Risk factors for progression of chronic kidney disease: An investigation in prepubertal children.

AIM: Previous studies on progression of chronic kidney disease (CKD) in children have included older post-pubertal subjects. This study attempted to evaluate risk factors for progression of CKD in pre-pubertal children. METHODS: An observational study of children aged 2-10 years with an eGFR within the limits of >30 and <75 mL/min/1.73 m2 was performed. Presenting clinical and biochemical risk factors, as well as diagnosis, were analysed for their association with progression to kidney failure, time to kidney failure and for the rate of decline of kidney function. RESULTS: One hundred and twenty-five children were studied of whom 42 (34%) had progressed to CKD stage 5 during the median period of follow up of 3.1 (IQR = 1.8-6) years. Hypertension, anaemia and acidosis at entry were associated with progression but they did not predict reaching the end point. Only glomerular disease, proteinuria and stage 4 kidney disease were independent predictors of kidney failure and the time to kidney failure. The rate of kidney function decline was greater in patients with glomerular than non-glomerular disease. CONCLUSIONS: Common modifiable risk factors, when present at initial evaluation, were not independently associated with CKD progression to kidney failure in prepubertal children. Only non-modifiable risk factors and proteinuria predicted eventual stage 5 disease. The physiological changes of puberty may be the major precipitator of kidney failure during adolescence.

High protein content in breast milk from South African mothers of preterm infants.

AIM: Macronutrient and energy content of human milk are largely assumed for fortification practices. The aim was to explore macronutrient and energy content of transition and mature human milk from South African mothers of preterm infants with a birth weight <1800 g. Secondary objectives compared day to night milk; and explored associations with selected innate factors. METHODS: In this single-centre, observational study macronutrient and energy content of day, night and mixed samples of transition (first 14 days of life) and mature (from Day 15 of life) human milk were analysed with mid-infrared spectroscopy. RESULTS: In total, 116 samples (38 days; 37 night; 41 mixed) from 47 mothers were retained for statistical analysis. Mean true protein, carbohydrate, fat and energy content of mixed samples per 100 mL were 1.5 ± 0.4 g, 7.2 ± 0.7 g, 3.5 ± 0.9 g and 69.4 ± 9.9 kcal, respectively. Mixed transition milk (n = 9) had 1.9 ± 0.3 g protein and 67.4 ± 9.6 kcal and mixed mature milk (n = 32) 1.4 ± 0.4 g protein and 70.0 ± 10.1 kcal, per 100 mL.The protein content of transition (p = 0.004) and mature (p = 0.004) milk were significantly higher than published data. Transition milk: 1.5 g protein, 65 kcal; mature milk: 1.2 g protein, 72 kcal per 100 mL. Night samples had less fat (p = 0.014) and energy (p = 0.033) than day samples. With increasing day of life protein content declined (p = 0.003). CONCLUSION: The protein content of human milk from South African mothers of preterm babies differs from published data and has implications for human milk fortification practises.

Combining cervical cancer screening for mothers with schoolgirl vaccination during human papillomavirus (HPV) vaccine implementation in South Africa: results from the VACCS1 and VACCS2 trials.

OBJECTIVE: The platform provided by human papillomavirus (HPV) vaccination for linked public health interventions to improve cervical cancer prevention remains incompletely explored. The Vaccine And Cervical Cancer Screen (VACCS) cross-sectional observation trials aimed to evaluate the efficacy of school-based HPV vaccination linked with maternal cervical cancer screening. METHODS: Girls from 29 schools in two provinces in South Africa were invited in writing to receive HPV vaccination. Two approaches to informed consent were compared, namely an audiovisual presentation (VACCS1) and in written format (VACCS2). Markers of vaccine uptake and coverage were calculated, namely uptake among the invited and consented cohorts, and rates of completion and sufficient vaccination. Mothers and female guardians received educational material about cervical cancer, and either a self-sampling device or an invitation to attend existing screening facilities. Knowledge was assessed via structured questionnaires (before and after), and screening uptake was self-reported and directly assessed and compared between these approaches. RESULTS: Vaccine acceptance among 5137 invited girls was similar for the two methods of consent; 99.3% of consented girls received a first dose; overall completion rate was 90.5%. More girls were vaccinated using a two-dose (974/1016 (95.9%)) than a three-dose regimen (1859/2030 (91.6%)). The questionnaire (n=906) showed poor maternal knowledge which improved significantly (p<0.05) after health education; only 54% of mothers reported any previous screening. The offer of a self-sampling device (n=2247) was accepted by 43.9% of mothers, but only 26% of those invited to screen at existing facilities (n=396) reported subsequent screening. CONCLUSIONS: Successful linking of primary health interventions to control cervical cancer was demonstrated. School-based HPV vaccination, linked to health education, self-sampling, and molecular screening resulted in significant improvements in knowledge and screening.

Resting energy expenditure of a diverse group of South African men and women.

BACKGROUND: In South Africa, overweight/obesity is a public health concern, disproportionally affecting Black females. A contributory role of a lower resting energy expenditure (REE) is suggested for African Americans. The present study assessed the REE of Black and White South African adults aiming to better understand the underlying predictors to overweight/obesity and transform this into locally appropriate recommendations. METHODS: In 328 (63% female; 39% Black) healthy South African adults, REE was measured with indirect calorimetry and body composition with multifrequency bioelectrical impedance analysis. The REE was estimated with 30 sets of published equations. Black-White differences in REE, as measured and adjusted (analysis of covariance), were determined with quantile regression. Reliability/agreement of estimated (against measured) REE was determined with intra-class correlations (ICCs) and Bland-Altman analysis. A new equation was developed by median regression followed by preliminary validation. RESULTS: Measured REE (adjusted for age along with fat-free mass [FFM], FFM index, FFM plus fat mass, FFM index plus fat mass index) in White subjects was significantly higher (p < 0.001) than in Black subjects for men and women alike, regardless of obesity class. None of the sets of estimation equations had good agreement with measured REE for Black, White, male and female subjects simultaneously. A new estimation equation, based on whole-body variables, had good reliability (ICC = 0.79) and agreement (mean difference: 27 kJ) and presents practical opportunities for groups at the local grass-roots level. CONCLUSIONS: The REE in Black South African adults is lower than in White adults. Tailored REE equations may improve REE estimation of racially/ethnically diverse South African groups and contribute to improved obesity management.

A novel screening tool to predict severe acute malnutrition through automated monitoring of weight-for-age growth curves.

Weight-for-age (WFA) growth faltering often precedes severe acute malnutrition (SAM) in children, yet it is often missed during routine growth monitoring. Automated interpretation of WFA growth within electronic health records could expedite the identification of children at risk of SAM. This study aimed to develop an automated screening tool to predict SAM risk from WFA growth, and to determine its predictive ability compared with simple changes in weight or WFA z-score. To develop the screening tool, South African child growth experts (n = 30) rated SAM risk on 100 WFA growth curves, which were then used to train an artificial neural network (ANN) to assess SAM risk from consecutive WFA z-scores. The ANN was validated in 185 children under five (63 SAM cases; 122 controls) using diagnostic accuracy methodology. The ANN's performance was compared with that of changes in weight or WFA z-score. Even though experts' SAM risk ratings of the WFA growth curves differed considerably, the ANN achieved a sensitivity of 73.0% (95% confidence interval [CI]: 60.3; 83.4), specificity of 86.1% (95% CI: 78.6; 91.7) and receiver-operating characteristic curve area of 0.795 (95% CI: 0.732; 0.859) during validation with real cases, outperforming changes in weight or WFA z-scores. The ANN, as an automated screening tool, could markedly improve the identification of children at risk of SAM using routinely collected WFA growth information.

In-hospital Growth of Very Low Birth Weight Preterm Infants: Comparative Effectiveness of 2 Human Milk Fortifiers.

OBJECTIVE: Amidst a high prevalence of prematurity, limited research on the growth of very low birth weight (VLBW) preterm infants and the availability of a reformulated fortifier c(RF), the study aimed to compare in-hospital growth of such infants receiving exclusively human milk fortified with either of 2 different formulations in a tertiary South African hospital. METHODS: In a prospective comparative effectiveness design, intakes and growth of VLBW infants on the Original Fortifier (OF; 2016-2017) were compared with those receiving RF (2017-2018). Daily intake was calculated using published composition of preterm and mature milk with fortifier (OF: 0.2 g protein, 3.5kcal/g powder; RF: 0.4 g protein, 4.4 kcal/g powder). Change in z scores from start to end of fortification for weight (WFAZ), length (LFAZ), and head circumference (HCFAZ) for age was the primary outcome. Additionally, weight gain velocity (g ·â€Škg-1 ·â€Šday-1) and gain in length and head circumference (HC) (cm/week) were calculated. RESULTS: Fifty-eight infants (52% girls; gestational age: 30 ±â€Š2 weeks; birth weight: 1215 ±â€Š187 g) received OF for 16 days and 59 infants (56% girls; gestational age: 29 ±â€Š2 weeks; birth weight 1202 ±â€Š167 g) received RF for 15 days. Protein intake of RF (3.7 ±â€Š0.4 g ·â€Škg-1 ·â€Šday-1) was significantly higher (P < 0.001) than of OF (3.4 ±â€Š0.2 g ·â€Škg-1 ·â€Šday-1). Protein-to-energy ratio of RF (2.6 ±â€Š0.2 g/100 kcal) was significantly higher (P < 0.001) than of OF (2.3 ±â€Š0.1 g/100 kcal). In both groups, WFAZ and LFAZ decreased; HCFAZ improved slightly. No significant differences (P > 0.05) were noted between the 2 groups for change in z scores, weight gain velocity, length or HC gain. CONCLUSIONS: Despite a modest increase in protein intake and protein-to-energy ratio, the growth of VLBW infants on RF was not better than on OF during their hospital stay.

Apoptotic profiling of chronic myeloid leukaemia patients' platelets ex vivo before and after treatment with Imatinib.

Chronic myeloid leukaemia (CML) is a malignancy of the haematopoietic stem cells. The first line of treatment for CML, especially in developing countries, remains the first-generation tyrosine kinase inhibitor, Imatinib. Patients with CML are frequently diagnosed with platelet abnormalities. However, the specific mechanism of platelet abnormalities in CML remains unclear and poorly understood. The aim of this study was therefore to determine the apoptotic profiles of CML patients ex vivo on platelets before and after treatment with Imatinib. Blood samples of healthy volunteers and CML patients at diagnosis and after 6 months treatment with Imatinib were collected. Platelet counts, viability and activation were determined. Results showed that CML patients' platelet counts were elevated upon diagnosis and these levels statistically significantly decreased after 6 months of treatment. Platelet activation was significantly increased after 6 months of treatment compared to levels at diagnosis (P-value < .05). Similarly, platelet apoptosis was also increased after 6 months of treatment. Abnormalities in platelet functioning found in this study may partly be due to clonal proliferation of haematopoietic cells in CML patients, specifically of megakaryocyte precursors as well as the inhibition of platelet tyrosine kinase's and the inhibition of platelet-derived growth factor.

Cardiovascular response to whole-body vibration on an automobile seat.

The study aim was to determine whether a relationship exists between the cardiovascular response, measured by HR and HRV and the magnitude of whole-body vibration. Cardiovascular response of sixty male participants in four groups, was measured during three states i.e. (1) no vibration, (2) a reference vibration and (3) an alternative vibration. The reference vibration was the same for all groups with the alternative vibrations different for each group. Weighted vertical seat vibration was 0.66 m.s-2, root-mean-square for the reference and 0.70, 0.73, 0.76, and 0.79 m.s-2, root-mean-square for the alternative vibrations. Vibrations only differed in magnitude with the difference between alternative vibrations based on relative difference thresholds. Nonparametric tests compared cardiovascular indicators between groups at State 3 adjusted for state of departure i.e. State 2. No significant differences between groups were found for most of the indicators, suggesting no relationship between cardiovascular response and the magnitude of whole-body vibration. Practitioner summary: The cardiovascular response to the magnitude of whole-body vibration on an automobile seat was investigated. Results suggest that no relationship exists between the magnitude and cardiovascular response and that the latter may not be as effective as other objective measures (e.g. acceleration) in evaluating the human's response to whole-body vibration.

The role of Mental Health Care Act status in dignity-related complaints by psychiatric inpatients: A cross-sectional analytical study.

BACKGROUND: Globally interest has grown in promoting the rights of patients, especially psychiatric patients. Two core elements of patients' rights are the rights to be treated in a dignified manner and to give feedback about services. Psychiatric patients may feel treated in an undignified manner, especially during involuntary hospital admissions. AIM: We explored the relationship between Mental Health Care Act 17 of 2002 (MHCA) status and dignity-related complaints. SETTING: The study was conducted at a specialist state psychiatric hospital. METHODS: We reviewed 120 registered complaints by psychiatric inpatients, retrieved the clinical files, and analysed 70 complaints. Fisher's exact tests described the relationship between patients' MHCA status and the frequency of dignity-related or other categories of complaints. Logistic regression analyses were adjusted for potential covariates. RESULTS: Most complaints were from single, literate male patients, aged 30-39 years, with mood disorders. Most complainants were admitted involuntarily (60%). Dignity-related complaints (n = 41; 58%) outnumbered nondignity-related complaints (n = 29; 41%). The proportion of dignity-related complaints was higher in involuntary (64%) and assisted (60%) patients than in voluntary patients (44%). Dignity-related complaints were not significantly associated with MHCA status (χ2 = 2.03 and p = 0.36). Involuntary patients were more than twice as likely as assisted and voluntary patients to complain about dignity-related matters (Odds ratio [OR]: 2.25; 95% confidence interval [CI] [0.71; 7.13]; p = 0.16). CONCLUSION: Involuntary patients are more likely to complain about dignity-related matters. Qualitative research is recommended for a deeper understanding of patients' experiences during admission.

Corrigendum: Do medical students feel career ready after their psychiatry clinical rotation?

[This corrects the article DOI: 10.4102/sajpsychiatry.v25i0.1397.].

Treatment Outcomes and Adverse Drug Effects of Ethambutol, Cycloserine, and Terizidone for the Treatment of Multidrug-Resistant Tuberculosis in South Africa.

Treatment outcomes among multidrug-resistant tuberculosis (MDR-TB) patients receiving ethambutol, cycloserine, or terizidone as part of a standardized regimen were compared, determining occurrence of serious adverse drug events (SADEs). Newly diagnosed adult MDR-TB patients were enrolled between 2000 and 2004, receiving a standardized multidrug regimen for 18 to 24 months, including ethambutol, cycloserine, or terizidone. Cycloserine and terizidone were recorded individually. SADEs and factors associated with culture conversion and unfavorable treatment outcomes (default, death, treatment failure) were determined. Of 858 patients, 435 (51%) received ethambutol, 278 (32%) received cycloserine, and 145 (17%) received terizidone. Demographic and baseline clinical data were comparable. Successful treatment occurred in 56%, significantly more in patients receiving cycloserine (60%) and terizidone (62%) than in those receiving ethambutol (52% [P = 0.03]). Defaults rates were 30% in ethambutol patients versus 15% and 11% for cycloserine and terizidone patients, respectively. Terizidone was associated with fewer unfavorable outcomes (adjusted odds ratio [AOR], 0.4; P = 0.008; 95% confidence interval [CI], 0.2 to 0.8). Patients receiving cycloserine were more likely to achieve culture conversion than those receiving ethambutol or terizidone (AOR, 2.2; P = 0.02; 95% CI, 1.12 to 4.38). Failure to convert increased the odds of unfavorable outcomes (AOR, 23.7; P < 0.001; 95% CI, 13 to 44). SADEs were reported in two patients receiving ethambutol, seven patients receiving cycloserine, and three receiving terizidone (P = 0.05). Ethambutol was associated with high culture conversion and default rates. Cycloserine achieved higher culture conversion rates than terizidone. Fewer patients on terizidone experienced SADEs, with lower default rates. The differences that we observed between cycloserine and terizidone require further elucidation.

Validity of Commonly Used Heart Rate Variability Markers of Autonomic Nervous System Function.

BACKGROUND: Despite strong reservations regarding the validity of a number of heart rate variability (HRV) measures, these are still being used in recent studies. AIMS: We aimed to compare the reactivity of ostensible sympathetic HRV markers (low and very low frequency [LF and VLF]) to that of electrodermal activity (EDA), an exclusively sympathetic marker, in response to cognitive and orthostatic stress, investigate the possibility of LF as a vagal-mediated marker of baroreflex modulation, and compare the ability of HRV markers of parasympathetic function (root mean square of successive differences [RMSSD] and high frequency [HF]) to quantify vagal reactivity to cognitive and orthostatic stress. RESULTS: None of the purported sympathetic HRV markers displayed a reactivity that correlated with electrodermal reactivity. LF (ms2) reactivity correlated with the reactivity of both RMSSD and HF during baroreflex modulation. RMSSD and HF indexed the reactivity of the parasympathetic nervous system under conditions of normal breathing; however, RMSSD performed better as a marker of vagal activity when the task required breathing changes. CONCLUSIONS: Neither LF (in ms2 or normalized units [nu]) nor VLF represent cardiac sympathetic modulation of the heart. LF (ms2) may reflect vagally mediated baroreflex cardiac effects. HRV linear analysis therefore appears to be restricted to the determination of vagal influences on heart rate. With regard to HRV parasympathetic markers, this study supports the suggestion that HRV frequency domain analyses, such as HF, should not be used as an index of vagal activity in study tasks where verbal responses are required, as these responses may induce respiratory changes great enough to distort HF power.

A nutrition education programme improves quality of life but not anthropometric status of adults living with HIV in Abeokuta, Nigeria.

OBJECTIVE: The focus of interventions for adults living with HIV (ALH) in Nigeria has been mostly on prevention and provision of antiretroviral therapy (ART) with little consideration to nutrition-related matters. Therefore, the present study aimed to improve the quality of life (QoL) and anthropometric status of ALH in Abeokuta, Nigeria. DESIGN: A quasi-experimental design where 200 conveniently selected participants were stratified by gender and duration on ART. The intervention group (n 100) received the nutrition education programme (NEP) for 12 weeks. The control group received a brochure on nutrition guidelines for ALH. Socio-biographical information, QoL and anthropometric status were assessed using previously validated questionnaires and standard techniques at baseline, week 12 and week 24. Generalised least squares (GLS) regression analysis was used for group comparisons. Anthropometric status was summarised by gender. SETTING: Two tertiary hospitals in Abeokuta, Nigeria. PARTICIPANTS: ALH. RESULTS: The NEP led to significant improvement in the physical functioning (week 12 and 24: P < 0·01), role limitation due to physical health (week 12: P = 0·01; week 24: P = 0·002) and pain (week 12: P = 0·01) constructs of the QoL of the intervention group compared with the control group. There was no significant difference (P = 0·07) between the mean weights of the two groups at baseline. CONCLUSIONS: There was a significant improvement at week 12 and week 24 in the QoL of the intervention participants. The results indicated that a tailored NEP could make a positive contribution to the management of ALH.

Do medical students feel career ready after their psychiatry clinical rotation?

BACKGROUND: In the South African healthcare system, mentally ill patients first come into contact with primary care physicians who then refer these patients for specialised care if needed. Medical students therefore need to acquire the knowledge, skills and confidence to treat mentally ill patients. AIM: To evaluate the perceptions of medical students regarding their career readiness as doctors after their clinical rotation in psychiatry. SETTING: The University of Pretoria, South Africa. METHODS: Data were collected retrospectively from questionnaires completed by final year medical students from 2011 to 2015. These data were analysed overall and by year using Chi-square tests and regression analyses (N = 770). RESULTS: Overall, 93.10% of medical students felt adequately prepared for their role as medical practitioners after their clinical rotation in psychiatry. The proportion of medical students exposed to post-traumatic stress disorder (p = 0.012), obsessive-compulsive disorder (p = 0.006) and alcohol-use disorder (p = 0.046) was found to vary significantly by year. Exposure to any one psychiatric condition did not influence perceptions of career preparedness. Students perceived themselves to be career ready if they had sufficient exposure to mentally ill patients, knowledge about prescribing appropriate psychiatric medication and especially psychiatric interviewing skills. CONCLUSION: Students who completed practical and clinical training in psychiatry perceived themselves to be career ready.

The impact of a change in work posture from seated to stand-up on work-related musculoskeletal disorders among sewing-machine operators.

BACKGROUND: Work-related postural change could lead to improved musculoskeletal health. METHOD(S): In a quantitative, retrospective, longitudinal study, data of work-related musculoskeletal disorders of 123 sewing-machine operators were captured for 4.5 years, and analysed using Poisson regression. RESULTS: Stand-up work posture (SUWP) reduced the incidence for spinal disorders (SD) to 0.29 fold the incidence for sitting work posture (SWP) (P < 0.001). Morbid obesity had significantly increased (P = 0.04) incidence of upper limb disorders (ULD), 3.35 times that of normal body mass index (BMI) (regardless of work posture). SUWP was associated with increased IRR (1.49) for lower limb disorders (LLD). LLDs were associated with obesity (overweight (IRR = 2.58; P = 0.08), obese (IRR = 2.45; P = 0.09), and morbidly obese (IRR = 6.24; P = 0.001)). CONCLUSIONS: The protective benefit of the SUWP was statistically significant for SD incidence. Owing to high mean BMI, SUWP had a negative impact on the incidence of LLDs for the first 2 months.

Comparative efficacy of three antiseptics as surgical skin preparations in dogs.

OBJECTIVE: To compare the antimicrobial efficacy of a 2% chlorhexidine gluconate and 70% ethanol solution (CG+A) with that of F10 Skin Prep Solution (F10) and electrochemically activated water (EAW) when used as a surgical preparation in canine patients. STUDY DESIGN: Prospective randomized clinical study. SAMPLE POPULATION: One hundred sixteen dogs presented for ovariohysterectomy. METHODS: Dogs were randomly divided into 1 of the 3 antiseptic groups (CG+A, F10, EAW). Skin samples with replicating organism detection and counting plates were taken at 4 different perioperative sites and time intervals (postskin preparation, postskin antisepsis, 2 hours after the second sample, and at the end of surgery) during ovariohysterectomies performed by students. The colony forming unit (CFU) counts from each sample were quantified according to the level of bacterial contamination. Zero CFU was defined as no contamination, 1-12 CFU was defined as low contamination, and greater than 12 CFU was defined as high contamination. The 3 antiseptics were compared with respect to the level of contamination. RESULTS: There was no difference in the level of colonization between the antiseptics at the first sampling time (P = .454). However, the level of contamination for CG+A was lower compared with F10 and EAW at the second, third, and fourth sampling times (P = .001, P = .01, P = .02, respectively). CONCLUSION: CG+A was more effective at achieving a zero CFU count and low levels of contamination compared with F10 and EAW for surgical preparation in dogs undergoing ovariohysterectomy. CLINICAL SIGNIFICANCE: This study does not provide evidence to support the use of F10 and EAW instead of CG+A for the surgical skin preparation of dogs undergoing ovariohysterectomy.

Growth in HIV-infected children on long-term antiretroviral therapy.

OBJECTIVES: To describe growth in HIV-infected children on long-term antiretroviral therapy (ART) and to assess social, clinical, immunological and virological factors associated with suboptimal growth. METHODS: This observational cohort study included all HIV-infected children at an urban ART site in South Africa who were younger than 5 years at ART initiation and with more than 5 years of follow-up. Growth was assessed using weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores (BAZ). Children were stratified according to pre-treatment anthropometry and age. Univariate and mixed linear analysis were used to determine associations between independent variables and weight and height outcomes. RESULTS: The majority of the 159 children presented with advanced clinical disease (90%) and immunosuppression (89%). Before treatment underweight, stunting and wasting were common (WAZ<-2 = 50%, HAZ<-2 = 73%, BAZ<-2 = 19%). Weight and BMI improved during the initial 12 months, while height improved over the entire 5-year period. Height at study exit was significantly worse for children with growth impairment at ART initiation (P < 0.001), and infants (<1 year) demonstrated superior improvement in terms of BMI (P = 0.04). Tuberculosis was an independent risk factor for suboptimal weight (P = 0.01) and height (P = 0.02) improvement. Weight gain was also hindered by lack of electricity (P = 0.04). Immune reconstitution and virological suppression were not associated with being underweight or stunted at study endpoint. CONCLUSIONS: Malnutrition was a major clinical concern for this cohort of HIV-infected children. Early ART initiation, tuberculosis co-infection management and nutritional interventions are crucial to ensure optimal growth in HIV-infected children.

Field effectiveness of microbial larvicides on mosquito larvae in malaria areas of Botswana and Zimbabwe.

BACKGROUND: The successful control of malaria vectors requires the control of both the larval and adult stages. The adult control methods through indoor residual spraying (IRS) and use of long-lasting insecticidal nets (LLINs) continue to be widely used with some high measure of success. Larval control methods are also being used by a number of National Malaria Control Programmes (NMCPs) with limited understanding of its contribution. Larval control might be needed in some areas to move from malaria control to elimination. This experimental study was conducted to assess the field effectiveness of winter larviciding on the larval stages of the mosquito in Botswana and Zimbabwe. METHODS: Two villages were selected in each of the two countries, one as an intervention and the other as the control. Water bodies in the intervention villages were treated using the commercial product VectoBac® WG (Valent BioSciences Corporation, IL, USA) containing the active ingredient Bacillus thuringiensis var. israelensis (Bti), a WHO recommended bio-larvicide, applied at a rate of 300 g per hectare. Random-effects Poisson regression was employed during data analysis to compare intervention with control sites with respect to larval counts. RESULTS: The average marginal effect of larviciding on the mosquito larvae taking interaction with time (period) into account, was -1.94 (95% CI -2.42 to -1.46) with incidence rate ratio of 0.14, thus an 86% larval reduction attributable to the intervention for both countries combined. There was a 92% and 65% effect for Botswana and Zimbabwe respectively. The effect on the early larval and late stages was 77% (P < 0.001) and 91% (P < 0.001), respectively. Overall, intervention larval sampling points had five more larvae than the control at baseline and 26 less after 16 weeks. The effect on the different species also showed similar trends. DISCUSSION/CONCLUSION: Larval control using Bti showed a high effect on the population of the mosquito larvae. The reduction of the early and late larval stages can lead to reduced adult mosquito emergence and low adult mosquito densities. Larviciding can be used to control mosquito vector population by suppressing the larval stages thereby reducing adult emergence and malaria risk.

Resting Energy Expenditure of Black Overweight Women in South Africa Is Lower than of White Women.

BACKGROUND: Overweight affects 65% of black South African women. Effective weight management requires accurate measurement or estimation of energy expenditure. AIMS: The study aimed to determine, among overweight women, whether measured resting energy expenditure (REE) differs between black and white participants, and the performance of REE estimation equations. METHODS: The REE of 44 black (age 39.6 ± 9.7 years, body mass index (BMI) 35.1 ± 6.2 kg/m2) and 41 white (age 38.0 ± 11.6 years, BMI 33.9 ± 7.6 kg/m2) women was measured with indirect calorimetry and estimated with equations. Body composition was assessed with multi-frequency bioelectrical impedance analysis. Differences in REE were determined with t tests (Welch), and included adjustment for fat free mass (FFM) and BMI, and for FFM index (FFMI). RESULTS: Measured REE was 585 kJ/day (95% CI 264-905; p = 0.0005) and 861 kJ/day (95% CI 499-1,221; p < 0.0001) lower in black than in white women when adjusted for FFM and BMI, and FFMI, respectively. Out of 14 equations, 13 underestimated REE (error range 2,261 ± 727 kJ/day (Bernstein equation, white women) to 8 ± 782 kJ/day (BMI equation, black women)). CONCLUSIONS: Black overweight women have significantly lower REE than their white counterparts. No tested estimation equation provided satisfactory results across race/ethnicity. REE measurements or development of overweight- or race/ethnicity-specific estimation equations are recommended.

Unique human papillomavirus-type distribution in South African women with invasive cervical cancer and the effect of human immunodeficiency virus infection.

OBJECTIVES: Cervical cancer is the most common cause of cancer-related deaths among South African women. Viral types associated with cervical cancer may differ not only between countries and regions, but possibly also between human immunodeficiency virus (HIV)-infected and noninfected women. METHODS: In a population with high HIV prevalence, human papillomavirus (HPV)-type infections detected with DNA analyses were reported in a cohort of 299 women diagnosed with invasive cervical cancer. RESULTS: One hundred fifty-four women tested HIV negative, 77 tested HIV positive, and HIV status was unknown for 68 women. The mean age for HIV-positive women was 41.3 years, and that for HIV-negative women was 55.8 years (P < 0.001). Ninety-two percent of women tested HPV-DNA positive. Human papillomavirus types 16 and/or 18 were present in 62% of HIV-negative women and 65% of HIV-positive women. The 5 most common HPV types in HIV-positive women were, in decreasing frequency, HPV 16, 18, 45, 33, and 58. In HIV-negative women, the most common HPV types were HPV 16, 18, 35, and 45, followed by HPV 33 and 52. Human papillomavirus type 45 was more likely in the HIV positive compared with the HIV negative (odds ratio, 3.07; 95% confidence interval, 1.07-8.77). The HIV-positive women had more multiple high-risk HPV-type infections than did the HIV-negative women (27% vs 8%, P = 0.001). CONCLUSIONS: A high number of women in South Africa with cervical cancer are HIV positive. Without viral cross-protection, HPV vaccines should prevent around 65% of cervical cancers in this population. Human papillomavirus type 45 infection is significantly linked to HIV and important for future vaccine developments.