Impact of an educational intervention on water, sanitation and hygiene knowledge, attitudes, and practices in early childhood development centres in low-socio-economic areas in the Nelson Mandela Bay, South Africa.

Good water, sanitation, and hygiene (WASH) enhance healthy living and safe environments for child development. The study aimed to evaluate the impact of an educational intervention on WASH status, knowledge, attitudes and practices in early child development (ECD) centres in low socio-economic areas in the Nelson Mandela Bay in 2021. This quasi-experimental, one group, pre-post-test study elicited responses from 51 ECD practitioners (1 per ECD centre). Telephonic structured knowledge, attitude and practices (KAP) questionnaires were used. KAP was good among participants. The educational intervention significantly improved mean knowledge (p<0.001, 95% CI: 0.58-1.11) attitudes (p<0.001, 95% CI: 0.39-0.67) and practices (p = 0.001, 95% CI: 0.20-0.74). WASH knowledge was significantly impacted by toilet facilities ventilation status (p = 0.083) while WASH attitudes scores were significantly impacted by ventilation where the potties are kept (p = 0.041). WASH practice scores were significantly impacted by across the bush/field (no facility) (p = 0.021) and plastic potties usage (p = 0.057). The educational intervention significantly improved WASH-related knowledge, attitudes, and practices among ECD practitioners. WASH conditions in the ECD centres in the study area require additional interventions targeted to sustainable strategies to enhance behavioural modifications for acceptability and sustainability of intervention strategies.

Dwelling Characteristics Influence Indoor Temperature and May Pose Health Threats in LMICs.

Background: Shelter and safe housing is a basic human need that brings about a sense of ownership, self-sufficiency, and citizenship. Millions of people around the world live in inadequate dwellings in unhealthy areas, such as urban slums. These dwellings may experience indoor temperatures that impact inhabitants' health. Indoor dwelling temperatures vary depending on many factors including geographic location, such as inland versus coastal. In an era of climate change, understanding how dwelling characteristics influence indoor temperature is important, especially in low- and middle-income countries, to protect health. Objective: To assess indoor temperature in low-cost dwellings located in a coastal setting in relation to dwelling characteristics. Methods: Indoor temperature and relative humidity loggers were installed from 1 June 2017 to 15 May 2018 in 50 dwellings in two settlements in a coastal town on the east coast of South Africa. Ambient outdoor temperature data were obtained from the national weather service, indoor temperature data were converted into apparent temperature, and heat index calculations were made to consider possible heat-health risks. A household questionnaire and dwelling observation assessment were administered. A mixed-effects linear regression model was constructed to consider the impact of dwelling characteristics on indoor apparent temperature. Findings: Among 17 dwellings with all data sets, indoor temperatures were consistently higher than, and well correlated (r = 0.92) with outdoor temperatures. Average differences in indoor and outdoor temperatures were about 4°C, with statistically significant differences in percentage difference of indoor/outdoor between seasons (p < 0.001). Heat indices for indoor temperatures were exceeded mostly in summer, thereby posing possible health risks. Dwellings with cement floors were statistically significantly cooler than any other floor type across all seasons. Conclusions: Low-cost dwellings experienced temperatures indoors higher than outdoor temperatures in part due to floor type. These results help inform interventions that consider housing and human health (n = 289).

Indoor Temperatures in Low Cost Housing in Johannesburg, South Africa.

Ambient and indoor temperature affects thermal comfort and human health. In a changing climate with a predicted change in temperature extremes, understanding indoor temperatures, both hot and cold, of different housing types is important. This study aimed to assess the hourly, daily and monthly variation in indoor temperatures in different housing types, namely formal houses, informal houses, flats, government-built low-cost houses and old, apartheid era low-cost housing, in five impoverished urban communities in Johannesburg, South Africa. During the cross-sectional survey of the Health, Environment and Development study data loggers were installed in 100 homes (20 per suburb) from February to May 2014. Indoor temperature and relative humidity were recorded on an hourly basis. Ambient outdoor temperatures were obtained from the nearest weather station. Indoor and outdoor temperature and relative humidity levels were compared; and an inter-comparison between the different housing types were also made. Apparent temperature was calculated to assess indoor thermal comfort. Data from 59 retrieved loggers showed a significant difference in monthly mean indoor temperature between the five different housing types (p < 0.0001). Low cost government-built houses and informal settlement houses had the greatest variation in temperature and experienced temperatures between 4 and 5 °C warmer than outdoor temperatures. Housing types occupied by poor communities experienced indoor temperature fluctuations often greater than that observed for ambient temperatures. Families living in government-built low-cost and informally-constructed homes are the most at risk for indoor temperature extremes. These types of housing should be prioritised for interventions aimed at assisting families to cope with extreme temperatures, gaining optimal thermal comfort and preventing temperature-related health effects.

Retrospective Investigation of a Lead Poisoning Outbreak from the Consumption of an Ayurvedic Medicine: Durban, South Africa.

Ayurvedic medicines have been gaining in popularity around the world in recent decades, but have also been associated with lead contamination and poisoning. In 2012 in Durban, South Africa, a lead poisoning outbreak among adolescents was associated with the consumption of an Ayurvedic medicine for the treatment of skin conditions. In 2014 eight individuals (out of 12 affected) were traced and interviewed. Questionnaires were administered; blood samples were taken for lead content analysis; and medical records were reviewed. Samples of the implicated medicines were analyzed to determine lead levels. Blood lead levels during the acute phase ranged from 34 to 116 µg/dL; and during the current study (two years later) from 13 to 34 µg/dL. The implicated lead capsules had a lead content of 125,235 µg/g. Participants suffered a wide range of non-specific ill health symptoms; and there was a significant delay in the diagnosis of lead poisoning. This study highlights the potential for lead poisoning outbreaks from the consumption of Ayurvedic medicines in African settings. There were weaknesses with regard to the diagnosis of and response to the outbreak, for which measures need to be put in place to ensure greater awareness of the role of Ayurvedic medicine in lead poisoning, and prompt diagnosis and treatment of future cases.

The extent, nature and environmental health implications of cottage industries in Johannesburg, South Africa.

Cottage industries comprise a sub-group of informal sector income generation activities which are conducted in the home environment and organized around families or households. Cottage industry workers may be at risk of exposure to harmful substances associated with their work, and given the lack of separation of cottage industry activities from living spaces, their families and neighbors may similarly be at risk of exposure. This study was undertaken to determine the extent and nature of cottage industries in five neighborhoods in Johannesburg (South Africa) A cross-sectional survey was conducted across five communities in Johannesburg in 2012. Data on metal-related cottage industry activities were collected through the administration of a pre-structured questionnaire. Metal-related cottage industry activities were defined as car repairs, spray painting, scrap metal recycling, electrical appliance repairs, welding, hairdressing and metal jewelry making. One fifth of the households interviewed were operating one or more cottage industries associated with the use of toxic substances. Therefore, the potential exists for associated ill health effects in a considerable proportion of the population. Further research is needed to fully assess exposure to the harmful aspects of cottage industry, as are scaled up campaigns to increase awareness of the risks and correct handling of toxic substances.

A Macroporous Bioreactor Super Activated by the Recombinant Human Transforming Growth Factor-ß(3).

Macroporous single phase hydroxyapatite (HA) and biphasic HA/ß-tricalcium phosphate with 33% post-sinter hydroxyapatite (HA/ß-TCP) were combined with 25 or 125 µg recombinant human transforming growth factor-ß3 (hTGF-ß(3)) to engineer a super activated bioreactor implanted in orthotopic calvarial and heterotopic rectus abdominis muscle sites and harvested on day 30 and 90. Coral-derived calcium carbonate fully converted (100%) and partially converted to 5 and 13% hydroxyapatite/calcium carbonate (5 and 13% HA/CC) pre-loaded with 125 and 250 µg hTGF-ß(3), and 1:5 and 5:1 binary applications of hTGF-ß(3): hOP-1 by weight, were implanted in the rectus abdominis and harvested on day 20 and 30, respectively, to monitor spatial/temporal morphogenesis by high doses of hTGF-ß(3). Bone formation was assessed on decalcified paraffin-embedded sections by measuring the fractional volume of newly formed bone. On day 30 and 90, single phase HA implants showed greater amounts of bone when compared to biphasic specimens; 5 and 13% HA/CC pre-loaded with 125 and 250 µg hTGF-ß(3) showed substantial induction of bone formation; 250 µg hTGF-ß(3) induced as yet unreported massive induction of bone formation as early as 20 days prominently outside the profile of the macroporous constructs. The induction of bone formation is controlled by the implanted ratio of the recombinant morphogens, i.e., the 1:5 hTGF-ß(3):hOP-1 ratio by weight was greater than the inverse ratio. The unprecedented tissue induction by single doses of 250 µg hTGF-ß(3) resulting in rapid bone morphogenesis of vast mineralized ossicles with multiple trabeculations surfaced by contiguous secreting osteoblasts is the novel molecular and morphological frontier for the induction of bone formation in clinical contexts.

Transforming growth factor-beta isoforms and the induction of bone formation: implications for reconstructive craniofacial surgery.

Craniofacial skeletal reconstruction remains a challenging problem despite major molecular and surgical developments in the understanding of bone formation by induction. The induction of bone formation has been a critical topic of research across the planet. The bone induction principle identified important cues for tissue engineering of bone, namely, osteogenic soluble molecular signals, the bone morphogenetic and osteogenic proteins, and insoluble signals or substrata including biomimetic bioactive matrices and responding stem cells. In primates, and in primates only, the osteogenic soluble molecular signals that initiate the induction of bone formation additionally include the 3 mammalian transforming growth factor-beta (TGF-beta) isoforms, members of the TGF-beta supergene family. The mammalian TGF-beta isoforms, when implanted in the rectus abdominis muscle of the nonhuman primate Papio ursinus, induce rapid and substantial endochondral bone formation resulting in large corticalized ossicles by day 30 after heterotopic implantation; in calvarial defects of the same nonhuman primates, identical or higher doses of the TGF-beta protein do not induce bone formation because of the overexpression of Smad-6 and Smad-7, gene product inhibitors of the TGF-beta signaling pathway. The addition of minced fragments of autogenous rectus abdominis muscle partially restores the osteoinductive activity of the human TGF-beta3 isoform resulting in the induction of bone formation in the treated calvarial defects. Recombinant human TGF-beta3 delivered by Matrigel matrix and implanted in class II and III furcation defects of mandibular molars of P. ursinus induce periodontal tissue regeneration. The addition of minced fragments of autogenous rectus abdominis muscle significantly enhances cementogenesis. This review highlights the induction of bone formation by the osteogenic proteins of the TGF-beta superfamily in the nonhuman primate P. ursinus and reviews combinatorial applications of myoblastic/myogenic stem cell-based therapeutics for bone induction and morphogenesis. The recruitment of myoendothelial cells is also discussed in the light of the intrinsic and spontaneous induction of bone formation by smart biomaterial matrices that induce bone differentiation in heterotopic extraskeletal sites of P. ursinus without the exogenous application of the osteogenic soluble molecular signals of the TGF-beta superfamily.

The induction of endochondral bone formation by transforming growth factor-beta(3): experimental studies in the non-human primate Papio ursinus.

Transforming growth factor-beta(3) (TGF-beta(3)), a multi-functional growth modulator of embryonic development, tissue repair and morphogenesis, immunoregulation, fibrosis, angiogenesis and carcinogenesis, is the third mammalian isoform of the TGF-beta subfamily of proteins. The pleiotropism of the signalling proteins of the TGF-beta superfamily, including the TGF-beta proteins per se, are highlighted by the apparent redundancy of soluble molecular signals initiating de novo endochondral bone induction in the primate only. In the heterotopic bioassay for bone induction in the subcutaneous site of rodents, the TGF-beta(3) isoform does not initiate endochondral bone formation. Strikingly and in marked contrast to the rodent bioassay, recombinant human (h)TGF-beta(3), when implanted in the rectus abdominis muscle of adult non-human primates Papio ursinus at doses of 5, 25 and 125 mug per 100 mg of insoluble collagenous matrix as carrier, induces rapid endochondral bone formation resulting in large corticalized ossicles by day 30 and 90. In the same animals, the delivery of identical or higher doses of theTGF-beta(3) protein results in minimal repair of calvarial defects on day 30 with limited bone regeneration across the pericranial aspect of the defects on day 90. Partial restoration of the bone induction cascade by the hTGF-beta(3) protein is obtained by mixing the hTGF-beta(3) device with minced fragments of autogenous rectus abdominis muscle thus adding responding stem cells for further bone induction by the hTGF-beta(3) protein. The observed limited bone induction in hTGF-beta(3)/treated and untreated calvarial defects in Papio ursinus and therefore by extension to Homo sapiens, is due to the influence of Smad-6 and Smad-7 down-stream antagonists of the TGF-beta signalling pathway. RT-PCR, Western and Northern blot analyses of tissue specimens generated by the TGF-beta(3) isoform demonstrate robust expression of Smad-6 and Smad-7 in orthotopic calvarial sites with limited expression in heterotopic rectus abdominis sites. Smad-6 and -7 overexpression in hTGF-beta(3)/treated and untreated calvarial defects may be due to the vascular endothelial tissue of the arachnoids expressing signalling proteins modulating the expression of the inhibitory Smads in pre-osteoblastic and osteoblastic calvarial cell lines controlling the induction of bone in the primate calvarium.

Pleiotropism of bone morphogenetic proteins: from bone induction to cementogenesis and periodontal ligament regeneration.

Bone morphogenetic and osteogenic proteins (BMPs/OPs), pleiotropic members of the transforming growth factor-beta (TGF-beta) supergene family, induce de novo endochondral bone formation and act as soluble signals of tissue morphogenesis, sculpting the architecture of multicellular mineralized structures, including the periodontal tissues. The presence of multiple forms of BMPs/OPs has a therapeutic significance and the choice of a suitable protein will be a formidable challenge to the practising periodontologist. Amino acid sequence variations in the carboxy terminal domain, the molecular basis of the structure/activity profile of each isoform, confer specialized and pleiotropic activities to each morphogenetic protein. Naturally derived BMPs/OPs regenerate cementum and alveolar bone in mandibular furcation defects of the primate Papio ursinus. Tissue morphogenesis induced by hOP-1 and hBMP-2 is qualitatively different when the morphogens are applied singly, indicating that the structure/activity profile amongst BMPs/OPs is controlling pleiotropic tissue induction and morphogenesis. Furcation defects of Papio ursinus with root surfaces exposed long-term to periodontal pathogens and filled with granulation tissue after inoculation of a pathogenetic human strain of Porphyromonas gingivalis twice a month for 12 months were implanted with hOP-1 osteogenic devices. Six months after surgery there was regeneration of alveolar bone and induction of cementogenesis, with Sharpey's fibres uniting the regenerated bone to the newly formed cementum. Although within the natural milieu of the bone matrix a plurality of morphogens may be required to initiate the cascade of pattern formation and the attainment of tissue form and function, recombinant y-irradiated hOP-1 delivered by a xenogeneic collagenous matrix induces complete periodontal tissue regeneration on periodontally affected root surfaces, showing an additional specific function of hOP-1 for tissue morphogenesis in clinical contexts. The pleiotropy of the signalling molecules of the TGF-beta superfamily is additionally highlighted by the redundancy of molecular signals initiating endochondral bone induction by the TGF-beta isoforms per se, powerful inducers of endochondral bone, but in the primate only. A novel approach in periodontal tissue regeneration is to induce heterotopic bone to be transplanted as morcellised autogenous grafts into established periodontal defects. The induction of bone develops a mosaic structure in which the osteogenic proteins of the TGF-beta superfamily singly, synergistically and synchronously initiate and maintain tissue induction and morphogenesis, with specific roles at different time points of the morphogenetic cascade.

Tissue engineering: TGF-beta superfamily members and delivery systems in bone regeneration.

The induction of bone formation requires three parameters that interact in a highly regulated process: soluble osteoinductive signals, capable responding cells, and a supporting matrix substratum or insoluble signal. The use of recombinant and naturally derived bone morphogenetic proteins and transforming growth factor beta(s) (TGF-beta(s)) has increased our understanding of the functions of these morphogens during the induction of endochondral bone formation. In addition, growing understanding of the cellular interactions of living tissues with synthetic biomaterials has led to the in vivo induction of bone formation using porous biomimetic matrices as an alternative to the use of autografts for bone regeneration. This review outlines the basis of bone tissue engineering by members of the TGF-beta superfamily, focusing on their delivery systems and the intrinsic induction of bone formation by specific biomimetic matrices with a defined geometry.