten-year period in the province has increased with the highest number of HIV tests being conducted in the 2018/2019 MTEF year. ANOVA analysis indicates that there was a statistically significant difference in the total number of HIV tests conducted and the number of HIV tests per 100 000 population across the province's 11 districts (p < 0.001). Statistically significant differences were observed in the HIV testing rate and in the HIV positivity rate over the period (p < 0.001). Results from multiple regression analysis showed that the HIV testing rate per 100 000 population was the strongest predictor of the HIV positivity rate. HIV positivity among clients correlated negatively with the number of HIV tests conducted per 100 000 population (r = -0.823; p < 0.001) and the HIV testing rate (r = -0.324; p < 0.01). This study has found that HIV testing could have an impact on reducing the positivity rate of HIV in the province and is therefore an effective strategy in curbing the HIV epidemic. The KwaZulu-Natal Department of Health should ensure that strategies for implementing and maintaining HIV testing and treating services should continue at an accelerated rate in order to achieve the first 95 of the UNAIDS 2025 SDG target.

Factors Associated With Compliance With Self-Management Home Therapies for Spine Pain: A Survey of Participants Attending a Chiropractic Teaching Clinic in South Africa.

Objective: The purpose of this study was to determine factors that affect compliance with various prescribed home therapies based on reported feedback from participants with spine pain. Methods: This was a descriptive, quantitative, cross-sectional survey. A purposive sampling method was used to recruit 121 participants with neck and back pain attending the Durban University of Technology Chiropractic Day Clinic located in KwaZulu-Natal, South Africa. Data were collected using a self-administered questionnaire. Descriptive statistics, including frequencies and percentages, were used to summarize the data, and odds ratios (ORs) were calculated. Results: Most participants presented with chronic pain, reporting an average severity of 6 out of 10 and little disability from the pain. Home therapy included stretches (92.2%), heat therapy (49.1%), and ice therapy (38.8%). Almost two-thirds (62.1%) of participants reported being fully compliant with the prescribed home therapy, while 32.8% reported partial compliance. The main factors that potentially affected compliance were laziness and forgetfulness. Participants who reported having depression were less compliant (OR, 0.181), while those with chronic pain were more compliant (OR, 3.74). Those who believed that home therapy would alleviate their pain were also more compliant (OR, 3.83). Conclusion: The study found that a majority of participants with spine pain were compliant with prescribed chiropractic home treatment. Key factors that potentially influenced compliance were identified.

Exploring the Lived Experiences of Vulnerable Females from a Low-Resource Setting during the COVID-19 Pandemic.

The onset of the Coronavirus disease 2019 (COVID-19) pandemic has affected the mental health and well-being of women in vulnerable settings. Currently, there is limited evidence that explores the wellness of elderly women under the associated restrictions. This study explores the lived experiences of elderly women in a vulnerable community in Durban, South Africa. A face-to-face, in-depth qualitative approach was implemented to interview 12 women aged 50 years and over. Thematic analysis was used to analyse the data. The findings suggest that social interactions, the effect of a high death rate, and financial strain predominantly affect stress and anxiety levels. Despite the women being in receipt of pensions and/or other grants, their supplementary income was reduced. This, together with the additional expenses incurred during the lockdown, resulted in anxiety over finances. The lack of social interaction, with limits on visiting family and other loved ones when they were ill, along with the limit on the number of people attending the funerals of loved ones were also stressful. This study also reports on the resulting coping mechanisms, which included using hobbies such as baking and sewing as a means of self-care. Religious beliefs also relieved stress while home remedies were used as preventative measures during the lockdown restrictions due to COVID-19.

Factors influencing the adoption of HIV prevention measures in low socio-economic communities of inner-city Durban, South Africa.

South Africa is the epicentre of the HIV pandemic. Although there have been health promotion education campaigns to reduce HIV incidence, these have not achieved the desired outcomes. When exploring the effectiveness of these campaigns, it is useful not only to examine HIV knowledge, but also to explore the relationship between that knowledge and health-related behaviour. This study aimed to determine the (1) level of knowledge of HIV prevention, (2) relationship between the level of knowledge and the adoption of these behaviours and (3) barriers to sexual behaviour change of vulnerable women in Durban's city centre, KwaZulu-Natal, South Africa. A mixed methods approach was used to collect information from a marginalised population of women (n = 109) attending a non-governmental organisation, which provides for the needs of people from low socio-economic strata. Data were collected during September 2018 at a wellness day programme at the centre. A total of 109 women, over the age of 18 years answered the questionnaire. Knowledge of HIV transmission was high, with majority of participants correctly identifying modes of transmission. Almost all the participants (91.2%) had been tested for HIV, with 68.8% tested a minimum of three times. Despite this, sexual risk behaviour was high. Despite the high level of knowledge of HIV transmission, there was no relationship between HIV knowledge and adoption of behaviours for the prevention of HIV transmission (p = .457). However, bivariate analysis showed an association between transactional sex and living in informal housing (OR = 31.94, 95% CI: 5.65-180.63, p < .001). Living in informal housing was also associated with having multiple current sexual partners (OR = 6.30, 95% CI: 1.39-28.42, p = .02). Multivariate analysis, after adjusting for all other factors, indicated that the odds of having transactional sex was increased by 23 times in those who did not have formal housing (OR = 23.306, 95% CI: 3.97-144.59, p = .001). Qualitative responses showed that women perceived poverty as the overarching factor determining the lifestyle choices which impacted their health. They indicated a need for employment opportunities and provision of housing to alleviate both poverty as well as transactional sex. Although, participants from this study understood the benefits of the protective behaviours to prevent HIV transmission, economic and social factors do not afford this vulnerable group the opportunity nor the motivation to adopt such behaviours. In the current climate of increasing unemployment and escalating GBV, urgent interventions are needed in terms of employment opportunities and empowerment drives to prevent an increase in HIV transmission.

Prevalence and associated risk factors of low back pain among users of a primary health care clinic serving semi-urban and rural settlements in KwaZulu-Natal, South Africa.

Background: Low back pain (LBP) is one of the most frequent musculoskeletal conditions and a common work-related health problem. In South Africa, people from lower socio-economic strata are involved in physical labour and also have unequal access to health services. There is minimal data on the prevalence of LBP in these communities. This study determined the prevalence and associated risk factors of LBP among public sector health care users in a semi-urban/rural area of KwaZulu-Natal, South Africa. Methods: The study was conducted at a primary health care clinic in the Umdoni municipality, KwaZulu-Natal, South Africa. Convenience sequential sampling was used. An interviewer-administered questionnaire was utilized due to literacy constraints. Participants (n=400) answered the questionnaire in either English or isiZulu. Results: The lifetime prevalence of LBP was 79.3%. Female gender and lifting heavy objects were associated with LBP. The direct impact of LBP was faced in the work place resulting in absenteeism, often followed by unemployment. Conclusion: In this setting, where the prevalence of LBP was high, specialized treatments for LBP were not available at the primary health care facility. Incorporation of such treatments will be useful, for people in lower socio-economic strata, to overcome the burden of LBP.

Knowledge, attitudes and behaviours toward COVID-19: A cross-sectional survey among Nigerian University students.

Background: The effect of the highly contagious coronavirus disease 2019 (COVID-19) began in Wuhan, Hubei Province, China, from which it spread worldwide. In Nigeria, to curb the spread of the virus, the government elected to close public places, halt the general use of public transportation, enforce isolation and manage infected persons. Aim: This study evaluated Nigerian university students' knowledge, attitudes and behaviour (KAB) towards COVID-19. Setting: This was an online survey of Nigerian university students. Method: A cross-sectional study was conducted among 1268 respondents aged 16 to 60 who completed the survey questionnaire. The respondents' demographic data and KAB toward COVID-19 were collected, allocated and scored based on specific stratified divisions. Data were analysed using student's t-test, analysis of variance and logistic regression analysis. Results: The respondents demonstrated good knowledge of COVID-19, with a mean knowledge score of 78.7%; this positively influenced their attitude and behaviour scores (84.1% and 72.3%, respectively). Multiple linear regression analysis showed that 98.9% of the variance associated with poor knowledge is explained by gender (98.9%), age (97.3%), education (97.3%), occupation (97.2%) and marital status (91.4%). Conclusion: The respondents had a positive attitude and satisfactory compliance with safety practices required to curb the spread of the virus. Nevertheless, there is a need to intensify health education campaigns targeting all Nigerians, especially the less educated, via community outreach programmes using local languages. Contribution: The findings of this study demonstrate the imperative role of the knowledge of COVID-19 in curbing the spread of the infection via improved attitudes and positive behaviours in compliance with safety practices.

Diarrhoeal prevalence and handwashing practices of children attending early childhood development centres in KwaZulu-Natal, South Africa.

Background: Diarrhoea, a leading cause of childhood morbidity and mortality, spread through contaminated food or water or from person to person, is a major cause of hospitalisation in South African children. Aim: To determine if hygiene practices of parents or guardians and early childhood development centre (ECD) educators contributed to diarrhoea in children attending the centres. Setting: The study was conducted at ECD centres in Mpumalanga Township of KwaZulu-Natal province, South Africa. Methods: A descriptive cross-sectional study was conducted at 10 ECD centres. Parents or guardians (n = 385) and educators (n = 121) answered self-administered questionnaires. Frequencies, bivariate associations and multivariate regression modelling were conducted. Results: The prevalence of diarrhoea in children ≤ 5 years was 67.3%. Most parents or guardians washed their hands after defecating and handling a child's faeces as well as before preparing food. Handwashing after urination was low. Washing of children's hands after these events was lower. Although all educators reported always washing the child's hands after defecating and before handling or eating food, they were less likely to wash the children's hands after urination (p = 0.003). Childhood diarrhoea was associated with the type of toilet, households with pit latrines having a higher prevalence of diarrhoea (p < 0.001). It was also associated with washing of children's hands after urination (p = 0.014), before handling or eating food (p = 0.001) and with increased number of children in the household (p = 0.001). Conclusion: In this population, the high prevalence of diarrhoea is related to the number of children in a household and handwashing practices. Contribution: This study highlights the importance of handwashing practices in the prevention of diarrhoea in children.

100 DAYS OF COVID-19: RISK FACTORS AND CONFIRMED CASES IN 19 AFRICAN COUNTRIES.

BACKGROUND: The trail of the transmission of COVID-19 in Africa needs to be understood and conceptualized. With the limited response time to curb the transmission, the pandemic is already in 52 countries in Africa. There is much anxiety about the devastating potential of this scourge in Africa, justifiably so because of the weak health systems, high levels of poverty, and overcrowded cities. Therefore, this report examined the association between the confirmed cases at 100 days of COVID-19 and some significant risk factors in 19 African countries that had at least 100 confirmed cases as of 09 April 2020. MATERIALS AND METHODS: We evaluated four major risk factors associated with COVID-19 confirmed cases in 19 African counties with over 100 cases in 100 days after the official declaration of COVID-19 by WHO. RESULTS: Three of the four risk factors (total population in urban areas, population age, and international exposure) correlated positively with the number of COVID-19 cases. In contrast, one (public health system) correlated negatively with the number of confirmed cases in the countries under study. International exposure was initially the main transmitter of the infection, but community transmission now becomes the driver of COVID-19 infections on the continent. CONCLUSION: Identification of confirmed cases, quick contact tracing with self-isolation, community engagement, and health systems measures are all-necessary to prevent the potentially harmful ramifications of an epidemic on the continent. There is, therefore, the need for a comprehensive and integrated approach between the government and society.