Seasonal and trend variation of methane concentration over two provinces of South Africa using Sentinel-5p data.

South Africa faces the urgency to comprehensively understand and manage its methane (CH4) emissions. The primary aim of this study is to compare CH4 concentrations between Eastern Cape and Mpumalanga regions dominated by cattle farming and coal mining industries, respectively. CH4 concentration trends were analyzed for the period 2019 to 2023 using satellite data. Trend analysis revealed significant increasing trends in CH4 concentrations in both provinces, supported by Mann-Kendall tests that rejected the null hypothesis of no trend (Eastern Cape: p-value = 8.9018e-08 and Mpumalanga: p-value = 2.4650e-10). The Eastern Cape, a leading cattle farming province, exhibited cyclical patterns and increasing CH4 concentrations, while Mpumalanga, a major coal mining province, displayed similar increasing trends with sharper concentration points. The results show seasonal variations in CH4 concentrations in the Eastern Cape and Mpumalanga provinces. High CH4 concentrations are observed in the northwestern region during the December-January-February (DJF) season, while lower concentrations are observed in the March-April-May (MAM) and June-July-August (JJA) seasons in the Eastern Cape province. In the Mpumalanga province, there is a dominance of high CH4 concentrations in southwestern regions and moderately low concentrations in the northeastern regions, observed consistently across all seasons. The study also showed an increasing CH4 concentration trend from 2019 to 2023 for both provinces. The study highlights the urgent need to address CH4 emissions from both cattle farming and coal mining activities to mitigate environmental impacts and promote sustainable development. Utilizing geographic information system (GIS) and remote sensing technologies, policymakers and stakeholders can identify and address the sources of CH4 emissions more effectively, thereby contributing to environmental conservation and sustainable resource management.

A cross-sectional study of knowledge, attitudes, barriers and practices of cervical cancer screening among nurses in selected hospitals in the Eastern Cape Province, South Africa.

BACKGROUND: Cervical cancer is a preventable but highly prevalent cancer in many low -and middle-income countries including South Africa. Cervical cancer outcomes can be improved with improved vaccination, a well-coordinated and efficient screening programme, increased community awareness and uptake, and increased knowledge and advocacy of health professionals. This study therefore aimed to ascertain the knowledge, attitudes, practices and barriers of cervical cancer screening among nurses of selected rural hospitals in South Africa. METHODS: A quantitative cross-sectional study was conducted in five hospitals in the Eastern Cape Province of South Africa between October and December 2021. A self-administered questionnaire was used to assess demographic characteristics of nurses and cervical cancer knowledge, attitudes, barriers and practices. A knowledge score of 65% was deemed adequate. Data were captured in Microsoft Excel Office 2016 and exported to STATA version 17.0 for analysis. Descriptive data analyses were used to report the results. RESULTS: A total of 119 nurses participated in the study with just under two thirds (77/119, 64.7%) being professional nurses. Only 15.1% (18/119) of participants were assessed as having obtained a good knowledge score of ≥ 65%. The majority of these (16/18, 88.9%) were professional nurses. Of the participants with a good knowledge score, 61.1% (11/18) were from Nelson Mandela Academic Hospital, the only teaching hospital studied. Cervical cancer was deemed to be a disease of public health importance by 74.0% (88/119). However, only 27.7% (33/119) performed cervical cancer screening. Most of the participants (116/119, 97.5%) had an interest of attending more cervical cancer training. CONCLUSION: The majority of nurse participants did not have adequate knowledge about cervical cancer and screening, and few performed screening tests. Despite this, there is a high level of interest in being trained. Meeting these training needs is of utmost importance to implementing a comprehensive cervical cancer screening programme in South Africa.

Diversity and determinants of traditional water conservation technologies in the Eastern Cape Province, South Africa.

Water scarcity remains a major threat to most rural areas in Africa due to heavy reliance on rainfed agriculture. This prompts the need to document and understand the determinants of traditional knowledge of water conservation practices. Our aim here is to document and identify the determinants of people's knowledge of traditional knowledge of water conservation in the South Africa's Eastern Cape province. A mixed research method was used. Purposive approach was used to collect data, i.e., elderly people were targeted during the face-to-face pre-COVID-19 pandemic interviews on the basis that traditional knowledge increases with age. However, people of different age groups were also included in the study especially when we employed only online questionnaire during the pandemic. We used questionnaire to collect all the data, and 93 people responded in total to our questions. We documented 10 traditional water conservation technologies. We identified rainfall variation, water quality issues, and increased water demand as the major challenges linked to these technologies, while easy access and the amount of water harvested are reported as benefits of these technologies. We found that traditional knowledge is not influenced by age (ß = -0.006 ± 0.01, P = 0.64) or gender (ß = -0.16 ± 0.25, P = 0.64) but rather correlates positively with geographic location, irrespective of the starting point of the distance measurement (distance from Port Elizabeth city: ß = 0.002 ± 0.0008, P = 0.004; distance from Ngqushwa village: ß = 0.0024 ± 0.0009, P = 0.008). Counterintuitively, formally educated people tend to have more traditional knowledge, but this is likely linked to the modern technologies (online survey and social media platforms) used to collect data during the COVID-19 pandemic. We suggest that traditional knowledge that has sustained life for centuries in rural communities must be integrated into water resource management to address water scarcity issues in rural Africa.

Plants Used for the Traditional Management of Cancer in the Eastern Cape Province of South Africa: A Review of Ethnobotanical Surveys, Ethnopharmacological Studies and Active Phytochemicals.

Cancer occurrence is rapidly increasing all over the world, including in developing countries. The current trend in cancer management requires the use of herbal remedies since the majority of anticancer drugs are known to be costly, with unwanted side effects. In the Eastern Cape province, the use of medicinal plants for cancer management has been climbing steadily over the past two decades due to their cultural belief, low cost, efficacy, and safety claims. With the aim of identifying some potential anticancer plants for probable drug development, this study was undertaken to review plants reported by ethnobotanical surveys in the Eastern Cape province of South Africa for the traditional management of cancer. Information regarding plants used for cancer management in the Eastern Cape province was obtained from multidisciplinary databases and ethnobotanical books. About 24 plant species belonging to twenty families have been reported to be used for the traditional management of cancer in the Eastern Cape province. Among the anticancer plant species, only 16 species have been explored scientifically for their anticancer activities. This review authenticated the use of anticancer plant species in the Eastern Cape province and, therefore, identified several promising unexplored species for further scientific evaluation.

Prevalence and determinants of tobacco use amongst South African adults with mental illness in the Eastern Cape.

BACKGROUND: Given the physical and mental health consequences of tobacco use amongst individuals with mental illness, it was imperative to assess the burden of tobacco use in this population. AIM: This study examined the patterns and factors associated with tobacco use in individuals attending the outpatient unit. SETTING: Cecilia Makiwane Hospital Mental Health Department in Eastern Cape province, South Africa. METHODS: Lifetime (ever use) use and current use of any tobacco products were examined in a cross-sectional study of 390 individuals between March and June 2020. A logistic regression was fitted to determine the correlates of lifetime and current use of any tobacco products. RESULTS: The rates of ever use and current use of tobacco products were 59.4% and 44.6%, respectively. Of the participants interviewed, lifetime tobacco use was more prevalent amongst individuals with schizophrenia (67.9%) and cannabis-induced disorders (97.3%) and lower in those with major depressive disorders (36.1%) and bipolar and related disorders (43.5%). Men were six times more likely to have ever used or currently use tobacco products in comparison to women. Also, those who had a salaried job or owned a business were over three times more likely to have ever used or currently use tobacco products compared with those receiving government social grants. CONCLUSIONS: The prevalence of tobacco use in this study was significantly higher than the general population in the Eastern Cape. Therefore, smoking prevention and cessation interventions targeted at the general population should target this often neglected sub-population in the region.

Community health workers impact on maternal and child health outcomes in rural South Africa - a non-randomized two-group comparison study.

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 < 0.01). Intervention-group children were significantly less likely to be wasted (OR: 0.5; 95% CI 0.3-0.9) and had significantly fewer symptoms of common childhood illnesses in the preceding two weeks (OR: 0.8; 95% CI: 0.7,0.9). 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.

Provision of immediate postpartum contraception to women living with HIV in the Eastern Cape, South Africa; a cross-sectional analysis.

BACKGROUND: Universal access to contraception is an important strategy adopted by the South African government to reduce the high rate of unintended pregnancies, especially in women living with HIV. In this article, we describe the choices of contraception and also, examine the influencing factors of the choices of contraception in the immediate postpartum period in parturient women with HIV in the Eastern Cape, South Africa. METHODS: In this prospective cross-sectional study, 1617 parturient women with HIV completed a survey on the choice of contraception received in the immediate postpartum period (within 72 h) across three large maternity services in the Eastern Cape between September 2015 to May 2016. Additional information was extracted from their medical records. Choices of contraception were categorised as; short-acting (injectables), long-acting reversible (intrauterine device and implants) and permanent contraception (tubal ligation). Adjusted and unadjusted logistic regression models were employed to determine the influencing factors of the choices of contraception received by the cohort. RESULTS: Participants were predominantly single (69.1%), unemployed (75.1%), had a grade 7-12 level of education (88.4%) and were HIV positive before their index pregnancy (81.3%). The prevalence of immediate postpartum contraception was high (n = 1507; 93.2%) with Injectables being the preferred choice in the majority of the participants (n = 1218; 75.3%). After controlling for all relevant covariates, single marital status was associated with a higher likelihood of immediate postpartum contraceptive initiation (AOR; 1.82 95% CI 1.10-3.03). Overall, women were more likely to initiate a long-acting reversible and irreversible methods when older than 35 years and having had more than two children. CONCLUSIONS: We found a high prevalence of immediate postpartum contraception with a preference for Injectables in the study setting. Long-term monitoring of this cohort will elucidate on contraceptive discontinuation and risk of unintended pregnancies in the region. Ensuring universal access to contraceptives is an important strategy to reduce the rate of unintended pregnancies at the population level. This strategy was adopted by the South African government with a vision of stemming the tide of unintended pregnancies among women living with HIV. In this study, the choices of contraception adopted by women living with HIV following the delivery of their babies were explored. In addition, the study highlights the factors that predict these choices. Participants were asked the choice of contraception they had received prior to being discharged from the maternity centres where they had delivered their babies. The various types of contraception were then categorised by their duration of action. Three distinct groups emerged; short-acting injectables, long acting reversible contraceptives and permanent methods. Of the 1617 women included in the study, 1117 were single and 1314 knew their HIV status prior to the onset of the index pregnancy. Almost all the women (1507 out of 1617) received one form of contraception before leaving the hospital. Many women (1218 out of 1617) chose injectable contraception (short-acting contraception) over the other types of contraception. Women who were older than 34 years and who had three or more children were more likely to choose a long-acting reversible contraceptive and permanent method over the short-acting contraception or nothing. In conclusion, given the short duration of action of the predominant method adopted by these women, a long-term follow up of the study participants will provide more information on the continued use of contraception and risk for unintended pregnancies.

High rate of unplanned pregnancy in the context of integrated family planning and HIV care services in South Africa.

BACKGROUND: Integration of family planning services into HIV care was implemented in South Africa as a core strategy aimed at reducing unintended pregnancies among childbearing women living with HIV. However, it is unclear whether this strategy has made any significant impact at the population level. This paper describes the prevalence and correlates of self-reported unplanned pregnancy among HIV-infected parturient women attending three large maternity centres in the Eastern Cape, South Africa. We also compare unplanned pregnancy rates between HIV-infected parturient women already in care (who have benefitted from services' integration) and newly diagnosed parturient women (who have not benefitted from services' integration). METHODS: Drawing from the baseline data of the East London Prospective Cohort Study (ELPCS), data of 594 parturient women living with HIV in the Eastern Cape were included. Chi-square statistics and binary logistics regression were employed to determine the correlates of unplanned pregnancy among the cohort. RESULTS: The prevalence of unplanned pregnancy was 71% (n = 422) with a higher rate among parturient women newly diagnosed during the index pregnancy (87%). Unplanned pregnancy was significantly associated with younger age, single status, HIV diagnosis at booking, high parity and previous abortion. Women who reported unplanned pregnancy were more likely to book late and have lower CD4 counts. After adjusting for confounding variables, having one child and five to seven children (AOR = 2.2; CI = 1.3-3.1), age less than 21 years (AOR = 3.3; CI = 1.1-9.8), late booking after 27 weeks (AOR = 2.7; CI = 1.5-5.0), not married (AOR = 4.3; CI = 2.7-6.8) and HIV diagnosis at booking (AOR = 3.0; CI = 1.6-5.8) were the significant correlates of unplanned pregnancy in the cohort. CONCLUSION: Unplanned pregnancy remains high overall among parturient women living with HIV in the region, however, with significant reduction among those who were exposed to integrated services. The study confirms that integration of HIV care and family planning services is an important strategy to reduce unplanned pregnancy among women living with HIV. The study's findings have significant implications for the elimination of mother-to-child transmission of HIV in South Africa. Innovative interventions are needed to further consolidate and maximise the benefit of the integration of family planning services with HIV care.

Ecological preferences and seasonal dynamics of ticks (Acari: Ixodidae) on and off bovine hosts in the Eastern Cape Province, South Africa.

A total of 31,425 ticks were collected from 10 cattle and also from six drag-samples during the 12-month study period. Adult ticks were removed from the right hand side of each animal and all instars of ticks were placed in containers filled with 70% ethanol. Based on morphological traits, 10 tick species were identified: Rhipicephalus (Boophilus) decoloratus (32.5%), R. evertsi evertsi (18.8%), R. appendiculatus (17.3%), Amblyomma hebraeum (16.3%), R. simus (7.7%), Ixodes pilosus (3.8%), Hyalomma rufipes (3.5%), R. follis (0.08%), Haemaphysalis elliptica (0.04%), H. silacea (0.02%). The southern African yellow dog tick, H. elliptica, was only found on vegetation. The agro-ecological zones differ significantly in tick species and their distribution. The A. hebraeum and R. evertsi evertsi counts were higher in Kowie Thicket (KT) during summer season (2.05 ± 0.01 and 1.00 ± 0.09, respectively) compared to Bedford Dry Grassland (BDG) and Bhisho Thornveld (BT) veld types. In all vegetation types, R. appendiculatus had higher counts in KT in spring (0.91 ± 0.08), summer (0.78 ± 0.08) and winter (0.78 ± 0.08). Rhipicephalus (Boophilus) decoloratus was more frequent in the BT (1.78 ± 0.11) during the summer season. BDG had lower tick infestation with R. evertsi evertsi being the most frequent species in summer. No H. rufipes was collected in the KT. Of epidemiological interest, R. (B.) microplus was absent in the study area which needs further investigation. Within the context of this study, we found agro-ecological differences and seasonal variations to have influence on tick species distribution.

Molecular detection of Porcine circovirus type 2 in swine herds of Eastern Cape Province South Africa.

BACKGROUND: Porcine circovirus type 2 (PCV2) remains the main causative viral pathogen of porcine circovirus-associated diseases (PCVAD) of great economic importance in pig industry globally. This present study aims at determining the occurrence of the viral pathogen in swine herds of the Province. RESULTS: The data obtained revealed that 15.93% of the screened samples (54/339) from the swine herds of the studied areas were positive for PCV2; while the severity of occurrence of the viral pathogen as observed at farm level ranges from approximately 5.6 to 60% in the studied farms. The majority (15 out of 17 = 88%) of the analyzed sequences were found clustering with other PCV2b strains in the phylogenetic analysis. More interestingly, two other sequences obtained were also found clustering within PCV2d genogroup, which is presently another fast-spreading genotype with observable higher virulence in global swine herds. CONCLUSION: This is the first report of PCV2 in swine herds of the Province and the first detection of PCV2b and PCV2d in South African swine herds. It follows the first reported case of PCV2a in an outbreak of porcine multisystemic wasting syndrome (PMWS) in Gauteng Province, South Africa more than one decade ago. This finding confirmed the presence of this all-important viral pathogen in pigs of the region; which could result in a serious outbreak of PCVAD and huge economic loss at the instances of triggering factors if no appropriate measures are taken to effectively curb its spread.

Use of sediment source fingerprinting to assess the role of subsurface erosion in the supply of fine sediment in a degraded catchment in the Eastern Cape, South Africa.

Sediment source fingerprinting has been successfully deployed to provide information on the surface and subsurface sources of sediment in many catchments around the world. However, there is still scope to re-examine some of the major assumptions of the technique with reference to the number of fingerprint properties used in the model, the number of model iterations and the potential uncertainties of using more than one sediment core collected from the same floodplain sink. We investigated the role of subsurface erosion in the supply of fine sediment to two sediment cores collected from a floodplain in a small degraded catchment in the Eastern Cape, South Africa. The results showed that increasing the number of individual fingerprint properties in the composite signature did not improve the model goodness-of-fit. This is still a much debated issue in sediment source fingerprinting. To test the goodness-of-fit further, the number of model repeat iterations was increased from 5000 to 30,000. However, this did not reduce uncertainty ranges in modelled source proportions nor improve the model goodness-of-fit. The estimated sediment source contributions were not consistent with the available published data on erosion processes in the study catchment. The temporal pattern of sediment source contributions predicted for the two sediment cores was very different despite the cores being collected in close proximity from the same floodplain. This highlights some of the potential limitations associated with using floodplain cores to reconstruct catchment erosion processes and associated sediment source contributions. For the source tracing approach in general, the findings here suggest the need for further investigations into uncertainties related to the number of fingerprint properties included in un-mixing models. The findings support the current widespread use of ≤5000 model repeat iterations for estimating the key sources of sediment samples.

Treatment Outcomes for Patients with Extensively Drug-Resistant Tuberculosis, KwaZulu-Natal and Eastern Cape Provinces, South Africa.

We analyzed data for a retrospective cohort of patients treated for extensively drug-resistant tuberculosis in 2 provinces in South Africa and compared predictors of treatment outcome in HIV-positive patients who received or had not received antiretroviral drugs with those for HIV-negative patients. Overall, 220 (62.0%) of 355 patients were HIV positive. After 2 years, 34 (10.3%) of 330 patients with a known HIV status and known outcome had a favorable outcome. Multivariate analysis showed that predictors of favorable outcome were negative results for acid-fast bacilli by sputum microscopy at start of treatment and weight >50 kg. HIV-positive patients were more likely to have an unfavorable outcome. The strongest predictor of unfavorable outcome was weight <50 kg. Overall outcomes were poor. HIV status was not a predictor of favorable outcome, but HIV-positive patients were more likely to have an unfavorable outcome. These results underscore the need for timely and adequate treatment for tuberculosis and HIV infection.

The impact of the COVID-19 pandemic on presentations with suicidal behaviour in a tertiary hospital Emergency Centre in the Eastern Cape, South Africa-A cross-sectional analysis.

Introduction: Suicidal behaviour is a public health emergency, causing an estimated one million deaths globally each year. The impact of the COVID-19 pandemic on suicidal behaviour is not fully understood. This study aimed to describe the impact of the COVID-19 pandemic on presentations with suicidal behaviour at a tertiary hospital in the Eastern Cape, South Africa. Method: This study was a retrospective cross-sectional analysis of patients with fatal and nonfatal suicidal behaviour who presented to Frere Hospital Emergency Centre in the Eastern Cape, South Africa. The analysis included three study periods: August to October 2019 (pre-COVID-19), August to October 2020 (wave 1), and August to October 2021(wave 3). Results: A total of 16 419 patients presented to the Frere Hospital Emergency Centre during the study period, with 6 204 in 2019, 4 909 in 2020, and 5 306 in 2021. These correspond to the research periods from August to October for each successive year. The overall prevalence of suicidal behaviour was 1.6 % but decreased marginally during the pandemic (1.8 % in 2019 vs. 1.4 % in 2021) - contrary to what occurred in high-income countries. The prevalence demonstrated a clinically insignificant stepwise decline as the pandemic progressed and was inversely associated with the number of daily new COVID-19 cases nationally. A significant increase in the emergency centre's total length of stay was however observed during the COVID-19 period (143 vs. 80 min, p < 0.001). The high proportion (66 %) of patients with suicidal behaviour requiring admissions increased further during the COVID-19 study period, placing an additional burden on inpatient disciplines. The proportion of social worker consultations increased significantly during the COVID-19 period (65% vs. 44 %, p<.05). Conclusion: The COVID-19 pandemic marginally reduced the prevalence of presentations with suicidal behaviour to the Emergency Centre, contrary to what was observed in high-income countries.

Prevalence of vitamin D deficiency and its association with cardiometabolic risk factors among healthcare workers in the Eastern Cape province, South Africa; cross-sectional study.

This study assesses the prevalence of Vitamin D deficiency and its potential association with cardiometabolic risk factors among South African adults residing in the Eastern Cape province. In this cross-sectional study, 1244 healthcare workers (HCWs) completed a self-administered questionnaire and venous blood samples were drawn at two academic hospitals in the Eastern Cape. History of hypertension and diabetes mellitus were self-reported. Participants were categorised as obese if their body mass index (BMI) ≥ 30 kg/m2. Participants were classified as having metabolic syndrome if they had hypertension, diabetes mellitus and obesity. Vitamin D [25(OH)D] deficiency was defined as venous blood concentrations < 50 nmol/L. Associations between vitamin D deficiency and participants' characteristics were assessed using multivariate logistic regression model analysis. The prevalence of vitamin D deficiency was 28.5% (n = 355), of whom 292 were female. Among the participants who were deficient in vitamin D, the prevalence of obesity, diabetes mellitus, hypertension, chronic kidney disease, and metabolic syndrome was 64.9% (n = 230), 9% (n = 32), 16.6% (n = 59), 2.3% (n = 8) and 18% (n = 64), respectively. In the adjusted multivariate logistic regression model, black Africans (AOR = 2.87; 95% CI 1.52-5.43) and individuals ≥ 42 years (AOR = 1.37; 95% CI 1.07-1.77) were more likely to exhibit vitamin D deficiency. However, there was no significant association by age, sex, and cardiometabolic markers. More than one in four healthcare workers was deficient in vitamin D among the study sample, especially the black Africans and older individuals. Further studies are needed at the population level to elucidate on the vitamin D status in the region.

Preferences for index-based crop insurance in South Africa.

The main reason cited for the low participation rate in indexed insurance in Africa is the lack of farmers' involvement in the initial conception. The main aim of this article was, therefore, to design an improved participatory methodology that would help farmers in South Africa gather information on the value they place in new crop insurance initiatives based on weather indices. The main objective of this study was to determine their willingness to pay (WTP) crop insurance in the Eastern Cape. The study adopted a cross-sectional design, and the respondents were selected by using a probability sampling procedure. A sample of 150 respondents was selected. The results from descriptive statistics showed that 62% of the smallholder irrigation scheme farmers were between 52 and above years of age, male and female: 87% and 13%, respectively. The results from the probit model revealed that out of nine variables included in the model, only four namely, logAge square, gender, marital status and age were significantly influencing the WTP index-based crop insurance at 1%, 5% and 10%, respectively. However, age was found to reduce the chances of participating in crop-based insurance. A large proportion of those who were willing to pay insurance had not previously experienced losses because of natural hazards. Therefore, it recommended that the government should use existing extension officers to educate the farmers and promote the importance and benefits of insurance products. Contribution: The results are expected to contribute to the local government to improve disaster resilience through strengthening regional financial funding.

CLINICAL PROFILES AND OUTCOMES OF ADMISSIONS FOLLOWING COVID-19 ADMISSIONS DURING THREE WAVES OF THE PANDEMIC: EXPERIENCE OF A TERTIARY HOSPITAL IN THE EASTERN CAPE PROVINCE OF SOUTH AFRICA.

Background: South Africa was the country worst affected by the Covid-19 pandemic in Africa. There is a paucity of data on the clinical characteristics and mortality of Covid-19 from the Eastern Cape province of South Africa. We report on the demographic and clinical characteristics as well as the mortality of patients admitted to the Covid-19 ward of Nelson Mandela Academic Hospital (NMAH), Mthatha, during three waves of the Covid-19 pandemic in South Africa. Materials and Methods: We conducted a single centre retrospective observational study of patients admitted for Covid-19 in a tertiary hospital in the rural Eastern Cape of South Africa. Data were collected from patient files, electronic databases and the National Health Laboratory Services (NHLS) database. The outcomes were duration of admission and in-hospital mortality. Results: There were 371 patients admitted across all three waves with a mean age of 52.2 ± 16.3 years. The proportion of females across the three waves is 61.2%. The commonly associated comorbidities, irrespective of the wave, were hypertension, diabetes and HIV infection. The median duration of admission was six days, with an overall mortality of 31%. The mortality for first, second and third wave were 29.3%, 31.5% and 37.9% respectively. Conclusion: Admissions for Covid-19 were predominantly in females and middle-aged. One third of the admitted patients died. Diabetes, hypertension and HIV infection were the most commonly associated comorbidities.

Benthic diatom diversity in microtidal mangrove estuaries.

Mangrove habitats support taxonomically diverse benthic communities, yet their effects on microphytobenthos remain understudied. This study investigated the benthic diatom community structure of 17 microtidal mangrove estuaries situated along the east coast of South Africa. High sediment organic content (≤ 18.1 %) and clay fraction (≤ 17.5 %) measured in the Avicennia marina and Rhizophora mucronata habitats favoured diverse communities (H' > 3) and the presence of unique benthic diatom species such as Gyrosigma balticum. The habitat complexity and stabilisation provided by the mangrove forests served as microrefugia for colonisation of benthic diatoms. Taxa displayed a broad range of nutrient tolerance, with some nutrient tolerant species (e.g., Halamphora acutiuscula, Navicula clausii, Navicula gregaria, and Navicula radiosa) dominating the communities in the Mbashe and Mnyameni estuaries. The presence of these nutrient tolerant taxa in relatively pristine systems serves as an early warning for possible anthropogenic nutrient enrichment.

A community service doctor's experiences of mental healthcare provision in rural Eastern Cape.

BACKGROUND:  Literature shows that in South Africa there are insufficient resources to meet mental healthcare needs. At general or district hospital level, the non-specialist doctor is often responsible for the holistic assessment and management of mental health service users. Such situations inevitably increase doctors' care load as they are required to treat across disciplines. We highlight the particular challenges faced by a community service (CS) doctor in this context. METHODS:  The presented case study formed part of a larger project that investigated public mental healthcare provision in the Eastern Cape province. Data were collected through a once-off semi-structured interview with the participant. The interview was transcribed and data analysed by utilising thematic analysis to yield results. RESULTS:  The study suggests that the CS doctor experiences being overloaded with duties, and feels overwhelmed in a healthcare context that lacks resources needed for service provision, which may lead to inadequate mental healthcare provision to public health service users. CONCLUSION:  Healthcare facilities in rural parts of the Eastern Cape province are in need of assistance. This in-depth account highlighted the consequences of working on the front line of a disadvantaged and under-resourced health system. The presented account can be interpreted as a cry for help by CS doctors for relevant authorities to improve access and provision of mental healthcare in the area.Contribution: The paper provides an exploration of the circumstances wherein mental healthcare is provided in rural parts of South Africa.

The utilisation of emergency point-of-care ultrasound in a tertiary hospital emergency department in East London, South Africa.

Introduction: Emergency departments are the primary entry point for emergencies in the public healthcare system. Resource constraints burden a large proportion of the public hospital emergency departments, which includes limited access to radiological services. Emergency point-of-care ultrasound provides a tool capable of bridging this gap. The Eastern Cape is yet to describe the utilisation of emergency point-of-care ultrasound in any of its emergency departments. Methods: Frere Hospital initiated a clinical audit to assess the utilisation of emergency point-of-care ultrasound in its emergency department in 2022. This study was a retrospective review of the audit between 01 November 2022 until 28 February 2023. Data from the handwritten register regarding patient's presenting complaints and provisional diagnoses was also captured during the study period to draw comparisons between burden of disease and use of emergency point-of-care ultrasound. Results: A total of 9501 patients attended Frere Hospital's emergency department over the study period with 492 emergency point-of-care ultrasounds performed (overall utilisation rate 5.2 %). The five credentialed emergency point-of-care ultrasound providers performed the majority (n = 360, 73.2 %) of the applications, compared to 132 (26.8 %) performed by the seven non-credentialed providers. The extended focused abdominal sonography in trauma (eFAST) was the most frequently performed application (n = 140, 28.5 %). Conclusion: Emergency point-of-care ultrasound is underutilised in Frere Hospital's emergency department. The varied casemix requires upskilling of clinicians in emergency point-of-care ultrasound to suit the burden of disease experienced in the department. Ongoing emergency point-of-care ultrasound training, credentialing and research is important to ensure appropriate and quality emergency point-of-care ultrasound utilisation.

Assessment of knowledge, attitudes, and practices related to the prevalence of sheep scab among communal sheep farmers in Eastern Cape Province, South Africa.

Background and Aim: Sheep scab is one of the most contagious diseases of sheep found in rural communities worldwide and is a major health and welfare concern for sheep farming. Information on the attitudes of communal farmers to sheep scab remains speculative in the Eastern Cape Province. This study aimed to investigate knowledge, attitudes, and practices related to the prevalence of sheep scab among communal sheep farmers in Eastern Cape Province, South Africa. Materials and Methods: From June to August 2022, a cross-sectional survey using a semi-structured questionnaire (n = 160) was conducted in two rural communities of the Enoch Mgijima Local Municipality in Eastern Cape Province. Purpose sampling was used to obtain respondents' knowledge, attitudes, and management practices regarding sheep scabs. Results: Among respondents, 81% were males and 19% were females. The majority of sheep farmers (59%) in both communities were aware of sheep scabs, but the majority (64%) did not receive any farming training. The majority of sheep farmers (65%) believed that sheep scab was the most serious threat to their sheep production since it increased mortality. In the past 3 years, approximately 57% of respondents reported an increase in the prevalence of sheep scab. The majority of farmers reported wool loss as the most noticeable clinical symptom (73%). More than 80% of sheep farmers do not use acaricide on a regular basis. Sixty-one percent of farmers prefer a pour-on topical application method. The frequency of annual dipping was every fortnight (40%), during summer and winter (24%). Most farmers (66%) regularly vaccinate their sheep. Conclusion: The prevalence of sheep scab is increasing in these communities; however, a better understanding of the factors that facilitate its transmission is required to allow improved management and control of this disease. The government must involve extension officers and distribute them to disseminate information to farmers. Thus, it will be easy to translate the literature into action.