Qualitative and quantitative detection of SARS-CoV-2 RNA in untreated wastewater in Western Cape Province, South Africa.

Recent studies have shown that the detection of SARS-CoV-2 genetic material in wastewater may provide the basis for a surveillance system to track the environmental dissemination of this virus in communities. An effective wastewater-based epidemiology (WBE) system may prove critical in South Africa (SA), where health systems infrastructure, testing capacity, personal protective equipment and human resource capacity are constrained. In this proof-of-concept study, we investigated the potential of SARS-CoV-2 RNA surveillance in untreated wastewater as the basis for a system to monitor COVID-19 prevalence in the population, an early warning system for increased transmission, and a monitoring system to assess the effectiveness of interventions. The laboratory confirmed the presence (qualitative analysis) and determined the RNA copy number of SARS-CoV-2 viral RNA by reverse transcription polymerase chain reaction (quantitative) analysis from 24-hour composite samples collected on 18 June 2020 from five wastewater treatment plants in Western Cape Province, SA. The study has shown that a WBE system for monitoring the status and trends of COVID-19 mass infection in SA is viable, and its development and implementation may facilitate the rapid identification of hotspots for evidence-informed interventions.

Fatal pyrrolizidine alkaloid poisoning of infants caused by adulterated Senecio coronatus.

Senecio coronatus (known as izonkozonko and ubulibazi in Zulu) is commonly used in traditional medicine in South Africa as purification purgative and enemas for infants during weaning. We show for the first time that this species does not contain pyrrolizidine alkaloids and that reported cases of fatal hepatic sinusoidal obstruction syndrome in infants were caused by wrongly identified Senecio species containing large amounts of retrorsine-N-oxide. A validated ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method for the detection and quantitation of pyrrolizidine alkaloids is described.

Prevalence of hookah pipe smoking in high-school learners in Johannesburg, South Africa.

BACKGROUND: Hookah pipe (HP) smoking has become popular globally, especially among young adults and adolescents. There are misperceptions regarding the safety of HP smoking, relative to cigarettes. OBJECTIVES: To assess the prevalence of HP use in grade 8 and 12 students and the factors associated with use in the different age groups. METHODS: A cross-sectional study was conducted in grade 8 and 12 high-school students from six randomly selected public schools in Johannesburg, South Africa. A self-administered structured questionnaire was completed by students after consent had been obtained from parents and students. The questionnaire focused on knowledge and awareness of HP smoking. Data were analysed using Stata/SE version 15. A p-value <0.05 was considered significant. RESULTS: A total of 347 grade 8 and 232 grade 12 students participated in the study. Of the sample, 26% in grade 8 and 70% in grade 12 had ever smoked an HP. In both grades a higher proportion of males smoked. Eleven percent of students in grade 8 and 37% in grade 12 were currently smoking the HP. Approximately 47% and 51% of grade 8 and grade 12 students, respectively, first started smoking at parties. The mean age of initiation was 8 and 12 years in grade 8 and 12, respectively. Grade 12 students had greater awareness of the risks of HP smoking. Having a family member who smoked an HP was significantly related to HP use in grade 8 students. Overall, factors associated with increased odds of smoking the HP were being in grade 12, not being aware of health effects, and seeing the health warnings on hookah tobacco package labels. CONCLUSIONS: HP smoking increased significantly between grades 8 and 12. Increasing knowledge and awareness of the risks involved in HP smoking in children at an early age is recommended. One of the factors influencing uptake of HP smoking in young students was having a family member smoking it; adult anti-smoking and anti-HP campaigns are therefore also important.

Living conditions and respiratory health in Walmer Township and Wells Estate, Port Elizabeth, South Africa.

BACKGROUND: Many impoverished communities in South Africa (SA) simultaneously face multiple preventable socioenvironmental hazards associated with elevated burdens of ill health. One such hazard is failure to institute effective buffer zones between human settlements and point sources of pollution such as airports and industrial zones. OBJECTIVES: To gather information on living conditions, housing quality and health status in two poor communities in the SA coastal industrial city of Port Elizabeth. METHODS: The study was undertaken in Walmer Township, situated in close proximity to Port Elizabeth International Airport, and Wells Estate, which borders two industrial sites. Approximately 120 households were randomly selected from each study site. Following written informed consent, information on the neighbourhood environment and housing conditions was collected through administration of a structured questionnaire. RESULTS: The two study sites were similar in respect of household language, income, education, high levels of debt servicing and high reliance on social grants. Relative to Walmer Township, higher levels of indoor dust and bad odours in the neighbourhood were reported in Wells Estate, as were higher rates of selected respiratory ill-health symptoms. Upper respiratory tract symptoms were significantly associated with reports of high levels of indoor dust, while lower respiratory tract symptoms were significantly associated with low income, overcrowding, and having a young child in the household. CONCLUSIONS: The study highlights a scenario of a triple environmental hazard to health in the study communities: (i) poverty; (ii) poor-quality housing; and (iii) lack of an effective buffer zone between the study communities and local point sources of pollution. Respiratory ill-health conditions were significantly associated with poverty, household composition and living conditions.

Gathering the evidence and identifying opportunities for future research in climate, heat and health in South Africa: The role of the South African Medical Research Council.

BACKGROUND: A changing climate is likely to have widespread and varying impacts on ecosystems and human health. South Africa (SA) is particularly vulnerable to the impacts of climate change, given the projected increases in temperature, and changes in the amount and patterns of rainfall. Moreover, SA's vulnerability is exacerbated by extreme inequality and poverty. To prepare for the impacts of climate change and to ensure timeous adaptation, a perspective is given on essential heat and health research in the country. Objectives. To gather studies conducted by the South African Medical Research Council (SAMRC)'s Environment and Health Research Unit (EHRU) to illustrate the range of possible research key areas in the climate, heat and health domain and to present future research priorities. Methods. Studies conducted by the SAMRC's EHRU were gathered and used to illustrate the range of possible research key areas in the climate, heat and health domain. Using national and international published and grey literature, and tapping into institutional research experiences, an overview of research findings to date and future research priorities were developed. Results. Heat and health-related research has focussed on key settings, for example, schools, homes and outdoor work places, and vulnerable groups such as infants and children, the elderly and people with pre-existing diseases. The need to address basic needs and services provision was emphasised as an important priority. Conclusions. High and low temperatures in SA are already associated with mortality annually; these impacts are likely to increase with a changing climate. Critical cross-sectoral research will aid in understanding and preparing for temperature extremes in SA.

The role of the South African Medical Research Council in reducing lead exposure and preventing lead poisoning in South Africa.

Even at low levels in blood, lead has been associated with reduced IQ scores, behavioural problems, learning impediments, aggression and violent behaviour. Since the 1980s, the South African Medical Research Council (SAMRC) has been investigating the sources of exposure to lead in South Africa (SA), the groups at highest risk of lead poisoning and a selection of the myriad associated health and social consequences. SAMRC research evidence contributed to the phasng out of leaded petrol, restrictions on lead in paint and other interventions. Subsequently, childhood blood lead levels in SA declined significantly. More recent studies have revealed elevated risks of lead exposure in subsistence fishing and mining communities, users of arms and ammunition, those ingesting certain traditional medicines, and users of certain ceramicware and artisanal cooking pots. Lead-related cognitive damage costs the SA economy ~USD17.7 (ZAR261.3) billion annually, justifying further SAMRC investment in lead exposure research in the country.

Prevalence of tobacco use in selected Johannesburg suburbs.

BACKGROUND: Tobacco smoking is estimated to kill more than 44 000 South Africans every year. Studies have shown that since the introduction of tobacco control measures, national smoking prevalence has declined in South Africa (SA). OBJECTIVE: To determine the prevalence of tobacco smoking over a 7-year period in five impoverished neighbourhoods in Johannesburg, SA. METHODS: Data were collected through the annual administration of a prestructured questionnaire to one adult respondent in preselected dwellings from 2006 to 2012. Information was collected on socioeconomic status, smoking practices and health status. RESULTS: Over the 7-year period of the analysis, smoking levels remained unchanged. The proportion of households with one or more smokers varied significantly across the five study neighbourhoods. Approximately 20% of households in Hillbrow and as many as 77% in Riverlea had a member who smoked. CONCLUSIONS: Despite a national downward trend in smoking levels, tobacco use remains high and persistent in certain vulnerable communities, requiring scaled-up action to reduce the risk of a range of tobacco-related diseases.

Lead poisoning in shooting-range workers in Gauteng Province, South Africa: Two case studies.

BACKGROUND: Lead exposure constitutes a major public health concern globally. Relative to developed nations, lead exposure is understudied and poorly addressed in Africa, and there is a dearth of information available to inform lead poisoning prevention strategies, even in high-risk groups such as workers in shooting ranges who are potentially exposed to lead daily. METHODS: Two workers at a private shooting range in Gauteng, South Africa (SA), had blood lead levels and exposure histories taken. RESULTS: Workers had highly elevated blood lead levels and clinical symptoms associated with elevated blood lead levels. CONCLUSION: Workers in private SA shooting ranges are vulnerable to lead exposure and poisoning, and scaled-up action is required to protect them and their families, as well as shooting-range users, from lead and the related health risks.

Food insecurity in households in informal settlements in urban South Africa.

Food insecurity in the urban poor is a major public health challenge. The Health, Environment and Development study assessed trends in food insecurity and food consumption over a period of 7 years in an informal settlement in Johannesburg, South Africa (SA). Annual cross-sectional surveys were conducted in the informal settlement (Hospital Hill). The degree of household food insecurity decreased significantly from 2006 (85%) to 2012 (70%). There was a spike in 2009 (91%), possibly owing to global food price increases. Childhood food insecurity followed the same trend as household food insecurity. During the first 3 study years, consumption of protein, vegetables and fruit decreased by 10-20%, but had returned to previous levels by 2012. In this study, although declining, food insecurity remains unacceptably high. Hunger relief and poverty alleviation need to be more aggressively implemented in order to improve the quality of life in poor urban communities in SA.

Using behavior change to reduce child lead exposure in resource-poor settings: a formative study.

The objective of this formative research was to explore the acceptability and feasibility of changing housekeeping behaviors as a low-cost approach that may reduce childhood lead exposure in Johannesburg, South Africa. Using the Trials of Improved Practices (TIPs) methodology, modified housekeeping behaviors were negotiated with participants who chose the behaviors they wanted to try and then performed them in their homes over 4 weeks. Researchers interviewed them at the end of the month to understand their experience of trying out the behaviors. The modified behaviors offered to each participant were as follows: cleaning window sills with detergent and water, cleaning window sills more frequently, mopping floors with two buckets (one with soapy water for washing and one with clean water for rinsing), mopping floors more frequently, dusting surfaces with detergent and water and dusting surfaces more frequently. Participants found cleaning window sills with soap and water and cleaning them more often the most acceptable and feasible of behavior modifications. Environmental samples showed a significant reduction in lead dust on window sills. These findings can assist in the development of acceptable and feasible medium-term interventions to reduce childhood lead exposure in resource-poor settings until more robust health policies are implemented.

Heavy metal contamination in a school vegetable garden in Johannesburg.

BACKGROUND: Feeding schemes based on school garden produce have been proposed as an effective solution to food insecurity and hunger among learners in South Africa. However, few studies have looked at the potential contamination of school food gardens when situated near mine tailing dams. OBJECTIVES: The aim of the study was to evaluate the potential heavy metal contamination in a school vegetable garden in Johannesburg. METHODS: Twenty soil samples were collected from the study school and a comparison school. Surface and deep (±10 cm beneath the surface) soil samples were analysed using X-ray fluorescence for levels of arsenic, chromium, copper, lead and zinc. Thirteen vegetables samples were collected from the school garden, and compared with six samples from a national retailer and four obtained from a private organic garden. The heavy metal concentrations of the vegetable samples were analysed in the laboratories of the South African Agricultural Research Council. RESULTS: High levels of arsenic were found in the school soil samples, and elevated concentrations of lead and mercury in the school vegetables. Calculation of the estimated daily intake for a child of 30 kg however, indicated that levels of lead, mercury and arsenic in vegetables were within acceptable limits. However, the levels of lead in the vegetable samples were high across all three sites. CONCLUSION: Further investigation and research should be undertaken to assess the source/s and extent of public exposure to heavy metals in vegetables in South Africa.

The prevalence of intentional and unintentional injuries in selected Johannesburg housing settlements.

Intentional and unintentional injuries were reported to be the second leading cause of Disability Adjusted Life Years in South Africa in 2000. We present household experiences of such injuries in 5 impoverished housing settlements in Johannesburg, Gauteng Province. Data for this study were extracted from the database of the Health, Environment and Development (HEAD) project. The incidence of reported intentional injuries was determined to be double that of unintentional injuries. Households in the Hospital Hill and Riverlea settlements reported the highest prevalence of stabbing and gunshot incidents. We concluded that impoverished South African neighbourhoods bear a high burden of intentional injury; surveillance mechanisms are required to inform prevention strategies at an individual, community and societal level.

A preliminary study of residential paint lead concentrations in Johannesburg.

While efforts are underway to phase out the use of leaded petrol in South Africa, relatively little attention has been devoted to the potential for childhood exposure to lead used in paint. This is one of the first studies undertaken on the African continent to report on the presence of lead-based paint. In South Africa, there is a dearth of information available on the extent of past and current use of lead-based paint. Recent studies demonstrate that large numbers of young South African children continue to be at risk of elevated blood lead concentrations. To investigate the prevalence of lead-based paint in Johannesburg dwellings, the South African Medical Research Council recently undertook a preliminary study in which samples of residential paint were collected from homes in 60 randomly selected suburbs across the city. The results indicate that 17% of all of the samples collected were lead-based paint (paint that contains lead levels equal to or greater than 0.5% by weight). The percentage of lead by weight in the samples ranged from 0.01% to 29.00%. Lead-based residential paint was found in 20% of the sampled homes, located in both new and old suburbs, and in suburbs from a variety of different socioeconomic backgrounds. These results, in conjunction with those emanating from other studies of childhood lead exposure currently being conducted by the Medical Research Council, indicate that weathering, peeling, or chipping lead-based paint may play an important role in childhood lead exposure in South Africa. Children who have a pica tendency may be at particular risk.

Testing selected behaviors to reduce indoor air pollution exposure in young children.

Indoor air pollution is responsible for the deaths and illness of millions of young children in developing countries. This study investigated the acceptability (willingness to try) and feasibility (ability to perform) of four indoor air pollution reduction behaviors (improve stove maintenance practices, child location practices, ventilation practices and reduce the duration of solid fuel burning). The study further aimed to identify the motivations for and barriers against modifying the behaviors, the perceived impact of the behaviors on children's respiratory health, and families intention to continue with the behaviors. Thirty families in a rural village of South Africa tried out one or more of the behaviors over a 4-week trial period during winter 2002. Improving stove maintenance and reducing the duration of solid fuel burning proved to be very difficult for most families. It is recommended that the main intervention should focus on improving child location and ventilation practices.

Comparison of indoor air quality in electrified and un-electrified dwellings in rural South African villages.

UNLABELLED: A feasibility study was undertaken to assess the suitability of South African rural villages due to be electrified, for the purposes of undertaking a large-scale study of the impact of reductions in indoor air pollution on acute lower respiratory infections. As part of the feasibility study, quantitative assessments of indoor air pollution in non-electrified and electrified dwellings were performed. Concurrent measurements were made of levels of respirable particulate matter (RSP-stationary), and carbon monoxide (CO) (personal on children <18 months), as well as a stationary co-located with RSP) over a 24-h period in 52 un-electrified and 53 electrified dwellings. The proportion of dwellings with a detectable 24-h concentration of RSP was significantly higher in un-electrified (48.1%) than electrified dwellings (24.5%) (chi(2) = 6.30 on 1 d.f., P = 0.012). In addition a Kruskal-Wallis test (adjusted for ties) showed that the distribution of RSP differed between un-electrified and electrified areas (Kruskal-Wallis chi(2) = 8.20 on 1 d.f., P = 0.014). In those dwellings where some RSP was detected, the amount was on average higher in the un-electrified areas (mean 162 microg/m(3), median 107 microg/m(3)) than in the electrified areas (mean 77 microg/m(3), median 37.5 microg/m(3)). Stationary (kitchen CO) levels in un-electrified dwellings ranged from 0.36 to 20.95 p.p.m. However, in electrified dwellings, kitchen levels ranged from 0 to 11.8 p.p.m. When mean concentrations of CO were compared between electrified and un-electrified dwellings using a two-sample t-test (on log-transformed data), there was overwhelming evidence (P = 0.0004) that the mean level of log (CO) in the kitchen was higher in the un-electrified areas (1.25 vs. 0.69) and also overwhelming evidence (P < 0.0001) that the mean level of log (CO) on the child was higher in the un-electrified areas (0.83 vs. 0.34). Of importance in terms of both policy and for a potential future large-scale study, is that measurable significant differences in indoor pollutants between electrified and un-electrified dwellings during summer were found in spite of only partial transition to electricity use for cooking in electrified villages. PRACTICAL IMPLICATIONS: It is estimated that at least two-thirds of all households in the developing world are still primary dependent on biomass fuels and coal. This situation applies to 59% of rural households in South Africa. In the last decade a program of providing electricity to three million homes has been underway in South Africa. Among others this intervention aims to reduce exposure to pollutants from burning biomass fuels and reduce detrimental health effects, especially in young children. This study provides scientific evidence that electrified homes in South African villages have lower levels of air pollution (RSP and CO) relative to their non-electrified counterparts.