Job satisfaction among rehabilitation professionals employed in public health facilities in KwaZulu-Natal.

Background: Job satisfaction is essential in stimulating productivity and efficiency in the health sector. Dissatisfied employees are likely to leave, which places an added burden considering the shortage of health workers. Rehabilitation professionals form a critical component of the public health workforce. Objective: The aim of the study was to document the level of job satisfaction and factors associated with job satisfaction among rehabilitation professionals employed in public health facilities in KwaZulu-Natal. Methods: A cross-sectional survey was conducted. A self-administered questionnaire was utilized. A Chi-square test and logistic regression were used to assess associations and to identify factors associated with job satisfaction. A p-value less than 0.05 was deemed statistically significant. Results: Most participants (59%) reported a low level of overall job satisfaction. The participants were dissatisfied about not getting recognition for work related to their specific professions (61.3 %) and not being considered for career advancement (74.3 %). In addition, inadequate financial rewards (87.2%) and benefits (71.3%) were also linked to low job satisfaction. Conclusion: Participants displayed a low level of job satisfaction. Rehabilitation services should be prioritized, and appropriate recognition should be granted to rehabilitation professionals in order to enhance job satisfaction.

Legacy and novel brominated flame-retardants in different fish types from inland freshwaters of South Africa: levels, distribution and implications for human health.

This study report the presence of polybrominated biphenyls (PBBs), polybrominated diphenyl ethers (PBDEs) and novel brominated flame-retardants (NBFRs) in muscle tissues of Labeo capensis (mudfish), Labeo umbratus (moggel), Cyprinus carpio (carp) and Clarias gariepinus (catfish) from Vaal River, South Africa. The concentrations (in ng g-1 wet weight (ww)) of these contaminants ranged from LOQ to 12.8 ng g-1 ww in catfish, with lowest concentrations found for mudfish ranging from

Concentrations and human exposure assessment of per and polyfluoroalkyl substances in farmed marine shellfish in South Africa.

Although the consumption of seafood is a major route of human exposure to perfluoroalkyl substances (PFAS), data on their concentrations in marine shellfish and the exposure of the African population to PFAS through the consumption of shellfish is lacking. In this study, the concentrations of 15 PFAS were measured in four species of farmed marine shellfish by using a validated UHPLC-MS/MS method. These concentrations were used to determine the human daily intake of PFAS through the consumption of marine shellfish and the hazard quotient thereof. PFPeA, PFOS, PFHxA and PFTeDA were the most prevalent compounds with detection frequencies of 94, 88, 76 and 71%, respectively. The Σ11PFAS concentrations (in ng g-1 wet weight (ww)) ranged from 0.12 to 0.49, 4.83-6.43, 0.64-0.66 and 0.22 ng g-1 ww in abalone, mussel, oyster and lobster, respectively. The prevalence of PFCAs reflects the current contamination profile of PFAS in farmed shellfish. The estimated daily intake for Σ10 PFAS through the consumption of marine shellfish ranged from 0.05 to 1.58 ng kg-1 bw d-1. Overall, the hazard quotients for these compounds were low, indicating that these compounds do not pose a health risk to the South African population through shellfish consumption. This study provides background data for future studies on the occurrence of PFAS and other emerging contaminants in the African coastal environment.

Obstructive jaundice: Studies on predictors of biliary infection and microbiological analysis in an HIV setting.

BACKGROUND: Early diagnosis of biliary infection is critical for timely antimicrobial therapy and biliary drainage. HIV infection may influence the spectrum and severity of biliary infection in an environment with a high HIV prevalence. Charcot's triad has low sensitivity and higher specificity for biliary infection, and more sensitive markers are required. OBJECTIVES: To investigate possible predictors of biliary infection (bacteriobilia) and identify the microbiological spectrum in patients presenting with biliary obstruction to a tertiary institute in an environment with a high prevalence of HIV. METHODS: Bile was assessed for infection at endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and surgery, and the roles of clinical/haematological factors, C-reactive protein (CRP) and procalcitonin (PCT) in determining biliary infection were evaluated. RESULTS: One hundred and six patients with obstructive jaundice had a mean age of 52 years (range 21 - 58); most were female (74%), and 36 (34%) were infected with HIV, with a mean CD4 count of 495 cells/µL. Choledocholithiasis (53%), biliary strictures (21%) and head of pancreas tumour (8%) were the main aetiopathologies. Bile was obtained for microbial culture from 104 patients (98%), and 56 (54%) were infected. Gram-negative bacteria were most frequent (58%), and 2 HIV-infected patients had fungal infections (Candida albicans and Aspergillus fumigatus). Screening for endoscopy-associated infections revealed Pseudomonas aeruginosa. PCT was a poor predictor of bacterial infection, whereas CRP was a fair predictor. CONCLUSIONS: The majority of bacteria cultured were sensitive to ciprofloxacin or amoxicillin-clavulanate. Duodenoscopes were a potential source of Pseudomonas infection.

Levels, distributions, and ecological risk assessments of polybrominated diphenyl ethers and alternative flame retardants in river sediments from Vaal River, South Africa.

Sediments are known to be the ultimate sink for most pollutants in the aquatic environment. In this study, the concentrations of both legacy polybrominated diphenyl ethers (PBDEs) and alternative halogenated flame retardants (AHFRs) were measured in sediments samples from the Vaal River catchment. The concentrations of Σ7BDE-congeners ranged from 20 to 78 ng g-1 dry weight (dw) with BDE-209, -99, and -153 as the dominant congeners. The concentrations observed ranged from 9.4-56, 4-32, and 1-10.6 ng g-1 for BDE-209, -99, and -153, respectively. The concentrations of AHFRs, mainly contributed by decabromodiphenyl ethane (DBDPE) at approximately 95% of total AHFRs, ranged from 64 to 359 ng g-1 dw while the concentration of polybrominated biphenyls (PBBs), mainly PBB-209, ranged from 3.3-7.1 ng g-1 dw. The ratios of AHFRs to PBDEs observed in this study were 0.76, 1.17, and 7.3 for 2-ethyl-1-hexyl-2,3,4,5-tetrabromobenzoate and bis-(2-ethylhexyl)-tetrabromophthalate (EH-TBB & BEH-TEBP)/penta-BDE; 1,2-bis-(2,4,6-tribromophenoxy) ethane (BTBPE)/octa-BDE; and DBDPE/BDE209, respectively. These results indicate dominance of some AHFRs compared to PBDEs. Our results indicates that BDE-99 poses high risk (RQ > 1) while BDE-209 posed medium risk (0.1 < RQ < 1). Though the concentration of DBDPE was several orders of magnitude higher than BDE209, its ecological risk was found to be negligible (RQ < 0.01). Thus, more attention is required to regulate the input (especially the e-waste recycling sites) of brominated flame retardants into the environment.

Investigating risk factors for under-five mortality in an HIV hyper-endemic area of rural South Africa, from 2000-2014.

INTRODUCTION: Despite global progress, there remains a disproportionate burden of under-five year old deaths in sub-Saharan Africa (SSA), where four out of five child deaths occur. Substantial progress has been made in improving sanitation, controlling communicable diseases and the spread of HIV in most parts of the world. However, significant strides to address some key risk factors related to under-five mortality are still needed in rural SSA if they are to attain relevant 2030 SDG targets. The aim of this study is to investigate the risk factors for under-five mortality in an HIV hyper-endemic area of rural South Africa, from 2000-2014. Some of the key risk factors investigated are, for example: household wealth, source of drinking water, distance to the national road and birth order. METHODS: We conducted a statistical analysis of 759 births from a population-based cohort in rural KwaZulu-Natal Province, South Africa, from 2000 to 2014. A Cox Proportional Hazards model was used to identify the risk factors and key socio-demographic correlates of under-five mortality leveraging the longitudinal structure of the population cohort. RESULTS: Child mortality rates declined by 80 per cent from 2000 to 2014, from >140 per 1,000 persons in years 2001-2003 to 20 per 1,000 persons in the year 2014. The highest under-five mortality rate was recorded in 2002/2003, which decreased following the start of antiretroviral therapy rollout in 2003/4. The results indicated that under-five and infant mortality are significantly associated with a low wealth index of 1.49 (1.007-2.48) for under-fives and 3.03 (1.72-5.34) for infants. Children and infants with a lower wealth index had a significantly increased risk of mortality as compared to those with a high wealth index. Other significant factors included: source of household drinking water (borehole) 3.03 (1.72-5.34) for under-fives and 2.98 (1.62-5.49) for infants; having an HIV positive mother 4.22 (2.68-6.65) for under-fives and 3.26 (1.93-5.51) for infants, and period of death 9.13 (5.70-14.6) for under-fives and 1.28 (0.75-2.20) for infants. Wealth index had the largest population attributable fraction of 25.4 per cent. CONCLUSIONS: The research findings show a substantial overall reduction in under-five mortality since 2003. Unsafe household water sources and having an HIV-positive mother were associated with an increased risk of under-five mortality in this rural setting. The significant risk factors identified align well with the SDG 2030 targets for reducing child mortality, which include improved nutrition, sanitation, hygiene and reduced HIV infections. Current trajectories suggest that there is some hope for meeting the 2030 SGD targets in rural South Africa and the region if the identified significant risk factors are adequately addressed.

Underlying determinants of maternal mortality in a rural South African population with high HIV prevalence (2000-2014): A population-based cohort analysis.

INTRODUCTION: Maternal mortality is one of the significant health indicators of any country and it's a frequent subject in many global heath discussions. Even though the global trends have shown a decrease on maternal mortality, many countries in sub-Saharan Africa failed to achieve the MDG 5 target in 2015.There is no specific single solution for reducing maternal mortality but there is unanimity that a reliable health system with skilled personal is vital for addressing maternal mortality. This study therefore seeks to identify the risk factors for maternal mortality in typical rural sub-Saharan African countries. METHOD: A longitudinal population based cohort study was conducted using data from 2000-2014 in Africa Health Research Institute (AHRI).The Cox regression method was used to assess the influence of selected risk factors using the Mosley-Chen model on maternal mortality. A total of 20701 women aged 15-49 years were included in the study. RESULTS: The study found 212 maternal deaths from 32,620 live births with a maternal mortality ratio (MMR) of 650 per 100,000 live births. The main causes of death were Communicable diseases (38.2%), Aids and TB (31%) and Unknown causes (11.8%). An increased risk of death was identified on, poor wealth index (HR 3.92[1.01, 15.3]), period of death 2000-2006(HR32.1 [3.79, 71.5]) and number of deliveries (6.76[2.70, 16.9]) were associated with a high risk of maternal mortality after adjusting for other independent variables included in the study. CONCLUSION: Socio-economic status, number of deliveries and period of death were found to be associated with maternal death in rural South Africa.

The usefulness of routine histological examination of appendicectomy specimens in a South African tertiary centre.

BACKGROUND: It is accepted surgical practice to send all appendicectomy specimens for histological examination, but the usefulness and cost associated with this practice have not been established in our setting, a tertiary hospital in KwaZulu-Natal Province, South Africa (SA). OBJECTIVES: To determine the histological diagnoses of appendicectomy specimens in our centre, and the cost of identifying an alternative histological diagnosis requiring further treatment. METHODS: Clinical data on patients undergoing appendicectomy for suspected acute appendicitis during the study period December 2012 - August 2015 were retrospectively retrieved from the hybrid electronic medical registry. Histological data were then extracted from the National Health Laboratory Service database. The cost of an appendicitis histology report was sourced from a private laboratory service. RESULTS: A total of 290 patients were identified during the study period. Males had a significantly higher risk (p<0.0001) than females of histologically confirmed appendicitis (odds ratio 3.2, 95% confidence interval 1.7 - 5.8). The negative appendicectomy rate was 22.4% (65/290). In 5.9% of specimens (17/290) an alternative diagnosis was made on histological examination, which influenced the management plan. These were parasitic co-infections in 13 cases (4.5%), premalignant conditions in 2 and tuberculosis in 2. The average cost of processing each appendicectomy specimen was ZAR871. The cost of identifying each patient with an alternative diagnosis that required treatment was ZAR14 858 ([290 × ZAR871]/17). CONCLUSIONS: This audit correlates with other SA studies showing that the aetiological differential for appendicitis is broad. Histological examination therefore remains critical in the management of patients with suspected acute appendicitis in our clinical setting.

Space-time patterns in maternal and mother mortality in a rural South African population with high HIV prevalence (2000-2014): results from a population-based cohort.

BACKGROUND: International organs such as, the African Union and the South African Government view maternal health as a dominant health prerogative. Even though most countries are making progress, maternal mortality in South Africa (SA) significantly increased between 1990 and 2015, and prevented the country from achieving Millennium Development Goal 5. Elucidating the space-time patterns and risk factors of maternal mortality in a rural South African population could help target limited resources and policy guidelines to high-risk areas for the greatest impact, as more generalized interventions are costly and often less effective. METHODS: Population-based mortality data from 2000 to 2014 for women aged 15-49 years from the Africa Centre Demographic Information System located in the Umkhanyakude district of KwaZulu-Natal Province, South Africa were analysed. Our outcome was classified into two definitions: Maternal mortality; the death of a woman while pregnant or within 42 days of cessation of pregnancy, regardless of the duration and site of the pregnancy, from any cause related to or exacerbated by the pregnancy or its management but not from unexpected or incidental causes; and 'Mother death'; death of a mother whilst child is less than 5 years of age. Both the Kulldorff and Tango spatial scan statistics for regular and irregular shaped cluster detection respectively were used to identify clusters of maternal mortality events in both space and time. RESULTS: The overall maternal mortality ratio was 650 per 100,000 live births, and 1204 mothers died while their child was less than or equal to 5 years of age, of a mortality rate of 370 per 100,000 children. Maternal mortality declined over the study period from approximately 600 per 100,000 live births in 2000 to 400 per 100,000 live births in 2014. There was no strong evidence of spatial clustering for maternal mortality in this rural population. However, the study identified a significant spatial cluster of mother deaths in childhood (p = 0.022) in a peri-urban community near the national road. Based on our multivariable logistic regression model, HIV positive status (Adjusted odds ratio [aOR] = 2.5, CI 95%: [1.5-4.2]; primary education or less (aOR = 1.97, CI 95%: [1.04-3.74]) and parity (aOR = 1.42, CI 95%: [1.24-1.63]) were significant predictors of maternal mortality. CONCLUSIONS: There has been an overall decrease in maternal and mother death between 2000 and 2014. The identification of a clear cluster of mother deaths shows the possibility of targeting intervention programs in vulnerable communities, as population-wide interventions may be ineffective and too costly to implement.

Spatial-temporal dynamics and structural determinants of child and maternal mortality in a rural, high HIV burdened South African population, 2000-2014: a study protocol.

INTRODUCTION: Child (infant and under-5) and maternal mortality rates are key indicators for assessing the health status of populations. South Africa's maternal and child mortality rates are high, and the country mirrors the continental trend of slow progress towards its Millennium Development Goals. Rural areas are often more affected regarding child and maternal mortalities, specifically in areas with a high HIV burden. This study aims to understand the factors affecting child and maternal mortality in the Africa Centre Demographic Surveillance Area (DSA) from 2003 to 2014 towards developing tailored interventions to reduce the deaths in resource poor settings. This will be done by identifying child and maternal mortality 'hotspots' and their associated risk factors. METHODS AND ANALYSIS: This retrospective study will use data for 2003-2014 from the Africa Centre Demographic Information System (ACDIS) in rural KwaZulu-Natal Province, South Africa. All homesteads in the study area have been mapped to an accuracy of <2 m, all deaths recorded and the assigned cause of death established using a verbal autopsy interview. Advanced spatial-temporal clustering techniques (both regular (Kulldorff) and irregular (FleXScan)) will be used to identify mortality 'hotspots'. Various advanced statistical modelling approaches will be tested and used to identify significant risk factors for child and maternal mortality. Differences in attributability and risk factors profiles in identified 'hotspots' will be assessed to enable tailored intervention guidance/development. This multicomponent study will enable a refined intervention model to be developed for typical rural populations with a high HIV burden. ETHICS: Ethical approval was received from the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu-Natal (BE 169/15).

Prevalence of Positive Coeliac Serology in a Cohort of South African Children with Type 1 Diabetes Mellitus

Background. Coeliac disease (CD) is characterised by immune-mediated damage to the mucosa of the small intestine. Both CD and type 1 diabetes (T1D) have common auto-immune origins. Many patients with CD and T1D are asymptomatic or present with only mild symptoms; hence early diagnosis may only be facilitated by serological screening. Distal duodenal biopsy remains the gold standard for confirming the diagnosis. Objective. To describe the prevalence of CD in T1D patients presenting to the paediatric endocrine service at Inkosi Albert Luthuli Central hospital (IALCH) in Durban and document the relationship between positive coeliac serology and small-bowel biopsy results.Methods. A retrospective chart review was done at IALCH; the paediatric tertiary referral centre for KwaZulu-Natal (KZN) Province. The study sample included all patients with newly diagnosed T1D diagnosed between January 2008 and December 2011.Results. A total of 120 newly diagnosed T1D patients were included in the study; of whom 49 (40.8%) were coeliac serology positive and 61 (50.8%) serology negative. There was no significant difference between the two groups regarding mean age of presentation with diabetes; race; sex; urban v. rural origin and baseline anthropometric measurements. Of patients in the serology-positive group; 97.6% had no symptoms suggestive of CD. Of the 49 patients who were coeliac serology positive; 8 (16%) were biopsied: 3 (37.5%) were positive; 1 (12.5%) had intra-epithelial lymphocytes and 4 (50%) were negative. There was a strong positive correlation between biopsy results and titres of endomysial antibody results (p=0.047). Conclusion. There is a high prevalence of coeliac serology positivity in newly diagnosed T1D patients in KZN. This study provides evidence for screening of children with T1D for CD; and also confirms the low prevalence of symptoms

Optimization and Simultaneous Determination of Alkyl Phenol Ethoxylates and Brominated Flame Retardants in Water after SPE and Heptafluorobutyric Anhydride Derivatization followed by GC/MS.

A gas chromatography-mass spectrometry (GC-MS) method was investigated for the simultaneous analysis of two types of endocrine disrupting compounds (EDCs), i.e., alkylphenol ethoxylates and brominated flame retardants (BFRs), by extraction and derivatization followed by GC-MS. Different solid phase extraction (SPE) cartridges (Cleanert PestiCarb, C18, Cleanert-SAX and Florosil), solvents (toluene, tetrahydrofuran, acetone, acetonitrile and ethyl acetate) and bases (NaHCO3, triethylamine and pyridine) were tested and the best chromatographic analysis was achieved by extraction with Strata-X (33 µm, Reverse Phase) cartridge and derivatization with heptafluorobutyric anhydride at 55 °C under Na2CO3 base in hexane. It was observed that APE together with lower substituted PBBs (PBB1, PBB10, PBB18 and PBB49), HBCD and TBBPA can be determined simultaneously under the same GC conditions. This simple and reliable analytical method was applied to determining trace amounts of these compounds from wastewater treatment plant samples. The recoveries of the target compounds from simulated water were above 60 %. The limit of detection ranged from 0.01 to 0.15 µg L-1 and the limit of quantification ranged from 0.05 to 0.66 µg L-1. There were no appreciable differences between filtered and unfiltered wastewater samples from Leeuwkil treatment plant although concentration of target analytes in filtered influent was slightly lower than the concentration of target analytes in unfiltered influent water. The concentrations of the target compounds from the wastewater treatment were determined from LOQ upwards.